AGAINST HOSPITAL ADVICE
I read in www.asiaone.com.sg while in Eastern Europe last week. The writer said he sent his mum to Changi General Hospital. 2 neutosurgeons and 2 visiting ones said his mum could have brain cancer and would not do a biopsy and lumbar tap due to high risk v. benefit.
The son scoured the internet and found a specialist who treated his mother at Tan Tock Seng Hospital and did the two tests. His mother had a brain infection and had since recovered!
No comments from CGH
Thursday, January 5, 2012
803. Liposuction death of Mr Heng was due to too much sedative
Straits Times Prime News Jan 5, 2012 Pg A3
"Doctors gave patient too much sedative: Coroner"
Heavily sedated man eventually died from the effects of asphyxia. His tongue was said to block his breathing. The more he struggled, the more sedative of propofol was given. This lead to the possibility that the patient could have suffocated leading to cardiac arrest, tongue rolled back causing obstruction of the airway.
13 intestinal perforations during liposuction not immediate cause of death -no massive bleeding or infections do not occur so fast.
LESSONS FOR VET ANAESTHESIA
1. I don't use propofol nor IV anaesthesia. However, some practices may not have isoflurane gas machine and theefore need to top up with IV anaesthetic drugs.
2. Keeping an accurate and meticulous record of sedation
2.1 The coroner said the two doctors "tailored" the figures - titration of the propofol and the total amount of propofol administered
2.2 The monitoring of the patient under sedation was treated with caution by the coroner. Dr Zhu could recall the sequence of titration and elvel of propoful tritratred during the entire procedure (of 3 hours) when no contemporarneous record was ever made of the number of times the propoful was adjusted or the level titrated. So the coroner was incredulous that she could recall the details.
The timing in Dr Wong's notes had been amended. Although 60 ml of propofol was claimed to have been given, this was actually more than 60 ml.
2.3 Dr Wong's nurse often paused when answering straightforard questions and claimed not to remembver important facts. So the nurse's demeanour in court was less forthcoming.
CIVIL SUIT filed against the two doctors.
For vet anaesthesia, keep proper and accurate anaesthetic records that can be believed.
"Doctors gave patient too much sedative: Coroner"
Heavily sedated man eventually died from the effects of asphyxia. His tongue was said to block his breathing. The more he struggled, the more sedative of propofol was given. This lead to the possibility that the patient could have suffocated leading to cardiac arrest, tongue rolled back causing obstruction of the airway.
13 intestinal perforations during liposuction not immediate cause of death -no massive bleeding or infections do not occur so fast.
LESSONS FOR VET ANAESTHESIA
1. I don't use propofol nor IV anaesthesia. However, some practices may not have isoflurane gas machine and theefore need to top up with IV anaesthetic drugs.
2. Keeping an accurate and meticulous record of sedation
2.1 The coroner said the two doctors "tailored" the figures - titration of the propofol and the total amount of propofol administered
2.2 The monitoring of the patient under sedation was treated with caution by the coroner. Dr Zhu could recall the sequence of titration and elvel of propoful tritratred during the entire procedure (of 3 hours) when no contemporarneous record was ever made of the number of times the propoful was adjusted or the level titrated. So the coroner was incredulous that she could recall the details.
The timing in Dr Wong's notes had been amended. Although 60 ml of propofol was claimed to have been given, this was actually more than 60 ml.
2.3 Dr Wong's nurse often paused when answering straightforard questions and claimed not to remembver important facts. So the nurse's demeanour in court was less forthcoming.
CIVIL SUIT filed against the two doctors.
For vet anaesthesia, keep proper and accurate anaesthetic records that can be believed.
802. HSA laboratory error making solutions - applicable to vet anaesthesia
Straits Times Review Jan 5, 2012 Pg A36
"To err is human, to confess remarkable"
Mistake: A senior lab manager misread the concentration of the reagent used for DNA tests. He made a solution 10 times as strong as it should be.
This reagent tested the DNA samples of 400 criminal cases.
How HSA prevents a similar occurrence in the future?
