1. Case 1. The aggressive self-diagnosing breeder. I had stopped providing vet services to all dog breeders for the past 2 years. What most of them want was usually very cheap services.
This particular breeder brought in a Shih Tzu on Sunday at 5 pm. His vet was not available. He said he had X-rayed the dam at another practice but the X-ray showed 4 pups. He did not bring the X-ray saying he was busy. He suspected there was a 5th pup and could feel it. 4 pups were born naturally on Saturday and were OK. That was 24 hours ago.
I palpated a bony mass. "The pup is dead," I advised as it was past 24 hours from the last pup and the foetal lump felt 'bony' and that meant the water bag had broken.
"There is no point in giving oxytocin injection. Your dam needs a Caesarean section." This breeder was insistent in having an oxytocin injection. I did not throw him out as he did not accept my advice. I gave the injection. After one hour, the dog did not produce any pup. My first assistant advised a Caesarean and he accepted the need for one since no pups were produced.
The pup was smeared with dark greenish glue from the melted placenta. It had no amniotic sac and was stiff as in rigor mortis. This breeder wanted no more veterinary treatment like IV drip and antibiotics IV. He wanted to bring back the dam and wanted to pay only $250. "The new vets are charging less," he said. He became aggressive as his demands were not agreed upon. It was unpleasant. This is the reason I have had stopped dealing with dog breeders.
The next morning, the dog died. The owners were very unhappy. A dog's death is an extemely emotional experience for the owners and for the vet. This was a case where the owner entrusted this breeder to handle their dog's accidental pregnancy. He said he had X-rayed but would not produce the X-ray.
I have barred this breeder from coming to Toa Payoh Vets and told my associate vets that it would be best not to accept breeders at all. It was just not a sustainable practice to offer $250 Caesarean sections and lose money and respect from breeders who want to cut corners.
Case 2. The cat with nasal cancer. The cat went home the next day after surgery to excise most of the tumours. The owner phoned me today and said that the cat was eating. The nose bleeding on Sunday morning after I had pulled out the swab which stopped inside the nose bleeding was no more. The family had decided on no chemotherapy. "Can you do surgery when the cancer returns?" the father asked. "No," I said. "There is a big hole on the top of the nose, now covered by the skin. This malignant tumour doubles in size every 7 days and I expect that the cat will not live long." Chemotherapy is not guaranteed and may cause the cat to lose appetite. So, what's the advice?
"Try chemotherapy in low dosage first," I advised. There was nothing to lose as the wife was quite close to this cat. Chemotherapy does not cost thousands of dollars unlike the case in human cancer treatment. "Euthanasia will be the only option when the cancer recurs and bacterial infections of the right nostril causes pain and suffering," I said. This cat had no infection from this surgery because she had been on antibiotics 6 days before surgery and after surgery. So she responded well and could eat and drink normally at home post-operation, much to the happiness of the wife. But death is really at the door. If chemotherapy helps, it will be a happy ending.
FOR MY RECORD
Weight: 3.5 kg. Cat.
Anaesthesia. Domitor 0.1 ml IV. Zoletil 100 0.1 ml IV. Atropine 0.5ml SC. Intubate. Gave oxygen. Duration of anaesthesia was nearly one hour. A few seconds of isoflurane gas was given towards the end of surgery. It was taking one hour to do it. IV saline and baytril drip given 24 hours.
Post-operation.
No Antisedan antidote was given so that the cat could be sedated and wake up with less pain. The cat was observed breathing normally through its left nostril (forceps into nostril confirming no cancer cells from right nostril). He slept for many hours and was fresh as a daisy on the next morning after surgery.
Surgery on Friday at 4 pm. Incise with scalpel. Undermine skin. Nasal tumour grows from inside the nose, break through nasal bone is 2.5 cm x 1 cm long and much deeper inside the nose.
Electro-surgery separates tumour as much as possible from nasal bone. Excised. Large hole in nasal bone eaten by the tumour seen. Around 1 cm x 0.5 cm. Round fatty tumour cells seen from inside the nose and excised.
I put a gauze swab into the nasal hole and pull it out from the nostril using forceps (see picture at www.toapayohvets.com). This stops bleeding. Electro-coagulation of the tissues inside the nose helps but does not stop the bleeding.
Goes home on Sunday at 10 am after I pull out the gauze swab. I smelled the gauze swab. Not smelly and this is a good sign that there is no bacterial infection. Red blood oozed out of the nostril. Owner asked to wipe the blood off regularly. (The bleeding stopped on Monday).
Case 3. The dog with white gums
The thin, hunch-backed 10-year-old Miniature Schnauzer with white gums would not eat. She had been treated 4 times by Vet 1. ACTH tests were normal. Ultrasound indicated possible tumours of the liver, pancreas and spleen. So, the owner was very worried and wanted surgery.
"The dog is not fit for surgery," I advised. "She will just die on the operating table. Look at the white gums. She has severe anameia. I will do a blood test."
The anaemia was due to low red cell count, low haemoglobin and very low platelet count. She was attended to by Vet 1 from August to November for 4 times and was not eating when the owner consulted me, being referred to by one of my clients.
Incredibly, after an intensive IV drip of saline, glucose, protein, Vit K1, antibiotics including baytril and metronidazole, B complex and iron injections s/c, the dog that lost 1 kg (25% of her weight in the last 4 weeks) was thriving. "She ate a lot and pooped a lot for the last 2 days," the young lady said. "Today, she is not eating. Shall I give her the Re... from Vet 1? It is said to improve her appetite."
What was the cause of this severe anaemia and the low platelet count? I suspect it was either some drugs or septic infection (from virus or bacteria) when the dog was brought downstairs in recent weeks.
During the first consultation with me, the dog screamed when I pressed the very painful disc pain at T/L area and bit me when I palpated the moderately enlarged left submandibular and popliteal lymph node. Her bladder was painful on palpation. Her left kidney was slightly painful. Her left tongue had some ulcers at the back and I took digital pictures to show the owner.
So what was happening to this dog? The lady had only one wish - that this dog would not die on her as she had a recent family bereavement. Yet, the dog's gums were as white as snow when I saw her at first. I did not take a picture then but her gums became a bit pinker 24 hours after the intensive care and injections. So, this dog had come back from death's door. But she is not out of the woods yet. Only time will tell.
Tuesday, November 16, 2010
Photography tips:Bridal Models
PHOTOGRAPHY TIPS
November 6, 2010. Philea Resort & Spa, Melaka, Bridal Fair 2010 Photography Contest. I was a guest at the Philea, taking a 3-day 2-night break from my veterinary work. The pro-active marketing manager saw me at the ballroom where the Bridal Fair was held and invited me to register for the Photography Contest. The bridal models in the ballroom showed off the bridal dresses. The Contest was outdoors at 6 p.m. It started to drizzle around 6 p.m.
The evening sky was gloomy. Lighting was poor as the sky was overcast at 6 p.m. It was my first time photographing bridal models or any human models. I wanted to give up. But a Muar photographer encouraged me to get on with it.
Tips from this Muar photographer were helpful. These were "focus on the eyes" and "eye contact" to get a lively and sharp picture. "Shout 'hello' just before you click to get the model's attention and her eye contact," he advised me.
I didn't dare to shout "hello" before clicking. I waited for the eye contact to happen by chance and there were 3 below.
One photographer shouted "Marina," and the model turned her head in his direction. I learnt about the tricks of the trade in Malacca. For my animal photography, shouting at a cat or dog for eye contact photography usually does not work!
I did not submit any photo for the Contest which had the theme of "Highlight of the beauty environment and exciting premises together with beautiful model as bridal". To satisfy the theme, a close-up of the bridal models would not qualify. It would need to show the environment and premises of the Resort and the best picture I had was that of the bridal couple directed by the photographers to stand at the edge of the pool. I captured this picture as I was moving away to take pictures of other models up the hill. I quickly snapped this scene. To me, it had an excellent composition, action of the pro-active photographer risking his camera to command the hard working bridal couple to take a risk on the rocky pebbles which are meant to discourage people walking on them. The lone photographer faced the bridal couple, reminding me of the famous Tiananmen Square Protests of 1989 photo of a man facing the army tanks, as in: http://en.wikipedia.org/wiki/Tiananmen_Square_protests_of_1989.
You can see that the photographer near the model was a pro-active type. The one in orange T-shirt ventured out a bit to risk his camera falling into the pool with him should he slip and fall. The others (hidden in the right) preferred not to take risk and stayed on firm ground. This picture shows the beautiful pool and the cascading waterfall features of Philea Resort and Spa and the bridal model. It might be on the final list to win a prize, in my opinion. Maybe not. One has to be hands-on to learn a new trade as reading all the photography magazines will not be sufficient as to go to be battle-tested.
I used "P" Mode and set the ISO to 3200. I was surprised to get some "good pictures" for my readers. These were the pictures where I was at the right place at the right time and got the right point of view without obstruction from the various Malaccan photographers.
Update and more photos are at:
www.toapayohvets.com/philea.htm
http://en.wikipedia.org/wiki/Tiananmen_Square_protests_of_1989
--------------------
6 MAR 2024 PHOTO OF TIANANMEN SQUARE
Photo taken from drive-by taxi using Canon R5. Use TV Mode. I doubt the iPhone 15 can take sharp images from a moving taxi.
Great idea from Kat to take photos from a taxi as tight security prevented tourists from getting near the Square where the Communist Party was hosting its annual political event "Two Sessions" with President Xi Jinping.
Monday, November 15, 2010
202. Golden Retriever with yellow discharge
"I did not want to spay her when you advised," the mother said. "I was worried about the death during anaesthesia." Now, the dog had lots of dirty vaginal discharge and I said; "She is suffering from pyometra - a womb infection." It is best to spay her as soon as possible"
The dog came in at night. My associate vet diagnosed pyometra and put her on a IV drip with antibiotics. He would operate the next day.
I had not seen this dog for some years after the initial first 3 vaccinations. The worried mum phoned me. "My associate vet is able to perform this surgery," I said. "Pyometra is one of the common surgeries."
However the mum insisted that I operate. So I took over the case from my associate vet who had no hard feelings over this as the dog was under my care since puppyhood.
PRE-OP
As the owner was very worried, I had the dog on IV drip and antibiotics for 3 days. She had an excellent appetite on 36 hours after being seen to, but still it was safer not to rush into surgery as scheduled. Total white cell count was high indicating a bacterial infection of the blood system. It would be best to kill all bacteria using antibiotics
ANAESTHESIA
Dog was 33 kg. Domitor 0.3 ml IV was given. Gas mask using isoflurane gas was inhaled for 15 minutes as this dog was now stronger now after the 3 days of IV and antibiotic. I intubated her and maintained her on isoflurane gas. In retrospect, Domitor could be given at 0.4 - 0.5 ml since no other sedatives like Zoletil were added. But isoflurane gas is the safest way.
SURGERY
A big swollen uterus, as in closed pyometra. As thick as the bigger hot dog you will see during barbecues. Some cysts appeared in one uterine horn near the ovaries. I took a picture for reference. Normally no cysts are seen but pyometra is cystic endometrial hyperplasia complex. So cysts are usually found inside the uterine tubes but these cysts were outside.
POST-OP
The dog was sent home 48 hours after surgery. She was not seen again as she had licked off her stitches on the 10th day. In any case, the stitches were self-dissolving.
CONCLUSION
Closed pyometra does present with vaginal discharge as the cervix opens during the later stages. Abdominal palpation in this dog did not reveal large uterine tubes. However the blood test with high white cell count was useful. In any case, purulent vaginal discharge in large amounts around 2 months after the heat is a quick diagnosis of pyometra. A rush into surgery is not advised as the dog is septicaemic. I would advise 3-4 days later.
ANOTHER CLOSED PYOMETRA CASE.
However, some owners want the dog operated and back home on the same day of diagnosis as they feel that the dog should not be separated even for one day. For such owners, the vet needed to use his common sense and judgment.
In this case, Vet 1 had X-rayed and took blood test and confirmed that the Maltese of 6 years had pyometra. Vet 1 phoned the next day for the dog to return for surgery. Pyometra is a much longer surgery than a normal spay and so the vet costs would exceed $1,000 with the x-rays and blood test. The surgery quoted by Vet 1 was $800 which was a reasonable cost. Unfortunately the owner felt it was too high.
"You will need to get the dog operated soon" I advised when the owner phoned me for a quotation. She wanted to wait till the weekend, 3 days later. After all, the dog looked well after Vet 1 had given antibiotics. "Delays mean more infections and complications. When the dog dies because you delay surgery, you tend to blame the vet as being incompetent in anaesthesia."
There was little difference but since I did not need to repeat the blood test nor take X-rays or ultrasound, my quote would be deemed lower.
The dog came in for surgery. An IV drip plus antibiotics was given 3 hours before surgery. Domitor 0.1 ml IV was given via the drip. The dog was masked and given isoflurane gas. She slept fast and was intubated. Isoflurane gas was given. I monitored this case very closely as it was a high risk case since the operation was done on the second day after Vet 1 had diagnosed closed pyometra. The 3rd day could be too late as the dog could die from septicaemia.
ANAESTHESIA TIP
The dog was not normal in the sense that the tongue was pale and bluish. Her re-breathing bag showed signs of very slow breathing and cessation of breathing. This was a touch and go case. The family expected 100% survival but this case could be the type of high-risk case best done by other vets. I disconnected the endotracheal tube when the dog was not breathing well and re-connected when the dog felt some painful reaction from the surgery.
OUTCOME
The dog survived and went home on the same day. She was OK.
Pictures will be at www.toapayohvets.com later.
The dog came in at night. My associate vet diagnosed pyometra and put her on a IV drip with antibiotics. He would operate the next day.
I had not seen this dog for some years after the initial first 3 vaccinations. The worried mum phoned me. "My associate vet is able to perform this surgery," I said. "Pyometra is one of the common surgeries."
However the mum insisted that I operate. So I took over the case from my associate vet who had no hard feelings over this as the dog was under my care since puppyhood.
PRE-OP
As the owner was very worried, I had the dog on IV drip and antibiotics for 3 days. She had an excellent appetite on 36 hours after being seen to, but still it was safer not to rush into surgery as scheduled. Total white cell count was high indicating a bacterial infection of the blood system. It would be best to kill all bacteria using antibiotics
ANAESTHESIA
Dog was 33 kg. Domitor 0.3 ml IV was given. Gas mask using isoflurane gas was inhaled for 15 minutes as this dog was now stronger now after the 3 days of IV and antibiotic. I intubated her and maintained her on isoflurane gas. In retrospect, Domitor could be given at 0.4 - 0.5 ml since no other sedatives like Zoletil were added. But isoflurane gas is the safest way.
SURGERY
A big swollen uterus, as in closed pyometra. As thick as the bigger hot dog you will see during barbecues. Some cysts appeared in one uterine horn near the ovaries. I took a picture for reference. Normally no cysts are seen but pyometra is cystic endometrial hyperplasia complex. So cysts are usually found inside the uterine tubes but these cysts were outside.
POST-OP
The dog was sent home 48 hours after surgery. She was not seen again as she had licked off her stitches on the 10th day. In any case, the stitches were self-dissolving.
CONCLUSION
Closed pyometra does present with vaginal discharge as the cervix opens during the later stages. Abdominal palpation in this dog did not reveal large uterine tubes. However the blood test with high white cell count was useful. In any case, purulent vaginal discharge in large amounts around 2 months after the heat is a quick diagnosis of pyometra. A rush into surgery is not advised as the dog is septicaemic. I would advise 3-4 days later.
ANOTHER CLOSED PYOMETRA CASE.
However, some owners want the dog operated and back home on the same day of diagnosis as they feel that the dog should not be separated even for one day. For such owners, the vet needed to use his common sense and judgment.
In this case, Vet 1 had X-rayed and took blood test and confirmed that the Maltese of 6 years had pyometra. Vet 1 phoned the next day for the dog to return for surgery. Pyometra is a much longer surgery than a normal spay and so the vet costs would exceed $1,000 with the x-rays and blood test. The surgery quoted by Vet 1 was $800 which was a reasonable cost. Unfortunately the owner felt it was too high.
"You will need to get the dog operated soon" I advised when the owner phoned me for a quotation. She wanted to wait till the weekend, 3 days later. After all, the dog looked well after Vet 1 had given antibiotics. "Delays mean more infections and complications. When the dog dies because you delay surgery, you tend to blame the vet as being incompetent in anaesthesia."
There was little difference but since I did not need to repeat the blood test nor take X-rays or ultrasound, my quote would be deemed lower.
The dog came in for surgery. An IV drip plus antibiotics was given 3 hours before surgery. Domitor 0.1 ml IV was given via the drip. The dog was masked and given isoflurane gas. She slept fast and was intubated. Isoflurane gas was given. I monitored this case very closely as it was a high risk case since the operation was done on the second day after Vet 1 had diagnosed closed pyometra. The 3rd day could be too late as the dog could die from septicaemia.
ANAESTHESIA TIP
The dog was not normal in the sense that the tongue was pale and bluish. Her re-breathing bag showed signs of very slow breathing and cessation of breathing. This was a touch and go case. The family expected 100% survival but this case could be the type of high-risk case best done by other vets. I disconnected the endotracheal tube when the dog was not breathing well and re-connected when the dog felt some painful reaction from the surgery.
OUTCOME
The dog survived and went home on the same day. She was OK.
Pictures will be at www.toapayohvets.com later.
A demanding dog breeder
Dog breeders in Singapore go for the cheapest vet and there will be new start ups that oblige. "It is better to have a case rather than have no business," this is the reality of life.
Yesterday was a Sunday. A dog breeder came in at 5pm saying that he had 4 pups born naturally from a Shih Tzu mated with a Poodle, producing "ugly crosses" that Singaporeans will not buy.
