Liz Barton's Activities

Intestinal mass

Liz Barton — Mon, 10 Dec 2018 00:34:17 GMT

This mass within the small intestine was causing obstructive disease in this cat.

Carpal Valgus

Liz Barton — Fri, 19 Nov 2021 09:08:06 GMT

This did require intervention for correction, but it was so long ago I can't remember what my colleagues did to fix him!

Nephrolithiasis and pain management

Liz Barton — Mon, 30 Nov 2020 10:43:35 GMT

Hi all

Would appreciate your advice with the following:

11yr old persian cat, bilateral nephrolithiasis, haematuria (sterile currently), PUPD, bloating after eating, also vomiting TID initially and ocular herpes signs (presumed herpes). Quite unhappy. Slow onset and progressively worse symptoms over last 8 weeks.

Treated with cerenia daily for 5 days - no longer vomiting. Prednicare and 'antibiotic drops' for eyes, which are now better.

This is my best friend's cat and not my case so I don't have all the clinical notes!

Her vets have said bloods were 'normal' with no renal disease and have signed her off with the above treatment, but the poor cat is still miserable and my friend has asked my advice.

I've said the following:

- most likely Ca oxalate so I'd want to make sure Ca++ is okay (if not taken on original bloods)

- would recommend swapping to a renal diet or CD

- analgesia (renal colic? I know some cats seem completely fine but others flinch with kidney palpation if they have calculi so suspect renal pain is possible/probable even if intermittent). Tramadol?

- I would probably wean off steroids; possibly swap for NSAIDs for analgesia with usual caveats - or would you avoid with renal calculi?

- it's bilateral so I wouldn't be recommending surgery.

-regular urine checks as increased risk of UTI. Would you monitor PCV for chronic haematuria if not grossly bloody urine? How often?

I suspect the bloating may be because they've clipped her and she may have lost a bit of abdominal muscle tone if cachexic from the vomiting. Bloats immediately after eating/drinking, then goes back to normal within hours.

Any other thoughts / advice welcome - particularly on analgesia? Tramadol/amantadine/meloxicam? I'm pretty sure she's painful.

Many thanks.

Free cycle and CPD - pick the specialists brains as you pedal

Liz Barton — Sun, 28 Jul 2019 11:14:14 GMT

Tangent of: Cycling thread - Tours, tyres, technical, anything cycling related

This year's WellVet weekend in Cambridge features the Tour de Cambridge bike ride led by Dan Brockman, Adrian Boswood and Jon Pycock. Come and join a 15 mile amble through the city +/- extend to a faster 30 mile route for free on 7th September 10am at Girton College, Cambridge. www.wellvet.co.uk

Would be great to see some of you and a good chance for an online community to meet in person. Message me here, or email info@wellvet.co.uk for more details.

Happy Sundays everyone

Liver masses

Liz Barton — Thu, 04 Apr 2019 11:49:04 GMT

Collective wisdom appreciated as I'm reviewing my approach to the common finding of scanning nodules on the liver of aged dogs and cats:

My general approach to discovering lesions on the liver during ultrasound exam has been thus:

- If small and hyperechoic in an aged animal presume most likely benign fibrotic change

- If small and hypoechoic in an aged dog presume benign nodular hyperplasia

In both cases offer a follow up scan in 6-8 weeks to see if it's rapidly growing +/- sAME supplementation if there are mild changes in liver enzymes on bloods

- If larger or mixed echogenicity I offer the same approach or percutaneous trucut where possible (after checking clotting obv)

- If it's a single mass at the periphery of a lobe offer ex lap / surgery.

Does this seem reasonable? Any other suggestions or common approaches. Should I be sending more for CT or referral?

Where owners don't want to sample or take things further, do people routinely put them on medication for a presumed 'liver tumour' if the animal is clinically well with no changes on bloods? I tend not to unless they're clinically unwell in which case I give appropriate supportive treatment and sAME.

Do you think they're painful and should be getting analgesics? I vaguely remember the liver capsule has some nociceptors so stretch of this may cause discomfort, but they rarely seem to react during a scan.

Steroids? I normally give them end stage on the Mike Herrtage mantra 'nothing should die without steroids'.

Local anaesthetic blocks

Liz Barton — Wed, 27 Mar 2019 09:43:31 GMT

Hi all

I've been using dental nerve blocks for years and am used to doing them a certain way. But I wondered what everyone else does.

I use 1 part lidocaine to 4 parts bupivicaine and always tend to use the caudal maxillary and caudal mandibular blocks. Does anyone commonly use the infraorbital or mental foramen blocks? What are the advantages of these over the caudal blocks?

Also, I tend to use a couple of drops directly into socket and surrounding gingiva post extraction.

Any other favoured protocols?

