Perth, Australia 10.30am
What is urohydropropulsion? During my undergraduate days some 30 years ago, there was no such term.
Basically it means pumping saline into the bladder (3ml/kg) and suck out the fluid together with the small uroliths (urinary stones) with a catheter. The stones in the bladder are too small and therefore no surgical removal is needed.
ANAESTHESIA. May or may not be need.
POSITION. 2 methods described in Small Animal Clinical Nutrition 5th edition.
POSITION 1. Hold the dog or cat upright so that the vertebral column is upright. The urine and stones will be at the bottom (neck) of the bladder.
POSITION 2. Lateral recumbency.
In both position, catherise, irrigate with saline (3ml/kg), massage or press bladder to shake up the stones, suck out the saline + stones with a syringe. X-rays to check if all are taken out but not all small ones can be seen.
Dietary and medical treatment
Wednesday, September 29, 2010
204. Client Advices: Prescription Diet s/d canine
Perth, Australia, 10.06 am.
After surgical removal of the struvite urinary stones or for medical and dietary treatment, how much should the owner give the dog/day?
Took some time just to read about Canine Struvite Urolithiasis case studies in the Small Animal Nutritition by Hand et. al, 5th Edition and the following is some general guidelines for Toa Payoh Vets in advising on Prescription Diet s/d to dogs
1. Puppy X-breed, 9 weeks, 5 kg. 700kcal (2.83MJ) 1/2 can 3x/day
2. Rottweiler, 5 years, 41 kg 1,800kcal (7.5MJ) 1.5 cans 2x/day
3. German Shepherd, 12 years, 27kg 1,150kcal (4.8MJ) 1 can 2x/day
Antibiotics from 14-30 days and review using urine cultures
Monthly urine analysis (check for UTI) and blood tests (esp. serum urea nitgrogen, magnesium, phosphorus and calcium and alkaline phosphatese)
Monthly x-rays of kidney (V/D view), bladder (lateral views)
Specialised tests like double-contrast cystography (to check out anatomic abnormalities of the bladder, obstruction of urine flow from kidneys), retrograde positive-contrast urethrocystography (to check out anatomical abnormalities of the urinary tract to the prostate gland area) if there is recurrent uroliths or UTI.
Back to normal commercial food for puppy as soon as X-rays show no stones. For adult dogs, give prescription food for one more month after negative X-ray results.
No commercial dog treats or snacks.
Very few Singapore clientele comply with the above instructions. It could be due to economic reasons. Urine is taken by cystocentesis. Voiding urohydropropulsion is used in cases where the uroliths are small.
After surgical removal of the struvite urinary stones or for medical and dietary treatment, how much should the owner give the dog/day?
Took some time just to read about Canine Struvite Urolithiasis case studies in the Small Animal Nutritition by Hand et. al, 5th Edition and the following is some general guidelines for Toa Payoh Vets in advising on Prescription Diet s/d to dogs
1. Puppy X-breed, 9 weeks, 5 kg. 700kcal (2.83MJ) 1/2 can 3x/day
2. Rottweiler, 5 years, 41 kg 1,800kcal (7.5MJ) 1.5 cans 2x/day
3. German Shepherd, 12 years, 27kg 1,150kcal (4.8MJ) 1 can 2x/day
Antibiotics from 14-30 days and review using urine cultures
Monthly urine analysis (check for UTI) and blood tests (esp. serum urea nitgrogen, magnesium, phosphorus and calcium and alkaline phosphatese)
Monthly x-rays of kidney (V/D view), bladder (lateral views)
Specialised tests like double-contrast cystography (to check out anatomic abnormalities of the bladder, obstruction of urine flow from kidneys), retrograde positive-contrast urethrocystography (to check out anatomical abnormalities of the urinary tract to the prostate gland area) if there is recurrent uroliths or UTI.
Back to normal commercial food for puppy as soon as X-rays show no stones. For adult dogs, give prescription food for one more month after negative X-ray results.
No commercial dog treats or snacks.
Very few Singapore clientele comply with the above instructions. It could be due to economic reasons. Urine is taken by cystocentesis. Voiding urohydropropulsion is used in cases where the uroliths are small.
Tuesday, September 28, 2010
203. Mindset and motivations for vet undergraduates
Monday Sep 27, 2010
Perth Royal Show, Queen's birthday today is a public holiday in Perth
Mindset
It is hard to change your mindset when you tell yourself you just can't do it. If you tell yourself you can't beat the top student in your class, you fulfill your prophecy every time you see that your exam results are lower than hers or his.
Passion for veterinary medicine and surgery
Human nature is such that 80% of the vet student population will not have passion for veterinary medicine and surgery. Passion means putting much more time and effort in your undergraduate studies to excel in the top 20% of the class. That is how I judge passion quantitatively. It is not for everybody. There has to be time sacrifices and the capability.
