Time flies. A month has passed again and this was August 31, 2011. I was on reception duty as that is the best way to know more about the customer service provided by Toa Payoh Vets.
A father and son came at 6.30 pm with his son and a broad chested Miniature Schnauzer. I took out his case card. He was from a neighbourhood where there are two vet clinics nearby just opposite his apartment.
"Why didn't you just go to the clinics nearby?" I asked the father as part of my survey on customer service. This is what most Singaporean pet owners will do. Why go far away when the time can be spent better not travelling.
There are at least 45 vet clinics in Singapore nowadays. So, there is no shortage of vets to the benefit of consumers, as in most businesses.
"My daughter prefers Toa Payoh Vets," the father said. Female members of the family may have a higher say in the choice of vets and veterinary surgery, from my preliminary survey. A daughter who studies overseas in marine biology in Australia had just instructed her family members to bring a dog to me for treatment earlier. The other daughter who phoned me to make an appointment for her father's favourite Chinese Crested dog in the story of Sedation worries of a good daughter is another example of the young ladies making decisions as to their choice of vets.
Services count and Dr Vanessa must have had provided good services as nowadays she handles most of the cases. A time to pass the baton.
What to do with this biting Schnauzer who has vomiting and diarrhoea? "He even bit me when I tried to carry him," the son showed me his left arm which was now OK. "He was bashed with a slipper at the groomer till his nose bled last time and so now he bites whenever anyone tries to muzzle him."
"Has he been neutered?" I asked.
"Yes," he said.
So what to do?
I let Dr Vanessa handle this case. The dog went to the consultation room. The two owners went in. Min had gone out for dinner as it was already 6.30 pm. I waited outside in the reception area for around 15 minutes. Soon, the two owners and dog came out and waited outside the Surgery patiently as the sun was setting. A quiet peaceful time as twilight set in.
I was doing my administrative work, looking into past case cards and checking the vaccination reminders. Why were they outside for so long, another 15 minutes? I went out to ask if they were looking for a taxi. "No," the father said. "I am waiting for your assistant to come back from dinner." Dr Vanessa came out from the consultation room to inform me too. She could not give this dog his anti-vomiting and anti-diarrhoea injection as the owners could not carry the dog onto the consultation table without being bitten and she could not cover the dog's head with a towel which I noted was on her consultation table.
This Schnauzer was a bit plump but younger and alert. He does not growl. He does not threaten. He was merely cool. Just don't mess around with covering his head or muzzling him or carrying him onto the consultation table. He would just bite.
So, Dr Vanessa advised waiting for Min. Some clients do come during certain lunch and dinner time as Dr Vanessa does consult, unlike some surgeries where certain times are closed. So, this is one period where Min had gone out for dinner and she had to wait for him.
I phoned Min and he said he was having dinner. At around 7 pm, he returned and I said to the owners: "It is sometimes better that you don't be around while they restrain the dog for injection." They agreed to wait outside the Surgery.
I let Dr Vanessa handle this case as usual. Another 15 minutes had passed. The father had come in from outside and was sitting on the chair. There was loud barking in the back of the surgery. "How many dogs do you have?" He asked. "Around 5 dogs but from the barking, it seems I have hundreds," I said. The father laughed and said: "Young doctor taking a long time to inject the dog? Is she your daughter?"
Youthfulness can be an advantage as many Singaporeans, in my perception and research, prefer young vets. It is sometimes a disadvantage in a ferocious biting dog case.
It was already more than one hour since the owners had come. So, I opened the door to enter the back of the Surgery. What was taking so long? In the room, I saw Min holding a lasso rope which came out from a long stick while another assistant was holding the leash of the Schnauzer on the other side. Dr Vanessa was holding a bigger muzzle at the right side of the dog. Her sedative of domitor and ketamine for IM injection was on the table. The Schnauzer was wary of Min whose lasso seemed to be rigid and inflexible. His lasso had one end inside a hollow tube. He held the tube and tried to lasso the Schnauzer while the other assistant Tun held onto the leash. As this lasso was inflexible, it did not work. So back and forth. It was taking a very long time.
It was an impasse. Now, I had taught Min how to use the original lasso which was of flexible plastic wrapped rope. He had used his own make as this original lasso had come out from the hollow of the pipe.
I had to intervene, being the leader. There was no choice. It was already 7.30 pm. "Give me the original lasso," I said to Min. He took it from the wall at the back gate. It had no hollow tube as that had broken. But the lasso end was still intact and so I loosen the rope to make a bigger circle to lasso the dog, without the pole. The pole was meant to protect the person holding the lasso from being bitten as it gave some distance. But the pole had broken and so I was holding the lasso end and the remaining rope.
The Schnauzer moved his head. He did not threaten. Tun held onto the leash. At the 3rd try, I manage to put the lasso over his head and pulled it tight. The dog pulled back his head in reaction. Tun held on to the blue leash which was originally with the dog.
"Get ready to inject the domitor IM," I said to Dr Vanessa as I held the dog firmly and upwards for a few seconds. She said: "Domitor is ineffective. I tried earlier on another dog. I am using domitor + ketamine combination". I said: "OK."
