From highlighting the gut-brain axis to managing complex brachycephalic patients, Katherine’s core message is clear: good medicine starts with thoughtful problem-solving, and with looking after ourselves as well as our patients.

Q: Can you tell me a bit about yourself, your journey into veterinary medicine, and what drew you towards small animal internal medicine and infectious disease in particular?

A: I'm one of those people who wanted to be a vet since they were a child. My earliest memory is from primary school when I wanted to be a vet, and it never really changed. So that decision was made at A-levels, GCSEs, etc.

Even in my final year at vet school, I thought that I would go down more the internal medicine route. I never had a passion for surgery. I got to the point where I was competent at it, but I was never enthusiastic, and I always felt that there could be someone better doing these operations than me.

So, I stayed within general practice for quite a long time, relatively speaking, because I really loved the relationships with clients. I was worried that by specialising, I would lose that kind of longer-term follow-up. I then did my BSAVA certificate in primary practice and realised that if I really wanted to see interesting cases more regularly, I did need to specialise. After my residency at Davies Veterinary Specialists, I’ve never left, and I have no regrets. I really love being a specialist.

Q: In general practice, where do you most often see clinicians lose confidence or face challenges when managing gastrointestinal cases or gut–brain interactions?

A: At the moment, there is quite a big divide in the primary care community between people who feel very strongly that antimicrobials should no longer be prescribed to treat stable gastrointestinal patients, and those who feel that antimicrobials are a standard of care. Antibiotic stewardship is one of my big passions, and it goes hand in hand with infectious diseases. I speak to clinicians frequently who say they know antibiotics shouldn’t have been given but feel they cannot get others to change. This creates conflict within teams.

Clinicians also struggle, unsurprisingly, with chronic enteropathy cases. These are difficult even for referral clinicians: they're emotionally draining, they take a lot of owner counselling, and they take time. In primary care, there is often less capacity to manage these cases in that way.

More generally, it is the rare and unfamiliar conditions that tend to cause the most concern. Now, Brucella is something causing a lot of stress in primary care, because it is new, not widely understood, and clinicians are unsure what to look for.

Q: Your session "Gut feelings: Exploring the gut-brain connection" explores how gastrointestinal and behavioural factors interact. Why is this relationship important for clinicians to recognise in practice?

A: In many ways, I’ve been led to this topic by my own dog. People have said you’re sent the dog you’re meant to have, and I didn’t believe that until I met Gus. He has chronic enteropathy—obviously, because he’s my dog—and I can clearly see that when his gut is bad, he is emotionally more unstable. He’s more reactive and his tolerance level is lower. And vice versa: a period of stress and anxiety can lead to a destabilisation of his gut.

That led me to want to find out more. There’s very little veterinary literature on this, but in the human field there are publications emerging almost daily on the gut–brain axis, the microbiome, and behaviour. It has made me slightly geeky about it, to be honest. I’ve really enjoyed following the discoveries, which are coming thick and fast. I’ve tweaked Gus’s diet plan and added fibre based on the available data, and it has really helped him.

There are also patients with chronic enteropathy where, if I don’t address their emotional health, I will never fully resolve their GI signs. I’ve worked very closely with Sarah Heath with my own dog, and she brings a completely different perspective. My brain is very clinician-tuned; hers is behavioural and emotionally tuned. Together, that blend creates a more complete understanding. That’s why it’s so valuable to deliver this talk with her—we can present both sides of the discussion.

Q: When approaching brachycephalic patients with gastrointestinal signs, what are the key principles or clinical considerations that should guide decision-making with these specific breeds?

A: Brachycephalics are a challenging group of patients for many reasons.

They struggle more with chronic stress due to various disease states as well as consistently compromised and poor-quality sleep. They tend to have a higher basal level of emotional stress compared to their longer-nosed counterparts; it is no surprise to me that Sarah Heath reports seeing a lot of brachycephalic patients. This patient cohort often presents with upper gastrointestinal problems, like regurgitation, hiatal hernia, reflux-induced rhinitis, and laryngeal collapse. We do see gastro-oesophageal reflux disease in long-nosed dogs as well, so this is not completely unique to brachycephalics. However, the combination of factors is quite distinctive in brachies.

They are, overall, a challenging patient set.

Q: Looking back to your early days in practice, how confident did you feel managing GI cases and gut–brain interactions, and how did your approach evolve with experience?

A: Pre-certificate, I would say I was reasonable, given that I was relatively recently graduated. Doing the certificate almost teaches you everything you learned at vet school again, but it’s so much more useful because you’ve had real-life experience. You can apply what you’re learning directly to the dog you saw last week, and it means much more.

By the time I completed my certificate, I felt I was a reasonably good clinician - then I started my residency and realised there was still so much more to learn. The approach to cases at a referral level is just so different.

I look back at some of the cases in my early career and think I managed them badly. Current me would look at new-graduate Katherine and wince. But every specialist colleague I speak to can say they missed a diagnosis early in practice. We’ve all been there.

I keep that in mind when I’m speaking to young vets who may have missed the elephant in the room. I was once that person. I used to ring Northwest Surgeons, my local referral centre, and ask for advice when I was newly qualified. So now it feels like my turn to pay that back.

Q: Across your sessions at BVA Live, what core mindset or practical takeaway would you most like delegates to walk away with?

My message for vets in general is that we are very bad at looking after ourselves, putting ourselves first, and prioritising our own welfare. So, the one thing I would say is that self-care is not selfish. To show up and be the best version of yourself for your patients and your colleagues, you need to look after yourself.

 In terms of clinical take-homes, I would encourage people to be more holistic in the way that they approach their cases. These patients are complex and multi-layered, and we just need to start thinking about them much more holistically.