A question of semantics…..

Filed under: @ 5:29 pm

Arose at work again the other day.

And granted, while I do have an assistant who went to Catholic school, she is far too lapsed a Catholic at this point to be able to answer the question so I’ll present it here.

Through the miracle of transubstantiation the communion wafer is transformed into the body of Christ, no?

So if you take communion and then, for whatever reason, you vomit how do you dispose of the resultant waste in a way that isn’t sacrilegious?

Seeing that I’m a good pagan Unitarian I hate to be all Protestant, but if the answer is something less than “There’s a ceremony and prayers and the vomitus is buried in a special, sacred plot of land.” doesn’t that mean that you don’t actually believe in the miracle of transubstantiation and that the Protestants were right all along?

Yeah, we do talk about weird things at work.


Who thinks this is a good idea?

Filed under: @ 7:13 am

HR 1406 is currently under the consideration of the Congressional & House Energy and Commerce Committee.

Sponsored by Utah Representative Jim Matheson The Fairness to Pet Owners Act involves regulating veterinary pharmaceuticals.
In essence, the bill as written states that, when prescribing medications for pets, veterinarians have to write a prescription for said medications even if the pet owner wishes to have the prescription filled at their veterinarian’s office.
Means that all pet owners have the ability to take advantage of the lower prices that the bigger human pharmacies can provide. Means that veterinary practices lose the income generated by their pharmacies, but it also means that veterinarians will have lower overhead (less stock in house), lower staff costs (don’t need so many people if prescriptions don’t have to be filled), and we can spend more of our time focusing on our patients.

All very well and good except for a couple of remarkably glaring things that are wrong, wrong, wrongity wrong.

1. The time I gain in not filling prescriptions for my patients will be taken up, and then some, writing scripts for the medications that my patients will need. To say nothing of the amount of money that I’ll have to spend getting the numbers of watermarked, non-reproducible prescription pads that this law will require me to have.

2. A good percentage (I can’t remember exact numbers at this immediate moment) of people with written prescriptions from their physicians don’t fill them with medications for themselves. I have enough problems with client and patient compliance with my medication recommendations already. I DON’T need my clients have to make another stop to have their pet’s meds filled.

3. Even if the client has medications filled for their pet AT THE VETERINARY OFFICE, we’d still be required to write a prescription. Um…. Doesn’t that mean that the client can have twice the amount of medication they’d need? If I fill a prescription for Xanax for separation anxiety for a patient and then the client goes off and gets the written prescription filled at the local drugstore…..

4. This is a biggie.
Pharmacy schools don’t teach anything, ANY! THING! about veterinary pharmacology. Human pharmacists are prone to wild disbelief when presented with prescriptions for something as simple as a thyroid supplement. An adult human (180-250 pounds) takes 0.15mg of thyroid supplement once daily. A 60 pound dog takes 0.6mg of thyroid supplement twice a day.
Cats die if you give them tylenol. Veterinarians are acutely aware of which narcotic analgesic products contain tylenol.
Xylitol in human liquid medications, the differences in metabolism of nonsteroidal anti-inflammatory drugs in cats and dogs as compared to humans. The differences in metabolism of insulin in cats versus people. Antibiotics in rodents and rabbits. Horses and effervescence.
I don’t know one single veterinarian, and through my online contacts I know a LOT of veterinarians in a LOT of different countries, who doesn’t have at least one story about a patient getting the wrong medications, getting the wrong dose, or getting the wrong information about drug interactions from human pharmacies. Mostly due to ignorance on the part of the pharmacist or misinterpretation of prescription instructions based on their knowledge of human medications and human prescriptions. It’s innocent in many cases, but it’s deadly nonetheless.

Veterinarians have the appropriate knowledge base for safely medicating their patients. If pharmacy schools want to add another year or two of classes to their curriculum I’d be pleased to let the human pharmacists take over that part of my job. Until they do I don’t trust that the majority of human pharmacies are going to dispense the proper medications for my patients.
I’m not qualified to make recommendations and distribute information about medications for people. How is it that having a human pharmacist making recommendations and distributing information about medications for my patients is an okay thing?

And this brings us to
5. The way the bill is currently written, the veterinarian is liable if the wrong medication is dispensed or if the medication is incorrectly labeled.
What? I’m liable for the dispensing errors of someone that I don’t employ in a pharmacy that isn’t on my property? How does that make sense?

6. Rep. Matheson has sponsored the bill, but the bill was written in part by Wal Mart and 1-800-PET-MEDS. I’ve said my say about Wal Mart previously, but Pet Meds (known to those of us in the biz as PME) is one I’ve failed to comment on until now. PME purchases a lot of their drugs from grey markets. The pedigree of much of their medication (the paper trail between the manufacturer and the dispensary) can’t be traced. The drugs are less expensive, sure, but when you get drugs from PME you might be getting the drug your pet needs, or it could be baking soda attractively packaged in a grubby backyard in central America.

