Today is Wednesday. On Sunday, the young couple from Bukit Panjang brought a 4-year-old male neutered Maltese to consult me. Late in the night, the dog suddenly went to a corner to hide. "He was restless and reluctant to walk," the young lady said. "He panted but could walk."
So the owner took him to an emergency clinic on that Saturday. Tramadol and meloxicam inj and SC drip were given.
Fever was present. She was told to monitor the breathing closely and keep JJ in a cool place and ensure access to water and to see her regular vet the next day. The owner was worried about tick fever as she had plucked out a fat mother tick 2 weeks ago from the dog. Also the dog is not on anti-tick spot on medication but never had tick problems.
The first blood test taken on Jul 21, 2012 at 8.54 pm showed high RBC, HCT and Hb and low MCHC. Other results were normal.
On Sunday morning, I saw the dog at 10 am. The dog still had fever at 40C. "The high RBC and Hb is a concern. I need another blood test to check," I asked for permission as the lady thought that the dog was dehydrated. Clients are much more sophisticated with the internet nowadays.
Other than fever, JJ had some pain on his back spinal area. He gave a soft "ha" when I pressed the spinal area between T7-13 and this effect could be reproduced as the owner could hear it too. "Did the vet check on this?" I asked. "Yes," she said. "She did it in a different way." No abdominal pain could be found but the dog was already given painkillers yesterday.
"There is some pain, now muffled by the use of Tramadol and meloxicalm painkiller injections given yesterday," I said. "Did the dog fall on his back?"
The dog could have tripped. For the pat 4 years, he hoped over the concrete bar to go inside the toilet for around 5x/day. Over 4 years, this would be over 6,000 hops and punishing to the spinal column. Pain --- panting --- leads to "fever".
2ND BLOOD TEST
July 22, 2012 10 am
The second blood test showed normal RBC, HCT and Hb and MCHC. "RBC, HCT and Hb" are on the higher side of the normal range," I explained. "MCHC was on the lower side of the normal range. " Other results were normal.
"The bad news is that the liver enzymes are high ALt 219( normal <59) and AST 196 (<81)," I said. "There could be hepatitis just starting and so the total WCC did not go up. However, the neutrophils are 77% as compared to 56% from the first vet. It is possible that there is a bacterial infection just starting. Since the first vet did not do this test, it would not be known if there was abnormal liver function."
So was this a case of heptititis causing fever? The owner consulted me on Tuesday as the dog was dragging his left hind feet but otherwise energetic and happy and eating. No fever but then he was on anti-fever medication. "The first vet used the hind legs to collect blood," I showed the lady the bruised black area around the hocks. Some vets like to collect blood from the back legs but usually no problem in walking."
Today, Wednesday, I phoned the owner at 5 pm. JJ was ok.
Advised toilet ramp and attention to paw licking. Wear booties? The owner didn't like the idea. I suggested a short-term use of anti-inflam and also trimming and washing the paws.
Conclusion. Cause of liver disorder and hepatitis? Hard to say. The dog was not vaccinated. He was walked daily outdoors by the mum and could have picked up an infection. He could have got infected in the liver from unhealthy dog treats. So, it is difficult to come to a conclusion. LD diet was given for 2 weeks for the liver and we have to wait and see.
Wednesday, July 25, 2012
1809. Vets to write down follow-up tel calls to owners
Sometimes the husband gets the calls and don't communicate with the wife, as in the case of the CKC with closed pyometra. I phoned the husband a few times as his tel is on the case card. The dog was hospitalised 5 days. On the 4th day, the wife phoned the clinic and told me that nobody ever informed her about the health of her dog operated by Dr Daniel Sing. The dog was in good condition.. This was surprising as I had spoken to her husband who knew the seriousness of the case based on blood test with total WCC hitting the roof.
Another owner of a jack russell that vomited phoned and told me that Dr Vanessa had not informed him of the blood test result. But Dr Vanessa said she had. It was her word against the owners.
