I also wanted to say, be sure to DATE everything:
- when you discovered Sienna's wound, the time and date you took her to the first vet (and whether or not that Banfield clinic had emergency services/after hours services)
- the time and date you took Sienna to the second vet
- the time and date you obtained health records from both vets, the actual request of which records you asked for and obtained from each vet
- recorded or logged phone conversations with either vet (or spoke to a receptionist or tech, get names if possible)
For everything, time and dates are important to show you were active in getting Sienna proper treatment, active in working toward proper diagnosis and care and treatment, etc.
Time and date when you send your letters, complaints, and write down addresses of each person/corporation/board etc you send them to. Keep a written log of every action you take.
As for statute of limitations, I'm not sure, but you might check the website of your state veterinary board for any information regarding that. If the website does not have that information, then ask the board when you write/call them.
You might request a prompt and timely response within 30 days, no longer than 60 days. Remember to log each time you make contact with them or anyone for that matter, and through which method (letter, email or phone call).
You could also try checking your state department's website for statute of limitations on filing complaints against businesses, but a better option would be to get a free consult with a local attorney to help answer your questions, and that consult could help you with various things you haven't yet thought of. That attorney can also help draft your complaints, explain how small claims courts work (if you choose that option) and help format it so it gets the attention of those needing it. The consult is free, I strongly advise you try to get one. (also log date and time this occurs etc). If you get a consult, take notes!
QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help!!!
Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help
..........Traci
-
darksatellites
- Posts: 21
- Joined: Tue Aug 23, 2011 11:32 am
- Location: Oregon
Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help
Hey Traci, I put up all the records I had and put them in order, of course removed my personal information, and other info more easily linking me....it's at the same flickr account "darksatellites." I would love to hear what you have to say! Thanks so much!
Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help
From: Cat Hospital-Page 1 of 3:
Second vet noted that the first vet did not do a CBC (he only did a chem profile).
Had the first vet done a CBC, he would have most likely clearly found dehydration, infection, inflammation to support any other diagnosis including but CERTAINLY NOT LIMITED TO FIP. When he saw the enlarged heart and fluid in the chest cavity on the xrays (let alone the fluid in abdominal cavity), he should immediately have suspected heart disease and should NOT have relied solely on the echocardiograph to make his assertion of no heart disease. Fluid in the chest or abdominal cavity can occur from several different sources, the assumption of FIP was premature and obviously incorrect.
I'm confused that in the first vet's cost sheet, it includes a fluid aspirate, but he told you he didn't take one.
On the same page, the second vet notes that Sienna is "hanging out near litterbox most of time, blood in stool, not drinking much so owner syringing water".
How long was Sienna hanging out near the litterbox most of the time?
On the same page, the second vet notes "patient has been coughing for about one month or so".
How often was Sienna coughing? Did she continue to cough more than say, 5 times after the appointment with the first vet on July 5th?
From Cat Hospital-Page 2 of 3:
There is a record of a date 7/5/2011 from the first vet:
"presented with hacking and strange behavior, seemed painful..."
"owner said gave grass gel and gave water...."
PE: abdomen distend w/gas
o declined rads, bloodwork and subq fluids (even though she was 5% dehydrated, she should have received a quick administration of subq fluids)
My opinion on this near end of my post.
On the same page, the second vet notes "received faxed medical history from Banfield".
Did she have that record before or after she saw Sienna? You said she did not have the records from the second vet at your appointment, I just want to be sure, because there are no time-stamps on her records, only mention that the copy was printed on Aug 30. Do you know exactly when the second vet actually got the records faxed to her clinic?
On the same page, it appears the second vet did a new echocardiograph, is this true? Or did she inadvertently mean to say that was actually in her treatment plan?
There is also a very specific treatment plan/recommendations by the second vet, but you apparently declined. Was that due to cost, or because of what you previously stated to us, that the second vet gave you a poor prognosis? Looking at the second vet's treatment plan recommendations, it was a good approach had you opted for it, but I am only going by what you said the vet said to you in terms of prognosis.
From Cat Hospital-Page 3 of 3:
Second vet notes that first vet saw "pleural effusion, enlarged heart" (which is noted on first vet's health record Page 1 of 3).
and second vet noted she saw no "treatment plan to be listed and started".
This is just one piece of evidence where I think the vet should be reprimanded for assuming no heart disease when he had what appears as crystal clear evidence from two xrays, and then, jumped to the wrong conclusion of FIP.
From Banfield Hospital-Page 1 of 3:
First vet noted clearly, "the thorax xrays evidence some pleural effusion and enlarged heart".
Again, he had xray evidence that should have been investigated. Yet, he appeared to "confirm" "(Negative for HCM)". This is a gross inconsistency on his part.
Then he said "unfortunately there is no specific and correct diagnostic or therapy" (for his assumption of FIP).
While I explained earlier that the titer is not 100% accurate, it is the gold-standard in testing for FIP, which should also be combined with CBC and chemical profile, other markers, as well as obtaining abdominal fluid for testing and analysis.
He DID offer referral to an internal medicine specialist, twice that day, but noted you would "think about it". Should this go to court, this might be to his favor (you should ask of your free consult attorney about that).
On the same record page, the first vet states, "gave final recommendations about care, "red flag signs", diets, etc, client left and said she understood".
What is he talking about here? Was he referring to that grim prognosis of FIP or something else? Be specific if you can.
From Banfield Hospital-Page 1 of 2-Invoice:
The treatment list is extensive, and according to your posts, half those procedures were never performed.
Was this sheet/invoice only a treatment plan "estimate" or was this the actual invoice, and did you pay the entire amount of $541.76?????
Re: Syringe-feeding water: You did not force water into her mouth did you? Syringing water in a pet's mouth the incorrect way could result in aspiration of the lungs. I'm not suggesting you did that, nor incorrectly, but just want to ask and rule it out.
Re: Grass gel: What exactly was this? (name and brand please)
Re: Coughing and distended abdomen: On July 5, the first vet noted hacking, strange behavior, extended abdomen w/gas and seemed painful.
It would have been better if you had opted for an xray at that time, even though you thought Sienna was trying to cough up a hairball. An xray then might have detected a heart condition/enlargement.
I feel the need to ask, how long before the July 5th appointment, was Sienna coughing?
How many times after that appointment did Sienna continue to cough?
Did she have a history of vomiting hairballs, more than once or twice a week long before the July 5th vet appointment?
As noted on the second vet's recommendations for July 5, he recommended a followup in another day, did you follow up? If Sienna continued to cough past that date, did you call or see that vet again to rule out something more than a hairball impaction?
Have you called the first vet to obtain the echocardiograph report/image?
Second vet noted that the first vet did not do a CBC (he only did a chem profile).
Had the first vet done a CBC, he would have most likely clearly found dehydration, infection, inflammation to support any other diagnosis including but CERTAINLY NOT LIMITED TO FIP. When he saw the enlarged heart and fluid in the chest cavity on the xrays (let alone the fluid in abdominal cavity), he should immediately have suspected heart disease and should NOT have relied solely on the echocardiograph to make his assertion of no heart disease. Fluid in the chest or abdominal cavity can occur from several different sources, the assumption of FIP was premature and obviously incorrect.
I'm confused that in the first vet's cost sheet, it includes a fluid aspirate, but he told you he didn't take one.
On the same page, the second vet notes that Sienna is "hanging out near litterbox most of time, blood in stool, not drinking much so owner syringing water".
How long was Sienna hanging out near the litterbox most of the time?
On the same page, the second vet notes "patient has been coughing for about one month or so".
How often was Sienna coughing? Did she continue to cough more than say, 5 times after the appointment with the first vet on July 5th?
From Cat Hospital-Page 2 of 3:
There is a record of a date 7/5/2011 from the first vet:
"presented with hacking and strange behavior, seemed painful..."
"owner said gave grass gel and gave water...."
PE: abdomen distend w/gas
o declined rads, bloodwork and subq fluids (even though she was 5% dehydrated, she should have received a quick administration of subq fluids)
My opinion on this near end of my post.
On the same page, the second vet notes "received faxed medical history from Banfield".
Did she have that record before or after she saw Sienna? You said she did not have the records from the second vet at your appointment, I just want to be sure, because there are no time-stamps on her records, only mention that the copy was printed on Aug 30. Do you know exactly when the second vet actually got the records faxed to her clinic?
On the same page, it appears the second vet did a new echocardiograph, is this true? Or did she inadvertently mean to say that was actually in her treatment plan?
There is also a very specific treatment plan/recommendations by the second vet, but you apparently declined. Was that due to cost, or because of what you previously stated to us, that the second vet gave you a poor prognosis? Looking at the second vet's treatment plan recommendations, it was a good approach had you opted for it, but I am only going by what you said the vet said to you in terms of prognosis.
From Cat Hospital-Page 3 of 3:
Second vet notes that first vet saw "pleural effusion, enlarged heart" (which is noted on first vet's health record Page 1 of 3).
and second vet noted she saw no "treatment plan to be listed and started".
