Hello and welcome to the webinar, Nursing Consultations. My name is Georgia Woodsley, and it's my great pleasure to deliver this session to you. I've been a veterinary nurse for over 24 years now, and I've done many roles throughout my career.
I started in mixed practise. I've worked in referrals. I've worked as an emergency and critical care nurse, as head nurse, and I now work as clinical lead for the weight management clinic at the University of Liverpool.
And what that's meant is that nursing consultations have always been a part of my daily activities. And so if you're thinking about starting out, doing some nurse consultations in your practise, I really hope that my experience and insight will be valuable to you throughout this session. If you're already running nursing consultations, that's brilliant.
And again, hopefully I've got some hints and tips throughout this session. That are really going to help you enhance your consultations and make them as best as they can be. So we're going to start by thinking about doing some personal prior planning, thinking of the reasons and the benefits of doing nurse consultations in the first place.
We'll then think about the in practise planning, so very much the practical side, what we need to have prepared on the day of the consultations, the actual consultation itself and what you may or may not wish to include, and then when we should be doing follow-up consultations. So let's start by thinking about what are our personal goals, what prior planning should we be considering when we are doing nursing consultations. And so I want you to think just for a moment, what are my personal goals and how do nursing consultations help me fulfil them.
And these might be daily goals in your practise. This may be much bigger as career goals. What are your particular motivations and are nurse consultations going to help you get there?
Well, for me it has always been about personal growth, and I became a veterinary nurse because I wanted to make a difference. It sounds a little cliche, but it really was at the base of everything that I have done in my career. I wanted to make a difference to cats and dogs and to rabbits and guinea pigs or any other pet that I came into contact with and I was responsible for caring for, but more than that, I wanted to be that safe pair of hands for those pet owners.
I wanted to be that trusted, valuable source of information, you know, the place that they can come with their problems and their questions and really offering that client support and pet care. Has of course been extremely valuable and satisfying to me in my own career. So you might be thinking of nursing consultations as a way to advance your career.
Are you just starting out or have you been doing this for a while? Either way, introducing consultations could help you advance. Now career advancement might be because you're looking for financial gain, and there is no shame in that, you know, we all have to live and of course as we become more experienced and work through our careers, we do expect, I think, a certain level of additional financial gain with the additional skills that we can provide.
It may also just be about job fulfilment, and as I said, for me this has been extremely fulfilling, but maybe you're currently not feeling 100% fulfilled by your role and maybe nursing consultations could really fill that gap, let you be hands on with your patients and your pet owners and getting a huge amount of job satisfaction. So as I said, I wanted to be this trusted source of information. I also wanted to upskill.
I wanted to become really good at nurse consultations, offer a really wide variety. And so if you're thinking something similar, then do we need to learn new skills to do that? Is there additional training that you may need to consider?
Do you want to improve on your current skills or your current knowledge? Maybe this is a gap which is in your practise. You see these pet owners with their pets, you know, come through your practise, but there really is nowhere for them.
And to have some of these conversations with you or to receive the care quickly and easily that you could provide them. Ultimately, everything that we do is about improving patient care, and I promise you that by putting nurse consultations, you will certainly be doing that. So our next question to ask ourselves is what knowledge do I need to offer excellent consultations to our pet caregivers or pet owners, whatever you want to give them.
And probably then you wonder, well, OK, where can I find all this information and we are hugely lucky, I think as an industry there are an awful lot of resources. Now of course there's webinars, which is why I'm guessing you're attending mine today. There are of course in-person lectures and seminars, there's workshops that you can attend.
But of course there's lots of books written on this topic. There is so much online resource now which is free to access and is available to everybody, which is, you know, which is wonderful. If you want to find out more about specific things, you can go again and look at scientific journals.
Google Scholar is your friend. If you want to find a scientific journal on a particular topic. But you may also turn to your more experienced team members, you know, those that have done these sorts of consultations in the past, may be looking for someone who could mentor you through starting consultations or improving or enhancing what you already offer.
So your senior nurses, your head nurse, you know, they are likely to have some insight here. And then it can just be about experience. When I first started doing nursing consultations, I had no one to guide me, really sadly.
Nobody was really interested in my practise, and so I saw it as a big gap, a big opportunity for me to really take ownership of, of these consultations and to have that direct contact with the pet owner. But because I didn't really know what I was doing when I set out, you learn by trial and error, and there is no harm in that at all. And to an extent, you can do as much learning as you can online in webinars, reading, and so on, but it's not really until you put these things into practise that you really figure out what works for you and what maybe doesn't work.
