Business as usual?

RE: Business as usual?

Lindsey Edwards — Wed, 03 Jun 2020 23:32:39 GMT

I will sedate most especially if owners observing (and cannula not present). Especially with anxious or painful patients owners very accepting of not wanting to stress them positioning or loking for collapsed veins. If very amenable large dog and already/willingly recumbent may use saphenous vein and extension (masks required for ppe!)

RE: Business as usual?

Sarah Keir — Wed, 03 Jun 2020 16:18:34 GMT

I've done this for years for dog euthanasia for everything that isn't collapsed. I cannot imagine anything worse for an owner than seeing their dog sitting or standing, wagging tail and then slumping to the ground. Sedation is much more peaceful and owners seem much more accepting of the death. I use dom/torb and some ACP if the practice still has is it. Some practices make me charge the client extra for this rather than building it in to the euth costs but once I explain to the owners, I have not had any refuse. This is how I sent my dog off.

RE: Business as usual?

Mark Holmes — Sat, 30 May 2020 21:15:13 GMT

Straight forward. In dogs I give DTK as a single mixed dose. I try to get it IM if I think the dog will be fine with it but it’s fine s/c just takes a bit longer. This can be given in the car or car park. I leave the dog to go to sleep with owners checking on them for time to time. Beyond that whatever works at the time. Preferably owners will step aside while a nurse and I collect the dog onto a blanket but smaller ones the owners may just place the dog on the blanket themselves. It depends. It usually becomes clear which will work best. I make it clear their will be a second injection to allow them to pass once they get into the practice but it generally (ie no failures yet) goes very well. Indeed I’ll probably maintain a version of it going forward. As the dogs are technically then anaesthetised if an ic injection is required it’s perfectly safe and acceptable to do so.

Cats are similar. I have recently switched to ACP/ torb and Ket after one cat started vomiting. It didn’t really present an issue but I figured I’d switch. With cats I show owners into a consult room. (Keeping distance) We have one accessible to a fire door. I ask them to place the carrier on the floor so I can collect it. I then inject the cat in the prep room and pass the cat and box back to clients. At a distance. They spend time together while the cat goes to sleep and I show them out keeping distance. There’s really no ppe etc, etc needed as you can keep plenty of distance. Cat then PTS usually by ic inj as under ga. Very simple no contact no fuss. Will probably keep a version of this as well.

RE: Business as usual?

Julie Innes — Sat, 30 May 2020 08:43:38 GMT

We're gradually seeing more and more patients at the surgery, but I think it will be quite a while before we have clients back in the building. My lovely husband rigged up a video intercom for us, and we have a system where we have double doors at the front with a little vestibule. We open front door, middle door locked, client puts animal in (we have a crate in there/ hooks for leads etc) client leaves, we bring animal in. It's a bit clumsy, but we are getting a little more efficient at it now.

we are doing telephone and e-mail consultations for things like skin rashes etc, and we are only charging a small fee for this, which we waive if we then decide the animal needs to come in. I have purchased a practice mobile for vets to call clients to keep the main phone lines free, as with taking payments etc over the phone the phone lines are very busy. We are still posting out flea/ worming products (as everyone seems to suddenly be obsessed with needing these, even people who have not deflead or wormed their dog in the last seven years!) to try to stop the practice doors being too busy.

For euthanasias we did try the long line, but I didn't like it. we now take the animal and sedate it, then bring it to the vestibule between the doors and allow the owner to sit with it until it is fully asleep. most owners have been quite accepting of this and it seems to work well. we have plans to clear one consulting room to eventually allow owners to come in wearing PPE just for euthanasias, as it is awkward at times now as we are getting busier. We will still sedate and let them sit with the animal then leave, I think.

For all I have always disliked the idea of remote prescribing, and I can see the dangers, I am actually not finding it too bad, especially when backed up with pictures. If in doubt, we see it, but there are so many things that I have always felt we saw which didn't really need seen that I can now just give advice on, which allows us to concentrate on more interesting cases! I LOVE not having to clip nails (or at least not in front of owners!)

RE: Business as usual?

Rob Loxley — Sat, 30 May 2020 08:28:01 GMT

[quote userid="12930" url="~/001/nonclinical/f/life-in-practice-discussions/29119/business-as-usual/223122"]I'm struggling with finding a good way for socially-distanced euthanasia presentl[/quote]

Place Iv catheter and using 2m long mini bore extension set (i think it’s a syringe driver extension). Finding somewhere suitable can be tough if car parks are public and busy, luckily we have access to a quiet garden

RE: Business as usual?

