E-MAIL TO DR SING DATED OCT 19, 2010
Hi,
I have 2 chihuahuas, they are both siblings from the same parent (just a batch difference). My female Chihuahua which I recently adopted after being used for breeding by pet shop and pretty much traumatised with low self esteem is on heat recently, and this has gone on for a few days to about a week. Just an hour ago I heard my female Chihuahua yelped and I found that the two of them were in the midst of a sexually engagement, it was impossible to separate the two. Could you please advise me on the next course of action to take as we are not ready for puppies especially when there’s a chance of the puppies being deformed due to the same family line of breeding, which can be very heartbreaking.
When we first adopted the female Chihuahua which was on 28 July 2010 (less than 3 months), her heat was already clearing up. We brought her to a clinic in hope of having her spayed, but the vet advised that we wait a few months to let her build some self confidence first, so we brought her home instead. So we didn’t expect her heat to come in less than 3 months time, and this had to happen when we were caught off guard with our work.
We would really appreciate all advices from you, in the best interest of the two Chihuahuas. Thank you!
Lots of Love,
Name
E-MAIL FROM DR SING DATED OCT 19, 2010
I am Dr Sing from Toa Payoh Vets. I offer the following advices.
1. If you don't want the offspring from the recent mating, please make an appointment with me to get the female dog spayed as soon as possible. If the female dog is healthy, there should be no anaesthetic problems during spay.
2. If you want breeding at a future date, come for an anti-conception injection promptly. This is effective if the injection is given within 3 days after mating. After the injection, you have to separate the male from the female and the heat period will be prolonged.
3. Come for pregnancy diagnosis around 3-4 weeks after mating to check if the dog is pregnant. Spay the dog when she is pregnant. There is a higher risk of spaying a pregnant dog but usually there should be no anaesthetic or bleeding death.
4. Come for an elective Caesarean section at the 60th - 65th day or when there are signs of impending birth. If the puppies are deformed, you have to decide what to do. This requires more than one consultation with the vet if you want to have good results.
5. Neuter the male Chihuahua if you don't future misalliances (accidental mating) and lots of worries.
Let me know if you more queries or phone the Toa Payoh Vets at 6254 3326.
Tuesday, October 19, 2010
Monday, October 18, 2010
Continuing Education and networking at SVA Conference 2010
Continuing education by attending seminars can provide useful knowledge in veterinary medicine and surgery as the speakers share experiences and latest knowledge in their field.
WHAT I LEARNT
1. The Australian vet aged around 69 years old has a large cat practice in Australia. He shared lots of useful experiences about cat surgeries and anaesthesia, pain killers and dosages. I asked him whether he has a book about his lectures.
It is a pity he has no time to record his experiences with dosages and effects of drugs in cats in a book as he has better things to do. His presentation was not boring as he inserted humourous video clips so that the audience does not fall asleep. I took images of his slides for knowledge management. Many of his surgical info can be applied to dogs, rabbits, ferrets. He does not favour domitor. Prefers methadone, fentanyl patches and meloxicam for cat analgesia.
2. An American vet from Guam has set up a top vet hospital in Guam though he was the last to set up. He has a vet who goes around the islands to do sterilisations and treat animals. He treated 7 dolphins.
Most common case is dog bite wounds. The vet bill would be around US$400 as they are serious wounds. Sterilisation is around US$30-35 payable in advance and no refunds. There are 5 practices in Guam which has a population of 170,000 and includes 42 islands nearby. Two vet practices may be closing down. "Are they backwards?" I asked. "Yes," he said. "They don't have gaseous anaesthetic machines."
I think success in vet practice is not a given as there are many factors involved. As at Oct 2010, Singapore's 41st small animal practice will be set up, one Hills' representative told me when he visited me.
The American vet has a sense of humour. Dr James Tan and I had the impression of him as the stereotypical Harley Davidson biker zooming on the highways of Guam in leather jackets and helmets. He looked like one. White haired, pony-tailed, white beard, a big sized belly and a commanding presence. Dr Tan expressed his thoughts of him as a HD biker. "No," he said. "I don't ride bikes since I had falls when I was 17. It is too painful." He is in his 50s. I will like to visit Guam one of these days and see his hospital.
Once he performed a Caesarean on a cow in Guam. "I had not done Caesarean for over 43years. So I phoned my friend in the U.S for help. Then I tied the cow to the tree while I operated. As I cut, the cow moved sideways. Coconuts started to fall from the tree."
"No coconut fell on your head?" I asked.
"No, no," he replied. "My assistants held up two umbrellas while I operated."
Cow caesareans are traditionally done in the field with epidural anaesthesia during my internship in Scotland in the early 1970s. Anaesthesia may have changed. The incision is from the flank. It is non-sterile surgery but the cow usually is OK with antibiotics.
Attending local conferences can be very interesting if the vet bothers to get to know the foreign vets instead of sitting with their friends.
WHAT I LEARNT
1. The Australian vet aged around 69 years old has a large cat practice in Australia. He shared lots of useful experiences about cat surgeries and anaesthesia, pain killers and dosages. I asked him whether he has a book about his lectures.
It is a pity he has no time to record his experiences with dosages and effects of drugs in cats in a book as he has better things to do. His presentation was not boring as he inserted humourous video clips so that the audience does not fall asleep. I took images of his slides for knowledge management. Many of his surgical info can be applied to dogs, rabbits, ferrets. He does not favour domitor. Prefers methadone, fentanyl patches and meloxicam for cat analgesia.
2. An American vet from Guam has set up a top vet hospital in Guam though he was the last to set up. He has a vet who goes around the islands to do sterilisations and treat animals. He treated 7 dolphins.
Most common case is dog bite wounds. The vet bill would be around US$400 as they are serious wounds. Sterilisation is around US$30-35 payable in advance and no refunds. There are 5 practices in Guam which has a population of 170,000 and includes 42 islands nearby. Two vet practices may be closing down. "Are they backwards?" I asked. "Yes," he said. "They don't have gaseous anaesthetic machines."
I think success in vet practice is not a given as there are many factors involved. As at Oct 2010, Singapore's 41st small animal practice will be set up, one Hills' representative told me when he visited me.
