The Straits Times April 6, 2011 "Patient's wife sues top heart surgeon".
The husband had a bypass surgery in Texas in Jan 17, 2007 but suffered a heart attack on March 9, 2007. The heart surgeon performed a re-do coronary artery bypass graft surgery 3 days later. The patient died 43 days after the heart surgery. Autopsy report said that death resulted from complications arising from the surgery. A coroner's inquest stated a verdict of misadventure.
The wife alleged that the surgeon was liable for the death and seeks damages. Her case was that the treatment was inappropriate, risks were understated and the husband was inadequately briefed on the options available. The surgeon, amongst other things, said that the patient had agreed to the operation after being advised about the options and thinking over.
The High Court hearing is in progress. What is the standard of care expected from a heart surgeon? Experts are being called to testify.
NOTES COMPARING REAL ESTATE TO MEDICAL PROFESSIONS
Comparing the disclaimer clause and the informed consent form
1. LAW OF TORT - DEFINITION
Definition: Tort is a breach of duty imposed by law, making the offender (defendant) liable to action for causing damage or injury to the plaintiff.
It is a body of law that addresses and provides remedies for civil wrongs not arising out of contractual obligation acts.
2. LAW OF TORT - DUTY OF CARE - TEST
Duty of Care - "But For" Test
A test of duty of care is: "You must take reasonable care to avoid acts and omissions that you can reasonably foresee, would be likely to injure your neighbour"
The cause of damage is established by the "but for" test:
The court will ask - would the plaintiff (patient, buyer, tenant, owner) has suffered the injury but for the defendant's (doctor's, agent's) negligence?
3. LAW OF TORT - DUTY OF CARE - BREACH
Standard of Care - Breach.
More important in professions requiring special skill or expertise, the person must exercise a reasonable standard of care that must be measured.
The standard of care is measured by the "reasonable man" test:
Whether the defendant's conduct fall below the standard of care which is expected of the reasonable man.
4. LAW OF TORT - NEGLIGENCE
To succeed in an action for negligence, the plaintiff must show that:
- the defendant owes him a duty of care
- the defendant has beached that duty of care
- his breach causes damage/loss to the plaintiff
- the damage/loss is not too remote (not controllable, not foreseeable, not an expert on a particular subject matter).
5. LAW OF TORT - DISCLAIMER
1. A disclaimer (e.g in veterinary medicine, an informed consent form signed by the pet owner or patient) may prevent an agent (doctor) being held liable to a 3rd party in tort arising from fiduciary duty.
2. A disclaimer does not automatically protect an agent (doctor) from any liability to the 3rd party.
3. For a disclaimer to be effective, it must be firmly incorporated into the contract and must be done at the time the contract was made.
4. Whether the disclaimer will be effective or not depends on the court's interpretation of the "reasonableness" test and the facts of each case.
A common disclaimer clause is as follows:
The vendor does not make or give and neither the agent nor any of his employee has the authority to make or give any representation or warranty whatever in relation to the property.
Thursday, April 7, 2011
Top 10 Canine conditions in the USA from an Insurance Company & Prostatitis in an old male dog
Top 10 medical insurance claims for dogs in 2009
Veterinary Pet Insurance Co (VPI), the oldest and largest pet health insurance in the USA received >1 million claims from pet owners each year. For 2009, the top 10 canine conditions are:
1. Ear infection
2. Skin allergy
3. Skin infection/hot spot
4. Gastritis/vomiting
5. Intestinal inflammation/diarrhoea
6. Bladder infection
7. Arthritis
8. Soft tissue trauma
9. Non-cancerous tumour
10. Eye infection
Most of the conditions affect all dogs, regardless of age.
At Toa Payoh Vets, Skin infection is the top canine condition in 2009 and 2010 seen by me. The others mentioned by VPI above are commonly seen but I don't have the statistics. As I have been in practice for over 30 years, many of my cases are old dogs as the children of my baby-boomer generation clientele have had grown up and become young adults taking over the care of their aged dogs.
An interesting case study of an old male dog problem is mentioned below.
