Saturday Sep 11, 2010
I was surprised to meet an ex-colleague near Centrepoint Shopping Centre yesterday afternoon. He was graduating from Glasgow University while I had just entered first year. That was in 1969. I was assigned to the Veterinary Diagnositic Labaoratory at Kampong Java Road while he was in the Vaccine Production Unit. Now, the whole area is the Kandang Kerbau Hospital. As a new vet, I knew nothing about poultry and swine virology and I learnt much from him and another vet.
The striking memory of him was that he was always scratching his hands and neck daily and many times. Then he would scratch his back. He was allergic to horses and so could not be near them when he was in the final year at Glasgow University. I wondered how he passed his horse examination.
I remembered more vividly the one day when we went to the poultry farm to collect blood as from vaccinated and unvaccinated chickens. The blood would be tested for antibodies called HI (haem-agglutination) titres which I was lectured about in my vet school.
The presence of HI titres and clinical signs of egg production drop and poor egg quality in non-vaccinated chickens indicated that the farm had this EDS (Egg Drop Syndrome). Actually this disease was present for the past 5 years in Europe but the veterinary authorities wanted to confirm its presence in Singapore's chickens before permitting import. Obviously this would take a long time and clever poultry farmers could not wait that long. However, this particular farm was more law-abiding and so we did the test with half of the poultry house not vaccinated and half vaccinated with the commercial EDS vaccine.
The trial confirmed the efficacy of the vaccine which was then approved for import into Singapore. This evidence-based veterinary medicine had cost the farmers much losses as EDS' 76 was a well known disease for the past 5 years in Europe. Yet the authorities had this ruling for this new "disease" in Singapore. I think the trial was done in 1980 and brought veterinary medicine and virology alive to a young vet. I was 30 years old then.
Time had flown by. But I had vividly remembered this vet who once thanked me for saving his life. How did I do it? It was a fine morning at Jalan Lekar. He inserted the needles into the chicken's wings and collected the blood in the blood collection tubes. The farmer's young daughter held the chicken while I assisted him by recording. We needed many chicken blood to get statistically significant results. I noticed that this vet started to have runny noses. After some time, he had difficulty breathing and his back hunched. He persevered in collecting blood. His eyes teared and reddened. He wiped off his runny nose. This was a shock to a young vet like me.
I had never encountered such a situation but I knew he was allergic to the chicken feathers and atmosphere as he was OK when he drove me to the farm. I had no car and he drove. "Stop blood collection, stop blood collection" I said to my senior. "Let's go back to the Vet Lab!". He had forgotten to bring his nebuliser on that day he told me later and thanked me for saving his life.
On this Saturday, he was fine and his hands were no longer itchy. "I don't have psoriasis," he corrected me. "It was dry skin." The following is the knowledge he imparted to me and which I hope will be of use to vets who suffer from dry skin in the whole body.
1. Aqueous cream BP must be applied to all the affected area daily, without fail. There are many types of aqueous cream which is a mixture of oil, water, emulsifier + a little preservative. If the person is allergic to preservative, then use ones without prservative.
2. Avoid aqueous cream with fragrance or preservative if possible.
3. In countries with low relative humidity, apply the cream more than 3 times. In Singapore, one time may be sufficient.
4. Sweat out at the club so that the skin pores open. A sauna bath perhaps?
5. Sources: Pharmacy. The cheapest source is in Johor Bahru at Jenski in Taman Sentosa. A big jar costs $18.00.
6. Alternative. The safest is vaseline which is petroleum jelly. But it is sticky in Singapore.
Conclusion: The aqueous cream is for "dry skin". That includes "dandruff" in the scalp which appears every 2 to 3 days despite anti-dandruff shampoos.
I know the water massage spa machine used daily as a 10-minute bath might be an easier solution for this vet as the heat opens the skin pores and the water currents massage the whole body. Do it every day for 10-15 minutes. De-stress at the same time. I did not mention this to him as he seems to be doing OK with his aqueous cream routine and I don't have evidence-based medicine to convince him to give it a trial!
