Question about surgery

[thereservoirdog]

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This week was my first time shadowing a vet and yesterday I watched my first surgery. Before that, I read a few news reports about human patients waking up during surgery and being able to feel all the pain, but not being able to give a signal since they were paralyzed from the drugs. So during the surgery on the chihuahua , I kept thinking about this and wondering if it could feel what was happening and I nearly fainted(embarassing). I heard that there are like 20,000 cases a year of people waking up during surgery. Is it possible for that to happen to animals?

sorry if it's a stupid question, it's just one thing that's been bugging me

 

[CookieBear]

I may be totally, completely and utterly wrong about the following... so... here's hoping no one will jump on me with this post. I'm sure the vets and/or vet students on here know way better than I.

I've been under the impression that injectable drugs like simply ketamine/valium simply paralyzes and does not imbue true anesthetic benefits (analgesia) - and that these animals can feel the pain.

I'm under the impression that gas inhalant anesthesia (isoflurane, sevoflurane, etc.) are true analgesics and that the animal is not feeing anything once under the effects.

Propofol, I'm also believing, is an injectable anesthestic - i.e., no feeling of pain.

Telazol? I think that's up there with ket/val? But I don't know.

I've unfortunately seen animals wake up during procedures. I've only been an observer in those cases, but I can't help but feel that much more motivated to study hard in school and to learn the best anesthetic practices so that I can help insure that animals I'm working on will NOT wake up unless I'm ready for them to! I don't know if this happens elsewhere. I haven't seen it often, but I've seen it.

 

[CookieBear]

This week was my first time shadowing a vet and yesterday I watched my first surgery. Before that, I read a few news reports about human patients waking up during surgery and being able to feel all the pain, but not being able to give a signal since they were paralyzed from the drugs. So during the surgery on the chihuahua , I kept thinking about this and wondering if it could feel what was happening and I nearly fainted(embarassing). I heard that there are like 20,000 cases a year of people waking up during surgery. Is it possible for that to happen to animals?

sorry if it's a stupid question, it's just one thing that's been bugging me

By the way, semi off subject, but I recall an episode of The Twilight Zone that had a guy waking up on the table of the medical examiner... 😱

I won't ever forget that one!

 

[Bill59]

The biggest problem is when you're using a neuromuscular blocker, like pancuronium along with an anesthetic. These are often used in human medicine to decrease muscle tone to make intubation and ventilation easier. In this case, if the anesthetic level gets too low, the patient would become aware but you may not notice it because they're unable to move.

Neuromuscular blocker are rarely used by veterinary general practitioners. With most of the commonly used anesthetics, such as isoflurane and the injectables, as the anesthetic level starts to get too low, you usually see increased respirations and some muscle movement before awareness. If the anesthetist is on top of things, you can increase the gas, bolus an injectable or something else to get the patient deep enough again.

FYI, ketamine is a dissociative anesthetics, not paralytic. It provides good analgesia at high enough doses.

Diazepam (Valium) is a tranquilizer/sedative. Alone, it's not sufficient for anesthesia, so it's often combined with other drugs. In fact using multiple drugs (balanced anesthesia) is common these days.

Telezol is tiletamine, a dissociative similar to ketamine, and zolazepam, a tranquilizer similar to diazepam.

 

[VelcroSky]

By the way, semi off subject, but I recall an episode of The Twilight Zone that had a guy waking up on the table of the medical examiner... 😱

I won't ever forget that one!

That actually used to be a big problem. In the early days of western medicine it would seem that even death was a common misdiagnosis. It was hard for anatomists to find bodies to examine partly because people had a legitimate fear that they would wake up on the dissecting table.

 

[ckgilabert]

well! i was volunteering at the humane society and i saw a dog almost wake up during surgery. it was basically coughing and they increased the gas for the dog.

i just hated seeing dogs wake up and cry/howl because they were in pain. i cant wait till i volunteer somewhere else to see how they handle thngs.

 

[silverelf]

i just hated seeing dogs wake up and cry/howl because they were in pain. i cant wait till i volunteer somewhere else to see how they handle thngs.

that's probably going to happen everywhere. There is only so much pain medication you can safely give an animal and sometimes its still just not enough. (See any episode of House if you don't believe me). Some dogs also howl because they are so disjointed during the wakeup from anesthesia...they are so out of it that they don't know where they are and what's going on. This is what happens to my Corgi whenever I put her under...even if its minor like a tooth pull or small lumpectomy, she howls like mad when she's waking up, and I don't think it has anything to do with pain.

