Thursday, April 29, 2010

2 female hamster cases - lip ulcer and pyometra

CASE 1
Young lady. Hamster 1 year. Not eating. Right fore paw not putting down. Big swelling up to right shoulder was obvious. What's the problem?

1. Instant diagnosis: Right pouch impaction and/or abscess?
2. Right fore paw swollen 2 x compared to the left. Occasionally he does put weight on the right fore paw.
3. Not eating. Why?

Isoflurane gas anaesthesia. Hamster's pouch everted and food empty. Big ulcer. Took digital

CASE 2
Young lady starting her wedding gown rental business. Female, 1.5 years old, dwarf hamster had been passing blood for one month. "After antibiotics and Biolapis electrolytes were finished, the hamster started passing a pool of smelly red blood. Now, her back legs are hair-less. She eats and passes a lot of well-formed stools. When she lies down, a pool of red blood flows out. Her urine is normal and clear. What's the problem?

1. Instant diagnosis: Wet Tail? Rectal growth? Anal growth? "But stools passed out are normal and well-formed," the lady said.

2. I saw the patches of reddish brown blood on the tissue paper. Now the blood is much more smelly.

Is this a case of pyometra?









Today, v.vigorous scratching after spraying with disinfectant spray all over body. Already scratching for 2 weeks. After scratching, bites paws fo 2 weeks. Bathed by pet shop warm water. 50% less scratching. Can walk and run. Pupils not reactive to bright light.

Don't clean the rabbit with wet cloth with anti-bacterial Dettol.

Wednesday, April 28, 2010

Can't house-train. Barks when confined, so let out

Case of the female 4-month-old poodle, 3rd vaccination and microchip

The niece who is a career HR girl had no time as she works long hours. Her mum dislikes the puppy. Tension in the relationship. Puppy is always crated in. Finally, gave the puppy to aunty who brought her in for 3rd vaccination. "My niece bought the puppy on impulse," she said. "Now I have to look after it."
"Why don't you sell the puppy back to the pet shop?" I said. "At a loss."
"My 10-year-old daughter will not part with the puppy" the mother said. "Her ankle always get nipped by the puppy. She will scream. The puppy will nip more."

BARKING NUISANCE. The puppy does not bark when not confined. So I asked "Where does the puppy sleep at night?" The mother said, "We put him in the kitchen and close the door." I asked, "Will the puppy barks non-stop?" The mother said, "Yes, but after some hours, she stops barking." So, you can see that there is a solution to barking control.

HOUSE-BREAKING
1. Common problem. Puppy barks loudly when confined in a cage. So, she is let out during the first week. Pees and poops everywhere. Headache of cleaning up for the mum.
2. Toilet area. Sometimes on newspapers. She likes to pee on the rug.

SOLUTION
1. Confine to kitchen. Baby gate. For 2-4 weeks.
2. Put newspapers in 2 places. Change to new ones frequently.
3. Focus on newspaper training. Newspaper with urine smell in early stages.

43. Should the vet cure the hamster wart with oral medication?

"Can you remember you did house-calls to a house in Ewart Park 30 years ago?" the mother brought in a 2-year-old hamster with a wart and 2 yellow upper eyelid abscesses asked me.

"I do remember Ewart Park," I said. "It is one of those secluded exclusive quiet leafy housing residential areas. You were a baby then" I could not recognise this mother of two teenaged daughters. "I wasn't a baby," she laughed.

I was joking with her. She was a teenaged girl when I did the house-calls. At that time, I was 29 years old.



But I remembered a Pekinese with maggot wound in the nose area and happy children running up and down a terraced patio, if my long-term memory served me right. I had never been to Ewart Park since. This was such a long time ago and now this teenaged child is a mother of teenagers.

Her hamster looked thin and was a bit dehydrated when the hamster skin remained upright when pulled. But this hamster was very well cared for and was still active. He wanted to exercise but just could not reach the wheel. He would just fall off. It was not a laughing matter and the mother lowered the wheel for him.

How to excise the wart completely? Freezing or just use scissors to cut it off at the stalk? I wanted to use electrosurgery to cut and kill off any surrounding wart viruses and stop bleeding. Cutting off usually leads to bleeding, so electro-surgery which coagulates and cuts is useful in this case.

But would this old hamster be able to stand to electro-surgery and not die of a heart attack during the procedure? I asked my intern Tanya to stand by with the camera and take a picture as I electro-incise the wart. "It will be less than a second," I said. "Be ready snap the picture as I cut." Well, Tanya managed a second too late and got a picture of the wart after cutting. Better than nothing.

As for the upper eyelid, I would not use electro-surgery as the area is too near to the eye. I used small scissors to snip off the abscess. There was a gap in the right upper eyelid of 1 mm x 2 mm but the wound healed well the next day.

"Why do you board the hamster at the pet shop?" I asked the mother who was glad to meet up with me after 30 years. "Did he get the wart after boarding?" The domestic worker was frightened of the hamster and so he was boarded when she was overseas. She did not know when the wart appeared but judging from the long finger nails of the left fore paw, it could be a few weeks.

The second day, she visited with a new packet of Japanese-made hamster food and paper litter. This hamster was on a flooring of big solid pellets which I consider sharp and rough for this paws. But these big pellets were absorbent and not so smelly.


Warts do occur in older hamsters. As to why, I don't know. It is best to get them excised when they are small. Warts don't disappear with oral medication.

However, not all Singapore vets will do it for pet owners. Instead, some may give you medicine for the hamster.


Hamster warts grow bigger daily. They never disappear and the hamster may try to bite them off if they are present in the paws. The hamster is irritated and stressed by their growth and infection. As to why some vets merely prescribe oral medication when presented with hamster warts, I just cannot understand the rationale. Each vet has his or her approach to treatment in a case but all vets should be careful about the legal consequences of straying from the standard treatment of warts.

More pictures are at "Hamsters", www.toapayohvets.com

42. Follow-up on No. 41 --- crate training a puppy

DRAFT REPORT

EMAIL REPLY FROM DR SING APRIL 29, 2010


SAW ONE PICTURE.

FORTUNATELY, YOU EMAIL PICTURES AS I WAS WONDERING WHY YOUR PUPPY PEES IN THE CENTRE ALL THE TIME. FROM YOUR PICTURE, YOU HAVE RUBBER MATS WITH HOLES ON THE LEFT 1/3 AND RIGHT 1/3 WITH THE MIDDLE BEING THE ORIGINAL WIRE FLOORING OF THE GRATE.

IN THE LEFT 1/3, THE BACK HALF OF THE LEFT IS THE POOPING AREA, THE FRONT PART IS THE FEEDING AND WATER AREA.

THE BACK HALF OF THE RIGHT IS THE SLEEPING CLEAN AREA.


THE RIGHT 1/3 IS THE CLEAN AREA AND SO HE DOES NOT PEE AND POOP THERE. HOWEVER THE LEFT 1/3 IS ALSO THE DRINKING BOTTLE AND FEEDING AREA. SO THE POOR PUPPY HAS TO WALK DIAGONALLY PAST THE SOILED CENTRE (WHERE HE PEES) TO GOTO THE WATER BOTTLE ON THE FRONT RIGHT.

I WILL RECOMMEND THAT THE FRONT OF THE RIGHT 1/3 AREA BE THE AREA WHERE THE PUPPY EATS AND DRINKS. THAT MEANS THE WATER BOTTLE SHOULD BE ON THE RIGHT, NOT ON THE LEFT.

IF YOU CAN, SEND ME 2 PICTURES IN .JPG FOR MY RECORDING PURPOSES.

SEE MORE REPLIES BELOW.

On Wed, Apr 28, 2010 at 10:42 PM, XXX@yahoo.com.sg> wrote:

Hi Dr Sing,
as promised, I've attached 2 pictures of Cookie's crate & pee pan. By the way my mum is a housewife but she goes out like 2 - 3 days a week and hence Cookie is not under full supervision on these days. I'll have to follow the way a working adult trains his/her puppy.

Hope it helps. I've also added further comments in the email below.

From: Kong Yuen Sing <99pups@gmail.com>
To: XXX@yahoo.com.sg>
Sent: Wednesday, 28 April 2010 10:05:11
Subject: Re: Toilet Training Chihuahua x Pom

Thank you for email. It is best that you email 2-4 pictures of Cookie's crate + pee pan with the positioning of water bottles, bowls and sleeping area as every puppy is housed differently.

The following is my reply to you:

On Tue, Apr 27, 2010 at 5:36 PM, Sharon Soh wrote:

Hi Dr Sing,

I’ve been reading up your toilet training blog and find it very useful when toilet training my puppy. However, I still have a few queries. I’m a first timer raising up a puppy and hence has been quite stress up. I’ve accompanied my puppy for the first 3 days (almost keeping him within my sight) and observed the following:



My puppy is a mix breed of Chihuahua and Pomeranian, 3 months named Cookie. He was with us since 24 Apr 10.




The pet shop owner came with a crate with wire flooring and a pee pan below. Initially I try to carry Cookie to the bathroom after nap/food with newspapers laid on the floor but was unsuccessful. Cookie usually poos twice a day, 1 in the early morning and another one in weird timing. I realized that he only pees in the middle of the crate; I supposed it’s due to the urine smell. He pooed everywhere though.


COOKIE IS USED TO THIS WIRE FLOOR SYSTEM. HE WAS IN THE PET SHOP WITH SUCH A SYSTEM. AS TO POOPING EVERYWHERE, ARE YOU SURE? Where is his sleeping area? Is the crate too small?

XXX: So far we've not really let him outta his crate for too long, only wanted him to get some exercise and will put him back aft 10 - 15 mins. We try to bring him outta his crate at least 3 times a day. He drinks a lot too esp aft play outside the crate. As for the crate size, please advise if it's too small or too big based on the attached pictures.

CRATE SIZE OK



Qn 1: Do you think Cookie will poo in the middle like where he used to pee if I spray those anti-pee/anti-poo spray (given by my friend) on those area that I don’t want him to do pee/poo? The spray has a strong smell and I'm contemplating to use it.

YOU CAN TRY. THE BEST IS TO ENSURE THAT HIS SLEEPING AND EATING AREAS ARE FURTHEST AWAY FROM THE POOPING AREA AND

THE MIDDLE OF THE CRATE.



