Singapore Watch to me
show details 8:38 AM (23 hours ago)
There is a new comment on the post "How to make HDB housing affordable (Part 2)".
http://singaporewatch.org/?p=1512
Author: Justina
Comment:
Hi David, thanks for your feedback!
1. I totally agree with you that some families need to rent out a room should their breadwinner lose their job or should they need to supplement their income. Just to clarify, I'm only suggesting a ban on the subletting of whole unit for type B flat, and not individual rooms. That would distinguish them from current flats, where after the 5 year MOP, they can apply to sublet the entire apartment out.
2. Unless my understanding of HDB grants have changed, the $30k ($40k if near parents) grant is ONLY ELIGIBLE for RESALE flats and not new flats. This is because new flats are already subsidised from current market prices. Additional Housing Grants still exist for low income earners though.
3. As for cooling measures, I don't think the Government can undo the sudden rise in flat prices in the last couple of years ago. Even if flat prices stay at current prices and do not go up anymore, it is still quite pricey, for public housing.
(In comparison, a 2 bedroom 2 bath apartment in some parts of the US costs only about $75k. And these are not public housing, but fully private, with facilities).
Good luck with your test!
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E-MAIL REPLY FROM DR SING DATED MAY 25, 2011
FIRST DAY OF CEA REA EXAMINATION.
You are correct in saying that the CPF Housing Grants of $30,000 and $40,000 are for new HDB flats as at May 25, 2011. HDB keeps changing the rules of the game and so we can't presume that new HDB flat design such as the one you propose will not be eligible for CPF Housing Grants (with the new Minister now having a fresh outlook) when new. Or even when sold as resale some 5 years later based on minimum occupation of 5 years as mandated as at present.
My point is that your title is "affordable HDB housing" or am I mistaken? You don't mean just affordable HDB housing when purchasing new HDB flats?
As for your prohibition of rental of the whole HDB flat after the minimum occupation period (which may be 10 years if the new Minister deems fit), why be-grudge a decent average Singaporean family of earning some honest income to cope with the high cost of living in the next 10 years?
HDB flat owners had so many restrictions some 10-20 years ago. They could not use the fully paid up HDB flat as security for overdraft or bank loan to finance their children's education overseas and so are already disadvantaged compared to non HDB-owners in the 1980s.
As HDB houses around 80-90% of the Singaporean population, your prohibition has a strong impact on the average person who just wants to ensure that his family has sufficient income for education of the children and one of the means is to monetise the HDB flat (by subletting the whole flat).
In my opinion, the heavily subsidised new HDB flat can still be more subsidised if the politicians want to make it affordable rather than making more rules to make it so much difficult for the average man to monetise his HDB flat. This is D-day today for me and thanks for pointing out my error, just in time, for Paper 1 of the CEA REA today.
Wednesday, May 25, 2011
Tuesday, May 24, 2011
453. Comment on affordable HDB housing for Singaporeans
My comments to the Singapore Watch website while my brain still retains my CEA REA lecture notes on Singapore Housing. The website is at:
http://singaporewatch.org/?p=1466
May 23, 2011 (2 days before the CEA REA exam on May 25, 26, 27)
It is great to read about your ideas on how to make HDB housing affordable to first-timers. It must have taken you many hours to think and write about the subject. I presume you are an architect or related to the profession to give such a thorough presentation. As I am taking my CEA's approved REA exam in 2 days' time, I am perhaps able to comment on your proposal since I have to study everything about Singapore housing to pass all 3 subjects or repeat all 3.
My feedback on your Type B flat
1. Buyers cannot rent just because they buy Type B flats. This is tough as the Buyer's family may suffer deaths or loss of the job of the bread winner due to poor health or economic downturn.
Renting a room may help to provide income in times of financial difficulty which can't be predicted. Therefore, Type B flat buyers are forced to rent out illegally and risk HDB acquisition and fines. Nobody can predict the future and so for this reason alone, this prohibition on room rental should not be one of the restrictions.
2. My proposal is to make use of the concept of the CPF Housing Grants to make HDB flats affordable for first-timers depending on the pricing. Presently the CPF housing grants are extremely generous. $30,000 for a brand new HDB flat purchase and an additional $10,000 (making it $40,000) if the buyer lives within 2 km of parents/married children. This is subsidy for the first-timer and is present only in Singapore as I doubt any government will dish out such a large amount of cash. There is still the Additional CPF Housing Grant subsidy.
Taking an example. Assume a household income of $4,200/month per couple buying a 4-room flat with the CPF Housing Grants,(as illustrated by Mr Mah Bow Tan in one of his speeches in the Straits Times prior to polling day), the couple has no difficulty in paying the monthly instalments for the flat. Lower income groups have more grants including the Special Housing Grants introduced.
