vet.babble

The semi-organized ramblings of a freshly-minted small animal/exotics vet.

[vetbabble]

I adopted a 1 year old Siamese male from shelter November 2020 - He has toys , I play with him - he walks around meowing & seems unhappy — Would it be wise to add another cat for playmate?

Hard to say! It might be worthwhile to foster another cat and see if he enjoys the company. Some cats do, and some don't. It's always important to have a backup plan if your kitty doesn't like the new addition.

[vetbabble]

My dog suddenly stiffens, have trouble getting up and holds up right hind leg. It only lasts for about 3 minutes and is no visible pain.

I'd recommend you take your pup to the vet; that could be so many different issues!

[vetbabble]

my puppy has been out side he returned with a cut on his chin and a limp

Definitely see your local vet to get that sorted!

[vetbabble]

My kitten was supposed to have her spay stitches removed on the 18th, but due to unforseen circumstances, the vet closed down and won't reopen until the 30th. They now want us to wait until then to remover her stitches. Is that safe? Should we find another vet?

I would ask your vet specifically, given that the answer may differ depending on the suture used. Generally, there’s unlikely to be great harm in waiting a little while to remove sutures, but it depends on the health of the incision. If you are worried, there is likely no harm in finding another vet who is willing to assess the site and remove them!

[vetbabble]

My spynix cat had 8 kittens 12 days ago and they are scratching up her belly and nipples. Can I put a&d ointment or will it harm the kittens

Ah, that is not something I can easily answer without examining the patient to assess if such a medication would be appropriate. One would have to, for example, check for infection, which can only be done with an exam. The best thing you can do is see your vet to have mum fully assessed!

[vetbabble]

Hi! My nine week old cat has really long legs will he be a big cat or a normal size one?

Ooh, that is impossible to tell.

He may grow into them, or he may be a little stilt cat forever!

I personally know of one cat who was a tiny little baby kitten and grew up into a tall monstrosity, so anything goes!

If you know your kitty’s parents, you might be able to guess, but beyond that, you’ll have the fun of discovery as he grows!

[vetbabble]

Pictured is a lateral radiograph of a cat’s abdomen. Chief abnormality: large amount of hard stool in the colon.

This cat, like many others, suffered from chronic constipation. This situation can occur for many reasons, nearly all of which involve dehydration and hardening of the stool to the point that the cat can no longer pass it. Conditions such as inflammatory bowel disease, various cancers, metabolic illness, kidney disease, and more can result in a chronically constipated kitty.

If left unchecked, the condition can lead to megacolon (essentially a stretched out colon that no longer moves normally), anorexia, and eventual death.

The above cat had undergone manual feces evacuation under sedation multiple times already. He was on multiple medications with mediocre results. To complicate matters, he was an obese patient who, anorexic due to the constipation, had developed hepatic lipidosis (fatty liver disease). Because of the severity of his condition and its chronic nature, the owner decided to euthanize.

[vetbabble]

Hi, im very happy to have found this blog! Would you be able to enlarge your text though?

Thank you kindly for your interest!

I think I managed to enlarge it; if you have any other trouble with it, let me know!

[vetbabble]

A recent radiograph of a dog's stifle (knee). This was a >10 year old lab mix that came in for a geriatric annual exam and an evaluation of a limp. The dog refused to put and weight on the affected leg, and palpation found subtle firm enlargement of that stifle. The radiograph showed a clear osteolytic lesion of the distal femur. Given the dog's age, presentation, and exam findings, the most likely diagnosis was osteosarcoma, a very serious, eventually fatal bone cancer. The location of the lesion also fit (the old saying for osteosarcoma is "away from the elbow, towards the knee"). While other differentials exist, such as fungal disease, testing would have to involve bone biopsy, if not leg amputation, to arrive at a concrete diagnosis. Given the probability of osteosarcoma, the dog's age, and the amount of pain she was in, the owner chose to euthanize.

[vetbabble]

Seen here is the heart of a deceased guinea pig. The pericardium, normally flush against the heart, has ballooned out due to accumulation of excess fluid between it and the heart (termed pericardial effusion). This guinea pig had died suddenly at home after exhibiting full body swelling, which turned out to be edema. While a gross necropsy could not fully confirm cause of death, edema alongside pericardial effusion suggests cardiac disease. Other possibilities include neoplasia, renal disease, or infection.

