Lil' Claire could use some prayers

[Elaine]

Lil Claire will be going into surgery in about an hour or so... we think there is an intestinal blockage... not entirely sure... would really appreciate some prayers right about now… and later I want to share the symptoms and early diagnosis.. so that it may help some of you in the future.

[Athy]

Oh, Elaine, prayers coming your and Lil Claire's way!

Athy

[Elaine]

Thanks. This started very simply, I wanted surgery ASAP. After a physical exam, blood work and two sets of abdominal x-rays (two views) the vet was confident it was NOT an obstruction. He thought it was HGE (Hemorrhagic Gastroenteritis), he kept her over night, on I.V. fluids and antibiotics (Flagy and Cephalexin ). This morning things are spiraling in the wrong direction. For those who know Lil’ Claire… as in indication of how bad she feels, she is actually doing what we ask. Empathically that is not Claire. She marches to her own drum, thank you very much. Her consent to do what we were asking should have been a significant finding of a serious problem. :(

Btw, unless the obstruction is metal it is not likely to show up on an x-ray. An obstruction is easy to miss. Last night I counted the socs in my laundry, one is missing.

[Athy]

This is true. My Emma ate a small cat toy that looked like a pom-pom a few years ago. The x-rays showed NOTHING. We gave her bowel stimulants and lots of baby food and after three or four days, she passed it. My vets tested the toy (yes, I dug it out of the poop and took it up to them in a plastic baggie) and sure enough - nothing on the x-rays.

She was spending her days at the vet on IV fluids and we planned for surgery but fortunately she pooped the toy out a couple days prior to the planned surgery date.

Kathleen was the person who suggested baby food. I fed it to her on a spoon and sure enough it gave just enough slickiness to push the whole mess out. A horrible time. I even managed to get a $150 dollar ticket driving her to the vet one morning.

[katdobemom]

Elaine
Sending good thoughts for your girlie.
Please keep us posted.
I know you must be on pins and needles.

[Elaine]

She is out of surgery... it was my soc... they had to remove part of her duoduem and about 9 inches of small intestine. The vet thinks she has HGE secondary to the blockage. She is on morphine…

[Tiburondobe]

Sending positive thoughts your way Elaine.

[doberdogsfd]

Bob and I are thinking of you and Arthur. Our most positive thougths and prayers are with you.

Kiss Claire when you see her and tell her to get well soon, her little cousins want to see her.

xoxo....Cheryl

[Elaine]

I am sure that Lil Claire will want to meet her cousins… she really loved the puppies from Brentina’s second litter… "love" might not be the right word, it’s more like, they looked up to her, and she appreciates being idolized.

[Lindsay]

Elaine-
I am so sorry to hear this....Please keep us updated, Lil Claire is in my thoughts.

[Athy]

The vet thinks she has HGE secondary to the blockage. …

Elaine, what does this mean? What is HGE?

[Elaine]

HGE stands for Hemorrhagic Gastroenteritis. Here is a link that can tell you about it more clearly than I can http://vetmedicine.about.com/cs/dogdiseasesh/a/HGEindogs.htm

[pretty dobe]

Oh Elaine, what a way to start the day....Thoughts are with all of you... Morphine, gee that is heavy duty stuff... Keep us all posted.... Poor baby..

Judie

[andyhilt27]

Elaine,
I am shocked and relieved at the same time. Sorry for the ordeal you and LC had to go through.

Was the sock clean or dirty?

My wife has to hide Amelia's socks from Eva. She even went so far as to hide a pair under the crib mattress. She found them of course.

Now if drugs or explosives smelled like baby socks I could easily put Eva to work. Until then if anyone has a lost baby sock give me a call.

Please keep us posted.

[Kissntell]

Don't know what to say to comfort you. All I can say is I have been through numerous vet emergencies and none of them are fun.

What a worry. I think since you found it, you should be on the mend though. It is the time spent finding what's wrong which is tough; but your lack of delay is key.

[Kissntell]

P.S.

Elaine...Of course you and your husband know that morphine should be closely monitored because it slows down heart rate and respiration. It might get tricky in dogs.

I just thought I'd mention it, not to offend you, but because I realize when things are like this you don't always remember all this stuff.

[Janice McGerr]

E,
I hope Lil' Claire is doing better today! We lost our Tease that way.
Our prayers are with all of you!

[Elaine]

P.S.

Elaine...Of course you and your husband know that morphine should be closely monitored because it slows down heart rate and respiration. It might get tricky in dogs.

I just thought I'd mention it, not to offend you, but because I realize when things are like this you don't always remember all this stuff.


