I'd sat around for the first 13 hours of my 14 hour shift, anxiously watching the clock and waiting for the time to go home. Having no patients for an entire day renders me a little stir-crazy.
And then it happened, 45 minutes before the end of my shift. Doorbell rings, technician greets a new client at the door. Dog is a 7 year old, muzzled, growling Sharpei. The client is bleeding from her face, hands and both legs. We all don gloves and start to ask for details of the situation.
"My dog got attacked by a pit-pull!" she screams. "You know how them pit-pulls are!" (no, that is not a typo. She wrote and pronounced it in this manner).
My technician answered "yes, I do know how they are. I have one, and she's the sweetest dog on earth.
....
Now, why are you bleeding?"
The woman replies that her OWN "sweetie" bit her on the face, legs and hands. She baby talks her dog as it snarls, growls and snaps at her and everyone who approaches it. From a distance, I can see he has multiple bites and lacerations over his back and neck, which require flushing and surgery, as well as probably drains and closure. These are big wounds - but I can't get near enough to actually see the extent of the injuries.
I've dealt with a lot of scared pets over my years in the ER. I know how to read them, approach them, and when to give them space. This dog wasn't simply scared, this dog was unsocialized, aggressive, fearful AND dangerous. In order to be able to even get within 4 feet of her, we had to find some way to protect ourselves from the client's fate. I wish I had a dart gun (like they use on wild animals), but alas, we don't keep those lying around since 99% of our patients are friendly (or at least approachable!). We sent the client to the human ER to get her wounds addressed while we took care of her dog. As she left, she didn't seem to understand the gravity of the situation.
"Bye sweetie, mommy loves you" she cooed, as the dog growled and snarled AT HER. "Mommy will be right back to take you home." I was dumbfounded - how do you get bitten in the face, and not realize that your dog is a terror, a danger to society, and could someday kill a child, someone's pet, or at least seriously maim an adult!?
Unfortunately, this patient was so nasty that it took all of my staff's strength, a rabies pole, three broken leashes, a broken muzzle (meaning she could now bite us un-hindered), three doses of drugs and 45 minutes to be able to get this dog even close to a handleable state. Once an adequate level of sedation was finally achieved, I took care of her gnarly wounds and recovered her, carefully. The great news was that none of my staff or myself got injured - but the bad news is this dangerous dog is back out in the world, with no hope of training, rehabilitation, or any sort of behavioral therapy to help treat her obvious anxiety, fear, and socialization issues. Regardless of the fact that we risked injury to ourselves, had to clean up the poop and urine sprayed around the clinic for hours, and cared for this woman's dog, she still would complain about the fact that my record indicated that her dog "had bitten." You know what? I'm here to tell the truth, not the truth as you see it.
I ended up leaving work 2 hours late that night, exhausted, frustrated and with no real reward. Usually I'm happy to have fixed an animal, even if the owner is awful, but this time, I worry that fixing the animal could result in future harm for some other creature. Euthanize? I think it probably would have been the right thing to do, but there's no way that this client could see her "sweetie" for what she truly was - anything but.
~Er doc
Monday, October 8, 2012
Tuesday, September 25, 2012
Kudos
"Do you have an internet survey?" my client asks, after receiving my update on her pet this morning.
"Not a specific one, but we do have paper surveys in the clinic. Why?" I replied.
"Because you were fantastic!" She said. "And everyone should know you are terrific!"
Positive feedback is amazing!
~ERdoc
"Not a specific one, but we do have paper surveys in the clinic. Why?" I replied.
"Because you were fantastic!" She said. "And everyone should know you are terrific!"
Positive feedback is amazing!
~ERdoc
Monday, September 24, 2012
Ouch.
Clients rushed in the front door, carrying their 60#, 2 year old German shorthair pointer. "He's been shot!"
I quickly assessed the patient, "Theo." An entry gunshot wound was present on his flank, and an exit wound on the other side. His mucous membranes were gray, and he was unable to stand. Theo was suffering extreme shock, and likely bleeding internally from the gunshot wound.
