Question about giving a steroid shot to a diabetic

[Holly and Pablo]

I copied this from my condo in Lantus Land yesterday, hoping to get some answers for a few questions:

Over the last few days, Pablo has rubbed two lesions on his chin, and one is even bleeding! I also just felt a lump about the size of a lima bean on his chin that I swear wasn't there before. Ideas? Before the dental when he had both upper canines removed two weeks ago, he started rubbing his face on things a lot, and I figured afterwards that it was because his teeth were bothering him. Maybe he's doing it now because his mouth is still sore and the suture is irritating? I dunno...it looks horrible! And now I'm worried he has some kind of tumor growing. :shock:

Today update: My vet (who is also my boss) recommends giving him a 1mL shot of Depo Medrol, a steroid, to see if the lump is inflammatory. If it is (which would indicate it is a RESULT of the rubbing), the growth will decrease in size. If it does NOT decrease, it is more likely a growth, in which case he recommends excising it and sending it off for histopathology. Does anybody have experience with this? It is almost exactly midline on the underside of his chin.

I reminded my vet that Pablo is diabetic, and he said that a steroid shot is less likely to throw off Pablo's BG than a steroid shot in a diabetic dog would. He said it shouldn't really affect him. What do you guys think? My initial reaction was "are you kidding me?! Not a chance!" But the steroid suggestion is his only suggestion for ruling out a tumor without just taking the thing off his chin. Is this safe?

 

[Jen & Squeak]

One steroid shot can cause diabetes. In an already diabetic cat, I do not know what the consequences might be. I'm in favour of using steroids when required if there are no other options, but I'm not certain you've reached that point. Why not get a biopsy done?

 

[Nancy and Cody]

I have a lot of experience with depo shots in my kitty, but not with my diabetic kitty. My diabetic cat is Cody, and his brother who is not diabetic has had severe inflammation around his gums/ teeth almost all of his 13 years. He had his most of his teeth pulled because the ulcers were so bad. He had years of monthly depo shots before Cody was diagnosed, but after I started reading about steroids and DM, I tapered off and stopped as soon as I could.

He scratches his face sometimes until the fur is gone, but I really don't want 2 sugarcats. It seems to be aggravated by some kind of seasonal allergy because the winter was usually better. I noticed that when I was giving shots he just seemed to need them more and more. Now his body has accommodated and he copes pretty well most of the time. Also he occasionally gets big nasty growths around his nostril and eye, which the vet finally diagnosed as herpes. These get worse if you use steroids to zap his immune system. Best thing is to decrease stress and wait it out, (about 10 days) using antibiotic if it looks like it might get a secondary infection. I'm guessing having a dental and extractions was "stressful" !

I guess the vet is sure its not an infection / cyst developing after the extraction?
Maybe its a swollen lymph node, which filters, catches and destroys body invaders, like infection.

If it were my diabetic cat I would try not to use depo if possible. Good luck , it stinks to see them suffer.

 

[Phoebe_TiggyGA_NortonGA]

Steroid shots are great for allergies and inflammatory conditions.

If you are hometesting blood sugar, you will know if your kitty needs a little bit more insulin.

ECID!

When Norton needed steroids to reduce inflammation from his acrocat brain tumor, it did not affect his BGs at all!!! I was watching very closely.

I am in favor of giving steroids when needed, and it sounds like your kitty does need them.

 

[Holly and Pablo]

Okay, so now that I'm not in a rush, here's more about the situation now that I'm home from work. My vet, after further thought and limited exam (it's impossible to do much without sedating him), thinks it's possible we're dealing with inflammation and a deep pyoderma that could take weeks to treat. He prescribed 250mg Cephalexin BID since the Clindamycin he's already on does not treat pyoderma. He also maintains that the Depo is advisable, but he's certainly not a diabetes expert.

To answer the asked questions:
Why not get a biopsy? I'm not opposed to having a biopsy, but the less invasive, "first-line" action suggested was the steroid and antibiotics. The biopsy involves sedating and a lot of pain because my vet wants to do completely remove the thing (if it even is a tumor) instead of just doing a punch biopsy then later having to do another procedure to remove it.

I guess the vet is sure it's not an infection/cyst developing after the extraction? The extractions were the upper canines, and this is under his chin. I wish it were something obvious like that!

I brought home the Depo but didn't give it yet. I'm in favor of holding off while I start the antibiotics. Luckily, we will have a more up-close look on the 19th because he goes back to the dentist then and will be sedated for a recheck.

