Maybe I missed it somewhere, but do we have an update on the two kitties??
[QUOTE=MeghanDACVA;5648792]
For the most part I would have to disagree that better medicine is resulting in longer lifes of pets. When I was in vet school (some 30 yrs ago no) we were taught that cats didn’t live past 12 or so, large breed dogs like danes, etc were geriatric at 5-7 and once a pet got cancer (any that we could detect) they were dead. We routinely see cats in late teens and even early 20’s now. Danes, etc are living into their teens. And many many cancers are reasonably treatable.
Rimadyl and aspirin…
Who put the dog on aspirin, and why? How long was the dog on aspirin?
What blood tests were supposed to be done? I don’t know of any so please educate me. As for a “downtime” between drugs, that is highly controversial.
Now, using both at the SAME time is definitely a no-no.
But having said that, there used to be a drug made by Upjohn that was aspirin and prednisone together. We now “know” that is a real no-no. But somehow dogs lived taking it.
Steroids in a young dog and addisons. No, no, no, no. Steroids are what we use to TREAT addisons. They do not CAUSE addisons. Excessive, prolonged use can cause iatrogenic cushings but not addisons.
Again, I know of no contraindications for corticosteroids in young dogs, no matter the breed. So again, please educate me.
Once the dog was diagnosed with addisons, why was it not treated?
I also don’t know what your issue is with pork in pet foods. It is a high quality protein. Cats are obligate carnivores and have a high protein requirement. Unless a patient has a specific allergy to a specific protein, the body does not know one protein source from another.
As for mistakes and mis-diagnoses…they happen. I have made them. I am sorry you had 2 that have apparantly had very negative impacts on you and are preventing you from remembering anything good and positive that has happened.
As for the vet getting funky about you asking how many GDV’s they had done, etc…If you have a dog that you know is at high risk of developing GDV, why don’t you have them pexied as a preventative. Easier and cheaper to do it as an elective than as an emergency.
And yes, you are the one ultimately responsible for your pets’ health. And well educated owners make our lives much easier.[/QUOTE]
Very old Borzoi was on aspirin for arthritis. I can’t remember for how long, but months at least, and options were limited back then. We were already giving Omega 3s to the dog, long before it was mainstream. That helped him too, but he needed a painkiller/anti-inflammatory. As an old dog, he should have had his liver and kidney values tested before switching to Rimadyl, esp. switching with no down time. You might consider abrupt switching of one NSAID to another fine, but my zoiboy would have argued otherwise. We switched abruptly, and he stopped eating. We questioned the vet as to whether we should discontinue the Rimadyl - vet said to continue. Dog died.
Our Addison’s dog had secondary (or was it called atypical? - it’s been years ago) Addison’s. And yes, it could have been caused by prolonged steroid use. He was on glucocorticoids for several months as a puppy because of his allergies. And he was treated for Addison’s (where did I say he wasn’t?), when it was finally discovered what he had. And why he died, no one knows. He just died in his sleep one night. It was not an Addisonian crisis. We took him several hundred miles to experts for a necropsy, and nothing definite could be found.
I have no issue with pork in pet foods - I do have an issue with giving animals foods they are in no way used to, when they already have diarrhea. And I’m quite familiar with cats’ nutritional requirements.
I have had dogs pexied when they are undergoing some other sort of surgery and a pexy would cause no real additional problems. But I always hesitate to do unnecessary surgeries on sighthounds. This breed has had all too many bad/deadly reactions to anesthesia and surgeries, not the least of which are hyperthermia and bleed-outs. Factor VII is a problem in the breed, and there seems to be a fairly high occurrence of DIC.
I can only speak from my own experiences. My cats and dogs lived longer in the old days. Without Rimadyl, my zoi would have lived to be older - I haven’t had one that old since. My other sighthound breed lived longer too - none have reached 11 in recent years, but had them reach that before. My cats did better as well. (I’ve always, for the 40 years or so that I’ve had cats, considered cats under 12 as pretty young.)
Liz
[QUOTE=MeghanDACVA;5648897]
Dentals, not that I do alot of them anymore!!..
If you can train your pet to let you brush their teeth, it does make a huge difference.
Dog, and cats, DO get dental disease. I see alot of dogs, and cats, with absolute pus in their mouth from the nasty stuff under all that dental calculus and gum disease.
How often does a pet need a dental? It depends on the pet. Some need it 1 or even 2 x a year, some every couple of years.
There is an actual veterianary dental SPECIALTY. Specialties don’t develope “just cuz”.
And yes, in most practices the techs are the ones that do the dentals. Ever had your dentist scale your teeth? Prob not. But the doctor (DS or DVM) is the one to do the diagnostics, read the xrays, do any extractions or other proceedures. So the scaling is only one part of the “dental”. Oh, and the equipment to do the dental with…not cheap these days.
And BTW, anesthesia can be a danger to ANYTHING. Nothing special about sighthounds these days since we are (hopefully) not using pentobarbital for anesthesia. Ket/val, telazol, propofol, isoflurane, sevoflurane are the drugs used anymore. None of which have the same “issues” as the long acting barbiturates did in sighthounds.[/QUOTE]
No argument that animals get dental disease. If you read my earlier post, you saw that one of my cats died following a dental, so I obviously get them when necessary. (Wish I hadn’t in that case, of course. I’ll think three times before I do it again.)