His family immediately approved triage care, and an IV catheter was placed. IV fluids were started, initial labs collected, and pain relief medication started.
"Do you know what happened?" I asked the family.
Through tears, the family explained what had occurred. "We let him out to pee..... We heard a gunshot and ran outside, and found out that he had jumped over the fence. The neighbor shot him just because he could....." The story broke away as the clients sobbed and hugged each other.
I returned to assess Theo. Therapy managed to improve his vitals, but he was still in a critical condition, likely due to internal injuries, bleeding and possible rupture of vital organs. His abdomen was becoming visibly more distended by the minute.
The only option for Theo was an immediate abdominal exploratory surgery to assess and attempt to repair damage. His family and I discussed risks and benefits of surgery, with ultimately no other way to try to save his life. It was surgery, or euthanasia.
The clients elected to proceed with surgery, with the clear instructions given to me that if it didn't look like a good chance at survival, then euthanasia would be their choice while Theo was under anesthesia. As we prepared Theo for anesthesia, blood started to pour out of his gunshot wounds. Pressure was applied, a unit of blood prepared for transfusion, and he was prepped for surgery.
Within minutes I was in his abdomen. My assistant applied pressure to bleeding vessels and held the body wall out of my way while I quickly assessed for injuries. One puncture to his bowel was found. Then another. And another. Ultimately, I located 9 perforations, 2 places were the intestines were nearly severed, and his major blood supply to the intestines was severed in multiple locations. Feces and tapeworms oozed out of the open intestines, and blood was everywhere.
I made the call. There was nothing left to sew together, and, in reality, no chance for Theo to recover from this injury. The clients and I made the difficult decision to let him go.
Theo's family returned to say goodbye. I grieved with them, and they shared memories with me of his life. The family thanked me for trying, and thanked me for being their in their time of need.
For the rest of the evening, my staff and I tried to understand the mentality of the person who shot at this kind, young, great looking dog. I understand if the person's life, children, or pets had been in danger...... but out of spite? Because your neighbor's dog jumped the fence and *gasp* stepped on your property? I just can't understand.
I'll be thinking about that family and their loss for a long time. I know we did everything we could - I just wish the injuries had been repairable.
~Erdoc
I quickly assessed the patient, "Theo." An entry gunshot wound was present on his flank, and an exit wound on the other side. His mucous membranes were gray, and he was unable to stand. Theo was suffering extreme shock, and likely bleeding internally from the gunshot wound.
His family immediately approved triage care, and an IV catheter was placed. IV fluids were started, initial labs collected, and pain relief medication started.
"Do you know what happened?" I asked the family.
Through tears, the family explained what had occurred. "We let him out to pee..... We heard a gunshot and ran outside, and found out that he had jumped over the fence. The neighbor shot him just because he could....." The story broke away as the clients sobbed and hugged each other.
I returned to assess Theo. Therapy managed to improve his vitals, but he was still in a critical condition, likely due to internal injuries, bleeding and possible rupture of vital organs. His abdomen was becoming visibly more distended by the minute.
The only option for Theo was an immediate abdominal exploratory surgery to assess and attempt to repair damage. His family and I discussed risks and benefits of surgery, with ultimately no other way to try to save his life. It was surgery, or euthanasia.
The clients elected to proceed with surgery, with the clear instructions given to me that if it didn't look like a good chance at survival, then euthanasia would be their choice while Theo was under anesthesia. As we prepared Theo for anesthesia, blood started to pour out of his gunshot wounds. Pressure was applied, a unit of blood prepared for transfusion, and he was prepped for surgery.
Within minutes I was in his abdomen. My assistant applied pressure to bleeding vessels and held the body wall out of my way while I quickly assessed for injuries. One puncture to his bowel was found. Then another. And another. Ultimately, I located 9 perforations, 2 places were the intestines were nearly severed, and his major blood supply to the intestines was severed in multiple locations. Feces and tapeworms oozed out of the open intestines, and blood was everywhere.
