Urinary incontinence kitten

Re: Urinary incontinence kitten

Sarah Keir — Wed, 22 Aug 2012 16:30:50 GMT

At Glasgow 10 years ago , I did a week rotation at the local PDSA clinic in final year. I didn't find it useful as all I saw all week was fleas and FAD! But I had supportive host pracitces that allowed me to do some supervised consulting.

Re: Urinary incontinence kitten

Jo Cobbett — Wed, 22 Aug 2012 11:14:31 GMT

[quote user="Michael Woodhouse"]

I wonder whether there is a model somewhere that could use vet students for the front-line work overseen by qualified VS. The students would get the experience and more cases could potentially be seen. It will never sit comfortably with me doing advanced surgeries with charity money, sorry.

[/quote]

This is what we did in 5th and 6th year at Cambridge, students ran the consultsat the RSPCA centre in town, took the history, examined the animal and made their assessment. Then the owners waited in reception while one of our tutors came in, heard our summary, examined anything we weren't sure about, and discusssed treatment. The students then saw the client again and talked through treatment with them. It meant we could get away with 1 or 2 vets overseeing 3 or 4 consult rooms, and was great experience for the students. I did a couple of extra weeks in the holidays and it was definitely my most useful EMS. Any surgery was done at the vet school, and this was how students got neutering experience.

Re: Urinary incontinence kitten

Rajat — Tue, 21 Aug 2012 12:46:38 GMT

[quote user="David Mills"]It doesn't, sadly - funding.[/quote]

That is such a shame. I remember how much our year enjoyed the Blue cross rotations. The vet there at the time who oversaw us (I think she was called Alison) was fantastic and I remember them having cert holders in a coupla disciplines too (ophtho, medicine..). Alison got a teaching award presented at our graduation ceremony. She got a roaring applause and a standing ovation from the entire year- goes to show how valued our time there was and what a good teacher she was!!

Re: Urinary incontinence kitten

Michael Woodhouse — Tue, 21 Aug 2012 10:09:23 GMT

David, please don't get me wrong - I am fully supportive of the work you do and the charity hospitals in general.

I suppose my argument would be if I donated £100 how many animals is that going to help. Even if you say the actual cost to a charity for spinal surgery isn't actually thousands, you have purchased the equipment, and spent a lot of staff time before during and in the days after recovering.

I know for an irrefutable fact that there is not enough of the charities to go around for the number of pets in need. Being out in the sticks there is nowhere that we can easily send anyone and that leads to a number of animals being put to sleep.

I suppose my biggest problem with these more complex surgeries would be that only people on means tested benefits are eligible (I believe, I stand to be corrected). There is a tier of people out there who work hard for a living, never have to claim benefits but are unable to afford spinal surgery on their dog, so they get put to sleep. (last case was a couple of pensioners, lovely couple, lovely dog - didn't have the money). I would almost rather the money went to those people that are trying as hard as they can and not living off the state rather than some of those people that are (yes I know for some it is not a choice, but you are now getting 3rd generations of families that have never worked a day in their lives).

Re: Urinary incontinence kitten

David Mills — Tue, 21 Aug 2012 01:05:26 GMT

[quote user="Michael Woodhouse"]

I don't know if it still happens but during our final year RVC rotations we spent a week in the Blue Cross Victoria Hospital.

[/quote]

It doesn't, sadly - funding.

[quote user="Michael Woodhouse"]

It is modern and well equipped. The facilities are better than any private practice I have worked in

[/quote]

True, but that goes for many charity hospitals. The throughput of cases is much larger than any private practice so there comes a point whereby efficiency is massively increased by having premises fit for purpose. Also having enough room to maximise capacity is important. The hospital was designed from scratch about 10 years ago with all sorts of things in mind, not least logical animal handling esp wrt to infection control and patient flow.

