QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help!!!

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Traci
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Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help

Post by Traci »

I just caught in your last post that he "1st suspected cardiomyopathy". He still should have taken an xray to rule in or out that suspicion. Seems to me he jumped to conclusions, felt he was (wrongly) an expert of echocardiography, and if this is how he practices, a complaint needs to filed against him.
..........Traci
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Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help

Post by darksatellites »

Sorry, for any seemingly inconsistent information. What he said he wanted to do in the beginning, and what he did in the end are different . I am a lil scatterbrained right now too.

He did do a ultrasound of the heart (he said this on the phone to me, i didn't see any images) he did do a body x-ray also, which clearly showed fluid in her abdomen and then pointed out fluid around the heart (i THINK he said it was in an isolated area, maybe some sort of sack [this i cannot accurately remember]) but then he said because of all the fluid (primarily referencing the abdomen) that he couldn't properly evaluate the rest of the internal organs.

He did initially state while doing vitals that she had a heart murmur and that her heart's beat was irregular. Interestingly enough after his heart ultrasound is when he said he had eliminated cardiomiopathy because the heart walls were normal (and aside from the body x-ray w/ the fluid around the heart) said nothing more about the heart or a possible condition. He just stated the fluid made it difficult to assess the organs.

He said he was worried she might "crash" under too much stress and initially he wanted to check her heart solely for the purpose of making sure she was a candidate for sedation. He didn't sedate her at all nor take an abdominal fluid because she would've needed to be sedated / she might have "crashed". He said her blood sample though (interestingly enough he can get a blood sample though?) had high levels of something (can't remember) in it (i'm wondering if he actually even took a blood sample). It does say (if i can remember correctly, the bill is not with me right now), that he DID take a fluid sample and i got billed for it. He did have the wound cleaned per my request, but the tech said she couldn't do it as thoroughly as she would've wanted (for whatever reason)...perhaps because they decided not to sedate her and the wound's level of extreme severity.

When I said he didn't take an x-ray I meant of just the heart, he DID take an x-ray but it was of the body, and did an ultrasound electively of the heart instead (which i never saw evidence of).

I looked up his credentials online and he has only been initially licensed since 2010.....you were right.

Jessica
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Traci
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Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help

Post by Traci »

I don't want to pressure you, you've just suffered a tragic loss.

Take some time to grieve, collect your thoughts. If you are inclined later, find your receipt and post what was "done" on the receipt, and as soon as you are of clear mind, get those printed health records from that vet.

BTW, one does not necessarily need to sedate a pet to aspirate fluid or air from the chest or abdomen. The procedure involves a tiny "butterfly" catheter that is gentle inserted between the ribs (into either the chest or abdominal wall, and the fluid or air is drawn out by a syringe attached to the catheter. If we waited to sedate every pet with pleural effusion or pneumothorax, they would crash before we could get it done. His tech was supposed to be capable enough to hold Sienna while the vet aspirated the fluid.
..........Traci
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Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help

Post by Tina B and crew »

Jessica...I am so sorry for your loss. You did what was right for your beautiful furbaby and the vet failed you. Gentle journey sweet Sienna.

:cry:
Tina B and "what a crew!"

How we behave towards cats here below determines our status in heaven ~Robert A. Heinlein
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Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help

Post by darksatellites »

Hi Traci and others

....so I am slowly compiling my case, got the records from both the vet's offices.... I highly value your opinion and would appreciate it if you took a look at my images just to see if you have anything additionally to add...If for some reason that link doesn't take you to all the images (about 6 of them), try looking me up by my username "darksatellites" on flickr

http://www.flickr.com/photos/67085294@N03/?saved=1

Thanks so much,
Jessica
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Traci
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Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help

Post by Traci »

Jessica, were these xrays taken by the first vet?

Did the second vet take xrays?

The xrays you have, CLEARLY show an enlarged heart, in both xrays, and how he didn't see that is just beyond me.