Re: the morphine… we asked for a Fentanyl Patch… which as is pointed out above - must be monitored. The hope was that it would be efficacious and would motivate the clinic to take “good care.” Also, we had all of her blood work faxed to a medical professional on the West Coast… I think doing so had the effect of heightening concern in the clinic that they should use care.

From this morning, Claire is doing well, they walked her, she peed, (Claire is one of the cleanest dogs, the vet tech commented that she loves it when her patients are housebroken, problem is, Claire will hold it and at this point I really do not want Claire stressed, I almost wish she would simply pee if she has to, we can always clean it up… but Claire is Claire and she’d be mortified to pee in a crate) She is on I.V. fluids and cefazoline or cephazolin (which is a first generation cephalosporin antibiotic). Soon she will progress to ice cubes and then a liquid diet. She should be able to come home in 24 hours.

Here’s a comment that makes me wince… the vet tech says, “She is in so much less pain today… last time I saw her (which was before the surgery) she was is so much pain…” The tech then stops to edit herself, she must have visualized the steam coming out of my ears… I’m thinking, “What… you all let her be in what you now describe as ‘so much pain’ and you all were waiting to operate til it was convenient…” Grrrrr.


If there is a hero in this story it is Brenna… who listened to my recitation of Lil Claire’s symptoms, asked a few questions and pointed me in the right direction… which for Claire was surgery ASAP. And of course, Arthur was there every step of the way as well.


What we might take away from this is that unless the obstruction is something that shows up on an x-ray ( like metal or a rock) you simply can not rely upon a x-ray to rule out an obstruction… you may have to run the bowel to see what’s up.

Hospitals use sponges with metal stripping that will show up on x-ray (in case a sponge gets left inside). Arthur says we need to have socks with metal stripping that will show up on x-ray.:)

[Athy]

Elaine, I'm very glad to hear that Lil Claire is so much better this morning.

And you are correct, you cannot rely on a x-ray to rule out an obstruction. Many Dobes enjoy gutting comforters, stuffy toys and of course ingesting socks, dish rags or other soft items.

In Emma's case, she suffered a partial obstruction so even the barium series really didn't show us anything. But everything about her body and behavior said OBSTRUCTION. When her bowels shut down (stopped pushing), that was a clearer indicator. Luckily for me, the cisapride and the baby food managed to push the cat toy on out so no surgery required.

I think it's important to be tuned into your dog's body and behaviors. We often KNOW when something isn't right with one of our dogs - back is a wee bit hunched, demeanor is a bit subdued, not as much bounce to the ounce as usual. We shouldn't ignore those signs and Elaine, good for you that you did not.

This is a very interesting story about a dog and a peach pit. This particular dog started to refuse food - a sure sign of trouble - but it illustrates how damned sneaky an obstruction can be!

http://www.peteducation.com/article.cfm?c=0+1540&aid=1518


Anyway, you girls hang in there and send updates!

Athy

[katdobemom]

Elaine
We had a gal in rescue several years ago that had had an obstruction but sure wasnt "text book".
The gal had gotten a toy at Christmas time and had gutted it as many of our doberkids do. The dog didnt start to have issues until 6 months later. What had happened is a piece of the toy had "attached' itself to her tummy but was still allowing food to pass and no issues. The toy had started causing issues when it had become rock hard.
When the gal had exrays when they were trying to figure out what was wrong with the dog, it showed up. Can you imagine a piece of a toy staying and attaching itself in the tummy and not causing issues for months later.
They had given the foster parents what they pulled out during surgery and thats when it was realized it was A Christmas toy. It was rock hard.
The gal had recovered and went on to be adopted but this is one I will never forget.
Glad your girlie is doing well and sure bet she will be glad to be home.

[Lou's mom]

Sending good post-surgery thoughts, from a dobermom who's had it happen too...

[Kissntell]

Elaine, I have one of the best specialist vets here on the West Coast. He travels around the Country teaching other vets the trade and doing clinics.

Recently, I took Macy to him and he quickly diagnosed her ailment, contrary to the other vet, who didn't know where to begin. It was something simple in compared to what the other wanted to do.

This guy graduated at the very top of his school; and, having worked in the business, he has the talent, plus the dogs love him.

He only takes referrals from other vets, however he knows when I knock on the door its necessary. So if you need a real good guy just let me know.

Had it not been for him, I would have lost my best dog sooner. This guy is really talented and those types are hard to find.

[Elaine]

Thanks, Lil Claire is in good hands and doing well. Once we got the diagnosis right things went well and we have no complaints with the clinic she is at. They care, they are professionals and we are appreciative of their part in saving her life.

