An unfortunate risk of surgery?

• Champ is a Rhodesian Ridgeback mixed breed, neutered dog. Date of birth: November 1, 2007.
• April 2013, Champ was diagnosed with diabetes.
• October 2013, Champ developed cataracts and lost his sight; referred to Carolina Veterinary Specialists (CVS) for surgery.
• October 2013, in preparation for cataract surgery, North Mecklenburg Animal Hospital diagnosed a UTI, resistant to the common antibiotics, including Ampicillin, Amoxicillin and Clavamox. Baytril was prescribed.
• November 2013, cataract surgery was performed by Dr. Treadwell at CVS Charlotte. Clavamox prescribed post-surgery.
• December 2013, Champ was not improving and when reminded CVS of antibiotic resistance, Clavamox was changed to Ciprofloxacin.
• March 2014, Dr. Marshall referred Champ to Dr. Jaeger at CVS Charlotte for diabetes related issues. Champ was infection-free upon admittance.
• March 2014, Dr. Jaeger prescribed Amoxicillin to treat a UTI that Champ contracted while he was at CVS. When reminded of Champ’s history of resistance to certain antibiotics, including Ampicillin, Amoxicillin and Clavamox, the antibiotic was changed to Ciprofloxacin.
• March 2014 through August 2014, Dr. Jaeger treated Champ’s diabetes with Levemir and Ciprofloxacin.

Champ began to limp and CVS could not accommodate an appointment to evaluate his leg as well as routine follow-up related to his diabetes; two separate appointments were required, plus emergency room charges to have his leg examined. Appointment made with Champ’s original veterinarian, Dr. Marshall of Paws and Claws Mobile Vet, to evaluate both his leg and blood glucose.

Dr. Marshall found a suspicious irregularity just below Champ’s knee and referred Champ to Dr. Nanfelt at the CVS Matthews hospital for x-rays and evaluation.

Dr. Michelle Nanfelt met with me after evaluating Champ and explained that there was a 99.5% chance that Champ had a bone tumor (osteosarcoma) in his left hind leg. She further explained that the bone was dead and nothing could be done to repair the fracture; amputation was necessary.

Dr. Nanfelt recommended additional tests to determine if cancer was present elsewhere in Champ’s body. We proceeded with the tests and agreed that upon any sign that the cancer had spread beyond the tumor, all further testing would cease and amputation would not be considered.

Upon the completion of the tests, Dr. Nanfelt reported there was nothing that would set us back from proceeding with the amputation the following morning and that the internal medicine specialist who performed Champ’s abdominal ultrasound, recommended amputation of the leg as soon as possible.

CVS reduced Champ’s regular insulin dose by 50%.

Surgery was scheduled for first thing the following morning so that Champ’s blood glucose could be monitored throughout the day.

Champ was dropped off at the CVS Matthews hospital at 6:45am. He was walking on all four legs with no limp. His blood glucose was recorded at 215.

Shortly after dropping Champ off, a technician called to confirm that I had not given Champ insulin that morning, which I had not. I mentioned that Champ was walking on all four legs that morning and questioned the possibility that the suspected tumor could be something that would not require removing his leg. The tech attributed Champ’s demeanor to the pain medication, but said she would relay my concerns to Dr. Nanfelt.

Prior to surgery, Dr. Nanfelt explained that amputation was required no matter what, the sooner the leg came off, the less likely it [the cancer] might spread. She identified the goals, risks and expected outcome stating:

• “So even if it was the less than 0.5 percent that could be fungal disease, it’s still unfortunately broken down completely and you’d have to amputate no matter what. Unfortunately and, and Dr. Marshall and I talked about this, you’re kind of in a, in a bind. We know he has, what is in 99.5 percent, cancer, and the sooner you get the leg off and remove the tumor burden, the less likely it might spread.”
• “So, and also in his case he also has what appears to be that the bone’s already been destroyed so much that it’s eaten away and it’s fractured. So, again you can’t repair that fracture and there’s nothing you can do. The bone is dead, basically, and so you can’t repair the fracture no matter what and I’m, I’m absolutely not surprised at all that he’s putting the leg down because he’s on really good pain meds right now.”
• “Our thing is to decrease his tumor burden, take away his pain that he’s got going on right now with the leg, with the tumor. And then, and then, you know, get him through surgery and, and try to normalize his life a little bit more.”
• “I know. I know it’s a lot, but I, I think Champ is gonna do much better than you think. Obviously, there are anesthesia risks, but we watch him very closely. That’s why, you know, we took the time to do all the tests yesterday morning to make sure that he can be the most stable patient, that he can be under anesthesia. But with that said, you know, the healthiest marathon runner can go under anesthesia and have some, some risks that are fatal, or just minor.”
• “And, so, I’ll use this number as a contact if there’s something very concerning. He does have cancer, I mean, he does have diabetes, that’s poorly controlled. Could something go awry, you know, I, I guess that’s possible. I don’t foresee that by any means. But I do need to get a hold of you in case there is something that occurs. I know you understand that.”
• “You know, I expect there’s gonna be some swelling, there’s gonna be some bruising. Do I think he’s totally gonna rock it? Yep. I do. I think he’s already tripoding himself on that back leg, and so, I think he’s gonna surprise us all.”