Prostatitis in the old male dog
"I thought he had died," the mum said. The Shih Tzu, male, neutered, 8 years old was motionless. He had a right perineal hernia repair and then neutering 2 weeks ago and was Ok for a few days. Then he stopped eating for a few days and collapsed as if he had died.
23.8.10
On examination, he on 23.8.10, I found that he had a high fever and was pale.
1. Palpation: Bladder felt firm and enlarged. Urine by catherisation.
Urine test: Urinary Tract Infection. The dog went home the next day. 3 days later, he came back as he was licking his private parts and urine kept leaking out. Cloudy urine.
Palpation: Bladder felt firm and painful. It could be an enlarged bladder wall, bladder tumour or prostrate enlargement.
2. Empty bladder using cathether. 15 ml of urine came out. Palpated the bladder. A little amount of urine came out but a rounded lump of 3 cm x 3 cm. This was the enlarged prostate.
3. Rectal digital palpation when the bladder is emptied. This confirmed that the prostate was enlarged.
To check the prostate:
1. Palpation. There was painful reaction. I diagnosed this as prostatitis and enlargement. Also epithelial cells seen in urine test.
BLOOD TEST
23.8.10 Creatinine was below normal. Red cell below normal. Total White Cell Count above normal. Neutrophils 97% (Absolute 17.2 x 10^9/L), Lymphocytes 2.5% (Absolute 0.45X 10^9/L).
URINE TEST
Colourless, slightly turbid. pH 6.5 (5-8), SG 1.005 (1.005 - 1.030). Protein - trace. Blood 4+, White blood cells >2250, Red blood cells 20, epithelial cells 0, Mucus Threads Occasional, Bacterial Occasional. Possible haemolysis of RBC in urine.
24.8.10
Vomited white froth overnight
"Tongue colour pinker," the mother told me. "At 7 pm yesterday when I saw him, his tongue was very pale."
Another urine test was taken. Owner was advised that an X-ray or ultrasound scan might be required. "The dog had never been sick for the last 7 years," she said. Now there were some veterinary expenses and worries. The dog is still incontinent and more work need to be done.
CONCLUSION
"Can a dog die of UTI?" the mother asked me.
"A dog can die of UTI or any infection if he is not treated," I replied. "Older dogs are more likely to die when they are sick as they have lower immune system. Your dog is 8 years old and is considered an old dog."
Neutering the dog when he was young would have prevented the worries but many owners feel it cruel to sterilise dogs. Annual vet examination and health check may be advised. Statistically, male dogs that are not neutered are likely to get perineal hernia and prostrate enlargement and infection.
Veterinary Pet Insurance Co (VPI), the oldest and largest pet health insurance in the USA received >1 million claims from pet owners each year. For 2009, the top 10 canine conditions are:
1. Ear infection
2. Skin allergy
3. Skin infection/hot spot
4. Gastritis/vomiting
5. Intestinal inflammation/diarrhoea
6. Bladder infection
7. Arthritis
8. Soft tissue trauma
9. Non-cancerous tumour
10. Eye infection
Most of the conditions affect all dogs, regardless of age.
At Toa Payoh Vets, Skin infection is the top canine condition in 2009 and 2010 seen by me. The others mentioned by VPI above are commonly seen but I don't have the statistics. As I have been in practice for over 30 years, many of my cases are old dogs as the children of my baby-boomer generation clientele have had grown up and become young adults taking over the care of their aged dogs.
An interesting case study of an old male dog problem is mentioned below.
Prostatitis in the old male dog
"I thought he had died," the mum said. The Shih Tzu, male, neutered, 8 years old was motionless. He had a right perineal hernia repair and then neutering 2 weeks ago and was Ok for a few days. Then he stopped eating for a few days and collapsed as if he had died.
23.8.10
On examination, he on 23.8.10, I found that he had a high fever and was pale.
1. Palpation: Bladder felt firm and enlarged. Urine by catherisation.
Urine test: Urinary Tract Infection. The dog went home the next day. 3 days later, he came back as he was licking his private parts and urine kept leaking out. Cloudy urine.
Palpation: Bladder felt firm and painful. It could be an enlarged bladder wall, bladder tumour or prostrate enlargement.
