Should I talk to my vet about the way my dog passed away?
September 30, 2023 4:15 PM Subscribe
TW: pet loss. My dog passed away suddenly a few days ago. I have my dog's lab results that were taken a few hours before he died, and after looking into what those high numbers mean, I believe my vet may have undertreated my dog's dehydration and potentially led to his sudden death. I have had a great working relationship with this vet for years, so it is breaking my heart thinking she may have made such a serious error. Should I talk to her about what happened? Ideas on coping with this?
TW for traumatic pet loss and for mentions of vomiting and diarrhea. There are medical descriptions too, and discussions of grief. Please skip this one if it is too upsetting. Take care.
Apologies this question is so long. I have worked with my local vet closely for 4+ years and have always had a lot of faith in her. She was the only vet who diagnosed my dog's kidney disease and hip arthiritis quickly and accurately when other vets missed it, and was able to put him on a very effective regime that improved his last years of life immeasurably. I will forever be so, so grateful she was so thorough, gentle and effective with those chronic health issues of my boy. So this entire situation has hit me like a boulder, since I never imagined she might have potentially made such a simple but catastrophic mistake with my dog. Obviously I'm no vet, and YNMV, but I got the general protocols for dehydration from pretty mainstream reputable online sources.
(Pretty heavy description of the last 24hrs of my dog's life here; please skip if too intense.)
Essentially, my sweet 15 year old dog passed away two days ago suddenly after a bout of vomiting and diarrhea. He was completely fine the during the day, happy and running around, but he had some vomiting & diarrhea during the night, so I booked a vet appointment in the morning ASAP because I was worried about dehydration, he seemed pretty lethargic and had begun to refuse water after drinking & vomiting it up a few times that night. They told me to bring him in immediately, so I did.
My vet ran blood tests to check his levels quickly. When she took the blood, it seemed thick and hard to get out which scared me, but she reassured me that that was likely a symptom of some mild dehydration from the vomiting that night, nothing too severe. I told her my dog had not vomited or had diarrhea since 7am that morning, it was now around 10:30am so he seemed to be improving a little, so things did not feel too urgent. Worrisome, but not a crisis. My dog was also relatively alert and walking around, if a little slow.
So she ran the tests, checked his skin elasticity & gums, checked for a fever (none), checked a stool sample for parasites, gave him an antiemetic, antibiotic and stomach liner protector, and also ran some tests on his kidneys to make sure his disease hadn't rapidly progressed. It was a long, thorough consultation that took about an hour and a half—with my dog okay during it, few symptoms present except some sleepiness and a bit of trembling.
We got the blood results back, and his values were not great but not severe—except for his kidneys (the BUN aspect, for any nerds out there), which showed one pretty severe & elevated value, but nothing life-threatening when looked at with bloodtest results, where he had moderate dehydration (roughly 5% over normal limits), his creatinine slightly higher than normal, slightly elevated white blood cells, a moderate higher blood cell count. But it was all moderate, not in the severe ranges apart from one value, and made a lot of sense due to his seemingly mild-ish dehydration. She said it was probably a mild bacterial infection causing the GI issues; treatable with rehydration at home, an antibacterial shot, stomach lining protector shot; some probiotic powder in his food once he started eating solid things like rice, etc.
So she prescribed me a good electrolyte solution for home, and said that if he did not want to drink it due to his aversion to his water bowl from the vomiting up his water last night (he tends to get averse to anything that makes him nauseous, so she thought that's why he may not want to drink), to gently squirt a small amount in his cheek and help him swallow to rehydrate him. To do it every half hour, follow the instructions, and if he did not improve or his symptoms deteriorated, to get him to the ER vet ASAP (her office closes on the weekends as it is local and for non-emergency cases).
So I took him home. He seemed a little better, still hadn't had any GI upset in hours and had stopped trembling, so he seemed to be doing better after the anti-emetic. I was relieved, and followed the syringe-in-cheek directions to the letter. My dog seemed calmer and like he was in less pain (less pacing, no trembling anymore), and seemed to be keeping the electrolyte solution down. I thought he'd just sleep this nasty bacterial infection off, get rehydrated w/ the electrolytes and then feel better by the next day.