It had not double-checked the solutions used and none in the world does that as it is only a basic tool.
NOW every batch is checked by an independent laboratory
"Why no test was done on the solution before?" No answer to this question.
APPLICATION TO VET ANAESTHESIA - DOMITOR AND KETAMINE IV
Using IV anaesthesia, I want the vet to write down on the anaesthesia record and calculate the dosage based on weight and age and % discounted for old dogs. I do this myself and monitor my associate vets doing it.
IV sedation should not be overdosed, otherwise the dog dies. So, it is important to have a system and process of checking by the Senior Vet.
"To err is human, to confess remarkable"
Mistake: A senior lab manager misread the concentration of the reagent used for DNA tests. He made a solution 10 times as strong as it should be.
This reagent tested the DNA samples of 400 criminal cases.
How HSA prevents a similar occurrence in the future?
It had not double-checked the solutions used and none in the world does that as it is only a basic tool.
NOW every batch is checked by an independent laboratory
"Why no test was done on the solution before?" No answer to this question.
APPLICATION TO VET ANAESTHESIA - DOMITOR AND KETAMINE IV
Using IV anaesthesia, I want the vet to write down on the anaesthesia record and calculate the dosage based on weight and age and % discounted for old dogs. I do this myself and monitor my associate vets doing it.
IV sedation should not be overdosed, otherwise the dog dies. So, it is important to have a system and process of checking by the Senior Vet.
801. Shih Tzu with possible GME - follow up on Jan 4, 2012
4 Jan 2012
The Shih Tzu had been treated for a fever 2 days by Dr Vanessa. I was overseas. I saw him at 7 pm when the young couple came to take him home and observed his walking. He could walk on 4 limbs but not for long. Left eye pupil had no response to light and was dilated fully. Right eye pupil reacted to the bright white light I shone on, but constricted around 70% normal.
Blood test was taken. Showed very low WCC and higher figures of elevated liver enyzmes and higher than normal platelet count. Previous blood test showed normal WCC and elevated liver enzymes.
The dog did not have much appetite but was otherwise normal.
GME - Granulo-meningo encephalitis.
Cause is unknown. Said to be an auto-immune disease.
I did advise pred 2.5mg 2x/day for 2 weeks when the owner said that the dog had panted hard but it was only today I saw the dog again.
Prognosis is usually poor and the owner must be informed. "Feed small amounts and around 6x/day with sweet multivitamins," I advised. "You have 4 weeks." The dog rejected hand feeding but this must be done. Liver Prescription Diet 2 cans and antibiotics were prescribed by Dr Vanessa
The important issues here are prognosis and feeding several times a day at home as the owner wanted the dog back.
The Shih Tzu had been treated for a fever 2 days by Dr Vanessa. I was overseas. I saw him at 7 pm when the young couple came to take him home and observed his walking. He could walk on 4 limbs but not for long. Left eye pupil had no response to light and was dilated fully. Right eye pupil reacted to the bright white light I shone on, but constricted around 70% normal.
Blood test was taken. Showed very low WCC and higher figures of elevated liver enyzmes and higher than normal platelet count. Previous blood test showed normal WCC and elevated liver enzymes.
The dog did not have much appetite but was otherwise normal.
GME - Granulo-meningo encephalitis.
Cause is unknown. Said to be an auto-immune disease.
I did advise pred 2.5mg 2x/day for 2 weeks when the owner said that the dog had panted hard but it was only today I saw the dog again.
Prognosis is usually poor and the owner must be informed. "Feed small amounts and around 6x/day with sweet multivitamins," I advised. "You have 4 weeks." The dog rejected hand feeding but this must be done. Liver Prescription Diet 2 cans and antibiotics were prescribed by Dr Vanessa
The important issues here are prognosis and feeding several times a day at home as the owner wanted the dog back.
Wednesday, January 4, 2012
Day 2 of work - Productivity & Efficiency in Vet Surgery - dental and electro-excision
Jan 4, 2012. Wednesday. 2nd day at work.