I record this for a young veterinary undergraduate who is allergic to horses. You may suffer from dry skin itchiness as part of the syndrome later in life. Always carry a nebuliser all the time if you want to live past 60 years of age as your immune system reacts violently and fatally to allergens in the atmosphere.
Sunday, September 12, 2010
Friday, September 10, 2010
192. Collect urine from a dwarf hamster?
I could see the look in her eyes. Eyes are windows to the soul and these eyes flashed a message. I don't claim to possess telepathy but these eyes texted "Is your mind going to pot? You ask me to do a mission impossible."
I have had done several hamster tumour removals and treatment, thanks to the internet group of hamster lovers. But to collect urine from a hamster for urinalysis? I have not personally done it. Now I challenge and command Dr Vanessa Lin to get it done.
How to do it? Think. As a mentor, I must be able to do it. Vanessa's silence was golden. I offered advices like:
"Put the hamster in a cage with a grated flooring. Put a plastic sheet below the grate. The hamster's urine will pee down onto the plastic sheet. Tilt the cage slightly so that the urine will flow downwards to one end. Then, you can collect the urine and put in a container to be sent to the lab for urinalysis. It should be a small cage."
Theory is great. Can this be done? Where do we find such a small cage? When will the hamster pee? How much pee can be collected. If the hamster pees 0.2 ml, the heat of the environment will just evaporate the pee.
I believe that many vet schools do not teach the students how to do it. So many animals to teach. Hamsters are low on the teaching totem pole.
The ability to perform is important for any new vet in private practice. Vanessa told me that the top graduate in her class was fired for non-performance. Impressive academic credentials don't mean a thing in the real world where a veterinary practice's profitability must be sustainable.
Collecting urine from a dwarf hamster? I must be joking. But this is a serious matter as the hamster owner had consulted a vet who had produced an excellent X-ray and from my examination of the real hamster (after telling her that a phone call diagnosis would not be possible), I knew I needed at least one urine test. To check for urine protein and the possibility of kidney disorders. "Blood tests are impossible in a live dwarf hamster unlike in dogs and cats," I said to the owner. "A urine test can be done."
So the owner left the hamster at the Surgery. And now, I asked Vanessa to get it done. Veterinary medicine throws up many situations and challenges. If Vanessa could not be successful in this task, could I show her how to do it? I asked her to do it. This was to make her think how to do it. Well, there was not much time. The owner would be back in 30 minutes as she was reluctant to leave the hamster in the Surgery in the first place. She had specifically made an appointment to see me through the Surgery phone but I was not given the message. I apologised to inconveniencing her for a second visit and asked why she did not phone me personally as she had done when she wanted a telephone diagnosis.
How to collect urine from a dwarf hamster? Read widely and take a leaf from practices from other animal species. Metabolism tests on sheep. What do they do at the science lab which conducted drug trials and which I have never visited.
20 minutes left before the expected arrival of the lady hamster owner. I had a brainwave. The urine was collected and shown to the owner. She was satisfied that she did not waste her time to seek a second opinion.
I have the pictures of the urine collection process for readers and veterinary undergraduates who may be tested during their fourth and fifth-year vivas (oral tests).
Details are at: www.toapayohvets.com
I have had done several hamster tumour removals and treatment, thanks to the internet group of hamster lovers. But to collect urine from a hamster for urinalysis? I have not personally done it. Now I challenge and command Dr Vanessa Lin to get it done.
How to do it? Think. As a mentor, I must be able to do it. Vanessa's silence was golden. I offered advices like:
"Put the hamster in a cage with a grated flooring. Put a plastic sheet below the grate. The hamster's urine will pee down onto the plastic sheet. Tilt the cage slightly so that the urine will flow downwards to one end. Then, you can collect the urine and put in a container to be sent to the lab for urinalysis. It should be a small cage."
Theory is great. Can this be done? Where do we find such a small cage? When will the hamster pee? How much pee can be collected. If the hamster pees 0.2 ml, the heat of the environment will just evaporate the pee.
I believe that many vet schools do not teach the students how to do it. So many animals to teach. Hamsters are low on the teaching totem pole.