The fact he thought he was an "expert" in echocardiography, just tells you what kind of idiot he is. Hearing a heart murmur should have first alerted him to a problem. Hearing irregular heartbeats should have prompted him to look further. "Seeing" what he "thought" was a normal heart wall just goes to show that the xray showed more, and he ignored the enlargement and thought it was only fluid. Notice in the xray that the heart takes up a great deal of space, is enlarged, and is shaped like a valentine heart, which is not always definitive, but when enlarged, is crystal clear, demanding further workup to determine absolute heart function. The xray looks like CHF (congestive heart failure).

Even with the fluid in the abdomen, one can still see how large the heart is! Granted, it's impossible to view the other organs like liver and kidneys, large and small intestine, bladder, etc. But, this is where he should have addressed the fluid properly by aspirating, testing it, sending a sample to test, prescribing diuretics, and determining overall heart function. Once the fluid was aspirated, diuretics initiated, an overnight stay in the hospital to address the obvious concerns could have determined if more fluid should be aspirated, and how exactly to address the heart function.

As for the wound, the tech did a fair job of cleaning it, but, judging by the photos, it appears that the wound was severely infected, and my guess is that there was a great deal of pus (infection) initially, and most likely hiding under the dermal layers, even deeper. It should have been completely flushed, and injectable antibiotics given immediately, pain medication given, plus a prescription for pain medication to be given at home. Yes, anesthesia would have been necessary to flush the wound properly, and to debride any diseased tissue.

But, instead, he wrongly diagnosed FIP, told you he couldn't aspirate fluid because of some hairbrained idea in his head that the immune function would attack itself - this in itself should tell any veterinary board he had better come up with some pretty heavy literature and proof to support that bogus assertion.

In a way, it is probably a good thing he did not put Sienna under anesthesia, as it would have been extremely detrimental to her heart, her lungs, her breathing. Even if he had, he should have aspirated fluid, done a complete heart workup, initiated diuretics, properly flushed and treated the wound and battled the heart problem in the following day or two. Add to that, he failed to detect extreme infection.

If you got records of Sienna's "emergency" treatment, and any other health record from this vet, make copies of every single page and receipt. Do not give any copy of anything to anyone without making an additional copy of everything - depending on how many people will be involved in your complaint, you'll need that many copies plus copies for your own use.

Same applies to records (and any xrays or ECG if performed), receipts etc from the new vet.

Write down a personal statement, and get a personal statement from the person who was with you when you took Sienna to this vet. You may not need it, but it would be good to have on hand or in the case someone needs it on record.

I'm so very sorry about everything. I would be just livid and that vet would rue the day if I ever had to deal with him. The more I know and see from your case, the more I hope you are encouraged to go after him, if for anything else, to prevent this from happening to another innocent pet and owner.

Sienna was such a beautiful little girl, my heart just goes out to her and you. :cry:
..........Traci
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Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help

Post by darksatellites »

Thanks so much for your ongoing support with this. I will be providing a link to this whole conversation in my letter to the board. Once I can spare some extra money, I'd like to make a small contribution to you and your site.

These are indeed from the 1st vet. The 2nd vet did not have this for reference, but kept saying how she wished she had them with the records that were sent over.

When you say that the xrays were indicative of CGH, would that scenario explain for whatever reason the fluid in the abdomen? I'm just not understanding how a failed heart can manifest the bloat, and where that fluid came from (or was it blood?) The 2nd vet said she was likely born with her heart condition (how long does it take for the heart to enlarge?) This was definitely something that had been going on a while, correct? Did the infection or wound likely cause the abdominal bloat and not the CGH? Once an animal is diagnosed with CGH, or similar heart problems mentioned that Sienna had, how much "time" would you estimate a person would have with their pet? I was told given what the 2nd vet said (without the images, of course), that she probably would've only had 2 months and would've had to have been on medication, etc. I'm just trying to figure out how the wound played into her long-term heart problem I didn't know about.....could you speculate with your professional opinion?