Beats — Sat, 30 May 2020 07:56:33 GMT

[quote userid="7232" url="~/001/nonclinical/f/life-in-practice-discussions/29119/business-as-usual/223118"]My euthanasias involve giving the dog Dom,torb and ketamine in the owner’s car.[/quote]

Is this one injection mixed SC?

Or Dom/Torb IM and then ketamine after?

Are you then lifting direct from owner or getting owner to move aside while you lift the body in?

Sorry for third-degree, but I'm struggling with finding a good way for socially-distanced euthanasia presently, so interested in details of what working for you!

RE: Business as usual?

Mark Holmes — Fri, 29 May 2020 21:27:03 GMT

My euthanasias involve giving the dog Dom,torb and ketamine in the owner’s car. Allowing the owners to sit with them and then carrying them in for a final injection in the practice to allow them to pass. It’s actually worked great and I can see a version of this being maintained. Not started boosters yet as no time with staff on furlough. Mobbed with urgent stuff given current staffing.

Remote consulting is a farce. Hopefully the RCVS will see it as it is and remote prescribing will be dead.

I’ve sent a photo - my breath is something wrong with his teeth?

RE: Business as usual?

Mark Holmes — Fri, 29 May 2020 21:20:36 GMT

Remote consulting is a farce. Hopefully the RCVS will see it as it is and remote prescribing will be dead.

I’ve sent a photo - my dog has bad breath is something wrong with his teeth?

RE: Business as usual?

Bob Russell — Tue, 26 May 2020 15:11:58 GMT

If anyone feels things have got out of hand then they should click +more and report as abusive.

Even the harshest of criticism can be made with good manners. In fact the better the manners, the more impact the criticism has IMO!

As a total aside, does anyone else out there find themselves social distancing when driving the car, just in case?

RE: Business as usual?

Arlo Guthrie — Sun, 24 May 2020 15:21:46 GMT

Camilla Edwards Hmm - that should not be displayed without logging in. It's not visible in search engines, so I think that must come off an RSS feed. Can you be more specific about where you get your weekly update from, please. PM me if you like.

RE: Business as usual?

Kate Richardson — Sun, 24 May 2020 15:17:45 GMT

Arlo Guthrie see above post from camilla

RE: Business as usual?

Camilla Edwards — Sun, 24 May 2020 15:13:42 GMT

Hi, Just wanted to alert people to the fact. I get a weekly update of all blogs/forum posts on the veterinary topic on the internet - that the following showed up in the feed (and I believe would do for anyone following blogs etc in this way).

Forum Post: RE: Business as usual?

Chris, By your own admission you were leaned on by someone (unnamed) in Belgravia House to keep your mouth shut and not rock the boat (on more than one occasion). I think that is an utter disgrace. I can be sure that had I been in your position I wou...

− Alastair Welch • 3 hours ago ★ Save

I'm not sure that others should be seeing this? Arlo? or that this is an appropriate way to speak to each other and what clients would think if they read this. Veterinary Voices may not be the most friendly place, but this thread is not a sparkling advert really.

RE: Business as usual?

Alastair Welch — Sun, 24 May 2020 14:54:31 GMT

Neil,

The point I was trying to make (deliberately inelegantly) was that Chris' Ad Hominem attack on me (describing me as unnecessarily rude) was an unsuitable smokescreen to avoid my substantive point, and that if he wants to call me rude I'm going to tell him to grow a thicker skin. My substantive point is that too many members (pretty much all of them) of the RCVS council seem to be unwilling to be publicly critical of the RCVS and that Chris' post above pointing out the sneaky way that the college have completely changed their advice is in contrast to his previous public championing of the college, and that this change in his approach is coincident with him retiring form council. Chris (and other councillors) may or may not have been privately disagreeing with college stance on this or many other issues but the 'private' approach clearly doesn't seem to be working.

I see it as a very unhealthy situation where almost all votes on council pass with unanimity, where we never hear dissenting voices and where the big decisions are all taken in the "Blue sky safe space' beloved of the President. I suspect that I share many of Chris Barker's opinions on how the college and the wider profession should be run, however I do not agree with his approach of people on positions of power and responsibility keeping schtum and hoping to change things on the quiet. Now that Chris is retiring form council any criticism he has can simply be dismissed as the ramblings of an embittered ex councillor. Had he pointed out (publicly) the errors of the council whilst early in his service he would very likely have garnered much support form the wider profession.

Again I don't agree that holding public office puts you beyond criticism, I may or may not chose to stand for council election at some point on the future but that in no way precludes me from criticising those that do.

