I would teach Mr Saw, my assistant whenever I had a good case. He would be going back to Myanmar in April 2011 to start-up a vet surgery in Yangon with a friend. He had been working for me for nearly 3 years and he would be considered an "experienced vet from Singapore" in Yangon.
I said to Mr Saw: "You can have a good name - experienced vet who has worked in Singapore, but remember one thing: if you can't give what the owner wants, your brand name is no use to him.
"See this case of the cat (with a problem that the brand name practice vet was not given a second chance to review). He takes his ten cats to this famous and big vet practice for the past years. He could have consulted Toa Payoh Vets as he lives in Toa Payoh. But he would never do it for some reasons.
"His wife had consulted Toa Payoh Vets once, the husband had said to me. That means there is something I had not done correctly or given to what the wife wanted. So I have to improve my services or the facilities and review my operations.
"Brand name opens the door for you, but if you can't give what the owner wants, you can be the most famous vet practice in Singapore and he will go elsewhere. You must be able to resolve his cat's problem at the price he can afford. If your practice is famous, you cannot solve his problem and you quote him a high vet cost, he will not come back to you the second time. This applies only to those who don't want to spend and spend on their pets' veterinary treatment."
Mr Saw nodded his head and appreciated the advices I gave him regarding competitiveness, the need to save on costs so as to give affordable vet treatment and not waste materials and medicine as many vet employees are prone to do so. He learns the running of the practice by working for an old vet who has been battle-tested. He was fortunate in this aspect as I had time for him to mentor him knowing that he has a good work attitude.
Sunday, October 31, 2010
Friday, October 29, 2010
231. Brand name v. benefits to the customer
My vet assistant, Mr Saw had worked with me for nearly 3 years. As he will be leaving next year to work in Yangon, I shared experiences of cases with him today and whenever we work together.
Case 1
Tumour in gum of Chihuahua, M, Neutered, 6 years.
"It is best to advise histopathology of this tumour," I said to him. "Some owners are not aware of the need to get this test. We want to lower our vet costs by not advising this test. However, the tumour may be cancerous and if we do not advise, the next time the tumour comes back, the owner will not have confidence in the vet.
The owner is a young woman with internet knowledge and so she will know many things by researching the internet for gum tumours. She had asked whether I would be doing a histopathology and I said yes. Not every owner wants the lowest price.
Case 2
Urinary stone stuck inside the penis. "Different vets will operate differently to take out the stones jammed packed behind the os penis, inside the penis ," I said to Mr Saw. "In this Yorkshire, the vet leaves the urethra wound open by NOT stitching the incision. I will not operate this way. Why?"
Mr Saw did not know. "Well, this is a male dog. So he usually lifts his one leg to pee. When he pees, his urine will leak out from under his penis where the urethostomy incision has not been closed. So he sprays urine or dribble urine all over the apartment. In Singapore, 80% of the people lives in apartments. By NOT stitching up the urethra, the male dog may pee from his penile end and from below the penis. If you are the dog's owner, you will be very unhappy as you have to clean up. Worse still, the dog dribbles urine all over the whole floor due to urine marking.
Case 2.1
"Don't let the dog go home on day 3," I advised my associate. "The catheter may be rubbed out at home or pulled out as the dog will be roaming all over the apartment. In the Surgery, he is confined and monitored and nursed every day. At home, most owners don't bother. Things become nasty when the catheter is pulled out and the urethostomy wound at the bottom of the penis has not healed yet. Worse of all, the urethostomy wound closes and cause obstruction before the 10th day as recommended. The owner will want 'free' surgery or treatment. In any case, you get an unhappy owner."
The dog was put in for at least 10 days as this was a serious case of bladder and lower urethra being cut to take out the stones. (see X-ray).
Case 3
Skin disease.
"What the owner wants is a cure after payment and not have to come again," I referred to a case. "Vet 1 had treated and prescribed anti-fungal drugs and washes for the last 14 days. You saw the owner who was very unhappy as the dog was very itchy in the elbow, backside and lower body."
Mr Saw learnt from how I handled this case.
1. Skin scraping
2. Ultra-violet light. This was most impressive to the owner as ringworm hairs flouresce in the umbilical area and backside.
3. Communication with the owner. "You need to clip the dog bald," I said. "Otherwise you will curse me 2 weeks later when the disease is not gone away."
4. Clipping bald.
5. Anti-fungal wash.
After clipping bald, I discovered scabies mites on the ear edgess. So this dog had arcptic mange as well. No wonder he was so itchy and wanted to bite the owner!
Case 1
Tumour in gum of Chihuahua, M, Neutered, 6 years.
"It is best to advise histopathology of this tumour," I said to him. "Some owners are not aware of the need to get this test. We want to lower our vet costs by not advising this test. However, the tumour may be cancerous and if we do not advise, the next time the tumour comes back, the owner will not have confidence in the vet.
The owner is a young woman with internet knowledge and so she will know many things by researching the internet for gum tumours. She had asked whether I would be doing a histopathology and I said yes. Not every owner wants the lowest price.
Case 2
Urinary stone stuck inside the penis. "Different vets will operate differently to take out the stones jammed packed behind the os penis, inside the penis ," I said to Mr Saw. "In this Yorkshire, the vet leaves the urethra wound open by NOT stitching the incision. I will not operate this way. Why?"
Mr Saw did not know. "Well, this is a male dog. So he usually lifts his one leg to pee. When he pees, his urine will leak out from under his penis where the urethostomy incision has not been closed. So he sprays urine or dribble urine all over the apartment. In Singapore, 80% of the people lives in apartments. By NOT stitching up the urethra, the male dog may pee from his penile end and from below the penis. If you are the dog's owner, you will be very unhappy as you have to clean up. Worse still, the dog dribbles urine all over the whole floor due to urine marking.
Case 2.1
"Don't let the dog go home on day 3," I advised my associate. "The catheter may be rubbed out at home or pulled out as the dog will be roaming all over the apartment. In the Surgery, he is confined and monitored and nursed every day. At home, most owners don't bother. Things become nasty when the catheter is pulled out and the urethostomy wound at the bottom of the penis has not healed yet. Worse of all, the urethostomy wound closes and cause obstruction before the 10th day as recommended. The owner will want 'free' surgery or treatment. In any case, you get an unhappy owner."
The dog was put in for at least 10 days as this was a serious case of bladder and lower urethra being cut to take out the stones. (see X-ray).
Case 3
Skin disease.
"What the owner wants is a cure after payment and not have to come again," I referred to a case. "Vet 1 had treated and prescribed anti-fungal drugs and washes for the last 14 days. You saw the owner who was very unhappy as the dog was very itchy in the elbow, backside and lower body."
Mr Saw learnt from how I handled this case.
