Friday, April 9, 2010

Dr. heal thyself (NOT thy dog)

A while back, I was presented with an interesting and sad scenario.

The story was muddled from the start. We'd received a call notifying us that a client was bringing in a dog for euthanasia.

From the beginning, this went south. The dog was down in the rear. He had a history of severe hip dysplasia and had received intermittent treatment for this from (I assumed, and you know what they say about assume) a veterinarian. Apparently, his condition had recently deteriorated, and his owner was ready from euthanasia.

When the owner arrived, he summoned us to help him. The dog could not get out of the car. My tech went to help and was bitten (rather badly - 2 deep puncture wounds) in the process. When she came back in crying, I helped her clean up the wound and then went to assist the owner in getting the dog into the hospital.

By the time everything was settled (paperwork filled out, cremation selected), I had done a quick assessment of the dog - namely that he was panting extremely hard and could not walk. He was 13 years old and obviously uncomfortable, so I felt no qualms about euthanasia. I didn't do a full exam on him (listen to his heart, check his gums), as he was obviously suffering. I also didn't look at the intake form where the owner writes what they brought the dog in for. Usually, it's something stupid like "sick" or "emergency" - so I rarely glean much info from that.

As I was preparing everything for euthanasia, I got to talking to the dog's owner. Turns out that he was a human ER doctor. As I was slowly injecting the Euthasol solution, he was telling me that HE'D been the one treating his dog for his hip dysplasia. What had he been treating with? Non-steroidal antiinflammatory drugs AND steroids. Without even thinking, I said to him, "but not together, right? Don't want to cause GI ulceration."

When I looked up and caught the stricken, stunned look in his eyes, it dawned on me that yes, he had been treating his dog with both at the same time. Apparently, this is ok in humans.

The kicker? When I went to look at the dog's intake form, the reason for the visit was "euthanasia for melena."

Melena is a term for digested blood in the feces. It's a sign of upper GI ulceration and damage. And then it hit me. The dog wasn't down from his arthritis. He was likely down and dying from a perforated intestinal tract. As I was thinking this, pure blood diarrhea began pouring of the (now) deceased patient. I now realized why the owner's eyes had looked so stricken. He'd realized that the bloody diarrhea and weakness were a result of his medicating the dog himself. It was his fault the dog was down and weak and possibly dying.

Meanwhile, the dog's owner is up front, sobbing to my receptionist about how he "killed his dog." And while that is - in the strictest sense - true, I felt terrible that I had made him realize this. It was not my intent. I had misunderstood why the dog was there (for euthanasia, yes. For the problem I thought, no) - due to a combination of factors - the stress of getting the very large, very aggressive dog out of the car, my technician getting bitten, etc. Had I slowed down and done my full exam, I would have realized it was likely a GI perforation.

Would the outcome have been the same? was ready for euthanasia. On the other hand, I could have spared his feelings somewhat and broken the news to him gently. He DID need to know that NSAIDs and steroids don't go together - as he had another dog at home. I just would have presented it more delicately.

This is why MDs shouldn't doctor their own pets. The same goes for veterinarians. We shouldn't doctor ourselves (unless this involves sewing up a minor laceration or an xray of a sore foot or something)...that's why MDs went to med school and we went to vet school. Sure, there's a great deal of overlap - but it's not the same - as this case evidenced. That's why - when someone asks me something about human medicine - I just demur and say, "you'd better call your doctor. I'm an ANIMAL doctor."


Brendan Howard said...

Great blog, doc! I posted a link to this on our discussion board at

Life in vet school said...

Oh, god. That poor man - and that poor dog!!! That's incredibly sad. :( :( :( I don't think there was anything really wrong with what you said to him -- when you've essentially killed your own dog, NO PRESENTATION of that information is going to make it easier to swallow. In a way it's maybe better to just get it out there quickly.

I almost killed my dog, just with NSAIDs. He's 9 and has hip dysplasia, and he was on fish oil and 1 baby aspirin a day, and it seemed to be helping. Then we started him on Rimadyl after the removal of a small melanocytoma, just for a few days post-op in case he was sore (if I remember correctly, we stopped the baby aspirin when we started the Rimadyl). And of course I knew about the potential for GI ulceration, but I thought there would be warning signs!!! He went from totally fine (appetite, energy, demeanor, everything) to perforated in 48 hours. Thank the gods there was an awesome surgical resident on call that night, and an awesome ICU staff to take care of him for the next 2 weeks, and he pulled through. But that was hands down the worst experience of my life.

Elizabeth said...

That's strange that he didn't know that. Most GP's do not administer NSAID's and steroids together. At least where I live. The risk of upper gastrointestinal complications has been shown to be higher when steroids are administered concomitantly with NSAIDs.
I feel for the guy but there was no good way to tell him, none. I am hoping he learned a very valuable lesson.

Best in Flock said...

Wow. First time visitor to your blog and this was the first post I read. Really appreciate how open and honest you are in talking about your experiences. That was a really powerful/emotional story.

How horrible it must have been for both you and the owner to realize what happened in that instance. I couldn't do what you do (I'd spend way too much time being either heartbroken or really angry).

GuitarGirlRN said...

I say that all the time! Recently my dog bit a friend's horse in the rear leg (and got kicked, dog is ok); the wound was quickly infected and it looked like cellulitis. Also there was something that felt like subcutaneous emphysema in there--not a good sign in humans. Everyone was asking me "Do you think we should call the vet?" and my response was, "Uh, yeah! I don't know anything about what's normal in horses!!"

They waited until the next day to call and by then the horse was really sick. And I had a huge vet bill to pay!

Mary said...

Great post. My husband is an MD and while his understanding of the science can be helpful (he can have higher-level discussions with our vet than I can) I still remind him frequently that he is not a vet. I'm going to print this post off for the next time he needs to be reminded.

Hope your tech is OK.

Nicki said...

Rough case. Funny though-I recently told my hubby not to take NSAID with his pred. Guess it would have been ok after all? Here I was thinking the pharmacist should have told him that...

The Homeless Parrot said...

Nicki: I'm not sure. Apparently, some MDs allow it, some recommend against it. I don't think it has near the ulcerogenic possibilities that it does in dogs, but it is still a problem.