411. A fast-growing backside tumour in an old Dachshund - a lipoma or liposarcoma?

"The lump on the right backside grows quite fast," the lady owner pointed to a 1.5 x 2 cm globular swelling to the right of the anus. "There are 4 other smaller lumps."
She was concerned about the large lump as it grows bigger every day. Could this be a liposarcoma (malignant growth) instead of a lipoma? Although middle-aged and old dogs, overweight female dogs do develop lipomas which are benign, I don't ask the owner to wait and see approach.

In one instance, Vet 1 had asked the owner of a Labrador Retriever to wait and see when the owner complained about a small globular growth above the neck of the dog. As typical of the busy Singapore owners, the owners waited till the lump becomes half the size of a tennis ball. When I saw it, it was a malignant tumour as it recurs after excision. "Well, Vet 1 had said that there was no need to remove the tumour when it was small," the owners said. Eventually, the dog had to be euthanased. From this experience, it is best NOT to advise the owner to wait and see. Give the owner the option to get the tumour resected and let her decide. The vet should not assume that every tumour under the skin is a lipoma and is benign.

In this female spayed Dachshund of 8.5kg, the owner had knowledge and asked me to operate. She was worried about the anaesthetic risk. A blood test showed the dog to be healthy for anaesthesia. Still the risks of death on the operating table are made known to her. She accepted the risks.

"Don't ask the vet to perform surgery during weekends or public holidays as the vet is busy and may need to rush through the surgery," I advised her and most clients that any rushed anaesthesia and surgery will not be in the interest of the patient.

I operated on April 19, 2011, a Tuesday morning at 10 am as scheduled and the owner arrived early. No food and water from 10 pm the night before. She used a marker pen to ink the 5 lumps as instructed by me. I still took one hour in total just to remove 5 fatty tumours and that included preparation, IV drip and surgery. The electro-surgery took around 30 minutes. Can't be shorter.

SEDATION
0.2 ml xylazine IM. My new assistant Mr Min asked if I wanted to give xylazine IV as I sometimes do. "No," I said. Isoflurane gas by mask was smooth and uneventful. The dog slept like a log. Intubated the dog to get oxygen and gas in. The anaesthetic machine was not leaking gas after industrial glue was applied to the hairline crack in the base tubing 2 days ago. 0.5 - 2% isoflurane gas was sufficient. "Keep to 0.5% and not less," I said to my assistant as he knew that the less the safer for the patient. But too little may lead to the dog waking up and delaying my surgery! A good assistant during anaesthesia is worth his or her weight in gold as vets don't have the luxury of the tax-payer's money to have an anaesthetist and the best equipment like the Singapore General Hospital.

ELECTRO-RESECTION
I like electro-surgery for such cases. No bleeding at all when I cut the skin of over 3 cm long to expose the pure white globular fatty tumour of 1.5 x 2 cm in size. Not one drop of blood. If you use scissors, you need to undermine the skin. The fine wire electrode just skim below the skin and the fatty tumour parted. I excised the base of this tumour attached to the muscle layer. I could see small red blood vessels of around 2 mm supplying this tumour with nutrients. This could be a liposarcoma as it grows fast.

Still no bleeding after I excised from the base of the skin to the top of the muscle layer and brought out the whole tumour intact. That is the usefulness of electro-surgical electrode (see image). There is no need to use scissors to undermine the skin and damage this fragile fatty tumour, pure white like snow and fragile too.

The owner came at around 11.30 am. The courier man had just taken the tumour inside the formalin bottle to bike back to the laboratory. So I could not show her but I have the image to show her. The other 4 small pieces of 3mm x 5mm were discarded as I did not keep them. However, she could see the stitched areas (3/0 absorbable sutures, horizontal mattress for the backside and simple interrupted for the others)

DOG POOPS
Unfortunately the dog started pooping. Brown solid stools started coming out from the anus. Surgery stopped and stools removed. Should have asked the owner to bring the dog to the toilet at home or plug the rectum.

