The Vet Vault 3.2.1.

The Hoo-Ha About Bedinvetmab, Practical Hydration Monitoring in Hospitalised Patients, and Poo Pills for Parvo

Jul 10, 2025

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3 Clinical Pearls.

1. Is The Hoo-Ha About Bedinvetmab Something We Should Worry About?

From Episode 193 in the Surgery Feed - With Dr Mike Farrell

It’s been a hot topic on the socials from the moment it was released (like most new meds) . Then it became a news story: ‘bedinvetmab is doing bad things to pets!’ But in practice, most of us were just seeing how well many of our older patients do on it. So what’s the deal? Is it all media hype, or should we be paying attention?

A few months ago Dr Mike Farrell and 17 other specialists published an article comparing the rate of musculoskeletal adverse effects from bedinvetmab to that of commonly used NSAIDs. The paper also presented 19 cases of rapidly progressive arthritis occurring after the patients were started on bedinvetmab. A week or so after this article was published an email from the manufacturers hit our inboxes criticising the article and its conclusions. So of course I had to speak to Dr Mike to try to make sense of it all. It’s an intense conversation, and one that I really encourage you to listen to. In stead of trying to summarise some key points in my own words, I’ll just leave you with 4 quotes from the conversation, and one picture from the article:

Colleagues just kept sending me these cases: ‘Mike, have a look at this.’ We’d just not seen anything like that before.
The theory that the dogs are treated and it's such a miracle treatment that they're accelerating their arthritis [by overusing the arthritic joint] is pure bullshit.
If people want to bury their head in the sand, they've got options. They go, ‘oh no, this isn't a randomised control trial, therefore you can't establish a causal relationship.’ And the answer to that is, well, they did in human healthcare. So bullshit.
We’ve been very careful as authors in saying - that’s your decision to make. Our job was to answer a couple of questions. Question one: are we seeing pathology in dogs equivalent to the pathology that stopped these drugs getting licensed in humans? And we voted unanimously as independent experts, with no skin in the game, that the answer was yes. Question two: when you do what the FDA did and look at the reports of specifically musculoskeletal adverse events - are they more likely in dogs getting bedinvetmab than in dogs that aren’t? And yes, compared to the next most common musculoskeletal side effect drug, which is carprofen, it’s 20 times more likely. What you do with that information, and how you educate your clients with it, is up to you. We passed our data to the EMA - they’re the official regulatory body. Individual practitioners are policy-makers within their own practices. I’m not going to tell you how to educate your clients - I’m just going to, with my co-authors, give you the raw materials to make your own decision.”

You can listen to it here. It’s behind the paywall, but if you’re not a subscriber - your first 2 weeks are free, so sign up, binge, and then cancel if it’s not for you. Oh, and while you’re there, listen to this episode on acute kidney failure - one of other favourites from the past few months. Our next pearl is from thatepisode:

2. How Do We REALLY Track Hydration Level in our Hospital Patients?

From Episode 188 in the ECC Feed - With Dr Bing Zhu

A few weeks ago we talked about how critical it is to keep our AKI patients at goldilocks-levels of hydration: both dehydration and over-hydration are detrimental to kidney function. But beyond kidney disease there are many other reasons why the RIGHT level of hydration is important. (“Twice maintenance” is not the answer!) Which is why I loved these highly practical pro tips on monitoring hydration in our hospitalised patients:

It relies heavily on body weight:
- Start with your patient’s ‘normal’ body weight - what did it weigh when it came in for its vacs/dental? Get a clear history from the owner - has Mittens gained/lost weight since the last time you weighed it?
- Once you’ve started your patient on fluids - keep weighing it. If hydration is critical for your patient (eg the kidney patient) - weight it every 4-6 hours.
- Calculate the ins and outs:
  - Weigh dogs before and after walks to figure out urine volume
  - For cats - weigh the litter tray
  - Consider the following: Did they eat? How many grams did they eat?
  - Weight of faeces produced.
- Aim to achieve your estimated dehydration weight gain (eg a 5% weight gain if your patient was 5% dehyrated at the start) by the end of 12 hours. If that % weight gain happens too quickly (e.g., by the 6-hour mark), you’re overdoing it.

