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HELP STOP THIS INHUMANE & DANGEROUS VETERINARY PRACTICE - Fill in the form below, print and mail to your local veterinarian, your jurisdictional veterinarian association & educational institutions. Also feel free to make copies of this material to pass out to dog and cat clubs and your friends.  Full Autopsy Report here or scroll down.
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The Report Newsmagazine www.report.ca - October 9, 2000

Going for the jugular

A Calgary dog breeder’s lawsuit illustrates the danger of vets drawing blood from the neck - by Candis McLean

Engraved on Trudy Kerr’s licence plate is the word "Shih Tzu." For the past 25 years she says she has devoted much of her life and half a million dollars to importing dogs and re-establishing an almost-extinct bloodline of the breed which came to the western world from the Peking palace in China. Not only is this line "living history," dog fanciers say, but it is free of the hereditary kidney ailment often found in the Shih Tzu breed. In a statement of claim which Ms. Kerr filed, she alleges her four-year-old female, Yasmine von Dalai (Minnie), was the last female of the line who had proven she could have pups. Expert estimates on Yasmine’s value range from $30,000 to $1 million. Just before Christmas 1994, Ms. Kerr asked Yasmine’s co-owners to take the dog to a Calgary veterinarian. "Minnie went in, wagging her tail, for another opinion on a non-life-threatening diagnosis and she came out dead," Ms. Kerr states.


(click photo to enlarge)

"I can still see this little dog lying there on her owner’s arm with nobody realizing she was bleeding to death." In June of this year, the lawsuit Ms. Kerr launched against the Associate Veterinary Clinics for $2.1 million was finally settled out of court for substantially less. "It’s an unnecessary tragedy that I’m absolutely positive happens more times than we will ever know," Ms. Kerr claims. "I nearly lost another dog in the U.S. this way. Pet owners have to be made aware of the danger of attempting to draw blood from the jugular vein."

An autopsy on the dog, paid for by Dr. Stone and performed by the Central Laboratory for Veterinarians in Calgary, attributes death to "acute blood loss and...it is almost certain that the hemorrhage was a result of disruption of an artery." A pair of 3-mm holes "on the left carotid artery are assumed to be the origin of the hemorrhage," the report states. The carotid artery is buried more deeply in the neck than the jugular vein; both are major blood vessels.

Ms. Kerr believes owners should take responsibility for examining the fate of their dead pets rather than simply permitting their bodies to be cremated without examination; she would also like some veterinary practices changed. "The traditional practices are better than the new," she claims. "Years ago they had me hold the dog’s leg while they drew blood where there was virtually no chance of hitting a major blood vessel. Then they would ask me to put my finger on the spot to stop the bleeding. But how can you put your finger on the neck to stop interstitial bleeding?"

Like most other veterinarians interviewed, Dr. Stone defends the standard practice. "We’ve done this procedure 30 times a day for the last 10 years and have had one complication--and it would have to be this dog! It’s been a living nightmare. I don’t want to be pilloried as some unethical and uncaring vet. We are the largest veterinary practice in Canada and we didn’t get to this size by being bad veterinarians. An Alberta Veterinary Medical Association (AVMA) investigation absolved us of any unskilled practice. Trudy is trying to achieve through the media what she could not achieve legally--the impugning of my reputation."

Not true, Ms. Kerr replies. "I trusted Dr. Stone and he killed our ‘kid’ [i.e., pet], her future progeny and my struggle to restore the bloodline. This will never leave me."

In a letter to Ms. Kerr shortly after the dog’s death, Dr. Stone wrote "For the past 10 years at least it has been our practice to take blood from the jugular vein on cats and small dogs. We do this for a variety of reasons, among them the difficulty of getting a large volume of blood from other sites and the wish to preserve front leg veins for future I/Vs...Although highly unfortunate, my conclusion is that this is a freak, fortunately extremely rare, occurrence and there are no additional steps which we can take to totally eliminate the risk."

However, Dr. Stone did admit in the examination for discovery that in a Shih Tzu, because of the short neck and abundance of fur, it is difficult to get an "anatomical configuration" in order to find the jugular vein. Asked if there was any way to have controlled the bleeding, Dr. Stone indicated that indeed there wasn’t because they couldn’t even see where the blood was coming from. He adds today that they didn’t know the dog was bleeding and acknowledges that had the blood been taken from the leg, he could have seen that it was bleeding. In the examination for discovery, too, Dr. Stone indicated that it was not uncommon to be forced to try a few times to hit the jugular in a dog like a Shih Tzu. Asked how a needle of 1 mm or less in width could make a laceration of 3 mm in the carotid artery, he explained that the end of the needle is bevelled, and the edges are sharp. If one touches a cylindrical structure like the carotid artery with the end of the needle, one could make a cut of any length.

