Hey readers,
I apologize for my long absence. Work has been unusually busy this winter, and I'm struggling to stay caught up. I'll try to get back into the swing of things soon.
~Er doc
Thursday, January 12, 2012
Sunday, December 18, 2011
Um..................... really?
Today, an older female client arrived at the front counter. She did not have a pet with her.
"I'd like to report a lost dog," the client stated. My receptionist gathered the form necessary to record this information and assist the woman in finding her dog.
"Okay, where did you last see him?" The receptionist asked.
"He's lost INSIDE my house," she stated plainly. "I've looked everywhere for him, and I just can't find him. I've looked under the beds, under the couch, and he's nowhere. I know he's in the house because I haven't left today and he slept on the bed with me."
"..... Ma'am, I'm not going to be able to help you find the dog inside your house - Lost dog reports only work if someone else finds your dog. If your dog is in your house, nobody else is going to find him. Can you have someone come over and help you? Have you tried shaking his food dish?"
....
Really? You lost your dog INSIDE YOUR HOUSE and you came in to report him lost?
"I'd like to report a lost dog," the client stated. My receptionist gathered the form necessary to record this information and assist the woman in finding her dog.
"Okay, where did you last see him?" The receptionist asked.
"He's lost INSIDE my house," she stated plainly. "I've looked everywhere for him, and I just can't find him. I've looked under the beds, under the couch, and he's nowhere. I know he's in the house because I haven't left today and he slept on the bed with me."
"..... Ma'am, I'm not going to be able to help you find the dog inside your house - Lost dog reports only work if someone else finds your dog. If your dog is in your house, nobody else is going to find him. Can you have someone come over and help you? Have you tried shaking his food dish?"
....
Really? You lost your dog INSIDE YOUR HOUSE and you came in to report him lost?
Monday, November 28, 2011
Trauma drama
5am, Thanksgiving morning.
A phone call comes through from a client. "Two of my dogs were shot! We're on the way!" She's too upset to give us any more details about their condition.
Immediately, I wonder -- how in the heck do not one but TWO of your pets get shot?
My technician and I start preparing for arrival of two potentially serious, potentially life-threatening injuries. Gunshots can result in any bad trauma you can think of; bleeding, penetrated bowels, ruptured bladder, spinal paralysis, pneumothorax, instant death, infection....
The first pet arrives and walks into the clinic under his own power, which is a surprise. My tech receives permission for initial treatment and diagnostics. He has two entry wounds on one side of his chest, but no exit wounds. He is experiencing mild shock, and is exceptionally painful, but for a gunshot wound, appears moderately stable.
We start pain medications, IV fluids, oxygen, and antibiotics. I walk up to the lobby to speak with the client who is understandably hysterical. Hysterical, however, slows down my ability to do my job.
"Hi, I'm ERdoc. Your pet is in fair condition, and is already receiving pain medicine, oxygen and IV fluids."
"TELL ME SOMETHING ABOUT MY DOG!" She screams.
"Ma'am, I understand you're upset, this is a very scary situation. You have to realize that we're working as fast as we can, and if you just take a deep breath and calm down a bit, we'll be able to help you more quickly. Now is there any major medical history I should know about ? How did this happen?"
The client calms a bit, and I get a history. The pets had escaped out the front door, and it was suspected that a neighbor shot them for being on their property. Cruel, but actually not illegal since the dogs were at large.
The second dog arrives and actually looks better than the first. He has a thru and thru gunshot wound so close to his spine that it's frightening.
Amazingly, both patients recovered well and were sent home with their (very) thankful families the next day.
Despite the high stress, extreme potential for disaster, and emotionally charged situation, we were able to provide happy outcomes for both of these patients!
A phone call comes through from a client. "Two of my dogs were shot! We're on the way!" She's too upset to give us any more details about their condition.
Immediately, I wonder -- how in the heck do not one but TWO of your pets get shot?
My technician and I start preparing for arrival of two potentially serious, potentially life-threatening injuries. Gunshots can result in any bad trauma you can think of; bleeding, penetrated bowels, ruptured bladder, spinal paralysis, pneumothorax, instant death, infection....
