A foreign student agent invited me for lunch at Novena Square today, Thursday Jul 1, 2010. An ex-principal of a neighbourhood secondary school was also invited.
"How do you discipline naughty boys?" I asked. "There must be many of them. Do you cane them?"
"Women are not permitted to cane students," she said. "Only the male disciplinary master will do it."
TIME OUT.
1. Detention at the Principal's office from 1 pm to 5 pm. Others can go home.
2. Parents to meet.
Thursday, July 1, 2010
Wednesday, June 30, 2010
Young poodle keeps shaking his head every day
"There is only one treatment," I said. "It is surgery to open up the vertical ear canal. Your poodle would feel better in the first 2 weeks after treatment and the problem of head shaking would come back."
"My poodle also had pimples all over the body," the lady in her 40s said.
"Most likely, the poodle had been rolling her body against the wall resulting in damaged skin and infections."
"You are correct. She has to rub her body against the floor tiles. How to cure this problem."
"The cause is due to hairy ears. Your groomer has to remove the hairs every 2-3 monthly. But you don't have time as you need to take care of your sick sister," I said. "So the head shaking comes back as the horizontal ear canals are infected and the lower ear is reddish and itchy." The poodle used her right hind paw to start scratching her neck again.
Most dog owners will just send the poodle to the groomer. But there was no real cure. Lateral ear canal resection surgery is the cure. "How is it done and will my dog be deformed?" the owner asked.
Pictures are best. Fortunately I had some pictures at www.toapayohvets.com, goto "Dogs" --- "Ear Problems" to clarify what the surgery would be. One picture is worth a thousand words.
"I have to ask the family members first," the lady said. Later she phoned and gave her consent to the surgery. "As the ears are infected, it will best to wait around 7 days before I do the surgery," I said. The owner understood.
"My poodle also had pimples all over the body," the lady in her 40s said.
"Most likely, the poodle had been rolling her body against the wall resulting in damaged skin and infections."
"You are correct. She has to rub her body against the floor tiles. How to cure this problem."
"The cause is due to hairy ears. Your groomer has to remove the hairs every 2-3 monthly. But you don't have time as you need to take care of your sick sister," I said. "So the head shaking comes back as the horizontal ear canals are infected and the lower ear is reddish and itchy." The poodle used her right hind paw to start scratching her neck again.
Most dog owners will just send the poodle to the groomer. But there was no real cure. Lateral ear canal resection surgery is the cure. "How is it done and will my dog be deformed?" the owner asked.
Pictures are best. Fortunately I had some pictures at www.toapayohvets.com, goto "Dogs" --- "Ear Problems" to clarify what the surgery would be. One picture is worth a thousand words.
"I have to ask the family members first," the lady said. Later she phoned and gave her consent to the surgery. "As the ears are infected, it will best to wait around 7 days before I do the surgery," I said. The owner understood.
116. The sucessful businessman and his 4 rabbits
Not all businessmen can be successful in global business. It is inspiring to meet one as they don't have much time for people who don't have any purpose in meeting them.
As my friend Khin Khin wanted some pricing info on shipping of diesel from Malaysia to Myanmar, I e-mailed him. He replied within 24 hours to say he would be back in Singapore on Jun 28, 2010 and we could talk further.
He has been in the shipping business for over 15 years and built ships. So, he was the right person to contact. On Jun 29, he messaged me apologising for the short notice, to meet at Amara Hotel to watch the soccer game between Paraguay and Japan yesterday evening and so I had to finish my dinner to go.
He introduced me to his friends as the vet who sterilised his four rabbits. "Before sterilisation, one male used to mount the female. The other female was jealous and bit the female. After sterilisation, all four became friendly and co-exist!"
It was good to know his rabbits were OK. How does one become a successful businessman globally?
1. High energy
2. Not needing many hours of sleep.
3. Able to be awake past midnight and get up to work the next morning.
4. Takes 2 hours to answer 400 - 500 e-mails.
5. Able to drink whiskey with clients. Also smoke.
6. Has a tremendous network of contacts.
7. Be a road warrior.
He loved chess and was playing a few games with his friends. One friend I would remember was a chess teacher who told me that he would be getting toe pain of gout the next day. But drinking a lot of water would alleviate the pain in his toes. He ate peanuts and fried chicken wings. He did not believe in taking anti-gout medication and so he just had to endure the toe pain the next day. I don't know whether he would get uric acid stones in his kidneys later but he was not worried.
