It's Anthony Chadwick from the webinar Vet welcoming you to another episode of Vet Chat, the UK's number one veterinary podcast. And I'm, I'm super pleased to have Sisa Valk on the line with me today. Siska is, she says ex veterinary nurse, you, you're always a veterinary nurse, Siska, but, you've had a very, very varied history, really fascinating to see what you're up to now.

Obviously, also from the Netherlands. But now living in London, and wanted to talk a little bit about end of life care cos that's an area that you're really interested in, also environmental, stuff as well. But perhaps before we, we delve into all of that, you perhaps want to give a little introduction for those people who, who may not know you on the podcast.

Yeah, thank you so much for having me, Anthony. I'm really excited for our chats for the next half hour. Yeah, I am the founder of Autumn Animals.

And autumn animals provide holistic palliative and hospice care to pets and their families, so we provide care to pets going through their, the autumn of their lives, so to say, and then during that same journey we support the, the pet family, members, or the humans through that journey as well, because as we all know as as pet guardians, it's, it's a very emotional journey, so I feel like We can't just focus on the non-human animal, we need to focus on the animal as well, and this interest in the human animal bond has always been. Something that I've been really passionate about. So when I started as a veterinary nurse almost 20 years ago, I knew that working in clinic wasn't wasn't the right fit for me.

So I continued studying. I became a human geographer, did a bachelor's and master's in human geography with a specialisation in environmental geography and international development, and my research. Was always focused on that human animal bond, so, not only how humans interact with their natural environment, but also how they interact with the, with the animal environment, so the animals that they're keeping, their, their herds or maybe in case of fish fishing communities, yeah, how they, how they can support their their fishing stock while also make it into into their livelihood.

So yeah, I've, always been really fascinated by that human-animal bond, and I think that, eventually led to autumn animals. Just so people are aware, those who are, who are listening, if there are cats that get involved during the podcast and you can't see them, this is another reason to, to go on to the podcast at the webinar vet site to, to watch this particular podcast podcast. With cats involved, obviously it becomes a podcast.

And, that is just behind your head. Mine is sitting, to my right hand side, but likes to show off. In fact, he knows he's being talked about, so he's now jumped down.

But he may come back. So if you're wondering what the, the fluffy thing behind, Siska's head is, it is actually a cat. Louis, Louis is very well well first in, being on screen, it's usually my partner who sits here and and then Louis is sat behind him during meetings, so he's very well trained.

And of course it's, you know, the autumn animals, it's very much. Not just the euthanasia, because one of my frustrations as a vet practising, you know, until 2016. Was when that skeletal cat was brought in, that was recumbent, you know, they, they couldn't, the cat couldn't walk and it was, it was laying on the table and it was skeletal, it was pretty close to death's door.

And You know, it used to really upset me because obviously this animal had obviously suffered to get to that state, it was, you know, it had no muscle or anything. And the that the the client's usual answer was well we didn't bring it to you because we knew you'd put it to sleep. And my answer back was, well, I haven't really got a lot of choice now for the future, please do bring it in because actually we're vets, we're very good at saving animals' lives as well as having unor at some points having to euthanize them.

. So, as much as obviously it's right and proper to talk about hospice and euthanasia, actually, if you can see an animal early enough and the importance of senior profiling, you can actually make a difference and improve people's animals quality of lives and obviously by reference the the clients as well. Yeah, I think one of the biggest things that I vouch for, both for pet guardians or pet owners, but also towards my veterinary professional like peers, is to start doing. Quality of life assessments before an animal gets old or diagnosed with a with a with an illness, because when you do a quality of life assessment from the start of an animal's life, you know what the baseline is, and then you can also See when changes are starting to occur, and these can be changes in mobility, but also in their emotional welfare in their like their social interactions, and, and it gives an opportunity as well to have a conversation with the pet owner, pet guardian about where their lying in the sand is, you know, .

What for them would a good death would look like for them in terms of like how they would like their pet to pass away, but also, yeah, like I said, where they're lying in the centre, so how far would they are they willing to take an animal before they decide, OK, now enough is enough, and I think having that conversation is something that a lot of people are very uncomfortable with. And I often joke that because I'm Dutch, I'm more comfortable talking about really weird issues such as death, but it's, yeah, I think it's really important to start having that conversation and also for pet owners like the ones that you just referred to with the, with the skeletal cat to know that, yeah, there are options and there are ways that Either can cost cost the world or not cost a lot to improve quality of life for that for that cats, but also that you can guide them through very comfortable transition that they don't have to be like afraid of, so I think it's really important to have these conversations very start having these conversations early and then keep on having these conversations throughout the life of that animal. And I thought the journey was really interesting because obviously, you know, you have the veterinary nurse training, but you were doing other things, you then, started working, I think with Chloe at vet Yogi, so you were doing some yoga, but also some pet care, dog sitting, dog walking.