A lot of veterinarians won’t work with PME. I don’t. If I get a fax from PME with a prescription request from a client I’ll write a prescription for the medication (if the medication is needed and safe for the pet, that is). Where the client gets it filled is their business, but I always aim people to online or brick and mortar pharmacies that I trust. I know veterinarians who match prices for medications purchased from PME, even though they’re probably doing it at a loss, just so that they know that their patients are getting trustworthy medications.

I don’t know any veterinarian who won’t write a prescription for client to fill at a human pharmacy, regardless of the human pharmacy, so long as it’s a medication that the human pharmacies carry. What would be the point of refusing such a request?

The official position of the American Veterinary Medical Association can be found here. They’re a little less vitriolic than I am, but they have to be since they’re the political voice of veterinarians in the U.S. Me, I can rant as much as I like.

So the bill as it stands is foolish, a waste of time, dangerous, and serves only the interests of mega pharmacies who are currently starting to carry veterinary specific medications anyway. Would y’all please write your representatives?
And if you’re feeling especially prickly, fax Rep. Matheson a photocopy of your butt will you?


Okay, so pretend you’ve never had any medical training….

Filed under: @ 5:52 pm

I can’t…. oooooOOOO……. *stamping around waving arms*……..
Some people’s children…….

So pretend you’ve never had any medical training.

You run over your 12 pound Shih-Tzu WITH A TRUCK. Do you:
A. Take it to the veterinarian for care.

B. Take it to the veterinarian for euthanasia because you can’t afford to treat it or

C. Let it sit around for 3 days “lookin’ like it’s gonna die” but then continue to ignore it because it “looks like it’s gettin’ better”.

And if, after a few months you notice that your 3 year old 12 pound Shih-Tzu isn’t as perky as you’d expect a dog her age to be. She doesn’t play very well and when she goes for a walk she can’t go for more than a block or two before she poops out.
Do you:
A. Think that there might be something wrong with your 3 year old 12 pound Shih-Tzu that you ran over with a truck two months previous and have her examined or

B. Assume that your 3 year old Shih-Tzu is getting out of shape, old, and lonely and arrange to purchase her a “purebred” Pug/Beagle puppy to “perk her up”.

And when, a few months after you purchase the puppy, you notice that your 3 year old 12 pound Shih-Tzu isn’t getting perkier with the puppy around and is, in fact, having coughing fits to the point that she faints do you:
A. Think that there might be something wrong with her since you ran her over with a truck 5 months ago and take her to the veterinarian to have her examined.

B. Ignore the whole situation and just assume that she doesn’t like the puppy or

C. Take everyone camping with the idea that spending some time alone with the family and the puppy will “do her the world of good”.

Then when your 3 year old 12 pound Shih-Tzu that you ran over with a truck gets so sick that you’re worried she’s going to die while you’re on your family camping trip and you FINALLY take her to a veterinarian do you:
A. Let the veterinarian do the diagnostic testing that needs to be done to find out what’s wrong with her or

B. Do you pay for the exam and refuse anything else but medication that you know will be of help because “every other Shih-Tzu we’ve had had heart disease and every one of them got better with this medication”.

I swear I’m not making this up.

I saw the Shih-Tzu in question ten months after she’d been run over by a truck, eight months after they’d purchased the puppy, and five months after she’d started on a diuretic which is usually used to treat patients in heart failure. Usually works, too, when the dog has heart failure, but this one didn’t.
I didn’t even see her because of her cough and exercise intolerance issues, I saw her because she had a skin problem and an ear infection…………
And just coincidentally she had most of her abdominal organs stuffed into the left side of her chest because when the idiot ran over her with the truck almost a year ago her diaphragm ruptured and all of her abdominal organs got shoved up into her chest.

The owner still doesn’t think there’s anything that needs to be done about that.

Can I refuse to be human? I don’t think I like being this species anymore.


One down

Filed under: @ 4:57 pm

Andrew had carpal tunnel surgery on his left wrist this morning. I obviously know nothing about this type of surgery, my patients not being prone to repetitive stress injuries much, but I was astonished at how little time it took.
We got to the hand specialist’s office at 0700 (actually we were there at 0630 because the traffic was better than I’d expected but regardless) and we were leaving at 0800.
Everyone that we’ve talked to that has had this surgery reports that it was somewhere between fantastic and the best thing they’ve ever done. Couldn’t tell you what the long term is going to shake out like for Andrew, but right now he’s certainly feeling no pain. Looped to the gills on hydrocodone, Andrew is on his third nap of the day. And amazingly, he’s not covered in cats.

The surgeon said that Andrew should lay low for about 48 hours postop, but then he can resume normal life and normal use of the hand as tolerated so long as he doesn’t lift anything. I’ll keep him full up on hydrocodone root beer and, if not South Park then something intellectual like Bugs Bunny cartoons tomorrow, and if everything goes as planned he should be fairly mobile by Friday.

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