2. Empty bladder using cathether. 15 ml of urine came out. Palpated the bladder. A little amount of urine came out but a rounded lump of 3 cm x 3 cm. This was the enlarged prostate.
3. Rectal digital palpation when the bladder is emptied. This confirmed that the prostate was enlarged.
To check the prostate:
1. Palpation. There was painful reaction. I diagnosed this as prostatitis and enlargement. Also epithelial cells seen in urine test.
BLOOD TEST
23.8.10 Creatinine was below normal. Red cell below normal. Total White Cell Count above normal. Neutrophils 97% (Absolute 17.2 x 10^9/L), Lymphocytes 2.5% (Absolute 0.45X 10^9/L).
URINE TEST
Colourless, slightly turbid. pH 6.5 (5-8), SG 1.005 (1.005 - 1.030). Protein - trace. Blood 4+, White blood cells >2250, Red blood cells 20, epithelial cells 0, Mucus Threads Occasional, Bacterial Occasional. Possible haemolysis of RBC in urine.
24.8.10
Vomited white froth overnight
"Tongue colour pinker," the mother told me. "At 7 pm yesterday when I saw him, his tongue was very pale."
Another urine test was taken. Owner was advised that an X-ray or ultrasound scan might be required. "The dog had never been sick for the last 7 years," she said. Now there were some veterinary expenses and worries. The dog is still incontinent and more work need to be done.
CONCLUSION
"Can a dog die of UTI?" the mother asked me.
"A dog can die of UTI or any infection if he is not treated," I replied. "Older dogs are more likely to die when they are sick as they have lower immune system. Your dog is 8 years old and is considered an old dog."
Neutering the dog when he was young would have prevented the worries but many owners feel it cruel to sterilise dogs. Annual vet examination and health check may be advised. Statistically, male dogs that are not neutered are likely to get perineal hernia and prostrate enlargement and infection.
Wednesday, April 6, 2011
391. Real estate. What is "failed attempt" in collective sale?
"What is the definition of 'failed attempt'"? I interrupted the lecturer of the real estate course I was attending on April 2, 2011. For 2 months, I must attend this course Monday, Wednesday and Friday from 10am to 1 pm. It is a very intensive course with lots to remember for the test in late May.
The lecturer said: "Failed attempt means that the sales committee had not been able to find a buyer for the enbloc sale of the property."
I asked: "What if the sales committee cannot get the 80% or 90% of the owners to agree to the enbloc sale? Is it considered a failed attempt?"
The students started to talk amongst themselves and the lecturer insisted on his definition. He had to speak louder and said: "Don't ask 'what if' scenarios unless you are in a position to know." He is a very good lecturer and concerned about the students ability to pass exam. Most students are in their late 20s and much older. He must have got up from the wrong side of the bed that day.
I said: "I am familiar with the Ridgewood enbloc sale as I had one to sell. As there was no 80%, the sales committee wrote to the owners that they would have to wait 2 years before another enbloc sale will be attempted."
It is tough to be a lecturer actually as there are so many rules and regulations merrily made by the Singapore bureaucrats in response to complaints and feedback.
According to his notes, the Rules for Disposal By Collective Sale stated some rules as follows:
SEP 2008 RULES
1. The Collective Sales Agreement (CSA) will LAPSE AFTER ONE YEAR if NO BUYER is forthcoming.
2. The Sales Committee CEASES to exist."
JUN 2010 RULES
1. A failed attempt "RESTRICTION PERIOD OF 2 YEARS" shall be imposed, STARTING from the date of failed attempt.
2. Within this "restriction period",
2.1 FIRST RE-TRY EGM, RE-APPOINT a sales committee.
2.2 With MORE THAN 50% by share value OR total number of owners.
3. After 2 years
3.1 EGM to appoint a sales committee.
3.2 Need 20% by share value OR 25% total number of owners.
CONCLUSION
Readers can appreciate how difficult it is to pass this exam as many rules and regulations must be memorised for the exam. 20%? 25%? Why did the regulators not just state one figure - 25% or 20%?
I asked the lecturer to look into the rules and regulations of the STB (Strata Titles Board, not Singapore Tourism Board). I sense that he was sticking to his own interpretation. "Well, you just need 50% to pass the exam," I told my lady classmate in her 40s and curly haired, sitting behind me as she said she was so confused about this definition of "failed attempt".
