{"version":"1.0.0","segments":[{"speaker":"Nathalie Dowgray","startTime":5.01,"endTime":8.52,"body":"Hello, welcome"},{"speaker":"Nathalie Dowgray","startTime":5.01,"endTime":8.52,"body":"to the March 2023 episode of"},{"speaker":"Nathalie Dowgray","startTime":8.52,"endTime":12.96,"body":"Chattering with ISFM. I’m"},{"speaker":"Nathalie Dowgray","startTime":8.52,"endTime":12.96,"body":"Nathalie Dowgray, Head of ISFM"},{"speaker":"Nathalie Dowgray","startTime":12.99,"endTime":16.56,"body":"and host of this months podcast."},{"speaker":"Nathalie Dowgray","startTime":12.99,"endTime":16.56,"body":"This month we are sharing"},{"speaker":"Nathalie Dowgray","startTime":16.56,"endTime":19.68,"body":"another of our in conversation"},{"speaker":"Nathalie Dowgray","startTime":16.56,"endTime":19.68,"body":"with sessions that were recorded"},{"speaker":"Nathalie Dowgray","startTime":19.68,"endTime":23.91,"body":"live at our Rhodes congress last"},{"speaker":"Nathalie Dowgray","startTime":19.68,"endTime":23.91,"body":"year. Dr Sam Taylor is speaking"},{"speaker":"Nathalie Dowgray","startTime":23.91,"endTime":28.11,"body":"with Dr Matt Gurney on feline"},{"speaker":"Nathalie Dowgray","startTime":23.91,"endTime":28.11,"body":"pain management and we are also"},{"speaker":"Nathalie Dowgray","startTime":28.11,"endTime":31.05,"body":"featuring our monthly JFMS"},{"speaker":"Nathalie Dowgray","startTime":28.11,"endTime":31.05,"body":"clinical spotlight interview."},{"speaker":"Nathalie Dowgray","startTime":31.65,"endTime":35.52,"body":"This month I’m speaking with Dr"},{"speaker":"Nathalie Dowgray","startTime":31.65,"endTime":35.52,"body":"Zoë Halfacree on feline urinary"},{"speaker":"Nathalie Dowgray","startTime":35.52,"endTime":38.37,"body":"tract trauma. We hope you enjoy"},{"speaker":"Nathalie Dowgray","startTime":35.52,"endTime":38.37,"body":"this episode."},{"speaker":"Sam Taylor","startTime":38.0,"endTime":45.2,"body":"So Matt is the"},{"speaker":"Sam Taylor","startTime":38.0,"endTime":45.2,"body":"clinical director at Anderson"},{"speaker":"Sam Taylor","startTime":45.2,"endTime":48.53,"body":"Moores Vet Specialists. And I"},{"speaker":"Sam Taylor","startTime":45.2,"endTime":48.53,"body":"think as you all know, he's an"},{"speaker":"Sam Taylor","startTime":48.53,"endTime":53.45,"body":"RCVS and European specialist in"},{"speaker":"Sam Taylor","startTime":48.53,"endTime":53.45,"body":"anaesthesia and analgesia. He's"},{"speaker":"Sam Taylor","startTime":53.45,"endTime":56.09,"body":"very passionate about pain"},{"speaker":"Sam Taylor","startTime":53.45,"endTime":56.09,"body":"management and does lots of"},{"speaker":"Sam Taylor","startTime":56.09,"endTime":59.87,"body":"lectures on this subject and we"},{"speaker":"Sam Taylor","startTime":56.09,"endTime":59.87,"body":"know him also as the co founder"},{"speaker":"Sam Taylor","startTime":59.87,"endTime":64.01,"body":"of zero pain philosophy."},{"speaker":"Sam Taylor","startTime":59.87,"endTime":64.01,"body":"Subcutaneous low dose ketamine."},{"speaker":"Sam Taylor","startTime":64.19,"endTime":69.14,"body":"Can you tell us a bit about how"},{"speaker":"Sam Taylor","startTime":64.19,"endTime":69.14,"body":"that works? Why it works? When"},{"speaker":"Sam Taylor","startTime":69.14,"endTime":71.99,"body":"you use it? Yeah, what are the"},{"speaker":"Sam Taylor","startTime":69.14,"endTime":71.99,"body":"indications for this?"},{"speaker":"Matt Gurney","startTime":73.49,"endTime":75.74,"body":"I'd love to be able"},{"speaker":"Matt Gurney","startTime":73.49,"endTime":75.74,"body":"to tell you how it works and why"},{"speaker":"Matt Gurney","startTime":75.74,"endTime":79.76,"body":"it works bit I don't honestly"},{"speaker":"Matt Gurney","startTime":75.74,"endTime":79.76,"body":"know. I first used subcutaneous"},{"speaker":"Matt Gurney","startTime":79.76,"endTime":85.49,"body":"ketamine in a dog, it was a dog"},{"speaker":"Matt Gurney","startTime":79.76,"endTime":85.49,"body":"with lumbosacral disease. And"},{"speaker":"Matt Gurney","startTime":85.55,"endTime":89.42,"body":"this dog was struggling on"},{"speaker":"Matt Gurney","startTime":85.55,"endTime":89.42,"body":"nonsteroidals and I can't"},{"speaker":"Matt Gurney","startTime":89.42,"endTime":94.07,"body":"remember what else we'd added."