Sooo, any experience with pyoderma?!

 

[Lindyloo]

I could be totally wrong but I will throw this out there anyway. Fluffy was having some weird chin issues a while ago also. He had some sort of rash or pimples, not a lump. I figured out that it was the plastic bowls I was feeding him from. That or the dish soap I was using to clean his dish. I switched to paper plates and it cleared up.

We are back to plastic again now since we use a timed feeder but he has been ok.

I have no feedback on the steroid shot. Fluffy was very ill many years ago and I had no choice but to give him the steroid shot. I often wonder if that is why he is now diabetic. Either way, the steroid shot saved his life.

 

[Jess & Earl]

If I understand the story correctly, your cat has an itchy chin and has a small lump in the skin under his chin. This has occurred within the last few days. Nothing is oozing pus, nothing smells bad, nothing appears attached to the jaw or muscle--it's all in the skin. Correct?

If I understood you correctly ... the situation just doesn't sound dire to me. It could end up being dire, but isn't there yet from what I'm hearing here. I have recently had a series of weird chin/lip things with my own cat, actually. The first time I thought he was getting a fat upper lip and I took him in although I didn't see anything (other than mild inflammation) myself. I did give him pred in case the swelling was the start of a "fat face" incident. That didn't happen, and when I took him in the vet saw nothing either. It went away completely in about a week. After that, I noticed he had a scab under his chin. Again I hauled him in (though I noticed nothing worrisome like pus or rapid growth) and the vet agreed there was nothing to see. It went away . Some time after that, he developed a flat, hard sore under his chin and I decided to wait a few days. It went away. None of these lesions were festering, odorous, actively bleeding, or attached to the bone or muscle. They were all on the skin, and none grew at all after I first noticed them. None of them required treatment. What the heck was up with his chin, then? (This was all a few months ago.) I have no idea, and I think it will remain a mystery. He had a brief flurry of "chin" activity that died on its own.

Back to you and your kitty ... Your cat is diabetic (mine isn't, my diabetic is GA) and just had a procedure done and could be more likely to have an infection. So he's already on antibiotics. Right now (as far as I can tell) he has an itchy, irritated chin and a new lump on the skin. This could be neoplastic (an abnormal growth, either benign or malignant), infectious, or immune-related. Sooo... based on the info I think I have from you, what would I personally do if this were my cat?

1) I'd wait a few days, still giving the ABs but no Depo. If he is still scratching his chin, I'd trim his claws and put a collar on him to prevent it.

2) if there was no change, I'd take my cat in, sedate him, and aspirate the lump. There's a chance that it's an abscess, too, in which case he'll be sedated already and it can be drained. Otherwise I'd send the slides of the aspirate out to the pathologist. It's not easy removing lumps from tight spaces (where there isn't much skin to cinch together) and if it appears to be malignant, someone has to remove a lot of surrounding tissue to be safe. I wouldn't want it to be removed non-aggressively and then find out it was malignant and the margins weren't clean. I wouldn't want to remove it aggressively and find out it was a benign fatty tumor, either.
Aspiration can also give you answers on infectious vs. inflammatory/immune-mediated. If it's infectious, a shot of steroid will depress the immune system and help the infection. If it's inflammatory/immune-related, a shot of steroid will give it a good shove back to normal.

3) If I did end up needing steroids, I'd prefer daily oral steroids rather than a shot. You can't "take back" a shot that lasts for weeks, like Depo-Medrol. If it sends his diabetes out of control (which it could, but probably wouldn't), if it sends him into heart failure (it could and probably would, if he has occult heart disease), or if it doesn't work, you're stuck with that choice for several weeks. At *most* I would use dexamethasone which lasts several days, max.

Now that's the course I would take, and the course I took with my own cat (though my waiting period included the resolution of the problem, so I never moved to steps 2 or 3). I don't know your cat's whole clinical picture--you and your vet do--so I'd discuss going the route of more diagnostics rather than the kitchen-sink method of antibiotics and steroids. This is not to knock the kitchen-sink method. In urgent matters, like cats with respiratory difficulty, throwing antibotics and steroids can make very good sense. A cat needs to breathe, after all. I just reserve my sink-throwing for these types of emergent situations, myself.

My $.02, FWIW. Keep us posted ok?

 

[Lisa dvm]

I just reserve my sink-throwing for these types of emergent situations, myself.

