E-MAIL FROM DR SING DATED SEP 29, 2011
Dear Dr ....
Thank you for taking the time to email to me. The following is my clinical research proposal which is of practical value for the health of dogs and cats in Singapore.
Presently, each vet practice in Singapore has its own blood testing machines or send the blood samples to Quest Lab which focuses on human medicine. The normal range of blood values vary greatly and are provided by the commercial people selling the machines or from some values published in veterinary books usually in the U.S.
For Quest Lab, the normal range given in their report is said to be for dogs and cats but since it is not a laboratory focused on veterinary medicine, I have not been able to find out from its staff where its reference values are sourced from.
Therefore I have had proposed a research project with Mr ... of .... Poly Veterinary to get a statistically significant sample of normal dogs and cats in Singapore to produce the blood values. This means working together with the bio-statistics department or a department that does clinical research to set up the research protocols to produce a scientific paper and statistically significant blood values for the normal Singapore dogs and cats.
Please let me know when you will be free to meet to discuss further.
Thursday, September 29, 2011
641. Eye injuries are emergencies. Do not wait.
E-MAIL TO DR SING DATED THURSDAY SEP 29, 2011
Attn: Dr Sing - Regarding XXX's condition
show details 10:35 PM (6 hours ago)
Dear Dr Sing,
I visited your practice on the 16th of September, Sunday due to an ulcer recurrence in my dog, XXX's right eye. I first came in because he was squinting in his right eye for a few days and there was discharge. Dr Vanessa and yourself checked both his eyes with fluorescein stain and diagnosed it to be an ulcer and some scratches in the right eye, while his left eye was clear with no problems. Surgery was done to stitch up his eyelids and i was to come back in a week's time for review and another time in 14 days(02/09) for removal of stitches.
I came back on the following Sunday for Dr Vanessa to take a look at XXX and told her a problem that XXX had a few days after surgery - his left eye seemed problematic, there was a lot of discharge and he couldn't open his eye properly. She said to apply eyedrops and that another fluorescein stain test would be done next week again to see if there is an actual problem (it was not done that day because she said it is not good to do the test so many times in a short period).
Til today(23/09), i have been doing as told and his left eye does not seem to be getting better. He can barely open it, and there is still alot of discharge. Even after flushing it with saline, the discharge appears again in a few seconds. Today, i noticed that his right eye opened and i guessed it is because the stitches are dissolving, though the stitches are still on his eyelid. His right eyelids are swollen, and he still has trouble opening his right eye. I am not sure how much it has healed as it seems like how it was before surgery.
On the 10th of March this year, he had the same surgery done to his right eye, and right after removing the stitches 14 days later, you commented that the cloudiness has cleared by 50 percent. Thereafter, recovery was very good and both eyes were big, bright and clear. This time, the process is very different. His right eye does not seem to be healing well. He seems weak, lifeless and appetite has not been as good as it was before surgery.
I am certain that i have done the same things and have taken care of him the same way I did back in March. E-collar is put on 24 hours every day, medication is given daily, and i took extra care to separate him from the other dog at home. Because of his condition, i am constantly distressed and worried.
The purpose of writing to you is to let you know what has been going on with XXX. I hope that you can help. I will be at your practice this Sunday morning. Thanks for your time in reading my email.
Regards,
Name
E-MAIL REPLY FROM DR SING DATED THURSDAY SEP 29, 2011 4.42 AM
Thank you for your e-mail and excellent report of XXX's health. Eye injuries are emergencies and ulcers are best treated within 24 hours of injury.
1. Pl bring your dog to see me today, Thursday Sep 29, 2011, not Sunday, as what you described in your email is serious eye injuries in Russell. .
2. Separation of your dog from the other dog. By separation, I mean 100% total separation as advised and not even one minute of meeting each other at any one time. This is because the other dog would have licked Russell's eyes. The other eye could have been injured and become ulcerated. This would be likely what had had happened, in my opinion. I recalled that you had agreed to isolate Russell in the bedroom all at least 14 days. Did Russell "escape" out to play with the other dog or did the other dog enter the bedroom?
3. Please bring your dog in immediately today Thursday Sep 29, 2011 for me to assess urgently.
I checked my records. The case done earlier is at:
http://www.sinpets.com/dogs/20110317corneal-ulcers-dog-tarsorrhapy-3rd-eyelid-flap-toapayohvets.htm
Attn: Dr Sing - Regarding XXX's condition
show details 10:35 PM (6 hours ago)
Dear Dr Sing,
I visited your practice on the 16th of September, Sunday due to an ulcer recurrence in my dog, XXX's right eye. I first came in because he was squinting in his right eye for a few days and there was discharge. Dr Vanessa and yourself checked both his eyes with fluorescein stain and diagnosed it to be an ulcer and some scratches in the right eye, while his left eye was clear with no problems. Surgery was done to stitch up his eyelids and i was to come back in a week's time for review and another time in 14 days(02/09) for removal of stitches.
I came back on the following Sunday for Dr Vanessa to take a look at XXX and told her a problem that XXX had a few days after surgery - his left eye seemed problematic, there was a lot of discharge and he couldn't open his eye properly. She said to apply eyedrops and that another fluorescein stain test would be done next week again to see if there is an actual problem (it was not done that day because she said it is not good to do the test so many times in a short period).
Til today(23/09), i have been doing as told and his left eye does not seem to be getting better. He can barely open it, and there is still alot of discharge. Even after flushing it with saline, the discharge appears again in a few seconds. Today, i noticed that his right eye opened and i guessed it is because the stitches are dissolving, though the stitches are still on his eyelid. His right eyelids are swollen, and he still has trouble opening his right eye. I am not sure how much it has healed as it seems like how it was before surgery.