I know there are animal dental specialists. We don’t have them here - though quite a number of our vets list “dental” in ads as something they really like. (:lol: You betcha, at what they charge…)
The difference between technician working on my teeth at my dentist’s office and the one working on my animals’ teeth is that the one at my dentist’s office is a trained dental technician. Not a general veterinary technician. Not denigrating vet techs here! But at the price my vet charges (more than my dentist charges for a cleaning, last time I checked…), I want a specialist, not a generalist.
I know anesthesia is a danger at all times for all pets and people. But my concern is sighthounds, and as I mentioned in the post preceeding this one, my breeds have problems in spite of the new (and far better) anesthetic protocols.
Liz
Anesthesia scares people. Even DVM’s. I have had it defined as “controlled death”, etc. And maybe it is. I don’t look at that way and never have, even before my residency in it. But it does scare ALOT of people.
The next several things may seem contradictory because of the broadness and generality of the statements I have to use, but hopefully you will get what I am meaning.
Our patients are very forgiving of our sins. Meaning the body has a wonderful ability to compensate for disruptions. Esp short term disruptions in normalicy. As such, we can make HUGE mistakes in anesthesia (and other parts of medicine/surgery) and the patient comes through it with no apparant problems. I often say that it is really darned hard to kill an animal, even a sick one.
But, we do “kill” them with anesthesia at times. Sometimes it is due to an actual blanant mistake we made. And OF COURSE the animal died. BTDT. Fortunately most of us learn from those mistakes and don’t do it again.
But most anesthetic related deaths are not from these sorts of blantant mistakes. Most of the time they are from us doing what we always do, what we are comfortable with and trust. The problem is that this is the one patient that cannot “forgive us of our sins”. It is not able to compensate for the disruptions we cause because it has been compensating for something else that we didn’t know about. There is no negligence, no intention, no incompetence, etc on the vet’s part. What they have done has served them well in thousands of other patients. Yes, maybe someone else would have handled it differently but like I said, this protocol has resulted in thousands of successful recoveries.
There are also times that apparantly normal healthy critters die. Just die. No warning, no nothing. Nothing done wrong. When this happens it is devastating to us as well as to you. You have no idea how horrible it is to have to call you tell you that your normal pet has just died. No, we did not KILL your dog/cat. It has happened to all of us. Even the very best of us. It has happened to me. It has happened to my mentors (who have forgotten more than I will ever know in a lifetime).
Veterinarians do not intentionally kill animals they are trying to treat. Veterinarians do not intentionally do “incompetent” things. I would like to believe that all veterinarians, no matter how skilled, are doing the best they really can. If that person’s best is not good enough for you, you need to find someone whose is.
This is not being snide. It is being truthful. I know veterinarians I woujld not take my pets or horses to. But there are a lot that I would (and do). We have an internal level of what we consider someones skill level to be for them be competent. That is not same for everybody. If you are not happy with the level is skill the person whose services you have engaged, find someone else. And that may mean traveling out of your immediate area.
But dental? Dental is a real money cow for most vets. Here anyway, they don’t actually do the dental themselves. Their techs do them. But you aren’t charged accordingly. My dogs are all trained from puppyhood to permit me to scrape their teeth if/when they need it. I do this not to save money, but because anesthesia is always a danger, and to sighthounds in particular.
oh, dentals, especially under full anesthesia, drive me crazy. Sure some dogs and cats need them. But not one of my raw-fed animals has ever had anything other than sparkly white teeth their entire life. Yet I had a vet tell me, without even looking at the dog’s mouth, that I would need to schedule a routine dental every year. He’s not my vet anymore.
And the commercial dry foods most vets urge their cat n dog owners to feed are what make the teeth dirty in the first place so the poor animal gets bad nutrition, gets dirty teeth, and then has to undergo dangerous anesthesia repeatedly throughout life. It’s a horrible cycle.
[QUOTE=threedogpack;5647996]
hypothetically? Lets set an arbitrary limit of $500. Then I’d ask him which should be done. This is HIS area of expertise. Remember I am not one of the anti-vets posters either. And right now I’m thinking about what Meghan said…something to the effect of - we can talk about this or I can take care of your pet. Now I’d think the quick assesment for $125 should be done…that should set some parameters, shouldn’t it? If only by elimination. I would also think IV fluids would be something that would not harm and might at least keep my dog alive till I could see my own vet. This puts us at $270 (is the exam really $145? That seems a little high), and if the exam is 145, we’re at $415 already. So the rest I’d leave up to him, with emphasis on the $500 limit.[/QUOTE]
Vet suggeste ALL…however if the financial limit was $500 they would have to go with what the client wants. I would think for this type of dog, I would choose the same thing you did if I had that financial limit.
OK - so here are your abnormal test results:
Base Exesses -21 (normal 4 to -4)
Lactate 6 (normal 0-2)
Bilirubin 6 (normal 0-3)
Glucose 23.1 (normal 4-8)
Ketones in urine (++++) - normal is zero.
Also hypo-osmolar.
So, from your standard in house bloodwork you have a diabetic ketoacidotic dog. Plus, a possible gallbladder issue (pancreatitis causing obstruction, mucoscoele, liver disease…?) - however the DKA is most pressing and life threatening.
