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"specialty" hospitals keeping owners in the dark??

Discussion in 'Pre-Veterinary' started by Maddiegirl, Feb 24, 2012.

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  1. Maddiegirl

    Maddiegirl

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    Just curious what others think... There is a fair amount of ranting here so sorry in advance for the long winded rant. :)

    Do referal vets in a specialty hopsital have a duty to provide reports of the care they provided directly to the client or only to the referring veterinarian?

    As many of you know Colby has osteosarcoma and is seeing an internist for chemotherapy. We've been having issues with his WBC counts rebounding slowly. It took 4 weeks between first round of carboplatin before we could start the second round chemo with doxorubicin, but with an extra week his WBCs rebounded nicely to above where he was when he started chemo. He was 5.2 in Dec when diagnosed. After first round of chemo at 3rd week he was 3.2, but waiting an additional week, and he was up over 7. I know that's still low, but it was a nice jump considering the circumstances.

    For the third round at 3 weeks they were low again, but the hospital wouldn't share the numbers with us only denied chemo that week and popped us with 100 "recheck fee." Now here we are at 4 weeks they're still borderline low, but we haven't been given any data.

    Today, the internist with the horrible personality tells my husband that we should probably stop chemo if he continues to have issues with WBC counts rebounding because it's pointless to continue. While I understand that dragging the chemo rounds out can lower the efficacy, I'm not certain that 4 weeks is too long. Specifically because the good doctor at that practice told us it was fine as long as we didn't push it to 5 or 6 weeks.

    I'm livid because she apparently hasn't even considered the idea that maybe Colby is just sensitive to the doxorubicin, and maybe we should just do carboplatin at 4 week intervals. I wasn't able to go to his appointment this morning so I didn't get to ask her myself. My poor husband gets so nervous about chemotherapy in general that he was shell shocked when she said it was time to quit.

    What really irritates me is that during his treatment, it's been like pulling teeth to get his WBC counts out of these people and dosage information. It's like requesting top secret information to get access to his CBC reports which I'm paying 100 bucks a pop for!!! The tech actually told me last time I was in there that "his white blood cell count was nothing I needed to concern myself with..." They don't tell us anything just take our dog to the back and bring him back out with a nice fat bill. For all I know they're back there doing the hokey pokey with him. /end rant

    I believe in taking an active roll in my pet's care. Am I being unreasonable for wanting all the information? or is the clinic failing me in some way by not providing the full picture of my pet's healthcare?
  2. Lissarae06

    Lissarae06 Insert Veterinarian Badge Here

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    I don't think it is unreasonable to ask for the info. You are a concerned pet parent and want to make an informed decision concerning your dog's health. I would formally request a copy of your dog's records. If they won't give you that, I would ask your normal vet to request a copy. If I was in your shoes, I would be inclined to seek a second opinion, but that's just me.
  3. nordicat

    nordicat Mizzou c/o 2016

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    You're not being unreasonable at all! Especially since those numbers actually mean something to you (you're not just Joe Schmoe off the street with absolutely no medical knowledge).

    That being said, when one of my clinic's patients sees a specialist, we get a report faxed back to us detailing the treatments and put it in the patient's file and pass it on to our doctors as a "FYI". Perhaps your vet can provide you with more information? I'm aware that's a bit of a pain, but if the specialists are being douchey...

    Ugh...next time you go, request copies of the records if you have to. They aren't legally obligated to provide you with them, but they look like d*cks if they don't :p Make sure they know that you are fully capable of understanding it all and intend to take an active role in your pet's care. If they're still being shady....take your business elsewhere (if you can)! Good luck!!!! :luck:
  4. SilverSpyderGT

    SilverSpyderGT Veterinarian/Engineer

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    As an owner, you are legally entitled to a copy of your pet's medical records on request. If the specialist keeps giving you a hard time, you can always complain to the licensing board to motivate them to comply.
  5. pooter

    pooter PennWe, 2015!