This is just one piece of evidence where I think the vet should be reprimanded for assuming no heart disease when he had what appears as crystal clear evidence from two xrays, and then, jumped to the wrong conclusion of FIP.
From Banfield Hospital-Page 1 of 3:
First vet noted clearly, "the thorax xrays evidence some pleural effusion and enlarged heart".
Again, he had xray evidence that should have been investigated. Yet, he appeared to "confirm" "(Negative for HCM)". This is a gross inconsistency on his part.
Then he said "unfortunately there is no specific and correct diagnostic or therapy" (for his assumption of FIP).
While I explained earlier that the titer is not 100% accurate, it is the gold-standard in testing for FIP, which should also be combined with CBC and chemical profile, other markers, as well as obtaining abdominal fluid for testing and analysis.
He DID offer referral to an internal medicine specialist, twice that day, but noted you would "think about it". Should this go to court, this might be to his favor (you should ask of your free consult attorney about that).
On the same record page, the first vet states, "gave final recommendations about care, "red flag signs", diets, etc, client left and said she understood".
What is he talking about here? Was he referring to that grim prognosis of FIP or something else? Be specific if you can.
From Banfield Hospital-Page 1 of 2-Invoice:
The treatment list is extensive, and according to your posts, half those procedures were never performed.
Was this sheet/invoice only a treatment plan "estimate" or was this the actual invoice, and did you pay the entire amount of $541.76?????
Re: Syringe-feeding water: You did not force water into her mouth did you? Syringing water in a pet's mouth the incorrect way could result in aspiration of the lungs. I'm not suggesting you did that, nor incorrectly, but just want to ask and rule it out.
Re: Grass gel: What exactly was this? (name and brand please)
Re: Coughing and distended abdomen: On July 5, the first vet noted hacking, strange behavior, extended abdomen w/gas and seemed painful.
It would have been better if you had opted for an xray at that time, even though you thought Sienna was trying to cough up a hairball. An xray then might have detected a heart condition/enlargement.
I feel the need to ask, how long before the July 5th appointment, was Sienna coughing?
How many times after that appointment did Sienna continue to cough?
Did she have a history of vomiting hairballs, more than once or twice a week long before the July 5th vet appointment?
As noted on the second vet's recommendations for July 5, he recommended a followup in another day, did you follow up? If Sienna continued to cough past that date, did you call or see that vet again to rule out something more than a hairball impaction?
Have you called the first vet to obtain the echocardiograph report/image?
..........Traci
-
darksatellites
- Posts: 21
- Joined: Tue Aug 23, 2011 11:32 am
- Location: Oregon
Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help
<i>I'm confused that in the first vet's cost sheet, it includes a fluid aspirate, but he told you he didn't take one.</i>
<b>He came up with that 541.76 on the estimate sheet for all the procedures he wanted to do, which ended up being exactly what I paid. He said he was unable to take a fluid sample because 1) his fear of her crashing 2) her being "skiddish," fussy definitely, but not skiddish AT ALL by the way
What I'm wondering is if he couldn't take the fluid sample how could he take blood work?</b>
<i>On the same page, the second vet notes that Sienna is "hanging out near litterbox most of time, blood in stool, not drinking much so owner syringing water".
How long was Sienna hanging out near the litterbox most of the time?</i>
<b>I only noticed her hanging out by the litterbox after I returned from my trip and first noticed her stomach bloat and wound.</b>
<i>On the same page, the second vet notes "patient has been coughing for about one month or so".
How often was Sienna coughing? Did she continue to cough more than say, 5 times after the appointment with the first vet on July 5th?</i>
<b>Sienna seemed like a hairball was lodged in her stomach or something after I noticed her try to cough it up over the course of a couple days (a few attempts but didn't seem bothersome, as she would have hairballs every now & then) then she seemed to be in extreme distress, would only sit in a few places and would bat her tail and hiss at us for getting close..so then i took her in. I opted for the laxative because I thought it would push out the problem instead of her having to purge it. She immediately seemed better and went back to her routine after a few days of the laxative. Stopped syringing her the laxative. I was also throughout this time syringing her water because I didn't notice her drinking. As far as syringing her water I was unaware this could be done wrong as I figured it would be the same as syringing an oral laxative that I received no instructions on.
What is the proper way?
<font color="red">This sparked something urgent in my mind....!!!! 1 of 2 scenarios deeply disturbs me...
1) I hypothetically squirted this water in her wrong and it went into her lungs instead? However, wouldnt that be an immediate problem? She wasn't bloated, or at least showed any signs until the Monday I 1st took her in. She also didn't seem like she was choking or such after I administered it.
2) Was it likely that this hairball may have passed into her intestines and caused the inability for anything to pass anymore or at least very little? She was up until her last day of life eliminating still. I didn't notice blood in her stool until right before I took her in to the 2nd vet, I even brought a sample of it...There wasnt a lot of blood in it. I didn't notice her peeing as much though.</b></font>
<i>Did she have that record before or after she saw Sienna? You said she did not have the records from the second vet at your appointment, I just want to be sure, because there are no time-stamps on her records, only mention that the copy was printed on Aug 30. Do you know exactly when the second vet actually got the records faxed to her clinic?</i>
<b>She had the records before she saw Sienna and said she had already looked them over, however, Banfield did not send her the x-rays. She didn't seem to think this was unusual. As far as exactly when they got the records faxed over, i do not know.</b>
<i>On the same page, it appears the second vet did a new echocardiograph, is this true? Or did she inadvertently mean to say that was actually in her treatment plan?</i>
<b>They did do a ECG. It clearly showed an enlarged right atrium and she said the valve coming out of it as well, along with both of them being thickened.</b>
<i>There is also a very specific treatment plan/recommendations by the second vet, but you apparently declined. Was that due to cost, or because of what you previously stated to us, that the second vet gave you a poor prognosis? Looking at the second vet's treatment plan recommendations, it was a good approach had you opted for it, but I am only going by what you said the vet said to you in terms of prognosis.</i>
<b>It was because the 2nd vet stated that essentially all the money in the world couldn't likely save her for much more than 2 months even after she was in the ICU and cost $3-5K + just in the several days she REQUIRED to save her life at that point, also which I did/do not have.</b>
<i>On the same record page, the first vet states, "gave final recommendations about care, "red flag signs", diets, etc, client left and said she understood".
What is he talking about here? Was he referring to that grim prognosis of FIP or something else? Be specific if you can.</i>
<b>Yes, referring to the grim prognosis, also he said to feed her wet food and he recommended seeing if she would like gatorade (because of the electrolytes). I did mention I had a syringe at home and if I should administer it that way and he said sure but that likely she wouldn't let me after several times of trying.</b>
<i>Was this sheet/invoice only a treatment plan "estimate" or was this the actual invoice, and did you pay the entire amount of $541.76?????</i>
<b> I think I answered this above, but it was both. Yes, I paid that entire amount.</b>
<i>Re: Syringe-feeding water: You did not force water into her mouth did you? Syringing water in a pet's mouth the incorrect way could result in aspiration of the lungs. I'm not suggesting you did that, nor incorrectly, but just want to ask and rule it out.</i>
<b>Answered above.</b>
<i>Re: Grass gel: What exactly was this? (name and brand please)</i>
<b>The front reads "Grass Gel for Cats" it says at the top "Great for hairballs & aids digestion." It's distributed by Gimborn Pet Specialties. Apparently they have a site gimborn.net</b>
<i>I feel the need to ask, how long before the July 5th appointment, was Sienna coughing?</i>
<b>A couple days in a row she was trying to cough up a hairball and it seemed more difficult for her than normal but she didn't seem distressed,and it wasn't constant, then after a few days went by that's when it seemed like it progressed- when she started basically not moving/walking and would make noises like she was in pain/hiss (which is something she never had done before, very odd of her) She wasn't coughing at the point when she started acting like she was in pain.</b>
<i>How many times after that appointment did Sienna continue to cough?</i>
<b>None that I recall. I thought the problem had resolved itself. At the appointment addressing her potentially lodged hairball they felt her abdomen and said that they didn't feel anything abnormal or lodged, "just a bit gassy" but then they said that didn't completely rule out the possibility of something being lodged, and judging by their reactions (they didn't say this, this is my impression) they didn't seem to think an xray was necessary, but more a precautionary measure.</b>
<i>Did she have a history of vomiting hairballs, more than once or twice a week long before the July 5th vet appointment?</i>
<b>She would infrequently have hairballs, maybe a couple a year. I cannot say for sure, but I think I remember sometime after taking her in and getting the laxative that she did have a hairball.</b>
<i>Have you called the first vet to obtain the echocardiograph report/image?</i>
<b>I haven't yet, I wanted to see if you had anymore discrepancies regarding the records so I could ask them all in one. Also, is it possible he did an ECG but didn't print out the image? And assuming that's the case, is that common? Did he not include the image/print the image because it wasn't in the estimate and I therefore wasn't paying for it? Also, if you look at the Banfield records it says the lab work was manually entered, is that fishy to you? I remember his saying Sienna had a high level of something in her blood work (i think he said globulins) that was further indicative of something that would occur with FIP. Is it possible that by "manually" entering these results it would have sided with the FIP scenario and it would've been an "open/shut" sort of case? Again, I'm just speculating.</b>
Jessica
_________________
<b>He came up with that 541.76 on the estimate sheet for all the procedures he wanted to do, which ended up being exactly what I paid. He said he was unable to take a fluid sample because 1) his fear of her crashing 2) her being "skiddish," fussy definitely, but not skiddish AT ALL by the way
What I'm wondering is if he couldn't take the fluid sample how could he take blood work?</b>
<i>On the same page, the second vet notes that Sienna is "hanging out near litterbox most of time, blood in stool, not drinking much so owner syringing water".