1. Skin scraping
2. Ultra-violet light. This was most impressive to the owner as ringworm hairs flouresce in the umbilical area and backside.
3. Communication with the owner. "You need to clip the dog bald," I said. "Otherwise you will curse me 2 weeks later when the disease is not gone away."
4. Clipping bald.
5. Anti-fungal wash.
After clipping bald, I discovered scabies mites on the ear edgess. So this dog had arcptic mange as well. No wonder he was so itchy and wanted to bite the owner!
Thursday, October 28, 2010
230. The ends justify the means
What is the meaning of "the ends justify the means?" I will illustrate. A father who is the sole breadwinner earns $3,000 a month. His daughter failed to get into the Singapore University due to not having straight As.
But she is accepted into an Australian University to pursue her dreams. The yearly cost of accommodation and tuition fees around $50,000. The mum does not work. So the source of income is around $36,000 from the father's earnings as an employee.
The company permitted the father to do outside work. He did manage to pay for the daughter's first year of overseas education through a stroke of luck. In the second year, Lady Luck enabled him to rent and sell a $3 million condo, thereby giving the daughter sufficient funds. But the timing was not right. So the father issued 2 cheques of $5,000 and $1,500 for an interest-free loan in cash. The cheques were dud ones as they could not be banked in. So, he got part of the money for his daughter. His "ends justify the means". Without the money, the daughter would be evicted from the course. Lady Luck had been kind to him again as no complaints to his company were made about his dud cheques. He repaid the monies 3 months later when the sales of the condo was completed. But there are two more years to go. Will Lady Luck still favour the brave father? Can he go round issuing dud checks to get money for his daughter and his own expenses? Is this an honest way to live? I don't think so. But there are such people using dud cheques to get the money. It is best not to lend any money to anybody.
But she is accepted into an Australian University to pursue her dreams. The yearly cost of accommodation and tuition fees around $50,000. The mum does not work. So the source of income is around $36,000 from the father's earnings as an employee.
The company permitted the father to do outside work. He did manage to pay for the daughter's first year of overseas education through a stroke of luck. In the second year, Lady Luck enabled him to rent and sell a $3 million condo, thereby giving the daughter sufficient funds. But the timing was not right. So the father issued 2 cheques of $5,000 and $1,500 for an interest-free loan in cash. The cheques were dud ones as they could not be banked in. So, he got part of the money for his daughter. His "ends justify the means". Without the money, the daughter would be evicted from the course. Lady Luck had been kind to him again as no complaints to his company were made about his dud cheques. He repaid the monies 3 months later when the sales of the condo was completed. But there are two more years to go. Will Lady Luck still favour the brave father? Can he go round issuing dud checks to get money for his daughter and his own expenses? Is this an honest way to live? I don't think so. But there are such people using dud cheques to get the money. It is best not to lend any money to anybody.
Wednesday, October 27, 2010
New puppy health check
E-MAIL TO DR SING DATGED OCT 27, 2010
Hi,
I am looking to adopt a new dog into my house, she is currently 1month old and still being weaned.
As i already have a 5 year old dog, i want to ensure that the newest addition is healthy and free from any disease.
Please let me know what tests which need to be run and at what age.
And also how long in advance would i need to make an appointment.
Thank you,
Name of owner
I am Dr Sing. My advice is to isolate the puppy from the adult dog for one month. Get the adult dog vaccinated 2 weeks before the puppy arrives if it is not vaccinated for the past one year. The puppy can be sent to me for general examination, testing of parvovirus +/- distemper and general examination after weaning and one day before going to your house. A blood test may be requested to check for liver and kidney disorders and blood status.
This will be around 6-8 weeks. First vaccination is at 6 weeks.
Appointment 24 hours earlier by phone 6254 3326 can be made. Best wishes.
Hi,
I am looking to adopt a new dog into my house, she is currently 1month old and still being weaned.
As i already have a 5 year old dog, i want to ensure that the newest addition is healthy and free from any disease.
Please let me know what tests which need to be run and at what age.
And also how long in advance would i need to make an appointment.
Thank you,
Name of owner
I am Dr Sing. My advice is to isolate the puppy from the adult dog for one month. Get the adult dog vaccinated 2 weeks before the puppy arrives if it is not vaccinated for the past one year. The puppy can be sent to me for general examination, testing of parvovirus +/- distemper and general examination after weaning and one day before going to your house. A blood test may be requested to check for liver and kidney disorders and blood status.
This will be around 6-8 weeks. First vaccination is at 6 weeks.
Appointment 24 hours earlier by phone 6254 3326 can be made. Best wishes.
228. Exploitation of a top performer
The following is my advice to any person who wants to be a joint-venture partner without putting down cash.
In this case study, I shall call this person Alan. In this private limited company, there are 2 directors at 50:50 share. Alan feels that he should be paid $5,000 per month as a "salaried" director as he brings in the bacon. The other director, Bernice puts in the money 100%.
So, Alan will get $60,000 per annum for the first year of operation. Bernice does not get paid but contributes in administration and management of the staff and office. At the end of one year, Alan wants 50% of the net profits but he will not be responsible for any loss. He thinks that there will never be losses since he has a wide network of prospective and loyal clientele. Bernice is only a "godmother" who pays for everything including his "salary".
The important issue is that he wants to consider $5,000/month to be classified under "operating manpower expense". That means he gets $60,000 per annum for the first year whether the company makes a profit or loses money.
After deduction of this expense and other expenses like salaries of supporting staff, office rental, utilities and miscellaneous expenses which may amount to around $72,000 per year, the estimated "operating expenses" will be $72,000 and with Alan's "salary", the total will be $132,000. Bernice does not get a cent for that first year.
Therefore the total loss to the investing director for this first year, will be around $132,000 in the worst case scenario of losses.
Alan, the paid director projects "profits" based on his extensive network of relevant clientele and your more than 30 years specialising in the industry. He brings in the bacon (as the clientele and expertise are his initially), but he does not bear the financial losses if the business fails.
There may be SARS virus equivalent or long periods of haze when nobody travels, a regional war, Singapore being attacked by terrorists. Money is needed to keep the business going during such unforeseen times and also to advance to him as the "directors' fees" which he wants to considers as his "salary".
Now, if Alan is merely an employee of the start up agency, the $5,000/month is classified as "salary." If not, it is considered "director's drawings".
Man proposes. God disposes. If the reader does not understand this idiom, I clarify that there is no sure thing as success in any start-up business. If there is, why are there so many more employees than self-employed?
With Alan's proposal to get $60,000 and 50% of the net profits (if any) but not the losses, Alan is effectively taking more than 50% of the net profits if the business makes profits. He does not take the losses and so he can just say goodbye and look for another job by becoming another employee after one year.
