feline echo teaching

Re: feline echo teaching

Anthony Todd — Sun, 13 Jan 2013 01:29:43 GMT

We were discussing a prolonged euthanasia where infection is hardly a factor....

Re: feline echo teaching

David Mills — Sun, 13 Jan 2013 00:29:31 GMT

[quote user="Rajat"]

By prolonging the GA, one increases the GA risk as well as the risk of infection, so to me this is not acceptable..

[/quote]

Not a big factor, actually, re infection. Common thinking is 'events not time' lead to infections - in fact surgical time has been shown to be almost of negligible effect in SSI infection rates.

Re: feline echo teaching

Michael Woodhouse — Sun, 13 Jan 2013 00:17:27 GMT

[quote user="Rajat"]

[quote user="Kate Richardson"]So is it ethical to prolong an anaesthetic for educational purposes then?[/quote]

No, definitely not. In fact in my eyes much worse than echo-ing a cat that is soon to be dead.

[/quote]

Rajat - how did you ever learn to spay bitches? Because I used to be very slow when learning. Similar when we let vet students either do or help with an operation.

A friend of mine who qualified as a doctor at a similar time to me performed internal examinations of patients without their consent under general anaesthetic - apparently it is commonplace.

Re: feline echo teaching

Rajat — Sat, 12 Jan 2013 19:26:43 GMT

[quote user="Kate Richardson"]So is it ethical to prolong an anaesthetic for educational purposes then?[/quote]

No, definitely not. In fact in my eyes much worse than echo-ing a cat that is soon to be dead. I envisaged (wrongly?) that a practice echo on a young pet to be neutered would be carried out in recovery where the anaesthetic has been turned off and the nurse is still monitoring the patient, but it is still enough to allow a newbie to practice on. By prolonging the GA, one increases the GA risk as well as the risk of infection, so to me this is not acceptable..

[quote user="Kate Richardson"]Maybe I should have said it can be a stressful procedure for the vet when you are learning the skills, otherwise I totally agree it is a haven- when you know what you are doing are and are confident. But when you are learning it can be frustrating, and for many people they maybe don't have the back up right there and then to assist and advise whilst actually doing the ultrasound. When I first started scanning, I remember my colleagues seemed to think I was instantly an expert and wanted immediate diagnoses! Add to that time pressures and animals that don't want to co-operate, and it can be stressful.[/quote]

Fair enough, I agree with you on this, I did swear a lot in my first year of learning ultrasound!

Re: feline echo teaching

Anthony Todd — Sat, 12 Jan 2013 19:20:56 GMT

[quote user="Utlendigur"] just playing devil's advocate[/quote]

Trouble is, these days, that becomes a valid argument not to allow, sanction condone or agree to something that's common-sensically good!

Re: feline echo teaching

Utlendigur — Sat, 12 Jan 2013 18:32:18 GMT

[quote user="Malcolm Ness"]The commonly applied test as to whether something is or is not an act of veterinary surgery (and therefore something that we are entitled to do) is whether or not the act is believed to be of benefit to that individual patient. If the act can't be argued to be in the interest of that particular patient then it isn't an act of veterinary surgery and therefore something that we shouldn't be doing - the "greater good" of the species, the herd, the client or the veterinary surgeon is not relevant. [/quote]

Just wondering where blood donation would fit in that definition. You could argue that an animal from the same household used as a donor is benefitting from the continued companionship of its housemate, but what about the dogs that donate to the Pet Blood Bank? I doubt they get a warm altruistic glow as a benefit (Not against the blood bank - just playing devil's advocate).

Many of the feral cats we euthanase have to be GA'd or heavily sedated in a crush cage to even get close to them. So administering a pre-euthanasia "knock-out" is being done anyway, they are not being anaesthetised as an extra procedure. Ultrasound is not an invasive procedure, nor is it a treatment, so if the animal is unconscious all it is doing is slightly extending the period between being fully alive and dead - something that probably happens regularly when you have to pts a feral cat on a busy day, when there isn't time to stand over the crush cage. Would delaying pts to allow a student to auscultate a heart not be in the same category?

Re: feline echo teaching

Kate Richardson — Sat, 12 Jan 2013 15:51:20 GMT

[quote user="Rajat"]

[quote user="Kate Richardson"]So whats the difference? [/quote]

The cat is going to be euthanased. The bitch isn't.

[/quote]

So is it ethical to prolong an anaesthetic for educational purposes then? One could argue that you pose additional risk (albeit small) to these bitches which could cause suffering for no benefit to the animal involved.

[quote user="Rajat"]

[quote user="Kate Richardson"]it adds up to a quite a stressful procedure for the vet, and this stress is transferred to the animal which then reacts to that stress and nothing is achieved. [/quote]

Maybe it's the vet who needs to take a chill pill then! The ultrasound room is a haven of peace in most veterinary hospitals/clinics I find..