As for me, I felt sleepy towards midnight. The businessman excused me and I left.
As my friend Khin Khin wanted some pricing info on shipping of diesel from Malaysia to Myanmar, I e-mailed him. He replied within 24 hours to say he would be back in Singapore on Jun 28, 2010 and we could talk further.
He has been in the shipping business for over 15 years and built ships. So, he was the right person to contact. On Jun 29, he messaged me apologising for the short notice, to meet at Amara Hotel to watch the soccer game between Paraguay and Japan yesterday evening and so I had to finish my dinner to go.
He introduced me to his friends as the vet who sterilised his four rabbits. "Before sterilisation, one male used to mount the female. The other female was jealous and bit the female. After sterilisation, all four became friendly and co-exist!"
It was good to know his rabbits were OK. How does one become a successful businessman globally?
1. High energy
2. Not needing many hours of sleep.
3. Able to be awake past midnight and get up to work the next morning.
4. Takes 2 hours to answer 400 - 500 e-mails.
5. Able to drink whiskey with clients. Also smoke.
6. Has a tremendous network of contacts.
7. Be a road warrior.
He loved chess and was playing a few games with his friends. One friend I would remember was a chess teacher who told me that he would be getting toe pain of gout the next day. But drinking a lot of water would alleviate the pain in his toes. He ate peanuts and fried chicken wings. He did not believe in taking anti-gout medication and so he just had to endure the toe pain the next day. I don't know whether he would get uric acid stones in his kidneys later but he was not worried.
As for me, I felt sleepy towards midnight. The businessman excused me and I left.
Sunday, June 27, 2010
114. Sunday's highlighted case. Lifestyle of dog
Jun 30, 2010
Dog: X, Male, 2.5 years old
"My dog didn't get fully cured," the couple in their early 30s said. "He had a neck bite wound some 3 weeks ago. He was treated by Dr Teo. Now the disease has spread to his left fore leg, his right fore dew claw and pad, his chin is red, there are pimples on either side of his penis. His penile sheath is swollen."
"These problems are due to the active the life-style of the male dog," I said. "It is like people. Those who drink alcohol a lot will get drunk, unlike others."
I drew illustrations to record the skin problems for ease of reference later.
1. Red inflamed chin. The dog was destroying the leather shoes of the brother
2. LF above carpus. 2 black spots due to medication and licking.
3. RF dew claw and nearby pad. Bleeding and red. Dog had bitten it. Microscopic exam showed ringworm.
4. Groin pimples and swollen penile sheath. The dog must have "humped" in the absence of the owners. There was another dog (female spayed) that might be injured.
After advising on treatment, I discovered that the young husband loved fishing. Their blog is ourfishingjourney.blogspot.com. There is a forum called fishingkaki.com.
"You need money to start a business," the young husband said and the wife noddded in agreement.
"Does it mean that if I start a travel agency business, I must own coaches, airplanes and hotels before I can start?" I asked.
"No need," the couple agreed.
"Nowadays, you have the internet. You can set up a niche deep sea fishing website and provide a service people want," I said. "Does it cost a lot of money to host this website? Will S$20/month do?"
The couple agreed that it would not need a lot of money to start a business out of a hobby.
What type of services?
1. Specialise in deep sea fishing over the next few months of years
2. Be a Singapore expert on local fishing.
3. Be able to arrange a deep sea fishing tour package.
"Anybody can search for what they want on www.fishingkaki.com," the wife said.
"What if I want to go for deep sea fishing tour package and want to know the cost. Can I find it on www.fishingkaki.com?" I asked.
"Yes," the wife said.
"No," the husband said. "You can find the boatman but not the whole package."
Dog: X, Male, 2.5 years old
"My dog didn't get fully cured," the couple in their early 30s said. "He had a neck bite wound some 3 weeks ago. He was treated by Dr Teo. Now the disease has spread to his left fore leg, his right fore dew claw and pad, his chin is red, there are pimples on either side of his penis. His penile sheath is swollen."
"These problems are due to the active the life-style of the male dog," I said. "It is like people. Those who drink alcohol a lot will get drunk, unlike others."
I drew illustrations to record the skin problems for ease of reference later.