Can’t say that is true of all vets we encounter. Honestly, we are stunned by the utter lack of professionalism we see with some veterinarians. It’s as though there are no minimal standards of professional conduct at all, one or two need an MMPI and medication, the things these neurotic gossipy women do “behind the scenes” goes well beyond malicious.. their conduct is antithetical to any professional standard. From what we’ve experienced and what we’ve heard lately, I know others feel the same. There are a few of us who are about a heart-beat away from filing formal complaints with the appropriate medical boards. I can only say that if these lunatics ever come near any of our dogs again they will regret it. I’ve never been one to sit silently by, watching pettiness, jealousy and ugliness directed at good people... I find over the years I am less and less tolerant of psychotic individuals scurrying around like cockroaches in the dark, spreading their personal brand of filth and malaise. When this kind of conduct impacts me or the people we care for… we will respond… aggressively. I suspect others here on this forum feel the same. Most all of us "know where the bodies are buried" and have no reservations about going public.

[Rauschund]

Glad to hear that Claire is doing well......a couple helpful tips...of course a hamper with a lid for socks, underwear, and washcloths...LOL! BUT....believe it or not if your dog is a bit out of sorts and you are wondering....give them metamucil.....it helps to bring out the foreign object....my girl loves scrunchies for your hair....a little mineal oil on their food doesn't hurt either. I have no idea why the metamucil works but it does....I have had the surgeries, the close calls too.....it really helps.
My vet's rule of thumb is as long as they are drinking water....and holding it down....watch them.....a dog can go almost 3 weeks without food as long as they are well hydrated....most times they will pass things are their own...but if they throw up the water, don't walk, run to the vet!

[Patty Storkel]

Oh, Elaine,
I really hope to hear she's doing well today. One of my friends just went through the same thing with her beautiful 3 yr old wolfhound bitch. Unfortunately, while the initial surgery went well, she developed complications- leakage from all surgical attachment sites, and had to have everything redone. She initially appeared to be doing well following the 2nd surgery, then began to fail. They had to help her to the Bridge later that morning. They figured out that kay had torn up one of her blankets and had eaten several pieces. They had no idea what was going on until carol bagan seeing pieces of blanket in poop last week. Having multiple dogs, she didn't know which one was the culprit, so went on poop watch, and was able to determine which one it was. Got her to the vets the instant she looked at them crosseyed...

One thing i don't understand with this type of surgery (bowel resection and partial removal, etc.) is why they give them water and feed them so soon??
I was under the impression that the gut needs to heal a little before reintroducing solid food. This is what my dad died from, and they told us that it was because he drank water after surgery and developed a severe peritonitis... But maybe it's different with dogs??

Anyway, it would be nice to hear some good news.
patty & neala

[Elaine]

It’s amazing how many people have been through this… across all breeds. A friend was telling me that their family Labrador used to regularly eat socks and underpants… lived to be about 12 years old, did it his entire life… they’d regularly find the evidence in the yard. Now of course this begs the question, "Why didn’t the family make some changes to prevent it?" Not sure what the answer is, but some dogs are pretty creative about getting what they want. I’m fine with Lil Claire wearing a muzzle for a while…

Just got off with the clinic. Lil’ Claire is resting… overall she is bright and perky, she has eaten… they’ve taken her out several times to pee, but she has not had a bm… so she is staying put for now. I have no desire to race her through this… I’d rather wait and give her time to heal and get things going again before we take her home. I do not want to be rushing around at midnight trying to find a good vet to do a second surgery. Patty’s story above really touches my heart, what a horrible way to loose a beloved family member.

[Elaine]

Lil’ Clarie is home… got this photo with some of the hospital staff before we left. Claire is not remotely 100%, but she’s clearly on the mend. We have her on a liquid diet and Baytril, Cephalexin and she still has the Fentanyl patch. Can’t begin to tell you all how good it is to have her home… it’s like the best Christmas present ever. Home just isn’t home without my Lil’ Claire.

http://i394.photobucket.com/albums/pp21/logresfarm/1-23-09-hospital-013.jpg

[Athy]

I'm glad she's home, Elaine - I can see she had everyone trained just right at the clinic....

Athy

[doberdogsfd]

Glad she is home Elaine! How cute is she with her fans there in the photos!

Cheryl

[katdobemom]

Elaine
Looks like your girlie has the staff wrapped around her little paw:)
Glad she is home and on the mend.

[pretty dobe]

Elaine I'm so happy you have her home....She will mend faster in her own home with everything familiar. From the look of the picture, she looks like she is ready to go and didn't want to take the time for the picture. I've seen that look before....

Judie

[Elaine]

Lil' CLaire is eating... she is drinking... she pees, but she has not had a b.m. Surgery was Wednesday... anytine soon would be "a good thing."

[Niko]

Elaine- I am glad to hear Lil Claire is doing better. I hear your concern regarding the BM issue. That is one of the final issues to hope for post surgical. She will be fine she has done so well so far, she just wants to keep you on poo watch ;).

