Friday, September 7, 2012

1082. Service Audit of Toa Payoh Vets: Recurreing urinary stones review case


DRAFT INVESTIGATION OF RECURRING UROLITHIASIS IN A SHIH TZU
A lot of time is needed to investigate this case to come to a solution for the dog.



At 9.50 am, today Saturday, I am at the Surgery and I review the case of the recurring urinary stones
in a gold/black male Shih Tzu, 4 years old. The patriarch came to see him yesterday and the day before (Thursday) and spoke to me twice, at length.

NOVEMBER 2011. TOA PAYOH VETS
"Why did you take the dog to another vet for "blocked bladder" after X-rays by my associate vet in Oct 2011?" my associate vet hadI asked. "Is there some worries about Toa Payoh Vets not being able to perform this surgery?"

"No," he said. "I was recommended a vet. After all, my dog had been to your place as a puppy earlier."  Vet 1 opened a hole in the urethra and allegedly told him that the hole would close in time and the dog would pee from the normal orifice of the penis. He was not happy that Vet 1 had to operated a 2nd time the next day without informing him. The dog's e-collar was smaller in size leading to the dog licking the urethral opeing.


APRIL 2012. VET PRACTICE X
"Was there any difficulty in urination or blood in the urine after Vet 1 operated?" I asked.
"Not for 7-8 months. My dog would lift his leg to pee a large volume of urine. However, he started having problems peeing. So, I rushed him to another practice (X). This practice has all the facilities and you can understand why I did not bring the dog to Toa Payoh Vets. Vet 2 operated on the bladder and removed the stones. The vet said he flushed the bladder several times." 


AUGUST 2012. VET PRACTICE X
The dog could not pee normally again. Less volume of urine and difficulty in urination.
"My dog's stomach was getting bloated and so I rushed him down to Vet 2. The bladder operation was done to remove the stones. However, Vet 2 told me that he need to open another hole and close the first hole as my dog could not pee. I do not want another operation and that is why I brought the dog to your Surgery."

Yesterday, Dr Daniel said there was an obstruction around the bend of the urethra. As I am not operating on this case, I will follow up.


WHAT'S THE SOLUTION?
This is a highly emotional case. The owner had spent over $2000 in Practice X recently and was assured that an X-ray post-removal of bladder stones was done. "This is good practice," I said. "So that there is proof as to whether all stones had been removed by the vet. I don't do it because of the costs involved."  But this X-ray could not be located presently.


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