Wednesday, October 19, 2011

696. Email query about toilet training

I am Dr Sing from Toa Payoh Vets. Thank you for your email.
Basically, you need to confine him for the first 2-4 weeks and let out only after he has pooped. If not, you can't be successful. An example of my advice to a puppy owner is at:

http://www.sinpets.com/F5/20111023puppy-toilet-training-paper-or-grate-not-both-singapore-toapayohvets.htm

Best wishes.

On Tue, Oct 18, 2011 at 4:53 PM, ...@hotmail.com> wrote:

Hi,
I adopted a 2yrs plus Maltese in Jun this yr,been trying to toilet train him for the past 3months.I've tried scolding him,beating him,dripping house-breaking aid on the newspaper but nothin seem to work.It's real frustrating when I see his poos & pees in the whole house after I got Home from work.Feel like caging him up when I go to work but feel bad about caging him up.I moped the floor with dettol but he will still pee at the same spot again.Can you kindly teach me how to toilet train him properly?Thks.

Name

Sent from my iPhone




E-MAIL REPLY FROM DR SING DATED OCT 19, 2011

I am Dr Sing from Toa Payoh Vets. Thank you for your email.
Basically, you need to confine him for the first 2-4 weeks and let out only after he has pooped. If not, you can't be successful. An example of my advice to a puppy owner is at:

http://www.sinpets.com/F5/20111023puppy-toilet-training-paper-or-grate-not-both-singapore-toapayohvets.htm

Best wishes.

Tuesday, October 18, 2011

695. Unacceptable veterinary advices



Sometimes it may be wise to pass up a case rather than to offer unacceptable veterinary advices as they do stress out the hamster owner and force her family members or mother to seek another opinion.

If you add value to the hamster owner by offering alternative advices other than unacceptable advices, you may retain the goodwill and that is good for you.










Case report at:
Toa Payoh Vets webpage
http://www.sinpets.com/F6/20111009unacceptable-veterinary-advices-hamster-tumouors-singapore_ToaPayohVets.htm

694. Two educational videos produced by two Temasek Poly Vet Tech students

We had fun producing these two video to educate pet owners and vet students. I hope you like it. The vet with the red nails is not Dr Vanessa. I seldom see lady vets in small animal practice with painted nails but times have had changed and I may be incorrect!



FIV in a stray cat
http://www.youtube.com/watch?v=ntHweZD49ec






Cystitis in a male dog
http://www.youtube.com/watch?v=HvV-00dDRg4

693. Anaesthesizing a roborovski hamster

Laughter is not the best medicine in the Roborovski hamster anaesthesia
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
18 October, 2011
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
The young woman said to me when I answered the phone: "I have decided to have the lump taken out by Dr Julia. Last week, he had been given antibiotics but the lump is still present."

"When can you bring the Roborovski hamster to the Surgery?" I asked.
"After work. It will be after 8 pm."
I was still working at this time and so I decided to operate together with Dr Julia and my assistant Min.

The instruments were prepared. "Put the hamster into the container and count 1 to 5," I said to Min as he inserted the endotracheal tube into the container. Min is not used to count loudly as this counting aloud is not part of his culture. "Start counting," I have had told Min that he has to do as instructed as this is part of the procedure for anaesthesia of dwarf hamsters. Otherwise, he may as well be his own boss.

"Accept instructions from your boss when you are an employee rather than do your own thing. When you become the boss of your practice, you expect your employees to follow your instructions. Otherwise, how can you trust your employee when you are not around? "

It takes time and patience to change the mindset of the average younger employee as they have their own ideas of doing things "better". This is the culture of the young ones and I accept this is the new world.

Now Min said aloud solemnly in his gruffly voice: "One... two...three..."
Dr Julia burst out laughing and so he stopped.
I said: "5 seconds of the 5% isoflurane anaesthesia is enough. Take the hamster out of the container to operate. If the hamster moves, repeat for another 5 seconds. The Roborovski is a very small hamster compared to the average dwarf hamster and so you have to be very careful. It is very hard to see whether he is sleepy or not as he is an active speedy fellow."

There was no problem. Dr Teo extracted one big fatty tumour. I said: "Stitch up with the 6/0 absorbable suture now!" It was a big tumour of 0.5mm x 0.5mm x 0.3mm. The surgery must be quickly completed as repeated gas anaesthesia will kill this hamster.

But it was not complete. Min said in his muffled voice: "There is one more lump,"
I was surprised as the fatty tumour had a twin. This was taken out and the skin quickly stitched with four interrupted sutures. The hamster woke up and walked like a drunk. I quickly had him put into the cage, just in case he rocketed off the operating table and fell on the floor. Roborovski hamsters don't walk. They sprint. This was a two-year old, much beloved by the young couple. Still, the vet must be alert as old does not mean less speedy as in an old man compared to a young one.

