The Vet Vault: Fall In Love With Veterinary Science

🔓Your Game Plan for Brachycephalic Anaesthesia: Tips, Drugs, and Red Flags. With Dr Abbie Tipler

Did you know that a brachycephalic dog with BOAS has a 433% higher anaesthetic risk than a dog with a normal nose? Let me rephrase that: that Frenchie you’re spaying later this week is more than four times more likely to die on her surgery day than any of your other patients. 😳 Do we have your attention?! Thanks mainly to the rising popularity of the French Bulldog, you’re probably anaesthetising these kinds of patients all the time. So how do we reduce that risk? How do improve patient safety while decreeing your stress levels?! At the Brachycephalic Care Unit [https://www.vss.net.au/brachycephalic-care-unit-jindalee.html], surgeon Dr Abbie Tipler [https://www.drabbietipler.com] and her team have polished brachycephalic anaesthesia down to a fine art, and in this episode, she shares all the gold. From the days leading up to anaesthesia to selecting the safest mix of premed and anaesthesia agents, all the way to a calm, well-oxygenated recovery, this episode is the ultimate masterclass in brachycephalic anaesthesia. Hit us up for the full show notes for this episode, as well as Dr Abbie’s brachycephalic pre-surgery history template, here.  [https://hi.switchy.io/SaferBrachycephalicAnaesthesia] This episode is one of more than 600 from our subscriber-only clinical podcasts. If you like this style of learning, where I dig for all the pro tips and updates from some of the best specialists in the world, then you’ll love our clinical feed. Go check it out at thevetvault.com [https://www.thevetvault.com/p/clinical-content/] Oh, and if you’d like to join me in Japan in February or the Maldives in April for the most fun you’ll ever have at a vet conference  - have a browse at vetsontour.com [https://vetsontour.com] Topics Covered: Before the big day * Structured history taking: airway, gastrointestinal, sleep, and anxiety indicators * Understanding the link between upper airway obstruction and GI dysfunction * Assessing regurgitation, silent reflux, and aspiration risk * Pre-treatment protocols: omeprazole, metoclopramide, and diet adjustments * Identifying when to delay elective procedures for optimisation * Using C-reactive protein and radiographs to assess for aspiration pneumonia * Managing anxiety pre-hospitalisation with trazodone Plan for the day of surgery * Fasting times and timing surgeries for optimal recovery monitoring * Strategies for minimising stress in brachycephalic patients pre-op * The role of early premedication and pain relief * Drug choices: the “Goldilocks” approach to sedation * Reducing regurgitation risk * Your pre-op pro tips * Extubation and recovery: positioning, monitoring, and oxygen weaning * The impact of cage-side nursing and owner-assisted recovery

148: Is the Veterinary Business Model Failing Our Patients? A Frontline Perspective From a Top UK Charity. With Dr Paul Manktelow

