The Vet Vault 3.2.1.
Wound care on a budget, the “asthma cat" that won’t get better, effusion analysis pro tip, and a super useful (free!) AI tool.
Before we jump in: Happy New Year! And while you’re in week 1 mapping out the year ahead, put the following dates in your leave calendar to come join me at the following conferences:
14–16 March for JAVECCS in Tokyo (It’s about a week before the cherry blossoms, so I’d stay for a week after the conference if I was you.)
10–15 August for the first ever combined Vets on Tour/ Vet Vault conference in Wanaka, NZ. We’ll send out full details in the next week or two.
3 Clinical Pearls.
1. Hosepipe hydrotherapy.
From ep 177 on the surgery feed. With Dr Jenny Groover.
Back in 2024 (remember 2024?!) when I spoke to the great Prof Karen Tobias she referenced a paper that showed that cleaning wounds with tap water can actually yield BETTER results compared to wound lavage with sterile fluids. Now, in this conversation about patients with $5000 wounds but a $500 budget, we get super practical with how to apply this knowledge. (Note that Dr Groover was very clear that these tips are not the IDEAL treatments, but rather a solid plan B for when your client can’t afford best-practice.)
For those wounds that require multiple bandage changes and wound cleaning, ie, multiple sedations, 30-60 minutes of staff time with each change, and expensive new dressings, a viable alternative option is for the owners to manage the wound at home with:
Petroleum jelly on the wound to keep it moist. (Ie, a large tub of vaseline.)
Some sort of home-made dressing, like a t-shirt or a tube sock. (DON’T let owners attempt placing actual bandages at home!)
A daily wash with the garden hose!
No, it’s not ideal. But in Dr Jenny’s experience it will often work, and it’s better than euthanasia
2. Your “asthma” cat that won’t get better.
From episode 181 on the medicine stream. With Dr Belinda Hopper.
You know how every once in a while you’ll get an ‘asthma cat’ that just doesn’t respond to treatment? Like Dr Hopper puts it:
…”they're still coughing, they're still wheezing, they’re on high-dose glucocorticoids, and it's just not going anywhere...”
Here’s the good news: it’s probably not your fault. What Dr Belinda talked about in this episode is an emerging understanding that bronchiolar disease, something that is well-recognised in human medicine, is a thing in cats.
Here’s why it matters:
Normal asthma in cats is bronchial disease, ie, inflammation of larger airways, while bronchiolar disease involves the smaller, non-cartilaginous airways.
Note that the bronchioles are tiny structures, but their combined cross-sectional area in the lungs is actually greater than that of the upper airways, making them critically important. Healthy bronchioles offer minimal resistance to airflow, but because of their small size, even a slight amount of inflammation in their walls can cause significant resistance and impair lung function.
So is bronchiolar disease just more severe asthma?
No, it’s a different disease. But often really bad asthma in cats will start extending into the bronchioles.
What you’ll see
Clinically: Cats with lung disease that don’t really respond to steroids.
Imaging: Obstruction of bronchioles by mucus and pus can lead to nodular formations that can mimic neoplasia, ‘military’ patterns, and something called the “tree bud sign.” (Ask your radiologist.)
What it means for your patient:
Well it’s not good news. Mostly it means that you’re not going to fix them. But at least you can set expectations with your clients, and stop loosing sleep about why your case won’t get better.
3. Effusion analysis pro tip.
From episode 182 on the medicine stream. With Dr Holly Brown and Jessica Wilson Hess.
This episode on how to evaluate effusion fluid in-house to allow you to make on-the spot decisions is packed full of pearls. Here’s a quick one that will save you heaps of time:
You know how you need a cell count to decide whether that fluid you just tapped is a transudate, modified transudate, or an exudate? Are you counting cells manually? (Me neither.) You’re probably just sending it to the lab and waiting for results, right?
But did you know that your in-house CBC machine will happily count and classify the cells in effusions?
ProcyteDX and the HM5 have been validated for this use, but pretty much any in-house analyser should be able to do it.
If it’s a very viscous fluid, like joint fluid, your machine might ask you to dilute the sample. But most body fluids will run just fine, even stinky purulent ones.
Note - it’s likely that your machine will have a hissy-fit and give you lots of stars and ‘invalids’ in the results, but that’s because it’s trying to match the results with what it expects to see in blood. Ignore it, and just look at the RBC and WBC counts - that’s all you care about.
2 Other things
“Consult your resentment. It's a revelatory emotion, for all its pathology. Resentment always means one of two things:
Either the resentful person is immature, in which case he or she should quit whining and get on with it, or
There is tyranny afoot, in which case the person subjugated has a moral obligation to speak up. Why? Because the consequence of remaining silent is worse.”
“You cannot pour from an empty bucket.”
- Radhanath Swami
1 Thing to think about.
I don’t know about you, but all the new AI tools out there has me simultaneously giddy with excitement about what I can do with it, in a state complete FOMO-driven panic that I’m missing out on some new wonder-tool, and sometimes paralysed by choice. Like when you’re in Bunnings looking for a box of screws, but there are so many bloody options to choose from that you end up leaving with a sausage, but no screws.
I’m discovering so many new useful AI tools for work and life that I thought I’d deviate slightly from my usual philosophical posts and write about a few practical, technical things to think about. But first - a bit of philosophy about this topic:
Here’s how I try to counter the FOMO and the paralysis I mentioned:
Every time I do a task on my computer or phone I ask myself: I wonder if there’s a smarter way to do this?
I note this task (on my Apple notes app) and tag it as #techquestion.
Then, a few times a week, I’ replace my social media time with some AI research time, exploring possible solutions for the thing on that list that irritates me the most.
This way I feel like I’m moving forward, however slowly.
Ok, let’s get practical. I’ll start with a tool I’ve been experiment with a lot over the past month for both clinical and podcasting work:
Google NotebookLM
Imagine you’re working on something where there are multiple sources of information that are all relevant to your project. Maybe you are researching something about a case of yours: let’s say you have a patient with IMHA, but you haven’t treated one for a while, so you need to do a bit of reading to refresh your memory. So you pull up your old study notes, you open your Vet Vault show notes on IMHA, you find article online, and maybe even a webinar on YouTube.
That’s a lot of information, and your next puppy vaccination appointment is in 5 minutes.
So here’s what you do:
Create a new notebook on NotebookLM called IMHA and add all of those things you found as sources in your notebook. Now the AI can search ALL of that information in seconds and provide you with pretty much any output you ask of it:
Need a summarised best-practice treatment plan? Done.
Want to check if your reasoning makes sense? Share the details of your case with it, including your test results, and ask it to check you and find anything you might have missed, or even give you your next diagnostic or treatment steps.
Maybe you have a specific question, like ‘what dose of Pred should I use? When should I recheck the PCV? Do I need to start a second immunosuppressive, and if so, which one, based on what I have on the shelf?’ Just ask.
How about a client info sheet on IMHA? Five second job.
If you’re a student then I think this might become your new best friend. Especially post-grad, where you don’t get handed a neat little pile of stuff you need to study. It’s great at making study summaries, a study plan, and can even create quizzes to test your knowledge.
———
Here are some examples of how I’ve used it over the past few shifts for cases that challenged me:
I made a neuro’s patient coma score and and treatment plan tool, where I can input exam findings from a head trauma patient to get an updated coma score (using several different scales), a prognosis, and a treatment plan.
I also made a critical care nutrition bot that can make daily feeding plans, down to the exact amount of food to feed, using a textbook chapter, 2 nutrition websites, and all of the nutritional information for the critical care diets that we stock as it’s sources. To make that practical, I told it: “I have a 23 kg dog who has not eaten for 5 days and has significant wounds. The patient is euvolaemic. We are feeding it Hills a/d via an NG tube. Please create a feeding plan for the next 3 days.”
Each of these took me 15-20 minutes to create, and now I have them for the next time I need it.
Technicalities
It’s free - you just need a Google account.
Each notebook can have up to 50 sources of information. (I forget how large each file can be, but it’s big.)
It can use the following as inputs:
PDF’s
Web links
Google docs
Youtube videos
Copied text (ie you can just copy/paste text into it.
You can share your notebook with up to 50 people by inviting them (via their google email address) to have access, which means you can create team notebooks. (Think protocols, both clinical and non-clinical.)
Go have fun with it, and let me know what you create. (Please invite me as a user to your super tools! In fact, let me know if you’d like access to the tools I’ve created - I’ll let the first 50 of you in.)
Also, let me know if you’d like me to share some more of the tech tools I discover on here from time to time.
Much love,
Hugh
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I would love access to your super tools! Excited to start using NotebookLM… I’ve been looking for a way to combine all my notes from vet school, internship, and now my first full time overnight ER job. Sounds like it’ll be perfect for streamlining the multiple sources I have to dig through to find info
I have loved reading The Vet Vault, up until today, when you posted a quote from Jordan Peterson. I cannot continue to support anyone that considers him to be of any value to humanity at all. Good day.