RANT HERE thread

[Aprilthearab]

Update: My manager said it has "been taken care of." The appointment is no longer on the schedule

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[battie]

I'm so sorry.

You know, you're saving me a lot of growing up steps where I get to skip straight to the no-nonsense attitude. I appreciate it lololol

"we don't need to hear irrelevant information in rounds, it's not pertinent to the case and wastes time"

For what it's worth, many of our clinicians, including our clinician that goes through all the communication training, think that having that information is super important and very helpful to know. They'd give you a bunch of gold stars for having such good client communication skills and situational awareness!!

 

[MOOSEygoosey]

You know, you're saving me a lot of growing up steps where I get to skip straight to the no-nonsense attitude. I appreciate it lololol

For what it's worth, many of our clinicians, including our clinician that goes through all the communication training, think that having that information is super important and very helpful to know. They'd give you a bunch of gold stars for having such good client communication skills and situational awareness!!

Thank you! I really needed to hear that! <3

 

[vetmedhead]

Thank you! I really needed to hear that! <3

Yeah honestly basic knowledge like this is super important and I bet this clinician has problems with clients because of not knowing it. It's important to know if your clients have medical backgrounds like this because you don't want to talk down to them for example.

I made a habit on clinics of writing down where every client was from and, if they mentioned it, what they did. It's come in handy more often than you'd think and has helped the clinicians come up with treatment plans that, for example, don't involve making a client from UT come back every two weeks even though the client absolutely would have.

 

[PippyPony]

they all pulled me aside and said that what happened was unacceptable and that she's always been a bitch (and now that she's pregnant it's way worse) and she talks to them like that all the time.

I'm sorry, that sounds so stressful!! If it is any consolation, it's likely completely unrelated to you (sounds like it, if she's always a jerk to people)... but on top of her pre-existing communication issues, sometimes pregnancy is awful and can make people act like grouches. A pregnant family member actually once confided to me in the past that she kept snapping at her employees and felt terrible about it, but it was because she needed to run to the restroom and/or puke into a trash can for the 3rd time every morning.

Definitely still doesn't make it ok though, and I only bring it up to emphasize that I'm sure you're doing an awesome job & it's just this woman's own issues. I'm sorry you are having a bad experience

 

[Aprilthearab]

(This is a long post so I put a TLDR at the bottom! It's not exactly a rant, but I think it fits this thread best.)

Last night, I started a pet sitting job for four older easy-going dogs. When the owner was giving me instructions, she included "Our one dog has epilepsy, but she hasn't had a seizure in months." Just two hours after she left, I heard a thud upstairs and ran up to find the dog (a lab/pit mix) in the start of a seizure.

The owner was actually on a trip with a vet I previously worked for (the vet referenced her friend to me for pet sitting) so I called them and they said sometimes she comes out of it on her own after a couple minutes, sometimes she doesn't. In case she doesn't, grab the diazepam in the cabinet downstairs. Five minutes of cluster seizures later, the vet said the diazepam was initially dispensed for the owner to administer rectally but it didn't work last time they tried it. She asked if there was any way I could give it IV. I said I could definitely try and hung up.

Miraculously, I hit the vein and gave 2 ml. I've drawn blood a good amount of times but I don't think I've ever given an IV injection, let alone on an actively seizing dog with no one to help restrain or hold off. She stopped seizing, vomited, then sat up and did alright for about ten minutes. I carried her downstairs to be closer to the med cabinet and the doorway. Just as I thought we might be in the clear, she started shaking, then fell back into cluster seizures. The vet said to give her another 2 ml of the diazepam. There was only 1.5 ml left. When I went to stick, she was with it enough to sit up and try to bite me, and when I stopped her, she screamed for a good minute interrupted by more attempts to bite me. Grabbed a blanket to put over her head, held her down with my leg, and tried again - gave 1 ml before she got too fractious. Gave the remaining 0.5 rectally.

Vomited again but seizing did not stop. Out of diazepam, the vet recommended I dissolve 3 tabs of clorazepate in water and give orally, then head over to ER. She said she would send over a neighbor to help me carry her to the car - no need, my 115lb self already carried her down the stairs, I could do it out to the car too.

The owners met me in the ER parking lot and sat with her while we waited for a vet in the pouring rain. Half an hour later, a vet and tech came out. The ER vet asked if she was on any long term meds - no - and started lecturing them about the importance of long term meds as the dog was still seizing in the car. Os got pissed off and insisted they take the dog in now and talk about that later. The ER vet changed subjects to how tonight will work - bring her in, put in a catheter - and the husband cut her off and started yelling about "you won't do anything to her until you give her the shot and make it stop." The ER vet tried explaining but the husband was too heated and wasn't understanding what a catheter was for. I interrupted to tell him, in a way he would understand, that putting in a catheter to give the diazepam is what I was doing at home except with one stick instead of many. He understood and backed down.

ER vet said protocol is to stop the seizures then monitor for 24 hours. Again, a sensitive topic to the husband. He started yelling "you might be a vet but you don't know MY dog, your job is to make her stop, and that's IT. Once you've done your job, we will bring her home." Cue more arguing about protocol vs owners' expectations. At that point, the dog had stopped seizing but was in a postictal state. I interrupted them to tell the ER vet what happened and what I had given. They finally started taking the dog inside and the owners tried following and arguing more - I interjected, talked to them about what happened earlier as a distraction, and calmed them down so that the vet and tech could take the dog in.

End result: the dog didn't seize anymore once inside, didn't get any more drugs, and was monitored for an hour before being sent home. I went home at 3am. I went back to their house today to pick up the stuff I left behind last night and was greeted by a dog overjoyed to see me. It made my heart happy.

TLDR: Epileptic dog went into cluster seizures two hours into pet sitting. Alone, I simultaneously restrained, held off, and injected IV diazepam into an actively seizing/otherwise fractious dog. Seizing started again, ran out of diazepam, and my 115lb self carried a lab/pit mix down the stairs, through the house, and out to the car to bring to the ER. Then acted as mediator between the angry owners and frustrated vet in the pouring rain at 2am. Dog ended up okay. I feel like a bada**.

 

[WildZoo]

(This is a long post so I put a TLDR at the bottom! It's not exactly a rant, but I think it fits this thread best.)

Last night, I started a pet sitting job for four older easy-going dogs. When the owner was giving me instructions, she included "Our one dog has epilepsy, but she hasn't had a seizure in months." Just two hours after she left, I heard a thud upstairs and ran up to find the dog (a lab/pit mix) in the start of a seizure.

