October 30, 2014
Today, an old client told me that she had received vaccination reminder card from a lady vet who was employed by me some 2 years ago. She commented that this vet was unethical and she would not go to consult her.
Is this practice ethical? There was a bank case in which the employee joined another bank and took the employer's list of clients to contact them. This employee was sued in court.
Employee vets will continue to use the employer's list of clients before they set up their own practice.
Thursday, October 30, 2014
Singapore stories. Mr Han goes to Phuket
Oct 30, 2014
Mr Han goes to Phuket today. His boss Joe asked me to a farewell breakfast at the usual food court. Mr Han had his laksa while Joe, for the first time, order beef ball and fish ball soup noodles. "I have never seen you order this dish," Mr Han commented. "Usually it is laksa and you drink all the gravy!"
I ordered the chee chiong fun with sesame seed and sweet sauce at $1.60.
I thought yesterday's breakfast was the last till Mr Han comes back from Phuket on Tuesday. As he had to go for his routine blood test for diabetes yesterday, he did not eat breakfast and was grouchy. He was at the food court and dozed off. The hawker lady from China, selling laksa, came to the table and curled her right index finger, indicating that Mr Han must have passed away. This was her sense of humour learnt from Joe.
After the breakfast today, Joe said I should take a photo of Mr Han as the "last" image.. In case his plane crashed. "It is best not to say such things," I tried to educate Joe who has this type of humour.
Yesterday Joe was on the same topic of plane crash and asked Mr Han to visit him after the crash and let him know he had come from heaven or hell. "Is there such a place as heaven or hell?" Joe asked.
"There is a supernatural but you need to encounter to believe," I narrated a story of my client who asked me to help her design a logo. Blood spots appeared on the table and draft logo papers when the design was not satisfactory to "datuk". A Caucasian employee had brought in a draft logo on his own initiative and designed by somebody while I was in the room. Blood spots appeared in this draft logo paper. Finally, there was a draft logo design done by me and the client with no appearance of blood and this would be deemed approved.
"I am more the scientific-evidence type and this encounter would be hard for anyone to believe," I said to the two senior citizens. "I don't believe if I have not witnessed this event."
Mr Han goes to Phuket today. His boss Joe asked me to a farewell breakfast at the usual food court. Mr Han had his laksa while Joe, for the first time, order beef ball and fish ball soup noodles. "I have never seen you order this dish," Mr Han commented. "Usually it is laksa and you drink all the gravy!"
I ordered the chee chiong fun with sesame seed and sweet sauce at $1.60.
I thought yesterday's breakfast was the last till Mr Han comes back from Phuket on Tuesday. As he had to go for his routine blood test for diabetes yesterday, he did not eat breakfast and was grouchy. He was at the food court and dozed off. The hawker lady from China, selling laksa, came to the table and curled her right index finger, indicating that Mr Han must have passed away. This was her sense of humour learnt from Joe.
After the breakfast today, Joe said I should take a photo of Mr Han as the "last" image.. In case his plane crashed. "It is best not to say such things," I tried to educate Joe who has this type of humour.
Yesterday Joe was on the same topic of plane crash and asked Mr Han to visit him after the crash and let him know he had come from heaven or hell. "Is there such a place as heaven or hell?" Joe asked.
"There is a supernatural but you need to encounter to believe," I narrated a story of my client who asked me to help her design a logo. Blood spots appeared on the table and draft logo papers when the design was not satisfactory to "datuk". A Caucasian employee had brought in a draft logo on his own initiative and designed by somebody while I was in the room. Blood spots appeared in this draft logo paper. Finally, there was a draft logo design done by me and the client with no appearance of blood and this would be deemed approved.
"I am more the scientific-evidence type and this encounter would be hard for anyone to believe," I said to the two senior citizens. "I don't believe if I have not witnessed this event."
Tuesday, October 28, 2014
Anaesthetic risk in dental scaling A 7-year-old Sheltie with bad breath
Oct 28, 2014
A new client - father and young adult daughter brought in a 7-year-old male entire Shetland for dental scaling. Their friend's Maltese had died after dental scaling in another vet practice and so they did not want to go to the practice.
"Very rarely do dogs die after waking up from anaesthesia given for dental scaling," I said. "Was the Maltese having heart diseases?" The owners of the gentle full sized Sheltie did not know but they would avoid this friend's vet
No vet can guarantee no anaesthetic risk. Even people do die.
PHYSICAL EXAMINATION
Other than periodontal disease grade 4 (tissue attachment loss over 50%), I noted that this Sheltie had congested maroon red gums, not the normal pink ones. You can see this in the video. Why? The capillary refill time was longer than the usual 2 seconds. Blood test showed that this dog had a higher than normal amount of haemoglobin in his blood at 19.1 (12-18). The total red cell count was normal. The haematocrit was normal too. Platelets were normal. What does it mean? Was he fed some supplements?
BLOOD TEST on 27.10.14 Abnormal values
Urea 12.3 (4.2 - 6.3)
Creatiine 65 (89-177)
Haemoglobin 19.1 (12-18)
All the other blood values within normal limits.
Sedation was 50% of normal dog. Isoflurane gas to minimal amount.
FOLLOW UP - Day 2 after dental scaling
The dog was a bit tired yesterday but is Ok and eating today.
"Tartar started to build up fast in last 3 years," the father said that the dog was not given meat. "Could it be the milk making the kibbles soft?". This dog had the biggest crusty tartar I had ever seen in a dog (see image/video).
The dry dog food was Science Diet Lamb and Rice with a brand of dog's milk since young. Dog treats were given.
ADVICES
No milk and treats to prevent tartar build up.
Eat dry food without milk and drink water.
Blood test 4 weeks later to check on the urea levels.
This case shows that a blood test is important for screening the health of an older dog. The owner was given the option. The blood test was done by me as this dog had an unusual congested gums.