Then he had diarrhea. And it was all the fluid he'd drank in the past 5 hours. And he suddenly got even more lethargic. I started to get scared, but told myself to wait a few more hours, maybe he just needed some more rest and electrolytes. But two hours later and with more fluids in him, he was breathing badly and had blood in his stool. Not just a tiny bit of blood, which my vet said may occur because the diarrhea can irritate the GI tract a little, but it was all blood. So I immediately rushed to the vet ER downtown like she said I should if he deteriorated. They told me he was critically ill and would likely not survive, but they would do all they could and he would stay overnight. I was driving home when they told me 20 minutes later he had died from respiratory failure.
Now I'm looking at my dog's blood test results again from that initial morning with my local, very trusted, seemingly skilled vet. And reading about the numbers and symptoms. His dehydration *was* moderate (only 5% over the normal range) but apparently moderate dehydration can require immediate IV or subcutaneous (injected below the skin at home) fluids, which my vet did not mention to me. Why didn't she give me subcutaneous fluids to inject him with at home? Why *just* the oral rehydration liquids, which only treat mild dehydration, not moderate-severe? Why didn't she worry more when she saw how thick his blood was when taken for the labs? Why didn't she feel super concerned that he was so dehydrated, and she simply recommended oral electrolyte solution and gave him anti-emetics? His kidney value was pretty bad–did she not notice, did she assume it was from something else like the bacteria, not dehydration?
The subcutaneous fluids might have worked much better at home. Or getting him IV fluid treatment that morning, before he decompensated, might have saved his life since it seems like he died of a cascade of the mild infection leading to vomiting, which lead to severe dehydration, kidney failure from the dehydration, and its complications.
I don't understand. How could she not see my dog was so sick in the lab results? We went through them together right there. Why did she think it was a good idea to try to rehydrate at home with an oral solution instead of the more effective procedure of subcutaneous fluids or getting him to a hospital for IV fluids? He might still be here if she'd treated this dehydration more urgently; if she'd not mistakenly downplayed the severity of his thickened blood or kidney test value.
But she did. And my boy died. And I feel sick at the idea that a) he suddenly died from a potentially preventable issue and b) that my vet, who helped me so much with my dog's kidney disease and arthiritis, who saved his life when he was young by getting him to the hospital after he ate a bone—who has been with me and my pup through so many years and health issues—could do this to him. Be so... Careless? Mistaken? Misguided? With his health when it was most critical. I feel this deep stab of betrayal—and so much grief. I don't want my favorite vet to have carelessly killed my dearest dog. The idea that this was easily preventable and the solution (IV fluids) was so simple but overlooked is making the grief of losing my dog to all this so much more painful.
So, end of the very difficult story and onto my questions:
1) is it a good or bad idea to talk to my vet one-on-one in a few days about what happened? I do not want to sue or report her so please do not suggest that unless you believe it is truly, genuinely needed. Despite this terrible situation and my deeply hurt heart, I know she truly cared for my pet and did what she believed would help him, and has never made a serious mistake like this before.
This conversation would just be to alert her to what happened, so she might be more aggressive with treating dehydration in the future, and to try to understand *why* she clincally believed subcutaneous or IV fluids were unnecessary for a dehydrated dog. I just want to understand why this happened, not shame or yell or report her—I cannot cause more pain in the world right now, even if someone believes she deserves it or something. I want to know what she was thinking as a vet. If she believes she made a clinical error in judgement. What happened?
2) Would this type of appointment/conversation be somewhat appropriate or am I crossing too many lines here? I know I am not thinking clearly in my grief. But I want to understand, potentially make amends, and not have other dogs go through this if she makes the same error again. I do not know if this is a good idea or not. Or if it's even a thing you can do; to book an appointment without a pet present to discuss a past treatment protocol.
3) If I do have this convo and find out my vet did make such a tragic treatment error of not aggressively treating my dog's dehydration, any ideas on how to cope with that? Particularly with the fact that my favorite vet potentially played a hand in my favorite dog's sudden death? I know my vet is not a friend or loved one and I don't owe her loyalty or forgiveness, but I have had a great, trusting working relationship with her for 4+ years, I know she truly cared about my dog's wellbeing, and I do not want to think the worst of her: that she did not care about my dog's life, or was too careless to actually help him properly. I do not want to go there, though I understand I may have to if for some reason that turns out to be the case. Maybe it's ridculous to focus so much on my vet when it's my dog who died—but this is all I can currently think about.
I'm so sorry this question is horribly sad and all over the place; my brain is foggy. Thank you in advance for any advice or gentle words.
TW for traumatic pet loss and for mentions of vomiting and diarrhea. There are medical descriptions too, and discussions of grief. Please skip this one if it is too upsetting. Take care.
