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  Discussion on Gelding gone wrong
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Member:
Sambor

Posted on Sunday, Dec 5, 2004 - 5:32 pm:

We had our stallion (he is 2 years old) gelded almost 3 weeks ago. Our local vet whom we have used for many years (The owner of the practice is a friend of the family) did the procedure. Our vet office is a very good practice; they have done many procedures for us and never has there been a problem.
Our vet was not sure she wanted to do the castration because of the size of our horse he is part draft and is 17.1 hands and around 1300 pounds. She decided she would do it, if we did it now and not wait until he got any larger. Her main concern was of over sedating him and not being able to get him up after the surgery.
Well what happened was she under sedated him and he jumped up during the surgery before she could complete the procedure. She was able to get him sedated again but he had bleeding from the site. She got the bleeding under control, and continued with the surgery but we got the feeling she was in a hurry from that point on, she did not reprep the area after he had kicked dirt and sand into and around the groin.
We got the normal post care instructions. We were unable to walk him much the first one and a half days because he would bleed. The second day post op we started walking him as much as we could. There was significant swelling already, not only was there swelling in the scrotum area but his penis was twice the normal size and completely out of the sheath.
For much of the post op care we were handling things over the phone we spoke with the vet office almost daily the first seven days. The horse was put on Tucoprim, an oral antibiotic, to deal with any possible infection and we were told to message and lubricate the penis. Three days post op we had one of the vets from the office out to check on the horse, she gave us lasix and recommended that we continue to follow previous instruction.
Seven days and several vet visits later the office came out to put a purse string suture in to keep the penis in the sheath. By this time the penis was four times normal size.
Over the next few days the swelling went down due to the penis splitting and the horse seemed to improve some, he had lost some weight at this point but his attitude was good.
Over the weekend my husband was working 12 hour shifts and I was sick with the flu so we did not get to check on him as frequently (but again we thought he was looking better).
On Sunday his temp was 101 and my husband walked him early am. On Monday (I was over the flu and went out to take over care) his temp was 103 and it looked like he had lost another 150 pounds over the weekend (so he lost a total or 300 pounds or so). At this time we started him on penicillin. I called and made an appointment at the specialty hospital in Ohio and called the vet office to let them know. Our vet came out that day and drew labs to fax over to the clinic. She also had mentioned that she wanted the horse to be on antibiotics the whole time, however the office did not provide us with enough medication to do this. On Tuesaday morning we took him up to the hospital.
The vet at the hospital performed a rectal exam and informed us that both cords were infected. Following a sono and abdominal aspirate we found out that the horse had developed peritonitis and had to have surgery the next day.
We were extremely surprised that our local vet never performed any type of exam to determine what was causing all the swelling in the horse, nor did they refer us sooner.
And since going to the hospital we have no contact from the vet office at all, which concerns us highly.
How early would have the infection have to have started to get as severe and was our long time friend and vet office negligent?
Member:
Liliana

Posted on Monday, Dec 6, 2004 - 3:01 pm:

Hello Elizabeth,

Well I don't know how to say this without sounding rude, but I feel that the vet was incompetent. As far as I know the sedative goes according to weight sooooo.

In my experience the swelling is normal although it looks scary and what helps is cold hosing or ice if they let you, also whenever Ive had a horse gelded, pain killer for five days, antibiotic for seven days and a tetanus shot at least a fortnight before gelding are standard procedure. Was any of this done with your horse?

You mentioned that the owner is a friend of the family's, so does he know what happened?

Please keep us posted.

