Wednesday, August 31, 2011

573. A biting Miniature Schnauzer has vomiting and diarrhoea

Time flies. A month has passed again and this was August 31, 2011. I was on reception duty as that is the best way to know more about the customer service provided by Toa Payoh Vets.

A father and son came at 6.30 pm with his son and a broad chested Miniature Schnauzer. I took out his case card. He was from a neighbourhood where there are two vet clinics nearby just opposite his apartment.

"Why didn't you just go to the clinics nearby?" I asked the father as part of my survey on customer service. This is what most Singaporean pet owners will do. Why go far away when the time can be spent better not travelling.

There are at least 45 vet clinics in Singapore nowadays. So, there is no shortage of vets to the benefit of consumers, as in most businesses.

"My daughter prefers Toa Payoh Vets," the father said. Female members of the family may have a higher say in the choice of vets and veterinary surgery, from my preliminary survey. A daughter who studies overseas in marine biology in Australia had just instructed her family members to bring a dog to me for treatment earlier. The other daughter who phoned me to make an appointment for her father's favourite Chinese Crested dog in the story of Sedation worries of a good daughter is another example of the young ladies making decisions as to their choice of vets.

Services count and Dr Vanessa must have had provided good services as nowadays she handles most of the cases. A time to pass the baton.

What to do with this biting Schnauzer who has vomiting and diarrhoea? "He even bit me when I tried to carry him," the son showed me his left arm which was now OK. "He was bashed with a slipper at the groomer till his nose bled last time and so now he bites whenever anyone tries to muzzle him."

"Has he been neutered?" I asked.
"Yes," he said.

So what to do?
I let Dr Vanessa handle this case. The dog went to the consultation room. The two owners went in. Min had gone out for dinner as it was already 6.30 pm. I waited outside in the reception area for around 15 minutes. Soon, the two owners and dog came out and waited outside the Surgery patiently as the sun was setting. A quiet peaceful time as twilight set in.

I was doing my administrative work, looking into past case cards and checking the vaccination reminders. Why were they outside for so long, another 15 minutes? I went out to ask if they were looking for a taxi. "No," the father said. "I am waiting for your assistant to come back from dinner." Dr Vanessa came out from the consultation room to inform me too. She could not give this dog his anti-vomiting and anti-diarrhoea injection as the owners could not carry the dog onto the consultation table without being bitten and she could not cover the dog's head with a towel which I noted was on her consultation table.

This Schnauzer was a bit plump but younger and alert. He does not growl. He does not threaten. He was merely cool. Just don't mess around with covering his head or muzzling him or carrying him onto the consultation table. He would just bite.
So, Dr Vanessa advised waiting for Min. Some clients do come during certain lunch and dinner time as Dr Vanessa does consult, unlike some surgeries where certain times are closed. So, this is one period where Min had gone out for dinner and she had to wait for him.

I phoned Min and he said he was having dinner. At around 7 pm, he returned and I said to the owners: "It is sometimes better that you don't be around while they restrain the dog for injection." They agreed to wait outside the Surgery.

I let Dr Vanessa handle this case as usual. Another 15 minutes had passed. The father had come in from outside and was sitting on the chair. There was loud barking in the back of the surgery. "How many dogs do you have?" He asked. "Around 5 dogs but from the barking, it seems I have hundreds," I said. The father laughed and said: "Young doctor taking a long time to inject the dog? Is she your daughter?"

Youthfulness can be an advantage as many Singaporeans, in my perception and research, prefer young vets. It is sometimes a disadvantage in a ferocious biting dog case.

It was already more than one hour since the owners had come. So, I opened the door to enter the back of the Surgery. What was taking so long? In the room, I saw Min holding a lasso rope which came out from a long stick while another assistant was holding the leash of the Schnauzer on the other side. Dr Vanessa was holding a bigger muzzle at the right side of the dog. Her sedative of domitor and ketamine for IM injection was on the table. The Schnauzer was wary of Min whose lasso seemed to be rigid and inflexible. His lasso had one end inside a hollow tube. He held the tube and tried to lasso the Schnauzer while the other assistant Tun held onto the leash. As this lasso was inflexible, it did not work. So back and forth. It was taking a very long time.

It was an impasse. Now, I had taught Min how to use the original lasso which was of flexible plastic wrapped rope. He had used his own make as this original lasso had come out from the hollow of the pipe.

I had to intervene, being the leader. There was no choice. It was already 7.30 pm. "Give me the original lasso," I said to Min. He took it from the wall at the back gate. It had no hollow tube as that had broken. But the lasso end was still intact and so I loosen the rope to make a bigger circle to lasso the dog, without the pole. The pole was meant to protect the person holding the lasso from being bitten as it gave some distance. But the pole had broken and so I was holding the lasso end and the remaining rope.

The Schnauzer moved his head. He did not threaten. Tun held onto the leash. At the 3rd try, I manage to put the lasso over his head and pulled it tight. The dog pulled back his head in reaction. Tun held on to the blue leash which was originally with the dog.

"Get ready to inject the domitor IM," I said to Dr Vanessa as I held the dog firmly and upwards for a few seconds. She said: "Domitor is ineffective. I tried earlier on another dog. I am using domitor + ketamine combination". I said: "OK."

She quickly held the dog's back leg and injected the back muscle in the wink of an eye. "Wait 10 minutes," I said. "The owner had instructed that he wanted the whole dog clipped and groomed, including ear cleaning, anal sac and toe nail clipping. At first he just wanted a sedative to clip the backside as the dog would not permit washing of the soiled backside from the diarrhoea."

The whole process took more than one hour. I have been focusing on shortening the process of veterinary work. In this case, it can't be helped as Min is still learning how to restrain ferocious dogs. Remember he was bitten by a dwarf hamster just a few days ago?

Hands-on experiences are learnt only from handling the real cases and this take time. Workplace safety for the staff is paramount.

Still there needs to be a solution to treatment of a ferocious dog for the owner who entrusts the vet to do it. A simple thing as a lasso can still be difficult to execute in practice as in this case when the tool presented is broken. Sometimes we can't have the ideal situation and I hope Min learnt from this coaching I had just presented.

Every person is afraid of being bitten by ferocious dogs but the vet is in charge and has to know what to do, to resolve the problem satisfactorily and safely. The dog was groomed without problem. "Don't bathe the dog?" Min asked me when I phoned at 8.30 pm. I said: "You must bathe the dog in warm water. His backside is dirty from the diarrhoea stools," I said. The dog could now be muzzled and bathe.

I still remember when I was a young vet. I muzzled a dog for vaccination when a pet shop operator brought it in. Later, I got a feedback from a client that this pet shop operator was bad-mouthing me and telling others behind my back: "Dr Sing is afraid of dogs! He muzzles dogs for vaccination."

I don't muzzle every dog for vaccination and in fact, seldom does it. Biting Pomeranians are muzzled as there was no point getting my fingers bitten by sharp canine tooth as I need my fingers for surgery.

But this pet shop operator expects vets to be bite-proof and to have hidden powers to soothe all ferocious beasts! Dog bites are the risk of veterinary science but it does not mean that the staff must be bitten at any time. Workplace safety is very important and it is the responsibility of the vet to ensure that the staff is safe from bites and scratches from dogs and eats. And even from a dwarf hamster!

Monday, August 29, 2011

572. PDS 2/0 has not dissolved by 3 weeks after neuter

My neighbour whose poodle was neutered by Dr Vanessa some 3 weeks ago asked me for help yesterday, Sunday, Aug 28, 2011 as he and his wife burned incense and papers to mark the end of the Hungry Ghost Festival.

The dog had 2 undescended testicles removed 3 weeks ago. The PDS stitches - 3 simple interrupted were still present on the right skin. No inflammation. I pulled them up and cut the knot. On tghe left side, some swelling and bleeding. Stitch inflammation and a reddish brown fluid spilled out. I squeezed out the blood and cut off the embedded stitch. Should be OK for the poodle. No need to wear the e-collar.

This is one case study to show that the PDS 2/0 absorbable stitches can hold on for at least 3 weeks. Two weeks to stitch removal usually but with most dogs and cats I sterilised, they don't need to come back for stitch removal as they do dissolve with time. Probably at the 4th week after surgery.

571. Bitten by a dog, a cat and now a dwarf hamster!

I am responsible for work place safety. So, I have had coached my assistant Min how to observe cat, and dog behaviour. He got bitten by a dog attended by Dr Teo, on his palms sometime ago and I had to bring him to see the doctor. The cat under Dr Vanessa bit his thumb which needed a doctor to stitch. Then on Aug 26, 2011, I asked him to wear cotteon glove to restrain a dwarf hamster, male, 11 months, 92 g.

The hamster was very itchy all over its elbows and hind limbs. Red rashes. The inguinal area was bald. Two bare patches of 0.3 cm x 0.3 cm on both backside of the end of the tail as if he had chewed on them.

1. Anal sacculitis? Licking of both backside and groin area. I tried to squeeze the anal sac. It was impossible. The hamster struggled and turned. Bits of brocolli flowers spilled out from his pouch. The younger lady was stressed out as she fidgeted. So I stopped.

2. I diluted pred 0.01 ml with 0.1 ml of saline in a one-ml syringe. Asked Min to hold the hamster's head area with his gloved hand. "He does not bite, " the older lady wanted to hold him, confident. But it is not wise to ask her to do it while I inject the skin above the rump on both sides. A little on either side.

Suddenly Min shrieked and withdrew his hand as I injected. "The hamster bites me!" he said. So, that's how he got bitten by a dwarf hamster under my care. So, 3 vets' animal patients bit this vet assistant.

I showed Min again how to hold the hamster's head while I injected SC.


August 28, 2011 Monday
I phoned the owner. "The hamster no longer bites his elbows after the injection," she said. "The next day he was back to normal."

She had switched to a different brand of bedding (paper cotton roll type) as the previous b rand was hard to find. Was this the cause? Or was the hamster too fat and had difficulty climbing up the wheel? "He seldom exercises on the wheel," the young lady said. "He eats only 3 sunflower seeds and I don't know why he is so chubby!" 92 g is a lot of weight for a dwarf hamster. "He has no sand and his ears are not itchy," she confirmed.

