Sunday Jul 1, 2012
Blue skies, white clouds. I came to the Surgery at 8am and took some pictures of the yellow flowers and lime against the bright morning sun. My air-conditioning lady neighbour had planted them on the flower lots separating the car parking lots and cared for them well. I managed to take a picture of a butterfly and a solitary busy bee. There was a small bird with a yellow neck seen for a short while. Taking flower images with a working Sunday bee in bright morning sun make them look better.
MEDICAL NEGLIGENCE - FAILURE TO EXAMINE THE BABY'S EYES
Earlier, I read a Straits Time report about a 52-year-old paedectrician having to settle with a parent whose 12-year-old child's eyes (one blind and one in poor visual health) were not examined by him 12 years ago.
I always emphasized to Drs Vanessa and Daniel that certain procedures must be done and recorded. If the pet owner does not want the procedures, this must be written on the case file. Failing to perform certain procedures will lead to "medical negligence" litigation. They are to write "AMA" - procedures informed but not wanted to be done.
As each vet or doctor has his or her own sensibility and responsibility, it is up to the licensee to ensure that best practices are followed. For example, in a haematuria case, urine analysis is mandatory. No excuses. If the dog dies subsequently, a failure to get the urine analysed opens the vet to medical negligence litigation. As simple as that. It takes a lot of patience to ensure that the clinic is well managed so as to minimise litigation.
Sunday, July 1, 2012
Thursday, June 28, 2012
1057. How to succeed in the wedding photography business
Jun 28, 2012
National Library Board
Professional Photographer www.professionalphotographer.co.uk Feb 2012
THE BUSINESS - New Series - "What recession..." Kevin Mullins Pg 73
His plan was to double the bookings year on year to a comfortable level.
In his first professional year in 2009, he shot 15 weddings. In 2010, 33 and in 2011 doubled again to 58 weddings. In 2009, the standard wedding rate was 800 pounds. In 2011, over 2000 pounds. Success affected his personal and social life.
Success factors:
1. USE STATISTICS TO YOUR ADVANTAGE
Every enquiry made in a preadsheet and keep track of enquiries even for dates he is not available.
Can see whether the referral came from (website, oral etc), the venue, date of wedding and importantly the date of enquiry.
*From statistics, he checked his business practices e.g. venues, busiest periods for enquiries is in Jan and Feb. 2nd spike inend of summer. Plan for 2011.
*statistics gave him a profit per hour per wedding. assess whether worth sacrificing 6 days a week and lot of his social and personal life.
*do not really want to increase his fees a lot. Decided to spend less time to make the same amount of money per wedding.
Three moves that changed his business for the better:
1. Move to a time-based fee
2. No more pre-wedding shots (taking up lots of evenings and Sundays) for wedding packages.
3. Reduce the amount of editing per wedding
2. TRIM YOUR SERVICES*His brand is a photojournalistic wedding photographic style, so it does not lend to pre-wedding shots (which is stationary, like taking pictures in Taiwan).
*if do pre-wedding shots, should charge for time spent in the package prices and do it at times suitable to his business and his family.
*reduce number of imagaes from 400to 200 to clients. So he saved many hours a week time in editing output
*got new tools in his workflow e.g. Photo Mechanic - another article.
3. CHARGE FOR OVERTIME WORK
*He noted that he rarely leave a wedding on time. He usually worked on a "bridal prep" to "first dance" basis. (Singapore does not usually have "first dance"). He found that in 2010 he spent 60 hours after the "first dance" unpaid.
*now he charges overtime (like caterers, DJ, drivers etc)
4. KNOW YOUR CAPACITY LIMIT
*58 weddings are too much to shoot and edit as he has no personal life. In 2012, he capped bookings at 30 in his diary.
5. USE FORUMS AND SUPPORT GROUPS FOR TRAINING
*The SWPP is great for mentoring, support and access to great photographers
*frequently use a photography forum called IPPN (www.ippn.co.uk) - very helpful.