Following the amputation of Champ’s leg, Dr. Nanfelt reported that Champ was doing fine, but not yet awake from anesthesia and his blood glucose was in the 400s; no visits so that Champ can rest. This is the last communication I had with Dr. Nanfelt.

Champ was discharged and a technician went over the post operative instructions and medications with me and then went to go get Champ. She returned with Champ walking, assisted with a sling. There was significant bruising and swelling around the surgical site and Champ’s abdomen; no bandage covered the incision. Champ was panting as the tech assisted Champ down the back hallway towards the exit, when he suddenly stopped walking and fell to his side, refusing to get up. The tech stated she had never seen anything like this.

Leaving Champ on the floor, lying on the uncovered incision, she rushed off to get help and returned moments later with two additional techs and a gurney. Champ was quickly taken back to the treatment area. About 20 minutes later the techs brought Champ out on the gurney and got him situated in my vehicle.

I was told that Champ’s vital signs were checked, as well as his blood glucose level, and that everything was fine; he just needed rest while adjusting to three legs. I was not informed that Champ was having difficulty walking all morning.

Champ had a rough night, panting heavily at times and whining for most of it. Dr. Mike Ficklin called and introduced himself as the intern working with Dr. Nanfelt. I expressed my concern about Champ’s restlessness, panting and whining. He stated that “while it’s not ideal, it’s not unexpected” and that “the first few days are always rough while he is adjusting.” He further stated that I should call if anything gets worse.

The bruising and swelling worsened throughout the day and spread to his chest and remaining rear leg. Shortly before 6:00pm, I spoke with Jen, a technician, about Champ’s condition and my concerns; the swelling was so profuse that the stitches were barely visible and his penis seemed three times normal size. Jen stated:

• “So what happens when they have a, a limb amputation, it’s not uncommon for them to get you know really, really swollen and everything. And what happens with that swelling as it goes kinda down, it kinda goes with gravity and settles you know, kinda sometimes up underneath their belly area. So that maybe what you’re seeing with his, his penis area being swollen.”

Jen asked if Champ was eating, drinking and urinating, which he was. Jen said to ice the area 3-4 times a day and to contact them if there was no reduction in the swelling over the next few days or if he stopped eating, drinking and urinating.

I also told her that he had two spots along the incision where there was a very small amount of fluid. She stated that as long as it was only a drop or two and was not dripping, this was ok.

As the night progressed, Champ’s panting and whining had become continuous. He felt warm and his breath was very noticeably hot. I texted Dr. Marshall a picture of Champ’s abdomen and incision and was told to get him to the emergency room immediately.

Very early morning, upon arrival to the Matthews hospital, Champ was taken into the back and Chris, the technician on duty, had me sign the standard Consent for Services and then asked the customary triage questions. Chris informed me that he had already called the doctor, who was on the way to the hospital, and would be there shortly.

Following a short wait, Dr. Jennifer Merlo sat with me in the lobby and informed me that although the surgical site looked “very angry,” everything was normal and to be expected with this type of surgery and Champ’s diabetes. Dr. Merlo recommended giving Champ three Benadryl in addition to three Tramadol every eight hours, to help him rest.

Dr. Merlo did not disclose that Champ had a fever or that all of his vital signs were elevated; temperature 103.6, heart rate 180 and blood pressure 152. Nor did she inform me that Champ had gained more than six pounds in the 40 hours since he was discharged.

Dr. Merlo documented in Champ’s medical record that when she “went back to the treatment room dog was actively licking at incision,” as Champ was apparently left unattended without an e-collar to prevent him getting at the incision. Dr. Merlo also documented that the technician also observed Champ licking the incision.

Dr. Merlo did not engage the services of the on-call specialists.

