Saturday Jan 12 2013
A bubbly Malay lady from Woodlands came with her blue-eyed cat and a little boy. "Why do you come all the way from Woodlands? There are clinics near your home." It was her personal choice.
After the usual examination, I said she could come back in one hour to take the cat home.
"One hour?" the little boy with bright big eyes said aloud. He was most attentive
"Yes," I said. "Do you know what is 'one hour'?" I asked him.
He did not reply. Mum laughed.
Two hours later, the mum came with him for the cat.
"There is some bleeding from the operation site," the mum said."
"Disgusting," the little boy added. I was surprised that he uttered this word and wondered whether he knew what it meant. He was 6 years old as his mother told me later as I thought he was 4 or 5 years old. He was bright and would do well in life if given proper attention and if he studied hard.
The cat was left in the surgery till 5 pm when another adult came with 3 more children. Lots of joy and laughter with these young kids around. "I am the 5th sister," the mum said. "This is my 3rd sister." Third sister was slim and more serious and drove a car. The cat was no longer bleeding and all went home happily.
As to why this 2-year-old cat was sent for neutering, it was because he was caterwauling.
"A stray pregnant female cat waits for him outside the door," 5th sister said. "He is on heat and wants to go out. That is why I want you to neuter him"
"Male cats do not stop meowing noisily immediately after neutering," I said. "It takes time for his male hormones to disappear.
"This male cat sprayed his urine and oil onto the neighbour's walls and they are so angry! That is why I want to neuter him!".
"In any case, why don't you get the pregnant female cat spayed?"
"She is my neighbour's cat," 5th sister replied. "Whe she heard it cost me $195," she did not want to do it.
"The cost of neuter is much less," I said to her. "You wanted the e-collar, the vaccination and the de-fleaing spot-on. This added up. The actual cost is around $125 with antibiotics and painkillers and surgery and anaesthesia@"
Sunday, January 13, 2013
1241. STANDARD OPERATING PROCEDURES. HOW LONG IT TAKES TO NEUTER A YOUNG POM?
Saturday Jan 12, 2013
STANDARD OPERATING PROCEDURES. HOW LONG IT TAKES TO NEUTER A YOUNG POM?
A young doctor came at 9.30 am on this fine Saturday morning, with a Pom as she had made an appointment for the neuter.
"Has he eaten?" I asked.
"Yes," she said.
"It is best not to feed the dog 10 hours before surgery as the dog may vomit during surgery."
"Your staff did not mention this when I phoned for an appointment," she said.
In the Singapore General Hospital where I went for surgery under general anaesthesia, surgery to remove a lump from my left wrist involved a consultation, blood test, X-rays, ECG and counselling on medical charges and anaesthetic risk and signing of informed consent after being informed of a possible risk of death on the operating table. A lot of time.
IV ANAESTHESIA
In veterinary medicine, such procedures would be costly. For this young dog, a general examination was done. The dog was deemed healthy and I operated 1 hour later. From my experience, the combined domitor + ketamine at 0.4 + 0.5 ml IV per 10 kg in a young healthy dog does not cause vomiting and permits short surgery without the need to top up with isoflurane gas.
My experienced vet assistant got the isoflurane gas ready. "If the vet is fast, there is no need for isoflurane gas top up because I gave 100% of the formula," I told Min. He was not convinced. As the dog would not permit shaving of the scrotal area, Min had to do it after I gave this formula.
Min recorded the time of the start of domitor and ketamine injection and the last stitch. It was 20 minutes which included shaving the scrotal area of around 2 minutes. It would be 18 minutes.
"What's the time between first skin incision and last stitch?" I asked Min to calculate. It was 10 minutes.
ANALGESIC EFFECTS
No isoflurane gas. Towards the 18th minute, the dog's leg moved a bit. As I started to stitch one horizontal mattress to close the skin, the dog moved a bit. "Standby for the isoflurane gas and mask," I said to Min.
I completed the surgery in 20 mintues from IV injection of domitor + ketamine + normal saline in one syringe of 0.55 ml IV.
SURGERY
Three forceps method clamping the tunica enclosing the spermatic cord and blood vessels is the best. The lowest forcep is released. I ligated 3/0 absorbable polysorb on the groove from the released forcep one way and repeat the other way. I threw in 5 knots. I excise the area between the 2nd and 3rd forceps. No bleeding.
The skin incison of around 1.3 cm long was stitched with just one horizontal mattress using the same 3/0.
Bandage.
PAIN-KILLERS AND ANTIBIOTICS given..