*learning all the time as idustry is tough. He knows that he must be on top of the business side of things to be successful.
Conclusion. Keep track of your business through metrics and accounting (including workflow and marketing), a lot of hard work and beautiful photography, have a faithful and honest work ethic, business will grow.
www.kevinmullinsphotography.co.uk
www.twitter.com/kevin_mullins
The above factors apply to the business of veterinary practices too esp. using metrics and proper accounting, hard work and do beautiful surgery (good surgical outcomes, no infections).
Today, I read that a "bogus vet" in Singapore was to be fined $42,000 for doing stray cat sterilisations in her Bishan apartment. She was a veterinary nurse working for a veterinary clinic. The Cat Welfare Society alerted the clinic that they had received invoices with two different types of clinic stamps. She gave $5.00 commission to the transport man for every cat brought to her and was using the clinic's invoices.
National Library Board
Professional Photographer www.professionalphotographer.co.uk Feb 2012
THE BUSINESS - New Series - "What recession..." Kevin Mullins Pg 73
His plan was to double the bookings year on year to a comfortable level.
In his first professional year in 2009, he shot 15 weddings. In 2010, 33 and in 2011 doubled again to 58 weddings. In 2009, the standard wedding rate was 800 pounds. In 2011, over 2000 pounds. Success affected his personal and social life.
Success factors:
1. USE STATISTICS TO YOUR ADVANTAGE
Every enquiry made in a preadsheet and keep track of enquiries even for dates he is not available.
Can see whether the referral came from (website, oral etc), the venue, date of wedding and importantly the date of enquiry.
*From statistics, he checked his business practices e.g. venues, busiest periods for enquiries is in Jan and Feb. 2nd spike inend of summer. Plan for 2011.
*statistics gave him a profit per hour per wedding. assess whether worth sacrificing 6 days a week and lot of his social and personal life.
*do not really want to increase his fees a lot. Decided to spend less time to make the same amount of money per wedding.
Three moves that changed his business for the better:
1. Move to a time-based fee
2. No more pre-wedding shots (taking up lots of evenings and Sundays) for wedding packages.
3. Reduce the amount of editing per wedding
2. TRIM YOUR SERVICES*His brand is a photojournalistic wedding photographic style, so it does not lend to pre-wedding shots (which is stationary, like taking pictures in Taiwan).
*if do pre-wedding shots, should charge for time spent in the package prices and do it at times suitable to his business and his family.
*reduce number of imagaes from 400to 200 to clients. So he saved many hours a week time in editing output
*got new tools in his workflow e.g. Photo Mechanic - another article.
3. CHARGE FOR OVERTIME WORK
*He noted that he rarely leave a wedding on time. He usually worked on a "bridal prep" to "first dance" basis. (Singapore does not usually have "first dance"). He found that in 2010 he spent 60 hours after the "first dance" unpaid.
*now he charges overtime (like caterers, DJ, drivers etc)
4. KNOW YOUR CAPACITY LIMIT
*58 weddings are too much to shoot and edit as he has no personal life. In 2012, he capped bookings at 30 in his diary.
5. USE FORUMS AND SUPPORT GROUPS FOR TRAINING
*The SWPP is great for mentoring, support and access to great photographers
*frequently use a photography forum called IPPN (www.ippn.co.uk) - very helpful.
*learning all the time as idustry is tough. He knows that he must be on top of the business side of things to be successful.
Conclusion. Keep track of your business through metrics and accounting (including workflow and marketing), a lot of hard work and beautiful photography, have a faithful and honest work ethic, business will grow.
www.kevinmullinsphotography.co.uk
www.twitter.com/kevin_mullins
The above factors apply to the business of veterinary practices too esp. using metrics and proper accounting, hard work and do beautiful surgery (good surgical outcomes, no infections).
