1 00:00:00,049 --> 00:00:03,589 Dr Emma Hancox: Hi and a warm welcome to the new Synaptic Tails podcast. 2 00:00:03,979 --> 00:00:07,190 I'm your host, Emma Hancox, a Technical Vet Advisor from 3 00:00:07,190 --> 00:00:09,230 TVM UK, a Dômes Pharma Brand. 4 00:00:09,829 --> 00:00:11,540 And I'm here in collaboration with Dr. 5 00:00:11,540 --> 00:00:13,219 Mark Lowrie of Movement Referrals. 6 00:00:13,559 --> 00:00:16,790 I'm sure you’re all familiar with Mark's name, but just by way of 7 00:00:16,790 --> 00:00:21,049 introduction, Mark qualified from the University of Cambridge before working 8 00:00:21,055 --> 00:00:23,090 in first opinion small animal practice. 9 00:00:23,839 --> 00:00:26,720 Following an internship at the Royal Veterinary College, he moved to the 10 00:00:26,720 --> 00:00:30,500 University of Glasgow to complete a residency in veterinary neurology. 11 00:00:31,610 --> 00:00:35,300 Mark worked for several years at a leading multidisciplinary centre near 12 00:00:35,300 --> 00:00:38,959 London, then as Clinical Director for another multidisciplinary 13 00:00:38,964 --> 00:00:40,910 referral centre in the East Midlands. 14 00:00:41,959 --> 00:00:46,010 Mark has a master's degree on steroid responsive meningitis arteritis 15 00:00:46,010 --> 00:00:49,459 in dogs, and has a particular interest in management of movement 16 00:00:49,459 --> 00:00:53,555 disorders, inflammatory brain and spinal disease and feline neurology. 17 00:00:54,605 --> 00:00:57,575 He is Veterinary Consultant to the International Society of Feline 18 00:00:57,575 --> 00:01:02,375 Medicine, the ISFM, and was awarded, finally, the prestigious national prize 19 00:01:02,375 --> 00:01:04,985 of Petplan Vet of the Year in 2022. 20 00:01:05,945 --> 00:01:07,805 That is quite some introduction Mark. 21 00:01:07,805 --> 00:01:08,705 Welcome, how are you? 22 00:01:09,209 --> 00:01:10,419 Dr Mark Lowrie: Sorry to make you read all that out. 23 00:01:11,019 --> 00:01:11,739 Thank you very much. 24 00:01:11,739 --> 00:01:12,619 No, all's good today. 25 00:01:12,619 --> 00:01:13,779 And it's nice to be in this room 26 00:01:13,869 --> 00:01:14,319 Dr Emma Hancox: Good. 27 00:01:14,379 --> 00:01:14,589 Good. 28 00:01:15,179 --> 00:01:19,139 For those that don't know, Mark has recently opened a new independent referral 29 00:01:19,139 --> 00:01:23,369 centre in the Northwest with four of his orthopaedic veterinary specialists, 30 00:01:23,369 --> 00:01:25,919 colleagues, maybe also friends, I think. 31 00:01:26,019 --> 00:01:27,879 Tell us a little bit about Movement Referrals. 32 00:01:27,879 --> 00:01:28,479 How's it going? 33 00:01:28,824 --> 00:01:29,754 Dr Mark Lowrie: Oh, it's exciting. 34 00:01:29,964 --> 00:01:31,164 I could talk about this all day. 35 00:01:31,224 --> 00:01:31,444 So 36 00:01:31,839 --> 00:01:32,839 Dr Emma Hancox: Please don't, I'm joking. 37 00:01:34,204 --> 00:01:37,139 Dr Mark Lowrie: It was set up by five of us in total. 38 00:01:37,470 --> 00:01:40,549 The other four are well-known veterinary specialists in orthopaedics, we want 39 00:01:40,549 --> 00:01:44,469 to provide sort of high quality but efficient specialist referral services. 40 00:01:44,570 --> 00:01:47,840 We obviously just concentrate on orthopaedics and neurology, 41 00:01:48,230 --> 00:01:50,750 and they're two of the most common reasons for referrals. 42 00:01:50,800 --> 00:01:54,040 We're able to offer common referral procedures such as TPLO, 43 00:01:54,570 --> 00:01:58,195 patellar luxation, don't ask me about them, and spinal surgery 44 00:01:58,225 --> 00:01:59,875 at really reasonable prices. 45 00:02:00,115 --> 00:02:02,995 Given the dramatic consolidation of recent years in the veterinary 46 00:02:02,995 --> 00:02:06,954 world, and the importance of GP vet recommendations in the referral process, 47 00:02:06,954 --> 00:02:11,424 I suppose it's fair to say there's been a reduction in competition and 48 00:02:11,424 --> 00:02:15,764 significant price inflation, so we really hope to provide more choice at 49 00:02:15,764 --> 00:02:19,434 better value and aim to objectively demonstrate our value through 50 00:02:19,434 --> 00:02:21,384 measuring and publishing our outcomes. 51 00:02:21,519 --> 00:02:22,089 Dr Emma Hancox: That's brilliant. 52 00:02:22,309 --> 00:02:26,379 Dr Mark Lowrie: I think it's important for owners to know what they can expect 53 00:02:26,619 --> 00:02:27,909 when they take their dog for surgery. 54 00:02:27,909 --> 00:02:29,769 What is the likely outcome going to be? 55 00:02:30,069 --> 00:02:32,920 And if we can publish what we've done in the past, they've got 56 00:02:32,920 --> 00:02:34,719 quite clear guidelines on that. 57 00:02:35,989 --> 00:02:37,034 We've had a great few months. 58 00:02:37,034 --> 00:02:41,174 We've not been open long, got big plans ahead, and we abide by the statement 59 00:02:41,174 --> 00:02:43,304 of getting it right first time. 60 00:02:44,294 --> 00:02:47,504 So that's one of the reasons something like canine epilepsy that we talk 61 00:02:47,509 --> 00:02:51,584 about today is so important as I feel it's that first meeting that 62 00:02:51,589 --> 00:02:55,634 can dictate the direction of an owner's decision and the direction 63 00:02:55,784 --> 00:02:57,314 that things might take in the future. 64 00:02:57,794 --> 00:02:58,514 Dr Emma Hancox: Absolutely. 65 00:02:58,994 --> 00:03:04,784 And I think having both that neurology and that orthopaedic kind of influence 66 00:03:04,814 --> 00:03:08,554 is really useful because, it's so easy in first opinion practice 67 00:03:08,554 --> 00:03:10,444 to sometimes misdiagnose these. 68 00:03:10,444 --> 00:03:14,344 So I guess it's great to see, or have, that influence of your 69 00:03:14,344 --> 00:03:17,644 colleagues as well and have both of those kind of inputs and you can all 70 00:03:17,644 --> 00:03:19,294 look at cases together sometimes. 71 00:03:19,509 --> 00:03:21,049 Dr Mark Lowrie: The two marry together brilliantly. 72 00:03:21,259 --> 00:03:24,569 So the number of times we'll see something that we feel is orthopaedic and it 73 00:03:24,589 --> 00:03:26,569 becomes neurological and vice versa. 74 00:03:26,569 --> 00:03:27,709 So it's great. 75 00:03:27,799 --> 00:03:31,599 And as you said earlier on, I'm working with my mates, that's always 76 00:03:31,599 --> 00:03:33,019 a good thing, always good fun. 77 00:03:33,069 --> 00:03:34,390 Dr Emma Hancox: You always have to have fun when you’re at work. 78 00:03:35,739 --> 00:03:37,869 That's brilliant though, Mark, we're so lucky to have you here. 79 00:03:38,499 --> 00:03:42,249 Our new podcast will focus on how to manage neurology cases in first 80 00:03:42,249 --> 00:03:45,129 opinion practice, hopefully offering you some tips and tricks that 81 00:03:45,129 --> 00:03:46,329 we've both learned along the way. 82 00:03:47,109 --> 00:03:50,739 Over the first few episodes, we're going to introduce you to TVMs new 83 00:03:50,739 --> 00:03:54,849 S.M.A.R.T Approach To Epilepsy, and how to apply this to some real life cases. 