The American vet has a sense of humour. Dr James Tan and I had the impression of him as the stereotypical Harley Davidson biker zooming on the highways of Guam in leather jackets and helmets. He looked like one. White haired, pony-tailed, white beard, a big sized belly and a commanding presence. Dr Tan expressed his thoughts of him as a HD biker. "No," he said. "I don't ride bikes since I had falls when I was 17. It is too painful." He is in his 50s. I will like to visit Guam one of these days and see his hospital.
Once he performed a Caesarean on a cow in Guam. "I had not done Caesarean for over 43years. So I phoned my friend in the U.S for help. Then I tied the cow to the tree while I operated. As I cut, the cow moved sideways. Coconuts started to fall from the tree."
"No coconut fell on your head?" I asked.
"No, no," he replied. "My assistants held up two umbrellas while I operated."
Cow caesareans are traditionally done in the field with epidural anaesthesia during my internship in Scotland in the early 1970s. Anaesthesia may have changed. The incision is from the flank. It is non-sterile surgery but the cow usually is OK with antibiotics.
Attending local conferences can be very interesting if the vet bothers to get to know the foreign vets instead of sitting with their friends.
Friday, October 15, 2010
Starting up a company at the age of 50 years
An old friend (Allan) wanted to be free from office politics and to start his own company at the age of 50 years.
He asked me for advice on his proposed event management company start-up with two trustworthy partners (Brian and Charlie). All 3 will have equal shares in a private Limited Company. Since he would be the one bringing in most of the business via his old clientele while the other two provides administrative and backup services, all 3 agreed to the respective following distribution of profits at 40:35:25 with Allan getting 40%. There will be no salary for the first 3-6 months. After 3 months, all 3-6 months, all 3 will get a salary based on 40:35:25 formula every month.
MY QUERIES
1. How much are Brian and Charlie earning now? Brian is unemployed, having left his food and beverage (F&B) hotel job in Vietnam. Charlie is earning around $5,000 a month as an employee in the F&B business.
2. What amount of revenue can Brian and Charlie generate? Practically none. They just provide the support services as they do not have business development experience or important decision-making clientele to generate business.
3. Is Charlie an IT expert? He has some information technology (IT) knowledge but is not an IT experienced. Therefore he has no valuable contribution and in any case, an event-management business does not depend mainly on IT skills and expertise.
MY OPINION
1. Brian and Charlie have 66.6% of the shares. In any company resolution, they can out-vote or frustrate Allan's plans for the business expansion or changes. Allan will be unhappiness when they do that since they don't generate income and are more like "sleeping partners".
2. Since Brian and Charlie will not be generating income, they are not worth being given 35% and 25% of the net profits.
3. What happens if Brian and Charlie find better job prospects since they don't get salaries for the first 3-6 months? Or they take long leave, die or become sick? They still get their 60% every month as agreed, assuming the company is profitable.
4. In the end, Allan will feel very unhappy as he brings in practically 100% of the revenue and gets 40% of the net profits. If he is that good, he should be getting the lion's share of the profits.
Getting in the business and sustaining the profitability of any business is extremely hard work while administrative services can be outsourced. If the business really generates $6 million in revenue as projected by Allan, there is no problem employing good people to do administrative work. Of course, Allan must be involved in ensuring that the accounts are properly kept.
CONCLUSION
Allan should be getting the controlling share of at least 51%. There are the operating costs to think about.
I know Allan has the clientele and can generate the $6 million revenue he projected since he is battle-tested for the past 30 years. He is now around 50 years old. He had started up two small businesses before and knew success in earning big money is not guaranteed. That was why he worked for others as there is a steady income every month.
With a large clientele who trust him, he ought to have the confidence to start up small. He needs to change his mindset that there must be a big office, top IT facilities and supporting staff as in established event management companies to be able to succeed as an entrepreneur.
He had seen too many people failing in businesses and that was why he worked for hotels and resorts for the past 30 years as an employee. There will always be office politics in corporations from employees and if he really can bring in a $6-million event management business, I don't see why he cannot be successful on his own now that he has been "battle-tested".
A better business model will be to give Brian and Charlie a commission based on each project they successfully completed. If they can't do the project, there are many others who can be out-sourced to do it. Otherwise, they still get paid a combined 60% of the net profit every month. This is a large amount if the revenue generated is $6 million a year. Assuming conservatively 5% as net profits, the income will be $300,000. Allan will get $120,000 but his non-income generating administrative partners making the connections get $180,000! He will not be happy to continue the business relationship and there will be nasty feelings when the business breaks up.
The $180,000 can be used to employ good energetic people who have been battle-tested in the getting more business deals. In business, it is how much profits you can generate for the company, not how good your administration is. Without income, top companies close down even though they are well administered. An ability to bring home the bacon is what counts in business start ups, whether one is a private veterinarian opening his veterinary clinic or an event manager.
P.S. "Bring home the bacon". Singaporeans generally don't eat bacon and eats for breakfast unlike the English and so may not appreciate the title of the story. I studied in Glasgow in the late 1960s and my favourite breakfast in the hall of residence was bacon and eggs. "Bring home the bacon" means to "achieve desired results or have success" in this story.
He asked me for advice on his proposed event management company start-up with two trustworthy partners (Brian and Charlie). All 3 will have equal shares in a private Limited Company. Since he would be the one bringing in most of the business via his old clientele while the other two provides administrative and backup services, all 3 agreed to the respective following distribution of profits at 40:35:25 with Allan getting 40%. There will be no salary for the first 3-6 months. After 3 months, all 3-6 months, all 3 will get a salary based on 40:35:25 formula every month.
MY QUERIES
1. How much are Brian and Charlie earning now? Brian is unemployed, having left his food and beverage (F&B) hotel job in Vietnam. Charlie is earning around $5,000 a month as an employee in the F&B business.
2. What amount of revenue can Brian and Charlie generate? Practically none. They just provide the support services as they do not have business development experience or important decision-making clientele to generate business.
3. Is Charlie an IT expert? He has some information technology (IT) knowledge but is not an IT experienced. Therefore he has no valuable contribution and in any case, an event-management business does not depend mainly on IT skills and expertise.
