Yesterday I spoke to my client whose heart had stopped beating for over one hour in 2008 when he went in for a surgery of his middle ear. Emergency resuscitation by the medical team revived him but now he feels deep chest rib pains. His heart is OK.
"My ECG reading was flat as a straight line," he said. "I was dead."
"Did you see bright lights?" I asked.
"I saw bright lights, blue skies and hear hymns."
Was it divine intervention for an athesist? Was there medical negligence as his medical form and his hand bracelet stated he was allergic to augmentin. Yet he was given augmentin prior to surgery? I am glad he is alive. His dog which was diagnosed with paraplegia by Vet 1 was massaged and managed to prevent bed sores survived to 15 years of age. He started to walk "but hopped" after home nursing. Recently he had kidney failure and I had to euthanased him. The client came for a death certificate and I asked him about his health after being "dead" on the operating table. I was most happy he was alive.
Doctors are not Gods. They make mistakes and will continue to make mistakes. Some mistakes cause deaths of patients. It is important to adopt a systematic procedure to check for drug allergies before anaesthesia and surgery and to ensure drug dosage is not above requirements.
Thursday, May 16, 2013
1419. Update: Anal wound closed up by Dr Daniel
"The old dog's circum anal wound is very big," my intern Ms Toh said to me. "But I can't illustrate. It is just very big!". Sometimes I try to motivate my intern to be more interested in the various surgical conditions in dogs. After all, she will be studying vet medicine next year and internship gives her real life cases.
"Is it a 12 to 6'oclock tumour around the anus?" I persisted.
"I don't know," she said. From Dr Daniel, it was this massive size. The wound was large as a big piece of the skin with tumours was removed and stools just lodge inside this big wound.
"This wound will never close by granulation because stools keep contaminating it," I said to the owner and to Dr Daniel. "A skin flap has to be made to stitch the anal sphincter to the skin." The owner consented to the surgery and even phoned yesterday to ask whether it was done. "It is being done now," I said. The surgery was done by Dr Daniel. No more defect or gap. Wait and see.
"Is it a 12 to 6'oclock tumour around the anus?" I persisted.
"I don't know," she said. From Dr Daniel, it was this massive size. The wound was large as a big piece of the skin with tumours was removed and stools just lodge inside this big wound.
"This wound will never close by granulation because stools keep contaminating it," I said to the owner and to Dr Daniel. "A skin flap has to be made to stitch the anal sphincter to the skin." The owner consented to the surgery and even phoned yesterday to ask whether it was done. "It is being done now," I said. The surgery was done by Dr Daniel. No more defect or gap. Wait and see.
Wednesday, May 15, 2013
1418. Large wounds
In some cases, I had to intervene when surgical wounds do not close and the owner will not want to pay for wound stitching..
Case 1. The kitten had a big left neck abscess. The pus was cleared and the wound stitched by my associate vet. Yet the stitch broke down. The owner did not want to pay for further stitching. "The wound is 3 cm x 2 cm," I said. "A large wound exposing the neck muscles and the big neck veins. Yellow pus and scratching will persist. Smelly later due to bacteria and hair trapped inside. Very itchy for the kitten. Stitching must be done." I offered him a below cost rate to get the kitten wound stitched up. The kitten recovered well.
Case 2. The old cross-bred had a massive circum-anal tumour from 6 to 12 o'clock. My associate vet excised the whole tumour. Now a big hole. The anal skin was gone. The anal opening shrank inwards. So the dog pooped and the stools are entrapped in this hole. What to do?
The owners let the maid look after the dog and did not seek treatment. The lady friends of the owner came to visit the dog. The owner had denque fever and could not turn up.
"It is not as if this dog is cuddly," the lady friend explained why the circum-anal tumour was permitted to grow so big, such that there is a big hole now. "The maid did not inform us." What is the solution? Re-stitching is the answer but there is no skin.
Case 1. The kitten had a big left neck abscess. The pus was cleared and the wound stitched by my associate vet. Yet the stitch broke down. The owner did not want to pay for further stitching. "The wound is 3 cm x 2 cm," I said. "A large wound exposing the neck muscles and the big neck veins. Yellow pus and scratching will persist. Smelly later due to bacteria and hair trapped inside. Very itchy for the kitten. Stitching must be done." I offered him a below cost rate to get the kitten wound stitched up. The kitten recovered well.
