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In non-emergent cases, should i take complete Hx before PE using an exam sheet or do both simultaneously without writing down collected Hx or PE findings at the time of consult? That approach seems professional but i worry about forgetting important details. I created a comprehensive sheet with sections for various information, including Hx and blank areas for PE findings, DDx and Diagnostic and Therapeutic plans. but, i fear being perceived as socially awkward or beginner for using this sheet.

Hello, It's Sueanoi here

I am going to hazard a guess that you're probably a vetling. You're training to become one very soon, that or you're a very fresh vet. A comprehensive sheet is very useful. It's like a manual paper. Like a gaming guide, a cheat code, a training wheel. Use it often times enough, and you will eventually be able to draw that sheet from inside your head. It would feel like learning to ride a bicycle. Or learning a difficult game like cheese. It's a skill with a very steep learning curve, but once you get to a point you never really forget how to do it.

For me, the first thing I get is Chef Complaint. It's like the start of a branching thought paths. Once you get which tree to follow, the amount of thought that you need to carry will not be so overwhelming.

History will help you prioritize branches on that throught tree. Lessening the load further.

Physical exam will sometimes confirm or deny your thought. but it's ok, because you already pulled up the relevant thoughts, you simply move on to the next most possible in your priority.

When you're training, you are taught to do each of these in order, one by one. But in practise, the process is much more complicated, because people are complicated. They might remember some information they forgot to tell. they might start another thought tree altogether. History might make you want to explore outside of the chef complaint. physical exam might pull you to another problem that's more urgent than CC, and so on.

I'd say there's no right or wrong order of work that you do, when you're talking to people. You can take history, start PE, then history again because you found something suspecious and you need more information. If you're fluent, you can start PE while the owner talks. but I personally don't like to do that only because they like to talk when I'm listening to thorax sound. Now I can't hear the lungs OR the information. So I don't like to do both at the same time.

I hope that helps a bit. You can do it!

#vetling

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I have a friend who, despite their best efforts and many consultations with vets and behaviorists, may be facing a behavioral euthanasia of a rescue dog. I am wondering if you might have some good resources I can read or point them to in order to cope with this situation? They are understandably very distraught, and I hope I can get them to stop blaming themselves for something that was by and large out of their control.

vet-and-wild here.

I'm very sorry to hear that. I've been through a behavioral euth myself and it is really difficult. If your friend has social media, check out Losing Lulu on Facebook. It's a support group for people who have been through behavioral euths (both personally and professionally).

#behavioral euth #tw animal death #anonymous

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Hi, my cat just came back home from the pet hospital for treatment of a total urinary obstruction. I caught it after he’d become lethargic and had a hard bladder when palpated. I was wondering what some earlier signs may be in the event this happens again. I’d hate to miss something and let him get this close to dying again.

Hi, Sueanoi here.

Blocked cat is extremely dangerous. Good thing that you catch that before it's too late. There's not much time after a cat becomes completely blocked before time runs out.

Watch his litter box activity. Does he take longer than usual, does the urine color become abnormal, is there blood in it. Is there pus in it. Does he vocalize when trying to strain. Does his urine stream becomes narrower than usual, does it becomes drops instead of stream.

If yes, he's probably partially blocked, or he might have other kinds of urinary problem.

If he strains, but no urine comes out, that's an emergency.

#blocked cat #veterinary

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Testament to pet insurance because I feel you guys would appreciate it: I adopted my new kitten, Gargoyle, today. I had arranged for him to go to the vet 3 days ago for his first vaccines and wellness exam so I could set up his insurance asap, even though he was still going to be with his foster for a few more days. LAST NIGHT he hurt his leg and his foster mom had to take him to emerg (not broken, thank god, but it was still 800$ for xrays and pain meds). Because I had that insurance set up already (and the company waived my 30 day waiting period when I set it up), I only had to pay 200$ out of pocket! SO GLAD I got it set up the day I decided to adopt him. Moral of the story for everyone on the fence about pet insurance: get it while they're young and don't have problems yet!!!!