"Is the dog awake?" the owner came at 11.30 am expecting a drowsy old dog. Well, this was the first time I met her and so she would have known about dog anaesthesia done in other clinics that use injectable IV anaesthesia. Isoflurane gas always allow the normal healthy dog to wake up within 10 minutes after completion of the surgery. As if it had a good nap. The surgery was not particularly painful but I gave the painkiller tolfedine SC and oral for the home.

"Yes," I said. "She woke up very fast after the end of anaesthesia." Xylazine 0.2 ml IM is a very low dose for a 10-year-old overweight Dachshund of 8.5 kg. I did not use xylazine IV this time as IM would be safer in an old dog, in my opinion.

"I had excised the 4 smaller tumours completely with their skins," I explained to the owner. "The backside tumour is large and if I removed it with the skin, there will be a big hole and the hole may not heal. So, I removed as much as possible under the skin and above the muscle. If it is malignant, it may recur." It is best to communicate this to the owner. The skin wound was over 5 cm long just to expose this 2x1.5x1.0 cm tumour and so there would not be enough skin to close the wound properly. I don't want a dog with a big gap in the backside due to the non-healing of the wound as this area is a high-tension area making wound healing difficult.

"Can you operate the other Dachshund? He has only 2 tumours similar to this dog?" the lady in her 40s asked. Red blood had oozed out from the dog's backside now despite the two horizontal mattress stitches closing the wound. "Your blouse and your handbag is stained with blood," I told her. "It does not matter," she said. The dog was alive and that was what mattered in her world.

She had earlier wanted two dogs done at one day. There are pros and cons for the vet. Pros - revenue comes in and client may go to the competitor if there is a delay. Cons - rushed job, not in the interest of the dog as mistakes in anaesthesia can result in the dog's death.

"It is always best not to stretch the vet as he has other surgeries and things to do in a day," I tried to educate this lady. I had asked her to bring just one dog today for the simple reason that I could focus on this dog alone and not be distracted.

I also did not want her to be waiting outside the reception room while I operated as to maintain a peace of mind during operation and not having a worried owner pacing outside the operating room.

"Well, it is best not to tempt fate," I told this personable lady. "Your operated dog is alive and well. It is not a guarantee that old dogs undergoing anaesthesia will survive and so it is best not to do another one on the same day. I am actually worried when I operate on old dogs! I don't even look forward to any old dog surgery." It is not that I am superstitious or can't do the 2nd surgery. There was no emergency for the 2nd dog to be operated on the same day and I do have a lot of things to do.

"Thursday will do," I said. Well, the lady was busy on Thursday. "How about Friday?" she asked. "If you come early on Good Friday at 9.30 am, I will operate as most clients don't come so early." However, I can understand that the owner is worried about the tumours in the sibling Dachshund becoming malignant through delay in surgery and she preferred me to operate. I had assigned Dr Vanessa to operate as this is a simple surgery. It is the anaesthestic death that the owner is very worried about and this must be understood.

Although there will be just 2 small fatty-like tumours, the whole procedure of preparation before op, sedating and giving the isoflurane gas and the IV drip and surgery can take 45 minutes in the 2nd dog.

No wonder, many vets just give injectable anaesthesia. No need to "waste time". I prefer isoflurane gas as it is much safer and the dog wakes up fast. But it sure takes 4 times as long. But in the end, the owner just wants a live dog and giving the owner a living dog is what she wants. Isoflurane gas gives a high safety margin and so I seldom use injectable anaesthesia in old dogs or young ones.

Injectable anaesthesia is also safe but it needs topping up in small amounts if the surgery takes longer than expected. A higher risk is involved in using injectable compared to isoflurane gas but usually a very small amount is injected and that is quite safe.

Well, each vet has his own choice but deaths on the operating table simply ruins a vet's reputation as owners spread the word and so, over the years, I rarely use injectable anaesthesia. It is preferred that other vets do the old-dog anaesthesia and surgery!