},{"speaker":"Matt Gurney","startTime":89.42,"endTime":94.07,"body":"And we gave the dog 0.5mg/kg of"},{"speaker":"Matt Gurney","startTime":94.07,"endTime":98.99,"body":"ketamine subcutaneously. And it"},{"speaker":"Matt Gurney","startTime":94.07,"endTime":98.99,"body":"made a difference. And we said,"},{"speaker":"Matt Gurney","startTime":99.08,"endTime":101.36,"body":"okay, fine, let's just work out"},{"speaker":"Matt Gurney","startTime":99.08,"endTime":101.36,"body":"how long this makes a difference"},{"speaker":"Matt Gurney","startTime":101.36,"endTime":105.53,"body":"for. And he ended up having"},{"speaker":"Matt Gurney","startTime":101.36,"endTime":105.53,"body":"0.5mg per/kg subcutaneously"},{"speaker":"Matt Gurney","startTime":105.53,"endTime":110.84,"body":"every month. And this went on"},{"speaker":"Matt Gurney","startTime":105.53,"endTime":110.84,"body":"for 18 months, two years. And"},{"speaker":"Matt Gurney","startTime":110.84,"endTime":114.17,"body":"then he became progressively"},{"speaker":"Matt Gurney","startTime":110.84,"endTime":114.17,"body":"more painful. And we started"},{"speaker":"Matt Gurney","startTime":114.17,"endTime":117.44,"body":"doing this every two weeks, and"},{"speaker":"Matt Gurney","startTime":114.17,"endTime":117.44,"body":"then every one week and then"},{"speaker":"Matt Gurney","startTime":117.44,"endTime":120.83,"body":"when we got to every one week"},{"speaker":"Matt Gurney","startTime":117.44,"endTime":120.83,"body":"stage, she said look, I know"},{"speaker":"Matt Gurney","startTime":120.83,"endTime":124.88,"body":"that we're getting right to the"},{"speaker":"Matt Gurney","startTime":120.83,"endTime":124.88,"body":"end. And this is my line in the"},{"speaker":"Matt Gurney","startTime":124.88,"endTime":128.06,"body":"sand to say that enough is"},{"speaker":"Matt Gurney","startTime":124.88,"endTime":128.06,"body":"enough. So that's an example of"},{"speaker":"Matt Gurney","startTime":128.06,"endTime":132.05,"body":"where we went from managing him"},{"speaker":"Matt Gurney","startTime":128.06,"endTime":132.05,"body":"on a monthly basis right into a"},{"speaker":"Matt Gurney","startTime":132.05,"endTime":135.71,"body":"kind of palliative setting."},{"speaker":"Matt Gurney","startTime":132.05,"endTime":135.71,"body":"Really, for me that was the sort"},{"speaker":"Matt Gurney","startTime":135.71,"endTime":140.45,"body":"of basis of my use of ketamine."},{"speaker":"Matt Gurney","startTime":135.71,"endTime":140.45,"body":"I have used it in cats since. I"},{"speaker":"Matt Gurney","startTime":140.45,"endTime":146.39,"body":"use a slightly lower dose, I use"},{"speaker":"Matt Gurney","startTime":140.45,"endTime":146.39,"body":"0.3mg/kg in cats. And he"},{"speaker":"Matt Gurney","startTime":146.39,"endTime":149.42,"body":"responds very well to that. And"},{"speaker":"Matt Gurney","startTime":146.39,"endTime":149.42,"body":"if we're going to do anything"},{"speaker":"Matt Gurney","startTime":149.45,"endTime":154.82,"body":"novel, or we're not quite 100%"},{"speaker":"Matt Gurney","startTime":149.45,"endTime":154.82,"body":"sure about, let's identify those"},{"speaker":"Matt Gurney","startTime":154.82,"endTime":158.42,"body":"behaviours. What are the pain"},{"speaker":"Matt Gurney","startTime":154.82,"endTime":158.42,"body":"behaviours in that individual"},{"speaker":"Matt Gurney","startTime":158.42,"endTime":161.27,"body":"patient. Have a conversation"},{"speaker":"Matt Gurney","startTime":158.42,"endTime":161.27,"body":"with the owner, work out three"},{"speaker":"Matt Gurney","startTime":161.27,"endTime":165.29,"body":"to five pain behaviours, make"},{"speaker":"Matt Gurney","startTime":161.27,"endTime":165.29,"body":"your intervention, reassess"},{"speaker":"Matt Gurney","startTime":165.29,"endTime":169.49,"body":"using those pain behaviours. And"},{"speaker":"Matt Gurney","startTime":165.29,"endTime":169.49,"body":"whatever else the owner notices"},{"speaker":"Matt Gurney","startTime":169.49,"endTime":173.06,"body":"in the meantime, you can"},{"speaker":"Matt Gurney","startTime":169.49,"endTime":173.06,"body":"guarantee, the minute you"},{"speaker":"Matt Gurney","startTime":173.24,"endTime":176.69,"body":"trigger an owner in a consult to"},{"speaker":"Matt Gurney","startTime":173.24,"endTime":176.69,"body":"start thinking about behaviours,"},{"speaker":"Matt Gurney","startTime":176.93,"endTime":180.02,"body":"they go away, and then they"},{"speaker":"Matt Gurney","startTime":176.93,"endTime":180.02,"body":"notice things. We definitely"},{"speaker":"Matt Gurney","startTime":180.02,"endTime":183.2,"body":"need