The Vet Vault 3.2.1.

Something Unexpected About FLUTD, A Surprising Tick Paralysis Finding, and A Pro Tip for Diagnosing FIP.

Jul 04, 2025

Before we start:

If you listened to Episode 121 of the Vet Vault, you’ll know about the incredible work that Dr Kat and Dr Alena are doing around suicide prevention in the veterinary profession. Now they are taking it a step further with a PhD research project to find answers to the big questions around vet science’s darkest corner. Part of the PhD involves a survey on suicide prevention in Australian vets, and your input could be a vital part of it.

If you're a current or former vet practising in Australia, please consider taking part and helping shape future support strategies:

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And on a much lighter note, here's a summary of what I'm really excited about for he upcoming 'conference season':

Our unmissable Vet Vault/ Vets On Tour Snow Conferences
in Wānaka, NZ (August ’250 - only 12 tickets left), and Nozawa Onsen, Japan (Feb ’26 - early bird tickets now on sale.)
ANZCVS Science Week, 24-25 July 2025. Come binge with me on the cutting edge of all things vet. ⁠⁠
⁠⁠IVECCS 2025⁠⁠, San Diego, September 4-8
Singapore Vet Show October 24-25. (I'm speaking at this one! 😳)

3 Clinical Pearls.

1. Something Unexpected About FLUTD

From Episode 198 in the Medicine Feed - With Dr Allison Kendall

I’ve already shared the exciting data on using radiation to treat FLUTD in a previous post. (If you missed it, a yet-to-be-published study from the University of Minnesota found that a single treatment of low-dose radiation therapy of the lower urinary tract in male cats with severe uncontrolled interstitial cystitis resulted in a drastic reduction in clinical signs of FIC and episodes of blocking.)

I’ve since had the privilege of chatting to Dr Allison Kendall, who led the research, about the details of the study, and here’s a very interesting little pearl that’s worth thinking about:

Radiation worked very well for relieving clinical signs of pain in male cats. BUT – the same is not true for female cats. When they repeated the same study with FIC queens, the results were nowhere near as good.
Which begs the obvious question – WHY?! Is it a different syndrome altogether? (The theory of why radiation works is that it reduces inflammation, as it does in other inflammatory diseases, like chronic rhinitis. So then why does it work in males, but not females?)
Dr Allison noted a few interesting generalisations about the cases in the two studies:
- The boys in the study were generally the more submissive or passive cats in multi-cat homes (i.e. they were often being bullied), while the FIC girls seemed to often be dominant or aggressive in the home (the bullies!).
- The male cats had a stronger pain component in their clinical signs, based on behaviour scoring.
- When the cases were being worked up for inclusion in the study, Dr Allison’s team found that a significant number of the females had small bladder stones (with or without crystalluria) that were not visible on radiology, but found on ultrasound.
Maybe that last one is a potential clinical takeaway from this? Should be much quicker at recommending ultrasound for our FIC female cats? But if nothing else – all of this definitely should make us ask some very interesting questions. So who’s doing the next study?!

2. Tick paralysis mortality: a link to the blink

From Episode 195 in the ECC Feed - With Dr Ben Reynolds

If you’re a vet on the East Coast of Aus, then you’d be well familiar with those horrible eye ulcers that our tick patients tend to get. In this episode we discuss Dr Ben’s study into how these happen and what the risk factors are, and of course how we can be better at preventing and managing them. Two things that stood out for me were:

A statistical finding from the study that showed that a tick dog was five times more likely to die if it had a reduced palpebral reflex noted by the attending clinician! Of course, there may be many reasons for this surprising result, and we can’t draw any solid conclusions from it, but I’ll definitely be watching those slow-blink/no-blink tick cases a lot more carefully, and adjusting my client communication accordingly.
In terms of prevention: we’re all very diligent at lubricating those eyeballs, but did you know that cellulose- or HPMC-based drops, like Viscotears, only hang around in the eye for about 10–15 minutes, versus hyaluronic acid-based drops that do their thing for an hour. (One sensible option is Hyalaforte (0.2%) from Chemist Warehouse, which sells for around $25–30 per bottle.)

3. A Trick for Hard-to-Diagnose FIP Case

From Episode 195 in the Medicine Feed - With Prof Danielle Gunn-Moore and Dr Samantha Taylor

The suspected FIP case with an abdominal effusion can be a slam-dunk: tap it, analyse it, diagnose it. (And these days - treat it!) But it’s not always that easy in the ‘dry’ form: who really wants to GA a sick FIP cat and go hunting for biopsies from those big lymph nodes or masses? But our guests for this episode have a nifty trick: make your own effusion!

Take a small sterile plastic tube - one that tapers at the bottom.
Add 0.2–0.3 ml of sterile saline.
FNA the suspicious tissue (e.g. a lymph node or mass) multiple times.
Rinse the needle into the saline between passes until the fluid turns cloudy.
- This should give you enough cells suspended for testing, either PCR or immunocytochemistry.

– Oh, and one more pro tip: if you are in the UK and your case doesn’t quite fit with FIP, or you keep getting negative results on your FIP diagnostics, consider TB. Prof Danielle and her team are seeing increasing numbers of mycobacteria cases that look for all the world like FIP.