Love it. Well-said.

Regarding pred versus dex - I just posted an abstract on that issue in Think Tank a few days ago.

 

[Holly and Pablo]

If he is still scratching his chin, I'd trim his claws and put a collar on him to prevent it.

Luckily, the morons, um, I mean, people who owned him before me had him completely declawed, so he can't scratch. He just RUBS on everything! If he keeps making it worse, I'll stick an e-collar on him.

Thanks, Jess, for your insightful post. My vet didn't mention sending out a slide of the aspirate...I'm assuming he knows how this is prepared (though we never send out needle aspirates), but because I don't, do you know how these are prepared so I can do it myself if he isn't willing/capable (or Dr. Lisa? ;-) )

I just wrestled Pablo to the ground...and I mean wrestled in every sense of the word, because I noticed one of the sores (not the lump) was bleeding again. I swear that thing looks like a deep abscess. Of course the more I tried to squeeze, the harder he struggled, but some sero-sanguinous liquid made its way out onto my fingers. He is utterly ridiculous about being restrained at all. It's a miracle I can even test him. We've agreed that I won't touch any part of his body except his ear, and he will hold still only until he hears the "beep" indicating the strip has filled. That is the only way testing works. :lol:

I'm holding off on steroids at all for now. I'll do a little research on the Depo v. Dex idea, though I don't think I would really convince my boss. He's a little Depo- and Clavamox-happy at times. As in, skin issues? Give it a little Depo! Got a sniffle? Eh, a little Clavamox will knock that out! Not that he's wrong, but he's a "kitchen sink" kinda guy (I think I see Dr. Lisa cringing from all the way over here in SC!). I totally see the benefit of sending out a slide rather than doing surgery to remove something that might not need removing or might need drastic, reconstructive surgery to fix. I was thinking very black and white, and you offered a nice gray option and thought process.

I think I'll do the abx over the weekend and take him with me on Monday to at least try to aspirate whatever it is. And my God, maybe when he's sedated I can actually see what the heck *it* is!

 

[Jess & Earl]

I think I'll do the abx over the weekend and take him with me on Monday to at least try to aspirate whatever it is. And my God, maybe when he's sedated I can actually see what the heck *it* is!

This sounds like a great idea, esp since you say it's oozing now. You can start out sedating him lightly (using an opioid/benzodiazepine combo) if you think you need to take the edge off; if he's a buck-wild sort of cat, you may as well just go for something stronger like dexdormitor, if your vet is familiar with it. It can be reversed so you don't have the whole ketamine-head-swinging wake up.

If you can get the sore to ooze, you can make an impression smear by pressing the slide to the ooze. You use the edge of a second slide to gently but firmly smear the liquid across the slide. For an aspirate, for such a delicate area and for something more cutaneous it'd be better if someone experienced does it (rather than you, since you've not done it or seen it done). It basically just involves jabbing the area with a needle and then using a syringe with some air in it to blow whatever is in the needle out onto a slide. I'm sure your vet has done it and does do it ... a lot of dogs have SQ lumps that turn out to be lipomas (the aspirate is literally a blob of grease) and don't get sent to the lab for that reason.

 

[Holly and Pablo]

[I'm sure your vet has done it and does do it ... a lot of dogs have SQ lumps that turn out to be lipomas (the aspirate is literally a blob of grease) and don't get sent to the lab for that reason.

Don't get me wrong, he aspirates things all the time. But rarely (if ever) do we make a slide and send it out. But essentially you just described the prep for fine needle aspiration of the lump the same as preparing a blood smear, which I am quite comfortable doing. Thanks for clarifying!

As for sedation, I've always just masked him down because he goes quickly with the Sevo. I am uncomfortable using injectables on him since at our clinic we typically only sedate cats with Telazol for surgical procedures. The dental vet, however, is planning on using domitor, but I don't mind as much with her because it's something they use routinely. I've never used it in a cat before, though I have with dogs. As for ketamine, we don't even stock it at our clinic, so I'm certain we won't be using it! It scares me, honestly, but like I said, all injectables do because you're stuck with them once they're in, even if they're "reversible." Maybe that's silly.

 

[Lisa dvm]

As in, skin issues? Give it a little Depo! Got a sniffle? Eh, a little Clavamox will knock that out! Not that he's wrong, but he's a "kitchen sink" kinda guy (I think I see Dr. Lisa cringing from all the way over here in SC!).

