Wednesday, July 28, 2010

Jack Russell swallows a dessicating tablet

Xylazine IM injection normally causes a dog to vomit. But nothing happened in this Jack Russell that ate swallowed half of his mistress' white tablet (around 2.5 cm in diameter). "This Japanese-made tablet is to keep my medication dry," the lady in her 30s wrinkled her nose and her brows.

After waiting 10 minutes, the dog dozed off inside the crate. Not a tinge of vomit. When I do not want a dog to vomit after xylazine sedation for anaesthesia, it will vomit. Now, this Jack Russell does not vomit. This is the second case it happened to me. The recent case was a case of the dog swallowing a condom.

What to do? I got some salt from the restaurant behind my surgery as I had run out of stock and such cases are rare in my surgery.

"What to do now?" I asked my assistant Mr Saw and intern Ms Lai. Both shook their heads in amazement as to why I need salt.

I wanted my assistant to be hands on. "Put some salt at the back of the dog's tongue," I said. But easier said than done.

"What if the dog bites me?" Ms Lai stood back a bit and did not volunteer. Male Jack Russells can bite and his long canines are sharp and brand new. He is around one year old but is actually a gentle dog.

"How to put salt at the back of the tongue?" I asked. I took out a dropper which is used for eye drops. No use as not much salt could not stay inside. In any case, how to drop salt to the back of the tongue?

"Can you get a long spoon?" I asked Mr Saw. He could not find one.

"Just pinch some salt, open the dog's mouth and rub the salt onto the tongue," I advised. It is easy to advise. However, I wanted to train Mr Saw to do it. Hands on experience is the only way for him to learn if he wanted to start his own practice in Myanmar. He had never heard of this method nor the use of salt and so he did not know exactly what to do.

"The dog is tranquilised," I told Ms Lai. "He will not bite." But I did not want Ms Lai to do it as she looked worried. Mr Saw tried. No reaction. "Try again," I said. He placed more salt at the back of the tongue. Nothing happened.

"Rub the throat a bit," I said. I demonstrated. "Then give 2 ml of water in a syringe." Ms Lai walked away to fill a syringe with water. The dog was outside the surgery on the table.

After what seemed like an eternity, she returned. Mr Saw squirted the syringe of water inside the dog's mouth. The dog swallowed. We waited. Nothing happened.

"This will take time," I said to the two people whom I hope, had trust in my professionalism. "Give another 2 ml of water."

This was dutifully done by Mr Saw. We waited. Holding our breath. Both of them must think I have a whacky way of inducing a dog to vomit.

After a minute, the dog gurgled and wrinkled his muzzle. Mr Saw put his head downwards. The dog vomited three times, the last time being white froth. Brown rice grains and pieces of white tablets spilled over the grey table where the dog was positioned.

I showed them to the lady owner and she was happy. She had gone home first as she noted that the dog had not vomited after tranquilisation with xylazine 2% but I asked her to come back to see the evidence and bring the dog home. I had initially wanted to put the dog on an IV drip to dilute the poison but this was now not necessary as the dog had swallowed the half tablet only 2 hours ago.

Does salt work? Well, it does. It is not an elegant way and is quite messy. In times when xylazine does not work, I used this method effectively and I remembered this strange incident. Once a young lady bought in a dog who had swallowed a condom. I gave a xylazine injection IM as usual. No reaction. The dog blinked at me.

The young lady said: "I am responsible for this. What if the condom jams up the small intestine and the dog need an operation to get it removed?"

"Please don't worry, " I said. I just placed salt on the back of the dog's tongue as what Mr Saw did today. I rubbed the back of the tongue with my finger three times. I syringe in a bit of water for the dog to swallow. The lady was pleased on seeing the condom out of the stomach.

Veterinary medicine is full of surprises. There is never a dull day and challenges presented. I read a lot of inducing vomiting in dogs. With all those modern drugs for vomiting, a simple solution of using salt may be used. Don't try this if the dog has swallowed bones or stones. X-rays and surgery will be highly recommended.

143. Toilet training problem - email

E-MAIL TO DR SING DATED JUL 29, 2010

Hello my name is Kia...

i am so worried i have a 5 month old snoodle named Princess. She is in inside dog very active puppy. At first her potty training was great a kept her in a small place and took her out early morning and couple of times a day and also put newspaper which she would use. Now she uses the restoom everywhere. Its so frustrating because i have carpet. It seems like she pees a lot a lot a lot!She is still not spayed which i am going to do soon. What can i do, i think she is peeing alot because before she was just in the small place and now she is everywhere. What should i do...also she drinks a lot of water... help thankz

E-MAIL REPLY BY DR SING

Pl bring her for vet check up promptly. She may have a urinary tract infection. Then please keep her in a small place again and train her again.

COMMENTS
It is hard to advise as an e-mail cannot be as good as speaking to the owner directly.

Tuesday, July 27, 2010

144. Eyeball prolapse. The Shih Tzu's left eyeball pops out

Tue July 27, 2010. Back to work after visiting Penang yesterday to talk to a swiftlet farm consultancy with my mentor who is interested in this cloak-and-dagger business. I presume the underworld has a hand in the swiftlet and bird nest production business but then where there is money to be made, the triads will be there.

At 3 pm after finishing perineal hernia in a Shih Tzu that cried during defaecation, I was surprised to see a lady in her 30s waiting in my reception. She was early for her appointment. She showed me her female Shih Tzu with a green left eye.

"Her left eyeball popped out after 5 pm yesterday as I saw her at that time and she was OK," lady owner said. Another dog had jumped onto this Shih Tzu. The eyeball pops out <24 hours. I could see that the dog had been rubbing eye vigorously till the upper area above the eyelid was a purplish red and the sclera (eye white) was as blood shot as it could ever be.

The lady consulted Vet 1 who had instilled green ophthalmic fluoroescein. This dye showed that > 80% of the eye cornea is ulcerated. She wanted a second quotation and Clara, a dog groomer and friend had referred her to my surgery where charges are apparently lower. Groomers sometimes play a great role in referrals according to the Penang vet I visited in Penang yesterday. The Penang vet showed me the pet shop whose owner regularly sent him cases. Well, I don't have such good connections as pet shop owners in Singapore tend to be promiscuous in veterinary referrals.

"The Shih Tzu has a high fever," I warned the lady of the risk of death on the operating table for an old dog. An old dog with a high fever too aggravated the risk. "However, eye injuries are emergencies and cannot wait another 24 hours." The lady had no choice and left the decision to me.

I gave the anti-fever and painkiller tolfedine and antibiotics baytril injection subcutaneous around 5 minutes before I used Isoflurane gas to anaesthesize the dog. There was no sedation as this would be riskier.

Surgery: Lateral canthoplasty increases the space for this enlarged injured popped out eye. The prolapsed eyeball was too large for a simple stitching up of the eyelids (tarsorraphy).

"But I had a previous Shih Tzu whose eyes popped out bigger and the vet did not do that," the young lady said.

"Each case is different," I said. "If you don't want the side of the eyelid to be cut to enlarge the eye socket to accommodate the eyeball, please don't blame me if the stitching of the upper and lower eyelids break down before 7 days."

The lady consented to leave the technical matters to me. Many owners want to voice their opinions on treatments and in some cases, they are more knowledgeable than he vet who has to treat several thousands of various cases and may not be an expert in a particular condition.

The following is a summary for vet students of what I did.

1. "Clip both eye area and eyelid lashes," I said to Mr Saw as he presented me with the dog. "Take out the 3rd eyelid and wash off any hairs and debris. Also rinse the eyeball thoroughly."
2. I note an embedded foreign body inside the eye-white. I used a scalpel blade cut off.
3. I ensured that all green dye and hairs are washed away.
4. Sub conj gentamycin and prednisolone subconjuctiva.
5. 3rd eyelid flap, use tension tubes and stitch lateral canthus.
6. For old dogs with fever, reduce the fever and stablised the dog first in normal situations. This will take 24 hours. Eye injuries are emergencies and so the vet has to decide whether to operate soon or not.

The beloved Shih Tzu recovered well from anaesthesia as if from a nap. I phoned the worried lady to let her know that her dog was OK. The eyeball should shrink back to normal in 7-14 days. The lady wanted her dog back and took her home the next morning.

Shih Tzu passes blood a few weeks, incontinent

"Blood in the urine and can't control bladder for past few weeks" the man with the dyed bronze hair said.

His usual vet, Vet 1 diagnosed bladder stones and did not charge him. He referred to Vet 2 as he did not want to do any surgery. Owner read that Vet 2 had a bad name in the internet forum. So, sms me regarding costs of surgery, X-rays etc.

Shih Tzu, Female, 1.5 years
"When's the last heat?" I asked as the vulval lips were still swollen.
"Last month," the young man said. "I thought it was due to heat problems."

BLADDER PALPATION
Crepitus (gas-like sensation) inside the bladder. A common indication of bladder stones.

BLOOD TEST
1. Blood urea above normal


URINE TEST
pH 6.5
SG 1.004
Nitrite +
Blood 4+
Bacteria Occasional
Protein +

Sometimes, no crystals in urine as stone is formed. Acidify urine. Change diet to wet food.
Goes home for one week of antibiotics. Then x-ray if the owner wants it.

Monday, July 26, 2010

142. Swiftlet farming and Golden Retriever split humerus repair

Monday July 26, 2010

"Switch off the phone, switch it off," the group of "aunties" spoke loudly to a member of the group whose phone emitted extremely loud musical noises as the Air Asia plane from Penang was about to land in Singapore at 8.30 pm Monday July 26, 2010. But the old woman answered her phone in the Hokkien dialect: "I am in Singapore now. What did you say? Can't hear you well. Speak up, speak up..."

"The plane is going to crash if you don't switch off your mobile phone," one aunty shouted. "Switch off, switch off..your phone."

But no cabin crew or passenger rushed to take the phone off the culprit. Air Asia cabin crew had advised about switching off the mobile phone before the plane lifted off from Penang, but the language was English and Malay. The old Chinese woman understood neither and so she did not switch off her mobile phone. No Singapoeans died as the plane did not explode.

I was in Penang to visit a swiftlet farming consultancy, Crystal Swiftlets, www.crystalswiftlets.com, with my mentor. A vet there picked us up. It was a bright sunny day in Penang. I will just record briefly in draft form, my visit this morning before I get sucked into the daily routine in Singapore and don't record anything.


