Andy Moores's Groups Activities

How far should we go in the treatment of animals?

Arlo Guthrie — Fri, 31 Oct 2025 13:54:45 GMT

This is the first question raised by the new book Veterinary Controversies and Ethical Dilemmas, so I met up with the author, lovely man called John Webster, who developed the five freedoms, and this is what he thinks...

What do you think?!

By the way, if you'd like to buy the book here's a link: https://amzn.to/3Jqynjy

Labrador elbows

Clare Tapsfield-Wright — Fri, 16 May 2025 10:56:09 GMT

My nine year old lab has DJD of her elbows. She is on librella, paracetamol , gabapentin and galliprant. She has just started amantadine too. I know I’m in the last chance saloon with her. I’m going to a referral centre for an opinion which might include elbow replacement. I’m torn as I’m not sure that just because it’s possible , is it the right thing to do. I’ve heard that it is challenging . She’s not your typical lab, I think she would find hospitalisation and rehabilitation very stressful. I’m not sure what I’m asking here but any opinions welcome , I know I can reply on you for straight talking

Depo-medrone intraarticular injections for patients on NSAID

Tom Ward — Tue, 07 Jan 2025 16:12:03 GMT

Hi guys,

I've got an elbow dysplasia case that has been on NSAID for some time, but is getting increasing discomfort with a chronically thickened elbow, which now has a joint effusion. If giving depo-medrone intra-articularly, is it advisable to take them off NSAIDs for a period prior to administration? I can't find any specific information about it, but presume there would be at least some systemic steroid effect even when given via this route that would be a contraindication for NSAIDS?

Many thanks!

Tom.

Do you follow referral centre recommendations?

David Mills — Wed, 28 Aug 2024 21:59:19 GMT

You send an animal for referral

Animal comes back to you and with instructions for ongoing care but you on some level disagree with the treatment.

e.g.

Ortho case that comes back with instructions for 4 WEEKS of an important abx for superficial wounds that were cultured (nowhere near fracture or surgery site)

e.g.

Medical case on preds and azathioprene. Bloods normal last 2 times, but referral wants every 6w whilst on months of therapy.

What do you do?

New RCVS guidance on referring cases

Arlo Guthrie — Mon, 19 Aug 2024 09:30:00 GMT

The RCVS has tightened up the Code of Professional Conduct concerning how general practitioners refer cases and how veterinary professionals talk about referral surgeons.

The first change has been made to paragraph 1.6 which now advises general practitioners to check whether the vet they are referring a case to is on the RCVS Specialist or Advanced Practitioner list, explaining the difference to the client and what sets them apart from other vets who might be prepared to accept a referral.

Also, practitioners who accept a referral should provide information to the referrer about the experience and status of those likely to be responsible for the case.

The guidance about conflicts of interest in paragraph 1.7 has also been amended such that referring surgeons should tell clients if they are referring their case to a practice owned by the same group.

There is new guidance about how vets and nurses talk about referral practitioners, with the new advice being to focus on accepted terms such as 'RCVS Specialist' and 'RCVS Advanced Practitioner', and avoid more general terms like 'referral surgeon' or 'consultant' to avoid confusion or implying that individuals hold more qualifications than they do.

Lastly, there is new guidance that vets may only use the name 'Specialist' in the name of their practice where there is genuine and meaningful involvement, and oversight, in case management by at least one RCVS specialist in all disciplines where any clinical services are offered under the business name.

https://www.rcvs.org.uk/setting-standards/advice-and-guidance/code-of-professional-conduct-for-veterinary-surgeons/supporting-guidance/referrals-and-second-opinions/

Surgery or not - fractured metacarpal

Stigen — Fri, 14 Jun 2024 10:39:15 GMT

One year old male cat that presented with 4/10 lameness right frontleg. X-ay show fractured metacarpal with some displacement. Would you reccomend surgery, or to heal by callus formation ?

CMA investigation: Is £45 too much for a booster?

David Mills — Thu, 07 Sep 2023 07:08:50 GMT

https://www.bbc.co.uk/news/business-66733077

Seems an odd aspect to quote...

Is this pro bono scheme the solution or a symptom of the problem?

Rob Loxley — Thu, 09 May 2024 19:55:21 GMT

Surrey-based Fitzpatrick Referrals has launched a new scheme whereby referring practices can send one client for free treatment for every 15 paid cases they refer

So those 15 owners are supporting someone else, ‘chosen’ by what criteria, rather than getting their own treatment for less money?

Is it just me, tying pro bono work directly to sending paid-for work, feels odd

WHAT WOULD YOU DO? Acute onset lameness in a hind limb where cruciate disease is suspected

Arlo Guthrie — Tue, 27 Feb 2024 11:29:13 GMT

Time for another ...

This one proposed by Gillian Mostyn

What would you do in the case of acute onset lameness in a hind limb where cruciate disease is suspected?

Rules here: https://www.vetsurgeon.org/f/clinical-questions/30841/what-would-you-do-discussions-rules-and-objectives

Who'll start us off?

