Many Malaysian vets I meet during continuing education talks have found the following effective for injectable general anaesthesia. Here is one from a helpful vet in Johor Bahru.
Hi there Dr. Sing,
For me, in terms of injectable zoletil most of us vets here uses the TKX mixture. here is how you do it:
1. take zoletil 100
2. discard the water diluent
3. mix 2 ml of xylazine 100mg/ml
4. mix 8 ml of ketamine 100mg/ml
then you will have 10ml of TKX (zoletil plus ket plus xylazine) where 0.1ml of this tkx should knock down an animal about 3kg for a decent 15-20 minutes. very good for short procedures and also the muscles are quite relaxed unlike those if you use in pure zoletil.
i personally use my own concoction of 3ml xylazine and 7 ml ketamine and i find that this mixture gives me a knock down of 20-25 minutes and the animal 'sleeps' longer. i maintain my animals on gas if the procedure takes any longer than 15 minutes. the only worry is the chance of hypotension (due to xylazine) and we should be mindful of older animals or those with cardiac insufficiency.
COMMENTS
I have seen the above TKX used effectively in cat spays in NANAS, an animal shelter in Johor some 2 years ago. It is said to be safe.
Saturday, June 11, 2011
Friday, June 10, 2011
471. AMA (Against Medical Advice) Form
Vomiting and diarrhoea in a dog, several times a day and over 2 days.
TREATMENT
1. Don't just give an injection and some antibiotics as this may be what the pet owner wants. The owner wants the pet to go home, but in such severe cases, it is best to hospitalise the dog, get IV fluids.
2. Check potassium levels. If it is low, the dog can get hypokalemic which can lead to life-threatening cardiac arrhythmias and death.
ONE CASE
The owner insisted on antibiotic injection and oral antibiotics first. If the dog still has vomiting and diarrhoea, she would bring it back. But the dog could not stop vomiting and passed watery stools past midnight. The next day, the angry son came with the owner (the mother) and verbally abused me.
A written form of discharge stating that IV fluids and hospitalisation is advised but the dog owner wants the dog back AMA (Against Medical Advice) would be best. In this case, the mum was rather embarrassed at the son's wanting the money back. I request him to send the dog to another vet for treatment. When the trust is not there and oral allegations of negligence set in, it is best not to continue with the case.
The AMA form is used in human medicine and this may be adapted for use in veterinary medicine as family members who are not present during consultation may start to get litigious when the clinical outcome is not to their favour, due to restrictions imposed or AMA behaviour of the primary caregiver who is present during consultation.
TREATMENT
1. Don't just give an injection and some antibiotics as this may be what the pet owner wants. The owner wants the pet to go home, but in such severe cases, it is best to hospitalise the dog, get IV fluids.
2. Check potassium levels. If it is low, the dog can get hypokalemic which can lead to life-threatening cardiac arrhythmias and death.
ONE CASE
The owner insisted on antibiotic injection and oral antibiotics first. If the dog still has vomiting and diarrhoea, she would bring it back. But the dog could not stop vomiting and passed watery stools past midnight. The next day, the angry son came with the owner (the mother) and verbally abused me.
A written form of discharge stating that IV fluids and hospitalisation is advised but the dog owner wants the dog back AMA (Against Medical Advice) would be best. In this case, the mum was rather embarrassed at the son's wanting the money back. I request him to send the dog to another vet for treatment. When the trust is not there and oral allegations of negligence set in, it is best not to continue with the case.
The AMA form is used in human medicine and this may be adapted for use in veterinary medicine as family members who are not present during consultation may start to get litigious when the clinical outcome is not to their favour, due to restrictions imposed or AMA behaviour of the primary caregiver who is present during consultation.
Thursday, June 9, 2011
470. Continuing Education: Adverse Reactions to food in the dog and cat
On Jun 7, 2011, I attended this seminar and was surprised to see most of the participants are young people of around 20-30 years of age. Probably from Malaysia and Indonesia.
I met Dr Lee who has a surgery in Johor Bahru's industrial area (small breeds 20% compared to my practice which is 95%; large breeds and mixed breeds 80%). He says there are around 15 vet clinics in JB. I said there are around 50 in Singapore. He mentioned about a very good 3-in-one sedation. "Just 0.1 ml IV and you can intubate the dog of 30 kg."
He said that he had attended a teaching seminar conducted by some European Vet Association in China (no Singapore vets were there). The European vets just use one layer of continuous appositional suture to close the bladder or intestinal incisions, unlike the American textbook recommendations of 2 layers of inverting sutures. He also said that in gastric torsion, the European vet just tears off the falciform ligament from the dog, exposing the twisted stomach for correction. No ill effect. Excellent teaching of ultrasound interpretation. He was generous as to share vet knowledge as most vets would just keep silent.
I met Dr Lee who has a surgery in Johor Bahru's industrial area (small breeds 20% compared to my practice which is 95%; large breeds and mixed breeds 80%). He says there are around 15 vet clinics in JB. I said there are around 50 in Singapore. He mentioned about a very good 3-in-one sedation. "Just 0.1 ml IV and you can intubate the dog of 30 kg."
He said that he had attended a teaching seminar conducted by some European Vet Association in China (no Singapore vets were there). The European vets just use one layer of continuous appositional suture to close the bladder or intestinal incisions, unlike the American textbook recommendations of 2 layers of inverting sutures. He also said that in gastric torsion, the European vet just tears off the falciform ligament from the dog, exposing the twisted stomach for correction. No ill effect. Excellent teaching of ultrasound interpretation. He was generous as to share vet knowledge as most vets would just keep silent.
469. Continuing Education - SAP Summit 2011 - The Future State - Engaging the customer
On Jun 8, 2011, I attended the SAP Summit 2011 - The Future State. The 9.10 am topic for the panelists was "The Secrets of Making A Best-Run Government Run Better; The Changing Mandate; The Shocking Disasters; The Future State
The Panelists were: Dr Anthony M Cresswell, Deputy Director, Center for Technology in Government, University at Albany, NY, USA; Zaqy Mohamad, Member of Parliament, Choa Chu Kang GRC, Singapore and Adaire Fox-Martin, SVP, Industry Business Solutions, SAP Asia Pacific Japan.
Mr Zaqy spoke about the better use of social media by politicians to engage the segment of the public. Apparently this had not been done effectively in the recent General Elections in Singapore if I heard Mr Zaqy Mohamad correctly.
The other panelist, Dr Anthony Cresswell talked about President Obama's Open Government's initiatives in the US and the difficulty of evaluating the key performance indicators of the services provided. It was an eye-opener for me when he said that over 80% of government computerisation projects fail.
What is the relevance of social media to veterinary surgeons in practice? There is a segment of the pet owners who are younger and would only be engaged through the use of social media. They will search for topics of relevance to their pet's illness and want to know which vet has the ability and experience to treat their beloved pets. Their own vet may not provide such a service.
Social media using webpages or blog requires the content to be created daily. There is now the twitter novel (short novels of 140 words are popular with netizens of China). Whatever the form, the contents must be updated daily or weekly to get a stream of "fans". Writing is very hard work for those who prefer not to touch a pen as there need to be research to produce a useful article. There are so many distractions and better things to do than to create good content after a hard day's work at the Surgery!
To illustrate the amount of work involved to produce a useful article, I will let readers know how I produced the article, "What Makes A Horse Racing Club Profitable?" This article was written in 1989 and the scanned pages are at Horses, starting with the first page at: http://www.asiahomes.com/dev/Stc1.JPG
On a recent encounter, 2 days ago on Jun 9, 2011, I met an aunty and her niece who brought a hamster with a large dangling ear wart to Toa Payoh Vets. This wart was initially very small but her vet said she would not operate due to the high anaesthetic risks. As the wart grew bigger over the last 4-5 months, her vet referred her to another vet whose location was quite far to her residence. So this aunty googled for "hamster, warts" and an asiahomes webpage, probably similar http://www.asiahomes.com/singaporetpvet/ popped out.
I was at the Surgery at that time and so I got the above-mentioned feedback from her. This episode demonstrated the culture and lifestyle of the younger generation. The aunty was around 30-40 years old. The niece was a teenager. I paid special attention to this case as I collaborated with Dr Vanessa to ensure that the outcome of anaesthesia was what the aunty hoped for. Signing an informed anaesthesia consent form is one thing. I don't usually request it but Dr Vanessa does.
What was important was that the hamster come out of the surgery room alive and biting (this hamster bites, the aunty had said). Obviously, I would bite if anybody messes around with my wart. The hamster was anaesthesized under isoflurane gas.
I kept a close eye on my assistant Mr Min telling him not to be distracted by looking for sutures etc while anaesthesizing the hamster. At one time, his eyes and one hand were on a drawer to take out a packet of suture for Dr Vanessa.
I told him off not to do it. "Hamsters die because there is no 100% focus on anaesthesia by one person or the vet." Unfortunately, new vet assistants and new vets need to be mentored closely. There is no other way to prevent anaesthetic deaths in hamsters. Deaths on the operating table damages the reputation of Toa Payoh Vets and I am very strict on anaesthetic training and procedures to ensure that no healthy pets should die on the operating table at all times.
Dr Vanessa excised the wart and sutured the wound. I proposed no suturing as the wound in the ear was so small and that bleeding would stop with pressure. As each vet has his or her own ideas, I will not interfere whenever an associate vet operates in most cases but I do monitor the handwork - the post-operation complications and the complaints. This is my duty of care for Toa Payoh Vets clientele.
Dr Vanessa decided to stitch up the wound. I recommended potassium permanganate to stop the bleeding. Each vet has his or her approach to a surgical case and there are several satisfactory outcomes on any approach. Bleeding still came back as I had predicted in this case. This bleeding was not life-threatening.