SWIFTLET FARMING
1. Swiftlet farming can mean big money as there is no need to provide feed for the swiftlets. Food can account for a big % of the production cost. They fly out to eat only flying insects (airborne and therefore healthy).

2. According to the consultancy, only 2 of around 15 species of swiftlets are worth investing. "In such situation, building a house for swiftlet production may result in losses if the wrong species come to nest," I asked. The consultant said that a site test would be conducted to see whether there is the useful species. This involved the use of vocalisation (music in CD, etc) and other methods by the consultancy.

The most useful species is Aerodramus fuciphagus which produces the high quality birds' nest in great demand. Its bird nest consists of white edible nest. 97.5% of the nest is made up of valuable glyco-proteins said to be good for the health of the consumer. The other useful species is Aerodramus maximus. Other species produce nests mixed with other twigs and branches.

3. Prices. In 2006, RM$4,000 - RM5,000/kg. l kg = around 110 nests. Wholesale price is around RM 40.00/nest.

4. Breeding cycle: 4-monthly. Weight of the adult bird is 8-10 grams. The birds have such short legs that they don't land on the ground since they can fly up again.

5. Swiftlet farming in Malaysia. It is a dirty smelly job and there are predators, the consultant said to me. There are scam investments asking people for money and then disappearing. Sungei Pantai and Alor Star syndicate claims they have >30 successful swiftlet farms. 1 farm produces 3 kg of birds' nest = RM9,000/month. A Penang couple tricked church goers into investing in their bird nest business and disappeared with the money. The Penang vet said that 80% of the farms close down.
5.5 storeys allowed in Malaysia now. Ground floor is housing for workers or holiday guests. Cost of construction around RM400,000. For 3.5 storeys, cost is around RM300,000.

Adult and bigger birds do not sleep inside the small nests. Baby birds fall down and die if disturbed. They cling onto the sides of the nests as they grow up. Within 3 days, a swiftlet will build another nest if people start removing the nest. "Obviously, the swiftlet will go away if nests or eggs get removed," the consultant said. The swiftlet lays a maximum of two eggs per season. If one egg is removed, it will not encourage more eggs to be laid unlike chickens. Eggs artificially incubated will result in weak flyers or birds that don't return to the nesting place. Adult weight said to be 6-8 g. I saw a dead swiftlet at the office. It was small but had long wings. Cannot walk on the ground as it has short legs.

A.fuciphagus nests further inside the house while A. maximus nest further out, the consultant said.

Rainy season, few airborne insects, affects production. The swiftlets need flying insects.

Attend courses at the consultancy:
1. Private individuals from Myanmar and elsewhere. Buy least cost players (RM140) to play the USB vocals to attract the swiftlets.
2. Big joint-venture private-govt company in Ho Chih Min, Vietnam was provided consultancy and had built 11 farms for the company. Now, the company wants to build another 22 farms.

6. "Just build a house in an area where the birds have access to flying insects and provide the appropriate environment including the vocal cries of A. fuciphagus," my mentor thought. "Not so easy," the consultant said. "There needs to be a site test to see if A. fuciphagus or maximus are present. A. fuciphagus produces 95 - 99% of the white colour in the nest with few % of feathers unlike other species. A. maximus produces 55%." South east Asia is the area where swiftlets are found. Indonesia, Thailand and Malaysia are the top producers of birds' nest.

7. Predators are many. Owls, snakes (green ones love eggs), bats, lizards and cockroaches (eats nest and baby birds). "I think the main predator is human beings," I said to my mentor. "If the birds' nests are so valuable, what is there to stop the workers from selling the nests enriching themselves?"

8. Government regulations in Malaysia. Land control (does not permit residences to be used for swiftlet farming or give licence yearly), veterinary control (audit of bird nests, check for nitrite contamination), export licence needed nowadays. Agriculture land may be the long-term solution. Can bird nests be produced in urban areas? Yes, if conditions are right. She said that Georgetown has around 500 bird nest farms, mostly in shophouses, according to the consultant. I don't hear any swiftlet farming in Singapore but then prices of land are higher here. In Malaysia, only 10% of the one-acre agricultural land is permitted for buildings for swiftlet production. The rest is for planting of dragon fruits (v. popular), mushrooms, fishes, holiday homes. Shophouses not encouraged. Licence is renewable annually. Consultancy sells speakers (music to attract birds to come into house and music to stay inside the house). Players to play the music. Both must match. Can fly >100 km per day. "Swiftlet farming can be done anywhere in Malaysia," the consultant said. "The environment must be suitable." 3 companies in Penang had their export licence revoked as their processed birds' nests were found to contain high nitrite levels.

Raw birds' nest. 3 types of bacteria checked by veterinary authorities.
Approval for building is very complicated.
Many investment scams. Kulim scheme RM500,000/investor share. Offers investors 80% of proceeds. Pumps to blow up insects for the birds to eat. Kulim, KL and Malacca firms raided for scams.

In my analysis, swiftlet farming is not a viable investment unless the investor does his own farming initially or has proper audit and financial controls as evident in the apparent success in Ho Chih Min joint-venture.

Saturday, July 24, 2010

141. Spaying A Chow Chow

Chow Chows are an uncommon breed in Singapore. They have a compact narrow abdominal area and a broad chest unlike Miniature Schnauzers or cats. So, it is hard to hook out the ovary using the method I am describing below. I record one case of a spay in a Chow Chow to share knowledge with veterinary students.

Patient: Chow Chow, female, 10 months old, 18kg. 39.7C (due to car ride and excitement, vomiting inside the car. Don't spay till 4 hours later)

Last Estrus: 3 months ago. This means that there will be less bleeding when the dog is spayed 3 months after the heat.

Anaesthesia: Domitor 0.25 ml IV although 0.3 ml should be OK too. Then isoflurane gas mask and intubate. IV saline drip given.
"Emergency drugs are to be given inside the IV drip," I explained to Ms Lai, the young intern who wants to study to be a vet. "But the best way is to prevent emergencies from happening by having one assistant monitoring the breathing bag, checking the eyelid reflexes and gum and tongue colour every few seconds. Equipment like ECG, pressure measurement, breathing sound measurement and others are useful but nothing can be beat a competent focused assistant."

Ms Lai already has a degree but she intends to be a vet and is doing a 2-month internship at Toa Payoh Vets. She seems passionate about veterinary medicine and so I explained much about the behaviour and medical and surgical problems to her the new world of dogs and cats, rabbits and hamsters and other small animals to her.

"Old man James used to be my assistant," I said to Ms Lai. "But now he is 75 years old and so he can only observe the breathing bag. When the dog under anaesthesia stops breathing, the bag will stop moving. If the assistant only observes the bag and nothing else, it may not be sufficient or too late. He has to observe the mucous membrane colour and check the eyelid reflexes as well as observing the rotation of the eyeball downwards to confirm surgical anaesthesia."

I don't know how much Ms Lai understands my explanation as she is so new to this world of veterinary anaesthesia and this is the first spay she is watching. My competent assistant Mr Saw was focused on anaesthesia.

"In the case of the Chow Chow, there is no point checking her tongue," I said to Ms Lai. "Look at her tongue. It is naturally purplish black and so we can't see the red colour of oxygenated tongue. We have to check the eyelids."

There was no problem with anaesthesia. Mr Saw tends to put on the lowest dosage to sometimes as low as 0.5%. "It is best not to put to such low rates," I said to Mr Saw. "The omental fat keeps popping out making it very difficult to stitch the muscles to close the wound. 2% gas will be sufficient for this Chow Chow. When I go to the skin incision, you can switch off the gas as Domitor is still sedating."

Overall, this Chow Chow had a very smooth anaesthesia. I took out the endotracheal tube as I saw her reacting by moving her mouth. She woke up with a head turned sideways for a few seconds. This was normal as she was under Domitor sedation. An Antisedan antidote would wake her up completely but we had to clean up the wound and apply the plaster.

Surgery:
1. Body fully stretched out.
"Stretch out the dog as much as possible," I said to my assistant and intern. "I use a 2-cm incision and insert the spay hook to the right and 45 degrees downwards to hook up the ovary. From my experience, it is much easier to hook out the left ovary. Otherwise, the vet may take a very long time to hook out the ovary. I have seen one new vet graduate actually sweating when he spay a big fat mongrel as he could not hook out the ovary for over 10 minutes. If it is difficult to hook out from a small incision, just extend the incision and it will be much easier."

My assistant could not stretch out the left hind leg as there was some jam in the operating table's sliding ring. "I will use my hand to pull the left hind leg," the intern proposed. Well, she had ideas as she could not manage to resolve the jam. My assistant did it.

N.B. Some vets incise around 4 cm from the umbilical hernia scar. In this position, the ovaries are harder to assess and the taut ovarian ligament may not be assessed and cut so easily as in my method. The vet has to pull the ovarian ligament to cut or rupture it using fingers. There is a danger of bits of the ovarian tissue retained during this difficult manipulation. However, each vet has his own ideas and experiences.

2. Skin incision:
Approximately 1.5 to 2 cm from the umbilical scar.

3. Linea alba incision:
Remove the subcutaneous fat. Look for the linea alba. The Chow Chow's body is compact and this 1.5 - 2 cm incision is too small to see the linea alba clearly. But it can be seen. Incise the linea alba. Subcutaneous fat can be seen below this small hole.

4. Spay hook:
With one forcep holding one edge of the muscle, I inserted the spay hook at 45 degrees to the right (dog's head to the vet's left), tilted the hook downwards and had to arc the hook upwards and to the left to hook out the abdominal fat with the ovary. In this Chow Chow, there was much omental fat. I failed the first two times to hook out the ovary as the fat was in the way. At the 3rd time, I saw a glistening knob at one end of the omental fat hooked out. This was the ovary. I used the forceps to clamp a bit of the ovarian tissue and after that, it was simple.

5. Bleeding after separation of omental fat from the uterine horns:
As I separated the omental fat around the uterine horns, prior to clamping the uterine body, there was a gush of bleeding. I clamped the uterine body lower to the bleeding area. The bleeding stopped. I ligate the uterine horns in two locations. No bleeding. Put the uterine stump inside the body.

6. Loosen the tautness of the body:
I asked my assistant to loosen the tight ropes around the dog's paws so that the body is now relaxed. The rest of the spay is as described elsewhere in my website.

