The Vet Vault 3.2.1.

Probiotics for your chemo patients, how to be a braver surgeon, and 'what is a dog'?!

Dec 12, 2024

Head’s up - I’m outta here for a few weeks. It’s school holidays, and I much as I love you all, I love my kids more (Well, mostly. We’ll chat again after a few weeks…)

Oh, and to the 100-odd people who were kind enough to share this newsletter after I asked last week: much obliged. The other 1224 of you who read it and DIDN’T forward it - I get it - life is busy. I’m not sad.

(But in case you had a space 5 seconds to share it this week… here’s that share button again…)

1. Probiotics for chemo patients.

From an upcoming Chemo in GP practice webinar, with Dr Penny Thomas.

If you’re one of our clinical podcast listeners you’ll know Dr Penny well for her easy-to-understand oncology teaching. Penny has a free webinar on chemotherapy safety tips coming up next week on the 18th, and I asked her for some preview pearls. Here’s one that will be useful in GP practice (because I might not be the one administering the chemo, but I’ll be the one dealing with the resulting diarrhoea!):

A recent study looked at the gut biome and response to probiotics in dogs with multicentric lymphoma. Notable findings where:
- At baseline, 40% of the study’s dogs had abnormal gut microbiomes.
- Dogs on probiotics had no diarrhea during treatment, compared to 80% of placebo dogs who did poo-paint the carpet.
Which probiotic you ask… (me too): Visbiome - “a multi‐strain probiotic (112.5 colony‐forming units [cfu]/capsule; Streptococcus thermophiles, Bifidobacterium breve, B. longum, B. infantis, Lactobacillus acidophilus, L. plantarum, L. paracasei, L. delbrueckii bulgaricus) at dose of 200 × 10⁹ cfu/10 kg.”
- No, I can’t find it in Australia.
- The nearest match in terms of Australian probiotics with similar ingredients that I could find with the help of AI is Proviable®-DC Capsules, although it has substantially fewer CFU’s. (Let me know if you have information on this that I missed so I can share it on here.)

2. What is a dog??

From episode 180 on the medicine stream. With nutritionist Romaine Trousset.

Sounds like a weird question, right? But it turns out that it’s a relevant one when it comes to the whole ‘feed your dog like a wolf’ conversation. In this conversation, where we explored the facts and the data around the raw food vs kibble debate, Romaine dropped a few bombshells that I feel, as a vet, I should have known:

Dogs and wolves diverged genetically between 12,000 and 20,000 years ago as the ancestors of dogs started hanging around human settlements and adapting to eat our scraps.

This domestication process resulted in genetic changes in dogs, making them distinct from wolves. So domestication is not the same as taming. Your tame wolf will do fine back in the wild. A pack or feral cavoodles will act and eat differently to wolves. (Although I think a pack of Chihuahuas would be up there with the wolves!)
Research has identified 36 areas of genomic difference between the two species.
- 19 of these genetic differences relate to the brain, highlighting the neurological changes associated with domestication.
- 10 of the genetic differences relate to metabolism and digestion, particularly starch digestion.
Dogs possess four times more replicas of the amylase gene compared to wolves. This genetic adaptation allows dogs to digest starch more efficiently than their wild counterparts. (The other mammals that have similar digestive capability are… pigs, rats, and YOU.

3. Before you refer that fat bitch spay… (or ask your senior colleague to do it).

From episode 175 on the surgery stream. With Prof Jon Hall.

I love a good old philosophical chat with an academic. Like this one with surgeon Dr Jon Hall, about how we can be braver surgeons. Like - how do you walk that line between extending yourself, and being a dangerous cowboy surgeon? But beyond the philosophical, Jon also gets practical with some tips for facing up to those horrible mature obese with spays, including how to communicate with the owners around it. You’ll be happy to know that Jon says these definitely rank up there as far as challenging surgeries go:

“Actually it's a hell of a thing! You're removing the reproductive system of an animal, and it lives in a really dark, difficult to get to place up near the kidneys, dorsal to the bladder and down into the pelvis. It's a challenging job. But because we're familiar with it, we devalue it.”

Communicate - “The first thing I'll always do is manage an owner's expectation very clearly. I won't sugarcoat it… they will get to hear all of the risks.”
Set your expectations: it’s a challenging long surgery. You’re not struggling because of your lack of skill - you’re struggling because it’s hard. (But it doesn’t mean you can’t do it!)
Make longer incisions!

“Actually, if you are prepared to do what the specialist will do, which is make a longer incision and maybe get some retractors in there to really open it up, you’ll manage just fine.”

Learn the duodenal maneuver, where you're lifting the duodenum up from the right side and pushing it over to the left body wall to give you a clear surgical field.

“ It'll be a damn sight easier procedure than if you try and do it through a little incision like you might try and do a smaller skinny dog. “

2 Other things

“Pressure is a privilege - it only comes to those that earn it.”
- Billy Jean King
“He is richest who is content with the least, for content is the wealth of nature.”
- Socrates
(Or, putting it in simpler terms: “The richest person in the world isn’t the one has the most, but the one who needs the least.”

1 Thing to think about.

About a month ago, my choir performed this incredible music: harps, clarinets, giant drums, cello, and all. The music is glorious, but complex, and very hard to learn and sing. Which meant hours and hours of listening to the practice tracks and rehearing the same thing over and over and over… By the time the season wraps up, you can feel a bit over it—like spending six weeks on holiday with a close friend - they’re great, and by the end of the trip, you love them even more, but after so much intimacy, you definitely need a little space.

I’ve had my space from John Rutter and his music, and I was ready for a short visit. So on Sunday night, while I did the dishes, I plugged in to a bit of Requiem - just listening to listen, not to learn or practice. And it stopped me in my tracks! It was like I’d never truly heard it before - FELT it in its entirety. Somehow, during the hours of rehearsal, and even during the performances, I’d missed it. I was so focused on my little part of it that entire movements, glorious harmonies, and moments of sheer bliss completely passed me by.

——

How often do we do that? We’re so convinced that our part of the show is the bit that REALLY matters. So focussed on not messing up, not letting anyone down, looking good, on being perfect, that we totally miss the show. Like forests and trees: missing the symphony for a single note.

Of course, you DO want to know your part and sing it well. If even 5 people in the choir butcher critical moments in their part because they are mostly just there to enjoy the music, much of that magic and glory will evaporate.

And I think that right there is the big challenge: how do you walk that line between being a high performer, doing work that you’re proud of, contributing at a standard that raises the quality of the product, while still being present enough to appreciate the magic of the thing that you’re making?

(If you’re waiting for the answer from me, you’ll be disappointed! All I have is simply to remember to sometimes let go of your perfectionism, and to make a point of listening. I’d love to hear your insights.)

Much love,

Hugh