Sep 24, 2015
A couple came to get the spayed dog's stitch removed by Dr Daniel today. The husband has grey hairs and is slim. He had retired from a large multinational company. His wife looked some 10 years younger or had a happy disposition.
"How long has Toa Payoh Vets been in operation?" he asked.
"Since 1982," I said.
"You must have a lot of clients," he stated.
"Many have had left for clinics nearer your home. Proxmity and convenience. There were only 5 clinics when I started but now there are over 70. Where do you stay?"
"We live in Seletar," he said. He agreed that there were a few clinics around his neighbourhood but he had not been to them. He was loyal to a big clinic and only during retirement did he shop around for affordable vet fees.
"The reason I came to your clinic is because of your fees, much lower than the big clinic I used to go. They quoted me over $600 for spaying my Shih Tzu."
"Well, the fees could include blood test to screen the health of the dog before surgery. In case the dog is too sick and likely to die during operation. How much does this clinic charge for blood tests?"
"I don't like to be surprised with a big vet bill after treatment. The blood test is over $250," he had never asked for prices when he was busy working as a regional manager. Now he has to save.
"This clinic has such nice furnishings and it costs more," I said.
"Many people still go there," the retiree said.
"Yes, many people drive Mercedes even when they retire and they are not cheap cars. What car do you drive?"
"A Japanese car."
He was a frugal man as he still had 2 children schooling.
"Best not to send your children to study in Australia or overseas," I said. "If you want to save for retirement. Ask your daughter to get a scholarship or study in the local university. Some married foreigners and don't come home or they prefer to migrate and settle in Australia."
Retirement age in Singapore is 62. The man did not want to continue working as it is exhausting. Yet his 2 children are still schooling and he needs to be counting pennies.
Thursday, September 24, 2015
2308. A 16-year-old Maltese X cannot stand up overnight
Sep 24, 2015
Public holiday. Hazy sky.
This 7.8-kg Maltese X is 16 years old. Usual sleep whole day and ambled slowly.
"He needed to be hand fed by the owner because of painful mouth," I said. "No dental for the past 10 or more years.The toxins from the mouth bacteria could have passed via the blood to the brain and body causing lethargy and difficulty to stand up for the past 2 weeks. But overnight, he just could not stand on his hind limbs. He had paraparesis or paraplegia.
"Is it common in old dogs?" the lady in her late 30s asked me.
"No," I said.
Public holiday. Hazy sky.
This 7.8-kg Maltese X is 16 years old. Usual sleep whole day and ambled slowly.
"He needed to be hand fed by the owner because of painful mouth," I said. "No dental for the past 10 or more years.The toxins from the mouth bacteria could have passed via the blood to the brain and body causing lethargy and difficulty to stand up for the past 2 weeks. But overnight, he just could not stand on his hind limbs. He had paraparesis or paraplegia.
"Is it common in old dogs?" the lady in her late 30s asked me.
"No," I said.
2307. No terrapin books in the Bishan library
Sep 24, 2015
The 11-year-old boy was responsible for the upkeep and health care of the adopted terrapin. For the past 2 months, the terrapin had lost appetite. He was very thin. So the father took him and the terrapin to consult me after checking out the Youtube.
"Any stools muddying the water in the tank?" I asked since the boy said the terrapin did eat around 3 pellets.
"Quite clean," he said. "His left eye is swollen. He closes his eyes when he is under water."
"How long has this situation been occurring?" I asked.
"Past 2 months."
Lethargy. No appetite for 2 months.
Severe weight loss - no fatty bulge under armpit and thigh area.
Breathing rapidly.
"Any basking area to dry out?" I asked as the owner had adopted the terrapin, tank and a mouldy wooden block from another person.
"The wooden block is small than him," the father said. "I threw it away as it was mouldy."
"So the terrapin had been submerged in water for the past year. How often do you change the water?"
"Once in every 3 days."
The terrapin had a good appetite after adoption, eating many dried shrimps and disliked the pellets. He was fed fresh prawns twice only in the past months. The father bought from the pet shop a bottle of medicine to eliminate flat worms, tapeworks and flukes in fish and poured into the tank. No improvement in appetite.
As for sunlight, recently he exposed the terrapin to direct sunlight for 4 hours. But the terrapin still would not eat any shrimps. Lethargy.
As the boy was not permitted internet surfing to prevent addiction, I asked if he had loaned terrapin books from the public library.
"None available," he said.
Actually, there was none available for loan when I asked again.
Terrapins are a popular niche pet and the library books would probably be borrowed or the boy had no time to persevere and does not know how to make a reservation.
"Usually it is the owner who is at fault when the pet is sick," the father said to me. "Same as for misbehaving children." This is a rare parent who stopped his 11-year-old son from surfing to prevent internet addiction and deprivation of sleep gaming till 4 am every night. This is what happens to some young Singapore men even at the age of 30 years.
The 11-year-old boy was responsible for the upkeep and health care of the adopted terrapin. For the past 2 months, the terrapin had lost appetite. He was very thin. So the father took him and the terrapin to consult me after checking out the Youtube.
"Any stools muddying the water in the tank?" I asked since the boy said the terrapin did eat around 3 pellets.
"Quite clean," he said. "His left eye is swollen. He closes his eyes when he is under water."
"How long has this situation been occurring?" I asked.
"Past 2 months."
Lethargy. No appetite for 2 months.
Severe weight loss - no fatty bulge under armpit and thigh area.
Breathing rapidly.
"Any basking area to dry out?" I asked as the owner had adopted the terrapin, tank and a mouldy wooden block from another person.
"The wooden block is small than him," the father said. "I threw it away as it was mouldy."
"So the terrapin had been submerged in water for the past year. How often do you change the water?"
"Once in every 3 days."
The terrapin had a good appetite after adoption, eating many dried shrimps and disliked the pellets. He was fed fresh prawns twice only in the past months. The father bought from the pet shop a bottle of medicine to eliminate flat worms, tapeworks and flukes in fish and poured into the tank. No improvement in appetite.
As the boy was not permitted internet surfing to prevent addiction, I asked if he had loaned terrapin books from the public library.
"None available," he said.
Actually, there was none available for loan when I asked again.
Terrapins are a popular niche pet and the library books would probably be borrowed or the boy had no time to persevere and does not know how to make a reservation.
"Usually it is the owner who is at fault when the pet is sick," the father said to me. "Same as for misbehaving children." This is a rare parent who stopped his 11-year-old son from surfing to prevent internet addiction and deprivation of sleep gaming till 4 am every night. This is what happens to some young Singapore men even at the age of 30 years.
2306. A cat jumped from 5th storey - multiple right femoral fractures - x rays
SURGICAL TREATMENT
1. Pin plus wires around fragments.
2. Screws.
The cost would be from $2,000. The owner said he had paid $1,000 to a vet who smoothen the molar spurs of his rabbit, saying this was a large amount.
He took the cat home.
2305. A cat and dog has difficulty peeing - follow up perineal urethrostomy in the cat
Thursday, Sep 24, 2015. Public holiday
I review the two in-patients
1. A 3-year-old male cat has dysuria after removal of the bladder and urethral stones around 2 weeks ago.
"He had never been able to urinate normally after the surgery," the owner said. Dr Daniel had prescribed the medication but the cat keeps going to the litter tray. The cat had been housed separately from the other 2 cats and had eaten his own Prescription C/D diet.
The cat came in 2 days ago. I palpated his bladder. It was swollen moderately, around the size of half an orange. Yesterday, Dr Daniel performed perineal urethrostomy and the cat now pees normally.
Urethral stricture was the cause of dysuria after bladder stone removal. The cat did not pee normally. The stone had lodged at the perineal urethra earlier and had caused obstruction. It was flush back into the bladder and removed with the bladder stones, but the cat had problems peeing post-op. So the solution was to do perineal urethrostomy and now the cat is OK.
2. The 13-year-old Chihuahua had scrotal ablation and neuter yesterday. He was seen by Vet 1 who had x-rayed which showed bladder and urethral stones. The urethral stones were packed tight behind the os penis (see x ray) and so the urine flow was obstructed. The bladder swelled to a mango size. The prostate also enlarged like a fish ball (see x ray). Too old for anaesthesia. Vet 1 inserted a syringe and sucked out 15 ml of the urine. But the dog still could not pee but dribbled urine.
Today, I checked on him. His urine was clear as seen at the catheter. No full bladder. His scrotum was cut away as they were swollen. The wounds are healing well.The dog goes home on Sep 27, 2015. Another dialysis SC before going home.
Sep 27, 2015
No problem peeing now. Cause of dysuria in the cat was urethral stricture. In the dog, it was urethral obstruction behind the os penis. X-rays
I review the two in-patients
1. A 3-year-old male cat has dysuria after removal of the bladder and urethral stones around 2 weeks ago.
"He had never been able to urinate normally after the surgery," the owner said. Dr Daniel had prescribed the medication but the cat keeps going to the litter tray. The cat had been housed separately from the other 2 cats and had eaten his own Prescription C/D diet.
