Sunday, August 10, 2014

1450. SUBMITTED TO MVA - FINAL YEAR VET TALK NO. 7. NO IMAGES.





YOU CAN BE A VERY GOOD VET  IN MYANMAR
- Belief, Passion, Drive, Perseverance and Focus

Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS, Toa Payoh Vets, Singapore.
http://www.toapayohvets.com/

TALK TO FINAL YEAR VET STUDENTS
UNIVERSITY OF VETERINARY SCIENCE, YEZIN, MYANMAR
Aug 15, 2014


PART 1.  INTRODUCTION

 I graduated from Glasgow University in 1974. I worked as an army vet (Guard and Tracker dogs), a government vet (pigs and poultry), a horse vet (racehorses) and a small animal vet. I started Toa Payoh Vets in 1982 and am still practising there.

40 years ago, I was a final year veterinary student like all of you. I had to buy veterinary books and subscribe to veterinary magazines to acquire skills and knowledge to become a competent young vet. Now, you have online sources of veterinary information anytime to help you with your research and study for examinations.

Veterinary medicine and surgery is too large a subject for any vet to master. Vets are expected to know how to diagnose and treat many animals, unlike the general practitioner who can refer difficult cases to the specialists who focus on only people. 

So, how can you be a very good vet in Myanmar?  My opinion is that you must acquire or possess at least 5 values - Belief, Passion, Drive, Perseverance and Focus for your many years of practice as a vet.  


1.  BELIEF. A feeling that veterinary medicine and surgery is good, right or valuable for you.
If curing sick animals is what you believe in, you must practise veterinary science and do it well.


2.  PASSION. A strong enthusiasm or interest for practising veterinary medicine and surgery for as long as you live.  You need to be motivated but how do you do it?

Motivation is said to be either internal or instrumental. Internal refers to being self motivated. You look forward to every new day to practise vet medicine without considering how much money you will make. Instrumental refers to a person wanting to make more and more money every day. Be a trader, banker or property developer as veterinary medicine does not make the average vet rich.

3.  DRIVE.  A determination to always try very hard to acquire veterinary knowledge and and be successful in treatment outcomes. You need:

- Lots of energy to do emergencies, read up, research and be available for clients.
- Hard work with most time spent at work.
- Little sleep. You may age faster, get burned out or divorced.

If you want a work-life balance, office hours 5 days a week job and time for your family, it is your choice.  

4.  PERSEVERANCE.  A continued effort to become a very good veterinarian despite difficulties, failures or opposition from other people.

- Your reputation of delivering good outcomes in the diagnosis and treatment will get you many referrals.


- Referrals sustain your practice but you must work hard and be available for clients. If you keep going abroad for holidays, your clients just go to the competitors. 

- It is much easier to retain an existing client compared to getting new ones.  

5. FOCUS. An ability to concentrate on how to provide better veterinary diagnosis and treatment and pay particular attention to the case/surgery handled. 

-  You need to focus on the bigger picture of what you hope to be 10 years later.

- Do you want to start your own practice?If you do, you need to focus on acquiring a wide range of relevant knowledge and skills to correctly diagnose and treat the animals and to manage your financial aspect of your business.


PART 2 - SOLVE THE PROBLEMS
OF CLIENTS/PATIENTS



Five of my interesting case studies showing some or all of the 5 above-mentioned values are discussed. I hope they may be useful in your revisions for your September examinations.

These are:

1. The young military German Shepherd Guard Dog had Patent Ductus Arteriosus.
2. The egg-laying hens produced more abnormal eggs. Egg Drop Sydrome 76 viral infections.
3. The professional dog breeders wanted the cheapest Caesarean sections.
4. More racehorses were being shot by the vets.
5. Giving back to the veterinary community.

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Case Study 1. The young military German Shepherd Guard Dog had Patent Ductus Arteriosus.

He became tired easily after a few minutes of dog patrol with his handler, guarding the Tengah Air Base. The Army wanted me as an army vet, to put him to sleep. He was young and had a curable congenital heart diagnosed by me as Patent Ductus Arteriosus (PDA). He needed a heart surgery. What should I do to help him avoid death by lethal injection?

SOLUTION

1. The Ductus Arteriosus is a foetal blood vessel that connects the pulmonary artery to the descending aorta. During pregnancy, it shunts blood away from the collapsed foetal lungs as the foetus is still not breathing inside the womb. After birth it closes by around 8 days of age and becomes a fibrous tissue called ligamentum arteriosum.

If it is still present, it is called Patent Ductus Arteriosus. In this case, some of the unaerated (venous) blood from the pulmonary artery by-passes the lungs and goes to the the descending aorta via the PDA. As he had less oxygenated blood, he tired easily and was useless as a military guard dog.    

