Photo taken on 13th August, when Waffles was first admitted to Mount Pleasant Jalan Gelenggang. He passed on on 17th August. He was 7 years and 4 months old. 


Pet owner raises queries on level of medical attention received at Mount Pleasant Jalan Gelenggang

by Kimberly Yeo

This is a long one, regarding Waffles' health issues, his medical treatment at Mount Pleasant Veterinary Group, and the inadequate medical attention he received at Mount Pleasant Jalan Gelenggang.

Pet dog injured in 2015 but recovered

Ever since 2015, Waffles' birthday always marked disaster. That's why we didn't celebrate for him this year. On 12 April 2015, after we celebrated his birthday, he tore his cranial cruciate ligament (CrCL) in his left hind knee from jumping off the sofa and landing awkwardly. He went for surgery at Mount Pleasant Jalan Gelenggang under Doctor Dennis Choi, and took about four months to recover almost completely. The injury didn't seem to bother him because he was still running and jumping everywhere. After his birthday celebration in 2016, I realised that he was losing weight. By the time I brought him to his regular vet, Doctor Ling at Namly Animal Clinic, he had already lost 1 kg. He was 5.5kg to begin with.

Over the next couple of weeks, our weekly trip to the vet saw him going through blood tests, taking vitamin b12 jabs and taking pills. The bloodwork always revealed that he had elevated  alanine aminotransferase (ALT) enzymes, which essentially meant liver problems. He still kept losing weight.

Doctor Ling referred us to the best specialist, Doctor Nathalie Prakash at Mount Pleasant Jalan Gelenggang, in Singapore and Doctor Prakash said that Waffles might have a portosystemic shunt after looking at his bloodwork and scan results, and that we should do a biopsy to confirm it. She proceeded to do another blood test for Waffles even though Waffles just did one like 2 days before. My family didn't wanna cut Waffles up so we stopped going to the vet. That was October 2016. Every trip to the vet saw me bawling my eyes out there, because there's basically nothing anyone can do for Waffles. He was 2.8kg. He lost half his body weight. He lost almost all his fur, but he was still an energetic little ball of joy.

Google became my only hope and I found a Nutritionist in the states who believed in using natural foods and supplements to remedy liver issues in dogs. He gave us a tailored diet for Waffles to follow and we didn't see results for the first few months. I was frustrated because the supplements were expensive and they didn't seem to be helping. I honestly had little faith in this diet shit. The Nutritionist kept asking me to be patient when I questioned him angrily on a few occasions. But how could I be patient when my dog was wasting away? But there was really nothing else we could do but trust that it would work.

Fast forward to April 2017, Waffles actually put on weight and his fur became glorious again. He was still the happy boy he's always been. I was beyond grateful.

Old injury led to hospitalisation 

In June, we realised that his old injury in his knee was giving him problems. There was something poking him from inside. He started biting it and chewed a small hole in his knee. We took him to Doctor Dennis Choi immediately and apparently, the synthetic material in his knee had been dislodged. Don't ask me how or why because the surgeon never mentioned something like this could happen. He was placed on anti-inflammatory medicine, and if the swelling and pain went away, Waffles might not require surgery. Honestly, though, I knew he would have to take that thing out eventually.

After taking the meds, Waffles started to lose appetite. He started to not drink and eat. I thought it was because his knee was getting worse so I called Dr Choi and scheduled for a surgery on 15th August, as Dr Choi was away until then. Waffles was holding up decently well, until after my birthday (7 August). He started to really not eat at all. If you know my dog, you would know that he's extremely greedy and he will do anything for food. He started to not even eat apples, bread and coconut water, which were all his favourite. The surgery was just a couple of days away and Dr Choi was away so I thought Waffles should be able to hold up.

On 12 August, Waffles could barely even walk. He was holding his hind left leg up and balancing on threes. He tried to poop but his legs gave way and he fell backwards. He got a shock and he couldn't blink for a long time. We sent him to A&E at Mount Pleasant Whitley immediately. He didn't move at all in my arms on the way there. Once we got there, the attending vet who happened to be Waffles' regular vet at Namly Animal Clinic attended to him. She said Waffles showed signs of jaundice and dehydration. So he was placed on drip and stayed a night. I awaited bad news as they ran a blood test.