The ability to perform is important for any new vet in private practice. Vanessa told me that the top graduate in her class was fired for non-performance. Impressive academic credentials don't mean a thing in the real world where a veterinary practice's profitability must be sustainable.
Collecting urine from a dwarf hamster? I must be joking. But this is a serious matter as the hamster owner had consulted a vet who had produced an excellent X-ray and from my examination of the real hamster (after telling her that a phone call diagnosis would not be possible), I knew I needed at least one urine test. To check for urine protein and the possibility of kidney disorders. "Blood tests are impossible in a live dwarf hamster unlike in dogs and cats," I said to the owner. "A urine test can be done."
So the owner left the hamster at the Surgery. And now, I asked Vanessa to get it done. Veterinary medicine throws up many situations and challenges. If Vanessa could not be successful in this task, could I show her how to do it? I asked her to do it. This was to make her think how to do it. Well, there was not much time. The owner would be back in 30 minutes as she was reluctant to leave the hamster in the Surgery in the first place. She had specifically made an appointment to see me through the Surgery phone but I was not given the message. I apologised to inconveniencing her for a second visit and asked why she did not phone me personally as she had done when she wanted a telephone diagnosis.
How to collect urine from a dwarf hamster? Read widely and take a leaf from practices from other animal species. Metabolism tests on sheep. What do they do at the science lab which conducted drug trials and which I have never visited.
20 minutes left before the expected arrival of the lady hamster owner. I had a brainwave. The urine was collected and shown to the owner. She was satisfied that she did not waste her time to seek a second opinion.
I have the pictures of the urine collection process for readers and veterinary undergraduates who may be tested during their fourth and fifth-year vivas (oral tests).
Details are at: www.toapayohvets.com
Thursday, September 9, 2010
191. Telephone diagnosis
"My dwarf hamster has a bloated stomach since last week," the lady owner phoned me. "He has not been eating or pooping much. What can I do?"
It is hard to give a telephone diagnosis. Bring down for a check-up.
Vet 1 gave a laxative oil and oral antibiotics for 5 days as well as produce a beaufiful X-ray of the backide. Constipation?
"Looks like he has stones," my assistant saw big lumps on x-rays
It is hard to give a telephone diagnosis. Bring down for a check-up.
Vet 1 gave a laxative oil and oral antibiotics for 5 days as well as produce a beaufiful X-ray of the backide. Constipation?
"Looks like he has stones," my assistant saw big lumps on x-rays
New vet at Toa Payoh Vets - Dr Vanessa Lin Hui Jun
On Sep 3, 2010, Dr Vanessa Lin Hui Jun joins Toa Payoh Vet as an associate vet. She has around two years of experience. I have confidence that she will make a good veterinarian and will be her mentor.
I briefed Vanessa on the values of honesty and responsibility of a vet by giving her various real-life examples where the pursuit of making more money erodes such values. These examples can make interesting reading.
It is important that the leadership walk the talk and impart the values to young ones and reject vets who don't agree to the values of Toa Payoh Vets.
"There are many things you will learn in a small practice and these lessons will be very useful when you start your own practice," I said to Vanessa. "In your previous practice, you have many assistants to do things. Here, you may need to think how to do things efficiently and economically." One advantage for Vanessa is that she has me as a mentor.
"I know you have intention of opening your own practice. That is OK with me. You have your future to think of. You can see that Mr Saw has been with me for over two years and I have given my blessings for him to join other practices with better pay and prospects."
Being of the same age as the younger generation, Dr Vanessa Lin will be more their type of vet.
I briefed Vanessa on the values of honesty and responsibility of a vet by giving her various real-life examples where the pursuit of making more money erodes such values. These examples can make interesting reading.
It is important that the leadership walk the talk and impart the values to young ones and reject vets who don't agree to the values of Toa Payoh Vets.
"There are many things you will learn in a small practice and these lessons will be very useful when you start your own practice," I said to Vanessa. "In your previous practice, you have many assistants to do things. Here, you may need to think how to do things efficiently and economically." One advantage for Vanessa is that she has me as a mentor.
"I know you have intention of opening your own practice. That is OK with me. You have your future to think of. You can see that Mr Saw has been with me for over two years and I have given my blessings for him to join other practices with better pay and prospects."