So, does "failed attempt" include the failure to get 80% (for properties more than 10 years old) or 90% (for properties less than 10 years old) to agree to the enbloc sale? The answer is important because if the question of failed attempt is 5 marks. Each of the 2 answers is worth 2.5 marks. If only one answer is given, the student gets 2.5 marks only, due to the "failure of the lecturer to provide 2 answers"!
P.S
I am writing this article to educate myself for the exam. It is hard to remember every fact but the exam requires such facts and figures.
Another rule for "Private Properties - Disposal by Collective Sale"
SEP 2008 RULES
1. The majority CONSENT.
80% of the building's GFA (gross floor area) + 80% of the SHARE VALUE for projects >10 years old and 90% if less than 10 years old.
4-weekly UPDATES certified by a lawyer must be provided.
2. A LAWYER must be present whenever an owner signs a CSA and to explain the terms of the agreement. He assists in VETTING the minutes of the sales committee meeting and DRAFTRS motions for the general meeting.
3. A 5-day COOL OFF PERIOD for owners who have signed the CSA.
4. Upon legal completion, the fund and sinking fund must be RETURNED to the enbloc sellers according to THEIR share value allotments.
This is only 1% of the facts and figures I must remember. 5 out of 8 questions to be answered. 15 questions for 3 days of examinations. Must pass at one sitting. Or no licence. The May 2011 exam will be the first for the RES exam. It will be a killing field as the students are mature students and many are not even in real estate.
The lecturer said: "Failed attempt means that the sales committee had not been able to find a buyer for the enbloc sale of the property."
I asked: "What if the sales committee cannot get the 80% or 90% of the owners to agree to the enbloc sale? Is it considered a failed attempt?"
The students started to talk amongst themselves and the lecturer insisted on his definition. He had to speak louder and said: "Don't ask 'what if' scenarios unless you are in a position to know." He is a very good lecturer and concerned about the students ability to pass exam. Most students are in their late 20s and much older. He must have got up from the wrong side of the bed that day.
I said: "I am familiar with the Ridgewood enbloc sale as I had one to sell. As there was no 80%, the sales committee wrote to the owners that they would have to wait 2 years before another enbloc sale will be attempted."
It is tough to be a lecturer actually as there are so many rules and regulations merrily made by the Singapore bureaucrats in response to complaints and feedback.
According to his notes, the Rules for Disposal By Collective Sale stated some rules as follows:
SEP 2008 RULES
1. The Collective Sales Agreement (CSA) will LAPSE AFTER ONE YEAR if NO BUYER is forthcoming.
2. The Sales Committee CEASES to exist."
JUN 2010 RULES
1. A failed attempt "RESTRICTION PERIOD OF 2 YEARS" shall be imposed, STARTING from the date of failed attempt.
2. Within this "restriction period",
2.1 FIRST RE-TRY EGM, RE-APPOINT a sales committee.
2.2 With MORE THAN 50% by share value OR total number of owners.
3. After 2 years
3.1 EGM to appoint a sales committee.
3.2 Need 20% by share value OR 25% total number of owners.
CONCLUSION
Readers can appreciate how difficult it is to pass this exam as many rules and regulations must be memorised for the exam. 20%? 25%? Why did the regulators not just state one figure - 25% or 20%?
I asked the lecturer to look into the rules and regulations of the STB (Strata Titles Board, not Singapore Tourism Board). I sense that he was sticking to his own interpretation. "Well, you just need 50% to pass the exam," I told my lady classmate in her 40s and curly haired, sitting behind me as she said she was so confused about this definition of "failed attempt".
So, does "failed attempt" include the failure to get 80% (for properties more than 10 years old) or 90% (for properties less than 10 years old) to agree to the enbloc sale? The answer is important because if the question of failed attempt is 5 marks. Each of the 2 answers is worth 2.5 marks. If only one answer is given, the student gets 2.5 marks only, due to the "failure of the lecturer to provide 2 answers"!
P.S
I am writing this article to educate myself for the exam. It is hard to remember every fact but the exam requires such facts and figures.