How long was Sienna hanging out near the litterbox most of the time?</i>
<b>I only noticed her hanging out by the litterbox after I returned from my trip and first noticed her stomach bloat and wound.</b>
<i>On the same page, the second vet notes "patient has been coughing for about one month or so".
How often was Sienna coughing? Did she continue to cough more than say, 5 times after the appointment with the first vet on July 5th?</i>
<b>Sienna seemed like a hairball was lodged in her stomach or something after I noticed her try to cough it up over the course of a couple days (a few attempts but didn't seem bothersome, as she would have hairballs every now & then) then she seemed to be in extreme distress, would only sit in a few places and would bat her tail and hiss at us for getting close..so then i took her in. I opted for the laxative because I thought it would push out the problem instead of her having to purge it. She immediately seemed better and went back to her routine after a few days of the laxative. Stopped syringing her the laxative. I was also throughout this time syringing her water because I didn't notice her drinking. As far as syringing her water I was unaware this could be done wrong as I figured it would be the same as syringing an oral laxative that I received no instructions on.
What is the proper way?
<font color="red">This sparked something urgent in my mind....!!!! 1 of 2 scenarios deeply disturbs me...
1) I hypothetically squirted this water in her wrong and it went into her lungs instead? However, wouldnt that be an immediate problem? She wasn't bloated, or at least showed any signs until the Monday I 1st took her in. She also didn't seem like she was choking or such after I administered it.
2) Was it likely that this hairball may have passed into her intestines and caused the inability for anything to pass anymore or at least very little? She was up until her last day of life eliminating still. I didn't notice blood in her stool until right before I took her in to the 2nd vet, I even brought a sample of it...There wasnt a lot of blood in it. I didn't notice her peeing as much though.</b></font>
<i>Did she have that record before or after she saw Sienna? You said she did not have the records from the second vet at your appointment, I just want to be sure, because there are no time-stamps on her records, only mention that the copy was printed on Aug 30. Do you know exactly when the second vet actually got the records faxed to her clinic?</i>
<b>She had the records before she saw Sienna and said she had already looked them over, however, Banfield did not send her the x-rays. She didn't seem to think this was unusual. As far as exactly when they got the records faxed over, i do not know.</b>
<i>On the same page, it appears the second vet did a new echocardiograph, is this true? Or did she inadvertently mean to say that was actually in her treatment plan?</i>
<b>They did do a ECG. It clearly showed an enlarged right atrium and she said the valve coming out of it as well, along with both of them being thickened.</b>
<i>There is also a very specific treatment plan/recommendations by the second vet, but you apparently declined. Was that due to cost, or because of what you previously stated to us, that the second vet gave you a poor prognosis? Looking at the second vet's treatment plan recommendations, it was a good approach had you opted for it, but I am only going by what you said the vet said to you in terms of prognosis.</i>
<b>It was because the 2nd vet stated that essentially all the money in the world couldn't likely save her for much more than 2 months even after she was in the ICU and cost $3-5K + just in the several days she REQUIRED to save her life at that point, also which I did/do not have.</b>
<i>On the same record page, the first vet states, "gave final recommendations about care, "red flag signs", diets, etc, client left and said she understood".
What is he talking about here? Was he referring to that grim prognosis of FIP or something else? Be specific if you can.</i>
<b>Yes, referring to the grim prognosis, also he said to feed her wet food and he recommended seeing if she would like gatorade (because of the electrolytes). I did mention I had a syringe at home and if I should administer it that way and he said sure but that likely she wouldn't let me after several times of trying.</b>
<i>Was this sheet/invoice only a treatment plan "estimate" or was this the actual invoice, and did you pay the entire amount of $541.76?????</i>
<b> I think I answered this above, but it was both. Yes, I paid that entire amount.</b>
<i>Re: Syringe-feeding water: You did not force water into her mouth did you? Syringing water in a pet's mouth the incorrect way could result in aspiration of the lungs. I'm not suggesting you did that, nor incorrectly, but just want to ask and rule it out.</i>
<b>Answered above.</b>
<i>Re: Grass gel: What exactly was this? (name and brand please)</i>
<b>The front reads "Grass Gel for Cats" it says at the top "Great for hairballs & aids digestion." It's distributed by Gimborn Pet Specialties. Apparently they have a site gimborn.net</b>
<i>I feel the need to ask, how long before the July 5th appointment, was Sienna coughing?</i>
<b>A couple days in a row she was trying to cough up a hairball and it seemed more difficult for her than normal but she didn't seem distressed,and it wasn't constant, then after a few days went by that's when it seemed like it progressed- when she started basically not moving/walking and would make noises like she was in pain/hiss (which is something she never had done before, very odd of her) She wasn't coughing at the point when she started acting like she was in pain.</b>
<i>How many times after that appointment did Sienna continue to cough?</i>
<b>None that I recall. I thought the problem had resolved itself. At the appointment addressing her potentially lodged hairball they felt her abdomen and said that they didn't feel anything abnormal or lodged, "just a bit gassy" but then they said that didn't completely rule out the possibility of something being lodged, and judging by their reactions (they didn't say this, this is my impression) they didn't seem to think an xray was necessary, but more a precautionary measure.</b>
<i>Did she have a history of vomiting hairballs, more than once or twice a week long before the July 5th vet appointment?</i>
<b>She would infrequently have hairballs, maybe a couple a year. I cannot say for sure, but I think I remember sometime after taking her in and getting the laxative that she did have a hairball.</b>
<i>Have you called the first vet to obtain the echocardiograph report/image?</i>
<b>I haven't yet, I wanted to see if you had anymore discrepancies regarding the records so I could ask them all in one. Also, is it possible he did an ECG but didn't print out the image? And assuming that's the case, is that common? Did he not include the image/print the image because it wasn't in the estimate and I therefore wasn't paying for it? Also, if you look at the Banfield records it says the lab work was manually entered, is that fishy to you? I remember his saying Sienna had a high level of something in her blood work (i think he said globulins) that was further indicative of something that would occur with FIP. Is it possible that by "manually" entering these results it would have sided with the FIP scenario and it would've been an "open/shut" sort of case? Again, I'm just speculating.</b>
Jessica
_________________
Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help
Did you review the cost sheet before you paid? You didn't find it odd that the procedures were not even done?
Example, procedures not done, according to your posts:
Abdominal Fluid Sample Collect/Prep = 43.68
Dexdomitor 0.5 mg/Ketamine 100 mg/ml/Torbutrol 10mg/ml (per ml) = 41.04
Histopathology/Cytology Interpretation Fee = 53.02
Laceration Repair (Deep) = 108.00
Midazolam 1 mg/ml Vial - 22.21
I know exactly what all of these procedures are, and if none of these were done, I believe the vet owes you a refund of $267.95, and I'd be asking for it. The fact that he and whomever checked you out that day allowed you to pay for services NOT rendered, is just inexcusable, not to mention a bit fraudulent.
But, confusingly, he told you he "wanted to do an analysis" on the fluid (aspirate), but then told you Sienna was too distressed and skittish to handle to do so. Yet, he noted on the health record that he analyzed the fluid: "The analysis of the fluid evidence high protein (300) and mild leukocytes: exudate". AND, he charged you for it. So he did or he didn't, do you know for certain?
Btw, the globulin was within normal range on the chem profile. It would be considered a "high normal", but it was NOT OUT OF RANGE. This was not high enough to determine FIP.
Additionally, he charged you for two xrays, plus "Radiology Interpretation", "Radiology Setup and Handling", all at the total of $167.10, which to me is an excessive amount of questionable and dubious fees. Interpretation and set-up fees for xrays? Charging for that is just rediculous and I have NEVER seen charges like that. It is possible Banfield has a set fee schedule that all the vets have to abide by, but this is just simply rediculous. You should only have been charged for two xrays, which most any other private vet practice would have charged. If for some strange and very unlikely reason, an actual radiology professional was required to view the xrays, then an extra fee might be applied, but we're talking about Banfield, and I highly doubt this vet required a professional radiologist to review the xrays (although given his competence level, maybe one should have!). This is generally reserved for extreme and diffult to diagnose cases involving cancer, orthopedic problems, or extreme cases of vital organ disfunction or other strange anomalies.
