So, if you read my last post, then you have been introduced to the concept of caval syndrome - a massive overload of heartworms found in the right heart leading to right heart failure. As I outlined, there is only one way to treat it - extract the heartworms manually from the heart. This is done by isolating the jugular vein, cutting into it, and placing a long, long pair of forceps into the heart. The worms are grasped and removed via the hole. It is a bloody, messy procedure, and it has a 50/50 shot at working. Further, I have never done the procedure.
Here is my question for you, readers. If a patient comes through the door suffering caval syndrome, the owners are appraised of the risks, outcome, my inexperience with the procedure, and the prognosis, and they want me to TRY to remove the worms, should I attempt to do it?
My colleagues and I recently got into a heated debate about this. I have seen 3 caval syndromes in 18 months. Two of them have died within 30 minutes, the last was euthanized. None of them would have survived to go to a referral facility where the worms could be removed by specialists. It was me or nobody. If the owners had wanted me to try, I would have done it - as I see no other option for the pet, save rapid death or euthanasia. My colleagues say that I shouldn't be doing something like that without experience. I argue that I am the pet's only chance for survival, and it is my job to intervene if I can.
If we, as veterinarians, didn't do things outside our comfort level, no GDV would ever be fixed, no pericardium would ever be tapped, no foreign body would ever be removed. I still remember vividly every time I did all 3 of those things for the first time. It was nerve-wracking, but it was necessary. If I could refer these cases to a specialist, I would do so. However, as I said, all 3 lived less than 30 minutes from the moment they arrived on our doorstep.
So, what do you guys think? Intervene or push euthanasia?
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