So we've got our, we've got our round table session now. We have got a few questions, particularly for you, Alex, if you're there. I see your, your screens come up, but I can't see you.

So I thought I'd start off with those and then invite anybody who wants to to pop any other questions in the, in the Q&A for us and then we'll see. How these two brilliant people can perform under pressure, which I'm sure is fine. So, this one I think is for you, Alex, but also for you, Georgia, I suppose, do you feel that in some cases we need to aim for a target weight less than ideal, so the usual lack of compliance with weight management measures still have a positive effect on the pet's quality of life, as many owners still offer too much food, too many treats and and less exercise than recommended.

It's, sorry, if I just make sure I understand that, sorry, the line cut out a little bit a target weight below ideal was that? Is it better to, yeah, I say, is it better to . It says aim for target rate less than ideal.

In fact, I'm, I'm, yes, I, I don't understand either. I don't know whether that means go for lower than I can, I can play it both ways, don't I? So I suppose one thought would be whether you're actually deliberately setting your target weight below what the ideal weight is on a kilogramme to get to it, yeah.

Yeah, we probably wouldn't ever try to get them to go less. Bear in mind, obviously the healthy weight is a range. So, you know, so you, we, we, we, it wouldn't be uncommon to.

To try to sort of, you know, the, the, the ideal weight to come out as the lower end of that range, maybe when, for example, a dog was a 4 out of 9 rather than a 5 out of 9, and technically it's not below their ideal because it's within the ideal weight range. OK. I suppose the other way to be looking at this is whether you're, you're kind of from a psychological point of view, you actually almost try to say to them, this is actually where we need to go.

And they kind of get to what you want their target, the actual ideal weight to be, and then you say actually we're, we're good, we can stop here. So it's almost like. Making the journey look worse than it is and and and then kind of surprising them that that things are done sooner.

Georgia might want to comment whether that would be a useful strategy. The the only other way they could be reading it was their meaning that the target weight is kind of, we, we're kind of compromising anyway with the weight, knowing it's, it's challenging, so, so, you know, there may be no medical problems, but sometimes we do kind of say allow an owner, for example, who's happy. They've, they've gone far enough, even if their patient's overweight, their, their, their pet's overweight, sometimes we'll, we will kind of end them early as a compromise.

So it may have been that that's what they were getting at, but whatever they're doing, I hope I've provided enough answers that people can take which one they prefer. I know when I was running clinics, I would say, you know, we're going to aim roughly for here, this is what this is, should be the ideal if they look great when they're 3. I will stop if they look like they could do with a bit more, we'll carry on and, and be a bit fudgy about it and then hope that the improvements in quality of life that they could see he gotten spurred them on.

Georgia, have you got anything to add to that before I go to the next question? Yeah, I think so. I mean, it's very difficult from a sort of creating expectation point of view, you know, and then say, right, we want your dog to be 20, but actually we're going to finish.

At 25, I can well imagine an own going, Yeah, but hang on, we've not done what you said we should do. You know, I, I don't know whether, what they'd be like, like that. But I think it's that, that flexibility is so, so important, you know?

And I always say, yes, this is what we believe is their ideal weight. However, it's not set in stone. When we're done, we're done.

And I would far rather they lost a little bit and kept it off. Forever, then, you know, went all the way down and bounced back up and, you know, went on that sort of yo yo, kind of, a thing that goes on. So, I think it's very much individual as to where those situations, come.

But certainly, taking everything as a win, if it's in the right direction. And possibly your relationship with the owner makes a big difference there as well, with this, why you've stressed 1 to 1. You know, consistency of, of, clinician and, and, and, and nurse practitioner to, to see them because then they want to stick with you more.

And that's one of the key parts of why you can't just give them the information and a bag of food and tell them to go away. So hopefully, yeah, they, everyone's got that point going through. And I also, sorry, I just, just to add to that, from a vet or a nurse point of view, to have those clients and to have those relationships with them and be part of that success is incredibly rewarding for us.

You know, just coming in and, you know, on a case that you don't know, you don't quite get that back. Whereas if you're helping your own cases, you know, it's the sort of job satisfaction that everyone would hopefully want. So, yeah, yeah, that's a really good point.

