Jan 8, 2013
Recently Dr Daniel and I had 2 cases of high anaesthetic risks - the very young and the very old patient. Every vet will inform the owner of the high risks. Invariably, the owner would not want the operation. So, the disease progresses as in the following cases:
Case 1. Rabbit, F, 3.5 months
The lady bought 2 siblings at 1 month old at Farm Mart which is in Chua Chu Kang. This patient had a twisted leg but the appetite was "good." Over the next 2.5 months, her sibling doubled in size while this rabbit started to hide in a corner.
"She refused to move as she grows older," the lady had phoned me for the fees for amputation. "The two vets in the same practice wanted to charge $1,000 to cut off the leg. I have already spent over $1,000 treating this rabbit!"
"I have to examine the rabbit in order to quote you," I said. "If the surgery is short, the fees are lower."
The lady came while I was out. Dr Daniel advised amputation. "She wanted to try TCM (traditional chinese medicine)," Dr Daniel said when I asked why he had bandaged the leg.
I spoke to the owner as she was paying the bills after consultation with Dr Daniel and not accepting amputation as the medical advice. The rabbit's leg had swollen at least 3 times and multiple yellow abscesses flowered inside the leg. "Do you know that this rabbit's life is endangered as his leg will become gangrenous and septic, spreading bacteria to her whole body and killing her? I have already given you a below cost fee to amputate her twisted leg. Yet you want to try TCM."
"I tried TCM in the sibling which was similarly lame and he recovered," she said.
"The sibling did not have the same condition of fractured lowered leg that became twisted and infected," I had not seen the sibling but it is highly improbable that both siblings suffered fractured legs. The sibling was probably weak in his hind limbs but the fact is that he is a thriving rabbit, double the size now.
Tuesday, January 8, 2013
Tuesday, January 1, 2013
1232. 2 years and 2 months old hamster with breast tumour
Dec 31, 2012
Last hamster case of the year.
"I still have to pay for cremation if the hamster dies on the op table?" the mother asked me about the chances of survival if I operated on her dwarf hamster with an infected black-scabbed leaking pus breast tumour below the neck.
"Yes, you need to pay or you can bury the hamster yourself," I noted that the hamster was alert and had passed several stools indicating he was eating.
"How long more can he live?" the mother asked me.
"Normally, dwarf hamsters live up to 2.5 to 3 years," I said.
"He is now 2 years and 2 months," the mother calculated that it was not worth the $200 to operate and stitch the tumour.
"One month of the dwarf hamster's life is equivalent to 2 years of the Singaporean human life," I said. "If he survives the surgery, he could live, provided the tumour does not come back again." The mother had waited 2 months before her daughter asked her to send him to Toa Payoh Vets for surgery. She could not decide what to do now. "I phone my daughter," she said. "He is her pet.". Her daughter would not decide in view of the high risks of death on the operation table. Finally her her husband said to proceed,
HOW MUCH ANAESTHETIC TO USE?
"Isoflurane gas will not give sufficient time to operate," Dr Daniel said to me.
"This is correct," I said. "Zoletil injection by IM will give you 60 seconds of operating time if the dosage is just right."
How much to give? This is where the judgment and experience comes in. Too little, the hamster needs top up with isoflurane gas to sleep. Too much, he dies.
"This is a very old dwarf hamster," I said. "His body weight is 54 g which is good sized. He is alert and eating and that is good. But he is aged and so the Zoletil dosage should be reduced so that the hamster is alive at the end of the operation."
The theory is easy. The practice is not. How much of Zoletil 50 to give by IM?
Dr Daniel decided on 2 drops which I approved. "They must be full drops," I said as I saw Mr Min's hand trembling as he held the 1-ml syringe to draw out Zoletil drops from Dr Daniel's 1-ml syringe.
"Hey, your hands are shaking!" I said to Min. "Shaky hands cannot be a surgeon! Rest your elbows on the op table to stabilise the syringe."
Dr Daniel injected IM. The hamster has very little muscle and so the needle must just get into the muscle and this can be difficult to assess. Practice makes perfect. "There is so blood on the operating cloth," Dr Daniel said after his injection. "Unusual to see it," I had never encountered such a situation. "It could be from the muscles after injection."
Soon the hamster felt sleepy. I asked Intern Gina to video this case study. The tumour was excised. Lots of yellow pus inside the tumour which was 1.5x1x1 cm globular in size which black scabs. The skin was excised and undermined. The tumour was cut off from the clamped area. Skin was stitched with 6/0 absorable sutures.
It was most likely a malignant tumour which was put nside a plastic bag for the owner to see. The hamster went home alive and that was what the owner wanted. Now, there was another subcut lump near the left inguinal area. "Never operate on two tumours at one time," I said to Dr Daniel. "The hamster will die as op time has been too long." So we left the other tumour of around 0.8x0.8 x 0.5 cm alone. This was New Year's eve and the famiily wanted the hamster home to celebrate life and a new year.
Last hamster case of the year.
"I still have to pay for cremation if the hamster dies on the op table?" the mother asked me about the chances of survival if I operated on her dwarf hamster with an infected black-scabbed leaking pus breast tumour below the neck.
"Yes, you need to pay or you can bury the hamster yourself," I noted that the hamster was alert and had passed several stools indicating he was eating.
"How long more can he live?" the mother asked me.
"Normally, dwarf hamsters live up to 2.5 to 3 years," I said.
"He is now 2 years and 2 months," the mother calculated that it was not worth the $200 to operate and stitch the tumour.
"One month of the dwarf hamster's life is equivalent to 2 years of the Singaporean human life," I said. "If he survives the surgery, he could live, provided the tumour does not come back again." The mother had waited 2 months before her daughter asked her to send him to Toa Payoh Vets for surgery. She could not decide what to do now. "I phone my daughter," she said. "He is her pet.". Her daughter would not decide in view of the high risks of death on the operation table. Finally her her husband said to proceed,
HOW MUCH ANAESTHETIC TO USE?
"Isoflurane gas will not give sufficient time to operate," Dr Daniel said to me.
"This is correct," I said. "Zoletil injection by IM will give you 60 seconds of operating time if the dosage is just right."
How much to give? This is where the judgment and experience comes in. Too little, the hamster needs top up with isoflurane gas to sleep. Too much, he dies.
"This is a very old dwarf hamster," I said. "His body weight is 54 g which is good sized. He is alert and eating and that is good. But he is aged and so the Zoletil dosage should be reduced so that the hamster is alive at the end of the operation."
The theory is easy. The practice is not. How much of Zoletil 50 to give by IM?
Dr Daniel decided on 2 drops which I approved. "They must be full drops," I said as I saw Mr Min's hand trembling as he held the 1-ml syringe to draw out Zoletil drops from Dr Daniel's 1-ml syringe.
"Hey, your hands are shaking!" I said to Min. "Shaky hands cannot be a surgeon! Rest your elbows on the op table to stabilise the syringe."
Dr Daniel injected IM. The hamster has very little muscle and so the needle must just get into the muscle and this can be difficult to assess. Practice makes perfect. "There is so blood on the operating cloth," Dr Daniel said after his injection. "Unusual to see it," I had never encountered such a situation. "It could be from the muscles after injection."
Soon the hamster felt sleepy. I asked Intern Gina to video this case study. The tumour was excised. Lots of yellow pus inside the tumour which was 1.5x1x1 cm globular in size which black scabs. The skin was excised and undermined. The tumour was cut off from the clamped area. Skin was stitched with 6/0 absorable sutures.
It was most likely a malignant tumour which was put nside a plastic bag for the owner to see. The hamster went home alive and that was what the owner wanted. Now, there was another subcut lump near the left inguinal area. "Never operate on two tumours at one time," I said to Dr Daniel. "The hamster will die as op time has been too long." So we left the other tumour of around 0.8x0.8 x 0.5 cm alone. This was New Year's eve and the famiily wanted the hamster home to celebrate life and a new year.
Sunday, December 30, 2012
1231. Hong Kong Dec 24-27 2012 stories & images
Hong Kong is a fascinating place to visit and for street photography if you look further than its shopping centres and its good food.
