RANT HERE thread

[itsrocky]

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Not that many if they aren't in e-collars, more surprised there haven't been more.

Animals lick, healing itches, they chew/lick in response. I almost crafted mini e-collars for my hands when I was healing from my appendectomy years ago.

that makes me feel a lot better, thanks!
My scar from where I had a chest tube still gets itchy, it is so hard keeping myself scratching it to the day. Haha

 

[Rainheart]

Officially postponing my wedding in October 🙁 I'm just sad

 

[allygator13]

This was the week for my surgeries to have complications! 2 scrotal hematomas, a spay that got her interdermals out and then today an abscess along the suture line of another spay 😵 2 of the surgeries I did some time ago, the other 2 I just did in the past week. my clinic doesn’t routinely give out cones, and one of the neutered straight up admitted to me she let the dog chase squirrels while he was healing so I do feel a bit better about it but geez that seems like a lot.

Save yourself and your local ER clinicians some cases and just send home E-collars lol

 

[genny]

Save yourself and your local ER clinicians some cases and just send home E-collars lol

I wish it was that easy! I push e-collars pretty hard, and there are still people who get home and don't use them. Even knowing that they're financially responsible if I have to fix a spay incision.

 

[Trilt]

My clinic never routinely sent home cones until I started working there. I just tell people I am gonna send them and if they wanna decline the ten bucks at checkout, whatever, but my pen is going to be much heavier when they come back with an infected wound from licking...

 

[alissa14]

This was the week for my surgeries to have complications! 2 scrotal hematomas, a spay that got her interdermals out and then today an abscess along the suture line of another spay 😵 2 of the surgeries I did some time ago, the other 2 I just did in the past week. my clinic doesn’t routinely give out cones, and one of the neutered straight up admitted to me she let the dog chase squirrels while he was healing so I do feel a bit better about it but geez that seems like a lot.

My clinic sends home an e collar and includes it in the surgery price. You have no idea how many come back with inflammation and discharge at the incision and the dog comes in WITHOUT the e collar lots of people also try to get away with the blow up collars or a spay onesie but we find that overall the e collar is the best to prevent chewing and licking

 

[finnickthedog]

Kind of a petty rant but... my doctor wants me to try a restrictive diet and my usual version of "cooking" is assembling a sandwich.

It's been three days and I'm dying. I am a bad adult.

 

[allygator13]

I wish it was that easy! I push e-collars pretty hard, and there are still people who get home and don't use them. Even knowing that they're financially responsible if I have to fix a spay incision.

Oh, I know haha trust me. But at least give the owners the opportunity to be the dumb ones.

 

[Minnerbelle]

Save yourself and your local ER clinicians some cases and just send home E-collars lol

Yup, I don’t care how much I don’t think a particular patient will leave their incisions alone. Every surgery patient and every dental patient that either has a hx or allergies or any canine teeth extractions get an e-collar. If the client doesn’t keep it on and something happens, it’s their problem. If I don’t send one home, it’s on me.

 

[DVMDream]

Yeah, I worked at a clinic where the office manager allowed this rescue massive discounts. Like insane discounts, greater than I could get as a staff member. She had a pyo surgery for the rescue set at $90.... (I worked on production and hated this damn rescue, it was literally stealing from me).

Anyway, I neutered a dog for this rescue and the rescue lady refused to take an e-collar, I point blank told her "I am recording in his record you are refusing an e-collar and you completely understand that if this dog damages the surgery site you are entirely financially responsible and there will be no rescue discount for repair surgery."

She was livid, but I didn't care at all. Hated the woman and I have never really despised someone in the way I despised this woman that ran this crappy rescue, why the office manager gave her such absurd discounts is beyond me, other than she claimed this woman was a friend. Don't know how they became friends because she even treated the office manager like crap all the time.

