The dog was treated by Dr V on May 1, 2012 for coughing. The cough had disappeared after 3 days of drugs and the dog stopped eating. Blood test was taken but he said that he was not told of the results. I apologised to him and reviewed his records. Liver enzymes were high and Dr V had prescribed heart medication and advised review in 14 days . However, he did not turn up and now it is May 24, 2012 and the dog is very thin and weak. A loss of 3 kg from May 1 to May 24 is too drastic.
Now it is very thin. The 62-year-old man came with his daughter. As he had white hair, I said incorrectly that his grand-daughter was accompanying him. I asked Dr Daniel to handle this case with me. Respiratory rate and pulse were normal.
SIGNIFICANT FINDINGS
1. Below normal rectal temp at 37.5
2. Weight loss
3. No appetite and does not drink water.
4. Periodontitis Stage 4 and painful throat area.
5. No abdominal pain or swelling of the liver which is good news.
6. Penile sheath was swollen.
7. Heart murmurs.
"This dog could be more than 15 years old," the father said. He remembered I did a tail amputation on a tail lump in 2007. "He had seizures in 2010," I saw the record but he could not remember. His daughter confirmed and said no more seizures.
What's the cause of this loss of appetite and painful throat? Blood test, urine test and IV drip done first.
Pet health and care advices for pet owners and vet students, photography tips, travel stories, advices for young people
Thursday, May 24, 2012
Management meeting on May 23, 2012 8pm
Dr Vanessa and Mr Min were held back after the last case at 8 pm as I wanted to meet them to communicate their work performances to them. Frequent trust and audit meetings are necessary at this stage as workers and vets find it very hard to change their mindset and ways of working. This applies to all businesses.
I took out medical records done by Dr V yesterday to illustrate and to get improvements in standard of care.
Discussion centred on meticulous record keeping, evidence-based medicine to diagnose yeast infection and other skin diseases, in-patient recording to be kept for file, not just elsewhere, X-ray and other records to be kept in one file. Litigation prevention with proper records including consent forms and correct diagnosis.
Accounts to be properly filed. Interns to be guided and made sure they are gaining the experience and coming on time - a file to be started by them and Min to supervise. Min to speak out and reply when asked a question and to let me know if he has problems at work. "There are many graduates and vets in Myanmar out of job," I told Min. "Every year there are new graduates, even in Singapore. Therefore, wake up each day with happy feelings that you have a job you have been trained for as a vet in Myanmar and open your own clinic like Mr Saw at the end of the contract." Min was saying that Dr Saw in Yangon is doing very well.
These are old issues but need communications again as it is part of management. Change management is seldom effected without communications and explanations.
I took out medical records done by Dr V yesterday to illustrate and to get improvements in standard of care.
Discussion centred on meticulous record keeping, evidence-based medicine to diagnose yeast infection and other skin diseases, in-patient recording to be kept for file, not just elsewhere, X-ray and other records to be kept in one file. Litigation prevention with proper records including consent forms and correct diagnosis.
Accounts to be properly filed. Interns to be guided and made sure they are gaining the experience and coming on time - a file to be started by them and Min to supervise. Min to speak out and reply when asked a question and to let me know if he has problems at work. "There are many graduates and vets in Myanmar out of job," I told Min. "Every year there are new graduates, even in Singapore. Therefore, wake up each day with happy feelings that you have a job you have been trained for as a vet in Myanmar and open your own clinic like Mr Saw at the end of the contract." Min was saying that Dr Saw in Yangon is doing very well.
These are old issues but need communications again as it is part of management. Change management is seldom effected without communications and explanations.
1010. Westie puppy can't open his mouth - Craniomandibular Osteopathy
Yesterday, May 23, 2012, I answered a phone call. A lady wanted to speak to an experienced vet (Dr Sing) at Toa Payoh Vets. She had consulted another experienced vet (Vet 1) who had apparently diagnosed her Westie as having enlarged "lymph nodes" and prescribed antibiotics and medication. After that, the Westie puppy again had difficulty in opening her mouth.
"I know my Westie is suffering from an inherited disease called 'lion jaw'," she could not pronounced craniomandibular osteopathy and told me to surf the internet for 'Westie, lion jaw'. She was not happy with the breeder but would not return the puppy.
I identified myself and told her that I had not come across the disease in my 40 years of practice. "Singaporean breeders seldom breed Westies," I said. "This breed is not easy to breed for some reasons. This breed has a type of skin disease."
I advised her to go back to Vet 1 who is experienced and has X-rays facilities. Even experienced vets cannot be expected to know everything in every breed and in every system, but we are learning every day. The internet is a great help and many owners know more than the vets in specific disease conditions!
An image of a Westie with "lion jaw" is at:
http://www.flickr.com/groups/westie/discuss/72157622728730796/
"I know my Westie is suffering from an inherited disease called 'lion jaw'," she could not pronounced craniomandibular osteopathy and told me to surf the internet for 'Westie, lion jaw'. She was not happy with the breeder but would not return the puppy.
I identified myself and told her that I had not come across the disease in my 40 years of practice. "Singaporean breeders seldom breed Westies," I said. "This breed is not easy to breed for some reasons. This breed has a type of skin disease."
I advised her to go back to Vet 1 who is experienced and has X-rays facilities. Even experienced vets cannot be expected to know everything in every breed and in every system, but we are learning every day. The internet is a great help and many owners know more than the vets in specific disease conditions!
An image of a Westie with "lion jaw" is at:
http://www.flickr.com/groups/westie/discuss/72157622728730796/
Tuesday, May 22, 2012
Do-it-yourself (DIY) tail docking a Schnauzer X
"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.
"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.
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
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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 |
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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. |
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