Thursday, November 28, 2013

1220. Audit of urolithiasis case TP 44309

Much follow up by the vet must be done as the owner usually does not bring in urine samples on a 2-monthly basis. Unfortunately vets are busy and perhaps a written schedule of urine tests should be given to the owner.

Three bi-monthly urine tests negative of crystals and acidic pH with no bacteria and an X-ray is my advice before the dog is off the medical dissolution of stones diet.
Each vet has his or her own advices.

In this case, the owner does buy C/D or Urinary S/O seriously and has no urinary problems since 3rd opinion at Toa payoh Vets on Apr 4, 2013 to date (Nov 28, 2013).

It is time consuming to get history from Vet 2 and the vet needs this history to know what's happened on April 1, 2013 when the dog consulted Vet 2 for a 2nd opinion. The $1800 cystotomy fees prompted the owner for a 3rd opinion. As the stone appears quite small and had been flushed into the bladder by Vet 2, Dr Daniel recommended medical dissolution as an alternative.

My audit recommendations.
A written schedule of urine testing every 2 months and calling the owner to comply is necessary in medical dissolution trials as an alternative to surgery. Use of social media to remind the owner to send urine samples to Toa Payoh Vets, using Google calendar? This will be the future of vet medicine. Vets just don't have time. Must make time. Just advising anti-struvite diet is usually the case.

The dog still has bacteria in the urine and so far the owner has not come for antibiotics.  X-ray from Vet 2 and comments are below. Very rare case of an owner taking some trouble to send urine for testing, but at >2 months for the 2nd sample!  Still it looks like the diet is effective as the owner is happy with no urinary tract obstruction and has saved $1,800 on surgery!

The purpose of audit is to see whether standard operating procedures are effective or new processes need to be implemented and is not meant to reflect on the skills of any veterinarian.
at Toa Payoh Vets. I do audit my own cases too.  There is just no time to do audits as it takes many hours of research and review.

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