She quickly held the dog's back leg and injected the back muscle in the wink of an eye. "Wait 10 minutes," I said. "The owner had instructed that he wanted the whole dog clipped and groomed, including ear cleaning, anal sac and toe nail clipping. At first he just wanted a sedative to clip the backside as the dog would not permit washing of the soiled backside from the diarrhoea."
The whole process took more than one hour. I have been focusing on shortening the process of veterinary work. In this case, it can't be helped as Min is still learning how to restrain ferocious dogs. Remember he was bitten by a dwarf hamster just a few days ago?
Hands-on experiences are learnt only from handling the real cases and this take time. Workplace safety for the staff is paramount.
Still there needs to be a solution to treatment of a ferocious dog for the owner who entrusts the vet to do it. A simple thing as a lasso can still be difficult to execute in practice as in this case when the tool presented is broken. Sometimes we can't have the ideal situation and I hope Min learnt from this coaching I had just presented.
Every person is afraid of being bitten by ferocious dogs but the vet is in charge and has to know what to do, to resolve the problem satisfactorily and safely. The dog was groomed without problem. "Don't bathe the dog?" Min asked me when I phoned at 8.30 pm. I said: "You must bathe the dog in warm water. His backside is dirty from the diarrhoea stools," I said. The dog could now be muzzled and bathe.
I still remember when I was a young vet. I muzzled a dog for vaccination when a pet shop operator brought it in. Later, I got a feedback from a client that this pet shop operator was bad-mouthing me and telling others behind my back: "Dr Sing is afraid of dogs! He muzzles dogs for vaccination."
I don't muzzle every dog for vaccination and in fact, seldom does it. Biting Pomeranians are muzzled as there was no point getting my fingers bitten by sharp canine tooth as I need my fingers for surgery.
But this pet shop operator expects vets to be bite-proof and to have hidden powers to soothe all ferocious beasts! Dog bites are the risk of veterinary science but it does not mean that the staff must be bitten at any time. Workplace safety is very important and it is the responsibility of the vet to ensure that the staff is safe from bites and scratches from dogs and eats. And even from a dwarf hamster!
Thursday, September 1, 2011
Monday, August 29, 2011
572. PDS 2/0 has not dissolved by 3 weeks after neuter
My neighbour whose poodle was neutered by Dr Vanessa some 3 weeks ago asked me for help yesterday, Sunday, Aug 28, 2011 as he and his wife burned incense and papers to mark the end of the Hungry Ghost Festival.
The dog had 2 undescended testicles removed 3 weeks ago. The PDS stitches - 3 simple interrupted were still present on the right skin. No inflammation. I pulled them up and cut the knot. On tghe left side, some swelling and bleeding. Stitch inflammation and a reddish brown fluid spilled out. I squeezed out the blood and cut off the embedded stitch. Should be OK for the poodle. No need to wear the e-collar.
This is one case study to show that the PDS 2/0 absorbable stitches can hold on for at least 3 weeks. Two weeks to stitch removal usually but with most dogs and cats I sterilised, they don't need to come back for stitch removal as they do dissolve with time. Probably at the 4th week after surgery.
The dog had 2 undescended testicles removed 3 weeks ago. The PDS stitches - 3 simple interrupted were still present on the right skin. No inflammation. I pulled them up and cut the knot. On tghe left side, some swelling and bleeding. Stitch inflammation and a reddish brown fluid spilled out. I squeezed out the blood and cut off the embedded stitch. Should be OK for the poodle. No need to wear the e-collar.
This is one case study to show that the PDS 2/0 absorbable stitches can hold on for at least 3 weeks. Two weeks to stitch removal usually but with most dogs and cats I sterilised, they don't need to come back for stitch removal as they do dissolve with time. Probably at the 4th week after surgery.
571. Bitten by a dog, a cat and now a dwarf hamster!
I am responsible for work place safety. So, I have had coached my assistant Min how to observe cat, and dog behaviour. He got bitten by a dog attended by Dr Teo, on his palms sometime ago and I had to bring him to see the doctor. The cat under Dr Vanessa bit his thumb which needed a doctor to stitch. Then on Aug 26, 2011, I asked him to wear cotteon glove to restrain a dwarf hamster, male, 11 months, 92 g.
The hamster was very itchy all over its elbows and hind limbs. Red rashes. The inguinal area was bald. Two bare patches of 0.3 cm x 0.3 cm on both backside of the end of the tail as if he had chewed on them.
1. Anal sacculitis? Licking of both backside and groin area. I tried to squeeze the anal sac. It was impossible. The hamster struggled and turned. Bits of brocolli flowers spilled out from his pouch. The younger lady was stressed out as she fidgeted. So I stopped.
2. I diluted pred 0.01 ml with 0.1 ml of saline in a one-ml syringe. Asked Min to hold the hamster's head area with his gloved hand. "He does not bite, " the older lady wanted to hold him, confident. But it is not wise to ask her to do it while I inject the skin above the rump on both sides. A little on either side.
Suddenly Min shrieked and withdrew his hand as I injected. "The hamster bites me!" he said. So, that's how he got bitten by a dwarf hamster under my care. So, 3 vets' animal patients bit this vet assistant.