P.S LIPOSARCOMAS are uncommon malignant tumours of the fatty tissue. As this lump grew fast, the owner agreed to the histopathology to be done by the Lab.
Classified as low, intermediate or high-grade liposarcomas. With low and intermediate grade, the risk of spread to other parts of the body is low. With high-grade, the risk is much greater.

UPDATE APRIL 22, 2011
Histopathology results: A lipoma with no malignant cells seen. This is good news for the old Dachshund.

410. Vicarious liability & Duty of Care

Vicarious liability is a doctrine of English tort law. Employers will be held liable for the wrongdoings of their employees while the employee is conducting his duty. Intentional wrongdoings not in the course of ordinary employment were historically not the employer's liability.

But now, the employer is vicariously liable if the employee's intentional wrongdoings (e.g. deceit, fraud or sexual assault) is closely connected with the employee's duties.

EMPLOYER'S LIABILITY
Employers are vicariously liable for negligent acts or omissions by their employees in the course of EMPLOYMENT. For an act to be considered within the course of employment, it must either be authorised or be connected with an authorised act such that it can be considered a mode, though an improper mode, of performing it.

COURTS will sometimes distinguish between an employee's "detour" or "frolic". For example, an employer is vicariously liable if the employee had gone on a mere detour in carrying out his duties. If an employee acts in his own right rather than on employer's business, the employer is not liable for the employee's frolic.

Generally, an employer will not be liable for assault or battery committed by employees unless the use of force is part of their employment (e.g. police officers).

However, the employer of an INDEPENDENT CONTRACTOR is not held vicariously liable for the tortious acts of the contractor, except where the contractor injures someone to whom the employer owes a non-delegable DUTY OF CARE such as where the employer is a school authority and the injured party is a pupil (e.g. principal abusing the child on a field trip).



DUTY OF CARE
is a legal obligation for an individual to conform to a standard of REASONABLE care
while performing any act that could foreseeably harm others.

THERE ARE 4 ELEMENTS - LAW OF TORT - NEGLIGENCE
To succeed in an action for negligence, the plaintiff must show that:
1. the defendant owes him a duty of care.
2. the defendant has breached that duty of care
3. the breach causes damage/loss to the plaintiff
4. the damage/loss is not too remote (not controllable, not foreseeable, not an expert on the particular subject matter).


It is the first element (defendant owes him a duty of care) that must be established to proceed in an action of NEGLIGENCE. The plaintiff must BE ABLE TO SHOW a duty of care imposed by the law which the defendant has breached.



THE STANDARD BY WHICH DUTY IS MEASURED
Once a duty exists, the plaintiff must show that the defendant has BREACHED IT.
This is the 2nd element of negligence. Breach involves testing the defendant's actions against the standard of REASONABLE PERSON. This varies depending on the facts of the case. For example, doctors will be held to reasonable standards for members of his profession rather than the GENERAL PUBLIC, in negligence actions for MEDICAL MALPRACTICE.

Once the appropriate STANDARD has been found, the BREACH is proven when the plaintiff shows that the defendant's conduct fell below or did not reach the relevant STANDARD OF REASONABLE CARE.

However, if the defendant took every possible precaution and exceeded what would have been done by an REASONABLE PERSON, yet the plaintiff was injured, the plaintiff cannot recover in negligence.

Sunday April 17th - interesting cases

Bright sunshine and blue skies. Sunday morning April 17th, 2011

Started work at 9.30 am and finished at 6.00pm with Dr Vanessa.

1. Shih Tzu bites till the paws and feet bleeds. Very distressed to see a dog going at its body and feet. E-collar helped but bleeding stains apartment. Couple saw Vet 1 twice but no resoltion. Expat husband phoned Vet 1 today (Sunday) but no response. "When Vet 1 returns call," the husband said to me, "I had already phoned Toa Payoh Vets for an appointment."

"Skin diseases are not easy to cure in many cases," I said. I handled this case as the leading vet with Dr Vanessa as it would be an emotional case and I prefer to take the lead. Dr Vanessa was OK with this approach.