I'm going to kinkos tomorrow to make copies of everything, and I will scan the records so you can see all of that too. My mom spoke to the Vet on the phone also, she is writing a letter with her statement. I'm also going to send copies of the x-rays to the 2nd vet and ask her to write her professional opinion on the 1st vets care/lack of care, etc. I'm not sure how to properly approach a vet to do that or if it's unorthodox? I also have 2 other people to add to my report (that went to the vet with me).

The 1st vet said he did an ECG but there was no evidence on the records showing it, nor any images. I also don't recall him showing me the 2nd xray at the office (I will have to confirm that with my friend).

Is there anything else you would recommend including before I send the report out? Do you know if there's a statute of limitations? I'm not attempting to prolong this, I will likely submit it in the next week. Also, any idea how long it takes to get a word back from the board roughly?

Thanks again soooooooo much!!!!!! You have really been my angel through all of this....

Jessica
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Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help

Post by darksatellites »

Also, I uploaded 2 of my favorite photos of Sienna, so you have a face you are fighting for. It's all at the same flickr account.
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Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help

Post by k9Karen »

Jessica, I'm so sorry to see your post about losing Sienna. It's never easy to lose one, but when you know the care she received was sub-par (to say the least), I know it must be even harder. Most of us here have lost at least one furry family member and truly understand your grief and the pain you're experiencing. I wish you luck and success with your complaint.
"A dog is the only thing on earth that loves you more than he loves himself." ~ Josh Billings.
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Traci
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Re: QUESTIONING CAT DIAGNOSED WITH F.I.P....VET/TECHS...help

Post by Traci »

darksatellites wrote:Thanks so much for your ongoing support with this. I will be providing a link to this whole conversation in my letter to the board. Once I can spare some extra money, I'd like to make a small contribution to you and your site.
Jessica,although I appreciate the sentiment, it's not necessary to contribute, this is what I do, I love being able to help where I can, advice and support is free here!
darksatellites wrote:These are indeed from the 1st vet. The 2nd vet did not have this for reference, but kept saying how she wished she had them with the records that were sent over.
I believe I advised it when you informed us about the first vet's "diagnosis" - those records/xrays should have been faxed to the new vet upon your request - and she should have asked/made mention to you to give permission to the first vet to fax those records/xrays.

That said, with this new information you posted, I'm wondering how the second vet felt there was an abnormal heart condition, yet did not have, nor take a new xray or other heart workup diagnostics to wager that opinion? Your post about what she "found" or her "opinion" on Sienna's health issue, was rather brief and didn't state what she really felt was the contributing issue, other than an educated guess on heart disease (valve defect).

Also, what exactly did the new vet do to address the open gaping wound, consideration about aspirating fluid, administering antibiotics, and exploring further heart workup diagnostics? She knew she could take a new xray and a new ECG, why didn't she? I'm only assuming, based on your post, that what she told you was detailed, and left you with the option of "attempting to treat", or barring further stress and diagnostics and expense, left the option of euthanasia. Did you opt for additional treatment, or decline any treatment?
darksatellites wrote:When you say that the xrays were indicative of CGH, would that scenario explain for whatever reason the fluid in the abdomen? I'm just not understanding how a failed heart can manifest the bloat, and where that fluid came from (or was it blood?) The 2nd vet said she was likely born with her heart condition (how long does it take for the heart to enlarge?) This was definitely something that had been going on a while, correct? Did the infection or wound likely cause the abdominal bloat and not the CGH? Once an animal is diagnosed with CGH, or similar heart problems mentioned that Sienna had, how much "time" would you estimate a person would have with their pet? I was told given what the 2nd vet said (without the images, of course), that she probably would've only had 2 months and would've had to have been on medication, etc. I'm just trying to figure out how the wound played into her long-term heart problem I didn't know about.....could you speculate with your professional opinion?
The xrays look, in my opinion, like congestive heart failure. CHF can occur as end-stage in cardiomyopathies as well.

