RANT HERE thread

[jmo1012]

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Yeah, I guess I'd heard once upon a time that we can use Zofran in animals, but I've always seen the vet choose Cerenia.

3 years ago was the last I heard on another major human drug trial for the NK1 antagonists from a drug rep, but I hadn't heard anything since. That would be great to have in the human market! The last I heard, the drug companies were willing to limit it to cancer and terminal patients while waiting for the long term studies for general use, but I never heard whether it passed.

I reach for Cerenia because it works incredibly well and is once a day. The problem with Zofran is then my clients have to give it 2-3 times a day, and that diminishes compliance. We also tend to use very low doses at my hospital, and only have 1 larger tablet size which means that many of my smaller patients can't have it orally unless I script it out (diminished compliance). I like it for adjunctive control, same with Reglan.

 

[JaynaAli]

We use anzemet/dolasetron quite a bit in my practice, especially in those er cases of vomiting dogs where we don't have money to do rads and exclude a foreign body before using cerenia. I definitely prefer cerenia, but for a big dog it can get really expensive.

 

[that redhead]

I tend to give an injection of Cerenia at initial presentation and then move to famotidine at home if possible since Cerenia is so freaking expensive. We carry a ondansetron, Reglan etc. but I've had success with what I do so I figure why change it unless necessary 🙂

 

[LetItSnow]

I tend to give an injection of Cerenia at initial presentation and then move to famotidine at home if possible since Cerenia is so freaking expensive. We carry a ondansetron, Reglan etc. but I've had success with what I do so I figure why change it unless necessary 🙂

I use cerenia AND dolasetron together for crit care patients fairly often. I generally don't start with both (overkill), but for certain types of cases where I really want them eating or at least keeping their tube fed clinicare down..... (Parvo puppies are a good example)....

 

[orca2011]

Placed an order for food where it originally said it would take between 40-60 minutes, which was fine because I wasn't starving. Received an email that said food would be delivered by like 10:10 PM. WTF. If I knew you were going to tack on 3 additional hours when I ordered the food, I wouldn't have bothered.

 

[cowgirla]

That awful moment when you really really really want to Facebook stalk a guy and he is nowhere to be found on social media. Boo.

 

[deleted498041]

Are you a scavma member?

Yeah, but I don't know my number =/ Never bothered to remember it because I've never had an issue accessing JAVMA. I guess it's time to be bothered.

 

[deleted498041]

We use anzemet/dolasetron quite a bit in my practice, especially in those er cases of vomiting dogs where we don't have money to do rads and exclude a foreign body before using cerenia. I definitely prefer cerenia, but for a big dog it can get really expensive.

I feel like this is a really dumb question... why don't you use Cerenia as a first choice drug in vomiting dogs with no money for rads? I didn't think Cerenia was a prokinetic (bad with a potential FB), and I thought it's inhibition of substance P could be useful in that scenario.

 

[dyachei]

I feel like this is a really dumb question... why don't you use Cerenia as a first choice drug in vomiting dogs with no money for rads? I didn't think Cerenia was a prokinetic (bad with a potential FB), and I thought it's inhibition of substance P could be useful in that scenario.

It used to be thought it was contraindicated in FB cases. However, that really isn't the case. The thought was you could cause a perf but dogs on cerenia may still vomit before it causes one.

 

[JaynaAli]

I feel like this is a really dumb question... why don't you use Cerenia as a first choice drug in vomiting dogs with no money for rads? I didn't think Cerenia was a prokinetic (bad with a potential FB), and I thought it's inhibition of substance P could be useful in that scenario.

Dyachei laid it out well. Change is slow for many clinicians and at my internship a lot of what we're told to do is because 'that's just the way we do it.' Like I said, I prefer using Cerenia, but not everyone I work with is comfortable making it their first line drug.

Edited to add: I realize now that I just made it sound like we don't make changes based on new recommendations, which isn't the case. It just takes time to convince some seasoned clinicians to embrace new thinking.

