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supershorty said:
Not gonna lie, I'm seriously considering melting some chocolate and dunking it in it before my next dose.
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And owners always think I’m just being over dramatic about the taste! No, you cannot crush that pill and mix it with food, or your cat will never want to eat again.
 
genny said:
And owners always think I’m just being over dramatic about the taste! No, you cannot crush that pill and mix it with food, or your cat will never want to eat again.
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Bonus points for (at least the human dose) being a giant pill, feels like every time I take it, it goes down sideways and prolongs the bitterness.

I'm really warming to the chocolate idea, though.
 
genny said:
And owners always think I’m just being over dramatic about the taste! No, you cannot crush that pill and mix it with food, or your cat will never want to eat again.
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I mean, I developed a severe aversion to the beverage I used to take it when I was on it as kid so... I hear ya, cats.

To this day, I just think about gatorade rain and I want to vomit.
 
supershorty said:
Bonus points for (at least the human dose) being a giant pill, feels like every time I take it, it goes down sideways and prolongs the bitterness.

I'm really warming to the chocolate idea, though.
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The tiny tabs I use with cats are coated but only 50mg. So much easier to give as a coated tablet.
 
For cats, buy an empty gelatin capsule and break the metronidazole to fit into the capsule. Give the capsule instead... no taste at all. This is what I did for my cat.

Could probably do this for humans too.

I got lucky and never got the bitter taste when taking metronidazole. I was also prepared for it and basically was shoving it half down my throat and swallowing instantly.
 
I kept a stash of gelatin caps for owners at my previous job. Alternatively, just wrapping a bit of pill pocket all around the outside works nicely to make them not hate you when you shove it.
 
Trilt said:
I kept a stash of gelatin caps for owners at my previous job. Alternatively, just wrapping a bit of pill pocket all around the outside works nicely to make them not hate you when you shove it.
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This just causes taste aversion to the pill pockets or anything that tastes similar. Because cats be weird and associate that taste with "mom shoved something down my throat and that is gross and well, **** you taste."
 
DVMDream said:
No promises that the metro is absorbed as quickly as it is without the gelatin capsule, but i can't imagine it impacts it much. This is what internal medicine recommended for my cat.
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Based on my experience tonight, the next week is going to be much more pleasant with the gelatin capsules. Thanks again! Metro is gross.
 
DVMDream said:
This just causes taste aversion to the pill pockets or anything that tastes similar. Because cats be weird and associate that taste with "mom shoved something down my throat and that is gross and well, **** you taste."
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I use pill pockets for Cindy and for a week or two she'll just eat them, and then she'll decide nah, hate these...so I'll switch flavors. And then she'll start eating them again. Rinse and repeat...she is not the brightest bulb :laugh:
 
DVMDream said:
This just causes taste aversion to the pill pockets or anything that tastes similar. Because cats be weird and associate that taste with "mom shoved something down my throat and that is gross and well, **** you taste."
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That's fine, I'm not trying to make them like pill pockets. I'm just doing the same thing as a gelatin capsule and masking the grossness with a thin layer.

I find not many cats will consider eating pills with pill pockets on their own. Cindy excluded, obvs. 😉
 
Trilt said:
That's fine, I'm not trying to make them like pill pockets. I'm just doing the same thing as a gelatin capsule and masking the grossness with a thin layer.

I find not many cats will consider eating pills with pill pockets on their own. Cindy excluded, obvs. 😉
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I was shocked to hear the internest recommend against them. Or really hiding pills in anything food wise. She also recommended spacing out giving meds to cats and feeding by at least 15 minutes just because they associate food with medication administration then. (I'm really bad at this as my cat doesn't want to wait 15 damn minutes and tries to turn me into her meal instead then). Basically she summed it up as if they even get a tiny taste of the medication with the food wrapped around the medication or just a normal meal fed immediately before/ after they'll develop an aversion to that product or anything similar in taste.. be that pill pockets or their normal cat food that has a similar flavor profile. She also said just the stress/act of the medication process can be enough to turn them away from a particular product as they then associate evil "shoving things down throat" with their food or cheese or pill pockets or whatever.