I showed Min again how to hold the hamster's head while I injected SC.
August 28, 2011 Monday
I phoned the owner. "The hamster no longer bites his elbows after the injection," she said. "The next day he was back to normal."
She had switched to a different brand of bedding (paper cotton roll type) as the previous b rand was hard to find. Was this the cause? Or was the hamster too fat and had difficulty climbing up the wheel? "He seldom exercises on the wheel," the young lady said. "He eats only 3 sunflower seeds and I don't know why he is so chubby!" 92 g is a lot of weight for a dwarf hamster. "He has no sand and his ears are not itchy," she confirmed.
So what was the cause of this itchiness? Bedding? The hamster is on 14 days of pred and antibiotics. The owner may be able to source the old brand.
"Self stimulation on the groin area leading to a shiny bald groin?" I enquired. The owner did not know. The whole hind limb was bald and itchy, two backsides were bald. The hamster lives alone. Food allergy perhaps? Same hamster food, the owner disagreed. To the owner, the same food but it is not the same composition or sources of seeds and pellets. One of the components could cause allergies. It is hard to explain to the owner.
So, it is a mystery as to the cause of this intense itchiness causing the hamster to scratch non-stop. As for my assistant, he is much more alert and careful. His thumb is still bandaged after 3 weeks from the cat bite. The hamster's bite was nothing. A pin prick.
The hamster was very itchy all over its elbows and hind limbs. Red rashes. The inguinal area was bald. Two bare patches of 0.3 cm x 0.3 cm on both backside of the end of the tail as if he had chewed on them.
1. Anal sacculitis? Licking of both backside and groin area. I tried to squeeze the anal sac. It was impossible. The hamster struggled and turned. Bits of brocolli flowers spilled out from his pouch. The younger lady was stressed out as she fidgeted. So I stopped.
2. I diluted pred 0.01 ml with 0.1 ml of saline in a one-ml syringe. Asked Min to hold the hamster's head area with his gloved hand. "He does not bite, " the older lady wanted to hold him, confident. But it is not wise to ask her to do it while I inject the skin above the rump on both sides. A little on either side.
Suddenly Min shrieked and withdrew his hand as I injected. "The hamster bites me!" he said. So, that's how he got bitten by a dwarf hamster under my care. So, 3 vets' animal patients bit this vet assistant.
I showed Min again how to hold the hamster's head while I injected SC.
August 28, 2011 Monday
I phoned the owner. "The hamster no longer bites his elbows after the injection," she said. "The next day he was back to normal."
She had switched to a different brand of bedding (paper cotton roll type) as the previous b rand was hard to find. Was this the cause? Or was the hamster too fat and had difficulty climbing up the wheel? "He seldom exercises on the wheel," the young lady said. "He eats only 3 sunflower seeds and I don't know why he is so chubby!" 92 g is a lot of weight for a dwarf hamster. "He has no sand and his ears are not itchy," she confirmed.
So what was the cause of this itchiness? Bedding? The hamster is on 14 days of pred and antibiotics. The owner may be able to source the old brand.
"Self stimulation on the groin area leading to a shiny bald groin?" I enquired. The owner did not know. The whole hind limb was bald and itchy, two backsides were bald. The hamster lives alone. Food allergy perhaps? Same hamster food, the owner disagreed. To the owner, the same food but it is not the same composition or sources of seeds and pellets. One of the components could cause allergies. It is hard to explain to the owner.
So, it is a mystery as to the cause of this intense itchiness causing the hamster to scratch non-stop. As for my assistant, he is much more alert and careful. His thumb is still bandaged after 3 weeks from the cat bite. The hamster's bite was nothing. A pin prick.
570. Sunday's interesting case - Two emaciated adult dogs
"When you consult 10 vets, you will get 10 different opinions in most cases," I said to the mother and daughter who consulted me on this fine Sunday morning, August 28, 2011. The daughter said the internet recommended me. My surgery was relatively far away for them. "The first vet said she would cut away the "three" mouth growths," the daughter said angrily. "She cut one and sent it to the laboratory. The report said it was not a cancerous growth. So she told me to apply the cream onto the growths in the mouth as they were infections. She said the growths would then disappear."
Well, I had no comment. The histopathological report did not confirm that the growth was cancerous or not.
But the "three" oral tumours have grown much bigger. So they consulted Vet 2 nearby their home. But Vet 2 did not care to excise the growths and so the internet lead them to me on this fine Sunday morning when I was interviewing a fair young lady graduate with first class honours in an Australian University. She wanted to volunteer on weekend to see practice to know whether she would like to study veterinary science.
"These oral tumours are likely to be cancerous," I stated on the fact that the growths grew fast over the last 3 months and the spread to the submandibular lymph nodes and down to the nearby ones.
"Feel this thick cord of 8 cm x 3 cm x 2 cm on either side of the neck from the submandibular lymph nodes," I asked the daughter and mother to place their thumb and forefinger onto the cord. "These are likely to be spread of the cancerous cells from the mouth to the lymph nodes."
"What do you advise about the mouth tumours? Vet 1 should have removed them as promised." the daughter was quite unhappy as the tumours had metastasized and she had already spent $2,000.