[vetbabble]

Hi! I am currently a Veterinary Technician in Training and just wanted to say I love your blog! I currently work for a doctor who also specializes in exotics so your post are really cool to see!

Thank you very much!

[vetbabble]

Pictured are two radiographs of a 10 year old female spayed St. Bernard's left hind limb, specifically the tibia and fibula. These rads were taken four months apart, with the one on the left being the initial. The patient initially presented with lameness in the left hind. Examination revealed swelling proximal to the tarsus. Radiographs found bony lysis (breakdown) of the distal fibula. Such a lesion in an older large breed dog brings real concern for cancer, such as osteosarcoma (even though this isn't a common location). The clients declined any further diagnostics and opted to palliate with pain medication. The dog re-presented today for increased swelling and lameness. The radiograph on the right shows dramatic destruction of over half of her fibula. Without further diagnostics, we can't tell exactly what the diagnosis is (cancer vs. severe fungal infection, for example), but given age, breed, and severity, cancer is unfortunately likely.

[vetbabble]

Last week, we had a chicken come in with severe periorbital swelling on her right side. The owners had been treating her with some antibiotics from the farm store, thinking she had some form if sinus infection. Unfortunately, she was just not getting better, so they brought her in. Long story short, the swelling turned out to be a large, deeply involved tumor that we were only able to debulk. The owners declined biopsy, so we'll likely never know what the tumor really was, but an impression smear suggested some form of lymphoid neoplasia, possibly due to one of the many viruses chickens can get.

[vetbabble]

The top image is a quick view of what generally clean, healthy dog teeth look like. In order to keep your dog’s teeth nice and healthy, regular brushing and dental care under anesthesia at your vet’s office is strongly recommended. 

The two pictures below are an example of what can happen if such measures aren’t taken. This dog had teeth so diseased that most of them were mobile and covered in so much filth, they weren’t visible.

A dog has 42 teeth. This dog was missing 10, and I pulled out 25. She went home with a grand total of seven healthy teeth left in her mouth. 

“Dog breath” is essentially a myth: if your dog’s mouth stinks (and boy, did this one!), then take them to a vet for a dental assessment and possible dental probing, radiographs, and care under anesthesia.

A couple other points:

Chewing raw bones is NOT recommended: I see a great many fractured teeth that require extraction due to raw bones. Not to mention the fact that raw bone chewing does nothing for disease under the gumline, which is what leads to tooth loss. Pretty teeth are not necessarily healthy teeth.

In addition, you may hear of “anesthesia-free dentals”: procedures where a dog’s teeth are cleaned while they are awake. These are NOT recommended either, for a number of reasons. First, one can never examine and clean teeth completely and well on an awake dog. Second, any pathology found during such a procedure cannot be immediately addressed. Third, putting sharp instruments in an animal’s mouth, particularly a mouth with possible hidden disease, is dangerous for both the operator and for the animal involved.   

[vetbabble]

do you have any advice on how to persuade my mum to take our dog to the vet? I'm worried she's I'll but my mum keeps putting it off and I can't take her because I can't drive and I don't have access to the money it's so upsetting and frustrating

I'm afraid I don't have a perfect answer to your question. I don't think there's a great way to "make" someone take their animal to the vet. Some things you could tell your mum are that, depending on what's going on with your dog, she may be suffering. Also that, again depending on the situation, waiting to take your dog could result in conditions worsening and becoming more difficult/expensive to fix. Again, though: I don't have a perfect answer for this. Sorry :/

[vetbabble]

These are radiographs of a savanna monitor who presented for generalized lethargy. Her abdomen is essentially filled to brimming with fat. She was morbidly obese because the owner, wanting to keep two monitors in the same enclosure for breeding, fed her excessively to prevent her from attacking her cagemate. In addition to a poor diet, she never received proper UVB lighting.

The result was a morbidly obese animal whose bloodwork showed severe inflammation/infection, high risk of hepatic lipidosis, and renal failure with possible gout. Unfortunately, her disease was too advanced, and she died.

