Who's client is she anyway?

RE: Who's client is she anyway?

Hannah Wynne Richards — Sun, 13 Dec 2015 10:12:55 GMT

No no, you've got it the wrong way round.

It's Crappy Initials Responsible for Critical Illness ( in veterinary surgeon who's suffered apoplexy as a result of fury)

Wynne

RE: Who's client is she anyway?

Francisco Gomez — Sat, 12 Dec 2015 17:50:38 GMT

Critical Illness Responsive to Crappy Initials

RE: Who's client is she anyway?

Hannah Wynne Richards — Sat, 12 Dec 2015 15:12:44 GMT

CIRCI !!!!!!!!!!!!!!!!!!!!!!!!!! One of the Cs must stand for critical, but what on earth do the other letters stand for?

Yet more blasted initials

The sooner that fad goes away the better

Wynne

RE: Who's client is she anyway?

grumpyoldman — Sat, 12 Dec 2015 14:16:37 GMT

My first bosses always said that nothing should die without a shot of dexafort.

RE: Who's client is she anyway?

grumpyoldman — Sat, 12 Dec 2015 14:15:14 GMT

Things do tend to go around in circles now ,the emergency gurus are now talking about CIRCI , which loosely says that severely shocked critical patients / septic abdomens etc that do not respond to standard management with fluids colloids analgesia antibiotics catecholamine infusions plasma etc are suffering from adrenal depression ,and appear to respond well to a last resort shot of dexafort at physiological dosages. So it turns out some of those old gits were not quite as daft as we thought.

RE: Who's client is she anyway?

patrick murphy — Fri, 11 Dec 2015 11:45:45 GMT

in my first year, I clearly remember that practice as with the same coloured bottle, I gave a dangerously ill male dog an emergency iv of oxytocin. did not achieve much.

RE: Who's client is she anyway?

Evelyn Barbour-Hill — Fri, 11 Dec 2015 01:57:24 GMT

[quote user="Stephen Courtney"]Not all pet owners are mad,[/quote]

No, the rest are just a bit odd.

RE: Who's client is she anyway?

Glen McIntosh — Thu, 10 Dec 2015 18:02:40 GMT

[quote user="Bob Russell"]

20 years ago we were told that steroids, especially solu-medrone V, was the drug of choice in all shock situations! A shot of dex would have been considered quite standard in these situations. Every RTA would get i/v steroids as 'best practice'.

Time and ideas move on, hopefully taking most vets with them!

[/quote]

Yep, I was there and remember doing the same on occasion, usually 0.5 -1mg/kg of dexamethasone. It really was best practice in those days.

What really disturbs me, though, is that it was 20 years ago, and I was really there...

RE: Who's client is she anyway?

Stephen Courtney — Thu, 10 Dec 2015 17:40:19 GMT

Not all pet owners are mad, but all mad people have pets.

Unfortunately that puts us at risk sometimes - better not to do house visits alone.

RE: Who's client is she anyway?

Hannah Wynne Richards — Thu, 10 Dec 2015 16:51:25 GMT

Give the samre 2 options, but state unequivocally "Those are the only 2 options" I was trying to be too polite, saying "It really would be better if I either hospitalise or put to sleep" It's still possible I might have had the same problem, because it would have started Cheyne-Stoking in the car - and the owner would probably have accused me of murdering it as soon as it was out of her sight

Wynne

RE: Who's client is she anyway?

Clive Ansell — Thu, 10 Dec 2015 15:12:25 GMT

[quote user="Hannah Wynne Richards"]

Mid afternoon the dog was collapsed. I went out, found it with chalk white membranes - virtually bled out. This was before lungworm reared its ugly head, so my top differentials were warfarin, a bleeding tumour (couldn't palpate one) or a massive bleeding ulcer. I gave the owner the options of hospitalisation/transfusion/ further investigation/possible surgery/possible euthanasia, or immediate euthanasia. She refused both options.

I injected steroid (generic treatment for shock) and continued trying to persuade her. Whilst we were talking, the dog started Cheyne-Stoking. IT DIED She complained to Royal College that I had murdered her dog, even though she hadn't given consent. Royal College dismissed the complaint at the PIC stage, but it was all very stressful

[/quote]

What would you do today given the same?

RE: Who's client is she anyway?

Hannah Wynne Richards — Thu, 10 Dec 2015 15:09:19 GMT

Don't know. It was her only animal and she didn't come in with another whilst I was there, so either she was sacked, she took the huff and went elsewhere, or she didn't get another animal

Wynne

RE: Who's client is she anyway?

Stephen Courtney — Thu, 10 Dec 2015 15:06:01 GMT

Glad to hear it - but I hope he sacked her!

RE: Who's client is she anyway?

Hannah Wynne Richards — Thu, 10 Dec 2015 15:03:52 GMT

The boss was totally suppportive - to the extent of telling the owner that he would have done exactly the same thing

Wynne

RE: Who's client is she anyway?

Stephen Courtney — Thu, 10 Dec 2015 14:33:29 GMT

Wynne just out of curiosity, how much support did you get from your employer over this?

I would hope that they were suitably supportive.

For what it's worth i don't think you did anything wrong, particularly with your hands tied behind your back.

RE: Who's client is she anyway?

