Friday, August 31, 2012

1074. Young couple cares for old dog

I showed the young couple, 20-30 years old, my writing on the case card cover: "young couple cares for old dog" - written on Nov 25, 2009. Happy, black and white Shih Tzu, female, was adopted as a 13-year-old by them. R eye had deep white ulcer and black pigment 99% covering the cornea. Loose teeth. Heart OK. These were recorded in my case sheet.
3rd eyelid flap and dental work was done.
R eye had pus


Dog very lethargic this afternoon, came to consult me. Last time I saw them was 2009. Now the couple thought left eye (being closed) had ulcers too. Did fluourescein tests. Both eyes had ulcers but they were old ones.
"Lack of grooming," I said. The dog sat quietly on the table. "But the dog would move here and there at home," the wife said.  

This couple really cared for an old abandoned dog. 13 years old. Now she is 16 years old and they thought she had eye ulcer. I checked the temperature. 40.3 C. "Fever, that's why the dog was not standing up," I said. "The left eye has no tears and may be painful. The right eye was tearing and the tears matted the hairs at the medial side. I wipe off the matted hair. The dog wrinkled and wanted to bite me.

1073. Uncontrolled fever in a Samoyed

Today, Friday, Aug 31, 2012, an old friend visited me. "How's the Samoyed?" he asked. "I came to visit this dog as Vet 2 could not control the fever but the fever went down when treated by you."

"How long was the Samoyed having fever in Vet 2?" I asked. "Was it 3 days?"
"I think it is 2 days. The vet sponged it and injected it, but the fevcr appeared again the next day! Vet 2 told me that the dog was sent to my good friend at Toa Payoh Vets and the fever came down the next day!"

"When the dog came in, it was having of a very high fever of 41.2 degree, panting non-stop and unable to stand," I got the dog from the transport couple who said there was a traffic jam. "I told Dr Daniel that this dog would die as the fever was so high and had been at 41 degrees in Vet 2 for the last 2 days. No hope as the internal organs must be burnt out!"

"Is the dog still alive?' my friend asked. "I don't see him in the Surgery."
"Yes," I said. "According to Dr Daniel who was in charge of the case as I was in Hong Kong, thedog is now normal and walking!"

My friend smiled at the strange situation: "Vet 1 knew the dog had high fever and quickly referred to Vet 2! So Vet 2 was landed with a "hot" dog with uncontrolled high fever and being unable to stand on the back legs.

"Actually the dog had fever again the next day!" I said to my friend. "My anti-fever injection could only bring down the fever for a few hours." So this Samoyed had uncontrolled fever. What was the cause? I was very worried. In my younger days, like Vet 1, I would have referred the case away to others.  

But in this case, Dr Daniel had accepted the dog as it was one of the two neutered by Dr Jason Teo earlier. Also I am more experienced in knowing what to do. Yet, this dog's fever could not come down. Was it a viral fever? A tick fever? Blood test by Vet 2 showed negative Babesia which caused tick fever. My test showed E.canis negative.

"It could still be tick fever," I said to Dr Jason Teo on that Saturday, the 2nd day of admission. He said Vet 2 tested negative Babesia. I gave instructions for treatment of Babesia canis using the imidazole injection and E. canis using oral vibravet. Dr Daniel had proposed clipping off the coat and I got it completely shaved down on Saturday. Anti-fever and antibiotics and IV drips were given.

Surprisingly, on Sunday, the fever was no longer above 40.5. No more heavy panting.

So, in reality, this Samoyed's fever went down after 4 days. "It could be that I was the lucky vet to cure this dog as medication needs time to act," I said to my friend. He was quite happy to know that the Samoyed was alive and walking. As to the cause of uncontrolled fever, it is still a mystery. Blood tests did reveal high white cell count. Was it tick fever? Possibly since the medication was "effective" but many pyrexias of unknown origin (PUOs) are not easy to get the cause.  

  
  

Thursday, August 30, 2012

1027. SOP for rabbit cheek abscess at Toa Payoh Vets

The following will be the Standard Operating Procedure (SOP) for rabbits with cheek abscesses with effect from Sep 1, 2012

1. Examination of the mouth for overgrown incisors and molars. Record of size of abscess
2. Advise X-rays or record AMA (Against Medical Advice) if the owner does not want it. Record which cheek tooth is affected and whether there is osteomyelitis of the jaw bone.
3. Sedation and clipping away the hairs
4. General anaesthesia gas using isoflurane gas via mask
5. Open the mouth to check for overgrown molars
 

6. Make a long skin incision in the ventral part
7. Lance the abscess
8. Irrigate the abscess
9. Post-op stay and treatment to express more pus, for 3 days
10. Review in 3 weeks 
11. Take images of pre and post-surgery if possible (see example below).

