Monday, June 17, 2013

1468. Update: Matted Shih Tzu with bladder stone surgery - Hair inside the stitches when going home

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Date:   18 June, 2013  
 
Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
KPI - How long it takes me to remove a bladder stone in a poodle 
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   18 June, 2013  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

Monday, June 17, 2013

1468. Update: Matted Shih Tzu with bladder stone surgery - Hair inside the stitches when going home

 
Yesterday Monday, Jun 17, 2013, I was on evening duty after having time off to watch "The Man of Steel" at Ang Mo Kio Hub at 3.30pm. A male gold and white Shih Tzu with very thick coat that had bladder surgery by Vet 1 had come in for re-stitching. It seemed there was stitch breakdown and the owner claimed that all the time the Shih Tzu had been wearing the e-collar. By inference there would be no way that the Shih Tzu could lick the incision wound beside the penile length.

The wife who came to collect this Shih Tzu said: "My dog had hair inside the stitches when he went back. There should not be hairs inside the stitches!"  I reviewed the case record. The Shih Tzu had been warded for 4 days and then sent home. Many owners are unhappy when their dogs return for wound breakdown and would blame the vet.

I examined the dog's lower body and showed it to the owner. The whole of the lower body was clipped bald from the neck to the scrotum by Vet 1 before surgery. So there was no possibility of hairs being "stuck" inside the stitches. The owner had not cleaned up the stitched area.

"If I was operating, I would have the whole dog clipped bald," I said to the owner. "Your dog has many turfs of matted hair in the hind legs and the whole body. In such cases, the vet should insist on the dog getting clipped bald as loose hairs from the matts could stick onto the wound. If the owner did not want to do it, then don't operate on the dog to prevent such complaints.

"I have just operated on a bladder stone poodle with similar matted hair in her body and back and I got it clipped bald. There is no complaint about hairs stuck inside her stitches as she had no hair." The vast majority of dogs coming in for bladder stone surgery don't have matted hairs and so Vet 1 would not have thought of getting this one clipped bald unlike me. 

I phoned Vet 1 and let her talk to him. But she did not mention about the "hairs being in the stitches" on handing over by him. She just asked about the medicine.

A senior citizen was present in the waiting room and he overheard the complaint. As the dog was being discharged, the whole conversation demonstration were in the waiting room. He had come in to buy a special diet for his Golden Retriever who had put on lots of weight. This R/D diet gave instructions on how much to feed to target the ideal weight. The bag mentioned how many "cups" to feed or how many grams of the kibble to feed to attain the targetted weight. "Use grams as the American manufacturer's cup is not the same as the Singapore's cup. Usually I don't stock R/D bags as Singaporeans in general don't buy them although they are effective. But there is a bag I reserved for a lady who buys regularly and her Golden Retriever now is quite slim." 

This gentleman is one of those rare kind men as he spends his money to bring the stray cats in his neighbourhood to be sterilised at normal rates, without quibbling with the vet to reduce fees to the bare minimum.  Most stray cat carers in Singapore are women and men are rarely seen. 

"If a large  operating skin area is clipped, there is usually no complaint about wound or stitch breakdown," I said. "This Shih Tzu is badly matted but Vet 1 did not think of getting the whole body clipped clean before surgery. So loose hairs get "stuck" onto the stitches causing infection and irritation and stitch breakdown."

"You are an old vet," the gentleman implied that experience counted. "I had a Husky and the Golden Retriever sterilised by you and I had no problem (of stitch or wound breakdown)." Frankly I cannot remember neutering his two big dogs but owners don't forget the operating vet who is responsible. For better or for worse. 

"Sometimes, it is common sense," I said. "A badly matted dog must be clipped bald when there is major surgery." In this case, the dog had been clipped bald from the neck to the scrotal area by Vet 1. This was a large area as normally vets would shave only the lower half of the body for bladder stone surgery.

Feedback from the owners is excellent if not viewed negatively. From now onwards, I instructed my assistant that all badly matted dogs must be clipped totally bald before bladder stone surgery as he had seen me doing for the poodle. There should be a proper handing over, with digital images taken during handing over and signature of the vet on the state of the sutures and wound on handing over.

This is ideal but not done usually, even by me. A systematic process of handing over is best for all parties concerned and I shall implement it from today. Negative feedback is very useful as it helps to improve the service standard.  
 
Updates will be on this webpage:
www.sinpets.com/F5/20130618matted_hairs_poodle.htm


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