So, nowadays, all vets will write down date and time of informing the owner in the case file, to avoid misunderstanding. Such feedback is valuable to improve our services and that is why I do answer phone calls to know the ground level.
Complaints about long waiting time and not be seen at the appointed time are another issue that have to be resolved.
Another owner of a jack russell that vomited phoned and told me that Dr Vanessa had not informed him of the blood test result. But Dr Vanessa said she had. It was her word against the owners.
So, nowadays, all vets will write down date and time of informing the owner in the case file, to avoid misunderstanding. Such feedback is valuable to improve our services and that is why I do answer phone calls to know the ground level.
Complaints about long waiting time and not be seen at the appointed time are another issue that have to be resolved.
1809. Toa Payoh Vets Anaesthsia & Surgery Record
Today the printer came with the books. Each of the 4 vets here will be having his own book to record % of isoflurane gas used, time taken, sutures, tranquilisers used. This record will be used in cases of complaints/litigation and each vet will be accountable for his recording.
These records will serve as a check and audit for 'controlled drug' usage and shown to the authorities when needed. Such records are necessary to ensure good management in vet surgery and anaesthesia and it is the responsibility of the licensee vet. For the vets, it means meticulous recording is required and serves as a good defence in cases of litigation/investigation.
These records will serve as a check and audit for 'controlled drug' usage and shown to the authorities when needed. Such records are necessary to ensure good management in vet surgery and anaesthesia and it is the responsibility of the licensee vet. For the vets, it means meticulous recording is required and serves as a good defence in cases of litigation/investigation.
1808. Cambodia Khmao Project
Dear Dr Sing.
Some information about myself and The Khmao Project.
I moved to Cambodia 3 years ago and instantly recognised the plight of animals here, it is extremely difficult not too, regardless of your education and background.
Being a developing country, Cambodia is still coming to terms with genocide, war, widespread corruption and heartbreaking poverty.
Animals in Cambodia that do not have financial value (livestock having monetary value) are not considered companion animals or pets, as they are in western cultures.
They merely exist, and have to fend for themselves for food, shelter, health wise.
Cambodia, being a buddhist country, also does not believe in desexing or an interruption to "the natural order"..therefore euthanasia is also against their beliefs.
Everyday here, you are confronted with neglect on such a massive scale. Hence the need for an animal welfare project here in Siem Reap.
There are Khmer "vets" here, but their level of training is very minimal (if any), this is of great concern, when they can advertise themselves as Veterinarians
The only other western vet is 6 hours away..not great in the case of an emergency!
I also have access to a laboratory at a western run hospital, where I can take various pathology samples in for analysis then I send the results to a vet friend in Australia for diagnosis and a treatment plan. This has proven to be invaluable!
All of the female desexings I refer to Phnom Penh (the capital-6 hours away).
I am lucky that the French vet in Phnom Penh supplies me with antibiotics etc..but these items can prove quite costly as they are imported from France. Obviously the cheaper alternative are available here in Cambodia, but mostly these items are not of great quality,(also are "copy medications, non generic) and have been stored in the correct manner and therefore lose their effectiveness. I try to go to Bangkok as much as possible, (to source anesthetics in particular) but sometimes this is difficult.
About The Khmao Project...
The project is in its infancy stages at the moment. Currently we are treating a small amount of local/stray dogs and cats for various conditions, offering vaccinations, general health care and re homing them to expats once they are healthy.
The plan is to (once we have the appropriate funding) to open a facility with a veterinary clinic,(proceeds of this go back into the project) kennels to house stray dogs and cats, offer desexing, vaccinations, health care. Eventually we would like to have a mobile clinic to go out to the various provinces in Cambodia and continue to offer free treatment to Cambodians.
Obviously once we have the facilities etc we will be asking for volunteer vets from overseas to come and donate their time. We will also be employing local Khmer staff and training them in animal care and husbandry. Eventually we would also like to offer further sustainable training for Cambodian vets by western trained veterinarians.
