The High Cost Of Becoming A Vet
9 years ago
Saturday, July 31, 2010
AVMA Atlanta
I'm heading to Atlanta Sunday night for the Monday and Tuesday ER lectures at AVMA. See you Wednesday...
Friday, July 30, 2010
Thursday, July 29, 2010
Tuesday, July 27, 2010
The Southern heat
The dog before me looked bad. He was laterally recumbent and poorly responsive. He would respond to his name by opening his eyes, but otherwise, he didn't move. Light brown diarrhea oozed from his rectum as a result of injury to his GI tract (mucosal sloughing). Bright red blooms of blood (petechia) were present all over his abdomen and gums. He was suffering a heat stroke.
His owners had recently moved here from cooler climes and had left him outside today. They found him, collapsed and barely responsive. They immediately began cooling him off with a hose, as well as trying to get him to drink water. By the time he got to us, his temperature was only 102 degrees.
My techs leapt into action. IV catheter, fluids (Normosol-R and Hetastarch), mannitol for suspected heat injury to the brain, fresh frozen plasma to stop the inevitable DIC, heparin to help ward it off, and antibiotics to combat bacterial translocation from his intestines. We placed nasal oxygen, as well as a urinary catheter. Often, dogs that suffer heat injury will develop renal failure as a result. Monitoring urine output is an important part of therapy.
For the first 2 hours, he looked like death on wheat toast. Then, he started to lift his head. It progressed to sitting sternal, then sitting up on his front legs. By 4 am, he was wagging his tail, giving kisses, and wiggling irrepressibly in his cage.
He's not out of the woods yet. His platelet count dropped this morning a bit, and he has extremely bloody urine, but he looks far better than any other heat stroke I've ever treated at this stage.
Keep your fingers crossed for him. So far, he's made a miraculous recovery.
His owners had recently moved here from cooler climes and had left him outside today. They found him, collapsed and barely responsive. They immediately began cooling him off with a hose, as well as trying to get him to drink water. By the time he got to us, his temperature was only 102 degrees.
My techs leapt into action. IV catheter, fluids (Normosol-R and Hetastarch), mannitol for suspected heat injury to the brain, fresh frozen plasma to stop the inevitable DIC, heparin to help ward it off, and antibiotics to combat bacterial translocation from his intestines. We placed nasal oxygen, as well as a urinary catheter. Often, dogs that suffer heat injury will develop renal failure as a result. Monitoring urine output is an important part of therapy.
For the first 2 hours, he looked like death on wheat toast. Then, he started to lift his head. It progressed to sitting sternal, then sitting up on his front legs. By 4 am, he was wagging his tail, giving kisses, and wiggling irrepressibly in his cage.
He's not out of the woods yet. His platelet count dropped this morning a bit, and he has extremely bloody urine, but he looks far better than any other heat stroke I've ever treated at this stage.
Keep your fingers crossed for him. So far, he's made a miraculous recovery.
Monday, July 26, 2010
Wednesday, July 21, 2010
Aloha...
I finally did it. After untold years of school, work, and no real vacation...I booked tickets to Hawaii for 6 days in October! My intern-mate and good friend lives on Oahu, and she has graciously offered (begged) me to come visit. So, we'll be heading down there in October. I'm so excited!
Tuesday, July 20, 2010
Boiling point
Sorry I've been such a slacker about posting lately. Work has gotten on my nerves to the point that when I'm off (as I have been for the past 8 days), I don't really want to talk about it. This anecdote, however, is too good to not tell. I found my boiling point...
A couple of Saturdays ago, I was presented with a 13 year old German shepherd. She had suddenly begun urinating blood. Not just blood but blood clots. That's usually not good. My top differentials would be urinary tract infection, bladder stones, bladder cancer (usually transitional cell carcinoma), maybe renal failure, or less likely, a clotting problem or heartworm disease (caval syndrome). I went over these with the elderly, male owner and recommended diagnostics. He couldn't answer my questions well, and he kept stammering over things - such as - "is Fluffy on monthly heartworm prevention?" Finally, tired of my questions, he summoned his wife - who, as it turns out - was sitting in the car.
