Friday Dec 9, 2011
I was in the consultation room facing Dr Vanessa and Mr Min as I conducted a meeting regarding work performance. "In many companies, there is a monthly meeting to discuss work matters like problems and solutions," I said to both of them. "I don't do it as I expect both of you to do your part and to adopt my advices for changes."
One of the topics I spoke about was the need for direct eye-contact with clients to connect well.
"When a client comes into the consultation room, stand up and greet him, rather than sit down and look up to him," I said. "You may be tired but still this is the proper way to do. You may get a chair and ask the client to sit down if you wish to sit down to discuss the dog's health. I always stand up to greet the client throughout my years of practice or invite them to sit. There was a complaint of one unfriendly vet who sat down and looked up at the client...."
I illustrated with my personal anecdotes and gave my tips as how to handle several cases by Dr Vanessa and Min who is a vet from Myanmar.
As regards examination of the severely "paralysed" recumbent panting dog that came in yesterday as a second opinion, the important things to do would be to collect blood and urine samples first, before any treatment like IV drip. If the owner objected to it due to the fact that Vet 1 had just done the blood test, record this objection, time and name of the owner. "The dog was diagnosed as having spinal injuries by Vet 1. How do you know whether the dog at the time of arrival half dead and panting and unable to stand up was also suffering from hypoglycaemia which would be obvious from a simple blood test?" This morning, I took the dog outside for a review and he was walking unsteadily as he had been given IV drip, painkillers and frequent feeding.
I said: "A quadraplegic dog with a cervical fracture or dislocation would not be able to walk at all. In addition, there is no rush to do an X-ray which was done yesterday as the dog's head was twisted and the X-ray views were not so good," I said. "Go back to basics of neurology. A quadraplegic dog cannot normally be having spinal problems in the lumbo-sacral area as the brain stem and cervical spinal area would be the likely area of traumatic injury. It is possible that there is injury in the tail spinal area as evident by the presence of pain on palpation, but the primary diagnosis should be the brain stem and cervical area.
"Stabilise the dog, give the IV and medication and take the neck X-ray later in cases where the dog had a twisted neck on admission." We all learn by experiences of handling a case and that include me even though I have practised for over 40 years. This was an unusual case. The dog could put weight on the right fore but limped on the other 3 legs. What was he suffering from? Was it head concussion, bleeding and traumatic injury as I suspected? A kick to the side of the head. So, the right eye pupil constricts on direct light but the left eye pupil does not constrict and is dilated even this morning. Yet he can stand up on his own on the right fore limb and walk a distance like a drunken. I am still suspecting a brain stem injury and am reviewing this mysterious case.
A fair lady in red with black eyeliner suddenly came into the waiting room and waved at me. I had to stop the meeting which had taken over 30 minutes as I guess my assistants had enough of me.
The lady in red said: "Do you remember the Corgi? I am coming for the S/D diet."
"I am sorry I can't recognise you," I said. "But I do remember (name of dog). He had seen a few vets and always passes smelly urine after antibiotics. For at least 2 years or so."
"Well," the lady beamed. "She is no longer passing smelly urine after one month of treatment. Your medication has been taken. Her urine is clearer. Best of all, I don't have any smelly urine in the apartment."
I was surprised that her female spayed dog peed all over the apartment. "The fault lies with the owner," I said. "For not properly house-training the dog as a puppy."
"Well, I did," she said. "She would hold her urine and then let go a lot." She spread her arms wide. "Is it common for dogs to pass a vast amount of urine every day"
"A dog would pass a lot of urine in the morning for one time," I said. "But not several times. Your dog has been withholding the urine until she can't stand it anymore. You must be beating her up when she had peed all over the apartment when she was younger," I said. "Holding urine leads to bladder infection and the smelly urine that the various vets you consulted before could not cure. Your dog is not fully cured yet. It is only one month. You need 3 months of S/D diet to know whether she will be free of urinary tract infection as the S/D diet acidifies the urine and prevents bacteria forming struvite sand in the bladder, leading to bad smelly urine."
"Yes, she got spanked" the lady said. "What do you suggest I do now?"
As she was moving to a new apartment away from Woodlands, I advised complete confinement for 24 hours in a room for 4-6 weeks. Newspapers with her urine smell on one side and bed on the other. Confinement is the key to success.
This case seems to be successful but urine monitoring per month should be done. I gave her a urine collection bottle and asked her to know volume of water drank per 24 hours. I hope the new apartment will be free of dog urine smells as friends can smell it but owners who live there will not smell it as their noses are used to it.
Will wait and see.
4.40 pm. Back to work. A shih tzu with central eye ulcer.