thevetsaidwhat

[thevetsaidwhat]

hey i was wondering if you could take a look at my recent post. im a veterinarian assistant in texas and i just really need some advice. thanks

I’m sorry you went through that. I can’t give you a great answer for situations like it, just commiseration. I would feel as angry and helpless as you when faced with an oblivious owner. You’re not alone—this is one of the worst causes of compassion fatigue. Education and conversation are sometimes the only way to get through, and only if they’re receptive.

I may have shared this story before, but once had a physical therapist bring in his dog for limping. I did my exam, ultimately determined that it was probably a soft tissue injury, and offered pain medication. The physical therapist looked at me and said the dog didn’t seem in pain. This man, educated in the physical signs of a broken body and how to treat it, didn’t recognize what I saw.

How I got him to take medication home wasn’t the most politic method. But I stared at him and just asked “Do you limp for no reason?” When he said no, I continued. “Then why would you expect your dog to do so?”

I don’t think that would have worked for you, but vet med is a weird balance of gentle education and blunt honesty. It’s also a lot of human interaction, and trying to figure out which path is the best one.

[thevetsaidwhat]

This student probably doesn’t know the cursed Q and S words, either.

Shit you hear in vet med

Vet: Why did you bring me one catheter?

Student: Is it the wrong size?

Vet: No, but why did you only grab one?

Student: ???

Vet: Hasn’t anyone told you that you need at least 3 or you’ll curse the vein?

Student: it’s such a good vein I didn’t think we’d need extra

Vet: *stares*

Vet: *preps other leg while educating about how to not curse a vein*

[thevetsaidwhat]

Prosal is a great thing! I’m glad you made the switch. I wouldn’t go to straight salary.

Now as an aside from my personal experience on prosal…

My previous job (first ever as a vet) was corporate, though I won’t specify which one. We were prosal but the kicker was that if you didn’t meet your production quota, you went into negative accrual.

Need to make the hospital 40k this month, and make 45k? Sweet.

Next month, you only make 38k. You now owe the hospital.

Month after, you make 45k again. But you don’t get that same production bonus. First you have to pay off the negative accrual from that missing 2k from last month. If you didn’t make it, your red ledger only grew.

A coworker that had to go out on medical leave for a year had 12 months of negative accrual. They wouldn’t forgive it.

During my last couple years there they tried to say they got rid of negative accrual due to being overwhelmingly unpopular (no, you don’t say). Really all they did was go from monthly to quarterly production, and average out the ups and downs.

You want to talk about essentially being told to upsell products so you could break even. That’s it.

This is the first month that I’ve been on prosal and today I’m honestly so glad that I chose to do it. I didn’t want to at first because I thought I’d be “tempted” or something and legit that’s so dumb. Most of us are on salary and don’t get any kind of overtime or anything. So on days like today where I had 5 emergencies in 4 hours and ended up staying almost 2 hour after close, I was basically working for free before. Now I at least get something for my time. And you know what? I don’t feel guilty about it. It doesn’t change how I practice medicine. It doesn’t make me offer services that I shouldn’t. It doesn’t stop me from trying to cut a bill down as much as I can. But oh it makes me feel so much better to know I’m at least getting paid for my time. And screw feeling guilty about that. I worked my ass off today and was almost reduced to tears from the emotional and physical stress. So you know what? Fuck the mentality that made me feel like I didn’t deserve to be paid for this.

[thevetsaidwhat]

Oh sweet potatoes, some people…

Me: “Hi, it’s Dr. Blank. What’s going on with Doofers?”

Owner: “He had surgery Wednesday and when we took the bandage off leg, the bone is showing!”

Me: “I see we neutered Doofers on Wednesday. Nothing was done with his leg other than a catheter. How long ago did you notice this?”

Owner: “Wednesday”

Me: “His bone has been exposed since Wednesday?”

Owner: “Yes”

Me: “I’m sorry, this sounds serious. Can you send a photo?”

Owner:

“His skin is gone”

Me: “Ok. So, his fur has been shaved for the IV catheter. But his skin is intact, is there a wound you can see?”

Owner: “You can see the bone right there. It wasn’t like this before the surgery.”

Me: “You can see the shape of his bone, yes, but his skin is still covering it. If you look at your own wrist see how you can see that bony bump? But it’s not exposed bone, it’s covered by skin.”

Owner: “His skin has been shaved off. His arm is skinny.”

Me: “His fur is shaved off. His skin is under the fur. It’s like when you get a hair cut.”

Owner: “But I can see the bone.”

Me: “Ok well let’s get him in for an appointment because that is serious. You can come right now.”

Owner: “I can’t come until Wednesday.”

Me: “We really need to see him, he could be very sick.”

Owner: “We can’t. I’ll call back.”