----------------------------------------------------------------------------------
VIDEO
Oct 28, 2014. A father and young adult daughter presented this gentle 7-year-old male Sheltie for dental scaling. A friend's Maltese had died after dental scaling by another vet and so the owners were worried about anaesthetic death. "Dogs usually do not die under anaesthesia or after anaesthesia," I said to the father. "Unless the dog has heart disease or poor health."
A thorough physical examination showed that this Sheltie with bad breath was generally healthy in heart and lungs. The heart beats were irregular. 50% sedation of domitor and ketamine IV calmed this nervous Sheltie.
In this case, I gave an IV drip, with IV baytril, frusemide and Vit B complex.
It is very important to provide a very close monitoring of the maintenance of isoflurane gas at 0-2%, oxygen flow rate at 2 litres/minute to ensure that minimal anaesthesia is being given. The dog did wake up in the midst of dental scaling as the maintenance dose was 0.5%. He was intubated again and maintained at 2%. The dog woke up fast and went home 3 hours later. Follow up 2 days later showed that the dog is OK. The dog had been given dry dog food and milk since young. He likes only certain brands of milk. Well beloved family dog and in excellent body condition.
A new client - father and young adult daughter brought in a 7-year-old male entire Shetland for dental scaling. Their friend's Maltese had died after dental scaling in another vet practice and so they did not want to go to the practice.
"Very rarely do dogs die after waking up from anaesthesia given for dental scaling," I said. "Was the Maltese having heart diseases?" The owners of the gentle full sized Sheltie did not know but they would avoid this friend's vet
No vet can guarantee no anaesthetic risk. Even people do die.
PHYSICAL EXAMINATION
Other than periodontal disease grade 4 (tissue attachment loss over 50%), I noted that this Sheltie had congested maroon red gums, not the normal pink ones. You can see this in the video. Why? The capillary refill time was longer than the usual 2 seconds. Blood test showed that this dog had a higher than normal amount of haemoglobin in his blood at 19.1 (12-18). The total red cell count was normal. The haematocrit was normal too. Platelets were normal. What does it mean? Was he fed some supplements?
BLOOD TEST on 27.10.14 Abnormal values
Urea 12.3 (4.2 - 6.3)
Creatiine 65 (89-177)
Haemoglobin 19.1 (12-18)
All the other blood values within normal limits.
FOLLOW UP - Day 2 after dental scaling
The dog was a bit tired yesterday but is Ok and eating today.
"Tartar started to build up fast in last 3 years," the father said that the dog was not given meat. "Could it be the milk making the kibbles soft?". This dog had the biggest crusty tartar I had ever seen in a dog (see image/video).
The dry dog food was Science Diet Lamb and Rice with a brand of dog's milk since young. Dog treats were given.
ADVICES
No milk and treats to prevent tartar build up.
Eat dry food without milk and drink water.
Blood test 4 weeks later to check on the urea levels.
This case shows that a blood test is important for screening the health of an older dog. The owner was given the option. The blood test was done by me as this dog had an unusual congested gums.
----------------------------------------------------------------------------------
VIDEO
Oct 28, 2014. A father and young adult daughter presented this gentle 7-year-old male Sheltie for dental scaling. A friend's Maltese had died after dental scaling by another vet and so the owners were worried about anaesthetic death. "Dogs usually do not die under anaesthesia or after anaesthesia," I said to the father. "Unless the dog has heart disease or poor health."
A thorough physical examination showed that this Sheltie with bad breath was generally healthy in heart and lungs. The heart beats were irregular. 50% sedation of domitor and ketamine IV calmed this nervous Sheltie.
In this case, I gave an IV drip, with IV baytril, frusemide and Vit B complex.
It is very important to provide a very close monitoring of the maintenance of isoflurane gas at 0-2%, oxygen flow rate at 2 litres/minute to ensure that minimal anaesthesia is being given. The dog did wake up in the midst of dental scaling as the maintenance dose was 0.5%. He was intubated again and maintained at 2%. The dog woke up fast and went home 3 hours later. Follow up 2 days later showed that the dog is OK. The dog had been given dry dog food and milk since young. He likes only certain brands of milk. Well beloved family dog and in excellent body condition.
The Jack Russell keeps vomiting for 2 days.
Tuesday, Oct 28, 2014
Breakfast with 2 senior citizens, Mr Han and Joe .
Mr Han, the 67-year-old man related the following stories again to me today:
Story 1. $40 consultation fee for no consultation.
His friend wanted to renew his driving licence but had to see a general practitioner to sign the form.
"Did you have any heart surgery," the doctor asked.
"Yes," his friend said. "I have a pace-maker."
"In that case, you need to go to the Tan Tock Seng Hospital to be certified fit for driving!"
"But you can certify that I am fit at the time of examintion," the friend said.
The doctor refused to do so and the consulation fee was $40 for "doing nothing."
He advised his friend not to pay but the friend did.
"There was consultation," I said. "Though not in his favour."
"Why not go to the next doctor and tell him you do not have heart surgery," the 2nd senior citizen suggested.
"He did," Mr Han said. "Exactly the same reply and the doctor filled up the form."
"How much was the fee?" I asked.
$25.00"
Story 2. The 14-year-old daughter has late nights.
Mr Han's daughter goes out after 11 pm every night and comes home past 3 am.
"Don't go out at this time," Mr Han said. "What will neighbours think? Leave the house at 7 pm."
The daughter ignored him. He slapped her once. She called the police and he was put in jail.
"It is a case of assault," I said.
"If you have a well brought up child, you are lucky," Joe said to me. Joe has a son who graduated from an American University and has an excellent relationship with him.
"If the father cuts off the allowance to the daughter," Joe said that a solution is to stop giving the daughter her financial support. "If Mr Han does that, she will blame him as she earns money from prostitution."
Story 3. The neighour had stomach cancer.
The neighbourhood doctor was sued by the neighbour for not diagnosing stomach cancer as he would prescribe some medication during every visit. The neighbour's wife suggested that the husband seek a second opinion and was scolded. Finally, the husband got a second opinion and engaged a lawyer to sue the doctor.
