Vet Science Week - the Australia New Zealand College of Veterinary Surgeons conference - is fast approaching. From 24-26 July I’ll be recording live podcasts with speakers from the programme. I’m almost paralysed by the vast number of excellent talks - trying to choose who I should interview is proving to be nearly impossible!
And if you thought Science Week is all high-level stuff over the head of the average GP - you’re wrong. Yes, there’s plenty of specialist-level content for the real nerds, but a big chunk of the programme is aimed squarely at GP vets. For the first time ever, I’m speaking too: a clinical talk on what I’ve learnt from making the Vet Vault that has changed the way I practise, plus a deep dive on AI as a clinical decision-making tool. Come support me, heckle me, or just say hi on the red couch on the trade floor.
From Episode 225 Surgery Feed With Andrea Tarr
People love their supplements, and it’s no different when it comes to their old arthritic dogs. You hand out the registered medications, and then your client adds their own cocktail of joint supplements to the mix - courtesy of Google, Facebook adds, and what the neighbour told them. But also - sometimes based on what their vet (that’s you) told them. Andrea Tarr, our guest for this episode, runs the Veterinary Prescriber , where she critically evaluates veterinary evidence to help us make better evidence-based decisions. In this conversation we tried to put the science back into Veterinary Science with a critical look at some of the popular joint supplements our clients are using. Spoiler alert: the evidence is not nearly as strong as the marketing. Here’s something to think for one increasingly popular group supplements:
Marine-derived joint supplements, like krill oil and green-lipped mussel extracts, are big in 2026. You may even sell some of these, based on some research someone showed you at a lunch-and-learn. Yes, there are randomised controlled studies that loudly proclaim the therapeutic benefits of some of these products, but if you read past the conclusions the story gets less exciting:
Most of these studies are underpowered, too short, and far from perfect in their design.
Some of the studies that look better at first glance are funded by the manufacturer and not publicly registered, which means we cannot independently verify the end point.
If you read the whole thing the authors will often clearly state that the results are at best a signal that warrants further investigation. But you won’t find any of that in the brochure or the website.
But let’s be generous and assume that there is some benefit. We want to help our patients, so if we think it might help, then what’s the harm, right?
BUT here’s something that Andrea mentioned that I hadn’t considered before:
Krill oil comes from a wild-harvested marine animal that sits right at the centre of the Antarctic food web. We think krill oil might help some painful dog joints. We KNOW krill matter to whales, seals, penguins, fish, squid, seabirds, and the broader Southern Ocean ecosystem.
So is it justifiable to use as an arthritis joint supplement in pets? Maybe. But I think the bar should be higher than “it probably won’t hurt”. Consider it if:
Your patient doesn’t respond sufficiently to or can’t have a registered medication, like a non-steroidal
You use a formulation with the most/best evidence.
You diligently monitor the response in your patient, and if it’s not making a real difference, leave the krill in the ocean
And speaking of NSAID’s...
From Episode 229 Medicine Feed, with Prof Jill Maddison
Old cat or dog needs to start on an NSAID. But you’re a thorough vet, so you run some bloods to check that his kidneys are fine first. Bloods come back: azotaemia. Damn. Guess you better start looking at alternative painkillers for those old hips. But wait, Prof Jill Maddison wants you to think again:
Most NSAIDs aren’t excreted by the kidneys - the liver does the cleaning.
NSAIDs, at therapeutic doses,* don’t do damage in a well-perfused kidney. In fact - they don’t actually directly damage kidneys at all - they just remove the kidney’s protective mechanism for when they are under-perfused.
Which means that, even if you’re older patient has some degree of CKD - as long as they are not dehydrated or under-perfused - some welcome non-steroidal pain relief is likely not making those kidneys worse. **
So does that mean an animal that is azotaemic can have NSAIDs?
“They’re not going to put that on the data sheet…” But there are plenty papers that show that you can. Like this one that showed that meloxicam in cats with chronic kidney disease does not to shorten their life, and might even extend it.
*Overdose of NSAID is obviously a different story, as we all know from those ‘ate the whole pack tragedies.
** Don’t willy-nilly splash around meloxicam in your CKD patients - the study above showed that Meloxicam can cause increased proteinuria, which isn’t great for kidneys in the long term either. To quote the paper: “clinicians should weigh the risk of potential increased proteinuria against quality of life benefits when considering meloxicam for analgesia in cats with renal disease.”
AND - speaking of sad kidneys...