So what was the cause of this itchiness? Bedding? The hamster is on 14 days of pred and antibiotics. The owner may be able to source the old brand.

"Self stimulation on the groin area leading to a shiny bald groin?" I enquired. The owner did not know. The whole hind limb was bald and itchy, two backsides were bald. The hamster lives alone. Food allergy perhaps? Same hamster food, the owner disagreed. To the owner, the same food but it is not the same composition or sources of seeds and pellets. One of the components could cause allergies. It is hard to explain to the owner.

So, it is a mystery as to the cause of this intense itchiness causing the hamster to scratch non-stop. As for my assistant, he is much more alert and careful. His thumb is still bandaged after 3 weeks from the cat bite. The hamster's bite was nothing. A pin prick.

Sunday, August 28, 2011

570. Sunday's interesting case - Two emaciated adult dogs

"When you consult 10 vets, you will get 10 different opinions in most cases," I said to the mother and daughter who consulted me on this fine Sunday morning, August 28, 2011. The daughter said the internet recommended me. My surgery was relatively far away for them. "The first vet said she would cut away the "three" mouth growths," the daughter said angrily. "She cut one and sent it to the laboratory. The report said it was not a cancerous growth. So she told me to apply the cream onto the growths in the mouth as they were infections. She said the growths would then disappear."

Well, I had no comment. The histopathological report did not confirm that the growth was cancerous or not.

But the "three" oral tumours have grown much bigger. So they consulted Vet 2 nearby their home. But Vet 2 did not care to excise the growths and so the internet lead them to me on this fine Sunday morning when I was interviewing a fair young lady graduate with first class honours in an Australian University. She wanted to volunteer on weekend to see practice to know whether she would like to study veterinary science.

"These oral tumours are likely to be cancerous," I stated on the fact that the growths grew fast over the last 3 months and the spread to the submandibular lymph nodes and down to the nearby ones.

"Feel this thick cord of 8 cm x 3 cm x 2 cm on either side of the neck from the submandibular lymph nodes," I asked the daughter and mother to place their thumb and forefinger onto the cord. "These are likely to be spread of the cancerous cells from the mouth to the lymph nodes."

"What do you advise about the mouth tumours? Vet 1 should have removed them as promised." the daughter was quite unhappy as the tumours had metastasized and she had already spent $2,000.

I said: "Each vet has his or her own way of handling a case of mouth tumours. Vet schools may teach the vet to do a biopsy first. If the lab results find that the growths are not cancerous, then the owner is informed as to the next step. By then, some cancerous ones will have grown much bigger due to the delay.

"Unfortunately, tumours don't disappear even if they are not cancerous. In practice, it is best to cut them off when they are small. They interfere with the dog eating, being painful and ulcerated. And smelly. However anaesthesia in old dogs is highly risky and the dog may just die on the operating table. So the vet may not want to operate as deaths of dogs under his or her care badly damage his or her reputation."

The daughter asked: "What are the chances of survival?"

I said: "I estimated around 40% as your dog is emaciated. All skin and bones now. You can see the spine protruding."

The daughter said: "My dog eats a lot and will even eat the other dog's food. The vets don't believe when I say that."

"It is hard to believe. Any dog or person that eats a lot will put on weight. What do you feed?"

"Brown rice and potatoes," she said. "The vet advised against dry dog food as she has skin problems. Her foot pads are licked red and so the vet thinks that my dog is allergic to dry dog food."

This is surprisingly the second emaciated dog I was presented on this fine Sunday morning. I had just hospitalised an emaciated poodle who had a painful mouth and screamed when I touched the mouth. Blood tests were taken to find out why. The lady owner had another dog with urinary stones. So no dry dog food for that dog. And similarly for this poodle. Skin and bones and protruding spines.

Back to the old Shih Tzu. What to do?
"Do you advise euthanasia?" the daughter asked me since I said that the Shih Tzu was at the end of his life-span of 10 years. Healthy ones may live up to 15 years but they usually live to 10-15 years in Singapore.

"The decision to euthanase is up to the owner," I advised. In advising euthanasia, some owners deem the vet to be a good for nothing. Only know how to advise euthanasia.

I said: "In many cases, it is a matter of economics too. These tumours can be cut off by electro-surgery. You may buy some time for the old dog."

"How long?"

"If they are cancerous, the tumours will recur around 2 months."

"What to do then?"

"It is best you and your mum take 3 or 4 days to think what to do," I said. "If surgery is your option, I will operate but you know the chances of survival are around 40% and I have not done any blood test to know the dog's health, to save some money, since you had spent $2000 at the other vets."

"How much is the surgery?"
"I can only estimate. Around $500 - $1,000"
"My dog barks at me when I tell him that he will be put to sleep," the daughter said. "So, I do not want to do it."

The owners went home to feed the dog on a good diet for the next 3-4 days, multivitamins and antibiotics. Surgery will be scheduled on Thursday morning at 10 am if she wants surgery. This is the type of high-risk surgery where fools go in where angels feel to tread. But is there any other choices? Chemotherapy will not work and I don't want the owners to get false hopes. Neither will surgery if there is recurrence. But there is no other choice. It was Hobson's choice.















Saturday, August 27, 2011

569. Playpen and crate with pee pan pictures wanted

E-MAIL TO DR SING DATED AUG 25, 2011

from ...@gmail.com
to judy@toapayohvets.com
date Thu, Aug 25, 2011 at 5:48 PM
subject playpen for dogs

Hi

can u recommend one for my 5 mth old chinese crested puppy?

E-MAIL REPLY FROM DR SING DATED SUNDAY AUG 25, 2011

I am Dr Sing from Toa Payoh Vets. Thank you for your email. Your Chinese Crested Puppy can be housed in a crate with a grate and pee pan below or in a playpen with 4 panels of fencing. Much depends on your wish, economics and available space inside your residence. If there is space, 3 feet long x 3 feet wide will be all right. All these are available at pet shops in Singapore.


E-MAIL TO DR SING DATED AUG 27, 2011

On Sat, Aug 27, 2011 at 5:52 PM, ...@gmail.com> wrote:

Hi
Can u forward me a picture of the crate with grate n playpen with 4 fencings?
Thanks


E-MAIL REPLY FROM DR SING DATED SUNDAY AUG 28, 2011
Some pictures are at:

http://www.toapayohvets.com/sinpets/050620play_pen_toilet_training.htm


To save you time, the relevant pictures are at:

To save you time, the two relevant pictures are at:

http://www.toapayohvets.com/images/dogpix/050218AAplay_pen.jpg



http://www.sinpets.com/dogpix/20070806rubber_mat_toilet_ToaPayohVets.jpg

Pl let me know if you need some clarification.

THE FOLLOWING ARE THE TWO RELEVANT PICTURES:



568. Surgery Audit. How long it takes to spay a female dog? 18 minutes

I don't know whether the Vet Schools teaches surgery audit nowadays but they did not do that in the 1970s when I studied in Glasgow University.

A surgery audit is important as it improves the surgical and anaesthetic processes, productivity and efficiency of the veterinary surgeon. A vet who takes a long time to spay a female dog uses up more than necessary anaesthetic gas and exposes the dog to a longer risk of anaesthetic deaths.

So, I will be doing a surgery audit of the time taken by a vet to spay a female dog at Toa Payoh Vets. To do that, I have to research on how long it takes me to spay a female dog. I have recorded two cases done earlier. The details are at:
http://www.sinpets.com/F5/20110816domitor-ketamine-spay-fox-terrier-26minutes_ToaPayohVets.htm

In the two cases, the time between the first skin incision and skin stitched up was 18 and 26 minutes respectively.

Now, in this case of the Shih Tzu I am reporting, the time was 18 minutes as shown in the images below.







Time of first skin incision to time the skin is stitched up = 18 minutes

CONCLUSION
If the female dog is in surgical anaesthesia without the need to top up, the time taken will be 18 minutes based on 2 female dogs I had spayed. When the dog wakes up in the middle of surgery and needs top up isoflurane gas + oxygen, the time taken will be much longer, e.g. 26 minutes as illustrated in my first report. Without topping up, the surgery time is shortened by as much as 8 minutes!

From the cases, the objective is to ensure that the dog is given isoflurane gas + oxygen as maintenance, rather than use IV anaesthesia of lowered dosage as in the case that took 26 minutes. For my female dog spays in the last 30 years of practice, I have had not used IV anaesthesia as I believe my procedure should be the best and safest. During the last 2 years, I change my mindset and use IV anaesthesia in spaying female dogs as part of continuing education.
18 minutes will be the target for experienced vets doing spay in Toa Payoh Vets. It is a standard to aim for as the shorter the anaesthesia, the safer it is for the dog, especially the older ones.

For cats and with the appropriate dosage, the surgery to spay can be completed as fast as 5 minutes as the cat is much smaller and generally, it is easier to hook out the ovary. However, I need to properly record and document that it is 5 minutes sometime later.
Shih Tzu I am reporting, the time was 18 minutes as shown in the images below.






Friday, August 26, 2011

567. Cardiac Tamponade - pericardiocentesis for an 8-year-old Lab Retriever - Part 1

"You are one of the two vets I know," the Labrador Retriever owner had fixed a 10 am appointment to consult me. "Vet 1 had taken an X-ray of the abdomen and said there was nothing wrong in the stomach and intestines. He had prescribed antibiotics and pannadol for the skin infections in the swollen skin under the chin.

"That was around 2 weeks ago. But my dog is very tired and the skin swelling is still there.

"Look," the owner pointed to the skin puffing out from the side of the two mandibles. "The right side of the chin is even more swollen. See the right front paw. It is swollen compared to the left paw!"

I could see that both front paws are 20% more swollen than both hind paws. The male Labrador Retriever also had loose flabby skin hanging out from the right and left side of the jaws, such as you would see in people with double chins.

In August 2011, there are three vets at Toa Payoh Vets and owners have a choice of who to consult. I have not retired but it is time to hand over to the younger generation and Dr Vanessa would be on duty from 11 am to around 7 pm usually on weekdays. I would usually be around from 9.30 am to 12noon and at other times agreed upon by the owner who wanted to consult me.

This was no more a skin infection at first presentation. Somehow, this dog's condition reminded me of a cow presented by my professors in 1974 when I was in the final year of vet studies in Glasgow University. It was a case of mediasternal tumour. Blood flow to the heart was obstructed and skin swelling or subcutaneous oedema in the side of the face appeared. Could this be a rare case of mediasternal tumour in an older dog?

It was 1974 and now it is 2011. But certain interesting rare cases are never forgotten by me. "Have you seen such presentation of swollen folds in cattle in Myanmar?" I asked my assistant Mr Min and his friend Tun who are qualified vets from Myanmar. "It was a case of medisternal tumour in a cow I had seen when I was in Vet School." They shook their heads and probably didn't know what I was talking about. Mediasternal? What the hell is it? Where's the mediasternum and what is it?

"This dog would be suffering from diseases affecting one of the 3 organs," I said gravely. "It could be the heart, liver or kidney. More tests would be needed. Are you OK with having tests like ultrasound, X-ray and blood and urine tests done?"

I asked for permission as the tests could cost the owner a bit of money.

The lady owner showed me a piece of the laboratory test: "Vet 1's blood test said there was no liver and kidney problem. I would like to know what's wrong with my dog. He is still young. Only 56 years old in human age. But he has lost a lot of weight. I had also reduced his food intake tought. However, he is breathing faster than normal. Not his usual active self!"

The Labrador preferred to sit on his chest rather than stand up on the consultation room floor. Occasionally he wagged his tail. I could see his chest movements of over 90/minute which is faster than normal and coached my assistant how to take the respiratory rate/minute based on number of respirations per 6 seconds x 10. This case is part of a teaching case as it is a rare medical condition presenting as skin swellings in the face, front limbs and penile skin. I coached my assistant how to take the pulse rate. The pulse was barely palpable and of poor quality.

After the general observation, I got the dog to be put onto the consultation table and did the routine checks. Significantly, the heart sounds was barely audible. "Give me another stethoscope," I said to Min who handed me another stethoscope.

I asked Min: "How come the Littman stethoscope was broken? And who broke it?" Min was silent.

One new auroscope's cover was cracked. The electro-surgical handle insulating the hand from electric shock had disappeared. The new Shoreline operating table of less than one year and costing me around $7,000 was scratched in several places. I had to replace a new isoflurane vaporiser. This time, I would have to do a surgical audit of instruments as such damages should not happen. A heavy hand?

566. Do you love your hamster, warts and all?

How to educate hamster owners that they should get the vet to excise the hamster's warts when they are very small? When the warts are small, they don't bleed profusely. Big warts command a large blood supply and as you can see in this case, with images presented, the bleeding was a lot in the wart excised from the hind limb.








Unlike dogs and cats, it was practically not possible to ligate the bleeder since the blood vessels were not visible. The good news is that this hamster survived the operation.

If you love your hamster, get her warts removed by your vet early.

MORE IMAGES OF THE ELECTRO-SURGERY ARE AT:
http://www.sinpets.com/F5/201108028electro-surgery-excise-hamster-warts-singapore_ToaPayohVets.htm

565. How to win the heart of someone?

A tip for the single readers who may wish to win the hearts of someone.

1. Buy a good camera that can focus well and fast.
2. Teach yourself how to take good digital pictures by reading the numerous photo magazines at the National Library branches.
3. Practise and practise taking street photography.
4. Sunlight is very important, in my opinion as it brings out the shine.
5. Then look for a song with appropriate lyrics to accompany the photo.
6. Present the photo to the person to win his or her heart.
7. Any chance of success? If you create good pictures, you may win his or her heart when you email the picture with the appropriate love song.

If you can sing like Lionel Richie, then no need photos!

After so much writing, I am giving an example as shown below:

1. Song - "Hello" by Lionel Richie
From You Tube:

http://www.youtube.com/watch?v=PDZcqBgCS74

http://www.youtube.com/watch?v=62XB9IbMnxQ&feature=related

2. Photo - "Sunlight in your hair" from the lyrics of Lionel Richie's song.


564. E-mail inquiry about finding a mate for a female poodle

E-MAIL TO DR SING

On Thu, Aug 25, 2011 at 3:50 PM, ...@gmail.com> wrote:

Hi,

I am planning to breed my female toy poodle. However yet to find a mate for her. Can you provide me more sources to read up on home breeding ( e.g. Related books) and where should I look for a suitable mate for my dog.

Hope to hear from u soon.

Thanks,
Name of lady owner


E-MAIL REPLY FROM DR SING
I am Dr Sing from Toa Payoh Vets. In reply, there are many dog books and magazines in the National Library branches in Singapore for you to read. It is difficult to find a mate for your dog as few Singaporean male poodle owners are interested in breeding.

You may be able to find one at Pasir Ris Farmway 1 breeder farms if you ask around as some do provide stud services for a fee. Or some pet shops. Your vet may be able to help. The Singapore Kennel Club may have poodle owners who may be interested.

563. E-mail recommendations of a play pen for a Chinese Crested puppy

E-MAIL TO DR SING
On Thu, Aug 25, 2011 at 5:48 PM, ...@gmail.com> wrote:

Hi
can u recommend one for my 5 mth old chinese crested puppy?
thanks.


E-MAIL REPLY FROM DR SING
I am Dr Sing from Toa Payoh Vets. Thank you for your email. Your Chinese Crested Puppy can be housed in a crate with a grate and pee pan below or in a playpen with 4 panels of fencing. Much depends on your wish, economics and available space inside your residence. If there is space, 3 feet long x 3 feet wide will be all right. All these are available at pet shops in Singapore.


Thursday, August 25, 2011

562. A Tourist Under Suspicion - Part 3

Incredible Travel Stories:
A Tourist Under Suspicion - Part 3

Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
7.23 am, August 26, 2011, Singapore

Continued from Part 2.

"Perhaps, 'black-marked' is not the correct word," I replied. "If I accept your offer not to enter Hong Kong and go to Macau directly, the Hong Kong Immigration Office will stamp my passport with a secret code letting all other countries' Immigration Officers know that I have been denied entry into Hong Kong today. Maybe the correct word is 'blacklisted."

The MIO had said that he would chop my passport "Transit in Hong Kong" on the way to Macau and that would show that I had not been denied entry into Hong Kong on August 20, 2011. I had been classified as a tourist under suspicion. Either I accept his offer to go direct to Macau transiting Hong Kong or be sent home on the next plane.

In reply, the MIO said: "If I want to let other immigration officers know that you are blacklisted by us, the information will not be inside your chop "Transit in Hong Kong. It is done another way."

I guessed it would be some codes encrypted inside the passport and understood only by Immigration Officers.

"In 1988, I was a member of the Singapore Turf Club's task force invited by the Royal Hong Kong Jockey Club. There was no problem."

The MIO said: "Hong Kong is no longer under the British rule. Since 1997, Hong Kong is the special administrative region (SAR)of the People's Republic of China."

I knew about SAR but kept quiet. Well, I had no friends in Hong Kong as referees and had not visited Hong Kong for the past 23 years. So I used the only reference I had. But the name of the Racing Clubs cut no ice with the MIO.

The MIO said: "If you go to Macau from the Hong Kong International Airport, there is a direct link and you need not step into Hong Kong. Then I need not send you back to Singapore on the next plane. I consider it a hostile and unfriendly act."

"What have I done wrong to be a national threat to the security of Hong Kong?" I asked as if discussing the prognosis of my canine patient suffering from cardiac tamponade. The prognosis would be poor and I would ask the dog owner to spend the last few days with her old dog.

The MIO said: "You have not done anything wrong. However I am not allowed to let you know the reason."

So, here I was. Two and a half hours had passed. My last few minutes inside Hong Kong. No more second chances of visiting Hong Kong again if I accepted this offer. There were more implicatons than just being banned from Hong Kong.

"If Hong Kong bans me as a threat to its national interest, I will also be banned from entering Macau since Macau is also part of China," I believed that both share the same blacklists of tourists under suspicions since Macau is also part of China, being one of the two special administrative regions under the one-government two-systems policy of China.

"No," the MIO said. "Macau has its own information system as to who to prohibit from entering Macau."

I did not ask him how he was so sure that I would also not be welcome in Macau since both SARS have their independent system? Don't they share a blacklist of undesired person? That would be logical since both are part of China. I might also detained for a 3-hour questioning and Macau would do the dirty work for Hong Kong Immigration Office by sending me back on the next plane.

I said: "China will also ban me since Hong Kong has me on the blacklist."

The MIO said: "I see that you had visited China and had no problems."

I did not retort that it was some 2 years ago so as not to offend the MIO.

"Does it mean that I will not be able to visit Hong Kong forever?" I asked.

"Not necessarily. Things may change with time."

"I am 60 years," I said. "I don't have time on my side." Besides, I don't realistically see any changes for the better for me once I accept his offer not to step into Hong Kong now.

"I am suggesting that you go to Macau as sending you back on the next available plane is a hostile act. I don't want to commit an unfriendly act. You can spend your next four days visiting Macau."

I said: "My main purpose was to visit Hong Kong. To see the changes since 23 years ago. Macau is just a side trip as I have never travelled to Macau before."

"What do you want to do in Hong Kong?" the MIO asked.
"To see Times Square," I said off my head.
"You come to Hong Kong to see Times Square?" the MIO rolled his eyes in surprise. I guessed I had provided an incorrect answer.















Wednesday, August 24, 2011

Never discharge a spayed dog with a "hole" home

I was in Hong Kong when I received a phone call from an owner who said that his dog still had a "hole" some 10 days after spaying by Vet 1. "I thought all vets will not discharge a dog when she has a wound that does not heal," he said from Singapore, rather annoyed.

As I was not in Singapore, I told him that I would check the dog out. In the meantime, I asked Dr Vanessa to examine the dog and get the infected surgical wound re-stitched. It was not her case. I had to make sure that I communicate with the owner and that she would do so as the owner was very upset.