"Ironically, the lawyer is another neighbour," Mr Han said.
"Did he win the case?"
"No, no," Mr Han said.
"The doctor might have suggested visit to the specialist and had written this advice in his medical records," I said.
"You can't expect a general practitioner to diagnose stomach cancer," Joe said.
"But he should have referred for further investigations at the hospital and he probably had done so."
Story 4. Charcot's foot.
Charcot's foot is said to be a progressive degeneration of the joints of the foot. One cause is diabetes and Mr Han had diabetes. Initially, Mr Han consulted the general practitioner who prescribed some medication without even looking at his foot.
"Maybe your foot was smelly," I said.
"Not at all."
He was diagnosed Charcot's foot by the specialist and had a special shoe made.
Breakfast with 2 senior citizens, Mr Han and Joe .
Mr Han, the 67-year-old man related the following stories again to me today:
Story 1. $40 consultation fee for no consultation.
His friend wanted to renew his driving licence but had to see a general practitioner to sign the form.
"Did you have any heart surgery," the doctor asked.
"Yes," his friend said. "I have a pace-maker."
"In that case, you need to go to the Tan Tock Seng Hospital to be certified fit for driving!"
"But you can certify that I am fit at the time of examintion," the friend said.
The doctor refused to do so and the consulation fee was $40 for "doing nothing."
He advised his friend not to pay but the friend did.
"There was consultation," I said. "Though not in his favour."
"Why not go to the next doctor and tell him you do not have heart surgery," the 2nd senior citizen suggested.
"He did," Mr Han said. "Exactly the same reply and the doctor filled up the form."
"How much was the fee?" I asked.
$25.00"
Story 2. The 14-year-old daughter has late nights.
Mr Han's daughter goes out after 11 pm every night and comes home past 3 am.
"Don't go out at this time," Mr Han said. "What will neighbours think? Leave the house at 7 pm."
The daughter ignored him. He slapped her once. She called the police and he was put in jail.
"It is a case of assault," I said.
"If you have a well brought up child, you are lucky," Joe said to me. Joe has a son who graduated from an American University and has an excellent relationship with him.
"If the father cuts off the allowance to the daughter," Joe said that a solution is to stop giving the daughter her financial support. "If Mr Han does that, she will blame him as she earns money from prostitution."
Story 3. The neighour had stomach cancer.
The neighbourhood doctor was sued by the neighbour for not diagnosing stomach cancer as he would prescribe some medication during every visit. The neighbour's wife suggested that the husband seek a second opinion and was scolded. Finally, the husband got a second opinion and engaged a lawyer to sue the doctor.
"Ironically, the lawyer is another neighbour," Mr Han said.
"Did he win the case?"
"No, no," Mr Han said.
"The doctor might have suggested visit to the specialist and had written this advice in his medical records," I said.
"You can't expect a general practitioner to diagnose stomach cancer," Joe said.
"But he should have referred for further investigations at the hospital and he probably had done so."
Story 4. Charcot's foot.
Charcot's foot is said to be a progressive degeneration of the joints of the foot. One cause is diabetes and Mr Han had diabetes. Initially, Mr Han consulted the general practitioner who prescribed some medication without even looking at his foot.
"Maybe your foot was smelly," I said.
"Not at all."
He was diagnosed Charcot's foot by the specialist and had a special shoe made.
2015Singapore stories: Charcot Foot and other stories
Tuesday, Oct 28, 2014
Breakfast with 2 senior citizens, Mr Han and Joe .
Mr Han, the 67-year-old man related the following stories again to me today:
Story 1. $40 consultation fee for no consultation.
His friend wanted to renew his driving licence but had to see a general practitioner to sign the form.
"Did you have any heart surgery," the doctor asked.
"Yes," his friend said. "I have a pace-maker."
"In that case, you need to go to the Tan Tock Seng Hospital to be certified fit for driving!"
"But you can certify that I am fit at the time of examintion," the friend said.
The doctor refused to do so and the consulation fee was $40 for "doing nothing."
He advised his friend not to pay but the friend did.
"There was consultation," I said. "Though not in his favour."
"Why not go to the next doctor and tell him you do not have heart surgery," the 2nd senior citizen suggested.
"He did," Mr Han said. "Exactly the same reply and the doctor filled up the form."
"How much was the fee?" I asked.
$25.00"
Story 2. The 14-year-old daughter has late nights.
Mr Han's daughter goes out after 11 pm every night and comes home past 3 am.
"Don't go out at this time," Mr Han said. "What will neighbours think? Leave the house at 7 pm."
The daughter ignored him. He slapped her once. She called the police and he was put in jail.
"It is a case of assault," I said.
"If you have a well brought up child, you are lucky," Joe said to me. Joe has a son who graduated from an American University and has an excellent relationship with him.
"If the father cuts off the allowance to the daughter," Joe said that a solution is to stop giving the daughter her financial support. "If Mr Han does that, she will blame him as she earns money from prostitution."
Story 3. The neighour had stomach cancer.
The neighbourhood doctor was sued by the neighbour for not diagnosing stomach cancer as he would prescribe some medication during every visit. The neighbour's wife suggested that the husband seek a second opinion and was scolded. Finally, the husband got a second opinion and engaged a lawyer to sue the doctor.
"Ironically, the lawyer is another neighbour," Mr Han said.
"Did he win the case?"
"No, no," Mr Han said.
"The doctor might have suggested visit to the specialist and had written this advice in his medical records," I said.
"You can't expect a general practitioner to diagnose stomach cancer," Joe said.
"But he should have referred for further investigations at the hospital and he probably had done so."
Story 4. Charcot's foot.
Charcot's foot is said to be a progressive degeneration of the joints of the foot. One cause is diabetes and Mr Han had diabetes. Initially, Mr Han consulted the general practitioner who prescribed some medication without even looking at his foot.
"Maybe your foot was smelly," I said.
"Not at all."
He was diagnosed Charcot's foot by the specialist and had a special shoe made.
Breakfast with 2 senior citizens, Mr Han and Joe .