Basically cats be ridiculous/dramatic sometimes so try to minimize flavors/ foods with the medication process if possible because they develop taste aversion easily unlike most dogs.
 
*should say they can develop an aversion, not that will. I think it is probably more important for cats that are already picky/ have underlying GI disease where food options are already fairly limited.
 
I haven’t had to medicate many cats outside of a hospital setting but I remember before tramadol fell out of favor it was really important to never touch the outside of the pill pocket/cheese/pb/whatever with the fingers you touched the tramadol with. I got food at smashing the pill pocket with my right hand, dropping the tramadol into the center with my left, and closing the pill pocket back up with only the right. Because if you got any of that bitter dust on the outside, no way was my dog going to willingly eat it again.
 
When the school fails to make it clear before break that we have to drop off saliva samples the day we come back in January. Which means I think I have to make an extra trip to the school to pick a kit up before then? Would it not have made more sense to just make sure we all got kits before leaving? At least I live relatively close.
 
finnickthedog said:
When the school fails to make it clear before break that we have to drop off saliva samples the day we come back in January. Which means I think I have to make an extra trip to the school to pick a kit up before then? Would it not have made more sense to just make sure we all got kits before leaving? At least I live relatively close.
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you can pick up and drop off immediately after, just do the test in your car. If you go to trowbridge you grab the kit from the attendant, pull forward 10 ft, spit, then drop it in the trash can. Or grab it at towbridge, drive to parking, spit, drop it off in front of vmc? this is all moot if your jan 4 rotation is not on campus...
(worst case scenario is you grab it from g150 or pharm, go to car, then go back to g150 or in front of vmc to drop off. In this case i would just use g150 loading zone assuming you have badge access... which I don't cuz they took that away from us...)
 
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JustPaws said:
you can pick up and drop off immediately after, just do the test in your car. If you go to trowbridge you grab the kit from the attendant, pull forward 10 ft, spit, then drop it in the trash can. Or grab it at towbridge, drive to parking, spit, drop it off in front of vmc? this is all moot if your jan 4 rotation is not on campus...
(worst case scenario is you grab it from g150 or pharm, go to car, then go back to g150 or in front of vmc to drop off. In this case i would just use g150 loading zone assuming you have badge access... which I don't cuz they took that away from us...)
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Thanks. I have path next so I think I can pick it up at the VDL but then I have to go to the VMC some time before 1 to drop it off.
 
Matthew9Thirtyfive said:
A study was done ... The best Younger physicians are much more likely to follow evidence based medicine, keep up with literature, and apply correct guidelines. The lazy Older physicians are more likely to not use EBM and go by their “experience”.
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Fixed that for you.

In case you're curious, if my interns, students and residents did not stay up-to-date, they would be in a big-a** boatload of trouble. Don't be lazy with patient care. Just saying.

Edit: added A study was done.
 
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In other news, everything keeps coming back negative so we still have no explanation for the symptoms or the eosinophilia, and I got an appointment with a specialist but not until after New Years. 🙁

Day 23 of this.
 
Doctor-S said:
Fixed that for you.

In case you're curious, if my interns, students and residents did not stay up-to-date, they would be in a big-a** boatload of trouble. Don't be lazy with patient care. Just saying.
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There wasn’t anything to fix. I was speaking specifically in regard to the study I mentioned. I agree with you in general.
 
supershorty said:
In other news, everything keeps coming back negative so we still have no explanation for the symptoms or the eosinophilia, and I got an appointment with a specialist but not until after New Years. 🙁

Day 23 of this.
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JK just got some bloodwork back that supports @LetItSnow 's hypothesis
 