Dagmar Steele — Thu, 10 Dec 2015 09:51:31 GMT

[quote user="Hannah Wynne Richards"]

It didn't do it any good, but I was less confident those days, and was faced with an owner begging me to do something, but without moving the animal, and I couldn't think of anything else to give it It didn't kill it, as it died within 5 minutes, so I doubt if a subcut injection in a very shocked dog would have even been absorbed, but not my proudest moment.

Wynne

[/quote]

Don't get me wrong Wynne, for once I didn't criticize you, I would have done exactly the same 20 years ago. But I wanted to point out to less experienced colleagues that it almost always backfires and that they would be better off to listen to these stories rather than to make the same mistake themselves.

RE: Who's client is she anyway?

Hannah Wynne Richards — Thu, 10 Dec 2015 09:25:52 GMT

Wynne

RE: Who's client is she anyway?

Bob Russell — Thu, 10 Dec 2015 09:24:05 GMT

Time and ideas move on, hopefully taking most vets with them!

RE: Who's client is she anyway?

Dagmar Steele — Thu, 10 Dec 2015 08:56:51 GMT

[quote user="Hannah Wynne Richards"]

Thanks It was rather horrible for a couple of months

Wynne

[/quote]

I bet it was and with the benefit of hindsight of 25+ years work in this field I can only give one advice to young vets: Never ever give in to what an owner wants against your better judgement. It nearly always backfires and they won't be grateful because you did what they requested... Not that the steroids would've killed that poor dog, but I'm sure they wouldn't have helped much either. So as Wynne said about being much tougher on these owners today: It's either taking it to the clinic, further workup and maybe PTS or immediate PTS there and then, can't do anything else without doing more harm. I'm a cynic old hag by now, but it saves me a lot of stress.

RE: Who's client is she anyway?

Hannah Wynne Richards — Thu, 10 Dec 2015 08:39:09 GMT

Thanks It was rather horrible for a couple of months

Wynne

RE: Who's client is she anyway?

grumpyoldman — Wed, 09 Dec 2015 22:33:18 GMT

[quote user="Hannah Wynne Richards"]I injected steroid (generic treatment for shock) and continued trying to persuade her. Whilst we were talking, the dog started Cheyne-Stoking. IT DIED She complained to Royal College that I had murdered her dog, even though she hadn't given consent. Royal College dismissed the complaint at the PIC stage, but it was all very stressful [/quote]

You have my sympathy : this is another one that should never have got past the scrutiny stage , I bet it took them ages as well before not apologising for any of the needless anguish. Its that rock and a hard place situation with someone else's client. In those days they would have had career cow vets and horse vets scrutinising small animal complaints , people who could write their recent knowledge and experience of small animal practice on the back of 10B&H in block capitals, plus Colonel Someone posh's wife. Not having a clue what they were looking at they passed it up the food chain.

RE: Who's client is she anyway?

Hannah Wynne Richards — Wed, 09 Dec 2015 16:47:51 GMT

Very poor ooh service from the RSPCA - 1 Inspector for around 1/4 of Wales. The threat of "Make up your mind - now, or I'll phone the RSPCA 1st thing tomorrow morning" may need to be resorted to.

I've been a lot tougher on these owners since an unpleasant experience > 20 years ago. At that time I was an assistant. One client would normally only see the boss, so I was at a disadvantage to start with when she phoned on a Saturday afternoon to request a home visit to her collapsed dog. It was an elderly German Shepherd which had been on bute for ages for arthritis. She had phoned at 9 am, as the dog was unwell, but on being told the boss was off for the weekend, opted to wait till Monday. It wasn't that she disliked me - we hadn't even met - she always refused to see any of the assistants.

Wynne

RE: Who's client is she anyway?

Virginia Campbell — Wed, 09 Dec 2015 16:25:33 GMT

Wynne, can you call the RSPCA at 11pm? We don't have the RSPCA where I work. So you are down to two options. What if they stand there crying and looking at you and won't point to option one or option 2? Would you agree to admit it for fluids, analgesia and anti-emetics? Yes it may well be kicking the can down the road till tomorrow, but at least tomorrow the owners can come and visit their cat, look at the IV line in its leg, realise that it's not eating the Dreamies and chicken they brought it and stroke it and cry for a bit while you get on with consults and phonecalls, then hopefully they will be ready for euth and give you the nod?

RE: Who's client is she anyway?

Hannah Wynne Richards — Wed, 09 Dec 2015 15:19:33 GMT

Home with symptomatic treatment would be wholly inadequate in this case. That's what the 1st practioce did - and look at the thankd they didn't get. The 3 choices for the owner of this cat would be:

1) "I'll admit it and investigate/treat it properly, the bill will be what it will be, and you will be legally liable. I may, after investigation still advise putting to sleep"

2) "I'll put to sleep now"

3) "I'll call the RSPCA, because as things stand, this poor cat is a prosecution case"

Wynne

RE: Who's client is she anyway?

Clive Ansell — Wed, 09 Dec 2015 11:32:22 GMT

I with Wynne on this, our duty, professional obligation and the oath we swore is to the animal patient, not the owner.

Taking the cat in the OP at 11pm on a Saturday night faced with someone else's client with no money, I certainly would not be spending 90 minutes trawling through the 5 stages of (their) grief (90 minutes of my professional time OOH is gonna be expensive!) It would be a 10-15 minute consult and a decision would have to be made fairly quickly to admit, pts or home with symptomatic treatment and analgesia. I would want it wrapped up PDQ at that time of the day!