2. Rabbit with big jaw abscess. I asked my vet whether she would operate. She passed. So I did it the next day.

3. Three female SPAYED dogs with skin disease.
1. Low platelet. Lots of yellow pus in vulva. Why?
2. Bites flanks both sides. Alopecia. Endocrine? Vulva very small (spayed very young). Reddish.
3. Old dog. Health screening. Blood test. Vulva normal pink and size.

409. Entropion in the Sharpei can be cured if the owner knows

EMAIL TO DR SING DATED APR 19, 2011
Hi Judy,

I have a 6 years old male Shar Pei and have been having watery
eyes and yellow sticky discharge.
I am cleaning him a few times a day with eye wash and the problem
keep coming back.
I understand that surgery on the eye lid is necessary to stop this problem.
Can I know what will be the total cost for this surgery. And how long do I
have to leave him there.

Thanks



EMAIL FROM DR SING DATED APR 19, 2011

I am Dr Sing from Toa Payoh Vets. Thank you for your email. Estimated costs are around $600 - $700 for both eyes as general anaesthetic gas is used. Bring the dog in at 9.30 am and bring home in the evening. No food and water the night before after 10 pm. Phone 9668 6468 or 254 3326 for appointment.

A love child

"Where are your front teeth?" I asked a little girl sitting on the left side of the van which had parked to pick up her mother who had brought in the old Pomeranian for oxygen therapy (gasping for breath and coughing earlier and was treated by Dr Vanessa). "How many teeth have you lost?"

The little girl smiled when I said "hello" and so I could see that she had lost 2 front teeth upper and lower. She also had two backward aligned corner incisors. The mother came and I asked: "Is this your daughter? How old is she?"

I couldn't believe that 6 years had passed. The mother was a single mother working for a dog breeder and running his pet shop in Marine Parade and then in MacPherson Road. The breeder had packed his bags and left the industry. Wow, the baby is a very happy 6-year-old girl.

"You will have to spend around $3,000 to align your daughter's teeth when she is older," I said to the happy mum. I am glad she is still a groomer and making ends meet. I don't know much about her love child and did not intrude on her privacy. She takes so much trouble to come to Toa Payoh Vets when there are over 45 vet clinics and some nearer to Pasir Ris.

Dr Vanessa gave her dog the necessary treatment and the oxygen therapy. This was her sister's dog. I said to her: "This dog will not live past one week. If you give the medication for the heart problems, give 3 to 4 times a day according to her panting."

She had brought her sister's dog for treatment and since I was not available, my associate treated the dog. She said: "I was told to give two times a day."

"Yes, that is the standard recommendation. Giving to effect will let this Pomeranian live a bit longer. In the end, the heart fails and the dog passes away peacefully."

I heard a hissing sound when I was in the room where the dog had the oxygen therapy by mask and the necessary injections. I noted that Dr Vanessa had pressed the red button a few times to flush out any isoflurane gas before giving the oxygen. The anaesthetic man had replaced my "faulty" vaporiser 3 days earlier as there was a leakage of oxygen. But all was well since.

Now, I could hear a faint hissing sound. Was there another leak in the piping? I phoned the anaesthetic man who was busy and wanted the whole set back to his factory. "Is there some elephant glue to seal the hairline crack in the piping under the vaporiser?" I asked him. "We need to operate and can't afford to wait a few days."

Dr Vanessa was going to postpone surgeries but I stopped her. The anaesthetic man came and saw the crack. His girl had placed some soapy water and I could see the bubbles from the blue tubing. So, there was a crack here too or was it there earlier? Was it due to the pressing of the red button repeatedly? Well, equipment piping do wear and tear.

Surprisingly, my old car had this ping message "Add one litre of engine oil when you next fill up." I had the car repaired by the mechanic when this message appeared earlier. Still now, the problem showed itself. Wear and tear or an inability of the mechanic to diagnose and treat? I top up the engine oil and the message disappeared. There must be a hairline crack somewhere. Should I sell off the car? But COE prices had shot up and 2nd hand cars fetch a good value. But it is much more expensive and stupid to buy a new car now. So, I have two identical problems of hairline cracks - in a car engine oil system and in my veterinary anaestethic gas system. Both need management and assessment of risks.

