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Avatar universal

The vet versus emergency hospital.

When do you choose an emergency hospital over a dog's regular vet?  Last week I chose vet with tragic consequences. My Westie woke up early and dashed to the door to go out. A short while later I saw him straining to produce a bowel movement although it appeared he had already had a normal one. Charlie would have been 15 next month so his vet did not think his occasional constipation was a serious issue since he was a healthy dog in remarkable shape for his age. The situation usually resolved itself. This time, after awhile Charlie began trembling as he did when he was anxious or in pain. He yelped when I picked him up. He obsessively tried to have a bowel movement but only produced a little liquid. I called his vet as soon as the office opened at 8:30. His vet would not be in until 10 AM but I could have the first appointment. By then Charlie was lethargic and depressed. The vet did a routine exam and said he did not appear constipated, his vitals were normal and the only cause for immediate concern was a fever of 105. He gave Charlie injections to bring down the fever and reduce the intestinal distress, sent him to the back for a transfusion of fluids and gave me some antibiotics. He instructed me to give Charlie an antibiotic pill with a little food as soon as we got home and to call back at 2:30 when he hoped to have lab results from the blood he drew. Charlie would not take any food and I had to pry open his jaw to get the antibiotic down. Then he began wandering the house pressing his head against the wall and furniture. After a while he laid down in his favorite spot and seemed to be sleeping peacefully. I cooked up some rice and boiled chicken as the vet had recommended. When I went to Charlie I noticed he was breathing heavily for him (he usually was a very light breather). He seemed frightened of me when I awakened him.  When I carried him to the kitchen to see if he would take a little food or water, his legs buckled and he laid down on his side. He had trouble getting back up, sat down immediately, then toppled over. His breathing grew heavier. It was 1 PM. I called his vet and was told he was in surgery and could not talk to me until 2:30 but I could bring Charlie in if I was worried. After finding someone to hold my dog as I drove, I headed to the vet. At 1:45 another vet in the practice listened to Charlie's heart and lungs and decided the situation was not urgent. We were sent to reception to wait for his vet. After a half hour Charlie's breath grew raspy and he was taken to the back for oxygen. About 10 minutes later his vet came out to say Charlie was in bad shape and they were trying to stabilize him. After another 10 minutes he came out to say they weren't able to stabilize him and we needed to discuss our options. Ominously he said trying any intensive procedures was not a safe option since the vets left at 5 PM and Charlie was too unstable to stay at the hospital without medical supervision. I was in shock and wanted to know more about his condition. How could he be okay at !0, not urgent at 1:45 and dying at 2:30? The lab tests had not come in but the vet said he could do an in office blood test to see if it yielded any clues. A few minutes later he came out to say Charlie had suffered cardiac arrest as they were drawing blood and they had been unable to restore a normal heartbeat. He took me back to say goodbye. Charlie was not breathing. The vet's guess was that Charlie's organs had been failing slowly because of his age and had just given out because it was his time to go He gave me papers to sign for disposal of his body and asked me to sign permission to euthanize, in case, he said, there was a residual heartbeat. The lab tests came back the next day. At 10 AM all of Charlie's levels were normal except for a low platelet count and a slight, non-serious high level of liver enzymes. There was no sign of infection or organ failure. When I called the office a few days later to express my devastation over how Charlie had been treated, the office manager belatedly said he should have been kept for observation and put on intravenous fluids that morning. He should have been seen right away when I came back at 1:45. I believe Charlie died of shock but have no idea what the underlying problem was (I suspect he my have eaten something that violently disagreed with him). I will never know for sure, but think he might have survived if I had taken him to an emergency vet. I would be taking him for a walk today instead of waiting to pick up his ashes. In any case I might have had more answers and he might have had less suffering.
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Avatar universal
My mother lost her 16 year-old mixed breed dog from a similar-type illness, although he lasted two or three days.  Gut symptoms and fever.  After he was gone, she thought back and believed he might have gotten into the trash and eaten a pork chop bone.  She felt horribly guilty.  My feedback to her was the same as it is to you.  He didn't die because he ate that bone, if he even did eat it.  He died because he was 16.  Stuff happens, and when a dog is 16 and stuff happens, it's generally fatal.  Had he eaten a bone when he was young and healthy, he probably would have gotten over it.  He died of old age.