Apologies this question is so long. I have worked with my local vet closely for 4+ years and have always had a lot of faith in her. She was the only vet who diagnosed my dog's kidney disease and hip arthiritis quickly and accurately when other vets missed it, and was able to put him on a very effective regime that improved his last years of life immeasurably. I will forever be so, so grateful she was so thorough, gentle and effective with those chronic health issues of my boy. So this entire situation has hit me like a boulder, since I never imagined she might have potentially made such a simple but catastrophic mistake with my dog. Obviously I'm no vet, and YNMV, but I got the general protocols for dehydration from pretty mainstream reputable online sources.
(Pretty heavy description of the last 24hrs of my dog's life here; please skip if too intense.)
Essentially, my sweet 15 year old dog passed away two days ago suddenly after a bout of vomiting and diarrhea. He was completely fine the during the day, happy and running around, but he had some vomiting & diarrhea during the night, so I booked a vet appointment in the morning ASAP because I was worried about dehydration, he seemed pretty lethargic and had begun to refuse water after drinking & vomiting it up a few times that night. They told me to bring him in immediately, so I did.
My vet ran blood tests to check his levels quickly. When she took the blood, it seemed thick and hard to get out which scared me, but she reassured me that that was likely a symptom of some mild dehydration from the vomiting that night, nothing too severe. I told her my dog had not vomited or had diarrhea since 7am that morning, it was now around 10:30am so he seemed to be improving a little, so things did not feel too urgent. Worrisome, but not a crisis. My dog was also relatively alert and walking around, if a little slow.
So she ran the tests, checked his skin elasticity & gums, checked for a fever (none), checked a stool sample for parasites, gave him an antiemetic, antibiotic and stomach liner protector, and also ran some tests on his kidneys to make sure his disease hadn't rapidly progressed. It was a long, thorough consultation that took about an hour and a half—with my dog okay during it, few symptoms present except some sleepiness and a bit of trembling.
We got the blood results back, and his values were not great but not severe—except for his kidneys (the BUN aspect, for any nerds out there), which showed one pretty severe & elevated value, but nothing life-threatening when looked at with bloodtest results, where he had moderate dehydration (roughly 5% over normal limits), his creatinine slightly higher than normal, slightly elevated white blood cells, a moderate higher blood cell count. But it was all moderate, not in the severe ranges apart from one value, and made a lot of sense due to his seemingly mild-ish dehydration. She said it was probably a mild bacterial infection causing the GI issues; treatable with rehydration at home, an antibacterial shot, stomach lining protector shot; some probiotic powder in his food once he started eating solid things like rice, etc.
So she prescribed me a good electrolyte solution for home, and said that if he did not want to drink it due to his aversion to his water bowl from the vomiting up his water last night (he tends to get averse to anything that makes him nauseous, so she thought that's why he may not want to drink), to gently squirt a small amount in his cheek and help him swallow to rehydrate him. To do it every half hour, follow the instructions, and if he did not improve or his symptoms deteriorated, to get him to the ER vet ASAP (her office closes on the weekends as it is local and for non-emergency cases).
So I took him home. He seemed a little better, still hadn't had any GI upset in hours and had stopped trembling, so he seemed to be doing better after the anti-emetic. I was relieved, and followed the syringe-in-cheek directions to the letter. My dog seemed calmer and like he was in less pain (less pacing, no trembling anymore), and seemed to be keeping the electrolyte solution down. I thought he'd just sleep this nasty bacterial infection off, get rehydrated w/ the electrolytes and then feel better by the next day.
Then he had diarrhea. And it was all the fluid he'd drank in the past 5 hours. And he suddenly got even more lethargic. I started to get scared, but told myself to wait a few more hours, maybe he just needed some more rest and electrolytes. But two hours later and with more fluids in him, he was breathing badly and had blood in his stool. Not just a tiny bit of blood, which my vet said may occur because the diarrhea can irritate the GI tract a little, but it was all blood. So I immediately rushed to the vet ER downtown like she said I should if he deteriorated. They told me he was critically ill and would likely not survive, but they would do all they could and he would stay overnight. I was driving home when they told me 20 minutes later he had died from respiratory failure.
