So what does a song written in 1967 by the great Paul McCartney have to do with veterinarians? Probably everything. In Singapore, a small country of five million people where there are 52 clinics (in my last article in June, it said 48 clinics – the numbers have gone up in only four months!), we do not have the advantages of a veterinary school or a register for veterinary specialists. It will probably take a couple more years for our local veterinarians being trained overseas to come home and set up a good network of veterinary specialists. However, this doesn’t stop clinics from providing the standards of care of modern veterinary practice. Thinking outside the box was one of the important steps, next comes calling in the favours.
‘Baby’ is a 15 month old female Pomeranian dog that presented to the practice with a 6 month history of regurgitation and a chronic moist cough. She had been diagnosed at a previous practice with pyothorax and came in septic with a chest drain attached. Radiographs were obtained and it was clearly evident that between 6 general practitioners in our practice, we knew something was wrong with the chest, we just could not put our finger on what was amiss. We elected to send pictures of the radiographs to Veterinary Imaging Associates based in Sydney where it could be read by board certified radiologists. With their expertise more than 7000 kilometers away, we obtained contrast radiographs of Baby and it was quickly proven that she had a oesophageal diverticulum with a broncho-oesophageal fistula. Causes of broncho-oesophageal fistulae are few and it was generally narrowed down to congenital or acquired (by penetrating foreign body). It appears that this condition is seen as a congenital rather than acquired defect in most human babies.
At this point, it became quickly evident that the case was something quite novel and certainly not a surgery that we had performed before. Without a specialist hospital available, we had to become resourceful in order to achieve the best clinical result for our patient. As luck would have it, an interested surgeon had seen the radiographs and was quite willing to make the commute to Singapore. It then became a question of logistical planning and obtaining the appropriate licenses to practice or operate here in Singapore.
Another recent interesting development was the services of the Veterinary Anaesthesia and Pain Management Consultancy (VAPMC). Spearheaded by Kieren Maddern, VAPMC is a new specialist anaesthesia service which is based here in Singapore. The very first for Singapore, a full time practicing board certified specialist consultancy service was available.
It took three weeks to plan flights, accommodation, logistics, equipment, drug orders and the whole team pulled together to make it work. As best-laid plans always are, we had a minor hiccup on the day of surgery when it was realised that the clinic was out of medical oxygen. A great deal of buzzing (shouting at various decibels) and several grey-hairs later, oxygen was delivered and we were ready to go.
With great teamwork, the thoracotomy was performed with John Culvernor as lead surgeon. The diseased and collapsed lung lobe with the fistula was resected and the oesophageal diverticulum was identified. The cause of the diverticulum and fistula was finally identified and it was none other than the common chicken wing bone. Pieces of bone was gently fished out and the oesophagus was repaired. With intensive care, Baby recovered uneventfully and was discharged to grateful owners after a week.
I believe that the successful outcome came from a lot of hard work from a great team, comprising of everyone from the nurses to the consultants. All of whom I consider to be my friends. Invaluable advice contributed to obtaining a diagnosis quickly and the ability to provide the appropriate treatment even though all involved came from different practices and different countries. In our veterinary industry, we rely on our friends and colleagues much more than we realise. It was wonderful to see the passion existing in so many for a common outcome. Many practices in Singapore and in other parts of South East Asia rely on all our friends from around the world to be willing to lend their area of expertise. It is a great working relationship which not only expands our global veterinarian network but it will definitely lead to new partnerships and even new discoveries. It is a potential not to be overlooked.
John Culvenor summed it all up. “It was just a longer commute to work” he said…