Obi's death

[sea4th]

Obi died because the two sections of bowel, which were sutured together, came apart. How likely is this to happen? What I'm wondering is if the vet who performed the surgery was even skilled enough to do this type of surgery.

 

Three years ago, Tam, one of my own border collies, went in for surgery after 3 weeks of screwing around with a couple of vets who didn't open him up. The third vet, the one who performed the surgery (same clinic where I took Obi but different vet), took out, not only the obstruction (portion of a rubber ball), but 18 inches of necrotic bowel as well. Tam, who was 7 yrs. old at the time bounced back and we have never looked back.

 

Obi, 11 months old, a healthy and normal pup, died, because the sutures didn't hold.

 

Not being a vet, not even being in the medical field, I'd like to wrap my mind around WTH happened in Obi's case, why it went so wrong, but Tam, who was in worse shape than Obi, by the time he saw the vet, but came through great.

 

I don't expect the vet who did the surgery to tell me that maybe she screwed up. I don't even know that she did. I also am not looking for anyone to say that this vet was bad or incompetent. I'm thinking that maybe she just didn't have the skills for this sort of surgery.

 

And finally, maybe it wasn't the vet at all. I'm not looking to blame, but just wondering the factors involved that in similar circumstances, one dog lived, one dog died, why in Obi's case, the sutures didn't hold. Why in Tam's case, they did.

 

Hopefully, this will never happen again, but if it does, I'm asking for one of two vets at the clinic and neither are the person who performed the surgery on Obi.

 

Thanks.

[Guest pax]

I feel bad because once again all I have to offer is horse experience, but I'm sitting here watching sheep and killing time till my kid's dr's appt, so I'm going to have a go.

 

I don't know what went wrong with your dog.

 

I do know that what the vet finds when he gets opens up a gut is a crap shoot. It's possible that if Obi had anything going on for any amount of time before you saw it...that is, he had an upset tummy for a few days, or even hours, before hand and showed no signs of it, that the condition of his gut could have deteriorated enough that even though you moved promptly once you realized something was wrong, too much time had already gone by for that section of gut to remain viable. Yes, the vet trimmed away what he thought he needed to, but...the intestine is quite thin. Even when it's healthy, it's slippery and hard to suture. When it's diseased or distressed, it gets thinner and much more fragile. Imagine trying to sew together sausage casings, inside an animal that's been using the sausage casings.

 

It's also possible that a suture ruptured, and/or there was leakage during the surgery and what actually caused his problem was straight up peritonitis, which sounds lke something lovely and simple to fix, like tonsilitis, but is NOT easy to knock once it's got hold. For all intents and purposes, you're opening up a piece of bacteria-filled bowel in the animal's abdominal cavity. It's amazing more of them don't have problems.

 

There are all kinds of things that go wrong during gut surgery and these are just a couple of the things that sprang to my mind.

 

 

I really understand wanting to get a better handle on it, though, so I hope you get more and better answers than this one. In the meantime, I am very, very sorry.

[Guest WoobiesMom]

I watch alot of E-vet interns so that's my only experience. My Airedale died of bloat but we chose not to operate due to his age and general health. I've heard again and again with regards to gut surgeries that they are very risky and unpredictable. I think the ability for the sutures to hold was a matter of luck and also the general health of the tissue being sutured. From what I've seen on the show, I think it's very hard to tell which section of tissue is likely to survive and which needs to be removed. There's also the overwhelming incidence of fatal infection when dealing with that area as well. There may never be the answers you're looking for but you gave him a shot and no one could ask more of you than that. I question to this day if my Rush could have survived the bloat surgery. Did I do him a disservice by putting him down at 10? Would he have bounced back? Was I being selfish by choosing not to have him suffer and possibly die on the table rather than in the arms of the family who loved him? I still don't know. You just have to find your own path to peace with your decision.

 

I think you gave Obi every chance you could. I hope this helps a bit.