XXX: I tried spraying on the red rubber mat and Cookie refused to eat after that. I guess its due to the pungent smell. He continues his eating after I wiped the mat.

SPRAY IS NOT VERY USEFUL IN MANY CASES




Qn 2: It seems like he’s trained to pee/poo in the crate. Is that a good idea? It’s ideal for us since we are working. However, if we bring Cookie out eg. to a friend’s place, will he pee/poo everywhere since there’s no crate?

YOU MAY NEED TO BRING YOUR CRATE ALONG. COOKIE WILL PEE AND POOP ANYWHERE IF LET ALONE FOR THE FIRST 2-4 WEEKS as he is not fully house broken.



XXX: how do we determine if a puppy is fully house broken?

WHEN THE PUPPY KNOWS WHERE TO PEE AND POOP IN AREA REQUIRED BY THE OWNER. E.G. PAPER TRAINED PUPPY WILL ELIMINATE ON PAPERS ONLY AT ALL TIMES, UNLESS THERE IS NO PAPER. OR HOP INTO CRATE WHEN HE NEEDS TO ELIMINATE AND NOWHERE ELSE. OR TO A SPOT IN THE GARDEN.



Qn3: Cookie seems to be stepping hard on his own poo when all of us are asleep. He’s also seems to be shifting them around. I can see portions of it at different areas of the crate. We also caught him eating his own poo once. How do we prevent such action from happening especially when we are all asleep?


EATING STOOLS IS A COMMON COMPLAINT. YOU MAY NEED TO REMOVE STOOLS PROMPTLY. IF NOT PRACTICAL, YOU MAY NEED OTHER METHODS I had mentioned in my blog. These are not guaranteed to succeed.

XXX: Will try a few of the methods and update you on the improvement.



Qn4: When I let him out to play in the living room, will it be better to leave the crate door open and let him run to the crate to pee/poo? YES. HOWEVER, MONITOR HIM CLOSELY SO THAT HE DOES NOT PEE/POOP OUTSIDE THE CRATE. KEEP ALL DOORS OF BEDROOMS CLOSED.

XXX: So far he hasn't poo outside but has an accidental pee just outside the toilet.



Or will it be better to lay newspapers on a pee pan (given by my friend) with Cookie’s urine smell at a corner so he can pee/poo when he’s out playing and need not rush back to the crate? DECIDE ON ONE METHOD - CRATE WITH WIRE FLOORING OR NEWSPAPERS FOR THE NEXT 2-4 WEEKS IF YOU WANT EARLY SUCCESS. In the Crate method, your dog will then use the Crate as the toilet area and outside as his den in 2-4 weeks, in most cases. So, you just clean the crate. Later, you can buy the GRATE + PEE PAN which is actually the same as the lower half of your present crate, without the enclosed vertical walls.

XXX: "In the Crate method, your dog will then use the Crate as the toilet area and outside as his den in 2-4 weeks, in most cases. So, you just clean the crate." When you said "outside as his den in 2 - 4 weeks", are you saying that Cookie will want to sleep outside of his crate in 2 - 4 weeks?

DEPENDS ON THE TYPE OF TOILET TRAINING PROVIDED BY THE OWNER IN THE FIRST 2-4 WEEKS.

MOST PUPPIES WILL SLEEP OUTSIDE THE CRATE AS THERE IS FREEDOM. JUST GOES INTO THE CRATE'S WIRE FLOORING TO PEE AND POOP. OTHER SMALL BREEDS WILL SLEEP INSIDE THE CRATE AND ELIMINATE OUTSIDE (ON NEWSPAPERS).

As for Grate & Pee Pan, can I just used the current pee tray and removed the vertical walls since it's similar to the one you recommended?

OK



I've let him out of the crate twice on 26 Apr and surprisingly, he climbs back to his crate when he's thirsty after running a few rounds. I see that as a good sign of recognising his own den?


FOCUS ON CRATE TRAINING FOR THE NEXT 2-4 WEEKS, SINCE YOU ARE WORKING AND HAVE NO TIME. IF YOU START PAPER-TRAINING, YOU WILL NEED TO FOCUS ON PAPER TRAINING. The puppy gets confused as to what you want.

XXX: Will heed your advice and focus on crate training for the next 2 - 4 weeks.




YOUR PICTURE SOLVES THE MYSTERY OF WHY YOUR PUPPY PEES EXACTLY IN THE CENTRE. THE PUPPY 'FEELS' THE FLOORING AND IS USED TO THE WIRED FLOORING OF THE PET SHOP. SO HE PEES IN THE CENTRE SINCE YOUR LEFT 1/3 AND RIGHT 1/3 HAS RUBBER MATS WITH A DIFFERENT FEELING.

IN THEORY, YOU SHOULD HAVE ONLY RUBBER MATS ON THE RIGHT 1/3, THE WATER BOTTLE ON THE RIGHT 1/3 FRONT PART AND FEEDING NEAR THE WATER BOTTLE.

SO THE LEFT 2/3 IS THE WIRE FLOORING INTENDED TO BE A TOILET AREA. WIRE FLOOR GRATING. THIS WILL NOT CONFUSE THE PUPPY AS IT DOES "FEEL" THE FLOORING AS WELL AS DETECT THE URINE SMELL IN THE NEWSPAPERS BELOW FOR PEEING AND POOPING.

I HOPE YOU KNOW WHAT I AM WRITING ABOUT.



Sorry for the long post and thank you for the time to read my email, I would be very much delighted to receive your reply



Regards,

Tuesday, April 27, 2010

41. Focus on one house-breaking method for first 2-4 weeks to succeed

DRAFT

E-MAIL REPLY FROM DR SING DATED APR 28, 2010

Thank you for email. It is best that you email 2-4 pictures of Cookie's crate + pee pan with the positioning of water bottles, bowls and sleeping area as every puppy is housed differently.

The following is my reply to you:

On Tue, Apr 27, 2010 at 5:36 PM, ...yahoo.com.sg> wrote:

Hi Dr Sing,

I’ve been reading up your toilet training blog and find it very useful when toilet training my puppy. However, I still have a few queries. I’m a first timer raising up a puppy and hence has been quite stress up. I’ve accompanied my puppy for the first 3 days (almost keeping him within my sight) and observed the following:



My puppy is a mix breed of Chihuahua and Pomeranian, 3 months named XXX. He was with us since 24 Apr 10.



The pet shop owner came with a crate with wire flooring and a pee pan below. Initially I try to carry XXX to the bathroom after nap/food with newspapers laid on the floor but was unsuccessful. Cookie usually poos twice a day, 1 in the early morning and another one in weird timing. I realized that he only pees in the middle of the crate; I supposed it’s due to the urine smell. He pooed everywhere though.


XXX IS USED TO THIS WIRE FLOOR SYSTEM. HE WAS IN THE PET SHOP WITH SUCH A SYSTEM. AS TO POOPING EVERYWHERE, ARE YOU SURE? Where is his sleeping area? Is the crate too small?



Qn 1: Do you think XXX will poo in the middle like where he used to pee if I spray those anti-pee/anti-poo spray (given by my friend) on those area that I don’t want him to do pee/poo? The spray has a strong smell and I'm contemplating to use it.

YOU CAN TRY. THE BEST IS TO ENSURE THAT HIS SLEEPING AND EATING AREAS ARE FURTHEST AWAY FROM THE POOPING AREA AND THE MIDDLE OF THE CRATE.



Qn 2: It seems like he’s trained to pee/poo in the crate. Is that a good idea? It’s ideal for us since we are working. However, if we bring XXX out eg. to a friend’s place, will he pee/poo everywhere since there’s no crate?

YOU MAY NEED TO BRING YOUR CRATE ALONG. XXX WILL PEE AND POOP ANYWHERE IF LET ALONE FOR THE FIRST 2-4 WEEKS as he is not fully house broken.



Qn3: XXX seems to be stepping hard on his own poo when all of us are asleep. He’s also seems to be shifting them around. I can see portions of it at different areas of the crate. We also caught him eating his own poo once. How do we prevent such action from happening especially when we are all asleep?


EATING STOOLS IS A COMMON COMPLAINT. YOU MAY NEED TO REMOVE STOOLS PROMPTLY. IF NOT PRACTICAL, YOU MAY NEED OTHER METHODS I had mentioned in my blog. These are not guaranteed to succeed.



Qn4: When I let him out to play in the living room, will it be better to leave the crate door open and let him run to the crate to pee/poo? YES. HOWEVER, MONITOR HIM CLOSELY SO THAT HE DOES NOT PEE/POOP OUTSIDE THE CRATE. KEEP ALL DOORS OF BEDROOMS CLOSED.


Or will it be better to lay newspapers on a pee pan (given by my friend) with Cookie’s urine smell at a corner so he can pee/poo when he’s out playing and need not rush back to the crate? DECIDE ON ONE METHOD - CRATE WITH WIRE FLOORING OR NEWSPAPERS FOR THE NEXT 2-4 WEEKS IF YOU WANT EARLY SUCCESS. In the Crate method, your dog will then use the Crate as the toilet area and outside as his den in 2-4 weeks, in most cases. So, you just clean the crate. Later, you can buy the GRATE + PEE PAN which is actually the same as the lower half of your present crate, without the enclosed vertical walls.





I've let him out of the crate twice on 26 Apr and surprisingly, he climbs back to his crate when he's thirsty after running a few rounds. I see that as a good sign of recognising his own den?


FOCUS ON CRATE TRAINING FOR THE NEXT 2-4 WEEKS, SINCE YOU ARE WORKING AND HAVE NO TIME. IF YOU START PAPER-TRAINING, YOU WILL NEED TO FOCUS ON PAPER TRAINING. The puppy gets confused as to what you want.



Sorry for the long post and thank you for the time to read my email, I would be very much delighted to receive your reply J



Regards,

Sunday, April 25, 2010

Microchip error from the vet?

--- On Sat, 4/24/10, Joanne Woo wrote:


From: Joanne Woo
Subject: Error in microchip number
To: judy@toapayohvets.com
Date: Saturday, April 24, 2010, 4:09 AM

Dear Dr. Sing,

We spoke on the phone earlier regarding the wrong microchip number given to me when I first brought my dog, Oreo to be vaccinated and microchipped at your clinic on 30 March 2008.

