Clinical - Recent Threads

RE: OA: do you take a whole-practice approach?

Evelyn Barbour-Hill — Sat, 11 Jul 2026 23:48:37 GMT

[quote userid="3169" url="~/f/clinical-questions/31386/oa-do-you-take-a-whole-practice-approach/249105#249105"]

I would lay you a healthy bet 99% of "written pain management plans" are never looked at a 2nd time. Not a good use of time IMO

I don't want to ever watch a video on an owners phone or look at a photo of literally any fluid your pet may have produced. Sorry.

[/quote]

Two points with which.... I entirely agree.

OA: do you take a whole-practice approach?

Chris Ritchie — Fri, 10 Jul 2026 12:57:18 GMT

In this month's Vet Edge, Nichi Cockburn offers some practical tips on veterinary teams refining their approach to supporting rather than exacerbating chronic pain, arguing that chronic pain may hide in plain sight.

How much do you do this? Do you view this as a priority in consultations even if the animal isn't directly presented for something OA-related?

From my perspective as a cat owner, and mindful that my old dog was not assessed for anything OA when her legs were failing her, I don't recall my then vets taking any particular steps such as those Nichi suggests:

• Provide written pain management plans.
• Encourage owners to record videos of mobility at home and to regularly complete their chronic pain scores, for example before every nurse mobility clinic or medication check-up.
• Train all team members – from receptionists to nurses – to recognise pain indicators.

The full article is here, from page 30: indd.adobe.com/.../df696ccb-38db-4b36-9143-1a507b86242e

RE: OA: do you take a whole-practice approach?

Clare Tapsfield-Wright — Sat, 11 Jul 2026 19:03:10 GMT

I do think that some owners don’t realise their dogs are struggling and I have nudged my friends to go to the vet when they think their dog is “ slowing down “ and I think it is experiencing some dull pain and reduced mobility.
With my own dog who has horrendous elbows I don’t film her movements and deterioration and do pain scoring but maybe I should or would if not a retired vet .
The reluctance of the general public to give medication for pain relief really bugs me . There seems to be a fear of side effects and also a cynicism of vet intervention now which is very depressing. The distrust means that some dogs who would be so much happier with some NSAIDs struggle on so maybe some client education but also reassurance that maybe we won’t compel people to have full X-rays and bloods before prescribing would be helpful . Some clients would happily go for full workup , physio etc but maybe an OAP with a thirteen year old dog just wants to try a pragmatic approach . Contextualised care I think they call it nowadays

RE: OA: do you take a whole-practice approach?

Michael Woodhouse — Fri, 10 Jul 2026 21:47:09 GMT

(this is the article I think feels very AI generated!)

Reception are behind a desk they can't see most pets, they have almost zero role in this. If someone raises a concern then encourage raising with the vet, add it to diary notes.

I would lay you a healthy bet 99% of "written pain management plans" are never looked at a 2nd time. Not a good use of time IMO

I don't want to ever watch a video on an owners phone or look at a photo of literally any fluid your pet may have produced. Sorry.

Do I think we are good at assessing animals that are struggling/slowing down and showing signs of arthritis - yes, absolutely? I always watch the animal enter the room, make general enquiries as to mobility, look for significant increases in weight (as a reasonable proxy for reduced exercise). One of the drug companies will let us dispense a box of NSAID for a month FOC to see if it helps, that does more to convince the sceptical, and I'd say 66% continue on NSAIDs or other drugs.

Over the years we've had display boards, leaflets, surveys to fill in while waiting, and I'd say its has practically zero effect on us discussing arthritis in the consult room or prescribing meds. I'm unconvinced that there is a population of dogs that come for boosters and see the vet when their owners have concerns with significant levels of undiagnosed arthritis. They are a lot of dogs out there who never or very rarely see a vet, they are the ones I worry about more.

(and still very possible to do this during a booster in a 10 min appointment, including brief notes and dispensing).

RE: Complications from dog castration

Anthony Dennison — Tue, 07 Jul 2026 09:54:44 GMT

[quote userid="8991" url="~/f/clinical-questions/31370/complications-from-dog-castration/249055#249055"]I bet you had a circular cushion for a while though. Or ice. [/quote]

Nope. In fact I had it done a Thursday afternoon, that weekend my wife was working so I was sole charge with 3 kids going to all the activities. Bit of a dull ache but not crippling.

Complications from dog castration

Beats — Thu, 28 May 2026 21:29:58 GMT

What complications (things happening as a result of the castration procedure that otherwise wouldn't have occurred) do you see from dog castrations?

Surgical site infections (SSI)

Other wound complications (if so what)

Clipper rash / Inflamed skin on scrotum or where shaved

Vomiting or diarrhoea

Scrotal haematoma

Other (please specify)

Thanks!

PS - I'm trying to audit outcomes for these going forwards, but really struggling to decide what a bad outcome looks like and how to go about this - I'm not interested in just producing some meaningless figures going "aren't we great" but some actual genuine figures looking at positive and negative outcomes from a more objective and scientific outlook. My suspicion over the years is that we see more clipper rash problems with dog castrates causing obvious distress than actual wound infections, but the various classification schemes I have seen to-date only focus on the wound itself (aiming at SSI incidence). Interested to hear other folks thoughts!

