1 00:00:04,239 --> 00:00:07,680 Nathalie Dowgray: Hello, welcome to the September episode of Chattering with ISFM. 2 00:00:08,310 --> 00:00:12,020 I'm Nathalie Dowgray, Head of ISFM and host of this month's podcast. 3 00:00:12,790 --> 00:00:16,739 This month I'm speaking with Dr Hugo Swanstein on his clinical spotlight 4 00:00:16,739 --> 00:00:21,629 article, Feline Friendly POCUS, How to implement it into your daily practice. 5 00:00:22,865 --> 00:00:26,215 But first up, we have the second part of the discussion on feline chemical 6 00:00:26,215 --> 00:00:31,584 communication with iCatCare's own Sarah Ellis speaking with Daniel Mills. 7 00:00:37,734 --> 00:00:40,135 Sarah Ellis: Daniel, as well as different pheromones and different 8 00:00:40,144 --> 00:00:44,979 synthetic pheromones, we've also got different ways of them being given 9 00:00:44,979 --> 00:00:46,327 or distributed or preparation and I feel it's constantly changing. 10 00:00:46,327 --> 00:00:48,079 Is there one method that's better than the other or are these all 11 00:00:48,079 --> 00:00:48,618 different tools for different 12 00:00:52,388 --> 00:00:53,448 situations? 13 00:00:53,848 --> 00:00:56,150 Daniel Mills: I think they're largely tools for different 14 00:00:56,150 --> 00:00:57,790 situations, what's convenient. 15 00:00:58,260 --> 00:01:03,010 So yes, you've got the plug in diffusers, you've got the sprays, etc. 16 00:01:03,040 --> 00:01:06,869 People are starting to now develop impregnated gels, which means you don't 17 00:01:06,870 --> 00:01:10,319 have to worry about an electricity source, but it allows you to produce the pheromone 18 00:01:10,319 --> 00:01:13,660 over an extended period of time, bit like the old fashioned gel air freshener. 19 00:01:13,680 --> 00:01:15,190 And that can be useful. 20 00:01:15,780 --> 00:01:19,780 I think if you're talking about cats and things like urine marking, then it's 21 00:01:19,829 --> 00:01:24,769 always important to clear up the urine in an effective way, either a commercial 22 00:01:24,859 --> 00:01:29,759 cleaner that has enzymes in it, or I still swear by using biological washing powder. 23 00:01:30,309 --> 00:01:33,880 Rinse it, followed by surgical spirit, lift off any fatty elements. 24 00:01:33,990 --> 00:01:35,600 I find that very effective. 25 00:01:35,600 --> 00:01:38,460 And if you've got wooden floors and the cat's done it on the carpet, 26 00:01:38,470 --> 00:01:42,359 then potentially if it's sprayed the wall and it's run down into the 27 00:01:42,359 --> 00:01:45,919 carpet, you may have to lift the carpet and scrub those areas as well. 28 00:01:45,969 --> 00:01:49,975 That's one thing you have to be careful of though, if you do use those sorts of 29 00:01:50,395 --> 00:01:54,484 enzymatic sprays is that if you apply a pheromone spray over it, the enzymes 30 00:01:54,484 --> 00:01:56,074 may be active and can break it down. 31 00:01:56,234 --> 00:01:58,425 So that's one of the reasons why sometimes people say, I 32 00:01:58,425 --> 00:01:59,675 tried the product, didn't work. 33 00:01:59,744 --> 00:02:03,604 So in those situations, the sprays are useful if you want to apply 34 00:02:03,604 --> 00:02:06,104 it tactically in particular areas. 35 00:02:06,354 --> 00:02:09,784 So we know that cats tend not to scratch, for example, where they face rub. 36 00:02:09,784 --> 00:02:15,054 So it can be useful, I think, using some of the sprays where the cats tend to 37 00:02:15,064 --> 00:02:18,445 be scratching, as long as you provide them with an outlet where to scratch. 38 00:02:18,734 --> 00:02:23,595 And I know that there has recently been a big clinical trial, which actually 39 00:02:23,595 --> 00:02:26,344 looked at the rate of scratching in cats. 40 00:02:26,364 --> 00:02:30,714 And the classic Feliway does seem to reduce that as does the Feliway Optimum. 