Dog neuter evisceration phone call response (non-COVID thread!)

RE: Dog neuter evisceration phone call response (non-COVID thread!)

Aine Seavers — Tue, 21 Apr 2020 06:32:08 GMT

Why is anyone doing neutering at the moment anyway? Why would not giving it pain relief be a reason to increase evisceration. In the decades before analgesia, dogs went home with no pain relief yet we didnt expect evisceration. Equally we virtually never supply a buster collar so again not sure why this is a reason to blame the first vet.. The 4 eviscerations I have seen is the old suture material-was it Dexon...in a spay done by another vet-the suture knot held but the material broke at the curve of the loops, the other was the dog jumped the pool fence to get to the stray cat and the other was a staffie whose owner took it to play cricket on the beach 48 hrs post op-amazingly the sutures held for the 4 hours of play untll the dog had to jump into the back of the truck. The frist was a charity clinic so o charge, other 2 owners fault and the 4th was our locum doing a bad job. Neighbouting clinic saw it a/h-we paid the bill but the clinic just charged us cost price to them so all good.

I would send to closest vet and if our faultt pay for it.

Aine

RE: Dog neuter evisceration phone call response (non-COVID thread!)

Gillian Mostyn — Thu, 16 Apr 2020 11:32:26 GMT

As a sole vet for many years, I have had to send appointments home unseen a few times while dealing with a genuine emergency, either in house or for a visit. Not one person, when the circumstances were explained, has complained. People realise it could be their pet one day. People generally only complain if they're left waiting without explanation.

RE: Dog neuter evisceration phone call response (non-COVID thread!)

Beats — Thu, 16 Apr 2020 11:25:15 GMT

[quote userid="11308" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/29029/dog-neuter-evisceration-phone-call-response-non-covid-thread/221777"]

I think ideally we could try number 1, but with restraints on vet or nurse availability we may not be able to get to the animal as quickly as the owner could bring it down. Clear instructions over the phone could save half an hour or more.

Way our practice works we would find it hard to drop and run immediately.

[/quote]

I guess that's what I'm getting at a bit. I'd like to think this one through should it happen again as is unlikely to be at a convenient time to think about what is best.

It's not a run-of-the-mill scenario, so I accept some thinking on feet will be required and will not be a one-size fits all circumstances solution. Perhaps "policy" (by this I mean what call-answer personnel are trained to do) should simply be receptionist grabs most available vet from what they are doing and puts them on phone (or video call!?) to owner and that vet makes the call as to what to do from there, but it is acknowledged that the clinic believes it quite appropriate for them to drop what they're doing and grab car key and go if they feel that is most appropriate (even if that leaves some fuming chihuhua owners in for puppy vaccines in the waiting room!)

If I'm in the middle of an abdominal procedure or fracture repair or something from which I can't stop and talk on phone, and there is no other vet in the clinic or on-call and likely available at drop of a hat, then it's options (2) or (3). Most of the time though, I think it is unlikely that I would be doing anything that couldn't be left (it might be inconvenient and poor client service if they have to go home and come back for their vaccines, nail clips and ear checks another day but from a triage most-urgent-case-gets-priority point-of-view I think it is hard to justify continuing with non-critical activities in preference to dealing with a critical case (and I think an eviscerated post-neutering case is one) IF I think that dealing with the critical case would improve it's chances significantly) and there would be no other vet available who could deal with.

I'm still torn.

RE: Dog neuter evisceration phone call response (non-COVID thread!)

Anthony Dennison — Thu, 16 Apr 2020 10:34:25 GMT

Way our practice works we would find it hard to drop and run immediately.

RE: Dog neuter evisceration phone call response (non-COVID thread!)

Lucy Fleming — Thu, 16 Apr 2020 10:33:26 GMT

3 would be my preference, but wouldn't rule out number 1, depending on the situation. If a very big dog, small/ frail owners, or owner extremely distressed, then a visit to collect might be safer and faster for all concerned. If a calm/ unflappable owner happy to gather everything into a clean towel, and someone else available to sit in the back of the car and monitor, then that would get the dog to treatment faster, especially if it was OOH.

I've been lucky enough never to see a post-surgical evisceration, but having spend my first couple of years in practice in a small town in New Zealand on the edge of the bush have seen a number of pig dogs carried in by hunters with various quantities of omentum or intestine wrapped in a Swazi fleece shirt (depending on how far in the bush they were, often having been carried for a full day) - feral boars being pretty dangerous beasts. It's amazing what dogs can recover from!

