Hello. This is Anthony Chadwick from the Webinar vet welcoming you to another episode of Vet Chat The U K's number one veterinary podcast. But we're not going to do a podcast today.
We've got Zofia Gilmer, Macarena, Sanchez Martel. Recently, we, who I had the pleasure of both meeting at, ISFM conference in Dublin in June. July time.
So it's been difficult to track you two down, but you're here, and we're gonna be talking about the ISFM conference. And, of course, when we only talk about cats, it's not a podcast anymore. It's a podcast.
So welcome to the podcast. Thank you very much. It was, it was a great conference.
Dublin is a beautiful city. It's not quite as warm as, some of the other ISFM conferences I've been to. I think the ISFM family like to, go to sunnier climb.
Sort of places Macarena where you're from originally. So perhaps introduce yourself, to the listeners. Sure.
So I'm Macarena. I'm from Malaga. I came to I graduated in court in 2013.
No, Sorry. No, I can't even remember. Yeah, 2013.
0, my goodness. And I came over to England a few years back. Sorry.
We've got a little cat here. The podcast. There we go.
And I moved to Sheffield 10 years ago. And here I am still here. And 10 years a vet, nearly 11 years a vet.
I always I remember being 10 years a vet and realising I couldn't say that I was a young vet anymore. Is that fair, or am I? I'm always young in spirit, but now un.
Unfortunately, I am not young. That anymore. Yeah, but, you know, with experience comes an extra degree, isn't it?
So you get more confident You get to learn more things every day. I just learning every day, that's for sure. But you know, here we are every day.
Brilliant. And then Zofia tell us a little bit about you For the listeners. So I graduated from Glasgow University in 2013, went straight into small animal practise.
And then I've been working in South Yorkshire. Mainly Sheffield. Since then, and yeah, couple of years in quickly realised that actually, cats were my thing.
And yeah, I started sort of specialising a little bit further, but still very much a GP vet and enjoying everything that that brings. Yeah, I think similarly. You know, when I was in, I did a CT.
That was my particular passion, although obviously cats, you know, and dogs. But if you really pushed me, you really pushed me. I'd probably say I'm more of a cat person than a dog person.
And I know you've both done the, the fellowship or the membership with the Australian college particularly looking at feline. So perhaps tell us a little bit about that. And in fact, did you meet on that, or did you meet because you were both in that South Yorkshire area?
So did they all know. So we both started off with doing, the feline medicine course through the University of Sydney, which is very sort of structured 10 modules covering all aspects of feline medicine over two years and then following that, there is the option to sit the membership exam to become a member of the Australian and New Zealand Society of Veterinary Surgeons. So maca and I was doing it at the same time.
And I got a little email one day being like, Hey, I'm in Sheffield, too. Do you want to be a study, buddy? So we met up.
Got on famously. Well, what was meant to be a quick coffee? We ended up getting kicked out of the coffee shop about four hours later.
We were chatting about everything, and then met on a regular basis in preparation for our exam. And I think that was probably part of the reason that we managed to pass because it wasn't an easy, easy exam by any any means. So not easy journey.
But it was so much nicer with her. I'm aside so much easier, I think, collaborating with each other. I mean, we used to call it cheating, didn't we?
You know, you sat in the same room and you said What? What? What have you done for this one?
You know, it's it's ridiculous because we work together. We work together. Yeah, definitely.
Definitely. So there was lots of time spent trawling through past exam papers and going through how we would answer them and just getting somebody else's perspective of it. It's really helpful or somebody else's way of learning something.
Like we sort of had strengths in different areas. So having some someone explain an aspect that you were struggling with in a slightly different way can can definitely make all the difference and also having someone having someone that goes through the same thing that you are going because it's difficult to understand what you're going through when you have someone so close to you that it is like going suddenly through the same stress, same emotions. So it's a very, very helpful to have a study body.
Honestly, that's and a friend for life, you know, might be down. And actually, I want to give up on this and actually, you encourage each other and vice versa. Obviously.
Yeah, exactly. There's bad days. There's good days.
But having someone next to you telling you good morning, we can do this. It was every day we walk up like we got this. We can do this even though we thought that we couldn't.
But brilliant well done for passing both of you, but also having those, cases that you were working on, you know, in your practises again. Look, this is the way I've approached this feline diabetic I'm not having success, you know? Can we have a think about it?
