As much as I hate to tell the ending to this story...
Lilly rallied and was doing well Monday night. Her condition continuously improved. Prospects were looking good for her survival. Then her parents decided that they no longer had the finances to pursue treatment. They euthanized her.
I was stunned and crushed. To drag her through all of that, only to have her euthanized! It was such a blow.
To top it off, I feel like I wasted $5000 of their money...
I'm so sad. :(
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Stories from the ER veterinarian world
DISCLAIMER
Any similarity between my stories and any person or animal, living or dead, is strictly a coincidence. Names, breeds, sexes, and details of the stories have been changed to protect the guilty and innocent alike.
About Me
- The Homeless Parrot
- I am an emergency veterinarian in North Carolina. Despite the crazy people I deal with, the awful cases of injured and sick animals, and the overall stress of emergency work, I absolutely love what I do. Happily married since I was 20, I have a wonderful husband who has a PhD in Mathematics, and a daughter around whom our world currently revolves. We also have a zoo living in our house that can be alternately wonderful and maddening. There are cats, parrots, and a dog who is very low on the totem pole. Our days are never dull and we are learning to balance the demands of work and family. If you'd like to contact me: homelessparrot@gmail.com
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Medical terminology
- Azotemia - elevation in kidney enzymes (BUN and creatinine) indicating dehydration, kidney failure, or urinary obstruction
- Lactate - a salt/ester of lactic acid that is produced as energy for a cell when oxygen levels are low. In critically ill animals, elevated lactate can be an indicator of inadequate blood flow to organs (perfusion), decreased delivery of oxygen, and/or decreased oxygen uptake. Values > 6-7 are usually considered to be poor prognostic indicators for survival.
- GI sloughing: when the cells lining the GI tract die (can be secondary to MANY things, including heatstroke) with resulting bloody diarrhea, bacterial translocation into the bloodstream and sepsis
- TTJ: transfer to jesus: code for when an animal needs to be euthanized or die
- DIC: disseminated intravascular coagulation: a very, very bad thing - when the hemostatic system gets out of whack, and clots start forming in the blood vessels until all clotting factors are wasted. once those are gone, internal hemorrhage ensues, followed by death, usually. also known as "death is coming"
- Pleural effusion - fluid contained in the pleural space (chest) - this is not the same as fluid in the lungs (see pulm edema) - in cats can be caused by infection in the chest, heart failure, cancer, FIP, feline leukemia, FIV, and in some cases, the cause is never found (idiopathic)
- Anisocoria - unequal pupil size (related to any number of causes including brain damage/head trauma)
- Laterally recumbent - lying on side, unable to rise
- Hyperglycemia - elevated blood glucose
- Hyperkalemia: elevated blood potassium - a life-threatening condition related to several disorders (kidney failure, antifreeze toxicity, urethral obstruction...etc)
- Sepsis - refers to a bacterial infection in the bloodstream or body tissues. This is a very broad term covering the presence of many types of microscopic disease-causing organisms.
- Nephrectomy - kidney removal
- Splenectomy - removal of spleen
- Pulmonary edema - condition in which fluid accumulates in the lungs, usually because the heart's left ventricle does not pump adequately ( can be caused by heart failure, electrocution, drowning, too many IV fluids, to name a few)
- Tick borne diseases - any of a myriad of diseases transmitted by ticks - including but not limited to Rocky Mtn Spotted fever, Lyme disease, Ehrlichia
- Fine needle aspirate - A method of sampling in which a needle is used to suck in cells or tissue bits for diagnoses (good for diagnosing masses/lumps)
- Blood glucose - The principal sugar produced by the body from food–especially carbohydrates, but also from proteins and fats; glucose is the body's major source of energy, is transported to cells via the circulation and used by cells in the presence of insulin (normal range in a dog/cat is 75-100)
- PCV - packed cell volume - the volume of packed red cells in milliliters per 100 ml of blood (normal range 35-45)
Diseases I see/treat frequently
- Dystocia - difficulty birthing. May be responsive to oxytocin administration (Pitocin, as in people) but may require c-section.