[kelpiegirl]

Here's what happened to my Kylie. Three weeks after ingesting what I hoped was a piece of an edible toy, she get SICK. Every time she moved, she puked. Got her into the vet that night. They took radiographs, and found that INEDIBLE piece of toy. They had to go in. Okay. So, the good thing was that this vet came from an emerg practice. The other GOOD thing, was that I had just watched that episode of emergency vets where the dog had surgery to remove a foreign object, and initially did well, but one night, after whining, and being uncomfortable, the owner found him dead- something had gone wrong. BUt, I digress- the point of saying all that, was that I was really on the vet to make sure that she did a SUPERIOR job, because I didn't want to lose my Kylie like that. So, end result was that the vet had to open the stomach, and the small intestine to remove inedibles. OKay, Not good when you open the intestine- in any animal. Just not cool. So, when I go to pick Kylie up, I meet with the vet and reiterate again that I am worried about infection, etc. By the time I left the vet, she told me how nervous I got her- GOOD! So, she had me do tpr every few hours (temp/pulse/resp), and watch her closely. This I did. It was tough recovery, but she did well. I don't know why Obi's stitches didn't hold. It may have been a bad suture job, or not. You will probably never know. The big thing to remember is that opening intestines is rough stuff, and fraught with danger from myriad source. My father went in for a hernia surgery last year. They nicked his instestine. Protocol at the hospital is that you MUST stay 5 days if there is any problems with the bowel (ie: nicking them). MY father was mad as a hornet, but we were all glad that he stayed- the best place for him. I really feel for you about Obi, but there wasn't much you could do. THe only thing I would offer is to, when speaking with the vet who will do surgery of this magnitude, is to ensure that you KNOW how dangerous it is, and that they NEED to be qualified- I even asked my vet how many she did.

 

Julie

[sea4th]

Thanks for your input. I think the vet who performed the surgery was very conscientious regarding post op care and monitoring Obi very carefully. When I got the call when they had opened Obi up the second time, how grim things looked, they certainly didn't try to sugar coat things. I feel that they helped me in making the right decision - which I feel that I did - When he was gone, the vet called me. It was late and she cried with me on the phone. I KNOW she cared. My favorite saying of late - "coulda, woulda, shoulda". None of it makes any difference now. Obi is gone, there is that little niggling in the back of my mind that maybe I should have asked for the other vet who worked on Tam.

 

It's human nature. I don't feel the need to blame anyone. I appreciate the fact that I think she did the best she could - but was the skill there for that sort of surgery. I think I'm getting my answers thanks to your feedback.

 

It's never easy to lose them - especially not this way. OTOH, I have one bc mix who came back - and I'm kind of wishing he'd leave again.

[sweet_ceana]

I had a kitty who had a similar thing, only with his esophagus. They cut open his esophgus and then vet told me that the tissue may or may not hold the sutures (not sure how similar esophogus and and intestine or kitty and dog tissue are). Poor little guy just could not hold on and she wanted to know if they sutures held or not, they did but he died from the stress anyway. It sounded like it depended more on the animal than the surgeon. She even did that surgery for free because it was so risky she said she would write it off as research... or something like that

[Guest pax]

I once had a large animal vet have me come into a colic surgery and show me what he was trying to piece together. Every time he attempted to suture, the intestine would shred. It got this funny kind of pearly colour and it just shredded everywhere. In the end, he removed a LOT of intestine trying to get solid ends with good vascular flow. It was a pretty stressful, all in all.

 

Again, I am really sorry. And I'm writing again, really, to suggest that it might help you to call the vet and talk to her, if what you need is to get a handle on the details. It might help.

[Alaska]

I don't have any personal experience to contribute, but I just received a forwarded email locally about a somewhat similar situation. I've removed all the names from this email, but I know almost all of the people mentioned, and the vets, especially "Dr. M", are experienced vets I have trusted with my dogs. I think this story underscores the point others have made that intestinal surgery can have risks that are hard to evaluate, before or after the fact.

 

I've been wanting to post this story for its cautionary tale but didn't want to be disrespectful to Obi, so I'm glad you opened a separate thread where it (sort of) fits.

