I read about this on STOMP. It's about the death of a Maltese and the interesting response given by the animal hospital.
--------------------------------
Philia's email to STOMP
(Posted on 09 May, 2007)
I had brought my 13 year old maltese, Koo Koo to M**** P***** Animal Medical Centre, a clinic at Clementi on 1st April 2007 and was advised by Dr Simon Quek that Koo Koo needs an operation to sterilize and remove his testicles.
As my dog was very old in age, I was rather hesitant at first as I was worried about the side effects and whether Koo Koo was able to take the toil. After discussing with Dr Quek, the decision was to go ahead with the operation. But this was an upsetting mistake.
After Koko had completed the surgery, he was whining and crying, seemingly in great pain. He could not even walk, sit or stood up. Every single bit of movement is extremely painful and unbearing for Koo Koo. I noticed that his private area was very swollen and red and there was even a patch of skin hanging. (I later checked with my friend who had his dog sterilized too, and was told that the skin should be patched back nicely !). Koo Koo was in so much pain that the black portion of his eyeballs went behind his eyes and only half black could be seen.
I was very worried and concerned with Koo Koo's health and consulted Dr Quek on the reasons why it was swollen. Dr Quek's reply was just a mere 'I don't know' ! As a vet, whose duty was to cure sick animals and their concern for animals should be innate, but what I am getting is a flat refusal and nothing was done to help check why Koo Koowas in extreme pain after the operation. Were there any other side effects or implications ?
I also found out from the staff at Clementi clinic that Koo Koo was unable to eat nor move for the few days that I left him in the clinic. Because of this, he was extremely weak and because he was unable to move, his urine and discharges were stuck in his coat and legs. He was in a very bad condition when I went to collect him. No one at the clinic had informed me that Koo Koo had not been eating these while.
Come next was even more atrocious. Dr Quek proposed an operation to treat Koo Koo's legs as her legs got worse after the operation. I consulted a senior vet in another pet hospital and was advised that for Koo Koo is not suitable for any operation at this stage as she is too weak to take it any further.
I am not pleased with the standard replies given by M**** P*****. They mentioned that there is no need for patching of skin after testicle surgery. Why shouldn't there be any patching back of scrotum (the skin which covers the testicles) if it had been cut in order to facilitate removal of testicles. It is absurd that the dog's skin is still hanging after surgery.
Also, M**** P***** replied that Koo Koo's abnormal positioning of its eyeballs were not due to pain, but because of anaesthetic effects. Why wasn't I informed in the first place that her eyeballs will be abnormal after the surgery. It came as a shock to me.
M**** P***** claimed that they would clean the animals cages every morning, and if the animals had soiled themselves, they would be given a wash as well too. But this was definitely not the case. Koo Koo was in a terrible state when I saw him. His coat were smelly and soiled with urine and feaces.
I am very disappointed with the services provided by M**** P*****. It is my fault that I had brought Koko to M**** P*****. If I had known, I would have brought Koko elsewhere for treatment and perhaps, I could have accompanied Koko for a few more years.
Koko had died few days after the surgery, in pain and suffering. I feel sad what they had done to my dog.
--------------------------------
M**** P***** Animal Medical Centre's Dr Heng Yee Leng not only responded to STOMP's query about this, but also sent Philia an email to clarify some misunderstandings she has about the case.
Koo Koo, says the centre had to have his testicles removed as he had testicular torsion, and was also suspected of having a hormonal problem.
The hanging patch was not removed as it was his scrotum; it would have been very painful for the dog and would shrink over time to normalcy. His genital area was red and swollen post-op, and would be all right over time.
His eyes appeared to be abnormal due to a reaction to the anaesthetic.
A second operation was recommended as he was suspected to have torn his ligament, a condition he had even before the operation.
Koo Koo was hand-fed by staff though he refused to eat.
The animals and cages are cleaned in the mornings; treatment is also administered then.
The centre appreciates her feedback, and says they will work towards achieving better standards.
