Monday, January 23, 2012

We ALL Need Options!

There are many times I see a client and their pet when I curse myself for not being able to clone myself.

How do I keep myself available to all of my clients and their pets and still try to have a life with my own pets and my own family?

I grew up in a small town with a vet who lived over his practice, (Dr. Barsanti) and was available 24/7 to his clients. Now in my own defense I will say that he didn't have the luxury of an emergency clinic for his clients and patients to go to after hours, and he didn't have as many clients as I am serving. But the point is, his clients knew he was there for them at anytime they needed him and he was able to save many pets because people called him for help as soon as they needed it. They didn't wait until Monday when their dog has been vomiting profusely since Saturday afternoon, and they didn't go to the emergency clinic to be given an estimate they couldn't afford and therefore "elected euthanasia" because they had no other options. He was an Vet, a shoulder to lean on, a friend, and always available. His clients loved him, trusted him, stayed very faithful to him, and he built a respected and cherished practice because of these.

I know that there are many vets out there who need to be able to "turn off the clinic" and focus on their family, and I have not worked for a clinic that puts you "on call" so that you never get a full nights sleep. I understand and empathize with trying to wear every hat at every minute, it is an impossible task.

But I feel incredibly guilty leaving my clients to fend for themselves and be at the mercy of a new place, a new face, and a new set of hospital policies when my door isn't open. I am lucky to have two emergency clinics available to my clients within a 20 minute drive. The problem lies in the inherent nature of an emergency clinic. In most cases the emergency clinics are going to be more expensive than your local vet, and they have to provide you with a wide ranged estimate to cover all of the possible diagnosis. This wide range estimate means that you, the client, need to be able to provide a deposit for the mid to high range of their estimate.

I have many clients go to the emergency clinic and either leave without their pet because they could not afford to treat them, or left because they could not afford the deposit. Either way those patients don't get the care they need.

I use the saying "you do the best you can in life, and that's the best you can do." But medicine needs to be about treatment options..OPTIONS, you all always have options. Here is a story of a dog who needed lots of options.

On Wednesday morning while I was back in surgery sweating nervously over Wrens eyelid surgery a very very sick young Rottie walked in. I will call her DiDi. She had a sweet gentle face and was unable to move more than just picking up her head to look around. She was what we call "flat out." You could see the misery in her young beautiful face. She remained on the surgery floor while the vet and techs on her case gathered her medical information.

She had been found by the people who brought her in 4 months ago. She had not been to the vet since they found her, and they had no history on her. This is a very tough place for the vet to try to build a case when we have a very ill patient. We have no idea of vaccine status, age, history, etc etc. It makes your possible list of diagnosis long and difficult to dissect through.

As Dr. E came back to the surgery area I asked "what the deal with DiDi was?" She filled me in on the scant history and said that the people, (I will call them her owners, because at this point they are), said that "they had brought her in because they noticed blood on her backside." Sure enough she had a butt covered in dried blood. We spent a few minutes making sure that the blood was indeed coming from the rectum and not the urinary or reproductive organs. (Very important to know where the source of your bleeding is!) A digital rectal exam revealed a gloved finger covered in frank blood. She was definitely bleeding from her butt. But why?

Our first bit of detective work told us that we had a very sick young female dog in front of us. She appeared to have lost a significant amount of blood. She was depressed, dehydrated, and had more unanswered unattainable questions than we were going to find answers. So we started collecting any information that we could. Her blood work looked terrible, (honestly it usually does if you are dehydrated and you look terrible). She had a very high PCV (packed cell volume) and TP (total protein), so, OK even her blood knew that she was dehydrated. She had elevated kidney values, (dehydrated), and her temperature was low.

We took x-rays and found no additional clues to help here. By the time we had covered our basic diagnostics it was closing time. Our presumptive diagnosis was HGE (hemorrhagic gastroenteritis) so the i.v fluids that we had started a few hours ago were hopefully going to start to treat both the dehydration and assist her body in its own healing process. Because she was still so ill, needed to stay on i.v. fluids and needed 24 care we sent her to the local emergency clinic for overnight care. Her owners came to JVC to pick her up at 7 pm and headed with her to the ER. When they arrived there the attending vet gave her an exam and repeated the x-ray. She then reported to the owners that she believed there was blood in the abdomen and told the owners they needed to put down a $1500 deposit for her overnight care JIC she needed surgery. The owners called us back immediately and said that they couldn't afford to keep her at the ER overnight. So back to JVC she came. Certainly not ideal because we are not 24 hour and she couldn't be monitored overnight. But she needed her i.v. fluids and she needed a break.

The next morning DiDi looked worse. We knew she needed immediate intervention and she couldn't wait any longer. With a sad phone call to her owners we told them that her only two options were to euthanize her or go in to her belly and take a look. 20 minutes later she was on our OR table and we saw for ourselves what had her feeling so terrible. Her intestines were black from her stomach to her anus. She had been dying from the inside for at least 3 or 4 days.

She was put to sleep on our operating table and her owners were called with the terrible news.

She is a sad story with an unhappy ending but I am glad that we could give her owners some answers even if I still don't know exactly what happened to her or why.

She could have found a poison somewhere. She could have torsed (twisted) her stomach and the rest of the intestines that follow it, or she could have had some disease that just ravaged her entire gi tract.

I think of how many owners bring their pets in to us in search of treatment and options and how many of them never get either. It is heart-breaking to think that we can't at least offer some small answers and some hand of compassion without an estimate and a deposit.

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