When to dilute IV meds?

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So I just spoke to my fathers mother, and learned a little. My dad worked assisting a country livestock vet named Dr. Bailey who taught him for years, and when my father had questions about his livestock, he would call Dr. Bailey and she says she remembers one event that Dr. Bailey went to his house. This is before my time so I had absolutely no knowledge of this.



Vet? In it for the money??? Isn't starting pay dismally low? Like 50k? I always assumed vets just had huge hearts for animals because school isn't cheap and it takes a lot of dedication and you make far less than the human counterpart

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I think people outside of the healthcare industry tend to think we are, because on the whole they have never likely paid more than a copay for their own health issues.

A GP can start anywhere from 65 to 75 k. Specialists 90+. Still difficult with an average loan debt of 150k (in-state, if you are lucky enough to get into the one school state most states have). OOS is much worse but due to paucity of schools.....I think we have 31 in the US, total....many people do go OOS.
 
I've never had insurance. When I went to the doctor on the rare occasions that I did, they charged me much lower than the usual price. Such as 50 for an office visit instead of 200. Insurance is a scam.
 
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A GP can start anywhere from 65 to 75 k. Specialists 90+. Still difficult with an average loan debt of 150k (in-state, if you are lucky enough to get into the one school state most states have). OOS is much worse but due to paucity of schools.....I think we have 31 in the US, total....many people do go OOS.

I’m 3 years out and I have yet to hit $65k. Yanno.
 
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I’m 3 years out and I have yet to hit $65k. Yanno.
That's insane. You'd think with your level of expertise you'd make more. My first year out as an RN I made 115. Before I was on these forums I figured a vet made around 120-140 out the gate.
 
Yeah, it blows. I mean, of course we know we're never going to make as much as "human doctors" for the main reason that human life > animal life. Plain and simple. Most of us (probably close to all) realize that and are cool with it. It isn't so much the salary by itself, but the massive debt that comes with it.

Every time I see some med student bitching about physician salaries, or how they wouldn't go into medicine if they "only" made 150k/yr.....then I look at all of us....:rolleyes:
 
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Yeah, it blows. I mean, of course we know we're never going to make as much as "human doctors" for the main reason that human life > animal life. Plain and simple. Most of us (probably close to all) realize that and are cool with it. It isn't so much the salary by itself, but the massive debt that comes with it.

Every time I see some med student bitching about physician salaries, or how they wouldn't go into medicine if they "only" made 150k/yr.....then I look at all of us....:rolleyes:

I feel that way about fellow nurses. They bitch about how much they work or the stress and that they don't make enough. I often make 81 an hour (nursing shortage incentive pay and overtime), and the least I ever make is 35.

I told them if they think it isn't enough, tell that to our enlisted soldiers making 30,000 a year, getting shot at and surviving in 140 degree heat, getting maybe 1 day a week off. Most don't even know the meaning of the word suffering, I mean 30 year olds still having mommy and daddy paying their car note, insurance, and cell phone.
 
Yep. We generally do everything we can to reduce cost, or else the clients won't pay and it's the animal who suffers. People don't have a concept of how much medicine costs to perform because of insurance. I mean, how much does a hysterectomy cost for a person? Thousands, I'm sure. Heck, even a biopsy with path readout? Probably still quite a bit. Yet we quote a hundred or so for a spay, or sixty bucks for an incisional biopsy, and people lose their minds.

Financials always have to be in the forefront of our minds, which sucks. People don't understand the cost of paying your techs, keeping your lights on, payments on your X-ray machine, surgical tools, medications, anesthesia equipment, etc etc. not to mention our horrendous school debt payments. Which is why it drives us nuts when people say vets are in it for the money.
I just got a wart surgically removed from my fingertip. $7000, just for the surgery. More in addition to that for the anesthesia, room use, etc.

An identical surgery in a vet's office would probably not go any higher than $200. I've seen various small cosmetic concerns removed for $30-50 using mild sedation, lidocaine and suture, which is essentially what was done for me (except I got propofol, which actually was really painful for me to get IV).

I don't have any desire to say an MD/DO doesn't deserve to be paid for their time, but their costs are so dramatically inflated thanks to insurance.

I also have family/non-vet friends that didn't know I wouldn't be making $200k+ as a vet. They truly thought the salary was on par with human medicine just because they know you are a 'doctor.'
 
I just got a wart surgically removed from my fingertip. $7000, just for the surgery. More in addition to that for the anesthesia, room use, etc.

An identical surgery in a vet's office would probably not go any higher than $200. I've seen various small cosmetic concerns removed for $30-50 using mild sedation, lidocaine and suture, which is essentially what was done for me (except I got propofol, which actually was really painful for me to get IV).

I don't have any desire to say an MD/DO doesn't deserve to be paid for their time, but their costs are so dramatically inflated thanks to insurance.

I also have family/non-vet friends that didn't know I wouldn't be making $200k+ as a vet. They truly thought the salary was on par with human medicine just because they know you are a 'doctor.'
Propofol for watt removal?!? Wow. Gave you some good stuff.

The trade off for vet is probably satisfaction. I can't stand 90% of my patients/their families. There are a very few that make it worth it. This is why I've decided not to be a pulmonologist. Most of my patients that are a pleasure are ENT patients recovering from total laryngectomies etc.
 
Propofol for watt removal?!? Wow. Gave you some good stuff.