The hamster was now free of "shouldering" a burden. Actually, the wart of 1.5 cm x 1.2 cm x 0.5 cm looked so much like one of those big dangling ear rings worn by some ladies. The hamster scratched his left ear where the wound was. The aunty was concerned. So I proposed a paper e-collar. "The hamster hates it very much," I said to the aunty as she put the e-collar on. The hamster used all his two hands to pull out the hamster. Vigorously and angrily I think. So, no more e-collar. "Just use the clean tissue to wipe off the blood," I advised the aunty. "And take the medication." The niece did not say a word but I presumed she was the real owner of this beloved hamster and was happy.
P.S. What are the Secrets of Making A Best-Run Government Run Better? There were no clear list of secrets enumerated as far as I know. The political party who knows how to engage the Generation Y effectively will be the one to win their votes and get the increased mandate to govern if the Generation Y is the vote swinger. The Government is now said to be a business. So, the Government who provides "public value" to the citizens will be a better-run government.
The Panelists were: Dr Anthony M Cresswell, Deputy Director, Center for Technology in Government, University at Albany, NY, USA; Zaqy Mohamad, Member of Parliament, Choa Chu Kang GRC, Singapore and Adaire Fox-Martin, SVP, Industry Business Solutions, SAP Asia Pacific Japan.
Mr Zaqy spoke about the better use of social media by politicians to engage the segment of the public. Apparently this had not been done effectively in the recent General Elections in Singapore if I heard Mr Zaqy Mohamad correctly.
The other panelist, Dr Anthony Cresswell talked about President Obama's Open Government's initiatives in the US and the difficulty of evaluating the key performance indicators of the services provided. It was an eye-opener for me when he said that over 80% of government computerisation projects fail.
What is the relevance of social media to veterinary surgeons in practice? There is a segment of the pet owners who are younger and would only be engaged through the use of social media. They will search for topics of relevance to their pet's illness and want to know which vet has the ability and experience to treat their beloved pets. Their own vet may not provide such a service.
Social media using webpages or blog requires the content to be created daily. There is now the twitter novel (short novels of 140 words are popular with netizens of China). Whatever the form, the contents must be updated daily or weekly to get a stream of "fans". Writing is very hard work for those who prefer not to touch a pen as there need to be research to produce a useful article. There are so many distractions and better things to do than to create good content after a hard day's work at the Surgery!
To illustrate the amount of work involved to produce a useful article, I will let readers know how I produced the article, "What Makes A Horse Racing Club Profitable?" This article was written in 1989 and the scanned pages are at Horses, starting with the first page at: http://www.asiahomes.com/dev/Stc1.JPG
On a recent encounter, 2 days ago on Jun 9, 2011, I met an aunty and her niece who brought a hamster with a large dangling ear wart to Toa Payoh Vets. This wart was initially very small but her vet said she would not operate due to the high anaesthetic risks. As the wart grew bigger over the last 4-5 months, her vet referred her to another vet whose location was quite far to her residence. So this aunty googled for "hamster, warts" and an asiahomes webpage, probably similar http://www.asiahomes.com/singaporetpvet/ popped out.
I was at the Surgery at that time and so I got the above-mentioned feedback from her. This episode demonstrated the culture and lifestyle of the younger generation. The aunty was around 30-40 years old. The niece was a teenager. I paid special attention to this case as I collaborated with Dr Vanessa to ensure that the outcome of anaesthesia was what the aunty hoped for. Signing an informed anaesthesia consent form is one thing. I don't usually request it but Dr Vanessa does.
What was important was that the hamster come out of the surgery room alive and biting (this hamster bites, the aunty had said). Obviously, I would bite if anybody messes around with my wart. The hamster was anaesthesized under isoflurane gas.
I kept a close eye on my assistant Mr Min telling him not to be distracted by looking for sutures etc while anaesthesizing the hamster. At one time, his eyes and one hand were on a drawer to take out a packet of suture for Dr Vanessa.
I told him off not to do it. "Hamsters die because there is no 100% focus on anaesthesia by one person or the vet." Unfortunately, new vet assistants and new vets need to be mentored closely. There is no other way to prevent anaesthetic deaths in hamsters. Deaths on the operating table damages the reputation of Toa Payoh Vets and I am very strict on anaesthetic training and procedures to ensure that no healthy pets should die on the operating table at all times.
Dr Vanessa excised the wart and sutured the wound. I proposed no suturing as the wound in the ear was so small and that bleeding would stop with pressure. As each vet has his or her own ideas, I will not interfere whenever an associate vet operates in most cases but I do monitor the handwork - the post-operation complications and the complaints. This is my duty of care for Toa Payoh Vets clientele.
Dr Vanessa decided to stitch up the wound. I recommended potassium permanganate to stop the bleeding. Each vet has his or her approach to a surgical case and there are several satisfactory outcomes on any approach. Bleeding still came back as I had predicted in this case. This bleeding was not life-threatening.
The hamster was now free of "shouldering" a burden. Actually, the wart of 1.5 cm x 1.2 cm x 0.5 cm looked so much like one of those big dangling ear rings worn by some ladies. The hamster scratched his left ear where the wound was. The aunty was concerned. So I proposed a paper e-collar. "The hamster hates it very much," I said to the aunty as she put the e-collar on. The hamster used all his two hands to pull out the hamster. Vigorously and angrily I think. So, no more e-collar. "Just use the clean tissue to wipe off the blood," I advised the aunty. "And take the medication." The niece did not say a word but I presumed she was the real owner of this beloved hamster and was happy.