And we're all different, so it's finding the things that work for you. Our next question to ask ourselves is, well, what sort of consultations would I like to offer? There are a huge variety of different topics that you could, or different things that that you could offer.
Nail clipping should be nice and easy, although we all know those pug nail clips aren't particularly easy, but certainly nail clipping consultation. And you know, if we have an old cat, for instance, and they're not dealing with their nails very well, you know, in terms of consulting, that's a really nice conversation that we can have with that pet owner around the nail care and the nail health of their senior cat. Medication administration.
It's important that we don't just get these individuals in, shove the tablet down and wave them away, you know, this is a great opportunity to get to know them a little bit better, understand the difficulties, maybe help train them to administer the medication at home, for instance. Wound checks are going to be very common, and again, we want to know what's normal and what's not normal, so we can highlight where we've got problems. Parasite control consultations.
This may be a standard advice or maybe this pet is going on holiday and is travelling abroad. What do they need to do and prepare in terms of parasite control. Expressing anal glands, it's not for everybody, and I know not all nurses will do this.
However, as you know, it's not pleasant as it is, I actually find this really satisfying and of course this is something that we can hopefully do fairly quickly and easily and in a gentle manner so that the dog doesn't find it traumatic. And again we can talk an owner through how to maybe express their pet's anal glands at home, and that would, that would be beneficial. Dressing changes, it's always something I've really enjoyed doing.
And again, just that brings in the wound checks as well. We might want to offer behavioural consultations, and I would say that you do need, some extensive training before you could probably offer behaviour consultations, but behaviour comes into so many consultations and so frequently, I think it's something we all end up talking about quite a lot. We might be also able to offer physiotherapy or even hydrotherapy if you have that within your practise.
We could talk to new puppy and kitten owners about either buying a new puppy or kitten or at the very least, because I don't think this happens very often, at least having a conversation with them as soon as they do get their new puppy or kitten. Bereavement consultations are so, so important, and again I think this is much more recognised now than it was certainly when I first started nursing. Bereavement support was not something as nurses we would have offered, whereas now it is a critical part of that end of life care that we can offer to our pet owners.
So we've got all life stages to talk about. We've got growth to talk about with little ones. We've got senior pets and senior healthcare to talk about our with our goals and oldies.
And of course, no surprises to you, nutrition is probably one of the most common and for me most important conversations and consultations that you can offer within your practise. You know, and the nutrition might be life stage nutrition. And that of course is going to be very useful to those pets, but also of course talking about different diseases where nutrition plays a central role in the overall management strategy.
So nutrition consultations are certainly one you would want to be thinking about. The next question to ask ourselves is, well, how good are my communication skills, because it's just like reading something, you have to put it into practise. What we have to do is get this knowledge and experience that we have in our heads out to the clients in a way that our client can understand and we have to be adaptive in our communication.
Not all clients will have the same educational background. Not all clients will understand what you're saying. You may need to describe things in different ways.
And it's often something that I hear that nurses find difficult in certain situations. So you know, just wondering to yourself, do I actually find this difficult? And if so, what could I do about that?
You know, there are certain topics, obesity actually being one of them that I'm commonly told can be quite challenging, but there are really good ways of introducing this topic. Now, communication within veterinary practise, this is probably a whole day of webinar on its own. So I'm not going to dwell here too long, but I think if you want some help with communication skills, there is lots out there, and it, it is something that, we are thinking about as an industry much, much more.
So just really briefly, It's important to remember that we're not just there to talk at the clients or at the pet owner. It is a two-way street, and actually it's the listening that's probably much more important than what we're going to say. If we want to have really good understanding for our pet owner, we need to hear what they're saying, listen to their difficulties, you know, ask questions around their challenges, and so on, really gain understanding.
And then if we are delivering communication, it always needs to be reinforced. So if we are delivering something verbally, then we should give something written. If we're handing out something written, we should give a brief verbal summary so that it will start to instil itself into the owner's mind.
And of course remembering if you hand the a leaflet, chances are that's going in the recycling by the time they get home, or it's left on the car seats or, or whatever. So you have to be mindful that an owner has to be very motivated to read a leaflet. So giving them that brief overview can be really important.