Today, I read that a "bogus vet" in Singapore was to be fined $42,000 for doing stray cat sterilisations in her Bishan apartment. She was a veterinary nurse working for a veterinary clinic. The Cat Welfare Society alerted the clinic that they had received invoices with two different types of clinic stamps. She gave $5.00 commission to the transport man for every cat brought to her and was using the clinic's invoices.
1056. KPI and follow-up: Open Pyometra chihuahua
On Jun 15, 2012, the breeder's Chihuahua that had been adopted by a couple was spayed after 24 hours of IV drip and antibiotics.
12 days later, the owner complained about some bloody discharge from the dog's vagina.
"Is she eating normally?" I asked. "Yes," he replied. "Some cases of pyometra do have small amounts of bloody discharge some days after operation," I prescribed him antibiotics.
Today, I review the June 14 blood test result. Total WCC 14.4 (6-17) was normal. N59%, L21%, M15%, E2%, B3%. Platelets wee lower at 175 (200-500). Platelet clumping noted. However, the dog is normal and the high monocytes (M) and low platelets did not adversely affect this dog.
USING STATISTICS TO LOOK AT MY BUSINESS PRACTICE - TIME SPENT/DOG SPAYED BY THE VET. IN THIS CASE, THE VET IS MYSELF.
HOW LONG IT TAKES TO SPAY AN OPEN PYOMETRA CHIHUAHUA?
Date of surgery: Jun 15, 2012
Vet: Dr Sing Kong Yuen
Procedures: Spay and dental scaling
Chihuahua, F, 9 years old, 2.2 kg, 37.2C.
No. of packets used: 2. Type: Polysorb absorbable 2/0 and 3/0
Dom + Ket at 25% 0.02 + 0.03 ml IV
1. A: IV inj Dom + Ket 10.07 am
2. B: Isoflurane gas first given 10.09am
3. C: Isoflurane gas Stopped: 10.51am (spay and then dental work)
4. D: First skin incision: 10.18 am
5. E: Skin stitched: 10.44 am
E-D = 26 minutesE-A = 37 minutesA small breed dog or cat spay should be completed (E-D) in less than 20 minutes and (E-A) should be less than 30 minutes. For pyometra as in the above dog, the time taken is longer as the womb is filled with pus and extra care and longer skin incision are needed during surgery.
Proper accounting must be done to ensure that the business can survive in this harsh economic environment.
12 days later, the owner complained about some bloody discharge from the dog's vagina.
"Is she eating normally?" I asked. "Yes," he replied. "Some cases of pyometra do have small amounts of bloody discharge some days after operation," I prescribed him antibiotics.
Today, I review the June 14 blood test result. Total WCC 14.4 (6-17) was normal. N59%, L21%, M15%, E2%, B3%. Platelets wee lower at 175 (200-500). Platelet clumping noted. However, the dog is normal and the high monocytes (M) and low platelets did not adversely affect this dog.
USING STATISTICS TO LOOK AT MY BUSINESS PRACTICE - TIME SPENT/DOG SPAYED BY THE VET. IN THIS CASE, THE VET IS MYSELF.
HOW LONG IT TAKES TO SPAY AN OPEN PYOMETRA CHIHUAHUA?
Date of surgery: Jun 15, 2012
Vet: Dr Sing Kong Yuen
Procedures: Spay and dental scaling
Chihuahua, F, 9 years old, 2.2 kg, 37.2C.
No. of packets used: 2. Type: Polysorb absorbable 2/0 and 3/0
Dom + Ket at 25% 0.02 + 0.03 ml IV
1. A: IV inj Dom + Ket 10.07 am
2. B: Isoflurane gas first given 10.09am
3. C: Isoflurane gas Stopped: 10.51am (spay and then dental work)
4. D: First skin incision: 10.18 am
5. E: Skin stitched: 10.44 am
E-D = 26 minutesE-A = 37 minutesA small breed dog or cat spay should be completed (E-D) in less than 20 minutes and (E-A) should be less than 30 minutes. For pyometra as in the above dog, the time taken is longer as the womb is filled with pus and extra care and longer skin incision are needed during surgery.