Yesterday I met 2 vet undergraduates whom I know to be in the top 20% of the class and another one probably in the bottom 20% of the class. I will call them A, B and C.
The recent SAM (small animal medicine) exam for the 4th year was packed to the gills with questions such that most students would not be able to complete answering all questions and therefore "had an excuse to fail". It was apparently a new examination format according to C and so I was interested to know more.
"The top student got 88% (High Distinction)," C said. "How about A and B?" I asked with very high expectations. C replied: "They got Distinction which is 70-80%."
"If nobody can complete answering all the SAM questions, how could anyone get Distinction or High Distinctions?" I asked C.
C replied: "They got correct answers for the questions they completed. This just does not cut ice with me. Unless the professors use the standard deviation curve and award the Ds and HDs according to this curve. So, even if no student completes all questions, they still can be graded according to the bell curve. Know what I mean? Go and research statistics.
C said to me: "It is impossible for me as I need >90% in the forthcoming exam to pass the SAM." Nothing is impossible if one is very hungry. "What if you get 80-90%? Will the professor be kind towards you so that you need not repeat the whole SAM exam?"
"Your mindset is already fixed," I took some time to talk to this young man who was once a straight A student in his A levels. "Why don't you just drop out of vet school and do something else if you have no passion for vet medicine? Do something that pleases you.
"You had straight As in his A levels and I know you have the capability to at least pass the examinations. Your parents will be disappointed but why do you care about their feelings?"
As a parent myself, I feel really sad for his father and mother who must have had high hopes for him and would not know his examination performance.
Is there any hope for him? If he cannot get over 90% in the final exam, he will need to repeat the whole SAM exam which involves much more subjects to study. I advised the following which may be useful for other undergraduates in vet school.
1. Males who tend to study 2 weeks before the 4th year examination may fail because there is a vast amount of info to remember.
2. Study daily your lecture notes. Use "cards" to write down the important points from past year exam questions. Read the cards one at a time when you are free. And do it daily, not 2 weeks before the exam.
3. Do wider reading but since you just want to pass, I don't expect you to bother. A wider reading reinforces and adds to the knowledge from your lecture notes.
4. Cut off the addiction to watch downloaded TV movies or use the internet till 3 am in the morning. If not possible, restrict to half an hour. During my undergraduate days in the early 1970s, there was no internet and I watched only the 10pm news in Glasgow. It was back to the grindstone every evening, except weekends, to study and read other books on vet medicine.
5. Vet medicine is full of information to remember. There is no other way but to spend time to memorise the facts. It is easier than law which requires case precedents to be quoted.
6. Stay-in at a practice to help out. But this option does not appeal to most students as it means responsibility. Only certain students who need the money saved from not having to rent a place will do it. A and B did it. They would have seen real cases which bring vet medicine and surgery alive to their mugging. That is one way to get top marks. Reading text without seeing practice or real cases can be sleep inducing.
7. "I open the text book and I fall asleep immediately," is a common observation for vet students whose motivation is poor. The reason is due to addiction to online pleasures of gaming and video watching.
Life is full of ups and downs for families - financial, health and death of young ones preceding the death of the parents. If you are an undergraduate with no financial problems, know that you are so fortunate to just simply having to pass the vet course. Many aspiring vet students will sacrifice a few years of their life if they were in your position.
Competitive spirit. A competitive spirit in the top 20% of the vet student. Is it inborn or acquired? It is hard to know. From my observation of A, it seems to be inherent in her based on my observation of the Mad Cow Rodeo performance. I heard her commenting to herself that she got the lowest grades as she was thrown off the cow earlier than B, C and another classmate. The other 3 vet students managed to hang on with two hands (incorrect way as one hand was the trick to rodeo riding)for a longer time.
A competitive spirit and a photographic memory will be hard to beat but never say "can't do it". Once your mindset is negative, you will never beat her at all if you have only acquired a competitive spirit by being associated with her. Both A and B will encourage each other in good company. So, much depends on the "porer"performer (B) to get a very positive mental attitude to study correctly and excel to be top of the class.
Do top students take multi-vitamins, grinko nuts and ginseng? I don't know. I presume A does it. Most likely she has a photographic memory as C told me that the classmates were impressed that she remembered the name of some plant causing sheep diseases during class. Unfortunately for me, C could not remember what was the name of the plant when I asked him!
Perth Royal Show, Queen's birthday today is a public holiday in Perth
Mindset
It is hard to change your mindset when you tell yourself you just can't do it. If you tell yourself you can't beat the top student in your class, you fulfill your prophecy every time you see that your exam results are lower than hers or his.