Another rule for "Private Properties - Disposal by Collective Sale"
SEP 2008 RULES
1. The majority CONSENT.
80% of the building's GFA (gross floor area) + 80% of the SHARE VALUE for projects >10 years old and 90% if less than 10 years old.
4-weekly UPDATES certified by a lawyer must be provided.
2. A LAWYER must be present whenever an owner signs a CSA and to explain the terms of the agreement. He assists in VETTING the minutes of the sales committee meeting and DRAFTRS motions for the general meeting.
3. A 5-day COOL OFF PERIOD for owners who have signed the CSA.
4. Upon legal completion, the fund and sinking fund must be RETURNED to the enbloc sellers according to THEIR share value allotments.
This is only 1% of the facts and figures I must remember. 5 out of 8 questions to be answered. 15 questions for 3 days of examinations. Must pass at one sitting. Or no licence. The May 2011 exam will be the first for the RES exam. It will be a killing field as the students are mature students and many are not even in real estate.
390. An Australian veterinary student from Singapore in the top 5%
On Sunday, I took time off in the afternoon to bring Julia to her old hair-dresser in a shopping mall. She did not visit this hair-dresser for many years owing to the loss of personal attention as the hair-dresser expanded her business and asked her staff to attend to her. However, Julia asked about this hair-dresser and I took her to her shop. I knew this hair-dresser and her husband for over 15 years and I did go for some hair cuts in the past.
Hair-dressing and veterinary practice appears to be very personal. There are clients who will specify that they want Dr Vanessa only and there are some of my clients disappointed with me for not being available when they have to consult Dr Vanessa.
It was great to see her again. No health problems at the age of 60. No high cholesterol level unlike many Singaporeans. "You look lean and mean," I said. "As if you don't have enough to eat."
"I eat only 2 meals a day," she told us her secret of being healthy as most older Singaporeans of over 40 years are on anti-cholesterol and high blood pressure medication. Here she was as fit as a fiddle.
"I don't eat meat." She does eat some fish occasionally.
Her business was booming as the economy has recovered and she had said: "During SARS, I had to ask my staff to take some days off not to work. Now, I wish they work every day!" So, business must be very good.
"How's your son doing in his veterinary studies in Australia?" I had seen him as a pre-teen in Canberra some 15 years ago. He is an Australian citizen and so his veterinary fees of $300,000 for 5 years will not be paid by his parents.
"He's got free education as a citizen," the mum said. "He gets $1,500 scholarship for the next 4 years. So I don't have to pay anything till the 5th year."
"How did he get this scholarship for 4 years from the Australian Government? What is the name of this scholarship?" I asked.
"He was the top 5% in his first year in economics. Then he switched to veterinary medicine. I don't know the name. All I know is that he asks me to pay after the 4 years in vet course."
Academic excellence still counts in any part of the world. Scholarship for the top 5% to motivate the student.
I saw her hand worn out through years of treating clients and washing their hair. "Veins are very big in the hands if you are a hair-dresser," she showed me her big veins above her hand and then another male hair-dresser.
She did share with me her business management and success. I always ask to improve my own practice. In her practice, no hair-dresser is allowed to write name and address of clients so that they don't poach clients. In veterinary practice, vets who leave the practice can download the customer data base and inform clients when they go elsewhere if such vets want to be unethical.
She gave me the hair-dresser appointment book which is excellent and told me what she used it for in certain product and service recording. I will use it and improve my management.
Hair-dressing and veterinary practice appears to be very personal. There are clients who will specify that they want Dr Vanessa only and there are some of my clients disappointed with me for not being available when they have to consult Dr Vanessa.
It was great to see her again. No health problems at the age of 60. No high cholesterol level unlike many Singaporeans. "You look lean and mean," I said. "As if you don't have enough to eat."
"I eat only 2 meals a day," she told us her secret of being healthy as most older Singaporeans of over 40 years are on anti-cholesterol and high blood pressure medication. Here she was as fit as a fiddle.
"I don't eat meat." She does eat some fish occasionally.
Her business was booming as the economy has recovered and she had said: "During SARS, I had to ask my staff to take some days off not to work. Now, I wish they work every day!" So, business must be very good.