1. Red inflamed chin. The dog was destroying the leather shoes of the brother
2. LF above carpus. 2 black spots due to medication and licking.
3. RF dew claw and nearby pad. Bleeding and red. Dog had bitten it. Microscopic exam showed ringworm.
4. Groin pimples and swollen penile sheath. The dog must have "humped" in the absence of the owners. There was another dog (female spayed) that might be injured.
After advising on treatment, I discovered that the young husband loved fishing. Their blog is ourfishingjourney.blogspot.com. There is a forum called fishingkaki.com.
"You need money to start a business," the young husband said and the wife noddded in agreement.
"Does it mean that if I start a travel agency business, I must own coaches, airplanes and hotels before I can start?" I asked.
"No need," the couple agreed.
"Nowadays, you have the internet. You can set up a niche deep sea fishing website and provide a service people want," I said. "Does it cost a lot of money to host this website? Will S$20/month do?"
The couple agreed that it would not need a lot of money to start a business out of a hobby.
What type of services?
1. Specialise in deep sea fishing over the next few months of years
2. Be a Singapore expert on local fishing.
3. Be able to arrange a deep sea fishing tour package.
"Anybody can search for what they want on www.fishingkaki.com," the wife said.
"What if I want to go for deep sea fishing tour package and want to know the cost. Can I find it on www.fishingkaki.com?" I asked.
"Yes," the wife said.
"No," the husband said. "You can find the boatman but not the whole package."
Thursday, June 24, 2010
112. Health screening to prevent diseases in your dog or cat
Emergency lab work includes measuring packed cell volume (PCV), total protein (Tp), blood glucose concentration, blood urea nitrogen (BUN) and serum potassium and sodium concentrations, total and differentiated white cell count (WCC), haemoglobin level.
WCC increase may indicate sepsis or inflammation. Low blood glucose may indicate sepsis, hypoadrenocorticism or hepatic disease. Electrolyte disorders may mean hypoadrenocorticism
Complete cell count, serum chemistry, urinalysis
HAEMATOLOGY
Detects infection (increased or decreased neutrophils), toxaemia or lymphoma (increased lymphocyte count). Eosinophilia may be due to eosinophilic gastritis or enteritis, parasitism, mastocytosis or hypoadrenocorticism.
SERUM CHEMISTRY ANALYSIS
Provides info about protein-losing enterpathies, azotaemia, liver disease, hypoadrenocorticism, diabetes mellius, hydration status and electrolyte concentrations. Serum amylase and lipase are not specific of canine or feline pancreatitis.
URINALYSIS
Provides info about kidney and liver diseases, ketoacidosis, glucosuria and hydration. Urine specific gravity and pH. Sediment examination for urinary crystals.
WCC increase may indicate sepsis or inflammation. Low blood glucose may indicate sepsis, hypoadrenocorticism or hepatic disease. Electrolyte disorders may mean hypoadrenocorticism
Complete cell count, serum chemistry, urinalysis
HAEMATOLOGY
Detects infection (increased or decreased neutrophils), toxaemia or lymphoma (increased lymphocyte count). Eosinophilia may be due to eosinophilic gastritis or enteritis, parasitism, mastocytosis or hypoadrenocorticism.
SERUM CHEMISTRY ANALYSIS
Provides info about protein-losing enterpathies, azotaemia, liver disease, hypoadrenocorticism, diabetes mellius, hydration status and electrolyte concentrations. Serum amylase and lipase are not specific of canine or feline pancreatitis.
URINALYSIS
Provides info about kidney and liver diseases, ketoacidosis, glucosuria and hydration. Urine specific gravity and pH. Sediment examination for urinary crystals.
112. A young businessman is not patient nor respectful
"Find another agent," Khin Khin was told by the young couple who were her partners and had a prospective buyer for S$3 million of diesel oil. "We don't like this Agent X. Don't you have another one?" Agent X is a commodity agent with a vast network. It is not as if such agents are a dime a dozen unlike property agents.
So, I deduce that the young couple do not know much about the commodity trading business. The performance is closing the deal, not in having a prospective buyer or seller.
I had met Agent X some months ago and knew what he really had the knowledge and the network. He had a big scar on his left hand. "What happened to your left hand?" I asked. "Oh, the surgeon took a vein for my heart. I had quadruple by-pass."
