The mother and her young adult daughter adopted this cat as a stray kitten 3.5 years ago and came for the regular vaccination on receipt of the vaccination reminder card. So, I saw them today as they had booked an appointment for me to vaccinate.
"You were the one who spayed her when she was 10 months old," the mother said. "She was making a lot of noise and you charged $150." I checked my record. Yes, it was dated June 29, 2009. How time flies. The daughter had graduated and had worked for Jet Star as a cabin crew for 2 years. "
"The cat's receipt 4-digit draw number came out on Saturday (Aug 11, 2012) and Sunday (Aug 12, 2012)," the mum said to me. "On Saturday, it was 2nd prize for the number 5124 and on Sunday, 2415 was lst prize!"
"How much would you get for the first prize?" I asked.
"$2,000 for a $1.00 bet," she said.
"Did you get it?"
"No," she said. "I bought the number 2451". The cat's receipt number on the first visit 3 years ago was 12451. I know of one other owner who did make money buying the 4D on receipts from Toa Payoh Vets.
"Why didn't you buy all combinations of 2451?" I asked. "You would have won $2,000 on Sunday and some amount on Saturday!"
"I would have to pay $24 and it was too much. I usually buy $2.00. I had been buying other numbers as well."
In this case, there was a vaccination reminder. She made an appointment to see me whereas last year, it was Dr Vanessa. The Gods of Fortune came. This is a true incredible 4-D story. The cat was plump and well cared for. "Where does she scratch her paws?" I asked. "Onto the sofa," the daughter said that they bought older sofas and so this was ok.
"Why does your mum buys 4D?" I asked the equally slim be-spectacled daughter.
"She has a stall next to the 4D outlet," she said.
The mum fixed costumed jewellery only on Sundays by renting a small table space at the Lorong 7 market.
"I have regular customers," she had been in this line for 9 years. I was most impressed at her perseverance and success in this small business. "Now my eye-sight is not so good to do the repairs," she said she had to pay rental even if she did not turn up on Sunday. I was happy that the owners take good care of the cat.
Wednesday, August 15, 2012
1041. Seizures in a young Dachshund
E-MAIL REPLY FROM DR SING DATED AUG 14, 2012
On Tue, Aug 14, 2012 at 3:32 PM, ...> wrote:
E-MAIL REPLY FROM DR SING DATED AUG 15, 2012. I had asked the owner to email to me her earlier recent blood test report which she said was normal according to Vet 1 she consulted.
I am Dr Sing Kong Yuen from Toa Payoh Vets. Thank you for the blood test report from your vet. Lipase enzymes were high in your attached first report done by the other vet.
One blood test may not be sufficient to come to any conclusion of the cause of seizures. A CSF check and other tests may be needed.
I advise a 2nd blood test with the same vet if you are OK with it.
The cause of seizures in dogs can be varied and hard to pin-point in many cases. One of the causes could be canine distemper viral infections during puppyhood and sometimes there is evidence of "hard pads" in the recovered dog. Did your dog receive all the 3 vaccinations at the appropriate timing? Fevers of unknown origin are another cause. There are unknown causes in the majority of dog seizures.
Hi,I've visited Toa Payoh Vets today with my dog.Dog Name: ....Breed: DachshundProblem: SeizureAttached is his historial blood test results.Do let me know if there's any problem noted from the results.Many thanks.XXX
E-MAIL REPLY FROM DR SING DATED AUG 15, 2012. I had asked the owner to email to me her earlier recent blood test report which she said was normal according to Vet 1 she consulted.
I am Dr Sing Kong Yuen from Toa Payoh Vets. Thank you for the blood test report from your vet. Lipase enzymes were high in your attached first report done by the other vet.
One blood test may not be sufficient to come to any conclusion of the cause of seizures. A CSF check and other tests may be needed.
I advise a 2nd blood test with the same vet if you are OK with it.
The cause of seizures in dogs can be varied and hard to pin-point in many cases. One of the causes could be canine distemper viral infections during puppyhood and sometimes there is evidence of "hard pads" in the recovered dog. Did your dog receive all the 3 vaccinations at the appropriate timing? Fevers of unknown origin are another cause. There are unknown causes in the majority of dog seizures.
Dr Daniel will contact you regarding your dog's recurring seizures follow up.
Tuesday, August 14, 2012
1040. Dark blue-red blood from the bladder -- Grape poisoning?
On Sunday Aug 12, 2012 at 6 pm, a Maltese came in with blood in the urine. The young lady flashed the pool of reddish blood image from her handphone. "Will my dog die?" she asked.