Anaesthesia in Roborovski hamsters needs to be very careful. The easy part is the surgery if the tumour can be shelled out as in this case. The couple came back at 9 pm and took the hamster home. This was a happy ending. Laughter is the best medicine but in hamster anaesthesia, I discourage any jokes or chatter as there is a great need to focus on anaesthesia.















4638 - 4643. Anaesthesia of the Roborovski hamster at Toa Payoh Vets
Every hamster that survives the surgery builds up the reputation of
Toa Payoh Vets as the place to go for hamster surgeries. Unlike the Singapore hospitals where you have a specialist anaesthetist and a specialist surgeon, the vet is both and many deaths on the operating table are due to a lack of focus by the assistant. So idle chatter and jokes are out if the vet and his assistant is doing anaesthesia and surgery and serious about getting excellent surgical outcomes.

No point having a perfect surgery done when the patient has had died on the operating table. The only outcome the hamster or any pet owner wants is a pet alive and going home, not a dead one. So I have been very careful about anaesthesia in my 30 years of practice.







Webpage at:
http://www.sinpets.com/F6/20111029roborovski-hamster-anaesthetic-success-singapore-toapayohvets.htm

Monday, October 17, 2011

692. Sunday Oct 16, 2011's interesting cases

Last Sunday, Oct 9, 2011, I took the day off. Yesterday, I was present.

Case 1.
A young man came with a newly purchased English Cocker Spaniel that had passed blood in the loose stools since yesterday. The puppy had loose stools since purchase 9 days ago from a pet shop in Pasir Ris. No stools sample was available. I palpated the puppy's stomach. There was some discomfort. Other signs were normal.

This was a case study for Kim who wanted to study vet medicine and I asked her to write up the process and procedures in the diagnosis and treatment of this case. "Some vets will just give a jab for gastroenteritis and send the puppy home with medicine," I said to Kim. "However, a newly purchased puppy from a breeder or pet shop needs more thorough investigation as parvoviral infection of the gut is the first of the differential diagnosis. Parvoviruses are very common in breeding farms and pet shops.

"The puppy looks all right today but if the vet fails to check for parvovirus, he or she is actually professionally incompetent if the puppy dies a few days later of bloody diarrhoea and vomiting."

Parvovirus check -ve. Blood test taken for haematology. The puppy was warded. Will report further.

Case 2
"I don't want my 5-year-old Miniature Schnauzer to be under anaesthesia for dental scaling," the mother of a young adult daughter repeated her concern when I told her that her dog would need dental scaling. I had written on the case sheet since she came for vaccination booster last year.

"It is a vet's duty to advise," I said. "It is the owner's choice not to do it. If the vet does not advise dental check up during vaccination and the dog develops oral tumours or bad teeth or ulcers later, the owner will say that the vet has not advised me, just give vaccination only."

"In any case," the mother said, "the groomer had charged me and did the dental scaling."

"I don't see how the groomer can do it," I said as the Schnauzer moved his head here and there to prevent me and the owner from opening his mouth. "I have heard of groomers grabbing the dog and pinning it down to do dental scaling. There is one pet shop providing this service for around $120. I hear that the grooming assistant who left this pet shop was very unhappy about forcing the dog down to do the dental scaling."

"I will do it next time," the mother must be thinking I am desperate and soliciting for business.

"How much did your groomer charge?" I asked as this groomer was from a well-known chain of pet shops that has branches all over Singapore.

"$70.00" the mother said.
"$70.00 for dental work or for grooming + dental work?" I asked.
"Grooming included. I can see that the front teeth are whiter now."
"In this case, the dental work is $20 as grooming of the Schnauzer will be $50.00. It certainly is much cheaper than a vet's job."

"And no anaesthesia death. Or the dog becoming groogy after anaesthesia and can't walk properly as that is what the groomer told me!" the mother said.

"Anaesthesia is very safe in most dogs nowadays. But the vet must know what to do to ensure safe anaesthesia," I said.

It so happened that there was a Shih Tzu with his tongue protruding. That Shih Tzu had domitor 0.1 ml IV and isoflurane gas given for stitching up of the cut in the interdigit of one front paw. This was done by Vet 1 and the dog was now outside as the owner dialed for a taxi.

So the mother saw a "groogy" dog as she asked the owner what happened.
I said to my assistant, "Get me the Antisedan and bring the Shih Tzu back to the Surgery Room. I got 0.2 ml of Antisedan, added 0.2 ml of normal saline and asked Vet 1 to give it to the dog IV. The dog was alert and awake.

"As you can see," I told the mother. "There is the antidote a vet may use to wake up the dog after anaesthesia. It is up to the vet's judgment as to whether he or she wants to use it. As for me, I usually do it but not all the time as that depends on each case."

I got the Schnauzer's mother opened up finally. Thick tartar in all back teeth and some gum inflammation. The mother saw it. This is just an education for the dog owner, not a desperate hard sell to get her business. Each owner has to decide as to anaesthetic risks of dental scaling. The groomer now goes into dental scaling to take advantage of such fears and well, this is the real world.

