| Today Sat Jun
9, 2012, another bright and
blue-sky morning, I came to
Toa Payoh Vets at 9.30 am
for a trust and audit check
and an appointment of a lady
owner who had a rabbit with
a red nose. I phoned a Miniature Schnauzer lady owner from Punggol at 9.15 am but her phone was switched off. I left a message of the blood test done on 2 days ago. "Blood test for XXX. A high cell count indicates bacterial infection. Are eyes still tearing? Please tel me". My i phone displayed: "Message failure" The lady owner wanted to consult me specifically on Jun 7, 2012, as her Miniature Schnauzer, female, 1 year 2 months old, has tearing eyes for the past 4 days. No fever. Still eating and drinking but pus in the eye discharge for 4 days. There are two Dr Sings in Toa Payoh Vets and sometimes, there is a confusion. She confirmed she wanted to consult me. Red eyes. Pus in tearing areas for 4 days. Swollen submandibular and adjacent lymph nodes on both sides. I diagnosed the dog as having "glanders" and told Dr Daniel who was assisting me that this is a rare case nowadays. "Usually puppies and treatment is effective."  The submandibular lymph nodes were enlarged like 10-cent coins on both sides and I taught the owner how to palpate them. She was surprised. They should not be felt at all in normal dogs, including young ones. "Glanders is a bacterial infection of puppies," I said. "However, this dog is still young. Your dog must have an active lifestyle!"
Yes," she said. "He loves to do that when we take off the lease at the park." "Why do you bring her to the Bishan Dog Park since you live in Punggol?" "The Bishan Dog Park is the place where the dog can run around without a lease," she replied. "Any construction nearby?" Dr Daniel asked. "Yes," she said. There are new HDB flats being built in this pretty new town with waterfronting views, so there was dust all around. "The soil bacteria could have gone into the eyes, nose and mouth and then the submandibular lymph nodes," I said. " A blood test will be important to help in the diagnosis." I got permission for a blood test. BLOOD TEST RESULTS - Significant findings were: Total white cell count 17.4 (6-17) N=71%, L=23%, M=6%, E=0.2%, B=0.6% Urea 10.5 (4.2-6.3) Use evidence-based medicine to come to a diagnosis if the owner can afford the blood test as it tells a lot of causes but the vet must know how to interpret them in relation to the clinical signs. In this case, glanders was confirmed by the increase in total white cell count in the blood test as a result of a systemic bacterial infection. What is the significance of increase in monocytes? This could mean a long-standing chronic infection and well, this young dog had an active outdoor digging and eating soil and so, the infection from the soil had been going on for some months. Hence, an increase in monocytes. Based on clinical signs, blood test helps in coming to a correct diagnosis of "glanders". The owner would know simply that her dog had a bacterial infection. I tried phoning the owner again to close the case by giving her the blood test results. As I typed, the happy owner phoned me and said that the dog was still eating and drinking as before and had the following improvements as compared to 2 days before treatment "Both eyes are still tearing but much less," she said. "No more redness in the eyes." She was referring to the acute conjunctivitis which she saw when I pulled down the eye lids. "How about the size of the submandibular lymph nodes?" I asked. "I don't know whether it is psychological but I feel them as being much smaller than on that day." "You are correct in finding that the size had gone down considerably due to the injection," I said. "Continue the antibiotics and change his life-style". So, no more soil digging and eating grass for the active pet as the soil bacteria had infected her. P.S The owner got the dog treated early and so the total white cell count had not reached a much higher level and the young dog was still eating and drinking. The submandibular lymph nodes could have expanded bigger and ulcerate. The owner was worried about the dog having pus in both eyes for the last 4 days and made an appointment to see me. The bacteria had gone to the eyes as well but antibiotics and anti-inflammatory injections I gave had nipped the infection in the bud. So, the owner was happy with the recovery when I phoned 2 days later. This was good news for everyone. Except for the Schnauzer as he has to change his free soil digging and eating life-style. P.S "Glanders" is more a disease of horses in the older days. It is rare to get a case in the young Singapore dogs and puppies nowadays as the standard of hygiene is much higher in Singapore kennels. I remember my professor's lecture about this disease and that was in 1973 as a final year vet undergraduate. I did see a few puppy cases from breeders some years ago but no more. This is not just a case of acute conjunctivitis. Just prescribing some eye drops will not help to resolve the problem. P.S It is best to follow up on the owner 2 days and do a blood test. UPDATES AT: http://www.sinpets.com/dogs/20120609glanders_young_Schnauzer_singapore-ToaPayohVets.htm |
Saturday, June 9, 2012
1018. Two eyes tearing young Schnauzer
Friday, June 8, 2012
"Red eye" in a dwarf rabbit
E-MAIL REPLY FROM DR SING DATED JUNE 6, 2012
Hi,
I pondered upon your vet webpage and would like to make a appointment for consultation for my pet rabbit.
It is a Netherland dwarf, about 2 months old. Recently it has eye dirt found on its eyes and one of the eye is seemingly reddish around it and opening not as wide as the other eye. Is it sick or suffering from eye infection?
Warmest Regards,
Name of owner
5359 -5363. Blood inside the anterior chamber of the right eye
E-MAIL REPLY FROM DR SING DATED JUNE 8, 2012
I am Dr Sing. Thank you for your email. Your rabbit suffers from hyphema (bleeding inside the eye). Pl continue to confine the rabbit in a SMALL cage for the next 14 days to prevent further bleeding inside the eye. The bleeding is due to a forceful injury to the eye and needs some 14-21 days to resolve.
Continue medication for another 10 days.
UPDATE AND MORE PIC AT:http://www.bekindtopets.com/animals/20120608hyphema-netherland-dwarfd-rabbit-2months-old-ToaPayohVets.htm
Hi,
I pondered upon your vet webpage and would like to make a appointment for consultation for my pet rabbit.
It is a Netherland dwarf, about 2 months old. Recently it has eye dirt found on its eyes and one of the eye is seemingly reddish around it and opening not as wide as the other eye. Is it sick or suffering from eye infection?