It is important that the vet advises X-rays as part of provision of a high standard of care. If the owner rejects the advice, this should be recorded in the case sheet.








Updates and webpage is at:
http://www.sinpets.com/rabbits/20120831rabbit_cheek_abscess_treatment_toapayohvets.htm




1071. Birth certificates from the vet?

EMAIL TO DR SING DATED AUG 30, 2012

On Thu, Aug 30, 2012 at 4:40 PM, Christine Park ..gmail.com> wrote:
He is a male schnauzer and the vet surgeon's name was Dr sing kong yuen

Thanks so much!
Sent from my iPhone



EMAIL FROM DR SING DATED AUG 30, 2012
Hello

BIRTH CERTIFICATE FOR MINIATURE SCHNAUZERS

I am Dr Sing Kong Yuen who answered your phone call and did not understand what you wanted before you sent this email.

I am a vet at Toa Payoh Vets. The birth certificate is never kept by the vet because the breeder or seller is the one who is responsible for the registration of the puppy. The vet just vaccinate the puppy and that is the vaccination certificate issued by the vet (as you have emailed the image).

As it costs money to register the dog with the Singapore Kennel Club, nearly 99% of Singapore's dog breeders and sellers do NOT phone the SKC to send its people to go to the kennels, examine the puppy and previous pedigree certificates if any. After that, the SKC may issue a "birth certificate". This birth certificate costs the breeder and sellers money and 99% of the buyers usually does NOT want to pay this amount of money to buy the puppy with the birth certificate. Therefore, most puppy Sellers (except professional dog show champion breeders or those specialists in breeding certain breeds at premium prices) don't register the birth of the puppy and the vaccination certificate is the document which will show the date of birth and details of the puppy.   

I hope this information helps you to understand the industry practice of selling puppies in Singapore. You can phone me 9668 6468 or email if you wish to know more info.

Wednesday, August 29, 2012

The pet shop operator's point of view

Yesterday, Aug 29, 2012, I phoned an old client cum pet shop owner as I reviewed his 2009 case records. He had sold off his share of consultancy business which included clientele like the Singapore Tourism Board. He had a pet shop which he now manages.
"How's business?" I asked. "Will you be interested in selling hermit crabs>"
"You've have the source?" he asked me.
"Yes, I have a supplier," I told him I was doing a survey.
"The AVA does not even allow me to sell a fish," he said.
"Why? Is your pet shop next door to a coffeeshop?"
"No, 3 shops away." he replied.
"That's strange," I said. "AVA allows pet shops to be opened elsewhere.
"I cannot sell any pets within 2 km of this food production factory," he enlightened me. "In case, disease goes to the food production factory." So, here, he wanted to increase his scope of services. The authorities put up 2km range to prohibit entrepreneurship.
"Business in pet shops in Jurong is very bad," he said the suppliers told him.
"Why? Is it because the public prefers to go to big operators where there is a diverse range of products and maybe cheaper?" I asked. This seems to be the trend. "This big operator (name given) kills all small operators. It does provide dog grooming too! People go for the cheapest prices."
So, there seems to be no hope for small pet shop operators as Landlords keep increasing the rentals. Singapore is just like Hong Kong. Only the Landlords and those tenants with deep pockets can benefit from intense competition. Kill all small operators in no time.

"What about the vet business?" he asked me.
"I am OK as I have been established over 40 years," I said. "That does not mean I will be OK in the near future as there are around 50 vet clinics being set up. If the management is poor or the standard of vet care is not up to excpectations or the Landlord closes me down, that is the end." I need to buy my own premises.

"There are many owners complaining about vets," the ex-management consultant said.
"What type of complaints?" I asked.
"Over-charging and being too young."
"Well, the vet costs to start up a clinic are very high as the younger vets with good financing installed all kinds of equipment and pay high rentals or buy the premises at over $2 million. Usually some have a business manager and several lay staff increasing overhead cost.  It is hard to price lower. May as well be an employee if the practise loses money on every case handled. Furthermore, new clinics have less clientele and therefore, the vet may need to charge higher. That gives the perception of over-charging. "

"imes will be rough for vets in private practice," I said. "Even some specialists leaving the government hospitals are not all having lots of patients."

    

1069. Update: Perineal hernias (bilateral).


Did the maid do it?

Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS

First written: 30 November, 2008

Update: 30 August, 2012 TOA PAYOH VETS

Be Kind To Pets

Veterinary Education

Project 2010-0129

Friday, August 3, 2012

1023. Did the maid cause the perineal hernias?



Today Saturday, I came to work at 9 am. Reviewed the case of the Jack Russell who had passed away on the op table yesterday.



This was a case of a very poor prognosis because



1. The bladder was twisted. During surgery, this bladder was dark red and bleeding when seen from the hernia side, only a small portion of the neck of the bladder was the normal pink.



2. The associate vet was not able to catherise and lots of dark red blood inside the swollen bladder leaked out).



3. In addition, fresh blood leaked out from the anus.



An emergency surgery to reduce the bladder size was done but the dog passed away after the repair of the right perineal hernia. The owner said that around 4 weeks ago, the dog gave a loud cry as the maid had hit him. He was frightened of the maid since then. "Did the backside swelling disappear after some time?" I asked the father. "Yes," he said. "I could feel some water inside the swelling. It disappears but now it comes back again and grows much bigger."



So, was the maid's hitting cause the perineal hernias (left and right) to develop? It is a possibility but I don't think so. Old male, not sterilised dogs do develop perineal hernias and this Jack Russell fitted the picture. He was around 10 years old, not neutered and had a large perineal swelling that could reduce. I diagnosed perineal hernia.



The associate vet (Vet 1) diagnosed tumour e.g prostate tumour as there was too much bleeding from the penis. "Are you sure?" Vet 1 asked me. "Yes, I am 100% sure. I based this on the history of the backside swelling increasing in size and disappearing when pressed some 4 weeks ago. Look at the big swellings on the backside." As the dog came in recumbent and not able to stand up, the perineal hernia swellings were NOT obvious. The profuse bleeding from the anus and the penis distracted from the not so obvious perineal hernial swelling especially when the dog was so ill and lying on his die panting. Therefore, I would not expect Vet 1 to miss the diagnosis of perineal hernia which was the main problem. All associate vet cases are monitored by me to ensure a high standard of care and all vets have to learn from experiences of "challenging" cases presented. A normal standing dog will show the perineal hernia swelling but this dog was down and out and therefore its bilateral backside swellings were not obvious.



The father requested an X-ray to confirm the diagnosis of tumour. "Normally, no X-ray will be done if it is a perineal hernia," I said to the vet. "However, the owner had requested X-ray to confirm. It should be done. In any case, this dog would die soon as he could not stand up and was in great pain, passing blood in the urine and stools. This is serious and the owner has been told. I had shown the owner past case images of perineal hernia from www.toapayohvets.com and he understood what the problem was."



X-RAY

Showed a large swollen bladder trapped on the right perineal side while the left side was swollen with intestines filled with stools



Blood test - the owner did not want a blood test.



SURGERY. The dog passed away on the operating table after the bladder was emptied of over 30 ml of fresh blood and pushed back into the abdomen and the skin stitched. The owners knew that the chances of survival was practically low but wanted to take the chance.



CONCLUSION. If the perineal hernias were discovered much earlier, chances of survival are good. Male dogs are prone to getting perineal hernias and one prevention is to get the male dogs neutered early in his life. This may appear "cruel" to the internet generation. Therefore perineal hernias and anal tumours do present in the some of the older non-sterilised males in old age.





tpvets_logo.jpg (2726 bytes)5558 - 5565. Bilateral perineal hernias. Twisted bladder (right side) and twisted intestines (left side) trapped inside the perineal hernias     webpage:
http://www.sinpets.com/dogs/20120829bilateral_perineal_hernias_jack_russell_toapayohvets.htm

1068. Update on closed pyometra in 2009



Closed Pyometra In A Miniature Schnauzer

Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS

Article written on: 15 March 2009. Updated: 30 August, 2012 toapayohvets.com

Be Kind To Pets

Veterinary Education

Project 2010-0129

Old Miniature Schnauzer, Not Spayed. Closed Pyometra. Toa Payoh Vets



Closed Pyometra. Spayed 12 hours ago. Miniature Schnauzer 10 years vomit next 2 days. Toa Payoh Vets.

Closed Pyometra



All owners do not want a dog to die on the operating table. This dog was at death's door. Surgery could not be delayed.



When to operate and how much IV fluids must be given to maximise the dog's chances of survival during surgery will depend on the veterinarian's judgment and experience.



A dead dog on the operating table is never forgiven by the owner and bad mouthing of the veterinary competence might be the consequence.

