Wednesday, October 29, 2014

Ethics?

October 30, 2014

Today, an old client told me that she had received vaccination reminder card from a lady vet who was employed by me some 2 years ago. She commented that this vet was unethical and she would not go to consult her.

Is this practice ethical? There was a bank case in which the employee joined another bank and took the employer's list of clients to contact them. This employee was sued in court.

Employee vets will continue to use the employer's list of clients when they set up their own practice.     

Singapore stories. Mr Han goes to Phuket

Oct 30, 2014

Mr Han goes to Phuket today. His boss Joe asked me to a farewell breakfast at the usual food court. Mr Han had his laksa while Joe, for the first time, order beef ball and fish ball soup noodles. "I have never seen you order this dish," Mr Han commented. "Usually it is laksa and you drink all the gravy!"
I ordered the chee chiong fun with sesame seed and sweet sauce at $1.60.

I thought yesterday's breakfast was the last till Mr Han comes back from Phuket on Tuesday. As he had to go for his routine blood test for diabetes yesterday, he did not eat breakfast and was grouchy. He was at the food court and dozed off. The hawker lady from China, selling laksa, came to the table and curled her right index finger, indicating that Mr Han must have passed away. This was her sense of humour learnt from Joe.

After the breakfast today, Joe said I should take a photo of Mr Han as the "last" image.. In case his plane crashed. "It is best not to say such things," I tried to educate Joe who has this type of humour.
Yesterday Joe was on the same topic of plane crash and asked Mr Han to visit him after the crash and let him know he had come from heaven or hell. "Is there such a place as heaven or hell?" Joe asked.

"There is a supernatural but you need to encounter to believe," I narrated a story of my client who asked me to help her design a logo. Blood spots appeared on the table and draft logo papers when the design was not satisfactory to "datuk". A Caucasian employee had brought in a draft logo on his own initiative and designed by somebody while I was in the room. Blood spots appeared in this draft logo paper. Finally, there was a draft logo design done by me and the client with no appearance of blood and this would be deemed approved.  

"I am more the scientific-evidence type and this encounter would be hard for anyone to believe," I said to the two senior citizens. "I don't believe if I have not witnessed this event."

Monday, October 27, 2014

Anaesthetic risk in dental scaling

Oct 28, 2014


A new client - father and young adult daughter brought in a 7-year-old male entire Shetland for dental scaling.  Their friend's Maltese had died after dental scaling in another vet practice and so they did not want to go to the practice.

"Very rarely do dogs die after waking up from anaesthesia given for dental scaling," I said. "Was the Maltese having heart diseases?"  The owners of the gentle full sized Sheltie did not know but they would avoid this friend's vet

No vet can guarantee no anaesthetic risk. Even people do die.

PHYSICAL EXAMINATION
Other than periodontal disease grade 4 (tissue attachment loss over 50%), I noted that this Sheltie had congested maroon red gums, not the normal pink ones. You can see this in the video. Why? The capillary refill time was longer than the usual 2 seconds. Blood test showed that this dog had a higher than normal amount of haemoglobin in his blood at 19.1 (12-18).  The total red cell count was normal. The haematocrit was normal too.  Platelets were normal. What does it mean? Was he fed some supplements?


BLOOD TEST on 27.10.14  Abnormal values

Urea 12.3  (4.2 - 6.3)
Creatiine 65  (89-177)
Haemoglobin 19.1 (12-18)

All the other blood values within normal limits.


Sedation was 50% of normal dog. Isoflurane gas to minimal amount.




FOLLOW UP - Day 2 after dental scaling
The dog was a bit tired yesterday but is Ok and eating today.

"Tartar started to build up fast in last 3 years," the father said that the dog was not given meat. "Could it be the milk making the kibbles soft?". This dog had the biggest crusty tartar I had ever seen in a dog (see image/video).

The dry dog food was  Science Diet Lamb and Rice with a brand of dog's milk since young. Dog treats were given.


ADVICES
No milk and treats to prevent tartar build up.
Eat dry food without milk and drink water.
Blood test 4 weeks later to check on the urea levels.