[quote user="Michael Woodhouse"]

We were doing medicine & consults but during our week I was aware of a dog undergoing a hemilaminaectomy. This was at the same time deserving animals were being turned away because people lived in the wrong postcode. If I was an animal charity that is not how I would spend my money.

[/quote]

This is not a good comparison. The charity situation in London is quite clear - postcode areas are arbitrarily divided up between the various charities - pdsa, rspca, bx, wood green etc - according to catchment area. Each charity has their own policy regarding who they will see and how much it costs - some impose minimum charges depending on circumstance. The Blue Cross, in fact, is the most generous, seeing a wider range of people, imposing no minimum charge, and running various free Staffie neuter campaigns. In certain circumstances we will see out of postcode people especially out of hours. Your implicaion that people are left to fend for themselves in some sort of postcode lottery simply isn't true.

Regarding the surgeries we choose to carry out, this can be contentious. However, this is strictly costed and controlled such that the only variable is staff time - and this is the cheapest element. Implants etc are all consumables and relatively cheap - little more than fracture repairs. We are fortunate enough to have a fantastic diploma holder surgeon working for us part time, who is supremely efficient and gets fantastic results. Cases are selected very carefully, with most spinals with deep pain intact actually being conservatively treated - hemilaminectomies are approx 3-4 a year at most. There are, admittedly, other specialist surgeries we do, but with the interests of animal welfare and with audited outcomes underlying them - PRAAs, PDAs, PSS, TTAs - most of which we insist on a minimum donation. As with everything, cases are very carefully selected. The fact we have good facilities with plentiful means that outcomes are optimised and efficiency is high.

Any charity care boundaries are arbitrary by definition. Some impose maximum spend per case that would see parvo cases PTSd as soon as they walk through the door, others decide on a case by case basis. We do the latter, and heavily rely on our clinical audits/evidence base to pick the appropriate cases. It is all very well to say i would do x, y, or z in situation a, b, c but there are significant grey areas. 'Mended cheaply' - how cheaply? how do you decide? What is 'cheap medication' - preds are cheap but an atopic dog needs regular check ups so adding hidden costs. There is no algorithm applicable to all situations, and retaining excellent staff is impossible if all you do is neuter, use amoxicillin and kill everything else.

[quote user="Michael Woodhouse"]

Euthanasia is never a welfare issue - a dog can't suffer once dead. I suspect many of these dogs suffer when alive.

[/quote]

Yes euthanasia isn't a welfare issue but that ignores the vast swathes of other options available - euthanasia is an endpoint in a decision making process, taking into account the animal's status, disease, prognosis, not a blanket policy anything that isn't for conditions f,g or h. To wield it as a solution to the charity sector's problems is irresponsible, callous, and goes against what being a VS is about.

As for your other assertion, that is simply ill-informed irresponsible assumption made from afar without reference to even anecdotal evidence.

Re: Urinary incontinence kitten

Rajat — Mon, 20 Aug 2012 23:15:57 GMT

[quote user="Michael Woodhouse"]Euthanasia is never a welfare issue[/quote]

I am very interested to hear others opinions on this. For me the complete opposite is true. Life if possible is unique and should be preserved where possible. IF suffering is not treatable then euthanasia becomes the welfare treatment of choice.I prefer to explore every last option before going for euthanasia.

[quote user="Michael Woodhouse"]Owning a pet is a privilege not a right.[/quote]

I don't believe this is under question, I can only concur..?!

Re: Urinary incontinence kitten

Michael Woodhouse — Mon, 20 Aug 2012 23:01:40 GMT

I don't know if it still happens but during our final year RVC rotations we spent a week in the Blue Cross Victoria Hospital.

It is modern and well equipped. The facilities are better than any private practice I have worked in (other than the microscope, that was crap).

I suppose my approach would be if it could be mended cheaply or maintained on cheap medication then ok. IMO it should be there to relieve pain and suffering and cure minor ailments.