2.  In 1976, Singapore vets did not have diagnostic imaging like echocardiography and angiography. I diagnosed PDA based on a characteristic continuous (machinery) murmur heard at the left axillary region and a palpable cardiac "thrill".IMAGE


3.  I got Dr James Tan, an experienced veterinary surgeon to operate free of charge. Intercostal thoracotomy at the left fourth space to assess the PDA. The PDA in dogs is around 1 cm wide and less than 1 cm in length.  The lungs would collapse when the thorax is opened and since we did not have the mechanical ventilator.  I pressed the anaesthetic bag regularly as a manual ventilator to inflate the lungs while Dr James Tan operated fast, being experienced. He ligated the PDA. The dog was cured as he no longer felt tired so easily. He went back to work.

4.  Be humble and spend time to network and learn from more experienced vets. Ask for help if you need it. 
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Case Study 2. The egg-laying hens produced more abnormal eggs. The Egg Drop Syndrome 76 (EDS 76) virus caused severe drop in the egg production in Singapore's large commercial poultry farms. This disease, present in Europe, was confirmed by the government lab vet testing for HI
(hemagglutination inhibition) titres. But the government (Primary Production Department) prohibited EDS 76 vaccine imports from Europe unless the vet could proven them to be locally effective. This big farmer had over 100,000 layers and he would need to illegally import the vaccine to avoid being bankrupted.  

I could see the egg layers producing soft-shelled and abnormal shaped eggs for many months. The farmer was losing a lot of money as the egg production was less than 50% instead of 80%.

IMAGE

I was the government vet in charge of extension work. Seeking vaccine import approval from the big boss was the responsibility of the Vaccine Production Unit. There was a solution - I proposed a vaccine trial. 

SOLUTION

An EDS 76 vaccine trial with Dr Ng Fook Kheong, Head of Vaccine Production Unit and the poultry farm was done. Half the layers in one house would not be vaccinated. The other half was vaccinated. HI titres were taken from each group. The vaccinated half of the house did not have egg production drop or abnormal eggs. With this evidence of the efficacy of the EDS 76 vaccine, the government approved import.
Try to solve the veterinary problems of farmers by being pro-active in seeking help from other vets.

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Case Study 3. The professional dog breeders wanted cheap Caesarean sections. A vet provided cheap Caesarean sections for $250 and sold dog hundreds of vaccines/week to the professional dog breeders instead of vaccinating the puppies personally. He was suspended from practice.

Jenny, my nurse asked if I wanted to offer similar cheap C-sections to a big breeder with several hundred female dogs?

Should I work 24 hours/day, 7 days a week? Should I sacrifice my free time and not switch off my hand phone after 9 pm?  For the first 2 years, I provided $300 C-section services for all the professional dog breeders at any hour of the day. I gained valuable surgical skills with over 300 C-sections.

After each C-section, I would usually take images of the dam and/or puppies. I would review each surgery and how I would better manage the outcome in similar situations. See my webpage at:
http://www.bekindtopets.com/animals/20081201PAGE2_Dog_Surgery_Anaesthesia_ToaPayohVets.htm

IMAGES

Some vets who start their own practice may have insufficient number of cases. A good idea is to volunteer to spay and neuter stray dogs and cats cheaply to gain more surgical practice rather than watch online videos. Animal welfare people will appreciate your good work and refer more clients to you.


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Case Study 4. More racehorses were being shot by the vets - Adding value to my employer. Singapore Turf Club employed me as a vet on a 3-yearly contract. At one time, Singapore's economy was in recession. I could see that the horse owners were not paying their horse trainers and the number of race horses were dropping as they had to be put down.

In one race, there were only 3 racehorse running. Ideally, there should be more than 10. This decline in horse racing was a serious financial loss to the Club.. As a horse vet, I should not bother with the management problems of the racing industry. My job was to look after the health of racehorses.

IMAGES

What could a vet do besides advising on health care of racehorses?

SOLUTION

I was a member of the Club's task force to look into the racing problems and suggest solutions. The Club sent us to talk to the administrators of the racing clubs of Hong Kong, South Korea and Thailand. The Racing Manager of the task force was responsible for a management report.

I suggested interviewing two respectable horse owners who were stock brokers and loved horse racing. They provided valuable feedback. I wrote to several racing clubs in the USA, South Africa and Hong Kong to ask them to send me 5 years of their annual reports for my research. I read up marketing books as I did not write management reports as a vet.

A new racing magazine wanted an article on horses. I submitted the following report entitled "What makes a horse racing club profitable?" and got paid $200. The board and management got a copy of this magazine. See my report at:
http://www.asiahomes.com/dev/20120513history-1988-horse-racing-decline-veterinary-ToaPayohVets.htm

IMAGES X 2
Page 1 of the report
http://www.asiahomes.com/dev/Stc1.JPG

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Case Study 5. Giving back to the community.  When the internet started around 1997,  I believed that it would would be very useful in educating the pet owners in Singapore as they can read the contents anytime. The usual method was to print out articles on diseases or show the text book. This is time-consuming in a busy practice. 

SOLUTION

With online, conveniently accessed knowledge, better vets and pet owners will be better equipped to take good care of the sick pets or animals.