 

[sofficat]

Some dogs also howl because they are so disjointed during the wakeup from anesthesia...they are so out of it that they don't know where they are and what's going on.... and I don't think it has anything to do with pain.

i totally agree. some animals are so disoriented that when they are waking up the room is spinning and they are flying high. just b/c they are howling doesn't mean they are in pain. as a new volunteer and shadower (is that a word?) it is important to understand the differences b/t being high and being in pain. and NEVER feel afraid to ask the doctor if you think an animal is in pain. if a doc gets mad at you for asking, screw him/her. we need to make sure that our patients are comfortable.

 

[VelcroSky]

i totally agree. some animals are so disoriented that when they are waking up the room is spinning and they are flying high. just b/c they are howling doesn't mean they are in pain.

That's true. Apparently when I was waking up after the surgery that I had, I was pretty loud, making stupid jokes etc... It was fun! 🙂

But also, it was my impression that we have to keep animals a little less under because we usually don't have as sophisticated of a monitoring system in place that we do for humans and since we are basically dancing around that thin line of too much, it is better to err on the side of not enough than too much. But I could be wrong about that, it's just my impression.

 

[bakaduin]

Although we change up our medication procedures on a dog by dog basis (depending on blood, ECG, etc) our most common plan though is Ketamine/Valium as a premed with Atropine (depending on heart rate) and during surgery isoflurane.

 

[Pigsfoot]

ditto here-we use ketamine/ace, give a dose of atropine and then use iso during the entire surgery-iso's nice esp. cuz you can vary the amounts during surgery and if you *think* they may be light, you can heighten the amount and pretty much watch the heart rate decrease and them fall back into lovely relaxation....

 

[sofficat]

why premed with atropine? i don't understand the medical reasons behind it.

 

[bakaduin]

Atropine (or glycopyrrolate for that matter) is often used as a premed because studies have shown that its safer to use anticholinergics as a premed in the treatment of bradycardia as opposed to giving it once the heart rate drops.

 

[ratbandit]

By the way, semi off subject, but I recall an episode of The Twilight Zone that had a guy waking up on the table of the medical examiner... 😱

I won't ever forget that one!

I was listening to a Steven King book on tape in the car (I know I'm a dork) called Autopsy Room about a guy who got bit by a snake and was alive when they were going to do his autopsy. CREEPY!

 

[sofficat]

Atropine (or glycopyrrolate for that matter) is often used as a premed because studies have shown that its safer to use anticholinergics as a premed in the treatment of bradycardia as opposed to giving it once the heart rate drops.

how often is atropine used to treat bradycardia during sx anyways? where i work (and have worked), we never premed with atropine and we have never had to give it due to bradycardia. it seems unnecessary to pre treat with it when it is rarely needed. this is just my opinion, but i haven't read any research on it... just from experience.

 

[silverelf]

how often is atropine used to treat bradycardia during sx anyways? where i work (and have worked), we never premed with atropine and we have never had to give it due to bradycardia. it seems unnecessary to pre treat with it when it is rarely needed. this is just my opinion, but i haven't read any research on it... just from experience.

atropine is more of an "old-school" drug....it was often used in conjunction with acepromazine (the "ace/atro" you often hear in old medical shows) as a pre-med. I work with a surgeon who graduated from vet school in the 60s...he swears by the stuff and HATES it when I premed his surgeries with our "superbag" combination (a pleasantly yellow cocktail of drugs the younger vets came up with). In the same vein, he also hates ket/val and only wants to use pentathol....just stuck in his ways 🙂

 

[Nexx]

Atropine is a very common pre-med, and no it isn't old-school. Using it in certain combinations may be, but it is a very important drug.

It is especially indicated in older animals and breeds prone to bradycardia. (Schnauzers, Cockers, etc). In this case it is sometimes good to perform an atropine response test (Give the atropine IM, check heart rate/run ECG 30 min after) and if you have a positive response (generally speaking a heart rate between 120-200 Bpm you are good to proceed with anesthesia.

However if you have an older dog with damage to the sinus node and a heart rate of 85 bpm already you run the high risk of running into complications when you put them under. So basically if you don't have atropine or glycopyrrolate in your clinic (doubtful) or don't run preanesthetic ECGs on your patients I would call into question quality of care.