The cat came in 2 days ago. I palpated his bladder. It was swollen moderately, around the size of half an orange. Yesterday, Dr Daniel performed perineal urethrostomy and the cat now pees normally.
Urethral stricture was the cause of dysuria after bladder stone removal. The cat did not pee normally. The stone had lodged at the perineal urethra earlier and had caused obstruction. It was flush back into the bladder and removed with the bladder stones, but the cat had problems peeing post-op. So the solution was to do perineal urethrostomy and now the cat is OK.
2. The 13-year-old Chihuahua had scrotal ablation and neuter yesterday. He was seen by Vet 1 who had x-rayed which showed bladder and urethral stones. The urethral stones were packed tight behind the os penis (see x ray) and so the urine flow was obstructed. The bladder swelled to a mango size. The prostate also enlarged like a fish ball (see x ray). Too old for anaesthesia. Vet 1 inserted a syringe and sucked out 15 ml of the urine. But the dog still could not pee but dribbled urine.
Today, I checked on him. His urine was clear as seen at the catheter. No full bladder. His scrotum was cut away as they were swollen. The wounds are healing well.The dog goes home on Sep 27, 2015. Another dialysis SC before going home.
Sep 27, 2015
No problem peeing now. Cause of dysuria in the cat was urethral stricture. In the dog, it was urethral obstruction behind the os penis. X-rays
Tuesday, September 22, 2015
2304. BKTP story -- A little boy's 14-year-old dog is going to die soon
Sep 22, 2015
The little boy listened to every word but said nothing. He was 12 years old, trim and be-spectacled and studying in Primary Six of the school. He comprehend what his father and the vet was saying. If his best friend, a dog he had loved since babyhood, did not get operated upon within 2 days, she would die. If she were to be operated, she might die too as the odds were stacked against her. But she might live.
This Silkie Terrier was 14 years old. If she was an old lady, she would be 98 years old in human years. She was in poor health as her blood test showed she had sepsis with total white cell count and neutrophil count way off the charts of normalcy.
I had examined her and had told Mr Tan that there would be an anaesthetic risk of her dying during surgery. "What are the chances?" the father asked. "Less than 50% based on the two criteria of old age and septicaemia. The good news is that she is not suffering from kidney disease. You will need to sign a consent form stating that you have been informed and understand the risks."
Every dog owner knows the procedure of informed consent. Mr Tan would still have to pay the surgical fees even though his dog had died. He was dealt a poor hand. The other party was the divine powers that had the good cards. The vet would represent the dealer in a casino. He would earn his fees whichever party won.
What should Mr Tan do? His son was quiet as most boys of that age would be. His mother remained silent too. He did not voice his opinion as he deferred to the head of the household.
Mr Tan hesitated: "Why throw away good money after bad? The dog had a poor chance of survival. She was aged, being 14 years old. He might not live another year. 14 years is a ripe old age for any small breed.
"There are many expenses such as the $300 tuition fees for my two children. A baby is on the way. Why spend money to save a dog? The human beings need to survive in this harsh urban jungle of rising costs every year".
The bureacrats increase the fees to justify their existence while the private sector increases its fees to retain the loyalty of the job-hopping employees who will leave for a few dollars more.
But This Silkie was active although she had eaten much less and licked her back area to keep herself clean and not dirty the home. She was house-proud and would run to the papers on the toilet floor to avoid dirtying the den when she was doing her normal peeing and pooping. Now, she could not cope with the copious flow of brownish sticky pus dripping from her vagina as she tried to run to the toilet to pee. But it was not urine. It was bacterial pus from the womb.
Only during the last one week, she had this brownish-red vaginal discharge. Non-stop bleeding. Drip, drip, drip. She just could not cope with licking and swallowing the infected uterine discharge, poisoning herself. Now her blood had bacteria as shown by the high increase in white blood cells.
A dog soiling the floor of the apartment needed the mother to mop and clean up. So Mr Tan had no choice but to consult the vet. Last year, this dog had breast tumours removed. Another vet had removed them and the fees opened a big hole in the financial pocket.
Now, there would be a medical cost of more than $500. There was a doubt that this dog would survive. So why throw good money after bad?