7. 2/0 absorbable suture. 2 simple interrupted stitches closed the peritoneum and the muscles. I gave an additional 1 more stitch. Skin is closed with 2 horizontal mattress.

8. Bleeding in the skin sutures. I asked the intern to press swab onto the bleeding area. Bleeding stopped after 10 minutes.

9. Elastoplast bandage covered the wound. The dog could be bathed. No e-collar as I doubt that this Chow Chow likes e-collars. In any case, tolfedine painkillers post-op injection and oral for next 4 days would prevent pain and licking.

10. The dog was able to wag her tail and walk when the owners came one hour after the operation to take the dog home. No Anti-sedan antidote was given as the dog could stand up and walk. The mother was relieved as she was worried about anaesthesia but did not express this worry to me earlier. I could sense it as deaths on the operating table due to anaesthesia are are common worry for many owners.

Spaying this Chow Chow at 3 months after the last heat was the correct timing made by the knowledgeable lady owner. There was practically no bleeding from the omental or ovarian fat and surgery could be completed earlier. Still it took some 30 minutes to do the surgery and I don't look forward to do more spays in Chows Chows owing to the greater difficulty of hooking up the ovaries.

Friday, July 23, 2010

140. Doing research

Article: In search of Ma - Mother's Day Story
The Straits Times, May 1, 2010


Devonshire Road, Teochew Tong San Tng temple photo with Mia Tan's mum praying taken by a German photographer almost 20 years ago. Photo was exhibited in the temple. How to trace him for the photo? Took one year to get result.


1. Countless online searches, emails to German photograhers working or had worked in Singapore, photojournalists, Goethe Institute for names, but disappointed.
2. Friend suggested online National Library Board Digitalised Newspaper archives. Found a newspaper article "Candles kindle love for temple photography" by Wolfgang Pippert.
3. Went to National Library microfilm reels and books to get a photo of Mr Pippert.
4. Finally, search Facebook. Mr Pippert sent her a scanned photo in her email. Gave to mum on Mother's Day.


Mum is 70 years old but the photo is a constant reminder of Mum's values of steadfastness, patience, compassion and wisdom.

Wednesday, July 21, 2010

139. The Chihuahua bites the vet

"Why can't Frank write down the terms and conditions for the sale and purchase of diesel?" Khin Khin asked me a few times today July 21, 2010. "He is the Seller's agent and should provide the info in writing."

Khin Khin wants to be a successful businesswoman doing big deals. She had stopped being an employee veterinary technician for the past two years. But the mega deals seem to be elusive. Meetings after meetings are a common occurrence in commerce. She would invite me to attend some meetings to help her close. But for the past two years, she had no mega deals in commodities. In business, performance counts. There must be a deal closed. Otherwise, time would have passed and there would be no income for the year.

"It is possible that Frank does not write or know how to write the terms and conditions," I said. "I will phone him and ask for the details." I don't get involved in this wheeling and dealing as it takes up too much of my time. But it seems that Khin Khin does not know how to close. The first thing is to know what is the problem.

THE PROBLEM
The Buyer wants to buy diesel at the lowest price, far below market rates monthly at a fixed price every month.

THE SOLUTION
The Buyer's wishes cannot be fulfilled. "Walk away from this deal," I advised Khin Khin. "It is a waste of time and I get fat when you order oily food for me to eat when I attend your meetings."

PERSEVERANCE
But Khin Khin would not give up. If the deal is closed, she gets commission. At least 40 times more than a veterinary technician earning $2,500 a month. That is for one deal.

MY SOLUTION
I wrote the following sales procedures for Khin Khin's buyer after talking to Frank who was lamenting and cursing that Khin Khin's buyer keeps asking for old prices. "If the Buyer had bought 2 months ago, the prices were much lower and he could have made US$150,000!" I provided a listening ear as Frank who is around my age had 4 heart by-pass. I noted that the scar on his left hand where a vein was taken for his heart had healed almost 90%.

This is my e-mail to Khin Khin:

1. If you want to buy at a fixed price every month for 12 months, but pay only by monthly payments when you receive the diesel, the Seller does NOT do business this way.

2. The Seller wants a 12-month contract and a Letter of Credit (LC) which must be paid to the Seller's Bank in the full amount of 12 months. The Bank will only release the money to the Seller monthly when the Buyer takes delivery of the diesel.

3. If you want to buy diesel one month at a time, you will have to pay spot prices) depending on market prices. You will not get a fixed price as it is given only for a long-term contract such as 12 months with pre-approved LC.

4. When the LC is shown to the Seller, then the terms and conditions of the contract will be given to the Buyer. For example, how long the diesel will arrive at Yangon and any other questions will be answered.

5. The problem here is that diesel prices keep going up monthly but the Buyer's agent in Singapore wants to buy at old prices 2 or 3 months ago saying that they can get the price at such low prices in Myanmar.

6. If this problem can be resolved, then there will be business for both parties.

To: The Buyer
If you want to buy diesel at a fixed price for one year, the following procedure from the Seller is as follows:

1. Open a transferable LC with (XXX - Name of Company) in a Singapore Bank.
2. When the price of diesel is agreed by the Buyer, XXX will transfer the LC to a Singapore Bank of the Seller.
3. A contract of sale will be given to the Buyer only when the LC with XXX is shown. This is to make sure that the Buyer is serious.
4. The Seller's Bank will release the money monthly to the Seller only when the documents of sale are in order. If not, no money will be released.
5. The Seller's Bank holds the one-year amount for this one-year fixed price locked-in contract.
6. If the price is not agreed, XXX keeps the LC or returns the LC to the Buyer.
7. In this situation, the LC costs around $4,000 - $5,000. This will need to be paid by the Buyer and will be his loss if there is no transaction.
8. Without proof of the LC in XXX, no other paperwork will be prepared as the Seller considers that the Buyer is not serious in this purchase.

I hope the above will be easy to understand. 

If the price is lower in Myanmar, the Seller is not agreeable to lower or to match the price in Myanmar. Therefore, it will be a waste of time negotiating for previous low prices. Diesel prices have gone up a lot and so the Seller will not be selling at old prices. 
THE BEST SOLUTION
Direct oral communication with the real Buyer in Yangon to know what his worries are as the money to be given to the Seller is in large amounts. Writings can be mis-interpreted.

DOG ATTACK
I was at the apartment of Khin Khin's friend and business partner to type the e-mail during lunch-time. The friend had adopted a Chihuahua given up by the first owner.

The Chihuahua had stayed in my Surgery for some time in 2009 when he was ill and was neutered. He kept barking at me with the full force of a lion, knowing that he had a big mama to protect him. Khin Khin's friend had to take the dog away from me but the dog persevered in barking at me.

As I left the apartment after writing the e-mail, the dog found his chance, sprang up and nipped my right leg trousers just as I stepped out from the main door.

"It is lucky that I wear long pants," I said to Khin Khin's friend. "Otherwise I will get a nasty bite." Both businesswomen had no sympathy for me nor do they reproach the dog. They simply laughed at this little dog who had exacted his revenge on a vet who had injected and neutered him when he was younger. It was no laughing matter for me. Such are the hazards of being a free lance unpaid consultant to Khin Khin and in going to a apartment of a Chihuahua who dislikes me. The image shown here is the Chihuahua with his first owner. It is good to know that he is well loved by Khin Khin's friend in Toa Payoh. To the extent that he is allowed to bite the vet!

Monday, July 19, 2010

138. Separation anxiety in a 6-month-old Bichon Frise

2010 CASE: THE 6-MONTH-OLD BICHON FRISE HAS A VERY PAINFUL MOUTH AND SEPARATION ANXIETY
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
20 July, 2010 toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129

SEPARATION ANXIETY.
A young couple purchased a Bichon Frise at around 2 days ago. The dog barked a lot when the couple went to work. He has "separation anxiety," I said. The couple had tried all solutions from the internet including placing a clock. "The neighbour downstairs now close their windows. They do not do that," the wife said. How to solve the problem?

1. Spend time with the dog but this was not possible. Spending time means changing clothes to go out to work but comes back in 5 minutes, then 15 minutes and gradually increase the time of outing. These need several days to be effective.

2. Bring dog outdoors more often. Not practical advice. "The dog seemed afraid of going out, afraid of the drain grates and just wanted to sniff around," the man said.

3. Get another puppy. Not practical as the HDB apartment regulations prohibit more than one.

4. "Get a rabbit," I wanted to let him adopt a rabbit on a trial basis as I have one. "The dog will kill him," the man said. "Put the rabbit inside the cage," I said. The couple rejected this idea.

5. "Come back for lunch daily," I said. This was not practical.

6. "There is no solution," Mr Aung said when I asked him. "De-bark the dog." This was not acceptable by the owner.

7. "Give Kong balls with dog treats inside the holes," I suggested this method to occupy the dog's attention while the owners are at work. In theory, the dog tries to pull out the favourite treats hidden inside the holes of the Kong balls." The couple had tried but the dog was not interested. This was before I examined the dog's mouth and found that he had this rare gum abnormality. His gums practically cover all his back teeth from the four sides of the jaws. So, how could he shear or chew on dog treats? See pictures at:
http://www.asiahomes.com/singaporeaur/0703hunting_4_5k.htm

8. There is one impractical solution. Place the dog with a house-hold where there is always somebody at home. But this is not a practical solution as the couple will have to give away this dog free of charge to a friend.

In any case, I had just excise the enveloped gingival epithelium of this quiet Bichon Frise so that his covered back teeth are now exposed. We will wait and see whether he is happier now as he can eat hard food and now ignore his chew toys or treats.

Pictures of my gingiva (gum) electro-excision is at:
http://www.asiahomes.com/singaporeaur/0703hunting_4_5k.htm

137. BEHAVIOUR. Golden Retriever is frightened when it rains

July 20, 2010

I went to the National Library, Victoria St to research on bird nest production. It is a secretive business apparently as demand for high quality bird nests is great, sales of which can be as much as RM$4,000/kg or S$2000/kg.

One officer suggested checking out nature.com. "How's your abalone book?" he asked and encouraged me to use the internet. "Not much info about the hundreds of species in this world in the internet," I said. I expect the same paucity of information from the internet with the technical aspects of bird nest production.