The risks and options are explained clearly to the owner and recorded. An informed consent form must be signed in case of litigation as Singapore is becoming a litigious society as the country develops into a "first world".



During litigation, the medical notes will be referred to and if there are no records of informing the owner of the risks and alternative treatments, the medical negligence suit will not be in the doctor's favour.



UPDATE ON AUGUST 30, 2012:

In 2012, I have implemented a work process in which all vets performing operations at Toa Payoh Vets have to be responsible for recording in their own book of anaesthesia and surgical templates the details of their anaesthetic dosages and times taken as well as surgical procedures. This book of records will be their defence in cases of litigation and investigations.

TIPS FOR VETS



Each vet has his or her own judgment as to the use of IV drips during surgeries.



I notice one vet inserting an IV catheter without attachment to any IV drip set during surgeries.



I will advise all vets to connect an IV drip to the IV catheter when performing spays and surgeries rather than just inserting an IV catheter into the cephalic vein by itself.



This is because, during emergencies, the IV catheter will be clogged by the blood clot while an IV drip will give instant IV access to emergency drugs during the surgery. In some cases, I give antibiotics and pain-killers prior to the start of surgery as the dog is not well and needs prompt surgery. In some pyometra cases, I run the IV drip overnight first to re-hydrate the dog and give her the antibiotics and pain-killers. This gives her a better chance of survival rather than rushing into surgery immediately.



In the above case, about 100 ml of glucose is given IV, not the whole bottle! Know your IV infusion well. 


Webpage and images are at:
http://www.sinpets.com/F5/20110438close-pyometra-schnauzer-iv-glucose-drips-catheter-toapayohvets-singapore.htm

1067. Pyometra in 3 Miniature Schnauzers reviewed

Yesterday, I reviewed 3 cases of Miniature Schnauzers with closed pyometra.

CASE 1. This was operated by me in 2009. The father prohibited surgery as the first dog died when given by an injection by Vet 1. However, the dog continued vomiting and so there was no choice. The surgery was a success but the dog continued vomiting. I had already told the young lady that the blood tests revealed kidney failure before I operated. The dog did survive but since the kidneys had failed, she vomited for the next 10 days. Euthanasia was done. This was a case whether the older baby-boomer generation has not much knowledge of the high fatality of procrastination in seeking surgery early.


CASE 2. In this case, operated by my associate vet recently, the older baby-boomer generation was the 60-year-old mother who did not want any surgery in case her vomiting dog died on the operating table. vomit and so why not wait. My associate vet warded her for 3 days with treatment given. One sister (Sister 1) took the dog back as the dog did not vomit. Conclusion was that the dog had some stomach infection. Then on the next evening, she brought the dog back and told me she was vomiting again. I was on reception duty and that is the best place to pick up complaints and feedback from clients. Three days had passed and the mis-diagnosis was gastritis. I examined the dog in the presence of the associate vet (Vet 1).

"A history of heat somewhere around Christmas" Sister 2 meant that this dog had heat around June. Now it was August, 2 months after the end of heat and so it was possible that pus had accumulated in the Schnauzer and caused vomiting.  Abdominal swelling and pain on the lower 1/3 of the abdomen.

"It is closed pyometra," I based my diagnosis on the 3 factors mentioned above. "An X-ray will be useful but it is not necessary. The solution is to spay her soon." The sister did not believe me. Vet 1 stuck to the diagnosis of stomach infection (gastritis) as the history given was that the heat period was more than "3 months ago" or "unknown" and advised an X-ray of the abdomen. So there was a delay of one day. "How's the X-ray interpretation?" I asked the associate vet. "Is there closed pyometra?" Sister 1 came and requested that the operation be done the next day as Vet 1 was busy with cases till past 8 pm during her visit. and Sister 1 wanted a vet who would be not so tired doing surgery. This is the situation with multi-family interactions on the veterinary duties.  "This dog could still be operated after 8 pm," I said but since Sister 1 had said so, I did not object. This closed pyometra dog had already been over 6 days since the first consultatio by Vet 1 and delays in surgery are not good for the dog's health and prognosis.

Vet 1 did not think the X-ray showed closed pyometra although I disagreed with Vet 1.  "However the owner did not mind getting the dog spayed," Vet 1 said.