I told Alan that his proposal is unfair and unacceptable to any investor. "Obviously, you have considered that Bernice, the investing director doesn't deserve any monthly payment as she does not bring in the bacon. Well, she does the necessary administrative work saving time that permits you to do business development and she is putting down the money where her mouth is."
I elaborated: "Both directors in this 50:50 share holdings must be fair. When 2 people start up, they put in money and their initial shares are based on the monies they invested. They may pay themselves a small salary or forgo salary. Certainly, $5,000 a month is not the amount the start up will pay the partner as that depletes the operating capital.
"Bernice also thinks she deserves $5,000/month too as she bears more responsibilities being answerable to the regulatory authority as the key executive officer, her valuable time spent in administration and in bringing some business (though Alan presumes he will be the only one doing it). The investing director is also responsible for the family money invested ($100,000 paid up capital). $100,000 is not a small sum."
Alan said" "I can easily get a 80:20 deal with established agencies whereby I get 80% of the commission as a referring agent."
I replied: "Well, you should do what gives him the highest financial benefit."
Alan did not like the idea of sowing his odds to various agencies as he would not be able to project a solid reputation.
Alan said: "My friend runs an agency himself. He is given a salary and a share of the profits."
I said; "You can be sure that it will not be 50% of the net profits in the general cases. Do check with him. If he gets 50% of the net profit and does not put his hands inside the till, he must be a very lucky person."
I continued: "I doubt it. It is just not financially viable for the investing partner to give such a big share when he does not put up a dollar.
"A start up is like a baby. It needs a father and a mother ideally. Obviously, a mother (in this case, Alan) can do it alone. Many single mothers have raised children to be outstanding graduates. But we hear of such success stories. Many more single mothers have had failed miserably and we don't hear sad stories. We don't want to hear sad stories."
In conclusion, I spent much time elaborating the realities of commercial business life to Alan. "You have had been a very good employee for much of your life time by being honest and able to deliver the sales without the company getting into bad debts. Such employees are in great demand but there is a limit to what most agencies can afford to pay.
"See the other side of the coin. Business is feast and famine. When there is feast, you, as an employee feels "exploited" as a top performing employee bringing in 6 million dollars worth of sales income. You don't get to share the fruits of your big deals or get "appreciated" by being given some percentage of the revenue generated. But how much of the crumbs will satisfy you?
"You feel exploited as you feel you deserve high financial incentives that the company should give you for generating the six million dollars' revenue. You do not realise that the net profits may be as little as 5% as there are lots of overheads of a company. You feel that the net profits from your sales are 15-20% but you don't take into account the cost of overheads of the company and other factors like depreciation.
"The company may give you some bonus but it can't be lavish on you alone as there are the managing director, the finance director, the accounts director and others to pay. These are the supporting staff.
"A business development person brings in the bacon but they do the support. If the business development person gets exceptional big bonuses out of his performance, what about the supporting staff and the Chairman who invested in the infrastructure of the business. Without his investment, this person will not have been employed in the first place. You contracted as an employee with an agreed salary and you had been paid for that amount. Any bonus would be up to the boss.
"When there is famine or office politics, you seek other employers. This is also the reality of the life of an employee. In a start up, you needs to understand that you are no longer an employee and must get rid of your "exploitation" mindset.
"There will be no more exploitation of you by anybody because you are your own boss. Bernice does not give you targets since she knows that a start up is an uncertain business, no matter how optimistic projections of past performance you have made. If you are so sure that the start up agency is going to be profitable, why not sell your HDB apartment, rent one for the family for the interim period and go all out guns blazing. Sure to win. In no time, you have made millions."
In conclusion, I reminded Alan the harsh reality: "A start up is not a sure to win business. Even a successful business will have its ups and downs. There will be economic recessions and Bernice has to continue payment to tide over the bad times. This is the other side of the coin that you, a long-serving honest and productive employee cannot understand as you have not suffered considerable losses of a business set up and encounter stiff competition to lower pricing and high demands for cheap and good services from Singaporeans and elsewhere."
In this case study, I shall call this person Alan. In this private limited company, there are 2 directors at 50:50 share. Alan feels that he should be paid $5,000 per month as a "salaried" director as he brings in the bacon. The other director, Bernice puts in the money 100%.
So, Alan will get $60,000 per annum for the first year of operation. Bernice does not get paid but contributes in administration and management of the staff and office. At the end of one year, Alan wants 50% of the net profits but he will not be responsible for any loss. He thinks that there will never be losses since he has a wide network of prospective and loyal clientele. Bernice is only a "godmother" who pays for everything including his "salary".
The important issue is that he wants to consider $5,000/month to be classified under "operating manpower expense". That means he gets $60,000 per annum for the first year whether the company makes a profit or loses money.
After deduction of this expense and other expenses like salaries of supporting staff, office rental, utilities and miscellaneous expenses which may amount to around $72,000 per year, the estimated "operating expenses" will be $72,000 and with Alan's "salary", the total will be $132,000. Bernice does not get a cent for that first year.
Therefore the total loss to the investing director for this first year, will be around $132,000 in the worst case scenario of losses.
Alan, the paid director projects "profits" based on his extensive network of relevant clientele and your more than 30 years specialising in the industry. He brings in the bacon (as the clientele and expertise are his initially), but he does not bear the financial losses if the business fails.
There may be SARS virus equivalent or long periods of haze when nobody travels, a regional war, Singapore being attacked by terrorists. Money is needed to keep the business going during such unforeseen times and also to advance to him as the "directors' fees" which he wants to considers as his "salary".
Now, if Alan is merely an employee of the start up agency, the $5,000/month is classified as "salary." If not, it is considered "director's drawings".
Man proposes. God disposes. If the reader does not understand this idiom, I clarify that there is no sure thing as success in any start-up business. If there is, why are there so many more employees than self-employed?
With Alan's proposal to get $60,000 and 50% of the net profits (if any) but not the losses, Alan is effectively taking more than 50% of the net profits if the business makes profits. He does not take the losses and so he can just say goodbye and look for another job by becoming another employee after one year.
I told Alan that his proposal is unfair and unacceptable to any investor. "Obviously, you have considered that Bernice, the investing director doesn't deserve any monthly payment as she does not bring in the bacon. Well, she does the necessary administrative work saving time that permits you to do business development and she is putting down the money where her mouth is."
I elaborated: "Both directors in this 50:50 share holdings must be fair. When 2 people start up, they put in money and their initial shares are based on the monies they invested. They may pay themselves a small salary or forgo salary. Certainly, $5,000 a month is not the amount the start up will pay the partner as that depletes the operating capital.