I made a phone call to Khin Khin to ensure that she contacted the owner on my behalf and to ask him to bring the dog to Toa Payoh Vets for treatment. It was a Sunday and I felt that it was not Dr Vanessa's job to phone the owner and therefore I phoned Khin Khin. She did that. When the dog was re-stitched, I ensured that Khin Khin phoned the owner to let him know too.


Post-operation wound infections do occur to every vet. It is important that the vet check the dog carefully and not discharge the dog if the spay wound is infected.

On Wednesday, Aug 24, 2011, I was back at Toa Payoh Vets. The dog was OK. Dr Vanessa had stitched up the dog. The wound was clean. No inflammation. I phoned the owner to update him. He was quite happy that everything was OK. Many unhappiness and complaints and litigation can be avoided with good updated communications. This dog was not spayed by me. However, it can be quite time-consuming in answering to complaints from authorities and lawyers even if I am not involved. I will still have to be a witness and write reports. So, I normally handled such post-op complications of other vets with as much care as if they were my complications. A happy owner will seldom bad-mouth a practice.

The important thing is to keep spaying simple. No fanciful subcuticular sutures. But each young vet has his or her own ideas. In this case, there wasubcuticular sutures which could have had hindered healing of the skin incision or introduced infection. I don't know as I did not see the "hole" but I had asked Dr Vanessa to take some pictures. As every vet will encounter post-op complications and infections, it is best to keep skin suturing simple. I use horizontal mattress.

I note that Dr Vanessa has her own appositional stitching as she has her own success with them and experiences. Both type of stitching pattern will work. Some dogs just can't stand the stitching or they could be allergic to them. Not all dogs but a small percentage and subcuticular sutures would be very intensely itchy.

Even with e-collars. The spayed dog could just rub her tummy directly onto the floor, the mat and get the wound opened up. Hence the complaint of the "hole"


Syrian hamsters can be housed together without fighting

According to the pet shop girl I wrote about earlier, she said Syrian hamsters live harmoniously and therefore new batches can be housed together with older ones. Not for dwarf hamsters.

559. Bald backside neutered dwarf hamster - due to dominant male

August 22, 2011. I was in Hong Kong. A phone call from a gentleman who asked me whether he should buy the cream from the pet shop. "No problem with the dwarf hamster you neutered some time ago," he had still housed the neutered one with the dominant male to keep each other company.

"It is usually due to the neutered hamster being mounted by the dominant male," I said. "Creams will not be of any use. Separate for two weeks and the hair should grow back."

Usually such bald backside hamsters are the ones housed together. In this case, the dominant male must have disturbed the neutered one many times. Pet shops in Singapore do sell cream for any hamster hair loss or tumours. It is part of their marketing.

I was in Hong Kong restaurant eating dinner in a spacious Chinese restaurant called Foo Lum (Auto Plaza) near The Royal Garden, Tsim Sha Shui. Excellent steamed small lobster with noodle + cheese or without cheese at HK$138 or S$20. Good roast goose.

At least 3 waitresses were selling the restaurant made moon-cakes to me. 100% made in Hong Kong, not from China. Bought one box. As Sing dollar is high, it seems that the moon-cake with double yolk ling yong with plastic spoon, knife and fork and metallic box of lotus flower is really much cheaper than in Singapore! I am debating whether to give this box to a friend or not since I bought only one box.

All the sea food and moon cakes can be quite addictive and high cholesterol- need self-restraint if one does not want a heart attack.

558. Pied roborovski hamsters

"Not for sale," the pet shop girl said to me as she had a sign on the cage of two dwarf hamsters. I thought every hamster should be sold as this was a pet shop.

"These are for creating awareness of this rare-coloured dwarf hamsters. They are pied hamsters."

Size between dwarf and roborovski hamsters. Sells at $90/pair. Still she had insufficient stock to meet demand. Originated from Holland. Colour - light brown and white. Hard to breed, like Roborovski. So, she kept a pair. The following is from this pet shop girl who has hands-on experience in breeding hamsters, purchase and network with breeders

INFORMATION ON DWARF HAMSTERS IN SINGAPORE
1. Hard to breed - Roborovski and pied dwarf hamsters. According to the pet shop girl, roborovski sprints so fast, therefore, hard to breed. "Why not cool them down with air-conditioning?" I asked. Not practical as the cost would be higher. She had not tried.

2. Maturity. 2-3 months of age, NOT 5 weeks as in hamster books (usually written by Caucasian authors). Syrians - usually 7-8 weeks. Usually 3-4 months in Singapore. Depends on diet - a high protein-based diet (extra oats, alfalfa and vitamins).

3. Gestation. 3 weeks usually. If >3 weeks, dead.
4. Pregnancy. Abdominal bulge. Behaviour - aggressive when usually docile, restless.
5. Demand - Syrian hamsters not in great demand in Singapore. Grows up fast. Lots of stools to clear. Not worth stocking up. Therefore, not selling Syrian hamsters. Main demand from Singaporeans is dwarf hamsters.

Monday, August 22, 2011

557. A Tourist Under Suspcion - Part 2

Incredible Travel Stories:
A Tourist Under Suspicion - Part 2

Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
August 20, 2011, Room 1231, 5 am
The Royal Garden, Hong Kong


The MIO was a gentleman looked to be in his 40s and has an air of confidence and experience in catching crooks, I guessed since he was more senior in rank than the previous officer. I was a lieutenant in the National Service in Singapore Armed Forces' Provost Unit Dog Company some 30 years ago and his two piques would be equivalent to the rank of lieutenant in the Singapore Armed Forces.

He offered me the use of the bathroom at the far end of the room or drinking water in the office. The cups were a cone made of paper with no fanciful trimmings unlike the more expensive ones in Singapore's office. They were the paper equivalent of ice-cream cones and that was good for it meant less trees would be chopped down unlike those fanciful cups.

I thanked him for the kind offer and sat down in the same room to be interrogated. I enquired politely as to why I was detained. "You are not detained, you are being interviewed," he replied courteously. "If you are detained, you will not be in this office." I imagined I would be in a dungeon underground and hand-cuffed going there since I had never encountered an Immigration interview in my 60 years of living.

In any case, I was about to be sent packing to the airport on a one-way ticket to Singapore without even eating the delicious tim sum and sea food of Hongkong after 18 years of absence. The power is always in the hand of the Immigration Officer on the ground. Of course, Hong Kong is a civilised and most developed country, not a banana republic and a mad and angry tourist under suspicion can be got rid off without reasons being given.

In any case, I was not angry. Each country has a right to deny visits from foreigners. The world is never fair. I just did not want to spend 4 days and 3 nights sight-seeing in Macau as a substitute to visit the fastest growing capitalistic one-China-government-two-administrative-systems. I just wanted to re-visit the old places I went to when I was marketing Orlando,Florida properties in Hong Kong some 20 years ago. Wanchai, Times Square, Hong Kong Convention and Exhibition Centre, see the trams and see the ordinary Hong Kong people.

Yet the MIO thought otherwise. No friends in Hongkong. No visits since 1988. Unusual for a Singaporean. A tourist under suspicion. But what was so serious that I would be denied entry into Hong Kong?

"You have not committed a crime," the MIO told me when I suggested that the squad who black-marked me interview me. Why not? They have the fish in the net now.

"It is not that simple," the MIO explained. "In any case, what do you mean by 'black-marked'?"

556. Travel Stories: A Tourist Under Suspicion - Part 1

Incredible Travel Stories:
A Tourist Under Suspicion - Part 1

Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
August 20, 2011, Room 1231, 5 am
The Royal Garden, Hong Kong

"I offer you a way out. You go to Macau direct from the Airport and spend your time in Macau," the female Immigration Officer (FMO) said to me after an interview and logging onto her office computer to check out my background at www.toapayohvets.com. If I did not accept her offer, I would be sent back to Singapore on the next plane. If I accepted her offer, my passport would show a stamp "transit" in Hong Kong. In this way, there would be no record of me having been denied an entry to enter Hong Kong.

On August 19, 2011, I had arrived in Hong Kong at 5.45 a.m, from Singapore, flying Cathay Pacific. The Immigration Counter Officer took longer than usual to check me out on his computer. Then he wrote on a white slip of paper with the heading "Restricted." A young thin Immigration man who was directing passengers to the various Immigration Counter then detained me.

I went with him into a room as he waited for the Immigration Counter Officer to return back to him. I noted a change of shift work as another new Immigration Counter Officer, together with others, entered the booths with their silver boxes and chops. So, the original officer who stopped me from leaving the Immigration Area had gone home.

The young Officer consulted another officer. Then he led me to a big room which had white walls, working desks, computers, around 8 rows of blue chairs and closed circuit TV. A lady officer had unlocked this room, switched on the lights and asked me to wait. After some half an hour, the FMO whom I mentioned in my first paragraph interviewed me and made the offer I should not refuse.

She was a young serious woman in her 30s. "It is a random check on passengers," she had said earlier as she asked and scribbled on a piece of table, information about me, my family, my brother and sisters, my purpose in coming to Hong Kong, the amount of money I had, my credit card. I said I had no friend in Hong Kong as I was not much of a net worker and that probably was against me. Then she offered me the above-mentioned proposal not to enter Hong Kong for national security reasons.
"Why am I not allowed to enter Hong Kong?" I asked. This was the first time I had been rejected from entering a country.

"It is for Immigration reasons I am not permitted to tell you," she said.
|
"Did somebody commit a cheating scam in my name?" I asked. I deduced that I was not a criminal since she did not throw me into the cells. In any case, my life is that of an ordinary Singaporean.
|
"No," she said. "I am not permitted to tell you. If you go to Macau straight from the Airport, your passport will be stamped "transit" and there will be no record of you being denied entry to Hong Kong and sent back to Singapore (by the next available plane).

"If I accept your officer, it means that I have had done something wrong. Your immigration records will tell that I have had been denied entry into Hong Kong."

"No," she said. "It will show that you have transited via Hong Kong Airport to go to Macau."

"I don't know how the Immigration works," I said. "How can I trust the Immigration system? Surely, it will record that I was denied entry to Hong Kong and that I then agree to go to Macau, avoiding the prospect of being sent back to Singapore on the next plane." This would be the way all bureaucrats would work. I was a bureaucrat once.