Al the best ]
Liliana
Member:
Sambor

Posted on Monday, Dec 6, 2004 - 3:27 pm:

Hi Liliana,
We are the owners of the horse. The owner of the Vet Office is the friend of the family. I know the vet that came out very well and she has done many procedures in the past without complications. I agree that in this situation there was some carelessness. We did do cold therapy, bute or banamine and antibiotics for two weeks. On Monday when he spiked a temp and I decided to take him to the clinic the local vet said she meant for him to be on antibiotics still (but they only gave us enough for a two week course and I did not question it because on Friday he was doing a little better, I guess it was just the calm before the storm). We are very upset that the local vet office has not called to see how he is doing or offer assistance.
Thanks for responding,
Liz
Member:
Lisamg

Posted on Monday, Dec 6, 2004 - 5:37 pm:

Elizabeth;

Sorry to hear you have gone trough so much. Sounds like a nightmare! How is the horse now?

Lisa
Member:
Sambor

Posted on Monday, Dec 6, 2004 - 9:59 pm:

Thanks for your concern Lisa,
He is doing better but still remains in the recovery stall because if he lies down he can not get up without help. He is still so weak and under weight, he just does not have the strenth to lift himself. Each day he is staying up a little longer so I hope that means he is getting a little stronger.
We also worry about the risk of the e-coli and clostridium becoming resistant to the antibiotics. His one incision is still draining and irritated (probably from the sling)so they worry about a local infection there.
We are also want to get as many calories safely into him as possible. He is being a little picky about things being added to his grain. Any suggestions anyone? He is getting timothy and a little alfalfa, and I am not sure how much grain the clinic has him on right now.
Liz
Member:
Ribbons

Posted on Tuesday, Dec 7, 2004 - 11:36 am:

Elizabeth,

I know horses aren't people, but in reading your posts, I could help but draw some parallels between your horse's plight and my own as a result of a botched gall bladder removal and poor post operative in care. In my instance, I developed peritonitis, too. I lost my appetite and a significant amount of weight, but have no fear, both found me again! I would say it took me about three months to feel like my oldself and get back my energy. Four years out I have suffered no long term consequences from either the peritonitis or the massive antibiotics.

I am not surprised you haven't heard from your local vet as my original surgeon never followed up with me, either, after I changed to another one. They maybe fearing a law suit as there looks like negligence maybe involved. I would certainly expect the local practice to reimburse you for any expenses you have incurred after the surgery and not charge you for the mess they created! Because I live in a smallish town and would have to involve friends and people in the community I admire in a law suit,I did not pursue legal action. To this day, I debate whether I should have or not.

Sounds like your boy is improving and best wishes for a speedy recovery!
Moderator:
DrO

Posted on Tuesday, Dec 7, 2004 - 7:47 pm:

Hello Elizabeth,
I apologize for the slow response to such a serious post. I posted a reply Mon night and apparently the Internet ate it. I will try to recreate it here.

Without examining all the records I cannot comment on negligence however the swelling in the penis is very irregular (as apposed to the sheath itself) and a thorough exam and assessment should be done immediately on such a complication. Though antibiotics are indicated the key to healing an infected wound is close attention to the wound itself, removing infected material, establishing good drainage, and maintaining a clean area.

Your infection question is problematic: infection occurs in all open castrations almost immediately following the surgery. However as long as good drainage is maintained usually the infection does not ascend the cords/canal and result in peritionitis.

Thank you for continuing to keep us appraised and feel terrible that you are having trouble contacting your regular vet: we all have problems from time to time but I have problems trying to explain the lack of communication.
DrO
Member:
Oscarvv

Posted on Wednesday, Dec 8, 2004 - 4:53 am:

DrO,
I read your other post. It is still 'alive' under Elizabeth's 2nd post under 'Deworming Schedules'.

Elizabeth,
I hope your boy coninues to improve. I would be pretty angry at your vet's lack of response.
-B
Member:
Sambor

Posted on Wednesday, Dec 8, 2004 - 10:03 pm:

Hi Everyone,
Teresa, thank you for sharing your own experience. I can’t imagine going through that. I’m sure it is going to take months for Diamond to fully recover; they expect him to be at the clinic for another couple weeks.