The trade off for vet is probably satisfaction. I can't stand 90% of my patients/their families. There are a very few that make it worth it. This is why I've decided not to be a pulmonologist. Most of my patients that are a pleasure are ENT patients recovering from total laryngectomies etc.
Yeah I wasn't expecting to be out at all. The doc told me I would be sedated and I interpreted that to mean I'd get some midazolam or something.

Also, no, vets don't really have that many clients that make it worth it :laugh:. If we did, our suicide rate would probably be a little lower. I'd said vets have some clients that are fine, a very small number that the entire staff love to see, and a sizable proportion that are sh*tty to deal with. Percentages probably vary from each clinic/person. If I had to estimate from a tech's viewpoint, my last clinic job would have been 50-60% fine, 10% amazing, 30-40% not fine. That doesn't mean 30-40% are screaming at us and throwing things at me across the room, but that happens too. I don't really invest my energy in hating people, but there were a handful of clients I would avoid seeing into a room if I could.
 
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Propofol for watt removal?!? Wow. Gave you some good stuff.

The trade off for vet is probably satisfaction. I can't stand 90% of my patients/their families. There are a very few that make it worth it. This is why I've decided not to be a pulmonologist. Most of my patients that are a pleasure are ENT patients recovering from total laryngectomies etc.
You’re very mistaken if you think clients in vetmed are any better than human. In human med, your patient and client are the same. For us, the animal is out patient, but the owner is the client. Often times what’s best for the patient is at odds with the desires of the client, whether it’s for money, not understanding the neccessity of a particular treatment, or just plain not caring. That plays a huge role in compassion fatigue and other mental health issues in the profession (next to the debt and poor work life balance many employers expect). You may be able to fix a patient, but you’re not allowed to. That’s going to wear on anyone.
 
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You’re very mistaken if you think clients in vetmed are any better than human. In human med, your patient and client are the same. For us, the animal is out patient, but the owner is the client. Often times what’s best for the patient is at odds with the desires of the client, whether it’s for money, not understanding the neccessity of a particular treatment, or just plain not caring. That plays a huge role in compassion fatigue and other mental health issues in the profession (next to the debt and poor work life balance many employers expect). You may be able to fix a patient, but you’re not allowed to. That’s going to wear on anyone.

It's like that for me too. The patient is brain dead in 30% of my cases, the family is keeping them alive for either unrealistic expectations or to collect a paycheck. Usually they never come visit, and when they take a turn for the worst they come and try to fight you. Or you have a patient that's vegetative and the spouse or children expect you to constantly stay at the bedside, and come to the nurses station and throw a fit if you're not in there constantly, like you don't have 2-3 other patients. Once had a man cuss me out because I didn't get him ice within 30 minutes, yeah well I was on the code team and had to run to another floor for a code blue.

Human patients on ICU/Stepdown are often a nightmare. The other night on neuro critical care, they lost a patient and there were 40 people outside the ICU brawling over it. All members of his family. Reminded me of my glory days breaking up bar fights in the Army.

Vet clients may be a pain in the ass, but at least all animals are innocent. People are often selfish, undeserving pricks and a select few are the exception and make it worth it.

It doesn't help that I work at a glorified charity hospital. Most of my non ent patients are drug dealers who got shot or stabbed and they or the families are just awful people. And my city is number 1 or 2 for homicides in the US.
 
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Vet clients may be a pain in the ass, but at least all animals are innocent.
An animal being 'innocent' doesn't make it any less frustrating when the dog/cat/whatever quite literally wants to kill you.

I'm not going to fall into the one-upping trap you've set here because each profession has frustrations. I get pretty tired of the 'Well at least you don't have to deal with x!' I'm going to point out again that with each post, you make assumptions that show you really don't know the first thing about vet med.
 
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An animal being 'innocent' doesn't make it any less frustrating when the dog/cat/whatever quite literally wants to kill you.

I'm not going to fall into the one-upping trap you've set here because each profession has frustrations. I get pretty tired of the 'Well at least you don't have to deal with x!' I'm going to point out again that with each post, you make assumptions that show you really don't know the first thing about vet med.
I'm just relating to I don't get very mad the patient when they hit me and they're completely out of it. When I do get aggressive with them is when they're totally sane and they threaten or assault my fellow nurses. I had one young punk threaten to hit a fellow pregnant nurse, and when his grandma stepped out of the room I had a talking to him and explained what would happen if he even laid a hand on one of the nurses.

Not a one upping match, good points made about the animal side. Im just saying don't for a minute think patients are typically a joy to care for. I'm sure is like animals- a few make it worth it.

For some reason the sane patients never threaten me.. only the females I work with.. hmm.
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You're missing a huuuuge chunk of important information here, which is not unexpected given that you have very limited knowledge of what real food animal medicine is like. There are many reasons why a farmer buys his/her own abx and administers themselves under a vet's direction. There is truly too much discussion here to be had adequately via a forum. We rounded on stuff similar to this for like 3 hours on a slow day during my farms rotation.