“If you can’t afford a pet, you shouldn’t own one.”  Ever said this line? Once you’ve  been on the receiving of someone’s anger about the cost of their vet bill, it’s an easy thought to have.  But it’s not the whole story, is it? In this episode, I sit down with Dr. Paul Manktelow [https://theconsultroom.co.uk/dr-paul-manktelow/] - a veterinary surgeon with 20+ years in UK animal charities and current Director of Veterinary Services at Blue Cross [https://www.bluecross.org.uk]. Dr Paul shares lessons learned in not-for-profit vet care to help us untangle that tension between care, compassion, and commercial reality. We cover: * Trends from the front lines in the charity sector * How “affordability” is shifting under rising cost of living * Decision-making tools that balance optimal vs achievable care * Business models that either enable or block access to care * How vets can approach financial conversations with clarity, dignity, and trust You’ll learn about: 💡 “Pragmatic care” as the antidote to chasing the mythical ‘gold standard’ 💡 Cost-based vs value-based pricing models  💡How to think in tiers of care—and where the limits lie Because behind every clinical decision is a human one. Find out how we can help you build you in your vet career at thevetvault.com [https://www.thevetvault.com]. Check out our Advanced Surgery Podcast at ⁠⁠⁠⁠⁠⁠cutabove.supercast.com⁠⁠⁠⁠⁠⁠ [http://cutabove.supercast.com/].  Get case support from our team of specialists in our ⁠⁠⁠⁠⁠⁠Specialist Support Space⁠⁠⁠⁠⁠⁠ [https://the-vet-vault.mn.co/share/pWYTrfLxiUnCVDHu?utm_source=manual%E2%81%A0]. ⁠Subscribe to our weekly newsletter⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠here⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠ [https://thevetvault.substack.com/?r=2v2kg5&utm_campaign=pub-share-checklist]for Hubert's favourite clinical and non-clinical learnings from the week. Join us in person for our epic adventure CE events at ⁠⁠⁠⁠Vets On Tour⁠⁠⁠⁠ [https://vetsontour.com/]. (Next up: Japan snow conference!)  Topics and Time Stamps 03:11 Balancing Costs and Care in Veterinary Practice 06:45 Challenges and Changes in the Veterinary Profession 11:41 Client Expectations vs Financial Realities 16:32 The Impact of Economic Hardships on Pet Care 32:16 Blue Cross's Model 39:10 Individual Responsibility in Veterinary Practice 42:54 Getting Clear on Quality of Life and Prognosis 47:23 Cost-Based vs Value-Based Pricing Models 01:10:05 Pragmatic Care and Clinical Guidelines 01:16:54 The One Question

147: What I Got Wrong (And Right!) About AI in VetMed: A Software Engineer Sets Me Straight. With Rohan Relan

In episode 141 [https://www.thevetvault.com/141-from-fomo-to-pro-how-i-use-ai-in-the-clinic-and-how-you-can-too-with-dr-hubert-hiemstra/], I shared my take on where AI fits into veterinary medicine - and where it might take us next.  But I’m no expert. So I brought one in. In this episode, I sit down with Rohan Relan [https://www.linkedin.com/in/rohan-relan?] , Silicon Valley software engineer and founder of ScribbleVet [https://www.scribblevet.com] ,an AI tool built for vets. We unpack the promise and pitfalls of AI in clinical practice and try to figure out how you can use it without losing sleep (or your license). What we cover: * Why AI is not just a "smarter Google”- and why that matters * The risky shortcuts vets are already taking (and how to avoid them) * How to increase trust and accuracy when using AI * Where innovation collides with privacy, data, and consent * DIY AI vs purpose-built tools  If you're curious about AI but not sure what’s hype and what’s helpful, this one’s for you. Come find out what W(asabi)TF Wednesday is all about at our Japan Snow Conference [https://www.eventcreate.com/e/nozawa26] Check out our podcast for business owners [https://podcast.acceleratepracticeacademy.com], and Dr Sam’s ‘How To Make A Hell Of a Profit And Still Go To Heaven [ https://apa.acceleratepracticeacademy.com/profit-without-pressure?am_id=hubert850 ]’ workshop. Join our community of Vet Vault Nerds to lift your clinical game and get your groove back with our up-to-date, easy-to-consume clinical episodes at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠vvn.supercast.com⁠ [https://vvn.supercast.com/]⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠. Get help with your tricky cases in our ⁠⁠⁠⁠⁠⁠⁠⁠Specialist Support Space.⁠⁠⁠⁠⁠⁠⁠⁠ [https://the-vet-vault.mn.co/spaces/11631272/discovery] V⁠⁠isit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠thevetvault.com⁠ [https://thevetvault.com/]⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠for show notes and resources related to this episode. ⁠Subscribe to our weekly newsletter⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠here⁠⁠⁠⁠⁠⁠ ⁠ [https://thevetvault.substack.com/?r=2v2kg5&utm_campaign=pub-share-checklist]for Hubert's favourite clinical and non-clinical learnings from the week. Topics and Timestamps 04:39 What I got wrong about AI 08:19 How models “know” things — next‐word prediction & reasoning 15:00 Grounding AI responses using external tools / search 19:19 Scribble Vet features 38:12 Privacy, ownership, and AI liability 51:00 Rohan’s podcast and AI tool recommendations 54:00 Key misconceptions & Caveats