Up to Nov 2012, Hong Kong has 44 million visitors, up 16% from the same period last year, according to the Hong Kong Tourism Board. That means more revenue to Hong Kong's retailers, government and people.
Here are my observations on how Hong Kong has become more progressive:
1. Excellent communications with passengers.
Cathay Pacific Airlines staff would communicate their feedback to the passenger before the passenger leaves the plane. For some reason, I was given a feedback form and so I said that the "bacon and eggs" were of poor quality in that the bacon was not "real" bacon. It looked like ground meat with an even layer of fat in between. This roll would then be sliced to give the appearance of bacon. The English bacon and eggs will be the standard if the traveller knows it and so it was a poor quality breakfast. The manager told me she would speak to the food side. So this was immediate feedback on complaints. The overhead light was not working. One crew said I should have told her so that I could change seats or she could "reset" the light. Why not check before flying? This flight was an old Airbus (brushes like thick eyebrows seen at the emergency exit door for disarming or arming the door). The inflight stereo phone set had one plug instead of the usual two and so the adaptor for the head phone could not be used. Regional flights' passengers get poorer facilities.
2. Survey on efficiency
Wait times at the Immigration. There was a person who gave me an electronic counter at the start of the queue and at the end of the queue, I was to return the counter. There was a message saying that the waiting times are being surveyed. This would be good for feedback on management and be useful for any organisation interested in cutting down the waiting times.
3. Interest of the organisation in service staff
On Dec 25, I went to Peking Garden Restaurant for dinner. No prior booking. I was about to leave but the gentleman in charge said that I could eat if I could leave by 7 pm. It was 5.45 pm then. So, he was a flexible manager able to add revenue to his employer. I did not order the famous Peking duck as it was too big for me. The fish was great.
On Dec 27, I wanted to eat at Din Dang Fong near Regal Hotel Hong Kong. It was jammed packed with lunch people. "It will only take a few minutes," the waitress said as I handed back the queue number. She had the interest of the organisation at heart as she could have not bothered. It seemed that F&B staff is highly motivated to increase the revenue for the company.
3. High rentals keep increasing.
Dec 24, 2012. I had dinner at the Sweet Dynasty Restaurant in Canton Street. The last day for the operator as the rentals were too high and the famous restaurant had relocated to Causeway Bay. "An Apple store" will be opening, according to one Langham Hotel staff.
Canton Street looks much like Orchard Road, only busier. It was closed to traffic on Christmas eve and there was a band playing. Crowds of few thousands stream from the subway and there was crowd control. Nothing like this in Singapore's Orchard Road on Christmas eve.
I saw some policemen towing away a scooter parked outside the shops on Haiphong Road near Canton Road at 5 pm. Serious business in crowd control. A few hundred thousands I would estimate for that Christmas Eve night.
4. Use of IT.
Hong Kong Tourism Board equips its staff with iPad at the branch outlets. More efficient as no staff can remember all info. The lady checked out opening times of Peking Garden Restaurant and location using her iPad. This was efficient and fast.
Up to Nov 2012, Hong Kong has 44 million visitors, up 16% from the same period last year, according to the Hong Kong Tourism Board. That means more revenue to Hong Kong's retailers, government and people.
Here are my observations on how Hong Kong has become more progressive:
1. Excellent communications with passengers.
Cathay Pacific Airlines staff would communicate their feedback to the passenger before the passenger leaves the plane. For some reason, I was given a feedback form and so I said that the "bacon and eggs" were of poor quality in that the bacon was not "real" bacon. It looked like ground meat with an even layer of fat in between. This roll would then be sliced to give the appearance of bacon. The English bacon and eggs will be the standard if the traveller knows it and so it was a poor quality breakfast. The manager told me she would speak to the food side. So this was immediate feedback on complaints. The overhead light was not working. One crew said I should have told her so that I could change seats or she could "reset" the light. Why not check before flying? This flight was an old Airbus (brushes like thick eyebrows seen at the emergency exit door for disarming or arming the door). The inflight stereo phone set had one plug instead of the usual two and so the adaptor for the head phone could not be used. Regional flights' passengers get poorer facilities.
