End of life…

emergency-vet-center

As I walked out of clinic at 1am on Monday morning a family were arriving to say goodbye to their pet having been summoned by phone just 15 minutes before when he started to deteriorate so rapidly that it was obvious he only had minutes to live. They made it in time to say bye thanks to the Vets Now ECC nurse recognising what was happening early and allowing them to be summoned.

Through the weekend we’d helped countless animals who left the clinic to go home with their parents, yet there was a high proportion that was never going be leaving, whether or not their pet parents realised it when they arrived. Unfortunately our pets can never tell us how sick they are, how much pain they are in, and that they want to go on over the rainbow bridge.

This is worse as often it is not just that they are seriously ill (and sometimes even dying painfully), but is also so sudden that their parents may not have had time to come to terms with this and accept it. It is not human nature to give up and sometimes when it comes to the decision to end life it can feel this way even though it is really not.

The weekend was a mix of those that came to ask us to help them send their loved pets on over Rainbow Bridge – the request of one parent that nearly made me cry was that someone would cuddle them as they moved on. Then there were those that hadn’t realised how bad the condition was and how much pain their pet was in that let them go on pain free when realising. There were also those that just refused to give up even though it could be considered to be  the kindest thing for their pets.

Vets are legally entitled to euthanise an animal on welfare grounds if they believe the welfare is compromised and the animal is suffering. However , we realise the importance of the bond parents make with their pet and that doing so will not be easy on the parents – in fact it would be very traumatic for the parents which is something we never want.

Instead we rely on our ability to communicate with pet parents. Sometimes it is very obvious to us how bad an animal is because of our experience and training whilst it may not be to their parents. We release that the animal is never going to be able to leave alive, and whilst we may attempt to make the animal comfortable with very strong pain medications, it is the owner that we need to treat.

Euthanasia is one of the most powerful tools that a vet has – read about how it really works here.

It’s not all about money… how Vets Now try to save you money!

the-emergency-patient

The emergency vet is always going be more expensive than your normal day vet. It costs money just to open the door and have the team there ready whilst it is not possible for them to guarantee that they will have patients.

Because of this fee just to be seen by a vet there is a big effort to make sure that only pet parents that really need to be seen arrive at the clinic. This starts with the national contact centre where a call handler, supported by a qualified veterinary nurse  will talk to you about your pet on the phone and tell you whether you can wait for your day vet or you need to be seen by an emergency vet.

If, on arriving at the clinic, the client’s pet has improved dramatically, then or course they can change their mind with no charge. If a vet is not available to see an owner and sick or injured pet within a short time of arriving, then as soon as possible a registered veterinary nurse will triage the animal and get any immediate first aid needs started. Veterinary nurses are unable to diagnose or prescribe medication so this may be in conjunction with the veterinary surgeon ‘behind the scenes’ but with the owner’s informed consent.

There are a limited number of consultations that registered veterinary nurses are legally allowed to undertake on their own. These include things such as replacing a slipped or damaged dressing and are charged at a lower fee.

Then something that really surprised me when I arrived was that a manual blood test was used (I’ll write more about this later) instead of using automated machines that were used by the day vet in the same building. This was weird at the start – however in discussion it costs less than half the price of the automatic machines, is faster, and most importantly takes much less blood to do. It took less than 0.2ml for nearly every patient over the weekend which for an emergency patient keeping as much blood as possible in the body is important. Plus it means that certain parts of the blood test (such as amount of Red Blood Cells) can be repeated as needed without being forced to test everything again.

Sometimes a pet may need to come into the hospital for monitoring or to be given IV fluids to help them with dehydration for example. When this happens instead of being charged for the entire night or weekend the hospitalisation is split into 7 hour slots so you only actually get charged for the time your pet is in the hospital.

Off course the treatment varies between patients, however the vet does consider the different options to keep the cost of treatment as low as possible whilst keeping your pet alive. Emergency medicine is about trying to rule out possible life-threatening conditions and it can be necessary to be proactive to achieve this. While this can cost money it could potentially be life-saving and cost less in the long run, both financially and emotionally. Anything Vets Now do will be discussed with you and as I have said options will be discussed wherever possible and at the earliest opportunity. Many of the emergency tests Vets Now use regularly need to be repeated to get the most value from them. Sometimes repeats are built into the hospitalisation and nursing fees so there are no additional charges but allow your pet to have a high standard of monitoring and care.

