I will be on leave from April 29 to May 2, 2012 and will be in Cambodia. Any queries can be directed to Dr Daniel Sing +65 9664 0404 or text me at +65 9668-6468. Best wishes.
If the internet connections are OK, I will be blogging in Cambodia.
Saturday, April 28, 2012
967. The new Yangon vet practice
On April 25, 2012, I sent James Aung and his wife off at Changi Airport to Yangon. He has been renovating his own practice in Yangon and should be opening in June 2012.
James Aung is a Myanmar qualified veterinarian but in Singapore, he is just a veterinary technician. He had worked in various practices and know much more over the last 20 years as he is hands-on in assisting in veterinary surgery and medicine. He gives values to his employers by giving more time and effort to hospitalised cases than expected of an employee. He has earned a good reputation in Singapore.
"Got to get the models to be at the opening ceremony," the wife had invited me by offering to pay for my air tickets. Her friend had the connections to the media in Yangon. Car salesroom in Yangon always show models standing around.
"No models," I advised. "Actresses and actors. Famous ones! Any lion dance like Dr Jason Teo who opened his clinic?"
"No, no," the wife said. "Lion dances are for the Chinese."
"Ok, how about horse or donkey dance?" I asked as I had seen such events during my travel to Mandalay from a resort military garrison town.
In this practice, a big pre-owned car had been bought for $60,000 cash. Renovation of the 3-storey building would be at least $40,000. Two water tanks, a well dug and sewerage pits must be planned unlike in Singapore.
Sometimes, it is penny wise pound foolish in starting up a vet clinic. James said he would buy the auroscope but not the opthalmoscope because his wife objected. I told the wife that was not the right thing to do and she gave permission. Asian wives can be quite powerful as James hand over his pay to his wife and get an allowance.
Still, there is much more to having a pretty modern veterinary clinic and an experienced vet like James. Will the clinic be able to sustain its profitability? There is the marketing part. The business development part. The technical part. If the clinic is not profitable over the years, it is a white elephant and James' wife would have lost a lot of money..
James Aung is a Myanmar qualified veterinarian but in Singapore, he is just a veterinary technician. He had worked in various practices and know much more over the last 20 years as he is hands-on in assisting in veterinary surgery and medicine. He gives values to his employers by giving more time and effort to hospitalised cases than expected of an employee. He has earned a good reputation in Singapore.
"Got to get the models to be at the opening ceremony," the wife had invited me by offering to pay for my air tickets. Her friend had the connections to the media in Yangon. Car salesroom in Yangon always show models standing around.
"No models," I advised. "Actresses and actors. Famous ones! Any lion dance like Dr Jason Teo who opened his clinic?"
"No, no," the wife said. "Lion dances are for the Chinese."
"Ok, how about horse or donkey dance?" I asked as I had seen such events during my travel to Mandalay from a resort military garrison town.
In this practice, a big pre-owned car had been bought for $60,000 cash. Renovation of the 3-storey building would be at least $40,000. Two water tanks, a well dug and sewerage pits must be planned unlike in Singapore.
Sometimes, it is penny wise pound foolish in starting up a vet clinic. James said he would buy the auroscope but not the opthalmoscope because his wife objected. I told the wife that was not the right thing to do and she gave permission. Asian wives can be quite powerful as James hand over his pay to his wife and get an allowance.
Still, there is much more to having a pretty modern veterinary clinic and an experienced vet like James. Will the clinic be able to sustain its profitability? There is the marketing part. The business development part. The technical part. If the clinic is not profitable over the years, it is a white elephant and James' wife would have lost a lot of money..
966. Sharing memories online - SingaporeMemory.sg web portal
1. The Singapore Memory Project aims to build up the story of Singapore through the eyes of Singaporeans was started in 2011 and aims to collect 5 million memories from Singaporeans by 2015
2. Every Singaporean has a "personal memory account" on the website. An SG Memory iPhone app will be launched in April 2012.
3. I would like the future generation to know more about Singapore veterinary matters and learn from the mis-steps of some pet owners, therefore I have participated in this Project. However, most of my files will be at http://www.toapayohvets.com/ and http://www.bekindtopets.com/ .