A new client is difficult to come by as there are now 47 veterinary practices in Singapore. This was revealed to me by one veteran drugs salesman who saw me yesterday. We knew each other for more than 40 years and he had become busier now, with so many new practices compared to 4 when I first started out in 1982.
A quiet slim lady brought a black-brown Miniature Schnauzer to the Surgery as the dog had two loose front teeth. From her expressions and conversations directed at me, she would prefer me to handle her case. "I will do it together with Dr Vanessa as part of my mentoring process. When did the dog eat?"
"My dog ate at 10 am. Is it OK to do anaesthesia? "
"It is ideal that the dog should not have eaten for 10 hours before anaesthesia as the dog may vomit," I said. As the owner did not have time to postpone the tooth extraction, I said, "I will do it at 5 pm which is 6 hours later. It should be OK".
5-year Min Schnauzer, Female Spayed.
Chief complaint: 2 loose front tooth with exposed roots were surprisingly seen. Other teeth in good condition.
"i used the finger brush and gel," the owner said.
"You must have been brushing too vigorously," I replied. "The gums of the two incisors are exposed. It is best not to use the finger brush. In any case, the back teeth needs scaling."
Chief Complaint - My Schnauzer has two loose front teeth
Complaint No. 2 - My Schnauzer has a big ear lump that increases in size
4886 - 4895. Electro-surgery productivity
2nd complaint: R ear inflammatory nodule, firm, 7mmx7mmx5mm with central hole.
"A bee stung her tongue sometime ago," the lady said.
"Any bees seen in the last 2 weeks?" I asked as the owner said that the lump grows bigger in the past days. The dog had been scratching the right ear.
"It is best to excise it while the dog is under General Anaesthesia (GA) for dental scaling," I advised. "If you don't want histopathology, we will not know whether it is cancerous or not. A biopsy can be done but it costs money and delays. The best is for me to excise it since it is growing bigger day by day ."
The lady agreed to dental scaling and excision of the lump but not to blood test or histopathology. I asked Dr Vanessa to check the heart and pulse as well as general examination of the lungs. All were OK. So, the GA will be at 5pm to be done jointly.
I wanted to demonstrate how to be efficient and productive in veterinary surgery to my staff as it is one thing to lecture to young ones. Show how it is done will be best.
PLANNING
Scrub & clean ear well before sedation. "Any clipping of the ear?" Min asked me. "No need," I said.
I checked that Min had prepared the setting up of the electrosurgery equipment, dental scaling equipment and covered the operating table with a towel to prevent electric shocks to the vet on contact. After all this was done, the dog's dosage of IV anaesthesia was calculated. "Give 50% of the calculated dose and you have around 10 minutes of anaesthesia," I said to Dr Vanessa.
5 min after sedation, electro-excision by Dr Vanessa was completed within 60 seconds and then dental scaling was done. As the dog had little tartar due to the teacher's vigorous finger brushing, the dental scaling of the back teeth took a very short time.
Productivity means using the correct amount of anaesthetic drugs and least time to complete surgery and dental scaling. Therefore, the dog has the best chance of survival on the operating table. Delays by not preparing the equipment at first increases the risk and that would account for some deaths on the operating table.
The following is what happened as I asked my intern, Mr Lim to do the recording. Normally Min would do it but Mr Lim needed to be hands-on to learn if he wanted to be a vet after his National Service.
5.22 pm Sedate at 50% calculated dosage*
5.25 pm Electro-excision
5.26 pm Dental scaling
5.36 pm End of dental scaling
*10kg, healthy, young dog Domitor = 0.4 ml, Ketamine = 0.5ml IV combined
This dog - 5 years is not young. The staff is to calculate on paper the dosage
D= 0.11ml + K=0.14 ml. Total = 0.25ml. Add 0.25ml Hartmann = 0.5 ml to be given IV.
Normally, the IV anaesthesia lasts around 15-30 minutes. Very slight reaction to electro-incision but was OK for dental scaling done by Dr Vanessa. Two teeth and nodule given to owner.
