This is a list of scheduled forum discussions which will be held over the coming months. This page is a collaborative one, which means anyone can contribute a suggestion for a discussion. Please do add any ideas you have to the paragraph at the foot titled suggestions. 

Anaesthesia and Analgesia

1. The best approach to a crashed patient (dog) under anaesthetic
2. What is anaesthetic and analgesia protocol, with reasons, for routine neutering in health animals?
3. Is routine blood testing necessary to prescribe long term NSAID's?
4. Is routine pre anaesthetic/surgery screening for lungworm a good idea?
5. Practical local anaesthesia techniques for common surgeries - tips, tricks, learning curves etc?
6. Are pre-anaesthetic blood tests in young healthy animals justifiable or a rip-off?

Cardiology

1. Echocardiography for GPs - how to get the views you need?
2. What is your approach to the coughing dog, if constrained by costs?
3. How do you diagnose and manage congestive cardiac failure on a limited budget?
4. Owner brings in new pup for 1st vac and you note a heart murmur. What do you do - tell them to take it back to the breeder asap - wait and see - refer to specialist?
5. At what point do you start a dog with an asymptomatic but progressive heart murmur on medications? 

Dentistry and oral surgery

1. Is it acceptable to perform dentistry without the facilities for taking intra-oral radiographs?
2. When is it appropriate to use antibiotics in dental cases?
3. How many clients follow advice you give to brush their pet's teeth, and does it actually make any difference with regard to recurrence of dental disease?
4. What’s the best approach to dentals? Aka how can a general practice try and keep them to less than 4hr+ each! Is it an equipment issue? Skills issue? Other?

Dermatology

1. Are we grossly overdoing parasite control in cats and dogs?
2. Best approach to the itchy dog at various ages, eg under 1 year old, and mature adult. 
3. Is it worth doing potentially unreliable skin scrapes if you suspect sarcops or demodex - or  is it easier  to just give a dose of Nexgard/Bravecto etc. as a clinical  trial.
4. Do corticosteroids still have a place in Dermatology?

Diagnostic Imaging

1. Thoracic radiograph and lung patterns - what can you tell from radiographs? 
2. Should you always perform a BAL after radiographs when investigating a chronic cough? 

ECC

1. How to treat a patient with sepsis/SIRS
2. Use of xenotransfusion in feline blood transfusions 
3. Steps to stabilise an animal in respiratory distress. 

Equine

Exotics

1. Reproduction problems in backyard hens (egg peritonitis / salpingitis complex) - is treatment futile?

Farm Animal

Medicine

1. Are we vaccinating too often?
2. Should we recommend monthly lungworm treatment if you are not in an area of prevalence (Do you know if you are actually in an area of prevalence?)
3. Do 'Healthy Pet Clubs' encourage over-use of parasiticides.
4. Does the average pet dog need roundworm/tapeworm treatment every month? Even into old-age?
5. Cats with 'cystitis', dogs with KC/diar/otitis/ hot spots etc. - should systemic antibiotics ever  be used?
6. How effective are owners at treating ears with topical products - in particular if you have not given them a practical step-by-step guide  - and are the new 'one shot' topical ear products going to become the norm?
7. Should non-antibiotic anti-bacterial  products be used in preference to abs for most cases of otitis?
8. Controlled Drugs - storage/recording and disposal - are you doing it right?  (this is the single most prevalent problem identified on PSS visits - even in otherwise highly compliant practices).
9. Should vets be dishing out highly dangerous and addictive (to humans) opiods for long term use in pet animals.
10. Monitoring temperatures where medicines are stored and avoiding exposing meds to temperatures outwith the data sheet recommendations. - another big problem area - even  more so for ambulatory FA/Eq vets in their vehicles. Does it actually matter?
11. Are 'life-style'/'breed specific'  pet foods for dogs and cats just  a marketing rip-off?
12. Should all diabetic animals be monitored to the nth degree - or just allowed to pootle along if they seem to be doing well clinically?
13. Booster vaccs for dogs and cats - do you follow the data sheet/ advice from WSAVA etc. or do you do  what seems appropriate to your own area.
14. Will the new oral KC vacc make intra-nasal vaccs obsolete? If a dog is seriously  phobic about intra-nasal vac is it likely to be more tolerant  to the oral vacc?
15. Will you push KC vaccs more with the avalablility of the new oral vac?
16. Pup has had 1st vac with breeder - comes to you for 2nd vac - your practice uses an unrelated brand of vaccs. What do you advise?
17. what is your approach to an otherwise health young dog that has vomited multiple times over the last 24 hours?