41 00:02:31,064 --> 00:02:34,820 When I first got in to this, we really knew very little and we were 42 00:02:34,820 --> 00:02:40,030 starting to probe and it's a new treatment modality for vets and other 43 00:02:40,030 --> 00:02:41,860 people and to try and understand it. 44 00:02:41,860 --> 00:02:45,330 And while some people will just embrace it and misunderstand it, 45 00:02:45,390 --> 00:02:48,310 they'll think about aromatherapy, but it's not relevant to them. 46 00:02:48,540 --> 00:02:51,250 For vets, it was very difficult for them to get their head 47 00:02:51,270 --> 00:02:52,890 around that this wasn't a drug. 48 00:02:52,920 --> 00:02:54,100 What was it exactly? 49 00:02:54,150 --> 00:02:55,190 Was it just an odour? 50 00:02:55,560 --> 00:03:01,149 And I think in the first 10, 15 years, people were very skeptical 51 00:03:01,160 --> 00:03:02,560 because they didn't understand it. 52 00:03:03,079 --> 00:03:05,229 And were these products going to be successful? 53 00:03:05,249 --> 00:03:07,759 Clearly they are, they've been well adopted. 54 00:03:07,969 --> 00:03:12,819 And as long as people use them appropriately, they can be life changing 55 00:03:12,819 --> 00:03:14,390 for both the cat and for the owners. 56 00:03:14,739 --> 00:03:18,809 And now companies like Ceva are prepared to do those large RCTs. 57 00:03:19,589 --> 00:03:23,229 And that was one of the criticisms I think that was made by some of the skeptics 58 00:03:23,229 --> 00:03:25,609 early on was, well, these aren't big RCTs. 59 00:03:25,780 --> 00:03:29,630 You wouldn't invest in a large RCT unless you're confident in your product and your 60 00:03:29,640 --> 00:03:31,489 product has got a big enough market share. 61 00:03:32,160 --> 00:03:35,529 And that's easy for a drug, but when you're talking about completely new 62 00:03:35,529 --> 00:03:37,640 treatment modality, it takes time. 63 00:03:38,269 --> 00:03:42,920 These sorts of trials cost a lot of money and you don't invest in them until 64 00:03:43,160 --> 00:03:45,179 you've got all the available information. 65 00:03:45,179 --> 00:03:49,029 And over the years, we've accumulated through a number of small trials, but 66 00:03:49,029 --> 00:03:53,205 also some of the stuff that we've done outside of a clinical treatment setting 67 00:03:53,435 --> 00:03:56,995 to understand how these work and say, okay, these are the routes to go down. 68 00:03:57,005 --> 00:03:57,445 Sarah Ellis: Absolutely. 69 00:03:57,525 --> 00:04:01,954 I've read a lot of that research and seen it develop and expand in different areas. 70 00:04:01,954 --> 00:04:05,755 And it's been mostly focused on the pheromones that Ceva have produced, 71 00:04:05,755 --> 00:04:09,295 but, more recently, I've seen a huge uptake of other companies 72 00:04:09,315 --> 00:04:12,855 producing pheromone products or products labeled as pheromones. 73 00:04:12,855 --> 00:04:16,765 It suddenly just seems to have exploded and I think that could be quite 74 00:04:16,765 --> 00:04:21,314 difficult for not just caregivers but for veterinary clinicians as well to navigate. 75 00:04:21,375 --> 00:04:24,075 Are they all the same thing made by different companies or are we 76 00:04:24,075 --> 00:04:26,555 actually dealing with different pheromone compounds here? 77 00:04:27,025 --> 00:04:30,165 Daniel Mills: It's a really important point and I can reassure you if 78 00:04:30,205 --> 00:04:32,785 you struggle to keep up with it, I'm struggling to keep up with it. 79 00:04:32,795 --> 00:04:36,735 But the first thing I think to appreciate is this is an unregulated industry. 