The owner was actually on a trip with a vet I previously worked for (the vet referenced her friend to me for pet sitting) so I called them and they said sometimes she comes out of it on her own after a couple minutes, sometimes she doesn't. In case she doesn't, grab the diazepam in the cabinet downstairs. Five minutes of cluster seizures later, the vet said the diazepam was initially dispensed for the owner to administer rectally but it didn't work last time they tried it. She asked if there was any way I could give it IV. I said I could definitely try and hung up.

Miraculously, I hit the vein and gave 2 ml. I've drawn blood a good amount of times but I don't think I've ever given an IV injection, let alone on an actively seizing dog with no one to help restrain or hold off. She stopped seizing, vomited, then sat up and did alright for about ten minutes. I carried her downstairs to be closer to the med cabinet and the doorway. Just as I thought we might be in the clear, she started shaking, then fell back into cluster seizures. The vet said to give her another 2 ml of the diazepam. There was only 1.5 ml left. When I went to stick, she was with it enough to sit up and try to bite me, and when I stopped her, she screamed for a good minute interrupted by more attempts to bite me. Grabbed a blanket to put over her head, held her down with my leg, and tried again - gave 1 ml before she got too fractious. Gave the remaining 0.5 rectally.

Vomited again but seizing did not stop. Out of diazepam, the vet recommended I dissolve 3 tabs of clorazepate in water and give orally, then head over to ER. She said she would send over a neighbor to help me carry her to the car - no need, my 115lb self already carried her down the stairs, I could do it out to the car too.

The owners met me in the ER parking lot and sat with her while we waited for a vet in the pouring rain. Half an hour later, a vet and tech came out. The ER vet asked if she was on any long term meds - no - and started lecturing them about the importance of long term meds as the dog was still seizing in the car. Os got pissed off and insisted they take the dog in now and talk about that later. The ER vet changed subjects to how tonight will work - bring her in, put in a catheter - and the husband cut her off and started yelling about "you won't do anything to her until you give her the shot and make it stop." The ER vet tried explaining but the husband was too heated and wasn't understanding what a catheter was for. I interrupted to tell him, in a way he would understand, that putting in a catheter to give the diazepam is what I was doing at home except with one stick instead of many. He understood and backed down.

ER vet said protocol is to stop the seizures then monitor for 24 hours. Again, a sensitive topic to the husband. He started yelling "you might be a vet but you don't know MY dog, your job is to make her stop, and that's IT. Once you've done your job, we will bring her home." Cue more arguing about protocol vs owners' expectations. At that point, the dog had stopped seizing but was in a postictal state. I interrupted them to tell the ER vet what happened and what I had given. They finally started taking the dog inside and the owners tried following and arguing more - I interjected, talked to them about what happened earlier as a distraction, and calmed them down so that the vet and tech could take the dog in.

End result: the dog didn't seize anymore once inside, didn't get any more drugs, and was monitored for an hour before being sent home. I went home at 3am. I went back to their house today to pick up the stuff I left behind last night and was greeted by a dog overjoyed to see me. It made my heart happy.

TLDR: Epileptic dog went into cluster seizures two hours into pet sitting. Alone, I simultaneously restrained, held off, and injected IV diazepam into an actively seizing/otherwise fractious dog. Seizing started again, ran out of diazepam, and my 115lb self carried a lab/pit mix down the stairs, through the house, and out to the car to bring to the ER. Then acted as mediator between the angry owners and frustrated vet in the pouring rain at 2am. Dog ended up okay. I feel like a bada**.

Dang that is crazy! Go you for handling that situation like a boss.

... Also that dog needs to be on long-term meds

 

[Aprilthearab]

Dang that is crazy! Go you for handling that situation like a boss.

... Also that dog needs to be on long-term meds

Agreed, but it def wasn't my place to give unsolicited medical advice

 

[vetmedhead]

Dang that is crazy! Go you for handling that situation like a boss.

... Also that dog needs to be on long-term meds

Right? Lol all I could think is if it's having uncontrollable cluster seizures and is on absolutely no epileptic meds that's not gonna go so well in the long run

 

[Aprilthearab]

Dang that is crazy! Go you for handling that situation like a boss.

... Also that dog needs to be on long-term meds

Also, while we were in the parking lot and they were arguing with and insulting the vet, I just kept thinking to myself, "Oh god, they're those kind of clients." Though I can definitely understand where the initial owner frustration came from because the ER vet basically decided to ignore the actively seizing dog and instead lecture the clients about a conversation that can be had after the fact.

 

[DVMDream]

(This is a long post so I put a TLDR at the bottom! It's not exactly a rant, but I think it fits this thread best.)

Last night, I started a pet sitting job for four older easy-going dogs. When the owner was giving me instructions, she included "Our one dog has epilepsy, but she hasn't had a seizure in months." Just two hours after she left, I heard a thud upstairs and ran up to find the dog (a lab/pit mix) in the start of a seizure.

The owner was actually on a trip with a vet I previously worked for (the vet referenced her friend to me for pet sitting) so I called them and they said sometimes she comes out of it on her own after a couple minutes, sometimes she doesn't. In case she doesn't, grab the diazepam in the cabinet downstairs. Five minutes of cluster seizures later, the vet said the diazepam was initially dispensed for the owner to administer rectally but it didn't work last time they tried it. She asked if there was any way I could give it IV. I said I could definitely try and hung up.

Miraculously, I hit the vein and gave 2 ml. I've drawn blood a good amount of times but I don't think I've ever given an IV injection, let alone on an actively seizing dog with no one to help restrain or hold off. She stopped seizing, vomited, then sat up and did alright for about ten minutes. I carried her downstairs to be closer to the med cabinet and the doorway. Just as I thought we might be in the clear, she started shaking, then fell back into cluster seizures. The vet said to give her another 2 ml of the diazepam. There was only 1.5 ml left. When I went to stick, she was with it enough to sit up and try to bite me, and when I stopped her, she screamed for a good minute interrupted by more attempts to bite me. Grabbed a blanket to put over her head, held her down with my leg, and tried again - gave 1 ml before she got too fractious. Gave the remaining 0.5 rectally.