Your first question, one can generally always get a blood sample from a pet with proper restraint and a good vet or tech who is experienced in getting it done painlessly and quickly.
The aspirate however, takes some time and the patient has to be extremely still because the butterfly needle/catheter has to be placed in a specific area through the chest wall or abdominal wall, within so many centimeters so as not to puncture a vital organ. When it is placed between specific ribs for example, and if the pet moves suddenly or violently, the needle could scrape a rib, or move in a way to be painful or detrimental. It can and often is done without anesthesia (although sometimes anesthesia is required), and most of the time when it is required, the pets are generally in a state of shock or cannot muscle enough energy to fight examination or procedure. It can take upwards of 10-15 minutes depending on how much fluid should be removed. Oftentimes, the procedure must be repeated if the fluid cannot be controlled before medications take effect.
If Sienna was stressed and pulling away from the vet due to distress, discomfort, pain, then he had good reason not to persue an aspirate. But if I remember correctly, one of your posts mentioned he in fact told you he was going to, or actually did, pull some fluid to look at it. Again, the health record clearly says he did, charged you for it, but at one point told you he didn't.
That Midazolam in the cost sheet is a sedative, often used before or during other anesthetic agents to calm the pet or enough to relax the body for precise procedures. Likewise, the Dexdomitor, Ketamine and Torbutrol are a combination anesthetic. That he charged you for that is so totally wrong!
If he actually DID give Midazolam, he should have told you, because one does not release a pet back to the owner without informing them the patient has received a sedative, with the purpose of telling the owner to watch the pet carefully upon or post-recovery of the sedative/anesthetic!!
To answer your second question:
1) yes, generally a reaction would occur either instantly or within 1-8 hours or so if aspiration of the lungs occured. You did not cause lung aspiration. I simply wanted to rule out the potential, since "lung crepitus" was noted on the vet's notes - this is fluid accumulation, usually it is subcutaneous when it occurs elsewhere, but in case of the lungs, it can surround the lungs, not always IN the lungs. The correct way to use a syringe for water OR pureed food, is to place the syringe in the lower corner of the pet's mouth, slowly push the syringe plunger in the corner's "pocket" of the lip, just drops at a time, and waiting for the pet to swallow after a couple small drops or two. The lower corner of the mouth, that "pocket" would be under the tongue, so the pet has control of moving it in the mouth to swallow it properly.
2) Not likely. If a hairball impaction occurred, she would most likely be vomiting any food or water she consumed, and not eliminating at all. While an impaction can certainly cause bloating and distended abdomen, it does not cause fluid accumulation that seen on her xrays. It can cause a great deal of gassy loops in the intestines, but the vet, upon palpation would have felt a rather firm abdomen, not soft, and would have known to investigate hairball impaction upon learning the pet had not eaten, had been vomiting, had not eliminated and would be quite dehydrated and in severe pain. Also, severe and serious hairball impactions leave the pet in quite a detrimental health state, it is an unmistakable array of symptoms, mainly distended abdomen, inability to eliminate, and obvious pain. Xrays are needed, and many times, followed by a barium series (where barium substance is given orally, then xrays taken every 15-20 minutes to watch where the barium is passing, or where it stops, indicating the location of obstruction - sometimes surgery is necessary to remove the impaction).
Do you feel the second vet may have been surmising that Sienna had end-stage heart failure, but didn't explain it in specific terms like this?
Tip, re: the cat grass gel: I never recommend Gimborn products to pet owners, their products are generally the bottom of the line stuff, generic, and not as effective as many other brands. In the future, I would recommend Laxatone (Petromalt would be second choice), for hairball remedies.
Extra tip: cats don't need or require grass in their diets. It is rather a myth that cats eat grass to feel better or because they have some mysterious notion that eating grass will make them vomit in any good way, or that they actually like it. I'm talking about regular lawn grass, not the oat-grass kits one can buy for their cats at petstores. Regular grass only serves to make cats vomit because 1) the barbs on the grass irritate the lining of the esophagus, stomach, intestines, and of course, is bound to make them vomit, and 2) most lawn grass has been chemically treated at some point, and those chemicals, while possibly dilute over time, can't be helpful for the cat.
The fact that Gimborn puts "grass extract" or "natural grass" in their hairball remedy kind of defeats the purpose of hairball remedy. It is most likely to make cats vomit as opposed to moving a hairball through the intestines. The malt in the product is for taste, and I suspect they have to put some form of petrolatum in it to allow it to coat and smooth things along (which is ok, most products have some form of petrolatum for this purpose), but it shouldn't be used long term. Gimborn's rationale and ingredients to me, are questionable.
When I asked about the coughing, and possible relation to or not, a hairball impaction, I was trying to discern how long she had been coughing, since coughing can be a symptom of heart problems. Since it was only just over a month between the July appointment and recent events, this could still be a clue to potential heart disease just surfacing and possibly unrecognized. I'm certainly not suggesting you could have known that, but it's possible Sienna had a heart problem brewing and it escalated quickly. It's also possible that the hairball was correct and it was totally unrelated at the time.
Whenever a vet performs an ECG, he/she should always put the graph and image in the patient's health chart, this is as good as an xray or any other ultrasound procedure. Images are always kept in the patient's file for future reference, and because the vet already charged the client for the procedure, it is just good practice to keep the proof and stellar record-keeping.
To answer your last question, you will have to ask him. There is proof on both HIS record of Sienna's health chart, as well as the second vet's notes, that he in fact, did an ECG, that's how he determined the heart was normal, no thickening, and that it was negative for HCM (hypertrophic cardiomyopathy). It is recorded in the health record: "With a short US exploration of the heart, there is no signs of excessive thickening of the ventricle walls. (Negative for HCM)".
The vet couldn't make the judgment of "negative for HCM" on the xrays, he made that assumption on the ECG. Ask him for the copy of the ECG and ask why it wasn't included in the records sent to the second vet. Why he didn't charge you for the ECG is beyond me, perhaps he knew he wasn't quite as experienced as he made himself out to be, but that is only conjecture on my part. He in fact took an ECG, you should call him out on that. You should also mention that in your complaint (that you don't understand why he told you he did an ECG but did not show it to you, did not include it faxed to the second vet, and did not give it to you when you first obtained Sienna's health records, and lastly, did not charge you for it). The fact that he did not charge you for the ECG leaves open the question: it's a procedure that takes a bit of time, interpretation, working directly with the patient, usually involves a tech's assistance - apparently, Banfield is big on big and dubious charges, why the heck wouldn't he add an additional charge for the ECG? Out of the goodness of his heart, I doubt it (again, conjecture on my part, but it deserves an answer).
Manually entered means the results or other data or patient's information is entered into a computer system or main veterinary system used by the clinic for keeping patient records and other data. Most blood work is done automatically by analyzers and prints out the results (most vets put the print-out in the patient's file). Other lab tests that require a human hospital lab or outside lab for more sophisticated or specific testing, require the vet to enter data into forms so the lab has a copy (for specific requests, accuracy, etc). He didn't need to use any forms since he didn't send any bloodwork, fluid or any other samples to an outside lab (unless he sent the blood to a human hospital, vets who don't have decent analyzers often do that, then they have to fill in forms for the hospital, plus enter the information into their own computer system - if you had to wait an entire day or more for those bloodwork results, that might tell you if he sent the blood to the local human hospital lab - the health chart indicates he did not, since the time stamp was only a couple hours between admittance and lab work results).
That couldn't be an open and shut case, because he didn't definitively diagnose FIP (he never aspirated the fluid, he never looked at the fluid under a slide (or did he?), he never sent a fluid sample to an outside lab, he never repeated any bloodwork to note any changes, etc. To his credit though, he did offer to refer you to a specialist, and made mention he "was not 100% certain on the FIP" - but that doesn't excuse the lack of care for the other problems (the wound, the heart problem, the costs charged you).
What he did do, is jump to conclusions about FIP based only on one blood marker that while high normal, was still within normal range (globulin), falsely assumed the fluid in the chest and abdomen were fluid caused by FIP without aspirating and testing it, and he IGNORED the clearly enlarged heart on the xrays and relied solely on an ECG to "rule out" heart disease/HCM, etc. He also failed to properly treat the wound, give antibiotics, pain medication, and overcharged you for services not rendered, and told you to wait to drain any fluid based on a dubious opinion (which ultimately kept Sienna very uncomfortable -totally lacking the care and medical attention she needed).
In my opinion, you have enough evidence to get the attention of those who need to make sure this never happens to another pet at that clinic. The seriousness of Sienna's worsening condition, the assumption of FIP without testing, his ignoring an enlarged heart, the failure to treat her wound, the failure to aspirate fluid and initiate diuretics to relieve the fluid and help Sienna to be more comfortable, are totally negligent in my opinion.