Now I'm looking at my dog's blood test results again from that initial morning with my local, very trusted, seemingly skilled vet. And reading about the numbers and symptoms. His dehydration *was* moderate (only 5% over the normal range) but apparently moderate dehydration can require immediate IV or subcutaneous (injected below the skin at home) fluids, which my vet did not mention to me. Why didn't she give me subcutaneous fluids to inject him with at home? Why *just* the oral rehydration liquids, which only treat mild dehydration, not moderate-severe? Why didn't she worry more when she saw how thick his blood was when taken for the labs? Why didn't she feel super concerned that he was so dehydrated, and she simply recommended oral electrolyte solution and gave him anti-emetics? His kidney value was pretty bad–did she not notice, did she assume it was from something else like the bacteria, not dehydration?
The subcutaneous fluids might have worked much better at home. Or getting him IV fluid treatment that morning, before he decompensated, might have saved his life since it seems like he died of a cascade of the mild infection leading to vomiting, which lead to severe dehydration, kidney failure from the dehydration, and its complications.
I don't understand. How could she not see my dog was so sick in the lab results? We went through them together right there. Why did she think it was a good idea to try to rehydrate at home with an oral solution instead of the more effective procedure of subcutaneous fluids or getting him to a hospital for IV fluids? He might still be here if she'd treated this dehydration more urgently; if she'd not mistakenly downplayed the severity of his thickened blood or kidney test value.
But she did. And my boy died. And I feel sick at the idea that a) he suddenly died from a potentially preventable issue and b) that my vet, who helped me so much with my dog's kidney disease and arthiritis, who saved his life when he was young by getting him to the hospital after he ate a bone—who has been with me and my pup through so many years and health issues—could do this to him. Be so... Careless? Mistaken? Misguided? With his health when it was most critical. I feel this deep stab of betrayal—and so much grief. I don't want my favorite vet to have carelessly killed my dearest dog. The idea that this was easily preventable and the solution (IV fluids) was so simple but overlooked is making the grief of losing my dog to all this so much more painful.
So, end of the very difficult story and onto my questions:
1) is it a good or bad idea to talk to my vet one-on-one in a few days about what happened? I do not want to sue or report her so please do not suggest that unless you believe it is truly, genuinely needed. Despite this terrible situation and my deeply hurt heart, I know she truly cared for my pet and did what she believed would help him, and has never made a serious mistake like this before.
This conversation would just be to alert her to what happened, so she might be more aggressive with treating dehydration in the future, and to try to understand *why* she clincally believed subcutaneous or IV fluids were unnecessary for a dehydrated dog. I just want to understand why this happened, not shame or yell or report her—I cannot cause more pain in the world right now, even if someone believes she deserves it or something. I want to know what she was thinking as a vet. If she believes she made a clinical error in judgement. What happened?
2) Would this type of appointment/conversation be somewhat appropriate or am I crossing too many lines here? I know I am not thinking clearly in my grief. But I want to understand, potentially make amends, and not have other dogs go through this if she makes the same error again. I do not know if this is a good idea or not. Or if it's even a thing you can do; to book an appointment without a pet present to discuss a past treatment protocol.
3) If I do have this convo and find out my vet did make such a tragic treatment error of not aggressively treating my dog's dehydration, any ideas on how to cope with that? Particularly with the fact that my favorite vet potentially played a hand in my favorite dog's sudden death? I know my vet is not a friend or loved one and I don't owe her loyalty or forgiveness, but I have had a great, trusting working relationship with her for 4+ years, I know she truly cared about my dog's wellbeing, and I do not want to think the worst of her: that she did not care about my dog's life, or was too careless to actually help him properly. I do not want to go there, though I understand I may have to if for some reason that turns out to be the case. Maybe it's ridculous to focus so much on my vet when it's my dog who died—but this is all I can currently think about.
I'm so sorry this question is horribly sad and all over the place; my brain is foggy. Thank you in advance for any advice or gentle words.
First off, I'm so sorry for your loss.
I've briefly worked in a vet office when I was much younger as basically a secretary, so take my answer for what you will.
First off, 15 is a senior dog. Yes some dogs live longer but many many many dogs don't for a variety of reasons some of which we understand fairly well and some that we don't. It is possible, even with the most perfect vet in the world and all the interventions known to man that your dog still would have passed. I can't tell you for certian either way, and that's something that's hard to think about.
Here's a paper/ conference talk regarding fluid therapy. There's a nice table a ways down. Oral fluids are recommended in circumstances in which it is concidered a short term illness, which is the assumption your vet was working under.
Here is the thing she did provide an antiemetic and hydration fluid which the dog did keep down. His hydration lab values should have theoretically improved, especially with holding down fluid for 5 hours. IV fluids would have bypassed the stomach and the vomiting ( which the antiemetic helped solve too) but really don't solve diarrhea from my understanding. It's very possible to recieve IV fluids and continue to have diarrhea.