--------------------------------
M**** P***** Animal Medical Centre's letter to Philia
17th April 2007
Dear
Re: Letter of Complaint
I refer to your letter of complaint against Dr Simon Quek.
As a senior veterinarian, I have been instructed by Dr Tan Hwa Luck to investigate your complaint.
Firstly, condolences to you on the demise of your dog. Thank you for your feedback. I have looked into the case regarding your dog Koo Koo and there appears to be some misunderstandings I hope can be clarified.
Koo Koo was brought into the clinic on 1st April 2007 with the complaint of swollen testicles. Upon examination by Dr Quek, castration was recommended. The castration had to be carried out NOT because of kidney implications as you had stated in your letter. The castration had to be performed as there was a high chance of the blood vessels supplying the testicle being twisted, a condition known as testicular torsion. During the visit, it was also noticed that the dog had a potbellied appearance and sparse hair coat. He was also informed that the dog was eating a lot, drinking and urinating a lot.
Based on the clinical signs, Dr Quek had suspected that the dog might have a hormonal problem, specifically Cushings Disease ( also known as Hyperadrenocorticism). He had recommended to you that a test be done to confirm the disease at a later stage. The dog had to be castrated as testicular torsion is a painful condition and can only be treated by means of surgery.
With a castration, the testicles are removed via an incision in front of the scrotum ( the skin which covers the testicles). In cases where by the scrotum is not damaged , as in Koo Koos case, the scrotum is not removed as it is a much more painful and bloody procedure. In older dogs or cases with an enlarged testicle( as with Koo Koo) , post operatively, the scrotum will appear as a patch of skin hanging between their legs. In your friends case, if the dog was castrated at a younger age or castration was not complicated, the scrotum will not be as well developed and will shrink to appear level with the rest of the skin, therefore you will not see a patch of skin.
Therefore, no patching of the skin is required. Post operatively, in most cases, there will be some degree of swelling around the surgical site and within the scrotum due to bruising and accumulation of blood as the testicles and scrotum is an area with a heavy blood supply. Injectable painkillers are given to help the animals with pain after surgery.
In your letter, you mentioned that Koo Koo's eyeballs were in an abnormal position. This is not because Koo Koo was in pain but due to the anaesthetic. When an animal is anaesthetised for surgery, the third eyelid comes across the eyeball, giving the owner an impression that the eyeballs are in an abrnomal position. The third eyelid is a pinkish membrane that is normally hidden in the corner of the eye so it is very normal for an owner to be shocked when this covers up part of the eyeball.
On the review dated 3rd April, your concern was of Koo Koo being in pain and unable to walk. When examined, Koo Koo was found to have a laxity in the ligaments in both his knees, with a possible rupture of the cruciate ligaments. Upon questioning, you replied that Koo Koo had always been weak in his hindlegs. As there were no other reasons for his lameness at the time of examination, Dr Quek gave you the option of performing another surgery on Koo Koo to repair the ruptured cruciate ligaments in his knee. He discussed with you the costs, risks and prognosis taking into account the condition of your dog at the time of presentation. While you were considering your options, Koo Koo was hospitalised.
During the time when your dog was hospitalised, pain killers were being given. The staff reported that Koo Koo did not eat on his own. It is standard practice for the staff at the clinic to offer the dog a variety of foods, both regular kibbles and soft foods to encourage them to eat. In cases where the dog does not want to eat, the staff hand feed them with a veterinary prescription diet, namely Hills Prescription Diet A/D which is formulated for recuperating animals.
All the animals hospitalised at the clinic are given an examination in the morning and given their required treatment, and their cages cleaned out. The animals that have soiled themselves would be given a wash as well. However, we appreciate your comments and will work towards achieving higher standards.
I hope this has cleared up your understanding of the situation.
