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Case that is still bothering me

Published on: September 19, 2022 • By: ilovesplinter · In Forum: Dogs
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ilovesplinter
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September 19, 2022 at 05:48am
I had a case a few months ago that is still bothering me because we never got answers. I am a veterinary technician at a pretty large animal hospital. We had a patient that was an 11.5yo male neutered Shetland sheepdog presenting for inappetence, regurgitating, and lethargy for ~24hr. P had history of renal disease. We checked his values every 3 months to keep tabs. O states P was doing very well up until that evening when she noticed regurgitating then that next morning P refused breakfast. O gave P Cerenia tabs they had on hand and SQ fluids. O went to work for the day and returned home and P still would not eat and was lethargic so they brought P in. Ran labs and began P on IV fluids. Renal values were about the same as they were last we checked about a month and a half ago. P was anemic and albumin was low. CPL was normal. Otherwise, unremarkable to my memory. Kept P overnight for observation and fluids. P seemed less lethargic the next morning but was still regurgitating. He ate a small amount of canned food. We ended up keeping him for 2 more days as he wouldn't eat after that but his lethargy and weakness had improved. We hoped P would be more willing to eat at home. I took abdominal rads before we sent him home, they were unremarkable. Sent him home that evening. He did well that evening at home but still would not eat. The next morning he was still OK, but as the morning progressed P was so weak he would collapse when trying to walk so O brought him back in. Back on fluids he went for the day and that night. We had one of our doctors who were very good ultrasounds do an abdominal ultrasound and it was unremarkable other than some ascites, but not enough to tap, and mild inflammation of pancreas. Pancreatitis, but CPL is normal, and P has no history. Next morning I was hospital attendant and I noticed his breathing was off. I took thoracic rads and P had some fluid in his cranial thorax. No noticeable crackles in chest when doc listed to it earlier that morning. Not enough fluid to tap when looked on ultrasound. We start a plasma transfusion, thinking maybe the effusion and ascites are due to low albumin? About 30 minutes in, P begins to seize. O is notified and makes the call to euthanize. We never got a clear answer on what happened and it is eating me up because I'm very close with the owner. I feel like we kept giving O false hope because he would get better then worse. O was on board to treat anything, so the doctors on case encouraged them to keep trying. Any ideas would be greatly appreciated.
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Liz Buchanan BVSc MRCVS
Moderator
September 20, 2022 at 02:19am
Hello - this sounds like a very sad and frustrating case for everyone.  For vets, nurses and lab techs, there are a lot of peer support case resources that might be a better source to consult for this question, as this resource is actually specific to owners and you were obviously the professionals in the case.  There are many vet professionals-only  Facebook discussion groups, for example, and once registered with your membership number, you can even post on them anonymously.  Ideally point out what you do so that some specialist doesnt come along and blind you with specialist-level-science-speak, but they will have more scope (and more vet brains) to talk through this.  I think that the conclusion may be that more information may be needed - but you might be able to find the information out, especially if you team up with the vet.  For example, but you don't say anything about the type of anaemia, whether this could have been an error of the blood machine (was it double-checked with a slide, whether all the red blood cells were the same size or different, did any still have nuclei, etc)  Usually this would help to work out whether the anaemia was regenerative or non regenerative, which mahelp to pinpoint its possible origins.  Your vet will hopefully know this, or have tried to find out and certainly will have information that provides clues.  With pancreatitis, CPLi and ultrasound would usually give a reasonable indication, used
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Liz Buchanan BVSc MRCVS
Moderator
September 20, 2022 at 02:34am
together.   Giving fluids containing albumen can help in some cases but hinder in others - hopefully an appropriate group would tell you more about this.  However, I would suggest that your first port of call should be your vet, as in 'Can I talk to you about this case because I wasn't happy with it....?  If they weren't happy either (we vets do beat ourselves up) they may be glad to have soneone to talk it over with.  They might help you to post anonymously onto a site in order to see what other professionals said, in order to set both your minds at rest and help you both to know what to consider next time.  Previously in the veterinary industry, there has been a culture of not talking through difficult cases that staff may have learned from, because vets cultured a 'hero' image and didnt feel that they could say 'I dont know.'  That is fast changing  and case discussion is becoming much more acceptable, hence all of the wonderful groups case discussion groups that are springing up.  Wishing you the best of luck in satisfying your understanding of this case.
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