Educating For Empathy - Journal of General Internal Medicine 2006.
Empathy in doctors significantly influences patient satisfaction, adherence to medical recommendations, clinical outcomes and professional satisfaction. Frequency of medical errors among doctors decrease as the empathy levels increase
Friday, March 27, 2015
1151. Video on annual health screening for a 10-year-old Shih Tzu
This trim fair lady loves her female, spayed 10-year-old dog very much as she will present her dog yearly for the vaccination. She had made an appointment today after receiving my vaccination reminder card.
This time she requested a blood test. I was surprised that she was well informed.
As for the dental scaling, she said: "I am worried about anaesthesia. Maybe another time."
The back teeth were full of tartar but the teeth were still strong and solid. When I opened the dog's mouth wider, she gasped although the shy Shih Tzu with clear corneas did not flinch a bit.
"It is necessary to check for mouth ulcers and tumours," I explained to her.
Normally, some of my vets just give the vaccination and general examination or just the vaccination owing to the owner's financial cost constraints. So no blood and urine tests were done or advised by my vets.
I did a health check video for the benefit of the younger dog owners. The dog was a good patient. The overall experience was eventful as more and more dark brown anal sac oil kept discharging as I expressed the anal sacs. Yet the dog did not bite her backside. The tell-tale sign was just some hair loss and skin irritation at the end of the tail. The ear canals were dirty and need cleaning.
This was a happy interaction for the vet, the dog and the lady dog owner on this Friday morning.
This time she requested a blood test. I was surprised that she was well informed.
As for the dental scaling, she said: "I am worried about anaesthesia. Maybe another time."
The back teeth were full of tartar but the teeth were still strong and solid. When I opened the dog's mouth wider, she gasped although the shy Shih Tzu with clear corneas did not flinch a bit.
"It is necessary to check for mouth ulcers and tumours," I explained to her.
Normally, some of my vets just give the vaccination and general examination or just the vaccination owing to the owner's financial cost constraints. So no blood and urine tests were done or advised by my vets.
I did a health check video for the benefit of the younger dog owners. The dog was a good patient. The overall experience was eventful as more and more dark brown anal sac oil kept discharging as I expressed the anal sacs. Yet the dog did not bite her backside. The tell-tale sign was just some hair loss and skin irritation at the end of the tail. The ear canals were dirty and need cleaning.
This was a happy interaction for the vet, the dog and the lady dog owner on this Friday morning.
Thursday, March 26, 2015
A 7-year-old Pom coughs non-stop - x-rays
Chihuahua, F, 6 years.
No respiratory distress. X-rays of normal heart and lungs for comparison with the Pom case below.
Pom, F, 7 years
Acute respiratory distress
Non-stop coughing
The first vet had taken a 2nd X-ray 7 days ago when the dog started coughing again and prescribed medication. He did not think it was a heart problem.
Yet the dog's coughing got worst and became continuous during the past week. The owner consulted me. No X-rays were taken by me.
No heart murmurs. Irregular heart beats.
What is the problem? Any cure?
X RAYS FROM THE FIRST VET
Compare to a 1-year-old Pom with right-sided heart enlargement, coughed blood and panting
No cardiogram or another X-ray were done during consultation at Toa Payoh Vets,owing to cost constraints.
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ANALYSIS - COMPARISON WITH X RAYS OF 2 OTHER DOGS
LATERAL VIEWS OF X-RAYS
7-year-old Pom with continuous coughing. The heart looks normal. This X-ray by the first vet was taken around 7 days before the non-stop coughing presented itself. I did not have any X-rays taken to lower medical costs for the owner.
A 6-year-old Chihuahua with a normal heart and lungs
A 1-year-old Pom with right-sided heart enlargement
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ANOTHER CASE OF COUGHING AND PANTING in a Pom seen by me in 2009.
POM, F, 1 year old.
---------------------------------------------------------------------------------------------------------------
A CHIHUAHUA WITH NO PANTING OR HEART PROBLEMS FOR REFERENCE
No respiratory distress. X-rays of normal heart and lungs for comparison with the Pom case below.
Pom, F, 7 years
Acute respiratory distress
Non-stop coughing
The first vet had taken a 2nd X-ray 7 days ago when the dog started coughing again and prescribed medication. He did not think it was a heart problem.