Matthew9Thirtyfive said:
Were you having bloody diarrhea? Or even just BRBPR?
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No blood at all during this whole thing, actually. It's less supportive of the UC hypothesis vs just IBD. I'm not familiar with the panel I got results for but I have a follow up appt in person tomorrow so hoping to get more info then.
 
supershorty said:
No blood at all during this whole thing, actually. It's less supportive of the UC hypothesis vs just IBD. I'm not familiar with the panel I got results for but I have a follow up appt in person tomorrow so hoping to get more info then.
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What did you have done? Crohn can present without frank blood and can take years to get a diagnosis unfortunately. There’s also some chronic infections and malabsorption syndromes that can look like IBD.
 
Matthew9Thirtyfive said:
What did you have done? Crohn can present without frank blood and can take years to get a diagnosis unfortunately. There’s also some chronic infections and malabsorption syndromes that can look like IBD.
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Going to spoiler it in case not everyone wants to read about my fecal testing :laugh:
Bloodwork: CBC, CMP, ESR, TTG, CRP, TSH
Ova & parasites (3x), C. diff, Giardia, fecal leukocyte staining, crypto

I switched clinics at this point b/c our campus clinic decided the answer after those labs was "we don't know" but refused to refer me, do any imaging, or do any empiric therapy, and told me to just "hang in there."

New clinic did stool testing for H. pylori, another O&P, and a multiplex PCR that was for campy, salmonella, shigella, vibrio, Y. enterocolitica, shiga toxin 1+2, norovirus, + rotavirus

Bloodwork: they used LabCorp's IBD panel, I was WNL for S. cerevisiae IgA and atypical pANCA, but S. cerevisiae IgG was 44 and looks like the ref range is 0-24.9
 
supershorty said:
Going to spoiler it in case not everyone wants to read about my fecal testing :laugh:
Bloodwork: CBC, CMP, ESR, TTG, CRP, TSH
Ova & parasites (3x), C. diff, Giardia, fecal leukocyte staining, crypto

I switched clinics at this point b/c our campus clinic decided the answer after those labs was "we don't know" but refused to refer me, do any imaging, or do any empiric therapy, and told me to just "hang in there."

New clinic did stool testing for H. pylori, another O&P, and a multiplex PCR that was for campy, salmonella, shigella, vibrio, Y. enterocolitica, shiga toxin 1+2, norovirus, + rotavirus

Bloodwork: they used LabCorp's IBD panel, I was WNL for S. cerevisiae IgA and atypical pANCA, but S. cerevisiae IgG was 44 and looks like the ref range is 0-24.9
Click to expand...

Yeah that’s more common in CD and microscopic colitis, though the antibody panel is not great for differentiating between the two. Sounds like you’re getting close to an answer.
 
supershorty said:
JK just got some bloodwork back that supports @LetItSnow 's hypothesis
Click to expand...

Doctoring like a boss.

My replacement came on today and said "got a case for you I took over this weekend - want to know what you'd have done".

But it was interesting to me not really because of the case itself, but because I think it highlights how 'autopilot doctoring' can sneak up on anybody, and maybe moreso in today's current world of incredibly high caseloads (my personal caseload is up about 60% this year, and it was already stressful).

For funsies, here's the case. I probably got a few details wrong, but it's basically correct.

What would you do next and why for you SA (or anyone, really) types:

13-week-old puppy presents for a 3-day history of lethargy and hyporexia and "odd behavior" that progressed to vomiting and profound hematochezia. Vaccine history is incomplete/unknown, but thought to have received at first round of a typical combo vax. Had initially seemed healthy. [I don't recall the full signalment, but it's irrelevant. If it bugs you, call it a male intact Lab.]

PE summary: Looks like a typical craptasting parvo puppy.