Can we? Can we talk about it? I remember one of our most lovely testimonials we had was from, a vet who said, You know, I was struggling with a feline diabetic and I decided to go home.
Look at a couple of hours of webinar webinars from people like Mike Heritage. Ian Ramsey. All right, these are the things that I'm not doing.
Quite right. Let's go back on that. And suddenly they have AAA well balanced diabetic cap.
And that's why you do, you know, CPD and training. It's to actually make you better at the job rather than as lovely as I'm sure your certificate from Sydney and from the Australian College is. Actually you know that doing that qualification has made you both better be, hasn't it?
Yeah. And give us such a confidence as well, picking off things that we couldn't pick up on that before. Like, you know, things like that.
Oh, actually, I've never seen this before, or I may have done it before and never realised that it could be that Yes. And actually, when you study It's always interesting because you also realise, Oh, that's what that cat had three years ago that I had no idea of. Yeah, yeah, it was very much.
The more I know, the less I know, which is a very humbling experience. Actually. The the big question is, did you get out to Australia to sit the exam, or was it all done on this boring online way, which, you know, Sorry, I.
I probably was partly responsible for, So we did get a little trip down to London. So that was fun, but not Australia. Unfortunately not No, it's not Sydney or the opera house.
It was a great experience. Yeah, fantastic. And I think just before we go on to ISFN, you know, because obviously we I think we all had a good time at ISFN.
But it's actually really interesting, You know, you're both 1011 years qualified, and we do have a problem with attrition. I've just been chatting to the CEO of Aha. They've done a great paper on state.
Please. You know the great attrition, why we're losing that And and I had a really poor first two years. You know, I I struggled, but I want to be a vet.
I had some people who weren't particularly nice to me, but I wasn't going to let that spoil the dream. So I carried on and, you know, I had, you know, a a reasonable clinical career. But we lose a lot of people in that sort of first five years, don't we?
And yet if we can get people over that pump, actually with experience comes confidence. And I think there's a danger, you know, people leaving. In the first five years, they've had a bad experience.
I was speaking to a young vet who dropped a year. Three of our colleagues who are friends, you know, one's had a bit of a breakdown. Two of them have had a bad experience in their first job and left the profession.
You know, it's such a shame to see that. Did you have times, you know, perhaps in your 1st 5 to 10 years where you thought, you know, I really want to be a vet, but this isn't the job for me. And how has you know the training that you did with Sydney and with the Australian and New Zealand college.
How is that learned? Helped to sort of, transform you into the, you know, two. Fantastic.
I'm gonna say the word young compared with me. So yeah, I. I mean, I definitely had a rough first couple of years.
I think, in practise, I think you go from this very well supported sort of insular environment at that school to out on your own. And I think at the time, we qualified, like, a lot of these sort of new grad schemes weren't quite in place yet. And there was still very much an attitude of, you know, kind of get on with it.
Yeah, basically, yeah, yeah, absolutely. So, yeah, it was tough, but for me, actually finding an aspect of practise that you really enjoy and developing your knowledge in that area, that gives me real job satisfaction. And then also with what you've learned, you know, educating others in the practise or, you know, chatting to fellow colleagues again.
That just helps with the sort of job satisfaction. So there are still tough days, and there's still days where you're like, why am I doing this? But actually to Yeah, I think with experience and also with, you know, CPD and finding something that you're really passionate about that definitely increases sort of job satisfaction for me.
So yeah. So in my case, I was left. When I came to England, I found my first job, and after three months, I was left on my own on my own as a new grad.
I was like, Great. So it was really tough. And obviously you have to do a lot of self learning.
And in Spain is not CPD. S are not as compulsory as they should be as they are in the UK and being able to have to do every year habit and go through CPD going to Congresses, learning about different things. It made me actually float rather than drown.
So it was really good. But I specifically remember this case of a cat that I had to refer because he had fill asthma and I panic. I didn't know how to treat the cat with feeling asthma, and I referred it.
So then that's what I started to say. Right? I need to crack up with feline medicine.
I know nothing about feline medicine because in Spain. I mean, things are changing quite a lot, but we kind of was Well, cats are like a small dog. I was like, No, no, no, they're not small dogs at all.
