Rant

Re: Rant

Stephen Courtney — Fri, 30 Nov 2012 22:44:19 GMT

Cystocentesis in most cats is a very benign procedure - you need to pick your cat and pick your bladder size though! trying to get a small bladder in a stressed and wriggling cat is a bad idea, but i can do almost all my bladders with just the client holding, often with neither the cat nor the client being particularly aware of what i am doing

The value of a specific gravity and a dipstick, with or without a sediment exam, is in my opinion on a par with a basic blood biochem panel.

Having said that i have yet to find an FLUTD cat with a bladder suitable for a cysto, at least in the acute phase. and the OP's patient was surely a sprayer rather than a periuria/ dysuria

Re: Rant

plantagenet — Fri, 30 Nov 2012 18:52:34 GMT

I have tried to be good and not treat UTIs in cats with antibiotics.

They often don't respond, I reach for the antibiotics - they get better.

My experience leads me to think that bacterial infection plays a bigger part than indicated by studies. Where are these studies done? Are they the cats that we see in practice?

I am not a fan of cystocentesis either - I would let my GP try it on me.

We were lectured constantly lectured on how ear infections were seldom bacterial in children, after a period of miserable child (variable time depending on Dr), antibiotics would be prescribed, child would cease to be miserable. Presumably said child was the 15% that had bacterial infections.

Re: Rant

Mark Holmes — Thu, 29 Nov 2012 18:01:24 GMT

[quote user="Kate Richardson"]

I may have dreamt this but I think there was a more recent study that showed that the incidence of bacterial infection in younger cats was higher than originally suspected albeit still very low. The low risk I believe is due to the high SG of cats urine, which bacteria don't thrive in. Hence in older cats the increased incidence of bacterial infection, usually related to a lower SG related to older age diseases such as renal insufficiency. And in older cats with renal insufficiency (or other diseases causing lower SGs or glucosuria) it can often be sub clinical so ideally regular routine urinalysis including bacterial culture is recomended as part of CRI monitoring.

[/quote] Kate, the study into feline uti was that based on urine culture of bladder tissue culture? I have diagnosed a suppurative cystitis in several cats which had a negative urine culture but a positive culture from bladder wall biopsies. It has lead me to wonder if bacterial infections are more common than the study would indicate if it was based on culture results

Re: Rant

Kate Richardson — Thu, 29 Nov 2012 12:53:30 GMT

Re: Rant

Mark Frost — Thu, 29 Nov 2012 12:46:07 GMT

That is ok, I'm probably wrong - I've always treated young females with a combo of anti-inflammatories, supplements, increased water intake, diet, environmental modification etc.. depending on the situation, and older cats usually with antibiotics and an investigation into underlying cause - those younger cats where a culture was done by cysto as part of an investigation that came back as + always seemed to be male (or old), as I said I can't find the reference I remember (probably as it would appear it doesn't exist or is not how I remembered!)

Re: Rant

Simon Neuhoff — Thu, 29 Nov 2012 10:21:52 GMT

[quote user="Mark Frost"]

[quote user="Chris Geddes"]

Curious why antibiotics considered when bacterial cystitis responsinble for <2% of FLUTD (Buffington 1997)?

Re welfare concern, I would've thought obstruction far more likely than pyelonephritis? Admittedly less common in entire cats...

[/quote]

I understood this was females not males, who are more likely to have bacterial cystitis (still not top of the list though) - can't seem to access the paper right now to check either way. Regardless, I think the point the OP was making was about the rude and unreasonable nature of the client rather than the best way of approaching the clinical issue as whatever the advice/treatment plan it wasn't going to happen. People like this seem to think that simply walking through the door of a vets assuages their guilt at the fact that the problem has been left for ages when they plan on ignoring any advice given (unless that advice is simply, have a free course of treatment that is easy to administer and will guarantee to fix the problem forever and also stop any other health issues ever happening to your animal regardless of how you look after it!).

[/quote]

Not sure I'm understanding your post correctly Mark - males are VERY unlikely to have bacterial cystitis, esp young males. Females and elderly cats more likely. Is that in fact what you were saying?

Re: Rant

Mark Frost — Thu, 29 Nov 2012 09:59:54 GMT

[quote user="Chris Geddes"]

Curious why antibiotics considered when bacterial cystitis responsinble for <2% of FLUTD (Buffington 1997)?

Re welfare concern, I would've thought obstruction far more likely than pyelonephritis? Admittedly less common in entire cats...

[/quote]

Re: Rant

Mark Hedberg — Thu, 29 Nov 2012 08:44:38 GMT

The one time I ever took the wind out of someone's sails was when they went into the whole 'you should be treating me free' and I just started laughing; couldn't help myself. It was a weird day; don't ask me why it was so funny that day, but apparently they can't stand being laughed at. (No, I never tried it on purpose because I don't fancy a punch in the nose.)