OK, so the next question is, is a thyroid question, Alex, which came in when you were talking about the, the rareness of thyroid hypothyroidism. If you have thyroid hormones close to inferior threshold for hypothyroidism in an excessive weight pets, how can you tell if true hypo T4 or non thyroidal disease? Very good question.

And yeah, I, I, I, I may, may well not have disguised well my disdain for the diagnosis of hypothyroidism. And it's not to say you don't see genuine cases, it's just they're not nearly as common as we think. So, I guess probably as a general rule, as a clinician, if you never want to be wrong about any diagnosis, so you, or you only are ever write about a diagnosis, then you should only ever test.

Dogs, where you are pretty much 100% certain they have the disease to begin with. On that basis, the kind of, the likely prevalence of the disease in the population of testing is very high. So whatever the sensitivity and specificity of the tests, it's, you're going to be pretty reliable.

And so that, I guess, would be my main first rule, which is, you know, examine the patient and decide for yourself how likely is it, ignoring the weight. That this individual has hypothyroidism. So I want to think about all those other signs that we might see.

So, you know, particularly skin signs, so alopecia, we might get changes, of, of the coat quality, might see things like myxedema, you know, there, there, there may well be other signs which we would say, yeah, this, this looks like this patient otherwise independently has hyperthyroidism. I would also want to think about, is it likely at this particular age. So by and large, hypothyroidism in dogs is a disease of middle age to older dogs.

If it was a dog that's 1 or 2 years of age, it's probably, it's probably not got it, you know, so again, that would be one where I would say less likely. Granted, there can be congenital hypothyroid cases, but they present differently. They present as, disproportionate dwarf.

Animals, so that would be a completely different presentation anyway, so you can kind of discount that. So that's the, the second thing. First clinical science.

Secondly, is it the right kind of population? And thirdly, if I've got blood tests, then there will be other things on there that I can kind of cross-check as verification. And I say the one I, I mentioned in the talk was cholesterol.

It's uncommon for cholesterol to be in double figures if you measure on a millimole per litre basis. So if your cholesterol's 1516, 17, I want to know why that is, and there aren't many things other than hypothyroidism that do that. So, I guess my first point is checking other things.

The other thing is, I would never do a T4 on its own, so I'd want to run that alongside something like a TSH and if in doubt, I might even think about a stimulating, you know, doing a, a test where we for stimulating either TSH or TRF. Stimulating if needs be, but usually you don't need to do that, . So I, I guess, for, for my mind, that's the way we go.

We, George and I interestingly had a case recently where we were unsure, and we'd done free T4 and it was borderline and we weren't sure. So we had decided to, well, not to ignore it, but to park the thyroid on the basis that if it didn't lose weight on our normal plan, then we'd come back to it, because that's my final criterion. And remind me what happened, Georgia, it lost weight perfectly well, so it's losing weight incredibly well, yeah.

And when we retested it, actually the tee4 was fine. So I think for me, if in doubt, try the weight loss because you've got a bit of time, and if it's not working, then you can retest. That's a great rule of thumb.

Thanks, Alex. On the back of that, if you are starting thyroxine supplementation in obese hypothyroid patients, how do you calculate calculate the thyroxine dose? Is it based on actual weight or their target weight or you know, the ideal weight?

Yeah. I don't lose sleep over this, to be honest. I, I would do it, typically, we just do it on the normal weight because most drug doses are, are based on that, and that's not to say we shouldn't do that.

But ultimately for thyroid disease, you base the, the, the final dose on response to therapy. So I would start them on a, an amount. Which is typically 22 mcg per kilogramme, you know, that's, that's there, again, different products may say different things, so that would reduce the chosen amount.

I wouldn't, I mean, I'd probably use the current weight. I don't think it matters. I'd test them 4 to 6 weeks later and see where their, their T4 levels are.

And, and ultimately, the, the dose is then finessed onto that. Thank you. OK, do you keep energy restriction brackets, weight loss management during post-surgery recovery?

How can it affect healing? OK, I missed the first bit. Sorry, my connection isn't great, so can you do you mind just repeating that question?

Yeah, do you keep up with the weight loss management plan, if you are, if you've got a patient recovering postoperatively. So if they have to go into something in the middle of your plan, perhaps you're getting weight loss before they could have. Orthopaedic surgery or something.

