janine redman's Groups Activities

Would welfare-based insurance cover solve the price problem?

Arlo Guthrie — Mon, 11 May 2026 16:14:18 GMT

Sharing a post here that I put up on Linkedin and wondering if anyone here has any thoughts:

As if we needed it, more research has found pet owners are worried about rising vet bills. What's more, the results are startlingly similar to another study published in the Veterinary Record a few weeks ago.

At that time, Joshua Stern argued that this kind of data does not indicate a systemic problem, just an 'unmet need', which can addressed by emphasising the breadth of treatment options available.

He also said that I should write a solutions-based article which explains how vets could continue advancing care whilst simultaneously bringing prices down.

I continue to disagree with the idea that this is primarily a communication problem rather than a systemic one.

If large numbers of owners repeatedly report anxiety about affordability, across multiple studies, it becomes difficult to argue that the issue exists only at the level of consultation-room communication.

And I’m not convinced that simply emphasising the breadth of treatment options, aka contextual care, fully solves the problem either.

Because unlike getting the fridge repaired, there's a lot of emotion attached to the dog, and people will always want more treatment than they can afford, and resent it when they can't.

What's more, people make rational, logical decisions about their fridge. If it cost £500 to replace, they won't spend £600 fixing it. The same is not usually true of the dog.

Joshua argues — and he is not alone in this — that I am wrong to talk about a “rational” limit on spending, and that I am simply projecting my own view of what constitutes rationality.

But society clearly does make judgments about proportionality in healthcare spending, whether we admit it or not.

If someone spends £30,000 treating a 15-year-old dog, many people would regard that as disproportionate. A billionaire may view it differently, but the earlier research suggested owners themselves place the limit far lower than modern veterinary medicine increasingly assumes — somewhere well south of £3,000.

It was suggested that I write an article which shows how vets can continue advancing care whilst bringing prices down.

I don't think that's possible. Advancing care whilst bringing prices down seems oxymoronic.

I think the solution may lie in offering a lower, more affordable standard of care, perhaps based more strictly on the welfare needs of the animal, and supported with an appropriate level of cheaper insurance cover.

In other words, shifting cheaper insurance from simply offering less comprehensive financial protection to supporting a consciously different model of veterinary care — one focused more on welfare thresholds than maximal intervention.

Of course that doesn't restrict those who want the highest clinical standards for their dog. But the cost of that should not come from the premiums paid by low-income owners.

Just a thought!

Should dental radiography be mandatory?

David Mills — Sun, 01 Mar 2026 20:15:19 GMT

I had a lovely debate on an ethics panel at the BVDA Congress yesterday (thanks Rob Davis) where the last discussion point was that dental radiography should be mandatory for practices carrying out dental procedures. I believe there are some moves to make this a RCVS requirement.

What do people think?

This article summarises it better than the above

pmc.ncbi.nlm.nih.gov/.../

My take is that you need an incontrovertible reason (i.e. to as to be sure) to make anything mandatory. Equally, I can see the benefits of dental rads. But are the benefits so overwhelming and the risks so severe to justify the position?

What would you do?

Kate Richardson — Wed, 15 Apr 2026 13:53:32 GMT

I thought this might be a useful idea- post a case scenario then post what you would do if working on a budget.

I'll start with this one:

15 yo MN DSH comes in- owners concern is he is struggling to jump up and down off sofa and occasionally urinates inside on the mat. On questioning, is eating ok, and has been drinking more over the past 6months. Faeces unknown as he goes outside. Occasional vomits, but no more frequent than 'normal' for this cat.

Clinical exam- BCS 3/9, used to be 5.kg, now 3.7. Coat a bit stary and matted in places. Muscle atrophy hindlimbs, nails a bit over grown. Obviously very stiff on hindlimbs.

Teeth- more tartar then tooth. Heart rate 160, soft systolic murmur, no arrhythmia, lungs clear. No palpable goitre. Abdominal palpation unremarkable.

Owners love the cat but haven't got a lot of money.

What would you do?

Be as specific as possible.

I'll let you know what I would do later

Can I have some feedback on a website please?

Arlo Guthrie — Fri, 08 May 2026 14:23:01 GMT

Hi all,

I need to up my game on the youtube side of things. So I've redesigned my website and I wonder what you think? It only has one job to do!