Warmest Regards,
Name of owner
5359 -5363. Blood inside the anterior chamber of the right eye
E-MAIL REPLY FROM DR SING DATED JUNE 8, 2012
I am Dr Sing. Thank you for your email. Your rabbit suffers from hyphema (bleeding inside the eye). Pl continue to confine the rabbit in a SMALL cage for the next 14 days to prevent further bleeding inside the eye. The bleeding is due to a forceful injury to the eye and needs some 14-21 days to resolve.
Continue medication for another 10 days.
UPDATE AND MORE PIC AT:http://www.bekindtopets.com/animals/20120608hyphema-netherland-dwarfd-rabbit-2months-old-ToaPayohVets.htm
Thursday, June 7, 2012
1016. Just-enough dosage of injectable anaesthesia for cat spay
What is the most effective optimal dosage of injectable anaesthesia for a cat spay without the use of isoflurane anaesthesia? This answer is obtained from observations and the review of record keeping if the vet is interested. If not, the vet just has to give the cat isoflurane gas by mask to continue the surgery if the cat moves.
Obviously, an employee or associate vet has no need to account for the bottom-line of the practice and is not interested in reducing costs. So there is no motivation to conserve resources and use just-sufficient anaesthestics as they don't bear the expenses and responsibility for the economic health of the practice. If the practice closes down, just go to another practice to work!
Just give the cat isoflurane gas by mask to continue the spay if the cat is not sufficiently anaesthesized by xylazine and ketamine. So, more isoflurane and oxygen needs to be ordered if the vet has no interest in practical research in wanting to know what is best for the cat and for the practice economics.
Yesterday, June 6, 2012, a shy 3kg black and white cat from Bedok came in. I used this case to share my experience and demonstrate to Dr Daniel how I would use an effective optimal dosage of injectable anaesthesia WITHOUT the need of isoflurane gas top up. Toa Payoh Vets has the isoflurane gas facility and so, there is no need to catherise the cat or dog to top up, if the dosage of injectable anaesthesia is insufficient. However, catherisation means a waste of resource, more time spent in catherisation of the cephalic vein and in topping up to get surgical anaesthesia. This can make a spay surgery twice as long.
I prefer surgery to be simple and fast by giving the effective optimal dosage of xylazine and ketamine for a cat spay. I can get the whole spay done from first incision to stitching in 10-15 minutes if there is no need to top up.
As a guideline, a cat at 3 kg needs 0.15 ml xylazine and 0.6 ml ketamine IM to be sufficiently anaesthesized without the need of isoflurane gas or top up. Dr Daniel did not think this was possible and so the isoflurane gas was switched on as standby.
However, this amount lasted more than 30 minutes and he could see that the formula was sufficient. After the IM injection of 0.15 ml xylazine and 0.6 ml ketamine, there was a wait of 10 minutes. During this time, the cat's belly was shaved.
Obviously, if the vet takes a bit longer, isoflurane gas will be needed.
TIPS
1. Don't snip off the SC fat if possible. Just undermine and see the linea alba.
2. The start of the incision is around 1.5 cm from the umbilical scar.
3. This cat had enlarged congested ovaries with follicles and uterus of over 8 mm in diameter although she was never "mated". So, it was difficult to hook out the womb. A longer incision was needed and more surgery time had to be spent. I could not believe when I saw the uterine horns being as large as 8 m min diameter and over 12 cm long. The ovarian blood vessels were enlarged and engorged. As if the cat was pregnant.
Could this be a case of cystic ovaries, pyometra or early pregnancy? However, the lady owner said: "My cat would never leave the HDB flat. Whenever she sees another cat, she would run away. It is not possible that she was mated."
"Is there a male cat in the apartment?" I asked.
"Yes, he was neutered some time ago at another vet practice."
"Did he try to mate with this caterwauling female 2 weeks ago? " I asked.
"Yes, the male cat was humping her."
So, this could be a case of false pregnancy with the signs of pregnancy in the uterus being developed. There was no foetal lumps. I did not cut into the uterine bodies to check for foetuses. The uterus was just swollen and thicker by 100x normal for a non-pregnant young cat of around one year old. It could be a case of early pyometra.
RESTRAINT OF THE SHY CAT
I put the cat carrier on the consultation table. A wire crate was ready. As soon as I opened the carrier door and tilted the carrier, the cat shot out like a rocket and jumped onto the floor to a corner of the back table. I expected the cat. Dr Daniel bent on his knees and talked to the cat. He got her back into the crate. Now, what to do?
"Put some telephone books inside the plastic crate to corner him and I will inject the anaesthestic," I said. But there were no phone books. So, he put a large dog carrier to corner the cat. "Ready for injection," he asked me. The cat had crawled to the top of the plastic crate and was moving.
"Can you inject him now?" Dr Daniel asked.
"Based on my experience, the cat will move when injected as she is not tightly cornered. Only half dose may be given."
"That should be OK," Dr Daniel replied.
"Sometimes the syringe needle may bend when the injection is given as the cat springs away," I said. In practice, it is so much different from in theory from the lectures.
"In any case, a full dose IM must be given to get the best optimal anaesthesia," I said.
As I tried to get the cat cornered, she climbed up the plastic crate top towards Dr Daniel and away from me.
"There is a gap in the side of wire crate which could not be closed properly after he had put in the plastic crate."
It was only a gap of 8 mm but the small cat's head went out. In an instant, she sprang out and jumped onto the floor back to the corner of the floor as before.
I was quite angry at this "waste of time". The side of the wire crate was not secured properly first after the plastic crate was put in. The cat was dropped into the wire crate from the top as there was a door. So, the cat escaped and I cursed. I hate wasting time which is much more precious to me at my age.
So, I left the consultation room for Dr Daniel to coax the cat back and put her into the plastic crate. Why not the wire crate? I was surprised but since now there was a new situation, I had to decide what to do, being the senior.
"If your hand is strong enough to grip the scruff of the cat and you do not mind being scratched," hold the cat up with your hand and I will inject the back muscle" I said.
