Thursday, September 30, 2010

The 65-year-old gardener

"My body is full of cancer cells," the white-haired, 65-year-old grey-eyed white eye-brow gardener said to me when I met him doing gardening at the house where I was staying in Perth. I had asked why he did not retire and just stayed at home. His children were grown up. He reminded me of an old Englishman in the UK during my undergraduate days. This old English man was still active doing gardening and any housework when I stayed at a bed-and-breakfast home in the 1960s.

I was surprised as he was active and busy doing gardening and cleaning the swimming pool. The gardener elaborated: "When the doctor injected some drug into my spine," the drug caused the arsenic in my body system to form scattered small Grade 2 tumours inside my muscles. So, my body is full of cancer cells."

"What treatment did you receive?" I asked. "Some blood changes," he said. "Nothing can be done to eliminate the tumours. It was from arsenic from my 30 years in the printing firm. Arsenic was used for the printing plates at that time."

He was offered blood changes in the US at a cost of US$50,000 but his doctors advised againt it as it would not completely cure him. "Maybe 40%," he said. The gardener had skin cancer and had taken 18 operatrions. He showed me his leg scars after tumour excision and grafting of the skin. Some rough scars but no tumours. Apparently Caucasians and Irish Caucasians are prone to skin cancers. Now, his wife covered his body with UVL cream. Only his hands were free from skin cancers.

Yet this man lives a positive mindset and did a good job at the gardening and pool cleaning. It took him some one hour to do it and getting exposed to the UVL. Will UVL cream prevent skin cancers? He is a guinea pig as the doctors are using his blood and "soon they have a discovery which will benefit his children to prevent skin cancers in the gene."

Networking or Sucking up to the professors?

"It is actually a smart thing to do," I said when the vet students told me that they don't bother to "suck up"to the professors compared to one classmate. I presume "suck up" means getting closer to them to talk to them during lectures and practicals.

"But this type of networking is not easy for everybody to do. Professors are influential people and if you get to know them better, they think well of you and remember you when you ask for a testimonial. If you distance away from them, you are just an unknown."

To suck up to the professors is not an easy thing to do if you don't have common interests. Common interests will be academic subjects and maybe sports. I don't know as I did not suck up to my Glasgow professors during my undergraduate days. It is an innate abiility - a part of your personality. Such vets will be most successful in getting clientele too and will be in great demand since they bring in the business.

As to how important this public relations nature is, I did get an answer from a top vet student during one dinner after the Royal Perth Show a few days ago. I was talking to her about a young Singapore vet who has excellent public relations according to my feedback. She agreed with my observation and said: "70%" I don't know where she got this statistic but I tend to agree with her that excellent PR is very important. So, sucking up to the professors is part of personal public relations and a training for the real world after graduation. Bedside manners is what public relations mean in medicine.

Sparring partners in vet surgery team

Perth, Sep 30, 2010

Had dinner after library visit. The Chinese restaurant was surprisingly packed with Caucasians on this Thursday. We were the only Asian of vet students and me. I knew that the target clientele is non-Asian. I asked the young man (graduate) waiter. He said that the restaurant cooked to the taste of Caucasians. Prices are maybe 10%. The ambience was good. The restaurant was clean and homely. Food was surprisingly good and better than Singapore standards. Perth is a sprawling place and each suburb has its own shopping mall and restaurants and are located within a 5-minute drive. Competition must be greater than in Singapore as each suburb is small in population.

"You are her sparring partner," I said to the vet student. In Murdoch, each surgical team has 3 vet students. "Sparring partners?" the vet student furrowed her eyebrow and looked at me.

"I am using a boxing analogy," I explained to her. "You and the other student are of the same class and therefore I say you are her sparring partner. Now, if you were at the pits ie. bottom of the examination ranking, you will not be her sparring partner as one punch will knock you out. She will not bother to discuss any academic subjects with you since you would not be up to her standards."

I said: "It is important to get a sparring partner if one wants to excel as the punches from your sparring partner pushes you to your limit of endurance." It sounds too technical to this young girl.

"I can't measure to her standards," she said to me.

"It is your mindset that tells you that," I said. "When your mind defeats you, you have already lost the first round of boxing. The positive mindset is very important to a scholar or sportsman. If you think you can't win, you have already lost."

The girl was not convinced. She must have lost a few battles in her mind and soul and would be realistic.

"It is the date of graduation that will decide the winner," I said. "Many things can happen to your sparring partner and nobody can predict the future."

Changing the method of study may be one way. I can't advise further as self-motivation and the competitive spirit are in the DNA of a person. Much depends on the growing up years of the youth and the family nuturing. But a sparring partner of similar ability will push one to greater heights and win, if one has the positive mindset to do it. "Do your best," I said to her. But how to do it? I have no answer as I am not a training coach.











In Willeton, Australia, Thursday's supermarkets like Cole (except IGA supermarkets which open 7 days a week) close late to 9 pm.

Ovariectomy and ovariohysterectomy in dogs and cats

Sep 30, 2010 Perth Murdoch Vet Library
A cloudy day

A one-week break for Murdoch Univ students ending in Oct 3, 2010. I was surprised to see around 5-10 students at the Murdoch Vet Library for some time from 8.30 am to 6.30 pm to read their latest vet journals. Singapore has no vet library at all and so it is a great joy to read the various publications including old issues in this Vet library.

One article of great interest to small animal vets and new vets is in "In Practice" Jul/Aug 2010 Vol 32, No. 7 and also Sep/Oct 2010 No.8 as the two articles describe medical and surgical conditions of the reproductive system in the dog and cat in detail.

Before I get distracted and do other things, I will share my experiences of the past 30 years in small animal practice and also comment on the "surgical complications of spay" from Jul/Aug issue on "Surgical diseases of the female genital tract. Part 1. Ovaries and Uterus"

The authors mention that haemorrhage during spay is usually from the ovarian vessels and propose a solution - find the bleeding pedicle using "duodenal or colic manoeuvres." I have not heard of these manoeuvres. Always new things to discover. My solution is just to track the bleeding pedicle to the kidney area by parting the omentum and looking for the bleeding pedicle. An explanation or reference should be given by the authors.

Bleeding after spay can also be from:
1. Uterine blood vessels. The authors say that blood appears at the vulva.
2. Omental fat and the broad ligament blood vessels esp. when the dog is on heat.

If there is significant blood loss, repeat the surgery. The authors said to check the demeanour of the dog post op and check pulse rate and quality, PCV/total solids.


OVARIECTOMY is mentioned as an alternative to OVARIOHYSTERECTOMY in normal spays where there is no pyometra or neoplasia.


STUMP PYOMETRA AND REMNANT OF OVARIAN TISSUE
The authors say that if there are no remnants of ovarian tissue or use of exogenous progesterone (e.g. Ovarid being given to the dog), Ovariectomy will not lead to stump pyometra. Uterine neoplasia is very rare in the female dog and so Ovariectomy is OK. But most UK vets still do Ovariectomy.

In my 30 years in practice, I only encountered one case of stump pyometra in a dog spayed elsewhere. I excised the stump but did not do extensive laparatomy to look for the remnant ovarian tissues as the dog was old. The owner complained about vaginal discharge and pus happening even though the female dog was spayed.

BREAKING THE SUSPENSORY OVARIAN LIGAMENT attached to the kidney. In the early years, surgical books used to advise breaking the ovarian ligament using finger pressure.
I used this advice but it is not practical as sometimes the ovarian blood vessels get broken too. This leads to haemorrhage of the ovarian pedicle as mentioned by the authors and it is worrying.

Some 15 years ago, I use the scalpel blade just to cut off the ligament and then proceed to ligate the ovarian vessels. The ligament is quite taut and a scapel cut is so easy. I seldom have bleeding after spay unless the omental blood vessels of a dog in heat were bleeding. Very rarely do I have bleeding in the past 15 years.

DOUBLE LIGATURE OF THE UTERINE BODY.
I find this sufficient and have no post-op bleeding complaints or death. Transfixing ligature is an alternative in pregnant dogs. In pyometra, I invert the uterine body stump to prevent leakage of pus into the abdomen. Normally post-op antibiotics for 2 weeks prevent infection.

HOW LONG SHOULD THE UTERINE HORN BE LIGATED AND CUT OFF?
The authors said there is no worry about the ureters being ligated together with a longer uterine body. Ureters enter the bladder directly. In any case, if the ovarian tissues are completely removed, there will be no remnant ovarian tissues to cause vaginal discharge again. Ovaries are the only source of progesterone and if no exogeneous progesterone is given (e.g. Ovarid), the spayed dog will have no vaginal discharge regularly. Therefore, a shorter uterine body can be ligated without problem. Also uterine neoplasia is very rare in the dog. So, no problem here with a longer uterine stump left behind.

I don't excise too long a uterine stump in dogs, cats or rabbits. Just in case, the ureters are caught accidentally inside the ligatures. This may happen rarely but has not happened to me. Vet anatomy is full of surprises and one must be verfy careful not to be caught in cases of abnormal more cranial positioning of the ureters in the female dog.


