The Vet Vault 3.2.1.

Another Reason to Love Ketamine, 'Love Therapy’ to Reduce Complications During Post-Op Recovery, and Could There a Better Way Than Buttholes?

Jun 20, 2025

Quick note for our veterinary practice owners (or wannabe owners!) and leaders: I’ve been working with vet business coach Dr Sam Bowden to create a brand new podcast - Veterinary Business Accelerator. Here’s the blurb: What's the difference between feeling trapped by your business and leading with purpose - making the impact that inspired you to open your doors in the first place? This podcast is for veterinary business owners who want to reclaim their time, grow their profits, and build a business that brings freedom - not just responsibility. Click the image to listen.

3 Clinical Pearls.

1. The T in TPR: Is There a Better Way Than Buttholes?

From Episode 195 in the Medicine Feed - With Prof Danielle Gunn-Moore

Who loves taking temperatures in cats? You’re not alone - in this FIP masterclass Prof GM, one of the most qualified ‘cat people’ in the world, told us that a review showed that fewer than half of feline patients seen at their facility had their temperatures taken during consult. Not because anyone is lazy, just because, well… cats.

Which is why they looked at a better way to do it:

Another study found that the vast majority of cats will tolerate an ‘axillary’ temperature very well:
- Use a fast-acting, rigid thermometer (e.g. Kruuse digital thermometer)
- Approach from behind, tuck the thermometer in the cat’s armpit and gently press the forelimb back against the body.
The study showed that 80% of axillary readings were within 0.5°C of the rectal temperature.
The 20% that were less accurate were either fat or fuzzy. (The cats, not the researchers.)

2. Another Reason to Love Ketamine

From Advanced Surgery Podcast - With Dr Claire Sharp

Septic peritonitis patients usually need a lot of pain control, right? I bet opioids are the cornerstone of your pain plan. But in this ‘everything a surgeon needs to know about septic peritonitis’ episode, Dr Claire reminded us not to forget about ketamine CRI’s, because:

It can help reduce the amount of opioid you need, which in turn
- Reduces ileus and the other opioid effects that might stop your patient from eating, AND…
- There are good studies (like this one) demonstrating that ketamine can have an immunomodulatory effect (through cytokine and white blood cell actions) which can reduce the severity of the inflammatory response that will push these patients into SIRS and beyond.

3. ‘Love Therapy’ to Reduce Complications During Post-Op Recovery

From the Advanced Surgery Podcast with Dr Bronwyn Fullagar

You’ll be familiar with the moment during GA recovery when that Frenchie suddenly ‘wakes up’… and then completely freaks out! Cage banging, thrashing, and making that weird bird-like scream that they do. And you desperately just want them to chill, so that they don’t irritate that delicate upper airway, because the last thing you feel like right now is an emergency tracheostomy. Ah, good times.

Well, put away the medetomidine, because Dr Bron gave us this pearl:

A retrospective study divided 63 BOAS surgery dogs into two groups:
- Owner-Assisted Recovery: 42 dogs recovered from anaesthesia in the presence of their owners and were discharged on the same day.
- Standard Recovery: 21 dogs underwent standard postoperative care without owner presence and were hospitalised for 24 hours.
The study found that the incidence of postoperative complications was 2% in the owner-assisted group, compared to 28% in the standard recovery group. None of the dogs in the owner-assisted group required veterinary assistance after discharge.
I’m no statistician, but I count a 26% reduction in the likelihood that your ‘babysit the BOAS dog’ shift will be ruined. (“He’s just starting to wake up. Please, come in and make yourselves comfortable! Yes, the screaming is quite normal… “)

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2 Other things

“At some point in life the world's beauty becomes enough. You don’t need to photograph, paint or even remember it. It is enough.”
Toni Morrison
“Generalisations without examples and examples without generalisations are both useless.”
Steven Pinker

1 Thing to think about.

About six weeks ago my son came home from school with a sore knee after a particularly energetic PE class. Not ‘something’s ruptured’ sore, just enough to warrant a week of rest and NSAIDs. But halfway through rugby training a week later he had to limp off the field, the knee now worse than before. I had a cursory feel of his leg that night, confirming that it was indeed a bit swollen. If he was a dog he’d be an un-castrated kelpie, so if this was anything that would required actual structured exercise restriction, we’d need some evidence to strengthen our case. So off the the doctor he went.