 

[missdarjeeling]

Odd. I heard that same bit about Cerenia being contraindicated in FB cases from a vet who graduated last year and another who graduated 3 years ago. Is it possible they still learned that in school or is it more likely that they've adapted to "that's how we do it here"?

 

[deleted498041]

It used to be thought it was contraindicated in FB cases. However, that really isn't the case. The thought was you could cause a perf but dogs on cerenia may still vomit before it causes one.

Dyachei laid it out well. Change is slow for many clinicians and at my internship a lot of what we're told to do is because 'that's just the way we do it.' Like I said, I prefer using Cerenia, but not everyone I work with is comfortable making it their first line drug.

Awesome, thanks guys 🙂

Odd. I heard that same bit about Cerenia being contraindicated in FB cases from a vet who graduated last year and another who graduated 3 years ago. Is it possible they still learned that in school or is it more likely that they've adapted to "that's how we do it here"?[/QUOTE]

Both, although I can tell you that I never learned about it being contraindicated in that scenario while in school. Keep in mind some hospitals are very protocol happy and don't allow any wavering from anesthetic protocols, surgical protocols, CPR protocols -- even if they're not what the most current research suggests is best.

 

[alohacat319]

I am so excited to move next fall for vet school. After living in the same town for 18 years, it will be a nice change. I'm so tired of all the same petty drama from the same people. Even if I'm not even slightly involved everyyyyonee has to hear about it. I'm sure vet school will have copious amounts of drama too, but at least I'll get to meet some new faces.

Gonna miss my parents though. It's been nice living 20 minutes from home all through undergrad and being able to go home and see them.

 

[Jess Monster]

If there is one specific thing that I'm disappointed in most about my degree program, it's the lack of training in SAS (a statistical software that nearly every health department and health agency uses). There are some online resources I can pursue independently to learn it, but I would have preferred taking a course while I was in school and could be given data sets to work with and have a professor or TA to ask questions to about the programming language (I tried to take the only course offered but the space was limited and reserved for a specific group of students which adds to my disappointment). What's frustrating is that many entry level jobs now want BS public health and MPH students to have basic proficiency in SAS (traditionally, it was taught on the job).

 

[LetItSnow]

Odd. I heard that same bit about Cerenia being contraindicated in FB cases from a vet who graduated last year and another who graduated 3 years ago. Is it possible they still learned that in school or is it more likely that they've adapted to "that's how we do it here"?

There's widespread difference of opinion. One camp says don't give them Cerenia unless you're sure they aren't obstructed because you'll mask the signs (i.e. Stop the vomiting) and that will delay treatment allowing more damage to accumulate. The other camp says obstructed dogs will vomit through the Cerenia so it's ok to give.

Everybody you ask is 100% positive they are correct regardless of which camp they are in. It's really kinda amusing.

 

[Jess Monster]

I'm happy that I might have an interview for a food safety inspection job for the city in the near future. The problem is that offer is conditional on me applying to be a registered Sanitarian in Training with the State Board of Sanitation. I have to turn the application in before the board meets next month and I have to pay $80 in doing so. I'm a little hesitant though because I know if I were to get this job and get into vet school, I would likely not meet my 1 year work requirement to take the Registered Sanitarian exam and I'm not sure how that would affect things down the line (it's beneficial to be an SIT and eventually an RS, but that certification requires maintenance like CE courses and there are consequences if you don't follow through with things in a timely manner).

Plus $80 right now is a whole utility bill or two. Gotta spend money to make money, I guess.

... but on a completely unrelated note, I entered a picture of my rabbit into General Mills' Real Trix Rabbit contest! Check it out!

 

[orca2011]

Bought a case of soda about a week or so ago...about half of the 12 were dented with tiny punctures that made them flat...

 

[katashark]

Bought a case of soda about a week or so ago...about half of the 12 were dented with tiny punctures that made them flat...

Oh my gosh 🙁 🙁 🙁

 

[pp9]

Bought a case of soda about a week or so ago...about half of the 12 were dented with tiny punctures that made them flat...

