[QUOTE=grayarabpony;5644052]
Stupid question. Of course I didn’t know how the practice was run before I went there.
But now I will not go back.
Do you understand now?? Maybe?[/QUOTE]
Now that you explained it, yes I do. The way it was worded it sounded like you knew that and went anyway which is why I could not understand your unhappiness.
[QUOTE=threedogpack;5644655]
Now that you explained it, yes I do. The way it was worded it sounded like you knew that and went anyway which is why I could not understand your unhappiness.[/QUOTE]
OK. 
Sorry for being snappish then.
“Wow, laugh in a face of a doctor who says “this mole looks a little funny…shall we send it off?” You would laugh in their face? I cant believe a lipoma ended your dogs life, are you really that cheap to not have a simple lipoma removed? Lipomas dont kill dogs, stupid owners do.”
How sweet…when they try to pull the "you’re a horrid owner if you don’t do every test I want to bill you for. In this case, a 12 year old boxer with old dog “warts” being removed. If you’re a vet, sure hope you read better for comprehension…I wrote: “I had an old Boxer, a lovely girl, had an “old dog bump” taken off her leg.” You really have to read for comprehension. I wouldn’t do chemo or radiation on any dog, it doesn’t matter what the bump was.
Of course, 2 years later an internal lipoma can mechanically block the intestines, making your dog look like the Michelin Man in short order as the gas back up (with no torsion type pain either). Didn’t matter what ultimately made me put her to sleep, especially a 14+ year old boxer…sure wouldn’t be any benefit to an owner, only the clinic adding their fee on top of tests. Lot more incompetent vets kill animals than owners, and everyone on Coth has bad vet stories, either for rip off prices or just poor quality work.
Ah well, oxen being gored and unhappy people…the meat of Coth.
Ditto Blu’s suggestion about Care Credit.
Not only can it be used for veterinary bills (some equine practices accept it too), it can also be used for dental and eye care stuff for you too.
When you apply for it, I suggest picking a BIG limit. It doesn’t mean you have to use that much since it is a credit LIMIT.
[QUOTE=Trakehner;5644753]
“Wow, laugh in a face of a doctor who says “this mole looks a little funny…shall we send it off?” You would laugh in their face? I cant believe a lipoma ended your dogs life, are you really that cheap to not have a simple lipoma removed? Lipomas dont kill dogs, stupid owners do.”
How sweet…when they try to pull the "you’re a horrid owner if you don’t do every test I want to bill you for. In this case, a 12 year old boxer with old dog “warts” being removed. If you’re a vet, sure hope you read better for comprehension…I wrote: “I had an old Boxer, a lovely girl, had an “old dog bump” taken off her leg.” You really have to read for comprehension. I wouldn’t do chemo or radiation on any dog, it doesn’t matter what the bump was.
Of course, 2 years later an internal lipoma can mechanically block the intestines, making your dog look like the Michelin Man in short order as the gas back up (with no torsion type pain either). Didn’t matter what ultimately made me put her to sleep, especially a 14+ year old boxer…sure wouldn’t be any benefit to an owner, only the clinic adding their fee on top of tests. Lot more incompetent vets kill animals than owners, and everyone on Coth has bad vet stories, either for rip off prices or just poor quality work.
Ah well, oxen being gored and unhappy people…the meat of Coth.[/QUOTE]
Back to your old dog bump issue… If I, as a vet, did not offer to you the option of submitting the mass for histopath, I would not be doing my job. Unfortunately for us vets, we can’t read minds and therefore have no way to know which owner WILL want to submit it and if it comes back as something bad, may even treat it. Or owners that don’t. Neither is right, neither is wrong. But to lamblast a vet for asking you if you WANTED to is just plain rude and nasty.
As for the lipoma…Are you sure it wasn’t a leimyoma and not a lipoma?
If she didn’t have surgery for it, and you didn’t do a necropsy, how do you know what it was that caused her to have to be PTS? Apparantly I am missing some piece of this story?
As for lots of incompetent vets killing animals…I find that hard to believe. Can you provide substance to this statement?