Yeah, so, yeah, it's good, it's a good question. Typically we don't, we don't change that partly because, of course, during recovery, effects on energy balance are going to be variable. So the likelihood is they're going to be less active, and, and therefore, their, their kind of requirements may be less certainly from an energy point of view.

So generally, we wouldn't say, let's just pause the weight loss. You could make a case, could there be concerns with healing? But I don't, I, I think in reality it's not something we'd be too worried about.

Part of the reason for using the therapeutic diets, as everyone would know, is that you've got all those extra essential nutrients relative to the energy, so you should still be delivering enough, enough of the calories of all your essential nutrients. Certainly we've not observed any problems with healing clinically, . So I, I think again for me, I usually it's better not to make a, a, a, a change unless there's a real reason.

Yeah, I can chip in it I'll chip in as a, as a, as a spokesperson for pet food manufacturer. So, for satiety in that it's got because it's high protein and it's got, you know, it's got antioxidants, it's also got, the foss and moss and things that will help support the gut actually. It's going to be better doing that than switching to something, you know, a normal diet or just home cooked land or or whatever.

And I would suggest that it doesn't make any difference at all. So it's going to help support wound healing as well, and just because it's not a low protein diet. So as long as it's a properly formulated weight loss diet, I society or, or perhaps another particular brand that you, that we, we're not talking about today, then you could, you can have no problems keeping them on it.

From the, pet owner's point of view, when we do have those patients, I would probably try and set the expectations that if we don't get any weight loss in that two week recovery period, it's fine. You know, I, we wouldn't necessarily change the diet, but, we probably just have to accept that we might not. You know, the weight loss might pause naturally.

If it doesn't, great, you know, but we're not going to push it within that, phase either. And then just let them recover and see how the weight loss continues afterwards. OK.

I've got one more very specific question, before we go on to, I can see that lots of questions popping in on the Q&A. So, what would you recommend for an overweight cat that's currently cage resting, needs to lose about 1.5 kg.

The cat has a stable fracture of its tibia and fibula. Pulsing. Wait a few weeks.

I mean, it's, I guess it depends on how long standing the weight is. I mean, it needs to lose 1.5, I guess it depends on whether there are other impacts of it.

I don't, I don't think necessarily you, I mean, you could, you could start that, recognising that cat's not going to be very active. You'd build in, as we talked about, an adjustment for inactivity. But a little bit like as, as George said just a moment ago, in that first two weeks, we wouldn't necessarily be expecting wonders.

So again, we might want to just. Manage owners' expectations. If they were being hospitalised that time, so we had control, that actually could be an opportunity, possibly to go even a little bit more.

I was going to use the term brutal, but that's not, it's not the right term for a communication point of view. Yes, so that we, we, we could, you know, just to get some a little bit of success to show that it can be done. Right.

Yeah, there's probably not a hard and fast rule as to to when and and where. OK. So, I'm gonna go to to the bottom of these questions.

May I ask why all veterinary formulated diets, oh, this is a question for me. I'm gonna come on to some questions for everybody. If you choose one practical and simple weight loss intervention for maximum impact in the shortest time, so the owners become motivated to continue their pet's weight loss journey with you over a medium to long term, what would you recommend to start?

11 Practical and simple weight loss intervention. Georgia, you have one. Well, I mean, I think.

I think in the media, any, any inspect it's just weighing them. Being aware of what's going on. If you, you know, even if you're starting plans and that sort of thing, if you don't weigh them, you don't know what's going on.

So the intervention for me would be to weigh them frequently. Great, thank you. I'm gonna carry on.

No, no, no, no, no, Alex. Yeah, I, I think it partly depends on what your intention is, but if, if you've got an owner who's undecided, then I, I would certainly agree that, you know, well, you know, finding something simple, weighing is a, is a good one because it doesn't create a lot of a burden, or seeing if there's something an owner might be able to suggest. Oh yeah, OK, maybe I can try out the treats or I can try weighing the food, just almost to get them on the process.

If you want to say, what's the best chance that, you know, if I want to know that in the first few weeks of weight loss, I get success, then the, the thing I would, I wouldn't recommend changing exercise, I wouldn't like that, but I would, I would go absolutely hell forever with the diet plan. And we, we've done this, and we would typically go, you know, we, we'd almost didn't go sub the sort of starting points normally because we want to make sure we get some success. But that, that's a kind of different case from maybe an undeci donor.