Mr Han, the 67-year-old man related the following stories again to me today:
Story 1. $40 consultation fee for no consultation.
His friend wanted to renew his driving licence but had to see a general practitioner to sign the form.
"Did you have any heart surgery," the doctor asked.
"Yes," his friend said. "I have a pace-maker."
"In that case, you need to go to the Tan Tock Seng Hospital to be certified fit for driving!"
"But you can certify that I am fit at the time of examintion," the friend said.
The doctor refused to do so and the consulation fee was $40 for "doing nothing."
He advised his friend not to pay but the friend did.
"There was consultation," I said. "Though not in his favour."
"Why not go to the next doctor and tell him you do not have heart surgery," the 2nd senior citizen suggested.
"He did," Mr Han said. "Exactly the same reply and the doctor filled up the form."
"How much was the fee?" I asked.
$25.00"
Story 2. The 14-year-old daughter has late nights.
Mr Han's daughter goes out after 11 pm every night and comes home past 3 am.
"Don't go out at this time," Mr Han said. "What will neighbours think? Leave the house at 7 pm."
The daughter ignored him. He slapped her once. She called the police and he was put in jail.
"It is a case of assault," I said.
"If you have a well brought up child, you are lucky," Joe said to me. Joe has a son who graduated from an American University and has an excellent relationship with him.
"If the father cuts off the allowance to the daughter," Joe said that a solution is to stop giving the daughter her financial support. "If Mr Han does that, she will blame him as she earns money from prostitution."
Story 3. The neighour had stomach cancer.
The neighbourhood doctor was sued by the neighbour for not diagnosing stomach cancer as he would prescribe some medication during every visit. The neighbour's wife suggested that the husband seek a second opinion and was scolded. Finally, the husband got a second opinion and engaged a lawyer to sue the doctor.
"Ironically, the lawyer is another neighbour," Mr Han said.
"Did he win the case?"
"No, no," Mr Han said.
"The doctor might have suggested visit to the specialist and had written this advice in his medical records," I said.
"You can't expect a general practitioner to diagnose stomach cancer," Joe said.
"But he should have referred for further investigations at the hospital and he probably had done so."
Story 4. Charcot's foot.
Charcot's foot is said to be a progressive degeneration of the joints of the foot. One cause is diabetes and Mr Han had diabetes. Initially, Mr Han consulted the general practitioner who prescribed some medication without even looking at his foot.
"Maybe your foot was smelly," I said.
"Not at all."
He was diagnosed Charcot's foot by the specialist and had a special shoe made.
Saturday, October 25, 2014
2015 Vets - The dog groomer and the Judge
Friday Oct 25, 2014
A couple with over 10 years of dog grooming and pet shop operation experience shared with me their grooming situation.
"Vets are making good money compared to groomers," Jim Mandalay said. "In one practice, the vet bills are not less than $200/customer. In another practice, they are over $500/customer. My grooming charges are $60 and I take at least 2 hours to groom one dog!"
"The pasture is always greener on the other side," I said. "There are vets who charge less than $100/customer," I named one practice that advised blood tests and even weekly blood tests for ill dogs.
"With blood tests compulsory at the first clinic, at $140/blood test, the bill would be more than $200/customer," I said. "The customer can always go to another vet and there are over 60 vet clinics in Singapore nowadays!"
"The other vet also charges high fees," Jim laughed. Jim knows about vet charges as he transport pets to the clinic for treatment, charging $100/trip. His wife would do the grooming while he would answer calls and do the transport. In Singapore, competitors charge $10 for dog transport and $60 for grooming. So, Jim said that he could not increase the costs as that would drive customers to the arms of another groomer.
"Proximity and convenience are what the dog owner wants," I said.
"There is no loyalty from the customers," Jim and his wife were exhausted from so many years of grooming and the great difficulty in retaining a Singaporean receptionist.
In Singapore, the receptionist would be young ladies. They would work for a few months and change jobs or find a downtown office with lots of colleagues to work. Not content with being a receptionist in a small pet shop. So, the couple had to work by themselves. Or close shop.
"How about selling puppies?" I asked as they used to sell puppies. With puppy sales, they can retain clients as groomers.
"No, no," Jim said. "The consumer is now well protected with one year's return policy. That is the lemon law."
"Are you sure?" I asked. "In one year, the puppy can be returned to the Seller with money back? A person can buy a new car and can return it back within one year if there is a defect?"
"Yes, yes," Jim said authoritatively as regards puppy sale.
Jim related his personal experience. He sold a poodle some years ago with a sales contract between the husband buyer and himself.
"After one year, the wife phoned me to ask what compensation I would give her as the poodle had become 2 inches taller than the standards stated in breeders' books and had changed to a lighter colour."
The Buyer brought the case to the Small Claims Court and Jim had to attend the hearing.
"The judge dealt with the case although the complainant was the wife who was not the one signing the sales contract with me!" Jim said.
"It is up to the judge as he has the power," I said. "Maybe the wife is family. Who knows what the the judge based his decision upon. Did you win the case? After all, you were not selling a pedigree dog for dog shows but a pet quality dog. The coat colour could fade or darken when the dog grows older."
"Poodles have different shades of brown," Jim said. "But the judge does not know it. Photos were submitted by the wife as evidence! She even had an expert witness to testify for her as regards the standard height of a poodle! Another pet shop owner!"
"Was the expert witness paid by her?" I asked.
"No, no," Jim said. "That poor fellow had to close his pet shop to attend the hearing! He was suppoenaed by the court to attend the hearing. No need for this woman to pay him. That was the price of him voicing his opinion on the height of what a poodle should be as an adult dog!"
This experience should teach readers not to venture any opinions in cases of disputes as the complainant can ask the Court to subpoena us for expert testimony.
"This woman would cancel the hearing and I would have to wait for another day, cancelling my grooming and transport appointments again! She knows the process of the Small Claims Court of last-minute cancellations.