On the 10th of March this year, he had the same surgery done to his right eye, and right after removing the stitches 14 days later, you commented that the cloudiness has cleared by 50 percent. Thereafter, recovery was very good and both eyes were big, bright and clear. This time, the process is very different. His right eye does not seem to be healing well. He seems weak, lifeless and appetite has not been as good as it was before surgery.
I am certain that i have done the same things and have taken care of him the same way I did back in March. E-collar is put on 24 hours every day, medication is given daily, and i took extra care to separate him from the other dog at home. Because of his condition, i am constantly distressed and worried.
The purpose of writing to you is to let you know what has been going on with XXX. I hope that you can help. I will be at your practice this Sunday morning. Thanks for your time in reading my email.
Regards,
Name
E-MAIL REPLY FROM DR SING DATED THURSDAY SEP 29, 2011 4.42 AM
Thank you for your e-mail and excellent report of XXX's health. Eye injuries are emergencies and ulcers are best treated within 24 hours of injury.
1. Pl bring your dog to see me today, Thursday Sep 29, 2011, not Sunday, as what you described in your email is serious eye injuries in Russell. .
2. Separation of your dog from the other dog. By separation, I mean 100% total separation as advised and not even one minute of meeting each other at any one time. This is because the other dog would have licked Russell's eyes. The other eye could have been injured and become ulcerated. This would be likely what had had happened, in my opinion. I recalled that you had agreed to isolate Russell in the bedroom all at least 14 days. Did Russell "escape" out to play with the other dog or did the other dog enter the bedroom?
3. Please bring your dog in immediately today Thursday Sep 29, 2011 for me to assess urgently.
I checked my records. The case done earlier is at:
http://www.sinpets.com/dogs/20110317corneal-ulcers-dog-tarsorrhapy-3rd-eyelid-flap-toapayohvets.htm
Wednesday, September 28, 2011
640. Referrals from high-quality clientele
I witnessed an unusual style of management and advised my friend according to the e-mail as follows:
Yesterday, I was at your office and saw your style of leadership. It reminded me of a newspaper report in which the boss (father) of a big company has a habit of scolding his staff. His son was made managing director and could not get along well with some senior staff who resigned. From what I read in the newspapers, I assumed that the father must have had scolded and shouted at the son in front of the staff, as this is his usual management practice. The son who is well qualified and experienced in working for other big companies had returned to his father's business. The son resigned immediately. "Scolding and shouting at staff" is an old management practice which is not well accepted by the younger generation in Singapore and in other countries, from what I know.
It is not going to help you be successful in business if you continue with a similar style of management I described above. I saw you intervening during your Operations Manager's interview with an applicant, "scolding" the applicant in front of everybody saying you prefer not to accept her as she would cause trouble later to the agency.
For that particular "too smart" applicant asking a lot of questions, I will consider her a good prospective employee. It is best for a prospective employee to ask many questions from the employment agent before getting a suitable employer. This means she will not want to keep changing employers and that is good for the employment agency too.
It is common for an applicant to ask for the highest salary especially when they have Master's degree and a few years of work experience. So they become time-consuming pests, taking up much of the employment agency's time during the interview qualification.
As to whether the "too smart" applicant will cause trouble to the agency later, I don't agree with you as we cannot foresee the future. If you do a good job and follow the laws of the Ministry Of Manpower, knowing what to do in the processes, there will be little trouble. I will say that a "too-smart" applicant, if well serviced will provide more good quality referrals to you as that is her circle of friends.
Referrals are what most business survive on in the long term. And what a business want is high quality clientele. As a vet, I will wish to have high quality clientele who ask me a lot of questions about her pet rather than one who wants the lowest price in town and a service that cause me to lose money.
As a start up, if you keep on "scolding" applicants and staff, you will find that your business will not grow as staff do not stay long and applicants prefer not to do business with your company. You can blame every staff who resigns as not good staff. But in the end, it is the quality of leadership that makes or breaks a business. And that means retaining experienced staff.
I hope this e-mail will not make you angry. Staff management is a big headache for all companies but you can't do a business without staff.
Best wishes.
Yesterday, I was at your office and saw your style of leadership. It reminded me of a newspaper report in which the boss (father) of a big company has a habit of scolding his staff. His son was made managing director and could not get along well with some senior staff who resigned. From what I read in the newspapers, I assumed that the father must have had scolded and shouted at the son in front of the staff, as this is his usual management practice. The son who is well qualified and experienced in working for other big companies had returned to his father's business. The son resigned immediately. "Scolding and shouting at staff" is an old management practice which is not well accepted by the younger generation in Singapore and in other countries, from what I know.
It is not going to help you be successful in business if you continue with a similar style of management I described above. I saw you intervening during your Operations Manager's interview with an applicant, "scolding" the applicant in front of everybody saying you prefer not to accept her as she would cause trouble later to the agency.
For that particular "too smart" applicant asking a lot of questions, I will consider her a good prospective employee. It is best for a prospective employee to ask many questions from the employment agent before getting a suitable employer. This means she will not want to keep changing employers and that is good for the employment agency too.
It is common for an applicant to ask for the highest salary especially when they have Master's degree and a few years of work experience. So they become time-consuming pests, taking up much of the employment agency's time during the interview qualification.