Init dx:
Parvo snap: "weak positive" (I'm not a fan of 'weak' anything. It's either positive or negative. But that's how it was reported, so deal with it. 🙂)
CBC/Chem/Lytes highlights: HCT 24.5% (PCV 21%), Retic 500k, WBC 55k (primarily a marked neutrophilia, but I don't recall the specific diff or cytologic characteristics). Chem/Lytes WNL.

It was hospitalized as a parvo patient and tx'd with generally typical parvo care (though no NG tube was placed). Puppy improves somewhat initially, like a typical parvo patient, but its PCV continues to drop somewhat faster than is typical.

What's your next diagnostic step(s) and what's really happening?

This case is actually a pretty decent example of why all that stuff you go through in school is important. In school you think "duh, this is so easy" as you trudge through ClinPath or whatever. Out in the real (hectic, overworked) world it is super easy to get into the trap of repetition - you see a young puppy with that history, your techs ask if they can run a parvo snap, you mumble yes and move on to the next patient, you get the 'weak positive' result, and your brain shuts down when you settle on parvo as your dx. You don't think that will happen to you, because you're a super smart on-top-of-your-stuff vet student, but I guarantee you it can. 🙂

So, what's up with this puppy? Students only, no experienced clinicians allowed, especially those of you who have treated these cases. 🙂
 
LetItSnow said:
Doctoring like a boss.

My replacement came on today and said "got a case for you I took over this weekend - want to know what you'd have done".

But it was interesting to me not really because of the case itself, but because I think it highlights how 'autopilot doctoring' can sneak up on anybody, and maybe moreso in today's current world of incredibly high caseloads (my personal caseload is up about 60% this year, and it was already stressful).

For funsies, here's the case. I probably got a few details wrong, but it's basically correct.

What would you do next and why for you SA (or anyone, really) types:

13-week-old puppy presents for a 3-day history of lethargy and hyporexia and "odd behavior" that progressed to vomiting and profound hematochezia. Vaccine history is incomplete/unknown, but thought to have received at first round of a typical combo vax. Had initially seemed healthy. [I don't recall the full signalment, but it's irrelevant. If it bugs you, call it a male intact Lab.]

PE summary: Looks like a typical craptasting parvo puppy.

Init dx:
Parvo snap: "weak positive" (I'm not a fan of 'weak' anything. It's either positive or negative. But that's how it was reported, so deal with it. 🙂)
CBC/Chem/Lytes highlights: HCT 24.5% (PCV 21%), Retic 500k, WBC 55k (primarily a marked neutrophilia, but I don't recall the specific diff or cytologic characteristics). Chem/Lytes WNL.

It was hospitalized as a parvo patient and tx'd with generally typical parvo care (though no NG tube was placed). Puppy improves somewhat initially, like a typical parvo patient, but its PCV continues to drop somewhat faster than is typical.

What's your next diagnostic step(s) and what's really happening?

This case is actually a pretty decent example of why all that stuff you go through in school is important. In school you think "duh, this is so easy" as you trudge through ClinPath or whatever. Out in the real (hectic, overworked) world it is super easy to get into the trap of repetition - you see a young puppy with that history, your techs ask if they can run a parvo snap, you mumble yes and move on to the next patient, you get the 'weak positive' result, and your brain shuts down when you settle on parvo as your dx. You don't think that will happen to you, because you're a super smart on-top-of-your-stuff vet student, but I guarantee you it can. 🙂

So, what's up with this puppy? Students only, no experienced clinicians allowed, especially those of you who have treated these cases. 🙂
Click to expand...
Did Puppy get into anything? Wondering about anticoagulant toxicity causing hemorrhage into the GIT (and maybe other spots).

Hematochezia was frank blood? Maybe intussuseption (spelling....) or foreign body damaging the mucosa to bleeding point?
 
This is a bizarre one that I don’t know is possible, but some form of thrombocytopenia or other aquired clotting/platelet issue that is causing hemorrhage into the GIT. Just a weird spot to bleed into with no petechiae or other signs.
 
LetItSnow said:
Doctoring like a boss.

