Class of 2015... How ya doing?

Veterinary Science Graduate Certificate from UofI
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nyanko said:
I don't get the "ivory tower of internship" thing. At most internships you feel like cheap ER labor (even if in the end, you did learn a ton). You know what happens in the ER? 90% of what you recommend gets declined and you have to come up with alternate plans or send a patient home to die if the owner doesn't believe in euthanasia etc.
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To me, it's being able to offer the higher tech toys, having multiple specialists available, having consistent help and often times having people that understand they're going to be paying more for what you're offering. I understand if it's a private practice/private ER internship you're going to get much of the same thing I see in the GP trenches, but for all of the academic and/or specialty-based internships, you're already selecting for clients who are often more willing to go with your recs. Sure, sometimes I send someone to a specialist and they opt to literally do nothing, but more commonly people follow their recs/pursue further diagnostics or treatment or even just agree to things I had previously offered and they declined.

Edited just for clarity: I'm not trying to knock the academic training, and I don't mean to come across as disdainful.
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that redhead said:
To me, it's being able to offer the higher tech toys, having multiple specialists available, having consistent help and often times having people that understand they're going to be paying more for what you're offering. I understand if it's a private practice/private ER internship you're going to get much of the same thing I see in the GP trenches, but for all of the academic and/or specialty-based internships, you're already selecting for clients who are often more willing to go with your recs. Sure, sometimes I send someone to a specialist and they opt to literally do nothing, but more commonly people follow their recs/pursue further diagnostics or treatment or even just agree to things I had previously offered and they declined.

Edited just for clarity: I'm not trying to knock the academic training, and I don't mean to come across as disdainful.
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I think this depends a little bit on the academic er as I have sent a lot of things home without doing much of anything. We are more rural and are the only er for 150 mi so we see it all. This was extremely untrue where I went to clinics and everyone there during day er came in the door with the multi thousand dollar quote from their vet. It's very interesting to me to see such extremes
 
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I wasn't rural in LA or NY but the ERs at my rotating and specialty internships certainly had our fair share of people coming through the door either as first-opinion emergency or even sometimes from their GP vets without an accurate expectation for costs.

Even the referred cases sometimes had no idea that we were going to recommend a four-figure MRI or CT or surgery or whatever.
 
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nyanko said:
I wasn't rural in LA or NY but the ERs at my rotating and specialty internships certainly had our fair share of people coming through the door either as first-opinion emergency or even sometimes from their GP vets without an accurate expectation for costs.

Even the referred cases sometimes had no idea that we were going to recommend a four-figure MRI or CT or surgery or whatever.
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Well. I think it's shades of gray, right? I mean, even the highest-tech 95% referral-only facility in a rich suburb still is going to see first-line patients from owners who don't have money or don't want to spend it. Nobody is saying that being at a busy specialty practice or academic internship means everyone is willing to pay top dollar for advanced care.

But I still think it's probably accurate to say that in general people come to the academic ER (or referral specialty practice) more often prepared to spend money than those that show up at a GP or a rural ER or that sort of thing.

I'm in an unusual situation that makes it very easy for me to see the difference. We have 7 hospitals. Three are in out-state regions (Duluth, St. Cloud, Rochester) and four are in the Twin Cities metro area. Two of our metro area hospitals are co-located with a well-known, multi-state referral/specialty practice. While I predominantly work at our metro hospitals, I have worked at every one of our hospitals except Duluth, and I still work at Rochester and St. Cloud occasionally.

There is a marked difference in clientele. In the metro hospitals - especially at the ones co-located with the referral practice - clients are much more likely to come prepared to spend a lot of money. At Rochester and St. Cloud? A noticeably higher percentage show up, see the price tag, and do the euth or "Uh, I'll just watch him overnight and take him to my vet in the morning" thing.

So yes. I think there is a big difference.
 
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Of course it's shades of grey, I just roll my eyes so hard at the whole IVORY TOWER HURF thing that I may develop some manner of strabismus. I actually kind of enjoyed having to come up with alternate plans for diagnostics and treatment when people had a limit, and was grateful for clients who let me know up front they did. I felt like it allowed me to use my brain more to think about what would give me the most information and where the money would best be spent for the patient.

Sure, it was a bit stressful to send a dog home immediately after tapping its pneumothorax and then having them come back for free under-the-table x-rays at 6 am, or treating and keeping an eclampsia dog for 10 hours for less than the cost of the exam and sending it home at 5 am with some Tums before the seniors came in for rounds, but there was some thrill in the whole thing that I just didn't get as much from the I'll-do-everything-plus-some DKA cases.
 
