When to dilute IV meds?

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I've never given it at all to an animal. My attending pulmonologist was telling me he had.
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RNtoMD87 said:
I've never given it at all to an animal. My attending pulmonologist was telling me he had.
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He's a *****, benadryl does jack **** for anxiety, probably just causing the dog to be drowsy and he is interpreting that has "reducing anxiety" when in reality, the dog is still anxious as ****, but is just too tired to do anything about it.
 
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RNtoMD87 said:
He knew which animals to give the antibiotics to though. He wasn't just giving them random drugs. Like I said he had studied these medications at length. He would lecture me on these types of things. I've always been the one who is afraid to give medications to animals. I didn't realize Benadryl could be given to dogs for anxiety until one of my physicians told me that he did. I never even looked it up, for some reason I just didn't think it sounded safe to. I never had to give my animals medications on my own because I don't know those things. All I've ever given a dog is the prescribed medicine for Annie, and hartguard. And ive given IM antibiotics to goats before. That's about it.

There are many online certified resources that tell you the dosages of antibiotics for each species. And I remember the Ivomec had dosage on the container per weight of animal.
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Did you consult a food animal vet or FARAD about those goat antibiotics? Every antibiotic is off label for a goat. You can't just fill em up with whatever you want and then go about your way. A food animal vet or FARAD should have been consulted about which antibiotics are appropriate as well as how long you have to dump the milk/not slaughter the animal to keep antibiotics out of the food supply.

This **** is important. You can't willy nilly give antibiotics to food animals without following proper protocol. I mean you can, but you shouldn't and if you are discovered to, the farm will get hit with a hefty fine.
 
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Not to mention who knows how the medications/vaccines that end up in feed stores have been treated. They could have been left out on a loading dock in 90 degree weather for days for all we know. The trucks that bring supplies to these places are bringing tons of items - fertilizer, feed, supplies, gardening equipment, etc. They are not concerned with necessary refrigeration and/or treatment of sensitive items (not to mention loading/unloading time). I wouldn't be surprised if half the **** sold on the cheap in these places is totally inactive.
 
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DVMDream said:
Did you consult a food animal vet or FARAD about those goat antibiotics? Every antibiotic is off label for a goat. You can't just fill em up with whatever you want and then go about your way. A food animal vet or FARAD should have been consulted about which antibiotics are appropriate as well as how long you have to dump the milk/not slaughter the animal to keep antibiotics out of the food supply.

This **** is important. You can't willy nilly give antibiotics to food animals without following proper protocol. I mean you can, but you shouldn't and if you are discovered to, the farm will get hit with a hefty fine.
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Our goats aren't food animals. They're lawn mowers/pets. I always wanted to butcher them but my father wouldn't let me. He even let a baby goat stay in the bed with him (he had it in a box by the beside and was bottle feeding it because the mother wouldn't. She would jump out of the box, and stand on his chest while he was asleep. It was a big shocker for us, because he wouldn't even let my pet dog come down the hall to his bedroom. I always BEGGED him to let me butcher the old bucks because I love chevon, and the goats were inbreeding, but he never would.

We never sold any of our products either. If we consumed milk, meat or eggs it was only for us personally. The majority of the farm was crop rows, fruit trees, etc. We had maybe 40 goats at the height of it all back in 1999, about 25 chickens, two donkeys, a horse, a cow, and a hog intermittently while we were fattening it up for slaughter.
 
RNtoMD87 said:
Our goats aren't food animals. They're lawn mowers/pets. I always wanted to butcher them but my father wouldn't let me. He even let a baby goat stay in the bed with him (he had it in a box by the beside and was bottle feeding it because the mother wouldn't. She would jump out of the box, and stand on his chest while he was asleep. It was a big shocker for us, because he wouldn't even let my pet dog come down the hall to his bedroom. I always BEGGED him to let me butcher the old bucks because I love chevon, and the goats were inbreeding, but he never would.

We never sold any of our products either. If we consumed milk, meat or eggs it was only for us personally. The majority of the farm was crop rows, fruit trees, etc. We had maybe 40 goats at the height of it all back in 1999, about 25 chickens, two donkeys, a horse, a cow, and a hog intermittently while we were fattening it up for slaughter.
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Even in pet goats, certain antibiotics are not legal to use.
 
We didn't really use a broad array of antibiotics. We used ivomec as I mentioned earlier and I forgot the name of the other one.
 