This is a massive task and we are hoping to be able to achieve this.
If there are ANY items in the future that you would be able to supply..it would be greatly appreciated!
Please feel free to contact me if you have any queries or questions. Hoping soon to face our Facebook page up and running so we can keep you up to date The Khmao Project, if you wish.
Katie Beattie V.N
1808. Too risky pyometra surgery
EMAIL TO DR SING DATED JUL 24, 2012
On Tue, Jul 24, 2012 at 2:17 PM, Jan Cavanwrote:
Hi Dr Yuen,
I was researching about Pyometra and came across your blog. I really need your help. I'm very desperate.
My dog has pyometra, but the vet does not recommend surgery for the following reasons. If they ever perform surgery (when she gets better), they won't do it without injectable anesthesia/complete sedation. But based on your blog, gaseous anesthesia is actually okay to use too.
1. her age (she will be 13 years old this December)
2. she has kidney problems (creatinine was 5.0, gone down to 2.0 after some medication, but is now back up to 13)
3. she is anemic
But I believe that 2 and 3 above are caused by pyometra. Right now, she is taking:
1. antibiotics for pyometra
2. Nefrotec to make her urinate and release the toxins
3. Red Cell for some iron supplement
4. She is currently in IV fluids to rehydrate her as she appears to be dehydrated
I am in California and my dog is in Cebu, Philippines with my parents. I wish I could fly her out to Singapore so you can maybe help her out, but that is no longer an option at this point since we need to make decisions immediately as my dog is getting weaker. I would actually also fly you to Cebu to perform the surgery and we rent out a veterinary clinic's equipment here. If that is something you would consider, please let me know as soon as you can. It's 11PM here and I might sign off soon. If this is something you would consider, would you be able to please contact my parents? The Philippines and Singapore have the same timezones.
....
I understand that you may not be like the usual emails that you get, but I'm really, really, very desperate right now. My initial plan was to postpone surgery until she recovers so I can bring her to CA with me. But now, I am desperate. I really, really, really need your help. I am a complete wreck.
Looking forward to hear from you.
Thanks,
EMAIL REPLY FROM DR SING DATED JUL 24 2012
There will be other vets in Philippines that can operate on pyometra using gaseous isoflurane anaesthesia and IV drips. You need to find them, esp. those in bigger practices and hospitals, maybe in the city? Your country is large, unlike Singapore and there will be more vets who can do the surgery. You may need to drive the dog to the particular vet or vet school.
I am sure there will be one vet who will do it but it may be too far from your place.
However, gaseous anaethesia is NOT a guarantee that your dog will survive the surgery or post-surgery and you need to understand and give the informed consent you have to give to the vet.
Best wishes.
On Tue, Jul 24, 2012 at 2:17 PM, Jan Cavan
Hi Dr Yuen,
I was researching about Pyometra and came across your blog. I really need your help. I'm very desperate.
My dog has pyometra, but the vet does not recommend surgery for the following reasons. If they ever perform surgery (when she gets better), they won't do it without injectable anesthesia/complete sedation. But based on your blog, gaseous anesthesia is actually okay to use too.
1. her age (she will be 13 years old this December)
2. she has kidney problems (creatinine was 5.0, gone down to 2.0 after some medication, but is now back up to 13)
3. she is anemic
But I believe that 2 and 3 above are caused by pyometra. Right now, she is taking:
1. antibiotics for pyometra
2. Nefrotec to make her urinate and release the toxins
3. Red Cell for some iron supplement
4. She is currently in IV fluids to rehydrate her as she appears to be dehydrated
I am in California and my dog is in Cebu, Philippines with my parents. I wish I could fly her out to Singapore so you can maybe help her out, but that is no longer an option at this point since we need to make decisions immediately as my dog is getting weaker. I would actually also fly you to Cebu to perform the surgery and we rent out a veterinary clinic's equipment here. If that is something you would consider, please let me know as soon as you can. It's 11PM here and I might sign off soon. If this is something you would consider, would you be able to please contact my parents? The Philippines and Singapore have the same timezones.