3. Property cooling measures of new HDB flat owners not allowed to buy private property till after 5 years of occupation and private property owners having to sell their private properties within 6 months of purchasing the HDB flat are excellent measures that should have been introduced 2 years before the General Elections.
These measures definitely will decrease speculation and property investments from the better off Singaporeans. This will make HDB prices more affordable, together with the Seller having to pay 16,12,8 and 4% of the purchase price if they sell their private properties within 1,2,3 and 4 years respectively, as the investors and speculators have been better controlled than in the past years.
Companies can now only borrow 50% from the bank also reduce speculations by non-individuals as these companies have the monies to flip properties before the introduction of the Seller's Stamp Duties of 16,12, 8 and 4% of the purchase price.
There are other property cooling measures which I think are effective. However, the increasing cost of living is the issue that the government may want to look into as it affects housing and food prices.
The cost of living continues to rise due to the government's inability to rein in costs. I believe each Ministry has to justify its existence (to pay its own civil servants amongst other things). It has to "recover cost" and make money. So the bureaucrats think of how to increase fees, introduce new regulatory fees of as much as $20,000/item to get a permit to import and sell some pharmaceutical goods. Therefore, the cost of living will increase, making it harder for the first-timer or those with financially difficulty to be afford to purchase HDB flats.
I hope my comments are OK with you. Keep up the good work.
http://singaporewatch.org/?p=1466
May 23, 2011 (2 days before the CEA REA exam on May 25, 26, 27)
It is great to read about your ideas on how to make HDB housing affordable to first-timers. It must have taken you many hours to think and write about the subject. I presume you are an architect or related to the profession to give such a thorough presentation. As I am taking my CEA's approved REA exam in 2 days' time, I am perhaps able to comment on your proposal since I have to study everything about Singapore housing to pass all 3 subjects or repeat all 3.
My feedback on your Type B flat
1. Buyers cannot rent just because they buy Type B flats. This is tough as the Buyer's family may suffer deaths or loss of the job of the bread winner due to poor health or economic downturn.
Renting a room may help to provide income in times of financial difficulty which can't be predicted. Therefore, Type B flat buyers are forced to rent out illegally and risk HDB acquisition and fines. Nobody can predict the future and so for this reason alone, this prohibition on room rental should not be one of the restrictions.
2. My proposal is to make use of the concept of the CPF Housing Grants to make HDB flats affordable for first-timers depending on the pricing. Presently the CPF housing grants are extremely generous. $30,000 for a brand new HDB flat purchase and an additional $10,000 (making it $40,000) if the buyer lives within 2 km of parents/married children. This is subsidy for the first-timer and is present only in Singapore as I doubt any government will dish out such a large amount of cash. There is still the Additional CPF Housing Grant subsidy.
Taking an example. Assume a household income of $4,200/month per couple buying a 4-room flat with the CPF Housing Grants,(as illustrated by Mr Mah Bow Tan in one of his speeches in the Straits Times prior to polling day), the couple has no difficulty in paying the monthly instalments for the flat. Lower income groups have more grants including the Special Housing Grants introduced.
3. Property cooling measures of new HDB flat owners not allowed to buy private property till after 5 years of occupation and private property owners having to sell their private properties within 6 months of purchasing the HDB flat are excellent measures that should have been introduced 2 years before the General Elections.
These measures definitely will decrease speculation and property investments from the better off Singaporeans. This will make HDB prices more affordable, together with the Seller having to pay 16,12,8 and 4% of the purchase price if they sell their private properties within 1,2,3 and 4 years respectively, as the investors and speculators have been better controlled than in the past years.
Companies can now only borrow 50% from the bank also reduce speculations by non-individuals as these companies have the monies to flip properties before the introduction of the Seller's Stamp Duties of 16,12, 8 and 4% of the purchase price.
There are other property cooling measures which I think are effective. However, the increasing cost of living is the issue that the government may want to look into as it affects housing and food prices.
The cost of living continues to rise due to the government's inability to rein in costs. I believe each Ministry has to justify its existence (to pay its own civil servants amongst other things). It has to "recover cost" and make money. So the bureaucrats think of how to increase fees, introduce new regulatory fees of as much as $20,000/item to get a permit to import and sell some pharmaceutical goods. Therefore, the cost of living will increase, making it harder for the first-timer or those with financially difficulty to be afford to purchase HDB flats.
I hope my comments are OK with you. Keep up the good work.
452. Sunday May 22 2011's interesting cases
Bright sunshine blue sky Sunday
1. Case 1. 14-year-old Pom. The young lady came at 9.15 am as scheduled. "You know the high anaesthetic risk for old dogs?" I asked. "This could be the reason that the other vet did not want to operate and asked you to 'wait-and-see?".
She nodded her head: "She (the other vet) did say that it is highly risky as my dog is 14 years old."
I palpated the 3 cm x 3cm sized lump on the right chest. "There seem to be two lumps now," I said.
