Friday, May 16, 2008

Longview Texas Vet Janice Petree Fails to Diagnose or Treat Bloat in Spite of Being Told That Owner and ER Vet Suspected Bloat

Molli was a Boxer. Deep chested dogs like Molli are at highest risk for BLOAT -- a life-threatening, emergency medical problem. Also, bloat, otherwise known as GDV, is cited (link below) as the SECOND leading cause of death among dogs, second only to cancer.

The Veterinary Information Network (VIN) states that aggressive and early treatment of bloat is very important, and that with this early and aggressive treatment, 80% of dogs now survive the medical emergency that bloat presents. (Another veterinary website estimates that the survival rate is 90% with appropriate, aggressive and early surgery). Moreover, VIN says: "earlier the veterinarian gets started with treatment, the better chance there is for survival."

So, although bloat is very life-threatening, it is also common, and it is also easy to diagnose: a simple x-ray will help diagnose bloat.

It is very hard to imagine that a veterinarian, presented with a dog like Molli -- a deep chested breed prone to bloat -- who is showing the "hallmark" symptom of trying to vomit but being unable to vomit, and who has been tentatively diagnosed as likely suffering from bloat based on a phone consultation with an EMERGENCY vet -- would apparently set aside that possibility, and fail to do x-rays, and send the dog home with the owner with medicine for the much less serious problem of "gastritis" -- but that is exactly what Texas vet Janice Petree did, according to Texas Vet Board documents.

Here is the story this document tells:

"[Molly's owner] noticed a slight swelling in [her] abdomen . . . The dog seemed to want to vomit but produced no vomitis. The swelling increased. [Molli's owner] contacted the Animal Emergency Clinic in Shreveport [Louisiana]. Consulting by phone, the veterinarian at the clinic said that the dog likely had "flipped stomach" (gastric dilatation and volvulus or GDV). The veterinarian could not immediately see the dog ad referred [Molli's owner] to the East Texas Pet Emergency Clinic (ETPEC) in Longview, Texas. About an hour later, [Molli's owner] and "Molli" arrived at the ETPEC where the dog was examined by Janice Petree, D.V.M.

After examining the dog, Dr. Petree opined that "Molli" did not have GDV, but was suffereing from gastritis. [Molli's owner] questioned Dr. Petree about her diagnosis in light of the dog's symptoms, but Dr. Petree was firm that the problem was gastritis since the dog was not showing all the expected symptoms of GDV. Dr. Petree administered an injectio of Centreme and some Centrene tablets to take home. Dr. Petree said she could take x-rays, but reportedly said they were unnecessary and she would not take x-rays of her own dog under comparable conditions. [Molli's owner] took his dog home."

"Shortly after arriving home, [Molli's owner] noticed that the abdominal swelling had increased and 'Molli' appeared to be more uncomfortable. He rushed the dog to the Shreveport emergency clinic aroudn 3:30 a.m. Dr. Renee Jones observed that hte dog was shocky and lethargic. Her cranial abdomen was extremely extended and she was having difficulty breathing. Dr. Jones . . . took x-rays which clearly showed [Molli] had GDV. [Molli] underwent emergency surgery but her condition declined and she died at around 6:48 a.m."

"Dr. Petree's failure to x-ray and correctly diagnose and treat [Molli] does not represent the same degree of humane care, skill, and diligence in treating patients as is ordinarily used in the same or similar circumstances by average members of the veterinary medical profession . . . for the following reasons:

The Shreveport veterinarian had already suggested possible GDV to the client and the client, who had observed bloating and non-productive vomiting, had traveled a considerable distance for treatment. Although the client on several occastions expressed concern about possible GDV, Dr. Petree assured [him] that gastritis was the problem. An x-ray and bloodwork would have conclusively settled the matter . . .

Large, deep-chested breeds are most commonly affected . . . The client had described the acute onset of bloating and non-productive vomiting. These factors mandated an x-ray and foundational blood work to rule out GDV.

Although x-rays were discussed . . . Dr. Petree actually discouraged them. The medical history for [Molli] says 'I did tell the husband that if it were my dog, I would not do radiographs at this time and would see if medications started to help.' . . .

[Editorial comment: OK, Dr. Petree, THEN YOUR DOG WOULD DIE OF BLOAT.]

. . . "The client apparently relied on this statement in declining x-rays."

[Editorial comment: It doesn't sound like Molli's owner declined the x-rays, it sounds like Petree declined to do them!]

" . . . waiting and monitoring as recommended by Dr. Petree could have delayed needed treatment . . ."

[COULD HAVE????? Ya gotta love how these vet boards word things.]

So, does it sound to you like Dr. Petree is likely responsible for Molli's death? Now, I am not making this statement as a matter of fact, but as a matter of opinion: I believe that Molli had a better than 80% chance of surviving this emergency when she arrived at the East Texas Pet Emergency Clinic. And I believe that Dr. Petree's arrogant failure to heed the preliminary diagnosis of her colleague, to heed the concerns of Molli's owner, and to treat Molli's condition as potentially imminently life-threatening -- her failure to even investigate Molly's condition when both the owner AND another vet were mentioning bloat as a likely or possible cause of her symptoms -- TOOK AWAY MOLLI'S best chance to survive this emergency. The literature I have found says that survival rates are reduced from 80-90% to 50% or less. If I were Molli's owner, I would definitely hold Petree responsible for her death.