A random sampling of veterinarians reveals many have never heard of problems with extracting blood from the jugular, but an Edmonton veterinarian who asked not to be identified because "every vet in town would descend upon me," says the practice of drawing blood from the jugular "absolutely horrifies" him. "When you pull the head back it brings the carotid further forward, and if you’re not careful you hit all kinds of things. The most vulnerable part of the body is the neck region with a complexity of blood vessels, wind pipe, food pipe, major glands and nerves." Although he is aware of a number of complications, he knows personally of only two cases resulting in the death of a small animal, "but I’m sure it happens many, many times. In my opinion blood-collection techniques from the jugular vein are acceptable only in large animals or small animals under anaesthesia. It is extremely objectionable to routinely bleed pets for blood samples from the jugular vein when much simpler and safer techniques are available. Why take the risk?"
(click photo to enlarge)

A random sampling of veterinarians reveals many have never heard of problems with extracting blood from the jugular, but an Edmonton veterinarian who asked not to be identified because "every vet in town would descend upon me," says the practice of drawing blood from the jugular "absolutely horrifies" him. "When you pull the head back it brings the carotid further forward, and if you’re not careful you hit all kinds of things. The most vulnerable part of the body is the neck region with a complexity of blood vessels, wind pipe, food pipe, major glands and nerves." Although he is aware of a number of complications, he knows personally of only two cases resulting in the death of a small animal, "but I’m sure it happens many, many times. In my opinion blood-collection techniques from the jugular vein are acceptable only in large animals or small animals under anaesthesia. It is extremely objectionable to routinely bleed pets for blood samples from the jugular vein when much simpler and safer techniques are available. Why take the risk?"

Contacted for his opinion on the debate, the deputy registrar of the AVMA, Dr. Clay Gellhaus, cautions, "Items like this should be reported but they shouldn’t cause alarm. Because one dog had a problem, we don’t want people to say we can’t ever do the procedure again."

Adds Dr. Stan Rubin of the University of Saskatchewan School of Veterinary Medicine "Collecting blood from dogs is much more difficult than the medical profession deals with--dogs wiggle and don’t understand. You have to be a real artist. We train people to use the jugular."

2000 United Western Communications
Reprinted with permission

TO: ALL DOG FANCIERS - THIS HAS TO STOP!!!!

RE: "DIAGNOSIS: ACUTE HEMORRHAGE"

Below you will find exact copy of Central Laboratory For Veterinarians Ltd. Autopsy Report on Minnie. We never would have known of Minnie's fate were it not for the fact that she was brought home after her death. We noticed blood on her coat on her neck and a lot of thickness under the skin and we suggested that maybe she bled to death, but we were told this could not have been the case and an autopsy was offered with the results as follows below.  click here for autopsy report below

Minnie went into the Vet Wagging her tail for a simple thyroid test and came out dead from loss of blood from attempting to draw blood from the jugular vein which was missed resulting in "two small slightly oblique lacerations are present approximately 3 mm apparent at roughly halfway between the thoracic inlet and angle of the jaw on the left carotid artery and are assumed to be the origin of the hemorrhage." "DIAGNOSIS: ACUTE HEMORRHAGE."

Our opinion is that this happens more times than we will ever know. This unnecessary loss and tragedy was said by the vet to be a "fluke". It is our intention to stop this method of drawing blood as common practice, unless absolutely necessary, to prevent this extremely upsetting tragedy from happening to others. The undersigned had always asked to have the blood drawn from the leg, but unfortunately her master took her and this is now said to be their "standard practice". It appears they intend to continue to use the jugular vein to draw blood on smaller animals and don't seem to want to accept that this is very dangerous. There is no reason why they cannot use a tourniquet if they have difficulty with the veins on the legs of small dogs and cats, but it seems to me they choose the quickest method regardless of consequences. On many occasions in the past my dogs have come home from hospitalization with huge hematomas on the neck and I really believe this happens often, but not with such severe consequences so it is continued and thought to be acceptable. Three months prior to Minnie's death I had another dog in the same clinic and I feel the same thing happened as he apparently collapsed on the table prior to operating which could have been when the blood test had been take prior to operating.