Vomited again but seizing did not stop. Out of diazepam, the vet recommended I dissolve 3 tabs of clorazepate in water and give orally, then head over to ER. She said she would send over a neighbor to help me carry her to the car - no need, my 115lb self already carried her down the stairs, I could do it out to the car too.

The owners met me in the ER parking lot and sat with her while we waited for a vet in the pouring rain. Half an hour later, a vet and tech came out. The ER vet asked if she was on any long term meds - no - and started lecturing them about the importance of long term meds as the dog was still seizing in the car. Os got pissed off and insisted they take the dog in now and talk about that later. The ER vet changed subjects to how tonight will work - bring her in, put in a catheter - and the husband cut her off and started yelling about "you won't do anything to her until you give her the shot and make it stop." The ER vet tried explaining but the husband was too heated and wasn't understanding what a catheter was for. I interrupted to tell him, in a way he would understand, that putting in a catheter to give the diazepam is what I was doing at home except with one stick instead of many. He understood and backed down.

ER vet said protocol is to stop the seizures then monitor for 24 hours. Again, a sensitive topic to the husband. He started yelling "you might be a vet but you don't know MY dog, your job is to make her stop, and that's IT. Once you've done your job, we will bring her home." Cue more arguing about protocol vs owners' expectations. At that point, the dog had stopped seizing but was in a postictal state. I interrupted them to tell the ER vet what happened and what I had given. They finally started taking the dog inside and the owners tried following and arguing more - I interjected, talked to them about what happened earlier as a distraction, and calmed them down so that the vet and tech could take the dog in.

End result: the dog didn't seize anymore once inside, didn't get any more drugs, and was monitored for an hour before being sent home. I went home at 3am. I went back to their house today to pick up the stuff I left behind last night and was greeted by a dog overjoyed to see me. It made my heart happy.

TLDR: Epileptic dog went into cluster seizures two hours into pet sitting. Alone, I simultaneously restrained, held off, and injected IV diazepam into an actively seizing/otherwise fractious dog. Seizing started again, ran out of diazepam, and my 115lb self carried a lab/pit mix down the stairs, through the house, and out to the car to bring to the ER. Then acted as mediator between the angry owners and frustrated vet in the pouring rain at 2am. Dog ended up okay. I feel like a bada**.

Dude that would be end of pet sitting for these people indefinitely. And I'd have given them hell about their **** treatment of vet staff and their dog. That dog deserves better. Poor dog.

 

[Aprilthearab]

Dude that would be end of pet sitting for these people indefinitely. And I'd have given them hell about their **** treatment of vet staff and their dog. That dog deserves better. Poor dog.

I'm hoping this episode convinces them to start long-term meds, though it's likely empty hope. First time and probably last time I'll be pet sitting for them anyway! Very nice people otherwise, tried to pay for my car to be professionally cleaned after the back seat got a tiny bit of vomit on it. I declined because my car always smells like horse poop anyway.

 

[LetItSnow]

Except every time they get to talk to the manager/ vet it undermines you. I get it is better than your last job but it still is undermining you. The either take the answer you give or pound sand. That's how you support staff. Not "oh I'll talk to them" that is giving them what they want. A talk with someone "higher up" than you. It still reinforces bad behavior from clients.

Plus it is reinforcing their bad behavior. They are being demanding and unreasonable (expecting to talk to a doctor immediately? get f'ing real). Getting back to them that quickly is just teaching them that being bossy and demanding gets them what they want.

They need to be put in the penalty box or fired.

 

[LetItSnow]

Vomited again but seizing did not stop. Out of diazepam, the vet recommended I dissolve 3 tabs of clorazepate in water and give orally, then head over to ER. She said she would send over a neighbor to help me carry her to the car - no need, my 115lb self already carried her down the stairs, I could do it out to the car too.

Oral medications to an actively seizuring patient? Hmmm.

ER vet said protocol is to stop the seizures then monitor for 24 hours. Again, a sensitive topic to the husband. He started yelling "you might be a vet but you don't know MY dog, your job is to make her stop, and that's IT. Once you've done your job, we will bring her home." Cue more arguing about protocol vs owners' expectations. At that point, the dog had stopped seizing but was in a postictal state. I interrupted them to tell the ER vet what happened and what I had given. They finally started taking the dog inside and the owners tried following and arguing more - I interjected, talked to them about what happened earlier as a distraction, and calmed them down so that the vet and tech could take the dog in.

I'm thrilled when owners get that specifically demanding with me. Makes my job 500x easier - saves me having to explain anything, put an estimate together, take care of the dog overnight, etc. I just do <precisely> what they say, document that they rejected my recommendation, make them sign an AMA, and move on with my night. All fine by me. You don't want to manage the seizures appropriately? You just want an injection to make it stop? No problem - here's yer 60mg/kg keppra IV, kkthxbai!

 

[supershorty]

Hospitalized with pancolitis is exactly how I wanted to spend the weekend when I need to give a speech at a memorial service tomorrow. Great. Cool. Fun.

 

[Aprilthearab]

Oral medications to an actively seizuring patient? Hmmm.

She was going in and out of seizures, a couple minutes of laying on her side seizing and a couple minutes of sitting up and shaking. I waited until a moment when she was sitting up and licking her lips and she took it fine, then carried her straight out the door.

 

[SkiOtter]

She was going in and out of seizures, a couple minutes of laying on her side seizing and a couple minutes of sitting up and shaking. I waited until a moment when she was sitting up and licking her lips and she took it fine, then carried her straight out the door.

I think he’s more so questioning the vet who recommended it than you who was just following directions

 

[Aprilthearab]

I think he’s more so questioning the vet who recommended it than you who was just following directions

I understand - the vet also knew the situation through phone calls and videos and that she was in and out of seizing. She said don't do it if you can't find a moment where she stops seizing.

 

[MOOSEygoosey]

(This is a long post so I put a TLDR at the bottom! It's not exactly a rant, but I think it fits this thread best.)

Last night, I started a pet sitting job for four older easy-going dogs. When the owner was giving me instructions, she included "Our one dog has epilepsy, but she hasn't had a seizure in months." Just two hours after she left, I heard a thud upstairs and ran up to find the dog (a lab/pit mix) in the start of a seizure.

The owner was actually on a trip with a vet I previously worked for (the vet referenced her friend to me for pet sitting) so I called them and they said sometimes she comes out of it on her own after a couple minutes, sometimes she doesn't. In case she doesn't, grab the diazepam in the cabinet downstairs. Five minutes of cluster seizures later, the vet said the diazepam was initially dispensed for the owner to administer rectally but it didn't work last time they tried it. She asked if there was any way I could give it IV. I said I could definitely try and hung up.