[Sheila]

Hi Elaine
Is she drinking lots of water??? I'm sure she'll go soon but maybe you could add a couple of tbsps of plain pumpkin to her food. Not spiced pie filler but the all natural stuff. Couldn't hurt her and might help.

Sheila

[Elaine]

Actually... Lil Claire is not drinking... but she is eating a very watered down liquid mix of canned with water... so she is getting fluids. Her temp is normal, her capillary refill time is normal, her pulse is normal... the Fentanyl patch is supposed to be removed today. She is on Baytril and Cephalexin.


http://i394.photobucket.com/albums/pp21/logresfarm/1-29-09-Claire.jpg

[andyhilt27]

poor girl

[Athy]

Aw, bless her pointy little head. She'll poop, Elaine, just give her time. She looks so pathetic.

And while we're on it, send prayers to Lucy, my neighbor's little Lab mix. She got a package of sugar free gum and ate the entire thing. They got hydrogen peroxide down her and she did vomit but she's not out of the woods. She's at the ER right now on fluids. It's always something.

Athy

[Elaine]

Lil' Claire pooped... thank god her bowel is waking up... there was still a remnant of a sock in the "product."

I am on my way to the vet to see about the I.V. wound, which is dehiscing (sp?) ... they say it is "normal" even though it is hideous this morning.

Athy, I will say a prayer for Lucy... keep us updated.

[Janice McGerr]

I am happy everything came out O.K.
She will be back to driving you crazy real soon!

[Elaine]

Just back from the vet… Claire is resting.

Thought I ‘d show you what we’re dealing with now… apparently this is “normal” .. I guess “normal” is a relative term, we all have different definitions…. all I know is that up until today, this kind of wound was not in my realm of “normal.”

The wound is from an i.v. site. It is behind Claire’s elbow, about 5”-6” across… exposing the layer of muscle beneath it. The tissue is dehiscing. Today Dr. John cut the center patch of skin out completely (it was dead tissue) … so there is now a big hole in Claire’s side. They flushed it, packed it with cotton gauze and raw (unpasteurized) honey… wrapped it back up and I’m home. I will re-bandage it each day… in a week or so he will stitch it closed (can't even visualize how he's gonna do that... but this is "normal" and "exactly what [they] expected to happen"). Supposedly this hole will fill in and all will be fine. She does not seem to mind too much. She was begging for treats from the techs right after Dr. John was done wrapping her up. She in on Cephalexin and Baytril... but not on pain meds, except that I can give her Tramadol as needed. The body is an amazing thing.


Hopefully the next person going through this will take comfort that dogs get through stuff like this. I have never seen anything like it... never.

And mom was right, "Pick up your dirty socks and put them in the hamper!!!" :)

http://i394.photobucket.com/albums/pp21/logresfarm/IMG_3839.jpg

[Patty Storkel]

How wonderful to hear she's doing well and has pooped. Who but devoted dog people could get excited about a dog pooping??!!!:D And that you're several days out from the surgery and she's healing just fine/along expected parameters. Prayers continuing for healing and patience for you as you deal with this new wound experience.
As an aside- the picture of her in her bed with her lampshade would make a great get well card...
And do you know about the new neck wrap/collar that prevents them getting at sutures and other owies, but doesn't restrict their vision? I got one for keenan, and they work really great. For him, the brace, i forget whet it's called, is about 12 ~ 14 inches wide, and long enough to wrap around his neck once and a half. It has velcro strips that you use to snug it around the neck, and a loop that goes from the bottom center through the front legs and attaches over the shoulders so they can't push it off over their heads. It's made out of some type of flexible plastic or ?? and is well-lined with soft padding. The dogs take to it immediately as it allows them full vision, drinking and eating access, but they just can't turn their head back to get at the owie. If i remember correctly, i paid about $35.00 - 39.00. I'll never use a lampshade again!
patty & neala

[Elaine]

And do you know about the new neck wrap/collar that prevents them getting at sutures and other owies, but doesn't restrict their vision?

IIf i remember correctly, i paid about $35.00 - 39.00. I'll never use a lampshade again!
patty & neala

I bought something from the vet... it was $39.00, inflatable… basically a ring around her neck… .. by the time we got home it had deflated…. and, turns out it was too big, so it fell off. :(

[Sonquest]

Soooo happy that Claire is mending!! What does the honey do?
Tina

[Athy]

And mom was right, "Pick up your dirty socks and put them in the hamper!!!" :)


And you should also put away your sugar free gum! Lucy my friend's Lab mix, came home from the ER yesterday morning and will be at the regular vet's for a couple days on IV fluids and having her glucose levels monitored until they level.

