Julie Turner's Groups Activities

What do you think of the 'blessed sleep' protocol for pre euthanasia sedation?

Mialee Blair — Wed, 05 Apr 2023 17:50:11 GMT

After a less than successful pre euth sedation with dom and torb, it worked but there was some retching and then a lot of agonal breathing, I have been researching better solutions.
I came across an American protocol called blessed sleep, a mixture of ketamine, xylazine, acp and butorphanol.

it sounds great as it’s a small volume with a s/c injection.

for ease they premix and keep a ready made solution

thing is I’m not sure how you would square that with ketamine regulations. We could work out per ml ketamine and log as used but the 10 ml we use to make the solution would be flagged up as being past 28 day breach and need disposal etc.

obviously we could make up the injection each time but that’s a right faff and negates having a simple solution.

anyone in the uk that does this or have any better ideas ?

CAN ANYONE HELP Please?

Julian Earl — Wed, 10 Feb 2021 14:08:55 GMT

Hello, This is a difficult post for me to write.

As many will know, I am/was an experienced vet, having qualified in 1981 in fact after wanting to be a vet since I was aged 7 or 8 years old. Then on the 8th August 2012, about 7.30pm, I crashed in a local cycle race, my passion outside of work and sustained life-threatening injuries: A basal skull fracture, multiple brain haemorrhages, a subdural haematoma, five broken ribs and a punctured lung plus a broken collar bone. Indeed, my wonderful consultant neurosurgeon at Hull, Gerry O'Reilly told my wife that I was not expected to survive, but here I am.

I was placed in an induced coma for 11 days and spent the subsequent four months after intensive care on the neurosurgical ward being largely confined to bed! Gerry clearly had the brain surgeon's skills to repair the damage to my skull etc, but I have tried to acknowledge that it has been my family and friends who have kept my inner spirit alive. This includes very many professional colleagues such as your good selves here on vetsurgeon.org. My cycling clubmates have gone out of their way to help me as well and I discovered how many true friends I really have! Far more than I knew about! These included school friends whom I had not seen for 40 years!! I have tried to thank everybody via letters,in the Vet Record and also the Vet Times!

Sheep Veterinary Society, do deserve a special mention as I have been a member since 1984 I joined for CPD but acquired lifelong friends! :) I now also consider Gerry O'Reilly himself as a good friend because he has been so supportive since and so positive. I must count as one of his successes? My first memory after my crash, at a recorded 30-35mph by a farm entrance where my helmeted head struck the tall kerbstone, was when I awoke; Gerry was sat next to my bed. He asked me what I was like as a person and what did I want to do in the future? I said, "Well, I am quite stubborn and do not give up easily!" In the future? Sorry RCVS, but I said, "All I want to do is get back on my bike!" He said, stubbornness is good on this ward! If you want to get back on your bike, then I will get you there! A fantastic reply, not Don't be daft, you cannot even even stand up alone at the moment! And especially that he had recently told Annika my wife that I was very unlikely to survive! But here I am, thanks to Gerry in the first instance...!

I am pleased to say that I am indeed back on the bike albeit as a Para-cyclist and have achieved top ten placings in the National Championship in 2018, and 2019, when after 2016 and when first registered as such I had to pull out due to lack of full control of my left hand on the handlebars and veering wildly a lot! In 2017 near Chester I finished in 11th; in 2018 5th in Essex, and 2019, 6th in South Wales. Pleasing progress Then in June 2021 I achieved 5th again, . Thwarted by COVID in 2020 as no champs were possible. Edited in June 2021 to say that on 5/6/21 I matched that 2018 result with 5th again in the National para-cycling time trial held near Bath on a hilly circuit of 18.5 miles. An edit: In 2021 I won my first two National Para-cyling events, in my particular category and those two wins have given me the National Title for the Para-Cycling Time Trial Series of this year. I never expected to be aNational Champion in mybeloved sport, para-cyclist or otherwise so this has been immensely satisfying!

ow do I top this next year, being the major problem now?? So where am I going with this? When in hospital I suffered some abuse from some nurses: a male nurse punching my arm if he thought I was trying to get out of bed which I was not! And bearing in my mind I had 5 broken ribs and the collar bone at the time. And one female nurse slapping me to wake me up! "You shouldn't be asleep at this time of day [It was 4pm]. I was in the process of recovering from the anaesthetic following one of my operations so that is why I was sleeping! I did rather snap at that nurse on that occasion! As for the male nurse, I told the Ward manager about this when I returned for a check up and he said, Yes I know who you mean but he was fired a few months later for something unrelated. Oh I said, well I'll shed no tears for him! In the following months when I was at home, I slept very poorly and suffered a lot of nightmares related to still being in hospital. I try to use mindfulness to return my presence of mind to the here and now of being at home in my own bed. My GP diagnosed PTSD and even now, 8 years later I still suffer nightmares and almost hallucinations of where I am.

