E-MAIL TO DR SING DATED JAN 11, 2012
Hi Dr Sing
Thank you for your follow up call on Pillow's recovery last Sunday. To
be quite honest, I was quite surprised to receive your call and was very
impressed with your concern and professional service :). Even my own
physician do not follow up on my visits, kudos for your kind concern
.... great customer service :)
PP was recovering quite well over the last few days and he should
finish the Antibiotics today. The 'coughing' has decreased
substantially but I still do hear him cough every now and then after
meals. Is this normal ? or should he stop coughing completely by now ?
He is eating well and playing well but breathes heavily at times when
running around.
Do I need to bring him back to you for a check up ?
The next appointment for his Vaccination is this Friday, do I proceed
with this or should I postpone till next Monday ? Appreciate your
advise, thanks
Best Regards
E-MAIL FROM DR SING DATED JAN 11, 2012
Dear ....
Thank you for your email and compliments. I try to follow up cases whenever possible to know the effectiveness of treatment and therefore acquire the knowledge that vet books and professors cannot impart.
In reply, PP is still coughing, though considerably less.
It is not possible to predict exactly when the coughing will cease after medication. The medication to treat bacterial infections of the upper respiratory tract. However, kennel cough is caused by a bacteria and a virus. There is no usual medication against viral infections and therefore the puppy needs time to recover.
Vaccination must be delayed till 7-14 days after the end of coughing as this will indicate that the puppy has fully recovered. In your case, the puppy has already got 2 vaccinations and the 3rd one has to wait 7-14 days after the date of no coughing from the puppy.
Pl let me know if you have more queries. Thank you for 3 pictures of PP. PP was my first case for 2012 and reminds me so much of my son's Bichon who is now 5 years old and is well behaved (no urine marking inside the house)
P.S
I have 2 Sec 3 students and Dr Vanessa Lin produced an educational video on kennel cough with one rehearsal only. Pl let me have your comments as to
1. whether you have a better understanding of kennel cough and
2. whether the video was fun to view or make you fall asleep and snore.
Feedback is important to improve my pet video educational work. The video is at:
http://www.youtube.com/watch?v=tmTYP8T95V4
Best wishes for the New Year
Thursday, January 12, 2012
Wednesday, January 11, 2012
810. Hands-Feet-Must-Quick Newspaper stand
Today I went to the HDB Hub newstand to buy my Straits Times. There was a queue of 4 people and so I stood at the 5th and read the papers. "You can go to the other girl if you want to pay," a kind lady told me.
I did not see the young girl as the last time, it was only Aunty working alone. Aunty is a slim Chinese lady in her 50s. She had told me that she would resign as the hours 9 am to 9 pm are too tiring for her. At that time I asked what happened to the young girls, usually in their early 20s, employed by this kiosk. They had quit.
Today, I assumed she was alone and the queue was waiting for her as she photocopied the documents. The young girl was next to her but I did not see her.
"Aunty, you still around?" I said (in Chinese translation). "Why don't you ask the young girl to do the photocopying and you collect money?"
"Hands-Feet-Must-Quick", the Aunty told me. The new girl would not be able to use the multi-function copier and she probably did not bother to teach her. This is quite a common situation in Singapore employment matters. Why teach the young ones when they don't stay long?
I paid up and left. Singapore has developed but the parents and the education system have had no time to teach the students to be able to do what the industry wants.
Chinese language usually has 4 words to express a situation and that is why I translated literally Aunty's reply to me.
I did not see the young girl as the last time, it was only Aunty working alone. Aunty is a slim Chinese lady in her 50s. She had told me that she would resign as the hours 9 am to 9 pm are too tiring for her. At that time I asked what happened to the young girls, usually in their early 20s, employed by this kiosk. They had quit.
Today, I assumed she was alone and the queue was waiting for her as she photocopied the documents. The young girl was next to her but I did not see her.
"Aunty, you still around?" I said (in Chinese translation). "Why don't you ask the young girl to do the photocopying and you collect money?"
"Hands-Feet-Must-Quick", the Aunty told me. The new girl would not be able to use the multi-function copier and she probably did not bother to teach her. This is quite a common situation in Singapore employment matters. Why teach the young ones when they don't stay long?
I paid up and left. Singapore has developed but the parents and the education system have had no time to teach the students to be able to do what the industry wants.
Chinese language usually has 4 words to express a situation and that is why I translated literally Aunty's reply to me.