"I need an oxytocin injection for the dam. It is past 24 hours since the 4th pup was born. I could feel one pup still prsent"
I palpated a bony foetus, hard as a bone and said: "There is a pup in the right side, below the rib cage. The pup is dead as you had waited too long. Oxytocin injection may not help."
He insisted on the oxytocin injection. The dam contracted a bit and there was no puppy delivered after 30 minutes.
My first assistant was present. He told the breeder that a Caesarean section was necessary.
"I had an X-ray done at Vet 1," the breeder said. "Only 4 pups seen during the X-ray".
"Are you sure?" I had no X-ray from him since he did not bring it."Normally, at this late stage, you can see 5 foetal heads and skeletons."
I will describe the I/V anaesthesia in this case as Caesarean sections have had been written in many reports in www.toapayohvets. The black pup was smeared with dark green placenta melt-down. It was dead and stiff on taking out from the womb.
Domitor 0.1 ml. Then Zoletil 100 0.1 ml. Both were diluted with another 0.1 ml saline before IV injection via a drip line. Atropine 0.5 ml given. Dog was intubaed and given oxygen at high flow rate around 5 litres/sec.
CAESEAREAN SECTION
No pain problem. Towards the end, I increased the dosage of isoflurane for a brief few seconds. The dog woke up at the last stitch. The surgery took around 45 minutes and that was the duration of analgesia in this dam, weighting around 7kg.
The dam's tongue was initially pale but became normal pink at the completion of surgery.
ANAESTHESIA
Yesterday was a Sunday. A dog breeder came in at 5pm saying that he had 4 pups born naturally from a Shih Tzu mated with a Poodle, producing "ugly crosses" that Singaporeans will not buy.
"I need an oxytocin injection for the dam. It is past 24 hours since the 4th pup was born. I could feel one pup still prsent"
I palpated a bony foetus, hard as a bone and said: "There is a pup in the right side, below the rib cage. The pup is dead as you had waited too long. Oxytocin injection may not help."
He insisted on the oxytocin injection. The dam contracted a bit and there was no puppy delivered after 30 minutes.
My first assistant was present. He told the breeder that a Caesarean section was necessary.
"I had an X-ray done at Vet 1," the breeder said. "Only 4 pups seen during the X-ray".
"Are you sure?" I had no X-ray from him since he did not bring it."Normally, at this late stage, you can see 5 foetal heads and skeletons."
I will describe the I/V anaesthesia in this case as Caesarean sections have had been written in many reports in www.toapayohvets. The black pup was smeared with dark green placenta melt-down. It was dead and stiff on taking out from the womb.
Domitor 0.1 ml. Then Zoletil 100 0.1 ml. Both were diluted with another 0.1 ml saline before IV injection via a drip line. Atropine 0.5 ml given. Dog was intubaed and given oxygen at high flow rate around 5 litres/sec.
CAESEAREAN SECTION
No pain problem. Towards the end, I increased the dosage of isoflurane for a brief few seconds. The dog woke up at the last stitch. The surgery took around 45 minutes and that was the duration of analgesia in this dam, weighting around 7kg.
The dam's tongue was initially pale but became normal pink at the completion of surgery.
ANAESTHESIA
Friday, November 12, 2010
240. Email query about vaccination for cats
I am Dr Sing. Thank you for your email. The reply in CAPITAL LETTER is as follows:
On Thu, Nov 11, 2010 at 9:41 PM, ...@gmail.com> wrote:
Hi,
I recently took in a small black stray cat that a friend of mine had found and nursed back to health. I wanted to schedule some time to bring him in to get any required vaccinations and a general check up.
I have a few queries:
1. What vaccinations are normally required?
ALL CATS SHOULD BE VACCINATED AGAINST THE FOLLOWING FIRST 3 COMMON DISEASES IN SINGAPORE LISTED BELOW
* Panleukopenia virus (distemper)
* Feline calicvirus (FCV)
* Feline herpes virus (rhinotracheitis)
AS FOR RABIES, THERE HAVE BEEN QUERIES FROM CAT OWNERS.
* Rabies (NO NEED TO VACCINATE FOR CATS IN SINGAPORE AS THERE IS NO RABIES IN SINGAPORE)
* Panleukopenia Vuaccine (also called "Feline Distemper")
Panleukopenia is caused by a feline parvovirus (FPV), and is particularly vicious, capable of being spread rapidly, with a high mortality rate, especially in younger cats.
* Feline Calicivirus
This virus, along with the Feline Herpes virus, causes the majority of upper respiratory infections URIs in cats, and can be spread by "carrier" cats for years.
* Rhinotracheitis (Feline Herpes Virus)
Rhinotracheitis causes serious potential respiratory and neurological diseases, especially in kittens.
2. Do I need to make an appointment or can I just drop in?
Drop in is OK but sometimes the vet is operating and you need to wait a long time. It is best to make an appointment.
3. As it is a male cat I may need to consider getting it spayed. Would you recommend that?
NEUTERING IS ADVISED FOR THE MALE CAT to prevent caterwauling, wandering urges, urine marking and fighting. SUCH BEHAVIOUR IS COMMON IN MANY MALE CATS
4. What would it normally cost for all of that? VACCINATION IS $35.00 IF THERE IS NO CONSULTATION WHICH IS $35 - $40. Neutering, anaesthesia and post-op antibiotics and painkiller are estimated to be $110-$130.
Please let me know - many thanks.
Regards,
Name of Owner
On Thu, Nov 11, 2010 at 9:41 PM, ...@gmail.com> wrote:
Hi,
I recently took in a small black stray cat that a friend of mine had found and nursed back to health. I wanted to schedule some time to bring him in to get any required vaccinations and a general check up.
I have a few queries:
1. What vaccinations are normally required?
ALL CATS SHOULD BE VACCINATED AGAINST THE FOLLOWING FIRST 3 COMMON DISEASES IN SINGAPORE LISTED BELOW
* Panleukopenia virus (distemper)
* Feline calicvirus (FCV)
* Feline herpes virus (rhinotracheitis)
AS FOR RABIES, THERE HAVE BEEN QUERIES FROM CAT OWNERS.
* Rabies (NO NEED TO VACCINATE FOR CATS IN SINGAPORE AS THERE IS NO RABIES IN SINGAPORE)
* Panleukopenia Vuaccine (also called "Feline Distemper")
Panleukopenia is caused by a feline parvovirus (FPV), and is particularly vicious, capable of being spread rapidly, with a high mortality rate, especially in younger cats.
* Feline Calicivirus
This virus, along with the Feline Herpes virus, causes the majority of upper respiratory infections URIs in cats, and can be spread by "carrier" cats for years.
* Rhinotracheitis (Feline Herpes Virus)
Rhinotracheitis causes serious potential respiratory and neurological diseases, especially in kittens.
2. Do I need to make an appointment or can I just drop in?
Drop in is OK but sometimes the vet is operating and you need to wait a long time. It is best to make an appointment.
3. As it is a male cat I may need to consider getting it spayed. Would you recommend that?
NEUTERING IS ADVISED FOR THE MALE CAT to prevent caterwauling, wandering urges, urine marking and fighting. SUCH BEHAVIOUR IS COMMON IN MANY MALE CATS
4. What would it normally cost for all of that? VACCINATION IS $35.00 IF THERE IS NO CONSULTATION WHICH IS $35 - $40. Neutering, anaesthesia and post-op antibiotics and painkiller are estimated to be $110-$130.
Please let me know - many thanks.
Regards,
Name of Owner
Monday, November 8, 2010
Old dog with cheek tumour
The skin wound did not close entirely. This is a complication of surgery of the cheek tumour excised from outside the cheek. The Miniature Schnauzer of 11 years of age,10 kg bodyweight drooled saliva out of two gaps in the cheek. The young lady owner wanted surgery to close the holes as the right cheek keeps getting wet.
"It is lymph," my first assistant speculated. "Do you think so?" I asked him again. "It is possible as the surrounding area had a type of wetness that looked oily. Like melted butter. However, there was saliva from inside the mouth flowing out of the two gaps.
The old dog had 3 general anaesthesias and I did not look forward to a 4th. Try not to be complacent as deaths on the operating table of an old dog are always a possibility.
INJECTABLE IV ANAESTHESIA
This time, I do not use isoflurane gas as in the previous 3 operations as the endotracheal tube would get in the way of the surgical procedure of debridement.
For 10 kg, the formula for a safe dosage of injectable IV is 0.5 ml diazepam 5 mg/ml and 0.5 ml ketamine 100 mg/ml by slow IV injection.
I used 0.4 ml + 0.4 ml respectively. It was insufficient. As the needle was in the vein in case of the need for top up, my first assistant injected 0.02 ml Zoletil 100 mg/ml diluted in 0.18 ml saline to make it 0.2 ml. The dog was sedated but his eye reflexes were present.
6 DAYS PRE-OP.
Dog was on Baytril oral for the past 6 days. The young lady remembered the appointment as I do not phone or text message unlike the Singapore General Hospital staff of some medical departments. I ought to do it and will do it.
SURGERY
Snip off granulated edges, debride. Undermine skin to separate some areas from the underlying cheek muscles. New raw bleeding edges. I used simple interrupted sutures 3/0 at 0.3 mm apart. 1.0 ml atropine SC was given to reduce salivation as Zoletil does cause salivation as a side effect. Sent dog home to reduce vet cost as this young lady had used her savings for the operations.
Only time will tell whether the old companion finally has a healed intact right side of the cheek.
OBSERVATION
It was too early to see whether the cheek tumour had recurred again. For readers, it is best to get your dog over 3 years of age, annual dental check up for mouth tumours rather than not do it. Some do develop into cheek or gum tumours as in this old Schnauzer and would then cost a lot of worries and money.
"It is lymph," my first assistant speculated. "Do you think so?" I asked him again. "It is possible as the surrounding area had a type of wetness that looked oily. Like melted butter. However, there was saliva from inside the mouth flowing out of the two gaps.
The old dog had 3 general anaesthesias and I did not look forward to a 4th. Try not to be complacent as deaths on the operating table of an old dog are always a possibility.
INJECTABLE IV ANAESTHESIA
This time, I do not use isoflurane gas as in the previous 3 operations as the endotracheal tube would get in the way of the surgical procedure of debridement.
For 10 kg, the formula for a safe dosage of injectable IV is 0.5 ml diazepam 5 mg/ml and 0.5 ml ketamine 100 mg/ml by slow IV injection.
I used 0.4 ml + 0.4 ml respectively. It was insufficient. As the needle was in the vein in case of the need for top up, my first assistant injected 0.02 ml Zoletil 100 mg/ml diluted in 0.18 ml saline to make it 0.2 ml. The dog was sedated but his eye reflexes were present.
6 DAYS PRE-OP.
Dog was on Baytril oral for the past 6 days. The young lady remembered the appointment as I do not phone or text message unlike the Singapore General Hospital staff of some medical departments. I ought to do it and will do it.
SURGERY
Snip off granulated edges, debride. Undermine skin to separate some areas from the underlying cheek muscles. New raw bleeding edges. I used simple interrupted sutures 3/0 at 0.3 mm apart. 1.0 ml atropine SC was given to reduce salivation as Zoletil does cause salivation as a side effect. Sent dog home to reduce vet cost as this young lady had used her savings for the operations.
Only time will tell whether the old companion finally has a healed intact right side of the cheek.
OBSERVATION
It was too early to see whether the cheek tumour had recurred again. For readers, it is best to get your dog over 3 years of age, annual dental check up for mouth tumours rather than not do it. Some do develop into cheek or gum tumours as in this old Schnauzer and would then cost a lot of worries and money.
238. Integrity of the vet
"No general anaesthesia," the young man suggested local anaesthesia as he was worried that his cat might die on the operating table. His cat was weak as he had been sneezing blood and had runny noses for the past 2 months. He wanted my second opinion after Vet 1 advised a CT scan costing $1,500 excluding surgery for 2 lumps above the right nostril and below the right eye.
"Local anaesthetic cannot be applied to this area as there is not much space due to the large size of the growth," I said. "The cat would feel the pain of injections of the local anaesthetic and scratch me." I had a feeling that this cat was suffering from tumour as he had around 3 grey melanomas in the ear pinnae. Both ears and melanomas may have spread to this nose area.
The following was briefly how I handled this case with the least cost as required.
PROCEDURES
1. History & Palpation of the tumour. Firm but no pain. The cat had 10 days of vibravet 50 mg at 3/4 tablet per day from Vet 1. Now he had yellow runny nostril on the right side. "Did he get nose discharge on the left nostril?" I asked the young man. "No," he said. But I could see the brownish stain not completely wiped out, below the left nostril (see picture). His mum later confirmed that the cat had discharge of both nostrils.
2. Aspiration with 18G needle. The quiet cat was held by my assistant (without wrapping him in a towel as it should be done. My right wrist was scratched). I aspirated 0.02ml of red blood from the bigger of the two lumps.
3. Incision for biopsy. I used the scalpel to excise the lump to see what is inside. As I had promised the young man, I did not use general anaesthesia. The cat raised his front left paws weakly a few times. I got scratched once as I took out 2 pieces of the greyish maroon muscle-like mass below the skin, put in formalin and sent them to the Laboratory.
4. Anaerobic bacterial cultures and Gram stain were not done as the cat just had been on 10 days of antibiotics from Vet 1.
5. I had asked my assistant to clip the hairs of the forelegs so as to insert the IV catheter easily. This was done with no prolem. Blood test and an IV drip was done. In the IV saline drip to be given as 500 ml, I put in baytril antibiotic according to weight, a small 0.2 ml dexamethosone anti-inflammatory and metronidazole according to weight.
RESULTS
Least veterinary cost is what the young man's father wanted. With the above procedures, the cost was "affordable" as it was well below $1,000 since there was no general anaesthetic and surgery. And no possibility of death.
24 hours later, the cat had no runny left nostril. I did not expect such drastic improvement. He went home on Day 3 with Baytril antibiotics. He had no problem with runny nose and was eating well. Lab reports indicate he had cancer - malignant cellular infiltrate with a differential diagnosis including malignant melanoma. I advised surgical excision but the father wanted to wait and see.
LAB REPORT. Cat, M, 6 years. Soft tissue lesion, near muscle. MALIGNANT CELLULAR INFILTRATE. Different diagnosis includes malignant lymphoma, malignant melanoma, carcinoma or sarcoma. Immunostains needed to delineate and type the tumour.
CONCLUSION.
A biopsy is important in growths. A CT scan of $1,500 is too costly for most cat owners. In chronic sinusitis as suspected in this case, a gram stain, a fungal and anaerobic culture would be good but these were not done as the cat had been on antibiotic in the past 10 days. There was a budget from the owner.
Metronidazole IV may be effective in this case when combined with Baytril. As there was no bacterial culture done, it was hard to say what caused the blood sneezing and nose discharge. Metronidazole is effective against anaerobic bacteria (unique anaerobic bactericidal activity). It seldom cause the pseudomembranous colitis sometimes associated with the use of clindamycin. Metronidzole is said to be potentially mutagenic (likely to cause cancer), but short-term use has not been shown to cause cancer.
"Local anaesthetic cannot be applied to this area as there is not much space due to the large size of the growth," I said. "The cat would feel the pain of injections of the local anaesthetic and scratch me." I had a feeling that this cat was suffering from tumour as he had around 3 grey melanomas in the ear pinnae. Both ears and melanomas may have spread to this nose area.
The following was briefly how I handled this case with the least cost as required.
PROCEDURES
1. History & Palpation of the tumour. Firm but no pain. The cat had 10 days of vibravet 50 mg at 3/4 tablet per day from Vet 1. Now he had yellow runny nostril on the right side. "Did he get nose discharge on the left nostril?" I asked the young man. "No," he said. But I could see the brownish stain not completely wiped out, below the left nostril (see picture). His mum later confirmed that the cat had discharge of both nostrils.
2. Aspiration with 18G needle. The quiet cat was held by my assistant (without wrapping him in a towel as it should be done. My right wrist was scratched). I aspirated 0.02ml of red blood from the bigger of the two lumps.
3. Incision for biopsy. I used the scalpel to excise the lump to see what is inside. As I had promised the young man, I did not use general anaesthesia. The cat raised his front left paws weakly a few times. I got scratched once as I took out 2 pieces of the greyish maroon muscle-like mass below the skin, put in formalin and sent them to the Laboratory.
4. Anaerobic bacterial cultures and Gram stain were not done as the cat just had been on 10 days of antibiotics from Vet 1.
5. I had asked my assistant to clip the hairs of the forelegs so as to insert the IV catheter easily. This was done with no prolem. Blood test and an IV drip was done. In the IV saline drip to be given as 500 ml, I put in baytril antibiotic according to weight, a small 0.2 ml dexamethosone anti-inflammatory and metronidazole according to weight.
RESULTS
Least veterinary cost is what the young man's father wanted. With the above procedures, the cost was "affordable" as it was well below $1,000 since there was no general anaesthetic and surgery. And no possibility of death.
24 hours later, the cat had no runny left nostril. I did not expect such drastic improvement. He went home on Day 3 with Baytril antibiotics. He had no problem with runny nose and was eating well. Lab reports indicate he had cancer - malignant cellular infiltrate with a differential diagnosis including malignant melanoma. I advised surgical excision but the father wanted to wait and see.
LAB REPORT. Cat, M, 6 years. Soft tissue lesion, near muscle. MALIGNANT CELLULAR INFILTRATE. Different diagnosis includes malignant lymphoma, malignant melanoma, carcinoma or sarcoma. Immunostains needed to delineate and type the tumour.
CONCLUSION.
A biopsy is important in growths. A CT scan of $1,500 is too costly for most cat owners. In chronic sinusitis as suspected in this case, a gram stain, a fungal and anaerobic culture would be good but these were not done as the cat had been on antibiotic in the past 10 days. There was a budget from the owner.