Dr. Oglesby, No problem on the “slow response” it was my mistake, I accidentally placed the post in the wrong area initially. We were cleaning his wound daily and there was daily drainage but we did not realize it was only draining from one side (the side that was sutured did not drain well and was the side that was grossly infected).
The vet at the clinic said that the antibiotics that our horse was on would not have treated his infection. His cultures grew out e-coli and clostridium. He felt that follow up could have been more aggressive and Diamond could have been diagnosed sooner. He agreed that the degree of swelling was highly unusual. He also spoke with our local vet about our concerns with the lack of communication and we got a phone call from one of our vets that day. I have an appointment made with the owner of the office next Tuesday. My husband and I hope they will help to cover the costs of Diamonds treatment, they are already much higher than we expected. I am not upset with my local vets, accidents happen and we all make mistakes and or miss things. I know the vet that did the castration is very upset and I hope that I will get a chance to talk to her soon (she is out of the office this week), I do not want her to be beating herself up over this. I am surprised they were not more concerned earlier on; they have always been the kind of vets that tell you the worse case scenario and usually over treat not under.
Diamond is doing slightly better, he is still very weak and if he lies down he is unable to get up without the aid of the sling but he was able to walk a short distance today for the first time. His CBC was close to normal as were his other labs and his second cultures (post surgery) were negative.
Right now Diamond is busy winning all the staff over and getting spoiled rotten (I DrOve up yesterday to groom his mane and tail, they were so tangled from the surgery, and one of the techs had already done that.) The Equine Specialty Hospital that he is at is wonderful and even though they are over 2 hours away I know I will not hesitate to take another horse there in the future.
Thanks again to everyone for their advice and well wishes.
Liz
Moderator:
DrO

Posted on Wednesday, Dec 8, 2004 - 10:53 pm:

I hope Diamond makes a full recovery Liz: was intrabdominal surgery required?

Thanks Barbara for pointing out where my post turned up. I am sure it is my fault, while traveling it is difficult to manage the site like when I am home. When I get back I will move it.
DrO
Member:
Sambor

Posted on Thursday, Dec 9, 2004 - 6:53 am:

Yes Dr. Oglesby he did require intrabdominal surgery. He removed both cords which were infected, and he removed a large abscess that was
attached to the omentum (which was 3-4 times normal size). He also removed the omentum and flushed the abdomen with 40L or saline.
His incision looks good right now (even with having to place the sling over the site). He has tons of edema over the abdomen, sheath, and some in the leg, which I do not expect that to resolve untill he can move around more.
Liz
Member:
Liliana

Posted on Thursday, Dec 9, 2004 - 1:57 pm:

Hello Elizabeth,

I am so sorry for you and Diamond, I do admire your loyalty to your friends though I would be so mad. But then again we are only human after all and we can all make mistakes.


All the best to you and Diamond, lets hope that he has a full recovery soon!
Moderator:
DrO

Posted on Thursday, Dec 9, 2004 - 10:51 pm:

What antibiotics is he on now and are there bowel sounds?
DrO
Member:
Sambor

Posted on Friday, Dec 10, 2004 - 5:20 pm:

Dr O.
Diamond has normal bowel movements now and he is on Naxcel, Gentamicin, and
Metronidazole. He is also on Banamine, and Gastrogard. He looks much better today (12/10), he is more alert and is eating well. He is getting stronger and can be walked for short distances.
Liz
Member:
Frances

Posted on Saturday, Dec 11, 2004 - 6:20 am:

That's great, Elizabeth. May he go from strength to strength!

Lynn
Moderator:
DrO

Posted on Saturday, Dec 11, 2004 - 7:04 am:

That sounds really good Liz.
DrO
Member:
Dyduroc

Posted on Sunday, Dec 12, 2004 - 6:17 am:

Liz, I've been following your ordeal and can only say that I'm greatly relieved to hear Diamond is on the mend.

Can't imagine how much sleep you've lost over the past few weeks!

