"I have no objection to letting you have the blood samples to give to Vet 1" I said to the two women in their 20s on this fine sunny morning at 9.30 am. My associate who consulted in the evenings and Saturdays had treated the Westie yesterday and told the owners that he suspected liver and kidney diseases. He had told them that the blood samples would be sent to an outside laboratory today. My associate had said that the results would be available after 2 days.
However Vet 1 could produce instant haematological results and the 2 women now wanted the blood to be given to Vet 1 whose instant blood test results would tell them whether the Westie was suffering from liver and kidney diseases.
I checked the case card. The complaint was that the Westie had stopped eating. I had given this 10-year-old Westie dental scaling 2 months ago and he was all right during general examination. I had not requested blood test prior to dental work as that meant extra expenses to the dog owners. Most don't like to pay more and many Singaporean dog owners don't even send their dogs for dental check up and would live with their bad breath for years.
"I am open to owners wishing to have 2nd opinions. But have you considered that Vet 1 may not be elated to receive your blood samples collected by his competitor? He may want to collect blood again as he may not trust the blood from my Surgery. He may say that the blood collected overnight will not be good for the test and therefore he has to collect fresh blood for analysis.
Human behaviour is unpredictable. If he is not happy, do you expect your dog to be well looked after? I had bad encounters with 2 vets in this practice before. When two of my owners wanted the dogs to be treated by them, I made prior phone calls. The two vets were very busy and judging from their phone conversation and mannerism, they would rather not get 2nd hand cases.
The 2 ladies had not thought of such behaviour but they do exist. "In any case, your Westie had been barking for at least half an hour and he sure did not look as if he was going to die soon." My associate had given the necessary IV drips and treatment yesterday evening and I would rather not interfere with his case to avoid confusion.
The apparently elder of the two ladies asked, "If Vet 1 collects blood again, will the blood test be different and affected by the treatment given?"
"Yes," I said. "Your Westie in the animal holding area was barking non-stop for at least 30 minutes this morning. He did not look as if he was going to die soon and therefore needed instant blood tests. In any case, blood test results from this laboratory can be available within 24 hours if we request urgent results"
The ladies vacillated. To go to see a new vet or not to go. Doctor hopping leads higher expenses.
I asked my assistant to bring the Westie into the consultation room for me to examine and then release for the 2nd opinion. There was no point in retaining this client. Mr Saw brought in the Westie and put the dog on the consultation table. The dog stood quietly as I opened his mouth. I showed the gums to the ladies and they could see that the dog had almost white gums. "Your dog has severe anaemia and blood tests would be very useful to help the vet know what is the cause of the anaemia."
Then I palpated the anterior abdominal area. As I felt the stomach area, the Westie shivered and gave a grunt of pain. The two ladies could hear and see his reaction.
"Did you feed chicken bones to this dog?" I asked. "Does he pass black smelly stools and had difficulty passing stools sometimes?"
"Yes," the older lady nodded their head in reply to the 3 questions. "I feed him chicken bones every day."
"Some chicken bones could have lacerated his intestines over the years causing bleeding in the intestines leading to black smelly stool formation. Some fragments of bones could be passed through undigested and got stuck in his rectum temporarily causing pain in passing motion. The prolonged episodes of bleeding would have caused severe anaemia. Of course kidney disease and other internal organ diseases can cause anaemia too."
"What else do you feed this dog?" I asked.
"Well," the older lady said. "He likes to catch rats when I exercise him around the coffee shop. Sometimes he would bring me the rats behind the coffee shop."
I was surprised that this 10-year-old senior could still hop around to catch rats. But he looked compact and solid. Some incipient cataracts but he was living his life to the fullest by catching rodents.
"Have you read in the newspapers about two people dying after eating rojak in a Geylang Serai food court?" I asked the two ladies.
"Yes," they could not connect the topic of food poisoning deaths in two human beings with their Westie's severe anaemia but were too polite to tell me.
"Well," I said. "Some patrons of this food court said that there were many rats in the food court running around."
Rats are common in food courts and they can be large and plump. They hide inside the sewers near the food court.
So what has rats in Geylang Serai to do with this Westie's severe anaemia?
I postulated, "The government authorities instituted a cleaning up. I am sure that the pest exterminatiors would be called in to get rid of the rats. Other food court operators in Singapore would take similar actions. They would use rat bait poisons to kill the elusive and fast-running rats beside other methods.
"So what?" the ladies sent me their thoughts by telepathy and awaited patiently for the connection.
"It is possible that your Westie had eaten rats poisoned by rat poison. More rat bait poison granules would have been placed on the areas where the Westie went hunting. They are attractive to dogs too. So, it is possible that your Westie had ingested them. The poison went to his blood system and destroys his red blood cells. So, he developed internal bleeding and showed this severe pallor of his gums and tongue. The blood results should come in within 24 hours if you are still interested in me sending the samples this morning."
The ladies spoke to each other and decided to wait. In the meantime, I gave this Westie 2 ml of Vit K1 subcutaneously. My associate had given the Westie intensive IV drip and that was OK.
Later in the evening, the blood results came in by fax and I informed the ladies that the Westie had very low red blood cells and platelets.
The next morning, the ladies visited the Westie. Mr Saw brought the dog onto the consultation table. The Westie moved his head away and struggled and preferred that I did not open his mouth. But I had to. What would be the colour of his gums?
The ladies gasped in surprise. Not really as Chinese ladies seldom express their feelings so opening unlike Caucasians. There are a reddish glow in the gums compared to 24 hours ago. As if the Vit K1 was an antidote and had helped to produce more blood. Of course there was the protein and other IV drips given to this dog. But the results were spectacular. From snow white to a reddish tinge. This was what counted.
Not just talk and talk.
To cut a long story short, the Westie was warded for around 5 days. His blood tests showed he had kidney and liver malfunction as well. This could be related to his suspected rat bait poisoning.
The important thing for the two ladies was that the Westie had regained his gum colour at the end of 5 days and could go home much alive and eating.
As for his rat-catching days, I guess that the ladies would retire him. In this economic depression, the Westie would be considered retrenched as his services were no longer required. But he would never be homeless or be deprived of tender loving care till the end of his life.
UPDATED STORY
goto www.toapayohvets.com or www.bekindtopets.com May 2009 serial.