Example, procedures not done, according to your posts:
Abdominal Fluid Sample Collect/Prep = 43.68
Dexdomitor 0.5 mg/Ketamine 100 mg/ml/Torbutrol 10mg/ml (per ml) = 41.04
Histopathology/Cytology Interpretation Fee = 53.02
Laceration Repair (Deep) = 108.00
Midazolam 1 mg/ml Vial - 22.21
I know exactly what all of these procedures are, and if none of these were done, I believe the vet owes you a refund of $267.95, and I'd be asking for it. The fact that he and whomever checked you out that day allowed you to pay for services NOT rendered, is just inexcusable, not to mention a bit fraudulent.
But, confusingly, he told you he "wanted to do an analysis" on the fluid (aspirate), but then told you Sienna was too distressed and skittish to handle to do so. Yet, he noted on the health record that he analyzed the fluid: "The analysis of the fluid evidence high protein (300) and mild leukocytes: exudate". AND, he charged you for it. So he did or he didn't, do you know for certain?
Btw, the globulin was within normal range on the chem profile. It would be considered a "high normal", but it was NOT OUT OF RANGE. This was not high enough to determine FIP.
Additionally, he charged you for two xrays, plus "Radiology Interpretation", "Radiology Setup and Handling", all at the total of $167.10, which to me is an excessive amount of questionable and dubious fees. Interpretation and set-up fees for xrays? Charging for that is just rediculous and I have NEVER seen charges like that. It is possible Banfield has a set fee schedule that all the vets have to abide by, but this is just simply rediculous. You should only have been charged for two xrays, which most any other private vet practice would have charged. If for some strange and very unlikely reason, an actual radiology professional was required to view the xrays, then an extra fee might be applied, but we're talking about Banfield, and I highly doubt this vet required a professional radiologist to review the xrays (although given his competence level, maybe one should have!). This is generally reserved for extreme and diffult to diagnose cases involving cancer, orthopedic problems, or extreme cases of vital organ disfunction or other strange anomalies.
Your first question, one can generally always get a blood sample from a pet with proper restraint and a good vet or tech who is experienced in getting it done painlessly and quickly.
The aspirate however, takes some time and the patient has to be extremely still because the butterfly needle/catheter has to be placed in a specific area through the chest wall or abdominal wall, within so many centimeters so as not to puncture a vital organ. When it is placed between specific ribs for example, and if the pet moves suddenly or violently, the needle could scrape a rib, or move in a way to be painful or detrimental. It can and often is done without anesthesia (although sometimes anesthesia is required), and most of the time when it is required, the pets are generally in a state of shock or cannot muscle enough energy to fight examination or procedure. It can take upwards of 10-15 minutes depending on how much fluid should be removed. Oftentimes, the procedure must be repeated if the fluid cannot be controlled before medications take effect.
If Sienna was stressed and pulling away from the vet due to distress, discomfort, pain, then he had good reason not to persue an aspirate. But if I remember correctly, one of your posts mentioned he in fact told you he was going to, or actually did, pull some fluid to look at it. Again, the health record clearly says he did, charged you for it, but at one point told you he didn't.
That Midazolam in the cost sheet is a sedative, often used before or during other anesthetic agents to calm the pet or enough to relax the body for precise procedures. Likewise, the Dexdomitor, Ketamine and Torbutrol are a combination anesthetic. That he charged you for that is so totally wrong!
If he actually DID give Midazolam, he should have told you, because one does not release a pet back to the owner without informing them the patient has received a sedative, with the purpose of telling the owner to watch the pet carefully upon or post-recovery of the sedative/anesthetic!!
To answer your second question:
1) yes, generally a reaction would occur either instantly or within 1-8 hours or so if aspiration of the lungs occured. You did not cause lung aspiration. I simply wanted to rule out the potential, since "lung crepitus" was noted on the vet's notes - this is fluid accumulation, usually it is subcutaneous when it occurs elsewhere, but in case of the lungs, it can surround the lungs, not always IN the lungs. The correct way to use a syringe for water OR pureed food, is to place the syringe in the lower corner of the pet's mouth, slowly push the syringe plunger in the corner's "pocket" of the lip, just drops at a time, and waiting for the pet to swallow after a couple small drops or two. The lower corner of the mouth, that "pocket" would be under the tongue, so the pet has control of moving it in the mouth to swallow it properly.
2) Not likely. If a hairball impaction occurred, she would most likely be vomiting any food or water she consumed, and not eliminating at all. While an impaction can certainly cause bloating and distended abdomen, it does not cause fluid accumulation that seen on her xrays. It can cause a great deal of gassy loops in the intestines, but the vet, upon palpation would have felt a rather firm abdomen, not soft, and would have known to investigate hairball impaction upon learning the pet had not eaten, had been vomiting, had not eliminated and would be quite dehydrated and in severe pain. Also, severe and serious hairball impactions leave the pet in quite a detrimental health state, it is an unmistakable array of symptoms, mainly distended abdomen, inability to eliminate, and obvious pain. Xrays are needed, and many times, followed by a barium series (where barium substance is given orally, then xrays taken every 15-20 minutes to watch where the barium is passing, or where it stops, indicating the location of obstruction - sometimes surgery is necessary to remove the impaction).
Do you feel the second vet may have been surmising that Sienna had end-stage heart failure, but didn't explain it in specific terms like this?
Tip, re: the cat grass gel: I never recommend Gimborn products to pet owners, their products are generally the bottom of the line stuff, generic, and not as effective as many other brands. In the future, I would recommend Laxatone (Petromalt would be second choice), for hairball remedies.
Extra tip: cats don't need or require grass in their diets. It is rather a myth that cats eat grass to feel better or because they have some mysterious notion that eating grass will make them vomit in any good way, or that they actually like it. I'm talking about regular lawn grass, not the oat-grass kits one can buy for their cats at petstores. Regular grass only serves to make cats vomit because 1) the barbs on the grass irritate the lining of the esophagus, stomach, intestines, and of course, is bound to make them vomit, and 2) most lawn grass has been chemically treated at some point, and those chemicals, while possibly dilute over time, can't be helpful for the cat.
The fact that Gimborn puts "grass extract" or "natural grass" in their hairball remedy kind of defeats the purpose of hairball remedy. It is most likely to make cats vomit as opposed to moving a hairball through the intestines. The malt in the product is for taste, and I suspect they have to put some form of petrolatum in it to allow it to coat and smooth things along (which is ok, most products have some form of petrolatum for this purpose), but it shouldn't be used long term. Gimborn's rationale and ingredients to me, are questionable.
When I asked about the coughing, and possible relation to or not, a hairball impaction, I was trying to discern how long she had been coughing, since coughing can be a symptom of heart problems. Since it was only just over a month between the July appointment and recent events, this could still be a clue to potential heart disease just surfacing and possibly unrecognized. I'm certainly not suggesting you could have known that, but it's possible Sienna had a heart problem brewing and it escalated quickly. It's also possible that the hairball was correct and it was totally unrelated at the time.
Whenever a vet performs an ECG, he/she should always put the graph and image in the patient's health chart, this is as good as an xray or any other ultrasound procedure. Images are always kept in the patient's file for future reference, and because the vet already charged the client for the procedure, it is just good practice to keep the proof and stellar record-keeping.
To answer your last question, you will have to ask him. There is proof on both HIS record of Sienna's health chart, as well as the second vet's notes, that he in fact, did an ECG, that's how he determined the heart was normal, no thickening, and that it was negative for HCM (hypertrophic cardiomyopathy). It is recorded in the health record: "With a short US exploration of the heart, there is no signs of excessive thickening of the ventricle walls. (Negative for HCM)".
The vet couldn't make the judgment of "negative for HCM" on the xrays, he made that assumption on the ECG. Ask him for the copy of the ECG and ask why it wasn't included in the records sent to the second vet. Why he didn't charge you for the ECG is beyond me, perhaps he knew he wasn't quite as experienced as he made himself out to be, but that is only conjecture on my part. He in fact took an ECG, you should call him out on that. You should also mention that in your complaint (that you don't understand why he told you he did an ECG but did not show it to you, did not include it faxed to the second vet, and did not give it to you when you first obtained Sienna's health records, and lastly, did not charge you for it). The fact that he did not charge you for the ECG leaves open the question: it's a procedure that takes a bit of time, interpretation, working directly with the patient, usually involves a tech's assistance - apparently, Banfield is big on big and dubious charges, why the heck wouldn't he add an additional charge for the ECG? Out of the goodness of his heart, I doubt it (again, conjecture on my part, but it deserves an answer).
Manually entered means the results or other data or patient's information is entered into a computer system or main veterinary system used by the clinic for keeping patient records and other data. Most blood work is done automatically by analyzers and prints out the results (most vets put the print-out in the patient's file). Other lab tests that require a human hospital lab or outside lab for more sophisticated or specific testing, require the vet to enter data into forms so the lab has a copy (for specific requests, accuracy, etc). He didn't need to use any forms since he didn't send any bloodwork, fluid or any other samples to an outside lab (unless he sent the blood to a human hospital, vets who don't have decent analyzers often do that, then they have to fill in forms for the hospital, plus enter the information into their own computer system - if you had to wait an entire day or more for those bloodwork results, that might tell you if he sent the blood to the local human hospital lab - the health chart indicates he did not, since the time stamp was only a couple hours between admittance and lab work results).
