End of life…

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As I walked out of clinic at 1am on Monday morning a family were arriving to say goodbye to their pet having been summoned by phone just 15 minutes before when he started to deteriorate so rapidly that it was obvious he only had minutes to live. They made it in time to say bye thanks to the Vets Now ECC nurse recognising what was happening early and allowing them to be summoned.

Through the weekend we’d helped countless animals who left the clinic to go home with their parents, yet there was a high proportion that was never going be leaving, whether or not their pet parents realised it when they arrived. Unfortunately our pets can never tell us how sick they are, how much pain they are in, and that they want to go on over the rainbow bridge.

This is worse as often it is not just that they are seriously ill (and sometimes even dying painfully), but is also so sudden that their parents may not have had time to come to terms with this and accept it. It is not human nature to give up and sometimes when it comes to the decision to end life it can feel this way even though it is really not.

The weekend was a mix of those that came to ask us to help them send their loved pets on over Rainbow Bridge – the request of one parent that nearly made me cry was that someone would cuddle them as they moved on. Then there were those that hadn’t realised how bad the condition was and how much pain their pet was in that let them go on pain free when realising. There were also those that just refused to give up even though it could be considered to be  the kindest thing for their pets.

Vets are legally entitled to euthanise an animal on welfare grounds if they believe the welfare is compromised and the animal is suffering. However , we realise the importance of the bond parents make with their pet and that doing so will not be easy on the parents – in fact it would be very traumatic for the parents which is something we never want.

Instead we rely on our ability to communicate with pet parents. Sometimes it is very obvious to us how bad an animal is because of our experience and training whilst it may not be to their parents. We release that the animal is never going to be able to leave alive, and whilst we may attempt to make the animal comfortable with very strong pain medications, it is the owner that we need to treat.

Euthanasia is one of the most powerful tools that a vet has – read about how it really works here.

It’s not all about money… how Vets Now try to save you money!

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The emergency vet is always going be more expensive than your normal day vet. It costs money just to open the door and have the team there ready whilst it is not possible for them to guarantee that they will have patients.

Because of this fee just to be seen by a vet there is a big effort to make sure that only pet parents that really need to be seen arrive at the clinic. This starts with the national contact centre where a call handler, supported by a qualified veterinary nurse  will talk to you about your pet on the phone and tell you whether you can wait for your day vet or you need to be seen by an emergency vet.

If, on arriving at the clinic, the client’s pet has improved dramatically, then or course they can change their mind with no charge. If a vet is not available to see an owner and sick or injured pet within a short time of arriving, then as soon as possible a registered veterinary nurse will triage the animal and get any immediate first aid needs started. Veterinary nurses are unable to diagnose or prescribe medication so this may be in conjunction with the veterinary surgeon ‘behind the scenes’ but with the owner’s informed consent.

There are a limited number of consultations that registered veterinary nurses are legally allowed to undertake on their own. These include things such as replacing a slipped or damaged dressing and are charged at a lower fee.

Then something that really surprised me when I arrived was that a manual blood test was used (I’ll write more about this later) instead of using automated machines that were used by the day vet in the same building. This was weird at the start – however in discussion it costs less than half the price of the automatic machines, is faster, and most importantly takes much less blood to do. It took less than 0.2ml for nearly every patient over the weekend which for an emergency patient keeping as much blood as possible in the body is important. Plus it means that certain parts of the blood test (such as amount of Red Blood Cells) can be repeated as needed without being forced to test everything again.

Sometimes a pet may need to come into the hospital for monitoring or to be given IV fluids to help them with dehydration for example. When this happens instead of being charged for the entire night or weekend the hospitalisation is split into 7 hour slots so you only actually get charged for the time your pet is in the hospital.

Off course the treatment varies between patients, however the vet does consider the different options to keep the cost of treatment as low as possible whilst keeping your pet alive. Emergency medicine is about trying to rule out possible life-threatening conditions and it can be necessary to be proactive to achieve this. While this can cost money it could potentially be life-saving and cost less in the long run, both financially and emotionally. Anything Vets Now do will be discussed with you and as I have said options will be discussed wherever possible and at the earliest opportunity. Many of the emergency tests Vets Now use regularly need to be repeated to get the most value from them. Sometimes repeats are built into the hospitalisation and nursing fees so there are no additional charges but allow your pet to have a high standard of monitoring and care.

I personally would recommend getting insurance such as Pet Plan to help you cover the cost of emergencies. Responsible pet ownership is something that Vets Now are very keen to promote, as they understand just how quickly veterinary bills can rise . Costs can quickly rise in the initial part of any emergency, even if the outcome is not good. Being able to find out more information to help the vet get an idea of prognosis, while not having to worry about the fine detail of the financial situation can be a great benefit of pet insurance. Lots of policies exist however and it is important to find one that meets your needs so always read the small print.

Poultry with a slice of emergency surgery

First GDV of 2016 xray

Thursdays for me is either protection of the environment which is about cleaning things so I am confused as to why it is in my 5th year of vet school or poultry medicine which is more what I think 5th year should be like.

This Thursday was a poultry day and spent in the exotics department learning about chickens. Something I know a little about but still have a ton to learn. The chicken industry is big business with the only economical operations being industrial – however that is a topic for another day.

After finally getting home and sitting down to read up on stuff for tomorrow my phone goes – its emergency surgery for a GDV. Now a GDV is Gastric Dilation and Volvulus – often referred to as bloat or twisted stomach in dogs. The body of the stomach twists around so that the contents are trapped in a pocket of the stomach with no entrance or exit channels. As gas is produced from the breakdown of food material this pocket then starts to swell.

The swelling stomach then starts to squash other organs within the abdomen due to its increase in size – it has nowhere else to go and the abdomen is a limited space so this can also put pressure on the diaphragm and limit the lung space. This includes the blood vessels and finally the vessels and tissues that make up the stomach wall and lining are compressed as well. This leads to what is called pressure necrosis which is where tissue doesn’t get enough blood supply because all the blood vessels inside have been squashed so the tissue starts to die and turn black.

I’ve been in surgeries where pressure necrosis has been so great that the entire stomach is black and there is no way for us to fix the patient so it can survive.

The second complication of the increased pressure inside the abdomen is for the distribution of blood in the body. When we release the pressure from the stomach we need to have fluids ready so that we can help the body rebalance its blood fluid to fill the now empty blood vessels where the stomach was compressing them.

However tonight’s patient is a weird presentation. It was referred from a private vet for a suspected GDV, however there was no dilation when it arrived – and the dog was relatively stable. However when it made it into xray it would not lie on its side so the only radiograph we could get was the one with it on its back (ventral-dorsal position) which is here.

On this xray you can see that it is like a shape of a 8 with loads of gas (dark areas) within the abdomen. This line going across splitting the image is common with GDV presentations.

Taking the dog into surgery it was a successful repair to the stomach, however we found some haemorrhage around the spleen vessels so performed a partial splenectomy as well. The dog recovered very well.