Did you know that a brachycephalic dog with BOAS has a 433% higher anaesthetic risk than a dog with a normal nose?

Let me rephrase that: that Frenchie you’re spaying later this week is more than four times more likely to die on her surgery day than any of your other patients. 😳

Do we have your attention?!

Thanks mainly to the rising popularity of the French Bulldog, you’re probably anaesthetising these kinds of patients all the time.

So how do we reduce that risk? How do improve patient safety while decreeing your stress levels?!

At the Brachycephalic Care Unit, surgeon Dr Abbie Tipler and her team have polished brachycephalic anaesthesia down to a fine art, and in this episode, she shares all the gold.

From the days leading up to anaesthesia to selecting the safest mix of premed and anaesthesia agents, all the way to a calm, well-oxygenated recovery, this episode is the ultimate masterclass in brachycephalic anaesthesia.

Hit us up for the full show notes for this episode, as well as Dr Abbie’s brachycephalic pre-surgery history template, here. 

This episode is one of more than 600 from our subscriber-only clinical podcasts. If you like this style of learning, where I dig for all the pro tips and updates from some of the best specialists in the world, then you’ll love our clinical feed. Go check it out at thevetvault.com

Oh, and if you’d like to join me in Japan in February or the Maldives in April for the most fun you’ll ever have at a vet conference  - have a browse at vetsontour.com

Topics Covered:

Before the big day

• Structured history taking: airway, gastrointestinal, sleep, and anxiety indicators
• Understanding the link between upper airway obstruction and GI dysfunction
• Assessing regurgitation, silent reflux, and aspiration risk
• Pre-treatment protocols: omeprazole, metoclopramide, and diet adjustments
• Identifying when to delay elective procedures for optimisation
• Using C-reactive protein and radiographs to assess for aspiration pneumonia
• Managing anxiety pre-hospitalisation with trazodone

Plan for the day of surgery

• Fasting times and timing surgeries for optimal recovery monitoring
• Strategies for minimising stress in brachycephalic patients pre-op
• The role of early premedication and pain relief
• Drug choices: the “Goldilocks” approach to sedation
• Reducing regurgitation risk
• Your pre-op pro tips
• Extubation and recovery: positioning, monitoring, and oxygen weaning
• The impact of cage-side nursing and owner-assisted recovery

 “If you can’t afford a pet, you shouldn’t own one.” 

Ever said this line?

Once you’ve  been on the receiving of someone’s anger about the cost of their vet bill, it’s an easy thought to have. 

But it’s not the whole story, is it?

In this episode, I sit down with Dr. Paul Manktelow - a veterinary surgeon with 20+ years in UK animal charities and current Director of Veterinary Services at Blue Cross. Dr Paul shares lessons learned in not-for-profit vet care to help us untangle that tension between care, compassion, and commercial reality.

We cover:

• Trends from the front lines in the charity sector
• How “affordability” is shifting under rising cost of living
• Decision-making tools that balance optimal vs achievable care
• Business models that either enable or block access to care

• How vets can approach financial conversations with clarity, dignity, and trust

You’ll learn about:

💡 “Pragmatic care” as the antidote to chasing the mythical ‘gold standard’

💡 Cost-based vs value-based pricing models 

💡How to think in tiers of care—and where the limits lie

Because behind every clinical decision is a human one.

Find out how we can help you build you in your vet career at thevetvault.com.

Check out our Advanced Surgery Podcast at ⁠⁠⁠⁠⁠⁠cutabove.supercast.com⁠⁠⁠⁠⁠⁠. 

Get case support from our team of specialists in our ⁠⁠⁠⁠⁠⁠Specialist Support Space⁠⁠⁠⁠⁠⁠.

⁠Subscribe to our weekly newsletter⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠here⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠for Hubert's favourite clinical and non-clinical learnings from the week.

Join us in person for our epic adventure CE events at ⁠⁠⁠⁠Vets On Tour⁠⁠⁠⁠. (Next up: Japan snow conference!) 