Basically, I found that the microchip implanted in my dog has a different number from the bar code that is pasted on his first vaccination form. I have attached a scanned copy of the vaccination form to this email for your perusal.

The microchip number in his body is: XXX6618
The microchip number on the bar code pasted on the vaccination form is: XXX6722

As a result of this misinformation, I have been licensing my dog under the wrong microchip number with AVA for the last 2 years. My next license renewal is due on 6 May 2010 and hence, I would like to rectify this mistake with AVA before I renew it. I would appreciate if you could assist me on this matter.

Thank you.

Yours sincerely,
Name of owner


E-MAIL REPLY FROM DR SING.

Thank you for email. There were several Border Collies siblings I microchipped together. I believe that the Seller gave you the wrong microchip paper. I need to scan your Border Collie and give you a report of the correct number.

EXPLANATION FROM DR SING
On the surface, the dog owner must have the misleading impression that I have lost my marbles or my mind. Instead of disputing over the phone, I asked her to email to me a scan of the microchip and vaccination certificate to save time and prevent miscommunications. She was very polite and helpful.

This mystery was solved when the owner emailed me the details of the case as there were more than 1 Border Collie siblings microchipped by me from a home breeder. He must have given any microchip certificate as Border Collies were all black and white and he had no microchip scanner prior to sale.

Hamsters on steroids

From:
To: judy@toapayohvets.com
Date: Saturday, April 24, 2010, 5:28 PM

Hi

My name is XXX, I have been to your place before and I have 2 hamsters that require some medical attention.

Both are about 2 years old, 1 male and 1 female.

Male suffers from having skin lesions and pus filled abcess in skin folds, I clean him regularly and he is on prednisolone, his conditions fluctuate between good and bad, my previous vet has suggested to keeping him in a high dosage of steroids to keep the inflammation and growth down since not much can be done and he is rather old. However recently he has been losing alot of weight and the situation is worse.

The female one has been very healthy for most of 2 years. However she likes getting into fights. She has a little wound above her right eye cause by a fight that simply wouldnt heal. However, the major problems that she has a pus filled growth in her mouth, it was originally very small and on the outside(with no pus), so I also started her on prednisolone. Only this week did I really she was walking weirdly and lethargic, upon further inspection I realized her her mouth sacs were swollen and there was solid pus on the growth. I cleaned off the pus with cotton wool. Also she has a deep red swell on her abdomen, near her right leg. I use the same syringe for both hamsters, but I wash it before feeding medication to each of them. Also, she bit me about 2 weeks ago while I was feeding her, as I pulled away she fell off from about half a meter on the back.

I was wondering if you will be free for a consult on monday evening.

I can be contacted via

Cheers
XXX


I am Dr Sing. From what you described, the infections have overwhelmed the hamsters due to your use of steroids. I will be available during office hours. If you wish, you can leave the hamsters in my Surgery for daily check and treatment rather than just do it yourself.

Friday, April 23, 2010

Grooming success

Today, I spoke to two experienced dog groomers today regarding their business successes as they brought their puppies for vaccination.. Their location is in middle-class areas.

GROOMER 1. Couple. Over 40 years old. Children. Vet surgery nearby.
Challenges.
1. Too many young unqualified groomers underprice
2. Not easier to hire good help.

Advantage:
A vet practice nearby. As the vet does not do grooming, this couple is in an envious position of getting grooming clients. Apparently, a tenant in the laundry business blocked the view of their signboard. I have not visited this shop.

GROOMER 2. A gentleman in his 30s. He was born into the pet shop business and I could see that he had developed the pet shop well. The mother is an experienced groomer. I knew the father for over 10 years and recently visited the shop and had a long chat with him. The father had an accident and was discharged from the general hospital on the same day. He became comatose at home and passed away recently. I was shocked as I had talked to the father about his high cholesterol levels.

1. Underpricing is not the way to sustain the profitability.
2. Quality clientele is the way to go.
3. Dog owners who go for the cheapest quote are not wanted.
4. Important point for growing the business is that the dog must look forward to grooming, not being abused and goes home happily.

CONCLUSION
It is the groomer's service that brings in the cases rather than the pricing.

Thursday, April 22, 2010

37. Non-closing midline wound

Every vet will encounter non-healing of a long midline surgical wound. Stitch breakdown is one complications of surgery. This Cocker Spaniel is normal but the wound just will not close some 4 weeks after surgery to remove the stones in the intestines by Vet 1.

The dog went home and the stitch broke down. So Vet 1 had to stitch up the wound again. Yet, the wound just does not heal as the tension in this area is very great. I could see the stitches cutting through and the gap getting bigger.

The assistant applied antibiotic powder daily for the last 2 weeks. The wound was moist, as if exudate leaked from below the skin prevents granulation tissue from forming. Thus the long wound persists and the family members esp. children could not stand the sight of a long moist channel in the belly or underside of their dog.

What can be done to resolve the problem so that the dog can go home? This case study of the management of non-healing wounds in a normal dog would be good for Tanya, the intern.

1. Remove all stitches.
2. Wash the wound daily with clean warm water.
3. Use trimaxazole antibiotic powder. Do not apply cream.
4. Pack gauze onto surface of wound.
5. Bandage the lower chest and abdominal area to prevent exudate formation or irritation by the dog's paws. Although a big e-collar was in place, I suspect that there was some way the dog could lick the wound or the stitches were irritating.
6. Remove the bandage daily and repeat steps 1-5.
7. Antibiotics and non-steroidal anti-inflammatory would be given to effect.

Today April 22, 2010 is the first day of bandaging. I took a picture yesterday. I have told Tanya to expect granulation in 14 days if the above procedures were done diligently. Let's see.

Basically, a wound will heal by granulation if it is kept clean and dry. Somehow, this dog's wound had not healed and I suspected that the dog had been irritating it when nobody is looking. It is my hypothesis. Whatever it is, all the owner wants is for the wound to close and the dog to go home.

Wednesday, April 21, 2010

36. Exclusion of the mum at the award

"It is not the right thing to do," I said to my god-daughter. There would be an award presentation for her at the University. The top 2% of the cohort would be given awards and she asked mum not to attend. After so many years of bringing a child up as a single mum, I would say that this mum should attend since she could afford the fares. But the daughter said no as she had no accommodation for mum. "Most likely no time for mum," I said to her. "As your examinations are just round the corner and at least 3 of your friends had visited you recently, taking up much study time."

Mum was understanding and did not insist. Yet it is one of those very rare occasions in motherhood because out of 100 students, only 2 would be given awards for academic excellence. Maybe the awards should be given at the end of the examinations?

35. Looks can be deceiving. Circum-anal tumour

How to make internship interesting and entertaining? Young people can get bored easily. The following case had some elements of humour for the quiet and serious vet intern whom I tested her on her powers of observation. A 9-year-old male black Labrador Retriever was limping on right fore and walking on 3 legs yesterday. So the careful groomer brought him for consultation. He was to shave this dog bald every 2 months and was worried that if he lifted the leg to clip, the dog would get worse. Possibly he could be blamed for a lame dog after grooming. So, he pre-empted blame by consulting the vet first. This was smart of him.

EXAMINATION OF LAMENESS
How to make internship for Tanya interesting? One method is to ask her what the problem was and to ensure she is hands-on. In this case, I asked the groomer to walk the dog outside the surgery and then trotted as I would do as a racehorse veterinarian. The dog moved normally but suddenly collapsed on her left fore during running. This should make an unforgettable impression on Tanya as the dog was OK now, according to the groomer who had seconds thoughts of consulting me. He was busy and had many grooming cases and therefore he would prefer not to come.

To save time, I got the dog to lie down on the floor, muzzled her and palpated each digit and toe to the shoulder of the right fore. I flexed and extended all joints of the right fore limb, as I did when I was a racehorse veterinarian some 20 years ago.

LOCATION OF PAIN
Palpation at right fore, 4th digit, between phalanx 2 and 3. The dog reacted by withdrawing and whining in pain. So this was the pain location and the diagnosis was sprain of the ligaments in this area. Not a serious problem.

OBSERVATION
"Is that the dog's testicle near the tail?" I queried Tanya as the dog had a big swelling below the tail and near the anus. "Yes," she said immediately. The powers of observation need to be enhanced with age and experience and so Tanya's answer was expected.

"Are you sure?" I asked again. From general observation, it sure looked like one to the lay person. Tanya was sure. "It is in the wrong position," I told Tanya. She had just passed Junior College and so could not be expected to know dog anatomy. On first impressions, this looked very much like the scrotum. This was one of nature's tricks on interns who will be starting first year vet. Looks can be deceiving. A detailed hands-on examination on the table should be done in many cases. The vet or intern must be hands-on.



"The normal testicle is nowhere near the anus or tail in the male dog," I said. "Where is the anus actually? Please push the large spherical swelling to reveal the anus." Tanya used her hand to move the circum-anal tumour to the right as the dog was trying to sit down. There it was. "Is the tumour very near to the anal opening?" I asked. "Yes," she was convinced that this was no testicle.

IS THE MALE DOG NEUTERED?
The vet must be thorough in checking. This dog has no scrotal sacs. "This dog has been neutered," the groomer stated. This is another trick of nature. No scrotal sac does not mean that the dog is neutered. The vet has to be hands-on..

The dog was reluctant to stand for long. However, I had to get him standing and showed Tanya where to locate the two undescended testicles under the skin near the penile area. The groomer tried and felt nothing. The testicles had swollen in size but not excessively. These could be the start of testicular cancer. The only signs of a feminising testicular tumour were that this dog had put on weight and had a very shiny coat. I did not pursue the matter further as the owner was not interested. Undescended testicles do become cancerous and circum-anal tumours are best removed when they are small. But each dog has his own destiny. This dog had interesting teaching material for the vet intern but I don't know she will remember this case during her 4th year which will be in 2015.

CONCLUSION
Neutering of the 9-year-old male dog, especially removal of the two undescended testicles in this dog when he was young would have prevented testicular tumours and circum-anal tumours to develop, in most probability. It is not a guaranteed thing but removal of undescended testicles early will have been best for the older dog as no testicular cancers will be present in old age. Dog owners all over the world seldom give old dogs much notice or time unlike puppies and therefore neutering young ones may avoid much of the hormonal or gender-related tumours in our companion dogs. The vet's responsibility is to inform the owner via the groomer about the circum-anal tumour and a few black ones below the anus. The owner did not want any surgery.