No complaint today, Sunday, 24 hours after surgery. I will follow up tomorrow.
CONCLUSION
I audit associate vets' efficiency. Surgery should be speedy, accurate and complete. Much time and resources are wasted when the vet is not well prepared by visualising the whole process. Pre-anaesthetic shaving saves a few mintues but this Pom would not have it done and so was shaved post-sedation.
STANDARD OPERATING PROCEDURES. HOW LONG IT TAKES TO NEUTER A YOUNG POM?
A young doctor came at 9.30 am on this fine Saturday morning, with a Pom as she had made an appointment for the neuter.
"Has he eaten?" I asked.
"Yes," she said.
"It is best not to feed the dog 10 hours before surgery as the dog may vomit during surgery."
"Your staff did not mention this when I phoned for an appointment," she said.
In the Singapore General Hospital where I went for surgery under general anaesthesia, surgery to remove a lump from my left wrist involved a consultation, blood test, X-rays, ECG and counselling on medical charges and anaesthetic risk and signing of informed consent after being informed of a possible risk of death on the operating table. A lot of time.
IV ANAESTHESIA
In veterinary medicine, such procedures would be costly. For this young dog, a general examination was done. The dog was deemed healthy and I operated 1 hour later. From my experience, the combined domitor + ketamine at 0.4 + 0.5 ml IV per 10 kg in a young healthy dog does not cause vomiting and permits short surgery without the need to top up with isoflurane gas.
My experienced vet assistant got the isoflurane gas ready. "If the vet is fast, there is no need for isoflurane gas top up because I gave 100% of the formula," I told Min. He was not convinced. As the dog would not permit shaving of the scrotal area, Min had to do it after I gave this formula.
Min recorded the time of the start of domitor and ketamine injection and the last stitch. It was 20 minutes which included shaving the scrotal area of around 2 minutes. It would be 18 minutes.
"What's the time between first skin incision and last stitch?" I asked Min to calculate. It was 10 minutes.
ANALGESIC EFFECTS
No isoflurane gas. Towards the 18th minute, the dog's leg moved a bit. As I started to stitch one horizontal mattress to close the skin, the dog moved a bit. "Standby for the isoflurane gas and mask," I said to Min.
I completed the surgery in 20 mintues from IV injection of domitor + ketamine + normal saline in one syringe of 0.55 ml IV.
SURGERY
Three forceps method clamping the tunica enclosing the spermatic cord and blood vessels is the best. The lowest forcep is released. I ligated 3/0 absorbable polysorb on the groove from the released forcep one way and repeat the other way. I threw in 5 knots. I excise the area between the 2nd and 3rd forceps. No bleeding.
The skin incison of around 1.3 cm long was stitched with just one horizontal mattress using the same 3/0.
Bandage.
PAIN-KILLERS AND ANTIBIOTICS given..
No complaint today, Sunday, 24 hours after surgery. I will follow up tomorrow.
CONCLUSION
I audit associate vets' efficiency. Surgery should be speedy, accurate and complete. Much time and resources are wasted when the vet is not well prepared by visualising the whole process. Pre-anaesthetic shaving saves a few mintues but this Pom would not have it done and so was shaved post-sedation.