80 00:04:37,344 --> 00:04:40,724 So if you claim that your product does this and you can't evidence it, 81 00:04:40,724 --> 00:04:42,534 then potentially you can be done. 82 00:04:42,885 --> 00:04:46,405 But using a word like a pheromone, it doesn't seem to be something that 83 00:04:46,455 --> 00:04:48,465 advertising standards want to go after. 84 00:04:49,275 --> 00:04:53,315 So, the first thing I would say to people is, regardless of what it says 85 00:04:53,325 --> 00:04:56,664 on the bottle, whether or not it's pheromones, and as we've already said, 86 00:04:56,705 --> 00:05:01,094 pheromones are different to odour therapy, and there are chemicals that 87 00:05:01,104 --> 00:05:06,364 have all sorts of effects on us as well, but look at the ingredients. 88 00:05:06,830 --> 00:05:10,770 I did look at the newer products and one of them says that it's particularly 89 00:05:10,770 --> 00:05:12,730 good because it's a unique blend. 90 00:05:12,930 --> 00:05:14,820 And I'm thinking, what does that mean? 91 00:05:14,859 --> 00:05:18,950 A unique blend could actually have things that, rather than things that complement 92 00:05:18,950 --> 00:05:21,379 each other, when you put them together, they could antagonise each other. 93 00:05:21,995 --> 00:05:24,665 And I've already said that I've done a lot of work for Ceva and I 94 00:05:24,665 --> 00:05:27,805 should, for the sake of transparency, people need to be clear of that. 95 00:05:28,025 --> 00:05:29,145 But I am a traditionalist. 96 00:05:29,145 --> 00:05:31,675 I will stick with Ceva products because I know what's in them 97 00:05:31,734 --> 00:05:33,375 and I know that they're reliable. 98 00:05:33,755 --> 00:05:37,134 It's an important part of veterinary medicine that you don't just switch 99 00:05:37,154 --> 00:05:38,215 because there's a new product. 100 00:05:38,245 --> 00:05:40,655 A new product doesn't necessarily mean a new class and if it's 101 00:05:40,655 --> 00:05:42,055 just another manufacturer. 102 00:05:42,315 --> 00:05:46,405 The reason why there has been an explosion, I think is partly because 103 00:05:46,405 --> 00:05:50,950 Ceva have been very successful in producing very effective products. 104 00:05:50,950 --> 00:05:53,650 So people have jumped onto that bandwagon and there is some 105 00:05:53,650 --> 00:05:55,410 unscrupulous advertising there. 106 00:05:56,150 --> 00:06:00,410 And secondly, the Feliway formula is now out of patent. 107 00:06:00,420 --> 00:06:02,159 So other people can make generics. 108 00:06:02,420 --> 00:06:07,830 And so there is much more opportunity there, which means that potentially 109 00:06:07,830 --> 00:06:11,875 there are cheaper versions out there as well, which are just as effective. 110 00:06:11,905 --> 00:06:15,505 But because I deal with clinical cases, I'm not going to say there is this cheaper 111 00:06:15,505 --> 00:06:17,624 option and I'll recommend that instead. 112 00:06:17,644 --> 00:06:20,665 Now, if a client comes back to me and they say, I really can't afford 113 00:06:20,665 --> 00:06:23,675 that, then I might say, I don't know this product as well, but 114 00:06:23,675 --> 00:06:24,765 it's not going to be my first line. 115 00:06:24,765 --> 00:06:26,674 My first line is going to be what I'm familiar with. 116 00:06:27,095 --> 00:06:27,805 Sarah Ellis: Exactly. 117 00:06:28,144 --> 00:06:31,355 And I think one of the other things that I often hear as well from our vets 118 00:06:31,395 --> 00:06:36,895 and the veterinary team is the use of pheromones in conjunction with other 119 00:06:37,175 --> 00:06:41,205 products as well that, for example, Pet Remedy or some of the other products 120 00:06:41,205 --> 00:06:45,045 that are available that don't require a license, very often there's sort 121 00:06:45,045 --> 00:06:47,235 of a either or kind of attitude. 