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I mean, and even in the same city clinics select where to send their clients for emergency care... we have the vet school, several specialty hospitals, and a couple more humble emergency clinics in our city area. It's not 100%, but in general the "nicer" clinics are the ones that refer their clients to the school/specialty places after hours vs. the just generic e-clinics.
 
nyanko said:
Sure, it was a bit stressful to send a dog home immediately after tapping its pneumothorax and then having them come back for free under-the-table x-rays at 6 am, or treating and keeping an eclampsia dog for 10 hours for less than the cost of the exam and sending it home at 5 am with some Tums before the seniors came in for rounds, but there was some thrill in the whole thing that I just didn't get as much from the I'll-do-everything-plus-some DKA cases.
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And I respect that you make it work for those patients and their people. But where I am, the former situation is the more common and loses its thrill pretty quickly when all you get to practice is patch-work medicine because you can't actually work up a case properly. The carte blanche is more exciting for me because I actually get to use my brain cells and the tools at my disposal to figure out what's happening. Maybe you're in the wrong part of vet med?! ;)
 
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No I'd kill myself if I had to do vaccines and itchy skin all the time. I'll stick with neuro, thanks. :D

edit: I'm not even sure I'd know what to talk to someone about at a wellness visit, haha
 
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nyanko said:
Sounds complicated. I'll just go with the simple circuit of the nervous system. :)
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Praise Jesus people like you exist :bow: Pretty sure all my consult cases are like "lol silly GP, it's obviously suppuratogranulomatous meningioencephaloradiculitis of the mediradiulnar branch of the brachial symphysis"and I'm just like "....oh yes, why didn't I think of that?!"
 
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that redhead said:
Praise Jesus people like you exist :bow: Pretty sure all my consult cases are like "lol silly GP, it's obviously suppuratogranulomatous meningioencephaloradiculitis of the mediradiulnar branch of the brachial symphysis"and I'm just like "....oh yes, why didn't I think of that?!"
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Exchange "GP" for "all other types of dvms" to make your statement more accurate haha. As a side note, we are having the Neuro weekend of hell on Er and it's terrible. At least 70%of our cases for the last few days have been Neuro. Ugh. Least favorite and most likely to spontaneously die haha
 
Trilt said:
This is totally going as a differential in my next record.
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That's funny. The more cases I see, the closer my differential dx lists come to "something wrong I don't know what but I'm going to give it sq fluids, famotidine, and see how it does kkthxbai peace out"
 
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LetItSnow said:
That's funny. The more cases I see, the closer my differential dx lists come to "something wrong I don't know what but I'm going to give it sq fluids, famotidine, and see how it does kkthxbai peace out"
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My ddx lists are pretty sad nowadays. "Assessment: open" is a good fall back when I really have zero idea :laugh:
 
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LetItSnow said:
That's funny. The more cases I see, the closer my differential dx lists come to "something wrong I don't know what but I'm going to give it sq fluids, famotidine, and see how it does kkthxbai peace out"
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my own personal kitty is vomiting. this is basically what I've done.
 
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that redhead said:
Praise Jesus people like you exist :bow: Pretty sure all my consult cases are like "lol silly GP, it's obviously suppuratogranulomatous meningioencephaloradiculitis of the mediradiulnar branch of the brachial symphysis"and I'm just like "....oh yes, why didn't I think of that?!"
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*twitch*

*twitch*

Must.

Hold.

Back.
 
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LetItSnow said:
Oh knock it off. You know you pathologists love your fancy stack-them-all-together terminology. Whereas the rest of us are like "Diagnosis: Broken leg."
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I was reading a pathologist report the other day and it was all could be blah blah blah but can't rule out bleh bleh bleh and meh meh meh should also be a consideration. Consider presentation when interpreting. They have so many words to basically say, "we think it is x but y and z can't be ruled out. "
 
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DVMDream said:
I was reading a pathologist report the other day and it was all could be blah blah blah but can't rule out bleh bleh bleh and meh meh meh should also be a consideration. Consider presentation when interpreting. They have so many words to basically say, "we think it is x but y and z can't be ruled out. "
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DACVP also stands for Diplomate of Ass Covering and Vague Predictions.
 
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90% of my cytology reports get to end in..."If clinically warranted, consider histopathology for additional diagnostic information." [insert 'grease monkey' comment from WTF, haha].

Edit: sometimes I go crazy and substitute 'warranted' for 'indicated.'
 
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I don't know what I just read, but I love all of it. Reminds me, if you aren't in a FB group called Not One More Vet, you should ask one of us SDNers to have you added (they check people to make sure they're vets before added). The goal is to be supportive toward fellow vets experiencing illness or entertaining suicide, but a bunch of random **** gets posted as well, plus random questions about cases. It has its moments as any page does, but it can be quite entertaining too. I know I've seen a few familiar names on there already...can't hurt to add a few more.
 
I find DACVR to be very similar tbh. Consider CSF analysis if clinically indicated.

edit: THANKS YES WE ALREADY DID THAT AND THE DOG IS AWAKE FROM ANESTHESIA NOW.
 
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Most of my histopaths lately are "looks like this, BUT you should do this, this, and probably that, just to be sure." Owners love that:wacky:. I do understand the CYA aspect of it, though.
 
psilovethomas said:
Most of my histopaths lately are "looks like this, BUT you should do this, this, and probably that, just to be sure." Owners love that:wacky:. I do understand the CYA aspect of it, though.
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lil-wayne-money.gif
 
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Nothing makes me grumpier than submitting rads for radiologist review and them not finding anything. C'mon, you're supposed to have the imaginoscope and see the obvious problem I'm missing! Wah.
 