to get to the stage where"},{"speaker":"Matt Gurney","startTime":180.02,"endTime":183.2,"body":"we can start a prospective"},{"speaker":"Matt Gurney","startTime":183.23,"endTime":185.96,"body":"study. I don't think we can"},{"speaker":"Matt Gurney","startTime":183.23,"endTime":185.96,"body":"really run that against a"},{"speaker":"Matt Gurney","startTime":185.96,"endTime":188.54,"body":"placebo because that'd be"},{"speaker":"Matt Gurney","startTime":185.96,"endTime":188.54,"body":"challenging from an ethics point"},{"speaker":"Matt Gurney","startTime":188.54,"endTime":191.48,"body":"of view. We probably need to do"},{"speaker":"Matt Gurney","startTime":188.54,"endTime":191.48,"body":"a group that have subcutaneous"},{"speaker":"Matt Gurney","startTime":191.48,"endTime":194.84,"body":"ketamine and subcutaneous"},{"speaker":"Matt Gurney","startTime":191.48,"endTime":194.84,"body":"methadone maybe, methadone is"},{"speaker":"Matt Gurney","startTime":194.84,"endTime":197.45,"body":"licensed to be used"},{"speaker":"Matt Gurney","startTime":194.84,"endTime":197.45,"body":"subcutaneously. So, I think you"},{"speaker":"Matt Gurney","startTime":197.45,"endTime":201.41,"body":"could arguably say that that is"},{"speaker":"Matt Gurney","startTime":197.45,"endTime":201.41,"body":"a suitable control treatment."},{"speaker":"Matt Gurney","startTime":202.58,"endTime":207.14,"body":"Ketamine is what we refer to as"},{"speaker":"Matt Gurney","startTime":202.58,"endTime":207.14,"body":"the antihyperalgesic. So when we"},{"speaker":"Matt Gurney","startTime":207.14,"endTime":211.97,"body":"have a central sensitization and"},{"speaker":"Matt Gurney","startTime":207.14,"endTime":211.97,"body":"activation of the NMDA receptor,"},{"speaker":"Matt Gurney","startTime":211.97,"endTime":215.18,"body":"it's the NMDA receptor that we"},{"speaker":"Matt Gurney","startTime":211.97,"endTime":215.18,"body":"think we're switching off with"},{"speaker":"Matt Gurney","startTime":215.18,"endTime":219.8,"body":"ketamine. Although ketamine does"},{"speaker":"Matt Gurney","startTime":215.18,"endTime":219.8,"body":"have a lot of other actions. So"},{"speaker":"Matt Gurney","startTime":219.83,"endTime":224.9,"body":"actually, this effect, it could"},{"speaker":"Matt Gurney","startTime":219.83,"endTime":224.9,"body":"be another receptor, or ion"},{"speaker":"Matt Gurney","startTime":224.9,"endTime":227.78,"body":"channel action rather than an"},{"speaker":"Matt Gurney","startTime":224.9,"endTime":227.78,"body":"NMDA action we're talking about"},{"speaker":"Matt Gurney","startTime":227.78,"endTime":233.18,"body":"with subcut ketamine. With"},{"speaker":"Matt Gurney","startTime":227.78,"endTime":233.18,"body":"central sensitization, we see a"},{"speaker":"Matt Gurney","startTime":233.18,"endTime":237.35,"body":"general sensitivity so we see"},{"speaker":"Matt Gurney","startTime":233.18,"endTime":237.35,"body":"allodynia hyperalgesia, we're"},{"speaker":"Matt Gurney","startTime":237.35,"endTime":240.47,"body":"looking to drive down that"},{"speaker":"Matt Gurney","startTime":237.35,"endTime":240.47,"body":"hyperalgesia with our use of"},{"speaker":"Matt Gurney","startTime":240.71,"endTime":244.25,"body":"medications that target the NMDA"},{"speaker":"Matt Gurney","startTime":240.71,"endTime":244.25,"body":"receptor, hence the word"},{"speaker":"Matt Gurney","startTime":244.55,"endTime":249.17,"body":"antihyperalgesic rather than"},{"speaker":"Matt Gurney","startTime":244.55,"endTime":249.17,"body":"analgesic. Most of my"},{"speaker":"Matt Gurney","startTime":249.17,"endTime":254.24,"body":"experiences with a population"},{"speaker":"Matt Gurney","startTime":249.17,"endTime":254.24,"body":"coming into the hospital anyway"},{"speaker":"Matt Gurney","startTime":254.24,"endTime":257.75,"body":"that are suffering with pain, I"},{"speaker":"Matt Gurney","startTime":254.24,"endTime":257.75,"body":"think there are two categories"},{"speaker":"Matt Gurney","startTime":257.75,"endTime":260.87,"body":"there, there are those painful"},{"speaker":"Matt Gurney","startTime":257.75,"endTime":260.87,"body":"patients that are coming in for"},{"speaker":"Matt Gurney","startTime":261.14,"endTime":265.49,"body":"x procedure, absolutely. I would"},{"speaker":"Matt Gurney","startTime":261.14,"endTime":265.49,"body":"use ketamine in those patients."