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When an older female dog has pus in the vaginal discharge or is suspected of having closed pyometra, the following will be the procedures at Toa Payoh Vets to provide the highest standard of care. This SOP defend the vet during allegations of negligence litigation or complaint if the dog dies later. |
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1. HISTORY. Record all vaccinations done and dates and by whom. Do not forget to do so. Record your estrus onset and duration to determine whether parvovirus is a likely cause. 2. GENERAL EXAMINATION. Demeanour. Weight, rectal temperature, pulse and respiratory rate. Abdominal pain, gas in the GIT and other observations. 3. DETAILED EXAMINATION. Parvoviral test, blood test (haematology or complete blood test), stool test. There may be a case for veterinary negligence if the parvoviral test has not been done. 4. TREATMENT. According to symptoms. IV, SC or oral fluid therapy depending on situation. Antispasmodic, antibiotics, multivitamins, protein drip, Vit K1 when necessary. Times and amounts given will be recorded. The vet in charge of the case is responsible for details of time, amount and other information will be recorded in the hospitalisation sheet. 5. COMMUNICATIONS WITH THE OWNER IN WRITING. A veterinary report explaining the significance of the tests and case must be given to the owner on discharge/death of the puppy. It is best to keep the owner informed daily of the health of the puppy. Such phone calls must be recorded in the medical case files. |
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6. RECORD AMA
(Against Medical Advice) the
owner's rejection of advices
of the test in your medical
record. Failure to do so
implies that the vet has not
advised at all in cases of
litigation/complaint. As
Singapore is becoming a
litigious society, I advise
that the highest standard of
care to be given at all
times. An example of a case
done by me is down shown in
the images. TOA PAYOH VETS WEBPAGE: http://www.sinpets.com/dogs/20111036puppy-blood-in-stools-diarrhoea-vomiting-singapore-toapayohvets.htm |
Monday, June 25, 2012
1053. SOP: A dog with closed pyometra
A FEMALE DOG WITH CLOSED PYOMETRA - STANDARD OPERATING PROCEDURES (SOP) AT TOA PAYOH VETS
1051. Sunday Jun 25 12's interesting cases
Sunday Jun 25, 12 was a bright sunny morning. It was my nephew's wedding and it was the day my car's malfunction (battery warning sign) meant I had no car.
INTERESTING CASES
1. Rabbit with backside licking.
New client. The Hongkong mum and two pre-teen daughters living in Singapore wanted to consult Dr Vanessa.
I was at the counter service making sure that all clients get served within 5 minutes of waiting as there was a complaint of having to wait over an hour for one of my vets by a guinea pig owner whose guinea pig has eye ulcer in one eye and now had another eye ulcer.
Referrals from a pet shop as the owner of the rabbit had been twice to Vet 1 near her place but could not get resolved. Referrals are important but resolving the problem of the rabbit is more important. "Otherwise the owner will have to go to the 4th vet," I said to my vet. It is as simple as that. I would monitor this case.
2. Emaciate Bischon has no more hard "durian seed" in the abdomen compared to 2 days ago. The owner did not want any blood test and X-ray. I showed her how to feel the durian seed as the dog was skin and bones. She said she had paid $2000 at another vet for her dog treatment and would not want any test. I gave the IV drip for past 2 days. Today, I palpated the abdomen and there was no more hard mass. The dog had passed hard greenish stools thick as the biggest German sausage. Will be sent home on Monday.
3. Eye ulcers are emergencies
One home-maker with a small daughter noticed that her Shih Tzu's eye was tearing and half-closed. She phoned her husband to abort his golf tournament. I handled the case and use the fluorescein eye stain test. The ulcer is obvious and my vets don't feel it necessary to do the test. I have to get them to change their mindset and adopt a SOP or treatment protocol.