Anyway, here's my stinker:

He's getting around just fine, despite the cast he has to have on for the next 5 days.

vet-and-wild here.

Shameless boost to encourage more people to get pet insurance. I have it, most of my coworkers have it, and I encourage every new client to get it. It's such a game changer.

Please keep in mind though that most insurances won't cover pre-existing conditions! It always sucks when I have to tell a client that no, they can't go out and get insurance for the cancer we just diagnosed. Pet insurance also reimburses you, they do not pay up front; it is NOT like human insurance. Consider something like Care Credit if you need help paying for services up front. I have both, and so do a lot of my coworkers.

#pet insurance #vet med #care credit #finances

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Hello, I was wondering is there any good and free resources on basic veterinary knowledge. I'm currently working as a receptionist as my first job, I don't have any previous animal husbandry knowledge or handling experience; Pretty sure I was hired bc my English proficiency and somewhat okay with computer

Oftentimes I receive call about some basic inquiry (like can my dog get vaccinated when she is in heat) and have to response back to client about it. While I read animal welfare articles and consult colleague on how to answer, I still feel extremely anxious about not knowing enough. A lot of information that goes deeper are paid-wall and some are just not something a receptionist are required to answer, but I would still like to know more if not to ease anxiety. Despite my anxiety I really like the job and just don't want to loss it, plus I want to be more helpful/useful

Sorry for getting personal in the lateral part. Have a nice day!

vet-and-wild here.

Honestly, you'll probably learn with time and experience. It's also helpful for clinics to have SOPs/scripted answers for common questions.

A specific source might be a bit tricky, just because a lot of the ones I can think of are gonna be way more in depth than you'd need. But you could try reading articles written by the various veterinary specialties (i.e. veterinary nutritionists, cardiologists, etc). A lot of them have info or position statements on their websites. The AVMA (or equivalent organization for other countries) has free articles for owners and vets, and sometimes VIN has some open access ones. VCA also has some really nice owner handouts that are available for free (I usually just Google "VCA cat (disease) handout" or whatever I'm looking for) if I want to find one to print. The International Cat Care Council has a lot of nice articles about cat behavior and health too. Sometimes the various universities with vet hospitals have stuff available online. Cornell usually has a lot. Clinician's Brief is helpful but usually requires a subscription. But if you really want to read stuff behind a paywall you could also ask your boss if they'd be willing to pay the subscription.

#anonymous #vet med #resources

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A weird thing happened, but I won't bore you with the details and head straight for the question:

Is it possible for a "lump" (possible tumor?) to just up and disappear?

(if more details/background are wanted I can add of course)

(I am in contact with a vet, but I haven't had the chance to specifically ask this in between instructions and other stuff)

Hello, it's Sueanoi here.

I can think of one possibility at the top of my head. Lumps that can disappear are usually inflammation swelling. Sometimes a clump of white blood cells can accumulate in such a way that it doesn't become an abscess that we can lance out. Once the cause of inflammation is gone, the swelling disappears.

I am not able to be sure that this is correct, but I hope that my guess is useful.

#veterinary #inflammation #granuloma

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Disclaimer: kitten has already seen a vet, enucleation is planned as soon as she hits their minimum weight. Just asking as a vet student who feels like they have way too many little bits of info floating around in their brain to be sure about anything lol.

Kitten was dropped off at shelter with 0 history (of course), and my knowledge on this case is a little vague. Is this likely just from an infection left too long, that probably sealed the eye shut at some point and worsened? (Like, viral -> bacterial?) It looks it’s proptosed to me, but I’m also not sure if that’s just massive swelling. If it IS proptosed, is that a common sequelae of severe infection? Or do you really only get that with trauma in cats, and then secondary infection?

Not sure if my thinking is way off base, just looking for some general insight into how these eyes end up looking so gnarly. I feel like we’ve had quite a few dropped off this year. Thank you!

Hi, it's Sueanoi here.

I'm glad the kitten is getting some vet attention now. I hope the healing goes as smooth as it can.