122 00:06:47,235 --> 00:06:49,345 I don't use this one because I use this one. 123 00:06:49,795 --> 00:06:52,804 Do you think you only have to use one or is there benefit to using both? 124 00:06:52,824 --> 00:06:55,215 Are they doing two things trying to do the same thing? 125 00:06:55,235 --> 00:06:57,215 Does one plus one equal two? 126 00:06:57,235 --> 00:06:58,915 Or what's your thoughts on that? 127 00:06:58,995 --> 00:07:01,715 Daniel Mills: My starting point is, where's the evidence 128 00:07:02,045 --> 00:07:03,015 for any of these products? 129 00:07:03,075 --> 00:07:06,925 So there's a wide variety of products and a lot of them are marketed 130 00:07:06,925 --> 00:07:08,525 on the basis of testimonials. 131 00:07:08,925 --> 00:07:13,675 And nothing sells a product like celebrity endorsement, I'm sure, but that 132 00:07:13,715 --> 00:07:15,745 doesn't necessarily mean that it works. 133 00:07:16,105 --> 00:07:19,184 Animals get better, they fluctuate in their behaviour, 134 00:07:19,665 --> 00:07:21,225 and that is always an issue. 135 00:07:21,275 --> 00:07:24,525 The first thing I would say is be cautious of that. 136 00:07:24,675 --> 00:07:28,535 I would start with those with the best evidence, and of all of those 137 00:07:28,535 --> 00:07:31,965 sorts of products, I would say that the pheromones are better than things. 138 00:07:31,995 --> 00:07:38,045 There have been some trials published with Pet Remedy, I'm, I don't find the data 139 00:07:38,094 --> 00:07:42,604 that convincing, but I hear enough people telling me that it's really good that I do 140 00:07:42,635 --> 00:07:47,844 think that there is something there, but exactly what the indications are, just to 141 00:07:48,235 --> 00:07:52,104 flip back to what we were talking about earlier about the different parts of the 142 00:07:52,120 --> 00:07:53,870 territory and the emotional reactions. 143 00:07:54,260 --> 00:07:59,440 Personally, I don't think saying that something helps stress is terribly useful 144 00:07:59,960 --> 00:08:02,370 because stress is such a general term. 145 00:08:02,580 --> 00:08:06,239 And my job as a behaviour clinician is to work out what 146 00:08:06,240 --> 00:08:07,889 emotions relate to that stress. 147 00:08:07,890 --> 00:08:10,769 As we've said, you've got fear, you've got frustration, they're different emotions. 148 00:08:10,769 --> 00:08:12,070 They have different solutions. 149 00:08:12,480 --> 00:08:16,070 So I could be cynical and say it's lazy to say stress, but people 150 00:08:16,070 --> 00:08:17,680 understand what the word stress means. 151 00:08:17,940 --> 00:08:20,939 But if you get the wrong type of stressor that product's not going to work. 152 00:08:21,220 --> 00:08:23,130 That doesn't mean that product is useless. 153 00:08:23,130 --> 00:08:25,830 It just means you've used it for the wrong indication. 154 00:08:25,830 --> 00:08:27,960 And that's part of what my training is. 155 00:08:28,330 --> 00:08:32,749 And I will still tend to use the individual Ceva products rather than the 156 00:08:32,750 --> 00:08:36,409 Feliway Optimum, unless I'm uncertain, or I think that there is a social element 157 00:08:36,409 --> 00:08:39,539 that needs to be included together with the physical, then I might recommend 158 00:08:40,120 --> 00:08:43,970 the Optimum, but to go back to answering your question, actually, we haven't 159 00:08:43,970 --> 00:08:46,380 got any evidence to suggest that, 160 00:08:47,160 --> 00:08:52,069 certainly, yeah, with things like pet remedy and some of the nutritional 161 00:08:52,069 --> 00:08:56,290 supplements, there's no reason to suppose that one should antagonise the other. 