Saturday, July 6, 2013

New Vet

I am missing Dizzy a bit, even though he could be a bit of a nuisance. He was very noisy! Mummy and Daddy are looking for a new vet for me. Mummy and Daddy have not been 100% happy with what happened with Dizzy's condition now they have had time to review all the facts.

Originally, back in Feb, Dizzy developed a distinctive cough then had rapid breathing difficulties, as well as being snappy and in pain. So we visited our vet, but he was too busy to see Dizzy so we saw another vet in the same practice who dealt with orthopaedic cases, although this is not why Dizzy had an appointment. Mummy and Daddy did said they thought there was something wrong with his chest, but the vet ignored any questions and just started pulling Dizzy's legs out. Dizzy always squeaks when you do that, and Mummy and Daddy already knew he had joint stiffness and age related weakness....but the chest and breathing was a different thing. The vet told us that all dogs pant and breathe like that, and he was probably just hot. We knew differently and were not that happy. I kept saying 'I know my own dog, and there is something very wrong with him'' especially as Dizzy was snapping at home, and having difficulty breathing out....and I asked if we could have an xray, but the question was never answered. We both asked, does an xray mean he would have to go under a general anaesthetic, and the vet said yes of course he we did not pursue asking for an x ray, trusting the vet would know if we did need one and was not keen to do one. Dizzy was 9 so we did not take a general anesthetic lightly.

The vet handed over to our usual vet, outside of our hearing, and the normal vet came in said he was too busy to have a conversation or answer any questions, so we just had to listen and he just talked at us non stop about Dizzy's back legs and what it could be, and the options....all of us  wanted to say, ''forget the legs...what about the breathing!'' We were prescribed Cimalgex for his bad legs, but nothing for his chest.

That evening the cough developed and worsened and he was very unwell, so we had to go back....and he was diagnosed with a cough and given antibiotics. We had several trips back and forth, where it was difficult for us to get any information across because the vet was too busy or too tired, and he tested the urine and found some blood or protein, and so we continued with antibiotics for a bladder infection with the advice he had probably got a bladder infection from being run down with the chest infection.

The really distinctive straining and coughing and breathing abnormality just got worse but we were just continuing to treat the bladder with antibiotics but Mummy was not happy about not doing anything with the chest. So in May, about 4 mths after the onset of the cough, Mummy talked to the vet on the phone and said she was really not happy about what was happening and that instinctively, it looked like Dizzy was wasting away, refusing to eat, and that there was something very wrong in the chest with loud intermittent honking and straining noises. The vet said  it sounded like a tumour on his chest and we really needed an x ray asap. At last, Mummy thought, and she asked about the procedure, thinking it would be a general, and found that actually, all was required was to lay Dizzy on his side and possibly have a sedative. It was done so quickly, and so easily without a sedative Mummy was wondering why we had waited so long to do it and why we were told it would need a general. So why had he not had one before? Despite going back and forth?

The vet phoned us, told us he had found a really big mass in front of his heart and it was probably a cancer like thymoma, or lymphoma. He kept telling us, if he did open the chest and it was a thymoma he had treated several dogs in the same way and they all lived. However, that changed to a diagnosis of cancer after needle biopsy with a rare chance it could be something mimicking cancer, but no suggestions as to what diseases could give such chest symptoms and results. We talked over the treatment options and he advised us if we decided to go elsewhere for oncology, then Dizzy would get treated without our consent and they would 'take over' our dog and we would 'not get a say in what happens' like we do at our nomal vet....Mummy and Daddy were suitably worried by that, so decided to stay with their trusted overall general vet. Dizzy did love being there. We were told it was about 99% a cancer tumour, and that surgery was very risky and a big deal, so we were advised to have chemo.

So poor old Dizzy went through lots of chemo treatment and came out in sores, stopped eating, but kept  getting the same symptoms of the cough, struggling to breathe and a dipping spine and laboured panting....and each time the only thing that relieved it was draining the fluid off. We got to know the hallmark symptoms of fluid building up really well and specifically requested that Dizzy was drained sooner, rather than later, to avoid it becoming a painful crisis like it had done each time. However, the last time it built up pre surgery the vet said there was no need to drain it because he could see outwardly that his breathing was fine and his bloods were so good, but we were back in 2 days for it to be done as it was another crisis and Dizzy in huge pain. He was not fine, he would stand in front of the TV for attention for hours, panting in and out, and if he tried to move or lie down he would cry out, grown and growl and get up. He got so tired he would collapse on our hands. But all the time, we did not want to think the vet was wrong and trusted his judgement.

