Sunday May 13, 2012
I was at the Surgery in the morning and saw a large amount of reddish brown urine drops in the waiting and consultation room. Dr Daniel was consulting with the owners and Mr Min was mopping the floor. If I were Dr Daniel, I would restrain the dog on the consultation table but each vet does his own thing and so this situation led to bloody urine every where. I mean, if the waiting room was full, the other clients would be most unhappy to see blood everywhere.
This is what I mean by "common sense" in a vet who handles a case. Restrict the dog's movement or crate her. I did my trust and audit in this case. The X-ray showed around 6 small radio-opaque stones of around 4 mm x 6 mm and other sizes. Dr Daniel said were unlikely to cause so much bladder bleeding. Each vet has his own opinion and so that is life.
I disagreed with him as there was one stone with a sharp edge, like a dagger. This sharp stone swished about inside the bladder would have stabbed the bladder mucosa and cause bleeding. "This is not chronic cystitis," Dr Daniel disagreed with me. "The blood in the urine occurred only 2 weeks ago." This is a difference of opinion.
An old Beagle. Likely to be a bladder carcinoma as well. Dr Daniel advised ultrasound and surgery with high anaesthetic risks of death on the op table. Since the dog's red blood cells were low, his opinion was that this dog would not survive the operation. So what to do? The consultation took more than 30 minutes and he was still talking.
I intervened by entering the consultation room which had a bloodied floor now. I said to the couple: "Basically, you have two options. Consent to an operation and know the high risks and get the stones removed. If there is cancer of the bladder, give us consent to euthanase the dog during surgery. The other option is to medicate and euthanase the dog when the drugs don't work as she is suffering from pain and incontinence. In the meantime, get the dog on the IV drip, painkillers and antibiotics for at least one day and before surgery."
Vets can't afford the luxury of time on a busy Sunday morning to handle a case for more than 30 minutes unless it is necessary. Others have to wait a longer time. Owners of hospitalised dogs need to be called. The sick dogs need to be checked and there are many things to do. So, it is not possible to keep on talking while the old Beagle keeps on dripping.
Monday, May 14, 2012
997. Trust and Audit on a Saturday
Saturday May 12, 2012, I did a trust and audit on Dr Jason Teo's work at Toa Payoh Vets by going to the Surgery at 9 am. Dr Teo starts work at 11 am - 12 noon and 3 pm to 5 pm by appointment only and this have been his practice for the past 5 years. It is not a practice I will endorse in view of the mushrooming of 45 veterinary clinics in Singapore with more to come.
Dr Teo has set up his own practice and there have been issues of conflicts of interests. He will be on duty on Saturdays and I asked if he really wanted to be away from his own practice which he can build up. I have not decided what to do with his hours of work but he must be available during the hours and in between, another vet like me will be present.
As the founder and licensee, I will have to make hard decisions as to what to do. The status quo cannot remain as clientele numbers are increasing due to referrals.
Dr Teo has set up his own practice and there have been issues of conflicts of interests. He will be on duty on Saturdays and I asked if he really wanted to be away from his own practice which he can build up. I have not decided what to do with his hours of work but he must be available during the hours and in between, another vet like me will be present.
As the founder and licensee, I will have to make hard decisions as to what to do. The status quo cannot remain as clientele numbers are increasing due to referrals.
996. National Family Celebrations, 2012 Singapore
Singapore has many organisations promoting family bonding and work-life balances nowadays. That means a 5-day week, high pay and generous leave of up to 4 months in the case of maternity entitlement.
Unfortunately, the cost of living keeps shooting up due to many government's policies and so it is quite rough on the younger generation. Take the COE (Certificate of Entitlement) to buy a new car policy. Now, it is bidded at around S$50,000 and will shoot up further.
For example, in Perth in the same period of time, a young man or woman undergraduate can buy a car for S$5,000 and be mobile. I know of a young lady vet who has now graduated. She bought an older car with a clicking noise whenever she changed gears. I was worried for her as I wondered whether the constant clicking would cause sparks and set fire to her car. But she was OK with this. It was around $500 and here in Singapore, $500 may buy you a car tire.
Therefore in Singapore, after the vet graduated from Australia and comes to work at home in Singapore, he must pay around $50,000 to buy a decent 10-year-old car.
Back to the National Family Celebrations 2012, I got an email as follows:
E-MAIL TO DR SING DATED MAY 7, 2012
Dear Businesses for Families Pledgers
CALL TO SUPPORT NATIONAL FAMILY CELEBRATIONS 2012
The National Family Celebrations is an annual month-long event that seeks to promote, strengthen and celebrate families. It is organised by the National Family Council (NFC), a people sector-led committee that aims to build resilient families in Singapore, with strong support from the Ministry of Community Development, Youth and Sports (MCYS).
2 Running strong for the 27th year, National Family Celebrations has been an iconic national event earmarked by many families in Singapore. Last year, National Family Celebrations (NFC’11) adopted the theme “Connecting Youths with Their Family”. It aimed to engage the youths and inculcate a family first mindset among them. NFC’11 was a big draw to families, with active participation of over 400,000 people at 330 ground events organised by our partners throughout the month-long celebrations.
3 This year, NFC’12 will be held from 25 May (Friday) to 23 June (Saturday) 2012. With the theme “Family Time Odyssey: Past. Present. Future”, NFC’12 boasts a strong line up of interesting activities for families. Details of the Celebrations are at Annex 1.