162 00:08:57,110 --> 00:09:01,130 But some of the products that I'm starting to see labelled as pheromones, 163 00:09:01,240 --> 00:09:04,910 I struggle a little bit more with because some of the ingredients, they talk 164 00:09:04,950 --> 00:09:07,050 about calming scent with added catnip. 165 00:09:07,100 --> 00:09:07,290 Yes. 166 00:09:07,330 --> 00:09:08,950 And you're thinking, hang on. 167 00:09:09,560 --> 00:09:12,629 Nathalie Dowgray: And now I'm speaking with Dr Hugo Swanstein about his 168 00:09:12,629 --> 00:09:17,126 JFMS Clinical Spotlight article, Feline Friendly POCUS, How to 169 00:09:17,126 --> 00:09:18,665 implement it into your daily practice. 170 00:09:18,665 --> 00:09:21,999 So to start with, I just wondered if you could explain to us 171 00:09:25,379 --> 00:09:28,719 what POCUS is for those listening who may not be familiar with the term. 172 00:09:29,964 --> 00:09:34,255 Hugo Swanstein: So, point of care ultrasound is quite different from 173 00:09:34,265 --> 00:09:35,915 formal consultative ultrasound. 174 00:09:36,045 --> 00:09:41,395 It involves more questions or series of clinically driven questions that 175 00:09:41,395 --> 00:09:45,044 you have asked yourself even before putting the probe on your patient. 176 00:09:45,765 --> 00:09:49,395 Of course, it's ultrasound, but it's not really in the same sort of area, because 177 00:09:49,415 --> 00:09:53,245 you don't go around assessing organs or structures and don't have these open 178 00:09:53,245 --> 00:09:55,474 ended differential diagnosis questions. 179 00:09:55,694 --> 00:10:00,464 It's more of a rapid, evidence based, non invasive, of course, repeatable, 180 00:10:00,694 --> 00:10:04,864 and specifically cage side or patient side sonographic examination. 181 00:10:04,934 --> 00:10:08,915 And in this article, me and the other authors have really tried to 182 00:10:08,985 --> 00:10:14,150 point out that POCUS can be done in a way where we really try to ask 183 00:10:14,150 --> 00:10:17,380 clinically driven questions without compromising the felines wellbeing. 184 00:10:17,790 --> 00:10:20,810 Nathalie Dowgray: So do you have any tips for how we could start to integrate 185 00:10:20,820 --> 00:10:22,429 it into our day to day practice? 186 00:10:22,740 --> 00:10:26,570 Is it just for emergency cases or can we use it for other things as well? 187 00:10:26,860 --> 00:10:28,449 Hugo Swanstein: It's not just for emergency. 188 00:10:28,449 --> 00:10:32,610 I would say it's a first day or first practitioner's 189 00:10:32,960 --> 00:10:34,270 skill that you should learn. 190 00:10:34,760 --> 00:10:39,580 It's about practicing a little bit every day, five minutes a day will do wonders 191 00:10:39,589 --> 00:10:42,530 in two months or in two weeks even. 192 00:10:42,919 --> 00:10:46,780 And you start on one skill, build on it, and you will be surprised 193 00:10:46,820 --> 00:10:48,430 about what you find in your patients. 194 00:10:49,100 --> 00:10:50,486 Nathalie Dowgray: So how do you manage that fur? 195 00:10:50,486 --> 00:10:53,740 What's your advice for getting good views without clipping? 196 00:10:54,120 --> 00:10:57,460 Hugo Swanstein: Especially in feline patients, the problem with gel 197 00:10:57,460 --> 00:11:01,260 and not clipping is that you will trap the gel within the fur, and 198 00:11:01,450 --> 00:11:05,839 anytime you get an air bubble in that gel pocket, your view is lost. 199 00:11:06,350 --> 00:11:09,700 And it's a mess to clean up, and the cat doesn't like it, and 200 00:11:09,710 --> 00:11:11,060 everything is just horrible, right? 201 00:11:11,530 --> 00:11:14,270 When I started doing POCUS, I learned that the best way was to 202 00:11:14,270 --> 00:11:18,430 have a spray bottle with a bit of mixture between alcohol and water. 