As to answer your question, I don't think that's proptosis (eyeball goes out of orbit). I think it is ruptured cornea that has severe inflammation on top.

Anything at all can cause a secondary corneal injury if the eye is irritated, causing the animal to scratch it and worsening the lesion. Over time, superficial ulcers can become perforated.

Over here in SEA, young stray cats are very often infected with feline herpes. It is a very common cause of blindness (as the last consequence of virus-induced ulcer) here.

Your thinking isn't entirely off base, because virus -> bacteria -> catastrophic consequense IS probably correct.

Once it is time to enucleate, I suggest you observe the surgery. I am quite certain that the globe itself is still sitting within the orbit. The things that are coming out of the cat's head is the eyeball's insides that are spilled out of the ruptured cornea.

Keep clean and control infection. There is a chance that the cat won't even need the surgery if the eye shrink down and become enophalmos before it reaches minumum weight (which might take weeks...whichever happen first). Downside of keeping the shrunk eye is having to keep it clean for the rest of its life. So if that is a factor for the cat getting an adoption, removing it anyway for ease of care is still a valid choice.

Best of luck!

#ophthalmology #veterinary #graphic content #vetling

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So my cat broke a lower fang clean off. I'm already going to take him for bloodwork tomorrow to prepare for extraction, but the best I can do for earliest dental extraction is next week without paying over $1000 at an emergency clinic, which I can't afford. I called many places. The receptionists didn't sound alarmed for my cat though, so that makes me wonder. While google says that a broken tooth can be an emergency, how risky is it to get it extracted a week later? I'm not planning on saving his tooth either. That I know is time sensitive.

vet-and-wild here.

Maybe it's a regional thing, but where I'm at we don't consider a broken tooth an emergency. I'd be curious to know where you're located (you don't actually have to tell us, I just think what you said is really interesting) because I can't imagine any ER around me being willing to extract a tooth. They'd probably prescribe pain meds and antibiotics and recommend follow up with a general practitioner. The reason a broken tooth is concerning is that if there is exposure of the pulp cavity (where the nerves and vessels are) it can lead to potential pain and infection. Sometimes we find a broken tooth on a physical exam just by chance. We don't know when it happened and the owner is surprised to hear that it happened at all because the animal isn't showing symptoms. We still recommend removal if there is exposure of the pulp cavity, because it could lead to further problems. And tooth pain sucks.

The only time we have to try to rearrange our schedule for a dental to get it done sooner is if the animal's teeth are so bad it isn't eating, or there is a broken tooth causing severe pain/infection. I can count on one hand the number of times I've had that happen, and of course one of them was my own dog. Otherwise, we can generally schedule it as a routine dental. Dentals with tooth extractions are pretty involved procedures so it's not something we can do at the drop of a hat. Unless a tooth is already super loose, we often have to burr away bone and make gingival flaps to get the tooth out. It also rarely makes sense (both from a financial and practical perspective) to just extract a single tooth and not do the rest of the dental (i.e. dental x rays, scaling and polishing, probing, etc) so we also have to account for that time too.

#vet med #anonymous #dentals #teeth #dentistry

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vet-and-wild here.

I figured I'd add on because my clinic does offer telehealth, but there are restrictions.

Honestly, with some exceptions, I really dislike telehealth appointments. Legally, we cannot make a diagnosis or give a prognosis, along with a few other restrictions for telehealth. It does vary state by state in the US though! Other states may be more lenient, others may be more strict. I just don't feel like it's very useful most of the time since I'm not examining the animal in person. Basically all I can do is say "yup looks like he needs to be seen" or "no it can probably wait". I hate it for those kinds of appointments. I feel like it's a waste of my time and the client's time.