Miraculously, I hit the vein and gave 2 ml. I've drawn blood a good amount of times but I don't think I've ever given an IV injection, let alone on an actively seizing dog with no one to help restrain or hold off. She stopped seizing, vomited, then sat up and did alright for about ten minutes. I carried her downstairs to be closer to the med cabinet and the doorway. Just as I thought we might be in the clear, she started shaking, then fell back into cluster seizures. The vet said to give her another 2 ml of the diazepam. There was only 1.5 ml left. When I went to stick, she was with it enough to sit up and try to bite me, and when I stopped her, she screamed for a good minute interrupted by more attempts to bite me. Grabbed a blanket to put over her head, held her down with my leg, and tried again - gave 1 ml before she got too fractious. Gave the remaining 0.5 rectally.

Vomited again but seizing did not stop. Out of diazepam, the vet recommended I dissolve 3 tabs of clorazepate in water and give orally, then head over to ER. She said she would send over a neighbor to help me carry her to the car - no need, my 115lb self already carried her down the stairs, I could do it out to the car too.

The owners met me in the ER parking lot and sat with her while we waited for a vet in the pouring rain. Half an hour later, a vet and tech came out. The ER vet asked if she was on any long term meds - no - and started lecturing them about the importance of long term meds as the dog was still seizing in the car. Os got pissed off and insisted they take the dog in now and talk about that later. The ER vet changed subjects to how tonight will work - bring her in, put in a catheter - and the husband cut her off and started yelling about "you won't do anything to her until you give her the shot and make it stop." The ER vet tried explaining but the husband was too heated and wasn't understanding what a catheter was for. I interrupted to tell him, in a way he would understand, that putting in a catheter to give the diazepam is what I was doing at home except with one stick instead of many. He understood and backed down.

ER vet said protocol is to stop the seizures then monitor for 24 hours. Again, a sensitive topic to the husband. He started yelling "you might be a vet but you don't know MY dog, your job is to make her stop, and that's IT. Once you've done your job, we will bring her home." Cue more arguing about protocol vs owners' expectations. At that point, the dog had stopped seizing but was in a postictal state. I interrupted them to tell the ER vet what happened and what I had given. They finally started taking the dog inside and the owners tried following and arguing more - I interjected, talked to them about what happened earlier as a distraction, and calmed them down so that the vet and tech could take the dog in.

End result: the dog didn't seize anymore once inside, didn't get any more drugs, and was monitored for an hour before being sent home. I went home at 3am. I went back to their house today to pick up the stuff I left behind last night and was greeted by a dog overjoyed to see me. It made my heart happy.

TLDR: Epileptic dog went into cluster seizures two hours into pet sitting. Alone, I simultaneously restrained, held off, and injected IV diazepam into an actively seizing/otherwise fractious dog. Seizing started again, ran out of diazepam, and my 115lb self carried a lab/pit mix down the stairs, through the house, and out to the car to bring to the ER. Then acted as mediator between the angry owners and frustrated vet in the pouring rain at 2am. Dog ended up okay. I feel like a bada**.

you're gonna come work with me in the SA Cornell ER right? Right?! Amazing work!!!

 

[DVMDream]

I understand - the vet also knew the situation through phone calls and videos and that she was in and out of seizing. She said don't do it if you can't find a moment where she stops seizing.

I wouldn't give anything to a dog orally between seizures either, especially one that's been vomiting. Really not a good idea for the patient or the human administering the medication and the vet giving those directions, well, they're lucky nothing went wrong, cause not even their PLIT would be able to get them out of that mess. That's like 500 things not to do when a dog has seizures.

 

[Aprilthearab]

you're gonna come work with me in the SA Cornell ER right? Right?! Amazing work!!!

My boyfriend and I are on our way!!

When I was waiting in the ER parking lot, I gave my boyfriend a quick text about what was going on. He had just gotten home from a 14 hour vet tech shift and I had to talk him out of jumping in his car at 2 am and driving an hour to meet me there. He's incredible.

 

[genny]

I wouldn't give anything to a dog orally between seizures either, especially one that's been vomiting. Really not a good idea for the patient or the human administering the medication and the vet giving those directions, well, they're lucky nothing went wrong, cause not even their PLIT would be able to get them out of that mess. That's like 500 things not to do when a dog has seizures.

I've had a neurologist prescribe oral keppra as part of a rescue protocol to disrupt clusters of seizures.

 

[battie]

@silverrains I'm sorry you've had this happened to you. You've been so amazing working towards living the life you want. I hope that you get some good news!

 

[DVMDream]

I've had a neurologist prescribe oral keppra as part of a rescue protocol to disrupt clusters of seizures.

I have seen it prescribed to be suspended and administered rectally for active seizures as an alternative to diazepam, but not to attempt to shove in orally during cluster seizures.

I stand by my statement, oral medications during a seizure, in a post-ictal period, or to a pet that has been vomiting and has an alternate mental status is questionable and potentially dangerous. The patient could aspirate, bite the administrator of the medications in post-ictal confusion or start seizing again and clamp down on the person giving the meds and not be able to relax/release due to seizures starting again.

The entire scenario described though was incredibly bizarre-- a vet verbally telling a pet sitter to give IV controlled drugs and repeatedly doing so instead of just saying take to ER is beyond mind boggling to me. I could understand a try of rectal diazepam once, but the instant that didn't work, it would be "go to ER meow, right meow, do not pass Go, do not collect $200."

 

[Aprilthearab]

I have seen it prescribed to be suspended and administered rectally for active seizures as an alternative to diazepam, but not to attempt to shove in orally during cluster seizures.

I stand by my statement, oral medications during a seizure, in a post-ictal period, or to a pet that has been vomiting and has an alternate mental status is questionable and potentially dangerous. The patient could aspirate, bite the administrator of the medications in post-ictal confusion or start seizing again and clamp down on the person giving the meds and not be able to relax/release due to seizures starting again.

The entire scenario described though was incredibly bizarre-- a vet verbally telling a pet sitter to give IV controlled drugs and repeatedly doing so instead of just saying take to ER is beyond mind boggling to me. I could understand a try of rectal diazepam once, but the instant that didn't work, it would be "go to ER meow, right meow, do not pass Go, do not collect $200."

I worked as a tech for this vet for over a year and a half, she has been present for this particular dog's seizures before, she knew that 2 ml of diazepam had successfully stopped it in the past, she knew that I was capable of administering it, and gave me that recommendation thinking it would have saved this dog from seizing for a full hour while in the car and in the ER parking lot (which is how long it took me to get there plus the wait time after I got there). Unfortunately, it wasn't enough this time, even though it has been in the past. The oral clorazepate was a small amount of liquid in a syringe, my hand clear of her mouth while not actively seizing, given in the corner of her mouth. She worked as an ER vet for many years before deciding to work a quieter general practice job and would not have given those recommendations if I was just any pet sitter, if she didn't know the pet, or if I had never worked for her.

I understand how it can seem over the internet. I'm not intending to get into a medical advice argument. Just telling a crazy story about a crazy situation.

 

[DVMDream]

I understand how it can seem over the internet. I'm not intending to get into a medical advice argument. Just telling a crazy story about a crazy situation.

It is a crazy story/situation, sorry you got stuck in the middle of that. I get there is background there that can't all be explained in posting on the internet, but I can still say there is so much there that was not ok to put onto you, regardless of if you were a trained professional or not. Heck, even more so if you were a certified tech, because it ropes you/your license in as well if anything goes wrong and the owner elects to file a board complaint. And given you, yourself stated you have never given an IV injection indicates you really weren't adequately trained to be dealing with this alone. Glad you got the IV in, but it was insanely unfair of them to ask you do do that to begin with.

I mean, I would have declined to pet sit the instant they mentioned the non-medicated seizure history.... nope, I'm out, not responsible..... having worked ER and GP most health issues go heavily south the instant an owner leaves and stress kicks in, be it seizures, GI issues, addison's, diabetes, urinary obstruction, etc. Stress makes things to berserk and an unmedicated pet with a known issue + stress is asking for all hell to break loose. Something you learn from experience and will hopefully be able to avoid with future pet sitting jobs.

I hope you don't take this as I think you did wrong, I don't, I think you rocked it with the hand you were dealt, sounds like you kept a level head. Got in an injection on a seizing pet (which is badass ) and did what you could given what you were told to do. Keep rocking it out and hopefully you won't be stuck in a similar position ever again.

 

[Aprilthearab]

It is a crazy story/situation, sorry you got stuck in the middle of that. I get there is background there that can't all be explained in posting on the internet, but I can still say there is so much there that was not ok to put onto you, regardless of if you were a trained professional or not. Heck, even more so if you were a certified tech, because it ropes you/your license in as well if anything goes wrong and the owner elects to file a board complaint. And given you, yourself stated you have never given an IV injection indicates you really weren't adequately trained to be dealing with this alone. Glad you got the IV in, but it was insanely unfair of them to ask you do do that to begin with.

I mean, I would have declined to pet sit the instant they mentioned the non-medicated seizure history.... nope, I'm out, not responsible..... having worked ER and GP most health issues go heavily south the instant an owner leaves and stress kicks in, be it seizures, GI issues, addison's, diabetes, urinary obstruction, etc. Stress makes things to berserk and an unmedicated pet with a known issue + stress is asking for all hell to break loose. Something you learn from experience and will hopefully be able to avoid with future pet sitting jobs.

I hope you don't take this as I think you did wrong, I don't, I think you rocked it with the hand you were dealt, sounds like you kept a level head. Got in an injection on a seizing pet (which is badass ) and did what you could given what you were told to do. Keep rocking it out and hopefully you won't be stuck in a similar position ever again.

I should clarify, I've never given an IV injection because at the jobs I've worked, anything needing an IV injection gets a catheter instead, and I have placed catheters plenty of times. Between drawing blood and placing catheters, the skills were there.

I do understand the rest of your points and I appreciate the input and kudos.

 

[capri1722]

(This is a long post so I put a TLDR at the bottom! It's not exactly a rant, but I think it fits this thread best.)

Last night, I started a pet sitting job for four older easy-going dogs. When the owner was giving me instructions, she included "Our one dog has epilepsy, but she hasn't had a seizure in months." Just two hours after she left, I heard a thud upstairs and ran up to find the dog (a lab/pit mix) in the start of a seizure.

The owner was actually on a trip with a vet I previously worked for (the vet referenced her friend to me for pet sitting) so I called them and they said sometimes she comes out of it on her own after a couple minutes, sometimes she doesn't. In case she doesn't, grab the diazepam in the cabinet downstairs. Five minutes of cluster seizures later, the vet said the diazepam was initially dispensed for the owner to administer rectally but it didn't work last time they tried it. She asked if there was any way I could give it IV. I said I could definitely try and hung up.

Miraculously, I hit the vein and gave 2 ml. I've drawn blood a good amount of times but I don't think I've ever given an IV injection, let alone on an actively seizing dog with no one to help restrain or hold off. She stopped seizing, vomited, then sat up and did alright for about ten minutes. I carried her downstairs to be closer to the med cabinet and the doorway. Just as I thought we might be in the clear, she started shaking, then fell back into cluster seizures. The vet said to give her another 2 ml of the diazepam. There was only 1.5 ml left. When I went to stick, she was with it enough to sit up and try to bite me, and when I stopped her, she screamed for a good minute interrupted by more attempts to bite me. Grabbed a blanket to put over her head, held her down with my leg, and tried again - gave 1 ml before she got too fractious. Gave the remaining 0.5 rectally.

Vomited again but seizing did not stop. Out of diazepam, the vet recommended I dissolve 3 tabs of clorazepate in water and give orally, then head over to ER. She said she would send over a neighbor to help me carry her to the car - no need, my 115lb self already carried her down the stairs, I could do it out to the car too.

The owners met me in the ER parking lot and sat with her while we waited for a vet in the pouring rain. Half an hour later, a vet and tech came out. The ER vet asked if she was on any long term meds - no - and started lecturing them about the importance of long term meds as the dog was still seizing in the car. Os got pissed off and insisted they take the dog in now and talk about that later. The ER vet changed subjects to how tonight will work - bring her in, put in a catheter - and the husband cut her off and started yelling about "you won't do anything to her until you give her the shot and make it stop." The ER vet tried explaining but the husband was too heated and wasn't understanding what a catheter was for. I interrupted to tell him, in a way he would understand, that putting in a catheter to give the diazepam is what I was doing at home except with one stick instead of many. He understood and backed down.