84 00:03:55,349 --> 00:03:58,679 Some of you may have seen this already in lunch and learns, so if 85 00:03:58,679 --> 00:04:01,399 you haven't already, you can always book those via our website as well. 86 00:04:02,639 --> 00:04:05,729 The aim of the S.M.A.R.T Approach To Epilepsy is to help you guide 87 00:04:05,729 --> 00:04:07,619 conversation in first opinion practice. 88 00:04:07,619 --> 00:04:11,969 So it's not really anything that you as vets don't know in practice, 89 00:04:11,969 --> 00:04:13,709 but it's just there as a reminder. 90 00:04:15,029 --> 00:04:18,689 S.M.A.R.T is, of course, an acronym because we all know how much marketers 91 00:04:18,719 --> 00:04:25,414 love an acronym, and stands for speak, measure, advise, realistic and tailor. 92 00:04:25,504 --> 00:04:28,414 So that's going to be our focus for the next few episodes. 93 00:04:29,239 --> 00:04:32,689 This has been largely based on some recent work that was published at the 94 00:04:32,689 --> 00:04:34,780 beginning of the year, in the vet record. 95 00:04:35,169 --> 00:04:39,759 So from authors, Amy Pergande, Zoe Belshaw, Holger Volk and Rowena Packer, 96 00:04:40,210 --> 00:04:43,809 which was the first to look at how owner perspectives of their vet and their 97 00:04:43,809 --> 00:04:48,340 vet owner bond impacts upon decision making and ultimately how this impacts 98 00:04:48,340 --> 00:04:50,349 upon clinical outcomes for epilepsy. 99 00:04:51,249 --> 00:04:53,979 And this is why speak and communication is at the beginning 100 00:04:53,979 --> 00:04:57,639 of that S.M.A.R.T approach because it's so important yet, honestly, is 101 00:04:57,639 --> 00:04:59,319 quite often overlooked in practice. 102 00:04:59,529 --> 00:05:02,799 I think I can hold my hands up and say, I always looked 103 00:05:02,799 --> 00:05:04,119 at the numbers, to be honest. 104 00:05:04,169 --> 00:05:07,049 This is something that we had discussed the first time we met, wasn't it Mark? 105 00:05:07,049 --> 00:05:10,409 Actually, that kind of communication and time in practice 106 00:05:10,409 --> 00:05:12,329 is one of the biggest hurdles. 107 00:05:13,204 --> 00:05:13,385 Dr Mark Lowrie: Time. 108 00:05:13,534 --> 00:05:14,104 Yeah, time. 109 00:05:14,104 --> 00:05:15,155 There just isn't enough time. 110 00:05:15,329 --> 00:05:16,529 Dr Emma Hancox: There isn't, really isn't, no. 111 00:05:16,784 --> 00:05:19,485 Dr Mark Lowrie: And these cases don't come in when you've got lots of time. 112 00:05:19,845 --> 00:05:24,255 They're inevitably going to come in when you've got 10 other patients to see. 113 00:05:24,314 --> 00:05:27,195 The waiting room is full to bursting, dogs are attacking each other. 114 00:05:27,525 --> 00:05:28,424 You can imagine the scene. 115 00:05:28,965 --> 00:05:32,509 But the owner, when they first come in, they've obviously in the very 116 00:05:32,509 --> 00:05:36,679 recent past, witnessed their dog have a fit, which is such a scary thing. 117 00:05:36,784 --> 00:05:37,384 Dr Emma Hancox: Absolutely. 118 00:05:37,549 --> 00:05:37,939 Dr Mark Lowrie: To see. 119 00:05:37,939 --> 00:05:42,569 So you’re suddenly in this position counselling as well as preparing them 120 00:05:42,929 --> 00:05:48,179 what's ahead, and you've probably got 5, 10, maybe 15 minutes if you’re lucky. 121 00:05:48,234 --> 00:05:49,404 Dr Emma Hancox: If you’re lucky, I was gonna say. 122 00:05:50,339 --> 00:05:54,599 Dr Mark Lowrie: So I think if you’re able to have a really long period 123 00:05:54,599 --> 00:05:57,299 of time to sit down with these owners, it makes a huge difference. 124 00:05:58,049 --> 00:06:00,090 And I'm sure as you’re all listening to this, you probably 125 00:06:00,094 --> 00:06:01,009 think, I don't have that. 126 00:06:01,519 --> 00:06:02,509 I don't have that time. 127 00:06:03,019 --> 00:06:10,499 So signposting is really helpful here to get an owner to know where to 128 00:06:10,499 --> 00:06:13,679 look to get the information they need because you’re not going be able to 129 00:06:13,679 --> 00:06:15,359 provide it in the time that you've got. 130 00:06:16,169 --> 00:06:19,699 I think there's a role for all members of the practice here. 131 00:06:19,699 --> 00:06:23,969 So, the owner's phoned up, they've said my dog's had a fit, and they 132 00:06:23,969 --> 00:06:25,469 want to book in to see the vet. 133 00:06:25,559 --> 00:06:28,169 But the receptionist there, the person answering the phone can 134 00:06:28,169 --> 00:06:30,539 help a little bit and say, actually we've got some information on this. 135 00:06:30,799 --> 00:06:32,929 And you can direct them to that information, whether it's 136 00:06:32,929 --> 00:06:34,340 something on your own website. 137 00:06:34,864 --> 00:06:38,625 Some leaflets indeed, TVM could provide information around 138 00:06:38,625 --> 00:06:40,475 this to support these clients. 139 00:06:41,445 --> 00:06:44,115 I think that really helps just to settle them down while they're waiting 140 00:06:44,120 --> 00:06:47,385 for that appointment or even while they're waiting in the waiting room. 141 00:06:47,444 --> 00:06:47,609 Dr Emma Hancox: Yeah. 142 00:06:47,649 --> 00:06:48,759 Dr Mark Lowrie: It can help enormously. 143 00:06:49,399 --> 00:06:54,704 The other thing that's omitted is owners aren't prepared with what's ahead. 144 00:06:54,704 --> 00:06:57,434 They're coming in having seen their dog have a fit, and they 145 00:06:57,434 --> 00:06:58,904 never want to see that ever again. 146 00:06:59,024 --> 00:06:59,314 Dr Emma Hancox: Yeah. 147 00:06:59,924 --> 00:07:01,094 Dr Mark Lowrie: And that's not realistic. 148 00:07:01,364 --> 00:07:02,474 We can't do that. 149 00:07:02,534 --> 00:07:03,974 If we could, that would be amazing. 150 00:07:04,304 --> 00:07:09,014 Owners need to be ready that there's gonna be a lot more fits ahead, most likely. 151 00:07:10,084 --> 00:07:13,734 And the most important thing that's never ever said, if we are dealing 152 00:07:13,734 --> 00:07:16,824 with epilepsy, which we'll assume here, this is a dog that's had its 153 00:07:16,824 --> 00:07:20,184 first fit and it's got epilepsy, it's a progressive condition, 154 00:07:20,274 --> 00:07:22,459 it's going to get worse and worse. 155 00:07:22,529 --> 00:07:23,329 Now, that's miserable. 156 00:07:23,854 --> 00:07:24,124 Dr Emma Hancox: Yeah. 157 00:07:25,204 --> 00:07:29,104 And I think as vets, we don't wanna say that, we don't want 158 00:07:29,104 --> 00:07:32,074 to be the bearers of bad news in that stressful situation, do we? 159 00:07:32,074 --> 00:07:36,764 But it was certainly something that was picked out actually of that paper that I 160 00:07:36,764 --> 00:07:40,739 mentioned, that actually being realistic with those owners and having that frank 161 00:07:40,739 --> 00:07:45,449 conversation upfront was one of the, even if they don't wanna hear it, is one of 162 00:07:45,449 --> 00:07:49,369 the positive outcomes from that paper. 