4. Sustainability of the Project. As I don't know how long the Singapore Memory Project will be around as all government policies keep changing (new Chief Executives/Board of Directors have their own pet ideas and chop and slash older projects when there is a need to cut cost and this Project is free of charge), I have copied my notes written at the Project webpage below:
PARTICIPATION IN THE SINGAPORFE MEMORY PROJECT
Saturday, April 29, 2012
I am Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS, aged 61 years, a veterinary surgeon in Singapore. I graduated in 1974 and there was around 1 small animal veterinary practice located in a commercial premises in Watten Estate.
After graduation, I had to work for the Primary Production Department for 8 years (inclusive of 2.5 years in full-time National Service), as a condition of my veterinary scholarship. Soon after graduation, I met Dr James Tan, a private dog and cat vet 5 years my senior, telling me he had to be on the look-out for Dr Giam Choo Hoo, from the Primary Production Department. He was practising from his home in Tiverton Lane and I presumed he was being hounded. I was a greenhorn and did not ask him why he had to behave that way.
Now, there are over 45 veterinary practices and the numbers keep increasing as some of the younger vets are well financed by their parents who set up the practices for them. I had no such fortune.
In 2012, the younger generation dog and cat owners are much more sophisticated owing of internet information and are much more caring compared to my baby-boomer generation when I started Toa Payoh Vets sometime in 1982.
I record my stories of so many interesting clients I encountered and their pets' conditions, at www.toapayohvets.com as part of my giving back to the small animal community and to bring veterinary medicine and surgery alive to the stressed out veterinary undergraduate. I hope the stories of practice-based research cases are of interest and use to the new generation in the years to come.
The link to the Project is at:
http://www.singaporememory.sg/contents/SMA-d847587c-eca0-41c9-b042-991b2a7ae823
I hope this Project is still around in 2015. Five million memories are not difficult to get from Singaporeans. It is the quality of the memories that is difficult to source.
Friday, April 27, 2012
965. Food allergy?
"I guess every vet will give a different opinion about the skin infections on the lower body," the woman brought in an older Golden Retriever full of ticks and Vet 1 had prescribed anti-allergy food diet for the past 3 months. But the dog was still furiously scratching to blackness, the neck and armpits.
The pest control had fumigated the garden and house and the dog would need to be de-ticked by a vet.
"My theory is that the dog had itchy infected ears and he scratched with his hind paws, the neck to relieve the ear itch for many weeks till the skin becomes black."
As if on cue, the dog's hind leg vigorously scrubbed the neck.
A plan of treatment is given to Dr Vanessa to treat this dog. I doubt its black neck and armpits are due to dog food allergy.
"I trim the hair short," the owner said.
The pest control had fumigated the garden and house and the dog would need to be de-ticked by a vet.
"My theory is that the dog had itchy infected ears and he scratched with his hind paws, the neck to relieve the ear itch for many weeks till the skin becomes black."
As if on cue, the dog's hind leg vigorously scrubbed the neck.
A plan of treatment is given to Dr Vanessa to treat this dog. I doubt its black neck and armpits are due to dog food allergy.
"I trim the hair short," the owner said.
964. Two old female spayed dogs
Yesterday, Thursday, April 25, 2012, I saw two old female spayed dogs from 7.20 pm to 9.30 pm.
Case 1. Lhasa Apso, 13 years. Tearing on right eye last 2 days. I used fluroescein strip and showed the lady owner that the dog had a new ulcer. A white scar above it was bigger and was a healed ulcer. The left eye cornea also had white ulcers.
"I am out of Clavulox," she was prescribed Clavulox to be given 3 times a week for many weeks as her dog had "lump" in the bladder on X-ray and had bacteria on initial urine analysis. She does regular health screening of blood and urine test with Vet 1. "No more bacteria in the urine," she said. I checked the vulval mucosa. The dog winced and withdrew. But overall, there was only inflammation at the tip.
There are some vet recommendations to give antibiotics weekly at 2-3x/week for many weeks for UTI, but I would not advise it. It would lead to drug resistance. So I did not prescribe antibiotics. For the eye ulcer, the husband requested e-collar wearing instead of surgery. So, this matter was settled by the husband.
