Hello, it's Anthony Chadwick from the webinar Vets, welcoming you to another episode of Vet Chat, and we're very fortunate today to have one of my best friends, superstar vets, queen of behavioural medicine, it's Sarah Heath. Thanks for coming on, Sarah. Hi Anthony, lovely to see you or hear you.

Great to see you and hear you, although as, as a podcast, this is obviously just a. And audio, and, you know, it's really interesting, so, we, we spend a lot of time together going to the football. One of our passions is Liverpool Football Club.

We, whenever this comes out, we'll, we'll probably know whether we've won cups or what we've done, but . It's been an exciting season, hasn't it? It certainly has.

It's been a, yeah, exciting, but also I know that when we see each other every other Saturday at Anfield, we, we often say that, gosh, this is our hobby, and yet we're here we are having a heart attack. So yeah, I'm not quite sure why we put put ourselves through such immense stresses in in the name of a hobby, but, yeah, it's been, it's been a great season, it's been great. I've been to Wembley already once, about to go to Wembley again on Saturday, the FA Cup finals, so.

Oh yeah, it's been, it's been great. And and then of course we've got Paris as well, so, yeah. It's all, it's all good.

What's really fascinating was, you know, finding out perhaps a little bit about your background because, of course, when you, started your behavioural practise, you were really the first vet, I think, correct me if I'm wrong, in the UK. That was doing behavioural medicine, there were obviously behaviourists there who were non-vets, but I think you were really one of the first if not the first to set up a behavioural practise, weren't you? Yeah, in terms of a clinical practise in behavioural medicine, I was the first.

Daniel Mills was the first person to be, sort of, recognised, in the profession, but slightly more of an academic background than myself, although Daniel and I have done a lot of work together over the years, and one of our greatest achievements was the setting up of the International Veterinary behaviour Meeting which Daniel and I started in 1997. So yeah, so we've done a lot together. But probably from a clinical in practise, you know, communicating with GP level behaviour and behavioural medicine, then yeah, certainly.

I was in there at the beginning, Anthony, which basically means I'm old. You're not old, Sarah. If you're old, then I'm old, so I'm not allowing that.

Sarah, just really interesting, you know, obviously you want to be a vet, but where did this interest, I actually think, you know, it's normal, isn't it, that we think of animals as having characters, you know, they have personalities and so on. But of course if you go back 30, 40 years, I remember John Webster, I think he was professor at Bristol, wasn't he? He was when I was when I was there as a student, yeah.

And he gave us lectures. He came up to Liverpool and this was really the first welfare unit and that would have been, you know, in the 80s. So going back to, you know, maybe before you went to vet school, did, was that something that you already had a feeling for had you done stuff?

Was that just part of who you were, or had you done stuff perhaps before going to vet school that had had made you become interested in behavioural medicine, perhaps without you realising that you were calling it behavioural medicine or animal welfare? Very definitely, yeah, from, well from the age of 8 I wanted to be a vet. And then as soon as, you know, I'm absolutely unwavering ever since and and still, you know, more than 30 years qualified and I still absolutely love the job, the profession, and would never do anything else.

So it's been part of my life, obviously, since, since I was 18 in, in my head as a, as a concept of what I was going to do. And then of course, as soon as I could, I, I was looking for, for experience and I worked on dairy farms because I'm a Cheshire girl and I wanted to go to vet school to be a dairy vet, and I never even envisaged working with small animals that that never entered my head. It was cows, cows, cows, that's that's really what I cared about.

Although obviously I had dogs at home, and fish, goldfish, the old thing that we did in the back in the 70s. And, yeah, so I, I was had animals and I had a, also a very passionate interest in wildlife, particularly cheetahs, which is where my cat, passion comes from. And that to this day, back going back to Africa, thankfully this month to, so I spend a lot of time there when I can, because of that interest.

So it's all kind of linked together. And then I started working on the dairy farm and they had a stockman there called Len, who was unbelievably ahead of his time, but at the age of, I don't know, 1415 when I started working there. I really had no idea that what Len was telling me wasn't just normal knowledge for everyone that, that, that everyone thought like he did.

