FREQUENTLY ASKED QUESTIONS
Having achieved the Tier 3 Veterinary Hospital accreditation by independent inspection some of the practical aspects that relate to patient care include:
PREVENTATIVE HEALTH AND NUTRITION
1. When can we start our puppy’s vaccinations?
Immunocompetent (fit and healthy) puppies can be vaccinated in one of two ways depending on the local situation and individual factors:
I. Standard: Canigen LPPi at 8weeks followed by Canigen DHPPiL at 10weeks
OR
II. High Risk: Canigen DHPPiL at 8weeks followed by Canigen DHPPiL at 10weeks
Earlier vaccination can be considered in certain situations dependant on breed, environmental risks and health status. An individual decision is made for each puppy.
2. Does my dog need vaccinating once it’s had its “puppy jabs”?
Yes. The primary vaccination course does not give life long protection and hence annual boosters are necessary. It has now been confirmed however that some of the vaccinations need only be given every three years. The following is the protocol used at Moor Cottage once a primary course is given:
First booster: should ALWAYS be a full booster: Canigen DHPPiL (making sure that each puppy is fully protected and has not slipped through the net.)
Second Booster: Canigen PiL*
Third Booster: Canigen PiL*
Fourth Booster: Canigen DHPPiL
Fifth Booster: Canigen PiL*
Sixth Booster: Canigen PiL*
Seventh Booster: Canigen DHPPiL etc etc
Thus, distemper, parvo virus and hepatitis protection need only be done every third year following the initial protection.
3. When should I vaccinate against Kennel cough?
Generally we recommend vaccination at least 2 weeks prior to your dog going into kennels. This still holds true although we can now consider annual regular vaccinations as the vaccine lasts this long and means your dog can be put into kennels at short notice.
4. How do I test for Feline Leukaemia Virus and Feline Immunodeficiency Virus?
The in-house test gives us initial screening results and involves taking a small blood sample which can be tested virtually as you wait provided we are given notice of the test. If we have any concerns, especially where a result is positive, we would strongly recommend further testing at an external specialist laboratory which utilizes a different testing method.
DIAGNOSTICS
1. How much help can a laboratory on site be?
Obviously of great importance in emergency situations but also invaluable for checking body functions prior to anaesthesia or for screening purposes especially in older patients. A laboratory on site provides results within minutes in certain circumstances.
2. Why do you x-ray and ultrasound some patients?
Both x-ray and ultrasound modalities allow us to visualise the internal structures and organs of the body. They work in very different ways, each ‘preferring’ slightly different tissues as they provide an image for us –e.g. fluid build up tends to obscure detail for x-rays whilst enhances our images for ultrasound. Thus, very different levels of information is gained depending on what is being studied and which modality is used e.g. a chest x-ray will gives us a great deal of information about the lungs but really only give us the shape and size of the heart and not what goes on inside it. An ultrasound scan however will give us a great deal of detail on what the heart is doing and how well it is working whilst no information on the lungs is gained. For the best chance of a full diagnosis both systems should be utilised.
3. How does the ultrasound help diagnose tumours?
Relatively accurate diagnosis of certain tumours can be achieved via specific testing of samples taken whilst guided by the ultrasound scanner’s picture. These samples are usually taken using special needles and sampling can often be carried out without the need for full anaesthesia even for internal lumps.
4. Apart from looking down the bowel what can you do with an endoscope?
Not only can we visualise the inside of the gut but, by using specific instruments, we can take biopsies or remove foreign material without the need for a major surgical operation. This means that the pet recovers more quickly without the risks inherent in any form of abdominal surgery and with trauma of a large incision. The bronchoscope used to look down the airways can help with more accurate and safer sampling of fluids or tissues within the lungs, often taking much less time and much less anaesthetic. Another major advantage is the ability to retrieve some foreign bodies such as an inhaled grass-seed from within the airways, avoiding open chest surgery, thus greatly reducing risks.
5. Why x-ray teeth?
A few straightforward radiographs can provide a huge amount of precious information leading to knowing when to keep or remove teeth; when only medical treatment is needed and not surgical.
INPATIENT CARE AND HOSPITALISATION
1. What care is provided for the inpatients at Moor Cottage?
The following protocol is part of our standard policy:
Moor Cottage Veterinary Hospital Minimum In-Patient Care:
Continual nursing presence in the hospital ward from 6.00a.m. to 12.00 midnight. Monitoring of patients overnight is tailored to the clinical requirements of the individual and can be continuous.