"Is there an injection and antibiotics to treat pyometra?" Mr Tan wanted this option. I gave the dog the IV drip, pain-killer and antibiotics as an in-patient for 2 days. She was barking wildly and loudly to greet the little boy and Mr Tan. She had no vaginal discharge.
"Her vaginal discharge has stopped temporarily due to the effects of the medication," I said to the father. "Soon, it will recur if the dog is not spayed." The father decided to bring her home.
Normally, I do not follow up as there would be considered soliciting. However, I could feel that the little boy's dog is going to die soon if there is procrastination in getting the surgery. I phoned Mr Tan.
"My dog is now lethargic and not eating again," he said. I advised immediate surgery. As this was a little boy's best friend, I decided to lower my fees to the minimum. The dog recovered, stayed one night as an in-patient and as I walked the family to their small car, I asked the little boy: "Are you happy now?"
He nodded his head and gave me his widest smile. No words. This was one of the happy outcomes of pyometra surgery. Not every pyometra case will survive an operation. Much depends on the progress of the disease. In this case, this dog had not suffered kidney failure and was treated quite early before vomiting and collapse occurred. The dog was running out of time but not out of luck. Sometimes, luck plays a part in successful surgeries as in success in life and love.
The little boy listened to every word but said nothing. He was 12 years old, trim and be-spectacled and studying in Primary Six of the school. He comprehend what his father and the vet was saying. If his best friend, a dog he had loved since babyhood, did not get operated upon within 2 days, she would die. If she were to be operated, she might die too as the odds were stacked against her. But she might live.
This Silkie Terrier was 14 years old. If she was an old lady, she would be 98 years old in human years. She was in poor health as her blood test showed she had sepsis with total white cell count and neutrophil count way off the charts of normalcy.
I had examined her and had told Mr Tan that there would be an anaesthetic risk of her dying during surgery. "What are the chances?" the father asked. "Less than 50% based on the two criteria of old age and septicaemia. The good news is that she is not suffering from kidney disease. You will need to sign a consent form stating that you have been informed and understand the risks."
Every dog owner knows the procedure of informed consent. Mr Tan would still have to pay the surgical fees even though his dog had died. He was dealt a poor hand. The other party was the divine powers that had the good cards. The vet would represent the dealer in a casino. He would earn his fees whichever party won.
What should Mr Tan do? His son was quiet as most boys of that age would be. His mother remained silent too. He did not voice his opinion as he deferred to the head of the household.
Mr Tan hesitated: "Why throw away good money after bad? The dog had a poor chance of survival. She was aged, being 14 years old. He might not live another year. 14 years is a ripe old age for any small breed.
"There are many expenses such as the $300 tuition fees for my two children. A baby is on the way. Why spend money to save a dog? The human beings need to survive in this harsh urban jungle of rising costs every year".
The bureacrats increase the fees to justify their existence while the private sector increases its fees to retain the loyalty of the job-hopping employees who will leave for a few dollars more.
But This Silkie was active although she had eaten much less and licked her back area to keep herself clean and not dirty the home. She was house-proud and would run to the papers on the toilet floor to avoid dirtying the den when she was doing her normal peeing and pooping. Now, she could not cope with the copious flow of brownish sticky pus dripping from her vagina as she tried to run to the toilet to pee. But it was not urine. It was bacterial pus from the womb.
Only during the last one week, she had this brownish-red vaginal discharge. Non-stop bleeding. Drip, drip, drip. She just could not cope with licking and swallowing the infected uterine discharge, poisoning herself. Now her blood had bacteria as shown by the high increase in white blood cells.
A dog soiling the floor of the apartment needed the mother to mop and clean up. So Mr Tan had no choice but to consult the vet. Last year, this dog had breast tumours removed. Another vet had removed them and the fees opened a big hole in the financial pocket.
Now, there would be a medical cost of more than $500. There was a doubt that this dog would survive. So why throw good money after bad?
"Is there an injection and antibiotics to treat pyometra?" Mr Tan wanted this option. I gave the dog the IV drip, pain-killer and antibiotics as an in-patient for 2 days. She was barking wildly and loudly to greet the little boy and Mr Tan. She had no vaginal discharge.
"Her vaginal discharge has stopped temporarily due to the effects of the medication," I said to the father. "Soon, it will recur if the dog is not spayed." The father decided to bring her home.
Normally, I do not follow up as there would be considered soliciting. However, I could feel that the little boy's dog is going to die soon if there is procrastination in getting the surgery. I phoned Mr Tan.