So I, I grew up with knowing that cows have feelings, they have emotions, that they're individuals, that he talked about the cows very much as individuals, and he would spend a lot of time thinking and debating about why a cow wouldn't use a particular cubicle. You know, what was it that upset her about that he talked in those sorts of terms or she's upset today, or she doesn't seem very happy or I'm not sure why she doesn't like that or that sort of terminology, really, talking about them having feelings. And then I went to vet school, and as you just said, John Webster was there and and talking about welfare.

And I was listening to this welfare stuff thinking, It's, it was being presented to us as vet students as very groundbreaking new information, new thinking, and a bramble report around that time that all of that was happening and there was a lot of interest in welfare. And I was thinking, this is what Len's been doing for years and years and years, and, and didn't really realise how new it was particularly to the veterinary profession at that time. And so yeah, I continued with my interest in cattle, wildlife, and then while I was at university, got very, very interested in cats through, Tim Griffith Jones was there, so obviously Bristol at that time was the place to be to understand that cats are incredibly important creatures and and fascinating and and not small dogs and not small dogs and my love of cheetahs then became translated into a love of love of domestic cats.

Yeah, and then gradually, it kind of expanded from that. We had one day of lectures from, Roger Mugford, who at the time, of course, was a very prominent non-veterinary person working in the field and has contributed a great deal to the understanding in the field as well. And he gave a one day of lectures, and I'm sitting there thinking, oh gosh, this applies to small animals as well.

This is all the same thing. This is about them having emotions, this is about them, you know, perceiving the world differently to us and us needing to understand them in their species specific right. So yeah, very much comes from a welfare background and large animal originally, wildlife, and then at vet school, realising, gosh, this applies to small animals as well, and then went into a 70-30 large small veterinary practise for my first job, very much still large animal orientated at that stage, but then started seeing the reality of emotional health in domestic animals that were being presented and, I, I, I've been really fortunate to be surrounded by very forward thinking people in my life.

So Len was the first one, then Jim Pincent, who I think you also remember, who was at Bristol, my large animal medicine lecturer, who talked about the art of veterinary science, talked about veterinary science being more than just science and. That you need to, he was talking about stockmen and farmers and understanding, you know, the whole system, if you like. But then when I got into general practise, I could see that applied to the caregivers of domestic pets as well, that their lives are inextricably entwined with one another.

It's when I set up the skin vets as my dermatology practise, I talked about the art and science of veterinary dermatology, you know, and it's the same, it's the same thing, and I think if you are empathetic. With the client, but also with the pet, you, you have an understanding of where the pet's going, you know, is this a pet that's going to suddenly try and launch at you or, you know, is it a pet that you can give a, give a stroke to or whatever, and it makes our job a lot easier if we can think in that empathetic way, doesn't it? Absolutely.

And, and I was very fortunate. My first job, I stayed there for 4 years until I set up behavioural referrals, veterinary practises, so I set up. My practise in, 1992, it's 30 years old this year.

And so, yeah, I was very fortunate. I worked for, for this mixed practise and my boss, Peter Waite was again another forward thinking ahead of his time, there, and I owe a lot to him. And he was already enlisting the services of David Appleby as a behaviourist for his clients.

Now that was really forward thinking. So he was already having David come in, to see clients, who he was referring to him, so. On my, in those days I had a half day on a Monday, in my clinical work and GP practise, and on a Monday afternoon I would ask David Appleby if I referred a case to him if he would book it for a Monday afternoon and I'd go to the house and see the case with him.

And so that David Appleby's another person I owe a lot to, and he really started my interest in how this is a clinical subject. This is, this is a subject that actually applies to us. And welfare and behaviour are so intrinsically linked.

If you've got an unhappy cow, it's probably going to act strangely, it's probably, you know, not going to do as well with things like milk because if it's not in sound mind, it's probably not going to be in sound body either, is it? Yeah, and looking back, obviously at that stage I was already aware of the health triad, but not going to be calling it that or talking about it in those terms until after I, I established the sink analogy of emotional health in about 2010 and then started expanding from that into really considering the health triad and this idea that you have physical, emotional and cognitive health in all animals, whether they're human animals or non-human animals. And that that is really important for veterinary surgeons to consider healthcare is not just physical, it's physical, emotional and cognitive.

