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Friday, July 22, 2016

Sudden Unexpected Deaths

When a client brings a pet to the vet, death is rarely on the forefront of their mind.  Most of the pets that we see are not in a serious or potentially terminal condition, so to unexpectedly lose a pet can be difficult for a pet owner to understand.  While rare, completely unexpected deaths do happen.

My first experience with this tragedy was back in 1998, only about a year after I graduated from vet school.  A client had brought an old boxer to our clinic for a simple bath.  He was there all day and received his bath without any problems.  That afternoon the kennel assistant took him outside for a walk and to eliminate, again without any problems.  I even commented on how energetic and healthy he seemed for his age (around 10 years old if I remember correctly).  About an hour after he had been outside he was found dead in his kennel.  There were no warnings and no explanation for why it had happened.  And I had to explain to the owner that the apparently healthy dog she had brought in for a bath had suddenly and inexplicably died.

Earlier this year we had a small dog come in for a routine semi-annual exam, fecal check, and deworming.  The owner had stated that he had been breathing funny for a week or two and wanted us to evaluate this while we were looking at him.  It was an extremely busy day and I was running around trying to keep on schedule with everything.  This was one of those days that I didn't take any breaks at all and ate my lunch while typing medical notes and calling clients.  Initially we had kept the dog in the front treatment area to keep an eye on him, but he was extremely noisy and barked at anything that was in the room.  He was wagging his tail and obviously energetic.  Because he didn't seem like he was in any kind of distress we moved him to the back kennel area to save our ears and keep from stressing out the other pets who were sick or recovering from surgery.  By early afternoon I finally had a chance to look at him, and while he did have a slightly increased respiratory rate and effort, all other vital signs were normal and his lungs sounded clear.  I did want to do some chest x-rays, but had some rooms to see first before I could call the client and talk about my recommendations.  About an hour or so after we put him back (after my exam), one of my staff found him lying limp, not breathing.  I immediately examined him and he had apparently died within a few minutes prior to him being noticed like this.  There was no warning and no signs of something this serious earlier in the day, or even on my exam.  Yes, I thought he might have some kind of mild to moderate respiratory problem, but nothing warned me of imminent death.  When I called and talked to the owners they were understandably very shocked and upset, especially when I didn't have an easy explanation.

Last week I received a call from one of our local specialty referral centers.  I had sent a patient there for years of persistent nasal problems without any response to antibiotics, antihistamines, or steroids.  The clients allowed a CT scan to be performed, which was completely normal and unremarkable.  To allow this scan the dog was lightly anesthetized with low doses of intravenous drugs.  After the procedure was over the specialist noticed a very slow heart rate (18 beats per minute).  This resolved on its own to 80-90 BPM very quickly.  However, within the next 30 minutes the dog began having a serious arrhythmia that progressed quickly and didn't respond to medications.  The vet in charge was a board-certified internal medicine specialist.  He got a board-certified cardiologist involved, as well as one of their emergency specialists.  Between the three of them they still couldn't explain why the dog was deteriorating so rapidly.  They used a defibrillator three times along with manual CPR and multiple drugs.  In the end, despite three specialists and intense care, the dog died.  It was especially strange because for the last four years in a row we have done deeper anesthesia for annual dental cleanings on this patient without ever encountering any kind of problem.

In all of these cases (and others that I didn't mention), the staff were shocked and broken-hearted.  Even though we don't have the same emotional investment in the pet that the owner does, we are still affected by our patients' outcomes.  When I spoke to the specialist about the death of our mutual patient, I could hear the tension and sadness in his voice.  The death of the respiratory case changed my mood for the rest of the day and even resulted in me snapping at my assistant manger, something I've never done in the five years she's worked with us.

Despite the incredible knowledge and training that doctors have, we don't know everything.  And despite our best care and efforts, sometimes things happen to pets that defy easy explanation and result in tragic situations.  I of course encourage every client to ask questions and get a copy of the medical notes when things like this happen.  Some sudden deaths can be due to mistakes, negligence, or malpractice.  And when such a sudden thing happens I can understand that a client wants answers and is looking to figure out what happened.  But in many of these cases there isn't anyone to blame.  It's like a human suddenly dying from a heart attack.

Veterinary medicine isn't an easy profession for a multitude of reasons.  One of the biggest stresses is the daily life and death situations we face.  It's hard enough when we're expecting a possibly tragic outcome, but when one surprises us it makes it even worse.

2 comments:

  1. I had been following a Doberman for a while for advanced chronic kidney disease. The dog came in for his 3 month check up of blood pressure and blood tests. His physical exam was as good as could be possible, he was very alert and happy during the consultation. His kidney value came back stable, his blood pressure was normal, no arrhythmia or anything wrong.
    While the owner was paying, the dog just suddenly had a cardiac arrest and collapsed in the waiting room. Unfortunately we couldn't bring him back.

    ReplyDelete
  2. Prior to our current pack, we had a wonderful Golden Retriever named Bailey. She had fairly typical issues common to her breed - yeasty ears, minor allergies.

    When Bailey turned eight years old she suffered pyometra. Emergency surgery and $2100 later all was seemingly well.

    When she was 8.5 years old, within just 24 hours, Bailey went from seemingly fine to collapse. We rushed her to the vet. X-ray revealed she was peppered with tiny tumors. Absolutely peppered. The vet indicated she was not in pain and I wished for her to pass at home. The vet agreed this was a fine option after we discussed her state further.

    The vet gave her an injection to help with the fluid around her lungs and we were on our way.

    Pulling out of the parking lot, my husband hears Bailey make a whimper and turned just in time to watch her take her last breath.

    We backed in, the vet came out and attempted CPR right in the backseat. No luck. I could see the heartbreak on her face.

    Turned out to be hemangiosarcoma. It blindsided all of us.

    ReplyDelete

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