I have a dilemma, and I would like the opinions of those reading - vets, vet students, and pet owners alike.
About 3.5 weeks ago, I saw a small breed dog with a traumatically proptosed eye. The eye was not salvageable, in fact it was mangled. I told the owners that removal was the only option for this eye, and after much arguing, debating, and scrounging to afford it, they came up with the money for an enucleation.
Fast forward to today. The owner calls because the empty, closed eye socket has been having drainage since the surgery 3.5 weeks ago. He has been to his referring veterinarian with the dog, a culture of the drainage has been submitted, and the dog was placed on appropriate antibiotics. Once the antibiotics were stopped, the drainage came back.
Initially, I thought this was likely an infection - probably from the initial trauma to the eye. I did a quick VIN search though, and apparently, a not uncommon complication of enucleation is that some fluid producing tissue (conjunctiva or lacrimal tissue) may get left behind. If this is the case, re-exploration of the socket and removal of this tissue is necessary. In other words, the dog MIGHT need another surgery.
Here are my dilemmas:
1) First, as an ER clinic, we are not supposed to recheck clients. This is done by the general practitioner that normally sees the pet. So, I have not seen the dog and have no knowledge of the character of the discharge, where it's coming from, or any other detailed knowledge of it. I have no idea if this is a surgical complication or a consequence of the dog having been bitten across the eye and deep infection introduced into the socket. The pet HAS been seen by the regular veterinarian, and he is handling follow-up. Thus, I should not offer to recheck the dog. I think. We ER vets have to tread cautiously here.
2) If this is a post-op complication - do I refund the money for the original surgery? Offer to re-explore the eye socket for free (I'm not sure I would know what I'm looking for and thus, would likely have a more experienced surgeon present)? At this point, I have no idea if I have ANY culpability in this outcome. Post-op complications DO happen.
3) Do I call the referring vet and alert him to what I have found in my literature search? The biggest problem here is that the referring vet is none other than the one that was fired from my position years ago. He hates our clinic and takes any opportunity to throw us under the bus. Any other clinic, any other veterinarian, and I would already be on the phone - but I am so hesitant to call this vet. No matter what happens or what the case, he will try to blame me. That's not a good reason not to call, I realize.
I talked this over with our office manager and my husband, and I will tell you what they recommended, but I would like to hear opinions from you guys first.
Realistic Dog Model To Replace Cadavers
2 months ago