SPAYING A PREGNANT DOG WITH PUPS
No problem with milk production as the dam will still produce milk even after spay during a caesarean section. Different hormonal pathways involved in milk production. This is where vet studies of endocrinology (4th year vet students to note) can be very useful in providing the answers as to whether milk production will cease once a dam is spayed during Caesarean section of dystocia and depriving the pups of the dam's milk.

BLOOD SEEN IN THE UTERUS AFTER SPAYING
The authors mention that blood seen after spaying could be due to haemorrhage of slipped ligature of the uterine body.

In the past 30 years, I had one complaint of the Lhasa Apso spayed by me. The owner complained of some blood seen. It could be due to incipient estrus. I noted a cystic lump in the uterus (starting of pyometra) and had taken photos. Blood stopped flowing after 2 or 3 days. The Lhasa Apso is very much alive and loved (if you see her blog or facebook) today.


LAPAROSCOPIC OVARIECTOMY OR OVARIOHYSTERECTOMY. The authors say specialised training is needed. I doubt there is a demand for such services as they will be very costly.

TIPS FOR INEXPERIENCED VETS
1. Spay is a major surgery.
2. Make a large incision from umbilicus to half way between umbilicus and pelvic inlet.
3. Get vet nurse to assist. (Use of abdominal retractors? I don't think the authors mention this).
4. Find the bleeding pedicle using "duodenal or colic manoeuvres." This was stated twice in the article but no further reference.

MY COMMENTS
Spay is easy if the incision is larger than 5 cm and be nearer to the umbilicus and the dog is not fat. I use a 2.5 cm incision but inexperienced vets should not cut so short as it takes time to learn how to hook out the ovaries. I have written several articles on my spay surgical approach in www.toapayohvets.com

FAT FEMALE DOG SPAY
I still remember a new Murdoch Univ vet graduate who worked for me some 20 years ago. He was unfortunate to get a big fat cross-bred of 20 kg. His brows were sweating as he could not locate the uterus despite a large incision. It took a bit longer to hook out the uterus in fat dogs. I still dread spaying fat dogs even though I have so many years of experience.

SPAY 3 MONTHS AFTER THE END OF HEAT
The authors did not include this advice but it is sound advice. Very little bleeding from the omental and broad ligament blood vessels. Even the ovarian and uterine blood vessels have shrunk in size.

LIGATING THE UTERINE BLOOD VESSELS AND TRANSFIXATION OF THE UTERUS
The authors advise this to be done. For me, I normally clamp the uterine body twice and ligate the whole body twice. In pregnant dog spay, I have to be careful and may ligate the uterine blood vessels separately via incision through the side of the uterine body and ligate before finally ligating the whole uterine body twice. This is overkill. Or I place a transfixing ligature.

DO NOT USE CATGUT
The authors say that catgut is not suitable. Something about capillary action (I need to check on this), fast dissolving and difficulty in knotting. I have not used catgut for the past 20 years. Like the authors, I use syntetic absorbable sutures. They definitely dissolve much slower.

Overall, the surgical articles in both issues are very useful to practising vets as part of their continuing education. Photographs are in colour and surgical approaches are shared. Episiotomy (extra-luminal tumour of the vagina) and episioplasty (excess skin folds around vulva causing dermatitis) surgical procedures are shown.


EPISIOTOMY FOR REMOVAL OF VAGINAL TUMOUR

The use of straight bowel clamps on either side of the vulva is a great idea as in horizontal ear canal resection. One arm of the clamp is placed inside the vestibule and one arm of the clamp on the perineum on the leftmost side of the tumour. Similarly for the other clamp to the rightmost side. The skin is cut in between. An assistant holds the clamp apart. The extralumninal vaginal tumour is seen cranial to the urethral orifice (catherised) and dissected. A beautiful photo shows the anatomy of the area with the urethral orifice seen clearly very well.

Closure in 3 layers - vaginal mucosa, muscle and then the skin.


EPIOSIOPLASTY
Stretch the loose skin upwards and sideways. Excise a crescent-shaped piece of skin above the dorsal aspect of the vulval lips. First incision around the 9 o'clock and 3 o'clock position. Then a parallel one dorsal. Stitch up after excision of the crescent piece of excess skin. Same surgical procedures as in entropion surgery.


INTERSEX
Excellent definitions of male pseudohermaphroditism (enlarged clitoris but testicles producing testosterone inside abdomen) and female pseudohermaphritism (small penis and ovaries inside scrrtoum), true hermaphroditism (have ovarian and testicular tissues)

For more details, it is best for vet undergraduates to rush to the Vet Library to download a copy. I am sure you will get HD (High Distinction is over 80%) in this fascinating animal sexuality topic in your stage of life.

Acupressure project

E-MAIL TO DR SING DATED OCT 1, 2010

To: Dr Sing Kong Yuen

We are a group of students from ...(Pre University) and we are doing a project on the general well being of the animals. Our project focus is to suggest the use of acupressure on the animals housed in animal shelters. We hope to influence pet owners as well as our cohorts to raise their awareness that animals' general well-being is equally important as physical well-being. We feel this issue would be best demonstrated through helping the animals in animal shelters.



To be more detailed; the objectives of our project are to extend the benefits of acupressure to animals in organizations such as animal shelters, SPCA, the Singapore Turf Club and pet obedience schools. We understand that animals in these organizations receive sufficient medical treatment; however, we feel more could be done for the animals.



We are formulating a proposal to as part of our project, and we would be extremely grateful if you could help us with the following questions:



1) We would just want to find out whether animal shelters would send their animals to you or you would visit the animal shelter if there was a sick animal?

2) We have designed a product that could help an acupressure practitioner to perform the therapy conveniently at any location. We would like to seek your professional advice on our product to see its feasibility. Attached is the general product of how our product would be like.



If you need further information, please contact us via this email:


Thank you very much for your kind attention and cooperation.



E-MAIL REPLY FROM DR SING

In your project proposal, please define "Acupressure". Also state why should animal owners want acupressure for their animals? What are the benefits and the costs? Are there commercial products available?


As for animal shelter animals, they are usually in great need of money and many volunteers to sustain their operations. They do send sick animals to the vet for treatment as it is relatively lower cost than house-calls.

In my opinion, acupressure may not be practical for their situation. Your proposed product for aromatherapy use may be useful for dog owners who may want aromatherapy as an alternative veterinary medical treatment.

As for racehorses, I think your product is not appropriate.

Wednesday, September 29, 2010

Communications with younger generation - English

"English is a difficult language to master," I said to the young lady who stated that she had not heard of the word "nincompoop". I was having dinner with a group of 4th year vet students after the Royal Perth Show.

If you are in the puppy business, you may think it has something to do with toilet-training "poo" or "poop"

Have I heard of it? Yes. It means a foolish silly person. The young lady next to me whipped out her mobile phone, checked the meaning and showed it to me. No more wasting time on offline dictionaries. Communications with the young in the "Queen's English" is sometimes not possible. Some examples are:

1. "Why so drama?" the husband asked the wife. I was having dinner with the younger generation in their late 30s in Joondalup yesterday. The husband meant "What are you so dramatic?"

2. When I said to a young vet undergraduate that I would like to be properly introduced to her friend and husband, she said she would arrange a dinner meeting. I asked: "Does your friend entertain at home?" The young lady said: "Yes, she is able to chat easily with people". I meant whether she hosts dinner at home.

3. My young intern Ms Lai worked for a famous gynecologist who was my secondary school classmate and who highly recommended her for an internship with me - a condition of her internship as she had mentioned his name as a referree. One day I asked: "Have you seen him lately?" I wanted to catch up with this old classmate whom I had not met for over 15 years.

"No," she said. "I feel embarrassed to see him." She meant she would not consult him for her gynecological problems as she worked closely with him on a hornbill project.


4. "The young vet has excellent public relations," I said to the young lady who did not know the meaning of "nincompoop" earlier. She agreed with my opiniated comments.

I continued: "You know, in the pet internet forums, some lady clients said that if you want "eye candy", bring your dog to consult him."

"No, no," this young lady objected. "He is no eye candy." At least there is one communication I successfully carried on with one young one. I am a male and so I do not know whether the particular young vet is eye candy or not.




So, communications with the younger generation of Singaporeans by the old foggies can be quite alarming and interersting sometimes.

121. Vet communications

DRAFT
Perth, Thursday, September 30, 2010 6.28 am.

During a dinner after the Perth Royal Show, a 4th year vet undergraduate asked me what do I look for in employing a vet? This lady sure knows what to ask.
Excellent Communications skills with clients is a fore-most trait I look for in a new vet who wants to work at Toa Payoh Vets.

The following notes from a book in Murdoch University library on Sep 28, 2010 may seem irrevelant as it applies to the art of communications with readers of newspapers but the basic principles apply to veterinary communications in newsletters and brochures.


Book: Journalism & Meaning-making – Reading the Newspaper, edited by Verica Ruper, 2010.

Two articles I will summarise here.

1. "Images and Text face off in the broadsheet feature story by Dorothy Economou, Univ of Sydney" - The Stand Out - an unrecognised newws genre.

2. "Image-nuclear news stories" - a new news story genre by Helen Caple, Univ of Wollongong.


ARTICLE NO. 1 - IMAGES AND TEXT FACE OFF
D. Economou said that the standout is an unrecongised news genre. It has the obligatory 5 components:
1. Large image or images (colourful pictures, illustrations)
2. Main bold headline ("screamer" headline")
3. Image captions ("screamer" captions)
4. by-line
5. Sub-headline (stand-first or write-off)

The 5 components enable busy masses of readrs to be attracted to buy the SMH. Others who want to read the long-feature story will go into details further inside the SMH.

The layout of 4 columns is as follows:

NUCLEUS: LURE (lst row, all 4 columns spanned)
Image 1

Headline Image 2 (right-most 4th column)

Satellite: Image 3 (3rd column) overlap 2nd row
Point Satellite: "Quote" e.g. letter from somebody Satellite:
Imager Anchor

ORBITAL STRUCTURE OF A STANDOUT EXAMPLE

I will post a picture as blogger.com does not accept tables.

The "Point" with its verbal component (the standfirst or abstract of the written story) is the "story" in the Standout.

She said that the standout is visually provocative and verbaby abbreviated.




ARTICLE NO. 2
The writer, Helen Caple stated that the Sydney Morning Herald (SMH) presents news in a new and innovative manner using the IMAGE-NUCLEAR NEWS STORIES which is a new news story genre. It said THE STANDOUT is an unrecognised news genre.

Basically it means that the SMH presents a new format to capture the attention of the busy time-pressed readers with a large picture and some text. if the reader wants more info, he can read the in-depth report further in the newspapers. In this format, the SMH sustains its readership and its profitablility by retaining advertisers and reader loyalty.

Helen Caple said that the SMH prints a large photograph with a heading (not a headline) above and a short caption either below or to the side of the picture. No more text, hence she called it the "Image-nuclear news story". The heading is witty and interests SMH's cateogry of readers.

HOW DOES THE ABOVE APPLY TO VET COMMUNICATIONS IN EDUCATING THE CLIENT ABOUT SURGICAL PROCEDURES? The following are my thoughts of applying the above to vet communications and education material


1. Big colourful pictures and text to "lure" or attract the client - Dog's eye pops out?
2. A "screamer" headline e.g. "Save your dog's eyesight or lose the eye by procrastination?"
3. Image captions explaining the surgical procedures in brief.
4. By-line - name of vet or surgery
5. Sub-headline - summary of surgical procedure.

Reading about other industry practices can and do provide new ideas to veterinary industry usually. Unfortunately, you need time to devote to research and reading. The above took me 2 hours to read and to draft. I still have to take a picture to illustrate what I mean.

Tuesday, September 28, 2010

205. Vet Surgery: Voiding urohydropropulsion in dogs and cats

Perth, Australia 10.30am

What is urohydropropulsion? During my undergraduate days some 30 years ago, there was no such term.

Basically it means pumping saline into the bladder (3ml/kg) and suck out the fluid together with the small uroliths (urinary stones) with a catheter. The stones in the bladder are too small and therefore no surgical removal is needed.

ANAESTHESIA. May or may not be need.
POSITION. 2 methods described in Small Animal Clinical Nutrition 5th edition.

POSITION 1. Hold the dog or cat upright so that the vertebral column is upright. The urine and stones will be at the bottom (neck) of the bladder.

POSITION 2. Lateral recumbency.

In both position, catherise, irrigate with saline (3ml/kg), massage or press bladder to shake up the stones, suck out the saline + stones with a syringe. X-rays to check if all are taken out but not all small ones can be seen.

Dietary and medical treatment

204. Client Advices: Prescription Diet s/d canine

Perth, Australia, 10.06 am.

After surgical removal of the struvite urinary stones or for medical and dietary treatment, how much should the owner give the dog/day?

Took some time just to read about Canine Struvite Urolithiasis case studies in the Small Animal Nutritition by Hand et. al, 5th Edition and the following is some general guidelines for Toa Payoh Vets in advising on Prescription Diet s/d to dogs


1. Puppy X-breed, 9 weeks, 5 kg. 700kcal (2.83MJ) 1/2 can 3x/day
2. Rottweiler, 5 years, 41 kg 1,800kcal (7.5MJ) 1.5 cans 2x/day
3. German Shepherd, 12 years, 27kg 1,150kcal (4.8MJ) 1 can 2x/day

Antibiotics from 14-30 days and review using urine cultures
Monthly urine analysis (check for UTI) and blood tests (esp. serum urea nitgrogen, magnesium, phosphorus and calcium and alkaline phosphatese)
Monthly x-rays of kidney (V/D view), bladder (lateral views)

Specialised tests like double-contrast cystography (to check out anatomic abnormalities of the bladder, obstruction of urine flow from kidneys), retrograde positive-contrast urethrocystography (to check out anatomical abnormalities of the urinary tract to the prostate gland area) if there is recurrent uroliths or UTI.

Back to normal commercial food for puppy as soon as X-rays show no stones. For adult dogs, give prescription food for one more month after negative X-ray results.

No commercial dog treats or snacks.

Very few Singapore clientele comply with the above instructions. It could be due to economic reasons. Urine is taken by cystocentesis. Voiding urohydropropulsion is used in cases where the uroliths are small.

Monday, September 27, 2010

203. Mindset and motivations for vet undergraduates

Monday Sep 27, 2010
Perth Royal Show, Queen's birthday today is a public holiday in Perth

Mindset
It is hard to change your mindset when you tell yourself you just can't do it. If you tell yourself you can't beat the top student in your class, you fulfill your prophecy every time you see that your exam results are lower than hers or his.

Passion for veterinary medicine and surgery
Human nature is such that 80% of the vet student population will not have passion for veterinary medicine and surgery. Passion means putting much more time and effort in your undergraduate studies to excel in the top 20% of the class. That is how I judge passion quantitatively. It is not for everybody. There has to be time sacrifices and the capability.

Yesterday I met 2 vet undergraduates whom I know to be in the top 20% of the class and another one probably in the bottom 20% of the class. I will call them A, B and C.

The recent SAM (small animal medicine) exam for the 4th year was packed to the gills with questions such that most students would not be able to complete answering all questions and therefore "had an excuse to fail". It was apparently a new examination format according to C and so I was interested to know more.

"The top student got 88% (High Distinction)," C said. "How about A and B?" I asked with very high expectations. C replied: "They got Distinction which is 70-80%."

"If nobody can complete answering all the SAM questions, how could anyone get Distinction or High Distinctions?" I asked C.

C replied: "They got correct answers for the questions they completed. This just does not cut ice with me. Unless the professors use the standard deviation curve and award the Ds and HDs according to this curve. So, even if no student completes all questions, they still can be graded according to the bell curve. Know what I mean? Go and research statistics.

C said to me: "It is impossible for me as I need >90% in the forthcoming exam to pass the SAM." Nothing is impossible if one is very hungry. "What if you get 80-90%? Will the professor be kind towards you so that you need not repeat the whole SAM exam?"

"Your mindset is already fixed," I took some time to talk to this young man who was once a straight A student in his A levels. "Why don't you just drop out of vet school and do something else if you have no passion for vet medicine? Do something that pleases you.

"You had straight As in his A levels and I know you have the capability to at least pass the examinations. Your parents will be disappointed but why do you care about their feelings?"

As a parent myself, I feel really sad for his father and mother who must have had high hopes for him and would not know his examination performance.

Is there any hope for him? If he cannot get over 90% in the final exam, he will need to repeat the whole SAM exam which involves much more subjects to study. I advised the following which may be useful for other undergraduates in vet school.

1. Males who tend to study 2 weeks before the 4th year examination may fail because there is a vast amount of info to remember.

2. Study daily your lecture notes. Use "cards" to write down the important points from past year exam questions. Read the cards one at a time when you are free. And do it daily, not 2 weeks before the exam.

3. Do wider reading but since you just want to pass, I don't expect you to bother. A wider reading reinforces and adds to the knowledge from your lecture notes.

4. Cut off the addiction to watch downloaded TV movies or use the internet till 3 am in the morning. If not possible, restrict to half an hour. During my undergraduate days in the early 1970s, there was no internet and I watched only the 10pm news in Glasgow. It was back to the grindstone every evening, except weekends, to study and read other books on vet medicine.

5. Vet medicine is full of information to remember. There is no other way but to spend time to memorise the facts. It is easier than law which requires case precedents to be quoted.

6. Stay-in at a practice to help out. But this option does not appeal to most students as it means responsibility. Only certain students who need the money saved from not having to rent a place will do it. A and B did it. They would have seen real cases which bring vet medicine and surgery alive to their mugging. That is one way to get top marks. Reading text without seeing practice or real cases can be sleep inducing.

7. "I open the text book and I fall asleep immediately," is a common observation for vet students whose motivation is poor. The reason is due to addiction to online pleasures of gaming and video watching.