So question is now - you have spent $400 of your $500 in diagnostics… but now would you increase your budget if you knew you had a treatable disease? (but not for under $1000)
[QUOTE=SquishTheBunny;5649793]
So question is now - you have spent $400 of your $500 in diagnostics… but now would you increase your budget if you knew you had a treatable disease? (but not for under $1000)[/QUOTE]
this is still at the E clinic?
if so, then I would want to stablize and do minimal treatment, in order to take dog to my own vet in the morning.
if not, and this IS my vet, we are going to either take payments or euth.
[QUOTE=prairiewind2;5648424]
First off, I seem to hear a bit of sarcasm in your first question. “Budget for your beloved dog…” IOW, if you don’t spend all that we vets think you should spend, you don’t love your dog. Never mind that the physical exam is overpriced (if you do the minimal things that our vets do) and that I may have lost my job, my COBRA has run out and I have Type I diabetes or heart disease (all hypothetical, but then this is a hypothetical question, yes?). Never mind that as the dispenser of services, you have an incentive to get the customer to spend as much as possible. (Maybe you aren’t that kind of vet, but maybe you are, and we customers have no way of knowing the truth.)
But skip all that. We’ll assume that no judgement or sarcasm was intended in that first question. We’ll assume that you truly aren’t trying to pay for that ultrasound machine by getting as many people to use it as is even remotely necessary. We’ll assume the world is as it should be, perfectly honest.
I’ve never had a Lab, so I’m not familiar with the sorts of problems that beset the breed. I can only assume that 10 is oldish for a Lab. (My expertise is with sighthounds, as I’ve said.) With the sorts of giant breeds I’ve had, I’d be thinking of two possibilities - heart and GDV. Symptoms don’t fit GDV perfectly, but then I’ve known of many sighthounds that partially torsed and didn’t show pain right away - and anyway, that is the thing that strikes terror in sighthound owners and is always a consideration. But cardiomyopathy and other heart problems crop up a lot too, and sometimes rather quickly. Some of them can lead to swollen abdomens. Of course, ulcers and other things can cause bleeding into the belly, though the gums are pink so maybe that isn’t happening.
I’ve never scrimped on my animals. I’d probably have most of the tests done, though maybe not the overnight stay. My particular sighthound breed is very sensitive, many have torsed after stressful things such as overnight stays at the hospital or kennel, so I would only leave my dog there if something immediately life-threatening was found. Where I live, there is no overnight care at the clinics except in emergencies, and the dog might well be better off at my house with the IV stuff here. We’ve done that in the past. I would get IV fluids if the vet recommended them, either staying with the dog while the fluids were dispensed or taking the dog home with the equipment.
If I got the ultrasound, I wouldn’t waste my time with anyone but a specialist. Not around here, anyway. Of course, there are no ultrasound specialists here, but some of the vets are set up to send the ultrasounds (and x-rays) to specialists elsewhere. We’ve had that done and I considered it money well spent. It would obviously be better to have the specialists actually do the ultrasounds and x-rays, but that’s the price we pay for living here and not in a big city.
I have to say, though, that for that initial $145 Physical, you’d better do more than look in my dog’s ears and eyes, and listen to his heart. Because $145 is way too much for that.
Liz[/QUOTE]
No sarcasm…actually the opposite! I know I would have a limit, Im not made of money!!!
Not sure what kind of crappy physical exams you are used to? A good ER vet needs to do a better job than your regular vet as he has never seen your animal or have a history. Physical exams on ER include a FULL physical, rhythm strip on EKG, auscultate heart/lungs, blood pressures, eye pressures if needed, lymph node palpation, BSI, thorough exam! And $145 is standard ER exam fee, as they are far longer than 15 minute vaccine exams. Exam fees also include temperatures, pulse/respiration, rectals etc.
And yes, that $475 for an ultrasound is from a board certified radiologist - not a GP vet.
And in the case of this dog, he was a diabetic ketoacidotic. If he didnt stay for severeral overnights, he would likely no longer be alive. 
If you dont know what DKA is, google it - pretty interesting…but not something that can be managed at home.
Also,your comments on pricing for specialists - yes, maybe not your local ER, but ours has BOARD CERTIFIED specialists that do ultraounds…not internal medicine vets doing ultrasounds or ultrasound getting sent off for specialists to read - but you are getting FAR better quality diagnostics. Same with surgeons, IM and criticalists. Sure there are GP vets with a “special interest in…” but until they are board certified you are just paying for a glorified GP vet (which isnt necessarily bad…but you should know the differene when it comes to reason for price differences!)
[QUOTE=threedogpack;5649813]
this is still at the E clinic?
if so, then I would want to stablize and do minimal treatment, in order to take dog to my own vet in the morning.
if not, and this IS my vet, we are going to either take payments or euth.[/QUOTE]
Minimal treatment would be invasive to keep dog alive for the time being - once OUT of the crisis, sure a regular vet can manage a regular diabetic case.
Does your regular vet clinic have a tech educated in dosing/maintaining insulin CRI’s? 95% of GP practices would never accept a DKA dog requiring an insulin CRI at their clinic, as they require specialists to maintain their glucose levels properly.
Your regular vet also does not have the source to run in house bloodwork (other than glucose) so certain tests would take hours to get back, where sometimes in these cases results are needed in minutes.