1. Food animal vets often can't make reasonable profit off of selling abx/drugs like a SA vet can. Farmers have a hard 'cost line' they adhere to-if they go over by a dollar, they are losing more money than the animal will make at market. A bottle of LA-200 runs $70 or so right now. That means the vet has to mark that up by however much they feel is necessary for them to get an adequate revenue in (SA clinics I've worked for typically do anywhere from 50-200% depending on the true cost). Depending on what you're treating/the weight of the animal, you may be going through 40+ml of the bottle per day per animal. You can see that every dollar the farmer can save here would matter in terms of whether or not they keep the animal alive to treat vs. just euthanizing or sending to market (if the disease present wouldn't condemn the carcass). Yes, there are strict rules/guidelines as to whether any animal presented to a slaughterhouse will actually be slaughtered for meat.

2. If a vet is the only one keeping/selling the abx, can you imagine how much of their time/money would be lost by going to a 100 head (which is considered a small operation) to give antibiotics during an outbreak of something? It would be several hours, if not an entire day, to run a sizable beef herd through the chutes just for meds, and that's with help and experienced cattle movers. Dairy would go faster assuming you're not out in pasture chasing/keeping track so you don't double dose or miss a cow. Also keep in mind travel time, some ambulatory calls can be up to 2 hours away in my experience. Also make a note that small-scale operations are disappearing, and farmers are dealing with more and more large-scale operations. The amount a vet would have to charge for selling the drug as well as making sure it is given according to their direction (by giving it themselves) would be astronomical in terms of what farmers can afford/are willing to pay for. A vet can't physically carry around this much drug on their truck, either. You tell the farmer to go get enough bottles from the farm store to last them for however long, and you come back in a week or so to reassess. The vet doesn't even stick around to give the herd the first dose.

3. Farmer's don't just go to the farm supply store and say 'Oh, this drug looks good, let's go with this.' They were told directly by a vet what to get. In food animal med, you can't just decide to treat a disease with whatever you want/whatever route/however often. There are legally enforced rules/regulations. Like mentioned, people that get caught are slammed with so many fines that operations are shut down out of bankruptcy over it. It isn't always intentional (a farm hand might make a mistake, for example), but when you're caught, you're held accountable. Sure, some farmers decide they think they know what disease process is going on and decide to go pick up a bottle based on that, but I was the student on several cases the other week with 'Well doc, we treated with this because we thought it was x but it didn't work.' 'Well, it's not x, that's why it didn't work.' So the farmer learns that if they would have called the vet in the first place, they would have spent less. Sometimes they guess correctly, often they don't.

Also, if a farmer intentionally gives abx illegally, they do this knowing they risk sabotaging their own reputation. Farming is a small world.

And yes, you can get some human medications online pretty easily. It doesn't take much searching. Some require a written rx to be faxed/mailed, but that's not that big of a hurdle to overcome if you're that determined.

just wanted to point out that small animal vets don't make much on medications, either. There's no reasonable profit anymore, especially with online pharmacies. Clinics that depend on that are failing. Procedures are the money makers.

I've never had insurance. When I went to the doctor on the rare occasions that I did, they charged me much lower than the usual price. Such as 50 for an office visit instead of 200. Insurance is a scam.

It's not a scam if you have a chronic illness. It's not even a scam for most people getting it from work.

I just hope you never find out you have something that requires maintenance medical care. I'm pretty sure my insurance company hates me.
 
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I'm just relating to I don't get very mad the patient when they hit me and they're completely out of it. When I do get aggressive with them is when they're totally sane and they threaten or assault my fellow nurses. I had one young punk threaten to hit a fellow pregnant nurse, and when his grandma stepped out of the room I had a talking to him and explained what would happen if he even laid a hand on one of the nurses.

Not a one upping match, good points made about the animal side. Im just saying don't for a minute think patients are typically a joy to care for. I'm sure is like animals- a few make it worth it.

For some reason the sane patients never threaten me.. only the females I work with.. hmm.
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I get angry when an angry dog is lunging at me and my techs. THat's a literal threat from an aware patient. It's different and they aren't all innocent.
 
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An animal being 'innocent' doesn't make it any less frustrating when the dog/cat/whatever quite literally wants to kill you.

I'm not going to fall into the one-upping trap you've set here because each profession has frustrations. I get pretty tired of the 'Well at least you don't have to deal with x!' I'm going to point out again that with each post, you make assumptions that show you really don't know the first thing about vet med.
I was going to say, where I work we are often in position for advocating directly against the welfare of our patients in favor of the welfare of the public. Our officers testify on behalf of the prosecution all of the time at dangerous dog hearings, and if an animal is legally declared dangerous then they are frequently euthanized because the requirements owners have to meet in order to keep them are so stringent they are nearly impossible to meet.
 
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just wanted to point out that small animal vets don't make much on medications, either. There's no reasonable profit anymore, especially with online pharmacies. Clinics that depend on that are failing. Procedures are the money makers.



It's not a scam if you have a chronic illness. It's not even a scam for most people getting it from work.

I just hope you never find out you have something that requires maintenance medical care. I'm pretty sure my insurance company hates me.
I have the VA so I do have some coverage plus don't have to pay the penalty. The VA is basically a death sentence, but now we can't be denied for preexisting so I'll get insurance if I see something coming up.
 
I get angry when an angry dog is lunging at me and my techs. THat's a literal threat from an aware patient. It's different and they aren't all innocent.
Yeah but all some pissed dog knows is he doesn't know you, and doesn't know why you're messing with him when he's miserable and just wants to be left alone.

