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Saving Pet Sight: Veterinary Ophthalmology with Dr. John Burgess · Under The Fur

• speaker-0: Hello and welcome again to Under the Fur, where we're actually going to go under the eyelid today. We've got with us John Burgess from Berkshire Ivets and we're going to talk about ophthalmological... ⁓ Jesus that is hot! ⁓ my God, ophthalmology conditions! I'm not even writing the tape because that is a hard word to say. What I was trying to say was ophthalmological... Can you please say it? speaker-1: You've done well, you've done well. speaker-0: I don't know. Yes. eye conditions. Yes. Yeah. Yeah. Yeah. So we're talking a little bit about that, but first of all, we're to find out about you. I did a little quick Google on the way in and then I realized you're a lot younger than me. You graduated in 2018. I was 10 years before you. speaker-1: Yeah, we'll take that. I've I've aged rapidly, so I don't know. speaker-0: Yeah, see, there's an age difference. Yeah. And, ⁓ you grew up in Zimbabwe. And did you qualify there or did you? speaker-1: Was that wow too of a while, sorry, no fine. Correct, yeah. So studied in South Africa. So yeah, University of Pretoria. Yeah. ⁓ as well. There's a slight twang still. The accent is still there just about, but it is fading. ⁓ and then yeah, came over here not long after graduating, about six months afterwards. ⁓ yeah. Quick. So quite quick, yeah. I mean the the goal at that stage was to to come over and specialise, I think. ⁓ that was mind made up. So yeah, it was to to come over and do that. Or in ophthalmology at that stage, yeah. It was a it was a a wild turn of events, I think, from what I speaker-0: ⁓ wow, really? in ophthalmology or ways you just... speaker-1: Thought I was gonna do, but I'm sure a lot of us have that same that same sort of journey. speaker-0: ⁓ yeah, I thought I was going to be on farms. Yeah, same. And since graduation, I potentially haven't even touched a cow. speaker-1: Exactly. Yeah. And on my my track finally it was like ⁓ what intensive ⁓ beef production, dairy, pigs, poultry. I was like, Great, I'm gonna go into industry, do all this sort of stuff. And yeah, ⁓ it kind of went ⁓ in in finally it was like, Well, we're not doing much opfos, which I'm sure you guys are the same, having chatted to Therese and crowds as well. So it was kind of like, Well, I better go do some EMS on on OPFO just to make sure I actually know what I'm doing with this. And ⁓ yeah, two two brilliant specialists over in in South Africa, ⁓ have their own hospital up there and just spent the week with them and it was just I was like, ⁓ this is so cool. Like Yeah, just I guess from just from the exam point of view, just from actually you can see a problem, which is kind of I guess one of the few organs where you can actually be like all all the puns come out with eyes, sorry. But you can visu you can visualize it. Yeah, you can visualize it. No, but I mean you know what you know what I'm saying, like I mean the the problem is there. So if you ⁓ if you can spot it, you're kinda gonna be able to to move forward instead of having to wait for like, you know, these results, those results. So I found that very cool. And then ⁓ I I love surgery, so just like you, I really do like surgery, so the speaker-0: Yeah. speaker-1: The micro stuff really, really interests me a lot as well. So that it kinda ticked a lot of boxes to yeah to get to get from that point. speaker-0: I love the eye surgery. Like I don't do the fancy stuff that you do. What did you tell me about earlier? speaker-1: The pirate duck transposition I was ⁓ toiling with all morning. Yeah. No, no, that's like the first like six months is that we're like here's the dictionary, rewrite it. Yeah, learn how to say it all, learn how to spot it all. But yeah. Yeah. speaker-0: Are there any easy words in ophthalmology? and try. So you re-rigged it, the duct from the salivary gland. speaker-1: One of the slivery glands from the mouth up to up to the eye. Underneath the skin basically. Yeah. Yeah. Yeah. Under the skin, not under the fur. You've got to go under the skin. speaker-0: Yep. wow. That's amazing. How successful is that? speaker-1: It's pretty it's pretty decent. So a majority of dogs, about eighty five, ninety percent, will will actually do very well. Yeah. There's a small a small subset that don't tolerate the saliva on the eye. because it's actually very similar. I didn't realise that. But obviously having dug into this a bit deeper, ⁓ it's it's almost identical to the tear form. So they often get ⁓ mineral deposits, that's one of the the downsides of it. So if you do have issues, it's often to do with ⁓ to do with that. They just don't they just don't tolerate it that well. But speaker-0: I wonder why we don't do that surgery more often apart from the fact I don't think I'd ever heard of it before. speaker-1: It it used to be super common. Yeah. Super, super common. speaker-0: Because the drops for dry eye are so bloody expensive. Even myself, I'm like, what? And I'm used to seeing expensive drugs now. like every single day, eye drops. speaker-1: It's it is hectic, isn't I think it's you you look at the you look at the drugs like cyclosporin. So I mean back in the day that was compounded in various different oil formulations, like mixed up in this tincture, you put it in the eye. Yeah. And but when that started coming in, that's what actually got rid of the the PDT surgery, to be honest. That was that was one of the things that got rid of it. No, so I think it's just to do with success rates. If you can ideally stimulate a tear form production rather than having to substitute it with saliva, it is better in the long run. ⁓ So although it's a faft to put the the oint. speaker-0: Is that based on cost or? speaker-1: Theoretically the ones that do respond do a lot better. They're basically back to normal. So yeah. That's why it's ⁓ it's a good thing. speaker-0: Okay. So if your dog is all right with eye drops, you would go for that one first. And then if you've got a patient that doesn't really want things put in the eye every day, then you go for surgery. speaker-1: This option, exactly. Yeah. And to be fair, there's various different things we can do these days as well. ⁓ there's a a company in the States now affiliated with one of the unis that's making a lot of ⁓ subconjunctival implants, which are also super cool. So say your dog doesn't like ointments, or you're sick of applying drops or ointments. So you can actually implant those surgically and they last 12, 18 months. Crazy. So that's it's it's bad. No, I I must say I'm a bit of a a nerd for like the the the innovations, the tech stuff. speaker-0: know any of this stuff. speaker-1: So I'm always trying to trying to figure out these. But no, it's that's a very cool it's a very cool speaker-0: But it sounds like you found your home straight away. This is great. So you must have done general practice first. speaker-1: Yeah, I did. Bits and pieces of it. I think so it was quite it was quite broken up. A lot of people will do like two years straight and then go into an internship, then residency go down that route. So I was kind of bitty. I I randomly went into Equine straight out of ⁓ out of uni. So I was back in South Africa. so I guess it kind of ties into what I'm doing now and that it was ambulatory a lot of the time. So it's yeah, it's just hopping in the car, driving out to the yard, doing speaker-0: Okay. Yeah. speaker-1: Exactly. I really I really enjoyed that part of it. I enjoyed number one, meeting the people, you know, meeting them on sites, you know, doing all those sorts of things. I really enjoyed that. So that's that's a nice little carryover I've got now, which is which is good. Yeah. ⁓ but yeah, working with horses was another ball game for sure. I think ⁓ growing up I was always kind of surrounded by them. My mom and my sister are are horse mad, so they're ⁓ yeah. So that was fine. I always kind of grew up with them. I I was I was comfortable in that world, I guess. But it's ⁓ yeah, happy it was fine. Yeah, it was fine. But I I speaker-0: Yeah, definitely. Horse behavior was fine for you. speaker-1: ultimately knew what I wanted to do. So it was kind of just buying time to wait for R C V S registration and then ⁓ No, thankfully not. So really, really lucky that they had there was a kind of crossover between our degree and and they kind of accepted it still, which was which was a benefit. speaker-0: Did you have to the exam here? So you just apply, probably pay some money I imagine. And then which internships did you do? Did you do general ones or specific optimologies? speaker-1: Yeah, as with everything. So I just did a rotating actually, which is quite rare at this day and age. Normally