1039. SOP - spaying a cat on heat
An example of the steps involved in spaying a young cat on heat (caterwauling was the reason for spaying) done by me is given as follows:
Record No. 155
Toa Payoh Vets Anaesthesia & Surgery Record
Patient's Name: Anja
TP Ref: 43711 Date: 13-8-12 Age: 10 m Wt: 3.8kg* Temp: 38.6*
Surgical procedure: Spay (on heat)
Type of suture: polysorb Size:2/0 No. of packets used: One
DOCUMENTATION OF STEPS IN A SPAY OF AN AGGRESSIVE YOUNG CAT ON ESTRUS
1. Restraint. Owner to take the cat out of its carrier bag and put into the crate which has top and side doors. Do NOT put cat with its carrier bag inside the crate as in this case.
Use phone books to corner the cat or lasso if aggressive as it is not possible to sedate just by holding the cat, causing staff to be in danger of being scratched and cat escaping.
2. Sedation. For a 3.8 kg cat, I injected xylazine 0.15 ml + ketamine 0.6 ml combined IM left back msucles.
3. Pre-op clipping and cleaning was done 2 minutes later.
4. Surgery: A very bloody surgery as the ovaries and uterus were swollen with large blood vessels. More care in ligation is needed in such situations.
For younger vets, do make a larger skin incision of more than 2 cm long to get good exposure. In this case, I started the skin incision 1.5 cm from the umbilical scar, then made a 1.5 cm skin incision.
OVARIES. I hooked out the left ovary at the first attempt. I used 2 artery forceps to clamp the ovarian ligament and ligate cranial to the lower clamp. I ligate in one direction (5 throws of the knot) and then swung back to ligate in the opposite direction for the ovary. Then I used the scalpel to sever the ovarian ligament between the two forceps.
UTERINE BODY. I asked my assistant to loosen the front paws and in some cases to elevate the front half of the body (hand under the shoulders) to gain access to the uterine horn (right). Or I would extend my skin incision to 1.8 cm long to access the swollen and vascularised uterine body.
In this case, the uterine body was easily taken out after ligation of the right ovary. I clamped the uterine body with 2 artery forceps. Then I put the 2/0 suture below the lower forceps. I loosen the lower clamp to expose the grooved indentation. I slipped this suture into the groove and ligate 3 times. First in one direction, then in the other direction as for the ovarian ligament ligature. However, I ligate once more.
Normal cats not on heat. I ligate the ovaries and uterus twice only.
SPAY PROCEDURE TIMES
I asked Min to record:
Left ovary hooked out (first attempt) 8.08pm
Right ovary taken out 8.15pm
Uterine body ligated started (with 3 ligatures) 8.21pm
Linea alba muscles stitched started 8.26pm (2 simple interrupted)
KPI
A: Injection of xylazine + ketamine 0.l5+0.6 ml IM 7.54pm
B: Isoflurane 5% given 8.15pm
C: Isoflurane stopped 8.17pm
D: lst skin incision 8.06pm
E: Skin stitched up 8.29pm (2 horizontal mattresses)
E-A = 35 minutes (whole spay procedure) excluding restraint of the aggressive cat.
E-D = 23 minutes (spay surgery)
As the cat was full of swollen blood vessels, extra care and time were needed to ensure that there would be no complications of bleeding to death. The left ovary was hooked out at the first attempt and the ovaries were unusually enlarged at around 8 mm x 8 mm x 6 mm (see images).
The above report serves as a benchmark for my associate vets. Elevate the op table to be comfortable doing surgery as each vet has his or her own height.
*Cat aggressive. Lassoed and sedated inside crate. Rectal temp and weight were then recorded.
Record No. 155
Toa Payoh Vets Anaesthesia & Surgery Record
Patient's Name: Anja
TP Ref: 43711 Date: 13-8-12 Age: 10 m Wt: 3.8kg* Temp: 38.6*
Surgical procedure: Spay (on heat)
Type of suture: polysorb Size:2/0 No. of packets used: One
DOCUMENTATION OF STEPS IN A SPAY OF AN AGGRESSIVE YOUNG CAT ON ESTRUS
1. Restraint. Owner to take the cat out of its carrier bag and put into the crate which has top and side doors. Do NOT put cat with its carrier bag inside the crate as in this case.
Use phone books to corner the cat or lasso if aggressive as it is not possible to sedate just by holding the cat, causing staff to be in danger of being scratched and cat escaping.
2. Sedation. For a 3.8 kg cat, I injected xylazine 0.15 ml + ketamine 0.6 ml combined IM left back msucles.
3. Pre-op clipping and cleaning was done 2 minutes later.
4. Surgery: A very bloody surgery as the ovaries and uterus were swollen with large blood vessels. More care in ligation is needed in such situations.
For younger vets, do make a larger skin incision of more than 2 cm long to get good exposure. In this case, I started the skin incision 1.5 cm from the umbilical scar, then made a 1.5 cm skin incision.
OVARIES. I hooked out the left ovary at the first attempt. I used 2 artery forceps to clamp the ovarian ligament and ligate cranial to the lower clamp. I ligate in one direction (5 throws of the knot) and then swung back to ligate in the opposite direction for the ovary. Then I used the scalpel to sever the ovarian ligament between the two forceps.
UTERINE BODY. I asked my assistant to loosen the front paws and in some cases to elevate the front half of the body (hand under the shoulders) to gain access to the uterine horn (right). Or I would extend my skin incision to 1.8 cm long to access the swollen and vascularised uterine body.
In this case, the uterine body was easily taken out after ligation of the right ovary. I clamped the uterine body with 2 artery forceps. Then I put the 2/0 suture below the lower forceps. I loosen the lower clamp to expose the grooved indentation. I slipped this suture into the groove and ligate 3 times. First in one direction, then in the other direction as for the ovarian ligament ligature. However, I ligate once more.
Normal cats not on heat. I ligate the ovaries and uterus twice only.
SPAY PROCEDURE TIMES
I asked Min to record:
Left ovary hooked out (first attempt) 8.08pm
Right ovary taken out 8.15pm
Uterine body ligated started (with 3 ligatures) 8.21pm
Linea alba muscles stitched started 8.26pm (2 simple interrupted)
KPI
A: Injection of xylazine + ketamine 0.l5+0.6 ml IM 7.54pm
B: Isoflurane 5% given 8.15pm
C: Isoflurane stopped 8.17pm
D: lst skin incision 8.06pm
E: Skin stitched up 8.29pm (2 horizontal mattresses)
E-A = 35 minutes (whole spay procedure) excluding restraint of the aggressive cat.
E-D = 23 minutes (spay surgery)
As the cat was full of swollen blood vessels, extra care and time were needed to ensure that there would be no complications of bleeding to death. The left ovary was hooked out at the first attempt and the ovaries were unusually enlarged at around 8 mm x 8 mm x 6 mm (see images).
The above report serves as a benchmark for my associate vets. Elevate the op table to be comfortable doing surgery as each vet has his or her own height.
*Cat aggressive. Lassoed and sedated inside crate. Rectal temp and weight were then recorded.
1037. More records and responsibilities
Yesterday, Monday, August 14, 2012 at 7 pm, I stopped any consultation and had another talk with Drs Daniel and Vanessa regarding the need to keep proper records in cases of complaints, investigation, litigation as Singaporeans are becoming more litigious. So, we have the inpatient, outpatient, surgical and anaesthetic records and the hospitalisation records.
"In the past, there would just be the one case card recording "everything", but now, this is not sufficient," I said. "The veterinary authorities do have public complaints when the pet dies and so proper records are a good defence. Otherwise, your licence may be suspended or revoked."
In management, it takes many times to speak to the associate vets about changes in the work process. Unfortunately, there is no other way to get new changes executed. Each vet now has his or her own anaesthetic records which they are responsible and will be documentary evidence in cases of litigation. So, the vet has to maintain meticulous records and I will be auditing them. This process improves the standard of care as human nature is such that, the less work, the better.
"In the past, there would just be the one case card recording "everything", but now, this is not sufficient," I said. "The veterinary authorities do have public complaints when the pet dies and so proper records are a good defence. Otherwise, your licence may be suspended or revoked."
In management, it takes many times to speak to the associate vets about changes in the work process. Unfortunately, there is no other way to get new changes executed. Each vet now has his or her own anaesthetic records which they are responsible and will be documentary evidence in cases of litigation. So, the vet has to maintain meticulous records and I will be auditing them. This process improves the standard of care as human nature is such that, the less work, the better.
Sunday, August 12, 2012
1036. Sunday Aug 12, 2012. Loss of confidence in a vet
Sunday's interesting cases
Aug 12, 2012
Case 1
Bright sunshine. I came to work at 8.15 am as Mr Min took Sunday off at 7 am.
I had an appointment as the lady of a biting chihuahua, female, spayed, 14 years old decided to get dental work done. This was the first sister. She wanted me to do the dental on her dog and no other associate vet here to do it.
"Why?" I asked this fair lady of around 30 years of age, arriving in a taxi so early on Sunday morning. "My associate vets can do dental too."
"Because you are experienced. Because, Kiki is very precious to me."