15 or 15 is a short time, compared to our life spans and how long we would like for a pet to live.  I've had dogs that I wished could stay with me my whole life.

Again, I'm so sorry for your loss.
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Avatar universal
I don't have an answer for you, I would just like to say you tried very hard for Charlie, and he was a lucky dog to have you.It sounds to me like  your vet didn't take any of your concerns seriously, and he was very wrong.  If he didn't know what was wrong with your dog, he should have sent you to a specialist that would  know, and would be open 24/7 so they could have watched him closely.  I hope you find comfort in knowing you did a great job with Charlie for 15 years, which is a very long time.  Take Care.,
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Avatar universal
I'm sorry, but with all due respect, I have a 180-degree different opinion from the other feedback that you received.  It sounds to me like Charlie received good, conscientious care, from both you and the vets and that he simply reached the end of his appointed days.  

A 15 year-old dog is like a 100 year-old human.  Human centenarians often pass away in such a manner as your dear Charlie did.  They live an exceptionally long time, and then one day they have a short illness that doesn't really "seem" like it should be a big deal, except that they just up and die.  Sometimes they lie down to go to sleep, seemingly perfectly healthy, and they just don't wake up.  That's the normal way for centenarians to die.  They don't go into intensive care and linger for weeks or months, at that age.  Their bodies can't take it.  There is a certain frailty that comes with  being that age.  The whole system gets worn out, and the slightest little thing that goes physiologically wrong can mean the end.  

Charlie's illness was over and done with in a matter of, what, 8 or 10 hours?  If it had all happened at night while you were asleep, and you had simply woken up to find him gone, your heart would still be broken, but you would be content that he died peacefully and in his own time.  The only difference between that scenario and what actually happened is that this occurred in daytime, and you took him to the vet, and both you and the vets tried as hard as you could to save him.  That is something that you can choose to feel good about, if you can find it in your heart.  I would have no quarrel with the doctors.  They tried.  They tried like he was 5 years old and not 15.  They did not decline to even try, as some doctors might, just because he was exceptionally old

I am truly sorry for your loss.  You seem like an exceptionally caring owner, and Charlie sounds like he was a very good dog.  I hope you can eventually come to a peaceful place about this and that you will be able to provide the same kind of love to another dog.  Please accept my best wishes and deepest condolences.
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1916673 tn?1420233270
Hi. I just wanted to add my sincere condolences to you for losing Charlie, particularly in the way it happened. I rather agree with both landapalm and with skydnsr. The vets certainly seemed on the one hand to do over and above what some vets would have done, while unfortunately not being consistent (due to other vets being involved) when it mattered. My guess is that everything that could have been done, was done, and nothing would necessarily have changed the outcome. Charlie had reached a good age - and no doubt has had the most fantastic life with you up until that point - so there is absolutely nothing to reproach yourself or the vets over. Sadly, our best friends never live as long as we would like.

I wish you peace, despite the grief and shock of losing him so suddenly. You are in my thoughts. Run free Charlie. Tony
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Avatar universal
15 or 16, I meant.
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Avatar universal
I want to thank you all for your comments and concerns. They were equally helpful. However, by going into so much detail in my post I think my original concern got lost. My general question was whether the vet rather than a 24 hour emergency clinic is really the best option when faced with a rapidly worsening situation. I do not think either my vet or I did anything "wrong." However, this office like others has schedules. They see pets in the morning or late afternoon/early evening. They are in surgery performing routine procedures in the early afternoon and are available for phone consultations only between 2:30 - 3:00 PM. They have limited on-site diagnostic capabilities and either have to wait for results or send a client elsewhere for more advanced diagnostics. Their overnight facilities can not handle critical cases because of a lack of veterinary supervision. The example I gave was to show that in some cases this may not be sufficient. My dog appeared non-critical when he was seen in the AM. On site lab tests would have revealed that his condition was more serious than it appeared. His condition deteriorated too rapidly to wait for a late afternoon appointment or consultation. By the time he was seen, he was too unstable to be moved and too critically ill to remain at the hospital. I have no idea what the shot-term outcome or longer term prognosis might have been if he did go to an emergency vet.
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1916673 tn?1420233270
Hi. I think the problem is that all vets are slightly different, so it probably depends on your circumstances, how well you know your vet, the facilities and services of your vet's practice, the symptoms and condition of your dog, etc.

