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RE; Alfreds medical report

Update from the vets. I received a holding email from the acting clinical director. She is a sincere and genuine person and I trust her very much. She will be speaking with the vet who oversaw Alfreds care during the day at the hospital. I have a report from the day vets which I will probably post tomorrow as I don't have time tonight and I haven't looked at it in any detail. I am still very very raw and still deeply upset.
The acting clinical director is a very comprehensive lady - someone we have known for a long time and she knows acutely well just how much our rabbits mean to us. I do not doubt for one minute that she would not do a thorough and detailed investigation. And, when I feel up to it, I will discuss in person with her. I just deeply wish that things could be reversed but I know they cannot. And this is the conflict within me. I am a complex person emotionally - this is extremely hard for me to deal with.
But I am grateful for your support and your honest opinions.
Craig x
 
Update from the clinical director (acting) on Alfred. It paints a slightly different picture to that from the out of hours vets. It upsets me reading it because, and this is always the danger when one asks for someone to investigate, I still have no real answers and what upsets me even more about Alfreds passing is that it now makes even less sense that it did 3 weeks ago.The assessment that the day time vets gave (and I have absolutely no reason to doubt this) is that Alfred was very much on the up and improving. So I cannot now understand why and how he deteriorated so quickly on coming home. I missed something - I know I did but I do not know what.
Here is what the clinical director has said

"I have taken some time to review Alfred's clinical notes and I have had a chat with L. L took over Alfred's care on the morning of 8th July and received the hand over from Vets Now. She has offered to speak with you directly if you feel like this email doesn't suffice in providing you closure.
With regards to your question about whether Alfred should have received analgesia - you are correct in saying that in most instances, a rabbit with suspected gut stasis, would normally receive pain relief. The vet on shift that night explained to L that none was given because they were concerned about shock. This was not a concern when L examined him that following morning hence why she gave him some Metacam, to which he became much brighter after. I am not sure as to why Vets Now did not radiograph his abdomen - but perhaps again, they were worried about shock and wanted to ensure he was stable first. At handover, the vet for Vets Now informed L that Alfred's stomach was rock solid and extremely distended when admitted to the hospital, but with time, had considerably improved. Certainly by the time L examined him, it was soft on palpation and had reduced in size. Throughout the day, it reduced further to a normal size and Alfred was passing faeces, eating without assistance etc., hence why L deemed it suitable for him to come home to you.
I can see from his notes that he had a history of eating cardboard, newspaper and bedding which potentially caused a blockage. Despite him seemingly returning to normal, it is possible that sadly he re-blocked again whilst at home.
I appreciate that I have not been able to provide you with any definitive answers as such. I could put you in touch with a Vets Now representative who would be able to put your questions to the vet who was working that night. Furthermore, if you would like a phone call from L, I can certainly arrange this.
Again, I am incredibly sorry for your loss. I completely understand how much love, time and attention you put into your foster rabbits - always doing your very best by them. It is heart-breaking that you have had to go through this again.
Please let me know if you think I can help further in any way"

Thank you all so much again for following Alfreds journey with us
Craig x
 
It appears that her review has covered only the period of Alfred's care after he was handed over on the morning of 8th July. Anything relating to his treatment at the OOH vets has been reviewed only by referring to information given at handover. Yet it is mostly surely the treatment at the OOH vets, that you have queried?

I do not consider this a thorough review.
 
I agree with Omi. In addition, one thing I would want to know is whether they checked Alfred's BG again before he was discharged. I remember when Fudgie was admitted to hospital last year she had a BG reading of 18. They repeatedly tested it and wouldn't discharge her until it came down to within the normal range. The reason I'm mentioning it is that there seems to be a strong implication in their response that they had "fixed" Alfred, but that he had then made himself unwell again when he was back home by eating more cardboard, or similar. However, if they hadn't run more BG tests or taken X-rays then they don't know for certain the issue had been resolved before they sent him home.
 
It's a very nice, personal, sympathetic response - but it doesn't address the main issues of whether protocols were followed, especially regarding blood glucose monitoring and x-rays to determine if there was a blockage (as would be indicated by several factors). A single BG of 28 should have put hourly(?) BG monitoring in place as it's a very high result with major implications. It all needs to be less personal now, and concentrate on this not happening again with another rabbit. It doesn't mean that the outcome would necessarily have been any different for Alfred, but it doesn't give confidence in the service provided when you (ie the vets) don't have the full background information to act on.