4 It is our pleasure to invite your business to participate in this year’s Celebrations. We believe that this will offer an excellent opportunity for your organisation to strengthen your branding and extend your outreach, while joining a meaningful cause of promoting strong families in Singapore. As part of our Businesses for Families Community, we strongly encourage you to offer special discounts, promotions and packages for families (two or three generational families) during NFC’12. If you have any existing family discounts or promotions that coincide with the Celebrations period, do let us know. We will be happy to include them.
5 Please let us have the details of your family discounts and promotions (offered during the celebration period) at Annex 2 by 18 May 2012 (Friday). We will help publicise them in two websites: www.nfc.sg (National Family Celebrations) and www.bfc.sg (Businesses for Families Council). To submit your offers or for more information, you may contact:
Mr Mervyn Seah
Secretariat, Businesses for Families Council
E-mail: mervyn_seah@mcys.gov.sg
Fax: 6354 9868
Tel: 6354 9847
6 As our valued partners, we hope that you can support us in this meaningful cause, as we promote family values and strengthen families in Singapore. We look forward to your favourable reply.
Thank you!
E-MAIL FROM DR SING DATED MAY 11, 2012
I am Dr Sing from Toa Payoh Vets. Family pets are family members for all Singaporeans. Health screening of the older pets over 2 years is important. I have offered a 10% discount on blood test for the family dog or cat for the 2 months, May 25 to July 28, 2012, as attached in your Annex 2. Pl phone me at 9668 6468 for more info. Thank you.
E-MAIL TO DR SING DATED MAY 11, 2012
Hi Dr Sing
Thank you very much for your kind support in NFC.
To make the offer more family targeted, we suggest adding the following terms and conditions:
“Discount is only applicable when families of at least 2 generations are present”
For your approval please.
Please also kindly provide your business logo for us to attach the offer under.
Thank you.
Best Regards
Mervyn Seah (Mr) / Businesses for Families Council
Ministry of Community Development, Youth and Sports
| DID: (65) 6354 9847 | Fax: (65) 6354 9868 | Website: www.mcys.gov.sg / http://www.bfc.sg
E-MAIL FROM DR SING DATED MAY 14, 2012
It is not practical to insist on 2 generations to be present because most pet owners do not have cars or spaces to bring their 2 generations to see a vet. Usually it is the parent and the younger children.
Logo is attached:
Pl let me know if you have published any of my offers. Thank you.
Unfortunately, the cost of living keeps shooting up due to many government's policies and so it is quite rough on the younger generation. Take the COE (Certificate of Entitlement) to buy a new car policy. Now, it is bidded at around S$50,000 and will shoot up further.
For example, in Perth in the same period of time, a young man or woman undergraduate can buy a car for S$5,000 and be mobile. I know of a young lady vet who has now graduated. She bought an older car with a clicking noise whenever she changed gears. I was worried for her as I wondered whether the constant clicking would cause sparks and set fire to her car. But she was OK with this. It was around $500 and here in Singapore, $500 may buy you a car tire.
Therefore in Singapore, after the vet graduated from Australia and comes to work at home in Singapore, he must pay around $50,000 to buy a decent 10-year-old car.
Back to the National Family Celebrations 2012, I got an email as follows:
E-MAIL TO DR SING DATED MAY 7, 2012
Dear Businesses for Families Pledgers
CALL TO SUPPORT NATIONAL FAMILY CELEBRATIONS 2012
The National Family Celebrations is an annual month-long event that seeks to promote, strengthen and celebrate families. It is organised by the National Family Council (NFC), a people sector-led committee that aims to build resilient families in Singapore, with strong support from the Ministry of Community Development, Youth and Sports (MCYS).
2 Running strong for the 27th year, National Family Celebrations has been an iconic national event earmarked by many families in Singapore. Last year, National Family Celebrations (NFC’11) adopted the theme “Connecting Youths with Their Family”. It aimed to engage the youths and inculcate a family first mindset among them. NFC’11 was a big draw to families, with active participation of over 400,000 people at 330 ground events organised by our partners throughout the month-long celebrations.
3 This year, NFC’12 will be held from 25 May (Friday) to 23 June (Saturday) 2012. With the theme “Family Time Odyssey: Past. Present. Future”, NFC’12 boasts a strong line up of interesting activities for families. Details of the Celebrations are at Annex 1.
4 It is our pleasure to invite your business to participate in this year’s Celebrations. We believe that this will offer an excellent opportunity for your organisation to strengthen your branding and extend your outreach, while joining a meaningful cause of promoting strong families in Singapore. As part of our Businesses for Families Community, we strongly encourage you to offer special discounts, promotions and packages for families (two or three generational families) during NFC’12. If you have any existing family discounts or promotions that coincide with the Celebrations period, do let us know. We will be happy to include them.
5 Please let us have the details of your family discounts and promotions (offered during the celebration period) at Annex 2 by 18 May 2012 (Friday). We will help publicise them in two websites: www.nfc.sg (National Family Celebrations) and www.bfc.sg (Businesses for Families Council). To submit your offers or for more information, you may contact:
Mr Mervyn Seah
Secretariat, Businesses for Families Council
E-mail: mervyn_seah@mcys.gov.sg
Fax: 6354 9868
Tel: 6354 9847
6 As our valued partners, we hope that you can support us in this meaningful cause, as we promote family values and strengthen families in Singapore. We look forward to your favourable reply.
