The following tips from fellow vets were given to me at the Veterinary anaesthesia continuing education of Mar 26, 2011 by Dr Kieren Maddern, European Specialist in Veterinary Anaesthesia:
1. INJECTABLE ANAESTHESIA from a practice in Malacca.
According to the vet who runs a practice in Malacca, the UPM professors had been using the following formula safely and effectively for the past 15 years. He had been using it for the past 10 years.
1.1
Zoletil 100 (don't use the diluent provided).
Add in the bottle 8 ml of ketamine
Add in the bottle 2 ml of xylazine
Dose: 0.04ml/kg IM. 0.03ml/kg very slow IV.
Use isoflurane gas if needed or top up 1/2 to 1/3 dose IM when the dog wakes up.
1.2
Zoletil 50 (don't use the diluent provided).
Add in the bottle 4 ml of ketamine
Add in the bottle 1 ml of xylazine
Dose: 0.04ml/kg IM. 0.03ml/kg very slow IV.
Use isoflurane gas if needed or top up 1/2 to 1/3 dose IM when the dog wakes up.
1.3 For CATS
Be careful. Use the IV dosage for IM injection. That is 0.093 ml/kg for IM.
Top up if necessary.
Zoletil is an expensive drug and therefore the above combinations is less expensive and effective and safer.
2. Lecturer's tips
Ketamine & ACP - excellent for cats. Ketamine alone makes the cat's body
rigid. Seldom use atropine (makes throat dry).
3. A Singapore's vet's tips
Xyalzine + Atropine + Ketamine. Then use isoflurane gas.
Each vet has is own method. If he uses new drugs e.g. N2O, the dog may die.
Sunday, March 27, 2011
372. Continuing education - Veterinary Anaesthesia & tarsorrhapy advice
Yesterday, Saturday March 27, 2011, I attended a continuing education lecture by a veterinary anaesthesia specialist, Dr Kieren Maddern, BVSc (Hons), MACVSc, Dip ECVAA, European Specialist in Veterinary Anaesthesia. The topic was "Overcoming the odds - Anaesthesia for difficult situations."
It was a very well attended lecture - some 70 people there. An excellent lecture. I caught up with a senior vet who has done a few thousand dog and cat surgeries over the last 40 years and asked his advices about young vets referring corneal ulcer cases to other practices.
He said: "The young vet may find that it is a difficult case or that the owners are the type liable to sue. So, just refer the case out. Or the young vet thinks that you can't do the surgery! He or she does not usually ask for advice but just refer!
"When the case goes from Toa Payoh Vets to the other vet, the other vet will just laugh and say 'Dr Sing does not even know how to operate a simple corneal ulcer case! What's wrong with him?' Maybe you should give instructions that all cases that your younger vets want to refer to others should go through you!"
I was not alone in having this problem of the younger vets doing their own thing without consulting the senior vets in the practice.
The senior vet told me: "Tarsorrhapy is very effective in corneal ulcer cases. Even in cases where the eyeball collapses. Just sew up the two eyelids and the outcome is usually very good. I find that the eyeball is seldom infected even with perforated ulcers."
I listened attentively for the free advice. The senior vet is 5 years older than me just in case but he puts in the very long hours and do the after hours emergencies. High energy and therefore he has more caseload experiences.
"By the way, how do you treat corneal ulcers in the dog?" my mentor asked.
"I am more kiasu," I said. "I do the 3rd eyelid flap and tarsorrhapy." Not all the time, but sometimes.
The pictures of my case in a Jack Russell are shown below.
It was a very well attended lecture - some 70 people there. An excellent lecture. I caught up with a senior vet who has done a few thousand dog and cat surgeries over the last 40 years and asked his advices about young vets referring corneal ulcer cases to other practices.
He said: "The young vet may find that it is a difficult case or that the owners are the type liable to sue. So, just refer the case out. Or the young vet thinks that you can't do the surgery! He or she does not usually ask for advice but just refer!
"When the case goes from Toa Payoh Vets to the other vet, the other vet will just laugh and say 'Dr Sing does not even know how to operate a simple corneal ulcer case! What's wrong with him?' Maybe you should give instructions that all cases that your younger vets want to refer to others should go through you!"
I was not alone in having this problem of the younger vets doing their own thing without consulting the senior vets in the practice.
The senior vet told me: "Tarsorrhapy is very effective in corneal ulcer cases. Even in cases where the eyeball collapses. Just sew up the two eyelids and the outcome is usually very good. I find that the eyeball is seldom infected even with perforated ulcers."
I listened attentively for the free advice. The senior vet is 5 years older than me just in case but he puts in the very long hours and do the after hours emergencies. High energy and therefore he has more caseload experiences.
"By the way, how do you treat corneal ulcers in the dog?" my mentor asked.
"I am more kiasu," I said. "I do the 3rd eyelid flap and tarsorrhapy." Not all the time, but sometimes.
The pictures of my case in a Jack Russell are shown below.
Saturday, March 26, 2011
371. Studying vet in the USA after A levels? Not possible?
Dr Sing Kong Yuen
Dear Sir,
I am involved with recruitment for the Freeman Scholarship Program at Wesleyan University in Middletown, Connecticut in the US. We did a recruitment session recently for our finalists. One is a lady with a strong interest in becoming a veterinarian.
I believe we are badly-positioned to help her realize her dreams. Specifically, vet schools in the US are graduate programs, requiring the applicant first complete four years of undergraduate study …. Then take the MCAT exams and go through the entire school admissions process again!
I suggested to her school systems that work on the British system, such as Glasgow. I also suggested the AVA scholarship program. I noted from your website that you attended Glasgow on the Colombo Plan, served with the SAF Provost Dog Unit, tended race horses for the Bukit Timah Club, started your own clinic, and are now headed into happy retirement.
You have walked the path that she is considering. Might you have a moment to take a call from her and give her the wisdom that comes from real experience?
I am an ex-infantry officer who spent his life as a civil engineer building prisons, police compounds and the coastal barrier for the Singapore government. My ability to guide her is terribly limited.
Thank you so much for any help you can give.
With best regards,
Name given
REPLY FROM DR SING DATED MAR 24, 2011
Hi
Thank you for your email. I can always spare more than a few minutes to meet one-on-one to the young lady who wants to be a veterinarian. Phone calls are a waste of time if the persons are sincerely interested in knowing more about veterinary medicine and surgery. During the meeting, I can assess whether the young lady is really passionate about veterinary medicine and surgery. Phone calls and text messages and emails are preferred by the younger generation who don't have the real interests or passion and merely wants to go fishing.
Let me know as soon as possible. I don't know where you get the impression that I am into "happy retirement". I have an associate veterinarian who is younger and takes care of many of my old clientele as there is insufficient rooms for 2 vets at any one time. I still consult and yesterday I spayed a Fox Terrier as the owner wanted me to do it. I am even busier than before in veterinary medicine, travel and real estate.