But it is very useful for a few things! Exotics husbandry stuff, for one. Or animals that it is difficult/unsafe to bring them in. Let me be clear that it does NOT replace a physical exam, nor does it establish an actual client-doctor relationship for new clients. However, the times when it is useful to say "no you don't have to come in right now" are the 150lb pot bellied pig, the venomous snake located hours from us, or the 100gal multi species fish tank. Because even though I can't make a diagnosis or prescribe anything, I can talk about husbandry, environmental modifications, diet, water quality, etc. Sometimes I still end up saying "sorry I really need to examine this animal to be able to do more", but it has been really helpful for a handful of exotics because so many of their issues are husbandry related. We use it a lot for aquatics because it is more difficult to get them safely to the clinic.

Also well established clients who want a real time assessment on if they should be seen. I find it useful for that too. We obviously don't charge clients for sending emails or photos or anything, but there's no guarantee on when we'll get to them. I have a few clients who don't live local and have high maintenance animals, so it's been helpful for being able to sit down at a scheduled time and triage if they need to come in or not.

So yeah, some benefits, but it's pretty situational. Definitely more supplemental and has tons of limitations.

my apologies if this has been answered before, i tried to look for an already existing post on your blog but couldn't find it: but what's your opinion on telehealth veterinary practices? yesterday i saw an ad for a vet who you can just video call and it just seems very strange to me. vets physically assessing (like touching and feeling) an animal is ingrained in my head as the best way to go about things. just seeing a video of someone's pet doesn't feel right at all. what's your take on this stuff?

Hello, Sueanoi here.

The only way I can see it working is when there is a vet or at least a vet staff (including but not limited to vet tech, vet nurse, vet assistant) on the receiving end. They have to at least know how to examine the animal and what to look for according to recommendation of the vet on the other end.

Consultation is a normal thing that vets do. Most if not all vets have experienced contacting a specialist of a specific issue to ask for their help over distance.

There is no way tele-medicine can work without a vet or vet staff on both ends. A layman cannot recognize signs of disease, or they cannot communicate what they see for lack of vocabulary to describe what they're seeing.

I'll give you an example, most examinations require the vet to use all the senses except taste. They look, they listen, they smell, they touch (palpate). They may need to collect samples from the animal to find out what's wrong. These actions cannot be performed by laymen. At the very least, a vet staff is required.

Another example, I am an ophthalmology focused vet (cannot call myself specialist due to technical issue), most often I get consultation requests from general practitioners. They would tell me the result of their examinations and sometimes with photos. They would usually ask for my diagnosis list and what to do next. I might ask for more info, for example : because an eye is a 3D structure, a flat photo might not tell me enough. I would usually ask for a short clip of the eye in different angles. I might ask for more tests like Fluorescine stain (which the other person must know what it is and how to do it) I might ask them to perform some reflex tests (which they have to know how to do) and once enough info are compiled, I can give them the most likely diagnosis and recommend their next plan. If they do not have enough tools, my recommendation sometimes would be to send the patient to me (or to other specialist).

I hope this answers your question.

#telehealth #vet med #long post

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Is it true that purebred dogs need more medical attention than mixed breeds? Why?

vet-and-wild here.

Not necessarily. We know that certain breeds are prone to certain diseases, and that some breeds are generally just not very healthy (i.e. brachycephalic breeds), and some are frequently overbred with no regard for health/temperament (i.e. Frenchies, doodles, GSDs...really anything popular). There's some breeds that when I see for their first puppy visit I really really push for them to get pet insurance on principle. But if someone walked in and said they had a mix of those particular breeds I would still say the same thing.

There's kind of a misunderstanding about crossbreeding and "hybrid vigor", and this assumption that crossbreeding automatically makes the resulting puppies healthier. While genetic diversity is a good thing for a population, breeding two unhealthy dogs just produces more unhealthy dogs, regardless of breed or how much they've been crossbred. I wouldn't say that I see more sick purebreds than mixed breeds, or that one particular group seems to outlive the others.

Except really old chihuahuas with no teeth and a raging heart murmur. They outlive everyone. (jk jk)

#vet med #thesilverstarling #dogs #dog breeding

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I have trouble finding the pulse on patients (we work with dogs and cats). I know where it is located but it takes me 2 years to finally feel it. Do you have any tips?

vet-and-wild here.