Re: Rant

Utlendigur — Wed, 28 Nov 2012 20:35:36 GMT

[quote user="Chris Geddes"]

Curious why antibiotics considered when bacterial cystitis responsinble for <2% of FLUTD (Buffington 1997)?

Re welfare concern, I would've thought obstruction far more likely than pyelonephritis? Admittedly less common in entire cats...

[/quote]

Also would want to know whether cat is spraying or squatting.

But yes, the clients sounds a total ar**hole. One thing that annoys me is when clients like this get their bills written off (as this client has previously by the sound of it) - it just rewards them and gives them more incentive to kick off next time. One from our practice - a guy who'd bought a staffie pup and thought he should have free vaccinations because he was on benefits - the nurse spend a long time discussing PDSA pet aid but said it didn't cover preventative treatment - which didn't go down well and ended up with him swearing and ranting in reception that's he''d just paid £x hundred for the dog and if anything happened to it it would be our f***ing fault because we wouldn't vaccinate it free of charge

Re: Rant

Julie Innes — Wed, 28 Nov 2012 19:51:52 GMT

I feel your pain, OP. One of the things I hate most about the job is people trying to lay the guilt for their lack of money at my door

If you can't afford basic healthcare for a cat, don't get a cat. I'd love to see if "rescuing" a new car from gumtree would entitle me to free petrol- worth a try??

I am usually bluntly honest with people in this situation: "you are asking me to lend you money. I don't know you and can't afford to. Yes, i know you think vets earn megabucks, but I don't, and I have bills to pay too. Which nooone helps me pay. Do you not have anyone who knows and likes you who might be willing to lend you something towards the cost of treatment?"

But there are so many idiots out there, and they always somehow manage to make US feel bad for their complete lack of responsibility. Hope you have a better day tomorrow, OP

Re: Rant

Chris Geddes — Wed, 28 Nov 2012 19:14:02 GMT

Curious why antibiotics considered when bacterial cystitis responsinble for <2% of FLUTD (Buffington 1997)?

Re welfare concern, I would've thought obstruction far more likely than pyelonephritis? Admittedly less common in entire cats...

Re: Rant

Mark Holmes — Wed, 28 Nov 2012 09:31:16 GMT

I find it stings worse when it's unjustified.

Re: Rant

plantagenet — Wed, 28 Nov 2012 09:25:01 GMT

It does no harm to speak to the VDS so that your side is recorded.

It's funny how the nastiness can sting even though 100% unjustified.

Poor you, hope the rant helped.

Re: Rant

Simon Neuhoff — Wed, 28 Nov 2012 09:13:25 GMT

Only one thing to add to the generally excellent advice here - make careful and thorough notes! Especially of the clinical exam (such as it was).

Re: Rant

Louise6732 — Wed, 28 Nov 2012 07:32:51 GMT

[quote user="An On MRCVS"]They were also unwilling to accept that the fact that they have three indoor cats (2 x entire male) together with one litter tray was even part of the problem never mind getting them to do anything about it. [/quote]

What is wrong with people?! One of the most annnoying things when people come to you for advice, (money issues aside!) and won't listen when you don't tell them what they want to hear.

Re: Rant

An On MRCVS — Tue, 27 Nov 2012 15:47:26 GMT

[quote user="Clive Ansell"]

I don't see the issue here.

Clients sound like vermin, if they spoke to me in that manner they would be shown the door PDQ.

We are under no obligation whatsoever to provide free advice or treatment, other than in the case of an emergency of course. My approach would have been quick triage (i.e not a full on consult and discussion etc) to ascertain there was no immediate emergency (urethral blockage, RTA etc). I may have offered urinalysis and antibiosis if needed, but it would have to be paid for at the time. Cat peeing in the house isn't an emergency. say goodbye to them, and hope that the tom cats p*** in their house forever.

[/quote]

Agreed.. there is no issue - they are vermin and won't be coming back, just needed a rant! Shame that their pets have to exist in their situation but nothing I can do and as usual, having slept on it and read all your replies feel much better. I know there are people like this and these certainly aren't the first I have dealt with or the last I will encounter but still it still shakes you.

Re: Rant

Clive Ansell — Tue, 27 Nov 2012 14:45:37 GMT

I don't see the issue here.

Clients sound like vermin, if they spoke to me in that manner they would be shown the door PDQ.

Re: Rant

An On MRCVS — Tue, 27 Nov 2012 14:32:59 GMT

OP Anon here..