Case 2. The old cross-bred had a massive circum-anal tumour from 6 to 12 o'clock. My associate vet excised the whole tumour. Now a big hole. The anal skin was gone. The anal opening shrank inwards. So the dog pooped and the stools are entrapped in this hole. What to do?
The owners let the maid look after the dog and did not seek treatment. The lady friends of the owner came to visit the dog. The owner had denque fever and could not turn up.
"It is not as if this dog is cuddly," the lady friend explained why the circum-anal tumour was permitted to grow so big, such that there is a big hole now. "The maid did not inform us." What is the solution? Re-stitching is the answer but there is no skin.
1417. Update: The Chow Chow's backside hair has grown
There was another Chow Chow who bit her right backside bare and started losing hair. I remember this owner as he keeps beautiful arowanas displayed in big tanks in his office and beautiful koi. He has two pretty Golden Retrievers. And a Chow Chow.
The carer had gone back to China for a holiday and the Singapore employee groomer had resigned. "How's the dog?" I asked the brother of the owner. I had the dog clipped bald too and gave the skin disease treatment.
"I don't know," he said as he brought his dog for skin disease treatment. Later he checked and told me the hairs had grown back.
The carer had gone back to China for a holiday and the Singapore employee groomer had resigned. "How's the dog?" I asked the brother of the owner. I had the dog clipped bald too and gave the skin disease treatment.
"I don't know," he said as he brought his dog for skin disease treatment. Later he checked and told me the hairs had grown back.
1416. Update: The Chow Chow is a Sharpei? Skin disease
May 15, 2013
This Chow Chow looked very much like a Sharpei when she was clipped bald. But she looked like a Chow Chow when her hair grows back. I saw the dog yesterday, around 2 months after treatment for skin diseases and passing blood in the urine. She had skin diseases for several months and was referred to me by my wife's ex-colleague Susan.
It is very difficult to get dog owners to return for a review of the skin diseases. After all, if the dog has recovered, why see the vet? It was pragmatism in Singaporeans.
Yet, the skin may not be fully recovered if the dog has some leftover skin diseases. In this case, the Chow Chow has no more "dandruff" and the hairs are sturdy and not falling off. Yet the dog had started scratching around the ears.
"The ears are full of wax," I showed the cotton bud tip sticky with yellow brown wax. The neck hair had bloomed. Wetness was due to the dripping of water when drinking from the water bowl. The owner brought a urine sample for testing as previously the dog's urine tested for struvite crystals, high pH of 9.0 and presence of blood and bacteria. I prescribed 12 S/D cans to dissolve the crystals but the owner did not return for more. "The dog vomits the S/D," the young adult daughter said. Yet on further questioning, the dog did eat at least 10 cans but started vomiting the 2 cans later. There were no phone calls to me for advice.
"Taking S/D to dissolve the struvite crystals prevent them becoming stones," I explained. "It must be taken for 1-3 months, not 10 days."
I did not want to do hard sell. I advised spaying and entropion surgery of the two eyes. The Chow Chow had been peering from 3/4-closed eyelids for the past 3 years and the entropion surgery would have resolved the problems.
"We don't want the dog to go under anaesthesia," the young adult daughter said. to me.
"With this continuous eyelid rolling inwards irritation, the cornea becomes infected and ulcerated. In later years, you have a blind dog as the cornea becomes black from pigmentation and the dog can't see. It is important that the Chow Chow has her eye surgery. As for the spay, if you don't want it, that is OK."
Ignorance of the safety of modern anaesthetics is a reason for no spay and no eye surgery. This can't be helped.
This Chow Chow looked very much like a Sharpei when she was clipped bald. But she looked like a Chow Chow when her hair grows back. I saw the dog yesterday, around 2 months after treatment for skin diseases and passing blood in the urine. She had skin diseases for several months and was referred to me by my wife's ex-colleague Susan.
It is very difficult to get dog owners to return for a review of the skin diseases. After all, if the dog has recovered, why see the vet? It was pragmatism in Singaporeans.