Be as rude as you like - I have to develop a thick skin in this game

Thanks for any thoughts / opinions. And if you're interested in any of the things I cover (on the list), do drop your email in the box. I wont spam you! Promise. Just one email when there's a new film.

https://arlo-guthrie.com/

Do you think it's OK to 'have a go' at surgery any more?

Arlo Guthrie — Tue, 14 Apr 2026 08:40:53 GMT

We live in an era of refer-all, and from time to time I hear vets saying they are frightened to give something a go (either because of repercussions from client or from RCVS if it goes wrong), or just that it's not the done thing any more.

Would you agree that far fewer vets are happy to give something a go these days?

Do you think that is a good or a bad thing?

If you think it is a bad thing, then what do you think are the main drivers of the refer-all culture or barriers to 'having a go'.

What is an acceptable level of care?

Arlo Guthrie — Fri, 24 Apr 2026 09:44:54 GMT

Prompted by Kate Richardson's case study, and in particular her desire to:

[quote userid="6386" url="~/f/clinical-questions/31345/what-would-you-do/248698#248698"] to help develop a contextualised approach to cases and gain confidence that you can mange cases like this with confidence and no fear of retribution[/quote]

Together with some very interesting replies to a post I made on Facebook, esp from mariette asselbergs, which raised the issue of the continuing systemic bias towards excellence, and a post on here a while back where someone was explaining how you are judged (in any DC case) as to whether a number of your peers would consider your actions acceptable ...

All lead me towards thinking ... perhaps we should have a series of discussions here on VetSurgeon, titled Minimum Acceptable Care: [name of condition]

Leading to a list of condition-based discussions which reach a conclusion of an agreed level of care that would be defensible.

I'm thinking back to Kate's point as to whether this would be helpful for new grads in particular.

What do you think? If you think this has legs, would anyone like to kick me off with a condition (start a new thread with that title).

Post op complication Urethrotomy

An On MRCVS — Thu, 07 May 2026 10:04:27 GMT

I would very much appreciate any help with this case, especially if anyone has come across this before.

7 year old male entire german short haired pointer.

Had a cystotomy last year, which recovered well from.

Seen this year, initially for collapsing episodes, cardiologist referral, SVT and now on sotalol which appears to have sorted this.

Couple of days after had seen the cardiologist started to struggle to pass urine, initially had enlarged prostate so given ypozane. Did not resolve this and further work up revealed lots of stones in urethra. Stopped urinating, so performed a pre scrotal urethrotomy. I did close this with monocryl.

Recovered ok, just seemed quite sore. ! week post op, passing urine, some blood still. Incision site healed well but is very sore here and around testicles. Temperature is normal. Urine sample, awaiting culture but no white blood cells.

Last 24 hours now urinating frank blood again. Anyone come across anything similar? Any ideas what we do next. Not insured.

I have done 2 prescrotal urethrotomies before and both recovered well,

Inspirational influences

Alasdair Hotston Moore — Sat, 11 Apr 2026 22:42:04 GMT

The death of Dr Barbara Weaver recently has made me think. Which colleagues have left a mark on your career? Living or deceased.
Barbara was one of mine, A woman in veterinary science way ahead of her time. Kind and funny. Occasionally irritating ( aren’t we all?). Not only interested in the pharmacology of anaesthesia but the physics and practicalities. And above all, deeply caring for her patients and own pets

Treating you own dog? Exp. of Onion toxicosis?

Stigen — Sun, 26 Apr 2026 13:23:54 GMT

I just wonder if someone can share cases and experiences of treating onion toxicosis here please. Every story I hear it seems like something simple and self resolving, but in my case it was just completely aggressive and unhaltering.

I am riddled with self-guilt, and in a really bad place now for what happened to my dog. She was my everything. The cutest Yorkie in the world - I saved her from euthanasia 6 years ago from owners that didnt want to pay for a simple treatment( full mouth extraction).

I did everything for her and she was as healthy as rain. She would have been 11 this week.

