Episode Transcript
[00:00:05] Speaker A: Welcome to All Cats Considered, a new podcast from the American Association of Feline Practitioners, where we interview professionals from across the veterinary world and take deep dives into the latest evidence based research developments, studies, and guidelines that improve feline health and well being. My name is Dr. Kira of Ramdis, President of the AAFP, and I'm proud to introduce this new podcast. We are the home for veterinary professionals seeking to improve the care of cats through high standards of practice, continuing education, and evidence based medicine. In each podcast, you will hear interviews from a variety of experts throughout our field, covering a wide range of topics and recent developments in the practice of feline health, sharing the key points you need to know to improve your patient's care. Let's dive in and take a listen with this week's experts.
[00:01:00] Speaker B: Hi, I'm Dr. Kelly St. Denis, past president of the American Association of Feline Practitioners and co editor of the Journal of Feline Medicine and Surgery. And JFMS open reports. I'm very excited to welcome our listeners to the podcast. Today we have two very special guests who are going to tell us more about the 2023 Aafpia HPC Feline Hospice and Palliative Care Guidelines. Welcome to doctors Diane Egner and Katrina Brett, trader, co chairs of the guidelines. Welcome to both of you today.
[00:01:34] Speaker C: Thank you.
[00:01:35] Speaker B: And I just want to say congratulations to both of you on this publication. It is a fantastic guideline and we're looking forward to sharing it with everyone.
And I wondered if both of you could just take a moment to introduce yourselves with a little bit of background. Dr. Agner, if you wanted to start.
[00:01:52] Speaker D: I also am a past president of AFP, though I think it might have been more than 20 years ago now. So a little bit before your time there. Kelly, when you served. I owned a feline practice in Philadelphia for about 34 years, and then I moved down here to the Jersey Shore, where I now provide in home euthanasia services, hospice, and palliative care. And I also do virtual quality of life assessments for Blue Pearl, in addition to my teaching responsibilities at Pan's Veterinary School, where I teach end of life care.
[00:02:29] Speaker B: Excellent. Thank you, Dr. Britteder.
[00:02:34] Speaker C: Hi, I'm Katrina Brightwater. I am a board certified specialist in feline practice, and I own a cat hospital in Austin, Texas, called South Austin Cat Hospital. I've worked exclusively with Cats for about seven years now, and I was really excited to be part of these Guidelines.
[00:02:54] Speaker D: Thank you for having me here.
[00:02:55] Speaker B: Really glad to have the both of you here. So one of the things that's unique about this is that the AFP fosters collaborative work with a lot of other organizations. And in the past, we've published guidelines with ISFM, Every Cat Foundation, AVMA, to name a few. These new guidelines are with the Iaahpc. And Diane, I wondered, I think you're past president, and I wondered if you could tell us a little bit more about that organization, since some of our listeners may not be familiar with it.
[00:03:21] Speaker D: Yeah, it was the Braychild practitioner from Chicago, dr. Amir Shannon and some other colleagues started about maybe 13 years ago. I know I should know the exact age, but it's around there. And there were veterinarians who realized that they could do a better job at end of life care and really more so hospice and palliative care. They felt that there was definitely a place to amass knowledge that could really allow people to grab onto best practices in this area. The organization has continued to evolve, and one of the most exciting things that that founder did, in addition to additional colleagues, is we created a certification program. And that was what introduced me to the Ihdc, because after I sold my cat practice, I decided that I wasn't quite ready to hang up my clinician's hat and so decided to focus on hospice and palliative care. And just like all the years that I focused on all the education that AFP offered me, I figured if I was going to do that, I should do it the best I could. Right then I began working my way up through their executive board to their president, a group of incredibly passionate, really thoughtful practitioners that I've learned a lot from.