203 00:11:18,480 --> 00:11:21,200 So what you should start with is that you should part the fur 204 00:11:21,200 --> 00:11:22,540 until you see a bit of skin. 205 00:11:22,580 --> 00:11:25,380 And then you apply a little bit of alcohol and you put your probe on. 206 00:11:25,790 --> 00:11:29,430 And just having that coupling agent, a little bit of liquid between 207 00:11:29,430 --> 00:11:33,160 the probe and the skin, you will actually get quite a good picture. 208 00:11:33,689 --> 00:11:36,530 There's no point in just taking a cat, putting it on the table, 209 00:11:36,710 --> 00:11:39,520 spraying him down with alcohol because you won't see anything. 210 00:11:39,520 --> 00:11:42,189 You really need to part that fur to actually get the alcohol 211 00:11:42,189 --> 00:11:43,590 between the skin and the probe. 212 00:11:43,870 --> 00:11:47,079 And then once you have quite a good contact, you will be surprised about 213 00:11:47,099 --> 00:11:51,209 how much you can usually move that probe around by taking your non 214 00:11:51,220 --> 00:11:55,980 ultrasound hand and moving the skin around and, in a cat on the thorax, 215 00:11:56,030 --> 00:11:59,640 most of the time you're able to scan almost the entire thorax in one go. 216 00:12:00,310 --> 00:12:03,370 It doesn't take a lot of practice, but you really got to be thorough with the 217 00:12:03,370 --> 00:12:05,090 parting and the spraying and so on. 218 00:12:05,410 --> 00:12:08,839 Nathalie Dowgray: We obviously recommend not using alcohol in 219 00:12:08,900 --> 00:12:12,820 some of our cat friendly guidelines because cats find the smell aversive. 220 00:12:12,850 --> 00:12:16,270 Do you find that, that because it's diluted that reduces the problem? 221 00:12:16,565 --> 00:12:20,035 Hugo Swanstein: Definitely, it definitely helps to dilute the down in the cat 222 00:12:20,035 --> 00:12:24,885 doesn't really smell it as horrible, or they don't seem to react that much. 223 00:12:25,195 --> 00:12:27,835 Nathalie Dowgray: What do you consider the most useful clinical 224 00:12:27,835 --> 00:12:29,925 questions that POCUS can answer? 225 00:12:30,045 --> 00:12:31,415 Hugo Swanstein: Oh, this is a big one. 226 00:12:31,675 --> 00:12:35,299 My entire way of operating has changed since I discovered POCUS. 227 00:12:35,640 --> 00:12:38,990 Since I don't have to drag them down to radiology anymore, I 228 00:12:38,990 --> 00:12:40,380 don't have to go on suspicion. 229 00:12:40,780 --> 00:12:42,900 I can do everything in the examination room. 230 00:12:42,950 --> 00:12:43,720 It's fantastic. 231 00:12:43,720 --> 00:12:45,580 It's like having eyes inside the patients. 232 00:12:46,140 --> 00:12:51,250 You can really get the smallest amount of fluid or in the patients that 233 00:12:51,260 --> 00:12:54,280 no one can put an IV catheter in, you can use the ultrasound as well. 234 00:12:54,519 --> 00:12:57,590 It helps you with the practical problems of your daily life. 235 00:12:57,725 --> 00:13:00,205 Nathalie Dowgray: And definitely reading through the article, it really sounds like 236 00:13:00,205 --> 00:13:04,355 there's a lot of uses for POCUS within just our day to day sort of workload. 237 00:13:04,635 --> 00:13:07,124 We sort of hear feedback from the audience about just not 238 00:13:07,145 --> 00:13:08,775 having enough time to do it. 239 00:13:09,074 --> 00:13:11,135 Owners not wanting to pay a bit extra. 240 00:13:11,485 --> 00:13:14,964 Do you have sort of any suggestions about how we could overcome these barriers? 241 00:13:15,045 --> 00:13:15,915 Hugo Swanstein: Oh, yes. 242 00:13:16,074 --> 00:13:17,914 This is important, right? 243 00:13:17,915 --> 00:13:22,835 The big thing I think is the selling argument for POCUS compared to 244 00:13:23,325 --> 00:13:26,765 consultative or formal ultrasound would be the time difference. 