"You know, she is the wife of one of those rich developers in Singapore and must have good experience of making puppy sellers pay for defective puppies. That was before the lemon law was introduced in Singapore and my case was that the puppy had been sold to her for over a year! Now, with the lemon law which states that there is a one year of guarantee, I do not sell puppies anymore!"
"I don't agree that there is a one-year-guarantee for puppy purchase. He could have bloody diarrhoea from parvoviral infection 2 months after purchase and died. So the owner cannot claim that the puppy was bought with parvoviral infections. The incubation period for parvovirus would be around 14 days, that is, signs would appear 14 days after infection and 2 months equal 60 days. So, the Buyer cannot claim losses and medical treatment costs."
"I am telling you it is one year," Jim insisted.
"What happened to the expert witness for the Buyer?"
"He was not even called in to testify," Jim laughed. "He had to cancel his grooming appointments to attend the hearing, making him lose income! Serves him right for being a smart aleck.
"As for me, the complainant cancelled the hearing at the last minute and so I had to close shop a second time and lose income! The Buyer certainly knows how to make me suffer losses of income!"
I usually do not comment on competitor's treatment of a case and that would not be subpoenaed as a witness.
"So what happened? Did you lose the case?" I asked. "I think the judge would not more than you think, about dog's standard height and colour. A lighter colour could be due to bleaching shampoo and I don't think he would be fooled by the Buyer. How much did she ask for compensation?"
"The judge asked her. She wanted much more than what she paid me for the puppy. For emotional distress, you know. So much worries when the poodle became taller by two inches and losing the redness of the coat!"
"How much she paid for the puppy?" I asked..
"$1,900. She wanted much more. To be a puppy seller, you must have a good lawyer. Refer all complaints to the lawyer.
"There was this big puppy seller who had this good lawyer. One day, a very rich lady was dissatisfied with the puppy and he referred her to his lawyer. But the rich lady did not proceed with the 'see you in court' threat."
"That is why she is rich," I replied. "No point paying lawyers to sue as the legal costs would be more than the cost of the puppy! She is from the elite family of Singaporeans and she certainly can afford it but she did not do so."
But Jim could not afford to retain a lawyer as he sold only a handful of puppies from his own pets some years ago. I opened the can of drinks he offered me and it was getting dark now, closer to 7 pm when he should be sending the groomed dog home to Woodlands.
"So what was the verdict?" I reminded him that he was late for his transport.
"The rich woman lost her case."
"Why?" I asked as the government is deemed to be pro-consumer.
"She placed the photo evidence of the coat of the puppy not in chronological order, hoping to fool the judge."
"Really? How did she do it?"
"She placed the older dog's photo as the first photo. The judge said the coat colour was light and it could be due to the flash bulb!"
A couple with over 10 years of dog grooming and pet shop operation experience shared with me their grooming situation.
"Vets are making good money compared to groomers," Jim Mandalay said. "In one practice, the vet bills are not less than $200/customer. In another practice, they are over $500/customer. My grooming charges are $60 and I take at least 2 hours to groom one dog!"
"The pasture is always greener on the other side," I said. "There are vets who charge less than $100/customer," I named one practice that advised blood tests and even weekly blood tests for ill dogs.
"With blood tests compulsory at the first clinic, at $140/blood test, the bill would be more than $200/customer," I said. "The customer can always go to another vet and there are over 60 vet clinics in Singapore nowadays!"
"The other vet also charges high fees," Jim laughed. Jim knows about vet charges as he transport pets to the clinic for treatment, charging $100/trip. His wife would do the grooming while he would answer calls and do the transport. In Singapore, competitors charge $10 for dog transport and $60 for grooming. So, Jim said that he could not increase the costs as that would drive customers to the arms of another groomer.
"Proximity and convenience are what the dog owner wants," I said.
"There is no loyalty from the customers," Jim and his wife were exhausted from so many years of grooming and the great difficulty in retaining a Singaporean receptionist.
In Singapore, the receptionist would be young ladies. They would work for a few months and change jobs or find a downtown office with lots of colleagues to work. Not content with being a receptionist in a small pet shop. So, the couple had to work by themselves. Or close shop.
"How about selling puppies?" I asked as they used to sell puppies. With puppy sales, they can retain clients as groomers.
"No, no," Jim said. "The consumer is now well protected with one year's return policy. That is the lemon law."
"Are you sure?" I asked. "In one year, the puppy can be returned to the Seller with money back? A person can buy a new car and can return it back within one year if there is a defect?"
"Yes, yes," Jim said authoritatively as regards puppy sale.
Jim related his personal experience. He sold a poodle some years ago with a sales contract between the husband buyer and himself.
"After one year, the wife phoned me to ask what compensation I would give her as the poodle had become 2 inches taller than the standards stated in breeders' books and had changed to a lighter colour."
The Buyer brought the case to the Small Claims Court and Jim had to attend the hearing.
"The judge dealt with the case although the complainant was the wife who was not the one signing the sales contract with me!" Jim said.
"It is up to the judge as he has the power," I said. "Maybe the wife is family. Who knows what the the judge based his decision upon. Did you win the case? After all, you were not selling a pedigree dog for dog shows but a pet quality dog. The coat colour could fade or darken when the dog grows older."
"Poodles have different shades of brown," Jim said. "But the judge does not know it. Photos were submitted by the wife as evidence! She even had an expert witness to testify for her as regards the standard height of a poodle! Another pet shop owner!"
"Was the expert witness paid by her?" I asked.
"No, no," Jim said. "That poor fellow had to close his pet shop to attend the hearing! He was suppoenaed by the court to attend the hearing. No need for this woman to pay him. That was the price of him voicing his opinion on the height of what a poodle should be as an adult dog!"
This experience should teach readers not to venture any opinions in cases of disputes as the complainant can ask the Court to subpoena us for expert testimony.
"This woman would cancel the hearing and I would have to wait for another day, cancelling my grooming and transport appointments again! She knows the process of the Small Claims Court of last-minute cancellations.