Tuesday, January 10, 2012
809. Update Travel Stories; Young Adults Who Are Not Hungry
Just update the following:
Travel Stories. Dubai - Jan 1, 2012 Winchester Hotel 12.08 am
Many young adults in a free world of abundance like Singapore, live in a virtual world of the smart phone texting and connecting with friends day to day. No responsibilities of adulthood and parenthood.
How to pretty themselves? How to look cools? There seems to be a trend in Singapore's young adults from the middle and upper class to go for Laser Surgery of two eyes.
It is cool. Their peers do it and they desire it. A 5-hour eye test free of charge. They are sold on the benefits and want to book immediately.
Go for cosmetic eye surgery since other young adults in the middle class go for it. Side effects like dry eyes that need eye drops daily after laser operation and corneal damage affecting beauty and vision due to a possible mis-positioning or inadvertent mistake by the sophisticated eye laser machines or machine operator are ignored. Such side effects will not happen to them. How about long-term effects on vision loss. Well, the young adults are invincible. They are not 30 years old. Why think longer than 1 year later? They are not aware of the other young adults who have adverse effects after the cosmetic eye surgery as they don't want to know. They think high tech eye laser machines are perfect and will not damage their cornea. $4,000 is the price. So what?
In Europe now, I read that 40,000 breast implants which leak and may cause cancer are worrying so many women who had gone for breast cosmetic surgery. The standard of care was not there as manufacturers of breast implants use poor quality material. Who suffers daily worrying about the implants rupturing and causing cancer? How many celebrities with botched cosmetic surgeries have these young adults research? There is a website devoted to such cases but why bother to read them?
The years rush by. Time flies. Those young adults who acquire specialised relevant skills after graduation, works hard and is honest, get the good jobs globally as they are useful and indispensable to the employer.
Most of the old guards or senior citizens will never be able to compete in this global world for jobs needing more than a degree from the University and work experience. There is a need for specialised relevant technical experience in many high-paying jobs globally.
Many Singaporean young adults are blessed growing up in abundance in a Singapore, free of wars, natural disasters and crime from the 1950s - 2012 and are unprepared for the shocks of the real world. There are many hungry young adults in Eastern Europe and China who value time and money, and not cosmetic surgery to pretty themselves. They know the importance of hard work (not working 5 days a week, at 9-5 am) to succeed in life. Singaporean parents try to shelter their young ones from hard work and long hours, thinking that the world owes them a living. Or the Government will provide.
Many young Singaporeans don't bother to learn how to read the financial statements but will punt or accept a friend's advice to invest in some schemes which appear to be Pansy schemes. For example, buying a gold bar and paying for 20% below market price and getting regular returns above average. Sounds too good to be true and seems to me to be another version of Madoff's US$50 billion ponzi scheme on a small scale.
2012 appears to be another recession caused by the Euro crisis but how many young Singaporean adults can discuss in depth what is the Euro crisis and how it will impact their parents' livelihood, their own job prospects and their country's economy.
Webpage at:
http://www.sinpets.com/F6/20120110eye-cosmetic-cornea-laser-surgery-singapore_ToaPayohVets.htm
Travel Stories. Dubai - Jan 1, 2012 Winchester Hotel 12.08 am
Many young adults in a free world of abundance like Singapore, live in a virtual world of the smart phone texting and connecting with friends day to day. No responsibilities of adulthood and parenthood.
How to pretty themselves? How to look cools? There seems to be a trend in Singapore's young adults from the middle and upper class to go for Laser Surgery of two eyes.
It is cool. Their peers do it and they desire it. A 5-hour eye test free of charge. They are sold on the benefits and want to book immediately.
Go for cosmetic eye surgery since other young adults in the middle class go for it. Side effects like dry eyes that need eye drops daily after laser operation and corneal damage affecting beauty and vision due to a possible mis-positioning or inadvertent mistake by the sophisticated eye laser machines or machine operator are ignored. Such side effects will not happen to them. How about long-term effects on vision loss. Well, the young adults are invincible. They are not 30 years old. Why think longer than 1 year later? They are not aware of the other young adults who have adverse effects after the cosmetic eye surgery as they don't want to know. They think high tech eye laser machines are perfect and will not damage their cornea. $4,000 is the price. So what?