I made the call. There was nothing left to sew together, and, in reality, no chance for Theo to recover from this injury. The clients and I made the difficult decision to let him go.
Theo's family returned to say goodbye. I grieved with them, and they shared memories with me of his life. The family thanked me for trying, and thanked me for being their in their time of need.
For the rest of the evening, my staff and I tried to understand the mentality of the person who shot at this kind, young, great looking dog. I understand if the person's life, children, or pets had been in danger...... but out of spite? Because your neighbor's dog jumped the fence and *gasp* stepped on your property? I just can't understand.
I'll be thinking about that family and their loss for a long time. I know we did everything we could - I just wish the injuries had been repairable.
~Erdoc
Thursday, August 23, 2012
But it doesn't hurt...
A frantic lady arrived, screaming "He's choking, he's choking! My baby is choking!"
The technician who answered the door quickly took at look at the 3lb hairless chihuahua who was clearly not choking. He growled as she approached him to look at his mucous membrane color. His vitals were normal, and he and his family were placed in an exam room so I could come take a look.
I entered the room, introduced myself as usual, and asked the client what she'd been seeing at home. Clutching the dog to her chest, she told me that the dog had eaten some cat food and suddenly started choking so she rushed right in.
I tried to get a look at her dog, but she clutched him closer, burying him in between her breasts. Without touching something inappropriately (which I was obviously not willing to do), there was no way for me to access even one square inch of her 3 pound dog.
"You're going to have to put Zorro on the table so I can take a look at him," I said. "I can't see him when you've got him held that tightly to your body."
She set Zorro on the exam table, and then leaned over, burying him again in her generous bosom.
"Ma'am, I am really sorry, but I need you to allow me to see your dog and get my hands on him so I can help you figure out what the problem is. You can hold on to him with your hands, but you'll have to take a step back from the table so he's not buried in your ..... body."
Finally, she complied. At this point, Zorro started to show his true colors. He growled, snapped and snarled when I even attempted to place a stethoscope on his chest. He refused to allow me to look at his face, and forget thinking about approaching his mouth.
The client picked Zorro up and clutched him desperately, as if I'd beat him with a bat.
"I'm sorry, I'm not going to be able to look in Zorro's mouth," I said. "He's too scared and aggressive, and if I get near his face, he's going to bite me."
"He doesn't BITE!" the client shrieked, and at the exact time, Zorro proceeded to bite her hands and fingers 5-10 times, repeatedly. "HE DOES NOT BITE!"
"Ma'am...... he's biting you right now....." I said, incredulous that I was having this conversation with an adult.
"Well, it doesn't HURT. You just need to stick your finger down his throat! He's choking!"
"It's irrelevant how much it hurts if he bites me; I can't have your dog biting me at all. First of all, I don't think he's choking based upon his physical appearance, but if you still want me to be able to look in his mouth, he'll need to be sedated. My hands are vital to me being able to do my job, and I can't be bitten by my patients; not to mention the risk of infection....." (Really?!? Do I really need to explain why I can't be bitten by a dog?)
The client refused to have her dog sedated, and I offered him some food, which he ate. Pets who are choking can't and don't eat, so I tried to explain to her, again, that he doesn't appear to be choking and she can watch him at home for any problems.
As medical records must be complete and accurate, I filled in the section for oral cavity exam, truthfully: "not able to examine, patient will bite."
The client was furious, and demanded I retype the medical record, because of course...... her dog doesn't bite!
Of course I refused to falsify my medical record, and the client stormed out. Really?!?
The technician who answered the door quickly took at look at the 3lb hairless chihuahua who was clearly not choking. He growled as she approached him to look at his mucous membrane color. His vitals were normal, and he and his family were placed in an exam room so I could come take a look.
I entered the room, introduced myself as usual, and asked the client what she'd been seeing at home. Clutching the dog to her chest, she told me that the dog had eaten some cat food and suddenly started choking so she rushed right in.