P.S. What are the Secrets of Making A Best-Run Government Run Better? There were no clear list of secrets enumerated as far as I know. The political party who knows how to engage the Generation Y effectively will be the one to win their votes and get the increased mandate to govern if the Generation Y is the vote swinger. The Government is now said to be a business. So, the Government who provides "public value" to the citizens will be a better-run government.
468. What Makes A Horse Racing Club Profitable? Dr Goh Keng Swee's few good men and women
Dr Goh Keng Swee's few good men and women tasked to reverse the horse racing decline - Part 1
"Dr Goh Keng Swee's men will assess your performance. They use financial ratios," Mr Ismail, the Personnel Manager said to me, a Junior Veterinary Surgeon of the Singapore Turf Club in 1988.
The Singapore Turf Club prior to 1988 was a private club registered with the Registrar of Societies. I heard that "black balls" were shown when any proposed member is rejected by the Management Committee. Some time around 1986 or earlier, a newspaper report mentioned that the $286 million in the 1986 bank deposits could be shared by the 580 members if the Club was dissolved as it was a private club.
On Jan 1, 1988, the Singapore Totalisator Board (STB) was set up. It appointed the newly formed Bukit Turf Club as an agent to run the racing and 4-D operations in Singapore. The Singapore Turf Club was a private club and now would be "dormant" with the formation of the Bukit Turf Club.
So, my 6th year of employment contract was now assigned to the Bukit Turf Club in the sense that I was not asked to new a new contract which would be unfavourable to me as compared to the old contract.
Dr Goh Keng Swee who had retired from politics was the man in charge of the new changes. The "decision-maker" would be Mr Quek Chee Hoon, an accountant resigned from Temasek Holdings and was appointed as the General Manager of the STB. Mr Yu Pan Fey, an accountant from the Big Four (auditing firms) would be the General Manager of the Bukit Turf Club. The Senior Veterinary Surgeon was no longer my immediate boss as I had my performance assessed by the Chief Stipendiary Steward who was answerable to the Racing Manager who reported to another Head of Racing Department.
1988 - 1999 was a time of great changes for the Singapore horse racing industry and the people involved. A newspaper report said that the racing industry would benefit from the progressive management of the STB and would turn around the decline in the horse racing industry.
As a racehorse veterinarian working for the last 5 years with the horse trainers and jockeys, I talked to them. I could sense their hope and aspirations for a better future with the formation of the STB.
The trainers and jockeys are said to be the prime movers of the racing industry and they were not earning sufficiently from their hard work and getting into debts from bad horse owners, there was something wrong in the horse racing industry at that time.
Therefore, they looked to the leadership of Dr Goh Keng Swee and his few good men and women to do the right thing. Just as Dr Goh had done to revamp the Ministry of Education, as reported in the newspapers.
What was the right thing to do to reverse the decline in racing? The STB's leadership had pin-pointed the problem - a trend of decline in racing profitability. In 1988, almost all of the STB members had no horse racing proficiency, judgment or training in the business of horse racing.
In fact, the majority of top civil servants and politicians did not want to be seen inside the premises of the Singapore Turf Club unlike in countries like the U.K and Australia. The ex-Prime Minister Lee Kuan Yew first visited the Singapore Turf Club officially only sometime in 1987 and that was the first time I saw him at the Paddocks where horses were checked prior to going out on parade.
I was only an equine veterinary surgeon with 5 years of employment at the Singapore Turf Club. No track record or qualifications in business management. Around 8 years of veterinary service in the Primary Production Department dealing with pigs and chickens. Then another 5 years dealing with horses.
The reverse in racing decline was a management problem. It was not a veterinary problem overall. It was none of my business. I treated equine problems, not human ones. Yet much could be improved in the lives of the trainers, jockeys and the racehorses if I would not be selfish and know what to do.
Knowing what to do in a time of crisis and great upheavals of the workplace is the most difficult thing for most people. I could complete my last year of employment contract as it was most unlikely that the new management would want to terminate my services or the services of the racing and betting managers as they were well chosen to be Dr Goh Keng Swee's team. It seemed to me that they were mostly trained in accountancy.
So the financial ratios that the Personnel Manager spoke to me about made sense. What financial ratios would be applicable to monitor the performance of the Veterinary Department of the Turf Club? I had no clue as I had not been interested in business or financial management in general.
Updates later. See www.toapayohvets.com, goto HORSES
"Dr Goh Keng Swee's men will assess your performance. They use financial ratios," Mr Ismail, the Personnel Manager said to me, a Junior Veterinary Surgeon of the Singapore Turf Club in 1988.
The Singapore Turf Club prior to 1988 was a private club registered with the Registrar of Societies. I heard that "black balls" were shown when any proposed member is rejected by the Management Committee. Some time around 1986 or earlier, a newspaper report mentioned that the $286 million in the 1986 bank deposits could be shared by the 580 members if the Club was dissolved as it was a private club.