And they all interplay with one another because really, until really recently, we were asking questions like, is it medical or is it behavioural? And the question, that's not the right question. Because it's both, if we mean by medical health, physical health, well then it's physical and emotional and cognitive because healthcare is a triad and they're all interlinked with each other, and healthcare is what we as veterinary surgeons are charged with.

Looking after in terms of nonhuman animals that that's our domain to care for the health, which is all three aspects of nonhuman species. I remember probably one of the first times we met was at a dermatology conference where you were speaking about behaviour and it was very much. You know, because we had this feline endocrine alopecia condition which was of course didn't exist or is incredibly rare if it does exist.

Of course, a lot of the time that was just cats that were licking themselves because they, you know, weren't happy. OK, they may have a flea allergy as well, but just, yeah, exactly, but just controlling their cystitis or, or, or, you know, their flea allergy wasn't enough. You had to enrich environments as well.

That's fascinating. So optimised environments and just I, I know those people who hear me talk, know that I'm a bit of a stickler for language. That comes from my dear dad who's another influential person in my life, who, who passed away sadly, a long time ago now, but, he was a stickler for English and grammar, and I learned that I learned a love of language from him, but it has really served me well in that in my work I'm very.

Particular about words, just because I think it's really important not to underestimate how it, how the value of describing something with a word that enables people to understand what you're talking about. So people who know the sync model will know that I use the word repulsion, not fight and not aggression. As in repulsion, meaning you're trying to make something go away, and then talk about confrontation, which isn't necessarily repulsive, so confrontation can look very similar, but if it doesn't have the aim of getting something to go away, then it's not actually repulsion.

It, it's a confrontational response, and that's often associated with the emotion of frustration, for example. But the reason I just talked about words then is because you said environmental enrichment. And I think it's very important that we also are careful about how we describe environments because I think there are 3 things we do to environments.

One is what I term environmental optimisation, which is creating an environment that that supplies the needs of. Species and that's not optional. That is something that has to be done, like, you know, giving something to a pig to root in is not enrichment, it's an optimisation.

They, it's not an added extra that would be nice to have. It's something they absolutely need. So what we're looking at in optimisation is what does the species need?

So the cat has 5 pillars of environmental needs according to the AFPIFSM guidelines, which are excellent. And so that is optimisation if you're providing those. Enrichment for me is adding in extra, adding in the the stuff that would be nice to have but actually your life would still be OK if you didn't have it.

So I, I think there's a big difference between enrichment and optimisation. And then the other one is modification, so sometimes if you've got an animal that's lame or an animal that's got OA, you might need to modify the environment, so you put in a ramp or steps, which is neither enrichment nor optimisation, but it is modification and it's necessary. So I talk about environmental change in those three ways.

You either optimise it, which you should do for every single animal of any species, and then you can enrich it, which is adding stuff which is nice to have. But you could be having an optimal life without it, but you're just adding more of that, and then modification if you need it to modify it for a specific reason. So is LFC enrichment or optimisation?

It's probably in Richmond because I could, I could live my life without it. But I would find it very difficult to do so. Yeah, I mean this is all very interesting because at the moment I'm, I'm enjoying Sean Wensley's book through Yvette's side, which talks a lot about, you know, how pigs are kept, you know, from just bare cages and sow farrows into, you know, outdoors in, in very enriched environments where they're able to.

Exhibit some of those natural things that they do in the wild like, you know, grub around in in the in, in the soil for, you know, for things as well and you can't do that if you're on a bare cage, can you? No. Sean's a Liverpool graduate.

I taught him behavioural. And when he was at, Liverpool and he's he's an amazing guy, another forward-thinking individual who's contributed a great deal to animal welfare. So yeah, the book's great and, well done, Sean, that it's a great, addition to the, to the library.