 

FRIENDS

 

I am sending this sad message from a friend who just lost her dog and wanted other dog owners to be aware of this lethal problem. For those of you who have been on the list for awhile, you may remember that I sent out a similar message a few years ago when my golden almost died because beach grass wrapped around his intestine and "strangled" it. Two surgeries and a long recuperation and he is fine but he was lucky that his intestine was not perforated. The grass is tough and sharp as a knife.

 

P

 

------------------------------------------------------------------

 

I’m writing in hopes you will let other dog people know something that even after 25 years in vet med, I didn’t realize.

 

We adopted K at age 10 months 4 years ago from the Humane Society and she quickly became a beloved family member.

 

This past Friday evening she began vomiting, which continued through Saturday and Sunday. I got some fluids to give her SQ from Dr. V on Sunday and took her into Dr. M on Monday. He radiographed her and diagnosed a possible bowel obstruction. He proceeded immediately with surgery and found an obstruction from grass in her upper duodenum near the stomach and 3 other obstructions in her distal small intestine – all of which he removed.

 

K spent Monday night at home on an IV morphine drip and Tuesday I took her back to the clinic. Tuesday night she was back at home and did OK until 11 PM when she began having renewed abdominal pain and distension, a fever, and rapid heart rate.

Wednesday morning early, I got her back to Dr. M and he re-explored her abdomen surgically and found massive intestinal adhesions, peritonitis (infection throughout the abdominal cavity), and intestinal perforations from grass. We consulted and she was euthanized on the table.

 

<snip>

 

I never – until now- realized how lethal eating grass could be for a dog. Especially the lush spring grass and coarser beach grasses.

 

Dr. M said he consulted with the board-certified veterinary surgeon in Anchorage who remarked he has seen similar cases where the obstruction from grass is removed, then about 36 hours later, perforation occurs from grass that is not palpable when the vet checks the bowel during the initial surgery.

[sea4th]

You know, I'm glad I started this thread too. It's helped me come to grips somewhat with Obi's death. I've decided I'm going ask the vet if I can have a few minutes of her time to talk. She did say that going in again, she didn't know what she'd find, but she never expected to find what she did. He did have some intestinal adhesions too, besides the abdominal cavity being contaminated.

 

Funny part is, is that he did have a normal BM after the surgery and doing well, when the bowel probably came apart.

 

I was talking to a friend of mine today who breeds afghans and salukis. She has a 9 yr. old male who at 18 months lost 80% of his intestine - removed because it became nectrotic after an obstruction caused by hair - which doesn't show up on x-rays. She opted to do it although the prognosis was poor. Not only did he pull through, but after the first two weeks where he had a lot of diarrhea, he managed to maintain weight OK and was obviously getting the nutrition he needed. Same clinic I go to. She said even after all of these years, the vet who performed that surgery on her dog, continues to be amazed and proud of his handiwork.

 

I thought removing 2/3 of Obi's intestine sounded bad, but here is a dog that had a lot more removed and not only survived, but thrived.

 

Sounds like gastrointestinal surgery is as varied as the individual, the situation and the vet.

 

Oh, and Alaska. That you for posting what you did, when you did.

[sharkie]

one of my professors told us that such surgeries are automatically considered clean-contaminated or even worse. this may sound harsh and these are not my words but he deals with alot of surgical side infections and said that most such infections are preventable through timely and appropriate selection of abx. the odds of survival are greatly diminished if the timing is off

[AK dog doc]

You have to bear in mind, though, that theres'a huge diff between the results of ab's given prophylactically after a gut surgery that has no dehiscence, and results of ab's given when there's a dehiscence (when the incision line doesn't hold) - no matter how appropreiately timed and chosen the ab's were. In the first case, you're dealing with WAY less contamination than the second. No amount of ab's (however appropriately chosen or timed) is enough to control the infection in such a massive exposure, particularly in the abdomen (where a million nooks and crannies exist in which the bacteria can sequester themselves and grow like wild.)