....
I understand that you may not be like the usual emails that you get, but I'm really, really, very desperate right now. My initial plan was to postpone surgery until she recovers so I can bring her to CA with me. But now, I am desperate. I really, really, really need your help. I am a complete wreck.
Looking forward to hear from you.
Thanks,
EMAIL REPLY FROM DR SING DATED JUL 24 2012
There will be other vets in Philippines that can operate on pyometra using gaseous isoflurane anaesthesia and IV drips. You need to find them, esp. those in bigger practices and hospitals, maybe in the city? Your country is large, unlike Singapore and there will be more vets who can do the surgery. You may need to drive the dog to the particular vet or vet school.
I am sure there will be one vet who will do it but it may be too far from your place.
However, gaseous anaethesia is NOT a guarantee that your dog will survive the surgery or post-surgery and you need to understand and give the informed consent you have to give to the vet.
Best wishes.
Monday, July 23, 2012
1807. Wanting to be rich
My advice to a Filipino vet from a middle-income family. She couldnt' find a vet tech job or a waitress job in Singapore on a recent visit. She had sprained her shoulders and back and left limb having been a medical transcriptist for past 7 years as it paid S$1,000/mth compared to vet job and wanted to do some work without typing. Singapore has tightened its rules and so approvals are very difficult.
EMAIL TO DR SING DATED JUL 17, 2012
Hello Dr. Sing,
Eileen here...I just want to express my utmost gratitude for all your words of wisdom yesterday. Maybe I still need time to do a bit of internalizing to figure out what I really want to do. You are right, I really am confused about what career move I should make. I have booked a ticket going back to the Philippines to clear my head and get a better perspective. Thank you so much for the chance of experience. Learning is quite priceless.
Regards,
Eileen
Thank you and good luck. Life is never easy for most people who want to be rich. There must be a passion and a compassion in such person and lots of personal sacrifices (health, personal, friends, family) if they want to be really rich.
EMAIL TO DR SING DATED JUL 17, 2012
Hello Dr. Sing,
Eileen here...I just want to express my utmost gratitude for all your words of wisdom yesterday. Maybe I still need time to do a bit of internalizing to figure out what I really want to do. You are right, I really am confused about what career move I should make. I have booked a ticket going back to the Philippines to clear my head and get a better perspective. Thank you so much for the chance of experience. Learning is quite priceless.
Regards,
Eileen
Thank you and good luck. Life is never easy for most people who want to be rich. There must be a passion and a compassion in such person and lots of personal sacrifices (health, personal, friends, family) if they want to be really rich.
Sunday, July 22, 2012
1086. sunday July 22, 12 interesting cases
July 22, 12
Bright sunshine, blue skies, white clouds
6 pm
1. Maltese with fever last night. Saw Vet 1 and given treatment. Blood test showed unusual high RBC and Hb. So, unlikely to be tick fever. "Sudden onset, not wanting to move yesterday evening" was the clue. I palpated spinal area inT7 - 13 area. Dog was already on pain killers from Vet 1 but responded with a soft "ha ha " sound which I could reproduced to let the young lady owners hear. As to the cause of fever 40C today at 10 am, I suspected there could be extreme pain and panting - increasing body temp but why increase in RB C and HB? Gave IV drip and tolfedine and to observe. "Must I come back on Monday?" the young lady asked. "No need if the dog is active and eating." I said. "Continue with anti-fever and other medication. I will check the blood." A case of PUO? Pyrexia of unknown origin.
2. Golden Retriever with the most smelly neck. Can't stand this smell. Cellulitis. "Must we complete 10 days of medication?" the lady asked me. "Yes," I said. "The stinking smell is due to a flesh-eating bacteria and 3 days will not be sufficient." "Need antiseptic daily?" she asked. "Yes, use the wash." "Any cream?" she asked. "No need." I said.