USE OF ELECTRODES
"Don't bend the circular wire," I said to Dr Vanessa as she looped the nodule and the wire tilted at 45 degrees. "It is a very thin wire. It will break and it is very expensive to buy." The wire loop was originally 90 degrees to the electrode. Training a person how to use the tools of the trade correctly is important and acquiring the correct skills makes a vet more productive. The Vet School provides some knowledge of electro-surgery but I doubt every of the 60 - 80 students has the chance to handle the electro-surgical equipment. So they acquire the skills after graduation.
WART OR NODULE?
I would say it is an inflammatory nodule (with a hole in its centre, possibly bee sting). Dr V thinks it is an ear wart. "Physically, it does not look like a wart," I argued. "A wart usually is cauliflower shaped or rough, not smooth. However, veterinary medicine has exceptions and I can't say this is not an ear wart. Since the owner does not want histopathology, we can't send the lump to the laboratory for examination. Therefore, there is no definitive diagnosis."
VACCINATION AND HEARTWORM PREVENTION
"I give heartworm tablets monthly," the owner said. "The last vaccination was 2 years ago." I explained to her the difference between the usual vaccination and heartworm.
"You may be getting your priority wrong. In the countryside like England, where most dogs don't meet other dogs, some dogs may be safe without further vaccination as they don't get exposed to many other dogs as in city living." I explained. "Parvovirus is still around. Distemper is still present in unvaccinated puppies. Have you been to England?" I asked. She said she was in England for two years and understood what I said.
PRODUCTIVITY & EFFICIENCY
If there is no proper planning, a lot of time is wasted. This dog would need top up IV anaesthesia or isoflurane gas to complete the job. As demonstrated by me, the whole process after sedation took 3 minutes for electro-excision and 10 minutes for dental scaling.
OUTCOME
The dog was groggy for over 1 hour as I did not use Antisedan. Went home without problems as at 12 hours at the time of writing this first draft report. However, in this final copy, the owner had texted me saying that the surgical area was weepy and inflamed and what should she do?
"Hi dr Sing, I'm .....Brought ....to ur clinic for teeth extraction n ear surgery on Wed. ....ear is not doing well...Had inflammation. Can I administer iodine on her ear? What shd I do? I gv her medication as indicated, didn't bring her out. Can y kindly advise? Thanks very much
Younger people prefer texting. I phoned her and advised daily cleaning with the iodine and to let the dog wear the e-collar as she had been scratching the surgical area. She would let me know if there are problems again.
AN EXAMPLE OF POOR PRODUCTIVITY WASTING MANY HOURS HAPPENED ON THE SAME DAY
The HDB contractor came to replace the wooden bathroom door (rotten base) with a plastic one. He dismantled the door and then found that the plastic one was too narrow to fit in. 3 weeks ago, another person had come to measure the dimensions. This was really a waste of time, being unproductive. This is what I mean by productivity and efficiency.
"Please put back the old door," I asked the thin Malaysian man from Malacca with jet black hair. "I have a lady vet and you can understand that she can't use the bathroom with no doors. She works to past 8 pm at night. For men, an open door may be OK"
The contractor actually took the trouble to fix back the old door and said, "OK. I will get the new door back to the factory to replace one with correct dimensions today." He had previously said it might take 2 weeks, since Chinese New Year falls on Jan 22, 2012 and most workers had gone home. I was surprised. He even gave me two discarded wooden boards for me as shelving.
UPDATES AND MORE PICTURES AT:
http://www.sinpets.com/F6/20120107vigorous-finger-tooth-brush-exposed-roots-Schnauzer-singapore_ToaPayohVets.htm
A new client is difficult to come by as there are now 47 veterinary practices in Singapore. This was revealed to me by one veteran drugs salesman who saw me yesterday. We knew each other for more than 40 years and he had become busier now, with so many new practices compared to 4 when I first started out in 1982.
A quiet slim lady brought a black-brown Miniature Schnauzer to the Surgery as the dog had two loose front teeth. From her expressions and conversations directed at me, she would prefer me to handle her case. "I will do it together with Dr Vanessa as part of my mentoring process. When did the dog eat?"