However, his bloodwork came back almost clean. Liver enzymes were almost normal and everything else was in pretty normal range too. I can't tell you how relieved I was. I was certain that it was his leg that was causing all the problems.

We picked Waffles up at 815am the next morning(13 August) to transfer him to Mount Pleasant Jalan Gelenggang. He already looked better than he did the night before. He still kissed us and was relatively active compared to the night before. We saw Doctor Keshia Beng and she said Waffles showed signs of jaundice but the bloodwork looked okay, but he was definitely dehydrated. So she said we should keep Waffles for one or two more nights. We left Waffles there in hopes that he would get better. Waffles stood up in his cage when we were saying bye to him. We asked if Waffles can have a towel, and a vet tech just placed one inside the cage. Waffles was placed on drip, protectants, antibiotics and painkillers.

Dog seemingly got worse and had its stomach bloated

Doctor Beng called a few hours later and told me that Waffles' ultrasound scan showed that he has a mass in his spleen, and his intestinal linings are very inflamed. She told me the possible causes, and recommended a scope or biopsy to get more information. I didn't want Waffles to go under general anesthesia and he was too weak to do so too.

On Monday evening(14 August), I went to see Waffles with Jon and Clara. Waffles was standing in his cage when we got there. He didn't have a towel with him. We brought him out but he didn't want to eat or drink anything we brought him. He kept shivering, and just leaned his head against me and not moved at all. He seemed dull and listless but could still walk around. He was hardly the same dog I brought in the day before.

Doctor Beng told me, once more, the possible causes of Waffles' condition and that he seemed to be very quiet and dull, as compared to the day before. She suggested keeping Waffles for another night and left. Jon pointed out that Waffles' stomach was bloated. And I said yeah, but if it was anything to be concerned about, the vet would have said something. Before we left, I asked for a towel for Waffles again. He was shivering, and to be honest, the hospital is cold, even for me. Waffles' condition was truly heartbreaking but I prayed so hard that he would be better the next morning. I called to check on Waffles late at night and asked for him to always have a towel to keep warm.

On Tuesday morning(15 August), Doctor Beng called and said that Waffles was really quiet in his cage and his stomach was obviously bloated. They realised that he probably could not absorb the fluids that were going into his system via the drip. I arrived at the hospital about 15 minutes later. Waffles looked really terrible and he was curled up, without a towel, once again. He didn't even realise I was outside his cage until I started crying uncontrollably.

Doctor suggests not to do anything about bloating

Doctor Beng told us that they have slowed down the flow of the drip by more than half, and elaborated on the different possible causes of Waffles' current condition and said that it seemed like end stage liver cirrhosis and Waffles probably had 2 months left. I was devastated and asked if Waffles could have his abdomen drained. Doctor Beng said that there were important proteins in the fluids in his abdomen and the body might reabsorb it if we leave it. So we took her advice and discharged Waffles.

Doctor Beng scheduled a review consult on 21 August for Waffles. I couldn't understand why it took so long for them to realise that Waffles was bloated, and couldn't absorb the fluids. I can't help but feel that it was negligence. How did my dog get so much worse in two nights at the hospital? Waffles could hardly walk when he got home. His abdomen was obscenely large. And every time he tried to lie down, he would whine softly. He got up every five to ten minutes, before taking two steps, and laying down again. He was in so much pain and discomfort but he was still such a good boy - he still tried to make it to the pee tray to do his business even though he could hardly walk.