"My dog is now lethargic and not eating again," he said. I advised immediate surgery. As this was a little boy's best friend, I decided to lower my fees to the minimum. The dog recovered, stayed one night as an in-patient and as I walked the family to their small car, I asked the little boy: "Are you happy now?"
He nodded his head and gave me his widest smile. No words. This was one of the happy outcomes of pyometra surgery. Not every pyometra case will survive an operation. Much depends on the progress of the disease. In this case, this dog had not suffered kidney failure and was treated quite early before vomiting and collapse occurred. The dog was running out of time but not out of luck. Sometimes, luck plays a part in successful surgeries as in success in life and love.
Monday, September 21, 2015
2303. Asking for $3,500 salary
Sep 21, 2015
Singapore has a very low unemployment rate as compared to Greece where it is said that 25% of the young people are unemployed. However, there is intense competition for business as rentals keep increasing every year and local employees asking for more pay and less work, preferably no work on Sundays and public holidays. Singapore appears to be going into economic recession as I notice more clients ask for discounts and delay treatment of their pets.
"My Chihuahua is 13 years old," one man said to me. "Unlikely to live many years. So, no need treatment." But the dog could not pee and the alternative is to let the dog die from bladder rupture as the bladder swelled to the size of the mango. The first vet had inserted a needle and withdrew some urine but the bladder continued to fill with urine. The dog just could not pee.
"Whether the dog is young or old," I explained. "If it needs treatment which can save its life, it must be done."
The economy is bad but you will see that the Certificate Of Entitlement (government permit to buy a car) of cars has not dropped. A permit is now around $60,000. "There are many rich people around," I said to a client who commented on this. The government is the one making the money and raising rentals amongst its own properties, increasing the cost of living every year. The private landlords raise the rent much more and so the government officers raise the rent too, but not to a greedy extent.
Yesterday, a 21-year-old new polytechnic graduate with no veterinary experience asked me for $3,500 per month after the interview and tentative agreement of $2,000 and a one-year-contract. I was looking for a full-time veterinary assistant who can work weekends and public holidays and asked how much she was looking for. She said $2,000/month and for a one-year-contract. I was Ok with that.
She had been doing some weeks of paid internship to learn more about veterinary medicine. She wanted to become a vet.
I just cannot understand what made her ask $3,500. I just could not afford her and know that she would not be committed to work. I told her to shop around for employers who pay more than me as she will not stay long. She will be looking for jobs while working for me and there is a waste of time training her as a veterinary assistant.
Sometimes our impulse side makes us do things which are not realistic and honest. After gaining experience, we can job hop for a few dollars more.
Singapore has a very low unemployment rate as compared to Greece where it is said that 25% of the young people are unemployed. However, there is intense competition for business as rentals keep increasing every year and local employees asking for more pay and less work, preferably no work on Sundays and public holidays. Singapore appears to be going into economic recession as I notice more clients ask for discounts and delay treatment of their pets.
"My Chihuahua is 13 years old," one man said to me. "Unlikely to live many years. So, no need treatment." But the dog could not pee and the alternative is to let the dog die from bladder rupture as the bladder swelled to the size of the mango. The first vet had inserted a needle and withdrew some urine but the bladder continued to fill with urine. The dog just could not pee.
"Whether the dog is young or old," I explained. "If it needs treatment which can save its life, it must be done."
The economy is bad but you will see that the Certificate Of Entitlement (government permit to buy a car) of cars has not dropped. A permit is now around $60,000. "There are many rich people around," I said to a client who commented on this. The government is the one making the money and raising rentals amongst its own properties, increasing the cost of living every year. The private landlords raise the rent much more and so the government officers raise the rent too, but not to a greedy extent.
Yesterday, a 21-year-old new polytechnic graduate with no veterinary experience asked me for $3,500 per month after the interview and tentative agreement of $2,000 and a one-year-contract. I was looking for a full-time veterinary assistant who can work weekends and public holidays and asked how much she was looking for. She said $2,000/month and for a one-year-contract. I was Ok with that.
She had been doing some weeks of paid internship to learn more about veterinary medicine. She wanted to become a vet.
I just cannot understand what made her ask $3,500. I just could not afford her and know that she would not be committed to work. I told her to shop around for employers who pay more than me as she will not stay long. She will be looking for jobs while working for me and there is a waste of time training her as a veterinary assistant.
Sometimes our impulse side makes us do things which are not realistic and honest. After gaining experience, we can job hop for a few dollars more.
Subscribe to:
Posts (Atom)