1240. How to create an interesting video?
 TOA
PAYOH VETStoapayohvets.com Date: 13 January, 2013
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First Romance or Fall In
Love With You? Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS First written: 9 January 2013 Date: 13 January, 2013 |
 toapayohvets.com
Be Kind To Pets Veterinary Education Project 2010-0129 |
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For the past 20 years, I have been writing text and
inserting images. In 2013, I will try to learn how to create interesting videos. The following is one of my first few attempts to create video with interest. This video was filmed by me at at the 25th Anniversary of the Nonyas and Babas in Malacca in late 2012. I was not really keen to go as such functions would be boring as I am not a Peranakan and I don't know anybody in this Association. Surprisingly, there were around 700 participants from Malaysia, Singapore, Indonesia, Thailand and Australia and the organisation was superb as compared to heavy rain at the outdoor function in the previous year. Instead of sitting down with strangers making small talk during dinner, I took my camera to the dance floor and tried to create some videos. The following video with a story line may be of interest to viewers. http://www.youtube.com/watch?v=L0f0ZTKlS6U The following is how I teach my vet interns in video production. The same principles of a compelling story applies whether you produce a veterinary education video or a dance video. HOW DID I PRODUCE THE VIDEO ABOVE? Hook - Protagonist -- An attractive woman with flowers in her hair. She loves dancing and found a capable dancer hopefully. Is she a Nonya? Is he a Baba? I don't know them. Introduction - Crowded dance floor. Focus on this Protagonist whenever possible as a story is all about people and a character. . Middle - Antagonist -- Another good-looking woman who loves dancing too came into the scene. Would she be a better dancer? Who is her beau? Is he a good dancer? Is he a first romance? Will she fall in love again? To break the boredom of just showing dancers, I angled the zooms lens vertically. Not a good idea as conventional movies don't do it. Who is the singer? Is he Cliff Richard? My lens zoomed on him. A camera man went into the dance floor and blocked my view. I was hand-holding my camera and moved elsewhere. A steady hand to produce good video with focus. I zoomed back to the Protagonist as she is a good dancer. But more dancers blocked my view. The Antagonist is hearing some conversation but the music is loud. What did she hear? Other dancers. Too soon, this 1-minute video had to end with the end of the song. Ending - Quite abruptly. Without a visual impact. This is my first video and I have much to learn. The website and updates will be at: http://www.kongyuensing.com/folder5/20130112video_first_romance_toapayohvets.htm Conclusion: Is this video capturing the attention of viewers? I think so. But it is up to the general viewer to judge. Tips & Advices: Join the fun rather than just eat and watch the poor quality TV screens of the dancers at the dining table. Get up. Take your camera. Go and see the real people and appreciate life. If you know how to dance, find a partner from your group of friends. There are many women who know how to dance well. I thought the song was "First Romance" but could not find it in You Tube. I grow up listening to Cliff Richard's songs but there are so many other singers. At that time in the 1960s, there were no distractions like coloured TVs and the internet or mobile phones. The song was "Falling In Love With You" by Cliff Richard and they are at: http://www.youtube.com/watch?v=QRq642i-VVA http://www.youtube.com/watch?v=SB_fTsVcv24 http://www.youtube.com/watch?feature=endscreen&v=dEeP42flo6o&NR=1 http://www.youtube.com/watch?v=hp1ZLjavWd8 includes Mean Woman Blues http://www.youtube.com/watch?v=qEz3emlyZhs (with lyrics) Song: The Young Ones: http://www.youtube.com/watch?feature=endscreen&v=5Tmv7YMcdXc&NR=1 Apache http://www.youtube.com/watch?feature=endscreen&NR=1&v=bNAyPK2O4fk These songs are for baby-boomers who grow up with music of the 60s. We still get the screaming girls in 2013! I would be going to Cliff Richard's performance in Singapore in Feb 2013 and the audience would be mostly in their late 40s and the screaming girls have had grown up with responsibilities. They would be more controlled in their emotions. I hope most of them have not fallen out of love. I just booked the seats today Jan 13, 2013 but the good ones are booked. Although Cliff Richard is 72 years old, I am not expecting him to be at his peak. Just enjoy the music. After all, the baby-boomer generation has matured too and the younger generation has taken over. Update and webpage is at:http://www.kongyuensing.com/folder5/20130112video_first_romance_toapayohvets.htm | ||
Saturday, January 12, 2013
Create veterinary videos to educate and entertain
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Veterinary videos by
interns Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS First written: 9 January 2013 Date: 12 January, 2013 |
toapayohvets.com
Be Kind To Pets Veterinary Education Project 2010-0129 |
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"It is better to create 3 imperfect video rather than
create one perfect video as you are doing hands-on
learning as an intern," I said to the girl who produced 3
videos for me and told me she might edit it if I find some
major flaws. "It takes too long for an intern to produce a
video as they are not professionals. Once the video is
done, no editing will be done. Producing veterinary videos
is part of the experiential learning for an intern at Toa
Payoh Vets ." She produced 3 videos for me as follows: http://www.youtube.com/watch? http://www.youtube.com/watch? http://www.youtube.com/watch? |
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Friday, January 11, 2013
Be proactive and create
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1237. Industrial dogs in Singapore dying from distemper
Jan 11, 2013
I had a chat with a lady who cycles to feed industrial dogs in the evening and nights and had adopted two.
"Do you know that industrial dogs are dying of distemper?" she asked me.
"No," I said. Many industrial dogs had been culled by the authorities and so there are few seen at Toa Payoh Vets.
"They lie down, shivering. Their muscles start twitching," she said. "The vet said nothing can be done to cure it and put them to sleep."
"Is it an infectious disease to all dogs?" she asked.
"Yes," I said. "The virus attacks the brain cells and other parts of the body. There is an effective vaccination."
"Factory owners don't vaccinate the dogs," she said. "How come in a group of dogs, not all will die?"
