The veterinary haunting: On the patient who could have been saved
Last month’s patient had perhaps a 90% chance of survival. Too bad I didn’t find out until after I’d euthanized her.
Just in time for Halloween, I’ve finally decided this scary story is worth telling. Equal parts cautionary tale and vehicle for personal catharsis, this patient’s case began with a near-tragedy: the owner’s.
After a personal medical emergency left her days in the hospital, this dog’s owner returned home to a very sick animal. A female shepherd mix, she’d been acting “funny” before her owner had suffered the healthcare crisis that led to her hospitalization. But it was nothing compared to her present appearance, one her well-meaning temporary caretakers had thought it best not to describe while her owner was recovering.
Cautionary tale point #1: Never leave your pet with people who do not share your views on animal caretaking.
When five year-old Casey finally presented at the hospital (as a new patient), her pulses were weak, her abdomen was painful, her temperature was low, she was desperately dehydrated and she could barely stand. She had been vomiting foamy liquids, unable to keep down even the barest amounts of water.
A previous close call with a chew toy meant that Casey’s owner was convinced of a gastrointestinal obstruction. Indeed, she was suffering all the telltale sigs of a peritonitis (intra-abdominal infection/inflammation), which could easily have been the result of a foreign body lodged somewhere in her bowels, possibly even perforating her intestines.
Cautionary tale point #2: Do not make assumptions.
Inspection of the X-rays showed severe gas accumulation in what appeared to be loops of bowel, but I had other suspicions.
Casey had never been spayed. The close call with the chew toy had left her owner with a bad feeling about her previous veterinarian and by now it had been years since Casey had received any medical attention. What’s more, her owner was not even aware of the small mammary gland tumor and was ignorant of her last heat cycle’s timing.
Cautionary tale point #3: A spay is basic unless you have a specific reason to choose not to have it undertaken. If you don’t spay, you must be aware of the possibility of certain common conditions and be on the preemptive lookout for their signs.
By now, most of you astute pet people will have the same bad feeling I did then: This is probably a pyometra (an infected uterus), which can look just like gas-filled bowel loops on an x-ray and is typically a terminal condition if it’s not treated. Eventually (just as with a bowel obstruction) peritonitis will ensue and basic treatment, once easily achievable via surgery, will now include critical care expenses and their risks.
At this point, I explained my suspicions and the need for 1) referral to a surgeon/criticalist team or 2) if she hadn’t the funds, an ultrasound and/or exploratory laparotomy (abdominal surgery) on site. Further, I cautioned that either problem––whether a bowel obstruction or the more likely pyometra––meant days of critical care ahead and the possibility of death, though far more so if this was the result of bowel obstruction should loops of bowel require resection and fecal material have seeded the abdomen.
The owner, convinced the uterus could not be the problem, deliberated briefly before electing euthanasia: “I would spend the money if I knew she could be saved but I won’t if there’s a high chance she’ll die.
Given her presentation, I couldn’t give her more than a 50-50, though the pyometra likelihood would mean a far better chance at survival. Hence my dilemma: How do I cast this case in a better light so I could change the owner’s mind? Is it even my role to present anything other than the facts?
Knowing, as I did, that my own pets would never lack for aggressive treatment in this case, I felt like shaking this owner out of her apparent stupor by telling her that any reasonable pet owner wouldn’t hesitate at a chance at life if they had the funds. But, as I eventually concluded (and maybe you’ll agree)...that would mean overstepping my bounds.
Instead, I euthanized her and was granted the right to explore her on my own afterwards...“for the improvement of medical knowledge that could be applied to future patients.”
And, of course, I found an uncomplicated pyometra––uncomplicated, that is, but for the extreme accumulation of gas in the grossly distorted uterus. Lacking any apparent peritonitis or any other obvious stumbling block, this dog would have almost certainly lived. But for the standard risk of anesthesia and post-pyo renal failure, that is. That's when the Monday morning quarterback in me identified the failure and chalked it up to chance...until now.
Cautionary tail point #4: Veterinarians should stick to the facts, but it’s OK to offer diverging opinions...even when the owner clearly doesn’t want to hear them.