3. Roborskvi with backside cellulitis. Lady owner could not cure it. On 29 Jun 2012, one of the two siblings was treated by Dr Daniel for similar backside wound and had healed after 5 days of hospitalisation. Owner asked to separate the siblings but she put them together again. "What happened to the other hamster?" I asked. "He drowned." "How?" I asked as she was living in a Toa Payoh HDB flat. "He fell into the hole," she said. "What hole?" I was shocked. "The hole where my washing machine pipe discharged the water." Now, this sibling's backside had got bad and needed hospitalisation.
3. Chihuahua spayed 5 days ago with pyometra came at last minute. "Dog was licking the side of the spay wound causing a reddish patch to the side. Why?. Also a blood spot on my cushion," the lady owner said. "Is this normal?"
"This is normal in that residual blood get passed out after spay from pyometra, but is not serious. Is the dog active and eating?"
"Very well," she said. "Probably plaster is irritating," I checked the spay wound and removed the plaster. No inflammation on wound, so that was ok. Gave injection and sent the dog home. No need plaster.
4. Shih Tzu with both ear pinnae inflamed. "Came at 3.30pm, now it is nearly 6 pm", the lady said to me. I had done the eye ulcer tarsorrhapy on one eye and Dr V had done the other. Both eyes are OK but she said ear problem came soon after wearing the e-collar. She had the dog spayed at another practice. The vet said ears were dirty and prescribed ear drops of 2 bottles. Now the ears are itchy. She preferred Dr V and had to wait. Personalised services are like that, otherwise the clients will be assigned to me or Dr Daniel Sing if they can't wait. "Ear problems are common in Shih Tzu," she was so busy that she has no time for the dog and would not want hospitalisation. So she was waiting for ear irrigation. I sedated the dog first and told Dr V about it, so she could save some time. It was already 6 pm and the client from Changi had to pick up her daughter from the enrichment lessons somewhere.
5. A young cat vomited food half an hour or more after eating 4 x in the past 4 months. Losing weight compared to the other cat. Both fed separately.
Is this a case of some foreign bodies inside the stomach or a stomach diverticula? The couple wanted immediate X-rays and blood test and I referred them to another vet with complete facilities but who does not work on Sunday.
Bright sunshine, blue skies, white clouds
6 pm
1. Maltese with fever last night. Saw Vet 1 and given treatment. Blood test showed unusual high RBC and Hb. So, unlikely to be tick fever. "Sudden onset, not wanting to move yesterday evening" was the clue. I palpated spinal area inT7 - 13 area. Dog was already on pain killers from Vet 1 but responded with a soft "ha ha " sound which I could reproduced to let the young lady owners hear. As to the cause of fever 40C today at 10 am, I suspected there could be extreme pain and panting - increasing body temp but why increase in RB C and HB? Gave IV drip and tolfedine and to observe. "Must I come back on Monday?" the young lady asked. "No need if the dog is active and eating." I said. "Continue with anti-fever and other medication. I will check the blood." A case of PUO? Pyrexia of unknown origin.
2. Golden Retriever with the most smelly neck. Can't stand this smell. Cellulitis. "Must we complete 10 days of medication?" the lady asked me. "Yes," I said. "The stinking smell is due to a flesh-eating bacteria and 3 days will not be sufficient." "Need antiseptic daily?" she asked. "Yes, use the wash." "Any cream?" she asked. "No need." I said.
3. Roborskvi with backside cellulitis. Lady owner could not cure it. On 29 Jun 2012, one of the two siblings was treated by Dr Daniel for similar backside wound and had healed after 5 days of hospitalisation. Owner asked to separate the siblings but she put them together again. "What happened to the other hamster?" I asked. "He drowned." "How?" I asked as she was living in a Toa Payoh HDB flat. "He fell into the hole," she said. "What hole?" I was shocked. "The hole where my washing machine pipe discharged the water." Now, this sibling's backside had got bad and needed hospitalisation.