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    This. If they keep giving you the run around, ask to talk to the doctor (because the techs/receptionists aren't always up to speed on the legal issues) and if she denies you information threaten to talk to the state licensing board. (You can look up their info here: http://www.aavsb.org/DLR/)
  6. SilverSpyderGT

    SilverSpyderGT Veterinarian/Engineer

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    Yes, they are. The AVMA has a summary of records release laws by state. The details vary by state, but the general idea is the same - owners are entitled to their pets' records. The release laws are more geared toward release of medical records outside of a VCPR.

    http://www.avma.org/advocacy/state/issues/sr_confidential_records.asp

    For Texas:

    Put it in writing. File a board complaint if the hospital still refuses.
    Last edited: Feb 24, 2012
  7. Maddiegirl

    Maddiegirl

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    Thank you all for the replies! I'm highly inclined and have actually made a phone call to an oncologist at a different clinic.

    Going through all of this just makes me wish I was already a vet!!!

    That said, I love the other doctor at the same practice. He's a great guy and has graciously agreed to allow me to shadow with him. He works 3 week rotations with a week off, and Colby's WBC count dictates that we see the evil troll and not him. Fortunately, when he's there she isn't. :thumbup:

    Now my next question: How do I untangle Colby from the clinic without ruining a shadow opportunity? Ultimately, I don't care if I do because Colby's care comes first, but if I can have my cake and eat it too that would be ideal. :laugh:
    Last edited: Feb 24, 2012
  8. Maddiegirl

    Maddiegirl

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    Thanks for the board info. Much appreciated. Will definitely be keeping this. I do not know why but this woman has had it in for me from the very first visit. Every question I asked, she shot down. She was completely unwilling to explain anything. My hour long consultation lasted 15 minutes.

    She told me "if your dogs wiggles during chemo we may have to amputate another leg and a dog with 2 legs is not good...."

    I was floored. I immediately attempted to switch to the other doctor and than in itself was like pulling teeth. I met him and loved him. He was so patient and answered each question. He even inquired about an herbal complementary treatment I read about on a cancer website. But, like I said earlier, his schedule prevents us from being able to work with him. :mad:
  9. Maddiegirl

    Maddiegirl

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    HA! State board is here in Austin!! I can make a personal appearance! She better turn over records ASAP.
  10. nordicat

    nordicat Mizzou c/o 2016

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    Good to know! I've heard so many different (and B.S.) stories from different doctors I've worked with.

    Is it legal to require a records transfer fee if, for example, the clinic I work at purchased records from another clinic when it closed? Cuz we totally do that...I feel like such a douche when I have to tell people that!!! :(
  11. Maddiegirl

    Maddiegirl

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    I would imagine a small fee to cover the customary costs associated with copies, time to send out, and postage/fax charges wouldn't be out of line, but to charge in order to make a profit on the records seems wrong.
  12. nordicat

    nordicat Mizzou c/o 2016

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    I know, right? It's $25!!! :eek: And that's to HAND the record to the owner. No copies needed.
  13. bandierose

    bandierose

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    Hi,

    I shadowed a veterinary oncologist for 4 weeks at a specialty clinic in Detroit. I saw that you are in georgetown, so you are probably going to Gulf Coast Specialists? So, here is my two cents. I saw many patients that were slow to rebound 2, 3, 4, even 5 weeks. It is best if you can do it between 1-2 weeks, but the oncologist I worked with took the tact that you are extending life and quality of life. SO, if doing it at 4 weeks means that your pup gets 9 good months instead of 12-18 then I personally would still go for it. Also, the oncologist I worked with said that when this happens (extended rebound time) he almost always finishes the treatment and gets as much remission time as possible (weeks, months, years) then tries another drug if/when the cancer comes back. Lastly, there were a couple of times the pet came out of remision durring treatment or really struggled with the drug and the doctor switched the drugs then. Depending on finances (and I don't know what drugs are acceptable for use with that type of cancer) perhaps finsihing this round and then another if he comes out of remision or simply switching drugs now can help with his rebound time. Any way you look at it, you have a right to be informed and a right to your pets medical records. Shame on them for not assisting you in everyway possible. The oncologist I worked with was phenomenal and I hope that you can get as good of an expierience with a little prodding.
  14. Maddiegirl