Dr Daniel did that. He has a strong grip. The cat did not move at all when I inject. That is the norm as a strong grip on the scruff makes a cat not feeling any pain in injection, in my experience. A weak grip will result in the cat feeling the IM injection and clawing.
Then Dr Daniel put the cat inside the wire crate and from then on, he could see that a full dose IM according to my formula was really effective and no isoflurane gas was ever needed to spay this cat. The duration of analgesia was at least 30 minutes and that was more than enough time to spay a cat.
As mentor, many optimal and safe anaesthetic lessons are taught to the younger vets by "seeing is believing"
as each young vet has his or her own ideas of anaesthesia, basically from what the vet professors have had taught them and used in the Vet School. When they come out to work in the industry, they have to adapt to different anaesthetic and formulas which their professors had never used. This is because there is more than one combination to safely anaesthesized the cat and the vet practice has its own experienced method usually different from the Vet School which could teach and advise more injections (pre-med with ACP, sedate with another drug, atropine etc) as according to the theory.
Website with images and updates at:
http://www.bekindtopets.com/cats/20120607spay-optimal-safe-anaesthetic-injectable-singapore-ToaPayohVets.htm
Obviously, an employee or associate vet has no need to account for the bottom-line of the practice and is not interested in reducing costs. So there is no motivation to conserve resources and use just-sufficient anaesthestics as they don't bear the expenses and responsibility for the economic health of the practice. If the practice closes down, just go to another practice to work!
Just give the cat isoflurane gas by mask to continue the spay if the cat is not sufficiently anaesthesized by xylazine and ketamine. So, more isoflurane and oxygen needs to be ordered if the vet has no interest in practical research in wanting to know what is best for the cat and for the practice economics.
Yesterday, June 6, 2012, a shy 3kg black and white cat from Bedok came in. I used this case to share my experience and demonstrate to Dr Daniel how I would use an effective optimal dosage of injectable anaesthesia WITHOUT the need of isoflurane gas top up. Toa Payoh Vets has the isoflurane gas facility and so, there is no need to catherise the cat or dog to top up, if the dosage of injectable anaesthesia is insufficient. However, catherisation means a waste of resource, more time spent in catherisation of the cephalic vein and in topping up to get surgical anaesthesia. This can make a spay surgery twice as long.
I prefer surgery to be simple and fast by giving the effective optimal dosage of xylazine and ketamine for a cat spay. I can get the whole spay done from first incision to stitching in 10-15 minutes if there is no need to top up.
As a guideline, a cat at 3 kg needs 0.15 ml xylazine and 0.6 ml ketamine IM to be sufficiently anaesthesized without the need of isoflurane gas or top up. Dr Daniel did not think this was possible and so the isoflurane gas was switched on as standby.
However, this amount lasted more than 30 minutes and he could see that the formula was sufficient. After the IM injection of 0.15 ml xylazine and 0.6 ml ketamine, there was a wait of 10 minutes. During this time, the cat's belly was shaved.
Obviously, if the vet takes a bit longer, isoflurane gas will be needed.
TIPS
1. Don't snip off the SC fat if possible. Just undermine and see the linea alba.
2. The start of the incision is around 1.5 cm from the umbilical scar.
3. This cat had enlarged congested ovaries with follicles and uterus of over 8 mm in diameter although she was never "mated". So, it was difficult to hook out the womb. A longer incision was needed and more surgery time had to be spent. I could not believe when I saw the uterine horns being as large as 8 m min diameter and over 12 cm long. The ovarian blood vessels were enlarged and engorged. As if the cat was pregnant.
Could this be a case of cystic ovaries, pyometra or early pregnancy? However, the lady owner said: "My cat would never leave the HDB flat. Whenever she sees another cat, she would run away. It is not possible that she was mated."
"Is there a male cat in the apartment?" I asked.
"Yes, he was neutered some time ago at another vet practice."
"Did he try to mate with this caterwauling female 2 weeks ago? " I asked.
"Yes, the male cat was humping her."
So, this could be a case of false pregnancy with the signs of pregnancy in the uterus being developed. There was no foetal lumps. I did not cut into the uterine bodies to check for foetuses. The uterus was just swollen and thicker by 100x normal for a non-pregnant young cat of around one year old. It could be a case of early pyometra.
RESTRAINT OF THE SHY CAT
I put the cat carrier on the consultation table. A wire crate was ready. As soon as I opened the carrier door and tilted the carrier, the cat shot out like a rocket and jumped onto the floor to a corner of the back table. I expected the cat. Dr Daniel bent on his knees and talked to the cat. He got her back into the crate. Now, what to do?
"Put some telephone books inside the plastic crate to corner him and I will inject the anaesthestic," I said. But there were no phone books. So, he put a large dog carrier to corner the cat. "Ready for injection," he asked me. The cat had crawled to the top of the plastic crate and was moving.
"Can you inject him now?" Dr Daniel asked.
"Based on my experience, the cat will move when injected as she is not tightly cornered. Only half dose may be given."
"That should be OK," Dr Daniel replied.
"Sometimes the syringe needle may bend when the injection is given as the cat springs away," I said. In practice, it is so much different from in theory from the lectures.
"In any case, a full dose IM must be given to get the best optimal anaesthesia," I said.
As I tried to get the cat cornered, she climbed up the plastic crate top towards Dr Daniel and away from me.
"There is a gap in the side of wire crate which could not be closed properly after he had put in the plastic crate."
It was only a gap of 8 mm but the small cat's head went out. In an instant, she sprang out and jumped onto the floor back to the corner of the floor as before.
I was quite angry at this "waste of time". The side of the wire crate was not secured properly first after the plastic crate was put in. The cat was dropped into the wire crate from the top as there was a door. So, the cat escaped and I cursed. I hate wasting time which is much more precious to me at my age.
So, I left the consultation room for Dr Daniel to coax the cat back and put her into the plastic crate. Why not the wire crate? I was surprised but since now there was a new situation, I had to decide what to do, being the senior.