Yet the dog's coughing got worst and became continuous during the past week. The owner consulted me. No X-rays were taken by me.
No heart murmurs. Irregular heart beats.
What is the problem? Any cure?
X RAYS FROM THE FIRST VET
ANALYSIS - COMPARISON WITH X RAYS OF 2 OTHER DOGS
VENTRAL-DORSAL VIEWS OF X-RAYS
VENTRAL-DORSAL VIEWS OF X-RAYS
7-year-old Pom with continuous coughing. Pulmonary edema (cloudy lungs).
The right and left ventricles are enlarged when you compare to the normal heart of the Chihuahua. No heart murmurs. Irregular heart beats.
As a Mar 27, 2015, the dog no longer coughs, being given heart medication
The right and left ventricles are enlarged when you compare to the normal heart of the Chihuahua. No heart murmurs. Irregular heart beats.
As a Mar 27, 2015, the dog no longer coughs, being given heart medication
Compare that to the 6-year-old Chihuahua with no heart problem. Clear lungs (black)
Compare to a 1-year-old Pom with right-sided heart enlargement, coughed blood and panting
No cardiogram or another X-ray were done during consultation at Toa Payoh Vets,owing to cost constraints.
--------------------------------------------------------------------------------------------------------------------
ANALYSIS - COMPARISON WITH X RAYS OF 2 OTHER DOGS
LATERAL VIEWS OF X-RAYS
7-year-old Pom with continuous coughing. The heart looks normal. This X-ray by the first vet was taken around 7 days before the non-stop coughing presented itself. I did not have any X-rays taken to lower medical costs for the owner.
A 6-year-old Chihuahua with a normal heart and lungs
A 1-year-old Pom with right-sided heart enlargement
--------------------------------------------------------------------------------------------------------------------
ANOTHER CASE OF COUGHING AND PANTING in a Pom seen by me in 2009.
POM, F, 1 year old.
---------------------------------------------------------------------------------------------------------------
A CHIHUAHUA WITH NO PANTING OR HEART PROBLEMS FOR REFERENCE
1149. Singapore: A safe and prosperous haven
"I am not a free lance tour guide," the girl with the deep set sad eyes said. "I am a part-time tour guide." She was on duty at the travel agency office, just like a car salesman but this was the first time I saw her, despite over 10 visits to this office.
"What is your target sales?" I asked.
"150," she has no problem getting 150 people to go on tours since she is an "old bird". She said she would be on duty this coming Sunday March 29, 2015 at Marina Bay Sands as she was required to be present. But with the passing of Mr Lee Kuan Yew on March 23, the travel fair was cancelled.
It is Mr Lee's transformation of Singapore from a swamp land to a First World Country with almost full employment, making Singapore a safe and prosperous haven in churning waters that this lady can work part-time.
The older generation would worry about losing a full-time job and getting another. Here, she could work part-time for this agency and also for other agencies whenever she likes. There is a labour crunch due to the full employment, unlike countries like Greece with 25% unemployment.
"What is your target sales?" I asked.
"150," she has no problem getting 150 people to go on tours since she is an "old bird". She said she would be on duty this coming Sunday March 29, 2015 at Marina Bay Sands as she was required to be present. But with the passing of Mr Lee Kuan Yew on March 23, the travel fair was cancelled.
It is Mr Lee's transformation of Singapore from a swamp land to a First World Country with almost full employment, making Singapore a safe and prosperous haven in churning waters that this lady can work part-time.
The older generation would worry about losing a full-time job and getting another. Here, she could work part-time for this agency and also for other agencies whenever she likes. There is a labour crunch due to the full employment, unlike countries like Greece with 25% unemployment.
1148. Skin diseases: White skin spots or patches in a dog or cat
Skin cells called melanocytes produce pigment giving the skin its colour. If melanocytes disappear or is not produced or produced less, the skin loses its colour. "White spots appear".
In people, the causes are:
1. Pityriasis versicolor (white spot disases), body and limbs, mild itchiness. The acids secreted by yeasts - Malassezia, inhibit melanocytes from making melanin. Selenium sulphide solution and clotrimazole cream are common treatments. Oral anti-fungal medication for severe cases. Recovery of normal skin pigmentation may take many months.