3. Chihuahua spayed 5 days ago with pyometra came at last minute. "Dog was licking the side of the spay wound causing a reddish patch to the side. Why?. Also a blood spot on my cushion," the lady owner said. "Is this normal?"
"This is normal in that residual blood get passed out after spay from pyometra, but is not serious. Is the dog active and eating?"
"Very well," she said. "Probably plaster is irritating," I checked the spay wound and removed the plaster. No inflammation on wound, so that was ok. Gave injection and sent the dog home. No need plaster.
4. Shih Tzu with both ear pinnae inflamed. "Came at 3.30pm, now it is nearly 6 pm", the lady said to me. I had done the eye ulcer tarsorrhapy on one eye and Dr V had done the other. Both eyes are OK but she said ear problem came soon after wearing the e-collar. She had the dog spayed at another practice. The vet said ears were dirty and prescribed ear drops of 2 bottles. Now the ears are itchy. She preferred Dr V and had to wait. Personalised services are like that, otherwise the clients will be assigned to me or Dr Daniel Sing if they can't wait. "Ear problems are common in Shih Tzu," she was so busy that she has no time for the dog and would not want hospitalisation. So she was waiting for ear irrigation. I sedated the dog first and told Dr V about it, so she could save some time. It was already 6 pm and the client from Changi had to pick up her daughter from the enrichment lessons somewhere.
5. A young cat vomited food half an hour or more after eating 4 x in the past 4 months. Losing weight compared to the other cat. Both fed separately.
Is this a case of some foreign bodies inside the stomach or a stomach diverticula? The couple wanted immediate X-rays and blood test and I referred them to another vet with complete facilities but who does not work on Sunday.
Thursday, July 19, 2012
1085. Blood tests and X-rays in the diagnosis of pyometra in dogs
Recent history of estrus, clinical signs and abdominal swelling and pain on palpation may be sufficient. However, blood tests give an indication of the health status and the anaethetic risks using evidence-based medicine in case the dog dies during or after surgery.
TWO RECENT CASES as example
Both female dogs around 4 years old.
Date: Jul 16, 2012
CKC with closed pyometra
Estrus said to be less than 1 month ago.
Goes home 5 days after surgery as she needed IV drips. Wagged tail on Day 3.
Womb looks about to rupture. It was extremely swollen and has petechial haemorrahges. See images
However good news. Went home.
Hb 11.6 (12-18)
RBC 4.9 (5.5-8.5)
Platelets 11 (200-500)
PCV 0.34 (0.37-0.55)
Total WCC 127 (6-17)
N=95%
L=5%
M=0.5%
E=0.3%
B=0%
Blood cells show degenerative changes ? age/transport. Several abnormal cells seen. No platelet clumps seen.
NOTES: Actually degenerative cells due to toxins of bacterial infection in the uterus.
Compare to chihuahua with open pyometra
Abnormal
SGOT/AST 117 (<81)
Urea 36 (4.2-6.3)
Creatinine 174 (89-177) - normal
No X-ray though advised.
Chihuahua. Consulted vet early when dog was not eating and was lethargic but discharge of pus from vagina for around 10 days.
Goes home 3 days after surgery as she was more alert than the CKC, growling all the time.
X-ray showed enlarged uterus (arrows compared to image of uterus) but some vets may not agree with me.
Hb 17 (12-18)
RBC 7.2 (5.5-8.5)
Platelets 208 (200-500)
PCV 0.49 (0.37-0.55)
Total WCC 6.2 (6-17) N=75%
L=10%
M=13%
E=0.3%
B=1.2%
Abnormal
SGOT/AST 115 (<81)
Urea 3.7 (4.2-6.3)
Creatinine 53 (89-177)
TWO RECENT CASES as example
Both female dogs around 4 years old.