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Two Things I’ve Done with AI
I’m going to try something new here: my ‘two other things’ typically comes from something that I read or heard during the week that struck a chord or that I found useful. Well, a lot of what I’m reading and listening to these days (and subsequently experimenting with) is around AI tools. So, I’m going to share some of that here. Here’s what we’ll try: in every second newsletter I’ll replace ‘Two Other Things’ with ‘Two things I’ve done with AI’ – obviously with a veterinary bias – whether it was successful or not. I hope you find it useful.
AI-assisted reading: I did an AI search for a new consensus statement article on pyoderma after seeing someone mention it on the socials. I copied the full (very long!) paper into GPT and asked for a summary of highlights, and specifically for “things that might surprise me (a vet with 20 years of experience) or change how I manage my pyoderma cases”.
Verdict: Success. (Not a replacement for reading the whole thing, but a hell of a lot better than not reading it at all, or just reading the conclusions, like I usually do.)
Email management: I created a custom GPT that works like this: I copy the original email into the GPT and type: ‘reply with:’ Then I use the voice-to-text function (the little microphone in the prompt box) to speak my reply. Once done, GPT transcribes my rambling and cleans it up into a perfectly edited email that I just copy into my email.
Verdict: Huge win. I don’t type fast, so speaking halves the time I spend on emails. But this is so much better than just dictation, which I used to use. With AI interpreting my dictation I can speak without having to say “full stop, comma, next line”, and I can repeat myself, rephrase something, or say “actually, leave out that last bit, rather say X”. (I’m basically like a 1950s business tycoon dictating my thoughts to a diligent and eager PA who has to make sense of my ramblings!)

1 Thing to think about.

After 15 years in ECC I’m back doing some GP shifts. I once heard a metaphor to consider for anyone thinking about giving a failed relationship another go: “Yuck! The milk in this bowl of cereal is off. Let me put it aside and then try it again tomorrow to see if it’s any better.” That is to say: I wasn’t so sure about my move back to GP land. But I’m happy to report that the milk has miraculously turned a lot fresher!

I’ve been thinking a lot about why. What has changed for me, or in me, that has altered my experience?

One major change is the fact that this time around, for the most part, I really know what I’m talking about. (After prepping for, recording, editing and making show notes for more than 600 clinical podcast episodes you’d hope that I’ve managed to learn a thing or two!) I drive home at the end of a shift with a general feeling of ‘I did good work today - I’m good at this stuff.’ And I can tell you - that’s a nice feeling that, in retrospect, is in stark contrast to how I felt driving home for the first 15 years of my career.

I’m embarrassed to admit how bad I was for the first 10 or so years of my career at ongoing learning. Maybe I felt that 6 years of study was plenty for a while, and that I deserved to have my free time back for non-vet related stuff. And in my defence, (and in defence of all of us) when you work a 10–12 hour day, 5 to 7 days a week, you kinda do need those work-free hours for something else. I hear this often when I tell people about the Vet Vault: ‘They’re great, but I do vet stuff all day - I really don’t want to engage with more of it when I’m not at work.’ Fair point. But this is problematic, because confidence is the driver of that contentment that I’m feeling at the end of my shift these days – a peace of mind that I lacked the first time around.

This was underlined for me this week when I had to do my first dental in a very long time. I said before that I know my stuff ‘for the most part.’ Well, that doesn’t extend to dentistry. (Not that much dentistry in ECC!) We’ve covered enough dentistry on the podcast for me to know what good dentistry can look like, but after 15 years out of the game I was acutely aware that I am not at that standard.

While I was assessing those teeth I had this niggly feeling of ‘I don’t think I should be the one doing this’. A feeling that, in retrospect, was pretty much how I felt about most of my work day when I was a young vet.

Note that the feeling I’m describing here is not imposter syndrome. Imposter syndrome is ‘I don’t belong here’, despite being as qualified and as deserving as the next person. The unease I experienced here was quite rational – I have plenty of evidence that there are people out there who can do a much better dental than me.

I don’t think I’m alone in this. I have a suspicion that for a bunch of high achievers who are used to being ‘best in class’ and doing things ‘right’, having to do what we know to be, or perceive to be, potentially sub-standard work is really stressful. We have high standards. In our training we are shown how things are supposed to be done, and then we are thrust into the working world where the business model dictates that we can’t always do it that way. The result: lots of guilt and worry.

(This is definitely not universal – I’ve known, and envied – plenty of vets who seem to thrive on the challenge and love pushing themselves to edge of their comfort zone, but many of us are just not wired that way.)

Contrast that to how I feel these days when I see a vomiting dog, or discuss atopy, or diabetes, or what’s new in the management of urinary tract disease, or any of the topics that we’ve covered extensively on the podcast. This is my jam. I’m up to date and very well qualified.

I’m also (and I think this is crucial) very clear about the limits of my knowledge – without feeling any shame about it. The reason I can’t answer your question or solve this case isn’t because there’s something wrong with me – I just haven’t learnt it yet, or the complexity of it is beyond what is expected of me as a GP vet. But I know who does know the answer. And counter-intuitively, the more I know, the more comfortable I am with what I don’t know, and about asking for help.

The feeling of mastery, or at least active growth, also massively helps with the other major stressor of vet science: client interactions. I realise now how insecure I felt around clients, driven by that pervasive low level fear of ‘being found out’. I can tell you – this vibe does nothing for driving connection and trust-building – the keystones of good consults.

So, what’s the point of my musings?

Here’s how to keep the milk fresh: ongoing, active learning. For many of us a major determinant of how much we’ll enjoy this vet gig will be tied to the confidence that comes from true competence.

Disengaging because ‘too much vet stuff’ doesn’t work’ - I’ve tried it. On-the-job experience alone won’t cut it either, because how often is 10 years’ experience just 1 year’s experience repeated 10 times? (Which took me 10 years to learn!)

And it doesn’t need to be heroic. You don’t need to specialise. (Or spend your days making podcasts!) Just commit an hour or so each week getting better at one aspect of your work. Probably the one causing you the most discomfort. You’ll never ‘master’ it all - there’s just too much to know, and things change too fast. But forward motion builds momentum, competence fosters confidence, and it feels good to know your shit!

(By the way – anyone know of any good practical dentistry CE?!)

Much love,

Hugh