http://www.sinpets.com/dogs/201006260catheterisation-female-urethra-dog-Singapore-ToaPayohVets.htm
In male dogs, every vet knows where to insert the urethral catheter, but in the female dog, it is very common to incorrectly insert the catheter in the clitoral fossa if the vet does not know the anatomy of the female urinary system! So, I am attaching an illustration for reference.
An X-ray of a Miniature Schnauzer that has urethral catherisation. Digital palpation and insertion of a soft catheter was done by Vet 1 as I had referred the owner to her. I was in Hong Kong at that time and the dog had difficulty peeing after passing out some stones. Did the dog owner agree to Vet 1 removing the urinary stones? No.
"Why?"
I asked Vet 1 later
when I returned to
Singapore. She was
willing to spay and
remove the urinary
stones at one
surgery whereas I
did not want to do
two-in-one as I
don't increase
my anaesthetic and
surgical risk by
doing a
prolonged surgical
procedure.
She did not know the
reason. "Is it the
cost?" I asked her.
"No," she said. "The
owners were
agreeable to do the
two surgeries when
they consulted me."
 |
First X-ray shows numerous stones. Advice to remove the bladder stones not taken up as the owners wanted a spay to be included at one surgery, i.e. 2-in-one operation. I declined taking unnecessary risks as the surgery will be prolonged and may kill this dog. | |
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Subsequently, second X-ray with urethral catherisation. I checked out this X-ray 24 hours before the spay and discussed the case with Vet 1's boss. He said spay and urinary stone removal in one go should be OK. | |
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Vet 1's boss tries to send image to me via his Blackberry phone. He was unsuccessful as I have an iPhone and some application software was missing. | |
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| Owner shows me the 5 stones peed out. As at Jul 20, 2012, the dog still has the urinary stones and did not present any blood in the urine. This procrastination is "penny wise, pound foolish" as the owner did not persevere in putting the dog on the S/D diet, in the hope that the stones be dissolved or reduced in size to be peed out. This must be given for 2 months as advised by me but he bought 3 cans after the spay. | Spayed by me but no urinary stone removal during the spay. The owner bought 6 cans of S/D diet to dissolve the stones and no more news from him for the past one month. | |
"How much did you
quote?"
"The usual rates,"
she would not give
me the actual
figure. A fuzzy
reply from the
internet generation
vet.
"Did you do it
immediately?" I
asked.
"No, it was a
Saturday and the
cost would be much
higher. I
hospitalised the
dog and would have
done it on Monday. The
owner took back
the dog back on Sunday."
"Did you follow up?"
I asked.
"Yes, but there was
nobody answering
the phone." This is
a very good vet as
many vets don't do
follow up at all,
waiting for the
owner to phone. I
don't follow up in
some of my cases too
but owners are very
glad if vets do it.
This follow up is
part of excellent
service and will
retain the loyalty
of the clientele.
"I am sure it is the
cost," I said to the
serious sounding Vet
1 over the phone.
"No, no," she replied.
"They had agreed to
the surgery."
Other than cost,
what could it be?
Many days later, the husband
came to me to get
the dog spayed. The
husband would not
give me the reason
as to why he did
not accept the
combined surgery as
that was what he
wanted and Vet 1
said she had done
such surgeries
without problems. A fuzzy
reply again. He said
that the dog could
pee after the
catherisation by Vet
1.
"My dog
peed out the 5
stones after
consulting you and
taking a can or two
of the S/D diet,"
the man took out 5
white stones and put
them on the table. I
had not followed up
with him since the
consultation and so
I did not know.
Sometimes, following
up could be
misconstrued as
trying to solicit
for surgery
business.
Since the 5 stones
were passed out, the
couple did not
want the bladder operation. The
husband asked: "Vet
1 says the bladder
will rupture if I
don't remove the
bladder stones as
they will increase
in size. Is it
correct?"
"The bladder will
rupture if the urine
can't flow out for a
long time," I said.
"If there is no
obstruction, the
bladder will not
rupture. You may
have heard her
incorrectly. The
large stones will
irritate the bladder
causing bleeding. As
to whether the
stones will rupture
the bladder by
themselves, I don't
think they will as
they are not sharp."
It is a difference
of opinion. Some
vets will not agree
with me.
The dog still has
the 3 stones and
apparently had no
blood in the urine.
I did not advise
further as this
would be like
high-pressure
selling. The husband
had associated
feeding 2 cans of
S/D diet with the
passing out of 5
stones (see image)
and got another 6
cans. I had advised
1-3 months feeding
of S/D diet for
struvite stone
dissolution but that
means more than 6
cans!
Knowing the reasons
of the client is
important to improve
the standard of care
and service. If the
vet does not bother
to ask, the answers
will never be known
and the standard of
care cannot be
improved.
The first report of
this case is at:
http://www.sinpets.com/dogs/20120246bladder-stone-spay-packaged-deal-singapore_ToaPayohVets.htm