I think this is a nice summary https://veterinarydentistry.net/dental-nerve-blocks-dogs-cats/

Diets for pancreatitis

Liz Barton — Wed, 13 Mar 2019 08:55:08 GMT

Chronic recurring pancreatitis in a very picky miniature poodle. Any diet recommendations? She’s already tried chappie, GI low fat, variety of sensitive diets...

We’ve imaged and the pancreas look pretty sad; bright, enlarged, painful, but no mass lesions. There is a degree of delayed gastric emptying.

Does anyone use analgesics for longer term us at home with these chronic cases to use on a bad day? Pardale? Tramadol? Anything else?

TIA!

Negative media influences

Liz Barton — Mon, 11 Mar 2019 13:17:31 GMT

[quote user="Arlo Guthrie"]I wonder ... there's this distinction between 'depressed' and 'clinical depression'. Does anyone know of any research showing a link between the two. What I mean is ... We all get 'depressed', in the loosest sense of the word, from time to time: business not going well, problems with relationships with other people, can't pay the bills, bereavement, feeling of being on a treadmill with no real purpose, that sort of thing. My question is whether anyone, exposed to enough of these sorts of things, for long enough, will likely suffer from clinical depression. Or is clinical depression completely separate to any external trigger. In other words, sufferers will suffer depression regardless of external triggers around them. It would be really interesting to hear from those who have suffered from depression whether they can remember it being brought on by external factors or not. If external factors are causative, then addressing things like this https://medium.com/@drsarahboston/medias-emotional-blackmail-is-killing-veterinarians-51bcb3823164 could be expected to help. (I thought that was a very well written article BTW, worth a discussion in its own right). [/quote]

Tangent of: RE: Anxiety, Depression and Suicide

[quote user="Arlo Guthrie"]If external factors are causative, then addressing things like this https://medium.com/@drsarahboston/medias-emotional-blackmail-is-killing-veterinarians-51bcb3823164 could be expected to help.[/quote]

Summarising the article - owners with sick puppy cannot afford life saving treatment. Vet explains we're not a charity and works tirelessly to come up with options to save said pup - suggestions, phoning around local rehoming centres, passing on charity details, giving cost effective treatment (and a bit of free SQ fluids to buy some time...). All of this costs the practice money and time, and causes stress/distress for the vet team. Pup is passed to rehoming charity, recovers, and vet team is bashed in the media for separating pup from owner. Cue local campaign to claw the animal back to the owners. Bottoms line is vets are money grabbers who only care about the finances.

Working in an ECC hospital this type of attitude from the owners is a common - almost daily - occurrence. Rarely have I seen this particular scenario escalated to the levels she talks about in the article, but I know it happens. Even within the shelter setting there have been similar accusations, and that's at a point when owners are relinquishing their animals by their own choice to a charity.

When anyone wants to complain about a bill these days it seems they resort to the internet to name and shame professionals who are simply attempting to do their best. If the practice backs down and gives them a discount to stop the situation developing are we not inadvertently perpetuating this behaviour? Does it not also make the practice complicit in the undervaluation of staff negatively impacting both morale and self-esteem of the team?

It seems in response to this 'vet bashing' on social there is a Newton's III law where vets are increasingly 'client bashing' on social groups. Greater understanding is required on both sides - cue Arlo's RCVS poster! Maybe also a video along these lines to be played in waiting rooms.

Complaints process

Liz Barton — Fri, 08 Mar 2019 12:34:51 GMT

[quote user="grumpyoldman"][quote user="Liz Barton"]the complaints process is the pits (I've been on the receiving end - thrown out at the first assessment stage but absolutely floored me waiting to hear!). [/quote] Its Amateur Clumsy and Judgemental, its gone the way of employment tribunals in assuming guilt whenever possible requiring the defendant to prove their innocence or in most cases give the complainer enough rope to let themselves looks stupid mean spirited and mean minded. Most of the time you can see it coming and head trouble off before it get to the RCVS . The best way to support the vets involved is to take a hand when the client initially causes stress. Apologise for the negative or unsatisfactory outcome or complication. Agree to write off or refund the fees involved ,with the proviso that the client seeks veterinary services elsewhere in future. Vets do not function properly when they are waiting 3 months for the results of an RCVS enquiry or when some vile client has returned to the waiting room to haunt their day. [/quote]

Tangent of: RE: Anxiety, Depression and Suicide

On that score, if it requires a third party to be involved, the RCVS piloted and now continue to fund the independent Vet Client Mediation Service:

https://www.vetmediation.co.uk

Have you come across this? I don't know too much about it, other than it's a step between the direct practice-client complaints process and the RCVS one. The RCVS signpost this above their own complaints procedures. Has anyone been through the VCMS process? I'd be interested to know how it compares.