As to whether the "too smart" applicant will cause trouble to the agency later, I don't agree with you as we cannot foresee the future. If you do a good job and follow the laws of the Ministry Of Manpower, knowing what to do in the processes, there will be little trouble. I will say that a "too-smart" applicant, if well serviced will provide more good quality referrals to you as that is her circle of friends.
Referrals are what most business survive on in the long term. And what a business want is high quality clientele. As a vet, I will wish to have high quality clientele who ask me a lot of questions about her pet rather than one who wants the lowest price in town and a service that cause me to lose money.
As a start up, if you keep on "scolding" applicants and staff, you will find that your business will not grow as staff do not stay long and applicants prefer not to do business with your company. You can blame every staff who resigns as not good staff. But in the end, it is the quality of leadership that makes or breaks a business. And that means retaining experienced staff.
I hope this e-mail will not make you angry. Staff management is a big headache for all companies but you can't do a business without staff.
Best wishes.
Monday, September 26, 2011
639. Why 10-12 o'clock ulcer in the left eye of this Miniature Pinscher?
639. Why 10-12 o'clock ulcer in the left eye of this Miniature Pinscher?
Monday, Sep 26, 2011
I review around 50 images of the eyes of the fidgeting Miniature Pinscher whose owner reject injections and anaesthetics as a matter of personal preferences.
The green dye had stained the left eye 10-12 o'clock cornea a zigzagging green. I saw it. The owner saw it. But my camera techniques are lacking in that I can't capture the ulcer clearly in the operating room after application of the dye and doing hand-held. I had one respectable image. What I needed was a reflector but then Sunday was a busy day and I have not organised myself.
This morning at 8.30 am, I went through the 50 images again. Miniature Pinschers don't suffer from eye ulcers unlike the Shih Tzus and the Pekineses. She did have a small central eye ulcer scar of 3mm in diameter in 2006 when the owner first saw me and that was the only time I was consulted.
In retrospect, I must have not made a good impression to retain her services but this is expected for all vets as she lived nearby but went to another practice much further away. In any case, life is like that. Clients will doctor hop whether it is human or veterinary medicine but the vet must do his best in the diagnosis and bedside manners as well as in his receptionist services and other renovations. There are many factors involved in retaining a client's loyalty. A research subject and a book.
In any case, I was surprised that I had not seen the 3 melanomas on the upper eyelid at the 11-1 o'clock position. That is the cause of the ulcer which appeared just below these "melanomas." The 9-year-old spayed female dog felt irritated by these 3x3 mm lumps and must have tried to scratch them off. So, there was the zig zag upper corneal ulcer stained green. Vet 1 and I had not noted these melanomas. For me, the right eye was the main complaint and that was corneal degeneration/dystrophy. But the left eye was not normal as revealed by the green stain of ulcers.
The dog was moving. The owner did not want any sedation nor did I ask since she was not in favour of any injections or anaesthetics. She held the dog tightly. I muzzled the dog. Focus was on the right eye. The green ulcers in the left eye was picked up by the fluorescein dye. But what was the cause? I did say eye rubbing by the dog. The owner said: "I don't see my dog rubbing her eyes. Is the green dye poisonous?" Much of the time had been spent trying to flush away the green dye while the dog avoided by moving her head sideways. The owner tried to syringe the normal saline and said: "I wetted myself". The owner had wanted a male vet to check her dog out. Was it Dr Jason Teo or myself she could not say. It was me 5 years ago and so it was OK with her as she did not want to go to the "referred vet" named in the letter given by Vet 1. She did not believe that there are veterinary eye specialists in Singapore and this is correct.
The "melanomas" were small but could be seen clearly in the image. This shows that visual aids are good for reviews and help to diagnose. Will post the image later. It is time to go to work at 8.54 now and close the computer.
Monday, Sep 26, 2011
I review around 50 images of the eyes of the fidgeting Miniature Pinscher whose owner reject injections and anaesthetics as a matter of personal preferences.
The green dye had stained the left eye 10-12 o'clock cornea a zigzagging green. I saw it. The owner saw it. But my camera techniques are lacking in that I can't capture the ulcer clearly in the operating room after application of the dye and doing hand-held. I had one respectable image. What I needed was a reflector but then Sunday was a busy day and I have not organised myself.
This morning at 8.30 am, I went through the 50 images again. Miniature Pinschers don't suffer from eye ulcers unlike the Shih Tzus and the Pekineses. She did have a small central eye ulcer scar of 3mm in diameter in 2006 when the owner first saw me and that was the only time I was consulted.
In retrospect, I must have not made a good impression to retain her services but this is expected for all vets as she lived nearby but went to another practice much further away. In any case, life is like that. Clients will doctor hop whether it is human or veterinary medicine but the vet must do his best in the diagnosis and bedside manners as well as in his receptionist services and other renovations. There are many factors involved in retaining a client's loyalty. A research subject and a book.
In any case, I was surprised that I had not seen the 3 melanomas on the upper eyelid at the 11-1 o'clock position. That is the cause of the ulcer which appeared just below these "melanomas." The 9-year-old spayed female dog felt irritated by these 3x3 mm lumps and must have tried to scratch them off. So, there was the zig zag upper corneal ulcer stained green. Vet 1 and I had not noted these melanomas. For me, the right eye was the main complaint and that was corneal degeneration/dystrophy. But the left eye was not normal as revealed by the green stain of ulcers.