And it was really beginning, and I think this is often the best way to start a new venture is when you understand what the problem is. Rather than think you, you kind of know or you think there's a problem and there isn't being able to see that. Having the right attitude to older pets, you know, noticing how they were perhaps changing, noticing how that was perhaps upsetting, the, the owners, you know, the, the pet, parents, and then being able to help with the yoga elements of perhaps helping people cope with these difficult times because of course, you know, the the cat or the dog is very much a part of the family and.

When we see a pet suffering or when we have to put a a pet to sleep, it's it can be like losing a treasured member of the human family as well, can't it? Yeah, exactly. Yeah, so I was trained as a yoga meditation teacher in 20.

16, I believe, so I was teaching yoga and meditation here in London in like group group classes, but also individual like private classes. I was training, I was teaching accessible classes to to elderly people and . Yeah, that I think that really informs my way of working with pet owners, .

Because, yeah, not only having that veterinary nursing background, but also being able to teach people and to teach them mindfulness, which is very important, especially going towards the end of life phase of your pets where you're just so focused. On doing whatever is best for them, that sometimes you forget to take a step back and take a breath for yourself and take care for yourself. But it's also very useful, for instance, when I'm teaching, owners to give subcutaneous fluids to their cats or their dog, .

To Not hold a lot of tension in your body. So I learn, I teach people to inject subcutaneous fluids, I teach people how to give oral medication to their cats in a way that is not stressful to them or the pet, and I do that by really focusing, letting them focus on their breath, on their posture. I really censoring them before they started to.

Give the medication. That skill in itself could be worth millions, because we always see the cartoons of people trying to give the cats in particular a tablet. It's one of the gifts that I have that I'm able to do it even with Mr.

Feisty over there, who's on some medication at the moment after his dental. But I think it's interesting, you know, as I was saying earlier, it's always. Good to learn something from doing a webinar or a podcast and the new word for me was the doula word, which is very much what I think you were explaining there, that guidance and support that you're giving to people when they are making, You know, it's a big decision to make that decision that this is the time for the pet to go and.

My feeling with that always, and it was a real blessing and a privilege that you'd spent time with that person and their pet for many years as their vet, you know, I had my own practise for 15 years, and to get the sense that now was the time to at least start talking about it and make sure that, We didn't leave the pet too long, you know, that I always used to say let's make sure that we take the pet 2 weeks too early rather than 2 weeks too late, because that's the right thing, . You know, the three people in the room, the dog, the human, sorry, the owner and the vet, the most important person in the room, was always the dog or the cat in, in my view, and I think people appreciated that, that, you know, as the vet or the vet nurse, we're seen there as the advocate for the pet who obviously can't talk, but we're detached enough that we can help the person make the right decision, not necessarily the emotion the emotional decision, which is often, We'll keep him or her going for as long as possible and ideally we'd love the animal to, you know, die in its sleep, so to speak, which isn't. Necessarily the fairest if that animal has suffered 4 weeks, months, you know, before that's happened, albeit, you know, with medicines, we can obviously help a lot with pain relief.

You've obviously developed that into autumn animals. You have vets and some power professionals that can assist people. Starting to also go out to practises, I know you do that in an environmentally friendly way in London, the bus or the bike is probably better than the car anyway, just in terms of speed, but tell us a little bit about how autumn animals is perhaps developing as well.

Yeah, so I just wanted to go back to what you were saying earlier about advocating for the pet and me being a doula trying to do that as well, advocating for both the human client and the and the patient. I think a lot of veterinarians. That still work in a practise where they tend, where they are able to create this relationship with the family.

They are a little bit more resistant to a person like me coming in because they have that relationship with the family and with that pet. They have seen the the dog at puppy puppy stage and now as a 15 year old dog. But, what I've been noticing, especially here in London, is that vets come and go.

And a lot of the clients that come to me are incredibly frustrated with the lack of continuity of care, and so they come to me first of all, sometimes fuming about like the lack of continuity of care and having to tell that story all over again every time and just and every vet recommends something else and and then yeah, second of all, they just don't know. You know, sometimes it's, it's being said, you know when the time is right, and they, they don't, they don't, and that is also like, like, you said earlier, . It's a conversation that you as somebody who knows the family and who knows the pet can have and the veterinary nurses, but if you have never seen those people before, it's very difficult to To really know this dog or this cat or this other animal and to know the family and also knowing what the family dynamics are.