Does your regular clinic have a tech available to watch your dog 24/7 and balance every drop of fluid that comes in/out of your dog until your dog’s insulin levels have balanced?
We get hundreds of DKA animals transferred TO us from regular vets, because the extent of care is more than they can provide.
Generally with these animals with DKA do very well post treatment and the regular vet can then trend their glucose levels in monthly curves once they are stable and on a home insulin regime.
These are the reasons REAL ER/Referral clinics exist (not just overnight transfer clinics).
Most do not accept payment plans through the clinic…but offer medicard - like a credit card which will foot the bill and you pay them back in installments (but of course, with interest)
Im not going to ask if you would treat or euthanize…because either is fair. However, this is NOT something a regular vet can handle as its not something that can be treated/cured in 12 hours and like in people…requires a specialist.
[QUOTE=prairiewind2;5649013]
Very old Borzoi was on aspirin for arthritis. I can’t remember for how long, but months at least, and options were limited back then. We were already giving Omega 3s to the dog, long before it was mainstream. That helped him too, but he needed a painkiller/anti-inflammatory. As an old dog, he should have had his liver and kidney values tested before switching to Rimadyl, esp. switching with no down time. You might consider abrupt switching of one NSAID to another fine, but my zoiboy would have argued otherwise. We switched abruptly, and he stopped eating. We questioned the vet as to whether we should discontinue the Rimadyl - vet said to continue. Dog died.
Our Addison’s dog had secondary (or was it called atypical? - it’s been years ago) Addison’s. And yes, it could have been caused by prolonged steroid use. He was on glucocorticoids for several months as a puppy because of his allergies. And he was treated for Addison’s (where did I say he wasn’t?), when it was finally discovered what he had. And why he died, no one knows. He just died in his sleep one night. It was not an Addisonian crisis. We took him several hundred miles to experts for a necropsy, and nothing definite could be found.
I have no issue with pork in pet foods - I do have an issue with giving animals foods they are in no way used to, when they already have diarrhea. And I’m quite familiar with cats’ nutritional requirements.
I have had dogs pexied when they are undergoing some other sort of surgery and a pexy would cause no real additional problems. But I always hesitate to do unnecessary surgeries on sighthounds. This breed has had all too many bad/deadly reactions to anesthesia and surgeries, not the least of which are hyperthermia and bleed-outs. Factor VII is a problem in the breed, and there seems to be a fairly high occurrence of DIC.
I can only speak from my own experiences. My cats and dogs lived longer in the old days. Without Rimadyl, my zoi would have lived to be older - I haven’t had one that old since. My other sighthound breed lived longer too - none have reached 11 in recent years, but had them reach that before. My cats did better as well. (I’ve always, for the 40 years or so that I’ve had cats, considered cats under 12 as pretty young.)
Liz[/QUOTE]
Dog died (your old one): did you ever discover of what? Do you know for sure there was a perforated gastric ulcer?
yes, older dogs/cats should have blood work checked, for a variety of reasons. And I do admit that I would have prob wanted to know kidney values in an old dog on ANY NSAID. Even aspirin. But that said, what would have done differently? If he was painful on aspirin and you were needing more pain relief, and in that time zone we didn’t know about using the drugs we do now (tramadol, gabapentin, amantidine, adequan, etc), what would you have done instead? Would you have NOT given him aspirin, or any NSAID,for that matter?
The controversy about wash out time between NSAIDS (and NSAIDs/Steroids) is that does the body really know what substance is blocking the production of COX1? Prob not. COX1 is blocked by aspirin today. Then we stop the aspirin and tomorrow give Rimadyl. Tomorrow COX1 is blocked by rimadyl. Either way COX1 is blocked. Now, giving BOTH is a problem.
Steroid use and addisons. If a patient is on long term, high dose steroids, acute discontinuation of the steroids can result in transient addisons. This is because by us giving high doses for a long time, the body does not need to be producing its own, so the adrenal gland has backed down its production. Sudden “withdraw” takes all the steroids away suddenly the adrenal gland has to make them. But it can’t gear up that fast. It is not a permenant condition. And it happens immediately after stopping the LONG TERM, HIGH DOSE steroid use.
You only said your dog died of addisons. You did not say you were treating it. I will assume you have been monitoring electrolytes and all that on a very regular basis and that s/he was on a corticosteroid (pred most likely) and a mineralocorticoid (florinef or hydrocortisone). If he did not die of an addisonian crisis, and necropsy was inconclusive, I am stumped as to why you are so sure the steroids he got years before as a puppy 1) caused the addisons and 2) why he died of it. Just asking. I can’t read your mind or know your thought processes.
Sighthounds anesthesia/surgery/etc:
Repeating…today’s anesthetic drugs are not an issue with sighthounds, any more than they are with any other breed. Back when we relied on barbiturates (the thiobarbs in particular) it was an issue.
DIC: DIC is not a breed specific problem. It is a syndrome triggered pathologically during sepsis/sirs/etc. It is a “consumptive coagulopathy” so there has to be a pathological reason why platlets and coag factors are being consumed abnormally. We do not know what starts it. If it was something that happened alot in sighthounds, there would be tons of research on sighthounds and DIC.
And you can screen/test for the Factor 7 issue.
If I had a large breed dog that was at risk of GDV, and possibly a Factor 7 deficency, I would test them and then pexy them. As opposed to waiting until it is an emergency and having do deal with any bleeding, etc.