"Some dogs will be resistant to the distemper viral infection. These will not die. It is like drinking a small potion of poison. You will not die unless it is a lot or very potent. If the dogs are dead, how come you are still feeding the industrial dogs?"
"Another part of the industrial estate," she laughed.
She continues her cycling to feed the stray dogs her home-cooked food.
"It is fortunate that your husband does not mind you adopting the stray puppy," I said and found that she adopted two.
"He nags and nags," she said. "I am looking for homes for them."
ADVICE
All Singapore dog owners should get their dogs vaccinated against distemper yearly but sadly, many don't bother. Dogs at dog parks, boarding and grooming should ensure protection from distemper by just taking time off to see the vet and get the dog vaccinated.
I had a chat with a lady who cycles to feed industrial dogs in the evening and nights and had adopted two.
"Do you know that industrial dogs are dying of distemper?" she asked me.
"No," I said. Many industrial dogs had been culled by the authorities and so there are few seen at Toa Payoh Vets.
"They lie down, shivering. Their muscles start twitching," she said. "The vet said nothing can be done to cure it and put them to sleep."
"Is it an infectious disease to all dogs?" she asked.
"Yes," I said. "The virus attacks the brain cells and other parts of the body. There is an effective vaccination."
"Factory owners don't vaccinate the dogs," she said. "How come in a group of dogs, not all will die?"
"Some dogs will be resistant to the distemper viral infection. These will not die. It is like drinking a small potion of poison. You will not die unless it is a lot or very potent. If the dogs are dead, how come you are still feeding the industrial dogs?"
"Another part of the industrial estate," she laughed.
She continues her cycling to feed the stray dogs her home-cooked food.
"It is fortunate that your husband does not mind you adopting the stray puppy," I said and found that she adopted two.
"He nags and nags," she said. "I am looking for homes for them."
ADVICE
All Singapore dog owners should get their dogs vaccinated against distemper yearly but sadly, many don't bother. Dogs at dog parks, boarding and grooming should ensure protection from distemper by just taking time off to see the vet and get the dog vaccinated.
Referral is best but the vet must deliver
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Wednesday, January 9, 2013
1236. Not recognised vet degree
Nobody can "influence" the AVA on your behalf unless you are the son of a
big important person, things may be reviewed again. That is a fact of
life.
I have given your resume to an employment agent. It is NOT possible for you to be a vet in Singapore due to AVA's licensing requirements of accredited vet universities for practising vets and your degree is not recognised by the AVA. .
But if you are flexible, you may get other industry jobs or even in Yangon. But the pay is not what you expected and if you are agreeable, you may get a job e.g. in a vet pharmaceutical company that is looking for a vet to provide after-sales services for its veterinary products to vets in Singapore and the region..
I am really sad that you are in this situation but life is full of ups and downs. Whether you can be resilient or not, it is up to you.
I have given your resume to an employment agent. It is NOT possible for you to be a vet in Singapore due to AVA's licensing requirements of accredited vet universities for practising vets and your degree is not recognised by the AVA. .
But if you are flexible, you may get other industry jobs or even in Yangon. But the pay is not what you expected and if you are agreeable, you may get a job e.g. in a vet pharmaceutical company that is looking for a vet to provide after-sales services for its veterinary products to vets in Singapore and the region..
I am really sad that you are in this situation but life is full of ups and downs. Whether you can be resilient or not, it is up to you.
House-call to vaccinate 2 cats
On Tue, Jan 8, 2013 at 8:37 AM, Daniei@gmail.com> wrote:
Thank you for your email. House-call will be $250 and 2 vaccinations will be $70. Total $320.
Hi. I live near Orchard and my two cats need their annual
vaccinations. Can you tell me how much it would cost to get these
vaccinations done via a house call?
Thanks,
Dan
Thank you for your email. House-call will be $250 and 2 vaccinations will be $70. Total $320.
Tuesday, January 8, 2013
1234. Anaesthetic risks for the young rabbit and the old cat
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.
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 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)  | | |||
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| 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.
1223. Eye specialist with defective software?
On Monday Dec 17, 2012, I was referred by my GP to an eye specialist in the Gleneagles Hospital as I told him I could see some "bubbles" floating in front of my eyes and an arc of white lights flashing in the left eye at the left side. It could be retinal detachment or worse.
The eye specialist was an experienced person of over 70 years of age. The nurses did the tests for glaucoma (eye pressure), macular degeneration (flashing lights and focusing on a bright central light) and dilated my pupils. Then the specialist put a ring to widen the eyelids and scan my eye retina.