 

[LetItSnow]

Save yourself and your local ER clinicians some cases and just send home E-collars lol

Are you kidding? Those are great cases. For a paltry $1000+ (probably more than twice the cost of the original surgery) I throw them under anesthesia, open up the skin incision, make sure the abdomen is intact, debride and clean the SQ space and skin as needed, close it all up. I make lotsa money for an easy peasy outpatient procedure.

By all means, keep not using e-collars. 🙂

 

[itsrocky]

I would definitely send them home but my 70 year old boss won’t let me lol. Swears they aren’t needed, but also says all of my complications are from how I did the surgery. Combine that with one rude, insubordinate tech and another who just won’t listen and I’m having a great time. Good thing I’m leaving this job at the end of the month!

In other news, I’m having the world’s worst hay fever. My nostrils feel like I’m inhaling through straws. And my mom keeps yelling across the house to come here because she needs to tell me something or just barging into my room every 2 minutes. Like pleaseeeee leave me be for a least like 10 minutes.

 

[SkiOtter]

I would definitely send them home but my 70 year old boss won’t let me lol. Swears they aren’t needed, but also says all of my complications are from how I did the surgery. Combine that with one rude, insubordinate tech and another who just won’t listen and I’m having a great time. Good thing I’m leaving this job at the end of the month!

In other news, I’m having the world’s worst hay fever. My nostrils feel like I’m inhaling through straws. And my mom keeps yelling across the house to come here because she needs to tell me something or just barging into my room every 2 minutes. Like pleaseeeee leave me be for a least like 10 minutes.

I’m glad you’re getting out of there! Hopefully the next clinic will be tons better.

Also hay fever is the worst and I’m sorry your mom won’t leave you alone

 

[WildZoo]

When you're the only doctor on the premises but the technicians change your sedation protocol because "the boss doesn't like that" and prefers gassing down instead of using injectables 🙄

 

[Trilt]

When you're the only doctor on the premises but the technicians change your sedation protocol because "the boss doesn't like that" and prefers gassing down instead of using injectables 🙄

There's "that's weird are you sure?" from techs, and then there is changing things and undermining YOUR license. If you're not comfortable with something and they're trying to force you, you need to nip that in the bud stat.

There are lots of ways to do things but ultimately you're the doctor and need to be comfortable.

 

[WildZoo]

There's "that's weird are you sure?" from techs, and then there is changing things and undermining YOUR license. If you're not comfortable with something and they're trying to force you, you need to nip that in the bud stat.

There are lots of ways to do things but ultimately you're the doctor and need to be comfortable.

I'm a weenie. So I missed my chance to address it today, but I will if it happens again.

 

[SARdoghandler]

When you're the only doctor on the premises but the technicians change your sedation protocol because "the boss doesn't like that" and prefers gassing down instead of using injectables 🙄

This makes me really glad for the clinic I'm in where I asked "so what are your protocols?" And was told by the techs "well doc A likes this, docs B and C do this, doc F does this totally different thing... So whatever you want to use, that's what we'll do!"

Mostly because I am also a weenie and don't know if I'd have the oomph to stick to my guns as a new grad

 

[DVMDream]

Are you kidding? Those are great cases. For a paltry $1000+ (probably more than twice the cost of the original surgery) I throw them under anesthesia, open up the skin incision, make sure the abdomen is intact, debride and clean the SQ space and skin as needed, close it all up. I make lotsa money for an easy peasy outpatient procedure.

By all means, keep not using e-collars. 🙂

Minus the ones where the intestines fall out and are dragging all about.

 

[Trilt]

This makes me really glad for the clinic I'm in where I asked "so what are your protocols?" And was told by the techs "well doc A likes this, docs B and C do this, doc F does this totally different thing... So whatever you want to use, that's what we'll do!"

Mostly because I am also a weenie and don't know if I'd have the oomph to stick to my guns as a new grad

I'm a weenie. So I missed my chance to address it today, but I will if it happens again.

At my clinic, I was nicely asked to spend a bit of time with the way they did things before rocking the boat.

When the "way they did things" ended up being atropine/xylazine/ketamine for cat abdominal surgeries, I basically said hell no that's not acceptable to me - explained why - and they respected that and let me adjust.