 

As for reasons the gut can dehisce.... there are many. One WOULD be trying to put back together tissue that lacks integrety, but to me - from the description you gave of Obi's surgery - it doesn't sound like that's the case. Or I should say, it doesn't sound as if your vet tried to suture tissue that DETECTABLY lacked integrety. Sometimes the tissue will look and feel perfectly healthy and it still isn't vital enough to hold a suture. Sometimes it IS vital enough at the time of surgery, but at some time after surgery is loses integrety to the point where tissue that was sturdy enough at surgery isn't sturdy enough a few days out. Even perfectly healthy tissue depends on circulation for healing. If that circulation fails for any reason, it doesn't matter how healthy the tissue WAS, it's not going to STAY healthy. If there isn't enough microcirculation to allow healing, then the most perfect job in the world is going to fail. At the time of surgery, you can tell if the tissue HAS circulation - but you can't always tell if the MICROcirculation is adequate - or if it will STAY adequate. Remember, a certain amount of tissue handling is inevitable suring surgery - you HAVE to touch it to do the surgery. Sometimes this will cause thrombosis (clotting which blocks off the vessels). This can happen in a big vessel to the gut, or in the tiny delicate capillaries. In either case, the tissue integrety is in deep trouble. It must also be borne in mind that some animals are prone to thrombosis genetically, or as a condition of illness (which can dramatically alter the coagulation profile). Even having a section of tissue that has previously thrombosed and been removed - as sometimes happens with a foreign body - can increase the chances of ANOTHER thombosis happening elsewhere. The body is an integrated system; nothing happens in a vacuum. Sometimes something triggers a cascade of events that will ultimately snowball and create disaster. What occurs in one part of the body affects the others, and not always predictably.

 

It must be remembered that the gut is a mobile organ. It has layers that are so delicate that a thread can cut trough them like a knife. You rely primarily on one (strong) layer of the gut to hold the suture; the others will be sliced through. In a given animal, that tissue layer might not be as sturdy as in the next dog over. We see that; it can be a temporary condition of illness or nutrition, or one that is related to the individual animal's genetics. In such cases, the movement of the gut may start to put tension on the incision line, and if the gut layers aren't strong, the movement will make the sutures start to saw through the tissue.

 

I don't know what section of the gut was being sutured... the duodenum, the jejunum or the ileum. The ileum in particular is prone to dehiscence. It is in fact the single most likely segment of the small intestine to suffer dehiscence. I should point out that the gut doesn't have an obvious "marker" of where one segment of gut segues into the next; unfortunately there is no line tatooed on it that says "duodenum stops here; jejunum is from here forward to the next line; this is ileum." That's a microscopic distinction. You might TRY not to have a surgery involving the ileum since it dehisces more easily, but A) you may have no choice in the matter, depending on where the gut injury is, and B ) even if you TRY to have a choice, you can't know exactly where that microscopic anatomy changes.

 

Another thing that can happen - rarely but unpredictably - is that a given animal my have almost an allergic-type reaction to the suture material. The best surgery in the world isn't going to hold if that happens - but there's no way to predict that THIS animal can't have THAT suture type because it will have a tissue reaction.

 

This is by no means a complete list - but I hope it's more apparant how many things can go wrong. IRL, most of these things DON'T go wrong, or maybe one thing happens none of the other things do. But some days things just go south, no matter how good a job you do. I'm sorry that Obi died and I'm sorry you're suffering right now... but it may in fact not be possible for your vet to be able to tell you why this happened. Not having an answer does NOT mean that your vet made a mistake. She may have properly dealt with every variable that was in her control - but there are many that are in NO ONE'S control. Sometimes one or two of these things can go badly and the overall picture will still be good enough. Sometimes too many things go wrong.