},{"speaker":"Matt Gurney","startTime":266.0,"endTime":269.72,"body":"In a general practice"},{"speaker":"Matt Gurney","startTime":266.0,"endTime":269.72,"body":"population, a chronic pain"},{"speaker":"Matt Gurney","startTime":269.72,"endTime":273.2,"body":"clinic population. If you're"},{"speaker":"Matt Gurney","startTime":269.72,"endTime":273.2,"body":"seeing those patients on a"},{"speaker":"Matt Gurney","startTime":273.2,"endTime":276.77,"body":"repeated basis, maybe you've"},{"speaker":"Matt Gurney","startTime":273.2,"endTime":276.77,"body":"tried subcutaneous ketamine, it"},{"speaker":"Matt Gurney","startTime":276.77,"endTime":279.44,"body":"doesn't work and I would always"},{"speaker":"Matt Gurney","startTime":276.77,"endTime":279.44,"body":"try that to start with because"},{"speaker":"Matt Gurney","startTime":279.44,"endTime":283.67,"body":"it's it's quick, easy, it's"},{"speaker":"Matt Gurney","startTime":279.44,"endTime":283.67,"body":"cheap. If that's not working, if"},{"speaker":"Matt Gurney","startTime":283.67,"endTime":286.31,"body":"you're just scratching your head"},{"speaker":"Matt Gurney","startTime":283.67,"endTime":286.31,"body":"with what do I do next with this"},{"speaker":"Matt Gurney","startTime":286.31,"endTime":289.34,"body":"patient? I would bring them into"},{"speaker":"Matt Gurney","startTime":286.31,"endTime":289.34,"body":"the hospital. I normally say a"},{"speaker":"Matt Gurney","startTime":289.37,"endTime":293.03,"body":"12 to 24 hours CRI, some people"},{"speaker":"Matt Gurney","startTime":289.37,"endTime":293.03,"body":"don't want to leave the pet"},{"speaker":"Matt Gurney","startTime":293.03,"endTime":296.54,"body":"overnight, so, and we don't"},{"speaker":"Matt Gurney","startTime":293.03,"endTime":296.54,"body":"honestly know, is 12 hours"},{"speaker":"Matt Gurney","startTime":296.54,"endTime":300.11,"body":"better? Is 24 hours better? We"},{"speaker":"Matt Gurney","startTime":296.54,"endTime":300.11,"body":"know in human clinics, they"},{"speaker":"Matt Gurney","startTime":300.11,"endTime":304.61,"body":"bring people in for the day. I"},{"speaker":"Matt Gurney","startTime":300.11,"endTime":304.61,"body":"think it varies from clinic to"},{"speaker":"Matt Gurney","startTime":304.61,"endTime":309.59,"body":"clinic how long people get those"},{"speaker":"Matt Gurney","startTime":304.61,"endTime":309.59,"body":"ketamine infusions for. So yes,"},{"speaker":"Matt Gurney","startTime":309.62,"endTime":313.28,"body":"it is definitely something that"},{"speaker":"Matt Gurney","startTime":309.62,"endTime":313.28,"body":"I think is worth doing in those"},{"speaker":"Matt Gurney","startTime":313.28,"endTime":315.32,"body":"chronically painful patients."},{"speaker":"Matt Gurney","startTime":313.28,"endTime":315.32,"body":"Definitely."},{"speaker":"Sam Taylor","startTime":315.83,"endTime":319.43,"body":"If you can't examine"},{"speaker":"Sam Taylor","startTime":315.83,"endTime":319.43,"body":"a cat, and you don't have any"},{"speaker":"Sam Taylor","startTime":319.43,"endTime":321.95,"body":"blood, so you don't have any"},{"speaker":"Sam Taylor","startTime":319.43,"endTime":321.95,"body":"sort of knowledge of its general"},{"speaker":"Sam Taylor","startTime":321.95,"endTime":326.39,"body":"health. What sedation protocol"},{"speaker":"Sam Taylor","startTime":321.95,"endTime":326.39,"body":"would you use in that situation?"},{"speaker":"Matt Gurney","startTime":326.54,"endTime":329.9,"body":"We are thinking a"},{"speaker":"Matt Gurney","startTime":326.54,"endTime":329.9,"body":"lot more about before that cat"},{"speaker":"Matt Gurney","startTime":329.93,"endTime":334.37,"body":"even comes into the clinic now"},{"speaker":"Matt Gurney","startTime":329.93,"endTime":334.37,"body":"and thinking about Gabapentin as"},{"speaker":"Matt Gurney","startTime":334.37,"endTime":339.77,"body":"part of the perianaesthetic care"},{"speaker":"Matt Gurney","startTime":334.37,"endTime":339.77,"body":"for a cat, I use 20 mgs/kg one"},{"speaker":"Matt Gurney","startTime":339.77,"endTime":344.45,"body":"or two hours before either the"},{"speaker":"Matt Gurney","startTime":339.77,"endTime":344.45,"body":"visit to the vet or we need to"},{"speaker":"Matt Gurney","startTime":344.45,"endTime":347.54,"body":"try and get that blood sample or"},{"speaker":"Matt Gurney","startTime":344.45,"endTime":347.54,"body":"get that IV. So I think there is"},{"speaker":"Matt Gurney","startTime":347.54,"endTime":352.1,"body":"a huge value to thinking ahead"},{"speaker":"Matt Gurney","startTime":347.54,"endTime":352.1,"body":"and using Gabapentin in those"},{"speaker":"Matt Gurney","startTime":352.1,"endTime":355.67,"body":"cases. We know that that's a"},{"speaker":"Matt Gurney","startTime":352.1,"endTime":355.67,"body":"suitable option in healthy cats."