Thursday, July 21, 2011

Bones cont'd (part 2)

Lori went to her veterinarian for the day come Monday morning. She reportedly did very well. Normal vitals, normal physical exam, drinking, urinating, but reluctant to eat still. At 5:30, a colleague examined her, found normal vitals and a quiet dog. She sent her back to us for overnight monitoring. That clinic is 2 miles down the road from us. The temperature was around 90 outside. When Lori arrived 10 minutes later, she was laterally recumbent, spewing projectile brown vomit, with a body temperature of 105.

My heart sank. Was her intestinal incision failing? Were her intestines leaking? Was she becoming septic? Bloodwork did not confirm this suspicion, and after treatment with an anti-nausea medication, IV fluids, and cooling, her body temperature was normal, her vitals were normal, and she completely came around. Flummoxed, I assumed I was dealing with either a heat stroke or a manifestation of malignant hyperthermia - a problem that Greyhounds are genetically prone to having.

The owners were understandably distressed about this sudden shift and elected to take her to the 24 hour clinic in the morning, so that she could finish convalescing in one place and not have to be transported back and forth.

I sent a stable, quiet, alert dog out the door. When she left, her blood sugar was stable, she was not vomiting, she did not have a fever, and her belly was not painful. Her abdomen was severely, severely bruised - secondary to surgery. Greyhounds have very thin skin, and as a result, bruise like peaches. One of her clotting times was VERY slightly elevated- and I mean very slightly (4 seconds).

When she arrived at the specialty hospital, she remained stable. The intern, a new graduate, talked to the owners and gave them the same spiel I had. Dehiscence of the surgical site could happen any time in the first 3 days, she might need a plasma transfusion if her clotting times continued to elevate, and the like. It was nothing that I hadn't told them already.

They signed the consent to treat agreement, left a deposit, and left Lori in the care of the ER doctors. Five miles down the road, they turned around, came back, and elected to euthanize her!! She was stable, through the worst of it, and recuperating/convalescing. Apparently, the owners had had too much. They were concerned about Lori's quality of life. They were done in.

I am devastated by this. What I found in surgery -was it a red herring or was it truly causing her pain? Had I not taken her to surgery, would she have recovered with IV fluids and pain medications? Had I done more harm than good? Barring finding something on histopathology like cancer or severe inflammatory bowel disease... I will never know if what I did was right or wrong.

It was such a frustrating case.


Elizabeth said...

oh no... I could see if she was not stable but she was...

Anonymous said...

Dunno about the case of the original abdominal pain, but I agree with the subsequent differential of heatstroke or malignant hyperthermia.

Sometimes "I don't want to put her through it" translates into buyer's remorse: "I don't want to admit it, because the veterinarian will think less of me, but I can't afford to spend anymore money on this 10yo dog."

Sorry about the sad case. I've been there.