A veterinary surgeon must be informed immediately if you have any concerns regarding a patient’s clinical state.
SURGICAL AND MEDICAL PROCEDURES
1. What do you monitor for an anaesthetic?
Prior to any anaesthetic the patient will have been evaluated by a member of the clinical team, blood tests may have been requested and taken and any concerns addressed. Once asleep the patient is closely monitored with a nurse constantly checking a number of parameters and indicators of the patient’s status. We can measure blood oxygen levels; blood pressure; heart rate; respiratory rate; levels of oxygen, carbon dioxide and other gases in inhaled and exhaled air as well as the patient’s core temperature. These provide figurative indicators of the patient’s welfare which are used in conjunction with a number of neurological tests and checks a nurse carries out throughout the anaesthetic until a patient is fully recovered. So both modern technology and veterinary nursing/anaesthesia skills combine to make the procedure as safe as possible.
2. Why use more than one pain killer (analgesic)?
Each type of pain killer we use works in a different way and so a combination gives much better overall relief and is also longer lasting. Apart from making the patient more comfortable this level of pain control also reduces the depth of anaesthesia needed hence increasing the safety margin for surgery and anaesthesia still further.
3. What are you doing to reduce the risks of MRSA and other infections?
As a Veterinary Hospital high levels of hygiene and surgical protocols have to be achieved to gain this standard. To this end, our theatre is kept for sterile surgery only and is very specifically and thoroughly cleaned twice daily – before and after our main operating period. All who enter the theatre have to be correctly dressed in specific surgical gowns, clogs, caps, masks and gloves. The hospital and prep area are thoroughly cleaned daily and an isolation unit is present if any patient is suspected of being contagious. Many other aspects of infection control throughout the Hospital, including the choice of materials; the cleaning agents used and systems in place, all work together to minimise any risk.
STANDARDS AND QUALIFICATIONS
1. What do we mean by ‘Certificate Holder’?
When a Veterinary Surgeon develops a special interest within the field of Veterinary Surgery or Medicine he or she can take additional examinations to gain this further qualification. Numerous subjects are available including surgery; cardiology (heart medicine); ophthalmology (eyes –medicine and surgery); dermatology (skin) amongst many others. The Veterinary Surgeon will have to have had a certain level of experience, dealt with enough cases and written up a series of reports to a high enough level before being allowed to take the examinations. Thus, it is a recognised high level and difficult qualification to gain.
2. Are there any Certificate Holders at Moor Cottage?
At present we have a Certificate Holder in Ophthalmology along side one taking a Surgical Certificate and another taking a Cardiology Certificate.
3. What are Trainee Nurses?
These are members of our nursing team in the process of being taught both externally – our trainees are on a day release courses at local Colleges; and internally by our qualified assessors, to achieve level 2 and 3 NVQ Veterinary Nursing qualifications.
4. Who teaches the Veterinary Trainees?
Apart from ongoing help and support by all our Veterinary Surgeons and Veterinary Nurses we have further qualified members of the team as Assessors, to guide and monitor our trainees according to NVQ/TP guidance and regulations. The Assessors are responsible for the training and Portfolio marking of the trainees and are themselves regularly examined. In addition they must attend annual external meetings to maintain their qualifications.
THE HOSPITAL FACILITIES
1. What does being a Veterinary Hospital mean to me?Having achieved the Tier 3 Veterinary Hospital accreditation by independent inspection some of the practical aspects that relate to patient care include:
- Clinical staff are on the premises 24 hours a day specifically responsible for the care of any hospitalised patients. If your pet is an inpatient it is being looked after at all times 365 days a year at Moor Cottage. (See minimum inpatient care protocol)
- Guaranteed high level of specified equipment including laboratory facilities, X-ray, Ultrasound etc .
- Theatre patient care to the highest standard for sterility of area and monitoring of patient anaesthesia. Staff wear correct theatre garments emphasising our aim to avoid infections and associated problems e.g. MRSA.
- High level of instrument sterility and care – reducing infection risks.
- Continual Professional Development is mandatory for Veterinary staff.