"My dog ate at 10 am. Is it OK to do anaesthesia? "
"It is ideal that the dog should not have eaten for 10 hours before anaesthesia as the dog may vomit," I said. As the owner did not have time to postpone the tooth extraction, I said, "I will do it at 5 pm which is 6 hours later. It should be OK".
5-year Min Schnauzer, Female Spayed.
Chief complaint: 2 loose front tooth with exposed roots were surprisingly seen. Other teeth in good condition.
"i used the finger brush and gel," the owner said.
"You must have been brushing too vigorously," I replied. "The gums of the two incisors are exposed. It is best not to use the finger brush. In any case, the back teeth needs scaling."
Chief Complaint - My Schnauzer has two loose front teeth
Complaint No. 2 - My Schnauzer has a big ear lump that increases in size
4886 - 4895. Electro-surgery productivity
2nd complaint: R ear inflammatory nodule, firm, 7mmx7mmx5mm with central hole.
"A bee stung her tongue sometime ago," the lady said.
"Any bees seen in the last 2 weeks?" I asked as the owner said that the lump grows bigger in the past days. The dog had been scratching the right ear.
"It is best to excise it while the dog is under General Anaesthesia (GA) for dental scaling," I advised. "If you don't want histopathology, we will not know whether it is cancerous or not. A biopsy can be done but it costs money and delays. The best is for me to excise it since it is growing bigger day by day ."
The lady agreed to dental scaling and excision of the lump but not to blood test or histopathology. I asked Dr Vanessa to check the heart and pulse as well as general examination of the lungs. All were OK. So, the GA will be at 5pm to be done jointly.
I wanted to demonstrate how to be efficient and productive in veterinary surgery to my staff as it is one thing to lecture to young ones. Show how it is done will be best.
PLANNING
Scrub & clean ear well before sedation. "Any clipping of the ear?" Min asked me. "No need," I said.
I checked that Min had prepared the setting up of the electrosurgery equipment, dental scaling equipment and covered the operating table with a towel to prevent electric shocks to the vet on contact. After all this was done, the dog's dosage of IV anaesthesia was calculated. "Give 50% of the calculated dose and you have around 10 minutes of anaesthesia," I said to Dr Vanessa.
5 min after sedation, electro-excision by Dr Vanessa was completed within 60 seconds and then dental scaling was done. As the dog had little tartar due to the teacher's vigorous finger brushing, the dental scaling of the back teeth took a very short time.
Productivity means using the correct amount of anaesthetic drugs and least time to complete surgery and dental scaling. Therefore, the dog has the best chance of survival on the operating table. Delays by not preparing the equipment at first increases the risk and that would account for some deaths on the operating table.
The following is what happened as I asked my intern, Mr Lim to do the recording. Normally Min would do it but Mr Lim needed to be hands-on to learn if he wanted to be a vet after his National Service.
5.22 pm Sedate at 50% calculated dosage*
5.25 pm Electro-excision
5.26 pm Dental scaling
5.36 pm End of dental scaling
*10kg, healthy, young dog Domitor = 0.4 ml, Ketamine = 0.5ml IV combined
This dog - 5 years is not young. The staff is to calculate on paper the dosage
D= 0.11ml + K=0.14 ml. Total = 0.25ml. Add 0.25ml Hartmann = 0.5 ml to be given IV.
Normally, the IV anaesthesia lasts around 15-30 minutes. Very slight reaction to electro-incision but was OK for dental scaling done by Dr Vanessa. Two teeth and nodule given to owner.
USE OF ELECTRODES
"Don't bend the circular wire," I said to Dr Vanessa as she looped the nodule and the wire tilted at 45 degrees. "It is a very thin wire. It will break and it is very expensive to buy." The wire loop was originally 90 degrees to the electrode. Training a person how to use the tools of the trade correctly is important and acquiring the correct skills makes a vet more productive. The Vet School provides some knowledge of electro-surgery but I doubt every of the 60 - 80 students has the chance to handle the electro-surgical equipment. So they acquire the skills after graduation.
WART OR NODULE?