MY OPINION
1. Brian and Charlie have 66.6% of the shares. In any company resolution, they can out-vote or frustrate Allan's plans for the business expansion or changes. Allan will be unhappiness when they do that since they don't generate income and are more like "sleeping partners".
2. Since Brian and Charlie will not be generating income, they are not worth being given 35% and 25% of the net profits.
3. What happens if Brian and Charlie find better job prospects since they don't get salaries for the first 3-6 months? Or they take long leave, die or become sick? They still get their 60% every month as agreed, assuming the company is profitable.
4. In the end, Allan will feel very unhappy as he brings in practically 100% of the revenue and gets 40% of the net profits. If he is that good, he should be getting the lion's share of the profits.
Getting in the business and sustaining the profitability of any business is extremely hard work while administrative services can be outsourced. If the business really generates $6 million in revenue as projected by Allan, there is no problem employing good people to do administrative work. Of course, Allan must be involved in ensuring that the accounts are properly kept.
CONCLUSION
Allan should be getting the controlling share of at least 51%. There are the operating costs to think about.
I know Allan has the clientele and can generate the $6 million revenue he projected since he is battle-tested for the past 30 years. He is now around 50 years old. He had started up two small businesses before and knew success in earning big money is not guaranteed. That was why he worked for others as there is a steady income every month.
With a large clientele who trust him, he ought to have the confidence to start up small. He needs to change his mindset that there must be a big office, top IT facilities and supporting staff as in established event management companies to be able to succeed as an entrepreneur.
He had seen too many people failing in businesses and that was why he worked for hotels and resorts for the past 30 years as an employee. There will always be office politics in corporations from employees and if he really can bring in a $6-million event management business, I don't see why he cannot be successful on his own now that he has been "battle-tested".
A better business model will be to give Brian and Charlie a commission based on each project they successfully completed. If they can't do the project, there are many others who can be out-sourced to do it. Otherwise, they still get paid a combined 60% of the net profit every month. This is a large amount if the revenue generated is $6 million a year. Assuming conservatively 5% as net profits, the income will be $300,000. Allan will get $120,000 but his non-income generating administrative partners making the connections get $180,000! He will not be happy to continue the business relationship and there will be nasty feelings when the business breaks up.
The $180,000 can be used to employ good energetic people who have been battle-tested in the getting more business deals. In business, it is how much profits you can generate for the company, not how good your administration is. Without income, top companies close down even though they are well administered. An ability to bring home the bacon is what counts in business start ups, whether one is a private veterinarian opening his veterinary clinic or an event manager.
P.S. "Bring home the bacon". Singaporeans generally don't eat bacon and eats for breakfast unlike the English and so may not appreciate the title of the story. I studied in Glasgow in the late 1960s and my favourite breakfast in the hall of residence was bacon and eggs. "Bring home the bacon" means to "achieve desired results or have success" in this story.
Monday, October 11, 2010
219. Malignant cheek tumour & accountability of a vet
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
The miniature schnauzer had a malignant cheek tumour which was removed twice. See:
Malignant cheek tumour in an old Miniature Schnauzer
The tumour grows back a second time two months later. It was excised. It recurs for the 3rd time. The dog could not eat normally and had a painful mouth. The young lady owner wanted another operation without the dog dying on the operating table.
"It is highly risky to do anaesthesia on an old dog," I warned her of the possibility of death again. "This old dog had survived two general anaesthesias. His cheek tumour is malignant as it keeps doubling in size every week. Why don't you consider chemotherapy?"
The young lady did not want chemotherapy for her beloved companion as it had side effects and was not guaranteed to work. I told her that I needed to remove the cheek tumour from outside by blunt dissection from the skin.
"Your dog may be paralysed," I said. "There will be a lot of bleeding."
The lady said: "Why don't you operate from inside the cheek to remove the cheek tumour as you had done before?"
"I need to cut away as much of the cancer cells as possible. There may be a root of the tumour and I need to access the root from the skin to dissect away the tumours. If all cancerous cells can be removed from the skin approach, it will be good for your dog. Provided he survives the operation which will take a long time compared to the previous two excisions"
The lady was worried about deaths on the operating table. Every time an old dog is put under general anaesthesia, the chances of dying are increased. Every time a vet operates on such high-risk dogs, he or she is bound to suffer fatalities and damage to his reputation.
The dog was given antibiotics and painkillers for the next 2 weeks. The lady did not turn up on the appointed day and so I thought she decided to opt out of the surgery. Then she turned up. She was a busy working girl.
PRE-SURGERY
Antibiotic and anti-inflammatory pred injection on day 1 and antibiotics after Day 1. On Day 2, tolfedine pain-killer oral. No pain in the cheeks on Day 3. Surgery on Day 4 after admission. An IV drip is very important in case emergency drugs are needed.
ANAESTHESIA
Domitor 0.2 ml IV from the IV saline drip line. The dog had a cyanotic tongue. It was not a good sign of health. I had a premonition that he would die on the operating table.
TEAM
Teamwork is essential in this high-risk anaesthestic case. I had two experienced assistants who are old experienced Myanmar vets with over 20 years of experience combined and Dr Vanessa Lim to assist.
SURGERY TIPS
1. "I don't need the scalpel blade," I said to my assistants. "An electro-surgery electrode needle incises the skin."
2. "Dissection with scissors is not advised," I explained to my assistants. "I will use the electrode to separate this hard mass of tumour from under the skin. The tumour has a capsule."
3. Bleeding. Electro-surgery reduces bleeding considerably. There was a small bursting artery which was clamped. I could not find the big vein or artery supplying blood to the tumour nodules. There were 3 nodules inside the cheek muscles.
4. "Where to incise?" I asked my assistants as part of my mentoring process. "A horizontal cut or vertical curved cut or both?" They had to think.
EMERGENCY RESUSCITATION
The surgery took more than 30 minutes. The shorter the better survival rate for an old dog. "The dog has died," my second assistant pointed to the dilated pupil which now showed a whitish cataract. A matted white. The isoflurane gas was given at a minimum. Too little, the dog's cheek muscles would twitch and so I had asked for an increase. There was no twitching and surgical dissection proceeded smoothly. Too smoothly.