Passion for veterinary medicine and surgery
Human nature is such that 80% of the vet student population will not have passion for veterinary medicine and surgery. Passion means putting much more time and effort in your undergraduate studies to excel in the top 20% of the class. That is how I judge passion quantitatively. It is not for everybody. There has to be time sacrifices and the capability.
Yesterday I met 2 vet undergraduates whom I know to be in the top 20% of the class and another one probably in the bottom 20% of the class. I will call them A, B and C.
The recent SAM (small animal medicine) exam for the 4th year was packed to the gills with questions such that most students would not be able to complete answering all questions and therefore "had an excuse to fail". It was apparently a new examination format according to C and so I was interested to know more.
"The top student got 88% (High Distinction)," C said. "How about A and B?" I asked with very high expectations. C replied: "They got Distinction which is 70-80%."
"If nobody can complete answering all the SAM questions, how could anyone get Distinction or High Distinctions?" I asked C.
C replied: "They got correct answers for the questions they completed. This just does not cut ice with me. Unless the professors use the standard deviation curve and award the Ds and HDs according to this curve. So, even if no student completes all questions, they still can be graded according to the bell curve. Know what I mean? Go and research statistics.
C said to me: "It is impossible for me as I need >90% in the forthcoming exam to pass the SAM." Nothing is impossible if one is very hungry. "What if you get 80-90%? Will the professor be kind towards you so that you need not repeat the whole SAM exam?"
"Your mindset is already fixed," I took some time to talk to this young man who was once a straight A student in his A levels. "Why don't you just drop out of vet school and do something else if you have no passion for vet medicine? Do something that pleases you.
"You had straight As in his A levels and I know you have the capability to at least pass the examinations. Your parents will be disappointed but why do you care about their feelings?"
As a parent myself, I feel really sad for his father and mother who must have had high hopes for him and would not know his examination performance.
Is there any hope for him? If he cannot get over 90% in the final exam, he will need to repeat the whole SAM exam which involves much more subjects to study. I advised the following which may be useful for other undergraduates in vet school.
1. Males who tend to study 2 weeks before the 4th year examination may fail because there is a vast amount of info to remember.
2. Study daily your lecture notes. Use "cards" to write down the important points from past year exam questions. Read the cards one at a time when you are free. And do it daily, not 2 weeks before the exam.
3. Do wider reading but since you just want to pass, I don't expect you to bother. A wider reading reinforces and adds to the knowledge from your lecture notes.
4. Cut off the addiction to watch downloaded TV movies or use the internet till 3 am in the morning. If not possible, restrict to half an hour. During my undergraduate days in the early 1970s, there was no internet and I watched only the 10pm news in Glasgow. It was back to the grindstone every evening, except weekends, to study and read other books on vet medicine.
5. Vet medicine is full of information to remember. There is no other way but to spend time to memorise the facts. It is easier than law which requires case precedents to be quoted.
6. Stay-in at a practice to help out. But this option does not appeal to most students as it means responsibility. Only certain students who need the money saved from not having to rent a place will do it. A and B did it. They would have seen real cases which bring vet medicine and surgery alive to their mugging. That is one way to get top marks. Reading text without seeing practice or real cases can be sleep inducing.
7. "I open the text book and I fall asleep immediately," is a common observation for vet students whose motivation is poor. The reason is due to addiction to online pleasures of gaming and video watching.
Life is full of ups and downs for families - financial, health and death of young ones preceding the death of the parents. If you are an undergraduate with no financial problems, know that you are so fortunate to just simply having to pass the vet course. Many aspiring vet students will sacrifice a few years of their life if they were in your position.
Competitive spirit. A competitive spirit in the top 20% of the vet student. Is it inborn or acquired? It is hard to know. From my observation of A, it seems to be inherent in her based on my observation of the Mad Cow Rodeo performance. I heard her commenting to herself that she got the lowest grades as she was thrown off the cow earlier than B, C and another classmate. The other 3 vet students managed to hang on with two hands (incorrect way as one hand was the trick to rodeo riding)for a longer time.
A competitive spirit and a photographic memory will be hard to beat but never say "can't do it". Once your mindset is negative, you will never beat her at all if you have only acquired a competitive spirit by being associated with her. Both A and B will encourage each other in good company. So, much depends on the "porer"performer (B) to get a very positive mental attitude to study correctly and excel to be top of the class.
Do top students take multi-vitamins, grinko nuts and ginseng? I don't know. I presume A does it. Most likely she has a photographic memory as C told me that the classmates were impressed that she remembered the name of some plant causing sheep diseases during class. Unfortunately for me, C could not remember what was the name of the plant when I asked him!