Case 2. Xylazine 0.1 ml IM was given at 9.20 am. I was about to commence anaesthesia when the owner of the Maltese with shivering came in to say that her dog still had a "swollen abdomen." I examined the dog. "No," I said. "But she has more back pain," I showed her the area of back pain in her dog by pressing and getting a response from the thoraco-lumbar area. "My advice is that the dog be confined inside a playpen for the next 3 months. If not, at least 1 month but very few Singaporean owners comply with my advice."
The dog was active and looked OK. What's the big deal? To prevent further damage to the spinal disc which could have prolapsed partially for now. But it is hard to make owners understand and so some vets just prescribe steroids, as in the case of the SGH Professsor's friend's Miniature Schnauzer.
"Can my dog take her daily walk and exercise?" the lady asked me. "No," I said. "Just go out to pee and poop, at least for 1 month."
Case 3. Soon another young lady with a heart-shaped fair face came. She had made an appointment for a second opinion on her 8-year-old Jack Russell, female, not spayed. "What happens to this area with bluish swelling?" she pointed to the high-energy dog's lower breast area. Two small hills from both mammary glands 4 and 5 on left and right.
"These could be due to the dog suckling her nipples here and causing the breast to swell with milk. The bluish colour is due to bruising from her suckling," I said. The young lady looked at me as if I was talking some nonsense. What did I mean?
I pressed one of the nipples in the bluish area. A missile of brownish discharge shot out onto my shirt. "Your dog has produced milk," I said. "She has false pregnancy." I showed her milk being produced by the other 2 mammary glands.
But her main purpose was to consult me about the abscess in the dog's elbows. Vet 1 had prescribed a cream. "Creams are ineffective," I said. "The dog just licks it off." She said: "I watch the dog for 2 hours. Every time she tries to lick, I will say 'no, no.'. I was impressed with her patience. "So what happens after 2 hours?" I asked. She sighed and shook her head. She could never beat time. So the dog just licked at the cream and the encapsulated abscesses on the elbow. "Surgical excision of such big abscesses is the only option," I said. She had also been advised to spay her dog to prevent pyometra (womb infection) later but she said the dog was too old.
Then she asked me about a globular growth above the carpus and the pad in the right foot. "What is this and what can be done?" I checked. "It is likely to be a tumour," I said. Again my advice was to excise it as it was now 5mm x 5 mm and would be easy to do so. The owner was not in agreement. So, I bundled some antibiotic medication and gave the injections and asked her to think about the surgery for the carpal tumour while it is still small in size. As for spay and the elbow abscesses, she had been given a second opinion. Maybe she needed a 3rd opinion?
Case 4. Just as I was going to operate on the 14-year-old Pom, another client came in with a large Samoyed said to be limping on and off in the front legs but appeared OK now. I had the Samoyed trotted outside at the side of the Surgery and told my intern Shirley to observe. Shirley wanted to study to be a vet after her graduation from the NUS and was working for the next 2 months. "Just listen, don't need to write much, " I said to her as she preoccupied herself writing the case being seen, as I wanted her to write reports to learn more, than just watching and forgetting.
After the trot which did not reveal limping, I got the dog inside the consultation room and got him on the table. Dr Vanessa had arrived and so I said she would collaborate me with this case as I would need to get operating soon. We got the dog on the table. The dog resisted being laid on her side and somehow we managed. I took the first examination and checked out the left forelimb. I extended and flexed the paws vigorously, then the carpus, the elbows, the shoulder joint. I abducted and adducted the shoulder vigorously. Not a whimper of pain from the dog. Somehow I sensed that the owners were worried about such a vigorous manipulation of the joints. However, this is necessary and normal joints, tendons and ligaments will not elicit pain. There was none.
"Now, it is your turn to check the right forelimb," I said to Dr Vanessa as we struggled to pin the dog down with her right side up. Dr Vanessa appeared to me to be gentler, picking up the paws to examine the inside for wounds. Each vet has his or her own method of limb examination. The dog could not be restrained and asserted her authority by getting up.
"So, is there lameness in the right leg or not?" the anxious wife in her 40s asked. "I can only confirm that the left front leg is OK since the dog will not permit any more examination!" I said. I left the case to Dr Vanessa as I had to operate the Chihuahua.
SURGERY. Careful and minimal isoflurane gas by endotracheal tube. It was bad news for the owner. Under the skin were a cluster of black grape-like lumps and more smaller ones spread further out, covering the subcutaneous tissue of around 6 cm x 4 cm. I tried to cut off all the grey "grapes" with the biggest being 4mmx4mm and sent them for histopathology. I suspected melanomas which have spread. I was frank with the lady owner: "It is bad news as the tumours have spread out like from the main cluster. Some are very small. It is not possible to remove 100% as some cannot be seen yet. Also, I can cut off the whole piece of affected skin as there will be a large hole on the chest."