I had asked to see an image of my retina and he said OK. He checked my eyes and said they were OK. What I saw would be floaters due to softness of the inner aqueous humour. I asked to see the images on his scan. I seemed able to see some retinal blood vessel branches when he scanned me.
They were all blurred, like a rose bud closing. He said that the images were blurred. Somehow, this made me wonder whether his software was defective or do all eye specialists have this problem of not being able to show the images of the retina in this modern world?
The eye specialist was an experienced person of over 70 years of age. The nurses did the tests for glaucoma (eye pressure), macular degeneration (flashing lights and focusing on a bright central light) and dilated my pupils. Then the specialist put a ring to widen the eyelids and scan my eye retina.
I had asked to see an image of my retina and he said OK. He checked my eyes and said they were OK. What I saw would be floaters due to softness of the inner aqueous humour. I asked to see the images on his scan. I seemed able to see some retinal blood vessel branches when he scanned me.
They were all blurred, like a rose bud closing. He said that the images were blurred. Somehow, this made me wonder whether his software was defective or do all eye specialists have this problem of not being able to show the images of the retina in this modern world?
1222. Internship - video production educational videos for vet students and owners
Internship at toa payoh vets
| ||
Dec 23, 2012
Pl get some videos completed with Vanessa while I am in Hong Kong from Dec 24 to 27, 2012. Vanessa will be completing her internship in 1 day's time. Pl let Vanessa see this email.
VIDEOS NEEDED ARE:
1. Microscopic examination of ringworm in the dog.
Similar format and narration as to what has been produced in the video below:
That means Vanessa has to illustrate (draw) normal hairs and infected hairs as well as show magnified images (1000X) from the new microscope of both types with reference to the Siberian Husky case.
Include the following 4 images with your other images:
2. Swollen eyes in a red-eared slider in Singapore and the latest video on Dec 22, 2012.
DIAGNOSIS, DIFFERENTIAL DIAGNOSIS and TREATMENT of one case study must be clearly written and videoed. Seven images of feeding multivitamins to the slider by mouth are at: www.toapayohvets.com and they must be used as well as the videos. 4/7 are shown below:
OTHER CASES AT:
2.1 http://www.sinpets.com/F5/
2.2 http://www.bekindtopets.com/
Use the images
In the CONCLUSION, provide advices on prevention of swollen eyes and also on "How to tell whether the slider is male or female and its life cycle e.g. male matures at ... years and females at ... years. Some research is needed.
3. Electro-surgery in a hamster. TOOLS, PROS AND CONS COMPARED TO SCALPEL BLADE EXCISION. Most young people will find electro-surgery as a dull subject as they have so many more interesting distractions. Therefore, produce a video fascinating and compelling to educate vet students and pet owners with images, audio and a strong narrative.
USE THE FOLLOWING IMAGE AS A HOOK - THE HAMSTER WITH AN ARMPIT FULL OF TUMOURS
http://www.kongyuensing.com/
The case is at:
http://www.asiahomes.com/
There is another case of the nose swelling too. Use the images of electro-surgery.
How you are able to integrate the images and tell a good story depends on you.
TOOLS OF THE TRADE
PROS AND CONS COMPARED TO SCAPEL
CASE STUDIES OF INTERESTS (see URLs below) including a guinea pig case.
CONCLUSION. Electro-surgery will not electrocute the hamster or the persons involved. It is a safe technique for certain types of surgery where the scalpel blade cannot be used or used efficiently. If the vet knows how to use the equipment properly and has a sound knowledge of the electro-surgical process to avoid electrical burns and shocks to the persons or animals involved, electro-surgery is a very useful process in veterinary surgery.
URLs of cases done at Toa Payoh Vets
Cases and images should include:
3.1 A case to remove a hamster's ear tumour. Extract the essence of the technique and provide visual images. The case is at:
http://www.bekindtopets.com/
3.2 Another case at:
http://www.sinpets.com/
An example of electro-surgery In another animal is the guinea pig operated by me at Toa Payoh Vets. e.g. a guinea pig (illustrate with the following case study).
Electro-surgery in a guinea pig at Toa Payoh Vets.
http://www.sinpets.com/F5/
3.2 Other cases done by me at Toa Payoh Vets. Get the "relevant" images onto the video. The images are at:
3.2.1 Scalpel blade excises the tumour
http://www.sinpets.com/
3.2.2 Images of one case of electrosurgery at:
http://www.kongyuensing.com/
The case report is at:
http://www.sinpets.com/F5/
3.2.3 A recent case of ear tumour removed by electro-surgery by Dr Daniel is at:
Pl let me know by email if there are queries.