Thank you!
E-MAIL FROM DR SING DATED MAY 11, 2012
I am Dr Sing from Toa Payoh Vets. Family pets are family members for all Singaporeans. Health screening of the older pets over 2 years is important. I have offered a 10% discount on blood test for the family dog or cat for the 2 months, May 25 to July 28, 2012, as attached in your Annex 2. Pl phone me at 9668 6468 for more info. Thank you.
E-MAIL TO DR SING DATED MAY 11, 2012
Hi Dr Sing
Thank you very much for your kind support in NFC.
To make the offer more family targeted, we suggest adding the following terms and conditions:
“Discount is only applicable when families of at least 2 generations are present”
For your approval please.
Please also kindly provide your business logo for us to attach the offer under.
Thank you.
Best Regards
Mervyn Seah (Mr) / Businesses for Families Council
Ministry of Community Development, Youth and Sports
| DID: (65) 6354 9847 | Fax: (65) 6354 9868 | Website: www.mcys.gov.sg / http://www.bfc.sg
E-MAIL FROM DR SING DATED MAY 14, 2012
It is not practical to insist on 2 generations to be present because most pet owners do not have cars or spaces to bring their 2 generations to see a vet. Usually it is the parent and the younger children.
Logo is attached:
Pl let me know if you have published any of my offers. Thank you.
Sunday, May 13, 2012
995. Sunday's interesting cases. The Alsatian hates going to the vet
Sunday's Interesting Cases. May 13, 2012
My god-daughter's dog had a skin growth (like cyst) on left. I went to the house and the mum drove the dog and me and 2nd daughter, Belle to Toa Payoh Vets. She seldom used my services as I don't charge her and she preferred to pay. So, she does not know my surgery location and I went to her house at 9.00 am to pick up the dog with her driving.
The Alsatian reached my surgery at 10 am but would not accept injection by Dr Daniel. So there was an impasse. "Cannot do inside the consultation room. Will not allow injection if put on the consultation table" Belle said. So much time had been wasted. Sunday is a busy day and in any case, productivity counts a lot to me. But this dog would not permit IV sedation. I had prepared the domitor+ketamine IV at 50%. Belle took the restless dog outside to the waiting area while her mum watched. Much time is wasted in this impasse. Dr Daniel could not do much but to wait for the dog to settle down. Will the dog ever settle down? He has much anxiety whenever he goes into the car to see a vet. "That is the only time he goes inside the car," the mum told me. "So he knows it is to go to the vet." The mum had bought online in Perth a back seat protective canvas cover which hooks onto the headrest of the two front seats and then into the back seats hook. Therefore, the car seats would not be soiled by hairs et.
"I will inject the dog," I said as I knew waiting was not the solution and would not be productive and efficient on a Sunday morning. Clients would stream in after 11 am. Dr Daniel gave me the syringe. But I decided that he must learn how to handle such difficult situations without wasting time. But easier said than done.
"The vet has to think out of the box," I said to the mum. "If the dog is afraid of the vet practice and smell, take it out far away." I asked Bernice to take her dog 6 shops away from Toa Payoh Vets. Then what?
I asked Dr Daniel and Min to go there.
"Belle," I shouted from 6 shops away at my surgery's main door. "Put your leg under his tummy." But she could not do it as Min and Dr Daniel were obstrcting her. I could see the dog becoming more nervous and fidgety. He was muzzled and so not a threat. "Stand in front of your dog," I shouted. "He must see you to remain calm." From what Dr Daniel told me later, Belle is the only person who can handle this dog inside the car.
Well, Dr Daniel and Min and Belle managed to give the IV. Of course, the dog could still walk as he was only given 50% of the dosage. "Wait 5 minutes," I asked Belle to walk the dog outdoors for 5 minutes while Julia chatted with the mum who had a busy lunch appointment and needed to drive home soon.
After a while, I couldn't see her as she had walked the dog to the back of the building. I asked her mum who was rushing to go home to change and we saw Belle at the back of the surgery walking the ataxic dog. Dr Daniel took over. Both mother and daughter left to go home first.
"I give you my mobile number to phone me when Texan is ready to go home," she said.
"Come in one hour's time," I said. "Dental scaling and removal of the lump should be completed in less than one hour. If not, there is something wrong with the vet." A procedure has certain key performance indicators and benchmarks of completion.
At 10.44 am Belle sms me for the address of the surgery: "Can SMS me your clinic address? In case I get lost". This is Singapore English and the "Speak Good English Committee will lose their hairs in reading her SMS!
I texted: "1002 toa payoh lor 8, 01-1477. S. 319074. Dog ready to go home."
Belle texted: "Wah so fast! K will come as soon as Mei is ready. She drowsy?"
"Yes," I texted in a reserved manner as I dare not take liberties in texting with an old friend's daughter in case of misunderstandings with the parents. My generation is more conservative and less expressive and so I don't do it in SMS.
I informed Dr Daniel that Belle will be coming. The younger generation is so much
abbreviated in Singapore English. It will be hard to change their mindset since there was no emphasis on good English writing during the school years. So a "Speak Good English" organisation has the uphill task of doing the corrections.
Belle is a tall slim and fair young lady graduate whom I have known since she was born. Now she must be 27 years old. This shows how fast babies grow or how ancient I am now. To her, the whole process of dental scaling and lump removal seemed quick. To me, the whole procedure had been very slow. From arrival at the Surgery at around 9.45 am to going home at around 11.30 am.
