"How much do you charge to neuter a stray cat?" the woman, probably over 40 years old phoned me yesterday. "You had operated on some of my stray cats before."
I quoted her a fee lower than my usual charges. She phoned later after checking out the other vets and said, "Will you be using anaesthetic for the neuter? I want my cat to be operated under anaesthesia." Providing cheap vet services raise doubts about the veterinarian's ethics and morals. "I use anaesthetic to neuter the stray cat," I said to the woman. "It is not possible to neuter a cat and it is very painful for the cat." I don't subscribe to some practices in other countries where the cat or dog is held by force for surgery. Or during the old days where people are operated without anaesthesia.
A cheap and good vet. That is what many Singaporeans want. The cheaper the vet, the busier he is. He must be a good vet since he is busy. This is the Singaporean mindset: The longer the queue at the hawker stall, the better is the hawker's quality of cooking.
Unfortunately, cheap and good seldom applies to medicine and surgery that require more extensive treatment.
I illustrate 2 similar cases of rabbit limb abscesses below and their outcome. Some history is written in: Large limb abscess in a 10-year-old rabbit. What to do?
In the first rabbit, I presumed that, in this competitive veterinary industry, there was a desire to provide an affordable vet service and obtain the loyalty of the rabbit owner. The vet lanced the abscess and gave a cream to be applied. Lancing the abscesses to get out the pus would do in many cases of abscesses in the dog and cat. However, in this rabbit, the abscess persisted and the cream was applied for a long time.
So, how should I treat such cases? As if the Divine Powers were challenging me, the 10-year-old rabbit was presented to me some 3 days later. It must be a coincidence if you are scientific.
I handled this case differently. Lancing the abscesses was part and parcel of the standard treatment. However, I had the rabbit under general anaesthesia of more than 20 minutes as I needed a much longer time to irrigate and flush away the pus.
I removed as much of the capsule of one of the two encapsulated abscesses as possible. Pus from the other side leaked as you can see from one of the pictures.
I made a much longer skin incision to clear the pus and bacteria lingered in the recesses of the big abscesses. The wound was more than 3 cm long and on both sides of the leg. I stitched to close the big hole with 4/0 nylon interrupted sutures. Absorbable sutures might encourage bacterial infection into the wound and therefore I did not use them.
At home, I followed up with phone calls. Apparently, the rabbit did not bother with the wound. "Just licked it," the father reported. Mum had delegated the nursing to the father and son.
"Buy a bandage that can self adhere, at the pharmacy and cover the stitches," I advised over the phone. The owner got the leg bandaged effectively but it was not the type of bandage I recommended. But it did the job. Pain-killers given to the rabbit for 7 days prevented attacks on the wounds.
I 14 days later, the father phoned me and really came back for stitch removal unlike some owners who ignored medical advices (to save money).
The anaesthetic and surgical cost was much higher at over $300 compared to less than $50 in just lancing the abscess, squeezing out the pus. Was the extra cost worth it? The outcome and cosmetic results were satisfactory for the owner. Most important of all, the rabbit would not continue licking and biting the foot.
CASE OF THE FIRST RABBIT.
For many months, the cream was applied to the big swelling in the foot. Now, the skin is bald and the problem of abscessation still persists. The thinning of the skin could be the effect of the anti-inflammatory wound applied for a very long time. Owners must seek second or third opinions when abscesses do not heal as many abscesses do heal with ordinary lancing unlike the case of the second rabbit described below.
CASE OF THE SECOND RABBIT.
The boy who is now a young adult was permitted one rabbit as a pet. I had not seen him once only some 7 years ago. His father contacted me when the rabbit developed a large swelling on his hind limb. It was a pure coincidence as I had just seen a rabbit with a similar leg abscess problem. What should I do to cure this second rabbit once and for all? Owners don't like repeated treatments. Was it possible to resolve this rabbit's problems at one visit? The answer is yes. The costs would be treble.
CASE OF THE SECOND RABBIT. 14 DAYS LATER
I performed a very thorough removal of the pus. The father was warned that the rabbit could die on the operating table as he was really at the end of his life span. Rabbits live up to 10 years and this rabbit was 10 years old. The father phoned his son to inform him. But the son did not answer the phone. So, the father granted the permission to operate.
More pictures of the surgery are at: Large limb abscess in a 10-year-old rabbit. What to do? 14 days later, the father came to get the rabbit's stitches removed. I gave him an anti-inflammatory cream to be applied strictly for 7 days only as the stitch wounds looked inflamed. I seldom do that but this was an exceptional case as I was worried that the rabbit might attack the wound.
Owners want the rabbit to look normal and prefer not to have to apply cream for a long time. Some of my owners do come for cream and do not bring in their dogs for review despite being advised.
The pet's welfare depends much on the education and sophistication of the pet owner as pets can't complain. They can scratch but if the owner ignores such scratching but applies cream, that is the reality of life and the vet can't do much for the pet.
Many owners of rabbits all over the world, and not in Singapore want "cheap and green" veterinary services. A veteran salesman always used this favourite phase regarding Singapore's pet owners with skin diseases. They want "cheap and green" vet services.
Economics and competition dictate the reality of the private practice. This "cheap and green" phrase is the Chinese Hokkien dialect equivalent of "cheap and good". In some skin disease cases and rabbit abscessation, it is just not possible to provide such services to achieve a satisfactory outcome.
This must be communicated effectively to the prospective client. If it is not possible to provide a sustainable profitable service, it is best to reject the client or the dog breeder. It just does not make economic sense to provide below-cost services as the vet will go bankrupt one day or will be unable to upgrade his facilities. The laws of the concrete jungle are as harsh as the laws of the natural jungle in the survival of a business.
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