Malaysia Veterinary Forum (Archive)

exanimo · Joined: 13 Mar 2008 Posts: 6 Location: KL

Can the vets on this forum tell me if tubal ligation is commonly done here vs ovariohysterectomy?
I recently had a rescued dog spayed and did not ask the vet before the procedure if it was gong to be a tubal ligation or ovariohysterectomy as I made a personal assumption that it would be the latter since the former procedure clearly has disadvantages.

The vet definitely did not do an ovariohysterectomy as both the ovaries and the uterine horn was found intact when I brought her to another vet who had to do exploratory surgery. Unfortunately our dog developed a uterine infection and it was not until later that this was discovered during the exploratory surgery after two serious bouts of illness.

Can you tell me why a vet would choose to perform tubal ligation instead of the OHE and if the layman should routinely ask the vet which procedure they do.

If the ovaries were still attached to the uterine horn, does that mean that even the ligation was not done? If I'm not mistaken, the second vet said that only part of the uterus had been removed and the incision scar from the spay operation appeared to have been made lower and smaller than normal.

Can you tell me if I have any means of recourse and how to help other pet owners avoid the same fate and complications? I have photographs of the distended uterine horn and evidence of pyometra.

I am also upset at the integrity of the vet who did the spaying. I had called her on the 2 occasions when our dog was seriously ill as we wanted to backtrack and fill in as much info as possible to help the current vet make his diagnosis. I even told her the info on the full bloodwork and our dog's condition so she knew the situation was critical. At no point did she mention that she had not done the OHE which has implications for serious undesirable side-effects- in this case pyometra.

exanimo · Joined: 13 Mar 2008 Posts: 6 Location: KL

I'd like to make an amendment to the details provided so far. I just did a double check with my current vet and it's confirmed that what he removed was both ovaries and uterine horn intact. Only part of the uterus was removed during the initial spay operation. This seems to indicate that an incomplete procedure was performed.

I hope to get some advice and comments here as to what I can constructively do towards ensuring that this vet is not negligent in future surgeries performed by her. I will be contacting the vet who did the original questionable spaying to discuss this but I was also hoping to get some professional opinion here too. Thank you.

Dr HanMRCVS · Joined: 07 Jun 2006 Posts: 566 Location: Johor Bahru

i personally think that if possible, you may need a letter from both vets that did the surgery and what exactly they do during the surgery and what they found.

if indeed there is a case of gross professional misconduct, you may bring the case to the Malaysian Veterinary Council in putrajaya.

exanimo · Joined: 13 Mar 2008 Posts: 6 Location: KL

Thank you for your comment Dr Han.

As much as I can see that a medical professional might not be willing or comfortable disclosing full details regarding an animal that had been under their care (for whatever reason), my next question is, can a vet refuse to disclose such information?

My second question is how can a member of the public ensure that the vet they are consulting is licensed to practice? i dare say the reality is that in any profession there are some who practice under the guise of being qualified professionals. (Bad eggs in a basket of good ones!!)

Dr HanMRCVS · Joined: 07 Jun 2006 Posts: 566 Location: Johor Bahru

firstly it depends on how the vet handles the situation and i cant say what is right or wrong for the vet to respond.

all registered vet practitioners are provided with an annual practising licence which they are obligated to 'show' clients.

exanimo · Joined: 13 Mar 2008 Posts: 6 Location: KL

Thank you Dr Han, I appreciate your time to reply.
I will pursue this matter with the appropriate government agency as I feel that is my minimum duty to put in a report as I strongly feel this is a case of gross professional misconduct and as a result, I almost lost the life of this dog twice.

Actually the dog is a street dog I was feeding everyday as she was so emaciated. And all I wanted was to have her spayed so that she didn't have the additional burden in life and unfortunately it has turned out to be a long painful and life threatehning saga for her due to someone's professional negligence. She may be a street dog but to me, she is a dog.

Dr Nat · Joined: 07 Dec 2005 Posts: 1834 Location: Klang Valley

Let me comment here...