I hope we can meet one day and not just e-mail. Best wishes.
E-MAIL FROM DR SING DATED MAR 25, 2011
To: ....
Sent: Friday, March 25, 2011 12:44 AM
Subject: Re: Fw: For Dr Sing Kong Yuen
Hi
Yesterday, I told a prospective intern who had straight As (except one B) in her A levels to go home since she could not work the hours required of an intern. Her father had objected to her working "long hours" and she had phoned me yesterday wanting to negotiate to shorter hours. This young lady, about to venture overseas to study in the U.S and accepted by US vet school is still tied to the apron's strings. Can excellent "A" level results open a place to study vet medicine in US universities as apparently is the case in this lady.
REPLY TO DR SING DATED MAR 26, 2011
Dear Dr. Sing,
Thank you very much for taking so much time with me.
What that perspective/rejected intern told you does not make sense to me. I pulled the below off the Veterinary Medical College Application Service website:
Major- Choose a major in an area that interests you. You do not have to be a science major to go to osteopathic medical school. However, you must complete certain course requirements. Most osteopathic medical schools require the same courses as allopathic medical schools, listed below:
1 year of physics with lab
1 year of general chemistry with lab
1 year of organic chemistry with lab
1 year of biology with lab
1 year of english
Requirements do vary between schools. Many schools require biochemistry and genetics in addition .
As you can see, the American system requires one to take a four year undergraduate liberal arts curriculum before they even apply to vet school.
Might that prospective intern have been mistaken in her assumption she could apply directly to an American vet school?
P.S
On your second query: No I have never met Gerald of .... Properties! I train with a guy named Gerald at the NUSS gym, but I believe he is a teacher.
I am actually ex-US Army and ex-civil engineer (retired).
I was involved in a recruitment exercise for my old university held down in the (location given).
We got the usual collection of arts-stream types who all want to be writers or artists. But we got one applicant who stood out; this lady was math/science, wanted to be a vet, and seemed to have her priorities straight.
Our admissions officer made some ... comments about this student's career plans (apparently they wanted her to study political science!).
I had an ugly confrontation with the admissions officer after the meeting, then I went on the computer and started googling information on proper vet programs and veterinary career paths.
Your name stuck with me because you had been commander & veterinary officer of guard & tracker dogs with the Provost Guard Dog Unit. I also noted you had worked with race horses at Bukit Timah and now had your own clinic. You had been a government scholar.
I wrote you because you had the right background. I can tell this student not to waste her time with political science. But only you can set her on the right path.
If you have a moment, I can bring her by your clinic. She wrote me asking whether next Tuesday would be okay. If that day is convenient, I will bring her to:
Block 1002, Toa Payoh Lorong 8
#01-1477
Just let me know what time is convenient.
I will disappear during the meeting and you will be free to give her the good, the bad, and the ugly of her career choice.
Thanks so much.
Name given
-----------------
UPDATE MAR 27, 2011 FROM Dr Sing
Will meet prospective vet student on next Tues Mar 29, 2011 11 am at Toa Payoh Vets
Dear Sir,
I am involved with recruitment for the Freeman Scholarship Program at Wesleyan University in Middletown, Connecticut in the US. We did a recruitment session recently for our finalists. One is a lady with a strong interest in becoming a veterinarian.
I believe we are badly-positioned to help her realize her dreams. Specifically, vet schools in the US are graduate programs, requiring the applicant first complete four years of undergraduate study …. Then take the MCAT exams and go through the entire school admissions process again!
I suggested to her school systems that work on the British system, such as Glasgow. I also suggested the AVA scholarship program. I noted from your website that you attended Glasgow on the Colombo Plan, served with the SAF Provost Dog Unit, tended race horses for the Bukit Timah Club, started your own clinic, and are now headed into happy retirement.
You have walked the path that she is considering. Might you have a moment to take a call from her and give her the wisdom that comes from real experience?
I am an ex-infantry officer who spent his life as a civil engineer building prisons, police compounds and the coastal barrier for the Singapore government. My ability to guide her is terribly limited.
Thank you so much for any help you can give.
With best regards,
Name given
REPLY FROM DR SING DATED MAR 24, 2011
Hi
Thank you for your email. I can always spare more than a few minutes to meet one-on-one to the young lady who wants to be a veterinarian. Phone calls are a waste of time if the persons are sincerely interested in knowing more about veterinary medicine and surgery. During the meeting, I can assess whether the young lady is really passionate about veterinary medicine and surgery. Phone calls and text messages and emails are preferred by the younger generation who don't have the real interests or passion and merely wants to go fishing.
Let me know as soon as possible. I don't know where you get the impression that I am into "happy retirement". I have an associate veterinarian who is younger and takes care of many of my old clientele as there is insufficient rooms for 2 vets at any one time. I still consult and yesterday I spayed a Fox Terrier as the owner wanted me to do it. I am even busier than before in veterinary medicine, travel and real estate.
I hope we can meet one day and not just e-mail. Best wishes.
E-MAIL FROM DR SING DATED MAR 25, 2011
To: ....
Sent: Friday, March 25, 2011 12:44 AM
Subject: Re: Fw: For Dr Sing Kong Yuen
Hi
Yesterday, I told a prospective intern who had straight As (except one B) in her A levels to go home since she could not work the hours required of an intern. Her father had objected to her working "long hours" and she had phoned me yesterday wanting to negotiate to shorter hours. This young lady, about to venture overseas to study in the U.S and accepted by US vet school is still tied to the apron's strings. Can excellent "A" level results open a place to study vet medicine in US universities as apparently is the case in this lady.
REPLY TO DR SING DATED MAR 26, 2011
Dear Dr. Sing,
Thank you very much for taking so much time with me.
What that perspective/rejected intern told you does not make sense to me. I pulled the below off the Veterinary Medical College Application Service website:
Major- Choose a major in an area that interests you. You do not have to be a science major to go to osteopathic medical school. However, you must complete certain course requirements. Most osteopathic medical schools require the same courses as allopathic medical schools, listed below:
1 year of physics with lab
1 year of general chemistry with lab
1 year of organic chemistry with lab
1 year of biology with lab
1 year of english
Requirements do vary between schools. Many schools require biochemistry and genetics in addition .
As you can see, the American system requires one to take a four year undergraduate liberal arts curriculum before they even apply to vet school.
Might that prospective intern have been mistaken in her assumption she could apply directly to an American vet school?
P.S
On your second query: No I have never met Gerald of .... Properties! I train with a guy named Gerald at the NUSS gym, but I believe he is a teacher.
I am actually ex-US Army and ex-civil engineer (retired).
I was involved in a recruitment exercise for my old university held down in the (location given).