"Eye stain of a bright green means a recent ulcer," I told my vets. "The other parts of the cornea with no obvious ulceration will show a lighter green as in this case." I showed the image to my vets. It is hard to change mindsets as most vets don't feel the need to demonstrate the presence of corneal ulcers. After all, it is obvious as the eye is itchy, watery and inflamed. This type of thinking is not based on evidence-based medicine. The picture of this case showed a deep central ulcer with other keratitis from central area upwards. Could this be due to the baby daughter pulling the dog's tail or scratching the dog's eye? She was with the grandma. "Nobody knows how the injury is caused," I said. "It is best not to upset the caregiver. As the eye injury is within 24 hours and the cornea is not perforated, chances of healing with tarsorrhaphy are good."
4. Syrian hamster with scabs and crusts on face and spinal area. Probably scabies but hard to find the mites on microscopic exam. Given ivomec inj. Warded 4 days to get the scabs peeled out, otherwise, they irritate the hamster (84 g, lost weight for Syrian). Mother and Primary 6 daughter came to bring the hamster home today. She is very current on newspapers as I mentioned that females are very good at studies and work if they are motivated. "Like the two IT ladies mentioned in the Straits Times corruption cases. They can close deals but the way it was done was not the way." She knew what I was talking about but not her mum. She said: "Mum does not know." The hamster's skin needed to be treated properly at home and I would see it in 2 weeks' time.
5. Instant diagnosis. "A malar abscess" I told Dr Daniel when a Golden Retriever came in with a swelling below the eye.
"He needs an X-ray to see whether there is any tooth root fracture," Dr Daniel said.
"For economic reasons, the X-rays and blood tests are not wanted," I replied. So, we would give the IV drip and antibiotics and operate the next day.
6. "Dead dog smell" Shih Tzu looks better and scratches its lower body much less. I smelled the body as it is the only way to confirm the owner's complaint "dead dog decomposed smell." Dry eyes. Under treatment. Bathed.
7. American cocker paw maggot wound finally closing. >30 maggots. "The exposed toe nail needs to be cut off," I said to the owner and Dr Daniel. Otherwise, it is irritating and painful."
8. The Beagle with the bladder cancer came in for dental work and ear irrigation under anaesthesia. He was quite active but I noted he has difficulty peeing in the morning when let out today (Monday 10 am). He would lift his leg against the tree trunk and not a drop of urine passed out. He had peed in his crate overnight though. Needs his anti-fits medication or his body will tremble.
9. Young Schnauzer still has nasal discharge and sneezing (cold?). Vet 1 was consulted and recommended "saline into the nose." This is unconventional treatment and so I don't know why. Conventional treatment by Dr Daniel. I phoned on Monday 11 am and the lady said the dog was not sneezing. Each vet has his or her way of treatment but in the end, the good clinical outcome counts. This is the reality of life.
INTERESTING CASES
1. Rabbit with backside licking.
New client. The Hongkong mum and two pre-teen daughters living in Singapore wanted to consult Dr Vanessa.
I was at the counter service making sure that all clients get served within 5 minutes of waiting as there was a complaint of having to wait over an hour for one of my vets by a guinea pig owner whose guinea pig has eye ulcer in one eye and now had another eye ulcer.
Referrals from a pet shop as the owner of the rabbit had been twice to Vet 1 near her place but could not get resolved. Referrals are important but resolving the problem of the rabbit is more important. "Otherwise the owner will have to go to the 4th vet," I said to my vet. It is as simple as that. I would monitor this case.
2. Emaciate Bischon has no more hard "durian seed" in the abdomen compared to 2 days ago. The owner did not want any blood test and X-ray. I showed her how to feel the durian seed as the dog was skin and bones. She said she had paid $2000 at another vet for her dog treatment and would not want any test. I gave the IV drip for past 2 days. Today, I palpated the abdomen and there was no more hard mass. The dog had passed hard greenish stools thick as the biggest German sausage. Will be sent home on Monday.