Wednesday, December 19, 2012
Building trust - an old poodle snored loudly making mum's sleep impossible.
Dear Gina
Narrate this case study - Building trust and use the video you had done for me so beautifully. Many thanks. Let Vannessa know and edit this article as I have no time and have to rush to the airport today Dec 24. Have a good holiday. It is very rare to have two interns who are so diligent and interested in veterinary medicine. Best wishes.
REVIEW - A loud snoring old poodle affects working mum's sleep. What to do?
The Patient
Male poodle, 14 years old, sneezing, snoring and difficulty in breathing
1. Jul 29, 2012. Toa Payoh Vets, associate vet reported glaucoma and cataract. Right canine tooth root abscess extracted under general anaesthesia. Most decayed teeth had dropped out. (In Dec 18, 2012, the mum said to me there was a smaller swelling below the left eyelid at this time).
2. Nov 2012. Consulted another vet at another practrice. He accepted medication but not advices on surgery and other tests.
3. Dec 15, 2012. The son consulted me. Blood from nose as he fell yesterday. Sneezing, snoring, breathing difficulty. Heart and lung sounds normal. Surgery advised but worried about risks.
"What are the chances of surviving the anaesthesia?" the young undergraduate was told it was slightly more than 50% after I examined the heart of his mum's very old poodle and found it to be in good state. He said: "50% is not good enough. The poodle could just die on the operating table. Would you say 20%? I have not got the dog operated because the other vet said the same 50% as you. My mum's dog is here today and gone tomorrow if he dies on the operating table! How about some medication?"
"As your dog has normal heart sounds, I assessed his survival as more than 50% but I can't say it is 80% as he is very old. He is blind and has fully developed cataracts in both eyes.
I believe that your dog's snoring is due to an infection of the sinuses near the left eye. Your dog has a large 'eye-bag' below the length of the lower eyelid. It is around 3 cm in lenght. It is most likely an infected tumour. An abscess in this left eye. It spreads the bacteria from there to the sinuses and to the back of the nostrils. The sinuses will be the maxillary sinuses which get infected and blocked as well." I said. "This obstruction and inflammation causes pain and snoring."
"How can that be?" the young man questioned my hypothesis. "The nose is quite far from the left eye!"
"The maxillary sinuses are connected to the nostrils. The inner side of the left eye connects to the nostrils through the lacrimal or tear gland ducts. Any bacteria from the left eye's lower eyelid will spread from there to the tear gland ducts and into the maxillary sinuses and into the back of the nostril. This causes sneezing and painful breathing difficulties."
The young man was not convinced. So I advised a blood test to screen the health of the old dog and if the dog is healthy, the blood test will show it. Then he can decide whether to permit anaesthesia or not.
"The dog did survive one anaethesia in July 2012 to extract the rotten right canine tooth," I said.
"I don't think he will survive another anaesthesia," he said.
"Surgery is the solution. I can give you the medication which would just be a waste of money." A vet can't build trust if he milks the patient just to make his money. But here, the issue is of anaesthetic risk and veterinary competence. Every vet will say this is extremely risky and so most owners will procrastinate till they can't wait any longer.
The blood test showed normal results and the dog was operated on Dec 18, 2012. The dog now objected strongly to direct isoflurane gas by mask before intubation. What to do? I decided on 25% of the dosage for domitor and ketamine IV. The dog needed just less than 5 minutes of isoflurane gas and he was knocked out. Electro-surgery acrosss the lower abscess shot out lots of yellow pus. I used the electrode to cut off as much of the tumour under the skin as possible. The tumour had 4 holes with pus leaking outwards. Pus also leaked out from inside the eye at the medial canthus but this was going on for some days (the owner wiped it off every day, she told me after my surgery but more pus oozed out again). The old dog did not wake up despite me switching off the isoflurane gas for some 5 minutes as I electro-excised the tumour. A spurting arteriole on the lateral canthus area sprayed me like a machine gun. I used the electrode to coagulate and quickly stitched up the cut with 3/0 absorbable sutures interrupted.
