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Maybe that friend of a friend forgot to mention the respiratory distress, hemothorax, bladder rupture, and pelvic fracture repair that happened?
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Apr 25, 2016 21:39
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Amzingly NOTHING major. No broken bones, no internal bleeding besides some fluid buildup, nothing that would be longterm I'll see if I can pull up pictures of the bill he sent me see, gotta wipe out personal info firsst
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Apr 25, 2016 23:30
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Even full body xrays can get expensive I guess.
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Apr 25, 2016 23:49
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Alan Smithee posted:Amzingly NOTHING major. No broken bones, no internal bleeding besides some fluid buildup, nothing that would be longterm 'Some fluid buildup' could mean a lot of things, quite a few of them potentially pretty significant and expensive. Fluid's gotta come from somewhere, y'know? And if it's in the lungs or chest it often needs to be removed in some fashion and that typically requires pretty extensive care.
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Apr 25, 2016 23:56
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Shnooks posted:Even full body xrays can get expensive I guess. 100kg Mastiff complete thoracic and abdominal series with complete thoracic and pelvic limb rads and a cervical series. 
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Apr 26, 2016 17:37
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We do the money talk for 90% of what comes through the door here - just about every single client gets an estimate for services, whether that's diagnostics to start or a surgery or what. Two of our doctors are great, and one of them pads the poo poo out of the estimates. 200-400 in estimated medications for a blocked cat over a weekend? Sure! Just about all of that doc's cases get the emergency/exam, two view rads, cbc/chem15/lytes to start, where other doctors might be much more discerning about what they're looking for/at. People regularly balk at those estimates, and then it falls on the techs to bear the entire weight of the "all you care about is money, you're letting my dog SUFFER". So at this point a few of the techs have decided to go in with the estimates and just undermine the poo poo out of the doctor, which is also terrible. The last couple of times I've gotten that line when someone has called, I've just let them know I don't work on commission. Our doctors sure do, though. I can kinda understand day practice production bullshit, but in emergency it's super lovely. It opens the door for doctors to treat unethically, rather than really putting patients and clients first. It's almost never something blatant, but there are some things that are probably medically appropriate strictly speaking, but when a client says they have exactly $700 and the pet needs $400 worth of treatment, don't pad it out with $200 worth of stuff. You can even predict when it's going to happen, too. Whenever the doc comes back from a vacation, everyone is getting hospitalized, nobody is going to be outpatient if it can be helped.
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Apr 28, 2016 01:10
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There are certainly some that do. I'm a big proponent of salaried only and the big reason is to remove the perception that exists. There are a lot of fights that occur on VIN about it, with some arguing the perception/rare overcharge vet while others argue encouragement/lazy vet scenarios. I also tended to be a much more casual vet in terms of things, so when the boss told me my pay was getting cut by ~3-5k a year because I wasn't producing enough I was pissed since I was doing stuff off the clock and teaching the techs, which didn't involve $$$ - that's carried over to now in my hatred of production-based vet care. I much more prefer the general business goals where all employees get bonuses when certain things are hit - increasing the number of clients seen per day over a month, bonuses when enough great reviews come in, reaching numbers selling appropriate preventative meds (i.e. selling more heart worm meds in an area that has significant heart worm). Unfortunately not a lot of that really applies to emergency. Like they say, vet med is at the unhappy intersection of money and emotions. I decided to waste my time coming up with an estimate with the small amount of info Alan Smithee provided.... let's see where this story leads us.... Day 1: $150: Patient comes in for emergency to an ER clinic $80: IV catheter placed and a bag of fluids opened up because looks kinda shocky $250: CBC/Chem/UA done, before getting the urine sample there's some fluid noted in the abdomen $100: FAST ultrasound confirms there's mild abdominal effusion, and the urinary bladder is a bit small. $50: Sample of the fluid is taken $550: Meanwhile, three view