    Maddiegirl

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    That's just wrong. I keep all of my receipts for every vet visit my animals have ever had. So this wouldn't apply to me, but for others who don't keep diligent records it's like extorting money from a client wanting to leave your practice!
  15. Maddiegirl

    Maddiegirl

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    I just want Colby to have as much good and healthy time as possible. When he tells me he's tired of fighting I will know it's time to stop NOT when some biatch doctor on her almighty high-horse tells me to without even considering the big picture.

    I guess what I'm saying is that I might be throwing money away, but when he draws his last breath I want to know in my heart that I did all I could for him. I promised him when we got his diagnosis that I would fight with him as long as he had fight in him. With him being half pit and me being stubborn as an ox, I'd say we've got a lot of fight left in both of us!
    Last edited: Feb 24, 2012
  16. bandierose

    bandierose

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    I live in Houston, but I'm in Austin all the time... You might think about taking him to another specialist. Where I shadowed they provided a client with a printed detailed acount of what was done at each visit (down to the dosage) and the only cost to client was $3.00 for a burned CD of X-ray's.
  17. breenie

    breenie Weenie 2015

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    Hey Maddie, you might want to edit out the name of the clinic you go to. I feel like talking unkindly about one of the doctors (however well-deserved) of the practice on an internet forum would do more to damage your shadowing opportunities than asking to switch to a different doctor at the practice.
  18. squeegee

    squeegee

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    when i worked at my old practice we had plenty of patients that were going to referral hospitals for chemo but would come to us for the CBCs and we would fax them over to the referral hospital as soon as we got the results (and to the owners if they wished). perhaps this is something you could do? might be cheaper for you- we would usually do it as a nurse's visit and depending on the circumstance might only charge them the price of the CBC. just be sure they are aware that you are pulling the CBC for chemo so jug sticks only :)
  19. nordicat

    nordicat Mizzou c/o 2016

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    It's not even that, it's clients who have never technically been OUR clients at OUR practice! :mad: I hate it and agree, it sucks.
  20. Maddiegirl

    Maddiegirl

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    I edited the name out just in case. Better safe than sorry. :D
  21. Maddiegirl

    Maddiegirl

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    oh wow, Nordi, that is messed up....!!!
  22. david594

    david594 The-OSU CVM c/o 2013

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    How does knowing your dogs White blood cell count is 1,800 versus 1,600 really change things for you? I agree with them that it isn't something you really need to concern yourself over. And if its just a curiosity, I'd probably state that when your asking for a copy of the results. They aren't doing it maliciously, and threatening board complaints is only going to make them unhappy to deal with you.

    The issue with giving out the results is you get a lay person that ends up trying to interpret their own bloodwork(which they have no training in). This isn't uncommon in human medicine either. Your paying the Dr to interpret the bloodwork for you. They will give it to you if you ask. But they usually dont volunteer the info because you will end up freaking out and searching doctor google trying to figure out why you had an albumin outside the reference range.
  23. Maddiegirl

    Maddiegirl

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    I asked for it and was told not to concern myself with the information. The fact of the matter is that it's not their concern if I understand it or not. What concerns my animal absolutely concerns me. Thinking it does not is poor client relations.

    You're right, I'm am paying a doctor to interpret the bloodwork for me, but tell me, where is the value to me with a doctor that fails to explain their interpretation to me? The service I am paying for is two-fold: treat my animal and educate me as an owner. Ultimately the decisions regarding his care are in my hands because I'm the one who has to pay the bills and live with the decisions made. I should at least have the chance at an informed decision. Since when did patient education become a bad thing?

    Bottomline is, I expect to see copies of his lab reports. Just because I haven't yet been to vet school, yet, you shouldn't assume that a) I'm planning to interpret the reports myself and more importantly b) that I have no clue what those pretty letters and numbers on the report may or may not indicate.
    Last edited: Feb 24, 2012
  24. pooter

    pooter PennWe, 2015!

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    It changes things because it's incredibly hurtful when vets hold this information back after the client specifically asked for it. It sends the impression that the vet thinks the client is too stupid to know or somehow can't handle knowing. That's not the vet's decision to make. It changes things because she's the owner of a sick dog and is trying to make the basic decisions about how he's going to live and die. And if there's something she doesn't understand, I'm sure she's perfectly capable of asking the vet what it means--in fact, I'm sure she's capable of asking several vets, which is probably what this specialist is worried about. At the end of the day, it's the client, not the vet, who has to accept the treatment plan and live with the consequences. I take issue with bringing out the "Dr. Google" argument, especially in a case like this where it's clear that MaddieGirl has gone out of her way to educate herself about the disease. But, even if we accepted your argument, it doesn't change a thing because the client still has an undisputed legal right to those records.

    Sorry if you don't like the tone of this post, but you've hit a sore spot. When my pup got his diagnosis last summer, the e-vet tried to pull this crap with me. It made an already impossible situation ten times harder when I had to find his PCV on his cage card because the vet thought it wasn't something I should worry myself about. Actually, no, I don't apologize. Your post makes you sound like a condescending ass.
  25. Maddiegirl

    Maddiegirl

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    Thanks Pooter! I'm sorry you went through this with your pup. It's definitely frustrating.

    If this person really is a vet student, and I have my doubts....I seriously hope they get a grasp on their attitude and learn a thing or two about client relations.

    I know I'm not a vet. I know my limitations. I don't take anything on Google as the gospel. I also know when to question a professional that I feel is doing me a disservice with their almighty attitude. Client education is paramount in the veterinary industry. I wish all owners would take the time to educate themselves besides just blindly following what the DVM, or any doctor for that matter, says. Because at the end of the day, we're all human and we all make mistakes. Sometimes a person with no training can see something that the most highly trained individuals overlooked in their infinite wisdom.

    Finally, threatening action with the medical board would be a last resort, but I wouldn't hesitate on the grounds that it might make them not like me because while they may not like me, they will respect my wishes as a client or suffer the consequences.



    Finally, Pooter is right...you are a condescending ass.
    Last edited: Feb 24, 2012
  26. Maddiegirl

    Maddiegirl

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    :thumbup::thumbup: I will ask about this tomorrow when I shadow at my vet.

    Thanks!
  27. kakurubird

    kakurubird

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    I actually thought of this reading Maddiegirl's first post since we do this where I work too (and, as far as I know since I don't do any reception-type things, only charge for the CBC or whatever is being run) and I know we've shared bloodwork from other hospitals, especially emergency/referral places. I'd imagine it many cases it would be cheaper too? (We'll also send home rads and occasionally copies of bloodwork with owners to take with them to the specialist later.)
    Also, while it certainly doesn't apply to the situation of chemo, we also occasionally fill meds for animals we know post-specialist visit (we have quite a few clients that have seen allergists/dermatologists, cardiologists, orthopedists, etc. in the area).
  28. alliecat44

    alliecat44 KSU CVM Class of '11 Moderator Emeritus

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    Hey guys, easy with the name-calling....

    Maddiesgirl, I understand your frustration--but it seems to me (I could be wrong) that your frustration is in the doctor's communication style, NOT that knowing your dog's WBC on any given week will help you any further. Yes, as the client you have the right to know--absolutely--but I also agree with the other poster asking what, exactly, will you do with that information...you mention the possibility of pointing out a mistake or somesuch thing.

