Ford Veterinary Associates, P.C.

Man's best friend has rightfully earned its place in our hearts. The bond that an owner and dog experience is no different than any of the other loves we experience in this life. That is why the loss of such a dear friend is an emotionally challenging and taxing experience. Owners need to...

make challenging decisions during extremely stressful times based on the information that is in front of them.  As a veterinarian my first concern is always the animal patient, but of course their loving caretaker is critical in the decision making process when their companion is sick. Veterinarians guide owners based on their professional experience and expertise, but the individual circumstances of each owner are incredibly different. For that reason multiple options are always presented to owners with the final decision ultimately in their control. In the case of complaint [redacted], an animal experiencing gastrointestinal distress was presented to my office on Friday April 3, 2015 following five consecutive days of inappetance and vomiting at home. A physical exam at that time was largely unremarkable. The owner noted that the stool was dark, possibly suggestive of an upper gastrointestinal bleed, Our animal patients cannot clearly communicate with us, so we must rely primarily on blood work and advanced diagnostics to further understand their disease process. Preliminary blood work was sent out to an independent lab. In the mean time an anti nausea injection was given and gastric protectants were initiated. On the morning of Saturday April 4 the blood work returned from the lab and indicated healthy kidney function, normal liver function, no electrolyte or glucose abnormalities, a mild increase in white blood cells, and no anemia. Pancreatic enzymes were elevated. The owner was immediately contacted and antinausea medications were continued and antibiotics were added in. Unfortunately our office is not a 24 hour emergency facility and we are closed on Saturday afternoons and all day Sunday. Hospitalizing an animal over the weekend is not ideal under these circumstances and the owner was directed  visit an emergency hospital over the weekend if the condition did not improve. The following Monday the patient returned because its condition had not improved over the weekend. Additional diagnostics were discussed to further identify the cause of illness and the owner agreed. A canine pancreatic lipase immunoreactivity test was run and the abnormal result is highly suggestive of pancreatitis a disease with an extremely variable prognosis and outcome. Options were discussed at length with the owner. Ideally pancreatitis is treated with hospitalization, aggressive fluid therapy, gastroprotectants, and pain management. Treatment is costly, the prognosis is guarded, and owners need to make individual decisions based on their financial abilities and emotional connection with the animal. Considering the patient revealed no other significant organ dysfunction treatment was a reasonable and sensible option I the owner agreed to it. The option was also presented to discontinue treatment and opt for euthanasia, but the owner refused and wanted to give her pet the best possibility of a favorable outcome. I told her that if I were presented with. this situation with my pet I would hospitalize with the understanding that the final outcome could still be an unfortunate one. The owner did present that finances were a concern, so a treatment plan within her financial capacities was established. Owners, of course, want to do the best they can for the animals and as veterinarians we do whatever we can to offer those services. At this point at home therapy had failed and hospitalization was necessary for further treatment. An estimate of $400 dollars was presented to hospitalize the animal overnight and initiate treatment. The owner agreed and left a deposit of $200. An intravenous catheter was placed in the right forelimb and pain medications and gastroprotectants were administered. Aggressive fluid therapy was also initiated. The owner understood that no overnight technician or doctor would be present and the patient would rest comfortably without supervision. The patient did so resting comfortably on pain medications in a thermally controlled environment on soft blankets.The following morning the IV catheter was still in place and the owner was called with an update of the patient's status. At that time things were no better or worse, and treatment would continue throughout the afternoon when the owner would again be contacted with an update. After performing another physical exam and placing the patient back in the cage the fluids unfortunately started to infiltrate around catheter site. This is a typical sign of a vein that has failed and can no longer support the high volume of fluids that need to be given; a situation not uncommon  older patients. Once this was identified the catheter was removed and six different attempts were made to regain intravenous access and continue fluid therapy. Unfortunately these attempts (none of which the owner was charged for) failed as the result of geriatric vascular fragility and chondrodystrophia. At that time fluids were place subcutaneously (at no charge) to increase fluid retention of the veins with the intention of placing another catheter in an hours time. At no time did the patient experience any unnecessary discomfort or cruelty as the owner suggests. Simply necessary medical procedures were performed to improve the patients overall outcome. Outside of standard office hours, the owner entered the hospital and requested that she see the dog. Of course she was given this opportunity and told why the catheter was not in place. Being outside of our standard office call hours I was unfortunately unavailable, but the owner had made the difficult decision  to no longer continue treatment and opted to euthanize the patient immediately. The euthanasia solution must be given intravenously, but considering the state of the patient's veins it was obviously a challenging process. My technicians made several attempts but unfortunately the veins again failed. Enough solution was given to result a "deep snoring sleep", rendering the dog unconscious and unaware of any perception pain or discomfort. To minimize any further distress and end an obviously uncomfortable and emotional situation the humane option was to deliver a cardiac injection to the unconscious patient. This was done humanely and quickly with the owner's permission and the patient passed away.  Watching any animal be put to sleep is a time that no owner will ever forget. It is a time understandably charged with emotion, fear, and easiness, but also understanding for an unfortunate and sad situation. However, to suggest that this situation or the actions taken within it were inhumane, cruel, or disrespectful is simply not true. For my staff and I the objective is, and always will be, to consider our patients first and take all the necessary steps to perform medical procedures in the most humane and professional way possible.  I do however recognize that this can be lost on owners when distraught by the loss of a loved one. Following the euthanasia the owner charged $399.00 for the cost of care and hospitalization over the 24 hours period as discussed and agreed upon prior to treatment. She then received a bill for the cost of euthanasia and processing of the body for $162.00. This charge was not discussed in the original office call with the owner. Unfortunately in Veterinary Medicine we cannot tell the future and predict how every patient will respond to treatment. Just because a patient is "old" doesn't mean they don't deserve compassion and care. Every situation is different, and it is our job to give every animal the best chance, especially when an owner requests it. We make ethical decisions fueled by our compassion for animals. We are guided by our expertise and education; we do not sacrifice the well being of animals for financial gain. Medicine isn't kind or fair, we are oftentimes left frustrated as powers far beyond our control ultimately dictate the final outcome. We offer the best care possible often times under less than ideal circumstances. Not every outcome is ideal, but t is unfortunately the reality of our profession. Ultimately owners use the information we give them to make decisions for their pet, and we do our absolute best to openly discuss those costs and offer all treatments discussed in the most humane way possible.