"Bernice also thinks she deserves $5,000/month too as she bears more responsibilities being answerable to the regulatory authority as the key executive officer, her valuable time spent in administration and in bringing some business (though Alan presumes he will be the only one doing it). The investing director is also responsible for the family money invested ($100,000 paid up capital). $100,000 is not a small sum."
Alan said" "I can easily get a 80:20 deal with established agencies whereby I get 80% of the commission as a referring agent."
I replied: "Well, you should do what gives him the highest financial benefit."
Alan did not like the idea of sowing his odds to various agencies as he would not be able to project a solid reputation.
Alan said: "My friend runs an agency himself. He is given a salary and a share of the profits."
I said; "You can be sure that it will not be 50% of the net profits in the general cases. Do check with him. If he gets 50% of the net profit and does not put his hands inside the till, he must be a very lucky person."
I continued: "I doubt it. It is just not financially viable for the investing partner to give such a big share when he does not put up a dollar.
"A start up is like a baby. It needs a father and a mother ideally. Obviously, a mother (in this case, Alan) can do it alone. Many single mothers have raised children to be outstanding graduates. But we hear of such success stories. Many more single mothers have had failed miserably and we don't hear sad stories. We don't want to hear sad stories."
In conclusion, I spent much time elaborating the realities of commercial business life to Alan. "You have had been a very good employee for much of your life time by being honest and able to deliver the sales without the company getting into bad debts. Such employees are in great demand but there is a limit to what most agencies can afford to pay.
"See the other side of the coin. Business is feast and famine. When there is feast, you, as an employee feels "exploited" as a top performing employee bringing in 6 million dollars worth of sales income. You don't get to share the fruits of your big deals or get "appreciated" by being given some percentage of the revenue generated. But how much of the crumbs will satisfy you?
"You feel exploited as you feel you deserve high financial incentives that the company should give you for generating the six million dollars' revenue. You do not realise that the net profits may be as little as 5% as there are lots of overheads of a company. You feel that the net profits from your sales are 15-20% but you don't take into account the cost of overheads of the company and other factors like depreciation.
"The company may give you some bonus but it can't be lavish on you alone as there are the managing director, the finance director, the accounts director and others to pay. These are the supporting staff.
"A business development person brings in the bacon but they do the support. If the business development person gets exceptional big bonuses out of his performance, what about the supporting staff and the Chairman who invested in the infrastructure of the business. Without his investment, this person will not have been employed in the first place. You contracted as an employee with an agreed salary and you had been paid for that amount. Any bonus would be up to the boss.
"When there is famine or office politics, you seek other employers. This is also the reality of the life of an employee. In a start up, you needs to understand that you are no longer an employee and must get rid of your "exploitation" mindset.
"There will be no more exploitation of you by anybody because you are your own boss. Bernice does not give you targets since she knows that a start up is an uncertain business, no matter how optimistic projections of past performance you have made. If you are so sure that the start up agency is going to be profitable, why not sell your HDB apartment, rent one for the family for the interim period and go all out guns blazing. Sure to win. In no time, you have made millions."
In conclusion, I reminded Alan the harsh reality: "A start up is not a sure to win business. Even a successful business will have its ups and downs. There will be economic recessions and Bernice has to continue payment to tide over the bad times. This is the other side of the coin that you, a long-serving honest and productive employee cannot understand as you have not suffered considerable losses of a business set up and encounter stiff competition to lower pricing and high demands for cheap and good services from Singaporeans and elsewhere."
Monday, October 25, 2010
227. Oronasal fistula in a dog - veterinary costs
ORONASAL FISTULA IN A DOG - ESTIMATED VETERINARY COST IN 2010
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case written: November 15, 2007
Update: 25 October, 2010
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
I am Dr Sing from Toa Payoh Vets, toapayohvets.com. Thank you for your email. Your dog is suffering from oro-nasal fistula caused usually by the abscess in the root of the big cheek tooth, the 4th premolar. In reply to your queries, see CAPITAL LETTERS below.
2010/10/24 ....@hotmail.com
Hi,
I have a jack russell of 7 years old, lately, we have been noticing small bumps on her face, right under her right eye. We have brought her to a vet and was told that it was due to gum problem, and this was further caused by tooth decay.
In that case, if we would like to proceed with a tooth extraction, how much would that cost?
1. SEDATION + ISOFLURANE GAS ANAESTHESIA $200
2. TOOTH EXTRACTION $20/TOOTH
3. DENTAL SCALING OF OTHER TEETH $50
4. POST-OP PAINKILLER AND ANTIBIOTIC INJECTION $30
5. POST-OP PAINKILLER AND ANTIBIOTIC ORAL $30 APPROXIMATELY
6. I/V DRIP + ANTIBIOTICS I/V $60
7. BLOOD TEST $150 (IF YOU DON'T WANT THE TEST, THEN THIS IS ZERO CHARGE)
8. CONSULTATION FEE $40 (NO CHARGE IN THIS CASE AS DIAGNOSIS IS DONE BY YOUR VET)
and what are the procedures?
NO FOOD AND WATER AFTER 10 PM THE DAY BEFORE. THE DOG COMES IN THE MORNING.
WEIGHED, EXAMINED GENERALLY, HEART CHECKED, TEMPERATURE, PULSE AND RESPIRATION DONE. BLOOD TEST (OPTIONAL).
THEN I/V DRIP + ANTIBIOTIC I/V, SEDATION AND GAS ANAESTHESIA. PREMOLAR TOOTH EXTRACTED. OTHER LOOSE ROTTEN TEETH EXTRACTED. DENTAL SCALING OF GOOD TEETH.
INJECTION SC PAINKILLER AND ANTIBIOTICS. THE DOG RESTS IN CAGE FOR >4 HOURS AND OBSERVED. GOES HOME IN THE EVENING.WITH PAIN-KILLER AND ANTIBIOTICS.
Two of my pet owner educational cases of canine oronasal fistula are at: A Pomeranian's facial wound that never heals
When is the soonest that we can have it done? Cause my dog seems to be in great pain.
WITHIN 24 HOURS OF YOU MAKING AN APPOINTMENT BY TEL 6254 3326.LET US KNOW AS SOON AS POSSIBLE.
Thanks!
Regards,
Name of Owner
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case written: November 15, 2007
Update: 25 October, 2010
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
I am Dr Sing from Toa Payoh Vets, toapayohvets.com. Thank you for your email. Your dog is suffering from oro-nasal fistula caused usually by the abscess in the root of the big cheek tooth, the 4th premolar. In reply to your queries, see CAPITAL LETTERS below.
2010/10/24 ....@hotmail.com
Hi,
I have a jack russell of 7 years old, lately, we have been noticing small bumps on her face, right under her right eye. We have brought her to a vet and was told that it was due to gum problem, and this was further caused by tooth decay.