I receive regular counselling both locally and initially from Vet-Life, I am told this will Pass! But can I be sure? My wife has gone above and beyond the call of duty in helping me. She was retiring as a district nurse, her own leaving do, when I crashed! The first advice that I was given was to be open about this problem. The PTSD has evolved into depression and anxiety which are extremely common after a major injury to the head! "So do not be ashamed", it is not a sign of weakness when I was concerned how it might be seen? Hence I am posting on here to ask for suggestions from my professional colleagues, all of whom have been wonderfully supportive of my difficulties during the past 8 years. I am honest enough to admit that I am glad I am now retired and away from practice so that I no longer have ready access to the Euthatal and similar should my resolve completely crumble. My former boss, David Greenhalgh to be specific, from 30 years ago has been very caring and he has pointed out that suicide stops things from getting worse, but it also stops things getting better! I could not inflict that pain on my wife and son, and nor on my sister who lost her husband from thyroid cancer just a couple of months ago. In one word, the reason I would not take this option, LOVE!, for my wife Annika and my son Robert. Plus I do still have unfinished business on the bike. There are personal bests to be broken yet!

I lost a good friend, Harvey Pickup to this in 2009 and my initial reaction afterwards was was both sorrow and anger! Blimey Harvey! Did you not know that you had friends out here? I've spoken to his parents since and he never talked to them about his difficulties either! So again, that is a reason for posting on here about this. So, Please be kind!

Thank you in anticipation for your help and suggestions. Much appreciated thanks.

Julian Earl Cert AVP- status [ SHP.] and WEL.], now retired....

The beautiful valley of Oxcombe,

Lincolnshire...

What being a veterinarian really takes

Arlo Guthrie — Thu, 23 Sep 2021 15:16:59 GMT

www.youtube.com/watch

Discuss.

70% of pet owners' calls to vets at night are unnecessary

Arlo Guthrie — Thu, 02 Sep 2021 14:26:00 GMT

A survey carried out by VetSurgeon.org and VetNurse.co.uk has found that over 70% of the calls from pet owners to veterinary surgeons after hours are unnecessary.

For the survey, veterinary surgeons and nurses were asked: "Thinking about the last time you (or your OOH provider on your behalf) were called by a pet owner out-of-hours within the last fortnight, was the call ...

a) Something which was clearly NOT an emergency (eg vaccination, nail clip, dematt, pet passport etc.)

b) A condition which should have been seen in normal working hours (either because it has been present for some time already with no deterioration or because - in your opinion - it could have waited till the morning).

c) A genuine emergency, which needed prompt attention to prevent the animal suffering.

475 members took part, 69% of which were vets and the remainder vet nurses.

Of the out-of-hours (OOH) calls they had taken:

28.2% were genuine emergencies, which needed prompt attention to prevent the animal suffering.

64.8% were about a condition which should have been seen in normal working hours (either because it has been present for some time already with no deterioration or because it could have waited till the morning).

6.9% were about something which was clearly NOT an emergency (eg vaccination, nail clip, dematt, pet passport etc.)

So in total, 71.7% of the calls to veterinary surgeons OOH are unnecessary.

This raises a number of important questions, chiefly whether a profession struggling with a staffing crisis can afford to maintain the blanket requirement for all practices to make provision for OOH, particularly now that society places so much greater demands on the profession than it did when the rules were invented, demanding wormers in the middle of the night and then blackening the name of the vet on social media if they refuse. It happens.

Is it time to go the same way as some other countries and let the market meet the demand?

Or can anything else be done to relieve the pressure that OOH places on the profession? Ideas floating around include making all veterinary OOH telephone lines premium rate, charging at least enough to focus the caller's mind on whether it is actually necessary to renew their pet passport at 3:00am. Or perhaps a concerted effort by all parties to communicate the message that OOH is A&E. You shouldn't ring unless you really need to. But that message may not carry much weight when at the end of the day, it's the insurance company footing the bill.

