Dietary management to dissolve struvite stones in the bladder & voiding urohydropropulsion
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Written: Perth, 29 September 2010
Update: 11 October 2010
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
After the surgical removal of the struvite urinary stones or for medical and dietary treatment, how much of the prescription diet should the owner give the dog/day?
I took some time just to read about Canine Struvite Urolithiasis case studies in the thick book "Small Animal Clinical Nutrition" by Hand et. al, 5th Edition and the following is some general guideline for Toa Payoh Vets in advising on Prescription Diet s/d to dogs in 3 case studies.
How much of the s/d diet to be given:
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, 27 kg
1,150kcal (4.8MJ)
1 can 2x/day
Other procedures to ensure compliance from the owner:
1. Antibiotics from 14-30 days and review using urine cultures
2. Monthly urine analysis (check for UTI) and blood tests (esp. serum urea nitrogen, magnesium, phosphorus and calcium and alkaline phosphatese)
3. Monthly x-rays of kidney (V/D view), bladder (lateral views)
Back to normal commercial food for the 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 during the period of treatment.
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.
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. The owner must be informed that it takes 2-4 months or longer to get all struvite stones dissolved. The owner must be aware of the need for reviews and to note the costs involved in the dietary management to dissolve struvite urinary stones.
VETERINARY SURGERY --- VOIDING UROHYDROPROPULSION IN DOGS AND CATS
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, catheterise, 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.
More information is at: Small Animal Clinical Nutrition" by Hand et. al, 5th Edition
This webpage:
http://www.sinpets.com/F5/20100697struvite-dietary-management-voiding-urohydropropulsion_ToaPayohVets.htm
Wednesday, October 20, 2010
222. Defensive Medicine at the 49th day of pregnancy
The owner said that her British Bulldog was 49th day pregnant. Dr Vanessa Lin was the vet in charge. She palpated the abdomen and declared that the dog was not pregnant. I palpated and agreed with her. There was no big foetal lump or lumps in the abdomen. A simple case of pregnancy diagnosis. Not pregnant.
But veterinary medicine can throw out surprises for the vet who wants to provide least-cost veterinary services.
"There is a possibility that the foetal lump is positioned cranially below the diaphragm such that the vet can't feel it," I cautioned. I had read some dog breeding reports on this type of situations.
"If the dog is diagnosed as not pregnant now and she loses her sole pup due to this diagnosis, there will be a lot of unhappiness. Bulldogs usually need a Caesarean section as the puppy's head is too big. Since the vet has diagnosed this dog as non-pregnant, the owner would not have had prepared the dog for an elective Caesarean section as veterinarians are trusted professionals.
I related an incident to Dr Lin about the single pup syndrome case in a Pomeranian. A vet diagnosed the Pom as not being pregnant by abdominal palpation. The breeder who brought in the dog agreed with him. The vet assistant supported his diagnosis. Three people with experience said not pregnant.
The Pom had a difficult birth and required Caesarean section. The pup died after the Caesarean section. The dam died a few days later. The death of the beloved dam evoked much anger and resentment. If only an X-ray or ultrasound were done as part of defensive medicine, this sad outcome would not have occurred. This pup would probably had been located as a small foetal lump in the most cranial position behind the diaphragm.
Dr Lin advised an ultrasound. The dog was confirmed not pregnant. Defensive medicine is needed in many cases. When the owner is unhappy or provoked by the competitor vet, many complaints are made. A simple X-ray or ultrasound taken should have been done as part of defensive medicine as vets are not Gods and variations in medicine can sometimes ruin a hard-won reputation.
Updates at www.toapayohvets.com
But veterinary medicine can throw out surprises for the vet who wants to provide least-cost veterinary services.
"There is a possibility that the foetal lump is positioned cranially below the diaphragm such that the vet can't feel it," I cautioned. I had read some dog breeding reports on this type of situations.
"If the dog is diagnosed as not pregnant now and she loses her sole pup due to this diagnosis, there will be a lot of unhappiness. Bulldogs usually need a Caesarean section as the puppy's head is too big. Since the vet has diagnosed this dog as non-pregnant, the owner would not have had prepared the dog for an elective Caesarean section as veterinarians are trusted professionals.
I related an incident to Dr Lin about the single pup syndrome case in a Pomeranian. A vet diagnosed the Pom as not being pregnant by abdominal palpation. The breeder who brought in the dog agreed with him. The vet assistant supported his diagnosis. Three people with experience said not pregnant.
The Pom had a difficult birth and required Caesarean section. The pup died after the Caesarean section. The dam died a few days later. The death of the beloved dam evoked much anger and resentment. If only an X-ray or ultrasound were done as part of defensive medicine, this sad outcome would not have occurred. This pup would probably had been located as a small foetal lump in the most cranial position behind the diaphragm.