The young lady closed her eyes and I could see that she was sad for her companion of 14 years. If only she had checked the dog daily and got the lump removed some months ago. Wait-and-see is NOT the advice of the vet for old dogs with tumours as some may be malignant. All dogs with tumours should be advised to be excised as vets are not gods and in this case, the wait-and-see advice was not good advice.
1. Case 1. 14-year-old Pom. The young lady came at 9.15 am as scheduled. "You know the high anaesthetic risk for old dogs?" I asked. "This could be the reason that the other vet did not want to operate and asked you to 'wait-and-see?".
She nodded her head: "She (the other vet) did say that it is highly risky as my dog is 14 years old."
I palpated the 3 cm x 3cm sized lump on the right chest. "There seem to be two lumps now," I said.
Case 2. Xylazine 0.1 ml IM was given at 9.20 am. I was about to commence anaesthesia when the owner of the Maltese with shivering came in to say that her dog still had a "swollen abdomen." I examined the dog. "No," I said. "But she has more back pain," I showed her the area of back pain in her dog by pressing and getting a response from the thoraco-lumbar area. "My advice is that the dog be confined inside a playpen for the next 3 months. If not, at least 1 month but very few Singaporean owners comply with my advice."
The dog was active and looked OK. What's the big deal? To prevent further damage to the spinal disc which could have prolapsed partially for now. But it is hard to make owners understand and so some vets just prescribe steroids, as in the case of the SGH Professsor's friend's Miniature Schnauzer.
"Can my dog take her daily walk and exercise?" the lady asked me. "No," I said. "Just go out to pee and poop, at least for 1 month."
Case 3. Soon another young lady with a heart-shaped fair face came. She had made an appointment for a second opinion on her 8-year-old Jack Russell, female, not spayed. "What happens to this area with bluish swelling?" she pointed to the high-energy dog's lower breast area. Two small hills from both mammary glands 4 and 5 on left and right.
"These could be due to the dog suckling her nipples here and causing the breast to swell with milk. The bluish colour is due to bruising from her suckling," I said. The young lady looked at me as if I was talking some nonsense. What did I mean?
I pressed one of the nipples in the bluish area. A missile of brownish discharge shot out onto my shirt. "Your dog has produced milk," I said. "She has false pregnancy." I showed her milk being produced by the other 2 mammary glands.
But her main purpose was to consult me about the abscess in the dog's elbows. Vet 1 had prescribed a cream. "Creams are ineffective," I said. "The dog just licks it off." She said: "I watch the dog for 2 hours. Every time she tries to lick, I will say 'no, no.'. I was impressed with her patience. "So what happens after 2 hours?" I asked. She sighed and shook her head. She could never beat time. So the dog just licked at the cream and the encapsulated abscesses on the elbow. "Surgical excision of such big abscesses is the only option," I said. She had also been advised to spay her dog to prevent pyometra (womb infection) later but she said the dog was too old.
Then she asked me about a globular growth above the carpus and the pad in the right foot. "What is this and what can be done?" I checked. "It is likely to be a tumour," I said. Again my advice was to excise it as it was now 5mm x 5 mm and would be easy to do so. The owner was not in agreement. So, I bundled some antibiotic medication and gave the injections and asked her to think about the surgery for the carpal tumour while it is still small in size. As for spay and the elbow abscesses, she had been given a second opinion. Maybe she needed a 3rd opinion?
Case 4. Just as I was going to operate on the 14-year-old Pom, another client came in with a large Samoyed said to be limping on and off in the front legs but appeared OK now. I had the Samoyed trotted outside at the side of the Surgery and told my intern Shirley to observe. Shirley wanted to study to be a vet after her graduation from the NUS and was working for the next 2 months. "Just listen, don't need to write much, " I said to her as she preoccupied herself writing the case being seen, as I wanted her to write reports to learn more, than just watching and forgetting.
After the trot which did not reveal limping, I got the dog inside the consultation room and got him on the table. Dr Vanessa had arrived and so I said she would collaborate me with this case as I would need to get operating soon. We got the dog on the table. The dog resisted being laid on her side and somehow we managed. I took the first examination and checked out the left forelimb. I extended and flexed the paws vigorously, then the carpus, the elbows, the shoulder joint. I abducted and adducted the shoulder vigorously. Not a whimper of pain from the dog. Somehow I sensed that the owners were worried about such a vigorous manipulation of the joints. However, this is necessary and normal joints, tendons and ligaments will not elicit pain. There was none.
"Now, it is your turn to check the right forelimb," I said to Dr Vanessa as we struggled to pin the dog down with her right side up. Dr Vanessa appeared to me to be gentler, picking up the paws to examine the inside for wounds. Each vet has his or her own method of limb examination. The dog could not be restrained and asserted her authority by getting up.