I tried to get a look at her dog, but she clutched him closer, burying him in between her breasts. Without touching something inappropriately (which I was obviously not willing to do), there was no way for me to access even one square inch of her 3 pound dog.
"You're going to have to put Zorro on the table so I can take a look at him," I said. "I can't see him when you've got him held that tightly to your body."
She set Zorro on the exam table, and then leaned over, burying him again in her generous bosom.
"Ma'am, I am really sorry, but I need you to allow me to see your dog and get my hands on him so I can help you figure out what the problem is. You can hold on to him with your hands, but you'll have to take a step back from the table so he's not buried in your ..... body."
Finally, she complied. At this point, Zorro started to show his true colors. He growled, snapped and snarled when I even attempted to place a stethoscope on his chest. He refused to allow me to look at his face, and forget thinking about approaching his mouth.
The client picked Zorro up and clutched him desperately, as if I'd beat him with a bat.
"I'm sorry, I'm not going to be able to look in Zorro's mouth," I said. "He's too scared and aggressive, and if I get near his face, he's going to bite me."
"He doesn't BITE!" the client shrieked, and at the exact time, Zorro proceeded to bite her hands and fingers 5-10 times, repeatedly. "HE DOES NOT BITE!"
"Ma'am...... he's biting you right now....." I said, incredulous that I was having this conversation with an adult.
"Well, it doesn't HURT. You just need to stick your finger down his throat! He's choking!"
"It's irrelevant how much it hurts if he bites me; I can't have your dog biting me at all. First of all, I don't think he's choking based upon his physical appearance, but if you still want me to be able to look in his mouth, he'll need to be sedated. My hands are vital to me being able to do my job, and I can't be bitten by my patients; not to mention the risk of infection....." (Really?!? Do I really need to explain why I can't be bitten by a dog?)
The client refused to have her dog sedated, and I offered him some food, which he ate. Pets who are choking can't and don't eat, so I tried to explain to her, again, that he doesn't appear to be choking and she can watch him at home for any problems.
As medical records must be complete and accurate, I filled in the section for oral cavity exam, truthfully: "not able to examine, patient will bite."
The client was furious, and demanded I retype the medical record, because of course...... her dog doesn't bite!
Of course I refused to falsify my medical record, and the client stormed out. Really?!?
Friday, August 17, 2012
fuzzy thinking
Few things frustrate me more than lack of a proper diagnosis. Certainly, there are some cases where a diagnosis isn't attainable for financial, logistical, or medical reasons, but a lot of times, it's a failure on the part of the doctor.
A 10 year old great dane presented to me for a 5 week history of dribbling urine, which had progressed to not really being able to pee a full stream. He wasn't straining, the urine was clear (not bloody) and he was otherwise acting normally. His regular veterinarian had prescribed antibiotics 5 weeks ago, without any testing, and when those didn't help, prescribed a second antibiotic. The first error in logic is in this decision. Dribbling urine is not a common symptom of a urinary tract infection. Antibiotics only help if a UTI is present and won't help a long list of other problems. Signs of a urinary tract infection include frequent small urination, bloody urine, or straining to urinate. Furthermore, male dogs are very unlikely to get a urinary tract infection without a mitigating factor, primarily due to the length of their urethra. If a male dog indeed does have a UTI (confirmed with a urinalysis or culture), a search is indicated to look for the underlying cause (such as bladder stones, diabetes, etc.)
Medical training teaches the new doctor to start with a history (to gather a list of symptoms) and physical exam (to look for abnormalities), and then create a list of medical problems, followed by a list of most likely causes (differential diagnoses in medical terminology), which should each be ruled in or ruled out with testing. This dog's problem list consists of dribbling urine, which could be a result of urinary incontinence, inability to empty his bladder (due to obstruction, bladder stones, mass, or spinal cord problems), or a long list of other possibilities. The job of the clinician is to determine the cause of the symptoms, and most of the time, that requires testing. I can't (nor can any human) be 100% sure if there's bladder stones, or bacteria, or a mass in the bladder without imaging (such as ultrasound). The treatment for each of these is very different, and so a diagnosis must be achieved to select the proper course of therapy.