Thanks for keeping us posted and I look forward to future updates.
Member:
Sambor

Posted on Tuesday, Dec 14, 2004 - 9:05 am:

Well Dr. O.
One step forward, one back, He is acting better and is moving better. It looks like he is gaining strength but his latest culture (from a drain) has grown our acinetobacter. I talked to the infectious control nurse at work, she said it is like MRSA and can be very resistant to antibiotics. Should we be concerned?
Thanks,
Liz
Moderator:
DrO

Posted on Wednesday, Dec 15, 2004 - 9:49 am:

It is hard to say Elizabeth, Acinetobacter can be isolated as a contaminant but it also is known as a opportunistic pathogen that is resistant to a large number of antibiotics:

Journal of Clinical Microbiology, November 2000, p. 4280-4281, Vol. 38, No. 11
Copyright © 2000, American Society for Microbiology. All rights reserved.

Acinetobacter baumannii-Infected Vascular Catheters Collected from Horses in an Equine Clinic

Mario Vaneechoutte,1,* Luc A. Devriese,2 Lenie Dijkshoorn,3 Benedicte Lamote,2 Piet Deprez,2 Gerda Verschraegen,1 and Freddy Haesebrouck2
Department of Clinical Chemistry, Microbiology and Immunology, University Hospital Ghent,1 and Faculty of Veterinary Medicine, University of Ghent,2 Ghent, Belgium, and Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands3

ABSTRACT
Acinetobacter baumannii was isolated from tips clipped from seven intravenous jugular catheters collected from horses in the Ghent University equine clinic. They originated from seven different horses. Three of the seven showed evidence of local infection.


TEXT
Acinetobacter baumannii is a well-known cause of a wide spectrum of nosocomial infections in hospitals. Multiresistant strains of this species are particularly important as pneumonia agents in intensive care units (8). Pneumonia and catheter-related infection are the common sources of A. baumannii bacteremia. Unlike other Acinetobacter species, A. baumannii is found only rarely on human skin in nonepidemic situations (9), and its natural habitat remains unknown.

The ecology of the different (genomic) species of the genus Acinetobacter is scarcely known. Two reports have attested to the presence of unspecified Acinetobacter strains in samples from lower respiratory tract infections in horses without evidence of any involvement in the pathologic conditions (5, 12). One paper described the frequent isolation of Acinetobacter strains from infectious keratitis in horses, again without presenting evidence of a pathologic role for the bacteria (7). Several publications from the 1960s and 1970s reported on the occurrence of acinetobacters (at the time designated by several names that are no longer valid: Herellea vaginicola, Moraxella lwoffi, or Bacterium anitratum) in animals (4). In a Polish study (6), a high proportion (32.3%) of workers on a horse farm were found to have precipitins to Acinetobacter calcoaceticus sensu lato, which may indicate an immunological response to acinetobacters in their environment. Since the authors used the name A. calcoaceticus, which in the past was used for all members of the genus, it is not clear against which of the presently known (genomic) species antibodies were directed.