[/quote]

Maybe I should have said it can be a stressful procedure for the vet when you are learning the skills, otherwise I totally agree it is a haven- when you know what you are doing are and are confident. But when you are learning it can be frustrating, and for many people they maybe don't have the back up right there and then to assist and advise whilst actually doing the ultrasound. When I first started scanning, I remember my colleagues seemed to think I was instantly an expert and wanted immediate diagnoses! Add to that time pressures and animals that don't want to co-operate, and it can be stressful.

Re: feline echo teaching

Anthony Todd — Sat, 12 Jan 2013 15:45:55 GMT

No, me too; no animal suffers, some might gain.

There's now this culture of righteous, reasoned, almost religious, prevention, always supported by convoluted argument, accompanied by the quoting of a regulation, which manages to make everyone lose sight of the reasons for the act or action in the first place!

This overrides any benefit which was the original reason!

It's as if someone proposed to anaesthetise a cat for an hour, no reason no benefit, just 'cos they wanted to; whereas what the OP wants to do is anaesthetise a cat for an hour then increase the dose and euthanase it so that someone, or some, can learn how to echo cats and help cats in the future.

Seems an obvious no-brainer to me and a good thing to propose.

Re: feline echo teaching

Rob Loxley — Sat, 12 Jan 2013 15:19:58 GMT

Ethically, I'm not sure I have a problem with what the OP proposes.

The bit of my post in italics is however from the A(SP)A...

Re: feline echo teaching

Anthony Todd — Sat, 12 Jan 2013 10:36:02 GMT

[quote user="robloxley"]the ethics are an interesting discussion[/quote]

Surely the protocol described is no more than a prolonged euthanasia?

Surely the end ,in this case, justifies the means?

Surely we should justify the end, that is the reason for the protocol, rather than disregard it?

Surely ,if the "dignity of the animal" is to be considered, then the euthanasia of any unwanted but healthy or "un-suffering " animal should also be considered?

How would we regard the anaesthesia of a Rottweiler to simulate its death in a road accident [or a major film] be regarded today?

That, I would support, as being ,at least ,very dodgy ethically.

Re: feline echo teaching

Rob Loxley — Sat, 12 Jan 2013 00:12:06 GMT

My thoughts
- the ethics are an interesting discussion
- concerns that administering an anaesthetic where it wouldn't otherwise be done puts you in A(SP)A territory ("the administration of an anaesthetic or analgesic to a protected animal... ...for the purposes of any experimental or other scientific procedure shall itself be a regulated procedure")
- but on a practical note I agree that it could be a PR nightmare in the wrong hands (particularly given the above)

How about scanning animals you are anaesthetising anyway e.g. for neutering?

Re: feline echo teaching

Claire McConnell — Fri, 11 Jan 2013 20:38:39 GMT

[quote user="Rajat"]

I don't think the animal will suffer at all but a part of me is uncomfortable with this idea. I don't know why. Maybe it is something to do with respecting an animal's end of life, where we help it to die with dignity. I am not saying this will remove dignity altogether, but it is not in the animal's interest and somehow it just doesn't sit well with me. I am just trying to voice my sub conscious(?) thoughts though, I don't have a strong opinion on it.

Why can your vets not learn to echo cats that aren't anesthetized to be PTSd David? Everyone else does and if I can I am sure they can.

[/quote]

I understand what Rajat is trying to say here but I disagree. I feel if anything its respecting the stray/feral cats end of life further - its letting the end of its life help hopefully a future generation of cats without any suffering.

The only real problem I can see however is that if it was a stray cat (without ID chip) that required pts rather than a real feral and later an anxious owner phoned asking if you had found a cat of said description then the owner may be upset to find clipped patches for the echo if they wante dto vieww body for confirmation.

Re: feline echo teaching

Rajat — Fri, 11 Jan 2013 18:35:17 GMT

[quote user="Kate Richardson"]Why is it such a british thing to make something that should be fairly simple into such a complicated issue! [/quote]

Lol I thought it was an interesting philosophical discussion...

[quote user="Kate Richardson"]So whats the difference? [/quote]

The cat is going to be euthanased. The bitch isn't.

[quote user="Kate Richardson"]it adds up to a quite a stressful procedure for the vet, and this stress is transferred to the animal which then reacts to that stress and nothing is achieved. [/quote]

Maybe it's the vet who needs to take a chill pill then! The ultrasound room is a haven of peace in most veterinary hospitals/clinics I find..

[quote user="Kate Richardson"]Nothing substitutes for actual practice as far as ultrasonography goes. [/quote]

No one is arguing that point...