Topics and Time Stamps

03:11 Balancing Costs and Care in Veterinary Practice

06:45 Challenges and Changes in the Veterinary Profession

11:41 Client Expectations vs Financial Realities

16:32 The Impact of Economic Hardships on Pet Care

32:16 Blue Cross's Model

39:10 Individual Responsibility in Veterinary Practice

42:54 Getting Clear on Quality of Life and Prognosis

47:23 Cost-Based vs Value-Based Pricing Models

01:10:05 Pragmatic Care and Clinical Guidelines

01:16:54 The One Question

In episode 141, I shared my take on where AI fits into veterinary medicine - and where it might take us next. 

But I’m no expert.

So I brought one in.

In this episode, I sit down with Rohan Relan , Silicon Valley software engineer and founder of ScribbleVet ,an AI tool built for vets. We unpack the promise and pitfalls of AI in clinical practice and try to figure out how you can use it without losing sleep (or your license).

What we cover:

• Why AI is not just a "smarter Google”- and why that matters
• The risky shortcuts vets are already taking (and how to avoid them)
• How to increase trust and accuracy when using AI
• Where innovation collides with privacy, data, and consent
• DIY AI vs purpose-built tools 

If you're curious about AI but not sure what’s hype and what’s helpful, this one’s for you.

Come find out what W(asabi)TF Wednesday is all about at our Japan Snow Conference

Check out our podcast for business owners, and Dr Sam’s ‘How To Make A Hell Of a Profit And Still Go To Heaven’ workshop.

Join our community of Vet Vault Nerds to lift your clinical game and get your groove back with our up-to-date, easy-to-consume clinical episodes at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠vvn.supercast.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠.

Get help with your tricky cases in our ⁠⁠⁠⁠⁠⁠⁠⁠Specialist Support Space.⁠⁠⁠⁠⁠⁠⁠⁠

V⁠⁠isit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠thevetvault.com⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠for show notes and resources related to this episode.

⁠Subscribe to our weekly newsletter⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠here⁠⁠⁠⁠⁠⁠ ⁠for Hubert's favourite clinical and non-clinical learnings from the week.

Topics and Timestamps

04:39 What I got wrong about AI

08:19 How models “know” things — next‐word prediction & reasoning

15:00 Grounding AI responses using external tools / search

19:19 Scribble Vet features

38:12 Privacy, ownership, and AI liability

51:00 Rohan’s podcast and AI tool recommendations

54:00 Key misconceptions & Caveats

Today’s bonus IVECCS live session wasn’t your average ‘clinical 101’. I had the absolute privilege of getting two brilliant minds on the yellow couch, and … wow. 

Apparently 1 + 1 = 🤯 !!

Clinical pathogist Dr Cynthia Lucidi joined me to unpack her talk on Diagnosing Ineffective Hematopoiesis.  If you’re a bit lost with that title - don’t worry, so was I!  So I brought backup: ECC legend Dr Claire Sharp joined me to ask the smart questions, and together, they cracked open a topic every GP and ECC vet needs to understand: PIMA – Precursor-Targeted Immune-Mediated Anaemia. (If you’ve ever managed an anaemia case that almost looked like IMHA but just didn’t quite fit, or just an anaemia that didn’t want to fit into ANY of the boxes, it was probably this!) 

This one started out GP-friendly, but with two minds like these-it escalated fast. Expect specialist-level gold. You’ll want to give this one your full attention. But I promise - it’s worth it!

What we cover:

• Defining ineffective haematopoiesis and how it differs from hypoplasia
• Diagnostic criteria and differentials for PIMA vs. IMHA
• Importance of timing and interpretation in persistent non-regenerative anaemia
• Why bone marrow aspiration is underused and how to perform it effectively
• Pathologist tips on identifying spherocytes and phagocytosis artefacts
• Challenges of diagnosing IMHA and PIMA in cats
• Role of transfusions and crossmatching in long-term PIMA management
• Timeframes for response and remission in PIMA treatment
• When to consider splenectomy for refractory cases
• Clinical significance of myelofibrosis in dogs with PIMA
• Educating clients and general practitioners on prognosis and referral timing

Click here⁠⁠ to access all of our clinical content at IVECCS special rates.