In that case, if we would like to proceed with a tooth extraction, how much would that cost?
1. SEDATION + ISOFLURANE GAS ANAESTHESIA $200
2. TOOTH EXTRACTION $20/TOOTH
3. DENTAL SCALING OF OTHER TEETH $50
4. POST-OP PAINKILLER AND ANTIBIOTIC INJECTION $30
5. POST-OP PAINKILLER AND ANTIBIOTIC ORAL $30 APPROXIMATELY
6. I/V DRIP + ANTIBIOTICS I/V $60
7. BLOOD TEST $150 (IF YOU DON'T WANT THE TEST, THEN THIS IS ZERO CHARGE)
8. CONSULTATION FEE $40 (NO CHARGE IN THIS CASE AS DIAGNOSIS IS DONE BY YOUR VET)
and what are the procedures?
NO FOOD AND WATER AFTER 10 PM THE DAY BEFORE. THE DOG COMES IN THE MORNING.
WEIGHED, EXAMINED GENERALLY, HEART CHECKED, TEMPERATURE, PULSE AND RESPIRATION DONE. BLOOD TEST (OPTIONAL).
THEN I/V DRIP + ANTIBIOTIC I/V, SEDATION AND GAS ANAESTHESIA. PREMOLAR TOOTH EXTRACTED. OTHER LOOSE ROTTEN TEETH EXTRACTED. DENTAL SCALING OF GOOD TEETH.
INJECTION SC PAINKILLER AND ANTIBIOTICS. THE DOG RESTS IN CAGE FOR >4 HOURS AND OBSERVED. GOES HOME IN THE EVENING.WITH PAIN-KILLER AND ANTIBIOTICS.
Two of my pet owner educational cases of canine oronasal fistula are at: A Pomeranian's facial wound that never heals
When is the soonest that we can have it done? Cause my dog seems to be in great pain.
WITHIN 24 HOURS OF YOU MAKING AN APPOINTMENT BY TEL 6254 3326.LET US KNOW AS SOON AS POSSIBLE.
Thanks!
Regards,
Name of Owner
Friday, October 22, 2010
8-year-old neutered male cat can't pee
"I know my cats well," the lady said when I asked whether 8-year-old her male neutered cat was having constipation instead of having difficulty in urination. "I have 5 of them. I can differentiate constipation from urination difficulty."
She had consulted Vet 1 twice on Monday and Wednesday but the cat still had dysuria (difficulty in passing urine). She said: "I find that the vet is not sure of what's happening to my cat." When the cat does not get well, many Singapore owners will lose confidence and seek another opinion. Diseases take time to resolve with antibiotics and the second vet usually benefits from the passage of time to deliver an excellent outcome.
Vet 1 had told her that there was no major problem after palpation of the bladder. She said that her maid had kept a close eye on this cat and was sure that the cat had not peed a drop of urine for the past 2 days.
I said: "I have the same finding as Vet 1 in that the bladder is not full at all. So there is no urethral obstruction. If there is urinary sand obstructing the urethra, the bladder should be as big as a mango. If the cat had not peed for 2 days, the bladder should be swollen and can be felt easily."
The maid was holding the cat upside down for me to examine his private parts. There was a purplish red tip of the penis which was otherwise not swollen and normal in size and colour. The cat had medications from Vet 1 and the "normal finding" of the penis must be taken into account.
The lady was in the subway train on the way to the surgery after work. Her mum and maid had brought the cat in first. The cat had lost appetite today and had dysuria. She was insistent that the cat had a problem with urination.
PHYSICAL EXAMINATION
1. Cat standing on the examination table. Palpation of the bladder. Not swollen at all. Slight pain around the bladder area but not
2. Cat turned upside down. The penile length was extruded. Except for a purplish red tip due to traumatic licking, there was nothing abnormal. I asked the maid: "Is it possible that the cat peed when every family member including you were asleep? The bladder pain may have gone for a while and the cat pees most of the urine." The maid did not object to this comment. "Did you see blood in the cat's urine earlier?" I asked the maid. "No," she said.
WHAT TO DO NOW?
There was no doubt that the owner knows best. The cat does not have constipation as the palpation does not reveal hard faecal stools. Yet the cat does not have a full bladder or blood in the urine history.
WHAT THE OWNER WANTS
An accurate diagnosis on what's wrong with her cat. In the male dog, it is much easier to catheterise the dog's bladder and get the urine out for examination of blood and bacteria.
RE-EXAMINE THE CAT'S PENILE AREA AGAIN
I asked the maid to bring the cat to the operating room for a re-examination of the penile area again under the bright operating lights. My assistant pushed the penis out from the prepuce. The prepuce and penile body were normal pink. Only the penile tip was purplish red in colour as seen in traumatic licking.
The cat was now getting angry with all these manipulations. Suddenly the maid pointed to her right side of her T-shirt and shouted: "The cat peed onto me!" She managed a twist and turn. Much of the pee bombed onto the floor. There was a big drop of blood-stained urine remaining on the preputial area.
"Get a one-ml syringe," I shouted to my assistant. "Suck out the urine for examination." In the meantime, I took out my digital camera to take evidence for the owner who was rushing to the surgery.
"You need a 2-ml syringe," my assistant went to the chest of drawers to get one. That drop of urine would fill the 1-ml syringe. While my assistant was looking for the syringe, the cat gave a turn to be upright. So, there was no more bloody urine evidence. The maid was the witness. The bloody urine on the floor was of no use as the floor tiles were greyish in colour and anyway, the amount was not that much. It was around 20 ml spread out on the tiles.
The owner arrived. "The cat had blood in the urine," I said. She looked at me for proof. I took out the digital camera and got the image for her to see. Dark red blood at the penile tip. She seemed satisfied. Nothing can convince the doubting owner than real physical evidence of bloody urine.
TREATMENT
The owner reluctantly agreed to the cat being warded one day. Blood test would be done. The urine would be collected the next day while the cat had a IV saline to produce urine. I will then catheterise the cat and collect the urine. After that, the bladder would be flushed well with saline to get all urinary sand out.
DIAGNOSIS
In dysuria and haematuria in an 8-year-old cat of recent onset, the possible causes are:
1. FIC (feline idiopathic cystitis). This is the most common cause.
2. Urolithiasis (stone or sand in the bladder). Usually in cats over 10 years old.
3. Urethral plugs.
In this case, the tentative diagnosis is FIC but it may be a combination of 3 causes. After manipulation of the penile tip, the urethral plug was loosened and the cat peed onto the maid.
TESTS
1. Blood test
2. Urine test - cystocentosis, catheterisation or voiding. I prefer catherisation although some vets advocate cystocentosis is said to prevent introduction of bacteria into the bladder.
