"My puppy's tail is swollen and Vet 1 gave him an injection yesterday," the man with three 7-week-old puppies brought one to amputate the dead swollen tail. "I brought him to see Vet 1 yesterday and was told that tail docking is illegal in Singapore. But I see many dog breeders doing it."
"Tail docking of puppies are not banned in Singapore," I asked what material he used to do tail docking of his Schnauzer X as the puppy was already 7 weeks old and he started tying the tail at the first week of age
"I read in the internet that dental floss strings are the best," he replied.
"Most breeders either dock the tails at day 3 or use a rubber band," I said. "The rubber band strangulates the tail. The tail becomes gangrenous as it gets no blood supply and drop off after around one week. It is very painful for the puppy."
For this man, the tail was still around for the past 6 weeks. One puppy's tail had just dropped off. The other had a tail that still has feelings. Only this Schnauzer's tail was dead and swollen at the strangulated area. He wanted tail amputation.
ANAESTHESIA
Miniature Schnauzer X, 7 weeks, 1.6 kg.
What safe anaesthesia to use? The puppy is still not mature.
I used Domitor and Ketamine at 50% of the usual formula and add an equivalent 0.15 ml of saline, totalling 0.3 ml given IV by Dr Daniel
ELECTROSURGERY
"How will you amputate the tail?" I asked Dr Daniel.
"V-shaped incision," he said as that was what his professors had lectured. I asked him to sketch his plan.
"There is a big septic dead area and the V-shaped incision will comprise some of the gangrenous area," I said. "Use my surgical approach which consisted of two horizontal skin incisions on the dorsal and ventral aspect of the tail. The dorsal incision is further away from the anal area than the ventral but as far from the gangrenous strangulated wound as possible." Then the dorsal area will flap downwards covering the whole tail, giving a good cosmetic appearance."
I have never used the "V-shaped incision" method in tail amputation but it can be one of the alternatives.
Pet health and care advices for pet owners and vet students, photography tips, travel stories, advices for young people
Tuesday, May 22, 2012
Hypersexuality is hard to diagnose
Trust and Audit case
An interesting "skin disease" case
TP 42859
Pom White Male Born March 2012
(one year two months now as at May 22, 2012)
Born March 2011. Fluffy coat
Around 8 months, hair starts to drop from back area
1. Vet 1 in another practice attributed it to "puppy hair loss". Not much loss at that time.
2. Mar 18, 12 Vet 2. Complaint alopecia. Licks flanks, alopecia flanks and ventrum, no crusting, erythematous scaling Neoderm cream.
3. Apr 20, 12 Vet 3. Cream not better. Pustules. Hair around anus growing. Skin infection.
4. May 14, 2012. Vet 4. Bald, bilateral alopecia. I suspected hormonal imbalance, possibly testosterone. History important. Humping cats and people. I diagnosed hypersexualtiy. Castration.
5. May 22, 2012. I phoned. "More calm and less sex drive since castration."
Blood test slightly elevated enzymes.
How to squeeze the anal sacs? owner asked.
An interesting "skin disease" case
TP 42859
Pom White Male Born March 2012
(one year two months now as at May 22, 2012)
Born March 2011. Fluffy coat
Around 8 months, hair starts to drop from back area
1. Vet 1 in another practice attributed it to "puppy hair loss". Not much loss at that time.
2. Mar 18, 12 Vet 2. Complaint alopecia. Licks flanks, alopecia flanks and ventrum, no crusting, erythematous scaling Neoderm cream.
3. Apr 20, 12 Vet 3. Cream not better. Pustules. Hair around anus growing. Skin infection.
4. May 14, 2012. Vet 4. Bald, bilateral alopecia. I suspected hormonal imbalance, possibly testosterone. History important. Humping cats and people. I diagnosed hypersexualtiy. Castration.
5. May 22, 2012. I phoned. "More calm and less sex drive since castration."
Blood test slightly elevated enzymes.
How to squeeze the anal sacs? owner asked.