Monday, April 19, 2010

31. Incredible but true Singaporean gangster story

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


Setbacks in life occur for many people. For one of my old clients, this story was narrated to me some 2 days ago.

In 2003, the SARS virus affected the world economy and people like Harry lost his sales job and could not find any for several months. His marriage was on the rocks and his mum sided with the daughter-in-law. He had to move out.

He decided to open a food stall in a corner two-storey coffeeshop at Desker Road selling mee-siam and mee-goreng. As to why he set up a stall in this notorious red-light district, I forgot to ask him but I made him show me the real place. Not that I don't trust him. His tale was too incredible to be true.

I met him for lunch two days ago. I wanted to keep in touch and learn some secrets of his success as a sales person for a corporation. Learn from the best. Lately, I had been meeting men and women in dire straits and so meeting Harry was so much positive for the spirits.

During lunch at Hans eating his favourite sweet and sour fish , Harry recalled the setback in his life in 2003.

"One day, a young man on a bicycle beckoned him with a finger to come out of his stall to extort money. "Brother, I can give you free food," Harry said. "I have no money to give you." The extortionist was not pleased.

"Why so depressed?" Susan, the coffeeshop lady asked me one day. "Susan is the wife of Tenant and controls the drinks stall," Harry elaborated. "She will barter free drinks for my food. But no beer."

"I don't want to cause trouble," Harry told Susan what happened and Susan told him that he would see some fireworks soon.

"So, what happened?" I asked.

"The gangster chief came for dinner and I served him. Two eggs for his mee-goreng." And I thought the triads and secret societies were wiped out by the number "999" in Singapore since 1990. Many secret societies had numbers but somebody told me that the only gang in Singapore is "999" nowadays. Even in the red-light district of Desker Road. For the benefit of readers, "999" refers to the Singapore police force.

Harry said, "The gangster chief asked his man to get Pig Face (the extortionist on the bicycle).

The gangster chief cursed Pig Face with all the swear words in the Hokkien vocabulary. "When my mother does not cook my dinner, I come here to eat. Why are you harassing Yuan?"

Seeing me perplexed, Harry explained that "Yuan" meant "Handsome" in Hokkien. More expletives. Then his men kicked Pig Face. Pig Face fell and he was kicked more times. Harry is a Hokkien Peranakan and understood the Hokkien foul words well. "Every word from the gangster's mouth is a foul word as he reprimanded Pig Face," Harry did not repeat those expletives as he was the type who does not do it in my presence.

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

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

"He always pay for his meals," Harry said to my surprise. "Do you know what Pig Face does for a living?"

"No," I said.

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

Harry said, "Pig Face is a runner." But runners can be ambitious too to rise up the corporate ladder. Only that he picked the wrong person to extort. All the characters of 2003 had disappeared although the coffee shop, now taken by a new management, still exists.

Harry is now a very successful sales person and earns at least $5,000 per month. He still works for various corporations. But legal ones. He is the type who is afraid of starting up but he has the network and supporters over the past 10 years to support him if he knows how to be an entrepreneur. He has the guaranteed salary at the end of the month. So, why bother getting out of his comfort zone and being at risk of no income. He never takes kick backs when he works for the corporation. Nor does he go for the wine and women.

So, his reputation remains good and there is a great demand for excellent sales person in his industry. Gangsters still exist in Singapore but they are emasculated and not so fearsome as before. They used to be identified with tattoos but many young Singapore females tattoo themselves and therefore, we can't be sure who is the real gangster.

When the chips are down, Harry started a food stall rather than borrowing money from friends and strangers and conning Singaporeans of their money. He is the sort of rare person who is an asset to any business and a role model for young men.

33. Breast nodules in 6-year-old Maltese

As many Singapore dog owners want the cheapest veterinary surgery, many breast tumours in dogs are not sent for histopathology. In this 6-year-old female Maltese which I operated to remove the closed pyometra womb and recorded in:
http://www.bekindtopets.com /dogs/20100135Video_Education_Closed_Pyometra_ToaPayohVets.htm,

the nodules were analysed. The report is as follows:

GROSS DESCRIPTION. A piece of tissue measuring 1.7 cm x 1.5 cm x 0.7cm.
MICROSCOPIC DESCRIPTION. Section shows skin with a well circumscribed nodule in the dermis. It consists of elongated and dilated ducts lined by hyperplastic columnar epithelium with papillary infoldings and which join up to form lobules. A loose fibroblastic stroma is present within the vicinity of the lobules and other areas show lobules of mature cartilage. No malignancy is seen.

DIAGNOSIS
Breast tissue. Benign mixed tumour of the skin


I was surprised. I thought it was a breast tumour. The lab doctor said this was a skin tumour which happened to be over the breast. She would consult another doctor for a second opinion.












Human pathology is applied to this case as the lab does human. She gets dog and cat growth from various vets in Singapore. Mast cell tumours from the limbs in dogs from her experience. Overall, tumours are classified according to human medicine and she said there were differences.

"I believe a cancerous cell is the same, whether from the dog and cat or from human beings," I said.

"There was a vet pathologist I knew many years ago, I can't remember her name," she said. "You know, you can send your biopsy samples to a veterinary pathology lab in Singapore. I don't know why vets send samples to us. We are doing the vets a favour as we do human histopathology," the lady doctor said over the phone.

"I have never heard of a veterinary pathologist in Singapore," I said. "Vet pathologists are post-graduate specialists and I don't know of any vet who is this specialist. Pl let me know the name of the specialist."

"I will phone you back after I find it," she said.

Her text message: "The lab that accepts animal histo is CVL-AVA tel 6316 5172". The lab is in my "backyard!"

Sunday, April 18, 2010

31. Old dogs take a longer time to heal

Young people recover fast. But old people take a longer time to recover from illness and surgery. Does this apply to old dogs? Yes.

Each vet has his or her own idea on whether to spay a dog presented with breast tumours and excise the tumours in one anaesthesia and surgery. I always advise spay first and tumour removal 2 weeks later so that the old dog had a higher survival rate during and after surgery. Spaying a dog would take some time. Breast tumour removal takes more time.

As most Singaporean owners are interested in economics, one procedure would satisfy the owner. If the dog does not die. If the dog dies, too bad for the owner. He still has to pay up as he has had signed a surgery and anesthesia consent form informing him of the risks involved.

What about the interest of the old dog? This ought to be paramount. Survival rates are much higher if the anaesthesia is not prolonged as the dog's health is not so good. But the owner has to be sophisticated and educated to understand. And many don't. I had a case of closed pyometra and breast tumours. After spaying to resolve the pyometra problem and not excising the breast tumours at the same time so as to shorten the anaesthetic time and enhance survival rate, the owner forgot about the breast tumour removal advices. That is the typical attitude of many dog owners of older dogs.

So, some vets may feel that it is better to spay and excise breast tumours at one go and this is OK if the dog does not die.

In one case I encounter, the dog had spay, breast tumour removal and dental scaling by a vet. This 13-year-old Pom just looked half dead the next day. I thought it was the end. A maroon redness spread over the breast area. The next day, the sternal area was also red maroon. That meant the whole belly and groin area was dark red due to scratching or licking. The dog seemed to feel very painful despite pain-killer medication.

The dog would not eat and had to be hand-fed with canned food for the next 7 days but she looked brighter on day 7. I/V drips were given. Medication too. Still the dog would not eat on her own.

"Was there any blood test done?" I asked the owner. Apparently not. The couple was lucky to have a dog alive. In such cases, much depends on the vet's decision and the consent of the owner to take the risk in a 3-in-one operation. If the dog lives, it is considered "lucky". If the old dog dies after surgery, it is considered "unlucky."

31. A Puppy & Old Dog with Itchy Backsides

Today is the second Sunday I came back from a break in Perth Australia. Last Sunday, I wrote about 2 related cases of house-breaking in two Cocker spaniels. Today, I saw two cases related to the anus of the dog. One in a 4-month-old Silkie and one in a 5-year-old Pomeranian.

CASE 1. OLD DOG. ANAL SQUAMOUS CELL CARCINOMA

History
Around 3 weeks before the surgery on March 23, 2010, Vet 1 diagnosed anal sacculitis, expressed the anal sacs and sent the dog home. As the dog was still licking the anal area, the owner came to me for a second opinion. "Vet 1 said it is anal sac infection," the personable lady in her 30s said. A wound that does not heal would need review.

KNOWLEDGE OF ANATOMY
In 99% of the cases, it will be anal sacculitis. But in this case, the lump was vertically below the anus, not at 4 or 8 o'clock position. This is where the vet student will find need to apply their knowledge of anatomy, a dull subject. Could this Pom be suffering from a chronic anal sacculitis?











Perianal (circum-anal) tumour resection in a Pomeranian. The anal sacs were normal. A lot of yellow oil was expressed out prior to surgery

Follow-up on Sunday, April 18, 2010
The daughter in her 30s together with her dad, came for a review, 3 weeks after the anal surgery of her male Pom, 5 years old. Many Singapore owners don't bother to come in for reviews as the dog's problems had resolved by surgical excision. The culture of Singaporeans is to be frugal and so they do not go for reviews of their dogs. But this attitude is at the expense of the older dog with tumours, some of which can be prevented.

"What's the result of the pathology report on the tumour?" she asked after I took out the stitches. The details of the histopathology report are as follows:
GROSS DESCRIPTION
The ellipse of skin measures 1.2 cm x 1.0 cm. It has a darkish lesion measures 0.7 cm x 0.6 cm. The underlying subcutaneous fat measures 0.4 cm thick.

MICROSCOPIC EXAMINATION.
The skin sections show ulceration of the epidermis. Beneath the ulcer is an infiltrative squamous cell carcinoma which is composed of irregular, closely-packed nests of atypical squamous cells. There is focal keratin pearl formation. Other areas show irregular anastomosing trabeculae of tumour cells. Most of the atypical squamous cells have voluminous eosinophilic calcification. There is surrounding desmoplasia and focal dystrophic calcification. The tumour reaches the resection margin. No lymphovascular tumour embolus is seen.

DIAGNOSIS
ANAL LESION, EXCISION BIOPSY. Well to moderately-differentiated squamous cell carcinoma.
ADVICES TO OWNER
1. Inspect anal region weekly for any hard lump as the tumour has spread past the resection margins. I explained that it was not possible to cut bigger as the wound will have difficulty in healing.
2. Get lump excised when it is small.
3. Get two retained testicles removed as soon as possible.