On Jan 1, 1988, the Singapore Totalisator Board (STB) was set up. It appointed the newly formed Bukit Turf Club as an agent to run the racing and 4-D operations in Singapore. The Singapore Turf Club was a private club and now would be "dormant" with the formation of the Bukit Turf Club.
So, my 6th year of employment contract was now assigned to the Bukit Turf Club in the sense that I was not asked to new a new contract which would be unfavourable to me as compared to the old contract.
Dr Goh Keng Swee who had retired from politics was the man in charge of the new changes. The "decision-maker" would be Mr Quek Chee Hoon, an accountant resigned from Temasek Holdings and was appointed as the General Manager of the STB. Mr Yu Pan Fey, an accountant from the Big Four (auditing firms) would be the General Manager of the Bukit Turf Club. The Senior Veterinary Surgeon was no longer my immediate boss as I had my performance assessed by the Chief Stipendiary Steward who was answerable to the Racing Manager who reported to another Head of Racing Department.
1988 - 1999 was a time of great changes for the Singapore horse racing industry and the people involved. A newspaper report said that the racing industry would benefit from the progressive management of the STB and would turn around the decline in the horse racing industry.
As a racehorse veterinarian working for the last 5 years with the horse trainers and jockeys, I talked to them. I could sense their hope and aspirations for a better future with the formation of the STB.
The trainers and jockeys are said to be the prime movers of the racing industry and they were not earning sufficiently from their hard work and getting into debts from bad horse owners, there was something wrong in the horse racing industry at that time.
Therefore, they looked to the leadership of Dr Goh Keng Swee and his few good men and women to do the right thing. Just as Dr Goh had done to revamp the Ministry of Education, as reported in the newspapers.
What was the right thing to do to reverse the decline in racing? The STB's leadership had pin-pointed the problem - a trend of decline in racing profitability. In 1988, almost all of the STB members had no horse racing proficiency, judgment or training in the business of horse racing.
In fact, the majority of top civil servants and politicians did not want to be seen inside the premises of the Singapore Turf Club unlike in countries like the U.K and Australia. The ex-Prime Minister Lee Kuan Yew first visited the Singapore Turf Club officially only sometime in 1987 and that was the first time I saw him at the Paddocks where horses were checked prior to going out on parade.
I was only an equine veterinary surgeon with 5 years of employment at the Singapore Turf Club. No track record or qualifications in business management. Around 8 years of veterinary service in the Primary Production Department dealing with pigs and chickens. Then another 5 years dealing with horses.
The reverse in racing decline was a management problem. It was not a veterinary problem overall. It was none of my business. I treated equine problems, not human ones. Yet much could be improved in the lives of the trainers, jockeys and the racehorses if I would not be selfish and know what to do.
Knowing what to do in a time of crisis and great upheavals of the workplace is the most difficult thing for most people. I could complete my last year of employment contract as it was most unlikely that the new management would want to terminate my services or the services of the racing and betting managers as they were well chosen to be Dr Goh Keng Swee's team. It seemed to me that they were mostly trained in accountancy.
So the financial ratios that the Personnel Manager spoke to me about made sense. What financial ratios would be applicable to monitor the performance of the Veterinary Department of the Turf Club? I had no clue as I had not been interested in business or financial management in general.
Updates later. See www.toapayohvets.com, goto HORSES
Tuesday, June 7, 2011
467. Seeing is believing
"Doc, my Dachshund has a big lump behind his neck?" the lady owner phoned me regarding a big lump in her Dachshund. "It appears in the last 2 days. I think it is due to the tight bandage. What shall I do?"
"Is it as large as a ping pong ball?" I asked.
"Yes."
"It may be an abscess (pus inside) or a haematoma (blood inside)," I said. "It is hard to diagnose without examination."
She brought the dog in on Friday evening. "Well, there is no pain in this lump," I said as I pressed it. Firm and tense, around the 3/4 of the size of a table-tennis ball. I scheduled for surgery on Saturday, forgetting I had my day off on Saturday.
"I can't come on Sunday," the owner phoned me. "I have to travel overseas on Sunday. Can the lump wait till I come back 10 days later?"
"It is best not to wait. The lump could harden or the bacteria inside could spread to the muscles, making it very painful and hard to operate. Can you ask your husband to bring the dog in on Sunday at 9.30am so that I can operate first thing in the morning?"
I was surprised she was single as she had that essence of a combination of inner and outer beauty. "Well, I can arrange for a dog taxi man to bring the dog to the Surgery."
She said she would phone me and later made an appointment for Sunday morning 9.30 am. She was very punctual.
"There is no electricity," my assistant Min suddenly told me. The HDB management had given prior notice of no electricity supply till 9 am on Sunday morning but my staff did not inform me.
"What to do?" the lady owner asked me pleasantly. That is her personality. Not to get angry over unexpected circumstances beyond her control.
