On Thu, Feb 17, 2011 at 11:11 PM, ... wrote:

Dear Doctor Sing,

I've previously brought 2 of my dwarf hamsters to your clinic for treatment (removal of tumor & ear growth).

I've another dwarf hamster turning 2yrs 4mths at the end of February. Just yesterday night I noticed there was some blood stain on the left side of her ear. Today, it got worst due to excessive scratching.

I've attached 2 pics for your review. As she's getting old, I wonder if there's any external medication/application that I can apply on her to stop her itch.

May I also check with you on the earliest slot that I can bring her over for your review @ your clinic.

Looking forward to hearing from you as soon as possible.

Thanks & regards,



Hi

I just came back from Myanmar. Please accept my apologies for the late reply as it is practically impossible to access the internet in Myanmar or it takes a long time. So, I did not access the internet.

Your pictures of the hamster shows an ear infection deep inside the ear canal and on the surface of the ear and may require ear irrigation and cleaning under anaesthesia.

Pl make appointment at 6254 3326 and let the receptionist know that you will be making appointment with me as there are 3 vets at Toa Payoh Vets.


BEST TO TELEPHONE 6254-3326 but young generation prefers email or text!

342. Educating and entertaining Vet Undergraduates Project

Feb 23, 2011

I am back from a trip to Myanmar to hike a trail and see the schools near Lake Inle and visit a village in the Ayeyawaddy Division to see the Future Foundation's primary school construction in progress. I met an 81-year-old artist in his Art Gallery. I was looking for an oil painting of a flower vendor in Myanmar. He did have one that was sold long ago. The next best thing was a painting of flowers and market. Will display in the Toa Payoh Vets later.

AUDIO-VIDEO veterinary education project is being done with the volunteer and help of 2nd year vet student Ms Daphne Low. This 2nd video really took me by surprise as i did not expect much from her (being a busy multi-tasking distracted young generation with many things to do). My comments are recorded as follows:



OVERVIEW. Ms Daphne Low has to create the video based on the outline. I should have said "Audio-Visual" Production as the creation had music but no voice over!

Video Production
1. Define condition
2. Diagnosis
3. Treatment

Topics
1. Anaesthesia (TPVets)
2. Surgery (what is involved)
3. Puppy Toilet Training in Singapore
4. Disease conditions
- Bladder stones
- FUS (Feline Urinary Syndrome) / CUS (Canine Urologic Syndrome)
- Ear problems
- Heartworm
- Periodental Disease
- Skin abscess: ringworm(fungal), dermatitis (bacteria), mites
5. Vomiting/Diarrhoea
6. Cesearian
7. Corneal Ulceration - esp in Shih Tzu
8. Spaying/Neutering

Vomiting/Diarrhoea
- if many times = emergency as possible death due to dehydration/bacteria intoxication
- blood test, check stools for parvovirus/foreign body, x-ray
- treatment: no food/water for intestines to recover, iv drip + medicine to control infection for 2-3days

Infection of Ear Canal
-non-stop scratching
-head scratching
-affect immune system
-groomer will treat but unsuccessful
-if unsuccessful for 2 times, lateral ear resection will be required


E-MAIL FROM MS LOW dated Feb 18, 2011

Hi Dr Sing,

Sorry i took so long to get back to you! I was so busy with cny and stuff. How was your cny? (: I just managed to do a video on cesarean which i have attached in this email. Please take a look and tell me if this is what you are looking for. I saw that you are overseas from 17feb to 22feb. Have a safe trip! I will send to you more videos once I have the time to do them!

Cheers,
Daphne




E-MAIL TO MS LOW dated Feb 23, 2011

Feb 23, 2011

Dear Daphne,

I just came back from Myanmar yesterday and expected to see a similar video production as the first video production you did for me. Thank you for spending time and effort to produce a beautiful "movie" which will help to educate and hopefully to entertain veterinary undergraduates in developing countries where there are no computers and facilities in the schools and where internet access is slow and expensive.

I just can't believe that you have had progressed to making a professional-looking video with music. Everything was well timed and clear. It is as if a rose bud has started to blossom, when I compared to your previous video production for me. Pl do not infringe on music copyright.

COMMENTS
1. No audio in this production unlike your first video you produced for me . Please make some comments about surgical techniques (the text is inside the pictures) so that the viewer does not need to strain to read the "subtitles" inside the images. Hearing is best. Reading subtitles deprives much of the fun in viewing as the viewer must focus on reading the small text. That is why foreign language non-English movies don't do well with the English-educated audience in Singapore.