The intervention she chose is an intervention that is relatively common and not unheard of by vets for the level of dehydration you are describing, it's a logical step to make, especially for an animal willing to drink and the information you provided.
For what it is worth I'm sorry. Personally, I don't think a conversation with the vet will be very helpful, vets want the animals they care for to live! They want to assist in the best way possible, and sometimes things just don't work out. Clinically nothing seems really out of place ( to me) and IV fluids vs oral hydration sometimes is a guess. I'm not sure that her answer will solve the what ifs in your mind. This is a huge loss for you.
I think it's perfectly reasonable to use another vet going foward no matter what, just because of the trust.
Take gentle care
posted by AlexiaSky at 5:11 PM on September 30, 2023 [18 favorites]
I've briefly worked in a vet office when I was much younger as basically a secretary, so take my answer for what you will.
First off, 15 is a senior dog. Yes some dogs live longer but many many many dogs don't for a variety of reasons some of which we understand fairly well and some that we don't. It is possible, even with the most perfect vet in the world and all the interventions known to man that your dog still would have passed. I can't tell you for certian either way, and that's something that's hard to think about.
Here's a paper/ conference talk regarding fluid therapy. There's a nice table a ways down. Oral fluids are recommended in circumstances in which it is concidered a short term illness, which is the assumption your vet was working under.
Here is the thing she did provide an antiemetic and hydration fluid which the dog did keep down. His hydration lab values should have theoretically improved, especially with holding down fluid for 5 hours. IV fluids would have bypassed the stomach and the vomiting ( which the antiemetic helped solve too) but really don't solve diarrhea from my understanding. It's very possible to recieve IV fluids and continue to have diarrhea.
The intervention she chose is an intervention that is relatively common and not unheard of by vets for the level of dehydration you are describing, it's a logical step to make, especially for an animal willing to drink and the information you provided.
For what it is worth I'm sorry. Personally, I don't think a conversation with the vet will be very helpful, vets want the animals they care for to live! They want to assist in the best way possible, and sometimes things just don't work out. Clinically nothing seems really out of place ( to me) and IV fluids vs oral hydration sometimes is a guess. I'm not sure that her answer will solve the what ifs in your mind. This is a huge loss for you.
I think it's perfectly reasonable to use another vet going foward no matter what, just because of the trust.
Take gentle care
posted by AlexiaSky at 5:11 PM on September 30, 2023 [18 favorites]
I'm so sorry. This sounds incredibly hard. I'm sending you internet hugs if you want them.
Here are my thoughts about your questions:
Do you know what you're seeking from a vet convo? Is it that you want her to answer the question of whether it was a flawed treatment? (And would you believe her if she said it wasn't?) Is your main goal to alert her so she doesn't do the same thing next time? Or are you looking for some kind of interpersonal closure?
Because I think different goals might point to different things to do. If you want to know if her treatment was reasonable, you might get a better answer from someone else. If you want to let her know so she's less likely to do it again, you could probably accomplish that via a letter. The main reason for a face-to-face would be for some kind of interpersonal closure.
If you do want to talk to her face-to-face, I'd write a note to the office, something like "As you know, my dog died at X hospital on Y date. I'm trying to make sense of it and would really like to talk to Doctor Z. Can you tell me how this could happen?"
(On a bit of a side note, I don't know if she was negligent -- I'm a layperson and it doesn't sound egregiously negligent to me -- but I do know that after medical traumas I've experienced, I've often gotten stuck in a mental whirlpool about what if I'd done XYZ differently, could that have changed things? -- and I think it's a part of traumatic grief. It's so hard to lose someone, and especially in a fast and disturbing way like what happened here; I wish for you that you can find some support in your grief, whether it be a pet loss support group, talking with an existing therapist, or from books like this.)
Wishing you peace and strength.
posted by hungrytiger at 5:46 PM on September 30, 2023 [10 favorites]
Here are my thoughts about your questions:
Do you know what you're seeking from a vet convo? Is it that you want her to answer the question of whether it was a flawed treatment? (And would you believe her if she said it wasn't?) Is your main goal to alert her so she doesn't do the same thing next time? Or are you looking for some kind of interpersonal closure?
Because I think different goals might point to different things to do. If you want to know if her treatment was reasonable, you might get a better answer from someone else. If you want to let her know so she's less likely to do it again, you could probably accomplish that via a letter. The main reason for a face-to-face would be for some kind of interpersonal closure.