BEHAVIOUR OF DOG
I asked about his dog. "Still the same behaviour. My main door has a big hole now. I have to board it up." For the past 6 years, whenever there is rain, lightning or thunderstorm, this 6-year-old female spayed Golden Retriever will paw at the main door to be let inside the house. Once inside, she will pace up and down.

SOLUTIONS
1. Play CDs of thunderstorm and lightning. One Filipino vet technician advised him to download from the internet .wav files. He went to google, type ".wav + lightning." Then he would play the CD which lasts about 10 minutes for one hour per day for 7 days.

"Any success?" I asked him.
"The Golden Retriever just listened in boredom."
"So, it is a failure?" I said.
"Yes," the man with greyish hair said. "There needs to be the environment - the change of temperature before the thunderstorm. I don't have time to wait for such ambience to play the CD."

There is never any time for working adults to train a dog not to be afraid of thunderstorms and lightning. In any case, the total experience of climate changes was not produced. So, now the owner is resigned to the door damage.

2. SPECIFIC TREATS TO BE ADDED INTO THE FOOD. "It costs me $25.00 to buy the treats from ... (a dog farm in Pasir Ris) and this product was on sale. It would cost $40.00normally.

"Does it work?" I asked.
"No," he said. "The dog appears drowsy. I must feed it with this product every day."
So, it was money down the drain.

3. DOG PHEROMONES. I mentioned that there is one product which I believe has been used in the UK for the past few years and not available in Singapore. But how effective dog pheromones are to calm dogs during thunderstorm, I do not know. So, I dare not advise him to spray it onto the dog's nose prior to thunderstorms.

It seems that this poor owner would have to replace several main doors as the Golden Retriever is outdoors and rain is quite common in Singapore nowadays.
Readers who have successful solutions, please e-mail to me at judy@toapayohvets.com

Sunday, July 18, 2010

Success factors in a fashion business

Saturday July 17, 2010 10 p.m Cathay Cineplex

It was nearly 10 pm on a Saturday which was my day off. Most senior citizen mothers in the middle class would be enjoying themselves, playing mahjong, singing at karaoke or entertaining.

I had come back from the National Day Parade Rehearsal at the Padang to get my car at the Cathay Cineplex car park.

Earlier, a kind lady had given me a red entry ticket to view the rehearsal from the Padang. She approached me as I was standing on the ledge of the fencing of St Andrew's Cathedral at 5.30 pm dangerously with one hand grabbing the railing and the other hand taking pictures. She asked me if I wanted a spare red ticket she had. I said yes. I did not apply for such rehearsal tickets as they were in great demand and I could not be bothered. With this ticket, I was near the centre of action and could take some good pictures in this bright evening

I was surprised that this mother was still manning her son's small fashion retail shop. She worked 7 days a week. Push-carts at the ground floor would have changes of shift workers but for her, she was the only saleswoman as the previous employee had not be honest.

Her eyes were about to close as she sat behind the counter. Julia had bought some T-shirts from her previously but could not find any interesting apparel in her shop. "Just

Saturday, July 17, 2010

135. Sunday Case: Stray cat salivates and has bad breath

"Like some people, this cat looks haggard due to his lifestyle. He may be younger than 5 years of age," Mrs Bell said when I estimated the thin stray cat as 5 years but probably older. Most of his teeth had fallen out. This male neutered cat would not permit me to open his mouth without showing his claws.

My groomer Mr Aung wrapped the cat in a white towel and put the cat on the consultation table. I did not think of using the towel at that moment. I presumed Mr Aung remembered the house-call he attended with me very well as I had suggested a white towel to wrap a house cat. The fortunate well cared for cat adopted by a Caucasian expatriate in this case is recorded at:


Going inside a lion's den
The stray cat was not fortunate as he has lost so many teeth. Now he was very weak and Mr Aung used a string to anchor to his lower jaw to pry open his saliva-stained mouth.

I found ulcers in the middle and both lower sides of his tongue, on his hard palate and in his upper front gums.

"This cat had been living in my neighbourhood for a long time," Mrs Bell said. "He has this salivation for the past two months or so." Mrs Bell phoned me to make an appointment. Should she put the cat to sleep as the cat was in a bad shape.

He was not well and thus he was unable to groom himself. The saliva stained and dried up on his front paws as he tried to clean himself. He was dehydrated. Dull and lethargic. He was neutered by somebody in the community or most likely he was an abandoned cat.

"How do you know he is suffering from feline AIDS?" I asked Mrs Bell as I examined this dehydrated dirty cat with lots of black specks of flea dirt falling onto the consultation table. "A friend told me," she said.

"Are you sure you want to spend money treating a stray cat?" I asked Mrs Bell after I estimated the costs to be more than $500. "Most locals don't even want to spend ten dollars to treat a sick stray cat. This is a part of the Singaporean culture." But Mrs Bell is not a local. "Yes, treat the cat." Mrs Bell said. "I know the English is well known for loving their dogs and cats more than their children."

The cat was warded for a few days for treatment.

1. Blood test showed high blood urea and eosinophilia but no feline aids.
2. IV drip of glucose saline strengthen the cat. He would not permit me to open his mouth on Day 2. He even growled at me.
3. Pain-killers and antibiotics by IV and injection reduced his mouth pain. He could eat on Day 2.
4. He looked quite handsome after Groomer Aung bathed him. He would need a second bath.
5. On Day 2, I e-mailed Mrs Bell to phone me as her phone seemed engaged for a long time. She must have those instant e-mail Blackberries as she phoned me within 10 minutes. She gave permission for dental work for this cat.

"The cat may be toothless," I warned Mrs Bell. "Has he got feline AIDS?" she did not mind the cat being toothless and asked. "No," I said. "He is doing well and will be able to go home after a few days. He should not be out in the streets anymore." Mrs Bell said she would keep the cat indoors with her two cats. That was great news for this vagabond.

"There is no point sending the cat home without dental work," I explained to my assistant Mr Saw who was worried that the English lady may complain about the additional cost for anaesthesia and dental work. "The mouth ulcers will come back again. The cat will salivate again and will cost the owner more money."

"This cat has a disease that causes eosinophils to increase in large numbers," I showed Mrs Lai the blood test result of 6% for eosinophils. She wrote down the word in her book. Ms Lai has so much to do and works from 8 am to 10 pm, 5 days a week to gain the maximum exposure to veterinary medicine for the next two months. "Unfortunately the cause of eosinophilia is unknown," I told Ms Lai. "Extraction of all rotten teeth resolve the problem."

"Go and get the blood results of other cats for comparison," I asked Ms Lai. She brought me a blood test report which showed zero eosinophils in the blood test.

"Do you know how old is the cat in this report?" I asked the young and slim lady.|

"This cat is 18 years old while the case is around 5 years old."

Mr Saw said: "This old cat is dying." My associate is treating the 18-year-old cat which is in her last stage of her life.

Poor Ms Lai has lots to learn about veterinary medicine. That is the purpose of doing internship and I hope she gets accepted in one of the vet schools in Australia in 2011.

134. 3 cases reviewed - lateral ear resection by Dr Sing

CASE 1.
Cavalier King Charles, Male, Blenheim, 2years 3 months
Left ear scratching all the time

July 5, 2010 - Left ear canal resection. 9.7kg
Electrosurgery
Domitor 0.1 ml IV, Zoletil 0.1 ml IV, isoflurane gas
Surgery. Tolfedine 60mg 1/2 tab/day 5 days, antibiotics, panalog
Goes home Jul 11, 2010

July 12, 2010 - back to Surgery. Cannot handle nursing.
Stitch out July 15, 2010. Wet area.

July 18, 2010 - goes home. With e-collar. Pic taken.




CASE 2. Cocker Spaniel, Male, Brown, 5 years
Ear scratching both years

Jun 21, 2010 Surgery 14.7 kg
Domitor 0.2 ml IV, Isoflurane gas
Electro-surgery both ears
Tolfedine inj and baytril inj post-op
Goes home on Jun 25, 2010
Back to Surgery on Jul 9, 2010. Complaint bleeding and smelly
35 maggots removed.

July 12, 2010. Re-stitch under anaesthesia.
Domitor + Isoflurane gas
Tolfedine and Baytril inj. Tolfedine 3 days.
July 17, 2010. Stitch removed.
July 18, 2010. Can't go home. Wound not fully closed. Pic taken.


CASE 3.
Cocker Spaniel, Male, 12 years. Right ear shaking. rotten smell
July 12, 2010 ear surgery
Domitor 0.2 ml IV, Zoletil 0.1 ml IV, Atropine 1.0 ml IV, isoflurane gas
IV drip saline
Post-op rimadyrl 1.0 ml and baytril 1.3 ml, antibiotics.
Goes home Jul 16, 2010. No electro-surgery.

Thursday, July 15, 2010

Beagle puppy steps on poop and urine

Young couple from Australia
Beagle, Male, April 8, 2010: Bought from big puppy farm and kennels in Pasir Ris 4 weeks ago
Miniature Schnauzer, Female, March 4, 2010:
Paper-trained fast. Bought from small breeder husband and wife, small operation in Pasir Ris.

4 weeks. Now come for 3rd vaccination.
PROBLEM IS WITH BEAGLE:

1. Watery stools for many days and this meant special attention. Freedom to roam. I treated. Stools better formed.

Wednesday, July 14, 2010

131. Epileptic fits after 6 months and hypersexuality after fits

Shih Tzu, Male, Not neutered, Born 28 Sep 2005

July 15, 2010. 7.8kg 38.6 degrees C. Acute conjunctivitis both eyes. The groomer had commented on the red eyes.

Has fits for 10 X since 2 days ago. Wanted to hump with objects after recovery from fits. Daughter had given phenomav 30mg (1/2 tab per day), but once a day. No fits for the last 6 months. The dog was on K/D diet but also ate children's food given by the children. He had put on weight, now weighing 7.8 kg. "More alert," the mother said.

"Is the anti-fit tablet given the same time every day?" I asked the daughter. The mother had presumed this to be done as there were no fits for the last 6 months.
"No," the daughter said.
"In this case, the dosage is not effective. Sometimes you forget to give, sometimes you give at different times."

HISTORY
Fits started on Jul 28, 2008. Consulted Vet 1. Blood test OK.
Phenomav 30mg at 1/2 tab/day but not given regularly from 2008 - now.

Urine test: Aug 14, 2008.
pH = 9.0, SG 1.048.
crystals: triple phosphate ++
spermatozoa +++

TREATMENT Aug 18, 2008
acidify urine, C/D diet. Owner did not follow up.