We got the usual collection of arts-stream types who all want to be writers or artists. But we got one applicant who stood out; this lady was math/science, wanted to be a vet, and seemed to have her priorities straight.
Our admissions officer made some ... comments about this student's career plans (apparently they wanted her to study political science!).
I had an ugly confrontation with the admissions officer after the meeting, then I went on the computer and started googling information on proper vet programs and veterinary career paths.
Your name stuck with me because you had been commander & veterinary officer of guard & tracker dogs with the Provost Guard Dog Unit. I also noted you had worked with race horses at Bukit Timah and now had your own clinic. You had been a government scholar.
I wrote you because you had the right background. I can tell this student not to waste her time with political science. But only you can set her on the right path.
If you have a moment, I can bring her by your clinic. She wrote me asking whether next Tuesday would be okay. If that day is convenient, I will bring her to:
Block 1002, Toa Payoh Lorong 8
#01-1477
Just let me know what time is convenient.
I will disappear during the meeting and you will be free to give her the good, the bad, and the ugly of her career choice.
Thanks so much.
Name given
-----------------
UPDATE MAR 27, 2011 FROM Dr Sing
Will meet prospective vet student on next Tues Mar 29, 2011 11 am at Toa Payoh Vets
370. Procedure and costs of dental scaling at Toa Payoh Vets in 2011
E-MAIL TO DR SING DATED MAR 25, 2011
--- On Fri, 25/3/11, ...@hotmail.com> wrote:
Subject: Scaling for dogs
To: judy@toapayohvets.com
Received: Friday, 25 March, 2011, 2:00 PM
Hi,
I am looking for a trusted vet and doctor who can perform scaling on my 2 year old chihuahua. I am interested upon sending her to Toa Payoh Vets. I would like to know how much it would cost and what I should do to prepare her for the day of her visit.
Thank you,
Name given
E-MAIL REPLY FROM DR SING DATED MAR 26, 2011
Hi
I am Dr Sing from Toa Payoh Vets. Thank you for your email to Judy.
The dental scaling plus anaesthesia cost is around $250 normally. Decayed tooth extraction will be around $10-$20 per tooth extracted. Medication of antibiotics and pain-killer is estimated at around $20 if necessary. Blood test for pre-anaesthesia risk checking will not be done in normal healthy dogs and will cost $150 if it is needed but you will be informed first.
Do not feed or give water to your dog after 10 pm the night before the dental work. Bring your dog to Toa Payoh Vets are 10 a.m. The dog will go home around 5pm usually after rest and recovery from general anaesthesia.
Pl make an appointment at 6254 3326. Pl indicate which vet you will prefer. These are Dr Sing, Dr Vanessa Lin and Dr Jason Teo.
--- On Fri, 25/3/11, ...@hotmail.com> wrote:
Subject: Scaling for dogs
To: judy@toapayohvets.com
Received: Friday, 25 March, 2011, 2:00 PM
Hi,
I am looking for a trusted vet and doctor who can perform scaling on my 2 year old chihuahua. I am interested upon sending her to Toa Payoh Vets. I would like to know how much it would cost and what I should do to prepare her for the day of her visit.
Thank you,
Name given
E-MAIL REPLY FROM DR SING DATED MAR 26, 2011
Hi
I am Dr Sing from Toa Payoh Vets. Thank you for your email to Judy.
The dental scaling plus anaesthesia cost is around $250 normally. Decayed tooth extraction will be around $10-$20 per tooth extracted. Medication of antibiotics and pain-killer is estimated at around $20 if necessary. Blood test for pre-anaesthesia risk checking will not be done in normal healthy dogs and will cost $150 if it is needed but you will be informed first.
Do not feed or give water to your dog after 10 pm the night before the dental work. Bring your dog to Toa Payoh Vets are 10 a.m. The dog will go home around 5pm usually after rest and recovery from general anaesthesia.
Pl make an appointment at 6254 3326. Pl indicate which vet you will prefer. These are Dr Sing, Dr Vanessa Lin and Dr Jason Teo.
Friday, March 25, 2011
Passing the buck - The pug with a perforated corneal ulcer
March 24, 2011 was a day to remember due to the following 3 incidents.
1. The Junior College student with straight As and 1 B and an excellent testimonial from her form teacher could not work "long hours." She had phoned me the previous night to let me know that she would not work the long hours of internship as it was "tiring". So, I told her that I would phone her back regarding her terms and conditions of work. That implied that she ought to stay at home till I decided since my offer was not accepted. Yet she presented herself at the Surgery today at 8 am as I had told my assistant Mr Saw that the intern would not be coming.
I asked if her father or mother was against her working hard? She had no objection to the hours of work during the interview yesterday and even arranged for her driving test lessons to take place at 5 pm on Friday. She would work 6 days a week with one weekend day off. She arranged for 6 weeks of internship - a very short period but that would give her some credentials as she had applied for an AVA veterinary undergraduate scholarship.
Apparently her father was against it. "You will be going overseas to study," I said sadly to this young personable lady who did not need to take the "O" level examinations unlike the average Singaporean student as she was the "top 10% of her cohort likely to go to the university."
"Your working hours are non-negotiable. In any case, you will be off before 5 pm on Friday for your driving test at Bukit Batok and you don't work on one Saturday or Sunday." I was rather sad that she could not put her foot down for her own future. "You need to think for yourself and not get tied to the apron's strings."
I wished her good luck and let her go. Over-protective Singaporean parents who think that the world owes their academic superstar-children a living will be in for a rude shock when their children goes to the real world of commerce as their attitude doesn't make the progeny street-wise and realistic.
2. Mr Saw phoned me at 11.30 am while I was at the Singapore General Hospital area to say he was not feeling well and would try his best. He had generalised muscular aches. I often told him: "You are a young man." But he would say "I have an old man's body."
Mr Saw is a very responsible assistant and if he was a Singaporean, he would make a very good vet. I could see that he has the passion during the past 3 years with me and I had mentored him with whatever knowledge of the skills of surgery and medicine I had.
I rushed back after taking a few photos of Everton and Spottiswood Park conservation houses (bright sunshine - good for pictures).
3. I told my associate vet that Mr Saw was sick and he would be taking time off. I would be the customer service officer taking money and processing the credit card and nets machine as my other staff was on leave. Another assistant Mr James Ang had retired at the age of 73 years as he was bent double for some unknown reason. I had to let him go in February after some 20 years with me. He would be giving prospective clients a bad impression compared to the nubile young girls at competitor's practice as he was hunched as if he could not stand straight.
Two days ago, the mother and adult daughter of a Maltese with red eyes had smiled at me when they saw me handling the payment at reception counter after consultation with my associate vet. They were old clients. The daughter had now become a grown up in her early 30s. I said: "Like the PAP who introduce new politicians at the elections, I must renew the vets at Toa Payoh Vets. Young vets, new ideas. Lots of energy."