Sometimes that's also obviously that's also a very tricky point when one person says this animal doesn't have quality of life anymore and the other says, Well, there's still some life in there. I don't want to euthanize just yet, and I'm currently working with a family that is going through that journey. So that is my role to facilitate that conversation and see how they can find a middle ground.

And also to make sure that. While they are coming towards that decision that is in the best interest for, for the dog, which they all know it's not going to last much longer, but while they are coming to that decision that the dog is taken care of and is not suffering or not is not in discomfort, is being kept in a hygienic way, is still enjoying his food, is still enjoying his very short walks and is mentally stimulated. So I have taken on a little bit that advocating role that usually a vet vet's practise would take on if it would be so often it's an independent practise or at least a practise where there is continuity of care and I think as a as a doula you would take people by the hand you're guiding and I've .

I've incorporated also a bit of the veterinary nursing background where I'm also giving advice. So it's a combination of veterinary nursing and do lying. So, .

And yeah, I'm using my ability to to start difficult conversations about dying and what is, what is a peaceful death to you to, yeah, I use that in my time with people to, to really have that conversation and, and that often takes hours of conversations or text messaging back and forth and that is unfortunately not something that we can do in like in normal veterinary practise anymore. So I think this . Yeah, my role in the veterinary sector, just like you now have veterinary social workers, is to meet the family in their own space as well, in their home environment and meet the pets and be a kind of an advocate, be a liaison officer between The medical, the veterinary staff and more emotional family side.

But the most important part is always to keep the welfare of the pets in mind. Yes, exactly. I think it's really interesting those comments that you've made, particularly my other interest when I was practising was dermatology, and quite often.

I, one of my questions would be, you know, which vets have you seen in this particular practise, and they would say, well, we've seen all 6 of them, and as you say, they've all suggested something slightly different. Yeah. And what I was able to do was to say, well, you will only see me and we will sort this condition out either through cure or through this is the programme that will keep it controlled as much as possible.

And obviously I knew, you know, perhaps a bit more about dermatology than than the people who were referring, but the big. Blessing I had was the hour that I could spend with that client because if you try to do this in 10 minutes, even to take a decent history is difficult. So I think the time was really important.

And then also we had somebody on a number of years ago talking about this very subject. And actually it makes sense to sometimes make sure we can if you like, outsource this because. I remember her saying that they did surveys and they realised that if a pet was euthannased in the clinic, often that meant that if the clients got another pet a year, 6 months, however long down the line, they were actually unable to go back to that practise again because they were unable to go into that same room.

And it was one of the reasons that I was always very happy because I thought it was the more appropriate thing anyway. Was to offer home visits. It obviously made it more expensive because you had to spend more time.

But I would also have other clients from the practises ringing up and saying, our practises said they don't do home visits, that's kind of a a rule. But would you come out and for me it was one of those times that you could obviously make a difference in somebody's life and it was important. You know, I, I felt it was, sounds a bit weird, but .

You know, you could get, you could actually get something from knowing that you'd helped somebody in a difficult situation. So actually going outside and. Euthanizing that pet in a familiar environment in a home environment.

I think just makes sense often, you know, for the client as well, for their own peace of mind, having seen that all happen there, perhaps the pet is left there to be buried in the garden, probably. Not quite as easy in London with all of, you know, the, the, the, not, not everybody has a garden. But I, I do think that having that ability to go out.

To do that and to be able to spend the time with people is, is really, really important, so I think the service you're giving is fantastic. I know I was in America recently at BMX and Lap of Love. I think there's a similar service in America as well.

How do you see that, do you see that just developing more and more as people just kind of begin to see the er importance of this? How do, how will the service? Yeah perhaps evolve.

It's a really good question because I, autumn animals is now almost 2 years old in April will be 2 years old and I feel in the beginning that if people found us, either through their own veterinarian or through Googling us one of the first things they said was I did not know this was an option to do home euthanasia and I've noticed that over like the past two years, more people seem to find us and more people seem to think that. Yeah, this, this is only natural. It is only natural for this to happen at home and for it not to happen under the often harsh lights in a sometimes noisy clinical environment.

And we have seen, this is when I was setting up autumn animals, I, I'm a member of the International Association for Animal Hospice and Palliative Care, and we have a register. Of everybody that is connected to their to their organisation or who is a member. When I started thinking about setting up autumn animals, there was nobody in this environment that at least was signed up as a member with them.