The dog was moving. The owner did not want any sedation nor did I ask since she was not in favour of any injections or anaesthetics. She held the dog tightly. I muzzled the dog. Focus was on the right eye. The green ulcers in the left eye was picked up by the fluorescein dye. But what was the cause? I did say eye rubbing by the dog. The owner said: "I don't see my dog rubbing her eyes. Is the green dye poisonous?" Much of the time had been spent trying to flush away the green dye while the dog avoided by moving her head sideways. The owner tried to syringe the normal saline and said: "I wetted myself". The owner had wanted a male vet to check her dog out. Was it Dr Jason Teo or myself she could not say. It was me 5 years ago and so it was OK with her as she did not want to go to the "referred vet" named in the letter given by Vet 1. She did not believe that there are veterinary eye specialists in Singapore and this is correct.
The "melanomas" were small but could be seen clearly in the image. This shows that visual aids are good for reviews and help to diagnose. Will post the image later. It is time to go to work at 8.54 now and close the computer.
638. Sunday Sep 25, 2011 - A kitten's generalised ringworm infected the owner
The kitten has generalised ringworm
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
STORY 1
The pet transport man came to get the address to pick up two kittens from The Sails condo at Marina Bay. "Today is F1 day. The road to this condo will be closed," I said. Dr Vanessa will phone the owner to inform her.
The owner who had connections with my old school known to produce "nerds" according to her, had e-mailed to me for a house-call which was done by Dr Vanessa. She brought back a kitten full of ringworm on the skin. As I was around when the owner came, I had a word with her on ringworm. Sometimes it is fun to help the owner know more about their pet's treatment, reinforcing Dr Vanessa's advices and this communication from two vets instead of one makes the owner's visit much more interesting. Most times, I don't introduce myself and am mistaken for the receptionist or vet assistant. This owner had a lot of tattoos which surprised me as she was a young fair lady. She had ringworm lesions on her throat, her thighs and her belly and showed the anatomy to Dr Vanessa and I. Well, this is a modern world and I lifting the blouse to show ringworm lesions in the belly is not immodest.
She showed me a tube of cream to apply to her various ringworm lesions. "I feel so itchy," she said or that was what I heard. Well, she had so many infected skin spots shaped like a ring and ringworm is a very itchy disease. I am surprised that her finger nails have not been infected.
"Normally, the doctor will prescribe a tube of cream. You should ask your doctor to prescribe oral medication if it is widespread," I advised and told her that ringworm is common in Singapore's dogs and cats when she asked. "We are treating your kitten with medication and ringworm washes, but no cream as kittens lick away the cream and poison themselves in the long run."
"Long ago, I had ringworm in my hair when I was an undergraduate in Glasgow University. It was very itchy and took several weeks to be cured. I had to take tablets and de-contaminate my clothing as well. You need to de-contaminate your apartment, brushes and sleeping areas!"
"Can I have some of the tablets you prescribe for the kitten?" she asked.
"No, no," I said. "We are licensed to treat animals, not people. You can speak nicely to your general practitioner and ask for the oral tablets. I am sure he will give them to you." I don't know whether I had heard clearly whether she said she had ringworm in her back. It would be difficult to apply cream there herself. Fortunately, her hair was clear of ringworm.
"I have engaged a pest controller for my apartment," she said.
"They are a waste of money," I said. "You need to personally clean up the apartment daily while the controller comes once. You need to vacuum the corners, wash the brushes and clothing and bed sheets and other. You need to get your other two kittens clipped bald as well as ringworm is contagious. Put your kittens in a carrier and bring them down to the Surgery quickly."
Dr Vanessa said: "I am getting Martin to transport the two kittens to be clipped." But the day chosen was F1 Sunday and so Martin came for nothing. Martin is our pet taxi man.
This reinforcement of Dr Vanessa's advices about ringworm is good for the lady as ringworm is a zoonosis. It may help to retain clientele and that is how a vet practice sustains its profitability. It is not about the individual veterinary ego although most owners prefer the vet that treats their dogs and in this department, Dr Vanessa is dealing with most of them and is the hot favourite.
STORY 2
From the receptionist's counter, I learnt much more about the owner's needs than as a vet. There was one interesting owner, a business man who kept asking me for the bill as he came to get his daughter's dog home from an overnight stay for treatment.
However, Dr Vanessa was in her consultation room discussing another dog treatment with some owners. This took more than 15 minutes and he was getting restless. So I talked to him as I did my work.
"How did you locate Dr Vanessa?" I asked.
"The counter girl at her old practice told me," he said.
"I thought the practice would never reveal as this means a loss of customers." Nowadays, don't expect your staff to be loyal to the employer anymore. It is now more like biting the hand that feeds you as times have changed. It is up to the employer to create loyalty amongst the staff but that is not easy as the younger generation goes to another place for a few dollars more.
"Well," he said. "Dr Vanessa must have been nice to the counter girls."
I agreed with him and asked what occupation he was in as a part of conversation.
"I am retired," he said. "What were you doing before you retired?" I asked. He was a food and beverage man.
"Did you read about the case of the supplier bribing the Chinese restaurant chefs with millions of dollars?" I asked.
"It is still a common practice," he said. "Only that this supplier was caught by the anti-corruption agents. Unlike big hotels that have a purchasing department, Chinese restaurant chefs are in charge of purchasing. So, they ask for money. Otherwise they will reject the seafood as not fresh. If they are bribed, they don't bother with the freshness or the correct weight of the food received. The supplier just increase the price or decrease the weight of the seafood to pay for the bribes!"
It is hard to eradicate corruption even in Singapore with the anti-corruption agency. We talked more about his excellent achievements of his two daughters and property investments during our era of the 1980s when bank loan qualifications were not so stringently controlled by the MAS (Monetary Authority of Singapore), the bureaucrats, the academics and the politicians.