Life is full of ups and downs for families - financial, health and death of young ones preceding the death of the parents. If you are an undergraduate with no financial problems, know that you are so fortunate to just simply having to pass the vet course. Many aspiring vet students will sacrifice a few years of their life if they were in your position.

Competitive spirit. A competitive spirit in the top 20% of the vet student. Is it inborn or acquired? It is hard to know. From my observation of A, it seems to be inherent in her based on my observation of the Mad Cow Rodeo performance. I heard her commenting to herself that she got the lowest grades as she was thrown off the cow earlier than B, C and another classmate. The other 3 vet students managed to hang on with two hands (incorrect way as one hand was the trick to rodeo riding)for a longer time.

A competitive spirit and a photographic memory will be hard to beat but never say "can't do it". Once your mindset is negative, you will never beat her at all if you have only acquired a competitive spirit by being associated with her. Both A and B will encourage each other in good company. So, much depends on the "porer"performer (B) to get a very positive mental attitude to study correctly and excel to be top of the class.

Do top students take multi-vitamins, grinko nuts and ginseng? I don't know. I presume A does it. Most likely she has a photographic memory as C told me that the classmates were impressed that she remembered the name of some plant causing sheep diseases during class. Unfortunately for me, C could not remember what was the name of the plant when I asked him!

Sunday, September 26, 2010

202. Make money tips from Loral Langemeir

"I will never do business," the young lady studying veterinary medicine in Murdoch University told me when I said it would be good for her to know one of my business contact who markets products in Indonesia. She must think that she would be an employee veterinarian forever.

An employee has a fixed income but I know she does not have a fixed potential and will do well in business (as a self-employed vet). She probably thinks that veterinary practice is not a business but a calling. She is still young and so it is possible that she thinks of being only an employee as it needs one year of working for others before a vet in Singapore is allowed to start his or her own surgery.


I happen to read a wealth creation article and asked another vet student whether he has had read it since the Fitness First magazine, Sep/Oct 2010 issue, Australia was his copy. "No," he said.

Well, here are the tips of becoming your own cash machine from the
author of America's best selling books such as "The Millionaire Maker", appearance on "Dr Phil" shows as the resident 'money expert'. Loral Langemeir does not believe that you need money to make money. Her concept "The 2lst Century Lemonade Stand"
encourages one to change one's attitude. One's mindset can sabotage one's success as you have the wrong conversation with your mind. If you say, "I'll will never have a lot of money," you should ask yourself "How can I have a lot of money?" according to the writer of this article.

Be open to opportunities to make more money. The focus should be on creating more cash rather than how to pay down debt. This is easier said than done. The 5 tips are:

1. Turn what you know into money, e.g. your talents, skills, hobbies, interests, knowledge and experience. (In Perth, I would say it is the tuition business for Asian at A$30/hour for undergraduates if they need money). Much time spent on online gaming and messaging is just that - fun and no cash income. Even the facebook skills is a means of making money as I noted that one undergraduate's contact in her facebook account is about a professional bride photography connection. She linked to it.

2. Learn from other people's mistakes and expand on their success. This means doing your reearch.

3. Keep it simple.

4. Focus on what makes you unique and therefore sets you apart from others.

5. Develop a short 30-second pitch for your brand to gain a contact or a customer when the opportunity comes.

It will be difficult for the young lady and the young man I spoke to recently, to know how to execute (which is Point No. 5). If they can execute, they have money in the pockets.

201. Fleas in Australian dogs

Perth, Australia

From "Fitness First" magazine Sep/Oct 2010

I was surprised to see a 2-page advertorial in this magazine with Ms Sami Lukis, an Australian TV and radio personality who takes her dog for daily walks. It is for Comfortis (spinosad) - a clean, convenient way to protect your dogs from fleas.

THE USP (Unique Selling Proposition)
Fast acting, month-long and because it is a tablet, it can't rub off or wash off.

As houses here are usually carpeted, fleas hiding in carpets can be a big problem unlike in Singapore where ticks are a big problem. I presume ticks are a big problem in Australia too as the dogs do go to dog parks (no leash required unless outside dog parks).

200. Use Facebook, blog and Flickr to help find a home for a stray cat, Singapore

Sep 26, 2010
Writing from Perth, Australia.
5.37 am Willeton

Facebook seems to be the great thing for undergraduates. They get to interact instantly and see beautiful people and pictures.

However, private individuals who are animal activists can use the facebook, blog and flickr to make a difference to the homeless cats and dogs in their neighbourhood.

Vets or vet students can use Facebook and Flickr to make a difference by helping homeless strays in Singapore.

I guess advocacy for homeless stray cats have not much appeal to most young adults with Facebook accounts. They usually have no worries about the next meal or suffer deprivations.

But they can use their bountiful energy and youthful idealism to make a difference, one stray cat at a time and learn about advocacy from the comfort of their homes.


For the baby-boomer generation of vets (old vets of my generation), it is tough for most of them as they find the technology difficult and time-consuming to learn.

Much now depends on the younger vets to be interested in finding homes for some stray cats recovered from illness. Unfortunately, younger vets may have other priorities. Still, if one of a hundred younger vets find the time to advocate for the homeless strays, it is still good. Advocacy for the homeless strays generates no revenue for the younger vets who treat some stray cats or dogs. However, try and help one or two within your time constraints. Unfortunately, good visuals are important as the young ones are also visual-biased. Do what you can.

I have started a Flickr account to help a homeless stray cat recently.

See my example at:

http://www.flickr.com/photos/33995662@N00/?saved=1

TWO PICTURES ARE POSTED IN THIS BLOG









Success in finding homes is unpredictable. If you have a positive mindset, you will find success in many ways even if you fail to find a home for your advertised stray. For example, success in learning how to craft a message to help the homeless and to take excellent pictures over time by being hands on.


COMMENTS
From my review of my pictures, I realise that I should have taken better compositions when the cat has had recovered from scabies treatment. I should have photographed the normal cat without the cage and show the cat in full (with legs intact and show paws free from scabies). This is what I mean by being hands on. You will learn from each case how to be a better advocate for the homeless strays next time.

In this situation, I photographed the stray cat outdoors on a bright sunny day. It must be crated just in case, it leapt away. I should photograph it indoors with lighting but I was busy. Definitely will do away with crates next time.

Saturday, September 25, 2010

199. Health screening for adults

Sep 23, 2010 Perth, Australia

Health screening at SGH

"We practise evidence-based medicine," the nurse at the reception said to me when I asked her about health screening for people with no signs and symptoms of illnesses like heart disease or cancer. What is evidence-based medicine? Must a person be dying of heart attack first to be eligible for health screening in the Singapore General Hospital?

Recently I met Edwin, a good friend of a pastor whom I knew from my National Service some 30 years ago and who had died some 5 years ago. The pastor's son had become a doctor and was at the government polyclinic. Edwin told him that he came for a health screening as his sister-in-law was pestering him to do it. "Sorry, uncle," the doctor said. "I can't permit you to do it." Edwin who brought in his dog for health certification before export to Malaysia said: "I am glad that Pastor ... imparted values of integrity to his son." Edwin said: "What are the chances of meeting the pastor's son at a polyclinic? I don't even want a health check. It was my sister-in-law pestering me to do it. Now Pastor ... must be satisfied and happy from Heaven." I don't know what to say. This Pastor ... had many divine inspirations prolonging his life by a few years despite having heart diseases, kidney failure and diabetes.

It was not surprising therefore that the nurse at the reception rejected me. No choice but to go to the private hospital. A staff in violet uniform told me that I needed an appointment to consult the doctor for health screening. I was a walk-in prospective patient. "OK," I said. "I will make after I return from my holiday in Perth." I doubt I would bother as I have no health problems. I still would like a health screening for cancer as two older vets had been diagnosed with cancer and I was not a spring chicken at the age of 60.

I could not give a date for appointment and said I would call. This meant I would procrastinate. After all, evidence-based medicine is the excuse. I have no evidence of poor health. A bit tired nowadays. Due to stress of hectic pace of city living in Singapore.

As I was about to leave, a fair lady in black dress with some floral strip on one side of the neck came to the receptionist and said: "You can see the doctor today as somebody did not turn up." No show is common in Singapore as many don't have the courtesy to cancel their appointments.

"So now the walk-in cannot walk out?" I tried my hand at humour with the service staff. Nobody laughed but there were some smiles. "I wish to consult an old doctor," I said. "Don't you want to give young ones an opportunity to gain experience?" the receptionist said. "Well, at my age, I may not live long to be a guinea pig. I know every doctor learns from experience in handling cases but I can't afford to let young ones do it at my age. I need experienced doctors to tell me whether I am all OK."

"Don't worry," the lady in the black number assured me. "The doctor is the head of the department." It was my lucky day as I don't have any referrals for this health screening. People usually ask friends for referral but here I was, a walk-in who had starved for the past 12 hours and was trying my luck.

My health screening took about one day from 10 am to 4 pm. The following was accomplished.

