Thank you and thanks so much of you for giving up your Saturday evening for this topic that I'm really passionate about. So we're gonna be talking for the next hour about decision making in geriatric cats and dogs in a shelter environment. And the things I want to try to cover are going to be these, these topics, really.

So determining how we can best work with staff in the shelters to obtain useful background information about your geriatric patients, thinking about the importance of a multi-step history and complete clinical exam, focused specifically on this geriatric topic. Appraising the value of a problem-based approach is my internal medicine hat coming on here, to decision making in the geriatric patient. Developing a pragmatic plan for investigating common abnormalities identified in older cats and dogs, and then really thinking about how we apply that to a shelter situation because as Jenny spent a fantastic talk, telling us, you know, stuff in the shelter is quite different to what you would do if it was an individual pet.

We're really dealing with herd health now in the shelter environment where we're thinking about how resource allocation is going to be feasible across a tremendous number of animals. So pragmatic treatments is really important. And just finally to review whether or not additional veterinary inputs is gonna be helpful in the management and rehoming of longer term geriatric residents in the shelters in which you work.

So first of all, a poll question, I'll hand over to Bruce for this one, just to see who you are and where you've come from. Right, so let's get that pole running for you. There it is.

Pole is open, guys. Question is simple, what is your interest in shelter medicine? Number 1, I work with a shelter as a vet.

#2, I visit shelters and provide veterinary services as part of my job. Number 3, local shelter, bring pets to my clinic for veterinary treatment. 4th 1, more than one of the above.

And right down the bottom, something else. So, you know the thing here now, simply just click on the answer that you feel most represents you. And once we've got enough people voting, we will reveal the answers to Zoe.

And that gives her a nice feedback as to who she's talking to. So come on folks, let's click on those answers. We're getting there.

We're not quite there yet. Another 15 seconds and we will then end that poll. People are a bit slow now.

Maybe I gave them permission to go to the toilet too soon. Sorry about that. Right, let's end the poll and reveal what we've got so far.

There you go, yeah, brilliant. So, most of you are something else, so that's cool, . About 40% of you have, that's interesting, actually.

Yeah, you have local shelters bringing pets to the clinic for veterinary treatment, and a couple of you work for a shelter as their vets. So that's really useful. And I think there'll be lots in here, actually, for those of you who just see shelter, pets in your own clinic, and hopefully lots of you for something else as well.

That's super. OK. So we're talking about geriatric patients today, which is one of my real passions.

I love a, love a crusty old dog and cat. And when we're thinking about, the trajectory for how geriatric pets end up in the shelter and who they are, it's quite useful to just think about the different routes they may have come from. So, Probably the the easiest scenario is going to be a geriatric pet that's been relinquished by an owner into a shelter that's previously been in a home environment, that probably will make up the majority of the geriatric pets that you will see in in many shelters.

So, a pet that may really struggle to adapt to this, very different environment to what they're used to, and reasons for relinquishment are going to be hugely variable from the death of an owner to an owner's inability to financially care for an animal if it has some, some morbidity, and we'll talk about, management of diseases and geriatric patients later on. But there may also be other routes for these animals coming in, so it could be that actually they've bounced serially from shelter to shelter. They've been moved around between different locations by a charity.

So we've actually been within a shelter system for quite some period of time. Or it may be that actually in more unusual examples where they, retaining animals for Long period of time within the shelter system, it may be that an animal has actually become geriatric, because it's been a shelter for so long. And it's just worth thinking about really where this animal has come from, because it determines so much about what we're gonna know about it and really how well that animal is potentially going to, going to be able to adapt to being in a shelter.

Also worth remembering that, some of the animals that we may see that are older may have been picked up as strays. And as Jenny was saying in the previous talk, it's not ideal to have sort of feral animals coming into shelters, but we know that there's an increase in the animals being, being imported from overseas. And it may actually That that those animals coming into a shelter, were strays in their native country.

And equally, there are still some programmes of track needs to release where actually, instead of, putting a cat, feral cat, back into its natural environment, it is going into a, a shelter thanks to somebody well-meaning, thinking that that would be the best thing to do. So again, these geriatric animals may be used to an incredibly different lifestyle to the home environment and to the shelter environment. And again, may find it quite stressful.

And also be aware that some animals that are being re-relinquished and brought back to a shelter may again have come from this background of having once been a stray, having once been an imported dog. So again, sometimes it's worth doing some digging to really consider, actually, you know, how complex is the history of this animal in front of me and how's it got to being here at this current age. As Jenny's, I think in the previous talk, and if you didn't hear that, then I really would urge you to go back and listen to it, because it really tallies well with this one.

And she's made the really good points, that there's so many different types of shelter out there. And I think it's incredibly useful to think about really what shelter it is, especially those of you that are seeing animals in your clinic from a shelter. What actually is that shelter like?

And have you ever visited it? And if you haven't been there yourself, then I would really urge you to go and have a look at the shelter that's bringing you animals because it's gonna really impact so many aspects of the animals that are brought to you. So some shelters are gonna be super duper modern ones, where the number of animals in that shelter is very low, where the staff are very professional, they're very well trained.

They've got lots and lots of clear policies for things as, as to what, you know, what they do in different situations. They're very used to handling, say, older animals. Other examples may be a little bit more ramshackle.

It may be a single person who has a house with, hutches, for example, outside, which is keeping a mixture of cats and dogs. It may be a multi-species, kind of rescue centre where they are, they're dealing with lots of different, different types of animals. Some may have a real focus on geriatric pets.

For some others, it may be, very unusual that they would take them in. Other things to be aware of are that Some shelters will be hugely reliant on a volunteer base to both care for animals but also to recognise animals that may need veterinary attention. So it's incredibly useful to know from any shelter with which you're working, what's the level of training amongst their staff, and specifically in this instance, what do they know about geriatric patients?

Are they aware of common diseases of geriatric patients or common symptoms of disease? What would they do if they saw them? What's the chain of commands to for an animal first exhibiting a sign of a problem, for example, polyuria and Polydipsia and an older pet to actually getting that animal to you in the clinic.

Obviously, this is different if you're the vet working in a shelter, because hopefully you'll have much more of an oversight of this. But for those people, you'll probably be much more aware of the politics, as well as to what can happen with different volunteers versus paid staff, versus potentially veterinary staff all working in a shelter environment, trying to make decisions about these pets. And also again, really thinking about what's the life like for a geriatric pet in this shelter environment which is, you know, where it's coming from.

And actually, as Jenny said in the previous talk, what would you think if that was your geriatric pet in the shelter? Is it gonna cope in there? Is it OK?

So, for example, the bottom two pictures here, you know, this, the kennel block on the bottom left there for that dog. The flooring looks quite slippery. If that's a dog with osteoarthritis, it may not cope very well.

It's gonna be cold. It's potentially gonna be quite noisy in there and very scary for a geriatric pet that spent a long time in a home environment. Equally, for the cats on the right hand side, they're in a multi-cat environment.

We know quite a lot of cats don't like that very well, but specific to geriatric cats again there, you can see those two cats are sitting on some kind of roof type structure. And actually, if you've got a cat with severe osteoarthritis, those cats may not be able to jump to access that vertical space. And if that's the case, and they really want to get away from some other cats with whom they've got a less than ideal relationship, it may be much more difficult for them.

And finally, if we're thinking about doing any procedures relating to our geriatric pets, is it gonna be OK for them to go back into this environment? Are there going to be people that can care for them? Are there staff that can be managing, for example, a dog with diabetes mellitus, or a cat with hyperthyroidism that's on medical management?

If we're thinking about doing a major tumour resection, is there gonna be somewhere comfortable, safe, clean for that animal to go back to, where actually it's gonna, it's recovery is gonna be OK. And I think it's so useful to go and have a look around the shelter, even if it's in your own free time, but ideally, as the vet who works with that shelter to really go and get your eyes, eyes in there and just see what the situation is like. So some of the animals that are geriatric in a shelter may perceptibly have very little wrong with them.

And again, it will vary from shelter shelter to shelter as to whether every animal that comes in gets a veterinary assessment, or whether it's up to the individual staff within that shelter as to which animals are taken from the clinic, potentially, and presented to the shelter, or if you're a vet who works within a shelter, but you're just there for half a day a week, for example, which animals are presented to you for assessment on that day. And again, this really hammers home the point of how important it is to understand the training that the staff in the shelter have had around recognising, disease. So you may have a cat like this that looks, you know, kind of OK, sits there very happily on its carpet, but actually is very PUPD and has underlying quite severe renal disease and may benefit from veterinary attention.

But on the surface of it, it looks OK. And many of the geriatric patients you see may well be OK. Equally, you may, on some occasions see in a shelter an animal that really has quite severe disease.

So this animal's got, by the looks of it, quite hypermature cataracts. It may have glaucoma, it may have got underlying diabetes mellitus. It's potentially sitting in a way that suggests it might have osteoarthritis in that left leg.

And we really need to start thinking about these animals in the context of all the other animals in the shelter, and how much resource allocation in terms of time and money, and also kennel space that these animals are taking up. And to make decisions in maybe a quite different way to how we would with a single geriatric pet. So, for example, looking at that little dog, that dog to me, looks like a dog that's gonna be quite tricky to rehome unless you've got a very, very special owner.

And if that's the case, That dog may be taking up quite a lot of staff time and staff resource to manage it in the shelter. It may be costing the shelter quite a lot in veterinary bills. And actually, it's also occupying a kennel that another young, healthy dog may well come through.

And so, I think when you're looking at these animals, when they're presented to you, one of the big things we need to think about is Taking that animal into that herd health environment, thinking about it as one of 40 dogs in the shelter, 200 dogs in the shelter, even, and saying, well, you know, is that, is that kennel best for that dog? And that sounds really awful, and it's certainly not what we do in a private practise situation. Some shelters will be very pragmatic about this.

Others may really need a conversation, especially with a pet, where there's lots of volunteers or staff members that are very bonded with that pet for lots of different reasons. But actually, it may just not be the best use of that shelter's resources to keep that pet. And also, it may well not be in the best interests of that animal to be in that shelter.

This may be a dog, which has come from a very loving home environment that's really struggling to adapt in the shelter environment. We actually moving into a foster home or considering euthanasia may be, maybe better bets for that dog. So really, you need a different hat when you're considering these geriatric patients to the ones that you would wear if it was an own single pet, I would say.

And also when we're thinking about the stakeholders around any decision when we're moving on to the decisions that we may need to make. It would be lovely to think, well, this is an unowned animal, so it's just basically between me and the animal as to what I'm going to do. Here's me as the vet, and there's the dog, and, you know, I'll make my best possible decision.

But of course, we already know that there are shelter staff involved. And those shelter staff, may be working to quite strict rules financially. They may equally have very strong reasons to recommend a specific course of treatment, which may be practical or maybe be very emotionally driven.

But actually there's potentially even more stakeholders in that to make things more complex. So actually, in some shelter situations, there may already be an owner identified who's going to take on this animal. They may have met the animal already, they may be super excited about it, and then suddenly you've realised in the shelter, oh my goodness, potentially this animal has diabetes mellitus or has a pyometra, or that lump that we thought was fine, actually, we really need investigating right now.

So there may have to be a complex situation of discussion with this potential adopting owner who may then also become an an an extra stakeholder. I would say that's not super common, but it may well happen. And you may also have stakeholders of trustees or people in head office of a larger charity, who are then more detached from that clinical decision, but may well be looking at the spreadsheets, looking at the resource allocation and the budget available, who may be putting pressure on the shelter to try and reduce their veterinary bills.

And they, in turn, may well be, putting limits on the decisions that you can make. Equally, maybe they've just had a massive donation and they're suddenly gonna change the policy to be able to allow possibilities. So it's quite a complex situation, and that's not always very transparent to you when it's you, especially working in the, your normal clinic, where a shelter animal is brought to you.

But there may be a tremendous amount going on behind the scenes. And again, the more you can understand that. In the specific shelter with which you're working to understand what their policies are, to understand who the person is that's bringing the pet into you in the clinic, and how that, how that person comes to be the person bringing the pet, how much they know about the pet, and how influential they are in terms of the decision-making process.

It, it just makes your job much, much easier. So there's a whole range of different things that might influence decisions that are made about geriatric pets and shelters. And I think we've covered some of those already.

So, for example, rehomeability is gonna be something that you would hope is really important for shelters, albeit that in the previous talk, Jenny absolutely rightly mentioned that people may be more focused on the intake of the pets into the shelter rather than the rehoming at the other end. But rehome ability for some shelters certainly will be, at the very, very forefront of their minds. Money will also be potentially a big thing for, for many, shelters because they are going to be budget limited.

But then when we're thinking about individual pets, actually, thinking about the quantity of life versus quality of life can be a very big tradeoff. And thinking about, Individual patient characteristics can sometimes get a little bit lost, and that's so integral, I believe, to quality, quality of life, really thinking about going back to that pet as an individual, albeit that we have to make some decisions in the context of it being part of a herd. Actually, when we're making quality of life type decisions, it's very individually focused.

But you may also have these other factors that are muddying the waters that mean you can't just be focused on that. Ideally though, from my perspective as a vet who has done some work with shelters and right now works in the charity sector when we're thinking about. Any decisions as vets with an individual element in front of us, quality of life to me needs to be really front and centre of the decisions that we're making about that individual, if it's, if it's, decisions on an individual level and we've got multiple different options.

So there's a poll question now, I'll pass you back to Bruce for this one. I appreciate that I could put about 40 different options here about how do you think, what do you think best defines quality of life. And those of you that heard me speak before, know this is my pet topic, please don't worry, there is no, there's absolutely no wrong answer here.

So just vote for what you think. Yeah, this is a real tough one, Zoe. It's it it's difficult because of course we've got huge emotions that start to come.

I don't know if I'm meant to be able to hear you. Can you, can you hear me now? Sorry?

I can hear you fine. Right, let us, come on guys, we've got a couple more seconds, . And then we'll see if we've got, Zoe, can you hear me now?

Hello, hopefully somebody can still hear me cause I can't hear you I can still hear you. Folks, we seem to have a bit of a technical. And I hope that you can.

I've got the poll results back now. Thank you very much indeed, Bruce. So, yeah, super.

I've got that, about 59% of you think that quality of life is best defined by whether the animal is happy. 31% think if it's the animal isn't suffering. A few of you think it was the animal is in good health and a few of you think that you're really not sure, which is super interesting, thank you very much indeed for voting there.

So. It's a really tricky one to define quality of life. And for me, I really like the idea of happiness.

We have a real tendency, I think, to view quality of life as quite a glass half empty thing, whereas vets will talk about the quality of life not being good enough to carry on anymore. Well actually, I would be really keen that we could flip that the other way round and start instead talking about trying to make quality of life as good as it can be. So instead of seeing a measure that we Look at and then kind of see, well, almost wait until it's got bad enough that we can stop, but not try and do anything to flip it over to make it better.

I would much rather we look at it from a positive perspective. And I really like the, the definition of, you know, is this animal happy? Because especially when you're working with staff who may be volunteers in a shelter situation, I think.

And it's very unscientific, but maybe we can say we have a bit of a gut instinct about what happiness looks like. And it's not just eating, drinking, peeing, pooing. It is actually having some enjoyment, in life and really seeing positives across a whole range of different aspects of life.

And so it's not just for me, whether or not the animal is suffering. So whether it's got a big, you know, horrible mammary mass, for example. But actually, there's lots of other aspects of things that can impact quality of life and.

Having a horrible suppurating mammary tumour is absolutely gonna impact your quality of life in the short term, but potentially so is being a brachycephalic dog, where you've got this hereditary difficulty breathing. Older animals may well have lots of impacts on their quality of life, just because they can't access the opportunities that they were previously able to do. They can't walk as far, they may not be played with as much.

And there can be a tendency for older animals to almost be lost within a household because they are just not interacting as much with the owners. You have to almost go and seek them out, especially if there's a younger animal there that's demanding more attention. And that probably is going to impact that animal's happiness.

And also, we need to think about behavioural problems. So this dog on the bottom right looks quite worried to me. And being very fearful in a shelter situation, even if you're in good physical health, I think can really impact your quality of life.

And for all of these animals, just being in a shelter setting potentially can have a very negative impact on quality of life. Some shelters are fantastic and will work very, very hard to meet the needs of all the animals there. But many just don't have the Time and resource on every single individual animal giving them what they want.

And so quality of life really can be quite impacted in a shelter. And there's a range of ways in which that can happen. So being in a shelter can potentially have a detrimental effect on the physical, and I would say that very much of the mental health of animals in that shelter setting.

So they may be, certainly for geriatric animals, not living in the same comfort that they were used to. Again, one of my pet diseases is osteoarthritis, and thinking about sleeping in a, one of the plastic beds, potentially without any bedding. Having to be exercised potentially without any particular thoughts to the underlying condition that you have.

So being asked to walk faster than you want to or further than you want to, if there's a specific exercise regime. Cats again, potentially having to jump higher than they would want to, or having to avoid other animals if they're in a multi, cat environment. Mental health, I think, is hugely, important for our shelter patients.

So, the, just being in a shelter environment can be tremendously stressful. They don't nec you know, won't have any concept of why they're there, how long they're there for. There may be all sorts of things that they've never encountered before that an older age are really scary.

Animals may have quite strong personalities and have been able to teach their previous owners really what they want. Certainly lots of small dogs, are very good at this, and cats and will have been able to express their own personality and their own preferences. And suddenly all of that knowledge may well be lost.

And so these animals may become very frustrated and may actually have to change how they behave again in the multi-cat environment to try and fit in a little bit more. That may have a big impact. Obviously, the environment's going to be very different in that shelter setting to what they were used to at home.

The opportunities may well be very, very limited relative to, to what they would be in terms, especially cats that are used to being autonomous, being able to go out and about and do what they like. Suddenly they're in a pen. And I think can really negatively potentially impact the quality of life of those pets.

And this matters again, because when you're making decisions on behalf of those animals in the clinic, especially when we're thinking about whether or not those animals should be euthanized, potentially, then, it's worth just thinking about what would it be like to be that animal in that shelter, and would I like that to be my pet? And if you wouldn't, then a, thinking about addressing those challenges within the shelter, but B, really thinking about, is it fair for that animal to be there? Is it fair to send it back to that environment after it's been here?

But also looking at the positives and saying, well, what can we do to make things better? And some of the changes that you can make are potentially gonna be very, very simple. So thinking about improving the environment of an osteoarthritic pet by providing a bed, ensuring that the cats where they need to access multi-levels.

