Friday, October 5, 2007

And that is why I became a vet!

Yesterday (the Feast Day of St. Francis), I walked up to a room and checked the file. It was a new client with an animal that had never been seen at the clinic before...and it was here for a euthanasia.

This scenario happens with some regularity. Old, sick and/or injured animals from other practices come to us to be euthanized. The reasons are as varied as the animals themselves. We are the only practice in town with a crematorium, so that sways some people. Often, people feel embarrassed to take their long-ill pet to their regular vet for this final service on some mistaken notion that the vet may be "disappointed" in them for "giving up."

I typically don't ask why a new animal that arrives is being euthanized. I trust that the owner has thought long and hard about this decision and the last thing they need is a nosey, unfamiliar vet questioning this hardest decision of any pet owner. Especially if the animal is old, thin, and lethargic, there seems little need to ask why they are euthanizing. However, in the case I saw yesterday, I just had to ask the question.

The dog was a 7 year old, spayed female poodle by the name of "Nina." (random poodle picture at right) When I entered the room, she was the first thing I saw. She was sitting alert on the table, looking at me with clear eyes and a smiling face. Her docked tail was wagging vigorously...and her back right leg was sticking out at an unnatural angle. Her owners, a younger couple with two kids aged ~4 yr and ~2 yr, were all crying, and clearly had been for a while. The receptionist had informed me that the owners didn't want to be present when I euthanized Nina, but they wanted to talk to me before I did so. I certainly thank St. Francis that they wanted to.

Looking at the dog, it was fairly obvious what the problem was...that leg. As the owners asked if Nina would feel any pain when she was euthanized, I was struck by those happy eyes. This was a young dog, a happy dog, an otherwise-appearing healthy dog with a loving family. I couldn't just euthanize her without finding something out about her.

Asking the owner for her history, they said this injury had occurred some time on Sunday. They had taken her elsewhere where a knee problem had been diagnosed. An estimate was given for repair which was up in the 4-digits and full payment was needed, no down payment or billing allowed. That was why Nina was here...because they couldn't pay that sum so suddenly, she was in pain, and they didn't want her to be in any pain anymore.

She was clearly painful. Though obviously a sweet dog, when she was touched anywhere near that back leg, she would try to bite. I just couldn't think that this was a knee injury. No matter how damaged, I had never seen a dog with an injured knee in this much pain. And the angle of that just had to be a problem in the hip. And my money was on a hip subluxation (displacement).

I said as much to the owner after looking at Nina. I told them that this was a fixable problem...if that is what it was the problem. I wouldn't know for sure without examination under sedation and radiographs. I told the owners we would be able to work out a payment plan for them, if they could put half of the estimate down as a down payment. They were ecstatic with that idea and, after seeing the estimate (which was a little more than half of the first estimate), they agreed. Nina went home on pain medication with plans to return in the morning for sedation, radiographs, and surgical repair.

After they left, I had a small crisis of conscience. From the outside, this situation had all of the trappings of a set-up "bad account." I started to question my standards. Were crying children and an adorable dog the things that pushed me towards being overly helpful? Is that my "sucker" price? I decided that I had to trust my instincts and look forward to the next day.

Today rolled around and Nina arrived for surgery. It was a busy surgery schedule today, so we got some of the more routine stuff out of the way before starting on Nina. Bloodwork came back showing normal parameters, so a catheter was placed and Nina was anesthetized.

Under anesthesia, it is much easier to assess orthopedic conditions; the muscles are relaxed, and the animal is no longer in pain. Palpating Nina's hip, I was convinced that that was where the problem was. It just didn't move correctly. Next step: radiographs.

The first radiographs I wanted was the straight leg ventrodorsal view. Essentially, this is where the dog is lying on its back and we stretch the back legs out as straight as we can so that the knees are level. While positioning Nina, there was a sudden audible and "feel-able" pop....and, suddenly, the hip was back in place. Excited, we took the radiographs and, lo, her hips looked great! Everything was lined up and in the proper place! Feeling the hip and moving it, everything felt like it was supposed to! Nina was "fixed" at a fraction of the cost and her life has been saved!

Hip luxations are notoriously troublesome to deal with. When a hip has been displaced, all of the ligaments that normally hold it in place are torn. Depending on several factors, the femur can pop right back out of where it should be. Therefore, I put an Ehmer sling (pictured at left) on Nina which will stay on for several weeks. The idea is that it holds and rotates the head of the femur so that it stays firmly in place which the surrounding tissues heal. As long as she doesn't have any problems between now and then, we won't see her again until then.

When she woke up, she was clearly more comfortable. Though the sling is awkward and it will take her some time to learn how to move around with it, now you can hold her and touch her hip without pain.

I'll certainly post any updates about her. For now, Nina's story will keep my spirits up for a long time!

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