163 00:07:49,369 --> 00:07:54,444 So it's, as I said, it's stuff that you do know, but it's just putting that 164 00:07:54,444 --> 00:07:56,194 into perspective a little bit as well. 165 00:07:56,529 --> 00:07:59,379 Dr Mark Lowrie: And if you are that honest vet that gives that information, 166 00:08:00,009 --> 00:08:03,129 that's what's gonna help that bond between you and the client because 167 00:08:03,129 --> 00:08:05,619 they'll, you’re not telling the owners something they want to hear. 168 00:08:05,959 --> 00:08:08,889 you’re telling them something they need to hear and they may not take 169 00:08:08,889 --> 00:08:12,339 it well, they may take it great, but then they'll go away, have a think 170 00:08:12,339 --> 00:08:13,419 about it and say, you know what? 171 00:08:13,419 --> 00:08:15,339 My vet was really honest from the get go. 172 00:08:15,879 --> 00:08:19,359 And that's gonna put you absolutely on the right grounding for the future. 173 00:08:19,449 --> 00:08:23,479 So they know that, you’re not a miracle worker, but you’re there for them and 174 00:08:23,479 --> 00:08:24,889 you can help advise them through it. 175 00:08:24,889 --> 00:08:27,559 So that is so important right from the beginning. 176 00:08:27,694 --> 00:08:28,054 Dr Emma Hancox: Yeah. 177 00:08:28,354 --> 00:08:32,674 You mentioned that there was a role for other members of the veterinary 178 00:08:32,674 --> 00:08:36,064 staff, you picked up the front of house staff there, and I think it is really 179 00:08:36,064 --> 00:08:40,834 useful for them to at least have that kind of triage type advice as well 180 00:08:40,834 --> 00:08:42,274 when they first get that phone call. 181 00:08:42,274 --> 00:08:44,134 It just, again, instils that confidence. 182 00:08:44,584 --> 00:08:49,894 But again, something in this paper is suggesting that owners like to talk to 183 00:08:49,894 --> 00:08:54,154 the nurses as well and maybe confide a lot in them, some things that they 184 00:08:54,154 --> 00:08:55,924 might not confide in their vets. 185 00:08:56,224 --> 00:09:01,434 So actually, and we know that nurses are brilliant at doing their nurse clinics. 186 00:09:01,484 --> 00:09:07,294 They will, often do things like OA clinics and things like that for us then it's 187 00:09:07,504 --> 00:09:12,214 unfortunate that I don't see sometimes a lot of epilepsy type clinics where I 188 00:09:12,214 --> 00:09:13,774 think actually they could get involved. 189 00:09:13,774 --> 00:09:14,584 What do you think about that? 190 00:09:15,109 --> 00:09:16,024 Dr Mark Lowrie: Oh, I think that's vital. 191 00:09:16,024 --> 00:09:18,874 So I’ve mentioned the receptionist, but yeah, the nurse. 192 00:09:18,879 --> 00:09:19,864 What can the nurse do? 193 00:09:20,324 --> 00:09:20,859 So much! 194 00:09:20,864 --> 00:09:24,609 So you've got that owner, they've turned up in the waiting room, their dog's had a 195 00:09:24,609 --> 00:09:26,979 fit potentially, it's still having a fit. 196 00:09:27,109 --> 00:09:27,909 We've got to remember that. 197 00:09:27,909 --> 00:09:29,919 So triage, absolutely. 198 00:09:29,949 --> 00:09:33,579 I think if there's a veterinary nurse available, who can bring 199 00:09:33,699 --> 00:09:36,699 the owners and the dog to one side and have a chat with them. 200 00:09:37,644 --> 00:09:41,214 If the dog's actively fitting, well clearly the role of the nurse is to 201 00:09:41,214 --> 00:09:44,304 bring the dog through and make sure it receives that veterinary attention with 202 00:09:44,304 --> 00:09:46,004 the vet immediately, so that's easy. 203 00:09:46,004 --> 00:09:46,634 We know that. 204 00:09:46,694 --> 00:09:48,404 I think everyone would be familiar with that. 205 00:09:49,364 --> 00:09:53,354 But in the scenario where the dog stopped fitting, the owner's 206 00:09:53,354 --> 00:09:54,584 probably still panicking. 207 00:09:55,004 --> 00:09:59,624 And I think for the nurse to take them to one side, reassure them, but 208 00:09:59,624 --> 00:10:02,864 something that isn't done much, and I think this is where the nurse can help, 209 00:10:02,864 --> 00:10:06,889 is just to get information from the owners as to what it is they've seen. 210 00:10:07,289 --> 00:10:07,659 Dr Emma Hancox: Yeah. 211 00:10:07,959 --> 00:10:11,459 Dr Mark Lowrie: Now a vet can do this, but they haven't got much time, 212 00:10:12,059 --> 00:10:16,979 so you don't want to spend a lot of the veterinary consultation talking 213 00:10:16,984 --> 00:10:20,609 about how the fit looked, because you want to cut to the chase and get 214 00:10:20,609 --> 00:10:21,929 to the nitty gritty of what's ahead. 215 00:10:22,709 --> 00:10:26,609 So for a veterinary nurse, I think it's a really good opportunity for them to 216 00:10:26,609 --> 00:10:30,959 ask key questions about what the fit looked like, to check it truly was a fit. 217 00:10:31,859 --> 00:10:35,249 The smartphone's been amazing because the smartphone allows you to 218 00:10:35,729 --> 00:10:38,519 witness these episodes in real time. 219 00:10:38,549 --> 00:10:42,659 So in the past, an owner would come in, they say 'My dog's had a fit, 220 00:10:42,689 --> 00:10:44,099 a seizure', whatever it might be. 221 00:10:44,099 --> 00:10:48,184 And an assumptions made that's exactly what the dog's having. 222 00:10:48,514 --> 00:10:52,184 But if you get video footage of what's happening, because 223 00:10:52,184 --> 00:10:53,644 we never see them in practice. 224 00:10:53,944 --> 00:10:58,679 In fact, I joke that I'm probably the best anti-epileptic device there is 225 00:10:58,679 --> 00:11:00,724 'cause I never see a fit in practice. 226 00:11:00,724 --> 00:11:02,214 Dr Emma Hancox: So we all need you just at home with us basically. 227 00:11:02,214 --> 00:11:02,394 Dr Mark Lowrie: Just me. 228 00:11:02,394 --> 00:11:02,454 Yeah. 229 00:11:02,454 --> 00:11:04,199 I’ll come and I’ll take myself home with the owners. 230 00:11:04,214 --> 00:11:05,644 I’ve not worked out my charge or hourly rate yet but we can do that, 231 00:11:05,644 --> 00:11:06,354 I don't know, you can brand me. 232 00:11:06,494 --> 00:11:06,854 Dr Emma Hancox: That's it. 233 00:11:06,854 --> 00:11:11,374 We've got a new treatment from this podcast! 234 00:11:12,264 --> 00:11:17,044 Dr Mark Lowrie: But if you can get the owners to, to film the episode, then 235 00:11:17,044 --> 00:11:20,104 that helps because the vet, the nurse can look at that in their own time. 236 00:11:20,494 --> 00:11:24,474 But the nurse can ask questions such as, well refer to autonomic signs 237 00:11:24,499 --> 00:11:26,959 to say, has the dog been salivating? 