Spaying showed closed pyometra. The dog was standing and barking the day after the operation. However, post-op complications set in after 3 days of hospitalisation. Complications of wound breakdown do occur in surgeries for all vets. The dog became recumbent and the 3 sisters and mother were visiting her every day. "Why is the dog vomiting?" one sister asked me at one visit one evening. I told her that the dog would be operated by Vet 1 to close the stitch. Vet 1 operated late at night at around 10 pm on Aug 27, 2012. A drainage tube was inserted. As post-op complications do happen, I monitored this dog daily.

Yesterday, Aug 29, 2012, she started eating, wolfing down the steamed fish but ignoring the whole bowl of cut pears yesterday morning at 10 am. The mother had cooked the fish and came to give her the food. On Aug 28, 2012, this dog also wolfed down the fish given by the mother.

 "Since she eats the food fast, she has recovered from the operation," I said to Sister 2 who came yesterday evening to visit and asked me if the dog could go home. Vet 1 was busy consulting and could not spend time with multi-family visits.  "We have to wait and see the next few days," I said to Sister 2.        


CASE 3. Another Schnauzer with closed pyometra was operated by Vet 1 on Aug 28, 2012. The uterus was packed full with pus, much fuller than that of Case 2. In the evening, I could see that the dog post-op was not well. She was shaking in her body and then she pushed her head against the crate's bar, as if trying she had headache. "What's wrong with the Schnauzer? She looks very sick," one young lady who was visiting her vomiting Shih Tzu hospitalised asked me. I told her that the dog had an operation.

I had seen such head butting against the crate behaviour from distemper puppies with fits and it is not a good sign of health. The young lady owner came in the evening and wanted to take this dog back. "A dog that is not eating should be hospitalised and given drips," I said to her and Vet 1. "Why is the dog not on drips?" I asked Vet 1 who was preparing to send the dog back home as requested by the young lady who would not be in Singapore till the next Saturday (10 days later).

Vet 1 said, "The dog flung off the IV set." I said to Vet 1: "If the dog dies at home, all the family members will not only bad-mouth you, but also Toa Payoh Vets. This dog should not be allowed to go home (to give her a better chance of survival on IV drip. The lady owner had been shown the swollen pus in the uterus). I could not believe that the young lady wanted the dog back on the same day after surgery as most owners accept the vet's advice. Maybe it was economics, but here there was the dog successfully operated but could die a few days later due to the lack of IV drips.  "Get the owner to sign a letter stating the possiblity of death and that the dog was discharged against medical advice by you and I," I instructed Vet 1.

It is tough nowadays for vets as clients want their own way. But there must be a firm action to let the lady owner and her family members know that the dog could die due to the lack of post-op IV support. The vet has to be alert and mindful of the consequences of the failure of IV support since this dog was not in good health. The young lady phoned her family. I noted that the dog was hospitalised. In this case, it was likely economics.

In conclusion, in all 3 cases, had the dogs been spayed when they were younger and healthier, closed pyometra would never be present and much financial expenses and more worries would not be present. But many Singaporean owners think it is cruel to spay the dog. So, there are more cases of pyometra seen and it is not guaranteed that a dog that survived the operation would remain alive after surgery as you could see in Case 1.

1066. Black lump on the older roborovski hamster

On Thu, Aug 30, 2012 at 3:59 AM, ....@hotmail.com> wrote:

Hi Dr Sing,

I came across your website while searching for more info regarding the lump on my robo hamster. It was quite a big one and black in colour. I am not sure how long it have been there (assuming 2 weeks) because as robo is a very active hamster and does not like to be handle so i usually only observe it through the cage and close the cage after i feed her on my hand. Her movement and everything else seems normal, no limping etc. As i am the second owner of my robo, i am also not sure how old it is (she is already with me for 1 year and 2 month). Merry was abandon by her previous owner and she was left outside the house to hibernate without food and water bottle dried up. She was given to my cousin by the previous owner's sister.

I would like to seek your advice on this and would like to check with you if you have come across black lump on hamster. I would also like to know the cost if operation is needed and if it is within my means.

Hope to hear from you soon Dr Sing.

Thank You

Regards,

Name of lady owner


EMAIL REPLY FROM DR SING DATED AUG 30, 2012

Thank you for your email. It is difficult to say what your hamster's "black" lump is. Based on his old age, it is likely a tumour, probably a melanoma. It could be a black gangrenous tumour that has lost its blood supply.

As you did not provide any images, I can't say whether I have had seen similar "black" lumps in other robo. Older hamster has various lumps of various sizes on various parts of its body and some do have "black" ones.

Anaesthesia and surgery for the removal of the lump is estimated at around $100-$200 depending on its size and time to excise it. Pl make an appointment one day in advance at 6254 3326 and come at 9.30 am on a weekday preferably. Best wishes.

