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Tuesday, March 12, 2013

When A Clinic Comes To A Screeching Halt

It was a busy but otherwise pretty normal day.  We had lots of appointments, routine surgeries, and patients dropped off for minor illnesses and well visits.  Thought it was a little hectic, we were getting through okay and I anticipated being able to get a short lunch break for the first time in over a week.  

I should have known better.  

It started with a hollered "Kain is seizuring in the car!"  Kain is a 120 pound Presa Canario who started having seizures a few months ago.  He is a sweet boy but rather large and strong.  At seven years old we were worried about the seizures, but they were mild and infrequent and all lab tests were normal.  We had elected to not start him on antiseizure medication yet because it only happened a few times.  Until today.

Kain had been seizuring off and on for nearly and hour by the time the owner managed to get him in.  He couldn't walk in on his own and wouldn't stay on the wheeled gurney, so the owner somehow was able to carry Kain into the treatment area.  The dog was scared, breathing heavy, and disoriented.  Everything in our well-planned day came to a grinding, screeching halt.  Three assistants tried to restrain this dog that outweighed at least one of them and was stronger than all of them while a fourth tried to place an intravenous catheter.  Between his struggles and poor positioning this wasn't an easy task.  My associate was trying to get our surgery cart over to him so we could get oxygen up to his face.  That's when we discovered that the tube from the machine wasn't designed to reach all of the way to the ground, something that had never been an issue before.  Putting him on an exam table wasn't an easy prospect given his weight and the fact that he kept trying to struggle and move around.  It was better for him to be on the floor, and easier for us to work on him there.

Out of the six people in the back of the clinic I was the only one not directly involved in the case.  And that's because I thought it was best for me to stay back and not add to the crowd around the dog.  I tried to help from afar, getting drugs and materials, but knew I'd only get in the way if I tried to get in the middle of things. While that many people on one pet may seem excessive, it really did take that many to keep him restrained and allow work to be done.

Unfortunately, that meant that there was nobody available to do the dental cleaning and spay that had yet to go under anesthesia.  And since we only have one anesthesia cart which was being used to give Kain oxygen, it wouldn't have mattered much if someone was free to help me.  So for nearly two hours the team worked on this one dog until we manged to get him controlled, oxygenated, and heavily drugged.  As we reached this point we were finally able to start allowing people to take lunch breaks and could start to concentrate on the remaining procedures.

Of course, by this time we were well into the normal afternoon appointment times.  I had anticipated this happening and had the receptionist start calling to reschedule appointments.  In the end we had to move six different appointments, having gotten about 90 minutes behind, even with us doctors basically skipping lunch.

We're not sure what is going to happen to Kain.  The owner can't afford to take him to a specialist and we don't know if we can control seizures like this easily.  Tomorrow we'll find out how he did overnight and see if he still has some time left before they make a final decision.

This also illustrates how even in a general practice we never know what is going to come through the door and how that will affect us.  Experienced vets and staff know exactly what I'm talking about.  Vet students?  This is your future.  And to pet owners out there who don't work in the field, please understand that if we ask you to reschedule because we had a sudden emergency, we don't do so lightly and we really do have times when we have to drop everything to save a life.

2 comments:

  1. We discovered our short oxygen hose during a large dog seizure episode too!

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  2. I definitely have to check that out! I'm pretty sure our oxygen hose reaches but I've never tried.

    I understand completely, but I'm sorry for your busy day. Being behind makes the whole rest of the day so stressful! Fortunately my surprise yesterday was my last appointment of the day....a "sick" puppy that ended up having parvo. The owners didn't have money to refer to a clinic with an isolation ward (and we have lots of puppy exams coming up) so I had to hurry and come up with a budget at-home protocol. Here's hoping it works!

    I'm trying:
    1) Injectable penicillin
    2) Oral reglan
    3) Syringe feeding pedialyte after 24 hours if not vomiting
    4) SQ fluids three times daily
    5) Oral Tamiflu twice daily if he holds it down

    I've seen two hospitalized cases make such huge headway on Tamiflu I think it might be worth the expense. I'm rechecking the pup tomorrow evening (after office hours) to see how he is.

    Anything else you guys would do for a parvo pup? I am on vin, but I like as much input as possible! :) I've heard cerenia is bad for pups under 16 weeks of age?

    Thanks!
    Katie

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