Friday, October 1, 2010

The 65-year-old gardener

"My body is full of cancer cells," the white-haired, 65-year-old grey-eyed white eye-brow gardener said to me when I met him doing gardening at the house where I was staying in Perth. I had asked why he did not retire and just stayed at home. His children were grown up. He reminded me of an old Englishman in the UK during my undergraduate days. This old English man was still active doing gardening and any housework when I stayed at a bed-and-breakfast home in the 1960s.

I was surprised as he was active and busy doing gardening and cleaning the swimming pool. The gardener elaborated: "When the doctor injected some drug into my spine," the drug caused the arsenic in my body system to form scattered small Grade 2 tumours inside my muscles. So, my body is full of cancer cells."

"What treatment did you receive?" I asked. "Some blood changes," he said. "Nothing can be done to eliminate the tumours. It was from arsenic from my 30 years in the printing firm. Arsenic was used for the printing plates at that time."

He was offered blood changes in the US at a cost of US$50,000 but his doctors advised againt it as it would not completely cure him. "Maybe 40%," he said. The gardener had skin cancer and had taken 18 operatrions. He showed me his leg scars after tumour excision and grafting of the skin. Some rough scars but no tumours. Apparently Caucasians and Irish Caucasians are prone to skin cancers. Now, his wife covered his body with UVL cream. Only his hands were free from skin cancers.

Yet this man lives a positive mindset and did a good job at the gardening and pool cleaning. It took him some one hour to do it and getting exposed to the UVL. Will UVL cream prevent skin cancers? He is a guinea pig as the doctors are using his blood and "soon they have a discovery which will benefit his children to prevent skin cancers in the gene."

Networking or Sucking up to the professors?

"It is actually a smart thing to do," I said when the vet students told me that they don't bother to "suck up"to the professors compared to one classmate. I presume "suck up" means getting closer to them to talk to them during lectures and practicals.

"But this type of networking is not easy for everybody to do. Professors are influential people and if you get to know them better, they think well of you and remember you when you ask for a testimonial. If you distance away from them, you are just an unknown."

To suck up to the professors is not an easy thing to do if you don't have common interests. Common interests will be academic subjects and maybe sports. I don't know as I did not suck up to my Glasgow professors during my undergraduate days. It is an innate abiility - a part of your personality. Such vets will be most successful in getting clientele too and will be in great demand since they bring in the business.

As to how important this public relations nature is, I did get an answer from a top vet student during one dinner after the Royal Perth Show a few days ago. I was talking to her about a young Singapore vet who has excellent public relations according to my feedback. She agreed with my observation and said: "70%" I don't know where she got this statistic but I tend to agree with her that excellent PR is very important. So, sucking up to the professors is part of personal public relations and a training for the real world after graduation. Bedside manners is what public relations mean in medicine.

Sparring partners in vet surgery team

Perth, Sep 30, 2010

Had dinner after library visit. The Chinese restaurant was surprisingly packed with Caucasians on this Thursday. We were the only Asian of vet students and me. I knew that the target clientele is non-Asian. I asked the young man (graduate) waiter. He said that the restaurant cooked to the taste of Caucasians. Prices are maybe 10%. The ambience was good. The restaurant was clean and homely. Food was surprisingly good and better than Singapore standards. Perth is a sprawling place and each suburb has its own shopping mall and restaurants and are located within a 5-minute drive. Competition must be greater than in Singapore as each suburb is small in population.

"You are her sparring partner," I said to the vet student. In Murdoch, each surgical team has 3 vet students. "Sparring partners?" the vet student furrowed her eyebrow and looked at me.

"I am using a boxing analogy," I explained to her. "You and the other student are of the same class and therefore I say you are her sparring partner. Now, if you were at the pits ie. bottom of the examination ranking, you will not be her sparring partner as one punch will knock you out. She will not bother to discuss any academic subjects with you since you would not be up to her standards."

I said: "It is important to get a sparring partner if one wants to excel as the punches from your sparring partner pushes you to your limit of endurance." It sounds too technical to this young girl.

"I can't measure to her standards," she said to me.

"It is your mindset that tells you that," I said. "When your mind defeats you, you have already lost the first round of boxing. The positive mindset is very important to a scholar or sportsman. If you think you can't win, you have already lost."

