Wednesday, September 22, 2010

My head: 0 Wall: 1

At 7:30am on Thursday morning, 30 minutes before I left for my week of relaxing, camping, football, and good friends, a woman rolled through the front door with her large breed (>60 pounds) male dog that had been neutered the day before at the local El Cheapo spay/neuter clinic.

The dog's empty scrotum was about the size of a cantaloupe or maybe a small melon. It was bruised, and blood was leaking from the incision site. This is a somewhat common post-operative complication of big dogs that are neutered later in life. It's called a scrotal hematoma - when there is marked hemorrhage at the incision site after surgery, and the scrotum fills up with blood. It looks downright horrifying but is rarely life-threatening. Treatment is usually strict cage rest, cold compresses, an e-collar to prevent self-trauma, sedation, and anti-inflammatory therapy (prednisone often).

In this case, the dog did not have a cone of shame on, and he removed his stitches for us. As a result, I had to sedate him to clean the incision site and re-suture it. She had the neuter done for $20! At our ER, sedating a big dog and sewing up an incision costs about $300. Of course, she didn't have it. After an hour of running in and out of the front doors, calling people, and applying for CareCredit, she finally procured the money. I gave her the option, since it was ALREADY 8am at this point, of waiting to see her veterinarian (who might be able to work with her financially) or going back to the spay/neuter clinic. She did not want to wait. She was very slow, and the sight of her dog bleeding sent her into near hysterics. No amount of explaining that her dog was going to be just fine could convince her to wait a half hour.

I sedated the dog, removed the chewed out sutures, placed new ones, cold compressed the scrotum, and administered anti-inflammatory medications. The dog recovered rapidly. Afterwards, I carefully went over his care with the owner - explaining that the incision would likely still ooze blood for a while, that cage rest was important, that the scrotum would remain swollen for anywhere from 5 days to 3 weeks. I also explained that RARELY, a scrotal ablation (complete removal of the scrotum) is needed if the sac becomes over-stretched. This is a last ditch approach due to the bleeding and the need for complete anesthesia again.

2 days ago, the incision was still oozing. The owner took the dog to her veterinarian. He advised her that the blood was old, the hematoma was healing, and she should go home and not fret too much. She called our office, demanding a refund yesterday because we "didn't do anything for her dog."


No, really?

I didn't sedate your dog and replace all the stitches he had torn out? Must have been somebody else at another clinic. Perhaps I was sleeping and dreamed that I repaired your dog's surgical site. But that doesn't really constitute doing anything, right?


Elizabeth said...

I am still reeling from a $20 neuter... did they just hit the dog over the head to knock it out and use a razor blade for the surgery...

CEVC said...
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CEVC said...
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The Homeless Parrot said...

Our local spay/neuter place does $20 neuters for clients receiving gov't assistance. Big, older dogs really need to be done with a laser to prevent this complication. Unfortunately, $20 neuters don't pay for lasers!

Holly said...

I've had this happen 2x. Once was with a colt that was gelded. I did the prescribed protocol but he started to clot up inside the scrotum which created a mass of blood/serum and had to be cleaned out. Once all that was done, you could see the new tissue grow in every day. It was a little gross to see the gelled blood/serum and it was totally amazing how quickly he healed once it was removed.

The other was with a rescue dog that had been neutered at a shelter clinic. When I picked this dog up he was 24 hrs. post-op, he looked swollen to me but I thought it could be due to not keeping him quiet. When I took him to my vet for stitch removal, she told me he was going to need it cleaned out but rescue was paying for everything and I did not have authorization at the time. The next morning his suture line split and he went back for a drain and flush/antibiotics/surgery to clean him out. He also healed fine.

One of the things I tell my training clients who don't believe in crating is that at some point they may HAVE to crate and tell them the story of Rodney the SBT. That had to be painful, if only from the massive amount of swelling and fluid in such a sensitive area.

However, the "you didn't do anything for me" bit.....I'd remember her. Oh yes....I'd remember her.

selfreliantguy said...

there are some clients that are just not considerate. no what your efforts are. they even have the nerve to ask for a refund.