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Thursday, August 25, 2011

Freak Accidents Unfortunately Happen

This afternoon one of our clients brought their dog in for a simple nail trim.  He is a 13 year-old German shepherd mix (probably with husky) and not in the best of health.  He also is a bit of a biter.  One of my assistants brought him to the back to have the nail trim done, and a new doctor we just hired was holding the dog.  As they were doing this the dog's hind legs suddenly slipped on the smooth tile flooring and he went sprawling with his hind legs splaying in a "frog-leg" position. 

When they tried to get him up they found that he couldn't stand and was painful.  They brought the owner back and got me to look at him.  I noticed that he was very painful in his left hip and couldn't put that leg down.  I was also having difficulty trying to extend the hip backwards.  We put him in a kennel to rest for about 30 minutes and then got him out for another exam; we found the same problem.  The next step was x-rays.  We told the client that we needed to sedate him and do this, and wouldn't charge her for it.  Once we put up the films we noted quickly that the left hip had dislocated.  Ouch!  For many reasons.

This is a very old dog who wasn't in the best of health.  When we ran routine blood tests in May we noted increases in his liver values.  He also had severe muscle wasting in his hind legs and hips, though he was walking pretty normally.  In fact, I think the lack of good muscle mass was the reason for the dislocation.  Many people don't realize it but good muscle tone and development is just as important for hip support and strength as tendons and ligaments.  I've seen many dogs slip or lay like he did, but I've never seen a hip dislocation.  It was also strange because normally when a hip dislocates the femur moves craniodorsal ("up" and "forward").  This hip slipped ventrally ("down"), opposite the normal direction.  I think that the muscle atrophy allowed the hip to move abnormally; a normal amount of muscle likely would have prevented the injury.

Unfortunately we found other problems on the x-rays.  The 3rd through 7th lumbar vertebrae had bone bridging that was fusing the vertebrae together (called spondylosis, and not an uncommon finding in older dogs).  We also saw stones in both kidneys.  These findings were incidental but weren't good to see.

So let's recap. We had a geriatric dog with underlying liver problems, atrophied muscles, spondylosis and kidney stones slip on the floor and dislocate his hip.  Not a good situation by any analysis.  While he was sedated and relaxed I tried to put the hip back in socket, but no luck.  It's hard enough to replace a dislocated hip, but this hip was out in a way that I was never trained to fix. 

This was a completely freak accident that I have never heard of before.  Unfortunately it happened at our facility, so we feel responsible even though we didn't do anything wrong, and there is some potential liability since it happened under our care.  We sent the dog home with analgesics and didn't charge for anything we did.  We're also sending him to an orthopedic surgeon tomorrow to have the case reviewed.  I'm hoping that the surgeon may know some tricks to non-surgically put the hip back in joint because this dog is a pretty poor surgical candidate.  We're also going to cover the costs of any treatment, even if it comes to surgery.  We're not technically to blame, but we don't want the owner to feel that way and also do feel bad about the situation.

No, it's not easy being a vet.

6 comments:

  1. I just ran across your blog. Sad story. My 11 yr. old dog has fallen like that a couple of times, and looks just like Bambi on the ice. That has made her very afraid of vinyl flooring so we have to keep rugs in the kitchen so she can hop the islands. We gently lift her up and so far she recovers from the soreness in a few days. I hope your patient mends well.

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  2. We recently had a dog jump from a kennel and break a leg. It happens. Sucks, but it does.

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  3. Several years ago I took my dog in to be spayed - and everything seemed to be status quo - until I got her home and saw she had silver on the tips of her teeth and it looked like stitches on the inside of her mouth - around her dog "lips". I immediately called the vet office to ask them about all of that and that's when they finally came clean and told me that she had been very nervous and while she was in the kennel waiting for her surgery - she had chewed on the side of the cage (thus the silver tips) and when they tried to sedate her - she was trying to bite at them and ended up biting the insides of her dog lips. They also told me that it had taken nearly every employee to hold her down. While I understand that these things can happen - I would have appreciated their being honest with me and letting me know what was happening earlier on in the process or at the very least, let me know when I picked her up the series of events that led to her having stitches. Needless to say, I quickly found another vet. Not because of what happened - but because they hid it from me until I confronted them. I appreciate that vets often have to deal with difficult animals and accidents can happen - but honesty with the owners is key. I'm sure it may be a little embarrassing to face the owner when things like this happen - but I'm glad that most vets are up front about it.

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  4. You're absolutely right, Stefanie. Vets should be honest about this. I have had times that pets did something bad, or even I made a mistake, and I've been very open and honest with the clients. For example, one time I accidentally nicked the urinary bladder when making my incision for a routine spay. I noticed it immeidately and repaired the small hole without any problems. I knew the pet would be fine and the client would never know since it was inside. But I still told the owner, just on the small chance that something went bad. It's always hard to admit your mistakes, but it's always the right thing to do.

    I've always know that mistakes will happen in any business or industry. To me it's more important HOW the mistake is handled, not that it actually happened (though I never want it to). I've continued to go to businesses and recommend them after a mistake was made because they were so great about handling it aftewards.

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  5. Oh boy, that is some bad luck! :-( Poor guy.

    I have to believe that sometimes bad things happen for a reason. Would anybody know about all his other problems without the accident?

    Jasmine had a freak misfortune when she suffered severe drug induced hyperthermia from Buprenorphine. She went in for an x-ray and almost died! Muscles fried, blood fried, liver shot ...

    At the end this horror saved her life as a large abdominal abscess was found which probably wouldn't have been discovered ...

    My dad for all intents and purpose died to food poisoning (in combination with the heart meds he was on). So pointless, one has to think that perhaps this was the easier way for him to go (bleeding out internally) that what else future might have had in store for him.

    Note to myself? No nail trimming on high tables for our guys.

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  6. I rescued a pitbull from the streets, had him for a week and he was throwing up at night. I took him to my vet and after testing him for every parvo, distemper, disease under the sun the vet still couldn't answer any questions. I asked for an X-ray on the second vet visit, however they kept talking me out of it and would talk me into a different test of some sort. A week later and 4 different visits to the vet my dog was deathly ill not eating or going to the bathroom... I finally insisted on an X-ray to look for a blockage, which they finally found!! My problem, I just picked up my dog from his emergency surgery, the vet said he chewed up a FOAM mat covered in vinyl while in the vets care!!! Not only did she charge me for the mat she made a statement that she wasn't responsible for any future surgeries if the foam becomes a problem??! I am furious... The number one rule to owning a puppy is NEVER leave them unattended with something they can chew up!! How can she not be responsible for watching my pet after surgery?? I have spent $2500 in the last 8 days, and I expect someone to take responsibility for their mistakes no matter what their job title. I know that being a doctor, vet, dentist is not as easy or profitable as we may think but we are trusting you with our families. If were a babysitter and I harmed your child the laws wouldn't protect me!!

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