In Europe now, I read that 40,000 breast implants which leak and may cause cancer are worrying so many women who had gone for breast cosmetic surgery. The standard of care was not there as manufacturers of breast implants use poor quality material. Who suffers daily worrying about the implants rupturing and causing cancer? How many celebrities with botched cosmetic surgeries have these young adults research? There is a website devoted to such cases but why bother to read them?
The years rush by. Time flies. Those young adults who acquire specialised relevant skills after graduation, works hard and is honest, get the good jobs globally as they are useful and indispensable to the employer.
Most of the old guards or senior citizens will never be able to compete in this global world for jobs needing more than a degree from the University and work experience. There is a need for specialised relevant technical experience in many high-paying jobs globally.
Many Singaporean young adults are blessed growing up in abundance in a Singapore, free of wars, natural disasters and crime from the 1950s - 2012 and are unprepared for the shocks of the real world. There are many hungry young adults in Eastern Europe and China who value time and money, and not cosmetic surgery to pretty themselves. They know the importance of hard work (not working 5 days a week, at 9-5 am) to succeed in life. Singaporean parents try to shelter their young ones from hard work and long hours, thinking that the world owes them a living. Or the Government will provide.
Many young Singaporeans don't bother to learn how to read the financial statements but will punt or accept a friend's advice to invest in some schemes which appear to be Pansy schemes. For example, buying a gold bar and paying for 20% below market price and getting regular returns above average. Sounds too good to be true and seems to me to be another version of Madoff's US$50 billion ponzi scheme on a small scale.
2012 appears to be another recession caused by the Euro crisis but how many young Singaporean adults can discuss in depth what is the Euro crisis and how it will impact their parents' livelihood, their own job prospects and their country's economy.
Webpage at:
http://www.sinpets.com/F6/20120110eye-cosmetic-cornea-laser-surgery-singapore_ToaPayohVets.htm
808. Veterinary Surgery Productivity in Employee Vets
I have just updated the report today:
Jan 4, 2012. Wednesday. 2nd day at work.
A new client is difficult to come by as there are now 47 veterinary practices in Singapore. This was revealed to me by one veteran drugs salesman who saw me yesterday. We knew each other for more than 40 years and he had become busier now, with so many new practices compared to 4 when I first started out in 1982.
A quiet slim lady brought a black-brown Miniature Schnauzer to the Surgery as the dog had two loose front teeth. From her expressions and conversations directed at me, she would prefer me to handle her case. "I will do it together with Dr Vanessa as part of my mentoring process. When did the dog eat?"
"My dog ate at 10 am. Is it OK to do anaesthesia? "
"It is ideal that the dog should not have eaten for 10 hours before anaesthesia as the dog may vomit," I said. As the owner did not have time to postpone the tooth extraction, I said, "I will do it at 5 pm which is 6 hours later. It should be OK".
5-year Min Schnauzer, Female Spayed.
Chief complaint: 2 loose front tooth with exposed roots were surprisingly seen. Other teeth in good condition.
"i used the finger brush and gel," the owner said.
"You must have been brushing too vigorously," I replied. "The gums of the two incisors are exposed. It is best not to use the finger brush. In any case, the back teeth needs scaling."
Chief Complaint - My Schnauzer has two loose front teeth
Complaint No. 2 - My Schnauzer has a big ear lump that increases in size
4886 - 4895. Electro-surgery productivity
2nd complaint: R ear inflammatory nodule, firm, 7mmx7mmx5mm with central hole.
"A bee stung her tongue sometime ago," the lady said.
"Any bees seen in the last 2 weeks?" I asked as the owner said that the lump grows bigger in the past days. The dog had been scratching the right ear.
"It is best to excise it while the dog is under General Anaesthesia (GA) for dental scaling," I advised. "If you don't want histopathology, we will not know whether it is cancerous or not. A biopsy can be done but it costs money and delays. The best is for me to excise it since it is growing bigger day by day ."
The lady agreed to dental scaling and excision of the lump but not to blood test or histopathology. I asked Dr Vanessa to check the heart and pulse as well as general examination of the lungs. All were OK. So, the GA will be at 5pm to be done jointly.
I wanted to demonstrate how to be efficient and productive in veterinary surgery to my staff as it is one thing to lecture to young ones. Show how it is done will be best.
PLANNING
Scrub and clean ear well before sedation. "Any clipping of the ear?" Min asked me. "No need," I said.