I phoned him to find out what happened and to learn something about the oil industry as Khin Khin asked me whether there is a Malaysian quoted diesel price and that she must pay $99.90 per month to get the price.
INFORMATION
Agent X said that the couple wanted the previous price quoted but this was not possible as they had not locked in with money. The previous price was $580/metric tonne and just today, it was $660 FOB/metric tonne. So, the couple was not happy. This showed that they had did not know how business was done.
Prices are quoted in Singapore at www.bunker.com. Look for MDC (marine diesel oil) for prices.
So there is no separate Malaysian quotation. Prices had gone up as the buyer had not confirmed. At 5,000 metric tonnes, it would be around S$3.5 million and the couple had to get the LC done first. The couple wanted the price to be $500 -$600 which was not possible as at Jun 14, 2010. Agent X had quoted $583 earlier but prices had shot up. I had read in the Straits Times something about diesel prices going sky high and the impact on Singapore's economy a few days ago.
Lock In, the money must be there in the form of the LC.
To confirm, a Letter of Credit (LC) must be opened and made payable to the Seller (Petronas). This means that the Buyer had to put the money into Khin Khin's company. Once the price is agreed, the money will be paid, FOB. If the LC is in the Buyer's bank, then no commission would be likely to be paid to Khin Khin. So, it was important that Khin Khin controlled the money matters.
Commission for Agent X is paid by Khin Khin's company, based on trust. This sounds dicey to me.
So, I deduce that the young couple do not know much about the commodity trading business. The performance is closing the deal, not in having a prospective buyer or seller.
I had met Agent X some months ago and knew what he really had the knowledge and the network. He had a big scar on his left hand. "What happened to your left hand?" I asked. "Oh, the surgeon took a vein for my heart. I had quadruple by-pass."
I phoned him to find out what happened and to learn something about the oil industry as Khin Khin asked me whether there is a Malaysian quoted diesel price and that she must pay $99.90 per month to get the price.
INFORMATION
Agent X said that the couple wanted the previous price quoted but this was not possible as they had not locked in with money. The previous price was $580/metric tonne and just today, it was $660 FOB/metric tonne. So, the couple was not happy. This showed that they had did not know how business was done.
Prices are quoted in Singapore at www.bunker.com. Look for MDC (marine diesel oil) for prices.
So there is no separate Malaysian quotation. Prices had gone up as the buyer had not confirmed. At 5,000 metric tonnes, it would be around S$3.5 million and the couple had to get the LC done first. The couple wanted the price to be $500 -$600 which was not possible as at Jun 14, 2010. Agent X had quoted $583 earlier but prices had shot up. I had read in the Straits Times something about diesel prices going sky high and the impact on Singapore's economy a few days ago.
Lock In, the money must be there in the form of the LC.
To confirm, a Letter of Credit (LC) must be opened and made payable to the Seller (Petronas). This means that the Buyer had to put the money into Khin Khin's company. Once the price is agreed, the money will be paid, FOB. If the LC is in the Buyer's bank, then no commission would be likely to be paid to Khin Khin. So, it was important that Khin Khin controlled the money matters.
Commission for Agent X is paid by Khin Khin's company, based on trust. This sounds dicey to me.
Wednesday, June 23, 2010
Skepticism & criticism starting something
Giving Back- Connecting your business and community - Bert Berkley, Peter Economy
Matthew Flannery, cofounder of kiva.org
A business with social mission - giving people access to credit, access to financial systems, the ability to pursue their dreams -- connecting people.
When you don't have reputation or money, it is hard selling people your idea. Lots of skepticism and criticism.
Belief in yourself. Take more risks earlier, more aggressive earlier. Have a vision of a product and a service and an idea of what happens 2 to 3 years in the future. Dedicate to achieve. Build brick by brick, for years and years.
Time and web-hosting bill. Small hidden costs and cost of time.
Volunteers - if they know they make a difference, don't need to motivate them with wards, compensation.
Sustainable business. A business that make a positive impact on the world, not just making money and then giving back.
number of users, number of dollars, delinquency rate and repayment rate.
success - the financial health of the organisation, the burn rate, income, financcial sustainability and qualitative things like morale and happiness of workers
Matthew Flannery, cofounder of kiva.org
A business with social mission - giving people access to credit, access to financial systems, the ability to pursue their dreams -- connecting people.