Being of the same age as the younger generation, Dr Vanessa Lin will be more their type of vet.
189. Sep 3, 2010
Sep 9, 2010
I welcome Dr Vanessa Lin Hui Jun to my team at Toa Payoh Vets on Sep 3, 2010. This was a very happy occasion for me and my clients as I am getting on in years, being 60 years old now.
Meanwhile, in Perth, something unforeseen and very sad happened.
My god-daughter, Ms Celina Chua who was only 5 weeks before graduation as a veterinarian from Murdoch University was killed in a car accident in Perth, Australia. Her friends will be holding a memorial at the University on Friday Sep 10, 2010.
I welcome Dr Vanessa Lin Hui Jun to my team at Toa Payoh Vets on Sep 3, 2010. This was a very happy occasion for me and my clients as I am getting on in years, being 60 years old now.
Meanwhile, in Perth, something unforeseen and very sad happened.
My god-daughter, Ms Celina Chua who was only 5 weeks before graduation as a veterinarian from Murdoch University was killed in a car accident in Perth, Australia. Her friends will be holding a memorial at the University on Friday Sep 10, 2010.
Wednesday, September 8, 2010
188. The Chinatown coffeeshop lady said: "Call the police!"
"Call the police! Call the police!" the lady stated loudly as Mr Lim answered the phone. Somebody representing me had demanded that he pay his debt of $2,000 to me. Mr Lim had stopped payment of his $2,000-cheque to me and would not return my calls for the past 1 year. He had asked me for a $5,000 temporary loan as he had cash-flow problems and promised to return the money in one month's time with interest.
"I don't want your interest," I don't want to make money out of a businessman in dire financial straits. I only prayed that I would recover my loan as I have had bad experiences.
However, if I could help this businessman who had made millions before but now needed cash, I would as I had been acquainted with him for the past 20 years. He took the $5,000 and I was out of sight, out of mind.
That was one and a half years ago. After many phone calls for half a year, he gave me a cheque of $5,000. The next 2 days, he wanted the cheque back and gave me a cheque of $3,000 and a few days later, another one for $2,000 cheque which he stopped payment soon. He just ignored my calls for another year. I told a friend about him and he offered to help me by phoning me. He was no bill collector or loan shark as I don't get involved with the shady underworld. Mr Lim promised to phone me the next day and he did. He paid $500 and that was OK with me. He still was in the dumps but I could not help him. It is the disadvantage of of being self-employed. A self-employed can make millions and can crash and burn and he was burnt by a project which did not pay him.
Honesty is important in business and he should know better. I invited him for breakfast at Chinatown on Sep 7, 2010 to see if I could advise him or be of help to him in his business, but not in another loan.
"Who was the lady who asked you to call the police?" I asked Mr Lim at the Chinatown coffeeshop. A bright sunshine morning and I took a photograph for readers to appreciate the street where I had coffee with him.
I knew Mr Lim for the past 30 years and his lady assistant. From what I know of the character and personality of his lady assistant from a well brought up family in Indonesia, I would say she was not the instigator to call the police. But I had to know whether my judgment of character was up to par.
I asked Mr Lim: "Who was the lady who asked you to call the police? Her husband must be some big gun in the Singapore Police Force."
"The lady eaves-dropped my conversation. Your friend was speaking in a loud voice and was quite rough. The lady is a coffeeshop operator in Keong Siak Street."
I said: "The famous previous red-light district of Singapore's Chinatown. Where is she now? I would like to see how she looks like."
Mr Lim said: "She is not working so early. I told her at that time not to interfere with my business."
I said: "Call the police. Call the police. Why didn't you call the police?"
I was surprised when Mr Lim admitted: "I am in the wrong."
I said: "The coffeeshop lady must have police connections as she was rather aggressive shouting over your head such that my friend could hear her.
"Is her husband the Commissioner of Police?" I asked Mr Lim. "My friend who phoned you asked you to call the police or he would call the police in your presence."
"No, no," Mr Lim said. "The husband is a training instructor in the police force."