"Don't worry," I said. "The dog will go home at 11.00 am". My operation room has glass walls on one side facing the back door which brings in the morning light and a glass screen between it and the consultation room, bringing in daylight from the consultation room. It is not a windowless operating room as in most surgeries. We have torch-lights too.
I told Mr Min to clip as I had sedated it with 0.3% xylazine IM. Min said, "No electricity. You cannot use the gas anaesthetic machine."
I shook my head. "Do anaesthetic machine need electricity?" I asked Min shaking my head. Sometimes I can get very impatient with such feedback with no basis.
This was the Dachshund's 3rd anaesthesia and though nothing ought to go wrong, I did not want to tempt fate as old dogs are high anaesthetic risk. On the other hand, I could just sedate the dog and drain the abscess and cut off the hock melanoma spotted by the owner. It could be painful. A higher dose of sedation may also kill the dog.
Therefore a light sedation of xylazine and isoflurane gas is the best safest method of general anaesthesia. This was done and the dog was as awake as a normal dog when the happy owner came in a taxi to pick him up to go home.
"A lot of gas and blood with pus," I said to the owner.
"Really?" she replied.
"Min, take out the syringe with the blood and pus," I said.
I forgot to present the syringe but I did stick the melanoma from the hock to show her.
Min took out the syringe and the lady was convinced. Seeing is believing in veterinary medicine. I do not know why I had not shown the syringe earlier.
Emergency surgery lights can be installed. However, these must be maintained and tested weekly as they do fail if they are not tested.
This is the Dachshund's 3rd anaesthesia in 2 months. It is best not to tempt fate anymore.
http://www.sinpets.com/F5/201006252abscess-haematoma-Dachshund-old-ToaPayohVets.htm
has all the pictures. One of them is shown here.
"Is it as large as a ping pong ball?" I asked.
"Yes."
"It may be an abscess (pus inside) or a haematoma (blood inside)," I said. "It is hard to diagnose without examination."
She brought the dog in on Friday evening. "Well, there is no pain in this lump," I said as I pressed it. Firm and tense, around the 3/4 of the size of a table-tennis ball. I scheduled for surgery on Saturday, forgetting I had my day off on Saturday.
"I can't come on Sunday," the owner phoned me. "I have to travel overseas on Sunday. Can the lump wait till I come back 10 days later?"
"It is best not to wait. The lump could harden or the bacteria inside could spread to the muscles, making it very painful and hard to operate. Can you ask your husband to bring the dog in on Sunday at 9.30am so that I can operate first thing in the morning?"
I was surprised she was single as she had that essence of a combination of inner and outer beauty. "Well, I can arrange for a dog taxi man to bring the dog to the Surgery."
She said she would phone me and later made an appointment for Sunday morning 9.30 am. She was very punctual.
"There is no electricity," my assistant Min suddenly told me. The HDB management had given prior notice of no electricity supply till 9 am on Sunday morning but my staff did not inform me.
"What to do?" the lady owner asked me pleasantly. That is her personality. Not to get angry over unexpected circumstances beyond her control.
"Don't worry," I said. "The dog will go home at 11.00 am". My operation room has glass walls on one side facing the back door which brings in the morning light and a glass screen between it and the consultation room, bringing in daylight from the consultation room. It is not a windowless operating room as in most surgeries. We have torch-lights too.
I told Mr Min to clip as I had sedated it with 0.3% xylazine IM. Min said, "No electricity. You cannot use the gas anaesthetic machine."
I shook my head. "Do anaesthetic machine need electricity?" I asked Min shaking my head. Sometimes I can get very impatient with such feedback with no basis.
This was the Dachshund's 3rd anaesthesia and though nothing ought to go wrong, I did not want to tempt fate as old dogs are high anaesthetic risk. On the other hand, I could just sedate the dog and drain the abscess and cut off the hock melanoma spotted by the owner. It could be painful. A higher dose of sedation may also kill the dog.
Therefore a light sedation of xylazine and isoflurane gas is the best safest method of general anaesthesia. This was done and the dog was as awake as a normal dog when the happy owner came in a taxi to pick him up to go home.
"A lot of gas and blood with pus," I said to the owner.
"Really?" she replied.
"Min, take out the syringe with the blood and pus," I said.
I forgot to present the syringe but I did stick the melanoma from the hock to show her.
Min took out the syringe and the lady was convinced. Seeing is believing in veterinary medicine. I do not know why I had not shown the syringe earlier.
Emergency surgery lights can be installed. However, these must be maintained and tested weekly as they do fail if they are not tested.
This is the Dachshund's 3rd anaesthesia in 2 months. It is best not to tempt fate anymore.
http://www.sinpets.com/F5/201006252abscess-haematoma-Dachshund-old-ToaPayohVets.htm
has all the pictures. One of them is shown here.
Sunday, June 5, 2011
466. Family firms must plan their succession well & UVP
The founder of a family business must be able to plan his succession well. Otherwise, family feuds ruin the business. There will be no business continuity during the critical period after the founder dies.
What can be done?