RE: Dog neuter evisceration phone call response (non-COVID thread!)

Gillian Mostyn — Wed, 15 Apr 2020 19:25:42 GMT

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/29029/dog-neuter-evisceration-phone-call-response-non-covid-thread/221731"]Not a fair comparison really. We don't have a 24/7, fully staffed, blue light, rapid response service for animals. [/quote]

Yes, I do realise that comparisons can't be made directly. But whereas a person with a broken leg, having a heart attack, even a stab wound COULD be taken to hospital by another person to get them to treatment more quickly, I don't think anybody would be prepared to move an eviscerated person?

Like I said, there are lots of variables and if the owner could and would move the pet, that would be ideal. I just think that this could be one case that would benefit from a vet being on site.

RE: Dog neuter evisceration phone call response (non-COVID thread!)

Stephen Courtney — Wed, 15 Apr 2020 19:00:37 GMT

We had a total evisceration after splenectomy, large GSD. Were able to send a vet and nurse round in our van to collect. the dogs guts were everywhere...no way the client could've coped.

Amazingly the dog survived.

We didn't charge, accepted responsibility...hard to see this as anything other than a technique issue 2 days post op

clients can smell BS....even so we never saw this client again

RE: Dog neuter evisceration phone call response (non-COVID thread!)

Clive Ansell — Tue, 14 Apr 2020 20:05:37 GMT

[quote userid="2457" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/29029/dog-neuter-evisceration-phone-call-response-non-covid-thread/221694"]Imagine if you saw an eviscerated person...would you call for an ambulance or try to move them yourself?[/quote]

Not a fair comparison really. We don't have a 24/7, fully staffed, blue light, rapid response service for animals. Home visits can sometimes be difficult to arrange, can take a long time, or are sometimes not even possible.

Fortunately, these cases are rare, but each case should be assessed on its own merits. Elderly couple with large dog and no vehicle I would visit if I could. Dodgy area and no means to visit, I would get them to bring it in.

In most cases the time taken to arrange and carry out the visit, client could have got to you

RE: Dog neuter evisceration phone call response (non-COVID thread!)

Derek Lyon — Tue, 14 Apr 2020 10:45:51 GMT

About 35 years ago we had a Labrador that had a very large ovarian tumour removed successfully. It went home and owners rang to say it had chewed it's sutures and guts hanging out, Dog had eaten a large length of it's intestines and vomited them up. Vet on duty told them to cover whole mass in a sheet and bring it in. An end to end anastomosis performed and dog recovered well and went on to live many more years!

RE: Dog neuter evisceration phone call response (non-COVID thread!)

Gillian Mostyn — Mon, 13 Apr 2020 22:01:51 GMT

All depends on lots of variables, but my first thought was that I'd probably tell them to cover the gubbins with a wet towel then I'd just go to the dog. Unless it was moribund, I don't think it would be fair to expect a person to bundle up their pet and all it's guts and carry it to the practice. This is probably one of those rare instances where it's welfare would be compromised by movement.

I absolutely agree that the owner bringing the dog to the practice is the quickest way to get it treated, but I just think most people couldn't do it without either causing more damage and pain . Imagine if you saw an eviscerated person...would you call for an ambulance or try to move them yourself?

I've had a couple of dogs brought in with small pieces of gut or mesentery protruding, and they are always best just brought in, but never a total evisceration thank goodness.

RE: Dog neuter evisceration phone call response (non-COVID thread!)

Joyce Whitehead — Mon, 13 Apr 2020 21:30:20 GMT

I’d also advise get straight to us. It’s likely being more rural that we are not that much further than other vets anyway although we have some more distant clients that I’d be thinking of suggesting a nearer practice. I would want to get set up ready to ga as soon as possible.

I saw one of these when I was about 18 months in practice. Ooh call, bitch spayed that day, wound opened up was the message. Owner reported something protruding so I advised seeing it, assuming it would be minor and fat or similar. When the dog arrived at the surgery siting on the owner’s knee (she was in a wheelchair, dog was a Yorkie) I realised all the guts were out and had bite wounds.

Being brave/foolhardy and in a practice where very little was referred (this was 35 years ago) I knocked it out, flushed everything and removed a long length of small intestine with multiple punctures. Gave the owner a grim prognosis but it survived and did well. I was startled to see midline closed with quite thin catgut and when I spoke to the owner later discovered it had been spayed at a neighbouring practice but she phoned us ooh as the op had gone wrong. I can’t remember if my boss contacted the other practice or not. But we gained a client. It still makes me shiver thinking of her peeling back the towel covering the dog.