406. I want to sue the vet

"I want to sue Dr ...!" the employment agent who could never control her demons in her brain shouted over the phone. I had her to get a replacement for Mr Saw who left at the expiry of his lease on amicable terms last week. Mr Min started work for less than a week and here I had this threat to sue my associate vet because Mr Min could not get his regular break for dinner during some busy days.

I had known her for more than 15 years and know that she bears grudges and will tell me off whenever the anger demons dominate her brain. She would rattle off her anger over the handphone though I had told her to call me back later. Her loud voice could be heard distinctly by my friends in a car in Penang and during other inappropriate occasions when she aired her complaints about work-related problems. I could switch off the handphone as she would not let me speak but I consider it better that her demons get out of her brain through her big mouth and cool down.

However a threat to sue any my associate vets is not tolerated by me at all. I said to Mr Min and the associate vet at a meeting I convened: "When Khin Khin wants to sue Dr ..., she is suing me as I own the practice. Dr ...has no share in this practice. I will engage a lawyer to defend any associate vet who is sued. Has she got a lot of money to sue? Don't threaten to sue. Just sue."

I had advised my vet to ensure that Mr Min, the vet assistant get his meal breaks. I said to Mr Min: "Khin Khin does not respect older people. Maybe she thinks I am old and stupid and therefore can shout at me. You have to think for yourself as to what is good for you. If you don't want to work at Toa Payoh Vets, have you got another offer from another vet?

"Old people have gone through the life of war, meeting all sort of nonsenses and people and suffering losses while gaining experiences and wisdom," I said to both parties who are at least 30 years younger than me. "They are a valuable source of knowledge and I always respect people older than me so that they can share their experiences with me. Obviously if you have no respect for the seniors, you can't expect them to share their experiences with you so that you don't suffer losses.

"You will have to think for yourself as regards your need to respect your employment agent. You had paid her the money for her services. Do you want this job or not? Do you have another employer waiting for you now? I have many applicants from the Philippines asking for your job."

Mr Min wanted this job as he was practically unemployed in Myanmar and earned very little. In Myanmar, the vets don't earn more than S$500 a month, I believe.

I told Mr Min and my associate vet a bit of my philosophy and why I employ Myanmar vets as vet technicians.

"I employed my first Vet Technician many years ago. She was a Myanmar Vet working for Dr XXX. Dr... did not want to continue employing her because she was slow in her work. She also could not speak English well, just like you now. So, it was very difficult for her.

"I employed her and she completed her year of employment and wanted to go home to see her sick father. An army officer, I believe. Around 2 years later, she visited me and gave me a present. I was much surprised. You can check her out as she is in Yangon and Khin Khin knows her.

"In your first week here, I have complaints from a pet shop owner that her referred customers cannot understand what you are talking about over the phone. This is a common complaint of Myanmar vet technicians as their standard of conversational English is not good. You just start your job in Singapore. Over time, like your friend, Mr Saw, your English will be good. This is one reason why most vet technicians employed in Singapore are Filipinos as they speak very good English and can start work without the employer worrying about client services being downgraded.

"You may be able to get a job at one of the 45 vet clinics in Singapore, but do you want to work in a clinic where there are no cases during some days? Just sit and go for your scheduled lunch and dinner times waiting for cases? You learn nothing because there are no cases over the year of employment. Or you work in a very big practice in a small area like Haematology. You can't do other aspects of vet medicine as there are other vet technicians assigned.

"So you can't start your own practice confidently because you have no cases in the new clinics. Do you want that?

Mr Min did not want to work in such a situation. All employees have this "what's in it for me" attitude and I accept that they are in a job for themselves. Times have changed.

I can easily employ a Filipino vet and grow my practice very fast due to good service as Filipinos are culturally excellent in English language communications and services.