NOW, 5 years old. Fits recently in July 2010.
To review blood, urine again. Daughter agreed to neuter to reduce humping behaviour. What's the cause of the fits? Usually the cause is unknown.

131. Lateral ear resection observations

As at July 15, 2010

1. Cavalier King Charles. The wound is wet. The dog feels the pain when the horizontal canal is checked. Panalog ear ointment was applied inside the horizontal canal on July 14, 2010. Why is there wetness around the area of the horizontal canal? Is the fluid from the middle ear? I need to investigate further. No more head shaking seen. If you look at his pre-op picture, he had been using his left back paw to scratch the area whee the middle canal is located.

2. Cocker Spaniel. 12 years. Wound heals well. Should be able to go home 3 more days. This dog has no more urinary problems after I removed 31 stones in the bladder last year. Owner feeds home-cooked food, mainly vegetables with a bit of chicken meat.

3. Cocker Spaniel with maggot wounds on left ear. Wound healing well. Drainage tube removed.

130. Working couple, 1 puppy, condo - grate toilet training

Miniature Pinscher, Female, 3 months. Came for 3rd vaccination.
Confined to balcony when owner is working. Grate + Pee Pan.
Two weeks with expatriate couple, both working.
Feeding: 10 minutes. Recently eating 50%.
Pooping: Around 20 minutes after eating. How many times does a puppy poop? "2-4 x per day," I said.
Peeing: Many times. Using the n-1 formula as a guideline where n=age in months, the 3-month-old puppy is expected to pee 2 hourly.

Problem: "She pees on the grate and pee pan mostly but sometimes outside it," the gentleman wanted the dog to pee inside the bathroom next to the balcony (utility area).

Solution: Confine to bathroom with baby gates at the door for 2-4 weeks. Put grate + pee pan inside the bathroom. Observe where the puppy eliminate. Keep grate cover clean from urine and poo. As the couple works, it will be difficult to use positive reinforcement consistently.

Conclusion:
The puppy may be trained to eliminate on the bathroom floor if that is what the owner wants.

Best time to Spaying
I advise 3 months after the first heat so that the female private parts are fully developed. If the owner does not want blood staining the condo floor, spay at 6 months of age.

129, Air-con for the Chow Chow After Spay?

Wednesday, July 14, 2010 inspection

Dusk fell fast in July. The waiting room was pitch dark as my assistant was at the back feeding the dog while the intern had just gone for her dinner. I was in the consultation room typing up my ear canal resection observations for my record and experience. Delays in writing mean never writing them up as every day seems to fly by so fast.

I noticed a young lady in black spectacle frames coming into the waiting area at 6.30 pm on July 14, 2010 as my consultation room door has a glass window on the top half.

I thought she was going to pick up her dog, cat or hamster as my associate Dr Teo has several in-patients. 3 cat fight wounds and 3 other dogs and two hamsters. I had two ear canal resection cases, a motorbike abrasion trauma case and 4 hamsters from one owner and two young rabbits nobody wanted to adopt. The kennel at Toa Payoh Vets was full house today.

After a while, I left my computer to speak to her. She had made appointment to inspect the Surgery prior to spaying her dog on Sunday. This was the first time I get an inspection from the non-regulatory veterinary authorities and I showed her the premises and answered all her queries.

The following queries regarding the spay of her Chow Chow this Sunday are recorded for the benefit of dog owners and for my knowledge management archives.

Dear Ms ....

1. No food and water 10 hours before arrival at the Surgery.
2. Your Chow Chow will arrive at 12 noon on Sunday and surgery will be performed around 1-2 hours later depending on my caseload. 
3. Bathe your dog before coming to the Surgery and check that she has no skin disease on her belly area.
4. She should be active and has had normal appetite on Saturday. If she has vomiting, diarrhoea, loss of appetite or is inactive, do not bring her for spay. Let us know when you cancel the appointment.

5. At the Surgery, she will examined and if she has no fever or heart problems, spaying will be done by me.
6. Belly hair will be clipped. Dog goes to Operation Room. Surgery takes around 15 minutes.
7. Anaesthesia domitor IV and isoflurane gas will be given.
8. An IV saline drip will be set up.
9. An antidote to domitor called Antisedan will be injected post-operation. This injection wakes up the dog in a few seconds as if from a short nap.
10. Post-op tolfedine and baytril antibiotic injection will be given.

11. The dog can go home 2 hours later with antibiotics and tolfedine pain-killers for the next 4 days. We will phone you.
12. For the first 2 days, the dog may or may not be active or eating much. It will be good if you take leave on Monday. If not, ensure that the dog is crated or in a small room.

13. Check the surgical area daily for pus or abnormal bleeding. Replace the plaster 2 days later after using a piece of facial cotton with clean warm water to wash away the blood clots. Dry the wound after washing. Then put on the new plaster.

14. No e-collar will be used in your dog although I do recommend in many female dogs. Your Chow Chow may not like it.
The plaster usually protects the wound. Usually the dog does not lick the wound if the painkillers are given as instructed. Some owners are unable to give the tablets directly onto the back of the tongue, close the mouth, stroke the neck while lifting up the head.  Some dogs are too smart and just spit out the tablets and therefore do not get the pain-killing effect. They start to lick the operation wound. 

Therefore, an alternative method is to conceal the tablets in cheese or meat balls. The first two ball given will not contain the drug. The third will contain the drug. Delay the meal time by one hour as an example. Usually the dog just swallow her favourite food quickly. 

15. The absorbable skin stitches will dissolve in 21 -28 days. So you need not come for stitch removal unless you want to get the stitches removed in 14 days as some dogs do get irritated by the stitches. Stitch abscesses form and are irritating. Observe daily and you can use clean scissors to cut off the knots on Day 14. Usually I stitch 2 skin stitches and they can be cut off easily 14 days after surgery.

16. If possible don't let the dog walk up and down slopes or stairs in the first 7 days. As the wound is 2 cm long (if there is no complications), this will not be a big problem with stitch breakdown. However, try not to let the dog jump and run around as she will feel active by Day 2 as the painkillers mask the pain.

17. Air-condition post-operation for the Chow Chow with her thick coat. In my experience, the body temperature after surgery drops due to the sedation and anaesthetic. No air condition is necessary and no Alaskan malamute, Siberian Huskies or Chow Chow have suffered from heat stress due to the lack of air conditioning post-operation. In your case, the dog goes home two hours post-operation and therefore she should be OK with you.

18. During the past years, I seldom get post-operation infections and complications after the spay if the owner nurses the dog well. Some 10-15 years ago, I did not give pain-killers post-surgery and the dog may howl in pain at home and during the first night. With pain-killers and antibiotics properly taken, no spayed dog will howl at home 24 hours after spay.  

19.  I hope all the questions are answered. E-mail your questions if there are more. Best wishes. 

Tuesday, July 13, 2010

127. Lateral ear canal resection - Cocker Spaniel

Dog went home 4 days after surgery as I wanted the owner to save veterinary costs.
35 maggots 1 cm long in left lateral ear below the horizontal canal 14 days later.
Drainage cartilage eaten away. Ear and e-collar full of blood.

"Was the dog outdoors?" I asked.
"Yes," the mother said.
"Any flies buzzing around the dog? There is a strong smell of maggot wound."
"No flies," the mother said.
"Yes," the teenaged daughter replied.

I had to ward the dog for treatment. 20 maggots extracted out. Negasunt powder given. After 3 days of antibiotics and anti-inflam treatment, the wound was fresh red. I phoned for permission to close up the wound. Permission given.

The dog's wound looked wet and yellowish. Some 15 maggots still were around. Maggots removed. Wound stitched. Drainage tube.

Saturday, July 10, 2010

Sunday's interesting case: The case of the missing Struvite Stones

E-MAIL TO DR SING SUN JUL 11, 2010

On Sun, Jul 11, 2010 at 3:15 AM, ...@gmail.com> wrote:

Hi. I found out about Toa Payoh vets as I was browsing pet forums and blogs. I have a 5yr old female mini schnauzer (high risk for stones). I adopted her from one of my husband's friend's last year. She has been struggling with struvite stones ever since we adopted her. There was blood in her urine last July/Aug. It subsided after a course of antibiotics. The condition recurred again this year (June). I reckon it was due to the new food supplement I gave her. I have already consulted 2 vets, but they said surgery is main cure. I was browsing your website and saw that you guide owners who do not want surgery. I am interested in this approach.

I hope to have a second opinion. I am already cooking for my pet and she eating home cook food with Urinary s/o and cranberry juice. I hope to do more for her to ensure she has a better quality of life. Not sure if I can bring my pet down this coming week (preferably Mon, Fri or Sat mornings) for a consultation.
P/s: My pet is outside trained, and if she starts peeing indoors for no reason, it means the stones are back. She urinated at home again today, but not sure if it is due to stones or the change in schedule since we brought her for grooming and didn't bring her for her usual long walk due to the heavy downpour.
Thank you for patience in reading this long email.

An anxious owner,
Name and telephone



FOR THE BENEFIT OF OWNERS WHO WANT TO USE MEDICAL TREATMENT FOR THEIR WITH URINARY STRUVITE STONES, HERE IS A CASE STUDY.


Sunday July 11, 2010. Bright sunshine. Blue skies. Should be outdoors.
I phoned the owner after reading the e-mail as this is a case with no definitive diagnosis!

HISTORY
Spayed dog was adopted when she was 4 years old.

July 2009. Passed blood in urine. Vet 1 took X-ray and check urine pH. Vet 1 was unsure whether there were bladder stones but said urine pH was alkaline but the owner could not say whether it was pH 7 or 8. Clavet antibiotics for 2 weeks and Royal Canine Urinary S/O diet for one month. No problem. The owner stopped giving dry and canned dog food and treats. Home-cooked food with a piece of chicken meat now gave her peace of mind till the dog started peeing at home, an abnormal behaviour in July 2010.

June 2010. Passed blood in urine and urinary incontinence. Vet 2 from the same practice prescribed same antibiotics for 2 weeks. Now no blood in the urine and bladder control. Will the stones come back again?

WHAT THE OWNER WANTS
"What do you want for your dog?" I asked. I might have woken her up from sleep by phoning at 10 am.
"No recurrence of the blood in the urine and urinary incontinence problem for the 3rd time." She forgot to mention no urinary stone removal surgery.