[QUOTE=wendy;5649422]
oh, dentals, especially under full anesthesia, drive me crazy. Sure some dogs and cats need them. But not one of my raw-fed animals has ever had anything other than sparkly white teeth their entire life. Yet I had a vet tell me, without even looking at the dog’s mouth, that I would need to schedule a routine dental every year. He’s not my vet anymore.
And the commercial dry foods most vets urge their cat n dog owners to feed are what make the teeth dirty in the first place so the poor animal gets bad nutrition, gets dirty teeth, and then has to undergo dangerous anesthesia repeatedly throughout life. It’s a horrible cycle.[/QUOTE]
I have 3 dogs, all eat crap kibble apparently. the oldest is 14, the youngest is 6…none have needed dentals. But they arent on raw food…are you sure kibble makes their teeth bad? Maybe it will happen at year 15.
And I agree, some dogs are just more prone to it than others (especially the bearded dogs), but your vet should really look at your pets mouth before suggesting dentals!!!
We do the cop dog’s teeth yearly even if they look white - but the reason for that is that we need to check actual tooth function, make sure there are no loose teeth, pockets, small fractures etc as they NEED their teeth for their jobs.
[QUOTE=prairiewind2;5649067]
I know anesthesia is a danger at all times for all pets and people. But my concern is sighthounds, and as I mentioned in the post preceeding this one, my breeds have problems in spite of the new (and far better) anesthetic protocols.
Liz[/QUOTE]
Liz, just curious…what problems do your particular breed of sighthounds have with the new (and improved!) anesthetic protocols? Id be really interested to know as we see them and have them under anesthetic on a daily basis. We typically see greyhounds, italians, and borzoi’s but maybe you have something that needs a different protocol??
[QUOTE=SquishTheBunny;5649879]
Minimal treatment would be invasive to keep dog alive for the time being - once OUT of the crisis, sure a regular vet can manage a regular diabetic case.
Does your regular vet clinic have a tech educated in dosing/maintaining insulin CRI’s? 95% of GP practices would never accept a DKA dog requiring an insulin CRI at their clinic, as they require specialists to maintain their glucose levels properly.
Your regular vet also does not have the source to run in house bloodwork (other than glucose) so certain tests would take hours to get back, where sometimes in these cases results are needed in minutes.
Does your regular clinic have a tech available to watch your dog 24/7 and balance every drop of fluid that comes in/out of your dog until your dog’s insulin levels have balanced?
We get hundreds of DKA animals transferred TO us from regular vets, because the extent of care is more than they can provide.
Generally with these animals with DKA do very well post treatment and the regular vet can then trend their glucose levels in monthly curves once they are stable and on a home insulin regime.
These are the reasons REAL ER/Referral clinics exist (not just overnight transfer clinics).
Most do not accept payment plans through the clinic…but offer medicard - like a credit card which will foot the bill and you pay them back in installments (but of course, with interest)
Im not going to ask if you would treat or euthanize…because either is fair. However, this is NOT something a regular vet can handle as its not something that can be treated/cured in 12 hours and like in people…requires a specialist.[/QUOTE]
Dear Squish the Bunny. Why are you so intense about this? I’m not one of the thinkallvetsareouttogetme crowd.
I feel singled out because I played to your scenerio. I’m not a vet, I never said I was a vet and I listen to what my vet (and if was at an ER that vet) says and make as informed a decision as I can. I was playing YOUR game here. But I won’t again.
You have a nice day.
I live 45 minutes to an hour away from ANY Emergency animal care. I have had to make that drive 3 times with dying suffering animal in car which was so not fun. At the one clinic I got treated with some hostility until in one situation I wound up giving verbal a##whipping to vet because she would NOT listen to word I said. That got her attention and I got treated much nicer. Cat still had to be euthanized but I didn’t need to be treated like dirt. Other situation, vet started off being upset at me, until he heard cat’s history. He was quite kind to me after and tragic outcome was far less horrendous.
Last visit to ER was with boy kitty with urinary blockage. They were lovely to me and kitty. I did get presented with bill for $700 which I did a line by line veto on and once vet undertood that I knew what I was doing and could really do most of the care at home, let me go with bill for $350 which - since I did not qualify for CARE credit - they let me pay off.
I figure animal ERs are like human ERs - some are bad and some are good. I work in an ER and some of my doctors I wouldn’t give a dead rat to and others I would trust with my life. Just sayin…
What about cats? They seem much more sensitive to the effects of general anesthesia than dogs. Is it more dangerous for them or do they just take longer to clear it from their system?
[QUOTE=SquishTheBunny;5649838]
No sarcasm…actually the opposite! I know I would have a limit, Im not made of money!!!
Not sure what kind of crappy physical exams you are used to? A good ER vet needs to do a better job than your regular vet as he has never seen your animal or have a history. Physical exams on ER include a FULL physical, rhythm strip on EKG, auscultate heart/lungs, blood pressures, eye pressures if needed, lymph node palpation, BSI, thorough exam! And $145 is standard ER exam fee, as they are far longer than 15 minute vaccine exams. Exam fees also include temperatures, pulse/respiration, rectals etc.
And yes, that $475 for an ultrasound is from a board certified radiologist - not a GP vet.