Monday, September 27, 2010
202. Make money tips from Loral Langemeir
"I will never do business," the young lady studying veterinary medicine in Murdoch University told me when I said it would be good for her to know one of my business contact who markets products in Indonesia. She must think that she would be an employee veterinarian forever.
An employee has a fixed income but I know she does not have a fixed potential and will do well in business (as a self-employed vet). She probably thinks that veterinary practice is not a business but a calling. She is still young and so it is possible that she thinks of being only an employee as it needs one year of working for others before a vet in Singapore is allowed to start his or her own surgery.
I happen to read a wealth creation article and asked another vet student whether he has had read it since the Fitness First magazine, Sep/Oct 2010 issue, Australia was his copy. "No," he said.
Well, here are the tips of becoming your own cash machine from the
author of America's best selling books such as "The Millionaire Maker", appearance on "Dr Phil" shows as the resident 'money expert'. Loral Langemeir does not believe that you need money to make money. Her concept "The 2lst Century Lemonade Stand"
encourages one to change one's attitude. One's mindset can sabotage one's success as you have the wrong conversation with your mind. If you say, "I'll will never have a lot of money," you should ask yourself "How can I have a lot of money?" according to the writer of this article.
Be open to opportunities to make more money. The focus should be on creating more cash rather than how to pay down debt. This is easier said than done. The 5 tips are:
1. Turn what you know into money, e.g. your talents, skills, hobbies, interests, knowledge and experience. (In Perth, I would say it is the tuition business for Asian at A$30/hour for undergraduates if they need money). Much time spent on online gaming and messaging is just that - fun and no cash income. Even the facebook skills is a means of making money as I noted that one undergraduate's contact in her facebook account is about a professional bride photography connection. She linked to it.
2. Learn from other people's mistakes and expand on their success. This means doing your reearch.
3. Keep it simple.
4. Focus on what makes you unique and therefore sets you apart from others.
5. Develop a short 30-second pitch for your brand to gain a contact or a customer when the opportunity comes.
It will be difficult for the young lady and the young man I spoke to recently, to know how to execute (which is Point No. 5). If they can execute, they have money in the pockets.
An employee has a fixed income but I know she does not have a fixed potential and will do well in business (as a self-employed vet). She probably thinks that veterinary practice is not a business but a calling. She is still young and so it is possible that she thinks of being only an employee as it needs one year of working for others before a vet in Singapore is allowed to start his or her own surgery.
I happen to read a wealth creation article and asked another vet student whether he has had read it since the Fitness First magazine, Sep/Oct 2010 issue, Australia was his copy. "No," he said.
Well, here are the tips of becoming your own cash machine from the
author of America's best selling books such as "The Millionaire Maker", appearance on "Dr Phil" shows as the resident 'money expert'. Loral Langemeir does not believe that you need money to make money. Her concept "The 2lst Century Lemonade Stand"
encourages one to change one's attitude. One's mindset can sabotage one's success as you have the wrong conversation with your mind. If you say, "I'll will never have a lot of money," you should ask yourself "How can I have a lot of money?" according to the writer of this article.
Be open to opportunities to make more money. The focus should be on creating more cash rather than how to pay down debt. This is easier said than done. The 5 tips are:
1. Turn what you know into money, e.g. your talents, skills, hobbies, interests, knowledge and experience. (In Perth, I would say it is the tuition business for Asian at A$30/hour for undergraduates if they need money). Much time spent on online gaming and messaging is just that - fun and no cash income. Even the facebook skills is a means of making money as I noted that one undergraduate's contact in her facebook account is about a professional bride photography connection. She linked to it.
2. Learn from other people's mistakes and expand on their success. This means doing your reearch.
3. Keep it simple.
4. Focus on what makes you unique and therefore sets you apart from others.
5. Develop a short 30-second pitch for your brand to gain a contact or a customer when the opportunity comes.
It will be difficult for the young lady and the young man I spoke to recently, to know how to execute (which is Point No. 5). If they can execute, they have money in the pockets.
201. Fleas in Australian dogs
Perth, Australia
From "Fitness First" magazine Sep/Oct 2010
I was surprised to see a 2-page advertorial in this magazine with Ms Sami Lukis, an Australian TV and radio personality who takes her dog for daily walks. It is for Comfortis (spinosad) - a clean, convenient way to protect your dogs from fleas.
THE USP (Unique Selling Proposition)
Fast acting, month-long and because it is a tablet, it can't rub off or wash off.
As houses here are usually carpeted, fleas hiding in carpets can be a big problem unlike in Singapore where ticks are a big problem. I presume ticks are a big problem in Australia too as the dogs do go to dog parks (no leash required unless outside dog parks).
From "Fitness First" magazine Sep/Oct 2010
I was surprised to see a 2-page advertorial in this magazine with Ms Sami Lukis, an Australian TV and radio personality who takes her dog for daily walks. It is for Comfortis (spinosad) - a clean, convenient way to protect your dogs from fleas.