"So, is there lameness in the right leg or not?" the anxious wife in her 40s asked. "I can only confirm that the left front leg is OK since the dog will not permit any more examination!" I said. I left the case to Dr Vanessa as I had to operate the Chihuahua.
SURGERY. Careful and minimal isoflurane gas by endotracheal tube. It was bad news for the owner. Under the skin were a cluster of black grape-like lumps and more smaller ones spread further out, covering the subcutaneous tissue of around 6 cm x 4 cm. I tried to cut off all the grey "grapes" with the biggest being 4mmx4mm and sent them for histopathology. I suspected melanomas which have spread. I was frank with the lady owner: "It is bad news as the tumours have spread out like from the main cluster. Some are very small. It is not possible to remove 100% as some cannot be seen yet. Also, I can cut off the whole piece of affected skin as there will be a large hole on the chest."
The young lady closed her eyes and I could see that she was sad for her companion of 14 years. If only she had checked the dog daily and got the lump removed some months ago. Wait-and-see is NOT the advice of the vet for old dogs with tumours as some may be malignant. All dogs with tumours should be advised to be excised as vets are not gods and in this case, the wait-and-see advice was not good advice.
451. Hamster's everted cheek pouch e-mail
... to judy
show details 10:56 PM (3 hours ago)
Dear Doctor,
I have a hamster that has an everted cheek pouch. Since yesterday, her cheek pouch has been hanging outside her mouth. She seems to be in pain. Does she have to go to surgery? How much does it cost and how long does it take? I would also like to make an appointment on Wednesday, 25th May 2011 between 3 to 5 pm. Can you confirm if you are available? Please reply as soon as possible. Thank you.
Regards,
Name
E-MAIL REPLY FROM DR SING
Tuesday, May 22, 2011 2.04 am
I am Dr Sing from Toa Payoh Vets. Thank you for your email.
In reply, your hamster may need surgery if the everted cheek pouch cannot be put back inside the cheek, e.g. if it is infected and damaged badly. Cost is capped at the maximum of $150 for consultation, anaesthesia and surgery (longer duration as likely to be in your case). It takes around 10 minutes for surgery but with preparation and gas anaesthesia to effect, it will be around 25 minutes . I will only be available at 9.30 am on May 25, 26, 27 which are respectively Wed, Thu and Friday to operate as I will be studying and taking examinations for these 3 evenings.
Therefore, if we can't meet, you may consult Dr Vanessa Lin or Dr Teo by phoning 6254-3326 for appointment. Or you can leave the hamster with my assistant on Tuesday with instructions for my assistant that I will be attending to this hamster. I will operate at around 9.15 am on Wed, Thur or Friday for emergency cases such as yours. If you need to see me, it will be at 9.15 am for the above-mentioned dates or you can consult and get surgery done by the two associate vets.
Best wishes.
show details 10:56 PM (3 hours ago)
Dear Doctor,
I have a hamster that has an everted cheek pouch. Since yesterday, her cheek pouch has been hanging outside her mouth. She seems to be in pain. Does she have to go to surgery? How much does it cost and how long does it take? I would also like to make an appointment on Wednesday, 25th May 2011 between 3 to 5 pm. Can you confirm if you are available? Please reply as soon as possible. Thank you.
Regards,
Name
E-MAIL REPLY FROM DR SING
Tuesday, May 22, 2011 2.04 am
I am Dr Sing from Toa Payoh Vets. Thank you for your email.
In reply, your hamster may need surgery if the everted cheek pouch cannot be put back inside the cheek, e.g. if it is infected and damaged badly. Cost is capped at the maximum of $150 for consultation, anaesthesia and surgery (longer duration as likely to be in your case). It takes around 10 minutes for surgery but with preparation and gas anaesthesia to effect, it will be around 25 minutes . I will only be available at 9.30 am on May 25, 26, 27 which are respectively Wed, Thu and Friday to operate as I will be studying and taking examinations for these 3 evenings.
Therefore, if we can't meet, you may consult Dr Vanessa Lin or Dr Teo by phoning 6254-3326 for appointment. Or you can leave the hamster with my assistant on Tuesday with instructions for my assistant that I will be attending to this hamster. I will operate at around 9.15 am on Wed, Thur or Friday for emergency cases such as yours. If you need to see me, it will be at 9.15 am for the above-mentioned dates or you can consult and get surgery done by the two associate vets.
Best wishes.
Sunday, May 22, 2011
450. An e-mail survey or a scam e-mail?
On Sun, May 22, 2011 at 5:22 PM, ...@gmail.com> wrote:
Dear Dr Sing
I am a student of Anglo-Chinese School (Independent) and as part of an Economics research essay, I am required to conduct interviews with veterinarians practicing in the local veterinary scene in order to successfully complete the report. Having done the necessary ground work, I am impressed with the work of Toa Payoh Vets and have therefore specially chosen to include your clinic in this research essay. However, if necessary, your business name may be kept anonymous.