I continued in a cordial tone: "How can I trust that the Hong Kong Immigration would just forget about the fact that I was detained and interrogated for around an hour and just record that I transited via Hong Kong to visit Macau? My travel plans were to visit Hong Kong 2 nights and Macau 1 night. Now, you advise me to visit Macau for the whole duration."

The FMO was silent. She was always polite. It was a very strange first encounter in my 60 years of living. I seldom tour countries as I built up a practice on my own and raised a family and paid mortgage. It was 18 years ago since I last visited Hong Kong and here, I was a suspect, in my opinion. A dangerous man. Well, we have "dangerous dogs" under the Singapore's veterinary regulations. So why not "dangerous tourist" under the Immigration regulations.

It is the prerogative of any government not to permit foreigners to enter the country. But there is more than meets the eye. So, I said: "This is Hong Kong, not a undeveloped country where government officials can do what they like.

The FMO offered the same proposal again as she apologised that she could not reveal the reason I was rejected.

I said as if discussing a dog's clinical case to the dog owner: "Your poster on your wall has stated a value - Integrity and Impartiality. Yet I am asked to leave Hong Kong without being given a reason (as to why I was discriminated)."

The FMO repeated patiently as a teacher would do to a dullard: "It is in the national interest of Hong Kong. I am not permitted to tell you more than that."

I said: "If I accept your offer, the Singapore Government will be after me when I return to Singapore. I will be investigated as to why I accepted your offer not to land in Hong Kong. The Singapore Government officer would ask me: "If you had not committed any offence, why did you accept the Hong Kong offer? And I will have no answers."

"Wait," she went to consult another officer in an office to the left of the main door entrance. An older slim woman in blue uniform. Some 60 minutes had already passed. Julia phoned me at the bag collection counter as she had no problem entering Hong Kong: "Where are you?"

I said tersely, "The Immigration Officer stopped me and is interviewing me." I did not want to talk too much. "For security reasons, a video recording is in progress" notice has been tacked to the notice board in this office. A few strategically place big blue glassed "eyes" were spying on anyone in the room. I presume there would be somebody in the CCTV(closed-circuit television) room monitoring my action and speech.

Was I a suspected terrorist? That was what my first thought was. I was not permitted to enter Hong Kong as that would be against the national interest. A drug dealer? A Triad or Mafia boss with a veterinary practice in Singapore as a front? A big-time money launderer flying Cathay Pacific economy class to throw off the scent of the government hounds?

After some time, a male Immigration Officer (MIO) wearing a white shirt with epaulettes showing two stars and in blue trousers arrived and cordially invited me to an interview in the same room and asked me more questions as well as the previous ones as he wrote the answers on a piece of paper: "Where do you wish to visit when you come to Hong Kong?" he asked.

"Times Square," I said, off the cuff, truthfully.

"Times Square," he asked incredulously. I wondered why.

"Well, I would like to visit Times Square which I went in 1988," I just could not figure out why Times Square was not on his list of tourist attraction to Singaporeans. "To see the changes after 18 years. I would also be going shopping."


Thursday, August 18, 2011

Do you love your hamster, warts and all?

It can get very boring viewing hamster images unless you are a hamster lover. How to educate a hamster owner with a good message? I have thought of one today as follows:


It does not have any impact unless the reader views the other images before this one.
This is the first image.





I have not written a full report of the surgery yet, but you can see the other images at www.toapayohvets.com for this period of time.

554. Events happen in twos?

August 18, 2011. Thursday

I had written about events/things of similar themes happening in threes. But yesterday, the following events happen in twos.

1. A couple (a newly married man and wife) came with a male Shetland puppy for vaccination which was due on August 18, 2011. A new client.

2. The husband had two wounds on his left leg. One penetrating wound below the knee and one big red skin abrasion further down. He was limping and I advised him to see a skin specialist as his wound was still discharging fluid. I suspect some foreign bodies deep inside when he fell from his bike onto some stones in Bali. In Bali, the doctor poured some alcohol and that was 8 days ago.

3. The husband called an NTUC cab via his mobile phone. The first yellow cab whizzed by the Surgery. When he limped out, the cab driver had disappeared round the corner. So, NTUC gave him another cab. I went outside the Surgery with him to stop this 2nd cab. From afar, actually one block away, I saw the blue cab coming. It did not bother to approach further and turned left at the end of my block. So two taxis failed him. "Let me call a cab for you," I said. I noticed that he had spent some 30 minutes and was not in good standing (being lame) and must be suffering.

I used my Surgery fax phone to get the NTUC cab for him. "You better retire your husband and come out," I said to the wife who handed the Sheltie to him. "He is kind of slow." We stopped the blue Sonata cab and they went home.

4. Soon a man came with a female Sheltie pup for vaccination. "The brother of this pup just came," I said. "How do you know?" he asked. He is one of those knowledgeable puppy owners. He had phoned for an early morning appointment to vaccinate his pup just in case parvoviruses or any disease arrive from other clients' dog during the day. I said: "Same vaccination card. Same home breeder's name and breed and date for vaccination." As Dr Vanessa had arrived, usually after 11 am, I passed the case to her and attended to the counter.

I had done a health check on the first Sheltie which was purchased on August 18, 2011 and advised no vaccination till 7 days later to observe for any poor health. The couple came at 10 am and so I handled this case and that is how I encounter events happening in twos.

5. Two new clients with two Shelties from the same breeder to the same surgery. There are around 43 veterinary practices in Singapore and Shelties are rather rare in Singapore. So, what are the chances of seeing two of them in Toa Payoh Vets on the same day and in the morning? I will say, very low probability.

So is there divine intervention or just coincidence or the internet? Nobody knows.

TIPS
Don't vaccinate a puppy on the day of purchase as the puppy is stressed out by change of ownership, environment and may be incubating the deadly paroviral disease. If the vet vaccinates and the puppy really comes down with parvoviral disease, the vet gets the blame. Actually, the puppy is already infected and has not shown signs of the fatal disease yet.

The owner of the 2nd Sheltie had purchased 1 week ago. So, it was OK to vaccinate. For the lst Sheltie, no vaccination till 7 days later. Though it is not ideal, it is better to be safe than sorry.

The second owner knows much more about puppy diseases and that is why he wanted first appointment. He prefers not to go to the vet surgery to vaccinate, he told me. But then, he will need a house call and that may not be inexpensive.


553. Veterinary costs of canine breast tumour removal for an old dog

E-MAIL TO DR SING DATED AUG 19, 2011
Hi Dr Sing

I would like to find out what is the estimated cost for breast tumor surgery? My dog is currently 10 years of age. And what mode of payment do you receive?

E-MAIL FROM DR SING DATED AUG 19, 2011
Thank you for email. Cost depends on number and size of tumours as this affects the time taken for surgery

My estimated cost/large tumour (>2.5 cm in diameter), without complications, will be as follows:

1. Sedation and general anaesthesia gas for the first 30 minutes around $200.
2. Additional $100 per 30-minute block of isoflurane and oxygen gas used.
2. Surgery - excision per tumour $150 - $200
3. Suture (absorbable) used x 1 packet, IV drip, antibiotics and painkiller injections estimated $110
4. Post-op oral antibiotics, painkillers, e-collar estimated $80
5. Complete blood test $150 is advised before surgery to know the health status of your dog and the risks involved.

The total is around $600 - $800 excluding blood test.

For small tumours, the time of surgery is usually <30 minutes and the cost is usually 50% lower. For massive tumours, the cost is usually 50% higher.


Payment by cash, nets, credit card and cheque.

552. Follow up on pug with urinary stones operated twice - SD diet, no choice

At 7pm, the young lady working in the clinic who keeps only pugs as pets came for her S/D canned diet. "My pug has been taking for over 6 months, she said. "No choice. She already had two bladder operations to remove stones, the last one was under you.

"When I give home-cooked food and meat, the urine becomes cloudy and discoloured. When I give S/D, the urine colour is clear."

The pug is in excellent health.

ADVICE
1. To collect urine sample for analysis of struvite crystals and change to C/D. She will bring the pug downstairs and catch his urine. She has her own urine collection bottle.

FIRST OP AT VET 1
26 Aug 2009
Pug Male 9.3 kg 2years and 2 months, Fawn
Dribbling urine. X-ray - multiple uroliths in bladder and urethra before os penis. Cystotomy.
Hartman's IV
Induction: 0.3 ml torbuge4sic + 0.35 ml dormitor IV. Isoflurane + O2 maintenance.
Cystomy incision closed wih 4/0 PDS.
Reverse with 0.35 ml antisedan IM

Stone analysis: magnesium Ammonium Phosphate (struvite) 95%
Calcium phoosphate carbonate 5%


Jan 26, 2011
Toa Payoh Vets
Dysuria 7 days. Blood in urine.
X-ray, urine analysis



Wednesday, August 17, 2011

551. Auditing Veterinary Spays at Toa Payoh Vets - Key Performance Indicators

KEY PERFORMANCE INDICATORS FOR SPAYING A HEALTHY AND YOUNG
FEMALE DOG AT TOA PAYOH VETS

Key Performance Indicators (KPI) should also be applied to veterinary surgeries as in any other businesses to improve the performance of a practitioner, to be operationally efficient and reduce wastage of veterinary materials used. A shorter surgery means lesser risk for pets undergoing anaesthesia.

From 2011, I will be monitoring the time it takes for a vet spaying of a female dog in Toa Payoh Vets and to do that, I have had recorded two spay cases done by me in 2011.

How long does it take to spay a female dog without complications? Two cases done by me are illustrated.

CASE 1.
Fox Terrier, Female, 1 year, 9.3 kg
Last heat 3.5 months ago. Skin incision 1.5 - 2.0 cm long. Spay hook is used. No subcuticular or subcutaneous sutures as they do irritate the dog. No IV drip set up.