RE: Complications from dog castration

Lucy Fleming — Sat, 04 Jul 2026 08:51:39 GMT

[quote userid="8991" url="~/f/clinical-questions/31370/complications-from-dog-castration/249055#249055"]Not to diss your wife but I did a c section tonight and the dog walked out half an hour after waking up....[/quote]

Was she walking on two legs and carrying the puppies though?

RE: Handovers

Clive Ansell — Thu, 02 Jul 2026 09:18:13 GMT

Was this a handover from one vet to another within the same practice, or between a practice and an out of hours clinic?

I have come across many instances of problems handing cases over between daytime practices, and out of hours clinics. I have worked in both, so have seen it from both sides of the fence. Communication is the key, and ideally a vet/RVN to vet/RVN conversation, with any relevant history sent via email.

very different down on planet real world though. Often clients and cases are just told to turn up with no communination and no clinical notes, This happens in both directions.

Handovers

An On MRCVS — Wed, 01 Jul 2026 17:29:04 GMT

Hi , what would you think ? Is it acceptable to get a text message handover of a critical case from an RVN for a critical case to be seen in clinic the next day Saturday . Was told mrcvs would write notes and then they actually didn't . On investigating , in my opinion case was not suitable to be sent home overnight for re-check mid Saturday morning as was unstable with two life threatening conditions , one of which was not attempted to address and hospitalisation records although minimal showed clear deterioration . No evidence on PMS or hospital records that Mrcvs had been involved at all . Messaged MRCVS stating unacceptable to get confusing handover from RVN who didn't seem to know the case and then got very short text which ignored one aspect of the case stating that if qol poor pts has been discussed. I did not know the case until I looked into it during the appointment .

RE: Handovers

Michael Woodhouse — Wed, 01 Jul 2026 22:13:02 GMT

Assuming dog? Sounds pretty buggered, if I'm honest. One of those cases where I discuss PTS early. I can see a case like this would get a young medicine internist tingling in their pants with excitement.

Two complex medical problems that you can choose to throw lots of money and intervention at, or try a more conservative approach and see what happens. CHF we have excess fluid to get rid of, heart to support. DKA is one of those conditions I find triggering and I think the profession tends to over treat. If a true DKA then needs lots of fluids, insulin possible glucose, poss feeding tube etc. The paradox of one problem caused by excess fluid and one needing more fluid giving also pushes me down a PTS route, if it was my dog think thats what I'd do.

[I think a lot of animals diagnosed as DKA are diabetic and do have ketones, but those ketones resolve as an out patient with Caninsulin once or twice a day, they don't need hospitalisation and simultaneous soluble insulin and glucose infusions]

Although, I will say, I don't think even I would give this steroids........

Not sure why it couldn't go home, if owner wanted. Neither a painful condition.

RE: Handovers

Dinu Catilina — Wed, 01 Jul 2026 22:09:13 GMT

The way I see it:

1. Are you unhappy with the treatment received? Call the other vet and discuss the case. Find out if this is a knowledge issue or lack of interest in the patient. The two would be handled very differently.

2. Are you unhappy with who handled the communication? In this case, does the clinic have a protocol in place? If we have any cases that are handed over as inpatients then the inpatient vet will have to text message or call the oncall vet or the next day's vet to update/discuss the case. If there is no protocol in place where you work then you should push for one.

3. Are you unhappy with the clinical notes? Again have a word with the vet in person or over the phone and find out why their notes are poor and ask them to update the notes the first day they are back at work. Poor clinical notes will get them in trouble with the RCVS if there is a complaint.

RE: Handovers

An On MRCVS — Wed, 01 Jul 2026 21:57:52 GMT

Lasix / drain / IV drip / nurse encouraged or offered feed

RE: Handovers

Michael Woodhouse — Wed, 01 Jul 2026 21:43:33 GMT

[quote userid="10402" url="~/f/clinical-questions/31382/handovers/249071#249071"]Pet had CHF plus DKA . [/quote]

And what treatment had the animal received?

RE: Handovers

An On MRCVS — Wed, 01 Jul 2026 21:36:28 GMT

I do think it's okay for RVN to do handover actually if they've also had a decent handover and plan . Pet had CHF plus DKA . Respiratory rate increasing , body temperature decreasing- quite hypothermic , anorexic . Owner not informed re diabetes or DKA . Rvn not informed re this either - leading to quite a bit of confusion . Worked it all out during the appointment . Owner reasonably pragmatic as dealing with home issues and quietly regretful but not overtly annoyed .

RE: Handovers

Michael Woodhouse — Wed, 01 Jul 2026 21:24:19 GMT

As you are using the anon account - I think you need to give more details. There is no harm in that, as long as you don't use owner names or anything compromising GDPR.

As a new grad almost every referral I made was after a telephone call MRCVS to MRCVS. Animal sent with a brief letter. None of this nonsense of a complete history so they can see how well wormed as a puppy. Now its all portals where things are uploaded and often a junior vet rings if you want to speak, rather than the specialist etc who I want to be dealing with. The world has changed. I will often leave a referral process completely in the hands of our nurses, now. This was never the case before.