Again, not knowing how the second vet came to her conclusions, it's difficult to answer. Had she done a complete heart workup, she would have been in a better position to predict the exact type of heart condition, extent of heart disease, treatment approach and prognosis. Without those diagnostics, and without the previous records from the first vet, I am truly curious how she came up with the heart defect opinion.

There are various types of heart conditions, some congenital, some acquired. Cardiomyopathy types for example, usually occur in older cats (but cats age 5 and older can develop this). Sometimes, specific breeds like Maine Coons or Ragdolls may be predisposed to heart disease.

In cardiomyopathy, blood flow is restricted to the heart's chambers and valves and left unchecked/untreated, the heart cannot pump enough blood or fast enough, so fluid accumulates either around the heart, or in the chest's pleural space, or even the abdomen (or all three areas) - it is possible that Sienna had cardiomyopathy, and could have been diagnosed with proper and timely diagnostics. Treatment would have been geared to extent of disease, response to medications.

Likewise, congestive heart failure (CHF) can also occur at any age, and can also develop fluid around the heart, pleural space and/or abdomen. It is also congenital or acquired. Oftentimes, CHF is actually end-stage progression of a heart condition.

If the second vet's suspicion of heart valve defect were correct, then this negates the first vet's "expert" opinion on the "normal heart wall" etc, since an expert would have been able to detect heart enlargement, fluid buildup, valve defects, and heart wall thickening. He detected nothing or failed to detect what was truly going on. (and again, failed to detect upon clear evidence of the xrays). Not to mention, when heart disease is suspected, particularly with strong evidence like xrays and ECG, then the primary vet usually feels it best to refer to a feline cardiologist for definitive diagnosis and treatment strategy. The first vet was probably a first year vet (or resident), and certainly not an expert, least of all in echocardiography. (I think Banfield should be made aware that the vet's comments about being an "expert" or having a considerable amount of experience in echocardiology, should be called in question!!)

Treatment for either cardiomyopathy or CHF may include any of the following: diuretics to remove fluid, ACE inhibitors/vasodilators to open blood vessels and maintain blood flow to the heart, calcium channel blockers, to maintain heart muscle constriction, maintain blood flow, and sometimes other medications or combination of meds to maintain heart function.

Both conditions may be silent and undetectable for months to several years, particularly with unchecked defects (like valve defects) - however, both conditions usually develop recognizable symptoms like exercise intolerance, sometimes coughing, labored breathing, weight gain, fluid accumulation, unable to get enough oxygen, heart murmurs and "gallop" rhythms heard by using a stethoscope, etc.

This is why it is imperative for owners to get yearly exams on their cats (and dogs) to stay ahead of these issues and get them diagnosed and treated early on before they escalate and treatment becomes less effective. The heart murmur may have been present when Sienna was a kitten, and may have been present all this time, but may have went unchecked and unmonitored.

It would be strange if you never noticed any of the symptoms described above, particularly exercise/activity intolerance, potential coughing, open-mouthed breathing, etc. Many cats will be asymptomatic until the condition is found early during a vet exam. Again, this is why it's important to get those yearly exams so the condition can be caught early and treated.

In asymptomatic cats with a heart condition, medications can help maintain heart function for several years, providing they are monitored regularly. In symptomatic cats, it is anyone's guess due to the extent of damage, response to medications, age, irrepairable defects, potential for lethal blood clots, etc.

I suspect (only my opinion), that Sienna may have been at end-stage heart failure, especially due to the increasing fluid accumulation in her chest and abdomen. Coupled with a serious and extreme infection, the infection could also have targeted her heart, as in infection becoming systemic (affecting any number of vital organs). Unfortunately, the exact type of heart problem and the extent of damage could only have been defined with a necropsy.

