Referrals

As a veterinarian, I am a creative problem solver. Our relationship with local hospitals means that both the perceived lower cost humane society sends patients when they are too busy or the clearly more expensive specialty 24 hour emergency hospital sends patients when clients don’t have enough funds to fix and very sick or badly injured animal. Some people simply call around until they hear what they like.

So we play “Let’s Make a Deal!” and attempt to provide borderline specialty level care. The latest patient comes from far away. The dogs owner called saying she had been to over 5 hospitals having been told they could fix her pet but when she gets there they say they are unable. Or won’t. Or it’s too expensive.

I request records be forwarded so I can properly determine if/how I can help. The records sent to me from the large corporate place have no useful information so I call. Dr Unaware tells me he wasn’t the one who examined the poor dog, “my nurses say his femur (thigh bone) is in many pieces.” Then adds “no, wait, the records says it was the tibia (leg bone below the knee) — pause — ah, it came from the Emergency Hospital, you need to call them.”

Sigh

The Emergency records are very informative. Perhaps too much so. They include financial estimates which really aren’t appropriate and long paragraphs about how difficult the client was being, verbatim. Also probably not appropriate but it did aid my understanding of this clients mind set. It appeared to be precipitated by the client not accepting the 5 digit estimate. 5 digits. As well as that euthanasia (chemical induced “gentle death”) was advisable. Which a veterinarian should NEVER instruct a client to do. Our position from my perspective is to support the decision if or when it comes up as appropriate almost always brought up by the client pet caretaker, but not initiate the conversation. It certainly belongs at the bottom, as the last of the list of options when all other choices have been exhausted.

But having reviewed the information, indeed poochers had a very badly broken pelvis on one side and a barely broken tibia on the other side with a degloving injury which is the most difficult thing to overcome. Degloving is like it sounds = a skin defect where the skin is removed as if a glove is peeled off/back. I told her owner I could indeed help this dog, if it was worth it to her and she really needed to bring the dog to me so that in hand we could go over all of her injuries and make a plan that was mutually acceptable.

Dog (trying to keep some her identity confidential to protect those that may be considered less than capable) comes in with a magically healed 2 weeks later pelvic injury as evidenced by her use of the leg. Which was key because she couldn’t use the other broken degloved leg. She needed A leg to stand on and had it. The broken tibia was protected only because she couldn’t step on the badly swollen foot secondary to the massive degloving wound which was trying to heal poorly and had a huge stuck scab that works against things. So sad. Amazingly she was a sweet pet despite being clearly in a lot of pain.

Her owner was somewhat brusque. She didn’t trust vets anymore. She had a human medical adviser on the phone. A nurse? They can be very difficult for veterinarians to interact with. The first sentence out of my mouth included an incorrect pronoun Dogs owner thought so she corrected me harshly.  I never would have made that mistake with the obviously female named pet, I was simply misheard me. Dog also hasn’t been spayed which is going to be a problem for another day, in a dog of her middle age.

I was told that this dog had seen at least 4 other veterinarians beyond the two known so far in the two weeks since her injury. She is going to forward me those records so I can complete my understanding. Currently Dog was on a wimpy dose of pain medicine and no antibiotics. The owner had been instructed to sanitize (ouch!) the open wound with a provided solution and put neosporin on it. NOT the way to heal a wound of this sort in my experience. The original prescribing Dr gave one week of medication and clearly Dogs owner did not obtain additional care until after that. Poor creature.

The badly injured non healing wounded unused leg should be amputated, I told Dogs owner. She wouldn’t accept that. She is prepared to spend an equivalent amount attempting to fix it which will require bandage changes every 2-3 days for at least a month. With no guarantees that it will work and may end up with the same expense amputation and Dogs suffering in the meantime.
We’ll see

I still don’t know how Dog found her way to me

CS

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