I am still doing a trust and audit check on my vets to make sure that the time spent/spay is not too long due to lack of planning and inefficiency or idle chatting. Employees love to chat and that is part of human nature. However, no chats should be done during surgery as there must be focus on the patient's life.
Proper accounting must be done to ensure that the business can survive in this harsh economic environment.
1055. Update on article: Be Kind & Brave - Adopt a Stray
PROMOTING THE ADOPTION OF STRAY CATS
My latest image "Be Kind & Brave" was inspired by a Singaporean couple who adopted a cat from the Cat Welfare Society. "Adopt a female cat," I advised since the 7-year-old male cat had signs of FLUTD and had passed away during treatment at a veterinary practice, causing much distress and sadness to the wife.
Compared to my older image in 2003, I have improved my photographic skills and have got a better lens! Both cats were photographed outside the Toa Payoh Vets with the wall as the background. I prefer the 2003 image as it seems more dynamic.
It is quite difficult to think of captions. Both cats were sterilised by me. The male cat in 2003 was brought in by a cat activist to be neutered and left ear tip snipped. After that, he was put back to the streets. Over the years, pest control firms appeared to net the stray cats and so in 2012, you seldom see stray cats at eating places in the wet market.
However the other "Be Kind & Brave" cat in 2012 has a very good home and is well loved. There was no need to snip her left ear tip unlike community cats without homes. Her spay operation is shown below. She is OK and back to normal now.
I hope that in the next 3 years, Singapore will permit cats to be housed in the HDB apartments so that they need not be "illegal" in public housing.
A pretty stray cat from the Cat Welfare Society was adopted and came to Toa Payoh Vets for general examination and later on, vaccinations.
She grows up fast. She caterwauls and is the loud screams disturb the neighbours. I spayed her around the 10th day from the onset of caterwauling.
Her owner wanted a complete blood test and FIV screening to check her health status. Blood test shows low platelet count which was worrisome. FIV test was negative. As at Jun 28, 2012, the cat is in excellent health and is very active, being much loved by a Singaporean couple.
TIPS TO EXCEL IN VETERINARY MEDICINE AND SURGERY
Young vets are advised to learn the skills of digital photography such that they can produce excellent veterinary images. By illustrating reports of cases seen with attractive pictures, the vet improves his or her veterinary knowledge and diagnosis.
There are many distractions in Singapore such as the many online shows and TV programs to watch. If young vets want to be great vets, they need to sacrifice their spare time to do practical research and write up case studies. In doing this, the vet reflects on his or her handling of the case and gets better at treatment of similar cases. Good clinical and surgical outcomes are produced and the vet builds up a good reputation over the years as referrals from happy clients come from distant parts of Singapore. They come not because the vet is "cheap", but because he or she can resolve the owner's pet problems fast.
IMAGES ARE AT:
http://www.toapayohvets.com/sinpets/20120615digital_photography_stray_cat_adoption_singapore-ToaPayohVets.htm
My latest image "Be Kind & Brave" was inspired by a Singaporean couple who adopted a cat from the Cat Welfare Society. "Adopt a female cat," I advised since the 7-year-old male cat had signs of FLUTD and had passed away during treatment at a veterinary practice, causing much distress and sadness to the wife.
Compared to my older image in 2003, I have improved my photographic skills and have got a better lens! Both cats were photographed outside the Toa Payoh Vets with the wall as the background. I prefer the 2003 image as it seems more dynamic.
It is quite difficult to think of captions. Both cats were sterilised by me. The male cat in 2003 was brought in by a cat activist to be neutered and left ear tip snipped. After that, he was put back to the streets. Over the years, pest control firms appeared to net the stray cats and so in 2012, you seldom see stray cats at eating places in the wet market.