Firstly, regarding your first question - if tubal ligation is the 'norm'. No, it is not. When a vet says "spay" or "neuter" (for females), it usually refer to the removal of both ovaries and uterus. If you ask for clarification, then the vet has to oblige to explain to you the procedures to be done on your pet.

Secondly, regarding disclosure of medical information. The vet does not have to show you their own records. However, if you request for a medical report, then the vet has to give you a report on what is done on your pet. In this case, it is better to ask for a written medical report on your pet for the first 'spay' procedure. If I'm not mistaken, only the authorities, in this case the Malaysian Veterinary Council, have the right to go through the clinic's records.

Thirdly, each vet has the obligation to display in the clinic (at each clinic the vet practices) his/her current Annual Practicing Licence. You have the right to ask to see it (although I know it does insult some of the vets).

Lastly, you're right about the few bad eggs (or apples?) spoiling the whole basket. Its negligent vets like those are the ones who put off pet owners and creates distrust. Also, as your intentions are good (to spay your dog), cases like this does put a lot of ppl off spaying their pets - hence, making it more difficult for animal welfare organisations and vets to persuade people to get their pets neutered.

Also, I'd like to give you my advice for your case. If I were you, I'd request for a written report of both surgeries by both vets. Then write to the Malaysian Veterinary Council and Jabatan Perkhidmatan Haiwan and submit those reports. (its always better to get black and white reports -signed by vets, plus written complaints to the council and jabatan. Verbal complaints are useless).

filet0fish · Joined: 13 Jul 2007 Posts: 30 Location: Pee Jay

examino, i'm so sorry to hear of what had happened.

please do keep us posted on how the "complaint" went.

God bless.

Dr csh · Joined: 21 Jan 2006 Posts: 427

There are some confusing parts of the story......

You mentioned "two serious bouts of illness". One is the pyometra but what was the other?

The photo will tell alot so if you can post it it could make better sense but how did you know it was a tubal ligation? Was the ovaries not connected to the uterine horns by the oviducts? was there a complete ovary or just ovarian remnant? In canines, the ovary is hidden within the fatty ovarian bursa so did the second vet submit the tissues for histopathology? or did the vet just examine them grossly? Was there both ovaries or just one?

When you say "distended uterine horn" did you mean it as a singular or pleural? did you mean horns? and the evidence of pyometra... was it pus or just fluid distention and you did not cut into it to confirm? We make it a routine to get a culture of the bacteria in pyomeytra to determine resistance patterns to antibiotics but I'm guessing that was not done.

You mentioned "uterine horn intact" but then you proceed to say "only part of the uterus was removed during the initial spay". If this was the case, obviously it was not a tubal ligation (which makes absolutely no sense to begin with). So, was the uterus intact? or was part of it removed?

It is really difficult to figure out based on your reports and I agree that we need formal reports from both vets for the ingestigation. You got your answers (tubal ligation is NOT DONE in canines and you should report to the Vet council). Ovarian remnant is not unheard of and happens from time to time especially when done in very fat or young animals and more often in cats than dogs but certainly it can happen. It is a vet's worse nightmare to screw up on something like that and sadly I agree that if we make mistakes like this, we should be sued. Eventually we all will have to buy malpractice insurance and your vet bills will have to relect this but it is an inevitable change.

exanimo · Joined: 13 Mar 2008 Posts: 6 Location: KL

Sorry for the confusion as I had only sketched out the broad scenario.

To clarify, my first question was is tubal ligation practiced here vs OHE.
The second question was how might I pursue this case to ensure that our animals get the proper professional standard of veterinary care.

I began this subject with my question regarding tubal ligation and OHE. The reason why I asked this was in the due course of making calls to government agencies and related professional associations with regard to how I could pursue this case (if it is indeed due to gross professional misconduct) I spoke to a faculty member at UPM and he said that while tubal ligation was not encouraged, it may be practiced here. This came as an unpleasant surprise to me as I'm aware of the negative implications of doing a tubal ligation vs OHE. This spun off my first question in a panic- could my own ignorance to the fact that tubal ligation may be practiced here have caused a dog all the trauma and risk and I needed to clarify with the practitioners themselves here if this is indeed the case.