That Xylitol is no joke. Apparently the gum was a stocking stuffer from Mom and was just tossed on the counter top when the stocking was emptied. Thank goodness Mike knew to get hydrogen peroxide down her as soon as he realized she'd eaten the gum. They nearly lost her.

These dogs will keep you hoppin', no doubt about it!

Athy

[katdobemom]

All
I agree Athy. They def keep us hopping. I have been so fortunate in that I have never had an "ingester". Kayla is a chewer at 9 years old still and can do a number on a comforter, blanket, etc in seconds. Thank goodness she spits out the stuffing.
When we first brought her home many moons ago she did gut a feather pillow which warranted surgery to remove the feathers that had gotten up her nose.
They do keep us hopping.

[Elaine]

This was Lil Claire on January 28th.
http://i394.photobucket.com/albums/pp21/logresfarm/1-28-09-Claire-.jpg

http://i394.photobucket.com/albums/pp21/logresfarm/1-28-09-Claires-wound.jpg

[Elaine]

This is Lil Claire at the vet's this morning.

We discussed putting in a drain and trying to close the wound. The vet feels the wound is healing very well and that it will continue to do so. We opted not to put in a drain. We are going to continue the present course of treatment (with my cleaning the wound and wrapping it at home each day), for another week or so. At some point when the wound has healed to about the size of a nickel we will surgically remove some of the tissue and stitch it closed. Lil’ Claire has the spring back in her step, she is back to eating normally. She is up from post surgery weight of 54 lbs. to almost 57 lbs. Her normal weight is closer to 70 lbs., so she has a ways to go but “she’s Lil Claire” … she’ll get there.

We are using a product developed by a friend of ours - Dr. Bellows DVM .. the product is new on the market, it is called Bannixx and it seems to be working very very well. Here is a link to Bannixx http://www.victorycanter.com/Bannix-Hoof-Wound-Care-p-20866.html


http://i394.photobucket.com/albums/pp21/logresfarm/2-2-09-Claire-IMG_3908.jpg

[doberdogsfd]

Glad to hear she is doin gwell! weight going up is a good thing and it looks nice and healthy.

Kiss her for us!
Cheryl and Bob

[Elaine]

Lil’ Claire is not a big bitch and she is not a really high energy bitch. She usually eats about 6 cups a day… more if she’s been active. Her body mass and muscle are good, but not great. She is no where near the weight or mass of our other bitches. Here is a photo I took of her a month ago on 12-30-09. And naturally, if her ears are up, her tail is not, 'cause she's Lil' Claire

http://i394.photobucket.com/albums/pp21/logresfarm/Claire-on-12-30-09x.jpg

[dobesign]

Hey who is lil claire's red shadow? LOL. It's good to see she's on the mend. Sorry it's so much work for you. I would say that you should have it as easy as I do, but i'd be cursing myself for sure. NEVER EVER say, gosh it sure is quiet round here...Bah might hear you! Seriously, it's good to know that lil claire is getting a second wind. She's beautiful. But don't tell her I said that!

[Elaine]

Hey who is lil claire's red shadow? LOL.

The "red shadow" is your boy Warkant. Here’s the whole photo... he and Claire are looking at a tennis ball. As you can see, I am a slave to fashion.. all part of this elegant lifestyle of mine … as a Drs.’ wife. E2 can tell you all about it. :p And notice the great handling technique. Look where the leads are. Claire’s lead is half way down her neck. I should give classes, competitors would love it. :o

http://i394.photobucket.com/albums/pp21/logresfarm/Claire-W-on-12-30-09.jpg

[dobesign]

Claire looks as great as she'll let us see (she doesn't ever want us to see her at full potential because we might develop high expectations). But I WAS fairly certain that I recognised those exceptionally handsome feet!

[Sheila]

So glad to see the improvement!!!! Claire will gain back the weight in good time. Best she puts it back slowly. Certainly the would doesn't seem to be bothering her from the pix taken in the snow.

Sheila

[fabertdobes]

how could this happen, i am sorry Elaine but there is NO way i have ever seen or heard of this...i am very upset just looking at the picture. I would have cried my eyes out... i have no clue why this poor girl had to have this kind of intervention on the side of the chest...i am so sorry to see this:(

[Elaine]

Believe me, I understand your concern… just imagine how we felt. We think what happened to Claire is that some fluid collected in the spot that dehisced… and that she may have been laying on a heated pad after surgery, and was not turned, so that fluid filled spot got too hot.. and that possibly the morphine may have been a contributing factor too… the wound is like a pressure sore that people in hospitals get… it looks horrible… I have never seen anything like it, but the good news is that it is healing… and Claire is back to eating normally and generally being Lil’ Claire. I will take some photos of the wound again tomorrow so you can see how it is progressing… I am very pleased with how it is healing.