Labor Day evening, I called the Matthews hospital because Champ refused to eat and therefore could not be given insulin. I was instructed to take him to the Huntersville hospital because the on-call specialists were at that location. Dr. Huff examined Champ and diagnosed his condition as DKA (diabetic ketoacidosis) and provided me with some printed literature on the subject.

Dr. Huff suggested that I take Champ the following morning to see Dr. Jaeger at the Charlotte location. I explained why I did not want to do that and urged Dr. Huff to admit Champ for observation overnight. After collecting a $1,500 deposit, Dr. Huff admitted Champ to the Huntersville hospital.

Following my departure from the hospital and expressing my concerns about Champ’s declining condition to Dr. Marshall, she called Dr. Huff and requested that she start Champ on the antibiotic Clindamycin. Clindamycin was started around 2:00am along with Unasyn; Baytril was added at 3:00am.

Dr. Huff did not engage the services of the on-call specialists.

Champ was examined by Dr. Susanne LeGrange, a board-certified specialist who diagnosed a severe surgical site infection and the cause of the DKA. Dr. LeGrange further stated that surgical intervention was necessary to control the infection and would cost $6,000 to $9,000.

Dr. LeGrange put me in contact with the surgeon, Dr. Sara Schillinger who further explained the need for surgery to control the infection, then transferred me to Rebecca who informed me a $6,700 deposit was required before they would proceed with Champ’s surgery. I asked for a phone number to speak with someone on a corporate level; Rebecca said she would speak to the hospital director, Lisa, who would speak with the medical director, Dr. Bass, and then Lisa would call me.

Shortly thereafter, Dr. Schillinger called and said that no one was available to talk to me Again, I requested the phone number of someone in the corporate office. She refused and would only give me the phone number for the Matthews hospital. Dr. Schillinger explained that in order to continue Champ’s treatment at the Huntersville hospital, a deposit was needed, further stating “if you don’t want to do that, you can come pick him up.”

Multiple attempts were made to speak with Dr. Nanfelt and Danielle Caisse at the Matthews hospital, as well as PetVet Care Centers, the parent company located in Connecticut. None of my calls were ever returned.

The medical director of the Huntersville hospital, Dr. Shannon Bass, called and we discussed the situation at length. Dr. Bass agreed that Champ did not wake up on Monday with an infection that he didn’t have on Saturday. In fact Dr. Bass stated:

• “I agree with you, in hindsight, in hindsight there’s no question that it was brewing earlier. We can’t, you know, hindsight is, is just something that we don’t always have the luxury of. And so, Saturday morning it was not obvious. By Monday night, it was.”

I responded, emphatically stating:

• “But they didn’t do anything to check on Saturday.”

Again, Dr. Bass agreed stating:

• “And I’m not disagreeing with that. Obviously, that’s fact. They did not do anything to check. Her opinion based on her physical exam was that there wasn’t an infection. That’s a fact. You know and there’s nothing to disagree with about that. I agree. And so I agree with you, this didn’t just start on Monday, in hindsight we know that it was cooking. But she didn’t know that on Saturday morning.”

Later the same day, Dr. Bass informed me that all the doctors carried insurance for these kinds of situations; Champ’s records were being sent to the insurance carrier and it would be a couple days until she knew more.

Eight days after the amputation surgery, numerous entries were added to Champ’s medical record and existing entries altered, removed altogether, or replaced with less than accurate reports. Dr. Nanfelt added a full page summary of “written down notes from my personal conversation when Dr. Marshall called me the morning of the consultation” purportedly from a discussion on 8/26, which directly contradicts earlier reports and communication. Believing the report to be true, the Huntersville hospital acted on what was stated and decreased Champ’s normal dose of insulin, only to increase it to the correct dose when he did not respond well to the lower dose.

Champ’s medical record indicates that he was in surgery with Dr. Schillinger, beginning at 9:25am. The record also indicates that he was in surgery with Dr. Bonin, beginning at 9:35am. Furthermore, Champ’s record indicates that Dr. Gordon performed the surgery that morning.

Dr. Bass informed me that she, along with Dr. Robert Bergman (medical director of the Matthews hospital) and the doctors currently treating Champ, had determined no errors were made that would cause the hospital to be financially responsible for Champ’s care. She further explained that infection is an unfortunate risk of surgery and that I was responsible for the cost of Champ’s treatment, already over $10,000 and incremental to the $5,000 that I had spent the previous week at the Matthews hospital.

Dr. Bass called and informed me that Champ’s doctors were unwilling to continue caring for him and other staff was unwilling to get involved, because they all knew they would not be paid. Dr. Bass also stated numerous times that she didn’t want to send Champ home before he was medically ready, but she couldn’t keep paying thousands of dollars with my financial participation.