Reducing the number of spurious calls doesn't, of course, help the staffing crisis. But it is surely pertinent to ask whether an obligation for 100% of general practices to make arrangements to service something which is 70% unnecessary is the most efficient way to operate.

Maybe the time has come for the profession to consider OOH and general practice as two very distinct things. Discuss.

The RCVS didn't want to comment.

Clarification on code of conduct change re euthanasia and scanning for microchips.

Bibs — Fri, 21 May 2021 11:49:38 GMT

https://www.vetsurgeon.org/news/b/veterinary-news/posts/vets-now-required-to-scan-healthy-dogs-for-a-rescue-backup-prior-to-euthanasia

I have just been reading about this change to the code and I'm unclear on a few things. Maybe I'm just being thick but I thought I'd just put the questions out there so I can learn.

1. What flexibility do we have if we don't think scanning is appropriate? I may have missed it, but I didn't read about any flexibility. Is this because the code is not fully binding or set in law?

2. I usually rely on other staff to call microchip databases. If we scan a dog, it doesn't tell us what brand the chip is does it? So does that mean we have to call all known databases in these circumstances?

3. If the dog is registered with someone else or reported as stolen what can we do? I assume we can call the number registered to check the situation?

4. To be clear, the circumstances the code refers to are when you're brought a dog that you don't think needs to be euthanised, right? If you're brought a dog that's unwell then you're not obliged to check for a chip?

out of hours provision

ian bates — Fri, 23 Apr 2021 15:16:42 GMT

Hello all,

Quick poll on this please...? Like most we are struggling to recruit and about to go down to 4 1/2 vets in a 3 site, 6 1/2 vet rural, small animal practice. This will have the inevitable impact on the workload and On Call rota.

We have the opportunity to out source the OOH - I have proposed weekends and bank hols and to keep doing the weeknights ourselves. I am being met with resistance from the other CD's with one reason given as "it is too far way".

The figures are :

Site A to OOH centre - 36 mins, 23 miles

Site B to OOH centre - 46 mins, 28 mile

Site C to OOH centre - 1h10min, 44 miles

I realise it is not ideal, but I think we are in danger of OOH becoming unsustainable in our current format. The other CD's will not be around for ever. Recruiting on a 1:6 is very difficult, recruiting on a 1:4 or even less.....? I am trying to head off a staffing crisis before we get into one.

Is there a recognised industry standard / accepted time and distance to adhere to for OOH provision?

Many thanks in advance

Ian

Loxicom - 2 syringes - be careful

Neil Wheadon — Tue, 13 Apr 2021 18:57:08 GMT

With more people using loxicom as metacam is out of stock it's worth pointing out to take one of the syringes out when dispensing, especially to small dogs. There have been a number of 'near misses' where dogs have been given 10 times the dose (small = cat, large = dog in clients eyes)

Neil

Cat Intestinal mass - Lymphoma vs Sarcoma - does it matter?

Beats — Mon, 11 Jan 2021 13:49:11 GMT

13yr Maine Coon with large intestinal mass (and small goitre, and possibly some TMJ pain responsive to metacam).

Had lost weight (5.8kg 4 years ago), 4.2kg in October 2020 and 3.5kg in December 2020.

Large jejunal mass removed and up to 4.4kg 2 weeks later.

Here is histpath below. My question is does it matter if lymphoma vs sarcoma (I'd planned to just bin, but owners were very keen to send off for histopath) and what might change as result of requesting further staining if done?

"1. The section of lymph node [4mm punch from jejunal mesenteric root which had large amount of lymphoid tissue] has retained architecture and overall is within normal parameters.

2. Early section of jejunum identifies a large intramural mass formed by neoplastic round to spindled cells. These are often more spindle-shaped in areas but also associated with stromal spindle cell proliferation. These demonstrate moderate anisokaryosis and have a large single prominent nucleoli and mitotic figures are numerous. The oral and oral [sic] margins however are devoid of tumour infiltrates and the majority tumour appears to be confined to the muscular tunic but there is also moderate lymphoid aggregation in the serosa however tumour cells are not readily identified.

MORPHOLOGICAL DIAGNOSIS:

2. Poorly differentiated malignant tumour, high grade lymphoma vs sarcoma

COMMENT:

I have discussed this case with a colleague and we are finding it difficult to identify the origin of this tumour. It does not appear to be metastasising to the lymph nodes supplied nor does it appear to be particularly invasive anteriorly or posteriorly. Lymphoma I feel still warrants consideration even though some cells are more spindle-shaped but to gain further prognostication immunohistochemistry would be required... The oral and aboral marginal tissue sections do however appear to be devoid of tumour infiltrates.