Yeah the powers that be don’t care if a goat, sheep, pig, chicken, or whatever is for food or is a beloved a pet. They decree that certain drugs are banned in that species to protect the public/food supply and that’s just how it is. If you’re caught giving them you can expect some consequences, which is why it’s important to consult a vet who was actually trained in these things.

Also FYI while ivermectin is not outright banned in goats, it’s an extralabel use to give it to goats. Which means it’s only legal to give it if your vet prescribed it.
 
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If its illegal to give animals antibiotics, why is it legal to buy them? You cannot legally buy human drugs out of a magazine.
 
I don't get why people illegally get human drugs though. So many of my friends buy black market steroids which is so stupid. I get prescription Cypionate, for much cheaper, plus it's clean, from a physician.
 
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It can be legal for a layperson to use drugs for their labelled use at the labellled dose in the labelled species. Examples: You (generic "you") can give a cow oxytetracycline (LA-200) to treat pneumonia and pinkeye. But using it for foot rot or something else is an extra-label use and needs the order of a vet to be legal. It can't be given to a goat at all unless a vet says. Nuflor (florfenicol) is okay to give to a beef cow for respiratory disease and foot rot, but it's illegal in a female dairy cow over 20 months old. You can give Micotil (tilmicosin) to a cow or sheep for respiratory disease. But it's toxic to goats, pigs, and people so better not try to give that to a pig because it worked on your cow. We can't control when people decide to take legal things into their own hands and use things in a way that is not approved by the FDA. DVMD is right that things will likely tighten up in the future. It's like when people huff spray paint or get drunk off hand sanitizer or something. All we can do is educate people. But these situations are why vets tell people to consult a veterinarian.
 
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RNtoMD87 said:
I don't get why people illegally get human drugs though. So many of my friends buy black market steroids which is so stupid. I get prescription Cypionate, for much cheaper, plus it's clean, from a physician.
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Why do people illegally get ANY drugs? Human or Animal??? It is all stupid and risks the life of the person/animal you are giving the drug to.
 
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JaynaAli said:
It can be legal for a layperson to use drugs for their labelled use at the labellled dose in the labelled species. Examples: You (generic "you") can give a cow oxytetracycline (LA-200) to treat pneumonia and pinkeye. But using it for foot rot or something else is an extra-label use and needs the order of a vet to be legal. It can't be given to a goat at all unless a vet says. Nuflor (florfenicol) is okay to give to a beef cow for respiratory disease and foot rot, but it's illegal in a female dairy cow over 20 months old. You can give Micotil (tilmicosin) to a cow or sheep for respiratory disease. But it's toxic to goats, pigs, and people so better not try to give that to a pig because it worked on your cow. We can't control when people decide to take legal things into their own hands and use things in a way that is not approved by the FDA. DVMD is right that things will likely tighten up in the future. It's like when people huff spray paint or get drunk off hand sanitizer or something. All we can do is educate people. But these situations are why vets tell people to consult a veterinarian.
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La 200! That's the other one I was thinking of, I was thinking it was something 2000 but it's LA 200! We used that and ivomec.
 
DVMDream said:
Why do people illegally get ANY drugs? Human or Animal??? It is all stupid and risks the life of the person/animal you are giving the drug to.
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Good point. No telling what's in the drugs. Seems completely insane to me.
 
I guess a lot of people don't know about it being off label/illegal. There are many big .coms that discuss giving it
IMG_3613.PNG
 
There are also probably websites that tell people how to make meth, doesn't mean that they should do it. I would recommend pulling up the actual product labels from the manufacturers, not random websites. I wouldn't consider 'tennesseemeatgoats.com' to be a highly scientific source. Look into FARAD. (goats would be considered a 'minor species' on there)

Liquamycin LA-200 - Zoetis Inc.: Veterinary Package Insert
 
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Oh I'm not saying it is. But sites telling you to how to make meth are probably very back web, not an out in the open dot com. Especially with a name like "tennesseemeatgoat" and contact info for the site owner. Just saying its very easy for an old farmer who barely knows how to use the internet like my dad to use this info. My dad never knew how to use the internet, so he relied on his books and me googling the info back when I was a kid. But he also kept a folded piece of paper with at least a hundred phone numbers on it, written in small print. He got mad at me for not doing the same. "But dad, I can store them in my phone." "Yeah but what if something happens to that phone?! Then what are you going to do?! Quit being lazy!" And it cracked me up that he would talk into the cell phone like a microphone, hold it up to his ear, then move it back to his mouth like a microphone again..

