Monday, May 31, 2010

Follow-up on Chihuahua after urinary stone surgery

May 31, 2010

The owner cycled to the Surgery to settle his bills.

"How's the Chihuahua?" I asked.

"He's OK in his urination. Sometimes I do see some blood in his urine but this is rare."
"The colour may not be blood. It is best to get his urine checked. Does he still go outdoors and pee a lot at the first time?"

"No," he said. "He just pees here and there in his favourite bushes. He will pee till he has nothing to pee. Yet he still lifts his legs to pee."

"Do you feed dry dog food anymore?" I asked.

"No more as you advised. But sometimes, when his stools are watery. Dry dog food hardens his stools."

"Does he urine-mark inside the apartment?" I presumed he was staying in the same place.

"No, not at all. He will go outdoors twice a day and urine marks till he has nothing left in his bladder and still he goes on and on."

I suspected the occasional blood in the urine could be due to traumatic injury. So I asked the tall slim man in his 40s: "Does the dog humps on cushions?"

"Yes," the owner said.

"He might have injured himself with too much of this humping. Does he grip people's legs and rub against the leg?"

I was surprised when the owner said: "He does grip my left frequently."

"Daily?"

"Yes," the owner replied.

"You should stop him," I advised. "Or get him neutered."

"I thought the dog needs to do it. So I did not push him away."

"The cause of blood in the urine could be due to penile tip injury. Some male dogs have a strong behaviour to self-stimulate. Probably he licks his scrotum too."

"Yes," the owner said.

"Neutering will remove his urge to behave this way obsessively everyday."

"I will think about it," the owner said. It was about to drizzle. He cycled home quickly. I was not surprised at the anti-social behaviour of this male dog as humping is a common observation and shown in some movies as a humourous joke. Therefore to this owner, the behaviour is perfectly normal.


Update at www.toapayohvets.com

85. Plastic grate + pee pan house breaking

Thank you for your email. My reply is in CAPITAL letters below.


E-MAIL TO DR SING AND DR SING'S REPLY IN CAPITAL LETTERS

From: ...@gmail.com>
Subject: Help for toilet training
To: judy@toapayohvets.com
Date: Monday, May 31, 2010, 11:36 AM

Hello Dr. Sing,

I am a first time dog owner and has specially taken one week leave to toilet train my dog. I feel a bit frustrated now that I am not seeing any results.

IT TAKES 4-8 WEEKS OF CONFINEMENT AND TRAINING TO SEE SUCCESSFUL RESULTS

I just got my toy poodle named Ginger, close to 3 months old, back home on Saturday afternoon. I have set up my playpen as per the photo attached.

I have been trying hard to train her to get up onto the Pee tray. Sometimes she pees on the pee tray (that's when we confined her to just the pee tray) by a fence in btw. Yet most of the times, she will pee outside the Pee tray-Black area.

THERE ARE A FEW REASONS FOR THIS BEHAVIOUR.
1. YOUR PUPPY MAY BE USED TO PEEING ONTO THE SOLID FLOOR. YOU NEED TO LET ME KNOW WHAT TYPE OF FLOORING SHE WAS USED TO AT THE BREEDER'S HOME. IT MAY BE JUST TILED FLOORS. SO THE PEE TRAY BLACK AREA CLOSELY FEELS LIKE THE TILED FLOOR. CHECK WITH THE BREEDER. I suspect that your new puppy has no experience with this yellow plastic grate as the breeder or seller never uses it. It is usually sold to puppy buyers. The puppy has been used to another type of grate or flooring and so you do not expect her to eliminate on it.

URINE SMELL. For the yellow grate, you need to put urine smell (tissue paper with puppy's urine smell onto the pee pan. This pee pan is below this yellow grate. I hope you know what I mean.

2. YOUR PUPPY MAY BE THE TYPE THAT IS VERY CLEAN AND FUSSY. YOU WILL NEED TO WASH THE GRATE everytime she pees on it and also to get some urine smell onto the pee pan.

THE YELLOW THING IS CALLED THE GRATE + PEE PAN WHICH COLLECTS URINE BELOW THE GRATE. THE BLACK THING IS ALSO A PEE PAN OR PEE TRAY.

The spot she always pee outside the pee tray is the spot closest to us, marked "X" .Weirdly that's the area where we feed her food.

SHE HAS NO CHOICE FROM THE LAYOUT OF YOUR PLAYPEN. THE BACK OF THE BLACK PEE PAN IS WHERE SHE SLEEPS. THE YELLOW GRATE IS AVOIDED BY HER, I PRESUME. SO SHE HAS TO PEE ON THE FRONT PART OF THE BLACK PEE PAN.

MANY OWNERS HAVE PROBLEMS WITH TRAINING THE PUPPY ON THIS YELLOW PLASTIC GRATE + PEE PAN BECAUSE THE PUPPY IS USED TO THE WIDER METALLIC GRATE. GO AND VISIT PET SHOPS SELLING PUPPIES AND YOU WILL KNOW WHAT I MEAN OR SEE MY PICTURES OF GRATE + PEE PAN IN MY WEBSITE. YOUR PUPPY IS ONE OF THEM.

When she pees correctly on the pee tray, i will say "Good" , "Pee pee here", pat her and give her a treat.

PRAISE AND TREAT IS CORRECT. HOWEVER, DID YOU WASH THE YELLOW GRATE + PEE PAN? YOUR PUPPY MAY AVOID STEPPING ON IT AS SHE CAN SMELL IT AS UNCLEAN.

Sometimes, I like to say "Pee pee here" at the pee tray and get her to come to the Pee tray and put her in the peeing position. But she doesn't pee most of the time.

IT TAKES AT LEAST 4 WEEKS OF TRAINING AND CLOSE MONITORING AND TEACHING. YOU CANNOT EXPECT RESULTS IN ONE WEEK. KNOW THE HISTORY ABOUT HOW THE PUPPY PEES AT THE BREEDER AND LET ME KNOW.

Question 1: May I know if my method is correct? Cause weirdly after treating, the next time she still pees wrongly.

METHOD OF ORAL COMMAND, PRAISE AND TREAT IS CORRECT. BUT CAN YOUR REALLY STAY WITH THE PUPPY 24 HOURS. I DOUBT YOU CAN DO IT. SHE PEES EVERYWHERE INCLUDING THE FRONT OF THE BLACK PEE PAN.

THE SOILED YELLOW GRATE AND THE BLACK PEE PAN NEEDS TO BE WASHED PROPERLY. URINE SMELL ON THE BLACK PEE PAN (FRONT PART) NEEDS TO BE NEUTRALISED WITH VINEGAR:WATER AT 1:3 TO PREVENT MORE PEEING THERE.

Question 2: She got two ways of peeing. One is semi squat (the usual way), the other is " she will jump onto the fence-Legs on ground, hands on the fencing and pee. Is that normal?

YES. SOME OWNERS OF PUPPIES DO TELL ME THAT THEIR PUPPIES GRIP THE FENCING TO PEE. MOST LIKELY THIS IS BECAUSE SHE HAS NO SPACE OR IS TRYING TO AVOID THE FRONT PAWS STEPPING ON THE SOILED AREA. IF ONLY PUPPIES CAN TALK.

Question 3: For the past 2 nights she has been here, she poos in the early morning (eg 3-4am, 10am). I have peeped once before and saw that she poos with her legs on ground and hands on fencing. Do I have to stay up to make sure I catch her in the act and correct her when she poos?

IF YOU SLEEP NEAR THE PUPPY, YOU CAN DO THE HOUSE-BREAKING WITHIN 1-2 WEEKS. BUT THIS MAY NOT BE PRACTICAL FOR YOU. POOPING WITH FRONT PAWS ON THE FENCING IS DONE BY SOME PUPPIES, ACCORDING TO SOME OTHER OWNERS. I DON'T THINK IT IS ABNORMAL.

Question 4: Do I have to give her water often? I think maybe restricting her to peeing during certain hours could be better. So can I only give her water before play and during food time. Is that sufficient?

STOP ALL WATER AFTER DINNER OR 8 PM TO GET THE PUPPY HOUSE-BROKEN EARLIER. WATER AT ALL TIMES ADVISED. FOOD SHOULD BE GIVEN FOR 15 MINUTES AND TAKEN AWAY TO ENSURE THAT THE PUPPY DOES NOT EAT ALL DAY LONG. DO NOT DISTRACT THE PUPPY DURING FEEDING TIME AND SHE POOPS USUALLY WITHIN 30 MINUTES AFTER EATING. THIS IS NOT POSSIBLE IF YOU KEEP PLAYING OR DISTURBING HER.

My dog is very hyper. She doesn't seem to listen to my cue. When I say NO in a fierce manner, she doesn't really seem to catch it.

YOUR ORAL COMMANDS TAKE TIME TO BE USED TO. PROBABLY YOUR PUPPY DOES NOT KNOW WHAT YOU WANT. USE TWO WORDS INSTEAD OF 3 WORDS OR A SENTENCE AND USE THE SAME TWO WORDS FOR HOUSE-TRAINING.

You just need to be patient and keep at training. No other way.
See one case report at:
http://www.bekindtopets.com/dogs/20100158Grate_Training_Shih_Tzu_puppy_ToaPayohVets.htm

It may be useful for you. Let me know if you have any queries.


Draft report in this blog. Update is at www.toapayohvets.com

Sunday, May 30, 2010

84. Sunday case - 2nd opinion and feedback

Sunday 30th May 2010

The lady wanted a second opinion. Vet 1 said that her 5-year-old Chihuahua had heart disease and had prescribed a cough mixture (on the first visit) and heart drugs (Fortekor 5mg and a white capsule) on the second visit. The owner does not know what the white capsules were for.

It was a beautiful Sunday morning. One entrepreneur had opened a small office at Peninsula Plaza and I had dropped by at 9.30 am to congratulate her. Then I rushed back to the Surgery for this second opinion.

I put the stethoscope on the dog's chest on the right and left. "I confirm that your dog has a serious heart disease. Is he still coughing?"

"Well, he did cough 2 days ago, but not today."

"Your heart drugs need to be given regularly and listen to the coughing period. Your dog must not be permitted to be too active."

"I can give him the cough mixture when he coughs," the lady in her late 40s said.

"In heart disease, there will be water in the lungs. The dog wants to cough up the water from the lungs. If you give the cough mixture to prevent coughing, your dog will "drown" with excessive water inside the lungs."

Fortunately she did not self-medicate or her dog would have had died. She sought a second opinion and that was good for her dog.