I would greatly appreciate your time and effort in completing the attached. The survey would take no longer than 10 minutes to complete.
Thank you and looking forward to hearing from you soon.
Yours sincerely
Name Given
E-MAIL REPLY FROM DR SING DATED SUNDAY MAY 22, 2011
I presume you are really who you claim you are - a student of ACS (I) and not one of the hundreds of scam e-mails I receive daily. I am not able to help you in answering the economic questions you ask as the financial data is private and confidential. However, you are welcome to interview me for other questions at a time convenient to both parties.
Conducting a thorough realistic research means really being hands-on, getting outdoors, seeing the place and spending time and money to meet the person rather than sending an e-mail survey.
Usually, I discard such e-mail surveys as they need to be downloaded and uploaded as in your format. There is an error in your survey form. There is no such practice called Toa Payoh Veterinary Centre in Singapore.
Best wishes.
Dear Dr Sing
I am a student of Anglo-Chinese School (Independent) and as part of an Economics research essay, I am required to conduct interviews with veterinarians practicing in the local veterinary scene in order to successfully complete the report. Having done the necessary ground work, I am impressed with the work of Toa Payoh Vets and have therefore specially chosen to include your clinic in this research essay. However, if necessary, your business name may be kept anonymous.
I would greatly appreciate your time and effort in completing the attached. The survey would take no longer than 10 minutes to complete.
Thank you and looking forward to hearing from you soon.
Yours sincerely
Name Given
E-MAIL REPLY FROM DR SING DATED SUNDAY MAY 22, 2011
I presume you are really who you claim you are - a student of ACS (I) and not one of the hundreds of scam e-mails I receive daily. I am not able to help you in answering the economic questions you ask as the financial data is private and confidential. However, you are welcome to interview me for other questions at a time convenient to both parties.
Conducting a thorough realistic research means really being hands-on, getting outdoors, seeing the place and spending time and money to meet the person rather than sending an e-mail survey.
Usually, I discard such e-mail surveys as they need to be downloaded and uploaded as in your format. There is an error in your survey form. There is no such practice called Toa Payoh Veterinary Centre in Singapore.
Best wishes.
449. Show, don't tell - Maltese shivers and has bloated "stomach"
On Saturday, May 21, 2011, I returned to the Surgery to discharge the shivering Maltese that had been hospitalised and treated for the past 2 days and is now OK. An earlier report is at: The Maltese dog with a bloated abdomen keeps shivering. Why?
"Did the dog pass stools?" I asked my assistant Min. "No," he said. I expected this answer as I had given the dog an anti-spasmodic injection on day 1.
The dog had not I palpated the abdomen. It was not bloated but felt full and rounded. The concerned lady owner would be flying back from Hongkong today. Her mum and her brother came to get the dog home and to be briefed on what's the problem.
SHOW, DON'T TELL
1. INTERPRET THE X-RAY TO THE OWNER
X-ray of distended bladder had been shown to the mum and e-mailed to the owner in Hong Kong with explanation of a urinary tract infection. The owner was far away and was worried.
2. DEMONSTRATE THE BACK PAIN.
"Since the dog was boarded with a family that has small children, it is possible that the dog had been injured on her back," I told the mother and son. I put the dog on the table and pressed the length of the spinal area from the neck to the tail. "Can you hear the 'cough sound' when I pressed this area (thoraco-lumbar)?" I asked. "That is the area of pain. Something could have been dropped onto her back but I cannot say this is the case. The dog could have fallen on her back. The pain would cause the shivering."
They did not hear anything. I repeated three times and reproduced that very soft sound reaction in that area. The son lowered his head nearer to the dog standing on the table. I repeated the procedure. He heard the sound.
3. DEMONSTRATE NO BACK PAIN IN A NORMAL DOG
I got a normal Shih Tzu and repeated the spinal area pressing. Not a single sound came from this dog. "A normal dog will not 'cough' in reaction to my pressing of the spinal area as he has no pain there," I convinced the mother and son.
The dog went home. She had a nasty neck skin infection (yellow flakes on red skin, right eyelid infection and both elbow skin inflamed). "My daughter had seen many vets - yeast infection but no cure after many visits to the vets. She researched the internet and does her own treatment," the mum said. The rest of the coat was thick and normal. A small amount of dandruff fell off the dog's body. I said: "The neck skin infection should be cured as the dog keeps scratching. I will say that the neck skin should be normal if treated properly." Unfortunately, some owners give up when their vet or vets failed to produce results for the skin infections and do self-treatment instead.
4. SHOW THE URINE RESULTS. Dipstick indicated bacterial infection of the urinary tract infection. The change of colour was shown to the mother earlier. Laboratory results are not in yet. Blood test report with no abnormal findings were given on discharge of the dog.
In conclusion, this dog's shivering could be due to more than one cause. The pain in the spinal area, the pain in the neck skin area and the pain in peeing from an infected bladder. If only dogs can talk.