And then of course while you're delivering information, check in, you know, make sure, do you understand, is that OK? Have you got any questions for me? Because it's easy for us to have all this information in our heads, desperate to get it out, desperate to talk to our clients about what we know and how we can help, but we should pause and make sure, have they understood us?
Do they get what we're talking about? And actually there is an awful lot of growth in this area, particularly in veterinary medicine, looking at communication and communication skills. So get on to Google Scholar and have a little Google and you'll bring up lots of scientific papers now in this area.
So to give you three words that I try and keep in mind whenever I am talking to a pet owner. And that is that I should be delivering communication that's considered. So I've thought about what I'm saying.
It's considerate. So am I going to cause offence with what I'm saying? Have I thought about the pet owner and their individual circumstance and collaborative?
Now we have talked, I think, in veterinary medicine for a very long time about client compliance, that, that kind of assumes that we have the role of telling them what to do and they have to do it. But that's not actually the case. And of course if we have this collaborative approach, we work with the client, we compromise, we have different options, we find different ways around, we will be much more successful in reaching our goals for that pet.
So considered, considerate, collaborative communication. All right, so now we've done that sort of background work and, you know, that, that prior thinking that we need to get going. What about the practical aspects of what we are going to be doing?
And this is really, to sit down with all your team members and you know, have a bit of a nurses meeting or and have the vets in there too, because as a team, You need to decide and agree upon certain things. So these are the things that we'll need to think about the who, the what, the when, the where and the how. And everyone's input is vital in the overall running of these consultations and of course your general practise.
So firstly, thinking about who, is it just going to be you that runs consultations or are everybody in your practise going to run consultations, or is it going to be, a number of you or, are you going to have some backup? This is important because as we'll talk about in a moment, continuity is really important for clients, but you might have an enormous client base and so you may not get to see as many clients as you would like. So thinking about who is actually going to do it is really important.
I think also to consider that forcing people and forcing nurses into consultations when it's just not their thing is not necessarily the best use of their skills. I was always wanting to be out front. I wanted to talk to the client.
You'd find me hanging out at the reception desk because I wanted to have these consultations. I know many other nurses. That's the worst thing that they can think of, and they'd far rather be out the back, either in the in the hospital or in the operating theatre.
And so why not allow the team members whose strength lie at the sort of front of house at the client facing consultations to really utilise their skills, but that is a team decision. The next question is the what. So what are we going to include?
Well, every consultation really should include a physical examination. We're going to record weight, body condition score, muscle condition score. We're going to be doing health checks depending on the consultation.
We may well need to be doing nutritional assessments, pain assessments. We may take blood samples and we may take urine samples. Again, we need this to be decided ahead of time so that when you see these consultations on your list, you know how to prepare.
Then the next question is going to be when, when in our day can we fit these in, you know, and how will everyone know where these slots are? Can you save slots in your diary? Does your practise management system allow you to do that?
Is a certain time every day going to be allocated? So you know it's going to depend on what space you have. And so during ops is often a good time.
So while the vet is busy in theatre, their consultation room is standing empty and unused. Well, that of course is a perfect time if you have the staff to do it, to run nurse consultations. It could be over lunchtime, so if you're the consulting nurse, having an early or a slightly later lunch might work.
Offering these consultations in the evening, this would certainly work from the client's point of view. Not necessarily from a veterinary staff point of view, but many people will, you know, could consider doing a late finish or consultations till 7 in the evening, for instance, to allow those pet owners who do work a 9 to 5 to also have access to this service. And the same goes at weekends.
Generally practises are quieter and it's emergency work only and maybe vaccines. But are there spare consulting rooms at a weekend? Could we do some nurse consultations then too?
And then also thinking about the length of each appointment, how long would you ideally need, how long would you like? You know, I, for me, I for most consultations, I would be wanting a minimum of 15 minutes, but if I'm doing a nutrition consultation of some sort or other, I would love at least half an hour. And if I could actually book out an hour to really have an in-depth consultation with the pet owner, it would be lovely to be able to do that.
So thinking about when this time is going to be available. The next question is where, where is the space? We don't want to be doing these consultations in the waiting room.
Now of course I'm not suggesting for a moment that you'd start expressing anal glands in the waiting room. But even having discussions either about end of life or nutrition, you know, pet owners don't want other owners overhearing these discussions, so we do want to avoid the waiting room and talking about any of these things. So finding private space somewhere, even actually if that's outside.