Do I think it's OK for the vet to get a RVN to pass on the information - in principle yes. Professional member of the team, may have nursed consistently whilst looked after by different vets.

In the real world lots and lots of animals are sent home who are not really "suitable to be sent home overnight", for a heap of reasons. Owner expectations, finances, one last night at home, not happy with overnight care, as long as client made aware of what may be best, this is not your place to judge - especially on limited information. I throw in a caveat - assuming not in significant pain or distress.

What were the two conditions, and what is your measure of deterioration?

Messaging the MRCVS saying unacceptable, I think is the most unacceptable thing you have written. That is the time you pick up the phone for a professional discussion. You have no idea what that other vet is dealing with on a work and private level. Sometimes my notes are poor when I'm pulled in 5 directions, if I have 10 mins to give I'd rather spend it with the animal than in front of a keyboard. If I'm late finishing then I'm going home for my tea and to see the kids and will do some notes another day.

Please expand the information given, and also the owners expectations when you met them, and this could be a great thread.

RE: Complications from dog castration

David Mills — Mon, 29 Jun 2026 23:30:06 GMT

Not to diss your wife but I did a c section tonight and the dog walked out half an hour after waking up....

[quote userid="11308" url="~/f/clinical-questions/31370/complications-from-dog-castration/249045#249045"]As my wife said when she called me as I drove back to work 'it's not like you've had a caesarian though is it'[/quote][quote userid="11308" url="~/f/clinical-questions/31370/complications-from-dog-castration/249045#249045"]Played rugby 2 weeks late[/quote]

I bet you had a circular cushion for a while though. Or ice.

RE: Kitten eye - what's going on?

David Mills — Mon, 29 Jun 2026 23:19:12 GMT

[quote userid="12930" url="~/f/clinical-questions/31380/kitten-eye---what-s-going-on/249051#249051"]are there anterior synechiae there[/quote]

Home pic so hard to tell but yes maybe.

This was a delayed eye opening no flu signs so I can't square it with herpes. Other eye always normal. But it probably is having said that.

Kitten eye - what's going on?

David Mills — Sun, 28 Jun 2026 22:56:21 GMT

After a bit of advice about this one.

Now 8wo kitten delayed opening R eye which presented with conjunctivitis, mucoid discharge, no ulcer, corneal oedema, Some improvement maxitrol not fully resolved. No change chloramphenicol for a week. No ulcers still, no obvious pain. Visual, cat otherwise well.

Thoughts on next steps?

Tricky owner, wants immediate fix etc.

RE: Kitten eye - what's going on?

David Mills — Mon, 29 Jun 2026 23:17:18 GMT

I thought uveitis too..

No pred forte in stock so it's on maxidex for now.

[quote userid="14693" url="~/f/clinical-questions/31380/kitten-eye---what-s-going-on/249048#249048"]Looks like uveitis[/quote]

RE: Kitten eye - what's going on?

Beats — Mon, 29 Jun 2026 18:52:24 GMT

are there anterior synechiae there?

RE: Kitten eye - what's going on?

Clive Ansell — Mon, 29 Jun 2026 18:32:44 GMT

Would folk want to exclude a viral aetiolgy before using more potent or more frequent corticosteroids?

[quote userid="14693" url="~/f/clinical-questions/31380/kitten-eye---what-s-going-on/249048#249048"]Pred forte usually better than maxitrol[/quote]

agree.

RE: Kitten eye - what's going on?

Lesley Strong — Mon, 29 Jun 2026 16:24:04 GMT

Looks like uveitis

? trauma but watch FIP

Pred forte usually better than maxitrol

RE: Kitten eye - what's going on?

Anthony Dennison — Mon, 29 Jun 2026 12:46:09 GMT

[quote userid="5012" url="~/f/clinical-questions/31380/kitten-eye---what-s-going-on/249039#249039"]2. Continue topical meds, Maxitrol as seemed to help,[/quote]

I often use Pred Forte in these cases. For some reason it's in my brain that it penetrates deeper into the eye than Maxitrol for some reason. It may be something i misheard a long time ago and kept it as Dogma, but it hasn't failed yet.

Start BID dosing, then slowly taper, to SID, EOD then twice a week

RE: Complications from dog castration

Anthony Dennison — Mon, 29 Jun 2026 12:31:29 GMT

[quote userid="8991" url="~/f/clinical-questions/31370/complications-from-dog-castration/248962#248962"]In humans the closest corollary is a vasectomy which is sore especially when moving around so I suspect there may be a little bit of understimation of pain with castrations.[/quote]

It's not that bad. When I got my appointment last year we were so short staffed I had to nip out and have it done on my lunch break. Played rugby 2 weeks later.

As my wife said when she called me as I drove back to work 'it's not like you've had a caesarian though is it'

RE: Kitten eye - what's going on?

Kate Richardson — Mon, 29 Jun 2026 12:12:00 GMT

It’s always herpes until proven otherwise I was once told