1. Blood collection. Blood test must be done again if the previous one was more than 6 months if one wants to go for general anesthesia.
2. Urine collection. Clear light yellow urine as far as I could see.
3. Lung function test. Bit a plastic mouth piece and breathe out as much as I could.
4. Fat, water etc analysis of the body. I stood on a machine and pressed two thumbs on the handle. Can't figure out how it worked.
5. X-ray. Although I had X-ray 9 months ago, the nurse advised one as it was part of the package. "You will not get a refund if you don't do it," she knew many Singaporeans are the calculating type. "It is the radioactivity that I am worried about," I said. "The radiation dosage is very low," she said. OK. I went for it.

6. Eye pressure test. Some machine to check for glaucoma.



7. The doctor's consultation and tests include
7.1 History of past treatments as he keyed into the computer the report
7.2 Physical examination for hernias and palpation for abdominal growths
7.3 Eye-sight. Bright light shone onto my eyes. He said I have no cataracts. A few days earlier, an experienced optometrist said I have little bits of cataract. In any case, I trusted this doctor. It was good news.
7.4 Hearing test. 3 types of sounds I had to say "yes" when I heard it. "The last type is one which many people thinks they may have or have not heard it," the good doctor laughed when I told him that I could hear something but was not sure.
7.5 Explanation of the Treadmill test. (see para 8 below).

8. The Treadmill test. I had to sign a consent form in case I suffer a heart attack during the test. "Don't worry," the doctor took back the signed form. "My nurse is very experienced in detecting any heart attack and will stop the test." I was given the ECG leads and proceeded to walk slowly. The speed increased. "Stop," I said as I became breathless after the 7th minute. "I need the maximal rate to be 85%," the kind slim senior nurse said. "Do you have chest pains or cramped muscles?" I had neither. I was just breathless and did not want to over-exert myself. The machine must have had reached 85% as the nurse stopped the movement. It was past 9 minutes of threading. She printed out the graphs and did not seem too happy with the reading. The doctor would explain to me.

Bad news. "See the ECG," the doctor showed me. "ECG reading is normal before exercise." I could see the regular repetition of the PQRST complexses throughout the strip of paper.

"After exercise, the blood takes a long time to flow back to the heart, even after 5minutes. The ST curve did not rise up as normally as it should be. Indicating a blockage in the heart's coronary arteries."

Yet I had occasional chest pain like over-exertion but it was once in a few months. So I opted for a CT scan of the heart.

9. CT scan
Blood pressure taken at least 3 times and said to be normal although I could see that it was 138 at the upper value. I cannot remember the lower value. Maybe I should be 138 for my age of 60. I thought it should be less than 120. Must do some research.

BPS. This was below 50 beats per minute. "Exellent reading, so we don't need to give you sedatives as the CT machine dislikes people with high pulse rate," a nurse told me. I thought it was abnormal as bps should be 70. Need to do some research.

An experienced nurse tapped my right hand and inserted a long 23G catheter for the injection of radioactive dye when I went into the CT scan for X-raying.

"MRI would be better," another nurse told me. "There will be no radioactivity but it costs a few hundred dollars more."

10. Abdominal ultrasound scan for abnormalities of the liver, spleen, kidneys usually. This was done before CT scan. An experienced nurse put gel. I had to be scanned from above the abdomen, turned to the right and left side. "Can the ultra-scan detect bones in the stomach?" I asked the cheerful nurse. I knew of one vet who had advised ultrasound scan for foreign body the the dog's stomach to confirm what X-rays had shown some opaque foreign bodies. So I was interested in asking this nurse whether it could be useful. "No," she said. "Too much gas, movement in the stomach." I remembered she said about some fat affecting the results. "I have not done it." I need to do some research here. In foreign bodies in the dog's stomach, X-rays with or without contrast media are traditionally done. I am not convinced that ultra-sounds can pick up foreign bodies in a dog's stomach.

Will stop now. I recorded the above for reference. It is 8 am in Perth on a Sunday. Some Royal Show. Some flower show. The Queen's birthday on Monday. So a long week end. Bright sunshine, blue skies. Clear spring air at Willeton near Murdoch University. I have this sadness as my plane touched down at Perth Airport on Sep 24, 2010. There was a car accident on Sept 3, 2010 affecting a girl whom I had carried as an infant and whom I saw growing up.

Wednesday, September 22, 2010

198. Toilet training an adult male dog

EMAIL TO DR SING APRIL 2010

Hi Dr Sing,

I’ve been reading up your toilet training blog and find it very useful when toilet training my puppy. However, I still have a few queries. I’m a first timer raising up a puppy and hence has been quite stress up. I’ve accompanied my puppy for the first 3 days (almost keeping him within my sight) and observed the following:



My puppy is a mix breed of Chihuahua and Pomeranian, 3 months named Cookie. He was with us since 24 Apr 10.



The pet shop owner came with a crate with wire flooring and a pee pan below. Initially I try to carry Cookie to the bathroom after nap/food with newspapers laid on the floor but was unsuccessful. Cookie usually poos twice a day, 1 in the early morning and another one in weird timing. I realized that he only pees in the middle of the crate; I supposed it’s due to the urine smell. He pooed everywhere though.



Qn 1: Do you think Cookie will poo in the middle like where he used to pee if I spray those anti-pee/anti-poo spray (given by my friend) on those area that I don’t want him to do pee/poo? The spray has a strong smell and I'm contemplating to use it.



Qn 2: It seems like he’s trained to pee/poo in the crate. Is that a good idea? It’s ideal for us since we are working. However, if we bring Cookie out eg. to a friend’s place, will he pee/poo everywhere since there’s no crate?



Qn3: Cookie seems to be stepping hard on his own poo when all of us are asleep. He’s also seems to be shifting them around. I can see portions of it at different areas of the crate. We also caught him eating his own poo once. How do we prevent such action from happening especially when we are all asleep?



Qn4: When I let him out to play in the living room, will it be better to leave the crate door open and let him run to the crate to pee/poo? Or will it be better to lay newspapers on a pee pan (given by my friend) with Cookie’s urine smell at a corner so he can pee/poo when he’s out playing and need not rush back to the crate? I've let him out of the crate twice on 26 Apr and surprisingly, he climbs back to his crate when he's thirsty after running a few rounds. I see that as a good sign of recognising his own den?



Sorry for the long post and thank you for the time to read my email, I would be very much delighted to receive your reply J



EMAIL TO DR SING SEP 22 2010

Hi Dr Sing,
It's me again. I'm having some difficulties with Cookie's potty problem. He used to pee & poo in at the left side of his crate but recently, he totally stop this habit. Instead, he'll bear with it and wait till we let him out of the crate.

No choice, we had to place a pee pan at a designated area in the living room. Cookie will sometimes pee & poo on the pee pan but he still has accidents and forgot where he should do his business. We've been guiding him and telling him but it doesn't seems to work.

We also try to confine the area and let him out once a while and when we let him out, he'll eliminate elsewhere. Any suggestion what else we can do about it? Btw, he's coming to 8 mths, is he considered adult yet? Is it time to neuter him already?

Thanks for your time reading and replying to my email :)

Thanks & Cherers,



EMAIL FROM DR SING SEP 23, 2010



From your email, I have the following observations:

1. Cookie is an adult dog now. He can be neutered anytime.
2. As an adult male dog, he wants to keep his den (crate) clean and so he waits till you let him out to eliminate.
3. As a male dog, he wants to urine-mark his territory (natural instinct). So he pees everywhere. It is not that he "forgets" but that when you are around, he has to behave himself otherwise he may get punishment.
4. As a male dog, he may want to mark his territory with poop although most male dogs mark with urine.

5. Solutions:
5.1. Neutering as early as 6 months may reduce his urine-poop marking but you have delayed this. Still it is not too late although it may not be as effective.
5.2 Neutralise your flooring with white vinegar: water in 3 parts to 1 part respectively.
5.3 Confine the dog to his crate or to a small toilet area for the next 264 weeks after neutering.
5.4 Every day, twice a day, after meals, bring him outdoors to eliminate. Praise and reward with dog treat when he eliminates outdoors in an area not used by members of the public.
5.4.1 Pick up the poop with papers and dispose properly. Going outdoors is a positive "reward" and he will learn not to dirty the whole apartment which is his "den". This takes patience and time. Many owners find the above-mentioned tips to be useful.
6. Adult dogs are harder to toilet-train but you need to have a routine for him now. He must have realised that you are his "subordinate" and this is natural for dogs. Dogs need a firm leader and I believe you are gentle towards him when he is growing up. Now, he thinks you are his follower. Therefore, you need to be a leader and start with him going outdoors at least once a day (morning and/or evening).

Sunday, September 19, 2010

197. Taking responsiblity for your pet's health

Sunday case
19th Sep 2010

"I will not be able to take it if my dog dies under anaesthesia," the lady had made an appointment to see me on this fine Sunday morning. Her Shih Tzu was 11 years old and her vet had told her that there should be no more yearly dental scaling for the past years.