Its something how different our generations are.

Hell my girlfriends grandma believes Michelle Obama has a penis just because something on the internet said so. Many old folk don't understand how unreliable internet info is. We still can't convince maw-maw rose otherwise :laugh:
 
RNtoMD87 said:
If its illegal to give animals antibiotics, why is it legal to buy them? You cannot legally buy human drugs out of a magazine.
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That's kind of like saying "if it's illegal to give children a bottle of whiskey, why is it legal to buy it?' It is legal to give antibiotics to your own animals if they are specified on the label, and you give it for the specified reason in the specified amounts.
 
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RNtoMD87 said:
If its illegal to give animals antibiotics, why is it legal to buy them? You cannot legally buy human drugs out of a magazine.
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You're missing a huuuuge chunk of important information here, which is not unexpected given that you have very limited knowledge of what real food animal medicine is like. There are many reasons why a farmer buys his/her own abx and administers themselves under a vet's direction. There is truly too much discussion here to be had adequately via a forum. We rounded on stuff similar to this for like 3 hours on a slow day during my farms rotation.

1. Food animal vets often can't make reasonable profit off of selling abx/drugs like a SA vet can. Farmers have a hard 'cost line' they adhere to-if they go over by a dollar, they are losing more money than the animal will make at market. A bottle of LA-200 runs $70 or so right now. That means the vet has to mark that up by however much they feel is necessary for them to get an adequate revenue in (SA clinics I've worked for typically do anywhere from 50-200% depending on the true cost). Depending on what you're treating/the weight of the animal, you may be going through 40+ml of the bottle per day per animal. You can see that every dollar the farmer can save here would matter in terms of whether or not they keep the animal alive to treat vs. just euthanizing or sending to market (if the disease present wouldn't condemn the carcass). Yes, there are strict rules/guidelines as to whether any animal presented to a slaughterhouse will actually be slaughtered for meat.

2. If a vet is the only one keeping/selling the abx, can you imagine how much of their time/money would be lost by going to a 100 head (which is considered a small operation) to give antibiotics during an outbreak of something? It would be several hours, if not an entire day, to run a sizable beef herd through the chutes just for meds, and that's with help and experienced cattle movers. Dairy would go faster assuming you're not out in pasture chasing/keeping track so you don't double dose or miss a cow. Also keep in mind travel time, some ambulatory calls can be up to 2 hours away in my experience. Also make a note that small-scale operations are disappearing, and farmers are dealing with more and more large-scale operations. The amount a vet would have to charge for selling the drug as well as making sure it is given according to their direction (by giving it themselves) would be astronomical in terms of what farmers can afford/are willing to pay for. A vet can't physically carry around this much drug on their truck, either. You tell the farmer to go get enough bottles from the farm store to last them for however long, and you come back in a week or so to reassess. The vet doesn't even stick around to give the herd the first dose.

3. Farmer's don't just go to the farm supply store and say 'Oh, this drug looks good, let's go with this.' They were told directly by a vet what to get. In food animal med, you can't just decide to treat a disease with whatever you want/whatever route/however often. There are legally enforced rules/regulations. Like mentioned, people that get caught are slammed with so many fines that operations are shut down out of bankruptcy over it. It isn't always intentional (a farm hand might make a mistake, for example), but when you're caught, you're held accountable. Sure, some farmers decide they think they know what disease process is going on and decide to go pick up a bottle based on that, but I was the student on several cases the other week with 'Well doc, we treated with this because we thought it was x but it didn't work.' 'Well, it's not x, that's why it didn't work.' So the farmer learns that if they would have called the vet in the first place, they would have spent less. Sometimes they guess correctly, often they don't.

Also, if a farmer intentionally gives abx illegally, they do this knowing they risk sabotaging their own reputation. Farming is a small world.

And yes, you can get some human medications online pretty easily. It doesn't take much searching. Some require a written rx to be faxed/mailed, but that's not that big of a hurdle to overcome if you're that determined.
 
RNtoMD87 said:
Like I said it depends on the drug. But how often is an attending going to say "oh yeah. Mix that 2 mg morphine in 5 ml saline before you give it"? And if you mix it in 5 or 10 does it really matter? The risk is slamming it too fast sending the patient into respiratory depression.
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I'm an RN on the human med side; I saw this and went WTF.