A bench if it's a nice sunny day that could be a very nice relaxed space for you to use or of course if you've got spare consulting rooms to use, they would be the preference. If you're really stuck for space, it's wondering how can we make space? Can we repurpose some space?
Is there a broom cupboard even, you know, is there opportunities in the area that the pharmacy used to be? Where can you shift things around? Within your practise to give you this little bit of space to actually be able to to do the consultations and if all else fails, yeah, is there somewhere outside?
Is there a little cabin? Is there, you know, a nice bench or somewhere covered, for instance, that you could potentially sit with some of these owners to talk to them? So thinking about where.
Next, we need to think about, OK, we've got all these things, but how are we really going to make this work? Firstly, are we fully prepared is the things we need to order, you know, do we have the right staff in mind? Do we need to alter rotas?
Have we done all that preparation yet? So are we prepared? Is the space that we're offering going to be comfortable for the pet and the pet owner?
Is it going to be stress free and quiet? Can we ensure that it's going to be well equipped and well resourced? So is there going to be a computer in there?
Are you going to have access to any documents you might need, any online tools? Are we going to have information posters on the wall? Are we going to have products that are for sale?
So thinking about, you know, the actual practical how we're going to do this. The other how that we should consider is how much will we charge. Now this is a controversial topic, I think, because there is no good answer.
People ask me all the time, should we charge for our nursing consultations? My personal opinion is that we should as veterinary nurses, absolutely value our time. So in some way or other we shouldn't be giving our nursing consultations our knowledge, our skills for free.
But there are different ways of charging. So, you know, are you going to just charge for your time? So per 15 minutes, is there going to be a set fee?
Are there going to be set fees for the different consultations? Again, this is something you'd need to discuss as a practise. How will the caregiver feel that you've actually given them value for money?
Well, this for me is about doing all the extra stuff, you know, if they're in for medication administration, as I said, don't just shove the tablet down and send them out the door. That won't feel like value for money, you know, allow them that time if you've got 15 minutes to give that tablet, sit down, ask how they are, ask how their pet is. Is there any problems?
Have they got any questions? Or even just build some relationship with that client? Are they going on holiday, you know, They had a nice Christmas and so on, you know, you can use your consultation space for much more than just what it's booked in for.
So that helps the client really feel like you care and so makes them feel like they are getting value for money that that cash that they hand over at the end of the appointment was totally worth it. And if you're not going to charge for these appointments, well, where is revenue going to come from? Because as I say, you have to be valued.
You really must be. So are these consultations going to be part of a health plan? If an owner pays monthly, for instance, and these are becoming much more popular, can you have some sort of other scheme where nursing consultations are paid for annually rather than each consultation?
You know, what are going to be included for those costs? Are you going to have products included within those costs? These are again all things to think.
About and to come to some practise decisions. Food is another one that you could think about, or money off food is is quite common sometimes where people, if they come for a consultation, they can have, I don't know, 5 pounds off their bag of food and so on. All right, so our next question is, well, what support do I need?
So we've now allocated, who is going to be doing the consultations, but they can't just be abandoned at that point. So space has to be kept sacred, you know, it can't just be squeezed and squeezed by other things. It must be ring fenced for your consultations.
So must your time, time not just to do the consultation, but to learn. To prepare and that may well take you away from other daily activities. So how are those staffing levels going to look?
Then we need to think about funding because although there is a lot of free CPD out there, some of it, of course, does cost, and some of the very good courses, of course, will need to be paid for. So you will need your management's support here to be able to allow you to go and do these things, bring back those skills. Into your practise.
And one way of doing this is that you can write a proposal to your practise manager or to your head nurse explaining what the CPD is, what the course is, what you intend to get from it, and then present your learnings, present what you have got from that course when you've finished it. Again, this is going to show them your willingness to learn and those vital skills that you're going to be bringing back. It may also be you need funding for certain equipment and certain resources, certain products you would want to see, and then how are you going to advertise that you're doing this.
So is this going to be a nursing consultations poster, for instance? Could you put social media posts, could the rest of the team be brought in and make sure that everyone is promoting your clinics? Referral cards in the consulting rooms, these are a nice, easy, quick way of reminding everybody visually that this is a service that you provide, because ultimately, of course, it doesn't matter if you're all set up if you don't have suitable patients, and of course that's what you need filtered to you.
So asking myself where are my appointments going to come from? So referrals into your nursing consultations can come from many places. The veterinary surgeon is going to be a big source of these consultations.