you've got to go rotating and down to a specialist one and go from there. ⁓ I actually did one ⁓ up in Manchester. So I was actually at Advaits now up in Manchester. So it's very ECC heavy. Yes. That's that rotating one. So ⁓ which I really liked, surprisingly, because it's far away from eyes, but Yeah. Yeah. So one of their one of their two kind of referral hospitals. That's great, yeah. speaker-0: In a specialist hospital? Yes, I remember there was a Glasgow one. speaker-1: Yeah, yeah. So it was a smaller one, smaller than the Glasgow one, but similar vibes. I think. So yeah, loads of loads of after hours, loads of of night stuff. But ⁓ yeah, really nice team there, really. Yeah, just I don't know. I enjoyed the kind of just getting on with it if that made sense. You whereas a lot of rotating internships, I think they are they're very hands off. You're kind of Yeah you're given certain small tasks, certain bits, but you can't actually you know, you might cut some sutures here and there, but that's about it. Whereas this was speaker-0: period then. Yeah, that's actually part of the reason I didn't want to do it. I went to some, you know, that when you just spend the day there and I was honest to God bored shitless. I'm so active as well. And I was just like jumping in my seat and I was like, ⁓ don't think I can do this. Yeah. I'm also not good with authority. Yeah. So, ⁓ good for you getting through it. I don't think I could have. speaker-1: Yeah. But yeah, so that was that was that was good. I mean that was a good stepping stone. Then I did ⁓ a lot of night work vet work with them afterwards. So stayed on their kind of part time, or it was kind of half my time was there. So mostly after hour shifts with them. ⁓ either back shifts or or after hours. Discovered my body does not like night work very much at all. speaker-0: Yeah, I did a stint about it. don't think I could anymore. speaker-1: More. It's weird, it doesn't matter. Like I could sleep the full eight, nine hours during the day, which everyone like, You're crazy, can I do something with your life? I like, No, like I tried. I can't like eight, nine hours I still feel like a zombie and yeah. speaker-0: Yeah, it's really tough on your body. ⁓ speaker-1: Short lived. I was short lived. The benefit of it was ⁓ because they didn't have Optho on site, they were quite happy for me to go off and do like almost like EMS type stuff. But my extern my externships were quite extensive. So I'd I'd go to various different Optho faculties and go and see their, you know, see their setups, you know, just yeah, ask about their residency programs and things like that. And ⁓ yeah, I ended up spending a lot of time down at ⁓ Dick White referrals back in the days. This was back twenty eighteen, twenty nineteen. yeah, yeah, one of their one of their speaker-0: That's when my best mate did her residency. I wonder if you overlapped. Jenny Ellis. You will know her if you met her. ⁓ speaker-1: No, don't. So I I spent a few weeks down there with them, but one of their seniors was actually ⁓ really good friends with who ended up being my supervisor over at the Ralph. So ⁓ so completely just co complete coincidence. I think it's kinda just right place, right time. So yeah, I ended up ended up getting the the gig over at the Ralph. Started the residency on the the first day of the first lockdown of COVID, which was great. So we were all like super certain of what was gonna happen then. We were like, Well, we can't really see any patients. What's gonna happen? speaker-0: I'll to my... speaker-1: D did the grind, finally got there, we didn't even know what was gonna happen. speaker-0: So let's think about most battery clinics in lockdown said emergency only. So what's an ophthalmolic? ⁓ my God, I can't say this Ophthalmic? Ophthalmic. I'm just going to say eyes. What's an eye emergency? What is an eye emergency? speaker-1: Correct. Yeah. Trust me, everyone in the audience will appreciate that. Yeah, yeah. speaker-0: Ten time dyslexia. Something's good. speaker-1: Yeah, so that I mean I mean first we'll get into the emergencies in a sec, but I think it was interesting there 'cause they were a fairly young startup when I started there anyway too. So as as a hospital they were like, Well, this is really bad timing to just be seeing emergency speaker-0: Although it started as an emergency only place and then expanded. So I guess they were good on that sprint. speaker-1: They're fine on that front, which is good. ⁓ but no, getting to to kind of eye emergencies. I think the the biggest ones from my side would be and the kind of the true ones you need to see there and then would be glaucoma. So the high pressure in the eye, that's probably number one. You know, the the unfortunate thing with the eyes it is very fragile. So it can take a beating, don't get me wrong. Like I think more than I thought it could, but I think the optic nerve, the retina are very, very fragile structures. So as soon as that pressure gets up above forty, fifty, you need to really be getting it down quite quickly. And that's ⁓ forty fifty. Yeah. So ⁓ I'm not too I mean, obviously you're concerned, but you're not too concerned. Twenty, thirty, you can like, Yeah, we're fine, we can manage that. That's okay. We've got time, we can buy time, but yeah, once you start climbing above as everyone falls asleep in the audience, okay. ⁓ yeah, no, so that that is ⁓ definitely a true emergency. We go down that route. ⁓ perforated eyes ⁓ that are actively leaking. That's another one. ⁓ surprisingly, perforated eyes that are sealed, I am a lot less concerned about. So I would say to you to everyone, you know, you can pop a pop a protective collar on there. speaker-0: I think I speaker-1: pain relief, keep them quiet. You can see them the next day. That's absolutely fine. Because a lot of the time it happens, you know, late afternoon, late evening. ⁓ they need to see very grumpy The anesthesia team or the nursing team is very grumpy when you call them in for a graft at that time. So you're like, you know, as long as they're stable, they're fine. There's absolutely speaker-0: Okay, so if it's perforated, I'm not just whipping it out. No, we're going to graft it. speaker-1: So with a dazzle reflex there's hope. I can't remember where I heard that, but it was definitely not my I didn't come up with that, but ⁓ someone someone did but I've definitely speaker-0: Okay! speaker-1: I definitely came up with that. Doesn't Yeah, no, but literally. So if if you have a Dazzle reflex, ⁓ or a PLR, if you can see that as well, for sure. We can graft that, we can save that eye. So I I like the I like the corneal corneal grafts, so corneo congentival we call them. So you move a part of healthy cornea over the top and stitch that in place. You can use various different different donor grafts and things as well. ⁓ in the States they use a load of conjuntival grafts, just conjunctival grafts. ⁓ speaker-0: Yeah, I've done a contactival graph. It was so fun. I loved it. Yeah, but I like fiddly. Weirdly, because I don't have patience. to say, is yeah. No, I know it's really ironic. I don't have very much patience, but it was something about these little tiny instruments in my hands. ⁓ speaker-1: Yeah, they're off one. But good, aren't they? Really cool. the thing when you see like students and and interns, they in and they see it, they're like, That's not real. Like surely not. Like especially the suture material we use, they're like you're just you're just waving your hands around, you're not actually doing anything. And then you actually look under the microscope and you're like, ⁓ hang on, you actually are actually doing something there. Yeah. But but yeah, no, it's ⁓ the going back to the conjugatical graphs. I think the the guys in the States use conjugatical graphs loads. I just I like to try and use corneal if we can, you just get slightly better clarity after. speaker-0: not to lose vision. speaker-1: support. So yeah, that's that's the go to. But yeah, so those are very, very saveable. ⁓ and I think a lot of people would be whipping them out a lot of the time, which I I used to do to be fair. Like I was like, ⁓ yeah, that's that's gone, that's toast. Like get rid of it better at the bottom. speaker-0: I did two eyes on a dog, but honest to God, the eyes were taking themselves out. And I don't even know when they had ruptured. I was helping a charity and they were trying everything. They'd been doing drops for ages. They were doing everything. But by the time I got there, I was like, this ruptured a while ago. I said, I'm going to take the eyes out and said, but he won't be able to see. I was like, definitely can't see anyway. Don't worry. We're just taking away pain and the risk of infection. speaker-1: Don't worry. The thing though, isn't