"I must tell you that your dog will not live to a ripe old age of 15 years unlike some Chihuahuas," I had to give the owner the prognosis. "If you are careful with the heart drugs and monitor him closely for coughing or other signs, he may live longer. He may need more dosage over time or other drugs. I don't expect him to live more than 1-2 years."

The owner held back her tears. I checked my records as this dog had dental scaling and teeth extraction done by me one year ago. He was OK.

"Coughing at night started one month ago," the owner said.

"Why did you consult Vet 1?" I asked for feedback to improve my services. Was something lacking in this case? Well, Vet 1's surgery was much nearer to her apartment and that would be the main reason.

"Vet 1 does not need appointments," the lady said. "She is very busy as there is a big crowd of patients. I had to wait one and a half hours to see her."

This feedback is important to me. No appointments mean more business perhaps? Dog owners in Singapore dislike appointments or are there more factors for owners to switch loyalty? I am sure the causes are many. I am glad that this owner got a second opinion. I asked her to check with Vet 1 what the white capsules were for and to keep in touch.

P.S It is deadly to give cough mixture to dogs with heart disease. Try and get proper veterinary advices.

83. Sudden death during boarding

May 29, 2010 Saturday was my day off and it was a hot sunny day. Sex and City 2 movie was shown. I appreciated the better script and the great humour about menopausal hot flushes and irritable moods in Abu Dhabi, of actress called Samantha in the movie Sex and City 2.

During dinner, I went to the Inle Restaurant at Marina Square served a well cooked fried sweet, sour and chilly bass. This was the first time I had been to this outlet although I had eaten several times at the Peninsula outlet. I was pleasantly surprised that the fish was well presented and cooked to my taste. I am wary of smelly fish dishes not cooked properly. Then my mobile phone rang at 8.30 pm.

"A dog boarded at a kennel had died after a shower. Can you certify that he is dead?" Groomer Clara phoned me. I had known her for over 5 years and could trust her when she said she would come. Some people don't turn up after making emergency or ordinary appointments and don't inform me. Therefore, I have to be careful nowadays. Still I had to wait 45 minutes at the Surgery for Clara to arrive.

"Can you wait till tomorrow Sunday morning?" I asked.

"The owner wants it done today," Clara said.
I went back to Toa Payoh Vets. Clara arrived with a dog boarding kennel operator in a very small rectangular type of van for 2 people.

The Maltese had died. Rigor mortis had set in. His tongue was dark purple. I could just certify that the dog had died and go away. However this sudden death would be very distressful to the owner. She might want some answers for closure.

"Let me talk to the owner," I said to Clara.

"I had transported this owner's other dog to see you," Clara said. As I saw Clara rarely, I had presumed that this owner was not a client of mine.

I asked my assistant to take out the case card after checking the computer and to write a death certificate while I phoned the owner. My assistant took the card out and wrote the certificate. I checked the certificate and spoke to Mr Saw: "Do check the dog as your details are those of another breed of the owner." As the card showed one dog's details, he assumed the dog info was that of the dead dog.

I spoke to the grieving owner: "Your dog had passed away suddenly from a heart attack. Did he show any breathing problem or coughing?"

"No," the lady said. "He went for urinary stone removal via the penis and then 2 months later, the vet took the stones out from the bladder."

"When was that?" I asked.

"One year ago," she said.

"The dog had fully recovered," I said. "I don't know what is the cause of the heart attack. Do you want a post-mortem to check the cause of death?"

The owner was not keen on this advice. She said: "I am in confinement." By that I presume she had just given birth to a baby. "What do you want to do with the dog? Do you wish to have him cremated?"

After some discussion, Clara would bring the dog back to the kennel and the owner would see him on Sunday.

Some dogs do die during boarding. Many owners don't do annual health screening of old dogs. This dog was around 7 years old and was in good body condition. The teeth was encrusted with tartar as no dental check up was done.

P.S
It is important for the vet to communicate with the owner as regards sudden death in a boarding kennel as sudden death of a beloved pet during boarding, far away from home, is a very emotional issue.

Annual health screening using blood and urine tests and dental examination are seldom done by the Singaporean dog owner. Many diseases can be prevented or controlled from annual health checks if you want your pet to live long.

Friday, May 28, 2010

82. 6-month-old cat neuter and spay


SHARING KNOWLEDGE ON INJECTABLE ANAESTHESIA IN THE STERILISATION OF CATS AT WWW.TOAPAYOHVETS.COM, SINGAPORE - PART 1

Frequently Asked Questions For Dr Sing

1. Best time to spay my female cat?
If cats are home-based and not permitted to stray outdoors, it is best to spay at 6 months of age as their private parts (vulva) will be be able to develop into adult size.

2. Best time to neuter my male cats?
I advise 6 months of age. However, if there is a male and female sibling cats living in the same apartment, the male will be much interested in the female at 6 months of age. Get them sterilised when interest is shown or neuter the male at 5 months.

One case study

Two domestic short haired cats were adopted as kittens.
At 6 months of age, the male was very interested in the female cat at 6 months.
During sterilisation, the female cat's ovaries were enlarge and blood vessels were very red and big, indicating the cat was on heat. However she was not pregnant. The owner stopped water and food at 10 pm the previous night. One website claims that cats can still be given water prior to surgery. I don't agree with this.

3. What anaesthesia I use in the sterilisation of cats in 2010?
I find the following combination in one syringe given by IM safe and effective

INJECTABLE ANAETHESIA IM
Male cat 4.2 kg
Xylazine 2% @ 0.15ml + Ketamine 0.6 ml IM
Surgery: 10 minutes after injection.
Excellent analgesia


Female cat 3.0 kg
Xylazine 2% @ 0.1 ml + Ketamine 0.4 ml IM
Surgery: 20 minutes after injection as there was some delay by my assistant in the clipping of hair and cleaning of the surgical area. The cat was awake by then. There is no problem as isoflurane gas by mask at 5% for around 60 seconds and to effect provided excellent analgesia.

The combination dosage for this cat should be similar to the one in the male cat if isoflurane gas top up is not needed.

4. Cat cats be sterilised at 3 months of age or younger?
I am aware that cat-control activists and shelters spay them as early as 3-4 months to prevent unwanted pregnancies. On one websigte, one "vet" working for an animal shelter said that anaesthesia is safe for such age groups as anaesthesia nowadays are better than those in the 1960s. She did not give the % of deaths or type of anaesthesia used.

5. Will my cat's left ear tip be cut off after sterilisation?
No. I don't do it, even in stray cats, unless the owner requests it to be done. Many owners actually dislike seeing their cats being "disfigured" but stray cat activists do get such surgeries done.

6. Can vaccinations be done at the same time?
Yes. However, I don't advise it as the cat is under stress of anaesthetic drugs, pain-killer drugs and antibiotics. But some owners don't have time. So, vaccination is done. Usually there are no adverse effects.




SHARING KNOWLEDGE ON INJECTABLE ANAESTHESIA IN THE STERILISATION OF CATS AT WWW.TOAPAYOHVETS.COM, SINGAPORE - PART 2


1. Observations of one cat neutered by me

I find the following combination effective as one IM injection

1.1. 3 kg cat. Today, I spayed a Ragamuffin, female, 1 year. 3 kg using injectable anaesthetic.
Xylazine 0.15 ml Ketamine 0.6 ml in one syringe IM
Duration of anaesthesia around 20 minutes in this case. I don't need isoflurane gas top up. This is the ideal situation as it means less operating time.

1.2 5 kg cat. I have used xylazine 0.2 ml and ketamine 0.8 ml IM without side effects.

2. IV
I don't use IV as I find it time consuming but it is one vet's favourite mode of administration and he following simple formula, easy to remember is shared with vets.

2.1 3-kg cat. xylazine 0.1 ml, ketamine 0.2 ml in one syringe, totalling 0.3 ml. Inject 0.1 ml IV first, then another 0.1 ml to effect.

2.2 5-kg cat. xylazine 0.1 ml and ketamine 0.4 ml, totalling 0.5 ml.
Note that you give 0.2 ml IV first. Then increase by 0.05 ml doses to effect. You don't need to use all 0.5 ml.

3. MY CONCLUSIONS
I prefer the IM method for ease of administration and permitting me to focus on surgery. I do give isoflurane gas by mask for a few seconds to top up if necessary. This is very effective.

However, the IV top-up method is excellent if you don't have isoflurane facilities. The cat is shaved 5 minutes after IM and I operate 10 minutes after injection. Many years ago, I used xylazine IM and then isoflurane gas for cat spay. Now, I don't use it as I find the IM method extremely effective in healthy cats.

In the IV top up method, an IV catheter has to be used and this seems to be less efficient in my opinion. Every time the analgesia is insufficient by observation of the painful movement or cries, the IV anaesthetic is injected by increments to effect. This method is important in countries where the gas anaesthetic machine and isolfurane gas are costly.

For me, a whiff of the isoflurane gas by mask for a few seconds seems more efficient and quieter. Obviously, the vet has to be vigilant on the signs of surgical anaesthesia in both the IV and gas top up. The cat under my regime wakes up earlier than those using IV and I prefer to see a cat up and about as soon as surgery ends.

Thursday, May 27, 2010

81. High cost of webmasters in Singapore

1. It was great meeting you one morning to talk about IT from a practitioner.

2. I attach two pictures about "Be Proactive To Make Your Dreams Come True" to inspire you as you are a young man and can achieve so many great things in life. I hope you like the 2 pictures and can see the story in the picture. If not, I will explain to you the story behind my 2 pictures.


3. You are I are service providers in our own industry. Sometimes, our points of view may differ from the customers' point of views. If we can give what our customers want, we will get excellent referrals and lots of businesses. Good quality business clients are from referrals who trust me rather than think that I am the cheapest vet in Singapore.

4. I wish to share with you my experience in looking for a webmaster from a "customer's point of view". Yesterday, a client of mine whose dog I treated, introduced me to her boss who has a website producing company in Joo Chiat. It is a small office with 2 men and my client. It is called .... This young girl will make an excellent frontline administration officer as she follows up for her boss and ensures that I meet him.

4.1 COSTS OF AN E-COMMERCE WEBPAGE
The boss had only one account that suited my requirements. It was a website with e-commerce payments by Nets, Master and Visa credit cards for a charity run by a local university. "How much to produce this website?" I asked. "$15,000".