Metronidazole IV may be effective in this case when combined with Baytril. As there was no bacterial culture done, it was hard to say what caused the blood sneezing and nose discharge. Metronidazole is effective against anaerobic bacteria (unique anaerobic bactericidal activity). It seldom cause the pseudomembranous colitis sometimes associated with the use of clindamycin. Metronidzole is said to be potentially mutagenic (likely to cause cancer), but short-term use has not been shown to cause cancer.
Dry lips
Cause varied. Sjogren's syndrome (an autoimmune disorder associated with dry mouth and dry eyes), hypothyroidsim, drugs in the treatment of hypertension, acne (Roaccutane). Most common cause is environment like cold dry weather. Allergy to metal canister. Treatment is frequent application of misturisers or lip balms containing beeswax (good moisturing properties) +/or topical steroids in allergies. More detailed medical test if problem persists.
236. Sleep bruxism
Sleep bruxism - grinds one's teeth involuntarily during sleep. One in 3 children and some adults. Causes - stress, anger, trauma, some drugs, genes. Leads to jaw pain, tense facial muscles, head and ear aches, worn out teeth.
Does this happen in dogs and rabbits during sleep? In people, treatment of underlying conditions, pain relief and mouth guard to wear during sleep.
Does this happen in dogs and rabbits during sleep? In people, treatment of underlying conditions, pain relief and mouth guard to wear during sleep.
235. Uterine Artery Embolisation (UAE) shrinks fibroids
Reference: The Straits Times Mind Your Body, Oct 21, 2010
Fibroids are benign tumours in women and affect 40% of women aged over 40. Cause pain and heavy bleeding or prevent pregnancy if inside the fallopian tubes. It will not eliminate all fibroids unlike surgical removal but does not require surgery with its complications.
UAE is a non-surgical way using a tiny catheter to block the blood flow in the artery that supplies blood to the fibroids. It is done by radiologists but Dr Bruce McLucas, an American gynaecologist wants to train gynaecologists to do it. In SGH, Prof Tan Bien Soo, senior consultant radiologist said it is team work between different specialists that matters. He says there is "continuity of care" in SGH where the procedure is currently done by radiologists who usually don't follow up on the patient, unlike the gynecologist.
Done under sedation, UAE leaves no scars and no blood loss. Outpatient procedure, less cost and recovery time. In 9/10 women, UAE shrinks the fibroid by 60% within 6 months, sufficient to stop pain and other compications. UAE is less damaging han myomectomy (surgical removal of fibroids) or hysterectomy (entire womb with or without ovaries and fallopian tubes surgically removed).
Fibroids are benign tumours in women and affect 40% of women aged over 40. Cause pain and heavy bleeding or prevent pregnancy if inside the fallopian tubes. It will not eliminate all fibroids unlike surgical removal but does not require surgery with its complications.
UAE is a non-surgical way using a tiny catheter to block the blood flow in the artery that supplies blood to the fibroids. It is done by radiologists but Dr Bruce McLucas, an American gynaecologist wants to train gynaecologists to do it. In SGH, Prof Tan Bien Soo, senior consultant radiologist said it is team work between different specialists that matters. He says there is "continuity of care" in SGH where the procedure is currently done by radiologists who usually don't follow up on the patient, unlike the gynecologist.
Done under sedation, UAE leaves no scars and no blood loss. Outpatient procedure, less cost and recovery time. In 9/10 women, UAE shrinks the fibroid by 60% within 6 months, sufficient to stop pain and other compications. UAE is less damaging han myomectomy (surgical removal of fibroids) or hysterectomy (entire womb with or without ovaries and fallopian tubes surgically removed).
Sunday, November 7, 2010
Holiday at Philea
I had a 3-day 2-night stay at a brand new resort in Melaka and shares my experiences with readers
MARKETING INFO FOR DESIGN TRAVEL PTE LTD, www.designtravel.com.sg
1. Philea Resort & Spa, Ayer Keroh, Melaka. I arrived on Friday (Deepavali), 5 Nov 2010. There was a Bridal Fair 2010 at the Philea Ballroom which can seat a maximum of 500 people for weddings. For 200 people, the ballroom can be partitioned. There are small meeting rooms which seat around 10-20 people.
2. All info on the Philea Resort is at:
http://www.phileahotel.com/resort_melaka_malaysia/index.html
3. MARKETING SEGMENT. I believe that the type of corporate customers for this resort is:
3.1 Not those on budget like young adults who want to shop and dine till past midnight as they will need a taxi to come back to the Philea Resort & Spa which is not in the down-town location.
It will be OK for expatriates who can afford taxis and I have seen 2 older Caucasian expats in their 30s, returning by taxi at around 9pm.
3.2 Prospects with spending power including families and professional bodies. According to travel agency owner, Mr Richard Goh who picked me up from Equatorial Hotel on arrival in Melaka to send me to Philea Resort, thinks that church people may not have the spending power to host the retreat in Philea Resort & Spa.
3.3 If you send corporate customers, they will be those that appreciate the finer things in life like living in a spacious all-pinewood rooms including flooring and walls, new bathroom with long bath and showers rustic environment far from the city crowds and noises and villas instead of apartment-type or room-type hotel, low rise low density resort alternative to hotel high-rise of around 200 units or as pre-arranged.
3.4 Caucasians will definitely like this wooded villa ambience and the Russian-sourced pinewood buildings. Pictures are at the website.
3.5 Food & Beverage was generally good. During my 2 nights stay, the buffet dinner was excellent. The baby lobster was great on the first night but not so good on the second night. The satay of beef and chicken was consistently great. I like the braised beef. No pork is served. So this resort may appeal to the Singapore Muslim community for retreats.
3.6 50% F&B discount for senior citizens is a great incentive. The buffet dinner had 2 types of soups. There was a great interest in baby lobsters, prawns, shell fish, squids, Italian food, cakes, ice-cream etc was around RM26.00 per senior citizen. The breakfast coffee was bad and tasted like charcoal. Waiters' service was great. Dinner may be outdoors with no air-condition as the air conditioned cafe can seat around 100 people.
3.7. New resort. This is a selling point. Opened around June 2010.
3.8 Around 10-minute drive to the town centre. There are taxis available. For our corporate clients, you will need to provide a shuttle service and driver. I know of one operator who picked me up from Hotel Equatorial to this place. He is a travel agent and is contracted to Transtar. He has his own coaches and tour guides as well as taxis. Will give you the email later.
3.9 A Butterfly farm is just 5-10 minute walk by the back gate from Philea Resort. I will go there today, Sunday morning before I check out.
4.0 3-4 hour coach ride from Singapore to Melaka. There was an accident somewhere during my departure from Singapore to Melaka on Friday, Deepavali. The Causeway jam was from 9 am to 1.30 pm. I reached Philea Resort & Spa at around 6 pm.
4.1 The coach could have dropped me at the last toll gate which is a short walk to Philea Resort & Spa. Instead Transtar arranged for me to go to Hotel Equatorial. The taxi driver and travel agency owner, Mr Richard Goh was not around. I had to ask the Equatorial hotel receptionist to phone him. Transnational Travels had not made any arrangments for delayed arrivals nor give me instructions on what to do or tel when there is a delay in arrival. This was bad planning. Mr Richard Goh said it was unusual as most people from Singapore took 3-4 hours to reach Melaka by 3 p.m. So, he left the Equatorial Hotel which was just a drop-off point.
5. Room in the Pavillion Villa (180 units - 2 storeys bungalows, each with 4 units, upper and lower separated by a central staircase). Spacious and is bigger than some Singapore's 5-star hotel rooms like Westin. Pinewood flooring looks clean and bright. It feels great to walk upon, without the need to wear shoes. Bathroom has pinewood doors, rectangular white porcelain basin top, no-closed up screen on long bath, spacious shower area with glassed partition, big mirror and black tiled flooring giving a luxurious appearance. No adjoining room for big families but the central staircase of each level has doors facing each other and therefore the families with children can connect via the staircase landing.
6. Possibly Philea Resort & Spa has only two competitors. One in the same class will be A' Famosa Resort Malaysia, http://www.afamosa.com/main.php?m=Content&op=page&id=160. Philea Resort is not a theme-park concept unlike A'Famosa. It is said to be the only resort with pinewood logs (inter-locking, no screws and nails) with logged villa accommodation in Malaysia. There is one new development with villas built over the sea in KL I can't recall its name.
I hope the above info helps.
Best wishes.
MARKETING INFO FOR DESIGN TRAVEL PTE LTD, www.designtravel.com.sg
1. Philea Resort & Spa, Ayer Keroh, Melaka. I arrived on Friday (Deepavali), 5 Nov 2010. There was a Bridal Fair 2010 at the Philea Ballroom which can seat a maximum of 500 people for weddings. For 200 people, the ballroom can be partitioned. There are small meeting rooms which seat around 10-20 people.
2. All info on the Philea Resort is at:
http://www.phileahotel.com/resort_melaka_malaysia/index.html
3. MARKETING SEGMENT. I believe that the type of corporate customers for this resort is:
3.1 Not those on budget like young adults who want to shop and dine till past midnight as they will need a taxi to come back to the Philea Resort & Spa which is not in the down-town location.
It will be OK for expatriates who can afford taxis and I have seen 2 older Caucasian expats in their 30s, returning by taxi at around 9pm.
3.2 Prospects with spending power including families and professional bodies. According to travel agency owner, Mr Richard Goh who picked me up from Equatorial Hotel on arrival in Melaka to send me to Philea Resort, thinks that church people may not have the spending power to host the retreat in Philea Resort & Spa.
3.3 If you send corporate customers, they will be those that appreciate the finer things in life like living in a spacious all-pinewood rooms including flooring and walls, new bathroom with long bath and showers rustic environment far from the city crowds and noises and villas instead of apartment-type or room-type hotel, low rise low density resort alternative to hotel high-rise of around 200 units or as pre-arranged.
3.4 Caucasians will definitely like this wooded villa ambience and the Russian-sourced pinewood buildings. Pictures are at the website.
3.5 Food & Beverage was generally good. During my 2 nights stay, the buffet dinner was excellent. The baby lobster was great on the first night but not so good on the second night. The satay of beef and chicken was consistently great. I like the braised beef. No pork is served. So this resort may appeal to the Singapore Muslim community for retreats.
3.6 50% F&B discount for senior citizens is a great incentive. The buffet dinner had 2 types of soups. There was a great interest in baby lobsters, prawns, shell fish, squids, Italian food, cakes, ice-cream etc was around RM26.00 per senior citizen. The breakfast coffee was bad and tasted like charcoal. Waiters' service was great. Dinner may be outdoors with no air-condition as the air conditioned cafe can seat around 100 people.
3.7. New resort. This is a selling point. Opened around June 2010.
3.8 Around 10-minute drive to the town centre. There are taxis available. For our corporate clients, you will need to provide a shuttle service and driver. I know of one operator who picked me up from Hotel Equatorial to this place. He is a travel agent and is contracted to Transtar. He has his own coaches and tour guides as well as taxis. Will give you the email later.
3.9 A Butterfly farm is just 5-10 minute walk by the back gate from Philea Resort. I will go there today, Sunday morning before I check out.
4.0 3-4 hour coach ride from Singapore to Melaka. There was an accident somewhere during my departure from Singapore to Melaka on Friday, Deepavali. The Causeway jam was from 9 am to 1.30 pm. I reached Philea Resort & Spa at around 6 pm.
4.1 The coach could have dropped me at the last toll gate which is a short walk to Philea Resort & Spa. Instead Transtar arranged for me to go to Hotel Equatorial. The taxi driver and travel agency owner, Mr Richard Goh was not around. I had to ask the Equatorial hotel receptionist to phone him. Transnational Travels had not made any arrangments for delayed arrivals nor give me instructions on what to do or tel when there is a delay in arrival. This was bad planning. Mr Richard Goh said it was unusual as most people from Singapore took 3-4 hours to reach Melaka by 3 p.m. So, he left the Equatorial Hotel which was just a drop-off point.
5. Room in the Pavillion Villa (180 units - 2 storeys bungalows, each with 4 units, upper and lower separated by a central staircase). Spacious and is bigger than some Singapore's 5-star hotel rooms like Westin. Pinewood flooring looks clean and bright. It feels great to walk upon, without the need to wear shoes. Bathroom has pinewood doors, rectangular white porcelain basin top, no-closed up screen on long bath, spacious shower area with glassed partition, big mirror and black tiled flooring giving a luxurious appearance. No adjoining room for big families but the central staircase of each level has doors facing each other and therefore the families with children can connect via the staircase landing.
6. Possibly Philea Resort & Spa has only two competitors. One in the same class will be A' Famosa Resort Malaysia, http://www.afamosa.com/main.php?m=Content&op=page&id=160. Philea Resort is not a theme-park concept unlike A'Famosa. It is said to be the only resort with pinewood logs (inter-locking, no screws and nails) with logged villa accommodation in Malaysia. There is one new development with villas built over the sea in KL I can't recall its name.
I hope the above info helps.
Best wishes.
233. Hamster vets
E-MAIL TO DR SING DATED NOV 7, 2010
I am writing to you because I have a dwarfhamster that has not emptied
his cheek pouch in two weeks not even when I gently press on the back
of his pouch. It also seems that his teeth might be too long, although
I am not quite sure how long hamster teeth should be. On your website
you have many stories about how you have treated hamsters, and it
seems that you have a lot of knowledge on this subject therefore I am
asking you for your help.
I live in the Netherlands where it is very hard to find a veterinarian
that knows how to treat small animals. I have called the vet and they
said they could not say anything without seeing the hamster first and
that they do have knowledge of hamsters. I have had several small pets
and this is their usual reply and when I bring my pet over the vet
usually knows a lot less than I do and always recommends just putting
it to sleep. The consultations are quite expensive therefore I really
would not like to go unless I would find a doctor that actually knows
something about small animals, they always say they do on the phone
but a soon as you stand in front of them they do not even know its
head from its tail.
The hamster seems to be doing fine, he does not look in distress and
he still eats and drinks. However, he seems to have slowed down.
Normally he is a very active animal that runs in his wheel for hours
and moves everything around in his cage but lately he is less active
and he seems to keep tripping and falling over when he is climbing
around on his toys, in such a manner that I have actually removed most
of his toys so that he would not be able to hurt himself. He is almost
two years old now, so maybe him slowing down is just because he is
getting older. Although my previous hamsters would remain active until
their death.
Another of my concern to bring the hamster to the vet is because he is
getting older and I am afraid that maybe the stress of being there and
maybe being handled by an inexperienced vet would make him die from
stress. Therefore, I hope you will be willing to give me advice on how
to take care of my hamster myself so I can do it in the comfort of his
own home. I would be very grateful! Could you tell me step by step how
to clean out his cheek pouch? Also how I could locate it, because when
I hold him by the scruff of his neck which makes him "smile" I cannot
see any entrance to his cheek pouch. Would you maybe be able to send
me a picture of how long the teeth of a dwarfhamster should normally
look like? I can find a lot of pictures online where the teeth are
extremely long and curled up, but my hamster does not have this. Oh I
almost forgot to say that my hamster also does not drool from the
mouth but he has not closed his mouth in a couple of days its always
just open for a little bit.
I really hope you can help me quickly before he gets sicker, I am of
course willing to pay for your consultation.
Kind regards,
Name of Owner
E-MAIL REPLY FROM DR SING
If the cheek pouch is impacted, you need to empty it. Usually I put the hamster under gas anaesthesia as it will be stressed and may die.
As for your case, your hamster may be comfortable with you. You need to restrain him and this is not easy, to empty his pouch. Use a blunt ended forceps to do it in this case. If the cheek pouch is inflamed and infected, you will need to look for an experienced hamster vet to use anaesthesia and do surgery.
I hope this advice will help. Impacted and/or infected cheek pouches are sometimes very difficult to empty as some seeds may have stuck inside and become embedded causing great pain in the mouth. If there is no anaesthesia and you try to force the hamster to empty its pouch, it may just die during your manipulation. That is why many vets don't like hamster treatment. No vets want to damage his reputation when the hamster dies during treatment. Best wishes.
I am writing to you because I have a dwarfhamster that has not emptied
his cheek pouch in two weeks not even when I gently press on the back
of his pouch. It also seems that his teeth might be too long, although
I am not quite sure how long hamster teeth should be. On your website
you have many stories about how you have treated hamsters, and it
seems that you have a lot of knowledge on this subject therefore I am
asking you for your help.
I live in the Netherlands where it is very hard to find a veterinarian
that knows how to treat small animals. I have called the vet and they
said they could not say anything without seeing the hamster first and
that they do have knowledge of hamsters. I have had several small pets
and this is their usual reply and when I bring my pet over the vet
usually knows a lot less than I do and always recommends just putting
it to sleep. The consultations are quite expensive therefore I really
would not like to go unless I would find a doctor that actually knows
something about small animals, they always say they do on the phone
but a soon as you stand in front of them they do not even know its
head from its tail.
The hamster seems to be doing fine, he does not look in distress and
he still eats and drinks. However, he seems to have slowed down.
Normally he is a very active animal that runs in his wheel for hours
and moves everything around in his cage but lately he is less active
and he seems to keep tripping and falling over when he is climbing
around on his toys, in such a manner that I have actually removed most
of his toys so that he would not be able to hurt himself. He is almost
two years old now, so maybe him slowing down is just because he is
getting older. Although my previous hamsters would remain active until
their death.
Another of my concern to bring the hamster to the vet is because he is
getting older and I am afraid that maybe the stress of being there and
maybe being handled by an inexperienced vet would make him die from
stress. Therefore, I hope you will be willing to give me advice on how
to take care of my hamster myself so I can do it in the comfort of his
own home. I would be very grateful! Could you tell me step by step how
to clean out his cheek pouch? Also how I could locate it, because when
I hold him by the scruff of his neck which makes him "smile" I cannot
see any entrance to his cheek pouch. Would you maybe be able to send
me a picture of how long the teeth of a dwarfhamster should normally
look like? I can find a lot of pictures online where the teeth are
extremely long and curled up, but my hamster does not have this. Oh I
almost forgot to say that my hamster also does not drool from the
mouth but he has not closed his mouth in a couple of days its always
just open for a little bit.
