MRSA infection in pets and animals forum

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HEAD TRAUMA IN CATS Started by Jane IP Address 80.3.160.13	Posted: August 16, 2006 at 15:39

Please check my original write up at 'Re PTSD (and loss)'. What comes under the heading in laymans terms of 'professional misconduct'? WHAT IS THE RIGHT PROCEEDURE FOR CHECKING A CAT WITH POTENTIAL HEAD TRAUMA? PLEASE HELP ME. 16355

Re: HEAD TRAUMA IN CATS Reply #1 by Sheena IP Address 195.93.21.1	Posted: August 18, 2006 at 10:44

Jane, sadly I see no Vet has answered your question. If you are making a complaint to the RCVS I thought I should perhaps tell you that the Vet who seems to deal with such complaints had told me in writing that he is not a cat expert but surely only a cat expert should deal with complaints about cats. His area of expertise is entirely different and so I wonder why he is dealing with complaints about the treatment of cats by clients. 16462

Re: HEAD TRAUMA IN CATS Reply #2 by ex vet IP Address 217.33.74.20	Posted: August 18, 2006 at 13:33

Jane. taking a full history and clinical examination to begin with. had head trauma occured or was suspected? had the cat been in an accident or RTA? A full examination should take place, including a neurological exam to pinpoint the location of any brain/spinal cord lesion. If any abnormalities are noted then they would be monitored to asssess change over time. Serious head injuries as a result of trauma are usual fatal in animals, but less severe ones can be treated; usually high doses of corticosteroids and sometimes diuretics to reduce inflammation and intracranial pressure, and analgesics to control pain Most vets do not have ready access to MRI and CT scanners as do the medical profession, which are the only way the brain/spinal cord can be imaged accurately. 16470

Re: HEAD TRAUMA IN CATS Reply #3 by Rupert IP Address 62.49.21.95	Posted: August 18, 2006 at 14:13

Jane, Have you requested a copy of your cat's clinical records from the vet? 16471

Re: HEAD TRAUMA IN CATS Reply #4 by Jane IP Address 80.3.160.13	Posted: August 19, 2006 at 12:55

Hello all, thank you for responding. I was sent a brief 'medical history' but it does not contain a great deal of information, so I have re-requested, explaining that I would like an actual copy of her 'clinical notes'. My initial concern was that the vet that examined her in the first instance has 'now' said that at the time she showed no signs of abnormal head carrige, this is untrue, it was the reason that I called her out as her head was tucked in and tilted slightly to her left. I had seen my cat hit her head twice jumping into a closed window. The vet did not see her walking and at my suggestion to this she said 'no' and to 'just put her on the counter'. I was alarmed by the extent that the vet pulled my cats head up, back and side to side, as I understand, with any suspected head or spinal injury that it would be of utmost importance to go vary carefully.She was given an anti inflamatory. 16515

Re: HEAD TRAUMA IN CATS Reply #5 by Bob IP Address 195.93.21.1	Posted: August 19, 2006 at 15:23

Jane, you are entitled to your cat's records under the Freedom of Information act, the examination you have described above is worrying. How is the cat? I hope she recovered but suspect from your post she may not have. There are vets with MRI scanners and also mobile scanners which travel to vet surgeries, your own vet should know where they are and if you could have gained access to them, did they suggest this? 16525

Re: HEAD TRAUMA IN CATS Reply #6 by ex vet IP Address 82.14.65.13	Posted: August 19, 2006 at 17:31

Part of a neurological exam would include watching the patient walk if they were able to, to determine if and how they negotiate obstacles and to assess how coordinate they are. MRI scanning is not readily available in an emergency situation, very few practices have their own and referal to a specialist centre would involve time and possibly traveling a considerable distance. When I was in general practice in the midlands(UK) we used to refer MRI cases to Newmarket or the Wirral, or there was a mobile one which visited Coventry monthly Cost is also a limiting factor with MRI, anaesthesia and the scan will cost most of £1000. Anti inflammatory drugs, either non steroidals (nsaids) or corticosteroids (not both together) are indicated and would be a sensible choice in cases of actual or suspected head trauma. 16540

Re: HEAD TRAUMA IN CATS Reply #7 by Jane IP Address 80.3.160.13	Posted: August 20, 2006

Sadly my cat did not recover. After keeping her in the bathroom as advised by the vet to prevent her from hurting herself further(I stayed in there with her) from 7am until 3.45pm, (which was the soonest that they would see her if she had not recovered), I rushed her to the surgery as she had started to become very distressed and was deep purring. At this time they said that she was in too critical a state to do any tests and that they would try to stablise her by the following morning and do tests then. I was told later that she had sustained further head damage at the vets as she had been 'walking into things' and that this was the reason that she had deteriated and died. The vet that had told me he would be monitoring her that night and would call me if her condition deteriated at all, decided that at 4am she was fine and went home....she died sometime after that apparently. I was called at 9am and obviously shocked to hear that she had (possibly) had a seizure sometime between 4am-8am as I had not been called earlier. I believe that her painkilling drug diazapam had not been administered since 9pm or maybe even 6.30pm the previous evening. I understand that it would have helped to prevent seizures as well as providing pain relief, the night vet did not administer pain relief at all that night and said the previous vet had given her enough until morning...when pushed on this he said up until 7am. Hopefully the clinical notes will reveal this. The drug initially administered on call out was Dexafort 3mg/ml 1ml(as appears on med history). I was not told that they did not have the necessary scanner until after her death. They knew my insurance covered her for up to £6,000. 16566