I said: "Each vet has his or her own way of handling a case of mouth tumours. Vet schools may teach the vet to do a biopsy first. If the lab results find that the growths are not cancerous, then the owner is informed as to the next step. By then, some cancerous ones will have grown much bigger due to the delay.
"Unfortunately, tumours don't disappear even if they are not cancerous. In practice, it is best to cut them off when they are small. They interfere with the dog eating, being painful and ulcerated. And smelly. However anaesthesia in old dogs is highly risky and the dog may just die on the operating table. So the vet may not want to operate as deaths of dogs under his or her care badly damage his or her reputation."
The daughter asked: "What are the chances of survival?"
I said: "I estimated around 40% as your dog is emaciated. All skin and bones now. You can see the spine protruding."
The daughter said: "My dog eats a lot and will even eat the other dog's food. The vets don't believe when I say that."
"It is hard to believe. Any dog or person that eats a lot will put on weight. What do you feed?"
"Brown rice and potatoes," she said. "The vet advised against dry dog food as she has skin problems. Her foot pads are licked red and so the vet thinks that my dog is allergic to dry dog food."
This is surprisingly the second emaciated dog I was presented on this fine Sunday morning. I had just hospitalised an emaciated poodle who had a painful mouth and screamed when I touched the mouth. Blood tests were taken to find out why. The lady owner had another dog with urinary stones. So no dry dog food for that dog. And similarly for this poodle. Skin and bones and protruding spines.
Back to the old Shih Tzu. What to do?
"Do you advise euthanasia?" the daughter asked me since I said that the Shih Tzu was at the end of his life-span of 10 years. Healthy ones may live up to 15 years but they usually live to 10-15 years in Singapore.
"The decision to euthanase is up to the owner," I advised. In advising euthanasia, some owners deem the vet to be a good for nothing. Only know how to advise euthanasia.
I said: "In many cases, it is a matter of economics too. These tumours can be cut off by electro-surgery. You may buy some time for the old dog."
"How long?"
"If they are cancerous, the tumours will recur around 2 months."
"What to do then?"
"It is best you and your mum take 3 or 4 days to think what to do," I said. "If surgery is your option, I will operate but you know the chances of survival are around 40% and I have not done any blood test to know the dog's health, to save some money, since you had spent $2000 at the other vets."
"How much is the surgery?"
"I can only estimate. Around $500 - $1,000"
"My dog barks at me when I tell him that he will be put to sleep," the daughter said. "So, I do not want to do it."
The owners went home to feed the dog on a good diet for the next 3-4 days, multivitamins and antibiotics. Surgery will be scheduled on Thursday morning at 10 am if she wants surgery. This is the type of high-risk surgery where fools go in where angels feel to tread. But is there any other choices? Chemotherapy will not work and I don't want the owners to get false hopes. Neither will surgery if there is recurrence. But there is no other choice. It was Hobson's choice.
Well, I had no comment. The histopathological report did not confirm that the growth was cancerous or not.
But the "three" oral tumours have grown much bigger. So they consulted Vet 2 nearby their home. But Vet 2 did not care to excise the growths and so the internet lead them to me on this fine Sunday morning when I was interviewing a fair young lady graduate with first class honours in an Australian University. She wanted to volunteer on weekend to see practice to know whether she would like to study veterinary science.
"These oral tumours are likely to be cancerous," I stated on the fact that the growths grew fast over the last 3 months and the spread to the submandibular lymph nodes and down to the nearby ones.
"Feel this thick cord of 8 cm x 3 cm x 2 cm on either side of the neck from the submandibular lymph nodes," I asked the daughter and mother to place their thumb and forefinger onto the cord. "These are likely to be spread of the cancerous cells from the mouth to the lymph nodes."
"What do you advise about the mouth tumours? Vet 1 should have removed them as promised." the daughter was quite unhappy as the tumours had metastasized and she had already spent $2,000.
I said: "Each vet has his or her own way of handling a case of mouth tumours. Vet schools may teach the vet to do a biopsy first. If the lab results find that the growths are not cancerous, then the owner is informed as to the next step. By then, some cancerous ones will have grown much bigger due to the delay.
"Unfortunately, tumours don't disappear even if they are not cancerous. In practice, it is best to cut them off when they are small. They interfere with the dog eating, being painful and ulcerated. And smelly. However anaesthesia in old dogs is highly risky and the dog may just die on the operating table. So the vet may not want to operate as deaths of dogs under his or her care badly damage his or her reputation."
The daughter asked: "What are the chances of survival?"
I said: "I estimated around 40% as your dog is emaciated. All skin and bones now. You can see the spine protruding."
The daughter said: "My dog eats a lot and will even eat the other dog's food. The vets don't believe when I say that."
"It is hard to believe. Any dog or person that eats a lot will put on weight. What do you feed?"
"Brown rice and potatoes," she said. "The vet advised against dry dog food as she has skin problems. Her foot pads are licked red and so the vet thinks that my dog is allergic to dry dog food."