I really hope you can help me quickly before he gets sicker, I am of
course willing to pay for your consultation.
Kind regards,
Name of Owner
E-MAIL REPLY FROM DR SING
If the cheek pouch is impacted, you need to empty it. Usually I put the hamster under gas anaesthesia as it will be stressed and may die.
As for your case, your hamster may be comfortable with you. You need to restrain him and this is not easy, to empty his pouch. Use a blunt ended forceps to do it in this case. If the cheek pouch is inflamed and infected, you will need to look for an experienced hamster vet to use anaesthesia and do surgery.
I hope this advice will help. Impacted and/or infected cheek pouches are sometimes very difficult to empty as some seeds may have stuck inside and become embedded causing great pain in the mouth. If there is no anaesthesia and you try to force the hamster to empty its pouch, it may just die during your manipulation. That is why many vets don't like hamster treatment. No vets want to damage his reputation when the hamster dies during treatment. Best wishes.
Sunday, October 31, 2010
232. Brand name opens the door
I would teach Mr Saw, my assistant whenever I had a good case. He would be going back to Myanmar in April 2011 to start-up a vet surgery in Yangon with a friend. He had been working for me for nearly 3 years and he would be considered an "experienced vet from Singapore" in Yangon.
I said to Mr Saw: "You can have a good name - experienced vet who has worked in Singapore, but remember one thing: if you can't give what the owner wants, your brand name is no use to him.
"See this case of the cat (with a problem that the brand name practice vet was not given a second chance to review). He takes his ten cats to this famous and big vet practice for the past years. He could have consulted Toa Payoh Vets as he lives in Toa Payoh. But he would never do it for some reasons.
"His wife had consulted Toa Payoh Vets once, the husband had said to me. That means there is something I had not done correctly or given to what the wife wanted. So I have to improve my services or the facilities and review my operations.
"Brand name opens the door for you, but if you can't give what the owner wants, you can be the most famous vet practice in Singapore and he will go elsewhere. You must be able to resolve his cat's problem at the price he can afford. If your practice is famous, you cannot solve his problem and you quote him a high vet cost, he will not come back to you the second time. This applies only to those who don't want to spend and spend on their pets' veterinary treatment."
Mr Saw nodded his head and appreciated the advices I gave him regarding competitiveness, the need to save on costs so as to give affordable vet treatment and not waste materials and medicine as many vet employees are prone to do so. He learns the running of the practice by working for an old vet who has been battle-tested. He was fortunate in this aspect as I had time for him to mentor him knowing that he has a good work attitude.
I said to Mr Saw: "You can have a good name - experienced vet who has worked in Singapore, but remember one thing: if you can't give what the owner wants, your brand name is no use to him.
"See this case of the cat (with a problem that the brand name practice vet was not given a second chance to review). He takes his ten cats to this famous and big vet practice for the past years. He could have consulted Toa Payoh Vets as he lives in Toa Payoh. But he would never do it for some reasons.
"His wife had consulted Toa Payoh Vets once, the husband had said to me. That means there is something I had not done correctly or given to what the wife wanted. So I have to improve my services or the facilities and review my operations.
"Brand name opens the door for you, but if you can't give what the owner wants, you can be the most famous vet practice in Singapore and he will go elsewhere. You must be able to resolve his cat's problem at the price he can afford. If your practice is famous, you cannot solve his problem and you quote him a high vet cost, he will not come back to you the second time. This applies only to those who don't want to spend and spend on their pets' veterinary treatment."
Mr Saw nodded his head and appreciated the advices I gave him regarding competitiveness, the need to save on costs so as to give affordable vet treatment and not waste materials and medicine as many vet employees are prone to do so. He learns the running of the practice by working for an old vet who has been battle-tested. He was fortunate in this aspect as I had time for him to mentor him knowing that he has a good work attitude.
Friday, October 29, 2010
231. Brand name v. benefits to the customer
My vet assistant, Mr Saw had worked with me for nearly 3 years. As he will be leaving next year to work in Yangon, I shared experiences of cases with him today and whenever we work together.
Case 1
Tumour in gum of Chihuahua, M, Neutered, 6 years.
"It is best to advise histopathology of this tumour," I said to him. "Some owners are not aware of the need to get this test. We want to lower our vet costs by not advising this test. However, the tumour may be cancerous and if we do not advise, the next time the tumour comes back, the owner will not have confidence in the vet.
The owner is a young woman with internet knowledge and so she will know many things by researching the internet for gum tumours. She had asked whether I would be doing a histopathology and I said yes. Not every owner wants the lowest price.
Case 2
Urinary stone stuck inside the penis. "Different vets will operate differently to take out the stones jammed packed behind the os penis, inside the penis ," I said to Mr Saw. "In this Yorkshire, the vet leaves the urethra wound open by NOT stitching the incision. I will not operate this way. Why?"
Mr Saw did not know. "Well, this is a male dog. So he usually lifts his one leg to pee. When he pees, his urine will leak out from under his penis where the urethostomy incision has not been closed. So he sprays urine or dribble urine all over the apartment. In Singapore, 80% of the people lives in apartments. By NOT stitching up the urethra, the male dog may pee from his penile end and from below the penis. If you are the dog's owner, you will be very unhappy as you have to clean up. Worse still, the dog dribbles urine all over the whole floor due to urine marking.
Case 2.1
"Don't let the dog go home on day 3," I advised my associate. "The catheter may be rubbed out at home or pulled out as the dog will be roaming all over the apartment. In the Surgery, he is confined and monitored and nursed every day. At home, most owners don't bother. Things become nasty when the catheter is pulled out and the urethostomy wound at the bottom of the penis has not healed yet. Worse of all, the urethostomy wound closes and cause obstruction before the 10th day as recommended. The owner will want 'free' surgery or treatment. In any case, you get an unhappy owner."
The dog was put in for at least 10 days as this was a serious case of bladder and lower urethra being cut to take out the stones. (see X-ray).
Case 3
Skin disease.
"What the owner wants is a cure after payment and not have to come again," I referred to a case. "Vet 1 had treated and prescribed anti-fungal drugs and washes for the last 14 days. You saw the owner who was very unhappy as the dog was very itchy in the elbow, backside and lower body."
Mr Saw learnt from how I handled this case.
1. Skin scraping
2. Ultra-violet light. This was most impressive to the owner as ringworm hairs flouresce in the umbilical area and backside.
3. Communication with the owner. "You need to clip the dog bald," I said. "Otherwise you will curse me 2 weeks later when the disease is not gone away."
4. Clipping bald.
5. Anti-fungal wash.
After clipping bald, I discovered scabies mites on the ear edgess. So this dog had arcptic mange as well. No wonder he was so itchy and wanted to bite the owner!
Case 1
Tumour in gum of Chihuahua, M, Neutered, 6 years.
"It is best to advise histopathology of this tumour," I said to him. "Some owners are not aware of the need to get this test. We want to lower our vet costs by not advising this test. However, the tumour may be cancerous and if we do not advise, the next time the tumour comes back, the owner will not have confidence in the vet.
The owner is a young woman with internet knowledge and so she will know many things by researching the internet for gum tumours. She had asked whether I would be doing a histopathology and I said yes. Not every owner wants the lowest price.
Case 2
Urinary stone stuck inside the penis. "Different vets will operate differently to take out the stones jammed packed behind the os penis, inside the penis ," I said to Mr Saw. "In this Yorkshire, the vet leaves the urethra wound open by NOT stitching the incision. I will not operate this way. Why?"
Mr Saw did not know. "Well, this is a male dog. So he usually lifts his one leg to pee. When he pees, his urine will leak out from under his penis where the urethostomy incision has not been closed. So he sprays urine or dribble urine all over the apartment. In Singapore, 80% of the people lives in apartments. By NOT stitching up the urethra, the male dog may pee from his penile end and from below the penis. If you are the dog's owner, you will be very unhappy as you have to clean up. Worse still, the dog dribbles urine all over the whole floor due to urine marking.
Case 2.1
"Don't let the dog go home on day 3," I advised my associate. "The catheter may be rubbed out at home or pulled out as the dog will be roaming all over the apartment. In the Surgery, he is confined and monitored and nursed every day. At home, most owners don't bother. Things become nasty when the catheter is pulled out and the urethostomy wound at the bottom of the penis has not healed yet. Worse of all, the urethostomy wound closes and cause obstruction before the 10th day as recommended. The owner will want 'free' surgery or treatment. In any case, you get an unhappy owner."
The dog was put in for at least 10 days as this was a serious case of bladder and lower urethra being cut to take out the stones. (see X-ray).
Case 3
Skin disease.
"What the owner wants is a cure after payment and not have to come again," I referred to a case. "Vet 1 had treated and prescribed anti-fungal drugs and washes for the last 14 days. You saw the owner who was very unhappy as the dog was very itchy in the elbow, backside and lower body."
Mr Saw learnt from how I handled this case.
1. Skin scraping
2. Ultra-violet light. This was most impressive to the owner as ringworm hairs flouresce in the umbilical area and backside.
3. Communication with the owner. "You need to clip the dog bald," I said. "Otherwise you will curse me 2 weeks later when the disease is not gone away."
4. Clipping bald.
5. Anti-fungal wash.
After clipping bald, I discovered scabies mites on the ear edgess. So this dog had arcptic mange as well. No wonder he was so itchy and wanted to bite the owner!
Thursday, October 28, 2010
230. The ends justify the means
What is the meaning of "the ends justify the means?" I will illustrate. A father who is the sole breadwinner earns $3,000 a month. His daughter failed to get into the Singapore University due to not having straight As.
But she is accepted into an Australian University to pursue her dreams. The yearly cost of accommodation and tuition fees around $50,000. The mum does not work. So the source of income is around $36,000 from the father's earnings as an employee.
The company permitted the father to do outside work. He did manage to pay for the daughter's first year of overseas education through a stroke of luck. In the second year, Lady Luck enabled him to rent and sell a $3 million condo, thereby giving the daughter sufficient funds. But the timing was not right. So the father issued 2 cheques of $5,000 and $1,500 for an interest-free loan in cash. The cheques were dud ones as they could not be banked in. So, he got part of the money for his daughter. His "ends justify the means". Without the money, the daughter would be evicted from the course. Lady Luck had been kind to him again as no complaints to his company were made about his dud cheques. He repaid the monies 3 months later when the sales of the condo was completed. But there are two more years to go. Will Lady Luck still favour the brave father? Can he go round issuing dud checks to get money for his daughter and his own expenses? Is this an honest way to live? I don't think so. But there are such people using dud cheques to get the money. It is best not to lend any money to anybody.
But she is accepted into an Australian University to pursue her dreams. The yearly cost of accommodation and tuition fees around $50,000. The mum does not work. So the source of income is around $36,000 from the father's earnings as an employee.
The company permitted the father to do outside work. He did manage to pay for the daughter's first year of overseas education through a stroke of luck. In the second year, Lady Luck enabled him to rent and sell a $3 million condo, thereby giving the daughter sufficient funds. But the timing was not right. So the father issued 2 cheques of $5,000 and $1,500 for an interest-free loan in cash. The cheques were dud ones as they could not be banked in. So, he got part of the money for his daughter. His "ends justify the means". Without the money, the daughter would be evicted from the course. Lady Luck had been kind to him again as no complaints to his company were made about his dud cheques. He repaid the monies 3 months later when the sales of the condo was completed. But there are two more years to go. Will Lady Luck still favour the brave father? Can he go round issuing dud checks to get money for his daughter and his own expenses? Is this an honest way to live? I don't think so. But there are such people using dud cheques to get the money. It is best not to lend any money to anybody.
Wednesday, October 27, 2010
New puppy health check
E-MAIL TO DR SING DATGED OCT 27, 2010
Hi,
I am looking to adopt a new dog into my house, she is currently 1month old and still being weaned.
As i already have a 5 year old dog, i want to ensure that the newest addition is healthy and free from any disease.
Please let me know what tests which need to be run and at what age.
And also how long in advance would i need to make an appointment.
Thank you,
Name of owner
I am Dr Sing. My advice is to isolate the puppy from the adult dog for one month. Get the adult dog vaccinated 2 weeks before the puppy arrives if it is not vaccinated for the past one year. The puppy can be sent to me for general examination, testing of parvovirus +/- distemper and general examination after weaning and one day before going to your house. A blood test may be requested to check for liver and kidney disorders and blood status.
This will be around 6-8 weeks. First vaccination is at 6 weeks.
Appointment 24 hours earlier by phone 6254 3326 can be made. Best wishes.
Hi,
I am looking to adopt a new dog into my house, she is currently 1month old and still being weaned.
As i already have a 5 year old dog, i want to ensure that the newest addition is healthy and free from any disease.
Please let me know what tests which need to be run and at what age.
And also how long in advance would i need to make an appointment.
Thank you,
Name of owner
I am Dr Sing. My advice is to isolate the puppy from the adult dog for one month. Get the adult dog vaccinated 2 weeks before the puppy arrives if it is not vaccinated for the past one year. The puppy can be sent to me for general examination, testing of parvovirus +/- distemper and general examination after weaning and one day before going to your house. A blood test may be requested to check for liver and kidney disorders and blood status.
This will be around 6-8 weeks. First vaccination is at 6 weeks.
Appointment 24 hours earlier by phone 6254 3326 can be made. Best wishes.
228. Exploitation of a top performer
The following is my advice to any person who wants to be a joint-venture partner without putting down cash.
In this case study, I shall call this person Alan. In this private limited company, there are 2 directors at 50:50 share. Alan feels that he should be paid $5,000 per month as a "salaried" director as he brings in the bacon. The other director, Bernice puts in the money 100%.
So, Alan will get $60,000 per annum for the first year of operation. Bernice does not get paid but contributes in administration and management of the staff and office. At the end of one year, Alan wants 50% of the net profits but he will not be responsible for any loss. He thinks that there will never be losses since he has a wide network of prospective and loyal clientele. Bernice is only a "godmother" who pays for everything including his "salary".
The important issue is that he wants to consider $5,000/month to be classified under "operating manpower expense". That means he gets $60,000 per annum for the first year whether the company makes a profit or loses money.
After deduction of this expense and other expenses like salaries of supporting staff, office rental, utilities and miscellaneous expenses which may amount to around $72,000 per year, the estimated "operating expenses" will be $72,000 and with Alan's "salary", the total will be $132,000. Bernice does not get a cent for that first year.
Therefore the total loss to the investing director for this first year, will be around $132,000 in the worst case scenario of losses.
Alan, the paid director projects "profits" based on his extensive network of relevant clientele and your more than 30 years specialising in the industry. He brings in the bacon (as the clientele and expertise are his initially), but he does not bear the financial losses if the business fails.
There may be SARS virus equivalent or long periods of haze when nobody travels, a regional war, Singapore being attacked by terrorists. Money is needed to keep the business going during such unforeseen times and also to advance to him as the "directors' fees" which he wants to considers as his "salary".
Now, if Alan is merely an employee of the start up agency, the $5,000/month is classified as "salary." If not, it is considered "director's drawings".
Man proposes. God disposes. If the reader does not understand this idiom, I clarify that there is no sure thing as success in any start-up business. If there is, why are there so many more employees than self-employed?
With Alan's proposal to get $60,000 and 50% of the net profits (if any) but not the losses, Alan is effectively taking more than 50% of the net profits if the business makes profits. He does not take the losses and so he can just say goodbye and look for another job by becoming another employee after one year.
I told Alan that his proposal is unfair and unacceptable to any investor. "Obviously, you have considered that Bernice, the investing director doesn't deserve any monthly payment as she does not bring in the bacon. Well, she does the necessary administrative work saving time that permits you to do business development and she is putting down the money where her mouth is."
I elaborated: "Both directors in this 50:50 share holdings must be fair. When 2 people start up, they put in money and their initial shares are based on the monies they invested. They may pay themselves a small salary or forgo salary. Certainly, $5,000 a month is not the amount the start up will pay the partner as that depletes the operating capital.
"Bernice also thinks she deserves $5,000/month too as she bears more responsibilities being answerable to the regulatory authority as the key executive officer, her valuable time spent in administration and in bringing some business (though Alan presumes he will be the only one doing it). The investing director is also responsible for the family money invested ($100,000 paid up capital). $100,000 is not a small sum."
Alan said" "I can easily get a 80:20 deal with established agencies whereby I get 80% of the commission as a referring agent."
I replied: "Well, you should do what gives him the highest financial benefit."
Alan did not like the idea of sowing his odds to various agencies as he would not be able to project a solid reputation.
Alan said: "My friend runs an agency himself. He is given a salary and a share of the profits."
I said; "You can be sure that it will not be 50% of the net profits in the general cases. Do check with him. If he gets 50% of the net profit and does not put his hands inside the till, he must be a very lucky person."
I continued: "I doubt it. It is just not financially viable for the investing partner to give such a big share when he does not put up a dollar.
"A start up is like a baby. It needs a father and a mother ideally. Obviously, a mother (in this case, Alan) can do it alone. Many single mothers have raised children to be outstanding graduates. But we hear of such success stories. Many more single mothers have had failed miserably and we don't hear sad stories. We don't want to hear sad stories."
In conclusion, I spent much time elaborating the realities of commercial business life to Alan. "You have had been a very good employee for much of your life time by being honest and able to deliver the sales without the company getting into bad debts. Such employees are in great demand but there is a limit to what most agencies can afford to pay.
"See the other side of the coin. Business is feast and famine. When there is feast, you, as an employee feels "exploited" as a top performing employee bringing in 6 million dollars worth of sales income. You don't get to share the fruits of your big deals or get "appreciated" by being given some percentage of the revenue generated. But how much of the crumbs will satisfy you?