"How's your son doing in his veterinary studies in Australia?" I had seen him as a pre-teen in Canberra some 15 years ago. He is an Australian citizen and so his veterinary fees of $300,000 for 5 years will not be paid by his parents.
"He's got free education as a citizen," the mum said. "He gets $1,500 scholarship for the next 4 years. So I don't have to pay anything till the 5th year."
"How did he get this scholarship for 4 years from the Australian Government? What is the name of this scholarship?" I asked.
"He was the top 5% in his first year in economics. Then he switched to veterinary medicine. I don't know the name. All I know is that he asks me to pay after the 4 years in vet course."
Academic excellence still counts in any part of the world. Scholarship for the top 5% to motivate the student.
I saw her hand worn out through years of treating clients and washing their hair. "Veins are very big in the hands if you are a hair-dresser," she showed me her big veins above her hand and then another male hair-dresser.
She did share with me her business management and success. I always ask to improve my own practice. In her practice, no hair-dresser is allowed to write name and address of clients so that they don't poach clients. In veterinary practice, vets who leave the practice can download the customer data base and inform clients when they go elsewhere if such vets want to be unethical.
She gave me the hair-dresser appointment book which is excellent and told me what she used it for in certain product and service recording. I will use it and improve my management.
389. Appreciation from the Buddhist culture
"You sit on the chair," my assistant asked me to enter the consultation room and pointed to the yellow chair when I arrived at around 10 am at Toa Payoh Vets. Mr Saw was busy cleaning up the kennels but he asked me to enter the consultation room before him.
"Why?" I asked. He just repeated "Sit on the chair."
So I sat on the chair as I thought he wanted to discuss something with me since April 5 was his last day at work. He would be back in Yangon tomorrow.
I was so surprised that he knelt down, bent his head and touched my shoes three times before he stood up. "This is Buddhist culture," he was thanking me for the past 3 years of mentorship. I hope he would do well in Yangon in private practice. He had been through 3 tough years under me and learnt much more since he was willing to learn. Veterinary practice is not just treating the dog. It involves communicating with the pet owner to create confidence and a lot of administration work. In a small practice like mine, he learnt all the tricks of the trade - to build up a practice with integrity and a high standard of service, not by under-pricing the competitors. A practice must be profitable, I said to Mr Saw many times. No point being the most well equipped practice in Singapore and being the best vet when the practice loses money every day. He understood what I meant after 3 years with me. There were offers from competitors to get him. This is Ok with me, I had said to him. "That means you are good and hard working. So, you have my blessings to get a better future."
Mr Saw can start his own surgery in Yangon without any worries of technical competency in small animal practice. But he knows it needs customers and money and that it will never be as easy as ABC.
"Why?" I asked. He just repeated "Sit on the chair."
So I sat on the chair as I thought he wanted to discuss something with me since April 5 was his last day at work. He would be back in Yangon tomorrow.
I was so surprised that he knelt down, bent his head and touched my shoes three times before he stood up. "This is Buddhist culture," he was thanking me for the past 3 years of mentorship. I hope he would do well in Yangon in private practice. He had been through 3 tough years under me and learnt much more since he was willing to learn. Veterinary practice is not just treating the dog. It involves communicating with the pet owner to create confidence and a lot of administration work. In a small practice like mine, he learnt all the tricks of the trade - to build up a practice with integrity and a high standard of service, not by under-pricing the competitors. A practice must be profitable, I said to Mr Saw many times. No point being the most well equipped practice in Singapore and being the best vet when the practice loses money every day. He understood what I meant after 3 years with me. There were offers from competitors to get him. This is Ok with me, I had said to him. "That means you are good and hard working. So, you have my blessings to get a better future."
Mr Saw can start his own surgery in Yangon without any worries of technical competency in small animal practice. But he knows it needs customers and money and that it will never be as easy as ABC.