I used to hate this answer but now I've realized how true it is: practice. Honestly, just practice with every animal you can and it'll start to become second nature. But there are some things that may either help or hurt (assuming we're talking about femoral pulses here):

-Good luck finding it when they're sitting/laying. Sometimes I can get it on a laying animal but it's always harder than if they're standing.

-Don't press to hard, you might be accidentally occluding the vessel.

-Overweight animals or little stubby legs can be tricky.

The best animals to practice on are large, fit, short haired dogs. If you want an easy target, that is. It's generally really easy to find on those kind of dogs and it can help you get comfortable with anatomy until it becomes easier to apply to smaller/sicker things.

#vet med

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What are the chances of a seizure being a one-off seizure in a dog?

My dog recently had one and all the tests came back normal. He's been fine ever since. But I am worried about it happening again.

vet-and-wild here.

It's possible, depending on the underlying cause. It's also possible for seizures to be very infrequent. We don't always immediately start seizure medications, because they're really not benign medications and can have a lot of potential side effects. Our goal with seizure control is to lessen the frequency and severity, but we can't always get to zero so we balance how many and how severe the current symptoms are with the potential side effects of anti-seizure medications.

#vet med #seizures

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How long does ivermectin (heartworm prevention) stay in a dogs system?

vet-and-wild here.

I'll give a little caveat that I'm most familiar with Heartgard, because that's what my clinic uses. Heartworm medication basically works by back-treating infections before the larvae can grow and cause disease. This is different than how most flea/tick meds work, because those are providing forward prevention. Meaning, when you give heartworm medication you're basically treating for the previous 30 days (or whatever the product is labeled for). Conversely, flea/tick meds are treating for the following 30 (or whatever) days. So heartworm meds aren't really in the system for very long.

Keep in mind that this is different from something like ProHeart, which has a different active ingredient (moxidectin). ProHeart shots work more like standard flea/tick meds that provide protection forward from the point of administration.

#preventatives #vet med #heartworm

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Hi! I was just prescribed an ear solution for my dog's infection called zymox and it's been working well so far but I was wondering if you all were familiar with it and the no pre clean application. I'm following the directions on it from the vet but from what I've seen of other ear solutions it's the only one that doesn't need the ear cleaned before using.

vet-and-wild here.

Yes, Zymox is legit and it is normal to not clean before application. You just let it do its thing. Interesting thing about Zymox is that it actually has some really good anti-biofilm properties, so it can be really helpful as an adjunctive treatment for those tricky pseudomonas infections that are a pain to get rid of.

#vet med #otitis #ear infections

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are there any extra challenges when examining bigger cats like maincoons?

as a cat owner, are there any signs unique to big fluffy cats that we should watch out for?

vet-and-wild here.

Not really, unless they're fractious. But honestly, so many of the cats we see are overweight that we're dealing with angry 12, 15, or even 18+ pound cats all the time. Regular low stress handling techniques still apply. The only thing I could think of specifically for Maine Coons is that if they were so fractious that they needed full sedation, I would be more hesitant to use certain medications because they're very prone to heart issues. This is assuming I couldn't touch the cat at all beforehand to listen to them, but it's not something that's really come up with a purebred Maine Coon specifically for me.

I always recommend regular cardiac workups for purebred Maine Coons. They are the poster children for hypertrophic cardiomyopathy. Another big issue is that people tend to get fixated on a weight range in the breed standard for their cat rather than appropriate body condition. Yes, Maine Coons are big. But just because some Maine Coons are healthy at 15lbs doesn't mean that a 15lb Maine Coon is automatically at a healthy body condition. I can't even fathom the number of times I've had to explain to a client with a Maine Coon that yes, their cat is in fact obese and not big just because of his breed. And just like larger dog breeds, larger cat breeds may be more prone to joint issues as they age (especially if they're chunky). Something I see with any long haired breed is that when they become old and arthritic, they don't groom as well, so they get matted and/or fecal matting on their fur. Grooming in general is often a problem with long-haired breeds of all species. It's really important to desensitize young animals to grooming and medical handling so they will be more tolerant of it later in life. Especially for something like a Maine Coon that is going to need grooming and medical care lifelong.