"You feel exploited as you feel you deserve high financial incentives that the company should give you for generating the six million dollars' revenue. You do not realise that the net profits may be as little as 5% as there are lots of overheads of a company. You feel that the net profits from your sales are 15-20% but you don't take into account the cost of overheads of the company and other factors like depreciation.
"The company may give you some bonus but it can't be lavish on you alone as there are the managing director, the finance director, the accounts director and others to pay. These are the supporting staff.
"A business development person brings in the bacon but they do the support. If the business development person gets exceptional big bonuses out of his performance, what about the supporting staff and the Chairman who invested in the infrastructure of the business. Without his investment, this person will not have been employed in the first place. You contracted as an employee with an agreed salary and you had been paid for that amount. Any bonus would be up to the boss.
"When there is famine or office politics, you seek other employers. This is also the reality of the life of an employee. In a start up, you needs to understand that you are no longer an employee and must get rid of your "exploitation" mindset.
"There will be no more exploitation of you by anybody because you are your own boss. Bernice does not give you targets since she knows that a start up is an uncertain business, no matter how optimistic projections of past performance you have made. If you are so sure that the start up agency is going to be profitable, why not sell your HDB apartment, rent one for the family for the interim period and go all out guns blazing. Sure to win. In no time, you have made millions."
In conclusion, I reminded Alan the harsh reality: "A start up is not a sure to win business. Even a successful business will have its ups and downs. There will be economic recessions and Bernice has to continue payment to tide over the bad times. This is the other side of the coin that you, a long-serving honest and productive employee cannot understand as you have not suffered considerable losses of a business set up and encounter stiff competition to lower pricing and high demands for cheap and good services from Singaporeans and elsewhere."
In this case study, I shall call this person Alan. In this private limited company, there are 2 directors at 50:50 share. Alan feels that he should be paid $5,000 per month as a "salaried" director as he brings in the bacon. The other director, Bernice puts in the money 100%.
So, Alan will get $60,000 per annum for the first year of operation. Bernice does not get paid but contributes in administration and management of the staff and office. At the end of one year, Alan wants 50% of the net profits but he will not be responsible for any loss. He thinks that there will never be losses since he has a wide network of prospective and loyal clientele. Bernice is only a "godmother" who pays for everything including his "salary".
The important issue is that he wants to consider $5,000/month to be classified under "operating manpower expense". That means he gets $60,000 per annum for the first year whether the company makes a profit or loses money.
After deduction of this expense and other expenses like salaries of supporting staff, office rental, utilities and miscellaneous expenses which may amount to around $72,000 per year, the estimated "operating expenses" will be $72,000 and with Alan's "salary", the total will be $132,000. Bernice does not get a cent for that first year.
Therefore the total loss to the investing director for this first year, will be around $132,000 in the worst case scenario of losses.
Alan, the paid director projects "profits" based on his extensive network of relevant clientele and your more than 30 years specialising in the industry. He brings in the bacon (as the clientele and expertise are his initially), but he does not bear the financial losses if the business fails.
There may be SARS virus equivalent or long periods of haze when nobody travels, a regional war, Singapore being attacked by terrorists. Money is needed to keep the business going during such unforeseen times and also to advance to him as the "directors' fees" which he wants to considers as his "salary".
Now, if Alan is merely an employee of the start up agency, the $5,000/month is classified as "salary." If not, it is considered "director's drawings".
Man proposes. God disposes. If the reader does not understand this idiom, I clarify that there is no sure thing as success in any start-up business. If there is, why are there so many more employees than self-employed?
With Alan's proposal to get $60,000 and 50% of the net profits (if any) but not the losses, Alan is effectively taking more than 50% of the net profits if the business makes profits. He does not take the losses and so he can just say goodbye and look for another job by becoming another employee after one year.
I told Alan that his proposal is unfair and unacceptable to any investor. "Obviously, you have considered that Bernice, the investing director doesn't deserve any monthly payment as she does not bring in the bacon. Well, she does the necessary administrative work saving time that permits you to do business development and she is putting down the money where her mouth is."
I elaborated: "Both directors in this 50:50 share holdings must be fair. When 2 people start up, they put in money and their initial shares are based on the monies they invested. They may pay themselves a small salary or forgo salary. Certainly, $5,000 a month is not the amount the start up will pay the partner as that depletes the operating capital.
"Bernice also thinks she deserves $5,000/month too as she bears more responsibilities being answerable to the regulatory authority as the key executive officer, her valuable time spent in administration and in bringing some business (though Alan presumes he will be the only one doing it). The investing director is also responsible for the family money invested ($100,000 paid up capital). $100,000 is not a small sum."
Alan said" "I can easily get a 80:20 deal with established agencies whereby I get 80% of the commission as a referring agent."
I replied: "Well, you should do what gives him the highest financial benefit."
Alan did not like the idea of sowing his odds to various agencies as he would not be able to project a solid reputation.
Alan said: "My friend runs an agency himself. He is given a salary and a share of the profits."
I said; "You can be sure that it will not be 50% of the net profits in the general cases. Do check with him. If he gets 50% of the net profit and does not put his hands inside the till, he must be a very lucky person."
I continued: "I doubt it. It is just not financially viable for the investing partner to give such a big share when he does not put up a dollar.
"A start up is like a baby. It needs a father and a mother ideally. Obviously, a mother (in this case, Alan) can do it alone. Many single mothers have raised children to be outstanding graduates. But we hear of such success stories. Many more single mothers have had failed miserably and we don't hear sad stories. We don't want to hear sad stories."
In conclusion, I spent much time elaborating the realities of commercial business life to Alan. "You have had been a very good employee for much of your life time by being honest and able to deliver the sales without the company getting into bad debts. Such employees are in great demand but there is a limit to what most agencies can afford to pay.
"See the other side of the coin. Business is feast and famine. When there is feast, you, as an employee feels "exploited" as a top performing employee bringing in 6 million dollars worth of sales income. You don't get to share the fruits of your big deals or get "appreciated" by being given some percentage of the revenue generated. But how much of the crumbs will satisfy you?
"You feel exploited as you feel you deserve high financial incentives that the company should give you for generating the six million dollars' revenue. You do not realise that the net profits may be as little as 5% as there are lots of overheads of a company. You feel that the net profits from your sales are 15-20% but you don't take into account the cost of overheads of the company and other factors like depreciation.
"The company may give you some bonus but it can't be lavish on you alone as there are the managing director, the finance director, the accounts director and others to pay. These are the supporting staff.
"A business development person brings in the bacon but they do the support. If the business development person gets exceptional big bonuses out of his performance, what about the supporting staff and the Chairman who invested in the infrastructure of the business. Without his investment, this person will not have been employed in the first place. You contracted as an employee with an agreed salary and you had been paid for that amount. Any bonus would be up to the boss.
"When there is famine or office politics, you seek other employers. This is also the reality of the life of an employee. In a start up, you needs to understand that you are no longer an employee and must get rid of your "exploitation" mindset.
"There will be no more exploitation of you by anybody because you are your own boss. Bernice does not give you targets since she knows that a start up is an uncertain business, no matter how optimistic projections of past performance you have made. If you are so sure that the start up agency is going to be profitable, why not sell your HDB apartment, rent one for the family for the interim period and go all out guns blazing. Sure to win. In no time, you have made millions."
In conclusion, I reminded Alan the harsh reality: "A start up is not a sure to win business. Even a successful business will have its ups and downs. There will be economic recessions and Bernice has to continue payment to tide over the bad times. This is the other side of the coin that you, a long-serving honest and productive employee cannot understand as you have not suffered considerable losses of a business set up and encounter stiff competition to lower pricing and high demands for cheap and good services from Singaporeans and elsewhere."
Monday, October 25, 2010
227. Oronasal fistula in a dog - veterinary costs
ORONASAL FISTULA IN A DOG - ESTIMATED VETERINARY COST IN 2010
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case written: November 15, 2007
Update: 25 October, 2010
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
I am Dr Sing from Toa Payoh Vets, toapayohvets.com. Thank you for your email. Your dog is suffering from oro-nasal fistula caused usually by the abscess in the root of the big cheek tooth, the 4th premolar. In reply to your queries, see CAPITAL LETTERS below.
2010/10/24 ....@hotmail.com
Hi,
I have a jack russell of 7 years old, lately, we have been noticing small bumps on her face, right under her right eye. We have brought her to a vet and was told that it was due to gum problem, and this was further caused by tooth decay.
In that case, if we would like to proceed with a tooth extraction, how much would that cost?
1. SEDATION + ISOFLURANE GAS ANAESTHESIA $200
2. TOOTH EXTRACTION $20/TOOTH
3. DENTAL SCALING OF OTHER TEETH $50
4. POST-OP PAINKILLER AND ANTIBIOTIC INJECTION $30
5. POST-OP PAINKILLER AND ANTIBIOTIC ORAL $30 APPROXIMATELY
6. I/V DRIP + ANTIBIOTICS I/V $60
7. BLOOD TEST $150 (IF YOU DON'T WANT THE TEST, THEN THIS IS ZERO CHARGE)
8. CONSULTATION FEE $40 (NO CHARGE IN THIS CASE AS DIAGNOSIS IS DONE BY YOUR VET)
and what are the procedures?
NO FOOD AND WATER AFTER 10 PM THE DAY BEFORE. THE DOG COMES IN THE MORNING.
WEIGHED, EXAMINED GENERALLY, HEART CHECKED, TEMPERATURE, PULSE AND RESPIRATION DONE. BLOOD TEST (OPTIONAL).
THEN I/V DRIP + ANTIBIOTIC I/V, SEDATION AND GAS ANAESTHESIA. PREMOLAR TOOTH EXTRACTED. OTHER LOOSE ROTTEN TEETH EXTRACTED. DENTAL SCALING OF GOOD TEETH.
INJECTION SC PAINKILLER AND ANTIBIOTICS. THE DOG RESTS IN CAGE FOR >4 HOURS AND OBSERVED. GOES HOME IN THE EVENING.WITH PAIN-KILLER AND ANTIBIOTICS.
Two of my pet owner educational cases of canine oronasal fistula are at: A Pomeranian's facial wound that never heals
When is the soonest that we can have it done? Cause my dog seems to be in great pain.
WITHIN 24 HOURS OF YOU MAKING AN APPOINTMENT BY TEL 6254 3326.LET US KNOW AS SOON AS POSSIBLE.
Thanks!
Regards,
Name of Owner
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case written: November 15, 2007
Update: 25 October, 2010
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
I am Dr Sing from Toa Payoh Vets, toapayohvets.com. Thank you for your email. Your dog is suffering from oro-nasal fistula caused usually by the abscess in the root of the big cheek tooth, the 4th premolar. In reply to your queries, see CAPITAL LETTERS below.
2010/10/24 ....@hotmail.com
Hi,
I have a jack russell of 7 years old, lately, we have been noticing small bumps on her face, right under her right eye. We have brought her to a vet and was told that it was due to gum problem, and this was further caused by tooth decay.
In that case, if we would like to proceed with a tooth extraction, how much would that cost?
1. SEDATION + ISOFLURANE GAS ANAESTHESIA $200
2. TOOTH EXTRACTION $20/TOOTH
3. DENTAL SCALING OF OTHER TEETH $50
4. POST-OP PAINKILLER AND ANTIBIOTIC INJECTION $30
5. POST-OP PAINKILLER AND ANTIBIOTIC ORAL $30 APPROXIMATELY
6. I/V DRIP + ANTIBIOTICS I/V $60
7. BLOOD TEST $150 (IF YOU DON'T WANT THE TEST, THEN THIS IS ZERO CHARGE)
8. CONSULTATION FEE $40 (NO CHARGE IN THIS CASE AS DIAGNOSIS IS DONE BY YOUR VET)
and what are the procedures?
NO FOOD AND WATER AFTER 10 PM THE DAY BEFORE. THE DOG COMES IN THE MORNING.
WEIGHED, EXAMINED GENERALLY, HEART CHECKED, TEMPERATURE, PULSE AND RESPIRATION DONE. BLOOD TEST (OPTIONAL).
THEN I/V DRIP + ANTIBIOTIC I/V, SEDATION AND GAS ANAESTHESIA. PREMOLAR TOOTH EXTRACTED. OTHER LOOSE ROTTEN TEETH EXTRACTED. DENTAL SCALING OF GOOD TEETH.
INJECTION SC PAINKILLER AND ANTIBIOTICS. THE DOG RESTS IN CAGE FOR >4 HOURS AND OBSERVED. GOES HOME IN THE EVENING.WITH PAIN-KILLER AND ANTIBIOTICS.
Two of my pet owner educational cases of canine oronasal fistula are at: A Pomeranian's facial wound that never heals
When is the soonest that we can have it done? Cause my dog seems to be in great pain.
WITHIN 24 HOURS OF YOU MAKING AN APPOINTMENT BY TEL 6254 3326.LET US KNOW AS SOON AS POSSIBLE.
Thanks!
Regards,
Name of Owner
Friday, October 22, 2010
8-year-old neutered male cat can't pee
"I know my cats well," the lady said when I asked whether 8-year-old her male neutered cat was having constipation instead of having difficulty in urination. "I have 5 of them. I can differentiate constipation from urination difficulty."
She had consulted Vet 1 twice on Monday and Wednesday but the cat still had dysuria (difficulty in passing urine). She said: "I find that the vet is not sure of what's happening to my cat." When the cat does not get well, many Singapore owners will lose confidence and seek another opinion. Diseases take time to resolve with antibiotics and the second vet usually benefits from the passage of time to deliver an excellent outcome.
Vet 1 had told her that there was no major problem after palpation of the bladder. She said that her maid had kept a close eye on this cat and was sure that the cat had not peed a drop of urine for the past 2 days.
I said: "I have the same finding as Vet 1 in that the bladder is not full at all. So there is no urethral obstruction. If there is urinary sand obstructing the urethra, the bladder should be as big as a mango. If the cat had not peed for 2 days, the bladder should be swollen and can be felt easily."
The maid was holding the cat upside down for me to examine his private parts. There was a purplish red tip of the penis which was otherwise not swollen and normal in size and colour. The cat had medications from Vet 1 and the "normal finding" of the penis must be taken into account.
The lady was in the subway train on the way to the surgery after work. Her mum and maid had brought the cat in first. The cat had lost appetite today and had dysuria. She was insistent that the cat had a problem with urination.
PHYSICAL EXAMINATION
1. Cat standing on the examination table. Palpation of the bladder. Not swollen at all. Slight pain around the bladder area but not
2. Cat turned upside down. The penile length was extruded. Except for a purplish red tip due to traumatic licking, there was nothing abnormal. I asked the maid: "Is it possible that the cat peed when every family member including you were asleep? The bladder pain may have gone for a while and the cat pees most of the urine." The maid did not object to this comment. "Did you see blood in the cat's urine earlier?" I asked the maid. "No," she said.
WHAT TO DO NOW?
There was no doubt that the owner knows best. The cat does not have constipation as the palpation does not reveal hard faecal stools. Yet the cat does not have a full bladder or blood in the urine history.
WHAT THE OWNER WANTS
An accurate diagnosis on what's wrong with her cat. In the male dog, it is much easier to catheterise the dog's bladder and get the urine out for examination of blood and bacteria.
RE-EXAMINE THE CAT'S PENILE AREA AGAIN
I asked the maid to bring the cat to the operating room for a re-examination of the penile area again under the bright operating lights. My assistant pushed the penis out from the prepuce. The prepuce and penile body were normal pink. Only the penile tip was purplish red in colour as seen in traumatic licking.
The cat was now getting angry with all these manipulations. Suddenly the maid pointed to her right side of her T-shirt and shouted: "The cat peed onto me!" She managed a twist and turn. Much of the pee bombed onto the floor. There was a big drop of blood-stained urine remaining on the preputial area.
"Get a one-ml syringe," I shouted to my assistant. "Suck out the urine for examination." In the meantime, I took out my digital camera to take evidence for the owner who was rushing to the surgery.
"You need a 2-ml syringe," my assistant went to the chest of drawers to get one. That drop of urine would fill the 1-ml syringe. While my assistant was looking for the syringe, the cat gave a turn to be upright. So, there was no more bloody urine evidence. The maid was the witness. The bloody urine on the floor was of no use as the floor tiles were greyish in colour and anyway, the amount was not that much. It was around 20 ml spread out on the tiles.
The owner arrived. "The cat had blood in the urine," I said. She looked at me for proof. I took out the digital camera and got the image for her to see. Dark red blood at the penile tip. She seemed satisfied. Nothing can convince the doubting owner than real physical evidence of bloody urine.
TREATMENT
The owner reluctantly agreed to the cat being warded one day. Blood test would be done. The urine would be collected the next day while the cat had a IV saline to produce urine. I will then catheterise the cat and collect the urine. After that, the bladder would be flushed well with saline to get all urinary sand out.
DIAGNOSIS
In dysuria and haematuria in an 8-year-old cat of recent onset, the possible causes are:
1. FIC (feline idiopathic cystitis). This is the most common cause.
2. Urolithiasis (stone or sand in the bladder). Usually in cats over 10 years old.
3. Urethral plugs.
In this case, the tentative diagnosis is FIC but it may be a combination of 3 causes. After manipulation of the penile tip, the urethral plug was loosened and the cat peed onto the maid.
TESTS
1. Blood test
2. Urine test - cystocentosis, catheterisation or voiding. I prefer catherisation although some vets advocate cystocentosis is said to prevent introduction of bacteria into the bladder.
3. Urolith analysis (struvite & calcium oxalate usually).
ADVICE
"Stop feeding dry cat food," I said to the owner firmly. "If you feed dry food, the cat may suffer from the same lower urinary tract disease again and you will have to spend money for treatmen. Don't say I did not tell you."
The lady said: "My cat loves dry food. The other 4 cats are also eating dry food. One of them is older than him and has no such problem."
I said: "Not every person or cat will suffer from the same disease or condition. This is the diversity of life."