[00:04:41] Speaker B: It's an amazing group, and I'm actually excited because I'm going to have the opportunity to attend the conference this fall, and it looks like a really good lineup, so I'm looking forward to learning a lot myself when I'm there. So the other thing that I've noticed, in addition to the two of you being all star, you guys have an all star lineup of authors in these guidelines. They're well suited to speak as authorities on the subject of hospice and palliative care. And I just wondered if the two of you take a couple of minutes to tell us about the other authors and know diane, right before we started, we were talking about how it was such a great experience for you. So if you want to kick off about the people that you were working with and how that went, Getting involved.
[00:05:22] Speaker D: With IHPC has been as much fun as it was for me to get involved with the AAFP more than 30 years ago. And I became acquainted, as I mentioned, with some very passionate and capable practitioners. So when we decided initially this was going to be a toolkit that we were going to put together, I wanted to invite people that I had gotten to know that I felt were really just thoughtful, caring practitioners. That a lot of knowledge. And first person that came to mind was another past president of the IHPC, Tyler Carmack, who's a practitioner from Virginia. She's amazing.
And then in addition, Shay Cox also was a past president of the IHPC, and has actually, in the last few years, been working with Blue pearl to bring hospice and palliative care to all of their specialty practices.
And of course, my closest friend, Alona Rodin, who I wanted to introduce to this field when I first got excited about it. And I thought that we couldn't really do a good job talking about hospice and palliative care if we didn't bring in her expertise in cap.
[00:06:37] Speaker B: Absolutely.
[00:06:39] Speaker D: As we were working our way through the outline, when we got to talking about quality of life assessments, I thought, who better than somebody as wonderful as Dr. Sheila Robertson to contribute information about that and then just know? I heard this incredible presentation that Robin Downing had given, I think maybe on Vin, on ethics. And I don't know if you all know that she's recently gotten her PhD in bioethics. And so she was the late addition to the panel and I think an incredibly valuable addition to the task. That's pretty much, I think, everybody that Katrina. Anybody? Of course you, Katrina. I love getting to know what an.
[00:07:21] Speaker B: Amazing lineup young Katrina, is this the first time that you've worked on a Guidelines then?
[00:07:25] Speaker C: Yes, this is the first time I've been involved in a project this large. And getting to work with that all star lineup has just been an absolute honor for me.
[00:07:36] Speaker B: Yeah, well, that's great. And I know in myself in the past, with some of the Guidelines I've had the opportunity to do is just fantastic. Learning from everyone around you just takes things to a new level.
Just kind of thinking about the Guidelines, and we were talking about I've read them a couple of times now because I'm Chair of Guidelines Committee. And then just prepping for this interview and just looking at when we're in clinical practice, a lot of us are kind of buried in the day to day.
We might only be dimly aware of even the terms or concepts of hospice and palliative care as it applies to veterinary medicine. So I wondered if the two of you could talk about the terms individually, what the difference is and why they're important topics for us in veterinary medicine and to learn about.
[00:08:26] Speaker D: Is it okay if I let you start there, since this was kind of new in a way, for you when you got involved? And I'd love to hear what you got out of being involved because you're experienced feline practitioner, and I'm sure you've dealt with a lot of very seriously ill cats before. So maybe share a little bit of your thoughts on those new terms that you've learned and how they impacted you.
[00:08:50] Speaker C: Absolutely. I think you're right. I think that I am a good example of kind of the audience we're trying to reach with these Guidelines because I am a clinician that works with cats every day, and I do, of course, see hospice patients and involved in end of life care and all of those things. So being involved in this project really was very educational for me. The terms end of life care, hospice, palliative care, palliated death, all of those things are not necessarily things that are thrown around in the clinic every day.
Being involved in these Guidelines really did kind of open up a new insight to how we can best help our feline caregivers through one of the most difficult things that they'll be going through with their cats. So I think these Guidelines are going to be hugely beneficial to your average practitioner.
[00:09:54] Speaker B: So in terms of what they mean and even myself when I first started learning about this a few years ago, what is this hospice and palliative care and end of life care? Where do they fit into what we do and what sort of definitions would you give them and are they different? Like, what's different between hospice and palliative care, for example?