Case:
So this started last week when I gave her some pork meat that had been used for taco. She always eats everything, and tolerates everything, so I have become very lax about this. For this whole week I realised that she had onion toxicosis as she had Heinz bodies (and had not had any Zinc or paracetamol), but I didnt know how it happened. That is until today when I checked the taco spice that was used contains 25% onion and garlic powder.

19.04 ; - I noticed on a walk that she was really moving slowly, and not being herself , but figured she was just having an "off" day. this was noticed about 6-8 h after eating the pork.
20.04; - still lethargic , not really eating, and I stupidly still did`nt investigate much as she has had these bouts before.

21.04: even weaker , blood sample showing anemic by hematocrit 23,5 ,bilirubin also elevated. So from her healthy HCT 48 that is a 50% drop in 48 hours. otherwise fine on biochemistry, fever of 39,6. elevated heart rate and breathing. No anaplasma/erlichia/borrelia , no leucocytosis. Smear showing what looks like heinz bodies. I did`nt treat onion toxicoses before so took a while to connect the dots. I cant remember what exact I did, but think she had dexamethasone, doxycyline to cover, and supplements vitamin and weheamo.

22.04; HCT dropped to 13,5 , so another 24 hours and the HCT is halved. this is when I started to panick, and I got a blood donor, but only collected 250ml stupidly. I gave her 120ml to not overload her, cause she was getting Ringer fluids as well. She perked up and was being more herself again. she had more dexamethasone , about 0,3mg/kg. I also stupidly gave her 10mg/kg iv paracetamol as she had high fever (40+), probably from hemolysis. I did`nt know that this would probably increase the hemolysis even more. This was her first blood transfer and donor was DEA negative.

23.04: HCT at 19 after blood transfer , continued supplement treatments, but stupidly not given any N-acetylcysteine that could have helped with the oxidation. Her reticulocytes not really showing any movements, and platlets remain low.

24.004: HCT at 9,4 after 24 hours. she is really weak, all clinical parameters worsening, fever 39,6+ , tachycardia,tachypnoea, icterus, inappetant,not drinking. At this point I am panicking. Give her higher dose dexamethasone in case of sec. IMHA, and give her the rest of the blood from a new line 100ml . I know this is high risk as she probably already started making antibodies for this, but I see her dying for sure if I don`t do it. No acute reactions, she perks up a bit, starts eating. I know at this point that this is not gonna last long, but I thought it would give me 24 hours at least. I get some blood donor dogs come in in the afternoon, but they dont seem to be a good match as I did a major crossmatching with her blood and it was negative. So I make a plan to get more dogs in the following day and test against her blood which I found is DEA positive. But then in the evening she gets progressively worse (maybe exsasperated by me giving another 10mg/kg paracetamol cause I wanted to help with pain and fever). The last blood sample was taken in the evening, and gave me no hope that she could be saved. She was so weak that I think she would have died by herself within an hour, so did`nt get any blood donor dogs to come in as it felt too late.

I know my treatment was really insufficient, but I really did try, but should have sent her to someone less emotionally invested, as I did a lot of mistakes. But based on these blood sample do you guys thing there could have been hope ? Seems like onion toxicosis+Imha+DIC and whatever else. www.vetsurgeon.org/.../JOLIE_2D00_JENSEN_2D00_2026_2D00_04_2D00_24_2D00_0813.pdf

Please help, my own dog - onion poisioning ?

Stigen — Tue, 21 Apr 2026 15:18:38 GMT

Hi, I dealing now with my own dog suddenly being very sick, and running out of options. So she is a 11 year old spayed yorkshire terrier. She has always been healthy, but last 2-3 days becoming progressively more lethargic, and today barely moving. Has still been eating and drinking, but somewhat less Took her to the clinic, and full check.
Bloods show anemia and low platelets and high bilirubin (presumably from Hemolysis) . Biochemistry is largely normal. I took blods a month ago, and everything was normal then. Ultrasund abdomen - nothing much of interest to see, no free fluid, no signs of tumors etc. Somewhat big gall blader. X-ray thorax - all normalt.
www.vetsurgeon.org/.../JOLIE_2D00_JENSEN_2D00_2026_2D00_04_2D00_21_2D00_1132.pdf www.vetsurgeon.org/.../JOLIE_2D00_JENSEN_2D00_2026_2D00_03_2D00_02_2D00_0935.pdf
HAd her hospitalised today and had her on a drip of Iv Ringer. Ran Anaplasma, erlcihia,babesia and Borrelia snap - all negative. Blood smear possibly heinz bodies, not seen schistocytes or typical anaplasma signs. No ticks has been seen on her. Agluttination test with saline - nothing.