},{"speaker":"Matt Gurney","startTime":355.7,"endTime":358.64,"body":"We've studied that in"},{"speaker":"Matt Gurney","startTime":355.7,"endTime":358.64,"body":"hypothyroid cats, you can read"},{"speaker":"Matt Gurney","startTime":358.64,"endTime":364.22,"body":"that paper open access in JFMS."},{"speaker":"Matt Gurney","startTime":358.64,"endTime":364.22,"body":"And we also have a licenced"},{"speaker":"Matt Gurney","startTime":364.22,"endTime":368.27,"body":"pregabalin coming at some stage,"},{"speaker":"Matt Gurney","startTime":364.22,"endTime":368.27,"body":"so that's a fantastic option"},{"speaker":"Matt Gurney","startTime":368.51,"endTime":372.05,"body":"that we need to think about"},{"speaker":"Matt Gurney","startTime":368.51,"endTime":372.05,"body":"beforehand. If we then move on,"},{"speaker":"Matt Gurney","startTime":372.08,"endTime":373.64,"body":"we've then got to ask the"},{"speaker":"Matt Gurney","startTime":372.08,"endTime":373.64,"body":"question, what do we actually"},{"speaker":"Matt Gurney","startTime":373.64,"endTime":377.15,"body":"need to do with the cat? Are we"},{"speaker":"Matt Gurney","startTime":373.64,"endTime":377.15,"body":"then looking at subcutaneous"},{"speaker":"Matt Gurney","startTime":377.15,"endTime":381.44,"body":"option are we then looking at an"},{"speaker":"Matt Gurney","startTime":377.15,"endTime":381.44,"body":"intramuscular option? If you go"},{"speaker":"Matt Gurney","startTime":381.44,"endTime":386.12,"body":"on alfaxan.co.uk there is an"},{"speaker":"Matt Gurney","startTime":381.44,"endTime":386.12,"body":"article on IM alfaxalone in"},{"speaker":"Matt Gurney","startTime":386.12,"endTime":389.96,"body":"cats. It's got all of the"},{"speaker":"Matt Gurney","startTime":386.12,"endTime":389.96,"body":"options that are available"},{"speaker":"Matt Gurney","startTime":389.96,"endTime":393.2,"body":"there. We also talk about"},{"speaker":"Matt Gurney","startTime":389.96,"endTime":393.2,"body":"subcutaneous options. So there"},{"speaker":"Matt Gurney","startTime":393.2,"endTime":396.47,"body":"was a study from the University"},{"speaker":"Matt Gurney","startTime":393.2,"endTime":396.47,"body":"of Melbourne, and they looked at"},{"speaker":"Matt Gurney","startTime":396.5,"endTime":401.12,"body":"3mg/kg of alfaxalone and"},{"speaker":"Matt Gurney","startTime":396.5,"endTime":401.12,"body":"0.3mg/kg of butorphanol"},{"speaker":"Matt Gurney","startTime":401.12,"endTime":405.95,"body":"subcutaneously. The aim of that"},{"speaker":"Matt Gurney","startTime":401.12,"endTime":405.95,"body":"study was to get these cats"},{"speaker":"Matt Gurney","startTime":405.95,"endTime":409.7,"body":"relaxed enough that 45 minutes"},{"speaker":"Matt Gurney","startTime":405.95,"endTime":409.7,"body":"later, the cats could be pilled."},{"speaker":"Matt Gurney","startTime":409.88,"endTime":412.55,"body":"And they were still able to hold"},{"speaker":"Matt Gurney","startTime":409.88,"endTime":412.55,"body":"their heads up and swallow a"},{"speaker":"Matt Gurney","startTime":412.55,"endTime":416.36,"body":"pill. So it's a very mild level"},{"speaker":"Matt Gurney","startTime":412.55,"endTime":416.36,"body":"of sedation, but that might be"},{"speaker":"Matt Gurney","startTime":416.36,"endTime":421.4,"body":"suitable for your purposes. And"},{"speaker":"Matt Gurney","startTime":416.36,"endTime":421.4,"body":"then moving forward to needing a"},{"speaker":"Matt Gurney","startTime":421.4,"endTime":424.94,"body":"deeper level of sedation. We are"},{"speaker":"Matt Gurney","startTime":421.4,"endTime":424.94,"body":"really looking at intramuscular"},{"speaker":"Matt Gurney","startTime":424.94,"endTime":429.26,"body":"options in that circumstance."