Now the dog had stopped breathing. He had not died as my first assistant in charge of anaesthesia had much experience and had observed regular breathing. A dilated pupil is common in the deepest surgical anaesthetic stage.
A big dilated pupil could also mean imminent death or death. Whatever it was, I stopped the anaesthesia, blew air into the trachea tube and started cardiac massage immediately. Three cardiac massages and blow three times. My second assistant flushed out the isoflurane gas by pressing the red button and gave me the tube to connect oxygen to the dog. "It is better to blow air in and massage the heart," I advised. The dog was not breathing normally. A stethoscope to check the heart beating showed no sounds. My lst assistant injected Doxapram respiratory stimulant 1.0 ml into the IV line. I continued cardiac massage and air blowing into the tracheal tube. My 2nd assistant injected 0.2 ml Antisedan which is the antidote for Domitor.
It took more than 5 minutes but it seemed like eternity. "There was no hope," I thought as I could not hear the breathing sounds when I put my ears to the endotracheal tube after several cardiac massages. At one time, my first assistant would compress the heart from the top while I put my hand on the lower part of the dog's chest. It was touch and go. The dog started breathing.
My second assistant offered me the anaesthetic tube to connect to the endotracheal tube as the surgery was only 95% complete. There was the stitching to be done.
"God may not give 2nd chances," I pointed above my head and declined the anaesthetic connection to the gas machine. The Antisedan had reversed the Domitor sedation and the dog's head started to move. There was little time to stitch up. Subcutaneous stitching in certain areas could be done. Horizontal mattress stitches quickly closed up the skin incision. The dog put up his head in around 3 minutes as if he had a long nap. He did not cry or whine. Dr Vanessa Lin gave me the meloxicalm pain-killers. "It is best not to inject any drug to this old dog as he might just die after the pain-killer injection," I thanked her.
fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore
antibiotics for 10-14 days before surgery as tumour is badly infected 3 hard nodules in the cheek muscles. Domitor 0.2 ml IV given malignant tumours as they double in size every week
fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore
the owner did not turn up for appointment till 2 days later. Tumour is infected electro-incision close to the skin. Thoroughly remove remnants of cancer cells 3 cheek tumours excised leaving a big hole in the cheek but there is the skin to close up the wound
fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore tpvets_logo.jpg (2726 bytes)3827 - 3834. Malignant cheek tumours excised via the skin approach.
a third nodule is not shown here. Histopathology is being done <1 hour after completion of surgery. Dog is ok
A dog alive is what the owner wanted. Nothing more. No excuses. The dog ate 2 days after surgery and should be going home soon. In high-risk anaesthetic cases, it is best to have a team of experienced assistants. The brain dies when it is deprived of oxygen and in this case, a team definitely helped to revive this old beloved companion for the young lady.
The anaesthetist is more important than the surgeon as anaesthesia deaths are fatal. An experienced team is advised in high anaesthetic cases. Intubation and IV drip line are essential in such surgeries. If the surgery can be completed in less than 154 minutes, old dogs seldom die but in this case, the 3 tumours were large and time had to be spent on bluntly dissecting them to prevent excessive bleeding. Surgery took more than 30 minutes to complete. It was through teamwork that the old dog did not die on the operating table.
Pictures and details are at www.toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
The miniature schnauzer had a malignant cheek tumour which was removed twice. See:
Malignant cheek tumour in an old Miniature Schnauzer
The tumour grows back a second time two months later. It was excised. It recurs for the 3rd time. The dog could not eat normally and had a painful mouth. The young lady owner wanted another operation without the dog dying on the operating table.
"It is highly risky to do anaesthesia on an old dog," I warned her of the possibility of death again. "This old dog had survived two general anaesthesias. His cheek tumour is malignant as it keeps doubling in size every week. Why don't you consider chemotherapy?"
The young lady did not want chemotherapy for her beloved companion as it had side effects and was not guaranteed to work. I told her that I needed to remove the cheek tumour from outside by blunt dissection from the skin.
"Your dog may be paralysed," I said. "There will be a lot of bleeding."
The lady said: "Why don't you operate from inside the cheek to remove the cheek tumour as you had done before?"
"I need to cut away as much of the cancer cells as possible. There may be a root of the tumour and I need to access the root from the skin to dissect away the tumours. If all cancerous cells can be removed from the skin approach, it will be good for your dog. Provided he survives the operation which will take a long time compared to the previous two excisions"
The lady was worried about deaths on the operating table. Every time an old dog is put under general anaesthesia, the chances of dying are increased. Every time a vet operates on such high-risk dogs, he or she is bound to suffer fatalities and damage to his reputation.
The dog was given antibiotics and painkillers for the next 2 weeks. The lady did not turn up on the appointed day and so I thought she decided to opt out of the surgery. Then she turned up. She was a busy working girl.
PRE-SURGERY
Antibiotic and anti-inflammatory pred injection on day 1 and antibiotics after Day 1. On Day 2, tolfedine pain-killer oral. No pain in the cheeks on Day 3. Surgery on Day 4 after admission. An IV drip is very important in case emergency drugs are needed.
ANAESTHESIA
Domitor 0.2 ml IV from the IV saline drip line. The dog had a cyanotic tongue. It was not a good sign of health. I had a premonition that he would die on the operating table.
TEAM
Teamwork is essential in this high-risk anaesthestic case. I had two experienced assistants who are old experienced Myanmar vets with over 20 years of experience combined and Dr Vanessa Lim to assist.
SURGERY TIPS
1. "I don't need the scalpel blade," I said to my assistants. "An electro-surgery electrode needle incises the skin."
2. "Dissection with scissors is not advised," I explained to my assistants. "I will use the electrode to separate this hard mass of tumour from under the skin. The tumour has a capsule."
3. Bleeding. Electro-surgery reduces bleeding considerably. There was a small bursting artery which was clamped. I could not find the big vein or artery supplying blood to the tumour nodules. There were 3 nodules inside the cheek muscles.
4. "Where to incise?" I asked my assistants as part of my mentoring process. "A horizontal cut or vertical curved cut or both?" They had to think.