Many times it is used as a pre-med for dentals simply because it helps decrease salivation as well.

Sofficat, I don't have data on how often it is used, but I work in a facility where we perform a LOT of electrocardiograms on a daily basis. Most of them are pre-operative for clinics heading to anesthesia and I would venture to guess that in at least 50-60% of those we recommend atropine challenges or just simply pre-medding with atro prior to induction. That being said in a normal practice might see more of a rate of 2-5% of their patients needing pre-meds. Then again it depends on the age of the patient, if they have any respiratory/ocular diseases (or other conditions that cause increased vagal tone). Basically if you are seeing a lot of "routine" procedures on healthy animals you probably will have a lower incidence of bradycardia. Another factor influencing things is the choice of anesthetics the doctor uses. For instance using ketamine will increases heart rate/cardiac output/blood pressure.

 

[sofficat]

thanks for all the info

....don't run preanesthetic ECGs on your patients I would call into question quality of care.

i don't really see not running ecgs before sx being poor or even low quailty of care. i've worked at many a.h and the only hospital that would push it was a corp. hospital and even then we rarely did them. unfortunetly, we are lucky to get people to do pre sx b/w and iv cath. ecg? good luck. it just seems like people have the... 'he'll be fine, in the old days they never had to do that stuff' attitude. it sucks, but it is often true.

 

[Nexx]

It is low quality of care. Would you want to go to anesthesia without having a complete workup? When you turn 30 do you want to go into the doctor and not have a complete workup performed prior to surgery? I know I wouldn't.

But I know where you are coming from in trying to sell it to many owners. The thing is, it all depends how you market it. Can you do a preliminary ECG in-house for almost no cost? Yep, one tech and 15 minutes could perform a complete ECG tracing and have results back from a specialist for a total clinic cost of $25-$30. This cost could easily be built-in to the cost of a surgery. If you have owners who don't want to pay that initially clinics can throw in an in-house scan, and as long as the doctor has a decent handle on ECG basics (rates, rhythms, waveform limits, etc) you can at least rest in relative comfort until a problem arises and the cost to the clinic is minimal.

I talk to doctors on a daily basis who have performed surgery and are either seeing severe abnormalities during surgery and need help, or they have a patient who is in congestive heart failure 3 days after having an elective dental performed. Fluffy went in for stained teeth and now needs heart meds and an echocardiogram. Where could that $150 been spent more effectively? Cleaning the teeth or working up a heart condition that most likely would have presented some evidence on an ECG?

I know it is hard to talk owners into spending extra money when they can go spend $65 at the humane society to have a neuter/spay done. But you get what you pay for. Sorry for the quasi-ranting but I see a lot of incompetence on a daily basis from vets who I know to be both old and new.

Examples from the last 3 weeks:
-I could take chest rads but I wouldn't know what I am looking at.
-I gave atropine, but the heart rate just won't come down so I gave another dose and the heart rate is still 300.

I'll end the examples here, but there is at least one good one on a daily basis, but at least they are calling for help!

 

[bakaduin]

Nexx I forgot to mention decreased salivation! Good call on that. I agree with you totally though, any clinic that isnt doing ECGs on atleast the aging dogs is giving a poorer quality of care. We use Veterinary Heart Institute in Gainesville to do our ECGs. Its childs play, call up the company on the phone, put the leads on the dog/cat and let it run across the phone line. It takes 15 minutes and can be a life saver. As Nexx stated, you wouldnt go into surgery in your 30s/40s without getting blood work and a full work up so why would you expect your 8-9 year old dog to? I cant count how many times the specialist gives us special instructions on premeds/maintenance because of the dogs health. For instance we had a cat in the other day for a dental, older, ran an ECG and it had an abnormal heartbeat. They told us to hold off on the dental and run blood which revealed the cat had hyperthyroidism! Thanks ECG!

 

[Spartanvet4cows]

Yeah, from what they told us in anatomy when we were learning about the parasympathetic nervous system is that atropine is given to compete with its receptors and inhibit its action. This decreases salivation, mucus production, GI motility, and prevents a decrease in heart rate below its basal rate. My profs said they routinely do it because it prevents excess mucus buildup in the lungs during intubation, and prevents bradycardia.

Nexx....someone actually gave atropine to SLOW a heart rate!? Yikes! Run, run as fast as you can, or at least don't let that doc see your animals!

