Epistaxis after Sodium Thiopental

Re: Epistaxis after Sodium Thiopental

Martin Atkinson — Tue, 07 Jan 2014 17:25:40 GMT

[quote user="Starling"]

If you were in our situation, wanting to do something but "low cost" what have you done?

[/quote]Given that retrospectoscopes and crystal balls are in short supply right now and if available would be prohibitively expensive anyway, I'd have done the same as you. You will learn from the experience and may choose a different approach next time but if the will or funds are not available you may still make the same decision. Don't worry, move on.

Re: Epistaxis after Sodium Thiopental

Hannah Wynne Richards — Tue, 07 Jan 2014 15:53:44 GMT

It always happens to the nice ones.

Wynne

Re: Epistaxis after Sodium Thiopental

Christopher Saul — Sat, 04 Jan 2014 18:29:36 GMT

You most definitely did the right thing. Even if they had found the money, I reckon better than evens chance that they would have ended up with a paralysed dog anyway.

Chris

Re: Epistaxis after Sodium Thiopental

Starling — Sat, 04 Jan 2014 18:15:33 GMT

Owners really wanted to try although we were very clear from the beginning about the bad prognosis and more if she wasn't referred. They were even thinking about selling properties to pay the referrals service. These and the fact that in the first examination she had deep pain made us keep her in our practice and see the evolution within 48h.

After 24h, seeing that she was even worse I spoke to them seriously and they also came with the idea of PTS just because what somebody has said before; maybe they were able to achieve the money for the tests and possible surgery but not for all the posterior treatment.

Very sad because they were nice people and she was a nice dog.

Thank you for your opinions

Re: Epistaxis after Sodium Thiopental

Christopher Saul — Sat, 04 Jan 2014 17:25:05 GMT

Irrelevant of money , Schiff-Scherington and a loss of deep pain are bad prognostic factors; and without the option of immediate referral to a specialist neurologist the prognosis was hopeless. Given the circumstances, I would say euthanasia was the only humane option

Re: Epistaxis after Sodium Thiopental

Mark Holmes — Sat, 04 Jan 2014 14:20:41 GMT

I would have euthanased her and to be honest if costs were difficult advised very early on that whatever the diagnosis recovery would be long and costly. There seems to be very little point in spending everything on a diagnosis leaving nothing for treatment. When discussing costs you often need to persuade people to commit fully or don't get started as half measures are invariable a waste of money. That's not a criticism of you, but the always investigate comments.

Re: Epistaxis after Sodium Thiopental

John Flynn — Sat, 04 Jan 2014 13:48:35 GMT

[quote user="Starling"]In 24 hours she lost deep pain totally...[/quote]

I would have euthanased also.

Re: Epistaxis after Sodium Thiopental

mariette asselbergs — Sat, 04 Jan 2014 13:47:58 GMT

Angiostrongylus?

Mariette

Re: Epistaxis after Sodium Thiopental

Starling — Sat, 04 Jan 2014 13:41:49 GMT

I agree with you Martin about performing blood tests; In fact the first thing we offered is to refer the case to a Neurology Service (we are a 24 h general medicine practice). It wasn't possible because a very bad economical situation of the owners (I'm not working in the UK). Although we offered to keep her in the practice during 48h with strong analgesya, absolute rest, etc. (they were aware of the bad prognosis).

At physical examination she only had abnormalities in the neuro exam: Schiff-Scherrington posture, fore limbs OK but hiperextension, hind limbs lack of propioception, patellar reflexes ok, only a little response to deep pain reflex. We located the lesion at T3-L3 region.

In 24 hours she lost deep pain totally...

We performed spinal X-ray and saw a T9-T0 fusion; also abnormalities in the shape of T7-T8. She was a rescued dog and owners reported she was bad treated in her previous home...so we though that these were old lesions of spine; She also had pain at thorathic spine zone and musculature contracture. Owners also reported a posible recent trauma by other dog they have.

All these things brought us to think more in a spinal damage than in a hemorrhage/embolism/inflammatory thing... but knowing that the only definitive way to know was with a mielography, MR, etc... (not affordable by owners).

Writing all these I've remembered that owners confessed to have given her human painkillers at home (Dexketoprofen and Ibuprofen). Fortunatelly she didn't develop any ulcer or GI problem...

So I don't know if she had a coagulation problem it was a cause or a independent problem. Now I'll investigate about dexketoprofen/ibuprofen bleeding implications in dogs. But alive she didn't present any signs...

I'm a young vet (but I wasn´t alone bringing the case) so your experienced opinions will be very usefull for me.

If you were in our situation, wanting to do something but "low cost" what have you done?

Re: Epistaxis after Sodium Thiopental

Christopher Saul — Sat, 04 Jan 2014 11:49:28 GMT

Aye, i agree with Martin, most likely to be a bleeding diathesis, perhaps also responsible for the spinal issue.

In general terms the differentials for epistaxis can be grouped into nasal disease and bleeding disorders (and hypertension). Whilst nasal disease is possible, I think it's pretty unlikely that it would just suddenly decide to become clinical at the moment you euthanise it for an unrelated condition. I assume you took care of the hypertension differential with your pre med, so that only really leaves bleeding disorders as a likely explanation.

Re: Epistaxis after Sodium Thiopental

Martin Atkinson — Sat, 04 Jan 2014 11:21:35 GMT

My first thought was that you may indeed have had a coagulopathy and the spinal problem was a bleed into the spinal cord. Not the first thing you'd think about but another good reason to perform blood tests before any procedure. Whether this would have helped this dog is another matter especially if the owner just wanted a PTS, but if you had some blood results that told you it had an autoimmune thrombocytopaenia for example it may have altered your approach to the case. The moral is to always offer investigations, if the owner declines then what shit happens subsequently is not your problem.