If they've got osteoarthritis, there's a series of steps that that they can use to get up there. So a series of small blocks to get up to the top. Lots of different things that you can do in terms of giving them personal one on one time, and potentially thinking about sending them out to a foster home if they're really not coping very well in this environment.

So quality of life for me is really important. So for the next part of this talk, what I'm gonna go through is this series of kind of 5 steps. To really think about whenever you get an animal presented to you that's a geriatric in a shelter setting, or in your veterinary clinic that's coming from a shelter, the steps that you would need to go through.

So who and why is this animal in front of me is the first one that we're gonna start with. That might sound like a really basic question, but certainly, from my experience when I was working as a volunteer for shelters, before I started in vet school, I would say it was unfortunately, not uncommon that the wrong pet would be sent to the vets. Either that was because pets, we're in a multi, cats, in a multi-cat environment where actually, everybody thought that it was Bruce, the cat that had a really nasty diarrhoea, but actually it ended up being fluffy, and Bruce was the one that was sent down to the, to the vets to have a diarrhoea workup, and actually, it wasn't Bruce that was a problem cat at all because there were multiple cats sharing a single litter tray.

Equally, there may be problems where there are two animals called Jack, and the wrong animal called Jack has been sent down. So just triple checking, is this definitely the right animal, especially if you're working away from the shelter? Does it make sense?

Is this actually a 12 year old dog, or is it looking more like it's a 3 year old dog? And also then trying to get that information that we talked about at the very beginning in terms of Where's this animal come from? Who is it?

Is it just come from a home? Has it been bouncing around shelters for years? Has it become old in a shelter?

Has it previously come in from abroad? Do we know that it spent most of its life in Romania, for example, before it's now ended up in this clinic in in England? That will really help to get you a little bit into, I would say into the psyche of the animal, really, to really start thinking from its perspective of how it might be coping.

And also, to start thinking about, again, in the context of the shelter, how well it will be able to adapt and how well they will be able to adapt to it to meet its needs. So that's the first one. And you want to be really asking also, why is this animal here?

And again, it may well be that the animal's brought to you by a volunteer. And they may not necessarily know all that much information about why the animal's there. And that's something when you're working with a charity, you can address to make sure that the person bringing you the animal knows why they're bringing it, because it's very frustrating having an animal presented to you, where the person presenting it that is just the driver and doesn't know very much.

And that history hasn't come along with that. So what history then is available, and I would really say take as much history as you can. This is really, really important.

Absolutely, you'll know this already, but especially in this context of an animal where you're seeing it in an unusual situation, get as much insight as you can do, just again, to help you triple check, is this history that I'm getting about its most recent stay really compatible with prior history? You know, is it an animal that's already had two knee operations? Is it an animal that's come in that we know about that's got cardiac medication?

Or is this really a completely blank slate of an animal that's been brought in, you know, by a council, as a stray and now needs to rehoming? So it sign, get all of its prior history, really get as much information as you can do about any known and ongoing health and behavioural problems. Really useful, I think, in these geriatric pets.

Many of them will come into you, potentially on a care plan or with medication. So an animal may be relinquished, that's Cushingoid, that's got diabetes mellitus, that's, say, osteoarthritic, and it's got a world of different medications and supplements that it's coming in onto you. And I would just review that, rather than just accepting, actually, this is what this animal needs.

Does it? Are you sure? And the dose is definitely right.

At the shelter aware of exactly how and when to give this medication? That maybe that you can do some pragmatic deprescribing at this point in time if the shelter's potentially gonna have to take on the bills for paying for these medications for that pet. And actually, some of them are very poorly evidence-based.

Some of them may no longer be necessary. It's a really good time when you first see an animal, and gain serially when you see it over time. Just to be certain, does it really need this thinking with your pragmatic, both in terms of, ability of the shelter to give the medication and the effect of that medication on the animal, and also, obviously, the, the, the charitable status in terms of finances of that charity.

Just be, just have that oversight and think, don't just accept, OK, it's hyperthyroid, it needs this, and I'm gonna move on. Is that really true? Then you want to talk to the person that's brought the animal to you and just check, are there any specific problems that they've noticed?

Why is this animal here today? Is it just a general once over because it's a new admit, or actually, is there a lump that they're concerned about, or do they think it's one of a cohort of pets that's got horrible diarrhoea, and they want to check that it is definitely this one. Be aware also that you may be getting behavioural problems presented to you as well as physical health problems, and it, it's great when people do do that, to and pick up those things, but that's a specific type of knowledge that not every vet will necessarily be that confident with.

And I would. Certainly say if that's the case, and you're gonna be working with shelters regularly with pets with behavioural problems, go on some CPD to upskill yourself on that and certainly help to work with a local, behaviourist, if you can do a veterinary behaviourist, to try and, learn what they do, if you're able to access, that information. If there is a specific problem, basics, how long has it been going on for?

How often is it happening? Say it's something like a cough or diarrhoea, how severe is it? And is it changing?

That's a really, really key question, is it changing? Is it getting better? Is it getting worse, or is it staying the same?

Because it may well be that in a shelter situation, maybe even more so than in the home environment, you can do a pragmatic watch and wait rather than necessarily diving in to do lots of diagnostic tests. If something's waxing and waning or something is actually getting better, it may well be that you don't need to do anything at all. So those questions are really useful.

Are there other animals affected? We just had a great talk from Jenny about infectious disease and actually, albeit that this is a geriatric animal and we may be thinking about more individual kind of diseases in our geriatric. Actually, is this one of 50 dogs that's coughing in the shelter, or is it just this one animal that's affected?

So could it be an infectious problem or not? Really useful again, are there any constraints within which you need to work, you know, has this been promised to an owner and they're picking it up tomorrow, and therefore you've got to get everything done today? Is there a financial constraint that means the charity can only afford a very limited, array of tests, potentially, .

Or is it an environment that this animal's going back to, which means that it just wouldn't be compatible with having a major surgery, for example. All of that stuff's super useful at the, at the baseline to, to make sure that you're not wasting time, not wasting money, and you're gonna be making the right decisions for that pet in front of you. And I would really strongly say, if the answers to these questions are repeatedly poor, really try and work with the shelter to try and make sure better information's collected.

I would say in history, that's kind of your minimum database history, really. Who is this animal? Where's it come from?

