There’s no end to the havoc one’s own body can potentially wreak. Autoimmune disease (where the body’s immune system attacks itself) is one example. Colic in horses, where intestines slither and twist into unnaturally painful contortions, is another.
I mention colic because today’s disaster case was kind of like the dog’s version of colic. I guess you could also call GDV (AKA, “bloat” where the stomach fills with gas and twists on its own ligamentous axis) colic-like, but it’s not really about the intestines, as in today’s adventure.
Enough lead in. Today’s patient is a four month-old yellow Lab pup. He and his fellow pups had somehow unearthed and devoured a forty-pound bag of their parents’ food. After about a week, they’d all recovered from their obligatory cases of overindulgence-inspired diarrhea –except for this pup. His had just gotten worse. And now he was vomiting, too.
Simple palpation of his abdomen revealed the problem immediately: intussusception.
His parents had never heard the word, but anyone with experience in major intestinal disturbances might. It’s when one part of the intestine “telescopes” on itself. I like to picture it as one bit of bowel devouring the one that came before it. Here’s a pic of its human version:

Once you can see that in your mind’s eye it makes you wonder how it doesn’t happen more often. Seems like a stupid loop of intestine wouldn’t ordinarily know how to keep itself out of that kind of trouble (especially when stressed by something as inadvisable as the consumption of a whole bag of dog food).
Dogs, horses and goats are the only species I know of who can easily kill themselves in a single act of dietary overconsumption. Humans come darn close, but it usually takes some extra work—or some serious stupidity.
Dogs, by their very nature, are prone to gorging. When they do so, their bowels go into overdrive, working hard to move everything along as best they can. Sometimes the bowels get tired and quit. That’s when we see nasty intestinal slow-downs that lead to vomiting and stinky, slurrried stools. Sometimes the bowels just get overactive in spots, sort of like they’re compensating for their lax counterparts. And that’s when it happens.
It happens with viruses (like parvo), bacterial infections (like salmonella), worms, but most commonly with garden-variety dietary indiscretion, as with this pup. Serious diarrhea is how it starts, usually. And serious vomiting is most commonly how it ends.
In this case, the ileum (the last section of small intestine), was swallowed whole by the adjacent large intestine. Unfortunately, it’s the most common spot for such a travesty. Surgery is the only reasonable option for this disease (as in all intussusceptions). Without it, the ingested loop of intestine dies and the whole bunch of tissue encasing it falls apart like a rancid sausage—not something you want inside your pet’s body.
Problem is, surgery usually means cutting out the affected bits—in this case, a crucial bit of small intestine and a significant bit of the large intestine.
If only I could’ve punted this one to a surgeon—this is a nightmare surgery! But somehow, puppy and kitten cases always get fewer funds allocated to their survival. Here’s one example where the human paradigm doesn’t hold true: While old guys get the benefit of all the years of adoration, babies suffer the misfortune of a proportionate lack of history. Few owners are willing to blow their load on the unknown, it would seem.
That may sound coarse. But it’s the truth. Not always, but this case was no exception. “Do it for under a thousand or euthanize him, Doc.”
What heartless person would stop halfway knowing their work was destined to end in euthanasia unless he stopped cutting mid-surgery? So we finished it, three hours later, for $1,000 in three payments. Don’t seem fair for all the work, stress, materials, drugs, days of hospitalization and staff time—but there you have it.
If this post seems half-a$$ed and whiny, it’s only because I’m tired. All because one pup couldn’t keep his head out of an endless bag of chow. Or is it because one owner couldn’t keep his pups out of it? To be fair, it’s more likely on me. If we weren’t willing to do the work, maybe fewer people would undertake to consider a surgical outcome for a truly nasty disease like this. Knowing we can fix it, though, makes all the difference—to us anyway.
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I don't see it as whining, more like venting. This guy has a roly-poly, melt-your-heart-pup that he (or she) has allowed to get into something, and holds YOU accountable for it? "Fix him for MY price or kill him"???? That aload of cr@p to dump on you Dr. Patty. This is not the wild west! I'm sorry that people continually take advantage of your compassion.
You can't win in these situations. I mean, you lay down the law on surgerys costs/fees and you are heartless. You do the compassionate thing to save the pup and you lose income. Clearly you made the choice that helps you sleep well at night, but still............
Thank you for saving that pup's new little life.
Amy in Somerville January 16th, 2008 08:54:00 AM
I don't know how he said it but it seems to me like a version of the decision owners makes every day, pay X amount or euthanise. If it can't be done for a price the ownder can or chooses to afford than somebody had to make the decision and he was providing his upper limit.
emily January 16th, 2008 09:12:00 AM
Yeah, that's a tough call. On the one hand, you shouldn't be a pet owner if you can't afford their medical care when necessary, but on the other, if we all forego owning pets because their care has the potential to exceed our budgets, there would be a lot less pet owners and a lot more homeless animals. I hope that I never have to make the choice between my budget and my babies. That's kind of the risk you take when you own animals - you hope they'll have long, healthy lives, but if they don't, there's going to be a difficult decision on your hands.
Thanks for fixin' the pup, though. You did good!