CONCLUSION
This is one of those cases where the cat is presented with no swollen bladder. So any vet will say that there is no urethral obstruction. So the owner will lose confidence in the vet and seek a second opinion. The second opinion was no better than the first opinion till the cat delivered the blood urine as evidence of a lower urinary tract disease! Luck does play an important part in living and in veterinary diagnosis sometimes.
She had consulted Vet 1 twice on Monday and Wednesday but the cat still had dysuria (difficulty in passing urine). She said: "I find that the vet is not sure of what's happening to my cat." When the cat does not get well, many Singapore owners will lose confidence and seek another opinion. Diseases take time to resolve with antibiotics and the second vet usually benefits from the passage of time to deliver an excellent outcome.
Vet 1 had told her that there was no major problem after palpation of the bladder. She said that her maid had kept a close eye on this cat and was sure that the cat had not peed a drop of urine for the past 2 days.
I said: "I have the same finding as Vet 1 in that the bladder is not full at all. So there is no urethral obstruction. If there is urinary sand obstructing the urethra, the bladder should be as big as a mango. If the cat had not peed for 2 days, the bladder should be swollen and can be felt easily."
The maid was holding the cat upside down for me to examine his private parts. There was a purplish red tip of the penis which was otherwise not swollen and normal in size and colour. The cat had medications from Vet 1 and the "normal finding" of the penis must be taken into account.
The lady was in the subway train on the way to the surgery after work. Her mum and maid had brought the cat in first. The cat had lost appetite today and had dysuria. She was insistent that the cat had a problem with urination.
PHYSICAL EXAMINATION
1. Cat standing on the examination table. Palpation of the bladder. Not swollen at all. Slight pain around the bladder area but not
2. Cat turned upside down. The penile length was extruded. Except for a purplish red tip due to traumatic licking, there was nothing abnormal. I asked the maid: "Is it possible that the cat peed when every family member including you were asleep? The bladder pain may have gone for a while and the cat pees most of the urine." The maid did not object to this comment. "Did you see blood in the cat's urine earlier?" I asked the maid. "No," she said.
WHAT TO DO NOW?
There was no doubt that the owner knows best. The cat does not have constipation as the palpation does not reveal hard faecal stools. Yet the cat does not have a full bladder or blood in the urine history.
WHAT THE OWNER WANTS
An accurate diagnosis on what's wrong with her cat. In the male dog, it is much easier to catheterise the dog's bladder and get the urine out for examination of blood and bacteria.
RE-EXAMINE THE CAT'S PENILE AREA AGAIN
I asked the maid to bring the cat to the operating room for a re-examination of the penile area again under the bright operating lights. My assistant pushed the penis out from the prepuce. The prepuce and penile body were normal pink. Only the penile tip was purplish red in colour as seen in traumatic licking.
The cat was now getting angry with all these manipulations. Suddenly the maid pointed to her right side of her T-shirt and shouted: "The cat peed onto me!" She managed a twist and turn. Much of the pee bombed onto the floor. There was a big drop of blood-stained urine remaining on the preputial area.
"Get a one-ml syringe," I shouted to my assistant. "Suck out the urine for examination." In the meantime, I took out my digital camera to take evidence for the owner who was rushing to the surgery.
"You need a 2-ml syringe," my assistant went to the chest of drawers to get one. That drop of urine would fill the 1-ml syringe. While my assistant was looking for the syringe, the cat gave a turn to be upright. So, there was no more bloody urine evidence. The maid was the witness. The bloody urine on the floor was of no use as the floor tiles were greyish in colour and anyway, the amount was not that much. It was around 20 ml spread out on the tiles.
The owner arrived. "The cat had blood in the urine," I said. She looked at me for proof. I took out the digital camera and got the image for her to see. Dark red blood at the penile tip. She seemed satisfied. Nothing can convince the doubting owner than real physical evidence of bloody urine.
TREATMENT
The owner reluctantly agreed to the cat being warded one day. Blood test would be done. The urine would be collected the next day while the cat had a IV saline to produce urine. I will then catheterise the cat and collect the urine. After that, the bladder would be flushed well with saline to get all urinary sand out.
DIAGNOSIS
In dysuria and haematuria in an 8-year-old cat of recent onset, the possible causes are:
1. FIC (feline idiopathic cystitis). This is the most common cause.
2. Urolithiasis (stone or sand in the bladder). Usually in cats over 10 years old.
3. Urethral plugs.
In this case, the tentative diagnosis is FIC but it may be a combination of 3 causes. After manipulation of the penile tip, the urethral plug was loosened and the cat peed onto the maid.
TESTS
1. Blood test
2. Urine test - cystocentosis, catheterisation or voiding. I prefer catherisation although some vets advocate cystocentosis is said to prevent introduction of bacteria into the bladder.
3. Urolith analysis (struvite & calcium oxalate usually).
ADVICE
"Stop feeding dry cat food," I said to the owner firmly. "If you feed dry food, the cat may suffer from the same lower urinary tract disease again and you will have to spend money for treatmen. Don't say I did not tell you."
The lady said: "My cat loves dry food. The other 4 cats are also eating dry food. One of them is older than him and has no such problem."
I said: "Not every person or cat will suffer from the same disease or condition. This is the diversity of life."
CONCLUSION
This is one of those cases where the cat is presented with no swollen bladder. So any vet will say that there is no urethral obstruction. So the owner will lose confidence in the vet and seek a second opinion. The second opinion was no better than the first opinion till the cat delivered the blood urine as evidence of a lower urinary tract disease! Luck does play an important part in living and in veterinary diagnosis sometimes.
Wednesday, October 20, 2010
Toa Payoh Vets - Dietary management to dissolve struvite stones in dogs
Dietary management to dissolve struvite stones in the bladder & voiding urohydropropulsion
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Written: Perth, 29 September 2010
Update: 11 October 2010
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
After the surgical removal of the struvite urinary stones or for medical and dietary treatment, how much of the prescription diet should the owner give the dog/day?
I took some time just to read about Canine Struvite Urolithiasis case studies in the thick book "Small Animal Clinical Nutrition" by Hand et. al, 5th Edition and the following is some general guideline for Toa Payoh Vets in advising on Prescription Diet s/d to dogs in 3 case studies.
How much of the s/d diet to be given:
1. Puppy X-breed, 9 weeks,
5 kg.
700kcal (2.83MJ)
1/2 can 3x/day
2. Rottweiler, 5 years, 41 kg
1,800kcal (7.5MJ)
1.5 cans 2x/day
3. German Shepherd, 12 years, 27 kg
1,150kcal (4.8MJ)
1 can 2x/day
Other procedures to ensure compliance from the owner:
1. Antibiotics from 14-30 days and review using urine cultures
2. Monthly urine analysis (check for UTI) and blood tests (esp. serum urea nitrogen, magnesium, phosphorus and calcium and alkaline phosphatese)
3. Monthly x-rays of kidney (V/D view), bladder (lateral views)
Back to normal commercial food for the puppy as soon as X-rays show no stones. For adult dogs, give prescription food for one more month after negative X-ray results. No commercial dog treats or snacks during the period of treatment.
Specialised tests like double-contrast cystography (to check out anatomic abnormalities of the bladder, obstruction of urine flow from kidneys), retrograde positive-contrast urethrocystography (to check out anatomical abnormalities of the urinary tract to the prostate gland area) if there is recurrent uroliths or UTI.
Very few Singapore clientele comply with the above instructions. It could be due to economic reasons. Urine is taken by cystocentesis. Voiding urohydropropulsion is used in cases where the uroliths are small. The owner must be informed that it takes 2-4 months or longer to get all struvite stones dissolved. The owner must be aware of the need for reviews and to note the costs involved in the dietary management to dissolve struvite urinary stones.
VETERINARY SURGERY --- VOIDING UROHYDROPROPULSION IN DOGS AND CATS
What is urohydropropulsion? During my undergraduate days some 30 years ago, there was no such term.
Basically it means pumping saline into the bladder (3ml/kg) and suck out the fluid together with the small uroliths (urinary stones) with a catheter. The stones in the bladder are too small and therefore no surgical removal is needed.
ANAESTHESIA. May or may not be need.
POSITION. 2 methods described in Small Animal Clinical Nutrition 5th edition.
POSITION 1. Hold the dog or cat upright so that the vertebral column is upright. The urine and stones will be at the bottom (neck) of the bladder.
POSITION 2. Lateral recumbency.
In both position, catheterise, irrigate with saline (3ml/kg), massage or press bladder to shake up the stones, suck out the saline + stones with a syringe. X-rays to check if all are taken out but not all small ones can be seen.
Dietary and medical treatment.
More information is at: Small Animal Clinical Nutrition" by Hand et. al, 5th Edition
This webpage:
http://www.sinpets.com/F5/20100697struvite-dietary-management-voiding-urohydropropulsion_ToaPayohVets.htm
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Written: Perth, 29 September 2010
Update: 11 October 2010
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
After the surgical removal of the struvite urinary stones or for medical and dietary treatment, how much of the prescription diet should the owner give the dog/day?
I took some time just to read about Canine Struvite Urolithiasis case studies in the thick book "Small Animal Clinical Nutrition" by Hand et. al, 5th Edition and the following is some general guideline for Toa Payoh Vets in advising on Prescription Diet s/d to dogs in 3 case studies.
How much of the s/d diet to be given:
1. Puppy X-breed, 9 weeks,
5 kg.
700kcal (2.83MJ)
1/2 can 3x/day
2. Rottweiler, 5 years, 41 kg
1,800kcal (7.5MJ)
1.5 cans 2x/day
3. German Shepherd, 12 years, 27 kg
1,150kcal (4.8MJ)
1 can 2x/day
Other procedures to ensure compliance from the owner:
1. Antibiotics from 14-30 days and review using urine cultures
2. Monthly urine analysis (check for UTI) and blood tests (esp. serum urea nitrogen, magnesium, phosphorus and calcium and alkaline phosphatese)
3. Monthly x-rays of kidney (V/D view), bladder (lateral views)
Back to normal commercial food for the puppy as soon as X-rays show no stones. For adult dogs, give prescription food for one more month after negative X-ray results. No commercial dog treats or snacks during the period of treatment.
Specialised tests like double-contrast cystography (to check out anatomic abnormalities of the bladder, obstruction of urine flow from kidneys), retrograde positive-contrast urethrocystography (to check out anatomical abnormalities of the urinary tract to the prostate gland area) if there is recurrent uroliths or UTI.
Very few Singapore clientele comply with the above instructions. It could be due to economic reasons. Urine is taken by cystocentesis. Voiding urohydropropulsion is used in cases where the uroliths are small. The owner must be informed that it takes 2-4 months or longer to get all struvite stones dissolved. The owner must be aware of the need for reviews and to note the costs involved in the dietary management to dissolve struvite urinary stones.
VETERINARY SURGERY --- VOIDING UROHYDROPROPULSION IN DOGS AND CATS
What is urohydropropulsion? During my undergraduate days some 30 years ago, there was no such term.
Basically it means pumping saline into the bladder (3ml/kg) and suck out the fluid together with the small uroliths (urinary stones) with a catheter. The stones in the bladder are too small and therefore no surgical removal is needed.
ANAESTHESIA. May or may not be need.
POSITION. 2 methods described in Small Animal Clinical Nutrition 5th edition.
POSITION 1. Hold the dog or cat upright so that the vertebral column is upright. The urine and stones will be at the bottom (neck) of the bladder.
POSITION 2. Lateral recumbency.
In both position, catheterise, irrigate with saline (3ml/kg), massage or press bladder to shake up the stones, suck out the saline + stones with a syringe. X-rays to check if all are taken out but not all small ones can be seen.
Dietary and medical treatment.
More information is at: Small Animal Clinical Nutrition" by Hand et. al, 5th Edition
This webpage:
http://www.sinpets.com/F5/20100697struvite-dietary-management-voiding-urohydropropulsion_ToaPayohVets.htm
222. Defensive Medicine at the 49th day of pregnancy
The owner said that her British Bulldog was 49th day pregnant. Dr Vanessa Lin was the vet in charge. She palpated the abdomen and declared that the dog was not pregnant. I palpated and agreed with her. There was no big foetal lump or lumps in the abdomen. A simple case of pregnancy diagnosis. Not pregnant.
But veterinary medicine can throw out surprises for the vet who wants to provide least-cost veterinary services.
"There is a possibility that the foetal lump is positioned cranially below the diaphragm such that the vet can't feel it," I cautioned. I had read some dog breeding reports on this type of situations.
"If the dog is diagnosed as not pregnant now and she loses her sole pup due to this diagnosis, there will be a lot of unhappiness. Bulldogs usually need a Caesarean section as the puppy's head is too big. Since the vet has diagnosed this dog as non-pregnant, the owner would not have had prepared the dog for an elective Caesarean section as veterinarians are trusted professionals.
I related an incident to Dr Lin about the single pup syndrome case in a Pomeranian. A vet diagnosed the Pom as not being pregnant by abdominal palpation. The breeder who brought in the dog agreed with him. The vet assistant supported his diagnosis. Three people with experience said not pregnant.
The Pom had a difficult birth and required Caesarean section. The pup died after the Caesarean section. The dam died a few days later. The death of the beloved dam evoked much anger and resentment. If only an X-ray or ultrasound were done as part of defensive medicine, this sad outcome would not have occurred. This pup would probably had been located as a small foetal lump in the most cranial position behind the diaphragm.
Dr Lin advised an ultrasound. The dog was confirmed not pregnant. Defensive medicine is needed in many cases. When the owner is unhappy or provoked by the competitor vet, many complaints are made. A simple X-ray or ultrasound taken should have been done as part of defensive medicine as vets are not Gods and variations in medicine can sometimes ruin a hard-won reputation.
Updates at www.toapayohvets.com
But veterinary medicine can throw out surprises for the vet who wants to provide least-cost veterinary services.
"There is a possibility that the foetal lump is positioned cranially below the diaphragm such that the vet can't feel it," I cautioned. I had read some dog breeding reports on this type of situations.
"If the dog is diagnosed as not pregnant now and she loses her sole pup due to this diagnosis, there will be a lot of unhappiness. Bulldogs usually need a Caesarean section as the puppy's head is too big. Since the vet has diagnosed this dog as non-pregnant, the owner would not have had prepared the dog for an elective Caesarean section as veterinarians are trusted professionals.
I related an incident to Dr Lin about the single pup syndrome case in a Pomeranian. A vet diagnosed the Pom as not being pregnant by abdominal palpation. The breeder who brought in the dog agreed with him. The vet assistant supported his diagnosis. Three people with experience said not pregnant.
The Pom had a difficult birth and required Caesarean section. The pup died after the Caesarean section. The dam died a few days later. The death of the beloved dam evoked much anger and resentment. If only an X-ray or ultrasound were done as part of defensive medicine, this sad outcome would not have occurred. This pup would probably had been located as a small foetal lump in the most cranial position behind the diaphragm.
Dr Lin advised an ultrasound. The dog was confirmed not pregnant. Defensive medicine is needed in many cases. When the owner is unhappy or provoked by the competitor vet, many complaints are made. A simple X-ray or ultrasound taken should have been done as part of defensive medicine as vets are not Gods and variations in medicine can sometimes ruin a hard-won reputation.
Updates at www.toapayohvets.com
Tuesday, October 19, 2010
A vomiting Chihuahua (Impaction of the stomach)
INTERPRETATION OF THE X-RAYS FOR THE OWNER
Chihuahua, Male, 6 years. Vomiting and not eating. What is the problem? The dog was warded for observation.
ABDOMINAL PALPATION
A soft mass in the stomach. No pain on palpation. The intestines were firm as if they were "sausage" rolls.
X-RAYS
Lateral view:
The stomach was impacted with some foreign body. The white arrows showed a fullness of the stomach pressing against the diaphragm (which separates the chest cavity from the abdominal cavity). The white foreign body inside the stomach and intestines (black arrows) would be fibers from the chew rope. The dog had been swallowing chew ropes for many months based on the owner's report. Chew ropes are commonly sold at Singapore's pet shops. This dog prefers to eat the pieces and they accumulate and fill the stomach. This medical condition is called impaction of the stomach.
Laxatives given showed fibers and hairs inside the stools. The owner told me the dog farted. He did not pass stools for the first 4 days. I/V drips and antibiotics prevent dehydration and death.
Ventral-Dorsal view
The full stomach is not so easily seen by the layman. There is no solid foreign body such as a bone or stone and so interpretation of this view is difficult without the clinical examination and history.
The outline of the stomach is shown by the black arrows. White foreign body of fibers impact the stomach. There is a dark area in the lower half of the stomach. This will be the gas. "Sausage-like" rolls of the intestines can be seen below the stomach. I have not marked the rolls.
The bladder shows a opaque urine which is not normal. Urine tests confirmed a moderate amount of struvite crystals which cause this whiteness of the bladder. On discharge of the dog, the dog peed with difficulty on the grass. This was seen by the owner.
Dietary management to dissolve the struvite crystals is an alternative to surgery. However the owner must know that it may take 2-4 months to see results and there must be strict compliance with veterinary instructions including diet and urine tests and X-rays of the bladder till no struvite crystals are present.
Two blood tests were taken. The second blood test showed liver disorder. In conclusion, the dog recovered after 4 days and went home. Dietary management to dissolve the stones had been discussed with the owner. A follow-up by the owner must be done in the next few days.
Updates at www.toapayohvets.com
Chihuahua, Male, 6 years. Vomiting and not eating. What is the problem? The dog was warded for observation.
ABDOMINAL PALPATION
A soft mass in the stomach. No pain on palpation. The intestines were firm as if they were "sausage" rolls.
X-RAYS
Lateral view:
The stomach was impacted with some foreign body. The white arrows showed a fullness of the stomach pressing against the diaphragm (which separates the chest cavity from the abdominal cavity). The white foreign body inside the stomach and intestines (black arrows) would be fibers from the chew rope. The dog had been swallowing chew ropes for many months based on the owner's report. Chew ropes are commonly sold at Singapore's pet shops. This dog prefers to eat the pieces and they accumulate and fill the stomach. This medical condition is called impaction of the stomach.