EMERGENCY RESUSCITATION
The surgery took more than 30 minutes. The shorter the better survival rate for an old dog. "The dog has died," my second assistant pointed to the dilated pupil which now showed a whitish cataract. A matted white. The isoflurane gas was given at a minimum. Too little, the dog's cheek muscles would twitch and so I had asked for an increase. There was no twitching and surgical dissection proceeded smoothly. Too smoothly.
Now the dog had stopped breathing. He had not died as my first assistant in charge of anaesthesia had much experience and had observed regular breathing. A dilated pupil is common in the deepest surgical anaesthetic stage.
A big dilated pupil could also mean imminent death or death. Whatever it was, I stopped the anaesthesia, blew air into the trachea tube and started cardiac massage immediately. Three cardiac massages and blow three times. My second assistant flushed out the isoflurane gas by pressing the red button and gave me the tube to connect oxygen to the dog. "It is better to blow air in and massage the heart," I advised. The dog was not breathing normally. A stethoscope to check the heart beating showed no sounds. My lst assistant injected Doxapram respiratory stimulant 1.0 ml into the IV line. I continued cardiac massage and air blowing into the tracheal tube. My 2nd assistant injected 0.2 ml Antisedan which is the antidote for Domitor.
It took more than 5 minutes but it seemed like eternity. "There was no hope," I thought as I could not hear the breathing sounds when I put my ears to the endotracheal tube after several cardiac massages. At one time, my first assistant would compress the heart from the top while I put my hand on the lower part of the dog's chest. It was touch and go. The dog started breathing.
My second assistant offered me the anaesthetic tube to connect to the endotracheal tube as the surgery was only 95% complete. There was the stitching to be done.
"God may not give 2nd chances," I pointed above my head and declined the anaesthetic connection to the gas machine. The Antisedan had reversed the Domitor sedation and the dog's head started to move. There was little time to stitch up. Subcutaneous stitching in certain areas could be done. Horizontal mattress stitches quickly closed up the skin incision. The dog put up his head in around 3 minutes as if he had a long nap. He did not cry or whine. Dr Vanessa Lin gave me the meloxicalm pain-killers. "It is best not to inject any drug to this old dog as he might just die after the pain-killer injection," I thanked her.
fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore
antibiotics for 10-14 days before surgery as tumour is badly infected 3 hard nodules in the cheek muscles. Domitor 0.2 ml IV given malignant tumours as they double in size every week
fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore
the owner did not turn up for appointment till 2 days later. Tumour is infected electro-incision close to the skin. Thoroughly remove remnants of cancer cells 3 cheek tumours excised leaving a big hole in the cheek but there is the skin to close up the wound
fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore tpvets_logo.jpg (2726 bytes)3827 - 3834. Malignant cheek tumours excised via the skin approach.
a third nodule is not shown here. Histopathology is being done <1 hour after completion of surgery. Dog is ok
A dog alive is what the owner wanted. Nothing more. No excuses. The dog ate 2 days after surgery and should be going home soon. In high-risk anaesthetic cases, it is best to have a team of experienced assistants. The brain dies when it is deprived of oxygen and in this case, a team definitely helped to revive this old beloved companion for the young lady.
The anaesthetist is more important than the surgeon as anaesthesia deaths are fatal. An experienced team is advised in high anaesthetic cases. Intubation and IV drip line are essential in such surgeries. If the surgery can be completed in less than 154 minutes, old dogs seldom die but in this case, the 3 tumours were large and time had to be spent on bluntly dissecting them to prevent excessive bleeding. Surgery took more than 30 minutes to complete. It was through teamwork that the old dog did not die on the operating table.
Pictures and details are at www.toapayohvets.com
Friday, October 8, 2010
Sense of humour with two generation gaps
Perth
Sunday, Oct 3, 2010
How do I connect with a group of undergraduates who are at least 26 years older than me? I would say that this group of 3 vet students would be from 22 to 24 years of age and I am 3 times older and how should I carry on an easy conversation with them?
A common interest in veterinary medicine mixed with a sense of humour is the key to interactions during a meal. But it is not easy to make the young adults feel that there is a two-generation gap between them and me making their acceptance to a farewell lunch a boring event with an old foggie.
It was a sunny Sunday afternoon and this Northbridge Chinese Restaurant in Perth was packed. We were given a smaller room away from the noise of the main eating area. The others at the two tables in this room were quietly eating.
It happened that one of the 3 vet students was not aware of my concept of a veterinary talk show that I deemed great for one of the vet students (not present at this lunch and whom I will name as Boo for the purpose of this story) I had shared with the other two yesterday. So I told him.
"You know," I said to this serious young man whom I shall call Ashton. "The name of the veterinary clinic should be 'Boo Clinic.' Dr Boo would host the veterinary talk show in Singapore. There would be an audience of pet owners at the show. One of them would ask her pet care questions related to a theme, for example skin diseases. She would examine the pet and give her advices.
After that, the audience will clap their hands in appreciation. Dr Boo will stand on a stage and sing a love song of unrequited love. That will make the young girls in the audience weep. A group of dancers will appear and swing with her as she sings. Another singer appears and there is more dancing. The audience claps their hands on cue in loud applause!"
The young man's eyes opened and shook his head as if he was saying: "What sort of whacky concept is to propose to Boo?"
I continued: "The veterinary clinic should be named "Peek-A-Boo" as it is such a good name to remember. The classmates will work in the background as more pet owners come to patronise this clinic. No need to worry about no business or falling turnover as Dr Boo brings in the fame and fortune.
The veterinary talk show should be called 'Peek-A-Boo' as I connect the surname with this English phrase I learnt in primary school. All dancers should wear a mask to peek at each other as they turn to face each other during dancing....
The young man's two classmates laughed loudly. Except for this serious young man. "I don't want to be associated with your mad scheme!" he exclaimed.
We had so much laughter. Laughter is the best medicine. Fortunately for me, Boo was not present at this lunch as I don't know whether she would appreciate the sense of humour at the use of her name. We ended the lunch on a happy note for my guests and I hope for this serious young man.