I got a first-hand view of how he did his overseas development business which books will never be able to explain. He was around my generation. Then he asked what I did before becoming a receptionist since I was at the reception counter. "Well," I said. "You can say that I am the original vet as I started this practice."
Finally Dr Vanessa was free for him. "You have kept our friend waiting for a long time," I said to Dr Vanessa. "No, no problem at all," he said and gave Dr Vanessa the name of his business that is very good for her. A Victoria Secrets type of business. Women's business are the best in this world of business, besides property development.
Webpage at:
http://www.sinpets.com/dogs/20110927kitten-generalised-ringworm-shih-tzu-singapore_ToaPayohVets.htm
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
STORY 1
The pet transport man came to get the address to pick up two kittens from The Sails condo at Marina Bay. "Today is F1 day. The road to this condo will be closed," I said. Dr Vanessa will phone the owner to inform her.
The owner who had connections with my old school known to produce "nerds" according to her, had e-mailed to me for a house-call which was done by Dr Vanessa. She brought back a kitten full of ringworm on the skin. As I was around when the owner came, I had a word with her on ringworm. Sometimes it is fun to help the owner know more about their pet's treatment, reinforcing Dr Vanessa's advices and this communication from two vets instead of one makes the owner's visit much more interesting. Most times, I don't introduce myself and am mistaken for the receptionist or vet assistant. This owner had a lot of tattoos which surprised me as she was a young fair lady. She had ringworm lesions on her throat, her thighs and her belly and showed the anatomy to Dr Vanessa and I. Well, this is a modern world and I lifting the blouse to show ringworm lesions in the belly is not immodest.
She showed me a tube of cream to apply to her various ringworm lesions. "I feel so itchy," she said or that was what I heard. Well, she had so many infected skin spots shaped like a ring and ringworm is a very itchy disease. I am surprised that her finger nails have not been infected.
"Normally, the doctor will prescribe a tube of cream. You should ask your doctor to prescribe oral medication if it is widespread," I advised and told her that ringworm is common in Singapore's dogs and cats when she asked. "We are treating your kitten with medication and ringworm washes, but no cream as kittens lick away the cream and poison themselves in the long run."
"Long ago, I had ringworm in my hair when I was an undergraduate in Glasgow University. It was very itchy and took several weeks to be cured. I had to take tablets and de-contaminate my clothing as well. You need to de-contaminate your apartment, brushes and sleeping areas!"
"Can I have some of the tablets you prescribe for the kitten?" she asked.
"No, no," I said. "We are licensed to treat animals, not people. You can speak nicely to your general practitioner and ask for the oral tablets. I am sure he will give them to you." I don't know whether I had heard clearly whether she said she had ringworm in her back. It would be difficult to apply cream there herself. Fortunately, her hair was clear of ringworm.
"I have engaged a pest controller for my apartment," she said.
"They are a waste of money," I said. "You need to personally clean up the apartment daily while the controller comes once. You need to vacuum the corners, wash the brushes and clothing and bed sheets and other. You need to get your other two kittens clipped bald as well as ringworm is contagious. Put your kittens in a carrier and bring them down to the Surgery quickly."
Dr Vanessa said: "I am getting Martin to transport the two kittens to be clipped." But the day chosen was F1 Sunday and so Martin came for nothing. Martin is our pet taxi man.
This reinforcement of Dr Vanessa's advices about ringworm is good for the lady as ringworm is a zoonosis. It may help to retain clientele and that is how a vet practice sustains its profitability. It is not about the individual veterinary ego although most owners prefer the vet that treats their dogs and in this department, Dr Vanessa is dealing with most of them and is the hot favourite.
STORY 2
From the receptionist's counter, I learnt much more about the owner's needs than as a vet. There was one interesting owner, a business man who kept asking me for the bill as he came to get his daughter's dog home from an overnight stay for treatment.
However, Dr Vanessa was in her consultation room discussing another dog treatment with some owners. This took more than 15 minutes and he was getting restless. So I talked to him as I did my work.
"How did you locate Dr Vanessa?" I asked.
"The counter girl at her old practice told me," he said.
"I thought the practice would never reveal as this means a loss of customers." Nowadays, don't expect your staff to be loyal to the employer anymore. It is now more like biting the hand that feeds you as times have changed. It is up to the employer to create loyalty amongst the staff but that is not easy as the younger generation goes to another place for a few dollars more.
"Well," he said. "Dr Vanessa must have been nice to the counter girls."
I agreed with him and asked what occupation he was in as a part of conversation.
"I am retired," he said. "What were you doing before you retired?" I asked. He was a food and beverage man.
"Did you read about the case of the supplier bribing the Chinese restaurant chefs with millions of dollars?" I asked.
"It is still a common practice," he said. "Only that this supplier was caught by the anti-corruption agents. Unlike big hotels that have a purchasing department, Chinese restaurant chefs are in charge of purchasing. So, they ask for money. Otherwise they will reject the seafood as not fresh. If they are bribed, they don't bother with the freshness or the correct weight of the food received. The supplier just increase the price or decrease the weight of the seafood to pay for the bribes!"
It is hard to eradicate corruption even in Singapore with the anti-corruption agency. We talked more about his excellent achievements of his two daughters and property investments during our era of the 1980s when bank loan qualifications were not so stringently controlled by the MAS (Monetary Authority of Singapore), the bureaucrats, the academics and the politicians.
