1145. Corneal ulcer surgery - differences of opinions

Sep 18, 2013

I operated on the Cavalier King Charles, sewing up his eyelids while Dr Daniel was in charge of anaesthesia. "It is OK with me that your opinion is different from mine," I said to him.The dog was hospitalised one day and was scheduled for stitching of the eyelids this afternoon. Dr Daniel observed that the right dry eye has not accumulated much mucus as before and said that surgery was not necessary after all.

As you can see from the 2 images below, from afar, the right eye looks "recovered" but actually it is badly inflamed with blood vessels forming towards the central part of the cornea.

 

"The dog had been given medication to relieve inflammation and infection and so the right eye looks better with less sticky mucus. How long will this condition last, nobody knows.  I believe this dog's right eye is in a bad state and this surgery will help, but you deem the surgery unnecessary. Not every vet will have the same opinion and this is to be expected by me. Some veterinary text books and articles say that such surgeries should not be done at all as there is the risk of infections in a closed eye stitched up. You have read such articles and you have your opinion."

Vet text books and articles sometimes portray and advise incorrectly. The dog's right eye is dry and has blood vessels and a thick opaque film. Closing up the eye will enable better healing as there is no more wind, sunlight, dirt and dust irritating the eye. The left eye with a big ulcer will have better results.

We will wait 7-10 days to see. Taking digital images before and after operation will be part of my clinical research to substantiate my claim that this surgery is in the best interest of the dog. In theory, this right eye may recover with careful nursing but how many Singaporean dog owners have the time and patience and skill to apply eye drops, restrain the dog in a crate with it barking noises affecting neighbours or to ignore the dog's cries to come out from imprisonment inside a crate almost 24 hours a day?

I had once advised an owner with a Shih Tzu's big eye ulcer to do the conservative treatment of eye drops and e-collars. In the end, the most unhappy owner went to another vet for treatment. She had rejected my surgery advice owing to financial constraints or other reasons.

This vet phoned me for medical records. In severe corneal ulcerations, stitching the eyelids is the best form of treatment, in my opinion.


Tarsorrhaphy was done on Sep 18, 2013. I usually do the stitch-into tubing as seen in the right eye. Dr Daniel proposed no stitch through but insert stitch inside tubing as seen in the left eye. Both eyes look OK today.



Today Sep 19, 2013. Looks good on the dog. No infection

   

Add value to yourself and bring joy to friends - Flowers Are A Dancer's Best Friend

I note that there are young Singaporeans who spend lots of time on computer gaming, the facebook or on their mobile phones. Too much of younger days is wasted. As an employee, many of them don't know the  finer art of digital photography which will add value to their profession and to bring joys to friends and families. They have the mobile phone but the quality of images are not up to standard.

The library is stocked full of excellent photography magazines and books teaching you how to create excellent images. Get a digital SLR and take time to learn while you are still young and not burdened with parenthood and mortgages.

An example of joys of this dancer's friends when she received flowers is shown in the 2 images below. I happen to stand on the stair case of the Kallang Theatre and zoomed onto this scene, focused within a split second and captured the joys of the dancer's friends.

Tooth root abscess in old cat - x-ray of left sinus

1142. Publishing goals. Amazon/Kindle e-book publishing template in 2021.

Jan 4, 2020

Writer's Digest May/Jun 2019
Become an Amazon Bestseller: 4 strategies for success

Amazon sells around 50 percent of all print books in America
Sells more than 70 percent of all e-books in America
Larest sales account for almost every publisher in America
Paid 1,000 indie* authors more than $100,000 each in book royalties in 2017
Market share continues to increase both in America and abroad.

*"indie author" refers to an independent author who self-publishes using Amazon's KDP service. They manage the writing, formatting and marketing functions for their books but receive a royalty rate of 35-70 percent.

If you want to sell more books, you must learn how to sell more books through Amazon.
Success depends on selling more books on Amazon. 4 secrets for authors:

1. USE AMAZON'S "HIDDEN DOOR" TO IMPROVE YOUR BOOK'S MARKETING COPY.
2. GROW YOUR AUTHOR EMAIL LIST USING AMAZON'S HUGE AUDIENCE
3. AMAZON WILL REVEAL HOW TO TARGET NEW POTENTIAL READERS
5. THE AMAZON "SALES RANKING" CAN IDENTIFY PIVOTAL MARKETING EFFORTS.

---------------------
Sep 18, 2013 to Amazon Creative Publishing

Thank you for following up. Pl see reply below:


1. As the author you have the flexibility to publish using our paid support services, free do-it-yourself book submission or a blend of both options. Will you be in need of editorial, design or marketing assistance using our paid solutions?

I will be publishing books for other authors in Singapore and also for myself. I need the design or marketing assistance and need to know the costs.