Forelimb tumour newly spotted at same time as cruciate injury - what to do first?

Elizabeth — Thu, 01 Feb 2024 09:34:20 GMT

My own dog typically.
10.5yr v bouncy working cocker, noticed lump on his left carpus earlier in the month. No lameness or pain associated with it as far as I can tell. Then 2 days ago ruptured his cruciate running across a field.
X-ray showed bony proliferation on the metatarsal but also one of the carpal bones, some lysis of one of the metacarpals. chest clear. FNAs taken, but not sure if they would be diagnostic.

Hind limb-wise, he’s hobbling but is weight bearing on his bad leg -stands on it to urinate, not carrying it.

What would you do?
Assuming it is a tumour, amputate first but have him managing on 2.5 legs, or have cruciate surgery first but then a potentially 2month delay for amputation?

Which prophylactic antibiotics do you use for orthopaedic surgeries?

Holly Lee — Mon, 12 Feb 2024 23:52:22 GMT

Hi,

I just wanted to canvas opinion from vets doing orthopaedic procedures e.g. fracture repairs, cruciate surgeries, patellar surgeries (with or without orthopaedic implants) as to what prophylactic antibiotic (pre- and post- surgery) you use and what led you to that choice.

I am auditing my practices use of 'critically important' antibiotics and trying to review some of those uses. Specifically in this case looking into the justification of 3rd generation cephalosporins as prophylactic courses in orthopaedic surgery.

Obviously I will do literature searching as well but wanted to see what the general approaches tend to be and where the decisions originate from.

Thanks in advance, Holly

Can I wish you all a very happy Christmas?

Arlo Guthrie — Wed, 20 Dec 2023 10:18:49 GMT

Well, I had to make it a question!

I've just been hit by the lurgy - which doesn't appear to be covid, but I still feel like death warmed up. On top of which a fox got in the other day and there's nothing left of our beloved chickens, Pip and Nugget, bar a few feathers. Oh and I knocked my computer monitor over the other day, which was an expensive mistake!

Hopefully it can only get better from here and I'll be well by our Christmas drinks on Friday.

And as we reach the end of the year, it does seem to me like the 'What would you do' discussion format has legs, and I am looking forward to making more of that next year.

Meantime, a very happy Christmas to one and all.

Pragmatic/charity minded orthopaedic referral recommendations?

charlievelyn — Thu, 07 Dec 2023 14:23:04 GMT

Hello hive mind. I am hoping to get some personal recommendations for orthopaedic referrals that from experience members have found to have a particularly pragmatic/charity medicine focused approach anywhere across the country.

I have only the highest respect for all specialist opinion and I do not want this to become a discussion of negatively comparing our wonderful colleagues or referral services. However, working within the charity sector, unfortunately, gold standard or expensive treatment routes are not always feasible and I am always grateful for a pragmatic approach when discussing and referring more complicated orthopaedic cases. A a basic example, when gold standard THR is not feasible financially in the name of helping as many patients as possible, but a FHNE will provide good quality of life, albeit maybe a shorter one, the latter may have to be the route taken.

Let me know if you have any thoughts, thank you

Can you advise on these swollen right fore carpus xrays?

smb — Wed, 29 Nov 2023 17:30:01 GMT

This is a 4 year male neutered lurcher. It has a swollen right fore carpus as seen in the radiographs.

It has a low grade lameness on this leg. The joint is hot to touch, there are no signs of injuries. The dog is otherwise well.

A joint tap was done by another vet that showed moderate neutrophilic inflammation. Nothing was grown on culture.

They started on a 2 week course of Marbocyl and the dog showed some improvement, however, stopped when the culture came back negative.

I suspect a septic arthritis despite negative culture and plan to give the dog a longer course of antibiotics.

However, please could I have your opinion on this case and the attached x-rays.

Trauma and immune mediated disease are other differentials I have in mind.

What is the best way to reduce medial traumatic shoulder luxation in 11wk old fox terrier pup?

Beats — Wed, 25 Oct 2023 21:07:28 GMT

Of my 3 go to surgery texts (Tobias, Butterworth and Denny, and Fossum, not all current editions), only Fossum provides practical advice:

It states that for a LATERAL luxation then to place in extension and apply medial pressure on humeral head and lateral pressure on distal scapula (or words to that effect I think - don't have open in front of me).

It then states that for a MEDIAL luxation (a few sentences on), to do the opposite of the approach to reducing a lateral luxation.

This led me to try reducing it in flexion for some time, before eventually just fiddling about based on first principles and eventually popping it back in extension and concluding that the "opposite" part perhaps referred to the medial and lateral pressure only and not whether was flexed or extended, and perhaps was meant to be extended when reducing in both lateral and medial scapulohumeral luxations?

Can someone with more experience or knowledge in reducing shoulder luxations help me check that I now understand this correctly and next time would be reducing in EXTENSION, irrespective of whether was lateral or medial luxation?

Many thanks!