chest rads and two view abdomen taken as well as a couple shots of a limb that has superficial abrasions and mild swelling $150: Fluid analysis/cytology in house $80: Fluid glucose, PCV/TP, and BUN measurement done - glucose is fine, PCV is about 15% and BUN is equivocal $60: rads sent off for radiologist review $30: Patient improves on fluids, but starts to get agitated, likely from pain, so pain meds given $60: Three more will be given over the next 24 hours due to agitation $150: clip and clean done on external wounds $30: Due to swelling and wounds, IV antibiotic dose given $90: Three more will be given over the next two days $60: Over the next 24 hours, peripheral PCV/TP is monitored $100: IV Fluids $200: 24 hour monitoring Day 2: $100: Another FAST abdominal scan is done, fluid is persistent but not increased $400: Complete abdominal ultrasound done by specialist to see if there's evidence of urinary bladder rupture or anything bleeding/hematoma formation, nothing pressing found $250: Recheck thoracic rads done and sent off to the radiologist, as the first found minor pulmonary contusions - only minor increase, nothing to go after. $100: thoracic FAST ultrasound done as there was "the impression of mild pleural fluid" on rads per the radiologist, but none was found $20: catheter care $100: IV Fluids $200: 24 hour monitoring $150: Radiologist requests additional views of limbs thinking there might be a fracture - there isn't on follow-up rads. Day 3: $100: Another abdominal FAST scan done, fluid is decreasing. Commence celebration! Patient is also looking better. $40: Patient chews out catheter and vet decides they should still have one because is still a bit worried. $100: IV Fluids $200: 24 hour monitoring $30: Oral NSAID and antibiotics started as patient is doing a bit better. $250: Recheck CBC/Chem/UA done just prior to starting NSAIDs to make sure the kidneys and liver are all okay after all this bullshit that happened. There, $4200 worth of poo poo at prices probably closer to some GP prices and there was "nothing done" other than some mild wound treatment and IV poo poo.
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Apr 28, 2016 03:30
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I was thinking that was awfully inexpensive for emergency.
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Apr 28, 2016 11:41
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When I was going to a specialist (well, a surgeon) for Bailey's mysterious gracilis muscle issue (thank you to those of you who discussed it with me in conjunction with my vet's advice) I discussed my ability to pay and preferences with respect to his care. I mean, basically I said, "I'm a grad student and he's getting old, if you don't think its cancer I dunno if putting him under and doing a biopsy would be my first choice" so we did meds and rechecks instead. Which ended up being about ~45$ per visit, every two weeks for two months, plus carprofen (~30 bucks). Initial consult was more due to rads, but I thought it was pretty reasonable altogether. They also ended up not charging me for two visits under 15 minutes, which I made 100% sure was intentional, because I dont want to gently caress anyone out of getting paid for their work. I guess my point is, as a customer, in an emergency situation there's a lot less you can probably negotiate at the time of service because things are pretty urgent, where as when treating chronic stuff, you might have more sensible options to talk things over. Besides, sometimes poo poo is just expensive no mater what you want to do.
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Apr 29, 2016 17:41
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It was probably because you were upfront about your money concerns, cool/nice, and your dog has an interesting pathology. I mean, it's true that for chronic stuff you can space things out and price shop meds or whatever, but if you have money concerns (and I don't care the reason so don't tell me) and tell me that upfront but are invested in doing what you can and seem to understand the work and limitations that entails... I used to do what I could to do free rechecks and discounted services too. I prefer to reward the clients I like working with rather than reward the clients that complain.
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Apr 30, 2016 06:43
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So tonight I got to see a dog get tased by the police. It killed a seven year old kid earlier today and had to be put down and it was too aggressive to handle at all. gently caress.
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Jun 5, 2016 05:43
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Jesus, that must have been horrifying
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Jun 5, 2016 21:08
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Is asking for help with a diagnosis acceptable in this thread? We're already seeing a specialist but I figured it couldn't hurt to have other vets at least take a look at his history and test results.