Here we report the isolation of A. baumannii from jugular catheter tips collected from horses suffering from a variety of conditions and hospitalized in the Ghent University equine clinic. Four of the horses were hospitalized for colic surgery, and three were hospitalized for treatment of enteritis. All animals survived and were discharged. Seven Acinetobacter isolates were obtained from seven catheter tips originating from seven horses. The Acinetobacter cases were part of an investigational series comprising 32 catheter tips derived from 23 horses with or without evidence of catheter infection. The other organisms belonged to Enterobacteriaceae (n = 7), Staphylococcus spp. (n = 6), Streptococcus spp. (n = 3), Enterococcus spp. (n = 3), and gram-negative nonfermenters (n = 3). One of the Acinetobacter cases had a mixed infection with Pseudomonas aeruginosa, and another had an infection with Enterococcus faecalis. Pus formation was noticed in the latter case and in one horse from which A. baumannii was obtained in pure culture. The organism was isolated in pure culture from a case of thrombophlebitis as well. The tips and subcutaneous inner and/or outer segments of the catheters were cultured by the semiquantitative roll plate method on Columbia agar plates enriched with 5% sheep blood. Catheter colonization was defined when at least 15 CFU of a similar morphology was obtained. Isolates were identified to the genus Acinetobacter if they were nonmotile, catalase-positive, oxidase-negative, nonfermenting, gram-negative coccobacilli. Further phenotypic characterization below the genus level was based on the oxidation-fermentation test for oxidative-fermentative acidification of glucose, the determination of hemolysis of the blood agar plate, growth at 44°C using the method described by Bouvet and Grimont (2), and the tests included in the commercial API 20NE system (BioMérieux, Marcy l'Étoile, France). None of the strains was hemolytic. By use of the test results of the API 20NE system with Database version 6.0 and with measurement of growth at 44°C as a complementary test, the organisms were identified as A. baumannii. However, during a previous study validating the API 20NE system with a large set of strains that had been identified to (genomic) species by DNA-DNA hybridization (1), it was found that one strain with API code 0001473 was not identifiable and that some of the isolates had to be identified as belonging to the A. calcoaceticus-A. baumannii complex. This complex also contains A. calcoaceticus, DNA group 3, and DNA group 13 sensu Tjernberg and Ursing, in addition to A. baumannii (10). Since growth at 44°C has been found to be positive both in A. baumannii and in DNA group 13 sensu Tjernberg and Ursing, the strains were phenotypically allocated to one of the latter (genomic) species. In this study, identification by means of amplified ribosomal DNA restriction analysis (3, 11) unambiguously allocated the seven strains to A. baumannii. Restriction digestion with the enzymes CfoI, MboI, and AluI of the amplified 16S rRNA gene yielded restriction profile 1,1,1, which is specific for A. baumannii (3, 11; https://allserv.rug.ac.be/~mvaneech/ARDRA/Acinetobacter.html).

All strains were resistant to the following antibiotics used in equine practice: amoxicillin, amoxicillin and clavulanic acid, ceftiofur (a cephalosporin), tetracyclines, and potentiated sulfonamides. They were intermediately susceptible or resistant to gentamicin and susceptible to neomycin. Two strains had acquired resistance against the fluoroquinolone antibiotics flumequine and enrofloxacin.

The pathogenic significance for the horses of the bacteria studied was probably low. Intensive care of debilitated animals is less often carried out in veterinary medicine, which curbs the possibility of serious pneumonia and bacteremia in these animals. The present study indicated the occurrence of A. baumannii in horses, but this was not always associated with disease. In light of the poor knowledge of the ecology of these bacteria, the present findings (including the resistance to multiple antibiotics) and the old and nearly forgotten literature are a stimulus to search for these organisms in animals. Whether or not horses or animals in general are a potential source of A. baumannii in humans remains to be determined.

If you have isolated this in large numbers and pure culture I don't think you can ignore it. Enrofloxacin seems to be the antibiotic of choice until sensitivities on your own sample can be run. For more on this see, Equine Medications and Nutriceuticals » Antibiotics and Antimicrobials » Baytril (Enrofloxacin) and the Fluoroquinolones.
DrO



Member:
Sambor

Posted on Friday, Dec 17, 2004 - 6:21 pm:

Well two things have happened since I last wrote. Diamond made it out of the recovery stall and to a normal stall but yesterday he laid down in the stall and was unable to get up so they sedated him and pulled him back (on a tarp) to the recovery stall. The put him in the sling and then after a short time he stood on his own. Once up he started eating and drinking and acting o.k.
Second thing, I had a meeting with the owner of the vet office that did the castration (not he vet that did the castration just the owner of the hopital). He said he would not have re-cleaned the surgical site after the horse stood up either. He said he felt that would just introduce more stuff and irritate the side that already had the testicle removed. He said he considered sending referral when he saw him 6 days post-op but felt that once he put him down (sedated) and broke up the clots and got things draining everything would be fine. He also had considered antibiotics (IM) but did not want to put the horse through that, he had seen too many horses "go bad" after weeks of twice daily IM injections. I told him at that point he should have put an IV in and we could have given the antibiotics IV if he felt the horse needed it (I am a Registered Nurse and my husband is a Respiratory Therapist). I told him how upset I was with the lack of communication esp. since I have been with him since he got out of school over 12 years ago. He said he was afraid of how we would react.
I asked him if he was going to help us with the vet bill from the surgical clinic. He said he felt that was a decision we made therefore our cost.
I got a phone call two days later that he turned the case into the American Veterinarian Association Liability Trust (My understanding is this is their insurance and my understanding is they do not settle).
The vet that did the castration feels the gross infection is our fault because we ran out of antibiotics and did not call the office to refill. The first set of cultures were of the infection site itself (obtained during surgery) the cultures showed that the horse was resistant to Tucoprim, so the vet at the clinic said it would not have mattered how long he was on those antibiotics it never would have treated the infection.
I feel like I am between a rock and a hard place and don’t know where to go
Member:
Deggert

Posted on Friday, Dec 17, 2004 - 6:50 pm:

Elizabeth,
I have been following your posts, I hope Diamond pulls out ok. I think the vets comment on IM injections was fairly lame, if AB's are needed they are needed and a catheter should have been placed. It is more expensive but much easier on the horse and owner. Sounds like he "thought" alot but did not act. GEEZ - good luck with him, and we will stay posted on his progress.
Member:
Liliana

Posted on Friday, Dec 17, 2004 - 6:55 pm:

Dear Elizabeth,

I am so sorry for you and Diamond. Back on my first post, I asked if the owner
(of the hospital i.e. you friend) knew about what happened,

It did not smell right to me from scratch and I had the feeling this was going to be the outcome. This to me just proves that the vet was negligent and now is trying to pass the bucket to you.

I suggest you stop being Mrs. Nice and get a lawyer. That horse and you have gone through a terrible ordeal and it is very unfair that now they want to wash their hands.

Friend or no friend take is arse to court!

Best of luck
Liliana
Member:
Eoeo

Posted on Friday, Dec 17, 2004 - 10:23 pm:

I second that. EO
Member:
Oscarvv

Posted on Saturday, Dec 18, 2004 - 8:07 am:

Wow....
I am just shaking my head. The IM comment turning horses bad is just idiotic. If they need antibiotics, they get antibiotics.
I wish Diamond a quick recovery. I am sorry you have to go through this.
-B
Moderator:
DrO

Posted on Saturday, Dec 18, 2004 - 10:02 am:

Hello Elizabeth,
I hate to hear that there was some backing up and hope it is nothing but improvement from here. Let me try to help by sticking to the facts:
1) I cannot think of a situation where I would not have recleaned a castration surgical site, whether completed or getting ready to be done, that had become contaminated with dirt.
2) There are alternatives to twice daily penicillin, but I have given pen twice daily for weeks when necessary. Horses do get sore and some quite resentful.
3) It is not true that the Liability Trust will not settle a suit. It makes its decisions on whether to settle based almost solely on the recommendations of the veterinarian involved.
DrO
Member:
Sambor

Posted on Saturday, Dec 18, 2004 - 2:25 pm:

Hi,
Thank you for responding Dr. Oglesby, thank you for sticking to the facts we learn is school that we must always stick to facts and not let emotions get in the way. I do not want this whole thing to get ugly. I think my husband and I have to assume some fault and I think the office should assume some responsibility also. It is reassuring to hear that their may be a cases that the Liability Trust does settle, we were told by a couple of Vets that they do not.
The owner of the clinic did state that he was turning it in for an objective opinion, to see if the standards of care were breached. He also said that if the office is going to pay $ then why not have the insurance pay that is why you pay dues monthly for insurance.
I guess as far as that goes it will be a wait and see situation.
I cannot let myself forget about all of the things that the local vet office has done right over the years and we are all human and we all make mistakes. I think the lack of rescrubbing is a mistake made in the moment of panic and our (Greg and I) mistake was when we ran out of antibiotics why did we not question that.
Thank you all for your well wishes and comments they help me to attempt to look at it from all sides.
Liz
Moderator:
DrO