:cry:

 

[Jess & Earl]

Can o' Worms Alert

As for sedation, I've always just masked him down because he goes quickly with the Sevo. I am uncomfortable using injectables on him since at our clinic we typically only sedate cats with Telazol for surgical procedures. The dental vet, however, is planning on using domitor, but I don't mind as much with her because it's something they use routinely. I've never used it in a cat before, though I have with dogs. As for ketamine, we don't even stock it at our clinic, so I'm certain we won't be using it! It scares me, honestly, but like I said, all injectables do because you're stuck with them once they're in, even if they're "reversible." Maybe that's silly.

Masking down ... oh that's a whole nother can of worms. Perhaps start by taking a look at this: http://www.vasg.org/waste_gas_exposure_concerns.htm on what you and your co-workers are inflicting on yourselves every time a cat is masked or boxed down. This alone makes masking/boxing out of the question for me due to its health risks. If your vet does this routinely, you should ask that he get everyone a waste gas badge so you can all be monitored.

Besides all that there are the effects upon the cat i.e. profound hypotension, stress, terror, and hypoxia. I don't know if you have access to JAVMA through work? There was a great article a few years ago on "Myths and Misconceptions" in anesthesia which analyzed the masking vs. injectable question, with the conclusion that the former is dangerous and should be avoided in the vast majority of cases. I have seen it done once where I practice, on an extremely fractious/semi-feral cat who had a broken pelvis. I work with a cardiologist, as you may know, so boxing is not an option for us, leading me to discover that even the aggressively-lunging-at-you-through-the-carrier-door types are still "injectable". As was the 20lb Savannah cat (who had two vets "fire" the client for the cat's aggression) we had a few months ago. Anyhow, your kitty is not nearly so difficult so there is no reason to put him or you and the staff in danger by masking. And remember, SpO2 and BP monitoring are essential.

Wait till Dr. Lisa sees this ;-)

 

[Holly and Pablo]

I think Dr. Lisa saw it earlier because she replied after I posted that. I was surprised she didn't tear my post to pieces, actually! :lol:

But seriously, I know it's not funny. I also know that my vet is not the most well-read, up-to-date fella, so a lot of times I'm going it on my own. And I am a house-trained assistant; I didn't go to school to get any of the education behind using one thing or another and the research to support it. I was under the (mistaken?) impression that Sevo was safer than injectables, but I guess that's NOT when it's used as an induction agent, Jess?

The only injectable we use on cats is Telazol, and I absolutely abhor it. I mean, I can't stand to see a cat waking up from it for more than eight hours. It makes me shudder. When I asked my vet yesterday about the use of Domitor in cats (since the dental vet plans to use it on Pablo for his recheck), he said he thought it was safe, but he just "doesn't use it in cats." Why? "I just don't." (Geeeee, thanks for clearing that one up!)

These are our standard practices: For canine S/N: Propfol IV, then intubation and maintenance with Sevo. For feline S/N: Telazol IM, then intubation/masking with Sevo (more often masking if the cat isn't sleeping from the Telazol). For canine procedures like suturing a wound, NT for fractious dogs, we use a combo of Xylazine/Butophanol or Domitor/Butophanol IV or IM, the former most commonly. For feline non-invasive procedures like sedated grooms, wounds, etc.: Masking with Sevo, then intubation if warranted.

The reason we use Telazol, according to my vet when I asked him a long time ago, is because it's difficult to hit a vein on a cat for Propofol. Now, I don't know that I agree with him in most cases; in the case of the ferals, yes...I love Telazol for them. My vet is, honestly, pretty set in his ways with "what has worked" for a long time, and given my choices, I always opted for masking as opposed to Telazol in Pablo's case. He is very difficult to restrain, so Propofol is difficult to get in him. Also, masking is the only method of sedation we use that is in and out of the system so the cat can leave the same day. Cats for S/N stay overnight, so the Telazol is out of their systems by then. We've only lost two animals under anesthesia in the almost-four years I've worked there, and neither were masked down, so I guess he figures his methods are good enough. In fact, I think a lot of things he does are "good enough" for him. I'd prefer excellence, but I've stopped trying to force him to be more motivated to learn new things, new practices. It usually doesn't work.