Date: Jul 16, 2012
CKC with closed pyometra
Estrus said to be less than 1 month ago.
Goes home 5 days after surgery as she needed IV drips. Wagged tail on Day 3.
Womb looks about to rupture. It was extremely swollen and has petechial haemorrahges. See images
However good news. Went home.
Hb 11.6 (12-18)
RBC 4.9 (5.5-8.5)
Platelets 11 (200-500)
PCV 0.34 (0.37-0.55)
Total WCC 127 (6-17)
N=95%
L=5%
M=0.5%
E=0.3%
B=0%
Blood cells show degenerative changes ? age/transport. Several abnormal cells seen. No platelet clumps seen.
NOTES: Actually degenerative cells due to toxins of bacterial infection in the uterus.
Compare to chihuahua with open pyometra
Abnormal
SGOT/AST 117 (<81)
Urea 36 (4.2-6.3)
Creatinine 174 (89-177) - normal
No X-ray though advised.
Chihuahua. Consulted vet early when dog was not eating and was lethargic but discharge of pus from vagina for around 10 days.
Goes home 3 days after surgery as she was more alert than the CKC, growling all the time.
X-ray showed enlarged uterus (arrows compared to image of uterus) but some vets may not agree with me.
Hb 17 (12-18)
RBC 7.2 (5.5-8.5)
Platelets 208 (200-500)
PCV 0.49 (0.37-0.55)
Total WCC 6.2 (6-17) N=75%
L=10%
M=13%
E=0.3%
B=1.2%
Abnormal
SGOT/AST 115 (<81)
Urea 3.7 (4.2-6.3)
Creatinine 53 (89-177)
1083. The internet connections open the door....
"I went to the internet and typed "Singapore Vets," the gentleman told me yesterday, July 18, 2012 as he and his wife came to take the chihuahua home at 4 pm. "I skipped church as I saw that my dog did not want to eat her breakfast and was sleepy. The internet showed Toa Payoh Vets being open on Sundays and the opening hours and so I came to your surgery. Normally my wife goes to another vet in Ang Mo Kio but she was overseas on that Sunday."
I told them that the dog was operated by Dr Daniel Sing who had not minded discharging the dog after surgery. But I had intervened and strongly advised the gentleman to hospitalise her for 3 days as pyometra is a serious illness and the daily temperature needed to be monitored at Toa Payoh Vets. There could be stitch breakdown due to the dog jumping at home and unhappiness in having to re-stitch. At least 2 days of hospitalisation and also not to wait till the wife return from the UK to see the dog before surgery as pyometra is life-threatening. I advised that the dog returned home when the wife came back from overseas and this meant 3 days of hospitalisation which was good for this fierce chihuahua who growls whenever she sees me. She remembered me palpating her swollen abdomen for the enlarged uterus to confirm pyometra (without X-ray or blood test if the owner didn't want the tests). It caused her pain and she never forgave me.
The dog was visited by the family including the adult daughter and her friend during the past 3 days.
The wife has her favourite vet and so this would be the last time I see the dog as the wife is the one in charge of the chihuahua's health.
The internet has opened the door for Dr Daniel Sing to gain a new client. Can he retain the loyalty of the client? A good surgical outcome helps but there is more to make the connections with a new client.
As for me, I have made the connections because the wife asked for my name and then for my name card. Dr Daniel was in Bangkok at this time, otherwise he would be present.
The internet connects open the door. Will Dr Daniel be able to connect with this new client? The veterinary professors have not taught him how to do it as this is not their main job.