Tuesday, April 5, 2011
388. Antisedan effects after waking up the dog
Injectable anaesthesia in the healthy dog and cat
in one syringe. Calculated dosage for healthy animals
Weight
Domitor
Ketamine
10kg healthy
0.4 ml IV
0.5 ml IV
Domitor 5-40ug/kg = 0.005mg/kg-0.04mg/kg
Ketamine 2-5mg/kg
Heart-diseased dogs - Do not use domitor+ketamine
Old dog - Use less domitor
Injectable anaesthesia in the healthy dog and cat
in one syringe. Calculated dosage for healthy animals
Weight
Diazepam
Ketamine
10kg healthy
0.8 ml* IV
0.5 ml IV
Diazepam 0.1-0.4 mg/kg.
* is based on maximal dose
Ketamine 2-5mg/kg
Heart-diseased dogs - give 50% + isoflurane gas top up
Spay healthy dogs - give higher dose in the higher range. No need isoflurane gas top up.
Rabbit & Guinea Pig. Use Subcutaneous inj only
in one syringe
Weight
Domitor
Ketamine
1kg healthy
0.2 ml SC
0.1 ml SC
Domitor 0.02 -0.25 mg/kg
Ketamine 10 -15mg/kg
DETAILS:
Domitor 1mg/ml = 1,000ug/ml
Ketamine 100mg/ml
Diazepam 5mg/ml
CASE STUDIES OF 3 DOGS USING DOMITOR+KETAMINE
Weight
Domitor
Calculated
Ketamine
Calculated
Domitor Given
Ketamine Given
10kg healthy
0.4 ml IV
0.5 ml IV
Case 1
Fox Terrier, 1 year, 9.3kg spay
0.37 ml IV
0.47 ml IV
0.2 ml IV
0.3 ml IV
Young, healthy
Needs isoflurane maintenance as dosage is below calculated dose. No problems. When antisedan 0.2 ml IM is given, wakes up alert but limbs are rigid. Can't stand up till atropine 0.1 ml IV is given.
Case 2
Shih Tzu, F, 7 years, 8.1 kg
0.32 ml IV
0.41 ml IV
0.1 ml IV
0.4ml IV
Old age, be careful
Needs isoflurane maintenance as dosage is below calculated dose. No problems. Dental scaling. When antisedan 0.1 ml IV is given, no cries. Just wakes up as if from a nap.
Case 3
Maltese, F, 8 years, 4.3 kg
0.17 ml IV
0.22 ml IV
0.1ml IV
0.2ml IV
Old age, be careful
No need isoflurane gas as dosage is close to calculated dose. 6 teeth extracted. No problem. When antisedan 0.1 ml IV is given, cries in pain. Given tolfedine injection. Stops crying.
Dosage for the two old dogs - shih tzu and maltese
Fox Terrier, 1 year, Spayed. Rigid limbs after giving antisedan
to wake up the dog early
In conclusion, domitor and ketamine are synergistic and their combined use will be safer if injectable anaesthetics are required and no isoflurane gas is available. For healthy dogs, use the calculated dosage given above. For heart-diseased dogs, use diazepam + ketamine at 50% of calculated dose and give isoflurane gas top up. Do NOT use domitor + ketamine is heart-diseased dogs.
As google does not permit proper table to be set up or I don't know how to do it, see Toa Payoh Vets webpage at:
http://www.kongyuensing.com/folder5/20110326injectable-anaesthesia-dogs-cats-rabbits-guinea-pigs-toapayohvets.htm
for an easier to read tabulated pres
entation of the 3 cases.
in one syringe. Calculated dosage for healthy animals
Weight
Domitor
Ketamine
10kg healthy
0.4 ml IV
0.5 ml IV
Domitor 5-40ug/kg = 0.005mg/kg-0.04mg/kg
Ketamine 2-5mg/kg
Heart-diseased dogs - Do not use domitor+ketamine
Old dog - Use less domitor
Injectable anaesthesia in the healthy dog and cat
in one syringe. Calculated dosage for healthy animals
Weight
Diazepam
Ketamine
10kg healthy
0.8 ml* IV
0.5 ml IV
Diazepam 0.1-0.4 mg/kg.
* is based on maximal dose
Ketamine 2-5mg/kg
Heart-diseased dogs - give 50% + isoflurane gas top up
Spay healthy dogs - give higher dose in the higher range. No need isoflurane gas top up.
