RE; Alfreds medical report

Could I please ask for some honest feedback on the medical report we have received from the vets in connection with Alfreds admission 2 weeks ago. I received teh report today in pdf format so I've had to snip it into screenshots - apologies, my IT skills are not that great.
I am looking for whatever it was I missed - but I'm not looking to aportion any blame. I cannot change the past nor what happened to Alfred but it haunts me as to why things changed so rapidly and why I lost him so quickly. I must have missed something so I would very much welcome anyones opinion on this.
I am grateful as always for everyones view
CRaig x
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Without commenting on the report, I just wanted to say that I think this is a very brave and positive action on your part.

A quick look through and the things that stood out to me:

Stressed / in pain? - breathing rate / heart rate high (but to be expected under the circumstances)
Seemed to be recovering overnight since 4am to 7am - passed caecos and poo, got fiesty, temperature - was low but returned to normal, abdomen became softer, etc.

BUT my areas of concern are:
Blood glucose initially v high at 28 - which indicates possible (risky) surgery required. Wasn't repeated after 11pm.
Blockage not ruled out but was syringe fed.
No urine output.
Pain relief? Can't see any listed...

There's quite a lot to take in. Someone like Jane would hopefully have a look through the report.

Don't forget - you did your absolute best for him. Rabbits can go downhill very quickly and there's not always an obvious reason - don't go blaming yourself. Remember the happy times you had and the joy he brought to you all.

I would also take the addresses off the pics of the report - yours is there as swell as the vet's.

My vets (rabbit savvy, protocols established by Frances Harcourt-Brown) are very quick to do x-ray and blood glucose tests. If they had received a rabbit in Alfred's condition they would have done both as routine ASAP. If the rabbit was so flat they probably would also run a blood screen. If the blood glucose reading of 15 - 20, they would repeat in an hour.

I share Shimmer's concern that when it was 28 it wasn't repeated. I can't understand why a rabbit with a blood glucose of 28 didn't have further investigations immediately to find out why. It would be a big red flag for blockage so x-ray would be the obvious... it could even be liver torsion so maybe ultrasound would be best for that but definitely blood screen to rule that out.

It's hard for you to read but I totally understand your need to make sense of it.

Agree with Shimmer and BB, a blood glucose of 28, hypothermia and tachypnea screams obstruction and IMUO should have been followed by abdominal radiography. Although I note the mention that Xrays might be required so I am assuming the Vet, in his/ her Professional opinion, felt that he/ she was able to ascertain enough information from just palpating and auscultation of the abdomen to make a judgement call regarding treatment. Personally I would have specifically requested Xrays, even if the Vet didn’t. BUT that is only because I have so much experience with caring for sick Rabbits. Sorry if that comes across as arrogant, not meant that way. NOR AM I IMPLYING YOU SHOULD HAVE BEEN MORE ASSERTIVE. Pet care givers should not be expected to have any in depth Veterinary knowledge. We pay a Professional for that and said Professional should provide an appropriate service.

If I have read the Treatment Summary correctly the lack of ANY analgesia is completely unacceptable and something I would have to take up with the Clinical Lead Vet at the Practice. There is NO reason why such a sick Rabbit who would be in very obvious pain should be denied analgesic cover

I have two words for it if it was what happened. CLINICAL NEGLIGENCE.

I would be embarking on the formal Complaints process. Not for ‘revenge’ but to address a serious failing in standards of care and to try to prevent the terrible error being repeated.

I understand that you might not feel able to go down that route though

I would certainly never use that Veterinary Practice again

Thank you everyone. It is hard to read the report - and I am sincerely grateful for your candid and honest opinions - especially Jane and Shimmer. I have just looked at the website of the practice and our trusted exotic vetinary specialist, someone who extensively supported and helped Lilllian with her urinary issues and who fought so hard to save Leo, is no longer at the practice. I was not aware of this. Had she still been at the practice, I am absolutely certain that Alfreds treatment and diagnosis would have been vastly different and would almost certainly be here today. There is a clinician director so I will contact them.
I will update everyone when I get some feedback from the practice.
Thank you for your expert views
Craig

Craig 1965 said:

Thank you everyone. It is hard to read the report - and I am sincerely grateful for your candid and honest opinions - especially Jane and Shimmer. I have just looked at the website of the practice and our trusted exotic vetinary specialist, someone who extensively supported and helped Lilllian with her urinary issues and who fought so hard to save Leo, is no longer at the practice. I was not aware of this. Had she still been at the practice, I am absolutely certain that Alfreds treatment and diagnosis would have been vastly different and would almost certainly be here today. There is a clinician director so I will contact them.
I will update everyone when I get some feedback from the practice.
Thank you for your expert views
Craig

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Thinking of you. I know I would hate to have to query the treatment of one of my rabbits, who had died, whilst at the same time knowing that I would have to.