238 00:11:27,709 --> 00:11:29,899 Has it urinated during an episode? 239 00:11:30,199 --> 00:11:32,779 If you are getting salivation during an episode, that for me 240 00:11:32,779 --> 00:11:34,309 is a sure fire hit that it's a 241 00:11:34,654 --> 00:11:34,879 Dr Emma Hancox: Yeah. 242 00:11:34,879 --> 00:11:34,939 Yeah 243 00:11:36,589 --> 00:11:41,019 Dr Mark Lowrie: If you've got a dog that's moving all four legs, very uncontrollably, 244 00:11:41,919 --> 00:11:45,989 but remains alert, that's ringing an alarm bell, this might not be a fit. 245 00:11:47,309 --> 00:11:47,489 A 246 00:11:47,489 --> 00:11:50,039 great example of this would be, again, going back to that 247 00:11:50,039 --> 00:11:52,209 busy consultation clinic. 248 00:11:52,689 --> 00:11:56,049 Your vet's there seeing lots of cases in, lots of vaccinations, and 249 00:11:56,054 --> 00:11:57,579 the odd vomiting dog here and there. 250 00:11:58,509 --> 00:12:02,414 They're really busy running late, and the phone call comes through that an owner has 251 00:12:02,419 --> 00:12:06,604 a dog that's fitting and the conversation would normally go, something along the 252 00:12:06,604 --> 00:12:10,354 lines of, my dog's been fitting for the last 20 minutes and hasn't stopped. 253 00:12:11,584 --> 00:12:13,724 So naturally the receptionist has taken that call and gone, you 254 00:12:13,724 --> 00:12:15,314 need to come down straight away. 255 00:12:16,184 --> 00:12:20,294 So they pile the dog in the car, they come down, the clinic's full to bursting. 256 00:12:20,894 --> 00:12:24,674 And then this Labrador that's been fitting for 20, maybe 30, 40 minutes by the 257 00:12:24,679 --> 00:12:29,864 time it arrives, comes running into the waiting room, bouncing around, crazily 258 00:12:29,864 --> 00:12:33,524 looking probably the healthiest dog in the waiting room there and then, and 259 00:12:33,524 --> 00:12:34,784 everyone thinks what's going on here? 260 00:12:34,834 --> 00:12:35,934 This owner's been lying. 261 00:12:36,424 --> 00:12:38,029 And of course the owner hasn't been lying. 262 00:12:38,149 --> 00:12:42,049 This dog has clearly had a prolonged episode that was very 263 00:12:42,049 --> 00:12:46,939 abnormal, but they've gone straight back to normal very quickly. 264 00:12:47,749 --> 00:12:50,989 And when you get a dog that bounces straight back to normal very quickly and 265 00:12:50,989 --> 00:12:55,129 back to normal consciousness and behaving normally, if they truly were fitting 266 00:12:55,134 --> 00:12:57,409 for 20 or 30 minutes, that's not a fit. 267 00:12:57,454 --> 00:12:57,744 Dr Emma Hancox: Yeah. 268 00:12:58,369 --> 00:12:59,839 Dr Mark Lowrie: So something else was going on. 269 00:13:00,199 --> 00:13:05,164 So your veterinary nurse can take a look at that dog and say, this is a really 270 00:13:05,164 --> 00:13:09,664 normal looking dog given it's been fitting for so long and that then tells us maybe 271 00:13:09,664 --> 00:13:13,534 this isn't epilepsy and to consider other possibilities for what might be going on. 272 00:13:13,924 --> 00:13:18,934 Whereas, of course, if the dog comes in, it looks drunk, confused, blind, it 273 00:13:18,939 --> 00:13:21,094 doesn't interact with the other patients. 274 00:13:21,394 --> 00:13:21,454 Dr Emma Hancox: Yeah. 275 00:13:21,454 --> 00:13:24,214 Dr Mark Lowrie: In the waiting room, yes, a fit is definitely 276 00:13:24,214 --> 00:13:24,874 what we're dealing with. 277 00:13:25,399 --> 00:13:27,409 Dr Emma Hancox: And that's, that can be both things really. 278 00:13:27,409 --> 00:13:31,219 So yes, it's getting vital information that they can pass back to the rest of 279 00:13:31,219 --> 00:13:33,229 the team, the vets that are in charge. 280 00:13:33,559 --> 00:13:37,879 But also if that dog does come bounding in and is quite happy, they can almost 281 00:13:37,969 --> 00:13:42,589 immediately reassure the owner that actually your dog is looking well right 282 00:13:42,589 --> 00:13:45,303 now so not to worry so much 283 00:13:45,353 --> 00:13:48,083 Dr Mark Lowrie: And that's great because then hopefully it calms the owners. 284 00:13:48,353 --> 00:13:52,523 So they're ready to get the information they need to know what's happening next. 285 00:13:53,063 --> 00:13:55,763 It's so difficult delivering information to someone who's panicking. 286 00:13:56,543 --> 00:14:00,143 I always say if you’re in an emergency and you’re in a room with a big red 287 00:14:00,143 --> 00:14:03,713 button on the wall that everybody can see, and you’re told to press the big 288 00:14:03,713 --> 00:14:05,453 red button in a hurry, you never see it. 289 00:14:05,693 --> 00:14:06,683 You look everywhere around. 290 00:14:06,683 --> 00:14:07,973 You can't see the big red button. 291 00:14:08,243 --> 00:14:10,433 You can only see the red button when you’re relaxed and calm. 292 00:14:10,493 --> 00:14:14,573 So yeah, you want to calm an owner and then deliver the information carefully. 293 00:14:14,948 --> 00:14:15,428 Dr Emma Hancox: Absolutely. 294 00:14:16,343 --> 00:14:22,643 Just to summarize in an emergency situation, it's obviously, communication 295 00:14:22,643 --> 00:14:26,453 with the owner is going to be important, one, in terms of ascertaining what's 296 00:14:26,453 --> 00:14:32,153 happened and trying to get that accurate diagnosis, but also, to calm them down 297 00:14:32,603 --> 00:14:36,783 as well, and to give them all of that kind of advice and time for that advice. 298 00:14:37,083 --> 00:14:41,763 How does that differ, do you think, when you see them as 299 00:14:41,763 --> 00:14:43,833 like a chronic, ongoing case? 300 00:14:44,053 --> 00:14:47,713 So how would your kind of conversation change? 301 00:14:47,893 --> 00:14:50,893 I guess it's now more about things like quality of life 302 00:14:51,223 --> 00:14:52,903 of that pet and that owner. 303 00:14:53,193 --> 00:14:55,443 Obviously we're still going to need to talk about the seizures 304 00:14:55,443 --> 00:14:59,823 and their frequency, but perhaps more about quality of life now. 305 00:14:59,898 --> 00:15:02,448 Dr Mark Lowrie: It is quality of life, and I think the owners, I’ve said 306 00:15:02,453 --> 00:15:05,208 already, they need to know what's coming ahead, what's in the future. 307 00:15:05,208 --> 00:15:08,748 So I don't mean crystal ball gazing, not that sort of thing, but for the 308 00:15:08,748 --> 00:15:10,188 owners to know more fits will happen. 309 00:15:11,018 --> 00:15:12,378 And what's that mean for a dog? 310 00:15:12,978 --> 00:15:16,518 Now, I think it really helps here to relate it to the human condition of 311 00:15:16,518 --> 00:15:21,228 epilepsy because also commonly you'll find that owner has some form of 312 00:15:21,228 --> 00:15:24,708 experience of epilepsy in people, whether it be a relative, a friend, maybe in 313 00:15:24,708 --> 00:15:26,718 the job they do, they come across it. 314 00:15:27,678 --> 00:15:30,498 And if they know someone with epilepsy, I'd encourage them to speak to them. 315 00:15:30,558 --> 00:15:33,258 Because if you speak to a person with epilepsy, they'll tell you 316 00:15:33,258 --> 00:15:35,148 that it's not a painful condition. 