Although Dr. Bonin had stated that he would call with an update and to discuss when Champ might be able to go home, he did not. When I visited Champ during the late afternoon, it was very clear that Champ was coming home with me. Dr. Thompson discharged Champ and reviewed his at-home care instructions, which I had to sign. Dr. Thompson also provided details on the three highly resistant organisms that were cultured from Champ’s surgical site and how to protect myself from infection; none of the other doctors shared this information with me although this information was known to them

Upon discharge, Champ was still unable to walk and had no control over his rear leg. There were multiple sores/wounds on his rear leg that were acquired while he was at CVS; stitches still remained in his neck from the jugular catheter.

Three days after CVS received the final sensitivity report, Dr. Schillinger called with the results and stated that CVS did not stock the medication needed; it could be ordered and would be at least 48 hours before they would receive the drug. With only one phone call, Dr. Marshall sourced the medication locally and started treatment within a few hours of her discussion with Dr. Schillinger.

That afternoon, Dr. Marshall and her assistant spent four hours at my home tending to Champ; his bandage was removed, the wound oozing pus was cleaned and redressed. Dr. Marshall brought all of the supplies necessary and educated me on how to administer Champ’s injectable antibiotics, plus clean and dress the wound.

Dr. Marshall reached out to CVS Huntersville upon discovering information contraindicating the three drug combo Dr. Schillinger had prescribed. Although the intern claimed to be unfamiliar with the sensitivity results and the three drug combo, Dr. Marshall was informed if that’s what Dr. Schillinger told her, that was correct.

At 1:00am, after hours of research and numerous telephone discussions, Dr. Marshall renounced the three-drug combination prescribed by Dr. Schillinger, discontinuing Chloramphenicol, which is known to cause anemia, low blood platelets, low white blood cell counts, lower the body’s ability to fight infection, and affect blood sugar in diabetic patients. Clindamycin and Meropenem were both increased. Champ responded immediately and for the first time in nearly two weeks, I felt that he had a chance.

Champ was able to walk when he was admitted to the Huntersville hospital, but was unable to walk and had no control of his remaining rear leg following the first of the surgeries to control the infection. CVS doctors claimed that Champ was just weak and would regain strength over time. Because of the numerous wounds he was discharged with and having lost three of the pads on his rear foot, Champ could not participate in a professional physical therapy program.

As such, Dr. Marshall used laser therapy on Champ’s foot to expedite the healing process and showed me how to exercise Champ’s leg. Using PVC, heavy-duty springs, and the padded strap to a knee board, I made Champ an apparatus to support him while I worked with his leg. Every week or two, the springs would be changed, providing less support, as Champ slowly regained the use of his leg. It was a slow process and three months before all the wounds had healed and Champ was able to ambulate without assistance.

Champ began to limp and there was a noticeable lump on the top of his foot. I spoke with Dr. Marshall and she asked me to have Dr. Lydolf at North Mecklenburg Animal Hospital take x-rays of Champ’s foot and his chest.

Less than two months shy of two years since Champ’s amputation, I met with Dr. Lydolf and updated her on all that had happened with Champ; correcting the inaccurate information that Dr. Bass from CVS had given her almost two years prior. Dr. Lydolf examined Champ and reported the x-ray results; the lump was suspected to be a tumor.

The tumor was growing so fast and through constant contact with Dr. Marshall, periodic appointments and medications adjusted, Champ seemed to be very comfortable. He was insistent on accompanying me on any errand or customer appointment that I had, just like always. But I knew the inevitable was near.

Dr. Marshall examined Champ, amazed at how well he was getting around given the size of the lump, and how happy he was. Thinking the lump might possibly be a soft tissue disorder and not a tumor, Dr. Marshall called North Meck and requested Champ’s x-rays.

Driving home with Champ, I thought my prayers had been answered and a miracle delivered. That all quickly ended when Dr. Marshall called after reviewing the x-rays which showed two fractures from almost two months prior. Dr. Marshall presented several options for possible treatment; all requiring surgery and another limb or partial limb sacrificed.

Almost two years ago, I promised Champ that I would never do that to him again. Through the tears, I realized that my miracle had already been delivered – Champ by my side far longer than anyone could have imagined. He was there for me through some extremely difficult times; no judgment or criticism, just unconditional love and companionship. I now had to be there and do what’s right for Champ.

Shortly before 7:00pm, with Dr. Marshall’s help, Champ fell asleep with his head in my lap one last time.