Jess (and Dr. Lisa, if you've made it through all this), because I highly value your professional insight and opinion, what are your options for sedation and what are the effects of the sedative? If you'd prefer to PM your thoughts, that's fine too. I try to do what's best for Pablo and thought I was making a decent choices, given my limited resources. As it stands now, I will probably attempt Propofol on him on Monday, followed by intubation and Sevo. But for future instances and other cats, I'd love thoughts to pass on to my vet. Even if he doesn't do anything about my suggestions, at least they're a thought in his mind. :roll: I get so frustrated with him, but he always listens to my concerns and doesn't think I'm a moron after more than three years of my endless questioning at times. A nuisance at times, but not a moron.

 

[Jess & Earl]

Hi HOlly

I was under the (mistaken?) impression that Sevo was safer than injectables, but I guess that's NOT when it's used as an induction agent, Jess?

Sevo is a great drug for maintaining anesthesia, it's just that administering it by mask or box is uncontrolled and poses a danger to the staff and the cat.

When I asked my vet yesterday about the use of Domitor in cats (since the dental vet plans to use it on Pablo for his recheck), he said he thought it was safe, but he just "doesn't use it in cats." Why? "I just don't."

I think that is his way of saying that he just doesn't feel comfortable with it d/t lack of experience.

These are our standard practices: For canine S/N: Propfol IV, then intubation and maintenance with Sevo. For feline S/N: Telazol IM, then intubation/masking with Sevo (more often masking if the cat isn't sleeping from the Telazol). For canine procedures like suturing a wound, NT for fractious dogs, we use a combo of Xylazine/Butophanol or Domitor/Butophanol IV or IM, the former most commonly. For feline non-invasive procedures like sedated grooms, wounds, etc.: Masking with Sevo, then intubation if warranted.

A few things:
1- It sounds like you and other staff members are getting a lot of exposure to anesthetic gas. I would ask for a monitoring badge. Even if he doesn't want to buy one for all the techs, all the time, he can do a trial and see what the exposure is for one full-time tech/assist.

2- I think the problem here is that the animals aren't getting IV catheters. With an IV catheter you needn't worry about hitting a vein. This means that the animals aren't getting fluids during their anesthesia, and I suppose that also means they aren't getting BP monitoring (or else he'd see that the animals were hypotensive). Is that correct?

3- Oh, xylazine. It is actually related to Dormitor (officially Dexdormitor now, slight change in formula) and pre-dates it, so a lot of older-school vets use it. It is significantly cheaper. There is some evidence that Dexdormitor, a more "specific" drug, keeps patients on a smoother plane both analgesically and anesthetically. You can check out more info on http://www.vasg.org/alpha_2_agonists.htm which is generally a great site for anesthesia/analgesia in small animals. From a vet journal:

"Comparison of xylazine and medetomidine as premedicants for cats being anaesthetised with propofol-sevoflurane

Vet Rec. July 2005;157(5):139-43.
A L Selmi, G M Mendes, B T Lins, J P Figueiredo, G R Barbudo-Selmi
Universidade Anhembi Morumbi, São Paulo, Brazil.

Abstract

The effects of premedicating cats with saline, xylazine or medetomidine before anaesthetising them with propofol-sevoflurane were compared. Twenty-four cats were randomly assigned to three groups of eight to receive either 0.25 ml of saline, 0.50 mg/kg of xylazine or 0.02 mg/kg of medetomidine intravenously, and anaesthesia was induced with propofol and maintained with sevoflurane. Medetomidine produced a greater reduction in the induction dose of propofol and fewer adverse postoperative effects than saline or xylazine. Hypoxaemia was observed after induction with propofol in the cats premedicated with saline and xylazine, but not in the cats given medetomidine. The cats treated with medetomidine and xylazine developed profound bradycardia. The blood pressure of the cats premedicated with saline and xylazine decreased, but the blood pressure of the cats premedicated with medetomidine was maintained. The cats premedicated with saline took longer to recover from anaesthesia than the other two groups."

Moving on :

what are your options for sedation and what are the effects of the sedative? If you'd prefer to PM your thoughts, that's fine too. I try to do what's best for Pablo and thought I was making a decent choices, given my limited resources. As it stands now, I will probably attempt Propofol on him on Monday, followed by intubation and Sevo. But for future instances and other cats, I'd love thoughts to pass on to my vet. Even if he doesn't do anything about my suggestions, at least they're a thought in his mind. :roll: I get so frustrated with him, but he always listens to my concerns and doesn't think I'm a moron after more than three years of my endless questioning at times. A nuisance at times, but not a moron.