 

[birdvet2006]

Sofficat:

I agree, atropine is not necessary. There are 2 main schools of thought that I have encountered. Some vet schools still teach that atropine should be used in almost every pre-med. Other schools (such as the Uni. of Glasgow and Oregon) teach that atropine/glyco should be used *only as emergency drugs*.

Anaesthesia is an art. You will find many ways that people do things, and they may not necessarily be wrong.

As to ECGs, I'm not a fan of them for anaesthesia (other than they come with most fancy monitoring systems). Did you know that the ECG continues to work and without alarm when an animal is dead? That's because the heart continues to move even when dead.

Some of my favourite monitors are blood pressure (indirect is most practical with small animals) and the pulse oximeter. Temperature is also important to monitor. These 3 things combined are my fav's. Now capnogaphry is supposed to be THE best, but I still haven't really learned to interpret it well. 🙁 ECGs -- phooey, I say.

 

[CookieBear]

Yes... I've seen the monitors lie too. Pulse ox machine that has the ECG portion... I've seen it showing a heart beat/rate and ... well, there not being one.

In those cases a stethoscope was more helpful!

I have a human nurse friend who works cardiac units, and she told me they see the same issues there.

 

[birdvet2006]

It is low quality of care. Would you want to go to anesthesia without having a complete workup? When you turn 30 do you want to go into the doctor and not have a complete workup performed prior to surgery? I know I wouldn't.

But I know where you are coming from in trying to sell it to many owners. The thing is, it all depends how you market it. Can you do a preliminary ECG in-house for almost no cost? Yep, one tech and 15 minutes could perform a complete ECG tracing and have results back from a specialist for a total clinic cost of $25-$30. This cost could easily be built-in to the cost of a surgery. If you have owners who don't want to pay that initially clinics can throw in an in-house scan, and as long as the doctor has a decent handle on ECG basics (rates, rhythms, waveform limits, etc) you can at least rest in relative comfort until a problem arises and the cost to the clinic is minimal.

I talk to doctors on a daily basis who have performed surgery and are either seeing severe abnormalities during surgery and need help, or they have a patient who is in congestive heart failure 3 days after having an elective dental performed. Fluffy went in for stained teeth and now needs heart meds and an echocardiogram. Where could that $150 been spent more effectively? Cleaning the teeth or working up a heart condition that most likely would have presented some evidence on an ECG?

I know it is hard to talk owners into spending extra money when they can go spend $65 at the humane society to have a neuter/spay done. But you get what you pay for. Sorry for the quasi-ranting but I see a lot of incompetence on a daily basis from vets who I know to be both old and new.

You may want to check a recent discussion on VIN (From the Trenches) about running "ECGs regularly" on healthy patients. It's not done in most instances and is not advised by veterinary cardiologists. You know why? Because most arrhythmias can be detected on a thorough physical exam. During auscultation of the heart, you detect an abnormal rhythm. You detect pulse deficits. THEN you run an ECG. Every vet should be conducting a thorough physical exam on their patients prior to anaesthesia.

Since you often cannot detect heart disease on physical exam (and ECG is not going to be of use for that in most cases) - you better do good anaesthesia monitoring that includes blood pressure. If you support the blood pressure during anaesthesia (using increased IV fluid rates with or without colloids and/or dopamine), it is less likely that the heart will go into failure afterwards. Those vets you saw that had cases of CHF after a dental - did they monitor and support blood pressure during the procedure?

As for CHF after anaesthesia, it's not surprising. There are many animals that have occult cardiomyopathy (cats) or that are not showing outward signs of heart disease. Most animals with cardiomyopathies actually do NOT have arrhythmias, so an ECG will be of no use. Many animals with heart disease do not even have a murmur. IMO, ECGs are only warranted in those animals presenting for syncope episodes (or possible syncope), or those with detectable arrhythmias (or bradycardia/certain tachycardias) on auscultation/physical exam.

But you know what, this is a veterinary discussion. Something that belongs on the types of boards that VIN has. Not a "pre-vet" forum!

 

[Nexx]

You may want to check a recent discussion on VIN (From the Trenches) about running "ECGs regularly" on healthy patients. It's not done in most instances and is not advised by veterinary cardiologists. You know why? Because most arrhythmias can be detected on a thorough physical exam. During auscultation of the heart, you detect an abnormal rhythm. You detect pulse deficits. THEN you run an ECG. Every vet should be conducting a thorough physical exam on their patients prior to anaesthesia.