So obviously that really kicked me in the tick and said right, you need to learn about cats. And the more I was learning about them, the more I love them. And then I found out about this cause the one that Sophie and I met on too, and I was like, Right, I'm doing that.
And then the rest is history. Yeah, so it was really rewarding. And now I see a cat.
Oh, that's fine. We know what to do now. So it takes you through different stages of like I come from a place of like fear every day of not knowing what I'm doing.
Like books looking Oh my God, what can it be differentials and just say OK, I've got a patient. Let's do a correct examination to see what happened here. What can we do?
Obviously we don't know everything, even though after we finish his qualifications, like I still don't know everything. But unless you have resources to go back to and it makes I felt like it made me a better clinician. Definitely more confident and as well, you know, your limitations.
Do you know when is the point to say, OK, I need to refer, because that's what you should be doing. Like, I know how much I know. And when things are getting out of hand, we need to find some help.
But yeah, definitely CPD learning every day, every day we learn That's it because you're so close together and have such a great relationship. Presumably, if you do get that difficult case. Still, I would guess who's on speed with each others.
Yeah. Yeah, absolutely. Which is really helpful.
And we're very fortunate that we've We've got that. So we're talking about this card you had yesterday. I was like, Wow, so we definitely do chat about We have, Like, what did you do with this?
I mean, I had the same experience. Do you Macarena II. I kind of realised I had no idea about dermatology, and, was using steroids.
Because that was what everybody did and then realising. Hm. I'm not sure this is actually the right way to be doing this and actually, do I recognise what a hider looks like?
How am I going to get better at this? And I remember going to a course in Llandudno and with Richard Harvey and and the sort of All right, OK, this is if we apply this logically, it makes a lot more sense and then spending the couple of years as you did to get the certificate of veterinary dermatology and at the end of it, really feeling confident that I'd turned from maybe being an empiricist as a, you know, as a young vet into a proper scientific clinician. So which I always tell the story.
My, daughter was in school and, the lesson. It was the lesson of what do your parents do? So you know, teacher, nurse, lawyer, You know, whatever the profession that or or job they were doing.
Electrician, plumber. And they came to my daughter, and, this was while I was studying hard for my certificate. And they said, What does your dad do?
And she said he reads books. That was my job to read books. So, yeah, it was so sweet.
It's good to, to finish it off and have that feeling of satisfaction. But then, of course, learning is life long. We never we never stop learning, do we?
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Simply vets.com to find out how we can help. So, we all were at ISFM, you know, three CX or two cat experts Me coming along for the ride cos I don't really practise anymore.
But I always love the ISFM conference. I think it's so well organised. The quality of the speakers is excellent.
And and I think the two areas that they touched on this year are such important areas. You know, the cat. Unfortunately, the kidney is an issue, isn't it?
They they they have, weaker kidneys perhaps than than we would like. Although they still can live for such a long time. And and particularly, you know, we talk a lot about chronic kidney disease, cos that's the problem.
We see. But at this conference, it was more around acute kidney disease. So what would be your two or three tips?
Take home messages that you took away from the conference And maybe with your own experience of what we should be doing and how we can one diagnose this and make sure that we're not missing it and then, you know, giving, suitable treatment going forward. Do you wanna start the ball rolling off? Yeah, Absolutely.
So one thing which I think we're sort of all generally aware of with cats is how vague the symptoms can be. They just seem to show the same clinical signs for all spectrums of diseases. There was quite a bit of discussion about sort of ureteral obstruction and how it's probably sort of more common than we may be initially appreciated.
But I think the difficulty that we have with these cases, as they might present just for being a bit off colour bit in appetent, and that's all you've got in front of you like you don't necessarily get this cat, which is really PUPD. And I think the Congress just definitely emphasised the fact that when we're presented with an ill cat, you know, it's really important that we're doing a really thorough work up, so, you know, getting on it, getting our blood work done, you know, checking for an a T. Yeah.
And there was definitely a lot about the importance of imaging with these cases as well. Like, we really should be sort of imaging our urinary tract. So, you know, a blocked bladder cat, for example?
Just doing an X ray. If it's stable enough prior to unblocking in a third of cases that would actually reveal potentially what the cause of the obstruction is, and with our sort of ureteral obstruction, you know, a quick ultrasound of the kidneys can tell you a lot. In general, sort of a young, healthy cat.