Monday, August 27, 2012

1065. Malocclussion in a lob rabbit

Lower jaw longer, upper jaw shorter. So malocclusion.
Trimmed 2 months ago. The rabbit's front teeth overgrows every 6 weeks due to malocclusion.
I advised filing the teeth after I have had clipped them short but the gentleman was busy working as a cabin crew. He used the cloth to wrap around the rabbit to file the front teeth. But the rabbit struggled and so he could not do it.

He asked whether there were solutions as he would not want to come every 2 months to file the rabbit's teeth. "Hold the scruff of the rabbit's neck firmly with your fingers of one hand," I showed him. The rabbit was immobile and he was impressed. "However, you need a person to do it while you file the front teeth."

The other solution would be to extract all the 4 front teeth under anaesthesia. "Usually, the teeth would not grow back again if the root is completrely removed.. There is always an anaesthetic risk of death," I said. "What is the cost?" the wife asked. "Around $250."

1066. Advise on a caterwauling cat without carrier

Cat was spayed on Monday yesterday. Came in on Sunday as she was caterwauling and was a noise nuisance.

A young Malay lady (nurse from Kandang Kerbau Hospital) came to take cat home after spay by Dr Daniel. Her father came into the clinic while her mum was in the car.
"Bising, neighbour complained," the father said. "Will she still make noise.?" So, the mother decided to put the cat here for 2 days after spay. Today, bring home.

She wanted to carry the cat out of the clinic to the car.
"No," I said. "Put it inside a carrier. Take the carrier to your car."
That should be the way.

"When can I bathe the cat?" the mum had come in while the father had gone to the car.
"You can bathe the cat if you don't wet the bandage covering the wound," I said.
"Better not to bathe," the daughter said.
"How long must wear the e-collar?" the mum asked.
"10 days," I said. "This is to prevent the cat biting the bandage and then the wound. Intestines may pop out if she does it."

"Will the cat still be noisy?" the mum was worried that neighbours were complaining.
"Possibly," I said. "It depends on the hormone level. As a precaution, give 1/4 of the Ovarid 20mg/day for the next 4 days and this would stop the meowing."

I advised feeding a cat food for "fat cats" as this cat was overweight at 6.5 kg at 11 months of age.
Also deworming and vaccination. This owner education is important and most vets don't do it as the cat came in only for spay. And so spay would be done.

FEEDBACK
I asked the young lady why she came from Woodland to Toa Payoh Vets to spay her cat. "There is one vet in Woodlands and one in Admiralty," she said. "I was referred to you."  Referrals are very important in this type of business.


1063. Rainy morning and how many years of experience in spay

Tuesday, Aug 28, 2012

For the past months, I have been taking the bus 238 from the Toa Payoh bus interchange to outside the Polyclinic and then walking to the Surgery every weekday, at around 8.30 am. Today, it rained dogs and cats. I drank coffee at Ya Kun coffeeshop and waited till 9am.

It is important for a vet to be around to answer phone calls as many are technical questions. I usually attended to the phone calls instead of leaving them to the receptionist and there have been good responses in the sense that the new clients come for treatment after knowing the technical details which a receptionist will never be able to advise with authority.

However, this morning I received a most direct phone call with the following questions from a lady who wanted her 2-year-old Maltese to be spayed by an experienced vet.

1. Do you have an experienced vet to spay my dog?
2. How long is the spay operation?
3. How long is the whole process?
4. Can I bring her to spay and wait?
5. Can I bathe her?
6. How long will she recover from spay?
7. Since she eats several times a day, how is she going to eat after spay and not starve to death?
8. Can I spay her on Saturday or Sunday?
9. How many years of experience do you have?

ANSWERS
1. We do have experienced vets like Dr Jason Teo, Dr Vanessa Lin and myself (Dr Sing Kong Yuen).
2. For experienced vets, it should take less than 15 minutes for the surgery.
3. The whole process should take less than 30 minutes if there are no complications.
4. The owner can't wait and take the dog home immediately. The dog has to rest and recover for the next 3 hours post-op. "Sometimes, the dog may die during transportation as the dog is not fully normal," I said. "Really?" the caller asked. "The blood and body systems need to stablise after anaesthesia and that would take at least 3 hours of rest."
5. Yes if she covered the op area.
6. Around 10 days normally and without complications and infections.
7. The dog would not eat for the first 24-48 hours after spay and would not starve to death.
8. Best time to spay the dog is on weekdays as the weekends are usually busy. Make an appointment one day before. No food and water after 10 pm the previous day.
9. I have around 30 years of experience.