From Episode 226 ECC Feed With Joanna Finstad
Your patient comes in with congestive heart failure. You start stabilising and run some bloods to make sure nothing else is going on… something else IS going on: Urea and creatinine are through the roof. Not good. You get ready to have a hard conversation with the client, because not only is this old pup’s heart packing up, its kidneys are failing too. But wait - put down the Lethabarb. There’s something you need to consider first. This episode is all about cardiorenal disease. Here are some principles we all need to know:
As veterinarians, we see a patient in heart failure with underlying kidney disease, or a kidney patient with a murmur, and the automatic thought is, “You’re between a rock and a hard place - this is a death sentence.” In fact, there’s a lot more to it. We can manage these patients, and they can do quite well, as long as we understand the complex interplay.
When you see azotaemia in a CHF patient, don’t assume pre-existing kidney disease and a dismal prognosis. There are two other explanations:
Forward failure from the heart disease reducing GFR (blood isn’t pumped through the kidneys well enough to be filtered). This is the traditional thinking.
Congestive nephropathy, a concept from human medicine that’s gaining attention, where the kidneys, like the lungs, become a bit “waterlogged”. The patient develops interstitial oedema in the kidneys, and because the renal capsule isn’t stretchy, the extra fluid squashes the nephrons, rendering them non-functional, leading to a reversible form of AKI.
Note: these animals may have some degree of underlying renal disease, but weren’t azotaemic until heart failure and congestion tipped them into acute kidney injury.
So what do we do about it?
First, don’t kill it. Dr Finstad’s main message is that in many of these patients you can carefully walk the process backwards. It isn’t simple, so consider referring to someone with the time and expertise to manage the intricate interplay between heart and kidneys.
If you’re the one managing, you need to treat the heart failure. But in the traditional model of forward failure reducing GFR, we’re face a conundrum: treating the heart with frusemide drops total volume and further reduces GFR, worsening renal function and azotaemia. Rock and a hard place, right? BUT
Human data show worse outcomes from fluid overload and congestive nephropathy than from modest pre-renal azotaemia or mild frusemide-induced hypoperfusion.
The takeaway: treat the heart failure - give the frusemide, reduce the renal congestion, and get them out of hospital.
Big caveat: this is fairly complicated stuff, and a brief newsletter post won’t give you enough to manage these patients. For example, there’s a reversed form of cardiorenal disease where severe kidney disease pushes the patient into heart failure. Like I said, not simple. I’d recommend listening to the full episode and doing some further reading before you take these cases on. But for now, don’t write them off as hopeless just yet.
2 Other Things
Marry
“Children”
“Constant companion, (& friend in old age)”
“Object to be beloved & played with - better than a dog anyhow”
Not Marry
“Loss of time”
“Cannot read in the Evenings”
“Fatness & idleness”
“Not forced to visit relatives, & to bend in every trifle”
-Charles Darwin’s list of reasons for deciding whether he should get married or not. (Charles obviously never met the right dog…)
“The first function of business is to create a demand and the second is to fulfil it. Think of all the things that wouldn't be made at all if people hadn't been told they needed them.”
-John Steinbeck’s tongue-in-cheek assessment of our capitalist society in "The Short Reign of Pippin the Fourth"
We have 3 cottages at our house that we rent out as short accommodation. This is my better half’s job - the cleaning, the laundry, managing bookings - the works. The managing bookings part takes a surprising amount of time. She hosts the cottages on both Airbnb and Stayz, which means cross-checking calendars to avoid double bookings and responding to booking requests and answering endless questions from ‘what’s the WiFi’ to ‘where’s the best cafe to get a good puppicino for our fur babies’? (The right answer to almost all of these questions is ‘read the f*&^ing house guide I sent you when you booked!’, but Ros is way too polite for this.) This means that whenever she sits down or stands still, which is not very often, she’s on her phone sorting out some administrative issue.
Now, my slight obsession with all things AI has cultivated within me a core belief that ‘surely there’s a better way of doing this’. If it’s happening on a screen and it’s something you do more than twice you can almost certainly build a system that does it for you, or at least takes the repetitive parts out of the process. So when I saw Ros once again tip-tapping away at her phone long after what should have been bed time I decided to intervene.
I had a good old chat to Claude about it and found out that there are several automations that can make your life as an Airbnb host easier, like automatic calendar syncing and an AI that drafts replies for you based on all your previous conversations. I commandeered her phone for a few hours and gave Claude access to the booking platforms, and soon we had a pretty slick system set up.
Well pleased with my tech prowess and expecting a long round of applause, possibly delivered as a slow clap, I showed Ros what I’d done and how her life would now be so much easier.
“Oh, thanks.”
You know when your grandma gave you a book for Christmas, when what you really wanted was a Rambo survival knife, or a puppy? That’s how enthusiastic Ros was.
‘Just wait’ I told myself. ‘She’ll see.’
She didn’t. She hasn’t. In fact, the feedback has mostly been ‘why can’t I change this booking… the app isn’t working properly… I’m so confused… these suggested messages aren’t really useful because each question is different….’
