tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS
toapayohvets.com
      Date:   16 May, 2012  
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
The audit of a case of urinary stones
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
16 May, 2012
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

Friday, May 4, 2012

974. Veterinary audit of one case TP ..569


TRUST & AUDIT PROCESS AT TOA PAYOH VETS


Saturday, May 5, 2012  10.25 am

I did a veterinary audit of one surgical case done by one of the vets (Dr X) at Toa Payoh Vets as part of my management of the practice to make it as one of the top 5 vet practices in Singapore. This is to ensure a high standard of veterinary care from vets at all times especially in veterinary surgery.

TP ...569
Chihuahua, Male, 10 years
Complaint: Blood in the urine.
Blood in the urine. X-rays and blood tests done by another practice (Vet 1) on Mar 31, 2012

Admitted: April 16, 2012.
Cystotomy: Bladder stones removed by Dr X: April 18, 2012
Neuter by Dr X: April 18, 2012
Sent home: Apr 18, 2012
Owner returned dog for hospitalisation as the dog screamed when touched or given medication: Apr 19 - May 3, 2012.

VETERINARY AUDIT PROCESS - 
LIST OF RECORDS MAINTAINED

Veterinary Surgeon - Dr X
1. Follow up phone call. I phoned owner today to find out about the present situation. No response on this Saturday morning.
2. Outpatient record  - Yes.
3. Anaesthetic and surgical record - Yes.
Anaesthetic dosage recorded. Number of packets used and type of sutures not recorded. 3 packets were used.
4. Inpatient record - Yes.  2 days. Apr 16-18, 2012
5. Hospitalisation record - Yes.  Apr 19 to May 3, 2012
100g dry food given and consumed per day. I checked on weight of food given by Mr Min.

TESTS DONE AS AIDS TO DIAGNOSIS
6. Blood test - done by Vet 1. Nothing abnormal discovered.
7. Urine test - not done by Dr X. Reason being that there was urethral obstruction. In this "audit and trust" procedure, I informed the vet that urine test should be done in all cases. It could be collected during cystotomy if there was urethral obstruction. This is to enable us to know the pH of the urine and whether there is bacterial infection.
8. X-ray of bladder - done by Vet 1  - 6 small stones seen on hard copy kept by the owner.
9. Bladder stone analysis done by Dr X - Yes. Mainly calcium oxalate with trace of phosphate and magnesium. This test is important.

CONCLUSION
It is extremely difficult to effect changes in all organisations as each manager or vet in this case, has his or her own mindset and way of practising veterinary medicine and surgery. The Domitor and Ketamine IV sedation formula, much discussed in my case reports, is now accepted by Dr X after many months as being scientific, effective and safe. Formerly Dr X would use Domitor in low dosages irrespective of weight of the dog and then top up with isoflurane gas for general anaesthesia taking a much longer time to do surgical procedures than nowadays.

Post-op care. As the dog was neutered and had urinary stones removed, the dog could have been hospitalised more than 2 days to enable him to recuperate and nursed at Toa Payoh Vets, rather than being sent home after 2 days. The owner was unable to nurse the dog and sent him back to be hospitalised for around 14 days.
Electro-GP-trichoepithelioma/20120342tn_guinea-pig-male-3years-large-ear-tumour-electrosurgery-toapayohvets-zoletil-isoflurane.jpg tpvets_logo.jpg (2726 bytes)5131 - 5141. Ulcerated ear tumour.
Electro-surgery to excise a guinea pig's trichoepithelioma using Zoletil 100 & isoflurane
tpvets_logo.jpg (2726 bytes)

BE KIND TO GUINEA PIGS --- GET EAR TUMOURS ULCERS TREATED WHEN THEY ARE SMALL.  More case studies, goto:  Guinea Pigs

To make an appointment: e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326

toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129
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All rights reserved. Revised: May 16, 2012

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