So sorry it is still a messy situation that you are trying to deal with.
 
100% agree with Omi, Scrappy and Shimmer. I would not find the explanation acceptable, however kindly the message was delivered. If you feel able to pursue the matter further I would do so. But I accept that some people would not feel up to any more stress.

I stand by my opinion that a degree of clinical negligence occurred. Whilst Alfred might still not have survived had the appropriate diagnostics, monitoring and treatment been given he would at least have had a chance. If I have understood the situation correctly the care he received offered him little if any chance at all.

The lack of analgesic cover remains unforgivable. Pain from an obstruction can send a Rabbit into systemic shock. IMUO not giving pain relief to Alfred was far more of a risk to him than giving it would have been.

I completely understand if you do not feel able to take things any further. But if you do not do so then I really, really would advise you to source a different provider of Veterinary care. I believe Sky-O kindly offered to chat with you about that as she is located relatively near you. Perhaps you could drop her a PM. I am not sure if she accepts PMs on here, so if you have any issues PM me ( I will change my settings now so you can do so) and I will contact Sky-O via FB
 
I agree with everything the others have said. The reason for not x-raying him baffles me. They were concerned about shock.. They desperately needed to know why he was so poorly and an x-ray could have answered it. I don't understand the excuse often given that basically says too poorly to x-ray. I don't know if using sedation is the reason it is considered risky but abdominal x-rays can be obtained without using sedation. I don't know enough about the play off between analgesia and state of shock but logic, for me, suggests that addressing the pain would reduce the shock - I would want and explanation to understand this better.

It's a kind letter and they have responded swiftly but I do find the line about cardboard rather defensive.. like they mended him, he went home and you let him eat cardboard - I am sure you watched him super closely and would not have let that happen. As Jane said at the time, I wonder if something was moving through his digestive system and got blocked for a second time, having moved from the first blockage? I don't know the timescales of a rabbit's digestive system well enough to know if this is a possibility but for me, there is a strong suspension that it's the same item causing a second blockage, not something new.


I hope you find some answers from this process and not just more, distressing questions.
 
Thank you again everyone.
In answer to the cardboard question - yes I watched him very closely and he had no access to cardboard or newspaper. I tried giving him critical care that evening to try to help but he was not really having it. Alfreds deterioration so quickly upsets me deeply. And it’s made worse by the fact he seemed to be showing all signs of progress.
I need time to process all this. It is incredibly difficult to have to believe in yourself to question people whom you trust and yet also feel that there was something that has been overlooked or missed. As I said previous, it’s not as tho I can take Alfred back and they can undo the problems because Alfred has gone and it is just so incredibly painful and hard because I carry a huge burden of guilt and “what ifs”. Something went very wrong from him being discharged to passing in my arms and I just don’t understand.
I will send a holding email to the clinical director and try to compose a further email over the weekend.
Thank you all again. And I wish my years would stop.
Craig
 
Craig, re-read your report to us when you brought Alfred home. It did not sound as though he was OK when he came home. He was very lethargic and not wanting to eat.
 
Craig, re-read your report to us when you brought Alfred home. It did not sound as though he was OK when he came home. He was very lethargic and not wanting to eat.
Yea I was thinking this too :(

I don't like the explanations in her email either :/ they don't actually make sense..

You need to find proper exotic pet care for Flo asap in my opinion x

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Craig, one thing that is concerning me is that the response you received from the clinic has started to cement in your mind the idea that something must have happened between Alfred's discharge and his passing and that you're therefore blame. Please, please take on board what we're all saying in this thread. We're pretty much in unanimous agreement that they discharged him prematurely without carrying out the proper diagnostics. The lack of prescribed pain relief is also a huge red flag with regards to the quality of his care. Sadly I know from experience that it can be a battle to get some vets to prescribe adequate pain relief.
 