[thevetsaidwhat]

“The young doctor should look about early for an avocation, a pastime, that will take him/her away from patients, pills, and potions…No one is really happy or safe without one.”

— William Osler M.D., The Medical Library in Post-graduate Work (1909). (via mednerds)

[thevetsaidwhat]

"Why Don't You Call the Cops?"

Lots of people want to know why veterinarians don't call the cops when there is suspected or actual animal abuse.

TL;DR is that the police often don't care or cannot do anything.

The longer version is more complex. First, what constitutes abuse? Unfortunately in many jurisdictions if an animal has food, water, and shelter it doesn't matter what medical condition it is in. I've had some really horrible cases and I have called the police and no charges were brought because the owner brought the animal to the vet which shows good intent. Never mind if they refuse all care, simply bringing the pet to the clinic can be enough.

Another issue is the sheer number of cases that could qualify as abuse. It's sad but I have to be selective about which cases I choose to report because the likelihood of anything being done is less when there are multiple other cases.

A major issue, at least for me, is my personal safety as well as that of the pet and other people in the home. On more than a few occasions the police have given my name or at least my clinic information to the person who I filed a complaint about. Call anonymously right? Often if they don't hear that it is a veterinarian they just don't follow up at all. I once reported someone because their dog was clearly being abused and I suspected the man's wife was as well. The police did a check and found nothing amiss but the next time I saw the woman she had a broken arm. I'll never know if it was related to my report but I worry I will endanger someone's life by reporting abuse of a pet.

[thevetsaidwhat]

Got head-butted by a 120 pound Mastiff, got a concussion.

Backstory — the dog was SWEET AS PIE, first of all. Due to other health conditions he developed glaucoma in both eyes and the owners had already done an enucleation on one side and were having me perform the second. He was completely blind and scared.

He also had skin like an elephant. We were placing an IV catheter but it just wasn’t working because wow could we not find the cephalic vein in all that skin. It was my turn as the Hail Mary pass (aka “when everyone else has tried, get the doctor”) and I’d given it two tries. Two pokes is my max. An RVT who hadn’t been in the room came to try, so I gave up my post and started to move and help hold.

This movement was to rock forward towards the dog, with the intent of shuffling on my knees to help hold his head/hold off his vein. It also happened to occur at the same time that the dog threw his head up because he was getting anxious.

Dog head. Human chin. Collision course that ended in a THUNK loud enough to be heard across the room.

I used him as a pillow while I “helped” restrain him but when I went to stand I nearly fell over again. Suffice to say that surgery didn’t happen that day.

What is the worst/most interesting injury you PERSONALLY have gotten while on the job? My kitten latched his claws to a poor vet tech who didn't even blink about it, I have to figure the average vet sees a lot worse than kitten claws haha

gettingvetted here.

Most of my in-clinic injuries are just the standard scratches with occasional minor bites. I can't say I've been seriously injured by an animal on the job... yet. I’ve had a needle stick that required some antibiotics... also I did an internship on a warmblood breeding farm and one of my jobs was to show the horses in-hand, and one of them spooked and (accidentally) stepped on my foot while we were (purposely) sprinting around the arena. I didn't break anything, but my foot did swell up massively and stayed that way for months, and I still have nerve damage. Got some pretty fun photos of that one if anyone is interested!

Sueanoi here,

Honestly I get hurt by trying to break open an ampule of medication more often than by the patient’s protest.

But for your “interesting” part of the question. I got scratched by a very sick cat during an epidemic of rabies. I looked like I fought the Wolverine from X-men. I got booster vaccinated immediately at an ER. That would be my 8th rabies shot. (I currently have 10 shots already.) 

[thevetsaidwhat]

So I realize I’ve been gone and then just kinda posted some random stuff. As an update that’s going to become a ramble:

To be honest there were some personal life issues that came to the forefront. But also… my job did a legitimate job of trying to kill me.

I went from a four doctor practice to a one doctor practice with a heavy case load. I went from being an associate to a figurehead medical director who wasn’t respected. I no longer did surgeries unless they were emergencies. I was at work for 12+ hour shifts by myself (as the doctor) for four days a week, checking on patients twice daily on the fifth, and still making callbacks from home. 25-30 cases a day, sometimes quadruple booked. Half the reason I was home so late every night was having to write all of my charts at night after the day was done, or even later after surgeries that had to happen.

I had a genuine moment where I told my former coworker that if it weren’t for my dogs in my car, who are my children, I would have driven off an overpass. I had visions of “what would happen if” that involved accidents I didn’t actually fear. I acknowledged this was bad and I told my superiors I didn’t want to be a veterinarian anymore, that something needed to change. They did nothing.