So there was this police connection which embolden the wife. The police do not interfere in civil matters. Otherwise they don't have time for real police investigation work.
I listened to Mr Lim's bad luck in the project in which he was owed $100,000. He had been advised to take legal action but he did not want to. I said: "Lawyers want deposits and then more deposits with no guarantee of success. Whoever advised you might pay on your behalf first. It is wise of you not to proceed with litigation. Let me talk to the other party if the party is interested. If not, just move positively in new projects and learn from the bad experience."
Giving a cheque to secure a loan is a big risk for the lender. Sometimes it is better not to help others in need as it is usually money down the drain and some threats to "call the police." Honesty is the best policy in business. Do not ignore a problem. If Mr Lim had paid even $50.00 per month, he would have had paid up after some months. But when a man is in dire financial straits, the aim is to get loans without any intention of return usually. Some of them behaved aggressively as if the lender owes the borrower money!
"I don't want your interest," I don't want to make money out of a businessman in dire financial straits. I only prayed that I would recover my loan as I have had bad experiences.
However, if I could help this businessman who had made millions before but now needed cash, I would as I had been acquainted with him for the past 20 years. He took the $5,000 and I was out of sight, out of mind.
That was one and a half years ago. After many phone calls for half a year, he gave me a cheque of $5,000. The next 2 days, he wanted the cheque back and gave me a cheque of $3,000 and a few days later, another one for $2,000 cheque which he stopped payment soon. He just ignored my calls for another year. I told a friend about him and he offered to help me by phoning me. He was no bill collector or loan shark as I don't get involved with the shady underworld. Mr Lim promised to phone me the next day and he did. He paid $500 and that was OK with me. He still was in the dumps but I could not help him. It is the disadvantage of of being self-employed. A self-employed can make millions and can crash and burn and he was burnt by a project which did not pay him.
Honesty is important in business and he should know better. I invited him for breakfast at Chinatown on Sep 7, 2010 to see if I could advise him or be of help to him in his business, but not in another loan.
"Who was the lady who asked you to call the police?" I asked Mr Lim at the Chinatown coffeeshop. A bright sunshine morning and I took a photograph for readers to appreciate the street where I had coffee with him.
I knew Mr Lim for the past 30 years and his lady assistant. From what I know of the character and personality of his lady assistant from a well brought up family in Indonesia, I would say she was not the instigator to call the police. But I had to know whether my judgment of character was up to par.
I asked Mr Lim: "Who was the lady who asked you to call the police? Her husband must be some big gun in the Singapore Police Force."
"The lady eaves-dropped my conversation. Your friend was speaking in a loud voice and was quite rough. The lady is a coffeeshop operator in Keong Siak Street."
I said: "The famous previous red-light district of Singapore's Chinatown. Where is she now? I would like to see how she looks like."
Mr Lim said: "She is not working so early. I told her at that time not to interfere with my business."
I said: "Call the police. Call the police. Why didn't you call the police?"
I was surprised when Mr Lim admitted: "I am in the wrong."
I said: "The coffeeshop lady must have police connections as she was rather aggressive shouting over your head such that my friend could hear her.
"Is her husband the Commissioner of Police?" I asked Mr Lim. "My friend who phoned you asked you to call the police or he would call the police in your presence."
"No, no," Mr Lim said. "The husband is a training instructor in the police force."
So there was this police connection which embolden the wife. The police do not interfere in civil matters. Otherwise they don't have time for real police investigation work.
I listened to Mr Lim's bad luck in the project in which he was owed $100,000. He had been advised to take legal action but he did not want to. I said: "Lawyers want deposits and then more deposits with no guarantee of success. Whoever advised you might pay on your behalf first. It is wise of you not to proceed with litigation. Let me talk to the other party if the party is interested. If not, just move positively in new projects and learn from the bad experience."
Giving a cheque to secure a loan is a big risk for the lender. Sometimes it is better not to help others in need as it is usually money down the drain and some threats to "call the police." Honesty is the best policy in business. Do not ignore a problem. If Mr Lim had paid even $50.00 per month, he would have had paid up after some months. But when a man is in dire financial straits, the aim is to get loans without any intention of return usually. Some of them behaved aggressively as if the lender owes the borrower money!