The girl was not convinced. She must have lost a few battles in her mind and soul and would be realistic.

"It is the date of graduation that will decide the winner," I said. "Many things can happen to your sparring partner and nobody can predict the future."

Changing the method of study may be one way. I can't advise further as self-motivation and the competitive spirit are in the DNA of a person. Much depends on the growing up years of the youth and the family nuturing. But a sparring partner of similar ability will push one to greater heights and win, if one has the positive mindset to do it. "Do your best," I said to her. But how to do it? I have no answer as I am not a training coach.











In Willeton, Australia, Thursday's supermarkets like Cole (except IGA supermarkets which open 7 days a week) close late to 9 pm.

Ovariectomy and ovariohysterectomy in dogs and cats

Sep 30, 2010 Perth Murdoch Vet Library
A cloudy day

A one-week break for Murdoch Univ students ending in Oct 3, 2010. I was surprised to see around 5-10 students at the Murdoch Vet Library for some time from 8.30 am to 6.30 pm to read their latest vet journals. Singapore has no vet library at all and so it is a great joy to read the various publications including old issues in this Vet library.

One article of great interest to small animal vets and new vets is in "In Practice" Jul/Aug 2010 Vol 32, No. 7 and also Sep/Oct 2010 No.8 as the two articles describe medical and surgical conditions of the reproductive system in the dog and cat in detail.

Before I get distracted and do other things, I will share my experiences of the past 30 years in small animal practice and also comment on the "surgical complications of spay" from Jul/Aug issue on "Surgical diseases of the female genital tract. Part 1. Ovaries and Uterus"

The authors mention that haemorrhage during spay is usually from the ovarian vessels and propose a solution - find the bleeding pedicle using "duodenal or colic manoeuvres." I have not heard of these manoeuvres. Always new things to discover. My solution is just to track the bleeding pedicle to the kidney area by parting the omentum and looking for the bleeding pedicle. An explanation or reference should be given by the authors.

Bleeding after spay can also be from:
1. Uterine blood vessels. The authors say that blood appears at the vulva.
2. Omental fat and the broad ligament blood vessels esp. when the dog is on heat.

If there is significant blood loss, repeat the surgery. The authors said to check the demeanour of the dog post op and check pulse rate and quality, PCV/total solids.


OVARIECTOMY is mentioned as an alternative to OVARIOHYSTERECTOMY in normal spays where there is no pyometra or neoplasia.


STUMP PYOMETRA AND REMNANT OF OVARIAN TISSUE
The authors say that if there are no remnants of ovarian tissue or use of exogenous progesterone (e.g. Ovarid being given to the dog), Ovariectomy will not lead to stump pyometra. Uterine neoplasia is very rare in the female dog and so Ovariectomy is OK. But most UK vets still do Ovariectomy.

In my 30 years in practice, I only encountered one case of stump pyometra in a dog spayed elsewhere. I excised the stump but did not do extensive laparatomy to look for the remnant ovarian tissues as the dog was old. The owner complained about vaginal discharge and pus happening even though the female dog was spayed.

BREAKING THE SUSPENSORY OVARIAN LIGAMENT attached to the kidney. In the early years, surgical books used to advise breaking the ovarian ligament using finger pressure.
I used this advice but it is not practical as sometimes the ovarian blood vessels get broken too. This leads to haemorrhage of the ovarian pedicle as mentioned by the authors and it is worrying.

Some 15 years ago, I use the scalpel blade just to cut off the ligament and then proceed to ligate the ovarian vessels. The ligament is quite taut and a scapel cut is so easy. I seldom have bleeding after spay unless the omental blood vessels of a dog in heat were bleeding. Very rarely do I have bleeding in the past 15 years.

DOUBLE LIGATURE OF THE UTERINE BODY.
I find this sufficient and have no post-op bleeding complaints or death. Transfixing ligature is an alternative in pregnant dogs. In pyometra, I invert the uterine body stump to prevent leakage of pus into the abdomen. Normally post-op antibiotics for 2 weeks prevent infection.

