Yesterday, Saturday March 27, 2011, I attended a
continuing education lecture by a veterinary anaesthesia specialist,
Dr Kieren Maddern, BVSc (Hons), MACVSc, Dip ECVAA, European Specialist
in Veterinary Anaesthesia. The topic was "Overcoming the odds -
Anaesthesia for difficult situations."
It was a very well attended lecture - some 70 people there. An
excellent lecture. I caught up with a senior vet who has done a few
thousand dog and cat surgeries over the last 40 years and asked his
advices about young vets referring corneal ulcer cases to other
practices as I had an unusual incident, written in
Passing the buck -
Perforated corneal ulcer
He said: "The young vet may find that it is a difficult case or that
the owners are the type liable to sue. So, just refer the case out to
others. No more headaches of the AVA investigation if the owners
complain. Just like the Old School Vet who just do simple cases. Maybe
your young vet thinks that you can't do the surgery! Young vets do not
usually ask for advice but just refer the cases away to others!
"When the case goes from Toa Payoh Vets to the other vet, the other
vet will just laugh and say 'Dr Sing does not even know how to operate
a simple corneal ulcer case! What's wrong with him?' Maybe you should
give instructions that all cases that your younger vets want to refer
to others should go through you!"
I was not alone in having this problem of the younger vets doing their
own thing without consulting the senior vets in the same practice. I told
the senior vet: "I do treat corneal ulcers using the 3rd eyelid flap
method and do stitch up corneas if necessary."
The senior vet told me: "Tarsorrhapy is very effective in corneal
ulcer cases. Even in cases where the eyeball collapses. No need to
stitch up the cornea*. Just sew up the two eyelids and the outcome
is very good. I find that the eyeball is seldom infected even
with perforated ulcers."
I listened attentively for the free advice. This senior vet is 5 years
older than me and I had hung around his practice when I first started
Toa Payoh Vets 20 years ago. I just stayed around till past midnight
as he was and is a workaholic and closed my Toa Payoh Vets in the
evening.
He still works the long hours and do
the after hours emergencies. High energy and therefore he has more
caseload experiences for me to tap.
"By the way, how do you treat corneal ulcers in the dog? Do you just
do the 3rd eyelid flap by itself?" my mentor asked.
"I am more kiasu," I said. "I do the 3rd eyelid flap and tarsorrhapy.
Not all the time as I also do tarsorrhapy by itself."
It is always
good to ask the older vets how a procedure is done, to tap on the
years of experience and wisdom. As veterinary medicine and surgery is
so diverse (from head to toe), it is not possible for a young or older vet to
know everything. Human doctors do specialise in one system e.g. heart
diseases but vets are expected to know all systems and that takes
years and years to master all the main problems of the various
systems. At the age of 60 years, I still encounter new and rare cases
in dogs and cats although I have been in practice for over 40 years!
A young vet has to overcome his or her inability to
ask older and possibly more intimidating seniors for advice. Asking
may make you sound incompetent but if you overcome this negative
thought and ask to make yourself more competent and wiser, you will be
confident enough to ask and receive good veterinary tips and advices.
P.S
No need to stitch up the cornea*
- this depends on the extent of laceration as most corneal
ulcers in dogs with extensive lacerations are hopeless cases.
Owners of such dogs don't seek veterinary treatment early! Each
case is unique and stitches do break down requiring repeat
sewing of the eyelids.
The follow up and pictures of my case in a Jack Russell where I did
the 3rd eyelid flap and tarsorrhapy with an excellent outcome is shown
below.
TOA
PAYOH VETS