2. Survey on efficiency
Wait times at the Immigration. There was a person who gave me an electronic counter at the start of the queue and at the end of the queue, I was to return the counter. There was a message saying that the waiting times are being surveyed. This would be good for feedback on management and be useful for any organisation interested in cutting down the waiting times.
3. Interest of the organisation in service staff
On Dec 25, I went to Peking Garden Restaurant for dinner. No prior booking. I was about to leave but the gentleman in charge said that I could eat if I could leave by 7 pm. It was 5.45 pm then. So, he was a flexible manager able to add revenue to his employer. I did not order the famous Peking duck as it was too big for me. The fish was great.
On Dec 27, I wanted to eat at Din Dang Fong near Regal Hotel Hong Kong. It was jammed packed with lunch people. "It will only take a few minutes," the waitress said as I handed back the queue number. She had the interest of the organisation at heart as she could have not bothered. It seemed that F&B staff is highly motivated to increase the revenue for the company.
3. High rentals keep increasing.
Dec 24, 2012. I had dinner at the Sweet Dynasty Restaurant in Canton Street. The last day for the operator as the rentals were too high and the famous restaurant had relocated to Causeway Bay. "An Apple store" will be opening, according to one Langham Hotel staff.
Canton Street looks much like Orchard Road, only busier. It was closed to traffic on Christmas eve and there was a band playing. Crowds of few thousands stream from the subway and there was crowd control. Nothing like this in Singapore's Orchard Road on Christmas eve.
I saw some policemen towing away a scooter parked outside the shops on Haiphong Road near Canton Road at 5 pm. Serious business in crowd control. A few hundred thousands I would estimate for that Christmas Eve night.
4. Use of IT.
Hong Kong Tourism Board equips its staff with iPad at the branch outlets. More efficient as no staff can remember all info. The lady checked out opening times of Peking Garden Restaurant and location using her iPad. This was efficient and fast.
1230. Posting to facebook of Stanley Veterinary Centre
Dec 30, 2012 From Singapore to Ms Rachel Woo with thanks
I am Dr Sing Kong Yuen, a veterinary surgeon from Toa Payoh Vets, (www.toapayohvets.com) Singapore.
1230. Posting to facebook of Stanley Veterinary Centre
On Dec 27, 2012, I took a train and taxi to visit Stanley Veterinary Centre and was most impressed with its well designed layout and facilities and the friendly staff.
I write to say thank you to Ms Rachel Woo, Clinic Manager for her time and sharing of her vast knowledge of the various aspects of practice management and veterinary medicine and the use of MRIs in Hong Kong. Hong Kong's veterinary services including SPCA's veterinary services appear to me to be most fascinating for closet writers, and more advanced at the MRI level compared to Singapore presently from my conversations with Ms Woo.
On the way, I was shocked to see a mini-bus advertising a veterinary clinic ("Veterinary Light??) but before I could snap an image to prove that vets are allowed to advertise on buses, my taxi driver had zoomed downhill towards Stanley Village.
Could this be the new kid in Stanley Village, Ms Woo?
In Singapore, bus adverts by vets are prohibited and so I was much surprised to see one in Hong Kong. Ms Woo says they are permitted in Hong Kong.
I wish Ms Rachel Woo all the best in the years to come Happy New Year. Keep up your good spirits
I am Dr Sing Kong Yuen, a veterinary surgeon from Toa Payoh Vets, (www.toapayohvets.com) Singapore.
1230. Posting to facebook of Stanley Veterinary Centre
On Dec 27, 2012, I took a train and taxi to visit Stanley Veterinary Centre and was most impressed with its well designed layout and facilities and the friendly staff.
I write to say thank you to Ms Rachel Woo, Clinic Manager for her time and sharing of her vast knowledge of the various aspects of practice management and veterinary medicine and the use of MRIs in Hong Kong. Hong Kong's veterinary services including SPCA's veterinary services appear to me to be most fascinating for closet writers, and more advanced at the MRI level compared to Singapore presently from my conversations with Ms Woo.
On the way, I was shocked to see a mini-bus advertising a veterinary clinic ("Veterinary Light??) but before I could snap an image to prove that vets are allowed to advertise on buses, my taxi driver had zoomed downhill towards Stanley Village.