Case 2. Miniature Schnauzer, 15 years, panting, swollen abdomen
Vet 1 suspected liver tumours (blood test on elevated liver enzymes and X-ray of enlarge liver) and advised an ultrasound.
"Abdomen looked fully distended as if it is going to burst," I viewed the X-ray. "What did Vet 1 say about this swollen abadomen?"
"She said nothing," the lady told me. "She put a needle in and nothing came out from the needle."
Overall, this would be a case of liver disease and I gave a poor prognosis of 6 months or less to live.
The surprising findings were:
1. that the Schnauzer's teeth were still good and had little tartar despite no dental work done, according to the owner.
2. the vulval lips and lower inguinal area were jet black, as compared to the Lhasa Apso above. The vulval mucosa was bright red. All these suggested a chronic UTI.
I advised monitoring of water intake and panting as I prescribed medication. Today, April 27, 2012, I phoned up. The 66-year-old mum answered the house phone and said: "The stomach is still swollen as before. I guess it will take time for the drugs to work."
"Is the dog panting?" I asked.
"Much less," the mother and later the daughter phoned me, gave the feedback.
"Is the dog more active?" I asked.
"Yes," the mum said.
"Did the dog pee a lot?"
"Yes, more than 3 x last night."
My hypothesis is that the fluid accumulated in the abdomen caused pain and difficulty in breathing, leading to heavy panting.
"Did the dog eat the L/D diet?" I asked.
"1/4 can."
Case 1. Lhasa Apso, 13 years. Tearing on right eye last 2 days. I used fluroescein strip and showed the lady owner that the dog had a new ulcer. A white scar above it was bigger and was a healed ulcer. The left eye cornea also had white ulcers.
"I am out of Clavulox," she was prescribed Clavulox to be given 3 times a week for many weeks as her dog had "lump" in the bladder on X-ray and had bacteria on initial urine analysis. She does regular health screening of blood and urine test with Vet 1. "No more bacteria in the urine," she said. I checked the vulval mucosa. The dog winced and withdrew. But overall, there was only inflammation at the tip.
There are some vet recommendations to give antibiotics weekly at 2-3x/week for many weeks for UTI, but I would not advise it. It would lead to drug resistance. So I did not prescribe antibiotics. For the eye ulcer, the husband requested e-collar wearing instead of surgery. So, this matter was settled by the husband.
Case 2. Miniature Schnauzer, 15 years, panting, swollen abdomen
Vet 1 suspected liver tumours (blood test on elevated liver enzymes and X-ray of enlarge liver) and advised an ultrasound.
"Abdomen looked fully distended as if it is going to burst," I viewed the X-ray. "What did Vet 1 say about this swollen abadomen?"
"She said nothing," the lady told me. "She put a needle in and nothing came out from the needle."
Overall, this would be a case of liver disease and I gave a poor prognosis of 6 months or less to live.
The surprising findings were:
1. that the Schnauzer's teeth were still good and had little tartar despite no dental work done, according to the owner.
2. the vulval lips and lower inguinal area were jet black, as compared to the Lhasa Apso above. The vulval mucosa was bright red. All these suggested a chronic UTI.
I advised monitoring of water intake and panting as I prescribed medication. Today, April 27, 2012, I phoned up. The 66-year-old mum answered the house phone and said: "The stomach is still swollen as before. I guess it will take time for the drugs to work."
"Is the dog panting?" I asked.
"Much less," the mother and later the daughter phoned me, gave the feedback.
"Is the dog more active?" I asked.
"Yes," the mum said.
"Did the dog pee a lot?"
"Yes, more than 3 x last night."
My hypothesis is that the fluid accumulated in the abdomen caused pain and difficulty in breathing, leading to heavy panting.
"Did the dog eat the L/D diet?" I asked.
"1/4 can."
963. Follow up: GME? The circling Schnauzer
Mini Sch Male 12 years
Consulted Vet 1 two weeks ago but Vet 1 said no obvious problem but would require MRI and blood test.
I saw the dog on April 24, 2012. Dog was circling anti-clockwise in smaller and small circles. Collapsed on April 24, 2012 as she couldn't circle anymore as the circle was too tight. Continuous movement, whining. Loss of bladder control. Euthanasia not accepted by the young lady owner. Her colleague referred her to me.