RE: Dog neuter evisceration phone call response (non-COVID thread!)

Dinu Catilina — Mon, 13 Apr 2020 20:39:12 GMT

A bit late to the party but

If there is a clinic very close and the one who did the surgery is more than 20 minutes further away I would go to the closest practice. It would not bother me a bit if it was ours, could have been an RTA, etc. A lot can happen in 20 minutes especially if the dog is unsupervised in the back of the car. I seen one that chewed bits of intestines off.

Considering the Chikosi (hope I spell it right) case Beats does have a point. But again it depends on how far the practice is. If it adds 20 minutes for me to get there...

I also am not sure I would foot the bill straight away. It may or may not be surgeon error. Maybe the collar wasn't worn or pain relief wasn't given. Promising things for free straight away can be taken as admission of guilt by the owner. If the other practice comes up with a massive bill and the initial vet is at fault, well, that's why we have indemnity insurance.

RE: Dog neuter evisceration phone call response (non-COVID thread!)

Beats — Mon, 13 Apr 2020 19:58:02 GMT

I recently ended up in a friendly neighbouring clinic chasing down an eviscerated medium-to-large dog. It's spleen, stomach, and all intestines including caecum were exterior to the body. It was sitting with it's rear foot 1cm from its spleen, with a towel under some of the viscera (but with some spilt off caudally). I tried to lift the dog myself (not trusting anyone else to touch it) and in spite of having received an NSAID and methadone already, it almost bit my ear off. I induced it where it was instead. It did leave me wondering was it really reasonable of me to expect the average pet owner to transport an eviscerated post-neuter medium-to-large dog to the clinic themselves without assistance.

RE: Dog neuter evisceration phone call response (non-COVID thread!)

Beats — Mon, 13 Apr 2020 19:33:19 GMT

Quite a consensus!

I'm honestly torn between the 3 options.

Option (1) potentially has the benefit of reduced risk of damage to viscera, which is probably more critical than reducing time to lavage by 15-30mins.

[and indeed armed with an assistant, a towel, some saline medetomidine atipamezole ketamine and a skin stapler, perhaps laryngoscope, ET tube and ambibag and some propofol and methadone also on reflection..., it may be feasible to get it to the clinic in a safer fashion]

RE: Dog neuter evisceration phone call response (non-COVID thread!)

Michael Woodhouse — Mon, 13 Apr 2020 19:33:17 GMT

Agree with Jill, also.

My problem to sort out. No need for a cape or pants on the outside (option2).

RE: Dog neuter evisceration phone call response (non-COVID thread!)

Evelyn Barbour-Hill — Mon, 13 Apr 2020 18:01:22 GMT

Wot Jill said.

RE: Dog neuter evisceration phone call response (non-COVID thread!)

Clive Ansell — Mon, 13 Apr 2020 17:18:52 GMT

1. pointless and wastes valuable time, can't administer emergency care in someones front room, needs to be in clinic asap.

2. Yes, if 3 not possible, and there is a clinic much closer or one able to deal with it better.

3. Yes - in an ideal world. get it seen asap. If towards end of the day may direct straight to the OOH provider, depending on circumstances of course.

RE: Dog neuter evisceration phone call response (non-COVID thread!)

Iain Richards — Mon, 13 Apr 2020 17:09:05 GMT

3 for preference, but 2 if more expedient.

Sometimes got this with lambs and saw all sorts with straw and gubbins in there. Amazing what they;ll cope with.

Munched guts however...

RE: Dog neuter evisceration phone call response (non-COVID thread!)

Jill Butterworth — Mon, 13 Apr 2020 16:28:32 GMT

3 Gather the dog and its guts up in plastic and get it here, to my clinic asap. Going to the house (unless to PTS) is wasting time, sending it to another clinic is patently unfair on the other practice, unless perhaps you plan to pay the bill (a whole other discussion). Tell client whilst they are travelling, you will be getting the nurse and theatre ready to get the dog back to surgery asap. Call it customer service or whatever you want, this client won't be getting much of bill. I'm ready for heated debate. I can hear young, inexperienced vets panicking and wanting to refer it or send the dog to a more experienced colleague, as they've been frightened that that can't do this, but the quicker the dog is on the table and the guts lavaged, the better. Phone a friend if you want. Repair/excise bowel as needed, if really severe contamination has occured, loosely suture the abdominal wall with non absorbable and lavage the abdomen several times daily. Disposable nappies are great for absorbing the excess fluid. Repair body wall 24/48 hrs later. Antibiotics and prayer also needed.