"If your hand is strong enough to grip the scruff of the cat and you do not mind being scratched," hold the cat up with your hand and I will inject the back muscle" I said.
Dr Daniel did that. He has a strong grip. The cat did not move at all when I inject. That is the norm as a strong grip on the scruff makes a cat not feeling any pain in injection, in my experience. A weak grip will result in the cat feeling the IM injection and clawing.
Then Dr Daniel put the cat inside the wire crate and from then on, he could see that a full dose IM according to my formula was really effective and no isoflurane gas was ever needed to spay this cat. The duration of analgesia was at least 30 minutes and that was more than enough time to spay a cat.
As mentor, many optimal and safe anaesthetic lessons are taught to the younger vets by "seeing is believing"
as each young vet has his or her own ideas of anaesthesia, basically from what the vet professors have had taught them and used in the Vet School. When they come out to work in the industry, they have to adapt to different anaesthetic and formulas which their professors had never used. This is because there is more than one combination to safely anaesthesized the cat and the vet practice has its own experienced method usually different from the Vet School which could teach and advise more injections (pre-med with ACP, sedate with another drug, atropine etc) as according to the theory.
Website with images and updates at:
http://www.bekindtopets.com/cats/20120607spay-optimal-safe-anaesthetic-injectable-singapore-ToaPayohVets.htm
Tuesday, June 5, 2012
1015. Distemper images
On Tue, Jun 5, 2012 at 3:26 AM, Criss, Katie L <CrissKL@alfredstate.edu> wrote:
Yes, it is oK to use the photos. Best wishes
I am Dr Sing from Toa Payoh Vets.Dear Toa Payo vets,
My name is Katie An I wanted to ask for your permission to use the photo "160. Feb 10, 2005. The invisible killers stalked the Miniature Schnauzers." For a collage project on canine distemper. The photo will only be seen by my professor an some classmates. The photo will not be published. If you could please get back to me I would greatly appreciate it.
Respectfully,
Katie.
Yes, it is oK to use the photos. Best wishes
Monday, June 4, 2012
1014. Sunday Jun 3, 2012's interesting cases
Sunday June 3, 2012
2.30 pm to 5pm
Yesterday, Saturday morning and today Sunday afternoon, I presented myself at Toa Payoh Vets to do my "trust and audit" veterinary work. This is an important part of management of a veterinary practice as veterinary performance counts in the sustainablility of the business. Referrals come from good performance and good clinical and surgical outcomes from all the 4 vets at Toa Payoh Vets. My duty is to ensure a consistent and high standard of performance and so I do my unannounced "trust and audit" checks and mentorship.
On this Sunday afternoon, I was surprised to see a familiar black and white Corgi with cataract eyes coming in for a check up and vaccination. Corgis are rather rare in my practice and a Black and White one is rarer compared to the brown ones. I can remember this case distinctly as its case file is quite thick due to much veterinary investigations that had to be done.
"You don't work on Sunday afternoons," the slim lady owner said to me.
"No," I said. "I came to do my checks on the staff and cases. How's the Corgi now? Any more smelly urine passed?"
A bit of history. This Corgi had been having urinary tract infections for the past year or more. After a course of antibiotics, the dog would recover. Then, the infection comes again. This interesting emotional case is reported at:
http://www.sinpets.com/dogs/20111044blood-urine-recurs-over10times-old-corgi-female-toapayohvets.htm
http://www.sinpets.com/F6/20111210recurrent-urinary-tract-infection-old-female-spayed-corgi-singapore-toapayohvets.htm
So, on this fine Sunday afternoon, I happened to be at the Surgery and see this Corgi again. She had lost some weight, around 1 kg and looked quite neat and majestic. She had come in for a check up, vaccination and pro-heart vaccination and Dr Vanessa would be in charge.
"When did you stop the S/D diet?" the lady said that S/D was too expensive.
"Around 2 months ago," she replied.
"S/D diet is specially formulated for cases of urinary struvite-stones and so it is more expensive. How long was she eating the canned S/D diet?"
"3 months," she replied. "Now she is on a holistic dry food."
"What is the name of the dry food?" I asked.
She did not remember.
"What is the colour of her urine?" I asked. "You are supposed to get her urine checked every 2 to 3 monthly for urinary tract infection and stones." But most owners don't do that till the dog has a urinary problem.
"Is she still passing smelly urine?" I asked. "Like ammonia?"
"No," she said. "No other vet had asked me about the smell of urine, except you."
Smelly urine is one topic vets don't ask, I guess that the vet professors never emphasize on smell during the lectures.
"Any difficulty in passing urine?"
"No more," the lady said. "Well, occasionally. I am seldom at home when she pees. She pees twice a day and sometimes when she pees on the 3rd time, there is a smell. But no more problem. She drinks more now."
"That's good news," I said. "She drinks more because she does not have to worry about painful urination as in the past months for over one year. I guess dogs with urinary tract infection may figure out that the less they drink, the less they need to pee as urination is painful."
The dog was checked by Dr Vanessa. I examined the dog too. There was some redness in her vulval mucosa and inguinal area.
"Any vulval licking?" I asked.
"Sometimes but not often as before"
I palpated the dog's bladder since this was her original source of problem. An empty bladder. There was a small walnut-sized lump of the bladder. The Corgi suddenly yelped as if it was painful but did not bite me. She was 9 years old and would bite and so I had to be careful as I was just bitten on the right forefinger tip guinea pig with the punk hair between the ears when I examined his mouth.
The dog had a blood test and was vaccinated. I made sure that the owner had a urine-collection bottle to send in the urine for testing during the week. Most owners don't do it but it is good for the dog with a long history of 2 years of urinary tract infection. The dog is in excellent condition. A bit of left forepaw itchiness for which Dr Vanessa prescribed a cream.
This is the type of challenging cases that need a lot of investigation and time. If the dog is treated by several weeks as was done in the previous 2 years, it was difficult to come to a satisfactory resolution of the old dog's urinary tract infections which recur after antibiotics. Bladder tumours were once diagnosed but with a good ultrasound of the bladder, as seen by Dr Daniel when he had not yet graduated, this case was diagnosed as not having bladder tumour but just bladder "sand".
