Dear Mr and Mrs Leech I write in response to your email dated Saturday 26th May at 06.26 am. Thank you for the time you have taken in addressing your concerns directly to myself as the Practice Owner. I have conducted a full investigation with several members of the team involved in Dukes care and am in a position to respond. You telephoned the practice at 08.47 on Friday the 18th of May. You seemed quite worried that Duke seemed to be painful with his damaged Dew claw and expressed some concern for him to be seen. Our morning surgeries were fully booked for that morning and as you were concerned we offered for a Veterinary Nurse to triage Duke for initial assessment to save him waiting for an appointment later that day with a veterinary surgeon. My team were also mindful that many dogs that have injured dew claws need removal of damaged nails under general anaesthesia, so this is much better managed during the day than of a Friday evening. You accepted and attended this appointment as offered at 10am. At this appointment you advised that the pulled nail has occurred on the Monday, some 5 days prior. It bled a little at the time and then had ceased. Duke had again pulled the nail on the bedding on this Friday morning. My nurse reported that although you were trying to restrain Duke for her to be able to assess the extent of the damage, Duke was very wriggly and this was proving difficult. She offered to take Duke to our preoperative area where other nurses may be available and also the theatre vet whom was with patients but available there and could assess the toe also. Obviously with Dukes breed being that of a Pug, it is not in his best interests to wriggly or to struggle, he was obviously also in pain and many times when we take patients away from owners they are actually much better. They often panic when owners are restraining, especially if they are painful and in a larger environment than in a consult room a lot of pets are much better. If at any point when we take pets away from owners they are more anxious, then indeed straight away we would return them to your presence. It was actually myself that was on theatre duty that morning. I can assure you that when Emma presented Duke to me, he was both vocalising and also wriggly before anyone even approached him. He had obviously become a little anxious in the consulting room with the initial attempt to look at his injury. He did actually settle within a few moments when stood on the examination table and given a minute to compose. We didn’t actually touch his damaged nail at all. I merely held the bottom of his limb around his wrist in order lift the foot and hold this still to visually look at the nail to see if it was loose, damaged and assess for infection. He was extremely vocal, likely as he resented this examination, and his nail was very painful. Duke clearly did not want us to look at this. Dogs sadly frequently damage their nails and they are often very painful, they lick, can be very swollen, and also as they in contact with the ground and there is a crack in the nail then quickly they become contaminated and trap dirt and matter between the nail and the nail bed. Therefore many damaged nails are very painful. There is also the initial pain cause by the force that caused the damage to the nail in the first place. This distressed cries as you so described in your letter were due to the pain the ripped toe nail was causing, probably exaggerated a little by vocalisation in communicating to us that he really didn’t want us to look, because it was so sore. I communicated to the nurse as it was apparent the nail was cracked to the base of the nail. She came to communicate this with you and go through the procedure to remove the damaged nail under general anaesthesia. I was actually also overseeing a patient undergoing radiography and was not able to leave the area for any period of time to actually speak to you in person. I wouldn’t have told you anything different than my nurse had done about what we recommended. Your letter suggested you questioned the removal as he is a Pug. The nail is damaged and painful and needs to be removed regardless of breed. There are indeed other considerations that are required for certain breeds which were all considered appropriately. According to my consent form details on admission despite calling first thing, you actually reported when we went through more details for admission that you gave Duke his breakfast at 9.30am. General anaesthesia requires a period of fasting to ensure the stomach is free from food. Therefore as he ate breakfast this resulted in a delay in how soon we could actually perform the procedure. At this point you asked could you take Duke home and bring him back later. I had multiple surgical procedures that day and we were also then accommodating Duke to this schedule as the nail was painful and we didn’t want any unnecessary delay. We also had to be mindful of the earliest time he could have his procedure from due to the lack of fasting. I also noted that you lived some distance from the practice meaning that when we were ready for Duke, it would likely take you some time to return to the practice. All patients that are having surgical procedures would be admitted first thing in the morning. Certainly where patients may have issues we would admit with an owner and then do straight away, and ring owners to collect when we are happy with the recovery. I know you were concerned about Duke becoming distressed. He was actually a very happy dog in our hospital ward. He rested very well, didn’t vocalise at all and was actually quite characterful with the other dogs, just waiting his turn. If any dog is anxious then of course we would have called you to collect him straight away. You advised that you were charged for pre- operative care. You were charged for hospitalisation for the period of time that Duke was with us. This charge was £39.56. There was no separate charge for the appointment with the nurse. Standard vet appointments would be £28.50. The hospitalisation charge incorporates the use of the kennel, bedding which is all washed, cleaning products for every kennel and professional time for the nursing time during the 4 to 6 hours that Duke was hospitalised. You were given an estimate at the time of the admission of approximately £300.00. You signed the consent form for the procedure and agreed to the costs and we proceeded as planned with the general anaesthetic and removal of the damaged nail. Once duke was anaesthetised and the nail was removed, it was apparent that there was significant pus and infection trapped under the nail bed. The total cost of the procedure was £306.72, which included