3. Urolith analysis (struvite & calcium oxalate usually).
ADVICE
"Stop feeding dry cat food," I said to the owner firmly. "If you feed dry food, the cat may suffer from the same lower urinary tract disease again and you will have to spend money for treatmen. Don't say I did not tell you."
The lady said: "My cat loves dry food. The other 4 cats are also eating dry food. One of them is older than him and has no such problem."
I said: "Not every person or cat will suffer from the same disease or condition. This is the diversity of life."
CONCLUSION
This is one of those cases where the cat is presented with no swollen bladder. So any vet will say that there is no urethral obstruction. So the owner will lose confidence in the vet and seek a second opinion. The second opinion was no better than the first opinion till the cat delivered the blood urine as evidence of a lower urinary tract disease! Luck does play an important part in living and in veterinary diagnosis sometimes.
She had consulted Vet 1 twice on Monday and Wednesday but the cat still had dysuria (difficulty in passing urine). She said: "I find that the vet is not sure of what's happening to my cat." When the cat does not get well, many Singapore owners will lose confidence and seek another opinion. Diseases take time to resolve with antibiotics and the second vet usually benefits from the passage of time to deliver an excellent outcome.
Vet 1 had told her that there was no major problem after palpation of the bladder. She said that her maid had kept a close eye on this cat and was sure that the cat had not peed a drop of urine for the past 2 days.
I said: "I have the same finding as Vet 1 in that the bladder is not full at all. So there is no urethral obstruction. If there is urinary sand obstructing the urethra, the bladder should be as big as a mango. If the cat had not peed for 2 days, the bladder should be swollen and can be felt easily."
The maid was holding the cat upside down for me to examine his private parts. There was a purplish red tip of the penis which was otherwise not swollen and normal in size and colour. The cat had medications from Vet 1 and the "normal finding" of the penis must be taken into account.
The lady was in the subway train on the way to the surgery after work. Her mum and maid had brought the cat in first. The cat had lost appetite today and had dysuria. She was insistent that the cat had a problem with urination.
PHYSICAL EXAMINATION
1. Cat standing on the examination table. Palpation of the bladder. Not swollen at all. Slight pain around the bladder area but not
2. Cat turned upside down. The penile length was extruded. Except for a purplish red tip due to traumatic licking, there was nothing abnormal. I asked the maid: "Is it possible that the cat peed when every family member including you were asleep? The bladder pain may have gone for a while and the cat pees most of the urine." The maid did not object to this comment. "Did you see blood in the cat's urine earlier?" I asked the maid. "No," she said.
WHAT TO DO NOW?
There was no doubt that the owner knows best. The cat does not have constipation as the palpation does not reveal hard faecal stools. Yet the cat does not have a full bladder or blood in the urine history.
WHAT THE OWNER WANTS
An accurate diagnosis on what's wrong with her cat. In the male dog, it is much easier to catheterise the dog's bladder and get the urine out for examination of blood and bacteria.
RE-EXAMINE THE CAT'S PENILE AREA AGAIN
I asked the maid to bring the cat to the operating room for a re-examination of the penile area again under the bright operating lights. My assistant pushed the penis out from the prepuce. The prepuce and penile body were normal pink. Only the penile tip was purplish red in colour as seen in traumatic licking.
The cat was now getting angry with all these manipulations. Suddenly the maid pointed to her right side of her T-shirt and shouted: "The cat peed onto me!" She managed a twist and turn. Much of the pee bombed onto the floor. There was a big drop of blood-stained urine remaining on the preputial area.
"Get a one-ml syringe," I shouted to my assistant. "Suck out the urine for examination." In the meantime, I took out my digital camera to take evidence for the owner who was rushing to the surgery.
"You need a 2-ml syringe," my assistant went to the chest of drawers to get one. That drop of urine would fill the 1-ml syringe. While my assistant was looking for the syringe, the cat gave a turn to be upright. So, there was no more bloody urine evidence. The maid was the witness. The bloody urine on the floor was of no use as the floor tiles were greyish in colour and anyway, the amount was not that much. It was around 20 ml spread out on the tiles.
The owner arrived. "The cat had blood in the urine," I said. She looked at me for proof. I took out the digital camera and got the image for her to see. Dark red blood at the penile tip. She seemed satisfied. Nothing can convince the doubting owner than real physical evidence of bloody urine.
TREATMENT
The owner reluctantly agreed to the cat being warded one day. Blood test would be done. The urine would be collected the next day while the cat had a IV saline to produce urine. I will then catheterise the cat and collect the urine. After that, the bladder would be flushed well with saline to get all urinary sand out.
DIAGNOSIS
In dysuria and haematuria in an 8-year-old cat of recent onset, the possible causes are:
1. FIC (feline idiopathic cystitis). This is the most common cause.
2. Urolithiasis (stone or sand in the bladder). Usually in cats over 10 years old.
3. Urethral plugs.
In this case, the tentative diagnosis is FIC but it may be a combination of 3 causes. After manipulation of the penile tip, the urethral plug was loosened and the cat peed onto the maid.
TESTS
1. Blood test
2. Urine test - cystocentosis, catheterisation or voiding. I prefer catherisation although some vets advocate cystocentosis is said to prevent introduction of bacteria into the bladder.
3. Urolith analysis (struvite & calcium oxalate usually).
ADVICE
"Stop feeding dry cat food," I said to the owner firmly. "If you feed dry food, the cat may suffer from the same lower urinary tract disease again and you will have to spend money for treatmen. Don't say I did not tell you."
The lady said: "My cat loves dry food. The other 4 cats are also eating dry food. One of them is older than him and has no such problem."
I said: "Not every person or cat will suffer from the same disease or condition. This is the diversity of life."
CONCLUSION
This is one of those cases where the cat is presented with no swollen bladder. So any vet will say that there is no urethral obstruction. So the owner will lose confidence in the vet and seek a second opinion. The second opinion was no better than the first opinion till the cat delivered the blood urine as evidence of a lower urinary tract disease! Luck does play an important part in living and in veterinary diagnosis sometimes.
Wednesday, October 20, 2010
Toa Payoh Vets - Dietary management to dissolve struvite stones in dogs
Dietary management to dissolve struvite stones in the bladder & voiding urohydropropulsion
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Written: Perth, 29 September 2010
Update: 11 October 2010
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
After the surgical removal of the struvite urinary stones or for medical and dietary treatment, how much of the prescription diet should the owner give the dog/day?
I took some time just to read about Canine Struvite Urolithiasis case studies in the thick book "Small Animal Clinical Nutrition" by Hand et. al, 5th Edition and the following is some general guideline for Toa Payoh Vets in advising on Prescription Diet s/d to dogs in 3 case studies.
How much of the s/d diet to be given:
1. Puppy X-breed, 9 weeks,
5 kg.
700kcal (2.83MJ)
1/2 can 3x/day
2. Rottweiler, 5 years, 41 kg
1,800kcal (7.5MJ)
1.5 cans 2x/day
3. German Shepherd, 12 years, 27 kg
1,150kcal (4.8MJ)
1 can 2x/day
Other procedures to ensure compliance from the owner:
1. Antibiotics from 14-30 days and review using urine cultures
2. Monthly urine analysis (check for UTI) and blood tests (esp. serum urea nitrogen, magnesium, phosphorus and calcium and alkaline phosphatese)
3. Monthly x-rays of kidney (V/D view), bladder (lateral views)
Back to normal commercial food for the puppy as soon as X-rays show no stones. For adult dogs, give prescription food for one more month after negative X-ray results. No commercial dog treats or snacks during the period of treatment.
Specialised tests like double-contrast cystography (to check out anatomic abnormalities of the bladder, obstruction of urine flow from kidneys), retrograde positive-contrast urethrocystography (to check out anatomical abnormalities of the urinary tract to the prostate gland area) if there is recurrent uroliths or UTI.
Very few Singapore clientele comply with the above instructions. It could be due to economic reasons. Urine is taken by cystocentesis. Voiding urohydropropulsion is used in cases where the uroliths are small. The owner must be informed that it takes 2-4 months or longer to get all struvite stones dissolved. The owner must be aware of the need for reviews and to note the costs involved in the dietary management to dissolve struvite urinary stones.
VETERINARY SURGERY --- VOIDING UROHYDROPROPULSION IN DOGS AND CATS
What is urohydropropulsion? During my undergraduate days some 30 years ago, there was no such term.
Basically it means pumping saline into the bladder (3ml/kg) and suck out the fluid together with the small uroliths (urinary stones) with a catheter. The stones in the bladder are too small and therefore no surgical removal is needed.
ANAESTHESIA. May or may not be need.
POSITION. 2 methods described in Small Animal Clinical Nutrition 5th edition.
POSITION 1. Hold the dog or cat upright so that the vertebral column is upright. The urine and stones will be at the bottom (neck) of the bladder.
POSITION 2. Lateral recumbency.
In both position, catheterise, irrigate with saline (3ml/kg), massage or press bladder to shake up the stones, suck out the saline + stones with a syringe. X-rays to check if all are taken out but not all small ones can be seen.
Dietary and medical treatment.
More information is at: Small Animal Clinical Nutrition" by Hand et. al, 5th Edition
This webpage:
http://www.sinpets.com/F5/20100697struvite-dietary-management-voiding-urohydropropulsion_ToaPayohVets.htm
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Written: Perth, 29 September 2010
Update: 11 October 2010
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
After the surgical removal of the struvite urinary stones or for medical and dietary treatment, how much of the prescription diet should the owner give the dog/day?
I took some time just to read about Canine Struvite Urolithiasis case studies in the thick book "Small Animal Clinical Nutrition" by Hand et. al, 5th Edition and the following is some general guideline for Toa Payoh Vets in advising on Prescription Diet s/d to dogs in 3 case studies.
How much of the s/d diet to be given:
1. Puppy X-breed, 9 weeks,
5 kg.
700kcal (2.83MJ)
1/2 can 3x/day
2. Rottweiler, 5 years, 41 kg
1,800kcal (7.5MJ)
1.5 cans 2x/day
3. German Shepherd, 12 years, 27 kg
1,150kcal (4.8MJ)
1 can 2x/day
Other procedures to ensure compliance from the owner:
1. Antibiotics from 14-30 days and review using urine cultures
2. Monthly urine analysis (check for UTI) and blood tests (esp. serum urea nitrogen, magnesium, phosphorus and calcium and alkaline phosphatese)
3. Monthly x-rays of kidney (V/D view), bladder (lateral views)
Back to normal commercial food for the puppy as soon as X-rays show no stones. For adult dogs, give prescription food for one more month after negative X-ray results. No commercial dog treats or snacks during the period of treatment.
Specialised tests like double-contrast cystography (to check out anatomic abnormalities of the bladder, obstruction of urine flow from kidneys), retrograde positive-contrast urethrocystography (to check out anatomical abnormalities of the urinary tract to the prostate gland area) if there is recurrent uroliths or UTI.
Very few Singapore clientele comply with the above instructions. It could be due to economic reasons. Urine is taken by cystocentesis. Voiding urohydropropulsion is used in cases where the uroliths are small. The owner must be informed that it takes 2-4 months or longer to get all struvite stones dissolved. The owner must be aware of the need for reviews and to note the costs involved in the dietary management to dissolve struvite urinary stones.
VETERINARY SURGERY --- VOIDING UROHYDROPROPULSION IN DOGS AND CATS
What is urohydropropulsion? During my undergraduate days some 30 years ago, there was no such term.
Basically it means pumping saline into the bladder (3ml/kg) and suck out the fluid together with the small uroliths (urinary stones) with a catheter. The stones in the bladder are too small and therefore no surgical removal is needed.
ANAESTHESIA. May or may not be need.
POSITION. 2 methods described in Small Animal Clinical Nutrition 5th edition.
POSITION 1. Hold the dog or cat upright so that the vertebral column is upright. The urine and stones will be at the bottom (neck) of the bladder.
POSITION 2. Lateral recumbency.
In both position, catheterise, irrigate with saline (3ml/kg), massage or press bladder to shake up the stones, suck out the saline + stones with a syringe. X-rays to check if all are taken out but not all small ones can be seen.
Dietary and medical treatment.
More information is at: Small Animal Clinical Nutrition" by Hand et. al, 5th Edition
This webpage:
http://www.sinpets.com/F5/20100697struvite-dietary-management-voiding-urohydropropulsion_ToaPayohVets.htm
222. Defensive Medicine at the 49th day of pregnancy
The owner said that her British Bulldog was 49th day pregnant. Dr Vanessa Lin was the vet in charge. She palpated the abdomen and declared that the dog was not pregnant. I palpated and agreed with her. There was no big foetal lump or lumps in the abdomen. A simple case of pregnancy diagnosis. Not pregnant.
But veterinary medicine can throw out surprises for the vet who wants to provide least-cost veterinary services.
"There is a possibility that the foetal lump is positioned cranially below the diaphragm such that the vet can't feel it," I cautioned. I had read some dog breeding reports on this type of situations.
"If the dog is diagnosed as not pregnant now and she loses her sole pup due to this diagnosis, there will be a lot of unhappiness. Bulldogs usually need a Caesarean section as the puppy's head is too big. Since the vet has diagnosed this dog as non-pregnant, the owner would not have had prepared the dog for an elective Caesarean section as veterinarians are trusted professionals.
I related an incident to Dr Lin about the single pup syndrome case in a Pomeranian. A vet diagnosed the Pom as not being pregnant by abdominal palpation. The breeder who brought in the dog agreed with him. The vet assistant supported his diagnosis. Three people with experience said not pregnant.
The Pom had a difficult birth and required Caesarean section. The pup died after the Caesarean section. The dam died a few days later. The death of the beloved dam evoked much anger and resentment. If only an X-ray or ultrasound were done as part of defensive medicine, this sad outcome would not have occurred. This pup would probably had been located as a small foetal lump in the most cranial position behind the diaphragm.
Dr Lin advised an ultrasound. The dog was confirmed not pregnant. Defensive medicine is needed in many cases. When the owner is unhappy or provoked by the competitor vet, many complaints are made. A simple X-ray or ultrasound taken should have been done as part of defensive medicine as vets are not Gods and variations in medicine can sometimes ruin a hard-won reputation.
Updates at www.toapayohvets.com
But veterinary medicine can throw out surprises for the vet who wants to provide least-cost veterinary services.
"There is a possibility that the foetal lump is positioned cranially below the diaphragm such that the vet can't feel it," I cautioned. I had read some dog breeding reports on this type of situations.
"If the dog is diagnosed as not pregnant now and she loses her sole pup due to this diagnosis, there will be a lot of unhappiness. Bulldogs usually need a Caesarean section as the puppy's head is too big. Since the vet has diagnosed this dog as non-pregnant, the owner would not have had prepared the dog for an elective Caesarean section as veterinarians are trusted professionals.
I related an incident to Dr Lin about the single pup syndrome case in a Pomeranian. A vet diagnosed the Pom as not being pregnant by abdominal palpation. The breeder who brought in the dog agreed with him. The vet assistant supported his diagnosis. Three people with experience said not pregnant.
The Pom had a difficult birth and required Caesarean section. The pup died after the Caesarean section. The dam died a few days later. The death of the beloved dam evoked much anger and resentment. If only an X-ray or ultrasound were done as part of defensive medicine, this sad outcome would not have occurred. This pup would probably had been located as a small foetal lump in the most cranial position behind the diaphragm.
Dr Lin advised an ultrasound. The dog was confirmed not pregnant. Defensive medicine is needed in many cases. When the owner is unhappy or provoked by the competitor vet, many complaints are made. A simple X-ray or ultrasound taken should have been done as part of defensive medicine as vets are not Gods and variations in medicine can sometimes ruin a hard-won reputation.
Updates at www.toapayohvets.com
Tuesday, October 19, 2010
A vomiting Chihuahua (Impaction of the stomach)
INTERPRETATION OF THE X-RAYS FOR THE OWNER
Chihuahua, Male, 6 years. Vomiting and not eating. What is the problem? The dog was warded for observation.
ABDOMINAL PALPATION
A soft mass in the stomach. No pain on palpation. The intestines were firm as if they were "sausage" rolls.
X-RAYS
Lateral view:
The stomach was impacted with some foreign body. The white arrows showed a fullness of the stomach pressing against the diaphragm (which separates the chest cavity from the abdominal cavity). The white foreign body inside the stomach and intestines (black arrows) would be fibers from the chew rope. The dog had been swallowing chew ropes for many months based on the owner's report. Chew ropes are commonly sold at Singapore's pet shops. This dog prefers to eat the pieces and they accumulate and fill the stomach. This medical condition is called impaction of the stomach.
Laxatives given showed fibers and hairs inside the stools. The owner told me the dog farted. He did not pass stools for the first 4 days. I/V drips and antibiotics prevent dehydration and death.
Ventral-Dorsal view
The full stomach is not so easily seen by the layman. There is no solid foreign body such as a bone or stone and so interpretation of this view is difficult without the clinical examination and history.
The outline of the stomach is shown by the black arrows. White foreign body of fibers impact the stomach. There is a dark area in the lower half of the stomach. This will be the gas. "Sausage-like" rolls of the intestines can be seen below the stomach. I have not marked the rolls.
The bladder shows a opaque urine which is not normal. Urine tests confirmed a moderate amount of struvite crystals which cause this whiteness of the bladder. On discharge of the dog, the dog peed with difficulty on the grass. This was seen by the owner.
Dietary management to dissolve the struvite crystals is an alternative to surgery. However the owner must know that it may take 2-4 months to see results and there must be strict compliance with veterinary instructions including diet and urine tests and X-rays of the bladder till no struvite crystals are present.
Two blood tests were taken. The second blood test showed liver disorder. In conclusion, the dog recovered after 4 days and went home. Dietary management to dissolve the stones had been discussed with the owner. A follow-up by the owner must be done in the next few days.
Updates at www.toapayohvets.com
Chihuahua, Male, 6 years. Vomiting and not eating. What is the problem? The dog was warded for observation.
ABDOMINAL PALPATION
A soft mass in the stomach. No pain on palpation. The intestines were firm as if they were "sausage" rolls.
X-RAYS
Lateral view:
The stomach was impacted with some foreign body. The white arrows showed a fullness of the stomach pressing against the diaphragm (which separates the chest cavity from the abdominal cavity). The white foreign body inside the stomach and intestines (black arrows) would be fibers from the chew rope. The dog had been swallowing chew ropes for many months based on the owner's report. Chew ropes are commonly sold at Singapore's pet shops. This dog prefers to eat the pieces and they accumulate and fill the stomach. This medical condition is called impaction of the stomach.
Laxatives given showed fibers and hairs inside the stools. The owner told me the dog farted. He did not pass stools for the first 4 days. I/V drips and antibiotics prevent dehydration and death.
Ventral-Dorsal view
The full stomach is not so easily seen by the layman. There is no solid foreign body such as a bone or stone and so interpretation of this view is difficult without the clinical examination and history.
The outline of the stomach is shown by the black arrows. White foreign body of fibers impact the stomach. There is a dark area in the lower half of the stomach. This will be the gas. "Sausage-like" rolls of the intestines can be seen below the stomach. I have not marked the rolls.
The bladder shows a opaque urine which is not normal. Urine tests confirmed a moderate amount of struvite crystals which cause this whiteness of the bladder. On discharge of the dog, the dog peed with difficulty on the grass. This was seen by the owner.
Dietary management to dissolve the struvite crystals is an alternative to surgery. However the owner must know that it may take 2-4 months to see results and there must be strict compliance with veterinary instructions including diet and urine tests and X-rays of the bladder till no struvite crystals are present.
Two blood tests were taken. The second blood test showed liver disorder. In conclusion, the dog recovered after 4 days and went home. Dietary management to dissolve the stones had been discussed with the owner. A follow-up by the owner must be done in the next few days.
Updates at www.toapayohvets.com
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