HOW LONG SHOULD THE UTERINE HORN BE LIGATED AND CUT OFF?
The authors said there is no worry about the ureters being ligated together with a longer uterine body. Ureters enter the bladder directly. In any case, if the ovarian tissues are completely removed, there will be no remnant ovarian tissues to cause vaginal discharge again. Ovaries are the only source of progesterone and if no exogeneous progesterone is given (e.g. Ovarid), the spayed dog will have no vaginal discharge regularly. Therefore, a shorter uterine body can be ligated without problem. Also uterine neoplasia is very rare in the dog. So, no problem here with a longer uterine stump left behind.

I don't excise too long a uterine stump in dogs, cats or rabbits. Just in case, the ureters are caught accidentally inside the ligatures. This may happen rarely but has not happened to me. Vet anatomy is full of surprises and one must be verfy careful not to be caught in cases of abnormal more cranial positioning of the ureters in the female dog.


SPAYING A PREGNANT DOG WITH PUPS
No problem with milk production as the dam will still produce milk even after spay during a caesarean section. Different hormonal pathways involved in milk production. This is where vet studies of endocrinology (4th year vet students to note) can be very useful in providing the answers as to whether milk production will cease once a dam is spayed during Caesarean section of dystocia and depriving the pups of the dam's milk.

BLOOD SEEN IN THE UTERUS AFTER SPAYING
The authors mention that blood seen after spaying could be due to haemorrhage of slipped ligature of the uterine body.

In the past 30 years, I had one complaint of the Lhasa Apso spayed by me. The owner complained of some blood seen. It could be due to incipient estrus. I noted a cystic lump in the uterus (starting of pyometra) and had taken photos. Blood stopped flowing after 2 or 3 days. The Lhasa Apso is very much alive and loved (if you see her blog or facebook) today.


LAPAROSCOPIC OVARIECTOMY OR OVARIOHYSTERECTOMY. The authors say specialised training is needed. I doubt there is a demand for such services as they will be very costly.

TIPS FOR INEXPERIENCED VETS
1. Spay is a major surgery.
2. Make a large incision from umbilicus to half way between umbilicus and pelvic inlet.
3. Get vet nurse to assist. (Use of abdominal retractors? I don't think the authors mention this).
4. Find the bleeding pedicle using "duodenal or colic manoeuvres." This was stated twice in the article but no further reference.

MY COMMENTS
Spay is easy if the incision is larger than 5 cm and be nearer to the umbilicus and the dog is not fat. I use a 2.5 cm incision but inexperienced vets should not cut so short as it takes time to learn how to hook out the ovaries. I have written several articles on my spay surgical approach in www.toapayohvets.com

FAT FEMALE DOG SPAY
I still remember a new Murdoch Univ vet graduate who worked for me some 20 years ago. He was unfortunate to get a big fat cross-bred of 20 kg. His brows were sweating as he could not locate the uterus despite a large incision. It took a bit longer to hook out the uterus in fat dogs. I still dread spaying fat dogs even though I have so many years of experience.

SPAY 3 MONTHS AFTER THE END OF HEAT
The authors did not include this advice but it is sound advice. Very little bleeding from the omental and broad ligament blood vessels. Even the ovarian and uterine blood vessels have shrunk in size.

LIGATING THE UTERINE BLOOD VESSELS AND TRANSFIXATION OF THE UTERUS
The authors advise this to be done. For me, I normally clamp the uterine body twice and ligate the whole body twice. In pregnant dog spay, I have to be careful and may ligate the uterine blood vessels separately via incision through the side of the uterine body and ligate before finally ligating the whole uterine body twice. This is overkill. Or I place a transfixing ligature.

DO NOT USE CATGUT
The authors say that catgut is not suitable. Something about capillary action (I need to check on this), fast dissolving and difficulty in knotting. I have not used catgut for the past 20 years. Like the authors, I use syntetic absorbable sutures. They definitely dissolve much slower.

Overall, the surgical articles in both issues are very useful to practising vets as part of their continuing education. Photographs are in colour and surgical approaches are shared. Episiotomy (extra-luminal tumour of the vagina) and episioplasty (excess skin folds around vulva causing dermatitis) surgical procedures are shown.


