Vet advice please
Discussion
Following on from my comments on this thread http://www.pistonheads.com/gassing/topic.asp?h=0&a... I could do with some advice perhaps from Bex or TheVet.
Our Springer Spaniel Lola was very poorly over Monday night, took her to the vet Tuesday morning, vet agreed to take blood to check for pancreatitis and also for liver function (liver function as Lola spent 6 months on high dose Prednisolone for an auto immune condition) and "other tests".
The Practice rang on Tuesday afternoon as promised with the result of the pancreas test and they advised that it was normal.
Lola has been poorly for the rest of the week so I made an appointment to take her in this morning as when I made the appointment first thing this morning she really wasn't any better.
Saw a different vet this morning who seemed to assume that I knew that they were of the view that her problem was with her pancreas.
They still don't have the liver results back but have others that are leading them to believe that it's pancreatitis and her symptoms fit.
We're feeding her a low fat diet and taking her back next week and she still seems to be improving.
I could do with some advice about why we got a duff first Pancreatic result - is this just "one of those things" or is there a problem somewhere?
They hadn't called me to tell me what they thought was wrong and I only booked today's appointment today so they didn't know I was coming in. I'm bothered that we were effectively just left with something that could have been hugely problematic. We have also not been helping her because we have been trying to persuade her to eat with high fat foods because we had been told that the pancreas result was clear.
Sorry, it's long
Our Springer Spaniel Lola was very poorly over Monday night, took her to the vet Tuesday morning, vet agreed to take blood to check for pancreatitis and also for liver function (liver function as Lola spent 6 months on high dose Prednisolone for an auto immune condition) and "other tests".
The Practice rang on Tuesday afternoon as promised with the result of the pancreas test and they advised that it was normal.
Lola has been poorly for the rest of the week so I made an appointment to take her in this morning as when I made the appointment first thing this morning she really wasn't any better.
Saw a different vet this morning who seemed to assume that I knew that they were of the view that her problem was with her pancreas.
They still don't have the liver results back but have others that are leading them to believe that it's pancreatitis and her symptoms fit.
We're feeding her a low fat diet and taking her back next week and she still seems to be improving.
I could do with some advice about why we got a duff first Pancreatic result - is this just "one of those things" or is there a problem somewhere?
They hadn't called me to tell me what they thought was wrong and I only booked today's appointment today so they didn't know I was coming in. I'm bothered that we were effectively just left with something that could have been hugely problematic. We have also not been helping her because we have been trying to persuade her to eat with high fat foods because we had been told that the pancreas result was clear.
Sorry, it's long
Hi, sorry not seen this earlier.
I don't know why you've had different info re: her results unless they ran the test twice. I'm also very surprised that you still haven't had the liver results back.
We can do these tests on site and have results within an hr of taking the blood. If we sent them away, we'd have them back the next day (unless the weekend)
I do feel there has been some communication breakdown which you need to get sorted, it doesn't sound great.
As for Lola, we usually admit dogs with bad pancrealities to put on iv fluids and give appropriate pain relief (it's a very painful condition) and monitor. Given her history I could see our vets wanting to do an ultrasound scan but it is a case by case scenario.
I reallly hope she picks up soon. Wish I could offer more useful info
I don't know why you've had different info re: her results unless they ran the test twice. I'm also very surprised that you still haven't had the liver results back.
We can do these tests on site and have results within an hr of taking the blood. If we sent them away, we'd have them back the next day (unless the weekend)
I do feel there has been some communication breakdown which you need to get sorted, it doesn't sound great.
As for Lola, we usually admit dogs with bad pancrealities to put on iv fluids and give appropriate pain relief (it's a very painful condition) and monitor. Given her history I could see our vets wanting to do an ultrasound scan but it is a case by case scenario.
I reallly hope she picks up soon. Wish I could offer more useful info
Thanks Bex, that's the kind of info I wanted, thank you.
I know some tests aren't conclusive (Lola didn't ever produce positive joint or spinal taps even at the height of her AI type issues) but we got a very positive "negative pancreatitis" call which is why I kept her home all week despite the fact that she wasn't improving.
I'm booked in again for Wednesday but I think I will ring on Monday morning to see if I can get in earlier in the week and I'll suggest an ultrasound as well.
One of my initial concerns is that the Uni vet never satisfactorily (in her own view) ruled out some kind of lurking infection in Lola
In your view what is the best way to deal with my concerns? Should I ask to see a Partner or the Practice manager? I don't want to make a huge fuss but I do want to understand what went on.
I know some tests aren't conclusive (Lola didn't ever produce positive joint or spinal taps even at the height of her AI type issues) but we got a very positive "negative pancreatitis" call which is why I kept her home all week despite the fact that she wasn't improving.
