Monday, September 22, 2014

1059. Continuing veterinary education

Sep 22, 2014
Attended a most interesting talk by an experienced vet.
"A new approach to utilizing lab diagnostics for the most challenging and misdiagnosed diseases"
Fred Metzger DVM, MRCVS, Diplomate ABVP, Metzger Animal Hospital, State College, Pennsylvania, USA, Oasia Hotel, Singapore, IDEXX Lab, Sep 22, 2014. Some points are:

1.  Complete blood counts should be included in evaluations of every sick patient (anaemia, inflam disease, platelet disorders, monitoring for trending of data in progression or regression of the sick animal disease), patient with vague signs of diseases, every pre-anaethetic evaluation (get baseline data every couple of years), wellness and geriatric profile, recheck of patients with previous erythrocuyte, leucocyte or thrombocyte abnormalities.  This is seldom done by some vets in Singapore to lower medical costs.

2. Start CBC at one-year of age to get the minimum database as reference.

3. A surgery release/preanaesthetic testing form
4. A cost estimate of CBC  $38, $52, $84 for patients <2 2-7="" 5="" 7="" age="" and="" ask="" by="" client="" do="" health="" income="" increase="" it.="" keep="" low.="" nbsp="" of="" or="" over="" p="" patients="" practice="" preanaesthetic="" price="" questionable="" status.="" test="" to="" with="" years="">5.Trend in the USA. Vaccination income is dropping. Pharmacy income has dropped as clients purchased from the internet. This will happen in Singapore.  Diagnostic income is 2.5 x more than vaccination income, more thanpharmacy income, outpatient services and treatment income, more than surgery income, hospitalisation and dentistry income combined.

6. Untapped profit center. Laboratory. 
Pre-anaethetic testing.  Wellness/preventive screen. Senior care. Monitor long-term meds.

7. Very few dentals are done by vets.

8. Quantative buffy coat analysis, impedance counting analyzers (not wanted in the US, sold to China and other countries), lasercyte and lasercyte DX, IDEXX procyte Dx (best of all)  and sysmex XTV.


Sunday, September 21, 2014

1058. The senior citizen cafe operator

Monday, Sep 22, 2014

I had a breakfast chat with this senior citizen at the coffee shop opposite Potong Pasir NTUC. His boss was late and so we had a good chat.

1.  Charcot's Disease - bone deformation. He had custom-made shoes. "It costs me $468," he said. That is expensive for a senior citizen.

2. Getting business for his employer. 

2.1  "Nowadays, no Singaporean wants to work in the cafe in this hotel. The younger ones don't stay long or don't know what to do to generate revenue to cover the operating cost of rental and salary. He was aware of that but he did not take advantage of the employer
"The younger man used to close shop and disappeared for lunch for 2 hours," he told me. "I don't close for lunch. If I am tired and there is no customer, I will rest on the chair. The young man will close shop at 6 pm but I do not close till 8 pm."

2.2  As this hotel has no seats in the lobby, people will want to sit in his area (32 seats) to study, to eat their own food and drink their own water. He recounted the story for the 3rd time today.

"There was one manager about your height but bigger in size eating his company buffet lunch on my table and chair without even purchasing a drink from me. The company had a management talk and there was a standing buffet lunch provided in the hotel lobby. I said to him: 'Excuse me, these tables and chairs are reserved for my customers." 

The burly manager replied: "Ask the security to evict me."

The operator said: "These tables and chairs are purchased by my company. They are not bought for nothing. Repeat what you just said to me."

The manager stood up and left, much to the laughter of the female colleagues.


Saturday, September 20, 2014

1507. A 5-year-old Chow Chow suddenly had fits and salivation

Saturday Sep 20, 2014

A female non-spayed Chow Chow came in recumbent, shaking all over the body and salivating thick sticky saliva. "These fits happened only 15 minutes ago. What is the cause? Can you do something to stop the fits"

I checked her medical records. No fits before. I gave IM 5mg diazepam. The dog stopped shaking one hour later. She was very thin and full of scales and oily skin. Her eyes had rolled in eyelids and were sticky with lots of pus. IV drip and medication were given. Blood test done.

Today, the dog had recovered and was eating. The whole body would be clipped and a bath given. Ears irrigated, nails clipped. The owner did not want entropion surgery. 