When the urine sample was analysed, there was no crystals, no bacteria, no white cells. Negative crystals do not mean there was no struvite crystals which had been diagnosed by one of the vets during the past 2 years. In this case, the effects of treatment with the S/D diet and the resolution of her urinary tract infections for the past 2 months confirmed that this beloved spayed female 9-year-old Corgi had a urinary tract infection due to struvites stones inside her bladder.
Ideally, she should have her urine tested every 2-3 months since she had 2 years of urinary tract infections, but no Singapore owner will do that. Till there is a problem! Singaporeans are time-pressed but dogs are families and so there is great emotions involved when the vet cannot resolve a chronic urinary tract infection as in this case.
2.30 pm to 5pm
Yesterday, Saturday morning and today Sunday afternoon, I presented myself at Toa Payoh Vets to do my "trust and audit" veterinary work. This is an important part of management of a veterinary practice as veterinary performance counts in the sustainablility of the business. Referrals come from good performance and good clinical and surgical outcomes from all the 4 vets at Toa Payoh Vets. My duty is to ensure a consistent and high standard of performance and so I do my unannounced "trust and audit" checks and mentorship.
On this Sunday afternoon, I was surprised to see a familiar black and white Corgi with cataract eyes coming in for a check up and vaccination. Corgis are rather rare in my practice and a Black and White one is rarer compared to the brown ones. I can remember this case distinctly as its case file is quite thick due to much veterinary investigations that had to be done.
"You don't work on Sunday afternoons," the slim lady owner said to me.
"No," I said. "I came to do my checks on the staff and cases. How's the Corgi now? Any more smelly urine passed?"
A bit of history. This Corgi had been having urinary tract infections for the past year or more. After a course of antibiotics, the dog would recover. Then, the infection comes again. This interesting emotional case is reported at:
http://www.sinpets.com/dogs/20111044blood-urine-recurs-over10times-old-corgi-female-toapayohvets.htm
http://www.sinpets.com/F6/20111210recurrent-urinary-tract-infection-old-female-spayed-corgi-singapore-toapayohvets.htm
So, on this fine Sunday afternoon, I happened to be at the Surgery and see this Corgi again. She had lost some weight, around 1 kg and looked quite neat and majestic. She had come in for a check up, vaccination and pro-heart vaccination and Dr Vanessa would be in charge.
"When did you stop the S/D diet?" the lady said that S/D was too expensive.
"Around 2 months ago," she replied.
"S/D diet is specially formulated for cases of urinary struvite-stones and so it is more expensive. How long was she eating the canned S/D diet?"
"3 months," she replied. "Now she is on a holistic dry food."
"What is the name of the dry food?" I asked.
She did not remember.
"What is the colour of her urine?" I asked. "You are supposed to get her urine checked every 2 to 3 monthly for urinary tract infection and stones." But most owners don't do that till the dog has a urinary problem.
"Is she still passing smelly urine?" I asked. "Like ammonia?"
"No," she said. "No other vet had asked me about the smell of urine, except you."
Smelly urine is one topic vets don't ask, I guess that the vet professors never emphasize on smell during the lectures.
"Any difficulty in passing urine?"
"No more," the lady said. "Well, occasionally. I am seldom at home when she pees. She pees twice a day and sometimes when she pees on the 3rd time, there is a smell. But no more problem. She drinks more now."
"That's good news," I said. "She drinks more because she does not have to worry about painful urination as in the past months for over one year. I guess dogs with urinary tract infection may figure out that the less they drink, the less they need to pee as urination is painful."
The dog was checked by Dr Vanessa. I examined the dog too. There was some redness in her vulval mucosa and inguinal area.
"Any vulval licking?" I asked.
"Sometimes but not often as before"
I palpated the dog's bladder since this was her original source of problem. An empty bladder. There was a small walnut-sized lump of the bladder. The Corgi suddenly yelped as if it was painful but did not bite me. She was 9 years old and would bite and so I had to be careful as I was just bitten on the right forefinger tip guinea pig with the punk hair between the ears when I examined his mouth.
The dog had a blood test and was vaccinated. I made sure that the owner had a urine-collection bottle to send in the urine for testing during the week. Most owners don't do it but it is good for the dog with a long history of 2 years of urinary tract infection. The dog is in excellent condition. A bit of left forepaw itchiness for which Dr Vanessa prescribed a cream.
This is the type of challenging cases that need a lot of investigation and time. If the dog is treated by several weeks as was done in the previous 2 years, it was difficult to come to a satisfactory resolution of the old dog's urinary tract infections which recur after antibiotics. Bladder tumours were once diagnosed but with a good ultrasound of the bladder, as seen by Dr Daniel when he had not yet graduated, this case was diagnosed as not having bladder tumour but just bladder "sand".
When the urine sample was analysed, there was no crystals, no bacteria, no white cells. Negative crystals do not mean there was no struvite crystals which had been diagnosed by one of the vets during the past 2 years. In this case, the effects of treatment with the S/D diet and the resolution of her urinary tract infections for the past 2 months confirmed that this beloved spayed female 9-year-old Corgi had a urinary tract infection due to struvites stones inside her bladder.
Ideally, she should have her urine tested every 2-3 months since she had 2 years of urinary tract infections, but no Singapore owner will do that. Till there is a problem! Singaporeans are time-pressed but dogs are families and so there is great emotions involved when the vet cannot resolve a chronic urinary tract infection as in this case.
Wednesday, May 30, 2012
1013. Travels broaden your mind if you know how
1013. Travels broaden your mind if you know how
It is 8.42 am May 30, 2012. I have just returned from a 5day-4night packaged tour to Hong Kong, Shenzhen and Macau on May 29, 2012. Packaged tours are the least expensive way to travel and if you know how, the best way to broaden your mind if you know how to do it.