Stick to your guns. There's lots of right ways to do things, but you also know when something isn't okay. And I wouldn't wait for a next time, Dubz, I'd personally recommend pulling the tech aside and discussing calmly that you may not do things exactly like bossman and are happy for feedback, but changing things without discussion is not acceptable.

 

[DVMDream]

I'm a weenie. So I missed my chance to address it today, but I will if it happens again.

I may just be the exact opposite because those techs would've gone home with new dinguses if they had pulled that **** with me.

 

[itsrocky]

Minus the ones where the intestines fall out and are dragging all about.

I would **** a brick.

When you're the only doctor on the premises but the technicians change your sedation protocol because "the boss doesn't like that" and prefers gassing down instead of using injectables 🙄

To echo what everyone says here, don’t be afraid to address it ASAP. I recently had to do this because a tech kept turning the iso vaporizer up to 5 during my surgeries. I didn’t say anything at first and one of my patient’s temperatures dropped below 90 and we could have lost him. So that was kind of the straw that broke the camel’s back. It may not have gone as easy if it did for me if I wasn’t the only doctor here that did surgeries, because they wouldn’t be getting done, so I get a good bit of control over things in that realm.

an excellent mentor from school always told me when you want something in your practice to change, become an expert in that area. If your practice is throwing endless clavamox at young male cats with FLUTD signs, become an expert in the feline urinary tract, and things will slowly change. If you come from a position of enlightenment, without sounding like a know it all, people will be receptive to change!

 

[itsrocky]

I’m glad you’re getting out of there! Hopefully the next clinic will be tons better.

Also hay fever is the worst and I’m sorry your mom won’t leave you alone

i have taken the acceptable limit of both Allegra and Benadryl and I’m still dying. This is fine lol

 

[SkiOtter]

i have taken the acceptable limit of both Allegra and Benadryl and I’m still dying. This is fine lol

Noooooo

Have you tried a medicated nasal spray (I’ve used Flonase and rhinocort) or at least a saline nose spray?

 

[itsrocky]

Noooooo

Have you tried a medicated nasal spray (I’ve used Flonase and rhinocort) or at least a saline nose spray?

tried that too! I’m this close to pulling up to the clinic and giving myself a shot of dex

(no way I would never do that)

 

[Minnerbelle]

I'm a weenie. So I missed my chance to address it today, but I will if it happens again.

All you have to say is, “well, that’s between me and Dr. boss, and I’m not comfortable with _____. So let’s try it this way”

if they follow, great. If they don’t, then send them home or switch them out with another tech who’ll comply. If after that boss takes the tech’s side over yours or isn’t supportive of you, put in your notice.

 

[Minnerbelle]

I would definitely send them home but my 70 year old boss won’t let me lol. Swears they aren’t needed, but also says all of my complications are from how I did the surgery. Combine that with one rude, insubordinate tech and another who just won’t listen and I’m having a great time. Good thing I’m leaving this job at the end of the month!

In other news, I’m having the world’s worst hay fever. My nostrils feel like I’m inhaling through straws. And my mom keeps yelling across the house to come here because she needs to tell me something or just barging into my room every 2 minutes. Like pleaseeeee leave me be for a least like 10 minutes.

Glad you’re getting the eff outa there

 

[Trilt]

tried that too! I’m this close to pulling up to the clinic and giving myself a shot of dex

(no way I would never do that)

I got eaten up by mosquitos out on my lyra a couple days ago and was definitely eyeballing some leftover pred from my doggo's heartworm treatment pretty hard... I resisted.

 

[capri1722]

tried that too! I’m this close to pulling up to the clinic and giving myself a shot of dex

(no way I would never do that)

Sudafed maybe? Freaking miracle drug. Has to be the good **** behind the counter though.

 

[WildZoo]

This makes me really glad for the clinic I'm in where I asked "so what are your protocols?" And was told by the techs "well doc A likes this, docs B and C do this, doc F does this totally different thing... So whatever you want to use, that's what we'll do!"