We shouldn't really be seeing any dilation of the renal pelvis, a cat with a ureteral obstruction if you're getting a dilation of great and 13 millimetres. I think they said that's pretty suggestive, of ureteral obstruction. So yeah, I think definitely need to any sort of ill cut, vague signs, you know, crack on and work it up.
And also the importance of sort of imaging these sort of urinary cases because that can tell us vast amount of information. I don't know what either of you do. You know, there's been this big rise in that whole area of, pocus as well.
Point of care. Ultrasound. Do you both have those machines or do you prefer just to go for a you know, a full on ultrasound?
If if you have a case coming in, you know, to abdominally ultrasound it well, ultrasound is not my strength, You know, we all know our weaknesses, but interestingly, after the Congress, they just say it's so easy. Just put it in certain places. And after the Congress, I started using it like, OK, you know, it gives me the comfort to say You don't have to be not so you don't have to do a certificate to be able to see certain things like what so was saying just now it's like, just put it out.
You know what a normal kid it looks like If it looks abnormal, take a picture and then you can look into it, so it just gives you the confidence to say Use it. You've got a tool. Use it.
I always I used to run away from it because I don't know how to use it properly. I used to, but I'm like, OK, the more you use it, the more you get to it, and the more confident you'll become again. It's learning every day.
And I had a block bladder last week again, So I just did everything I had to do. As you know, we learn in the course as well. And it's just and the Congress they were saying and I did my X rays and my ultrasound and I felt OK.
You know, I felt more confident to use them. I was looking for certain things that are quite important to look into, and that's the beauty of it, because you just go to a Congress and you think I can't do that. And then they said you can and you're like, all right, I'll give it a go.
So I say, I didn't use the other time as much as I used it for the Congress. I'm doing focus quite a lot now. Maybe not great.
But I can tell these days like, Oh, that's abnormal. Yeah, yeah, yeah. What about you?
So, yeah, I would say ultrasound is not my strength, but I'm definitely becoming sort of more confident in it. Definitely trying to use, you know, both ultrasound and also radiographs for the work up of the urinary cases. Because doing both increases the chances the sensitivity of, you know, finding something, especially with detection of sort of bladder stones or sort of Ulis and things.
Also, just even in a case which is renal like you can also end up scanning the chest. So if you've got a cat on fluids, you know, you're wanting to monitor that you're not over hydrating them. Quick probe on the chest.
Have we got greater than three bee lines in our field? Or actually, we might be, you know, giving this cat too much fluid. Checking sort of the heart size called of vena cava.
Are they too big? Are they too small? That can help us assess sort of volume status as well.
So yeah, I think definitely Just using it more. Yeah, I think it's a really good point because obviously, cats are so small. And, yes, they're not little dogs, but it it is so easy to over perfuse them and cause problems, isn't it?
So we we have to be quite precise with our with our fluid therapy. You know, even with a cat that we think it's got kidney disease, you can overdo it, can't you? Yeah, absolutely.
I think in your head, especially if you've got, like, an a K. I case you're like, I just need to get as much fluid into this cat, flush the kidneys out, and it doesn't It doesn't work like that. Like you can give them can give them too much.
You obviously want to get them. You know, rehydrated, make sure year and allowing for any sort of additional losses and things and maintenance. But having them on five times maintenance isn't going to improve that as a team year for them.
And I suppose where you can potentially miss it is when you take X rays and you have the big kidney little kidney syndrome where, you know, we have missed those, you know, not so obvious signs earlier, earlier, on and then I think there was still some work at the conference where sometimes you can help things if you can unblock quickly enough, can't you? Yeah, definitely. So with the sort of upper urinary tract obstructions, you know, some of them will respond to medical management, So getting them on fluids, I think sometimes maybe giving them a diuretic can help as well.
Obviously, you know, monitoring to see if your renal parameters are improving. But I think the vast majority which obstruct, sort of the year it is. I think a lot of them do need sort of referral and, sort of, you know, bypasses placing and things.
But it's being aware of these conditions in the first place. So if you get one in practise, you know you're gonna be able to sort of, recognise it and then can get everything in place to put the best provision of care in for that cat. Really?
So I think the more that we're talking about these conditions because I don't think it was mentioned when I was at university about ureteral obstruction like we all knew about urethral obstruction, we were all quaking in our boots on call that you would get a blood, but nobody mentioned your terrible obstruction. So and I think it's it's to do. What do you do afterwards?
Yeah, I definitely don't want to be put forward for for doing some of the bypass surgeries. I think that we leave that to the surgical experts. Obviously, you know, kidneys and bladder stones or stones in Ulis in general are very sort of intimately linked, you know, certainly part of why you might get kidney disease, but it was interesting at the conference talking about the number of, bladder stones where we operate on mistakenly.
And this is where, of course, nutrition is so important, isn't it? Nutrition, obviously for kidneys as well. But you know, particularly talking about it for bladders.
How do you prevent that happening? And my feeling when I saw those figures of, you know, I think it was 50% of stones taken out post surgery or or struvite and obviously could have been dissolved and dissolved quite quickly. Is that something that, you know, Is it young graduates who don't kind of get that?
Or is it older vets and sometimes you know who who are a bit blase. They've seen the stone, and they're very good at cutting open a gap. Going into a bladder, fishing stones out and actually missing a bit.
Where do you think that discrepancy comes? Because, you know, I remember when I was, you know? Well, even when I was a student, I was very interested in nutrition.
I did all the hills exams. Kind of saw the importance of kidney diets, I think would extend life, obviously, bladder diets, in the various sorts, so obviously would look and and, you know, look at urine under the microscope to see what I thought the the Stones were. And things What?
What do you think is happening there? Or is that Was that a very much an American story as well? Because obviously it was Josie who was talking about it.
What are your both your thoughts. We'll start with Macarena first. Yeah.
Thank you, I. I would say that in when I first started when I was first graduated. I've done it.
I've removed stones and was through by like, you know I know I didn't know that. So I think the further. We're going with feline medicine.
The more awareness there is people now these days know Hold on a minute. What do we have here? I think knowledge is the key is like awareness of you don't have to cut into a bladder to get a stone if we can fix with nutrition.
And again, I'm guilty myself. I've done it in the past. Like as a new grad.
You're there. You have to find stone. It's like, Oh, I need to remove it.
And in a way, you think right? I can't fix this gap, but I think new grads because, we have a few new grads in my practise, and they are very on it, I think new generations and getting more awareness of this. And I think we're doing a great job of, like, passing on the message and making people aware of this and so that we have a new grad.
Now she's wonderful, and she will never go into a bladder because she's aware of the the solution again. I know. 10 years ago, Yes, I've done it.
I've done it because that was what you should do back in the day. But I think, between like, you know, podcasts. ISFM There's such a big awareness these days of going forward so recently as well, like one of my colleagues who was like, Oh, I got a bladder stone.
I was like, What is it? Have you checked the urine? Do we have crystals?
And it's like I think it's like, Right, we're going to go for the solution. He's like, OK, how far is going to be like faster than you think? So that's the thing.
It's like people still don't know how fast we can dissolute through crystals and stones with diet simply just that. Then you have the client that said, Oh, he doesn't like that food. It's like, Well, we can help you to get through that you know, like little by little, trying to get through that.
Obviously, you might have the odd cat that will not eat that food, but at least you have to try. You have to encourage them to go for that. There's different brands, the different flavours.
There's different, you know, textures. So this there's gonna be always a way together. We're gonna be able to find something for them.
Just help them through them with a knife and get them out. I feel I've missed out of it because the cat who adopted me the room whereas both cats, your cats have obviously been very well trained to walk across the screen. But we know this is the thing cast off fastidious, also with diet.
So I think it's a great point. You know, it may not be the hills diet, but it might the royal canon one vice versa, or the Purina or whatever. Anything to add on that as well.
So, yeah, I guess a couple of things. I think the difficulty that we have often with these cases is that cats don't always follow the textbook. So I think sometimes it's not very clear cut.
It's not very obvious. You know, you can examine a urine sample and you might see strew vte crystals Doesn't necessarily mean the stone you're seeing on your X Ray is definitely strew V. We know that, you know, in the vast majority of sort of upper urinary stones, you know, you can be pretty confident that they're going to be calcium oxalate, so you know they're not going to dissolve.