What's going on with its background? Why is it here? And then the questions about the, the specific disease it's potentially suffering from the symptoms it's coming in with.

And really work with them otherwise to see if they can get better information. There's a range of ways that you can do that. As Jenny mentioned, that you can think about the intake policy with having an intake questionnaire.

So actually helping to work with the shelter to design a questionnaire, which is administered when an animal comes in. So to get as much information as possible from the person that's bringing that animal into the shelter, to understand what that animal. Likes, what's its personality?

What are its food preferences and choices? And certainly we'll meet lots of older small breed dogs and cats who have trained their owners incredibly well to only eat hand cooked organic chicken breast torn up into 1 millimetre cubes and hand fed off a silver plate. And if the animal is suddenly going to come into a shelter environment and be given a kibble in a metal dish twice a day and be expected to eat it, it may well become anorexic.

And so it's really useful to know things like that. If there's specific likes and dislikes of that pet. What's its favourite treat if you're gonna need to do some training with it or you want to make its day better?

Owners will probably know all of that information and can give it to you quickly when they're relinquishing, but if you don't ask, then that information's gonna be completely lost and you'd be starting from scratch. Finding out what their normal behaviours like when they're alone. So is this an animal that's very fearful?

Is it destructive? Is that the reason it's come in? Or actually, is it totally chilled on its own?

What's the behaviour like in company? Is it OK to put it with another cat? Is it gonna be fine in a multi-dog walk environment, or if you've got a playpen that they're going into?

What's its previous veterinary history and really useful if you've got the previous vet's contact details so that you can seamlessly transfer over any veterinary history. So if your shelter doesn't have an intake questionnaire, then you can certainly think about working with them because that information will be really handy when it comes across to you. And then you could also potentially think about having a kennel questionnaire where you're just putting in some questions to guide the staff, to create, to collect.

It's kind of baseline data really about all of the animals that are coming in. So when they come in, when did they come in? What's their food and water intake like?

So actually, are they grazing on their food? Are they wolfing their food down immediately? Are they ignoring it completely?

Is there any, it might be PUPD? They could potentially make some notes about what the behavior's like in the kennel, if any clinical signs, any symptoms arise that they're concerned about, any abnormalities detected, and if they're on any medications. And again, just getting staff trained really to collect information, collect it correctly, collect it consistently is really, really useful.

And that may mean you going to the shelter to actually deliver some training around how to do that. That's totally, you know, it Be an incredibly use, good use of, the charity's resources to get their staff trained up. But obviously be aware if there are multiple, multiple volunteers going in, you're not gonna catch all of them.

So maybe you need to think about having a protocol in place about who might fill in that kind of questionnaire and what time of day, etc. And finally, really, really do not undervalue the power of a mobile phone. If the, you know, the best you can get is that if the, if the person working in the cell brings the animal to you, is able to bring you a little video clip of the thing they're worried about, if it's a behaviour, if it's a photo of some diarrhoea, if it's that they think the animal's lame and you can't necessarily pick that up in the clinic.

Ideally train them to bring in this information with them, or potentially if this animal's gonna be in for a while and it's not hyper acute, you could say, look, go away if you don't mind, and collect me this information, whether that's the questionnaire information or whether it is that video clip or that photo that's really gonna help to move you, towards working out what it is that's going on without having to do loads of diagnostic testing. So then moving on next, what's the problem list from this history and clinic clinical examination? And this is my internal medicine hat on now.

So you really want to think about, a thorough clinical exam after you've got your history, and ensure that your clinical exam fits with your history. This is, again, your really good time to double check, is this definitely the right animal that's been put in front of me to match the history that I've got. Is there anything else that you're picking up on your clinical exam that the shelter wasn't aware of?

It's easy for us to pick up lumps and bumps and heart murmurs and all sorts of things that may not have been the reason for presentation, but maybe very, very important in a geriatric pet. Identify additional problems to add them to your history and keep looking for comorbidities, especially in this geriatric cohort of animals. There may be lots and lots of different things going on at once.

It's really important to get as many of those documented so that when you're making decisions, specifically around individual diseases of that animal, you can also look at what else is going on. And look at the bigger picture again at how all of that is interacting to potentially affect the quality of life of that animal in front of you. And again, document as well as you can, as you always would do, all the problems that you can see.

And different shelters will have different ways of working in terms of whether or not they want to take that history back with them to the shelter, whether you just keep it on record, either in your veterinary notes within the shelter, if you work within one, or whether you keep them on record at the veterinary practise. Really important, again, if you're if you're keeping notes in the veterinary practise, to make sure that you have really good identifiers of those animals that are coming in. It may be that every 5th dog coming in at the moment is called Jim.

And that you need, you need to make sure that your gym 3 on your computer system correlates with gym 3 at the clinic, at the, at the, rescue centre. Otherwise, potentially, you're gonna get into problems where you think that they're bringing down one animal, they think they're bringing down another animal, and your notes are gonna get mixed up. So again, that's good liaison with that shelter to work out exactly how their record keeping, how your record keeping, and where those notes are gonna be transferred.

So really think about it as you're making a shopping list, I would say with these geriatric pets because the the likelihood is that there's gonna be more than one item on that list of problems. And then at problem based medicine, which many of you will have been taught, this really nice framework for solving clinical problems using the knowledge that you've already got from your history and clinical exam, helping you to decide what tests are worth doing. And we'll talk a bit about primary versus secondary problems, where a primary problem is the original inciting thing.

And then a secondary problem is something that comes subsequent to that. So you might have a primary problem with severe dental disease, which leads to a secondary problem of anorexia. And actually, they're related to the the secondary is related to the primary.

They're not necessarily two separate things. Just be aware of that impact potential from, the multiple ripples really from, from one disease that can affect multiple systems. Space medicine, just to review this starts with taking a really good thorough history which we talked through already, followed by a really thorough clinical examination.

Then you want to make a list of all the problems that you've found and you can do this in your head. Personally, I always have to do it on a piece of paper cos I haven't got the brain ability to retain that much information. Define the problems, so really clearly think what actually is going on here?

Is it amnesia? Is it weight loss that's not necessarily related to anorexia or are you not eating? Where are the lumps and bumps that you found?