Warded 2 days. Treated. Could look straight when sent home on April 25, 2012 with phenobarb 30 mg bid.
Friday April 27, 2012
Follow up: Phoned lady owner today
1. Dog has excellent appetite, could control bladder and bowel movements
2. Head tilt to the left mainly but not permanently as prior to my treatment. Walk mainly anti-clockwise but can walk straight or turn right.
3. Head tilt to the right and left, like a pendulum sometimes. Therefore left and right turning possible, instead of permanently circling anti-clockwise befoe.
4. Can see
5. Looks at owner when called.
6. Not as restless as before treatment. No obsessive need to walk anti-clockwise and whine continuously.
7. "Is he dopey and sleepy?" I asked. "Not really," she said. I asked her to monitor the times of usage of phenobarb, now given twice a day by a family member.
Will phenobarb work? Much depends on owner's compliance with medication dosage and timing. There needs to be follow up by the owner.
Cause of this brain disease to be GME? Granulomatous meningo-encephalitis?
Eosinophils and monocytes were higher than normal.
Consulted Vet 1 two weeks ago but Vet 1 said no obvious problem but would require MRI and blood test.
I saw the dog on April 24, 2012. Dog was circling anti-clockwise in smaller and small circles. Collapsed on April 24, 2012 as she couldn't circle anymore as the circle was too tight. Continuous movement, whining. Loss of bladder control. Euthanasia not accepted by the young lady owner. Her colleague referred her to me.
Warded 2 days. Treated. Could look straight when sent home on April 25, 2012 with phenobarb 30 mg bid.
Friday April 27, 2012
Follow up: Phoned lady owner today
1. Dog has excellent appetite, could control bladder and bowel movements
2. Head tilt to the left mainly but not permanently as prior to my treatment. Walk mainly anti-clockwise but can walk straight or turn right.
3. Head tilt to the right and left, like a pendulum sometimes. Therefore left and right turning possible, instead of permanently circling anti-clockwise befoe.
4. Can see
5. Looks at owner when called.
6. Not as restless as before treatment. No obsessive need to walk anti-clockwise and whine continuously.
7. "Is he dopey and sleepy?" I asked. "Not really," she said. I asked her to monitor the times of usage of phenobarb, now given twice a day by a family member.
Will phenobarb work? Much depends on owner's compliance with medication dosage and timing. There needs to be follow up by the owner.
Cause of this brain disease to be GME? Granulomatous meningo-encephalitis?
Eosinophils and monocytes were higher than normal.
Thursday, April 26, 2012
962. Scratched by an angry drooling cat
On April 24, 2012, I peeped into the consultation room and saw my assistant Min holding a lasso at a hissing cat about to be treated by Dr Vanessa 1 with subcutaneous fluid and antibiotics before dental work the next day as the cat had not eaten for the past few days.
"Stop," I said. "You can't lasso the cat in an open consultation room." Actually I had thought them what to do with aggressive cats which are rather rarely encountered and I presumed they have forgotten. What happened was that this cat came in with drooling and bad breath and I had demonstrated to Dr Vanessa how I would examine the cat. I put the cat on the examination table, opened his mouth wide and shown the white torch-light inside the mouth.
The cat was rather quiet but he got quite fed up with me as I pried open his mouth again to check for oral tumours and ulcers and plaques in the fauces (back). He had pain in the mouth and here I had not respected him. The careful thing to do would be to sedate him to examine his mouth but he was sickly and had a fever. I advised treatment with fluid and antibiotics first and dental work under anaesthesia the next day.
So, in the afternoon, there was Min, with bite scars from dogs and cats, holding the lasso inside the consultation room and preparing to get the cat out of the wooden crate. I went into the room to show how I would restrain the cat by the scruff of the neck. "Take the cat cage into the room," I told Min as we need to put him into a crate. His owner had a small rattan box carrier and no angry cat would go in. Min said: "My hand is weak, can't do it."