},{"speaker":"Matt Gurney","startTime":424.94,"endTime":429.26,"body":"And alfaxalone is a brilliant"},{"speaker":"Matt Gurney","startTime":429.26,"endTime":432.89,"body":"drug in those cases. For those"},{"speaker":"Matt Gurney","startTime":429.26,"endTime":432.89,"body":"ones, like you say Sam, we might"},{"speaker":"Matt Gurney","startTime":432.89,"endTime":435.65,"body":"not have bloods, we might not"},{"speaker":"Matt Gurney","startTime":432.89,"endTime":435.65,"body":"have an echo, maybe we know that"},{"speaker":"Matt Gurney","startTime":435.65,"endTime":440.03,"body":"cats got a murmur, but we can't"},{"speaker":"Matt Gurney","startTime":435.65,"endTime":440.03,"body":"touch it. The combination we"},{"speaker":"Matt Gurney","startTime":440.03,"endTime":443.09,"body":"tend to use for the feisty"},{"speaker":"Matt Gurney","startTime":440.03,"endTime":443.09,"body":"hypothyroid cats, so let's say"},{"speaker":"Matt Gurney","startTime":443.09,"endTime":445.79,"body":"we've given them gabapentin, and"},{"speaker":"Matt Gurney","startTime":443.09,"endTime":445.79,"body":"we've given them Trazodone as"},{"speaker":"Matt Gurney","startTime":445.79,"endTime":449.72,"body":"well. And we need to sedate our"},{"speaker":"Matt Gurney","startTime":445.79,"endTime":449.72,"body":"cats that come in to the"},{"speaker":"Matt Gurney","startTime":449.72,"endTime":454.22,"body":"radioactive iodine clinic, we"},{"speaker":"Matt Gurney","startTime":449.72,"endTime":454.22,"body":"need to do their bloods, we need"},{"speaker":"Matt Gurney","startTime":454.22,"endTime":457.1,"body":"to clip a patch on the back of"},{"speaker":"Matt Gurney","startTime":454.22,"endTime":457.1,"body":"their neck, we need to give them"},{"speaker":"Matt Gurney","startTime":457.1,"endTime":459.95,"body":"their their radioactive iodine"},{"speaker":"Matt Gurney","startTime":457.1,"endTime":459.95,"body":"injection, we need to do that in"},{"speaker":"Matt Gurney","startTime":459.95,"endTime":462.68,"body":"a safe manner. So none of our"},{"speaker":"Matt Gurney","startTime":459.95,"endTime":462.68,"body":"staff get injected with"},{"speaker":"Matt Gurney","startTime":462.68,"endTime":465.74,"body":"radioactive iodine. So we do"},{"speaker":"Matt Gurney","startTime":462.68,"endTime":465.74,"body":"need to restrain these cats"},{"speaker":"Matt Gurney","startTime":466.13,"endTime":470.87,"body":"chemically. Alfaxalone,"},{"speaker":"Matt Gurney","startTime":466.13,"endTime":470.87,"body":"midazolam, butorphanol, is my go"},{"speaker":"Matt Gurney","startTime":470.87,"endTime":475.4,"body":"to combination for that. When we"},{"speaker":"Matt Gurney","startTime":470.87,"endTime":475.4,"body":"have either undetermined cardiac"},{"speaker":"Matt Gurney","startTime":475.4,"endTime":478.07,"body":"disease, we're actually some of"},{"speaker":"Matt Gurney","startTime":475.4,"endTime":478.07,"body":"those cats, we do have those"},{"speaker":"Matt Gurney","startTime":478.07,"endTime":481.64,"body":"echo results and we know what's"},{"speaker":"Matt Gurney","startTime":478.07,"endTime":481.64,"body":"going on. The doses, I'm not"},{"speaker":"Matt Gurney","startTime":481.64,"endTime":485.09,"body":"going to verbalise the doses"},{"speaker":"Matt Gurney","startTime":481.64,"endTime":485.09,"body":"now, but take a look at that"},{"speaker":"Matt Gurney","startTime":485.09,"endTime":488.48,"body":"article on the Alfaxan website"},{"speaker":"Matt Gurney","startTime":485.09,"endTime":488.48,"body":"because that goes through all of"},{"speaker":"Matt Gurney","startTime":488.48,"endTime":489.47,"body":"those options for you."},{"speaker":"Sam Taylor","startTime":489.83,"endTime":491.87,"body":"Brilliant, thank you"},{"speaker":"Sam Taylor","startTime":489.83,"endTime":491.87,"body":"very much. I think we could"},{"speaker":"Sam Taylor","startTime":491.87,"endTime":494.12,"body":"spend the whole day asking you"},{"speaker":"Sam Taylor","startTime":491.87,"endTime":494.12,"body":"questions, but we don't quite"},{"speaker":"Sam Taylor","startTime":494.12,"endTime":497.12,"body":"have time. So we're gonna let"},{"speaker":"Sam Taylor","startTime":494.12,"endTime":497.12,"body":"you go. And say thank you very"},{"speaker":"Sam Taylor","startTime":497.12,"endTime":497.72,"body":"much."},{"speaker":"Nathalie Dowgray","startTime":498.32,"endTime":500.78,"body":"And now we're"},{"speaker":"Nathalie Dowgray","startTime":498.32,"endTime":500.78,"body":"speaking with Dr Zoë Halfacree"},{"speaker":"Nathalie Dowgray","startTime":501.05,"endTime":504.17,"body":"about her JFMS clinical"},{"speaker":"Nathalie Dowgray","startTime":501.05,"endTime":504.17,"body":"spotlight article on Urinary"},{"speaker":"Nathalie Dowgray","startTime":504.17,"endTime":505.79,"body":"Tract Trauma in cats."