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"The dog has been passing blood in the stools for 14
days. You don't just give a jab and ask the owner to go home, " I said
to Dr Vanessa as the owner wanted treatment on the spot and no
hospitalisation for the 13-year-old Beagle X. A gentle giant looking
Beagle with a white face. I was also in the consultation room.
"Should the old dog die soon, the vet may be sued."
"For negligence," the young lady asked whether the
dog had colitis as there was fresh blood in the stools and I had said
that the likely area of bleeding would be in the colon. This indicated
a young lady with knowledge and the vet must be able to provide the
standard of care expected by his peers in such situations.
"Consent is the best form of defence," the young
fair lady in her late 20s said.
 "This
case is more a standard and duty of care rather than (informed)
consent (to specific treatments as requested by the owner," I said. "A
dog that had diarrhoea for 14 days resulting in more frequency of
diarrhoea and blood loss and loss of appetite cannot be treated as a
simple case with one injection and sent home. The dog may die due to
dehydration and that would be negligence on the part of the vet who
had not given the IV drip and relevant medication inside the drip.
Just one injection and some medication home will not be the reasonable
standard of care in this (severe gastroenteritis) situation."
Actually I can't figure out where "consent " comes into play in this
situation. This must be a lawyer or legally trained owner. Later I saw
her studying her book placed on a brown table in the waiting room as
she waited for the treatment of IV drip. I had instructed what type of
treatment to be given inside the IV.
 The
500-ml 5% glucose saline IV drip normally runs over one hour. As this
lady seemed capable and knowledgeable, I advised her to continue the
IV drip at home as this would take around 2 hours.
She said she was OK. So, I helped her to take the dog to the father's
car. The father would drive the car closer and reversed at the front
of the clinic and open the back left door.
I held the IV drip bag high up and she carried
the dog of 18kg out of the Surgery as we walked together closely. "Put
the dog on the floor of the car," I said as she noted that the bright
red blood gushed back into the drip set due to the lack of gravity for
the drip to flow. The front car seat was pushed forward by the father.
She entered the left front door and held the IV line as high as
possible. In this small car, she held the IV bag at the ceiling of the
car and her father zoomed home.
The IV drip droplets flowed again pushing the blood back into the
system. We rarely asked the owner to go home with the IV drip bag as
many owners would not know what to do if the dog moved and the drip
fell out, oozing lots of blood. But this lady had medical knowledge
and was capable and so after some education on the taking out of the
drip, I got her and the dog home.
FOLLOW UP AFTER 2 DAYS
I phoned today Day 3. Dr Vanessa had phoned
earlier twice. The dog was OK. "The dog can only be certified OK if he
has passed normal stools," I said to Dr V at 2pm. "Due to the
spasmogesic drug, he had not passed stools for 2 days. That does not
mean he is OK." The lady returned my call at 3.30pm and provided the
following feedback:
Day 1. Had diarrhoea for 14 days with increasing
frequency of diarrhoea. Dog would drink but pushed away the food.
Sought vet treatment at Toa Payoh Vets. Bundled home with IV drip set
in car as the owner did not want to leave the dog in clinic. According
to the owner, vomited lst day, diarrhoea for one week 1-2x/day, then
more and blood seen. last few days, diarrhoea 4-5X.
Day 2. No stools. Ate plain rice and chicken.
Day 3. Ate plain rice and chicken. At 3 pm, normal
stools passed. "The first faecal pellet was firm, then semi-soft but
no blood," she said.
1. Blood test - Neutrophils 47%,
Lymphocytes =17% but the total White Blood Cell Count was
normal. Normal % of Neutrophils and Lymphocytes should be
higher. Was there some pathogens affecting the ratio of N/L? A
subclinical parvo-viral infection? It is hard to say. Liver
enzymes were high.
2. Stool examination - Erythrocytes +. No leucocytes,
ova, cysts, parasites seen.
3. Parvovirus test on faeces. Owner did not want it. This
was recorded. No more vaccination for this dog for some
years. Old dogs can still be infected by parvoviruses causing
diarrhoea and blood in the stools. In this case, there was fresh
blood and so "colitis" was correctly stated by this young lady
owner. But what was the cause of colitis?' There is no
answer. Practise evidence-based medicine unless the owner is
against it. |
This case was done by Dr Vanessa. As it was one of
those cases of "Trust and Audit" I have instituted at Toa Payoh Vets,
I was present to monitor and ensure that a high standard of veterinary
care is presented. Later, the owner told me she was not too
happy with "mis-representation of the cost of spay or some surgery" by
a vet who has a practice nearer her home and that was why she did not
go there for this treatment. It is extremely difficult to be a vet
nowadays with the government increasing the cost of doing business.
For example, the Health Services decided to have every imported
medical device to be certified and that means hefty "certification"
fees.
So, a small dental instrument or a cathether must be "certified"
or prohibited from being imported although it had been certified in
the developed countries. The Singapore supplier must pay and pay the
fees for every piece of equipment to be imported. This leads to
high increase in health care costs but it seems that the bureaucrats
are unaware of the implications.
This webpage:
http://www.sinpets.com/F6/20120437diarrhoea-with-blood-2weeks-toapayohvets-singapore_ToaPayohVets.htm |
TOA
PAYOH VETS
