Thursday, October 28, 2010

231. Brand name v. benefits to the customer

My vet assistant, Mr Saw had worked with me for nearly 3 years. As he will be leaving next year to work in Yangon, I shared experiences of cases with him today and whenever we work together.

Case 1
Tumour in gum of Chihuahua, M, Neutered, 6 years.
"It is best to advise histopathology of this tumour," I said to him. "Some owners are not aware of the need to get this test. We want to lower our vet costs by not advising this test. However, the tumour may be cancerous and if we do not advise, the next time the tumour comes back, the owner will not have confidence in the vet.

The owner is a young woman with internet knowledge and so she will know many things by researching the internet for gum tumours. She had asked whether I would be doing a histopathology and I said yes. Not every owner wants the lowest price.

Case 2
Urinary stone stuck inside the penis. "Different vets will operate differently to take out the stones jammed packed behind the os penis, inside the penis ," I said to Mr Saw. "In this Yorkshire, the vet leaves the urethra wound open by NOT stitching the incision. I will not operate this way. Why?"

Mr Saw did not know. "Well, this is a male dog. So he usually lifts his one leg to pee. When he pees, his urine will leak out from under his penis where the urethostomy incision has not been closed. So he sprays urine or dribble urine all over the apartment. In Singapore, 80% of the people lives in apartments. By NOT stitching up the urethra, the male dog may pee from his penile end and from below the penis. If you are the dog's owner, you will be very unhappy as you have to clean up. Worse still, the dog dribbles urine all over the whole floor due to urine marking.

Case 2.1
"Don't let the dog go home on day 3," I advised my associate. "The catheter may be rubbed out at home or pulled out as the dog will be roaming all over the apartment. In the Surgery, he is confined and monitored and nursed every day. At home, most owners don't bother. Things become nasty when the catheter is pulled out and the urethostomy wound at the bottom of the penis has not healed yet. Worse of all, the urethostomy wound closes and cause obstruction before the 10th day as recommended. The owner will want 'free' surgery or treatment. In any case, you get an unhappy owner."

The dog was put in for at least 10 days as this was a serious case of bladder and lower urethra being cut to take out the stones. (see X-ray).

Case 3
Skin disease.
"What the owner wants is a cure after payment and not have to come again," I referred to a case. "Vet 1 had treated and prescribed anti-fungal drugs and washes for the last 14 days. You saw the owner who was very unhappy as the dog was very itchy in the elbow, backside and lower body."

Mr Saw learnt from how I handled this case.
1. Skin scraping
2. Ultra-violet light. This was most impressive to the owner as ringworm hairs flouresce in the umbilical area and backside.
3. Communication with the owner. "You need to clip the dog bald," I said. "Otherwise you will curse me 2 weeks later when the disease is not gone away."
4. Clipping bald.
5. Anti-fungal wash.

After clipping bald, I discovered scabies mites on the ear edgess. So this dog had arcptic mange as well. No wonder he was so itchy and wanted to bite the owner!

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