Monday, May 21, 2012
1007. Final report on "No Smoke Without Fire - No scabies without mites"
Webpage:
http://www.sinpets.com/dogs/20120522scabies-hard-to-find-singapore-ToaPayohVets.htm
http://www.sinpets.com/dogs/20120522scabies-hard-to-find-singapore-ToaPayohVets.htm
No Smoke Without Fire - No Scabies Without Mites?Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS21 May, 2012 |
toapayohvets.com
Be Kind To Pets Veterinary Education Project 2010-0129 |
1006. Mission, Vision, Guiding Principles of Toa Payoh Vets
Blogger.com can't display the proper layout. The webpage is at:
http://www.toapayohvets.com/sinpets/guiding_principles_toapayohvets_Singapore.htm
http://www.toapayohvets.com/sinpets/guiding_principles_toapayohvets_Singapore.htm
Vision, Mission &
Guiding Principles
|
|||
Vision | Six Guiding Principles | ||
A top 5 veterinary surgery in Singapore. A veterinary surgery where it is fun to work and treat pets via a personalised veterinary services. Where pet owners and their children get good clinical outcomes for their pets and become our friends over the years. |
1. We provide a great work and learning environment for staff. 2. We provide a very clean environment for warded pets, charging affordable rates and early discharge to reduce veterinary costs for clients. 3. We contribute to the community in partnership with corporations to educate young pet owners, pet shop operators and breeders. We have been involved, since 1995 in the "Be Kind To Pets" narrative community education under the sponsorship of asiahomes.com. 4. We know that time is a valuable asset for clients. We try to keep waiting time to less than 15 minutes for customers with prior appointments. 5. We recognise that sustainable profitability is essential to our success. We need to be profitable so that we can provide a highest standard of ethical and affordable service to our customers and to upgrade our premises, equipment and services. 6. Our Veterinarians, Veterinary Technicians, Dog Groomers and Interns must find time to be self-educated continually and attempt to write their clinical research and observations for the betterment of pet care. We try to share our findings with the pet community via the internet or by publishing books ourselves and/or in collaboration with others. Draft case studies are usually first published in Draft Case Studies: 2010vets and interesting case reports are published mainly in toapayohvets.com |
||
Mission | |||
To establish Toa Payoh
Vets as a veterinary surgery of excellence in Singapore, providing
affordable veterinary health care costs without compromising our
integrity and ethical behaviour.
We channel efforts to address the roots of Singapore pet's problems through advocacy, prevention, education and research. These efforts are shared via the internet with pet owners at Be Kind To Pets and Toilet training your puppy in Singapore. |
Sunday, May 20, 2012
Give what the customer wants? Urinary stone removal + spay packaged deal
A female Miniature Schnauzer has been passing blood in the urine and an X-ray showed several large bladder stones. The couple, in their late 40s, wanted a spay and bladder stone removal packaged deal as this would be cheaper.
Sometimes it is possible to provide such a deal. For example, dental scaling and vaccination or spay and vaccination. However, in this case, it is still possible to do what the customer wants. Make a longer incision, do the spay first. Then open up the bladder and remove the stones.
However, the two surgical procedures will take a much longer time. "There may be complications of bleeding, infection and death on the operation table," I advised the owner against doing this. No news from them since two weeks ago.
Shouldn't I be more flexible and close the deal? Give what the customer wants? In the interest of the dog, I don't do two-in-one surgeries lasting over one hour. The longer the procedure, the higher the chanes of complications like bleeding, infection and death. But other vets do not agree and some customers can be lost just by sticking to this policy. The younger generation in their 20s now may be better educated and more sophisticated to accept my advices.
Sometimes it is possible to provide such a deal. For example, dental scaling and vaccination or spay and vaccination. However, in this case, it is still possible to do what the customer wants. Make a longer incision, do the spay first. Then open up the bladder and remove the stones.
However, the two surgical procedures will take a much longer time. "There may be complications of bleeding, infection and death on the operation table," I advised the owner against doing this. No news from them since two weeks ago.
Shouldn't I be more flexible and close the deal? Give what the customer wants? In the interest of the dog, I don't do two-in-one surgeries lasting over one hour. The longer the procedure, the higher the chanes of complications like bleeding, infection and death. But other vets do not agree and some customers can be lost just by sticking to this policy. The younger generation in their 20s now may be better educated and more sophisticated to accept my advices.
Saturday, May 19, 2012
1004. Update on old Beagle with bladder cancer
DR SING'S TRUST & AUDIT PROCESS OF A BLADDER CANCER CASE AT TOA PAYOH VETS
998. Sunday's interesting case. An old Beagle drips lots of reddish brown urine
Sunday May 13, 2012
I was at the Surgery in the morning and saw a large amount of reddish brown urine drops in the waiting and consultation room. Dr Daniel was consulting with the owners and Mr Min was mopping the floor a few times. If I were Dr Daniel, I would restrain the dog on the consultation table but each vet does his own thing and so this situation led to bloody urine every where. I mean, if the waiting room was full, the other clients would be most unhappy trying to avoid stepping on bloodied urine on the floor in a small waiting room of Toa Payoh Vets.