"You know, she is the wife of one of those rich developers in Singapore and must have good experience of making puppy sellers pay for defective puppies. That was before the lemon law was introduced in Singapore and my case was that the puppy had been sold to her for over a year! Now, with the lemon law which states that there is a one year of guarantee, I do not sell puppies anymore!"
"I don't agree that there is a one-year-guarantee for puppy purchase. He could have bloody diarrhoea from parvoviral infection 2 months after purchase and died. So the owner cannot claim that the puppy was bought with parvoviral infections. The incubation period for parvovirus would be around 14 days, that is, signs would appear 14 days after infection and 2 months equal 60 days. So, the Buyer cannot claim losses and medical treatment costs."
"I am telling you it is one year," Jim insisted.
"What happened to the expert witness for the Buyer?"
"He was not even called in to testify," Jim laughed. "He had to cancel his grooming appointments to attend the hearing, making him lose income! Serves him right for being a smart aleck.
"As for me, the complainant cancelled the hearing at the last minute and so I had to close shop a second time and lose income! The Buyer certainly knows how to make me suffer losses of income!"
I usually do not comment on competitor's treatment of a case and that would not be subpoenaed as a witness.
"So what happened? Did you lose the case?" I asked. "I think the judge would not more than you think, about dog's standard height and colour. A lighter colour could be due to bleaching shampoo and I don't think he would be fooled by the Buyer. How much did she ask for compensation?"
"The judge asked her. She wanted much more than what she paid me for the puppy. For emotional distress, you know. So much worries when the poodle became taller by two inches and losing the redness of the coat!"
"How much she paid for the puppy?" I asked..
"$1,900. She wanted much more. To be a puppy seller, you must have a good lawyer. Refer all complaints to the lawyer.
"There was this big puppy seller who had this good lawyer. One day, a very rich lady was dissatisfied with the puppy and he referred her to his lawyer. But the rich lady did not proceed with the 'see you in court' threat."
"That is why she is rich," I replied. "No point paying lawyers to sue as the legal costs would be more than the cost of the puppy! She is from the elite family of Singaporeans and she certainly can afford it but she did not do so."
But Jim could not afford to retain a lawyer as he sold only a handful of puppies from his own pets some years ago. I opened the can of drinks he offered me and it was getting dark now, closer to 7 pm when he should be sending the groomed dog home to Woodlands.
"So what was the verdict?" I reminded him that he was late for his transport.
"The rich woman lost her case."
"Why?" I asked as the government is deemed to be pro-consumer.
"She placed the photo evidence of the coat of the puppy not in chronological order, hoping to fool the judge."
"Really? How did she do it?"
"She placed the older dog's photo as the first photo. The judge said the coat colour was light and it could be due to the flash bulb!"
Friday, October 24, 2014
1082. Just microchipping
A 7-year-old male Westie came for microchipping only as the vet authorities are more active in checking unlicensed dogs.
The previous owner had migrated. The dog had thick tartar, an undescended testicle and had no vaccination. The vet has to record that the owner does not want any dental scaling and neutering or vaccination in the record in case of misunderstanding later. The new owner said that the dog, being old, would feel the pain of neutering.
Dogs that are fortunate have owners who would have done the dental scaling at least once in 7 years and this prevents heart valve infections (endocarditis). However, not all owners care.
The previous owner had migrated. The dog had thick tartar, an undescended testicle and had no vaccination. The vet has to record that the owner does not want any dental scaling and neutering or vaccination in the record in case of misunderstanding later. The new owner said that the dog, being old, would feel the pain of neutering.
Dogs that are fortunate have owners who would have done the dental scaling at least once in 7 years and this prevents heart valve infections (endocarditis). However, not all owners care.
An old golden retriever has an eyelid tumour
23, 2014 was Deepavali, was a rainy morning. I did not expect any customers. A car parked outside and a man with a young adult son brought in a 9-year-old golden retriever with an eyelid tumour.
"It looks like a cauliflower wart, " I said. "How long has he got this lower eyelid tumour?"
"I saw it this morning," the father said. "Probably 2 weeks. He has been tearing and rubbing his eyes."
"The only cure is V-shaped cut to remove it. Has he got a blood test recently?".
"OK," he said.I "He was not eating and had a blood test done by Dr Daniel, but there was no problem."
I showed him the blood test results of 2 months ago and explained: "The total red blood cell, haemoglobin and platelets were low."
"He had anaemia probably due to tick bites," I said. "Did he have a lot of ticks 2 weeks before you consulted Dr Daniel?"
"Yes, yes," the father said. "The anti-tick spot on was not effective but now he has no ticks as I have had changed to a new brand."
"Your dog is thin although his gums are not pale now and has better appetite. The low platelet count in his blood showed that he was likely to have been poisoned at that time too. It also could be due to the tick-borne disease attacking his red blood cells."
I walked him to a chart illustrating the effects of tick bites explaining that Babesia parasites could destroy the red blood cells causing anaemia.
"Yes, it was possible that he could be poisoned. We used a lot of ant poison to get rid of the ants and he might have consumed it."
The dog was anaesthesized and operated upon by Dr Daniel. He used electro-excision to cut out the tumour in a V-shaped incision.. Then he stitched the two ends.
Histopathology showed that this was a meibomian gland epithelioma, not malignant.
The dog went home at around 3 pm. The father and two grown up adult sons came to bring the dog back home.
It was great to see a father who bothered to treat the old dog. Just two days ago, a lady told me that her husband refused to give the 9-year-old Schnauzer dental extraction as he would not pay for it. The Schnauzer had come for vaccination.
"How much would he pay for dental scaling and extraction?" I had quoted around $300 for anaesthesia and dental work.
"Less than a hundred dollars."
The dog had periodontitis Stage 4 with some teeth dropped. He had a hole below his right eye. A carnaissal tooth abscess opening up a hole below the right eye.
"Maybe the carnaissal tooth had dropped off," she said.
had
"It looks like a cauliflower wart, " I said. "How long has he got this lower eyelid tumour?"