2. CreateSpace offers print on demand for trade paperback books. Are you interested in printing a soft cover version of your book?

Yes. I wish to publish trade paperback books.

3. What is the name of the software you used to type your manuscript into your computer (i.e. Microsoft Word, In Design, etc.)?

I can use Microsoft Word.

4. Have you previously published a book? Tell us a little about this one.

No as traditional publishers are too costly for me and I will be stuck with 3000 unsold books in my house.

5. How is the writing going? When would you like to see your book in print?

Writing is to be completed as soon as I know how much it costs me

to pay for design of cover and layout services from Amazon. I have other authors to publish. Preferably in both CreateSpace and Kindle.

6. Tell us a little about yourself and your publishing goals.

Goals:

1. To publish veterinary educational stories for vet students and pet owners based on my 40 years in private practice. Articles are from www.toapayohvets.com.

2.  To publish one science fiction novel based on real life encounters.

----------------------------------------------

Dr Sing,  from Bridget Lum
11 Jul 2021

Kindle e-publishing template


Attached is the link for the template.
https://kdp.amazon.com/en_US/help/topic/G201834230

I am a veterinarian and most of my stories are in the website www.toapayohvets.com and in the blog listed in this website. As there are images, this is where I find there will be layout and formatting difficulties and hence need your services.

I look forward to hearing back from you and discussing your book project in greater detail.

Auditing my bladder stone surgery case - the surgical outcome

TOA PAYOH VETS toapayohvets.com Date:   18 September, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits Audit of my bladder stone surgery done in 2009     Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   18 September, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 Auditing my bladder stone surgery case - the surgical outcome In the above surgery, the dog is still alive in 2013 as I met the owner recently. The sibling of this dog had generalised body and head tremors and he had consulted 2 vets. Vet 1 prescribed glucosamine but the tremors persisted. Vet 2 referred him to get a CT scan at another practice. This costs $1,500 - $2,000 and so he remembered me, researched the internet for "Toa Payoh Vets" and phoned me.   The owner wanted an affordable bladder stone surgery in 2009 and vets of my generation often strived to provide least medical cost by not asking for X-rays pre and post operation or blood tests at the first visit. For example, this poodle had blood in the urine and the abdomen was very painful near the bladder region. I informed the owner of the diagnosis of bladder stones although there was no X-ray or stone analysis done to lower his medical costs by at least $200. He wanted an immediate surgery. I gave an IV drip and antibiotics and operated on the same day of consultation. I told the owner that the dog had 20% chance of survival on the operating table. If the dog is given an IV drip and stablised for 24 hours before surgery, the survival rate will be much higher. However, this dog did survive and so the owner had a favourable impression of me and I saw his trembling poodle, the sibling of the afore-mentioned dog with bladder stone surgery. I have my illustration to show readers who what anaesthesia was used and the number and nature of the bladder stones. When the dog survives despite the odds, the feeling is great and the owner remembers the vet who had performed according to his expectations, namely a good surgical outcome. In 2013, the expectations of a sophisticated younger generation of pet owners who trawl the internet and knows much more than the vet means that all processes and advices must be properly documented as supporting evidence in cases of litigation. I would record AMA (Against Medical Advices) and ensure close communication with the owner. Life was much simpler in 2009 and in earlier years, but the vet has to be much more careful in giving informed consent and recording all medical advices in the litigious society of first world Singapore.   Updates will be on this webpage: www.sinpets.com/F6/20130918poodle_ bladder_stones.htm More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 Toa Payoh Vets Clinical Research

Copyright © Asiahomes All rights reserved. Revised: September 18, 2013 Toa Payoh Vets

       

Can the right eye be saved?

Each vet will treat the above case differently. At first glance, the dry eye seems to be of a minor problem and the left eye corneal ulcer seems to have occurred just a day or two ago.

For Dr Daniel, he had cleaned up the eyes and thinks that the dry eye will heal with medication and the e-collar.

For me, I told the owner to confine the dog inside the crate for around one month, with the e-collar and eye drops and medicaton. "This is not possible," the slim young lady teacher said. It is easy to give advices but the reality at home is different. The owner will let the howling dog out to wander around the house. The dog will rub his eyes onto the bed corners, causing more injury.

So I proposed stitching up both eyes and their eyelids. Dr Daniel thinks that the dog will not be happy with both eyes stitched up. But there is no other way. The left eye already has blood vessels running into the central ulcer as you can see. The right eye is already beyond hope.

Tomorrow I will perform the surgery and in 7-10 days, we will know the results. I expect the left eye to heal well with a white spot where the ulcer is. As for the left, no dry eye will be the best outcome.

Eye injuries are emergencies. Do NOT wait 10 days if you want to save the eye sight. 