If you caught my conversation with Prof. Steve Epstein from IVECCS 2024, you already know this:

When it comes to septic patients, timing of antibiotics is everything. Ok, maybe not EVERYTHING, because in our follow-up discussion 1 year later at IVECCS 25, Prof Steve explored an idea that might just shift your ICU protocols: duration of administration matters. 

That’s the idea behind the concept is prolonged infusion - giving time-dependent antibiotics over extended periods for more sustained bacterial kill time. (Spoiler alert: it works. BUT...with a few caveats.)

Jump in to this one for a straight-forward data backed action you can take with your critical patients that will save more lives.

Topics We Unpacked:

• Time-dependent vs. concentration-dependent antibiotics
• Prolonged infusion vs. continuous rate infusion (CRI)
• Human evidence: findings from the BLING III trial
• Applicability of human data to veterinary patients
• Dosing challenges and pharmacokinetics in septic animals
• Practical recommendations for veterinary ICU settings
  

⁠Click here⁠⁠⁠ to access all of our clinical content at IVECCS special rates.

We’re live at IVECCS! For the next few days we’ll be sharing some highlights from our favourite recordings with the fabulous speakers, where we get to the best bits from their talks at IVECCS, the premier conference for emergency and critical care veterinarians, technicians, practice managers, and students. 

If you’ve worked in vet practice for more than a minute, you’ve seen it:A cat comes in, blocked and in pain.You know the treatment.The owner hears the estimate.And just like that — a treatable case turns into a heartbreaking goodbye.

But what if there’s a better way?

In this eye-opening talk, Dr. Corey Fisher breaks down practical, evidence-based protocols for managing feline urethral obstruction (iUO) without breaking the bank.
He draws on peer-reviewed research and ongoing clinical trials to bust some myths about fluids, catheters, and cost.

Most importantly?
He’ll show you how to tailor treatment to the client’s budget while still delivering acceptable clinical outcomes.

What You'll Learn:

• Recurrence rates and euthanasia risk in feline urethral obstruction
• The surprising data behind 8-hour catheter protocols
• To flush or not to flush
• Hyperkalemia management: hold the insulin!
• Should you perform decompressive cystocentesis? The evidence says...
• The most cost-effective pain relief 
• Fluid therapy without the fluff: shorter stays
• The meds we use that we shouldn’t
• The truth about urinalysis and prescription diets: essential or optional?

This isn’t just theory — it’s a mindset shift.Whether you're in a high-end clinic or resource-limited practice, you’ll walk away with real tools you can use today to improve care and protect your patients from unnecessary euthanasia.

Click here⁠ to access all of our clinical content  at IVECCS special rates.

We’re live at IVECCS! For the next few days we’ll be sharing some highlights from our favourite recordings with the fabulous IVECCS speakers, where we get to the best bits from their talks at IVECCS, the premier conference for emergency and critical care veterinarians, technicians, practice managers, and students. 

How much do you love intubating dogs with upper airway issues? You know that Frenchie or Pug needs an open airway - NOW - but you also know that intubating it is going to be hard. (And you REALLY would prefer not to do a tracheostomy!) We have good news…

In today’s highlight we hear from Dr Cassie Lux, Associate Professor of Surgery at University of Tennessee, to dig into her talk on upper airway emergencies. The conversation covers how to identify the likely location of airway obstructions, prepare for safe intubation, and apply temporary surgical techniques that stabilise patients without committing to high-risk interventions. From temporary palatopexies to laryngeal stents and novel uses for human piercing gear, Dr. Lux outlines tools and procedures that general practitioners and ECC clinicians can implement right away.