She lived quite close to a vet practice but would not go there. Two years ago, she went to a big practice but she had to go back twice to treat her dog's dental problems as the vet missed the oro-nasal fistula at the first visit. So her father, her sister and she tried my services on Nov 4, 2011.
Her sister's dog, Teddy had bad breath and decayed fractured maxillary Right canine.
Dental scaling and 8 teeth extracted. I checked my case sheet and the following anaesthetic record was given to her sister:
Nov 4, 2011 Teddy, Terrier X, 4.6 kg, 39.2C
Bad breath & decayed fractured canine R maxillary
AMA - does not want blood test
11.05 am xylazine 0.1 ml IM. Wait 10 min.
11.16 am isoflurane + O2 1% intubated
11.29 am isoflurane + O2 1% maintenance
11.32 am isoflurane + O2 0.5%
11.35 am end of dental. wakes up fast.
Post op tolfedine + baytril, trimeth + multivit.
Whole dental work process 11.35 am - 11.05 am = 30 minutes
Isoflurane used = 11.35 am - 11.16 am = 19 minutes
Today, 9 months later, I phoned the owner of Teddy. No dental problem. As for Kiki who came today, the owner agreed to do a blood test first. Now this was a biting dog. How to do it efficiently?
"Be gentle. The last time your vet did it," the lady said. "She had to take blood from 4 legs! This is because her veins are very thin."
I was surprised. "Normally one leg will do."
I told Dr Daniel to get a tourniquet.
"Shave the cephalic vein area," I said. "You can see the vein better.
A tourniquet, muzzle and shaving the vein area enable Dr Daniel to draw blood in sufficient amounts. But the dog shot out several stools and peed. I gave antibiotics for 7 days and will do the dental next Sunday.
Case 2. Surprisingly, one lady phoned to say that her dog was on heat. The dog was spayed as a 6-month-old in Aug 2011. The vet had told her that the left ovary could not be found and to phone if the dog was on heat. So, now, almost one year later, the dog was on heat and she asked:"When should I get the dog spayed?"
Aug 12, 2012
Case 1
Bright sunshine. I came to work at 8.15 am as Mr Min took Sunday off at 7 am.
I had an appointment as the lady of a biting chihuahua, female, spayed, 14 years old decided to get dental work done. This was the first sister. She wanted me to do the dental on her dog and no other associate vet here to do it.
"Why?" I asked this fair lady of around 30 years of age, arriving in a taxi so early on Sunday morning. "My associate vets can do dental too."
"Because you are experienced. Because, Kiki is very precious to me."
She lived quite close to a vet practice but would not go there. Two years ago, she went to a big practice but she had to go back twice to treat her dog's dental problems as the vet missed the oro-nasal fistula at the first visit. So her father, her sister and she tried my services on Nov 4, 2011.
Her sister's dog, Teddy had bad breath and decayed fractured maxillary Right canine.
Dental scaling and 8 teeth extracted. I checked my case sheet and the following anaesthetic record was given to her sister:
Nov 4, 2011 Teddy, Terrier X, 4.6 kg, 39.2C
Bad breath & decayed fractured canine R maxillary
AMA - does not want blood test
11.05 am xylazine 0.1 ml IM. Wait 10 min.
11.16 am isoflurane + O2 1% intubated
11.29 am isoflurane + O2 1% maintenance
11.32 am isoflurane + O2 0.5%
11.35 am end of dental. wakes up fast.
Post op tolfedine + baytril, trimeth + multivit.
Whole dental work process 11.35 am - 11.05 am = 30 minutes
Isoflurane used = 11.35 am - 11.16 am = 19 minutes
Today, 9 months later, I phoned the owner of Teddy. No dental problem. As for Kiki who came today, the owner agreed to do a blood test first. Now this was a biting dog. How to do it efficiently?
"Be gentle. The last time your vet did it," the lady said. "She had to take blood from 4 legs! This is because her veins are very thin."
I was surprised. "Normally one leg will do."
I told Dr Daniel to get a tourniquet.
"Shave the cephalic vein area," I said. "You can see the vein better.
A tourniquet, muzzle and shaving the vein area enable Dr Daniel to draw blood in sufficient amounts. But the dog shot out several stools and peed. I gave antibiotics for 7 days and will do the dental next Sunday.
Case 2. Surprisingly, one lady phoned to say that her dog was on heat. The dog was spayed as a 6-month-old in Aug 2011. The vet had told her that the left ovary could not be found and to phone if the dog was on heat. So, now, almost one year later, the dog was on heat and she asked:"When should I get the dog spayed?"
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