Unfortunately, the regular vet did not recommend nor offer any testing, such as a urinalysis or imaging to the clients. When their dog didn't improve after the antibiotics, the vet added pain medications to "relax" the dog's muscles, which also didn't provide any relief or ability to urinate. When the patient still didn't get better, referral was not offered or any sort of diagnosis as to the cause of his symptoms. The clients didn't know to ask for any other testing (as most laypeople have no way of guessing at the proper tests, and trust their doctor implicitly to do the right thing). When the clients felt their dog was simply too uncomfortable, they showed up at the ER for evaluation.
Immediately upon hearing the history I knew that this dog never had a urinary tract infection. As I mentioned above, UTIs are rare in male dogs. More likely, the cause of an adult/geriatric male dog to be dribbling urine is a bladder mass or bladder stones. I recommended an ultrasound, which was immediately authorized, and found the large mass with ease.
Breaking the sad news to the clients was beyond devastating. I am frustrated at the poor diagnostic process and lack of options the clients were given; perhaps 5 weeks ago, the tumor would have been operable.
A 10 year old great dane presented to me for a 5 week history of dribbling urine, which had progressed to not really being able to pee a full stream. He wasn't straining, the urine was clear (not bloody) and he was otherwise acting normally. His regular veterinarian had prescribed antibiotics 5 weeks ago, without any testing, and when those didn't help, prescribed a second antibiotic. The first error in logic is in this decision. Dribbling urine is not a common symptom of a urinary tract infection. Antibiotics only help if a UTI is present and won't help a long list of other problems. Signs of a urinary tract infection include frequent small urination, bloody urine, or straining to urinate. Furthermore, male dogs are very unlikely to get a urinary tract infection without a mitigating factor, primarily due to the length of their urethra. If a male dog indeed does have a UTI (confirmed with a urinalysis or culture), a search is indicated to look for the underlying cause (such as bladder stones, diabetes, etc.)
Medical training teaches the new doctor to start with a history (to gather a list of symptoms) and physical exam (to look for abnormalities), and then create a list of medical problems, followed by a list of most likely causes (differential diagnoses in medical terminology), which should each be ruled in or ruled out with testing. This dog's problem list consists of dribbling urine, which could be a result of urinary incontinence, inability to empty his bladder (due to obstruction, bladder stones, mass, or spinal cord problems), or a long list of other possibilities. The job of the clinician is to determine the cause of the symptoms, and most of the time, that requires testing. I can't (nor can any human) be 100% sure if there's bladder stones, or bacteria, or a mass in the bladder without imaging (such as ultrasound). The treatment for each of these is very different, and so a diagnosis must be achieved to select the proper course of therapy.
Unfortunately, the regular vet did not recommend nor offer any testing, such as a urinalysis or imaging to the clients. When their dog didn't improve after the antibiotics, the vet added pain medications to "relax" the dog's muscles, which also didn't provide any relief or ability to urinate. When the patient still didn't get better, referral was not offered or any sort of diagnosis as to the cause of his symptoms. The clients didn't know to ask for any other testing (as most laypeople have no way of guessing at the proper tests, and trust their doctor implicitly to do the right thing). When the clients felt their dog was simply too uncomfortable, they showed up at the ER for evaluation.
Immediately upon hearing the history I knew that this dog never had a urinary tract infection. As I mentioned above, UTIs are rare in male dogs. More likely, the cause of an adult/geriatric male dog to be dribbling urine is a bladder mass or bladder stones. I recommended an ultrasound, which was immediately authorized, and found the large mass with ease.
Breaking the sad news to the clients was beyond devastating. I am frustrated at the poor diagnostic process and lack of options the clients were given; perhaps 5 weeks ago, the tumor would have been operable.
Sunday, July 29, 2012
Sometimes the minutes DO count
Heartbreaking case today - if only we'd had a few extra hours, the ending might have been drastically different.