Could this be the new kid in Stanley Village, Ms Woo?
In Singapore, bus adverts by vets are prohibited and so I was much surprised to see one in Hong Kong. Ms Woo says they are permitted in Hong Kong.
I wish Ms Rachel Woo all the best in the years to come Happy New Year. Keep up your good spirits
Friday, December 28, 2012
1229. Veterinary matters in Hong Kong - visit to HK on Dec 27, 2012
Dec 28, 2012 5.50 pm
I visited Stanley Veterinary Centre yesterday 11 am to 12 noon. It is a well designed basement clinic as no space is wasted for veterinary use.
Three consultation rooms, 1 cardiology cum ultrasound room, one operating room, one dental area, one X-ray area, one laboratory, one pantry, one office cum pantry and one room for the boss. I like the elevator which is reserved only for large dogs with some diabilities. A very nice place to work. The hours are incredible good.
"No for people or dog owners? I asked the Manager Rachel who told me that Hongkongers love their pets very much.
"No, no," Rachel said. I was most surprised. Lifts are expensive to build and to maintain and this is a good idea.
I visited Stanley Veterinary Centre yesterday 11 am to 12 noon. It is a well designed basement clinic as no space is wasted for veterinary use.
Three consultation rooms, 1 cardiology cum ultrasound room, one operating room, one dental area, one X-ray area, one laboratory, one pantry, one office cum pantry and one room for the boss. I like the elevator which is reserved only for large dogs with some diabilities. A very nice place to work. The hours are incredible good.
"No for people or dog owners? I asked the Manager Rachel who told me that Hongkongers love their pets very much.
"No, no," Rachel said. I was most surprised. Lifts are expensive to build and to maintain and this is a good idea.
1228. Two videos produced by an intern - Urolithiasis &
By just being an observer is not good for the interns.
Interns learn better when they are hands on and do research as shown by the two videos:
Urolithiasis
http://www.youtube.com/watch?v=x6K4z3VtaXY&feature=youtu.be
Hamster tumours
http://www.youtube.com/watch?v=W4tSj8ubAyQ&feature=youtu.be
It takes a lot of time to mentor the interns and there is much editing and time of over several hours involved just to produce the two videos. The videos are not perfect but these are excellent ones produced by the young man.
Interns learn better when they are hands on and do research as shown by the two videos:
Urolithiasis
http://www.youtube.com/watch?v=x6K4z3VtaXY&feature=youtu.be
Hamster tumours
http://www.youtube.com/watch?v=W4tSj8ubAyQ&feature=youtu.be
It takes a lot of time to mentor the interns and there is much editing and time of over several hours involved just to produce the two videos. The videos are not perfect but these are excellent ones produced by the young man.
Old female rabbit has "breast" tumours
Dec 28, 2012 4.57 pm. Spoke to owner who wanted a second opinion.
The vet had taken a biopsy, checked under the microscope and had diagnosed tumour. Anaesthetic consent form needed to be signed and as the rabbit is 10 years old, the owner is worried. As to the $1,000 veterinary costs, I explained that much depends on the surgery time, blood tests and histopathology tests and any other medication that the vet would do and the costs could add up. The vet had lanced the "infected tumour" and the rabbit stopped eating after being fed some medication. However, it was active and eating when medication was stopped. I advised review and if the tumours were small, the surgical costs would be much lower. Will see him tomorrow 9.30 am.
-----------
Dec 27 (1 day ago)  | | |||
| ||||
| Hi Doc,
3 years ago I brought my rabbit to your clinic to clear matted fur. Now I want to bring it to you for medical attention again.
Rabbit was diagnosed to have 2 cancerous small breast tumours about 2 cm. I need your opinion and about how much for the surgery ? The young unexperienced vet nearby my house quoted 800 to 1k !!!!
Also,when is the earliest appointment I can make with you?
Regards --- On Wed, 3/6/09, Kong Yuen Sing <99pups@gmail.com> wrote:
|
Sunday, December 23, 2012
1226. Trip to Hong Kong
On Dec 24 to 27, 2012, I will be taking a short break to see how Hongkongers celebrate Christmas. I will be visiting the Stanley Vet Clinic on Dec 27, 2012 from 11 am to 12 am and I am looking forward to meeting some Hong Kong vets and learning more.