The first pet arrives and walks into the clinic under his own power, which is a surprise. My tech receives permission for initial treatment and diagnostics. He has two entry wounds on one side of his chest, but no exit wounds. He is experiencing mild shock, and is exceptionally painful, but for a gunshot wound, appears moderately stable.
We start pain medications, IV fluids, oxygen, and antibiotics. I walk up to the lobby to speak with the client who is understandably hysterical. Hysterical, however, slows down my ability to do my job.
"Hi, I'm ERdoc. Your pet is in fair condition, and is already receiving pain medicine, oxygen and IV fluids."
"TELL ME SOMETHING ABOUT MY DOG!" She screams.
"Ma'am, I understand you're upset, this is a very scary situation. You have to realize that we're working as fast as we can, and if you just take a deep breath and calm down a bit, we'll be able to help you more quickly. Now is there any major medical history I should know about ? How did this happen?"
The client calms a bit, and I get a history. The pets had escaped out the front door, and it was suspected that a neighbor shot them for being on their property. Cruel, but actually not illegal since the dogs were at large.
The second dog arrives and actually looks better than the first. He has a thru and thru gunshot wound so close to his spine that it's frightening.
Amazingly, both patients recovered well and were sent home with their (very) thankful families the next day.
Despite the high stress, extreme potential for disaster, and emotionally charged situation, we were able to provide happy outcomes for both of these patients!
Thankful for the boys in blue.
What a crazy weekend.
One of my most extreme situations ever occurred this weekend, and I'm very proud of my determination in preventing animal suffering.
I arrived at work in the morning and received patient rounds from the overnight doctor. One of the patients was a young, large beautiful cat who had arrived at 1am. The client found this cat tragically injured after being caught in a bear trap. As the cat entered the clinic, my colleague described that he was absolutely howling in pain. She quickly administered pain medication, despite the client's lack of ability to pay. The cat was injured nearly beyond repair. Both hind limbs were broken, in several locations, including the feet, ankles, and tibias bilaterally. Both hind limbs had severe degloving injuries; meaning that the skin was pulled away from the muscles, bone and tendons underneath. Both hind legs had the pads removed, and the tissue appeared very unhealthy due to lack of blood flow and overwhelming infection setting in. In order to try fixing this kitty's injuries, it would require far more than most veterinarians or clients are capable of - the repair would take months and months of dedicated treatment, daily bandage changes for much of that time, multiple surgeries, as well as thousands and thousands of dollars. My heart bled for this poor, poor cat.
If the cat was a human, amputation would probably be performed, however, a human has the ability to use a wheelchair, have assistance, and understands what is happening to them. A cat without hind limbs would be bordering on inhumane.
Unfortunately, the client was out of her mind crazy. She also had not a penny to contribute towards any sort of care. Let me reiterate that this was not a "give him some medicine and he'll be okay" situation. If this cat had been my own, I don't think that even I would have chosen to try to treat him. His injuries were massive.
The client had spent 5-6 hours trying to obtain any sort of financial assistance. By the time I arrived, the cat had been suffering for far too long.
I stepped in to her exam room. Immediately, I knew that something was off. The client could not sit still, could not make eye contact, and was agitated. She did not answer any questions or respond to my comments, she instead spoke to herself and rocked back and forth. In my experience with 'crazy' clients, she looked like a typical methamphetamine addict.
Then the unthinkable happened. The client demanded to take her cat home, without treatment.
I was stunned. Nobody in their right mind would think of doing that to a poor, innocent cat. Of course, this woman was definitely NOT in her right mind.
I stated plainly - "I will not allow you to take this cat home without treatment. This is cruel, and definitely classifies as animal neglect. I will report you to animal control and the authorities if you try to leave the building with your cat. I know that it is a very sad situation, but your cat is suffering and it is my job to make sure that all my patients are relieved of suffering. Even if you had a million dollars, I honestly can't guarantee that this could be fixed. "
She didn't get it. She tried to walk out of the building with her cat, and could not listen to reason. I had had enough and could not stand to watch the cat writhing in pain for one second more.
I contacted our local police department and asked them to assist in enforcing animal cruelty laws, as I do not have the authority to confiscate a pet.