2. For credits, just provide text as follows:

This is a "Be Kind To Pets" Audio-Visual Production with the objective to educate and entertain, thus making Veterinary Medicine & Surgery Alive for Veterinary Undergraduates in developing countries. This is Dr Sing Kong Yuen's Community Education Project made possible with the collaboration of veterinarians at Toa Payoh Vets. We thank the sponsors - Design Travel Pte Ltd and Asia USA Realty (S) asiahomes.com Pte Ltd, Singapore.

More information is at the respective websites:
bekindtopets.com, toapayohvets.com, designtravelpl.com and asiahomes.com.

Produced by Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Videography by: Ms Daphne Low, 2nd year, Veterinary Student, Sydney University, Australia. Feb 2011. All rights reserved.

3. Please upload this first draft to youtube.com as it is a pioneer batch.

4. I am glad that you are not wasting time on Farmville in Facebook and that it was a family member using your facebook account. Create beautiful educational "movies". Make a difference - make the world a better place for pets and children.

341. Follow up on the skin-and-bones megaoesophagus dog

On Feb 16 evening, I phoned the owner of the skin and bones dogs. I had proposed feeding every hourly from 7.30 am to midnight with small amounts of food (6 pellets and 1 tablespoonful of k/d diet) to get the dog to put on more weight and survive. In the past week, it was two-hourly and there was no more vomiting. Prior to consulting me, the lady owner fed small amounts of rice, cereal and other things like asparagus and multi-vitamin B's were fed by the husband 3x/day. The dog would "vomit" every day but not all the time. There was persistence in "vomiting". This was actually regurgitation of food eaten some minutes ago and finally, since the dog was depressed and unable to eat anymore and was tired out, the couple sought veterinary consultation, thinking the dog was suffering from stomach cancer.

"Didn't my wife phone you?" the husband said. "No," I said. She passed the phone to her wife. "My dog vomited at midnight after the last meal," she said. "I think every 2-hourly feeding would be fine," she suggested.

"It is a matter of trial and error in this case of megaoesophagus," I replied. "The gullet can't hold too much a large quantity of food and water and that is why I asked to feed every hourly to ensure she puts on weight."

The happy owner reiterated, "Now my dog does not have the pus discharge in her eyes every day and so I don't need to wipe off the eye discharge. She does not tire so easily and looked eagerly for her food when she hears the noise of crunching of her 6 pellets." The prescription d/d pellets are crushed into powder and mixed with the canned k/d diet so that they will not irritate the mucosa of the gullet and will pass into the stomach. 2.5 mg prednisolone was given daily too and would be stopped after 3 weeks. It reduced inflammation and promotes appetite effectively in this case. Trimaxazole antibiotics had been given and would be stopped after 3 weeks. We would wait and see.

"Is the dog putting on weight?" I asked.
"I can feel she is heavier when I carry her," the lady owner said. "She passes well-formed solid stools."
"Is she shivering?"
"No more, but she could be shivering due to your grooming clipping her bald to de-tick her last time," the lady owner was also getting the dog clothed and wrapped in a blanket at night in the air-conditioned room.
So far, no food regurgitation. The diagnosis of megaoesophagus was not a death sentence and this 8-year-old dog should live to an old age if there are no other health problems.

Earlier vet report about this "vomiting" skin-and-bone poodle is at http://www.toapayohvets.com/web1/20110204megaoesophagus-regurgitation-dog-toapayohvets-singapore.htm

This is NOT an easy case to diagnose. Regurgitation is often confused with vomiting by the owner and the owner often misled the vet by giving the incorrect complaint of "vomiting". I visited the apartment to see the dog in her natural environment and lifestyle. It is a rare case as most "vomiting" cases are really vomiting dogs!

P.S
Due to economic reasons, I did not ask the owner to X-ray the distal oesophagus with contrast medium as X-rays of the neck and abdomen had cost some money for these senior citizens. It would be good to do it, but at the owner's expense. In the X-ray, you can see that the oesophagus is dilated as gas and liquid filled up the dilated mid-oesophagus. The diagnosis is still megaoesophagus and the treatment depends on the cause. Feeding small amounts of food (powdered pellets and canned food) without regurgitation, the X-ray of mid-oesophagus and return to normal health supports the diagnosis of megaoesophagus. There appeared to be an area of granulation in the pharngeal area as the dog used to eat branches and grass for some years. It could be a granulation tissue. See the X-ray.