2. Vitiligo is a skin disordr. Melanocytes are destroyed. The skin is usually completely white and clearly demarcated from the surrounding normal skin.
3. Idiopathic guttate hypomelanosis are 2-4 mm flat pale spots on the face, arms and legs. Extnesive and chronic sun exposure causing skin damage.
4. Post-inflammatory hypopigmentation - previous skin injury. Pigment temporary disappear. After vaccination or injection in the dog or cat.
5. Chronic arsenic poisoning. Rare cases where contaminated well water or traditional Chinese medicines containing arsenic is consumed for a long time.
6. Hypopigmented mycosis fungoides is a form of skin cancer. White patches on the body. Uncommon. Slow progress
Skin colour may take several months to recover after successful treatment.
In Toa Payoh Vets, the number one skin disease in dogs is ringworm which is curable.
In people, the causes are:
1. Pityriasis versicolor (white spot disases), body and limbs, mild itchiness. The acids secreted by yeasts - Malassezia, inhibit melanocytes from making melanin. Selenium sulphide solution and clotrimazole cream are common treatments. Oral anti-fungal medication for severe cases. Recovery of normal skin pigmentation may take many months.
2. Vitiligo is a skin disordr. Melanocytes are destroyed. The skin is usually completely white and clearly demarcated from the surrounding normal skin.
3. Idiopathic guttate hypomelanosis are 2-4 mm flat pale spots on the face, arms and legs. Extnesive and chronic sun exposure causing skin damage.
4. Post-inflammatory hypopigmentation - previous skin injury. Pigment temporary disappear. After vaccination or injection in the dog or cat.
5. Chronic arsenic poisoning. Rare cases where contaminated well water or traditional Chinese medicines containing arsenic is consumed for a long time.
6. Hypopigmented mycosis fungoides is a form of skin cancer. White patches on the body. Uncommon. Slow progress
Skin colour may take several months to recover after successful treatment.
In Toa Payoh Vets, the number one skin disease in dogs is ringworm which is curable.
Tuesday, March 24, 2015
Was the neutered father guinea pig responsible for 2 babies?
Mar 24, 2015
The pair of guinea pigs gave birth to 1 male and 1 female on before the sire was neutered.
Parents about 1 year old.
Sep 3, 2014 dam gave birth to a male and a female. F1 generation
Oct 7, 2014 sire was neutered by Dr Daniel
Feb 13, 2015 dam gave birth to 2 males. F2 generation.
Was the neutered sire the father? The Korean lady asked me. Dr Daniel said that the neutered sire should be separated from the dam for 3 months after neuter.
Guinea pigs mature at 3 months of age.
Gestation period 59 - 73 days or 2 months.
Dec 3, 2014 F1 male will mature from 3 months and will mate with the mother.
Feb 13, 2015 (2 months' gestation, mating on Dec 13, 2014 by F1 son).
So the neutered father was NOT responsible.
The pair of guinea pigs gave birth to 1 male and 1 female on before the sire was neutered.
Parents about 1 year old.
Sep 3, 2014 dam gave birth to a male and a female. F1 generation
Oct 7, 2014 sire was neutered by Dr Daniel
Feb 13, 2015 dam gave birth to 2 males. F2 generation.
Was the neutered sire the father? The Korean lady asked me. Dr Daniel said that the neutered sire should be separated from the dam for 3 months after neuter.
Guinea pigs mature at 3 months of age.
Gestation period 59 - 73 days or 2 months.
Dec 3, 2014 F1 male will mature from 3 months and will mate with the mother.
Feb 13, 2015 (2 months' gestation, mating on Dec 13, 2014 by F1 son).
So the neutered father was NOT responsible.
1146. Pug with folliculitis
Mar 24, 2015
Review of the pug. 9 days. Still has inflamed skin. Appeared spreading.
Ringworm +ve some hairs
Skin scrapings 3 areas - no mites seen.
Allergy? Plastic biting of handles of mum's bedframe - allergic on chin and face.
Review of the pug. 9 days. Still has inflamed skin. Appeared spreading.
Ringworm +ve some hairs
Skin scrapings 3 areas - no mites seen.
Allergy? Plastic biting of handles of mum's bedframe - allergic on chin and face.
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