This tragedy is very hard to accept as a mere "fluke". Minnie was also the last proven female of the now virtually extinct old original line of Shih Tzu developed in China. Minnie was in her prime for breeding when she bled to death on her owner's arm at the Vet's while waiting for the Vet to come back into the examining room.

COPY & CIRCULATE

Without Prejudice:

TO: _________________________________________

ADDRESS:___________________________________

____________________________________________

FAX:________________________________________

Re: A Calgary dog breeder’s lawsuit illustrates the danger of vets drawing blood from the neck - by Candis McLean
- "two small slightly oblique lacerations are present approximately 3 mm apparent at roughly halfway between the thoracic inlet and angle of the jaw on the left carotid artery and are assumed to be the origin of the hemorrhage."
- "DIAGNOSIS: ACUTE HEMORRHAGE"

Please consider the undersigned hereto as a party to a group of individuals attempting to have vets on a world wide level discontinue the horrific practice of routinely drawing blood from the jugular vein in small animals, namely dogs and cats. This is an extremely dangerous site from which to draw blood for testing. Don't listen to them try to say it is rare that anything drastic happens. Here is a quote from a well qualified vet who says the drawing of blood from the jugular vein "absolutely horrifies" him. "When you pull the head back it brings the carotid further forward, and if you're not careful you hit all kinds of things. The most vulnerable part of the body is the neck region with a complexity of blood vessels, wind pipe, food pipe, major glands and nerves." He is aware of a number of complications, "I'm sure it happens many, many times" that animals die. "In my opinion, blood-collection techniques from the jugular vein are acceptable only in large animals or small animals under an anesthesia. It is extremely objectionable to routinely bleed pets for blood samples from the jugular vein when much simpler and safer techniques are available. Why take the risk?"

Respectfully submitted,

________________________________
(signature)

________________________________
(your name)

________________________________
(your address)

________________________________
(Ph/Fax and/or email address)

COPY ONLY)
CENTRAL LABORATORIES FOR VETERINARIANS LTD.

____________________________________________________________________________________

5645 - 199th Street, Langley, B.C., V3A 1H9 Phone: (604) 533-4884 Fax: (604) 533-0289

5080 - 12A Street S.E., Calgary, Alta. T2G 5K9 Phone: (403) 214-1506 Fax: (403) 214-1562

30 December 1994

LAB NO:                     94-12371

HOSPITAL:                CALGARY N VET HOSPITAL 412C495 CAL LAB

DOCTOR:                   STONE

OWNER:                     MCLEAN

ANIMAL:                     MINNIE

BIOPSY SITE:             NECROPSY

GROSS:  Received for autopsy examination is a spayed (this is incorrect - this female was never spayed) female dog. On external examination the dog is mildly to moderately overweight. There is pinkish red staining around the vulva. A 2 x 3 cm bruise is evident caudal to the right scapula and a 1 cm in diameter bruise is evident over the cranial point of the sternum. Several puncture wounds (needle marks) are present in a 1 cm area on the left ventrolateral aspect of the neck. The ventral neck appears generally swollen and slightly edematous. On internal examination in general there is moderate to abundant subcutaneous and intra-abdominal fat. The bruises previously described are superficial and seemingly involve only the dermis and superficial subcutaneous tissue. There is massive hemorrhage and mild edema involving the superficial and deep tissues of the ventral neck and appear to be originating in the area of the left jugular groove. The hemorrhage extends from the caudal mandible and larynx, surrounds the trachea and esophagus and extends throughout the mediastinum both cranially and caudally. Two small slightly oblique lacerations are present approximately 3 mm apparent at roughly halfway between the thoracic inlet and angle of the jaw on the left carotid artery and are assumed to be the origin of the hemorrhage. Bone marrow from the femur is uniformly dark red. On examination of the thoracic cavity a small amount of blood (approximately 10-15 ml) is present free in the pleural cavity. The lungs are somewhat collapsed. Approximately 5 ml of blood is present in the pericardial sac but the heart if otherwise normal. As previously mentioned there is hemorrhage throughout the mediastinum. On opening the abdominal cavity the stomach contains dog food and there is ingesta throughout the gastrointestinal tract with formed feces in the colon.

PAGE 2
 
94-12371

Patchy areas of congestion are present on the gastric mucosa in the fundic region and some of the mucous is blood tinged. The proximal duodenum contains blood stained mucous material which becomes progressively more normal colored as the jejunum is approached. The mesenteric lymph nodes are congested. The spleen is highly contracted and there is congestion/hemorrhage into the fat of the omentum where the spleen attaches. The bladder is contracted and the walls are thickened. A 5 mm in diameter area of hemorrhage is present on the ventral bladder serosa near the neck (cysto site?). The bladder mucosa is blackish appearing and thickened. A single 1-2 mm in diameter stone is present (submitted for analysis) along with some dust like mineral deposits. Multiple tissues are placed in formalin for future histologic examination. Jim Bilenduk, DVM; MVSc. Diplomate ACVP.


HISTOLOGY:

Multiple tissues are selected and include SKIN AND SUBCUTIS FROM THE VENTRAL NECK WHERE HEMORRHAGE WAS PRESENT AS WELL AS BOTH OVARIES AND URINARY BLADDER ARE EXAMINED. MULTIPLE SECTIONS OF LUNG ARE EXAMINED AS WELL AS SECTIONS OF STOMACH AND SMALL AND LARGE BOWEL. MULTIPLE SECTIONS OF HEART ARE EVALUATED AS WELL AS LYMPH NODES FROM MULTIPLE SITES. BOTH ADRENAL GLANDS AND KIDNEYS ARE EXAMINED AS WELL AS THYROID AND PARATHYROID GLANDS. THE DUODENUM AND ADJACENT PANCREAS ARE EVALUATED. THE SPLEEN TO INCLUDE THE AREA OF ADJACENT HEMORRHAGE IS ALSO EXAMINED. SECTIONS FROM THE LIVER AND MULTIPLE SECTIONS OF BRAIN TO INCLUDE ALL MAJOR SITES ARE EVALUATED. IN ADDITION, SAMPLES OF FEMORAL BONE MARROW ARE EVALUATED AND THE SEGMENT OF LEFT CAROTID ARTERY AND ADJACENT FATTY TISSUE AND NERVE ARE EMBEDDED IN BLOCK AND FROM WHICH MULTIPLE SECTIONS ARE PREPARED. The sections of CAROTID ARTERY include
(3/4 line of text whited out here) the site of disruption and hemorrhage of recent origin. At this area of disruption and intimately associated with it are several small fragments of foreign material some of which are clearly of plant origin. There is no inflammatory cell response associated with the hemorrhage and disruption of the vessel or with the foreign material. The sections of URINARY BLADDER reveal a chronic inflammatory process associated with considerable thickening of the mucosa accompanied by an inflammatory cell response which is of a mixed type of plasma cells and neutrophils present in abundance an in near equal numbers.

PAGE 3 

94-12371

Local areas of scarring and hemosiderosis can be found in the mucosa as well. Tissues selected from the sites of GROSSLY APPARENT HEMORRHAGE reveal recently extravasated blood unaccompanied by inflammation, degeneration or necrosis. Sections of LUNG reveal some sites to be diffusely congested and edematous and other sites to be extensively atelectatic with occasional small bullae. Sections of BONE MARROW reveal a normal tissue in which all of the usual elements are present and proportional. Sections of KIDNEY reveal some of the glomerular tufts to be more exaggerated by the presence of a homogeneous fibrillar material present in some of the vascular spaces. Special stains to evaluate basement membranes and to evaluate for amyloid provide no insight. That is to say there is no evidence of amyloid and the homogenous material noted grossly is not of basement membrane origin and almost certainly to be the result of fibrin deposits. OTHER TISSUES/ORGANS are unremarkable or uninformative and reveal only modest to moderate autolysis affecting some sites especially the mucosa of the bowel.
DIAGNOSIS:ACUTE HEMORRHAGE, EXTENSIVE, SOFT TISSUE OF VENTRAL NECK,
THORAX AND MEDIASTINUM
CHRONIC CYSTITIS WITH UROLITHIASIS

COMMENTS:

The acute death of this dog can be attributed to acute blood loss and based upon the volume and color of blood it is almost certain that the hemorrhage was a result of disruption of an artery. The lacerations noted in the gross description may be the sites of hemorrhage but the possibility that they were the result of having been nicked during the gross autopsy cannot be completely discounted because of the presence of foreign material in the blood clot at that site. There is nothing to suggest an impairment to the clotting or coagulation system as judged by absence of hemosiderin in the spleen or hemorrhages in other sites or an abnormal bone marrow. The fibrinous deposits in some of the glomerular tufts is probably the result of terminal coagulation set in motion by the hemorrhage. The atelectasis and congestion in the lung and hemorrhage adjacent to the spleen are most likely to be the result of resuscitative efforts

signed by:
David Gribble, DVM; PhD. Diplomate, ACVP