The Vet Vault 3.2.1.

🔪 Friday the 13th edition 🧟‍♀️

Jun 12, 2025

For our Friday the 13th edition, I thought we’d have a bit of fun with bad luck, horror, and superstition. Here’s some mood music to play in the appropriate places:

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To start us off, here are some potentially scary things about our conference in Nozawa Onsen in Japan next year:

The powder onthe ski runs (and in those glorious of-piste chutes) can sometimes be so deep and so soft that you sink into the snow when you fall. 🥶

The water in the onsen (natural hot springs) is scaldingly hot — especially when you jump in straight after skiing home through that scarily deep powder.
Saki hangovers. The horror!

If you think you’re tough enough to endure this kind of misfortune, tickets are now on sale. (And if the hot springs and sake are a bit much for you, but you still want world-class CPD in a stunning location, we still have about 15 tickets left for Wānaka, NZ, later this year.)

And if you’re more of a warm -weather person, come join me at ANZCVS Science Week on the 24th-26th of July. I was going to pick a few sessions that I’m particularly excited about to tempt you, but I’m in state of complete overwhelm after going through the program. So much good stuff!

3 (terrifying) Clinical Pearls.

1. Dog park horror

From Episode 179 in the Surgery Feed - With Bronwyn Fullagar

You know this story: it was a bright and sunny day at the park. Dogs were frolicking, chasing balls, and retrieving sticks, when suddenly (play the ominous music now!)… it all went horribly wrong…

Photo courtesy of a case recently shared by AES Tanawha. 🤮

Here are a few pharyngeal stick injury pearls that Dr Bron recently shared with us:

It’s not always this obvious. Owners might not witness the event, so keep stick injuries or stick-related foreign bodies in mind for any case presenting with gagging, difficulty swallowing, or reluctance to eat.
For ‘in-and-out’ stick injuries - that is, stick-related wounds with no visible foreign material - resist the urge to completely close the hole in the mouth. It’s a contaminated wound, so leave at least part of it open to drain.
If your patient presents with a stick protruding from its mouth, DO NOT PULL! You don’t know what structure it’s embedded in—it could be plugging something critical, like the carotid artery, or, in Dr Bron’s most impressive case, the heart. Yanking it out could cause catastrophic damage.
If the business end of the stick is lodged in the neck, don’t just dive in over the tip you can feel. Instead, approach via a midline incision and carefully dissect your way in. This gives you the best chance of avoiding the many 'exciting'structures in the neck. (Some types of bad luck can be avoided!)

2. The case of the severely anaemic cat

From Episode 194 in the Medicine Feed - With Dr Rachel Korman

No need to embellish this one - for most of us, it’s scary enough as it is, even without the mood music!

BUT… it might not actually be a story with an unhappy ending, despite what I always assumed. In my head, whenever I saw a cat with a PCV below 20 – especially if they were showing transfusion triggers – the prognosis felt pretty grim. But here’s Dr Korman’s pearl that completely challenges that bias:

A study she was involved in showed that the severity of anaemia in cats was not predictive of survival. (Step away from the lethabarb, doc!)
Young cats in particular often do very well if we can identify and treat the underlying cause.
Older cats with anaemia, however, might warrant a bit more concern. Differentials like neoplasia or anaemia of chronic disease become more likely – and as you know, quick fixes aren’t really a thing in those cases.
PRO TIP: Anaemia of chronic disease is unlikely to give you a super-low PCV. You’ll typically see it hovering between 15–25%, often in a cat that doesn’t meet transfusion criteria.

3. A night of asphyxiation

From the Advanced Surgery Podcast with Dr Bronwyn Fullagar

We’re back in the dog park. It’s a warm spring day, and the dogs are frolicking again. But one of them is frolicking a bit more than his deformed anatomy can handle (hit that music…) It starts with a throat tickle. Everyone laughs at his snoring, but it’s less funny when he starts turning blue…

The misfortune becomes yours when that Frenchie barrels through the door right at the end of your shift. Fortunately for him, his luck is about to change, because you’re a gun vet. You somehow manage to get an ET tube past those voluminous (and very oedematous) meat sacks in his throat. But it’s Friday the 13th, so later, when you try to extubate, things are still too swollen, and that excessively long soft palate just won’t stay clear of the trachea. Enter Dr Bron with some golden pro tips to save the day (again):

Mannitol swabs in the back of the throat. Soak them, pack them, and let them draw out that oedema. (Just don’t forget to remove them!)
Do a temporary palatopexy. In plain English: grab the edge of that troublesome soft palate with 3–5 sutures and tack it rostrally to the hard palate as a temporary measure to open that airway. Here’s a how-to video. (And then refer him for surgery.)

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2 Other things

“Monsters are real, and ghosts are real too. They live inside us, and sometimes, they win.”
Stephen King
“Normal is an illusion. What is normal for the spider is chaos for the fly.”
Morticia Addams (The Addams Family)

1 Thing to think about.

“Why is it so quiet?”

Did I just make you uncomfortable? (I hope you’re not reading this at work…)

The cursed Q-word is probably the most wide-spread and persistent superstition in vet med, and emergency services in general. But it’s definitely not the only one. Here are a few of mine:

Bad vein days. Once you’ve missed it 3 times, step aside. (The next person will get it first go.)
Stormy nights bring GDV’s (although I think there might be some science to this one.)
Don’t ever say of the tick paralysis patient: ‘Her signs are mild - I’m sure she’ll do well.’
Weird cases come in threes.
My lucky stethoscope. (Which used to belong to my dad!)
‘Oh, look at this great vein’ should never cross your lips.
Full moon = crazies! (Possibly fact, not superstition, right?)

What are yours? Do you have a ‘lucky’ scrub cap or pair of socks? Do you HAVE to have the right music when you’re in theatre?

For a science-based profession these things seem silly, but they might not actually be that ridiculous. I recently read a story from the Second World War that describes how most of the soldiers had some special object that they HAD to have with them during battle - a photo of a loved one, a bible, a coin or locket, or the lucky toy pig that was passed along from friend to friend to keep them safe and give them courage. I’d argue our medical superstitions do the same. And there’s probably some science in it:

There’s a study out there that measured activity in the medial prefrontal cortex of mice when competing for a desirable snack. The researchers were able to predict which mouse would triumph BEFORE the scuffle began, based on specific brain activity. In fact, this ‘winning mindset’ often had more of an effect on the outcome of the conflict than physical superiority.

I suspect that this is what superstitions and placebos do for us. So by all means, cling to the superstitions that give you courage. They can be a talisman of control and a bringer of confidence in a job ruled by unpredictability and complexity.

But there’s a flip side: what about the superstitions that undermine us? Example: there are several studies that have examined the effect of the q-word on how busy a shift is. Like this one, that found no significant differences in actual patient volumes when someone said “it seems quiet in here” at the start of a shift, versus when the the curse was not spoken. But tellingly, when the team was surveyed 3 hours into the shift that started with the Q-word, many people perceived the department as busier. And that belief definitely affects mindset, which affects performance. I suspect IV catheter superstitions turn me into the ‘other mouse’ in that study - the one that has lost before the fight has even started.

Before I leave you to face the bad luck of this day (I hope you’re wearing your lucky undies!), there’s on more thing on the topic of superstitions vs science that we need to discuss: clinical beliefs we cling to despite the evidence. ‘The things we know that just ain’t so.’ Metronidazole for diarrhoea, PPi’s for acute vomiting, antibiotics for the FLUTD male cat (actually, antibiotics for a lot of stuff!)… the list is long, and of course forever changing. Unlike harmless superstitions, these ones matter. And as comedian Tim Minchin put it:

“A famous bon mot asserts that opinions are like arse-holes, in that everyone has one. I would add that opinions differ significantly from arse-holes, in that yours should be constantly and thoroughly examined.”

So how do we examine our ‘arse-holes’? It’s pretty simple: keep learning. (Subscribing to our clinical podcasts is a great start! 😜) Be self-critical (but not self-flagellating.) Be open to feedback - in fact, seek it out. Yes, when things go wrong, but also when they go right. We’re all familiar with the truism that our patients often get better despite our treatments. Strive to figure out where this is true. Back to Mr Minchin:

“We must think critically, and not just about the ideas of others. Be hard on your beliefs. Take them out onto the verandah and beat them with a cricket bat. Be intellectually rigorous. Identify your biases, your prejudices, your privilege.”

So go ahead - embrace your helpful superstitions. Just don’t forget to challenge your thinking as fiercely as you defend your rituals. In a profession built on science and shaped by chaos, both can make you luckier.

Much love,

Hugh