Re: HEAD TRAUMA IN CATS Reply #8 by ex vet IP Address 82.12.243.128	Posted: August 20, 2006 at 08:16

Jane, I'm sorry to hear that you lost your cat. Diazapam (Valium) is not an analgesic drug, it is an anxiolytic sedative. It would be given to effect to control seizures or relax a stressed patient. Care has to be taken with opiate analgesics with head trauma cases, some are contraindicated because they increase intracranial pressure. Dexafort is corticosteroid and could be given to reduce inflammation in head trauma cases As brain surgery is rarely carried out in animals, and then only by very few specialist surgeons in very few specialist centres; it is doubtful that MRI would have altered the outcome in this case. Medical therapy is aimed at reducing inflammation and controling seizures if they occur. The prognosis is usually extremely poor. 16577

Re: HEAD TRAUMA IN CATS Reply #9 by Jane IP Address 80.3.160.13	Posted: August 20, 2006 at 11:00

Thank you for your help EX VET. Its very kind of you. I have listed below what was written (as written) on her medical history, can you explain what is what so I can have a clearer picture...this was when addmitted to the surgury- solumedrone: first fluid therapy valium 10mg/2ml 2ml vetergesic amp admin set spiral aqupharm no 11 hartmans 500ml Has aparently hit window twice today.plr intact but appears blind. neck pain, with restricted movement. concerned re intra cran heam/swelling. also beginning to mouth breath, disorientated and unhappy. adv solumed pain relief and diaz to calm and reduce threshold for seizures. warned o re prognosis, and discussed diagnostic options although advised that radiographs ect would not be undertaken until stablised. monitor overnight and repeat pain relief lasix and solumed if poss. The vet that did this then changed over to the night vet and no further pain relief was given. The night vet said she was stable at his last check at 4am. The reason I said Diazipam was because I was told by another vet there that that was what she was given, so is that under another name on the above list? Can you tell me also how long it takes for rogor mortis to set in and if it is possible for parts of the body not to be affected as her head and neck were fully moveable when I burried her yet her body had been stiff for at least 2 hours prior? Is there a reason for this? 16585

Re: HEAD TRAUMA IN CATS Reply #10 by anon IP Address 195.93.21.1	Posted: August 20, 2006 at 11:09

Jane so sorry to hear the above, you need to contact the action group about this as it appears to be a case which was not dealt with in the proper manner. If the vet went home at 4 am and left this critically ill cat this is clearly very wrong. Did they offer 24 hr care, if so this is not 24 hr care. We have had debates on here before about this issue of leaving cats alone overnight in surgeries. I think you need to contact the action group and a lawyer. 16587

Re: HEAD TRAUMA IN CATS Reply #11 by Jane IP Address 80.3.160.13	Posted: August 20, 2006 at 11:41

Hello anon I was told by the night vet that he would monitor her all night and inform me straight away if her condition declined in any way. I was given exact details of her death ie she died at 8am after a fit and that 2 hours previous she had had a massive bleed, by the morning duty vet. This suggested that someone had been with her as expected. It was only because I then phoned and spoke to another two vets including the night vet that I discovered and was told that nobody actually knew what had happened to her as no one had been at the surgury at that time. I cannot afford a lawyer but I will contact the action group. Many thanks. 16591

Re: HEAD TRAUMA IN CATS Reply #12 by ex vet IP Address 82.12.243.128	Posted: August 20, 2006 at 11:52

Solumedrone is a corticosteroid that is usually given in high doses intravenously in cases of shock or trauma. Vetergesic is an opiate analgesic. Lasix is a powerful diuretic. It seems this cat was given intravenous fluid therapy steroids and analgesia, but despite this its condition deteriorated (increased disorientation and altered or irregular breathing are signs of deteriorating brain/cns function) I cannot see that anymore could have been done therapeutically in this case. once the medication has been given little more can be done other than give it time to work. I accept that animals should not be left on their own overnight, but I feel the outcome here would probably have been the same. if the vet went home at 4am, it maybe that he/she worked all the previous day and was working all the next day too - we cannot work 36 hour shifts without sleep! This should be discussed with the practice owners. Anon, I can understand a campaign for improved 24hr care although it is an age old debate and I've not yet seen any realistic suggestions on how it would implemented, staffed and funded? As I have said in another posting, one energency clinic is facing bankrupcy - in short people want, but will not pay for a high standard of care. I fail to see what a lawyer would do here? an animal died as a result of serious head injuries, despite every reasonable therapeutic option being carried out. 99.9% of veterinary surgeons, myself included, would have treated this in the same/similar way. 16593