Please do not hesitate to call if you have any questions or concerns about this report, or if interpretation does not fit with your clinical impression.

European Specialist in Veterinary Pathology"

Mirtazapine as regular treatment for CKD cats.

Beats — Mon, 04 Jan 2021 10:28:19 GMT

Who uses this, what is your experience, what formulation and dose do you use?

Live Case discussion: Young adult cat acute lethargy over night; lilies or not?

Beats — Sat, 24 Oct 2020 16:46:29 GMT

2 year old otherwise healthy cat (one slow healing wound a month ago).

Fine at bedtime, in morning hardly moving, no interest in food, very lethargic.

On exam: T=39.5'C on arrival in cat carrier, sitting quietly with head down.

Owner concerned about there were lilies in downstairs room as part of floral gift - had cut the stamens out of them, but in morning there was one which had some dusting of lily like pollen on 2 of its petals that she thinks would have noticed had it been there no signs of petals being eaten - owner has feeling that cat plays a lot and floral display looked like had been ruffled a bit and could have missed some pollen and cat rubbed against it and then licked off coat - just a vague instinct, nothing specific to say that any part of lily has been ingested.

What do you wish to do?

RCVS investigation fails to identify mole on Council

Arlo Guthrie — Thu, 03 Sep 2020 17:26:00 GMT

The RCVS has confirmed that it commissioned an independent investigation earlier this year which has failed to discover who leaked information contained in confidential Council papers.

The College first became aware that confidential information had been leaked earlier this year after the Veterinary Record made the decision to publish details.

The College says it then provided a number of informal opportunities for the person leaking the information to come forward and discuss the reasons for their actions, but nobody stepped forward.

A Council member then made a formal complaint about the leak, which triggered the complaints policy set out in the College’s Code of Conduct for Council Members and instigated the investigation.

The investigation was run independently of the RCVS by an external specialist consultancy, and coordinated by a legal assessor.

Initially, the investigators were asked to focus on a single leak, but following a number of further leaks over ensuing months, it became necessary to widen the scope and depth of the investigation.

The investigators’ report concluded that there had been several separate and deliberate leaks of confidential information by a current or former Council member over an extended period.

However, they were not able to identify who specifically was responsible for the leaks, and because nobody admitted it, no further action under the complaints policy of the Code of Conduct for Council Members was appropriate.

The investigators concluded that the leaks were not the result of poor understanding of College or Council processes, but a deliberate decision to provide confidential information to third parties.

Council members have therefore agreed to review existing training requirements and mechanisms for handling confidential information and to explore in more detail the potential motivation of the person or people who leaked the information, together with the underlying culture of Council that might have influenced their behaviour.

RCVS President Mandisa Greene, said: “There is no denying this is a sad day for the College, and for RCVS Council in particular. As Council members of our professions’ regulatory body, we must maintain the very highest standards of probity and integrity if we are to maintain the trust and confidence of our professional colleagues. In the same way, we must subject ourselves to the same level of scrutiny and investigation if these values and behaviours are ever called into question.

“That someone chose to breach the trust placed in them by their peers is extremely disappointing, especially when they were given every opportunity to come forward to discuss their concerns, and avoid the College having to launch a formal investigation.

"Our default position during Council meetings is to hold as many discussions as possible in public session to ensure Council’s decisions are as open and transparent as possible – something that we will continue to increase as much as possible. Like any organisation, however, there may be a small number of issues that need to be discussed in closed session – for example, those still at concept stage prior to any decision being made public or put out for consultation, or those containing personal or commercially sensitive data.

"I sincerely hope that all of us on Council can learn from this unfortunate and unnecessary episode. We must rebuild and maintain sufficient confidence in each other, and in our processes, that, even if we disagree on certain matters, it is always best to do so in a direct, upfront and honest manner."

Do we need to remove the whole uterus in bitch spays now?

Julie Turner — Mon, 13 Jan 2020 10:15:17 GMT

This question has been bugging me for ages....as far as I’m aware, laparoscopic spaying involves bilateral ovariectomy alone (am I correct?).