This is what I mean by "common sense" in a vet who handles a case. Restrict the dog's movement or crate him. I did my trust and audit in this case handled by Dr Daniel to improve the process of consultation and consistency of practice.
The X-ray showed around 6 small radio-opaque stones of around 4 mm x 6 mm and other sizes. Dr Daniel said were unlikely to cause so much bladder bleeding. Each vet has his own opinion and so that is life.
(May 19, 2012 - RETROSPECTIVE REVIEW - Dog had been operated by me and had a large adenocarcinoma of the bladder. The blood clots were dark red black and green and were from the degenerating cancerous cells of the adenocarcinoma)
I disagreed with him as there was one stone with a sharp edge, like a dagger. This sharp stone swished about inside the bladder would have stabbed the bladder mucosa and cause bleeding. "This is not chronic cystitis," Dr Daniel disagreed with me. "The blood in the urine occurred only 2 weeks ago." This was a difference of opinion.
(May 19, 2012 - RETROSPECTIVE REVIEW - Dog had been operated by me and had a large adenocarcinoma of the bladder)
An old Beagle. Likely to be a bladder carcinoma as well. Dr Daniel advised ultrasound and surgery with high anaesthetic risks of death on the op table. Since the dog's red blood cells were low, his opinion was that this dog would not survive the operation. So what to do? The consultation took more than 30 minutes and he was still talking.
(May 19, 2012 review. In my opinion, ultrasound adds to cost and will not help to resolve this dog's problem. The newly graduated vet has been taught by the professors to go for more and more tests to confirm a diagnosis of cancer. In practice, he must know what to do in an old dog with cancer, not asking for more tests as many owners prefer to have lower veterinary costs. In this case, blood and urine tests and an X-ray of one view had been done. The X-ray was average quality and an air-contrast X-ray of the bladder would be preferred)
I intervened by entering the consultation room which had a bloodied floor now. I said to the couple: "Basically, you have two options. Consent to an operation and know the high risks and get the stones removed. If there is cancer of the bladder, give us consent to euthanase the dog during surgery. The other option is to medicate and euthanase the dog when the drugs don't work as she is suffering from pain and incontinence. In the meantime, get the dog on the IV drip, painkillers and antibiotics for at least one day and before surgery."
Vets can't afford the luxury of time on a busy Sunday morning to handle a case for more than 30 minutes unless it is necessary. Other clients have to wait a longer time. Owners of hospitalised dogs need to be called. The sick dogs need to be checked and there are many things to do. So, it is not possible to keep on talking while the old Beagle keeps on dripping.
In any case, the pressures of having to provide affordable veterinary costs v. high overheads of operating expenses and increase government regulatory payments mean that not much time can be spent on having long consultations per owner. All employee and associate vets have to be aware of the high financial aspects of running a veterinary surgery and not just how much they get paid.
SURGERY DONE BY ME
The longer the surgical procedure, the higher the possibility of complications of death on the operating table. I told Dr Daniel and the owner that I would be operating on this high risk old dog with seizures. The wife did not want euthanasia even if an inoperable cancer was found. There was an inoperable cancer in the bladder. I excised as much as I could of the cancer.
As at May 18, 2012, the dog was eating and had peed clearer urine. I had not expected this old dog with seizures to survive a 2-hour surgery. Dr Daniel was collaborating with me while I operated to excise the tumour near the neck of the bladder. There was no way I could complete such a bladder cancer excision in 30 minutes. The couple took the high risks to consent to an operation. It was a surprise to me that this dog survived.
DETAILS OF SURGICAL PROCEDURES ARE BELOW:
5297 - 5303.
Bladder cancer surgery in an old Beagle
Proper pre-surgical treatment and planning gave this old dog the best chance of survival on the operating table. It is not a given that all old dogs will survive as many of them have poor health.
UPDATES AND MORE IMAGES ARE AT:
http://www.sinpets.com/dogs/20120440veterinary-audit-cystotomy-carcinoma-bladder-toapayohvets-singapore_ToaPayohVets.htm
998. Sunday's interesting case. An old Beagle drips lots of reddish brown urine
Sunday May 13, 2012
I was at the Surgery in the morning and saw a large amount of reddish brown urine drops in the waiting and consultation room. Dr Daniel was consulting with the owners and Mr Min was mopping the floor a few times. If I were Dr Daniel, I would restrain the dog on the consultation table but each vet does his own thing and so this situation led to bloody urine every where. I mean, if the waiting room was full, the other clients would be most unhappy trying to avoid stepping on bloodied urine on the floor in a small waiting room of Toa Payoh Vets.