InspectorMorse said:

Agree with Shimmer and BB, a blood glucose of 28, hypothermia and tachypnea screams obstruction and IMUO should have been followed by abdominal radiography. Although I note the mention that Xrays might be required so I am assuming the Vet, in his/ her Professional opinion, felt that he/ she was able to ascertain enough information from just palpating and auscultation of the abdomen to make a judgement call regarding treatment. Personally I would have specifically requested Xrays, even if the Vet didn’t. BUT that is only because I have so much experience with caring for sick Rabbits. Sorry if that comes across as arrogant, not meant that way. NOR AM I IMPLYING YOU SHOULD HAVE BEEN MORE ASSERTIVE. Pet care givers should not be expected to have any in depth Veterinary knowledge. We pay a Professional for that and said Professional should provide an appropriate service.

If I have read the Treatment Summary correctly the lack of ANY analgesia is completely unacceptable and something I would have to take up with the Clinical Lead Vet at the Practice. There is NO reason why such a sick Rabbit who would be in very obvious pain should be denied analgesic cover

I have two words for it if it was what happened. CLINICAL NEGLIGENCE.

I would be embarking on the formal Complaints process. Not for ‘revenge’ but to address a serious failing in standards of care and to try to prevent the terrible error being repeated.

I understand that you might not feel able to go down that route though

I would certainly never use that Veterinary Practice again

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I completely agree, I'd be furious with that treatment, I'm so sorry Craig xx

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There's no guarantee that anything we have suggested would have changed the outcome. The blood glucose level alone would have me extremely worried. Alfred was obviously very poorly.

If you feel up to it, it would be worth asking why there was no pain relief given, no blood glucose monitoring & query why no x-rays (they could argue that eg. sedation was contra-indicated). You don't need to make it personal - just ask about standard protocol, what it is, and if it was followed. It could be a letter, or contact the clinical manager / head vet.

RIP beautiful Alfred.

I don’t have any advice but you, as always, did your very best for him. None of this is your fault. Sending you hugs xx

Thank you all again. I know you have all identified this - but for me at this very moment in time, it is beyond heartbreaking and so tearful to do this. I know you understand how I feel. The guilt I feel and the conflict I feel now is really intense and I’m really starting to question my own purpose in the world now.
So, I’ve emailed the clinical director this morning on between the bouts of tears which I still have now writing this. I have asked the question without formally citing negligence. At this point, nothing can be amended from a full bodied claim of incompetence and nothing can bring back my beautiful Alfred. Nothing can change that, and it upsets me so so so much.
The report posted appears to be only from the out of hours vet service - NOT our usual practice. They operate from the same premises - one covers day, the other the night and weekend. So it may be the case that the day practice did administer pain meds. This doesn’t in any way defend them nor the decision not to xray but again I can’t change that. I have asked why an X-ray was not considered or more importantly undertaken. Alfred lost his life so quickly and in my heart I did wonder if some protocols were not followed. Also when we brought him home, if I had returned to the vet that night with him, I would be seeing the same out of hours vet practice and although this is purely an assumption, it could have been that Alfred may have passed during the night at the hospital on his own, afraid and possibly in pain. This compounds my deep sense of guilt and upsets me so very much now. It was my fault.
I’ll see what the clinician director comes back with. She can’t change what is. It’s not like taking a car back to the garage to be re-repaired after a bodge job. Alfred has gone from our lives and my heart is totally smashed to pieces now. Along with my toe as I walked into the bedroom door last night and my toe made an awful cracking noise and is now multi coloured and beyond painful.
Still, my tears are numbing the pain.
Thank you all again for your experienced views and honesty.
Craig x

I think you need your toe looking at. I would hope for an x-ray, but there's not much that happens with a standard broken toe. If it's not your big toe, you will probably just be shown how to strap it to the next toe with a bit of padding between. They are incredibly painful for about 3 weeks. Meanwhile, raise it and apply an ice pack, plus your preferred pain relief. I've done the same thing quite a few times - usually wrapping my little toe round some piece of furniture.