You know, if this animal's obese, exactly how obese is it? So really define the problem as well as you can do. And then the potential differential diagnoses that are available, you know, in your brain and textbooks, if you need to look at those, if it's something a little bit unusual to work out what's going on, and work out what, if anything, and I would stress it, if anything, you're gonna do about it.

And there's lots of different ways that people will teach, thinking through problem-based medicine. And a common one that you hear about is that you should use this vitamin D or DAITV, process. And I think it is really, really useful, but this is very much a disease processes thing.

So this will give you an idea of what the underlying mechanism for disease is, but often these are most useful for a problem that's localised to a single organ. So absolutely fine if you've got an animal that you know has got liver disease or you know has got a, a mass lesion on it, then you can use this, this system. But actually, when you've got an animal that's potentially losing weight, I find this system quite a lot more difficult to use.

But it can be useful just to think about specifically again with our geriatric pets, which of these types of problems may be more common. And I think certainly we'd all have neoplastic disease up there, I would say. And we probably, would also have idiopathic disease up there and degenerative disease.

But it's worth remembering as well that when you're putting an animal from an owned environment into a shelter environment, especially if they are really stressed, and infectious diseases that you may not necessarily normally see in a geriatric pet may suddenly become a lot more prevalent. Similarly, if the animal's had a big shift in its nutrition, where it's been moved from You know, potentially having even a, a specific diet, because it has a specific dietary requirement, then, moving that into the shelter environment may really be quite stressful for it, and you may get some nutritional problems related to shifting onto a different type of food. So absolutely all of those could still be possible, but those would be 2 that I, I, or 3 that I'd be really be thinking about.

Obviously also inflammatory diseases of your gut, may start younger, but may also start in a, in older pets, and you'll be picking up potentially diseases that started at a young age, like immune-mediated diseases for which the animal remains potentially on lifelong treatment. So, lots of things going on with vitamin D, some of them more relevant to our geriatric patients than others, but I don't find that as a particularly useful framework with where to start with my problem-based medicine. Instead, for something like weight loss, I prefer to think about it as more of a kind of mechanistic pathway.

So, if we've got an animal like this that's presented to us, where the shelter's saying, Well, they've got this animal and it's quite skinny, or I've had it in my property and I, for a while, and I can see it's actually losing weight, then actually, for me, thinking about this biomechanistic pathway is much more useful. So thinking about the process by which that animal in that shelter potentially be, would be losing weight. Is it not being offered enough food?

Is it aversive to the food that's being offered, so is it one of our really fussy little dogs that actually just doesn't like the food you're putting in front of it? Could it not access the food or chew it or swallow it again in our geriatric patients? Maybe some of them are fearful if they've been put into a multi-pet environment for the first time.

Maybe with our cats, specifically, we seem to see some awful dental disease and some awful, oral tumours that may mean actually they just can't physically get their teeth around that food to get it in. Is it that they can't digest or assimilate the food, so they've got gastrointestinal disease, liver disease, pancreatic disease that's inhibiting their ability to get enough calories and you retain them. Are they losing nutrients through protein losing enteropathy or protein losing nephropathy?

And then is the demand energy demand potentially exceeding their intake. So actually, if they've got a really nasty neoplastic process going on, if they've got multiple chronic diseases going on, for example, again, osteoarthritis, you're potentially gonna see, quite a lot of weight loss in the hind limbs there. So actually, again, thinking about defining our problem, what weight is it that we're losing?

Is it muscular weight? Is it whole body fat, or is it all over? And stress is potentially a really big one again, for our geriatric population, of being in this novel environment, that could be enough really to make some of these animals lose quite substantial amounts of weight.

But for me, when I'm presented with an animal with weight loss, I will really try to think through that mechanistic pathway, and then potentially when I've localised it to an organ, if I need to, I'll go back to down my TV. The problem that we're seeing increasingly, I think, in shelters is obese animals being presented. And again, the mechanistic pathway can work.

For this one, almost in reverse from the weight loss. So is it that the animal's being given too much food? Is it that it's not being given enough exercise?

Has it got a metabolic problem going on that's tending to make it gain weight? Or is it actually that the weight gain is being misdiagnosed and that instead this animal's acitic for whatever reason, whether it's, Protein losing disease, whether it's got a mass potentially in the abdomen that's making it look like it's gaining weight. So again, always make sure your clinical exam is compatible with your history, And really with animals that genuinely are too fat, again, this isn't, this is a condition that we need to be concerned about and work again with the shelter to check that they know what they're doing in terms of weight loss programmes, if they believe that the animal themselves is too fat and want to do something about it.

Are they reducing its weight safely? Do they know exactly what they're doing with that? Or are they thinking, well, actually, this animal's too fat, we're just going to halve the amount of food we offer it, which may set up a whole world of different metabolic problems that you didn't necessarily want them to do.

Obviously, entirely unintentionally. So again, around these, these conditions, it's just worth really working with the shelter staff that are available to you to say, you know, you're happy, you know what you're doing here and what exactly is it that you're gonna do in this situation? For other problems, for example, dysne, I quite like an anatomic pathway because the respiratory tract's quite finite.

I like starting with the nose and working my way down, really, on the atomic pathway to think around what might be causing dyspnea in this patient in front of me. And again, these things are really useful if you haven't got a particularly good history. Thinking about our older cats again, nasal and oral disease, horrible, nasal tumours can be not uncommon.

Carcinomas and lymphomas in this population. So using a little bit of cotton wool to test airflow, equally cats chronic rhinitis can be super snotty. And if they get really bunged up noses, if they're used to having them cleaned at home every day, now they've come into a shelter where that level of care isn't possible, it may be something as simple as that.

And again, a lot of this comes down to how experienced are these shelter staff? Are they bringing these animals into you without having done the real basics of trying to work out what's going on themselves? Or actually, are they really sophisticated in their knowledge about geriatric medicine, where they've got an idea about what, what may be going on?

Really useful again to know that. So for me, this near anatomic pathway, thinking down the respiratory tract, whereabouts might it be happening? And then when we've found that, we can start applying our dammit fee.

So this is just something you can get from a very, very good clinical exam, plus or minus radiographs if you need to do that. PUPD, I quite like the system pathway. So, if I've got a PUPD animal, I think about, well, what systems might be leading to it being PUPD.

Again, this will be a quite a common one in our older pets, really worth thinking about. Are you sure this animal is PUPD Again, in a multi, pet environment? Are we certain that it is the animal that's drinking a lot?

