Tuesday, September 17, 2013

Auditing my bladder stone surgery case - the surgical outcome


Date:   18 September, 2013  
Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
Audit of my bladder stone surgery done in 2009    
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   18 September, 2013  
Be Kind To Pets
Veterinary Education
Project 2010-0129

Auditing my bladder stone surgery case - the surgical outcome

In the above surgery, the dog is still alive in 2013 as I met the owner recently. The sibling of this dog had generalised body and head tremors and he had consulted 2 vets. Vet 1 prescribed glucosamine but the tremors persisted. Vet 2 referred him to get a CT scan at another practice. This costs $1,500 - $2,000 and so he remembered me, researched the internet for "Toa Payoh Vets" and phoned me.  

The owner wanted an affordable bladder stone surgery in 2009 and vets of my generation often strived to provide least medical cost by not asking for X-rays pre and post operation or blood tests at the first visit.

For example, this poodle had blood in the urine and the abdomen was very painful near the bladder region. I informed the owner of the diagnosis of bladder stones although there was no X-ray or stone analysis done to lower his medical costs by at least $200. He wanted an immediate surgery.

I gave an IV drip and antibiotics and operated on the same day of consultation. I told the owner that the dog had 20% chance of survival on the operating table.

If the dog is given an IV drip and stablised for 24 hours before surgery, the survival rate will be much higher. However, this dog did survive and so the owner had a favourable impression of me and I saw his trembling poodle, the sibling of the afore-mentioned dog with bladder stone surgery.

I have my illustration to show readers who what anaesthesia was used and the number and nature of the bladder stones. When the dog survives despite the odds, the feeling is great and the owner remembers the vet who had performed according to his expectations, namely a good surgical outcome.

In 2013, the expectations of a sophisticated younger generation of pet owners who trawl the internet and knows much more than the vet means that all processes and advices must be properly documented as supporting evidence in cases of litigation. I would record AMA (Against Medical Advices) and ensure close communication with the owner.

Life was much simpler in 2009 and in earlier years, but the vet has to be much more careful in giving informed consent and recording all medical advices in the litigious society of first world Singapore.
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To make an appointment: e-mail judy@toapayohvets.com
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