A small globular under the skin behind the temporo-mandibular joint had now grown to 1.5 cm x 1.5 cm. "Why didn't your vet remove the tumour when it was small and when the dog was younger?" I asked.

"My vet advised me to wait and see," she said.
"There are slow-growing cancerous tumours," I said. "It is important that they be removed when they are small."

What the lady wanted was:
1. Dental work to remove the tartar and loose teeth causing bad breath without the dog dying under general anaesthesia. I auscultated the dog's heart. "Around 60% chances of survival," I estimated. "A blood test will be useful to assess the blood, kidney and urinary systems."

"My vet had taken the dog's blood some 8 months ago and said there was nothing wrong," she said.

"Do you have the blood test report?" I asked.

Thursday, September 16, 2010

196. Toilet training an adult dog that lies on her own pee

E-MAIL TO DR SING DATE SEP 14, 2010


On Tue, Sep 14, 2010 at 3:04 PM, Eian T wrote:

Hi Dr Sing,

I was desperately surfing the website for help when I chanced upon your articles. Then I called your clinic and left a message.

My dog is currently not your patient and so I would like to ask if you provide any sort of advice/toilet training?

I just got a miniature poodle from the farm (I was told she was vaccinated by a vet in Toa Payoh, I need to check it out). The poor poodle must have been in the farm for the past 8 months as she is very comfortable eating, sleeping and doing her business in the same place. And she has no problem lying in her pee.

What I did was cordon her off in the kitchen with a pee tray (used by my older dog) and everytime I see her pee/poo, I carried her to the pee tray. It didnt help. She has this problem of whining til she pees when I go away. So I put the tray where she likes to stand so that if she whines and pees, it will end up in the tray. This is to keep the place clean since I have to work in the day.

Other problems - she hardly does it when I watch her but the moment I go away she will relieve herself. I take her down for long walks and she has not done it at all. When I other dog goes to the tray, the new dog doesnt learn as well.

I'm quite lost and wonder if you do provide some house visit on toilet training a dog like that?

Hope to hear from you.

Thank you.






E-MAIL FROM DR SING DATE SEP 17, 2010


1. Just read your e-mail today as I was busy attending the wake of my god-daughter who had an accident in Perth and had returned back to Singapore.

2. I do house-calls by appointment, but the best and less expensive method is to have a one-to-one discussion in the Q&A format at Toa Payoh Vets. There are many management factors affecting toilet training that cannot be written in your e-mail. This will take up around 30 minutes of discussion at Toa Payoh Vets. However, this may not be practical advice for you. In the meantime, I have written some guidelines for you and for other readers in your situation:

3. The following is my guideline for you as your dog is now an adult dog much conditioned to its environment in which she has lost her natural instinct to be clean. So she keeps lying on her pee. She does not want to eliminate on your other dog's tray or environment.

3.1 Buy a new big crate with a grated flooring and a pee pan below.
3.2 Confine this dog inside this crate when you work.
3.3 On half the floor area of this, put non-slip rubber mats for her as a sleeping and eating area.
3.4 On the other half is the grated floor. Below the grated floor, in the pee pan, there are newspapers lined on the pee pan. On the half that is below the grated floor, put this dog's urine onto the newspapers. The other half below the non-slip mats, you should not soil it with the dog's urine.
3.5 Try this method to restore the dog's natural instinct to be clean. Let me know. It will take 2-4 weeks. Pl make an appointment if you wish to discuss further with me as it takes a book just to discuss about toilet-training an adult dog! Each dog and owner have their own personality and that is why it is important to meet at Toa Payoh Vets (for economic reasons). The best way to contact me is to phone me directly and my receptionist will give you my phone number.

Let my receptionist know if you wish to make appointment to discuss further as there are 3 vets and many of my ordinary cases are handled by Dr Vanessa Lin.

Tuesday, September 14, 2010

195. Horse banged car in Brisbane

Sep 14, 2010
9 pm

"As I drove round the bend, a horse trotted across the road," Dr J said as he started eating the nuts and melon seeds. We were attending the wake of my god-daughter who had a car accident on Sep 3, 2010. He wanted to attend the wake and phoned me. My god-daughter had worked in his veterinary surgery for around one year before embarking on a second degree to become a veterinarian. She had worked as an intern in his practice around 2 months ago. She was 5 weeks before graduation and a car accident happened.

"What happened to the horse?" I asked. Kangaroos and deer do cross the road suddenly in Australia causing car accidents. I recalled an incident when a deer crossed the road suddenly in Scotland where I had studied veterinary medicine but the vet braked in time. This was the first time I heard about a horse.

"The horse slid up my car bonnet and smashed the wind screen," Dr J said. "You know that the bonnet usually has a curved front. After the accident, the bonnet was as flat as a pancake. The bonnet then sprung upwards."

"So what happened to the horse?" I was glad he lived to tell the tale. A draught horse would weigh over 600 kg. I imagined that the huge body of the horse would have killed Dr J if he had driven the usual small car.

"The horse had to be put down later," Dr J said. "My face was pock-marked with glass shards. The doctor had to extract the pieces. When Nellie (a vet student in the 3rd year while Dr J was in the 5th year in Queensland University in the 1960s) saw my face, she burst out laughing."

"What make of car were you driviing?" I was surprised that he did not suffer more serious injuries.

"A Holden" Dr J said. "A big solid car which is common in Australia but too expensive to be sold in Singapore". This explained why he was not killed in the accident as it seemed that the impact sent the horse's side body shooting towards him crashing into the windscreen. In Australia, the minimum speed for expressway is said to be 100 km/hr unlike lower speed in Singapore. So, drink-driving daccidents are common every weekend such that the trauma nurses in the Perth's hospital know exactly what to do when the helicopter flies in the accident victims.

"These trauma nurses would literally run towards the helipad when the announcement was made of the arrival of the helicopter," my god-daughter's mum told me when I visited her yesterday to comfort her. She had been hospitalised in Perth's major trauma hospital before her return to Singapore. "Is it like the TV show 'ER'" I had asked her. "Yes, very much like that."

As for Dr J, he was fortunate to be alive today as he had driven a big car. The car was around 8 years old but it protected him as it had a longer bonnet than the usual Japanese car.

"Did you get compensation?" I asked Dr J. "The laws said that in this accident, nobody is at fault. Nobody gets compensation. It was around 3 months before the final year examination. I had to go to various farms to do internship. So, I rushed to buy another car."

"Why would a horse be wandering around at 9 pm?" I asked Dr J.

"The farmer said that his horse had escaped." This was plausible. "When you are young, you tend to take risks. I was driving a motorcycle everywhere in Brisbane and up and down the expressways as a student."

"A young man thinks that he is invincible." I remarked. The testosterone surge in young men in their early 20s had led to a large number of fatal accidents in Singapore and all over the world. When I was a young man, I tested my Mini-Clubman on the Malaysian expressways, overtaking big lorries as much as possible driving from Singapore to Kuala Lumpur at night. I sped till the Clubman rattled at 120 mph and I thought it would split open. Fortunately the Clubman returned to normal status when I slowed down or I would not have lived to write this story.

As for Dr J, he went to Brisbane recently. "I looked at the GPS navigation system as I drove," he said to me. I had to hold the handset close to see the map and to drive as well. There is no need to check the map anymore."

Fortunately he lived again as this is a very risky way of driving in Australia. The country side roads are full of gravel and some expressways have pot-holes. "Drink-drivers are common," Dr J said to me. "You may need to be alert as they may hit you even though you are careful. As the expressway is long, you can fall asleep while driving."

Sunday, September 12, 2010

194. Sunday case: Thousands of baby ticks & other interesting cases

Sunday Sep 12, 2010 6.15 pm recording of cases seen today.

VEXING CASE

"My Jack Russell went to the vet last week for nail clipping," the young couple said. "He peed on the grass. Now he has lots of ticks on the body and inside the ears. I used Frontline yesterday and today a tick wash sold by the groomer."

Examination & de-ticking.
1. Clipped bald. Hundreds of ticks paralysed and stuck on the body
2. Forceps to pick up ticks but then many smaller ticks still alive.
3. "I need to use the tacktic wash," my groomer said. "Otherwise the owner will not be happy when he sees more ticks after de-ticking. The owner did NOT use sufficient dosage of the insecticide (2 caps to 1 litre of water, unknown drug) and therefore the baby ticks are still alive.

Examination after de-ticking.
The owner complained one tick was seen in the left ear and one on the face (left side). He bites when the owner tried to pull out the hanging ticks.

"The procedure is incorrect in this case," my groomer said. "Should have given tick wash first at correct dose, then shave and the ticks will fall off."

We picked up all the very small baby ticks that were still alive. The dog bit the owner and so it was a time-consuming case to brush out all baby ticks. Took almost one hour.

Owner advised to use Frontline Spot on tomorrow as the apartment is full of ticks. Advantix from Bayer repels the tick but the owner was not keen and wanted to buy Frontline from the pet shop as this could be cheaper. "Repels" means preventing ticks from the surrounding kitchen and bathroom to attach onto the dog but the owner could not understand the difference.