ER vet said protocol is to stop the seizures then monitor for 24 hours. Again, a sensitive topic to the husband. He started yelling "you might be a vet but you don't know MY dog, your job is to make her stop, and that's IT. Once you've done your job, we will bring her home." Cue more arguing about protocol vs owners' expectations. At that point, the dog had stopped seizing but was in a postictal state. I interrupted them to tell the ER vet what happened and what I had given. They finally started taking the dog inside and the owners tried following and arguing more - I interjected, talked to them about what happened earlier as a distraction, and calmed them down so that the vet and tech could take the dog in.

End result: the dog didn't seize anymore once inside, didn't get any more drugs, and was monitored for an hour before being sent home. I went home at 3am. I went back to their house today to pick up the stuff I left behind last night and was greeted by a dog overjoyed to see me. It made my heart happy.

TLDR: Epileptic dog went into cluster seizures two hours into pet sitting. Alone, I simultaneously restrained, held off, and injected IV diazepam into an actively seizing/otherwise fractious dog. Seizing started again, ran out of diazepam, and my 115lb self carried a lab/pit mix down the stairs, through the house, and out to the car to bring to the ER. Then acted as mediator between the angry owners and frustrated vet in the pouring rain at 2am. Dog ended up okay. I feel like a bada**.

As a pharm student, I just wanna say…

MEDS 👏🏼 ONLY 👏🏼 WORK 👏🏼 IF 👏🏼 YOU 👏🏼 TAKE 👏🏼 THEM 👏🏼

As soon as I saw "oh she hasn't had a seizure in months" combined with possible status epilepticus I knew there's no way they have her on any preventative therapy. This kind of thing happens in human med too and it irks me to all hell.

Congrats to you for how you handled that.

 

[vetmedhead]

As a pharm student, I just wanna say…

MEDS 👏🏼 ONLY 👏🏼 WORK 👏🏼 IF 👏🏼 YOU 👏🏼 TAKE 👏🏼 THEM 👏🏼

As soon as I saw "oh she hasn't had a seizure in months" combined with possible status epilepticus I knew there's no way they have her on any preventative therapy. This kind of thing happens in human med too and it irks me to all hell.

Congrats to you for how you handled that.

Oof especially things that need time to reach steady state or that need a lot of fiddling to hit the right dose.

 

[LetItSnow]

As a pharm student, I just wanna say…

MEDS 👏🏼 ONLY 👏🏼 WORK 👏🏼 IF 👏🏼 YOU 👏🏼 TAKE 👏🏼 THEM 👏🏼

As soon as I saw "oh she hasn't had a seizure in months" combined with possible status epilepticus I knew there's no way they have her on any preventative therapy. This kind of thing happens in human med too and it irks me to all hell.

Congrats to you for how you handled that.

Huh? Epilepsy is not infrequently progressive. You can certainly be administering appropriate anticonvulsant therapy and then suddenly have clustering seizures after months of quiescence.

It doesn't inherently mean the owner hasn't been giving meds. Although that, obviously, also happens.

("My cat hasn't had urinary signs in a few years, so I stopped giving him that expensive diet!" "Yes, ma'am, and now your cat is blocked again.")

 

[Ariel-Li]

(This is a long post so I put a TLDR at the bottom! It's not exactly a rant, but I think it fits this thread best.)

Last night, I started a pet sitting job for four older easy-going dogs. When the owner was giving me instructions, she included "Our one dog has epilepsy, but she hasn't had a seizure in months." Just two hours after she left, I heard a thud upstairs and ran up to find the dog (a lab/pit mix) in the start of a seizure.

The owner was actually on a trip with a vet I previously worked for (the vet referenced her friend to me for pet sitting) so I called them and they said sometimes she comes out of it on her own after a couple minutes, sometimes she doesn't. In case she doesn't, grab the diazepam in the cabinet downstairs. Five minutes of cluster seizures later, the vet said the diazepam was initially dispensed for the owner to administer rectally but it didn't work last time they tried it. She asked if there was any way I could give it IV. I said I could definitely try and hung up.

Miraculously, I hit the vein and gave 2 ml. I've drawn blood a good amount of times but I don't think I've ever given an IV injection, let alone on an actively seizing dog with no one to help restrain or hold off. She stopped seizing, vomited, then sat up and did alright for about ten minutes. I carried her downstairs to be closer to the med cabinet and the doorway. Just as I thought we might be in the clear, she started shaking, then fell back into cluster seizures. The vet said to give her another 2 ml of the diazepam. There was only 1.5 ml left. When I went to stick, she was with it enough to sit up and try to bite me, and when I stopped her, she screamed for a good minute interrupted by more attempts to bite me. Grabbed a blanket to put over her head, held her down with my leg, and tried again - gave 1 ml before she got too fractious. Gave the remaining 0.5 rectally.

Vomited again but seizing did not stop. Out of diazepam, the vet recommended I dissolve 3 tabs of clorazepate in water and give orally, then head over to ER. She said she would send over a neighbor to help me carry her to the car - no need, my 115lb self already carried her down the stairs, I could do it out to the car too.

The owners met me in the ER parking lot and sat with her while we waited for a vet in the pouring rain. Half an hour later, a vet and tech came out. The ER vet asked if she was on any long term meds - no - and started lecturing them about the importance of long term meds as the dog was still seizing in the car. Os got pissed off and insisted they take the dog in now and talk about that later. The ER vet changed subjects to how tonight will work - bring her in, put in a catheter - and the husband cut her off and started yelling about "you won't do anything to her until you give her the shot and make it stop." The ER vet tried explaining but the husband was too heated and wasn't understanding what a catheter was for. I interrupted to tell him, in a way he would understand, that putting in a catheter to give the diazepam is what I was doing at home except with one stick instead of many. He understood and backed down.

ER vet said protocol is to stop the seizures then monitor for 24 hours. Again, a sensitive topic to the husband. He started yelling "you might be a vet but you don't know MY dog, your job is to make her stop, and that's IT. Once you've done your job, we will bring her home." Cue more arguing about protocol vs owners' expectations. At that point, the dog had stopped seizing but was in a postictal state. I interrupted them to tell the ER vet what happened and what I had given. They finally started taking the dog inside and the owners tried following and arguing more - I interjected, talked to them about what happened earlier as a distraction, and calmed them down so that the vet and tech could take the dog in.