That couldn't be an open and shut case, because he didn't definitively diagnose FIP (he never aspirated the fluid, he never looked at the fluid under a slide (or did he?), he never sent a fluid sample to an outside lab, he never repeated any bloodwork to note any changes, etc. To his credit though, he did offer to refer you to a specialist, and made mention he "was not 100% certain on the FIP" - but that doesn't excuse the lack of care for the other problems (the wound, the heart problem, the costs charged you).
What he did do, is jump to conclusions about FIP based only on one blood marker that while high normal, was still within normal range (globulin), falsely assumed the fluid in the chest and abdomen were fluid caused by FIP without aspirating and testing it, and he IGNORED the clearly enlarged heart on the xrays and relied solely on an ECG to "rule out" heart disease/HCM, etc. He also failed to properly treat the wound, give antibiotics, pain medication, and overcharged you for services not rendered, and told you to wait to drain any fluid based on a dubious opinion (which ultimately kept Sienna very uncomfortable -totally lacking the care and medical attention she needed).
In my opinion, you have enough evidence to get the attention of those who need to make sure this never happens to another pet at that clinic. The seriousness of Sienna's worsening condition, the assumption of FIP without testing, his ignoring an enlarged heart, the failure to treat her wound, the failure to aspirate fluid and initiate diuretics to relieve the fluid and help Sienna to be more comfortable, are totally negligent in my opinion.
..........Traci
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darksatellites
- Posts: 21
- Joined: Tue Aug 23, 2011 11:32 am
- Location: Oregon
Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help
Hey Traci, just keeping you informed....I wrote the 2nd vet, included the x-rays she didn't get to see, asked for a documented response sent in snail mail, I'm also waiting to receive my mother's testimonial on her conversation with the 1st vet. So, things are still moving! I will let you know!
-
darksatellites
- Posts: 21
- Joined: Tue Aug 23, 2011 11:32 am
- Location: Oregon
Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help
Hello again Traci! So, today I called and requested the ECG graph/images that the Vet said he was "rather good at" on the telephone, interestingly enough (despite his notes in my records I obtained) the receptionist said (she was relaying with him) that he didn't do one, and that, "it was not necessary for her condition." Then the receptionist got flustered and insisted she have the Vet call me back when he was available.
I then received a telephone call back with a voicemail saying, (this is verbatim by the way) "Misses Backstrom this is Dr. Tello, um, trying to return your call, I just wanted to address what's going on about Sienna I think there is a little confusion, What I told you is during the echocardiogram who is the ultrasound that we did ah -about Sienna to find whether there is the fluid you ran at the same time an ECG but that's not a formal ECG, it's not intended to diagnose rhythm problems, it's intended to diagnose electromechanical associations, thats means the electrical activity goes along with the mechanical activity in the heart . For an ECG it's a totally different exam. So if, if you want to give me a call I'm happy to answer any questions or any concerns you have about this ok? ....And I hope Sienna is doing fine, ok, looking forward to your call."
I then phoned and gave the 2nd vet this new information, and they asked if I had gotten a lawyer yet.
I have also a few questions after reviewing all our correspondence again...
How does one determine what necrotic tissue is/looks like? Based on my images does she appear to have had necrotic tissue?
Also do you think that the distended abdomen was from infection/ascites or from heart failure manifesting itself?
Also, in your professional opinion do you feel that given her state in documentation from the 1st vet/xrays/my photos provided, as well as my correspondence.... that if properly caught on the 1st vets visit would she have been able to live much longer/recover from the infection much more easily? Clearly it didn't help having her wait to go to another vet, but I guess what I'm asking is whether or not the prognosis would've been virtually the same?
Also do ECG's commonly not get sent over to other vet's similarly to X-rays? Also do ECGs' data usually go directly into a computer/database? How does one go about clearing ECG data/US data? Does it automatically clear with its next use?
Thanks so much!
I then received a telephone call back with a voicemail saying, (this is verbatim by the way) "Misses Backstrom this is Dr. Tello, um, trying to return your call, I just wanted to address what's going on about Sienna I think there is a little confusion, What I told you is during the echocardiogram who is the ultrasound that we did ah -about Sienna to find whether there is the fluid you ran at the same time an ECG but that's not a formal ECG, it's not intended to diagnose rhythm problems, it's intended to diagnose electromechanical associations, thats means the electrical activity goes along with the mechanical activity in the heart . For an ECG it's a totally different exam. So if, if you want to give me a call I'm happy to answer any questions or any concerns you have about this ok? ....And I hope Sienna is doing fine, ok, looking forward to your call."
I then phoned and gave the 2nd vet this new information, and they asked if I had gotten a lawyer yet.
I have also a few questions after reviewing all our correspondence again...
How does one determine what necrotic tissue is/looks like? Based on my images does she appear to have had necrotic tissue?
Also do you think that the distended abdomen was from infection/ascites or from heart failure manifesting itself?
Also, in your professional opinion do you feel that given her state in documentation from the 1st vet/xrays/my photos provided, as well as my correspondence.... that if properly caught on the 1st vets visit would she have been able to live much longer/recover from the infection much more easily? Clearly it didn't help having her wait to go to another vet, but I guess what I'm asking is whether or not the prognosis would've been virtually the same?
Also do ECG's commonly not get sent over to other vet's similarly to X-rays? Also do ECGs' data usually go directly into a computer/database? How does one go about clearing ECG data/US data? Does it automatically clear with its next use?
Thanks so much!
Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help
That vet is certifiably crazy. If that is exactly what he said, then he's more than crazy, he's incompetent.
He actually sounds like he's talking about an EKG, which uses electrodes, and prints out the graph. The ECG is the ultrasound, which can print out an image. All his notes indicated he did an ECG (an ultrasound of the heart). There is NO "informal" ECG, you do one or you don't, you can't do it halfway and then charge the client for it. My guess is he possibly did an EKG (graph only), and didn't know how to interpret it. Or, he did NEITHER an ECG or EKG. Too bad you can't get the truth from him, perhaps Banfield, the judge, the board can.
And, either the ECG or EKG can detect abnormal rythms, valve problems, thickening, decreased blood flow to the heart, etc. Listening from the stethoscope could have told him that much, to start. He's flat out lying to you. It would be interesting to hear what the second vet thought of that verbatim comment he gave you.
To answer your questions, it is really hard to say, since the first vet neglected to address anything, and appears to be lying to you about the ECG, he had better come up with that graph or image if you intend to take him to court, otherwise he is going to perjure himself (if he hasn't already). Since the second vet did not do any tests, then she essentially could only give an educated guess based on what records she had at the time from the first vet, and only upon exam of Sienna. A fluid aspirate would have determined leaking heart fluid or bacteria. The xrays were already indicative of enlarged heart, and possibly heart failure. The fluid in the chest and abdomen could have been one or the other, or a combination of both (heart fluid and bacteria). Without a fluid aspirate, it's impossible to determine unless other tests had been done. The ECG however, should have told the first vet that Sienna had an obvious heart problem, and the xrays were pretty much indicative of that.
Since he didn't provide you or the second vet a graph or image, then he's lying, or he's failing to admit how incompetent he is, or both. He may or may not have printed a graph or image (or both), but failing to do so when you've already told the client you've done so is BAD practice. These tests must be a physical RECORD in the patient's chart. If he charged you for an ECG, then he's a fraudster as well.
Necrotoc tissue is dead and diseased tissue or skin that occurs when there is infection and/or loss of blood or blood flow to tissue, blood vessels etc. In skin, it usually bruises, turns dark or blackened, and starts sloughing. If not treated properly and promptly, necrosis can spread to surrounding tissue and both prohibit healing as well as increase the level of infection. That infection in turn, can lead to the bloodstream and cause sepsis and make it extremely difficult to treat effectively.
While the photos seems clear, there are darkened areas, but I suspect much of that is fur matted to the wound, and one had to look under the top layer of skin to determine how healthy the skin and muscle were. The furthest edges of the wound look sort of clean, but pictures can be deceiving, not to mention the tech attempted to clean it. In one picture, some of the dermal layers look to have a yellowish appearance, which could mean povidone (iodine solution) might have been used, although it would have been better to use something like surgical scrub, and of course, completely flushed and antibiotics given immediately. Likewise, the yellow tint could also be pus/infection. You said Sienna had continued to eat and drink, so unlikely that the yellowish tint was jaundice or anything like that (unless bloodwork indicated a liver problem or anemia). Again, pictures can be deceiving, only the vet and tech know how serious that wound was before cleaning. You were charged a hefty fee for cleaning the wound when it wasn't exactly cleaned professionally, in my opinion. (remember he said he was going to sedate, then properly clean the wound, but instead had the tech attempt to do it without anesthesia, which cannot by any means get a good tissue cleaning done on an alert cat).