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Jun 28, 2016 21:02
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Reik posted:Is asking for help with a diagnosis acceptable in this thread? We're already seeing a specialist but I figured it couldn't hurt to have other vets at least take a look at his history and test results. If you're already seeing a specialist we probably aren't gonna be able to do more than maybe give you more information with respect to what they're finding if you have specific questions.
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Jul 1, 2016 06:13
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A question for any other Veterinarian goons out there. Do your bosses dictate what CE you can take? I've only been out a few years and I've never heard of this before, but is this a thing now? My boss requires that I submit a "curriculum" of every class I plan to take so that he can give the Yea or Nay on each class before he will sign off on the trip. It seems pretty lovely. CE is supposed to be about me learning to be a better vet, filling holes in my knowledge, and picking up skills that interest me. Now he is paying for it so I understand that he doesn't want me goofing off, but seriously? He couches it as "Wanting to take CE that will benefit the practice". Ie make money. But if this is the new way CE is being handled then I guess I'm SOL.
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Jul 7, 2016 08:18
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My boss lets me take whatever, as long as it counts towards the hours I need for license renewal.
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Jul 7, 2016 12:30
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Just left my old (emergency) practice to take a new job in a bigger city at a specialty practice. It is mostly awesome, except they use paper records. They even have avimark, so they don't have to do it this terrible, laborious way, but "the owner likes paper". Blergh. I recognize that I'm kinda waffling, and it's only been a week, so I figure I should give it a fair shake at least. I have been trying to decide if vet med is even the right field for me, so I'm going to finish my bachelors and then figure out what I really want to do I guess.
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Jul 8, 2016 17:38
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I just completed a specialty internship at a hospital that got bought out by a huge corporation and they did not care at all what I spent my CE money on. Hell, they let me spend it on textbooks so I got to buy all my cardio residency textbooks using that money.
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Jul 8, 2016 22:38
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Boss here doesn't mind. Went on a basic abdominal ultrasound course last year and am spending my whole budget at IVECCS this year. Conference + 3 labs, woo!
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Jul 9, 2016 14:26
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Ok guys, I have a problem that needs some outside of the box thinking, although I may be grasping at straws here. I'm a receptionist at a pretty busy practice in California. I recently took a call from a regular client whose four year old mastiff had passed away suddenly at home. He wanted the pet privately cremated, and I asked if he wanted a paw print done as well (our cremation company, Koefran, offers a white ceramic disc on a stand that has an impression of the pet's paw print and their name in a color of the client's choosing). He did, and I noted it in Avimark. So he brings the dog in and lets me know at that point that he actually wants three paw prints done. Ok fine, noted in Avimark for the techs. This is where things start to get hosed up. The ashes arrived a few days ago, sans paw prints. This is not a good sign. So we called the company, and it appears that the tech who filled out the tag for the remains marked no paw prints to be done. Obviously the dog has been cremated at this point, so we're kind of screwed on that front. However, we have a backup plan. We almost always have an ink and paper paw print done in house that we send out in a sympathy card, written by the pet's regular doctor, or at least the one they've seen most recently. So with this in mind, our office manager calls the owner and tells them about the error, but that we can have that ink paw print laser etched into a wooden plaque (actually looks pretty classy and has saved our asses once or twice when Koefran has messed up and missed a paw print). Turns out that the vet, for reasons I cannot wrap my brain around, decided that since the client was getting three paw prints, there wasn't a need to send the paper one. And now the client knows that that was screwed up too. They are, understandably, furious. Their daughter is devastated - she was going to get a tattoo done of the paw print (and the ink stamp one would have been ideal for that, even over the ceramic ones which lose detail in the clay and glazing). It gets worse. I was the one balancing money on the day our manager called this client, and I noticed that a refund had been noted in Avimark, but there was no receipt to match. The credit card terminals confirmed it hadn’t been done. She was gone for the day, so I e-mailed her and asked if she had meant to do it and forgot. She often writes down credit card info for charges or refunds in