This is what I mean by "common sense" in a vet who handles a case. Restrict the dog's movement or crate him. I did my trust and audit in this case handled by Dr Daniel to improve the process of consultation and consistency of practice.
The X-ray showed around 6 small radio-opaque stones of around 4 mm x 6 mm and other sizes. Dr Daniel said were unlikely to cause so much bladder bleeding. Each vet has his own opinion and so that is life.
(May 19, 2012 - RETROSPECTIVE REVIEW - Dog had been operated by me and had a large adenocarcinoma of the bladder. The blood clots were dark red black and green and were from the degenerating cancerous cells of the adenocarcinoma)
I disagreed with him as there was one stone with a sharp edge, like a dagger. This sharp stone swished about inside the bladder would have stabbed the bladder mucosa and cause bleeding. "This is not chronic cystitis," Dr Daniel disagreed with me. "The blood in the urine occurred only 2 weeks ago." This was a difference of opinion.
(May 19, 2012 - RETROSPECTIVE REVIEW - Dog had been operated by me and had a large adenocarcinoma of the bladder)
An old Beagle. Likely to be a bladder carcinoma as well. Dr Daniel advised ultrasound and surgery with high anaesthetic risks of death on the op table. Since the dog's red blood cells were low, his opinion was that this dog would not survive the operation. So what to do? The consultation took more than 30 minutes and he was still talking.
(May 19, 2012 review. In my opinion, ultrasound adds to cost and will not help to resolve this dog's problem. The newly graduated vet has been taught by the professors to go for more and more tests to confirm a diagnosis of cancer. In practice, he must know what to do in an old dog with cancer, not asking for more tests as many owners prefer to have lower veterinary costs. In this case, blood and urine tests and an X-ray of one view had been done. The X-ray was average quality and an air-contrast X-ray of the bladder would be preferred)
I intervened by entering the consultation room which had a bloodied floor now. I said to the couple: "Basically, you have two options. Consent to an operation and know the high risks and get the stones removed. If there is cancer of the bladder, give us consent to euthanase the dog during surgery. The other option is to medicate and euthanase the dog when the drugs don't work as she is suffering from pain and incontinence. In the meantime, get the dog on the IV drip, painkillers and antibiotics for at least one day and before surgery."
Vets can't afford the luxury of time on a busy Sunday morning to handle a case for more than 30 minutes unless it is necessary. Other clients have to wait a longer time. Owners of hospitalised dogs need to be called. The sick dogs need to be checked and there are many things to do. So, it is not possible to keep on talking while the old Beagle keeps on dripping.
In any case, the pressures of having to provide affordable veterinary costs v. high overheads of operating expenses and increase government regulatory payments mean that not much time can be spent on having long consultations per owner. All employee and associate vets have to be aware of the high financial aspects of running a veterinary surgery and not just how much they get paid.
SURGERY DONE BY ME
The longer the surgical procedure, the higher the possibility of complications of death on the operating table. I told Dr Daniel and the owner that I would be operating on this high risk old dog with seizures. The wife did not want euthanasia even if an inoperable cancer was found. There was an inoperable cancer in the bladder. I excised as much as I could of the cancer.
As at May 18, 2012, the dog was eating and had peed clearer urine. I had not expected this old dog with seizures to survive a 2-hour surgery. Dr Daniel was collaborating with me while I operated to excise the tumour near the neck of the bladder. There was no way I could complete such a bladder cancer excision in 30 minutes. The couple took the high risks to consent to an operation. It was a surprise to me that this dog survived.
DETAILS OF SURGICAL PROCEDURES ARE BELOW:
5297 - 5303.
Bladder cancer surgery in an old Beagle
Proper pre-surgical treatment and planning gave this old dog the best chance of survival on the operating table. It is not a given that all old dogs will survive as many of them have poor health.
UPDATES AND MORE IMAGES ARE AT:
http://www.sinpets.com/dogs/20120440veterinary-audit-cystotomy-carcinoma-bladder-toapayohvets-singapore_ToaPayohVets.htm
Friday, May 18, 2012
Planning for the bladder cancer surgery - The Beagle
As Dr Daniel was handling the case, he had a long chat with the couple. X-ray revealed 6 small pieces of stone but the blood test showed red blood cells being low. The dog was bleeding from the bladder. He advised ultrasound.
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