Laxatives given showed fibers and hairs inside the stools. The owner told me the dog farted. He did not pass stools for the first 4 days. I/V drips and antibiotics prevent dehydration and death.
Ventral-Dorsal view
The full stomach is not so easily seen by the layman. There is no solid foreign body such as a bone or stone and so interpretation of this view is difficult without the clinical examination and history.
The outline of the stomach is shown by the black arrows. White foreign body of fibers impact the stomach. There is a dark area in the lower half of the stomach. This will be the gas. "Sausage-like" rolls of the intestines can be seen below the stomach. I have not marked the rolls.
The bladder shows a opaque urine which is not normal. Urine tests confirmed a moderate amount of struvite crystals which cause this whiteness of the bladder. On discharge of the dog, the dog peed with difficulty on the grass. This was seen by the owner.
Dietary management to dissolve the struvite crystals is an alternative to surgery. However the owner must know that it may take 2-4 months to see results and there must be strict compliance with veterinary instructions including diet and urine tests and X-rays of the bladder till no struvite crystals are present.
Two blood tests were taken. The second blood test showed liver disorder. In conclusion, the dog recovered after 4 days and went home. Dietary management to dissolve the stones had been discussed with the owner. A follow-up by the owner must be done in the next few days.
Updates at www.toapayohvets.com
222. Misalliance (accidental mating) of dogs
E-MAIL TO DR SING DATED OCT 19, 2010
Hi,
I have 2 chihuahuas, they are both siblings from the same parent (just a batch difference). My female Chihuahua which I recently adopted after being used for breeding by pet shop and pretty much traumatised with low self esteem is on heat recently, and this has gone on for a few days to about a week. Just an hour ago I heard my female Chihuahua yelped and I found that the two of them were in the midst of a sexually engagement, it was impossible to separate the two. Could you please advise me on the next course of action to take as we are not ready for puppies especially when there’s a chance of the puppies being deformed due to the same family line of breeding, which can be very heartbreaking.
When we first adopted the female Chihuahua which was on 28 July 2010 (less than 3 months), her heat was already clearing up. We brought her to a clinic in hope of having her spayed, but the vet advised that we wait a few months to let her build some self confidence first, so we brought her home instead. So we didn’t expect her heat to come in less than 3 months time, and this had to happen when we were caught off guard with our work.
We would really appreciate all advices from you, in the best interest of the two Chihuahuas. Thank you!
Lots of Love,
Name
E-MAIL FROM DR SING DATED OCT 19, 2010
I am Dr Sing from Toa Payoh Vets. I offer the following advices.
1. If you don't want the offspring from the recent mating, please make an appointment with me to get the female dog spayed as soon as possible. If the female dog is healthy, there should be no anaesthetic problems during spay.
2. If you want breeding at a future date, come for an anti-conception injection promptly. This is effective if the injection is given within 3 days after mating. After the injection, you have to separate the male from the female and the heat period will be prolonged.
3. Come for pregnancy diagnosis around 3-4 weeks after mating to check if the dog is pregnant. Spay the dog when she is pregnant. There is a higher risk of spaying a pregnant dog but usually there should be no anaesthetic or bleeding death.
4. Come for an elective Caesarean section at the 60th - 65th day or when there are signs of impending birth. If the puppies are deformed, you have to decide what to do. This requires more than one consultation with the vet if you want to have good results.
5. Neuter the male Chihuahua if you don't future misalliances (accidental mating) and lots of worries.
Let me know if you more queries or phone the Toa Payoh Vets at 6254 3326.
Hi,
I have 2 chihuahuas, they are both siblings from the same parent (just a batch difference). My female Chihuahua which I recently adopted after being used for breeding by pet shop and pretty much traumatised with low self esteem is on heat recently, and this has gone on for a few days to about a week. Just an hour ago I heard my female Chihuahua yelped and I found that the two of them were in the midst of a sexually engagement, it was impossible to separate the two. Could you please advise me on the next course of action to take as we are not ready for puppies especially when there’s a chance of the puppies being deformed due to the same family line of breeding, which can be very heartbreaking.
When we first adopted the female Chihuahua which was on 28 July 2010 (less than 3 months), her heat was already clearing up. We brought her to a clinic in hope of having her spayed, but the vet advised that we wait a few months to let her build some self confidence first, so we brought her home instead. So we didn’t expect her heat to come in less than 3 months time, and this had to happen when we were caught off guard with our work.
We would really appreciate all advices from you, in the best interest of the two Chihuahuas. Thank you!
Lots of Love,
Name
E-MAIL FROM DR SING DATED OCT 19, 2010
I am Dr Sing from Toa Payoh Vets. I offer the following advices.
1. If you don't want the offspring from the recent mating, please make an appointment with me to get the female dog spayed as soon as possible. If the female dog is healthy, there should be no anaesthetic problems during spay.
2. If you want breeding at a future date, come for an anti-conception injection promptly. This is effective if the injection is given within 3 days after mating. After the injection, you have to separate the male from the female and the heat period will be prolonged.
3. Come for pregnancy diagnosis around 3-4 weeks after mating to check if the dog is pregnant. Spay the dog when she is pregnant. There is a higher risk of spaying a pregnant dog but usually there should be no anaesthetic or bleeding death.
4. Come for an elective Caesarean section at the 60th - 65th day or when there are signs of impending birth. If the puppies are deformed, you have to decide what to do. This requires more than one consultation with the vet if you want to have good results.
5. Neuter the male Chihuahua if you don't future misalliances (accidental mating) and lots of worries.
Let me know if you more queries or phone the Toa Payoh Vets at 6254 3326.
Monday, October 18, 2010
Continuing Education and networking at SVA Conference 2010
Continuing education by attending seminars can provide useful knowledge in veterinary medicine and surgery as the speakers share experiences and latest knowledge in their field.
WHAT I LEARNT
1. The Australian vet aged around 69 years old has a large cat practice in Australia. He shared lots of useful experiences about cat surgeries and anaesthesia, pain killers and dosages. I asked him whether he has a book about his lectures.
It is a pity he has no time to record his experiences with dosages and effects of drugs in cats in a book as he has better things to do. His presentation was not boring as he inserted humourous video clips so that the audience does not fall asleep. I took images of his slides for knowledge management. Many of his surgical info can be applied to dogs, rabbits, ferrets. He does not favour domitor. Prefers methadone, fentanyl patches and meloxicam for cat analgesia.
2. An American vet from Guam has set up a top vet hospital in Guam though he was the last to set up. He has a vet who goes around the islands to do sterilisations and treat animals. He treated 7 dolphins.
Most common case is dog bite wounds. The vet bill would be around US$400 as they are serious wounds. Sterilisation is around US$30-35 payable in advance and no refunds. There are 5 practices in Guam which has a population of 170,000 and includes 42 islands nearby. Two vet practices may be closing down. "Are they backwards?" I asked. "Yes," he said. "They don't have gaseous anaesthetic machines."
I think success in vet practice is not a given as there are many factors involved. As at Oct 2010, Singapore's 41st small animal practice will be set up, one Hills' representative told me when he visited me.
The American vet has a sense of humour. Dr James Tan and I had the impression of him as the stereotypical Harley Davidson biker zooming on the highways of Guam in leather jackets and helmets. He looked like one. White haired, pony-tailed, white beard, a big sized belly and a commanding presence. Dr Tan expressed his thoughts of him as a HD biker. "No," he said. "I don't ride bikes since I had falls when I was 17. It is too painful." He is in his 50s. I will like to visit Guam one of these days and see his hospital.
Once he performed a Caesarean on a cow in Guam. "I had not done Caesarean for over 43years. So I phoned my friend in the U.S for help. Then I tied the cow to the tree while I operated. As I cut, the cow moved sideways. Coconuts started to fall from the tree."
"No coconut fell on your head?" I asked.
"No, no," he replied. "My assistants held up two umbrellas while I operated."
Cow caesareans are traditionally done in the field with epidural anaesthesia during my internship in Scotland in the early 1970s. Anaesthesia may have changed. The incision is from the flank. It is non-sterile surgery but the cow usually is OK with antibiotics.
Attending local conferences can be very interesting if the vet bothers to get to know the foreign vets instead of sitting with their friends.
WHAT I LEARNT
1. The Australian vet aged around 69 years old has a large cat practice in Australia. He shared lots of useful experiences about cat surgeries and anaesthesia, pain killers and dosages. I asked him whether he has a book about his lectures.
It is a pity he has no time to record his experiences with dosages and effects of drugs in cats in a book as he has better things to do. His presentation was not boring as he inserted humourous video clips so that the audience does not fall asleep. I took images of his slides for knowledge management. Many of his surgical info can be applied to dogs, rabbits, ferrets. He does not favour domitor. Prefers methadone, fentanyl patches and meloxicam for cat analgesia.
2. An American vet from Guam has set up a top vet hospital in Guam though he was the last to set up. He has a vet who goes around the islands to do sterilisations and treat animals. He treated 7 dolphins.
Most common case is dog bite wounds. The vet bill would be around US$400 as they are serious wounds. Sterilisation is around US$30-35 payable in advance and no refunds. There are 5 practices in Guam which has a population of 170,000 and includes 42 islands nearby. Two vet practices may be closing down. "Are they backwards?" I asked. "Yes," he said. "They don't have gaseous anaesthetic machines."
I think success in vet practice is not a given as there are many factors involved. As at Oct 2010, Singapore's 41st small animal practice will be set up, one Hills' representative told me when he visited me.
The American vet has a sense of humour. Dr James Tan and I had the impression of him as the stereotypical Harley Davidson biker zooming on the highways of Guam in leather jackets and helmets. He looked like one. White haired, pony-tailed, white beard, a big sized belly and a commanding presence. Dr Tan expressed his thoughts of him as a HD biker. "No," he said. "I don't ride bikes since I had falls when I was 17. It is too painful." He is in his 50s. I will like to visit Guam one of these days and see his hospital.
Once he performed a Caesarean on a cow in Guam. "I had not done Caesarean for over 43years. So I phoned my friend in the U.S for help. Then I tied the cow to the tree while I operated. As I cut, the cow moved sideways. Coconuts started to fall from the tree."
"No coconut fell on your head?" I asked.
"No, no," he replied. "My assistants held up two umbrellas while I operated."
Cow caesareans are traditionally done in the field with epidural anaesthesia during my internship in Scotland in the early 1970s. Anaesthesia may have changed. The incision is from the flank. It is non-sterile surgery but the cow usually is OK with antibiotics.
Attending local conferences can be very interesting if the vet bothers to get to know the foreign vets instead of sitting with their friends.
Friday, October 15, 2010
Starting up a company at the age of 50 years
An old friend (Allan) wanted to be free from office politics and to start his own company at the age of 50 years.
He asked me for advice on his proposed event management company start-up with two trustworthy partners (Brian and Charlie). All 3 will have equal shares in a private Limited Company. Since he would be the one bringing in most of the business via his old clientele while the other two provides administrative and backup services, all 3 agreed to the respective following distribution of profits at 40:35:25 with Allan getting 40%. There will be no salary for the first 3-6 months. After 3 months, all 3-6 months, all 3 will get a salary based on 40:35:25 formula every month.
MY QUERIES
1. How much are Brian and Charlie earning now? Brian is unemployed, having left his food and beverage (F&B) hotel job in Vietnam. Charlie is earning around $5,000 a month as an employee in the F&B business.
2. What amount of revenue can Brian and Charlie generate? Practically none. They just provide the support services as they do not have business development experience or important decision-making clientele to generate business.
3. Is Charlie an IT expert? He has some information technology (IT) knowledge but is not an IT experienced. Therefore he has no valuable contribution and in any case, an event-management business does not depend mainly on IT skills and expertise.
MY OPINION
1. Brian and Charlie have 66.6% of the shares. In any company resolution, they can out-vote or frustrate Allan's plans for the business expansion or changes. Allan will be unhappiness when they do that since they don't generate income and are more like "sleeping partners".
2. Since Brian and Charlie will not be generating income, they are not worth being given 35% and 25% of the net profits.
3. What happens if Brian and Charlie find better job prospects since they don't get salaries for the first 3-6 months? Or they take long leave, die or become sick? They still get their 60% every month as agreed, assuming the company is profitable.
4. In the end, Allan will feel very unhappy as he brings in practically 100% of the revenue and gets 40% of the net profits. If he is that good, he should be getting the lion's share of the profits.
Getting in the business and sustaining the profitability of any business is extremely hard work while administrative services can be outsourced. If the business really generates $6 million in revenue as projected by Allan, there is no problem employing good people to do administrative work. Of course, Allan must be involved in ensuring that the accounts are properly kept.
CONCLUSION
Allan should be getting the controlling share of at least 51%. There are the operating costs to think about.
I know Allan has the clientele and can generate the $6 million revenue he projected since he is battle-tested for the past 30 years. He is now around 50 years old. He had started up two small businesses before and knew success in earning big money is not guaranteed. That was why he worked for others as there is a steady income every month.
With a large clientele who trust him, he ought to have the confidence to start up small. He needs to change his mindset that there must be a big office, top IT facilities and supporting staff as in established event management companies to be able to succeed as an entrepreneur.
He had seen too many people failing in businesses and that was why he worked for hotels and resorts for the past 30 years as an employee. There will always be office politics in corporations from employees and if he really can bring in a $6-million event management business, I don't see why he cannot be successful on his own now that he has been "battle-tested".
A better business model will be to give Brian and Charlie a commission based on each project they successfully completed. If they can't do the project, there are many others who can be out-sourced to do it. Otherwise, they still get paid a combined 60% of the net profit every month. This is a large amount if the revenue generated is $6 million a year. Assuming conservatively 5% as net profits, the income will be $300,000. Allan will get $120,000 but his non-income generating administrative partners making the connections get $180,000! He will not be happy to continue the business relationship and there will be nasty feelings when the business breaks up.
The $180,000 can be used to employ good energetic people who have been battle-tested in the getting more business deals. In business, it is how much profits you can generate for the company, not how good your administration is. Without income, top companies close down even though they are well administered. An ability to bring home the bacon is what counts in business start ups, whether one is a private veterinarian opening his veterinary clinic or an event manager.
P.S. "Bring home the bacon". Singaporeans generally don't eat bacon and eats for breakfast unlike the English and so may not appreciate the title of the story. I studied in Glasgow in the late 1960s and my favourite breakfast in the hall of residence was bacon and eggs. "Bring home the bacon" means to "achieve desired results or have success" in this story.
He asked me for advice on his proposed event management company start-up with two trustworthy partners (Brian and Charlie). All 3 will have equal shares in a private Limited Company. Since he would be the one bringing in most of the business via his old clientele while the other two provides administrative and backup services, all 3 agreed to the respective following distribution of profits at 40:35:25 with Allan getting 40%. There will be no salary for the first 3-6 months. After 3 months, all 3-6 months, all 3 will get a salary based on 40:35:25 formula every month.
MY QUERIES
1. How much are Brian and Charlie earning now? Brian is unemployed, having left his food and beverage (F&B) hotel job in Vietnam. Charlie is earning around $5,000 a month as an employee in the F&B business.
2. What amount of revenue can Brian and Charlie generate? Practically none. They just provide the support services as they do not have business development experience or important decision-making clientele to generate business.
3. Is Charlie an IT expert? He has some information technology (IT) knowledge but is not an IT experienced. Therefore he has no valuable contribution and in any case, an event-management business does not depend mainly on IT skills and expertise.
MY OPINION
1. Brian and Charlie have 66.6% of the shares. In any company resolution, they can out-vote or frustrate Allan's plans for the business expansion or changes. Allan will be unhappiness when they do that since they don't generate income and are more like "sleeping partners".
2. Since Brian and Charlie will not be generating income, they are not worth being given 35% and 25% of the net profits.
3. What happens if Brian and Charlie find better job prospects since they don't get salaries for the first 3-6 months? Or they take long leave, die or become sick? They still get their 60% every month as agreed, assuming the company is profitable.
4. In the end, Allan will feel very unhappy as he brings in practically 100% of the revenue and gets 40% of the net profits. If he is that good, he should be getting the lion's share of the profits.
Getting in the business and sustaining the profitability of any business is extremely hard work while administrative services can be outsourced. If the business really generates $6 million in revenue as projected by Allan, there is no problem employing good people to do administrative work. Of course, Allan must be involved in ensuring that the accounts are properly kept.
CONCLUSION
Allan should be getting the controlling share of at least 51%. There are the operating costs to think about.
I know Allan has the clientele and can generate the $6 million revenue he projected since he is battle-tested for the past 30 years. He is now around 50 years old. He had started up two small businesses before and knew success in earning big money is not guaranteed. That was why he worked for others as there is a steady income every month.
With a large clientele who trust him, he ought to have the confidence to start up small. He needs to change his mindset that there must be a big office, top IT facilities and supporting staff as in established event management companies to be able to succeed as an entrepreneur.
He had seen too many people failing in businesses and that was why he worked for hotels and resorts for the past 30 years as an employee. There will always be office politics in corporations from employees and if he really can bring in a $6-million event management business, I don't see why he cannot be successful on his own now that he has been "battle-tested".
A better business model will be to give Brian and Charlie a commission based on each project they successfully completed. If they can't do the project, there are many others who can be out-sourced to do it. Otherwise, they still get paid a combined 60% of the net profit every month. This is a large amount if the revenue generated is $6 million a year. Assuming conservatively 5% as net profits, the income will be $300,000. Allan will get $120,000 but his non-income generating administrative partners making the connections get $180,000! He will not be happy to continue the business relationship and there will be nasty feelings when the business breaks up.
The $180,000 can be used to employ good energetic people who have been battle-tested in the getting more business deals. In business, it is how much profits you can generate for the company, not how good your administration is. Without income, top companies close down even though they are well administered. An ability to bring home the bacon is what counts in business start ups, whether one is a private veterinarian opening his veterinary clinic or an event manager.