Moral of the story: overfeeding lizards is not a solution for aggression.

[vetbabble]

So I just read your post on clients complaining about cost when coming into the clinic. I work at a small, family owned clinic and we get a lot of reviews saying we're too expensive. What would you consider high for a privately owned buisness??

That’s a good question! Unfortunately, it doesn’t have a straight answer. This post got very long, so I’m popping it behind a cut.

I am not a practice owner; I work for someone else, so I don’t have exact knowledge of how much it costs to run a business. I do know, however, that the overhead on a private veterinary practice is very high. One thing I do know is that, in order to stay open, without the owner making a cent of profit whatsoever, our practice needs to make about $3000 a day. We’re open 11 hours a day and see appointments 9 of those hours. A regular appointment is twenty minutes, so we can see three clients an hour. This is a bit of an oversimplification, since recheck appointments are less time, and involved appointments are more, but for the sake of this explanation, let’s pretend each appointment is twenty minutes. This being the case, we would see a maximum of 27 animals (without overlap, because few clients want to wait because their appointment slot was double-booked) per day. 

In order to make enough money to BREAK EVEN (without the owner making a dime off of his business), we’d need each client to pay an average of $111 per visit ($3000/27). Now, this is just assuming we’re seeing appointments. No surgery or anything. Say an appointment fee is $45. That still leaves over $60 average additional expense to be added in order to make the numbers work. That comes out of vaccines, medications, diagnostic tests, etc. And, of course, surgery on our surgery days. 

The point, however, isn’t the exact numbers. It’s the reality of the private clinic situation. Do you think an average of $111 per visit is expensive? According to the reality of a business standpoint, it isn’t. It doesn’t even given the owner a profit. Why in the world would you own a business, with all the stress and work behind it, without making a profit? What would be the point? I wouldn’t do it. You wouldn’t do it. I doubt any of our clients would look at hours and hours of labor without any reward and say “oh, yeah, I’ll do that.”

Yet I guarantee that a huge number of our clients, and likely clients in general, would balk at the price of $111. They’d balk at the price of a $45 exam. Almost $50 just to look at an animal? Why not $30? Or $20?

I had one client once tell me that he felt the whole visit, drugs and exam and diagnostics, should be around $50. Okay. So let’s do the math on that. Mind you, if everything all together cost $50, then an animal just getting a regular check up, that wasn’t sick, would cost less. But for the sake of simplicity, let’s pretend that every animal we saw in a day needed “the works.” Which, according to this client, should cost $50.

$3000 per day at an average of $50 per visit. That would mean that we would have to see 60 clients/pets. 60 appointments in 9 hours means nine minutes per appointment. 

Nine minutes for a full physical exam, full history, getting diagnostics on an animal (mind you, not all animals stay still for any of this, so this doesn’t often take two seconds, it can take 5-10 minutes on its own), running bloodwork/urinalysis, reading bloodwork, giving an animal treatments, explaining diagnoses to the client, discussing a client’s concerns, filling medications, showing how to give the medications, answering more questions, and finally ending the appointment. 

Does anyone really think that doing all of that in less time than a Steven Universe episode is really possible? And if it is, then possible without making a client feel rushed, confused, and undervalued? 

What about anxious, fearful, and/or aggressive animals? Is it acceptable to pin them down and sit on them to get a physical and diagnostics done? Or would it be better to go slowly, try some behavioral modification, given them time so that they whole exam isn’t traumatizing for them? 

What about euthanasia appointments? Is it acceptable to rush them in nine minutes to make way for the next appointment so that the $$ quota for the day can be filled to keep the clinic doors open and the lights on? 

Perhaps it’s possible to plow one’s way through a very high volume of patients given a stellar medical staff, front desk staff, amiable patients, and quick-to-grasp clients, but the reality is far from this ideal. Even with a perfect, always-on-game staff, animals and clients can and often are belligerent, difficult, and demanding of more and more time to answer repeated questions. And even if the appointments all go perfectly, where does this leave time to write up charts and call clients at home, checking in on how patients are doing?