Yours sincerely,
Dr Heng Yee Ling
BVM&S ( Edin.), MRCVS
cc. Dr Tan Hwa Luck
--------------------------------
M**** P***** Animal Medical Centre's letter to STOMP
8/05/2007
Dear STOMP team,
Please find attached our reply to the clients complaint.
We have included the correspondence to the client so that you may be able to understand the situation better. Upon receiving her letter of complaint, we investigated and replied to her accordingly. No professional negligence was found upon investigation. However, it appears that the client may not fully understand the medical condition her dog was in and thus does not understand the necessary actions that were taken.
It would have been helpful if she had communicated her concerns with Dr Quek initially so that such a misunderstanding would not have happened.
1. The client initial complaint was the dog having a swollen testicle. Upon examination, a swollen testicle was confirmed and diagnosed as a testicular torsion. This means the blood vessel supplying the testicle had become twisted upon itself, leading to swelling and pain of the testicle. Surgery to remove the testicles was necessary to alleviate the pain and inflammation. The incision was made in front of the scrotal sac as with a routine castration and skin was stitched with absorbable suture material. The flap of skin that the client had mentioned is actually the empty scrotal sac. This sac can become slightly swollen after castration, but subsides and retracts over time. On the second visit a few days later, the wound from the castration was healing well and the scrotal sac was still loose as expected at this stage.
2. In the clients letter to you,she mentioned that Dr Quek replied I dont know to her question. This happened in the first consultation even before surgery had been done to remove the dogs testicles. She had asked why would a condition such as testicular torsion occur. In reply to her question, Dr Quek said I dont know the exact cause of the testicular torsion. He went on to explain that there is no way to determine why the testicular torsion occurred to her dog, which the client failed to mention in her letter.
3. The client also mentioned that the dogs eyes were in an abnormal position indicating that the dog was in pain. After surgery the dog was put on painkillers to help with pain. With anaesthesia the third eyelid would come across the eyeball. This protrusion of the third eyelid can sometimes be present a few days after the anaesthesia as the dog is recovering from the surgery. The protrusion of the third eyelid would give the impression that the dogs eyes are smaller and owners may mistake it for pain.
4. On the second consultation, the dog was found to healing well from the castration. However another problem was highlighted. The dog was still not walking properly. It had lameness in both legs. The initial reluctance to walk was thought to be due to pain from the testicular torsion. That pain and inflammation from the swollen testicles would now have been eliminated. Further investigations were carried out and the dog was found to have ruptured cranial cruciate ligaments in both knees. It was also determined by further questioning of the owner that the dog had been lame for many months before presentation.
Dr Quek had given the client the options for treatment. The options include operating to repair the ruptured ligament, or conservatively to treat the pain as the dog was very old, or even an option for euthanasia. The client could not decide on the course of treatment and so the dog was hospitalised for monitoring. While at the clinic the dog was given painkillers for the knee problem. The client returned 2 days later and decided that she does not want to put the dog through surgery. It was decided that conservative treatment for the knee problem would be best for the time being. The dog was then discharged with more painkillers. The client did not return for any follow up after that.
5. All animals hospitalised at the clinic would be examined every morning and given their required treatment. If they had soil themselves overnight, they would be washed by the vet nurses.
I hope the explanation has illustrated to you in chronological order, the presentation, diagnosis and treatment options of the dog. It is understandable that she is upset by the death of her dog but as a professional organisation, we need to determine if there was any professional negligence in this case. The proper route of investigation is for her to direct her letter of complaint to the Agri-Food and Veterinary Authority ( AVA) which is the governing body for veterinarians. AVA will then make an independent investigation to determine if there was any case of negligence involved.
It is improper for the owner to send a letter to the press, such as yourself, before any investigations have been carried out. Such a letter, if published, would be defamatory to the individual and the organisation if there was no profession negligence found. The organisation and the individual vet would then reserve the right to take legal action against the owner and parties involved in dissemination of the story.
Please feel free to contact us if you require more information.