About crying my eyes out… you’d have to speak with Brenna… that may indeed have been my initial reaction… it's all a blur and I forget what I was feeling, but I realized early on that I really didn’t have the luxury of falling apart. Lil’ Claire needed me to cope… and I did. Most of us have a gear we can shift into when we have to deal with things like this. We step up and deal with it.

[dobesign]

No, E1 did not cry. Rage, confusion, and overwhelming concern? Absolutely! E1 was a consummate professional. Which was EXACTLY what lil Claire needed. And, as always, e1 has the tenacity of a pit bull and didn't freak out, get sqeamish, or disintegrate when everything happened all at once. It was a bit surreal. Or like that "Life comes at you fast" commercial. It's hard to be in a place where something horrid is happening and to realise that the skill set you have is about to be challenged. E1, you should be proud! Not many have that kind of Chutzpah! You go girl! And Claire...time to get better now, so sayeth rung tung tungsten...

[fabertdobes]

tied down after the initial shock...things like this makes me doubt about the security our dogs are in the hands of vets...i hate leaving them at vets now it will be more than ever...give Lil clair a big hug from all of us...happy she is on her way to better things and that food is one of her main goal
:o

[Elaine]

tied down after the initial shock...
Not sure what you are referring to when you wrote “tied down after the initial shock.” About Lil’ Claire, we believe she was simply laying on her one side too much and that turning her from side to side would have been a good idea.


...happy she is on her way to better things and that food is one of her main goal
:o
One indication that the surgery for the bowel obstruction was successful is that Lil Claire is eating well again and all systems are working.

The wound is healing… when it gets a bit smaller we will have it closed and put this experience behind us.


About trusting vets and their staff... though the wound has been "an experience" at this point in time we are comfortable with our relationship with the vets who treated Lil’ Claire. We’ve known them for a long time, they are used by most all the show people in our area. They have enjoyed a good reputation in this area for about 50 years. We trusted them. From what I hear, I believe they may be re-organizing some parts of their practice, including the management of staff. I don't have any more details about this and really have no other comments. I simply want this behind us.

Having lived all over the United States I can offer a few generalities. The quality of veterinary care really varies widely. It seems to me that we'd all benefit from a bit more professional oversight. Some vets aren’t professional on any level (either personally or professionally), some clinics are filthy, some clinics are poorly equipped, some have poorly trained and/or poorly supervised staff. There is room for improvement across the board. Some people love their vets without the remotest thought to what is going on in the practice. Can’t say that I’ve ever seen much correlation between the client’s devotion to a vet and the quality of veterinary service. I can think of vets - that client’s love - who probably shouldn’t be practicing.

[fabertdobes]

to being tied down is that i would have wanted to get her out of there immediately and would be looking for answers on how this could have happened and i could have made a scene right there n then...sadly being french i am VERY emontional and sometimes to much :(
this was what i meant, like my Mimi says i take things concerning my family of dogs and people very seriously and sometimes i dont think before my mouth opens LOL LOL

[Elaine]

Oh… Hmmm? How to put this?

I did not make a scene… I can’t see how doing so would have helped Lil Claire. If anything, it would have upset her and I wanted her to remain calm. That is not to say that it didn’t cross my mind that this was a mess that might have been avoided… but I do not want to go down that road. Life is short and I choose my battles; this is not one. The clinic has seen the wound. Ideally they have adjusted some of their protocols, but what they do is entirely up to them at this point. My goal is to get Lil’ Claire well. My hope is that someone may learn something from this experience, which is why I documented it and shared it here.

You should know the wound did not dehisce until after Claire was home. When Lil Claire left the clinic she had no wound at all, just a rough patch of skin. The techs/staff who discharged Lil Clare (the vets had the day off and were not in the clinic at the time) told me that the wound might “slough some skin.”

I’ll say!!!

One of my concerns is that if it were not for medical supplies we had at home because Arthur is a medical doctor, I would not have been able to wrap the wound as it started to dehisce. I am critical that the techs sent Lil Claire home if indeed they knew this large an area of skin was about to fall off. I do not know how the average pet owner would have dealt with all of this.

[dobesign]

Wounds typically dehisce several days AFTER the initial injury (often a burn that is thermal or chemical in origin) and occur often at the site specific to this injury, such as the suture line. Because this did NOT occur there nor at the site of the fentanyl patch, and it is deinitely NOT an IV injection site, it does suggest a mechanical burn. Often when dogs undergo a prolonged surgery, the will place heated IV bags around the and ON them to maintain their inteternal body heat. When the bag is too hot (and sometimes with a chemical catalyst like morphine) it will burn. But the wound will not dehisce until the tissue itself becomes necrotic. If the tech knew it would dehisce, then the time line would be two to three days in the future. It disturbs me that the tech knew it was going to do it, and didn't tell you why. Animals don't just slough/dehisce for no reason. There are treatments such as Biodress which would have occluded this nicely, slap it on, leave it on for a week then slap another on. A burn is a burn is a burn.I am sorry Claire had to go through this. And that E1 had to go through it...and that medical people put those we hold most precious in that place to begin with...I just hope the angels sit on Claire's shoulder from now on, and she never needs to set foot in a clinic again.