I personally would recommend getting insurance such as Pet Plan to help you cover the cost of emergencies. Responsible pet ownership is something that Vets Now are very keen to promote, as they understand just how quickly veterinary bills can rise . Costs can quickly rise in the initial part of any emergency, even if the outcome is not good. Being able to find out more information to help the vet get an idea of prognosis, while not having to worry about the fine detail of the financial situation can be a great benefit of pet insurance. Lots of policies exist however and it is important to find one that meets your needs so always read the small print.

The emergency patient…

a-day-of-maggot-emergencies

Arriving to Vets Now with a quick tour of the practice and introduction to the team I changed and it was time to see my first consult with head vet Rebecca. It was not the bleeding dying dog or cat that I expected but a rabbit with early gastrointestinal stasis that had stopped eating – giving medication against pain and to encourage gut movement we hope that we had caught it early and that the rabbit would be fine.

One of the attractions of emergency and critical care is that you never really know what is going to come through the door. Most patients will go through telephone triage so we may get a little notice to prepare if necessary; however there is always the chance that someone will run a dying pet straight in. If you have time to telephone (or can get someone else to telephone) before you come then it is better because it allows preparation of anything necessary before you arrive. This can be even more important if there are already critical patients as it may be necessary to triage the least critical to a secondary area so we have a table to work on or a connector for oxygen.

The uncertainty of what is next is also one of the challenges of  emergency medicine; you need to be very confident in your ability to deal with whatever comes in. And you have to be able to cope well under pressure  – especially when multiple emergency patients arrive at the same time.

Whilst able to send some patients home, there were unfortunately a few where euthanasia was the best option – either because they were not treatable or because they lacked any quality of life. I’ve written an entire post on euthanasia that will follow in the next couple of days.

The day quickly became one of maggots with what felt like an endless supply of the wriggly white flesh eaters being found on a cat, pigeon and a rabbit. It is amazing how quickly with the summer heat that flies will take advantage of any moist fur to lay their eggs. The eggs tend to hatch rather quickly so within 24 hours there can be a serious problem if not treated so these were emergencies. Fortunately shaving half the cat managed to remove all the maggots and only the top layer of skin was damaged, however the pigeon and rabbit had much more extensive wounds and had to be euthanised on welfare grounds.

For my first day however it was a rather relaxed introduction to emergency practice – I had time to learn how things worked – and to pick the brains of the vets and vet nurses I was working with to get a better understanding of how it worked with Vets Now. It also gave me some time to practice some of the clinical skills such as manual PCV (blood cell counts) that I’d not done for several years.

The Emergency Vet…

chris-learns-emergency-and-critical-care

Accidents can and will happen, most often when you are not expecting them, and medicine is not cheap. This is especially so when it happens when your normal vet is not open, as then you are often sent to a specialist emergency vet, which is almost like an A&E department for pets. The vets here are trained to save your pets life; in addition to specialist training they have access to the important equipment and drugs necessary to do this.

Over the next 4 days I have been invited to join Vets Now one of the UK’s leading providers of Emergency Centres for Pets that have been in accidents or are seriously ill. I’m excited to learn a lot of things to help with emergencies, yet I am apprehensive about how intense it will be and how little I know.

I’ve been invited into two different centres in two different cities so I can see a range of different patients and learn from several different vets.

The first centre I am at just for the weekend, expecting to be there from 12 lunchtime until 7pm Saturday evening. Then again all day on Sunday from 8:30am until evening again with night staff taking over to continue to provide the care needed.

The second centre I am on overnights on Monday and Tuesday from around 6pm until the next morning as the normal overnight shift is 15 hours long. This centre also takes patients from the PDSA charity so is expected to be a lot busier.

During this time I’ve been allowed to tweet – so keep an eye on my twitter feed @vetschooldiary for live updates from behind the scenes as it happens.

And off course I will be blogging my experience as well (potentially once I’ve managed to catch up on sleep!).