Well worth a read, but hopefully we'll, we'll get to talk to Sean at some point, so do come in and listen to that one as well. Do you want to join the largest online veterinary community in the world? The webinar vet's membership is the perfect tool to complete your veterinary CPD with ease anytime, any place, on any connected device.

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I always think the problem, I go to the AWF most years. I think it was last week I didn't go, but most years I go to it down in London and Is there a danger? I remember reading a paper, I think it was in the vet record that said.

Veterinary surgeons. Don't know much more than ordinary members of the public, which I was shocked about. But of course when you go to something like the AWF.

You know, it's in a fairly small auditorium. There aren't huge numbers of people clamouring to get through the door. It's, it's something, you know, webinar vet obviously working, you know, with you and others.

We've seen it as being a very important part of, of what we do as GP vets. How can we become better vets? And to me, part of that is, is understanding the importance of welfare and behaviour and.

You know, is what are your thoughts about that paper if you remember it, and do you think it's a bit unfair, or do you think it's a, it's a fair judgement that we perhaps don't do as much as we should either, you know, through our, through our period at university, but perhaps also afterwards, do we take it as seriously as we should as vets and perhaps as nurses as well? I think we definitely, you can, can do better. I do think it's improved.

I mean, when I, you know, 30 odd years ago was, was, was starting to talk about behavioural medicine, I think the profession would like to have put me in a straitjacket and. A padded cell, you know, it's that sort of what on earth are you talking about? And also very much a feeling that that's not what vets do, that's what non-vets do.

And it's like, no, this is behavioural medicine, this is, this is what vets do, and we need the input of people who are looking at it from a cognitive point of view as well. So it's very important that we have, behavioural work is multidisciplinary, but behavioural medicine is a veterinary discipline. And so, and, but they work together or they should work together, complementing one another, and sadly, we have seen quite a lot of vet bashing from the non-vet behaviour world at times, and we have also seen vets who have not given enough credibility to behaviour as well.

So it, it's happens from both sides unfortunately, but I think it has got a lot better. And do you think the UK actually has been one of the best countries for recognising the multidisciplinary approach, and involving vets and non-vets in a harmonious way. It's one of, one of the best, I'm proud of that.

It's one of the best countries for that not to be so much of a divide and it's that's not what's good for the. For the animals. So if we think about human healthcare, it's multidisciplinary, you know, and when you think about cognitive, emotional and physical health, you can think about a child needs a doctor, a child needs a teacher, and a child may at times need a.

Psychologist, but all of those need to communicate, and that's probably one of the reasons we've got a mental health crisis in humans that that lack of communication, and we shouldn't kid ourselves that we're not on the verge of an emotional health crisis in domestic pets as well. And, and we need to be in, you know, in the mix of this as the BVA so nicely call it, but I really like this term, the vet led team. So yes, that should be leading this because these are nonverbal and not non-communicative, but they're not telling us in human language how they feel.

And so we need to have vets at the forefront, in order to safeguard welfare, but we do need a multidisciplinary approach. And the other thing is education of vets. No CPD and thank you to the webinar vet.

You've done a great deal for improving education to the veterinary profession, and you have included a lot about not only behavioural medicine, but also human wellness as well, and about the whole, you know, this one health concept and the one welfare concept. And you've been great at promoting that, so thank you to Webinar vet and to you, Antony for that. But what we also need to do is make sure there is undergraduate education as well as postgraduate supplies of CPD because we need to have a whole mindset of thinking in terms of the health triad from the beginning and even those vets who are not going to go and specialise in behavioural medicine, of course, not everyone's gonna do that.

It's a, it's a specialist niche, but. There's also general practise behavioural medicine, which is every single day. Do I neuter this dog?

Is this dog emotionally stable enough for me to castrate it? Should I think about giving emotional support to this cancer patient? Because of the emotional impact of this treatment, should I give pre-veterinary visit medication to this very anxious dog in order to not get too much negative impact from that veterinary visit?