THE USP (Unique Selling Proposition)
Fast acting, month-long and because it is a tablet, it can't rub off or wash off.
As houses here are usually carpeted, fleas hiding in carpets can be a big problem unlike in Singapore where ticks are a big problem. I presume ticks are a big problem in Australia too as the dogs do go to dog parks (no leash required unless outside dog parks).
200. Use Facebook, blog and Flickr to help find a home for a stray cat, Singapore
Sep 26, 2010
Writing from Perth, Australia.
5.37 am Willeton
Facebook seems to be the great thing for undergraduates. They get to interact instantly and see beautiful people and pictures.
However, private individuals who are animal activists can use the facebook, blog and flickr to make a difference to the homeless cats and dogs in their neighbourhood.
Vets or vet students can use Facebook and Flickr to make a difference by helping homeless strays in Singapore.
I guess advocacy for homeless stray cats have not much appeal to most young adults with Facebook accounts. They usually have no worries about the next meal or suffer deprivations.
But they can use their bountiful energy and youthful idealism to make a difference, one stray cat at a time and learn about advocacy from the comfort of their homes.
For the baby-boomer generation of vets (old vets of my generation), it is tough for most of them as they find the technology difficult and time-consuming to learn.
Much now depends on the younger vets to be interested in finding homes for some stray cats recovered from illness. Unfortunately, younger vets may have other priorities. Still, if one of a hundred younger vets find the time to advocate for the homeless strays, it is still good. Advocacy for the homeless strays generates no revenue for the younger vets who treat some stray cats or dogs. However, try and help one or two within your time constraints. Unfortunately, good visuals are important as the young ones are also visual-biased. Do what you can.
I have started a Flickr account to help a homeless stray cat recently.
See my example at:
http://www.flickr.com/photos/33995662@N00/?saved=1
TWO PICTURES ARE POSTED IN THIS BLOG
Success in finding homes is unpredictable. If you have a positive mindset, you will find success in many ways even if you fail to find a home for your advertised stray. For example, success in learning how to craft a message to help the homeless and to take excellent pictures over time by being hands on.
COMMENTS
From my review of my pictures, I realise that I should have taken better compositions when the cat has had recovered from scabies treatment. I should have photographed the normal cat without the cage and show the cat in full (with legs intact and show paws free from scabies). This is what I mean by being hands on. You will learn from each case how to be a better advocate for the homeless strays next time.
In this situation, I photographed the stray cat outdoors on a bright sunny day. It must be crated just in case, it leapt away. I should photograph it indoors with lighting but I was busy. Definitely will do away with crates next time.
Writing from Perth, Australia.
5.37 am Willeton
Facebook seems to be the great thing for undergraduates. They get to interact instantly and see beautiful people and pictures.
However, private individuals who are animal activists can use the facebook, blog and flickr to make a difference to the homeless cats and dogs in their neighbourhood.
Vets or vet students can use Facebook and Flickr to make a difference by helping homeless strays in Singapore.
I guess advocacy for homeless stray cats have not much appeal to most young adults with Facebook accounts. They usually have no worries about the next meal or suffer deprivations.
But they can use their bountiful energy and youthful idealism to make a difference, one stray cat at a time and learn about advocacy from the comfort of their homes.
For the baby-boomer generation of vets (old vets of my generation), it is tough for most of them as they find the technology difficult and time-consuming to learn.
Much now depends on the younger vets to be interested in finding homes for some stray cats recovered from illness. Unfortunately, younger vets may have other priorities. Still, if one of a hundred younger vets find the time to advocate for the homeless strays, it is still good. Advocacy for the homeless strays generates no revenue for the younger vets who treat some stray cats or dogs. However, try and help one or two within your time constraints. Unfortunately, good visuals are important as the young ones are also visual-biased. Do what you can.
I have started a Flickr account to help a homeless stray cat recently.
See my example at:
http://www.flickr.com/photos/33995662@N00/?saved=1
TWO PICTURES ARE POSTED IN THIS BLOG
Success in finding homes is unpredictable. If you have a positive mindset, you will find success in many ways even if you fail to find a home for your advertised stray. For example, success in learning how to craft a message to help the homeless and to take excellent pictures over time by being hands on.
COMMENTS
From my review of my pictures, I realise that I should have taken better compositions when the cat has had recovered from scabies treatment. I should have photographed the normal cat without the cage and show the cat in full (with legs intact and show paws free from scabies). This is what I mean by being hands on. You will learn from each case how to be a better advocate for the homeless strays next time.