[QUOTE=Trakehner;5643206]
I hate these bloody crooks. Radiographs aren’t expensive to take, especially with digital x-rays…no film/developing etc. They’re easy and a real money maker for the human doctor wanna-be’s.
Sedation…a real rip off…"Oh, but we need to do a chem panel and a full blood testing to make sure Fluffy is in good enough shape to get a shot of acepromazine/ketamine etc. Bull Scata…again, a money maker.
Fecal float…2 cents of solution, 20 cents for a test tube (if you even get a new one vs. washed out) and a minute to view the slide…another rip off, doesn’t take a lot of talent to spot a roundworm ovum, or to tell a hookworm from a whipworm egg.
I had an old Boxer, a lovely girl, had an “old dog bump” taken off her leg. The vet said, “We don’t like the look of that and would like to send it off to the vet pathologist”. I laughed in her face and told her to ship it off, but I wasn’t paying for it. Later when a lipoma (probably) finally made it time to put her to sleep, the vet afterwards said, “A necropsy is only several hundred dollars, wouldn’t you like to know what happened to her?” Worked in some profanity that time…money grubbing idiots.
Small animal vets, especially emergency vets, are getting a terrible reputation (and it’s deserved). Just because you watched ER and House and see all the neat tests you can do, you can’t justify screwing pet owners over with unneeded tests during a time of high stress and perhaps not them being in a not great state of mind…gee, sounds like a funeral home preying on the family.[/QUOTE]
I hope I am never so cursed as to have you walk in the door while I’m working. I’m sure as hell am no human doctor wanna-be. It’s actually the other way around. Veterinary school is vastly harder to get into. That quick and easy digital system costs close to $100,000.00
I’d worry if you’re pet’s being knocked down with ace/ketamine. That pre-anesthetic panel, especially in cats, is great at finding renal disease before you pet is super sick. If you care enough to take a lump off, it’s worth knowing what it is.
You have the option of declining a test, but the diagnostics are critical if you’re going to provide the best care.
There are some people who will always find a reason to complain. The same person who “laughs in the face” of a vet who suggests a histopath be done for a dog (who is of a breed known for rampant cancer) would scream blue murder about “that lazy incompetent vet who killed my dog” if the service were not recommended. Bottom line is they want it done for free, because these people think everyone owes them something.
And I’ll back you up on the “doctor wanna-be” thing as well. I know TWO doctors who are doctors because - wait for it - they couldn’t get into vet school.
Well, about the pre-anesthetic panel… I have gotten funny looks when I’ve declined that for a spay or neuter. Then I get the, “Oh, well I guess you don’t want pain meds, either.” Ummm, what? Of course I want pain meds but if the cat can’t be spayed/neutered because the blood work is off, it’s a no go for me anyway. I just can’t add any more cats to the population around here. This, honestly, goes for the (semi-feral) strays and the house cats. (The house cats are all former strays, anyway.)
I also declined blood work before my 12 yo cat had his teeth examined. Vet called me right after I dropped him off and said they had to do it if a cat was over a certain age. Well, ok. Whatever. But seriously, the whole side of the cat’s face was a hard, swollen mess. In my mind it would be better for him to succumb to the anesthetic on the table than come home with no surgery/procedure and what I was pretty sure was a nasty abscess (it was) and no doubt a HUGE headache for however long he lasted. Hell, it could have been a tumor for all I knew but I knew when I took him in he’d have to go under the gas. Why can’t I make that call? If he didn’t make it, it would break my heart - but I would have signed a release. I knew the risks.
All the above was from different regular vets. I get it that vets have to deal with unreasonable people quite often, people who don’t pay, etc., but I do think that some of this stuff should be talked over between the owner and vet (not the front desk & owner) so the vet has some idea where the owner is coming from. In the case of the 12 yo cat with the abscess, I’m pretty sure the vet never even heard about my denial for pre-anesthetic, much less the reason why. It was just a generic policy.
I just had a good (well, not “good” but had excellent care) from an ER vet. My cat decided to have a urinary block then re-block. He spent a total of 4 nights inpatient with urinary catheters etc. These vets were great both with him and with me, the paranoid mom! I could call as much as I wanted and visited each day.