This is behavioural medicine at GP level. And if we don't teach undergraduate vets about this, they won't have that mindset. Now Liverpool University, I've been there for a very long time supplying education there and we have traditionally done 3rd year lectures, and, and then we've done, handling in 1st year where we've spoken.

Emotional benefits of of understanding emotion for handling then 3rd year lectures, and then final year, we've done rotations, so small groups, just 4 or 5 people in a clinical context, really trying to get that mindset and I see a massive difference in the Liverpool graduates in that way. And I hear that from my GP colleagues that that they have thought differently because they've had this really small group, individual, I've known every vet student. And then seeing them at London Vett show last year, just in November, so lovely they come up to you and it's like you taught me behavioural medicine.

It's been so helpful and I've been in general practise. Now sadly that has been stopped in 2022 and it won't be small group, clinical teaching of behavioural medicine anymore, and I think that's really, really sad. They are going to do more clinical c clinical scenario based teaching with me in 4th year, but it's in a group of 70 students and that's not the same, and, and it won't get that, that individual interest, I, I fear will not, will not be there.

But Liverpool have done a great deal more than some other universities, and so what we need to be doing is making sure that we have a more standardised approach that behavioural medicine is a discipline of veterinary medicine just like any other. So it's it's as important as. Any other discipline.

Now we know that disciplines are not given equal time in the curriculum, of course they're not. So I'm not for a minute suggesting that behavioural medicine would get equal time to some of the disciplines which are, you know, the majority of of have more hours in the curriculum and I that's of course, that's right, but that it should be. A discipline which is recognised and must be part of the undergraduate curriculum and must be taught in a clinical sense.

So as part of clinical teaching, clinical rotations, not just in theory, not just in lectures, but in in a GP relevant way, so that when you go into general practise as a new graduate, you're thinking about healthcare in terms of the triad of health, emotional, physical and cognitive. No, I think it's really important. I mean, it is obviously I'm not as au fait with what's going on at all the universities.

You know, but 20 years ago there was very little talk on exotics and dentistry, and I think some of those areas are still not concentrated on, and yet dentistry, you know, is a huge area. And of course if you've got a bad tooth then you're probably going to be a bit grumpy about it, aren't you, and not wanting to be handled and things. Pain is so important in changes in behavioural output and dental or oral.

Pain, oral health is so important and I agree with you, it's another discipline that that thankfully is now recognised as a veterinary discipline, I think, but isn't given as much time as much devoted time and certainly not in a clinical context. So again, this idea that it it's got to be at that clinical stage of teaching where it's real sort of, you know, day one GP practise skills. I think the danger, and I think, you know, I'm sure universities recognise this, that.

Given what they see at universities, they can turn out people who know how to do a hip replacement, but, you know, perhaps haven't seen many bitch bays and so that that is the quandary, isn't it, because in the end, most of us, you know, like myself, will be GPs maybe with a special interest, but you know, we won't be specialists like, like yourself or or others. So we need to make sure that at the university level we're being taught. At the GP level, which then once you've qualified, you can go on to do other qualifications to go to that higher level in orthopaedics behaviour or whatever you want to do.

And it's interesting because I, I, I am not a general practitioner, I haven't been for, for many years, but you can't take the GP out of me. I, I am so much a clinician at heart, and I miss general practise. I didn't become a specialist because I didn't like general practise.

I became a specialist because I didn't have time to do general practise, and I locumed, alongside my specialism until 20 until the year 2000. And so I, because I didn't want to let go of general practise because I really loved it. It wasn't that I didn't like it, at all.

And, and I think my passion is to make sure that behavioural medicine is seen as, yes, a specialism, and of course I, you know, train residents, I'm very involved in the college. I totally believe it's a, it's a specialism, but also that it's a general practise skill. And that to try and make behavioural medicine more accessible and better serviced within general practise is something that, that, yeah, I definitely feel passionate about.

And I'll do that through, through CPD to, to qualified vets, but I, I do think we need to be putting it into the undergraduate curriculum. And as when you just said then about GP skills, I think we sometimes bash the Royal College, but the Royal College of Veterinary Surgeons actually has done something really great recently, which is to say to universities that 70% of their teaching must be relevant to general practise. Now that is brilliant.

