Tuesday, October 19, 2010

222. Defensive Medicine at the 49th day of pregnancy

The owner said that her British Bulldog was 49th day pregnant. Dr Vanessa Lin was the vet in charge. She palpated the abdomen and declared that the dog was not pregnant. I palpated and agreed with her. There was no big foetal lump or lumps in the abdomen. A simple case of pregnancy diagnosis. Not pregnant.

But veterinary medicine can throw out surprises for the vet who wants to provide least-cost veterinary services.

"There is a possibility that the foetal lump is positioned cranially below the diaphragm such that the vet can't feel it," I cautioned. I had read some dog breeding reports on this type of situations.

"If the dog is diagnosed as not pregnant now and she loses her sole pup due to this diagnosis, there will be a lot of unhappiness. Bulldogs usually need a Caesarean section as the puppy's head is too big. Since the vet has diagnosed this dog as non-pregnant, the owner would not have had prepared the dog for an elective Caesarean section as veterinarians are trusted professionals.

I related an incident to Dr Lin about the single pup syndrome case in a Pomeranian. A vet diagnosed the Pom as not being pregnant by abdominal palpation. The breeder who brought in the dog agreed with him. The vet assistant supported his diagnosis. Three people with experience said not pregnant.

The Pom had a difficult birth and required Caesarean section. The pup died after the Caesarean section. The dam died a few days later. The death of the beloved dam evoked much anger and resentment. If only an X-ray or ultrasound were done as part of defensive medicine, this sad outcome would not have occurred. This pup would probably had been located as a small foetal lump in the most cranial position behind the diaphragm.

Dr Lin advised an ultrasound. The dog was confirmed not pregnant. Defensive medicine is needed in many cases. When the owner is unhappy or provoked by the competitor vet, many complaints are made. A simple X-ray or ultrasound taken should have been done as part of defensive medicine as vets are not Gods and variations in medicine can sometimes ruin a hard-won reputation.

Updates at www.toapayohvets.com

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