CONCLUSION
Many Singapore dog owners don't bother with the dog's backside tumours and so they grow larger. If this circum anal tumour was excised at 0.5cm x 0.5 cm when it was very small and Tardak (androgen inhibition drug) the prognosis is said to be good, according to the Tardak manufacturer.

A red ulcerated bleeding hard lump? I suspected it was a circum anal tumour due to its position. In my 30 years in practice, I had not seen anal sac discharge at the 6 o'clock position, ventral to the anus. This does not mean it will never happen. The probability is rare. So, the owner accepted my advice to get the tumour excised and sent for histopathology. It was a squamous cell carcinoma.

Circum anal tumours occur in old dogs. Dogs are said to be old when they are over 5 years of age. Hard swollen lumps even at the 4 and 8 o'clock position can still be circum anal tumours or perianal tumours. So, be vigilant and not be sued for misdiagnosis in this litigious age.


CASE 2. PUPPY - Clipper Burns. Silkie X, 4 months, male


"Do you think that the groomer was did not do a professional job?" the father of a 5-year-old daughter with big curious eyes asked me. "Before going to the groomer yesterday, he was normal. Today, he would rub his backside and lick it all the time. He was sleepy and did not want to eat. I felt that he has a fever."

The puppy had fever. His anal area had been shaved. His anus had a raised, reddish ring. His scrotal area was brownish for 75% of the area. 3 small brown patches of skin looked as if they were clipper burns.

"Talk to the groomer," I said. "Was the puppy having itchy backside prior to grooming?"

"This will be the last time I send my dog to her," he said. "Where do you find certified dog groomers?"

"Some groomers don't express anal sacs," I said to the groomer when the owner phoned her. "This is because some dogs feel the pain and the owner blames the groomer."

"But the course tells us to express anal sacs as part of the grooming services," the groomer said. "You know about this compulsory course conducted in the Temasek polytechnic?"

"I am only saying that some groomers learn from experiences similar to what has happened know and so, to avoid bad complaints, do not express the anal sac." I said to the young lady who must be a newbie.

"Does it mean groomers don't operate on the anal sac?"

"No, no," I answered. The owner was listening. "It is just that some dogs will experience intense pain after the groomer had expressed the anal sac. You may have to let the owner know after grooming, next time."

In this case, I suspected it was the clipper burns around the shaved anal area and near the scrotal area and subsequent application of a anti-bleeding purplish black potassium permanganate or iodine powder that burned the anal area and scrotum and caused the intense itchiness. The puppy just had to rub her backside to relieve herself of the itch.

The groomer's clipper had nicked the superficial skin of the anal area and below it and the groomer had dabbled he powder onto the wound, as this is the common practice in Singapore. I expressed the anal sacs. There was a very small amount of brown oil plus numerous specks of blackish powder which would be the potassium permanganate or iodine. But to prove it would require money and time.

So I better not instigate the owner who was already angry and would then had a big ugly fight with the poor groomer.

"Will you let me know how much it costs?" the groomer said. "OK," I asked my assistant to phone her after the owner had paid the bill.

This was a case where the vet could pour oil into the fire and made the owner extremely angry. Puppies are like babies. They are especially loved. This could lead to litigation and complaints to the veterinary authorities if the vet or his assistants played the game of running down other professions.

As for the fever, it could be a bacterial infection caused by clipper wounds. Or a viral infection as the dog vaccines protect against the major diseases. In any case, this puppy's primary complaint was an itchy backside and the problem needed to be resolved promptly with medication.

Wednesday, April 14, 2010

30. Closed pyometra in a 10-year-old Maltese

"My dog could not stand up yesterday," the son took time off to drive his mum, an woman in her late 50s and the family Maltese to consult me. He is really a good son as many grown up sons don't bother or delay. "Today, she can stand. But she is not eating."

HISTORY
This is the type of history the average Singaporean owner would tell the vet. The vet need to ask pertinent questions like vomiting (vomited 2x), polydipsia which is -drinking a lot of water (yes).

PHYSICAL EXAMINATION
Rectal temperature was 38.5C. Normal. Mucous membrane slightly cyanotic and pale.
A large distended abdomen was obvious. An old female dog not spayed. The first diagnosis was closed pyometra. Examine the vulva. A red spot of blood hung out from the vulva gave me the clue.

PALPATION OF ABDOMEN
No pain at all. Pain in the lower 1/3 of the abdomen is said to be present in closed pyometra and the swollen uterus can be palpated. The whole abdomen was just a swollen balloon and so it was difficult to palpate the two internal uterine horns. There seemed to be various swellings, some big. some small.

X-RAYS
X-rays can be done to show the swollen uterine bodies and to increase the income for the practice. A diagnosis of closed pyometra by history and clinical findings will cost the owner less. I did not milk the owner by getting X-rays done to protect myself from litigation. However, I insisted on a blood test to ensure that the dog's kidneys and liver are in good condition since the dog was vomiting. Vomiting could be due to high blood urea or liver disorder from the toxaemia.


BLOOD TEST
An increased white cell count is said to indicate a high bacteria infection. However, a normal white cell count does not mean that the dog has no pyometra as will be discussed in another case. I had blood test done in this case. There was a marked decrease in white cell count. A decrease in platelet count. Blood test is an ancillary aid to diagnosis and should never be relied upon to advise the owner on the closed pyometra case. If the owner wants to save money, I don't insist on a blood test but would advise the owner that he had been informed.
DIAGNOSIS
What is the instant diagnosis? Normal temperature and no fever. A drop of bright red bloody vaginal discharge. Just not eating much or not eating for 2 days. But there is polydipsia, polyuria and vomiting.

BE BRUTALLY FRANK ABOUT THE PROGNOSIS.
Due to the tendency of a few Singaporeans to complain and be litigious when outcomes are not to their satisfaction, I am nowadays brutally frank to dog owners when their dog's lives are in danger. Cut to the chase. I said to the son, "Your dog has a very serious womb infection. She will die within 2 days if you don't operate. If you operate she may die on the operating table as she is very old. Had you got her spayed when she was young, you would not have this worry."

"What are the chances of survival?" the son asked.
"50:50," I estimated. "If you permit her to be operated soon. Not wait till tomorrow."
"So low?"
"For most dogs in the same age group, I give less than 50%," I said. "Your dog is in good condition and not skinny. She has no fever and was sick only '2 days'. She has no heart disease but I don't know about the liver and kidneys." This dog looked well fed and could be considered a bit on the plump side. But since she collapsed yesterday and could not stand up, this was a warning sign not to give optimistic predictions. Blood test show toxaemia and yet this dog had a normal rectal temperature and looked bright. Most owners are worried about the poor chances of survival. So they delayed surgery or took their dog to another vet for another opinion and costing. This is OK if the dog is not in a toxic stage but who can tell?

TWO CHOICES?
"So, we have 2 choices," the son said. "To operate and not to operate."

PROPER COMMUNICATION IS IMPORTANT
"You have no choice," I said. "Your dog is going to die if you don't get her operated. Your mum may be seeing this dog for the last time before I operate today. It is very important I do it today as the womb is very swollen with toxic pus.

EMERGENCY SURGERY
In this case, I operated within one hour after giving her an IV drip. The dog ate the next day and is normal as at day 3 when I write this report. Soon, she would be going home. The surgery is illustrated in pictures below.




"Why you said the uterus is going to rupture soon?" the young intern asked me. It is good to ask why. The browning of the uterine walls indicated cellular necrosis and death. Within 2-4 days, the uterus would rupture leaking out pus and killing off the dog. If the owner procrastinated, don't blame the vet. The vet must give a letter of advice to protect himself or herself against frivolous complaints, should the owner want the dog discharged to seek a second opinion and the dog dies at the 2nd vet.
EARLY DETECTION, DECISIVENESS OF THE OWNER AND TRUST IN THE VET'S DIAGNOSIS AND SURGICAL COMPETENCE. A happy outcome in this case was not due to luck. When old dogs survive a toxic closed pyometra, surgery, it is not a matter of luck. It is knowing the fundamentals and the technicals of the diagnosis of closed pyometra, the anaesthesia, surgery and IV support and in excellent communications with the owner.


More pictures at www.toapayohvets.com DOGS OR
goto: http://www.bekindtopets.com/dogs/20100416closed_pyometra_old_maltese_toapayohvets.htm

29. Commodities Investment

The following is a draft report, before I forget.

An e-mail to invite me to the talk below. 2 reminder phone calls from the organisation the day below and on the day when I was late, showed that this organisation means business. In talks, it is best to take notes if you want to learn from another industry and to review. The talk was well attended as the room was almost full of older people above 30 years of age.

My impressions from this talk:
1. The Singapore's savings and fixed deposit interests are less than 1% and inflation will erode the spending power of the savings.

2. Investment in high quality funds over 5 to 30 years as part of your investment diversification should be done. Expect around 5% return per annum over the 5 years.

3. Expect around 8% return per annum when investing in funds dealing with good quality shares.

4. Do research to find out which funds are high quality and their portfolio.

5. Regular investment in a balanced fund. Invest monthly so that you need not worry when the market rises or crashes. 5% return per annum is better than fixed deposit interest rate of less than 1%. For example, monthly investment of $250. Global equiies return 7.44% and global bonds return 5.23% per annum as long term investment in the last 20 years. Much higher returns than fixed deposits. The average Singaporean retirees normally invest in fixed deposits in the POSB and do not know any other alternatives. CPF rates are 3.03%? Fixed deposit rates are 2% in Singapore. Mini-bonds are NOT bonds.

In 1939 - 2003
1. 70% you make money
2. 30% you lose money.
Any 3-year period, you make money
Any 5-year period, it is good for you.
Any 10-year period (long term), you should have better returns.

6. The Straits Times Index has shot up 100% as at April 2010 compared to Oct 2008. Oct 2008 was the economic crisis level when shares were at the bottom. Therefore many people have had missed the boat. The STI was 1,500 in Jan 2009. Now in April 2010, it is 3,000. Its peak is 3,800. When will it peak? Economic cycles are shorter nowadays. 4 years from now, it will peak at 3,800? I can't understand how the speaker comes to this conclusion or I have heard incorrectly.