She comes in, sits down. I start with my spiel again - differentials, recommended diagnostics, treatment options (hospitalization versus outpatient and follow-up with regular veterinarian). When I say "regular veterinarian" she pins me with a steely gaze.
"I don't speak to my vet anymore." She said.
Uh-oh, I thought. I deliberately DID NOT ask what her beef was and continued. She interrupted me and said, "They did not acknowledge that I administered my own vaccines. I am a NURSE. I KNOW how to give a subcutaneous injection."
I shrugged and said, "I'm sorry, ma'am, but I cannot help you with that. So back to Fluffy's bloody uri--", and here, she interrupted me.
"They wanted to charge me $200 for vaccines. That's rape. She was RAPING me. YOU ALL-" and here, I got a pointed, nasty look, "are raping us."
My temperature started to elevate. I could feel my face growing hot and flushed.
"Ma'am, I am not here to discuss your previous veterinarian and your complaints. I am concerned about Fluffy's bloody urine."
She glares at me. "I am a NURSE. What you said about kidney failure was contradictory."
I am speechless momentarily. Finally, I say, "what exactly was contradictory??"
She says, "She just started having bloody urine, how could she be in renal failure already? That's contradictory."
So then, I explain my concerns again and tell her that renal failure is LOW on my list, but that it needs to be ruled out. I explain that we will check her kidney enzymes on bloodwork and this, combined with her urine specific gravity, will give us an idea of the status of her kidneys. She interrupts and says, "Do the renal failure test. If it's positive, what then?" I then have to explain that it's not positive/negative test - it's measuring enzymes and comparing them to her urinalysis. This goes in one ear and out the other.
Then she REALLY throws me for a loop.
"Why are you recommending treatment for a terminal condition?"
I am speechless AGAIN.
"Ma'am, I do not know WHAT is wrong with your dog yet. I have given you a list of POSSIBLE causes, but I cannot rule them in or out without TESTING."
She continues to glare at me.
"I want her placed on APPROPRIATEpain medication, do you understand?"
At this point, I can barely control my rage. I take the file, the dog's leash, and leave the room before my head explodes, thus spraying her with gore.
Diagnostics found no bladder stone, no urinary tract infection, no giant tumor. Something was amiss here.
The owner, of course declined hospitalization, taking the dog home on cephalexin and tramadol. I managed to mostly hold my tongue, although I found myself explaining to her, in no uncertain terms, how very many pets we see in our ER that have been vaccinated by their owners and now have the disease which they were supposedly vaccinated against. She didn't care.
The absolute ICING ON THE CAKE?? Today, I spoke with our office manager, who did a callback to check on the dog. Three days after I saw it, the dog started dragging both its rear legs. The owner called because she thought it was the CEPHALEXIN that caused it. Our OM carefully explained that it was not the antibiotic and that a dog dragging both rear legs should be seen for emergency care immediately.
The dog did not show up at work. The owner called 2 days later, saying that the dog was now completely paralyzed in the rear limbs. She refused to bring it back in because she did not want it "poked and prodded" and "stressed by the car ride." She would let her die PEACEFULLYat home. I wasn't there for this, or there would have been words. The woman was a grade A bitch. Sorry, no other way to say it.
I'm working on getting Animal Control involved, because at this point, I have no idea if the dog is alive, dead, or lying in its own feces somewhere, dying a slow death.
Look, I understand if you don't want to subject your 13 year old, large breed dog to a bunch of diagnostics tests only to euthanize it. I don't have a problem with that. If you're ready, and you think your pet is ready, then I'm ready, too. Bring them to me, and together, we will ease their suffering. BUT AT LEAST GIVE ME THE CHANCE TO DO THAT INSTEAD OF LETTING YOUR DOG DIE A LINGERING DEATH.
Sometimes, I really hate people.