Sunday, Oct 3, 2010
How do I connect with a group of undergraduates who are at least 26 years older than me? I would say that this group of 3 vet students would be from 22 to 24 years of age and I am 3 times older and how should I carry on an easy conversation with them?
A common interest in veterinary medicine mixed with a sense of humour is the key to interactions during a meal. But it is not easy to make the young adults feel that there is a two-generation gap between them and me making their acceptance to a farewell lunch a boring event with an old foggie.
It was a sunny Sunday afternoon and this Northbridge Chinese Restaurant in Perth was packed. We were given a smaller room away from the noise of the main eating area. The others at the two tables in this room were quietly eating.
It happened that one of the 3 vet students was not aware of my concept of a veterinary talk show that I deemed great for one of the vet students (not present at this lunch and whom I will name as Boo for the purpose of this story) I had shared with the other two yesterday. So I told him.
"You know," I said to this serious young man whom I shall call Ashton. "The name of the veterinary clinic should be 'Boo Clinic.' Dr Boo would host the veterinary talk show in Singapore. There would be an audience of pet owners at the show. One of them would ask her pet care questions related to a theme, for example skin diseases. She would examine the pet and give her advices.
After that, the audience will clap their hands in appreciation. Dr Boo will stand on a stage and sing a love song of unrequited love. That will make the young girls in the audience weep. A group of dancers will appear and swing with her as she sings. Another singer appears and there is more dancing. The audience claps their hands on cue in loud applause!"
The young man's eyes opened and shook his head as if he was saying: "What sort of whacky concept is to propose to Boo?"
I continued: "The veterinary clinic should be named "Peek-A-Boo" as it is such a good name to remember. The classmates will work in the background as more pet owners come to patronise this clinic. No need to worry about no business or falling turnover as Dr Boo brings in the fame and fortune.
The veterinary talk show should be called 'Peek-A-Boo' as I connect the surname with this English phrase I learnt in primary school. All dancers should wear a mask to peek at each other as they turn to face each other during dancing....
The young man's two classmates laughed loudly. Except for this serious young man. "I don't want to be associated with your mad scheme!" he exclaimed.
We had so much laughter. Laughter is the best medicine. Fortunately for me, Boo was not present at this lunch as I don't know whether she would appreciate the sense of humour at the use of her name. We ended the lunch on a happy note for my guests and I hope for this serious young man.
217. A sense of humour in a child
A sense of humour is much appreciated during social interactions such as wedding dinners and meetings. But how does one acquire a sense of humour? Is humour inherent in a person's DNA or is it acquired through a good command of English in an intelligent person? I have no answer.
Yesterday, I was at a pet shop which sells rabbits, guinea pigs and hamsters. The pet shop owner has two daughters, Jane and Juliet aged 6 and 7 years old respectively. "Jane is a monkey," the mother told me when Jane showed a black face, put her hands on both sides of her waist and narrowed her eyes as the shop assistant disallowed her to take her lunch out of the shop to eat with other friends. She refused to eat lunch. Her mum explained to me: "Jane throws tantrums when she is not allowed to do what she wants. She was born in the year of the monkey and is a monkey. I give her three warnings to behave. Then I will give her a canning."
There was really a cane with a pink hook in the pet shop. As for Juliet, the mum's face brighten as she said: "Yesterday, Juliet told her brother that he needs to learn how to bottle fed the baby brother so that he can help his wife." I saw Juliet helping the mum to scan the pet products for sale.
This was a 7-year-old studying in Primary Two in a neighbourhood school in the heartlands. Not one of those fancy high-pressure primary schools of Singapore. I asked Juliet whether she had a story book for me to read and she took out "Under The Sea" published by Usborne as a beginner's series for young readers, level 1.
Every few seconds, Julie would ask to take back her book to keep inside her school backpack. Mum explained: "She will keep her story books in a good condition."
On the table where I read her book were three plastic containers with longan desserts and ice. The table was wet due to the melting of the ice causing dripping of water onto the table. Juliet came again to ask for her book back. "Let Dr Sing read your book," Mum said. Finally she got her book back. She put it on the table for a while. "Hey," I said. "Your book is now wet. You need to dry the cover up with a piece of tissue paper. Ask your mum for the tissue paper."
"No need," she said. "The book is under the sea." The title of the book was "Under the Sea" and I was surprised that this 7-year-old girl had that sense of humour to surprise me. I advised the mum that she should switch this child to a better school to give her the opportunity to grow intellectually as she has what it takes to be a scholar.
Yesterday, I was at a pet shop which sells rabbits, guinea pigs and hamsters. The pet shop owner has two daughters, Jane and Juliet aged 6 and 7 years old respectively. "Jane is a monkey," the mother told me when Jane showed a black face, put her hands on both sides of her waist and narrowed her eyes as the shop assistant disallowed her to take her lunch out of the shop to eat with other friends. She refused to eat lunch. Her mum explained to me: "Jane throws tantrums when she is not allowed to do what she wants. She was born in the year of the monkey and is a monkey. I give her three warnings to behave. Then I will give her a canning."
There was really a cane with a pink hook in the pet shop. As for Juliet, the mum's face brighten as she said: "Yesterday, Juliet told her brother that he needs to learn how to bottle fed the baby brother so that he can help his wife." I saw Juliet helping the mum to scan the pet products for sale.
This was a 7-year-old studying in Primary Two in a neighbourhood school in the heartlands. Not one of those fancy high-pressure primary schools of Singapore. I asked Juliet whether she had a story book for me to read and she took out "Under The Sea" published by Usborne as a beginner's series for young readers, level 1.
Every few seconds, Julie would ask to take back her book to keep inside her school backpack. Mum explained: "She will keep her story books in a good condition."
On the table where I read her book were three plastic containers with longan desserts and ice. The table was wet due to the melting of the ice causing dripping of water onto the table. Juliet came again to ask for her book back. "Let Dr Sing read your book," Mum said. Finally she got her book back. She put it on the table for a while. "Hey," I said. "Your book is now wet. You need to dry the cover up with a piece of tissue paper. Ask your mum for the tissue paper."