And the moment that I incorporated autumn animals, I went back to the register and checked whether there was somebody, and there was somebody just on the other side of the river who set up a hospice clinic, . Around the same time that I set up autumn animals. So instead of thinking, oh, this is competition, I was like, OK, come on, this person, we need to work together.

She's on the north side of the river, I'm on the south. There's enough, there's enough people that we can help, and patients that we can help so we can work together. So we have been working together and the veterinarians that have come to autumn animals to to work for us as locums.

These are all people that already had more interest in end of life care within general practise, but some of them are planning to setting up their, their own, hospice organisation. The one thing I would say how autumn animals is different is I'm not a veterinarian, so it comes more, the care that we provide comes more from . Holistic and a social background, so more keeping in mind the human animal bonds as such, rather than the, the merely veterinarian, veterinary focus of making sure that the euthanasia is done.

Well and as stress free as possible, but, and how we are also a little bit different is that I always exist during the euthanasia. So we, a veterinarian and I will both go to a consultation so that I can take care of all the operations around it, and I can take the animal with me to so that the crematorium can pick it up if, if, families choose for cremation. But so that the veterinarian can really focus on the patients, and I can focus on what is happening around it, both operations, but also the emotional care for the, the human family.

I think whenever I did . Euthanasia at home and occasionally if you had to do it on your own, that was a much more difficult and stressful than if you had a nurse coming with you and obviously the, the usual thing was to bring a nurse out because you know, you don't want clients necessarily raising veins, they're not necessarily very good at it and it's also, you know, potentially upsetting for them. I suppose, potentially with your human geography hat on, you know, I think it was a human geography er degree that you did, and I was also fascinated if we can move away slightly from the euthanasia topic, .

Fascinated to talk to you because I, I spent a bit of time with the Masai as well in, in, Kenya and Tanzania, that you did this lovely masters subject on er pastoralists without pasture and, and that human animal bond is, is huge between the Maasai tribes people and their cattle. The cattle are their wealth, their status symbol, they got them. They do so much for them, don't they?

So tell us a little bit about, the, the, the, the masters that you did, and I'm, I'm presuming some pretty nice trips you had over to Kenya as well. Yeah, so I was living for my master's, field work, my, my thesis. I was living in Kenya, with the Masai, so it was very much in the middle of nowhere, during a drought, which was fun.

But yeah, I was, researching how, so just to give a bit of context, Masai are pastoralists who used to roam the lands like they would follow the rain, so they didn't see the boundary between Tanzania and Kenya. They would just they would just move with their, with their herd. But the zebra.

Exactly, but then boundaries came up and yeah, and fences, especially in Kenya, fences in the last few decades have come up very severely and land has been privatised, which means that people with large herds couldn't move around anymore. On top of that, we have climate change, so a lot of droughts which killed off quite large parts of their herds. So I was researching how their identity as a community and as individuals changed as their livelihoods changed because they were stepping away from being purely pastoralists.

A living off their cows and how they moved away from that. Also within communities there was a lot of like intermarrying, so there wasn't just purely Maasai people and purely Qu people, but they were intermarrying, so their diets were changing as well. Like Masai before would only live off animal protein and now they started to grow like they started becoming sedentary and growing their vegetables and their roots and everything.

So it's a lot of changes for a community that has such a strong identity, their worlds like they're they're they're known worldwide as this community and now all of a sudden this is changing, so I was researching what impact that had on, on their identity and yeah, I found that. Like most people, they are very flexible and they were seeing the benefits of modernity of modern living. I, I found mostly with among the women they They were really enjoying that they were able to send their children to school, they were able to stop doing FGM, so genital mutilation for girls, .

One of the things that I had not expected when I went there was the role of the church. So they moved away from their, original religion, more spiritual religions to, Christianity, Methodist, Christianity, and so that was something that I had not expected and that was a big shock for me, but interesting to to find out as well, . Yeah, it was, it was an interesting time in my life and yeah, afterwards I did a little bit of travelling in Tanzania back to Kenya and a few years later I ended up on Zanzibar of all places to to do more research.

Yeah. And then also a gorgeous island. But throughout the sort of history before autumn animals, as you said before, drought, I was speaking at Vet Ed and I spoke to an Ethiopian vet and, you know, a million animals have died.

Through drought in Ethiopia, which is a massive catastrophe, because of course it is wealth, it is also status, but it's also food and, and wellbeing. And I know you've done a lot of work around water, also the mangroves, the mangalahs as they call them in in other places, and that importance of starting to mitigate against things, because we know climate change is here. We've had I think 1213 storms already this year, which is really quite abnormal.