1. I started a blog in blogger.com and wrote case studies in this blog and in my website around one case per day. 

The IMAGE of my first blog page, written in 2007 is at:

 http://singaporecatskittens.blogspot.sg/2007/06/1-lady-who-loved-cats-was-chased-by-dog.html

2.  I set up my company website, http://www.toapayohvets.com when the internet was just available and the webpages were grey and black.  Free websites sometimes close down their operations and all your veterinary content will be lost.


3.  In the last 2 years, I started You Tube videos to teach undergraduate vets and inform pet owners of veterinary cases. The younger generation prefers videos to reading text.  The webpage of my videos  is at:
http://www.kongyuensing.com/animals/20100609Educational_Vet_Videos_ToaPayohVets.htm


In this talk, all the following videos will be shown if there is time.

1. An experienced vet gives an I/V drip efficiently. Dr Thein Tun Aung of Royal Asia Veterinary Surgery, Yangon, Myanmar.

2. Spay of a cat at Toa Payoh Vets  - Myanmar language


3. Castration of a dog at Toa Payoh Vets - Myanmar language
http://youtu.be/0_c2ypTg6T0

4. Mammary neoplasia. Toa Payoh Vets - surgical techniques - Myanmar language
http://youtu.be/7qBCpl9Dg2I


5. Traumatic Proptosis of a dog's eye. Toa Payoh Vets - surgical techniques -  Myanmar language
http://youtu.be/BNFXO5a8t7U

6. Dwarf Hamster with ear warts - English

7. Turtle with ear abscesses - English

I usually wake up at 3 am to do the social media writing and uploading and producing digital images.
This has been going on since around 2007. 

All vets should make a difference and contribute to the society which gives them the opportunity to study to become veterinarians. A Singaporean studying in an Australian veterinary university needs to pay more than S$250,000 = 195,000,000 kyats.

I note that Drs Thein Tun Aung and his wife donates to the building and for the
education of the students at a monastery.

IMAGES 

CONCLUSION

HARD WORK AND TIME ARE NEEDED TO BE A VERY GOOD VET

1. Be proactive in helping the animals or clients to solve their problems. Add value to your employer. This makes your veterinary career so much more interesting as you wake up every morning.

2.  At the of the day, nobody in Myanmar know who you are if you are inexperienced or poorly located.  You will need to work hard and usually long hours for an experienced vet and tolerate office politics in order to be be a very good vet.

3. You may need to work a few years in Singapore, Japan or overseas to improve your skills. Dr Thein Tun Aung worked for around 10 years in Singapore for different vets, seeing so many varieties of cases and it was very hard work.

4. Distractions and pleasures nowadays are many. Some young vets prefer online gaming and partying  till 3 am or watching online movies at the work place. This take up the time you could use to gain more veterinary knowledge by writing case studies, following up with the owner, research on how to do a better diagnosis and treatment. Why the outcome was not so good.

5.  It is a pain to write case studies and research more on medical cases.  

However, hard work and time are required if you want to be a very good vet. The above-mentioned 5 values, amongst others, will guide you to be a very good vet in Myanmar.  

6.  I hope you enjoy this talk and wish you all good luck to your final year examinations.

ACKNOWLEDGEMENTS

I thank Dr Tin Tin Myaing, President, Dr Soe Min, Secretary and committee members  of the Myanmar Veterinary Association for organising this talk. I thank Drs Ling Ling Soe and Thein Tun Aung of Royal Asia Veterinary Surgery for their generous sponsorship.

IMAGES AND YOU TUBE VIDEOS will be presented at the talk. A powerpoint presentation with images and videos will be shown at the talk on Aug 15, 2014 to the final year vet students.



REFERENCES

Toa Payoh Vets webpage
http://www.toapayohvets.com/

Case studies of dogs at Toa Payoh Vets
http://www.bekindtopets.com/animals/20081201Dog_Surgery_Anaesthesia_ToaPayohVets.htm


Article of "What Makes A Horse Racing Club profitable?". 12 pages.
http://www.asiahomes.com/dev/20120513history-1988-horse-racing-decline-veterinary-ToaPayohVets.htm

Page 1
http://www.asiahomes.com/dev/Stc1.JPG

Page 2
http://www.asiahomes.com/dev/Stc2.JPG

Page 3
http://www.asiahomes.com/dev/Stc3.JPG

Page 12
http://www.asiahomes.com/dev/Stc12.JPG


Case studies of Caesarean Sections at Toa Payoh Vets
http://www.bekindtopets.com/animals/20081201PAGE2_Dog_Surgery_Anaesthesia_ToaPayohVets.htm

Case studies of hamsters at Toa Payoh Vets
http://www.toapayohvets.com/surgery/050609hamsters_ToaPayohVets.htm

Be Kind To Pets website
http://www.bekindtopets.com/

Veterinary Videos from Toa Payoh Vets
http://www.kongyuensing.com/animals/20100609Educational_Vet_Videos_ToaPayohVets.htm

Blog No. 2
http://2010vets.blogspot.sg/

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