1062. Antisedan is the antidote to be given routinely

"No point giving Antisedan," Dr Daniel was behind me and saw the deep purplish blue tongue tip of the 8-year-old Jack Russell as I was making a post-op check on this beloved dog of a lady in her 30s. "The dog has died."

"Get the dog out of the cage," I said but did not waste time informing him that I could see the dog's eye flickering, meaning he is still alive. "I am getting the Antisedan injection." 30 minutes ago, the dog had 75% of my Dom+Ketamine IV formula and had dental scaling and ear irrigation. I did the ear irrigation personally as that was what the owner wanted me to handle her dog's ear itchiness problem which had persisted for the last 2 months after Vet 1 had been consulted and given her ear drops. The 8-year-old female Jack Russell was still scratching her ears and dark black pigment and rough skin developed near the ear canal opening.
Many of my old clients had disappeared as proximity is important for them since around 50 vet clinics have been opened in recent years. I checked my case records.

In Oct 30, 2005, this dog had vaccination and false pregnancy. No more visit till Mar 5, 2008 when I diagnosed false pregnancy as there was milk. "My dog had ear infection and you had treated her successfully," the lady said. Dog owners always remembered their pet's medical history and the vet who can deliver results and those who failed them. It is a tough competitive world in Singapore vet medicine and all over the world in 2012!

I reviewed my case sheets. Sure enough. In August 17, 2009, I did an ear irrigation of the left ear otitis externa and teeth scaling as well as vaccination and deworming. "Left ear drawing - I wrote "red+, pus, 1 week".

In Dec 13, 2009, I treated the dog for inflamed D3/D4 interdigital right hind lameness. That meant the ears were no problem anymore.

So, that was why she came to consult me after 2 months of ear drops cleaning from Vet 1.

Back to the present situation, I injected Antisedan 0. 4 ml IM. The dog was walking and OK. I went out to buy surgical equipment and the surgical gloves at Jalan Besar. Later, the lady came and was most happy to see her dog. The dog's tongue was pink. As to why the tongue tip which protruding out and in between the teeth turned cyanotic, I don't know. The dog was resting on her chest and the head was on her paws. The teeth clamped on the protruding tongue tip. Cyanotic tongue colour meant no oxygen flow and in that stage, it would lead to death.

From now, I would insist on Antisedan to be given routinely. As the associate vets have their own judgment, they don't usually given Antisedan. I had advised but each vet has his or her own ideas as do all doctors. This case showed the importance of Antisedan as there would be no such drama if the associate vet under my mentorship had given Antisedan routinely as instructed by me.

It is not necessary to give Antisedan reversal in all cases, but in old dogs, this should be done. But my associate vets sometimes do it and sometimes don't and this case clearly illustrated the importance of getting the antidote and letting the dog recover faster from sedation.  




Sunday, August 26, 2012

1061. Sunday Aug 26, 2012's interesting cases

I was away in Hong Kong from last Monday to Friday. So, I had to catch up with my admin work on Saturday morning. Sunday was a bright sunshine day.

CASE 1. Rabbit abscess
A vet (Vet 1) told the young couple today, that she was too busy to operate on their rabbit's abscess and gave some injections and medication. They could phone her on Monday to make an appointment a week later. I would have just asked the couple to go to another vet as abscesses will enlarge with time. So, the couple came to consult me and told me their encounter. Sundays are always busy for vets. I had 2 cat spays (noisy caterwauling), one dog spay booked in and I know that another associate vet would have to operate on the closed pyometra Schnauzer suffering from post-op complications of stitch breakdown. There were clinical cases waiting too.

The young couple were knowledgeable about the rabbit abscesses as they had surfed the internet and so it was easy for me. "The abscess would recur," the husband said. "Sometimes," I said. "It depends on whether the tooth root is still infected. Do you want an X-ray done?"

The rabbit was a gentle brown sturdy creature. Isoflurane gas by mask.
"Anaesthesia must be short and surgery must be fast," I said to Dr Daniel who was present. "Rabbits may die if anaesthesia is prolonged, although not every rabbit will be affected."
I incise the skin, undermine the subcutaneous and a big bulge popped out. "It looks like a tumour," Dr Daniel said. "There are numerous blood vessels and nerves in this neck area." The abscess was at the angle of the jaw near to the neck.

