Poor Advice can be Expensive 

D. E. Larsen, DVM

The phone jarred me awake. I rolled over and looked at the clock. It was six in the morning. Sunday morning, I liked to sleep in on Sunday morning. I got up and walked out to the kitchen to answer the phone. Amy woke up with me, the meant there was going to be no sleeping in this morning.

“You go back and get in bed with Mom,” I said to Amy as I reached for the phone.

“Good morning, this is Doctor Larsen,” I said, trying to sound wide awake.

“I’m sorry to bother you so early, Doc. This is Jim and Sara,” Jim said. “We are just getting ready to leave from San Francisco and will be getting into Sweet Home around five this afternoon. Sally was hit by a car last night. We took her to the emergency clinic last night. She is doing pretty well, but the doctor said that Sally has radial nerve paralysis in her right front leg. They gave her a steroid injection and said she should have one we get home. We are hoping that you could look at her when we get back to town.”

“That’s no problem, Jim,” I said. “We are going to be around. Just give me a call when you get to town. Is Sally doing okay other than the paralysis?”

“She is a little sore, but everything else looks good,” Jim said. “They took a chest x-ray last night, and they said the heart and lungs look good, and they didn’t see any fractures. They said this leg should return to function with time.”

“I’ll get a look at her when you get to town, Jim,” I said. “But I can tell you one thing right now, I have never seen a leg with radial nerve paralysis return to function.”

“The emergency vet was pretty confident in his advice,” Jim said.

“I will see you when you get to town, and we can look at things then,” I said.

“Who was on the phone?” Sandy asked as I squeezed back into a now full bed.

“It was Jim, from out in Holley,” I said. “Sally was hit by a car in San Francisco, and she has a paralyzed leg.”

“Is there anything you can do for her?” Sandy asked.

“Not much, but that is the least of the problem,” I said. “The problem is the emergency vet down there told them it would return to function. I have never seen that happen. And they are bonafide Californians, they will never believe me after a Californian vet gave the advice contrary to my opinion, but time will tell.”

***

Jim was right behind me, carrying Sally, as I unlocked the clinic door. Sally, a young petite female Irish Setter. I had seen Sally several times before. 

“Set her on the exam table, and I will give her a good exam before we set her down to walk,” I said as I retrieved their file.

Sally looked fine except for an abrasion on the left side of her face. Her right leg hung limply from her shoulder, and the paw rested on the table on its dorsal surface.

“The radial nerve supplies all the extensor muscles of the front leg,” I explained as I closely examined Sally’s leg. “It runs across the lateral surface of the humerus, the upper leg bone, and when she was hit, the nerve was crushed between the vehicle part and the bone.”

“Yes, that is pretty much how the vet in California explained it,” Jim said. “He said with some medication to relieve the inflammation, we should expect it to return to function in a few weeks.”

“Jim, I have no real problem with trying some medication for a while,” I said. “But, I worry that you have expectations of a return to function, and I have never seen that happen.”

“Why would the vet in California tell us otherwise?” Jim asked.

“I don’t know, he maybe reads a different book than I do, or he knew he didn’t have to deal with you for the follow-up. The problem we will have in the immediate future is Sally is going to wear the skin off the top of her paw as she drags it on the ground.”

“How do we deal with that?” Jim asked.

“I guess we could try to keep a wrap on it,” I said. “To be honest with you, I don’t usually deal with that problem. These dogs will do far better with an amputation. People have problems with that consideration, but after a few days, you will have to count legs on her to know she is missing one.”

“I think Sara and I are pretty sure we don’t want to consider an amputation,” Jim said. “Can we set up some medication and see how things go for a while.”

“I have no problem with that,” I said. “I just want you to watch the surface of the paw. We also have a new neurologist in Portland. If you would like to see him, I could make a referral,”

“We will think about that, but for now, let’s see how the next week or two goes,” Jim said.

I got Sally medicated and sent them out the door with pills and instructions to look at Sally every week. And to check her earlier if the paw becomes an issue.