CASE 1. SPAYING THE YOUNG FOX TERRIER
1. Time when the dog is given Domitor + Ketamine IV*. Atropine IM (A) = 2.29pm.
2. Wait 5 minutes. Isoflurane + oxygen gas in mask. Intubate.
3. Time when the skin is incised (B) = 2.35pm.
4. Time when the skin is stitched (C) = 3.01pm.
The following key performance indicators are as follows:
C - A should be less than 35 minutes.
In this case, C-A = 32 minutes.
C - B should be less than 30 minutes.
In this case, C-B = 26 minutes.
No. of suture packets used - one packet 2/0 absorbable
No. of stitches to close the linea alba - 3 simple interrupted
No. of stitches to close the skin - 2 horizontal mattress
Skin incision 1.5 - 2.0 cm


DOMITOR + KETAMINE IV WITHOUT NEEDING ISOFLURANE + O2 IN HEALTHY YOUNG DOGS
At 10kg bodyweight, Domitor = 0.4 ml. Ketamine = 0.5 ml. Total = 0.9 ml in one syringe. Give via IV.

If the above is given at 50% of the calculated dosage, isoflurane + O2 top up for less than 60 seconds, to effect (eyeball rolls ventrally and other signs) will be needed. Intubation is needed. Atropine IM is advised before surgery. Antisedan IM after surgery may be useful to get the dog to wake up within 2 minutes.

Fox Terrier, 1 year, Spayed. Rigid limbs after giving antisedan
to wake up the dog early. Atropine was given to resolve the problem.



MORE DETAILS OF THE FOX TERRIER ANAESTHESIA CLINICAL RESEARCH ARE AT:
http://www.kongyuensing.com/folder5/20110326injectable-anaesthesia-dogs-cats-rabbits-guinea-pigs-toapayohvets.htm

CASE 2.
Shih Tzu, Female, 9 months, 5.3 kg
lst day of heat. Skin incision 1.5 - 2.0 cm long. Spay hook is used. No subcuticular or subcutaneous sutures as they do irritate the dog. IV drip is given before injection of sedatives.

1. Time when the dog is given Domitor + Ketamine IV*. Atropine IM (A) = 3.15 pm.
2. Wait 5 minutes. Isoflurane + oxygen gas in mask. Intubate.
3. Time when the skin is incised (B) = 3.23 pm.
4. Time when the skin is stitched (C) = 3.41 pm.
The following key performance indicators are as follows:
C - A should be less than 30 minutes.
In this case, C-A = 26 minutes.
C - B should be less than 20 minutes.
In this case, C-B = 18 minutes.
No. of suture packets used - one packet 2/0 absorbable
No. of stitches to close the linea alba - 3 simple interrupted
No. of stitches to close the skin - 2 horizontal mattress
Skin incision 1.5 - 2.0 cm





4411 - 4416. Spaying a dog at her first day of bleeding







How long it takes to spay a female dog?
Injection of sedative to skin stitched up
Skin incision to skin stitched up
Case 1. The Fox Terrier, 9.3 kg. Isoflurane gas top up needed. Domitor 0.2 ml + Ketamine 0.3 ml IV. Approximately 50% of the calculated dose was given. Calculated dose should be Domitor 0.37 ml + Ketamine 0.47 ml IV would not need isoflurane gas top us
32
26
Case 2. The Shih Tzu, 5.3 kg. No need isoflurane gas top up as the calculated dose is given. Domitor 0.2 ml + Ketamine 0.25 ml IV.
26
18
If there is no need to top up with isoflurane + oxygen gas, the time taken from skin incision to skin stitched can be as fast as 18 minutes since there was no time wasted in topping up the anaesthesia and the hooking out of the ovary can be successfully done within 3 hooks.

Injectable anaesthesia in the healthy dog and cat
in one syringe. Calculated dosage for healthy and young dogs and cats
Weight & Health Status
Domitor
Ketamine
10kg healthy, young female dog
0.4 ml IV
0.5 ml IV

Domitor 5-40ug/kg = 0.005mg/kg-0.04mg/kg
Ketamine 2-5mg/kg
Heart-diseased dogs - Do not use domitor + ketamine. Old dog - Use less domitor or 50% of the calculated dose. I will just use isoflurane + O2 gas solely if the dog is in poor health rather than taking risk with Domitor or Domitor + Ketamine IV.

Domitor and ketamine are synergistic and their combined use will be safer if injectable anaesthetics are required and no isoflurane gas is available. For healthy young dogs, use the calculated dosage given above. For heart-diseased dogs, use 50% of calculated dose and give isoflurane gas top up. Do NOT use domitor + ketamine is heart-diseased dogs.
I have around 30 years of small animal practice. I founded Toa Payoh Vets in 1980 and it is 2011 now. So practice makes perfect. The faster the surgery is done, the lesser the anaesthetic risk to the dog. So, I will be auditing veterinary surgery done by myself and vets at Toa Payoh Vets from 2011 onwards.


As I don't know how to lay tables properly at blogger.com, the proper layout and article is at:
http://www.sinpets.com/F5/20110816domitor-ketamine-spay-fox-terrier-26minutes_ToaPayohVets.htm


Tuesday, August 16, 2011

How to successfully toilet train an apartment puppy in Singapore?

Thank your for your e-mail. My reply is in CAPITAL LETTERS/


On Tue, Aug 16, 2011 at 10:57 AM, ...@yahoo.com.sg> wrote:

Dear Dr Sing


My family had gotten a 8 week old sheltie puppy for a week now. This is our first time. I have been trying to toilet train it but not sure if I have done it correctly. I have spent a lot of time reading up from the internet but the more I read, the more confuse I get and fear I have done it wrongly. I was so stress and frustrated until I saw your blog. It is so comforting to know there's someone who actually address puppy training problem that is relevant for Singapore pet owners. Thank you so much.


I have attached a picture of how I confine the puppy. I confine the puppy in the play pen most time of the day.
CORRECT WAY


I noticed that it will pee on the pee pad but not 100% of the time. Sometimes, it will pee on the boundary of the pad and a few times on the tiles.
BLADDER CONTROL IS VERY POOR FOR 8-WEEK OLDS.


Every time it pees on the tile, I would quickly soak up the urine and put the tissue paper on the pee pad with the puppy then proceed to clean up the area with odor remover. As for poops, it will also poop on the pad but sometime on the floor.


MOST COMMON SITUATION IS THAT THE PUPPY CANNOT POOP ALL AT ONE TIME DUE TO DISTRACTIONS FROM THE OWNER, THE OWNER'S CHILDREN, FRIENDS AND PARENTS WANTING TO PLAY WITH HIM DURING MEALS. SO, IT POOPS A BIT AND POOPS SOME MORE LATER. THE PUPPY SHOULD BE LEFT ALONE DURING FEEDING AND ONE HOUR AFTER FEEDING, BUT THIS IS SELDOM POSSIBLE IN BIG FAMILIES. A COUPLE WITH A PUPPY IS MORE SUCCESSFUL IN TOILET TRAINING.

Beside using the pee pad, I had a pee pan with grate which I had tried using. I noticed the puppy will sometime pee on the pee pan lined with pee pad but not always. It even lays on it sometimes. And if I put the grate on, it is more difficult to get the puppy to pee and poop on the grated- pee pan, even when I lined it with pad or left some urine on the tray. So now I removed the pee pan away and waiting to see how my puppy reacts.

YOU ARE CONFUSING THE PUPPY. IF YOU USE PEE PAN + GRATE, THEN USE IT. IF YOU WANT TO USE PEE PAD, USE IT SOLELY. IN ANY CASE, 1 WEEK IS TOO EARLY TO BE SUCCESSFUL. THE BEST WAY IS TO KNOW HOW THE PUPPY WAS HOUSED AND ITS TOILET HABITS AT THE SELLER'S PLACE BUT THIS IS USUALLY NOT KNOWN.


I do not confine the puppy 24 hrs in the play pen. I would let it out into the house with supervision. During these time, the puppy would sometimes pee on the floor even when our eyes are on him. He is simply too quick for us. One thing I noticed is the puppy does not always as predictable as describe in most articles. It doesn't always poop shortly after eating. Sometimes it will stay alert for a while and go to sleep after eating without pooping.
EACH PUPPY IS AN INDIVIDUAL. ALSO TOO MUCH DISTRACTIONS FROM YOU AND FAMILY. IT JUST CANNOT GET A ROUTINE OF PEEING AND POOPING AFTER MEALS SINCE HUMAN BEINGS ARE ALL OVER THE PLACE, FUSSING OVER IT (I ASSUME THIS IS THE SAME SITUATION FOR YOUR PUPPY).




During the first two nights, the puppy actually woke us up because he pee and poop in the pen.
COMMON OBSERVATION BY NEW PUPPY OWNERS. THE PUPPY ASKS FOR CHANGE OF SOILED AREA


Then I resorted to sleeping in the living room to monitor him. For two nights, I woke up to put him on the pad to pee. There was one night I actually didn't set my alarm on purpose and managed to sleep through the night waking to find the puppy only pee on the pad.

SUCCESS IN TOILET TRAINING TAKES TIME AND PATIENCE, NOT JUST 2 NIGHTS. IT TAKES 2-6 WEEKS DEPENDING ON THE OWNER AND PUPPY.

That gave me much encouragement! However, that was the only time. Subsequent nights, I woke up every 2 hrs to put him on the pad and pee. Then last night, the puppy pee and poop on the tiles before my alarm went off.

STOP WATER DRINKING AFTER 6 PM. FEED DINNER EARLIER AND LEAVE THE PUPPY ALONE ONE HOUR AFTER FEEDING.


I also want to know can the puppy be trained to pee and poop outdoors if he is being trained indoor now.
CAN BE TRAINED OUTDOORS BUT TAKE TIME AND PATIENCE AND A ROUTINE TOO.

I was told not to bring the puppy out before all vaccinations are given.
THIS IS TO PREVENT INFECTIONS BY DEADLY VIRUSES



Besides the toilet training part, I also read in your blog that handling puppy at this young age must be gently so as not to leave an imprint of fear in it. Now I am very worried because I had hold him on the floor when he tried to bite my hands during the first two day he came. I might have also caused him some stress when I tried to pull him with a lease once. How ignorant I was and why didn't I found your blog earlier. Will these experiences last forever in the puppy? What can I do to undo the damages I have done.