So whether this is discussion on certain topics like nutrition, whether this is owner support, maybe this is demonstration, this is wound checking, you know, and so on, many of them are going to come from there. We might also see these coming from other nurses, so maybe the discharge nurse is saying come back and see our consulting nurse for your wound and weight check in however many weeks' time. That your support staff can also philtre these patients to you.
I've, you know, they can come and say to you, I've noticed that this patient has X, Y, and Z. Do you, do you think that's something that you would like to talk to the owner about? Would it be, you know, would that be sensible, so support staff?
The reception team are a really good source and actually pet owners do value the reception team's opinions and They really do find them much more approachable sometimes than the vets, for instance. And again, when I was head nurse, my reception team was really vital in understanding our clients, listening to them, highlighting problems, and then booking them in with me to talk about some of the questions that they had over the desk. Social media posts can also generate these consultations.
We could have just client driven inquiry. Can I book my dog in for a nail clip, please? And then word of mouth, don't underestimate this.
So this could be peer recommendation. It could come from other clients. It could also come from some really influential people such as dog walkers or breeders or groomers.
You know, that nurse at that practise, she was excellent at doing this, that and the other. Go and see her, she'll look after you. That's the sort of recommendation that we want.
Ken, kennel cattery staff, you know, there are many different ways of building that reputation as being a really good consulting nurse. Next question. OK, let's get into the detail.
What equipment do I need? So thinking about everything that you could possibly need and don't feel like this is a silly list. We need to make sure we have it.
So we need scales somewhere within the practise. We need measuring tapes, pens, calculators, microchips, scanners. We need a table.
We need chairs. We need blankets, maybe. We need information leaflets, nutrition guides, access to the computer records.
This list is going to go on and on. And to make sure that nothing's missing, there's no harm in having this list up in your consulting room and making sure before you start you have everything that you need. So other than the actual physical resources, what other resources might be useful to you?
Well, there are going to be online resources and online tools that you can have access to. And we're going to talk more about these shortly, but there are so many free access, excellent evidence-based resources out there now. It's just knowing where to find them.
And at the very end of this session, I'm going to give you all the links, all the websites to every one of these resources. So, on the day, we are ready and raring to go. We've got a full appointment list.
And so we question, what do I need to prepare to give the best consultation to this client? Well, if your information gathering questionnaires given before the appointment are going to be very useful to you, now this can be given in the waiting room. It could be given online, just something that's easy for the owner.
If they find paper and pen easier, fine, let's do that. You'll need the full medical history, including the weight history, body condition score history, and muscle condition score history. We need to understand what medical issues they currently have and what they've had in the past.
That should all be on the practise practise management system or on their medical cards. You'll need to gather and prepare all the relevant equipment, so this might be weighing scales, it might be blood tubes, and we also may have had maybe before the day, but we may also have had to discuss patient training. To make this consultation as best as we can for them.
So that's catbox training so that they're comfortable going in their cat box. So it's not this awful thing that comes out of the loft that they're immediately scared of and maybe muzzle training too just for everybody's safety, but making this a really positive thing for both pet and pet owner. OK.
How can we make our pet and caregiver feel really comfortable within our practise? Well, this is just the real basics of being warm and welcoming. So every member of the team should be there, with a warm welcome.
Hello, even if you're. Walking through the, the waiting room for some other reason, you know, smile, say hello to the patients waiting there. It will mean a huge amount to your, to your, pet owners.
Have somewhere comfortable for them to wait, you know, hopefully you've not got long waiting times, but inevitably this sometimes does happen. We want relevant displays up on the wall, not anything that's outdated. They need to be neat and tidy because owners will take a sort of inference of what sort of practise you have if you have tatty old posters.
They'll think, well, what else is not being cared for properly? So you having nice displays up. This goes for product stands too, make sure all items are priced.
If you can have separate waiting areas, and I know your practise waiting room may not be able to accommodate this, but at least in some way have a separation for cats, dogs, and unfortunately exotics do not want to sit with a cat or a dog. So thinking about where they would be best waiting. Cat trees and cat shelves are a really nice way to get cats up off the floor, have blankets and towels in the waiting room so pet owners can cover the cat boxes so they're not terrified by the big slobbery hairy dog sticking their nose in the front of their carrier.
And for dogs have water available on request. Make sure you've got a poster up for this because owners might not know that they can ask. So a little and also we don't want that communal bowl which just becomes a sort of bowl of drool by the end of the day, or slimy and disgusting, you know, we need to give fresh water to each one of these patients and of course sharing things like water is not the best in terms of infection control, but have a poster, ask me for fresh water.