[OldDrumDobes]

Poor Lil'Claire she's had the long road to recovery! Hope things heal up nicely!!
Ali Doughty
Old Drum Dobermans

[Elaine]

Wounds typically dehisce several days AFTER the initial injury (often a burn that is thermal or chemical in origin) and occur often at the site specific to this injury, such as the suture line. Because this did NOT occur there nor at the site of the fentanyl patch, and it is deinitely NOT an IV injection site, it does suggest a mechanical burn. Often when dogs undergo a prolonged surgery, the will place heated IV bags around the and ON them to maintain their inteternal body heat. When the bag is too hot (and sometimes with a chemical catalyst like morphine) it will burn. But the wound will not dehisce until the tissue itself becomes necrotic. If the tech knew it would dehisce, then the time line would be two to three days in the future. It disturbs me that the tech knew it was going to do it, and didn't tell you why. Animals don't just slough/dehisce for no reason. There are treatments such as Biodress which would have occluded this nicely, slap it on, leave it on for a week then slap another on. A burn is a burn is a burn.I am sorry Claire had to go through this. And that E1 had to go through it...and that medical people put those we hold most precious in that place to begin with...I just hope the angels sit on Claire's shoulder from now on, and she never needs to set foot in a clinic again.

Thank you Brenna... I think you nailed what happened. Not exactly sure why, but having an explanation of this is comforting. The "this is normal; we expected it" thing didn't really fly.

[Elaine]

Just fed Lil' Claire and had her out... she is perky and running around like "Lil' Claire... but I am not as thrilled with all of this as I was a week ago.

The wound is healing... but this is starting to push me over a line.

The time-line here is that Claire was admitted to the vet clinic Monday morning 1/19/09 … I had called ahead, said I had a emergency... that I thought she had a bowel obstruction and asked that they do bowel obstruction surgery immediately that morning. The clinic vet did an exam, ran some blood work and took x-rays (two views) both in the a.m. (while I was there) and again in the p.m.. During the morning exam the vet noted a small amount of fluid (from fluid administered sub q) that had collected at the site behind her elbow on her right side, which is where the wound now is. Based upon the x-rays and physical exam the vet decided it was not a bowel obstruction… he thought is was HGE. They started her on i.v. fluid, metronidazole, cefazolin, flunicinamine and sucralfate. The clinic observed her Monday, convinced it was not a bowel obstruction, but HGE. Looking back I realize that the vet and the techs were saying rather "odd" things… e.g. Monday afternoon they were saying things were good and that she was “getting better” (she was dying from a bowel obstruction) and Wednesday, that she “was in much less pain" then she'd been on Monday (Wednesday she was on morphine). In hind sight, Claire was not getting better Monday and it seems reasonable that she was in less pain after the surgery, she was on a powerful pain med.

Late Monday afternoon I called the clinic saying I was missing a sock and that I was pretty sure Claire had swallowed it. Again, I wanted her operated on right then. The vet had left for the day and I had to wait until Tuesday. Tuesday morning, before the vet was in the clinic I had the office staff fax the lab work to Brenna. Brenna said “it’s an obstruction, probably in the duodenum or small intestine, they need to open her up ASAP and run the bowel to find it.” I called the clinic (the vet was still not there) and told them that it was an obstruction (most likely my sock), that it would not show up on an x-ray and that I wanted them to open her up ASAP and run the bowel. The vet arrived, he agreed, did the surgery, found the sock and removed part of her duodenum and about 9 inches of small intestine (which was necrotic). Immediately after the surgery the vet still said that she also had HGE, but that diagnosis seems to have slipped off the radar. Claire was on morphine during surgery and they put a fentanyl patch on her. They kept her in the clinic through Friday, when the tech’s discharged her. When I arrived at the clinic to pick up Claire, the techs showed me what was then a patch of skin (where the wound now is), that felt stiff... but was otherwise normal and said it would very likely slough off in the future. They gave me her antibiotics (with instructions on the bottles), they loaded Lil' Claire in the truck and off I went home, her without any paper work or medical records.