It was incredibly expensive (says the graduate student) but given the level of care, I can understand why it costs to much to provide it.
[QUOTE=alabama;5645111]
but I do think that some of this stuff should be talked over between the owner and vet (not the front desk & owner) so the vet has some idea where the owner is coming from. In the case of the 12 yo cat with the abscess, I’m pretty sure the vet never even heard about my denial for pre-anesthetic, much less the reason why. It was just a generic policy.[/QUOTE]
Does this mean you never saw this vet before, or that the front desk staff did not know you, or they did not pass it on to the vet? You’ve never had an opportunity to discuss these issues with him? Did you explain your reasoning to him when he did call? Over the last 5 years, I’ve built a relationship with my vet and we’ve talked several times about how to handle different situations. He pretty much knows that I’m going to do comfort measures for an elderly dog or a dog that has a poor prognosis, but that’s because we talked about it before it happened or at the first sign of illness.
To Trakehner and others of similar opinion
Hypothetical scenario:
Sick dog with vague history of vomiting, not feeling good, getting worse past 2 days, now very weak, barely able to stand. Physical exam : middle aged adult dog about 45#, pale mucous membranes, body temp low normal, resp rate sl above normal, HR about 100, pulses are weak. Dog is in good body condition.
Dog belongs to Trakehner so all I can do is a PCV. PCV is normal at about 40%.
What is wrong with the dog? What do I do now? Heaven forbid I screw her with more blood work or xrays!
Some facts Trakehner should know since she had her own lab business.
Ok, centrifuge cost $1,000 and let’s say the needle, syringe, PCV tube and clay are free.
Let’s say we depreciate the centrifuge out over 3 yrs, making it about $1/day to use it.
So, should I only charge her $1 for the PCV?
Oh, but we forgot…
The centrifuge needs electricity. I will use my home electric bill for simplicity’s sake. $300/month. Or $10/day.
The centrifuge needs a building to be in!! My mortgage payment is $2,000/month, or $67/day.
My phone bill is about $200/month, or $7/day.
Waste pick up: $45/month or $1.50/day
We are on well so we don’t have a water/sewer bill.
Insurance and taxes: $11/day
Minimum wage for my one assistant/receptionist: $7.25/hr, plus I have to pay the matching social security. This poor person does not get any benefits. Let’s assume she works 40 hrs or $290/day
My licenses (only the required ones), etc: $225 for state license, $420 for state drug license (3 yr registration), DEA $551 (3 yrs), required continuing education $2,500 (estimated), liability insurance $300/yr . Total for a year $3,349 or $9/day.
So now, I need to generate at least $395.50 that day to cover your $1 PCV. And that is the cost of things at home, not of a practice or much less a 24 hr practice.
That does NOT include any salary for me, any cost of other equipment in the hospital, the cost of keeping records, etc. And whether I use my other stuff on your dog, I still have to pay for it. As well as the drug bills, interest on the purchases, etc. It is only to pay for my house vs an actual hospital (even a very small one), one employee and the centrifuge.
I used to work in small rural practice in the late 1980’s that was an old converted house. We had 1 receptionist and one technician who also did kennels. We had very basic blood work capabilities, typical of that time. No monitoring equipment, 1 old anesthesia machine, etc. Even THEN it cost them almost $500/day to make ends meet. Things have gone up A LOT since then, even if they never changed their basic level of practice.
You say you STARTED a lab once upon a time? What happened to it? Did you make a living doing it? Did you charge $1 for a PCV? Did you do any other testing? Did always charge the vet only what it “cost” you to run the test so as to be sure to not be screwing the horse owners?
AND I still don’t know what is wrong with your dog.
What should I do next to make you happy and fix your sick dog?
Ball is in YOUR court now. Tell me what to do next. I am serious here. Tell me.
Opening a can of worms.
[QUOTE=alabama;5645111]
Well, about the pre-anesthetic panel… I have gotten funny looks when I’ve declined that for a spay or neuter. Then I get the, “Oh, well I guess you don’t want pain meds, either.” Ummm, what? Of course I want pain meds but if the cat can’t be spayed/neutered because the blood work is off, it’s a no go for me anyway. I just can’t add any more cats to the population around here. This, honestly, goes for the (semi-feral) strays and the house cats. (The house cats are all former strays, anyway.)