[00:10:15] Speaker D: I think when I think of either one, first thing that comes to mind now is comfort. Care is everyday language, but really speaks to what our job is in terms of for the P shift. Primarily though, I think since one of the terms is the care unit that we use a lot, which reminds us that when we're in, we have our clinician's hat on and we're communicating with our owners, those owners, you want to be major participants in the decision making that's going on regarding their very sick cat.
That care unit can even be expanded to other family members, anybody who's really going to be involved in the decision making about the care of that pet. So we want to consider the patient's perspective. Of course, as much as we can understand the pet, but we then want to really remember that we're treating the owners as well. Our first responsibility is to the comfort of our patient. Ethically we have to focus on that, but we can't separate the owner from the way we're communicating and handling these cases. Hospice is really utilized. The term is utilized when you've got a patient, when there are no other really therapeutic options available to that patient and the diagnosis is terminal, right?
They can actually recover from an illness, but they're seriously ill. And that one is especially focused on comfort here. I think what will be nice about the people that will be able to access these Guidelines is it'll remind us that sometimes when we unfortunately have to share a poor prognosis or diagnosis with an owner, we may not think holistically about how to provide that comfort care. And I think these Guidelines will help make that much more accessible to the reader and I think we'll be better able to meet the needs of those patients and of course, their owners.
[00:12:23] Speaker B: I think sometimes when I look at palliative care, some of us are we are practicing that in some ways already. And when I deal with all the senior cats that I'm dealing with that have long term illnesses like hyperthyroidism chronic kidney disease. We are working with those caregivers and keeping that cat comfortable and making sure we do what's best for the cat, but also along the caregivers needs.
[00:12:46] Speaker D: And it's so important to empower those owners, so feel very comfortable sharing all of their concerns and something we don't often think about, but our beliefs as well, because sometimes there are some not just ethical beliefs, but there could be religious concerns and other beliefs.
[00:13:04] Speaker C: And when I think of palliative care, I really have come to think of it as, how can I make this cat their life as great as it possibly can be, given the circumstances that they're in, the medical condition that they're dealing with? And then another thing that we talk a lot about in the Guidelines is budgets of care, because not every client can afford financially to do everything that we might want to do, but then two, emotionally and physically, and not every client is capable of giving subcutaneous fluids at home. Or maybe there is some strong emotional ties around a cancer diagnosis because of past experiences or things like that.
Those are all, I think, factors that have to come into mind whenever we're making a specific game plan for an individual patient, because we have to be mindful in the hospice setting of what the caregiver is able to do for that cat.
[00:14:15] Speaker B: Yeah, I really like that concept of budgets of care. I think we have that, too in the Senior Guidelines. Again, really stopping to think about not just, like you said, the finances, but what the caregiver is able and willing to do from a time and an emotional commitment as well. And physically. Like, I've had elderly clients in the past who can't even open a pill vial. They certainly can't pill their cats. And like you said, subcut fluids can be really challenging. So that budget care concept is really helpful.
So then the other thing diane you mentioned the word holistic earlier, and I find that with a lot of moving forward, with a lot of the guidelines that we've seen in the last few years to senior care cat friendly interactions, veterinary environment. We're starting to think more about the patient, not just their physical needs as veterinarians, because we focus so much on that in vet college. It's a lot of what we think about.
And I wondered if you guys wanted to talk about what additional things we're looking at for that patient as well, other than just the physical, in terms of being a more holistic approach to that cat.
[00:15:16] Speaker D: Katrina wants to share that because a lot of the information we have in our Guidelines is contributed by AFP in terms of falling back some of the work they've done and is ongoing in regards to the optimum way a cat should be cared for that includes their emotional health. Maybe you can share a little bit of that.
[00:15:38] Speaker C: I was heavily involved in the writing of the Comfort Care section, which talks about how do we meet these cats needs both physically and emotionally. So their environmental needs giving a cat who maybe has mobility restrictions access to places where they like to be. How do we enable them to still get into the sunny window or to the top of the cat tower? Because those are the places the cat wants to be, but there may be some physical limitation to how to get there. How do we make feeding more comfortable for the cat, not just what we're feeding, but how and where?