Shasta January 16th, 2008 09:45:00 AM
I agree, it would be a horrible decision to make (my worst fear, in fact)......but I would take responsibility for it. I would not 'bargain' a price limit for the surgery and put it out there to see if the Vet will accept it. I just find that is placing the responsibility for the life or death decision with the Vet and not me, and my animals are my responsibility. I also think that is exactly the type of situation that burns Vets out (among others).
Dr. Patty, if this person had a littler of pups - was he/she a breeder?
Amy in Somerville January 16th, 2008 10:08:00 AM
I gotta say, though, $1,000 is a lot of money for some people. And I get that. It's just that *I* don't feel comfortable saying no when things like this happen. I have to take some responsibility for that, too.
Dr. Patty Khuly January 16th, 2008 11:03:00 AM
Amy: The obligtory Christmas pup litter from a backyard breeder. What else?
Dr. Patty Khuly January 16th, 2008 11:04:00 AM
BYB, figures. *sigh*
Amy in Somerville January 16th, 2008 02:23:00 PM
I hate how some owners manage to phrase things in a way that shifts the blame to the veterinarian/staff - I'm not sure if they realize how hurtful it is to hear someone say, "fix him for $1000 or less or you'll have to put him down". The proper response when faced w/a procedure that you can't afford (which the staff DOES understand - we're human, too) is, "I can't afford that - if there are no other treatment options, then I have to decide to euthanize". One of the vets I work for prefaces many of those discussions with "I understand if your resources are limited and I will work w/you to determine which treatments will give the most benefit to your pet so that you can best allocate your resources, but ultimate treatment choices are yours, not mine". In doing so, she acknowledges that clients have financial limits but emphasizes that the hard choices are their responsibility, not hers. Tactfully done, it seems to help shift the focus off of our prices and back to doing what's best for the animal.
anna January 16th, 2008 03:39:00 PM
Anna - I'm not sure that I as a consumer would know how to phrase my financial limits appropriately. It seems like the discussions on urgent and unexpected veterinary care are usually phrased as this needs to be done or your animal will either die (often painfully) or be in severe, likely permanent, pain. As a result, this tends to make me think in terms of either being able to do this or removing the pain via euthanasia. I've learned that there are often other options and it's worth asking about, but I'm not necessarily at my most thoughtful and rational at the emergency clinic. And in my experience, sometimes the "cheaper" options are better for your situation for reasons other finances. My vet is very good at suggesting conservative and less expensive treatments when they might be a better fit for my animals, but her partners and the emergency clinic are not as good at this. (Some of this tends to be years in practice, the more years in practice, the more good results your vet has seen from some of the older and more conservative treatments.)
Juli January 16th, 2008 10:44:00 PM
It must also be noted that pet care can exceed *any* budget these days. Each person needs to know their limit--preferably having thought it through before the emergency situation arises. Otherwise emotions will get involved on all sides.
emily January 17th, 2008 04:29:00 PM
I am curious if anyone has experience with pet insurance? I checked out petinsurancereview.com and end up with Petplan US, gopetplan.com It is most like my own major medical insurance, with no sublimits. Many plans have odd limitations. I was able to insure my one year old with a $20,000 annual limit for $187, with $200 deductible and no copay.
I am not trying to publicize Petplan, I was just surprised at the limitations all the other plans had, and was happy to find one that made sense to me. Any negative comments about them would be appreciated, because I would like to find out if I made a mistake. I avoided pet insurance in the past, but I have three dogs now.
Erich Riesenberg January 18th, 2008 07:59:00 AM
Erich. I hadn't heard of them. Sounds like a deal, though. Accident only or illness, too? Does it carry over from one year to the next with chronic conditions? I'm meeting with some pet insurance companies this weekend (I'm at a conference right now) so I'll be sure to ask about this plan.
Dr. Patty Khuly January 19th, 2008 06:10:00 PM
I looked at all the plans from petinsurancereview.com and perhaps some others, and Petplan is the only one that had a single coverage limit which carries through the life of the policy. For instance, with $20,000 coverage, my understanding is it will cover that much annually for any illness or injury which was not excluded as pre-existing when the policy was first bought.
Other plans have limits for specific incidences, such as $10,000 per year but $2,500 for a specific incidence. Some plans also have lower limits or no coverage for chronic conditions for periods subsequent to the period in which the condition was first discovered.
Petplan is the only one I found that works most like my own major medical. It is a new company, but somehow affiliated with Petplan UK which is highly reputable.
Your Wharton connections may come in handy in finding out more about the company. ;-)
http://bpc.wharton.upenn.edu/pastwinners/2003.html...
Erich Riesenberg January 20th, 2008 08:22:00 AM
I got Pet Plan US policy papers today, and, surprise, there is a 30% coinsurance for specialized treatment such as referral care, care from a vet school, and so on; basically things not handled by the primary vet.
To find out about the 30% coinsurance, you have to go to this page and click on the "coinsurance" link. http://gopetplan.com/DogPlans/GoldSilverBronze.htm...
I think it is hidden and thus misleading.
I want to be able to cover a $15,000 cancer claim, for example. Good luck to anyone looking for quality pet insurance.
Erich Riesenberg January 22nd, 2008 12:18:00 PM
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