Shopping till you drop in air-conditioned comfort is a favourite of the Singaporean traveller. I will not be commenting on this retail therapy as I prefer not to visit the shopping malls of other countries if possible.
How to broaden your mind in your travels?
1. Listen more. Listen to your tour guide to gain knowledge of the world.
An experienced guide will provide much local information v. Singapore's situation. For example, my lady tour guide in Hong Kong mentioned that only 20% of the residents get public housing while 80% of Singaporeans get public housing. She was incorrect in the sense that the 20% of Hongkongers are renting public housing at very low subsidised rental rates while 80% of Singaporeans are "owners" of 99-year-leasehold HDB apartments. The statistics mean nothing to the average Singaporean but there is an economic significance. For example, the young Singaporean couple will find it better to buy the HDB flat rather than rent as rental flats, even in Hong Kong, are subject to long waiting lists and prices have had shot up recently.
2. The world is nowadays much more competitive. Speak to your tour guide and know how competitive her job and the travel industry has become over the last two years. Too many travel agencies have been set up and the more successful ones have grown big and can take away the business of the small ones. Success creates success. If you own a small business, like a solo veterinary practice you can see that you will be affected too as the bigger surgeries recruit more vet graduates and attract more Singaporean clientele. The new employees work a year or two and set up their own practices. So, there is an increase in competition for jobs, promotions and mates over the last few years, just like the travel industry has been forced to deal with direct internet bookings by prospective travellers and low budget airlines compete with established airlines like Singapore Airlines which has to compete in the premium business class with Emirates Airlines.
3. More IT-savvy younger generation. These are the ones that select their clients based on the lowest quotation and then the quality of service. In this tour, a group of "seven pretty girls" as the Macau tour guide referred to them in Cantonese, used their handphone to show the guide the itinerary. Not the usual printed paper but from the phone. When the tour guide gave her phone number to them to contact her for travel arrangements the next day, her phone rang immediately. One of the seven said she was the caller. This young generation knows what to do to verify the connection instantly.
4. Develop a sense of humour in life. Learn how the Macau tour guide has the sense of humour in reprimanding the client and yet get laughter. One example would be from paragraph 3. When the Macau tour guide answered her phone as it rang immediately when she gave her phone number, she said, "Shwai loi" in Cantonese. Ii can be translated to "naughty girl" and the group laughed. No ill feelings.
5. Be outstanding if you want attention. One of the seven ladies had a special hair cut. The Macau tour guide called her "Ma Been loi" in Cantonese. "Loi" refers to woman or lady in Cantonese.
"What is the meaning of "Ma Been"? Do you know Cantonese" I asked one of the other 7 ladies. "I am not Cantonese. It is the type of hair-style," her friend or sister said. The "seven pretty women" are sisters and cousins.
6. Ask if you don't know. Many young ones are afraid to ask as they may reveal their inadequacies and lack of knowledge. Obviously, a young one has less knowledge as the person is young. Don't be afraid to ask. I am 62 years old and though I understand and speak Cantonese, I still asked the tour guide what is the meaning of "Ma Been"? I would guess "Ma" refers to horses. "Been" refers to tail. The Macau tour guide told me the hair-style resembles the tail of the horse. As an ex-racehorse vet, I could see some resemblances. A picture is worth a thousand words and I will show you one.
I never had a chance to talk to the "Ma Been loi" though.
7. Learn to open up by replying with a sense of humour. The Macau tour guide said, "I have 22 female tourists today. You are the only male." I had not been observant of this fact. "Men work hard to make money," I said to her. "Women work hard to spend the money made by men." So, what was I doing as a thorn amongst roses?
8. Create a lasting impression by telling stories of your personal experiences. The Hong Kong and Macau tour guides are ladies and experienced. They could communicate very well and so created a good impression. That is because they don't stop chattering. Unfortunately, they use Cantonese often and for me, it was home ground as my mum spoke Cantonese to me while I was younger.
Singaporeans seldom speak Cantonese but Mandarin nowadays and so they feel left out, in my opinion. The guides do speak English and Mandarin but most of the time, it was Cantonese. No Tagalong for the two Filipino women joining the tour in Macau. However, the younger generation of Macau and Hong Kong residents learn more Mandarin but they prefer not to be tour guides. I guess the money is not there.
9. Walk the streets to know the real life of the residents. Hot and humid. Showers. Why not just stay in air-conditioning shopping malls?
Unfortunately, you will miss much gaining knowledge if you just prefer to be in air-conditioned places as the vast majority of residents in Hong Kong, Shenzhen and Macau don't have this luxury. Too smelly in wet markets. I went to one in Hong Kong and it was a street photographer's dream site. Will show some pictures. The blood, the gore and the foul smell puts off most of the younger Singaporeans. Our wet markets are well ventilated and all pork must be sold in air-conditioned fridges in wet markets. Our enforcement officers against pork sellers in this wet market will net them a gold mine as pork sellers display their trotters and ham hanging up in open air. Our bureaucrats think of ways of making food safe for the public and drafting more regulations to control the type of trade. Then they wonder why the cost of living goes up with the years. See my pictures of the vast competition in this wet market. It was like survival in the jungle as there are more fish sellers with live fishes seen in this market than any wet market in Singapore.
10. Don't put your backup discs in the same laptop bag. I left my laptop in Hong Kong International Airport as I was busy taking pictures inside the airport. Practice makes perfect pictures. I put the two back up discs in my camera bag, not the laptop bag. So, I don't lose my precious memories of my travel from May 26 - 29, 2012. I phoned Hong Kong Airport at 9.30 pm. "No such laptop," the reply came and I left my phone number. So, no hope. Fortunately I had my two backup hard discs with me.
11. Excellent Service Provider from Cathay Pacific. At 10.30 pm, the Hong Kong Airport officer phoned me to say they found it. I doubt any airport lost luggage will bother with me. On May 30, 2012, I phoned Cathay Pacific HK at 8.10 am thinking they have not started work (as like most offices in Singapore), I got a fast response from HK and I would get my laptop back from CX 739 reaching Singapore at 3 pm today. This is incredible service from Hong Kong and there is much my veterinary practice has to learn from them.