- DKA - diabetic ketoacidosis: the extreme end of the diabetic scale. A patient that is diabetic can develop DKA when other diseases make the blood glucose hard to regulate. Other diseases that are commonly associated include urinary tract infection, pancreatitis, pyometra, skin infection, and cancer. In DKA, the body starts metabolizing fat and producing acids that cause a drop in blood pH, nausea, weakness, severe dehydration, electrolyte derangments, and death.
- DCM - dilated cardiomyopathy: an idiopathic (cause unknown) cardiac disease in which the heart chambers become very thin/dilated, and cardiac output drops radically. Causes arrhythmias, tachycardia, and sudden death. Seen in large breed dogs like Dobermans, Great Danes, etc.
- Lymphoma - cancer of the white blood cells, the most common and treatable form of cancer in dogs
- Blocked cat - slang term for a male cat with a plug of mucus and crystals obstructing the urethra (fairly common in male cats) definitely a life-threatening because urine can't get out of the body! If present long enough, causes shock, acute renal failure, hyperkalemia (elevated potassium), coma, and death. Symptoms include straining in the litterbox, yowling while trying to urinate, producing small, bloody drops of urine (also symptoms of feline cystitis, a non-lethal condition)
- GDV - stands for gastric-dilatation and volvulus - a condition of large breed, deep-chested dogs (usually) in which the stomach rotates 180 degrees on its axis and thus - nothing can enter or leave, considered the "mother of all emergencies" - it warrants immediate surgery and carries a guarded prognosis
- IMHA - immune-mediated hemolytic anemia. A disease in which the immune system attacks the red blood cells and destroys them. It causes profound anemia and is life-threatening. Causes are primary (no known cause) and secondary ( tick borne disease, cancer, and heavy metal intoxication). Treatment is immunosuppression with drugs primarily. Prognosis is guarded at best.
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10 comments:
Wow I am very surprised. That is not the ending I was expecting... I'm sorry to hear that :( :(
So sorry. It hurts to lose. In this case, it sounds like everyone did.
Wow, that must be very hard on you... all the work plus the emotional ups and downs. But I'm sure it was even tougher for the family. You did MORE than the best you could for your patient, so focus on that! Such is life.
What a tragic end to immense heroic measures you took to save this dogs life. You are more than a great vet...you are a great human being. The passion you put into your work is heartwarming and impressive. This is a tough loss for all involved. My thoughts and prayers are with you.
*lets breath out*
I'm so sorry.
I'm sorry for you, and Lilly and her folks. To work and fight so hard......then to lose to money.
Thank you for all the thoughts. I was crushed when I called and heard the news. It's important that I did what I could, but if I'd known that would be the outcome, I never would have wasted the owners' money!
I was so discouraged to hear this outcome.
It is important for you to remember than you did not waste the owners money. You did what you were trained to do and did it well.
They chose to waste their own money by throwing it away.
I'm so sorry -- had been hoping for a better outcome.
WHAT?!?!? They euthanized her when she was IMPROVING?!?!? How the heck did they rationalize that?
I hope that I never understand people like that. :(
I found that this outcome was not uncommon in emergency. I remember very clearly a vet I worked with bringing back to life a cat that had been brought in with no heartbeat or respirations. Absolutely amazing. The owners were hysterical and said to do anything. The next day we transferred the cat, who was improving, to specialty and the owners euthanized due to money despite a good prognosis.
I try to be non-judgmental. People are very emotional and want to do everything in the heat of the moment. Reality doesn't set in until later. Non-medical folks have a hard time understanding how long recovery can take. They may not believe the estimate. I do think euthanasia is reasonable if someone runs out of money, if they're going to lose their house etc. I honestly don't know what I'd do in such a situation so that makes it easier to withold judgment.
I suspect these owners simply didn't understand how long a full recovery could take and how sick their dog was. They might have unrealistically hoped for a much faster turn around. And in the midst of such an emotional event, they might not have really heard or comprehended the amount of money involved.
You can't fault yourself for their not understanding. No matter how well you explain stuff, sometimes it just doesn't sink in.
I feel bad for the dog, going through all those invasive procedures and surgery only to be euthanized.
And by the way, excellent work on the medical end of things, I'm beyond impressed!
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