When pet therapies go wrong
It happens. You see a sick animal and you try to make it better: You plan to give it a drug or perform a procedure you expect will help. You inform the owners of the risks. They agree. You proceed. Then it all goes to hell when one of those risks, some bizarre reaction or any number of random wrenches thwarts your perfect planning.
Humans plan. God laughs. Too true. Read on…
Today’s disaster was a complex interaction of vet, owner, drug and dog error. I still haven’t sorted out the details but let it suffice to say that everything that could’ve gone wrong managed to do so with great flourish. I’m exaggerating, of course. At least Fido didn’t get run over by a bus…
So here’s the scene: A client comes in with her little dog for his annual exam. Every year I try to explain that the dog has serious health concerns and needs to be worked up. Every year I do just the basic bloodwork, always skipping the vaccines due to his generally poor condition (skin, heart, teeth, liver enzyme elevations, thyroid hormone aberrations, arthritis, etc.). I talk about chronic pain, Cushing’s disease, chronic valve disease, periodontal disease, primary liver disease and hypothyroidism…
This year we went through the same dance. But this time she caved…sort of.
This admittedly less-than-dedicated owner actually went so far as to explain that her pets are not her children. It’s not that she doesn’t have the money—it’s that she and her family have other priorities in life.
I respect clients like this. Especially when they give it to me straight. While it’s not how I like to practice, I can’t expect everyone to hold the same pet ideals and share identical vet care values.
But in my estimation this dog was less than comfortable. It was this “comfort” concept that she ultimately seized upon: “I don’t want him to be in pain. So what do you suggest?”
He was already taking a vitamin for his stiffening joints: the super-safe, tried and true glucosamine and chondroitin sulfate (which had helped considerably but was apparently no longer enough). So I suggested two drugs:
One for his heart—he had a whopping heart murmur and I was concerned it might march him right into congestive heart failure within the year if we didn’t try to head it off with a [low-side-effect] blood pressure drug.
The second drug was for his increasingly evident chronic back, hip and knee pain. Because his liver enzymes were elevated (and we were not planning to do anything for his liver, thyroid, adrenals or any other complicated inter-organ functions—per his owner’s request) I elected Metacam, a liquid NSAID similar to Rimadyl (see my post on this) but with fewer reported liver incidents under its belt.
We tabled the teeth for now with an eye towards tackling this next with routine antibiotic therapy if everything went well (since anesthesia was out of the question without working out the details of his internal issues).
36 hours and two doses of each drug later, this dog was vomiting. The owner had been advised to discontinue meds and call ASAP should any such symptoms arise. She did. I asked to see him. She said she’d watch and call in the afternoon. She did…at five o’clock. So I waited for him to come in.
By the time he arrived, the poor thing’s belly was very painful. I drew blood and took X-rays. The bloodwork was way worse than it was some 40-odd hours ago. Perhaps a bout of pancreatitis was brewing there. Then I developed the X-rays: Bits of bone or stone or some other mineralized debris was snaking its way through his GI tract.
I informed the owner—and showed her the X-rays. She promptly discarded the evidence with a well-turned phrase: “Impossible!”
Apparently this dog does not eat random debris—ever. And so what’s that stuff in the intestines? “It must be his dog food.” Alrighty then…Purina’s finally gone raw…I guess.
Despite the disagreement (which I did not bother to pursue), she accepted that her sick dog needed to be hospitalized so she wouldn’t have to deal with all the vomiting at home. No problem. Within a few minutes he’d received IV fluids, antibiotics, pain meds, anti-nausea injections, etc. and was set up to spend the weekend in a quiet cage.
Next day she calls me to assure me that the medication(s) I prescribed must have made her dog sick. All that stuff in his stomach? She reasoned that the drugs had made him feel so sick that he had taken to eating things out of the planter—something he never does (apparently her husband had taken silent notice of the behavior and reported it promptly on hearing of the dog’s subsequent crisis).
Now, it stands to reason that Metacam is my prime suspect for causing GI distress in this dog. NSAIDs are like aspirin and Advil. They can make a sensitive belly super-ouchy in no time. But once you stop the medication the tenderness tends to go right away. But not always.
And it also stands to reason that bits of random debris in a dog’s belly are not likely to make it hurt any less. In fact, such bits are likely to send an aching belly over the edge. Dogs can be silly. But that’s not his fault, is it?
Fido’s owner’s misperceptions would be of little concern to me but for the blame game she and I are currently playing—albeit at low volume. The inference is that Fido was fine enough before…and now he’s not. And while I’m willing to accept personal responsibility for my drug of choice (though it’s a perfectly defensible selection given the situation) I feel a tad odd about accepting responsibility for the entire spectrum of problems I’m seeing in this complicated case.
Given a second go at the situation I’d sure as hell never try this dog on any pain meds again. Today I feel guilty for even trying. But how can I live with myself if I’m not willing to try to make my patients’ lives better with the [carefully selected] tools I have at my disposal?
No doubt other professions have their similarly frustrating moments. I just hope mine doesn’t end in the guilt-blame axis of evil. After all, we can only do our best—and never stop learning…or trying.