The skin lump would be sent for histopathology and we hope it is not a skin tumour. It looked cystic and nodular, around 8 mm x 8 mm x 3 mm. Who knows till the histopathology results come out.
My god-daughter's dog had a skin growth (like cyst) on left. I went to the house and the mum drove the dog and me and 2nd daughter, Belle to Toa Payoh Vets. She seldom used my services as I don't charge her and she preferred to pay. So, she does not know my surgery location and I went to her house at 9.00 am to pick up the dog with her driving.
The Alsatian reached my surgery at 10 am but would not accept injection by Dr Daniel. So there was an impasse. "Cannot do inside the consultation room. Will not allow injection if put on the consultation table" Belle said. So much time had been wasted. Sunday is a busy day and in any case, productivity counts a lot to me. But this dog would not permit IV sedation. I had prepared the domitor+ketamine IV at 50%. Belle took the restless dog outside to the waiting area while her mum watched. Much time is wasted in this impasse. Dr Daniel could not do much but to wait for the dog to settle down. Will the dog ever settle down? He has much anxiety whenever he goes into the car to see a vet. "That is the only time he goes inside the car," the mum told me. "So he knows it is to go to the vet." The mum had bought online in Perth a back seat protective canvas cover which hooks onto the headrest of the two front seats and then into the back seats hook. Therefore, the car seats would not be soiled by hairs et.
"I will inject the dog," I said as I knew waiting was not the solution and would not be productive and efficient on a Sunday morning. Clients would stream in after 11 am. Dr Daniel gave me the syringe. But I decided that he must learn how to handle such difficult situations without wasting time. But easier said than done.
"The vet has to think out of the box," I said to the mum. "If the dog is afraid of the vet practice and smell, take it out far away." I asked Bernice to take her dog 6 shops away from Toa Payoh Vets. Then what?
I asked Dr Daniel and Min to go there.
"Belle," I shouted from 6 shops away at my surgery's main door. "Put your leg under his tummy." But she could not do it as Min and Dr Daniel were obstrcting her. I could see the dog becoming more nervous and fidgety. He was muzzled and so not a threat. "Stand in front of your dog," I shouted. "He must see you to remain calm." From what Dr Daniel told me later, Belle is the only person who can handle this dog inside the car.
Well, Dr Daniel and Min and Belle managed to give the IV. Of course, the dog could still walk as he was only given 50% of the dosage. "Wait 5 minutes," I asked Belle to walk the dog outdoors for 5 minutes while Julia chatted with the mum who had a busy lunch appointment and needed to drive home soon.
After a while, I couldn't see her as she had walked the dog to the back of the building. I asked her mum who was rushing to go home to change and we saw Belle at the back of the surgery walking the ataxic dog. Dr Daniel took over. Both mother and daughter left to go home first.
"I give you my mobile number to phone me when Texan is ready to go home," she said.
"Come in one hour's time," I said. "Dental scaling and removal of the lump should be completed in less than one hour. If not, there is something wrong with the vet." A procedure has certain key performance indicators and benchmarks of completion.
At 10.44 am Belle sms me for the address of the surgery: "Can SMS me your clinic address? In case I get lost". This is Singapore English and the "Speak Good English Committee will lose their hairs in reading her SMS!
I texted: "1002 toa payoh lor 8, 01-1477. S. 319074. Dog ready to go home."
Belle texted: "Wah so fast! K will come as soon as Mei is ready. She drowsy?"
"Yes," I texted in a reserved manner as I dare not take liberties in texting with an old friend's daughter in case of misunderstandings with the parents. My generation is more conservative and less expressive and so I don't do it in SMS.
I informed Dr Daniel that Belle will be coming. The younger generation is so much
abbreviated in Singapore English. It will be hard to change their mindset since there was no emphasis on good English writing during the school years. So a "Speak Good English" organisation has the uphill task of doing the corrections.
Belle is a tall slim and fair young lady graduate whom I have known since she was born. Now she must be 27 years old. This shows how fast babies grow or how ancient I am now. To her, the whole process of dental scaling and lump removal seemed quick. To me, the whole procedure had been very slow. From arrival at the Surgery at around 9.45 am to going home at around 11.30 am.
The skin lump would be sent for histopathology and we hope it is not a skin tumour. It looked cystic and nodular, around 8 mm x 8 mm x 3 mm. Who knows till the histopathology results come out.