Blood pressure really high 215/90 , and hr 160 , temperature is up now in 4-5 hours from 39,4 to 40 , suspect due to hemolysis!?

Then i remember this weekend she could have gotten hold of some onion and garlic from a dinner I made...

So I am left with thinking onion toxicity og some myeloprolifirative leukemia or similar (which I really dont want) , or some other infection destroying blood cels ,or a case of IMHA that doesnt cause agglutination (Or I did it wrong). I gave her som amlodipine to get BP down, but really lost now for what do further. Thinking to give her Dexadreson IM and clamoxcyl IM in the lack of any other options..... If anemia progress she will need a blood transfer, and possibly to get bone marrow sample.

Anyone have an idea ?

Another what would you do question

janine redman — Tue, 21 Apr 2026 00:00:37 GMT

Small independent practice, ( one and a half vets) , who cover 90% of their own OOH work on top of daytime schedule.
clinic closes at 6.00pm

phone call from client who has just got home . They have gone to take their headache medication which they took out the blister pack that morning (containing 500mg paracetamol and 30mg ephedrine ) , and cannot find it . No one else in the household admits to taking it . Client has a 4 year old nervous female neutered exotic short hair cat and concerned it may have eaten the tablet between 10 hours ago and 1 hour ago .

you see the cat as an emergency at 6.30 pm and though anxious it appears clinically normal . The practice does not stock acetyl cysteine but you have established that the local 24/7 out of hours clinic that you sometimes use does .

Do you

1) send cat home and ask them to monitor closely overnight for any signs of facial oedema , respiratory issues or any other signs of being unwell and arrange to re examine the following morning . If any signs develop they are to phone in

2) admit for overnight observation knowing you will have to check the cat regularly overnight and that you do not have the appropriate antidote available .

3) Refer for observation and management to the OOH clinic

if you do refer would you expect them just to monitor or to administer prophylactic treatment just in case there had been ingestion of the medication?

How aggressive should treatment be in an asymptomatic patient ?

if you phone the VPIS are you then obliged to follow recommendations that may be based on worst case scenario/ defensive medication or would you feel confident enough to take all the advice on board but make your own judgement with regards the clinical case you are monitoring?

how many paracetamol poisoning cases in cats have you seen ? The only two I have seen and treated were cats given paracetamol by well meaning owners

Does you place of work stock acetyl cysteine, just in case ?

Prescribing anti-parasitics: should we ignore the guidance and should it be enforced?

Clive Ansell — Mon, 13 Apr 2026 09:28:56 GMT

I work across many different practices as a locum, and what I am seeing is that most practices are following the guidance and will only prescribe anti-parasitic drugs when seeing a patient, usually at the annual vaccination where they prescribe for the following year to be dispensed either monthly, or every 3 or 6 months.

There are, however, a few practices that are not following the guidance at all, they are dispensing POM-V anti-parasitics without animals being seen or more usually they are not being prescribed when the patients are being seen.

It creates a difficult situation for a locum; I was recently faced with a large list of repeat prescriptions to sign off, most of these routine flea and worm treatments included on health care plans for patients. In almost all cases these had not be prescibed or pre authorized, meaning I would need to see the patients to be able to prescribe, if following the guidance. On a practical level, if the odd one slips through the net I am not overly worried, but when it is the whole list, not really

What would others do?

NEW: VetSurgeon Discussions — easier to follow

Arlo Guthrie — Sun, 12 Apr 2026 16:11:03 GMT

Why?

VetSurgeon discussions offer several things that social media platforms struggle to provide:

• Discussions you can actually find again

• Algorithm-free visibility — see every reply

• Space to express nuance and detail

• Profiles that give context to people’s opinions

In a science-based profession, I think those things really matter, and I hope you agree!

What VetSurgeon hasn’t previously offered is a convenient way to follow discussions without being flooded with notifications.

Now it does.

What’s happening?