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nyanko said:
I find DACVR to be very similar tbh. Consider CSF analysis if clinically indicated.

edit: THANKS YES WE ALREADY DID THAT AND THE DOG IS AWAKE FROM ANESTHESIA NOW.
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If I had a nickle for every "hepatomegaly" or "microhepatica" they over-interpreted because the stomach wasn't perfectly aligned to the ribs....
 
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Every pig we've ever sent to necropsy for sudden unknown death has invariably come back with septicemia. EVERY SINGLE ONE. :yeahright:
 
Trilt said:
Nothing makes me grumpier than submitting rads for radiologist review and them not finding anything. C'mon, you're supposed to have the imaginoscope and see the obvious problem I'm missing! Wah.
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Its worse when they DONT see the problem that you (and others) do...like an SI obstruction, or free gas in the abdomen to name a few...

5 shifts down 2 to go! Unless we get a vent case. In which case, I'm screwed and will have to spend the next 48 hours in the hospital. But here's to hoping that doesn't happen since I've already spent a full 25 hours there once this week (so far i've worked 5 shifts in 4 days for a total of nearly 65 hours. this weekend promises to have many more hours too. at least 24 if i'm lucky, more if i'm not). i'm so tired and emotionally exhausted. i've had some tough cases. one of said cases (that died) was one of the hardest, if not the hardest, case i've ever managed both from a medical and even more so from an emotional stand point (3yo dog came in BAR and bouncy after vomiting twice. was in anuric renal failure less than 24 hours later, and was dead despite dialysis 40 hours later from probably ethylene glycol toxicosis. my soul feels broken over this one. yes i knew the dog was doomed, but a 3 year old dog went from normal to dead in the blink of an eye. my dog is 3.)
 
jmo1012 said:
Its worse when they DONT see the problem that you (and others) do...like an SI obstruction, or free gas in the abdomen to name a few...

5 shifts down 2 to go! Unless we get a vent case. In which case, I'm screwed and will have to spend the next 48 hours in the hospital. But here's to hoping that doesn't happen since I've already spent a full 25 hours there once this week (so far i've worked 5 shifts in 4 days for a total of nearly 65 hours. this weekend promises to have many more hours too. at least 24 if i'm lucky, more if i'm not). i'm so tired and emotionally exhausted. i've had some tough cases. one of said cases (that died) was one of the hardest, if not the hardest, case i've ever managed both from a medical and even more so from an emotional stand point (3yo dog came in BAR and bouncy after vomiting twice. was in anuric renal failure less than 24 hours later, and was dead despite dialysis 40 hours later from probably ethylene glycol toxicosis. my soul feels broken over this one. yes i knew the dog was doomed, but a 3 year old dog went from normal to dead in the blink of an eye. my dog is 3.)
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I had a very similar case in a 2 year old dog just last week.... except cause was likely fungal... sucked so bad.
 
jmo1012 said:
Its worse when they DONT see the problem that you (and others) do...like an SI obstruction, or free gas in the abdomen to name a few...
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I've had a few of these too. Most recent were rads I sent over because I thought the proximal humerus looked a little moth eaten on a young-ish medium sized dog. PE had localized the pain to the carpus so I was confused and wanted a second opinion. They said it was positioning/overlay of the soft tissues or something like that.

Three weeks later the dog had a palpable bone tumor and lung mets. That was a horrific convo with the owners.
 
My time management skills need improvement...someone described it best the other day when he said he's just very optimistic about the amount of time it will take to complete tasks, and thus he is chronically late. Same here, and I'm also chronically under motivated haha.
 
You guys are all downers. Don't you ever celebrate the wins? :)

P.S. I just got an update from IntMed on the PCV 92% case I saw a little while back. Doing great. Rock on.
 
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LetItSnow said:
You guys are all downers. Don't you ever celebrate the wins? :)

P.S. I just got an update from IntMed on the PCV 92% case I saw a little while back. Doing great. Rock on.
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I had a win today, all of the clients I saw, except one, were super awesome people who actually listened to my advice and suggestions. I don't know what was in the air or water or whatever but I hope it sticks around for at least one more day, the rest of the month would be awesome and forever would be a damn miracle.
 
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DVMDream said:
I had a win today, all of the clients I saw, except one, were super awesome people who actually listened to my advice and suggestions. I don't know what was in the air or water or whatever but I hope it sticks around for at least one more day, the rest of the month would be awesome and forever would be a damn miracle.
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This isn't even your thread. Goon.
 
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LetItSnow said:
You guys are all downers. Don't you ever celebrate the wins? :)

P.S. I just got an update from IntMed on the PCV 92% case I saw a little while back. Doing great. Rock on.
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Haven't had any real wins lately but seeing a goofy lab puppy was a nice reprieve :)

Edit - and I start almost a week of staycation today!
 
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Today's wins:

1) OHE on 112 lb mastiff, recently in heat (tied with the other dog in the house 2 weeks ago) - went beautifully and my incision was the prettiest I've ever made.
2) Got to see my mom's dog today, found a new mass, might have talked her into lumpectomies.
3) Didn't go to my 10 yr high school reunion and instead sat my butt on the couch and watched tv.
 
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