If you do want to talk to her face-to-face, I'd write a note to the office, something like "As you know, my dog died at X hospital on Y date. I'm trying to make sense of it and would really like to talk to Doctor Z. Can you tell me how this could happen?"
(On a bit of a side note, I don't know if she was negligent -- I'm a layperson and it doesn't sound egregiously negligent to me -- but I do know that after medical traumas I've experienced, I've often gotten stuck in a mental whirlpool about what if I'd done XYZ differently, could that have changed things? -- and I think it's a part of traumatic grief. It's so hard to lose someone, and especially in a fast and disturbing way like what happened here; I wish for you that you can find some support in your grief, whether it be a pet loss support group, talking with an existing therapist, or from books like this.)
Wishing you peace and strength.
posted by hungrytiger at 5:46 PM on September 30, 2023 [10 favorites]
There is another possibility outside of error here. It’s possible that your vet saw what you couldn’t ahead of time, recognized that your pet would likely not get through another 24 hours, but froze up and didn’t have a good way to explain that and instead provided palliative care.
Doctors are professionals, and they are also people. And people can sometimes have a very difficult time communicating awful news to others, especially when it’s someone with whom they have developed a good working relationship. Multiple studies have looked into how doctors have significant challenges talking bluntly about end of life care, particularly in the U.S. where things are so litigious.
The world is chaotic and sometimes even our best efforts can’t prevent bad stuff from happening. And that’s part of the reason we love dogs so much, they are always happy when we come back home, they are something we can depend on for joy. And when that loss occurs it can sometimes feel better to look for “what went wrong” in an attempt to find order in that misfortune instead of helplessness.
Your dog sounds really special and it’s clear that he and you have been through a lot and I’m so sorry you are going through this loss of a dear pet. At the same time, I think placing all the responsibility and pain of that loss on the vet would not reduce the sadness of the loss of your friend. Give yourself time to grieve.
posted by donut_princess at 5:49 PM on September 30, 2023 [3 favorites]
Doctors are professionals, and they are also people. And people can sometimes have a very difficult time communicating awful news to others, especially when it’s someone with whom they have developed a good working relationship. Multiple studies have looked into how doctors have significant challenges talking bluntly about end of life care, particularly in the U.S. where things are so litigious.
The world is chaotic and sometimes even our best efforts can’t prevent bad stuff from happening. And that’s part of the reason we love dogs so much, they are always happy when we come back home, they are something we can depend on for joy. And when that loss occurs it can sometimes feel better to look for “what went wrong” in an attempt to find order in that misfortune instead of helplessness.
Your dog sounds really special and it’s clear that he and you have been through a lot and I’m so sorry you are going through this loss of a dear pet. At the same time, I think placing all the responsibility and pain of that loss on the vet would not reduce the sadness of the loss of your friend. Give yourself time to grieve.
posted by donut_princess at 5:49 PM on September 30, 2023 [3 favorites]
To me, reading your description of events, it isn't clear that dehydration was the cause of your dog's death, especially with the amount of blood you describe coming out with his diarrhea. I could of course be wrong. But it sounds to me like more was going on. It might still be helpful to speak with your vet about what happened, but I would recommend going into it more questioningly to understand, and not accusingly. It sounds like it all happened so quickly. I'm sorry for your loss.
posted by wondermouse at 6:13 PM on September 30, 2023 [8 favorites]
posted by wondermouse at 6:13 PM on September 30, 2023 [8 favorites]
My advise is to give this a bit of time, pause, and re-read this question before you do anything.
It is possible that your vet made a mistake or did not have the insight required to advise on the dehydration. But do you truly believe your vet was negligent? Would it make you feel better, or worse, if she knew that this was an option but did not believe it was worthwhile in her professional opinion? Would it make you feel better, or worse, to relieve your pet's last moments through her clinical eyes?
I have twice lost ill, aging pets in a sudden manner. I definitely wondered in both cases whether the treatment was appropriate and the deaths were preventable at that time, but on reflection I came to feel that my grief and guilt were really driving a lot of my questions. I don't believe that vets or any other medical professional are perfect, but I did not find it useful to replay all the decisions because frankly, sadly, it's too late. It would be very different if I had felt the vet had been truly careless, thoughtless, or ignorant, but I didn't. I have the sense that you don't either. You're in pain, and you want answers, but think carefully about whether the vet is the one who can give you the answers that will help you achieve closure. Spoiler: probably not.