Yeah. . I'm gonna I just answer the question that that's come to me because I do want to answer it.

Why a veterinary formulated diets use rehydrated or should be dehydrated meat or meat derivatives as their main protein source, not fresh meat. Owners are wanting more and more to feed free range food to their pets and also fresh meat. It's because they don't know anything about nutrition because dehydrated meat is simply fresh meat with the water taken out.

So fresh meat doesn't give any indication as to how much protein the animal will get. The only way to tell what's in the diet, in terms of quality is to look. The guaranteed analysis, not the ingredients list.

So this is an education thing. If you work in practise and you would like to contact your business manager, you can have access to some of our nutritional truth trainings or we can do some with your practise. And so this is something that's, we're really trying to get this message out to people because they just simply don't understand the nutrition.

And, meat and animal derivatives just means it was derived from a meat source, not a plant derivative, which would be derived from a plant source, but it's the misunderstanding of terminology. In the short term, if you, if you don't want to pursue some extra training on nutritional truths. You can go to Pet Food UK and look up some of the, the fact sheets that are written in very plain English about legislation and terminology and pet foods, very useful resource, and very easy for clients to understand as well.

So that, that's, that's not really anything to do with, Our, our topic today, but it's a, it's a really big topic because you're gonna come across this more often than, than we would like, but it's just simply misunderstanding. So, feel free to, to, to drop us a line with your, you know, in, in the chat box with your email address. I'm happy to take this offline and talk to you about it, if you wish.

Right. Is it still advised to not start a new diet when a kidney is staying in clinic, for example, a kidney diet due to possible food aversion? Yes, still advised not to.

In short, if you would you like to add anything to that? Either of you. I, I, I kind of again my line dropped out, Georgia, did you want to get, get, I'm sorry about that.

Sorry, Alex. Yeah, no, I, I mean, I, I think in many cases, yes. I think there potentially are some cases where you may well need to change the diet.

It depends how long the patient's likely to be staying in for and how critical the diet changes are. Potentially, but definitely we don't want to cause a food aversion or anything that that might do, but yeah, Alex, I don't know if you have any anything further on that. So do you mind just remind me of the original question, because I didn't hear it all, I'm sorry.

Is it still recommended to not feed a diet that you want them to feed in the long term if they're an inpatient hospital? My, my response to that is we, we recommend particularly with cats that we bear in mind food aversion for something like a kidney diet or, or something that's really critical to feed. And Georgia said it also balance out how long they've got to be and how critical that diet changes.

So, I think. It probably has the most bearing on the sort of senior cats with chronic disease, and that, and, and particularly kidney disease above all else is one where food aversion's an issue. I'm not sure I'd be too concerned about that with any, any case that is hospitalised necessarily, if they're otherwise well.

In fact, there's sometimes an argument they won't eat unless they're eating a familiar food. But I suppose where nausea potentially can play a part, that would, that would be the ones where I, I would certainly agree be cautious. Or I mean, there is an ad in, in that there are lots of different flavours of.

A sort of renal foods. I'm talking across, you know, companies, and it's not unheard of for some cases to have to go round the houses with different recipes and things, just because they seem to be fine and then suddenly they'll go off one for whatever reason, and, and, and sometimes without, you know, without a clear explanation. And it's not unheard of to be able to go back to some of the original ones again.

So, yeah, I, I wouldn't necessarily sort of choose the worst possible diet, you know, of my, of my choice diet, therapeutic diets at that point, just for, to, to solve the aversion, but just hopefully have enough, have enough up your sleeve, if, if you need to change. Yeah. So we've got another question and how can we discuss these online tailored diets?

I think we know who we're talking about. There aren't necessarily as tailors, as they think. I've had a few of my clients, at my clinic's clients, I think she said that won't budge as they think they're receiving a bespoke diet.

I find them harder than other life stage diets to sway to sway them away to try diet foods. So it's harder to move them away than feeding a regular life stage food. So do you have a, do you come across that, you, you too in your clinic?

I think we're talking about yeah I must admit I've not specifically come across that. I don't know, Georgia or whether. So I suppose, yeah, I suppose we have a slightly different situation because we wouldn't, contemplate using a diet that we didn't consider was safe for weight loss.