***

It was late Thursday morning when Jim rushed through the door with Sally.

“I know you close on Thursday afternoon,” Jim said. “But could you get a quick look at Sally for us?”

Sally’s paw was a mess. Most of the skin was gone from the upper surface of her toes. The paw was swollen and painful from the infection. The muscles on the leg were already starting to atrophy. Obviously, we were heading for a wreck if this leg didn’t come off.

“Let’s clean up this paw and get a wrap on it,” I said. “Then we need to get Sally on some antibiotics. Have you noticed that her muscles are getting smaller on this leg?”

“Sara and I talked last night, and we think we would like to go see the neurologist in Portland,” Jim said.

We got Sally cleaned up, wrap applied, and started her antibiotics. Then I gave the doctor in Portland a call, and he was delighted with the referral, and I handed Jim the phone to make the appointment.

“He sounds nice,” Jim said. “And he could get us right in. We will go up there tomorrow.”

“Yes, he is just getting started up there,” I said. “He is probably not too busy yet.”

I hated sending a client to a specialist who I had not met personally. But if anyone would set these two straight, it would be a specialist.

***

Several weeks later, Jim stopped by just to update me on Sally’s status.

“He has tried several treatments,” Jim said. “He has continued the anti-inflammatory medication, and he has used some high-frequency sound waves to try to stimulate some healing. There hasn’t been any change in Sally’s leg yet, but we are hopeful. He is planning to do surgery next week to try to free up some adhesions along the path of the nerve.”

“I hope he can help her out,” I said. “But, Jim, remember what I said when I first looked at Sally’s leg. You have to prepare yourself for how you will handle things if he recommends an amputation.”

“Doc, he hasn’t mentioned amputation one time,” Jim said. “He is very hopeful for a recovery. And so are we. Hopefully, this surgery will solve Sally’s problems.”

***

The following week, Jim and Sara came through the door carrying Sally; Sara was in tears. Sally was still not completely recovered from surgery, and her right front leg was amputated.

“He didn’t even call us to let us know what he was going to do,” Jim said as he handed me a folder with notes from the doctor.

I quickly scanned through the papers until I came to his surgery notes.

The notes read: “I was working along the tract of the radial nerve, freeing up adhesions as I progressed, when I finally realized that there was no hope for returning this nerve to function. I proceeded to do a full amputation.”

“Doesn’t sound like the best client relations to me,” I said. “Did he give you any heads up that an amputation was a possible endpoint to the surgery?”

“No, he didn’t,” Sara said. “I was horrified when we returned to pick Sally up today. He didn’t even call last night following surgery. We spent a lot of money up there, and we got nothing in return.”

“I can assure you, Sara, that he will hear from me on how I expect client communication to occur with my clients,” I said. “But, sad as it may seem, he did what needed to be done. When that nerve is crushed against the bone, there is almost no chance of returning to function. If it is a minor blow, maybe you could see some return to function, but that would occur in a day or two, sort of like you bumping your crazy bone in your elbow. The truth is that you got some really poor advice in San Francisco. I would guess that was just from inexperience. But it turned out to be costly advice for you guys.”

“What do we do now?” Jim asked.

“Take Sally home and make her comfortable,” I said. Give her the pain medication you were given, and in a few days, she will be back to her old self. She is a small setter, and the only thing you need to watch as she grows older is that she doesn’t get heavy. She will not miss this leg at all.”

***

And that is how it turned out. Sally healed, and she did wonderfully on her three legs. Sara and Jim came to realize I was their best source of advice. 

I consulted with the neurologist in Portland on rare occasions in later years. Still, I never sent another client to the man. As the years passed, I think he improved in his bedside manner, but I could never trust him again. And in the future, I never referred a client to a specialist I had not met personally.

Photo by Camylla Battani on Unsplash

Published by d.e.larsen.dvm

Country vet for over 40 years in Sweet Home Oregon. I graduated from Colorado State University in 1975. I practiced in Enumclaw Washington for a year and a half before moving to Sweet Home to start a practice.

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