245 00:13:26,855 --> 00:13:31,855 So a traditional ultrasound, I would say be 45 minutes somewhere 246 00:13:31,855 --> 00:13:35,665 around there, really go into all the nitty gritties and look everywhere. 247 00:13:36,315 --> 00:13:38,594 A POCUS is 5, 10 minutes. 248 00:13:38,934 --> 00:13:41,455 So time wise, it's a big difference. 249 00:13:41,465 --> 00:13:45,615 If you would be charging an hourly rate, you know, POCUS should 250 00:13:45,625 --> 00:13:50,185 definitely cost less because you could do more in an hour and you 251 00:13:50,185 --> 00:13:54,585 don't really go into all the details, meaning you shouldn't pay as much. 252 00:13:54,945 --> 00:13:59,664 You might not need the necessary training in the same way as a sonographer. 253 00:14:00,105 --> 00:14:03,370 So, should the owners pay the same? 254 00:14:03,380 --> 00:14:03,950 Probably not. 255 00:14:03,960 --> 00:14:06,820 They should probably pay less because you can see it as an extension 256 00:14:06,820 --> 00:14:08,330 of your physical examination. 257 00:14:08,820 --> 00:14:11,859 Nathalie Dowgray: Yeah, I have to say I really like that idea of incorporating 258 00:14:11,859 --> 00:14:16,349 it into your hospitalisation fees or your sort of triage emergency management costs 259 00:14:16,349 --> 00:14:20,015 because then you can be including all of the things that you need to do like 260 00:14:20,015 --> 00:14:21,475 blood pressure measurements, et cetera. 261 00:14:21,475 --> 00:14:24,005 And they're often things you do need to repeat because you're 262 00:14:24,005 --> 00:14:25,715 looking for changes and trends. 263 00:14:26,045 --> 00:14:29,285 I guess the other thing around, especially some of these views that we may be 264 00:14:29,285 --> 00:14:32,455 doing repeatedly to monitor for changes. 265 00:14:32,835 --> 00:14:35,935 Are they kind of things that nurses or veterinary technicians 266 00:14:35,935 --> 00:14:38,615 could also be trained up to do in the hospital situation? 267 00:14:38,765 --> 00:14:38,995 Hugo Swanstein: Yeah. 268 00:14:38,995 --> 00:14:43,055 So the tracking areas of POCUS can definitely be done 269 00:14:43,055 --> 00:14:44,905 by technicians and nurses. 270 00:14:45,255 --> 00:14:51,375 In POCUS we tend to talk about the six T's and the six T's are targeted, trauma, 271 00:14:51,435 --> 00:14:53,834 triage, treatment, tracking, and total. 272 00:14:54,145 --> 00:14:57,964 And I advocate for maybe we should add a seventh T, which would be team, 273 00:14:58,294 --> 00:14:59,494 because the entire team could do it. 274 00:14:59,754 --> 00:15:03,594 When I was a veterinary nurse before I graduated, I did it 275 00:15:03,594 --> 00:15:05,434 a lot on our ICU patients. 276 00:15:05,795 --> 00:15:07,735 So no, get your nurses trained as well. 277 00:15:08,095 --> 00:15:09,694 It will definitely help your time. 278 00:15:15,345 --> 00:15:16,275 Nathalie Dowgray: Thank you for listening. 279 00:15:16,515 --> 00:15:20,185 If you're an ISFM member, don't forget you can access the full version of 280 00:15:20,185 --> 00:15:25,035 the podcast and all other ISFM member benefits, including Congress recordings, 281 00:15:25,175 --> 00:15:28,915 monthly webinars, the clinical club, the discussion forum, and much, 282 00:15:28,924 --> 00:15:31,925 much more at portal.icatcare.org. 283 00:15:32,305 --> 00:15:36,215 If you are looking for more free CPD from ISFM in October, we do have an open 284 00:15:36,215 --> 00:15:38,345 access webinar brought to you by Purina. 285 00:15:38,875 --> 00:15:43,735 That's Helen Ballantyne speaking on One Health Approach, Human Cat Welfare. 286 00:15:44,564 --> 00:15:45,555 We'll see you again next month.