"Lucy," a 3 year old westie, presented to her regular veterinarian for not eating the last 3-4 days. The clients weren't concerned until she collapsed today. Her regular veterinarian's office took one look at her, noticed her white-as-a-sheet mucous membranes and recommended transfer to our emergency room. Unfortunately, the clients were a 2 hour drive away from our office.
When they arrived, Lucy was like a rag-doll. Floppy, listless and mucous membranes white as can be. The family noted that she did have access to rat bait, but had been abnormal for 3-4 days. She had no signs of trauma and no evdidence of bleeding, but instantly upon placing an IV catheter and pulling a small sample, it was clear that she was critically anemic. Her PCV was just 8%; barely enough red blood cells to provide her with the oxygen that her tissues so desperately need.
Given all this information, oxygen and supportive care were initiated. A unit of packed red cells was warmed and I looked at some in-house testing to determine the cause of her symptoms. A blood smear was evaluated under the microscope and confirmed the most likely diagnosis; immune mediated hemolytic anemia, or IMHA. IMHA is a condition where the body's own defenses, the immune system, attack and destroy the red blood cells, which carry oxygen. The causes of IMHA are unknown, and can include drugs, certain types of infections, rare reactions to vaccines or medications, but most commonly IMHA has no identifiable cause. More information can be obtained here.
The client gave permission for treatment, despite the risks and guarded prognosis. Just as the blood was nearing room temperature and ready for transfusion, Lucy became agonal; she vomited, stretched out, and started gasping (all typical reactions just before a pet dies). We worked hard to ger her stabilized; she was intubated, I gave atropine and epinephrine and started bolusing red blood cells in an attempt to pull her back from the brink of death. Unfortuantely, it was all for naught. Despite every medication and intervention I could give her, it was simply too late. The family had waited too long, her body couldn't take it any more and she had nothing left to fight with. She was gone. If we had only had 30 minutes or more to get her blood transfusion started before she went agonal, she just may have survived.
After several minutes of CPR, the clients and I decided that there was nothing left to do but to say goodbye to Lucy. With tears in our eyes, we made an impression of Lucy's paw and gave our heartfelt condolences for their loss. I still am racking my brain to see if I could have done anything differently, but there's just... nothing. The only way we could have saved her was to have her brought to us sooner.
If your pet isn't feeling well, 3-4 days is much too long to wait. If you notice your pet isn't acting right, isn't eating, or has any symptoms of illness, call and get advice from your local veterinary office immediately or bring them by for an exam. It could save your pet's life.
~ERdoc
"Lucy," a 3 year old westie, presented to her regular veterinarian for not eating the last 3-4 days. The clients weren't concerned until she collapsed today. Her regular veterinarian's office took one look at her, noticed her white-as-a-sheet mucous membranes and recommended transfer to our emergency room. Unfortunately, the clients were a 2 hour drive away from our office.
When they arrived, Lucy was like a rag-doll. Floppy, listless and mucous membranes white as can be. The family noted that she did have access to rat bait, but had been abnormal for 3-4 days. She had no signs of trauma and no evdidence of bleeding, but instantly upon placing an IV catheter and pulling a small sample, it was clear that she was critically anemic. Her PCV was just 8%; barely enough red blood cells to provide her with the oxygen that her tissues so desperately need.
Given all this information, oxygen and supportive care were initiated. A unit of packed red cells was warmed and I looked at some in-house testing to determine the cause of her symptoms. A blood smear was evaluated under the microscope and confirmed the most likely diagnosis; immune mediated hemolytic anemia, or IMHA. IMHA is a condition where the body's own defenses, the immune system, attack and destroy the red blood cells, which carry oxygen. The causes of IMHA are unknown, and can include drugs, certain types of infections, rare reactions to vaccines or medications, but most commonly IMHA has no identifiable cause. More information can be obtained here.
