On Jun 8, 2011, I attended the SAP Summit 2011 - The Future State. The 9.10 am topic for the panelists was "The Secrets of Making A Best-Run Government Run Better; The Changing Mandate; The Shocking Disasters; The Future State
The Panelists were: Dr Anthony M Cresswell, Deputy Director, Center for Technology in Government, University at Albany, NY, USA; Zaqy Mohamad, Member of Parliament, Choa Chu Kang GRC, Singapore and Adaire Fox-Martin, SVP, Industry Business Solutions, SAP Asia Pacific Japan.
Mr Zaqy spoke about the better use of social media by politicians to engage the segment of the public. Apparently this had not been done effectively in the recent General Elections in Singapore if I heard Mr Zaqy Mohamad correctly.
The other panelist, Dr Anthony Cresswell talked about President Obama's Open Government's initiatives in the US and the difficulty of evaluating the key performance indicators of the services provided. It was an eye-opener for me when he said that over 80% of government computerisation projects fail.
What is the relevance of social media to veterinary surgeons in practice? There is a segment of the pet owners who are younger and would only be engaged through the use of social media. They will search for topics of relevance to their pet's illness and want to know which vet has the ability and experience to treat their beloved pets. Their own vet may not provide such a service.
Social media using webpages or blog requires the content to be created daily. There is now the twitter novel (short novels of 140 words are popular with netizens of China). Whatever the form, the contents must be updated daily or weekly to get a stream of "fans". Writing is very hard work for those who prefer not to touch a pen as there need to be research to produce a useful article. There are so many distractions and better things to do than to create good content after a hard day's work at the Surgery!
To illustrate the amount of work involved to produce a useful article, I will let readers know how I produced the article, "What Makes A Horse Racing Club Profitable?" This article was written in 1989 and the scanned pages are at Horses, starting with the first page at: http://www.asiahomes.com/dev/Stc1.JPG
CASE 1. The hamster with a very large ear wart
On a recent encounter, 2 days ago on Jun 9, 2011, I met an aunty and her niece who brought a hamster with a large dangling ear wart to Toa Payoh Vets. This wart was initially very small but her vet said she would not operate due to the high anaesthetic risks. As the wart grew bigger over the last 4-5 months, her vet referred her to another vet whose location was quite far to her residence. So this aunty googled for "hamster, warts" and an asiahomes webpage, probably similar http://www.asiahomes.com/singaporetpvet/ popped out.
I was at the Surgery at that time and so I got the above-mentioned feedback from her. This episode demonstrated the culture and lifestyle of the younger generation. The aunty was around 30-40 years old. The niece was a teenager. I paid special attention to this case as I collaborated with Dr Vanessa to ensure that the outcome of anaesthesia was what the aunty hoped for. Signing an informed anaesthesia consent form is one thing. I don't usually request it but Dr Vanessa does.
What was important was that the hamster come out of the surgery room alive and biting (this hamster bites, the aunty had said). Obviously, I would bite if anybody messes around with my wart. The hamster was anaesthesized under isoflurane gas.
A good anaesthetic assistant is invaluable. However, he or she needs to be trained as vet schools don't teach much about hamster anaesthesias. I kept a close eye on my assistant Mr Min telling him not to be distracted by looking for sutures etc while anaesthesizing the hamster. At one time, his eyes and one hand were on a drawer to take out a packet of suture for Dr Vanessa Lin.
I told him off not to do it. "Hamsters die because there is no 100% focus on anaesthesia by one person or the vet." It is important that new vet assistants and new vets need to be mentored closely in hamster anaesthesia and surgery as such cases are high risk anaesthetic cases.
There is no other way to prevent anaesthetic deaths in hamsters when the vet does hamster anaesthesia. Deaths on the operating table damages the reputation of Toa Payoh Vets and I am very strict on anaesthetic training and procedures to ensure that no healthy pets should die on the operating table at all times.
Dr Vanessa Lin excised the wart and sutured the wound. I proposed no suturing as the wound in the ear was so small and that bleeding would stop with pressure. As each vet has his or her own ideas, I will not interfere whenever an associate vet operates in most cases but I do monitor the handwork - the post-operation complications and the complaints. This is my duty of care for Toa Payoh Vets clientele.
She decided to stitch up the wound. I recommended potassium permanganate to stop the bleeding. Each vet has his or her approach to a surgical case and there are several satisfactory outcomes on any approach. Bleeding still came back as I had predicted in this case. This bleeding was not life-threatening.
The hamster was now free of "shouldering" a burden. Actually, the wart of 1.5 cm x 1.2 cm x 0.5 cm looked so much like one of those big dangling ear rings worn by some ladies. The hamster scratched his left ear where the wound was. The aunty was concerned. So I proposed a paper e-collar. "The hamster hates it very much," I said to the aunty as she put the e-collar on. The hamster used all his two hands to pull out the hamster. Vigorously and angrily I think. So, no more e-collar. "Just use the clean tissue to wipe off the blood," I advised the aunty. "And take the medication." The niece did not say a word but I presumed she was the real owner of this beloved hamster and was happy.
P.S. What are the Secrets of Making A Best-Run Government Run Better? There were no clear list of secrets enumerated as far as I know. The political party who knows how to engage the Generation Y effectively will be the one to win their votes and get the increased mandate to govern if the Generation Y is the vote swinger. The Government is now said to be a business. So, the Government who provides "public value" to the citizens will be a better-run government.