the pain relief to go home, and the anticipated recheck to see Duke for his dressing removal. This was therefore £6.72 over the estimate once Dukes accurate bodyweight and drug doses were calculated. The additional antibiotics that were required due to the presence of infection added the extra £27.77 for the 5 day course we prescribed. When injuries are fresh it would be uncommon to require antibiotic therapy. You collected duke as planned that afternoon. A discharge appointment was with a nurse whom went through the post operative care with you. You attended the scheduled nurse appointment on Monday the 21st as planned. The post operative check was booked with a nurse. My nursing team and suitably qualified and indeed experienced in many aspects of post operative care and management of wounds and dressings. It is common that if nurses consider any issues with patients at the appointments then they would consult with a vet if needed. As vets we will often check wounds when dressings are removed as we usually remove dressings in the pre operative area. I note from the records that Rachel wanted to do this however you declined Duke being taken out of the consulting room and she proceeded to remove the dressing in your presence. Duke remained calm as his dressing was removed as your letter notes, thankfully this is likely as on this occasion his toe was much more comfortable. Your notes advise there was no vet on duty. I can assure you there were three veterinary surgeons present on the premises at this time. Two were consulting and one was in theatre. You reported to the nurse that Duke had been making a ‘funny noise’ but it had resolved within 24 hours. With any patient having undergone general anaesthesia then for a short time after, there can be a small amount of mucus or mild respiratory noise from the presence of the endotracheal tube. Rachel offered this as an explanation and as you already reported it had subsided, hence this is the most likely explanation. Your letter refers to Stridor which is a wheezing noise and usually occurs due to laryngeal disease or respiratory obstruction. Stertuous breathing is likely to create the noise that you were hearing and is very common in the brachycephalic breeds as you so describe and this occurs due to the multiple conformational abnormalities that exist in the breeds that I am sure you are aware of. During visits and I am sure normally you will probably notice a degree of respiratory noise especially during exercise and likely when Duke is sleeping he may snore?. It is unfortunate that you feel that the care Duke was given was negative. You called on Friday morning, he was attended to within a couple of hours and underwent general anaesthesia the same day. He has had one post op check and has recovered uneventfully and as we have not seen him back I am assuming he now has no infection and is no longer painful. I am sorry this does not meet your level of expectation. Our complaints guidelines are to respond in full within 14 days and my response to your email dates 26/05/18 is within these guidelines. Yours Sincerely Dr Lindsey Hopley BVSc BSc MRCVS Director and Practice Owner Longton Vets4Pets

Dear Miss Cotterill I have just become aware of your review and as the practice owner I would like to leave a comment for other readers about your visit. You and a gentleman attended the appointment last month with your pet, whom for the purpose of the response I will leave un-named. We had only ever seen your elderly Staffordshire Bull Terrier in January 2015 for two visits when she started a course of vaccinations. Your dog at this time weighed 20.4kg You telephoned the practice at 7.30pm the evening of Wednesday 16th of May concerned she was not eating and being sick. An appointment was booked for 11.15 the following morning. Your Staffordshire Bull Terrier weighed 14.8 kilograms and had therefore lost a huge amount of weight since her previous visit. Her body condition score was 3/9. You reported she had not been well for quite some time although had deteriorated the previous weekend. She was vomiting, drinking a significant amount of water, she was extremely pale and in very poor condition systemically, and looked very unwell. On examination an abdominal mass was easily palpable, although the source of which was not possible to determine due to the size. Your female dog was not neutered, and it was considered that the mass may be a severe distention of the uterus. A pyometra is an infection of the womb and sadly is very common in entire female dogs, causing vomiting, increased drinking, inappetance, all signs which your pet had, although when there has been a significant duration of infection they can become septicaemic, and very very poorly, like she was at the time of the appointment. There are also multiple other possible causes of abdominal masses such as splenic disease, intestinal issues, diseases of the liver to name but a few and a possible tumour/cancerous mass was advised as a possibility. It was recommended that we could consider undertaking a conscious ultrasound scan to help us identify the mass. This would allow us then to give a prognosis and consider treatment options. You were advised that given the current poor clinical state that if the mass was surgical amenable then the general anaesthetic was a considerable risk although patients requiring surgical treatment of a pyometra are often although unstable cured with surgical management. My Veterinary colleague that saw you and the gentleman on that morning reports that immediately as the suggestion of further diagnostic tests were raised he in particular became very defensive with a change in tone, followed by negative remarks regarding the cost of scans and the comments in particular ‘all you are interested in is the money’. You were courteously been informed that your dog was profoundly unwell, and if you would like us to find out why to consider any form of treatment , this is what we need to do. The choice of if you want to pursue further tests and possible treatments for your pet is of course entirely your decision. You elected the have your pet euthanased. Your review also advised that we had no compassion. I would like to inform the readers that despite the very saddening situation of your pets health at the time you presented her and the unnecessary remarks that were made when we were just trying to help your pet and provide realistic information to you as her owners, my veterinary surgeon still took the time to take a personalised ink footprint for your pet into our practice condolence card and I hope that you have received this. Lindsey Hopley BVSc BSc MRCVS. Practice Owner Longton Vets4Pets