1253. Why does the British Shorthair vomits and lose weight over the past 3 months?

A 5-year-old British shorthair vomits now and then for the past 3 months, losing weight. What's the cause? Evidence-based medicine using blood tests need to be practised, but sometimes the owner will not consent to blood tests owing to financial considerations or the misperception that it is not necessary. Vet 1 was consulted and had advised blood tests.

The owner came to me for a second opinion as the cat still vomits, before and after eating. In this case, he agreed to having blood test done. The test showed a high total white cell count indicating a bacterial infection of the blood. After a course of antibiotics and follow up, the cat does not vomit and is gaining weight.

This is an interesting case as vomiting is usually associated with hair balls in the cat. However hair ball vomiting does not lead to weight loss and this cat was thin. So the young couple was concerned.
It could be due to cat food allergies or kidney disease too. However, the blood test indicated a bacteraemia and eliminating this blood bacterial infection results in a happy outcome.

The Singapore pet owner is much more sophisticated than in earlier years. Some are interested in a doctor's youthfulness and energy. Others want an oldie with experience. Some prefer eye candy with good bedside manners. Yet another will check on the good house-keeping of the receptionist area and beautiful renovations of a modern clinic. For others, under-pricing influences his or her decision to retain the services of the vet! Underpricing deprives the clinic of funds for renovations and upgrading and payment of the high escalating operating costs. It is a tough new world for vets in developed countries nowadays.

I had written a report on the treatment of this interesting feline case in my blog or at www.toapayohvets.com

1252. Spaying a pregnant cat - standard operating procedures at Toa Payoh Vets

http://youtu.be/jkXDAXSB-z8

Case study with Dr Sing Kong Yuen. Videography by Intern Clara.


"Standard Of Procedure" should be "Standard Operating Procedure (SOP)."
Blood vessels to be properly ligated (not incised as stated in the video).

A final script may be needed for me to correct errors but perfection needs much more time and much fewer videos produced.  It is better for the intern to learn from mistakes as in this video. Overall, it is an excellent amateur video and I hope it educates the pet owner.

Handing over inspection between the vet and owner is important and should be part of the SOP.
The intern forgot to include the two clips  showing the stitched area and pale gums. I have inserted them as shown below:

1251. Fox Terrier limps for over 2 weeks. Why?

X-ray show no fracture but large swelling 4X normal of right fore digit 3. Possibly an abscess from traumatic injury (penetration wound). 

1250. New videos - roborovski siblings, poodle drooling

The young poodle has "locked" jaws
http://youtu.be/AiebDalZsvE

Two sick sibling Roborovskis
http://youtu.be/_fjyz7J0wIA

1249. New YouTube Videos - urinary stones x2 and internship at toa payoh vets

Internship
http://youtu.be/VnukHRGkUfA

Pees blood yearly  -  Urine collection  Part 1
http://youtu.be/vKTU4_JckYc

Pees blood yearly - Overview of lab tests  Part 2
http://youtu.be/q9Ax4OzwMhs

Pees blood yearly - Urine test in Dec 2013  Part 3

http://youtu.be/adtejcde6gs

100%

1248. Transforming the small animal veterinary industry

Saturday Dec 7, 2013

On Saturdays, Dr Jason Teo takes over in the afternoon from me and sometimes we talk about the veterinary industry and sometimes we share ideas of clinic management.

There are around 60 small animal veterinary practices and so the caseload/practice is low while prices are undercut such that it is not possible to recover costs for some practices. "A top-end blood test machine costs $64,000. The test costs $150. There needs to be 427 tests to be done to cover the cost price of the machine. This works out to be around 1 test/day which is easily achieved in busy clinics. In some heartland clinics, there may be an average of 10 cases.day. The price-conscious pet owner does not want to pay for the tests and so there may be less than 3 blood tests/week as blood test costs add up to the total medical costs. The cost of the test kit rotor is $30 and so the vet is grossing $120 instead of $150. There is the maintenance cost of the machine as this is not free. My point is that the heartland pet customer will like to spend as little as possible on pet care, less than $100 per visit and will go elsewhere if the costs are higher. Blood tests and X-rays add to the costs and they do not want them.

"Intense competition is a fact of life," I told Dr Jason Teo that I had listened to the audio files of how a poor Italian immigrant became a powerful rich man in Europe. His son bought a almost bankrupt newspaper, "The National Enquirer" and made it very successful in the US by giving what the customer wants and not what the owner thinks that the customer should get. "At first, it published gory murders but later changed to positive inspiring family stories. He got the papers marketed in super markets. He paid journalists much more than the industry but would fire anyone whom he disliked."

In other words, he can transform the small animal veterinary industry if he knew how. "How about Dr Daniel doing it?" he asked me. "It needs money as this publisher suffered losses at the beginning. He does not make money immediately till later."          

1247. Locked jaw poodle, 15 months - Hyperplastic lymphoid polyps?

Developmental disturbances of the oral lymphoid tissue

1.  Hyplastic lymphoid polyps are composed entirely of lymphoid tissues. Can be found on the gingiva, buccal mucosa, tongue and floor of the mouth

These firm nodular masses are seen on the ventro-lateral sides of the posterior part of the tongue.

2. Reactive lymphoid hyperplasia are also firm nodular masses and found on the posterior part of the tongue at the dorso-ventral aspect. They are part of the lingual tonsil which is one of the largest oral lymphoid aggregate.

The reason for the young poodle locking his jaw is the intense pain due to ulcers below the tongue. What is the cure? Dr Daniel prescribed a repeat of the anti-inflammatory and antibiotics. The aged mother was happier that the dog's behaviour was better - more active and eats more. Not enough to eat normally.

INTERNSHIP
In this case, I asked the young lady to video while the tongue was elevated. "Take some images using the other setting, not directly from the video," I advised.
She ignored my advice as she could take images in the video mode. I would not do it.
To her surprise, her video clip of the underside of the tongue was not available as she had spent more than 60 seconds to video the action while I elevated the tongue. She videoed and took digital images in the video mode contra to my instructions. This is a common trait of the young interns and sometimes they do have better ways of working. But this time, her video clip was gone 99%!.
.
"It seems to be over-ridden," the slim 16-year-old little woman said.
"It is best to comply with instructions when working under a mentor," I said. "It is fortunate that I had personally videoed the underside of the tongue after you."

As there is more than one way of filming, she would open up the LCD screen and flip to the left side to film on manual mode. I would not flip it sideways but view directly as it is, positioned below the view finder.  I would use the viewfinder, set to Auto focus and see the right beam spotted on the subject's eye or spot. She would view the subject from the LCD and so could not get sharp focus on specific body parts.

I accept that the younger generation has minds of their own but many learn from mistakes and it is sometimes costly to the operations of the business letting them learn from mistakes, re-inventing the wheel when they could have sought advices from the oldies or spent time doing lots of research.