In this situation, I photographed the stray cat outdoors on a bright sunny day. It must be crated just in case, it leapt away. I should photograph it indoors with lighting but I was busy. Definitely will do away with crates next time.
Sunday, September 26, 2010
199. Health screening for adults
Sep 23, 2010 Perth, Australia
Health screening at SGH
"We practise evidence-based medicine," the nurse at the reception said to me when I asked her about health screening for people with no signs and symptoms of illnesses like heart disease or cancer. What is evidence-based medicine? Must a person be dying of heart attack first to be eligible for health screening in the Singapore General Hospital?
Recently I met Edwin, a good friend of a pastor whom I knew from my National Service some 30 years ago and who had died some 5 years ago. The pastor's son had become a doctor and was at the government polyclinic. Edwin told him that he came for a health screening as his sister-in-law was pestering him to do it. "Sorry, uncle," the doctor said. "I can't permit you to do it." Edwin who brought in his dog for health certification before export to Malaysia said: "I am glad that Pastor ... imparted values of integrity to his son." Edwin said: "What are the chances of meeting the pastor's son at a polyclinic? I don't even want a health check. It was my sister-in-law pestering me to do it. Now Pastor ... must be satisfied and happy from Heaven." I don't know what to say. This Pastor ... had many divine inspirations prolonging his life by a few years despite having heart diseases, kidney failure and diabetes.
It was not surprising therefore that the nurse at the reception rejected me. No choice but to go to the private hospital. A staff in violet uniform told me that I needed an appointment to consult the doctor for health screening. I was a walk-in prospective patient. "OK," I said. "I will make after I return from my holiday in Perth." I doubt I would bother as I have no health problems. I still would like a health screening for cancer as two older vets had been diagnosed with cancer and I was not a spring chicken at the age of 60.
I could not give a date for appointment and said I would call. This meant I would procrastinate. After all, evidence-based medicine is the excuse. I have no evidence of poor health. A bit tired nowadays. Due to stress of hectic pace of city living in Singapore.
As I was about to leave, a fair lady in black dress with some floral strip on one side of the neck came to the receptionist and said: "You can see the doctor today as somebody did not turn up." No show is common in Singapore as many don't have the courtesy to cancel their appointments.
"So now the walk-in cannot walk out?" I tried my hand at humour with the service staff. Nobody laughed but there were some smiles. "I wish to consult an old doctor," I said. "Don't you want to give young ones an opportunity to gain experience?" the receptionist said. "Well, at my age, I may not live long to be a guinea pig. I know every doctor learns from experience in handling cases but I can't afford to let young ones do it at my age. I need experienced doctors to tell me whether I am all OK."
"Don't worry," the lady in the black number assured me. "The doctor is the head of the department." It was my lucky day as I don't have any referrals for this health screening. People usually ask friends for referral but here I was, a walk-in who had starved for the past 12 hours and was trying my luck.
My health screening took about one day from 10 am to 4 pm. The following was accomplished.
1. Blood collection. Blood test must be done again if the previous one was more than 6 months if one wants to go for general anesthesia.
2. Urine collection. Clear light yellow urine as far as I could see.
3. Lung function test. Bit a plastic mouth piece and breathe out as much as I could.
4. Fat, water etc analysis of the body. I stood on a machine and pressed two thumbs on the handle. Can't figure out how it worked.
5. X-ray. Although I had X-ray 9 months ago, the nurse advised one as it was part of the package. "You will not get a refund if you don't do it," she knew many Singaporeans are the calculating type. "It is the radioactivity that I am worried about," I said. "The radiation dosage is very low," she said. OK. I went for it.
6. Eye pressure test. Some machine to check for glaucoma.
7. The doctor's consultation and tests include
7.1 History of past treatments as he keyed into the computer the report
7.2 Physical examination for hernias and palpation for abdominal growths
7.3 Eye-sight. Bright light shone onto my eyes. He said I have no cataracts. A few days earlier, an experienced optometrist said I have little bits of cataract. In any case, I trusted this doctor. It was good news.
7.4 Hearing test. 3 types of sounds I had to say "yes" when I heard it. "The last type is one which many people thinks they may have or have not heard it," the good doctor laughed when I told him that I could hear something but was not sure.
7.5 Explanation of the Treadmill test. (see para 8 below).
8. The Treadmill test. I had to sign a consent form in case I suffer a heart attack during the test. "Don't worry," the doctor took back the signed form. "My nurse is very experienced in detecting any heart attack and will stop the test." I was given the ECG leads and proceeded to walk slowly. The speed increased. "Stop," I said as I became breathless after the 7th minute. "I need the maximal rate to be 85%," the kind slim senior nurse said. "Do you have chest pains or cramped muscles?" I had neither. I was just breathless and did not want to over-exert myself. The machine must have had reached 85% as the nurse stopped the movement. It was past 9 minutes of threading. She printed out the graphs and did not seem too happy with the reading. The doctor would explain to me.