This case shows that a blood test is important for screening the health of an older dog. The owner was given the option. The blood test was done by me as this dog had an unusual congested gums.

The Jack Russell keeps vomiting for 2 days.

Tuesday, Oct 28, 2014
Breakfast with 2 senior citizens, Mr Han and Joe .

Mr Han, the 67-year-old man related the following stories again to me today:

Story 1. $40 consultation fee for no consultation.
His friend wanted to renew his driving licence but had to see a general practitioner to sign the form.
"Did you have any heart surgery," the doctor asked.
"Yes," his friend said. "I have a pace-maker."
"In that case, you need to go to the Tan Tock Seng Hospital to be certified fit for driving!"
"But you can certify that I am fit at the time of examintion," the friend said.
The doctor refused to do so and the consulation fee was $40 for "doing nothing."
He advised his friend not to pay but the friend did.
"There was consultation," I said. "Though not in his favour."

"Why not go to the next doctor and tell him you do not have heart surgery," the 2nd senior citizen suggested.
"He did," Mr Han said. "Exactly the same reply and the doctor filled up the form."
"How much was the fee?" I asked.
$25.00"

Story 2. The 14-year-old daughter has late nights.
Mr Han's daughter goes out after 11 pm every night and comes home past 3 am.
"Don't go out at this time," Mr Han said. "What will neighbours think? Leave the house at 7 pm."
The daughter ignored him. He slapped her once. She called the police and he was put in jail.
"It is a case of assault," I said.
"If you have a well brought up child, you are lucky," Joe said to me. Joe has a son who graduated from an American University and has an excellent relationship with him.
"If the father cuts off the allowance to the daughter," Joe said that a solution is to stop giving the daughter her financial support. "If Mr Han does that, she will blame him as she earns money from prostitution."

Story 3. The neighour had stomach cancer.
The neighbourhood doctor was sued by the neighbour for not diagnosing stomach cancer as he would prescribe some medication during every visit. The neighbour's wife suggested that the husband seek a second opinion and was scolded. Finally, the husband got a second opinion and engaged a lawyer to sue the doctor.
"Ironically, the lawyer is another neighbour," Mr Han said.
"Did he win the case?"
"No, no," Mr Han said.
"The doctor might have suggested visit to the specialist and had written this advice in his medical records," I said.
"You can't expect a general practitioner to diagnose stomach cancer," Joe said.
"But he should have referred for further investigations at the hospital and he probably had done so."


Story 4. Charcot's foot.
Charcot's foot is said to be a progressive degeneration of the joints of the foot. One cause is diabetes and Mr Han had diabetes. Initially, Mr Han consulted the general practitioner who prescribed some medication without even looking at his foot.
"Maybe your foot was smelly," I said.
"Not at all."
He was diagnosed Charcot's foot by the specialist and had a special shoe made.
 

2015Singapore stories: Charcot Foot and other stories

Tuesday, Oct 28, 2014
Breakfast with 2 senior citizens, Mr Han and Joe .

Mr Han, the 67-year-old man related the following stories again to me today:

Story 1. $40 consultation fee for no consultation.
His friend wanted to renew his driving licence but had to see a general practitioner to sign the form.
"Did you have any heart surgery," the doctor asked.
"Yes," his friend said. "I have a pace-maker."
"In that case, you need to go to the Tan Tock Seng Hospital to be certified fit for driving!"
"But you can certify that I am fit at the time of examintion," the friend said.
The doctor refused to do so and the consulation fee was $40 for "doing nothing."
He advised his friend not to pay but the friend did.
"There was consultation," I said. "Though not in his favour."

"Why not go to the next doctor and tell him you do not have heart surgery," the 2nd senior citizen suggested.
"He did," Mr Han said. "Exactly the same reply and the doctor filled up the form."
"How much was the fee?" I asked.
$25.00"

Story 2. The 14-year-old daughter has late nights.
Mr Han's daughter goes out after 11 pm every night and comes home past 3 am.
"Don't go out at this time," Mr Han said. "What will neighbours think? Leave the house at 7 pm."
The daughter ignored him. He slapped her once. She called the police and he was put in jail.
"It is a case of assault," I said.
"If you have a well brought up child, you are lucky," Joe said to me. Joe has a son who graduated from an American University and has an excellent relationship with him.
"If the father cuts off the allowance to the daughter," Joe said that a solution is to stop giving the daughter her financial support. "If Mr Han does that, she will blame him as she earns money from prostitution."