OTHER INFORMATION
Licked vulval area most of the time after outdoor walk.
Dental hygiene poor - tartar.

PHONE DIAGNOSIS:
It seemed that there was no veterinary diagnosis of struvite stones. The owner believed that the dog has struvite urinary stones. The presence of struvite stones was not confirmed by urinary analysis. Although the Miniature Schnauzer is one breed prone to getting urinary stones, this case may be a case of urinary tract infection. She may not have non-struvite urinary stones.

ADVICE
1. Get a proper diagnosis:
t is best to get the dog examined for stones by palpation. A blood test to check the kidney function as the owner had been giving her own prescriptions. A urine test for crystals - collect urine via catherisation. X-ray after emptying bladder and use air contrast.

2. If the struvite urinary stones are very small, medical dissolution of the stones + acidification + prescription diet may be possible. 3-monthly check ups of urine will still be necessary.
3.
Behaviour - licking of vulval area must be stopped. Dental work must be done as the mouth is full of bacteria which may have infected the bladder via vulval licking. The female dog has a short urethra and bacterial infections are common. Veterinary cases such as this case of the recurrence of blood in the urine are more interesting than Sherlock Holmes' cases. However, I don't have Dr Watson to help me.

Thursday, July 8, 2010

125. Head tilt when ear drops applied

Friday July 9, 2010


English Cocker Spaniel, Female, Spayed, 12 years. 12.7 kg

Rotten tissue decay smell in the right ear
Scratches right ear onto the floor. Vet 2 advised 1,5 years ago to use ear drops from pet shop and seeing him 6-monthly. Ear drops worked till recently. Very smelly liquid from ear.

Advised: Surgery as permanent cure rather than visit Vet 2 six-monthly. 3 days of antibiotics, I would operate on Monday.

Last 3 days, head tilted to the right after pet shop Nova ear drops applied onto ear for one hour before sleeping.

1. It is important to check head tilt before surgery. Asked owner to exercise the dog. Slight head tilt to the right. May be blamed by the owner if head tilts after surgery.

2. Checked heart. OK for anaesthesia.

3. Blood tests. Father wanted to buy new puppy as $500 operation would pay for new puppy. "Does he want this old dog to be put to sleep?" I asked. "I will never agree to it," the young lady said. Due to economics, did not insist on a blood test.

4. Economics.
In August 2009, I removed 31 urinary stones (blood in the urine, complained that Vet 1 prescribed medication for few times, ineffective). No dry food or canned food. Fed vegetables, soup and little meat. No blood in urine colour. She used dipstick to check pH.

Then on January 2010, my vet removed a mammary tumour. No recurrence of tumour as checked today. So the young lady had to budget her expenses and savings as taught by her father from young. Very few parents teach their children financial management.

OLD DOG. 3rd anaesthesia after 31 bladder stones removed and breast tumour removal n 2009.

Sedation: Domitor 0.2 ml IM, Zoletil 100 0.1 ml IV, Atropine 1.0 ml IV. Top up with isoflurane gas. Excellent general anaesthesia.


SURGERY - A different surgical approach from my usual method.
Midline incision of vertical ear canal
Separate skin and SC tissues
Lateral wall seen
V-shaped cut of lateral wall from anterior and posterior ends.
Lots of bleeding controlled by swab
Cut lateral wall - cartilage end trimmed by cutting to depth of around 2mm so that the skin ends are free of cartilage (like ear cropping) and can be stitched. Nylon stitches.
NO drainage board. Much shorter operation time and incision.


POST OP
Antibiotics. Rimadyl 50mg/ml at 1.0 ml effective painkiller. Dog eating the next day.
Photograph on Day 2.
To stay 5 days.

124. Fever, Anaemia & anterior abdominal pain 2-year-old male Shih Tzu

History

Shih Tzu, M, 2 years
Admitted on Jul 6, 2010, 9pm. Lethargy, not eating for 2 days. Fever and white gums and tongue. The domestic worker said that the dog was given (chicken +/or fish) bones by a family member recently.

Presenting signs
Acute abdomen (anterior). Bites vet when the anterior abdomen was palpated.

Blood test on Jul 7, 2010 - anaemia, dehydration and toxaemia
Low red cell count ( 4.1) and haemoglobin (10.4)
Low packed cell volume (0.3)
Low platelets (47). No platelet clumps seen but few giant platelets present.
Surprisingly, the WCC on admission was below normal at 5.4 with neutrophils 94% and lymphocytes 4% instead of a big increase.
Liver profile normal. Kidney profile - urea is normal. Creatinine is below normal.

Urine test on Jul 8, 2010. Full bladder catheterised to collect urine. There appears to be one urinary stone in the bladder on X-ray.
Catherised urine results taken after X-ray showing one urinary stone are as follows:
brown, turbid, SG 1.020 pH 7.0. Abnormal findings are as follows:
Protein 3+, urobilinogen 1+, bilirubin 3+, blood 4+, WBC 58, RBC 243, Crystals of amorphous phosphate 2+, triple phosphate occasional, bacteria 3+

X-rays on Jul 8, 2010.
Stomach is filled with radio-opaque granules. Some larger radio-opaque lumps are present in the intestines. These are likely bones.
Spleen is enlarged.

Diagnosis
Toxaemia. Impacted stomach and intestines and urinary tract infections.

Treatment on Jul 7 & 8, 2010
IV drip x 2 bottles (glucose saline + saline) x 500 ml each for 24 hours
Vit K1 2ml in drip
Baytril 1.0 ml, Tolfedine 4% 1.0 ml x 2 days in IV.
No fever on Jul 8, 2010. Dog more alert but does not want to walk or poop.

Stomach mucosa bleeding. Surgical removal of foreign bodies in the stomach is needed but highly risky. The dog is unlikely to survive the anaesthesia.
Goes home for the next 2 days for observation of pooping. Owner has been informed about poor prognosis if the dog does not poop or has more stomach bleeding

X-ray images x 2 showed stomach and intestine are impacted with radio-opaque foreign bodies

Tuesday, July 6, 2010

A needle and thread inside a cat's mouth

Going to an apartment to treat a ferocious cat with a needle and thread inside his mouth can send shivers down a vet's spine. It is like going to a lion's den. But Mr Hall said he could put his cat inside a crate and bring him to the Surgery and so I had to make a house-call on a fine weekday evening. I drove to the Grand Hyatt in less than 15 minutes and such prompt attendance impressed Mr Hall. I parked outside the hotel after being given permission to do so as I told the valet I was treating Mr Hall's cat.

In the semi-darkened glowing lights of the lobby, I met my two assistants, Mr Aung and Mr Saw at the lobby. The receptionist in smart black jackets and well groomed ushered us into a lift and took us up to Mr Hall's apartment.

I knew what to do as I am an old vet and would finish the job in 20 minutes. But it would be best for my two assistants to get hands-on experience as they wanted to open their own practice in Myanmar next year. They are veterinarians if they practise in Myanmar but they are veterinary technicians or assistants when they work in Singapore.

PREPARATION FOR THE BATTLE
"What will you bring to this case?" I had phoned Mr Aung earlier. "Domitor and swabs to stop bleeding," he said. I packed my bag with Domitor, Antisedan, Xylazine, Ketamine, antibitoics, swabs, a pair of forceps, needles 21G and one-ml syringes. I forgot to pack 23G needles for use in the femoral vein injection as the cat has fine veins which bled in front of the Mrs Hall when Antisedan was injected IV using the bigger 21G needle. Experience is usually gathered after a case handled.

AT THE SCENE
Mr Aung is a hands-on man and he went for the cat. This cat was crouched tightly inside the master bathroom between the water closet and the wall. Mr Aung grabbed the scruff and got him out and placed him on the cat's white towel on the bed in the master bedroom. I had not briefed my assistants and was therefore surprised.

"It is best to prepare the sedative before catching the cat," I said to Mr Aung. "Look at the cat to estimate his weight and prepare the correct dose."

The cat was displeased and pawed Mr Aung vigorously. Mr Aung released him. The cat bounced off the bed and went under the master bed, exactly in the middle of the sanctuary. There was a moment of indecision as Mr and Mrs Hall and I did not know what to do.

"Maybe Mrs Hall should under the bed to get the cat out," I said like a General who bark orders from the safety of an army headquarters fall from the battle scene. Nobody moved.

"Let's lift up the bed," Mr Hall suggested intelligently. Mr Hall and my two assistants lifted up one end. I helped. It was surprisingly a very light bed but there were four of us. Mrs Hall looked on.

Being exposed, the cat sprang to hide behind the day curtains. The room has two sets of curtains. The day curtains are the translucent type. Mr Aung walked quickly towards the curtains to make friends with the cat. What he does normally is to talk to the cat and slowly let the cat (or dog) get used to the smell of his hand. The cat was ready to scratch him as he had scratched Mr Hall's hand a few times when Mr Hall tried to open the mouth to take out the needle.

ARMING THE TROOPS FOR BATTLE
"Prepare the sedative first," I said to Mr Aung. That would be what I would do before touching the cat. I estimated the cat to weigh 3 kg. Though he was adopted as a local cat, he certainly was bigger and fatter than the stray cats we see around the neighbourhood. Mr Aung got 0.1 ml Domitor and 0.1 ml Ketamine in one syringe and gave it to me. He realised that this cat would never accept an IV injection. IV injections at the Surgery could be done because the cat would be in foreign territory and would not be so ferocious usually. Here, the cat was on home ground.

FRONTLINE
Being a hands-on man, Mr Aung walked swiftly to the curtains and in one speedy grab, the cat's scruff was lifted up. He placed the cat on the white blanket on the master bed. I was ready and in less than one second, I had injected the cat's backside muscle with 0.2 ml IM of the combined sedative. Mr Aung let go of the cat.

UNDER-DOSED
It is always safe to under-dose a frightened cat. I knew the dose was insufficient. For the next 5 minutes, the cat ambled out of the master bedroom, dashed across the living cum dining room with the open concept kitchen and disappeared into Bedroom 2 at the other end of this apartment. Another 5 minutes passed. The cat was as fresh as a daisy.

REINFORCEMENTS
In a losing battle, the commander must call for reinforcements. "Give the cat Domitor IV," Mr Aung proposed catching the cat as he was one never afraid of getting cat scratches. "All three of us are veterans with cat scars on our hands" I had said to assure Mr Hall who must be wondering what was going on. The sedative seemed to be dud. A dud missile that fell and did not explode.