So Min could not restrain the cat for injection by me. He had some bad luck with cats as he had not been able to read "angry cat or dog behaviour" and got some serious hand injuries in the past year and I had to get him to see the human doctor twice! This was despite the fact that he had worked in a Malaysian vet surgery the year before. As the consultation room is very small, I asked her to leave the room. I took the cat out of the crate, placed him on the consultation table. No problem so far but the cat's tail and back hairs were up. He started hissing. From the look of his eyes, I know I had no time. "Open the crate upper door," I shouted to Min. Just in time, I put the cat into the crate. He hissed and jumped up like a pole vaulter. His claws pricked in my left hand and my middle finger of my right hand. Min got some claw marks too.
It was a matter of seconds, like a lightning strike. "The best way is to sedate the cat inside the crate with Zoletil 100 IM according to weight, and commence with the dental work," I said to Dr Vanessa. "You must inform the owner of the change of plans," Dr Vanessa reminded me. So, she did the necessary and had the cat's 4 rotten back teeth extracted, did scaling and sent the cat home the next day. Not a single claw scratch for her! As a routine, I do open the mouth of all salivating cats. Maybe, I ought to do it once and not more times. But no cat would co-operate as he has oral pain and a visual examination is important to plan for treatment.
Fortunately, we don't encounter many dangerous cats at Toa Payoh Vets as Min does the front-line. In this case, if he had lassoed the cat, all hell will break loose. It is important to reinforce instructions to staff several times as different situations occur and staff are people who think in different ways.
On April 24, 2012, I peeped into the consultation room and saw my assistant Min holding a lasso at a hissing cat about to be treated by Dr Vanessa 1 with subcutaneous fluid and antibiotics before dental work the next day as the cat had not eaten for the past few days.
"Stop," I said. "You can't lasso the cat in an open consultation room." Actually I had thought them what to do with aggressive cats which are rather rarely encountered and I presumed they have forgotten. What happened was that this cat came in with drooling and bad breath and I had demonstrated to Dr Vanessa how I would examine the cat. I put the cat on the examination table, opened his mouth wide and shown the white torch-light inside the mouth.
The cat was rather quiet but he got quite fed up with me as I pried open his mouth again to check for oral tumours and ulcers and plaques in the fauces (back). He had pain in the mouth and here I had not respected him. The careful thing to do would be to sedate him to examine his mouth but he was sickly and had a fever. I advised treatment with fluid and antibiotics first and dental work under anaesthesia the next day.
So, in the afternoon, there was Min, with bite scars from dogs and cats, holding the lasso inside the consultation room and preparing to get the cat out of the wooden crate. I went into the room to show how I would restrain the cat by the scruff of the neck. "Take the cat cage into the room," I told Min as we need to put him into a crate. His owner had a small rattan box carrier and no angry cat would go in. Min said: "My hand is weak, can't do it."
So Min could not restrain the cat for injection by me. He had some bad luck with cats as he had not been able to read "angry cat or dog behaviour" and got some serious hand injuries in the past year and I had to get him to see the human doctor twice! This was despite the fact that he had worked in a Malaysian vet surgery the year before. As the consultation room is very small, I asked her to leave the room. I took the cat out of the crate, placed him on the consultation table. No problem so far but the cat's tail and back hairs were up. He started hissing. From the look of his eyes, I know I had no time. "Open the crate upper door," I shouted to Min. Just in time, I put the cat into the crate. He hissed and jumped up like a pole vaulter. His claws pricked in my left hand and my middle finger of my right hand. Min got some claw marks too.
It was a matter of seconds, like a lightning strike. "The best way is to sedate the cat inside the crate with Zoletil 100 IM according to weight, and commence with the dental work," I said to Dr Vanessa. "You must inform the owner of the change of plans," Dr Vanessa reminded me. So, she did the necessary and had the cat's 4 rotten back teeth extracted, did scaling and sent the cat home the next day. Not a single claw scratch for her! As a routine, I do open the mouth of all salivating cats. Maybe, I ought to do it once and not more times. But no cat would co-operate as he has oral pain and a visual examination is important to plan for treatment.
Fortunately, we don't encounter many dangerous cats at Toa Payoh Vets as Min does the front-line. In this case, if he had lassoed the cat, all hell will break loose. It is important to reinforce instructions to staff several times as different situations occur and staff are people who think in different ways.
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