The tip for success in old dog surgery is to operate in as short a time as possible. In this case, the time had stretched to over 15 minutes. If more time is spent, the heart may fail as this is an old dog and other blood vessels may not be as strong as a young dog. Rupture of arteries may happen. The dog may die. So, surgery must be very fast. Bleeding was profuse. There was not much time to be wasted on catching all the bleeders. I closed the wound. As the dog could not get up, I gave 0.1 ml of the Antisedan antidote IM. He got up within 2 minutes with a profusely bleeding eye. I used a bandage to cover the wound. Still the bleeding continued. I used cold compress. However, such bleeding would be controlled by the closure of the wound and so I was not worried.
Today was a bright sunny morning of Dec 19, 2012. I phoned the mum. She sounded quite happy when I asked about the dog's snoring. "Will you say the snoring is less than 50% as compared to the night before surgery?" I asked. "Yes, yes," she said that the profuse bleeding had stopped, the dog had eaten and thanked me.
In private practice, building trust is important. But good surgical outcome and performance are still very important.
In old dogs, the client considers only one matter. His or her old companion is alive at the end of surgery. No excuses. There was no point doing a perfect surgery removing all bleeders and presenting a dead old dog with no post-op bleeding due to meticulous ligation and coagulation. In this case, the bleeding would stop by pressure control after stitching and it did so by the next morning when I phoned the owner to check on the bleeding status. I told the owner that it was not possible to remove 100% of the tumours and that only 80% of the tumours were electro-excised. As to whether the tumour below the eyelid was malignant or not, I advised sending the tumour to the laboratory as this is part of professionalism. The owner did not want histopathology but she had been informed and that is important for the veterinary surgeon.
Speed, accuracy and completedness are hall-marks of a good surgeon. In this case, speed is most important.
Narrate this case study - Building trust and use the video you had done for me so beautifully. Many thanks. Let Vannessa know and edit this article as I have no time and have to rush to the airport today Dec 24. Have a good holiday. It is very rare to have two interns who are so diligent and interested in veterinary medicine. Best wishes.
REVIEW - A loud snoring old poodle affects working mum's sleep. What to do?
The Patient
Male poodle, 14 years old, sneezing, snoring and difficulty in breathing
1. Jul 29, 2012. Toa Payoh Vets, associate vet reported glaucoma and cataract. Right canine tooth root abscess extracted under general anaesthesia. Most decayed teeth had dropped out. (In Dec 18, 2012, the mum said to me there was a smaller swelling below the left eyelid at this time).
2. Nov 2012. Consulted another vet at another practrice. He accepted medication but not advices on surgery and other tests.
3. Dec 15, 2012. The son consulted me. Blood from nose as he fell yesterday. Sneezing, snoring, breathing difficulty. Heart and lung sounds normal. Surgery advised but worried about risks.
"What are the chances of surviving the anaesthesia?" the young undergraduate was told it was slightly more than 50% after I examined the heart of his mum's very old poodle and found it to be in good state. He said: "50% is not good enough. The poodle could just die on the operating table. Would you say 20%? I have not got the dog operated because the other vet said the same 50% as you. My mum's dog is here today and gone tomorrow if he dies on the operating table! How about some medication?"
"As your dog has normal heart sounds, I assessed his survival as more than 50% but I can't say it is 80% as he is very old. He is blind and has fully developed cataracts in both eyes.
I believe that your dog's snoring is due to an infection of the sinuses near the left eye. Your dog has a large 'eye-bag' below the length of the lower eyelid. It is around 3 cm in lenght. It is most likely an infected tumour. An abscess in this left eye. It spreads the bacteria from there to the sinuses and to the back of the nostrils. The sinuses will be the maxillary sinuses which get infected and blocked as well." I said. "This obstruction and inflammation causes pain and snoring."
"How can that be?" the young man questioned my hypothesis. "The nose is quite far from the left eye!"
"The maxillary sinuses are connected to the nostrils. The inner side of the left eye connects to the nostrils through the lacrimal or tear gland ducts. Any bacteria from the left eye's lower eyelid will spread from there to the tear gland ducts and into the maxillary sinuses and into the back of the nostril. This causes sneezing and painful breathing difficulties."
The young man was not convinced. So I advised a blood test to screen the health of the old dog and if the dog is healthy, the blood test will show it. Then he can decide whether to permit anaesthesia or not.
"The dog did survive one anaethesia in July 2012 to extract the rotten right canine tooth," I said.
"I don't think he will survive another anaesthesia," he said.
"Surgery is the solution. I can give you the medication which would just be a waste of money." A vet can't build trust if he milks the patient just to make his money. But here, the issue is of anaesthetic risk and veterinary competence. Every vet will say this is extremely risky and so most owners will procrastinate till they can't wait any longer.