The next day the wound started dehiscing... barely noticable at first. I had never seen anything like it... I could not reach the vets. Claire’s temperature, capillary refill time and femoral pulse were all normal, she was not in distress, but by Sunday the wound was like the photo in #40. I was leaving messages at the vet's clinic… waiting for them to return my call. After a post here on DSNN, Andy found their home phone #... I called over a dozen times, but it rang to what sounded like a fax machine. So I faxed them that I needed to speak with them ASAP about Claire. Turns out the fax machine was on, but not set up to receive faxes (that is what my fax machine said when the fax did not go through). At about 6:00 p.m. (when I had run into town to find some more bandages), one of the clinic’s vets called. I missed her phone call by about 45 minutes. She was at the clinic but had not checked any messages, she was simply calling on her own initiative to “check up on Claire.” She left a message asking if Claire was "doing alright" ... but she left no phone number to reach her and there was no way to return her message saying, “Heck no, Claire is not doing all right!” Using caller i.d. I returned the call to the same clinic number I'd been using all day, and left yet another message at the clinic for them to call me back. They did not.

Sometime around 9:00 p.m. one of the vets finally answered their home phone. During the phone call I emailed photos of Claire's wound (including the photo that is posted on #40 of this thread). The vet repeatedly said the wound was "normal" ... that they "expected it" and that they were more concerned that Claire had not yet had a bm. It was agreed that Claire would be seen first thing Monday morning. I was at the clinic with Claire first thing Monday morning. Waited over an hour while walk in patients came and were seen, was finally seen… the vet said something flip about the messages made the day before, which apparently he'd heard or heard of. He cut away the dead tissue, applied a honey soaked cotton pad to the wound, wrapped it and sent us home. It was “normal' ... they 'expected it”… the rest is posted on this thread.

Claire was seen by another vet on Saturday January 31st for a second opinion. The second vet agreed that the wound was healing. He wanted to put in a Penrose drain. To do so he wanted to do another surgery... where he would make an incision (about 9 inches long) from the upper part of the wound to Claire’s withers, so that he would have enough loose skin to close the wound below. Not exactly sure how he planned to close the new wound above, but the whole things sounded like we'd be hacking poor Claire to shreds. Monday, Feb 2nd I went back to the original clinic, where they decided that the wound was healing well with the current treatment and that it would be best to let it heal to the point where the opening was about as small as a nickel and could be closed with simple surgery and a local. I agreed.

There may be details I am leaving out… but that’s the gist of it. The bill for all of the above is well over $3K.

[Kissntell]

Actually, I have only seen wounds like this from veniums bites like spider bites and rattlesnake bites on animals.

I'd also be letting it be known that I was not a happy camper.

I'd be on the states licensing board website looking at information.

To be a doctor with a business not watching that front is unreal. I would guess the vets working here have no vested interest in the business.

[Elaine]

I would guess the vets working here have no vested interest in the business.
The vets involved own the practice and one other. As I said in a post further above... I would simply like this to heal and then I want to put the entire experience behind me. At this point, the only reason to review it is to make changes in protocol so that it does not happen again... and so that others may learn from this. I will be happy as long as Lil' Claire heals.

God forbid this should happen again, but from this point on, I am not comfortable ruling out a bowel obstruction with an x-ray, but this is clearly a tricky diagnosis for a vet to make. I am not critical of the vets for any decision they made relative to waiting to do surgery... none of us want to be racing into surgery if it is NOT necessary. There were a few questions that Brenna asked (that the vets did not) that indicated it was an obstruction. However, since she has healed from the obstruction surgery the obstruction is a none issue.

As for the wound, obviously I wish it had not occurred... but that is up to the vets, their techs and their protocols to see that it not happen again. Here are some problems that I see, which can be easily remedied:

1. I think I should have had more information and some medical supplies before Claire was released on Friday, including written instructions and bandages to wrap the wound.

2. I think the vet should have given me a number to contact them, given that they say they knew this would happen. Or, I should have been trained in how to treat and bandage a wound like Claire's so that I was prepared.

3. Before being released, the vet and I should have discussed whether I was even comfortable treating the wound "they knew would come" or if maybe it was in Claire's best interest to stay a bit longer at the clinic so that they could treat the wound initially.

4. If you are going to allow messages to be left, you should check them and return calls from clients with post surgery dogs.

[Athy]

Any organization (even a veterinarian practice) should be interested in feedback geared toward process improvement. Your suggestions are on target, non-emotional and they should at least be willing to hear your feedback in a non-defensive fashion and consider incorporating some changes into their processes.

Lil Claire seems to be a tough little bird and will be good as new soon. At the same time, there is no sense in anyone going through all that if it can be avoided through a few process changes.

Athy

[Lou's mom]

What does the honey do?


"In addition to its antimicrobial properties, honey also appears to stimulate lymphocytic and phagocytic activity. These are key body immune responses in the battle against infection." from: http://dermnetnz.org/treatments/honey.html