I'm booked in again for Wednesday but I think I will ring on Monday morning to see if I can get in earlier in the week and I'll suggest an ultrasound as well.
One of my initial concerns is that the Uni vet never satisfactorily (in her own view) ruled out some kind of lurking infection in Lola
In your view what is the best way to deal with my concerns? Should I ask to see a Partner or the Practice manager? I don't want to make a huge fuss but I do want to understand what went on.
Hmm, that's a tricky one as I don't know how your practice works.
If it were us and it was an assistant vet we'd probably advise the client to spk to the vet concerned and let the vet know an owner isn't happy. If the owner didn't want to do that then they'd most likely be referred to my boss who is also a vet (all our clients know her!) if I was dealing with the call I would probably get our boss to call the owner back (once I'd explained your worries) as it'd only be fair to give her chance to review the notes and speak to the vet concerned first.
If it was the boss herself she would spk to the owner herself.
Our vets are generally really good at communicating with each other and discussing cases with each other, they are also very upfront with their clients and we all take this kind of thing very seriously and would want to get it sorted. Errors do happen (thankfully not often) but it's how it's dealt with that makes the difference.
Our practice manager is more a business manager (and my bosses husband) so he would not deal with this situation.
I really hope Lola is on the mend soon. How is she today?
If it were us and it was an assistant vet we'd probably advise the client to spk to the vet concerned and let the vet know an owner isn't happy. If the owner didn't want to do that then they'd most likely be referred to my boss who is also a vet (all our clients know her!) if I was dealing with the call I would probably get our boss to call the owner back (once I'd explained your worries) as it'd only be fair to give her chance to review the notes and speak to the vet concerned first.
If it was the boss herself she would spk to the owner herself.
Our vets are generally really good at communicating with each other and discussing cases with each other, they are also very upfront with their clients and we all take this kind of thing very seriously and would want to get it sorted. Errors do happen (thankfully not often) but it's how it's dealt with that makes the difference.
Our practice manager is more a business manager (and my bosses husband) so he would not deal with this situation.
I really hope Lola is on the mend soon. How is she today?
Thanks again, I think I'll have a chat with the second vet at the next appointment either Wednesday or earlier and raise my concerns and see how they are dealt with. My usual concern with this practice is a lack of communication, it's always a different vet and nobody ever seems to actually take ownership of a patient. They are a fairly large practice and see to have a very high staff turnover at assistant level - I suspect vets use it as a good training experience in their early years and then move on.
Lola is looking pretty good at the moment, she's clearly not 100% but she's eating and she's got some energy - we've been for a very short walk with her and she trotted around at probably 60% of her usual speed. She is back to being her normally alert self and is not showing any signs of pain. I'm just not sure whether this is a definite road to recovery or whether we might expect another pancreatic flare up.
Lola is looking pretty good at the moment, she's clearly not 100% but she's eating and she's got some energy - we've been for a very short walk with her and she trotted around at probably 60% of her usual speed. She is back to being her normally alert self and is not showing any signs of pain. I'm just not sure whether this is a definite road to recovery or whether we might expect another pancreatic flare up.
Yes practice size can make a difference. We have 4 vets 1 is the owner 2 have been their about 10yrs and one 2 yrs and we try very hard to have vet continuity and if not we tell the vets so they can discuss it with each other (and we tell the owners)
I'm glad she us feeling better. Reoccurrence can depend on why it happened. Jimmy had it quite badly years ago but it was due to a specific food substance he had and thankfully hasn't suffered it since (my cat has had it more nd I now have to be careful with him) however if she has a chronic problem she will be more prone to flare ups so it will need more management with diet mainly then other treatments if she is bad. It's probably a bit early to know yet what will happen. I'll keep my fingers crossed that it's a one off.
I'm glad she us feeling better. Reoccurrence can depend on why it happened. Jimmy had it quite badly years ago but it was due to a specific food substance he had and thankfully hasn't suffered it since (my cat has had it more nd I now have to be careful with him) however if she has a chronic problem she will be more prone to flare ups so it will need more management with diet mainly then other treatments if she is bad. It's probably a bit early to know yet what will happen. I'll keep my fingers crossed that it's a one off.
Piglet said:
I could do with some advice about why we got a duff first Pancreatic result - is this just "one of those things" or is there a problem somewhere?
In house pancreatitis test is looking at 2 blue spots - if one spot is more blue than the other then its positive for pancreatitis - obviously subjective, especially if the spots are of similar intensity, and all diagnostic tests have a percentage of false negatives.Did the vets send off an external pancreatitis test too? Check your invoice, it should be on there if they did. This provides a numerical value to the test, and can be more accurate than the inhouse testing. Its possible this happened and was not communicated to you, hence the discrepancy between the phone call and the visit.
Pancreatitis is not easy to diagnose - there are cases where the tests are negative but if the pancreas is biopsied (gold standard for diagnosis) these cases are shown to have pancreatitis. If an animal has all the correct history and clinical signs for pancreatitis, its often best to treat for it regardless.
Personally I'm not a fan of ultrasound for diagnosis of pancreatitis - you need to be very very very good with the ultrasound to be confident of it, and it often doesn't change how to treat the animal. Fluids and choice of drugs are very much on a case by case basis, depending on the severity of the case, and impossible to comment on without assessing the animal.
OP, if you want to see the same vet, make sure you insist on it when booking appointments, but be prepared to be flexible about your appointment time to accomadate the vet's shifts. If the practice won't facilitate this, change practices, it's basic client care.
Update time: Lola is worse again and we've just had to admit her to the vets for IV fluids, pain relief etc.
She was OK up until last evening when she started to refuse food, then started vomiting again.
We took her in at 9.30pm for another anti sickness injection and agreed to see how she went overnight rather than admitting her then but she got worse overnight so she went back in at 6am, she's clearly in a lot of pain again.
Got some more detail last night on what may have happened with the testing, the inhouse test was negative, the external test then came back indicating pancreatitis BUT in the meantime they had rung us to say "all clear" and they hadn't told us that there was a second, external test being done. They then failed to act on the external results. I suspect ideally as GD says they should also have started to treat for pancreatitis anyway as with hindsight (wonderful thing I know) her symptoms were textbook.
The on call vet tonight and this morning says she heard Friday's vet raising the issue on Friday and said that there had been a bit of a "hoo ha" about it so it sounds like they recognise that there was a problem. I'll follow this up again during the week to ensure that the practice is aware of this.
Very empty house this morning
She was OK up until last evening when she started to refuse food, then started vomiting again.
We took her in at 9.30pm for another anti sickness injection and agreed to see how she went overnight rather than admitting her then but she got worse overnight so she went back in at 6am, she's clearly in a lot of pain again.
Got some more detail last night on what may have happened with the testing, the inhouse test was negative, the external test then came back indicating pancreatitis BUT in the meantime they had rung us to say "all clear" and they hadn't told us that there was a second, external test being done. They then failed to act on the external results. I suspect ideally as GD says they should also have started to treat for pancreatitis anyway as with hindsight (wonderful thing I know) her symptoms were textbook.
The on call vet tonight and this morning says she heard Friday's vet raising the issue on Friday and said that there had been a bit of a "hoo ha" about it so it sounds like they recognise that there was a problem. I'll follow this up again during the week to ensure that the practice is aware of this.
Very empty house this morning
Just thought I'd update this. We've not had a good week or so.
Our vets kept her in from early Sunday morning until Tuesday lunchtime, on fluids, pain relief etc. to try to help her pancreas.
When we picked her up she didn't look good, her ears were very low and she didn't look bright. We took her home and watched her carefully and by Wednesday night she was off food and struggling again.
She wasn't vomiting though so, in consultation with the vet we kept her home overnight on Wednesday and then took her in first thing Thursday morning.
As background on the previous Saturday night when we took her in for an anti-emetic injection, OH told the vet that he thought he could feel a lump in her abdomen, we asked for an ultra sound and a referral to the Uni Vet Hospital where she was treated before. These things hadn't been done all the time that she was with them - the vet said that there was no point doing an ultra sound as it would only show them that her pancreas was inflamed.
They hadn't progressed the referral so by the Thursday morning we were no further forward - they were suggesting that they would scan and xray on Thursday but we took her to the Uni Hospital as we were very concerned about her.
The Uni vet saw her immediately and could also feel a lump in her abdomen, they admitted her straight away, scanned her and found a mass in her intestinal wall. They operated and found that she had a very sharp bone in her lower intestine which appeared to have perforated the bowel wall, causing damage to the wall - they have removed a 10cm section of her lower intestine BUT she had peritonitis.
She came through surgery (on Thursday) well but there is a huge risk that the infection will reoccur, we were given a 50% chance of her surviving depending on what happened over the next 4 to 5 days. We are now at day 4 and *fingers crossed she seems to be progressing well.
It's a bit of a horror story and we still don't know if she's out of the woods.I still don't understand how a dog that is being seen by a vet and had been an inpatient for 2.5 days can end up with an undiagnosed blockage leading to peritonitis. I've asked the practice manager to ask one of the Partners to review and report back to me.
The moral of the story is to follow your instinct. I wish we could go back 5 or 6 days and I'd got her to the Uni Hospital earlier
Our vets kept her in from early Sunday morning until Tuesday lunchtime, on fluids, pain relief etc. to try to help her pancreas.