If you're worried about respiratory depression, get the provider to order a different dose, a different drug, or you push it slower.
 
pinkpuppy9 said:
Maybe it's different in human med (which if that is in fact the case, I'm frightened for human patients), but I've never not been given explicit instructions on administering a drug.

Someone who is not prescribing the drug should not be the one determining how it is given, if it should be further diluted or not, etc.
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The burden of responsibility is shifted a little on the human side. Nurses are trained from day 1 to cross check orders, compatibilities, dosage, administration etc. After the orders are put in, the pharmacy does a precursory check. But we have reference tools for everything on hospital pharmacy databases so if you don't know the first and only thing you should be doing is logging into the database and confirm. "Dilute if you don't know" is wrong and potentially a dangerous practice.

If this person IS an ICU nurse they should know that dilution concentrations and patterns are hella important and are very often the cause of sentinel events in critical meds like pressors. A nurse messing with dilutions is wrong and NOT accepted practice.
 
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Melchizedek said:
I'm an RN on the human med side; I saw this and went WTF.

If you're worried about respiratory depression, get the provider to order a different dose, a different drug, or you push it slower.
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That's what I said.... you push morphine slower instead of slamming it.
 
Melchizedek said:
The burden of responsibility is shifted a little on the human side. Nurses are trained from day 1 to cross check orders, compatibilities, dosage, administration etc. After the orders are put in, the pharmacy does a precursory check. But we have reference tools for everything on hospital pharmacy databases so if you don't know the first and only thing you should be doing is logging into the database and confirm. "Dilute if you don't know" is wrong and potentially a dangerous practice.

If this person IS an ICU nurse they should know that dilution concentrations and patterns are hella important and are very often the cause of sentinel events in critical meds like pressors. A nurse messing with dilutions is wrong and NOT accepted practice.
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I wasn't speaking about meds you'd be administering in an ICU setting. When we administer those, they are already prepared for the most part. I was speaking about meds that a tech would be administering.
 
RNtoMD87 said:
I wasn't speaking about meds you'd be administering in an ICU setting. When we administer those, they are already prepared for the most part. I was speaking about meds that a tech would be administering.
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But vet techs ARE the nurses of the veterinary world, even in ICU settings, so....
 
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Oh I wasn't aware of that. I didn't realize it was a 4 year program.
 
RNtoMD87 said:
I wasn't speaking about meds you'd be administering in an ICU setting. When we administer those, they are already prepared for the most part. I was speaking about meds that a tech would be administering.
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Of which you have very well established that you have NO CLUE what meds a tech might be administering.

You weren't talking about what a tech would be administering, you were very clearly talking about your nursing experience and what you would do in nursing. Quit back-pedaling.
 
No, I figured a tech would have the same administration ability as an MA. I went through 4 years of school to know how much to dilute each medication I give, not to mention years of experience. I didn't realize techs were nurse equivalents. That's really cool that they can administer meds in an ICU setting.

When it comes to human medicine, most drugs we give either say on the packaging the dilution (which if those drugs did, the tech wouldn't be asking), or it doesn't matter. For instance, pantoprazole is ALWAYS 10ml dilution. But many things it truly doesn't matter within reason. Once again, I ask, what does it matter if I dilute morphine in 5 ml or 10ml or meropenem in 20 or 30 ml? It doesn't. What matters is that you don't depress the patient's respiratory drive, or cause extravasation by pushing too rapidly. Many antibiotics such as vancomycin obviously cannot be pushed, and I wouldn't infuse them over 170 or so ml/hr.
 
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It matters because in vet med our patients are different sizes and we have to be frugal. My impression is in human Med you have a lot of single use vials of stuff, but in vet med we may have patients share a vial or use it for more than one dose if the stability is there. Pantoprazole is expensive. It’s given once a day and only good for 24 hours once it’s reconstituted so a little dog won’t use it all. If I have a second dog getting it, I can maybe split the cost between the two dogs. If you dilute it to something other than what you’re told, and when I ask another tech to grab to bottle opened for Dobby earlier in the day and give 3 ml to Harry, Harry might not get the correct dose because you’re off writing your own dilutions. Another example would be a 1lb kitten...if you dilute its meds in twice the volume you run a real risk of fluid overloading the patient because you have to account for diluents in the meds when calculating fluid volumes for something that little. I’ve had patients receiving less than 5 ml of fluids per hour before to meet their needs and everything counts.
 