"No need," she said. "The book is under the sea." The title of the book was "Under the Sea" and I was surprised that this 7-year-old girl had that sense of humour to surprise me. I advised the mum that she should switch this child to a better school to give her the opportunity to grow intellectually as she has what it takes to be a scholar.
Sunday, October 3, 2010
216. A vet talk-and-sing show in Singapore
Saturday, Oct 2, 2010
Perth
Spring in Perth this past week was blue skies and brilliant sunshine during the daytime and coldness at night. Saturday would be my last day of visit to Perth. A choice of dinner at a popular small Italian restaurant packed mainly with young Asian people was excellent. Wood-fried pizza, noodles full of cheese and thick creamy tiramisu cakes would not be advised for the health conscious.
The Caucasian waiters interacted with the young adults very well, sat on the dining chair to take orders, posed for pictures and engaged in conversation, making the experience of eating there fun.
Can this be done at the vet surgery? I don't think any vet would do it. However much depends on the personality of the vet. I would say one particular lady vet student would be the ideal candidate as she had that type of extrovert personality. She was said to be the school cheerleader and was able to converse well.
"I have a good idea for you," I said to her at the end of the gathering. "Forget about being an eye specialist in Singapore. Be a talk show veterinarian. You'll make more money than operating on dog's eyes." To be a canine eye specialist, she would need to study post-graduate as a resident for another 3-4 years. To be a talk show veterinarian, she could do it after graduation. 99% of the vet cohort would not be able to do it. She was that rare bird that would be able to make it in the entertainment industry.
"Singapore is not US," her friend said. "There is no Oprah Winfrey show and therefore no prospects."
"I don't know about that. Singapore has no vet that is passionate and able to host a talk show. She has to start somewhere and that would be in Singapore as the testing ground.
"My idea for this half-an-hour veterinary talk show is for her to discuss one case with a real pet owner, take some questions about pet care from the audience, do a sing and dance routine with dancers with her being the star."
"Is there such a programme in Australia?" I asked the friend.
The friend said: "There is the Bondi Vet on TV."
"Does he look handsome and sing?"
"He is said to be handsome. He does not do any singing."
"If this vet is successful, her vet surgery will be packed with fans. You and the others may be her supporting vets and will not be jobless. Collaboration benefits everyone as each party in the team has his or her own strength."
Singapore might have tried to do some reality TV vet shows. One of them was a concept to follow up on a pet owner who would be present when her dog was put to sleep. I was approached for help in getting an owner who would consent to such a show. I declined. A dog trainer agreed. But the administrative arrangements or a poor script. The dog trainer gave up after some time.
Execution is the key to success in any venture. No money was paid to the dog trainer and there were so many delays. What do you expect the poor dog trainer to live on? The whole project was most likely ditched.
Perth
Spring in Perth this past week was blue skies and brilliant sunshine during the daytime and coldness at night. Saturday would be my last day of visit to Perth. A choice of dinner at a popular small Italian restaurant packed mainly with young Asian people was excellent. Wood-fried pizza, noodles full of cheese and thick creamy tiramisu cakes would not be advised for the health conscious.
The Caucasian waiters interacted with the young adults very well, sat on the dining chair to take orders, posed for pictures and engaged in conversation, making the experience of eating there fun.
Can this be done at the vet surgery? I don't think any vet would do it. However much depends on the personality of the vet. I would say one particular lady vet student would be the ideal candidate as she had that type of extrovert personality. She was said to be the school cheerleader and was able to converse well.
"I have a good idea for you," I said to her at the end of the gathering. "Forget about being an eye specialist in Singapore. Be a talk show veterinarian. You'll make more money than operating on dog's eyes." To be a canine eye specialist, she would need to study post-graduate as a resident for another 3-4 years. To be a talk show veterinarian, she could do it after graduation. 99% of the vet cohort would not be able to do it. She was that rare bird that would be able to make it in the entertainment industry.
"Singapore is not US," her friend said. "There is no Oprah Winfrey show and therefore no prospects."
"I don't know about that. Singapore has no vet that is passionate and able to host a talk show. She has to start somewhere and that would be in Singapore as the testing ground.
"My idea for this half-an-hour veterinary talk show is for her to discuss one case with a real pet owner, take some questions about pet care from the audience, do a sing and dance routine with dancers with her being the star."
"Is there such a programme in Australia?" I asked the friend.
The friend said: "There is the Bondi Vet on TV."
"Does he look handsome and sing?"
"He is said to be handsome. He does not do any singing."
"If this vet is successful, her vet surgery will be packed with fans. You and the others may be her supporting vets and will not be jobless. Collaboration benefits everyone as each party in the team has his or her own strength."
Singapore might have tried to do some reality TV vet shows. One of them was a concept to follow up on a pet owner who would be present when her dog was put to sleep. I was approached for help in getting an owner who would consent to such a show. I declined. A dog trainer agreed. But the administrative arrangements or a poor script. The dog trainer gave up after some time.
Execution is the key to success in any venture. No money was paid to the dog trainer and there were so many delays. What do you expect the poor dog trainer to live on? The whole project was most likely ditched.
Saturday, October 2, 2010
Buying products for others
A 71-year-old friend of Dr J asked me to buy hair growth products and glucose strips for him from Perth citizens thinking they would get them cheaper under the National Health Service. My contact said there was no NHS in Australia for citizens according to her search on the internet.
My mission was to buy the cheaper version of the hair loss. However, I don't use his product nor do I know which is the cheaper generic. "Hair A Gain" is what the buyer sms me as to what he has been using and he asked me to look for cheaper generic brands of minoxidil. On the 4th day of my stay in Perth, my contact had no success or advice for me. After dinner, I went to the Pharmacy in the mall. As it was a Thursday, the mall closes at 9 pm. The first product I bought was Men's Regaine Extra Strength as this pharmacy has only this product. This was the expensive original product, around 100% more expensive than "Hair A Gain" and this would not be what the buyer asked for.
It is best to get the Buyer to specify in writing what not to buy and what brands to buy. Now what should I do with Regaine as I don't have hair loss?