Soon, 3 young adults in their early 30s (2 ladies and one gentleman) came in with a pug with a bleeding leaking eye. I got them registered as they were new clients. I could see that one of the two young ladies was quite distressed. My associate vet handled the case as usual. I could see that it was a case of a central corneal ulcer, a common problem in breeds with protruding eyeballs.
"So what happened?" I asked the gentleman who came out of the consultation room and sat on the yellow chair after some minutes of discussion with my associate vet. I had been inside the room to evaluate the eyeball at one time but left without comments. He said: "The doctor is making arrangements to hospitalise the pug."
I was extremely surprised. Associate vets do get some freedom to do their cases in the manner they deem fit. Toa Payoh Vets is equipped with anaesthetic and surgical facilities and is capable of handling a corneal ulcer case. Referring what I considered to be a simple case of corneal ulceration to be hospitalised in another practice in Singapore was a big shock to me.
I don't want the vets at Toa Payoh Vets to be known as the "Old School Vets". This term was made known to me from a staff of a practice I visited last week as I brought a young male intern with a blue golden lock of forehead hair to visit the practice to buy some vaccines.
The lady manager in this practice where the vets will refer every "difficult and potentially litigious" surgical case to a brand-name practice said to me: "My friend asks me which veterinary clinic I was working and when I told her, she said I was working with an 'Old School Vet'. I don't mind. I am very happy and well treated in this clinic."
So, this practice does vaccination, dental scaling, sterilisation and removal of lumps. Nothing more complicated. This definitely was not the sort of veterinary surgery I practise for the past 30 years.
Now my associate vet now making phone calls to another brand name practice to pass the case over.
This passing the buck of a simple case of corneal ulcer is not for associate vets of Toa Payoh Vets. If any associate vet can't perform surgery of a simple corneal ulcer and refers to a 2nd a brand name competitor, there is the "can't even do a simple corneal ulcer case" implication.
I know some vets dislike complicated surgeries as they are potentially litigious but this was a simple corneal ulcer case, in my observation. I went to the consultation room and asked my associate vet what was going on. Why was she referring to a brand name practice? She showed me the letter from Vet 1 to consult a certain vet in a brand name practice and since that vet was unavailable, she made alternative arrangements. Eye injuries are emergencies and ought to be treated within 4 hours. Now, it was 5 days post injury.
I was extremely surprised as my associate had at least 2 years of practice before joining me. If she could not deliver, she ought to consult me. There was this potential of the competitor's vet and staff labelling and bad-mouthing Toa Payoh Vets as being incompetent to handle a corneal ulcer.
I asked the owners to leave the consultation room, closed the door and had a private chat with my associate vet. I said: "This is going to be a highly contentious case as there is a lot of emotion involved as Vet 1 had given a name of a vet who would not take the case. The owners are much distressed. You just refer them to another practice.
That practice employs fresh graduates and rookie vets. You are not doing the dog a favour by just making appointment for an unknown vet to handle this case if the older vet was not available. I will take over this case as the owners are going to be unhappy should the other vet mis-treat this case."
If I refer a case to a vet, I must make sure that this vet has the relevant experience and a high standard of practice and will perform the surgery and not his fresh employee graduates. It does not mean that this vet must be employed in a brand name swanky practice.
I was in the consultation room earlier too but the associate did not introduce me and I did not introduce myself too. So, the distressed lady was apprehensive when I examined the dog's eye and tried to pull the dog back. So I left the room for my associate vet to manage the case.
I was around and yet she did not think of asking me for advice when issues and problems arise. Life for a practice manager is full of surprises and changes.
I told my associate to ask the clients to come in and to formally introduce me as that would be the correct way in professional practice. This case was high voltage and lightning had struck. The pug's eye was going to collapse any time soon and any miscommunication or bad referral resulting in the pug being blind would have cast Toa Payoh Vets in a bad light.
"The owners must be thinking I am just a receptionist since I was registering their case," I said to my associate. "This case is going to adversely affect the reputation of the Surgery if the brand name practice vet bungles the surgery. How do you know whether that this brand name practice will or will not assign a fresh vet with no experience in handling a Descemetocoele? This corneal ulcer is in a highly dangerous state as it is going to perforate soon.
"You know that this brand name practice's senior vet may not be available. If he assign a fresh vet to do it, the cornea perforates on the way to the vet, the pug goes blind. So, the owners would just bad-mouth Toa Payoh Vets as the practice that referred the case." I did not mention that this brand name practice charges top dollars and this case would set the owners back by over a thousand dollars.
My associate opened the door and asked the 3 adults and pug to come in. She introduced me as her boss.
"I am the founder of this practice," I elaborated. "I did not introduce myself earlier in the consultation room. I am responsible for the practice management." I was the licensee and any complaint or litigation would mean I have to waste time attending to investigations. I had assessed that the clients were sophisticated and knowledgeable and this is the profile of the younger generation. Whether they would complain about being passed the buck by Toa Payoh Vets would depend on how this emotional situation was handled and whether their pug's eyeball would be enucleated by the other vet. Owners just don't like the idea of their pets losing an eyeball.
This was a case that had a 50:50 chance of saving the dog's eye. If the vet knows how to resolve the problem.
The gentleman summarised the situation succinctly: "There is no one vet you can recommend to treat my pug." He must have superman's hearing as he was in the waiting area and he could not have had heard my conversation with the associage vet.
I said: "It is not necessary to refer the case at all as Toa Payoh Vets has the capability and experience to handle this case.
"I have handled several cases of corneal ulcerations and if you have no objection, I will do the 3rd eyelid flap. Have you visited Toa Payoh Vets' webpage on eye problems in the dog?"
Such sophisticated young adults would have had checked up Toa Payoh Vets' website at the waiting area with their iPhone 4 while I was having a closed-door discussion with my associate vet. The world has changed tremendously. Internet information flows freely and the clients know much more than the vet sometimes.
The gentleman said: "You operated mainly on Shih Tzus' eyes." This was an excellent feedback from him. I had not analysed my webpage on eye problems in the dog at www.toapayohvets.com. I had not posted other breeds I had treated as it is extremely time-consuming to create webpages to write the case report of all breeds I operated upon. I don't take pictures of all breeds too.
This article took 6 hours to write and to create the supporting images. There are so many things I want to do and I just can't have time to do many of my favourite things if I write case reports of all breeds having corneal ulcers. As a vet who does surgery, the range of surgical cases is from the head to the tail.
I replied: "Shih Tzus have the highest number of eye injury problems in my practice. Any breed with protruding eyeballs may suffer from this corneal ulceration problems. This includes the Pekinese and the Pug."
To cut a long story short, the owners had no objection in my performing the surgery. If they were not comfortable, I would just ask them to make their own decision to select their own vet.