A young Shih Tzu X vomits and purges after a stay in a Pasir Ris chalet

Sunday's interesting case  Sep 21, 2014

4 days ago, the dog went to the chalet. In Singapore, Pasir Ris chalets near the sea, are rented by the family to celebrate functions and have a BBQ.
"It was only the first night and the BBQ had not started till the next day," the dog vomited 6X and had diarrhoea 10X."
The family vet treated the next day but the dog continued vomiting and purging and so was brought to her the 2nd time. Blood tests and X-rays were "normal". 3 bottles of medication were given, but now she referred the dog to the parent branch. Ultrasound showed some inflammation in the liver, gall bladder, stomach and intestines. A foreign body in the full lumen could not be ruled out.

When the dog came to me this morning, he was most aggressive. Muzzling was done but he could take the muzzle out. "Hold by the scruff of the neck while I gave the injections," I said to my assistant. Just handling the dog with hands would not do as this male dog was very strong.

Vet 1 and the referred vet had prescribed 6 types of medications and had given injections. I palpated the abdomen. Empty except for a distended bladder. Some pain felt in the rectal area as the dog winced. Could there be bone fragments inside the rectum? X-rays may not show.

Based on the sudden onset persistent vomiting and diarrhoea in the chalet, this dog could have food poisoning. The treatment varies with different vets. For such serious cases, I would give the IV drip and anti-diarrhoea medication and let the intestines rest 48 hours, with electrolytes only for the first 48 hours. The other vets fed the dog chicken pieces and advised porridge. It may be better to advise fasting for 24-48 hours.          

Thursday, September 18, 2014

1505. Feedback on lateral ear canal resection surgery. A Schnauzer has very hairy ears

Sep 20, 2014

The lady asked whether Royal Canin delivers the hypoallergenic food to her house as she finds that it is better than Science Diet Z/D. Her dog had been tested for allergies which showed that the dog was allergic to grasses and even cockroaches.

."Keeping this expensive dog indoors reduces a lot of skin itchiness," she said. "Do you remember you opened up her vertical ear canals in April?"

"Some miniature schnauzers have hairy ears and so there is not much ear v. entilation or drainage. The ears become infected. Is the dog still scratching his ears and shaking his head continuously nowadays?" I asked.  

"Very much less," she said. "My friends can't believe that he is itchy to grasses"  This feedback shows that lateral ear canal resection is effective.

"There is a need to check the horizontal ear canal," I explained to her as there is some scratching of the ears. Very little .

Royal Canin does not deliver food to the house. She found it better and so she ordered it for her dog. Today another dog owner had bought 2 large bags and so there was none available. Toa Payoh Vets do not stock up such special diets as the demand is low and we have to throw away expired ones. She would phone to order the big bags. .

1504. Blood test for an old bad-breath Jack Russell X

TP 45534

Bad breath from a distance. The owner lives with the 8-year-old male dog will not be able to smell this because his nose is sensitized to the smell.

"My friend told me I must do a dental scaling," he said to me.  The dog looked like a Norwich Terrier but he said it was a Jack Russell X.

BLOOD TEST before dental work.
Surprisingly the total white cell count was 5.6 (6-17) but the neutrophils were normal at 56.4% (60-70%) and the absolute no. of neutrophils was 3.16 (0 - 3).  Overall, the values have not changed much.

Urea 6.9 (4.2 - 6.3), creatinine 81 (89-177).

4 teeth extracted. The smell was so strong that I could smell it when placed inside the plastic bag for the owner to see.
Usually I advised 7 days of antibiotics, but the owner wanted today (Sep 18, 2014) as he was free only once a week.  So I gave the antibiotic via the IV drip direct, to kill as much of the mouth's bacteria as possible. Dog goes home with antibiotics and painkillers oral

On Sep 19, 14, I phoned the owner.
"No bad breath?" I asked.
"No," he said happily. "Thank you.".

Wednesday, September 17, 2014

1503. How to make a killer presentation

Yesterday, I attended a presentation at Delifrance said to be given a lady insurance agent who told me she would be introducing her boss to me. I was asking her about insurance for a mortgage decreasing housing loan.

Instead, the boss gave the presentation on trust and leverage while she was quiet.

What she ought to do was to plan ahead, do rehearsal with her boss and give the presentation herself as she was the primary contact. The boss is a stranger. So, I sms her a Harvard Business Review article on "How to make a killer presentation."

"It is not rocket science advising a person to get a $1 million insurance cover with a 15% downpayment and recoverable yearly premiums of $6,000/month. "Just do it," I was sure she could have done a better job as she was the contact.

"Yes, Sir, Nike, Adidas" she sms me.
"Not  Adidas mdm," I replied. "Adidas is competitor. They do not do it."

We should try to give what the customer wants. In real estate, some agents bring clients to view houses they can't afford to rent or buy. Dog groomers insist on not clipping off the tip of the tail and the face when the owner wants a complete shave.