it? Like I think ⁓ a lot of people are are horrified. I mean it's you and I talking. We look at each other in the eye, don't we? Like that's our point of contact. And you know, with our our pets we're the same. And I think we we often kind of humanize that aspect of it. And I try and I try and get that across to pet owners. I say to you guys, like, look guys, don't worry. This eye is blind, it's painful. Absolutely. You you end up s you get the message across. They're still quite sad about it. You take the eye out, you know. Two days later the dog is racing around, chasing the ball around the It's so much more complicated. In the same way that you speaker-0: You can just flick them in the eyeball a lot and just be like, how do you feel? Yeah, either you can say like this for the rest of your life or tick your eyeball out. speaker-1: ⁓ exactly just spoke. Exactly right, exactly right. I guess it's the same with like with arthritis, things like that. It creeps up when you doesn't it? And it's the same with chronic chronic eye pain thing. speaker-0: Yeah. I have similar when I have to take a leg off. like those fractures don't heal, won't heal no matter what you do crushed. And I always say to people, your dog or cat usually, his legs off, doesn't care. They literally come with a spare leg and they don't care and they're not using it anyway. Which is similar with the eyes. He's not using that eye anyway. All they're going to feel when you take that off is relief. speaker-1: Yeah. That's exactly it. My my residency buddy and I throughout our residency we were kinda like, the eyes are non essential organ, whatever we do, it doesn't matter. Like we're fine. They're gonna be okay. Like these guys are doing like a cardio intervention. Yeah, this this animal is going to die if they don't do this. speaker-0: Yeah, yeah, they need the hard ice. The ice is fair. They've got only other senses. speaker-1: Patriots, they're gonna be fine, like honestly, yeah. No, we we we obviously joke about that because I mean it's it's all about it's about the quality of life too, isn't it? I mean, like we we are, I mean all jokes aside, like you are yeah, you know, you can see the the quality of life improve when you you actually give them their vision back after cataract surgery. I it's like it's my favorite thing to do because you know, you see that change. Like again, like like you've done loads of like charity work and it's these these dogs from puppy farms and they've come across, they haven't been able to see for the last four or five years because they just speaker-0: Yes! speaker-1: The number one being in a cage they've had cataracts they've just been bred from and they just sit there. They're so timid they won't even so middle-aged. So they're middle-aged. ⁓ majority of those would be just from inbreeding, unfortunately. So from I mean, that's the catch-22, isn't it? Because they're obviously being used for breeding, passing on these genes that are there, obviously a problem. But majority of them are are hereditary. speaker-0: Like are these young dogs? Cataracts already. Again, I didn't know that was hereditary. I'm going to log this as CPD afterwards. speaker-1: It's hilarious. Now the things you the things you don't know that you don't know, it's it's amazing. speaker-0: I sort of know that I'm not good at ophthalmology. have to also do general practice, remember? speaker-1: It's it's a good start. ⁓ it's me and authors like I'll be like, Well Saw is too big and too dangerous. I I don't know how you guys do it, honestly. I think it's speaker-0: ⁓ my God, there's so much, but you know what I like to do in my clinic, we sort of divide and conquer. So like Ellie and Jill are really good with eyes and they take that stuff on and more maybe medical stuff. then me and Sasha are more surgically inclined. So we just divide and Yeah. And we're super geeky wherever WhatsApp group, is the geekiest thing you will ever read in your life is just information. There's nothing fun. There's no banter, nothing in it. speaker-1: That's good, isn't it? The sub the subgroup that's just like. speaker-0: all that chat information we discussed like every single case. It's yeah. And it's nice for my clients because I say to them, like we asked permanent vets, but one day I might not be any UC Joe, I guarantee you everything about. speaker-1: Yeah. That's good though, that's healthy, isn't it? Like that's how you get better. That's how you get better. No, it's good. Jumping ahead, but obviously getting the into the peripotetic stuff is like it's actually working with the teams again. Yeah. Referral, you're kind of on an island sometimes, I think. You know, you we'd see we'd see a case, like you where the history's briefly come from, but you don't really like know. You like you'll summarize it, you you crack on, you do your referral, you send your letter. Like to be honest with you, a lot of the time the system summarizes where it's being sent to and I just we just type it, send it. I don't even know sometimes where it's gone to, you what I Yeah. Which is terrible. But like it's it's the truth. The reality of it is you You know, you're treating your patients and ⁓ yeah you don't think about the the poor vets sitting sweating at home like this is this is their their their patient. You know, they've had these clients potentially their entire yeah, you know, pet's life, potentially even before that. And you you know, that they're losing that for however long you just managing their their case. And yeah, going into that now it's been it's been brilliant. It's been ⁓ it's been a real eye opener, it's been good. speaker-0: So how did you go? So you've got your, ⁓ thank you. was just checking the words. Do I want to insult you and say the wrong one? was like, I think it's two years ago, 2024. ⁓ and then you set up. speaker-1: ⁓ diploma. ⁓ no, don't worry, it's okay. Yeah, twenty twenty four. Yeah, pretty much. So I think when we're exams. Exams were April, May, I think, or May, June, I think, twenty twenty four. speaker-0: We're now even more on an island. Yeah. speaker-1: Exactly. And then ⁓ yeah, then set up on ⁓ set up in August basically twenty twenty four. Very slow start. I ⁓ I'm sure you'll be in the same boat. You didn't you don't realise how long things take to actually get growing. speaker-0: Absolutely. And people tell you because they think it's such a demand for veterinary. They tell you, ⁓ you'll be flying. Yeah. speaker-1: ⁓ you crack on, it's absolutely fine. Yeah, try ordering a microscope from the States, be ⁓ it should be right. No, two, three weeks it'll be yeah, wait, like maybe December time. Yeah. So yeah, that was wild. It was the first like four or five months was literally just like carnage, like just trying to trying to get by, trying to do things. speaker-0: It's insane. And I don't know about you, but I had to support a family and a mortgage and everything during the time. So I was working night shifts, going to the clinic, working the days and go back to the night shift again. Six days a week working like a lot. speaker-1: It's hard. It's mad, isn't it? No, I I completely I feel I feel that that's strange as well. Two two young kids exactly the same, the same thing, mortgage, everything else going on. I was really lucky in that. I think the examination equipment came quite quickly. So I could do all the medical stuff. I could do the extraocular surgeries and things like that. We were fine. So that was all okay. But ⁓ speaker-0: And you started by going into practices. Which is so lovely for the clients to have you on their doorstep. then I remember you came in and taught us some stuff. So nice. ⁓ Yeah, which is, there's a few options for ophthalmologists, but to be honest, it was your friendliness and your approachfulness and your willing to answer WhatsApps to us. Maybe I should add you to our WhatsApp group. speaker-1: Yeah, but it was C P D, I remember that. Yeah. Yeah, need to, we need to. speaker-0: Yeah, it was so helpful and immediately we were like, you are the vet we want for our clients. So was so lovely that you've that. You're welcome. ⁓ And then you've obviously got the premises now. speaker-1: Yeah, so we we actually still we are still peripatetic fully at the moment. So yeah, we are literally in and out everywhere we go still. So yeah, we've got the team's grown. That's one big thing that's changed, I guess. Another ophthalmologist on board now and ⁓ a nurse who who thankfully runs our lives for us now, which is great. Right. ⁓ because yeah, we we need that. It's always the case, isn't it? It's the communication and the the admin stuff that just falls away when you're dealing with with all of the no, no Beck definitely runs our lives. It's great. Yeah. Yeah. ⁓ so no the it's speaker-0: Yeah. ⁓ absolutely. Yeah. speaker-1: It's exploded though. I think it's it's one of those things. We never really like I don't know, I never really went out like actively seeking tons and tons of practices. I thought, no, it'll be it'll stay small, like this is this is all it'll ever be kind of thing, the classic, you know. Yeah. And ⁓ I think it's just word of mouth basically it it traveled. ⁓ I never intended to go into London that much either, you know what I mean? It's it's like our our number one spot now. We're always trekking into London. So ⁓ which which is a good thing. Yeah. speaker-0: And so you took on another vet, Rebecca. ⁓ but she's a certificate holder. I love that. Cause you know, I'm the third holder, not a specialist. So I love the use of that. ⁓ but how does that go then? Does she do everything that you do? Do you do some stuff together or how does it work? speaker-1: The cert holder, yeah. It's good shout. Yeah. Yeah. So no, I'm I've always been super, super open about the fact, which I think a lot of specialists aren't in that. I think a lot of specialists are very precious about the the specialist title and I've like, No, no, I you know if ⁓ yeah, definitely if you are if you are doing a job, you're helping the clients, you're keen to learn more. Like you don't need the diploma behind your name as long as you are open and willing to do the stuff and you're doing the stuff. So I don't know. speaker-0: I get it a lot. I don't have a side eye. And when I use the word referral, because it is because people send me stuff. They're like, it didn't say I was specialist. speaker-1: Can imagine Yeah. Yeah, I can imagine. I know exactly why I did ooh. You shouldn't use Yeah, no, I know. ⁓ but no, so she so she does all the all the kind of medical stuff. Yeah. She was taking she was seeing referral cases as well before long before she came to see us, ⁓ came to join us as well. So all the nice, nice busy hospital, which I find incredible. Like she was, you know, she was kinda kinda quite quite high high from that practice, seeing loads of their stuff, you know, mentoring a lot of their their new grads and everything while doing office stuff as well. So yeah, it's a it's a big, it's a big job, big load. Yeah, I could never do that. speaker-0: So was she in a general practice? She was. She was. That's amazing. Yeah. speaker-1: So no. So yeah, she does a lot of that and then she does all the extraocular surgeries and stuff she's ⁓ she's very keen on. But she's ⁓ I mean you've you've met her now. She's ⁓ super bubbly, super nice, super speaker-0: Yeah, she's super friendly. I met her for the first time today. She walked straight in and was like, you're Vanessa. I knew who she was because she the trolley of stuff with her. speaker-1: Yeah, no the big old suitcases, exactly. speaker-0: Yeah, but she's lovely. I think she saw my friend's dog, the Shih Tzu with the Glycoma. Yes, exactly right. loved her. They she was very lovely, helpful and did a good job. speaker-1: ⁓ so no, where ⁓ she's she's also super keen to progress further. So a lot of the stuff you won't do in general practice, as you'd be aware, you don't have a microscope, you don't have a cat. So yeah, so no. So she's been doing like conjunctival grafts, fine, but now it's gonna be that that step up now to just be kinda it's kinda like a residency in that way in the in the surgical way that we need to, you know, tick a few boxes in terms of getting that that surgical training done. But ⁓ yeah, she's already flying, so it's it's great. Yeah. speaker-0: John. Amazing. sometimes, ⁓ it's not all vets that watch the podcasts. So I was thinking we could talk a little bit about what the common things are that pet owners will see when they need to come and see us or see you. They can come to you via me. I can do an aisle. So yeah, Conjunctive, no problem. Entropion. And then the rest. speaker-1: That's exactly right. No, that's that's that's it. We're on it, we're on it. Very good, very good. You can keep that. We'll take. speaker-0: Yeah. So one of the main ones, my dog's got a red eye on some discharge during the summer. speaker-1: During the summer, very good. So I mean the the the load a lot of things that we see during the summer months is gonna be the allergies, they flare up big time. So ⁓ allergic conjunctivitis is a lot more common than you think. ⁓ and despite what a lot of the the drug companies will tell you, the bacterial conjunctivitis in dogs is almost non existent. So you see it in ⁓ you see it in some younger dogs for sure, like in like puppy playgroups and things like that, but not not that common. speaker-0: Do we treat it? speaker-1: Yeah, so the al the allergic one for sure. So you can, depending on symptoms, you know, if it's if it's mild, a little bit of discharge, not really painful, I wouldn't worry too much about it. Kind of ride it out, treat treat symptomatically. ⁓ but yeah, the ones that are a lot more squinty, a bit sore, the discharge is getting a little bit green, a little bit gunky. ⁓ you actually you you reach for the steroids first. You don't actually go for the antibiotic first. So I know I know, I know. Which is it's it's a bit it's a bit voodoo saying that. I can we obviously a bit speaker-0: ⁓ speaker-1: Always a bit twitchy about saying, Yeah, use steroids, it's fine. But these are the cases that actually, you know, if we're going to treat them, that's what they need, to be honest. ⁓ so you'll find a lot of so I I think it's a culture and sensitivity is a good way to go. If you're gonna go down that route, if if you're open to it, if you can't get a swab from these, yeah, I would do that. But the first thing, the first thing you should do with every single eye. I mean, we do it, you'll see the the cases that come in for glaucoma perforated aile, they'll the owners will see me reaching for the Shermatia test trips and measuring tear production, and I'll go for even for the good eye, and they're like like. speaker-0: So how do we tell the difference? speaker-1: What are doing? Clearly, like you can see the the the massive massive hole in the other eye. And I'll be like, no, no, I need to I need to do this with every single patient. You need to know what the tear production is doing. So any red eye, you want to know what the the tear production is doing. Because dry eye is one of the pretty much the most common thing that we see. so I think that is first and foremost, rule that out. If you rule that out, you've got a young dog, you're not seeing any ulcer, you're not seeing a grass seed, which is a nice great, great topic for this time of year. Have you got a scoreboard going on your You can tell I've been around places. ⁓ speaker-0: Next time you're in the clinic, stop saying that. speaker-1: The first thing I shown, they're like, Would you like a coffee? Check out the scoreboard. How about he's running every time I go back or check it out? ⁓ so no, but that that's the thing. Rule out things like ulcers, foreign bodies like like that. And then if you if you're not seeing any of those things, typically a younger dog, you're gonna see if you're looking very closely you will see little follicles in the conjunctiva, and that's literally overproduction of of ⁓ lymphocytes pretty much. That's what's that's what's happening there. ⁓ so they're trying to get rid of whatever those allergens are and that's when you can try all the try all the steroids. Rule out the narcissist, reach for the steroids basically. That's a good speaker-0: for the stare. Another slogan for speaker-1: Yeah, no. So that's that's it's a common thing. Very, very common thing you see, which is it's nice it's it's it's nice 'cause it's common but it's not ⁓ it's not a difficult one to manage. It can be your kind of bread and butter. But you don't have to kinda reach for the the facidic acid, send them away, it just keeps coming. speaker-0: ⁓ that's how to stop now anyway. it's great. It's been gone. speaker-1: I was like I I was like, I need to actually ask around like some of my colleagues and say, guys, is it just me? ⁓ you're not seeing as many melting ulcers now that physic acid's gone. The thing is it's like it was always marketed as like this is your frontline airdrop, you know, your eye gel for for and and everyone takes it. And I used to take the same thing, you know, I was locuming and things like internal practice. I was like, ⁓ it's it's you know, it's got an ulcer, you know, what can I reach for physic acid on the shelf? Go for it, it's licensed, we'll use it. And yeah, what I didn't know and didn't realize till I looked into it and dug deeper, it's only licensed for bacterial conjunctivitis. That's it. speaker-0: That's such a good idea. speaker-1: Right. So yeah, so not also no. So the the flora it's it's a very, very narrow spectrum of