CAUTION
Soldiers could shock and awe in battle with more bombings to kill the enemies. But this is a cat that must be alive at the end of the house-call. "Better not to give another sedative," I advised Mr Aung. "The cat may react and die. Just wrap the cat inside a towel with his head sticking out. That would be safer. The cat would be sedated slightly by now. 15 minutes had passed." I asked Mr Saw to take the white towel and he went to the bedroom to get the cat for me. I could do everything myself but my assistants would never learn.

SUICIDE BOMBER ATTACK
Mr Aung went inside Bedroom 2 to risk his hands and got the cat by the scruff of the neck. Mr Hall and Mr Saw and possibly Mrs Hall were inside Bedroom 2. As the room was small, I stood outside the door to supervise. Like those consultants who talk but no action.

While Mr Aung was holding the cat for Mr Saw to wrap the towel around, the second cat, white with grey patches suddenly leapt up to claw either Mr Aung or the cat. I just could not believe this suicide bomber attack from the friendly troop. This attacking cat hissed and swung his paws widely. He leapt up and gravity pulled him down. From my point of view, he was attacking Mr Aung.

In cat attacks, it is wise not to interfere. Water hosing would be ideal but not inside the apartment. Mr Hall managed to get the attacker out of the room. He slinked outside the room and would not go away. He was just so furious. Was it the attention the other cat was getting? Mr Hall said to me: "This cat is very protective and was protecting me." Well, next time, no other cats should be present.
The next day, I noted that Mr Saw's left hand had two cat scratches too when we were taking blood from a dog. So, Mr Saw had suffered.

ACTION
After wrapping the cat in the towel, the cat seemed quiet. I said to Mr Saw: "Put the cat on this kitchen counter." I gave Mr Aung the forceps from my bag. He opened the cat's mouth. "There's the needle stuck in the hard palate!" he showed the culprit. I took some pictures with a zoom lens inappropriately. The zoom would not work at first until I stepped back further. Mr Aung took the needle out. A black thread with slimy saliva was attached to the end of the needle. I should have put the needle onto the tissue paper as Mr Hall seemed not too pleased when I placed it directly onto the kitchen counter. Mrs Hall took away the needle. I opened the cat's mouth to give a final check. "No injuries or ulcers," I said to Mr Hall.

ANTIDOTE
"Should give Antisedan," Mr Aung advised me. "Antisedan is an antidote," I said to Mr Hall. "The cat will wake up immediately. If Antisedan is not given, he would wake up fully over a few hours. Which do you prefer?"

"It is better that the cat be sedated for a while," Mr Hall said.

"There is a small risk that the cat may not wake up. A very small risk. An antisedan injection is an antidote that ensures that the cat's heart and lung systems are back to normal promptly."

The cat inside the towel hissed and hissed. Mr Hall agreed to the Antisedan injection. This was given via the cat's femoral vein at 0.1 ml IV. "Take the cat out of the towel and put him on the floor," I said to Mr Saw rather urgently. Mr Saw could not understand what I mean. In any case, he had no time to think. The cat looked up, assessed his situation well. The cat crawled out of the loosened towel, stood on the counter and in one spring, he leapt onto the floor and disappeared into the sanctuary of the master bedroom.

HAPPY ENDING
Everybody was happy that this cat was back to normal. Mr Hall asked me for my namecard as he was surprised that I was prompt in answering his house call. Mrs Hall would be more careful with her sewing needles and threads from now on.

CONCLUSION
Never give the frightened cat a second dose of sedatives as the cat may just die. This case took three times as long but the cat was alive and that was what every owner wants. It is best to treat such cases at the Surgery. Normally I don't even want to do it at the house as there are so many complications and surprises. Besides, it takes a longer time.

REVIEW
In this case, Xylazine 20 + Ketamine 100 at 0.1 ml + 0.4 ml respectively in one syringe IM would be more effective for this

Sunday, July 4, 2010

122. Compassion From Friends Is Not Forever

A father suffering hard times finds it hard to pay for his daughter's education overseas. The father asked me for a small loan to pay for his daughter's accommodation. He said he would pay me back two months later. I rejected him because I had helped him several times and he had not returned any money to me. He persevered. Compassion Fatigue sets in when interest-free loans to help a friend in financial distress are forgotten over the years.

An overseas undergraduate law education costs around A$150,000. The daughter had excellent A-level grades but the 3As could not qualify her to study law in Singapore. 4As would qualify and save the father a lot of financial stress.

She was therefore a "victim of circumstances" and deserved a helpomg jamd. The father's salary was insufficient to support her overseas. The father said to me: "My wife asks me to tell you we eat porridge everyday." I just could not believe my ears but it was probably true. He was the type of father who would "beg, steal of borrow" to ensure that his bright daughter would have sufficient funds to become a lawyer. She was the apple of his eye and she had the brains to be accepted by a top University in Australia to study law.

3 As were academic excellence but not good enough to study law in Singapore as there were many with 4As applying for the law, medical and accountancy courses. This was one lucky young lady as many fathers simply tell the bright progeny that there was no money to study in a subject the latter is interested.

"How's her studies?" I asked the father. I wanted to assess whether this girl deserved help one more time. "Is she getting high distinctions? Is she passing all her examinations?"

The father said: "She is a good girl. She does not go out partying and getting drunk like one of her classmates." This was not the answer I expected. But I did not pursue further as I expected a girl with 3As to pass her undergraduate examinations knowing that her sole breadwinner father had much financial distress to support her.

I don't know how this father is going to support her to graduation. As a lawyer, she would make big bucks as there is a shortfall of lawyers in Singapore. But the road to graduation is now full of financial pot holes. The father could downgrade by selling off the condo and rent a place for the time being. But there was an enbloc sale prospect and he would lose a lot of money. In enbloc sales, the property developer pays a premium price for the apartments.

"What happen to your real estate income over the past years?" I asked. This father had an inborn excellent marketing skills and could close cases unlike many realtors in Singapore. His employer was the compassionate type and permitted him to do real estate work to supplement his income. This was a rare type of employer in Singapore.

When he started as a part-time realtor with my company in 2005, he was grossing $100,000 in agency commissions handling the internet expatriate rental cases referred by me. He needed loans frequently to pay for his debts. After a year, I could no longer afford to give him loans as he borrowed more than he earned. You would assume that an agent earning $100,000 part-time would not need loans from anybody. But he needed more. So I had to cut him off. I was haemorrhaging badly as his loans exceeded his income and there was no light at the end of the tunnel. Compassion from friends and acquaintance cannot be not unlimited.

After 5 years, the father needed A$5,000 to pay for his daughter's accommodation. "Why don't you close some real estate cases?" I asked. It is easier said than done as he has to work full-time. His employer was still compassionate as long as he did his job competently and efficiently. This he did for the past 30 years in the same firm but his income was at a maximum for his position. He was not a graduate and I presumed the firm did not promote him further or found that he was not suitable.

He just dared not become self-employed as a realtor as income could be variable. He could be a hero for earning $100,000 a year - 3 times his salary. But he could be a vagabond when recession kicked in as it did in 2008. So, he did not strike out on his own as he had children in school. Which was a pity as I know he could do very well in real estate. Real estate is where the money is if you excel. Veterinary medicine and surgery give you a steady small income but if you want to be wealthy, get into the hot seat of real estate.

"My wife says that I am lucky when I work together with you," the father reminded me. Certainly he did perform as $100,000 in 2005 with me was not peanuts. "Do you have a case where we can work together?" I asked him. "If you close that case, you would be able to earn some money for your daughter's accommodation fees." He has a good network and should have some clients.

"I have a condo which the owner asks me to sell at $3.3 million or rent at $10,000 per month."

"That's great." I said. "Have you advertised this property in the Straits Times?"

The father said: "The Tenant's agent prohibits viewing. He makes it very difficult making various excuses."

"So you did not advertise in the Straits Times?" I inferred. "Straits Times advertisements still are the best way. I had over 10 phone calls a day when I advertised an HDB apartment for resale recently. Did you advertise in the Straits Times? The tenancy is in its last month. You ought to be advertising to secure a buyer or tenant before the lease expires."

Advertising 1 month prior to the expiry of the lease is the professional way to practise real estate in the interest of the realtor and the owner.

An apparently obstructive incumbent Tenant or protective Tenant's agent was no excuse, in my opinion. The owner had entrusted him with the property and he ought to do what was the right thing to do. I sensed that something was not right. Was there more to it than the behaviour of the Tenant's agent in repelling all appointments? The Tenant's agent had to be present for viewing as the Tenant was a multi-national. This Tenant's agent would have no financial income just by being present and therefore it was possible that he would delay or prevent viewings, attributing the rejection to the Tenant's policies.

I enquired about the type and location of the property the father was given exclusive marketing. The 2009 recession had passed by but the upscale $10,000 - $20,000 rental market was not booming. There was considerable interest in buying new property developments and not this 3-year-old condo.

"I will pay for the Straits Times Advertisements 2 to 3 times a week if you will split 50:50 on a successful outcome," I said. Advertisement of 3-lines cost around S$35.00/insert. It would be money down the drain if there was no response.

I advertised the property for sale at $3.45 million for the first week on a Wednesday and a Saturday. Not even one phone call. During the second week, there was only one phone call from an agent of a prospective buyer. The father made the appointment for the prospective buyer's wife to view. A second viewing with the husband was made two days later. "This case will close," the happy father said as the couple had asked about bank loans.

"Well, don't count your chickens before the eggs are hatched. The prospective buyer's wife was practically selling the advantages of the property to the husband during the viewing." I did not want to dampen the spirits of this father. He was a real estate veteran and now he had had unbridled optimism. I had stopped the newspaper advertisements as I did not want to throw good money away as the phone call response had been very poor. Money down the drain.

Several days passed. The eggs did not hatch. The tenancy would expire in 10 days. The owner texted saying that he would need a tenant to defray his mortgage loans. I placed 4 advertisements to rent over two weeks. Only 3 enquiries. I was pessimistic. It was my advertisement money down the drain. Nowadays, I don't do large Straits Times advertisement for properties as I find that they seldom effective. Many realtors now resort to mass-texting their properties for rent or sale as I received at least two per day on my mobile phone.