Re: feline echo teaching

Kate Richardson — Fri, 11 Jan 2013 09:54:53 GMT

Why is it such a british thing to make something that should be fairly simple into such a complicated issue! When learning ultrasound initially, the advice is generally to try to scan any dog clipped up for abdominal surgery such as bitch spays. So whats the difference? Cats are a different kettle of fish when it comes to scanning, mainly due to their temperament and size. Learning to perform echo's correctly is not easy; the positioning is so much more precise and tiny body movements make it even harder, add to that the more rapid heart rate compared to dogs and it adds up to a quite a stressful procedure for the vet, and this stress is transferred to the animal which then reacts to that stress and nothing is achieved. Yes you can recognise normals from a book or by watching, but its a hell of a lot different to trying to position your probe correctly and interpret the images at the same time! Nothing substitutes for actual practice as far as ultrasonography goes.

Re: feline echo teaching

Mike Martin — Fri, 11 Jan 2013 09:02:44 GMT

[quote user="Rajat"]I have to say I don't use M mode for anything other than mitral valve interrogation when looking at DLVOTO cases, everything else I do in 2d as do many of the specialist cardiologists these days. In fact that's what I learnt, 6-7 years ago - not to bother with M mode in cats as it is fraught with error.[/quote]

Yep

"- not to bother with M mode in cats as it is fraught with error." And dogs !

Its a challenging tool to use, with little real benefit. The high frame rates of 2D imaging in modern machines means 2D measurements are accurate enough.

Re: feline echo teaching

J G Wray — Fri, 11 Jan 2013 07:35:39 GMT

[quote user="Rajat"]Anyways,I wonder what the RCVS would say - genuinely interested.[/quote]

Therein lies another question. How do you raise any issue with RCVS and get them to take it seriously, timetabling Comittee time to feedback or questions from the profession? The renal transplant thing is a case in point. It is academic, esoteric even, therefore utterly delicious. Improving the skills in diagnostics is more general, but where's the route to get this topic discussed at RCVS?

RCVS have this profound remoteness that they reinforce by failing to provide a method of contact for consideration of issues like these. You will note there was nothing in their survey about this sort of thing. They're not really interested.

JGW

Re: feline echo teaching

Rajat — Thu, 10 Jan 2013 21:53:30 GMT

David I hear what you are saying. Like I said, I was voicing my thoughts - and while one can argue it will help teach these vets immensely, your idea of starting on dogs is much better. Or practising on one's own cat!

I think the issue of dignity is somewhat ethereal - I think what I am trying to verbalize is the dignity and value we assign to that cat may diminish, when we use it as an echo learning tool prior to euthanasia. Not that the cat will feel undignified!

It is a delicate procedure, and I agree operator error can be substantial. TBH I think it takes a lot of practice so a few feral cats prob won't be enough - I remember being told to scan one pet a day minimum while starting to learn echocardiography - And I had to teach myself more or less in the beginning!

I think a lot is to do with recognizing normals, don't you? And that can be achieved through watching echos (initially) too.

I have to say I don't use M mode for anything other than mitral valve interrogation when looking at DLVOTO cases, everything else I do in 2d as do many of the specialist cardiologists these days. In fact that's what I learnt, 6-7 years ago - not to bother with M mode in cats as it is fraught with error.

Anyways,I wonder what the RCVS would say - genuinely interested...

Re: feline echo teaching

David Mills — Thu, 10 Jan 2013 21:40:10 GMT

[quote user="Rajat"]

Why can your vets not learn to echo cats that aren't anesthetized to be PTSd David? Everyone else does and if I can I am sure they can.

[/quote]

Yes, another of our vets was in a similar place. But I suppose the nub is a philosophical one - an anaesthetised cat that will not wake up does not suffer, and for that reason I don't think its dignity suffers, being as it is, unconscious. And they are not being GAd for this purpose. I remember our ophthalmology lectuer telling us to look in every set of eyes of GA's animals, and squeeze all GA'd anal glands - it is arguable that this intervention was unwarranted also, as the animals were GAd for other reasons (although did wake up), even though it benefitted other animals in the future.

Most people who learn echo start on dogs then down-size to cats, but I think the potential for operator error is higher in cats becasue of the tiny movements required to distort an image to assign pathology where there is none - especially M-mode. Also, I think people get more annoyed with cat echo as it is a delicate procedure in a conscious or mildly sedated cat - add this to a busy, noisy hospital like ours and the opportunities for learning are minimal. It could really benefit individual cats given our throughput is about 80% feline so supporting good proficiency with feline echo as advantageous. Simply because everyone else learns on non-GAd cats isn't to say that is the best way to learn - what I would give for a GA'd cat when I was learning...

Re: feline echo teaching

Rajat — Thu, 10 Jan 2013 21:25:46 GMT

Why can your vets not learn to echo cats that aren't anesthetized to be PTSd David? Everyone else does and if I can I am sure they can.