Since you often cannot detect heart disease on physical exam (and ECG is not going to be of use for that in most cases) - you better do good anaesthesia monitoring that includes blood pressure. If you support the blood pressure during anaesthesia (using increased IV fluid rates with or without colloids and/or dopamine), it is less likely that the heart will go into failure afterwards. Those vets you saw that had cases of CHF after a dental - did they monitor and support blood pressure during the procedure?

As for CHF after anaesthesia, it's not surprising. There are many animals that have occult cardiomyopathy (cats) or that are not showing outward signs of heart disease. Most animals with cardiomyopathies actually do NOT have arrhythmias, so an ECG will be of no use. Many animals with heart disease do not even have a murmur. IMO, ECGs are only warranted in those animals presenting for syncope episodes (or possible syncope), or those with detectable arrhythmias (or bradycardia/certain tachycardias) on auscultation/physical exam.

But you know what, this is a veterinary discussion. Something that belongs on the types of boards that VIN has. Not a "pre-vet" forum!

You are right this does belong on another forum for in-depth discussion for professionals. I am still only a tech, but I work for a veterinary cardiologist. On the same note you are only a doctor and not a cardiologist--so our knowledge of the subject is probably on somewhat equal footing.

That being said I am not going to further debate the merits/necessities of electrocardiograms. What I will do is point out a few last things. I agree with you that not every healthy animal should have an ECG performed for the hell of it. But doing one prior to anesthesia is not just for ****s and giggles.

You even bring that point to the surface in your post, but ignore the ramifications.

here are many animals that have occult cardiomyopathy (cats) or that are not showing outward signs of heart disease

If you are not picking up any of your standard murmur/arrhythmia/pulse deficits/gallop sounds that may cause you reason to run an electrocardiogram, what are you going to do? Wait until it develops clinical signs to work it up? Refer out to a specialist for an Echocardiogram? Perform Chest rads (on 'healthy animals' - I also would like to see these as standard prior to anesthesia on older animals)?

No, your ECG is most likely going to pick up an abnormality. J

ust today I was looking at a case with a cat who had a seemingly innocuous ECG results. 15 year old (again in for an elective dental), no chest rads done, no catheter placed ended up crashing on the table and unable to recover. Initial electrocardiogram results revealed a heart rate of 250, sinus tachycardia. The doctor judged the elevated heart rate to be from stress and went ahead with the dental. Now was this a judgment call that went bad, was it an occult case, was there another cause? I know the doctor and have my personal (biased) opinion of what happened and will just say quality of care is determined by how convenient it is for this doctor to get done what they "have to do" instead of postponing their schedule.

For the record those patients who developed CHF after anesthesia, yes they were being monitored for blood pressure and were on fluids. BP dropped, fluid rate increased, and contributed to the compensation of the heart disease and the wonderful thing that is CHF.

For about $3000-$5000 (depending on model) you can buy a patient monitor to use in surgery that will do ECG/Capnography/Pulse Ox/ETC02/BP/Temp and it will print out stats and ECGs for you. That's a price for a brand new model as well, you can get units that are plenty cheaper if you want to buy used. I realize that capital equipment expenditures aren't exactly easy to do all the time and that you can't always spring for the latest and greatest. But in the end a vets business usually comes from word of mouth, and you aren't going to win over any customers if your patients keep dying off during common procedures.

In the end, the simple monitoring of a patient while they are already under anesthesia is like going skydiving before making sure you actually have a parachute attached to you.

-j

p.s. I don't know what crazy world (or crazy monitor you are using)you live on where the heart is still producing anything that looks remotely close to a normal QRS complex in a dead/dying animal.

 

[AuburnPreVet]

I think all of you probably know this already - but, you can get a FREE student subscription to VIN (Veterinary Information Network). All you need is a school email address.

 

[Nexx]

I think all of you probably know this already - but, you can get a FREE student subscription to VIN (Veterinary Information Network). All you need is a school email address.

For those who are still waiting to get into school but hold a job at a vet clinic VIN also hosts VSPN (Veterinary Support Personnel Network) available for free to any clinic employee www.vspn.org and they host a wide variety of topics (and debates as well). They also provide access to a lot of Continuing Ed topics.