Take them back!!

 

[orca2011]

Take them back!!

I would but I've tossed them and likely don't have the receipt anymore.

 

[pp9]

I would but I've tossed them and likely don't have the receipt anymore.

Awww. I would still have tried. Most grocery stores have a "Okay, whatever, go grab one off the shelf" attitude. I've even returned salad that went brown within 24 hours without being opened before!

 

[orca2011]

Awww. I would still have tried. Most grocery stores have a "Okay, whatever, go grab one off the shelf" attitude. I've even returned salad that went brown within 24 hours without being opened before!

Other factor is that the store I went to requires me to drive and I don't feel like moving my car. I've got a prime free parking spot which is a big deal here.

 

[pp9]

Other factor is that the store I went to requires me to drive and I don't feel like moving my car. I've got a prime free parking spot which is a big deal here.

Priorities. Moving is always low on that list.

 

[Trilt]

Today's afternoon appointment was an awesome game of "Lets think of twenty different ways to say 'your rDVM sorta sucks at dental care sorry about your dog's horrible teeth'" without actually saying it. Womp womp.

 

[JaynaAli]

I lost my favorite cup that I take to work every day. I've been out of town and just realized it's missing. I have looked all over my house. It's not at my regular clinic. It might be at the sister clinic I was at last week, but it has already closed for the day so I can't go check there until tomorrow. I realize now that I am quite possibly overly attached to it, but it's an awesome cup.

 

[hazelmoo]

Today's afternoon appointment was an awesome game of "Lets think of twenty different ways to say 'your rDVM sorta sucks at dental care sorry about your dog's horrible teeth'" without actually saying it. Womp womp.

This is how I felt when I once saw a morbidly obese animal and the owner was like, "my usual vet told me fluffy looks fine! And that he isn't fat! They also said it was okay to feed him Bologna, ham, and salami mixed in with his dog food.. But he normally just eats around the dog food"..... I wanted to ask the name and clinic of said vet and promptly go over there and slap them lol

 

[LetItSnow]

This is how I felt when I once saw a morbidly obese animal and the owner was like, "my usual vet told me fluffy looks fine! And that he isn't fat! They also said it was okay to feed him Bologna, ham, and salami mixed in with his dog food.. But he normally just eats around the dog food"..... I wanted to ask the name and clinic of said vet and promptly go over there and slap them lol

I mean this gently, but you need to reign that attitude in. It's great that you're concerned about the animal, but do not EVER UNDER ANY CIRCUMSTANCES believe that the rdvm said what the client reported they said. I've been on both sides of that and it is ASTONISHING how clients will hear what they want. I've had clients report back to their vet that i said exactly the opposite of what I ACTUALLY said.... Because that's just what they wanted to hear. Fortunately, I keep pretty detailed records.

It wouldn't surprise me at all if the vet had warned them that their animal was overweight and they magically transformed that into "our vet said Fluffy is doing great." Not one tiny bit.

Just remember that some day you'll be the vet that a client claims said something you didn't. I promise.

 

[missdarjeeling]

Oh, man, we even had clients on emergency who said the complete opposite of what the same exact doctor had told them the previous day.

On another note, vet med is a category on Jeopardy!. They filmed at UC Davis ...and introduced it with "ranked the #1 school in the world." Thought you guys would enjoy that.

 

[hazelmoo]

I mean this gently, but you need to reign that attitude in. It's great that you're concerned about the animal, but do not EVER UNDER ANY CIRCUMSTANCES believe that the rdvm said what the client reported they said. I've been on both sides of that and it is ASTONISHING how clients will hear what they want. I've had clients report back to their vet that i said exactly the opposite of what I ACTUALLY said.... Because that's just what they wanted to hear. Fortunately, I keep pretty detailed records.

It wouldn't surprise me at all if the vet had warned them that their animal was overweight and they magically transformed that into "our vet said Fluffy is doing great." Not one tiny bit.