338. An intern flirts with the danger of being terminated from her internship

February 17, 2011

Yesterday, Feb 16, 2011 Michelle came to work late again for the 2nd time. This was despite being warned the day before! It was incredible. She behaved as if she was indispensable and was a top vet, a prima donna whom the practice revolved around. Without her, the practice would be shut down!

"Does your Victoria Junior College teachers teach you punctuality at work?" I asked her. She had been warned and yet she did it again, thereby flirting with danger of being dismissed from internship. Her mother sent her to work everyday and her father or mother picked her home unlike Nat who had to take a bus and get to work himself. Her teacher had imparted her the values of punctuality but she chose to flirt with danger. "So, what's your excuse?" I asked her as I sat down in a room to interview her. "The traffic was heavy," she said. "This is a common excuse," I said. "It is not acceptable. If you don't value your internship, don't do it. You have been warned twice now. The third time will mean termination of your internship." There are other interns whom I can't accept due to lack of space and if Michelle behaves as if her mother owns the practice, she has better go. A rotten apple spoils the whole barrel.

Nat had not been late during the past 4 days despite having to take a bus to work. He bothered to wake up early and ensure he was a bit early. In fact, Nat asked to work from 8.30 am to 10 pm. Michelle had been a clock watcher and was hoping to be just-in-time at work from 10 am to 7 pm. Both are not paid.

"Obviously, you are doing work attachment or internship because you want a testimonial," I said. "If you don't work hard, you will get a mediocre testimonial - satisfactory performance but not punctual. Is that what you want?" I do spend time teaching them some cases of veterinary medicine and if an intern persists in behaving as if the world owes her a living, she is better off staying at home.

"As for your mum driving you to work late, you will need to ensure that she wakes up early to do so," I told Michelle. In the first place, there is no need for an intelligent lady to be told in this way. Treating internship like a holiday camp or vacation or like your father's office is not tolerated. Parents who feel the need to drive their children to internship need to be alert and impart values of punctuality and be a role model for the young ones.

One more time, Michelle will be asked to go. She is setting a bad example for my staff and Nat and the rot will be like a cancer, affecting the behaviour of all employees.

I noted that the vet's dog was no longer present in the Surgery to create fears and worries in clients. There is much relief on my part. There are vets whose dogs and cats are well loved by clients if they behave responsibly. Just like interns, those who don't behave as expected will create tension and are best banned from the practice.

It is the responsibility of the Clinic Manager who is myself if there are any complaints. Every day, there are new incidents and many issues are needed to be regulated and to prevent possible litigation in this fast-paced society. Bad eggs are best asked to go. No more blind loyalty. Employees and vets that don't perform at work are best let go despite their years of work for the practice. Once they lose their interest in the practice, it is best that they work somewhere else.

I will be on leave from Feb 17 to 22, 2011 and I hope nothing unusual will happen in Toa Payoh Vets. I will be visiting a primary school built by Future Foundation and its volunteers and see whether I can be of help in the education of the children. There is a need for the building of a secondary school in this village and sponsors must be found. Some pictures of the Primary School are at:
http://www.designtravelpl.com/tours_Myanmar/20110124volunteer-tour-inn-ma-ywar-lay-primary-school-myanmar-design-travel-singapore.htm

337. An intern flirts with the danger of termination of internship

February 16, 2011

Yesterday, Michelle came to work late again for the 2nd time. "Does your Victoria Junior College teachers teach you punctuality at work?" I asked her. She had been warned and yet she did it again, thereby flirting with danger of being dismissed from internship. Her mother sent her to work everyday and her father or mother picked her home unlike Nat who had to take a bus and get to work himself. "So, what's your excuse?" I asked her. "Traffic was heavy," she said. "This is a common excuse," I said. "It is not acceptable. If you don't value your internship, don't do it. You have been warned twice now. The third time will be termination of your internship."

Nat had not been late during the past 4 days despite having to take a bus to work. He bothered to wake up early and ensure he was a bit early. Michelle had been a clock watcher and was hoping to be just-in-time.

"Obviously, you are doing work attachment or internship because you want a testimonial," I said. "If you don't work hard, you will get a mediocre testimonial - satisfactory performance but not punctual. Is that what you want?" I do spend time teaching them some cases of veterinary medicine and if an intern persists in behaving as if the world owes her a living, she is better off staying at home.

"As for your mum driving you to work late, you will need to ensure that she wakes up early to do so," I told Michelle. In the first place, there is no need for an intelligent lady to be told in this way. Treating internship like a holiday camp or vacation or like your father's office is not tolerated. Parents who feel the need to drive their children to internship need to be alert and impart values of punctuality and be a role model for the young ones.