I consulted a few of my vet friends on the ascites fluid in Waffles' abdomen. They said that it was unlikely that it would go away on its own. On Wednesday(16th August), I called Doctor Beng around 145pm. She wasn't available so she got back to me at 730pm that night. I told her about Waffles' bloat not subsiding and she said that the body might reabsorb it, and that if Waffles wasn't uncomfortable, we should leave it. But Waffles was obviously suffering and I told her Waffles couldn't even sleep or walk so she said we could bring him in the next morning. Waffles sleeps with me and I'm a really light sleeper so every time Waffles even moved, I would wake up. I would always make sure that he was covered with a blankie. So I was awake when he walked up to my face, and sat beside my face and rested his face on mine. He hadn't come up this close to me voluntarily since 12 August. I felt he was saying goodbye but I wasn't ready to let him go. I just cried and told him that he would be okay.

Bloated stomach eventually drained but dog passed on soon after

On Thursday morning(17 August), we went to Mount Pleasant Jalan Gelenggang at 1015am. Waffles was in such a bad shape. His abdomen was really bursting, and he couldn't even stand. Doctor Beng wasn't working so we saw another vet. The vet said Waffles didn't look good and wanted to run even more blood tests on my puppy who was lying motionlessly on the table, but I said no. She said if we only wanted to make Waffles comfortable, then we could bring him home after they drained his abdomen. We took Waffles home and got back around 1130am. He seemed to be doing a little better, could breathe a little easier, and could get up, and even napped for awhile. Periodically, I'll syringe a few ml of water into his mouth. I sat beside him throughout and at about 220pm, I realised that Waffles wasn't moving at all, and his tongue was slightly out of his mouth. He also wasn't swallowing anymore. I tried to carry him but he felt like dead weight, and he couldn't move voluntarily anymore. I suspected that he had a stroke. I knew it was time for him to go. He really put up such a good fight and he's the bravest little soldier.

Kenny came to pick us to send us to the hospital to put Waffles to sleep. Before Kenny arrived, Waffles started shaking and it got progressively violent. The seizures were really bad. He passed away on my lap in the car about 15 minutes into the ride. The entire thing really destroyed me. It kept running through my mind. How Waffles suffered so badly in his final moments and there was nothing I could do but cry and hold him and tell him he's a good boy and that it's okay to let go, that he doesn't have to fight anymore. He was in so much pain. The moment he last jerked and left, and became stiff, as I held him, really broke me.

Regret to have caused agony for beloved dog

I will never forget how he left. I just feel like the worst person ever to have allowed my dog to suffer in this manner. Perhaps I was too selfish and too unrealistically hopeful about his situation. When he said goodbye, I should have let him go peacefully instead of still holding on and thinking he could get better. I ended up causing him to leave in agony. I should have alerted the vet about the bloat when we realised it, maybe I shouldn't have allowed Waffles to stay in the hospital for those 2 nights, maybe I should have let him stay in the hospital after they drained his abdomen instead of bringing him home. Maybe he would still be here now. These are regrets that I can never let go of. I don't think I can ever forgive myself.

When Waffles' seizures got worse, I knew we couldn't make it to Mount Pleasant Jalan Gelenggang in time, so we were en route to Mount Pleasant Farrer at Queens Road. When we entered the clinic, the receptionist immediately showed us to the operating room and shouted emergency. The nurse at the door looked at Waffles and said "it's dead already?" I can't tell you how angry I was at the comment but I couldn't react because I was really just crying so hard. The comment was utterly insensitive and really hurtful. We said our goodbyes and left Waffles behind.

Wonder if anything could have been done if bloating was addressed earlier

I can't stop thinking about what would have happened if the vet picked up Waffles' bloating earlier. How is it possible that they only realised it when it's so late? I really wanted to sue them or something but I decided to write in to them on 18 August, to ask for an explanation to help me come to a closure.

Two hours after I emailed Mount Pleasant, Doctor Beng called me and told me that she's sorry that she didn't realise that Waffles was bloating earlier, and that they usually check on the pets in the morning. That's why she called me on Tuesday morning to update me on Waffles after they ran an ultrasound, to realise that Waffles had a lot of fluid in him. She said she really didn't notice that Waffles was bloating before Tuesday. And that she understands that the bloat couldn't have happened overnight but she really didn't catch it, and she acknowledged that things could have been different if they had picked up Waffles' bloating sooner.

