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Monday, May 13, 2013

Thirty-Five Bites

**WARNING--GRAPHIC IMAGES**

Sometimes I want to throttle pet owners and take their pets away.

This past Saturday a client walks in, says their dog was in a fight and asked if we could see her.  We were busy but something like that needs to be seen right away, so we said we would.  The dog had to be carried in on a gurney from the car because she wasn't able to walk.  This was a 70-ish pound female pit bull and we could quickly see that she was in bad shape.  She was covered in blood and we knew this wasn't a simple bite wound.  Apparently she had been attacked by another dog in the family and was brought in quickly.

One of my associates was the primary doctor on the case but we worked on her together due to the severity of the case.  As we examined her we could tell that there were numerous small to medium puncture wounds on her body, legs, and ears, all which were oozing blood.  None of them were serious by themselves, but added together they were a sign of a severe attack.  If it was just a few we knew we could sedate her, use local anesthetic, and quickly clean and suture the wounds.  But due to the sheer number of wounds it was obvious that it would take a long time to fix her, requiring general anesthesia.  We gave her some potent pain medications and a sedative while we were trying to work with the client on what needed to be done.  Here is what she looked like at that point.





Believe it or not, the pictures don't really do the injuries justice.  And through all of this she never stopped wagging her tail!  She was the absolutely sweetest dog, and despite being covered by bruises and bites whenever we would talk to her or touch her she would immediately wag her tail.  All of us fell in love with her.

We were amazed at how many small punctures there were, but at the same time we knew this was a fixable situation.  With proper care she would likely be just fine.  It would take some work, but we knew we could do it.

That's when things became complicated.

The total for anesthesia, disinfecting the wounds, suturing the large ones, antibiotics, and analgesics came to over $700.  The actual owner was in California, the opposite side of the continent and country, and a friend of his was watching the dogs.  When my associate called him to discuss the case and get authorization to treat, he told us he didn't have the money and to just clean her up and send her home.

SAY WHAT????

Even though the wounds were not immediately life-threatening there were so many openings into the muscle that systemic infection was a real and serious concern.  If we didn't treat her properly she could possibly die from infection.  This was also a case where it really had to be all-or-nothing.  We needed to do the expensive care in order to save her life.

We didn't know what we were going to do.  In good conscience we couldn't just let her go home like that.  We do have funds for situations like this, but in order to make sure they are available for pets who really need it we require the client to apply for Care Credit first, with people who are declined then having to meet financial needs requirements before being given the funds.  With these rules we keep people who have the money or credit from taking funds that other people need more.  This guy wouldn't even bother to try applying for Care Credit.  A nearby local shelter offered to take her if the owner would sign her over, but then when they saw the bill they said they didn't have the funds for that much care.  We were all extremely frustrated at the situation and couldn't believe how callous the owner was being.  The friend also didn't seem to be offering any solutions.  The whole time this dog was suffering.

I was on the verge of calling Animal Control and talking to them about whether they would intervene as an animal neglect case.  I've never come closer to doing so and trying to get law enforcement involved, but this was a moral issue as well as a medical one.  I also think I would have had a mutiny on my hands from my staff if I simply let them walk out.

Thankfully we managed a work-around.  When we send someone to collections for an unpaid bill it is first handled in-house through our own financial staff (we are a large practice with several satellite clinics, so we do things a bit differently than many vets).  Our own financial department gives the owner three months to pay their debt.  If it isn't paid off during that time they get sent to an outside collections agency and affects their credit.  This option was discussed with the client, who agreed to pay $100 and get sent to "collections" for the rest, planning to pay it off during the three months.

This meant we could get to work on her!  She was anesthetized, the wounds cleaned, and the long process of suturing begun.  It took somewhere around 30-45 minutes to get finished and my associate counted a total of 35 puncture wounds!  Here's a look at some of them.










Later that evening she walked out of the clinic wagging her tail.  Yes, that's right.  Despite all of the injuries and deep bruises, despite hobbling out on four injured legs, her tail was wagging furiously.  Through all of the pain nothing could stop her spirit.  To me, that was the most amazing part of the whole ordeal.

6 comments:

  1. This is awful that an owner is so reluctant to pay for care for their dog. However it appears that despite the dog having what looks like level 5 (on the Dunbar bite scale) bites inflicted by another family pet you allowed the dog to go home to the same situation. Really there is more to this story than failure to want to pay.