Delegation to nurses - how does Sch 3 work in practice?

Liz Barton — Sun, 10 Feb 2019 21:14:45 GMT

[quote user="Old Grey One"]Interesting post Clive... Of course there are plenty of other high profile failures going on right now : Debenhams, Toys R Us, Patisserie Valerie, to mention just a few. so CVS plc is certainly not immune. I am wondering if there are two threads mixed up here : One seems to be about CVS / Corporate, and the other is about Nurse empowerment. Perhaps a moderator should seperate them out before we old ones get too confused....!![/quote]

Tangent of: RE: Has the CVS bubble burst?

Had been thinking just this Old Grey One when I read your post.

So, what are you 'happy' delegating to nurses? I've worked largely in shelter medicine, where the nurses do V2, KC checks and post op checks - only calling on the vet to check treatment plans or if there are concerns. These things would take up almost all the vet time if not done by RVNs.

Green cars

Liz Barton — Tue, 05 Feb 2019 22:53:56 GMT

[quote user="Clive Ansell"][quote user="Bob Russell"]So much investment has gone into diesel as that was what we were encouraged to buy. VW group fiddle the results and the bottom drops out of the market. Out of the blue diesel becomes public enemy number one, rightly or wrongly![/quote] I don't buy into the diesel is bad bullsh1t. I remember reading that diesel cars consume only about 1-2% of all heavy oil (Diesel), most of it is used in lorries, buses, trains, and ships. Therefore even if all diesel cars were scrapped, globally, it wouldn't make a jot of difference. I'm currently looking at replacing my car, and have been looking at electric models with some enthusiasm, but so far the cost is prohibitive (JLR's iPace = about £75k) and the technology just isn't there yet in terms of range, cold weather battery performance and charge times. Then there is the environmental question mark over used battery disposal too, not to mention mining of heavy and toxic metals in developing countries to manufacture them in the first place. A friends hybrid BMW uses more fuel and churns out more CO2 than his previous diesel model did, so not really sold on hybrids either.[/quote]

Tangent of: RE: The 'Backstop Issue': please explain!

Surely if you're using electric/hybrid cars, it only makes environmental sense if you're using electricity generated by green methods? In my simplistic knowledge of physics, if you're burning fossil fuels to create electricity which then has to be stored, transported to and inserted into your car battery, then you have more steps for energy loss. I'm presuming power plants are much more efficient at combustion than a typical vehicle engine, but even so, what is the actual bottom line of environmental benefit if green energy isn't harnessed for the electricity?

How often should you bath dogs?

Liz Barton — Sun, 20 Jan 2019 23:05:41 GMT

I generally don't recommend bathing dogs unless they need it. But is there a risk of over-grooming animals; pampered pooches have a wash and blow dry too often? Does anyone know how much is too much for stripping natural oils / commensal bacteria from the coat? Thanks.

Paying it forwards

Liz Barton — Mon, 14 Jan 2019 14:47:23 GMT

So I got this in the post at the weekend. Just one act of kindness from someone to nominate me has left me on a high, in a world where there are plenty of lows (including a couple this weekend).

It's made me want to draw attention to the brilliant initiative Veterinary - Pay it Forwards, set up by vet nurse Lacey Louise Pitcher. You can nominate anyone and they get sent an anonymous gift. Or you can ask to be given a name to gift one of the nominees.

"Pay it forward (PIF) was created to facilitate the anonymous gifting of care packages and crafted items to others within the veterinary profession (all members of the team) . We aim to spread positivity and aid wellness in a profession where the smallest kind gesture really can brighten someone’s day. A virtual hug or high five received by a person in the form of a gift should then have the kindness paid forward, thus spreading further happiness. Quite simply:
Receive a gift ➡️gift to another person ➡️and so the kindness spreads"

(Lacey's guide cut and pasted from the site)

Being a Successful Working Couple

Liz Barton — Sun, 13 Jan 2019 22:01:34 GMT

Hi all
I'm leading a session at SPVS/VMG congress on 'Being a Successful Working Couple'. I've created a 10 question survey, which should take less than 10 minutes to complete and would appreciate your input on this. I'll of course share the results for anyone interested.

Many thanks!

https://www.surveymonkey.co.uk/r/33W9PBX

Liver Cyst

Liz Barton — Sun, 16 Dec 2018 21:16:56 GMT

I scanned this cystic lesion in a severely PUPD stray geriatric Staffie. The only changes on bloods was elevated ALP. It was drinking 6-9 litres/day. The watery fluid that came out of this cystic lesion was acellular. It had other liver masses and a very nodular spleen (hence was PTS'd and this was post mortem). Has anyone seen anything like this before? Benign or otherwise? Related to PUPD???