It sort of goes from bad to worse now with the vets. I’ve just had a reply - the clinical director is off on maternity leave. The exotic specialist that we have had wonderful treatment from has also left - which is a great great loss - I did not know she had left.
There is an acting clinical director whom we have seen many times over the years and she is very good and thorough and I certainly trust her to be candid and professional. I will await her reply and update the thread. But it’s already quite clear that the localised expertise at the practice has gone and I am quite disappointed and shocked at that.
Craig.

Reply from the vets - the clinical director (acting) is extremely busy - which is very understandable as the last thing they really need is a complaint about professional treatment. But I am assured that the clinical director will get back to me within 7 days.
Craigx
Ps - re my toe. I know I should go to a&e but I don’t have 14 hours spare just to see a triage nurse look at it and tell me that there’s nothing they can do and that my strapping is exactly what they would do. I’ve lost all confidence in hospitals and to some extent medical services.

I'm sorry I blamed myself for loosing Jasmine, if I'd have asked exactly what medication she'd been given we may have found out that a toxic drug (antirobe) had been given and she would have got emergency treatment then and possibly had a chance of survival. However a year later I realise this was not my fault, the vet practice was negligent (I work in a vets so would never call a practice negligent that wasn't and many of my close friends are vets). It was entirely the vets fault who administered the drug, without my consent and without informing me. She was pretty much dead as soon as that happened. Mistakes, accidents, errors of judgement etc do happen but how the vet/practice deals with it makes all the difference. I hope you get some answers and please know this is not your fault. Sorry a quick reply I'm about to go for a swim.

Craig I just wanted to say, I'm so sorry that you find yourself in this awful position, but can so understand that you need answers. Just sending a big hug, and letting you know that you, Jan and Flo are in my thoughts xxx

So difficult for you... I've had some similar experiences in the past and, me being me, I've just moved vets rather than confront anyone. But I can totally understand and respect anyone who does.

With your toe, is it the big toe or one of the others? If it's one of the others, I think they just advise strapping it to the one next to it anyway, which you've probably already done.

SarahP said:

So difficult for you... I've had some similar experiences in the past and, me being me, I've just moved vets rather than confront anyone. But I can totally understand and respect anyone who does.

With your toe, is it the big toe or one of the others? If it's one of the others, I think they just advise strapping it to the one next to it anyway, which you've probably already done.

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Thanks Sarah - it's the third toe - which oddly enough sticks out more than the others. I forgot that I had put something behind the bedroom door to stop it blowing open last week as we had windows open upstairs due to the heat. I opened the door, it jammed and I carried on walking. My toe crumpled - quickly followed by me and a muffled development of tourettes. Oooh it throbbed. And I know it broke. There's not many colours it isnt and having had more than my share of sports injuries inmy football days (I was at hospital most weeks), I know the standard procedure is to strap the toe up to an adjacent toe and just let nature do what nature does.
Regarding Alfred and my complaint - I am very much like you. My default is to just pack and go. I hate confrontation - it is for me the last resort. It takes a great deal to grind my gears. And it's even harder when I am deeply deeply upset and grieving and full of guilt. But, for Alfreds memory, this is something I am compelled to do, and it is daunting to level critisism at professionals. One can only do this if one has the confidence of the facts being presented because it is very hard to then argue against them.
Thank you for your kind words and support.
Craig

Craig 1965 said:

Thanks Sarah - it's the third toe - which oddly enough sticks out more than the others. I forgot that I had put something behind the bedroom door to stop it blowing open last week as we had windows open upstairs due to the heat. I opened the door, it jammed and I carried on walking. My toe crumpled - quickly followed by me and a muffled development of tourettes. Oooh it throbbed. And I know it broke. There's not many colours it isnt and having had more than my share of sports injuries inmy football days (I was at hospital most weeks), I know the standard procedure is to strap the toe up to an adjacent toe and just let nature do what nature does.
Regarding Alfred and my complaint - I am very much like you. My default is to just pack and go. I hate confrontation - it is for me the last resort. It takes a great deal to grind my gears. And it's even harder when I am deeply deeply upset and grieving and full of guilt. But, for Alfreds memory, this is something I am compelled to do, and it is daunting to level critisism at professionals. One can only do this if one has the confidence of the facts being presented because it is very hard to then argue against them.
Thank you for your kind words and support.
Craig

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I'd struggle to do this too Craig, I hate confrontation too. It is the right thing to do & you have my utmost respect & admiration for doing it. As you say alfred deserves it & hopefully the practice will learn, reflect & change practice