And in the case of this dog, he was a diabetic ketoacidotic. If he didnt stay for severeral overnights, he would likely no longer be alive. If you dont know what DKA is, google it - pretty interesting…but not something that can be managed at home.
Also,your comments on pricing for specialists - yes, maybe not your local ER, but ours has BOARD CERTIFIED specialists that do ultraounds…not internal medicine vets doing ultrasounds or ultrasound getting sent off for specialists to read - but you are getting FAR better quality diagnostics. Same with surgeons, IM and criticalists. Sure there are GP vets with a “special interest in…” but until they are board certified you are just paying for a glorified GP vet (which isnt necessarily bad…but you should know the differene when it comes to reason for price differences!)[/QUOTE]
I apologize. I missed that the dog was in ER. We have no ER here, not for 250 miles or so. All we have are regular GP vets, so that’s the way I think. Very likely an ER would give a better physical than a regular vet, but I haven’t been to an ER for any of my pets since 1987 or so.
I also pointed out that I would leave my dog overnight if something life threatening was found, so if he was diabetic ketoacidotic, he wouldn’t be at home. Not that diabetes is a big problem in my breeds… And yes, I know what diabetic ketoacidosis is - I’ve known two people with Type I diabetes who died from it.
I also understand quite well the difference between a specialist and a GP, even a GP with a “special interest in.” I mentioned that I thought the specialist was worth the money, yes? We have no specialists of any kind here, but I have had them in other places I lived, and have also traveled that aforementioned 250 miles several times to get my pets to one.
Liz
[QUOTE=MeghanDACVA;5649190]
Anesthesia scares people. Even DVM’s. I have had it defined as “controlled death”, etc. And maybe it is. I don’t look at that way and never have, even before my residency in it. But it does scare ALOT of people.
The next several things may seem contradictory because of the broadness and generality of the statements I have to use, but hopefully you will get what I am meaning.
Our patients are very forgiving of our sins. Meaning the body has a wonderful ability to compensate for disruptions. Esp short term disruptions in normalicy. As such, we can make HUGE mistakes in anesthesia (and other parts of medicine/surgery) and the patient comes through it with no apparant problems. I often say that it is really darned hard to kill an animal, even a sick one.
But, we do “kill” them with anesthesia at times. Sometimes it is due to an actual blanant mistake we made. And OF COURSE the animal died. BTDT. Fortunately most of us learn from those mistakes and don’t do it again.
But most anesthetic related deaths are not from these sorts of blantant mistakes. Most of the time they are from us doing what we always do, what we are comfortable with and trust. The problem is that this is the one patient that cannot “forgive us of our sins”. It is not able to compensate for the disruptions we cause because it has been compensating for something else that we didn’t know about. There is no negligence, no intention, no incompetence, etc on the vet’s part. What they have done has served them well in thousands of other patients. Yes, maybe someone else would have handled it differently but like I said, this protocol has resulted in thousands of successful recoveries.
There are also times that apparantly normal healthy critters die. Just die. No warning, no nothing. Nothing done wrong. When this happens it is devastating to us as well as to you. You have no idea how horrible it is to have to call you tell you that your normal pet has just died. No, we did not KILL your dog/cat. It has happened to all of us. Even the very best of us. It has happened to me. It has happened to my mentors (who have forgotten more than I will ever know in a lifetime).
Veterinarians do not intentionally kill animals they are trying to treat. Veterinarians do not intentionally do “incompetent” things. I would like to believe that all veterinarians, no matter how skilled, are doing the best they really can. If that person’s best is not good enough for you, you need to find someone whose is.
This is not being snide. It is being truthful. I know veterinarians I woujld not take my pets or horses to. But there are a lot that I would (and do). We have an internal level of what we consider someones skill level to be for them be competent. That is not same for everybody. If you are not happy with the level is skill the person whose services you have engaged, find someone else. And that may mean traveling out of your immediate area.[/QUOTE]
Yes, living bodies are amazing biological machines, aren’t they? Machines that buzz along quietly repairing and rejuvenating themselves, dealing with an incredible number of insults every day. It is truly mind boggling.
I think I mentioned early on that I believed that most of the vets we’ve had, competent or relatively incompetent, were doing their very best. Those were not empty words. I do believe that. And I know that the vet who was supervising the dental for my heart cat that died was devastated. We knew the cat had health issues, but the vet assured me many times it would be all right, they knew what they were doing. Basically convinced me to do the dental, even though I had grave reservations (one time I even mentioned I didn’t think he would live through it). So yes, his death came as a shock to the vet, and the vet was truly devastated. It came as a shock to me too, because I was foolish enough to permit myself to be convinced when I knew better. (Episode reinforced my temporarily suspended belief to always follow my instincts. When I don’t, someone suffers.)
Was the vet incompetent? Was the vet just over confident? Was the cat’s death preventable, if a better vet had been there? I don’t know the answers. I suspect the latter to be true, but I’ll never know. I do know the vet tried very hard, and the whole clinic was in shock and very sad. Didn’t make the cat come back though, or ease my grief. Or increase my faith in the vet, or in vets in general - though I did feel bad for the clinic, even as I wrote that $400 check for the dental. Just one of those things, no win for anybody.
I don’t dislike vets. Nearly all of the ones I’ve had over my 57 years I’ve liked on a personal level. But I trust none of them anymore. Well, I take that back. There is a sports medicine vet in the East that all the sighthound people swear by. They absolutely love him. Him I might trust, except I’ll probably never see him!
I completely understand that people - vets - make mistakes. I make mistakes. But you must understand that even if I understand that concept, it doesn’t lead to increased faith in vets. It leads to empathy and compassion, but it doesn’t (can’t) lead to faith.
As far as traveling out of my immediate area - I live in Wyoming. There are about half a million people in the entirety of the state. The next town is 25 miles away, and it is tiny. Don’t know if it even has a vet. The town after that is even smaller and is 50 miles away. No, the only place we could go for better vet care is 250 miles away, and while we’ve done it, it’s not practical for everyday care, nor in emergencies, particularly in the winter when the highways are often closed. So I do the best I can with what we’ve got here. No whining, just the way it is.
I do appreciate the time you’ve taken to write, and I completely respect all the effort and worry that you and most other vets put into your work.
Liz
[QUOTE=MeghanDACVA;5649881]
Dog died (your old one): did you ever discover of what? Do you know for sure there was a perforated gastric ulcer?
yes, older dogs/cats should have blood work checked, for a variety of reasons. And I do admit that I would have prob wanted to know kidney values in an old dog on ANY NSAID. Even aspirin. But that said, what would have done differently? If he was painful on aspirin and you were needing more pain relief, and in that time zone we didn’t know about using the drugs we do now (tramadol, gabapentin, amantidine, adequan, etc), what would you have done instead? Would you have NOT given him aspirin, or any NSAID,for that matter?
The controversy about wash out time between NSAIDS (and NSAIDs/Steroids) is that does the body really know what substance is blocking the production of COX1? Prob not. COX1 is blocked by aspirin today. Then we stop the aspirin and tomorrow give Rimadyl. Tomorrow COX1 is blocked by rimadyl. Either way COX1 is blocked. Now, giving BOTH is a problem.
Steroid use and addisons. If a patient is on long term, high dose steroids, acute discontinuation of the steroids can result in transient addisons. This is because by us giving high doses for a long time, the body does not need to be producing its own, so the adrenal gland has backed down its production. Sudden “withdraw” takes all the steroids away suddenly the adrenal gland has to make them. But it can’t gear up that fast. It is not a permenant condition. And it happens immediately after stopping the LONG TERM, HIGH DOSE steroid use.
You only said your dog died of addisons. You did not say you were treating it. I will assume you have been monitoring electrolytes and all that on a very regular basis and that s/he was on a corticosteroid (pred most likely) and a mineralocorticoid (florinef or hydrocortisone). If he did not die of an addisonian crisis, and necropsy was inconclusive, I am stumped as to why you are so sure the steroids he got years before as a puppy 1) caused the addisons and 2) why he died of it. Just asking. I can’t read your mind or know your thought processes.
Sighthounds anesthesia/surgery/etc:
Repeating…today’s anesthetic drugs are not an issue with sighthounds, any more than they are with any other breed. Back when we relied on barbiturates (the thiobarbs in particular) it was an issue.
DIC: DIC is not a breed specific problem. It is a syndrome triggered pathologically during sepsis/sirs/etc. It is a “consumptive coagulopathy” so there has to be a pathological reason why platlets and coag factors are being consumed abnormally. We do not know what starts it. If it was something that happened alot in sighthounds, there would be tons of research on sighthounds and DIC.
And you can screen/test for the Factor 7 issue.
If I had a large breed dog that was at risk of GDV, and possibly a Factor 7 deficency, I would test them and then pexy them. As opposed to waiting until it is an emergency and having do deal with any bleeding, etc.[/QUOTE]
No, we don’t know what he died of. No one does necropsies here, and vet just said, “old dog.” As I also mentioned, we were younger and stupider then, and had more faith in vets.
We did not take him in for pain or stronger meds. He was doing fine. We were in for a checkup. The vet said they had a newer, better painkiller, and so “let’s get him off aspirin.” Not our idea. So I took in a dog who was doing very well for his age, gave him a new med, and he died. Is there a chance that something unrelated to the Rimadyl caused his death. Sure, I suppose so. Most all things are possible. But am I suspicious because a pretty healthy old guy went in, was given a new med with no tests or aspirin layoff, and died with a couple of days after becoming anorexic? You bet.
I was under the impression that Rimadyl (carprofen) inhibited Cox 2.
As far as Addison’s and glucocorticoids - you are describing primary Addison’s. That is not what my dog had. Checked my records last night, and he had what my vet generally called secondary Addison’s, though that may not be the scientific name. (Remember, no specialists here.) I looked in the Merck Manual to see if I could find what she was talking about and found with this page.
http://www.merckmanuals.com/professional/sec12/ch153/ch153c.html
Prolonged steroid use can bring it about, whether or not the steroid is stopped abruptly. There are other possible causes, and the dog/person probably has underlying issues. But do I still doubt the vet that put my puppy on months of steroids? Yes, because the next vet we took him to did allergy tests, and had allergy shots made that took care of the dog’s allergies with no steroids. Obviously the steroids were the easy way out, and may have contributed to my beloved dog’s illness and death. Perhaps I would have been more understanding if that same vet clinic hadn’t given my old dog Rimadyl with no tests, and nearly declawed my kitten (and I absolutely DO NOT believe in declawing cats!).