The police arrived and dealt with the crazy woman for about an hour and a half. She screamed, yelled, and threw things. She lied to the police and made up a story about another clinic doing thousands of dollars of treatment "for free." She made up crazy stories and eventually, the police told her that she could either agree to treat her cat (and present the funds necessary to do so), could agree to euthanize her cat, or she would be thrown in jail for animal cruelty. The cops prepared for a battle as the woman kicked, screamed, spit and was a all-around psycho as they escorted her from the building.
We couldn't thank the police officers enough for helping us to prevent this poor, sweet cat from suffering for one minute more. We pet him, told him what a good kitty he was, and teared up as I euthanized him.
For readers who have never experienced this sort of situation, I realize that it may sound odd that I fought for the ability to euthanize this cat. If left untreated, this cat would have died after days or weeks of suffering incredible pain, being unable to move, and having massive infection take over his wounds. The veterinary oath demands that I will use my skills for the "prevention and relief of animal suffering". There was truly no chance for healing and I couldn't allow this crazy person to torture an innocent pet.
Tough day. More stories to come.
~ERdoc
One of my most extreme situations ever occurred this weekend, and I'm very proud of my determination in preventing animal suffering.
I arrived at work in the morning and received patient rounds from the overnight doctor. One of the patients was a young, large beautiful cat who had arrived at 1am. The client found this cat tragically injured after being caught in a bear trap. As the cat entered the clinic, my colleague described that he was absolutely howling in pain. She quickly administered pain medication, despite the client's lack of ability to pay. The cat was injured nearly beyond repair. Both hind limbs were broken, in several locations, including the feet, ankles, and tibias bilaterally. Both hind limbs had severe degloving injuries; meaning that the skin was pulled away from the muscles, bone and tendons underneath. Both hind legs had the pads removed, and the tissue appeared very unhealthy due to lack of blood flow and overwhelming infection setting in. In order to try fixing this kitty's injuries, it would require far more than most veterinarians or clients are capable of - the repair would take months and months of dedicated treatment, daily bandage changes for much of that time, multiple surgeries, as well as thousands and thousands of dollars. My heart bled for this poor, poor cat.
If the cat was a human, amputation would probably be performed, however, a human has the ability to use a wheelchair, have assistance, and understands what is happening to them. A cat without hind limbs would be bordering on inhumane.
Unfortunately, the client was out of her mind crazy. She also had not a penny to contribute towards any sort of care. Let me reiterate that this was not a "give him some medicine and he'll be okay" situation. If this cat had been my own, I don't think that even I would have chosen to try to treat him. His injuries were massive.
The client had spent 5-6 hours trying to obtain any sort of financial assistance. By the time I arrived, the cat had been suffering for far too long.
I stepped in to her exam room. Immediately, I knew that something was off. The client could not sit still, could not make eye contact, and was agitated. She did not answer any questions or respond to my comments, she instead spoke to herself and rocked back and forth. In my experience with 'crazy' clients, she looked like a typical methamphetamine addict.
Then the unthinkable happened. The client demanded to take her cat home, without treatment.
I was stunned. Nobody in their right mind would think of doing that to a poor, innocent cat. Of course, this woman was definitely NOT in her right mind.
I stated plainly - "I will not allow you to take this cat home without treatment. This is cruel, and definitely classifies as animal neglect. I will report you to animal control and the authorities if you try to leave the building with your cat. I know that it is a very sad situation, but your cat is suffering and it is my job to make sure that all my patients are relieved of suffering. Even if you had a million dollars, I honestly can't guarantee that this could be fixed. "
She didn't get it. She tried to walk out of the building with her cat, and could not listen to reason. I had had enough and could not stand to watch the cat writhing in pain for one second more.
I contacted our local police department and asked them to assist in enforcing animal cruelty laws, as I do not have the authority to confiscate a pet.
The police arrived and dealt with the crazy woman for about an hour and a half. She screamed, yelled, and threw things. She lied to the police and made up a story about another clinic doing thousands of dollars of treatment "for free." She made up crazy stories and eventually, the police told her that she could either agree to treat her cat (and present the funds necessary to do so), could agree to euthanize her cat, or she would be thrown in jail for animal cruelty. The cops prepared for a battle as the woman kicked, screamed, spit and was a all-around psycho as they escorted her from the building.