activity. So all it was doing basically was taking out all the normal flora and ⁓ and leaving the nasty speaker-0: this is my teacher in university was David Williams. Such a fun guy. ⁓ my God. His bow ties are legendary. So fun. And that is what I remember him telling me. was like, you want to use this and take off all the good bacteria? Yeah. speaker-1: ⁓ yeah, yeah, Cambridge. Great body size all around. Yeah. Yeah. No, so I I think that's that's definitely something that's that's cropped up loads, is that actually speaker-0: Well, excellent. It's out of stock now. So there you go. then what about breeds and eyes? speaker-1: Yeah. That's that's a big thing. Yeah. I know you've had an episode on bracies as well. And ⁓ it's literally unfortunately for us, ⁓ it's it's the most common the most common thing is pugs, shits, Frenchies, English bill dogs. Those are like that's everything we see basically. You know, there's the odd other dog for other random things, but yeah, you know, day in, day out, you know, it's gonna be at least fifty percent of our cases are gonna be one of those breeds. ⁓ speaker-0: Because the eyes are poking out to the heads. speaker-1: Correct. Yeah, I know. I mean it's it's ⁓ you obviously you'll you'll touch on more of like the boas stuff and you know the spines, yeah, everything else. All of that is is a big factor. ⁓ but yeah, the eyes are definitely one of the it's one of those insidious things. You don't notice it throughout their lives and all of a sudden they reach five, six, seven years old and it's a disaster. So yeah. ⁓ it it is definitely one of those things that's overlooked. ⁓ it's a there's a crazy paper. I think it says something like there are something like eleven or twelve times more likely to get a corneal ulcer than say your bog standard labrador or greyhound or whatever, which is which is mad. speaker-0: That's huge. speaker-1: And that's not even factoring in like tear production, those sorts of things. Which again, they're prone to getting ⁓ you know, a worse quality tear film. It evaporates more frequently, the centre of the corner is exposed. So it's just a it's a horrible vicious cycle really. ⁓ just goes round and round. So speaker-0: And one of the things that I noticed so earlier in my career, CherryEye, I was doing cavaliers. Or ⁓ beagles. And now it's all French. speaker-1: Yes. Frenchies, Frenchies, Frenchies, English Bulldogs, Frenchies. speaker-0: Yeah, to the point where I forgot what I used to do. Cherry eye on. speaker-1: Yeah, isn't it ⁓ Yeah, no, for sure. Especially the referral stuff. So like when we were being sent things as like a secondary referral, it's always those breeds, you know what I mean? It was always the ones that have popped up because they've got a shallow orbit because it they just they just reject sutures, they just like it's it's an idea. speaker-0: This is the first thing I learned. So I thought I was like excellent at cherry eye surgery, doing like cavaliers and stuff. Pop it in. And then I started doing Frenchies and they come back two days later and I was like, I couldn't believe it. was like, ⁓ no, this is not good for the ego. That's come back. speaker-1: Great. I swear I just put that in. Disaster, yeah. You go from the mountain of stupid straight into the valley of despair. It's bad, isn't it? I know what you mean. It's a it's a rapid trip down there, I know. speaker-0: Exactly. Yeah, I was very upset about it. What's your technique? speaker-1: Yeah, I like I like the pocket technique. I still do go for it. I think the the thing I'd recommend Sometimes. ⁓ I sometimes do. Yeah. It's that's a bit hairy, isn't it? You feel like you're always quite close to the eye. You can't really feel where the tip of the needle is. You're like, Mm, I'm not sure. ⁓ but no, it's a very good technique. I think there's pros and cons. I think going back to the pocket, which I go for first. Yeah. I think the mistake that I used to make and the mistake a lot of first dominion vets will do is not being brave enough with your pockets. So speaker-0: You anchor them down. I've done it a couple of times. speaker-1: You wanna be extending it, say you've got a pair of your normal conjunctival scissors, like just your standard ones. Yes. You want to be extending that in ⁓ that pocket all the way down to the actual hinge of your scissors. So right underneath that eye. So which sounds crazy 'cause that's like probably I I I was gonna like a third of that distance maybe be like, ⁓ So yeah, if you if you do that you'll find your success rate instantly jumps up. ⁓ So that's ⁓ first and foremost. I do loads of those, loads of those. ⁓ speaker-0: I don't go there. Add that to the notes as well. speaker-1: There are breeds like a lot your ⁓ your mastif type breeds. So your your canny corsos, those sorts of breeds, ⁓ for sure. They they are more of a disaster no matter what you do, to be honest, in terms of cherry eye. ⁓ if you do a pocket on its own, quite often they do break down, they do flare up again. So I will often do a combo. So belts and braces, so I'll do I'll do a pockets. I might do like an over sewing technique as well, and then I'll anchor them as well. So that'll typically be when they've kind of popped out once before already. But even sometimes if I see them for the first time now in a certain breed, I'll say to people, look. I think it's worth doing the anchoring. Yeah. The downside of the anchoring, the only downside is you are kind of you're shifting the anatomy of the third eyelid slightly. It's not ⁓ and the physiology to you, not it's not able to move quite as well as it did before. So that's the only thing. Yeah, a little bit. So that's the downside. ⁓ but it is a it's a good technique. I think it is, it is good. But top tip, you need to grab the periosteum. So I always say to people you have to like be you have to lift your dog's head off the table almost. ⁓ There you go. And you'll be happy with that 'cause it's like two naught three naught as opposed to like the nine naught that we're right. Yeah, no, for sure. Yeah. speaker-0: or wire. And then you do the breed tests as well for the BVA. What's that? speaker-1: So yeah, so there's there's basically a hereditary eye disease testing panel. So it's run by the the Royal Kennel Club, ⁓ and through the BVA and the Sheepdog Society that all kind of form one, one body when it comes to this. So you might be familiar with like the elbow testing and the the hip dysplasia testing and things like that. Same sort of thing, but just for the eyes. So we have a a subset of breeds ⁓ that are listed on the on the site and they each have specific conditions that they are tested for. So We try our best to test them when they're puppies ⁓ for certain things. And then as they age before breeding, we try and test them for certain things. It's it's done wonders for ruling out things like, you know, lens luxation interiors. You may have seen the beginning of your career and you used to see more lens luxation interiors. It's one of the things we look for, and that is No, exactly. Like I mean, for our for our case logs for residency, we were like trying to find these dogs. We were like, Well, clearly the the the eye disease testing's working because you speaker-0: I don't think I've seen one in years. That's it. speaker-1: So you basically you you find something like say like that or like a closed angle glaucoma, which is really nice, you know, glaucoma we spoke about earlier being being a horrible disease. So, you know, that is a hereditary condition in many breeds. And ⁓ you know, you test them for that, you find that they have that, you say to the owners, look, I'm really sorry, but we we can't recommend breeding from from this dog. Yeah. And in the same way, if it's like partially affected by certain things, you can say, Okay, well, it's partially affected. But ⁓ we don't normally give breeding advice. But if if you are, you know, you know the the the kind of the score when it comes to those sorts of things, you can then say to them, Look, you're this much affected. Make sure you go to someone who's clear if you're gonna do it. Yes. ⁓ the European system is a lot more ⁓ strict. So they'll be like, you know, one little problem, no breeding done. So wow. I think I'm kind of on I lean, I'm I'm kind of in the middle, I guess. I'd be kind of, you know, you don't want to shrink these gene pools to the point where you're now breeding dogs that have so many other different issues. So ⁓ so no it's it's a super important thing that we do, I think, where you can speaker-0: Reading in general is absolutely mind-blowing. speaker-1: It's it's hard, isn't it? Yeah, no, I I try and steer clear. And I think the whole panel, the BVA panel, I think there's like 40 of us or something, and we we steer clear. Like we we