When you don't have reputation or money, it is hard selling people your idea. Lots of skepticism and criticism.
Belief in yourself. Take more risks earlier, more aggressive earlier. Have a vision of a product and a service and an idea of what happens 2 to 3 years in the future. Dedicate to achieve. Build brick by brick, for years and years.
Time and web-hosting bill. Small hidden costs and cost of time.
Volunteers - if they know they make a difference, don't need to motivate them with wards, compensation.
Sustainable business. A business that make a positive impact on the world, not just making money and then giving back.
number of users, number of dollars, delinquency rate and repayment rate.
success - the financial health of the organisation, the burn rate, income, financcial sustainability and qualitative things like morale and happiness of workers
Tuesday, June 22, 2010
Cherry eye British Bulldog, Male, 4 months
"The seller said to wait till the other eye develops a cherry eye before seeking vet treatment," the gentleman owner told me. "The cherry eye gets bigger over last 2 days." The conjunctiva of upper and lower eyelids was much swollen as well.
This was a referral case from a breeder in Pasir Ris.
ANAESTHESIA
Short nosed breed - need to be careful.
Isoflurane gas by mask worked very well.
SURGERY
1. Under general anaesthesia, wash all pus off the left eye.
2. I injected 0.1 ml gentamycin and pred into swollen subconjunctiva
3. Clamped the everted gland.
4. Incise above clamp.
5. Release clamp.
6. Profuse bleeding for a few seconds. Bleeding will stop.
7. A vet ligates a central blood vessel below clamp so that there will be no bleeding after excision of the gland. I have not tried it. In any case, the bleeding soon stops.
8. Eye drops, antibiotic and painkiller injection. Goes home.
ALTERNATIVE SURGERY
Some vets claim that tacking back the swollen nictitans gland will prevent dry eye later in life as the gland is not excised. However, there is a high failure rate and the owner will not be happy to pay for recurrence. As you can see from the picture, it is good in theory to save the cherry eye but in reality, this alternative surgery is not so simple and effective. As for dogs getting dry eyes in old age when the cherry eye is removed, this is said to be a possibility. How many dog owners are patient enough to come back again for reviews and to pay again and again for a cherry eye treatment? Not many.
This was a referral case from a breeder in Pasir Ris.
ANAESTHESIA
Short nosed breed - need to be careful.
Isoflurane gas by mask worked very well.
SURGERY
1. Under general anaesthesia, wash all pus off the left eye.
2. I injected 0.1 ml gentamycin and pred into swollen subconjunctiva
3. Clamped the everted gland.
4. Incise above clamp.
5. Release clamp.
6. Profuse bleeding for a few seconds. Bleeding will stop.
7. A vet ligates a central blood vessel below clamp so that there will be no bleeding after excision of the gland. I have not tried it. In any case, the bleeding soon stops.
8. Eye drops, antibiotic and painkiller injection. Goes home.
ALTERNATIVE SURGERY
Some vets claim that tacking back the swollen nictitans gland will prevent dry eye later in life as the gland is not excised. However, there is a high failure rate and the owner will not be happy to pay for recurrence. As you can see from the picture, it is good in theory to save the cherry eye but in reality, this alternative surgery is not so simple and effective. As for dogs getting dry eyes in old age when the cherry eye is removed, this is said to be a possibility. How many dog owners are patient enough to come back again for reviews and to pay again and again for a cherry eye treatment? Not many.
108. Perineal hernia repair Boston Terrier 7 years
Case: Boston Terrier, Male, Not neutered, 7 years, 12.4kg
Big swellings besides the anus, the left swelling being bigger.
Difficulty in pooping for past 3 weeks.
A knowledgeable young man who has his own views of dog care.
He presented a Boston Terrier with constipation for the past 3 weeks. He went to Vet 1 who referred him to another vet after taking a blood test as she did not want to perform the surgery. She had given him a laxative for the dog and the dog had passed loose stools instead of hard ones.
"Why don't you see the referred vet?" I asked.
"The Surgery has a bad reputation," the young man had googled the name of the practice he was referred to by Vet 1. "There is a very bad complaint about the vets from one dog owner. So I better not go there."