"I saw it this morning," the father said. "Probably 2 weeks. He has been tearing and rubbing his eyes."
"The only cure is V-shaped cut to remove it. Has he got a blood test recently?".
"OK," he said.I "He was not eating and had a blood test done by Dr Daniel, but there was no problem."
I showed him the blood test results of 2 months ago and explained: "The total red blood cell, haemoglobin and platelets were low."
"He had anaemia probably due to tick bites," I said. "Did he have a lot of ticks 2 weeks before you consulted Dr Daniel?"
"Yes, yes," the father said. "The anti-tick spot on was not effective but now he has no ticks as I have had changed to a new brand."
"Your dog is thin although his gums are not pale now and has better appetite. The low platelet count in his blood showed that he was likely to have been poisoned at that time too. It also could be due to the tick-borne disease attacking his red blood cells."
I walked him to a chart illustrating the effects of tick bites explaining that Babesia parasites could destroy the red blood cells causing anaemia.
"Yes, it was possible that he could be poisoned. We used a lot of ant poison to get rid of the ants and he might have consumed it."
The dog was anaesthesized and operated upon by Dr Daniel. He used electro-excision to cut out the tumour in a V-shaped incision.. Then he stitched the two ends.
Histopathology showed that this was a meibomian gland epithelioma, not malignant.
The dog went home at around 3 pm. The father and two grown up adult sons came to bring the dog back home.
It was great to see a father who bothered to treat the old dog. Just two days ago, a lady told me that her husband refused to give the 9-year-old Schnauzer dental extraction as he would not pay for it. The Schnauzer had come for vaccination.
"How much would he pay for dental scaling and extraction?" I had quoted around $300 for anaesthesia and dental work.
"Less than a hundred dollars."
The dog had periodontitis Stage 4 with some teeth dropped. He had a hole below his right eye. A carnaissal tooth abscess opening up a hole below the right eye.
"Maybe the carnaissal tooth had dropped off," she said.
had
Sunday, October 19, 2014
A Jack Russell has a large liver tumour
A 12-year-old Jack Russell came with a much swollen abdomen.
She was not spayed and so I thought she could have closed pyometra. This is a common problem of unspayed old female dogs. Yet the dog was active and could even walk 30 minutes to the Surgery. She had a very good appetite and drank a lot of water. She peed a lot. So, closed pyometra was ruled out.
Could there be an abdominal tumour since a vet had removed a breast tumour (MG 5 left side) some 8 months ago? Or metastasis of this breast tumour?
Could there be an ovarian tumour?
Next was ascites. On percussion of the abdomen, there was no tympany of gas or fluid thrill when I tap the right side of the abdomen and let my fingers of the other hand feel the other side.
I gave fruesemide to bring down any abdominal fluid and took an X-ray 12 hours later. There was the classical splenic neoplasia as diagnosed by Dr Daniel. This image was similar to the image in the Vet Surgery book which showed the lateral abdomen with the tail of the spleen being a globular shape.
According to an experienced older vet, an ovarian cyst would be higher up in the anterior abdomen.
So, the X-ray diagnosis is a splenic tumour. Could it have metastasized to the atrium causing an atrial tumour?
OCT 20, 2014. Exploratory laparotomy. Low dose of domitor + ketamine IV and isoflurane gas.
SURGERY
The large globular tumour was at one end of the lobe. The lobe was taken out. A scalpel blade cut one side of the lobe like "fracturing" the liver. That meant that the liver was incised on one side while the assistant could hold up the liver for ligation of the parenchyma blood vessels.
Bleeding inside the parenchyma area where the one side was cut was profused. The suture needle is put inside the parenchyma and ligation was carried out..
3/0 absorbable "gullotine" ligatures were placed inside the parenchyma to ligate the blood vessels and bile ducts. Electro-coagulation was done. "Gullotine" ligatures were put on the other side of the lobe 2 cm below the tumour to control bleeding.
The liver tumour was then excised, using electro-excision needle to cut and coagulate the stump. Surprisingly, there was no bleeding after this electro-excision.
HISTOPATHOLOGY. Malignant tumour composed of anastomosing traeculae, nests and pseudoacinar structures. The tumour cells are plyonal with mildly enlarged round nuclei, vesicular chromatin and small round nucleoli. Areas of tumour necrosis are seen. The uninvolved liver shows evidence of steatosis.
Diagnosis: Malignant tumour, favour heptocellular carcinoma
Liver neoplasia with multiple abscesses.
One 70% size of a tennis-ball-tumour in one lobe. Abscesses have spread all over the liver.
Another ping pong ball tumour in a smaller lobe. Histopathology in progress - whether it is simply abscesses or abscessed tumours.
24 hours post-op, the dog was eating and very active. I advised in-patient for 10 days as the other dog at home would play with this dog, causing suture breakdown.
The owner asked about prognosis.
Poor prognosis.
1. Locally advanced stage of liver neoplasia with abscesses. This is to be confirmed on histopathology of samples sent..
BLOOD TEST.
No leucocytosis. No "neutrophilia", but neutrophils % was 92%. (60-70% normal).
Liver enzymes SGOT and SGPT were raised.
TREATMENT IN DOGS.
In people, a combination of chemotherapy or radiation therapy to down-stage the cancer to a more early stage so that surgical resection can be done to provide a long-term survival or cure.
CONCLUSION
8 months ago, another vet had excised a breast tumour but did not send it for histology. This tumour was large and could have spread to the liver. No lung X-rays were done to lower medical costs. If the dog had been spayed young, it is possible that she would not have breast tumours which could have spread to the liver, now at 12 years of age.
SEVEN DAYS POST OP.
The dog is presently eating and drinking and is active as at Oct 28, 2014. But she panted a lot when taken out for a short walk. Will go home on Day 14 when stitches are removed. As to life span, it is unlikely to be more than 6 months.
--------------------------
NOTES
In people, liver cancer (HCC or hepatocellular carcinoma) is the 6th most, important cancer in the world and the 3rd most important cause of cancer mortality. 80% of all HCC patients are found in the Asia Pacific region because of the high incidence of viral hepatitis. In Singapore, it is the 4th most important cancer and the second cause of cancer death after lung cancer.