Dr Lin advised an ultrasound. The dog was confirmed not pregnant. Defensive medicine is needed in many cases. When the owner is unhappy or provoked by the competitor vet, many complaints are made. A simple X-ray or ultrasound taken should have been done as part of defensive medicine as vets are not Gods and variations in medicine can sometimes ruin a hard-won reputation.
Updates at www.toapayohvets.com
Tuesday, October 19, 2010
A vomiting Chihuahua (Impaction of the stomach)
INTERPRETATION OF THE X-RAYS FOR THE OWNER
Chihuahua, Male, 6 years. Vomiting and not eating. What is the problem? The dog was warded for observation.
ABDOMINAL PALPATION
A soft mass in the stomach. No pain on palpation. The intestines were firm as if they were "sausage" rolls.
X-RAYS
Lateral view:
The stomach was impacted with some foreign body. The white arrows showed a fullness of the stomach pressing against the diaphragm (which separates the chest cavity from the abdominal cavity). The white foreign body inside the stomach and intestines (black arrows) would be fibers from the chew rope. The dog had been swallowing chew ropes for many months based on the owner's report. Chew ropes are commonly sold at Singapore's pet shops. This dog prefers to eat the pieces and they accumulate and fill the stomach. This medical condition is called impaction of the stomach.
Laxatives given showed fibers and hairs inside the stools. The owner told me the dog farted. He did not pass stools for the first 4 days. I/V drips and antibiotics prevent dehydration and death.
Ventral-Dorsal view
The full stomach is not so easily seen by the layman. There is no solid foreign body such as a bone or stone and so interpretation of this view is difficult without the clinical examination and history.
The outline of the stomach is shown by the black arrows. White foreign body of fibers impact the stomach. There is a dark area in the lower half of the stomach. This will be the gas. "Sausage-like" rolls of the intestines can be seen below the stomach. I have not marked the rolls.
The bladder shows a opaque urine which is not normal. Urine tests confirmed a moderate amount of struvite crystals which cause this whiteness of the bladder. On discharge of the dog, the dog peed with difficulty on the grass. This was seen by the owner.
Dietary management to dissolve the struvite crystals is an alternative to surgery. However the owner must know that it may take 2-4 months to see results and there must be strict compliance with veterinary instructions including diet and urine tests and X-rays of the bladder till no struvite crystals are present.
Two blood tests were taken. The second blood test showed liver disorder. In conclusion, the dog recovered after 4 days and went home. Dietary management to dissolve the stones had been discussed with the owner. A follow-up by the owner must be done in the next few days.
Updates at www.toapayohvets.com
Chihuahua, Male, 6 years. Vomiting and not eating. What is the problem? The dog was warded for observation.
ABDOMINAL PALPATION
A soft mass in the stomach. No pain on palpation. The intestines were firm as if they were "sausage" rolls.
X-RAYS
Lateral view:
The stomach was impacted with some foreign body. The white arrows showed a fullness of the stomach pressing against the diaphragm (which separates the chest cavity from the abdominal cavity). The white foreign body inside the stomach and intestines (black arrows) would be fibers from the chew rope. The dog had been swallowing chew ropes for many months based on the owner's report. Chew ropes are commonly sold at Singapore's pet shops. This dog prefers to eat the pieces and they accumulate and fill the stomach. This medical condition is called impaction of the stomach.
Laxatives given showed fibers and hairs inside the stools. The owner told me the dog farted. He did not pass stools for the first 4 days. I/V drips and antibiotics prevent dehydration and death.
Ventral-Dorsal view
The full stomach is not so easily seen by the layman. There is no solid foreign body such as a bone or stone and so interpretation of this view is difficult without the clinical examination and history.
The outline of the stomach is shown by the black arrows. White foreign body of fibers impact the stomach. There is a dark area in the lower half of the stomach. This will be the gas. "Sausage-like" rolls of the intestines can be seen below the stomach. I have not marked the rolls.
The bladder shows a opaque urine which is not normal. Urine tests confirmed a moderate amount of struvite crystals which cause this whiteness of the bladder. On discharge of the dog, the dog peed with difficulty on the grass. This was seen by the owner.
Dietary management to dissolve the struvite crystals is an alternative to surgery. However the owner must know that it may take 2-4 months to see results and there must be strict compliance with veterinary instructions including diet and urine tests and X-rays of the bladder till no struvite crystals are present.
Two blood tests were taken. The second blood test showed liver disorder. In conclusion, the dog recovered after 4 days and went home. Dietary management to dissolve the stones had been discussed with the owner. A follow-up by the owner must be done in the next few days.
Updates at www.toapayohvets.com
222. Misalliance (accidental mating) of dogs
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.
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.
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
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