However the other "Be Kind & Brave" cat in 2012 has a very good home and is well loved. There was no need to snip her left ear tip unlike community cats without homes. Her spay operation is shown below. She is OK and back to normal now.
I hope that in the next 3 years, Singapore will permit cats to be housed in the HDB apartments so that they need not be "illegal" in public housing.
A pretty stray cat from the Cat Welfare Society was adopted and came to Toa Payoh Vets for general examination and later on, vaccinations.
She grows up fast. She caterwauls and is the loud screams disturb the neighbours. I spayed her around the 10th day from the onset of caterwauling.
Her owner wanted a complete blood test and FIV screening to check her health status. Blood test shows low platelet count which was worrisome. FIV test was negative. As at Jun 28, 2012, the cat is in excellent health and is very active, being much loved by a Singaporean couple.
TIPS TO EXCEL IN VETERINARY MEDICINE AND SURGERY
Young vets are advised to learn the skills of digital photography such that they can produce excellent veterinary images. By illustrating reports of cases seen with attractive pictures, the vet improves his or her veterinary knowledge and diagnosis.
There are many distractions in Singapore such as the many online shows and TV programs to watch. If young vets want to be great vets, they need to sacrifice their spare time to do practical research and write up case studies. In doing this, the vet reflects on his or her handling of the case and gets better at treatment of similar cases. Good clinical and surgical outcomes are produced and the vet builds up a good reputation over the years as referrals from happy clients come from distant parts of Singapore. They come not because the vet is "cheap", but because he or she can resolve the owner's pet problems fast.
IMAGES ARE AT:
http://www.toapayohvets.com/sinpets/20120615digital_photography_stray_cat_adoption_singapore-ToaPayohVets.htm
Wednesday, June 27, 2012
1054. Adopted stray cat with low platelet count
TOA PAYOH VETS ARTICLE AT:
http://www.toapayohvets.com/sinpets/20120615digital_photography_stray_cat_adoption_singapore-ToaPayohVets.htm
The owners wanted a complete blood test of the adopted cat that was to be spayed on the same day. She was caterwauling 11 days ago. There was a weight loss and I was told she was fed a Barf diet. I advised against spay surgery to be on the safe side. The wife wanted it. The ovarian vessels were much congested due to the heat period and needed extra care in ligation.
The cat took around 2 days to recover but this is the normal situation after spay. Now the cat is very active as I read from the email below.
BLOOD TEST
Jun 8, 12
TP 41855
Cat Welfare Society Adopted cat around 1 year old, female.
Significant findings blood test (jugular vein)
Total WCC 5.3 (5.5-19.5)
N 63%, L28%, M 4%, E6%, B0.1%
Plateltes 38 (300-800)
No platelet clumps seen. Large platelets present.
As to why the platelets are low, it is hard to know the cause. Clinically, the cat was active and the surgical outcome is excellent as the cat has no complications (bleeding and infection) after spay and is active. So, this low platelet count is one of the mysteries of veterinary medicine.
UPDATE JUN 27, 12. However, the cat is OK. One dangling stitch is still present 19 DAYS after spay on Jun 8, 12. But the is not bothered. I advised they will dissolve in 2-4 weeks' time, so no need to come to me for stitch removal. I use polysorb absorbable sutures 3/0 and did 2 horizontal mattress sutures. As the cat would not permit a focused image to be emailed to me, I don't know whether it is the stitch or not. In any case, all dissolvable stitches in the skin drop off from 14-28 days after surgery.
I am keeping the emails for reference and will reply if I have more info.
E-MAIL TO DR SING DATED JUN 27, 2012
Dear Dr Sing
Thank you for the care and advice concerning Sofi. As spoken yesterday, she has healed and recovered exceptionally well. The stiches are still visible though she shows no discomfort and does not lick the site at all. Please find the links below for 1) Barf and 2) Wellness
1) BARF - http://barfsingapore.com.sg/
This appears to be a well balanced and species approraite diet for cats though we are a little concerned about the possibility of contamination and exposure given the transportation process from Australia to Singapore. Going back to Sofi's blood test which indicated low platelets, we also wonder whether it could possibly be toxoplasmosis from eating the raw food, this is just speculation of course, the low platelet count could be due to a variety of reasons. Since the operation, we have stopped feeding her BARF completely.