"All veterinary practices will have one or two nasty complaints about service," I educated this young man. "The busier the practice, the higher the chances of getting complaints. This is because the vet has no time to handle each case as thoroughly as he or she would love to. This applies to over-worked doctors in human medicine too especially in the emergency wards."
VACCINATION HISTORY MUST BE ASKED
"Has your dog been vaccinated?" I asked.
"No vaccination for the past few years. Do you have parvovirus in your Surgery?" the young man asked me.
"Fortunately for your dog, my practice does not have parvo-viral cases for many months as I seldom provide service to the dog breeders nowadays. You have taken a big risk exposing your dog the risk of parvoviral and canine distemper infections."
PRE-OP BLOOD TEST IMPORTANT FOR OLD DOGS BEFORE SURGERY
I checked Vet 1's blood test results. It is wise not to trust the blood results of other practices based on one of my experiences (see one case I had written). However, he had paid $130 for the test and I would not insist as that would increase his vet bills. Overall, the dog was examined and was healthy. So I took the chance.
ANAESTHESIA
IV saline given. Then I gave Atropine 0.4 ml IV followed by Domitor 0.2 ml IV
Waited 10 minutes. Isoflurane gas mask. Dog struggled. So, I gave Zoletil 100 @ 0.1 ml IV. This sedated the dog who was masked and given isoflurane gas at 5%. The dog slept and was intubated. Isoflurane at 1-2% maintenance was done by my experienced assistant, Mr Saw. I asked him to increase the dose when the pelvic fat kept coming out from the hernia after pushing the fat into the abdominal cavity. The dog recovered smoothly.
SURGERY
I gave him antibiotics to take and schedule perineal hernia surgery 2 days later. The surgery took nearly an hour as the hernia was large. The hernia bulge with pelvic fat is large, around 4 cm x 6 cm. An electro-incision made a big cut to the left of the anus.
It was difficult to identify the medial coccygeal and levator ani muscles in this case as there is a lot of inflammation. The internal pudendal artery and vein and the pudendal nerve on the dorsal surface of the internal obturator muscle looked compressed as I showed to my assistant Mr Saw who nodded his head. Judging from his eyes, he did not believe they were what I said.
Is there a right perineal hernia too?
Electro-incision. Big amount of pelvic fat. A retractor enabled me to have a good field of view to stitch up the defect
See the big hole through which part of the colon and pelvic fat herniated through causing a big backside swelling
Left perineal hernia repaired. Neutering in 3-4 weeks if the owner wants to do it. The right perineal hernia may need to be repaired later.
The internal obturator muscle is on the ventral aspect of the pelvic diaphragm. This was a big fatty mass horizontally covering the muscle, unlike the no-fat muscles illustrated in Small Animal Surgery, T.W. Fossum 1997, pg 354.
I used a retractor to spread open up the operating area and to see the pudendal vessels and nerve just above the obturator muscles in this case. Do not stitch these vessels or nerves.
POST-OP
Dog woke up fast. Given tolfedine painkillers.
TWO HERNIAS TO BE OPERATED AT ONE GO
I doubt that it is possible to do two hernias at one go as the muscle stitching on one side (i.e. left hernia in this case) pulled the left anal area tightly to cover the herniated hole. Therefore doing two hernia repair at the same time just is not in the interest of the dog as he will feel very uncomfortable and painful.
LOOSE STOOLS leaking out from the anus. This must be plugged. The dog had been given an oil laxative by Vet 1 for 3 days and the loose stools start to come out despite atropine injection.
CONCLUSION
The dog was OK and was warded for at least 4 days as the owner did not have a crate to prevent the dog running loose. I checked the dog every day to ensure that he had proper nursing care and pain-killers. The boy's parents came to visit the dog yesterday. The dog should be back home after 7 days. He had managed to rub his backside onto the floor of the crate despite tolfedine 60 mg at half a tablet per day for 3 days. I decided to give him 1/4 dose of a 30mg phenobarb and then Rimadryl for another 3 days to prevent pain and inflammation.
P.S
1. Yearly vaccination is important. Fortunately this dog did not get infected with parvoviral disease in the practice of Vet 1 which is a very busy practice and in my surgery. Otherwise, I end up with a dog passing blood in the stools and dying later. At the time of writing this report, it is still early at Day 5 after visiting Vet 1. Parvoviral signs come in around 10-14 days after infection.