have our AGMs who like do the testing, don't give breeding advice. Like, you know, leave that leave that out of it. Cause you it's it's a mindfield, you it's so subjective. Whereas what we're doing is very objective. You know, we're like it's either got one, two, three, or four. So you know, I can grade that, I can send it off. It goes to the Kennel Club website. Everyone can then search that, which is really handy. So say you want to You want to breed and you've got like, you know, a particular side you're you're looking at and you can go and see, Okay, fine, they've got these certain things or they're clear from these certain things. So speaker-0: And is there any that if you test as a puppy, they might develop late and you wouldn't miss it? speaker-1: We can for sure. Yeah. So we we I can only test very, very limited things as a litter. So it's nice to have it done 'cause you can see like ⁓ certain things actually as a puppy, say collie eye anomaly in like sheepdogs or or border collies. Yeah. You actually only see it in the in the puppies for a lot of them. And there's a ⁓ a phenomenon called go normal where they actually ⁓ yeah, they actually ⁓ will will go normal so they look normal after a while. But other things mostly develop kinda later in life, so you won't be testing them all the way through. speaker-0: And you said, I think you said you have a lot of labradors bouncing. What are you testing? speaker-1: Yeah, tons tons of bouncy labs. It's the classic six six month-old bouncy labs running around the place. so they yeah, they have four different things that we test them for. So hereditary cataract, ⁓ and then there's three different retinal diseases that we're checking them for. So wow, that's yeah, so retinal dysplasia, ⁓ there's two different kinds of that, and then ⁓ PRA, which is a type of retinal degeneration that we test them for as well. speaker-0: Yeah, I a patient with that. speaker-1: Yeah, so it's it's all the things that are kind of sight threatening, vision threatening, you know or or they can be eye threatening. That's what we kinda test them for. So yeah, we're not being too nitpicky about about things like that. But ⁓ yeah. speaker-0: Because when you think of Labradors, people think hips. speaker-1: Absolutely, don't you? Hips, elbows, hundred percent. No speaker-0: nobody thinks eyes until you look on the BVA website and check those non-essential organs. ⁓ speaker-1: ⁓ hang on, they've got eyes as well. Good, yeah. You know, they use their their hips and and everything to navigate, but they have to actually focus on speaker-0: The eyes now. What, they just sniffed the food out and they're fine. Yeah. What do Akita's get? Do you test for them? You're not allowed to look in my Akita's speaker-1: There you go. That's it. That's it. ⁓ we do. We you can. So they're not No, no, we won't do that. Just sign the paperwork, right? No, so they're they're one of those breeds that wouldn't be I don't think they're officially listed on our on the BBA, but we still test them, hundred percent. So absolutely. Like I I always say we have like, I don't know, thirty or forty breeds, whatever they are, but we test everything. We recommend testing every single dog. Just 'cause they're not listed, it doesn't matter. Like I will still be able to test you and certify that everything is all good. speaker-0: Yes, of course. I've never thought of that. You generally look at the BVA websites and say what breed, what tests do those and then move along. But yeah, why wouldn't you test everyone? Yeah. She's not going to be a mom anyway. She said no. Yeah. In fact, she beat her boyfriend up. Yes. No, I did extra hips. They were fine. speaker-1: Hundred percent. ⁓ did she? ⁓ fine, fair play. Yeah. Very good. Yeah, no. ⁓ Akitas typically clinically we see them for ⁓ quite nasty ⁓ inflammatory conditions in their eyes actually. So like immune mediated ones, they quite closely mirror a lot of the human ⁓ autoimmune diseases in the retina. So that's what we typically see them for. If we're gonna see them clinically, that's that's the majority. ⁓ very, very rare that we see them though, which is a good thing. speaker-0: Yes. I used to see them a while back and I've, probably touchwood have not seen one for a while. Yeah. Allergic skin disease I seem to be getting now. I haven't seen any blind ones. speaker-1: A lot for sure. Not for a while. That that would that's a good point. Like I I've seen a few with like dermatitis and things like that around their eyes. So that is that's one thing. Yeah. The fine line between derma and optha, we're always like, I don't know, whose is this? I'm not sure. ⁓ yeah. speaker-0: Yeah, that's a good point. speaker-1: Yeah, there there are certain things where it's like, ⁓ this is yours or is it mine? I'm not sure. It's like neuro, but like optic neuritis, we're always fighting over the optic nervous. Proximal or distal, who's I mean who's talking? I don't know. Like it depends if you wanna from a brain point of view or an eye point of view. I don't know. speaker-0: I think ortho and medicine, do we fight? I'll tell you what, if it comes in out of ours, it's medical. ⁓ If it comes in at 9am, it's probably surgical. Yeah, no, ortho neuro, they definitely overlap as well. ⁓ speaker-1: Points, yeah. Yeah. Particularly with orthopods who would like to you like to cut spines potentially, you'd be like speaker-0: ⁓ So do you ever have a conversation with human eye doctors? they're like, what? You do that for animals too? speaker-1: I don't know you're getting there, you're on it. So it's it's it's cool. Like I think I haven't I haven't spent that much time with human ophthalmologists. I've got I've got friends who who have and they're like they're fascinated. They love what we do. They're like, This is madness. Like, yeah, this is super cool. And they'll be that's the cataracts we operate on. And they're like, No, yeah, you can't touch that. Like, no, there's no ways that'll have a successful outcome. Like, well, yeah, that's why ours is ninety percent and yours is ninety nine percent. That makes sense. Like, you see a speck of cataract, you cut them out. Like, no problem, because the human eye just responds so much better to inflammation than dogs' eyes do. Really? Yeah, just just like with the draw, unfortunately. We drew the species. speaker-0: Cause generally I feel like animals heal way quicker. speaker-1: Yeah, in general they do, for sure. I think the the human eye is one of those that's just more of a like a an immune privileged sight than a dog's eye is. So yeah, they don't try and attack themselves as much. So no, that they love it, they find it fascinating. But equally, I mean, I find it fascinating. You see the skills that those guys have. I like I would say absolutely. I mean, to be honest, we do the same techniques and things, which is nice. So we get to kind of piggyback off what they're doing, which is great. ⁓ but like you look at cataract surgery, I they'll do as many cataract ops in a week. speaker-0: Probably their equipment. speaker-1: as I'll do probably in like five years. It's crazy. Like they just they have such a thoroughfare of of cases. It's absolutely crazy. ⁓ pretty exaggerating a bit, but you know what I mean. speaker-0: No, but I wonder they do specialize more than we specialize in. ⁓ speaker-1: So they'll subspecialise in just cat surgery. That's all they'll They're just a regional surgeon, you whatever. Yeah. Whereas I think I'm fairly niche. Well, these guys are like speaker-0: No, no, no, no. You can get more niche. I was asking my, my insurance for referral. I've bloody always gotten injury. I swear. I'm always having to go. And they said, what do you need? And I was like an orthopedic surgeon and they're like, yeah, but what kind of, what kind would you was like, what do you mean? What do you mean? What kind? And they're like, should we narrow down to joint? And I was like, speaker-1: Just keep going down the down the line. speaker-0: What? We narrow it down to a joint? speaker-1: Crazy they do though, don't they? It's absolute madness. Yeah, no madness. Yeah. ⁓ classic. Yeah. There you go. No, that is good. It good. I mean I enjoyed my time ⁓ in rotating internship with with orthopedics as well. I I really did. I liked it. It's really, really good. Good stuff. But ⁓ I mean it seems a long way away from it now what I'm doing, but yeah. But no, I do. I speaker-0: Yeah, that's cool. I would do that. I would do knees. Yeah, sounds amazing though. I would really like to come watch some surgery. I will be like, wow, I'll be your biggest cheerleader. speaker-1: For sure, we need to get it organized. Yeah. No it it's cool the first time you see things though, isn't it? I it's the same with it, all of us, I think the first time we see anything new, we're like, Whoa, this is crazy. Yeah. It's like I see the new flea and worm is coming out, I'm like, whoa. HAH gotta see this guy. But it's funny how you de skill in and I don't know in so many things, don't you? Like you'll be out of it out of the game for so long. speaker-0: Yeah, when I opened the clinic, had to relearn vaccination protocols. Like you said, fleeing, I had to relearn that stuff, which is basic day one stuff. ⁓ And I couldn't afford another vet then. So had to relearn it and do it. speaker-1: My ⁓ my first Kennel Kennelkoff vaccine when I came to the UK. ⁓ I hope the VDS isn't listening. No, they ⁓ because I was doing equines and stuff when I first graduated. So allegedly, it could have happened, we don't know. It might not have even been me. Could have got stung by a wasp, I don't know. ⁓ but no, so I basically I like, Yeah, vaccine's great, so lepso goes in, do my three and one, all fine. Kennelkoff whack it in too. No worries, just injected it like straight. ⁓ yeah, so came back three days later, I wasn't. speaker-0: you say allegedly? I speaker-1: That's weird. I don't know why that's happened. Miraculously, like for some reason in that like three day period, I'd only had to do the one. Yeah. And I was like, What's gonna? And they were like, So you in you inject yeah. Let's just have a chat. I'm so sorry. It's the classic. We've we've all got those, don't we? Like the whoopsies. So yeah. speaker-0: In my first year as a vet, I gave a cat vaccine to a dog. Yeah, it was fine. Nothing happens. I just, but like when you first do it, you just feel your stomach drop and your heart is like, my God. And then you look the client in the eyes, they see the fear in your face and they're like, what have you done? And you're like, VDS said, be true to yourself. She just blurted out, I gave the wrong vaccine. I gave it for a cat. And then, ⁓ my God, they were so lovely. They were like, is it going to stop meowing? speaker-1: ⁓ yeah. It's great. It's great. It's perfect. It's funny though that's I mean it's it it's funny the the imposter syndrome follows you everywhere you go, doesn't it? Doesn't matter what stage of your career back then. You feel like yeah, if I if I look back at me now, like back then, I'd be like, ⁓ wow, he really knows what's going on now, that's great. And yeah, you still feel the same back again. There's always a there's always a bigger room, there's always a bigger like challenge, there's always something else. speaker-0: anywhere anytime. So who's your support system? Because you've gone out by yourself. Yeah. But everyone needs backup. everyone needs someone to call, phone a friend. speaker-1: I know, it's that is that is the hardest part. Yeah. I think I'm super lucky now having the team because there there is the three of us. Yeah. It was a it was a very, very lonely eighteen months. ⁓ yeah. For sure, for sure. I I think it's not. It'sn't like a cry for me moment. No, but ⁓ you because like you'd be stuck, you'd be sitting in like a I think I posted something about this on LinkedIn back in the day and I was like, you I got into a cataract surgery and I was like going about my merry business, everything was routine, all fine. 'Cause you know, you can kind of you don't want to say you go through the motions, but sometimes you do when you know it's it's nice, it's a nice easy part of all fine. And ⁓ yeah, all of a sudden I did like speaker-0: every day. speaker-1: most terrible thing, which was ⁓ you made a massive hole in the posterior lens capsule. So the capsule at the back of the lens is like a that's a big whoopsie. ⁓ then the rest of the cataract just went blub blue blub blub floated down into the back of the eye and you can imagine you're like, Well, this is not good news. ⁓ I've done in my residency before 'cause like you you're training, obviously everything's fine. And you're like, ⁓ mentor, help me please come Heidi, come and help me quickly come down. Come fix this, fix this. I need an adult. ⁓ and obviously, you know, she'd mark it to come down and make it all work. Everything nonetheless, all fine. speaker-0: I'm like, She came to. speaker-1: ⁓ but not not for this one unfortunately, so but this is the situation you're in, isn't it? Yeah. speaker-0: I see, so when you were there with grownups, they could come help you, but now you're on your own. speaker-1: To be grown up, so you're like, Yeah, it's just take a deep breath and try sort it out, isn't Yeah, but those are the kind of moments where it's where it's challenging. And I think that's the that's the trade-off, you know. You get to you get to be your own boss, you get to set your schedule, you get more time at home, you get to do all these things, but ⁓ you're a little bit isolated. ⁓ yeah, it was nice. I mean, it's having a lot of ⁓ like your residency buddies, like your your study group, you know, we're always kind of in comms, you know. It's not not that frequently, but every now and again you'd be texting and say, Hey, what do you think? What's this? Like, what are you up? speaker-0: Keyback group as well, right? Yeah. speaker-1: Yeah, we had a study a a good study group for the board exams. So speaker-0: Yeah. that's good. You need it. Like you need it. It's really tough. Yeah. love talking to you. You're so enthusiastic and you love it so much and everything. And I love that because I keep seeing sad people in veterinary. think actually now it's quite tough. We're getting in the net from all directions. speaker-1: It's it's rough. It is it is definitely rough. I think it's ⁓ particularly after the whole the whole CMA thing. I mean, obviously you were intimately involved with the panorama. ⁓ I mean it's I feel like we've been lucky as specialists. We are semi sheltered 'cause I think by the time your pet comes for a specialist eye surgery, I think they're a lot more wouldn't say relaxed about it, but they kinda they understand what's going on. They are speaker-0: ⁓ yeah. speaker-1: more motivated to go down that route. They ask less questions as as to like, are you just some money, money grabbing ophthalmologists trying to take this? They kind of understand, you know, this needs doing and things like that. But going to general practices, as I've been doing, I mean, you see it, it's, it's, it's, yeah, it's it's horrendous. I often want say to like a lot of my my colleagues working referral centers, like, you guys need to see what's happening on the ground. Like these guys are are in the trenches. They're going like, yeah. I mean, it's the thing is the other side of the coin I was going to say is like going to these places, like speaker-0: Yeah, absolutely. speaker-1: It's such a positive vibe seeing the practices popping up at the moment, seeing the teams, seeing their interactions. Like you read all the doom and gloom on the news, you read the doom and gloom on social media, but actually see the teams working, you see how positive their outlook is. Like you chat to practice owners, you chat to yeah just anyone from from the ground up and you actually see the they they're happy with the difference they're making with the the journey they're on. Like I don't know. That's that's a nice it's a nice positive swing, which I think we're just not seeing at the moment with ⁓ with a lot of the other stuff. So yeah. speaker-0: It's like Mike, mean my clients are so lovely. We're really lucky in the clinic that we're at. But I also wouldn't tolerate not very nice ones. So that's the nice thing when you own, can ask someone to leave or behave. But I feel for them when they open, you know, every newspaper we open, there's something negative written every, you know, every time you turn the TV on, there's something else on like social media threads. That's why swamp it. speaker-1: You have to but it it it is really sad. And ⁓ you know I get I get looks from clients and it it's funny, like you often you you never say anything, they never say anything, but often I'll ⁓ I'll go into a clinic, we'll they'll be the only pet I'll be seeing that day. So ⁓ see the case, you know, I'll pack up my stuff. I'll happen to be heading out as as they're heading to the car park as well. So having a bit of a chat, and you and they'll they'll hop into, you know, you know, ⁓ say in insert Range Rover type car here and then they'll watch me hop into like pile everything to my polo and hop into something like So this takes you to the private jet that goes to the super yard, right? Because this doesn't add up. Like what's ⁓ Because like what I'm hearing is not this, but therefore, yeah, no, it's it's funny. speaker-0: Exactly! Exactly! They literally asked me this. was on the news a couple of months ago and they, ⁓ she was like, you answered my questions really well. So I'm going to ask more. And I was like, it on me. And she's like, someone wrote in every, every vet is rich. You never see a poor vet. I was like, hold on. I've never seen a rich one. I want a Ferrari and like a yacht. And like, don't know where's mine. And then still people are like, ⁓ you're all rich. And you're like, speaker-1: It's funny, isn't speaker-0: But also if I was rich, do I not deserve to earn it? I my butt off and... speaker-1: That's all. Non essential but we're saving speaker-0: You're saving eyes. Essentials, but you're saving eyes. Like you should earn a very good living for what you do. speaker-1: That that is true. Like throughout all of all of veterinary care, all of healthcare in general. You know what I mean? It's I mean all of all of life. If you are providing that service, you know, you deserve to be compensated accordingly, don't you? It's just ⁓ yeah. It's a hard one. It's speaker-0: It's hard because we don't want barriers to care. And that's the main thing. And that's why we're not doing that amount because we don't want barriers and we do want to treat everything and look after it. But yes. speaker-1: Yeah. I don't know. That is that's the one benefit, I guess, of of being small, of being ⁓ on your own, I guess, too. Where the that is another positive, I guess, that that kind of helps you through the negatives is that you can say, ⁓ you know, there's this charity case, you know, it's lost one eye already. Literally, I'm thinking of a little cat that we we did this for and ⁓ lost one eye for horrendous ulcer, just didn't have eyelids that formed properly basically. So got nasty, nasty like entropy scratching, it's just horrible. so one eye had to come out, the other eye had perforated, and they were like, you know. We're just gonna take this eye out kind of thing. And I was like, well, hang on, can't we can't we make a plan? They're ⁓ no, it's a it's a charity case, you know, we just take it out and but this eye is still visual, like we can make a plan, yeah. Like let's j let's just do it. You know what I mean? Like I think we do this, this, and this, and this, and we just we ended up doing it and like it was really good because you're like, ⁓ at least you know you feel like you're giving back something. Absolutely. Which is good, isn't it? Yeah. Yeah. Not everyone's as privileged, I think, you know. I I know having having worked in a in a different setting before, you know what I mean? You don't you don't have those speaker-0: Which is nice. It's lovely to be able to do that. speaker-1: those levers you can pull. You know, you're just not you're not high enough up in management or whatever. So no, it's it's it's it's hard and I I feel that that is, you know, majority of the vets, the vet nurses, the teams, they're all in those situations day in, day out. And that is why we are finding ourselves where we are, struggling, aren't we? So yeah. Yeah. I am I am happy. Sure. I feel like everyone who sees me, like if they're watching this from like the second year of residency, they'll be like, Can't be the same guy. He's actually alive and well. It's tough. It's tough. I was naive, I'll be honest. ⁓ you know, everyone tells you it's tough. ⁓ my supervisor was completely upfront. She was like, This is horrendous. It's hard, you're gonna struggle and I was like, Yeah, yeah, yeah, I get it. But in the back of mine, but it's eyes, you know, eyes are hard. Yeah. speaker-0: ⁓ my god, residents, he's tough. We'll fine. speaker-1: They're fine. Like they're gonna it's not it's not like I'm, you know, out there saving lives, you know, toiling at two in the morning to make sure this p this patient lives. You know, it'll be it'll be okay. Yeah. ⁓ it's not okay. Same, it doesn't matter what you're doing. speaker-0: Yeah. And so many vets like almost just don't make it through residency. speaker-1: Which I think is sad actually. I think it's Yeah. I think we are we're on the wrong side of the curve as far as box ticking and pressure goes as far as residencies go. ⁓ I think a lot of our generation feels that way. You know, we'll have to see what happens by the time we actually get to mentoring ⁓ and see if there's anything we can change. I under Yeah. I mean, I feel like, you know I I don't know, say say for instance you love your orthopedics, you're into but you've got two young kids, you're not gonna be able to go and do residency. Number one, say say you are speaker-0: I'd love to change the way that it was. So the main reason was, like I'm really happy with my certificate and what I do. But the main reason was I don't have anyone to teach me anymore. So I contacted multiple places and I said, first of all, I'll do it for free. I don't want any money. But I need to do it part time. But I will come there three days a week. You don't need to pay me anything. I will work my butt off myself. But I want to do this. speaker-1: ⁓ you, yes. So there you go. Yeah. speaker-0: with a name, like, and it is possible to do a part-time residency. Every single one said no. They were like full-time or nothing. speaker-1: Yeah. Isn't it? It's it's just yeah, it's it's so tricky. I mean, I I can see it from both sides, ⁓ obviously having been through the system, but I I just think it needs to change. I just think a hundred percent. I I I completely agree. And even that I think I think that ⁓ like doing referral work shouldn't just be for for specialists. I think that there's a lot that particularly with eyes, I mean I don't know I don't know about authors, I don't know about medicine and those sorts of things, but yeah, but from an author speaker-0: I'd like it to be more accessible. Because then you're removing access to care for a lot of patients. speaker-1: I think there's there's so much stuff and I mean I try and do everywhere I go. I hope you kinda see that as well. Like if if if the vets are free, they come into the consult and like, Hey, have a look at this, this is what I've done, you know, doing all of those sorts of things. It's ⁓ it really it really helps the patients, it helps the owners if they've got access to a higher level of care at the point of contact without having to be referred. I think you we all speaker-0: is enough work you don't need to gatekeep the knowledge and the skill. speaker-1: Yeah, which I think is a it's a big thing. And I think yeah, that that kind of mentality is difficult. I think everyone's trying to divide up the pie and I'm just like, you know, just open the bakery and bake some more. You know what I mean? It's like that's literally that's literally it. Like, I don't know. I don't know. Every you know, everyone everyone can win, but it's it's hard to get that across, I think. It's which I understand. I get it. I get where people are coming from. They've obviously, you know, they've got they've got their their view of the world, which is just it's just different. And, you know, it's it's not a fault of theirs either. I think it's the way that they've they've had to deal with everything and it's just Yeah. Yeah, I don't know. If we could try and make it more accessible, it'd be brilliant. speaker-0: Yeah. I think it's great. mean, you've got the best attitude coming through you set examples leading the way. Yeah. That's what we've to do. No, that's fine. That's fine. And support each other and everything. And yeah, that's amazing. Thank you so much for coming on. I know I have a gift for you. speaker-1: We try. No, no worries, that's flown by. ⁓ brilliant. Look at this the merch. I've been waiting for the merch actually. I saw last video, I was like, I need one of these, it's good. ⁓ speaker-0: And this is for Rebecca as well. Yeah, I bet she won. speaker-1: Brilliant, thank you. She's gonna love this. I can I I'm gonna put this on the group now and when it's held Beck I'll be like Beck, sorry. speaker-0: But I need to give you a third one because you can't leave one member speaker-1: We can't leave back out. No, it should be right. I can see her on the WhatsApp group right now being like, hang on. speaker-0: Where's mine? What's in there? I'll bring you a third one. speaker-1: Thank you so much. I need to send you a a video of my ⁓ my one and a half year old daughter. She's just into handbags now. She's gonna love this. speaker-0: You can your older brother in it. speaker-1: ⁓ look at this, it's full of stuff as well. Yeah, super. No will speaker-0: There's some good merch in there. Proper merch. merch. We'll have to have a look. ⁓ thank you so much for coming. Thank you It's been so interesting. And I am going to now log my CPD hours. speaker-1: Thank you. Thank you for doing what you do. Honestly, I think ⁓ I think it's it's all brilliant. Like just keep keep smashing it. speaker-0: Mostly I just yap. speaker-1: It's what we need. It's what we need in the world, honestly. speaker-0: You can't shut me up. speaker-1: Thanks again.