Collapsed dog

Re: Collapsed dog

Richard Carter — Thu, 21 Nov 2013 17:59:11 GMT

yup - sometimes a fresh pair of eyes and brain will pick up what has been staring you in the face - then you need a helpful nudge in the right direction, hopefully before you have dug a hole too deep with the client.

Re: Collapsed dog

Gillian Mostyn — Thu, 21 Nov 2013 14:06:37 GMT

[quote user="Martin Atkinson"] I just wonder how many cases of Addisons are misdiagnosed as renal disease[/quote]

Guilty as charged. Luckily Ian picked it up when I asked his opinion on the bloods....

We can all miss things - having a chat with the vet was the best you could do. If they choose not to take your advice then there is nothing more you can do.

Re: Collapsed dog

Martin Atkinson — Thu, 21 Nov 2013 13:57:33 GMT

[quote user="Francisco Gomez"]I'd admit I had a moment of confusion when I referred a dog with 'suspected renal problem' to overnight care. [/quote] I suspect we've all been there especially earlier in our careers, I just wonder how many cases of Addisons are misdiagnosed as renal disease or because they are not classical and/or are subtle and episodic. I suspect Addisons is more common than the numbers actually diagnosed.

Re: Collapsed dog

Francisco Gomez — Thu, 21 Nov 2013 12:09:33 GMT

I think you did right. You tried to help a colleague and a patient, without getting anyone in trouble.

I'd admit I had a moment of confusion when I referred a dog with 'suspected renal problem' to overnight care. Vetsnow vet quickly picked up the electrolyte imbalance that I so idiotically missed and said: 'Wait a second', have you thought your dog maybe Addisonian instead?' ... and little (let's call him Jake) is still around having the happiest of lives with his florinef...

Re: Collapsed dog

An On MRCVS — Thu, 21 Nov 2013 11:57:26 GMT

I didn't say anything to the clients, but I did have a friendly chat with the referring vet, and told her that I was a bit confused by the owner's remarks about prednisolone causing the Cushing's. She said she thought everything was in order, so I left it at that. Maybe it's fine, maybe it isn't. At least now there's a good chance she'll go through the records and make sure.

Re: Collapsed dog

Hannah Wynne Richards — Thu, 21 Nov 2013 10:01:44 GMT

Another advising a friendly chat with the referring veterinary surgeon

Wynne

Re: Collapsed dog

Neil Wheadon — Thu, 21 Nov 2013 08:27:09 GMT

[quote user="Stephen Courtney"]That is all you should do[/quote]

[quote user="Stephen Courtney"]It is quite likely that the owner has the wrong end of the stick.[/quote]

[quote user="Stephen Courtney"]Look after the dog overnight. Send it back with to the original vets,[/quote]

Wise words.

That is all you should do, but pick the phone up and have a chat with the vet.

These aren't that uncommon, think of a referral clinician, they must get the 'Oh my goodness what an earth....' moment all the time, however clients are kept on side to all parties and the animal benefits.

Neil

Re: Collapsed dog

An On MRCVS — Thu, 21 Nov 2013 02:18:45 GMT

I don't like interfering with other people's cases, and I most definitely don't want to cause any drama or bad feeling, which is why I haven't mentioned my concerns to the clients or asked more detailed questions. I generally try to deal with this sort of case the way I would like it to be dealt with if the shoe was on the other foot. If the dog hadn't been given prednisolone this afternoon I might have done an ACTH stim test and found a nice, friendly way of explaining why.

The referring vet is a recent graduate who doesn't seem to get much support, and the Cushing's diagnosis may not have been her doing in the first place. I'll speak to her in the morning before sending the dog back and see where the conversation takes us.

Re: Collapsed dog

Stephen Courtney — Wed, 20 Nov 2013 23:47:15 GMT

Look after the dog overnight. Send it back with to the original vets, with written notes summarising what you have told us, and recommending that the new vets investigate the circumstances, based on what the client told you.. It is quite likely that the owner has the wrong end of the stick.

That is all you should do. If it was my case i would be grateful for someone pointing a potential issue like this out, but be careful not to create issues with the client that could prove awkward.

If it had prednisolone then an ACTH stim won't be useful until the pred is out of the system

Re: Collapsed dog

Michael Woodhouse — Wed, 20 Nov 2013 23:46:44 GMT

Without a full history I'd be wary of taking the owners word as gospel - they could have conveniently forgot the dog was off steroids for 2 months prior to diagnosis.

Do you ever speak to the referring vets on the phone or just email/fax? Maybe a quiet word in someone's ear might be wise, for the dog's sake. Not fair to have the dog on lifelong treatment it likely doesn't need.

(I don't believe for a single second that the Piriton has made any difference, another vial IV can make them a bit sleepy )