Recent sad case....

Re: Recent sad case....

Vicky RVN — Mon, 30 Aug 2010 14:11:25 GMT

Am late in seeing this. Palua so sorry that the case didn't turn out well, but not for want of you all trying your hardest for Max. RIP Max x

Re: Recent sad case....

SmegSlayer — Sun, 01 Aug 2010 14:23:49 GMT

we had 2 in on friday that i fitted in as extras at the end of morning consults. lovely golden retriever with diarrhoea and the owner said he was drinking loads but not urinating. when the dog came in it could barely stand and was white as a sheet. xrayed chest and abdo and did abdocentesis- blood came back. Huge tumour in liver/spleen.

the other one was a blind diabetic cocker spaniel with hyperglycaemia and ketosis. seemed to respond well to tx over friday but apparently on saturday he wouldn't stop vomiting, couldn't stand, veins completely collapsed despite fluids. exlap revealed a pancreatic tumour and he was pts on the table.

Re: Recent sad case....

S-J — Sun, 01 Aug 2010 12:13:49 GMT

iam so glad that im off this weekend though i would like to know whats happened to my parvo puppy, last sunday was one of the worst i have ever worked and was i was starting to get hysterical be the end of it, not including 2 patients that died we had to put 12 animals to sleep including a police dog and a great dane.

not a good day to be a nurse

Re: Recent sad case....

Saskia Quinn — Sun, 01 Aug 2010 09:52:49 GMT

thanks Jeniflower xxx

Re: Recent sad case....

Jeniflower — Sun, 01 Aug 2010 04:18:08 GMT

oh, so sad. I definately wouldn't have been able to do this PTS if I'd have been in your position. Well done for keeping his tail wagging for as long as you did.

Re: Recent sad case....

Saskia Quinn — Sat, 31 Jul 2010 23:23:35 GMT

I have his collar - owners didnt want it, I guess they were too upset

Re: Recent sad case....

Steph Worsley — Sat, 31 Jul 2010 22:57:21 GMT

all our pm's go over to our path lab and they analyse everything (can take months for a final report to be achieved though!!)

we never do a pm unless owner has requested it as like you say it is unethical, there are some cases more than others where we push for pm's tho

Re: Recent sad case....

Saskia Quinn — Sat, 31 Jul 2010 22:49:58 GMT

Mmmm...... interesting case Steph, its a shame though permission wasnt granted for a pm. I guess we could have pm'd Max had we wanted, as the owner opted for us to send him for general cremation.

However, unless permission is granted, its unethical I guess to carry out such a procedure, even if the vets want to know what may have happened.

We dont do pm's in our hospital though, so that thought would have never been considered. Sad really, as I would have been so interested to know what had happened to Max.

I often wonder about our policy of not performing pm's. There are cases we cant solve, and sometimes the animal is euthanased, though I do think sometimes, if we could send samples off for analysis or carry out pm's- it would stand the team in good stead for a future similar case to come through the doors.

If only us VN's could make the decisions lol!!

Re: Recent sad case....

Steph Worsley — Sat, 31 Jul 2010 22:07:05 GMT

hey we did have a very similar case recently presented with gastric dilation, performed a gastropexy on him, found stomach and intestines full of some black crud (still dont know what it was)

started regurgitating following surgery did imaging, stomach full despite not really eating, fluoroscopy showed some oesophageal dysmotility, did endoscopy found some oesophagitis (not suprising with the regurge) placed a PEG tube (would have like to put a J tube through this but the only we had in seemed to be a surgical not endoscopy one so not long enough)

we were routinely getting 200+ mls fluid back every 4 hours, despite not actually giving that much food/water combined, again on high rates of ivft. added in erythromycin with the ranitidine and metoclop infusion some slight improvement,

dog then developed pancreatitis on top of everything else, and owners opted for pts as we just couldnt see a way of getting the dog home. (think he would have ended up in multi-organ failure potentially)

usually the pro-motility drugs do their trick but sure there has to be underlying pathology, unfortunately we did not get permission for pm

Re: Recent sad case....

Saskia Quinn — Sat, 31 Jul 2010 22:00:03 GMT

[quote user="Laura 'Fluffy' Ringsell RVN MBVNA"]

Really, really feel for you. These cases are supposed to be the most rewarding not the most upsetting. At least you know he had the best nursing care in you - small consolation I know.

Take care of you and your lovely small dog icon from the lovely Arlo!!!

[/quote]

hehe thanks Laura - missed your post there as we were out putting the ducks in for the night!

Yeah, it did feel rewarding while it lasted, just didnt expect it to end so suddenly - thank you Laura xxx

I'm sure Arlo will be pleased with the compliment xxx

Re: Recent sad case....

Saskia Quinn — Sat, 31 Jul 2010 21:56:50 GMT

Many thanks Steph, I knew I could depend on you and your knowledge!!

Would you have similar cases in uni? Would you have done anything different? (Apart from erythromycin)

Re: Recent sad case....