And same with litter boxes and scratching posts and sort of all of those vital resources throughout the home. When you've got a hospice feline patient, modifications are likely going to be needed in that home environment in order to still meet their environmental needs.
[00:16:42] Speaker D: Right.
Alona, because of her vast knowledge of behavior, was able to bring in a lot of what she contributes regularly to AFP guidelines and show us how we don't want to lose focus on many of the ways that we need to try as much as we can to ensure emotional feline health. And so we've brought in information about that and applied it into this environment with hospice ability to care patients.
[00:17:15] Speaker B: I really like that. And you guys have a section where you talk about cats deserving moral consideration. And I find that with these sort of thinking about the cat as a holistic being and not just a know you have a physical health problem, we're starting to be able to give them more consideration that way. And Katrina, like, you're in regular practice, like I am. And do you find it sometimes challenging when you start introducing these concepts to either probably not your team members, but I know sometimes I work as a locum, and introducing these concepts can be really like they look at you like, what? But even just to caregivers when you start talking about emotional needs and that moral consideration for cats, how does that go for you?
[00:17:56] Speaker C: I love that you asked that, Kelly, because I don't know if other vets feel this way or not, but my most dreaded question that I get from clients all the time is, well, what would you do if this was your cat? And my answer to that question is always, well, it depends on which one of my cats we're talking about.
Clients often misinterpret that as playing favorites, and it's not.
I have one cat who she actually is a hospice patient, and she is afraid of life. And I chose not to do certain treatments on her because I knew that the frequency of veterinary visits I would have had to put her through would have been detrimental to her quality of life. Whereas if my other cat were going through the exact same health condition, who doesn't mind going into the clinic and is super friendly and relaxed and it would not be a detriment to him to go through some of those things. So I think that's where we as veteranians really need to rely on the caregiver to make some of those decisions because just because we can do something doesn't always mean we should. And what's right for one patient isn't always necessarily the thing that's right for another. And I think that that is kind of a newer concept in veterinary medicine. I think we're kind of taught this is the gold standard, this is what you should recommend, and you should only go to plan B if they decline in plan A. And in the hospice and palliative care setting especially, we can't be that rigid. We have to meet people where they are and really focus on the individual in front of us, right?
[00:19:48] Speaker B: So there's real room for flexibility there. And we're working on an accessible veterinary care special collection for JFMS, and that comes up a lot now. And it's more of a consideration in day to day. Veterinary medicine as well, is not fixating on that gold standard and trying to meet people where they are and figure.
[00:20:07] Speaker D: Out where they are.
[00:20:08] Speaker B: So I completely appreciate that observation when I think my own experience in veterinary medicine is that option to use the knives when a cat is sick and not doing well. And the concept of hospice and palliative care brings in a new thing to me and other people who might just think, okay, wait, we really should be this is time we should be euthanizing, that there are other options where sometimes people may not be able to or want to euthanize. So we struggle with euthanasia, decision making and helping our clients. But what do you guys suggest and what would you say about things like where you have cultural or religious practices that are impacting care decisions? If euthanasia is not an option, is there key guidance you would give to help veterinarians make the cat's death as comfortable as possible? If euthanasia is not an option in those situations, it's not really a new.
[00:21:02] Speaker D: Term, but it's a term that probably many people aren't familiar with.
It's often called hospice assisted or hospice pale death assisted natural death that comes into this situation when you may have an owner who for whatever reason, is not going to choose euthanasia. I think we as doctors just have to remember we have a lot in our toolboxes that can still help those patients. So that if euthanasia isn't going to be offered, we again are dedicated to keeping them comfortable as much as we possibly can. Internally would, of course be focusing on things like pain management if we thought that had pain. But going back to some of what we were just talking about, the environment, how to make sure that that is optimum if anxiety is an issue, not that we often can appreciate it that much in our cats in a typical way, we might think of it in some other species.