Definitely, I can't afford this amount."Can I see the website?" I asked since the boss was showing me printouts from his file. I am looking for past performances before I engage a webmaster as webmasters in Singapore are extremely expensive compared to South Korea. From a report I read some years ago, most Korean companies have online pages as the costs are much lower. Singapore is still in the Dark Ages as many companies don't do it. Now I understand why few small enterprises in Singapore do e-commerce as $15,000 is really a lot of money.

When I asked for the website to be demonstrated online, the boss said, "Sorry, No more," He suggested that I use PayPal for e-commerce. This is a sensible idea as it saves a lot of costs from webmasters.

4.2 CONTENT MANAGEMENT SYSTEM (CMS). I can't afford to pay the webmaster for updates. In any case, the webmaster will have no timely updates for me as I update anytime and daily. The boss said he can provide a CMS whereby the client updates pictures and pictures himself. As to the software used for webpage design, he said it is proprietary.

4.3 WHAT I WANT IN A WEBMASTER. Basically, it is e-commerce and self-updating at least cost. To save a lot of time for both of us at the meeting, I had an example of what I want from another company and asked the boss to click on "Asia Travel Concierge". Unfortunately, this webpage seems to have "expired" when the boss tried to access it. And I could see it in the morning before I met him.

I hope the above will be useful in letting you know what I want from a webmaster. I hope you will persevere and succeed in your IT enterprise. Go for it. Build up your commercial client base. Be amongst the best webmasters by giving what your customers want and having a large portfolio to prove it if this aspect of IT is what you are passionate about. Sometimes, bread on the table may be more important for your long-term survival. But if passion is there, your clients will sense it and with referrals, you will get "manna from heaven." I have the wording on my desktop to remind me daily. It is "Belief, Passion, Drive & Perseverance".


With best wishes.

80. Employee vets and locums

May I share with you my personal views on veterinary assistants and locums in Singapore since I graduated in 1974 and had started my own practice www.toapayohvets.com in 1980?

Employee vets in Singapore want the maximum pay and the least hours of work. Many married lady vets want to work part-time and less days. It seems to me that there are many newly graduated vets but they are mainly ladies. They don't want the hard work - night duties, after-hour emergencies and so expatriate vets have opportunities in Singapore.

Inevitably, those hard-working ones will think they have better be their own bosses, after 2 years. Why work long hours and get a "salary"? But this is the reality of private practice. The employee vet who is calculating will never be happy because he or she feels exploited when the practice is very busy.

For you, I will advise you to think what you want in life? If you want to work in Singapore, take a package that is a "stepping stone" to know about the culture and make contacts in Singapore after your locum work is completed.

If you are really good in your veterinary work, I have no doubt you will earn more once you are here as referrals are very powerful in Singapore. There is a large expatriate community here and they do have the spending power. The practice you will be working in does not have the expatriate business. This is an opportunity for you to start getting expatriates for this practice and later to be your own boss.

But what do you want in life? Just be a flitting butterfly by doing locums? Locums are highly paid for hours worked but they do not build up a practice. If you just want to be a hired gunman on a project, as in the film "Have Gun Will Travel" (a famous English TV movie in the early 1960s), then, so be it. You may out-price yourself as there are other expatriate locums looking for jobs in Singapore too.

It is best to be your own boss from what I can read about you in your emails. In that case, you can fail as well as being successful. Much depends on you. Nobody knows what you want. I met a lady English Vet in Siem Reap in Cambodia. She was closing down the clinic as business was poor. She was there for around 2 years and was the only expatriate vet. But Singapore's small animal practice is so much different from Siem Reap and you, as an expatriate vet with many years of experience, should have a large clientele of Caucasian expatriates when you start up. Obviously, it is not a guarantee.

With best wishes.

Tuesday, May 25, 2010

79. 13-year-old Shih Tzu with black corneas

I was surprised that the Shih Tzu recovered fully from having pus leaking out from his almost 100$% pigmented cornea in his right eye. This meant he was blind in the right eye.


He was 13 years old and was with the young man since he was 6 years of age. I did a 3rd eyelid flap under general anaesthesia to close up his eye ulcer and also removed all his rotten teeth. He was very thin. Surprisingly he survived the anaesthesia. That was 6 months ago. He looked and behaved as young as a 8-year-old dog. "He recovered completely," the young man said. "Just a white spot in the centre of his right eye. What's his problem?

6 months later, he had tearing in his right eye. Lots of tears and red sclera and conjunctiva. The eye was infected. He was rubbing his right eye. A white blob of tissue has protruded from the central ulcer. An eye infection. It could be from the inside of the eyeball. Antibiotics and eye drops are given.

P.S
1. Check your Shih Tzu'e eyes daily. Don't let the black or brown pigments grow till they cover the cornea 100% as the dog will not be able to see. Pigmentation is usually due to corneal irritation over several years. Singapore owners don't know that the hairs in the nasal fold grows and irritate the eyeball, causing pigmentation in some Shih Tzus and ultimately blindness. How would you feel if you can' see because your cornea is painted black? Prevention is better. Get your vet to snip off the nasal fold and no hairs will grow towards and irriate the cornea.

Monday, May 24, 2010

72. Male dog barking. 6 months. Success story toilet training

Barking male dogs

In Singapore, barking male dogs are commonly encountered. I describe 2 cases of male dogs I have just neutered in the last 2 days.

CASE 1
Problem: Social nuisance in the HDB apartment neighbourhood.

1. Jack Russell male, 5 years. Barking non-stop. When he sees another dog, he barks loudly at them, trying to get at them. In the surgery, he was to be vaccinated but he barked ferociously at the other dogs in the waiting room.

"This dog must be a noise nuisance at home," I said to the mother who is over 50 years old. "I know my neighbours for over 20 years. None has complained to me."

The domestic worker shook her head and said. "They are complaining about the barking." It is difficult for neighbours to sleep when this dog barks a lot. The mother agreed to neutering.

This male Jack Russell barked every second at the surgery where he was warded for 5 days for post-neutering care. Too good a chance to miss as there were other patients facing him.


CASE 2

Shih Tzu, Male, 6 months.

Problem: Barks loudly at 8 am nowadays. Owner bought him in for neutering.

Breakfast at 7 am. Pees and poop on grate + pee pan.
Put back into the playpen as lady has to work and he mum has to do house-work. Barks at 8 am. May disturb neighbours.

Male dog matures at 6 months. Starts to dominate
"He is mature now and knows barking will get him out of the playpen," I advised. "Neutering must be done together with obedience training."

Oral commands: "Quiet," or "No barking". The lady owner will grip the muzzle before saying one of the two commands.

Advice: "Just say 'No barking' in a firm voice, grip the muzzle and give a light tap." The gentle lady was not too keen on tapping the dog. For male dogs, a more assertive training is needed.


GRATE + PEE PAN TRAINING SUCCESS STORY


I could follow up this toilet training case because the lady owner told me that earlier, she had e-mailed to me for toilet-training advice. Her puppy was confined inside a playpen and given a grate + pee pan. Sometimes he would pee and poop outside the grate after one month. I had replied that the grate + pee pan would be soiled and so the puppy would not step onto it later. If she had no time to clean the soiled grate or remove the poop, she should buy a second grate + pee pan. She bought another one.

Secrets of success
1. Confinement for over 1 month in the playpen unless supervised.
2. 2nd grate + pee pan.
3. Immediate removal of morning stools and cleaning the grate with an enzymatic disinfectant. Nowadays, the dog seldom use the second grate + pee pan. He poops 2-3X/day and pees on the grate.
4. Sleeps inside the playpen at night. See floor plan in image.
5. Lots of training and patience.
6. When let out, watch for signs of elimination (turning, sniffing) closely. Pick up puppy quickly and put onto the grate.
7. Take leave to train the puppy in the first 2 weeks or ask mum to help.
8. Feed bowl put inside cage. Remove soon after eating. No free feeding.
9. Routine. Eats at am and 7 pm. Poops at 7.30 am, 11.30 am or 7.30 pm or 10 pm.

77. Injectable anaesthesia IM and IV for cat spay

SHARING KNOWLEDGE ON INJECTABLE ANAESTHESIA IN THE SPAY OF A CAT

1. IM

I find the following combination effective as one IM injection

1.1. 3 kg cat. Today, I spayed a raggamuffin, female, 1 year. 3 kg using injectable anaesthetic.
Xylazine 0.15 ml Ketamine 0.6 ml in one syringe IM
Duration of anaesthesia around 20 minutes in this case. I don't need isoflurane gas top up. This is the ideal situation as it means less operating time.

1.2 5 kg cat. I have used xylazine 0.2 ml and ketamine 0.8 ml IM without side effects.

2. IV
I don't use IV as I find it time consuming but it is one vet's favourite mode of administration and he following simple formula, easy to remember is shared with vets.

2.1 3-kg cat. xylazine 0.1 ml, ketamine 0.2 ml in one syringe, totalling 0.3 ml. Inject 0.1 ml IV first, then another 0.1 ml to effect.

2.2 5-kg cat. xylazine 0.1 ml and ketamine 0.4 ml, totalling 0.5 ml.
Note that you give 0.2 ml IV first. Then increase by 0.05 ml doses to effect. You don't need to use all 0.5 ml.

3. MY CONCLUSIONS
I prefer the IM method for ease of administration and permitting me to focus on surgery. I give isoflurane gas by mask for a few seconds to top up if necessary. However, the IV top-up method is excellent if you don't have isoflurane facilities. The cat is shaved 5 minutes after IM and I operate 10 minutes after injection. Many years ago, I used xylazine IM and then isoflurane gas for cat spay. Now, I don't use it as I find the IM method extremely effective in healthy cats.

76. Ventral dermatitis. Itchy dwarf hamster. Allergy?

A very itchy hamster.

Dwarf hamster, male, around 2 years old. Scratching ears non-stop, lower body hairless and red. Right leg, one hairless lump.

"You understand that the hamster has around 6 months of life left," the hamster bit my assistant through his fabric gloved hand when handled. He bits family members too. He pees everywhere unlike other hamsters who pees in a separate area.

My observations on Day 1 when the hamster came to the Surgery.
His cage:
He stays inside his food bowl and his sleep bowl (with tissue papers put in by the mother). "He takes the tissues and put in one right corner above the pelleted floor to sleep," the mother said.

"A new hamster costs $5.00. Veterinary charges will be more." I said.

"Should the hamster be put to sleep?" the mum asked. "I take care of the hamster. My daughter plays with him."

"New hamsters are free of charge," the mum replied.

"However, the younger generation will not want their pets to be put to sleep. Ask her."
The girl shook her head. So, the mum decided to get the hamster treated. I warded him for 4 days.

History
"Could he be suffering from allergy? His mother who lived separately had same red hairless lower body and itchiness. Vet 1 diagnosed allergy. The mother had died recently.

Any changes of the environment?
1. New litter in December 2009 - grey pelleted ones as the pet shop had stopped selling the white cottony litter which was used previously. Itchiness started for the mother and the son.

"Why don't you buy the coloured ones?" I asked. The owner did not like the coloured ones and so bought the grey pellets.

2. New sand bath in December 2009 too. No more sand bath for some weeks.

From the history, this seemed to be contact or ventral dermatitis due to irritation of the litter.

Treatment
Avoidance of irritating litter, sand and prevention of the hamster squatting inside the food bowl. I used a flat small food bowl. Wait and see for the next few days. On Day 2, I observed considerable less scratching and took some pictures.

Saturday, May 22, 2010

Teresa Teng's Chinese songs

I don't listen to Chinese songs. I got to know about Teresa Teng from an intern's mother in the following way.

On the 10th day of Chinese New Year (CNY), the intern's mother invited me for a CNY lunch at a Novena Square Chinese restaurant to thank me. The intern had gone back to Australia to study. In the 15 days of CNY, Chinese people in Singapore might celebrate by eating "raw fish" with slices of vegetables. This eating of raw fish would be considered a ritual to symbolise get good luck and prosperity for the New Year.

A brand new silver Mercedes 250 rolled outside my Surgery at 1 pm to pick me up for the lunch appointment. The intern's aunty had just got her new car on the eve of the New Year and had arrived with her sister (the intern's mother).

My friend Khin Khin was visiting me at my Surgery. I asked Khin Khin to come out so that I could introduce a role model to her. I hoped that Khin Khin who wants to be a business woman would be able to see a successful business woman who was doing the type of business she was going to do. The aunty got out of the car, was introduced and shook hands with Khin Khin instead of saying "hello" inside the car. This act showed she had the proper manners and was one reason she was successful in her cut-throat trading business.

At the restaurant, the aunty of the intern who would be paying for the lunch said: "No raw fish today." It was impolite to ask why. The aunty said: "I am a vegetarian. So, all of you eat meat." She checked the menu and ordered meat for us while she ate as small amount of rice and vegetables as she could. She even offered me half of her small bowl of rice. No wonder she was as slim as a fashion model on the runway. She dressed in a glittering violet material and wore light brown long boots. The intern's mother, her friend and I would appear to be under-dressed.

The aunty produced an National Trades Union Congress birthday voucher which entitled her to $100 off the price of lunch at this restaurant. She gave it to the Captain. "No, we don't accept this voucher today. It is for to be used for weekends and holidays like Valentine's Day and Mother's Day."

"Today is the 10th day of CNY," the aunty replied. "In CNY, there are 15 days of celebration and so the 10th day is a holiday. The voucher did not specify that it was not for use for the 15 days of CNY." This cut no ice with the Captain. The aunty stood her ground on the basis of principles. The Captain rejected her. So the voucher was no use for this strong-willed woman.

The aunty apologised to me after losing out to the Captain who had her instructions. The intern's mother said: "It is embarrassing for the doctor". After all, the aunty had bought a new Mercedes which would mean she was not in need of this discount voucher. "And in the presence of two accountants," I added. The mother said: "Two CPAs."

The aunty did not retort. I don't think it was embarrassing. It was business. A free voucher was to be claimed. The intern's mother said: "Phone the (name of a Chinese newspapers). They give $50.00 if they publish such news."

"At least you recover 50%," I said since her $100 voucher was not useful. What was there to talk to 3 career women who had seen at least 40 years of life? I asked whether the intern's mother had attended the ABBA show and heard their songs. "Who is ABBA?" the intern's mother asked. She said: "I listen to Chinese songs. My favourite singer is Deng Lijun." I had heard about this famous Taiwanese pop singer and asked: "Do you mean Teresa Teng?" The aunty nodded her head as the mum did not know.

The lunch was fun as all could converse. The lunch crowd left. It was 3 pm when I returned to the Surgery.

I checked out Teresa Teng on youtube.com and discovered that she had a large fan base and could sing English songs too. Some very good ones like Stevie Wonders' "I just called to say I love you" at:
http://www.youtube.com/watch?v=FIc1aodkQk0

Unfortunately she died of an asthmatic attack at the age of 42 years. That was 15 years ago.

One of her famous folk songs and romantic ballads is:
"The Moon Represents My Heart". See:
http://www.youtube.com/watch?v=97-GXzi6PPw

From a website, a writer wrote: Well, it's always hard to do a word-by-word translation, but the following is roughly what the original lyrics mean:
You ask me how deep's my love, and to what degree.
My feelings 're true, my love is true, the moon reflects my heart.
You ask me how deep's my love, and to what degree.
My feelings won't ebb, my love won't change... the moon reflects my heart.
The above translation of her song was not the complete lyrics but it would do.

TIPS FOR STUDENTS
Listening to her Chinese songs could help Singaporean students finding difficulty in studying Chinese. Pop songs in Chinese may help them to be motivated and to learn more about the Chinese language.

Thursday, May 20, 2010

75. An old cat's two puncture wounds would weep all day long

An old cat's two puncture wounds would weep all day long
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date: 08 June, 2010
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129

Getting ideas from vet assistants is one way of improving oneself as they are in the front line of nursing and have many ideas to resolve veterinary challenges. I am constantly amazed that I have not encountered every situation even after 30 years of practice and therefore I do ask my assistants how they would handle certain cases. Vets cannot know everything because there are so many surprises in new situations in veterinary medicine and surgery, as you can see in this commonly encountered case of two puncture wounds in an old cat.

An 11-year-old female spayed cat came in with two puncture wounds on her left flank. The wounds would not heal because they erupted a light brownish red fluid every day. Just like an active volcano.

Yet this cat was not feverish. The two wounds in the skin were around 4 mm x 4 mm. But they just would not close.

"The bite wounds are not superficial on the skin only," I said to the father and two adult daughters. "I would need the cat to be put under anaesthetic and explore the inside of the skin for debris. Therefore the cat must be warded for treatment." I gave the old cat an antibiotic and the tolfedine painkiller injection and put her in the crate for one day of observation.

On the morning of Day 2, I noted that the wounds were still weepy. My assistant VA2 had sprinkled his favourite yellow antibiotic powder onto the two wounds after cleaning up yesterday. Yet on the next day, the wound wept and all his yellow powder would spill out and downwards onto the lower body of the cat. This cat's subcutaneous fat had been melted away by the bacteria introduced by the other cat's saliva and so there was loose skin. The muscle layers had torn out and the jagged edges were producing the brownish red fluid.














"Just flush the inside of the skin with a 20-ml syringe," Thomas replied when I asked him how this case ought to be handled.

"You know, the suction pump is perfect for this case," I said. Thomas had never seen a suction pump being used in his 20 years of assisting in veterinary surgery. It is rarely used but is useful in certain conditions like peritonitis after surgery and maybe in some Caesarean sections.

"No need to use this equipment. Just flush normal saline via a 20 ml syringe," Thomas replied. The suction pump seemed lie a piece of fancy equipment to Thomas. This would be the first time he would see how useful this machine could be.

TWO-STAGE SURGERIES AND TWO ANAESTHESIAS
All old cats are high anaesthetic risks. This cat was thin but she looked very young. She just did not have a large appetite normally and weighed 3.3 kg when a good weight for her size would be 5 kg. There would be 2 anaesthesias needed for two surgeries and the owner must be informed in advance as to the costs, to avoid misunderstanding.

The first one would be to debride and flush out the dead muscle and fat cells. Then, on the next day, the cat would be anaesthesized to stitch up the normal skin edges after snipping off the rotten edges of the puncture wounds. There was no other way and so the risks of the cat dying on the operating table would be doubled. Definitely, the owner should be asked to sign the surgery consent form and receive advices on the prognosis.

FIRST ANAESTHESIA.
Zoletil 100 @ 0.2 ml IV femoral vein was given. Isoflurane gas via the mask was given to supplement as over 30 minutes were needed. I needed to cut away dead skin and muscle cells from damaged layers. Thomas said: "The muscle layers need to be stitched up, otherwise the cat would continue to have fluid production. When stitched, there would be no problem."

I said: "This is a very old cat. Healing of the wound will be slow. To stitch up the torn flank muscles, I would need to cut a bigger skin incision to reach deep into the muscles layer near the belly. If the big wound does not heal, the cat would be in trouble. If this is a young cat, it will be OK."

I observe that the cat could walk normally and so I would not advocate stitching of the irregular torn flank muscles. In old cats and dogs, it is best not to create big skin incisions. About 1000 ml of normal saline were squirted into the big space between the skin and the left flank muscles. A big suction tube pulled out yellowish fat and dead cells. I used scissors to snip off jagged muscle edges.

After the suction was completed, I checked the cat half an hour later. The cat was on an IV drip of normal saline. She was shivering. "Take the rectal temperature," I said to my intern Teresa. She put the thermometer in the rectum and showed me 33.5 deg C. This was low and worrying. Her normal temperature should be 38.5. This old cat had not taken anaesthesia and flushing well. Thomas blew hot air onto the cat using the hair dryer and rubbed her with a towel. "Give 20 ml of glucose," I said. This was given. The cat was wrapped with a towel. 2 hours later, her temperature was 36 deg. She growled as she did not like temperature taking. By the next morning, her temperature was normal. What was the cause of this hypothermia? "Irrigation of the flank with normal saline," Thomas said. This was plausible. I would think it was more the after effects of Zoletil as well.


SECOND ANAESTHESIA
24 hours after the flushing, there was no more weeping wound. The flesh looked pink. I masked the cat and gave isoflurane gas and she did not struggle. Stitching was done using horizontal mattress sutures, walk-in-sutures onto the muscle before stitching the skin and 2 appositional sutures using 3/0 absorbable. The cat woke up fast and had no shivering. She ate and went home one day later.

CONCLUSION
Isoflurane gas would be the choice anaesthesia in old dogs and cats. However, this cat was not very happy with her puncture wounds being poked around. As I did not want to stress her, I did not give her isoflurane gas direct during the first anaesthesia. Zoletil was sufficient for flushing of the flank. The process took a long time as I wanted to be thorough. Next time, flank irrigation could be shortened to 5 minutes instead of 15 minutes after debridement for old cats as they develop hypothermia easily.

In the usual cat bite wound cases, antibiotics and cleaning of the wounds would be sufficient treatment. In this case, the muscles were torn and infected deep below the skin. That was why the two puncture wounds produced a sero-sanguinous fluid daily and would not close. My vet assistant poured antibiotic powder onto the wounds as is the usual practice. The powder would just lodge deeper into the lower abdominal subcutaneous tissue and the wound just would weep again. The only effective treatment was to flush out the dead tissues rather than pour antibiotic powder so that the wounds would heal within 14 days.

Veterinary Performance counts in private practice. If the vet gives the owner a bottle of antibiotic powder and medication expecting the wound to heal, the owner would be much disappointed as such wounds would never heal. The owner would have wasted much time in putting powder clogging up the internal loose cavities of subcutaneous tissue destroyed by the bacteria toxins. In the end, the cat still needed surgery and the owner ends up paying much more.

This was not the simple case of cat bite wounds and the costs would be much higher as it involved two anaesthesias and surgeries. However, the clinical outcome was excellent. And that is what the owner wants - her cat's problems resolved in the fastest time.



updates at www.toapayohvets.com

coughing 4-month-old Mini Schnauzer

F, 4 m. 3.4 kg, 39.5 C
Bought 1 week ago. Harsh cough 3-4X/day but still eating.
Harsh lung sounds, anterior lobes. Start of pneumonia and fever.
As she can't be resting at home, I advised warding here for 2 days and given medication.

Day 2 warded. Much better. Less throat pain. Eating. Should go home on Day 3.
Complete cage rest is the secret to success but the dog at home will never rest as family members distract.

73. Big hard lump on right hip: 4 month old Syrian hamster

The young lady came from Bukit Batok.
"The vet did not accept my case," she replied as she was living quite far from Toa Payoh. Hamsters are not favoured by many vets.

Hard lump palpated around right hip. Disc-shaped 1.5 cm x 1 cm.
"Any other hamster biting her?" I asked.
"She lives alone."

A tumour? Unlikely. Too young.
I suspect it was a puncture wound (cage wire?)
Such cases are best hospitalised, given oral medication for 2-4 days rather than rush into surgery. This is a very young hamster and she may not survive the stress of surgery.

Day 2. Lost weight by 4 g. Sleeping during day time. Reviewed again at 3.58 pm. bright sunshine. took a picture. Pretty photogenic. Unusual case as there was no other hamsters.


I asked my assistant to check no. of faecal pellets passed per 24 hours and to give medication.

In retrospect, she could have been bitten prior to purchase and the bacteria infection developed under the skin over several weeks, resulting in a plate-like lump of pus. When did she buy her?

Tuesday, May 18, 2010

72. Veterinary Internship and character references

Story 1: End of a 3-month internship

May 18, 2010 is the last day of internship for Teresa. Three months of 6 days of seeing practice had passed by so fast. This is the forgetful intern who had caused me great embarrassment in the case of saying that the weight of a 3.6 kg cat as 2.6 kg. On this last day, I told her that I expect her to do well in her first-year veterinary studies and not have to re-sit examinations.

Our last case study was the discussion on the X-rays of a Cocker Spaniel who had swallowed stones and was operated by another vet. I had asked the owner to bring in the CD of the excellent X-rays taken by another practice. "It would be a simple veterinary radiology case," I thought. "Just show where the two pebbles are located. Either in the stomach or intestines."

Teresa downloaded the images into the desktop. I was surprised that the positioning of the "R" and "L" were not in their usual position as shown in veterinary radiology books and in almost 100% of small animal practices. Vets are used to seeing the "R" on the left side of the X-ray and "L" on the right side. In the original X-ray, the "R" was on the right side. So, a vet who does not check these two letters, would naturally and incorrectly diagnose that one pebble is inside the stomach and the other is in the small intestine.

I said to Teresa: "Veterinary life is always full of surprises. Veterinary medicine and surgery can be extremely stressful and challenging. A human doctor needs to know one species. A human surgeon specialises in one system, e.g. the alimentary system. A vet needs to know various diseases of many animals and is expected to operate on all body systems from the nose to the tail. It can be overwhelming for a new graduate."

I explained to Teresa that a vet also needs to have an excellent knowledge of veterinary anatomy in studying X-rays. "If you look at the original X-ray, the one with the lateral view, you will think that one pebble is inside the stomach," I said. "It is actually outside. You will need a ventro-dorsal view to confirm it.

"From the dorso-ventral view, you can see that the pebble is outside the stomach in the small intestine if you mirror the image of the original X-ray. If you don't mirror image, you will think that one pebble is in the stomach and one is in the small intestine. This is because almost 100% of the vets view the X-ray with the "R" on the left side of the X-ray. The stomach is located on the left side where the "L" will be shown in the usual X-ray. In this X-ray, the "R" is on the left side and if the vet does not have an excellent knowledge of veterinary anatomy, he or she mis-diagnose the pebble as being inside the stomach. If he operates, he will find no pebble."







I gave her a tip. "Just use your fingers to palpate the whole stomach before you incise it and you will feel that there is no stone. Take out the small intestine and palpate the length. Don't just incise the stomach based on the X-rays. This is the second check."

Teresa had no idea what I was talking about as she had not studied veterinary anatomy but she is an intelligent girl and will know what I was talking about.

"What is that black circle inside the stomach?" Teresa asked. "It is stomach gas." I said. "It is not a foreign body."


The original X-ray before I made this mirror image to teach the intern would have confirmed that the pebble was in the "stomach". The he stomach is on the left side in the usual X-ray, but this original X-ray was not the usual one. The "R" was not to the left side in the original X-ray
"You have to know veterinary anatomy very well," I said to the intern who tested my patience with too many questions. "Otherwise, you will look at the X-ray and think that the pebble is inside the stomach. Assuming you have only one X-ray, the lateral view. You still don't have to worry. You use your hand to feel the stomach. Such a large pebble can be felt. Do not incise the stomach first."

I don't know whether Teresa would remember this last case. But with 3 months of solid attendance at 6 days a week including Saturdays and Sundays, she must have had picked up a lot of knowledge. I wished her well. She was one of my best interns and one who caused me grief and great embarrassment in the case of
FORL in the Burmese cat. That is why some Singapore veterinary practices don't accept interns.

Story 2: Character referee sabotages the prospective intern's prospects

On this same day, the aunty of a prospective intern who had taken a lot of trouble to e-mail me phoned me. I was already fed up with this aunty who did not keep her appointment to meet me last Friday. During the conversation, I asked whether she could get a character reference who is not the mother for me to interview. The aunty said: "It does not matter. My niece can come to Jakarta when she comes back from the U.S."

I just could not believe my ears. This aunty was supposed to be the niece's character reference. She did not turn up after making an appointment last Friday. And now, she actually sabotaged her niece's prospects for internship. This was really weird. "Your niece has excellent grades and is the one who approaches me for an internship," I told the aunty in a loud voice. "She is an intelligent girl and has got her American professor to write her an excellent testimonial. Now you talk as if I am the one desperate for her services!"

I did not want to continue the tele-conversation with this aunty as I was really fed and I had plenty of things to do. The relative was actually sabotaging the niece's future. First, she did not turn up for her appointment to support her niece. Now she made casual remarks about internship. A take-my-niece as an intern or leave it, old boy!
The aunty must have thought that veterinary internships are a dime a dozen! Her niece has excellent grades and everybody will accept her as an intern. There is something not right with this thinking.

From this episode, all prospective veterinary interns should be careful as to whom they ask for help in getting character references. Never ask somebody who is not really keen to help. You really can get sabotaged. And it is an unpleasant experience for me to talk to such referees.



Updates and pic are at www.toapayohvets.com

Monday, May 17, 2010

A kind soul. Dysphagia in the cat: - a case of FORL?

TWO MONTHS AGO

A lady e-mailed to me regarding a cat whose owners sought help online as they had spent some money at a big veterinary practice. Now they had no money. So the kind soul enquired whether I accept payments (by the owner) by instalments.
I accepted the case.

Cat 5 kg. 5.1 years. 39.2 deg C. Very painful throat.
Difficulty in swallowing food for 1-2 months

History
"My cat eats a bit, drinks a bit but stops after a few seconds," the owner said.

Cause of dysphagia (difficulty in swallowing).
Sedation: Zoletil 100 at 0.05 ml IM sedated this old cat without problems. Isoflurane gas anaesthesia via mask was necessary to do a proper examination of the throat. I know that the owner would not be able to pay. However, I would not just give some antibiotics and send the cat home as there was something wrong with a cat not able to swallow for two months. Anaesthesia was costly but it needed to be done. In this case, there was a big ulcer at the side tooth PM4. Dental scaling and the right upper canine tooth was fractured and extracted. (see picture below).

Only the right nostril discharged pus. This was a case of right nasal sinusitis
Not surprisingly, only the right tonsil was inflamed and enlarged. I palpated he throat. It was very painful. Poor cat. He would die if he was not treated.

The owner said the kind soul would pay for him when I billed him. Obviously the kind just referred him to me. For the sake of the cat, I did not demand payment. I accepted $50 from him and I hope that the cat would be back to normal with the oral medication and after dental work.

The kind soul wanted to help the cat by seeking out a vet who might accept payments by instalments. The kind lady did a good job as the cat recovered fully after the dental work according to the owner who came 2 months later. Cats suffering from FORL (Feline Odontoclastic Respiratory Lesions) needs dental work to go back to normal as they have great pain inside the mouth.

2 MONTHS PASSED. The couple came back for medication without the cat. "The cat started eating the next day. He put on weight. He was OK for the last 2 months. Now he has some sneezing. My wife could have infected him."

"It is difficult to diagnose what's wrong without seeing your cat," I was happy for the cat who had been suffering for the last two months. Due to financial reasons and the recession, many owners simply ask for repeat medication. The vet has to advise accordingly. "It is not the tablets that work," I said. "There needs to be a proper examination."

UPDATE
The cat came in for an examination because the medication did not work. He suffered from an upper respiratory tract infection and high fever. This was likely to be due to a viral infection as he had the freedom to wander outdoors.




Two months after the first consultation, the cat had to come back.
He had cat flu. Vaccinate your wandering cat to prevent cat flu
if you can't keep her or him at home
He had never been vaccinated. "A 20% loss of weight," I told the owners. "This is serious." I taught the owner how to open the mouth to examine for ulcers and how to give the oral medication and electrolytes as he wanted the cat to be home.

P.S
Many Singaporean cat lovers permit their cats to stray outdoors. Vaccinate your cat yearly to prevent the common respiratory and other viral infections. Yearly dental checks help your cat to live longer.


Update at www.toapayohvets.com

Treat your veterinary internship seriously

INFORMATION FOR PROSPECTIVE INTERNS INCLUDING VETERINARY UNDERGRADUATES/VET TECHNICIAN STUDENTS FROM POLYTECHNICS

I receive many e-mails regarding internship. Some writers obviously have not visited the Toa Payoh Vets webpage to research on the requirements of internship (this webpage). These applicants will be rejected.

Market yourself well if you want to do well in life and get what you want. This is the reality of life. There are strong competitors and other factors affecting your chances of being successful. Therefore, be prepared if you want to be an intern. In Toa Payoh Vets, internship is Dr Sing's giving-back to the community rather than a tool to recruit employees. Therefore, applicants need to satisfy the following:

1. Application via e-mail/post. E-mail to judy@toapayohvets.com giving 5 reasons in 500 words as to why Toa Payoh Vets should accept you as an intern. Enclose your resume, 2 character references and academic results of your "O", "A" levels and undergraduate grades or equivalent.

2. Please note that we do NOT accept interns with poor academic grades and no two character references. In other words, your "A-level" and polytechnic grades must be in the top 5% to be accepted as prospective undergraduates in veterinary schools in the U.K, Australia, New Zealand or U.S.A. This usually means at least 3 straight As and some Bs at "A" levels or Junior College Year 2 results. Applicants with acceptance by the Veterinary School overseas will be given priority.

3. Applicants should provide their grades in their school and get 2 character references if they want to see practice in Toa Payoh Vets by e-mail or post. E-mail for internship without any required supporting documents will mean that you do not know how to be successful in the real world.  
  
4. Knowledge of digital photography will be an advantage. Show me your portfolio if you have such knowledge.

5. E-mails without our above requirements and those with attached files will not be entertained. We don't download attached files due to concerns about viral infections. Therefore, learn how to include your character references inside the e-mail directly or post the application to Toa Payoh Vets, Blk 1002, Toa Payoh Lor 8, 01-1477, Singapore 319074.

6. Interviews by Dr Sing. Bring your original certificates and testimonials together with photocopies. Testimonials unsigned by the teacher or referee or without letterheads are suspect and are unacceptable. I will phone your referees, therefore ensure that they are prepared to talk to me about your character and integrity.

7. Payment for internship. Please note that you will not be paid. If your parents or you expect payment, please apply elsewhere.

8. Honesty is most important for interns as dark forces in your mind seem to work harder at the growing up age to deviate you from the "straight" path. Thefts of money and property of Toa Payoh Vets will be reported to the police.


9. Diligence at keeping records and writing up cases within 48 hours are required. I will discuss with interns some cases. If they don't have time to record the findings and challenges encountered in the handling of such cases, how can they learn and profit from the internship? I note that there are many interns from Junior College not adhering to this requirement. This is a bad attitude.

9.1 Pen and Paper/Electronic pens. It is best you bring your non-electronic book to write down details and instructions of the cases.

I know some young ones are used to keying messages into the mobile phone. You are the internet generation. However, I cannot wait while you thumb furiously my verbal instructions and discussions of the cases into your mobile phone because I have lots of things to do myself and I can't wait for you.

Therefore, pen and paper are still necessary. However, if you have an electronic pen, it is OK with me. Reports are to be submitted within 48 hours by e-mail to me.

10. Personal safety. Toa Payoh Vets is in an industrial park but it is a very safe place to work in the evenings. I had an internist who told me her grandmother was worried about her working in the evening and therefore she should work during office hours. In such cases, my reply will be to just stay at home. Veterinary work in the real world involves evenings and weekend work.

11. Gossip. Try not to waste time spent at Toa Payoh Vets by idle talk with my staff. They have lots of work to do but some of my staff simply love idle chat and gossip with newcomers. Most likely you will find that you need time management and that you practically have no time to complete your tasks. So why spend time gossiping?

12.  Self-discipline & targets. You should write up the daily cases within 24 hours (that is why I will ask whether you have a note-book) and e-mail them to me (not as attached files - you figure how you do it electronically).

13. Independence. Ask your mother not to phone me enquiring about internship on your behalf. I don't accept students who can't be self-reliant. Please ask your parent or best friend NOT to accompany you for the interview. But if mum comes, introduce the parent/s to me as a matter of courtesy. Best friends are best left at home! This is one time you need to cut the apron's strings and be confident as you embark on a new and wonderful adventure into the big animal world.
In conclusion, many young people come for interviews and work unprepared without resume and requirements. Some girls come with their mothers and best friends for the interviews. Please note that you are asking for an internship and therefore should be well prepared for the interview so as not to waste time.  

Internship is serious business for you. You will learn the ropes and the challenges of the real world in a commercial veterinary practice. It is so much different from your school or home. It is not a travel or boat cruise at Toa Payoh Vets. It is not your "grandfather's house" where you come and go as you please and relax at Toa Payoh Vets just like the young man in the picture of "The Magnificent Twelve".

There is much to learn and much to teach the interns going to study to become good veterinarians in the very short time you are with me.

A lot of time and resources are given to the intern to get them on the feet into the exotic and beautiful veterinary world. I don't want youths who are not up to my expectations to be at Toa Payoh Vets. Therefore, ensure that you are able to comply with the above requirements before you apply to be an intern at Toa Payoh Vets. 

Common behaviour of Singaporean interns observed. Tardiness and not being punctual at work are commonly observed for the previous interns. This is unacceptable and your internship may be terminated immediately.
You may feel that you are not paid, therefore you can come and go as you please. Toa Payoh Vets actually must spend time and money to mentor you.

You are not an asset to the practice at this time of your life and if you feel otherwise, please do not apply for internship. The world does not owe you a living. You have to prove that you can be an asset to Toa Payoh Vets by your actions and your diligence once you are accepted as an intern. Note that punctuality at work is important in Toa Payoh Vets. If you feel that you can't be punctual or wake up early in the morning to go to work, please do not apply for internship.

Note that your internship will be terminated immediately if your working attitude and punctuality is not up to my expectations. Ensure you have sufficient rest at home. I have seen interns yawning or sleepy during my case discussions. This is not an acceptable behaviour and may mean instant dismissal. Therefore, treat your vet internship seriously. Your good or bad behaviour serves to undermine Toa Payoh Vets' scheme of internship for future applicants and therefore you need to do your best.

Even if you are selfish don't care about other young ones by displaying poor work attitudes during internship. In any case, your internship will be terminated immediately if you show little passion or interest in veterinary medicine and surgery. Note that testimonials are given only for interns who have worked full-time and for more than 4 weeks. Others will receive a record of attendance.

Sunday, May 16, 2010

68. Incredible But True Story: When the chips are down - Part 1

INCREDIBLE BUT TRUE STORY

Year: 1998 - 2003 SARS (Severe Acute Respiratory Syndrome)
Location: Singapore, Desker Road Coffee Shop
Yuan: Hokkien Peranakan. Male, Singaporean. Late 30s. Retrenched. Jobless. Estrangement from his wife. No children.
Big brother: Triad chief of Desker neighbourhood
Pig face: A look-out
Susan: Coffeeshop drinks operator

Between 1995 to 1998, there was a period of recession. Singapore was affected too even up to the early 2000s before SARS appeared in 2003. One of my friends lost his marketing job and could not find any executive job for several months. His marriage was on the rocks and his mum sided with the daughter-in-law for some reason I am not sure of. The HDB re-possessed his apartment as he was unable to pay the mortgage for many months. He had to move out to room with some friends.

He always had a coat-and-tie job in exotic places. I would marvel at his stories of interesting people he had met and the closing millions of dollars of sales for his employers in securing accommodation regional hotels and resorts. I had to stay put in Singapore tending to a small animal practice. Travelling to exotic areas of the region, let alone the world was just too expensive for a small-time vet building up a practice during recession.

The recession just stopped people from travelling and so he was retrenched. I was fortunate not to become bankrupt as most Singaporeans stopped getting their pets treated.

After several months of rejections in his job application, Yuan lost all his savings. He was not the type to go around looking for loans from friends. He decided to open a food stall in a corner two-storey coffeeshop at Desker Road selling laksa. As to why he set up a stall in this notorious red-light district, I did not ask him but I made him show me the real place as his tale of setback was incredible for a Singaporean brought up in a Hokkien Peranakan family with no connections to the underworld or to the politicians and top businessman.

I had met him for lunch two days ago on April 21, 2010. I wanted to learn some secrets of his success as a marketer for a corporation and how he bounced back from a severe setback in his life. Learn from the best and successful person. Books can only teach you theories. Lately, I had been meeting men and women in dire straits and looking for loans. So a meeting with Yuan was so much positive for my spirits as his stories were entertaining and uplifting.

During lunch at the Hans Cafe eating his favourite sweet and sour fish, I asked Yuan to re-tell me my favourite story of working in a combat zone called Desker Road. Desker Road was and probably is a "red-light" district and I imagine the place to be frothing with gangsters. It is a place that looks normal during the daytime, but I could imagine that the Singapore Mafia had a strong presence there.

Yuan recalled vividly the behaviour of gangsters in Singapore while he was operating a small food stall. "One day, a young man on a bicycle beckoned me with a finger to get out of my stall to meet him outside the coffee shop. He wanted to extort protection money from me."

Yuan said: "Brother, I can give you free laksa. "I have no money to give you." The extortionist was not pleased and threatened him bodily harm.

"Why are you so depressed nowadays?" Susan, the coffeeshop lady asked Yuan who was usually a cheerful person. No customers want to buy from unhappy people and he always showed a happy front. He was selling laksa at $3.00 per bowl and could sell 100 bowls per day during good periods. His friend who owned the coffeeshop had asked him to start a stall and said: "Pay me $25.00/day or whatever amount you can." So, Yuan had no pressure unlike the Marina Square food courts whose rental is $10,000 - $15,000 per month in 2010.

"Susan is the wife of the Landlord and operates the drinks stall," Yuan elaborated. "She will barter free drinks for my laksa. But I cannot barter my laksa for for her Tiger Beer or Guinness Stout."

"I don't want to cause trouble," Yuan had told Susan what happened. Soon Susan told him, "You will see some fireworks today."

"So, what happened?" I imagined the beast in man to be brought forth. The extortionist would be chased into a dead end by gangsters with poles, parangs and machetes and hit and clubbed and hacked to death.

"Big Brother (the gangster chief) came for dinner and I served him. I usually gave him two eggs for his laksa."

I have always thought that the triads and secret societies were wiped out by the number "999" in Singapore as the Singapore newspapers seldom report on gang warfare. Maybe the tabloids report such incidents but I don't read tabloids.

Many Chinese secret societies had numbers but somebody told me that the only gang in Singapore is "999" nowadays. Even in the red-light district of Desker Road, I had presumed. For the benefit of readers, "999" refers to the Singapore police force who is the top dog except that the control of loan sharks appear to be slackened.

Yuan recounted: "Big Brother ate his laksa. Then he asked his side kick to get Pig Face who was cycling up and down the alley between Desker Road and Rowell Road. Pig Face came and Big Brother said: "When my mother does not cook my lunch and dinner, I come here to eat. Why are you harassing Yuan?"

Yuan means "Handsome" in the Hokkien dialect according to my friend as this was his nickname in the coffeeshop. That was what Big Brother called him and this is what I call him for this story as I can't identify him as he is a real living person. More Hokkien expletives followed. Big Brother nodded his head and slammed his right fist on the table, spilling out the gravy of his laksa. He squinted his one good eye and curled the fingers of his right hand downwards at Pig Face. His men rained punches onto Pig Face's abdomen. Pig Face fell and he was kicked more times.

Extortion and violence are part and parcel of secret societies but as I did not associate with such elements, this was the first time I had heard of the culture of the gangsters at Desker Road.

"I presume the gangster chief and his men get free meals from you for protection," I said to Yuan.

"He always pay for his meals," Yuan said to my surprise. "Gangsters do have their code of ethics. Do you know what Pig Face does for a living?"

"No," I said.

"Pig Face's job was to cycle up and down the alley between Desker and Rowell Road. Whenever he sees the police, he will sound the alarm or ram his bicycle into them. This will alert the sellers of pirated CDs and pornographic material." Since Playboy magazine is prohibited in Singapore, there must be a demand for such items amongst the young national servicemen."

Yuan continued as he completed eating all his food: "Pig Face is a runner." But runners can be ambitious too to rise up the corporate ladder. Only that he picked the wrong person to extort. All the characters I had written had disappeared although the coffee shop, now taken by a new management, still exists.

After one year selling laksa, there was a marketing job in the a hotel. Many Singaporeans shun a marketing and sales career as there are targets to be made and people to be convinced to close a sale.

Yuan is now a very successful sales person and earns at least $5,000 per month. He still works for various corporations. Only for legal ones and he does not get involved with shady businessmen. He is very selective in making friends as many of his contacts just want to use him for his large network.

He is the type who is afraid of starting up but he has the network and supporters over the past 15 years to support him if he knows how to be an entrepreneur. He has the guaranteed salary at the end of the month. So, why bother getting out of his comfort zone and being at risk of no income. He never takes kick backs when he works for the corporation. Nor does he go for the wine and women, con people or ask for personal loans.

So, his reputation in the closely knit hospitality industry remains good. There is a great demand for experienced and successful marketers in his industry. When the chips are down, Yuan started a food stall rather than borrow money from friends. Or con Singaporeans by promising them high returns on their investment. Or like the older lady who spiked coffee of older men with Dormicum and ran off with their money and Rolex watches for the 4th time.

He is the sort of the rare honest employee who is an asset to any business and was never affected in the 2008 recession. He had no university degree but he could perform much better in getting sales than his managing bosses because he had the passion to sell. And know how and what to do in closing the sale.

As to why he worked in Desker Road and had survived the gangsters there for one year, I will ask him the next time I meet him. I am sure 99% of Singaporeans will not be able to survive there.

When the chips are down, Yuan did not go around looking for personal loans or stay at home. Well, you could say that he had no more home since his mother sided with his estranged wife and his HDB apartment was re-possessed.

But he found a way to survive. Today he is employed and as employees, he is exploited by corporations to make money for them as he has an extensive network of clientele. That is a reality of life. At the end of the month, he has a salary. And that is important for him. But I can see that he can make three times his salary if he is confident of coming out of his comfort zone. His supporters are there.

The Esplanade guitarist and singer. Labour Day. Singapore. Toa Payoh VetsIt is just like a successful songstress. If she has a good voice and good lyrics, she would have fans. They will increase in numbers over the years and she does not need to sing in seedy bars. If you have viewed the movie "The Runaways", you can see that Joan Jett was having setbacks in her early career. She persevered when her lead singer in her band gave up. She became the singer and started her own band "Joan Jett and the Blackhearts".



Today she is very successful as a rock and roll singer and has her own enterprise - Joan Jett and the Blackhearts. In Asia, Teresa Teng would be her equivalent in being successful. Belief, Passion, Drive and Perseverance are needed to recover from setbacks and to succeed against all odds when the chips are down.

Updates at www.toapayohvets.com

Saturday, May 15, 2010

How to identify an issue from its fundamentals?

Thin 2.5 kg


"Every morning, the cat will meow loudly for his breakfast. My wife will kick me out from the bed to prepare his cat food," the father told me when I asked whether the cat had been eating normally. I could feel the spines of backbones sticking out onto my fingers. The cat had two big holes in her left flank. Holes of 5mm x 5 mm.

The younger daughter said: "Two years ago, you said this cat would die of liver failure as she had not been eating for one month. She is very much alive!"

"If a cat does not eat for a long time, there is liver fat breakdown and soon the cat gets jaundice and dies. There must be some reason I said about liver failure."

"Yes," the father said. "The cat stopped eating because we got a small kitten in. You said to get rid of the kitten."

"Once the kitten left the house, this cat ate. So, it was stress."

Identifying an issue from its fundamentals is not easy.

Preventive Medicine

SUNDAY CASE - May 16, 2010
Miniature Schnauzer, Male, 6 years
Annual vaccination + proheart vacc

Examination:
Bladder palpated. Body shivered when lower abdomen is palpated. The 17-year-old daughter saw the vibrations. "He has some abdominal pain" I said. "Maybe a bladder infection."
"Can smell his urine from far away," the father said.
"Does the dog urine-mark?" I asked.
"Yes. He would pee a lot first and then urine-mark every spot even if he has nothing to pee."
"Does he drink a lot?"
"No," the father and daughter replied. "How to make him drink more and how much he should be drinking a day?"
"Exercise will make him thirsty. Some dogs love iced water. Put ice cubes into the water," I said.



Advice:
Dogs over 2 years need a preventive programme, not just annual vaccination.
1. Complete Blood test
2. Urine test to check for struvite stones and bacteria.

Permission:

Much depends on the parents.
Urine test agreed. Urine catheter, collect dark yellow cloudy urine to be sent to the Lab.

3. Read about prevention of urinary struvite stones.
4. 3-monthly or 3-6 monthly urine test will be best but no owners will do it.


Questions:

How long after neutering will my dog stop urine marking?

"Now, 6 years old. It will take many weeks to a year."
1. Probably 1 year
2. Schedule. lst month - urine mark same area. Change to another location

Thursday, May 13, 2010

65. Dwarf Hamster, Male, 6 months. Wet penile area

"Wet Tail," the young lady said that her dwarf hamster of 6 months was very inactive and not eating or drinking since yesterday evening. It was 1 pm now.

"Wet Tail means that the hamster passes watery stools," I noted that the hamster's penile area was very wet, with yellow urine stains.

"He passes a lot of stools, hard ones," the young lady said. "What's wrong with him? He has this continuous sniffling sound, as if he has asthma." I held the hamster near my ears. Yes, he was emitting a "sit, sit, sit" sound.

INFECTION
"The hamster has an infection and so he was not moving or eating," I said. "Does he pee in a corner normally?"

"He pees everywhere," the young lady said. "Yesterday and today."

COMPETITION FOR FOOD
The hamster lives with the sibling who is bigger size in the same cage. "They have company. They never fight," the young lady was at home all day and had observed them. "Many pairs of male dwarf hamsters are OK when they are less than 3 months old," I said. "When they grow up, one will bite or attack the other."

The lady would not believe me as she was a first-time hamster owner. "Do they compete for food?" I asked. "Each would stuff as many sunflower seeds into their pouches as they can?"

"Yes," the lady confirmed. "Sometimes they stuff until their cheek pouches are very big. They only eat sunflower seeds. They don't like the other type of food."

The mouths of the two hamsters were smelly as the cheek pouches were infected due to impaction of the sunflower seeds. The seeds were also smelly as I took two seeds out of the pouch. Finally, after 5 minutes, the patient poured out 30 seeds.

HYPOTHESIS

1. Cheek pouch impaction. Bacterial infection from the pouches to the whole body system. Hamster had fever and stopped moving.
2. Urinary stain. Incontinent due to urinary tract infection or bites at this area causing painful urination. Bitten by the bigger-sized hamster. "Not as big as Hamstaro," the lady said. "But bigger than this one."

Then her friend spoke to her in Malay with some words "gig" and laughed. The bigger sibling does bite the ears and other parts of this subordinate hamster. "Whenever the squeaking became too loud," I separate them," the lady said.

ADVICE
Separate the two males or use a fencing between them. Or one upstairs and one downstairs in the crate. "They don't fight," the lady said. "Separate means they have no company for each other." I could not convince her and said: "OK, wait for the Battle of the Hamsters first."

64. Tips For Vets: Vaccinatiion of "female" puppy

The diversity of puppy development can lead to litigation or bad reputation if the vet does not adopt a certain procedure during the first vaccination.

I had a phone call from a lady owner today. She said that the puppy was a male but was listed as a female in the vaccination card by Vet 1.

In this case the pet shop said the puppy was female. He had no scrotum and a "long urethra". So Vet 1 trusted the pet shop operator who is in the business for many years.

Basically it is common sense to examine every puppy prior to vaccination so as to avoid such rare cases from happening. Never trust the pet shop operator to give you the correct info or the record the info after you sign a blank cheque (vaccination record).

63. What to do when one can't lower cholesterol level?

LETTER TO A CORRESPONDENT

I hope you will be able to help me find out what are the alternatives to Lipanthyl 160 which does NOT work in reducing cholesterol. The family doctor did mention taking red brewer's yeast at one's risk or nicotine. Nicotine was said not to be that effective and said that it is better to use Lipanthyl than nothing. He said that cholesterol level would have shot higher if not for the use of Lipanthyl. I do not agree but said nothing. This drug is practically useless and causes liver damage. However, what can one advise a person who has no means of lowering the cholesterol level?

So, last month in Perth, I bought the last 2 bottles of red brewer's yeast. Apparently they were hot sellers after a TV advert, according to one retail person of a health shop.

Then I checked the internet. It was actually a statin. So, the person who takes it may die or go into a coma since she had shown severe side effects of statin use in the first place.

I ask for your help. Is there an effective drug alternative to statin? Or another method involving change of lifestyle. I read one journal - a person claimed that he ate certain nuts and his cholesterol level went back to normal.

Please let me know if you will do research and let many readers know what to do. If you discover something, you may be able to be self employed and smell the roses, just like the sellers of red brewer's yeast.

Best wishes.

62. The boy who was late for his date

I was at the famous Takashimaya Shopping Centre on May 1, 2010, a public holiday. It was a Saturday which was my day off from work. It had been almost a year I had not been to Takashimaya and so I wanted to see how this old lady is competing with the younger malls. How did she reinvent herself? How busy were its food stalls which used to be packed like sardines some years ago? Now we have the Marina Bay Sands with all the top fashion shops.

I found a seat to order ice kachang and the oily carrot cake to eat. There was this young tall and slim girl with long hair writing answers to mathematical problems and using her electronic calculator. She kept thumbing her mobile phone and part of her left side of her forehead was frowned with wavy lines. Eyebrows arched. I was sitting to her left and so could see only her left profile. She thumbed many times on her cell phone. She looked agitated.

Why would a young girl be doing homework on a public holiday in Takashimaya Shopping Centre's food mall? The public library at Takashimaya had closed down some years ago. In any case, the public libraries close on public holidays and this girl had no choice but to wait for her late date at this downtown shopping centre.

Who was she waiting for? Dressed up in modern fashion with zebra-striped T-shirt and coloured rectangles long pants. A touch of make up to give a natural look. At this tender age of 18 years. I could only see her profile as I sat to her left and ate the too sweet monstrous ice kachang and the extremely oily carrot cake which would up my blood cholesterol levels in a few seconds.

I guessed her date was late. Instead of wasting time, she was doing her homework on this public holiday at a public place. I was impressed with young adults who don't have time to waste and who are diligent to study for a bright future.

I was sitting to the left of the girl and she had focused on solving her 3rd maths problem. I peeked and saw words like "real numbers" in her maths worksheet. What is the meaning of "real numbers?". Are there false numbers? Fortunately for me, I did not have to do these maths problems during my A-levels in Medicine Class in Raffles Institution. There is no more "Medicine Class" nowadays in Singapore's junior colleges but there was this rare breed in the late 1960s.

After 10 minutes, a young boy-next-door suddenly banged his books on the table in front of her and greeted her with "I am here!". He appeared from nowhere and his banging attracted the others on the table.

"Ah, you are late!" I scolded him. "You must be her drinks!" The girl did not say a word, gathered her worksheet quickly, put them in her handbag. I looked at her from the side as her date helped her with her things. Was she mad? Was she embarrassed by his loud banging of the table in a public place? I don't know. Her profile showed a reddish brown face. In a few seconds she got away with her date. The young man said goodbye to me.

For young men, please let your date know if you are going to be late. There are many fishes in the ocean but treat each fish with care.

The plump aged dwarf hamster

May 12, 2010

LUMPS AND BUMPS IN AN OLD DWARF HAMSTER

I excised a large hard fatty tumour of around 1 cm x 1 cm 12 days ago. It had pus and the owner had just discovered its presence. Zoletil IM and isoflurane gas anaesthesia were effective for this fat hamster who was 2 years old, nearly the end of her lifespan.

I stitched large skin wound with three 6/0 absorbable sutures. Hamster went home on the same day. The right eye had a thickened upper eyelid due to pus infection. I asked the owner to wait while I went to my car to get the camera to take a picture of the clean wound with little bleeding. The owner could not wait and disappeared in the waiting taxi.

12 days later, the caring young man consulted me as the hamster had a reddish lump in the operation area. "For the first 3 days, there was some bleeding under the skin. The hamster eats a lot and is very active. But what is this lump? Is it an infection?"

"This hamster is old and the hard lump could be the recurrence of his cancer," I said.

"I don't want her to be operated again," the owner said. The hamster may not survive a second anaesthesia.

"Wait and see for the next 7 days. It may be an infection," I gave him oral antibiotics. Malignant tumours do recur even in people. People can get chemotherapy and radiation but this will not be possible for the dwarf hamster.

P.S.

Aging leads to several problems in this hamster.

1. Both lip commissures are ulcerated and has pus. She still eats the seeds and has an excellent appetite, hiding the seeds inside her pouches.

2. The upper eyelid of the right eye is swollen. This could be hardened pus. I had snipped off part of it. The hamster still rubs her eyes. In one hamster with the same swollen upper eyelids, I snipped off the whole of the upper eyelid with no problems for the hamster. See webpage:

3. The skin of the elbow and other joints have flaky inflamed areas. The owner extended the legs but the hamster bit him. He has to clean off the inflamed skin.

BE KIND TO DWARF HAMSTERS
Check your hamster daily and get very small tumours excised by your vet.

60. Educated young Singaporeans prevent oral diseases

Recently, I had two cases of owners phoning for dental scaling appointments for their dogs. I don't know about other surgeries, but few of my clients in the past bother about preventing mouth ulcers and tumours due to bad oral hygiene.

CASE 1. An 8-year-old Cavalier King Charles would not eat dry food. One of the 3 daughters complained that the dog had bad breath. So the father drove the mum and 2 daughters with the dog to get the dog dental scaling.

I had to extract 3 loose upper side teeth (PM 1 & 2 on Right Upper and PM 1 on Left Upper). Xylazine 2% 0.3 ml IM and isoflurane gas were used to anaesthesize the quiet friendly dog. "For an 8-year-old dog, his teeth are quite clean," I said to the family. "Other dogs of his age would have all teeth dropped out. What do you feed and do you brush his teeth?"

Mum said, "He eats chicken and rice. A little bit of dry food. He does not want to eat by himself and so I have to feed him."

I was surprised as most dogs eat by themselves. Is he a picky eater or because he has a painful mouth. "Do you brush his teeth?" I asked the mum. "I used a towel to clean his teeth but he is not cooperating."

"He should be able to eat dry food now that his loose teeth are extracted and therefore he should not feel any pain."

"But he has been eating chicken meat all these years," the mum said.

"Add a few pieces of dry food to his canned chicken meat for the first week," I advised. "Then increase more and more till he eats dry food. Dry food does clean his teeth. Brush his teeth 3 times a week too. Use the finger brush or the long tooth brush. I will not need to scale his teeth again."

"How long can a dog live?"

"In Singapore, the small breed can live up to 20 years, but in general, most live up to 10-15 years," I said to the happy family with 3 daughters now in their teens. Mum said the Cavalier King Charles was treated by me 8 years ago for diarrhoea. Well, he is now fully grown up and well loved.

As my intern Teresa was assisting me, I told her that the owner had prevented serious heart diseases by getting dental scaling done early. "What heart diseases?"


CASE 2

"How much do you charge for dental scaling?" a male voice asked. "$250 for general anaesthesia and dental scaling," I was answering the phone on this May 2010 Sunday. Asking for quotations is a common practice and so I did not ask whether he would like to make an appointment.

A handsome couple turned up. The lady was slim and as fair as the significant other with muscles was as dark. Both were in their early 30s. The Miniature Schnauzer had thick tartar in all his teeth and took at least 30 minutes of dental scaling unlike my Case 1. Stains and hard tartar enveloped the inside of the teeth. I wondered what the dog had been eating. Probably no teeth brushing.

"Is it not a boring job to be a cabin crew flying from one destination to another and flying back?" I asked the fair lady. She had minimal make up since she was not working and some red rashes showed on her cheeks. Those did not distract from her beauty. "No," she said. "It is an enjoyable job for me. There are hazards to this job."

"What hazards?" I asked, thinking of the air crashes.

"We get varicose veins due to long hours of standing," she showed me her some faint bluish blemish in her knee. Fortunately, the significant other did not get jealous.

Wednesday, May 12, 2010

59. How to be successful?

May 12, 2010
To: Ms Koh

Do what you think is correct. Learn from being hands-on and making mistakes. There is no other way to be wiser and smarter.

Singapore expatriate real estate rental markets are getting hotter in 2010. I have at least 10 times more e-mails for asiahomes.com this year than last year regarding rentals esp. serviced apartments.

Some agents sms me about the Bishan Loft advert. Pl use your phone to make preliminary contact and e-mail.

Become an expert at Google Docs for real estate. I attach a picture hoping it will inspire you. I am into creating inspirational pictures for young people like you and those studying hard for their future.



The Golden Age of the internet is in your hands. Internet connects the world unlike my youthhood in the 1970s. One example I gave you was an expatriate who surfed the net, contacted www.asiahomes.com, met me and bought a $3.3 million Wing On Life condo in Singapore. My co-broking agency commission was $15,000. We would never meet if not for the world wide web.

I will not live long to enjoy this Golden Age as I was born at the wrong time. But young people like you will enjoy and prosper in this Golden Age if you know how to use the internet. Create rather than consume. This is my advice to all young adults like you. But few young adults create.

One good example is a 26-year-old man, Singaporean I met recently. He had been doing e-bay sales for the past 9 years. He did not need to work for people. He would get orders to create Star Wars "guns" etc and get them made in Singapore. Then he would mail them to customers in the U.S.A.

He was passionate in his craft as he showed me his Facebook portfolio. I was impressed with his creation of a gold ring similar to the one in the movie "Lord Of The Ring." It looked like a simple gold band but I could recognise it as the LOTR ring. He said that the movie ring had words engraved on it using CGI. He said his LOTR webpage was shut down.

But competition is nowadays much stronger and therefore his net profits have had reduced considerably. "This is a common challenge when Singapore becomes fully developed," I said to him. "Many younger vets have also set up shop to provide cheaper services than the established ones to get the business."

This young man is venturing into a "new" field "internet marketing" which also has lots of competitors and is actually an old subject. Some people even advertise in the Straits Times to conduct courses on "internet marketing." Nine years is a long time and I can understand he needs a change.

I could not believe that such young Singaporeans exist as I think they are addicted in online computer gaming and enjoyment at the age of 17 years which was when this young man started his enterprise to create and sell on e-bay. This young man showed me one other young man in Hongkong. That man created the "Iron Man" suit for sale. He lamented that this was beyond his capability. My comment is that he has lost focus and interest. It is a pity that he has no "determination" or "perseverance". He could manufacture and produce really good toys and has a forum to market his work.

In conclusion, create and read widely. One day, you will be successful even though you may not want to do real estate anymore. It is the hands-on internet experience and solving the problems of the real estate that will give you the hard edge to take on another industry later.

Best wishes
Dr Sing Kong Yuen

Best wishes.