2) WELLNESS - http://www.wellnesspetfood.com/recipes.aspx?pet=cat&ft=2
We are currently feeding her the canned chicken version. She consumes a can in about one and a half days with a little water added in every meal. In addition to the canned food, she also receives about a spoonful of Wellness Core kibbles daily. This is more to add variety and give her something to chew on.
We would be happy eto hear your thoughts on the pet food and anything else you have to say.
Best Regards
TOA PAYOH VETS ARTICLE AT:
http://www.toapayohvets.com/sinpets/20120615digital_photography_stray_cat_adoption_singapore-ToaPayohVets.htm
http://www.toapayohvets.com/sinpets/20120615digital_photography_stray_cat_adoption_singapore-ToaPayohVets.htm
The owners wanted a complete blood test of the adopted cat that was to be spayed on the same day. She was caterwauling 11 days ago. There was a weight loss and I was told she was fed a Barf diet. I advised against spay surgery to be on the safe side. The wife wanted it. The ovarian vessels were much congested due to the heat period and needed extra care in ligation.
The cat took around 2 days to recover but this is the normal situation after spay. Now the cat is very active as I read from the email below.
BLOOD TEST
Jun 8, 12
TP 41855
Cat Welfare Society Adopted cat around 1 year old, female.
Significant findings blood test (jugular vein)
Total WCC 5.3 (5.5-19.5)
N 63%, L28%, M 4%, E6%, B0.1%
Plateltes 38 (300-800)
No platelet clumps seen. Large platelets present.
As to why the platelets are low, it is hard to know the cause. Clinically, the cat was active and the surgical outcome is excellent as the cat has no complications (bleeding and infection) after spay and is active. So, this low platelet count is one of the mysteries of veterinary medicine.
UPDATE JUN 27, 12. However, the cat is OK. One dangling stitch is still present 19 DAYS after spay on Jun 8, 12. But the is not bothered. I advised they will dissolve in 2-4 weeks' time, so no need to come to me for stitch removal. I use polysorb absorbable sutures 3/0 and did 2 horizontal mattress sutures. As the cat would not permit a focused image to be emailed to me, I don't know whether it is the stitch or not. In any case, all dissolvable stitches in the skin drop off from 14-28 days after surgery.
I am keeping the emails for reference and will reply if I have more info.
E-MAIL TO DR SING DATED JUN 27, 2012
Dear Dr Sing
Thank you for the care and advice concerning Sofi. As spoken yesterday, she has healed and recovered exceptionally well. The stiches are still visible though she shows no discomfort and does not lick the site at all. Please find the links below for 1) Barf and 2) Wellness
1) BARF - http://barfsingapore.com.sg/
This appears to be a well balanced and species approraite diet for cats though we are a little concerned about the possibility of contamination and exposure given the transportation process from Australia to Singapore. Going back to Sofi's blood test which indicated low platelets, we also wonder whether it could possibly be toxoplasmosis from eating the raw food, this is just speculation of course, the low platelet count could be due to a variety of reasons. Since the operation, we have stopped feeding her BARF completely.
2) WELLNESS - http://www.wellnesspetfood.com/recipes.aspx?pet=cat&ft=2
We are currently feeding her the canned chicken version. She consumes a can in about one and a half days with a little water added in every meal. In addition to the canned food, she also receives about a spoonful of Wellness Core kibbles daily. This is more to add variety and give her something to chew on.
We would be happy eto hear your thoughts on the pet food and anything else you have to say.
Best Regards
TOA PAYOH VETS ARTICLE AT:
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
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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 |
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.
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