Saying that there are ideal and less-ideal sedation protocols doesn't mean that the less-ideal protocols cause mass perioperative death. It's a matter of a few things, including:
1-- Do you get the animal where you need to in the first round, or is there frequently more struggle and added drugs?
2-- How is the pain management during and after the procedure?
3-- What are the unseen side effects? Hypoxia due to low blood pressure?
4-- How smooth is the induction and wake-up?

To really compare protocols head-to-head, you need to do proper monitoring. You may find that xyalzine does a great job and then get a Doppler and realize everyone is hanging out at 60mmHg. Monitor SpO2, and if possible, use a capnometer (these will hopefully become popular soon), and then compare your protocols. Can a young cat do great on a spay with telazol, sevo mask, and no perioperative meds? Sure. Can she do better (much better) on IV fluids and a more modern protocol? You bet. We will never know if the CKD cats we encounter later in life could have had a few more nephrons working if they hadn't become hypoxic and hypotensive during their spay and then their FB surgery, their two dentals, etc. Also, vet med is rife with stories of elderly cats who seemed to do great during their dental but came back in renal failure a week or two later, or just outright died. You have to think the events are related, but we can't know for sure.

For your cat, if the point is just to take a look at the bump on the chin, I don't know if you need to intubate, but you know your cat better than I do. I would think that with most cats -- even the grumps, though not the wild ones -- you can get them onto their side, and then turn the front end up (ventral/dorsal) to look at the chin. If the weird bumps and scabs are still there and look like they need attention, why not ask the vet if you can use some valium/torb or something? If this does not sound feasible given your cat's typical behavior, I'd put in an IVC and get the torb/val and propofol together, and see what you need. If you're doing a needle aspirate, I don't know why he'd need intubation -- this should take less than two minutes. We do some aspirates (of thoracic masses) with just torb/valium plus a touch of propofol, believe it or not.

Anyway I can't reasonably give you specific advice since there are so many variables and it's really the vet's choice of what he's comfortable with. I'm just trying to offer ideas without being *too* confusing ;-) If you are interested in analgesia/anesthesia, you can check out the vasg site I mentioned earlier, or pubmed.gov for peer-reviewed articles (I speak journal-ese and can help you with any absurdly worded phrases/paragraphs), or consider joining VSPN which has a lot of VIN info on these topics.

Take care
Jess

 

[Lisa dvm]

Great post, Jess. Thanks for the great deal of time you took to put that together.

Here are a few quotes from your post that I want to emphasize:

(My comment: Without IV access, what are you going to do when the patient crashes?)

Holly - I commend you for giving this a lot of thought and fully understand that you may be stuck between a rock and a hard place with your boss.

Kinda reminds me of my 86 year old father. "Dad...just because the horse that you used to herd cows on never DIED from X treatment.....this does not mean that X treatment was the best way to handle that situation."

From Jess' post:

"I think the problem here is that the animals aren't getting IV catheters. With an IV catheter you needn't worry about hitting a vein. This means that the animals aren't getting fluids during their anesthesia, and I suppose that also means they aren't getting BP monitoring (or else he'd see that the animals were hypotensive)".

"You may find that xyalzine does a great job and then get a Doppler and realize everyone is hanging out at 60mmHg."

"We will never know if the CKD cats we encounter later in life could have had a few more nephrons working if they hadn't become hypoxic and hypotensive during their spay and then their FB surgery, their two dentals, etc. Also, vet med is rife with stories of elderly cats who seemed to do great during their dental but came back in renal failure a week or two later, or just outright died".

 

[Holly and Pablo]

I think the problem here is that the animals aren't getting IV catheters. With an IV catheter you needn't worry about hitting a vein. This means that the animals aren't getting fluids during their anesthesia, and I suppose that also means they aren't getting BP monitoring (or else he'd see that the animals were hypotensive). Is that correct?

And you've highlighted precisely why I chose to take my cat 2.5 hours away and pay $1100 for a dental at a clinic that does all of the above (and much, much more). :-|

We only place IV catheters if the surgery is expected to be non-routine and lengthy. I've even asked several times about doing them on other surgeries (if not all, at least everything that isn't a spay or a neuter) and been shot down. I really feel like I'm stepping on toes when I go against what my BOSS wants, but there are times I think he's flat-out wrong. And actually, we have an expensive anesthesia monitoring device that has the capability to monitor BP, but the BP function is rarely ever used. In fact, I'm pretty sure I'm the only one who uses it.