This is surprisingly the second emaciated dog I was presented on this fine Sunday morning. I had just hospitalised an emaciated poodle who had a painful mouth and screamed when I touched the mouth. Blood tests were taken to find out why. The lady owner had another dog with urinary stones. So no dry dog food for that dog. And similarly for this poodle. Skin and bones and protruding spines.
Back to the old Shih Tzu. What to do?
"Do you advise euthanasia?" the daughter asked me since I said that the Shih Tzu was at the end of his life-span of 10 years. Healthy ones may live up to 15 years but they usually live to 10-15 years in Singapore.
"The decision to euthanase is up to the owner," I advised. In advising euthanasia, some owners deem the vet to be a good for nothing. Only know how to advise euthanasia.
I said: "In many cases, it is a matter of economics too. These tumours can be cut off by electro-surgery. You may buy some time for the old dog."
"How long?"
"If they are cancerous, the tumours will recur around 2 months."
"What to do then?"
"It is best you and your mum take 3 or 4 days to think what to do," I said. "If surgery is your option, I will operate but you know the chances of survival are around 40% and I have not done any blood test to know the dog's health, to save some money, since you had spent $2000 at the other vets."
"How much is the surgery?"
"I can only estimate. Around $500 - $1,000"
"My dog barks at me when I tell him that he will be put to sleep," the daughter said. "So, I do not want to do it."
The owners went home to feed the dog on a good diet for the next 3-4 days, multivitamins and antibiotics. Surgery will be scheduled on Thursday morning at 10 am if she wants surgery. This is the type of high-risk surgery where fools go in where angels feel to tread. But is there any other choices? Chemotherapy will not work and I don't want the owners to get false hopes. Neither will surgery if there is recurrence. But there is no other choice. It was Hobson's choice.
Sunday, August 28, 2011
569. Playpen and crate with pee pan pictures wanted
E-MAIL TO DR SING DATED AUG 25, 2011
from ...@gmail.com
to judy@toapayohvets.com
date Thu, Aug 25, 2011 at 5:48 PM
subject playpen for dogs
Hi
can u recommend one for my 5 mth old chinese crested puppy?
E-MAIL REPLY FROM DR SING DATED SUNDAY AUG 25, 2011
I am Dr Sing from Toa Payoh Vets. Thank you for your email. Your Chinese Crested Puppy can be housed in a crate with a grate and pee pan below or in a playpen with 4 panels of fencing. Much depends on your wish, economics and available space inside your residence. If there is space, 3 feet long x 3 feet wide will be all right. All these are available at pet shops in Singapore.
E-MAIL TO DR SING DATED AUG 27, 2011
On Sat, Aug 27, 2011 at 5:52 PM, ...@gmail.com> wrote:
Hi
Can u forward me a picture of the crate with grate n playpen with 4 fencings?
Thanks
E-MAIL REPLY FROM DR SING DATED SUNDAY AUG 28, 2011
Some pictures are at:
http://www.toapayohvets.com/sinpets/050620play_pen_toilet_training.htm
To save you time, the relevant pictures are at:
To save you time, the two relevant pictures are at:
http://www.toapayohvets.com/images/dogpix/050218AAplay_pen.jpg
http://www.sinpets.com/dogpix/20070806rubber_mat_toilet_ToaPayohVets.jpg
Pl let me know if you need some clarification.
THE FOLLOWING ARE THE TWO RELEVANT PICTURES:
from ...@gmail.com
to judy@toapayohvets.com
date Thu, Aug 25, 2011 at 5:48 PM
subject playpen for dogs
Hi
can u recommend one for my 5 mth old chinese crested puppy?
E-MAIL REPLY FROM DR SING DATED SUNDAY AUG 25, 2011
I am Dr Sing from Toa Payoh Vets. Thank you for your email. Your Chinese Crested Puppy can be housed in a crate with a grate and pee pan below or in a playpen with 4 panels of fencing. Much depends on your wish, economics and available space inside your residence. If there is space, 3 feet long x 3 feet wide will be all right. All these are available at pet shops in Singapore.
E-MAIL TO DR SING DATED AUG 27, 2011
On Sat, Aug 27, 2011 at 5:52 PM, ...@gmail.com> wrote:
Hi
Can u forward me a picture of the crate with grate n playpen with 4 fencings?
Thanks
E-MAIL REPLY FROM DR SING DATED SUNDAY AUG 28, 2011
Some pictures are at:
http://www.toapayohvets.com/sinpets/050620play_pen_toilet_training.htm
To save you time, the relevant pictures are at:
To save you time, the two relevant pictures are at:
http://www.toapayohvets.com/images/dogpix/050218AAplay_pen.jpg
http://www.sinpets.com/dogpix/20070806rubber_mat_toilet_ToaPayohVets.jpg
Pl let me know if you need some clarification.
THE FOLLOWING ARE THE TWO RELEVANT PICTURES:
568. Surgery Audit. How long it takes to spay a female dog? 18 minutes
I don't know whether the Vet Schools teaches surgery audit nowadays but they did not do that in the 1970s when I studied in Glasgow University.
A surgery audit is important as it improves the surgical and anaesthetic processes, productivity and efficiency of the veterinary surgeon. A vet who takes a long time to spay a female dog uses up more than necessary anaesthetic gas and exposes the dog to a longer risk of anaesthetic deaths.
