Saving Charlie: Referral & Communication in Critical Care

Sponsored by VCA

Charlie was a 2-year-old cat with a progressive series of adverse events and medical complications that are the stuff of veterinary nightmares. Follow this case to examine how Charlie’s owners and his primary veterinarian benefited from key collaborations with local specialists to facilitate his care and save his life.

The Case

Approximately one year prior to his most recent presentation to his primary veterinarian, Charlie was seen by surgical and emergency and critical care specialists at a referral specialty VCA hospital for a septic abdomen secondary to a GI foreign body. Complications in treatment led to cardiac arrest; thankfully, however, Charlie was revived.

Unfortunately, the arrest caused further complications for Charlie. He developed seizures—likely due to ischemia during the arrest—that were managed at a VCA specialty hospital by a neurology specialist. Phenobarbital was initiated. Addressing these complications required coordination and teamwork between multiple specialists and with the referring veterinarian.

Once Charlie was discharged, follow-up appointments were conducted by his primary veterinarian for continued seizure management, but Charlie’s complications continued. He developed anemia and thrombocytopenia from erythrocytic and thrombocytic blood dyscrasias secondary to phenobarbital administration.

Charlie was then referred back to the VCA specialty hospital by the primary veterinarian for management by the criticalist and neurologist. He received blood transfusions, underwent a bone marrow biopsy and management for breakthrough seizures, and was started on a new anticonvulsant. With time and care, Charlie’s anemia and thrombocytopenia resolved, and seizure activity was stabilized. Charlie was discharged, and follow-up care was performed as needed by the primary veterinarian.

Conclusion: The 4 Pillars

Caring for pets that have complicated diseases can be difficult for many pet owners. Throughout Charlie’s time at the VCA specialty hospital, the referring veterinarian received numerous updates, both by phone and fax. The specialist and referring veterinarian continued to follow up with each other after discharges and all subsequent appointments. Both the specialist and the referring veterinarian remained in contact with Charlie’s owners to ensure that all of Charlie’s medical needs were being met and that the owners were comfortable with his treatment and care. The owners expressed appreciation for the team effort between all of the specialists and the referring veterinarian and were grateful for everyone’s willingness to work so well together.

Comorbidities and the consequences of treatment can result in drastic changes in a pet’s health, warranting immediate aid at unexpected times. Building a foundation of teamwork through collaboration, communication, accessibility, and respect between specialists and the referring veterinarian was critical to Charlie’s positive outcome. Complicated but rewarding cases like Charlie’s demonstrate the importance of these collaborative efforts and their potentially extraordinary impact.