Waffles was already bloated on Monday evening. So why didn't anyone realise? Do the pets not get enough attention or checks throughout the day? Why was he allowed to deteriorate to such a state when he's supposed to be in the best care? Also, why was Waffles always without a towel when I repeatedly asked for one to keep my ill and small puppy warm? Is it really that difficult to replace the towel, even if he has soiled it? Waffles doesn't have a bell he can press if he needs help, he's not gonna shout or call for help when he's in pain. He's not a human being, so shouldn't he be receiving more attention and care when we are paying thousands of dollars for him to be cared for? Even the vet herself said that Waffles looked better when he was admitted than he did after a night at the hospital. So why wasn't he given more attention?

I understand that the vet techs and vets are all busy, but I've been up to the ward section a few times, and they do have quite a number of vet techs working. Was there no communication? I didn't see any notes attached to the cage. Did my message of letting Waffles have a towel all the time get passed on to the people on the next shift? Was it because his condition didn't seem serious enough to warrant more attention? I just can't understand how my puppy could bloat to such an extent without anyone noticing until 12pm on Tuesday, when he went in at 9am on Sunday. I just cannot comprehend.

Seeking answers to cope with dog's passing

Mount Pleasant Jalan Gelenggang has said that they will launch an investigation into this complex case and get back to me in two weeks. I'm not trying to find trouble here, but if there's anything that can be taken away from Waffles' death, it has to be that the hospital could work on the amount of attention and care that they are giving to their patients. It is so that a situation like this would never happen again. So that another beloved pet wouldn't have to die sooner than expected due to an oversight. Also, was not draining the fluid really the best solution before Waffles was discharged? His stomach was really extremely distended. I really think that the bloat caused his decline to be way faster than it would have been. I'm no vet, sure, but the severe bloating could have been avoided definitely.

I'm just trying to find answers to help me cope with Waffles' death. I know it's not easy being a vet or vet tech and it can get extremely overwhelming, but my puppy could still be alive today. Even if he was dying, and his liver was failing, he could have had more days, or even weeks, or even more than the 2 months that Doctor Beng said he had. I could have had the chance to make his last days the best and do all the things that I promised him we would. He could have had the chance to see all his favourite people before he departed. But he was gone, in just 4 days, after his admission to Mount Pleasant Jalan Gelenggang. I understand that medical conditions can take a drastic turn for the worst in hours or days but the bloating issue could really have been avoided. That said, I do appreciate Waffles' vet tech, Vanessa, who seemed to take quite good care of him - giving him a partial shower when he pooped, and again before he went home.

We've spent tens of thousands of dollars on Waffles' health and medical issues over the past 3 years and if it required us to pay more than $300/night (w/o complications) for Waffles to be given more attention, we definitely wouldn't mind. However, we paid more than $2k for 3 nights at the hospital, only to have our precious puppy not receive adequate care.

I'm sorry Waffles, that I didn't do more and do better for you. I know you're in a better place now, and no longer suffering, but I still can't believe you're gone. I really miss you so much.


The Online Citizen wrote to  Mount Pleasant on late Sunday evening and has yet to receive a response from the group as of time of publication of this post. Its response will be reproduced once we receive its reply. TOC also understands that the hospital has yet to revert to Ms Yeo in regards to the investigation on the matter.

Update on 31/8 - The hospital replied, saying, "The abdominal fluid in Waffles is likely to be an effect of Waffle’s underlying disease, rather than the cause of his demise. Unfortunately, Ms Yeo had declined further work up when it was initially brought to attention in October 2016. We respect the owner’s decision not to pursue any investigation, but we are consequently unable to speculate about Waffles’ primary disease process. We have since advised that if Ms Yeo has any concerns about Waffles’s medical management that she should seek an independent review with the Agri-food and Veterinary Authority, which is the appropriate channel."

Note that headings in the letter are written by TOC and not Ms Yeo in her original post.

 

This entry was posted in Animals, Letters.
This entry was posted in Animals, Letters.