“Look at what the patient is putting out, what are you putting in, and are you gaining hydration weight at the appropriate rate that you’ve set? And if you are gaining faster, lower that rate of fluids. I'll check again in four to six hours. And if you're still gaining at that rapid rate, then I'm worried you are actually oliguric.”

3. Poo Pills for Parvo

From Episode 199 in the Medicine Feed - With Kathrin Busch

Not many people get as excited about dog poo as medicine specialist and researcher Dr Busch. But once you listen to this conversation about the research findings of where faecal microbial transplants can be beneficial, you’ll start sharing her enthusiasm. Here’s one to get you started:

In a study 66 parvo puppies received either standard treatment or standard treatment plus FMT. Results showed that the FMT group had significantly faster faecal normalisation: 3 days vs 6 days.
The practical implications of this are massive: think shorter hospitalisation time (and so much less cleaning!), and just about halving the cost of therapy – a big deal in these cases where financial constraints are so common.
Mortality rate was also slightly lower in the FMT group (21% vs 36%) - not enough to be statistically significant with relatively low case numbers, but I’m definitely taking note.

“It’s really astonishing how well it works.”

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2 Other things
“Easy choices, hard life. Hard choices, easy life.”
Jerzy Gregorek
“It is utterly false and cruelly arbitrary to put all the play and learning into childhood, all the work into middle age, and all the regrets into old age.”
Margaret Mead

1 Thing to think about.

Here are some basic building blocks that contribute to the quality of my day and my general level of equanimity:

Enough sleep
Exercise
A bit of time outside
Some degree of autonomy over how I spend my time

I’m definitely not unique – it’s simple brain chemistry. Neuroscience is very clear that these things are directly linked to levels of feel-good neurotransmitters.

So then, why do we stubbornly persist with this notion of 10+ hour shifts?!

My new daytime GP role isn’t particularly onerous in terms of caseload or complexity. I start work at 8 am, and our last consult slot is at 5 pm - pretty cruisy compared to some of my previous vet jobs. But once you factor in the commute and an hour to tidy up patient records and admin after that last consult, it’s a 12-hour day, door to door. Add in an hour in the morning for getting ready and making lunch, and I’m busy with work-related activities from 6 am to 7 pm.

“And… what’s your point?” I hear you say. “That’s a normal day for the vast majority of working adults around the world – certainly for us vets.”

Well, that’s exactly my point. See, for the rest of my week I’m working from home on Vet Vault-related stuff. I work hard – often putting in longer hours in a 24-hour period than I do on a clinical day. But there are some key differences:

I can take a break when I need to – this usually involves doing something outside.
I can almost always make time for a run or spend 40 minutes in the gym.
If I need to call the bank or the dentist or my kid’s teacher, or do the school run, I can do it.

Versus a day in the clinic: My hours are dictated by what’s on the calendar and who decides to call last-minute or just walk through the door. On most days, there’s no time to achieve anything else. Yes, I could theoretically still exercise after getting home at 7 pm – I know many people do. But I’m pretty pooped by then, and I also want to eat dinner with my family, hear about their day, and help put the little one to sleep. That’s the remaining three hours of my day gone. (Sound familiar?)

I just do one day per week in the clinic – I can easily cope. I couldn’t (didn’t) if (when) it was five, or even four days a week. It’s very hard to squeeze enough dopamine boosters into three out of seven days a week. Yet we try, and then we’re surprised that we don’t like work quite as much as we thought we would. You probably do like it just fine – you just need a run, a nap, and a bit of sunshine.

I’ll ask it again: why do we persist with this notion of a 10-hour workday?

Because “that’s just the way it’s done.” Because “that’s what running a vet practice requires.” Because “I need to pay my car repayments / mortgage / student debt, so I need to work those kinds of hours.”

Look, if you need those hours to keep a roof over your head and food in your belly – by all means. But start planning for the next stage. For the rest of us, including the business leaders who determine what shift length should look like, consider a reset. Get creative. How much do you HAVE to work? (Asked differently – how much do you have to SPEND?) What would your ideal day or week look like?

Find the intersection between those points, and start negotiating – you have more agency than you think.

Much love,

Hugh