So the actual consultation itself. We should think about how we're going to structure this. You know, what are we gonna do first?
What, what are we going to need to do, to make sure we haven't forgot everything? Well, firstly, make sure everything is prepared. You've got the rooms nice and clean and tidy.
There's not syringe packets and needles and sharps left out. You know, have that clear space. Leave the baggage outside.
Now what I mean here is emotional baggage. You know, just take a moment before you open that door to call in your next client. We all deal in our careers with many difficult and often upsetting cases, and we may also, because we're all human, have some personal issues which we may be struggling with at home.
Now this is really important that you have support for these occasions where emotions can be difficult, but it's also really important that you don't bring this into your next consultation. And so by just taking a moment. And meeting this next client with a fresh, happy face, and you know some days you'll have to fake it, and that's, you know, that's fine, but it's important that every client feels like you're focused and you are pleased to see them.
So welcome your client, introduce yourself. It happens so often that Perth owners come out going, Oh, she was wonderful. What was her name?
So you want, you want them to know what your name is, or at least make sure you're wearing your badge, you know, these things again are really important, the pleasantries. Hi, how are you? Isn't the weather awful today?
Again, it helps build rapport with your client. It helps them feel cared for and that value for money. And as long as you've not got a lot to go through, allow the patient to have a bit of an explore and relax in your consulting room.
You can see here some examples of cats and dogs who are just making the most of what I've provided for them. So with dogs, I often have toys out, with cats, I often have beds. I've got a cat tree as well.
So if they want to hide and feel a bit more secure, they absolutely can. And you can see Echo here pretending that she is a cat wanting to sit on the chair as well. That's fine.
They're wipable. OK. Next thing we need to get onto is gathering information.
So what do we need to gather? Well, it's relevant information depending on our consultation. As I said, pre-appointment is probably the best time to get background information.
So using questionnaires either online or posted out or even in the waiting room. You want to look back at the previous consultations and previous questionnaires too, and that would be very helpful. And then in the consultation, actually using checklists can be very useful to you, having forms to fill out to make sure you don't forget anything, having somewhere to record your physical examination parameters, and then of course you're going to be having a good discussion with the owners.
This resource here about from WSAVA World Small Animal Veterinary Association, is a great way of collecting dietary information, just a short form, but it's really nice to have a standardised method of collecting that information. So what tools should you be using in your consultations? Well, weighing scales are an essential.
These are one of the most basic things you should have available to you. Different sizes of scale depending on what you're weighing, whether it's cats, dogs, or maybe food. Hamsters and these scales should be calibrated, whether that's with a set of calibration weights, with that, whether that's with a bag of food off your shelf, it's weighed very carefully during manufacture, so allow for 0.1, 0.2, and for the packaging, or if you've got a gym weight that you're pretty sure does weigh what it says on it, you could use one of them.
And most importantly, of course, always keeping a record of what that patient weighs so you can track it over time. Body condition scoring charts, another really useful tool. And again, these are topics that I could spend a lot more time on, but body condition scoring along side weighing is essential because otherwise you have no idea whether that weight on the scales is actually appropriate for your patient.
Now I've got a very brief video to show you, but body condition scoring will require you to look first, have a look at the shape of your patient. Then getting your hands on using flat hands, don't be tempted to stick your fingers in. Smooth the coats of any long-haired breeds, and don't just focus in on the rib cage.
Fill all areas of your patient. So you'll see as the video starts, I'm starting at the top and the front of the rib cage, moving down the rib cage before moving back to feel for the waist, then feeling over the hip bones and feeling for an abdominal tuck. And it really can be as quick as that.
That's all the information gathered that you will need to allocate them a body condition score, and again this should be recorded. Now muscle condition scoring is not something that I think is undertaken as nearly as often as it should be, but there are so many cases, particularly those that are senior or unwell for some reason, where muscle condition scoring is actually essential. Again, I could talk a lot longer on this, but I wanted to show you some brief information.
So just looking at this dog here, you can see he's got muscle loss from the top of his skull. You can see that crest there is very prominent. You can see his spinal prominences.
He almost appears to hang off his spine. This is because of muscle loss either side of that spinal prominence. We've got loss of loss of muscle mass on his hind leg here, and you can see these sunken eyes again, loss of muscle on his skull.