Monday, September 6, 2010
187. Vets being referred to
E-MAIL TO DR SING
Sep 5, 2010
Hi Dr Sing,
Just a quick line to let you know that I have finally returned to Singapore and just started work at (Name given). I am returning to Perth from 16th to 19th for my graduation. If you want me to carry anything for (Name given), I will be glad to. The other reason for this email is Dr. (Name given) heard that (Name given) might have been badly injured in a car accident in Perth on Friday night/ Saturday... is this true? If so, I hope all is ok with her... we are concerned about her welfare.
E-MAIL FROM DR SING
Sep 6, 2010 4.15 am.
Thank you for email. (Name given) is actually my god-daughter. She passed away on Sep 3, 2010 due to an accident as the other driver of an on-coming car overtook a car and smashed into her car.
In your new job, I hope you will present a kindness towards "smaller practices" as I have had nasty experiences of three vets from your practice when cases were referred to them. I gave you 3 examples in the hope that you would be kinder now that you have had started practice with them.
1. One vet demanded over the phone that I should call him first but I told him that his receptionist said he was busy and it was my client who wanted the case to be sent to him. So I extended the courtesy to phone him.
2. Another vet said I should fill up a form if I wanted to refer any animal to him.
3. The 3rd vet refused to give the X-ray of the bladder stone to a small animal practice vet. I shall name him as Vet X. His practice had fed your new employer with numerous cases over the last 20 years. Vet X's receptionist had a dog with haematuria. The dog was referred to your employer for an X-ray.
Vet X's mother had asked me to mentor her son in surgery. This was his first case of urinary stone removal from the bladder. I asked him to get the X-ray. It would be good to have an X-ray but since the vet did not want to release it, he could do nothing.
I said it was OK since I could palpate the bladder stone and in fact X-rays are not necessary if one is confident of the diagnosis based on clinical signs and history. Vet X operated under my supervision and the dog is still much alive and well when I saw the receptionist recently.
Best wishes to your new career.
P.S As for me, if any vet wants to refer to me their cases, they are welcome.
Sep 5, 2010
Hi Dr Sing,
Just a quick line to let you know that I have finally returned to Singapore and just started work at (Name given). I am returning to Perth from 16th to 19th for my graduation. If you want me to carry anything for (Name given), I will be glad to. The other reason for this email is Dr. (Name given) heard that (Name given) might have been badly injured in a car accident in Perth on Friday night/ Saturday... is this true? If so, I hope all is ok with her... we are concerned about her welfare.
E-MAIL FROM DR SING
Sep 6, 2010 4.15 am.
Thank you for email. (Name given) is actually my god-daughter. She passed away on Sep 3, 2010 due to an accident as the other driver of an on-coming car overtook a car and smashed into her car.
In your new job, I hope you will present a kindness towards "smaller practices" as I have had nasty experiences of three vets from your practice when cases were referred to them. I gave you 3 examples in the hope that you would be kinder now that you have had started practice with them.
1. One vet demanded over the phone that I should call him first but I told him that his receptionist said he was busy and it was my client who wanted the case to be sent to him. So I extended the courtesy to phone him.
2. Another vet said I should fill up a form if I wanted to refer any animal to him.
3. The 3rd vet refused to give the X-ray of the bladder stone to a small animal practice vet. I shall name him as Vet X. His practice had fed your new employer with numerous cases over the last 20 years. Vet X's receptionist had a dog with haematuria. The dog was referred to your employer for an X-ray.
Vet X's mother had asked me to mentor her son in surgery. This was his first case of urinary stone removal from the bladder. I asked him to get the X-ray. It would be good to have an X-ray but since the vet did not want to release it, he could do nothing.
I said it was OK since I could palpate the bladder stone and in fact X-rays are not necessary if one is confident of the diagnosis based on clinical signs and history. Vet X operated under my supervision and the dog is still much alive and well when I saw the receptionist recently.
Best wishes to your new career.
P.S As for me, if any vet wants to refer to me their cases, they are welcome.
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