The client gave permission for treatment, despite the risks and guarded prognosis. Just as the blood was nearing room temperature and ready for transfusion, Lucy became agonal; she vomited, stretched out, and started gasping (all typical reactions just before a pet dies). We worked hard to ger her stabilized; she was intubated, I gave atropine and epinephrine and started bolusing red blood cells in an attempt to pull her back from the brink of death. Unfortuantely, it was all for naught. Despite every medication and intervention I could give her, it was simply too late. The family had waited too long, her body couldn't take it any more and she had nothing left to fight with. She was gone. If we had only had 30 minutes or more to get her blood transfusion started before she went agonal, she just may have survived.
After several minutes of CPR, the clients and I decided that there was nothing left to do but to say goodbye to Lucy. With tears in our eyes, we made an impression of Lucy's paw and gave our heartfelt condolences for their loss. I still am racking my brain to see if I could have done anything differently, but there's just... nothing. The only way we could have saved her was to have her brought to us sooner.
If your pet isn't feeling well, 3-4 days is much too long to wait. If you notice your pet isn't acting right, isn't eating, or has any symptoms of illness, call and get advice from your local veterinary office immediately or bring them by for an exam. It could save your pet's life.
~ERdoc
What would you do?
Pretty much on a daily basis, a client asks me "What would you do?!" in their given situation.
While this may seem like a simple question, it's impossible to answer and loaded with problems.
One busy evening, a 2 year old beautiful pit bull mix arrived after being accidentally hit by a car on a busy highway. "Toby" had been playing outside on the client's rural property when he unfortunately chased a squirrel into the road, and was hit by a car who had no chance to slow down.
Toby's owner was a kind young man who rushed his dog in to our ER immediately.
I assessed Toby, and at my direction, the staff started emergency triage and care; providing oxygen, placing an IV catheter, start fluid therapy, and providing pain medications.
Toby's injuries were severe. He had two obviously broken hind legs, a possibly broken pelvis, and even more substatially, his tail was torn from it's attachment at the base, his rectum was torn and he had no sphincter remaining. Besides attempt at trauma resussitation, Toby's wound was very dirty and required immediate surgery, attempt at reconstruction, and possibly a tail amputation. With the injury to his rectum, Toby may never be able to control defecation and may develop permenant incontinence. Furthermore, after stabilization and initial wound management were complete, Toby had two broken legs that would likely require additional surgery. Needless to say, Toby's wounds were extensive, severe and would require a long hospital stay, likely several surgeries and a massive financial investment.
Could Toby be saved? Yes.
Should Toby be saved? That's the part I can't answer. Every individual person that walks through our doors has a different set of beliefs, values, religious affiliations, attachment to their pet, life experiences and financial abilities. As I'm sure the reader is aware, some people choose not to have blood transfusions or transplants for their own healthcare based upon their religious beliefs; others decline to have CPR or life saving care based upon their moral / ethical concerns. Some clients have been through chemotherapy themselves and would never want that thrust upon their pet. Some people have been through a trauma with their pet by their side, and would give anything to save their companion. The experience of each human being that I meet is drastically different, and there's no way for me, meeting them in a a time of extreme need, to determine what's right for them. I've met all types of clients; quite literally, from those who refused to even have their pet evaluated by a vet because it's "just a dog," to those who elect to try treatment despite an extremely low chance of a positive outcome.
Financially, Toby's care could easily cost over $5000, based upon the extreme nature of his injuires. Finances aside, he may need a week or longer of intensive care, several surgeries, and would have to endure excruciating pain in the interim. Some people feel that this duration of pain and suffering is not in Toby's best interest. The nature of his injuries also may make him unable to control his feces; resulting in a problem for any pet owner who wants to keep a clean and sanitary household, or relegating Toby to be an outside dog. Unlike human healthcare, euthanasia IS an option for our pets - and when it is appropriate to do so is dependent upon all the above factors.