I told them that the dog was operated by Dr Daniel Sing who had not minded discharging the dog after surgery. But I had intervened and strongly advised the gentleman to hospitalise her for 3 days as pyometra is a serious illness and the daily temperature needed to be monitored at Toa Payoh Vets. There could be stitch breakdown due to the dog jumping at home and unhappiness in having to re-stitch. At least 2 days of hospitalisation and also not to wait till the wife return from the UK to see the dog before surgery as pyometra is life-threatening. I advised that the dog returned home when the wife came back from overseas and this meant 3 days of hospitalisation which was good for this fierce chihuahua who growls whenever she sees me. She remembered me palpating her swollen abdomen for the enlarged uterus to confirm pyometra (without X-ray or blood test if the owner didn't want the tests). It caused her pain and she never forgave me.
The dog was visited by the family including the adult daughter and her friend during the past 3 days.
The wife has her favourite vet and so this would be the last time I see the dog as the wife is the one in charge of the chihuahua's health.
The internet has opened the door for Dr Daniel Sing to gain a new client. Can he retain the loyalty of the client? A good surgical outcome helps but there is more to make the connections with a new client.
As for me, I have made the connections because the wife asked for my name and then for my name card. Dr Daniel was in Bangkok at this time, otherwise he would be present.
The internet connects open the door. Will Dr Daniel be able to connect with this new client? The veterinary professors have not taught him how to do it as this is not their main job.
Wednesday, July 18, 2012
1082. Connect with the client - The Power of Prayer
I have no doubt that the story as narrated by a friend I have known for over 30 years is true though I did not witness it. So I advised Dr Daniel to communicate with him by talking about the "power of prayer". But he did do it.
The story was that one day, a New Zealander couple came to this friend's cafe for breakfast. The husband was in a wheel chair and had been paralysed a long time. So he would use the stick to get up and hopped with his wife's support. My friend asked permission to pray for the husband's recovery. Permission was granted. At the end of the prayer, the husband stood up and then threw away his stick as he could walk normally. I guessed Dr Daniel found it hard to believe in the power of prayer and did not mention this to my friend who had brought in a Golden Retriever with muzzle inflammation for treatment. This dog was seen twice by Vet 1 near his place but had not responded. He wanted a second opinion.
I asked Dr Daniel to follow up 3 days after our treatment. It is always excellent service to follow up. He phoned but there was no response. My friend phoned me later and said: "I can see some hairs growing in the muzzle skin. I guess it is recovering."
So I told Dr Daniel. "Do you think it is the power of prayer?" I asked him. I doubt that my friend prayed for the dog to recover in this case and I did not ask him as it sounds too frivolous. Dr Daniel still would not believe in the New Zealander story. "Well, you connect to a client not just on dog skin disease," I said. "It is on topics that interest him. By the way, he narrated another episode of healing. A woman was paralysed and could not even walk. She recovered after he prayed for her..." Dr Daniel rolled his eyes and would not talk further.
The story was that one day, a New Zealander couple came to this friend's cafe for breakfast. The husband was in a wheel chair and had been paralysed a long time. So he would use the stick to get up and hopped with his wife's support. My friend asked permission to pray for the husband's recovery. Permission was granted. At the end of the prayer, the husband stood up and then threw away his stick as he could walk normally. I guessed Dr Daniel found it hard to believe in the power of prayer and did not mention this to my friend who had brought in a Golden Retriever with muzzle inflammation for treatment. This dog was seen twice by Vet 1 near his place but had not responded. He wanted a second opinion.
I asked Dr Daniel to follow up 3 days after our treatment. It is always excellent service to follow up. He phoned but there was no response. My friend phoned me later and said: "I can see some hairs growing in the muzzle skin. I guess it is recovering."
So I told Dr Daniel. "Do you think it is the power of prayer?" I asked him. I doubt that my friend prayed for the dog to recover in this case and I did not ask him as it sounds too frivolous. Dr Daniel still would not believe in the New Zealander story. "Well, you connect to a client not just on dog skin disease," I said. "It is on topics that interest him. By the way, he narrated another episode of healing. A woman was paralysed and could not even walk. She recovered after he prayed for her..." Dr Daniel rolled his eyes and would not talk further.
Subscribe to:
Posts (Atom)