2. "Neutering the dog when he was younger would have decreased the chances of him getting perineal hernia," I said. "Perineal hernia is more common in non-neutered dogs." The young man said: "It is cruel and that is why I don't do it." He has been advised to neuter the dog around 2-4 weeks later. As for the right perineal hernia, it is a smaller one. Wait and see. If the dog is neutered and there is
no more swelling in the backside, then there is no need to do a right perineal hernia repair.
3. High anaesthetic risks. I don't enjoy doing high anaesthetic risk surgeries as they are very stressful for me. If the dog survives, everybody is pleased. There will be deaths and the owners may be very emotional and angry. Some may post a nasty complaint in the internet. To minimise risks of deaths of old dogs on the operating table, I don't force myself to perform hernia repair and neutering at the same time. The owner has to appreciate that I don't take risks unnecessary.
Detailed report at www.toapayohvets.com
Monday, June 21, 2010
107. Lateral ear resection
Patient: English Cocker Spaniel, Male, Neutered, 5 years. Gentle dog. No Cocker Rage.
Complaint: Head shaking for several weeks. Dark red ear wax in horizontal canal. Groomer could not resolve this problem.
Solution: I advised surgery to open up the vertical ear canal so that the trapped water and debris inside the canals can flow out easily in the long term. The couple in their 40s knew what I was talking about and agreed to the surgery.
ANAESTHESIA
Jun 21, 2010. Anaesthesia and Surgery took over one hour.
Pre-anaesthetic dose Domitor 0.25 ml IV. Waited 5 minutes. Isoflurane gas. Intubate. "How about Zoletil IV?" my assistant Mr Saw asked as in the recent debarking case, I had used both.
"It is best not to give more sedation drugs than necessary. I will be using isoflurane which is safest," I advised him. "Less sedation drugs, less likely to get anaesthetic deaths. If I use Zoletil, I will need to use Atropine to prevent salivation and muscle tremors. Then I need to top up as this surgery is going to be longer than debarking as I have two ear surgeries to do. That means I still need isoflurane gas to maintain surgical anaesthesia."
Pre-anaesthetic sedation using one drug and isoflurane gas is the safest method of anaesthesia for dogs and I use this method frequently. In debarking, I had no choice but to use injectable anaesthetics and there was the hassle of topping up via the IV catheter. For gas anaesthesia, just increase the dosage and that is so convenient when the dog is intubated and given gas. For injectable anaesthetic top up, it is given by small doses via the saline drip. It is quite convenient too but nothing is as safe as the isoflurane gas.
"Any surgery consent forms to sign?" the owner had asked me earlier. "The owner can sign forms for the vet. The important thing is that the dog does not die on the operating table." Usually I assess the dog's health and the owner's personality and I seldom give them forms to sign. But I have always communicated to them the risks of anaesthetic deaths. Consent forms are common even in human anaesthesia and surgery at the Singapore hospitals.
Performance (a live dog at the end of surgery) counts a lot. I cannot be complacent as one anaesthetic death creates massive waves of emotional upheavals in the owners and the family. This English Cocker Spaniel is healthy but still no vet can guarantee the owner that the dog will not die on the operating table.
SURGICAL PROCEDURE
1. Clipped skin of ear to the base, not just partly. My assistant had to shave more, increasing the anaesthetic time. Put artery forceps to base of vertical canal to identify the location.
2. Draw the outline of the surgical area from base of vertical canal and add 50% more length (see picture).
3. Electro-incision of rectangular outline.
4. Excise subcutaneous fat to see the vertical canal.
5. Be careful of a big vein posterior to the vertical canal. If cut, ligate this vein. Elevate cut skin upwards to see the subcutaneous fat.
6. Angle forceps at 30 degrees downwards and outwards so that the drainage board is wide and clamp anterior and posterior edges of vertical canal.
7. Electro-incision on clamped groove.
8. Scissors to cut.
9. Lower the cartilage. Cut cartilage long enough to anchor it to base of skin. I stitched at the horizontal canal level first. 2/0 absorbable sutures were used.
10. Pictures to illustrate the surgical procedures are presented in:
www.asiahomes.com/singaporetpvet/dogs/0750Schnauzer_lateral_ear_resection_Singapore.htm
POST-OPERATION CARE
Tolfedine painkiller injection after surgery and orally for the next 4 days were quite effective in controlling the pain. Dosage was 4mg/kg whether by injection or oral. An e-collar was given.