That is something that you need to be screening the cat for hypercalcemia. And that's a whole different story. And then generally, you know, our calcium oxalate stones, like if they were in the bladder tend to be sort of smaller.
We might have more of them, but there is definitely an overlap, so that can make it, I think, as a clinician, difficult to sort of interpret. But, I think like Macca says, You know, I think you don't necessarily have to rush to surgery. And if you're suspicious of the strew V and you know that it's not a detriment to a cat to not cut straight away, then absolutely try with the diet.
Because if it is strew V, you know it will dissolve really quickly. So it was really interesting seeing some of the pictures about how quickly things could dissolve and then also being able to see you know how stones look. You can get an indication from a radiograph of stone as well, can't you?
So all of these things are helpful. And, you know, you were both talking about ultrasound before and and obviously it can be misleading, but my favourite tool that I had in practise was my microscope, because you can learn so much in all well, not in all fields, but a lot of fields with a decent microscope, can't you? Yeah, definitely.
I think the key message there is, obviously, if it's strew V, we should give it a chance, although again sometimes with diet. And my worry was always, you know, a cap that was, for example, kept on SD for too long. Could be more prone to getting calcium oxalate, couldn't it?
So it's this balancing act all the time, of how stones can come and go. And obviously, as you said, the upper upper urinary tract stones are much more likely to be oxalate stones, aren't they? I think, you know, with our urinary diets.
A key thing is to be maximising the cat's hydration. So lots of wet food. You know there's that Purina Hydro care, for example, sort of water fountains, all of that stuff because regardless of what type of urinary diet they're on, if our urine is nice and dilute, it's not going to be super saturated.
So theoretically they shouldn't be sort of forming those stones in the first place. So I think a lot of it is sort of client education about that side of things as well. Cats like to get their water in different ways.
I've got a bird outside, so we will go out for that. And I don't want to talk about the rather disgusting habit of, trying to get water out of the toilet. They do strange things that they're awkward.
0 100%. But that's why we love them. So absolutely.
Yeah, but something really interesting because because we had, we went to a like a behavioural talk as well, didn't we? We Sergio, He was great. And it was talking about like, like, you know, like I never realised that actually putting water next to food like my own cat had water next to food for years.
You know, it's just like they don't like to have it, like they don't like to have the water in a corner, but they cannot see anywhere around. So I normally I'm just now saying to people just like put the water away from the corner so the cat can turn around so he can see what he's doing rather than having to go to a corner and drink water for them. So there's different things we can try to do, like adding a bit of warm water to the wet food to make it more smelly as well.
So there's a lot of, like good tricks that we can do to encourage to the hydration as well, and definitely, and as as we also would want it, you know, not necessarily putting the food or the water next to the tray. Precise location is so important as well. So and litter trays as well.
Because other thing is like cats are lazy. They don't want to go to the toilet. They are scared of the the litter tray be put on top of the or next to the washing machine so they don't evacuate, so the urine stays for a bit longer again.
You have more chances for the urine to be more concentrated. So, it's just like rumours. So we were talking about that last night about the different kind of like litter trays to make sure that two litre tray one to another is a big litter tray.
Make sure they're clean, the subtract they have either they're covered or uncovered. So you need to offer the cat different kinds of litter trays to make sure that they are using toilet as they like. Because again, they're cats, and they're not just gonna sit and settle for anything.
So they just want to find the the the liked one. Yeah. Yeah.
No, definitely. Listen, it's been absolutely fantastic speaking to you both, good to relive those memories. Of course, reliving them helps to sort of, concrete that knowledge as well, doesn't it that we've all learned, six months, seven months ago.
But I really appreciate your your time. Some really good insights. I always stay with a podcast or a webinar.
People who are listening can take one or two things away from that. Bring it into the professional practise that it's been a half an hour or an hour well spent. And I've certainly enjoyed spending this half an hour with you both.
Thank you. It's been great. It's been lovely.
Thank you so much. Thank you. Thank you both for, taking time.
Thanks everyone for listening. I hope you found this useful. Hopefully.
See you on a podcast or a webinar. Very soon. This has been Anthony Chadwick from the Webinar Vet.
And this has been vet Chat the U K's number one Veterinary podcast. Thank you. Bye.