My replacement came on today and said "got a case for you I took over this weekend - want to know what you'd have done".

But it was interesting to me not really because of the case itself, but because I think it highlights how 'autopilot doctoring' can sneak up on anybody, and maybe moreso in today's current world of incredibly high caseloads (my personal caseload is up about 60% this year, and it was already stressful).

For funsies, here's the case. I probably got a few details wrong, but it's basically correct.

What would you do next and why for you SA (or anyone, really) types:

13-week-old puppy presents for a 3-day history of lethargy and hyporexia and "odd behavior" that progressed to vomiting and profound hematochezia. Vaccine history is incomplete/unknown, but thought to have received at first round of a typical combo vax. Had initially seemed healthy. [I don't recall the full signalment, but it's irrelevant. If it bugs you, call it a male intact Lab.]

PE summary: Looks like a typical craptasting parvo puppy.

Init dx:
Parvo snap: "weak positive" (I'm not a fan of 'weak' anything. It's either positive or negative. But that's how it was reported, so deal with it. 🙂)
CBC/Chem/Lytes highlights: HCT 24.5% (PCV 21%), Retic 500k, WBC 55k (primarily a marked neutrophilia, but I don't recall the specific diff or cytologic characteristics). Chem/Lytes WNL.

It was hospitalized as a parvo patient and tx'd with generally typical parvo care (though no NG tube was placed). Puppy improves somewhat initially, like a typical parvo patient, but its PCV continues to drop somewhat faster than is typical.

What's your next diagnostic step(s) and what's really happening?

This case is actually a pretty decent example of why all that stuff you go through in school is important. In school you think "duh, this is so easy" as you trudge through ClinPath or whatever. Out in the real (hectic, overworked) world it is super easy to get into the trap of repetition - you see a young puppy with that history, your techs ask if they can run a parvo snap, you mumble yes and move on to the next patient, you get the 'weak positive' result, and your brain shuts down when you settle on parvo as your dx. You don't think that will happen to you, because you're a super smart on-top-of-your-stuff vet student, but I guarantee you it can. 🙂

So, what's up with this puppy? Students only, no experienced clinicians allowed, especially those of you who have treated these cases. 🙂
Click to expand...
I'm assuming you would have said this if it were available, but was there any imaging?

CAVEAT: I have been out of vet school for 2 years at this point and feel like I've forgotten everything beyond what a puppy looks like, so if I say something exceptionally stupid, I'm blaming it on the PhD thing for now. Although I'm confident in my ability to diagnose osteosarcomas at this point (full disclosure: not a differential for this pup).

I'm wondering about AHDS/HGE and would want imaging, PT/PTT, and imaging of some sort (US or rads probably). Are there any fecal smears/floats available? Or cytology?

Also wondering about parasites --> intussusception
 
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Matthew9Thirtyfive said:
Yeah that’s more common in CD and microscopic colitis, though the antibody panel is not great for differentiating between the two. Sounds like you’re getting close to an answer.
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Ooooh I don't think I like where this is heading. Can I opt out and have a worm instead? Much easier to manage 🙁
 
TheGirlWithTheFernTattoo said:
Did Puppy get into anything? Wondering about anticoagulant toxicity causing hemorrhage into the GIT (and maybe other spots).

Hematochezia was frank blood? Maybe intussuseption (spelling....) or foreign body damaging the mucosa to bleeding point?
Click to expand...

No dietary indiscretion is reported, but of course you can decide whether to trust an owner on that.

No screening tests for coagulopathy were performed.

Hematochezia is by definition frank/fresh blood.

Intussusception is a reasonable differential, especially if you are thinking perf/sepsis. Subsequent gFAST was negative for peritoneal effusion, palpation did not identify an intussusception on PE or recheck PE, and the person who performed the gFAST likely would have identified an intussusception.