However, making a small difference to the disadvantaged and the underdog have always been my philosophy as others had made a difference to me by awarding my a scholarship to study vet medicine in Glasgow in 1969.

It is very difficult for most of the younger vets in Singapore to understand my philosophy when their parents pay and pay for their vet studies. Pay and Pay? PAP? Elections in May 2011? Some distraction here.

In any case, I had instructed the associates to ensure that Mr Min get his meal breaks and I am personally checking on this. Time management is important for a vet and also for the employee.

I don't want the demons to re-appear again in Khin Khin's brains and there have been so many incidents from her such that I can write a novel of some interest to human relationship readers.

This incident is just one of the chapters of this novel. I said to Mr Min: "If you want to sue, don't threaten. Just do it. Pay the lawyer and sue the pants off the vet!"

I told Mr Min and the vet: "When I started Toa Payoh Vets, there were around 4 competitors. During the first few years, there were few customers. Just sit down and wait as vets cannot advertise. Now that Toa Payoh Vets is busier, I cannot be taking it easy. There are now at least 45 competitors and I know some of them have not sufficient number of customers to make ends meet."

Mr Min is a gentle person in his early 30s. He does not lose his cool and that is a good trait. I also advised Mr Min to buy some food during busy times when he can't go for the break as scheduled. In the end, he has to decide. Does he want the job or not? He is slow in his work but this will change with my training. He is not indispensible and there are so many stronger and better qualified Filipino vet technicians. Hire the best talent if you want your business to grow in this competitive world, the business management books will teach us. Why care about the disadvantaged with no experience or a good command of the English language. Why care for the underdog in this world? Why bother with employment agents who can't exorcise their demons? Why patronise a small businessman in a niche in veterinary anaesthesia when you can get business from an established corporation? All these encounters make life stressful. However, make a small difference to change the world if you are blessed with health and can do it. That is my philosophy.

405. BARF/raw food diet query to Dr Sing

On Sat, Apr 16, 2011 at 9:35 AM, ...@uqconnect.edu.au> wrote:

Dear Mdm Judy,

I have a question for Dr Sing which I hope you can pass on to him. I am interested to know about Dr Sing's position on feeding a BARF/raw food diet for small animals.

Thank you,
(Name given)


Kong Yuen Sing to Mr,

Thank you for your email. I am Dr Sing from Toa Payoh Vets, www.toapayohvets.com. The answer to your question can be several pages an even be a book as there are many pros and cons. There are various formulas recommended by various proponents for the BARF/raw food diet.

Briefly, I am not recommending the BARF/raw food diet to my Singapore clients for the simple reason that most of them have no time to educate themselves on what makes a balanced diet for their dogs. My clients will also not be able to provide the necessary supplements to make sure that the diet is balanced during the different stages of life in a dog. Feeding such a diet to puppies, for example, will not be good for the puppies.

Best wishes.

404. Follow-up on the itchy and scootering DachshundXJR

This is a follow up to a very interesting perplexing case I saw 2 days ago. My tentative diagnosis was allergy to the environment or dog food. The owner was more worried that the dog still scootered despite consulting Vet 1 earlier. Scootering was just continuous.

"My dog is calmer now. No more scootering and I don't scratch her anymore," the owner could not hear me distinctly as she was at the mall.

"What do you mean when you say you scratch the dog?" I asked the caregiver. "Well, I had to pet her and she would want more petting before I consulted you!". English is a hard language to understand. I was wondering why she would scratch her dog who was already itchy all over the body.

"How much hair loss?" I asked. She was not able to confirm as she was busy.

So far so good. I called to ask her to pick up the Hills' Canine d/d Potato and Salmon formula. It is a single animal protein source for allergic pets. The dog is not permitted to eat treats and any home-cooked or other food for the next 3 months. Then the owner can introduce treats and see if the body itch occur.

Painful ears with no infection, biting all four paws, whole body itch without skin diseases and hair falling out. These are one of the possible signs of dog food allergy. The dog just arrived from the USA. There could be multiple causes like heat, humidity, shampoos, stress and so many others.