Question one has been answered here -thank you all for your clarification.

I have since clarified with my current vet that it was not a tubal ligation. (please see further on below for what was found in exploratory surgery later)

Prior to the 1st serious bout of illness, the dog was eating well and starting to put on weight. She was also very lively.
The 1st serious bout of illness occurred 10 days after the dog left the vet No.1 (about 3 weeks after her said spaying). She refused to eat, began vomiting and could hardly stand. She reacted with signs of pain when her abdomen area was palpated. An xray was done immediately (to the credit of our vet No.2, he did not even wait for us to assure him that we would pay for the xray as we were overseas and he had trouble contacting us that day). The xray showed no visible foreign matter and inconclusive signs of inflammation. She was put on antibiotics for 2 weeks (if i recall the duration correctly) and seemed to have recovered. ie. back to normal behavior and eating.

About 3 weeks after her 1st serious bout of illness, she fell ill again, same symptoms but more severe plus the problem with blood clotting when a sample was taken from her ear. This time she deteriorated faster and we sent for a CBC. WBC was 38.9, platelet count 6 (and she was bruising all over her underside and ears), ALT 278, CREA 463.

We went on 2 possibilities-an infection in the abdomen area and leptopirosis. Lepto because I had noticed a wound on the tip of her tail about 2 months back (when she was boarding with the 1st vet) and has wondered if she had been bitten by a neighbouring dog in another crate or a rat as on several occasions when I visited the dog at the pet shop of the vet where she was boarding animals, I smelled rat urine. This wound was still there, we discovered it matted over by dried blood and not obvious until she had the fur shaved away.

Since lepto was one of the possibilities, I informed vet No.1 immediately as I was worried about the safety and health of the other animals boarding at the vet No.1’s pet shop. Also on one occasion when I visited the dog. the pet shop assistant was not well and he was sleeping on the floor in a small room at the back of the pet shop where the animals were being boarded and I was worried that he might also be exposed to the risk of lepto. Although I had informed the vet No.1 via sms, I heard nothing from her regarding this risk.

For the dog's 2nd bout of serious illness, she was put on antibiotics again and not penicillin for the lepto. She was also put on a drip, as with the first time when she was ill. Thankfully she made a slow recovery.

During her recovery, vet No2 found a soft lump in her abdomen area and she showed signs of tenderness when palpated. When this did not go away after a few days, we decided on exploratory surgery. This was when vet No2 found both ovaries and the uterine horn intact (bilateral). The uterine horn was distended as mentioned and I’m sorry I personally don’t have enough knowledge in the medical area or of the canine anatomy to know whether the distended area covered one or both horns. (This was the first time I'd seen the internal parts of a dog in real life!!!) Vet No2 showed me what was taken out during the exploratory surgery and cut into it in my presence and it was pus filled. As far as I know this was all done only by gross examination.

Dr csh- you mentioned that “ We make it a routine to get a culture of the bacteria in pyomeytra to determine resistance patterns to antibiotics but I'm guessing that was not done.”
In reply, no- a culture was not done. Could you explain this further so that those who read this, including myself, have a better understanding of the importance of doing a bacteria culture in pyometra.

Present situation:
I have requested a written medical report from vet No.2 and sent a registered letter (copied to the agencies whom I will submit my complaint to) to vet No.1 with the same request for a written medical report as vet No.1 is not answering my calls and has told me not to irritate her further.

Dr csh, thank you for being so candid. Your professional integrity and honesty is very encouraging. Without doubt mistakes are made every day, but the more pertinent point is why they were made and how they can be prevented from being repeated.

I am not an advocate for relying on the legal system to fix things but as you say, sometimes it is unfortunate that matters take that path and have to go through that system. I hope professional associations, academic bodies and government agencies can be more proactive and reflect some maturity to provide a multi-prong approach to keep up professional standards and not have the legal system working the hardest in such a situation when all might have really been already lost.

This is why I will pursue this to submit a report as it is my basic responsibility as a "wronged" client representative and not just sit around and non-constructively complain about some lousy vets out there. So thank you all for your help and replies- this all counts for something.