If it's a single animal, is it just spilling its water everywhere and actually they're having to top the water up because it's being spilled quite a lot. Especially in a shelter situation, something like a psychogenic polydipsia where stress related overdrinking may actually be something that you will encounter more commonly than you would in a normal environment. With our older pets, again, some of these endocrinopathies are gonna be increasingly prevalent.

So hypoadrenal corticism, hypoadrenal corticism, diabetes mellitus, and hyperthyroidism. Note that I've not got hypothyroidism on that list because hypothyroidism typically doesn't lead to PUPD. So that's something not, not to have on your PUPD list.

But also, obviously, don't rule out your infectious diseases. Your renal disease. So if you've got an animal with PUPD, fairly, two really useful things are gonna be, first, obviously, get a urine sample, check its urine specific gravity.

Is that compatible with it being PUPD? And then, if possible at all, get the shelter to measure this animal's water intake and check that it's, Not exceeding the normal threshold of 50 to 100 mL per kg per day. That's something that potentially may be a nightmare for a shelter to do if they're really busy, if it's a multi, multi-animal, kennel that they're in.

So just see again how feasible that is, but that would be a useful first step to start investigating. At the PDSA we see lots of pyometers, and so we're very used to doing kind of a very speedy ultrasound scan, actually, to just have a look at the cordial abdomen, find the bladder, turn the probe. Can we see any uterine horns there or not?

And potentially, that's something you wouldn't necessarily need to charge for in a shelter, but it's a really, really useful, rule in rule out for a yo that we find. Be aware as well that some of the problems that are brought to you in these geriatric pets may not necessarily be medical, it may be actually that this is a cat with very bad hip osteoarthritis that isn't able to access these very high lipped litter trays, or it may be that actually it just doesn't like that type of litter. Or doesn't like using a litter tray that's already soiled.

So again, going back to your history, make sure that the problem really is a problem. This is where your photos are incredibly helpful, because if you haven't seen these litter trays, you may not have on your differential list that actually the cat physically can't get in there. So be aware that there may be a lot more going on than again there could be in a home environment and potentially that the shelter may be too busy or may be staffed by very well meaning but very, very poorly, trained volunteers who may just not be aware that any of these things are either abnormal or are potentially problematic or fixable.

So then when we're thinking about our animals, as I've said, the likelihood is that, many of these animals in front of us are going to be multi-morbid. Can you actually prioritise any of those problems to work out which ones you should be dealing with? And again, this is really tricky.

We said at the beginning that quality of life is the thing that we as vets should be thinking about, so we can start to think about, well, actually, which of these problems is most gonna impact the quality of life of the pet in front of me, and then we work with those. And the, the BSAVA manual that Jenny mentioned at the end of the talk has some really nice flow diagrams in it, and I'll put up a slide at the end of mine just to show you again what the reference is for that. It's got some lovely algorithms, and I, I like the idea of this one of when you're looking at an individual problem in a geriatric pet, is this problem likely to cause current or future welfare compromise?

And if the answer's no, then it's probably not a priority problem. And if the answer's yes, then it is a priority problem. And probably you're all doing that all the time, but if you have got loads of stuff going on, really thinking into how is this problem impacting this animal in front of me as one way of deciding which Which one you work on.

So if it's got a large lipoma on its flank that looks unsightly, but potentially for that pet is doing absolutely nothing bothersome at the moment, then actually, maybe that's something that you would leave versus if it's got very severe dental disease, that's much more likely to be a, be a welfare compromise. And here's some good examples. So, you know, the cat on the left there, for that cat, those teeth are definitely gonna be a welfare problem.

Whereas the dog on the right hand side, potentially in the future, that tooth is going to become a problem, that canine there. But maybe you could argue at the moment that actually that isn't necessarily causing it a welfare problem. So if that dog had lots of other things going on, maybe that would be lower down your list.

Whereas for the cat on the left hand side, I would say that those teeth really need fixing, probably before anything else that that cat would present with. But unfortunately, other things may actually impact these decisions, so money may well be a big one. Rehomeability from the shelter's perspective and from your perspective, as well as charity policy, may actually come into play with reprioritizing these problems.

And also charity image may be quite important. I think, again, for those of you who don't necessarily work within a shelter environment, It, the decisions that are having to be made, it can be very, very difficult, and the charity's image may be quite negatively impacted by rehoming an animal whose teeth aren't beautifully clean. Maybe in that local community, that would be seen as an awful thing to do.

So actually, maybe that would reprioritize what you do in a different way. And so actually a problem we may face is, is this problem likely to cause problems with kenneling or rehoming of this animal? And if that's the case, and if our aim really is to get these animals out of kennels as quickly as possible, then maybe that does become a priority problem.

And so in some settings, actually, both of these animals may really be prioritised for a dental if it's perceived that having grubby teeth in the dog on the left may well actually limit, the rehomability of that animal. Some things are a little bit more clear cut, so for example this horrible mammary mass, I would say you absolutely would need to do something about that, and the best decision for that animal may be euthanasium, that would be something to talk to the shelter about, . The, the carpal mass on the Daxun there, a bit more tricky.

I'd certainly be finally aspirating that one to see if I could find out what was going on, because that mass may not be bothering that dog in the slightest, and it might be some pretty big heroic surgery to remove that. Thinking again about the potential, longevity of that animal, its rehomeability, the cost of the charity, and also the, the risks of that wound breaking down when it's put back into a kennel environment, potentially, and then the subsequent costs may well mean that actually you leave that. The dog on the left is a lot more tricky.

Looks like it's probably been a breeding dog and may have multiple mammary masses. And again, that's a discussion to have with the charity of really, irrespective of what the underlying cause is there, do they think anybody's gonna take that dog home? You know, is that a rehomable dog when it's sat next to another 20 dogs that all look perfectly physically healthy?

Maybe they know somebody that's gonna want to take that on. But equally, if that is an animal with aggressive, mammary cancer, then you're potentially gonna be in trouble when it comes to, Being able to fix that, and is that really the best use of the charity's money. So pragmatic decision making, finally lapirating your masses, really trying to feel the local lymph nodes, potentially, diagnostic imaging around that if you need to, to check for mets.

But really, before you do any of that, is this bothering the animal? Is this gonna affect rehoming? Is this a really good use of the charity's money?