End result: the dog didn't seize anymore once inside, didn't get any more drugs, and was monitored for an hour before being sent home. I went home at 3am. I went back to their house today to pick up the stuff I left behind last night and was greeted by a dog overjoyed to see me. It made my heart happy.

TLDR: Epileptic dog went into cluster seizures two hours into pet sitting. Alone, I simultaneously restrained, held off, and injected IV diazepam into an actively seizing/otherwise fractious dog. Seizing started again, ran out of diazepam, and my 115lb self carried a lab/pit mix down the stairs, through the house, and out to the car to bring to the ER. Then acted as mediator between the angry owners and frustrated vet in the pouring rain at 2am. Dog ended up okay. I feel like a bada**.

That was awesome! You were a bada$$ LOL!

Side note: I would never sit an epileptic animal that is not on anticonvulsant drugs...

 

[JaynaAli]

That was awesome! You were a bada$$ LOL!

Side note: I would never sit an epileptic animal that is not on anticonvulsant drugs...

I mean the goal of antiepileptic therapy is to reduce seizure frequency as much as possible so if a patient has a random single seizure months and months apart then I don’t think it’s wrong to not have them on long term therapy yet. There is a vet epilepsy task force that recommends you start meds when there’s been two seizures within 6 months, status epilepticus or cluster seizures, rough postictal periods, or worsening frequency/severity/length. So to blanket state that any dog with any seizure history ever needs meds or owners couldn’t have been giving things right seems short sighted. From the story, it sounds like the dog would meet these recommendations since the dog had clustered previously and I think that should have been made more obvious to the sitter for sure, but meds have side effects too and we don’t know other aspects of the patients history (or what owners would allow) to know the decision making behind the choices made by the vet and owner.

 

[Ariel-Li]

I mean the goal of antiepileptic therapy is to reduce seizure frequency as much as possible so if a patient has a random single seizure months and months apart then I don’t think it’s wrong to not have them on long term therapy yet. There is a vet epilepsy task force that recommends you start meds when there’s been two seizures within 6 months, status epilepticus or cluster seizures, rough postictal periods, or worsening frequency/severity/length. So to blanket state that any dog with any seizure history ever needs meds or owners couldn’t have been giving things right seems short sighted. From the story, it sounds like the dog would meet these recommendations since the dog had clustered previously and I think that should have been made more obvious to the sitter for sure, but meds have side effects too and we don’t know other aspects of the patients history (or what owners would allow) to know the decision making behind the choices made by the vet and owner.

What you said is totally fair! I guess my comment was more specific to this situation - it's completely different to sit a pet that had a history of random single seizures that doesn't require any medication, than like this instance, a pet with cluster seizures where emergency seizure medication was stored at home, and apparently was not sufficient in past experience. As a sitter for several years, I personally will not sit a dog like this.

And FYI, the male owner sounds completely ignorant and unreasonable. I admire @Aprilthearab for what she did, but I would never want to put myself in that situation. I'm not even sure about the legal liability of a unlicensed vet tech giving IV injections of controlled substance in a pet-sitting situation. What if the dog doesn't make it to the ER?

 

[DVMDream]

I mean the goal of antiepileptic therapy is to reduce seizure frequency as much as possible so if a patient has a random single seizure months and months apart then I don’t think it’s wrong to not have them on long term therapy yet. There is a vet epilepsy task force that recommends you start meds when there’s been two seizures within 6 months, status epilepticus or cluster seizures, rough postictal periods, or worsening frequency/severity/length. So to blanket state that any dog with any seizure history ever needs meds or owners couldn’t have been giving things right seems short sighted. From the story, it sounds like the dog would meet these recommendations since the dog had clustered previously and I think that should have been made more obvious to the sitter for sure, but meds have side effects too and we don’t know other aspects of the patients history (or what owners would allow) to know the decision making behind the choices made by the vet and owner.

With the seizure medication options out there now, there are drugs that are insanely safe with really the only side effect being lethargy and really only when first starting the medication. Heck, even giant overdoses don't cause serious issues with some of the seizure medications available now (keppra, I think zonisamide is this way as well). I can't find any excuse to not have the dog on something, especially a dog that clusters when it does have seizures and doesn't respond to rectal diazepam. Lethargy is much preferable to status epilepticus, organ damage from status and DIC. Heck, I don't think I have even seen phenobarbital be that severe, sure I have seen elevated liver enzymes with it, but never fulminant hepatic failure. This study (below) shows that it appears it more induced liver enzyme elevation but doesn't cause any actual hepatic damage, there is a lot of repeat labwork needed for phenobarbital so I could see wanting to avoid that, but there are other options...

Effects of long-term phenobarbital treatment on the liver in dogs - PubMed

I agree on the blanket statement doesn't fit all, a dog with a one off seizure history doesn't need meds, even a dog that has a seizure twice a year doesn't necessarily need meds. But a dog with a history of cluster seizures non-responsive to rectal diazepam (and having them frequently enough a vet thought it was reasonable for the owner to have diazepam and clorazepate available to administer during a seizure), I can't think of single reason not to have that dog on some sort of medication. I am guessing the owners are refusing to medicate the dog in this case, which brings me back to-- the dog deserves so much better.

 

[Aprilthearab]

I am guessing the owners are refusing to medicate the dog in this case, which brings me back to-- the dog deserves so much better.

Yes, they were, despite medical recommendations. What they told me was the dog was having seizures once a month for a few months in a row. They declined medication and instead started her on a homeopathic from a holistic vet and she hadn't had a seizure in over six months since starting it. I'm not big on homeopathics, especially not for something so serious, but it was seemingly "effective" under average conditions. Just not when the dog was stressed out, such as when the owners left, as we found. Lesson learned.

 

[PippyPony]

Gotta love it when magical remedies happen to coincide with the natural ebb and flow of a sporadic disease

 

[Aprilthearab]

Gotta love it when magical remedies happen to coincide with the natural ebb and flow of a sporadic disease

Exactly why I said the dog wasn't on any medication

 

[capri1722]

Huh? Epilepsy is not infrequently progressive. You can certainly be administering appropriate anticonvulsant therapy and then suddenly have clustering seizures after months of quiescence.

It doesn't inherently mean the owner hasn't been giving meds. Although that, obviously, also happens.

("My cat hasn't had urinary signs in a few years, so I stopped giving him that expensive diet!" "Yes, ma'am, and now your cat is blocked again.")