May 1932 Great depression
Jul 1982 Worse recession in 25 years
Dec 1994 Most dramatic Fed tightening
Oct 2008 Economic crisis
Apr 2010 Said to be in the expansion (boom) period. Commodities will outperform. Interest rates will rise.

Australia. The following may be of interest in students studying in Australia.

1. Interest rates are record lows except in Australia.
2. Unemployment has decreased more than expectations.
3. Australia is a commodity producer.
(Implication? Invest in a country that is a commodity producer). Buy commodity shares in Australian companies?

Singapore News in Apr 15, 2010
Singapore's inflation rate will increase from 2% to 2.5% according to April 15, 2010 news I have just heard. The economy has rebounded unexpectedly.


4. The following topic was educational as the speaker said 2010

Gold prices still have not reached their peak. In Jan 1980, the lady speaker said that gold was selling at the peak of US$1,816 but two participants said it was S$800 as they bought or sold gold for their wives.

The speaker said it was US$800. The US$1,816 was the figure adjusted for inflation at 2010 rates, the lady explained. "In 1980, an HDB flat was not selling for $1 million dollars!". I can't recall HDB flats selling for $1 million in 2010.

ENERGY V. GOLD ASSESSMENT

Focus on gold as the real interest rate is low and gold is relatively cheap. To evaluate, assess how many number of barrels of oil will buy 1 oz of gold. In Jan 1980, gold prices were at its peak of US$1,816 and the number of barrels was 48.2. In Nov 2009, gold was cheap when it could buy 15.2 barrels. This is because gold supply is down. The trend is for central banks to buy gold and so demand will increase.

Silver - Smaller market. Silver outperforms gold if its price rises. Invest in 10% of your diversified portfolio.

Platinum - Still high demand despite recession as European Union regulations require cars to have catalyst to reduce toxic emissions. Auto catalyst needs platinum. Invest in 5% of your diversified portfolio.

In summary, hold commodities esp. gold and metals to hedge against inflation for a long-term portfolio. Base metals prices were high last year (2009). The last 20 years were deflationary. Now, we are in the inflationary environment and the 20% bond and 80% equities formula may not be relevant. Commodities should do better than both.

In the economic cycle
1. Slow down
2. Recession
3. Recovery - equities and properties
4. Expansion

Agriculture, metal and energy. Agriculture is the last one to rally. Metals had their best performance in 2009. In 2010, consider gold price as an alternative investment for growth.

A simple rule: Be fearful when others are greedy but be greedy when they are fearful.

---------------------------------------------------------------------------
LECTURE

An International Portfolio in Commodities (lst Hour)

Because commodities are an area which have not been represented in investment portfolios, this market is relatively inefficient. Opportunities to outperform the market are much more likely to occur in an inefficient rather than a more developed market environment.” And like many asset classes, the long term is made up of a series of medium-term cycles, in which prices move up and down as supply and demand fall into and out of alignment with each other.

Looking ahead to the next few years, we see good reasons why the long-term and medium-term trends are highly encouraging for commodity investors.

· Why Commodity Futures?

· Outlook for Commodities in the 3 broad groups: Metals, Agriculture and Energy.

· How to take part of the exciting opportunities of Commodity Futures?

A Winning Investment Vehicle – Zurich (2nd Hour)

· How best to position yourself to take charge of the market rally

· What are the best periods in history to invest?

· A winning investment strategy with Zurich

Key Speakers:
1. A substitute lady speaker from Schroeders
2. Alan Tang - Chartered Financial Consultant, Certified Financial Planner, Chartered Life Underwriter , Senior Branch manager (PIAS), Money Sense Speaker (MAS)

Having done more than a thousand talks for corporations, unions, ministries and statutory boards, Alan is a revered speaker in the financial seminar circuit. He is not just effective in delivering the message, but his lessons will dramatically improve your finances.

Tuesday, April 13, 2010

28. Enterotomy, enterectomy, gastrostomy practical

To excel in veterinary surgery, one must have lots of practice. In human medicine, surgery is a post-graduate study and specialty but vets after 5 or 6 years of undergraduate studies are expected to be competent in veterinary surgery. There are veterinary specialists in surgery but he or she will not be able to earn a living in Singapore or in many countries.

Therefore, it is good to know that the 4th year students are given hands-on experience on intestinal surgery in the pig. 3 in a group. One would be a surgeon, one would be an anaesthestist and one would be a recorder at any one session. Anne was the one doing surgery yesterday. She had the short stick of the draw.

I did advise her to practise a lot on stitching pig intestines prior to the test. Reading notes and watching video may give the theory. But in the real McCoy, she needed to demonstrate competence if she was to get HD (High Distinction). For this high-achieving student, failure is not an option. Failure means having to repeat the test but I doubt that the University would be funding a pig for this repeat. It must be expensive and time-consuming. So, yesterday would be her trial by fire.

I discovered that she was a high-achieving student when her mother told me. It is rare to meet high-achievers doing internship in my practice and in veterinary medicine and surgery. There are around 70 graduates per year. 150 students might have started first year. The drop-out rate is high. In 70 students, only one veterinary graduate may get the University Medal for being amongst the top 7 in the whole campus. I presume the winner will be from the crop of the top 2%. It is not easy.

Veterinary medicine and surgery is a very tough subject unlike human medicine where only homo sapiens is the only species being studied to death.

A vet student has to study so many animals and each animal has its own diseases and various medicines to treat them. It is a wonder how the undergraduates can memorise and pass the examinations.

"How's the practical test on your intestinal surgery today?" I phoned Anne who was the surgeon in a group of 3. I had advised lots of practice on pig's intestines prior to the test if she wanted to get high marks. No 4th year student or even new graduates can demonstrate competence in stitching up the intestines because of the Western model of veterinary education which prohibits practices on live animals due to animal welfare concerns.

I was surprised that Anne accepted my advice and sourced for pig intestines from the butcher's shop to practise surgery. A butcher told her that pig intestines are never sold in Perth. Yet she found one selling at Northbridge. So, she practised and the vets and nurses at the vet surgery she stayed helped out.

I had many questions to ask about how she did the surgery on the pig. I don't do pigs. "Enterectomy, enterotomy and gastrostomy," she said. "How long did it take? Around one hour?" I asked optimistically. "The total surgery including stitching of the linea alba and skin stretched from 1.30pm to 4 pm."

I was just interested in one result regarding intestinal anastomosis. "Did the intestines leak after joining the two parts of the cut intestines?" Performance counts. You fail if your appositional sutures did not close the defect. The patient would suffer peritonitis and there will be a need to operate again.

"Did the intestines leak?" I asked again. This was her first intestinal surgery and she had diligently practised. "In a live pig, the intestines are mobile," Anne said. "It is not easy to stitch (unlike the dead specimens from Northbridge. The mucosa is hard to stitch up."

"So, did the intestines leak?" I asked patiently again. I could not afford to talk too long in international phone calls and this was the answer I wanted to know. You can have beautiful stitching. But the life and death issue is whether the patient's intestines, uterus, bladder, heart, blood vessel leak contents after your stitching.

"Yes," Anne explained to me that it was hard to stitch interrupted appositional sutures to join the two intestines. The sutures should not evert or invert. They should just close up tightly as in simple interrupted sutures in the skin. "Why don't you use inverting sutures on the serosa?" I asked. "Fine 4/0 absorbable sutures inverting the serosa as in gastrostomy?" Anne said, "The professors said that only one layer of appositional sutures would do as there may be intestinal blockage."

Well, I did read the lecture notes which taught what Anne just did. It also said wrapping of the omentum and tacking it to close the anastomosed area. Or a serosal patch after intestinal anastomosis.

This anastomosis of intestines is a rare surgery in a general practice. Practice on Caesarean sections would help a vet hone his skills. Unfortunately, there are not many Caesearean sections unless the vet has lots of dog breeders and provide dirt-cheap surgeries attracting them. "Why was there a leak?" I wanted to know. "Didn't you check after stitching?"

It is easy to criticise when one is not on the hot seat.
"It was closing time," Anne said. "I had to rush." Failure is really hard on high performers. Nobody wants to talk about the pains of failures. "Do you know your marks?" I asked. "No," she said. I think she would not get a HD for this surgery. And after all her hard work.

Monday, April 12, 2010

27. FAQ - Breast tumours in a 13-year-old Pomeranian

On this first Sunday after my return from Perth, I was still around at 6 pm when a couple came in with their 13-year-old Pomeranian with nodular breast tumours in the MG 4 and MG 5 glands, left side.

HIGH ANAESTHETIC RISK
"We are bringing in our dog for surgery," the couple explained to me that my associate had booked for them the appointment for surgery on Monday. "Will my dog be able to survive the anaesthesia? I hear it is very risky."

PRE-ANAESTHETIC BLOOD TEST
I checked the dog generally and the heart. "The dog's heart was OK and the general health is good," I said. "There is the gum and tooth disease as you had not done any dental work for the dog for the past 13 years. Generally, there should be no anaesthetic problem but please note that your dog is not as young as a 5-year-old female dog. There is the kidney and liver function which can be assessed by a blood test. This costs money." Owners must be advised fully the risks and a blood test will be good. But in practice, the owner may not want to pay for the blood test.

SPAY AND BREAST TUMOUOR REMOVAL
I advised separate anaesthesias to remove the breast tumours and the do the spay. "Won't the dog be having two risks in anaesthesia?" the husband asked.

"Anaesthesia in dogs older than 5 years is risky," I explained. "However, the shorter the surgery, the shorter the duration of anaesthesia. Therefore, the lower the risk of dying on the operating table. If a vet takes 1 hour to do a spay and breast tumour removal in your dog," I explained, "the higher the chance of the old dog's heart failing. If one surgery is done and this takes 15 minutes, the dog will be at much lower risk of death."

"Two surgeries in one is much cheaper," I said. "Many vets do that in the case of breast tumours plus spay. However, which owner will be happy when the dog dies on the operating table? If I charge you $5.00 and your dog passes away on the operating table after I completed two surgeries, will you be happy at all?"