3. Eye ulcers are emergencies
One home-maker with a small daughter noticed that her Shih Tzu's eye was tearing and half-closed. She phoned her husband to abort his golf tournament. I handled the case and use the fluorescein eye stain test. The ulcer is obvious and my vets don't feel it necessary to do the test. I have to get them to change their mindset and adopt a SOP or treatment protocol.
"Eye stain of a bright green means a recent ulcer," I told my vets. "The other parts of the cornea with no obvious ulceration will show a lighter green as in this case." I showed the image to my vets. It is hard to change mindsets as most vets don't feel the need to demonstrate the presence of corneal ulcers. After all, it is obvious as the eye is itchy, watery and inflamed. This type of thinking is not based on evidence-based medicine. The picture of this case showed a deep central ulcer with other keratitis from central area upwards. Could this be due to the baby daughter pulling the dog's tail or scratching the dog's eye? She was with the grandma. "Nobody knows how the injury is caused," I said. "It is best not to upset the caregiver. As the eye injury is within 24 hours and the cornea is not perforated, chances of healing with tarsorrhaphy are good."
4. Syrian hamster with scabs and crusts on face and spinal area. Probably scabies but hard to find the mites on microscopic exam. Given ivomec inj. Warded 4 days to get the scabs peeled out, otherwise, they irritate the hamster (84 g, lost weight for Syrian). Mother and Primary 6 daughter came to bring the hamster home today. She is very current on newspapers as I mentioned that females are very good at studies and work if they are motivated. "Like the two IT ladies mentioned in the Straits Times corruption cases. They can close deals but the way it was done was not the way." She knew what I was talking about but not her mum. She said: "Mum does not know." The hamster's skin needed to be treated properly at home and I would see it in 2 weeks' time.
5. Instant diagnosis. "A malar abscess" I told Dr Daniel when a Golden Retriever came in with a swelling below the eye.
"He needs an X-ray to see whether there is any tooth root fracture," Dr Daniel said.
"For economic reasons, the X-rays and blood tests are not wanted," I replied. So, we would give the IV drip and antibiotics and operate the next day.
6. "Dead dog smell" Shih Tzu looks better and scratches its lower body much less. I smelled the body as it is the only way to confirm the owner's complaint "dead dog decomposed smell." Dry eyes. Under treatment. Bathed.
7. American cocker paw maggot wound finally closing. >30 maggots. "The exposed toe nail needs to be cut off," I said to the owner and Dr Daniel. Otherwise, it is irritating and painful."
8. The Beagle with the bladder cancer came in for dental work and ear irrigation under anaesthesia. He was quite active but I noted he has difficulty peeing in the morning when let out today (Monday 10 am). He would lift his leg against the tree trunk and not a drop of urine passed out. He had peed in his crate overnight though. Needs his anti-fits medication or his body will tremble.
9. Young Schnauzer still has nasal discharge and sneezing (cold?). Vet 1 was consulted and recommended "saline into the nose." This is unconventional treatment and so I don't know why. Conventional treatment by Dr Daniel. I phoned on Monday 11 am and the lady said the dog was not sneezing. Each vet has his or her way of treatment but in the end, the good clinical outcome counts. This is the reality of life.
Sunday, June 24, 2012
1051. Urethral catherisation in the female dog
I manage to find my article written in 2011.
http://www.sinpets.com/dogs/201006260catheterisation-female-urethra-dog-Singapore-ToaPayohVets.htm
In male dogs, every vet knows where to insert the urethral catheter, but in the female dog, it is very common to incorrectly insert the catheter in the clitoral fossa if the vet does not know the anatomy of the female urinary system! So, I am attaching an illustration for reference.
An X-ray of a Miniature Schnauzer that has urethral catherisation. Digital palpation and insertion of a soft catheter was done by Vet 1 as I had referred the owner to her. I was in Hong Kong at that time and the dog had difficulty peeing after passing out some stones. Did the dog owner agree to Vet 1 removing the urinary stones? No.