- Qualified Veterinary Nurses– in our case all our nurses are either qualified or are undergoing a recognised course of training to become qualified.
- Isolation area for potentially contagious problems – special care for these patients whilst protecting others in our care.
PREVENTATIVE HEALTH AND NUTRITION
1. When can we start our puppy’s vaccinations?
Immunocompetent (fit and healthy) puppies can be vaccinated in one of two ways depending on the local situation and individual factors:
I. Standard: Canigen LPPi at 8weeks followed by Canigen DHPPiL at 10weeks
OR
II. High Risk: Canigen DHPPiL at 8weeks followed by Canigen DHPPiL at 10weeks
Earlier vaccination can be considered in certain situations dependant on breed, environmental risks and health status. An individual decision is made for each puppy.
2. Does my dog need vaccinating once it’s had its “puppy jabs”?
Yes. The primary vaccination course does not give life long protection and hence annual boosters are necessary. It has now been confirmed however that some of the vaccinations need only be given every three years. The following is the protocol used at Moor Cottage once a primary course is given:
First booster: should ALWAYS be a full booster: Canigen DHPPiL (making sure that each puppy is fully protected and has not slipped through the net.)
Second Booster: Canigen PiL*
Third Booster: Canigen PiL*
Fourth Booster: Canigen DHPPiL
Fifth Booster: Canigen PiL*
Sixth Booster: Canigen PiL*
Seventh Booster: Canigen DHPPiL etc etc
Thus, distemper, parvo virus and hepatitis protection need only be done every third year following the initial protection.
3. When should I vaccinate against Kennel cough?
Generally we recommend vaccination at least 2 weeks prior to your dog going into kennels. This still holds true although we can now consider annual regular vaccinations as the vaccine lasts this long and means your dog can be put into kennels at short notice.
4. How do I test for Feline Leukaemia Virus and Feline Immunodeficiency Virus?
The in-house test gives us initial screening results and involves taking a small blood sample which can be tested virtually as you wait provided we are given notice of the test. If we have any concerns, especially where a result is positive, we would strongly recommend further testing at an external specialist laboratory which utilizes a different testing method.
DIAGNOSTICS
1. How much help can a laboratory on site be?
Obviously of great importance in emergency situations but also invaluable for checking body functions prior to anaesthesia or for screening purposes especially in older patients. A laboratory on site provides results within minutes in certain circumstances.
2. Why do you x-ray and ultrasound some patients?
Both x-ray and ultrasound modalities allow us to visualise the internal structures and organs of the body. They work in very different ways, each ‘preferring’ slightly different tissues as they provide an image for us –e.g. fluid build up tends to obscure detail for x-rays whilst enhances our images for ultrasound. Thus, very different levels of information is gained depending on what is being studied and which modality is used e.g. a chest x-ray will gives us a great deal of information about the lungs but really only give us the shape and size of the heart and not what goes on inside it. An ultrasound scan however will give us a great deal of detail on what the heart is doing and how well it is working whilst no information on the lungs is gained. For the best chance of a full diagnosis both systems should be utilised.
3. How does the ultrasound help diagnose tumours?
Relatively accurate diagnosis of certain tumours can be achieved via specific testing of samples taken whilst guided by the ultrasound scanner’s picture. These samples are usually taken using special needles and sampling can often be carried out without the need for full anaesthesia even for internal lumps.
4. Apart from looking down the bowel what can you do with an endoscope?
Not only can we visualise the inside of the gut but, by using specific instruments, we can take biopsies or remove foreign material without the need for a major surgical operation. This means that the pet recovers more quickly without the risks inherent in any form of abdominal surgery and with trauma of a large incision. The bronchoscope used to look down the airways can help with more accurate and safer sampling of fluids or tissues within the lungs, often taking much less time and much less anaesthetic. Another major advantage is the ability to retrieve some foreign bodies such as an inhaled grass-seed from within the airways, avoiding open chest surgery, thus greatly reducing risks.
5. Why x-ray teeth?
A few straightforward radiographs can provide a huge amount of precious information leading to knowing when to keep or remove teeth; when only medical treatment is needed and not surgical.
INPATIENT CARE AND HOSPITALISATION
1. What care is provided for the inpatients at Moor Cottage?
The following protocol is part of our standard policy:
Moor Cottage Veterinary Hospital Minimum In-Patient Care:
- Patient identifiable at all times
- Patient kept clean, warm and groomed including having face washed.