My associate vet watched me doing the surgery. She said she had not seen me doing a surgery. Many of my surgical cases have been passed on to her to do and that was why I had less to do.
This is how I managed the corneal perforation case surgically:
INFORMED CONSENT. I took time to explain the risks of anaesthesia (death as this pug was infected for the past 5 days and could be infected in the blood stream. A delay of 24 hours with antibiotics prior to surgery would be preferred but this was an emergency as the cornea will perforate soon. I advise that I would give baytril antibiotics IV and perform the surgery soon).
I explained the risk of surgery (bleeding, pain, infection, collapse of the eyeball due to infection leading to the possibility of enucleation as the owner had not consulted the vet within 4 hours of the eye injury). The gentleman signed the form.
SEDATION & ANAESTHESIA
"Isoflurane gas alone is the safest anaesthetic for this young pug of 7 months with a possibility of infection of the past 5 days," I said to Mr Saw who takes close notes as he would be operating his own practice in Myanmar soon. "However, the pug's nose is flat and the pug will struggle a lot, leading to perforation of the cornea and collapse of the eyeball. So, what sedation would you give? Your favoured domitor and ketamine IV?"
Mr Saw was not so sure. This was a pug with suspect infection after 5 days or more of eye injury. The pug's eye look like an earthquake and tsunami disaster area as seen in the recent pictures of the calamity in Japan. Big patch of white gel and a stream of red-tinged flow of gel and blood at one end, measuring around 1.5 cm long. A continuous stream if you are observant. It reminded me of the oil spill in the Gulf of Mexico although I did not see the actual leak - only oil slicks in the ocean. Here, I could see the stream. It was fascinating as a case but extremely dangerous for the pug. A delay in treatment and the corneal hole would enlarge and the inside aqueous humour would just splash out. The end of the eyeball, although the vet can still stitch up the cornea. Most vets will not encounter such corneal ruptures or stitching and so it can be quite frightening to encounter this case.
I used 0.2 ml xylazine IV. Waited 5 minutes. The pug vomited out its food as this was the effect of xylazine (and even in domitor or domitor/ketamine IV) Then isoflurane gas.
SURGERY
The 3rd eyelid flap is done. Basically the needle goes into the upper eyelid, then under the 3rd eyelid and back out to the lower eyelid. Tied in a knot. "It will be easier if an assistant pulls out and upwards the 3rd eyelid for stitching," I said to my associate vet as Mr Saw automatically used forceps to do it for me.
SUTURE PATTERNS
Several combinations. For this case, I use 3 simple interrupted sutures. Another case, I used a horizontal mattress and one interrupted. Or just one horizontal mattress.
Question. "Are 3 sutures sufficient?" - Yes.
SUBCONJUCTIVAL INJECTION OF GENTAMYCIN AND DEXAMETHASONE.
I know some vets believe that steroids should not be used in eye ulcerations. Well, a small drop of dexamethasone will alleviate the inflammation and pain and does not cause harm.
"Get me the prednisolone," I said to Mr Saw. He got me the depot prednisolone and I rejected it. It is best to use dexamethasone or prednisolone meant for IV." Well, Mr Saw did as instructed but got the incorrect type. All vets must check the medication before injection. Well, Mr Saw learnt something from this participation in the case. "Use common sense," I said to Mr Saw. I wonder whether he knows what is the meaning of common sense as applied to his offer of depot prednisolone. Details of surgery and comments in 8 pictures at webpage of Toa Payoh Vets - goto DOGS - EYE PROBLEMS or at:
http://www.bekindtopets.com/animals/20081201PAGE3_
Dog_Surgery_Anaesthesia_Eye_ToaPayohVets.htm
POST-OP DAY 1 & 2
The IV drip continued. Tolfedine and baytril given SC. The pug was sleeping and woke up fresh the next day. Very active. At 3 pm on day 2, the gentleman and his wife visited. They took leave from work. It was one of those money can't buy joys to see the distressed lady back to her normal self.I expect the pug's ulcer to heal in 14 days' time and the pug to go home on Day 3. The outcome should be a white spot in the centre of the cornea and no eyeball collapse or infection.
RETROSPECTIVE REVIEW
1. Why did Vet 1 refer the case to a vet that is not available? This is a mystery to me. He probably thought that the cornea ulcer was extensive, needed stitching and he had no facilities to do it and had referred to my associate vet. However, I was on counter duty and saw the case first.
The eye ulcer looked terrible as if it had a big earthquake. It appeared to be a white reddish gel patch of at least 5-8 mm in diameter. Actually, it was 1-2 mm in diameter when I used a scalpel to scrape away the out flowing blood clot. After scrapping, I showed my assistant the black hole measuring around 1 mm in diameter. Aqueous humour leaked out from the hole. Surrounding the black hole was a circle of basement membrane measuring around 4-7 mm in diameter with the black hole as the centre. This membrane would rupture soon if the owners just don't bother to see Vet 1 who advised emergency eye treatment correctly and professionally.
To estimate the size of the corneal perforation, see the 'stream' of gel coming out as a streak. It was around 2-3 mm. See the images.
2. The pug had a perforated ulcer, not a Descemetocoele. The initial presentation was similar to a Descemetocoele with a streak of gelatinous or eye discharge. So, I said "Descemetocoele" to my associate at the examination room as the dog did not permit proper eye examination.
Under general anaesthesia, after scrapping away the blood clot, a black hole of 1mm x 1mm with watery aqueous seeping out indicates that the correct diagnosis is a perforated corneal ulcer also known as deep ulcerative keratitis.
3. Corneal wounds can be sutured with fine 6/0 sutures. Small perforations are best left to heal with the 3rd eyelid flap surgery. And they do heal very well if the inside of the eyeball is not infected. Can you see the pinkish-reddish blood sediment on the medial inner side of the eyeball in one of the pictures below?
I hope this report will be useful for undergraduates struggling to study so many subjects for their examinations to appreciate the anatomy of the dog's eye and its changes during ulceration.
For readers of my blog, updates and more pictures are in toapayohvets.com, goto DOGS - EYE PROBLEMS.
http://www.bekindtopets.com/animals/20081201PAGE3_
Dog_Surgery_Anaesthesia_Eye_ToaPayohVets.htm
For readers of my blog, updates and more pictures are in www.toapayohvets.com goto DOGS - EYE PROBLEMS.
http://www.bekindtopets.com/animals/20081201PAGE3_
Dog_Surgery_Anaesthesia_Eye_ToaPayohVets.htm
Details are in www.toapayohvets.com goto DOGS - EYE PROBLEMS.
1. The Junior College student with straight As and 1 B and an excellent testimonial from her form teacher could not work "long hours." She had phoned me the previous night to let me know that she would not work the long hours of internship as it was "tiring". So, I told her that I would phone her back regarding her terms and conditions of work. That implied that she ought to stay at home till I decided since my offer was not accepted. Yet she presented herself at the Surgery today at 8 am as I had told my assistant Mr Saw that the intern would not be coming.