Every vet practice I visit teaches me some angles and processes of veterinary practice. In this visit, I would like to know more about skin diseases in Hong Kong dogs and cats and the allergen testings.
Every vet practice I visit teaches me some angles and processes of veterinary practice. In this visit, I would like to know more about skin diseases in Hong Kong dogs and cats and the allergen testings.
1225. New microscope at Toa Payoh Vets
Dec 22, 2012
A new microscope with software to take images for research and to show clients was purchased by me today. It is able to display the images on the laptop screen. Unfortunately, its software works only with Windows XP while my laptop has Windows 7.0.
So I had to find older versions and older laptops to use this software. My intern Vanessa going to Melbourne Univ 3rd year in 2013 was very hard working and keen in veterinary science. I hope she would be able to complete her "ringworm" project as her last day would be Dec 25, 2012. We had been working on this project and others for the past week. At first we used the iPhone but the images were not good.
Yet with this microscope under high magnification of 100X, the images were not clear. She used Photoshop on her own initiative and we could see the structures of the hyphae, microconnidia, macroconnidia and more. Wait for her report.
Digital imaging will not be taught in vet schools and this project broadened her skills and expertise and see some "cool" creatures of the fungal family in the Tricophyton genus.
A new microscope with software to take images for research and to show clients was purchased by me today. It is able to display the images on the laptop screen. Unfortunately, its software works only with Windows XP while my laptop has Windows 7.0.
So I had to find older versions and older laptops to use this software. My intern Vanessa going to Melbourne Univ 3rd year in 2013 was very hard working and keen in veterinary science. I hope she would be able to complete her "ringworm" project as her last day would be Dec 25, 2012. We had been working on this project and others for the past week. At first we used the iPhone but the images were not good.
Yet with this microscope under high magnification of 100X, the images were not clear. She used Photoshop on her own initiative and we could see the structures of the hyphae, microconnidia, macroconnidia and more. Wait for her report.
Digital imaging will not be taught in vet schools and this project broadened her skills and expertise and see some "cool" creatures of the fungal family in the Tricophyton genus.
1224. Dog transport man's service was undercut by a vet
Today, Sunday, Dec 23, 2012, I spoke to a dog transport man who had transported a Sharpei to be put to sleep due to the fact that the owner was a 70-year-old woman who got bitten whenever she tried to clean his ears. She has 2 Sharpeis and her children from the US were worried about her safety and ability to cope with 2 dogs since she would be in poor health.
I had spoken to her and said it was her decision as to whether she wanted to euthanase 2 Sharpeis or the biting one or none . We had not met before and so I could not say whether the biting Sharpei with the infected ears could be treated for once and for all or would need repeated treatments which would mean veterinary and transport costs. She decided to have the biting Sharpei put down and her son would accompany the ferocious dog to the vet to be euthanased.
According to the transport man, the vet who was handling this case at an outside practice that was not his, said that this Sharpei should not be euthanased as it was just an ear infection. The dog could be sent to the SPCA. Better still, he would treat the dog at his practice as he has a bigger veterinary practice and has his own transport man and facilities.
His remark of having his own transport man made the tranport man wonder why he would be "stealing" his business from him and the other practice. There are all sorts of characters in this world and from some characters, one expect such undermining practices.
I had spoken to her and said it was her decision as to whether she wanted to euthanase 2 Sharpeis or the biting one or none . We had not met before and so I could not say whether the biting Sharpei with the infected ears could be treated for once and for all or would need repeated treatments which would mean veterinary and transport costs. She decided to have the biting Sharpei put down and her son would accompany the ferocious dog to the vet to be euthanased.
According to the transport man, the vet who was handling this case at an outside practice that was not his, said that this Sharpei should not be euthanased as it was just an ear infection. The dog could be sent to the SPCA. Better still, he would treat the dog at his practice as he has a bigger veterinary practice and has his own transport man and facilities.
His remark of having his own transport man made the tranport man wonder why he would be "stealing" his business from him and the other practice. There are all sorts of characters in this world and from some characters, one expect such undermining practices.
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