    I will tell you that even those of us who are just DVM's and not specialists were taught different things in vet school--don't give X if it's below 2000, other places won't give it if it's below 3000, still others will treat as long as it's above 1500...and these are specialists teaching us! Everyone has their own personal philosophy. And so while I understand your burning need to try to wrap your hands around every aspect of your dog's cancer, and agree that you absolutely have an inherent legal right to your dog's medical record....my question to you is what do you hope to glean from the numbers? (Note that I completely and totally support your right to request and receive that information.) By the way, it says in your post that the TECHNICIAN told you you don't need to worry about the number--but what did the DOCTOR say? Did you ask her? Before threatening a board complaint, I would make sure I asked the vet.

    I'm sure this is not going to be your favorite opinion, and NOBODY on this board can possibly know what the right thing for your dog is...carbo as sole agent might be a viable option, etc...BUT...as a general rule...when an oncologist is telling you that stopping chemo might be an option...I would listen and consider what they are saying and why before dismissing them. Most oncologists I have met over the years are far more likely to OVERtreat than undertreat...it's the nature of the specialty and their eternal optimism.

    Finally, just because you weren't at the appointment should NOT mean that you cannot talk to Colby's clinician about the case. Call and ask if carbo as a single agent would be a viable plan. If not, why not. Discuss. Specialists are accessible by phone, too--not just during your pre-allotted appointment time. She should be very willing to talk to you and address your concerns.

    Best of luck with your dog. :luck:

    P.S. I would think your chances of having a productive shadowing experience at this clinic to be very slim if you fire your current oncologist and/or threaten a board complaint. FWIW.
  29. bunnity

    bunnity Penn 2014

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    David has been on this board forever and is just as real a vet student as the rest of us. There is no need to abuse him for an opinion that you don't agree with, even though this is a sensitive topic.

    Best of luck with your dog's treatment. Maybe you could talk on the phone to the doctor you prefer on one of the days that he is there, and he could help explain the bloodwork in better detail.
  30. lailanni

    lailanni c/o 2012

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    +1

    I see you're listed as a pre-vet. So someday as a veterinarian, the "troll" doctor will be a colleague in your field - part of your veterinary family. Like a family, there are differing opinions. But as a profession, we treat each other with a general attitude of respect. Trust that your colleagues are doing the best they can with their knowledge and training. If you have questions or concerns, just directly ask them. They should be willing to talk things out and explain their point of view.

    While you may have a valid view on the treatment protocol, a boarded oncologist has gone through vet school and very long specialized training process. I am sure you are very well educated on the topic, but their depth of experience will be giving them a viewpoint that you don't have yet. If they're suggesting something, there's sound logic behind it.

    I understand that you'll want to be as involved as possible, and I'm not saying that either you or the doctor are right/wrong. From what I'm understanding, there's just a lack of communication going on. Most doctors are available by phone/email. I suggest making a succinct list of your concerns and getting them addressed. You'll feel better after that.

    I also recommend talking to the clinician, not the technician. No offense to any techs, but the doctor will be most familiar with the blood values and what that means as a whole for the patient. If you let the doctor know that you're interested in medicine, I see no reason why they'd hold back values from you.
  31. david594

    david594 The-OSU CVM c/o 2013

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    Maddie, Im sorry if it came across like I was personally attacking you. You definitely have a right to see the bloodwork results. And it definitely sounds like the vet is doing a sub optimal job in communicating with you guys. And given the fact that you are pursuing veterinary medicine, you really dont fall into the category of a "lay person". I'm also sure if you talked to the doctor directly and told them you were curious about the numbers on the bloodwork, they would provide them for you.

    My whole point was just that its pretty common for this info to not be routinely volunteered in both veterinary and human medicine.
    Last edited: Feb 24, 2012
  32. libster06

    libster06 Crank a wank!