Some stupid ghetto thug knows you're trying to help him but he just wants his pain medicines and for you to leave him alone. Nothing burns me up more than some homeless dude on step down bitching that his tv doesn't work or he doesn't get the exact food he wants. If he wasn't in the hospital he wouldn't have a tv or his choice of food either. I tell em, look I'll get to it but that isn't priority, and they threaten to attack you or sit there and cuss you out. Really hard to feel bad for them.

But I have to volunteer to get into med school because helping teach kids how to play a sport, or giving soup to the needy who are thankful somehow shows more compassion than caring for someone who verbally berates you every time you walk into the room (or providing medical care to some muj who your battle bud just shot that was trying to blow your MRAP with an RPG)
 
Saving client money is never thought of in human med. Human med is far more inefficient. I mean we will use the same fluid bags for multiple patients (assuming the patient didn't need most/all of the bag, or it wasn't hooked up to a catheter), among many more things. As long as nothing is contaminated, we use it for multiple patients.
I'm not sure I agree with this. Yes a lot of what we do it wasteful, but some of the practices are specifically to prevent spread of infection. i.e. if there is a room with a patient who had c.diff, EVERYTHING in that room gets tossed out and changed even its been unused equipment, but the reasoning there is that even if it hasn't been opened the c.diff spores can hide on the packaging and are notoriously hard to clean off.
Even the fluid bags in a normal patient are changed every 24 hours after being spiked even if its been hooked to the same patient. Wasteful? Probably. Safe practice? After an EBP/EBM i'd say yeah most likely.

While the inefficient use of materials might be expensive, its much more expensive and dangerous to readmit someone because of an infection they got unrelated to their initial visit.
 
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Yeah but all some pissed dog knows is he doesn't know you, and doesn't know why you're messing with him when he's miserable and just wants to be left alone.
No, not necessarily. Animals can have psychological conditions just like humans can (phobias, OCD, anxiety, and some are working on proving that there could be more disorders affecting animals). The description/definition and treatment of them is far less researched than it is in humans, but that's changing. It's not always as simple as 'Don't touch me doctor, you're going to give me a poke again and I don't want that.' Animal behaviorists are becoming more and more popular/recognized these days because of the increasingly-recognized mental aspect of animal care. Fear/phobias are an extremely real challenge. An animal reacting to a vet may just be saying 'Don't poke me,' or there may be something more complicated going on. It depends on the situation and severity. There are dogs that just aren't excited at the vet and are not happy with the pokes, and there are dogs that scream like you're stabbing them just because you walked in the exam room. I'm of the camp that believes there is a difference between the two reactions, but I know others don't totally believe in every aspect of behavioral medicine.

I'm not sure I agree with this. Yes a lot of what we do it wasteful, but some of the practices are specifically to prevent spread of infection. i.e. if there is a room with a patient who had c.diff, EVERYTHING in that room gets tossed out and changed even its been unused equipment, but the reasoning there is that even if it hasn't been opened the c.diff spores can hide on the packaging and are notoriously hard to clean off.
Even the fluid bags in a normal patient are changed every 24 hours after being spiked even if its been hooked to the same patient. Wasteful? Probably. Safe practice? After an EBP/EBM i'd say yeah most likely.
We do the same things when it's warranted (parvo is one infectious agent that comes to mind). Like I said, as long as there is no contamination concern, we clean appropriately and reuse.

Edit: More specifically, human med does not reuse things that most certainly can be sterilized or reused with reasonable assurance that you aren't compromising patient care. A few examples have been mentioned in earlier posts. I never said that something should be reused at the expense of patient care just to save money. That's a bit of a reach.
 
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An animal reacting to a vet may just be saying 'Don't poke me,' or there may be something more complicated going on. It depends on the situation and severity. There are dogs that just aren't excited at the vet and are not happy with the pokes, and there are dogs that scream like you're stabbing them just because you walked in the exam room. I'm of the camp that believes there is a difference between the two reactions, but I know others don't totally believe in every aspect of behavioral medicine.

Dog A: Happy the whole visit, pokes don't bother him. Sure clean my ears. Oh you want to cut my nails? Ok, sure that is fine. Whatever you do, I am cool because you are touching me and I LOVE TO BE TOUCHED!

Dog B: Hi, I like you. You are person and I like person. Why did you poke me? Hey, don't do that. Yelp, yelp, cry, but doesn't try anything.

Dog C: Husky, don't need to say anything further. He screams because he can.

Dog D: Freezes. Doesn't react. Not happy. Not fighting. Not biting. But if I don't move they will hurry up and leave me alone.

Dog E: Hides under chair. Nervous, scared. Low growls. Can be handled, examined and treated with a muzzle in place. Doesn't flip his ****, just fearful in this setting.

Dog F: Lunges as you walk in the door. Snarling, sometimes growling, sometimes not. No one can even muzzle this beast. You wish you had learned how to use a dart gun in vet school for this patient. This dog is psychotic. Needs drugs even for a vaccine. Owner may or may not be in denial. These are the ones you start to worry about in a home where you are concerned these ones could kill a child. I have long spiels for these clients. I either have a

Dog G: (The worst). Wags tail does great, nails you with no warning.

Not all of these dogs are "innocent" like our human nurse thinks.



At this point, either human nurse is a troll, or really doesn't have any desire to actually understand veterinary medicine and how it is much more complicated than he thinks it is.
 
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Yes, our clients can be just as bad as what you find in human med, we have called the cops on clients before. Clients have pulled weapons at vet clinics. So on and so forth. You have security on stand by at a hospital for assistance. We don't, we have to call and wait for the cops to assist us if clients escalate.
 
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Dog A: Happy the whole visit, pokes don't bother him. Sure clean my ears. Oh you want to cut my nails? Ok, sure that is fine. Whatever you do, I am cool because you are touching me and I LOVE TO BE TOUCHED!

Dog B: Hi, I like you. You are person and I like person. Why did you poke me? Hey, don't do that. Yelp, yelp, cry, but doesn't try anything.

Dog C: Husky, don't need to say anything further. He screams because he can.

Dog D: Freezes. Doesn't react. Not happy. Not fighting. Not biting. But if I don't move they will hurry up and leave me alone.

Dog E: Hides under chair. Nervous, scared. Low growls. Can be handled, examined and treated with a muzzle in place. Doesn't flip his ****, just fearful in this setting.

Dog F: Lunges as you walk in the door. Snarling, sometimes growling, sometimes not. No one can even muzzle this beast. You wish you had learned how to use a dart gun in vet school for this patient. This dog is psychotic. Needs drugs even for a vaccine. Owner may or may not be in denial. These are the ones you start to worry about in a home where you are concerned these ones could kill a child. I have long spiels for these clients. I either have a

Dog G: (The worst). Wags tail does great, nails you with no warning.

Not all of these dogs are "innocent" like our human nurse thinks.



At this point, either human nurse is a troll, or really doesn't have any desire to actually understand veterinary medicine and how it is much more complicated than he thinks it is.
Dog F comes with a lot of 'F's' if you know what I mean.

So many people outside vet med think animals just react. I'm not saying any particular animal that a SA vet sees is capable of any real intellectual thought (and that's because I don't know the answer), but there is more to them than just pure reaction imo. Sometimes it's a lack of coping skills, much like in human children. Other times I really believe these dogs have mental issues, whether it be some sort of treatable emotional disorder vs. some sort of abnormality in the way they perceive reality and connect/synthesize information that can't be helped. If a dog was raised well and has no reason to randomly attack people at home or in public, but does it anyways, there's more to the story there. And then some dogs are just trained to react with nothing but aggression.

Cats to me are the same way, but it seems more clients are willing to keep a dangerous cat in their home since you can pretty much have a cat in your house and never see them. Those are the cats that need sedation +/- full anesthesia for yearly preventative care and grooming. I've never been in an appointment with a client seeking behavioral advice for a cat despite there being clients that need to do that.

Edit: Clarifying that I'm not talking about people missing signals from a dog/cat that normally lead to aggression. Like DVMD mentioned, some animals truly don't give any cue that you need to back off.
 
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Yes, our clients can be just as bad as what you find in human med, we have called the cops on clients before. Clients have pulled weapons at vet clinics. So on and so forth. You have security on stand by at a hospital for assistance. We don't, we have to call and wait for the cops to assist us if clients escalate.
We don't always have security. At my last job I concealed a handgun once because they never locked the doors and people would come in off the streets and threaten the nurses if they wouldn't let them sleep in empty rooms, and we didn't have cameras or security guards. The females knew I'm a gun nut and begged me to go get my gun. I told them "no I can't do that" because I didn't want them to know I had it, but I did go and get it and wore it under my scrubs the remainder of that shift. They got cameras soon before I left- but still no guards, still no locked doors. If there wasn't a male nurse or RT working, the females got really nervous.
 
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Dog F comes with a lot of 'F's' if you know what I mean.

So many people outside vet med think animals just react. I'm not saying any particular animal that a SA vet sees is capable of any real intellectual thought (and that's because I don't know the answer), but there is more to them than just pure reaction imo. Sometimes it's a lack of coping skills, much like in human children. Other times I really believe these dogs have mental issues, whether it be some sort of treatable emotional disorder vs. some sort of abnormality in the way they perceive reality and connect/synthesize information that can't be helped. If a dog was raised well and has no reason to randomly attack people at home or in public, but does it anyways, there's more to the story there. And then some dogs are just trained to react with nothing but aggression.

Cats to me are the same way, but it seems more clients are willing to keep a dangerous cat in their home since you can pretty much have a cat in your house and never see them. Those are the cats that need sedation +/- full anesthesia for yearly preventative care and grooming. I've never been in an appointment with a client seeking behavioral advice for a cat despite there being clients that need to do that.

Edit: Clarifying that I'm not talking about people missing signals from a dog/cat that normally lead to aggression. Like DVMD mentioned, some animals truly don't give any cue that you need to back off.

Cats are different. Really. You can have a dangerous, pissed off cat at the vet who is completely fine at home.

My cat is a one chance and you are done. I can get blood from her but only if I do it quickly. I don't drag through the whole TPR, weighing, etc. I literally get blood, give vaccines and call it done. Maybe toss her on the scale at the end. If I toss her on the scale at the start, I have lost my opportunity. I have to do most invasive to least with her and stop when she has had it. Otherwise, I have to drug her every time. If you come to my home, she is out and about, not hiding, friendly, will rub up on most people and totally the opposite of in clinic. If someone is over doing work, she gets scared but is still interested and will come check it out.

Compare to my old cat that we put down last year. You can do anything to her at the vet. She lays there and lets you do it. Easiest cat patient ever. Need blood, fine, here is my neck. Oh you need to roll me over? Ok, sure, fine. Giving injections at home was fine. Cuddle her? Her socialize? Nope, not interested. That isn't to say she wasn't friendly but she was the hide if anything new comes over and I only want to be petted and not frequently. This was the sit on the couch cat and sleep all day, didn't want to interact with people and would hide if new people were over. She was cooperative but not social and only friendly with familiar faces at home.

Recently had a client with a hellion cat at the vet, worse than mine, that was diabetic. We got one shot to get blood on this cat and that was it. Client was able to give insulin without a problem at home.

Cats really can't be compared behaviorally to dogs, at least in the clinic setting.

Are there cat psychology issues? Yes. I definitely believe that cats can experience separation anxiety, storm phobias, etc just like dogs can, but it becomes much more difficult to recognize is this aggressive cat really a "behavioral issue" or is this just this particular cat at the vet.
 
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Cats are different. Really. You can have a dangerous, pissed off cat at the vet who is completely fine at home.

My cat is a one chance and you are done. I can get blood from her but only if I do it quickly. I don't drag through the whole TPR, weighing, etc. I literally get blood, give vaccines and call it done. Maybe toss her on the scale at the end. If I toss her on the scale at the start, I have lost my opportunity. I have to do most invasive to least with her and stop when she has had it. Otherwise, I have to drug her every time. If you come to my home, she is out and about, not hiding, friendly, will rub up on most people and totally the opposite of in clinic. If someone is over doing work, she gets scared but is still interested and will come check it out.

Compare to my old cat that we put down last year. You can do anything to her at the vet. She lays there and lets you do it. Easiest cat patient ever. Need blood, fine, here is my neck. Oh you need to roll me over? Ok, sure, fine. Giving injections at home was fine. Cuddle her? Her socialize? Nope, not interested. That isn't to say she wasn't friendly but she was the hide if anything new comes over and I only want to be petted and not frequently. This was the sit on the couch cat and sleep all day, didn't want to interact with people and would hide if new people were over. She was cooperative but not social and only friendly with familiar faces at home.

Recently had a client with a hellion cat at the vet, worse than mine, that was diabetic. We got one shot to get blood on this cat and that was it. Client was able to give insulin without a problem at home.

Cats really can't be compared behaviorally to dogs, at least in the clinic setting.

Are there cat psychology issues? Yes. I definitely believe that cats can experience separation anxiety, storm phobias, etc just like dogs can, but it becomes much more difficult to recognize is this aggressive cat really a "behavioral issue" or is this just this particular cat at the vet.
Not to mention that science says we never fully domesticated cats, so I think that adds complexity to it.

Out of my two cats, one is scared but lets you do anything to her at the vet. The other is like a husky-screams bloody murder (that awful blood curdling cat scream we all know) when you're doing something, but the second you stop the vet stuff and just hold him he's purring and nuzzling. Both are very affectionate with my fiance and I at home. Overall I've been pretty lucky with my animals, but the family dog that's with my parents right now has bitten me multiple times when I've tried to do her nails at home. She's got a weird attitude about certain things.
 
I'm not sure I agree with this. Yes a lot of what we do it wasteful, but some of the practices are specifically to prevent spread of infection.

I don't think that's what pinkpuppy was talking about. It's more like the hours I spend thinking about the cost of things to the client on a daily basis and needing to make a decision on that. Like, dog comes in with fever and cough after vomiting all night, also has a loud heart murmur. Owner can't afford the $300 for x-rays and wants us to just "try." I have suspicions for aspiration pneumonia but could be heart failure. As much as I shouldn't be doing this, I flash the chest with ultrasound and dog falls on the x-ray table and "accidentally" it goes off, just so I can get one shot to let me sleep at night. Ideally dog should be hospitalized to deal with the vomiting and initial doses of iv antibiotics. No way in hell the owner has a couple grand for that. Ideally, dog should get X antibiotic for empiric therapy but I know the owner has no money. It costs $250+ for the quinolone I want the dog to have (enrofloxacin or marbofloxacin), and another $200 for the vet labeled amoxi/clav. No go. So I go peruse goodrx to find costs of generic augmentin and cipro (which won't work in many dogs do to their metabolism). Even that costs too much for the owner. So I script out free amoxicillin at the local grocery store plus script for cipro. I give a shot of antinausea meds and say a little prayer. And I'm on the phone with the owner daily for the next several days as the dog struggles, and every time it's "well im not bringing him back in because I have no money but he's not eating, or I think his breathing is worse - are you crazy, no he doesn't need to be put down!!!" Super stressful for me, and a time suck for these cases that generate like negative money.

Or dog/cat with a fracture that the owner can't afford to surgically fix. Casting isn't all that much cheaper and some fractures just aren't amenable to that. Amputation or euthanasia, or try with a cast and maybe need to amputate either. I'll even discount the amputation to save a life and even send home some free pain meds to help. Or maybe a shelter would be willing to take the dog, fix and adopt out. Meanwhile I'm looking for every low cost option that the owner either doesnt qualify for (isn't poor enough), or the low cost option can't help. Owner refuses to do any of the above and I'm a horrible person for not helping... and I get bitched at when I say that if we can't come to an agreement on how to make the dog comfortable, I'm mandated to report for neglect because a dog can't be left with a humeral fracture untreated.

And iterations of this daily. Oh man... the no money diabetics are probably the biggest life sucks, though I kind of like the challenge.
 