Moreover, Petree's failure to approach Molli's situation as urgent, requiring immediate definitive diagnosis (x-rays, etc) and surgery, IS PARTICULARLY REPUGNANT in an EMERGENCY VET.

Why is the management of the East Texas Pet Emergency Clinic NOT making sure that its veterinarian's are well-educated in the apparently COMMON medical emergency that is BLOAT -- an emergency that if treated competently and quickly, is survivable 80-90% of the time, but if NOT treated competencly and quickly, will result in death?

Another veterinary hospital provides this explanation of what happens when bloat is not rapidly treated:

"Progression of Events

The first major life-threatening event that occurs is shock. This occurs because the distended stomach puts pressure on the large veins in the abdomen that carry blood back to the heart. The tissues (including the stomach wall) become deprived of blood and oxygen. If the blood supply is not restored quickly, the wall of the stomach begins to die and may rupture. If volvulus occurs, the spleen's blood supply will also be impaired. When the stomach twists, the spleen is also rotated to an abnormal position and its vessels are compressed. When the stomach is distended, digestion stops. This results in the accumulation of toxins that are normally removed from the intestinal tract. These toxins activate several chemicals which cause inflammation. This causes problems with the blood clotting factors so that inappropriate clotting occurs withinblood vessels. This is called disseminated intravascular coagulation (DIC) and is usually fatal."

On the Marvistavet website, a study of bloat is provided. This study included an evaluation of circumstances that lead to higher rates of death associated with bloat. One of those included: clinical signs of bloating for more than 6 hours before seeing the vet."

Let's do the countdown: By the time Molli's owner called the first emergency vet, she was already showing the symptoms of abdominal swelling and vomiting with nothing coming up. Then her owner called the Animal Emergency Clinic where a vet told him Molli likely had bloat. Since that vet could not see Molli in a timely enough fashion, Mollis owner drove "a considerable distance" to see Petree, and an hour elapsed betwee the referral and the time he arrived to see Petree. Presumably, by this time, Molli has been showing symptoms for at least a couple of hours.

The document doesn't say how long Molli and her owner were at the East Texas Pet Emergency Clinic, but let's assume it is 1 hour. Then, when Petree sent him home with medicine -- having taken NO x-rays, NO bloodwork, and NOT treating Molly for bloat -- he would have had to drive another hour home. Now we are up to 4 hours. Then there was time for Molli's owner to continue to observe her (getting worse) at home. Let's say that's another hour. We are up to 5. Then, he rushed her to the Shreveport ER, where she was finally seen and treated for what she had been suffering from all along -- BLOAT. By that time, it was probably about 6 hours. At least.

Seeing Petree was, as far as I can see, the same as not seeing a vet at all.

For this serious violation of the veterinary practice act, what did the Texas Veterinary Board do?

They reprimanded Dr. Petree.

And made her take some classes -- 6 hours worth, by the end of the year.

That's it. That's all. No fine. No suspension. Nothing sufficient, in my view, to really drum into this woman's head that Molli's situation DESERVED to be taken seriously. She as an ER vet had no business minimizing in her mind the potential of bloat in a susceptible breed with "hallmark" symptoms. She either knew, or SHOULD HAVE KNOWN, that bloat must be treated immediately to give the dog a good chance at survival.

Sadly and shockingly, as common and serious as bloat is, it seems that Dr. Petree is not alone in her failure to adequately diagnose and treat bloat.

"Dog Connections" published "Bloat Notes" -- a letter from the Director of the Purdue Bloat Research Program, in which Larry Glickman, VMD, said:

"Too often, however, owners of dogs that died of bloat tell me that they had recognized that the dog had a serious problem and rushed the dog to a veterinarian, only to be told that it was probably only a "belly ache," or that the dog's stomach was dilated, but not rotated . . . If you suspect your dog has bloat, but the veterinarian dismisses it as a minor problem, inquire about radiographs to rule out GDV."

Well, Molli's owner apparently did exactly that: Inquired about x-rays to rule out GDV, and Petree "discouraged them." When Molli finally got those x-rays, they "clearly showed [that she had] GDV."

Glickman recounts this story:

"Following is an excerpt of a letter that illustrates some of these points.

'I noticed Kelly [an Irish Setter] attempting to vomit with nothing coming up . . .We went home and Kelly went upstairs where she attempted to vomit several times. I immediately called my vet. Kelly and I arrived at the veterinarian's office within five minutes of the phone call. I told the veterinarian that Kelly had vomited two or three times with nothing coming up. I said that she looked a little broad around the ribs. The veterinarian did a physical examination and concluded that Kelly's problem was just a "stomach ache." ... I was directed to give her Pepto Bismol®. I took Kelly home and she lay down on the bed. About 45 minutes later she went out to the back yard. When I went out 10 minutes later, I found her bloated up. I grabbed her, took her back to the veterinary hospital, but she died on the operating table.'"

Glickman stresses the importance of taking a dog suspected of having bloat to an emergency clinic equipped to do the type of surgeries bloat requires, on an emergency basis. Presumably, East Texas Pet Emergency Clinic should have been one of those places. In my viewpoint, this is what makes the story of Molli even more maddening. The owner did everything right.


Texas Vet Board Document/Findings of Fact on Janice Petree

Dog Connections and Glickman's Notes on Bloat

Bloat Info and List of Breeds Most at Risk

Veterinary Info Network on Bloat

Explanation of bloat and surgery for bloat; more information on the importance of immediate diagnosis and treatment

Marvistavet Site on Bloat