i need help

[nanny100]

i took my 8 week old puppy to the vet because he started having dirreah and vomiting so the vet hospital took x-ray's and said he look to have swallowed something so they suggested surgery now because they seen something and it had to come out unless he would die ok i couldn't afford it but i had to make a way to have it done so they did it and found nothing they cut him for nothing without getting advise from another doc or whomever they could have done a ultrasound or something other than surgery for nothing please help with a little advise

[koneall]

I'm a veterinarian.  I've been  in mixed-animal practice for 26 years.  It's often a guessing game deciding whether to "cut".  Wait too long and the patient might die from whatever is wrong.  Cut too soon and I have to deal with a client who's pissed that his pet underwent unnecessary surgery.  

I never had a death during exploratory abdominal surgery in a healthy animal.  But I've lost several patients because I waited too deciding whether to cut.    A large-breed puppy generally has energy reserves to live on for several days  if needed.  A small-breed puppy generally doesn't have these reserves.   For me that's often the deciding factor.   Large breed pup:  medicate and watch for improvement.  Small breed pup:  Can't afford to wait, best to cut now.    

[Arnold L Goldman, D.V.M.]

Dear nanny100,

I gather from your post that your puppy has survived his illness and the surgery. For that I am grateful.

There are at least two ways to look at this situation.

First, decision-making regarding a cause of vomiting especially is fraught with challenges. While diarrhea is not usually a sign of gastrointestinal obstruction it may occur with partial obstruction or simply lower GI inflammation. Interpretation of x ray images is an art and in a small puppy especially, with little internal body fat to "outline" the organs it can be easy to overinterpret findings. Too, the disease intussecption, essentially a telescoping of the bowel on itself may cause temporary anatomic obstruction, which can resolve spontaneously some of the time. There isnt however usually time to lose in resolving a suspected GI obstruction, especially in a young small animal whose dehydration and electrolyte disturbances, not to mention inability to continue eating, may be life threatening.

Another way to view it is that the surgery, seen in retrospect was unnecessary. We may know this now, but at the time the physical findings, x ray evidence and signalment (young puppy eats stuff) indicated obstruction or at least the possibility of
and exploratory was suggested and performed. If anything a negative exploratory can be a good result as anything else might have involved partial bowel resection or other internal interventions more involved and risky than simply having a look.

Not having been there during the diagnostic process I cannot speculate on what in the x ray images made surgery necessary at the moment the decision was made. I can say that decision making in the absence of complete information, under the pressure of time (small breed, young puppy with little body mass) is challenging and imperfect.
There isn't always time for specialist consultations under such circumstances, and access to advanced imaging may also be limited geographically, chronologically or practically.

If your puppy is better now and otherwise normal and gaining weight, then I am glad.
Sometimes exploratory surgery as a diagnostic test is necessary to rule out what all available evidence indicates is an obstruction. With proper technique and pain relief medications it is a useful tool and sometimes lifesaving.

Sincerely,


Arnold L. Goldman DVM, MS
MedHelp & PDOC