We have some things we can do there. So our job is really to learn then how to support that owner through the anticipatory grief that they might be experiencing and how, as much as possible to be focused on that patient's needs. So however they're going to eventually pass, it's going to be as peaceful as possible. And I think that we sometimes I know myself. What was so dramatic to me when I enrolled in the certification program is I thought back to how many times in practice and I hate to admit that I did this, but how we would often in the back, maybe talk badly about an owner who brought us a seriously ill pat who clearly had been sick for a long time. We all wondered, how could this owner have let this get this bad? And who was still not able to accept how sick the cat was, maybe wasn't going to euthanize. And we'd be very judgmental in the back, of course, owner. And now I think differently about that. My job would be to try to understand that owner better and try again to support that owner where they are, make them feel it's safe to discuss any concerns they have, and then focus most of my efforts on making sure that that patient's comfort was going to be there until whatever time it was going to be when that patient passed. Right.
[00:23:19] Speaker B: Yeah, those are really good points. And it is difficult, I think, because day to day, when we see patient after patient, it can be very stressful for those of us in practice to not be judged and to not be judgmental is a challenge at times because it can be very stressful to see those things going on. And you really have to make sure you meet people where they are and try to understand. And so one of the other questions that Dr. Dagrey had wanted me to ask about with regards to euthanasia decisions, if we have individuals, we understand if there's some religious or other reasons that they may abduct to euthanasia. If you're in a situation where initially people are just not on board with euthanasia, but things are progressing, do you ever bring the concept of euthanasia or the topic of euthanasia back up with those individuals? If there's no religious objections, for example, it's just that they had an objection at the outset? Or do you just continue with your palliative care?
How do you approach those.
[00:24:27] Speaker C: Mean? I think it's a topic that we always need to be open to discussing. Right. And I do think that that is dependent on the comfort level of the client because maybe at the outset it was just a consideration they weren't ready for yet.
[00:24:46] Speaker D: Right.
[00:24:48] Speaker C: But maybe as things progressed, that is going to change. And I think in those situations, the client or caregiver needs reassurance that it's okay to many, many clients just need permission to think about it, especially to go through with it a lot of the time. So I think it's a delicate balance to be there for them and support them without pushing a decision one way or the other on a clinic behavior.
[00:25:21] Speaker D: We offer in the guidelines and best practices in terms of communication. We help practitioners have a better sense of how information will be better received. Definitely imagine a situation where an owner might have initially told me about religious beliefs or philosophical beliefs and euthanasia wasn't going to be at all on the table. And I think was feeling as a clinician that all the comfort care I was providing was still missing the mark.
Of course, you could loads and loads of pain medications and narcotics and really try to alter the mentality of the patient. So at least if it was uncomfortable, maybe uncomfortable at some level, it would feel it right, because of all the drugs that you'd be giving.
But one of the most important things when you're touching on subjects that could trigger an owner or be very sensitive is just asking for permission and very cautiously venturing into subject matters that maybe they've indicated might be very difficult for them to discuss. So beyond that, we have a lot of other information we share about ways to try to create an environment that's going to allow that communication to proceed as effectively as possible. Right.
[00:26:36] Speaker B: It really is a full time job. I can see why you went into a full time, Diane, because it's really something that can be requiring all of your time and effort. I mean, I think about the time that we spend in our practices, katrina, you and I in general practice with caregivers, trying to support them and be there for them as well as being there for their cat. And this just adds a whole other layer of things that I have a hard time wrapping my head around in terms of putting that into practice. And one of the things that you mentioned to Diane and we've kind of alluded to is the stress that the veterinary team goes through in these situations. Whether know relieving that stress by unfortunately having some judgmental moments and trying not to do that, but also just the moral distress of situations where we think a patient should be euthanized and the caregiver doesn't want to or can't for whatever reason.