Story 3. The neighour had stomach cancer.
The neighbourhood doctor was sued by the neighbour for not diagnosing stomach cancer as he would prescribe some medication during every visit. The neighbour's wife suggested that the husband seek a second opinion and was scolded. Finally, the husband got a second opinion and engaged a lawyer to sue the doctor.
"Ironically, the lawyer is another neighbour," Mr Han said.
"Did he win the case?"
"No, no," Mr Han said.
"The doctor might have suggested visit to the specialist and had written this advice in his medical records," I said.
"You can't expect a general practitioner to diagnose stomach cancer," Joe said.
"But he should have referred for further investigations at the hospital and he probably had done so."


Story 4. Charcot's foot.
Charcot's foot is said to be a progressive degeneration of the joints of the foot. One cause is diabetes and Mr Han had diabetes. Initially, Mr Han consulted the general practitioner who prescribed some medication without even looking at his foot.
"Maybe your foot was smelly," I said.
"Not at all."
He was diagnosed Charcot's foot by the specialist and had a special shoe made.
 

Friday, October 24, 2014

2015 Vets - The dog groomer and the Judge

Friday Oct 25, 2014
A couple with over 10 years of dog grooming and pet shop operation experience shared with me their grooming situation.

"Vets are making good money compared to groomers," Jim Mandalay said. "In one practice, the vet bills are not less than $200/customer. In another practice, they are over $500/customer. My grooming charges are $60 and I take at least 2 hours to groom one dog!"

"The pasture is always greener on the other side," I said. "There are vets who charge less than $100/customer," I named one practice that advised blood tests and even weekly blood tests for ill dogs. 

"With blood tests compulsory at the first clinic, at $140/blood test, the bill would be more than $200/customer," I said. "The customer can always go to another vet and there are over 60 vet clinics in Singapore nowadays!"

"The other vet also charges high fees," Jim laughed. Jim knows about vet charges as he transport pets to the clinic for treatment, charging $100/trip. His wife would do the grooming while he would answer calls and do the transport. In Singapore, competitors charge $10 for dog transport and $60 for grooming. So, Jim said that he could not increase the costs as that would drive customers to the arms of another groomer.

"Proximity and convenience are what the dog owner wants," I said.
"There is no loyalty from the customers," Jim and his wife were exhausted from so many years of grooming and the great difficulty in retaining a Singaporean receptionist.

In Singapore, the receptionist would be young ladies. They would work for a few months and change jobs or find a downtown office with lots of colleagues to work. Not content with being a receptionist in a small pet shop. So, the couple had to work by themselves. Or close shop.

"How about selling puppies?" I asked as they used to sell puppies. With puppy sales, they can retain clients as groomers.

"No, no," Jim said. "The consumer is now well protected with one year's return policy. That is the lemon law."

"Are you sure?" I asked. "In one year, the puppy can be returned to the Seller with money back? A person can buy a new car and can return it back within one year if there is a defect?"

"Yes, yes," Jim said authoritatively as regards puppy sale.
Jim related his personal experience. He sold a poodle some years ago with a sales contract between the husband buyer and himself.

"After one year, the wife phoned me to ask what compensation I would give her as the poodle had become 2 inches taller than the standards stated in breeders' books and had changed to a lighter colour."

The Buyer brought the case to the Small Claims Court and Jim had to attend the hearing.
"The judge dealt with the case although the complainant was the wife who was not the one signing the sales contract with me!" Jim said. 
"It is up to the judge as he has the power," I said. "Maybe the wife is family. Who knows what the the judge based his decision upon. Did you win the case? After all, you were not selling a pedigree dog for dog shows but a pet quality dog. The coat colour could fade or darken when the dog grows older."