- Bedding checked regularly and changed as necessary.
- Food and water provided for patient’s clinical requirements.
- Toileting allowed for by walking dogs at least twice daily in garden and cats’ litter tray changed as necessary.
- Safe and stress free handling wherever possible.
- Client contacted at least once daily
- Patient demeanour, mental state and appearance.
- TPR at least twice daily.
- Patient weighed once daily.
- Weight and type of food offered and ingested.
- Volume of water offered and ingested.
- Faeces and urine produced or not including its description, volume, how and where deposited.
- Discharges or vomiting (detail as above for faeces).
- Any other aspects of patient behaviour or changes.
- Medications to be given as directed by the Veterinary Surgeon.
- Sampling e.g. blood or urine as directed by Veterinary Surgeon.
- Specific measurements e.g. blood pressure, urine volume as directed.
Continual nursing presence in the hospital ward from 6.00a.m. to 12.00 midnight. Monitoring of patients overnight is tailored to the clinical requirements of the individual and can be continuous.
A veterinary surgeon must be informed immediately if you have any concerns regarding a patient’s clinical state.
SURGICAL AND MEDICAL PROCEDURES
1. What do you monitor for an anaesthetic?
Prior to any anaesthetic the patient will have been evaluated by a member of the clinical team, blood tests may have been requested and taken and any concerns addressed. Once asleep the patient is closely monitored with a nurse constantly checking a number of parameters and indicators of the patient’s status. We can measure blood oxygen levels; blood pressure; heart rate; respiratory rate; levels of oxygen, carbon dioxide and other gases in inhaled and exhaled air as well as the patient’s core temperature. These provide figurative indicators of the patient’s welfare which are used in conjunction with a number of neurological tests and checks a nurse carries out throughout the anaesthetic until a patient is fully recovered. So both modern technology and veterinary nursing/anaesthesia skills combine to make the procedure as safe as possible.
2. Why use more than one pain killer (analgesic)?
Each type of pain killer we use works in a different way and so a combination gives much better overall relief and is also longer lasting. Apart from making the patient more comfortable this level of pain control also reduces the depth of anaesthesia needed hence increasing the safety margin for surgery and anaesthesia still further.
3. What are you doing to reduce the risks of MRSA and other infections?
As a Veterinary Hospital high levels of hygiene and surgical protocols have to be achieved to gain this standard. To this end, our theatre is kept for sterile surgery only and is very specifically and thoroughly cleaned twice daily – before and after our main operating period. All who enter the theatre have to be correctly dressed in specific surgical gowns, clogs, caps, masks and gloves. The hospital and prep area are thoroughly cleaned daily and an isolation unit is present if any patient is suspected of being contagious. Many other aspects of infection control throughout the Hospital, including the choice of materials; the cleaning agents used and systems in place, all work together to minimise any risk.
STANDARDS AND QUALIFICATIONS
1. What do we mean by ‘Certificate Holder’?
When a Veterinary Surgeon develops a special interest within the field of Veterinary Surgery or Medicine he or she can take additional examinations to gain this further qualification. Numerous subjects are available including surgery; cardiology (heart medicine); ophthalmology (eyes –medicine and surgery); dermatology (skin) amongst many others. The Veterinary Surgeon will have to have had a certain level of experience, dealt with enough cases and written up a series of reports to a high enough level before being allowed to take the examinations. Thus, it is a recognised high level and difficult qualification to gain.
2. Are there any Certificate Holders at Moor Cottage?
At present we have a Certificate Holder in Ophthalmology along side one taking a Surgical Certificate and another taking a Cardiology Certificate.
3. What are Trainee Nurses?
These are members of our nursing team in the process of being taught both externally – our trainees are on a day release courses at local Colleges; and internally by our qualified assessors, to achieve level 2 and 3 NVQ Veterinary Nursing qualifications.
4. Who teaches the Veterinary Trainees?
Apart from ongoing help and support by all our Veterinary Surgeons and Veterinary Nurses we have further qualified members of the team as Assessors, to guide and monitor our trainees according to NVQ/TP guidance and regulations. The Assessors are responsible for the training and Portfolio marking of the trainees and are themselves regularly examined. In addition they must attend annual external meetings to maintain their qualifications.