I know with absolute certainty, unfortunately, that I cannot take a look at Pablo's chin without sedation. I took him to the vet Friday and tried. And I tried for an HOUR once to get blood from him unsedated. He is ridiculous. And I see that his chin is bleeding at times, and I know it will need to be aspirated. Uuugghh.

Having this discussion with you, Jess, has highlighted why I fully intend to find a new vet as soon as I can afford one for all of my animals. I need this job and am very comfortable with my position, but I am tired of the "I just don't care" attitude I get from my boss most of the time. It is sad that I care more about learning new techniques and implementing them than he does.

Dr. Lisa...thanks for following along as well. You are the perfect opposite of my boss...passionate, forward-thinking, and genuinely concerned about the animals and advancing veterinary medicine. And you're right about me being between a rock and a hard place...only I feel like I'm banging my head against said rock most of the time.

Thanks again Jess for the advice and links. I'm off to go read the vasg website and ponder about what to do now. If it wouldn't cost me literally $600 to just have the dental vet who "crosses all her t's and dots all her i's" when it comes to sedation and, well, everything else, aspirate the lump, I'd just have her do it and say screw my vet. But I'm a poor student who already spent more than I can afford on the dental two weeks ago. I try to make the best of what I'm stuck with.

 

[Lisa dvm]

You are the perfect opposite of my boss...passionate, forward-thinking, and genuinely concerned about the animals and advancing veterinary medicine.

Thank you, Holly, and the above comment is why I hang out here on this board.

I have learned SO much for the "forward-thinkers" on this board and it makes me so sad (to put it nicely) to see many of my colleagues sit back and neglect continuing education and practice a 'just get by' level of medicine.

 

[Holly and Pablo]

I give up.

My boss completely shot down doing the fine needle aspiration and Domitor. He said that aspiration isn't useful as a diagnostic technique because you really get enough cells for the pathologist to determine anything. He said the one exception was lipomas, and I've rarely seen him do that. He said that if I were sedating Pablo, we might as well just take the lump off. (Nevermind that we don't even know if it needs to be removed. What if it's just pyoderma, as he mentioned last week?!)

And when I told him that I'd rather use Domitor, he told me to mask him down. His exact words. And when I further questioned him, bringing up the research I'd read about hypotension/hypoxia with masking down, he stated that the hypotension/hypoxia is MORE severe with Domitor. Is he wrong? I'm actually becoming genuinely concerned that he might be an idiot. Not really, but is he misguided? Just ignorant because he doesn't do enough research? I scoured pubmed and couldn't find a any comparison studies. Jess/Dr. Lisa/anyone else who is following along, do you have specific articles that compare the anesthesias? He's not going to take anything I say seriously without scientific fact backing it up. I've got the vasg website info already.

Honestly, I don't think I'm ever going to take Pablo back to him. Isn't that sad that I don't trust my own boss? I guess Pablo better get used to the drive to Charlotte! His dental vet just became his regular vet! :lol:

I laugh but my wallet hurts just thinking about it...at least he'll be seen by a vet who cares, even if I have to wait another week to get him there.

 

[Jess & Earl]

I give up.

My boss completely shot down doing the fine needle aspiration and Domitor. He said that aspiration isn't useful as a diagnostic technique because you really get enough cells for the pathologist to determine anything.

he stated that the hypotension/hypoxia is MORE severe with Domitor. Is he wrong? I'm actually becoming genuinely concerned that he might be an idiot. Not really, but is he misguided? Just ignorant because he doesn't do enough research? I scoured pubmed and couldn't find a any comparison studies. Jess/Dr. Lisa/anyone else who is following along, do you have specific articles that compare the anesthesias? He's not going to take anything I say seriously without scientific fact backing it up. I've got the vasg website info already.

Hi Holly
I have to go to work and the Dormitor thing is complicated, so I'll post on that later. For the aspirate, it's true that some types of masses don't "exfoliate" well so it's possible to get a non diagnostic sample, and if we were giving your vet the benefit of the doubt, we could say that based on his apprasial of the lump he is concerned that an aspirate won't do any good. (This can happen if a lump is very flat, or hard, etc. and it's hard to bunch some cells up in the needle.) That's the benefit of the doubt, though. Personally, like I said, I'd want to know if this is something that needs radical removal or not, and if it is in a tight space and needs aggressive removal I would personally see a surgeon to do it as those types of surgery can be tricky.

Anyway I'm off to work now, I'll write about dormitor later.