Had the first vet properly diagnosed Sienna, or done the proper tests, Sienna could have at least been made more comfortable:
1) aspirate to relieve fluid would have taken pressure off her chest, lungs, etc.
2) diuretics to relieve fluid would have taken pressure off her chest, lungs, abdomen. At some point, once fluids were alleviated, a new xray could be taken to visualize the internal organs in more clear detail.
3) injectable antibiotics would have given a head start in treating any infection, whether directly from the wound, or systemic.
4) oxygen therapy if necessary would have aided in breathing etc. (remember he told you to WAIT on nearly everything, he didn't want to aspirate fluid because of that hairbrained idea in his head that it would attack her immune system by doing so).
5) once fluid was aspirated, diuretics given, antibiotics started, then the typical course of action would be to review Sienna's status and condition the following morning and advise/refer you to a feline cardiologist when he had evidence from 2 xrays and an ECG indicating a heart problem. Even a slide exam of the fluid could have determined what the fluid was exactly, therefore how to address it. Even if fluid had been aspirated, it is possible it may have needed to be aspirated again the following morning.
If it were heart failure, or, end-stage heart failure, and depending on the extent of damage to the heart (which is irreversible), would depend on survival time. End-stage does not lend a good prognosis.
In any event, a competent vet would have given you options, at least a referral to a cardiologist or, treating to keep Sienna comfortable and stable enough to transfer to either an emergency care facility or a new exam/ECG and heart workup with a cardiologist. A competent vet would have been able to advise you based on all test results, Sienna's response to medications, or again, depending on the extent of illness/damage. But, no definitive tests were done, no medications were given. The ONLY procedures that were done as far as I can tell were a cursory quick exam, a minimal blood profile workup, xrays, an ECG, an a quick attempt to clean the wound.
Remember, I don't know what the conversation was between you and both vets regarding testing and treatment, it seems you declined some "offers" of testing/treatment from both vets. Granted, you expected both vets to be professional and to guide you in your options, decisions, and the first vet definitely failed you, I can't say about the second vet because I do not know how that conversation went. In the second vet's exam notes, she does form a treatment plan, like the fluid aspiration, rule out infection, more thorough heart workup.
If you declined further diagnostics or treatment then unfortunately, a necropsy was the only way to determine for certain what exactly was affecting Sienna, and to what extent. Did the second vet even mention that to you? Sometimes vets prefer to offer the option because many a pet owner feel "the need to know what happened" in the face of difficult circumstances, especially when suffering is involved and the vet makes an educated guess that relieving suffering might be the best option and the owner is left with grief and questions and what-ifs.
I doubt the ECG graph or image would have been put into a database, it would be enough to enter that the procedure was done (including costs charged), both hand-written in the patient's chart, as well as diagnostics entered into the computer's patient information. The graph and image however, SHOULD HAVE BEEN PRINTED AND PLACED IN THE PATIENT'S CHART (the physical, hard copy of the patient's health file). The same applies to xrays, all xrays are either placed in the patient's health file, or stored with other xrays in a records room. Storing in records rooms isn't really done much anymore. (maybe in human hospitals but not so much in vet hospitals). That said, state-of-the-art clinics with expensive equipment can download some diagnostics like xrays, possibly ultrasound images to an online database in the clinic. I'd find out from Banfield if they have such equipment, but that is a question you might want to ask of your attorney - I do hope you have seriously considered a free consult with one.
If the second vet requested all of Sienna's health records from the first vet, then he should have sent either the originals or COPIES of them to her. The fact he had in his notes (which she obtained), clearly states he did an ECG (ultrasound) and clearly states his findings, and clearly states he was WRONG about any diagnosis. Be absolutely sure you know exactly WHICH records the second vet obtained from the first vet, and the dates, since that is part of your complaint. (not to mention catching him in outright lies).
I want to emphasize my opinion on potential infection. I don't know if it was severe, the aspirate should have shown that. Also, a CBC should have been done to detect infection, high WBC's, inflammation, dehydration etc, all of which could have indicated infection, and possibly how severe. I do have an opinion on the vet's failure however, to immediately give injectable antibiotics when he knew the date you noticed the wound, and the date of the exam with him. He also knew it was quite a nasty wound, left to fester for some time, and he SHOULD have given antibiotics without question. He also knew the muscle was exposed (which is also noted by the second vet in her exam notes), and he knew that leaving muscle exposed to an infection was a NO-NO, without properly treating the wound.
He actually sounds like he's talking about an EKG, which uses electrodes, and prints out the graph. The ECG is the ultrasound, which can print out an image. All his notes indicated he did an ECG (an ultrasound of the heart). There is NO "informal" ECG, you do one or you don't, you can't do it halfway and then charge the client for it. My guess is he possibly did an EKG (graph only), and didn't know how to interpret it. Or, he did NEITHER an ECG or EKG. Too bad you can't get the truth from him, perhaps Banfield, the judge, the board can.
And, either the ECG or EKG can detect abnormal rythms, valve problems, thickening, decreased blood flow to the heart, etc. Listening from the stethoscope could have told him that much, to start. He's flat out lying to you. It would be interesting to hear what the second vet thought of that verbatim comment he gave you.
To answer your questions, it is really hard to say, since the first vet neglected to address anything, and appears to be lying to you about the ECG, he had better come up with that graph or image if you intend to take him to court, otherwise he is going to perjure himself (if he hasn't already). Since the second vet did not do any tests, then she essentially could only give an educated guess based on what records she had at the time from the first vet, and only upon exam of Sienna. A fluid aspirate would have determined leaking heart fluid or bacteria. The xrays were already indicative of enlarged heart, and possibly heart failure. The fluid in the chest and abdomen could have been one or the other, or a combination of both (heart fluid and bacteria). Without a fluid aspirate, it's impossible to determine unless other tests had been done. The ECG however, should have told the first vet that Sienna had an obvious heart problem, and the xrays were pretty much indicative of that.
Since he didn't provide you or the second vet a graph or image, then he's lying, or he's failing to admit how incompetent he is, or both. He may or may not have printed a graph or image (or both), but failing to do so when you've already told the client you've done so is BAD practice. These tests must be a physical RECORD in the patient's chart. If he charged you for an ECG, then he's a fraudster as well.
Necrotoc tissue is dead and diseased tissue or skin that occurs when there is infection and/or loss of blood or blood flow to tissue, blood vessels etc. In skin, it usually bruises, turns dark or blackened, and starts sloughing. If not treated properly and promptly, necrosis can spread to surrounding tissue and both prohibit healing as well as increase the level of infection. That infection in turn, can lead to the bloodstream and cause sepsis and make it extremely difficult to treat effectively.
While the photos seems clear, there are darkened areas, but I suspect much of that is fur matted to the wound, and one had to look under the top layer of skin to determine how healthy the skin and muscle were. The furthest edges of the wound look sort of clean, but pictures can be deceiving, not to mention the tech attempted to clean it. In one picture, some of the dermal layers look to have a yellowish appearance, which could mean povidone (iodine solution) might have been used, although it would have been better to use something like surgical scrub, and of course, completely flushed and antibiotics given immediately. Likewise, the yellow tint could also be pus/infection. You said Sienna had continued to eat and drink, so unlikely that the yellowish tint was jaundice or anything like that (unless bloodwork indicated a liver problem or anemia). Again, pictures can be deceiving, only the vet and tech know how serious that wound was before cleaning. You were charged a hefty fee for cleaning the wound when it wasn't exactly cleaned professionally, in my opinion. (remember he said he was going to sedate, then properly clean the wound, but instead had the tech attempt to do it without anesthesia, which cannot by any means get a good tissue cleaning done on an alert cat).
Had the first vet properly diagnosed Sienna, or done the proper tests, Sienna could have at least been made more comfortable:
1) aspirate to relieve fluid would have taken pressure off her chest, lungs, etc.
2) diuretics to relieve fluid would have taken pressure off her chest, lungs, abdomen. At some point, once fluids were alleviated, a new xray could be taken to visualize the internal organs in more clear detail.
3) injectable antibiotics would have given a head start in treating any infection, whether directly from the wound, or systemic.
4) oxygen therapy if necessary would have aided in breathing etc. (remember he told you to WAIT on nearly everything, he didn't want to aspirate fluid because of that hairbrained idea in his head that it would attack her immune system by doing so).
5) once fluid was aspirated, diuretics given, antibiotics started, then the typical course of action would be to review Sienna's status and condition the following morning and advise/refer you to a feline cardiologist when he had evidence from 2 xrays and an ECG indicating a heart problem. Even a slide exam of the fluid could have determined what the fluid was exactly, therefore how to address it. Even if fluid had been aspirated, it is possible it may have needed to be aspirated again the following morning.