I checked that Min had prepared the setting up of the electrosurgery equipment, dental scaling equipment and covered the operating table with a towel to prevent electric shocks to the vet on contact.
After all this was done, the dog's dosage of IV anaesthesia was calculated. "Give 50% of the calculated dose and you have around 10 minutes of anaesthesia," I said to Dr V
5 min after sedation, electro-excision by Dr Vanessa was completed within 60 seconds and then dental scaling was done. As the dog had little tartar due to the teacher's vigorous finger brushing, the dental scaling of the back teeth took a very short time.
Productivity means using the correct amount of anaesthetic drugs and least time to complete surgery and dental scaling. Therefore, the dog has the best chance of survival on the operating table. Delays by not preparing the equipment at first increases the risk and that would account for some deaths on the operating table.
The following is what happened as I asked my intern, Mr Lim to do the recording. Normally Min would do it but Mr Lim needed to be hands-on to learn if he wanted to be a vet after his National Service.
5.22 pm Sedate/IV anaesthesia at 50% dosage guideline*
5.25 pm Electro-excision
5.26 pm Dental scaling
5.36 pm End of dental scaling
*IV Anaesthesia Guideline Toa Payoh Vets and Dr Sing Kong Yuen
10kg, healthy, young dog. Domitor = 0.4 ml, Ketamine = 0.5ml IV combined
Usually no top up is required in a spay if done within 20-30 minutes.
This dog - 5 years is not young. The staff is to calculate on paper the dosage
D= 0.11ml + K=0.14 ml. Total = 0.25ml. Add 0.25ml Hartmann = 0.5 ml to be given IV.
Normally, the IV anaesthesia lasts around 15 minutes. I noted a very slight reaction to electro-incision which lasted less than 10 seconds. The dog was adequately sedated for dental scaling done by Dr V. Two teeth and nodule given to owner. I demonstrated that this case did NOT need any isoflurane and O2 top up if proper pre-op preparation had been done and the vet is skilful in using the electro-surgical instruments.
USE OF ELECTRODES
"Be careful not to bend the circular wire," I said to Dr V as she looped the nodule and the wire tilted at 45 degrees. "It is a very thin wire. It will break and it is very expensive to buy." The wire loop was originally 90 degrees to the electrode.
Training a person how to use the tools of the trade correctly is important and acquiring the correct skills makes a vet more productive. The Vet School provides some knowledge of electro-surgery but it is not possible to let every of the 60 - 80 students a chance to handle the electro-surgical equipment.
So they acquire the skills after graduation.
WART OR NODULE?
I would say it is an inflammatory nodule (with a hole in its centre, possibly bee sting). Dr V thinks it is an ear wart. "Physically, it does not look like a wart," I argued. "A wart usually is cauliflower shaped or rough, not smooth.
However, veterinary medicine has exceptions and I can't say this is not an ear wart. Since the owner does not want histopathology, we can't send the lump to the laboratory for examination. Therefore, there is no definitive diagnosis."
VACCINATION AND HEARTWORM PREVENTION
"I give heartworm tablets monthly," the owner said. "The last vaccination was 2 years ago." I explained to her the difference between the usual vaccination and heartworm.
"You may be getting your priority wrong. In the countryside like England, where most dogs don't meet other dogs, some dogs may be safe without further vaccination as they don't get exposed to many other dogs as in city living." I explained. "Parvovirus is still around. Distemper is still present in unvaccinated puppies. Have you been to England?" I asked. She said she was in England for two years and understood what I said.
VETERINARY PRODUCTIVITY AND EFFICIENCY
Many employee vets and doctors are not aware of the need to manage financial costs as this subject is not taught in vet school in detail if at all. So, they use materials and waste time in surgery. After all, they don't pay out of their own pockets and so do not bother with using excessive packets of sutures or finding more efficient ways to stitch up a case.
If there is no proper planning, a lot of time and material are wasted. This dog would need top up IV anaesthesia or isoflurane gas to complete the job. As demonstrated by me, the whole process after sedation took 3 minutes for electro-excision and 10 minutes for dental scaling.
An example of poor productivity and efficiency in vet surgery would be as follows:
The dog was sedated for a spay. The legs were then anchored to the op table. The vet assistant started clipping the surgical area inside the surgery room. Then the area would be cleaned. A gas mask would be given to the dog to deliver isoflurane gas and O2. The dog struggled as sedation wore off. A lot of time had been wasted.