Posted on Sunday, Dec 19, 2004 - 12:18 pm:

I hope all goes well Elizabeth.
DrO
Member:
Pinkapp

Posted on Saturday, Dec 25, 2004 - 2:10 am:

Dr. O stated in a previous post:

3) "It is not true that the Liability Trust will not settle a suit. It makes its decisions on whether to settle based almost solely on the recommendations of the veterinarian involved."

I'm a nurse, too, and I'd sure like to have Malpractice insurance that worked like that!! Ruling a case based on the offending practioner's opinion is like leaving the fox to guard the henhouse! Of course he's going to side with himself, he'd be stupid not to.

The first mistake was made with the underdosing of the sedative. Since dosage is determined by weight, an adequate dose should have been easily and quickly calculated.

The second mistake was with the contiminated wound. I can NOT imagine a time in competent medical practice when a contiminated surgical site isn't re-scrubbed and/or flushed with COPIOUS amounts of sterile solution. From the original post, I'm unsure whether the horse was immediately placed on prophylactic antibiotics or only after the severe swelling began, but a prudent professional would have started antibiotics right away considering the increased risk of infection from the unexpected disruption in the surgery.

The fact that the owner of the practice said the reason he didn't call to follow up was because "he was afraid of how you would react", to me, is just short of an admission that he realized they screwed up, couldn't do anything about it now and hoped that by ignoring the situation and where you're long-standing friends, you'd just roll over and play dead about it.

When it comes to running out of the antibiotics, did the vet ever TELL you she wanted Diamond on antibiotics longer than 2 weeks?? If this scenario was being played out with people who were not medically knowledgable, would they have known to question that? No.

Another thing that bothers me is Liz's comment that "the mistake of not rescrubbing was made in the moment of panic...". The moment of panic was when the horse suddenly jumped up. After it was determined no one got hurt, the horse had been re-sedated and was back down, the time when the re-scrub should have occurred, that was NOT a panic time. That vet should have been able to get her head straightened around and get re-focused on proper procedure in very little time. She didn't and you and your horse are paying for it, literally and figuratively.

The definition of malpractice is any divergence in excepted medical procedure that any PRUDENT medical professional would do. In this case, there wasn't just ONE divergence, there were many. Your vet/friend is playing on your friendship and reticence to "make waves" like a cheap violin!! It's time to make him face the music and get justice for the pain and suffering that they needlessly put Diamond through. If bad care, human or animal, is continually swept under the carpet, it will continue...and the next time there may not be a recovery.
Member:
Sambor

Posted on Wednesday, Dec 29, 2004 - 5:12 am:

Dr O.
Two questions:
Is Penile swelling normal in castrations? Every time I have talked with the local vet he says that penile swelling is seen in castrations that have no other complications so that alone would not constitute a referral.
Second if the penis does swell would you ever lance it to relieve the pressure and decrease the swelling? The local vet lanced it on day 6 and the vet at the referral clinic said he should not have used a horizontal cut.
The penis has so much scar tissue where the cut was that he can not keep his penis in his sheath at this time.
I am wondering if we may have to do a penile amputation down the road.
Diamond stood up on his own for the first time yesterday (every other attempt he made he was unable to) so he may be able to come home this weekend.
He is so underweight; I have taken care of starvation cases that were not as thin as he is now and till yesterday he was too weak to stand.
Maureen, the written instructions for the antibiotics was 7 days, when the vet came out on day 6 they gave us another container. He did not state how long he wanted him on the antibiotics and since he had longer then a normal course (7-10 days) we did not question it. I would assume at that point (10 day course) if the horse was not responding then they would change antibiotics but as I stated earlier they did not want to switch to IM and Diamond did look a little better at that point but looking back on it I think he was looking better because his penis swelling had decreased (from suturing it up in his sheath) and Diamond was in less discomfort.
At this point it will be a wait and see what the insurance company does. The cost of the vet bill is not my only concern. I wonder how much this whole thing devalued the horse itself. We were unsure if we were going to sell Diamond down the road or sell my other dressage horse Teddy (I really do not need two personal horses) but now I know I will keep Diamond even if he is not the better of the two because who is going to want to buy a horse that has had all this surgery.
Again I want to thank everyone for their prayers and suggestions.
Liz
Moderator:
DrO