I got a first-hand view of how he did his overseas development business which books will never be able to explain. He was around my generation. Then he asked what I did before becoming a receptionist since I was at the reception counter. "Well," I said. "You can say that I am the original vet as I started this practice."
Finally Dr Vanessa was free for him. "You have kept our friend waiting for a long time," I said to Dr Vanessa. "No, no problem at all," he said and gave Dr Vanessa the name of his business that is very good for her. A Victoria Secrets type of business. Women's business are the best in this world of business, besides property development.
Webpage at:
http://www.sinpets.com/dogs/20110927kitten-generalised-ringworm-shih-tzu-singapore_ToaPayohVets.htm
637. Pemphigus follow up on Sunday Sep 26, 2011
I thank you for your photos emailed on Sep 24, 2011. We met at the Surgery on Sunday Sep 25, 2011. I have had discussed with you further the management of pemphigus in your dog.
An auto-immune disease has no cure and control is by medication that has to be given according to response. There is no fixed formula for medication in auto-immune diseases as dosage depends on response and this can only be known through weekly or regular assessment. Too high a dosage results in kidney damage. Too low a dosage and it does not work.
On Sun, Sep 25, 2011 at 9:24 AM, ...@yahoo.com> wrote:
Dear Dr Sing,
here is an update since the review on last sunday.
the lumps on the paws are getting bigger and started to be smelly for the past few weeks; even the small lump at the mouth is also getting visible and seems growing.
i have attached some photos taken for the mouth, ears & paws.
pls advise.
E-MAIL REPLY FROM DR SING AFTER DISCUSSION WITH THE OWNER
From your feedback of the paws and the right gum swelling, the disease needs a higher dosage of medication for the next 7 days. This dosage depends on response for the next 7 days and frequent monitoring and discussion with the vet.
MANAGEMENT
Washing of the ear flaps and each paws in a bowl of warm water + anti-fungal solution, keeping them very clean and dry, wearing of pad stockings, applying anti-fungal cream to blisters, wearing an e-collar at all times and taking medication of the two immuno-suppressive drugs and antibioics are part of the management of this disease for the next 7 days and beyond.
Best wishes.
An auto-immune disease has no cure and control is by medication that has to be given according to response. There is no fixed formula for medication in auto-immune diseases as dosage depends on response and this can only be known through weekly or regular assessment. Too high a dosage results in kidney damage. Too low a dosage and it does not work.
On Sun, Sep 25, 2011 at 9:24 AM, ...@yahoo.com> wrote:
Dear Dr Sing,
here is an update since the review on last sunday.
the lumps on the paws are getting bigger and started to be smelly for the past few weeks; even the small lump at the mouth is also getting visible and seems growing.
i have attached some photos taken for the mouth, ears & paws.
pls advise.
E-MAIL REPLY FROM DR SING AFTER DISCUSSION WITH THE OWNER
From your feedback of the paws and the right gum swelling, the disease needs a higher dosage of medication for the next 7 days. This dosage depends on response for the next 7 days and frequent monitoring and discussion with the vet.
MANAGEMENT
Washing of the ear flaps and each paws in a bowl of warm water + anti-fungal solution, keeping them very clean and dry, wearing of pad stockings, applying anti-fungal cream to blisters, wearing an e-collar at all times and taking medication of the two immuno-suppressive drugs and antibioics are part of the management of this disease for the next 7 days and beyond.
Best wishes.
Two toilet training advices - a Sheltie puppy and 7-month-old adopted Golden Retriever
Young Sheltie.
Playpen with newspapers occupying 1/3 of the playpen space. The lady owner said this was successful. A couple with the wife being an accountant and the husband being a financial professional. At the reception, I had good discussions about accounting, purchase of an HDB flat and not being allowed to invest in private property for 5 years, the good prospects of accountants, the shortage of auditors, secretarial fees of $600 being said to be amongst the lowest in Singapore, financial leverage in property asset accumulation and property rental investments which the wife is keen on. Vets are encouraged to read financial and property news to be able to carry on such a conversation with some clients like accountants.
An accountant can open his own shop and sign documents if he has been certified by CPA Singapore. "A finance and banking graduate can do insurance," the wife said to me. "But he can't open his own shop," I said. "Insurance professionals setting up a shop requires the person to be qualified as an actuary." An actuary is a professional who deals with the financial impact of risk and uncertainty.
Adopted Golden Retriever
"I used to think that it is cruel to confine the dog," the young lady said to me as this was what Dr Vanessa advised her. She adopted the dog as the other friend did not want him. He peed and pooped all over the kitchen floor and apartment.
"The best is to confine him inside the common bathroom for 2-4 weeks," I advised. "Put feed and water bowls in front. Observe where he sleeps (clean area) and put newspapers to cover his toilet area. Put up a fencing barrier at the door entrance so that the dog can see everybody.
"Or bring the dog out to the garden spot after he wakes up and after breakfast and dinner. Give a routine to this dog and he will eliminate outdoors."
Playpen with newspapers occupying 1/3 of the playpen space. The lady owner said this was successful. A couple with the wife being an accountant and the husband being a financial professional. At the reception, I had good discussions about accounting, purchase of an HDB flat and not being allowed to invest in private property for 5 years, the good prospects of accountants, the shortage of auditors, secretarial fees of $600 being said to be amongst the lowest in Singapore, financial leverage in property asset accumulation and property rental investments which the wife is keen on. Vets are encouraged to read financial and property news to be able to carry on such a conversation with some clients like accountants.