"Why?" I asked Vet 1 later when I returned to Singapore. She was willing to spay and remove the urinary stones at one surgery whereas I did not want to do two-in-one as I don't increase my anaesthetic and surgical risk by doing a prolonged surgical procedure.
She did not know the reason. "Is it the cost?" I asked her.
"No," she said. "The owners were agreeable to do the two surgeries when they consulted me."
First X-ray shows numerous stones. Advice to remove the bladder stones not taken up as the owners wanted a spay to be included at one surgery, i.e. 2-in-one operation.
Subsequently, second X-ray with urethral catherisation. I checked out this X-ray 24 hours before the spay
PHOTOS ARE IN TOA PAYOH VETS' WEBSITE
Vet 1's boss tries to send image to me via his Blackberry phone.
Owner shows me the 5 stones peed out
Spayed by me
"How much did you quote?"
"The usual rates," she would not give me the actual figure. A fuzzy reply.
"Did you do it immediately?" I asked.
"No, it was a Saturday and the cost would be much higher. I hospitalised the cat. They took back the cat on Sunday."
"Did you follow up?" I asked.
"Yes, but there was nobody answering the phone." This is a good vet as many vets don't do follow up.
"I am sure it is the cost," I said.
"No," she replied. "They had agreed to the surgery."
Other than cost, what could it be? Preference for a veteran?
Later the husband came to me to get the dog spayed. The husband would not give me the reason as to why they did not accept the combined surgery as that was what they wanted. A fuzzy reply saying that the dog could pee after the catherisation. Besides the dog could pass out the 5 stones. So, they did not want to operate. The husband asked: "Vet 1 says the bladder will rupture if I don't remove the bladder stones as they will increase in size. Is it correct?"
"The bladder will rupture if the urine can't flow out for a long time," I said. "The stones will irritate the bladder causing bleeding. As to whether the stones will rupture the bladder by themselves, I don't think they will as they are not sharp." It is a difference of opinion. Some vets will not agree with me.
The dog still has the 3 stones and apparently had no blood in the urine. I did not advise further as this would be like high-pressure selling. The husband had associated feeding 2 cans of S/D diet with the passing out of 5 stones (see image) and got another 6 cans. I had advised 1-3 months feeding of S/D diet for struvite stone dissolution but that means more than 6 cans!
Knowing the reasons of the client is important to improve the standard of care and service. If the vet does not bother to ask, the answers will never be known and the standard of care cannot be improved.
UPDATE: As at Jun 25, 2012, no complaints of blood in the urine. I have not phoned yet as it seems to be "pestering" if the owner has decided not to operate. The spay op was OK otherwise I would have heard from the owner. Since the stitches were dissolvable, I did not see the dog post-op to remove the stitches.
The first report of this case is at:
http://www.sinpets.com/dogs/20120246bladder-stone-spay-packaged-deal-singapore_ToaPayohVets.htm
http://www.sinpets.com/dogs/201006260catheterisation-female-urethra-dog-Singapore-ToaPayohVets.htm
In male dogs, every vet knows where to insert the urethral catheter, but in the female dog, it is very common to incorrectly insert the catheter in the clitoral fossa if the vet does not know the anatomy of the female urinary system! So, I am attaching an illustration for reference.
An X-ray of a Miniature Schnauzer that has urethral catherisation. Digital palpation and insertion of a soft catheter was done by Vet 1 as I had referred the owner to her. I was in Hong Kong at that time and the dog had difficulty peeing after passing out some stones. Did the dog owner agree to Vet 1 removing the urinary stones? No.
"Why?" I asked Vet 1 later when I returned to Singapore. She was willing to spay and remove the urinary stones at one surgery whereas I did not want to do two-in-one as I don't increase my anaesthetic and surgical risk by doing a prolonged surgical procedure.
She did not know the reason. "Is it the cost?" I asked her.
"No," she said. "The owners were agreeable to do the two surgeries when they consulted me."