Bad news. "See the ECG," the doctor showed me. "ECG reading is normal before exercise." I could see the regular repetition of the PQRST complexses throughout the strip of paper.
"After exercise, the blood takes a long time to flow back to the heart, even after 5minutes. The ST curve did not rise up as normally as it should be. Indicating a blockage in the heart's coronary arteries."
Yet I had occasional chest pain like over-exertion but it was once in a few months. So I opted for a CT scan of the heart.
9. CT scan
Blood pressure taken at least 3 times and said to be normal although I could see that it was 138 at the upper value. I cannot remember the lower value. Maybe I should be 138 for my age of 60. I thought it should be less than 120. Must do some research.
BPS. This was below 50 beats per minute. "Exellent reading, so we don't need to give you sedatives as the CT machine dislikes people with high pulse rate," a nurse told me. I thought it was abnormal as bps should be 70. Need to do some research.
An experienced nurse tapped my right hand and inserted a long 23G catheter for the injection of radioactive dye when I went into the CT scan for X-raying.
"MRI would be better," another nurse told me. "There will be no radioactivity but it costs a few hundred dollars more."
10. Abdominal ultrasound scan for abnormalities of the liver, spleen, kidneys usually. This was done before CT scan. An experienced nurse put gel. I had to be scanned from above the abdomen, turned to the right and left side. "Can the ultra-scan detect bones in the stomach?" I asked the cheerful nurse. I knew of one vet who had advised ultrasound scan for foreign body the the dog's stomach to confirm what X-rays had shown some opaque foreign bodies. So I was interested in asking this nurse whether it could be useful. "No," she said. "Too much gas, movement in the stomach." I remembered she said about some fat affecting the results. "I have not done it." I need to do some research here. In foreign bodies in the dog's stomach, X-rays with or without contrast media are traditionally done. I am not convinced that ultra-sounds can pick up foreign bodies in a dog's stomach.
Will stop now. I recorded the above for reference. It is 8 am in Perth on a Sunday. Some Royal Show. Some flower show. The Queen's birthday on Monday. So a long week end. Bright sunshine, blue skies. Clear spring air at Willeton near Murdoch University. I have this sadness as my plane touched down at Perth Airport on Sep 24, 2010. There was a car accident on Sept 3, 2010 affecting a girl whom I had carried as an infant and whom I saw growing up.
Health screening at SGH
"We practise evidence-based medicine," the nurse at the reception said to me when I asked her about health screening for people with no signs and symptoms of illnesses like heart disease or cancer. What is evidence-based medicine? Must a person be dying of heart attack first to be eligible for health screening in the Singapore General Hospital?
Recently I met Edwin, a good friend of a pastor whom I knew from my National Service some 30 years ago and who had died some 5 years ago. The pastor's son had become a doctor and was at the government polyclinic. Edwin told him that he came for a health screening as his sister-in-law was pestering him to do it. "Sorry, uncle," the doctor said. "I can't permit you to do it." Edwin who brought in his dog for health certification before export to Malaysia said: "I am glad that Pastor ... imparted values of integrity to his son." Edwin said: "What are the chances of meeting the pastor's son at a polyclinic? I don't even want a health check. It was my sister-in-law pestering me to do it. Now Pastor ... must be satisfied and happy from Heaven." I don't know what to say. This Pastor ... had many divine inspirations prolonging his life by a few years despite having heart diseases, kidney failure and diabetes.
It was not surprising therefore that the nurse at the reception rejected me. No choice but to go to the private hospital. A staff in violet uniform told me that I needed an appointment to consult the doctor for health screening. I was a walk-in prospective patient. "OK," I said. "I will make after I return from my holiday in Perth." I doubt I would bother as I have no health problems. I still would like a health screening for cancer as two older vets had been diagnosed with cancer and I was not a spring chicken at the age of 60.
I could not give a date for appointment and said I would call. This meant I would procrastinate. After all, evidence-based medicine is the excuse. I have no evidence of poor health. A bit tired nowadays. Due to stress of hectic pace of city living in Singapore.
As I was about to leave, a fair lady in black dress with some floral strip on one side of the neck came to the receptionist and said: "You can see the doctor today as somebody did not turn up." No show is common in Singapore as many don't have the courtesy to cancel their appointments.
"So now the walk-in cannot walk out?" I tried my hand at humour with the service staff. Nobody laughed but there were some smiles. "I wish to consult an old doctor," I said. "Don't you want to give young ones an opportunity to gain experience?" the receptionist said. "Well, at my age, I may not live long to be a guinea pig. I know every doctor learns from experience in handling cases but I can't afford to let young ones do it at my age. I need experienced doctors to tell me whether I am all OK."