Over the rainbow bridge…

Euthanasia - Crossing the rainbow bridge

As the vet reaches for the cats leg to give the final injection the cat lies alone on the table. She has had trauma and is not in good way, and her parents cannot stand to see her in this way. I reach out to do nothing more than stroke her as she starts her onward journey over the rainbow bridge.

As the injection goes in I see her laboured breathing stop, she looks calm and relaxed as I stroke her and wish her a safe onward journey. The injection is in and the vet removes the needle before reaching out and stroking her as well briefly before they listen for a heartbeat. I’m sure she’s gone but it is important to check, sometimes it can be difficult to tell with all the noises that occur after death so sometimes can feel like you are listening a long time.

I’m sad this cat I knew only for a short while at what is probably the worst point in her life couldn’t be saved, yet I take comfort in the fact she now gets to run free. We gently remove her IV cannula to go to the clinical waste, clean her, and then wrap her in her blanket to go home with her parents for burial.

She is not the first, and will not be the last; however she did not go alone. Even for those few minutes she took a piece of my heart with her, and she went on her final journey across the rainbow bridge loved and cared for. This is something her parents never saw and something maybe one day they will wonder about, however they should not worry. They have the memories of her running around the house not struggling to breathe unable to lift her head.

I will never judge a parent that cannot be there at the end, it’s one of those choices that is so difficult to make. There is rarely a right answer, and sometimes there is not even any time to even think about it properly. Yet these parents may say their goodbyes when it is time to bury her, I will never know. It is a choice that can only be made by you. Sometimes after trauma we will explain to parents what to expect to see as sometimes injuries look much worse after being shaved and cleaned so that the parent can make a choice.

Personally I believe saying goodbye is important, some vet practices even have rooms just for this so we can give as much time as parents need. Sometimes in a busy practice we do not have enough of these rooms so we make do with what we have. We will explain what will happen to you, and tell you what we are doing. We’ll never try to rush you, we’ll try to keep noise outside to the minimum, and we will all feel your pain.

EDIT
If you have lost a pet and are struggling with the loss then please do call the Blue Cross Pet Bereavement Helpline – 0800 096 6606 (UK Only) – or visit their website for more information at  https://www.bluecross.org.uk/pet-loss. It is a traumatic experience, and there are people that have experienced it themselves who want to listen to you.

Ticks and Fleas spread diseases…

Ticks like this carry disease

I spent years learning about diseases, medicine and surgery to become a vet so I could help make animals better. Yet sadly there have been many times where I’ve either seen a dog die or be euthanised because of diseases that are preventable. For me it is heart-breaking to see a dog die like this, yet even worse are the owners crying because they did not know any better. I hope by writing this I can help prevent suffering to another dog and their owners.

Most people with a dog will probably have seen a tick or flea at some time or other. Whilst it is common to believe they may just be an annoyance to your pet, in some cases they can carry diseases which may be spread to your pet or in some cases even you.

Actually calling fleas an annoyance may not even be accurate as the itchiness that they cause can be extremely painful and lead to a dog destroying its own skin trying to get it to stop. However today I want to rather focus on ticks. In April this year I saw 23 dead dogs due to a disease carried by ticks. It is one that is relatively new to the UK; however it is very common where I studied as a vet in Slovakia.

This disease is caused by another parasite called Babesia which exists inside blood cells and is transmitted by ticks when they feed. When it enters a new animal the parasite spreads in the blood entering the red blood cells and then replicating inside it causes the cell to rupture and die. This process repeats until there are very few red blood cells left, it is treated, or the dog dies.

The symptoms vary, when the dogs I have seen suffering from this have arrived they have often been lethargic, the worse ones have been yellow with icterus and collapsed. The common symptoms are blood in the urine, lack of appetite, weight loss, pale gums and tongue, lack of energy and collapse. In fact the symptoms can be so non-specific that one of my teachers here actually once told me that if I cannot explain the symptoms by any other means then I should check for Babesia.