I don't know whether the couple understand my explanation. I ask them to speak to my associate vet who will be handling their case. In old dog anaesthesias, the owner actually understands and takes the risk. The vet must produce a live dog at the end of the day. I mean, if there are 5 breast tumours and you remove all completely. The dog dies on the operating table or 2 days later because it is old and can't take the lengthy anaesthesia and surgery, no owner is going to refer any friends to you. Deaths do occur, but the trick of the trade is to make anaesthesia short and if surgeries need to be performed twice or thrice, inform the owner. An old dog is very much like an old family member. Every owner wants him or her alive at the end of the surgery and go home walking.

26. Large toe granuloma. Just cut it off?

As part of my training, I asked my assistant what to do in this case of the Labrador Retriever with a large lick granuloma in his 5th toe? It is good to ask for ideas although one may be deemed incompetent in asking.

"Just cut off the toe from here and stitch up from there to here," my assistant outlined the approach of "de-clawing in the cat" to cut off the large granuloma that had existed for one month. The owner finally sought veterinary advice as the dog kept licking and licking. If only he had consulted the vet early, the treatment was so simple and effective as it would just be a simple wound.

"If you cut this large granuloma, you will have a very unhappy owner," I said. "The hole will be so big as the granuloma now covers the second and third phalanx too. For cat declawing, only the first phalanx is cut off. In this dog, the area is inflammed and infected. After cutting off, the wound will not heal well. The owner is going to spend more money and the dog is going to lick."

"We can hospitalise the dog and treat for him after surgery," my assistant suggested.

"No owner will be happy if the dog's wound does not heal after hospitalisation," I explained to him. "There is the money to be spent and the worries."

"The first method is to reduce the granuloma size using drugs," I explained to him. If the granuloma disappears, there is one happy owner. "If not, the size will be reduced and surgery to cut it off will be easier and the hole will be much smaller."

Toe and other lick granulomas are common in dogs. Owners neglect early vet attention. The instinct of the vet is to cut it off. Veterinary surgery is not always the answers to inflammatory granulomas in the toes.

25. Xylazine:Ketamine IV sedation and anaesthesia in dogs

There are many methods of anaesthesizing the dogs. One of them is the use of xylazine and ketamine IV. I believe this is seldom used as each vet has his own preferences. For example, I use xylazine tranquilisation IM and halothane and nowadays isoflurane gas anaesthesia over the past 20 years of practice and I find it to be very effective and safe, with rapid recovery.

However, old dogs can learn new tricks and I always ask other vets what anaesthesia they use. There is a great variety.

My associate vet loves to use Domitor pre-anaesthetic dosage, isoflurane and then Anti-sedan reversal. Another vet loves the xylazine/ketamine combination for anaesthesia. Another one loves zoletil injectable anaesthesia. The principal vet my god-daughter is seeing practice with in Perth never uses mask anaesthesia at all and therefore he does not have anaesthetic mask.

The following is my observation of xylazine:ketamine IV anaesthesia I used in one 26-kg, 5-year-old Labrador Retriever yesterday to treat a lick granuloma of the LH D5 toe.


THE GENERAL GUIDELINE FROM ONE VET
FOR XYLAZINE:KETAMINE IV ANAESTHESIA IN DOGS

FOR ANAESTHESIA
26kg, 5-year old dog
Xylazine 2% at 2.3 ml
Ketamine 100mg/ml at 0.3 ml
In one syringe, the total is 2.6 ml, IV

FOR SEDATION, the dosage is reduced as follows:
26kg, 5-year old dog

Xylazine 2% at 1.3 ml
Ketamine 100mg/ml at 0.3 ml
In one syringe, the total is 1.6 ml. IV
This was what I gave to the dog

After 1 minute, the dog was sedated.
After 5 minutes, I injected prednisolone into his large LH 5th digit granuloma. Slick flicker of pain reaction. He was sedated well.

Recovery
He took more than half an hour to wake up and more than 1 hour to stand up. I did not given any anti-xylazine reversal as ketamine is involved.

CONCLUSION
I prefer dogs to be standing up within 2 minutes of the end of a procedure or surgery. So, I will not be using this method. It will be good for cases where there are no gas machines. This is why I am recording this case for the benefit of vets who may not have anaesthetic gas facilities.

P.S.
From this practitioner who is experienced in this method of anaesthesia, there is a general formula for xylazine:ketamine IV anaesthesia in adult dogs.

For example, 26 kg, 5-year-old dog
Xyalzine 2.3 ml + ketamine 0.3 ml = 2.6 ml in one syringe.
This is a general formula and must be reduced according to health, age and weight.

Sunday, April 11, 2010

24. Be proactive to save money - Telcos' confusion

Telcos all over the world confuse clients. Below is a excellent report on the situation in Singapore in April 20910 from one lady. She should be in the consulting and research field. All the time, I had the perception that Starhub who was the first mover in providing free in-coming calls was still the best value-for-money of the 3 telcos in Singapore.

Telcos rely on the "inertia" of people. People who have subscribed to the line will usually not want to switch to the better deal and they start giving various packages to confuse comparisons. Unless one has the time to research on this.

E-MAIL FROM DR SING

On Sun, Apr 11, 2010 at 4:24 PM, Kong Yuen Sing <99pups@gmail.com> wrote:

96640404 is not available. Can you recommend me whether I should subscribe to Starhub or Singtel and what plans? I will do it on Monday and get for you the tel no

E-MAIL TO DR SING

You can subscribe to corporate SunSaver Plus plan from M1 for a 3-months subscription period without handset.

Below is the details of this plan:
Corporate SunSaver Plus
- monthly subscription $48.15
- free local outgoing mins cap at 300mins
- free local sms cap at 500sms
- M1's free incoming calls is valid till 31 Dec 2012
- Excess local outgoing mins are charged 16.05¢ flat per min. Excess local sms-es are charged 5.35¢ per sms.

I estimated that the business calls usage would range from 400mins to 500mins so the monthly phone bill incurred is likely to ranged from $64.20 to $80.25. If one day you find that the monthly phone bill consistently exceeds $82.95 for months due to the business call usage exceeding 516mins and I would suggest an upgrade to SunMax plan (scroll down for details on SunMax plan). Meanwhile, you can subscribe to SunSaver Plan plan first.

Pls: scroll down below for explanation to the choice.

Thanks.

Regards,
Ling

------

Note: Though you told me to choose the plan, I think it's still right to explain to you the choice. Below is the rather lengthy explanation if you are free to go through:

The monthly subscription pricing of the free incoming calls corporate plans of the Starhub, M1 and Singtel are essentially the same. But Starhub's and M1's free incoming calls corporate plans comes with per second billing, which is more economical than Singtel which charges by an initial block of 1min and subsequent blocks of 6secs. For the validity date of the free incoming call, M1's free incoming call is valid till Dec 31, 2012 while Starhub's and Singtel's free incoming calls are valid till Dec 31, 2010.

The minimum subscription period without purchase of handset is 3-months for all the three mobile service providers.

If you plan to subscribe for 3-months or 6-months, for which the subscription would end before Dec 21, 2010, it wouldn't make a difference whether you choose to Starhub or M1. However, if you plan to subscribe for 1-year, I would suggest that you sign under M1 as Starhub's free incoming calls are not valid after Dec 31, 2010.

I estimate that the business calls minutes can range between 400 to 500mins.

If you intend to subscribe to Starhub, you can choose
- Corporate PowerValue 300
monthly subscription $48.15
free outgoing mins cap at 300mins
free sms cap at 500sms

- Corporate PowerValue 700
monthly subscription $82.93
free outgoing mins cap at 700mins
free sms cap at 500sms

If you intend to subscribe to M1, you can choose
- Corporate SunSaver Plus
monthly subscription $48.15
free outgoing mins cap at 300mins
free sms cap at 500sms

- Corporate SunMax
monthly subscription $82.93
free outgoing mins cap at 700mins
free sms cap at 500sms

To simplify, you can subscribe the corporate SunSaver Plus plan from M1 first. If you plan to renew the subscription in the future, you can still enjoy the free incoming calls which is valid till Dec 31, 2012. If one day you were to feel that the corporate SunSaver Plus plan is insufficient for your business calls usage, you can upgrade to the corporate SunMax plan.

23. Biosecurity in poultry farms - Part 2

E-MAIL TO DR SING
2010/4/11 ...@hotmail.com>


Hi Dr Sing!

Thank you for your comments. I have re-written my essay but i'm still not very sure if i'm on the right track. Should I put it as "I am the farmer" point of view, or a general point of view? And how do i link the different farm systems? Have i done it correctly?

Poultry Assignment 2010

“It is difficult for people to catch H5N1 bird flu, but when they do, it can be deadly, (Reuters, 2010).” Bird flu is one of the main concerns of the poultry industry leading to massive economic losses in farms. For example, in December 2008, authorities found H5N1 in a chicken at a poultry farm in Hong Kong, prompting the slaughter of more than 90,000 birds (AFP, 2009). Such diseases can be prevented by implementing biosecurity measures.

WHAT IS THE DEFINITION OF BIOSECURITY? Is it just purely disease prevention?

Diseases can be introduced to poultry farms through people, poultry, contaminated premises or equipment and vectors. The type of biosecurity measures to be implemented depends on whether I am operating a free range farm, barn layer system or a conventional caged farm. Some preventive procedures can apply to all systems, while others are specifically to one or two.



For any type of the three farm systems mentioned above, the following measures must be implemented. Firstly, newly arrived or sick birds must be quarantined to prevent transmission of diseases to the healthy flock.



Secondly, routine vaccinations will be given to all chickens to prevent a particular disease by triggering the bird’s immune system to produce antibodies that in turn fight the invading causal organisms (PoultryHub, 2009). For example, vaccines such as live (V4) vaccine and in ovo Mareks Disease Vaccination are commercially used.



Thirdly, I will oversee that visitor hygiene measures are strictly abided by. Signage and gates will be put up to discourage unauthorized individuals from entering the farm (PoultryHub, 2009). Visitors and service providers must wear overalls and boots that will be provided and foot washing baths will be available at the entrance of each shed for disinfection prior to entry (PoultryHub, 2009). I will also ensure that movement of people will be scheduled such that the youngest flocks are visited first and the oldest last (PoultryHub, 2009).



Fourthly, minimizing fear and anxiety in the birds to reduce their stress level will help the birds’ natural protective mechanisms to function optimally (PoultryHub, 2009). Also, using good quality feed is particularly important as bacteria and mould may be present in poor quality feed (PoultryHub, 2009).



