1038. Follow-up: Pyometra Chihuahua

Jun 20, 2012

Phoned owner today. Excellent news.
Today is Day 6 after pyometra surgery to remove infectd womb on Junb 14, 2012

Eating well, everything OK, quite active.

The husband said: "Drinking a lot of water the last 2 days, but otherwise OK."
On Jun 17, complained of "bleeding" from operation, see image. I said it was due to the e-collar traumatising the right side of the surgical area but the owners insisted that the dog never did it.
"The dog does not do the scratching in front of the owner," I said. "The owner cannot be watching over the dog for 24 hours every minute of the day."

DAY OF SURGERY (Upper image)

2 DAYS AFTER SURGERY (Lower image)

I gave a very low dose of pred and the inflammation subsided satisfactory.

RETROSPECT
I should not have sent the dog home on the same day as surgery as pyometra is a big surgery. However, this dog ate and wagged her tail in the evening at 6 pm when I asked Dr Daniel to take her out for some sunshine, observation and photography. 



At home, she must have walked around and felt the itch and pain and used her e-collar to rub the surgical area. The e-collar reached the right flank and the sharp edge also nicked and lacerated the base of the nipple sharply. It is hard for the owners to believe what I said as they said the dog never attempted to do it (in their presence).

1037. BE KIND AND BRAVE - ADOPT A STRAY

PROMOTING ADOPTION OF STRAYS
2012. My latest image inspired by a couple who adopted a cat from the Cat Welfare Society. "Adopt a female cat," I advised since the male cat had FLUTD and passed away during treatment at a veterinary practice, causing much sadness to the wife.

Compared to my older image in 2003. It is quite difficult to think of captions. Both cats were sterilised by me.

1036. Follow up: Constipated cat on Jun 19, 12

On Tue, Jun 19, 2012 at 4:13 PM, Mr Dong Liu <dong.liu@uqconnect.edu.au> wrote:

Dear Dr Sing,

I was reading your blog post 1033 Fecal impaction of the cat, I was just wondering how did you manage to pass the catheter into the cat? Did you use general anesthesia or Domitor on the patient?

Regards,
XXX

E-MAIL REPLY FROM DR SING DATE JUN 20, 12

This case was performed by Dr Daniel Sing. The cat wxxxas not aggressive and so no sedation and anaesthetic was used when the urethral catheter was inserted gently. The cat was very timid and did not mind.

In this case, there was a tube of enema given a few days earlier and two hard stools had passed out. Also, the oral laxative oil had been given and the cat had passed into the colon but no stools were passed.

The cat was X-rayed before the urethral catheterisation (2 images). They showed faecal impaction of the whole colon.

After the urethral catheter enema using normal saline of 70 ml by Dr Daniel, the cat passed another hard faecal tablet the next day.

June 20, 2012 TODAY
10.30 am. The owner phoned to say 5 hard faecal pellets had been passed out. He was quite happy. "My cat vomited as he pooped," he said. "Quite a lot of stools." That was good news. He will come with the cat tomorrow.   

MY DISCUSSION WITH A SENIOR VET ON JUN 18, 12

1. He said digital extraction of the stools. I clarified as this seemed to be drastic and traumatic.
He said to use forceps to pull out the stools.

2. I had done colonstomy to remove all the hard stools in one old cat with similar impacted stools in the whole large intestine. The cat was OK. In this case, the senior vet said no need to do such surgery. Use forceps to pull out the impacted faeces will do.

3. Such impacted faecal cases are not common compared to difficulty in passing urine.

1035. Medical negligence of 2 embryologists

Straits Times Jun 20, 12  A2
IVF mix-up: mum seeks damages

In a medical negligence suit, it is not only the practising doctor or vet that is liable for damages as the following case shows:
1. Thomson Fertility Centre (TFC) waived all hospital and docotrs' charges
2. Thomson Medical was fined the maximum of $20,000 for failing to ensure suitable practices were followed
3. The woman who alleged negligence had a baby with a stranger's semen insgead of her husband's sued Thomson Medical, Thomson Fertility Clinic and 2 embryologists for special damages of $750,000
4. She wants the court to assess the amount of general damages.
5. Legal fees must be paid by the company and this could amount to $100,000 in protracted trials.

As TFC had admitted clinical error, the court will decide a "fair outcome" for all parties as regards the quantum of compensation

In conclusion, the licensee or key appointment holder and the Practice can be sued for damages, not just employee doctors or vets who performed the procedure. Therefore, strict monitoring and management of the employee or associates vets are necessary to prevent possible litigation and that includes "trust and audit" procedures to be done by the licensee regularly.

1034. Westie's skin diseases - atopic dermatitis

This case was successfully treated by me, in the owner's opinion. It is not easy to treat all skin diseases

1033. Follow up: Faecal impaction of the cat

June 19, 2012

Yesterday, X-rays were done. A 70-ml normal saline enema via the whole dog's cathether was gently squirted into the colon. When blocked, squirted saline and push catheter in.  So, the whole length of the catheter was passed in. An enema and oil laxative was given. Today, the owner phoned Dr Daniel to say one very hard stool had been passed by the cat this morning.

"Should feed canned food," I advised. The cat would eat only dry food. The cat ate a bit and vomited the oil. Wait and see.

1032. Follow up: Monday Jun 18, 2012 JRX leukaemia

Trembling, recumbent on Thursday June 14, 12
Not eating for 5 days. Intensive IV fluid including amino acids, Vit K1
Went back on Saturday with poor prognosis of acute leukaemia. The shivering was attribute to a very low blood glucose from the blood test.

I phoned up on Monday Jun 18, 12

"The dog is good," the caregiver maid said. "He eats and drinks. No shivering. He does not want me to carry him downstairs to pee. He will walk to the lift and then walk on the ground floor." This dog will never pees inside the apartment. I was surprised at his rapid recovery considering that he was shaking all over his body 4 days ago.