[quote user="James Laidlaw"] I don't know if there's a right or wrong in this situation, but we are all in he basis of protecting and maintaining welfare of animals and euthanasia of otherwise treatable patients, in my mind at least, is contrary to that principle.[/quote]

I sort of have the complete opposite view - the best thing for many of these animals may be humane euthanasia. Euthanasia is never a welfare issue - a dog can't suffer once dead. I suspect many of these dogs suffer when alive.

Owning a pet is a privilege not a right.

Re: Urinary incontinence kitten

Rajat — Mon, 20 Aug 2012 21:56:23 GMT

[quote user="James Laidlaw"]So where do you draw the line? All non-neuter surgeries? Regardless of the philosophical/ethical side-debate, I'd be interested to know what the outcome was with this kitten![/quote]

It raises an interesting point. Where do we say - this is the fault line- any further and you can't be having this treatment on the charities books.

I am lucky despite doing a lot of charity work our local centre raises its own funds and funds treatment of animals this way. No way HQ is paying for treatment of parvo outbreaks, and so on. No sirr-ee, best to invest the tens of millions overseas in a very safe Icelandic bank.

Blanket or euthanasia of 'ill' patients so the healthy can be accommodated in greater numbers really bugs me (and yes I know no one is suggesting that here but it does happen) - especially when treating the underlying problem can result in a total cure.

I wonder how then we should treat

The patient with lungworm

The patient with a PDA (young not in CHF)

The patient with a GI foreign body (not perfd)

There are arguments they are all fatal diseases, and the patient can die despite adequate treatment ( but they are curable) so should we be PTS-ing these cases if from a charity?

Finally I'd like to lay rest the notion that this is a surgical rubbing-of-hands-in-glee please note I have already displayed my ignorance in surgical terms at the start of this post, and am much more of a medic so it is definitely not that!

Your opinions ?

Raj

Re: Urinary incontinence kitten

James Laidlaw — Mon, 20 Aug 2012 14:13:03 GMT

So where do you draw the line? All non-neuter surgeries? Regardless of the philosophical/ethical side-debate, I'd be interested to know what the outcome was with this kitten!

Re: Urinary incontinence kitten

Bob Russell — Mon, 20 Aug 2012 13:53:01 GMT

[quote user="James Laidlaw"]So then you'd just euthanise anything that isn't healthy or requires more than a small amount of medication? I'm sure they aren't refusing to do speys and preventative treatments because some individuals are having treatments... I don't know if there's a right or wrong in this situation, but we are all in he basis of protecting and maintaining welfare of animals and euthanasia of otherwise treatable patients, in my mind at least, is contrary to that principle.

[/quote]

We are talking about a charity clinic with (I assume) limited funds that have to be used as efficiently as possible. I would prefer my charity donations go to help as many as possible, as efficiently as possible.

Limited funds should be spent to give maximum benefit even if it means that an individual does not get treated. I am for protecting and maintaining welfare and sadly on occasions this means euthanasia.

Re: Urinary incontinence kitten

James Laidlaw — Mon, 20 Aug 2012 13:13:24 GMT

So then you'd just euthanise anything that isn't healthy or requires more than a small amount of medication? I'm sure they aren't refusing to do speys and preventative treatments because some individuals are having treatments... I don't know if there's a right or wrong in this situation, but we are all in he basis of protecting and maintaining welfare of animals and euthanasia of otherwise treatable patients, in my mind at least, is contrary to that principle.

Re: Urinary incontinence kitten

Bob Russell — Mon, 20 Aug 2012 13:07:10 GMT

[quote user="James Laidlaw"]

[quote user="Michael Woodhouse"]

David - aren't you Blue Cross? I would have thought the best thing for your funds would be PTS and spend the money on a more deserving cases.

[/quote]

What's more deserving than an animal with it's whole life potentially ahead of it?

[/quote]

Twenty or thirty other spays paid for with consequent welfare and re-homing benefits?

A surgical adventure for someone seems a bit of a moral grey area especially if it is coming out of charity funds.

