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Date:   06 September, 2010  
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
 
Urinary stones in Singapore dogs
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case 1 was recorded in 2008. Case 2 was recorded in 2010.
Saturday
06 September, 2010
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129
Case 1: 2010 - The Shih Tzu keeps passing blood in the urine every day
X-rays and blood tests would be best but sometimes it is not possible due to economic reasons. The vet has to be compassionate when the owner request least-cost surgery. However the diagnosis must be spot-on and the surgery must be planned to ensure survival of a dog during anaesthesia.
 
young shih tzu fresh blood in urine daily palpation urinary bladder stones  surgery cystotomy toapayohvets singapore "Your Shih Tzu needs an operation to remove the big bladder stone I felt," I advised the young man whose female dog passes blood in the urine for the past 2 months. I could feel the creptitus (gas-like feeling) in the bladder. But the owner did not want an X-ray nor surgery. He wanted drugs.
young shih tzu fresh blood in urine daily palpation urinary bladder stones  surgery cystotomy toapayohvets singapore young shih tzu fresh blood in urine daily palpation urinary bladder stones  surgery cystotomy toapayohvets singapore One month later, his dog had not stopped passing red blood. He requested surgery, but no blood tests or X-rays. I was OK with this request.
young shih tzu fresh blood in urine daily palpation urinary bladder stones  surgery cystotomy toapayohvets singapore young shih tzu fresh blood in urine daily palpation urinary bladder stones  surgery cystotomy toapayohvets singapore "It is an open-and-shut case," I thought when I saw one stone coming out. "This was the big stone I had palpated. Stitch up the bladder and go home.
Another big stone was stuck partially in the urethra as my catheter could not pass through. What to do?
The stone was stuck fast. Finally the forceps managed to grip one end and pull it out 
young shih tzu fresh blood in urine daily palpation urinary bladder stones  surgery cystotomy toapayohvets singapore young shih tzu fresh blood in urine daily palpation urinary bladder stones  surgery cystotomy toapayohvets singapore
Smaller stones spilled out like small bombs when the bladder was flushed. Catheter was earlier passed
out via the vagina
No more urinary stones after irrigation of the bladder
  urolithiasis, urinary stones, haematuria, blood in urine, shih tzu, toapayohvets, singapore urolithiasis, urinary stones, haematuria, blood in urine, shih tzu, toapayohvets, singapore
Day 3 after surgery. There has been difficulty in passing urine but the dog eats and has no fever. Antibiotics and pain-killers are given. I phone the owner that the dog can't go back today Sep 6, 2010 as the dog has dysuria.
Case 2: Employee Vets That Discourage Referrals

E-MAIL TO DR SING dated Sep 5, 2010

Hi Dr Sing,
Just a quick line to let you know that I have finally returned to Singapore and just started work at (Name given). I am returning to Perth from 16th to 19th for my graduation. If you want me to carry anything for (Name given), I will be glad to. The other reason for this email is Dr (Name given) heard that (Name given) might have been badly injured in a car accident in Perth on Friday night/ Saturday... is this true? If so, I hope all is ok with her... we are concerned about her welfare.

E-MAIL FROM DR SING dated Sep 6, 2010

Thank you for email. (Name given) is my god-daughter. She passed away on Sep 3, 2010 due to an accident as the other driver of an on-coming car overtook a car and smashed into her car.

In your new job, I hope you will present a kindness towards "smaller practices" as I have had nasty experiences of three vets from your practice when cases were referred to them. I gave you 3 examples in the hope that you would be kinder now that you have had started practice with them.

1. One vet demanded over the phone that I should call him first but I told him that his receptionist said he was busy and it was my client who wanted the case to be sent to him. So I extended the courtesy to phone him.

2. Another vet said I should fill up a form if I wanted to refer any animal to him.

3. The 3rd vet refused to give the X-ray of the bladder stone to a small animal practice vet. I shall name him as Vet X. His practice had fed your new employer with numerous cases over the last 20 years. Vet X's receptionist had a dog with haematuria. The dog was referred to your employer for an X-ray.

Vet X's mother had asked me to mentor her son in surgery. This was his first case of urinary stone removal from the bladder. I asked him to get the X-ray. It would be good to have an X-ray but since the vet did not want to release it, he could do nothing.

I said it was OK since I could palpate the bladder stone and in fact X-rays are not necessary if one is confident of the diagnosis based on clinical signs and history. Vet X operated under my supervision and the dog is still much alive and well when I saw the receptionist recently.

Best wishes to your new career.  
 

chow chow dog singapore spayed toa payoh vets 10 months no bleedingA code of honour is needed to manage employee vets if a practice wants to be a champion referral centre (thereby increasing its customer base and its own profitability). The culture of wanting to be champions must be in the team. Otherwise, you'll get vets who discourage referrals.  Reference: The ABC's of Building a Business Team That Wins - Blair Singer, Sales Communications Specialist

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More info at: Urinary Tract Infections and Stones in the dog in Singapore.
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