994. Part 2. Dr Goh Keng Swee's few good men and women
| Dr Goh
Keng Swee's few good men and women tasked to reverse the
horse racing decline - Part 2Dr Sing Kong
Yuen, BVMS (Glasgow), MRCVS13 May, 2012
Part 1 was written in June 2011; the webpage is at: http://www.sinpets.com/F5/201006256history-1988-horse-racing-decline-veterinary-ToaPayohVets.htm As the Club veterinarian, my job was to diagnose and treat race horses. There was no need for me to do management which would involve lots of meetings, gathering of facts and figures and making forecasts. When the Singapore Totalisator Board (STB) took over the horse-racing operations around 1988 and appointed the Bukit Turf Club as its agent, my employment contract was assigned to the Bukit Turf Club (BTC) with its own new managers. Changes are a constant in life and this new development of a new STB and BTC was a tsunami for the employees of the side-lined Singapore Turf Club (STC) which was a private club at that time. Many of us, including the Personnel Manager, knew our days of employment were numbered as the new management would replace us in time to come. New brooms sweep clean and this is the way of life. I had decided to go back to private practice treating dogs and cats and small animals and therefore I would just wait till my employment contract expired. I was given another one-year contract by the Bukit Turf Club and I accepted it. In the interim period, I was part of the task force formed by the STB to reverse the decline in racing. The task force comprised a small group of people under the leadership of Mr Quek Chee Hoon, the general manager of the STB. Excluding the STB's management staff, there was the BTC management staff. The Betting Manager, the Racing Manager and the Junior Veterinary Surgeon (myself) were the main work horses, working for the dormant STC earlier and were now the employees of the BTC. There was Ms Violet Lim, a Ms Universe Singapore, as the Manager in charge of this task force and she would be the one to produce the findings and give the recommendations to Mr Quek Chee Hoon, in my observation. Mr Quek would do his own visits and had others doing research. Once we had a meeting with Mr Quek and he said that the propeller-type aircraft door could not be closed tightly open when he flew to Sabah for a meeting, when the Racing Manager mentioned some matters about aviation. I went with the task force to visit and research the horse-racing clubs in Hong Kong, South Korea and Thailand. The members were supposed to write their comments to Ms Violet Lim. We had a tough time writing anything to reverse the decline in Singapore horse-racing, since we were not into writing reports under the old STC. Our lives were hands-on technical work and no writing management reports. Maybe the Racing Manager would compile some racing statistics for the STC Annual Report to Mr Thompson, the General Manager of the STC. So it was up to poor Ms Lim who asked us to write our observations after the overseas trip. But she would be able to do the writing as I believe she was trained in accountancy or business-management matters. Beauty and brains are a powerful combination for the business of racing and Ms Lim was a good catch for the BTC, in my opinion. After several weeks, including interviewing (as suggested by me), a prominent stock broker committee member of the STC and a brother of the then Prime Minister for their views to reverse the decline in horse-racing, there would be a presentation of the report by Mr Quek Chee Hoon to the Board of Directors of the STB and the BTC in the STB office in Alexandria PSA Tower. I did talk to the trainers and the jockeys and would submit my observations and analysis of the facts and figures by faxing a page of report with "analysis", directly to Mr Quek Chee Hoon. For example, I had faxed once, a report that a 3-horse race should not be permitted to start as it would be easy to fix the race and "tum" the tote. At that time, there was an insufficient number of horse running per race and so 3-horse races were permitted. As Mr Quek did not speak to me directly, there being a hierarchy of management from the Chief Stipendiary Steward as my boss to the General Manager of the BTC and then to STC, I did not expect any reply from him nor did he contact me. One day, the Racing Manager mentioned to me that Mr Quek asked him why he did not provide the "Analysis" when he submitted the racing statistics to Mr Quek. I did not inform him about my few faxed reports with "Analysis" to Mr Quek. Finally, the big day came for presentation of the report by Mr Quek to the Board. "You have to be present," Mr Quek instructed the Betting and Racing Managers and myself through Mr Lim. Just in case, we had to answer some questions from the Board. Mr Quek presented slides from a projector. There were no fanciful Power Point slides in 1989, if I remember correctly. At the end of his presentation, Mr E.W. Barker, a well-respected politician, horseman and Chairman of the BTC said "Good report, well done." Some 2- 3 weeks after Mr Quek's presentation, an inaugural racing magazine published a report on racing written by me. The Editor wanted an article on horse-racing and since I had done much research on the "racing decline", I gave him my report. It took me many weeks to compress all my research and findings into this report. It was a "monotonous black and white report" and I did not think of submitting this to Ms Lim or anybody as the report was in a mess of text, pictures and graphs that needed to be gelled to be readable. However, the magazine Editor had staff and produced this report in an interesting way, with colour and good layout. I hoped that this report would have an impact in an inaugural magazine rather than some pieces of written report to the STB and benefit the trainers and jockeys. I do not know whether it was of any use. A few days after the publication of this article, the General Manager of the BTC wanted to see me in his office and to let me know that all publications should be vetted first. I expected this administrative control in any organisation. So I phoned the magazine Editor to kill Part 2 of this article. It is 2012 now and I believe that the horse trainers and jockeys have a better stake in racing than before the STB took over.Dr Goh Keng Swee's few good men and women tasked to reverse the horse racing decline - Parts 1 & 2 will be located at Horses in www.toapayohvets.com |
993. Dr Goh Keng Swee's few good men & women tasked to reverse the decline in racing - Part 1
| Dr Goh Keng Swee's few good men and women tasked to reverse the horse racing decline - Part 1Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS17 June, 2011 |  toapayohvets.com Be Kind To Pets Veterinary Education Project 2010-0129 | ||
| |||
http://www.sinpets.com/F5/201006256history-1988-horse-racing-decline-veterinary-ToaPayohVets.htm
Saturday, May 12, 2012
992. Key Performance Indicators - Spay at Toa Payoh Vets
Key Performance Indicators (KPI) for a veterinary surgery - spay of a Chihuahua. The KPI is used to assess the performance of a process to ensure that efficiency and efficacy are produced to maintain a high standard of work. In the process of spay at Toa Payoh Vets, the KPI of the veterinary surgeon are illustrated below.