Also we see far less Maine Coons than people think, a lot of owners just label their overweight 17lb cats as Maine Coons because they genuinely don't realize that their cat is not at a healthy body condition.

#cats #maine coons #vet med

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Hi, I have an appointment coming soon where I'm going to be shown how to give injections for my bearded dragon. I'm confident they'll do well showing me how to do this, but injections in general terrify me and I'm scared to hurt my boy or make him afraid of me. Do you have suggestions or advice for folks having to give their pets injections?

vet-and-wild here.

The downside of medicating reptiles is that it is a very long process. Possibly months, depending on what's being treated. The upside is that many injectable medications for reptiles only have to be repeated every few days, or even just weekly depending on the medication and the species. They certainly don't like having it done, but reptiles are very resilient.

Having someone help you hold can help, especially if you have a larger or wigglier animal. Honestly, it's helpful even with a smaller animal. That way you can just focus on the injection and not worrying about if you're holding tight enough, or too tight, etc. Towels can also help. They aren't gonna hurt the animal and they can help protect your hands from uncomfortable spikes or nails, which in turn should help you feel more confident with your restraint technique. If you're still struggling, I would check with your vet about coming in for a tech visit to have it done in clinic if you can. We have a lot of clients that we teach how to give injections at home, but some aren't comfortable so they have us do it instead. You can also ask your vet if they have any videos you could watch for reference, or even to watch you give an injection to give you any tips.

#vet med #reptiles #injections #medications

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Hi! I know that it's important to socialize a puppy well with both people and other dogs. But I also know you shouldn't let a puppy in contact with other dogs or walk it in areas where other dogs go before they have been fully vaccinated to prevent diseases.

Does that mean the socialization starts only after they get all their vaccines? Or is there something I'm missing here? Also because I thought the early periods of a dog's life were especially important with regards to socialisation.

Thanks!

Question tax: who was the cutest puppy you've seen recently?

vet-and-wild here.

It is no longer recommended to wait to start socializing a puppy until after their vaccine series is done, but you do need to take precautions. The reason is that there is a critical socialization window right in the middle of this time that ends around 16 weeks. That doesn't mean they can't learn or be socialized outside of this time, but the experiences they have in this time period are very important for setting the stage to how they react to stimuli in the future. Puppies who are improperly or under socialized during this period are much more likely to have behavioral issues as adults.

It's important to also understand why we booster puppy vaccines so many times. Depending on what kind of vaccines or disease exposure the mother had, this same time period is when the maternal antibodies the puppy received will be lost. Those maternal antibodies protect the puppy, but also interfere with vaccine efficacy. We don't know when they will lose the protection from those maternal antibodies, so we booster through this period to make sure they are protected. So just having 1 or 2 vaccines wouldn't guarantee that the puppy was fully protected.

The compromise is to avoid areas of potentially higher risk during this time. Dog parks, for example, may be full of dogs of unknown vaccine status and could have wildlife around that may carry parvo, distemper, etc. However, a puppy class at a reputable training facility only allows vaccinated dogs and should have disinfection protocols in place to help reduce the risk of disease spread. Basically, your puppy doesn't need to live in a bubble during this period, but you should use reasonable caution. Also keep in mind that socialization doesn't necessarily mean meeting a bunch of people or dogs! It just means positive exposure. Sitting out in your yard and practicing appropriate reactions to strange dogs walking by is socialization. Playing videos with thunder, fireworks, etc and getting the puppy used to it is socialization. Getting used to the car, medical handling, grooming, strangers coming in the house, all of that is part of socialization.

I tried to think of the cutest puppy I've seen but I'm going to be lame and say they're all cute cuz I keep changing my mind!

#puppies #socialization #vet med #vaccines #behavior #dogs