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    I know that wth all the practices I've worked at, the styles of treatment have varied. Even in school, I've often thought "My goodness, that's never how I would've (or have) done that." Even if you did know what to do with said information, David is right. Your treatment method may not be the same as another person's. Just something to think about I guess...

    I'm reluctant to say this, at the risk of also being called a condescending ass, but if they won't give you the info, for whatever reason, then that may be an issue. But if they do, realize that she's doing what, given her extensive training, she thinks is the best plan of action for your animal. If you don't think so, you're welcome seek a second opinion, but how much more do you know about oncology than she does? I agree with someone above that her communication may be the issue (as it is with many vets) because she hasn't told you WHY things are or aren't being done, but I wouldn't discount her knowledge about what she's saying.
  33. sumstorm

    sumstorm

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    I'd just add in that your vet does not actually have to do something they feel is inappropriate during the course of treatment. If they feel a single agent therapy isn't appropriate, they can refer you to another chemo center. It would suck for all involved, and is a good reason to try to work with the vet, to ask for explanations, rather than starting out incredibly upset. I realize how difficult that is when our pets are struggling. You are entitled to the records, by all means, but you can't force a vet to do the treatment you dictate (unless, of course, you are a DVM and willing to do the treatments yourself and have the equipment and supplies to do so.)
  34. StartingoverVet

    StartingoverVet Flight Instructor for hire Gold Donor

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    I have to disagree to a point with david and alliecat, although I understand their points..

    Having had a fair amount of experience in human and vet med dealing with problems, there is NO circumstance (outside of emergency) where a doc should be making decisions without the best informed consent of the client/patient as possible. Many people in medicine forget that point, are veer off into the "they know best" attitude.

    Yes, a vet, or an oncologist knows vet med better than their clients, but they do not have the right to make those decisions on their own. When a client asks for information they are not just legally, but morally obligated to provide that info, explain it, and explain their reasoning if desired. Any practitioner who has the attitude that the info is too confusing needs to go into an area where they don't deal with clients 1 on 1.

    Even the most mentally challenged client needs to have some interaction with these kinds of decisions, if only perhaps to say "do what you think is best doc". When this is not provided, I guarantee you the likelihood of law suits and complaints goes waaaaay up.

    So, I really disagree with David's and Allie's defense of the dr in any manner. If vets have failed to work with the client, then they have failed as practicing clinicians, regardless of how knowledgeable and how medically sound their choices may be (assuming they are in fact sound).

    (and to be clear I am not in any way implying that David or Allie would ever act in such a manner).
  35. libster06

    libster06 Crank a wank!

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    I think we have all agreed that the problem in this case sounds like a communication issue.

    However, given that the OP said she did not actually get to go to the appointment and it was her husband relaying information, we are not aware if the doctor did in fact go over things like she should and that this is really a "tech issue" (because the tech was in fact the one who told her not to concern herself with the bloodwork). Since the OP hasn't cleared anything up for us, there's no way to know if the doctor has actually followed up with the OP and discussed why she is doing the things she's doing.

    No disrespect to the OP or her husband, but I know in some cases where the owners are a couple, there may be one person who deals more frequently with the veterinarian and the other who doesn't deal with the vet as much, and may not know all of the ins and outs of the case as the other person (or in this case, may not also have as much background knowledge as their partner). Sometimes when the vet tries to relay information to the person who isn't as up to speed, it may not come across as well as it would if the other person were there as well (to ask countering question, such as the OP said she would have if she had been there). Again, that's a communication issue. In a case like this where cancer is involved, I don't doubt that both of them have been actively involved in the care and treatment of Colby, but just throwing that out there, given the OP's above-average knowledge of vet medicine...
  36. StartingoverVet

    StartingoverVet Flight Instructor for hire Gold Donor

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    Agreed that is a reasonable view.
  37. sunshinevet

    sunshinevet

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    *bump*

    Hey Maddiegirl, just after an update :)

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