317 00:15:35,268 --> 00:15:36,618 There's no pain or discomfort. 318 00:15:36,978 --> 00:15:38,388 Owners always worry about pain. 319 00:15:38,478 --> 00:15:40,968 It doesn't matter whether we're talking about epilepsy or anything else. 320 00:15:41,298 --> 00:15:43,278 Pain is always their number one concern. 321 00:15:44,268 --> 00:15:45,408 So this isn't painful. 322 00:15:46,098 --> 00:15:49,668 And when you speak to a person with epilepsy, when they have a fit, what 323 00:15:49,668 --> 00:15:54,828 they'll say is they're completely unaware of what's happening in the moment. 324 00:15:55,638 --> 00:15:59,698 And so, if they're in a room full of people and they have a fit, they're fine. 325 00:16:00,178 --> 00:16:01,738 They've got no problem at all. 326 00:16:02,533 --> 00:16:06,163 When they come round from the fit, it's everyone else in the room that's panicking 327 00:16:06,523 --> 00:16:11,683 and doing things and maybe doing silly things like putting your hand in their 328 00:16:11,688 --> 00:16:13,603 mouth to try and establish an airway. 329 00:16:13,633 --> 00:16:14,623 Why would you do that? 330 00:16:14,683 --> 00:16:17,923 But in the heat of the moment, people do these silly things and get bitten. 331 00:16:18,103 --> 00:16:19,813 So of course we don't do that for dogs. 332 00:16:19,813 --> 00:16:21,673 We keep our hands well away from their mouths. 333 00:16:22,513 --> 00:16:26,563 But if you just apply logic to it, it's good to inform an owner that when 334 00:16:26,563 --> 00:16:28,993 their dog has a fit, try not to panic. 335 00:16:29,767 --> 00:16:32,347 Ensure they're in an area where they're not gonna hurt themselves because 336 00:16:32,347 --> 00:16:36,757 they're gonna be thrashing around, usually at home, it is important, 337 00:16:36,757 --> 00:16:40,427 I haven't said, but epilepsy always happens at home when a dog's relaxed, 338 00:16:40,427 --> 00:16:42,377 it doesn't tend to happen out on walks. 339 00:16:42,677 --> 00:16:47,212 We don't go out for a walk in the Peak District and see dogs fitting left, 340 00:16:47,217 --> 00:16:50,242 right and centre, yet we know there's a lot of epileptic dogs out there. 341 00:16:50,292 --> 00:16:51,132 Dr Emma Hancox: it's very true, actually. 342 00:16:51,132 --> 00:16:51,962 I hadn't thought about that. 343 00:16:51,962 --> 00:16:53,982 Dr Mark Lowrie: No, if you’re at the playground with your kids pushing 'em 344 00:16:53,982 --> 00:16:56,652 on a swing, you don't tend to see, oh, there's a dog over there having a fit. 345 00:16:57,267 --> 00:16:59,637 But, so it's always when they're relaxed. 346 00:16:59,847 --> 00:17:04,057 So when they're resting at home, early in the morning, late at night. 347 00:17:04,107 --> 00:17:07,077 Vets covering emergency clinics will be very familiar with the 348 00:17:07,082 --> 00:17:09,597 phone calls, whereas vets during the day won't get them so much. 349 00:17:09,612 --> 00:17:10,092 Dr Emma Hancox: It's true. 350 00:17:10,172 --> 00:17:10,462 Yeah. 351 00:17:11,107 --> 00:17:13,147 Dr Mark Lowrie: It does happen when these dogs are relaxed and not to worry 352 00:17:13,147 --> 00:17:14,347 about treating their dogs normally. 353 00:17:14,377 --> 00:17:16,757 They can go out on a walk, they can go about their daily routine. 354 00:17:17,447 --> 00:17:20,152 But when they are fitting in the house, move the furniture out the way, make 355 00:17:20,152 --> 00:17:23,062 sure they don't hurt themselves and maybe, if it's a bright room, dim the 356 00:17:23,062 --> 00:17:26,182 lights, and just be ready to be there for your dog when they come round. 357 00:17:27,532 --> 00:17:32,272 And a concern for a lot of owners is the behaviour following the seizure. 358 00:17:32,782 --> 00:17:36,082 And I’ve come across a few situations now quite frequently, 359 00:17:36,082 --> 00:17:38,452 where the seizure is a worry. 360 00:17:38,482 --> 00:17:40,942 Of course it is for the owners, but it's the behaviour following 361 00:17:40,962 --> 00:17:42,492 the fit that can be a concern. 362 00:17:44,142 --> 00:17:49,662 The behaviour, typically we will see ataxia, so a drunken gait, blindness, 363 00:17:49,662 --> 00:17:53,532 potentially all fairly transient, hopefully lasting, no more than 5, 10 364 00:17:53,532 --> 00:17:57,732 minutes, but it will be longer if the seizure's been going on for longer. 365 00:17:58,362 --> 00:17:59,502 But the big one is aggression. 366 00:18:00,492 --> 00:18:04,182 Dogs come around really disorientated and they will show aggression. 367 00:18:04,182 --> 00:18:05,922 Now that's probably fear aggression. 368 00:18:05,982 --> 00:18:07,392 It could be the brain doing things. 369 00:18:07,572 --> 00:18:09,702 It's hard to explain exactly why that happens. 370 00:18:09,802 --> 00:18:13,222 But it occurs, and so owners can find themselves in quite a threatening 371 00:18:13,222 --> 00:18:14,962 situation with their beloved pet. 372 00:18:15,832 --> 00:18:18,712 And I think all you can say in that situation is just try 373 00:18:18,712 --> 00:18:19,642 and keep away from your dog. 374 00:18:19,642 --> 00:18:22,992 Allow it to be in an enclosed room, just to come round and hopefully 375 00:18:23,082 --> 00:18:24,702 after 5, 10 minutes they'll be better. 376 00:18:25,512 --> 00:18:28,272 But it's when children and other vulnerable family members are 377 00:18:28,272 --> 00:18:29,802 present, that is a big concern. 378 00:18:30,552 --> 00:18:32,502 And we can't treat postictal signs. 379 00:18:32,622 --> 00:18:34,842 We can only manage the seizure activity. 380 00:18:35,022 --> 00:18:38,802 So the fewer seizures you have, the less this aggression will be seen. 381 00:18:39,387 --> 00:18:41,957 So it all comes back down to the medication and what 382 00:18:41,957 --> 00:18:43,197 we can do to help with that. 383 00:18:43,287 --> 00:18:43,647 Dr Emma Hancox: Yeah. 384 00:18:43,917 --> 00:18:44,727 Oh, that makes sense. 385 00:18:45,567 --> 00:18:48,717 And picking up on what you said about them being outside 386 00:18:48,877 --> 00:18:50,527 can we still enjoy our walks? 387 00:18:50,527 --> 00:18:52,027 Can we still go out for the day? 388 00:18:52,027 --> 00:18:53,617 Can we still do all of these things? 389 00:18:53,617 --> 00:18:58,407 And I think we don't want to see epilepsy as a life sentence for these dogs. 390 00:18:59,227 --> 00:19:02,197 We're all here for them to have a good quality of life at the end of the day. 391 00:19:02,557 --> 00:19:05,497 Dr Mark Lowrie: Absolutely, and I think there's two things I'd add there, but 392 00:19:05,497 --> 00:19:09,757 the first one would be I’ve said that I'm a good anti-epileptic medication. 