PIMA: The Anaemia That You Didn’t Know About, But Really Should. With Dr Cynthia Lucidi and Dr Claire Sharp. Bonus - Live at IVECCS

Today’s bonus IVECCS live session wasn’t your average ‘clinical 101’. I had the absolute privilege of getting two brilliant minds on the yellow couch, and … wow.  Apparently 1 + 1 = 🤯 !! Clinical pathogist [https://cvm.msu.edu/directory/lucidi]Dr Cynthia Lucidi [https://cvm.msu.edu/directory/lucidi] joined me to unpack her talk on Diagnosing Ineffective Hematopoiesis.  If you’re a bit lost with that title - don’t worry, so was I!  So I brought backup: ECC legend Dr Claire Sharp [https://researchportal.murdoch.edu.au/esploro/profile/claire_sharp/overview] joined me to ask the smart questions, and together, they cracked open a topic every GP and ECC vet needs to understand: PIMA – Precursor-Targeted Immune-Mediated Anaemia. (If you’ve ever managed an anaemia case that almost looked like IMHA but just didn’t quite fit, or just an anaemia that didn’t want to fit into ANY of the boxes, it was probably this!)  This one started out GP-friendly, but with two minds like these-it escalated fast. Expect specialist-level gold. You’ll want to give this one your full attention. But I promise - it’s worth it! What we cover: * Defining ineffective haematopoiesis and how it differs from hypoplasia * Diagnostic criteria and differentials for PIMA vs. IMHA * Importance of timing and interpretation in persistent non-regenerative anaemia * Why bone marrow aspiration is underused and how to perform it effectively * Pathologist tips on identifying spherocytes and phagocytosis artefacts * Challenges of diagnosing IMHA and PIMA in cats * Role of transfusions and crossmatching in long-term PIMA management * Timeframes for response and remission in PIMA treatment * When to consider splenectomy for refractory cases * Clinical significance of myelofibrosis in dogs with PIMA * Educating clients and general practitioners on prognosis and referral timing Click here⁠⁠ [https://vvn.supercast.com/?coupon=IVECCS25] to access all of our clinical content at IVECCS special rates.

Antibiotic CRI’s: Better Than Bolus? With Prof Steve Epstein. Bonus - Live At IVECCS

If you caught my conversation with Prof. Steve Epstein [https://www.vetmed.ucdavis.edu/faculty/steven-e-epstein] from IVECCS 2024, you already know this: When it comes to septic patients, timing of antibiotics is everything. Ok, maybe not EVERYTHING, because in our follow-up discussion 1 year later at IVECCS 25 [https://veccs.org/calendar-of-events/], Prof Steve explored an idea that might just shift your ICU protocols: duration of administration matters.  That’s the idea behind the concept is prolonged infusion - giving time-dependent antibiotics over extended periods for more sustained bacterial kill time. (Spoiler alert: it works. BUT...with a few caveats.) Jump in to this one for a straight-forward data backed action you can take with your critical patients that will save more lives. Topics We Unpacked: * Time-dependent vs. concentration-dependent antibiotics * Prolonged infusion vs. continuous rate infusion (CRI) * Human evidence: findings from the BLING III trial * Applicability of human data to veterinary patients * Dosing challenges and pharmacokinetics in septic animals * Practical recommendations for veterinary ICU settings ⁠Click here⁠⁠⁠ [https://vvn.supercast.com/?coupon=IVECCS25] to access all of our clinical content at IVECCS special rates.