12. Survey to get feedback from customers. The HKIA (Hongkong International Airport) girl asked me to do a survey. When she checked that my last country of travel was Cambodia which was not on his survey list, she said thanks. On Cathay Pacific CX711, an Indian steward supervisor in red silk blouse asked me if I could fill up a survey form. Survey is always good to check on staff. Overall, I rated their services as No. 1 and that was before I discovered that I had left my laptop at the HKIA. Feedback surveys are important and keeps staff on their toes. I do my own direct survey of the performance of my vets and staff by asking about the case outcome and being at the reception table and answering phone calls some days. No other way to ensure a high standard of care and service nowadays.
13. Don't complain about inconveniences or mistakes of service providers. On May 26, I checked into L'Hotel at Lina Towers and was given a beautiful room 61-12 facing the lifts. I was surprised there was a wooden bench inside the bathroom and the toilet bowl was higher than usual. The sinks were much smaller than normal. The shower rail was lower. Why is there a bench inside a bathroom? I thought it was a sauna bathroom. You just sit on the bench and sweat it out. Since I was not into sauna baths, I did not bother. Actually, this was a handicapped room. The hotel receptionist phoned later to ask if I wanted a normal room but this was OK for one night. The 4th night I returned back to the hotel, I was much surprised to be given the suite room. This room was at least three times in floor area compared to the normal room, had a bath tub, separate shower and toilet bowl. There was a marble table for four, a big dressing table, a foyer. The view of the harbour was around 180 degrees from inside the room. I would not book such a room as it would be costly.
Updates at:
http://www.designtravelpl.com/Folder_3/20120529travel-broadens-your-mind-singapore-ToaPayohVets.htm
It is 8.42 am May 30, 2012. I have just returned from a 5day-4night packaged tour to Hong Kong, Shenzhen and Macau on May 29, 2012. Packaged tours are the least expensive way to travel and if you know how, the best way to broaden your mind if you know how to do it.
Shopping till you drop in air-conditioned comfort is a favourite of the Singaporean traveller. I will not be commenting on this retail therapy as I prefer not to visit the shopping malls of other countries if possible.
How to broaden your mind in your travels?
1. Listen more. Listen to your tour guide to gain knowledge of the world.
An experienced guide will provide much local information v. Singapore's situation. For example, my lady tour guide in Hong Kong mentioned that only 20% of the residents get public housing while 80% of Singaporeans get public housing. She was incorrect in the sense that the 20% of Hongkongers are renting public housing at very low subsidised rental rates while 80% of Singaporeans are "owners" of 99-year-leasehold HDB apartments. The statistics mean nothing to the average Singaporean but there is an economic significance. For example, the young Singaporean couple will find it better to buy the HDB flat rather than rent as rental flats, even in Hong Kong, are subject to long waiting lists and prices have had shot up recently.
2. The world is nowadays much more competitive. Speak to your tour guide and know how competitive her job and the travel industry has become over the last two years. Too many travel agencies have been set up and the more successful ones have grown big and can take away the business of the small ones. Success creates success. If you own a small business, like a solo veterinary practice you can see that you will be affected too as the bigger surgeries recruit more vet graduates and attract more Singaporean clientele. The new employees work a year or two and set up their own practices. So, there is an increase in competition for jobs, promotions and mates over the last few years, just like the travel industry has been forced to deal with direct internet bookings by prospective travellers and low budget airlines compete with established airlines like Singapore Airlines which has to compete in the premium business class with Emirates Airlines.
3. More IT-savvy younger generation. These are the ones that select their clients based on the lowest quotation and then the quality of service. In this tour, a group of "seven pretty girls" as the Macau tour guide referred to them in Cantonese, used their handphone to show the guide the itinerary. Not the usual printed paper but from the phone. When the tour guide gave her phone number to them to contact her for travel arrangements the next day, her phone rang immediately. One of the seven said she was the caller. This young generation knows what to do to verify the connection instantly.
4. Develop a sense of humour in life. Learn how the Macau tour guide has the sense of humour in reprimanding the client and yet get laughter. One example would be from paragraph 3. When the Macau tour guide answered her phone as it rang immediately when she gave her phone number, she said, "Shwai loi" in Cantonese. Ii can be translated to "naughty girl" and the group laughed. No ill feelings.
5. Be outstanding if you want attention. One of the seven ladies had a special hair cut. The Macau tour guide called her "Ma Been loi" in Cantonese. "Loi" refers to woman or lady in Cantonese.
"What is the meaning of "Ma Been"? Do you know Cantonese" I asked one of the other 7 ladies. "I am not Cantonese. It is the type of hair-style," her friend or sister said. The "seven pretty women" are sisters and cousins.
6. Ask if you don't know. Many young ones are afraid to ask as they may reveal their inadequacies and lack of knowledge. Obviously, a young one has less knowledge as the person is young. Don't be afraid to ask. I am 62 years old and though I understand and speak Cantonese, I still asked the tour guide what is the meaning of "Ma Been"? I would guess "Ma" refers to horses. "Been" refers to tail. The Macau tour guide told me the hair-style resembles the tail of the horse. As an ex-racehorse vet, I could see some resemblances. A picture is worth a thousand words and I will show you one.
I never had a chance to talk to the "Ma Been loi" though.
7. Learn to open up by replying with a sense of humour. The Macau tour guide said, "I have 22 female tourists today. You are the only male." I had not been observant of this fact. "Men work hard to make money," I said to her. "Women work hard to spend the money made by men." So, what was I doing as a thorn amongst roses?
8. Create a lasting impression by telling stories of your personal experiences. The Hong Kong and Macau tour guides are ladies and experienced. They could communicate very well and so created a good impression. That is because they don't stop chattering. Unfortunately, they use Cantonese often and for me, it was home ground as my mum spoke Cantonese to me while I was younger.