her office and then gives it to me up front to run. Her response? “You are correct. Put a note that when he comes in that we need to refund him.” Ok, so it looks like we’ll need to refund this client when he picks up the ashes. No problem. The husband and wife came in last night, and were very intent on telling me how upset they were. I get it. I was furious for them and told them so. It shouldn’t have happened. I let them talk at me for a while about the incompetence of it, knowing they need to blow off steam. I can’t blame them. So then I ask for the credit card info to refund them, and I’m told that the manager already did it. This clashes with the info she gave me, but they are insistent and because so much has been said about incompetence already, I let them know I will look into it and send them on their way. I ask the manager, and it turns out she accidentally threw away their credit card info. I’m yelled at for not knowing that based on her e-mail. So now, I have to call them on Monday (because our manager is too busy being a counselor in our kids vet summer camp all next week) and tell them this. Her solution was to just send them a refund check in the mail. I don’t see that going over well. She’s basically washed her hands of the situation. Honestly, I can’t think of anything else to do for these clients, but I feel pretty shocked that no one else seems to be looking into how to make this better. I have even called the landfill asking if there is any chance in hell that trash might still be accessible so I could dig and look for the paw print (there isn’t - it’s been too long and too buried). I am serious, I want to help these clients. Does anyone have any ideas on what we can do to help make this better? TL;DR: Tech screwed up and marked a deceased pet as getting no ceramic paw prints when a client requested three. Pet has been cremated. Doctor screwed up and discarded the ink and paper copy for the sympathy card since the client was getting three ceramic prints. Manager screwed up and threw out the credit card info before refunding the client and expects me to fix it. Clients are understandably upset, and daughter is devastated - she wanted a tattoo of that paw print. What can I do at this point to even try and make things a little more right for this owner?
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Jul 9, 2016 17:36
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IMO there's nothing you can give them except for the money. They've already vented and probably on some level recognize that you (personally) aren't the one to blame, but that won't mean they aren't still pretty sore over the whole thing. What's done is done as far as the pet goes, so the only thing you can fix is the money situation. A check in the mail might be the actual best thing, +/- a written explanation that the financial aspect is now completely resolved, with reiterated condolences about the pet and the mistakes during a very trying time. I don't know the people, but I imagine they really just don't want any more phone calls from your clinic.
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Jul 9, 2016 18:40
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PS your boss is a dickhead.
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Jul 9, 2016 18:41
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Aye, you guys are pretty much screwed on this one, but it sounds like you have been going above and beyond. Bite the bullet, do the refund, and give them space. Let the client know what protocols you will put in place to prevent this from happening again.
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Jul 11, 2016 15:49
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my pup is having BOA surgery next week. I don't know where else to post about it so here. I'm super nervous even though I doubt I have much reason to be. I really hope it improves his quality of life. I really notice the snorteling when we are out for walks and he really struggles in the heat. He even had an episode at doggy daycare where he actually passed out from playing too hard. also I just watched the surgery on youtube by accident and it looks less scary than I thought it would be. luscious fucked around with this message at 01:41 on Jul 19, 2016 |
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Jul 19, 2016 01:33
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For you folks on VIN, a new 3D interactive anatomy project has launched. You can find it easier by using the VINdex (haha funny right), by hitting control and E on any VIN page. Then look for 3D Learning - IVALA or Anatomy in 3D (don't know why it's in two spots at the moment, but whatever). There's some on dog and horse bones/muscles, ocular anatomy, and canine abdominal anatomy. The plan is to keep expanding it (there's a bit of a focus on Neuro, just for you Topo) but that's where it's at now.
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Sep 10, 2016 03:39
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I'm not on VIN anymore (I switched back to my old account on here btw) because I can't afford a membership and apparently post-doc researcher DVMs at academic institutions don't count for the academic accounts, even when they make less than they did as an intern. Good old VIN paying lip service to caring about recent graduates in training who are inundated with debt and have little income but not actually practicing what they preach. 