Neurology

1. Are routine blood tests for monitoring phenobarb level necessary - if all seems well clinically?
2. When to start a dog having seizures on anti-eplieptic meds? What investigations should you do prior to starting treatment.
3. If a dog has been on phenobarb for years without any seizures should you stop treatment at some point - or just carry on for ever  and not risk causing more problems, which the owner will not be happy about
4. How to manage patients with spinal cord disease without referral for surgery

Oncology

1. "Looks like a lipoma" - should the client be told it IS a lipoma, or that it's highly likely to be? Should they be offered an FNA every time? What odds can they be given that it's something other than a lipoma. 
2. Should you always type a lymphoma prior to starting chemotherapy? 
3. Should post operative adjunctive chemotherapy always be used in high grade MCTs if there is no sign of metastatic spread after staging? 

Ophthalmology

1. Ophthalmology - should antibiotics be given during enucleations?
2. Corneal ulcers - a multitude of treatment options exist. What is the most sensible/practical course of action  in first opinion practice. Ditto aural haematomas (tho' that's been done to death on here).
3. Is optimmune worth the cost? 

Orthopaedics

1. Is fracture surgery sometimes over-complex - where a more basic technique might do the job OK. Or indeed amputation.
2. how do you approach a young (under 1 year old) Labrador with a fore limb lameness and elbow pain? 

Pathology/Cytology

Surgery

1. How do you manage lipomatous masses in older dogs?
2. There are still practices where long-acting abs are routinely  given to all 'clean' surgeries. Any justification in the 21st C?
3. Tail-docking pups (!) and dew-claw removal in pups/adults.
4. Is stapling a relatively  minor skin wound without use of any anaesthetic OK and an acceptable alternative  to full GA/suture.
5. Does a cat with a 'ripe' c.b. abscess always need a GA for drainage?
6. Should operations that correct a genetic abnormality (e.g. BOAS) only be performed with mandatory neutering? This includes referral centres.
7. Should neutering be compulsory for all bitches requiring a c-section, in particular where it is due to poor anatomical conformation?

Ethics

1. Have advances in veterinary medicines, techniques and knowledge improved the welfare and wellbeing of our patients; and are they living longer and better, or just taking longer to die?
2. Lumping together many of the suggestions put forward already, is it right that the large corporates are, or seem to be to me,  setting the scene in terms of peddling and upselling things like anti-parasitics, pre GA blood tests and peri-op IVFT, where there is no or little justification for them.
3. Is it right that staff subjected to the above work to targets or receive commission?
4. There seems to be an exponential rise in veterinary fees in some practices, and often phrases such as "gold standard" are used to support it. I have recently witnessed estimates for 1) routine elderly but healthy cat dental without any radiographs £1000 - £1200. and 2) 6 year old healthy Golden Retriever removal of a simple 1cm skin mass with histology, £900.
5. If you've advised a client that KC vac is not necessary if their dog isn't going to kennels (rather than explaining the pros/cons and letting them decide), should you charge them for treating KC in their dog that has never been in kennels?

General

1. Do first-opinion vets refer too many cases these days? Are first-opinion vets becoming de-skilled?
2. Are some referral fees verging on the ridiculous?
3. Is pet insurance becoming too expensive for the average citizen.
4. Should the antimicrobials vets are allowed to prescribe be restricted?
5. Have small-animal veterinary surgeons really grasped the new concept of antimicrobial stewardship, or are they merely giving it lip service?

Suggestions

Add your suggestions below.

1. How to treat canine dry eye if the client can't afford the licensed cyclosporine.
2. Bandaging limbs - can be associated with very severe morbidity.  How to avoid - how often to change bandages - whether bandages are best avoided in most cases.
3. Dispensing errors - surprisingly common.  How to avoid.
4. Euthanasia - a 'bad' euthanasia can be very distressing for the animal, the client and not least the vet.  e.g   'Difficult/aggressive' animal/over-emotional client, presence of children, poor lighting on home  visits, agonal gasping, voiding faeces/urine etc. How to avoid.  More and more vets are routinely sedating prior to euthanasia -  should this be considered best practice - but  itself can be problematic with emesis with some agents/collapsed veins etc. Should EMLA creme be more commonly used prior to i.v. injections - esp. small dogs and cats who are needle phobic and will cry out as soon as the needle touches the skin.  Is intra-renal injection for cats acceptable? etc etc.

            Bob L.