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Snap, Crackle, and Pop

Lisa enjoyed her nurse clinics as they were a welcome break from the hustle and bustle of the prep room and perpetual balancing of the controlled drugs register. She was particularly proud of her record on managing obesity and had developed a merry band of obedient followers previously resistant to the “name and shame” approach adopted by her veterinary colleagues.

Mr Arbuckle’s Springer Spaniel Twiggy, however, the irony of her name not lost on Lisa, had eluded her, primarily as a result of Mr Arbuckle and his wife, Mabel’s inability to count the calories in the ubiquitous treats and scraps eagerly awaited by the now, at best, portly Twiggy.

Defeated on this front, Lisa prepared herself for the inevitable battle required to clip the rather sedentary Twiggy’s nails, the mere sight of the nail clippers provoking a level of hysteria sufficient to impress even Jean-Martin Charcot (look him up! – Ed.), usually with accompanying evacuations of her bladder and anal sacs. As the fracas unfolded and battle commenced, Lisa recognised on this occasion she was beaten and suggested it might be sensible to sedate Twiggy in order to complete the task.

With the consent form completed, including the option of general anaesthesia should the need arise, Twiggy was admitted and a combination of medetomidine and butorphanol was injected intramuscularly. Sadly, by now, as Charlie the clinician assisting Lisa kicked himself for not recognising earlier, all of Twiggy’s alpha 2 receptors were snugly covered in a blanket of adrenaline with no room at the Inn for a lowly medetomidine molecule. With time ticking and Twiggy only demonstrating the slightest degree of sedation, a little propofol sealed the deal and her nails were clipped as short as Lisa dared and the stocks of silver nitrate allowed.

As Mr Arbuckle waited eagerly to collect Twiggy, sausage roll in hand, a little treat in recognition of the ordeal she had suffered, Lisa went to retrieve her from her kennel where she was now sleeping soundly. As she tottered out, the colour drained from Lisa’s face as Twiggy carried her left hindlimb with an unusual and unnatural looking swing to it. Charlie was swiftly called and a cursory examination revealed an ominous crepitus in the area of her mid femur, a pallor rapidly forming on Charlie’s face to more than match that of Lisa’s. A quick chat to Mr Arbuckle followed by radiography later confirmed everyone’s worst fears; somehow Twiggy had sustained an oblique fracture of her mid femoral diaphysis.

Racking their brains, the only incident Lisa and Charlie could recall apart from the initial scrabbling on the consulting room floor was a brief moment when Twiggy’s leg slipped between the prep room table and wall as the propofol was administered. With no evidence of bony pathology and apparently normal mineral density, the only option Lisa and Charlie felt they had was to refer Twiggy for surgical reduction and stabilisation of the fracture, the expense of which Mr Arbuckle was unfortunately unable to bear.

"As she tottered out, the colour drained from Lisa’s face as Twiggy carried her left hindlimb with an unusual and unnatural looking swing to it."

Lisa called the Society. The Claims Consultant explained how cases such as this can be quite challenging in terms of liability. After all, what more could Lisa and Charlie have done under the circumstances? Their actions would not be considered as negligent and yet Twiggy had sustained an injury whilst under their care. With Lisa and Charlie feeling they had a moral obligation to help Mr and Mrs Arbuckle, referral was arranged as the Claims Consultant explained the Society’s position was at that point reserved.

There are occasions when injuries can occur to patients through no fault of the attending veterinary surgeon or nurse; for instance, if there are unknown pre-existing conditions such as hip dysplasia, particularly in small breed dogs and cats. On such occasions we may take the view any claim brought as a result of, say a joint luxation, is defensible. It becomes more difficult if a patient escapes from restraint and is injured as they fall and the devil is very much in the detail when it comes to assessing such claims.

In Twiggy’s case, given there was no pre-existing disease and the referral surgeon concurred with Charlie and the Claims Consultant on the issue of skeletal mineral density, the Society took a sympathetic approach and reimbursed Charlie’s practice for the referral fees they settled net of VAT, the VAT component being recovered through their quarterly return.

The now bionic Twiggy recovered well and was oblivious to the anxiety she had caused. Mr and Mrs Arbuckle remained loyal clients, albeit with some reluctance to have Twiggy’s nails clipped again. This was however partly mitigated by Twiggy’s new-found athletic prowess as a result of her weight loss, deftly orchestrated by Lisa and the now more compliant Arbuckle’s, who Lisa had to concede were themselves looking a little trimmer than before.

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