First X-ray shows numerous stones. Advice to remove the bladder stones not taken up as the owners wanted a spay to be included at one surgery, i.e. 2-in-one operation.
Subsequently, second X-ray with urethral catherisation. I checked out this X-ray 24 hours before the spay
PHOTOS ARE IN TOA PAYOH VETS' WEBSITE
Vet 1's boss tries to send image to me via his Blackberry phone.
Owner shows me the 5 stones peed out
Spayed by me
"How much did you quote?"
"The usual rates," she would not give me the actual figure. A fuzzy reply.
"Did you do it immediately?" I asked.
"No, it was a Saturday and the cost would be much higher. I hospitalised the cat. They took back the cat on Sunday."
"Did you follow up?" I asked.
"Yes, but there was nobody answering the phone." This is a good vet as many vets don't do follow up.
"I am sure it is the cost," I said.
"No," she replied. "They had agreed to the surgery."
Other than cost, what could it be? Preference for a veteran?
Later the husband came to me to get the dog spayed. The husband would not give me the reason as to why they did not accept the combined surgery as that was what they wanted. A fuzzy reply saying that the dog could pee after the catherisation. Besides the dog could pass out the 5 stones. So, they did not want to operate. The husband asked: "Vet 1 says the bladder will rupture if I don't remove the bladder stones as they will increase in size. Is it correct?"
"The bladder will rupture if the urine can't flow out for a long time," I said. "The stones will irritate the bladder causing bleeding. As to whether the stones will rupture the bladder by themselves, I don't think they will as they are not sharp." It is a difference of opinion. Some vets will not agree with me.
The dog still has the 3 stones and apparently had no blood in the urine. I did not advise further as this would be like high-pressure selling. The husband had associated feeding 2 cans of S/D diet with the passing out of 5 stones (see image) and got another 6 cans. I had advised 1-3 months feeding of S/D diet for struvite stone dissolution but that means more than 6 cans!
Knowing the reasons of the client is important to improve the standard of care and service. If the vet does not bother to ask, the answers will never be known and the standard of care cannot be improved.
UPDATE: As at Jun 25, 2012, no complaints of blood in the urine. I have not phoned yet as it seems to be "pestering" if the owner has decided not to operate. The spay op was OK otherwise I would have heard from the owner. Since the stitches were dissolvable, I did not see the dog post-op to remove the stitches.
The first report of this case is at:
http://www.sinpets.com/dogs/20120246bladder-stone-spay-packaged-deal-singapore_ToaPayohVets.htm
Cat with rectal prolapse
I presume you are a veterinary foundation. You can use the image in its original form with "toapayohvets.com" in it. Best wishes.
On Sat, Jun 23, 2012 at 9:45 AM, Hannah Liebermanwrote:
Wow, thank you for getting back to me so quickly. That's exactly the one I want. It's very clear.
If we wind up using it, I will absolutely give you credit as requested. I will also send you the link to the finished product.
Oh jeez - I just re-read what I had written. I'm sorry. What I meant to say was that we don't treat rectal prolapses. Because we get so many requests, and because the general public doesn't typically understand what is happening with their pets, I am making lists of what we do and what we don't do, and trying to provide photographic examples for everything on both lists. The rectal prolapse is something that falls under surgeries we don't do. (Sadly.) I hope that doesn't change the status of your permission.
I'm attaching the requested image. Thank you again.
Sincerely,
Hannah Lieberman
Mobile Clinic Director
The Sam Simon Foundation
On Sat, Jun 23, 2012 at 9:45 AM, Hannah Lieberman
Wow, thank you for getting back to me so quickly. That's exactly the one I want. It's very clear.
If we wind up using it, I will absolutely give you credit as requested. I will also send you the link to the finished product.