Fifth, I will ensure that daily inspection is done on the birds; any sick or dead birds must be removed immediately to prevent the spread of bacteria or virus.



The following are measures related to specific farm systems. If I were to operate a conventional cage or barn layer systems, thus I will ensure that a good ventilation system is installed as birds are confined to a very small area and are thus very susceptible to any air borne diseases.



If I were to operate a free range farm system, I will wire net the barns to make them bird proof (PoultryHub, 2009), discourage wild birds from visiting by removing any spilled feed immediately (deGraft-Hanson, 2002) and by sanitizing water for bird consumption (Commonwealth of Australia, 2010). I will also ensure good fencing to prevent rodents from gaining access which may contaminate poultry feed.



In conclusion, it is important to know what type of farm system is used and implement the right measure to protect the birds against potential sources of diseases.

REFERENCES



E-MAIL REPLY FROM DR SING

Excellent report. Easy to understand and I don't fall asleep reading it. I think you have a gift for research writing.

You should look at the question and you will know the answer. I believe the question was "What aspects of the biosecurity program would you put in place to protect my poultry farm against the 4 potential sources of diseases? I don't know how many poultry housing systems there are in this world as I am out of the poultry line for at least 30 years. The only birds I see recently are those common black and white ones and crows in Perth.

I believe poultry has two types of housing systems - the indoor and outdoor (free ranging systems). How to link them? You have had done it.

I remember some points which may be relevant to biosecurity too.
1. Good record keeping of biosecurity measures and writing manual of standard operating procedures for hygiene controls.
2. Review of breaches of biosecurity and learn from them, sharing knowledge with managers.
3. Regular education program for new employees and staff on biosecurity measures
4. CCTV and alarm systems for expensive breeding stock?
5. Veterinary post-mortem of sick birds, blood test to check effectiveness of vaccination, health surveillance of random samples regularly.
6. Keep up research and good writing. Be hands on. Go and visit real poultry farms! Dog farms, fish farms, alpacca farms etc and you will see biosecurity in action. Study hard. Best wishes.

Saturday, April 10, 2010

22. The girl with the clicking car

Undergraduate days are frugal days and possessing a car in the 1960s was a big thing as most Singapore undergraduates then and now cannot afford ownership of a car. Not in Perth. A$3,000 will buy you a moving car and many undergraduates drive.

But this small car was clicking every time the girl shifted gears to drive. "Click," she shifted to gear 1. "Click," she shifted to gear 2 and so forth for the rest of the journey to see the principal vet.

"Are you sure your car is safe to drive?" I asked the girl. "Will it crash?"

"The mechanic says there should be no problem," she clicked again. "The mechanic needs to dismantle the gear box to solve the problem." The girl has no priority for a clickety car and was too busy.

I have my doubts about the safety of a clicking car. Must do some research. Will not the clicking cause friction. Friction causes sparks. Sparks cause the car to catch fire? I mean, if a dog is coughing, will persistent coughing lead to some serious illness? Does this not apply to a car too? Prevention is better than cure.

I did not mention this to the girl's mother in Singapore. Otherwise, the mother would worry more.

Friday, April 9, 2010

21. 79-year-old war veteran with agile mind

This one-week in Perth, far away from my practice in Singapore, gave me time to reflect and see life and matters in a new perspective.

1. Be proactive.
Inertia is preferred as it is troublesome and uncomfortable to start something new. The status quo is what most people wanted and therefore, the "opt-out" system of organ donation is being used by governments. If you don't "opt-out" in writing, the law states that you have agreed.

Being proactive may lead to undesirable consequences. 2 days ago, I asked a young man to drive me to visit the practice at 10 am since I suspect that my "god daughter" would not have time or the principal vet in that practice would not have time for me. It was an impressive practice with all the latest equipment to test for cortisol and thyroxine, blood pressure monitoring, ECG and a breath-rate-monitoring alarm system during anaesthesia. I sat on the bench to wait. Within 1 minute, the receptionist attended to me. "She's out," the receptionist said. So, I was surprised. Ought to have made prior appointment. She came back soon. The principal vet was a dynamic successful man in his 40s as he has 2 practices.

I was surprised that he has no anaesthetic masks in his practice. "No need," he said. "I induced them with drugs." This was a new perspective to me. I did not ask whether he use anaesthetic mask in dogs in shock in Caesarean cases as I had little time and did not want to impose on a stranger vet. I was surprised tha he was allergic to rabbits. "How about horses?" I asked. "Yes," he said. I considered myself fortunate in not being allergic to animals for the past 30 years.

I checked out the ambience of the surroundings as this was necessary for me to assess whether this neighbourhood was relatively safe. A typical suburb but unlike Willeton with its manicured lawns and rose gardens and overwhelming one-storey bungalows, this suburb has apartment blocks and low rises. Willeton is said to be a middle to upper class residential area and I can see boats parked. The practice's neighbourhood appeared to be OK for my god-daughter and so, a lot of worries for her mum can be dissipated when I report to her.

I visited a beautiful lake near the practice. Many children and families were present on this weekday morning. Pelicans and water fowl were abundant. This was a surprise to me as most parks are quiet.


79-year-old war veteran
A strong-looking tough man in dark sunglasses was walking a dog in the beautiful park. I asked him about the plant with cones of yellow, white, pink, brown and black colours, so commonly seen in parks and appears on the logo of Murdoch University. "You can suck the nectar from the small flowers of this banksia plant," he said to me and asked whether I wanted to do it. "No, thanks," I said. He walks dogs every morning and boards them for people. "Do you charge for your services?" I asked. "No," he said. "Just whisky at the end of the walk." He was 79 years old, had both eye lens replaced, a not so strong heart. But his mind was very active and alert. Many men in their 60s are senile but he was so mentally alert and could tell me the species of various birds in the park and the whole history of coin-collecting. "How do you safeguard your coins?" I asked. I presume he was living alone. "I don't put all my coins in one place," he said. "Some in the bank, some in a safe." I asked him, "The thieves can just cart away your safe when you are out exercising the dogs."

"My alarm system is connected to the security and in 5 minutes they will come."

"A clever thief will deactivate the system," I said.

He had the answers, "My safe is underground and it will take a long time to haul it out."

"The thief will just clear the safe by blowing it open," I said.

"Not so easy," the war veteran who is an expert in explosives for the Australian army told me. "I have a steel door to the room."

This was one man who was well prepared for all contingencies. He was an expert in old coins and all his expertise is inside his brain. "How do you sell your coins?" I asked. "There is a Phoenix auctioneer who charges a fee on successful sale," he said.

This is a 79-year-old average man on a pension, but he certainly was not "one foot in the grave." He has daily exercise by taking dogs out for people free of charge.

On knowing that I am a vet, he said, "In Australia, vets make a lot of money."
An immigrant who owns the Bull Creek Hawker told me the same thing.
"Why do you say that?" I asked the war veteran.
"See the skin lump on this miniature pinscher," he pointed to a 1-cm lump on the left chest of the dog. "The vet charges A$50 just to tell me it is a skin lump."

The successful boss of Bull Creek Hawker told me that it cost over A$100 to consult a vet when the dog has flu while a human being pays $27.00. "So, a man with no gardens don't walk a dog," the boss referred to some Cantonese idiom, meaning that a poor man should not own a dog.

While back from the park, my driver, a student switched lanes from the right to the centre to the left as he had gone on the wrong side. "What to do?" he asked me as a policecar had flashed him to stop. "Get onto a side road," I said. "And stop the car." He was having hand tremors, I think. Singaporeans are intimidated by police as they, until recently, had been aggressively unkind.

Thursday, April 8, 2010

20. Red rice yeast to lower cholesterol?

Apr 9, 2010. perth. last day of visit.

Julia had high total cholesterol over past many years. Statin caused muscle ache and rapid heart beat. So, the doctor recommended lipantol for the past 3 years. Cholesterol reading never went below 200. Latest reading was 230 and liver enzymes were raised, indicating liver disorder after so many years of taking of drugs to lower cholesterol and high blood pressure. What to do?

"You can try nicotinic acid," the good doctor had diagnosed that Julia's high cholesterol was hereditary. No hope of reducing. Cholesterol continues to plug her arteries. But nicotinic acid has adverse side effects and may not work. "You can try red rice yeast," the doctor suggested. "But it is not scientifically proven nor arre the ingredients standardised or declared. It is like taking herbal medicine. You take it at your own risk."

Is there a solution for Julia's high cholesterol? The doctor had run out of drug options. "Dr Chua has excellent bedside manners," I said to Julia. "If I were him, I would tell you to stop eating fried food, oily noodles and go on a 90% vegetable and fruit diet. And a serious program of exercise daily." Julia disliked exercise. TV and movies in air conditioned rooms and her office manager's job were her sedentary life-style. She lives to eat and good food is definitely not vegetables, fruits and rice. She was not particularly worried about high cholesterol. So far, no sickness.

Many mothers in their late 40s and 50s start putting on weight. It is the mother's sedentary lifestyle but they seem not to be able to reduce their weight. How about red rice yeast? I went to Boorangoon in Perth. Only 2 bottles were available for sale. I bought them. I went to Southmall in Willeton. None available. "Why?" I asked the health food shop operator. "The demand spiked last 2 months when the red rice yeast was advertised on TV," he said. "TV advertisement sells the product very fast." That was why I could not locate any bottles for Julia. There must be many people in Perth allergic to the statins and/or using the herbal alternative.

I bought glucosamine and chrondition brand for the mother of another student studying in Perth. This particular brand was on sale in Sydney at A$49.00 for 200 capsules. But in Perth's Boorangon shopping centre, it was more. The girl did not want to buy it. It is again the lifestyle of the mother. She just could not reduce weight and now her knees were painful. "You know," I said to the gierl's mother, "You just reduce 10 kg over 1 year and your knees would not need to bear so much weight." Since this was not what she wanted, I bought the 200 capsules which was what she wanted.

Lifestyle changes seldom appear in intelligent women in their 50s. They are proficient and good in their careers. But good oily meat and salty food is so much tastier. And deadly for them. It is such a pity. As for red rice yeast, I did a bit of internet research at: http://www.cholesterolcholestrol.com/red-rice-yeast-cholesterol-cholestrol.html
It was statin in low doses! The statin is deadly to Julia. So in fact, julia has no herbal alternative. Two bottles down the drain.