So I've got a brief video to share with you with some audio to show you a light body condition scoring, what you're going to be looking and feeling for when you muscle condition score. How to muscle condition score a dog? Start with the skull, feeling for that crest at the top of the skull.
Then feeling under the eyes in the eye socket for any loss of muscle mass. Then working nose to tail moved down the neck to the shoulders, feeling down each shoulder blade and again looking for loss of muscle mass in that area. Then slowly work your way down the spine, feeling those bony prominences and how much muscle mass is sitting either side.
Rocking back into over the spine is a good way to determine the muscle mass. Then move your way down to the pelvis again feeling for bony prominences of the pelvis and assessing if there's any muscle mass loss in that area. Finally, feel down the hind legs and feel the muscle mass at the top of the hind leg.
So just like anything with muscle conditions scoring, the more you do it and the more normal muscle mass that you feel, the easier it will be to spot when you've got loss of muscle mass. So get feeling in your patients, have a squeeze, you know, especially those long haired ones that can really hide what's going on underneath. The next tool we might be thinking about are growth charts, so these are used for patients at the other end of the scale.
So these are for our growing puppies and kittens, and they allow us to track ideal growth, and they also allow us to highlight growth patterns of concern if we're seeing them and so we can go in and ask more questions, dig in to exactly why our patient isn't growing in a manner that we would expect. Again, growth charts is a very big topic, but I will run very briefly through what's normal and what's not normal, and you may want to go out, go and find more information on this. So ideal growth looks like this.
We can see these pink lines travelling across the charts, and ideal growth will mean that the red dots, that's where we've plotted the points. So based on the age and weeks and the weight at that point, you see them following tracking along that 9th 9th centile very nicely, a little bit of bubbling about that's. Very normal.
Now they can be tracking in between two centiles, so maybe the 9th and the 25th, that would also be very normal. Now, the right centile line for your patient is the right one for them. So if they're deviating and going on to different lines when they started on one line, these are times that we should be concerned.
So this is a very good example of this. So what we have here is a patient who started on the 25th centile but essentially has grown too quickly and has now crossed over the 50th and the 75th and it actually ended up on the 91st centile. Now this crossing up of two centiles, that is your warning bell that something is going wrong.
This patient is growing too quickly, and the reason that this is important. It is because crossing up to centiles has been shown to put this patient at high risk of obesity later in their life, and of course that's not what we want to see. This growth chart in a similar way.
It's the opposite direction though. So now we've got crossing downwards of two centiles. So this individual started on the 7th.
But it's now fallen below the 25th centile. So what's going on here? Why is the growth flatlined?
Again, it's our warning bells to go and ask questions. Have they changed the diet? Has this puppy moved house and lives with somebody different, for instance?
Have they been ill for some reason? Again, we want to understand more, and our growth chart can really help us highlight that's happening. Our next growth pattern of concern is this one.
This one is an individual that's very, very large for their age. They're sitting right at the top or even above their appropriate chart. And the reason that this is a concern is because being very large for age predisposes those individuals to obesity later in life.
So there may not be a problem. There are certainly ones that we'd want to keep a closer eye on, and again that's something our growth chart can inform us on. And then this one, this is our double whammy.
And so let me explain what we've got here. So firstly, we've got a puppy starting right at the bottom of the chart. They started on the 2nd centile and as I said, the right centile for them is the right one for them.
So they should have continued on along that 2nd centile. Now what's happened here, we've got another rapid growth situation, and that's because many pet owners or breeders will look at these individuals when they're on the small side and think, Oh, you poor little thing, we need to encourage you to grow bigger, catch up with your siblings. And so they'll feed them a bit more and artificially accelerate their.
Growth. So we've got artificial acceleration of the growth, and you can see that this individual has crossed up two centiles. Both of those things predispose this pet to obesity later in life.
They may not have obesity yet, but they are at high risk moving forward. So again, these are the ones we're going to have to keep a close eye on. What other tools could we use?
Well, there is a lot of pet food manufacturer support out there. The big three, at the very least offer an awful lot of online services in terms of where you can go for CPD, for information on the diets, for just learning about certain conditions. So make sure you go and check all of those sources.
There are now lots of checklists available. So senior checklists, quality of life checklists, pain scoring. So this is, this is a Glasgow pain score, which I think is quite widely used now.
This canine ageing checklist is quite new. It's from BSAVA and was actually produced by colleagues of mine at the University of Liverpool. This is a great checklist to talk through with your pet owners to really start those conversations about senior pets and what they may or may not be struggling with.