I asked if her father or mother was against her working hard? She had no objection to the hours of work during the interview yesterday and even arranged for her driving test lessons to take place at 5 pm on Friday. She would work 6 days a week with one weekend day off. She arranged for 6 weeks of internship - a very short period but that would give her some credentials as she had applied for an AVA veterinary undergraduate scholarship.
Apparently her father was against it. "You will be going overseas to study," I said sadly to this young personable lady who did not need to take the "O" level examinations unlike the average Singaporean student as she was the "top 10% of her cohort likely to go to the university."
"Your working hours are non-negotiable. In any case, you will be off before 5 pm on Friday for your driving test at Bukit Batok and you don't work on one Saturday or Sunday." I was rather sad that she could not put her foot down for her own future. "You need to think for yourself and not get tied to the apron's strings."
I wished her good luck and let her go. Over-protective Singaporean parents who think that the world owes their academic superstar-children a living will be in for a rude shock when their children goes to the real world of commerce as their attitude doesn't make the progeny street-wise and realistic.
2. Mr Saw phoned me at 11.30 am while I was at the Singapore General Hospital area to say he was not feeling well and would try his best. He had generalised muscular aches. I often told him: "You are a young man." But he would say "I have an old man's body."
Mr Saw is a very responsible assistant and if he was a Singaporean, he would make a very good vet. I could see that he has the passion during the past 3 years with me and I had mentored him with whatever knowledge of the skills of surgery and medicine I had.
I rushed back after taking a few photos of Everton and Spottiswood Park conservation houses (bright sunshine - good for pictures).
3. I told my associate vet that Mr Saw was sick and he would be taking time off. I would be the customer service officer taking money and processing the credit card and nets machine as my other staff was on leave. Another assistant Mr James Ang had retired at the age of 73 years as he was bent double for some unknown reason. I had to let him go in February after some 20 years with me. He would be giving prospective clients a bad impression compared to the nubile young girls at competitor's practice as he was hunched as if he could not stand straight.
Two days ago, the mother and adult daughter of a Maltese with red eyes had smiled at me when they saw me handling the payment at reception counter after consultation with my associate vet. They were old clients. The daughter had now become a grown up in her early 30s. I said: "Like the PAP who introduce new politicians at the elections, I must renew the vets at Toa Payoh Vets. Young vets, new ideas. Lots of energy."
Soon, 3 young adults in their early 30s (2 ladies and one gentleman) came in with a pug with a bleeding leaking eye. I got them registered as they were new clients. I could see that one of the two young ladies was quite distressed. My associate vet handled the case as usual. I could see that it was a case of a central corneal ulcer, a common problem in breeds with protruding eyeballs.
"So what happened?" I asked the gentleman who came out of the consultation room and sat on the yellow chair after some minutes of discussion with my associate vet. I had been inside the room to evaluate the eyeball at one time but left without comments. He said: "The doctor is making arrangements to hospitalise the pug."
I was extremely surprised. Associate vets do get some freedom to do their cases in the manner they deem fit. Toa Payoh Vets is equipped with anaesthetic and surgical facilities and is capable of handling a corneal ulcer case. Referring what I considered to be a simple case of corneal ulceration to be hospitalised in another practice in Singapore was a big shock to me.
I don't want the vets at Toa Payoh Vets to be known as the "Old School Vets". This term was made known to me from a staff of a practice I visited last week as I brought a young male intern with a blue golden lock of forehead hair to visit the practice to buy some vaccines.
The lady manager in this practice where the vets will refer every "difficult and potentially litigious" surgical case to a brand-name practice said to me: "My friend asks me which veterinary clinic I was working and when I told her, she said I was working with an 'Old School Vet'. I don't mind. I am very happy and well treated in this clinic."
So, this practice does vaccination, dental scaling, sterilisation and removal of lumps. Nothing more complicated. This definitely was not the sort of veterinary surgery I practise for the past 30 years.
Now my associate vet now making phone calls to another brand name practice to pass the case over.
This passing the buck of a simple case of corneal ulcer is not for associate vets of Toa Payoh Vets. If any associate vet can't perform surgery of a simple corneal ulcer and refers to a 2nd a brand name competitor, there is the "can't even do a simple corneal ulcer case" implication.
I know some vets dislike complicated surgeries as they are potentially litigious but this was a simple corneal ulcer case, in my observation. I went to the consultation room and asked my associate vet what was going on. Why was she referring to a brand name practice? She showed me the letter from Vet 1 to consult a certain vet in a brand name practice and since that vet was unavailable, she made alternative arrangements. Eye injuries are emergencies and ought to be treated within 4 hours. Now, it was 5 days post injury.
I was extremely surprised as my associate had at least 2 years of practice before joining me. If she could not deliver, she ought to consult me. There was this potential of the competitor's vet and staff labelling and bad-mouthing Toa Payoh Vets as being incompetent to handle a corneal ulcer.
I asked the owners to leave the consultation room, closed the door and had a private chat with my associate vet. I said: "This is going to be a highly contentious case as there is a lot of emotion involved as Vet 1 had given a name of a vet who would not take the case. The owners are much distressed. You just refer them to another practice.
That practice employs fresh graduates and rookie vets. You are not doing the dog a favour by just making appointment for an unknown vet to handle this case if the older vet was not available. I will take over this case as the owners are going to be unhappy should the other vet mis-treat this case."
If I refer a case to a vet, I must make sure that this vet has the relevant experience and a high standard of practice and will perform the surgery and not his fresh employee graduates. It does not mean that this vet must be employed in a brand name swanky practice.
I was in the consultation room earlier too but the associate did not introduce me and I did not introduce myself too. So, the distressed lady was apprehensive when I examined the dog's eye and tried to pull the dog back. So I left the room for my associate vet to manage the case.
I was around and yet she did not think of asking me for advice when issues and problems arise. Life for a practice manager is full of surprises and changes.
I told my associate to ask the clients to come in and to formally introduce me as that would be the correct way in professional practice. This case was high voltage and lightning had struck. The pug's eye was going to collapse any time soon and any miscommunication or bad referral resulting in the pug being blind would have cast Toa Payoh Vets in a bad light.
"The owners must be thinking I am just a receptionist since I was registering their case," I said to my associate. "This case is going to adversely affect the reputation of the Surgery if the brand name practice vet bungles the surgery. How do you know whether that this brand name practice will or will not assign a fresh vet with no experience in handling a Descemetocoele? This corneal ulcer is in a highly dangerous state as it is going to perforate soon.
"You know that this brand name practice's senior vet may not be available. If he assign a fresh vet to do it, the cornea perforates on the way to the vet, the pug goes blind. So, the owners would just bad-mouth Toa Payoh Vets as the practice that referred the case." I did not mention that this brand name practice charges top dollars and this case would set the owners back by over a thousand dollars.