And then finally you have to think about what should I do and what can I do with any of these problems and these geriatric pets. And there's a really nice acronym in Human Healthcare called BRAN which is the benefits, risks, alternatives, and what do I do, what happens if I do nothing. And actually in the shelter environment, I think you can invert that and actually start the conversation with, well, what does happen if I do nothing?

What are the alternatives to doing nothing, and what are the benefits and risks of actually doing nothing. Because sometimes doing nothing in these geriatric pets may well be the most pragmatic plan. And actually, instead of doing some diagnostic tests or a definitive procedure, potentially doing some watchful waiting to say, OK, well, actually, is this a problem for this animal at the moment?

If we wait another week, potentially we'll get some more information. It won't cost us anything. And obviously on their euthanasia, I think for these geriatric pets does become increasingly, a priority, actually.

Depending on what's what's the problem with them, what's the likelihood of them being, being rehomed in a time frame that's compatible with the animal's welfare in that shelter. Really is it in the best interest of the animal. And it's very easy to reach for diagnostic tests, and Jenny's taught brilliantly first thing, just now about, you know, which tests are worth doing, and I think.

For me, again, history and clinical exam are absolute baselines, but it's very easy to rack up a tremendous amount of money taking blood tests. And I think it's really important in these situations to think, actually, is that test gonna change what I do? And as Jenny said before, thinking about Archie Cochrane, who said, When I, whenever I do a test, what am I gonna do if it's positive?

What am I gonna do if it's negative? And if the answer's the same, don't do the test. So whenever you're thinking about doing a blood test, really think, what's it gonna change for this pet in my hands in the shelter situation?

What diseases actually, is it gonna potentially pick up that is gonna narrow down my differential list? And actually, is any of that gonna change what I do? And you may find that actually the answer is no.

Urinalysis is very, very cheap, can give you a tremendous amount of information, actually on a range of different organ systems that can be used much more cheaply and instead of necessarily reaching straight for your blood tests. But again, that's a conversation for you to have with your shelters. But just always bear that in mind.

Is it really gonna change what I'm gonna do? And is the, this test necessarily the best use of that money? So just a few common problems to finish up with, diarrhoea is a big one that we'll see in shelters irrespective of the age of the animal and specifically in geriatric pets, stress is gonna potentially be a big cause of this, as is the diet change.

So these animals have come into a very different environment, maybe really stressful. Double check their worming history, double check that they have been wormed and reworm them, if not, and potentially, again, do some watchful waiting because it may well resolve over a period of a few days to weeks without them actually necessarily being particularly adversely affected by it. And again, it depends on shelter policy, how well they can cope with that.

Potentially, if that doesn't help, and think about changing the animal's diet. First of all. But, again, your history here is useful that they recently bought a batch of food that's different to usual, if there's multiple animals affected, could they potentially be using punctured cans, for example, if it's an intermittent but very severe problem.

Heart murmurs are a big one that you will pick up that the shelter may be unaware of and . This is one where your clinical exam again is really gonna be probably your best diagnostic test, because the louder heart murmurs are the ones that have the more negative prognostic indicators in terms of mitral valve disease, DCM, specifically in dogs. And this is a really good time to use pragmatic ultrasonography, because if you've got an enlarged left atrium, again, your prognosis is poorer.

So if you've got a loud murmur and a large left atrium, that suggests that the animal's heart disease is significant for that animal, and then it's up to you versus the charity as to whether you do more with that. Equally, if the murmur's quite low grade and the animal's not clinically affected, if it's got sinus arrhythmia, it may well be OK to leave that. We've talked about our mass lesions already, so I won't go back over that again, but FNAs are definitely the way to go here.

Some older animals are gonna have diseases like osteoarthritis. This may well be a case of going for the most. Effective treatment first of all, which is the NSAIDs, ensuring that the clinic and the shelter are watching really well for, potential adverse events, and also making sure that the environment is as good as possible for any osteoarthritic affected animals, so that the floors aren't too slippery, exercise is constant, they've got a nice, comfortable bed, and ideally, you can get the animal out into our foster home as soon as you can.

And always make, make sure you're thinking back to all aspects of quality of life. And we really need to think about whether or not rehoming these ill elderly pets is actually ethically OK. And I've got a poll question here about that, but I'm gonna skip that because I don't think we've got the time for it now.

But I, I just have that in your mind, really, because there's more and more studies coming out now as we work with owners that are starting to suggest that actually there's quite a lot of burden on an owner to having a sick companion animal. And, this is a nice study by, Spitznagel, which identified that actually owners of ill animals really found life a lot more stressful. And I think we do need to be mindful when we're thinking about rehoming animals with multiple comorbidities, of the life that that owner is gonna lead, potentially afterwards.

And is it really fair on both the pet and the, and the owner to, to take that animal on board? And there's a series of free articles in the vet record that cover some of these topics that I'd say, have a look at, because it gives you the insights from the owner's perspective, and it may lead to some useful conversations with your, with your shelter about whether or not it's OK to carry on. So just to summarise then, decision making in shelter medicine, I think can be really hard.

We need to balance the needs of the shelter and the animal. Problem-based approach can help you work through your differentials, I think, really well. Prioritise those problems.

Don't be investigating every lump on every pet. Really try to think about what's the most important thing for the welfare of this pet. Think about the risks, the benefits, the alternatives, and what if you do nothing, and actually start at the end of that.

So what if you do nothing? Is that really the worst thing? Maybe it's the best thing.

And really in a lot of cases, euthanasia may be the best option unfortunately for that pet in that shelter, given its chance of being rehomed successfully. But again, that's something to work with your shelters with very carefully. Unfortunately, you may not be the ultimate decision maker.

So again, as much time as you can spent with the shelter management to understand why they make the decisions they do. And ensure that you have those regular conversations, not just a one-off at the beginning. Keep having them because things may change.

So hopefully that's been useful. Again, as Jenny said, there's a BSABA manual that covers loads of these topics in there, which, I think is really fantastic. I dip into it loads now.

I've got a copy, and I would really urge you to have a look. Thanks very much. Oh, Zoe, that was absolutely fabulous.

Thank you so much for your time and unfortunately, we don't have time to, to get into questions at this stage. But yeah, I'm sure everybody has really, really enjoyed your presentation.