Yet, the skin may not be fully recovered if the dog has some leftover skin diseases. In this case, the Chow Chow has no more "dandruff" and the hairs are sturdy and not falling off. Yet the dog had started scratching around the ears.
"The ears are full of wax," I showed the cotton bud tip sticky with yellow brown wax. The neck hair had bloomed. Wetness was due to the dripping of water when drinking from the water bowl. The owner brought a urine sample for testing as previously the dog's urine tested for struvite crystals, high pH of 9.0 and presence of blood and bacteria. I prescribed 12 S/D cans to dissolve the crystals but the owner did not return for more. "The dog vomits the S/D," the young adult daughter said. Yet on further questioning, the dog did eat at least 10 cans but started vomiting the 2 cans later. There were no phone calls to me for advice.
"Taking S/D to dissolve the struvite crystals prevent them becoming stones," I explained. "It must be taken for 1-3 months, not 10 days."
I did not want to do hard sell. I advised spaying and entropion surgery of the two eyes. The Chow Chow had been peering from 3/4-closed eyelids for the past 3 years and the entropion surgery would have resolved the problems.
"We don't want the dog to go under anaesthesia," the young adult daughter said. to me.
"With this continuous eyelid rolling inwards irritation, the cornea becomes infected and ulcerated. In later years, you have a blind dog as the cornea becomes black from pigmentation and the dog can't see. It is important that the Chow Chow has her eye surgery. As for the spay, if you don't want it, that is OK."
Ignorance of the safety of modern anaesthetics is a reason for no spay and no eye surgery. This can't be helped.
1415. Updated: The old dog's tongue hangs out
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TOA
PAYOH VETS
Monday, May 13, 2013
1414. Saturday May 11, 2013's interesting case. A 3rd opinion - inoperable oral tumour
The 13-year-old brown cross-bred was slim and trim. "Her tongue slips out from the left side of the mouth when she is panting," the owner told me. "She is not eating much now." He was seeking a 3rd opinion from me after surfing the internet.
Two years ago, there was a pea-sized growth in the inner cheek. His vet had sent a biopsy to a histopathologist and the diagnosis was adenoma of the salivary gland. The report stated that it had few numbers of mitotic cells and would recur since this tumour was locally invasive. His vet advised "debaulking" and cutting off the right jaw.
The owner would not agree. So his vet referred him to the competitor who said that he did not think the histopathological results were correct. "He recommended CT scan and chemotherapy. He also said a sample should be sent to the U.S," the owner told me. However nothing was done as his advice was similar to the first vet. He prescribed clinadmycin and meloxicam as well as codeine. The oral tumour now is more than 5 cm x 3 cm x 3 cm and two more swellings of 1 cm x 1 cm and 1.5 cm x 2 cm below the left lower jaw on the underside of the neck had developed.
"Was an X-ray done by the 2 vets to see if the jaw bone was involved?" I asked.
"No," he said.
"As the growth of the tumours is fast recently, it is likely to be cancerous."
"Due to the massive size and spread, there are inoperable tumours. With surgery, there will be recurrence within weeks."
The owner agreed not to have surgery.
Two years ago, there was a pea-sized growth in the inner cheek. His vet had sent a biopsy to a histopathologist and the diagnosis was adenoma of the salivary gland. The report stated that it had few numbers of mitotic cells and would recur since this tumour was locally invasive. His vet advised "debaulking" and cutting off the right jaw.
The owner would not agree. So his vet referred him to the competitor who said that he did not think the histopathological results were correct. "He recommended CT scan and chemotherapy. He also said a sample should be sent to the U.S," the owner told me. However nothing was done as his advice was similar to the first vet. He prescribed clinadmycin and meloxicam as well as codeine. The oral tumour now is more than 5 cm x 3 cm x 3 cm and two more swellings of 1 cm x 1 cm and 1.5 cm x 2 cm below the left lower jaw on the underside of the neck had developed.
"Was an X-ray done by the 2 vets to see if the jaw bone was involved?" I asked.
"No," he said.
"As the growth of the tumours is fast recently, it is likely to be cancerous."
"Due to the massive size and spread, there are inoperable tumours. With surgery, there will be recurrence within weeks."
The owner agreed not to have surgery.
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