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Sep 12, 2016 02:13
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Sekhmet posted:I'm not on VIN anymore (I switched back to my old account on here btw) because I can't afford a membership and apparently post-doc researcher DVMs at academic institutions don't count for the academic accounts, even when they make less than they did as an intern. What are you researching? On an unrelated note, my school paid for me to fly to Prague to present my research at the veterinary anaesthetists' fall meeting. I'm slightly terrified, both of the presentations and also that I will get fat from all the good food and beer around here. Solis fucked around with this message at 09:14 on Sep 12, 2016 |
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Sep 12, 2016 09:08
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I'm at a canine genetics/genomics research lab and I have a few different things I'm doing here. Some of it is to make myself valuable to the lab like figuring out ways of handling of all the massive amounts of data we're getting back from whole genome sequencing of dogs. But as far as like, what my own original research is, there are a few little projects like trying to map using SNP markers what seems to be an X linked epilepsy in a breed, doing some screening for possible candidates for an unknown fatal possibly neurodegenerative disease of young puppies that has eluded the lab's grasp so far, and if I think I'll be in it for the longer term I may end up as a primary investigator on a breed's de novo genome sequencing project that would be a pretty big deal in the field. I'm in a good place to do these things with service funding (our lab has discovered a lot of genes and does a lot of genetic testing for veterinarians and breeders) for pilot projects and if I want to do a PhD I have that option too. I also get to tag along with the neuro service in the teaching hospital for rounds/journal club and am hoping that I'm making a good enough impression that they'll consider me for residency. So I guess I'd say it's complicated, but I'm enjoying it so far, haha. Except the paycheck. That part isn't good. I haven't gotten my state veterinary license yet because of finances (though I'm still licensed in NY through 2017), but I might just suck it up and put it on my credit card so I can start doing a little bit of ER relief work or vaccine clinics or something to earn some more money and also stay somewhat involved in clinical side of things. Sekhmet fucked around with this message at 22:14 on Sep 12, 2016 |
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Sep 12, 2016 22:11
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Sekhmet posted:I'm not on VIN anymore (I switched back to my old account on here btw) because I can't afford a membership and apparently post-doc researcher DVMs at academic institutions don't count for the academic accounts, even when they make less than they did as an intern. Did you email someone about it? A researcher in academia is quite a small group and it may be that it has been overlooked thus far, but based on what/where you do things it should fall under the academia exemption. I could see about fixing it - you know where to PM me.
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Sep 13, 2016 00:16
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I'm going to be applying for an ECC Residency at the end of the year. Any of your resident nerds have any application wisdom?
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Oct 3, 2016 18:44
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Are you applying through the VIRMP?
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Oct 3, 2016 19:31
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Yes, but considering we only have one program in the UK it's not a huge choice 8)
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Oct 3, 2016 23:00
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YourCreation posted:I'm going to be applying for an ECC Residency at the end of the year. Any of your resident nerds have any application wisdom? Here's my biggest thing for resident applicants. Everyone says in their letter of intent "I want to become a board certified specialist." Yeah, no kidding, that's what a residency does. What do you want to DO with the boards? It's even acceptable to say "I don't know, but I'm interested in..." to show that you have some idea of what's available in the field. Meeting people in person is helpful to - if you can do an externship or something at places you're interested in, it can really help.
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Oct 14, 2016 03:25
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Good point - it reminds me of my undergraduate advisor's advice when I was applying to veterinary school. Tell them exactly what you want them to hear. I have always struggled to plainly put into words what I feel and what I want to say. It is the main topic that really stimulates my intellectual curiosity and it just feels right at home. I would like to work in private practice and expand the availability of high-level ECC available in the UK (still a very new field over here). I would like to continue to conduct basic, sexy, and practical research in the field, and I would love to teach. I am fortunate that the school is around the corner from me and also my alma mater, so I keep in regular contact and send the occasional emergency referral their way.