 

BTW, Obi's short-gut syndrome PROBABLY didn't have time to affect his survival one way or the other (though I can't recall exactly how long post-op he was) - but ANY impairment in nutrition impairs healing and tissue integrety. It seems counter-intuitive, but if you have two dogs - one healthy and well-nourished, but on a falling plane of nutrition, and the other UNDERnonurished from starvation or illness, but on a rising plane of nutrition - the one on the FALLING plane will heal WORSE thatn the one on the rising plane, even though by an objective measure of general health and nutrition, it is actually better off overall than the starved one. I don't know that anyone knows for sure what the mechanism is for this... but in the case of a gut surgery that ALSO has a short-gut syndrome to deal with, this picure cannot help but be worse than a gut surgery that doesn't also have short-gut.

 

Anyway, not sure if that's helpful, but it's the best I can do at 4:40 in the morning...

[Guest pax]

Funny part is, is that he did have a normal BM after the surgery and doing well, when the bowel probably came apart.

 

 

It might have been lower in the gi tract then the impaction.

[Tassie]

Vicki - just wanted to say that I too was very sorry to hear about Obi. You've been having a rough time lately. Hope your good karma will start showing itself.

 

I'm really popping in here to say a huge thank you (yet again) to AK Dog Doc for that detailed explanation. I've been lucky so far (touch wood), but it's good to have that information in case my guys every have to have gut surgery. I'm one who likes to know as much as possible about what's likely/possible in any situation, so it's great to have this info - just in case. If nothing else, I guess it will make me even more careful about trying to make sure dogs don't get obstructed - something to emphasize to my puppy class as a general principle, too.

[sea4th]

Thank you Barb and everyone else for that matter for your input. AK Dog Doc - thanks for taking the time to write that explanation. It goes a long way in giving me only an inkling of what vets are faced with when trying to, in this case, save the life of a dog.

 

You're right, Barb, about everyone being aware of the dangers of obstructions. I'd like to think that Obi didn't die for nothing, that people here will come away just a little wiser because of what Obi went through. For that, maybe Obi's death will have some meaning.

 

It's a miserable feeling to lose a young dog, rescue or no, in anyway, but especially this way. I really miss him.

[AK dog doc]

Yes, it is. I'm sorry you're having to undergo this. I'm also glad that what I wrote between 4 and 5 a.m. was in any way intelligible.

 

Hope this eases up for you soon, Vicki.

[HighDesertSpice]

Yes, it is. I'm sorry you're having to undergo this. I'm also glad that what I wrote between 4 and 5 a.m. was in any way intelligible.

 

Hope this eases up for you soon, Vicki.

 

AK:

 

Thanks MUCH for sharing this detailed information. It is really insightful and nice to know someone will take the time to really demystify what does on with these unfortunate and heart wrenching experiences. (Glad for those of you who persisted in those really narly courses....and what appears to be narly work;)

[MaryP]

Vicki, as I said in your other post about Obi, I'm so very sorry for your loss. I hope this doesn't sound selfish, but after reading all of this, I am so glad that my puppy's obstruction did not come to need surgery. My vet explained how dangerous it was, but I guess it really never sunk in until now. Luckily, my puppy's obstruction kept moving, though slowly and with a lot of help from mineral oil. On the last day that my vet said he was going to give it to pass, it did. I feel so blessed now after reading what you went through with Obi. I can't imagine my life without my Charlie. Consider yourself hugged by Charlie and I.

[Eileen Stein]

AK dog doc: I've said this before but I'll say it again -- you are a treasure. It's a tremendous piece of good luck for these Boards that you came along and decided to stay on with us.

 

Vicki: I'm very sorry for your loss, and sorry for Obi that he didn't have the future we all would have wished for him.

[sharkie]

id have to second and triple that...its one thing to read off a textbook at school its totally different perspective from an experts view

[kelpiegirl]

AK Dog Doc et al

 

Does anyone see the parallel's between what my father is going through and Obi? I sure do. My father's fistula is in his ilium too. His problems are caused by myriad adhesions pulling on the intestines, and just a plain infected mess.

Julie

[AK dog doc]

Well, gosh... Thanks, everyone! But I get a lot out of being here, as well - friendship, community, advice, compassion, humor, education - not to mention Tha Amazing Raven, who I'd never have had a chance at if not for knowing Julie through the Boards.

 

I think I'm amply repaid.