We couldn't thank the police officers enough for helping us to prevent this poor, sweet cat from suffering for one minute more. We pet him, told him what a good kitty he was, and teared up as I euthanized him.
For readers who have never experienced this sort of situation, I realize that it may sound odd that I fought for the ability to euthanize this cat. If left untreated, this cat would have died after days or weeks of suffering incredible pain, being unable to move, and having massive infection take over his wounds. The veterinary oath demands that I will use my skills for the "prevention and relief of animal suffering". There was truly no chance for healing and I couldn't allow this crazy person to torture an innocent pet.
Tough day. More stories to come.
~ERdoc
Monday, November 21, 2011
Triage is the name of the game!
Last weekend was extremely busy at the ER. Multiple critical cases, mostly with positive outcomes, but of course some sad ones came through, too.
Out of all the chaos, the one call that I just can't understand -
The phone rings. My technician answers -
Caller: "Hi, I have a dog who's acting wierd. I need you to guarantee me that if I come in right now, I will be seen immediately."
Tech: "Well, sir, we'd be happy to take a look. We are an emergency room, and we're experiencing very high case loads right now, so a wait time does exist. When you arrive, a technician will triage your pet, obtain vitals, and if your pet is deemed stable, they will have to wait in line. The most critical cases have to be seen first, just like the human ER."
Caller: "NO!!! I demand that if I come in to see you, I WILL BE SEEN RIGHT AWAY!"
Tech: "Sir, what symptoms is your dog experiencing?"
Caller: "He's just acting weird, and I... I can't explain it. He's still eating and drinking normally."
Tech: "Has there been any vomiting or diarrhea?"
Caller: "No. But I WILL NOT WAIT! If I come, you have to promise me I'll be seen without waiting!"
Tech: "I'm sorry sir, but there's no way I can tell you that. Your dog sounds stable, but we are happy to take a look. If your pet is stable, you'll have to wait your turn to see the doctor. There are several people here waiting right now."
Caller: "FINE! YOU DON'T CARE ABOUT ANIMALS!"
**Hangs up.
WTF?
Out of all the chaos, the one call that I just can't understand -
The phone rings. My technician answers -
Caller: "Hi, I have a dog who's acting wierd. I need you to guarantee me that if I come in right now, I will be seen immediately."
Tech: "Well, sir, we'd be happy to take a look. We are an emergency room, and we're experiencing very high case loads right now, so a wait time does exist. When you arrive, a technician will triage your pet, obtain vitals, and if your pet is deemed stable, they will have to wait in line. The most critical cases have to be seen first, just like the human ER."
Caller: "NO!!! I demand that if I come in to see you, I WILL BE SEEN RIGHT AWAY!"
Tech: "Sir, what symptoms is your dog experiencing?"
Caller: "He's just acting weird, and I... I can't explain it. He's still eating and drinking normally."
Tech: "Has there been any vomiting or diarrhea?"
Caller: "No. But I WILL NOT WAIT! If I come, you have to promise me I'll be seen without waiting!"
Tech: "I'm sorry sir, but there's no way I can tell you that. Your dog sounds stable, but we are happy to take a look. If your pet is stable, you'll have to wait your turn to see the doctor. There are several people here waiting right now."
Caller: "FINE! YOU DON'T CARE ABOUT ANIMALS!"
**Hangs up.
WTF?
Thursday, October 27, 2011
Sometimes we all fall down....
Two rough shifts in a row, and minimal sleep make for one very sad and emotionally exhausted ER vet.
Two nights ago I performed a c-section on a 12 year old pug - yes, 12 years old. The sweet old dog had delivered one stillborn puppy, and had four remaining in her uterus when she arrived to the ER. Fortunately, I retrieved all four puppies alive! Unfortunately, she had a rough recovery and required more care than a typical c-section patient. Much of that to be attributed to her age and a moderate amount of bleeding during the surgery. Thankfully, her condition was not as a result of a surgical error, but simply a complication of her age, normal surgical losses, and other clotting factors. As of this time, she's recovering well and stabilized, but it was hairy for a few hours. Also unfortunate is that the clients are very upset with me. I understand the frustration of not having your pet do well after an expensive emergency procedure, however I'm not all-powerful. I'm human, and your 12 year old dog (compare to a 80-85 year old woman) should NOT be having litters of puppies. This was preventable. Furthermore, I saved all four of her puppies (so cute!) and she's probably going to pull through, too. I wish that the client could understand how much I care and how hard I work on my patients.