I know. It was just that, the way the story was going, I felt it in my gut.

 

[supershorty]

I finally have a diagnosis after 2 months of this and I kind of feel like I might cry, and I'm not sure if it's happy crying or sad crying or a little bit of both, but I'm just so relieved to have an answer and a plan.

@LetItSnow you win, it was ulcerative colitis (pancolitis because apparently even my internal organs take "go big or go home" seriously - why only have part of the colon be miserable when you could have the WHOLE THING!)

2 months of pred with some mesalamine +/- TNF inhibitors in the future for this kid

 

[WildZoo]

So so glad you finally have a diagnosis @supershorty

 

[LetItSnow]

With the seizure medication options out there now, there are drugs that are insanely safe with really the only side effect being lethargy and really only when first starting the medication. Heck, even giant overdoses don't cause serious issues with some of the seizure medications available now (keppra, I think zonisamide is this way as well). I can't find any excuse to not have the dog on something, especially a dog that clusters when it does have seizures and doesn't respond to rectal diazepam. Lethargy is much preferable to status epilepticus, organ damage from status and DIC. Heck, I don't think I have even seen phenobarbital be that severe, sure I have seen elevated liver enzymes with it, but never fulminant hepatic failure. This study (below) shows that it appears it more induced liver enzyme elevation but doesn't cause any actual hepatic damage, there is a lot of repeat labwork needed for phenobarbital so I could see wanting to avoid that, but there are other options...

Well, it's not just medical safety/indication. You also have to balance the fact that it will (should) be on it for life, which carries significant cost, even for a cheap medication. Lotsa people fret about whether they can afford a $15/month netflix subscription, so even a cheap med isn't something to take lightly.

I obviously agree with you that a dog that has cluster seizures should be on something long term if the owners are willing, since it automatically breaks the "more than 1/month or any lasting more than 5 minutes" rule, though.

I'm with you on phenobarbital. People get all worked up over the induced enzyme elevation, but as far as I am aware - and certainly in clinical practice - it has never had any actual impact on any of my own cases. Off the top of my head I can't think of a single time the liver value elevation has made me moderate therapy in any way. It's worth tracking so that you know where that particular pet sits at baseline so you can detect changes unrelated to the Pheno, but that's about it AFAIC.

 

[LetItSnow]

I finally have a diagnosis after 2 months of this and I kind of feel like I might cry, and I'm not sure if it's happy crying or sad crying or a little bit of both, but I'm just so relieved to have an answer and a plan.

@LetItSnow you win, it was ulcerative colitis (pancolitis because apparently even my internal organs take "go big or go home" seriously - why only have part of the colon be miserable when you could have the WHOLE THING!)

2 months of pred with some mesalamine +/- TNF inhibitors in the future for this kid

Gosh, it's like I practically treat GI issues for a living or something. ;-)

What did I win???

(But for real, I'm glad to hear you've got a path forward. So stressful not to have one.)

 

[DVMDream]

Well, it's not just medical safety/indication. You also have to balance the fact that it will (should) be on it for life, which carries significant cost, even for a cheap medication. Lotsa people fret about whether they can afford a $15/month netflix subscription, so even a cheap med isn't something to take lightly.

I obviously agree with you that a dog that has cluster seizures should be on something long term if the owners are willing, since it automatically breaks the "more than 1/month or any lasting more than 5 minutes" rule, though.

I'm with you on phenobarbital. People get all worked up over the induced enzyme elevation, but as far as I am aware - and certainly in clinical practice - it has never had any actual impact on any of my own cases. Off the top of my head I can't think of a single time the liver value elevation has made me moderate therapy in any way. It's worth tracking so that you know where that particular pet sits at baseline so you can detect changes unrelated to the Pheno, but that's about it AFAIC.

Oh I get finances come into it too, but monthly meds are a heck of a lot cheaper than rescue diazepam, clonazepate and an ER visit every few months. They're also a whole butt load cheaper than homeopathic non medicine.

If meds can't be afforded that owner needs a serious sit down about QOL and consideration for euthanasia.

 

[KCgophervet]

Had a case I thought was minor and easily resolved or treated yesterday turn into a ****show that died today while I was out and my coworkers covered. I can't stop thinking about it or if I could have done anything differently yesterday and wondering if I didn't give it enough attention yesterday thanks to the other things I was dealing with.

It's eating at me and I feel like I don't usually have this problem.

Blah

 

[supershorty]

What did I win???

A poop emoji stuffed toy.

Or you might get stuck being interview partners with me one day in the next few weeks, but I'm not sure everyone would call that a prize

 

[genny]

It's eating at me and I feel like I don't usually have this problem.

Hindsight is always clearer. I had a new pup appointment with a broken leg that looked healed on rads, came back for his 4 week recheck and it’s a non-union now. What if I had splinted it for those 4 weeks??? Dwelling on it doesn’t fix anything and just makes me feel crappy.

So don’t beat yourself up! A lot of things change over time, even in just 24 hours.

 

[Lupin21]

Yeah, I have had many of those types of cases lately as our caseload is still absolutely crazy and i can't always tell what is going to turn into a dumpster fire. Take today, I had a dog that ate a bunch of fondant, thought yeah, probably gonna see panc things. AKI and ALT/ALP elevated. WTF. I didn't have time to run bloodwork right away even. Took a quick rad to make sure he wasn't blocked up from it. Got him started on fluids, and got to bloodwork a couple hours later as I also had HBC cat, Lyme nephritis, and all the other sick appts and overflows to manage. Jaw dropped when I saw the kidney values. Here's hoping he diuresis and I still have some kidney function. :/

 

[Lawpy]

I finally have a diagnosis after 2 months of this and I kind of feel like I might cry, and I'm not sure if it's happy crying or sad crying or a little bit of both, but I'm just so relieved to have an answer and a plan.

@LetItSnow you win, it was ulcerative colitis (pancolitis because apparently even my internal organs take "go big or go home" seriously - why only have part of the colon be miserable when you could have the WHOLE THING!)

2 months of pred with some mesalamine +/- TNF inhibitors in the future for this kid

The colon is evil

heal shorty

 

[alissa14]

My cat likes to lay in the stinky dog bed and now she stinks.

That’s pretty much it

 

[finnickthedog]

Great feeling, when your grade is in part determined by someone who didn't even work with you and upon reading their feedback you're left questioning if they even know who you are because that's how little sense it makes.