393 00:19:10,027 --> 00:19:14,557 My second top tip here is taking dogs for a walk is a great anti-epileptic strategy. 394 00:19:15,457 --> 00:19:17,212 It's not endorsed by anybody other than myself. 395 00:19:17,212 --> 00:19:22,132 It is only my opinion, but I think taking a dog out on a walk, if they 396 00:19:22,132 --> 00:19:25,072 are about to have a fit, as long as you've not caught it too late, I think 397 00:19:25,072 --> 00:19:26,692 it can offset that seizure for a bit. 398 00:19:26,902 --> 00:19:29,512 Importantly, I think it offsets it rather than prevents it. 399 00:19:30,112 --> 00:19:33,262 But going out on a walk is a great activity to do. 400 00:19:33,382 --> 00:19:34,642 I would be very happy to do it. 401 00:19:35,182 --> 00:19:39,502 And then the second point would be dogs with epilepsy, they are really 402 00:19:39,562 --> 00:19:43,592 normal dogs otherwise, so they, they can go about a normal life. 403 00:19:43,622 --> 00:19:46,382 I can think of dogs I’ve treated where they're sniffer dogs, they 404 00:19:46,382 --> 00:19:47,672 sniff out drugs and do all that 405 00:19:47,672 --> 00:19:48,302 brilliantly. 406 00:19:49,022 --> 00:19:51,482 but their life's interspersed with the odd fit here and there. 407 00:19:51,572 --> 00:19:55,082 They're on medication, they're managed, they have a great quality of life and 408 00:19:55,082 --> 00:19:56,282 they're doing a brilliant service. 409 00:19:56,432 --> 00:19:56,822 Dr Emma Hancox: Yeah. 410 00:19:57,152 --> 00:19:59,852 Dr Mark Lowrie: So that should be enough for these owners that are 411 00:19:59,852 --> 00:20:04,772 faced with a diagnosis of idiopathic epilepsy, that actually their dog 412 00:20:04,772 --> 00:20:06,512 should have a good quality of life. 413 00:20:07,832 --> 00:20:11,102 Dr Emma Hancox: It almost doesn't make sense to me though, because when 414 00:20:11,102 --> 00:20:16,172 I think about seizure activity, it's almost described as too much activity. 415 00:20:16,172 --> 00:20:21,572 So why then stimulating them and going out for a walk and getting 416 00:20:21,572 --> 00:20:24,872 them to hear things and do things and how does that stave it off? 417 00:20:24,872 --> 00:20:26,282 That's just fascinating to me. 418 00:20:26,282 --> 00:20:27,152 I guess we don't know. 419 00:20:27,332 --> 00:20:29,642 Dr Mark Lowrie: And we don't know and I think, no, I think 420 00:20:29,642 --> 00:20:32,162 it's a really fair question and I think it's important to say. 421 00:20:32,577 --> 00:20:35,607 it's all right if so, if you litreally see your dog about to go into a 422 00:20:35,607 --> 00:20:37,387 fit, this strategy isn't gonna work. 423 00:20:37,497 --> 00:20:38,487 you’re already too late. 424 00:20:38,487 --> 00:20:41,577 So I think if you are getting the aura of signs that a fit's 425 00:20:41,577 --> 00:20:42,747 about to come on, it's too late. 426 00:20:42,747 --> 00:20:46,917 But I think just distracting a dog with other activities, it just, it's 427 00:20:46,922 --> 00:20:49,707 a way of allowing the body to function normally and it stops it happening. 428 00:20:50,067 --> 00:20:52,647 But yeah, I have to be honest to say we don't know why it 429 00:20:52,667 --> 00:20:55,217 works and it's not proven either. 430 00:20:55,257 --> 00:20:57,387 This is my view but it seems to work well. 431 00:20:57,387 --> 00:20:59,627 Dr Emma Hancox: So your two treatments that you’re advocate in here is 432 00:20:59,632 --> 00:21:01,007 you and going out for a walk. 433 00:21:01,112 --> 00:21:03,582 Dr Mark Lowrie: It's great, so much, you'll be out of business as a company 434 00:21:03,832 --> 00:21:04,937 Dr Emma Hancox: We're going be, aren't we? 435 00:21:05,297 --> 00:21:06,407 Why did we invite you again? 436 00:21:07,887 --> 00:21:08,427 Oh dear. 437 00:21:08,837 --> 00:21:13,902 on the flip side of that though, is it true that stressful environments, 438 00:21:13,902 --> 00:21:17,952 so vet visits and things like that, increase the risk of seizures? 439 00:21:17,952 --> 00:21:22,632 I think that's a concern of peoples, whether that be vets or owners. 440 00:21:22,632 --> 00:21:24,042 I just use the word people there. 441 00:21:24,372 --> 00:21:25,032 Is that true? 442 00:21:25,032 --> 00:21:25,782 Do you see that? 443 00:21:26,742 --> 00:21:26,922 Dr Mark Lowrie: Yeah, 444 00:21:27,072 --> 00:21:32,622 it's quite rare, and seizures happen more commonly in relaxed environments, but 445 00:21:32,622 --> 00:21:37,002 there's absolutely no question we come across the odd patient that it clearly, 446 00:21:37,432 --> 00:21:39,592 the fit has a clear, stressful trigger. 447 00:21:39,952 --> 00:21:45,512 So going into a vet we'll have dogs that maybe require some kind of sedative 448 00:21:45,512 --> 00:21:49,202 or anti-epileptic medication before arriving to try and offset that fit. 449 00:21:49,787 --> 00:21:52,517 It is rare, and it's not a common finding, but it does occur. 450 00:21:52,887 --> 00:21:55,427 And other fits, they're called reflex seizures. 451 00:21:56,297 --> 00:21:59,057 They're seizures that happen in response to a stimulus. 452 00:21:59,057 --> 00:22:03,167 So there was a dog I saw once that it was going outside that actually triggered 453 00:22:03,167 --> 00:22:05,227 a seizure, it was remarkably reliable. 454 00:22:05,247 --> 00:22:09,507 So that dog, I wouldn't have taken for a walk to stop the fit, but they'd 455 00:22:09,512 --> 00:22:13,197 go out and the light outside would just trigger a seizure, but take 456 00:22:13,197 --> 00:22:14,667 them at nighttime and it was fine. 457 00:22:15,912 --> 00:22:16,932 And noise. 458 00:22:16,962 --> 00:22:21,332 Noise is another one that can trigger off epilepsy in dogs and cats. 459 00:22:21,842 --> 00:22:23,732 And it's often not the kind of noises you'd think. 460 00:22:23,732 --> 00:22:27,782 I'm not talking loud banging noises,I'm talking subtle noises. 461 00:22:27,782 --> 00:22:30,842 And in cats in particular, it can be keys. 462 00:22:30,872 --> 00:22:31,667 The jangling of 463 00:22:31,667 --> 00:22:31,777 keys 464 00:22:31,777 --> 00:22:33,352 Dr Emma Hancox: Oh, Or the rustling of something or... 465 00:22:33,362 --> 00:22:36,252 Dr Mark Lowrie: You've got it, and banging a fork against a ceramic bowl. 466 00:22:36,252 --> 00:22:36,402 What? 467 00:22:36,402 --> 00:22:40,332 Banging is a strong word, gently tapping would trigger these things. 468 00:22:40,332 --> 00:22:41,892 So there are definitely, 469 00:22:41,992 --> 00:22:43,472 Dr Emma Hancox: I wonder whether it's to do with sound 470 00:22:43,522 --> 00:22:44,672 waves or something like that? 471 00:22:44,892 --> 00:22:47,482 Dr Mark Lowrie: And in cats it's fascinating 'cause it's older cats 472 00:22:47,482 --> 00:22:52,282 that tend to get it usually in the second decade of life and half of 473 00:22:52,287 --> 00:22:55,312 the cats that get this are actually deaf, which is unbelievable. 