I
was in Hong Kong on this bright sunshine Sunday August
21, 2011 when I received a phone call from an owner who
said that his dog still had a "hole" some 10 days after
spaying by Vet 1. "I thought all vets will not discharge
a dog when she has a hole," he said from Singapore.
As I was not
in Singapore, I told him that I would check the dog out.
In the meantime, I asked Dr Vanessa to examine the dog
and get the infected surgical wound re-stitched. It was
not her case as she did not spay the dog. I had to make
sure that I communicate with the owner and that she
would do so as the owner was very upset. Crisis do
happen in any business and how they are handled will
mean a big difference to the reputation of a company.
I made a phone call to my friend Khin Khin to ensure
that she had contacted the owner on my behalf and to ask
him to bring the dog to Toa Payoh Vets for treatment. It
was a Sunday and I felt that it was not Dr Vanessa's job
to phone the owner and therefore I phoned Khin Khin. She
did that. When the dog was re-stitched by Dr Vanessa, I
asked Khin Khin to phone the owner to let him know too.
Post-operation wound infections do occur to every vet.
It is important that the vet check the dog carefully and
not discharge the dog if the spay wound is infected.
On Wednesday, Aug 24, 2011, I was back to work at Toa
Payoh Vets. The dog was OK. Dr Vanessa's stitches were
holding the skin incision cleanly. No inflammation. I
phoned the owner to update him. He was quite happy that
everything was OK.
Much unhappiness and complaints and litigation can be
avoided with good updated communications. This dog was
not spayed by me but I could be called up as a witness
in cases of litigation in which only the lawyer makes
the money. It can be quite time-consuming in answering
to complaints from authorities and lawyers even if I am
not involved. I will still have to write reports about
this complaint. So, I normally handled such post-op
complications of other vets with as much care as if they
were my complications. A happy owner will seldom
bad-mouth a practice, sue or complain.
The important thing is to keep spaying simple. No
fanciful subcuticular sutures. But each young vet has
his or her own ideas. In this case, subcuticular sutures
could have had hindered healing of the skin incision or
introduced infection. I don't know as I did not see the
"hole" but I had asked Dr Vanessa to take some pictures.
As every vet will encounter post-op complications and
infections, it is best to keep skin suturing simple. I
use horizontal mattress as they are hold better than
appositional sutures and may be more difficult for the
dog or cat to lick them off. In any case, over 20 years
of use of this horizontal mattress stitching pattern
absorbable PDS or equivalent sutures in several hundreds
of operations had led to around 1 or 2 stitch breakdown.
Each vet will have his or her own stitching style and
pattern. They all work in closing the skin wound.
I
note that Dr Vanessa has her own appositional stitching
as she has her own success with them. Both type of
stitching pattern will work. Some dogs just can't stand
the stitching or they could be allergic to them. Not all
dogs but a small percentage and subcuticular sutures
would be very intensely itchy.
Even with
e-collars. The spayed dog could just rub her tummy
directly onto the floor, the mat and get the wound
opened up. Hence the complaint of the "hole" when the
dog was sent home after a few days at the vet.
It is best to do a mutual check with the owner before
sending home the dog after spay and record the
inspection. However, I don't do it and I doubt many vets
do that too. It is common sense not to send a spay dog
with a "hole" home though.
P.S. I saw the image of the "hole" after spay. The dog
had licked away all stitches leaving a big gap.
Infections under-run the skin and therefore the skin
edges did not close. There was no subcuticular stitches.
Debridement, cleaning of the wound and re-stitching of
the skin and antibiotics and pain-killers resolve the
owner's problem.
TOA
PAYOH VETS