So, I will be doing a surgery audit of the time taken by a vet to spay a female dog at Toa Payoh Vets. To do that, I have to research on how long it takes me to spay a female dog. I have recorded two cases done earlier. The details are at:
http://www.sinpets.com/F5/20110816domitor-ketamine-spay-fox-terrier-26minutes_ToaPayohVets.htm
In the two cases, the time between the first skin incision and skin stitched up was 18 and 26 minutes respectively.
Now, in this case of the Shih Tzu I am reporting, the time was 18 minutes as shown in the images below.
Time of first skin incision to time the skin is stitched up = 18 minutes
CONCLUSION
If the female dog is in surgical anaesthesia without the need to top up, the time taken will be 18 minutes based on 2 female dogs I had spayed. When the dog wakes up in the middle of surgery and needs top up isoflurane gas + oxygen, the time taken will be much longer, e.g. 26 minutes as illustrated in my first report. Without topping up, the surgery time is shortened by as much as 8 minutes!
From the cases, the objective is to ensure that the dog is given isoflurane gas + oxygen as maintenance, rather than use IV anaesthesia of lowered dosage as in the case that took 26 minutes. For my female dog spays in the last 30 years of practice, I have had not used IV anaesthesia as I believe my procedure should be the best and safest. During the last 2 years, I change my mindset and use IV anaesthesia in spaying female dogs as part of continuing education.
18 minutes will be the target for experienced vets doing spay in Toa Payoh Vets. It is a standard to aim for as the shorter the anaesthesia, the safer it is for the dog, especially the older ones.
For cats and with the appropriate dosage, the surgery to spay can be completed as fast as 5 minutes as the cat is much smaller and generally, it is easier to hook out the ovary. However, I need to properly record and document that it is 5 minutes sometime later.
Shih Tzu I am reporting, the time was 18 minutes as shown in the images below.
A surgery audit is important as it improves the surgical and anaesthetic processes, productivity and efficiency of the veterinary surgeon. A vet who takes a long time to spay a female dog uses up more than necessary anaesthetic gas and exposes the dog to a longer risk of anaesthetic deaths.
So, I will be doing a surgery audit of the time taken by a vet to spay a female dog at Toa Payoh Vets. To do that, I have to research on how long it takes me to spay a female dog. I have recorded two cases done earlier. The details are at:
http://www.sinpets.com/F5/20110816domitor-ketamine-spay-fox-terrier-26minutes_ToaPayohVets.htm
In the two cases, the time between the first skin incision and skin stitched up was 18 and 26 minutes respectively.
Now, in this case of the Shih Tzu I am reporting, the time was 18 minutes as shown in the images below.
Time of first skin incision to time the skin is stitched up = 18 minutes
CONCLUSION
If the female dog is in surgical anaesthesia without the need to top up, the time taken will be 18 minutes based on 2 female dogs I had spayed. When the dog wakes up in the middle of surgery and needs top up isoflurane gas + oxygen, the time taken will be much longer, e.g. 26 minutes as illustrated in my first report. Without topping up, the surgery time is shortened by as much as 8 minutes!
From the cases, the objective is to ensure that the dog is given isoflurane gas + oxygen as maintenance, rather than use IV anaesthesia of lowered dosage as in the case that took 26 minutes. For my female dog spays in the last 30 years of practice, I have had not used IV anaesthesia as I believe my procedure should be the best and safest. During the last 2 years, I change my mindset and use IV anaesthesia in spaying female dogs as part of continuing education.
18 minutes will be the target for experienced vets doing spay in Toa Payoh Vets. It is a standard to aim for as the shorter the anaesthesia, the safer it is for the dog, especially the older ones.
For cats and with the appropriate dosage, the surgery to spay can be completed as fast as 5 minutes as the cat is much smaller and generally, it is easier to hook out the ovary. However, I need to properly record and document that it is 5 minutes sometime later.
Shih Tzu I am reporting, the time was 18 minutes as shown in the images below.
Saturday, August 27, 2011
567. Cardiac Tamponade - pericardiocentesis for an 8-year-old Lab Retriever - Part 1
"You are one of the two vets I know," the Labrador Retriever owner had fixed a 10 am appointment to consult me. "Vet 1 had taken an X-ray of the abdomen and said there was nothing wrong in the stomach and intestines. He had prescribed antibiotics and pannadol for the skin infections in the swollen skin under the chin.
"That was around 2 weeks ago. But my dog is very tired and the skin swelling is still there.
"Look," the owner pointed to the skin puffing out from the side of the two mandibles. "The right side of the chin is even more swollen. See the right front paw. It is swollen compared to the left paw!"
I could see that both front paws are 20% more swollen than both hind paws. The male Labrador Retriever also had loose flabby skin hanging out from the right and left side of the jaws, such as you would see in people with double chins.
In August 2011, there are three vets at Toa Payoh Vets and owners have a choice of who to consult. I have not retired but it is time to hand over to the younger generation and Dr Vanessa would be on duty from 11 am to around 7 pm usually on weekdays. I would usually be around from 9.30 am to 12noon and at other times agreed upon by the owner who wanted to consult me.
