unbelievable misdiagnosis

Re: unbelievable misdiagnosis

argyro koukouseli — Thu, 09 Feb 2012 22:58:01 GMT

easy mistake to make if you are not a vet.or if mild ascites and you havent clinically examined the dog or if you are not a vet or severe ascites and not clinically examined the dog.And i say clinically examine,cause 15years ago,with no u/s or xray, i saw and learned from my father how to diagnose a late pregnancy using my eyes,hands and ears.And if not sure,not to diagnose a late pregnancy .

Re: unbelievable misdiagnosis

Robin Grimmer — Thu, 09 Feb 2012 22:24:29 GMT

[quote user="argyro koukouseli"]

people in the waiting room went "hoaw!is that dog pregnant?"

but they are not expected to distinguish ascites from pregnancy,diagnose and be paid for it.we are.

[/quote]

There you go, easy mistake to make

Re: unbelievable misdiagnosis

argyro koukouseli — Thu, 09 Feb 2012 22:07:09 GMT

people in the waiting room went "hoaw!is that dog pregnant?"

but they are not expected to distinguish ascites from pregnancy,diagnose and be paid for it.we are.

Re: unbelievable misdiagnosis

argyro koukouseli — Thu, 09 Feb 2012 22:03:57 GMT

[quote user="Mark Rowland"]

[quote user="argyro koukouseli"]

of course,but we are talking about a dog with severe ascites mistaken for late pregnancy. in generall i agree with you.

[/quote]

people in the waiting room,saw the dog ,and went"hoaw!how many puppies are in there?" no one is expecting them to distinguish ascites from pregnancy or make a definite diagnosis and be paid for it.thats a vets job.

Well I did the same tonight, asked a female client when she was due only to be told she wasnt preggers at all....

Dont suppose Ill ever be a doctor then.

That was one short awkward consultation

[/quote]

Re: unbelievable misdiagnosis

Clive Ansell — Thu, 09 Feb 2012 20:05:41 GMT

[quote user="Martin Atkinson"]

[quote user="Niall Taylor"]

Exactly - like owners who don't want their cat speyed if she is pregnant - how can you rule out a pregnancy of a few days?

[/quote]

You don't you take the opportunity to get it done before the idiots change their minds!

[/quote]

And/or just forget to tell them.

Re: unbelievable misdiagnosis

Martin Atkinson — Thu, 09 Feb 2012 18:10:14 GMT

[quote user="Niall Taylor"]

Exactly - like owners who don't want their cat speyed if she is pregnant - how can you rule out a pregnancy of a few days?

[/quote]

You don't you take the opportunity to get it done before the idiots change their minds!

Re: unbelievable misdiagnosis

Dagmar Steele — Thu, 09 Feb 2012 18:07:15 GMT

Mark, I've been there done that... it didn't go down very well!!! ;-)))

Re: unbelievable misdiagnosis

Mark Rowland — Thu, 09 Feb 2012 17:52:18 GMT

[quote user="argyro koukouseli"]

of course,but we are talking about a dog with severe ascites mistaken for late pregnancy. in generall i agree with you.

[/quote]

Well I did the same tonight, asked a female client when she was due only to be told she wasnt preggers at all....

Dont suppose Ill ever be a doctor then.

That was one short awkward consultation

Re: unbelievable misdiagnosis

argyro koukouseli — Thu, 09 Feb 2012 17:47:30 GMT

two days apart,i know that owners sometimes wrongly acuse colleagues,but the details given by the owner about what she was told,that the bitch was carrying 10 to 12 puppies that were moving etc.anyway....this things do happen,but they shouldnt .

Re: unbelievable misdiagnosis

Niall Taylor — Thu, 09 Feb 2012 11:32:42 GMT

[quote user="argyro koukouseli"]we are talking about a dog with severe ascites mistaken for late pregnancy[/quote]

Are we really - as I said, we don't have both sides of the story.

Niall

Re: unbelievable misdiagnosis

Hannah Wynne Richards — Thu, 09 Feb 2012 09:54:45 GMT

What was the time span between presentation to the 2 veterinary surgeons?

Wynne

Re: unbelievable misdiagnosis

Lorna McHardy — Thu, 09 Feb 2012 09:51:46 GMT

Well, of course it's an incredible mistake to make. But, hands up everyone who has never made a mistake they couldn't quite believe they'd made once it became apparent they'd made it. (No, I'm not going to share mine!)

Re: unbelievable misdiagnosis

Gerry Henry — Thu, 09 Feb 2012 09:38:40 GMT

'I'm too old to know everything' - Oscar Wilde

Re: unbelievable misdiagnosis

argyro koukouseli — Thu, 09 Feb 2012 09:08:25 GMT

of course,but we are talking about a dog with severe ascites mistaken for late pregnancy. in generall i agree with you.

Re: unbelievable misdiagnosis

Niall Taylor — Thu, 09 Feb 2012 07:12:10 GMT

[quote user="Clive Ansell"]she could have conceived 3 days ago[/quote]

Exactly - like owners who don't want their cat speyed if she is pregnant - how can you rule out a pregnancy of a few days?

Niall

Re: unbelievable misdiagnosis

Clive Ansell — Wed, 08 Feb 2012 19:45:24 GMT

[quote user="argyro koukouseli"]

I was told by the owner that although they insisted that there is no possibility of pregnancy,the vet insisted on his diagnosis.