Do you guys have advice for supporting your team members or even just taking care of yourself to make sure that you're not getting bogged down by that? And then, Diane, you do this. This is something you do a lot more even than Katrina and I, obviously. So is there something that you would suggest for us to support our team members and ourselves during those kinds of stresses?
[00:27:45] Speaker D: Well, to start, of course, I hope that I'll read these guidelines because I think be transformational for a lot of teams and the professionals that work with those teams. That's a great beginning.
And just like with all aspects of practice, we set boundaries and everybody has to really identify what their own personal level of tolerance is with all kinds all kinds of things we experience.
So I think that just giving permission to staff if something is too difficult for them to cope with, to have them be allowed to maybe not participate, would be one thing in terms of making sure not imposing value, maybe, that we have on them.
[00:28:37] Speaker B: And.
[00:28:40] Speaker D: Maybe this is just way too optimistic on my part. But I think if we're really communicating, that patient is the center of our efforts. Even though I know we don't separate the owner when we're reaching this time in an owner's life, if everybody on the team can understand that we're doing our very best for that patient and that sometimes we can't get past beliefs of owners, we're not going to throw up our hands and leave that patient without our probably, I don't know. Katrina, do you think that that would be one of the key foundations to helping our patients I'm sorry? With our team members, with that moral distress that they can experience?
[00:29:23] Speaker C: Yeah, I think this is a perfect example of like I say to my team all the time, that what we do veterinary medicine is hard enough on its own.
We have to support each other to make this a sustainable field to be a part of. I think the types of situation we're talking about here are a prime example of how what we do is hard enough on its own. And so I think the key to supporting your team is creating a culture where it's okay to be vulnerable and it's okay to be human and it's okay to experience the feelings that we all experience around illness and death and saying goodbye and all of those things.
I think having that culture and that support network for your team is essential.
[00:30:18] Speaker B: Thank you. I like that. That's really good.
And it has to be a very supportive team. And exactly what you said. We need to support each other because sometimes that's what keeps us going through the day, really, so I know, Diane, like you've said, that you're doing this as your main thing. This is what you do. But, Katrina, I wondered if you also could offer someone like me who would like to take more time in practice to be able to offer this type of I consider it to be part of a service.
How do you incorporate that into your day? I'm already running hour to hour trying to get even. My senior care appointments are an hour long because they take so much time. How do you work all of this aspect where this is really much about more handholding and support? There's so much support there. How do you work that into your practice?
[00:31:08] Speaker C: That's a great question. Kelly, one of. The things that the guidelines point out is there was a study done that looked at how cat caregivers like to be communicated with compared to our canine pet parents. And one of the things that stood out to me from that study was that cat caregivers aren't like they don't mind talking to people other than the veterinarian. And so one of the ways that we can really support these clients is by utilizing the whole veterinary team. I have technicians that have beautiful, beautiful quality of life type conversations with clients on a pretty regular basis and getting everyone involved in supporting these clients because they do need extra support and extra care, and the status of their cat can change day to day. And we've all had those super worried clients that called on a daily basis, needing to talk to somebody, whether that was to receive reassurance or find out the next steps or whatever the case may be.
It's a great opportunity for your entire team members to get involved and build those relationships and provide that support.
[00:32:28] Speaker D: So that's the interdisciplinary team that we also bring up in the Guidelines. But it a sensitive subject that for most engineering and for many of your team members to talk about the finances associated with this kind of care. That's a good point, because it's all wonderful we want to offer all this time, even that team members want to provide, but somebody's got to pay for that. Yes, something that it's sort of like our needing to accept that a certain amount of telemedicine that we've been doing will always go on without getting without a fee being associated with it. But many of us have moved to a place where some of our consultations we are actually charging for, and for the five step hospice consultation that we outlined in the Guidelines, which for me takes an hour to get through with an owner. My quality of life assessments take an hour to get through, so I charge that time for my owners. And I think one of the things that I hope practitioners will begin to have some confidence about is when they reach a point with a seriously ill pet and they want to try to adhere to some of the concepts they're going to be exposed to in these guidelines, to be able to with empathy and with concern. Say, would you like to schedule a follow up appointment where we're going to go through all aspects of the case, come up with a plan together, and, of course, give an appropriate estimate for that time that you're going to spend with that owner? So I think that's to think that you're going to get that done, if you just said your sickness, it's already taking hours. So now how are you going to justification when you reach so you really need to have the confidence to go ahead and say, let's schedule a follow up appointment to go over all of.