"Don't worry," the lady in the black number assured me. "The doctor is the head of the department." It was my lucky day as I don't have any referrals for this health screening. People usually ask friends for referral but here I was, a walk-in who had starved for the past 12 hours and was trying my luck.
My health screening took about one day from 10 am to 4 pm. The following was accomplished.
1. Blood collection. Blood test must be done again if the previous one was more than 6 months if one wants to go for general anesthesia.
2. Urine collection. Clear light yellow urine as far as I could see.
3. Lung function test. Bit a plastic mouth piece and breathe out as much as I could.
4. Fat, water etc analysis of the body. I stood on a machine and pressed two thumbs on the handle. Can't figure out how it worked.
5. X-ray. Although I had X-ray 9 months ago, the nurse advised one as it was part of the package. "You will not get a refund if you don't do it," she knew many Singaporeans are the calculating type. "It is the radioactivity that I am worried about," I said. "The radiation dosage is very low," she said. OK. I went for it.
6. Eye pressure test. Some machine to check for glaucoma.
7. The doctor's consultation and tests include
7.1 History of past treatments as he keyed into the computer the report
7.2 Physical examination for hernias and palpation for abdominal growths
7.3 Eye-sight. Bright light shone onto my eyes. He said I have no cataracts. A few days earlier, an experienced optometrist said I have little bits of cataract. In any case, I trusted this doctor. It was good news.
7.4 Hearing test. 3 types of sounds I had to say "yes" when I heard it. "The last type is one which many people thinks they may have or have not heard it," the good doctor laughed when I told him that I could hear something but was not sure.
7.5 Explanation of the Treadmill test. (see para 8 below).
8. The Treadmill test. I had to sign a consent form in case I suffer a heart attack during the test. "Don't worry," the doctor took back the signed form. "My nurse is very experienced in detecting any heart attack and will stop the test." I was given the ECG leads and proceeded to walk slowly. The speed increased. "Stop," I said as I became breathless after the 7th minute. "I need the maximal rate to be 85%," the kind slim senior nurse said. "Do you have chest pains or cramped muscles?" I had neither. I was just breathless and did not want to over-exert myself. The machine must have had reached 85% as the nurse stopped the movement. It was past 9 minutes of threading. She printed out the graphs and did not seem too happy with the reading. The doctor would explain to me.
Bad news. "See the ECG," the doctor showed me. "ECG reading is normal before exercise." I could see the regular repetition of the PQRST complexses throughout the strip of paper.
"After exercise, the blood takes a long time to flow back to the heart, even after 5minutes. The ST curve did not rise up as normally as it should be. Indicating a blockage in the heart's coronary arteries."
Yet I had occasional chest pain like over-exertion but it was once in a few months. So I opted for a CT scan of the heart.
9. CT scan
Blood pressure taken at least 3 times and said to be normal although I could see that it was 138 at the upper value. I cannot remember the lower value. Maybe I should be 138 for my age of 60. I thought it should be less than 120. Must do some research.
BPS. This was below 50 beats per minute. "Exellent reading, so we don't need to give you sedatives as the CT machine dislikes people with high pulse rate," a nurse told me. I thought it was abnormal as bps should be 70. Need to do some research.
An experienced nurse tapped my right hand and inserted a long 23G catheter for the injection of radioactive dye when I went into the CT scan for X-raying.
"MRI would be better," another nurse told me. "There will be no radioactivity but it costs a few hundred dollars more."
10. Abdominal ultrasound scan for abnormalities of the liver, spleen, kidneys usually. This was done before CT scan. An experienced nurse put gel. I had to be scanned from above the abdomen, turned to the right and left side. "Can the ultra-scan detect bones in the stomach?" I asked the cheerful nurse. I knew of one vet who had advised ultrasound scan for foreign body the the dog's stomach to confirm what X-rays had shown some opaque foreign bodies. So I was interested in asking this nurse whether it could be useful. "No," she said. "Too much gas, movement in the stomach." I remembered she said about some fat affecting the results. "I have not done it." I need to do some research here. In foreign bodies in the dog's stomach, X-rays with or without contrast media are traditionally done. I am not convinced that ultra-sounds can pick up foreign bodies in a dog's stomach.
Will stop now. I recorded the above for reference. It is 8 am in Perth on a Sunday. Some Royal Show. Some flower show. The Queen's birthday on Monday. So a long week end. Bright sunshine, blue skies. Clear spring air at Willeton near Murdoch University. I have this sadness as my plane touched down at Perth Airport on Sep 24, 2010. There was a car accident on Sept 3, 2010 affecting a girl whom I had carried as an infant and whom I saw growing up.
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