CAESAREAN
Water bag burst this morning, some 6 hours ago, but the Westie home-breeder wanted me to examine and see what I can do. I was about to close at 5p.m. After waiting for over 40 minutes, I phoned. She said she could not find a taxi but this was not credible as Singapore's taxis are many nowadays. She wanted us to wait. Such cases were not genuine. She agreed that she would not be coming.

Advice: If no puppy is born within 1 hour of the water bag rupture, an emergency Caesarean is needed. Not wait and see as the pup would have had died and the mother could be in danger of possessing a smelly dead pup (if delays over 12 hours).

DENTAL SCALING
Cavalier King Charles had dental scaling and pro-heart injection. No problem.

CAT CONSTIPATED FOR ONE WEEK. It could be that he was made to wear an e-collar to prevent scratching of his left eye. He had a cat flu and was sneezing. Somehow his left eye was itchy. When the e-collar was taken off, he scratched his left eye again. What's the cause of the conjuncitivits? I had the cat under general anaesthesia and flushed off any foreign body from under the 3rd eyelid. "He was OK," the young lady said. "When I took off the e-collar, he started to rub his left eye." I checked the left ear. It was clean unless the horizontal canal had some debris. Ears were both clean.

I palpated. Constipated stools felt. Enema given. Cat passed out some stools within 5 minutes. I asked: "Has he been wearing the e-collar 7 days ago? He did not poop as he had to wear an e-collar."

"Most likely he disliked the e-collar as he could not clean himself after pooping," the lady diagnosed. Boarded one day to observe. Should go home tomorrow.

LATERAL EAR CANAL RESECTION. The parents and daughter came to visit him. "The wounds are still wet and bleeding 4 days after surgery," I said. "The surgical area looks very bad after surgery but will look good some 14 days later." I showed the owner where the horizontal canal opening was by putting a cotton bud inside the canal on the left ear. The Miniature Schnazuer with hairy ears did not bite me. He shook his head and the cotton bud got stuck outside his horizontal canal opening and I had to take it out. He was still on NSAID pain-killers and did not bite. But not ready to go home yet as the owner will not know how to clean the ear surgical area. Another 2 days.

9 kg. Male. Not neutered. 5 years.

--- INTERESTING HISTORY FROM MY FILES

26 Jul 2007 Right head tilt. Right ear. brown pus and ear powder. Otitis externa. Dog tranquilised and ear hairs plucked. Panalog for ear cleaning.

3 Jan 2010 Excessive ear hairs and otitis externa. Tranquilised and ear irrigation. Panalog.


25 May 2010 Wanted panalog and antibiotics.


8 Sep 2010. Lateral ear canal resection together with Dr Vanessa Lin.


STRAY CAT WITH ORAL ULCERS RECOVERING AFTER PREDNISOLONE
The expatriate couple said they would pick up the cat 3 days ago but did not turn
up. Ulcers will recur again. No permanent cue. Will e-mail the couple again.


RIGHT HIP JOINT DISLOCATION IN A CHOW CHOW X. 10 days after car accident. X-ray confirmed dislocation. Surgery advised by Vet 1. "Not likely to be successful in popping the bone into the joint now," I said.

Saturday, September 11, 2010

193. Dry itchy skin in a veterinarian

Saturday Sep 11, 2010

I was surprised to meet an ex-colleague near Centrepoint Shopping Centre yesterday afternoon. He was graduating from Glasgow University while I had just entered first year. That was in 1969. I was assigned to the Veterinary Diagnositic Labaoratory at Kampong Java Road while he was in the Vaccine Production Unit. Now, the whole area is the Kandang Kerbau Hospital. As a new vet, I knew nothing about poultry and swine virology and I learnt much from him and another vet.

The striking memory of him was that he was always scratching his hands and neck daily and many times. Then he would scratch his back. He was allergic to horses and so could not be near them when he was in the final year at Glasgow University. I wondered how he passed his horse examination.

I remembered more vividly the one day when we went to the poultry farm to collect blood as from vaccinated and unvaccinated chickens. The blood would be tested for antibodies called HI (haem-agglutination) titres which I was lectured about in my vet school.

The presence of HI titres and clinical signs of egg production drop and poor egg quality in non-vaccinated chickens indicated that the farm had this EDS (Egg Drop Syndrome). Actually this disease was present for the past 5 years in Europe but the veterinary authorities wanted to confirm its presence in Singapore's chickens before permitting import. Obviously this would take a long time and clever poultry farmers could not wait that long. However, this particular farm was more law-abiding and so we did the test with half of the poultry house not vaccinated and half vaccinated with the commercial EDS vaccine.

The trial confirmed the efficacy of the vaccine which was then approved for import into Singapore. This evidence-based veterinary medicine had cost the farmers much losses as EDS' 76 was a well known disease for the past 5 years in Europe. Yet the authorities had this ruling for this new "disease" in Singapore. I think the trial was done in 1980 and brought veterinary medicine and virology alive to a young vet. I was 30 years old then.

Time had flown by. But I had vividly remembered this vet who once thanked me for saving his life. How did I do it? It was a fine morning at Jalan Lekar. He inserted the needles into the chicken's wings and collected the blood in the blood collection tubes. The farmer's young daughter held the chicken while I assisted him by recording. We needed many chicken blood to get statistically significant results. I noticed that this vet started to have runny noses. After some time, he had difficulty breathing and his back hunched. He persevered in collecting blood. His eyes teared and reddened. He wiped off his runny nose. This was a shock to a young vet like me.

I had never encountered such a situation but I knew he was allergic to the chicken feathers and atmosphere as he was OK when he drove me to the farm. I had no car and he drove. "Stop blood collection, stop blood collection" I said to my senior. "Let's go back to the Vet Lab!". He had forgotten to bring his nebuliser on that day he told me later and thanked me for saving his life.

On this Saturday, he was fine and his hands were no longer itchy. "I don't have psoriasis," he corrected me. "It was dry skin." The following is the knowledge he imparted to me and which I hope will be of use to vets who suffer from dry skin in the whole body.

1. Aqueous cream BP must be applied to all the affected area daily, without fail. There are many types of aqueous cream which is a mixture of oil, water, emulsifier + a little preservative. If the person is allergic to preservative, then use ones without prservative.

2. Avoid aqueous cream with fragrance or preservative if possible.

3. In countries with low relative humidity, apply the cream more than 3 times. In Singapore, one time may be sufficient.

4. Sweat out at the club so that the skin pores open. A sauna bath perhaps?

5. Sources: Pharmacy. The cheapest source is in Johor Bahru at Jenski in Taman Sentosa. A big jar costs $18.00.

6. Alternative. The safest is vaseline which is petroleum jelly. But it is sticky in Singapore.

Conclusion:
The aqueous cream is for "dry skin". That includes "dandruff" in the scalp which appears every 2 to 3 days despite anti-dandruff shampoos.

I know the water massage spa machine used daily as a 10-minute bath might be an easier solution for this vet as the heat opens the skin pores and the water currents massage the whole body. Do it every day for 10-15 minutes. De-stress at the same time. I did not mention this to him as he seems to be doing OK with his aqueous cream routine and I don't have evidence-based medicine to convince him to give it a trial!

I record this for a young veterinary undergraduate who is allergic to horses. You may suffer from dry skin itchiness as part of the syndrome later in life. Always carry a nebuliser all the time if you want to live past 60 years of age as your immune system reacts violently and fatally to allergens in the atmosphere.

Thursday, September 9, 2010

192. Collect urine from a dwarf hamster?

I could see the look in her eyes. Eyes are windows to the soul and these eyes flashed a message. I don't claim to possess telepathy but these eyes texted "Is your mind going to pot? You ask me to do a mission impossible."

I have had done several hamster tumour removals and treatment, thanks to the internet group of hamster lovers. But to collect urine from a hamster for urinalysis? I have not personally done it. Now I challenge and command Dr Vanessa Lin to get it done.

How to do it? Think. As a mentor, I must be able to do it. Vanessa's silence was golden. I offered advices like:

"Put the hamster in a cage with a grated flooring. Put a plastic sheet below the grate. The hamster's urine will pee down onto the plastic sheet. Tilt the cage slightly so that the urine will flow downwards to one end. Then, you can collect the urine and put in a container to be sent to the lab for urinalysis. It should be a small cage."

Theory is great. Can this be done? Where do we find such a small cage? When will the hamster pee? How much pee can be collected. If the hamster pees 0.2 ml, the heat of the environment will just evaporate the pee.

I believe that many vet schools do not teach the students how to do it. So many animals to teach. Hamsters are low on the teaching totem pole.

The ability to perform is important for any new vet in private practice. Vanessa told me that the top graduate in her class was fired for non-performance. Impressive academic credentials don't mean a thing in the real world where a veterinary practice's profitability must be sustainable.

Collecting urine from a dwarf hamster? I must be joking. But this is a serious matter as the hamster owner had consulted a vet who had produced an excellent X-ray and from my examination of the real hamster (after telling her that a phone call diagnosis would not be possible), I knew I needed at least one urine test. To check for urine protein and the possibility of kidney disorders. "Blood tests are impossible in a live dwarf hamster unlike in dogs and cats," I said to the owner. "A urine test can be done."