1. Systematic and organised handing of control to the next generation to prevent family feuds.
2. The founder has to resolve some conflicts. One big conflict is between the family's welfare and the company's value. The patriarch is responsible for finding a job for the adult children of the family. If they are capable, they will grow the business. If they are not capable, they are going to hurt the business. If the patriarch does not put the son in the company, the wife will not be happy. So, there are dilemmas for the founder.
3. If the company has a lack of talent, it can trust outsiders to hold the fort before the children can take over. But it has to offer good pay and an equal chance for promotion to attract talent. This may not mean that "loyalty can be bought" as good talent may set up a competitive firm.
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Enterprises must be more innovative and continuously offer a strong and unique value proposition (UVP) to their clients to stay ahead of competition. How to do it? That is the question hard to answer.
What can be done?
1. Systematic and organised handing of control to the next generation to prevent family feuds.
2. The founder has to resolve some conflicts. One big conflict is between the family's welfare and the company's value. The patriarch is responsible for finding a job for the adult children of the family. If they are capable, they will grow the business. If they are not capable, they are going to hurt the business. If the patriarch does not put the son in the company, the wife will not be happy. So, there are dilemmas for the founder.
3. If the company has a lack of talent, it can trust outsiders to hold the fort before the children can take over. But it has to offer good pay and an equal chance for promotion to attract talent. This may not mean that "loyalty can be bought" as good talent may set up a competitive firm.
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Enterprises must be more innovative and continuously offer a strong and unique value proposition (UVP) to their clients to stay ahead of competition. How to do it? That is the question hard to answer.
Saturday, June 4, 2011
465. Real estate: REA examination question
In May 2011, I attempted to answer a main question on REIT and another one on one part question on REIT. It is a tough question to answer as I don't know what the examiner wants.
Some detailed report is presented in The Business Times Weekend, Apr 30-May 1, 2011 Pg 30 Smart Money. This is for the benefit of future students of REA and in case I fail this exam.
Its topic is "Reit or business trust?" and has a detailed technical report comparing listed companies, business trust and reits.
1. Vehicle
2. Corporate Governance
3. Gearing limit
4. Dividend distribution
Reits - Unit holders --- Manager -- Trustee
I guess I would not get good marks as I didn't write about the above.
Some detailed report is presented in The Business Times Weekend, Apr 30-May 1, 2011 Pg 30 Smart Money. This is for the benefit of future students of REA and in case I fail this exam.
Its topic is "Reit or business trust?" and has a detailed technical report comparing listed companies, business trust and reits.
1. Vehicle
2. Corporate Governance
3. Gearing limit
4. Dividend distribution
Reits - Unit holders --- Manager -- Trustee
I guess I would not get good marks as I didn't write about the above.
464. What is effective leadership?
Managing a veterinary premises require excellent leadership. Otherwise, the business may close down. What is effective leadership?
I read The Business Times, May 14-15, 2011, Pg 8-9, Raffles Conversation. Robert Hogan, president and founder of Hogan Assessment Systems.
Briefly, Mr Hogan said that leaders are made, not born. A good leader is one where employees will work for him on their own free will. The leader's performance is assessed on his ability to build and maintain a team. Employees evaluate the leader under 4 aspects:
1. Integerity. Whether the leader is honest and can be trusted not to play them out.
2. Judgement. He said that 50% of business decisions are made by bad judgement. A good leader is one who is able to repair the bad judgement rather than know how to make a good judgement.
3. Competence. Know about the business. I often call that "Know what to do" in your profession. Not a "blur" king.
4. Vision. Able to explain, justify and convince the employees that what they do is worth their while.
Therefore a good manager makes money. A poor one incurs unnecessary costs and is unable to maintain the good talent. A good one creates high turnover, low absenteesim, high productivity and high customer satisfaction.
It is difficult to be a leader when you are not fit to be one as the business just will not succeed as there are high overheads and low turnover, making the company bankrupt. That is why it is extremely difficult to invest in a veterinary premises and expect to employee vets to make money for the investors. It seldom works.
I read The Business Times, May 14-15, 2011, Pg 8-9, Raffles Conversation. Robert Hogan, president and founder of Hogan Assessment Systems.
Briefly, Mr Hogan said that leaders are made, not born. A good leader is one where employees will work for him on their own free will. The leader's performance is assessed on his ability to build and maintain a team. Employees evaluate the leader under 4 aspects:
1. Integerity. Whether the leader is honest and can be trusted not to play them out.
2. Judgement. He said that 50% of business decisions are made by bad judgement. A good leader is one who is able to repair the bad judgement rather than know how to make a good judgement.
3. Competence. Know about the business. I often call that "Know what to do" in your profession. Not a "blur" king.
4. Vision. Able to explain, justify and convince the employees that what they do is worth their while.
Therefore a good manager makes money. A poor one incurs unnecessary costs and is unable to maintain the good talent. A good one creates high turnover, low absenteesim, high productivity and high customer satisfaction.
It is difficult to be a leader when you are not fit to be one as the business just will not succeed as there are high overheads and low turnover, making the company bankrupt. That is why it is extremely difficult to invest in a veterinary premises and expect to employee vets to make money for the investors. It seldom works.