Sincerely,
Dr Heng Yee Ling
Senior Veterinarian
M**** P***** Animal Medical Centre (2004) Pte Ltd
--------------------------------
Philia's email to STOMP
(Posted on 09 May, 2007)
I had brought my 13 year old maltese, Koo Koo to M**** P***** Animal Medical Centre, a clinic at Clementi on 1st April 2007 and was advised by Dr Simon Quek that Koo Koo needs an operation to sterilize and remove his testicles.
As my dog was very old in age, I was rather hesitant at first as I was worried about the side effects and whether Koo Koo was able to take the toil. After discussing with Dr Quek, the decision was to go ahead with the operation. But this was an upsetting mistake.
After Koko had completed the surgery, he was whining and crying, seemingly in great pain. He could not even walk, sit or stood up. Every single bit of movement is extremely painful and unbearing for Koo Koo. I noticed that his private area was very swollen and red and there was even a patch of skin hanging. (I later checked with my friend who had his dog sterilized too, and was told that the skin should be patched back nicely !). Koo Koo was in so much pain that the black portion of his eyeballs went behind his eyes and only half black could be seen.
I was very worried and concerned with Koo Koo's health and consulted Dr Quek on the reasons why it was swollen. Dr Quek's reply was just a mere 'I don't know' ! As a vet, whose duty was to cure sick animals and their concern for animals should be innate, but what I am getting is a flat refusal and nothing was done to help check why Koo Koowas in extreme pain after the operation. Were there any other side effects or implications ?
I also found out from the staff at Clementi clinic that Koo Koo was unable to eat nor move for the few days that I left him in the clinic. Because of this, he was extremely weak and because he was unable to move, his urine and discharges were stuck in his coat and legs. He was in a very bad condition when I went to collect him. No one at the clinic had informed me that Koo Koo had not been eating these while.
Come next was even more atrocious. Dr Quek proposed an operation to treat Koo Koo's legs as her legs got worse after the operation. I consulted a senior vet in another pet hospital and was advised that for Koo Koo is not suitable for any operation at this stage as she is too weak to take it any further.
I am not pleased with the standard replies given by M**** P*****. They mentioned that there is no need for patching of skin after testicle surgery. Why shouldn't there be any patching back of scrotum (the skin which covers the testicles) if it had been cut in order to facilitate removal of testicles. It is absurd that the dog's skin is still hanging after surgery.
Also, M**** P***** replied that Koo Koo's abnormal positioning of its eyeballs were not due to pain, but because of anaesthetic effects. Why wasn't I informed in the first place that her eyeballs will be abnormal after the surgery. It came as a shock to me.
M**** P***** claimed that they would clean the animals cages every morning, and if the animals had soiled themselves, they would be given a wash as well too. But this was definitely not the case. Koo Koo was in a terrible state when I saw him. His coat were smelly and soiled with urine and feaces.
I am very disappointed with the services provided by M**** P*****. It is my fault that I had brought Koko to M**** P*****. If I had known, I would have brought Koko elsewhere for treatment and perhaps, I could have accompanied Koko for a few more years.
Koko had died few days after the surgery, in pain and suffering. I feel sad what they had done to my dog.
--------------------------------
M**** P***** Animal Medical Centre's Dr Heng Yee Leng not only responded to STOMP's query about this, but also sent Philia an email to clarify some misunderstandings she has about the case.
Koo Koo, says the centre had to have his testicles removed as he had testicular torsion, and was also suspected of having a hormonal problem.
The hanging patch was not removed as it was his scrotum; it would have been very painful for the dog and would shrink over time to normalcy. His genital area was red and swollen post-op, and would be all right over time.
His eyes appeared to be abnormal due to a reaction to the anaesthetic.
A second operation was recommended as he was suspected to have torn his ligament, a condition he had even before the operation.
Koo Koo was hand-fed by staff though he refused to eat.
The animals and cages are cleaned in the mornings; treatment is also administered then.
The centre appreciates her feedback, and says they will work towards achieving better standards.