The blood test showed normal results and the dog was operated on Dec 18, 2012. The dog now objected strongly to direct isoflurane gas by mask before intubation. What to do? I decided on 25% of the dosage for domitor and ketamine IV. The dog needed just less than 5 minutes of isoflurane gas and he was knocked out. Electro-surgery acrosss the lower abscess shot out lots of yellow pus. I used the electrode to cut off as much of the tumour under the skin as possible. The tumour had 4 holes with pus leaking outwards. Pus also leaked out from inside the eye at the medial canthus but this was going on for some days (the owner wiped it off every day, she told me after my surgery but more pus oozed out again). The old dog did not wake up despite me switching off the isoflurane gas for some 5 minutes as I electro-excised the tumour. A spurting arteriole on the lateral canthus area sprayed me like a machine gun. I used the electrode to coagulate and quickly stitched up the cut with 3/0 absorbable sutures interrupted.
The tip for success in old dog surgery is to operate in as short a time as possible. In this case, the time had stretched to over 15 minutes. If more time is spent, the heart may fail as this is an old dog and other blood vessels may not be as strong as a young dog. Rupture of arteries may happen. The dog may die. So, surgery must be very fast. Bleeding was profuse. There was not much time to be wasted on catching all the bleeders. I closed the wound. As the dog could not get up, I gave 0.1 ml of the Antisedan antidote IM. He got up within 2 minutes with a profusely bleeding eye. I used a bandage to cover the wound. Still the bleeding continued. I used cold compress. However, such bleeding would be controlled by the closure of the wound and so I was not worried.
Today was a bright sunny morning of Dec 19, 2012. I phoned the mum. She sounded quite happy when I asked about the dog's snoring. "Will you say the snoring is less than 50% as compared to the night before surgery?" I asked. "Yes, yes," she said that the profuse bleeding had stopped, the dog had eaten and thanked me.
In private practice, building trust is important. But good surgical outcome and performance are still very important.
In old dogs, the client considers only one matter. His or her old companion is alive at the end of surgery. No excuses. There was no point doing a perfect surgery removing all bleeders and presenting a dead old dog with no post-op bleeding due to meticulous ligation and coagulation. In this case, the bleeding would stop by pressure control after stitching and it did so by the next morning when I phoned the owner to check on the bleeding status. I told the owner that it was not possible to remove 100% of the tumours and that only 80% of the tumours were electro-excised. As to whether the tumour below the eyelid was malignant or not, I advised sending the tumour to the laboratory as this is part of professionalism. The owner did not want histopathology but she had been informed and that is important for the veterinary surgeon.
Speed, accuracy and completedness are hall-marks of a good surgeon. In this case, speed is most important.
Sunday, December 16, 2012
New idea from Intern V
Sunday Dec 16, 2012
As part of her internship, I asked Intern V to illustrate the ringworm arthrospores etc. She came out with a new idea, using her iPhone to take images of the microscopic examination of the infected hair. I was most impressed. No more laborous inaccurate drawing.
I could use software to capture the images but I need a special microscope and this costs money. So her use of iPhone was great. Some images will be shown later.
As part of her internship, I asked Intern V to illustrate the ringworm arthrospores etc. She came out with a new idea, using her iPhone to take images of the microscopic examination of the infected hair. I was most impressed. No more laborous inaccurate drawing.
I could use software to capture the images but I need a special microscope and this costs money. So her use of iPhone was great. Some images will be shown later.
1218. Intern does not write post-card
Sunday Dec 16, 2012
A retiree puts a stray cat here for treatment as the cat had no appetite for over two weeks. The cat was syringed fed and given fluids and was better for a day or two. He drank a lot of water and today he was very ill despite supportive treatment for the past 5 days.
I tried to phone the owner, but his mobile phone was terminated according to the phone service provider. What to do? I asked Intern V to write a postcard in Chinese to post to him. She wrote in Chinese language covering the top right corner.
"Where do I paste the stamp?" I asked her. Young Singaporeans never send post cards nowadays and so they are not aware the position and space for a stamp!
A retiree puts a stray cat here for treatment as the cat had no appetite for over two weeks. The cat was syringed fed and given fluids and was better for a day or two. He drank a lot of water and today he was very ill despite supportive treatment for the past 5 days.
I tried to phone the owner, but his mobile phone was terminated according to the phone service provider. What to do? I asked Intern V to write a postcard in Chinese to post to him. She wrote in Chinese language covering the top right corner.
"Where do I paste the stamp?" I asked her. Young Singaporeans never send post cards nowadays and so they are not aware the position and space for a stamp!
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