Craig, one thing that is concerning me is that the response you received from the clinic has started to cement in your mind the idea that something must have happened between Alfred's discharge and his passing and that you're therefore blame. Please, please take on board what we're all saying in this thread. We're pretty much in unanimous agreement that they discharged him prematurely without carrying out the proper diagnostics. The lack of prescribed pain relief is also a huge red flag with regards to the quality of his care. Sadly I know from experience that it can be a battle to get some vets to prescribe adequate pain relief.
100% this! x

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Thanks everyone. I know what you are saying because you are all much greater experienced than I am.
Between the bouts of tears (now as it happens) I’m trying to just rationalise.
If it helps you all to understand me better, my default option on anything is to absorb blame. I’ve always been like that but things got worse for me when I had my breakdown 6 years ago and was sadly suicidal due to being bullied at work. I wasn’t on the forum then so most of you didn’t or wouldn’t know. At that point in my life, I broke inside. Very badly and so what I used to be able to cope with and rationalise, I can’t anymore. For me, assuming guilt is my way of shouldering a failing be that me or someone else’s. I wish I could fix that but I’ve not found a strategy in 6 years.
This is why I’m fragile and the irony is that my rabbits were the only part of my life that brought me back from the abyss. It is a very very lonely place when you reach the bottom and whilst my family did what they could to help me, I found solstice one the 2 rabbits I had at that time - Ben and Georgina. Since their passing, each loss has felt a greater pain to me and my mind tells me to accept the blame for not saving them.
I am so grateful that you are all so genuine and supportive and I do know what your saying.
Sorry - just need to go and grab my tissues now.
Craig xx
 
You don't have to follow anything up with the vets if you don't feel able to. You can pick it up later or just park it. The vets are aware of the issues now because you have expressed your concerns - hopefully they will act on it internally. It's very early days after losing Alfred and you need time to grieve, so put yourself first.
 
Update. I just happened to bump into the acting clinical director yesterday in our local supermarket. It was not the place to have an open discussion about the case to be fair, but I did glean the information about the lack of an exotic specialist. The vet who was the centres exotic specialist left to join vets now and she is now based in a different county. She now only covers the occasional emergency OOH cover - which we could have done with when Alfred was admitted. The vets now no longer have an exotic specialist and I did ask if they knew of a vetinary practice that did - which I didn't really feel comfortable doing but felt I had to ask. And she replied that there are no local vets to us with an exotic specialist. The nearest in our county is about 1 and a quarter hours away from us. This is a vet that has diversified into exotic specialism. And whilst I am happy to shift vets, if I find myself in a situation where I need emergency treatment, an hour plus drive and the problems that might bring with any delays and comfort, might be too much for my rabbits.
It was extremely difficult to have even an informal chat with the clinical director - one would normally be making light conversation. For me, this is all incredibly difficult.
I will draft an email to the vet later and see what I get back.
CRaig
 
The whole OOH scenario is a total nightmare. The best option is if you can get two vet practices that work with you and know you are registered with the other practice and both are happy to see your rabbits.

When my parents needed close care my rabbit vet 45 minutes away was too far for leaving the oldies unattended so I used my local vets, 5 minutes away. Both practices were okay with the arrangement.

My rabbit vets used to do their own OOH cover three evening and weekends but if your rabbit got sick on Tuesday or Thursday evening it was difficult to know how to play it as other practices would most likely turn you away. Those two evenings were supposed to be covered by Shamrock in Harrogate but if I told them I was travelling from 45 minutes away they would immediately say there were not rabbit specialists and dissuade me from going. All their OOH cover is now with a big practice 30 miles away and probably about 1 hour 20 minutes - same issue you have, that is not an ideal journey to take a sick rabbit.

Trouble is, of course, even if the practice does have an exotics vet it doesn't mean the OOH vet will have a clue about rabbits as Esupi found out about 10 years ago when one of her rabbits had poor treatment at a vet practice that should have been good with rabbits.

It it a bit of a lottery and that is terrifying when you have just gone through what you have with Alfred.
 
My vets are a bit of a drive can take well over an hour in busy times of day too, which isn't ideal, I was living 5 mins from them til recently. But I've lived this distance from them before and it's been okay tbh, getting the right care in a bit of extra time definitely works better than immediate care by people who have no idea ime x

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