It is difficult getting a taxi at 8 pm on Fridays and so I was glad to see a cab coming to Toa Payoh Vets. A young lady stepped out to visit her sick Miniature Schnauzer, 9 years old, female and having a belly as swollen as a Schnauzer with 6 big pups.
She had sent in her dog earlier to my associate vet. I noted in the vet case notes that "the dog had been not been eating for 3 days, was very weak and had pale mucous membranes, not spayed. Pyometra?"
The taxi-driver was her father. He agreed to be hired and on the way to my home, I asked him regarding this dog that was being operated by my associate vet. He was 60 years old but his white hairs and wrinkled face aged him to 70 years.
"Parents end up looking after the children's dog," he said. "During the last 3 days, the dog just was not interested in the food, unlike other days. She would just lie down as if she was tired when my wife put the food bowl on the floor in the morning."
"Did she drink a lot of water?" I asked.
"Did she pee more than normal?" I asked.
"How many days had she been vomiting?" I asked again.
"Seven days," he said. "She vomited every day. We thought she had stomach upset. My wife gave her bits of apples as these were her favourite. She would not eat more than a piece and then would vomit them out."
"What was the colour of her vomit and how long she been vomiting?" I asked.
"She vomited water for 7 days. I told my daughter that she ought to send the dog to the SPCA!"
She said to me: 'When you are old, I will send you to the old folks home!"
"The younger generation loves their dogs very much. SPCA does not treat sick dogs normally. Sending the sick dog to the SPCA means a death sentence and therefore, you ought to advise her to send the dog to the vet. Vomiting for 7 days every day is serious."
"I did tell her to send to the vet," the father said. "But she did not do so. That was why I said to send the dog to the SPCA."
The dog's temp was 37 C when she was examined by my associate vet.
The dog was operated by my associate vet yesterday at 7.30 pm. The daughter came at 8.15 pm and would have seen the infected womb which was larger than the biggest German sausage on sale at the supermarkets.
Today, this sunny Saturday morning at 9.35 am, I saw her standing up and wagging her tail on seeing me. I phoned the young lady at 9.40 am and let her know: "Chances are good that your dog will recover." She asked if her dog was eating and I said: "No, but she had her IV dextrose saline drip and would be OK." She thanked me with a sleepy voice as this was Saturday morning and young ones in developed countries don't wake up till noon time, having partied till 5 am on Fridays to Saturdays. She was most happy.
Blood test results were typical of pyometra in that the total WCC was extremely high at 150 (6-17). Nearly 10 x higher than the higher range of normal. This confirms an overwhelming bacterial infection. Any delay in surgery for 2 more days meant death for this gentle Schnauzer.
The differential cell count was even more interesting as Neutrophils (N) = 92% when the normal is around 70%.
N=92%, Absolute 138
L=0.7%, Absolute 1.05
M=5.2% Absolute 7.8
E=0% Absolute 0
B=1.8% Absolute 2.7
KEY PERFORMANCE INDICATORS
ANAESTHESIA & SURGERY FOR A CLOSED PYOMETRA CASE
Surgeon: An associate vet of Toa Payoh Vets
Domitor + Ketamine 0.24+0.30ml IV for 6 kg, 9-year-old dog vomiting for the past 7 days.
injection to last stitch: 70 minutes
Isoflurane gas maintenance: 45 minutes
First incision to last stitch: 41 minutes
Monosyn 2/0 x 2
This report is my continuing efforts to audit veterinary surgeries done by my associate vets to achieve my vision of making Toa Payoh Vets the top 5 veterinary surgeries in Singapore.
As a licensee, I am responsible for the overall standard of care in Toa Payoh Vets.
Today, Saturday, 10.39 am, I have audited this case as regards the operational process and record keeping.
INCORRECT RECORDING. The suture used was not 3/0 as recorded by my assistant Min in the anaesthetic records. Min writes the details but the operating vet is responsible for the accuracy of the anaesthetic records. This case shows that a "trust and audit" process is necessary to maintain a high standard of care in any profession as human beings are not Gods.
The sutures used should be 2/0, Min told me. I did an inventory check of the sutures. There was no 3/0 stock of Monosyn. One associate vet uses Monosyn although the PDS is excellent too.
As the uterus was grossly enlarged (the biggest German sausage you can find), it would take 41 minutes to remove them. However, the time to achieve should be 30 minutes. The shorter the anaesthesia, the lower the risks of death of an old dog on the operating table and a dog alive is what makes or breaks a vet's reputation over the years.
OTHER KPI OF CASES RESEARCHED AT TOA PAYOH VETS ARE AT: