Yesterday, Thursday,
Mar 21, 2012, I was at Toa Payoh Vets in the evening.
Usually I am not present as Associate Vet is the vet on
duty. Interns Jed and Mr Lim and my assistant Min were
working hard helping Associate Vet. Jed was bathing the
Golden Retriever with the right knee tumour wound.
Mr Lim was changing to a new e-collar for him before the
dog goes home. This dog had a big wound defect after
excision of the large knee tumour. The high-tension area
of the knee area led to stitch breakdown. The wife
wanted the dog back after surgery and had slapped purple
solution onto the wound which had started to break down
3 days after surgery. I asked her to bring the dog back
and saw that the stitches were not holding.
When I informed the husband, he threatened to report me
to CASE (consumer body) and then legal action. "If you
can't do the surgery, you should not have accepted the
surgery."
His opinion was that there should be no wound breakdown
and if there was, I should rectify and ensure that the
wound healed without charging him any money for further
surgery.
"I am suing one vet as my dog had died under his
treatment. My dog better not die in your Surgery." The
dog was hospitalised for over 20 days to get the wound
dressed daily. Stitching was not possible in this
high-tension area. The dog tended to lick the wound if
the e-collar was not worn. The wound had closed 20% but
would need another month to granulate. It was time for
the dog to go home with medication and I phoned the
husband who said he would come.
CASE 1. Big tumour
above the neck, between and behind shoulder blades
Suddenly at around 6.30 pm, three young ladies came with
a growling Miniature Schnauzer and I was at the
reception doing some administration work and answering
the phone calls while the others were doing kennel work.
Associate Vet was consulting with another owner.
"What's happened to your dog?" I asked one lady. This
was a 7-year-old male Schnauzer who warned vets off.
"Are you waiting to consult Associate Vet?"
"I want to consult you," the lady pointed to a hard lump
of 3 cm x 3 cm in the neck skin, midline, between and
slightly behind the ears. "It could be a microchip
inflamed lump," I said. "When did you microchip the
dog?"
"He was microchipped when young."
"Did any vet inject him in this shoulder area?"
"No," she said.
I pointed the microchip scanner at this lump and it
beeped showing the microchip number.
"It could also be a fast growing tumour," I said since
the young lady mentioned that she only discovered the
lump recently. She held the dog firmly while I examined
the hard lump again.
"Tumours are what I am worried about," she said.
Nowadays, many young ones read about their dog
healthcare in the internet unlike the old days when many
were quite ignorant. This lady, in her 30s had been
doing her research on dog tumours as she was more
concerned that this lump ought to be excised as soon as
possible rather than "wait and see" if it grows bigger.
It was big, around a 10-cent-coin disc-shaped and firm.
"If it is a tumour, I would need to make a big cut to
take out as much of the mass as possible and send the
tumour to the laboratory for histopathology to check
whether it is cancerous."
She made an appointment for this Sunday morning
operation. Not all lumps are due to microchip or
injections and if the vet thinks only these two
possibilities, he might be in for a rude shock if the
lump was cancerous and had spread to other cells.
So, it was best to excise it as early as possible and
certify that the microchip had been excised, so that the
owner had proof in case the regulatory AVA made a
surprise check for microchip.
CASE 2. The
one-year-old female cat passes pus copiously.
Another lady phone call was answered by me. "My cat
passes white yellow thick discharge from her vagina
non-stop. Drip, drip, drip everywhere for one month. At
first, it was a little bit. Now, the cat is not eating.
When do you close?"
"We close at 8 pm. It is better you get the cat treated
early as it is a womb infection. It is called pyometra."
After asking about the cost of surgery, the lady came
with the cat.
"Can you feel the swollen uterus?" I asked Associate
Vet. I could feel a swollen lump like a bladder swelling
of a golf-ball size and two long tubes around 1 cm in
diameter. No specific hard uterine bodies. Associate Vet
shook her had. "However, it is pyometra," I said as more
yellowish-white vaginal discharge fell in patches on the
consultation table.
"Now, what anaesthetic to sedate?" I asked Min. "This
cat is not in good health."
"Xylazine and ketamine IM," Min said.
"That is what we usually do. Zoletil is safer."
We rarely use Zoletil on cats and so Min did not mention
this.
I weighed the cat. She was 3 kg.
Zoletil 100 = 100 mg/ml. The dosage for IM was
10-15mg/kg and I decided on 12mg/ml.
I asked intern Jed to calculate so as to give him some
hands-on experience. His calculator showed 2.7 ml.
"Cannot be so much," I said.
The correct calculation was 0.36 ml of Zoletil 100.
I gave 0.3 ml IM. Then I gave 0.4 ml atropine IM to
prevent salivation and head twisting - side effects of
Zoletil.
Associate Vet operated. Isoflurane at 5% for a short
while by mask and then minimal 0.5%. The large womb was
taken out. Associate Vet decided on using horizontal
mattress this time as she was set in her ways, always
using simple interrupted. I had advised her to practise
on using horizontal mattress which is a stronger suture
but she would always do her own thing. Each young vet
has his or her own mindset and so I do not bother as
long as the stitches heal the wound.
Associate Vet believed in subcutaneous sutures despite
my advice not to do it as it would irritate the cat or
dog during healing. Well, each young vet has his or her
own mindset that would take time to change, with adverse
side effect experience encountered. All vet professors
lecture on the need to close up dead space using
subcuticular sutures and all young vets graduate with
this concept that they must do it after a simple spay.
Till they realise from intense itching in a few cases of
wound breakdown and unhappy owners that they need not do
it for spays and Caesarean sections. It is hard to
change a young vet's mindset since they believe that
their professors of surgery had to be a better teacher
than an old vet like me.
"For aesthetics, all sutures should be horizontal
mattresses", I believed in presenting a neat surgical
stitching pattern. Owners do peruse the wound as the pet
is a young family member and some do compare the
competence of the vet by comparing his stitching.
Associate Vet had
put in two horizontal mattresses at one cm in length but
felt that there was a small gap of 0.5 cm at the end of
the skin. She wanted to put in a simple interrupted. "If
you have to stitch that area, use a shorter horizontal
mattress," I said. In total she had 4 horizontal
mattresses done. Actually two would do. But it takes
time to change mindsets of young vets as most have a
mind of their own as regards suture patterns and the
need for more stitches to close small skin gaps. |
TOA
PAYOH VETS