As for the Shih Tzu, the owner wanted the interdigital wound stitched up. But Vet 1 decided to give injection, medication and wash. I intervened and told Vet 1: "The interdigital wound is not easy to heal when opened up. The dog will lick it and if a granuloma forms, the owner will be most happy. He will curse and go to another vet who will stitch up the wound belatedly. You did not advise the owner that surgery is an option. Actually the owner wanted surgery."

This Shih Tzu case showed that every vet or doctor has his or her own ideas in handling a case and no two vets will do the same thing. "Some vets advise surgery, some advise no surgery and some have no advices," I said to the Shih Tzu and Schnauzer owner. "This is the judgment of each vet."

Well, the Shih Tzu owner, being well read, wanted surgery. The Schnauzer owner agreed with him. So, you can see that a vet in private practice must give all the treatment options. Not just his or her own recommendation of conservative treatment which will be much less costly. But will it be effective in a interdigital wound recovering early and not degenerate into a interdigital granuloma or worse?

691. Switching from a government vet to a small animal vet

On Thu, Oct 6, 2011 ...@yahoo.com> wrote:

Dear Dr Sing,

I chanced upon your blog when I was looking up some vet related blogs. I read that you completed your bond with the PPD, then started up toapayoh vet clinic. Was it difficult to transition from a government vet to a small animal vet? How do you keep the knowledge learnt for small animals fresh in your mind as being a PPD government vet requires a completely different set of skills? Would be great if you could provide me with some advice on this issue. I've been pondering on career pathways recently and I need guidance.

Regards,
Name




E-MAIL REPLY FROM DR SING

Thank you for your email. In reply to your questions:

1. It is not difficult to change to small animal practice from regulatory practice for me as I had a mentor (an experienced senior vet) whom I spent time in the evenings (closing my practice) learning from him, assisting him, working as locum and doing house-calls.

2. Lots of reading on small animal vet journals. In 1982, when I started Toa Payoh Vets, there was no such thing as the world wide web. So, lots of reading vet articles and journals and subscription to the British and American vet journals. The PPD had a small vet library at 40 Kampong Java Road, now the K.K. Hospital.

3. For your situation, be an employee in one of the 46 vet practices in Singapore for at least two years. Choose a busy one, otherwise you would have not sufficient variety of cases. Work the night shifts and really attend to each emergency as if it was your own pet instead of being a "lazy" vet, letting the vet technicians do the hands-on blood collection, urine collection and X-rays.

Give practically free services to the dog breeders and animal activists. So much small animal veterinary work to do nowadays. Read up and discuss with mentors. Review cases done and see if there are better and more efficient and cost-effective ways to handling the case.

Add value to your employer. For example, I note that some young employee vets use more than necessary (increasing expenses to the practice and reducing the bottom-line) the sutures and materials used in surgery and treatment. This may not endear yourself to the Principal of the practice as it shows you don't care about the bottom-line. In private practice, the costs are high and you need to be aware of the economics of practice, other than the salary and benefits you are getting.

In conclusion, venturing to a new field requires a new mindset to work the long hours to achieve competence and success. Small animal private practice hours are longer and will not be similar to the regular hours of civil service as most clients are free during weekends and public holidays when the civil service vet is having time off.

Passion is required if you wish to excel. Competition is great nowadays as I expect more than 50 small animal practices to be set up in the next 5 years if you intend to open your own practice. Know the economics of practice. Add value to your employer or principal. Continuing education. Network. Be proactive in vet matters.

Phone me if you need more advice as writing advices are not as good as one-to-one talk.


E-MAIL REPLY TO DR SING DATED OCT 17, 2011


Dear Dr Sing,
Thanks so much for your reply. It has motivated me to work alot harder, and that nothing is impossible. Your advice has given me the direction I was missing before as I did not know who else to ask. Thank you once again.

Regards,
Name

Saturday, October 15, 2011

689. AVA Responsible Pet Road Show 2011 - Two talks by Dr Sing, Toa Payoh Vets

Today: Oct 15, 2011. Need to prepare for the following talks. A video presentation will be more fun and interesting to the audience.

Examples of videos will be:
1. Cystitis in A Male Dog
2. FIV in a Stray Cat
3. Carnaissal Tooth Abscess in an old dog
4. Closed pyometra and toxaemia in a dog
5. A gigantic perineal hernia in a silkie terrier
6. Heart disease in a Golden Retriever

5. Hamster tumours
6. Hamster warts

AVA RESPONSIBLE PET OWNERSHIP ROAD SHOW
CHANGI EXPO Nov 12 and 13, 2011

I will be giving two talks as follows:

Sat Nov 12, 2011 1.30 - 2pm Some common diseases in Singapore dogs - cases seen at Toa Payoh Vets


Sun Nov 13, 2011 3.30 - 4pm Tumoours and warts in Singapore hamsters - cases seen at Toa Payoh Vets