Case study of a Chihuahua spayed by Dr Sing K Y
Sunday May 6, 2012
New client. A young lady with her parents from North Singapore had booked me to spay their Chihuahua. Female, 8 months. Said to have heat 2 months ago. I noted that the vulva was still swollen.
I used this case to mentor Dr Daniel so that he could see how an experienced vet would handle a case in the fastest, safest and most efficient way. Veterinary surgery text on spays don't reveal the practical aspects of the real life and death situation. He was to ask questions about the spay.
1. PRE-OP.
1.1 Inpatient record. General health check up by Dr Daniel. Weight of dog: 1.7kg
1.2 The owner did not want blood test.
1.3 Clipping the surgical area outside the Surgery Room.
1.4 Anaesthesia & surgical record. Dr Daniel to calculate sedation dosage at 50% of the formula for Domitor (0.034 ml) + Ketamine (0.043) IV and add equivalent amount of 0.07 ml normal saline to make it 0.14 ml to be given IV by me.
1.5 Absorbable suture packet 3/0 x 1 was prepared. However, I used 2/0.
2. SURGERY ROOM
2.1 Sedation by m (Dr Sing K Y). Mr Min would hold the dog and distended the left foreleg cephalic vein. He was still not good at this despite his at least one year of experience. Somehow, he did not press the right elbow skin area and so the cephalic vein was not distended. I tried the IV but found no blood drawn out. I asked him to twist the skin to the side and the cepahlic vein was visible.
For some reasons, Mr Min can't distend the cepahlic vein in some dogs but could do in others and today was his bad day.
I knew the dog would not stay still long. So, once I injected and saw the blood gushing inside the syringe, the dog started withdrawing her left foreleg. I injected immediately instead of waiting. There was no time to waste as the full dosage to be given was just 50% of the calculated dose. "The whole dosage might not be injected," I said to Dr Daniel as the dog had withdrawn her leg as I completed the injection. It was a wink of the eye. However, the dog quietened and dropped her head. She was sedated within 60 seconds.
2.2 As 50%* of the formula is insufficient sedation for intubation, I asked Mr Min to give isoflurane gas at 5% for less than 60 seconds. It was around 40 seconds. I intubated the dog. There was slight coughing but soon the dog was anaesthesized and maintained on isoflurane at around 1%. Mr Min was to record the % at 5-minute intervals.
(*At 100% of the formula, no isoflurane gas would be necessary but I seldom use 100% as isoflurane gas is much safer and the dog wakes up at the end of spay. Giving 100% would delay waking up. Each procedure has its pros and cons).
2.3 Dog's belly shaved and cleaned.
2.4 Skin and linea alba incision. In this dog, the umbilical scar was not distinct. So I made the incision a bit further than the usual 1 cm from the scar. I showed how I blunt dissected the subcutaneous fat in less than 2 seconds to show the white fibrous linea alba. Many new vets took longer to find the linea alba due to slow dissection and separation of the fat. Sometimes, the new vet could not see the linea alba due to the cloudiness of the SC fat masking the white line. A piece of SC fat could be cut off if the dog was fat so that the linea alba can be seen.
Then I had to extend cranially to expose the left ovary as the ovary was leaning very close to the cranial edge of the incision without giving me access to the ovarian ligament. "The left ovary is more cranial than the left," I said to Dr Daniel. "I have to extend the incision to expose the whole ovary and the ovarian ligament."
QUESTION. "You didn't break the ovarian ligament of the left ovary," Dr Daniel said as I extended the incision of the linea alba cranially by 3 mm and could ligate the ligament.
REPLY. "There is no need to break the ovarian ligament in the Chihuahua if the left ovary is well exposed," I said. "You will note that the right ovary is easily exposed as it is more caudal and I did not need to cut or rupture the ovarian ligament. However, in larger breeds and with small incision, the ovarian ligament can be stretched and cut before ligation of the ligament."
3. The uterine body was ligated once.
4. Linea alba closed with 3 interrupted sutures.
5. Skin incision (2 cm long) was closed with 2 horizontal mattress sutures.
6. No bleeding but the ovaries and uterine bodies were swollen and red, indicating heat was still present. There was some bleeding of the surrounding tissues due to the dog being on heat.
7. Post-op tolfedine and baytril SC. 4 days of tolfedine. One bottle of trimethoprim and one bottle of multi-vitamin. E-collar and bandage of wound.
8. Dog woke up just as I completed the last stitch as I had asked Mr Min to switch off the isoflurane 1 minute as I stitched the skin.
SUGGESTION. "It is better not to switch off the isoflurane and disconnect in case of emergency," Dr Daniel suggested.
ANSWER. "Based on the smooth anaesthesia, such happening is unlikely. However, the endotracheal tube is still inside the dog if there is an emergency." In any emergency, there will be cardiac massage first, in my experience, rather than oxygen.
POST-OP. The Chihuahua got up without crying within 2 minutes of completion of stitching. This meant I don't need to give Antisedan antidote to reverse Domitor. The surgery took a longer time as I had to extend the cut cranially and to hook out the left uterine horn. In this case, after 6 tries and hooking up the small intestine, I switched to hooking out the right uterine horn and was successful. This delay added up to several seconds. Normally, I could hook out the left uterine horn in 3 attempts. But veterinary surgery is full of surprises.