I’ve introduced a new way to follow discussions on VetSurgeon without endless notifications.

Instead of getting an email every time someone replies to a thread, you can now subscribe to a daily, weekly or monthly digest which summarises:

the latest discussion topics raised by colleagues
new replies to ongoing discussions
the latest veterinary news on the site

Even better, the control for it is placed in the title bar of most pages, making it VERY easy to change your preference at any time.

For example, you might switch to daily updates while following an interesting discussion, then revert to weekly or monthly afterwards — or switch it off entirely when you’re on holiday.

Help rebuild the discussion

If you agree that an algorithm-free platform that offers space for nuanced and thoughtful discussion is an asset to the profession, please help the community grow and thrive:

• Subscribe to the Digest

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• Spread the word. Tell a colleague about VetSurgeon. Share our public content on social media.

An important note

As we try to reboot discussions on VetSurgeon, there is one thing I will insist on.

Please treat colleagues with kindness and respect, particularly newcomers.

If VetSurgeon is going to become a thriving professional community again, that culture is essential.

Thank you

Thank you to all of you, and in particular Lesley Strong for being the first out of the stalls with a question!

Please keep the interesting discussion topics coming.

Does this script sound plausible?

Arlo Guthrie — Fri, 10 Apr 2026 16:09:06 GMT

I've been approached by a scriptwriter who asked if he could join and see what you think of a short bit of script he's written for a vet scene - specifically whether it is plausible and accurate.

I said I'd post if and see what you think.

7. EXT. FARM YARD. DAY. ALICE (Blonde, attractive, well spoken, intelligent, funny.) is with CHARLIE PASCO (Sixties, farmer, Cornish.) They are in a stable.. ALICE examines the horse. CHARLIE stays at the door of the stable.
ALICE So what actually happened?
CHARLIE My daughter was riding him this morning. She said he didn't feel right. Then he took a tumble.
ALICE Right.
ALICE examines the horse's fetlock.
ALICE (cont'd) Ok. Well the cut isn't too bad.
ALICE takes a close inspection of the horse. She takes out a stethoscope. She listens to the horse's heart intently.
ALICE (cont'd) His resting heartbeat is too high. He must be in pain.
ALICE puts her hands on the horses girth and the horses winces in pain. She then does the same thing to the shoulders, girth and flank and gets the same reaction.
ALICE Has he lost weight recently?
CHARLIE My daughter reckons he has.
ALICE Has he been eating normally?
CHARLIE Not all the time.
ALICE He may have ulcers. I will need to take him in. First I'm going to get a sedative and clean his wound.
ALICE walks out of the horse box. CHARLIE looks at the horse and shakes his head.

Anyone?

VICE

Arlo Guthrie — Wed, 18 Mar 2026 10:19:29 GMT

As I am sitting here buried under the hood building all sorts of new things into VetSurgeon and VetNurse, I have been giving some (more) thought to the purpose of these forums.

It's not 'somewhere other than Facebook or Linkedin' because that battle is lost.

But actually, the one thing I still believe passionately, is that VetSurgeon offers a far superior platform for scientific discussion.

Provenance of author
Long form responses allow for nuance
Easy to refer back to (ie creates a knowledgebase)
No algorithm manipulating what you will see, so less of an echo chamber.

These are all things which really are better than other platforms.

I've joked recently about the profession needing an equivalent of NICE for assessing the cost-benefit equation of, well, everything, objectively.

And as I was walking in the hills this morning, I thought perhaps that's it. VICE. We could just have regular discussions about any aspect of clinical care or equipment, analyse the cost-benefit equation, and then summarise. Possibly then drop the summary into a new knowledge base, but we can get to that later.

Whaddyathink?

Anyone up for giving this a trial run? I'm minded to start with something dental, or something orthopody. Maybe dental radiography, the discussion started the other day would be a good starting point.

I am thinking it could run as follows: Topic opens with a summary of available evidence today. Follow by discussion introducing any other evidence. Challenging existing evidence. Getting some data on cost. Then finally concluding with some kind of rating, based on the cost/benefit analysis. Or perhaps better than a star rating system, a standardised cost per annum figure. I'm thinking: cost of procedure amortised over extended lifespan (or cost of procedure over extended qol).