TheGirlWithTheFernTattoo said:
The marked neutrophilia is making me a little suspicious it isn’t parvo. If there was bone marrow suppression causing the continued anemia I would expect to see a concurrent neutropenia.
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Agreed - off the top of my head I don't recall a parvo case with 55k. That said, I recently saw someone post something along the lines of "it isn't parvo if they have a neutrophilia" and that is 100% absolutely no-questions NOT true. MANY parvo patients start out with an initial neutrophilia (perhaps even most, I don't know, but by the time I see them they are typically normal or low). But I agree, 55k is too high for parvo. This patient did not have parvoviral gastroenteritis. (At least, its clinical signs were not caused by it.)


WildZoo said:
What about newish grads 😉
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Lol. Sure.

TheGirlWithTheFernTattoo said:
This is a bizarre one that I don’t know is possible, but some form of thrombocytopenia or other aquired clotting/platelet issue that is causing hemorrhage into the GIT. Just a weird spot to bleed into with no petechiae or other signs.
Click to expand...

Thrombocytopenia was not identified, and no coag screening tests were run (primarily because the problem was identified).

supershorty said:
I'm assuming you would have said this if it were available, but was there any imaging?

CAVEAT: I have been out of vet school for 2 years at this point and feel like I've forgotten everything beyond what a puppy looks like, so if I say something exceptionally stupid, I'm blaming it on the PhD thing for now. Although I'm confident in my ability to diagnose osteosarcomas at this point (full disclosure: not a differential for this pup).

I'm wondering about AHDS/HGE and would want imaging, PT/PTT, and imaging of some sort (US or rads probably). Are there any fecal smears/floats available? Or cytology?

Also wondering about parasites --> intussusception
Click to expand...

Imaging was not performed as primary diagnostics. gFAST was performed upon re-evaluation of the patient.

What would you be looking for with imaging, and what modality (we have x-ray/US/CT/MRI available)?

Comments on intussusception above. It was ruled out via PE and gFAST.

------------

Couple more comments:

1) I gave you all the initial diagnostics;
2) Now you have the gFAST results (consider intussusception ruled out);
3) If you want another dx, you have to tell me what you're looking for that you're spending the owner's money;
4) Not all cases have all the classic characteristics; and
5) Some things that may be noticed in a perfect setting (for instance, on pathology review or something) are commonly missed in the early stages of a case.

Good thoughts, but keep going. This is a case that if you practice SA medicine (especially ER/referral) you will see. I see one a year or so.
 
PippyPony said:
And I guess my next diagnostic test would be to examine the feces and potentially transfuse, because I don't think immunosuppressives would be safe
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Fecal result was "NPS" (no parasite seen, in case you use different terms).

Transfusion was not performed because of owner financial constraints and because the problem was identified prior to it being necessary. I agree that transfusion may have helped the puppy's clinical condition during the remainder of its recovery. In this case, the outcome was good and the puppy ought to do well without transfusion, but I agree with your thinking on supportive care.

But, transfusion doesn't fix things. You still need to find the problem. 🙂
 
LetItSnow said:
Fecal result was "NPS" (no parasite seen, in case you use different terms).

Transfusion was not performed because of owner financial constraints and because the problem was identified prior to it being necessary. I agree that transfusion may have helped the puppy's clinical condition during the remainder of its recovery. In this case, the outcome was good and the puppy ought to do well without transfusion, but I agree with your thinking on supportive care.

But, transfusion doesn't fix things. You still need to find the problem. 🙂
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Idk, blood smear and a coombs?
 
LetItSnow said:
But, transfusion doesn't fix things. You still need to find the problem. 🙂
Click to expand...
I appreciate this because I feel like sometimes in school we lose perspective. We transfused a dog on Saturday like there was no tomorrow just to maintain oncotic pressure & perfusion, not because there was any indication of acute blood loss. And that's probably a luxury that does not exist in many cases.

Kinda like running a lactate lol. Although I still don't understand why more places don't have that.
 
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