I also declined blood work before my 12 yo cat had his teeth examined. Vet called me right after I dropped him off and said they had to do it if a cat was over a certain age. Well, ok. Whatever. But seriously, the whole side of the cat’s face was a hard, swollen mess. In my mind it would be better for him to succumb to the anesthetic on the table than come home with no surgery/procedure and what I was pretty sure was a nasty abscess (it was) and no doubt a HUGE headache for however long he lasted. Hell, it could have been a tumor for all I knew but I knew when I took him in he’d have to go under the gas. Why can’t I make that call? If he didn’t make it, it would break my heart - but I would have signed a release. I knew the risks.
All the above was from different regular vets. I get it that vets have to deal with unreasonable people quite often, people who don’t pay, etc., but I do think that some of this stuff should be talked over between the owner and vet (not the front desk & owner) so the vet has some idea where the owner is coming from. In the case of the 12 yo cat with the abscess, I’m pretty sure the vet never even heard about my denial for pre-anesthetic, much less the reason why. It was just a generic policy.[/QUOTE]
Ok, I will open this awful can of worms. And am apt to get pretty flamed by others, esp vets, for it. Mind you, this is MY opinion, and take for that.
I am not a big adovocate of pre-op blood work FOR PRE-OP’S sake!! I am a consultant for VIN (Veterinary Information Network) in Anesthesia so I field alot of anesthetic death/complication questions. They almost always start with “blood work was normal”. Yeah, so? There is NOTHING in blood work that that cause a pet to die under anesthesia. Nothing. So let’s pick it apart as to why.
Kidney values: Patients cannot die of acute kidney failure in the course of even a vet school anesthetic period. No matter how bad the lab values are.
Liver: Patient cannot die of acute liver failure… Liver values have no effect on today’s anesthestics. Way back when this was true but not anymore. Heck how do you think we anesthetize animals to take out gall bladders, liver tumors, fix liver shunts, etc? The liver tests on a routine panel also tell you very little, if anything, about liver FUNCTION. You need different tests to determine that.
And then there really isn’t anything else on the blood panels anybody gets excited about.
Remember I do emergency work. Even if I do blood work before a surgery it is not going to keep me from doing surgery. The pet needs the surgery now, period.
Oh, what DOES the blood work really do for us? It gives us a chance to screen the patient for problems we might otherwise not know about. Things we may want/need to manage AFTER surgery/anesthesia. So the pet’s kidneys aren’t the greatest. Be sure it is on fluids before, during and after surgery. Avoid giving NSAID’s until the pet is awake. Ok, you say, how do you know to do this without the blood work? Look at the patient. I will bet that any cat (or dog) over the age of 5 or 6 does not have the same degree of kidney function it did when it was a year old. So just support the kidneys anyway. It is good medicine. A patient should come out of an anesthetic at least as good, if not BETTER, than it went in. No matter how healthy it was to start with.
If I had to pick what I want for pre-op lab work…Urinalysis looking for 1) glucose 2) protein and 3) specific gravity. These will clue me into early kidney disease and maybe early diabetes. (Note: there has to be AT LEAST 70% loss of kidney function before a blood value is abnormal. Specific gravity changes much earlier). PCV/TS: lets me know if patient is anemic (unlikely if PE was normal), what his protein level is (that can be sneaky) and if his WBC count is roughly normal. However, none of these will make me change my anesthetic protocol. It will however guide me as to whether or not I should look further. BUT it doesn’t tell me anything about liver stuff. And I admit that.
What will make me change my anesthetic protocol? The patient. Old, young, stupid crazy, quiet and laid back, sick, critical, normal, heart murmur, activity level, etc. And then, how it is responding to the anesthesia. No 2 patients quite the same.
I preach this to vets all the time. Most of the time it falls on deaf ears and I often feel like the little boy in The Emperor’s New Clothes. IDEXX and the other lab companies have done a tremendous “educational” campaign to teach us “the value” of pre-op blood work. And we have bought it hook line and sinker.