Oh jeez - I just re-read what I had written. I'm sorry. What I meant to say was that we don't treat rectal prolapses. Because we get so many requests, and because the general public doesn't typically understand what is happening with their pets, I am making lists of what we do and what we don't do, and trying to provide photographic examples for everything on both lists. The rectal prolapse is something that falls under surgeries we don't do. (Sadly.) I hope that doesn't change the status of your permission.
I'm attaching the requested image. Thank you again.
Sincerely,
Hannah Lieberman
Mobile Clinic Director
The Sam Simon Foundation
Use your tools of the trade - opthalmoscope
Yesterday, Friday, Jun 22, 12, I allocated cases to Dr V and Dr D so that waiting times don't drag on as most Singaporean pet owners hate to wait at the Surgery. This is a common trait and many vets and doctors at Clinics don't realise that trait. So, I install this system.
The new client went to Dr V.
"I just want a second opinion," the lady in her 40s said to me. "My vet (many years of experience and consulted by this owner for around past 20 years) said my dog's blindness is due to brain problem and not cataracts. He said there is no cure. MRI may detect where the problem occurs in the brain."
I went into the consultation room to particpate. After fluorescein stain showed negative corneal ulcers. The dog banged his head when he walked and so there was blindness in both eyes.
WHAT TO DO?
"Did your vet do an eye check with this opthalmoscope?" I asked the lady who came with her brother-in-law whom I mistook for her husband.
"No," she said. I guess her regular vet finds that it is not necessary to use the opthalmoscope or there are other reasons as each vet approaches a consultation differently from others.
NOTES: This may be a case of SARD
Sudden acquired retinal degeneration (SARD)
Bilateral. Middle aged. Older dogs females predisposed. All breeds affected.
Complete blindness
Cause unknown
No treatment
Bilateral absence of the menace and dazzle response
Resting mydriasis
Retina degeneration
Hyper-reflectivity of tapetum
Vascular attenuation
Differential diagnosis: Central (neurologic) blindness or peptic neuritis
Test: Electroretinogram
This case is a female Maltese, 8 years old, completely blind. Will wait for blood test report. From the opthalmoscopy, I saw in both eyes, the lower half of the fundus being very shiny reddish brown (hyper-reflectivity) like semi-circles. The upper half is greyish white with bigger blood vessels (Vascular attenuation) seen. The optic disc appears swollen (oedematous) - optic neuritis?
The new client went to Dr V.
"I just want a second opinion," the lady in her 40s said to me. "My vet (many years of experience and consulted by this owner for around past 20 years) said my dog's blindness is due to brain problem and not cataracts. He said there is no cure. MRI may detect where the problem occurs in the brain."
I went into the consultation room to particpate. After fluorescein stain showed negative corneal ulcers. The dog banged his head when he walked and so there was blindness in both eyes.
WHAT TO DO?
"Did your vet do an eye check with this opthalmoscope?" I asked the lady who came with her brother-in-law whom I mistook for her husband.
"No," she said. I guess her regular vet finds that it is not necessary to use the opthalmoscope or there are other reasons as each vet approaches a consultation differently from others.
NOTES: This may be a case of SARD
Sudden acquired retinal degeneration (SARD)
Bilateral. Middle aged. Older dogs females predisposed. All breeds affected.
Complete blindness
Cause unknown
No treatment
Bilateral absence of the menace and dazzle response
Resting mydriasis
Retina degeneration
Hyper-reflectivity of tapetum
Vascular attenuation
Differential diagnosis: Central (neurologic) blindness or peptic neuritis
Test: Electroretinogram
This case is a female Maltese, 8 years old, completely blind. Will wait for blood test report. From the opthalmoscopy, I saw in both eyes, the lower half of the fundus being very shiny reddish brown (hyper-reflectivity) like semi-circles. The upper half is greyish white with bigger blood vessels (Vascular attenuation) seen. The optic disc appears swollen (oedematous) - optic neuritis?