I am so very sorry for your loss.
posted by sm1tten at 6:15 PM on September 30, 2023 [15 favorites]
It is possible that your vet made a mistake or did not have the insight required to advise on the dehydration. But do you truly believe your vet was negligent? Would it make you feel better, or worse, if she knew that this was an option but did not believe it was worthwhile in her professional opinion? Would it make you feel better, or worse, to relieve your pet's last moments through her clinical eyes?
I have twice lost ill, aging pets in a sudden manner. I definitely wondered in both cases whether the treatment was appropriate and the deaths were preventable at that time, but on reflection I came to feel that my grief and guilt were really driving a lot of my questions. I don't believe that vets or any other medical professional are perfect, but I did not find it useful to replay all the decisions because frankly, sadly, it's too late. It would be very different if I had felt the vet had been truly careless, thoughtless, or ignorant, but I didn't. I have the sense that you don't either. You're in pain, and you want answers, but think carefully about whether the vet is the one who can give you the answers that will help you achieve closure. Spoiler: probably not.
I am so very sorry for your loss.
posted by sm1tten at 6:15 PM on September 30, 2023 [15 favorites]
I too am very sorry for your loss. If you do still wish to talk to her after some days, a framing I've found helpful just in general for talking to medical folks when I wonder if they're wrong or overlooking something crucial but also know that it'd be really out of character for them to make such a mistake is directly asking for help understanding. Something along the lines of a sincere "Would you please explain it to me so I can understand? I keep going over everything in my mind wondering if we should have been more aggressive with IV or subcutaneous fluids." And just see what she replies, and ask whatever questions you need to truly understand what she's saying and why she thinks/believes it. It really might be deeply reassuring in its own right, particularly given what excellent care she otherwise provided. Even if it's not though, again give yourself some time to reflect on it. She sounds like a good person who had good intentions and was presumably doing the best she could with the information she had. She also sounds like someone who has probably already scrutinized those lab values and other clinical notes with the tragic hindsight of knowing that her treatment plan was insufficient to save him, and I think it's unlikely your worries would come as a surprise to her.
posted by teremala at 7:11 PM on September 30, 2023 [5 favorites]
posted by teremala at 7:11 PM on September 30, 2023 [5 favorites]
I'm so sorry for your loss, and for the pain you clearly feel.
Our 14 year old girl died quite suddenly in February - chasing coyotes one day, gone a week later. The grief is profound and long lasting.
To me, the course of decline sounds like it was very fast and not related to dehydration, mild or otherwise. Lab values are only one piece of the clinical picture and oral rehydration is preferred over SQ or IV - it seems what your vet saw supported the oral route and she gave you good guidelines on what to do if that didn't work. A bad GI bleed is not exacerbated by dehydration - it seems likely there was a bigger underlying problem that final caught up with your sweet boy.
Could more aggressive therapy have bought you some more time with him, maybe. We never get to know all those answers, but it might be worth exploring it with the vet.
I'm so sorry this has happened. When our Hopi died I spent a long time second guessing everything around it, but thankfully never the vet with whom we had trusted our sweet girl's care. That's a cruel place to have found yourself.
posted by Pantengliopoli at 8:45 PM on September 30, 2023 [6 favorites]
Our 14 year old girl died quite suddenly in February - chasing coyotes one day, gone a week later. The grief is profound and long lasting.
To me, the course of decline sounds like it was very fast and not related to dehydration, mild or otherwise. Lab values are only one piece of the clinical picture and oral rehydration is preferred over SQ or IV - it seems what your vet saw supported the oral route and she gave you good guidelines on what to do if that didn't work. A bad GI bleed is not exacerbated by dehydration - it seems likely there was a bigger underlying problem that final caught up with your sweet boy.
Could more aggressive therapy have bought you some more time with him, maybe. We never get to know all those answers, but it might be worth exploring it with the vet.
I'm so sorry this has happened. When our Hopi died I spent a long time second guessing everything around it, but thankfully never the vet with whom we had trusted our sweet girl's care. That's a cruel place to have found yourself.
posted by Pantengliopoli at 8:45 PM on September 30, 2023 [6 favorites]
You describe a doctor that sounds professional, thoughtful and caring. She seems dedicated and devoted to her patients. That sounds like a good number of tests was run, and that she carefully examined the results. I'm not a doctor or vet, but I also suspect that something more than just dehydration was going on.