463. USP - A Timberland boy of Lake Indein, Myanmar
A USP (unique selling proposition) is very important for a person or for any business to have a chance to succeed. It positions the person or business foremost in the mind of the other friend or client respectively. In a photo contest, a USP of a picture is also needed as I will illustrate below.
Three days ago, I read the Digital Life magazine and saw a photo contest sponsored by Timberland whose products I have never bought. The photo contest is at: http://www.earthkeepers2011.com/sg/home.aspx.
The prize is a chance to be part of our Timberland® Earthkeepers™ reforestation activity in Horqin Desert, Inner Mongolia, and a nature appreciation trip to Jiuzhaigou Valley.
It is the category of travel I love very much as I get to see raw nature and it will be too expensive to go to such places.
However, I need to be realistic as my digital photography is not up to competition standards. Should I give up?
The theme was to tell a story in a picture with the theme:
What is your relationship with the outdoors?
I viewed my various images and came across the following. It is just an ordinary image of two boys standing on the banks of Lake Indein in February 2011 when my wife and I visited Myanmar. Nothing unique about two boys trekking along the bank of a stream of Lake Indein. The photograph was not of a high quality.
Then I saw the Timberland logo on the boy's shirt. The Timberland logo is the USP (unique selling proposition). This photo definitely will catch the eyes of Timberland judges owing to the logo unless they are blind.
It opens the door to a rare opportunity for a winner to participate in a reforestation project of a desert in Inner Mongolia.
So, how should I go about using this picture to show that "nature subtly connects our lives with meaningful relationships" as required in this contest?
I don't know exactly but the following image is my first draft, taking me over one hour to create the image. There are grammatical mistakes which I could not see yesterday.
What's the big deal about a boy wearing a Timberland shirt in Lake Indein, Myanmar?
Well, it is rare to spot a Timberland T-shirt in Yangon and Lake Indein is considered a remote area of Myanmar. I was in the boat much appreciative of being alive and healthy. I was able to see the willowy grass, hear birds chirping and smell clean unpolluted air and befar away from the urban jungles of Singapore.
For that brief instant when I clicked my camera, I realise that I was once like this Timberland boy. At his age, I was living with my grandparents in Bentong, a village in Pahang, Malaysia. Every morning, I would cycle with another boy to a stream to swim and to appreciate nature. Now, Singapore's children don't get this opportunity and to most Singaporeans, especially the females, a good travel itinerary is shopping. Not nature.
Try to enter photo contest and even if you don't win, you have educated yourself in being hands on, in creating a picture and writing text that would be much improved when you practise for many times. Just do it and you will find that your ability to take pictures and write better will come to you naturally.
Three days ago, I read the Digital Life magazine and saw a photo contest sponsored by Timberland whose products I have never bought. The photo contest is at: http://www.earthkeepers2011.com/sg/home.aspx.
The prize is a chance to be part of our Timberland® Earthkeepers™ reforestation activity in Horqin Desert, Inner Mongolia, and a nature appreciation trip to Jiuzhaigou Valley.
It is the category of travel I love very much as I get to see raw nature and it will be too expensive to go to such places.
However, I need to be realistic as my digital photography is not up to competition standards. Should I give up?
The theme was to tell a story in a picture with the theme:
What is your relationship with the outdoors?
I viewed my various images and came across the following. It is just an ordinary image of two boys standing on the banks of Lake Indein in February 2011 when my wife and I visited Myanmar. Nothing unique about two boys trekking along the bank of a stream of Lake Indein. The photograph was not of a high quality.
Then I saw the Timberland logo on the boy's shirt. The Timberland logo is the USP (unique selling proposition). This photo definitely will catch the eyes of Timberland judges owing to the logo unless they are blind.
It opens the door to a rare opportunity for a winner to participate in a reforestation project of a desert in Inner Mongolia.
So, how should I go about using this picture to show that "nature subtly connects our lives with meaningful relationships" as required in this contest?
I don't know exactly but the following image is my first draft, taking me over one hour to create the image. There are grammatical mistakes which I could not see yesterday.
What's the big deal about a boy wearing a Timberland shirt in Lake Indein, Myanmar?
Well, it is rare to spot a Timberland T-shirt in Yangon and Lake Indein is considered a remote area of Myanmar. I was in the boat much appreciative of being alive and healthy. I was able to see the willowy grass, hear birds chirping and smell clean unpolluted air and befar away from the urban jungles of Singapore.
For that brief instant when I clicked my camera, I realise that I was once like this Timberland boy. At his age, I was living with my grandparents in Bentong, a village in Pahang, Malaysia. Every morning, I would cycle with another boy to a stream to swim and to appreciate nature. Now, Singapore's children don't get this opportunity and to most Singaporeans, especially the females, a good travel itinerary is shopping. Not nature.
Try to enter photo contest and even if you don't win, you have educated yourself in being hands on, in creating a picture and writing text that would be much improved when you practise for many times. Just do it and you will find that your ability to take pictures and write better will come to you naturally.
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