If it were heart failure, or, end-stage heart failure, and depending on the extent of damage to the heart (which is irreversible), would depend on survival time. End-stage does not lend a good prognosis.
In any event, a competent vet would have given you options, at least a referral to a cardiologist or, treating to keep Sienna comfortable and stable enough to transfer to either an emergency care facility or a new exam/ECG and heart workup with a cardiologist. A competent vet would have been able to advise you based on all test results, Sienna's response to medications, or again, depending on the extent of illness/damage. But, no definitive tests were done, no medications were given. The ONLY procedures that were done as far as I can tell were a cursory quick exam, a minimal blood profile workup, xrays, an ECG, an a quick attempt to clean the wound.
Remember, I don't know what the conversation was between you and both vets regarding testing and treatment, it seems you declined some "offers" of testing/treatment from both vets. Granted, you expected both vets to be professional and to guide you in your options, decisions, and the first vet definitely failed you, I can't say about the second vet because I do not know how that conversation went. In the second vet's exam notes, she does form a treatment plan, like the fluid aspiration, rule out infection, more thorough heart workup.
If you declined further diagnostics or treatment then unfortunately, a necropsy was the only way to determine for certain what exactly was affecting Sienna, and to what extent. Did the second vet even mention that to you? Sometimes vets prefer to offer the option because many a pet owner feel "the need to know what happened" in the face of difficult circumstances, especially when suffering is involved and the vet makes an educated guess that relieving suffering might be the best option and the owner is left with grief and questions and what-ifs.
I doubt the ECG graph or image would have been put into a database, it would be enough to enter that the procedure was done (including costs charged), both hand-written in the patient's chart, as well as diagnostics entered into the computer's patient information. The graph and image however, SHOULD HAVE BEEN PRINTED AND PLACED IN THE PATIENT'S CHART (the physical, hard copy of the patient's health file). The same applies to xrays, all xrays are either placed in the patient's health file, or stored with other xrays in a records room. Storing in records rooms isn't really done much anymore. (maybe in human hospitals but not so much in vet hospitals). That said, state-of-the-art clinics with expensive equipment can download some diagnostics like xrays, possibly ultrasound images to an online database in the clinic. I'd find out from Banfield if they have such equipment, but that is a question you might want to ask of your attorney - I do hope you have seriously considered a free consult with one.
If the second vet requested all of Sienna's health records from the first vet, then he should have sent either the originals or COPIES of them to her. The fact he had in his notes (which she obtained), clearly states he did an ECG (ultrasound) and clearly states his findings, and clearly states he was WRONG about any diagnosis. Be absolutely sure you know exactly WHICH records the second vet obtained from the first vet, and the dates, since that is part of your complaint. (not to mention catching him in outright lies).
I want to emphasize my opinion on potential infection. I don't know if it was severe, the aspirate should have shown that. Also, a CBC should have been done to detect infection, high WBC's, inflammation, dehydration etc, all of which could have indicated infection, and possibly how severe. I do have an opinion on the vet's failure however, to immediately give injectable antibiotics when he knew the date you noticed the wound, and the date of the exam with him. He also knew it was quite a nasty wound, left to fester for some time, and he SHOULD have given antibiotics without question. He also knew the muscle was exposed (which is also noted by the second vet in her exam notes), and he knew that leaving muscle exposed to an infection was a NO-NO, without properly treating the wound.
..........Traci
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darksatellites
- Posts: 21
- Joined: Tue Aug 23, 2011 11:32 am
- Location: Oregon
Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help
Hello again!
So far things are coming together nicely.
I wanted you to look into something for me....
On your evaluation of Sienna's receipt of procedures not done, etc, you didn't mention anything about the internal organ function screen being fishy, but remember when i asked you what "manually entered" meant, as I thought something suspicious of this instantly...
So, to put this simply...
There were 13 things run for the internal organ function screen, all of which came back in the "normal" ranges. Each one of these items has a timestamp...all of which were done and entered in at 12:26pm. On the same note, on the health records at 12:27 it says "the lab results for internal organ function screen were manually entered."
I'm wondering how someone could read data, input it manually (13 items) within less than a minute, and then open a health chart and state this. Also what would be the benefit of frauding data such as this for him, hypothetically? Is there anything that appears to be oddly in a normal/moderate range for a cat such as Sienna that would've given more signs of heart disease, and thus needed to be overrode? Would any of the 13 screens usually be found out of normal range when indicative of heart disease? I would imagine so...
And to do an internal organ function screen, what is required? Is it just a sample of blood that is run in a machine? Several samples? Vet-tech assistance?
I also wanted to mention that I had a conversation on the phone with the 2nd vet, and that she confirmed that in her technician's own brief exploratory ECG that they could immediately tell the ventricles were enlarged (this technician is a licensed ultrasonographer). As a reminder, the 1st vet also did a "short US exploration of the heart" and said that there was no "excessive thickening of the ventricle walls. (Negative for HCM)." He also told me this on the phone the same day he saw Sienna.
I'm sure I'll have more questions, but that's all I can think of for now....
!! Thanks so much!!
So far things are coming together nicely.
I wanted you to look into something for me....
On your evaluation of Sienna's receipt of procedures not done, etc, you didn't mention anything about the internal organ function screen being fishy, but remember when i asked you what "manually entered" meant, as I thought something suspicious of this instantly...
So, to put this simply...
There were 13 things run for the internal organ function screen, all of which came back in the "normal" ranges. Each one of these items has a timestamp...all of which were done and entered in at 12:26pm. On the same note, on the health records at 12:27 it says "the lab results for internal organ function screen were manually entered."
I'm wondering how someone could read data, input it manually (13 items) within less than a minute, and then open a health chart and state this. Also what would be the benefit of frauding data such as this for him, hypothetically? Is there anything that appears to be oddly in a normal/moderate range for a cat such as Sienna that would've given more signs of heart disease, and thus needed to be overrode? Would any of the 13 screens usually be found out of normal range when indicative of heart disease? I would imagine so...
And to do an internal organ function screen, what is required? Is it just a sample of blood that is run in a machine? Several samples? Vet-tech assistance?
I also wanted to mention that I had a conversation on the phone with the 2nd vet, and that she confirmed that in her technician's own brief exploratory ECG that they could immediately tell the ventricles were enlarged (this technician is a licensed ultrasonographer). As a reminder, the 1st vet also did a "short US exploration of the heart" and said that there was no "excessive thickening of the ventricle walls. (Negative for HCM)." He also told me this on the phone the same day he saw Sienna.
I'm sure I'll have more questions, but that's all I can think of for now....
!! Thanks so much!!
Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help
I don't think the time stamp matters. The time of the labwork printout matters, for various reasons (for the tech, accuracy, monitoring the patient, good record keeping, etc), but he could have entered everything else later (notes, chart notes, etc). I don't even see a time-stamp on the blood profile, because it looks like it was either omitted on the page or cut off going to page 2... The date-stamp is a couple days later, so the time/date looks screwed up to me. What you're looking at is a printout, but when exactly the notes/etc were done by the vet is anyone's guess.
The "internal organ function screen" is the chemical blood profile. It's not fishy in any way. Normally, techs do the bloodwork. But, vets do them too, it just depends on who is available at that moment. Other times, the blood sample is sent to a human hospital or other lab when the vet doesn't have the appropriate tests or when there is a full comprehensive blood panel to be done that might help save the client costs when combined with other tests. The blood is spun in a centrifuge, then serum drawn off, enzyme plates are placed in the machine and the machine does the reading, then prints out the results. Part of the initial bloodwork can also be used for a CBC.
He did not do a CBC, which would have shown infection, dehydration, high white blood cell counts, if any.
The AST, CK and LDH, are common enzymes that might be altered in heart disease, but the physical tests such as the ECG/ultrasound, xrays etc are better for detecting it. The vet did not include any heart-related enzymes in the chemical blood profile. Remember, he was looking for signs of FIP.
It would be mighty difficult and stupid to falsify a blood panel. I don't even believe it's possible, since the machine does most of it and prints out the results.
The "internal organ function screen" is the chemical blood profile. It's not fishy in any way. Normally, techs do the bloodwork. But, vets do them too, it just depends on who is available at that moment. Other times, the blood sample is sent to a human hospital or other lab when the vet doesn't have the appropriate tests or when there is a full comprehensive blood panel to be done that might help save the client costs when combined with other tests. The blood is spun in a centrifuge, then serum drawn off, enzyme plates are placed in the machine and the machine does the reading, then prints out the results. Part of the initial bloodwork can also be used for a CBC.
He did not do a CBC, which would have shown infection, dehydration, high white blood cell counts, if any.
The AST, CK and LDH, are common enzymes that might be altered in heart disease, but the physical tests such as the ECG/ultrasound, xrays etc are better for detecting it. The vet did not include any heart-related enzymes in the chemical blood profile. Remember, he was looking for signs of FIP.
It would be mighty difficult and stupid to falsify a blood panel. I don't even believe it's possible, since the machine does most of it and prints out the results.
..........Traci