--------------------------------
M**** P***** Animal Medical Centre's letter to Philia
17th April 2007
Dear
Re: Letter of Complaint
I refer to your letter of complaint against Dr Simon Quek.
As a senior veterinarian, I have been instructed by Dr Tan Hwa Luck to investigate your complaint.
Firstly, condolences to you on the demise of your dog. Thank you for your feedback. I have looked into the case regarding your dog Koo Koo and there appears to be some misunderstandings I hope can be clarified.
Koo Koo was brought into the clinic on 1st April 2007 with the complaint of swollen testicles. Upon examination by Dr Quek, castration was recommended. The castration had to be carried out NOT because of kidney implications as you had stated in your letter. The castration had to be performed as there was a high chance of the blood vessels supplying the testicle being twisted, a condition known as testicular torsion. During the visit, it was also noticed that the dog had a potbellied appearance and sparse hair coat. He was also informed that the dog was eating a lot, drinking and urinating a lot.
Based on the clinical signs, Dr Quek had suspected that the dog might have a hormonal problem, specifically Cushings Disease ( also known as Hyperadrenocorticism). He had recommended to you that a test be done to confirm the disease at a later stage. The dog had to be castrated as testicular torsion is a painful condition and can only be treated by means of surgery.
With a castration, the testicles are removed via an incision in front of the scrotum ( the skin which covers the testicles). In cases where by the scrotum is not damaged , as in Koo Koos case, the scrotum is not removed as it is a much more painful and bloody procedure. In older dogs or cases with an enlarged testicle( as with Koo Koo) , post operatively, the scrotum will appear as a patch of skin hanging between their legs. In your friends case, if the dog was castrated at a younger age or castration was not complicated, the scrotum will not be as well developed and will shrink to appear level with the rest of the skin, therefore you will not see a patch of skin.
Therefore, no patching of the skin is required. Post operatively, in most cases, there will be some degree of swelling around the surgical site and within the scrotum due to bruising and accumulation of blood as the testicles and scrotum is an area with a heavy blood supply. Injectable painkillers are given to help the animals with pain after surgery.
In your letter, you mentioned that Koo Koo's eyeballs were in an abnormal position. This is not because Koo Koo was in pain but due to the anaesthetic. When an animal is anaesthetised for surgery, the third eyelid comes across the eyeball, giving the owner an impression that the eyeballs are in an abrnomal position. The third eyelid is a pinkish membrane that is normally hidden in the corner of the eye so it is very normal for an owner to be shocked when this covers up part of the eyeball.
On the review dated 3rd April, your concern was of Koo Koo being in pain and unable to walk. When examined, Koo Koo was found to have a laxity in the ligaments in both his knees, with a possible rupture of the cruciate ligaments. Upon questioning, you replied that Koo Koo had always been weak in his hindlegs. As there were no other reasons for his lameness at the time of examination, Dr Quek gave you the option of performing another surgery on Koo Koo to repair the ruptured cruciate ligaments in his knee. He discussed with you the costs, risks and prognosis taking into account the condition of your dog at the time of presentation. While you were considering your options, Koo Koo was hospitalised.
During the time when your dog was hospitalised, pain killers were being given. The staff reported that Koo Koo did not eat on his own. It is standard practice for the staff at the clinic to offer the dog a variety of foods, both regular kibbles and soft foods to encourage them to eat. In cases where the dog does not want to eat, the staff hand feed them with a veterinary prescription diet, namely Hills Prescription Diet A/D which is formulated for recuperating animals.
All the animals hospitalised at the clinic are given an examination in the morning and given their required treatment, and their cages cleaned out. The animals that have soiled themselves would be given a wash as well. However, we appreciate your comments and will work towards achieving higher standards.
I hope this has cleared up your understanding of the situation.
Yours sincerely,
Dr Heng Yee Ling
BVM&S ( Edin.), MRCVS
cc. Dr Tan Hwa Luck
--------------------------------
M**** P***** Animal Medical Centre's letter to STOMP
8/05/2007
Dear STOMP team,
Please find attached our reply to the clients complaint.