Thank you, Royal College because that will help, hopefully to to to make the university, . Level of education, think about how relevant is this to general practise, because if 70% of their teaching has to be relevant to general practise, that's brilliant and, and that hopefully will have an effect on teaching and mean that, you know, people have to include dentistry and behavioural medicine and and things that are. Really relevant to your day one skills, what you're gonna, someone's going to ask you on your first day in practise.

Probably they're going to ask you about something to do with the behavioural change in their animal and something to do with their teeth and their oral health. Yes, it's quite likely that that will happen. Yeah, and I think.

You know, as you said, even when you are approached with a case, often there are several elements to it, so you're not doing a behavioural consult, but it's all, it's all part of it. And you know, as a vet, if we're not aware of that component, then it will be very difficult for us to be great at the job because we'll also be involved in situations that we don't know how to deal with the pet because the pet is in, you know, in fear or, or whatever. And, and so it's then really important if we have those skills we can, you know, handle situations better, can't we?

Yeah, so another, another thank you, is to ISFM who through international, you know, cat care, they've worked so hard to improve the, the, the perception of cats as, as having this, emotional side to their health as well, and the cat friendly practise scheme is something I'm sure that the profession is very, very aware of. It's 10 years old this year, so it's their 10 year anniversary, and what an excellent scheme and, and thank you again for that fantastic charity I Cat Care. But I've said for many years that we need eye dog care, and I don't know if anyone listening wants to set that up.

I don't have capital. I wouldn't be able to do it, but, you know, if someone did have capital to start a charity, iog Care is desperately needed, to be modelled on iCAT Care to be the sister charity of ICA Care and look after the welfare of dogs because it's sadly not being looked after in the same way. When I was at vet school, cat welfare Tim Griffith Jones, I've mentioned before, and others like him who really championed the cat as a species in its own right.

And made amazing changes. And, and, and since that time, the cat has almost overtaken the dog as being looked after, according to its species specific needs, and the dog has almost got left behind. Now good news is that the British Veterinary behaviour Association have teamed up with Dogs Trust, and in June at the BVA live meeting in Birmingham, they're going to be launching the dog friendly practise scheme.

At last, I've waited many, many years for this to happen under the umbrella and care of an organisation, not some moneymaking scheme for an individual, but this is, done on the same basis as IA care does cat friendly practise. So done through an organisation, you know, in a very different way to some other schemes that are available. And so dog friendly practise, I think, you know, it's so exciting.

That 2022 is the year of the launch of dog friendly practise. And let's hope in 10 years' time we could be talking about how that scheme has transformed dog life in the same way that 10 years on from my from the cat friendly practise scheme being launched. We're talking about the differences in in the veterinary.

Approach to cats. So yeah, the exciting times and so many people involved in contributing to all of this. I've mentioned quite a few today, but you know, so many people that I personally am indebted to, like, like Len and Peter Wait and Jim Vincent and and people from my early career and David Appleby, but also.

The profession has so many people to thank, people who are forward thinking. Professor Webster, we've talked about ICAT care, BVBA dogs trust, but all these people who've done so much to improve the fact we're even talking about this, you know, 30 years ago or 30 plus plus years ago when I qualified. We weren't talking about this, not openly.

There were a few of us talking about it, a few of us knocking on the door, but this is now, you know, you're doing a podcast about it. We have, we have moved a long way. We've got a long way to go, but we have made moves in the right direction.

Well, and Sarah, obviously you spent a lot of time thanking other people, you know, also thank you for all that you've done because I know as a GP I'll often You know, ask you questions and obviously listen to the webinars that we've done together and think, hm, right, I need to do things a bit differently and I think that's, you know, for us webinar vets, if somebody comes on a webinar and it makes them change one little aspect of their veterinary practise, which they then, you know, take on board, that hour of CPD is a really worthwhile hour of CPD and I always get that when I speak to you as I have done today, so. Thank you so much. Oh thank you, thanks for the opportunity.

Thanks, Sarah.