Mostly because I am also a weenie and don't know if I'd have the oomph to stick to my guns as a new grad

This is more what it's like at the other location, which I much prefer working at

 

[allygator13]

Are you kidding? Those are great cases. For a paltry $1000+ (probably more than twice the cost of the original surgery) I throw them under anesthesia, open up the skin incision, make sure the abdomen is intact, debride and clean the SQ space and skin as needed, close it all up. I make lotsa money for an easy peasy outpatient procedure.

By all means, keep not using e-collars. 🙂

Lolz. And that's why there are ER clinicians in the world like you! As an aspiring radiologist previously forced to work ER, that sounds like a nightmare case to me!

 

[Minnerbelle]

Are you kidding? Those are great cases. For a paltry $1000+ (probably more than twice the cost of the original surgery) I throw them under anesthesia, open up the skin incision, make sure the abdomen is intact, debride and clean the SQ space and skin as needed, close it all up. I make lotsa money for an easy peasy outpatient procedure.

By all means, keep not using e-collars. 🙂

ahaha oh hell no. These are the clients that call the clinic all pissed off the next day for the shoddy surgery you must’ve done and demand that the clinic reimburse them for everything they paid at the ER.

 

[SkiOtter]

Sudafed maybe? Freaking miracle drug. Has to be the good **** behind the counter though.

i ****in love Sudafed
But also I usually use the D version of any allergy med so my brain didn’t even think to suggest that because it forgot most people use the regular versions

 

[PippyPony]

@itsrocky ...5?? 😱

eeeeeep

glad the patient is ok and you said something about it
holy smokes

 

[PippyPony]

@WildZoo I just saw a post in an anesthesia fb group the other day talking about gassing down... one of the comments was something to the effect of "it's 2020 -- who is still gassing down animals?"

That had to be so frustrating, I'm sorry.

 

[Trilt]

@WildZoo I just saw a post in an anesthesia fb group the other day talking about gassing down... one of the comments was something to the effect of "it's 2020 -- who is still gassing down animals?"

That had to be so frustrating, I'm sorry.

I knock out some exotics (basically the small herbivores) fairly routinely with gas, actually. I know some will disagree, but in species where I know I'll have trouble getting an airway, I feel leaning more on injectables that dramatically decrease respiratory drive are riskier (in my hands, in my opinion) than premedding and then gassing down.

I think medicine is a messy, complicated thing and saying any one thing is "bad" is innately questionable. As doctors, we have tools. We can use those tools poorly, well, or most often somewhere in between. It's just on us to do the risk:benefit analysis for everything, and that's why we're doctors, ha.

/soapbox?

 

[Trilt]

In an unrelated rant, I caught a crab at the beach today and that jerk pinched my main scrolling finger hard enough I've got a little skin flap I can feel with every single swype.

This is the most ridiculous small complaint I've had in ages but it legit hurts.

 

[vetmedhead]

This is reminding me that my boss puts in a single skin suture on her incisions that is completely useless for holding the incision closed. I asked her about it once and she says she puts it in because she'll know right away if the patient had been allowed to chew at the incision because they'll take that one out almost immediately.

When people come back for incision issues and she sees it out she can call clients/adopters on bull**** when they come in swearing up and down they did everything they were supposed to and she just did a ****ty surgery. I found it to be a funny strategy probably adopted after years of putting up with stupid clients

 

[LetItSnow]

ahaha oh hell no. These are the clients that call the clinic all pissed off the next day for the shoddy surgery you must’ve done and demand that the clinic reimburse them for everything they paid at the ER.