Just remember that some day you'll be the vet that a client claims said something you didn't. I promise.

Understandable! However, I've had family and friends with fat cats and dogs who say their vet said that the pet looked fine and that there was nothing to worry about. The vet who I work for told me that a lot of vets she knew would rather avoid confrontation and pretend like weight wasn't an issue because it's a difficult subject for some people to talk about, so I was more inclined to believe what said client had to say about the lunch meat and obesity (since I've seen it so many other times before).

 

[dyachei]

I mean this gently, but you need to reign that attitude in. It's great that you're concerned about the animal, but do not EVER UNDER ANY CIRCUMSTANCES believe that the rdvm said what the client reported they said. I've been on both sides of that and it is ASTONISHING how clients will hear what they want. I've had clients report back to their vet that i said exactly the opposite of what I ACTUALLY said.... Because that's just what they wanted to hear. Fortunately, I keep pretty detailed records.

It wouldn't surprise me at all if the vet had warned them that their animal was overweight and they magically transformed that into "our vet said Fluffy is doing great." Not one tiny bit.

Just remember that some day you'll be the vet that a client claims said something you didn't. I promise.

Also, owners are likely to give human food as treats whether you tell them it is ok or not. The trick is moderation. And that's what I tell owners. It needs to be a treat, not their food.

 

[hazelmoo]

Under no circumstance do I automatically believe whatever a client says! Because there have been times when other vets have called my clinic asking why one of our vets said/did something they didn't say/do. But this situation I did believe it and still think she was telling the truth.

 

[hazelmoo]

Also, owners are likely to give human food as treats whether you tell them it is ok or not. The trick is moderation. And that's what I tell owners. It needs to be a treat, not their food.

Agreed. I try to get them to switch to healthier treats like bland chicken or carrots or green beans, because a lot of people like to give cheese and lunch meats which is going to be high in calories no matter what (especially when we do a calorie count and the dog needs to be kept on a strict diet).

 

[dyachei]

Agreed. I try to get them to switch to healthier treats like bland chicken or carrots or green beans, because a lot of people like to give cheese and lunch meats which is going to be high in calories no matter what (especially when we do a calorie count and the dog needs to be kept on a strict diet).

yes, but my point is that perhaps the dog weighed more before because they were giving 6 strips of bacon a day and now they are giving less than 1. sometimes things take baby steps. You have no idea what kind of conversations they have had.

 

[hazelmoo]

yes, but my point is that perhaps the dog weighed more before because they were giving 6 strips of bacon a day and now they are giving less than 1. sometimes things take baby steps. You have no idea what kind of conversations they have had.

I don't disagree with you!

 

[LetItSnow]

Understandable! However, I've had family and friends with fat cats and dogs who say their vet said that the pet looked fine and that there was nothing to worry about. The vet who I work for told me that a lot of vets she knew would rather avoid confrontation and pretend like weight wasn't an issue because it's a difficult subject for some people to talk about, so I was more inclined to believe what said client had to say about the lunch meat and obesity (since I've seen it so many other times before).

So if you happened to be the vet who DID give good advice but had someone believe you didn't because that person had "seen it so many other times" how would you feel?

All I'm saying is that I would encourage you to be much more cautious about believing what a client says than what you demonstrated in the post to which I replied. That's all.

 

[Skimble]

I mean this gently, but you need to reign that attitude in. It's great that you're concerned about the animal, but do not EVER UNDER ANY CIRCUMSTANCES believe that the rdvm said what the client reported they said. I've been on both sides of that and it is ASTONISHING how clients will hear what they want. I've had clients report back to their vet that i said exactly the opposite of what I ACTUALLY said.... Because that's just what they wanted to hear. Fortunately, I keep pretty detailed records.

It wouldn't surprise me at all if the vet had warned them that their animal was overweight and they magically transformed that into "our vet said Fluffy is doing great." Not one tiny bit.

Just remember that some day you'll be the vet that a client claims said something you didn't. I promise.