My mission was to buy the cheaper version of the hair loss. However, I don't use his product nor do I know which is the cheaper generic. "Hair A Gain" is what the buyer sms me as to what he has been using and he asked me to look for cheaper generic brands of minoxidil. On the 4th day of my stay in Perth, my contact had no success or advice for me. After dinner, I went to the Pharmacy in the mall. As it was a Thursday, the mall closes at 9 pm. The first product I bought was Men's Regaine Extra Strength as this pharmacy has only this product. This was the expensive original product, around 100% more expensive than "Hair A Gain" and this would not be what the buyer asked for.
It is best to get the Buyer to specify in writing what not to buy and what brands to buy. Now what should I do with Regaine as I don't have hair loss?
Vet specialists in Singapore
Is there a need for a veterinary specialist centre in Singapore, one 4th-year vet student asked me.
"Yes," I said.
"Will only expatriates use vet specialists as they are the ones able to pay for the services?" she asked.
"No," I said. "Singapore has locals who are prepared to pay provided they see value for their money."
"So, in 2 years' time, you will be able to be a vet specialist and your husband will be shaking his legs staying at home to look after the babies," I said to the girl. If she undertakes specialist training after graduation, she will be qualified as a specialist in 2 years. Actually it will be more than 2 years but sometimes we must not take life so seriously during dinner conversations.
"No, no," she said. "It will be 10 years." I don't know where she has this 10-year-forecast.
As a vet specialist or referral centre, much depends on the skills of the vet. More important it is the public relations. If such vets are arrogant, no other vets want to refer any case to them at all.
"Yes," I said.
"Will only expatriates use vet specialists as they are the ones able to pay for the services?" she asked.
"No," I said. "Singapore has locals who are prepared to pay provided they see value for their money."
"So, in 2 years' time, you will be able to be a vet specialist and your husband will be shaking his legs staying at home to look after the babies," I said to the girl. If she undertakes specialist training after graduation, she will be qualified as a specialist in 2 years. Actually it will be more than 2 years but sometimes we must not take life so seriously during dinner conversations.
"No, no," she said. "It will be 10 years." I don't know where she has this 10-year-forecast.
As a vet specialist or referral centre, much depends on the skills of the vet. More important it is the public relations. If such vets are arrogant, no other vets want to refer any case to them at all.
213. Vet Surgery - Fusion podoplasty - interdigital cyst
Perth Saturday
Interdigital cysts in dogs are sometimes ignored by the owner. The dog keeps licking till the cysts become infected. Conservative medical treatment does not help after a while.
SURGICAL EXCISION. Normally I advise surgical excision for infected i/d cysts. No more problems usually. But how about three big ones with all i/d webs affected and big scar tissue on the palmar aspect of the paw bridging the 3rd and 4th digit? A successful case report is at: Australian Veterinary Practitioner Vol 40 (2) June 2010, pg 53 - Fusion podoplasty in a dog with inter-digital furunculosis.
I will summarise the case. 10-year-old Collie X, chronic pododermatiiws of the right forepaw unresponsive to conservative treatment.
I/v cephazolin (20mg/kg) at anaesthetic induction. Tourniquet 0.4 Penrose drain clamped with a heemostat distally to the riht carpus. Marker outline the dorsal i/d skin to be removed, leaving 2-3 mm of digital skin adjacent to the nail. Dissection was kept close to the dermis (to preserve e dorsal and palmar digital nerves and bv). All abnormal tissues excised. Tourniquet removed. Bleeding successful controlled by electrocoagulation. Skin 3/0 simple sutures. Surgical time of one hour. Fusidic acid-containing onitment and non-adherent dressings wrapped with an absorbent bandage extending to above the elbow. A plastic spoon-like splint up to the elbow secured with adhesive tape. Bandage and dressing changed twice daily for 7 days and once daily for a total of 15 days. Discharged 3 days with antibiotics and carprofen (2mg/kg po bid).Suture removal 19 days afer surgery. Good granulation tssue.
Conclusion - fusion podoplasty is an effective procedure for the permanent cure for chronic i/d furunculosis in the dog. Considerable bandaging and maybe additional surgeries if more than one paw is affected.
Many dog owners will be unlikely to pay for the vet costs involved. In above case, detailed blood tests, histopathology tests and bandaging post-op. Surgical excision is successful but how many owners will want to pay for the costs?
Interdigital cysts in dogs are sometimes ignored by the owner. The dog keeps licking till the cysts become infected. Conservative medical treatment does not help after a while.
SURGICAL EXCISION. Normally I advise surgical excision for infected i/d cysts. No more problems usually. But how about three big ones with all i/d webs affected and big scar tissue on the palmar aspect of the paw bridging the 3rd and 4th digit? A successful case report is at: Australian Veterinary Practitioner Vol 40 (2) June 2010, pg 53 - Fusion podoplasty in a dog with inter-digital furunculosis.
I will summarise the case. 10-year-old Collie X, chronic pododermatiiws of the right forepaw unresponsive to conservative treatment.
I/v cephazolin (20mg/kg) at anaesthetic induction. Tourniquet 0.4 Penrose drain clamped with a heemostat distally to the riht carpus. Marker outline the dorsal i/d skin to be removed, leaving 2-3 mm of digital skin adjacent to the nail. Dissection was kept close to the dermis (to preserve e dorsal and palmar digital nerves and bv). All abnormal tissues excised. Tourniquet removed. Bleeding successful controlled by electrocoagulation. Skin 3/0 simple sutures. Surgical time of one hour. Fusidic acid-containing onitment and non-adherent dressings wrapped with an absorbent bandage extending to above the elbow. A plastic spoon-like splint up to the elbow secured with adhesive tape. Bandage and dressing changed twice daily for 7 days and once daily for a total of 15 days. Discharged 3 days with antibiotics and carprofen (2mg/kg po bid).Suture removal 19 days afer surgery. Good granulation tssue.
Conclusion - fusion podoplasty is an effective procedure for the permanent cure for chronic i/d furunculosis in the dog. Considerable bandaging and maybe additional surgeries if more than one paw is affected.
Many dog owners will be unlikely to pay for the vet costs involved. In above case, detailed blood tests, histopathology tests and bandaging post-op. Surgical excision is successful but how many owners will want to pay for the costs?
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