Topics Covered:

• Why definitive airway surgery during crisis leads to poorer outcomes
• Sound-based and visual cues to localise airway obstruction
• Equipment essentials for challenging intubations 
• Palatopexy as a temporary airway intervention
• Use of laryngeal stents in laryngeal paralysis and collapse
• Alternative temporary tracheostomy sites and techniques 
• Novel use of silicone “flesh tunnels” for airway access
• Managing airway swelling 
• When to delay tracheostomy and opt for prolonged intubation
• Tips for extubation and airway support during recovery

Click here⁠ to access all of our clinical content  at IVECCS special rates.

Ever had a case where you just knew what was wrong before you even touched the patient - but if someone asked you HOW you know, you couldn’t explain it? 

That almost mystical “sixth sense” we develop in practice - that’s exactly what this episode is about.

Our guest is Dr Annie Wayne - a criticalist, educator, and learning strategist—who’s been exploring naturalistic decision making: the cognitive model that explains how experts think in real-time, and how to pass that intuition on.

We talk about what separates expert intuition from novice reasoning, how to break down unconscious diagnostic processes, and how the right kind of mentorship can accelerate the path to expertise. Annie also shares her research on parenting and vet careers, challenging the stigma around pregnancy and parenthood during training.

Here’s what you’ll learn:

• What “naturalistic decision making” really means (and why it feels like a sixth sense)
• How experienced vets spot subtle signs that others miss
• How to externalise your gut feeling so younger vets can learn from it
• Real-world strategies for mentorship and better clinical teaching
• How to avoid the traps of lazy “shortcut” thinking
• How this framework builds confidence and reduces stress in new grads
• Annie’s personal take on parenting through training—and how to smash the stigma around pregnancy in vet careers

This isn’t just about clinical decision-making - it’s about how we teach, how we lead, and how we support each other in a demanding profession.

Lift your clinical game with our RACE approved clinical podcasts at ⁠⁠⁠⁠⁠⁠vvn.supercast.com⁠⁠⁠⁠⁠⁠  for more clinical confidence and better patient outcomes, or check out our Advanced Surgery Podcast at ⁠⁠⁠⁠⁠cutabove.supercast.com⁠⁠⁠⁠⁠. 

Get case support from our team of specialists in our ⁠⁠⁠⁠⁠Specialist Support Space⁠⁠⁠⁠⁠.

⁠Subscribe to our weekly newsletter⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠here⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠for Hubert's favourite clinical and non-clinical learnings from the week.

Join us in person for our epic adventure CE events at ⁠⁠⁠Vets On Tour⁠⁠⁠. (Next up: Japan snow conference!) 

Topics and Time Stamps

04:53 What is Naturalistic Decision-Making?

08:36 Expert vs Novice Thinking: Why Mentorship Matters

15:55 Risks of Shortcut Thinking and Balancing with Algorithms

19:11 Speeding Up Expertise: Can We Teach "Sixth Sense" Thinking?

22:47 Mentorship Models: Building Skills and Confidence

34:45 Can AI Help Naturalistic Thinking?

37:20 Parenthood and Veterinary Careers: Breaking Stigma and Building Support

Thinking of trading grey skies for the Australian sun – stethoscope in hand?
Moving to Australia as a vet can change your life, but here’s the truth: it’s not a straight road. Between visa hurdles, the dreaded AVE exams, and adjusting to a new culture (gotta love the Aussie slang!), the journey demands grit, strategy, and support.

In this episode, we talk to Dr. Natalia Gomez , Colombian-born vet and co-founder of Brainy Bilby, a platform dedicated to helping foreign-trained vets prepare for the AVE, about the tips, pitfalls, and success stories learnt from her own her journey, and from the other overseas-trained vets she’s coached through the AVE.

Here’s what you’ll learn:

• Why Australia is one of the most in-demand vet destinations – and how to make it work for you
• The step-by-step roadmap to your veterinary licence (no fluff, just facts)
• AVE decoded: costs, structure, study tips & mistakes to avoid
• What it’s really like working under supervision (and finding supportive employers)
• The practical exam explained: sheep tipping, cow pregnancy tests, and more
• Surviving the financial and emotional rollercoaster – without burning out
• How to adapt to Aussie culture, slang, and workplace quirks
• Life on the other side: what makes it all worth it

🎧 Listen now and start mapping your own Aussie vet journey.