I once had a woman tell me that she had to return the kitten she purchased from a pet store because it was FIV or FeLV positive (I can't remember which) and her vet told her to return it right away because the disease was extremely contagious AND transferable to humans . I'm fairly certain no vet on the planet told her either of those diseases were transferable to humans.

As far as discussing pet weight with clients, that issue can be very sensitive and many vets may choose to take a cautious approach to discussing it with the owner. It's possible the vet broached the subject at some point, and the owner didn't react favorably, so instead of badgering the client about the pets weight every visit, they chose to say "Fluffy is doing well" as in status quo for Fluffy, and doing well considering his weight.

I also can't tell you how many times people came in making claims about what the emergency vet or specialist told them that was in complete contrast to the report we received. Sometimes this was clearly malicious intent while other times it was a misunderstanding, wishful thinking or something relatively innocent.

 

[LetItSnow]

Under no circumstance do I automatically believe whatever a client says! Because there have been times when other vets have called my clinic asking why one of our vets said/did something they didn't say/do. But this situation I did believe it and still think she was telling the truth.

.... Even though you don't actually have any evidence that would lead you to that conclusion? Ok.

 

[hazelmoo]

So if you happened to be the vet who DID give good advice but had someone believe you didn't because that person had "seen it so many other times" how would you feel?

All I'm saying is that I would encourage you to be much more cautious about believing what a client says than what you demonstrated in the post to which I replied. That's all.

Thanks for your advice, I will keep this in mind in the future. I have this funny habit of giving people the benefit of the doubt. Maybe I will stop doing this as I have more experience in the field? Who knows!

 

[LetItSnow]

Thanks for your advice, I will keep this in mind in the future. I have this funny habit of giving people the benefit of the doubt. Maybe I will stop doing this as I have more experience in the field? Who knows!

Your snark is not useful.

If you give people the benefit of the doubt .... Why are you not giving the vet the benefit of the doubt?

Some day the shoe will be on the other foot and a client will insist you said something you didn't and you're going to be stewing because you feel like that client is making you look bad and you can't do anything to defend yourself.

I guess maybe you just need to experience it personally for the lesson to hit home. Probably wasted breath on my part until you're further along.

 

[hazelmoo]

.... Even though you don't actually have any evidence that would lead you to that conclusion? Ok.

Lol. Your tone is always so friendly and welcoming, especially considering you don't even know me!

When someone tells you something, do you assume they are being truthful until proven otherwise? Because that's how I live on a day to day basis. If I automatically assumed everyone was lying all of the time, I would be miserable. And, I trust my ability to be able to tell when people are lying or not. Sometimes I'm wrong, but I am right more often than not.

 

[dyachei]

Lol. Your tone is always so friendly and welcoming, especially considering you don't even know me!

When someone tells you something, do you assume they are being truthful until proven otherwise? Because that's how I live on a day to day basis. If I automatically assumed everyone was lying all of the time, I would be miserable. And, I trust my ability to be able to tell when people are lying or not. Sometimes I'm wrong, but I am right more often than not.

you're probably wrong more often than you realize. As House says, everybody lies.

 

[Trilt]

I mean this gently, but you need to reign that attitude in. It's great that you're concerned about the animal, but do not EVER UNDER ANY CIRCUMSTANCES believe that the rdvm said what the client reported they said. I've been on both sides of that and it is ASTONISHING how clients will hear what they want. I've had clients report back to their vet that i said exactly the opposite of what I ACTUALLY said.... Because that's just what they wanted to hear. Fortunately, I keep pretty detailed records.

It wouldn't surprise me at all if the vet had warned them that their animal was overweight and they magically transformed that into "our vet said Fluffy is doing great." Not one tiny bit.

Just remember that some day you'll be the vet that a client claims said something you didn't. I promise.