Reference; Down-staging of liver cancer to allow curative surgery: An emerging paradigm. Prof Pierce Chow, Pg. 2, Salubris Issue No. 30, Jul - Sep 2014
She was not spayed and so I thought she could have closed pyometra. This is a common problem of unspayed old female dogs. Yet the dog was active and could even walk 30 minutes to the Surgery. She had a very good appetite and drank a lot of water. She peed a lot. So, closed pyometra was ruled out.
Could there be an abdominal tumour since a vet had removed a breast tumour (MG 5 left side) some 8 months ago? Or metastasis of this breast tumour?
Could there be an ovarian tumour?
Next was ascites. On percussion of the abdomen, there was no tympany of gas or fluid thrill when I tap the right side of the abdomen and let my fingers of the other hand feel the other side.
I gave fruesemide to bring down any abdominal fluid and took an X-ray 12 hours later. There was the classical splenic neoplasia as diagnosed by Dr Daniel. This image was similar to the image in the Vet Surgery book which showed the lateral abdomen with the tail of the spleen being a globular shape.
According to an experienced older vet, an ovarian cyst would be higher up in the anterior abdomen.
So, the X-ray diagnosis is a splenic tumour. Could it have metastasized to the atrium causing an atrial tumour?
 |
| Exploratory surgery showed that the abdominal mass was a liver tumour, not a splenic tumour. Blood test showed liver hepatitis. The dog had a mammary tumour by another vet 8 months ago. No histopathology was done. It is likely that this liver tumour was a metastatic tumour from the breast. Prevention of this liver tumour might or might not be possible if the dog had been spayed at a young age. Spayed dogs seldom develop breast tumours. Primary malignant liver tumours (hepatocellular carcinoma) are rare in dogs and they are usually due to the spread from other organs with tumours. In this case, histopathology is in progress as at Oct 24, 2014. |
OCT 20, 2014. Exploratory laparotomy. Low dose of domitor + ketamine IV and isoflurane gas.
SURGERY
The large globular tumour was at one end of the lobe. The lobe was taken out. A scalpel blade cut one side of the lobe like "fracturing" the liver. That meant that the liver was incised on one side while the assistant could hold up the liver for ligation of the parenchyma blood vessels.
Bleeding inside the parenchyma area where the one side was cut was profused. The suture needle is put inside the parenchyma and ligation was carried out..
3/0 absorbable "gullotine" ligatures were placed inside the parenchyma to ligate the blood vessels and bile ducts. Electro-coagulation was done. "Gullotine" ligatures were put on the other side of the lobe 2 cm below the tumour to control bleeding.
The liver tumour was then excised, using electro-excision needle to cut and coagulate the stump. Surprisingly, there was no bleeding after this electro-excision.
HISTOPATHOLOGY. Malignant tumour composed of anastomosing traeculae, nests and pseudoacinar structures. The tumour cells are plyonal with mildly enlarged round nuclei, vesicular chromatin and small round nucleoli. Areas of tumour necrosis are seen. The uninvolved liver shows evidence of steatosis.
Diagnosis: Malignant tumour, favour heptocellular carcinoma
Liver neoplasia with multiple abscesses.
One 70% size of a tennis-ball-tumour in one lobe. Abscesses have spread all over the liver.
Another ping pong ball tumour in a smaller lobe. Histopathology in progress - whether it is simply abscesses or abscessed tumours.
24 hours post-op, the dog was eating and very active. I advised in-patient for 10 days as the other dog at home would play with this dog, causing suture breakdown.
The owner asked about prognosis.
Poor prognosis.
1. Locally advanced stage of liver neoplasia with abscesses. This is to be confirmed on histopathology of samples sent..
BLOOD TEST.
No leucocytosis. No "neutrophilia", but neutrophils % was 92%. (60-70% normal).
Liver enzymes SGOT and SGPT were raised.
TREATMENT IN DOGS.
In people, a combination of chemotherapy or radiation therapy to down-stage the cancer to a more early stage so that surgical resection can be done to provide a long-term survival or cure.
CONCLUSION
8 months ago, another vet had excised a breast tumour but did not send it for histology. This tumour was large and could have spread to the liver. No lung X-rays were done to lower medical costs. If the dog had been spayed young, it is possible that she would not have breast tumours which could have spread to the liver, now at 12 years of age.
SEVEN DAYS POST OP.
The dog is presently eating and drinking and is active as at Oct 28, 2014. But she panted a lot when taken out for a short walk. Will go home on Day 14 when stitches are removed. As to life span, it is unlikely to be more than 6 months.
--------------------------
NOTES
In people, liver cancer (HCC or hepatocellular carcinoma) is the 6th most, important cancer in the world and the 3rd most important cause of cancer mortality. 80% of all HCC patients are found in the Asia Pacific region because of the high incidence of viral hepatitis. In Singapore, it is the 4th most important cancer and the second cause of cancer death after lung cancer.
Reference; Down-staging of liver cancer to allow curative surgery: An emerging paradigm. Prof Pierce Chow, Pg. 2, Salubris Issue No. 30, Jul - Sep 2014
Wednesday, October 15, 2014
A hamster in Africa
Hello,
My name is XXX and I need help with with hamster.
My girlfriend currently live in Mozambique is taking care of hamsters from a school there. Looks like one of them, L has the wet tail. I'm attaching the photos, that she send me.L (the hamster from the photos) doesn't seem to have wet tail disease, as she doesn't have diarrhoea. Also her wet back was from the spilled water. The problems with her that require treatment are :
If there is medicine or antibiotics needed to treat the problems,then I can pass it to her.
XXX
---------------------------------------------------------------------------------------
Oct 16, 2014
REPLY FROM DR SING
Hamster appears to have skin infections and abscesses, possibly from bite wounds. She is unable to groom her backside. Some images are not clear. Pl tel me for further discussion.
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