[00:34:25] Speaker B: And you have to charge for your expertise. And I never even thought of thank.
[00:34:29] Speaker D: You for bringing that up because I'm.
[00:34:30] Speaker B: Not on my scope of questions at all, which is probably why I don't want to practice anymore. But it isn't something you think about the hands on stuff we think about billing for, but we don't always think about the stuff where we're doing emotional and even just talking to people as being charged full time that we really do need to focus on.
[00:34:50] Speaker D: I think our goals with the IHBC is get to the point where regular practitioners I don't want to use the word burden because it's actually quite an honor to be involved in many of these cases, but where they will be able to refer to a hospice, Pale or even those quality of life assessments which are now being offered by companies where when owners are having difficulty knowing when the time is right to schedule their pet for what I like to call a peaceful passing. Know? Like I said, it takes me an hour to go through everything I want to discuss with those owners. And so for a busy practitioner, that time might not be there, but I foresee the future where that will be common, that won't be unusual to be happening.
[00:35:36] Speaker B: And there are increasing numbers of businesses like your own that are available for a referral, as I correct. I mean, we have a number of them in the US. And I have known a few colleagues here, even in Ontario, where I live in Canada, that have started up home hospice, palliative care, end of life care. So that is something that we can look forward to if we have to refer to as well.
[00:36:00] Speaker D: Because of that concept of the interdisciplinary team involves that hospice veterinarian with the primary peer veterinarian. So it's not like peer veterinarian is going to be out of the team, it's still a member team. So that's what I think. So exciting as this field keeps growing and more and more people are trained properly to provide it, that the primary care practitioner can do the best job, they can do what they're supposed to be doing in their hospitals and then others will take on some other responsibilities.
[00:36:33] Speaker B: That's lovely. I love that thought. Thank you. Well, I've really enjoyed talking with the both of you.
Do either of you have anything that you want to add that we haven't touched on before we close up for the podcast?
[00:36:49] Speaker D: It was just my great honor to be even involved in these guidelines and incredibly humbled to work with the people that were on the task force. I just want to thank AFP for the opportunity at IHPC, for agreeing, collaborate, and I want to give Katrina a super big thank you for being a great chair and of course, for Heather and everyone. Daniel at A P, we were just amazing to work with.
[00:37:13] Speaker B: Thank you so much, Katrina.
[00:37:15] Speaker D: I agree.
[00:37:16] Speaker C: This has been just an incredible honor to be a part of this team. And Diane, you're a fantastic, fearless leader. So thank been. I'm so very proud of this project and really can't wait for the publication to come out and I do think it's going to provide a lot of value to general practitioners.
[00:37:37] Speaker B: Thank you. Thank you to both of you and to your co authors for this amazing piece of work. I really hope everyone takes the time to read it when it is published and certainly keep it handy because I find with a lot of the Guidelines, it's just nice to have them there. You can refer to them, you're not necessarily going to remember everything that you read. So I really like having the Guidelines available that way. So thank you again to Doctors Diane Egner and Katrina Brettwater for joining us, our co chairs for the 2023 AFB IA HPC Feline Hospice and Palliative Care Guidelines.
[00:38:16] Speaker A: Thank you for listening to this episode of All Cats Considered. We hope you enjoyed this interview. For more information on the topics discussed during the episode, please be sure to head over to Catbets.com and explore the links in the podcast description. And please be sure to subscribe to this podcast and your platform of choice so that you don't miss any episodes as we release them. Have thoughts or ideas about the interview you heard today? Share them with us. Leave us a comment on our Facebook page or shoot us an email at info at thank you for joining us today.
