I really don’t know what I did to deserve so many complicated bleeding cases over the past two weeks. I was starting to think that our in-house blood machine was not working because every case I handled seemed to be suffering from anaemia (low red blood cell count). I had to collect blood from a perfectly healthy patient to check that our machine was not playing games with me.
I have had to give two blood transfusions in a span of a week and recommended a few more but owners could not afford it.
Sometimes a certain vet seems to attract a specific caseload. In the past two weeks, I was destined to become the anaemic workup vet and I have learnt so much and dealt with very challenging cases. Although I looked as stunned as ‘Jessie’ below when I started getting one bleeding case after another, I managed to get into the swing of matters and focus on determining the cause as fast as possible.
It all started last week when my first afternoon consultation was Myff, this adorable four-year old labrador that had been off colour for the past couple of days. The owner said she may have had access to ratsak six days ago from the compost bin. We immediately admitted her to hospital & collected bloods and found she was only mildly anaemic. The history of access to ratsak was confusing as it usually takes 2-3 days for patients to start bleeding and I would have expected more obvious signs of bleeding (coughing or abdominal swelling due to haemorrhage or even fresh blood from the nose or covering the stools) at that stage. We proceeded with giving her the anti-dote to ratsak and started her on IV fluids.
The next day, she seemed to slightly perk up but her gum colour was paler than the day before.
We repeated her CBC (complete blood count) and found her anaemia was significantly worse. We recommended a transfusion and her owner was happy for us to do whatever we needed to help her pull through. We decided to give her caniplas (contains all the clotting factors but lacks red blood cells) transfusion over blood transfusion (blood was collected two weeks ago and so would be lacking in the clotting factors). In an ideal world, we should have collected fresh blood and transfused her with it. However, given the circumstances, the better choice seemed to be the caniplas as ratsak poisoning depletes animals of their coagulation factors and that was the process we were trying to reverse!
Over the course of the day, ‘Myff’ was closely monitored and she became more interactive and lively and even ate a little bit of chicken. I did not take any chances that night and decided to check her CBC again before we headed home. I was not happy with the results as they indicated she was still losing blood. Her abdomen seemed quite distended and I was seriously concerned about her. Even though she was heaps brighter, I proceeded with giving her a whole blood transfusion based on her blood results.
She significantly started to go downhill after that and I suspected she may have developed a blood transfusion reaction.
At that stage, I was out of ideas and seriously concerned about my patient. I called her owner and strongly recommended he took her to a specialist emergency service (about 1.25 hours away) to give her the best chance of surviving and he did. Unfortunately the referring vets did further workup and discovered she was suffering from suspect multi-organ failure and gave her a very guarded prognosis so the owner opted to put her to sleep at that stage.
Needless to say, when I found out what happened to ‘Myff’ the next day, I was simply shattered. I was hoping that the specialists would give her a fighting chance and wondered if I should have sent her down there earlier. This challenging case leaves so much room for speculation. I wonder if the outcome would have been different had she been brought in to me straight after they suspected she had ratsak poisoning or even the day she started to look unwell.
I can not stop reflecting on what I could have done better in my workup.
Did I miss something? What was the primary cause of her bleeding if not ratsak? Why didn’t she respond to all the aggressive treatment? I owe it to ‘Myff’ to learn from her tragedy and try to determine what we all could have done better in her management. I have already emailed the specialist vets and we will be discussing her case thoroughly in the next couple of weeks to see if we could piece the history and clinical findings together. We all agreed it was a very odd case in terms of presentation and how fast the patient deteriorated in spite of aggressive medical therapy.
I would like to take the opportunity to emphasize the importance of getting your pet checked out by your local vet as soon as you notice it is unwell. If you think your dog may have ingested poison, don’t sleep on it and see what happens as you may seriously regret doing that.
If you have a labrador and it’s appetite is slightly decreased and it is low on energy, then get it checked out immediately.
I have found Labradors to be such stoic dogs and they can mask serious disease. I mean ‘Myff’ ate a small amount of food and was wagging her tail just to please us. She was feeling so rotten but in all honesty, she did not look like she was shutting down.
The next few cases I will be discussing did not have such a tragic ending. Some are still not out of the woods but stabilised. Tune in tomorrow for my continued discussion of atypical bleeding cases.
Related articles
- Poison is poison (rayyathevet.com)
- The curse of ‘they come in 3s’ (rayyathevet.com)
Dr Rayya's Online Veterinary Journal 
September 25, 2011 at 3:35 am
oh god :((
that’s so sad.