I would say it is an inflammatory nodule (with a hole in its centre, possibly bee sting). Dr V thinks it is an ear wart. "Physically, it does not look like a wart," I argued. "A wart usually is cauliflower shaped or rough, not smooth. However, veterinary medicine has exceptions and I can't say this is not an ear wart. Since the owner does not want histopathology, we can't send the lump to the laboratory for examination. Therefore, there is no definitive diagnosis."
VACCINATION AND HEARTWORM PREVENTION
"I give heartworm tablets monthly," the owner said. "The last vaccination was 2 years ago." I explained to her the difference between the usual vaccination and heartworm.
"You may be getting your priority wrong. In the countryside like England, where most dogs don't meet other dogs, some dogs may be safe without further vaccination as they don't get exposed to many other dogs as in city living." I explained. "Parvovirus is still around. Distemper is still present in unvaccinated puppies. Have you been to England?" I asked. She said she was in England for two years and understood what I said.
PRODUCTIVITY & EFFICIENCY
If there is no proper planning, a lot of time is wasted. This dog would need top up IV anaesthesia or isoflurane gas to complete the job. As demonstrated by me, the whole process after sedation took 3 minutes for electro-excision and 10 minutes for dental scaling.
OUTCOME
The dog was groggy for over 1 hour as I did not use Antisedan. Went home without problems as at 12 hours at the time of writing this first draft report. However, in this final copy, the owner had texted me saying that the surgical area was weepy and inflamed and what should she do?
"Hi dr Sing, I'm .....Brought ....to ur clinic for teeth extraction n ear surgery on Wed. ....ear is not doing well...Had inflammation. Can I administer iodine on her ear? What shd I do? I gv her medication as indicated, didn't bring her out. Can y kindly advise? Thanks very much
Younger people prefer texting. I phoned her and advised daily cleaning with the iodine and to let the dog wear the e-collar as she had been scratching the surgical area. She would let me know if there are problems again.
AN EXAMPLE OF POOR PRODUCTIVITY WASTING MANY HOURS HAPPENED ON THE SAME DAY
The HDB contractor came to replace the wooden bathroom door (rotten base) with a plastic one. He dismantled the door and then found that the plastic one was too narrow to fit in. 3 weeks ago, another person had come to measure the dimensions. This was really a waste of time, being unproductive. This is what I mean by productivity and efficiency.
"Please put back the old door," I asked the thin Malaysian man from Malacca with jet black hair. "I have a lady vet and you can understand that she can't use the bathroom with no doors. She works to past 8 pm at night. For men, an open door may be OK"
The contractor actually took the trouble to fix back the old door and said, "OK. I will get the new door back to the factory to replace one with correct dimensions today." He had previously said it might take 2 weeks, since Chinese New Year falls on Jan 22, 2012 and most workers had gone home. I was surprised. He even gave me two discarded wooden boards for me as shelving.
UPDATES AND MORE PICTURES AT:
http://www.sinpets.com/F6/20120107vigorous-finger-tooth-brush-exposed-roots-Schnauzer-singapore_ToaPayohVets.htm
799. lst case of 2012. A white puppy that coughs like an old man
Jan 3, 2012 10.30 am
My first case of the year. Poodle, Male, 3 months. Bought 7 days ago. Past 3 days, cough as if choked. Some runny nose with clear discharge. Excellent appetite. Had 2 vaccinations. 1 free vaccination voucher from a vet for 3rd vaccination and therefore I don't expect the father to see me for the 3rd vaccination.
The father had phoned for check up and the time. He came in the morning before 12 noon and I was on duty. As regards toilet training, I was surprised that the puppy was so intelligent as he would wait for treats by peeing a little bit first. There was one other case of a "manipulative" puppy reported to me during my over 600 case studies of house-breaking in puppies. One particular puppy I remember well is that this puppy would pick up all the toys and put them in a box when retiring to sleep at night.
"How's the puppy toilet trained?" I asked. The puppy was confined closely for grate training (plastic grate on one half, on top of grated floor, according to the father). He was very kind as to e-mail me 3 pictures of the most handsome "Bichon" I have ever seen and I share them with my readers. The Seller said it was a poodle but I said it looked more like a Bichon.