I asked the owners to take the dog home on Day 4 to reduce costs for them. Ideally I would like to keep the dog for 10 days to ensure complete healing but there is always the increase in veterinary costs for the owner and this may not be in their interest.
"The left ear has a stitch breakdown on the lower right side," I said to the couple. It will close. Do not wipe the wound. The stitches will dissolve usually. I need to review in 14 days from today."
Complaint: Head shaking for several weeks. Dark red ear wax in horizontal canal. Groomer could not resolve this problem.
Solution: I advised surgery to open up the vertical ear canal so that the trapped water and debris inside the canals can flow out easily in the long term. The couple in their 40s knew what I was talking about and agreed to the surgery.
ANAESTHESIA
Jun 21, 2010. Anaesthesia and Surgery took over one hour.
Pre-anaesthetic dose Domitor 0.25 ml IV. Waited 5 minutes. Isoflurane gas. Intubate. "How about Zoletil IV?" my assistant Mr Saw asked as in the recent debarking case, I had used both.
"It is best not to give more sedation drugs than necessary. I will be using isoflurane which is safest," I advised him. "Less sedation drugs, less likely to get anaesthetic deaths. If I use Zoletil, I will need to use Atropine to prevent salivation and muscle tremors. Then I need to top up as this surgery is going to be longer than debarking as I have two ear surgeries to do. That means I still need isoflurane gas to maintain surgical anaesthesia."
Pre-anaesthetic sedation using one drug and isoflurane gas is the safest method of anaesthesia for dogs and I use this method frequently. In debarking, I had no choice but to use injectable anaesthetics and there was the hassle of topping up via the IV catheter. For gas anaesthesia, just increase the dosage and that is so convenient when the dog is intubated and given gas. For injectable anaesthetic top up, it is given by small doses via the saline drip. It is quite convenient too but nothing is as safe as the isoflurane gas.
"Any surgery consent forms to sign?" the owner had asked me earlier. "The owner can sign forms for the vet. The important thing is that the dog does not die on the operating table." Usually I assess the dog's health and the owner's personality and I seldom give them forms to sign. But I have always communicated to them the risks of anaesthetic deaths. Consent forms are common even in human anaesthesia and surgery at the Singapore hospitals.
Performance (a live dog at the end of surgery) counts a lot. I cannot be complacent as one anaesthetic death creates massive waves of emotional upheavals in the owners and the family. This English Cocker Spaniel is healthy but still no vet can guarantee the owner that the dog will not die on the operating table.
SURGICAL PROCEDURE
1. Clipped skin of ear to the base, not just partly. My assistant had to shave more, increasing the anaesthetic time. Put artery forceps to base of vertical canal to identify the location.
2. Draw the outline of the surgical area from base of vertical canal and add 50% more length (see picture).
3. Electro-incision of rectangular outline.
4. Excise subcutaneous fat to see the vertical canal.
5. Be careful of a big vein posterior to the vertical canal. If cut, ligate this vein. Elevate cut skin upwards to see the subcutaneous fat.
6. Angle forceps at 30 degrees downwards and outwards so that the drainage board is wide and clamp anterior and posterior edges of vertical canal.
7. Electro-incision on clamped groove.
8. Scissors to cut.
9. Lower the cartilage. Cut cartilage long enough to anchor it to base of skin. I stitched at the horizontal canal level first. 2/0 absorbable sutures were used.
10. Pictures to illustrate the surgical procedures are presented in:
www.asiahomes.com/singaporetpvet/dogs/0750Schnauzer_lateral_ear_resection_Singapore.htm
POST-OPERATION CARE
Tolfedine painkiller injection after surgery and orally for the next 4 days were quite effective in controlling the pain. Dosage was 4mg/kg whether by injection or oral. An e-collar was given.
I asked the owners to take the dog home on Day 4 to reduce costs for them. Ideally I would like to keep the dog for 10 days to ensure complete healing but there is always the increase in veterinary costs for the owner and this may not be in their interest.
"The left ear has a stitch breakdown on the lower right side," I said to the couple. It will close. Do not wipe the wound. The stitches will dissolve usually. I need to review in 14 days from today."
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