Is the bloodwork of value? Yes. Will it change the outcome of the anesthetic? No.
Patients die under anesthesia for reasons other than bloodwork abnormalities.
However, I do still encourage doing bloodwork at the time of surgery. Like I said, it gives us a chance to screen for things that might be lurking and to act on them before they become major clinical problems.
Ok, now that I have thoroughly stirred that pot and will surely piss all your vets off when you go in and tell them this…
Now, your 12 yr old cat with the abscess. That cat I would suggest blood work on. I don’t know how your vet does their anesthesia but… in a cat this age I will bet that he has some early kidney dysfunciton. Prob not clinical. May not even show up on blood work. Since I know this I would be sure the cat is on fluids during anesthesia and afterwards. I would however like to know what his kidney levels are so I can counsel YOU as to what to do, if anything. And esp if your vet is going to use an NSAID in the cat for pain control. If he had kidney “issues” will it change the outcome of anesthesia? No (not even if all they use is Ket/Ace!). But it may well dictate what to do AFTER anesthesia.
And I wholeheartedly agree that this stuff needs to be discussed between vet and owner. Should it be broached initially by the staff? Yes. Be details, etc should be between DVM and O. Again, just my opinion. And my anal retentive, controlling, perfectionist, type A personality.
And now the *Itchy side of me
I can usually calm most irrate, irrational owners down with common sense. However there are the times I have to be the Queen Witch and call as it is:
Only one of us can play doctor here. You just pick. If it isn’t me, you need to take your pet to who is going to play doctor since I will no longer be involved.
I can sit here and talk with you at length about all the things I need to do and why and what if and how come while your pet is critical in the back. Or I can go treat your pet and talk with you when it is stable. You pick.
Fortunately I don’t have to use these very often but when backed into a corner, I will. Funny thing is that usually after I do the owner’s attitude does a 180.
There is also another phrase I use, though this one I really hate.
“I am good but I am not that good.” Referring to pets that have terminal, fatal problems.
Meghan, thanks for that little schpeil about pre-op bloodwork I particularly enjoyed it. And I’m with ya 100% on everything else…
I see Trakehner is making more friends in his usual way, around the boards.
For the record, he can be even more pleasant when mistaken for a woman.
Meghan, thank you. That was really eye-opening.
So not to derail this, but based on the information you’ve just shared, would it not be adviseable to schedule a blood panel as part of a pet’s yearly workup? Especially for pets over the age of 5-6? That is, of course, if the owner is willing to pay. I would be fine with that if it meant catching something early on.
[QUOTE=Long Spot;5645436]
I see Trakehner is making more friends in his usual way, around the boards.
For the record, he can be even more pleasant when mistaken for a woman.[/QUOTE]
His posts are rather PMSy lols! :lol:
[QUOTE=Mara;5645440]
Meghan, thank you. That was really eye-opening.
So not to derail this, but based on the information you’ve just shared, would it not be adviseable to schedule a blood panel as part of a pet’s yearly workup? Especially for pets over the age of 5-6? That is, of course, if the owner is willing to pay. I would be fine with that if it meant catching something early on.[/QUOTE]
Not all hospitals do, but we advise yearly “senior” screening urinalysis and bloodwork to identify problems when a pet reaches a certain age. You can decline it if you like, but it’s advisable for a reason.
really? wow. I had always been told that the bloodwork was essential to doing the anesthesia correctly.
of course I still don’t regret doing it for Duncan, but…wow.
[QUOTE=Pancakes;5645610]
Not all hospitals do, but we advise yearly “senior” screening urinalysis and bloodwork to identify problems when a pet reaches a certain age. You can decline it if you like, but it’s advisable for a reason.[/QUOTE]
Thanks. Mine are closing in on 7 this year, so I think I’m going to request these panels at their next checkups.
It probably would have caught my cocker’s diabetes early - we got him in as soon as he started drinking tons and peeing in the house (and I could still kick myself for thinking his loss of condition was due to his being 15 years old). He did live for another 6 years, but still.
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