4935. Crate training and treats for a smart puppy. He would go to the grate and pees a bit waiting for treats!
Examination as follows:
1. General exam - mouth and throat palpation - coughed
2. Detailed exam - opened mouth, puppy resisted, shone white torchlight - no tonsillitis, no ulcers
Auscultation of lungs - no lung sounds
"Overall, the puppy had kennel cough," I said. "It is not serious and he will recover in 10 days' time provided no exertion."
QUESTIONS ASKED
1. What causes kennel cough? A virus and bacteria usually from other dogs inside the breeder's premises. The breeders in Singapore do not vaccinate against kennel cough and so the kennel cough germs persist in the kennels. However they vaccinate the puppies against parvovirus as they have had suffered heavy losses for not doing it. So, most puppies sold in Singapore are immune to parvoviral infections causing severe diarrhoea and vomiting. And deaths."
2. "But the puppy had no cough when we brought her home for the first 3 days," the daughter said. "Many breeders gave the puppy cough mixtures and medication and so the cough was suppressed for the first 3 days," I said. "If the breeder said that the puppy for sale has coughing, the owner will not buy him. So, it is difficult for him to be honest. In your case, the puppy is 3 months old and is stronger and so the kennel cough should not be a big problem. Those puppies at 2 months old suffer more as their immune system may be poorer. Some of them die from pneumonia!"
"The breeder is also selling smaller puppies," the father said. "Size may not be correlated with age," I said.
3. "When should I send my puppy for the 3rd vaccination?" the father had e-mailed me later.
This depends on how fast the puppy recovers. As a guideline, 7-14 days after the puppy has stopped coughing.
Educational Video: Kennel Cough in Puppies produced by two St Andrews' Sec 3
students in collaboration with Dr Sing
I was surprised to meet a busy multinational company employee father and his daughter in junior college and her cousin. Singapore is too small for international corporations to survive if they focus on Singapore for business. Previously, Caucasian expats were employed for regional positions but now are replaced by locals. Which means a lot of travelling and less time for the family. However, children need money if they study overseas and a salaried employee working in Singapore mainly may not be able to afford overseas education for their children. I am always happy to see a busy father bringing the daughter and puppy to see the vet as the Singapore fathers are usually very busy and delegate the duty to the mother!
Webpage at:
My first case of the year. Poodle, Male, 3 months. Bought 7 days ago. Past 3 days, cough as if choked. Some runny nose with clear discharge. Excellent appetite. Had 2 vaccinations. 1 free vaccination voucher from a vet for 3rd vaccination and therefore I don't expect the father to see me for the 3rd vaccination.
The father had phoned for check up and the time. He came in the morning before 12 noon and I was on duty. As regards toilet training, I was surprised that the puppy was so intelligent as he would wait for treats by peeing a little bit first. There was one other case of a "manipulative" puppy reported to me during my over 600 case studies of house-breaking in puppies. One particular puppy I remember well is that this puppy would pick up all the toys and put them in a box when retiring to sleep at night.
"How's the puppy toilet trained?" I asked. The puppy was confined closely for grate training (plastic grate on one half, on top of grated floor, according to the father). He was very kind as to e-mail me 3 pictures of the most handsome "Bichon" I have ever seen and I share them with my readers. The Seller said it was a poodle but I said it looked more like a Bichon.
4935. Crate training and treats for a smart puppy. He would go to the grate and pees a bit waiting for treats!
Examination as follows:
1. General exam - mouth and throat palpation - coughed
2. Detailed exam - opened mouth, puppy resisted, shone white torchlight - no tonsillitis, no ulcers
Auscultation of lungs - no lung sounds
"Overall, the puppy had kennel cough," I said. "It is not serious and he will recover in 10 days' time provided no exertion."
QUESTIONS ASKED
1. What causes kennel cough? A virus and bacteria usually from other dogs inside the breeder's premises. The breeders in Singapore do not vaccinate against kennel cough and so the kennel cough germs persist in the kennels. However they vaccinate the puppies against parvovirus as they have had suffered heavy losses for not doing it. So, most puppies sold in Singapore are immune to parvoviral infections causing severe diarrhoea and vomiting. And deaths."