Then the last time he had fluid drained, a simple needle procedure, the fluid built up in about 4 or 5 days so it got to the crisis of surgery being needed and he was in so much pain and digging at the floor and totally unable to sit or lie down for about 12 hours, not even in the car and he was tired...he looked like he was dying to us, and I think he was.. So he had surgery and we were advised that the lung had become necrotic, and it was biopsied for cancer and removed and we were told it was probably cancer but could talk over treatment options.

Dizzy came home, became swollen in his legs which bothered him. but not that much.
However, the old symptoms of fluid inside the chest cavity came back. Mummy knew it was there and Dizzy would tell her by his behaviour. So Daddy took me back to the vet to see if we could drain it. A different vet saw Dizzy, and remarked that the wound was closed to the chest cavity and had no way of draining the fluid and advised that he would be kept in to open up the wound and drain the fluid out of the chest. And extraordinarily, he advised us this was not cancer at all, it was actually a twisted lung lobe. We were told his chances of survival were very good, provided the fluid can be drained etc and complications managed. That morning was the last morning I saw him alive. At home, we had a little party because we thought he was through the worst. Mummy researched lobe torsion and found that provided the twist is not untwisted in situ, and removed whole, and the chest kept free of fluid that dogs had a fairly good chance of recovery but obviously can die easily in the first 7 days. We were up to 8 or 9 days so should have been past danger. We did keep pushing for the chest xray, but being told it was unkind and too much to put him through.
Mummy was very concerned about there not being a drain or some kind of shunt to get rid of fluid in there. And his skin was crackling, like plastic everywhere, which we now know is subcutaneous emphysema where air tries to escape the chest cavity and comes up as bubbles through the skin and can be a sign of a serious underlying condition. That meant as well as fluid, he had air in the chest, and if that air got to the heart it could be fatal.

However, when our own vet came back on duty, he decided to not drain the main chest wound or chest cavity and treated the oedema in the legs only with pressure bandages. On the phone, we kept asking for the chest to be drained as we knew 100% what Dizzy's symptoms were telling us with his difficulties and pain and were advised, his breathing is fine so they do not feel we need to put him through the discomfort of xray. We were not invited to visit, and each day got ready to pick him up and also kept being told he was scoffing his food, but then when he was home it was really difficult to get him to eat. He was very weakened by lack of food, and lack of sleep. Mummy was grief stricken on the Wed and Thurs, she had a really bad feeling about this and kept pushing and pushing for someone to drain that chest. They did eventually open the chest, after Dizzy had died and loads of fluid came out.

Mummy also mentioned she was upset that Dizzy was suffering so much pain, we knew how bad it was when he tried to dig a hole in the carpet. He kept laying his head on her lap and looking so pathetic and in need of pain  relief. However, when Mummy asked about it she was advised that blood pressure could drop and put the dog into crisis so she understood why they were withheld. But the vet did make a comment about Mummy being uncomfortable about the pain, rather than Dizzy, and that it might be a case of making Mummy more comfortable rather than what Dizzy needs. After asking around, it turns out that a lot of other greyhounds have had similar or even less serious operations and had always had some form of strong pain relief. The research also said after lobectomy, patients improve faster if they are without pain because mobility is so important to avoid complications. I think if Dizzy had not been in pain from the fluid, he could have perhaps walked a bit more....and moved it. But why did he not have a drain? A greyhound has to wonder about seemed obvious to me.