Re: HEAD TRAUMA IN CATS Reply #13 by anon-3 IP Address 82.32.33.11	Posted: August 20, 2006 at 12:26

Are you saying vet that 99.9% of vets would have left that cat to die on its own because it is 4am? I totally disagree with you the owner would not pay that is absolute rubbish.The owner is unaware that the animal is on its own.I asked a vet when my animal had needed 24 houe care-she was unable to breath do you provide 24hr care "YES" was his reply.He did not provide 24hr care.the rest is a nightmare.Jane i think you need a post mortem to establish time of death. 16598

Re: HEAD TRAUMA IN CATS Reply #14 by Jane IP Address 80.3.160.13	Posted: August 20, 2006 at 13:01

Hello exvet, thank you for explaining that. The night vet started duty at 10pm when he changed over from the vet that I saw at 3.45pm and costs were not a problem as I had explained that my cat had a £6,000 insurance cover. I guess what I'd like to know is if the initial examination had been a thorough one, and more radical treatment could have been done sooner then she would possibly have survived. Also as it's suspected that she died from a seizure surly having been given further doses of 'lasix and solumed' as recommended, yet not supplied could possibly have countered the seizure. What answers do you have regarding the details of rigor mortis as mentioned above. I would appreciate any info you can supply. anon-3, hello, thank you for responding. She was a highly nervous cat around other people(rescued) and would have needed to be kept as calm drugwise as possible.She always open mouth breathed when travelling in the car as she was scared of going to the vets regardless. The way I see it, she was away from me (so terrified), her sight had suddenly faultered, she was in great pain and in a strange place without my care. If that wasn't enough, she had suffered further head trauma at the vets..........Its more than anyone could deal with surely. We always slept together and I imagine her coming round in those early hours and not being able to see or smell me or things that were familiar and it rips through me. She was the love of my life. 16600

Re: HEAD TRAUMA IN CATS Reply #15 by ex vet IP Address 82.12.243.128	Posted: August 20, 2006 at 13:03

Anon-3, if you read #12 again, I actually said that I accept animals should not be left on their own, but in this case there is no more medication that could have been given and had someone been in the building the result would have possibly been the same. Having been a partner in a practice and director of an emergency OOH clinic, I can state that the most limiting factor to the provision of full on 24hr care is lack of funds and the inabilty/unwillingness of people to pay for it. I can recall countless examples of giving people the option of 1) transfer to an OOH centre or 2) remain at the surgery despite being unmanned. Most choose the latter because of cost or take the animal home against veterinary advice. Unless the body was frozen immediately at the time, any post morten examination is likely to be inconclusive. The brain deteriorates very quickly after death. In any event, a diagnosis was not reached and is not in dispute because treatment was based upon presenting clinical signs 16602

Re: HEAD TRAUMA IN CATS Reply #16 by Yorkie IP Address 195.93.21.1	Posted: August 20, 2006 at 14:15

Jane, please accept my sincere condolences and I am sure that all those true animal lovers on here who have also experienced things such as this understand just what you are going through and how you feel. I am sick and tired of hearing excuses for bad veterinary care and for leaving animals alone overnight, as you say, she could have been with you and if there is no one there she may as well have been. This business of how long vets are on duty is no excuse, this profession should sort it out, as you say, money was not a problem in this case, is anyone had a dying animal they would pay whatever it takes I am sure, insurance or not. Your last line breaks my heart and I wish the vets could see that and understand the pain we go through and stop making excuses and try to improve things. 16607

Re: HEAD TRAUMA IN CATS Reply #17 by vet IP Address 82.153.143.88	Posted: August 20, 2006 at 16:30

Jane, Diazepam also goes under the trade name valium. Yorkie, yes, in an ideal world everyone would accept their responsibilities as owners and pay whatever it takes for constant 24 hour care. In reality the MAJORITY of pet owners in our area cannot or will not pay the initial out of hours consultation fee (under £100), let alone for further treatment. As a result operating dedicated out of hours service is not economically viable - the only alternative is for vets who have worked a day shift, and are likely to be working the following day, to tend to hospitalised patients to the best of their ability within the constraints of human fatigue. 16611

Re: HEAD TRAUMA IN CATS Reply #18 by Jane IP Address 80.3.160.13	Posted: August 20, 2006 at 17:54

Thank you 'vet' for clarifying that for me. Thank you Yorkie, I am glad that I am able to communicate with fellow animal lovers as it's a truly lonely place when you loose a companion, and you are shunned for your feelings of loss by people that consider a cat easily replaced. Animals are not just a commodity, and sickeningly though all the animal testing has gone on and goes on, they still can't expect the same services that a human life expects......what justice is there. Many thanks for your support. 16615

Re: HEAD TRAUMA IN CATS Reply #19 by Tracey IP Address 82.32.33.11	Posted: August 20, 2006 at 21:49

What is the point of leaving an animal at veterinary surgery overnight when nobody is looking after it.Not everyone is offered ooh So the vet works all day and then all night something wrong here. 16625

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