Case Discussion: What would you do?

[bassethoundlove]

Hi there,

I had to put down my 13 month old basset puppy on 4/20/17. I'm terribly upset. She was such a sweetie. Can you review the following case details from early on in her illness and tell me how you'd handle the following case upon presentation?

Around the beginning of the last week of March we noticed our puppy was slightly more lethargic. She was sleeping very late into the morning and we noticed that she was wetting her crate sometime during the night/ early morning. As the week went on we also noticed she was looking a little bit too skinny - this was a pretty muscular dog to this point but we were able to palpate vertebrae/ hips. Her appetite had been decreasing too. On the 27th and 28th she was lapping up a ton of water and having accidents all over the house. The next day we took her into a family vet due to the lethargy, weight loss, polydipsia, and polyuria (She had some coughing too for quite some time, i.e., weeks to months, but we just didn't recognize what a dog cough sounded like until we did some research after this appointment). He took a pretty comprehensive panel of labs, CBC, BMP, and UA. Her weight was 3# lower than her 6 month weight (43 pounds at 6 months, 40 pounds during the visit). She was also febrile at 103.9F. Lab work was completed STAT in office and all labs were WNL except for the following:

RBC 5.36M/microL
HCT 31.9%
HGB 11.1%
MCV 59.5fL
MCH 20.7 pg
Bands suspected
PLT 26K/microL
MPV 18.5 fL
PCT 0.05%
Creatinine 0.4mg/dL
ALB 2.2g/dL
Alk Phos 594U/L

Given that we live within 20 miles of three 24-hour animal hospitals with specialist vets on site, would you have tried to handle this anemia and thrombocytopenia yourself or would you have sent us out to one of the emergency facilities that day upon review of this bloodwork?

If you all want, I'll let you know the course of her illness over the coming days...

Thanks,
bassethoundlove

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[WhtsThFrequency]

Given that we live within 20 miles of three 24-hour animal hospitals with specialist vets on site, would you have tried to handle this anemia and thrombocytopenia yourself or would you have sent us out to one of the emergency facilities that day upon review of this bloodwork?

If you all want, I'll let you know the course of her illness over the coming days...

Thanks,
bassethoundlove

I'm sorry for your loss - it's never easy to lose a pet and especially a young one.

Unfortunately, asking us to publicly question another vet's judgement and especially when we have limited information on a dog none of us have personally physically examined (which is what it seems like it is what you are doing here) isn't really appropriate. It sounds like a red flag for a potential lawsuit.

 

[DVMDream]

I'm sorry for your loss - it's never easy to lose a pet and especially a young one.

Unfortunately, asking us to publicly question another vet's judgement and especially when we have limited information on a dog none of us have personally physically examined (which is what it seems like it is what you are doing here) isn't really appropriate. It sounds like a red flag for a potential lawsuit.

I was trying to think of a way to reply to this earlier in a manner that doesn't seem mean. I think you covered it very well.

OP, I'm very sorry for your loss, but if you have any questions or concerns perhaps sitting down with the vet who treated your pet to discuss those concerns would be best. Maybe once you've had time to grieve and can discuss the case with a semi-clear head?

 

[bassethoundlove]

I was trying to think of a way to reply to this earlier in a manner that doesn't seem mean. I think you covered it very well.

OP, I'm very sorry for your loss, but if you have any questions or concerns perhaps sitting down with the vet who treated your pet to discuss those concerns would be best. Maybe once you've had time to grieve and can discuss the case with a semi-clear head?

Thank you both for the condolences. I completely understand. I guess it would be kinda unprofessional to comment over the internet, lol. I am in no way looking to sue and I'm not really a confrontational kinda person so I doubt I'll ever discuss the early details of her illness with that initial vet. I am at peace that we did everything we could to save her based on the information professionals gave us. No regrets from my end and I can't change the past. I'm more so curious whether I should've followed my own gut from the start- ya know, if a human's platelets were in the 20's that would buy a ticket to the ER… I understand that you're operating off limited info, so no need to opine further. I get it.

It has been pretty tough. I feel like we did what we could and when you get a puppy you just don't expect to need to euthanize so soon. It's why we opted to get a puppy figuring the odds were higher that we'd get to keep her around for a while. We had a put down our older basset about 14 months ago (we are basset lovers ). Anyway, we met some awesome vets during her last days and I appreciated all they did to try and help her. I was so impressed with all they did and their professionalism in the final days. If I have another dog in the future, I'll be patronizing their business. Maybe you all feel this way, but you learn something new with the passing of each pet.

At the very least, thanks for letting me write this out!

 

[LetItSnow]

I'm more so curious whether I should've followed my own gut from the start- ya know, if a human's platelets were in the 20's that would buy a ticket to the ER… I understand that you're operating off limited info, so no need to opine further. I get it.

The only answer anyone can give to that question ("would a PLT in the 20s buy a ticket to the ER") is "maybe".

Just depends on the clinical condition of the patient, what diagnostics have been done, what diagnostics are available at the referral facility, what diagnostics the owner wants or is willing to do, what the attending clinician's interpretation of the case is, whether the patient would benefit from hospitalized therapy, etc. Just too many factors to say "yes" or "no". Sorry.

I will say this: My advice to any client that ever tells me that their gut is telling them something serious is wrong is: Listen to your gut. If you/they have the money/inclination to seek more advanced care, and you feel like your gut is telling you it's necessary, then do it. No referral facility will laugh at you for coming in with what turns out to be a straightforward case, and no GP is going to criticize you for wanting more advanced care than they can provide. GPs by and large are amazing doctors, but they have limits, and they know it. 90% of the cases I treat as an ER doc are completely treatable by the RDVM; they just weren't open, or didn't have time, didn't have the equipment, or the owner was scared/nervous and came directly to us, or whatever. It's fine. We'd rather have someone present early in the course of a less-serious disease than late in the course of very-serious disease.