My associate opened the door and asked the 3 adults and pug to come in. She introduced me as her boss.
"I am the founder of this practice," I elaborated. "I did not introduce myself earlier in the consultation room. I am responsible for the practice management." I was the licensee and any complaint or litigation would mean I have to waste time attending to investigations. I had assessed that the clients were sophisticated and knowledgeable and this is the profile of the younger generation. Whether they would complain about being passed the buck by Toa Payoh Vets would depend on how this emotional situation was handled and whether their pug's eyeball would be enucleated by the other vet. Owners just don't like the idea of their pets losing an eyeball.
This was a case that had a 50:50 chance of saving the dog's eye. If the vet knows how to resolve the problem.
The gentleman summarised the situation succinctly: "There is no one vet you can recommend to treat my pug." He must have superman's hearing as he was in the waiting area and he could not have had heard my conversation with the associage vet.
I said: "It is not necessary to refer the case at all as Toa Payoh Vets has the capability and experience to handle this case.
"I have handled several cases of corneal ulcerations and if you have no objection, I will do the 3rd eyelid flap. Have you visited Toa Payoh Vets' webpage on eye problems in the dog?"
Such sophisticated young adults would have had checked up Toa Payoh Vets' website at the waiting area with their iPhone 4 while I was having a closed-door discussion with my associate vet. The world has changed tremendously. Internet information flows freely and the clients know much more than the vet sometimes.
The gentleman said: "You operated mainly on Shih Tzus' eyes." This was an excellent feedback from him. I had not analysed my webpage on eye problems in the dog at www.toapayohvets.com. I had not posted other breeds I had treated as it is extremely time-consuming to create webpages to write the case report of all breeds I operated upon. I don't take pictures of all breeds too.
This article took 6 hours to write and to create the supporting images. There are so many things I want to do and I just can't have time to do many of my favourite things if I write case reports of all breeds having corneal ulcers. As a vet who does surgery, the range of surgical cases is from the head to the tail.
I replied: "Shih Tzus have the highest number of eye injury problems in my practice. Any breed with protruding eyeballs may suffer from this corneal ulceration problems. This includes the Pekinese and the Pug."
To cut a long story short, the owners had no objection in my performing the surgery. If they were not comfortable, I would just ask them to make their own decision to select their own vet.
My associate vet watched me doing the surgery. She said she had not seen me doing a surgery. Many of my surgical cases have been passed on to her to do and that was why I had less to do.
This is how I managed the corneal perforation case surgically:
INFORMED CONSENT. I took time to explain the risks of anaesthesia (death as this pug was infected for the past 5 days and could be infected in the blood stream. A delay of 24 hours with antibiotics prior to surgery would be preferred but this was an emergency as the cornea will perforate soon. I advise that I would give baytril antibiotics IV and perform the surgery soon).
I explained the risk of surgery (bleeding, pain, infection, collapse of the eyeball due to infection leading to the possibility of enucleation as the owner had not consulted the vet within 4 hours of the eye injury). The gentleman signed the form.
SEDATION & ANAESTHESIA
"Isoflurane gas alone is the safest anaesthetic for this young pug of 7 months with a possibility of infection of the past 5 days," I said to Mr Saw who takes close notes as he would be operating his own practice in Myanmar soon. "However, the pug's nose is flat and the pug will struggle a lot, leading to perforation of the cornea and collapse of the eyeball. So, what sedation would you give? Your favoured domitor and ketamine IV?"
Mr Saw was not so sure. This was a pug with suspect infection after 5 days or more of eye injury. The pug's eye look like an earthquake and tsunami disaster area as seen in the recent pictures of the calamity in Japan. Big patch of white gel and a stream of red-tinged flow of gel and blood at one end, measuring around 1.5 cm long. A continuous stream if you are observant. It reminded me of the oil spill in the Gulf of Mexico although I did not see the actual leak - only oil slicks in the ocean. Here, I could see the stream. It was fascinating as a case but extremely dangerous for the pug. A delay in treatment and the corneal hole would enlarge and the inside aqueous humour would just splash out. The end of the eyeball, although the vet can still stitch up the cornea. Most vets will not encounter such corneal ruptures or stitching and so it can be quite frightening to encounter this case.
I used 0.2 ml xylazine IV. Waited 5 minutes. The pug vomited out its food as this was the effect of xylazine (and even in domitor or domitor/ketamine IV) Then isoflurane gas.
SURGERY
The 3rd eyelid flap is done. Basically the needle goes into the upper eyelid, then under the 3rd eyelid and back out to the lower eyelid. Tied in a knot. "It will be easier if an assistant pulls out and upwards the 3rd eyelid for stitching," I said to my associate vet as Mr Saw automatically used forceps to do it for me.
SUTURE PATTERNS
Several combinations. For this case, I use 3 simple interrupted sutures. Another case, I used a horizontal mattress and one interrupted. Or just one horizontal mattress.
Question. "Are 3 sutures sufficient?" - Yes.
SUBCONJUCTIVAL INJECTION OF GENTAMYCIN AND DEXAMETHASONE.
I know some vets believe that steroids should not be used in eye ulcerations. Well, a small drop of dexamethasone will alleviate the inflammation and pain and does not cause harm.
"Get me the prednisolone," I said to Mr Saw. He got me the depot prednisolone and I rejected it. It is best to use dexamethasone or prednisolone meant for IV." Well, Mr Saw did as instructed but got the incorrect type. All vets must check the medication before injection. Well, Mr Saw learnt something from this participation in the case. "Use common sense," I said to Mr Saw. I wonder whether he knows what is the meaning of common sense as applied to his offer of depot prednisolone. Details of surgery and comments in 8 pictures at webpage of Toa Payoh Vets - goto DOGS - EYE PROBLEMS or at:
http://www.bekindtopets.com/animals/20081201PAGE3_
Dog_Surgery_Anaesthesia_Eye_ToaPayohVets.htm
POST-OP DAY 1 & 2
The IV drip continued. Tolfedine and baytril given SC. The pug was sleeping and woke up fresh the next day. Very active. At 3 pm on day 2, the gentleman and his wife visited. They took leave from work. It was one of those money can't buy joys to see the distressed lady back to her normal self.I expect the pug's ulcer to heal in 14 days' time and the pug to go home on Day 3. The outcome should be a white spot in the centre of the cornea and no eyeball collapse or infection.
RETROSPECTIVE REVIEW
1. Why did Vet 1 refer the case to a vet that is not available? This is a mystery to me. He probably thought that the cornea ulcer was extensive, needed stitching and he had no facilities to do it and had referred to my associate vet. However, I was on counter duty and saw the case first.