1139. VET STORIES - DRAMA - Events led to the lady avoiding the vets

TP 15075

I had recorded this dramatic case of Charcoal, the Silkie diagnosed as having serious kidney failure based on blood test results at Vet 1 in March 26, 2010. Charcoal came in today as he had 3 skin tumours and the lady was much worried that these were malignant.

As regards the 2010 incident, the owner consulted me for a 2nd opinion. I met the owner today and asked her to narrate the drama which would not be forgotten by her as her dog was her child.

"You said that Charcoal was active and bright and would not be dying of serious kidney and liver failure," she reminisced. Charcoal was vomiting occasionally since young.  My medical records showed that Vet 1 had based her diagnosis on blood test with high creatinine and BUN levels as well as high ALT levels.   


She sought a 3rd opinion and Vet 3 did a blood test. I did not do a blood test as she had said that Vet 1 had just done it and disputed my observation that the dog could not be having serious kidney and liver diseases based on clinical signs of health. Vet 3 said that the dog had a liver infection. She brought the blood test result to Vet 1.

"After 2 weeks, Vet 1 told me that their blood test machine was having errors in reading the results."

Now Charcoal had 3 skin lumps after I clipped off her coat. "Will my dog die and what if she has cancer?" she took lunch time off to visit Charcoal today, a working Tuesday. A blood test would be taken and the dog would be on minimal anaesthetic. I marked the 3 lumps. "Don't think so far ahead. The lab will check the skin lumps and then we will decide."

This case illustrated that blood test results can never be trusted.     





 

1138. Rectal prolapse in a rabbit

Today I saw a case of rectal prolapse of over one week in a rabbit. The lady brought her in as there was bleeding. Stools were hard.

"The rabbit has to eat daily and passes stool frequently. When I stitch up the anus after pushing in the rectal tissues, I need to take out the stitches after 3 days."  

7 days would be better for the rectal tissues to heal.

1137. Be meticulous

Today the lab phoned to say that the 3 blood tubes sent were not labelled. But my vet assistant swore he had done so, including the urine bottle sent on Saturday.

"The complaint is from the blood tubes," I was angry with him. "This is not the first time and it should not happen at all after the first time. I had just advised you to label the tubes before taking the blood but you would prefer to label them after taking the blood."

The lab girl said the tubes were not labelled, otherwise why should she waste her time phoning me. For unlabelled tubes, no blood test would be done. "I want to see the tubes, not just an image" I said. After all, Naing was adamant he did write.  The lab would not want to return the tubes.

If he had adopted my system, he would not have neglected to do it. It is possible that the lab had mis-placed the tubes and said that they were not labelled but I doubt it. Many young people would prefer to do it their own way and it takes a lot of patience to supervise them.

I asked him to sit down to have a chat. "You are veterinary graduate from Myanmar and you will know the importance of proper recording," I said. "There must be a system of labelling tubes and I have given you a new system because the other vets and staff had made similar mistakes of not labelling in the submission." I hope he will not repeat the 3rd time.

Many young employees and interns may not accept advices and instructions from the old persons and they waste time in their work due to inefficiency or mistakes. This seems to be part of the culture of the younger generation used to the good life and affluence of Singapore and the region over the last 30 years. Patience is needed but they should be aware that they brand themselves as incompetent and risk being fired from the job if they persist in doing a bad job.           

 

1136. A resourceful pet relocation man

"The life-style of the top (expatriate) dog is definitely hard to imagine," I said to this senior citizen who is much active in his pet relocation business. We met today at the practice where I had brought a poodle for a digital x-ray of the paws. He told me he served the most senior management and in one house, there were 4 Rhodesian Ridgebacks staying in a living room and cared for by 3 servants. This big house has two living rooms.

Once he saw a very old wobbly big Rottweiler to be shipped back to Texas, USA. He asked the expatriate how old the dog was. "15 years old," the top dog said. The journey would be 33 hours from Singapore to Texas by the usual airlines.

"At the end of the 33 hours, the dog would be exhausted or dead," I speculated. But he had his contacts and found a Singapore Airlines flight via Hong Kong and this trip took 18 hours. "At the meeting in Texas, the old dog was standing tall and pouncing on his expatriate owner."

He told me of his business plan to expand the business in partnership with an owner of a big boarding house by having an office in Changi Airport. All the airlines would contact him to relocate dogs and pets.

But this partner wanted another partner and he did not want 3 partners and so he backed out.  "There must be a reason," I said. "Nobody would want another partner to share the profits. What happened to this prospective partner and what does he do?"

"He imports wine and other goods," the retiree said. "The Changi Airport gives an office only to people who has a track record of moving at least 50,000 tons of goods."

That is the catch. The authorities want big proven companies and so it is the little man that cannot be given the opportunity with no money to prosper. But he is still serving good clientele.