One more time, Michelle will be asked to go. She is setting a bad example for my staff and Nat and the rot will be like a cancer, affecting the behaviour of all employees.

I noted that the vet's dog was no longer present in the Surgery to create fears and worries in clients. There is much relief on my part. There are vets whose dogs and cats are well loved by clients if they behave responsibly. Just like interns, those who don't behave as expected will create tension and are best banned from the practice.

I will be on leave from Feb 17 to 22, 2011 and I hope nothing unusual will happen in Toa Payoh Vets. It is the responsibility of the Clinic Manager who is myself if there are any complaints. Every day, there are new incidents and many issues are needed to be regulated and to prevent possible litigation in this fast-paced society. Bad eggs are best asked to go. No more blind loyalty.

336. The vet's dog made a lady shriek

February 15, 2011

Being the founder of Toa Payoh Vets, I do not wish the company to create unhappy customers. A Malay couple came in with their cat to see Dr Vanessa. I asked them to wait as she was busy in the operating room. I quickly cleared the laptop and other things of Nat on the table in the waiting room. I put their cat's cage and cat on the table to avoid another incident of Dr Vanessa's dog sniffing the cage and creating another unhappy customer.

I have to decide what to do with Dr Vanessa and her dog today. A good vet is no good if he or she creates unhappy customer. It is better to have a top team rather than a top vet if the practice is to survive and be around in the long term. I have made no decision yet but if there is a need, I will rather fire the top vet rather than create unhappy customers.

The dog was confined to the receptionist area when the door of the counter was closed. However, he again sneaked out. I noted that he was quiet and had not barked at anybody. He was confined by Dr Vanessa in a crate at the back yesterday for frightening the rabbit owner by sniffing the crate with the rabbit inside. I had to told Dr Vanessa to take him away from the waiting room. I had not specified banning of this dog from the Surgery yet as I would wait to see what she would do.

I presume that the Malay couple would prefer a cat's clinic but there is none in Singapore. The man went outside to answer his phone call. The lady sat at the corner of the waiting area where the table with her cat's crate is located. The cat was brought in for a spay and the couple had specified that they only wanted to consult Dr Vanessa.

Suddenly the lady shrieked. I was at the waiting room instructing my two interns what to do and teaching them some cases. I turned around and saw the dog going under the legs of this table. He did go under the table earlier when there was no people. But as Dr Vanessa opened the door to go to the back of the surgery, he followed her but now he had come out when Michelle opened the door to get to the waiting area. He must have decided to go under the table.

A few seconds more and he would have contacted the Malay lady and in her religion, this was not acceptable. As the dog wanted to bite Michelle the intern yesterday, I did not want to be heroic. I called Dr Vanessa to come out of the operating room and get the dog in. She would have heard the shrieks too.

Now, I need to decide what to do as I don't want to create unhappy customers who will go to the competitors. I will wait and see. I can see the humour of the situation but it will not be humourous to owners who are worried about their pets being "attacked" by Dr Vanessa's medium-sized dogs. Customers are what make a practice and if the founder cannot get his priority right, he deserves to lose his shirt and go bankrupt. It is not a guarantee that a veterinary surgery will be successful and be in existence if it is poorly managed and creating unhappy customers is no joke.

335. A very busy father seeks immediate treatment for his daughter's hamster

Yesterday, Feb 15, 2011, I was surprised to see a busy father rushing in with a hamster in a cage. "I am in a hurry," he said. "My daughter's hamster has broken his leg."

"Where's your daughter?" I asked. "She's in school and does not know about this yet."
It is very unusual to see a Singapore father taking time off to send the hamster to see the vet.

"Where's the vet?" he asked me.
"Dr Vanessa is in the operating room," I said. "Can you wait?"
As he was in a hurry, probably to close a real estate deal (based on he being awarded IEA Realtors Awards - lst runner up in 2008/2009 and Platinum award in 2007 and 2008, from his namecard which I got from him later), I decided to take charge of his case. Usually Dr Vanessa will handle the cases during the hours of duty.

He was hesitant as he thought I was the customer service staff.
"I am Dr Sing," I introduced myself. He smiled and said: "My daughter told me about you and your hamster cases." Since I do not know the 15-year-old daughter, I presume he was referring to my hamster case studies at www.toapayohvets.com, hamsters.

Since Dr Vanessa came in, I excused myself and let Dr Vanessa handle the case.