[/quote]

It is always possible. owners can be mistaken, and they do on occasions tell porkies.

I would never, never, never make the statement that an animal is definitely, 100%, not pregnant unless it is speyed. If I cannot palpate or visualise foetuses on US/rads I would be as vague as possible and say "I think she is not pregnant" , "she appears not to be pregnant" or "as far as I can tell she is not pregnant" she could have conceived 3 days ago?? Only If I can see viable foetuses on US with heart beats then a 100% positive diagnosis of normal pregnancy can be made.

Re: unbelievable misdiagnosis

Niall Taylor — Wed, 08 Feb 2012 18:46:21 GMT

[quote user="argyro koukouseli"]I was told by the owner that althouth they insisted that there is no possibility of pregnancy,the vet insisted on his diagnosis and said tha one should expect 12 puppies and to prepare a place for her to give birth.[/quote]

Hmmm, I'd certainly be getting the other side of the story before making any judgements

Cheers,

Niall

Re: unbelievable misdiagnosis

Jillian Hall — Wed, 08 Feb 2012 18:28:56 GMT

If you still have some of the lump, then that will probably be much more interesting to look at under the microscope than the fluid. Either take an FNA exactly as you would for a skin mass, or do some impression smears from a cut surface. This could give you a quick, easy (and cheap) diagnosis on the mass. But as mentioned above, expect bad things with an ovary.

Re: unbelievable misdiagnosis

argyro koukouseli — Wed, 08 Feb 2012 16:32:51 GMT

I was told by the owner that althouth they insisted that there is no possibility of pregnancy,the vet insisted on his diagnosis and said tha one should expect 12 puppies and to prepare a place for her to give birth.The dog was bearly able to breath,dehydratated and anorexic.If one doesnt want to pay you,you do not diagnose.I agree i should have insisted on the full package of operating ,biopsy,hospitalisation and not let them skip that part.But still there is a chance to re-think about it as i ve kept part of the tissue.

I do not get it cause you need to achieve a score at least 18,5 out of 20,to enter vet univercity and it is also hard to graduate it,20%of students drop out.

In any case ,my thoughts are that you have to be very very carefull about what you tell owners and make as sure as possible that they undrstood before leaving your office....

English is not my native language(pretty sure you can already tell...)so thanx for any corrections you take the time to make about the words i should use.

As for the fluid i want to make sure were did it came from

Re: unbelievable misdiagnosis

Hannah Wynne Richards — Wed, 08 Feb 2012 16:31:32 GMT

Again There but for the grace etc

Once a mass starts bleeding the abdomen fills very rapidly When was the bitch last in season ?

Was she allowed to roam, or did she escape?

31 years experience,and I still couldn't guarantee differentiating between a single pup and a large mass, if going on palpation alone-especially in a large bitch like a Rottie

Wynne

Re: unbelievable misdiagnosis

Bob Russell — Wed, 08 Feb 2012 15:55:34 GMT

There but for the grace of god do we all go! Not an unbelievable misdiagnosis but perhaps more than a little embarrassing!

I am not sure I would have the confidence to make any firm diagnosis with an abdomen full of fluid. Ovarian tumours are unlikely to be good news!

Re: unbelievable misdiagnosis

Clive Ansell — Wed, 08 Feb 2012 15:12:35 GMT

This reminds me of a case last year where a colleague saw a pair of Chavs with a Staffie that had whelped overnight, nad on exam, but said colleague advised that US scan or radiographs would be needed to confirm the abscence or presence of further foetuses - no money, so no investigation. 2 days later a dead puppy was passed, so Chavs were shouting "vet missed it" and "negligence" from the roof tops, it even ended up with a complaint to the RCVS who dismissed it as nonsense and no case to answer.

The point is that the puppy was not "missed", because the necessary investigations were not carried out. Take home message = always make good contemporaneous notes.

Re: unbelievable misdiagnosis

Robin Grimmer — Wed, 08 Feb 2012 14:09:02 GMT

I agree with above. Perhaps you should speak to the original vet before you accuse them of mis-diagnosis. There is always another side to the story - and I'm willing to bet money was involved as you said yourself they couldn't afford cytology, so presumably you also haven't done histopath on the ovarian mass? Maybe the original vet recommended investigation (and pregnancy would have been a differential) but the client refused due to cost.

I hate these sort of cases where owners want everything done but then say they can't afford this and that so you cut corners. If the dog had to have an ex-lap then I would say the histopath was mandatory and include it in the estimate and not give them the option of declining it. And of course they should have had her spayed years ago.

Re: unbelievable misdiagnosis

Neil Wheadon — Wed, 08 Feb 2012 13:47:22 GMT

If you've removed the mass, flushed the abdomen and the dog has recovered and the owners can't/won't afford more treatment, stitch it up, feed it lots and warn of metastatic spread, then everyone is happy?

Neil

Re: unbelievable misdiagnosis

Clive Ansell — Wed, 08 Feb 2012 13:28:13 GMT

How was the original "diagnosis" made?. If by abdominal palpation only, then one could argue that any palpable enlargement could be a normal pregnancy and just one of many possible differentials. If so I wouldn't use the term misdiagnosis or missed diagnosis.