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Yeah, that makes a lot of sense, thanks for the response Jayna. It is enlightening to see how medicine differs in various settings. Youre right about the single use vials. We either use the entire vial, or discard it and get a new one. I didn't realize vets reused vials.
 
RNtoMD87 said:
I didn't realize vets reused vials.
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Yup, within a certain time frame. We also store the unused volume from ampoules of drugs, (transferring it to a safer, air-tight container). And most of us reuse ET tubes and a smattering of other things that are single-use in the human field.
 
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CalliopeDVM said:
Yup, within a certain time frame. We also store the unused volume from ampoules of drugs, (transferring it to a safer, air-tight container). And most of us reuse ET tubes and a smattering of other things that are single-use in the human field.
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Oh wow. Interesting. I guess as long as you used a filter tip needle to transfer from an ampule, it wouldn't really cause a problem.
 
The are a few exceptions. For MOPP protocols for canine lymphoma, I believe (maybe an onco here can double check me) you cannot double dip mustargen. Hence why clients have to buy the whole bottle even if the dog only needs a small dose.
 
RNtoMD87 said:
Oh I wasn't aware of that. I didn't realize it was a 4 year program.
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Some programs are four, some are two, and they have to be accredited by the AVMA (American Veterinary Medical Association) Committee on Veterinary Technician Education and Activities (CVTEA). In terms of heirarchy, licensed vet techs (LVTs or RVTs, not "vet assistants" - the latter is a generic non-degree term) are on par with nurses at most human hospitals in terms of ability to administer drugs under the direction of attending vet.
 
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Ahh... okay. I thought vet tech =vet assistant. Makes much more sense to me now.
 
WhtsThFrequency said:
Some non-licensed techs and assistants who have been in the field for long periods of time are trusted as much as LVTs/RVTs, to be fair. But that is on a case-by-case basis.
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Yup, and I've met licensed and trained techs who aren't (and shouldn't be) trusted at all --- as you said, on a case-by-case basis.
 
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It's sort of that way in the human field, but not as extreme. I don't trust some nurses to wipe an ass, but when it comes to CNAs, the very worst I've seen was wiping patients faces with bleach wipes (even after being reeducated), and after she got fired we now have one that just watches tv and gets pissed if you ask her to do anything. She sits in the break room and watches tv. I hid the remote and she left the unit to watch tv somewhere else. (Takes forever to build a paper trail to fire someone).

The best CNAs I have, I trust to take vitals and do dressing changes that I've already inspected. One thing I never let UAP do from experience is take blood glucose measurements. At my first job fresh out of school one time I asked a CNA "hey, you forgot to take this blood glucose?" And she said "aww no baby! I accidentally wrote them in the wrong boxes. I shifted them down." Yeah well I had given someone 12 units of insulin that had a BG of much lower than the 350 or so I was treating for. Got them to drink a bunch of orange juice and called the MD. No adverse effect but scary nonetheless. Huge facility ball drop in my opinion. Ironically this facility did not let unlicensed personnel take vitals.
 
RNtoMD87 said:
It's sort of that way in the human field, but not as extreme. I don't trust some nurses to wipe an ass, but when it comes to CNAs, the very worst I've seen was wiping patients faces with bleach wipes (even after being reeducated), and after she got fired we now have one that just watches tv and gets pissed if you ask her to do anything. She sits in the break room and watches tv. I hid the remote and she left the unit to watch tv somewhere else. (Takes forever to build a paper trail to fire someone).

The best CNAs I have, I trust to take vitals and do dressing changes that I've already inspected. One thing I never let UAP do from experience is take blood glucose measurements. At my first job fresh out of school one time I asked a CNA "hey, you forgot to take this blood glucose?" And she said "aww no baby! I accidentally wrote them in the wrong boxes. I shifted them down." Yeah well I had given someone 12 units of insulin that had a BG of much lower than the 350 or so I was treating for. Got them to drink a bunch of orange juice and called the MD. No adverse effect but scary nonetheless. Huge facility ball drop in my opinion. Ironically this facility did not let unlicensed personnel take vitals.
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You thought she didn't take it, but you gave insulin anyways? I'm confused.