Singaporeans seldom speak Cantonese but Mandarin nowadays and so they feel left out, in my opinion. The guides do speak English and Mandarin but most of the time, it was Cantonese. No Tagalong for the two Filipino women joining the tour in Macau. However, the younger generation of Macau and Hong Kong residents learn more Mandarin but they prefer not to be tour guides. I guess the money is not there.
9. Walk the streets to know the real life of the residents. Hot and humid. Showers. Why not just stay in air-conditioning shopping malls?
Unfortunately, you will miss much gaining knowledge if you just prefer to be in air-conditioned places as the vast majority of residents in Hong Kong, Shenzhen and Macau don't have this luxury. Too smelly in wet markets. I went to one in Hong Kong and it was a street photographer's dream site. Will show some pictures. The blood, the gore and the foul smell puts off most of the younger Singaporeans. Our wet markets are well ventilated and all pork must be sold in air-conditioned fridges in wet markets. Our enforcement officers against pork sellers in this wet market will net them a gold mine as pork sellers display their trotters and ham hanging up in open air. Our bureaucrats think of ways of making food safe for the public and drafting more regulations to control the type of trade. Then they wonder why the cost of living goes up with the years. See my pictures of the vast competition in this wet market. It was like survival in the jungle as there are more fish sellers with live fishes seen in this market than any wet market in Singapore.
10. Don't put your backup discs in the same laptop bag. I left my laptop in Hong Kong International Airport as I was busy taking pictures inside the airport. Practice makes perfect pictures. I put the two back up discs in my camera bag, not the laptop bag. So, I don't lose my precious memories of my travel from May 26 - 29, 2012. I phoned Hong Kong Airport at 9.30 pm. "No such laptop," the reply came and I left my phone number. So, no hope. Fortunately I had my two backup hard discs with me.
11. Excellent Service Provider from Cathay Pacific. At 10.30 pm, the Hong Kong Airport officer phoned me to say they found it. I doubt any airport lost luggage will bother with me. On May 30, 2012, I phoned Cathay Pacific HK at 8.10 am thinking they have not started work (as like most offices in Singapore), I got a fast response from HK and I would get my laptop back from CX 739 reaching Singapore at 3 pm today. This is incredible service from Hong Kong and there is much my veterinary practice has to learn from them.
12. Survey to get feedback from customers. The HKIA (Hongkong International Airport) girl asked me to do a survey. When she checked that my last country of travel was Cambodia which was not on his survey list, she said thanks. On Cathay Pacific CX711, an Indian steward supervisor in red silk blouse asked me if I could fill up a survey form. Survey is always good to check on staff. Overall, I rated their services as No. 1 and that was before I discovered that I had left my laptop at the HKIA. Feedback surveys are important and keeps staff on their toes. I do my own direct survey of the performance of my vets and staff by asking about the case outcome and being at the reception table and answering phone calls some days. No other way to ensure a high standard of care and service nowadays.
13. Don't complain about inconveniences or mistakes of service providers. On May 26, I checked into L'Hotel at Lina Towers and was given a beautiful room 61-12 facing the lifts. I was surprised there was a wooden bench inside the bathroom and the toilet bowl was higher than usual. The sinks were much smaller than normal. The shower rail was lower. Why is there a bench inside a bathroom? I thought it was a sauna bathroom. You just sit on the bench and sweat it out. Since I was not into sauna baths, I did not bother. Actually, this was a handicapped room. The hotel receptionist phoned later to ask if I wanted a normal room but this was OK for one night. The 4th night I returned back to the hotel, I was much surprised to be given the suite room. This room was at least three times in floor area compared to the normal room, had a bath tub, separate shower and toilet bowl. There was a marble table for four, a big dressing table, a foyer. The view of the harbour was around 180 degrees from inside the room. I would not book such a room as it would be costly.
Updates at:
http://www.designtravelpl.com/Folder_3/20120529travel-broadens-your-mind-singapore-ToaPayohVets.htm
Thursday, May 24, 2012
Old dog lost 3 kg in 2 weeks.
The dog was treated by Dr V on May 1, 2012 for coughing. The cough had disappeared after 3 days of drugs and the dog stopped eating. Blood test was taken but he said that he was not told of the results. I apologised to him and reviewed his records. Liver enzymes were high and Dr V had prescribed heart medication and advised review in 14 days . However, he did not turn up and now it is May 24, 2012 and the dog is very thin and weak. A loss of 3 kg from May 1 to May 24 is too drastic.
Now it is very thin. The 62-year-old man came with his daughter. As he had white hair, I said incorrectly that his grand-daughter was accompanying him. I asked Dr Daniel to handle this case with me. Respiratory rate and pulse were normal.
SIGNIFICANT FINDINGS
1. Below normal rectal temp at 37.5
2. Weight loss
3. No appetite and does not drink water.
4. Periodontitis Stage 4 and painful throat area.
5. No abdominal pain or swelling of the liver which is good news.
6. Penile sheath was swollen.
7. Heart murmurs.
"This dog could be more than 15 years old," the father said. He remembered I did a tail amputation on a tail lump in 2007. "He had seizures in 2010," I saw the record but he could not remember. His daughter confirmed and said no more seizures.
What's the cause of this loss of appetite and painful throat? Blood test, urine test and IV drip done first.
Now it is very thin. The 62-year-old man came with his daughter. As he had white hair, I said incorrectly that his grand-daughter was accompanying him. I asked Dr Daniel to handle this case with me. Respiratory rate and pulse were normal.
SIGNIFICANT FINDINGS
1. Below normal rectal temp at 37.5
2. Weight loss
3. No appetite and does not drink water.
4. Periodontitis Stage 4 and painful throat area.
5. No abdominal pain or swelling of the liver which is good news.
6. Penile sheath was swollen.
7. Heart murmurs.
"This dog could be more than 15 years old," the father said. He remembered I did a tail amputation on a tail lump in 2007. "He had seizures in 2010," I saw the record but he could not remember. His daughter confirmed and said no more seizures.
What's the cause of this loss of appetite and painful throat? Blood test, urine test and IV drip done first.
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