An accountant can open his own shop and sign documents if he has been certified by CPA Singapore. "A finance and banking graduate can do insurance," the wife said to me. "But he can't open his own shop," I said. "Insurance professionals setting up a shop requires the person to be qualified as an actuary." An actuary is a professional who deals with the financial impact of risk and uncertainty.
Adopted Golden Retriever
"I used to think that it is cruel to confine the dog," the young lady said to me as this was what Dr Vanessa advised her. She adopted the dog as the other friend did not want him. He peed and pooped all over the kitchen floor and apartment.
"The best is to confine him inside the common bathroom for 2-4 weeks," I advised. "Put feed and water bowls in front. Observe where he sleeps (clean area) and put newspapers to cover his toilet area. Put up a fencing barrier at the door entrance so that the dog can see everybody.
"Or bring the dog out to the garden spot after he wakes up and after breakfast and dinner. Give a routine to this dog and he will eliminate outdoors."
A 16-year-old Golden Retriever with thyroid tumour and a 10-year-old Shih Tzu with oral tumours.
CASE 1
"It is best to ask the family to wait outside," I said to Dr Vanessa who wanted to catetherise the vein to euthanase the old Golden Retriever in the presence of a family of around 8 sad members inside the consultation room.
Earlier, a lady had phoned about the cost of euthanasia and subsequent preparations for cremation. As Dr Vanessa was very busy on this Sunday Sep 26, 2011 such that she had no time for lunch, I spoke to the lady. If Dr Vanessa answered every phone query, her cases would be delayed and it would be past 7 pm before anybody can go home on this fine Sunday. We close at 5 pm on weekends and from Min, I was told that last Sunday's cases were completed at 7 pm. I was not around and so did not know why but this would have to do with the vet's management of case flow, answering of client queries and surgeries being done on a Sunday.
Anaesthesia and surgeries do take up some time and there were two (dental extraction of a foul-smelly old Jack Russell Cross and skin wart removal of a Shih Tzu) on this Sunday. In between consultations, the vet may have to answer phone calls and if this can be done by an experienced receptionist, it would be fine but sometimes the technical questions may be best answered by the vet.
In this case of the Golden Retriever, it would be much kinder to euthanase as he was not eating and had lost weight. The dog did not want to get up to walk to the consultation room but was finally persuaded to do so. I could see that it was very emotional situation especially for one lady who had spoken to me earlier.
The best way to handle such a case is not to euthanase the dog in front of all grieving members of the family. Some dogs react to the lethal injection by screaming and some lose control of their bladder and bowels or vomit. Such a scene is not pleasant for the owners. So I advised the family members to leave the consultation room and go outside as the old dog could sense their grief, in my observation and might be more stressed.
In this case, the owners said good bye to the dog and waited outside the Surgery. I advised a Domitor+Ketamine IM sedation first and euthanasia injection after 10 minutes. The dog passed away peacefully. The lady who cared most for this dog came to say good bye.
CASE 2.
I was at the reception area when somebody inside the consultation room bashed his fist at the wall separating the reception area and the consultation room. A dog had been euthanased by Dr Vanessa and the family members of parents and adult children were inside.
"What's happening to your clients inside the consultation room?" I searched for Dr Vanessa who was inside the Surgery to do the dental scaling and extraction. "I just heard a loud bang against the gypsum board wall." This wall is not solid brick wall and I can't afford to let clients bang till it collapses.
Dr Vanessa did not hear the loud bang. She said: "They are waiting for the cremation man and are preparing prayers for the euthanased dog." I had not seen this case. The father brought in some leaves and I thought a pineapple. The cremation man came and I quickly got him into the consultation room. Dr Vanessa came soon. Later the father told me that the dog had oral tumours which could not be cured.
Regular dental care and scaling usually prevents oral tumours but few Singaporean dog owners bother with dental health of their dogs. More are getting dental check up and scaling done on old dogs. The best is to get dental check up yearly but older dogs are generally left alone after the initial burst of attention when they are puppies.
"It is best to ask the family to wait outside," I said to Dr Vanessa who wanted to catetherise the vein to euthanase the old Golden Retriever in the presence of a family of around 8 sad members inside the consultation room.
Earlier, a lady had phoned about the cost of euthanasia and subsequent preparations for cremation. As Dr Vanessa was very busy on this Sunday Sep 26, 2011 such that she had no time for lunch, I spoke to the lady. If Dr Vanessa answered every phone query, her cases would be delayed and it would be past 7 pm before anybody can go home on this fine Sunday. We close at 5 pm on weekends and from Min, I was told that last Sunday's cases were completed at 7 pm. I was not around and so did not know why but this would have to do with the vet's management of case flow, answering of client queries and surgeries being done on a Sunday.
Anaesthesia and surgeries do take up some time and there were two (dental extraction of a foul-smelly old Jack Russell Cross and skin wart removal of a Shih Tzu) on this Sunday. In between consultations, the vet may have to answer phone calls and if this can be done by an experienced receptionist, it would be fine but sometimes the technical questions may be best answered by the vet.
In this case of the Golden Retriever, it would be much kinder to euthanase as he was not eating and had lost weight. The dog did not want to get up to walk to the consultation room but was finally persuaded to do so. I could see that it was very emotional situation especially for one lady who had spoken to me earlier.
The best way to handle such a case is not to euthanase the dog in front of all grieving members of the family. Some dogs react to the lethal injection by screaming and some lose control of their bladder and bowels or vomit. Such a scene is not pleasant for the owners. So I advised the family members to leave the consultation room and go outside as the old dog could sense their grief, in my observation and might be more stressed.