Checking for Babesia is generally easy with a blood test where a smear is examined under the microscope – if it is positive for Babesia then they will be seen within the red blood cells as in the dog below…

Babesia parasite inside a red blood cell
The dark puple “butterfly” in the middle circle is typically what Babesia looks like under a microscope © Chris Allen 2017

So we have the diagnosis, now for the treatment. Unfortunately this is where it gets complicated as although there is medication to kill the Babesia parasite, it can often be a battle to keep the dog alive long enough for the medication to work. Without enough red blood cells to deliver oxygen throughout the body the organs cannot work, the heart starts working faster to try and move the few good cells it has around faster, and the waste is filtered into the urine. The regeneration of red blood cells takes a few days to really start, so one potential lifesaving treatment is a blood transfusion – however this often just buys more time as these red blood cells may then also be infected and destroyed by the Babesia parasite.

The next problem then comes with the cost of treatment as well; often these dogs need hospitalisation and intensive therapy which for some is unaffordable. It really can be a gamble as to whether or not they survive at all, even if treatment is attempted, potentially leaving a big bill and a dead dog vs the happy pet parent taking their dog home.

The main question though is why it is even necessary.  Although tick products are generally not licensed against tick borne diseases, to help prevent Babesia you should help protect your dog against ticks with a vet recommended treatment, remove any ticks you find as soon as possible, and especially make sure you do this if you travel into mainland Europe.

I fully support the Pet Parasite Action campaign – such a little thing as regular prevention could help save your dog’s life even though you may not know it. You don’t go out and leave your front door unlocked to avoid theft, why would you leave your pet unprotected against diseases such as this?

Click Below to Check You Are Protecting Your Pet…

Pet Parasite Action Protect your pet

The Best Marketing Tips for Veterinary Practices

Just like any business, a veterinary practice lives and dies by the customers it has. If you are not attracting enough clients to your practice, it could be because you aren’t marketing your clinic the right way. With that in mind, read on to discover the best ways to advertise your veterinary practice.

  • Focus on SEO – Search engine optimization is a must for all businesses today, veterinary practices included. Veterinary SEO involves using an array of different techniques to move your website up the search engine rankings. This is imperative in today’s digital age, giving your website plenty of exposure, and ensuring your business is at the top of the results whenever someone looks for a vet clinic in your area. After all, whenever people need to find a business today, they usually turn to the Internet!
  • Profile your team – When setting up your veterinary clinic, you may not have a big team of staff, but this does not matter, you should still create a profile for each member – it does not matter whether you are a team of two or ten. This is because people like to know who is going to be looking after their animals. By highlighting the accomplishments and talents of your individual staff members, people will feel more comfortable about leaving their pets in your hands.
  • Offer a reward for customer referrals – Word of mouth is still one of the most powerful marketing tools today. You can give your customers a push to recommend your clinic by offering a reward if they do so. For example, for every new client that signs up through an existing customer, you could give the existing customer a 10% discount off his or her next vet bill.
  • Start a blog – Having a website is one thing, but you can take it to the next level by adding a blog. This is the way to show your veterinary expertise, setting yourself apart in the industry. You can share posts about veterinary news, customer stories, pet care tips, and anything else related to pet care and health. Create original, interesting, and engaging posts, which people will want to read. Not only does this show you as an expert in the industry, but it will benefit your SEO strategy too.
  • Get customer testimonials – Ask your satisfied clients if they will provide you with a testimonial. You will find that most will be more than happy to do so. You can use these testimonials in a number of different ways – from including them in magazine ads and brochures to social media and websites.
  • Be active on social media – This leads onto the last point perfectly; make sure you are active on social media. This gives people the opportunity to get closer to your practice than ever before, which harvests loyal customer relationships. Don’t simply post a string of promotional messages – engage with your customers and post interesting messages about the industry in general. You could also run a competition for increased exposure, with winners getting a pet basket, a bag of pet treats, or something else for their pet.

Great Ways To Integrate A New Dog Into The Home

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Getting a new dog is an amazing experience, but it isn’t without its pitfalls. Sadly, not all pooches take to their new surroundings like a duck to water. In fact, some lash out like a hormone engorged, moody teenager. Of course, this is the last thing you want, especially if you have just been shopping or decorated. So, it’s important that you try and make the process as easy and simple as possible. To do that, you have to integrate the dog so that it feels like it is part of the family. If you don’t know how these tricks will come in handy.

Don’t Overwhelm It

Obviously, everyone will be excited at the prospect of adding a new member to the family. But, you can’t let the excitement boil over as it will overwhelm the dog. Instead, you have to act as if it is just another day in the household so as to smoothen out the process. With this in mind, there should be no welcome home parties or any functions of any kind. Also, refrain from crowding around and smothering the animal. Dogs, especially rescues, like their space and will bite back if strangers get too close.

Give It A Hearty Meal

Like men, the way to a dog’s heart is through food. Seriously, a good meal can do wonders because it shows your new pooch that you care. It is also a sign that this is its home. After all, not too many people feed pets that they don’t own. Snacks like chicken dog treats are also good for developing a bond. Indeed, you can use treats to for training purposes. If it does something good, reward it with a snack as positive reinforcement. There is a reason a dog is man’s best friend!

Walk It Around The House

There are lots of people that like to let a new canine wander around the house of its own volition. Although this is a smart move, so is introducing it the rest of property ASAP. That way, nothing will surprise the dog when it leaves the comfort of the living room or kitchen. Anyway, it has to go upstairs or outside at some time, and it may as well be sooner rather than later. If you are scared this will overwhelm it, don’t be as it only has to be a fleeting tour. After that, you can let leave it alone.

Establish A Routine

Dogs like to have a routine. Even though they don’t have cognitive reasoning, they do have instinct. As such, they know when something should happen, such as a daily walk. The quicker you establish a routine, the better for the animal. Then, there will be fewer surprises and less free time. As soon as it has something to do, it will take its mind off the move. And, when it does have some free time, it should be tired and go to sleep.

The process is never easy, but it isn’t as difficult when you follow the guidelines above.

Looking After Your Dog Post-Surgery

Every dog is different, so there’s not really any standard procedure when it comes to helping your friend through the post-operation process. But here’s some general advice that you should definitely take on board for when your dog is ready to come back home after a gruelling procedure!

Follow the instructions!

First and most important of all: your vet will give you instructions (usually written) that will give you specific advice on dealing with the recovery of your dog. You need to ensure that these instructions are followed to the letter, no matter what other options you try!

Look into further healing options

There tend to be a lot of options when it comes to speeding up the process of healing. This may come in the form of creams and other medications that help the wound heal quicker, or things that help your dog get to sleep and thus limit dangerous activity, or even canine laser therapy. Whatever option you consider, you should definitely consult with the vet first; you don’t want to do anything that may end up disrupting the process further!

golden-retriever-after-surgery

Limit activity

Too much activity can result in pain, wounds reopening, or other problems that will prolong the recovery process. So you need to consider the activity your dog usually takes part in. Jumping up on sofas and chairs needs to be limited. Keeping them away from other dogs as well as small children may be ideal for the first couple of weeks, as they tend to get very excited by both. Walks should be a lot slower as well as shorter; you may want to consider going on two brief walks per day instead of a long one. Consider having your dog spend some time in a small and confined space while they relax.

Check the sutures frequently

Dogs aren’t exactly known to report to your immediately if something goes wrong with their sutures! Proper surgical wound care is essential if you want to make sure the recovery is as fast and comfortable as possible. Antibiotic or antiseptic creams may come in very handy, but simple salt water washes may do the trick. (The vet will probably have given you some advice here!) You need to ensure that your dog doesn’t lick or scratch at their wound; if this means getting one of those funny cones on their head, then so be it!

dog-bed-after-surgery

Maximize comfort

When it comes to post-op comfort, there are at least three things you need to consider. One is temperature. In the first few days following surgery, dogs will have a hard time sensing temperatures. This doesn’t mean that they’re not getting cold or hot, however. You need to keep an eye on your pup and get a feel for their temperature so you know when to adjust the temperature accordingly. The second is the bedding your dog uses. A lot of people use quite cheap bedding for their dog because they know that dogs can basically sleep on anything, but now might be the time to invest in something a little more luxurious. Last but not least is your presence! Don’t stray too far from your friend; this will help them stay calm and happy.

Calling And Hygiene Training Techniques For Domesticating Your Cat

Perhaps you’ve just come home with the new arrival, or your feline friend has grown from a cute, cuddly kitten to a full sized adult with claws and teeth. Training a cat is sometimes seen as a fool’s errand because unlike dogs, cats by their very nature are independent animals. They like to be alone, and just like their larger cousins lions, like to patrol their territory quite avidly and routinely so. It can be quite the challenge trying to domesticate a cat that you’ve recently bought because integration for cats takes longer than pack animals who are social creatures, like dogs. However, with a few simple steps, you can teach you cat to be obedient and comfortable in all situations that may have previously been stressful.