This was no more a skin infection at first presentation. Somehow, this dog's condition reminded me of a cow presented by my professors in 1974 when I was in the final year of vet studies in Glasgow University. It was a case of mediasternal tumour. Blood flow to the heart was obstructed and skin swelling or subcutaneous oedema in the side of the face appeared. Could this be a rare case of mediasternal tumour in an older dog?
It was 1974 and now it is 2011. But certain interesting rare cases are never forgotten by me. "Have you seen such presentation of swollen folds in cattle in Myanmar?" I asked my assistant Mr Min and his friend Tun who are qualified vets from Myanmar. "It was a case of medisternal tumour in a cow I had seen when I was in Vet School." They shook their heads and probably didn't know what I was talking about. Mediasternal? What the hell is it? Where's the mediasternum and what is it?
"This dog would be suffering from diseases affecting one of the 3 organs," I said gravely. "It could be the heart, liver or kidney. More tests would be needed. Are you OK with having tests like ultrasound, X-ray and blood and urine tests done?"
I asked for permission as the tests could cost the owner a bit of money.
The lady owner showed me a piece of the laboratory test: "Vet 1's blood test said there was no liver and kidney problem. I would like to know what's wrong with my dog. He is still young. Only 56 years old in human age. But he has lost a lot of weight. I had also reduced his food intake tought. However, he is breathing faster than normal. Not his usual active self!"
The Labrador preferred to sit on his chest rather than stand up on the consultation room floor. Occasionally he wagged his tail. I could see his chest movements of over 90/minute which is faster than normal and coached my assistant how to take the respiratory rate/minute based on number of respirations per 6 seconds x 10. This case is part of a teaching case as it is a rare medical condition presenting as skin swellings in the face, front limbs and penile skin. I coached my assistant how to take the pulse rate. The pulse was barely palpable and of poor quality.
After the general observation, I got the dog to be put onto the consultation table and did the routine checks. Significantly, the heart sounds was barely audible. "Give me another stethoscope," I said to Min who handed me another stethoscope.
I asked Min: "How come the Littman stethoscope was broken? And who broke it?" Min was silent.
One new auroscope's cover was cracked. The electro-surgical handle insulating the hand from electric shock had disappeared. The new Shoreline operating table of less than one year and costing me around $7,000 was scratched in several places. I had to replace a new isoflurane vaporiser. This time, I would have to do a surgical audit of instruments as such damages should not happen. A heavy hand?
"That was around 2 weeks ago. But my dog is very tired and the skin swelling is still there.
"Look," the owner pointed to the skin puffing out from the side of the two mandibles. "The right side of the chin is even more swollen. See the right front paw. It is swollen compared to the left paw!"
I could see that both front paws are 20% more swollen than both hind paws. The male Labrador Retriever also had loose flabby skin hanging out from the right and left side of the jaws, such as you would see in people with double chins.
In August 2011, there are three vets at Toa Payoh Vets and owners have a choice of who to consult. I have not retired but it is time to hand over to the younger generation and Dr Vanessa would be on duty from 11 am to around 7 pm usually on weekdays. I would usually be around from 9.30 am to 12noon and at other times agreed upon by the owner who wanted to consult me.
This was no more a skin infection at first presentation. Somehow, this dog's condition reminded me of a cow presented by my professors in 1974 when I was in the final year of vet studies in Glasgow University. It was a case of mediasternal tumour. Blood flow to the heart was obstructed and skin swelling or subcutaneous oedema in the side of the face appeared. Could this be a rare case of mediasternal tumour in an older dog?
It was 1974 and now it is 2011. But certain interesting rare cases are never forgotten by me. "Have you seen such presentation of swollen folds in cattle in Myanmar?" I asked my assistant Mr Min and his friend Tun who are qualified vets from Myanmar. "It was a case of medisternal tumour in a cow I had seen when I was in Vet School." They shook their heads and probably didn't know what I was talking about. Mediasternal? What the hell is it? Where's the mediasternum and what is it?
"This dog would be suffering from diseases affecting one of the 3 organs," I said gravely. "It could be the heart, liver or kidney. More tests would be needed. Are you OK with having tests like ultrasound, X-ray and blood and urine tests done?"
I asked for permission as the tests could cost the owner a bit of money.
The lady owner showed me a piece of the laboratory test: "Vet 1's blood test said there was no liver and kidney problem. I would like to know what's wrong with my dog. He is still young. Only 56 years old in human age. But he has lost a lot of weight. I had also reduced his food intake tought. However, he is breathing faster than normal. Not his usual active self!"
The Labrador preferred to sit on his chest rather than stand up on the consultation room floor. Occasionally he wagged his tail. I could see his chest movements of over 90/minute which is faster than normal and coached my assistant how to take the respiratory rate/minute based on number of respirations per 6 seconds x 10. This case is part of a teaching case as it is a rare medical condition presenting as skin swellings in the face, front limbs and penile skin. I coached my assistant how to take the pulse rate. The pulse was barely palpable and of poor quality.
After the general observation, I got the dog to be put onto the consultation table and did the routine checks. Significantly, the heart sounds was barely audible. "Give me another stethoscope," I said to Min who handed me another stethoscope.
