Sometimes it is possible to provide such a deal. For example, dental scaling and vaccination or spay and vaccination. However, in this case, it is still possible to do what the customer wants. Make a longer incision, do the spay first. Then open up the bladder and remove the stones.

However, the two surgical procedures will take a much longer time. "There may be complications of bleeding, infection and death on the operation table," I advised the owner against doing this. No news from them since two weeks ago.

Shouldn't I be more flexible and close the deal?  Give what the customer wants? In the interest of the dog, I don't do two-in-one surgeries lasting over one hour. The longer the procedure, the higher the chances of complications like bleeding, infection and death. 

But other vets do not agree and some customers can be lost just by sticking to this policy. The younger generation of Singaporeans in their 20s is better educated and more sophisticated and may understand the high risk of long surgical procedures, especially in the older dog.

Not all long procedures will result in death on the operating table. An example is that of the 13-year-old Beagle with blood loss and seizures needing daily medication. He had bladder cancer. He survived two hours of bladder cancer removal surgery. The wife had said she would not mind cleaning up the copious patches of bloody urine of the floor but she was against euthanasia. Removal of parts of the inoperable bladder cancer gave the dog a "normal" life although he is still incontinent but has no blood in the urine so far (1 week after surgery - Trust & Audit in a Case of an old dog with fits and bladder cancer).

UPDATE IN JULY 20 2012: When I went to Hong Kong, the owner phoned me as his dog could not pee. I referred him to another practice. The story is continued at: The dog owner wanted me to spay his Schnauzer and remove the urinary stones in one surgery.