P.S. "Bring home the bacon". Singaporeans generally don't eat bacon and eats for breakfast unlike the English and so may not appreciate the title of the story. I studied in Glasgow in the late 1960s and my favourite breakfast in the hall of residence was bacon and eggs. "Bring home the bacon" means to "achieve desired results or have success" in this story.
Monday, October 11, 2010
219. Malignant cheek tumour & accountability of a vet
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
The miniature schnauzer had a malignant cheek tumour which was removed twice. See:
Malignant cheek tumour in an old Miniature Schnauzer
The tumour grows back a second time two months later. It was excised. It recurs for the 3rd time. The dog could not eat normally and had a painful mouth. The young lady owner wanted another operation without the dog dying on the operating table.
"It is highly risky to do anaesthesia on an old dog," I warned her of the possibility of death again. "This old dog had survived two general anaesthesias. His cheek tumour is malignant as it keeps doubling in size every week. Why don't you consider chemotherapy?"
The young lady did not want chemotherapy for her beloved companion as it had side effects and was not guaranteed to work. I told her that I needed to remove the cheek tumour from outside by blunt dissection from the skin.
"Your dog may be paralysed," I said. "There will be a lot of bleeding."
The lady said: "Why don't you operate from inside the cheek to remove the cheek tumour as you had done before?"
"I need to cut away as much of the cancer cells as possible. There may be a root of the tumour and I need to access the root from the skin to dissect away the tumours. If all cancerous cells can be removed from the skin approach, it will be good for your dog. Provided he survives the operation which will take a long time compared to the previous two excisions"
The lady was worried about deaths on the operating table. Every time an old dog is put under general anaesthesia, the chances of dying are increased. Every time a vet operates on such high-risk dogs, he or she is bound to suffer fatalities and damage to his reputation.
The dog was given antibiotics and painkillers for the next 2 weeks. The lady did not turn up on the appointed day and so I thought she decided to opt out of the surgery. Then she turned up. She was a busy working girl.
PRE-SURGERY
Antibiotic and anti-inflammatory pred injection on day 1 and antibiotics after Day 1. On Day 2, tolfedine pain-killer oral. No pain in the cheeks on Day 3. Surgery on Day 4 after admission. An IV drip is very important in case emergency drugs are needed.
ANAESTHESIA
Domitor 0.2 ml IV from the IV saline drip line. The dog had a cyanotic tongue. It was not a good sign of health. I had a premonition that he would die on the operating table.
TEAM
Teamwork is essential in this high-risk anaesthestic case. I had two experienced assistants who are old experienced Myanmar vets with over 20 years of experience combined and Dr Vanessa Lim to assist.
SURGERY TIPS
1. "I don't need the scalpel blade," I said to my assistants. "An electro-surgery electrode needle incises the skin."
2. "Dissection with scissors is not advised," I explained to my assistants. "I will use the electrode to separate this hard mass of tumour from under the skin. The tumour has a capsule."
3. Bleeding. Electro-surgery reduces bleeding considerably. There was a small bursting artery which was clamped. I could not find the big vein or artery supplying blood to the tumour nodules. There were 3 nodules inside the cheek muscles.
4. "Where to incise?" I asked my assistants as part of my mentoring process. "A horizontal cut or vertical curved cut or both?" They had to think.
EMERGENCY RESUSCITATION
The surgery took more than 30 minutes. The shorter the better survival rate for an old dog. "The dog has died," my second assistant pointed to the dilated pupil which now showed a whitish cataract. A matted white. The isoflurane gas was given at a minimum. Too little, the dog's cheek muscles would twitch and so I had asked for an increase. There was no twitching and surgical dissection proceeded smoothly. Too smoothly.
Now the dog had stopped breathing. He had not died as my first assistant in charge of anaesthesia had much experience and had observed regular breathing. A dilated pupil is common in the deepest surgical anaesthetic stage.
A big dilated pupil could also mean imminent death or death. Whatever it was, I stopped the anaesthesia, blew air into the trachea tube and started cardiac massage immediately. Three cardiac massages and blow three times. My second assistant flushed out the isoflurane gas by pressing the red button and gave me the tube to connect oxygen to the dog. "It is better to blow air in and massage the heart," I advised. The dog was not breathing normally. A stethoscope to check the heart beating showed no sounds. My lst assistant injected Doxapram respiratory stimulant 1.0 ml into the IV line. I continued cardiac massage and air blowing into the tracheal tube. My 2nd assistant injected 0.2 ml Antisedan which is the antidote for Domitor.
It took more than 5 minutes but it seemed like eternity. "There was no hope," I thought as I could not hear the breathing sounds when I put my ears to the endotracheal tube after several cardiac massages. At one time, my first assistant would compress the heart from the top while I put my hand on the lower part of the dog's chest. It was touch and go. The dog started breathing.
My second assistant offered me the anaesthetic tube to connect to the endotracheal tube as the surgery was only 95% complete. There was the stitching to be done.
"God may not give 2nd chances," I pointed above my head and declined the anaesthetic connection to the gas machine. The Antisedan had reversed the Domitor sedation and the dog's head started to move. There was little time to stitch up. Subcutaneous stitching in certain areas could be done. Horizontal mattress stitches quickly closed up the skin incision. The dog put up his head in around 3 minutes as if he had a long nap. He did not cry or whine. Dr Vanessa Lin gave me the meloxicalm pain-killers. "It is best not to inject any drug to this old dog as he might just die after the pain-killer injection," I thanked her.
fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore
antibiotics for 10-14 days before surgery as tumour is badly infected 3 hard nodules in the cheek muscles. Domitor 0.2 ml IV given malignant tumours as they double in size every week
fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore
the owner did not turn up for appointment till 2 days later. Tumour is infected electro-incision close to the skin. Thoroughly remove remnants of cancer cells 3 cheek tumours excised leaving a big hole in the cheek but there is the skin to close up the wound
fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore tpvets_logo.jpg (2726 bytes)3827 - 3834. Malignant cheek tumours excised via the skin approach.
a third nodule is not shown here. Histopathology is being done <1 hour after completion of surgery. Dog is ok
A dog alive is what the owner wanted. Nothing more. No excuses. The dog ate 2 days after surgery and should be going home soon. In high-risk anaesthetic cases, it is best to have a team of experienced assistants. The brain dies when it is deprived of oxygen and in this case, a team definitely helped to revive this old beloved companion for the young lady.
The anaesthetist is more important than the surgeon as anaesthesia deaths are fatal. An experienced team is advised in high anaesthetic cases. Intubation and IV drip line are essential in such surgeries. If the surgery can be completed in less than 154 minutes, old dogs seldom die but in this case, the 3 tumours were large and time had to be spent on bluntly dissecting them to prevent excessive bleeding. Surgery took more than 30 minutes to complete. It was through teamwork that the old dog did not die on the operating table.
Pictures and details are at www.toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
The miniature schnauzer had a malignant cheek tumour which was removed twice. See:
Malignant cheek tumour in an old Miniature Schnauzer
The tumour grows back a second time two months later. It was excised. It recurs for the 3rd time. The dog could not eat normally and had a painful mouth. The young lady owner wanted another operation without the dog dying on the operating table.
"It is highly risky to do anaesthesia on an old dog," I warned her of the possibility of death again. "This old dog had survived two general anaesthesias. His cheek tumour is malignant as it keeps doubling in size every week. Why don't you consider chemotherapy?"
The young lady did not want chemotherapy for her beloved companion as it had side effects and was not guaranteed to work. I told her that I needed to remove the cheek tumour from outside by blunt dissection from the skin.
"Your dog may be paralysed," I said. "There will be a lot of bleeding."
The lady said: "Why don't you operate from inside the cheek to remove the cheek tumour as you had done before?"
"I need to cut away as much of the cancer cells as possible. There may be a root of the tumour and I need to access the root from the skin to dissect away the tumours. If all cancerous cells can be removed from the skin approach, it will be good for your dog. Provided he survives the operation which will take a long time compared to the previous two excisions"
The lady was worried about deaths on the operating table. Every time an old dog is put under general anaesthesia, the chances of dying are increased. Every time a vet operates on such high-risk dogs, he or she is bound to suffer fatalities and damage to his reputation.
The dog was given antibiotics and painkillers for the next 2 weeks. The lady did not turn up on the appointed day and so I thought she decided to opt out of the surgery. Then she turned up. She was a busy working girl.
PRE-SURGERY
Antibiotic and anti-inflammatory pred injection on day 1 and antibiotics after Day 1. On Day 2, tolfedine pain-killer oral. No pain in the cheeks on Day 3. Surgery on Day 4 after admission. An IV drip is very important in case emergency drugs are needed.
ANAESTHESIA
Domitor 0.2 ml IV from the IV saline drip line. The dog had a cyanotic tongue. It was not a good sign of health. I had a premonition that he would die on the operating table.
TEAM
Teamwork is essential in this high-risk anaesthestic case. I had two experienced assistants who are old experienced Myanmar vets with over 20 years of experience combined and Dr Vanessa Lim to assist.
SURGERY TIPS
1. "I don't need the scalpel blade," I said to my assistants. "An electro-surgery electrode needle incises the skin."
2. "Dissection with scissors is not advised," I explained to my assistants. "I will use the electrode to separate this hard mass of tumour from under the skin. The tumour has a capsule."
3. Bleeding. Electro-surgery reduces bleeding considerably. There was a small bursting artery which was clamped. I could not find the big vein or artery supplying blood to the tumour nodules. There were 3 nodules inside the cheek muscles.
4. "Where to incise?" I asked my assistants as part of my mentoring process. "A horizontal cut or vertical curved cut or both?" They had to think.
EMERGENCY RESUSCITATION
The surgery took more than 30 minutes. The shorter the better survival rate for an old dog. "The dog has died," my second assistant pointed to the dilated pupil which now showed a whitish cataract. A matted white. The isoflurane gas was given at a minimum. Too little, the dog's cheek muscles would twitch and so I had asked for an increase. There was no twitching and surgical dissection proceeded smoothly. Too smoothly.
Now the dog had stopped breathing. He had not died as my first assistant in charge of anaesthesia had much experience and had observed regular breathing. A dilated pupil is common in the deepest surgical anaesthetic stage.
A big dilated pupil could also mean imminent death or death. Whatever it was, I stopped the anaesthesia, blew air into the trachea tube and started cardiac massage immediately. Three cardiac massages and blow three times. My second assistant flushed out the isoflurane gas by pressing the red button and gave me the tube to connect oxygen to the dog. "It is better to blow air in and massage the heart," I advised. The dog was not breathing normally. A stethoscope to check the heart beating showed no sounds. My lst assistant injected Doxapram respiratory stimulant 1.0 ml into the IV line. I continued cardiac massage and air blowing into the tracheal tube. My 2nd assistant injected 0.2 ml Antisedan which is the antidote for Domitor.
It took more than 5 minutes but it seemed like eternity. "There was no hope," I thought as I could not hear the breathing sounds when I put my ears to the endotracheal tube after several cardiac massages. At one time, my first assistant would compress the heart from the top while I put my hand on the lower part of the dog's chest. It was touch and go. The dog started breathing.
My second assistant offered me the anaesthetic tube to connect to the endotracheal tube as the surgery was only 95% complete. There was the stitching to be done.
"God may not give 2nd chances," I pointed above my head and declined the anaesthetic connection to the gas machine. The Antisedan had reversed the Domitor sedation and the dog's head started to move. There was little time to stitch up. Subcutaneous stitching in certain areas could be done. Horizontal mattress stitches quickly closed up the skin incision. The dog put up his head in around 3 minutes as if he had a long nap. He did not cry or whine. Dr Vanessa Lin gave me the meloxicalm pain-killers. "It is best not to inject any drug to this old dog as he might just die after the pain-killer injection," I thanked her.
fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore
antibiotics for 10-14 days before surgery as tumour is badly infected 3 hard nodules in the cheek muscles. Domitor 0.2 ml IV given malignant tumours as they double in size every week
fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore
the owner did not turn up for appointment till 2 days later. Tumour is infected electro-incision close to the skin. Thoroughly remove remnants of cancer cells 3 cheek tumours excised leaving a big hole in the cheek but there is the skin to close up the wound
fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore tpvets_logo.jpg (2726 bytes)3827 - 3834. Malignant cheek tumours excised via the skin approach.
a third nodule is not shown here. Histopathology is being done <1 hour after completion of surgery. Dog is ok
A dog alive is what the owner wanted. Nothing more. No excuses. The dog ate 2 days after surgery and should be going home soon. In high-risk anaesthetic cases, it is best to have a team of experienced assistants. The brain dies when it is deprived of oxygen and in this case, a team definitely helped to revive this old beloved companion for the young lady.
The anaesthetist is more important than the surgeon as anaesthesia deaths are fatal. An experienced team is advised in high anaesthetic cases. Intubation and IV drip line are essential in such surgeries. If the surgery can be completed in less than 154 minutes, old dogs seldom die but in this case, the 3 tumours were large and time had to be spent on bluntly dissecting them to prevent excessive bleeding. Surgery took more than 30 minutes to complete. It was through teamwork that the old dog did not die on the operating table.
Pictures and details are at www.toapayohvets.com
Friday, October 8, 2010
Sense of humour with two generation gaps
Perth
Sunday, Oct 3, 2010
How do I connect with a group of undergraduates who are at least 26 years older than me? I would say that this group of 3 vet students would be from 22 to 24 years of age and I am 3 times older and how should I carry on an easy conversation with them?
A common interest in veterinary medicine mixed with a sense of humour is the key to interactions during a meal. But it is not easy to make the young adults feel that there is a two-generation gap between them and me making their acceptance to a farewell lunch a boring event with an old foggie.
It was a sunny Sunday afternoon and this Northbridge Chinese Restaurant in Perth was packed. We were given a smaller room away from the noise of the main eating area. The others at the two tables in this room were quietly eating.
It happened that one of the 3 vet students was not aware of my concept of a veterinary talk show that I deemed great for one of the vet students (not present at this lunch and whom I will name as Boo for the purpose of this story) I had shared with the other two yesterday. So I told him.
"You know," I said to this serious young man whom I shall call Ashton. "The name of the veterinary clinic should be 'Boo Clinic.' Dr Boo would host the veterinary talk show in Singapore. There would be an audience of pet owners at the show. One of them would ask her pet care questions related to a theme, for example skin diseases. She would examine the pet and give her advices.
After that, the audience will clap their hands in appreciation. Dr Boo will stand on a stage and sing a love song of unrequited love. That will make the young girls in the audience weep. A group of dancers will appear and swing with her as she sings. Another singer appears and there is more dancing. The audience claps their hands on cue in loud applause!"
The young man's eyes opened and shook his head as if he was saying: "What sort of whacky concept is to propose to Boo?"
I continued: "The veterinary clinic should be named "Peek-A-Boo" as it is such a good name to remember. The classmates will work in the background as more pet owners come to patronise this clinic. No need to worry about no business or falling turnover as Dr Boo brings in the fame and fortune.
The veterinary talk show should be called 'Peek-A-Boo' as I connect the surname with this English phrase I learnt in primary school. All dancers should wear a mask to peek at each other as they turn to face each other during dancing....
The young man's two classmates laughed loudly. Except for this serious young man. "I don't want to be associated with your mad scheme!" he exclaimed.
We had so much laughter. Laughter is the best medicine. Fortunately for me, Boo was not present at this lunch as I don't know whether she would appreciate the sense of humour at the use of her name. We ended the lunch on a happy note for my guests and I hope for this serious young man.
Sunday, Oct 3, 2010
How do I connect with a group of undergraduates who are at least 26 years older than me? I would say that this group of 3 vet students would be from 22 to 24 years of age and I am 3 times older and how should I carry on an easy conversation with them?
A common interest in veterinary medicine mixed with a sense of humour is the key to interactions during a meal. But it is not easy to make the young adults feel that there is a two-generation gap between them and me making their acceptance to a farewell lunch a boring event with an old foggie.
It was a sunny Sunday afternoon and this Northbridge Chinese Restaurant in Perth was packed. We were given a smaller room away from the noise of the main eating area. The others at the two tables in this room were quietly eating.
It happened that one of the 3 vet students was not aware of my concept of a veterinary talk show that I deemed great for one of the vet students (not present at this lunch and whom I will name as Boo for the purpose of this story) I had shared with the other two yesterday. So I told him.
"You know," I said to this serious young man whom I shall call Ashton. "The name of the veterinary clinic should be 'Boo Clinic.' Dr Boo would host the veterinary talk show in Singapore. There would be an audience of pet owners at the show. One of them would ask her pet care questions related to a theme, for example skin diseases. She would examine the pet and give her advices.
After that, the audience will clap their hands in appreciation. Dr Boo will stand on a stage and sing a love song of unrequited love. That will make the young girls in the audience weep. A group of dancers will appear and swing with her as she sings. Another singer appears and there is more dancing. The audience claps their hands on cue in loud applause!"
The young man's eyes opened and shook his head as if he was saying: "What sort of whacky concept is to propose to Boo?"
I continued: "The veterinary clinic should be named "Peek-A-Boo" as it is such a good name to remember. The classmates will work in the background as more pet owners come to patronise this clinic. No need to worry about no business or falling turnover as Dr Boo brings in the fame and fortune.
The veterinary talk show should be called 'Peek-A-Boo' as I connect the surname with this English phrase I learnt in primary school. All dancers should wear a mask to peek at each other as they turn to face each other during dancing....
The young man's two classmates laughed loudly. Except for this serious young man. "I don't want to be associated with your mad scheme!" he exclaimed.
We had so much laughter. Laughter is the best medicine. Fortunately for me, Boo was not present at this lunch as I don't know whether she would appreciate the sense of humour at the use of her name. We ended the lunch on a happy note for my guests and I hope for this serious young man.
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