She might have missed that. It might not have been obvious or easy to detect. It might have been impossible to detect. If she did detect it, extra especially with the very rapid change in symptoms and what sounds like a very unexpected escalation, there might not have been anything that could be done. 15 is an elder animal and.... things just stop sometimes. No matter how much it breaks our hearts.
I don't think conversing with the vet would be a negative, if you know what you are looking for, and the possible results and how they could impact you. It sounds, to me, that she did her job to the best of her ability and recommended appropriate care for the situation she understood. I suspect the most likely thing you will be able to clarify is what she thinks was going on with your friend, but also possibly that she just doesn't know. Animals can be like that. I think it's least likely that she made a huge mistake. Doctors are not magic and can only do what they can. It sounds to me that knowing it was likely X conditions might soothe your mind some. Not knowing is super hard, it leaves so much room for anxiety and self recriminations. Knowing there was nothing that could be done might help. Knowledge can dispell doubts and provide a cold comfort. I don't know what to say if she did make a horrible mistake. I don't know what to do in those situations. It does sound like she did due diligence from here.
So yes, a conversation might help some. In no circumstances will it fix everything or remove all your pain. I fully understand the grief-guilt- powerlessness- what if spiral. I don't think there was anything you could have done differently. I think there wasn't anything she could have done differently.
posted by Jacen at 8:48 PM on September 30, 2023 [4 favorites]
She might have missed that. It might not have been obvious or easy to detect. It might have been impossible to detect. If she did detect it, extra especially with the very rapid change in symptoms and what sounds like a very unexpected escalation, there might not have been anything that could be done. 15 is an elder animal and.... things just stop sometimes. No matter how much it breaks our hearts.
I don't think conversing with the vet would be a negative, if you know what you are looking for, and the possible results and how they could impact you. It sounds, to me, that she did her job to the best of her ability and recommended appropriate care for the situation she understood. I suspect the most likely thing you will be able to clarify is what she thinks was going on with your friend, but also possibly that she just doesn't know. Animals can be like that. I think it's least likely that she made a huge mistake. Doctors are not magic and can only do what they can. It sounds to me that knowing it was likely X conditions might soothe your mind some. Not knowing is super hard, it leaves so much room for anxiety and self recriminations. Knowing there was nothing that could be done might help. Knowledge can dispell doubts and provide a cold comfort. I don't know what to say if she did make a horrible mistake. I don't know what to do in those situations. It does sound like she did due diligence from here.
So yes, a conversation might help some. In no circumstances will it fix everything or remove all your pain. I fully understand the grief-guilt- powerlessness- what if spiral. I don't think there was anything you could have done differently. I think there wasn't anything she could have done differently.
posted by Jacen at 8:48 PM on September 30, 2023 [4 favorites]
Response by poster: Thanks so much for your kind, informative answers, everyone. It really helped calm me down. I've been reflecting more on my dog's last few weeks of life, not just the past 24hrs, and I think he was likely in the last stage of kidney failure from his kidney disease, which he'd had for years (managed). All his symptoms from the past few weeks add up. I'm pretty sure that there was nothing we could've done, me or the vet, to save him, and he likely would've been euthanized very soon if this whole thing had not happened.
I think I'm still going to talk to my vet, but approach things in a much more compassionate way of just asking her if she believes this was acute renal failure with symptoms that were presenting as a mild bacterial infection—especially since his kidney values were bad that day but not immediately catastrophic—and see what she says. I may be wrong here too, I'm no vet, but I think it would help me to talk to her and just get some perspective on what she believes happened to my boy. I feel much calmer now, though, remembering that it was likely my dog's time no matter what we did, and that he would've reached this point eventually due to his age and kidney disease.
Thanks again everyone. Take care.
posted by Anonymous at 3:35 AM on October 1, 2023 [24 favorites]
I think I'm still going to talk to my vet, but approach things in a much more compassionate way of just asking her if she believes this was acute renal failure with symptoms that were presenting as a mild bacterial infection—especially since his kidney values were bad that day but not immediately catastrophic—and see what she says. I may be wrong here too, I'm no vet, but I think it would help me to talk to her and just get some perspective on what she believes happened to my boy. I feel much calmer now, though, remembering that it was likely my dog's time no matter what we did, and that he would've reached this point eventually due to his age and kidney disease.
Thanks again everyone. Take care.
posted by Anonymous at 3:35 AM on October 1, 2023 [24 favorites]
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posted by Anonymous at 4:28 PM on September 30, 2023