474 00:22:55,317 --> 00:22:57,007 Dr Emma Hancox: That's, even more remarkable. 475 00:22:57,637 --> 00:22:58,897 This is blowing my mind, Mark. 476 00:22:58,897 --> 00:22:59,527 I'm not gonna lie! 477 00:23:00,142 --> 00:23:02,752 Dr Mark Lowrie: It blew my mind and I can't explain it, but I think 478 00:23:02,752 --> 00:23:05,992 sometimes it is, there's, it's the frequency of the sound in particular. 479 00:23:05,997 --> 00:23:09,562 So it's not shouting or being loud that's triggering. 480 00:23:09,567 --> 00:23:13,302 It's a subtle sound that may be still the wavelength is such that it's 481 00:23:13,302 --> 00:23:15,252 still detected in these deaf patients. 482 00:23:15,252 --> 00:23:17,532 But yeah, it's a real can of worms. 483 00:23:17,532 --> 00:23:21,432 Some of these seizure triggers and it comes back to that really awful answer 484 00:23:21,432 --> 00:23:25,247 of we don't know, but if an owner knows, we don't know, we're being honest. 485 00:23:25,392 --> 00:23:28,902 We're being open, we're being honest, and I think that's really vital to help 486 00:23:28,902 --> 00:23:33,402 that relationship and help work through the difficult situation of epilepsy. 487 00:23:34,317 --> 00:23:37,197 Dr Emma Hancox: And so how often, again, something I see on these Facebook 488 00:23:37,197 --> 00:23:43,052 groups is, how has anyone been able to find a trigger for their pets seizure? 489 00:23:44,232 --> 00:23:47,157 How often do you think that we'll find those? 490 00:23:47,157 --> 00:23:50,847 I know that's really difficult to try and put a number to, but do 491 00:23:50,847 --> 00:23:53,727 you think owners should be like, I get the feeling some of them are 492 00:23:53,727 --> 00:23:58,437 fixated sometimes on trying to find a trigger or a cause for that seizure. 493 00:23:59,517 --> 00:24:03,147 I was under the impression most of them are just spontaneous. 494 00:24:03,147 --> 00:24:06,777 We don't know when they're going to happen unpredictable, but perhaps there are some 495 00:24:06,777 --> 00:24:10,317 triggers in some, could you put a number to those or is that really difficult? 496 00:24:10,752 --> 00:24:13,752 Dr Mark Lowrie: A number is hard, but I think it's fair to say it's 497 00:24:13,782 --> 00:24:15,522 really rare we find a trigger. 498 00:24:15,642 --> 00:24:17,432 Now, I don't think that's because we're not looking. 499 00:24:18,477 --> 00:24:19,437 Owners are very good 500 00:24:19,437 --> 00:24:24,087 at noting when the fits were, seeing if there's a relationship with 501 00:24:24,087 --> 00:24:28,497 feeding, with activity, with time of day, and I'd encourage them to do 502 00:24:28,497 --> 00:24:31,647 that because sometimes it does allow us to find out what's happening. 503 00:24:32,217 --> 00:24:36,927 A great case I can think of that I saw a number of years ago now was a dog that 504 00:24:36,927 --> 00:24:41,877 always had a fit at half past seven on a Thursday morning, every week reliably. 505 00:24:42,567 --> 00:24:43,747 So there's a clear pattern. 506 00:24:44,577 --> 00:24:45,127 But why? 507 00:24:45,317 --> 00:24:47,917 And so the owners didn't know why at all. 508 00:24:47,977 --> 00:24:49,297 We treated the dog with medication. 509 00:24:49,297 --> 00:24:52,697 It didn't seem to make any difference, but then they moved house. 510 00:24:53,567 --> 00:24:57,522 And when they moved house, it happened at 10 o'clock on a Tuesday morning 511 00:24:58,002 --> 00:24:58,712 and it was always 512 00:24:58,712 --> 00:25:00,722 Dr Emma Hancox: I feel it's the binmen or something that. 513 00:25:00,722 --> 00:25:01,622 Dr Mark Lowrie: How did you know? 514 00:25:01,622 --> 00:25:03,862 Dr Emma Hancox: I just was trying to think of something that happened every week. 515 00:25:03,862 --> 00:25:05,552 Sorry, I’ve taken your thunder away there. 516 00:25:05,852 --> 00:25:06,692 Dr Mark Lowrie: No, fantastic. 517 00:25:06,692 --> 00:25:07,592 But it's things like that. 518 00:25:07,592 --> 00:25:10,172 So it was, it's, the bin men arrived at the house. 519 00:25:10,172 --> 00:25:12,452 It was stressful for the dog and it triggered a fit. 520 00:25:12,632 --> 00:25:14,972 So silly things like that. 521 00:25:15,032 --> 00:25:17,112 And, it's, it was only the move of house that made them 522 00:25:17,112 --> 00:25:18,672 realise there is something here. 523 00:25:18,672 --> 00:25:20,562 What's the same in both situations. 524 00:25:20,592 --> 00:25:21,702 It's clearly not time of day. 525 00:25:21,707 --> 00:25:23,252 There's something happening at time of the day. 526 00:25:23,312 --> 00:25:24,752 Dr Emma Hancox: How are they ever gonna avoid that? 527 00:25:24,752 --> 00:25:26,702 They're just gonna have to put their bins somewhere else. 528 00:25:26,772 --> 00:25:28,882 Dr Mark Lowrie: They had to go to the tip themselves, just just 529 00:25:28,882 --> 00:25:29,982 go and, empty their own bins 530 00:25:29,982 --> 00:25:31,302 Dr Emma Hancox: Oh, the things we do for our dogs. 531 00:25:33,942 --> 00:25:37,842 This is all really great information, but I'm just wondering 532 00:25:37,842 --> 00:25:39,042 how we're ever gonna do this. 533 00:25:39,282 --> 00:25:41,592 Going back to the very beginning, how we're gonna do it in such 534 00:25:41,592 --> 00:25:44,652 a short consultation time, what are the kind of key points that 535 00:25:44,657 --> 00:25:45,522 you would want to bring out? 536 00:25:46,017 --> 00:25:48,237 Dr Mark Lowrie: So when you've got the owner in the consult and you've got a 537 00:25:48,242 --> 00:25:52,707 very short period of time, there are key points you always have to mention. 538 00:25:52,917 --> 00:25:56,307 And it doesn't matter who the owner is, what the dog's doing. 539 00:25:57,147 --> 00:25:58,617 I think it's important to bring these across. 540 00:25:58,617 --> 00:26:01,017 Now you could provide this in a resource somewhere, a little 541 00:26:01,017 --> 00:26:04,947 leaflet, a downloadable, PDF what whatever the owners need. 542 00:26:05,967 --> 00:26:09,507 For me, I’ve said it already, but the number one thing is to say epilepsy 543 00:26:09,507 --> 00:26:11,427 is a chronic progressive disorder. 544 00:26:11,847 --> 00:26:13,767 These dogs aren't going to be fixed. 545 00:26:14,217 --> 00:26:18,957 We will talk about medication later on, but medication, and we're all guilty of 546 00:26:18,957 --> 00:26:21,152 it, we tend to use the word treatment 547 00:26:21,347 --> 00:26:22,997 Dr Emma Hancox: Yes, I'm guilty of that for sure 548 00:26:23,492 --> 00:26:25,412 Dr Mark Lowrie: When we say we're treating epilepsy. 