 

[chris03333]

You are right this does belong on another forum for in-depth discussion for professionals. I am still only a tech, but I work for a veterinary cardiologist. On the same note you are only a doctor and not a cardiologist--so our knowledge of the subject is probably on somewhat equal footing.

wooo buddy, there is a huge difference between a Doctor who has been through internship training (even if not intern trained) and a cardiology technician. It is quite misguided for you to think you are "on somewhat equal footing" (and quite rude for that matter.) I suggest you wait to see if you agree with yourself after going through the four years(five in Cindy's case since she is a glasgow grad) of vet school training, and pass your boards, and do an internship.😡

 

[Nexx]

I'll say this and let people decide if I am being arrogant or not. And please note that I prefaced my statement with "I am only a tech" -- Trust me, just because you've been through school doesn't mean that you are an expert on a topic. You may have a good overview and even perhaps an above average understanding of a topic--but not an expert.

All I'm doing is simply claiming I have an above average understanding of the subject, even that on par or equal to current veterinarians. As evidence of that I put forth the following.

I have been working with a primarily with a cardiologist for the past 7 years. For 7 of those years I have been learning about ECGs, echocardiograms, cardiac meds, and everything else that goes along with cardiac cases. 6 of the 7 years have been spent going through and discussing not only case interpretation, but going through countless holter monitors and cardiac event recorders. In the past 6 years I've also worked in conjunction with a internist and a surgeon so I have a bit of an understanding outside of standard vaccine protocol. (That being said, there's a lot I have forgotten about primary veterinary care and much has changed from my initial 5 years as a general tech)

Now are you really going to discount my 7 years versus a semester (if you are lucky) of cardiology and a 3 week externship that most students do simply because I'm only about to start my vet school education?

You know what.... it doesn't matter if you (or anyone for that matter) don't want to listen to my opinion and want to discount it simply because I'm only a tech (and not even certified/licensed at that!). But then again, I'm confident in my words so do the research for yourselves folks. If you find out I am wrong, at least we can all learn along the way.

-j

 

[laurafinn]

I am still only a tech, but I work for a veterinary cardiologist. On the same note you are only a doctor and not a cardiologist--so our knowledge of the subject is probably on somewhat equal footing.

Ratcheting it down a notch would probably make folks more open to your way of thinking. A little humility goes a long way, which you'll find especially true in Australia (no tall poppies and all that).

 

[chris03333]

I'll say this and let people decide if I am being arrogant or not. And please note that I prefaced my statement with "I am only a tech" -- Trust me, just because you've been through school doesn't mean that you are an expert on a topic. You may have a good overview and even perhaps an above average understanding of a topic--but not an expert.

No but because I have been to school and gotten a LICENSE to practice, my opinion (and Cindy's) are the one's that will hold up in court legally.

You giving medical advise can get your a$$ in a sling if someone knew who you were and reported to the state board where you will someday apply for a license. So mentioning that this topic should be between professionals is not only a way for Cindy to state her expertise on the subject, but maybe a tip telling you that if you would like to discuss use the professional forum (VIN) and if "just Doctors" aren't good enough for you, only post on the cardiology board. I would highly suggest you take your pedestal out from beneath you and not risk pissing off your future collegues. And yes I really do not care how long you have been a tech in a cardiology setting😱

 

[Nexx]

As a preface I feel I should say that this will be my final post defending my opinions on ECGs/Surgical Monitoring/Etc..

My above statements are not medical advice, nor are they intended to treat. As we (and anyone who wished to) can see there is no reference to any patient being treated by birdvet, myself, or anyone else for that matter. Simply put there is a discussion going on over current treatment protocols in veterinary medicine.

So all lawsuits can be held off and my vet license granted in a few years until I respond to someone who comes along and says "fluffy has bradycardia, should my doctor treat him with atropine prior to surgery or monitor his ECG during the procedure" -- I think I'm well within my legal and professional rights to offer rational discourse in an open forum.

God forbid anyone asking about "atropine" learns a little more and perhaps a few "doctors" can learn along the way. Frankly I wasn't offended by Birdvets post and was offended moreso by yours. I realize she was just trying to offer her opinions, albeit a little brash. More than half the people on this forum can' view VIN. So every time you come in here and say "Go read VIN" you are saying 'we are more important than you and can have professional discussions most of you can't access'.

My comment about how I am -only- a tech, but work for a cardiologist was my attempt to defer to her higher education. But you apparently felt the need to come and place the smack down on me with your far superior knowledge.