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Things that seem wasteful to me are the single use items in human med. A lot of those things can be reused if sterilized. Having problems coming up with an exact example now, but often human docs will donate some of that stuff to vets. Not talking needles or syringes, either.
 
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Oh here's an example: suture kits in the ER. It's my understanding that those instruments are sometimes disposed of (hemostats or forceps particularly). We just re-sterilize and reuse them
 
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There's also nothing innocent about a 100 lb GSD lunging at my face for opening the door to the room. Sorry, I just don't call that innocence
 
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There's also nothing innocent about a 100 lb GSD lunging at my face for opening the door to the room. Sorry, I just don't call that innocence
I just don't blame the dog, I blame the stupid human. When the stupid human is your patient, it makes compassion very hard at times.
 
I just don't blame the dog, I blame the stupid human. When the stupid human is your patient, it makes compassion very hard at times.
We have to deal with both. And it makes compassion very difficult. I know you don't get it, so maybe shadow a vet for a day. Is it the dog's fault he's like that? Probably not. Probably the owner didn't want to train or socialize the dog. But it's hard to feel compassion for an animal that is literally looking to kill you while you try to help it.

And clients are bad, too. We get told how awful we are on a pretty regular basis because we don't do things for free, even in emergencies. You don't get the treatment first in vet med. I obviously don't love animals enough because I expect to get paid. Now mix those 2 situations together and you get something like 5% of my patients. Separately they add up to like 15-20%
 
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Oh here's an example: suture kits in the ER. It's my understanding that those instruments are sometimes disposed of (hemostats or forceps particularly). We just re-sterilize and reuse them
I was given a suture removal kit clearly labeled as 'disposable' by my hand surgeon. Iris scissors and forceps. They were decent instruments too (yes, I'm keeping them). I can't imagine throwing out instruments like that.

I've also seen some nurses bring in an extra catheter or two and instead of putting away what they don't end up using, they toss it in the trash/sharps. A vet clinic would most certainly see that wastefulness financially. I'm certain not every nurse does that, but like I said earlier, cutting costs is not going to be a concern on any human medical professional's mind (perhaps if you owned your own practice you might start realizing how much things cost). No vet tech in their right mind would ever toss an unused catheter simply for convenience.

If I really sat down and thought about it I could probably list more examples.
 
I reuse iris scissors and other tools like that when I can but it's not often. I'd rather use my trauma scissors. On the unit we have no way of sterilizing tools so it would be going against Nursing practice and be putting patients at risk to reuse them. I had to correct a new nurse a few weeks ago for not changing tube feed daily. She thought it was weekly... :/
 
I just don't blame the dog, I blame the stupid human. When the stupid human is your patient, it makes compassion very hard at times.

It isn't always the humans fault in these cases. There are dogs that are seriously just not wired right and despite all the training, medication, work and effort, they can not be fixed.

Even when these dogs are like this because the human didn't give them tools for success, it is hard to feel compassion for an animal that is literally ready to rip your throat out. You actually start to feel better about euthanizing that dog because you know that dog is suffering hard in its constant stressed out, anxious, nervous, aggressive mind-set.

So, no, it isn't "easy" to find compassion for these types of animals, it can be damn difficult.
 
Then you get those clients that are not only in complete denial that their dog is a grade A dingus but then they have the audacity to tell you that you "shouldn't be afraid of their dog" and that "it is your job to get bit". They refuse to let you muzzle the dog. Refuse to let a trained professional restrain the dog. Refuse anything that will make the process safe for the dog, yourself and your staff.

These are the ones that I tell to leave and let the door hit them in the ass on the way out. There is no mystery with these cases as to how their dog became a grade A dingus. This is the only protection I have from these cases is that I can refuse to see them. Basically when it comes to my safety and the staff's safety it is MY way or the highway, the end.
 
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A vet clinic would most certainly see that wastefulness financially.
And it's wasteful from a waste standpoint......all of that stuff that's tossed doesn't disappear into the atmosphere! It has to be disposed of either in a landfill or by burning, or both. Reduce, Reuse, Recycle; it may sound trite, but it's important.
 
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And it's wasteful from a waste standpoint......all of that stuff that's tossed doesn't disappear into the atmosphere! It has to be disposed of either in a landfill or by burning, or both. Reduce, Reuse, Recycle; it may sound trite, but it's important.
That's true but there is nothing any staff member can do. It along with redundant/unnecessary labs contributes greatly to astronomical costs but I have to follow hospital and nursing policy. The hospital structure would have to be completely reformed. They want us to throw out flush bags and tubing daily. The sp02 sensors we use, last maybe a day and cost a fortune. It's wasteful but what is a nurse to do about it? It's a management issue.

Also costs are hugely inflated. Every time I take an accuchek on a patient it costs 80$. Every single saline flush I use (I use at least a dozen on each patient daily flushing IVs, pushing meds, on trachs etc) costs 10$. Every bedpan is about 50$. For a simple piece of plastic.
 
That's true but there is nothing any staff member can do. It along with redundant/unnecessary labs contributes greatly to astronomical costs but I have to follow hospital and nursing policy. The hospital structure would have to be completely reformed. They want us to throw out flush bags and tubing daily. The sp02 sensors we use, last maybe a day and cost a fortune. It's wasteful but what is a nurse to do about it? It's a management issue.