Surgery for a work related shoulder injury probably saved me. I had time off to consider my life and what was happening, and I gave my notice on my return. This is a major gloss over severe anxiety about that but it’s not something I need to get into here.

When I say that I was overworked, I don’t just mean that I was running around so much I couldn’t function. I was exhausted yes, but it was an emotional soul suck to be the only person a practice depended on, to not have breaks or lunches or reliable time off in the evenings. To not be heard. It was something ingrained in me from my first day at the practice (and to be honest, my early years). This is the way it is. If you can’t function like this, YOU need to change, not us. Old school “grin and bear it” mentality, which I can get behind to some extent, but not to the point that I had the ideation of not existing in the back of my head.

So. Where does that leave me now? I’m in a different city/different practice. I’m better. I want to do more. I know more! I started this blog when I started as a doctor in 2013, and there’s so much for the future. We’ll see what I end up posting but for now I wanted to highlight why I was gone.

[thevetsaidwhat]

Damn right I’m more intimidating…

so hard to find a decent exorcist these days :/

[thevetsaidwhat]

[thevetsaidwhat]

This is a reminder that we need a current physical on your animals to be able to prescribe meds for fireworks. So please don’t wait until July 3rd to call us and then get mad when we have no appointments available. We legally cannot prescribe medications for an animal without an up to date physical exam. No, we cannot make exceptions. So if you have an animal that needs meds for fireworks, call your vet first thing Monday morning and get on the schedule. If you’re lucky you can still get in on time.

[thevetsaidwhat]

Dogs and cats = smaller, a little less prone to eeling their way onto the floor. Not big enough for one thing. Horses are another matter entirely.

Cool to watch them, though!

Everyone agrees! Your intestines squirming around like eels in your belly is horrifying!

[thevetsaidwhat]

Check out the tumblr @theexoticvet for your reptile needs. I know he’s a good one!

Hi Dr. Ferox! Can you recommend any good snake/reptile blogs out there. I just recently got a fresh danger noodle, trying to find a good community for when questions come up. Do you have a favorite type of reptile by chance? also hows your day?

I’m really not in the reptile scene at all, so the only one I can think of off the top of my head is @wheremyscalesslither but they might be able to point you in the right direction.

I’m quite fond of our frill necks, because I love their attitude.

Though I kind of like the monitors too.

My day has only just begun, but I let the asks on this blog get up over 120 and so some of them have started disappearing, so I’m trying to work through that a bit at the moment.

[thevetsaidwhat]

Every radiology professor ever:

“DO NO. EXPOSE. YOUR EXTREMITIES. IN THE BEAM.”

When radiologists take a selfie

[thevetsaidwhat]

Invasive species in the US. Be aware, east coasters.

[thevetsaidwhat]

Good lord, the mobile app sucks at telling you if you have messages.

Sorry if I ignored any of you when you asked me something. I had no idea it was there.

[thevetsaidwhat]

I have a fat cat. My vet says he's fine, but he can't reach his own rear to groom himself (I literally wash his ass for him about once a week just to help him a little) are there any warning signs for any of the other health problems he could experience? Like diabetes or arthritis? I've been supplimenting his diet (im gonna be honest. Its mostly meow mix, which is bad) with more meat (plain, unseasoned chicken, pork, and beef) and wet food and trying to get him to play and move around more.

Obesity in cats can make them more prone to diabetes (contrary to belief, GAINING weight does not make us think diabetes but instead the rapid loss of it). It is also very hard on their joints (triggering arthritis issues, yes) and if at any point they stop eating for a great length of time (generally greater than 24 hours but sometimes less than that depending on severity of issues) they can develop hepatic lipidosis, AKA fatty liver syndrome.Basically a cat’s body responds SUPER WELL to not eating by metabolizing fats. Too fast, even. The liver can’t keep up with the amount of fat that gets broken down, and that fat builds up in the liver tissue—essentially clogging the organ and preventing it from performing vital functions. An already sick cat will get much worse.Your vet will want to run blood work, including an in-house snap test for pancreatitis (not always as diagnostic for cats, it’s newer, but helpful). Alkaline phosphatase (ALP), alanine transferase (ALT), bilirubin, and other liver values may be elevated since the liver is so stuffed with fat it can’t do it’s main job. If the bilirubin level is high enough YOU will notice that the whites of your cats eyes (and more) are yellow. At this point they NEED hospitalization.(That was a schpiel, wasn’t it? Back to you.)Your chubby kitty might never get so sick it stops eating, but I always warn folks. As for your feeding regimen, what I would do is talk with your vet about your kitty’s current weight, their IDEAL weight, and the amount of calories their ideal weight should be fed. There’s nothing wrong with being fed supplements or even Meow Mix at this point—what I worry about is too many calories. And keep up the activity! Feed in a treat ball, or at the top of a cat tree. Make them work for it!