TRY USING POSITIVE REINFORCEMENT METHODS OF TRAINING - PRAISE, TREAT AND PLAY FOR SUCCESSFUL OUTCOME. CLICKER TRAINING PERHAPS?.


I hope Dr Sing you can help me with my puppy as I am really very stress and worried because I don't know if I am doing it right even after doing so much reading.

NO TWO PUPPIES CAN BE TOILET-TRAINED IN IDENTICAL METHOD AND BE TRAINED WITHIN THE SAME PERIOD OF TIME ESP. IN HOUSEHOLDS WITH LOTS OF FAMILY MEMBERS. CONFINEMENT, CHANGE OF SOILED AREAS, POSITIVE REINFORCEMENT TRAINING AND PATIENCE AND TIME ARE NECESSARY. SOMETIMES NEGATIVE REINFORCEMENT WORKS TOO DEPENDING ON THE PUPPY'S PERSONALITY. IT MAY TAKE 2-6 WEEKS TO TRAIN SUCCESSFULLY IN AN APARTMENT.


Thank you


Best Regards
Name of owner

549. Was the puppy vaccinated too early?





On Tue, Aug 16, 2011 at 11:42 AM, ...@yahoo.com.sg> wrote:

Dear Dr Sing


I have emailed you under the subject 9 week old sheltie puppy. I need you advice on another problem regarding vaccination. My puppy was vaccinated between 4th and 5th week by the breeder. The second vaccination was scheduled this Friday 19 Aug when the puppy is 9 weeks old. The problem is two or three days after I brought the puppy home, I brought him to a vet near my place because I found a tick on the puppy, at the same time also to consult the vet on bits of blood stain in mucous found when the puppy poops. The vet prescribed antibiotic, probiotic, kaopecin, spot on tick remover, deworm tablet for my puppy as treatment,and advise on cutting milk powder from its diet. During the consultation, the vet mentioned that the puppy was vaccinated way too early and I should postpone the 2nd vaccination till the puppy is 3months old. I am not sure if this was proposed because the puppy is under treatment or just to put the vaccination back on schedule.


I called up the clinic that did the 1st vaccination for the puppy and was told that they allowed vaccination for the puppy at 4-5 weeks old after examining the puppy to be health and the puppy was considered of good size, so no problem for that.


The puppy is fine now with firm stools except for the spot on tick remover which I will be applying tomorrow.


Could you advise me whether to proceed with the 2nd vaccination as scheduled by the vet who did the 1st shot or listen to the vet who treated the puppy for tick and soft stools.


Thank you


Regards
Name of owner


E-MAIL REPLY FROM DR SING DATED AUG 17, 2011


Thank you for your e-mail. It is difficult to advise as each puppy's immune status is different.
It seems that some vets in Singapore and in Australia have their own recommendations. I have had seen Australian vets recommending vaccinations more than 8 weeks after the first one.

Much depends on the disease situation and immune status of the puppy and whether the dam has had updated vaccination.

My personal recommendation for puppies bought from Singapore breeders (in Pasir Ris) will be a booster vaccinations 2-3 weeks after the first one. This is based on the vaccine brand I use and on this vaccine manufacturer's advices. 3 vaccinations are advised for the puppy.

In your situation, I cannot be more specific as much is unknown about the origin of your puppy and its updated health status. Therefore, you will need to take one of the vet's advices.

548. Dressing the incision wound after neuter or spay in a dog or cat

548. Dressing the incision wound after neuter or spay in a dog or cat
INSTRUCTIONS REGARDING THE DRESSING/STITCHES FOR YOUR PET
AFTER SURGERY

USE OF DRESSING
1. Before applying, clean and dry wound and the surrounding skin thoroughly.
2. Peel away the paper frame, exposing the adhesive surface.
3. Cover the wound with the dressing.
4. Smooth down the edges of the dressing.

REMOVAL OF DRESSING
1. Change the dressing 3 days after surgery or earlier if it is torn, no longer sticks or leaking with blood.
2. Lift the edge and peel fast (can be quite painful if you peel slowly).
3. Replace with a new dressing.
4. Remove the dressing 10 days after surgery.

REMOVAL OF SKIN SUTURES
1. If the vet has advised, return for stitch removal 14 days after surgery.
2. If dissolvable sutures are used, the vet will advise that there is no need to return for stitch removal.





Website and more pictures are at:
http://www.sinpets.com/F6/20110817dressing-stitch-removal-after-spay-neuter_ToaPayohVets.htm

547. How long does it take to spay a female dog at Toa Payoh Vets? 31 minutes

547. How long does it take to spay a female dog at Toa Payoh Vets? 26 minutes
KEY PERFORMANCE INDICATORS FOR SPAYING A HEALTHY
FEMALE DOG AT TOA PAYOH VETS

How long does it take to spay a female dog without complications? A case is illustrated.
The answer is around 26 minutes from skin incision to the end of stitching.
The whole process from sedation to the end of stitching is 31 minutes.

A case spayed by me as an example:

Fox Terrier, Female, 1 year, 9.3 kg
Last heat 3.5 months ago. Skin incision 1.5 - 2.0 cm long. Spay hook is used. No subcuticular or subcutaneous sutures as they do irritate the dog. No IV drip set up.

1. Time when the dog is given Domitor + Ketamine IV*. Atropine IM (A).
2. Wait 5 minutes. Isoflurane + oxygen gas in mask. Intubate.
3. Time when the skin is incised (B).
4. Time when the skin is stitched (C).

The following key performance indicators are as follows:
C - A should be less than 35 minutes
C - B should be less than 30 minutes




No. of suture packets used - one packet 2/0 absorbable
No. of stitches to close the linea alba - 3 simple interrupted
No. of stitches to close the skin - 2 horizontal mattress
Skin incision 1.5 - 2.0 cm
DOMITOR + KETAMINE IV WITHOUT NEEDING ISOFLURANE + O2 IN HEALTHY YOUNG DOGS
At 10kg bodyweight, Domitor = 0.4 ml. Ketamine = 0.5 ml. Total = 0.9 ml in one syringe. Give via IV.

If the above is given at 50% of the calculated dosage, isoflurane + O2 top up for less than 60 seconds, to effect (eyeball rolls ventrally and other signs) will be needed. Intubation is needed. Atropine IM is advised before surgery. Antisedan IM after surgery may be useful to get the dog to wake up within 2 minutes.












546. Sunday's interesting case: A 3-legged dwarf hamster with 3 warts

Tuesday Aug 16, 2011, 9.16pm typed at Toa Payoh Vets

As the owner's "hamster" vet was not free to operate on the hamster till 2 weeks later, the practice's other vet asked the owner to bring the hamster to Toa Payoh Vets. Some vets would just give oral medication but it would not work to get rid of the 3 warts.

I answered the phone and took over the case when the two ladies came. The hamster looked thin. "Very itchy, esp. the left hind thigh; it is just a stump; there is no leg."

WARTS. As the hamster disliked being handled and protested vigorously by squeaking, we could not examine her in detail. Two warts were seen. One on the front right fore leg and another one on the left thigh area. Actually there was a 3rd one seen later under anaesthesia

ANAESTHETIC RISKS. As the female, over 1-year-old hamster eats "very well," pees a lot and poops a lot, the hamster was deemed to be healthy. I warded her overnight for observation and gave oral antibiotics and anti-inflammatory. I gave a 60% chance of survival.

RECURRENCE OF WARTS. If sufficient normal skin is excised with the big wart, it is unlikely to get recurrence. But there may be a large skin wound which would expose muscles and bones, causing infections. This was communicated to the owner.

EXPOSURE OF BONE AND MUSCLES. If the wart has no stalk, it would be a bigger skin incision exposing the bone and muscles. There could be infections and gangrene. The owner was informed.

ELECTRO-INCISION WOULD BE THE BEST.

SEDATION USED
Monday Aug 15, 2011. Heavy rain. The hamster cleaned up its food bowl. Actually she stored all seeds inside the cheek pouch. However she was active and stool pellets were seen.

10.38 am Zoletil 50 x 2 drops IM, right hind muscle (left hind has wart). Usually I do it on the left. 54 g bodyweight. 1 drop would be insufficient. 2 drops would be just right. Two drops equal to 0.001 ml as the drug did not even reach the 0.01 ml mark in the 1 ml syringe. I pull in 0.08 ml of normal saline, making it total 0.01 ml and this amount was injected IM in the right thigh muscle.

Within 1 minute, the hamster was drowsy but awake.

10.44 am Electro-incision x 3 warts. Large blood vessel ruptured when left thigh wart was excised with more skin. Blood flooded lower half of the hamster. Imagine a dog with half the body with blood. It was not possible to ligate the big vein supplying this wart as in the dog. Electro-incision hopefully would cut and coagulate the vessel. But it could not as it would be a big vessel. A big wart grows big and the blood vessel also grows big too to supply more blood.
10.50 am End of surgery. Wakes up. Gave isoflurane gas to stitch up.

10.54am suture 4/0 dexon

The vet said the rabbit is normal. He died the next day.

I was busy typing the blog on pyometra in 2 old dog cases and lessons to be learnt for the owner. A young fair lady called me off the screen and asked whether she should get another rabbit. Her boyfriend's cat was being treated by Dr Vanessa.

"The vet said my rabbbit was normal," she extened her right elbow out and sideways while pulling in her left elbow and pointed her finger backwards to show the position of the rabbit. "This abnormal posture, instead of lying on the chest", she said was the reason she consulted the vet near her house in East Coast.

The rabbit died the next day. "Why did the vet say he was normal?" she asked me. The rabbit was around 5 years old and she found him lost at East Coast Park and adopted him.

"It is hard to explain why," I said. "The rabbit sounded as if he was in pain - heart pain and tried to spread out his legs to be more comfortable.

"He was also walking like a drunken person earlier," she said. The vet gave a bottle with powder. She was to add water and give it to the rabbit. After giving the medication, the rabbit died.

So this rabbit was not normal. "The cause of death would not be the medication," I said. "It would be something inside the brain or heart. A blood vessel might have ruptured. Sudden death as he was eating normally and pooping."