So even if this pet is just in for a nail clip, get them to fill out an ageing canine checklist so you can pick up any of the problems that they that they may have. So there's quality of life assessments by the cat friendly ICC, and there's also lots of other types of quality of life assessments. The chew questionnaire is one that is again quite widely used.
And again, I'll give you all these links to the resources at the end. So now we've done our initial consultation, it's important that we don't lose these clients to follow up, that we do follow up on our consultations. So thinking about how often we should be monitoring this patient or how often we should be suggesting.
So it's very much going to depend on what opportunities we are likely to have and what age the pet is and what the initial consultation was for. So for puppies and in line with the growth charts, we should be seeing them every month, so once a month until they're 6 months old, and then every 3 months until they reach skeletal maturity. Our smaller breeds, of course, reaching a skeletal maturity much, much quicker than our giant breeds.
And larger dog breeds. So tailoring that accordingly. Post neutering, well, they may well need a wound check.
They may have some other kind of postoperative check, but I would also be looking to put in a 4 week post-op weight check because if we've got weight gain. Just after neutering, then we'll want to be making adjustments quite quickly. As adults, we want to be thinking about checking in with them 3 or 4 times a year, having a chat with them about diet, having a chat with them about any concerns and parasite control and vaccines and, you know, just maybe talking about some of the misinformation that they've seen out there, allowing them an opportunity just to come and talk about their pets, you know, this is very valuable.
Then for seniors, depending on how senior they are and what other diseases they may have, seeing them every 2 to 4 months is probably going to be necessary, and you may for these and both the chronic disease cases might want to be doing that a little bit more frequently, so every 1 to 3 months, you know, talking about routine testing. Things. So whether we need to be doing blood sampling again, it's going to depend very much on the health status annually for seniors really should have a blood test to check on liver and kidney function at the very least and again whether we do blood tests on these chronic cases very much depends on the disease status and the stability of that disease.
And then if we have a patient with obesity, then we'll also want to be seeing them frequently, so every 2 to 4 weeks is standard, and I only ever move to 4 weeks if I've got a really good client, knows what they're doing, is happy with the plan. You've not got lots of begging and food seeking behaviours, and so on. So again, tailoring that to the individual.
So how much support is the owner going to need? Well, it depends, as we said, on all those factors, but ultimately continuity is going to be really important for those pet owners. Now that is challenging for us in practise because it may not suit our.
Or it may be difficult from the appointment book point of view, but if you are the one who are able to book your next appointments, then hopefully and do your best to book the same clients in, with you again, the client will really appreciate it. So revisit appointments, you know, we don't necessarily need lots of time for it, but you know, just checking in, allowing us to continue to monitor and record, make adjustments where needed. Every recommendation should be dynamic.
So we can't just set a recommendation and expect it to work forever. We have to be changing that recommendation based on the parameters and that we can record. So that's where this monitoring is, is so important.
Owners may well need you for emotional support. We think about our diabetic patients, for instance. That is a big thing to look after a diabetic cat or dog.
So your emotional support for that pet owner, reassurance, your point of contact is going to be vital to them. You may also need to be there in terms of motivation to keep going with what they are doing and particularly for our obesity cases this is going to be necessary, so thinking about certificates, maybe some sort of reward of some kind. You will certainly be needed to troubleshoot if things aren't working, and of course you will be the key person to get them back to see the vets, even if they do not recognise immediately that that is necessary, you will need to be there to say, look, I don't like the look of this wound.
You need, I need to book you back in with the vet to take a look at this, or, you know, offered to take that patient out the back to see a vet, if they happen to be available. So, you know, you do, you know, play a central role in, in supporting these patients. So thinking firstly about carefully planning what you're going to do in terms of nursing consultations.
Recognise that it's not just for the patients, it's for you too. In fact, for you, for the practise, for everybody there is benefits all around. Try and structure your consultations to make sure that you, get everything that you need in terms of information and that nothing is forgotten.
Don't underestimate the importance of building relationships with your clients, and that's why continuity is so important. Ultimately, all of this is going to play an essential role in caring for the patients that you see, and ultimately this really should empower you to make a huge meaningful difference to cats and dogs that you care for. I really hope that you found this information in this webinar useful to you.
Thank you very much for listening, and I will leave you in a moment with all the resources that I've mentioned throughout.