CASE 2. The hamster with a small ear wart
On Sunday July 3, 2011, I visited a hamster, rabbit, guinea pig and chinchilla pet shop after work at 6 pm. It was a busy Sunday working together with Dr Vanessa Lin.
The pet shop owner, Agnes asked me: "Many hamsters develop tumours after one year of age, according to my customers. Do you see many cases" I said: "Yes, I do see some cases and tumours do develop in most hamsters after one year of age but they can be excised if they are small."
Agnes said: "The hamster owner thinks that he or she can buy 10 hamsters rather than paying the veterinary fees. So, some don't bother. I suppose that even if the fees are $50.00, such owners will not send their hamsters for surgery."
Agnes is licensed to sell dwarf hamsters and each costs $12.00. As Singapore develops into a modern society, there are many caring hamster owners who do want their hamster tumours to be excised by the vet. Some wait too late as they hope that the tumour will disappear or they are just too busy to go to the vet. Some are poorly advised by their own vets to "wait and see" after taking "medication."
Many vets all over the world do not like to perform surgery on hamsters as they die easily as it is extremely difficult to monitor the stages of anaesthesia unlike in the case of the dog and cat.
Be Kind To Dwarf Hamsters. Get your vet to excise his ear wart when it is very small as in this case compared to the hamster with a large ear wart. Smaller warts cost you less to remove as they take shorter time and do not usually require stitching.
CASE 3. The hamster with two large chest tumours
Anaesthesia in this Syrian Hamster in Jun 2011
The Syrian Hamster was very thin. I could feel the spines. So I told the owner that I would give oral antibiotics and electrolytes for 24 hours at 3 times before anaesthesia and surgery. This hamster had stopped eating as was evident in no stool production.
I told the owner orally that the anaesthetic risks were very high as the hamster was not in good health. She understood the risks. This communication should be recorded in the case sheet and informed consent form should be signed in theory.
There are at least two methods of anaesthesia in this case. Isoflurane gas alone is the first method. However I find that this surgery can be better performed if the hamster is sedated by Zoletil so that less gas anaesthetic is required and I do not need to place him into the gas container every few seconds. It would be a very painful surgery as the lumps were massive and there were two of them.
I used the 2nd method of Zoletil sedation and topping up with isoflurane anaesthesia gas. I took out a new bottle of Zoletil 100. A 5-ml diluent is advised to make up Zoletil 100. However, I added 10 ml diluent so this would be Zoletil 50. I injected two drops IM. This dosage would not be sufficient from my experience but this hamster was not healthy and that was why I reduced the dose. It is very hard to know exactly the dosage that would not kill the hamster. A healthy plump adult Syrian hamster should have no problem with
4 drops of Zoletil 50 IM but this hamster was skinny as a rake.
OBSERVATION AND CLOSE MONITORING
"Count up to 10 and take the hamster out of the container," I said to my assistant whenever he put the hamster inside the plastic container of 5% isoflurane gas. He was not used to such instructions as he had little experience of hamster anaesthesia. My job is to train him up to assist all Toa Payoh Vets in hamster anaesthesia and receiving excellent outcome. Only with excellent clinical outcome and not anaesthetic deaths do the vet get referrals.
Mr Min felt it stupid to count as he graduated as a vet from Myanmar where I presume hamsters were not part of the veterinary studies. Even talking to dogs while giving injections is alien to his culture. Finally he counted: "1-2-3-4...10". He took the hamster out and I continued with the excision of over 3 cm long. The hamster gave a squeaky sound and I put him back to isoflurane gas container to get anaesthesized. On and off. Finally, the surgery was completed and the hamster woke up. He was OK and went home 48 hours later with no complaints.
4267 - 4275. Massive tumours in a Syrian hamster
CASE 4. Was it a bruised area or a chest tumour?
The vet is ultimately responsible for the deaths on the operating table. Extremely close monitoring of the stages of anaesthesia is very important in hamster anaesthesia as the eyelid and pedal reflexes are impossible to do unlike in the dog and cat. A bit more gas. A distraction of a few seconds. Cold air-conditioning air. Dampness and wetness. The hamster just dies on the operating table. It is indeed a very stressful anaesthesia and surgery when large massive tumours are presented.
Morally and ethically, it is best for the vet who does not want to handle hamster tumours, to reject the case outright rather than to prescribe the owner some medication and advise "wait-and-see" when they present hamsters with tumours (hard, firm lump). Just ask the hamster owner to seek another vet rather than give false hopes of recovery from oral medication. I can understand that vets may not wish to refer to competitors who may not be competent and if the hamster dies at the competitor's place, there will be blame on the referral.
4283 - 4290. HAMSTER PATIENT. Roborovski's tumour was discovered when the hamster's nose got bruised due to traumatic injury. "Is it due to the bruise?" the owner asked her vet. "Yes," the vet said. Within two weeks, the growth exploded to a gigantic size and was not operable.
Many caring hamster owners are from the younger generation of Singaporeans and are well educated. They are also quite sophisticated in knowing that oral medication for tumour cases are a waste of their money. Not only that, this act delays the owner from seeking early veterinary surgery for the removal of the tumour, some of which may be fast-growing malignant tumours.
Pictures are at: