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Cardiology takes a lot of heart—and Dr Rita Singh embraces the triumphs and challenges that come with the job. By Kerryn Ramsey
The desire to pursue a veterinary specialisation is a personal choice and everyone has their own reasons to do so. Specialists provide effective outcomes for patients by utilising their training, specialised equipment and specific knowledge.
This was the path for Dr Rita Singh who owns and operates Veterinary Cardiac Referrals (VCR), a mobile service covering Perth and the surrounding areas. An expert in diagnosis and treatment of all kinds of heart problems for pets, she embraces this specialisation. VCR is a one-person operation that’s booked out for weeks in advance.
“The most common procedure is echocardiography,” says Dr Singh. “When I’m treating an animal with a suspected heart murmur, I first image the heart to visualise it and figure out what’s going on. I also do ECGs for dogs and cats with irregular heartbeats. In dogs, the most common disease in middle to old age is degeneration of the heart valves. In cats, it’s hypertrophic cardiomyopathy, a thickening of the left ventricular heart muscle. While we’re starting to see some surgical options, both diseases are still largely managed with medication.”
Challenging aspects
Dr Singh finds cardiology challenging, satisfying and endlessly fascinating. “I love it when I discover a puppy isn’t actually sick or the disease won’t impact on a normal healthy life for the animal. It’s also wonderful when I identify a problem I know I can fix. The owner is happy, and the dog goes on to live a normal life.”
The most challenging part of her job is her location and the lack of facilities available. “There’s no one place in Perth where I can do all my work,” she says. “Interventional procedures require expensive, specialised equipment but the most specialist hospitals in Perth don’t have the full range. I’m limited in what I can do and where I can do it. A lot of my time is spent doing surgeries in different specialist hospitals and travelling around ICU wards afterwards.”
While Dr Singh consults regularly in specialist hospitals, space is always an issue. Everyone is busy and even if she had extra staff, there’s nowhere to set up. Starting her own practice has been on her mind for a while.
I’m consistently booked up to six weeks in advance. I need to add a full-time nurse and resident because I never manage to catch up. While this appears to be a good problem, it’s not ideal when I have patients who can’t wait.
Dr Rita Singh, owner, Veterinary Cardiac Referrals
“I’d love to be in one place where I could take my appointments, do all my surgeries, and have ICU care,” she says. “The problem is that cardiology requires so much specialised equipment; it’s very expensive to set up. The surgeries I perform do not involve cutting into the chest but use catheters via arteries and veins to get to the heart. This still needs to be done very carefully with high-end imaging equipment and a specialist anaesthetist. If a thoracotomy is required, a specialist surgeon is required to do this. After-hours recovery in ICU requires further staffing. Being closely associated with a multidisciplinary specialist hospital allows me to undertake the vast majority of procedures. Realistically, I think starting my own practice is out of reach. But I never say never.”
Exotics on the go
A small but important part of VCR is treating exotics. Dr Singh originally planned to keep Fridays free so she could have a day off but that quickly transformed into exotics day. Perth Zoo is a frequent client.
“I’ve treated Galapagos tortoises, orangutans, chimpanzees, iguanas, snakes and foxes,” she says. “I often help the team from the Unusual Pet Vet practices in Perth to diagnose and treat guinea pigs, rabbits, rats and birds with cardiac disease. Even though these animals are small, I can usually get a diagnosis. Birds are difficult. They have such tiny hearts I can only get one view. Air sacs can also get in the way. Unfortunately, I can’t see everything all the time which means on occasion, a diagnosis is impossible.”
For the majority of cases, Dr Singh can identify a clear path forward but there’s always some cases that don’t want to be solved.
“Some patients don’t respond how I would like and I’m not sure how to continue,” says Dr Singh. “Fortunately, there’s a worldwide forum of veterinary cardiologists where we talk about cases. It’s really helpful to get other specialists’ opinions.”
Follow your heart
When she graduated from Murdoch University in 1995, work prospects were very different to what they are today. There was a glut of qualified small animal vets and jobs were extremely hard to come by, particularly in a less populous city like Perth.
“Your only choice was to relocate to the country and work in a mixed practice,” says Dr Singh. “That didn’t appeal to me so I moved to England, working there for three years. During that time, I decided to specialise. My plan was to return to Perth, go back to Murdoch University and do an internal medicine residency.”
Things didn’t go exactly to plan, and instead she moved to Sydney in the early 2000s. Dr Singh undertook an internship at the University or Sydney followed by a residency in internal medicine at a private practice in Sydney. Cardiology was only one part of her studies but it sparked a passion. She finished her residency, became a specialist in internal medicine, but decided she needed to actively pursue cardiology.
In 2008, she moved to the USA to attend the University of California, Davis, and undertake a three-year cardiology residency. “My long-suffering husband was right there with me through two different residencies, which I appreciate. Most marriages struggle to last through one residency! The outcome was that I could finally do what I love.”
Back home
Dr Singh and her husband returned to Sydney in 2011 where she worked in private specialist hospitals for the next seven years. She finally took the plunge and became her own boss in 2018, setting up VCR in Sydney. The business operated successfully until 2022, when Dr Singh moved back to Perth, closing VCR Sydney and opening VCR Perth. Initially, she had a few concerns about whether such a specialised referral service would be viable in her hometown.
“I hoped it would give me the opportunity for a better work-life balance but that was not to be,” says Dr Singh. “I provide a mobile service and visit different specialist hospitals. I’m consistently booked up to six weeks in advance. I need to add a full-time nurse and resident because I never manage to catch up. While this appears to be a good problem, it’s not ideal when I have patients who can’t wait.”
While Dr Singh deals with many elderly animals, there’s also a high proportion of younger patients.
“Being the only animal cardiologist in Perth, I see a lot of congenital diseases of puppies,” she says. “These are dogs born with a cardiac abnormality. Not everything can be fixed, but a lot can. I can place a plug in an abnormal vessel that shouldn’t be there. If a vessel is constricted and stopping blood flow, I can dilate it with a balloon catheter. Older dogs, and sometimes young dogs, with very slow heart rates can be fitted with pacemakers.”
A pleasant surprise for Dr Singh is the willingness of clients to cover the cost of these types of interventions.
“I’ve had clients who’ve owned a puppy for two weeks but have strongly bonded,” she says. “The puppy is seriously ill but the clients wouldn’t even consider putting it down. They happily pay whatever it costs to improve their puppy’s quality and length of life. It’s these interactions that makes me glad I became a cardiologist. I wouldn’t want to do anything else.”