A victim of circumstances need the money. Of the 3 rental enquiries to my mobile phone, two prospective tenants with the budget of $12,000 rental wanted to view the apartment on Friday at 2.30 pm. The Tenant's agent was creating obstacles saying the Occupant prohibited viewing during her last week of tenancy. The Occupant would vacate the property in 3 days' time.

"So, what are you going to do?" I asked the father. He suggested waiting as the Tenant's Agent rejected him. I suspected that the Tenant's Agent had no time to be present on this Friday 2.30 pm viewing and therefore said that the Tenant would not permit viewing. This is because there was no financial incentive for the Tenant's Agent to close. Not a dime. So why should he oblige?

"You don't wait in real estate," I admonished the father gently. He was a very patient man not prone to raise his voice or get angry during our encounters. A smooth-talking guy? "These two prospects have the budget. No other phone queries. Do something."

But what could the father do? He phoned the Tenant's Agent and the owner but his head was butting against a brick wall. So he suggested that we wait for the Occupant to vacate the properties in 3 days' time as he would have the keys to the condo.

Now, there were two interested qualified prospective Tenants. Was there a solution to this problem? I had to think. Yes, there was one. I said to the father, "Is there not a clause in the tenancy agreement that the Tenant is to permit viewing of properties for rental or sale?"

"Yes," the father said.

"What happens if the Tenant breach the terms and conditions of the tenancy agreement? Will he have to pay penalties to the Landlord for loss of income?" I didn't have to state that the Landlord could deduct from the rental deposit and litigate for loss of income due to the Tenant's breach. The Tenant's Agent had to be given notice now and he should know how to advise his client early. He would lose his multi-national client if he was inert. However, the father had to know what to do without me telling him.

The father texted a message to the Tenant's Agent, c.c. to me. It read as follows:

"There is a prospective tenant willing to pay 11K fr the aptmt n yr tenant is deprivd my owner opportunity to show the aptmt this is breach of the terms n conditions of the tenancy agmt thanks."
The Tenant's Agent permitted a viewing on Saturday 10.30 am instead of Friday 2.30 pm. Well, that was a chance now.

I spent around $380 for the newspaper advertisements and there was a successful outcome. One of the expatriates rented the property. This is an incredible happy ending as I had only 2 qualified prospects from 4 rental advertisements placed over 10 days. Time is of the essence in real estate. Strike while the iron is hot. Life is full of hurdles to jump across. Be able to close a case. Performance counts in real life, not awards for being the top realtor.
God was kind to this father if you believe in Divine Powers. I am very happy for the victim of circumstance, a young lady I had never met. The laws of real estate contract had helped her as the case was closed. I hope she would study very hard and get High Distinctions. Lately, I know of a Singaporean who failed his first year at Murdoch University and came home. His sister had paid for his studies and he had failed. This was not good for the airline cabin crew sister who worked so hard.

Overseas undergraduates whose parents and family members have "apparently" no problems to finance their overseas studies must note that they have a rare opportunity to better themselves through education. Though they may not aim to get High Distinctions, passing their examinations and graduate will be the least they can do.

121. Performance counts in the real world

Text message to the Tenant's Agent c.c to me:

"There is a prospective tenant willing to pay 11K fr the aptmt n yr tenant is deprivd my owner opportunity to show the aptmt this is breach of the terms n conditions of the tenancy agmt thanks."

The players in this real estate rental stage are:
Tenant: A multi-national corporation
Tenant's Agent: Dominic
Occupant: A Japanese family
Landlord's Agent: Barry
Prospective Tenant's Agent: Shirley
A friend of Barry: Myself


Situation:
In the tenancy agreement, the Tenant agrees to permit the Landlord to bring prospective tenants to view during the last month of tenancy at times convenient to both parties. However, Dominic had been saying that the Tenant would not permit any viewing. So Barry thought that the best way would be for viewing to be done when the Tenant vacated the property.

"That is not the right thing to do as it is not in the interest of the Landlord who entrusted you with his property exclusively," I said to Barry. "You have to be proactive and get a new Tenant before the lease expires. Otherwise the Landlord loses a month or more when you start viewing after the Occupant leaves."

Saturday, July 3, 2010

Cat declawing

Cat owners are strongly discouraged in requesting declawing of cats. Very rarely do I encountered declawing requests in my surgery. Declawing will be done only if there are good reasons. The owner had used anti-scratching medication, nail covers and provided the scratching post. But the active cat still scratches furniture and people.

For Toa Payoh Vets Knowledge Management records, the following is written to share knowledge as it is a relatively uncommon operation.

Cat: British Shorthair, Male, Neutered, 1 year, 4.8 kg, rectal temp: 38.3 degrees C

Anaesthesia:
Xylazine 20@ 0.15 ml + Ketamine 100@ 0.6 ml IM. Front paw hairs clipped.
The above dosage was insufficient for surgical anaesthesia as clipping the soft furs in the paws took a longer time than usual to clip. I had to use scissors as well to get a clean hairless area for surgery. This cat's paw hairs were like wool and the clipper could not shave effecively.

Isoflurane gas top by mask for a few seconds was effective.

Surgery:
Rubber band tourniquet Electro-incision was used. However, it was not practical due to the need to trim at an angle of 45 degrees ventrally from the posterior end of phalanx 2 with the claw in extension. A bone cutter was used. 3-4 stitches of 3/0 absorbable sutures closed wound.

Bandaging:
Gauze was applied to the front of the paws while the rubber band tourniquet was cut. Blood flowed freely. Then a elastic bandage wrapped the gauze and the paws (picture). A strip of sticky bandage around the end of the elastic bandage was used to prevent the cat pulling off the whole bandage.

Pain killers: Tolfedine injection (0.5ml and then tolfedine tablets x 4 days (3 tab of 6 mg/day). Injection and oral dosage is the same, at 4mg/kg. Baytril @ 0.5 ml SC after surgery and 1/2 tab/day for 4 days.

The cat went home on Day 1 and advised to be crated or confined to a small room. However, the cat was active and kept flinging his paws. So he was warded at Toa Payoh Vets for 4 days.

On Day 2, the bandage was taken off to review the paws for bleeding. Not a drop of bleeding as the bandaging was tight but not too tight to cause paw swelling. So, the cat was given a bigger e-collar. With NSAID tolfedine being effective in this case, the cat was not bothering her front paws.

Unusual Complication: Part of the right whiskers of the cat was clipped off inadvertently. This was discovered by the owner. As it was difficult to clip the woolly fur of the paws and the cat was sedated with his head to the right side, near his right fore paw, the clipper must have accidentally clipped part of the whiskers.

In future, it would be best for one person to hold the head up during clipping of the paws.

Outcome. The results were excellent. Apologies were made for the clipping of the right whiskers.

P.S. For a successful outcome, it is best not to permit the cat to go home immediately.Some owners don't know how to do post-surgical nursing and checking or give the medication. The cat may pull out the bandage and lick the wound. Some owners don't bother to phone up the vet and when they do, it is too late as the paw has been badly infected. The paws may also gangrenous. Therefore I advise 4 days for observation.

Thursday, July 1, 2010

119, FAQ cat neutering

Jul 1, 2010 at 4:02 PM, ...@yahoo.com.sg> wrote:

Dear Judy,

I chanced upon a blog with your posting and email address. Pardon me for the abrupt email. I need help.

My male cat is about 1yr and 2 mths old. He is not neutered as I can't bring myself to see him go thru the pain. He has been a good cat all along. Very well toilet trained and will never poo or pee anywhere except his litter tray. However, 2 weeks ago, I realised he pee-ed on my couch! That was a 1 time off thing. It did not happen again after that. I've read about male cats spraying pee around the house if not neutered. Besides this, he also starts meowing pitifully at the door hoping to take a stroll outside. He is a 98% strictly indoor cat. The remaining 2% is only strictly for him to walk around the corridor outside my house. He has no contacts with other cats unless he is out for grooming or to the vet.

I have booked an appointment to have him neutered this coming Saturday. But, I am still in a dilemma. Should I neuter him? Is it necessary to neuter? Will he become depressed after the neuter? Will he be in great pain? Does he need to wear a cone after the neuter? (He hates wearing cone.) Is it very cruel of me to neuter him?

Sigh... Please help me!

Regards,
Name of Owner



E-MAIL REPLY FROM DR SING DATED JUL 2, 2010

I am Dr Sing Kong Yuen from Toa Payoh Vets, www.toapayohvets.com. In reply to your following questions:

Should I neuter him? Is it necessary to neuter? Will he become depressed after the neuter? Will he be in great pain? Does he need to wear a cone after the neuter? (He hates wearing cone.) Is it very cruel of me to neuter him?


1. Neutering a male cat or spay a female cat is perceived by many younger generation as cruel. So, it is a matter of choice for you.

2. Neutering is not necessary in the sense that it does not mean death if the surgery is not done. However, neutering at a young age (6 months of age) does help to stop, reduce and/or prevent your cat's male territorial marking (peeing on the couch) and mate-seeking behaviour (meowing loudly wanting to go out to find a mate, NOT to go for a stroll as you wrote).

3. After less than 14 days post-surgery, the cat does not feel the pain and is not "depressed" after the neuter.

4. After 2-3 days of poor appetite in most cases, the cat will start to eat. In any case, painkillers are given after surgery and for the next 4 days.

5. No need to wear the e-collar (cone) after neutering.

6. It is not cruel to neuter the male or female cat if the cat can has a better quality of life. A cat after 6 months of age has matured and though kept indoors, can still hear the meows and cries of outdoor cats fighting or looking for mates.

Caterwauling the whole night is a noise nuisance to everybody and is the main reason that owners start to get the cat neutered or spayed. The adult cat can't help himself or herself as he or she has heard the meows of other cats outdoors and want to go out to find the mates. Some make such loud noises at night that neighbours think that the cats are being beaten up by the owners. Neutering will prevent such sexual behaviours.

Please let me know if you have more queries.

118. A good principal makes a difference

A foreign student agent invited me for lunch at Novena Square today, Thursday Jul 1, 2010. An ex-principal of a neighbourhood secondary school was also invited.

"How do you discipline naughty boys?" I asked. "There must be many of them. Do you cane them?"

"Women are not permitted to cane students," she said. "Only the male disciplinary master will do it."

TIME OUT.
1. Detention at the Principal's office from 1 pm to 5 pm. Others can go home.
2. Parents to meet.