In this case, the owners said good bye to the dog and waited outside the Surgery. I advised a Domitor+Ketamine IM sedation first and euthanasia injection after 10 minutes. The dog passed away peacefully. The lady who cared most for this dog came to say good bye.
CASE 2.
I was at the reception area when somebody inside the consultation room bashed his fist at the wall separating the reception area and the consultation room. A dog had been euthanased by Dr Vanessa and the family members of parents and adult children were inside.
"What's happening to your clients inside the consultation room?" I searched for Dr Vanessa who was inside the Surgery to do the dental scaling and extraction. "I just heard a loud bang against the gypsum board wall." This wall is not solid brick wall and I can't afford to let clients bang till it collapses.
Dr Vanessa did not hear the loud bang. She said: "They are waiting for the cremation man and are preparing prayers for the euthanased dog." I had not seen this case. The father brought in some leaves and I thought a pineapple. The cremation man came and I quickly got him into the consultation room. Dr Vanessa came soon. Later the father told me that the dog had oral tumours which could not be cured.
Regular dental care and scaling usually prevents oral tumours but few Singaporean dog owners bother with dental health of their dogs. More are getting dental check up and scaling done on old dogs. The best is to get dental check up yearly but older dogs are generally left alone after the initial burst of attention when they are puppies.
634. Circum-anal tumours in a 14-year-old Shih Tzu
A young couple who came on Sunday Sep 25, 2011 as their vet (Vet 1) had at first said that their dog was too old for surgery to remove growths around the anus. When the growths spilled discharge, Vet 1 decided that surgery was necessary. A flip flop decision can cause a loss of confidence in a dog owner.
"Your dog has circum-anal tumours," I said while Dr Vanessa examined the dog with a stethoscope. "It usually occurs in a old dog, not neutered, old age. In some cases, on a busy day, I do get into the consultation room to do joint consultations with Dr Vanessa.
The young lady smiled. I was right on 3 counts. "Do you know what is the meaning of circumference?"
The couple nodded as they would have studied this during secondary school in Singapore. "Vet 1 is correct in saying that your dog is 'too old' for surgery - meaning that it is highly risky to operate on your dog as he may die from general anaesthesia. He is already 14 years old and is very old." I told the couple of a 16-year-old Fox Terrier whose circum-anal tumours grew to large sizes such that they cause a lot of bleeding and infection set in. This would be what happen if the dog lives up to a very ripe old age.
A blood test had been taken. This is a very high risk anaesthesia. I spoke to the couple and Dr Vanessa. If the anaesthesia is less than 15 minutes, the old dog seldom dies from anaesthesia. "That means doing the operation in 3 or 4 stages," I said to the couple. "Neuter first to remove the male hormones stimulating the growth of the circum-anal tumours. After 3 weeks, remove the larger tumours within 15 minutes and repeat with the remainder some 4 weeks later."
The tumours had spread under the anal skin from 9-3 o'clock in the upper side. Then at 5 o'clock a large tumour protruded with another small one. I did not take a picture. But this would be a protracted surgery and highly risky. If neutering and Tardak injection shrinks the tumours, then there may be less operating time. But owners and vets need to be patient in the treatment of circum-anal tumours in a very old dog.
"Your dog has circum-anal tumours," I said while Dr Vanessa examined the dog with a stethoscope. "It usually occurs in a old dog, not neutered, old age. In some cases, on a busy day, I do get into the consultation room to do joint consultations with Dr Vanessa.
The young lady smiled. I was right on 3 counts. "Do you know what is the meaning of circumference?"
The couple nodded as they would have studied this during secondary school in Singapore. "Vet 1 is correct in saying that your dog is 'too old' for surgery - meaning that it is highly risky to operate on your dog as he may die from general anaesthesia. He is already 14 years old and is very old." I told the couple of a 16-year-old Fox Terrier whose circum-anal tumours grew to large sizes such that they cause a lot of bleeding and infection set in. This would be what happen if the dog lives up to a very ripe old age.
A blood test had been taken. This is a very high risk anaesthesia. I spoke to the couple and Dr Vanessa. If the anaesthesia is less than 15 minutes, the old dog seldom dies from anaesthesia. "That means doing the operation in 3 or 4 stages," I said to the couple. "Neuter first to remove the male hormones stimulating the growth of the circum-anal tumours. After 3 weeks, remove the larger tumours within 15 minutes and repeat with the remainder some 4 weeks later."
The tumours had spread under the anal skin from 9-3 o'clock in the upper side. Then at 5 o'clock a large tumour protruded with another small one. I did not take a picture. But this would be a protracted surgery and highly risky. If neutering and Tardak injection shrinks the tumours, then there may be less operating time. But owners and vets need to be patient in the treatment of circum-anal tumours in a very old dog.
633. Cost to spay a cat at Toa Payoh Vets
Just picked up a stray.
Please tell me what the cost is to spay.
Thanks
Owner
E-MAIL REPLY FROM DR SING DATED SEP 26, 2011
For a cat, the spay is $100. The estimated cost will be around $150 including anaesthestic, spay surgery and post-op antibiotic and pain-killer injection and tablets. E-collar is excluded.
- Show quoted text -
Please tell me what the cost is to spay.
Thanks
Owner
E-MAIL REPLY FROM DR SING DATED SEP 26, 2011
For a cat, the spay is $100. The estimated cost will be around $150 including anaesthestic, spay surgery and post-op antibiotic and pain-killer injection and tablets. E-collar is excluded.
- Show quoted text -
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