I Googled where the term ‘Luddite’ came from, and why we use it to describe someone who is resistant to new technology. Here’s the summary: a group of 19th-century textile workers, under the leadership of one Ned Ludd, started smashing the new looms and other technology that threatened their highly skilled craft.
To call Ros a Luddite isn’t entirely accurate - the original technophobes wilfully destroyed the new technology. She really WANTS it to work, but technology seems to spontaneously destroy itself when she touches it. It’s quite a gift.
But Ros wasn’t the problem this time. Neither was my tech set-up - there are real solutions there. I just messed up the delivery. Which is making me think about the wave of new tech and solutions rushing our way in all aspects of our lives, including in our vet jobs. The solutions are there - the tech is not the problem. How we roll it out is where we’ll come unstuck.
Here are some lessons I learnt from my domestic experiment in AI optimisation:
No input, no buy-in
I brought solutions to what I perceived to be the main problem with only an outsider’s perspective, without asking Ros for her input. (Partially because I’m pretty sure the answer would have been ‘I could use a little help with ironing the sheets’, and I’ve yet to find a good AI for that. There’s a leadership lesson somewhere in there too.)
I had a solution that needed a problem to solve, rather than the other way around.
And yes - what I’d made could genuinely make life easier, but I didn’t get her involved in the problem solving process. My intentions here were good - I wanted to be the hero and not burden her with something else. But because she had no insight into the planning she also now has no context that will help her solve the inevitable problems that pop up, and not much desire to do so. Instead of a solution I gave her new problems to solve.
No proper training
Even if the new workflow was perfect, I didn’t take any real time to teach her how to use it. It was more ‘hey here’s this thing - you just have to click there and do that and the AI will take care of the rest.’ But I spend my days in front of a screen - problem solving stubborn software has become second nature for me, so what seems easy to me is challenging for her. Teaching someone how to do a spay isn’t ‘oh it’s easy - you just cut into the abdomen, take out the uterus - making very sure that nothing bleeds- and then you close it up. There’s nothing to it really.’ True, but incomplete.
No follow up
What I should have done, after thoroughly explaining how to use the new tools, was to check in the next day to see how things were working. And the next. And the next. I should have realised that the calendar syncing function was creating frustrating gremlins and fixed it before it irritated her and made her negative about the entire project. Instead I was annoyed that she couldn’t figure it out, subconsciously blaming her.
High expectations with no plan for early failures
Untested systems break. That doesn’t mean that they’re not valuable, and will become more and more useful the more you polish and reiterate. But promising ‘this will solve all your problems’ without a few caveats about what to expect, what to do and who to contact when things DON’T work sets you up for disappointment. I always finish my consults with ‘and if I’m wrong about my diagnosis then you’ll see x y z, in which case I want you to do a b and c. I’ve booked you a provisional follow-up appointment for 2 days’ time so we can review it.’ I should have done the same with Ros.
These are not new ideas. But the WHY interests me more: why are we humans so resistant to change? The things listed above are the signalment and clinical signs, but what’s the pathogenesis?
Neural pathways
Systems are sticky, and habits are hardwired in our brains. Neurologically speaking, the old way from A to B might be long and circuitous, but the path is clear, and you know the way. The new shortcut is unfamiliar, and the first few times you walk it you might need a machete to clear the path. Most of us would rather spend an hour struggling with the familiar than do 30 mins of uncomfortable work that might save us hours down the line.
Identity
What we do helps to define who we are. Who am I if I’m not doing the things that make me me? Is it any wonder that the Luddites decided to burn the looms?
Uncertainty and fear
The way you do something now might suck, but you know exactly how to do it. You feel a sense of control. Learning a new way introduces uncertainty: what’s the next step, what if it doesn’t work, what if I mess it up? And, if I don’t get it right I’ll look incompetent and feel stupid - one of our worst fears.
We kinda like the busy work
In fact, I think we’re addicted to it. Each successfully completed task feeds the dopamine machine. We complain about being busy, but the many little things we do make us feel useful and competent. What fills the gap when that gets taken away?
Emotional labour
The busy work is time-consuming, but it’s often low friction. The other stuff - the new thing that you never had time to do - that might require thinking, wrestling with ideas, failing, reiterating. That takes hard emotional labour. Busy is an excuse, and a great place to hide.
Understanding these things doesn’t necessarily make implementing change easier - it merely shows us why it’s so hard. But it does give you empathy. People generally aren’t wilfully stubborn, obstinate or obtuse. (Not even Ros.) Often they’re just scared.
Oh, by the way - here’s how the story with the original Luddites played out. The mill owners never read this article and chose the opposite path to empathy: eventually the movement was suppressed by legal and military force, which included executing several of them. Good to know that there’s a plan B for those team members who refuse to use your new AI note taking software.
Much love,
Hugh
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