My usual method is as follows:
To clip the dog (not ferocious) at the Preparation Room. Clean the surgical area. Sedate with Domitor and Ketamine IV. Dog goes into Operation Room. Anchor legs to table and clean surgical area again. Wait 5 minutes (time spent after sedation would take 5 minutes). Gas mask to deliver isoflurane and O2. Intubate. Spay. A lot of time is saved and the dog is exposed to much less anaesthetic in this way
.
OUTCOME
The dog in this case was groggy for over 1 hour as I did not use Antisedan to reverse the Domitor as I deem it not necessary to wake the dog up so early as she might feel the pain. Pain-killer and antibiotic injections were given.
The dog went home without problems as at 12 hours at the time of writing this first draft report. However, in this final copy, the owner had texted me saying that the surgical area was weepy and inflamed and what should she do?
"Hi dr Sing, I'm .....Brought ....to ur clinic for teeth extraction n ear surgery on Wed. ....ear is not doing well...Had inflammation. Can I administer iodine on her ear? What shd I do? I gv her medication as indicated, didn't bring her out. Can y kindly advise? Thanks very much
Younger people prefer texting. I phoned her and advised daily cleaning with the iodine and to let the dog wear the e-collar as she had been scratching the surgical area. She would let me know if there are problems again.
AN EXAMPLE OF POOR PRODUCTIVITY WASTING MANY HOURS HAPPENED ON THE SAME DAY
The HDB contractor came to replace the wooden bathroom door (rotten base) with a plastic one. He dismantled the door and then found that the plastic one was too narrow to fit in. 3 weeks ago, another person had come to measure the dimensions. This was really a waste of time, being unproductive. This is what I mean by productivity and efficiency.
"Please put back the old door," I asked the thin Malaysian man from Malacca with jet black hair. "I have a lady vet and you can understand that she can't use the bathroom with no doors. She works to past 8 pm at night. For men, an open door may be OK"
The contractor actually took the trouble to fix back the old door and said, "OK. I will get the new door back to the factory to replace one with correct dimensions today." He had previously said it might take 2 weeks, since Chinese New Year falls on Jan 22, 2012 and most workers had gone home. I was surprised. He even gave me two discarded wooden boards for me as shelving.
More pictures are at:
http://www.sinpets.com/F6/20120107vigorous-finger-tooth-brush-exposed-roots-Schnauzer-singapore_ToaPayohVets.htm
Jan 4, 2012. Wednesday. 2nd day at work.
A new client is difficult to come by as there are now 47 veterinary practices in Singapore. This was revealed to me by one veteran drugs salesman who saw me yesterday. We knew each other for more than 40 years and he had become busier now, with so many new practices compared to 4 when I first started out in 1982.
A quiet slim lady brought a black-brown Miniature Schnauzer to the Surgery as the dog had two loose front teeth. From her expressions and conversations directed at me, she would prefer me to handle her case. "I will do it together with Dr Vanessa as part of my mentoring process. When did the dog eat?"
"My dog ate at 10 am. Is it OK to do anaesthesia? "
"It is ideal that the dog should not have eaten for 10 hours before anaesthesia as the dog may vomit," I said. As the owner did not have time to postpone the tooth extraction, I said, "I will do it at 5 pm which is 6 hours later. It should be OK".
5-year Min Schnauzer, Female Spayed.
Chief complaint: 2 loose front tooth with exposed roots were surprisingly seen. Other teeth in good condition.
"i used the finger brush and gel," the owner said.
"You must have been brushing too vigorously," I replied. "The gums of the two incisors are exposed. It is best not to use the finger brush. In any case, the back teeth needs scaling."
Chief Complaint - My Schnauzer has two loose front teeth
Complaint No. 2 - My Schnauzer has a big ear lump that increases in size
4886 - 4895. Electro-surgery productivity
2nd complaint: R ear inflammatory nodule, firm, 7mmx7mmx5mm with central hole.
"A bee stung her tongue sometime ago," the lady said.
"Any bees seen in the last 2 weeks?" I asked as the owner said that the lump grows bigger in the past days. The dog had been scratching the right ear.
"It is best to excise it while the dog is under General Anaesthesia (GA) for dental scaling," I advised. "If you don't want histopathology, we will not know whether it is cancerous or not. A biopsy can be done but it costs money and delays. The best is for me to excise it since it is growing bigger day by day ."