Last night I had a beautiful young male cat arrive with an obstructed urinary bladder. I can't remember if I've written about this topic before, so I'll be sure to scan through and if not write a full informational post... Most of these guys I'm easily able to treat, restore urine flow, and place a urinary catheter under anesthesia. This cat was the second one in my career (of hundreds or thousands) that I wasn't able to relieve the obstruction. Long story short, the clients nearly didn't allow treatment to start, so with the setback, they euthanized their beautiful cat. I cried as I administered the euthanasia. I feel like I let him down - but there was nothing else that I could have done to change the outcome.
So, as I said, emotionally exhausted. :( Time to go snuggle my pets.
Two nights ago I performed a c-section on a 12 year old pug - yes, 12 years old. The sweet old dog had delivered one stillborn puppy, and had four remaining in her uterus when she arrived to the ER. Fortunately, I retrieved all four puppies alive! Unfortunately, she had a rough recovery and required more care than a typical c-section patient. Much of that to be attributed to her age and a moderate amount of bleeding during the surgery. Thankfully, her condition was not as a result of a surgical error, but simply a complication of her age, normal surgical losses, and other clotting factors. As of this time, she's recovering well and stabilized, but it was hairy for a few hours. Also unfortunate is that the clients are very upset with me. I understand the frustration of not having your pet do well after an expensive emergency procedure, however I'm not all-powerful. I'm human, and your 12 year old dog (compare to a 80-85 year old woman) should NOT be having litters of puppies. This was preventable. Furthermore, I saved all four of her puppies (so cute!) and she's probably going to pull through, too. I wish that the client could understand how much I care and how hard I work on my patients.
Last night I had a beautiful young male cat arrive with an obstructed urinary bladder. I can't remember if I've written about this topic before, so I'll be sure to scan through and if not write a full informational post... Most of these guys I'm easily able to treat, restore urine flow, and place a urinary catheter under anesthesia. This cat was the second one in my career (of hundreds or thousands) that I wasn't able to relieve the obstruction. Long story short, the clients nearly didn't allow treatment to start, so with the setback, they euthanized their beautiful cat. I cried as I administered the euthanasia. I feel like I let him down - but there was nothing else that I could have done to change the outcome.
So, as I said, emotionally exhausted. :( Time to go snuggle my pets.
Tuesday, October 25, 2011
No, you can't have that.
A case tonight reminded me of a constant battle between me and some of my clients --
A couple presented tonight with their kitty for a primary complaint of sneezing. He is otherwise young and healthy, eating and drinking normally, with a normal temperature. On physical exam, he has no nasal discharge, no ocular discharge, and no evidence of substantial illness.
His most likely diagnosis is a viral upper respiratory tract infection. Similar to the common cold in humans (although caused by different viruses), a viral URI will NOT respond to antibiotics. Antibiotics only kill bacteria, and do nothing to affect viruses. Most mild viral URIs will resolve without any treatment. Some do progress to involve bacteria; these patients usually have yellow milky nasal discharge, fevers, and are not eating. Bacterial URI does require antibiotics, however viral DOES NOT.
Most clients walk in expecting to leave with a prescription, so when I diagnose their cat with a suspected viral URI, and give them the above information, they get very angry. "Can't you just prescribe him antibiotics or something?" They say. "It will make me feel better to give him antibiotics..." and "Please, doc, it can't hurt anything, right?"
Wrong. Prescirbing antibiotics in this situation (or many others where they aren't indicated) only results in development of antibiotic resistance, as well as side effects on the patient from the antibiotics (typically vomiting or diarrhea), and does nothing to hasten recovery.