I which case, when routinely spaying, why do I need to perform hysterectomy to the cervix which usually involves a larger wound and more tissue trauma? I can understand this in the case of an active pyrometra, but what’s the accepted wisdom otherwise?

I’d love to hear that I need only remove the ovaries, not least for the sake of my aversion to bleeding and of course, the bitches’ recoveries!

Cat with PCV of 7%

Beats — Tue, 24 Dec 2019 12:24:10 GMT

Has history of cat bite abscesses.

1y6m 3.6kg MN DSH.

No vaccines I'm aware of (may have had some at shelter etc if got from one).

Idexx SNAP FeLV/FIV negative.

Was noticeably pale when seen by vet 2 weeks ago for bite to tail.

Can jump into top kennel from floor and land fine, but is lethargic and bit wobbly with PCV of 7%.

I thought there was slide agglutination, however I may be incorrect in that.

The blood smear just looked like very anemic (wbcs and platelets looked OK to me, no obvious rbc changes other than ghost cells, could be few spherocytes but I don't really know).

NMB stain NO obvious reticulocytes at all.

So:

1) Non-regenerative anemia in cat that has been pale for at least 2 weeks and is well-adapted to its low PCV = problem with bone marrow.

2) May or may not have some mild peripheral haemolysis.

3) Is going to get steroids, 5mg pred q12hrs and see how goes.

My questions:

1) How reliable is a negative Idexx SNAP FeLV in this setting, as this cat looks like a leukemic cat with FeLV otherwise to me?

2) Can cats get IMHA that is happily steroid responsive and mostly affects the bone marrow precursors with only mild (if present) peripheral haemolysis?

3) Anything I'm missing or other thoughts?

Many thanks!

Complaint about rectal diazepam

Stigen — Tue, 24 Dec 2019 20:01:33 GMT

I recently a small dog after hours. It was a small 5kg mix breed dog, 15 years old. Dog has had a seizure at home, and been somewhat lethargic after. NAD on clinical exam, completely rotten mouth(like worst I`ve seen) , hr -60, t: 37,7, blood sample biochem ok, slight elevated alt,and ALKP , and slight anemia rbc,hgb and hct.
I am at home now, so don`t have exact data.
It had a drip of nacl, and was given some 15mg phenobarbital tablets in case of further seizures, and a Stesolid diazepam rectal suppository to use in case of violent seizures. I have never given those out before, but felt in this case with particularly nervous owner it would provide an extra security. We only have one strengt of those at the clinic which is 10mg. Dose for dogs should be 0,5-2mg/kg , so for a 5 kg dog would be at the upper range.

So dog had another seizures the next day, the owner administered suppository and the dog died 10 min. later. Now she is all up in arms and preparing formal complaint. I don`t feel like I have done too much wrong in this case, although I do read from much litterature that normal dosage diazepam reccomended is 0,5-1mg/kg , in which case 2mg/kg would be double dose. But I also read toxicity reports on Diazepam stating that 22mg/kg gave no adverse effects on dogs , while 40mg/kg gave moderate signs of toxicity.

This leads me to conclude that Diazepam is quite safe even at 2mg/kg, and the dog likely died of whatever affliction caused the seizures to begin with. Any comments, or experiences with this drug ?

Why can’t I tick all those boxes?

Julie Turner — Fri, 26 Apr 2019 18:54:47 GMT

[quote user="Arlo Guthrie"][quote user="Neil Wheadon"]I've just introduced my wife to this. It's fabulous, you read the thread, click on the CPD tab, write something, it records it and you can then generate a certificate Absolutely brilliant, what's the maximum you can claim? Neil[/quote] Tangent of: CPD recording on Vetsurgeon Been giving quite a lot of thought to this Neil Wheadon, because it rather touched a nerve. As I said in that thread, I find it frustrating when I see clinical discussions happening on Facebook, because I think we offer a much more professional environment which is far better suited. I think there are two reasons why some clinical discussions are happening on Facebook. The first is that Facebook is more mobile-phone friendly and has notifications. We're working on those at the moment, as part of the next upgrade. The other problem is that I get so buried under the hood, I forget to go and shout about things loudly enough. Hence this poll ... [/quote]

Tangent of: Need your help with brainstorming

I wanted to include all of your answers but you cruelly limited me to one.

Another point is that with all the transgressions via Cambridge Analytica and so on (and I was sick of seeing friends’ Wonderful Worlds pics), I have not been on Facebook for at least 3 years!

I really enjoy the threads and find them useful too Arlo :-)