Communication errors happen everywhere, even with the best personnel. Very frustrating and can certainly endanger patient care
 
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pinkpuppy9 said:
You thought she didn't take it, but you gave insulin anyways? I'm confused.

Communication errors happen everywhere, even with the best personnel. Very frustrating and can certainly endanger patient care
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No it was missing on a patient that I knew was an accuchek, and she was like "oh no! Here is that one below it/above it" (can't remember which) but she had written them all in the wrong box. Think like an excel spreadsheet style format. She had written b2s result next to a1, c2 next to b1 etc. so she wrote say 405 BG next to a patient that in reality was maybe 195 or something. And I treated that patient for 405 BG instead of 195. Huge lesson learned. Took my own accucheks regardless of facility policy from then on. (Not to mention always rechecked something that high anyway.


Also left that LTAC. 8 patient load, long redundant paper charting, no history provided on patients many times, unstable patients that needed to be in a much more acute facility, patients kept in the hospital that weren't sick, etc. Plus it would be maybe 2-3 RNs, myself, the Charge nurse and maybe one more, and the rest were LPNs. We had to do all of their teaching, initial assessments, central line blood draws, and IV push medications since none of that is in their scopes.

It wasn't worth the 50 an hour I was being paid. I came on shift at 1830, and if I got everything done that I needed to, no way I would be out before 0900. But if we were there after 0745 we got harassed for incidental overtime.

New facility is MUCH better. 3-4 patient load, incidental overtime is fine, and I clock in at 1830 and leave by 0710 every day, with plenty of time to spare. No balls to the wall rushing = safer, happier patients.
 
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RNtoMD87 said:
Yeah, that makes a lot of sense, thanks for the response Jayna. It is enlightening to see how medicine differs in various settings. Youre right about the single use vials. We either use the entire vial, or discard it and get a new one. I didn't realize vets reused vials.
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I treat lots of small exotics and regularly have drugs where we use 0.01-0.05mL of meds (especially in anesthesia). A single use vial would be hilariously wasteful lol.
 
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I think what's fascinating about veterinary is being able to know so many body systems. As an exotic animal vet, about how many families of animals are within your knowledge?
 
RNtoMD87 said:
I think what's fascinating about veterinary is being able to know so many body systems. As an exotic animal vet, about how many families of animals are within your knowledge?
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I treat mostly small animals (dogs, cats) tbh. But I also see basically all the exotics in our city because we're the only clinic that treats them and I'm the one at my clinic who likes them. I routinely see birds (from chicken/ducks to zebra finches from petsmart to big ass macaws/cockatoos), small mammals (guinea pigs, ferrets, rabbits, rats, occasional hedgehog and others) and reptiles (mostly snakes and small reptiles like bearded dragons/leopard geckos). I've treated one total primate as a vet... a capuchin. ;)

In school we learned fish/amphibian/invertebrate medicine, but that knowledge is quickly leaving me because you can imagine the caseload is pretty low. You just do a lot of looking things up and treating the treatable. There are uniquities to all species but honestly, imho half the fun of vet med is extrapolation and improvising, and knowing a little about a lot of things while human med is much more focused.
 
RNtoMD87 said:
Yeah, that makes a lot of sense, thanks for the response Jayna. It is enlightening to see how medicine differs in various settings. Youre right about the single use vials. We either use the entire vial, or discard it and get a new one. I didn't realize vets reused vials.
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Saving client money is never thought of in human med. Human med is far more inefficient. I mean we will use the same fluid bags for multiple patients (assuming the patient didn't need most/all of the bag, or it wasn't hooked up to a catheter), among many more things. As long as nothing is contaminated, we use it for multiple patients.
 
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Yep. We generally do everything we can to reduce cost, or else the clients won't pay and it's the animal who suffers. People don't have a concept of how much medicine costs to perform because of insurance. I mean, how much does a hysterectomy cost for a person? Thousands, I'm sure. Heck, even a biopsy with path readout? Probably still quite a bit. Yet we quote a hundred or so for a spay, or sixty bucks for an incisional biopsy, and people lose their minds.

Financials always have to be in the forefront of our minds, which sucks. People don't understand the cost of paying your techs, keeping your lights on, payments on your X-ray machine, surgical tools, medications, anesthesia equipment, etc etc. not to mention our horrendous school debt payments. Which is why it drives us nuts when people say vets are in it for the money.
 
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