The lady agreed to dental scaling and excision of the lump but not to blood test or histopathology. I asked Dr Vanessa to check the heart and pulse as well as general examination of the lungs. All were OK. So, the GA will be at 5pm to be done jointly.
I wanted to demonstrate how to be efficient and productive in veterinary surgery to my staff as it is one thing to lecture to young ones. Show how it is done will be best.
PLANNING
Scrub and clean ear well before sedation. "Any clipping of the ear?" Min asked me. "No need," I said.
I checked that Min had prepared the setting up of the electrosurgery equipment, dental scaling equipment and covered the operating table with a towel to prevent electric shocks to the vet on contact.
After all this was done, the dog's dosage of IV anaesthesia was calculated. "Give 50% of the calculated dose and you have around 10 minutes of anaesthesia," I said to Dr V
5 min after sedation, electro-excision by Dr Vanessa was completed within 60 seconds and then dental scaling was done. As the dog had little tartar due to the teacher's vigorous finger brushing, the dental scaling of the back teeth took a very short time.
Productivity means using the correct amount of anaesthetic drugs and least time to complete surgery and dental scaling. Therefore, the dog has the best chance of survival on the operating table. Delays by not preparing the equipment at first increases the risk and that would account for some deaths on the operating table.
The following is what happened as I asked my intern, Mr Lim to do the recording. Normally Min would do it but Mr Lim needed to be hands-on to learn if he wanted to be a vet after his National Service.
5.22 pm Sedate/IV anaesthesia at 50% dosage guideline*
5.25 pm Electro-excision
5.26 pm Dental scaling
5.36 pm End of dental scaling
*IV Anaesthesia Guideline Toa Payoh Vets and Dr Sing Kong Yuen
10kg, healthy, young dog. Domitor = 0.4 ml, Ketamine = 0.5ml IV combined
Usually no top up is required in a spay if done within 20-30 minutes.
This dog - 5 years is not young. The staff is to calculate on paper the dosage
D= 0.11ml + K=0.14 ml. Total = 0.25ml. Add 0.25ml Hartmann = 0.5 ml to be given IV.
Normally, the IV anaesthesia lasts around 15 minutes. I noted a very slight reaction to electro-incision which lasted less than 10 seconds. The dog was adequately sedated for dental scaling done by Dr V. Two teeth and nodule given to owner. I demonstrated that this case did NOT need any isoflurane and O2 top up if proper pre-op preparation had been done and the vet is skilful in using the electro-surgical instruments.
USE OF ELECTRODES
"Be careful not to bend the circular wire," I said to Dr V as she looped the nodule and the wire tilted at 45 degrees. "It is a very thin wire. It will break and it is very expensive to buy." The wire loop was originally 90 degrees to the electrode.
Training a person how to use the tools of the trade correctly is important and acquiring the correct skills makes a vet more productive. The Vet School provides some knowledge of electro-surgery but it is not possible to let every of the 60 - 80 students a chance to handle the electro-surgical equipment.
So they acquire the skills after graduation.
WART OR NODULE?
I would say it is an inflammatory nodule (with a hole in its centre, possibly bee sting). Dr V thinks it is an ear wart. "Physically, it does not look like a wart," I argued. "A wart usually is cauliflower shaped or rough, not smooth.
However, veterinary medicine has exceptions and I can't say this is not an ear wart. Since the owner does not want histopathology, we can't send the lump to the laboratory for examination. Therefore, there is no definitive diagnosis."
VACCINATION AND HEARTWORM PREVENTION
"I give heartworm tablets monthly," the owner said. "The last vaccination was 2 years ago." I explained to her the difference between the usual vaccination and heartworm.
"You may be getting your priority wrong. In the countryside like England, where most dogs don't meet other dogs, some dogs may be safe without further vaccination as they don't get exposed to many other dogs as in city living." I explained. "Parvovirus is still around. Distemper is still present in unvaccinated puppies. Have you been to England?" I asked. She said she was in England for two years and understood what I said.
VETERINARY PRODUCTIVITY AND EFFICIENCY
Many employee vets and doctors are not aware of the need to manage financial costs as this subject is not taught in vet school in detail if at all. So, they use materials and waste time in surgery. After all, they don't pay out of their own pockets and so do not bother with using excessive packets of sutures or finding more efficient ways to stitch up a case.