549 00:26:25,802 --> 00:26:29,252 I personally feel, if I was an owner listening to a vet telling me they're 550 00:26:29,252 --> 00:26:32,537 going to treat my dog's epilepsy, that I'm gonna somehow get a cure. 551 00:26:32,927 --> 00:26:33,747 Dr Emma Hancox: Or you’re gonna fix it. 552 00:26:34,217 --> 00:26:36,077 Dr Mark Lowrie: We're gonna fix it and we can't fix it. 553 00:26:36,617 --> 00:26:39,707 So it's important to use, I try and use the word management. 554 00:26:40,127 --> 00:26:42,587 I think it's a more appropriate term, it's more understandable 555 00:26:42,947 --> 00:26:46,907 and it sets expectations, but epilepsy is going to continue. 556 00:26:47,477 --> 00:26:52,747 So the aim of managing seizures with medication is not to cure the seizures. 557 00:26:53,197 --> 00:26:55,727 It's to try and get them under some form of control. 558 00:26:56,477 --> 00:26:58,547 A quick fix is really unlikely. 559 00:26:59,207 --> 00:27:02,957 And an owner will have to expect to have fairly frequent visits to the 560 00:27:02,957 --> 00:27:05,307 vet to get some modicum of control. 561 00:27:05,452 --> 00:27:06,182 That's really important. 562 00:27:06,722 --> 00:27:09,092 Dr Emma Hancox: It's not just gonna be a course of medication and then stop. 563 00:27:09,482 --> 00:27:11,812 Dr Mark Lowrie: No, and I’ve known that, dogs will be given, 564 00:27:11,917 --> 00:27:13,142 prescribed, phenobarbital. 565 00:27:13,262 --> 00:27:16,442 They'll go away for two weeks with a two week course of phenobarbital. 566 00:27:17,222 --> 00:27:20,672 And because the owner hasn't understood, it's not the, it's not the vet's fault, 567 00:27:20,672 --> 00:27:23,992 it's because probably that owner was very stressed in the moment they've done it 568 00:27:24,062 --> 00:27:25,682 two weeks, they've stopped the medication. 569 00:27:26,417 --> 00:27:29,207 Then we know what goes on then, we get withdrawal seizures, 570 00:27:29,477 --> 00:27:30,797 the whole situation gets worse. 571 00:27:31,187 --> 00:27:34,067 So owners need to know any medication you give is life long. 572 00:27:35,207 --> 00:27:38,447 I think it's also important to say that adverse effects from the 573 00:27:38,447 --> 00:27:40,027 medication are really, really common. 574 00:27:40,707 --> 00:27:45,407 So all antiepileptic medication, despite what anybody says, will 575 00:27:45,407 --> 00:27:47,747 have some form of side effect. 576 00:27:48,287 --> 00:27:51,527 Now, hopefully that's mild and it's tolerable to the owners 577 00:27:51,557 --> 00:27:52,717 and it's tolerable to the dog. 578 00:27:53,567 --> 00:27:56,387 But we know that there are some dogs that are a bit more susceptible to 579 00:27:56,387 --> 00:27:57,857 those adverse effects than others. 580 00:27:58,577 --> 00:28:01,727 And if you've got a dog with loads and loads of fits, owners will 581 00:28:01,727 --> 00:28:04,767 tolerate more side effects than those dogs that maybe just have one fit 582 00:28:04,792 --> 00:28:07,107 every 6 to 12 weeks so it varies a lot. 583 00:28:07,177 --> 00:28:10,277 So owners need to know that sort thing too. 584 00:28:10,567 --> 00:28:15,727 And I think making sure owners know not to stop medication 585 00:28:15,777 --> 00:28:17,467 suddenly in any circumstance. 586 00:28:17,947 --> 00:28:21,087 You can stop medication, but it really needs to be done under veterinary 587 00:28:21,087 --> 00:28:24,417 guidance and carefully and ideally slowly. 588 00:28:24,867 --> 00:28:27,597 There will be situations when it needs to be stopped suddenly, if 589 00:28:27,597 --> 00:28:30,957 there are terrible adverse effects, life-threatening, adverse effects. 590 00:28:31,317 --> 00:28:32,097 But that's really rare. 591 00:28:32,537 --> 00:28:34,977 Phenobarbital is a very safe medication. 592 00:28:35,367 --> 00:28:37,197 I think it's got a lot of bad press. 593 00:28:37,707 --> 00:28:40,937 I say, vets seem to, I'm gonna include myself in this. 594 00:28:41,597 --> 00:28:44,297 I'm quite happy to give out steroids quite frequently. 595 00:28:44,297 --> 00:28:45,707 I'm a neurologist, that's what I do. 596 00:28:46,997 --> 00:28:47,778 So steroids are 597 00:28:47,793 --> 00:28:51,183 given out frequently and almost, dare I say it, like sweets. 598 00:28:51,663 --> 00:28:54,453 Whereas phenobarbital, people are a lot more reserved and concerned 599 00:28:54,453 --> 00:28:58,083 by, I dunno why, because I feel phenobarbital is much safer medication. 600 00:28:58,188 --> 00:28:58,668 Dr Emma Hancox: It's so true. 601 00:28:58,668 --> 00:29:03,088 I’ve never thought about it like that, but I'm nodding my head vigorously over here, 602 00:29:04,633 --> 00:29:07,248 Dr Mark Lowrie: So I think it's important for vets to understand that yes, they 603 00:29:07,248 --> 00:29:08,838 are worried prescribing phenobarbital. 604 00:29:09,143 --> 00:29:13,313 due to its safety profile, but actually it's much, much better than other 605 00:29:13,523 --> 00:29:15,473 routinely used medications in practice. 606 00:29:15,473 --> 00:29:17,663 I'd want to make that point so people are aware 607 00:29:18,283 --> 00:29:18,793 Dr Emma Hancox: Perfect. 608 00:29:19,203 --> 00:29:23,413 And I think actually we're gonna pick up on, measurements and management 609 00:29:23,413 --> 00:29:27,193 of things like that of phenobarbital in our next episode as well. 610 00:29:27,193 --> 00:29:27,803 I think. 611 00:29:27,933 --> 00:29:28,613 Dr Mark Lowrie: I can't wait. 612 00:29:28,843 --> 00:29:29,263 Dr Emma Hancox: I know. 613 00:29:29,323 --> 00:29:29,833 Same. 614 00:29:30,293 --> 00:29:31,043 Thank you Mark. 615 00:29:31,103 --> 00:29:34,133 I think that's probably all we've got time for in this first episode, 616 00:29:34,133 --> 00:29:37,823 but it has been really great speaking with you and finding out what we can 617 00:29:37,828 --> 00:29:39,443 learn from the, from these experts. 618 00:29:39,773 --> 00:29:42,863 Hopefully our listeners have found it as fascinating as I have, those triggers 619 00:29:42,863 --> 00:29:45,983 that we were talking about, it's really fascinating for me and please tune into 620 00:29:45,988 --> 00:29:49,763 our next episode where we were moving on to the second instalment of the 621 00:29:49,763 --> 00:29:51,203 S.M.A.R.T Approach, which is Measure. 622 00:29:51,203 --> 00:29:54,833 So hopefully we can pick back up that conversation that we maybe 623 00:29:54,833 --> 00:29:58,613 just alluded to, where it comes to phenobarbital, adverse effects and 624 00:29:58,613 --> 00:30:00,173 monitoring and things like that as well. 625 00:30:00,623 --> 00:30:03,563 Obviously, we'll be joined once again by Mark to discuss the importance 626 00:30:03,563 --> 00:30:05,473 of, managing our epileptic patients. 627 00:30:05,743 --> 00:30:06,433 Thanks again, Mark. 628 00:30:06,673 --> 00:30:07,288 Dr Mark Lowrie: Thanks, Emma. 629 00:30:07,483 --> 00:30:07,873 Dr Emma Hancox: Thanks. 630 00:30:07,873 --> 00:30:08,323 See you soon.