So what would I do? You and I are very different people, and that's why I can't actually answer that question when you come into my ER. It's not fair if I tell you that I would treat, and make it seem like you're heartless for not doing so. On the other side of the coin, it's not fair if I tell you I would euthanize, making it seem like there's no hope for survival. My task is to assess your pet and provide objective medical information, to help you to understand your pet's condition, to understand the possible outcomes and prognosis, the chance for success, and the possible time to recovery and cost. (Obviously, if the pet has zero chance of recovery, I tell the clients that as well). As the pet owner, it's your job to do what you think is right for your pet and your family. I'm just here to help you along the way.
Afer a lot of discussion and thought, Toby's family decided that due to his extensive injuries, euthanasia was the kind decision. We tearfully said good-bye, and I gave them my heartfelt sympathies for their tragic and unexpected loss.
~ERDoc
While this may seem like a simple question, it's impossible to answer and loaded with problems.
One busy evening, a 2 year old beautiful pit bull mix arrived after being accidentally hit by a car on a busy highway. "Toby" had been playing outside on the client's rural property when he unfortunately chased a squirrel into the road, and was hit by a car who had no chance to slow down.
Toby's owner was a kind young man who rushed his dog in to our ER immediately.
I assessed Toby, and at my direction, the staff started emergency triage and care; providing oxygen, placing an IV catheter, start fluid therapy, and providing pain medications.
Toby's injuries were severe. He had two obviously broken hind legs, a possibly broken pelvis, and even more substatially, his tail was torn from it's attachment at the base, his rectum was torn and he had no sphincter remaining. Besides attempt at trauma resussitation, Toby's wound was very dirty and required immediate surgery, attempt at reconstruction, and possibly a tail amputation. With the injury to his rectum, Toby may never be able to control defecation and may develop permenant incontinence. Furthermore, after stabilization and initial wound management were complete, Toby had two broken legs that would likely require additional surgery. Needless to say, Toby's wounds were extensive, severe and would require a long hospital stay, likely several surgeries and a massive financial investment.
Could Toby be saved? Yes.
Should Toby be saved? That's the part I can't answer. Every individual person that walks through our doors has a different set of beliefs, values, religious affiliations, attachment to their pet, life experiences and financial abilities. As I'm sure the reader is aware, some people choose not to have blood transfusions or transplants for their own healthcare based upon their religious beliefs; others decline to have CPR or life saving care based upon their moral / ethical concerns. Some clients have been through chemotherapy themselves and would never want that thrust upon their pet. Some people have been through a trauma with their pet by their side, and would give anything to save their companion. The experience of each human being that I meet is drastically different, and there's no way for me, meeting them in a a time of extreme need, to determine what's right for them. I've met all types of clients; quite literally, from those who refused to even have their pet evaluated by a vet because it's "just a dog," to those who elect to try treatment despite an extremely low chance of a positive outcome.
Financially, Toby's care could easily cost over $5000, based upon the extreme nature of his injuires. Finances aside, he may need a week or longer of intensive care, several surgeries, and would have to endure excruciating pain in the interim. Some people feel that this duration of pain and suffering is not in Toby's best interest. The nature of his injuries also may make him unable to control his feces; resulting in a problem for any pet owner who wants to keep a clean and sanitary household, or relegating Toby to be an outside dog. Unlike human healthcare, euthanasia IS an option for our pets - and when it is appropriate to do so is dependent upon all the above factors.
So what would I do? You and I are very different people, and that's why I can't actually answer that question when you come into my ER. It's not fair if I tell you that I would treat, and make it seem like you're heartless for not doing so. On the other side of the coin, it's not fair if I tell you I would euthanize, making it seem like there's no hope for survival. My task is to assess your pet and provide objective medical information, to help you to understand your pet's condition, to understand the possible outcomes and prognosis, the chance for success, and the possible time to recovery and cost. (Obviously, if the pet has zero chance of recovery, I tell the clients that as well). As the pet owner, it's your job to do what you think is right for your pet and your family. I'm just here to help you along the way.
Afer a lot of discussion and thought, Toby's family decided that due to his extensive injuries, euthanasia was the kind decision. We tearfully said good-bye, and I gave them my heartfelt sympathies for their tragic and unexpected loss.
~ERDoc
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