THE ANAESTHESIA AND SURGICAL RECORD
Weight Domitor Ketamine
Healthy, young, 10kg 0.4 ml 0.5 ml
Healthy, young, 1.7kg 0.068 ml 0.085 ml
*Give 50% 0.034 ml 0.043 ml
Actual given 0.03 ml + 0.04 ml = 0.07 ml. Add 0.07 ml normal saline. Total IV = 0.14 ml.
KEY PERFORMANCE INDICATORS
A: Injection of induction drugs: 10.45 am
B: Isoflurane first given: 10.46 am. Intubated.
C: Isoflurane gas stopped: 11.15 am
D: First skin incision: 10.54am
E: Skin stitching completed: 11.17 am
E-A = 33 minutes
E-D = 23 minutes
C-B = 29 minutes
BENCHMARKING SPAY PROCEDURE
The Chihuahua spay surgery by an experienced vet with 40 years of spay experience like me took around 23 minutes in this Chihhuahua. It could be as short as 15 minutes but I don't expect younger vets to achieve this benchmark. However, one hour is too long.
TIP: "The hydraulic operating table must be adjusted to the proper height for the vet to operate comfortably and efficiently," I said to Dr Daniel. Each vet has his or her own height and so it is best not to bend double by not making full use of the hydraulics of Toa Payoh Vets' operating table in long surgeries like spay.
QUESTION: "How is it possible for a spayed dog to bleed on heat when she is spayed?" Dr Daniel asked me when I said that there are complaints of dogs and cats still cycling with heat when they have been spayed. "Usually there is a bit of ovarian tissue left behind," I explained that the left ovary is more cranial. So, a vet may incise a bit of ovarian tissue after ligation of the ovarian ligament. The prevention is to make a bigger linea alba incision to expose the whole ovary and ligament. This means making a big skin cut which cannot be helped. Owners are unhappy when spayed dogs and cats come on heat staining the floor with blood and with cats, continuous caterwauling can drive the owner crazy as evident in one case of a spayed cat.
A spay is not that simple after all. Besides being on heat, there are reported cases of stump pyometra. I encountered one such case of a dog spayed by Vet 1, in the last 40 years of practice and that would be due to remnant of ovarian tissues left during spays.
All veterinary surgeries will adopt a consistent process and approach as described in this case study. I will be doing my trust and audit of some veterinary surgeries done by my associate vets.
In the April 20, 2012, AVA Veterinary Clinic inspection of Toa Payoh Vets, the letter of the annual renewal of the licence mentioned that the clinic was well managed. I intend to ensure that it will be well managed with the trust and audit procedures. It will always be difficult to effect changes for the better and this needs time and explanation.
Updates and more images are at this webpage:
http://www.kongyuensing.com/animals/20120436spay-chihuahua-post-op-follow-up-toapayohvets-singapore_ToaPayohVets.htm
Case study of a Chihuahua spayed by Dr Sing K Y
Sunday May 6, 2012
New client. A young lady with her parents from North Singapore had booked me to spay their Chihuahua. Female, 8 months. Said to have heat 2 months ago. I noted that the vulva was still swollen.
I used this case to mentor Dr Daniel so that he could see how an experienced vet would handle a case in the fastest, safest and most efficient way. Veterinary surgery text on spays don't reveal the practical aspects of the real life and death situation. He was to ask questions about the spay.
1. PRE-OP.
1.1 Inpatient record. General health check up by Dr Daniel. Weight of dog: 1.7kg
1.2 The owner did not want blood test.
1.3 Clipping the surgical area outside the Surgery Room.
1.4 Anaesthesia & surgical record. Dr Daniel to calculate sedation dosage at 50% of the formula for Domitor (0.034 ml) + Ketamine (0.043) IV and add equivalent amount of 0.07 ml normal saline to make it 0.14 ml to be given IV by me.
1.5 Absorbable suture packet 3/0 x 1 was prepared. However, I used 2/0.
2. SURGERY ROOM
2.1 Sedation by m (Dr Sing K Y). Mr Min would hold the dog and distended the left foreleg cephalic vein. He was still not good at this despite his at least one year of experience. Somehow, he did not press the right elbow skin area and so the cephalic vein was not distended. I tried the IV but found no blood drawn out. I asked him to twist the skin to the side and the cepahlic vein was visible.
For some reasons, Mr Min can't distend the cepahlic vein in some dogs but could do in others and today was his bad day.
I knew the dog would not stay still long. So, once I injected and saw the blood gushing inside the syringe, the dog started withdrawing her left foreleg. I injected immediately instead of waiting. There was no time to waste as the full dosage to be given was just 50% of the calculated dose. "The whole dosage might not be injected," I said to Dr Daniel as the dog had withdrawn her leg as I completed the injection. It was a wink of the eye. However, the dog quietened and dropped her head. She was sedated within 60 seconds.
2.2 As 50%* of the formula is insufficient sedation for intubation, I asked Mr Min to give isoflurane gas at 5% for less than 60 seconds. It was around 40 seconds. I intubated the dog. There was slight coughing but soon the dog was anaesthesized and maintained on isoflurane at around 1%. Mr Min was to record the % at 5-minute intervals.
(*At 100% of the formula, no isoflurane gas would be necessary but I seldom use 100% as isoflurane gas is much safer and the dog wakes up at the end of spay. Giving 100% would delay waking up. Each procedure has its pros and cons).
2.3 Dog's belly shaved and cleaned.
2.4 Skin and linea alba incision. In this dog, the umbilical scar was not distinct. So I made the incision a bit further than the usual 1 cm from the scar. I showed how I blunt dissected the subcutaneous fat in less than 2 seconds to show the white fibrous linea alba. Many new vets took longer to find the linea alba due to slow dissection and separation of the fat. Sometimes, the new vet could not see the linea alba due to the cloudiness of the SC fat masking the white line. A piece of SC fat could be cut off if the dog was fat so that the linea alba can be seen.
Then I had to extend cranially to expose the left ovary as the ovary was leaning very close to the cranial edge of the incision without giving me access to the ovarian ligament. "The left ovary is more cranial than the left," I said to Dr Daniel. "I have to extend the incision to expose the whole ovary and the ovarian ligament."
QUESTION. "You didn't break the ovarian ligament of the left ovary," Dr Daniel said as I extended the incision of the linea alba cranially by 3 mm and could ligate the ligament.
REPLY. "There is no need to break the ovarian ligament in the Chihuahua if the left ovary is well exposed," I said. "You will note that the right ovary is easily exposed as it is more caudal and I did not need to cut or rupture the ovarian ligament. However, in larger breeds and with small incision, the ovarian ligament can be stretched and cut before ligation of the ligament."
3. The uterine body was ligated once.
4. Linea alba closed with 3 interrupted sutures.
5. Skin incision (2 cm long) was closed with 2 horizontal mattress sutures.
6. No bleeding but the ovaries and uterine bodies were swollen and red, indicating heat was still present. There was some bleeding of the surrounding tissues due to the dog being on heat.
7. Post-op tolfedine and baytril SC. 4 days of tolfedine. One bottle of trimethoprim and one bottle of multi-vitamin. E-collar and bandage of wound.
8. Dog woke up just as I completed the last stitch as I had asked Mr Min to switch off the isoflurane 1 minute as I stitched the skin.
SUGGESTION. "It is better not to switch off the isoflurane and disconnect in case of emergency," Dr Daniel suggested.
ANSWER. "Based on the smooth anaesthesia, such happening is unlikely. However, the endotracheal tube is still inside the dog if there is an emergency." In any emergency, there will be cardiac massage first, in my experience, rather than oxygen.
POST-OP. The Chihuahua got up without crying within 2 minutes of completion of stitching. This meant I don't need to give Antisedan antidote to reverse Domitor. The surgery took a longer time as I had to extend the cut cranially and to hook out the left uterine horn. In this case, after 6 tries and hooking up the small intestine, I switched to hooking out the right uterine horn and was successful. This delay added up to several seconds. Normally, I could hook out the left uterine horn in 3 attempts. But veterinary surgery is full of surprises.
THE ANAESTHESIA AND SURGICAL RECORD
Weight Domitor Ketamine
Healthy, young, 10kg 0.4 ml 0.5 ml
Healthy, young, 1.7kg 0.068 ml 0.085 ml
*Give 50% 0.034 ml 0.043 ml
Actual given 0.03 ml + 0.04 ml = 0.07 ml. Add 0.07 ml normal saline. Total IV = 0.14 ml.
KEY PERFORMANCE INDICATORS
A: Injection of induction drugs: 10.45 am
B: Isoflurane first given: 10.46 am. Intubated.
C: Isoflurane gas stopped: 11.15 am
D: First skin incision: 10.54am
E: Skin stitching completed: 11.17 am
E-A = 33 minutes
E-D = 23 minutes
C-B = 29 minutes
BENCHMARKING SPAY PROCEDURE
The Chihuahua spay surgery by an experienced vet with 40 years of spay experience like me took around 23 minutes in this Chihhuahua. It could be as short as 15 minutes but I don't expect younger vets to achieve this benchmark. However, one hour is too long.
TIP: "The hydraulic operating table must be adjusted to the proper height for the vet to operate comfortably and efficiently," I said to Dr Daniel. Each vet has his or her own height and so it is best not to bend double by not making full use of the hydraulics of Toa Payoh Vets' operating table in long surgeries like spay.
QUESTION: "How is it possible for a spayed dog to bleed on heat when she is spayed?" Dr Daniel asked me when I said that there are complaints of dogs and cats still cycling with heat when they have been spayed. "Usually there is a bit of ovarian tissue left behind," I explained that the left ovary is more cranial. So, a vet may incise a bit of ovarian tissue after ligation of the ovarian ligament. The prevention is to make a bigger linea alba incision to expose the whole ovary and ligament. This means making a big skin cut which cannot be helped. Owners are unhappy when spayed dogs and cats come on heat staining the floor with blood and with cats, continuous caterwauling can drive the owner crazy as evident in one case of a spayed cat.
A spay is not that simple after all. Besides being on heat, there are reported cases of stump pyometra. I encountered one such case of a dog spayed by Vet 1, in the last 40 years of practice and that would be due to remnant of ovarian tissues left during spays.
All veterinary surgeries will adopt a consistent process and approach as described in this case study. I will be doing my trust and audit of some veterinary surgeries done by my associate vets.
In the April 20, 2012, AVA Veterinary Clinic inspection of Toa Payoh Vets, the letter of the annual renewal of the licence mentioned that the clinic was well managed. I intend to ensure that it will be well managed with the trust and audit procedures. It will always be difficult to effect changes for the better and this needs time and explanation.
Updates and more images are at this webpage:
http://www.kongyuensing.com/animals/20120436spay-chihuahua-post-op-follow-up-toapayohvets-singapore_ToaPayohVets.htm
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