PICTURES AND UPDATES ARE AT:
http://www.sinpets.com/F5/201006237shivering-bloated-abdomen-female-maltese-ToaPayohVets.htm
"Did the dog pass stools?" I asked my assistant Min. "No," he said. I expected this answer as I had given the dog an anti-spasmodic injection on day 1.
The dog had not I palpated the abdomen. It was not bloated but felt full and rounded. The concerned lady owner would be flying back from Hongkong today. Her mum and her brother came to get the dog home and to be briefed on what's the problem.
SHOW, DON'T TELL
1. INTERPRET THE X-RAY TO THE OWNER
X-ray of distended bladder had been shown to the mum and e-mailed to the owner in Hong Kong with explanation of a urinary tract infection. The owner was far away and was worried.
2. DEMONSTRATE THE BACK PAIN.
"Since the dog was boarded with a family that has small children, it is possible that the dog had been injured on her back," I told the mother and son. I put the dog on the table and pressed the length of the spinal area from the neck to the tail. "Can you hear the 'cough sound' when I pressed this area (thoraco-lumbar)?" I asked. "That is the area of pain. Something could have been dropped onto her back but I cannot say this is the case. The dog could have fallen on her back. The pain would cause the shivering."
They did not hear anything. I repeated three times and reproduced that very soft sound reaction in that area. The son lowered his head nearer to the dog standing on the table. I repeated the procedure. He heard the sound.
3. DEMONSTRATE NO BACK PAIN IN A NORMAL DOG
I got a normal Shih Tzu and repeated the spinal area pressing. Not a single sound came from this dog. "A normal dog will not 'cough' in reaction to my pressing of the spinal area as he has no pain there," I convinced the mother and son.
The dog went home. She had a nasty neck skin infection (yellow flakes on red skin, right eyelid infection and both elbow skin inflamed). "My daughter had seen many vets - yeast infection but no cure after many visits to the vets. She researched the internet and does her own treatment," the mum said. The rest of the coat was thick and normal. A small amount of dandruff fell off the dog's body. I said: "The neck skin infection should be cured as the dog keeps scratching. I will say that the neck skin should be normal if treated properly." Unfortunately, some owners give up when their vet or vets failed to produce results for the skin infections and do self-treatment instead.
4. SHOW THE URINE RESULTS. Dipstick indicated bacterial infection of the urinary tract infection. The change of colour was shown to the mother earlier. Laboratory results are not in yet. Blood test report with no abnormal findings were given on discharge of the dog.
In conclusion, this dog's shivering could be due to more than one cause. The pain in the spinal area, the pain in the neck skin area and the pain in peeing from an infected bladder. If only dogs can talk.
PICTURES AND UPDATES ARE AT:
http://www.sinpets.com/F5/201006237shivering-bloated-abdomen-female-maltese-ToaPayohVets.htm
Friday, May 20, 2011
448. An ethical and moral dilemma when clients demanded an injection only
I had two cases in the last 2 days of clients instructing me to give an injection and some medication.
Case 1. The woman brought her dog that was not eating and passing smelly vaginal discharge for more than two weeks. I palpated the swollen abdomen and the female Spitz gave up being gentle and started to curl up her lips to warn me not to do it any more. "Just give an injection and some drugs," the woman whose son was my son's classmate instructed me. I suspected closed pyometra which is a life-threatening disease - an infection of the womb.
I still remembered a recent case of the "Vets Who Don't Spay Big Breeds" where the cross bred was euthanased due to poor prognosis. The owners were referred by their vet to a brand-name veterinary practice and could not afford the fees. Much time had been wasted and the dog was no longer standing. Kidneys became infected. As the prognosis was poor, around 40% of survival, the owner decided not to operate and instructed euthanasia. This case quite upset me for this was really a dog that could have been saved if the family vet had tried not to be a one-tracked mind, always referring big breeds to an expensive surgery when his clientele comes from a neighbourhood not in the upper-middle class of Singapore.
Now, this woman demanded an injection. I did not do it as I advised X-rays and blood tests first to aid in the diagnosis of pyometra. She phoned her husband first she said. The husband and I exchanged words over the phone. He then asked his wife to go to another vet.
Case 2. In this case, the 14-year old Shih Tzu had passed a lot of blood in the urine and had difficulty peeing. "This is usually urethral obstruction, with stones blocking the urine flow," I said. But the owner insisted on an injection and medicine and wait-and-see. Now, give what the customer wants? If not, the customer goes to the competitor.
This is the type of ethical or moral dilemma. One could milk the client by doing what she wants. Revenue generated. The dog would have to come back again as the drugs will not work. This is obvious to the vet but the client wants to save money. I know the medicine will not work and refused to obey her wishes. The woman wanted it to save on costs. So there was an impasse.