On friday, poor Dizzy collapsed and could not be revived. He was xrayed and it was discovered he had a completely filled chest cavity. The vet says he cannot say what the cause of death is and was quite tearful about the experience. Mummy however feels she knows what the reason could be. Weakened by pain, fatigue of not being able to go to sleep and not able to eat his organs were probably in a very poor condition despite appearing 'normal'. But if that chest was so full of fluid, that it was causing him that much pain and pushing his chest out, how could a heart muscle keep pushing and beating against that pressure? Mummy and Daddy strongly feels they have lost confidence in their vet. Throughout the whole of this condition it seems as if treatment was reactive instead of proactive. Mummy and Daddy were so familiar with the conditions of him having pressure build up from the fluid, that they  could pinpoint how full that chest was....but sadly, they were made to feel as if they were neurotic parents and the vet knew best. However, they feel that if Dizzy had been sent for MRI or CT scan, it would have cost less than the chemotherapy did anyway (which was unnecessary) and then a vet might have operated and fixed that twisted lung. They feel that with the correct surgery, there probably would have been a drain or outlet put in....either tube or shunt...and that his chances were pretty fair. In January, he was a very fit and active dog...he went so downhill and got skinny and wizened and in poor condition, and at his very worst he ended up having the surgery. There were decisions being made after the event, but no particular hurry to try and get a clear treatment plan. And Mummy and Daddy are not qualified vets. But they feel their vet let them down in not listening and draining the chest of fluid before eventually it finished him off. The vet did cry when Dizzy passed away, but I wonder if he was crying for Dizzy and us, or feeling inadequate in some way. They could have been genuine, or could have been crocodile tears.

We were never actually told by our main vet that Dizzy did not have cancer, and never had the lung torsion explained to us at all by him. In fact, we suspect that when he removed the 'tumour' he did not actually know it was not a tumour, and that it was just a necrotic lung lobe as he did nor recognise it. And if he did not recognise it right away, (and Mummy and Daddy could have done now they have images of what they look like), then did he follow the procedure for tying off the drainage to it, so that necrotic fluid did not flood the other organs? As that is a major cause of death in a twisted lobe lobectomy surgery. And if Dizzy did not have cancer, and was doing so well in hospital...then why did the vet sound so miserable and spoke with a guarded (funereal) voice when we spoke to him, why did not say ''hey guys, good news, I was wrong, its not cancer after all'''?

Also, during Dizzy's treatment 3 times he was prescribed with an antibiotics that he has intolerance of and causes him severe vomiting and diarrhoea, and it was not written on his record. And several times a suggestion of a prescription were given but then the meds did not turn up in the dispensed drugs when we got home (or in the case of post surgery, we were only given one days supply of rehydration powders, no diuretics and only the min of one Cimalgex a day)And he had major, major surgery but no pain management as such other than taking one Cimalgex. Mummy understands pain relief can cause a drop in blood pressure etc, but really, for a major thing like he had...he was suffering. She did give him a little extra pain relief herself in addition, and found he was much recovered and able to walk and eat. All the evidence Mummy and Daddy found online about this major lung surgery showed that being pain free helped more in mobility aned then recovery.

We also got the opportunity ourselves of the referral to the Ohio SU and greyhound wellness program all set up  for our vet. But he didn't follow it through as requested, and then it was too late and Dizzy went into crisis and needed surgery.Mummy and Daddy had given him the tel no of a lady at the Ohio State University Wellness programme for greyhounds; they treat a lot of sick hounds there and are the World's expert in greyhound medicine....what a waste of a resource!

It is easy to blame someone when things go wrong, but we cannot help but think we could see all the warning signs and nobody was listening to what we knew of our own dog. Apparently, we are not the first people to have experienced these sorts of problems with vague diagnosis and treatment plan, and vague post operative care and not sticking to procedure. The vet is a lovely, lovely, man but we we cannot help doubt his expertise and ability to manage serious conditions. The RCVS had problems on previous cases with this vet, but we did not know of this until after Dizzy's death. We believe that half the problem of him being reactive and just treating what is visible in front of his eyes is down to plain overwork. He does not have the time to listen to our symptoms or descriptions, or look at our own suggestions or follow stuff up. He was always asking us to keep our information back, until the next time we speak, as he was seriously rushed off his feet and had a mental day. This was what he said on every appointment and of course, it did not help communicate very vital information about our dog's health and it was difficult to ask questions. We were invited to email instead and send pictures through, but he never even opened or discussed the emails.

So now we are looking for a vet who is not taking on too much, who can listen and proactively guard against complications rather than react to them.


houndstooth said...

I'm really sorry that your vet let you down! I think you're right to look for someone new, if only so that you gain more confidence in the treatment your dogs get from now on.

Anonymous said...

Hi Erssie, My heart breaks still.I hope the good memories will ease the ache in time. I cried for all 4 of you: you. OH, Dizzy and Lily.I loved all the pictures and stories about the greyhounds and have wondered how my life would have been if we had adopted one when we first moved out to the country.
Jackie( petmom on ravelry)