RE: Business as usual?

Neil Wheadon — Sun, 24 May 2020 12:58:14 GMT

I and I expect others value what Chris has to say, he's an invaluable part of this forum.

The language

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/29119/business-as-usual/222893"] Answer the points or grow a thicker skin. [/quote]

will only mean he will not comment on anything to the detriment of everyone

I also agree with

[quote userid="6353" url="~/001/nonclinical/f/life-in-practice-discussions/29119/business-as-usual/222891"]Now if those criticising from the sidelines actually stood for office and tried to make a difference ....[/quote]

Stand for the RCVS if you feel strongly about things

Neil

RE: Business as usual?

Alastair Welch — Sun, 24 May 2020 10:37:39 GMT

Chris,

By your own admission you were leaned on by someone (unnamed) in Belgravia House to keep your mouth shut and not rock the boat (on more than one occasion). I think that is an utter disgrace. I can be sure that had I been in your position I would have publicly outed the perpetrator on the first occasion, I would have made a huge song-and-dance about it and made sure it made the veterinary press was full of the 'Councillor gagged' type of story, but I must have missed it when you did so (in truth I don't think I am the sort of character who responds well to that sort of subtle pressure so I doubt anyone would try it on anyway, but they must have felt you susceptible enough to the dark arts to repeat it).

Now that you are on the way out you seem less inhibited and willing to voice your criticisms of the college more publicly. I have previously given you the opportunity to agree with me that the college's handling of the concerns procedure is disgraceful and that they they are failing badly. Instead you mounted a weak defence that they were aware of the problem and that things were being done about it, I don't think this is good enough. You might think it 'unnecessarily rude', whereas I feel I am simply pointing out your hypocrisy. You have the choice to agree with me that the college are generally doing a bad job (and as a member of council you must shoulder your portion of responsibility) or you can defend their (your) record ignoring the points I have made in which case I don't fee inhibited in calling you out for backing the wrong horse.

And if you think that standing for office somehow offers you some protection from criticism you are along way short of the mark. Answer the points or grow a thicker skin.

RE: Business as usual?

Chris Barker — Sun, 24 May 2020 09:36:54 GMT

[quote userid="12375" url="~/001/nonclinical/f/life-in-practice-discussions/29119/business-as-usual/222841"]The scales seem to have fallen from your eyes. It wasn’t that long ago you were championing the College but now you’re demob happy you are willing to criticise them. Why do serving RCVS councillors seem so emasculated, unable to point out what a generally bad job the College do?[/quote]

You can be unnecessarily rude Scales have never been over my eyes I have been critical of RCVS and the way it works since the day I was first elected It's just that the criticism is not always voiced in open forum As a practitioner I thought that the first pronouncements on Covid by the RCVS strayed into territory over which it currently has no jurisdiction (eg. regulation of practices) and I said so vocally within the Council forum. The difficulty is that unless you commit to the RCVS system and make your way through the Officer/Committee Chairman route your influence is limited, unless you are backed up on a specific issue by a sizeable number of others on Council And with Council shrinking in size this is a growing problem for the practitioner

And here we have to point out that the 'electorate' isn't helping Who did we elect this year? One practitioner One ex-practitioner now sitting on ++ committees One non-practioner sitting on ++committees ie. Richard Stephenson excepted, very little, current, relevant, coal-face experience

Now if those criticising from the sidelines actually stood for office and tried to make a difference ....

RE: Business as usual?

Rob Loxley — Fri, 22 May 2020 16:59:18 GMT

Changes to the furlough scheme look like they might allow people to come back part-time. There's also what work can be done remotely (albeit still needs childcare!)

RE: Business as usual?

Gillian Mostyn — Fri, 22 May 2020 15:49:39 GMT

[quote userid="9239" url="~/001/nonclinical/f/life-in-practice-discussions/29119/business-as-usual/222853"]Some staff have serious child care issues and will not be able to come back full time. Being furloughed with 80% does little to help, of course we are grateful as a business for it but it does affect people's choices. [/quote]

This is a difficult one I guess. Furloughing is supposed to be entirely at the discretion of the employer, and if there is work to be done then the employee is supposed to be available to come back to work. However, with limited school opening and no access to grandparents I can understand the problem. I believe that vet staff can access the keyworker scheme for school and nursery attendance but I can understand if people are reluctant to use it. Your children would be mixing with a higher risk group of children.

RE: Business as usual?