Sorry I am on the side of those suggesting it is better to spend limited resources in the most efficient way to maximise the overall welfare benefit to as many individual animals as possible.

Re: Urinary incontinence kitten

Rajat — Mon, 20 Aug 2012 11:23:34 GMT

[quote user="James Laidlaw"]What's more deserving than an animal with it's whole life potentially ahead of it?[/quote]

Completely totally head over heels agree.

Re: Urinary incontinence kitten

James Laidlaw — Fri, 17 Aug 2012 13:38:44 GMT

[quote user="Michael Woodhouse"]

David - aren't you Blue Cross? I would have thought the best thing for your funds would be PTS and spend the money on a more deserving cases.

[/quote]

What's more deserving than an animal with it's whole life potentially ahead of it?

Re: Urinary incontinence kitten

Rob Loxley — Thu, 16 Aug 2012 23:27:04 GMT

[quote user="Michael Woodhouse"] I would have thought the best thing for your funds would be PTS and spend the money on a more deserving cases.[/quote]

Assuming the blue cross wouldn't be paying for referral then surely the 'money' amounts to some drugs and consumables?

Re: Urinary incontinence kitten

Michael Woodhouse — Thu, 16 Aug 2012 22:09:27 GMT

David - aren't you Blue Cross? I would have thought the best thing for your funds would be PTS and spend the money on a more deserving cases.

Re: Urinary incontinence kitten

Rajat — Thu, 16 Aug 2012 22:00:16 GMT

[quote user="Evelyn Barbour-Hill"]Sorry if I've misunderstood but the original post seems not to be describing ectopic ureter - the ureters already go into the proper place in the bladder, don't they?[/quote]

You are right and I am wrong.. I got mixed up, and thought the cloaca type thingy described was referring to the ureters.

Sounds like the best bet would re-construction and re implantation of the urethra and resection of the dilated cloacal bit. And spaying of course.

[quote user="Evelyn Barbour-Hill"] am uneasy at the idea of a surgeon doing something like this, without guaranteed success, just for the chance to write it up and further his career.[/quote]

Well I wasn't suggesting just 'any' surgeon, a specialist rather...and writing up an interesting case is a non-monetary motivation surely not a bad thing if it helps a cat live and the owners who otherwise could not afford surgery?

funny I can think of many things I do everyday medically/surgically that don't 'guarantee' success..rather the best shot at it

sorry DM please ignore my initial post!

Re: Urinary incontinence kitten

Evelyn Barbour-Hill — Thu, 16 Aug 2012 21:10:17 GMT

[quote user="Rajat"]

2.Ureteroneocystostomy - tricky but best option

3.Colonic diversion - risks infections and if you're gonna divert might as well divert to the bladder!

[/quote]

Sorry if I've misunderstood but the original post seems not to be describing ectopic ureter - the ureters already go into the proper place in the bladder, don't they?

The problem is what to do with the urethra; or where to put the ureters if the bladder and urethra have to be abandoned. My guess (it's not my field!) is that urethral reconstruction is the best bet but still chancy.. so strictly for a good urological surgeon.

Frankly it seems a case for euthanasia. I am uneasy at the idea of a surgeon doing something like this, without guaranteed success, just for the chance to write it up and further his career.

Most incontinent kittens are euthanased and I see nothing wrong with that.

Re: Urinary incontinence kitten

Rajat — Thu, 16 Aug 2012 20:00:32 GMT

My guess re your options would be:

1.Ovariectomy and let her dribble- not really a nice option but avoids surgery

2.Ureteroneocystostomy - tricky but best option

3.Colonic diversion - risks infections and if you're gonna divert might as well divert to the bladder!

4.Permanent tube cystotomy - unlikely to be practically feasible esp in charity situation

5. Maybe try Davies for their monthly charity case or similar? A soft tissue surgeon may want to take it on at costs etc to have a chance to write it up..?

6.Hate to say it but PTS if cannot be fixed or adopted?