In the above scenario, the second vet could have been accurate in prediction of short-term survival rate. If end-stage heart disease, even the most aggressive medication approach may only have alleviated symptoms temporarily and helped her to be more comfortable for a time. Again, this is only my opinion, and I base that on just a snippet of information stated from your second vet, as well as the obvious xrays.
darksatellites wrote:I'm not sure how to properly approach a vet to do that or if it's unorthodox? I also have 2 other people to add to my report (that went to the vet with me).
Just simply ask her. Tell her you do not intend to put her into an unwanted situation in a potential court case, but that you would appreciate her input and educated opinion on Sienna's health condition when she saw her (including the untreated wound, lack of antibiotics and pain medications), ask her for copies of Sienna's records, her vet's handwritten notes on Sienna's health chart, etc. Ask her if she would be willing to write a brief statement to your favor. That statement does NOT have to portray anything about the first vet, only her opinion on Sienna's condition as a new patient in her clinic. Any records, opinions, diagnostics or diagnosis and prognosis would be the remaining evidence.

Keep in mind, most vets don't like treading on other vets' toes, particularly when there are complaints and lawsuits involved. Explain to the second vet that you do not intend to put her in any awkward position in any way, but that you simply would like the records, her opinion on paper, for your own use, and to aid in presenting your case.

That said, I would certainly OBTAIN ANY COPIES of health records or any treatment/diagnostic list, as well as your paid receipt, BEFORE you ask her for her personal/professional opinion and her notes - in the event she refuses to oblige you on the personal notes part, you will still have those records for your use - she cannot deny you copies of Sienna's health records. It's just the personal notes or statement she may not feel comfortable with. Get those records, make copies quickly, then approach her, ask for any personal notes or opinion statement, the worst she could do is say no.
darksatellites wrote:The 1st vet said he did an ECG but there was no evidence on the records showing it, nor any images. I also don't recall him showing me the 2nd xray at the office (I will have to confirm that with my friend).
I assume you got Sienna's health records already from the first vet. Now, call the vet's clinic and ask for a copy of the ECG report AND any image if taken. (again be prepared to pay a small amount for the copies). If they hem and haw, or tell you they don't have the ECG report/image or none was taken, then you can add that to your arsenal - after all, he was the "expert in echocardiography" and told you he did and that the heart wall was normal. /end sarcasm/.
darksatellites wrote:Is there anything else you would recommend including before I send the report out? Do you know if there's a statute of limitations? I'm not attempting to prolong this, I will likely submit it in the next week. Also, any idea how long it takes to get a word back from the board roughly?
1) All health records from the first vet:
- include any hand-written notes, diagnostics noted on such notes, bloodwork results, xrays, ECG, paid receipt, and your personal statement about your displeasure about his handling of the situation, his misdiagnosis on FIP, his refusal to aspirate fluid, treat the wound, and prescribe antibiotics, pain meds, and his "wait and see" approach that was obviously a very bad decision on his part.

Tip: if there is a notation of something like "clip/cleanse/debride" on your paid receipt, this would have been the attempt to clean/flush the wound, but since no flushing or debridement was done, you may have been charged for a service not actually performed.

2) All health records from the second vet:
- include any hand-written notes, diagnostics noted or performed, paid receipt, and hopefully her hand-written statement/opinion on Sienna's condition at the time she saw her, and her recommendations made to you.

3) Your mom's (or whomever was with you) personal statement.

Be as brief as possible - and I know the difficulty in this, just be very clear and concise, professional, write or preferably type clearly, include your name, address, email and phone number or additional phone number where you can be reached.

As for how long it can take for the veterinary board to review and respond, I have no idea, it depends on how serious the board is, if they are backlogged on complaints and reviews, and their integrity and professionalism. You can request a "timely response" either by hand-written letter or phone call, and be sure to note that you "are available for additional questions if necessary, at their convenience".

4) I would include a third copy of everything to be sent to Banfield, either directly to the managing vet/owner of the clinic you went to or the corporate headquarters or both (this is where you want them to question the vet's "expertise" or "experience" with echocardiography, as well as his neglect in treatment).

Hope this helps.
..........Traci
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