Sure, but that's a you problem, not a me problem. ;-)

 

[Minnerbelle]

Sure, but that's a you problem, not a me problem. ;-)

Lol, for that, the GPs near you shall not see any fit in appts for a whole week so you get inundated with an extra dose of diarrhea, ear infections, hot spots, broken nails and emergency check lumps

But seriously, it’s the reason why like eeeeveryone including cat neuters go home with a cone for me. And I ask if dogs will have issues staying quiet and point blank ask if O thinks sedation is needed to stay quiet and offer trazodone. When it gets infected/dehisced the client can be blamed for not Keeping their pets quiet or not keeping e-collar on. If the E-Clinic then sends home an E-collar after revision surgery, the gp really has no leg to stand on when the client calls irate and goes, “so why didn’t you send him home with a cone if he’s not supposed to lick it!?” Especially because the ER naturally asks the client if the pet was licking at the incision and if they were exercise restricted, and that gets the client on the “my vet didn’t...” train of thought because clients always try to pin surgical complications on you esp if they incur a huge fee (and the guilt too). When the ER sends home a cone and or sedative, that’s the nail on the coffin for the gp who did neither.

even if dr. Boss never sends home cones, I still do and the techs automatically do it and change the discharge notes

 

[mmmdreamerz]

I knock out some exotics (basically the small herbivores) fairly routinely with gas, actually. I know some will disagree, but in species where I know I'll have trouble getting an airway, I feel leaning more on injectables that dramatically decrease respiratory drive are riskier (in my hands, in my opinion) than premedding and then gassing down.

I think medicine is a messy, complicated thing and saying any one thing is "bad" is innately questionable. As doctors, we have tools. We can use those tools poorly, well, or most often somewhere in between. It's just on us to do the risk:benefit analysis for everything, and that's why we're doctors, ha.

/soapbox?

Yeah but I think there’s a big difference between boxing down an exotic and boxing down a cat. I think there’s probably legitimate reasons for the former while the latter does not need to happen but still does in a lot of places.

 

[Trilt]

Yeah but I think there’s a big difference between boxing down an exotic and boxing down a cat. I think there’s probably legitimate reasons for the former while the latter does not need to happen but still does in a lot of places.

I was responding to Pip posting about someone saying: "it's 2020 -- who is still gassing down animals?" Well, I am. In particular situations with particular species for particular reasons. Exasperated blanket statements annoy me, lol.

I totally agree re:cats, fwiw. My clinic routinely gassed down cats when I started working there. We don't now. 😛

 

[WildZoo]

I knock out some exotics (basically the small herbivores) fairly routinely with gas, actually. I know some will disagree, but in species where I know I'll have trouble getting an airway, I feel leaning more on injectables that dramatically decrease respiratory drive are riskier (in my hands, in my opinion) than premedding and then gassing down.

I think medicine is a messy, complicated thing and saying any one thing is "bad" is innately questionable. As doctors, we have tools. We can use those tools poorly, well, or most often somewhere in between. It's just on us to do the risk:benefit analysis for everything, and that's why we're doctors, ha.

/soapbox?

Yeah for sure situational. Which is why exotics anesthesia is spooky anyway
This case it was a cat, I've done plenty of cat sedation with drugs, he was a good candidate, and when the alternative is 5% iso AND 7% sevo (even just for a short period)...just let me do my kitty magic dude, it's better for everyone involved I was kind of surprised actually, I've lanced a couple cat abscesses at the other location with that protocol and nobody said anything, so it really threw me off guard.

 

[itsrocky]

I knock out some exotics (basically the small herbivores) fairly routinely with gas, actually. I know some will disagree, but in species where I know I'll have trouble getting an airway, I feel leaning more on injectables that dramatically decrease respiratory drive are riskier (in my hands, in my opinion) than premedding and then gassing down.

I think medicine is a messy, complicated thing and saying any one thing is "bad" is innately questionable. As doctors, we have tools. We can use those tools poorly, well, or most often somewhere in between. It's just on us to do the risk:benefit analysis for everything, and that's why we're doctors, ha.

/soapbox?

I am a member of that anesthesia group too and I always would get irritated when people said under no circumstances was boxing down ok. I think your post helped figure out why.