},{"speaker":"Nathalie Dowgray","startTime":505.0,"endTime":506.95,"body":"Why were you interested in"},{"speaker":"Nathalie Dowgray","startTime":505.0,"endTime":506.95,"body":"writing an article specifically"},{"speaker":"Nathalie Dowgray","startTime":506.95,"endTime":508.18,"body":"on surgical management of"},{"speaker":"Nathalie Dowgray","startTime":506.95,"endTime":508.18,"body":"urinary tract trauma?"},{"speaker":"Zoë Halfacree","startTime":508.18,"endTime":509.11,"body":"So I was"},{"speaker":"Zoë Halfacree","startTime":508.18,"endTime":509.11,"body":"approached to write the article,"},{"speaker":"Zoë Halfacree","startTime":509.14,"endTime":511.12,"body":"which I was really happy to do,"},{"speaker":"Zoë Halfacree","startTime":509.14,"endTime":511.12,"body":"I think it's valuable to discuss"},{"speaker":"Zoë Halfacree","startTime":511.12,"endTime":519.34,"body":"urinary tract trauma in the cat"},{"speaker":"Zoë Halfacree","startTime":511.12,"endTime":519.34,"body":"because it is something that"},{"speaker":"Zoë Halfacree","startTime":521.65,"endTime":527.38,"body":"occurs quite often. And whilst"},{"speaker":"Zoë Halfacree","startTime":521.65,"endTime":527.38,"body":"we do have notes and evidence"},{"speaker":"Zoë Halfacree","startTime":527.38,"endTime":529.99,"body":"base of new literature to"},{"speaker":"Zoë Halfacree","startTime":527.38,"endTime":529.99,"body":"support our decision making, it"},{"speaker":"Zoë Halfacree","startTime":529.99,"endTime":533.2,"body":"was useful, I feel to provide"},{"speaker":"Zoë Halfacree","startTime":529.99,"endTime":533.2,"body":"some case examples to help"},{"speaker":"Zoë Halfacree","startTime":533.2,"endTime":535.84,"body":"people have that information"},{"speaker":"Zoë Halfacree","startTime":533.2,"endTime":535.84,"body":"being more accessible."},{"speaker":"Nathalie Dowgray","startTime":536.11,"endTime":538.54,"body":"Building of"},{"speaker":"Nathalie Dowgray","startTime":536.11,"endTime":538.54,"body":"that, do you have any tips or"},{"speaker":"Nathalie Dowgray","startTime":538.54,"endTime":541.93,"body":"advice of things we can do to"},{"speaker":"Nathalie Dowgray","startTime":538.54,"endTime":541.93,"body":"just try and reduce the risk of"},{"speaker":"Nathalie Dowgray","startTime":542.08,"endTime":546.19,"body":"iatrogenic ureteral trauma when"},{"speaker":"Nathalie Dowgray","startTime":542.08,"endTime":546.19,"body":"we're catheterizing cats?"},{"speaker":"Zoë Halfacree","startTime":546.45,"endTime":549.18,"body":"Yeah, sure. There"},{"speaker":"Zoë Halfacree","startTime":546.45,"endTime":549.18,"body":"are a few really important ones."},{"speaker":"Zoë Halfacree","startTime":549.45,"endTime":553.77,"body":"The key one is that the cat"},{"speaker":"Zoë Halfacree","startTime":549.45,"endTime":553.77,"body":"should be adequately sedated or"},{"speaker":"Zoë Halfacree","startTime":553.77,"endTime":558.15,"body":"anaesthetised so that they are"},{"speaker":"Zoë Halfacree","startTime":553.77,"endTime":558.15,"body":"fully relaxed. Unfortunately, if"},{"speaker":"Zoë Halfacree","startTime":558.15,"endTime":562.92,"body":"they you know, were not"},{"speaker":"Zoë Halfacree","startTime":558.15,"endTime":562.92,"body":"adequately sedated, then there"},{"speaker":"Zoë Halfacree","startTime":562.92,"endTime":567.06,"body":"would be a significant risk of"},{"speaker":"Zoë Halfacree","startTime":562.92,"endTime":567.06,"body":"causing iatrogenic trauma. And"},{"speaker":"Zoë Halfacree","startTime":567.06,"endTime":570.6,"body":"having the patient adequately"},{"speaker":"Zoë Halfacree","startTime":567.06,"endTime":570.6,"body":"sedated, also allows more"},{"speaker":"Zoë Halfacree","startTime":570.6,"endTime":574.62,"body":"careful manipulation of the"},{"speaker":"Zoë Halfacree","startTime":570.6,"endTime":574.62,"body":"penis in the prepuce. One key"},{"speaker":"Zoë Halfacree","startTime":574.62,"endTime":578.64,"body":"aspect to recognising the cat is"},{"speaker":"Zoë Halfacree","startTime":574.62,"endTime":578.64,"body":"that where the penile urethra"},{"speaker":"Zoë Halfacree","startTime":578.64,"endTime":583.23,"body":"sits, sort of caudal to the"},{"speaker":"Zoë Halfacree","startTime":578.64,"endTime":583.23,"body":"pelvis orientated caudally, and"},{"speaker":"Zoë Halfacree","startTime":583.26,"endTime":587.67,"body":"there's a change in angulation"},{"speaker":"Zoë Halfacree","startTime":583.26,"endTime":587.67,"body":"as the penile urethra comes to"},{"speaker":"Zoë Halfacree","startTime":587.67,"endTime":591.54,"body":"meet the pelvic urethra, and"},{"speaker":"Zoë