EPISIOTOMY FOR REMOVAL OF VAGINAL TUMOUR

The use of straight bowel clamps on either side of the vulva is a great idea as in horizontal ear canal resection. One arm of the clamp is placed inside the vestibule and one arm of the clamp on the perineum on the leftmost side of the tumour. Similarly for the other clamp to the rightmost side. The skin is cut in between. An assistant holds the clamp apart. The extralumninal vaginal tumour is seen cranial to the urethral orifice (catherised) and dissected. A beautiful photo shows the anatomy of the area with the urethral orifice seen clearly very well.

Closure in 3 layers - vaginal mucosa, muscle and then the skin.


EPIOSIOPLASTY
Stretch the loose skin upwards and sideways. Excise a crescent-shaped piece of skin above the dorsal aspect of the vulval lips. First incision around the 9 o'clock and 3 o'clock position. Then a parallel one dorsal. Stitch up after excision of the crescent piece of excess skin. Same surgical procedures as in entropion surgery.


INTERSEX
Excellent definitions of male pseudohermaphroditism (enlarged clitoris but testicles producing testosterone inside abdomen) and female pseudohermaphritism (small penis and ovaries inside scrrtoum), true hermaphroditism (have ovarian and testicular tissues)

For more details, it is best for vet undergraduates to rush to the Vet Library to download a copy. I am sure you will get HD (High Distinction is over 80%) in this fascinating animal sexuality topic in your stage of life.

Acupressure project

E-MAIL TO DR SING DATED OCT 1, 2010

To: Dr Sing Kong Yuen

We are a group of students from ...(Pre University) and we are doing a project on the general well being of the animals. Our project focus is to suggest the use of acupressure on the animals housed in animal shelters. We hope to influence pet owners as well as our cohorts to raise their awareness that animals' general well-being is equally important as physical well-being. We feel this issue would be best demonstrated through helping the animals in animal shelters.



To be more detailed; the objectives of our project are to extend the benefits of acupressure to animals in organizations such as animal shelters, SPCA, the Singapore Turf Club and pet obedience schools. We understand that animals in these organizations receive sufficient medical treatment; however, we feel more could be done for the animals.



We are formulating a proposal to as part of our project, and we would be extremely grateful if you could help us with the following questions:



1) We would just want to find out whether animal shelters would send their animals to you or you would visit the animal shelter if there was a sick animal?

2) We have designed a product that could help an acupressure practitioner to perform the therapy conveniently at any location. We would like to seek your professional advice on our product to see its feasibility. Attached is the general product of how our product would be like.



If you need further information, please contact us via this email:


Thank you very much for your kind attention and cooperation.



E-MAIL REPLY FROM DR SING

In your project proposal, please define "Acupressure". Also state why should animal owners want acupressure for their animals? What are the benefits and the costs? Are there commercial products available?


As for animal shelter animals, they are usually in great need of money and many volunteers to sustain their operations. They do send sick animals to the vet for treatment as it is relatively lower cost than house-calls.

In my opinion, acupressure may not be practical for their situation. Your proposed product for aromatherapy use may be useful for dog owners who may want aromatherapy as an alternative veterinary medical treatment.

As for racehorses, I think your product is not appropriate.

Thursday, September 30, 2010

Communications with younger generation - English

"English is a difficult language to master," I said to the young lady who stated that she had not heard of the word "nincompoop". I was having dinner with a group of 4th year vet students after the Royal Perth Show.

If you are in the puppy business, you may think it has something to do with toilet-training "poo" or "poop"

Have I heard of it? Yes. It means a foolish silly person. The young lady next to me whipped out her mobile phone, checked the meaning and showed it to me. No more wasting time on offline dictionaries. Communications with the young in the "Queen's English" is sometimes not possible. Some examples are:

1. "Why so drama?" the husband asked the wife. I was having dinner with the younger generation in their late 30s in Joondalup yesterday. The husband meant "What are you so dramatic?"

2. When I said to a young vet undergraduate that I would like to be properly introduced to her friend and husband, she said she would arrange a dinner meeting. I asked: "Does your friend entertain at home?" The young lady said: "Yes, she is able to chat easily with people". I meant whether she hosts dinner at home.

3. My young intern Ms Lai worked for a famous gynecologist who was my secondary school classmate and who highly recommended her for an internship with me - a condition of her internship as she had mentioned his name as a referree. One day I asked: "Have you seen him lately?" I wanted to catch up with this old classmate whom I had not met for over 15 years.