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Oct 14, 2016 23:24
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I've administered injectible ivermectin orally to my dogs for years for heartworm but now I've got a new vet who gave me a stern talking to about how there are ivermectin resistant heartworms in the state now and I really should start buying interceptor from him. He insisted that professional guidelines prevented him from telling me whether there's a suitable replacement for ivermectin at the feed shop that I can administer myself. Help me out, goons. I still get my dog screened annually, I just don't want to pay extra for chewable pills and I'm not concerned about the manufacturer's guarantee.
poverty goat fucked around with this message at 19:07 on Nov 7, 2016 |
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Nov 7, 2016 19:00
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If you want different medical advice, the best thing to do is take your dog to a different vet who can do their own exam and then give you whatever medical advice they have for you. The internet (even here) is not a good place to get medication reccomendations. Aside from it being a bad idea for you to seek advice from people whom you don't know or have any relationship with, it is unethical (And in violation of most, if not all, State Practice Acts) for any of the vets here to give medication recommendations without a patient/client/doctor relationship.
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Nov 8, 2016 02:24
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Crossposting from the dog / puppy thread. This feels like a better place to post this question. Anyone have any knowledge or experience with partially/torn (ACL) CCL repair? Our 3.5 year old aussie mix has been lame in her back right leg for a little under a month now. Her vet initially thought it might be a meniscal tear after we first discovered her limping but her leg has been getting progressively worse over the last two weeks which prompted us to consult some orthopedic surgeons. We've gotten two consults with two different animal hospitals: one farther away closer to her original vet that recommends doing the TPLO procedure and a closer vet to our new house that has never done a TPLO but routinely does the TTA procedure and recommended that procedure over the 'fishing line' approach. Can anyone comment about the pros and cons between the two procedures? The first surgeon said that there is an preliminary case study that suggests that the TTA surgery is not as good as the TPLO over longer time periods (My understanding is that the TTA procedure is relatively newer in comparison so the data for those long term studies is coming out now). He performed all three common approaches to CCL repair and has returned to performing TPLO surgeries for medium sized active dogs which our pup fits that bill. The second surgeon said that there is no statistical significance in the outcomes between the two approaches. The cost between the two surgeons is comparable so I'm not concerned about which is cheaper but which has a better outcome for our pup in the long run. I understand she may never be able to do 100% of the activities she did prior to injury. She is 3.5 years old and ~65 lbs and a good girl 
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Nov 9, 2016 16:11
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Not Grover posted:If you want different medical advice, the best thing to do is take your dog to a different vet who can do their own exam and then give you whatever medical advice they have for you. The internet (even here) is not a good place to get medication reccomendations. Aside from it being a bad idea for you to seek advice from people whom you don't know or have any relationship with, it is unethical (And in violation of most, if not all, State Practice Acts) for any of the vets here to give medication recommendations without a patient/client/doctor relationship. I'm not asking for vetrinary/medical advice. I've already got that. I'm just seeking a factual answer about OTC meds.
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Nov 9, 2016 23:14
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lazerwolf posted:Crossposting from the dog / puppy thread. This feels like a better place to post this question. As far as the literature suggests, any significant difference between TTA and TPLO procedures is largely due to provider comfort - ie if you've been doing a TPLO for ages it's probably as good as if you've been doing a TTA for ages. Both probably have some advantages over the lateral suture procedure for large breed dogs if only because it's hard to not stretch out the nylon before the surgery finishes healing. That's based on what was true a couple of years ago anyway.
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Nov 9, 2016 23:18
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poverty goat posted:I'm not asking for vetrinary/medical advice. I've already got that. I'm just seeking a factual answer about OTC meds. Whether or not there really are ivermectin-resistant heartworms in your area is obviously going to depend on where you are--I haven't heard of this specifically being a problem yet, but I also am in an area without much heartworm so I almost never see positive dogs, let alone dogs who contracted HW while on ivermectin. Maybe your vet has. Re: OTC meds, if they are being used off-label (which, for animals, they usually are) it's then regulated the same as a prescription--I can't even give you a dose of Benadryl for your dog without a current relationship, because it's not labelled for dogs, and same goes for the rest of the OTC meds. That said, I am not aware of an OTC source of milbemycin, the active ingredient in Interceptor.
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Nov 14, 2016 06:15
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