We will have to wait and see. It is important that the dog does not scooter anymoe as that seems to be the main issue of the owner. She was very observant and said that I squeezed the anal sacs from quite deeply into the anal region. Of course, I did produce the grey particles and anal fluid. Evidence is important in veterinary medicine. The proof of the eating is in the pudding if there is such an English expression?



TODAY'S CASE
Old Jack Russell. Female, 8 years old said to be spayed 8 years ago and had no heat period.

Lost 2 kg from Oct 2010 (fat as a pig) to April 2011. Lethargy. Not eating much during past 3 weeks. Dried purulent eye discharge in both eyes suggested a serious systemic illness as in the hamster. Examine the whole body from mouth to private parts.

Dehydrated. Left gum ulcerated around Left Upper PM4. Yellow pus in swollen vagina (I showed to the busy lady owner's mother who brought the dog in). I suspected stump pyometra if the dog had not been properly sterilised but it could be UTI with pus inside the bladder and kidneys. No signs of vomiting. The dog just wanted to sleep and die.

BLOOD TEST. Low blood pressure and so I taught Min to use the tubing around the elbow and clamp with forceps just to collect 2 ml of blood successfully. Min is not inexperienced but he tended to do blood collection from the forelimbs and then the hind limbs but was unsuccessful today with both legs. So, I taught him how to fish rather than give him fish.

BLOOD TEST RESULTS

Very low platelets = 40 (normal 200-500). No platelet clumps. Large platelets present.
Liver enzymes elevated. Urea 15.6 (normal 4.2 - 6.3.
Red cell and haemoglobin below normal.
Total White Cell Count normal.

So what is the cause of the low platelets? I phoned the young lady. She said no Chinese medicine was given but the dog had the chicken flavouring or some powder added to the chicken meat for some weeks. Could this be the toxic substance depleting platelets? Would the dog live? Hard to say.

403. New anaesthetic gas machine

April 13, 2011.
I got a new anaesthetic machine vaporiser as the old one had leaked at the bottom. There is a hole on the lower right, hissing oxygen and depleting my oxygen tank. This vaporiser is only 3 years old. But I don't want it repaired. I bought a new one as gas anaesthesia is very useful and very safe, esp. for old dogs.

The vaporiser started hissing oxygen 3 days ago on a Saturday. All gas operations ceased and I had to get the experienced man to service but Mr Goh was in Malaysia doing some vet clinics set up there. So, on Wednesday (yesterday), I told him to treat urgently as I did not want to buy a vaporiser from his competitor. I support Mr Goh as he needs the help. If one does not support the small technical person who specialises in vet machines, he will go out of business and the vet community will be much worse. The big boys are not interested in vet machines anyway. Sales persons can't service.

"It is only $8,000," my Myanmar friend James said. "Throw away the old one. Even if you give to me, I don't want it. It is hard to repair in Myanmar." James is starting his clinic in Yangon soon. A few weeks ago, I offered him my old Shoreline veterinary surgery table which costs $7,000 to purchase as I bought a new one. He said no but his wife later said yes. So, there was much unhappiness with the

iPhone 4 or an Android phone

2 weeks ago, I decided to upgrade myself from the conventional mobile phone which was good for nothing but useful to send and receive calls. I could not surf.

iPhone 4 is already one year old. The Samsung was a new model. So, brand-name or the latest technology? iPhone 5 may come soon but maybe not.

I was much tempted to take the brand-name. But it is never good to do it when the brand name does not bother to upgrade and lose to its competitors. So, I took the Samsung. The HTC was sexy but it had caused me loss as it malfunctioned some 3 years ago when I first got one (I could write instead of thumb). The company took months to repair and the problem of hanging came back again. As you can see, good performance counts even in mobile phone sales and service.

Same tough competitions exist for the 45 vet clinics now existing in Singapore. Brand name clinics definitely lose out in numbers to the new ones with sexy renovations and frills. And that attract many younger pet owners.