If there is no proper planning, a lot of time and material are wasted. This dog would need top up IV anaesthesia or isoflurane gas to complete the job. As demonstrated by me, the whole process after sedation took 3 minutes for electro-excision and 10 minutes for dental scaling.
An example of poor productivity and efficiency in vet surgery would be as follows:
The dog was sedated for a spay. The legs were then anchored to the op table. The vet assistant started clipping the surgical area inside the surgery room. Then the area would be cleaned. A gas mask would be given to the dog to deliver isoflurane gas and O2. The dog struggled as sedation wore off. A lot of time had been wasted.
My usual method is as follows:
To clip the dog (not ferocious) at the Preparation Room. Clean the surgical area. Sedate with Domitor and Ketamine IV. Dog goes into Operation Room. Anchor legs to table and clean surgical area again. Wait 5 minutes (time spent after sedation would take 5 minutes). Gas mask to deliver isoflurane and O2. Intubate. Spay. A lot of time is saved and the dog is exposed to much less anaesthetic in this way
.
OUTCOME
The dog in this case was groggy for over 1 hour as I did not use Antisedan to reverse the Domitor as I deem it not necessary to wake the dog up so early as she might feel the pain. Pain-killer and antibiotic injections were given.
The dog went home without problems as at 12 hours at the time of writing this first draft report. However, in this final copy, the owner had texted me saying that the surgical area was weepy and inflamed and what should she do?
"Hi dr Sing, I'm .....Brought ....to ur clinic for teeth extraction n ear surgery on Wed. ....ear is not doing well...Had inflammation. Can I administer iodine on her ear? What shd I do? I gv her medication as indicated, didn't bring her out. Can y kindly advise? Thanks very much
Younger people prefer texting. I phoned her and advised daily cleaning with the iodine and to let the dog wear the e-collar as she had been scratching the surgical area. She would let me know if there are problems again.
AN EXAMPLE OF POOR PRODUCTIVITY WASTING MANY HOURS HAPPENED ON THE SAME DAY
The HDB contractor came to replace the wooden bathroom door (rotten base) with a plastic one. He dismantled the door and then found that the plastic one was too narrow to fit in. 3 weeks ago, another person had come to measure the dimensions. This was really a waste of time, being unproductive. This is what I mean by productivity and efficiency.
"Please put back the old door," I asked the thin Malaysian man from Malacca with jet black hair. "I have a lady vet and you can understand that she can't use the bathroom with no doors. She works to past 8 pm at night. For men, an open door may be OK"
The contractor actually took the trouble to fix back the old door and said, "OK. I will get the new door back to the factory to replace one with correct dimensions today." He had previously said it might take 2 weeks, since Chinese New Year falls on Jan 22, 2012 and most workers had gone home. I was surprised. He even gave me two discarded wooden boards for me as shelving.
More pictures are at:
http://www.sinpets.com/F6/20120107vigorous-finger-tooth-brush-exposed-roots-Schnauzer-singapore_ToaPayohVets.htm
Sunday, January 8, 2012
807. Sunday's interesting cases Jan 8, 2012
Case 1. Follow up of my first case seen in 2012 - The coughing Bichon puppy
The owner was surprised and appreciative to receive my call.
He said: "More active and much less coughing now. You are correct in that the puppy looks more like a Bichon than a poodle as we had checked the dog books.
"Does he still pee a bit to get treats?" I asked.
"Yes, he is a manipulative puppy as you had said."
This is a smart puppy.
Case 2. The 13-year-old male Shih Tzu barks when touched.
"This time, I decide to bring in my dog earlier than in Nov 5, 2011 when my dog barks when my wife wanted to clean him after eating or when he lay sideways. Dr Jason Teo prescribed rimadyl 25 mg for 7 days and he was OK."
On spending time with him, he said that Dr Jason Teo had got an X-ray done and nothing abnormal was seen. He had also asked for another 7 days of rimadyl and he dog was OK till Jan 6, 2012 (2 days ago).
PRESENTING SIGNS. Hunched back.
After Dr V had examined, I did an abdominal palpation and spinal area palpation.
"A hunched back indicates pain in the abdomen," I said to the owner.
"Where?"
I put my left hand on the front part of the abdomen and pressed. There was some sweling in the liver and spleen area to the kidneys. The dog yelped in reaction.
A painful liver/spleen area. The dog coughed violently when I palpated the pharynx.
So, there was pain. What's the cause? Tumour and/or inflammation of the kidneys, stomach, liver?