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  2. I am very glad/thankful that you were able to stitch her up and help her on her way to healing -- but I agree with the above post. It's a little frightening that she was going home to the situation that brought her there in the first place.

    Maybe Animal Control would have been the way to go, after all. With the owner out of town, is the caregiver really going to do the appropriate after-care to treat this dog if he couldn't even keep her out of harm's way to begin with? So sad. Poor thing.

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  3. Unfortunately we don't have any legal authority to confiscate the pet. And if the owner insists on taking it home there is little we can do about it. The pets involved have been together for a long time and this was the first incident of any aggression. It happened when nobody was watching, so we don't know what triggered it. Both dogs involved have been regular patients of ours and neither has evern shown signs of aggression in our clinic. Believe me, the owner was given a good lecture about this situation and was aware that we were considering contacting law enforcement. We have also been calling and checking on her daily to see how she is doing.

    We see bite wounds between family pets not infrequently. Most of the time it is minor wounds, but this was one of the worst I've seen in a while. I have a client that has had to bring her dogs in multiple times for wounds from fights, and we are trying to work through the situation and correct the behavior. My point is that inter-dog aggression happens more commonly than most people outside of the profession realize, and it's not the kind of situation where we routinely consider taking the dogs away. In this specific case we had no prior history of aggression between them, no previous wounds to fix, and no reason to continue to contact Animal Control when the owner finally agreed to do the appropriate treatment.

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  4. thanks for sharing the story and clarifying it in the comments. i can only guess how much strength, tact and determination on your part it required to make sure the dog gets proper treatment.

    my question is, you posted a story a while ago that i still can't get out of my head (and it makes me wonder which systemic solution could prevent these situation from happening) http://avetsguidetolife.blogspot.ca/2012/12/no-money-no-options-no-luck.html

    i wonder what was different from the point of view of procedure/finances in that story that didn't allow your clinic to use the same solution? was it not available at the time because of how your clinic's financial department used to work or was the owners' reluctance the problem?

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  5. Thanks for the comment, J. Yes, it takes a lot to handle these kinds of situations. I plan to blog about that at another time as it's an interesting discussion.

    Actually, if you go back and read the other blog you mentioned, the same options were there. We offered the client Care Credit, which was declined. We tried to get them qualified for our charity fund, but they didn't meet the standards. I'll admit that I didn't think about the in-house collections at the time, and even in the above case it was someone else's idea, not mine. It didn't occur to me either time to use collections as a source of payment since that's not why the collections/financial department exists. That particular method is a last-ditch way to give the client some grace before they get hammered hard. It's not a payment program. For many reasons it's not an ideal solution and not one we can offer to everyone. In the other case I suspect that they wouldn't have been able to make the payments and would have gone into default.

    In either situation we can't just give away those services. I'm willing to help out someone by giving them a free office visit or writing off the cost of euthanasia in a particularly hard case. But we can't stay open if we give away hundreds or thousands of dollars in services. It's a nice sentiment, but running a business that way is one of the big reasons so many veterinary practices close.

    Another interesting thing about this bite case. A few days later we saw the other dog in the fight, as a few of her wounds were becoming infected. The other dog only had a few wounds which were easily treated with disinfecting the wounds and starting antibiotics. The odd thing was that this dog was just as sweet as the more severely wounded one. Both dogs were patient and loving towards us, even when we were examining their wounds. Both of them wagged their tails and seemed like well-behaved sweethearts. I have no idea what triggered such a severe attack in otherwise great dogs.

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  6. It's not odd at all really - pitbulls are usually very wonderful with people, but often have aggressive problems with other dogs. When you think about what they were bred to do, it makes perfect sense. The handlers would have needed to be able to handle their dogs despite ramping up their aggressive traits, so they selected those who were good with people but not with other dogs.

    Dog behavior can change over time and dog/dog relationships change much as ours can when we live together. One dog may get older and the "power" shifts, or one dog develops pain or a chronic condition and is no longer tolerant of the other. Yes, these bites were numerous, but not life threatening as you said which indicates the fight was long but not meant to kill. One of the things you said could have been the trigger - the owner was not at home at the time and indeed was far away. It's quite possible the dogs were under good control in the owner's presence, but not so much away from him or if he was gone for a prolonged period of time.

    I'm sorry, and I'm sure you don't want to hear this for superficial wounds, but although we hope that people have money for situations like this saved up the truth is that many don't. Perhaps the judgement should be saved for people who truly abuse their animals.

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