She agreed that it would not be possible for any vet to diagnose what's wrong without further tests like X-rays. "In any case, the rabbit could have died of stress when X-rayed," I said. So I hope she was satisfied with the explanation. As she was young, I asked her and her boyfriend to quickly apply for the new HDB flat before prices rise again.

"The HDB Duxton flat cost around $300,000 last time and everybody was complaining," the boyfriend said. Now, the flats cost at least $400,000 to more. The boyfriend's mother kept mum about marriage encouragement. It might not be the right time yet.

Lateral ear canal resection - blood test for a fat spayed poodle

The toy poodle had been scratching her ears since puppyhood. The ears at the entrance to the ear opening were as rough as leather, greyed and blackened through much scratching. She was only 4 years old. Such cases would have ulcers and some foreign bodies inside. In the horizontal canal. Very difficult to dislodge. When the owner consulted the vet, the usual ear drops and medication. After around 2 months, the same ear scratching, head shaking and pain comes back again.

Best treatment for chronic otitis externa - ear resection surgery.
Alternative conservative treatment - 2 steps. Bring down inflammation. 5-10 days later, irrigate ear.

As this dog had high triglyceride level and one liver enzyme was high, I advised wait for a few weeks. Slim the dog down to 3.5 kg (presently 4.6 kg). I don't advise surgery as anaesthesia will be risky.

543. Clinical Research - The old poodle would have lived longer if not for pyometra

I had a review of this case of pyometra today Aug 14, 2011 at 6.54 pm at the Surgery as part of my clinical research on pyometra in old female dogs seen at Toa Payoh Vets.

This dog survived the surgery and anaesthesia despite a serious heart disease. But she died two days after the surgery, of heart failure.


I first saw this poodle, female, unspayed, 9 years in 17 March 2009 for an "asthmatic" attack. he had heart murmurs and was given oral lasix. As she had bad breath, I advised dental work. No teeth was extracted as they were in good condition. Only dental scaling done under isolfurane and oxygen gas anaesthesia.

July 20, 2009, Vet 1 prescribed some medication for a "swollen face" and a review in 10 days' time.

Aug 5, 2009, I extracted the left upper PM4 tooth as it was an oro-nasal fistula which presented as a "swollen face" to Vet 1.


July 8, 2011 - Vet 2 recorded a grade 5/5 heart murmur. The blood test showed a normal total white cell count. However the monocytes were high suggestive of a chronic infection.

Total WCC normal. Monocytes 14% (1.4 x 10(9)/L). Neutrophls 60%. L 22% E.38% Basophil 1.04%, urea high but creatinine low.

July 21, 2011 - Ultrasound showed swollen left and right uterine horns. A diagnosis of open pyometra was made. The dog was operated the next day and the swollen womb was taken out. She survived the surgery but died 2 days later.


This is a typical case in which the dog would have lived longer if she had been spayed when she was one year old. In addition, she had bad teeth which seeded bacteria damaging the heart valves over her last few years of life. 11 years of life is considered a long life in Singapore's small breeds.

I have stopped advocating spays in young female dogs as many Singapore owners feel that it is cruel to deprive a female dog of her reproductive organs or have some other reasons. Reproductive disorders come in when the female dog is old, leading to much sadness and money spent.

In another case, the owner of a 13-year-old dog could not decide whether to get her operated as she was discharging pus from her vagina for the past weeks and was no longer eating. Finally, he asked me to operate but he wanted the dog home on the same day after operation to care for her. The dog surprisingly survived the surgery and anaesthesia for 7 days with him treating her at home. On Day 3 after surgery, the dog had fits and came down for IV drip. She passed away at home around Day 7. This second case showed that it was very difficult for the owner to request euthanasia and the option of surgery, as in the first case, was too late as the dog was very ill by then. So, the survival rate was very low. However, it is not always death for old dogs with pyometra. The chances of survival are very slim.

Monday, August 15, 2011

542. How to close very big wounds

Very large wounds are hard to stitch up without stitch breakdown. So, how to stitch up big wounds e.g. after breast tumour removal and loss of big pieces of skin due to traumatic injury?

1. Walking sutures to combat excessive tension are not practical in distal limbs as they may damage blood vessels, nevers and tendons. They may be used in breast tumour surgeries.

Reference:
The use of skin stretching devices and their applications to Small Animal cases is well written in the Australian Veterinary Practitioner Vol 39 (3) Sep 2009.

Large wounds can be closed by
1) skin stretching, extensive undermining, application of skin grafts, axial pattern flaps and walk-in sutures
2) induced expansion of the skin eg. neck elongation of the neck custom in some Myanmarese women. One example in veterinary use is to stitch horizontal mattress anchored to tubings to stretch the skin on both sides of the big wound in the afternoon and then operate the next day to appose the skin wound after undermining. This method is shown in the reference article mentioned below.



Sunday, August 14, 2011

541. E-mail queries about a cat spay

E-MAIL TO DR SING DATED AUG 14, 2011

Hi Judy

This is t... who has 6month + female cat. (Her name is T...)
Would like to get her neutralization surgery soon.

Could you please let me know the price and when I can go there and get this done?
She never go outside before, do I need to put her in the cage when I go to there?

Thanks for your help.
Best
T...

http://www.bekindtopets.com/animals/tpvets_Dec3110.htm


E-MAIL REPLY FROM DR SING DATED AUG 15, 2011

I am Dr Sing from Toa Payoh Vets. Thank you for your e-mail to Judy.

1. My estimated fee for spaying your female cat is around $150 inclusive of anaesthetics, surgery and post-op antibiotics and pain-killer injection and tablets. The suture used is a dissolvable type and so you don't need to return for stitch removal. A dressing will be applied to the surgical wound and no e-collars are usually required. However, please confine your cat indoors preferably to a room for 7-14 days after surgery.

2. You must bring the cat to Toa Payoh Vets in a carrier cage as some cats do run away as they feel frightened in a new environment of dogs and other animals. Once I had to find a box and tape up the cover for a young lady who brought in a cat to spay inside a towel. The cat was spayed. But she was nervous when the owner came to pick her up to go home. Once a cat jumps out of the plastic bag, she would be lost forever.

3. Bring the cat in at 9.30 am and she should be able to go home at 12.00 noon. No food and water after 10 pm the day before.

4. It is best that your female cat has 3 vaccinations completed before surgery.

540. Sunday Aug 14, 2011 - interesting case

Usually the vet gives an injection and ear drops and antibiotics. But no cure. The owner is unhappy as the dog keeps on scratching and the ears become smelly and red.

CASE STUDY

Ears very painful, esp. painful for the last 4 weeks. The dog just scratched her ears to death.
The Maltese just could not stop scratching her two ears. So the busy lady consulted me. The ear canals were swollen and red and so I would not be able to scope the ear canals to see what's wrong.

In this case, I suspect some foreign bodies stuck deep inside the horizontal canal.

ADVICE 1
My treatment in such cases would be 2 steps.

1. Anti-inflammatory and antibiotics to control the itchiness and infections. The owner is asked to return 5 days later for ear irrigation.

2. Ear irrigation 5 days later (Sunday today). The dog was wary of her ears being touched. So, I advised sedation. The owner wanted to know whether no sedation would be possible. How badly infected were thears? Could she just apply the ear ointment? Could she see me irrigating the ears so that she would learn how to do it?

ADVICE 2
Option: Vertical ear canal resection for long-standing ear infections (over several months and years) but most Singapore owners are not keen on this option. However, this option must be told as it is another option to monthly cleaning of the ears.

EAR IRRIGATION
1. Sedation is best. The poor dog would be avoiding and turning her head if forced to be restrained to be irrigated in the ears. In the past, I had tried to do ear irrigation without sedation (to save the owner some money) but it was very painful and stressful to the dog.

COACHING LESSON FOR MY ASSISTANT

Thursday, August 11, 2011

540. Dad's favourite Chinese Crested 3 kg only

"She weighs only 3 kg. This is Dad's favourite dog," the young lady said to me solemnly and worriedly as I had advised anaesthesia to pluck the big thick turf of ear hairs, clip the nails short, clip paw hairs, de-matt a few areas and do dental scaling. The dog just would not permit her to do it and now had red skin in the paws, legs, ears. She also had lots of dry scales or dandruff.

"Will you be the one doing the surgery?" she asked. "Yes," I said. The key to success in anaesthesia is to give the minimal dosage. And the vet must be vigilant and has experienced assistants who know anaesthesia very well. In this case, I ensure that I was in charge of anaesthesia as well.

I gave 50% of the calculated dosage of domitor and ketamine IV. I asked my assistant Min to get an electronic calculator and coached him on how the dosage is calculated. I wrote down on the paper the calculations to teach him the basics.

At 10 kg, a young healthy dog will be OK with domitor 0.4 ml and ketamine 0.5 ml combined IV in one syringe as an IV general anaethesia.

But this is a thin Chinese crested, stressed out by skin itchiness over the years and not in top health as dandruff keeps peeling off her skin. I did not take a blood test this time as I deemed it not necessary from general physical examination and history. However, the anaesthesia must be lowest but effective. So, I gave 50% based on 3kg.

All went well. I gave the dog a sniff of isoflurane gas as she was getting up. A sniff of less than 60 seconds. I observed the eye white being prominent. This indicated Stage 4 as the eyeball had rolled down and into danger territory. So, the gas was switched off. Everything went well. The dosage was sufficient for around 30 minutes which included all grooming and dental scaling.

Just to be on the safe side, I gave the antidote - Antisedan. In less than 1 minute, the Chinese Crested stood up and looked as fine. Pooped green stools. Went home in the afternoon after ear irrigation and a bath as the father and daughter came to pick her up and the Miniature Schnauzer (9 years old with similar requirements but had 7 loose teeth extracted). Also 50% dosage based on weight. And antisedan.

"No steroids," the young lady said. In this case, I have prescribed Atopica for 2 months plus the young lady's own special oil application to the skin as she had done successfully for the other Chinese Crested (hairless). Otherwise the Chinese crested keeps scratching herself day in and day out.