Laura Ringsell — Sat, 31 Jul 2010 21:53:24 GMT

Really, really feel for you. These cases are supposed to be the most rewarding not the most upsetting. At least you know he had the best nursing care in you - small consolation I know.

Take care of you and your lovely small dog icon from the lovely Arlo!!!

Re: Recent sad case....

Steph Worsley — Sat, 31 Jul 2010 21:40:38 GMT

yep erythromycin is an antibiotic, pretty sure there is a dose rate in the formulary for GI motility

I know nothing i say can make you feel better, but I think it is a sign of a good nurse that we still get affected by some cases especially when we are caring so intesively for patients

Re: Recent sad case....

Saskia Quinn — Sat, 31 Jul 2010 21:38:08 GMT

many thanks Steph, its appreciated, wish I could say made me feel better thou!

As far as we could tell, he had been ill for approx 2 weeks before we had the initial consult

Well, we tried, but we lost, sadly. Erthyromycin is an anti-biotic, isnt it?

Re: Recent sad case....

Steph Worsley — Sat, 31 Jul 2010 21:33:45 GMT

so there was 2 drugs in there that aid motility, the only other one we would prob have added in would have been erythromycin

the other thing we are doing for these sort of cases is placing a PEG tube and completely emptying stomach every 2-4 hours prior to feeding.

you have done the best you can for this guy there was more than likely some underlying pathology (potentially cause by the FB being left in situ for a while)

hugs once again xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

Re: Recent sad case....

Saskia Quinn — Sat, 31 Jul 2010 21:28:44 GMT

oops! Made a mistake there Steph - cerenia wasnt given post op as no vomiting, had been getting that prior to 1st ex-lap

Re: Recent sad case....

Saskia Quinn — Sat, 31 Jul 2010 21:26:42 GMT

Steph,

he was on Cephalexin BID, Buprenorphine BID, Zantac BID, Cerenia SID, as well as a Metoclopramide infusion - 2mls to every 1000mls Compound Sodium Lactate.

24hrs post op, he was eating Hills A/D basically 2 spoonfuls every hour. Seemed to be doing so well other then the dehydration when fluids were reduced.

Re: Recent sad case....

Saskia Quinn — Sat, 31 Jul 2010 21:22:00 GMT

[quote user="mrs mac"]

When they manage a flick of tail despite how ill they are- that always gets to me. Lump in the throat time.

[/quote]

aw, Heather, that really got to me - I was really in tears, it was awful. Thanks xxx

Re: Recent sad case....

Steph Worsley — Sat, 31 Jul 2010 21:18:22 GMT

[quote user="Saskia Paula Quinn"]

[quote user="Steph Worsley RVN MBVNA"]

awwwww hugs Paula Max obviously recieved the best care from you and he showed his appreciation by trying to rally round one more time.

I hate these sort of cases cos you just cant find a cause for them to be so ill! I often see these sort of cases and as much as i try to distance myself there is always one or two that break my heart and make me cry

[/quote]

aw, thanks Steph I'm normally quite good at supressing my emotions at work, but there is always a special few that slip through the net, isnt there?

In your opinion, Steph, any ideas? I was thinking maybe a problem with emptying of the stomach?

[/quote]

Does sound like he possibly had delayed gastric emptying. the inability to maintain hydration seems to be something I have seen with these animals as well. Although the fact he didn't vomit till friday seems a bit odd, they seem to normally continuously vomit

what meds was he on?

Re: Recent sad case....

Mac Feather — Sat, 31 Jul 2010 21:12:25 GMT

When they manage a flick of tail despite how ill they are- that always gets to me. Lump in the throat time.

Re: Recent sad case....

Saskia Quinn — Sat, 31 Jul 2010 21:12:01 GMT

[quote user="Steph Worsley RVN MBVNA"]

awwwww hugs Paula Max obviously recieved the best care from you and he showed his appreciation by trying to rally round one more time.

[/quote]

aw, thanks Steph I'm normally quite good at supressing my emotions at work, but there is always a special few that slip through the net, isnt there?

In your opinion, Steph, any ideas? I was thinking maybe a problem with emptying of the stomach?

Re: Recent sad case....

Saskia Quinn — Sat, 31 Jul 2010 21:09:32 GMT

Thanks S-J

Very difficult for us when we have parvo too, isnt it? We always seem to have at least one parvo case in the hospital. Theres a fine line to 'giving them a chance' or putting them to sleep too quickly, isnt there?

Thinking of you xx

Re: Recent sad case....

Steph Worsley — Sat, 31 Jul 2010 21:07:50 GMT

awwwww hugs Paula Max obviously recieved the best care from you and he showed his appreciation by trying to rally round one more time.

Re: Recent sad case....

S-J — Sat, 31 Jul 2010 21:04:48 GMT

im sorry saskia sounds like u had a tough time but u obviously all did everything for him.

iv had a parvo puppy in all week that is so up and down dont quite know what to say to the 'o' such a brave little fella