Antibiotic resistance is a real concern that affects each and every one of us - since the invention of penicillin in the 1950's, increasing numbers of bacteria have developed the ability to survive its use, resulting in the formulation of more and more classes of antibiotics (cephalosporins, fluoroquinolones, tetracyclines, aminoglycosides,etc). The reason for the development of resistance is quite simple -- evolution. The lifespan of bacteria is in the realm of minutes; with each generation they undergo natural selection, and evolutionary pressures result in replication of ONLY the surviving population. Simply stated: if a population of bacteria is exposed to an antibiotic, only those who are resistant will survive. Only those who survive are able to reproduce (the resistant population) and we are left with clones of those bacteria carrying the ability to resist antibiotics. (Obviously the actual mechanisms are much more complicated than this, however that level of detail is not needed in this discussion.)
Each and every time antibiotics are used, the likelihood of a resistant strain emerging increases. Of course, antibiotics SHOULD be prescribed for conditions that they are needed for - bacterial infections. Pneumonia, urinary tract infections, bite wound/skin infections, just to name a few appropriate uses.
Prescribing an antibiotic for conditions that they do not treat, however, is an inappropriate use of a very important class of medications. It takes me about 3 times longer to explain to my clients why I am NOT prescribing antibiotics; honestly, it'd be easier for me to just cave in and give them the pills.
In the words of my mother -- "just because it's the easier choice doesn't make it the right choice." Responsible antibiotic use is a ethical obligation of the prescribing community, both veterinary and human.
A couple presented tonight with their kitty for a primary complaint of sneezing. He is otherwise young and healthy, eating and drinking normally, with a normal temperature. On physical exam, he has no nasal discharge, no ocular discharge, and no evidence of substantial illness.
His most likely diagnosis is a viral upper respiratory tract infection. Similar to the common cold in humans (although caused by different viruses), a viral URI will NOT respond to antibiotics. Antibiotics only kill bacteria, and do nothing to affect viruses. Most mild viral URIs will resolve without any treatment. Some do progress to involve bacteria; these patients usually have yellow milky nasal discharge, fevers, and are not eating. Bacterial URI does require antibiotics, however viral DOES NOT.
Most clients walk in expecting to leave with a prescription, so when I diagnose their cat with a suspected viral URI, and give them the above information, they get very angry. "Can't you just prescribe him antibiotics or something?" They say. "It will make me feel better to give him antibiotics..." and "Please, doc, it can't hurt anything, right?"
Wrong. Prescirbing antibiotics in this situation (or many others where they aren't indicated) only results in development of antibiotic resistance, as well as side effects on the patient from the antibiotics (typically vomiting or diarrhea), and does nothing to hasten recovery.
Antibiotic resistance is a real concern that affects each and every one of us - since the invention of penicillin in the 1950's, increasing numbers of bacteria have developed the ability to survive its use, resulting in the formulation of more and more classes of antibiotics (cephalosporins, fluoroquinolones, tetracyclines, aminoglycosides,etc). The reason for the development of resistance is quite simple -- evolution. The lifespan of bacteria is in the realm of minutes; with each generation they undergo natural selection, and evolutionary pressures result in replication of ONLY the surviving population. Simply stated: if a population of bacteria is exposed to an antibiotic, only those who are resistant will survive. Only those who survive are able to reproduce (the resistant population) and we are left with clones of those bacteria carrying the ability to resist antibiotics. (Obviously the actual mechanisms are much more complicated than this, however that level of detail is not needed in this discussion.)
Each and every time antibiotics are used, the likelihood of a resistant strain emerging increases. Of course, antibiotics SHOULD be prescribed for conditions that they are needed for - bacterial infections. Pneumonia, urinary tract infections, bite wound/skin infections, just to name a few appropriate uses.
Prescribing an antibiotic for conditions that they do not treat, however, is an inappropriate use of a very important class of medications. It takes me about 3 times longer to explain to my clients why I am NOT prescribing antibiotics; honestly, it'd be easier for me to just cave in and give them the pills.
In the words of my mother -- "just because it's the easier choice doesn't make it the right choice." Responsible antibiotic use is a ethical obligation of the prescribing community, both veterinary and human.
Subscribe to:
Posts (Atom)