In my circumstances, my vet is some distance away, but there is no 24hr animal surgery here, so the decision for me is very simple - I would go to my vet or use his out-of-ours emergency service (there's always a vet on-call).

I also think your circumstances were perhaps somewhat different to many, in that your dog's condition was not known to be serious and once it was known, he was too seriously ill to be moved. I think everyone should assess their vet's surgery and services in advance, so that should such a difficult decision have to be made in the future, hopefully it will be both possible and appropriate. Tony
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Avatar universal
"At 10 AM all of Charlie's levels were normal except for a low platelet count and a slight, non-serious high level of liver enzymes. There was no sign of infection or organ failure."

Had these results been known immediately, rather than the next day, would they have pointed to any life-saving treatment that Charlie could have been given that same morning?  
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Avatar universal
Around here, the emergency veterinary clinics are only open after hours, so one would not have an open choice of going to either a regular vet or an emergency vet.  During regular office hours, you go to a regular vet, and after office hours, you go to the emergency clinic.  When the first emergency clinic in our area opened, its founders chose not to compete with the established vets but to provide a service for them and to seek their support.  That worked out pretty well for both sides, so successive emergency clinics have followed suit.  

I have been to our local emergency clinics quite a few times in the 22 years that I have owned dogs.  Sometimes I have been ushered into an exam room within a few minutes of my arrival, and sometimes I have waited several hours in the waiting room.  Patients are triaged according to their apparent state of emergency.  The times I have brought in dogs that were sick but that didn't look like they were dying were the times that I waited for hours, if it happened to be at the same time when there were one or more animals onsite that were obviously critical.  Even sick dogs don't necessarily get seen immediately.  They have to look sicker than whoever else is there at the time.  Even if you have been waiting a long time already, if someone brings in an animal that looks more emergent than yours, that animal will be seen before your animal.  I have even had a dog that was brought in with a fish hook in its lip seen before my sick dog (and I didn't mind.)

Our local ER clinics do some tests onsite, but they do have to send some things out, and they don't have every diagnostic gadget that you might imagine.  I remember, in the 90's, my dog got hit by a car at about 5:30pm, and after she was treated at the ER that evening, I had to take her to my regular vet the next day to have an EKG done.  The emergency clinic didn't have an EKG machine.  They probably have one now (maybe), and I know they have always had an x-ray machine, but they very easily might not have something like an ultrasound machine.  

Again, I can only speak to how  things are in my area, but around here the main resource that the emergency veterinary clinics provide is the doctor.  They give you a veterinarian that you can see after hours.  Once your dog is in the exam room, the doctor provides pretty much the same service that your regular vet would give during regular office hours.    
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Avatar universal
It is a flag that there could be a serious issue which in some  cases requires immediate emergency treatment with prednisone, fluids or transfusions to prevent a dog from going into shock. I believe that was what happened with Charlie.  The longer term prognosis is unknown. After much thought I think the lesson here is that if your dog shows rapid decline after a vet visit, if possible you should rush your dog to an emergency vet especially if your vet is too busy to address the situation immediately.
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1916673 tn?1420233270
Hi Billi. Yes, I think you are right. Any rapid deterioration in a dog's condition would be best presented to an emergency clinic, because they are experienced in emergency work and would probably be more geared-up to quickly diagnose, assess and monitor condition, take and analyze bloodwork and then offer the appropriate treatment. That said, a good regular vet would probably be more likely to know you and your dog and possibly the history of other conditions that could have an impact on the current ailment. Like I said before, I think it's a tricky decision that can only be based on each individual circumstance. Tony
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