Moving away from appointments, let’s think about surgery. Let’s think about “routine” surgery, such as the spay. This is often another contender for the “it’s too expensive!” claim. 

What is a fair price for a spay? According to many clients (particularly ones seeking out low cost clinics)? Well, about $80 for a small dog. This is looking at a low cost clinic price in my area. Keep in mind that the overwhelming majority of such clinics are non-profit, getting the benefit of tax reductions and monetary donations to subsidize this price.

Where I work, we charge about $300-400. Why does it cost this much? Let me go through what’s involved in a spay.

The dog gets a full physical exam by a veterinarian who has gone through training similar (and some may argue more difficult) to what a human doctor goes through. The animal gets bloodwork done. This blood is obtained by trained veterinary technicians who need to know how to safely restrain the dog, hit a vein, draw out blood, and run this blood through a machine. These are all skills that take a good deal of practice and are not something the average joe off the street can achieve the first, second, or even third time. 

The bloodwork then needs to be read by the vet, taking further knowledge and training to interpret correctly. The dog then gets sedatives and pain medications, all which have to be correctly chosen for the specific patient, correctly dosed, and correctly given. Any side effects or odd reactions need to be correctly identified and managed.

The dog gets an IV catheter. This takes further correct restraint and correct placement, more advanced skills, to achieve. IV fluids are given, which need to be appropriately chosen with the correct rate for the patient and procedure. 

Induction follows with further drugs and doses that need to be carefully chosen to make the animal unconscious, at which time an endotracheal tube is placed to maintain the airway and deliver anesthetic gases to keep the patient asleep. These gases need to be titrated to keep the patient asleep but not dead. Monitoring equipment is applied to the patient and read constantly by a dedicated technician to ensure that they patient is not having a complication that can lead to injury or death. This also takes an immense amount of skill, learning, and experience.

At this time, the vet is performing the surgery. Skills needed for this include but are not limited to: choosing the right surgical tools for the size and shape of patient; cutting in the right spot; cutting with the right technique so organs are not lacerated and damaged; finding the ovaries and uterus; identifying any abnormalities with the ovaries and uterus; pulling the organs out without injuring them, causing bleeding, or injuring other organs; identifying the usual vessels that need to be tied of; choosing the right suture type and size; choosing the right knot to tie off with; performing these knots correctly multiple times; identifying vessels that need to be tied off that aren’t usually tied off; identifying bleeding during surgery; addressing any unusual bleeding correctly and safely; closing the body wall with the correct suture type, size, and suturing pattern; closing the subcutaneous tissues again with the right type of suture; closing the skin in a way that is pleasing to the client’s eye as well as surgically effective.

Then comes waking the animal up, which involves knowing when to take the ET tube out so that the animal can breathe safely. Take it out too early, and the animal may not be able to protect its airway from regurgitation. Take it out too late, and the animal may bite the tube, leading to tube becoming stuck where it should not.

Afterwards, the dog needs to be monitoring to make sure it is correctly aware, and the right temperature, right heart rate, breathing rate, etc. Then, medications to help the patient with pain and healing at home need to be correctly chosen, dosed, and administered.

During all of this, vets and techs need to be able to identify and address any of the following complications (this is list doesn’t include every complication possible): aggressive animals, low blood pressure, high blood pressure, high heart rate, low heart rate, panting, low respiratory rate, NO respiratory rate, NO heartrate, pain, dysphoria, suture failure, infection, and medication reactions.

I suppose, in the end, my answer to you, anon, is that I don’t consider ANYTHING “high” for a private veterinarian. Veterinary medicine is, considering the fact that medicine and surgery are being performed on patients who cannot speak, cannot be reasoned with, and have vastly different anatomies from our own, a very difficult and skill-based practice. Considering the level of knowledge and skill needed, and considering the fact that failure involves DEATH, I find today’s veterinary costs to be pretty cheap. Even the “high” costs.

I mean, we charge $300-400 to spay a patient who can’t talk to us, can’t be given direction, can’t tell us when things hurt, and (usually) has no health insurance. 

D’you know how much it costs to “spay” a human woman, who can be asked to nicely sit in a chair while having her blood drawn? Without health insurance?

Anywhere from $10,000 to $20,000.