So the owner left the hamster at the Surgery. And now, I asked Vanessa to get it done. Veterinary medicine throws up many situations and challenges. If Vanessa could not be successful in this task, could I show her how to do it? I asked her to do it. This was to make her think how to do it. Well, there was not much time. The owner would be back in 30 minutes as she was reluctant to leave the hamster in the Surgery in the first place. She had specifically made an appointment to see me through the Surgery phone but I was not given the message. I apologised to inconveniencing her for a second visit and asked why she did not phone me personally as she had done when she wanted a telephone diagnosis.

How to collect urine from a dwarf hamster? Read widely and take a leaf from practices from other animal species. Metabolism tests on sheep. What do they do at the science lab which conducted drug trials and which I have never visited.

20 minutes left before the expected arrival of the lady hamster owner. I had a brainwave. The urine was collected and shown to the owner. She was satisfied that she did not waste her time to seek a second opinion.

I have the pictures of the urine collection process for readers and veterinary undergraduates who may be tested during their fourth and fifth-year vivas (oral tests).






Details are at: www.toapayohvets.com

191. Telephone diagnosis

"My dwarf hamster has a bloated stomach since last week," the lady owner phoned me. "He has not been eating or pooping much. What can I do?"

It is hard to give a telephone diagnosis. Bring down for a check-up.

Vet 1 gave a laxative oil and oral antibiotics for 5 days as well as produce a beaufiful X-ray of the backide. Constipation?

"Looks like he has stones," my assistant saw big lumps on x-rays

Wednesday, September 8, 2010

New vet at Toa Payoh Vets - Dr Vanessa Lin Hui Jun

On Sep 3, 2010, Dr Vanessa Lin Hui Jun joins Toa Payoh Vet as an associate vet. She has around two years of experience. I have confidence that she will make a good veterinarian and will be her mentor.

I briefed Vanessa on the values of honesty and responsibility of a vet by giving her various real-life examples where the pursuit of making more money erodes such values. These examples can make interesting reading.

It is important that the leadership walk the talk and impart the values to young ones and reject vets who don't agree to the values of Toa Payoh Vets.

"There are many things you will learn in a small practice and these lessons will be very useful when you start your own practice," I said to Vanessa. "In your previous practice, you have many assistants to do things. Here, you may need to think how to do things efficiently and economically." One advantage for Vanessa is that she has me as a mentor.

"I know you have intention of opening your own practice. That is OK with me. You have your future to think of. You can see that Mr Saw has been with me for over two years and I have given my blessings for him to join other practices with better pay and prospects."

Being of the same age as the younger generation, Dr Vanessa Lin will be more their type of vet.

189. Sep 3, 2010

Sep 9, 2010

I welcome Dr Vanessa Lin Hui Jun to my team at Toa Payoh Vets on Sep 3, 2010. This was a very happy occasion for me and my clients as I am getting on in years, being 60 years old now.

Meanwhile, in Perth, something unforeseen and very sad happened.

My god-daughter, Ms Celina Chua who was only 5 weeks before graduation as a veterinarian from Murdoch University was killed in a car accident in Perth, Australia. Her friends will be holding a memorial at the University on Friday Sep 10, 2010.

Tuesday, September 7, 2010

188. The Chinatown coffeeshop lady said: "Call the police!"

"Call the police! Call the police!" the lady stated loudly as Mr Lim answered the phone. Somebody representing me had demanded that he pay his debt of $2,000 to me. Mr Lim had stopped payment of his $2,000-cheque to me and would not return my calls for the past 1 year. He had asked me for a $5,000 temporary loan as he had cash-flow problems and promised to return the money in one month's time with interest.

"I don't want your interest," I don't want to make money out of a businessman in dire financial straits. I only prayed that I would recover my loan as I have had bad experiences.

However, if I could help this businessman who had made millions before but now needed cash, I would as I had been acquainted with him for the past 20 years. He took the $5,000 and I was out of sight, out of mind.

That was one and a half years ago. After many phone calls for half a year, he gave me a cheque of $5,000. The next 2 days, he wanted the cheque back and gave me a cheque of $3,000 and a few days later, another one for $2,000 cheque which he stopped payment soon. He just ignored my calls for another year. I told a friend about him and he offered to help me by phoning me. He was no bill collector or loan shark as I don't get involved with the shady underworld. Mr Lim promised to phone me the next day and he did. He paid $500 and that was OK with me. He still was in the dumps but I could not help him. It is the disadvantage of of being self-employed. A self-employed can make millions and can crash and burn and he was burnt by a project which did not pay him.

Honesty is important in business and he should know better. I invited him for breakfast at Chinatown on Sep 7, 2010 to see if I could advise him or be of help to him in his business, but not in another loan.

"Who was the lady who asked you to call the police?" I asked Mr Lim at the Chinatown coffeeshop. A bright sunshine morning and I took a photograph for readers to appreciate the street where I had coffee with him.

I knew Mr Lim for the past 30 years and his lady assistant. From what I know of the character and personality of his lady assistant from a well brought up family in Indonesia, I would say she was not the instigator to call the police. But I had to know whether my judgment of character was up to par.

I asked Mr Lim: "Who was the lady who asked you to call the police? Her husband must be some big gun in the Singapore Police Force."

"The lady eaves-dropped my conversation. Your friend was speaking in a loud voice and was quite rough. The lady is a coffeeshop operator in Keong Siak Street."

I said: "The famous previous red-light district of Singapore's Chinatown. Where is she now? I would like to see how she looks like."

Mr Lim said: "She is not working so early. I told her at that time not to interfere with my business."

I said: "Call the police. Call the police. Why didn't you call the police?"

I was surprised when Mr Lim admitted: "I am in the wrong."

I said: "The coffeeshop lady must have police connections as she was rather aggressive shouting over your head such that my friend could hear her.

"Is her husband the Commissioner of Police?" I asked Mr Lim. "My friend who phoned you asked you to call the police or he would call the police in your presence."

"No, no," Mr Lim said. "The husband is a training instructor in the police force."

So there was this police connection which embolden the wife. The police do not interfere in civil matters. Otherwise they don't have time for real police investigation work.

I listened to Mr Lim's bad luck in the project in which he was owed $100,000. He had been advised to take legal action but he did not want to. I said: "Lawyers want deposits and then more deposits with no guarantee of success. Whoever advised you might pay on your behalf first. It is wise of you not to proceed with litigation. Let me talk to the other party if the party is interested. If not, just move positively in new projects and learn from the bad experience."

Giving a cheque to secure a loan is a big risk for the lender. Sometimes it is better not to help others in need as it is usually money down the drain and some threats to "call the police." Honesty is the best policy in business. Do not ignore a problem. If Mr Lim had paid even $50.00 per month, he would have had paid up after some months. But when a man is in dire financial straits, the aim is to get loans without any intention of return usually. Some of them behaved aggressively as if the lender owes the borrower money!

Sunday, September 5, 2010

187. Vets being referred to

E-MAIL TO DR SING
Sep 5, 2010

Hi Dr Sing,

Just a quick line to let you know that I have finally returned to Singapore and just started work at (Name given). I am returning to Perth from 16th to 19th for my graduation. If you want me to carry anything for (Name given), I will be glad to. The other reason for this email is Dr. (Name given) heard that (Name given) might have been badly injured in a car accident in Perth on Friday night/ Saturday... is this true? If so, I hope all is ok with her... we are concerned about her welfare.

E-MAIL FROM DR SING
Sep 6, 2010 4.15 am.

Thank you for email. (Name given) is actually my god-daughter. She passed away on Sep 3, 2010 due to an accident as the other driver of an on-coming car overtook a car and smashed into her car.

In your new job, I hope you will present a kindness towards "smaller practices" as I have had nasty experiences of three vets from your practice when cases were referred to them. I gave you 3 examples in the hope that you would be kinder now that you have had started practice with them.

1. One vet demanded over the phone that I should call him first but I told him that his receptionist said he was busy and it was my client who wanted the case to be sent to him. So I extended the courtesy to phone him.

2. Another vet said I should fill up a form if I wanted to refer any animal to him.

3. The 3rd vet refused to give the X-ray of the bladder stone to a small animal practice vet. I shall name him as Vet X. His practice had fed your new employer with numerous cases over the last 20 years. Vet X's receptionist had a dog with haematuria. The dog was referred to your employer for an X-ray.

Vet X's mother had asked me to mentor her son in surgery. This was his first case of urinary stone removal from the bladder. I asked him to get the X-ray. It would be good to have an X-ray but since the vet did not want to release it, he could do nothing.

I said it was OK since I could palpate the bladder stone and in fact X-rays are not necessary if one is confident of the diagnosis based on clinical signs and history. Vet X operated under my supervision and the dog is still much alive and well when I saw the receptionist recently.

Best wishes to your new career.

P.S As for me, if any vet wants to refer to me their cases, they are welcome.