Lift your clinical game with our RACE approved clinical podcasts at ⁠⁠⁠⁠⁠vvn.supercast.com⁠⁠⁠⁠⁠  for more clinical confidence and better patient outcomes, or check out our Advanced Surgery Podcast at ⁠⁠⁠⁠cutabove.supercast.com⁠⁠⁠⁠. 

Get case support from our team of specialists in our ⁠⁠⁠⁠Specialist Support Space⁠⁠⁠⁠.

⁠Subscribe to our weekly newsletter⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠here⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠for Hubert's favourite clinical and non-clinical learnings from the week.

Join us in person for our epic adventure CE events at ⁠⁠Vets On Tour⁠⁠. (Next up: Japan snow conference!) 

Episode timestamps:

04:32 Why Australia? The Allure for Vets

10:04 The Australian Veterinary Examination (AVE)

16:31 Navigating the English Test and Paperwork

26:35 The Cost and Commitment of the AVE

29:05 Working Under Supervision

36:58 Preparing for the Practical Exam

44:43 Cultural and Language Barriers

You can think of a bunch of things that make your working day (and career!) as a veterinarian more frustrating than you’d like it to be, right? But have you ever considered the role of the software that you use in how frazzled you feel at the end of the day?

And beyond the pure frustration of ‘too many clicks’ and that spinning wheel of doom when you have ten other things to do - have you considered how the very software that feels like it's holding you back could actually help solve some of the systemic challenges that feel like they’re just baked into the vet profession, like low clinical confidence, medical errors, and even burnout?

In this conversation, we speak to emergency vet and tech entrepreneur ⁠Dr Caleb Frankel⁠ , founder of ⁠Instinct Science⁠, about what’s broken in vet tech, what good software should actually do, and why the future of practice might depend on getting this right.

In this episode:

• Why building good vet software is so damn hard (and how to spot the tools worth your trust)
• What to look for (and avoid!) when choosing new software for your clinic
• Reducing the trauma of introducing a new tech tool to the team (yes, even the dreaded PIMS change!)
• How software design impacts clinical confidence, patient safety, and mental health  
• AI in clinical decision-making - why it’s more than just a productivity tool 
• Must-have tech tools for 2025 (that aren’t just another app) 

If you’ve ever felt like your tools are working against you, this is the conversation that might just change the way you practice—for good.

Lift your clinical game with our RACE approved clinical podcasts at ⁠⁠⁠⁠vvn.supercast.com⁠⁠⁠⁠  for more clinical confidence and better patient outcomes, or check out our Advanced Surgery Podcast at ⁠⁠⁠cutabove.supercast.com⁠⁠⁠. 

Get case support from our team of specialists in our ⁠⁠⁠Specialist Support Space⁠⁠⁠.

⁠Subscribe to our weekly newsletter⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠here⁠⁠⁠⁠⁠⁠ ⁠⁠⁠for Hubert's favourite clinical and non-clinical learnings from the week.

Join us in person for our epic adventure CE events at ⁠Vets On Tour⁠. (Next up: Japan snow conference!) 

Episode topics and timestamps: 05:55 Why veterinary software is so challenging

11:15 What to look for (and avoid!) in veterinary software

14:26 Cloud vs server-based software?

34:08 Unexpected ways where tech can help with the main challenges in veterinary medicine

37:07 AI in veterinary medicine

48:09 Must-have tech tools for 2025

55:14 Advice for new graduates

We love to hear from you. If you have a question for us or you’d like to give us some feedback please get in touch via our contact form at ⁠⁠thevetvault.com⁠⁠, or catch up with us on ⁠⁠Instagram⁠⁠.

And if you like what you hear, please share the love by clicking on the share button wherever you’re listening and sending a link to someone who you think should hear this.