As far as anesthesia goes - I am probably misspeaking. It is not the protocols that I have trouble with, it is anesthesia in general and surgery. I’ve had three sighthound breeds, one of them rare in this country. That one has a problem with malignant hyperthermia. I don’t know that the anesthesia protocol has anything to do with that, just anesthesia in general. I agree that protocols for sighthounds are much safer now than they used to be, in general anyway.
Factor VII can be tested for, and has proven to be of questionable predictive value in my rare breed. Some dogs with it don’t bleed, and some dogs without it do. No one knows why.
I can’t speak of DIC in all sighthounds, just in my three breeds (of which I have only one now, the rarest). And DIC is a problem in this rare breed. But because the breed is rare, there won’t be lots of testing and studies. Sighthound studies are usually done on greyhounds, because there are a reasonable number of those and lots of money in racing them. (At least there used to be.) DIC is a mystery and a terror to us owners, though less so to me because in my breed anyway, it most often happens in females and I only have males.
Liz
[QUOTE=SquishTheBunny;5649940]
Liz, just curious…what problems do your particular breed of sighthounds have with the new (and improved!) anesthetic protocols? Id be really interested to know as we see them and have them under anesthetic on a daily basis. We typically see greyhounds, italians, and borzoi’s but maybe you have something that needs a different protocol??[/QUOTE]
As I said to someone else, these days it’s not the protocols so much as anesthesia itself, and then the surgery. My breed of choice these days has a history of malignant hyperthermia. Also bleeding (which is the surgery part, not the anesthesia part).
My breed (which I won’t name as it is rare in this country, rare enough that I could be recognized by anyone in the know) doesn’t need a different protocol than the other sighthound breeds.
[QUOTE=magnolia73;5648451]
I feel like they expect you to spend, spend, spend. What makes me upset is that in the same practice, you can have varying thoughts. When my Jasmine cat died, the one vet was flabbergasted that bringing her in for dialysis was a no go, while the one who euthed her commented that her blood panel revealed more than just kidney issues and that I was doing the right thing.
My other cat broke her pelvis and the vet was clearly irritated that I would not take her to a surgeon, to the point that she did not communicate aftercare. I told her very clearly that $1000 was my limit, and certainly a surgery with a specialist would be more. If the cat was in pain without surgery, I was willing to euthanize. Within 2 days the cat was moving and in two weeks jumped out of her crate.
It seems far easier to get equine vets to give you the cheapest, cheap, expensive and most expensive scenarios. With the small animal vets, they seem to go expensive right off the bat.
I know it is well meaning, and a desire to see the animal treated to the best that can be done.[/QUOTE]
I really really need to learn how to put more than one thread quote in one post!!
Re: different vets different takes on stuff in same practice…
We all have different opinions, standards, experiences, etc. There are things I would do to my pet that perhaps you wouldn’t. And vice versa. Personally, I would not dialysis on my pet. But that is my opinion. As a vet I feel I need to tell you that it is an option (if it is). If a pet has multiple problems, then each of those need to be talked about–how they impact each other, what the treatments are for each, how each treatment may impact another treatment, etc.
I am working with a little dog now that most people would not be treating. But the owners want to as long as Lucy’s quality of life is good. She has 1) some eye problem that she sees an ophthomologist for and is on 4 different eye meds for 2) hypothyroid and is on thyroid replacement 3) diabetic and a very difficult one at that 4) addison’s which we just finally confirmed and are now treating hoping that helps straighten out her diabetes regulation 5) bladder infection that is only sensetive to a drug that can screwe up diabetes regulation. I know alot of vets who would not tackle this and would disuade the owners from. But they want to, and have spent tons on her for ALL her problems. (More than I could afford to, even at my cost). And they make the time and life style committment to treat her too.
Had a cat about a yr ago that belonged to a rather “unique” owner. Nice but definitely a “crazy cat person”. (I am one so I get on with these sorts of people). Cat had already had one thyroid out several years ago, was being treated for heart disease and kidney disease. Represented to her regular vet with more chronic problems. Vet called me to see the cat and to “talk her into euthanizing the cat” since he couldn’t “get thru to her”. Well, cat’s parathyroid glands were overworking so it was hyperparathyroid. Not exactly something every vet sees on a regular basis, or even see/recognize in a life time of general practice. So we fixed that, with surgery and then meds. Then the other thyroid gland became hyper and IT had to be removed. So now cat was on thyroid REPLACEMENT. Then his kidney disease resulted in anemia and we treated that for awhile. After a year of pretty good quality of life for both parties, it was time to put him to sleep. Again, would most owners make this sort of committment? No. Would most vets even want to deal this this night mare? No (as was the feeling of the regular veterinarian)
In both cases, and I could give tons of others, the owners were presented with the options of euthanasia far earlier on.
I cannot read an owner’s mind. I can only make recommendations. If the upper level, ideal, whole hog recommendation is not workable, I work my way down the list of options, with euthanasia being the last one. Sometimes this list is short, often only 2 options–treat as suggested or euthansia.
Now, this is how I practice. Today. Did I always? Prob not. Will I always? I hope so.
But is also why I am not happy in private general practice.
Pelvic fractures, esp in cats: I don’t usually recommend surgery but alot of people want it. And it is an option.
BTW, we euthanized the kitty that came thru the tornado today.