A couple of Saturdays ago, I was presented with a 13 year old German shepherd. She had suddenly begun urinating blood. Not just blood but blood clots. That's usually not good. My top differentials would be urinary tract infection, bladder stones, bladder cancer (usually transitional cell carcinoma), maybe renal failure, or less likely, a clotting problem or heartworm disease (caval syndrome). I went over these with the elderly, male owner and recommended diagnostics. He couldn't answer my questions well, and he kept stammering over things - such as - "is Fluffy on monthly heartworm prevention?" Finally, tired of my questions, he summoned his wife - who, as it turns out - was sitting in the car.
She comes in, sits down. I start with my spiel again - differentials, recommended diagnostics, treatment options (hospitalization versus outpatient and follow-up with regular veterinarian). When I say "regular veterinarian" she pins me with a steely gaze.
"I don't speak to my vet anymore." She said.
Uh-oh, I thought. I deliberately DID NOT ask what her beef was and continued. She interrupted me and said, "They did not acknowledge that I administered my own vaccines. I am a NURSE. I KNOW how to give a subcutaneous injection."
I shrugged and said, "I'm sorry, ma'am, but I cannot help you with that. So back to Fluffy's bloody uri--", and here, she interrupted me.
"They wanted to charge me $200 for vaccines. That's rape. She was RAPING me. YOU ALL-" and here, I got a pointed, nasty look, "are raping us."
My temperature started to elevate. I could feel my face growing hot and flushed.
"Ma'am, I am not here to discuss your previous veterinarian and your complaints. I am concerned about Fluffy's bloody urine."
She glares at me. "I am a NURSE. What you said about kidney failure was contradictory."
I am speechless momentarily. Finally, I say, "what exactly was contradictory??"
She says, "She just started having bloody urine, how could she be in renal failure already? That's contradictory."
So then, I explain my concerns again and tell her that renal failure is LOW on my list, but that it needs to be ruled out. I explain that we will check her kidney enzymes on bloodwork and this, combined with her urine specific gravity, will give us an idea of the status of her kidneys. She interrupts and says, "Do the renal failure test. If it's positive, what then?" I then have to explain that it's not positive/negative test - it's measuring enzymes and comparing them to her urinalysis. This goes in one ear and out the other.
Then she REALLY throws me for a loop.
"Why are you recommending treatment for a terminal condition?"
I am speechless AGAIN.
"Ma'am, I do not know WHAT is wrong with your dog yet. I have given you a list of POSSIBLE causes, but I cannot rule them in or out without TESTING."
She continues to glare at me.
"I want her placed on APPROPRIATEpain medication, do you understand?"
At this point, I can barely control my rage. I take the file, the dog's leash, and leave the room before my head explodes, thus spraying her with gore.
Diagnostics found no bladder stone, no urinary tract infection, no giant tumor. Something was amiss here.
The owner, of course declined hospitalization, taking the dog home on cephalexin and tramadol. I managed to mostly hold my tongue, although I found myself explaining to her, in no uncertain terms, how very many pets we see in our ER that have been vaccinated by their owners and now have the disease which they were supposedly vaccinated against. She didn't care.
The absolute ICING ON THE CAKE?? Today, I spoke with our office manager, who did a callback to check on the dog. Three days after I saw it, the dog started dragging both its rear legs. The owner called because she thought it was the CEPHALEXIN that caused it. Our OM carefully explained that it was not the antibiotic and that a dog dragging both rear legs should be seen for emergency care immediately.
The dog did not show up at work. The owner called 2 days later, saying that the dog was now completely paralyzed in the rear limbs. She refused to bring it back in because she did not want it "poked and prodded" and "stressed by the car ride." She would let her die PEACEFULLYat home. I wasn't there for this, or there would have been words. The woman was a grade A bitch. Sorry, no other way to say it.
I'm working on getting Animal Control involved, because at this point, I have no idea if the dog is alive, dead, or lying in its own feces somewhere, dying a slow death.
Look, I understand if you don't want to subject your 13 year old, large breed dog to a bunch of diagnostics tests only to euthanize it. I don't have a problem with that. If you're ready, and you think your pet is ready, then I'm ready, too. Bring them to me, and together, we will ease their suffering. BUT AT LEAST GIVE ME THE CHANCE TO DO THAT INSTEAD OF LETTING YOUR DOG DIE A LINGERING DEATH.
Sometimes, I really hate people.
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