Tuesday, May 17, 2011

444. Wait-and-see Veterinary Advices

"Have you retired?" the mother and adult daughter had been consulting me regarding their dog over the past few years but now was attended to by Dr Vanessa. "No," I said. "I do consultations in the mornings by appointment but most of my cases will be handled by Dr Vanessa. It is good for my clients to have a younger vet to consult as I am 60 years old."

The mother looked at me with incredulous eyes as if she expected 60-year-olds to be half hunched and said: "It is good to retire as older people get diseases. Where's your son? Is he graduating and will he be helping you?"

"Yes," I said. "He will be graduating in December this year." Five years had flown by and my golden years have melted away.

I said to the pretty and tall Indian daughter with thick black eyebrows and a sharp face and probably in her late 20s. "Why are you so well dressed today on Vesak Day? In the finest silk sari and a red sash over your left shoulder?" I asked the daughter.

Mum said: "I am also dressed in new clothes. We are Hindus but we celebrate Vesak Day." I should have complimented the mum first. She was wearing a light grey dress, silky and shiny but the bright maroon red sash of the daughter attracted my attention.

"So, what happened to your dog?" I asked them as they had consulted Dr Vanessa without bringing the dog.

"We came for medication," the mum said. "Our dog had a lump on the rib cage area but Dr Vanessa advised us to wait and see. If the lump gets bigger, she will consider operation."

"Is the lump under the skin?" I asked.
"Yes,"
"Well, is it a small lump?"
"It is quite big. We can bring him to you to see."
I said: "Every vet has his own opinion as regards lumps and bumps in old dogs. How old is your dog?"
"He is 14 years old."

I said: "Many vets do advise a wait-and-see. Unfortunately, many owners waited but don't see. They don't examine the lumps daily or weekly. After a few weeks, if the lump is cancerous, it will have exploded to a big size and that is when they see the vet for surgery. So, my advice to all owners with old dogs especially. Don't wait and see.

"Just get the vet to remove the lump when it is small. If it is cancerous, it could be removed with a wide margin including normal cells around it. If you wait and see, the cancerous cells have invaded the surrounding tissues, it would be very difficult to excise all and the cancerous lump recurs."

The mother and daughter were worried and they ought to be. A 14-year-old dog with a lump is likely but not guaranteed to have a cancerous tumour. There is the high risk of anaesthetic risk for dogs over 8 years of age. So, this could be the reason why some vets adopt a "wait-and-see" attitude.

The duty of care of a vet in such circumstances should be to advise surgical excision for old dogs and provide an informed consent. Not wait and see as, in my experience, most Singaporean owners of old dogs seldom "see" their dog's tumour daily till several weeks later, they discover that the tumour is much larger. By then, it is too late to save the dog as the cancerous growth has spread to the sides and will recur again after surgery.

P.S May 17, 2011 is Vesak Day and is a public holiday. A bright sunshine day when most Singaporeans would be relaxing.

I was at the reception counter, still trying to teach my new replacement vet assistant Mr Min how to work efficiently and faster and how to answer the many telephone queries.

For example, I taught him to put all the necessary stationery (ink pad, namecard of Dr Vanessa, stapler, date chop inside one plastic cup) so that he would not waste time looking for each one after Dr Vanessa signed the vaccination certificate. In a busy time, this saving of a few seconds counted as the Singapore clients dislike long waiting times. In addition, Mr Min had a habit of holding the dog while Dr Vanessa spoke to the client about the diagnosis. "Let the client hold his or her dog," I said to him. "You do the other work like preparing for the next case." This was what my old assistant Mr Saw would do. Mr Saw would weigh the dog and take the temperature of the next case for me. Here, Mr Min would be holding the little dog on the consultation table and waited. There was why the waiting times stretched.
So, I had to step in to speed the work flow.

Sometimes we would be busy on a public holiday but this Vesak Day was rather quiet. So I had time to talk to the mother and daughter and know more about their pet problems.

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