Posted on Thursday, Dec 30, 2004 - 8:17 pm:

I have never seen a penis swell after a castration nor is it listed in common complication lists in surgical text that I remember. It is very common to have mild to moderate swelling in the sheath (prepuce). Whether to lance or not would be based on the type of swelling: is there a fluid pocket that needed draining.

I hope Diamond gets to come home this weekend.
DrO
Member:
Sambor

Posted on Thursday, Jan 6, 2005 - 5:02 am:

Hi,
Diamond came home yesterday 1/5/05. He looks good, he has put on about 100 pounds (only 300 more to go). The only thing he may still have to have done is a penile amputation, he can not fully retract his penis. His strenth is returning, he even cantered a little in the indoor ring.
Thanks to everyone for their concern and prayers.
Liz
Moderator:
DrO

Posted on Thursday, Jan 6, 2005 - 7:48 am:

Great news Elizabeth,
Is there still swelling in the penis or are they assuming nervous damage?
DrO
Member:
Sambor

Posted on Thursday, Jan 6, 2005 - 11:38 am:

DrO.
There is a ton of scar tissue where the local vet lanced the penis. The thickness of the penis where the scar tissue is, is preventing him from pulling the penis all the way in. The vet lanced it horizontally instead of a vertical cut. The vet at the clinic thought the size of the cut and the direction of the cut is why there is so much scar tissue. The rest of the penis is normal size.
Liz
Member:
Lisamg

Posted on Thursday, Jan 6, 2005 - 5:21 pm:

Elizabeth;

Glad to hear you have your boy home. You all have been through hell. So, I'm hoping that things continue to improve for you and Daimond.

Lisa
Member:
Liliana

Posted on Thursday, Jan 6, 2005 - 5:58 pm:

Wow Elizabeth either there are no other vets in you area or...

Penis amputation?, oh what the heck is just a horse isnt it.

Hope he gets better soon
Member:
Redalert

Posted on Thursday, Jan 6, 2005 - 7:28 pm:

Elizabeth, my prayer for you , is that , one day you and Diamond can look back on all of this as an awful memory! You have stood the test of tenacious love and support in every way for the horse you love! I have a feeling you two will make it!!!!!
Nancy
Member:
Paul303

Posted on Friday, Jan 7, 2005 - 12:32 am:

I'm sure that Diamond is a horse that none of us will forget. What a nightmare! Thank you for your continued posts throughout this ordeal. I have to wonder, if the scar tissue is the only obstruction, and no nerve damage is present, why not try to reduce the scar? Wishing you an abundance of stress-free time in '05.
Member:
Sambor

Posted on Friday, Jan 7, 2005 - 8:23 pm:

Hi Elizabeth,
We are going to wait to see if any of the scar tissue decreases in size. At this time no one as any suggestions for helping to reduce the scar tissue. So we will have to wait and see. Diamond is happy to be home and has been playing in the indoor with his best friend (our 32 year old pony). We will not put him outside until he has gained some weight and strength.
Thanks again to everyone,
Liz
Member:
Dyduroc

Posted on Saturday, Jan 8, 2005 - 6:03 pm:

Elizabeth, Wonderful news! So happy the learn that Diamond is home and on the mend.

All my best to you for a healthy and calm '05!

D.
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