The eye ulcer looked terrible as if it had a big earthquake. It appeared to be a white reddish gel patch of at least 5-8 mm in diameter. Actually, it was 1-2 mm in diameter when I used a scalpel to scrape away the out flowing blood clot. After scrapping, I showed my assistant the black hole measuring around 1 mm in diameter. Aqueous humour leaked out from the hole. Surrounding the black hole was a circle of basement membrane measuring around 4-7 mm in diameter with the black hole as the centre. This membrane would rupture soon if the owners just don't bother to see Vet 1 who advised emergency eye treatment correctly and professionally.
To estimate the size of the corneal perforation, see the 'stream' of gel coming out as a streak. It was around 2-3 mm. See the images.
2. The pug had a perforated ulcer, not a Descemetocoele. The initial presentation was similar to a Descemetocoele with a streak of gelatinous or eye discharge. So, I said "Descemetocoele" to my associate at the examination room as the dog did not permit proper eye examination.
Under general anaesthesia, after scrapping away the blood clot, a black hole of 1mm x 1mm with watery aqueous seeping out indicates that the correct diagnosis is a perforated corneal ulcer also known as deep ulcerative keratitis.
3. Corneal wounds can be sutured with fine 6/0 sutures. Small perforations are best left to heal with the 3rd eyelid flap surgery. And they do heal very well if the inside of the eyeball is not infected. Can you see the pinkish-reddish blood sediment on the medial inner side of the eyeball in one of the pictures below?
I hope this report will be useful for undergraduates struggling to study so many subjects for their examinations to appreciate the anatomy of the dog's eye and its changes during ulceration.
For readers of my blog, updates and more pictures are in toapayohvets.com, goto DOGS - EYE PROBLEMS.
http://www.bekindtopets.com/animals/20081201PAGE3_
Dog_Surgery_Anaesthesia_Eye_ToaPayohVets.htm
For readers of my blog, updates and more pictures are in www.toapayohvets.com goto DOGS - EYE PROBLEMS.
http://www.bekindtopets.com/animals/20081201PAGE3_
Dog_Surgery_Anaesthesia_Eye_ToaPayohVets.htm
Details are in www.toapayohvets.com goto DOGS - EYE PROBLEMS.
368. Starting pay for new vet in Singapore?
Straits Times
ST Jan 1, 2011 Law & Accounting. The MONEY Page.
"Big Four" Accounting Firms - PricewaterhouseCoopers (PwC), Ernst & Young, KPMG and Deloitte pay new graduates more. Starting pay at mid-sized accounting firms $2,100 to $2,400. Big Four pay $2,600 and above.
Big law firms pay $4,500 - $5,000 for a fresh graduate. Foreign law firms $7,500 but with smaller bonuses. Small law firms pay $4,000 - $4,500. So, pay more upfront and less bonus to compete.
So what do fresh graduate vets in the Singapore private sector get paid? Is there a market rate? Or is it performance based?
ST Jan 1, 2011 Law & Accounting. The MONEY Page.
"Big Four" Accounting Firms - PricewaterhouseCoopers (PwC), Ernst & Young, KPMG and Deloitte pay new graduates more. Starting pay at mid-sized accounting firms $2,100 to $2,400. Big Four pay $2,600 and above.
Big law firms pay $4,500 - $5,000 for a fresh graduate. Foreign law firms $7,500 but with smaller bonuses. Small law firms pay $4,000 - $4,500. So, pay more upfront and less bonus to compete.
So what do fresh graduate vets in the Singapore private sector get paid? Is there a market rate? Or is it performance based?
Thursday, March 24, 2011
Internship: no knowledge, skills and discipline
I note that the younger generation doing their 2nd year Junior College and who applies for a veterinary internship has no knowledge, skills and discipline. The applicants are mainly ladies. Many of them have straight As and can get into any undergraduate studies they choose.
However, these Singaporean academic stars don't have hands-on experience nor interests in animal welfare and medicine. Straight As without passion in veterinary medicine. An unwillingness to work diligently and put in the hours.
I am thinking of terminating sponsorship of internship for Junior College students as my staff feels that they are a burden and they are. My assistant Mr Saw actually dislike them according to one of my feedback as they hinder his work. He has to teach them how to take temperature etc and why should he do that? I don't know what Dr Vanessa Lin and Dr Jason Teo think of them.
Many of these young interns and even veterinary undergraduates don't have simple social skills. They come for interviews silently. They don't know simple courtesies which will gain them brownie points, like greeting "Good morning, Dr Sing, Good afternoon Dr Vanessa or Good evening Dr Teo." Some fathers or mothers drive them to the Surgery and wait for them for the interview! They give me the impression that they can't be independent and are tied to the apron's strings.
Does the top school principals NOT impart such skills to their bright students? It is not that I am desperate to be greeted. Not being punctual, disappearing without letting me know. These are what some past interns do.
Therefore, I am thinking of terminating this program for such young people as they have been brought up in abundance and know no hardship. They don't want to work hard and seem to think that the world should suit their lifestyle and way of working late in the day (being night owls). Turning up late for work is a common trait too.
There are 3rd party injury liabilities too. What if the intern gets bitten or scratched by the dog and cat respectively? The parents will sue me to bankruptcy.
For the above reasons, it is wise for me not to accept interns unless they are highly passionate about veterinary medicine, rather than thinking of using the program to pad their resume.
However, these Singaporean academic stars don't have hands-on experience nor interests in animal welfare and medicine. Straight As without passion in veterinary medicine. An unwillingness to work diligently and put in the hours.
I am thinking of terminating sponsorship of internship for Junior College students as my staff feels that they are a burden and they are. My assistant Mr Saw actually dislike them according to one of my feedback as they hinder his work. He has to teach them how to take temperature etc and why should he do that? I don't know what Dr Vanessa Lin and Dr Jason Teo think of them.
Many of these young interns and even veterinary undergraduates don't have simple social skills. They come for interviews silently. They don't know simple courtesies which will gain them brownie points, like greeting "Good morning, Dr Sing, Good afternoon Dr Vanessa or Good evening Dr Teo." Some fathers or mothers drive them to the Surgery and wait for them for the interview! They give me the impression that they can't be independent and are tied to the apron's strings.
Does the top school principals NOT impart such skills to their bright students? It is not that I am desperate to be greeted. Not being punctual, disappearing without letting me know. These are what some past interns do.
Therefore, I am thinking of terminating this program for such young people as they have been brought up in abundance and know no hardship. They don't want to work hard and seem to think that the world should suit their lifestyle and way of working late in the day (being night owls). Turning up late for work is a common trait too.
There are 3rd party injury liabilities too. What if the intern gets bitten or scratched by the dog and cat respectively? The parents will sue me to bankruptcy.
For the above reasons, it is wise for me not to accept interns unless they are highly passionate about veterinary medicine, rather than thinking of using the program to pad their resume.
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