I try really hard, and have actually gotten fairly bitchy at classmates for making fun of rDVMs before. So I probably shouldn't complain. But in this case, we have clear records suggesting against dental care for this dog with multiple discoloured canines, extensive furcation exposure on his PMs, etc, with no big systemic health problems that would contraindicate anesthesia. Ended up having eight extractions with us, including multiple strategic teeth. Owner is super dedicated and dog is super nice for oral exam... just frustrating to me to then be pretty much straight asked if the other vet did something wrong, and have to dance around the answer.

 

[dyachei]

multiple discoloured canines

Discolored as in dead? Or just stained?

 

[WildZoo]

Thanks for your advice, I will keep this in mind in the future. I have this funny habit of giving people the benefit of the doubt. Maybe I will stop doing this as I have more experience in the field? Who knows!

I think one thing to remember is that memory is a very tricky thing. The brain is kind of an dingus sometimes. So unless the client got an exact printout of everything the vet told them, they may not really remember, or the time between may have been enough to allow their brain to warp the memory a bit. It's hardly malicious in most cases but people just aren't that good at remembering stuff.

ETA: Also sometimes people just don't want to take the blame for doing something that is harming their pet, especially when they see it as showing love. Very easy to push that blame off onto someone who isn't there, especially if you don't have medical notes and all that for the pet.

 

[LetItSnow]

Lol. Your tone is always so friendly and welcoming, especially considering you don't even know me!

When someone tells you something, do you assume they are being truthful until proven otherwise? Because that's how I live on a day to day basis. If I automatically assumed everyone was lying all of the time, I would be miserable. And, I trust my ability to be able to tell when people are lying or not. Sometimes I'm wrong, but I am right more often than not.

Sigh. Noted. Another pre-vet who is too good to listen to experience.

It's not about being "truthful". It's about being accurate. Clients are incredibly inaccurate sources of information. Does your magical lie detector perceive when they think they're being truthful but are just plain wrong? Didn't think so.

I will refrain from trying to offer you useful feedback in the future. I apologize for upsetting you.

 

[battie]

My boss did GPA checks on the RAs today and one of my senior RAs has tanked to a 2.0. To be a senior RA, you have to have a 2.5. So she's going to lose her senior RA position and will probably be on academic probation as well. . I like her and I feel super bad for her. But I can't say I'm surprised.

 

[LetItSnow]

I try really hard, and have actually gotten fairly bitchy at classmates for making fun of rDVMs before. So I probably shouldn't complain. But in this case, we have clear records suggesting against dental care for this dog with multiple discoloured canines, extensive furcation exposure on his PMs, etc, with no big systemic health problems that would contraindicate anesthesia. Ended up having eight extractions with us, including multiple strategic teeth. Owner is super dedicated and dog is super nice for oral exam... just frustrating to me to then be pretty much straight asked if the other vet did something wrong, and have to dance around the answer.

Yeah. There are clearly cases where the rdvm's own records make you go "huh???" But i would NEVER just take a client's word for it. They're wrong too often.

 

[Trilt]

Discolored as in dead? Or just stained?

Not just stained - very diffuse pink to pale blue discolouration throughout the teeth. Our dentist thought he'd be pulling them before rads, but didn't see any periapical lucency or widened canal on them, so just suggesting monitoring at this time. The suggestion that the owner get future dental rads done at his rDVM (who doesn't have that capability) is actually what sparked the fairly awkward conversation following.

 

[dyachei]

Not just stained - very diffuse pink to pale blue discolouration throughout the teeth. Our dentist thought he'd be pulling them before rads, but didn't see any periapical lucency or widened canal on them, so just suggesting monitoring at this time. The suggestion that the owner get future dental rads done at his rDVM (who doesn't have that capability) is actually what sparked the fairly awkward conversation following.

See, I guess I wouldn't necessarily yank discolored teeth (but I do have dental rads)

 

[Trilt]

See, I guess I wouldn't necessarily yank discolored teeth (but I do have dental rads)

Not saying the rDVM should have extracted them, just that the dog had obvious potential pathology in his mouth and an owner who was interested in getting to the bottom of it.