So those changes that have been in the South for perhaps the last 2030 years are moving upwards. How do we mitigate, You know, the importance of water, how we conserve, all of these things, you know, it makes it even more important for everybody to think about leaving the tap on when they're brushing their teeth, doesn't it? Hm.

Do people still do that? I remember when I was in primary school. I was, I remember I was still in primary school when we had stickers on top of our taps.

This was in the Netherlands, by the way, . Like when you brush your teeth, turn off the tap. When you are lathering up your soap, turn off the tap.

But I mean we, I come from a very water-logged country that is very well known for their water tech like technical skills, so I think maybe we're a little bit more aware of that. Yeah, it's, it's a real problem. I really don't have the answer to it.

I think there's Ah it's one of my pet peeves is how much focus there is on individual. Responsibility like us as consumers, I think a lot of the change also needs to come from business and government. We need better guidance, we need better.

Legislation, like I, I'm quite a stickler for doing everything as sustainable as possible, but that's that is also a reason for sometimes almost burning out because you just want to do everything as good as you can, as good as possible. Doing zero waste shopping and getting the the most environmentally friendly oat milk for instance, but there's only so much that we as individuals can do if we're not being supported by our government and by businesses, so this is maybe a nice segue into how autumn animals, tries to, to limit the carbon footprint. I think one of the biggest ones is we don't use a car.

To transport equipment or deceased pets, we use an e-cargo bike. And, . We share facilities, so I don't have a premises.

Autumn Animals doesn't have a physical clinic, but we do need a freezer obviously to store our deceased patients, so we use the local clinic's freezer because it's mostly empty most of the week, so we use theirs and we just pay them a small fee. Yeah, there are several like smaller things like the, the things that we recycle, we are zero and like we don't use paper and that kind of stuff, like I was saying before we started this conversation, I, I still peel the paper off the package of of needles and, and syringes, which is in the long term, not a sustainable option, but until we have. A good recycling system that is what I need to do.

Yeah. Yeah, it's the sharing economy as much as possible, can we, can we share, but also that we do think about it, and I, I agree with you, . I think we're both pretty committed to the environment.

There's some people who are not, so I do think there's a personal responsibility because I think we can also place it all on the government to do it and government to move slowly. Our particular regime at the moment, I don't think is particularly a green one. And I actually think it, it is more individuals and business that will.

Make the change and and come up with a solution because government is often not very imaginative. Having said that, of course there are good things that have been done like the plastic bag tax in the UK which massively reduced the amount of plastic bags being dredged out of the ocean, so. Government can play a part, but if we wait for them, then, we can push the responsibility onto them and not take our own personal responsibility.

So I think it's, you know, I agree with absolutely what you've said. But we have to look at it from both angles, don't we? Absolutely from all sides, yeah, and I think also things like what you were saying earlier, the discussion forum to have veterinarians come together to discuss how they can get better.

You have vet sustain. I've actually written a few articles for vet sustain. Because they have a programme now that supports veteran veterinary surgeries going through this more environmental sustainability, entrepreneurship.

So there are, there are movements, especially in the veterinary sector as well, towards becoming more sustainable or environmentally sustainable businesses, but yeah, we, we need support from all sides. Sis, hopefully we can get you along to the Veterinary green discussion forum in June. It's the 18th and 19th of June.

It's at the London Wetlands Centre, the last two years I've been up in Preston. We do struggle sometimes to get people across the Watford Gap because they think that it's savage country. We're quite nice up in the north, but we decided we'd come down to the, the south, so those people who are a bit fearful, er, can go to the London Wetlands Centre.

Hopefully those people who are listening to the podcast, please do get in touch with us at the webinar vet if you'd be interested in attending that and being part of the veterinary solution. To climate change, we all have to work together, nobody's going to solve this on their own, but I think as, as a group of people coming together that are committed to a cause, actually small numbers of people can do great things, can't they? Absolutely.

If you just if you one person, maybe it doesn't it, you know, throwing that one starfish back into the ocean, peeling that one syringe packet to separate the plastic from the paper. If everybody does it, it adds up to a lot of paper and a lot of plastic that we've separated, so. Yeah, just thank you for everything that you're doing, both from the end of life and autumn animals and hospice side, but also from the planetary side as well, because the experience that you've built up over the years is a real resource to help us in the profession as well.

So thank you for all that you're doing. Well, thank you for having me. I love, I love talking to you.

Thanks so much, C, and listen, thanks everyone for listening to the podcast. We hope to listen, to get you on a to listen to another podcast or a webinar very soon but have a great rest of the day. This has been Anthony Chadwick for the webinar vet, and this has been vet chat.

Take care.