So whether it's that one or another diet that we didn't, but in, in sort of general practise, when you're met with that level of resistance, it's, it is very difficult. And I suppose it's understanding from the owner's point of view, why is that so important? To them what's so important about that tailored, tailored diet that they feel they cannot get from a life stage diet?

Is it necessary to change to the life stage diet is probably the other question. If we're talking weight loss, then that's maybe different, but, you know, if the, if the food that they're currently on is complete and balanced, and, you know, they like this tailoring, whether we believe that it's as tailored as they do. Who, who know, who knows, but so yeah, I think I would want to understand more about the owners' motivations and what their resistance actually is before being able to move forward in whatever way.

Yeah, yeah, it's difficult, I think, sorry, you go ahead and I I was just gonna say I think that, I think we need to bear in mind and maybe that's again, this is part of the nutritional truths I've mentioned to to previous question. A lot of it is people's response to marketing rather than their knowledge of, of what's nutritionally correct, what's the ideal thing for their pets. So it's perhaps, perhaps we can give you lots of, lots of .

You know, tools to be able to answer these sorts of questions. But ultimately, marketing, you know, companies are really good at marketing and, and, you know, looking at nice bags and nice, nice pictures. It doesn't really give any information about what's inside.

So I think it's, it's very difficult to sway, to sway some people and, I, I guess I would say if you're, if you're trying to get somebody off for for a specific reason to lose weight and the animals not You know, is overweight with the diet that they've had made bespokely for them, then you just make it bite size, work out how long you think it might take and just say, look, let's just do it for your health of your animal from this time. And, and then you can always move back, you know, let's see how they go. And I think, you know, changing the world in one go is really difficult, but bite size is, is an easier way to do it, you know, so you don't, you're not changing everything about their life.

You're just doing something for the good of the pets and you'll work with them. Maybe that would be the answer. There's just the specific points I just wanted to add were related to weight loss, and can you ever use something that's not a therapeutic diet?

And if so, what are the kind of limits of what you would choose? So, a lot of the diets that we're talking about there aren't specifically designed for weight loss. That means essentially the nutrient contents have been, engineered to ensure that even despite removing the calories, you, you feed sufficient of everything.

We have done a study where we looked at using one of the sort of lower energy maintenance diets like the so-called light diets or a range of them, and looking at getting some modest weight loss with them and also comparing essential nutrient intakes, we can provide details if anyone's interested. Generally speaking, that was safe over a period of 2 months in that study, and though the average weight loss in that time was about 5%. So it's not a lot, it's about half a condition score unit in that time.

And then once you start getting longer, you're starting to have to make adjustments down because we were kind of feeding right about 80% of energy requirements rather than somewhere between 60 and 80%. So it would potentially lend itself to a dog or cat that's a 6 out of 9, or, or for the sort of senior cat where 6 out of 9 might be more normal, a 7 out of 9 down to a 6 out of 9. That, that's probably as far as you want to go.

If you've got a patient that is significantly more overweight than that. In order to get them, particularly if you're getting them anyway, towards their ideal weight, you need to restrict them more and for longer periods. So we certainly wouldn't be recommending that approach, and again, a therapeutic diet would be the one we would do.

And again, it might come back to what Georgia and what you've been saying in terms of understanding. What their motivation is to see how we can move them towards that. Thank you.

Now, I've got one question here about a specific cat. This lady said she's put her cat on a diet and not insulin, despite the vets saying that's what she should do. The cat isn't excessively peeing or drinking and has lost weight.

Should she get the blood's retested, this was 2 to 3 months ago. Thank you. I would say yes as a lay person.

So I guess the part of the question and I thought there was, we're assuming that the vet has made a diagnosis that the cat's diabetic, I guess is my understanding. My understanding too. And, and so I think if there's some doubt about that from a clinical science point of view, then certainly rechecking is sensible.

It's possible that there, that it was diagnosed on the basis of either just a blood glucose or possibly even blood and urine glucose, and what we might be seeing is a stress hyperglycemia, which is very common, as most people, I'm sure know, within the practise. So retesting, plus also maybe recommending doing fructosamine, which will give us an idea about where glucose has been over a 2 to 3 week period, I think would make sense. Now it's possible that the, the cat was only ever borderline diabetic, and if it has lost some weight, it may now be back into a kind of pre-diabetic phase.

So it's possible it was on the verge or, or, or, or just had just tipped over. So it could still have had diabetes before and it's now in remission, particularly if it's lost some weight. Again, you still wouldn't need insulin, but it would be not worth knowing where does it stand from a glucose sensitivity point of view.

Yeah, lovely. And we've got 2 more questions here. Can we refer clients to you for additional weight loss help, please?

Georgia? Yeah, absolutely. So.

So we are more than happy to take cases from anywhere, now because we do, we offer remote cases and in-person cases or a combination of both. So, even if you are a way away, you can refer the cases just like any other cases. But we are also helped, sorry, we're also happy to offer advice on cases.

So, in the way you can send in a sort of advice referral to us and we'll take a look at the case, probably have a chat with you, and make some recommendations. So depending on what you're dealing with in practise, yes, we're more than happy to help. Perfect.

And then final question we have. So just on that, can I just, thanks to the ongoing and very generous support of Royal Cannon, we're into our sort of 19th year now, and it is a subsidised service so. It's not something we charge for from a the consultations aren't charged.

If they, if they come and have a full workup, including DEXA, which we'll do on, on occasion now, those costs are covered. First food also is offered free. It's actually only then the therapeutic diets subsequent to that.

Or if there are comorbidities that need managing, either the vet needs to do those or, or there would be costs if we did them. Great. Excellent clinic, working very well.

And, I was gonna say final question, but then we've had a, an update from, our, our lady with the cat that you just answered about the potentially stress hyperglycemia. Thank you. I think it was due to stress.

My cat had a UTI and we went from there to, regarding a diabetic diagnosis. I'm just not seeing any huge side effects or symptoms. She's on a low carb wet food now.

OK. So it may even be that changing, she was diabetic and moving to a low carb food that's put her into remission. There's that possibility.

The other question, it might even be if there's, if we've got time to get a further reply, to just to know how, how the diagnosis was made. Was it a blood test? Was it a urine test, or was it both?

The only other possibility was if it were done on a, on a urine test only. You can sometimes have problems within the kidneys affecting the kid where you get leakage of glucose from the kidney tubules, a so-called complex tubular disorder, where the blood glucose is normal, and that can present, you know, if you just do a, a, a urine dipstick, you can make the mistake it's a diabetic cat. So there are potentially other things that could, could be worth working, working, but that one, I think if it was a blood test, we can kind of discount that one.

Great, OK. She was just in the diabetic zone, she believes. And the final question, I think George is for you, I'm looking to maybe work in nutrition at some point in the future, where would be a good place to start, and this is from an RVM.

So I think there is now, thankfully, lots of nutrition CPD out there, which is probably the best place to start. And then I, I guess once you feel that you've, done your CPD that you've upskilled yourself in the, in sort of nutrition skills, is to then be open to opportunities looking around, at maybe different companies that would offer, the ability to work in nutrition. If you'll stay.

In practise, then obviously getting that CPD doing, there's lots of courses now out there, everything from just CPD to something very formal. I think there is a master's now in Edinburgh, I believe that, they do a nutrition master's, for vet nurses now. So there's a huge range, of courses to choose from, depending on your current level of experience and what you're hoping to achieve later down the line.

Great. We would like people to be interested in nutrition. So I, unless any other last-minute questions pop in, I think we're giving you a half hour back.

It just, anything else you want to add before we close this, Alex or Georgia? I've covered. I'm sure we've, we've killed them all off, I think.

Well, from my point of view listening in, it's been a fantastic day. So thank you both very much for attending. And thank you to all of the people who've given up their day to attend.

I've just seen something pop in. Oh, lovely thank you. So, it's been fantastic.

We've had, the survey has been put in the chat. If anyone can fill that in, it'd be great. Your CPD certificates will be available from the webinar website next week as well the recording.

So if you've had to nip out and you've missed any bits here, you can, You can, you can access this next week. And we've got lots of thank yous coming in. I'm not sure if you can see them, Alex and Georgia, but there's lots of people very happy that, they, they've joined today.

So we can close this down and enjoy the rest of your evenings or possibly days if you've got somebody from Chile. Great. Thank you.

Thank you. Bye bye.