Follow up: Rabbit with large cheek abscess
E-MAIL TO DR SING DATED Jun 19, 2012
Dear Dr Sing,
here are the photos of Huihui and Ban Ban's most recent photos. No 18 is to let you see how they are housed currently, normally no partition only cos Huihui needs to be separated from Banban currently.
Thanks a lot for helping explain many things to us also and all the advice and recommendations.
Just to inform you that Huihui has started eating the pellets slowly and had drank at least 10mls of apple juice.
E-MAIL TO DR SING DATED Jun 24, 2012
I want to ask when should I stop pumping in the chlorohexidine wash into his face as the hole actually closes up every morning and evening and I have to poke through the sealed hole each time I wash..... The swelling has gone down considerably but the area around the hole is quite hard so I am not sure if there's anything wrong. I am not sure if there is still any pus inside although I thought I see some whitish stuff inside. His appetite has gone back to normal and his speed of eating has returned to normal. He also started to lick me after each treatment, which I considered as a good sign as he hasn't did that since the swelling started. He has also regained his energy, running and jumping up and down his toilet, standing up frequently to beg for treats/pats. So can you please advise me if I should continued poking through the hole to wash or just leave the hole to closed up?
Sorry for the long letter but I thought I should let you know how he is doing
E-MAIL FROM DR SING DATED Jun 24, 2012
I am glad to see one of your two rabbits after over 5 years. I am still checking my website the original picture taken when I neuter and spay your two rabbits.
You have written an excellent post-op nursing report. Good detailed report from the owner is very rare and is useful as a follow-up on the operation (lancing of the abscess done by Dr Vanessa before the X-ray as advised by me).
You need to flush out as much pus from deep inside the abscess and therefore continue irrigation till you don't see any "white" pus inside the cavity.
1. From the X-rays, the abscess from the elongated impacted molar is very deep and molar tooth extraction should be the solution to prevent recurrence of the abscess. However, this procedure is not so easy in a rabbit compared to the dog and cat.
2. The rabbit needs to be checked for molar spurs every 4 weekly. Trimming of the spurs to the gum line may be necessary in malocclusion.
3. Make an appointment next Sunday morning July 1, 2012 to check on the molars and the abscess. I am in the midst of writing a case report of your rabbit X-ray. It takes lots of time to do it. Best wishes.
Saturday, June 23, 2012
1047. Permission to use image of cat with rectal prolapse
On Sat, Jun 23, 2012 at 5:52 AM, Hannah Lieberman wrote:
Hi there,
I run a non-profit foundation mobile veterinary clinic that we take to low-income neighborhoods in Los Angeles, CA three days a week to perform veterinary surgeries on pets belonging to low-income residents. All services are completely free.
I am currently building a new website, and including photos of ailments that we're able to treat in our clinic. Since we treat rectal prolapses, I'd like to include a picture of one.
I really like the picture of the cat with the rectal prolapse you have your website, and would like to include it on ours. May we get permission to do that, please?
E-MAIL REPLY FROM DR SING DATED JUN 23, 2012
I am Dr Sing from Toa Payoh Vets. Which picture hyperlink is that? Please let me know.
You can use the picture of the cat with rectal prolapse if you use it without deleting "toapayohvets.com" acknowledgement. Good luck.
Hi there,
I run a non-profit foundation mobile veterinary clinic that we take to low-income neighborhoods in Los Angeles, CA three days a week to perform veterinary surgeries on pets belonging to low-income residents. All services are completely free.
I am currently building a new website, and including photos of ailments that we're able to treat in our clinic. Since we treat rectal prolapses, I'd like to include a picture of one.
I really like the picture of the cat with the rectal prolapse you have your website, and would like to include it on ours. May we get permission to do that, please?
E-MAIL REPLY FROM DR SING DATED JUN 23, 2012
I am Dr Sing from Toa Payoh Vets. Which picture hyperlink is that? Please let me know.
You can use the picture of the cat with rectal prolapse if you use it without deleting "toapayohvets.com" acknowledgement. Good luck.
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