Re: feline echo teaching

Anthony Todd — Thu, 10 Jan 2013 20:41:12 GMT

[quote user="Chris Barker"]However it has been pointed out that this stance is inconsistent with the Animal Scientific Procedures Act which requires a clinical justification for any intervention (the level of intervention 'starting' with the insertion of a needle through the skin) - otherwise the procedure should be considered to be 'research' with all the attendant legal requirements etc.[/quote]

See what I mean, it's a wonder that we are allowed to do anything to an animal at all.....

Re: feline echo teaching

Chris Barker — Thu, 10 Jan 2013 20:38:26 GMT

[quote user="Evelyn Barbour-Hill"]

So, removing a kidney from a donor is out.

[/quote]

Interestingly this subject is scheduled to be considered again by the RCVS Advisory Committee. In essence the position of the RCVS to date has not been to declare the removal of a kidney from an animal to be unethical (on the grounds that it is of no benefit to the donor) but to make it so difficult to satisfy all the attendent demands (see Approved guidelines for renal transplantation on the RCVS website) that the procedure is never performed. To date this has approached has 'worked' - no renal transplant has taken place in the UK in clinical practice.

However it has been pointed out that this stance is inconsistent with the Animal Scientific Procedures Act which requires a clinical justification for any intervention (the level of intervention 'starting' with the insertion of a needle through the skin) - otherwise the procedure should be considered to be 'research' with all the attendant legal requirements etc. However when the issue of transplantation was recently raised at RCVS Council the academics were troubled by the prospect of any re-examination - they seemed concerned that the RCVS might declare the procedure unethical. I suspect that one's person's 'freedom of clinical choice' is another person's 'unjustified and non-sanctioned research project'.

As a member of Advisory should the subject be returned to us for consideration then would I expect a huge amount of background material to arrive with committee papers!

Chris B

Re: feline echo teaching

Anthony Todd — Thu, 10 Jan 2013 20:16:10 GMT

It just depresses me that

[quote user="Malcolm Ness"]this well intentioned CPD exercise[/quote]

and a blatantly obvious one at that, can be argued by someone anyone in the way expounded in the post above.

Not that I believe, even remotely, that this is the poster's view .

It's another extrapolation of the "'elf and safey" culture which seems to be all pervasive yet remote from common sense.

Yet again it's a caveat against common good, and better animal care.

Now recovery surgery as was/is allowed in American veterinary schools is a different kennel of cruelty all together!

Re: feline echo teaching

David Mills — Thu, 10 Jan 2013 20:09:57 GMT

[quote user="Malcolm Ness"]

If the act can't be argued to be in the interest of that particular patient then it isn't an act of veterinary surgery and therefore something that we shouldn't be doing - the "greater good" of the species, the herd, the client or the veterinary surgeon is not relevant. The rub is that if it isn't an act of veterinary surgery it will probably be defined as vivisection

[/quote]

Yes, this is a point one of our vets came up with. But the counter argument would be that something like a blinded clinical trial against placebo is allowed - where there may be no benefit to the animal - without requirements for a Home Office licence. Stretching the boundary a bit may be that in many cases these cats are feral and require deep sedation/DTK to PTS - in which case it could be argued that no suffering is encountered by extending this period of anaesthesia.

I suppose there is an ethical discussion to be had whether anaesthesia negatively affects the welfare of an animal - it is doubtful an animal would choose to be anaesthetised - but once anaesthetised it does not suffer - but the utilitarian argument is obviously overwhelmingly in favour. The meeja, especially where my employers are concerned, would, as you point out, take rather a different view methinks.

[quote user="James Laidlaw"]

Care with the echo of an anaesthetised animal representing normal hearts I guess - dependent on drugs used.

[/quote]

Yes, but interestingly many of the normals as defined by Moise, Fox et al back in the day were on anaesthetised cats. The main problem is that feline echo is very hard to gain practical experience of on CPD courses, largely because of the unwillingness of the patient especially for multiple operators. We are (un)fortunate in having access to a large stray population many of whom cannot be re-released due to FIV/FeLV, flu etc etc. and many of our vets are keen to learn - just seems a huge pity that the poor creatures can't be put to some use before death.

Re: feline echo teaching

Evelyn Barbour-Hill — Thu, 10 Jan 2013 19:09:46 GMT

So, removing a kidney from a donor is out.

Re: feline echo teaching

James Laidlaw — Thu, 10 Jan 2013 17:03:28 GMT

Care with the echo of an anaesthetised animal representing normal hearts I guess - dependant on drugs used. Can't see much else wrong with it, better to gain something from their life to be put to good use than just put to sleep if that's the alternative. No harm to the animals and a benefit to the education of vets to me it's a no brainer. I'd echo Malcolm's sentiments too - but just because I'm quite cynical :)