In response to admin, I don't question that you follow protocol. I understand the dog was in respiratory distress and the possibility of collapse or death was very high. The communication and continuity of care was lacking. The overnight doctor, doctor Sorrento? was something else, she wasn't aware if the dog was given a diuretic and had to check because the dog has congestive heart failure. Dr. Bishop, who was the doctor that was caring for her from the onset noted that she would suspend giving it to hydrate her ? Let's pick an organ here. What happens when you have congestive heart failure and the heart fills with fluid? Respiratory distress. She would've rather hydrated her instead, and the diuretic would undo the hydration efforts.
I will stress the treatment my personal veterinarian decided on could've been something that a hospital with so many veterinary specialties, housed in one building, could have tried-just like suspending Lasix, if you're gonna take a risk...why not try any other thing to reduce the inflammation or consider anything else? The push to administer high flow oxygen, that would probably not do much at that point -at the exorbitant cost- was ridiculous conversation. It's already 18 hours later so she hasn't died yet and her respiration is in the 80s to 100s !?!? And what aggravated me the very most was that I told Dr. Bishop I don't want overnight. I was very much against leaving this dog, especially for several days, and that I was going to bring her to my personal vet. When you're beating a dead horse and you're it's hours and hours and hours without anything happening -even the 7 hours up until the doctor was off duty. I would've still had time to get to my vet and save thousands!
When I arrived at 2 am, because they were telling me doom and gloom and wanted to administer that high flow O2, I stressed that I would be taking my dog before they charged me for another day. The case doctor allowed me to visit with my dog. I felt so panicked at that moment. Even more so because, having a dog with CHF, I always monitor her resting respiratory rate and I can estimate the rate fairly well by sight. When I arrived , my dog was laying in the oxygen cage, facing the wall. Before my dog spotted me, I noted the respiration in regular oxygen at this time, and I estimated high 70s. The minute my dog saw me then she became highly excited and her respiration increased as she started to move toward me. Prior to this, I was calling several times throughout the evening and would get varying reports, but at about 11 PM a tech responding to my updates and said that she was breathing OK and resting fairly comfortably. The contribution of fluid buildup, if you're not giving, or toggling Lasix, stress, anxiety, strange people, unfamiliar setting, nebulizing treatments, all are flipping her out so yeah-respiration increasing! And staff are not standing there monitoring so closely- she was in an oxygen cage with 20 other dogs in the same room. AT that time, I asked for portable oxygen to transport my dog to my vet because I wanted to say goodbye in my way (yeah, they offered to euthenize her at Oradell), she said no without even checking or considering it. Three hours later, discharge doctor actually suggested portable oxygen and decided to see if she could find any without me requesting it-that's the variant incontinuity of care I'm talking about. it's just a handoff to different Vets on different shifts and it's hit or miss and unfortunately, I had more misses than hits.
During a prior visit, I had that doctor was very understanding. Yes, my decision was totally AMA. Initially she read me the riot act if I wanted to discharge an oxygen-dependent dog. But I persisted (my fault THIS time) and I was given medication for home. THE WORST PART OF THIS IS THAT YOU DELAYED ME GETTING TO MY VETERINARIAN THAT EVENING, WHEN HE WOULD'VE GIVEN HER HIS TREATMENT THAT IMPROVED HER SITUATION- GREATLY. And I am still upset about the hydration -suspending Lasix crap the Dr. Bishop TOLD ME UPON ADMISSION. Yeah-the dog survived the 18 hr crisis when my vet saw her, but his treatment was not without risk either and she was still breathing at 80-95 for two days after WITHOUT oxygen.
I understand it is totally AMA, and this is for the safety and the animal, but you need to consider patient wishes as well. You certainly had no problem considering euthanasia or pushing Care Credit financing options when MANY people have difficulty shouldering the ENORMOUS financial load (It was almost 5K!). Then-at least try another method orHail Mary treatment. Pneumonia does not just resolve in a day-Discuss AMA home treatment risks vs ER. We sign away your liability anyway.
Don't professed have any GOLD standard of care if you are including your ER because you're just standard care, CYA, making sure that there's no liability on your part. Unfortunately, I was expecting more. I was expecting that extra mile. read more