Halfacree","startTime":587.67,"endTime":591.54,"body":"it's that point going between"},{"speaker":"Zoë Halfacree","startTime":591.6,"endTime":593.61,"body":"the penile urethra and the"},{"speaker":"Zoë Halfacree","startTime":591.6,"endTime":593.61,"body":"pelvic urethra, where it's most"},{"speaker":"Zoë Halfacree","startTime":593.61,"endTime":596.85,"body":"common for iatrogenic and"},{"speaker":"Zoë Halfacree","startTime":593.61,"endTime":596.85,"body":"catheter injuries to occur"},{"speaker":"Zoë Halfacree","startTime":596.85,"endTime":600.06,"body":"because the catheter trajectory"},{"speaker":"Zoë Halfacree","startTime":596.85,"endTime":600.06,"body":"is going up and damages the"},{"speaker":"Zoë Halfacree","startTime":600.06,"endTime":604.32,"body":"dorsal surface of the urethra."},{"speaker":"Zoë Halfacree","startTime":600.06,"endTime":604.32,"body":"And so the real key is to"},{"speaker":"Zoë Halfacree","startTime":604.32,"endTime":608.19,"body":"actually when the patient is"},{"speaker":"Zoë Halfacree","startTime":604.32,"endTime":608.19,"body":"having the catheter inserted is"},{"speaker":"Zoë Halfacree","startTime":608.19,"endTime":611.28,"body":"to pull the penis caudally you"},{"speaker":"Zoë Halfacree","startTime":608.19,"endTime":611.28,"body":"so that you're stretching that"},{"speaker":"Zoë Halfacree","startTime":611.28,"endTime":613.8,"body":"out and straightening that out,"},{"speaker":"Zoë Halfacree","startTime":611.28,"endTime":613.8,"body":"and then the catheter should"},{"speaker":"Zoë Halfacree","startTime":613.86,"endTime":615.45,"body":"advance straight ahead"},{"speaker":"Nathalie Dowgray","startTime":619.02,"endTime":621.15,"body":"Thank you for"},{"speaker":"Nathalie Dowgray","startTime":619.02,"endTime":621.15,"body":"listening, if you are an ISFM"},{"speaker":"Nathalie Dowgray","startTime":621.15,"endTime":623.88,"body":"member you can hear more from Dr"},{"speaker":"Nathalie Dowgray","startTime":621.15,"endTime":623.88,"body":"Halfacree with her full"},{"speaker":"Nathalie Dowgray","startTime":623.88,"endTime":628.29,"body":"interview being available on the"},{"speaker":"Nathalie Dowgray","startTime":623.88,"endTime":628.29,"body":"ISFM members podcast, to access"},{"speaker":"Nathalie Dowgray","startTime":628.29,"endTime":632.25,"body":"this please visit"},{"speaker":"Nathalie Dowgray","startTime":628.29,"endTime":632.25,"body":"portal.icatcare.org. As well as"},{"speaker":"Nathalie Dowgray","startTime":632.25,"endTime":635.58,"body":"the podcast you can access all"},{"speaker":"Nathalie Dowgray","startTime":632.25,"endTime":635.58,"body":"the other ISFM member benefits"},{"speaker":"Nathalie Dowgray","startTime":635.82,"endTime":639.45,"body":"including Dr Gurney’s lectures"},{"speaker":"Nathalie Dowgray","startTime":635.82,"endTime":639.45,"body":"from our ISFM Rhodes congress,"},{"speaker":"Nathalie Dowgray","startTime":639.69,"endTime":643.89,"body":"monthly webinars, the discussion"},{"speaker":"Nathalie Dowgray","startTime":639.69,"endTime":643.89,"body":"forum and much more. Don’t"},{"speaker":"Nathalie Dowgray","startTime":643.92,"endTime":647.28,"body":"forget, JFMS is now an open"},{"speaker":"Nathalie Dowgray","startTime":643.92,"endTime":647.28,"body":"access journal so if you wish to"},{"speaker":"Nathalie Dowgray","startTime":647.28,"endTime":650.61,"body":"read Dr Halfacress clinical"},{"speaker":"Nathalie Dowgray","startTime":647.28,"endTime":650.61,"body":"spotlight article then please do"},{"speaker":"Nathalie Dowgray","startTime":650.61,"endTime":653.82,"body":"follow the link in the show"},{"speaker":"Nathalie Dowgray","startTime":650.61,"endTime":653.82,"body":"notes. We'll be back again next"},{"speaker":"Nathalie Dowgray","startTime":653.82,"endTime":657.24,"body":"month with more interviews"},{"speaker":"Nathalie Dowgray","startTime":653.82,"endTime":657.24,"body":"recorded at ISFM Rhodes and next"},{"speaker":"Nathalie Dowgray","startTime":657.24,"endTime":660.69,"body":"month's JFMS Clinical spotlight"},{"speaker":"Nathalie Dowgray","startTime":657.24,"endTime":660.69,"body":"interview. If you don’t want to"},{"speaker":"Nathalie Dowgray","startTime":660.69,"endTime":664.11,"body":"miss it make sure you sing up to"},{"speaker":"Nathalie Dowgray","startTime":660.69,"endTime":664.11,"body":"Chattering with ISFM on you"},{"speaker":"Nathalie Dowgray","startTime":664.11,"endTime":665.7,"body":"preferred podcast platform."}]}