She left the Surgery to consult somebody, probably her family or husband carrying the dog with her. I had asked Dr Vanessa to handle this case, under my lead management. This was going to be a hot potato if not handled professionally. I mean, if the vet gives the injection and medication as requested, the dog will not recover. The other family members start to curse the vet for incompetence especially if the dog were to die from renal failure and infection when sent to the competitor and treated belatedly. The competitor would cover for himself or herself by saying that I should have had done the blood test and the X-ray and give proper treatment early and the dog would have been alive. Not just give an injection and some antibiotics. What an incompetent vet!
Well, to make a long story short, the owner agreed to the X-ray which I told her was not necessary if she wanted to save costs on veterinary surgery. She did not believe my diagosis of urethral obstruction and so she agreed to the X-ray. A surgery by opening the bladder and getting out the urinary stones and pushing back the stones in the penile urethra into the bladder would save some money for the cash-strapped owner.
"Suck out all urine," I said to Dr Vanessa. "Pump air into the bladder and the stones would be seen clearly." She said: "The cathether cannot be passed into the bladder, so there is a urethra obstruction." Later she told me that another catheter could pass into the bladder and she got around 10 ml of bloodied urine which would be sent for urine analysis.
The X-ray came back with around 5 stones below the os penis and more stones in the urinary bladder. "How you manage this case is up to you," I passed the case to Dr Vanessa as we work well together.
My diagnosis was correct without the need for the X-ray but X-rays would be better as it is part of evidence-based medicine. Now, what to do next in view of the old age of the dog (14 years old) and the financial situation of the owner.
Case 1. The woman brought her dog that was not eating and passing smelly vaginal discharge for more than two weeks. I palpated the swollen abdomen and the female Spitz gave up being gentle and started to curl up her lips to warn me not to do it any more. "Just give an injection and some drugs," the woman whose son was my son's classmate instructed me. I suspected closed pyometra which is a life-threatening disease - an infection of the womb.
I still remembered a recent case of the "Vets Who Don't Spay Big Breeds" where the cross bred was euthanased due to poor prognosis. The owners were referred by their vet to a brand-name veterinary practice and could not afford the fees. Much time had been wasted and the dog was no longer standing. Kidneys became infected. As the prognosis was poor, around 40% of survival, the owner decided not to operate and instructed euthanasia. This case quite upset me for this was really a dog that could have been saved if the family vet had tried not to be a one-tracked mind, always referring big breeds to an expensive surgery when his clientele comes from a neighbourhood not in the upper-middle class of Singapore.
Now, this woman demanded an injection. I did not do it as I advised X-rays and blood tests first to aid in the diagnosis of pyometra. She phoned her husband first she said. The husband and I exchanged words over the phone. He then asked his wife to go to another vet.
Case 2. In this case, the 14-year old Shih Tzu had passed a lot of blood in the urine and had difficulty peeing. "This is usually urethral obstruction, with stones blocking the urine flow," I said. But the owner insisted on an injection and medicine and wait-and-see. Now, give what the customer wants? If not, the customer goes to the competitor.
This is the type of ethical or moral dilemma. One could milk the client by doing what she wants. Revenue generated. The dog would have to come back again as the drugs will not work. This is obvious to the vet but the client wants to save money. I know the medicine will not work and refused to obey her wishes. The woman wanted it to save on costs. So there was an impasse.
She left the Surgery to consult somebody, probably her family or husband carrying the dog with her. I had asked Dr Vanessa to handle this case, under my lead management. This was going to be a hot potato if not handled professionally. I mean, if the vet gives the injection and medication as requested, the dog will not recover. The other family members start to curse the vet for incompetence especially if the dog were to die from renal failure and infection when sent to the competitor and treated belatedly. The competitor would cover for himself or herself by saying that I should have had done the blood test and the X-ray and give proper treatment early and the dog would have been alive. Not just give an injection and some antibiotics. What an incompetent vet!
Well, to make a long story short, the owner agreed to the X-ray which I told her was not necessary if she wanted to save costs on veterinary surgery. She did not believe my diagosis of urethral obstruction and so she agreed to the X-ray. A surgery by opening the bladder and getting out the urinary stones and pushing back the stones in the penile urethra into the bladder would save some money for the cash-strapped owner.
"Suck out all urine," I said to Dr Vanessa. "Pump air into the bladder and the stones would be seen clearly." She said: "The cathether cannot be passed into the bladder, so there is a urethra obstruction." Later she told me that another catheter could pass into the bladder and she got around 10 ml of bloodied urine which would be sent for urine analysis.
The X-ray came back with around 5 stones below the os penis and more stones in the urinary bladder. "How you manage this case is up to you," I passed the case to Dr Vanessa as we work well together.
My diagnosis was correct without the need for the X-ray but X-rays would be better as it is part of evidence-based medicine. Now, what to do next in view of the old age of the dog (14 years old) and the financial situation of the owner.
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