I asked Min: "How come the Littman stethoscope was broken? And who broke it?" Min was silent.
One new auroscope's cover was cracked. The electro-surgical handle insulating the hand from electric shock had disappeared. The new Shoreline operating table of less than one year and costing me around $7,000 was scratched in several places. I had to replace a new isoflurane vaporiser. This time, I would have to do a surgical audit of instruments as such damages should not happen. A heavy hand?
566. Do you love your hamster, warts and all?
How to educate hamster owners that they should get the vet to excise the hamster's warts when they are very small? When the warts are small, they don't bleed profusely. Big warts command a large blood supply and as you can see in this case, with images presented, the bleeding was a lot in the wart excised from the hind limb.
Unlike dogs and cats, it was practically not possible to ligate the bleeder since the blood vessels were not visible. The good news is that this hamster survived the operation.
If you love your hamster, get her warts removed by your vet early.
MORE IMAGES OF THE ELECTRO-SURGERY ARE AT:
http://www.sinpets.com/F5/201108028electro-surgery-excise-hamster-warts-singapore_ToaPayohVets.htm
Unlike dogs and cats, it was practically not possible to ligate the bleeder since the blood vessels were not visible. The good news is that this hamster survived the operation.
If you love your hamster, get her warts removed by your vet early.
MORE IMAGES OF THE ELECTRO-SURGERY ARE AT:
http://www.sinpets.com/F5/201108028electro-surgery-excise-hamster-warts-singapore_ToaPayohVets.htm
565. How to win the heart of someone?
A tip for the single readers who may wish to win the hearts of someone.
1. Buy a good camera that can focus well and fast.
2. Teach yourself how to take good digital pictures by reading the numerous photo magazines at the National Library branches.
3. Practise and practise taking street photography.
4. Sunlight is very important, in my opinion as it brings out the shine.
5. Then look for a song with appropriate lyrics to accompany the photo.
6. Present the photo to the person to win his or her heart.
7. Any chance of success? If you create good pictures, you may win his or her heart when you email the picture with the appropriate love song.
If you can sing like Lionel Richie, then no need photos!
After so much writing, I am giving an example as shown below:
1. Song - "Hello" by Lionel Richie
From You Tube:
http://www.youtube.com/watch?v=PDZcqBgCS74
http://www.youtube.com/watch?v=62XB9IbMnxQ&feature=related
2. Photo - "Sunlight in your hair" from the lyrics of Lionel Richie's song.
1. Buy a good camera that can focus well and fast.
2. Teach yourself how to take good digital pictures by reading the numerous photo magazines at the National Library branches.
3. Practise and practise taking street photography.
4. Sunlight is very important, in my opinion as it brings out the shine.
5. Then look for a song with appropriate lyrics to accompany the photo.
6. Present the photo to the person to win his or her heart.
7. Any chance of success? If you create good pictures, you may win his or her heart when you email the picture with the appropriate love song.
If you can sing like Lionel Richie, then no need photos!
After so much writing, I am giving an example as shown below:
1. Song - "Hello" by Lionel Richie
From You Tube:
http://www.youtube.com/watch?v=PDZcqBgCS74
http://www.youtube.com/watch?v=62XB9IbMnxQ&feature=related
2. Photo - "Sunlight in your hair" from the lyrics of Lionel Richie's song.
564. E-mail inquiry about finding a mate for a female poodle
E-MAIL TO DR SING
On Thu, Aug 25, 2011 at 3:50 PM, ...@gmail.com> wrote:
Hi,
I am planning to breed my female toy poodle. However yet to find a mate for her. Can you provide me more sources to read up on home breeding ( e.g. Related books) and where should I look for a suitable mate for my dog.
Hope to hear from u soon.
Thanks,
Name of lady owner
E-MAIL REPLY FROM DR SING
I am Dr Sing from Toa Payoh Vets. In reply, there are many dog books and magazines in the National Library branches in Singapore for you to read. It is difficult to find a mate for your dog as few Singaporean male poodle owners are interested in breeding.
You may be able to find one at Pasir Ris Farmway 1 breeder farms if you ask around as some do provide stud services for a fee. Or some pet shops. Your vet may be able to help. The Singapore Kennel Club may have poodle owners who may be interested.
On Thu, Aug 25, 2011 at 3:50 PM, ...@gmail.com> wrote:
Hi,
I am planning to breed my female toy poodle. However yet to find a mate for her. Can you provide me more sources to read up on home breeding ( e.g. Related books) and where should I look for a suitable mate for my dog.
Hope to hear from u soon.
Thanks,
Name of lady owner
E-MAIL REPLY FROM DR SING
I am Dr Sing from Toa Payoh Vets. In reply, there are many dog books and magazines in the National Library branches in Singapore for you to read. It is difficult to find a mate for your dog as few Singaporean male poodle owners are interested in breeding.
You may be able to find one at Pasir Ris Farmway 1 breeder farms if you ask around as some do provide stud services for a fee. Or some pet shops. Your vet may be able to help. The Singapore Kennel Club may have poodle owners who may be interested.
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