"No," she said. "I feel embarrassed to see him." She meant she would not consult him for her gynecological problems as she worked closely with him on a hornbill project.


4. "The young vet has excellent public relations," I said to the young lady who did not know the meaning of "nincompoop" earlier. She agreed with my opiniated comments.

I continued: "You know, in the pet internet forums, some lady clients said that if you want "eye candy", bring your dog to consult him."

"No, no," this young lady objected. "He is no eye candy." At least there is one communication I successfully carried on with one young one. I am a male and so I do not know whether the particular young vet is eye candy or not.




So, communications with the younger generation of Singaporeans by the old foggies can be quite alarming and interersting sometimes.

121. Vet communications

DRAFT
Perth, Thursday, September 30, 2010 6.28 am.

During a dinner after the Perth Royal Show, a 4th year vet undergraduate asked me what do I look for in employing a vet? This lady sure knows what to ask.
Excellent Communications skills with clients is a fore-most trait I look for in a new vet who wants to work at Toa Payoh Vets.

The following notes from a book in Murdoch University library on Sep 28, 2010 may seem irrevelant as it applies to the art of communications with readers of newspapers but the basic principles apply to veterinary communications in newsletters and brochures.


Book: Journalism & Meaning-making – Reading the Newspaper, edited by Verica Ruper, 2010.

Two articles I will summarise here.

1. "Images and Text face off in the broadsheet feature story by Dorothy Economou, Univ of Sydney" - The Stand Out - an unrecognised newws genre.

2. "Image-nuclear news stories" - a new news story genre by Helen Caple, Univ of Wollongong.


ARTICLE NO. 1 - IMAGES AND TEXT FACE OFF
D. Economou said that the standout is an unrecongised news genre. It has the obligatory 5 components:
1. Large image or images (colourful pictures, illustrations)
2. Main bold headline ("screamer" headline")
3. Image captions ("screamer" captions)
4. by-line
5. Sub-headline (stand-first or write-off)

The 5 components enable busy masses of readrs to be attracted to buy the SMH. Others who want to read the long-feature story will go into details further inside the SMH.

The layout of 4 columns is as follows:

NUCLEUS: LURE (lst row, all 4 columns spanned)
Image 1

Headline Image 2 (right-most 4th column)

Satellite: Image 3 (3rd column) overlap 2nd row
Point Satellite: "Quote" e.g. letter from somebody Satellite:
Imager Anchor

ORBITAL STRUCTURE OF A STANDOUT EXAMPLE

I will post a picture as blogger.com does not accept tables.

The "Point" with its verbal component (the standfirst or abstract of the written story) is the "story" in the Standout.

She said that the standout is visually provocative and verbaby abbreviated.




ARTICLE NO. 2
The writer, Helen Caple stated that the Sydney Morning Herald (SMH) presents news in a new and innovative manner using the IMAGE-NUCLEAR NEWS STORIES which is a new news story genre. It said THE STANDOUT is an unrecognised news genre.

Basically it means that the SMH presents a new format to capture the attention of the busy time-pressed readers with a large picture and some text. if the reader wants more info, he can read the in-depth report further in the newspapers. In this format, the SMH sustains its readership and its profitablility by retaining advertisers and reader loyalty.

Helen Caple said that the SMH prints a large photograph with a heading (not a headline) above and a short caption either below or to the side of the picture. No more text, hence she called it the "Image-nuclear news story". The heading is witty and interests SMH's cateogry of readers.

HOW DOES THE ABOVE APPLY TO VET COMMUNICATIONS IN EDUCATING THE CLIENT ABOUT SURGICAL PROCEDURES? The following are my thoughts of applying the above to vet communications and education material


1. Big colourful pictures and text to "lure" or attract the client - Dog's eye pops out?
2. A "screamer" headline e.g. "Save your dog's eyesight or lose the eye by procrastination?"
3. Image captions explaining the surgical procedures in brief.
4. By-line - name of vet or surgery
5. Sub-headline - summary of surgical procedure.

Reading about other industry practices can and do provide new ideas to veterinary industry usually. Unfortunately, you need time to devote to research and reading. The above took me 2 hours to read and to draft. I still have to take a picture to illustrate what I mean.