When we picked her up she didn't look good, her ears were very low and she didn't look bright. We took her home and watched her carefully and by Wednesday night she was off food and struggling again.
She wasn't vomiting though so, in consultation with the vet we kept her home overnight on Wednesday and then took her in first thing Thursday morning.
As background on the previous Saturday night when we took her in for an anti-emetic injection, OH told the vet that he thought he could feel a lump in her abdomen, we asked for an ultra sound and a referral to the Uni Vet Hospital where she was treated before. These things hadn't been done all the time that she was with them - the vet said that there was no point doing an ultra sound as it would only show them that her pancreas was inflamed.
They hadn't progressed the referral so by the Thursday morning we were no further forward - they were suggesting that they would scan and xray on Thursday but we took her to the Uni Hospital as we were very concerned about her.
The Uni vet saw her immediately and could also feel a lump in her abdomen, they admitted her straight away, scanned her and found a mass in her intestinal wall. They operated and found that she had a very sharp bone in her lower intestine which appeared to have perforated the bowel wall, causing damage to the wall - they have removed a 10cm section of her lower intestine BUT she had peritonitis.
She came through surgery (on Thursday) well but there is a huge risk that the infection will reoccur, we were given a 50% chance of her surviving depending on what happened over the next 4 to 5 days. We are now at day 4 and *fingers crossed she seems to be progressing well.
It's a bit of a horror story and we still don't know if she's out of the woods.I still don't understand how a dog that is being seen by a vet and had been an inpatient for 2.5 days can end up with an undiagnosed blockage leading to peritonitis. I've asked the practice manager to ask one of the Partners to review and report back to me.
The moral of the story is to follow your instinct. I wish we could go back 5 or 6 days and I'd got her to the Uni Hospital earlier
I'm so sorry for what you have been through (and for Lola) I really do not understand the reluctance for the scan. When I suggested it's what we'd do, it wasn't just to ck the pancreas but it'd haver also able to assess the rest of the abdomen. An xray would've sufficed.
I remember a dobi being opened up and they found a chip fork had r=preforated er bowel and was floating around the abdomen, her abdomen was flushed out with literally litres of saline solution, she survived without peritonitis. They can also survive peritonitis but if she gets it they will need to open her up again.
Keepng my fingers crossed for her. Do you know where she got the bone from?
I should add, that I cannot say if your vets have done anything wrong (though I am aware from what you have said, it doesn't look great) but I'm just going on what I think my vets would have done in the same situation.
I remember a dobi being opened up and they found a chip fork had r=preforated er bowel and was floating around the abdomen, her abdomen was flushed out with literally litres of saline solution, she survived without peritonitis. They can also survive peritonitis but if she gets it they will need to open her up again.
Keepng my fingers crossed for her. Do you know where she got the bone from?
I should add, that I cannot say if your vets have done anything wrong (though I am aware from what you have said, it doesn't look great) but I'm just going on what I think my vets would have done in the same situation.
Edited by bexVN on Monday 8th October 13:05
Thanks Bex and Jill, fingers are still crossed.
Bex, not sure about the bone, we feed her raw chicken wings and have done for years but the bone described was longer and very sharp and they did not think it was raw chicken as those bones are shorter and softer. We are always careful about cooked bones and she's not really a scavenger so I'm not sure where she would have got it.
She had peritonitis when they operated and they have washed out her abdomen, she'd first become unwell over 10 days before this so I guess things were getting very nasty. They have been monitoring ever since to see if there are further signs. They felt that if it recurred, in their experience, dogs who are as poorly as Lola struggle to fight it off, hence the odds.
I can't dare to breath yet, she's a tough little thing, but we really did think we'd lost her, can't bear to get my hopes up though.
Bex, not sure about the bone, we feed her raw chicken wings and have done for years but the bone described was longer and very sharp and they did not think it was raw chicken as those bones are shorter and softer. We are always careful about cooked bones and she's not really a scavenger so I'm not sure where she would have got it.
She had peritonitis when they operated and they have washed out her abdomen, she'd first become unwell over 10 days before this so I guess things were getting very nasty. They have been monitoring ever since to see if there are further signs. They felt that if it recurred, in their experience, dogs who are as poorly as Lola struggle to fight it off, hence the odds.
I can't dare to breath yet, she's a tough little thing, but we really did think we'd lost her, can't bear to get my hopes up though.
So long as she doesn't have any further problems, the vet hospital hope that they will be able to release her late tomorrow. We'll still need to watch her closely for problems but they are hopeful that having got this far the outcome should be positive.
Can't quite believe it and won't until she's back here x
Can't quite believe it and won't until she's back here x
Gassing Station | All Creatures Great & Small | Top of Page | What's New | My Stuff