2. "But the puppy had no cough when we brought her home for the first 3 days," the daughter said. "Many breeders gave the puppy cough mixtures and medication and so the cough was suppressed for the first 3 days," I said. "If the breeder said that the puppy for sale has coughing, the owner will not buy him. So, it is difficult for him to be honest. In your case, the puppy is 3 months old and is stronger and so the kennel cough should not be a big problem. Those puppies at 2 months old suffer more as their immune system may be poorer. Some of them die from pneumonia!"
"The breeder is also selling smaller puppies," the father said. "Size may not be correlated with age," I said.
3. "When should I send my puppy for the 3rd vaccination?" the father had e-mailed me later.
This depends on how fast the puppy recovers. As a guideline, 7-14 days after the puppy has stopped coughing.
Educational Video: Kennel Cough in Puppies produced by two St Andrews' Sec 3
students in collaboration with Dr Sing
I was surprised to meet a busy multinational company employee father and his daughter in junior college and her cousin. Singapore is too small for international corporations to survive if they focus on Singapore for business. Previously, Caucasian expats were employed for regional positions but now are replaced by locals. Which means a lot of travelling and less time for the family. However, children need money if they study overseas and a salaried employee working in Singapore mainly may not be able to afford overseas education for their children. I am always happy to see a busy father bringing the daughter and puppy to see the vet as the Singapore fathers are usually very busy and delegate the duty to the mother!
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Sunday, January 1, 2012
798. Young Adults Face Intense Global Competition
Dubai - Jan 1, 2012 Winchester Hotel 12.08 am
Many young adults in a free world of abundance like Singapore, live in a virtual world of the smart phone texting and connecting with friends day to day. No responsibilities of adulthood and parenthood.
The years rush by. Time flies. Those young adults who acquire specialised relevant skills after graduation, works hard and is honest, get the good jobs globally as they are useful and indispensible to the employer.
Most of the old guards or senior citizens will never be able to compete in this global world for jobs needing more than a degree from the University and work experience. There is a need for specialised relevant technical experience in many high-paying jobs globally.
Many Singaporean young adults are blessed growing up in abundance in a Singapore, free of wars, natural disasters and crime from the 1950s - 2012 and are unprepared for the shocks of the real world. Many don't bother to learn how to read the financial statements but will punt or accept a friend's advice to invest in some schemes which appear to be Ponzi schemes. For example, buying a gold bar and paying for 20% below market price and getting regular returns above average. Sounds too good to be true and seems to me to be another version of Madoff's US$50 billion ponzi scheme on a small scale.
2012 appears to be another recession caused by the Euro crisis but how many young Singaporean adults can discuss in depth what is the Euro crisis and how it will impact their parents' livelihood, their own job prospects and their country's economy.
Many young adults in a free world of abundance like Singapore, live in a virtual world of the smart phone texting and connecting with friends day to day. No responsibilities of adulthood and parenthood.
The years rush by. Time flies. Those young adults who acquire specialised relevant skills after graduation, works hard and is honest, get the good jobs globally as they are useful and indispensible to the employer.
Most of the old guards or senior citizens will never be able to compete in this global world for jobs needing more than a degree from the University and work experience. There is a need for specialised relevant technical experience in many high-paying jobs globally.
Many Singaporean young adults are blessed growing up in abundance in a Singapore, free of wars, natural disasters and crime from the 1950s - 2012 and are unprepared for the shocks of the real world. Many don't bother to learn how to read the financial statements but will punt or accept a friend's advice to invest in some schemes which appear to be Ponzi schemes. For example, buying a gold bar and paying for 20% below market price and getting regular returns above average. Sounds too good to be true and seems to me to be another version of Madoff's US$50 billion ponzi scheme on a small scale.
2012 appears to be another recession caused by the Euro crisis but how many young Singaporean adults can discuss in depth what is the Euro crisis and how it will impact their parents' livelihood, their own job prospects and their country's economy.
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