Thanks for your replies, they will be sacked as clients - no benefit in having that kind of trouble around. Not going to worry too much about anything else as yet, I think the animals are in an inappropriate situation but not bad enough for the RSPCA to get involved - they do want to seek veterinary care when there is a problem, they just feel like they shouldn't have to pay a penny towards it. There is no debt here, I discounted the cons fee to the £10 they could pay, as there is really no benefit in chasing the remainder of the cons and no treatment had been given so I'm hoping we just never hear from them again!

Re: UTI - I'd have loved to have done a urine sample, or even just been able to convince them that the situation they are in is not helpful however when unwilling to even pay the cons fee even a urine sample is not an option. They were also unwilling to accept that the fact that they have three indoor cats (2 x entire male) together with one litter tray was even part of the problem never mind getting them to do anything about it. Wall + head.

Re: Rant

Robin Grimmer — Tue, 27 Nov 2012 13:37:24 GMT

seems to be an awful lot of guff on this thread about UTIs and giving prophylactic antibiotics. You request a urine sample (simple and cheap), you say that both male cats must ne neutered but you warn them it may not cure the problem as they have left it so long, they may need Feliway etc. also the carpets will need thorough cleaning. If they whinge about that you say rehome that cats - they will get neutered and find a happier place to live.

Re: Rant

Hannah Wynne Richards — Tue, 27 Nov 2012 12:54:52 GMT

UTI not ruled out-COULD end up as an ascending pyelonephritis-duty of care to protect from illness or injury-2 unneutered males and high risk of fight injury I could put forward enough arguments that if the AWA was strictly interpreted and the magistrates sympathetic could gain a conviction

Wynne

Re: Rant

Michael Woodhouse — Tue, 27 Nov 2012 12:07:38 GMT

[quote user="Hannah Wynne Richards"]

Not treating =cruelty so report

[/quote]

Does this entire male cat displaying normal scent marking behaviour actually require any treatment?

Re: Rant

Hannah Wynne Richards — Tue, 27 Nov 2012 12:06:00 GMT

Not treating =cruelty so report

Wynne

Re: Rant

Martin Atkinson — Tue, 27 Nov 2012 09:45:42 GMT

You have absolutely no obligation to treat this cat for what is basically normal behaviour. From what you say, he hasn't threatened you personally yet (only to report you to the RCVS & RSPCA for which he has absolutely no foundation so you have no concerns over that, its only an idle threat but if not let him waste his time) so it appears there is no indication to involve the police but the moment he shows threatening or abusive behaviour directed to you or your staff then report it - they will do sweet FA but at least its on record. Meanwhile send an invoice for the outstanding debt, if it is not paid send it to a debt collector they usually won't charge if they don't collect (not worth county courts fees) and write a letter, as advised, telling them they will never be seen as clients again in the future. As for reporting to the RSPCA, there doesn't seem to be an indication again for this as there is no suggestion there is a welfare or neglect/cruelty problem and it is not serious enough to compromise yourself over client confidentiality issues. It is not your problem so don't fret, a good rant always clears the mind but remember it happens to all of us, its part of the job and its just water off a duck's back but sometimes it makes it difficult to remember the 99% of decent clients.

Re: Rant

Dagmar Steele — Tue, 27 Nov 2012 09:14:19 GMT

[quote user="Malcolm Ness"]

Finally, remember that most people are really nice most of the time - though I do admit that that is sometimes hard to believe!

[/quote]

I know it's hard to believe just because one nasty id..... like this weighs out more than ten nice people. It always gets to me, too, even after all these years :-(

very good advice already given although I'm afraid OP might not be the boss and in the position to sack this client (which I would, being the boss...)

Re: Rant

Malcolm Ness — Tue, 27 Nov 2012 09:07:27 GMT

[quote user="james herriot lied"]

It would also be a good idea to just have a conversation with your local police, and retrieve a reference for the communication, as you do have some recourse under the Protection from Harassment Act if he were to repeat his threats (Harassment Orders are a doddle to obtain, without any need whatsoever to institute proceedings or attend court - basically of you can show that someone has been abusive to you on two or more occasions, plod will go round and give him a piece of paper)

You actually DON'T have to put up with this, you know.

[/quote]

Excellent advice.

Write the client a "sacking" letter asap (VDS will help you with the wording if necessary.

The benefits of this are several

1. It will make you feel better straight away

2. It will make you feel better medium and long term knowing that you will not have to deal with these people again.

3. Your staff will like the fact that you are demonstrating that you and they need not tolerate such behaviour.

4. Your good clients will benefit from the fact that you are spending time with them that you would otherwise expend pointlessly trying to placate fcukwits.

The cats and dog are beyond your care so don't fret about what you can't fix.

Finally, remember that most people are really nice most of the time - though I do admit that that is sometimes hard to believe!