Rabbit & Guinea Pig. Use Subcutaneous inj only
in one syringe
Weight
Domitor
Ketamine
1kg healthy
0.2 ml SC
0.1 ml SC
Domitor 0.02 -0.25 mg/kg
Ketamine 10 -15mg/kg
DETAILS:
Domitor 1mg/ml = 1,000ug/ml
Ketamine 100mg/ml
Diazepam 5mg/ml
CASE STUDIES OF 3 DOGS USING DOMITOR+KETAMINE
Weight
Domitor
Calculated
Ketamine
Calculated
Domitor Given
Ketamine Given
10kg healthy
0.4 ml IV
0.5 ml IV
Case 1
Fox Terrier, 1 year, 9.3kg spay
0.37 ml IV
0.47 ml IV
0.2 ml IV
0.3 ml IV
Young, healthy
Needs isoflurane maintenance as dosage is below calculated dose. No problems. When antisedan 0.2 ml IM is given, wakes up alert but limbs are rigid. Can't stand up till atropine 0.1 ml IV is given.
Case 2
Shih Tzu, F, 7 years, 8.1 kg
0.32 ml IV
0.41 ml IV
0.1 ml IV
0.4ml IV
Old age, be careful
Needs isoflurane maintenance as dosage is below calculated dose. No problems. Dental scaling. When antisedan 0.1 ml IV is given, no cries. Just wakes up as if from a nap.
Case 3
Maltese, F, 8 years, 4.3 kg
0.17 ml IV
0.22 ml IV
0.1ml IV
0.2ml IV
Old age, be careful
No need isoflurane gas as dosage is close to calculated dose. 6 teeth extracted. No problem. When antisedan 0.1 ml IV is given, cries in pain. Given tolfedine injection. Stops crying.
Dosage for the two old dogs - shih tzu and maltese
Fox Terrier, 1 year, Spayed. Rigid limbs after giving antisedan
to wake up the dog early
In conclusion, domitor and ketamine are synergistic and their combined use will be safer if injectable anaesthetics are required and no isoflurane gas is available. For healthy dogs, use the calculated dosage given above. For heart-diseased dogs, use diazepam + ketamine at 50% of calculated dose and give isoflurane gas top up. Do NOT use domitor + ketamine is heart-diseased dogs.
As google does not permit proper table to be set up or I don't know how to do it, see Toa Payoh Vets webpage at:
http://www.kongyuensing.com/folder5/20110326injectable-anaesthesia-dogs-cats-rabbits-guinea-pigs-toapayohvets.htm
for an easier to read tabulated pres
entation of the 3 cases.
The case of the skin and bone poodle. No more daily vomiting. Shall I cut to 3 meals a day?
"No more daily vomiting. Shall I cut down to 3 meals a day?" the wife asked.
"My dog only vomits when he is let free and he rushes out to eat the grass or late at night. I leash him and stop all feeds after 7 pm. So, my dog does not vomit at other times and is putting on weight. Shall I cut down to 3 meals a day instead of 2-3 hour daily from 9 am to 7 pm?"
"No," I said. "Your dog has a megaoesophagus condition and can't eat in large amounts." The lady probably could not understand what I was saying. Mega what?
I explained again: "Your dog's gullet near the stomach area is paralysed and enlarged. So food is trapped in that area instead of going straight into the stomach like normal dogs. The food accumulates and if in large amounts, together with drinking water, can get 'vomited' out."
Actually the dog regurgitates but it is hard to explain this to the elderly couple. If they feed 3x/day, the poodle would not put on weight. Now, she is still skin and bones but feel heavier.
The owner has to feed small amounts more than 3 times a day if she wants the dog to live. There is no surgical to resolve the problem now. In any case, there is a need for more investigation but the elderly couple needs to save up for their daily expenses. The money they spent on educating two children overseas to become high earners in society have been losses since now they have to be frugal.
Many middle-income parents do sacrifice so much that they start counting pennies when their pets need treatment. It can't be helped as they don't like to ask their children for money. Even though such children earn 10 times more than what they earn!
http://www.sinpets.com/dogs/20110215megaoesophagus-follow-up-toapayohvets-singapore.htm
has the previous case reports
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