Saturday, September 14, 2013

1133. Audit of my 2009 case. The vet must be able to deliver results?

Proximity is important for the time-pressed Singaporean dog owner. There are around 60 vet practices and so, there will be one down the road.

Recently an owner from Farrer Road phoned me as his other poodle was trembling and was unable to walk normally. His dog had seen two other vets and the second vet referred him to another vet for a CT scan which would cost $1500 - $2000. 

He remembered me and phoned to confirm that I was still in business at Toa Payoh Vets, a 'corner unit in Toa Payoh Industrial Park'. After all, it was 4 years ago and he had only consulted me on this male poodle, 5 years old, with blood in the urine in Oct 1, 2009. The dog had vomited many times brownish black fluid for a few days at 2-3 x per day and had passed blood in the urine for 7 days. The dog was severely dehydrated and had a very painful bladder. Surgery to remove the stones would be done on the same day and so I gave him this poor survival chance on the operating table. After surgery and 8 days of hospitalisation, he took the dog home and I did not hear from him again.

In the years to follow, at least 30 new vet practices were started and so proximity was the draw for most owners and the older practices bleed clientele. I was not spared the reality of life.

"You gave 20% chance of survival for my poodle to survive the bladder stone surgery in 2009," he said. "He is still alive."

Today, Sunday Sep 15, 2013, I audit my case record of this dog's bladder stone surgery and to assess as to why I gave 20% chance of survival on the operating table.

Oct 1, 2009
Haematuria for a few days and severe dehydration.

1.  BLOOD TEST with significant abnormalities as follows:

ALT/SGOT  102 (<59 -="" 6.3="" 69.6="" br="" nbsp="" urea="">Creatinine 499 (89-177)
Total white cell count  38.9 (6-17)

N 85%   Absolute 33
L 1.4%   Absolute 0.54
M 13.5%   Absolute 5.3
E 0.03%   Absolute 0.01
B 0.31%   Absolute 0.12

Overall there was a severe bacterial infection involving the kidneys although there was no fever.

Brown and turbid. pH 8, SG 1.021, Nitrite +ve, Protein 2+, Ketones trace, Blood 4+, white blood cells 333, red blood cells >2250, Bacteria 3+. Crystals Nil.

3. SURGERY ON Oct 1, 2009.
Spikey stones removed.

The dog was hospitalised for 5 days and went home. No stone analysis or follow up was done owing to fianancial constraints. As the dog has recovered, the owner did not come back during the past 4 years. Now his other poodle has generalised tremors all over the body and head  and he wanted a 3rd opinion as to what was causing this nervous disease.  As the first 2 vets had not done a blood test, one is being done. The dog is under observation. "Not all nervous disease cases can be cured," I said to Intern Daniel. "This is likely to be a case of cerebellar disease."   

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