Also costs are hugely inflated. Every time I take an accuchek on a patient it costs 80$. Every single saline flush I use (I use at least a dozen on each patient daily flushing IVs, pushing meds, on trachs etc) costs 10$. Every bedpan is about 50$. For a simple piece of plastic.
you keep acting like these prices are crazy, but really, you're not paying $10 for flush.

you're paying for the expertise of the professional staff administering that flush for whatever reason. Overhead exists and must be paid for.
 
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Healthcare costs are still ridiculous. Its just like education. The hospitals and universities know that no matter what, these expenses will get paid. You literally have no other option. Either you pay it, or you suffer greatly. Or the taxpayer pays for it.

Take vet care for instance, people have an alternative. The animal can be put down if costs are too high for them to afford.
 
hospital and nursing policy.
Right, we all have policies to follow......but that wasn't what I was talking about. My post was ABOUT policy, not about individuals. It's not all about you ;)
 
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Oh I agree definitely. Healthcare costs are ridiculous and now that the country is on board with the Affordable Care Act, its time to mandate healthy practices such as diet and exercise, smoking cessation, etc. in order to keep costs from becoming further unsustainable. I know that its about policy.


This in addition to changing healthcare practices as you suggest would greatly help reduce costs.
 
Healthcare costs are still ridiculous. Its just like education. The hospitals and universities know that no matter what, these expenses will get paid. You literally have no other option. Either you pay it, or you suffer greatly. Or the taxpayer pays for it.

Take vet care for instance, people have an alternative. The animal can be put down if costs are too high for them to afford.
they don't always get paid, though, especially in emergency departments and ICUs. So the hospital has to recoup that cost from somewhere. They know insurance has a deal with them for lower costs, and this is how they get what they need to stay operational
 
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A big problem is the extensions on EMTALA. Where as once a public hospital was only required to stabilize unstable patients, now they must admit them and treat them further. The only hospital I worked at went out of business due to this. They said the ER wasn't what ran them out of business, it was that these homeless people would come be treated in the ER and they had to admit them to the psych floor to treat all of their psych issues, and that this incurred many costs. When I did clinicals on the psych floor, I would guess 90% of them were all homeless. Very few were not.

We have the same problem on my step-down floor but not to as great of an extent.
 
its time to mandate healthy practices such as diet and exercise, smoking cessation, etc.
You think it's really possible (or even a good thing) to mandate diet and exercise? Or to outlaw smoking or drinking? Remember what happened the last time the government tried it.
 
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It will not be easy, but does that mean we should do nothing? Its just like more stringency on firearms. It won't be easy to pass but we must do something. Now that insurance coverage is a requirement (or face a penalty), we can further mandate healthy lifestyle choices, and simply implement penalties for not complying. For instance, nicotine tests. They did it while I was in the military. If you passed a nicotine test it saved money on insurance. My hospital has "healthy lives" which rewards individuals for maintaining a healthy lifestyle.

We can further implement more of these practices.
 
It will not be easy, but does that mean we should do nothing? Its just like more stringency on firearms. It won't be easy to pass but we must do something. Now that insurance coverage is a requirement (or face a penalty), we can further mandate healthy lifestyle choices, and simply implement penalties for not complying. For instance, nicotine tests. They did it while I was in the military. If you passed a nicotine test it saved money on insurance. My hospital has "healthy lives" which rewards individuals for maintaining a healthy lifestyle.

We can further implement more of these practices.

What about people that can't exercise? Quadriplegics, those with severe mental handicaps, those with certain cardiac conditions, etc, etc, etc. You can't create a "bonus" for some people that others can't ever obtain.

Honestly, I don't think implementing these are good things. I hate cigarettes more than anything, but I don't think you will make any progress by banning them. Those who want to smoke still will, fine or not.

Just like the current crack down on opioids. The ONLY thing this crack down is doing is making it harder for law-abiding citizens to get appropriate pain control and for veterinarians to be able to obtain these medications to use in hospital for their patients. They are severely limiting our resources when it comes to appropriately managing pain. And you will end up with MORE deaths in the long run as those who would normally get these medications from a doctor are going to have to seek outside sources that may not be legitimate.

Controlling people has historically and regularly proven to not work. You can outlaw things as much as you want, but people will still do it and often times to an even larger detriment than had things been left as they were in the first place.
 
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I just don't know how we can control costs while people continue living unhealthy lifestyles. Health is getting worse and worse and costs are continuing to rise. Eventually our whole paychecks will go to healthcare.
 
Mandating things like diet and exercise is diametrically opposed to current behavior change theory anyway. If you do something like that, all you'll do is encourage people to avoid the healthcare system entirely until they have overt illnesses, which balloons healthcare costs immensely as you lose out on all of the money saving that preventive healthcare gets you.

It's much more widely accepted knowledge now that you need to address multifactorial issues when it comes to something as complex as health (and yes, that includes things that are "obvious" and overtly measurable like weight). If you make healthcare accessible, affordable, relatively enjoyable to obtain, non-judgmental, and above all else something that people can choose to engage in themselves you have much better results and you get better adherence to healthy behaviors from your stakeholders.

This type of healthcare isn't just about what happens between the patient and you - it involves urban planning, maintaining a clean environment, supporting healthy family and social structures, supporting public infrastructure, encouraging literacy and education, building and maintaining patient motivation, etc. It seems like a ton of work, but really a lot of these things are much more simple than they seem and even little changes to any of those things (and more!) can lead to huge differences in health outcomes and adherence to healthy behavior modifications.
 
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