I’m subscribed to your blog but I’m so unprofessional in reading stories like that. I mean I get paralyzed with very egoistic fear for my cat and start thinking ‘what if one day …’
I really respect what you are doing and your clients are so lucky to have you. We never had access to such responsible and professional doctors and once my cat ( a kitten then) was very seriously ill and it was so scary, I can’t even start telling you how much.
Again, I’m being too self-centered.
It’s a very sad story but I have a feeling ( and it’s only a feeling as I’m far away from the profession) that you did all you could. I mean, you are thinking a lot about this and I’m sure you’ve got a lot of knowledge and experience in this job thus I think you did it right. It’s just in life it is sometimes like that – that when you do everything right it still doesn’t help.
I’m sending you my support and thanks so much for doing what you are doing and for helping all those great furry guys.
September 25, 2011 at 10:58 am
Dear Alexandra…thank you so much for your support…there’s nothing worse than doing your best and still losing the patient. We all secretly have those fears about our beloved pets…it is our responsibility to make sure they are well and getting them treated immediately.
September 25, 2011 at 4:03 am
That is very sad. Poor Myff and her owners.
Rayya, I feel your reflections and the questions you constantly ask yourself about your patients and the treatment you give them shows you are a very good vet, and if you were in my part of the world, I would be more than happy for you to be Not Cat’s vet. I would trust you.
September 25, 2011 at 11:01 am
Isobel, thanks heaps for your amazing comment. I am very touched by your words and feel very supported. I know I can’t save them all but I sure as hell shall try 🙂
September 25, 2011 at 4:30 am
Thanks for sharing this story. I’m really sorry for Myff, poor creature… I will for sure continue consulting with vets every time when I notice anything different about my dog (most of the times I’m a little paranoid but one time this “paranoia” saved his life, for sure, as it was babesiosis and because of early treatment everything ended fine). It would be so much easier for vets if nobody was waiting too long…
September 25, 2011 at 11:08 am
Our pets don’t always show obvious signs of illness and I find the so called ‘paranoid’ owners usually notice the subtle early changes. I take each and every concern seriously and try to rule in\out as much as possible during the consultation. I totally commend you for going with your gut feeling and saving your dog’s life…I definitely believe so many pet patients lost may have been saved if they had been brought in earlier…
September 25, 2011 at 11:07 pm
You work so hard for all your patients, you are just so amazing.. Sorry Myff didnt make it.. Lets think positive for next week..
September 26, 2011 at 8:51 am
Thanks my love…couldn’t do it without your support
September 26, 2011 at 1:25 am
Your posts are are absolutely fascinating insight into the life of a vet. I think you are doing incredible work. Please keep writing.
September 26, 2011 at 8:55 am
Getting your message first thing in the morning sure gives me an extra spring in my step…I promise to keep writing and sharing my journey with you 🙂
September 29, 2011 at 1:20 pm
hi rayya i am vet from pakistan but i specialized in poultry but i also want to become a good pet vet also
i want yours suggestion in this regards.
Best Regards
Dr.Zaka Ullah Khan
September 30, 2011 at 12:03 am
Hey Zaka…I have a lot to learn about poultry and usually refer to a medical book or internet journals…hence my best suggestions are expanding your knowledge through conferences, working along side a small animal vet, purchasing medical books, reading journals and of course utilizing the internet…hope that answers your question…goodluck…
September 30, 2011 at 3:29 pm
thanks for nice comments and i also want that u help me in such books and i also want to become a friend on face book with u if u dont mind my face book id is Zaka ullah khan from bannu it will help me to learn something new from u
Best Regards and thanks for reply
Zaka
September 30, 2011 at 10:40 pm
Hey Zaka…you should follow me on my website and like my facebook page as I put up lots of information on both…I keep my personal facebook separate from work. Feel free to email me any questions you may have. Take care 🙂
October 5, 2011 at 4:27 am
Hey Rayya once again thanks for reply and for the good suggestion and i follow u on your web site and face book also plz tell me whats your qualification and from where u got ur degree
Thanks
Zaka
October 5, 2011 at 11:10 pm
Hey Zaka, please refer to my linkedin profile..
January 27, 2012 at 12:36 am
This is so sad and I agree that everyone with animal companions should immediately take their friends into the vet as soon as they notice something wrong.I know many people like this and I always urge them not to be so tight with their money! I realize that many people are struggling, however if you are going to have an ainimal companion than you should also know that the commitment includes GOOD veterinary care and regular checkup- no different than is it was a a non furry person! Thank you for the good work you do, vets re hard working, wonderful people. Thank you for reading Bailey’s blog, now I will follow you to keep learning…
January 27, 2012 at 6:56 pm
Hey Sherri. Thank you for sharing your thoughts and wonderful remark about vets. I am very touched. I am glad toy discovered my blog through Bailey’s.:-)