Doc number one agreed on the swelling and said “I think he has patellar bursitis - let’s send him for an ultrasound.” Great plan. But the scan was a week away and we had to decide whether he should skip the big match that weekend, so I needed to understand the implications of our suspected diagnosis. Now, until recently I would have just Googled patellar bursitis. But I no longer Google - I AI, or GPT - or whatever we’re going to call this new thing we’re doing. I told ChatGPT the history and signalment and asked it to give me a rundown on patellar bursitis.

“I don’t think he has patellar bursitis.” I told Ros. She rolled her eyes at me - twice. Once, because she always does when I try to diagnose the kids, the second time because she’s getting tired of hearing ‘ChatGPT says…’

Ros took him to the scan. “It’s not patellar bursitis”, the ultrasonography said.

Vindicated, that night I took off my ‘concerned parent’ hat and went into diagnostician mode. “Lie down. Relax your leg. Does it hurt here? How about here?” (Let me tell you - this shit is MUCH easier in a patient that can talk!)

I went back to GPT and told it exactly what I’d found, using appropriate medical terms and specific detail. I recapped signalment, how he injured it, an which activities caused him most pain. “12 year old boy, injured during a jump. Pain on walking up stairs.”

“I’m sorry to hear about your son’s knee. Thank you for the detailed explanation. Based on what you told me I’d consider….”

Chat went into a long explanation, listed dd’s etc, but its top diagnosis was something called “Sinding-Larsen-Johansson Syndrome”.

“Random” I thought. “Probably not.”

So back to doctor to discuss scan results. Fast forward through the rest of the process: rads to rule out a chip #, another appointment. Four weeks in, still a problem: “let’s send him for an MRI.” Get the MRI done. Wait another week for results.

Last night Ros has another appointment to discuss the MRI findings:

Doc: “He has a condition called Sinding-Larsen-Johansson Syndrome. I’ve never heard of it.”

Ros: “No ways. My husband used ChatGPT 4 weeks ago to ask about his knee, and that’s what the answer was.”

Doc: “Well there you have it. Let’s see what it says about treating it…”

It’s an n of 1, and anecdote is the worst kind of evidence, but f me! So here’s what I’m thinking:

It’s not coming for your job - your average parent (or pet owner in our case) could not have used GPT to come to that diagnosis. My hands have been sniffing out pain and finding subtle swelling in uncooperative and uncommunicative patients for 25 years. I’m very good at that bit, and I don’t think any AI is replacing that part any time soon.
But it definitely ‘knows’ more than most of us, just like it knew more than my kid’s GP.
Research (and my personal experience) has shown that when it comes to medical knowledge, it’s not that great with non-specific histories. Don’t tell it ‘my son’s knee hurts. What’s wrong with it?’ Or - ‘my canine patient has come on with sudden collapse. Give me some dd’s.’ But narrow down its context and it suddenly becomes laser sharp.
Our days of bullshitting clients about stuff we’re not that up to date on are over. Clients are going to check what you are telling them. And if they’re even half-sensible they’ll get great answers. This is confronting. But I think we need to shift from feeling threatened or undermined by that and embrace it. “Show me what you found. Let’s explore that together. In this context, here’s why I don’t think that makes sense. Here’s what I found. Wow, I’ve never even heard of that before - let’s find out more.”

(Oh, the treatment for Sinding-Larsen-Johansson Syndrome? Rest and anti-inflammatories!)

Much love,

Hugh