But hey, I'm sure glad this is the pre-vet forum and apparently not the pre-med forums. And in the end Chris, I feel sorry for you... who apparently will end up not listening to your techs (who just as nurses act as a patient advocate) when they try to tell you that you may be doing something incorrectly. Because after all, you are a doctor and they are only techs. 🙄 You'll learn hopefully.

 

[chris03333]

But hey, I'm sure glad this is the pre-vet forum and apparently not the pre-med forums. And in the end Chris, I feel sorry for you... who apparently will end up not listening to your techs (who just as nurses act as a patient advocate) when they try to tell you that you may be doing something incorrectly. Because after all, you are a doctor and they are only techs. 🙄 You'll learn hopefully.

Okay seriously I do listen to my techs and like to keep mutual respect between us. Read your post to Cindy carefully especially the part where you said "I am still only a tech, but I work for a veterinary cardiologist. On the same note you are only a doctor and not a cardiologist--so our knowledge of the subject is probably on somewhat equal footing."

How could you not expect to offend someone with that. Just the "you are only a doctor" part is making little of what many of us worked very hard to accomplish.

I love to have input from my techs, and have never had problems getting along with them. I also have never been told by any of them that I am "only a doctor" and they have the same knowledge as me. Which is fine maybe they may have the same knowledge as me (maybe you are really educated in cardiology) but it is still my, or the person who is "only a doctor" whose license is on the line.

Sorry if I offended you but your remarks, although maybe not intended, were very offensive to me.

Now that we have completely hijacked this thread, I have no other comments😳

 

[birdvet2006]

Thank you for the defense, Chris.

To everyone:
As an intern I have worked with a cardiologist. True, I have not worked with a cardiologist as long as a "cardiology tech" - but I do have more training in the underlying physiology and pathophysiology of cardiac disease than a tech. The lives of my patients are on MY license and not yours.

My point was that even a cat with occult cardiomyopathy may never show ECG changes, and may never have a murmur. The echocardiogram is far more superior for detecting disease.

In my experience thus far, which is probably less than yours but at a level with more responsibility (the life is on my shoulders, my license), I have detected zero abnormal ECGs and plenty of abnormal blood pressures during anaesthesia. Yes, we use the very expensive monitors (Cardell and SurgiVet) during the majority of our anaesthetic procedures.

Please do visit VIN for such a discussion. If you're not a member of VIN, and are not eligible to join VIN - then maybe that tells you something. You shouldn't be discussing stuff like this unless you're actually going to be a vet (as proof by your being a veterinary student)...IMO.

 

[StealthDog]

I might also add that the type of client you see in a specialist clinic (or in a vet school hospital) is not necessarily representative of the "average" client. They've already been willing to follow a referral, which means they are more willing to spend money on their pet's care than many. Not offerring an ECG might be more indicative of a clinic's clientel than of their standard of care. Of course, you can't assume a client wouldn't want to spend extra for an ECG, but I worked in a rural clinic where it was like pulling teeth just to get people to pay for pain meds after a spay/neuter. In some areas, it really wouldn't make sense to invest in an ECG for your clinic if clients just aren't interested in paying for it. In vet school, you get used to being able to run whatever diagnostics you want to find out what's wrong with a patient.... Then you get out into the real world and don't have that luxury.

I don't think the attitude that you can only offer the best, or not offer anything at all, is very practical for many clinics. I'd hate to see low-income people get priced out of owning pets because they can't pay for high-end care.

 

[Nexx]

A valid point that I do tend to forget about. I've never worked in a strictly rural area. And it really is a bias as well that since I do see so may pre-surgical cases show up with issues or potential issues (my 2% of cases with issue is on the order of 15-25 per week, roughly--while standard practice could range from only 1-5 per month).

I am of the mindset that you can't catch everything on a physical exam. Heck, you can't always catch everything on an electrocardiogram. It's a small window of time you are looking at when examining/running the ECG. Gallop sounds can be missed, murmurs can be rate dependent, and you can see evidence of some other potential non-cardiac problems on ECG as well.

It's because of those reasons I feel the way I do. That and if you have clients who aren't willing to pony up for en ECG in a case that may have occult disease, are they really going to go the next step and go straight to the echocardiogram? Besides, if it comes to fruition and an echo needs to be done, a complete workup should be done to check the 'electrical system' of the hear. Otherwise you are just looking at the mechanics.

We'll see what comes when I'm out in private practice however, if I choose that route. It has been a while since I've fought with a client for something as simple as heartworm testing and monthly preventative. Then again my job brings its own special crazies.