Training your cat to come to you 

Getting your cat to come to you is the first part of training your cat to know that you are the ruler of the roost. Cats unlike dogs, don’t always work to please their owner for the sake of it, and in fact, need an incentive in the form of something beneficial to them in order to cooperate. The first action should be to instill within the cat to align positivity with the sound of calling them. Food is the great reward and incentivises the cat to engage in the activity. It will take experimentation but find their favorite treat which they enjoy the most. If treats don’t work then use a toy or something used to pet them with like a cat brush

  • Establish a call, that will be word or sound used to bring your cat to you. Decide on something and stick to it, and don’t change it.
  • Stand a few feet apart from your cat and call it. It may not respond at all, but don’t lose hope. Keep calling until it looks directly at you.
  • You may find that making noise by tapping your leg or rustling the bag of treats will get his or her attention quite regularly.
  • As soon as the cat acknowledges your call and comes to you, immediately give the cat a treat, with gentle petting.
  • Stand up and walk away after a few seconds, and the repeat the process. This is to establish the call and treat with a positive reaction the cat expresses by coming to you wherever you are. Above all else, remember to be patient and be persistent.

Eventually, you should slowly wean your cat off the treats and instead reward with affectionate petting and confirming each other’s bond. It’s important to establish such a connection with your cat because one day the simple act of calling it might save its life. When your cat recognizes your call it may stop them from running out into the road, or perhaps stop a fight with another animal, preventing injury.

japanese-litter-box-in-use

Cats are able to be house trained to also go outside to toilet

Cats must be house trained just like dogs to avoid bad smells and general poor hygiene. If you live in a safe area and your cat is outdoors then training to also go to the toilet outside may make sense. Of course, the alternative is to buy a litter box, but having you still have a chore to clean it and refill the box; it may not eliminate bad smells either. It takes time to educate your cat and training him or her to be respectful of the home will be a lengthy training process with a learning curve that requires patience.

Decide on the specific area where you cat will go to the toilet. The could be a specific area is most likely going to be the garden. However, if you cat feels vulnerable out in the open, move the litter box into the bathroom near the toilet. You’ll need a variety of supplies to train your cat to go to the toilet in a sensible manner that transitions them from the litter box to outside in the garden.

  • When you think your cat needs to go to the toilet next time, gently pick them up and take them outside.
  • They may want to go back inside to go in the litterbox, so bring the box outside and place it in a secure spot, out of view of the majority of the garden.
  • Allow them to go in the litter box while you give them praise. After the cat has finished, gently pet them.
  • Start playing with toys in an attempt to reward them. The best reward is catnip as their senses go wild and the brain releases substantial amounts of pleasurable chemicals.
  • The best catnip for cats will improve their responses to your commands because catnip can be put into toys and used as a reward.
  • Use the catnip toys to encourage your cat outside and slowly transition him or her off the reliance of a litter box.
  • Eventually after multiple times, take the litter box away completely and allow the cat to walk around getting comfortable. Reassure it with gentle petting and give it treats and toys to play with. Naturally, your cat will have to go to the toilet, and it will be excreting or urinating on the grass or soil of the garden.
  • The cat will try to bury their waste by putting grass blades or soil over it because cats are very concerned about cleanliness. This obsessive compulsive disorder stems from their ancient need to mark territory using their pheromones only.

cat-in-the-garden

When your cat is learning to be domesticated, it will often feel nervous and very tense. As the owner, try to be understanding and provide care and give your pet confidence by not making sudden moves or loud noises. Be as patient as you can because what you’re training the cat to do is sometimes against their instinct and building up trust is one key factor in maintaining a healthy relationship. The use of toys and treats cannot be overstated as your calls and affection won’t be enough because as mentioned before cats are often seen as solitary animals and may find it hard to do as you ask them. It’s a challenge to try and balance the normal behavior the cat possesses with fully house trained practices, but much like a dog, the cat will get used to willfully going outside if it connects doing so with a positive experience.