 

[Trilt]

I am a member of that anesthesia group too and I always would get irritated when people said under no circumstances was boxing down ok. I think your post helped figure out why.

I am a very low stress person who does *not* usually have work dreams, and I've literally had a nightmare about trying to intubate a guinea pig who stopped breathing and there being nothing I can do while he just slowly died. woof. Do not recommend, will do my best to avoid making real, lol.

 

[PippyPony]

I knock out some exotics (basically the small herbivores) fairly routinely with gas, actually. I know some will disagree, but in species where I know I'll have trouble getting an airway, I feel leaning more on injectables that dramatically decrease respiratory drive are riskier (in my hands, in my opinion) than premedding and then gassing down.

I think medicine is a messy, complicated thing and saying any one thing is "bad" is innately questionable. As doctors, we have tools. We can use those tools poorly, well, or most often somewhere in between. It's just on us to do the risk:benefit analysis for everything, and that's why we're doctors, ha.

/soapbox?

Sorry, I should have clarified that this was a cat. And I also should clarify that I obviously do not know the details of that particular situation, just was trying to commiserate with Dubz.

And for exotics...I have virtually no experience with most of those species and therefore would never personally be critical of others' decision making because I don't have much of a feel for what is best for them. I know we mask birds in wildlife because it works well in birds; that's about it.

I feel like I can come up with approximately one reason to gas down a cat, though -- and that's rabies. So if a place is doing that as a general protocol... I will see your soapbox and raise you a soapy soapy box about cats & how they get the shaft sometimes in terms of low stress handling. But I think you're already in that box with me + all my cat friends

 

[DVMDream]

I feel like I can come up with approximately one reason to gas down a cat, though -- and that's rabies. So if a place is doing that as a general protocol... I will see your soapbox and raise you a soapy soapy box about cats & how they get the shaft sometimes in terms of low stress handling. But I think you're already in that box with me + all my cat friends

I'd say there are a few more reasons for boxing down cats other than rabies. They won't be common or frequent and I can count on one hand the number of times I have felt that boxing down was in the best interest for that particular cat patient.

But, yes, even in cats, boxing down is needed, on the rare occasion.

Now, gassing down dogs, well, I won't get into that other than to say, if you can get the oxygen mask on the dog, you can stab it with drugs.

 

[DVMDream]

Also, pediatric medicine gasses down infants and young children all the time.

Parents hold the child while they place the mask over the child's nose/mouth and then as the child falls asleep, then the medical team takes over. IV placement in young humans isn't always straightforward, apparently

 

[Minnerbelle]

Also, pediatric medicine gasses down infants and young children all the time.

Parents hold the child while they place the mask over the child's nose/mouth and then as the child falls asleep, then the medical team takes over. IV placement in young humans isn't always straightforward, apparently

and with very young puppies and kittens, gassing down is actually safer than injectables.

though man, I absolutely hate when clinics routinely dump cats into tanks that hook onto vaporizers and gas chamber them down. It’s not safe for the cat, and it’s not safe for the people dealing with the situation. And what a horrible experience that must be for the cat.

 

[WildZoo]

Also, pediatric medicine gasses down infants and young children all the time.

Parents hold the child while they place the mask over the child's nose/mouth and then as the child falls asleep, then the medical team takes over. IV placement in young humans isn't always straightforward, apparently

I wonder if they use iso for that, or if they're more likely to use sevo because of the smell.

Of note, no chambers at the clinic I work at unless they've hidden them somewhere (the last time I used one was for a chinchilla at a zoo!), just a kitty in a burrito and a mask. He was shockingly good for it but I'm not sure what they do with the more difficult kitties.

 

[PippyPony]

Also, pediatric medicine gasses down infants and young children all the time.

Parents hold the child while they place the mask over the child's nose/mouth and then as the child falls asleep, then the medical team takes over. IV placement in young humans isn't always straightforward, apparently

Kids get midazolam +/- nitrous first, so they are sedated and unaware when this is happening. Also, they use sevo exclusively in human med.