Blood test and urine test doe
The owner was surprised and appreciative to receive my call.
He said: "More active and much less coughing now. You are correct in that the puppy looks more like a Bichon than a poodle as we had checked the dog books.
"Does he still pee a bit to get treats?" I asked.
"Yes, he is a manipulative puppy as you had said."
This is a smart puppy.
Case 2. The 13-year-old male Shih Tzu barks when touched.
"This time, I decide to bring in my dog earlier than in Nov 5, 2011 when my dog barks when my wife wanted to clean him after eating or when he lay sideways. Dr Jason Teo prescribed rimadyl 25 mg for 7 days and he was OK."
On spending time with him, he said that Dr Jason Teo had got an X-ray done and nothing abnormal was seen. He had also asked for another 7 days of rimadyl and he dog was OK till Jan 6, 2012 (2 days ago).
PRESENTING SIGNS. Hunched back.
After Dr V had examined, I did an abdominal palpation and spinal area palpation.
"A hunched back indicates pain in the abdomen," I said to the owner.
"Where?"
I put my left hand on the front part of the abdomen and pressed. There was some sweling in the liver and spleen area to the kidneys. The dog yelped in reaction.
A painful liver/spleen area. The dog coughed violently when I palpated the pharynx.
So, there was pain. What's the cause? Tumour and/or inflammation of the kidneys, stomach, liver?
Blood test and urine test doe
Saturday, January 7, 2012
806. The ferocious female cat passing red blood in the urine
Saturday Jan 7, 2012
I went to work although it is my day off. Checked on the cat that passed blood in the urine and under Dr V's care. The lady owner phoned: "How's Toto?" I said: "I am Dr Sing. Dr V is off today. Toto has not been passing blood in the urine since yesterday's admission to the Surgery." The cat was in a grated flooring and dark brown urine was seen, no more red blood."
"It was my grandpa who said that the cat had passed blood in the urine," the young lady said. "I don't see it."
"Well, grandpa is correct," I replied. "I saw the red blood myself when Dr V was sedating the cat. I was present and had tried to express some urine for the urine test." Around 1 ml was expressed after sedation. Bladder was empty. I did not palpate any big stone or thick wall suggstive of tumour. So this was likely an infection of the bladder, cystitis.
FLASHBACK YESTERDAY
A lady in her late 30s and her grandpa came with a brown cat to see Dr V. A vet had treated this cat, prescribed antibiotics and a Eukanaba dry food "guaranteeing" that the urination problem would be resolved if this dry food was consumed.
"This cat is fierce," the lady said. So, Dr V, Min, Nicole and Mr Lim were in the room
I went to work although it is my day off. Checked on the cat that passed blood in the urine and under Dr V's care. The lady owner phoned: "How's Toto?" I said: "I am Dr Sing. Dr V is off today. Toto has not been passing blood in the urine since yesterday's admission to the Surgery." The cat was in a grated flooring and dark brown urine was seen, no more red blood."
"It was my grandpa who said that the cat had passed blood in the urine," the young lady said. "I don't see it."
"Well, grandpa is correct," I replied. "I saw the red blood myself when Dr V was sedating the cat. I was present and had tried to express some urine for the urine test." Around 1 ml was expressed after sedation. Bladder was empty. I did not palpate any big stone or thick wall suggstive of tumour. So this was likely an infection of the bladder, cystitis.
FLASHBACK YESTERDAY
A lady in her late 30s and her grandpa came with a brown cat to see Dr V. A vet had treated this cat, prescribed antibiotics and a Eukanaba dry food "guaranteeing" that the urination problem would be resolved if this dry food was consumed.
"This cat is fierce," the lady said. So, Dr V, Min, Nicole and Mr Lim were in the room
Thursday, January 5, 2012
806.. Old mother died from post-op infections in the ward
I read this somewhere in the Straits Times in Dec 2011.
The surgeon operated successfully on the heart of the old mother. She became infected in the ward and it seemed that the doctors had not attended to her. She died. Civil suit. The registrar resigned and the surgical intern gave up his surgical internship.
Post-op infections can be very serious in old people and dogs.
The surgeon operated successfully on the heart of the old mother. She became infected in the ward and it seemed that the doctors had not attended to her. She died. Civil suit. The registrar resigned and the surgical intern gave up his surgical internship.
Post-op infections can be very serious in old people and dogs.
Subscribe to:
Posts (Atom)