We have included the correspondence to the client so that you may be able to understand the situation better. Upon receiving her letter of complaint, we investigated and replied to her accordingly. No professional negligence was found upon investigation. However, it appears that the client may not fully understand the medical condition her dog was in and thus does not understand the necessary actions that were taken.
It would have been helpful if she had communicated her concerns with Dr Quek initially so that such a misunderstanding would not have happened.
1. The client initial complaint was the dog having a swollen testicle. Upon examination, a swollen testicle was confirmed and diagnosed as a testicular torsion. This means the blood vessel supplying the testicle had become twisted upon itself, leading to swelling and pain of the testicle. Surgery to remove the testicles was necessary to alleviate the pain and inflammation. The incision was made in front of the scrotal sac as with a routine castration and skin was stitched with absorbable suture material. The flap of skin that the client had mentioned is actually the empty scrotal sac. This sac can become slightly swollen after castration, but subsides and retracts over time. On the second visit a few days later, the wound from the castration was healing well and the scrotal sac was still loose as expected at this stage.
2. In the clients letter to you,she mentioned that Dr Quek replied I dont know to her question. This happened in the first consultation even before surgery had been done to remove the dogs testicles. She had asked why would a condition such as testicular torsion occur. In reply to her question, Dr Quek said I dont know the exact cause of the testicular torsion. He went on to explain that there is no way to determine why the testicular torsion occurred to her dog, which the client failed to mention in her letter.
3. The client also mentioned that the dogs eyes were in an abnormal position indicating that the dog was in pain. After surgery the dog was put on painkillers to help with pain. With anaesthesia the third eyelid would come across the eyeball. This protrusion of the third eyelid can sometimes be present a few days after the anaesthesia as the dog is recovering from the surgery. The protrusion of the third eyelid would give the impression that the dogs eyes are smaller and owners may mistake it for pain.
4. On the second consultation, the dog was found to healing well from the castration. However another problem was highlighted. The dog was still not walking properly. It had lameness in both legs. The initial reluctance to walk was thought to be due to pain from the testicular torsion. That pain and inflammation from the swollen testicles would now have been eliminated. Further investigations were carried out and the dog was found to have ruptured cranial cruciate ligaments in both knees. It was also determined by further questioning of the owner that the dog had been lame for many months before presentation.
Dr Quek had given the client the options for treatment. The options include operating to repair the ruptured ligament, or conservatively to treat the pain as the dog was very old, or even an option for euthanasia. The client could not decide on the course of treatment and so the dog was hospitalised for monitoring. While at the clinic the dog was given painkillers for the knee problem. The client returned 2 days later and decided that she does not want to put the dog through surgery. It was decided that conservative treatment for the knee problem would be best for the time being. The dog was then discharged with more painkillers. The client did not return for any follow up after that.
5. All animals hospitalised at the clinic would be examined every morning and given their required treatment. If they had soil themselves overnight, they would be washed by the vet nurses.
I hope the explanation has illustrated to you in chronological order, the presentation, diagnosis and treatment options of the dog. It is understandable that she is upset by the death of her dog but as a professional organisation, we need to determine if there was any professional negligence in this case. The proper route of investigation is for her to direct her letter of complaint to the Agri-Food and Veterinary Authority ( AVA) which is the governing body for veterinarians. AVA will then make an independent investigation to determine if there was any case of negligence involved.
It is improper for the owner to send a letter to the press, such as yourself, before any investigations have been carried out. Such a letter, if published, would be defamatory to the individual and the organisation if there was no profession negligence found. The organisation and the individual vet would then reserve the right to take legal action against the owner and parties involved in dissemination of the story.
Please feel free to contact us if you require more information.
Sincerely,
Dr Heng Yee Ling
Senior Veterinarian
M**** P***** Animal Medical Centre (2004) Pte Ltd
No comments:
Post a Comment