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      Date:   28 March, 2011  

Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits

Toa Payoh Vets Clinical Research
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Seek Veterinary Advices To Become More Competent
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
28 March, 2011
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129
Yesterday, Saturday March 27, 2011, I attended a continuing education lecture by a veterinary anaesthesia specialist, Dr Kieren Maddern, BVSc (Hons), MACVSc, Dip ECVAA, European Specialist in Veterinary Anaesthesia. The topic was "Overcoming the odds - Anaesthesia for difficult situations."

It was a very well attended lecture - some 70 people there. An excellent lecture. I caught up with a senior vet who has done a few thousand dog and cat surgeries over the last 40 years and asked his advices about young vets referring corneal ulcer cases to other practices as I had an unusual incident, written in
Passing the buck - Perforated corneal ulcer

He said: "The young vet may find that it is a difficult case or that the owners are the type liable to sue. So, just refer the case out to others. No more headaches of the AVA investigation if the owners complain. Just like the Old School Vet who just do simple cases. Maybe your young vet thinks that you can't do the surgery! Young vets do not usually ask for advice but just refer the cases away to others!

"When the case goes from Toa Payoh Vets to the other vet, the other vet will just laugh and say 'Dr Sing does not even know how to operate a simple corneal ulcer case! What's wrong with him?' Maybe you should give instructions that all cases that your younger vets want to refer to others should go through you!"

I was not alone in having this problem of the younger vets doing their own thing without consulting the senior vets in the same practice. I told the senior vet: "I do treat corneal ulcers using the 3rd eyelid flap method and do stitch up corneas if necessary."

The senior vet told me: "Tarsorrhapy is very effective in corneal ulcer cases. Even in cases where the eyeball collapses. No need to stitch up the cornea*. Just sew up the two eyelids and the outcome is very good. I find that the eyeball is seldom infected even with perforated ulcers."

I listened attentively for the free advice. This senior vet is 5 years older than me and I had hung around his practice when I first started Toa Payoh Vets 20 years ago. I just stayed around till past midnight as he was and is a workaholic and closed my Toa Payoh Vets in the evening. 

He still works the long hours and do the after hours emergencies. High energy and therefore he has more caseload experiences for me to tap.

"By the way, how do you treat corneal ulcers in the dog? Do you just do the 3rd eyelid flap by itself?" my mentor asked.

"I am more kiasu," I said. "I do the 3rd eyelid flap and tarsorrhapy. Not all the time as I also do tarsorrhapy by itself."

It is always good to ask the older vets how a procedure is done, to tap on the years of experience and wisdom. As veterinary medicine and surgery is so diverse (from head to toe), it is not possible for a young or older vet to know everything. Human doctors do specialise in one system e.g. heart diseases but vets are expected to know all systems and that takes years and years to master all the main problems of the various systems. At the age of 60 years, I still encounter new and rare cases in dogs and cats although I have been in practice for over 40 years!

A young vet has to overcome his or her inability to ask older and possibly more intimidating seniors for advice. Asking may make you sound incompetent but if you overcome this negative thought and ask to make yourself more competent and wiser, you will be confident enough to ask and receive good veterinary tips and advices.

P.S
No need to stitch up the cornea* - this depends on the extent of laceration as most corneal ulcers in dogs with extensive lacerations are hopeless cases. Owners of such dogs don't seek veterinary treatment early! Each case is unique and stitches do break down requiring repeat sewing of the eyelids.   

The follow up and pictures of my case in a Jack Russell where I did the 3rd eyelid flap and tarsorrhapy with an excellent outcome is shown below.

Eye corneal ulcers can lead to eyeball rupture and loss of eye-sight. Toa Payoh Vets Eye corneal ulcers can lead to eyeball rupture and loss of eye-sight. Toa Payoh Vets Eye corneal ulcers can lead to eyeball rupture and loss of eye-sight. Toa Payoh Vets
tpvets_logo.jpg (2726 bytes)4041 - 4043. Eye pain and rubbing requires emergency treatment if you don't want your dog to become blind. Eye Problems
  pug 7 months, injuries serious, deep central ulcerative keratitis, leakage aqueous toapayohvets singapore tpvets_logo.jpg (2726 bytes)

BE KIND TO DOGS & CATS --- GET EYE ULCERS TREATED WITHIN 4 HOURS --- IF YOU DON'T WANT THEM TO BE BLIND.  More case studies, goto:  Cats  or  Dogs

To make an appointment: e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326

toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129
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Clinical Research
 

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