Dinu Catilina — Fri, 22 May 2020 13:01:11 GMT

We are seeing more cases as well but it's not back to normal. Some staff have serious child care issues and will not be able to come back full time. Being furloughed with 80% does little to help, of course we are grateful as a business for it but it does affect people's choices.

We can't have teams, it's impossible. We can't do social distancing between ourselves but we do it with owners. We changed to 20 minutes appointments and might have to open earlier and close later.

It will be impossible to keep owners outside in the heat of the summer even for short periods. We are buying a pod as an extra consult room or an extra waiting room hopefully worth spending 30.000.

We've done zero video consults up to now, we take photos and videos by email of facebook page and I call clients back. This allows them to take multiple takes and we get the best attempt. Most end up coming in anyway.

I must say I work now more than ever and I can't wait to have more vets back in. One weekend I was home about 8 hours in total after a Friday evening ventricular tachycardia Dobermann and a Saturday evening noncardiogenic pulmonary oedema Bulldog puppy on top of our normal hours.

I'm not worried about myself but I do worry about our elderly clients, some very vulnerable. For them we can take medication home, spray the outer boxes with virucidal solutions and leave them at their door.

And that's it, do the best we can.

RE: Business as usual?

Joyce Whitehead — Fri, 22 May 2020 11:12:44 GMT

Stepping up to agree with Michael too, we are currently doing year one boosters, but will start to send reminders for overdue next week, still within the 3 month limit. We have widely relaxed our repeat prescription time scale, mainly as we were keeping the vets that were working (we divided our vet team) busy enough. We are also upping staff levels again from next week.

Vet voices drove me mad in the first week or two, huge condemnation of anyone daring to touch an animal or see an owner, it seems to have calmed down again, but although I read bits and pieces I would very rarely even think of posting there, certainly not a clinical case. I think there were lots of people annnoyed by their bosses/clinical directors taking it out in Facebook, without thinking of the consequence of having no business/job to go back to.

We have done some diagnosis by photo, but it has proved that owners are incapable in the majority of taking a decent photo. I had one dog that I diagnosed with a rhinitis on video (snotty nasal discharge, owner reported otherwise well) 2 weeks ago. They sent another video this week and I didn’t like the look of it so got it in. It’s in heart failure with bubbling at the nose. Definitely puts me off video diagnostics! It’s doing ok now thankfully.

RE: Business as usual?

Alastair Welch — Fri, 22 May 2020 09:11:27 GMT

Chris,

The scales seem to have fallen from your eyes. It wasn’t that long ago you were championing the College but now you’re demob happy you are willing to criticise them. Why do serving RCVS councillors seem so emasculated, unable to point out what a generally bad job the College do?

RE: Business as usual?

Gillian Mostyn — Fri, 22 May 2020 08:23:19 GMT

Wow - I agree with Michael Woodhouse

We have avoided a massive avalanche of Covid cases. Businesses have now had lots of time to put in place plans for staff safety and social distancing with clients. We've been told that businesses that cannot be run from home should now return to work as long as these plans can be followed. Time and staff constraints allowing, 'routine' work should now resume to safeguard long term welfare.

As far as the Vet Voices comment- I know what Michael means. Whereas here on VS we can have robust but, in the main, reasoned debate - FB doesn't work like that! Any controversial opinion gets completely annihilated in a flurry of condemnation without explanation.

RE: Business as usual?

Stephen Courtney — Fri, 22 May 2020 08:22:10 GMT

Vet Voices is a nasty whinge-fest .... everyone exorting everyone else to 'be kind' while putting the boot in whenever someones sacred cow is scorned

I 'unjoined' and life is actually happier, calmer, and less time spent on Facebook too!

RE: Business as usual?

Arlo Guthrie — Fri, 22 May 2020 06:54:39 GMT

[quote userid="3169" url="~/001/nonclinical/f/life-in-practice-discussions/29119/business-as-usual/222828"]Now I wouldn't dare put this on Vet Voices:[/quote]

Genuinely curious why not. It doesn't seem that controversial to me! Seems pragmatic, providing you're not hugging your clients on the way in.

Joking aside, presume you're doing things so people can maintain distance whilst waiting and during consult.

RE: Business as usual?

Chris Barker — Fri, 22 May 2020 06:45:07 GMT

Yep That pretty much summarises what we do Boosters we did delay by two months but now running vaccine only sessions to play catch up Clients still not allowed in the building but we have a large lobby and 'dog-park' hooks which allow no-touch transfer of pets from owners to staff Covid risk is more staff-staff than client-staff so we have to urge colleagues to be scrupulous in their behaviour out of work so neither team gets infected