"Poodles have different shades of brown," Jim said. "But the judge does not know it. Photos were submitted by the wife as evidence! She even had an expert witness to testify for her as regards the standard height of a poodle! Another pet shop owner!"

"Was the expert witness paid by her?" I asked.
"No, no," Jim said. "That poor fellow had to close his pet shop to attend the hearing! He was suppoenaed by the court to attend the hearing. No need for this woman to pay him. That was the price of him voicing his opinion on the height of what a poodle should be as an adult dog!"

This experience should teach readers not to venture any opinions in cases of disputes as the complainant can ask the Court to subpoena us for expert testimony.
"This woman would cancel the hearing and I would have to wait for another day, cancelling my grooming and transport appointments again! She knows the process of the Small Claims Court of last-minute cancellations.
"You know, she is the wife of one of those rich developers in Singapore and must have good experience of making puppy sellers pay for defective puppies. That was before the lemon law was introduced in Singapore and my case was that the puppy had been sold to her for over a year! Now, with the lemon law which states that there is a one year of guarantee, I do not sell puppies anymore!" 

"I don't agree that there is a one-year-guarantee for puppy purchase. He could have bloody diarrhoea from parvoviral infection 2 months after purchase and died. So the owner cannot claim that the puppy was bought with parvoviral infections. The incubation period for parvovirus would be around 14 days, that is, signs would appear 14 days after infection and 2 months equal 60 days. So, the Buyer cannot claim losses and medical treatment costs." 
"I am telling you it is one year," Jim insisted.
"What happened to the expert witness for the Buyer?"
"He was not even called in to testify," Jim laughed. "He had to cancel his grooming appointments to attend the hearing, making him lose income! Serves him right for being a smart aleck.

"As for me, the complainant cancelled the hearing at the last minute and so I had to close shop a second time and lose income!  The Buyer certainly knows how to make me suffer losses of income!"

I usually do not comment on competitor's treatment of a case and that would not be subpoenaed as a witness.

"So what happened? Did you lose the case?" I asked. "I think the judge would not more than you think, about dog's standard height and colour. A lighter colour could be due to bleaching shampoo and I don't think he would be fooled by the Buyer. How much did she ask for compensation?"

"The judge asked her. She wanted much more than what she paid me for the puppy. For emotional distress, you know. So much worries when the poodle became taller by two inches and losing the redness of the coat!"

"How much she paid for the puppy?" I asked..

"$1,900. She wanted much more. To be a puppy seller, you must have a good lawyer. Refer all complaints to the lawyer.

"There was this big puppy seller who had this good lawyer. One day, a very rich lady was dissatisfied with the puppy and he referred her to his lawyer. But the rich lady did not proceed with the 'see you in court' threat."

"That is why she is rich," I replied. "No point paying lawyers to sue as the legal costs would be more than the cost of the puppy! She is from the elite family of Singaporeans and she certainly can afford it but she did not do so."

But Jim could not afford to retain a lawyer as he sold only a handful of puppies from his own pets some years ago. I opened the can of drinks he offered me and it was getting dark now, closer to 7 pm when he should be sending the groomed dog home to Woodlands.
"So what was the verdict?" I reminded him that he was late for his transport.
"The rich woman lost her case."
"Why?" I asked as the government is deemed to be pro-consumer.
"She placed the photo evidence of the coat of the puppy not in chronological order, hoping to fool the judge."
"Really? How did she do it?"
"She placed the older dog's photo as the first photo. The judge said the coat colour was light and it could be due to the flash bulb!"

Thursday, October 23, 2014

1082. Just microchipping

A 7-year-old male Westie came for microchipping only as the vet authorities are more active in checking unlicensed dogs.

The previous owner had migrated. The dog had thick tartar, an undescended testicle and had no vaccination. The vet has to record that the owner does not want any dental scaling and neutering or vaccination in the record in case of misunderstanding later. The new owner said that the dog, being old, would feel the pain of neutering. 

Dogs that are fortunate have owners who would have done the dental scaling at least once in 7 years and this prevents heart valve infections (endocarditis). However, not all owners care.