"Get a syringe and 18G needle to aspirate the abscess," I did not rule out tumour in this young rabbit, but the most common condition is abscess. Dr Daniel drew out 0.1 ml of yellow cheesy stuff and then nothing. I incised the muscles of the abscess which was 3/4 size of a golf ball. Thick cheesy yellow pus spurted out. The rabbit squealed as the anaesthesia was just sufficient. I top up the anaesthesia again and completed the pus aspiration within 2 minutes. I informed the owner who had earlier come again with the rabbit's pelleted food, squarish glass bowl, log of hay and his packet of white treats.

Rabbits are family members, just like dogs and in this case, this rabbit was free to roam around the apartment. As a new baby was present, the rabbit's old litter box was discarded and the rabbit lost interested in eating the hay. "We can't find another," the husband said. "Well, it may be the smell of the box," I said. "A new one may not help. Hay is good for rabbits."

In retrospect, as I review the case now, at 10.07 am on Monday, the cause of not eating hay or food could be the cheek abscess being formed. This lead to pain. "Did the rabbit eat after Vet 1 gave the injection?" I asked. "Yes," the couple said.

Large rabbit abscess are best operated as soon as possible. But Sundays are hectic days. Some vets may not wish to operate during lunch breaks as staff also need to rest. Much depends on the vets and the staff's attitude and their caseload.

Saturday, August 25, 2012

1060. Follow up: Another Beijing hamster with a fast growing lump

EMAIL TO DR SING DATED AUG 21, 2012
Hi Dr Sing,
Thank you very much for your time to reply. I will discuss this with the vet accordingly.
I'm very sorry I will have to trouble you with another question for my other hamster Yoda. He is also 2+ years old, currently on Itraconazole treating a recurring fungal infection (ringworm).
I noticed he had a soft moveable lump underneath (from chest to flank) him early this week and yesterday we went to the vet. The lump wasn't noticeable 2 weeks ago.
Attached is the pics of him, you can see part of the lump. Unfortunately this is the best shot I could get of him.
My hamster went under isofluorane over his head for almost 4-5 mins (I think this was too much?) and the vet aspirate very very little liquid from the lump. It is not blood.
The samples was sent to the lab but it will take about 10 days before we know what it is.
I'm afraid with the lump will be much bigger by then and the risk to remove it is higher.
Is there an absolute need to wait for the results from the lab before surgery? Or can we do an xray or ultrasound to determine more?

Would you please be so kind to advise me. I will present your reply to my vet and I'm desperate to cure Yoda's condition before it gets worse.
Appreciate your reply, thank you again.
Name of owner


 EMAIL TO DR SING DATED AUG 22, 2012
As each vet has his or her own professional opinion on how to treat a hamster case, it is best you do not impose my advices onto your vet as he or she may be most unhappy.

From my knowledge with the younger vets trained overseas, usually in Australia, I note that the vets have been trained to take a biopsy of the tumour first, send to the laboratory to check whether it is cancerous or not. Then they will advise further. Unfortunately, the lab results may take over 7-14 days. But it can take one day, depending on the laboratory. The owner may also procrastinate. Soon, the tumour, if malignant, grows fast and becomes inoperable in a small creature, like the dwarf hamster's subcutaneous tumour, as that was probably present in your hamster.

My approach is to take out the tumour early, send to the laboratory for histopathology after surgical removal. As each vet has his or her own idea on what to do, the fate of a pet depends on the action of the vet consulted and on the pro-activeness and knowledge of the owner.

I am presently in Hong Kong and may not reply to you. My advice is still to be pro-active to seek a vet who is comfortable with hamster anaesthesia and surgery. Best wishes. 

Common cancers in dogs

According to the National Canine Cancer Foundation (USA), 1 out of every 3 dogs get cancer which is fatal in >50% of the cancer cases.

COMMON CANCERS

1. Lymphoma. Cancer of lymphocytes - the immune system cells. Swollen lymph nodes, skin lesions, mass in the abdomen. Usually detect by owner or groomer - lump around the neck, in front of the shoulder or behind the knee. Chemotherapy can extend life and make the dog feel better and eat.

2. Mast cell tumours. 20% of the skin lumps and bumps. May be localised or metastasize (spread throughout body). If not spread, surgical removal witho or without radiation is sufficient.

3. Osteosarcoma. Bone cancer. Long leg bones of large dogs. Amputation and chemotherapy. Signs - limping. Usually has spread when discovered.

4. Skin cancer. Melanoma and squamous cell carcinoma most common. If latter occurs in the mouth or toes, it is more aggressive.
5. Soft tissue sarcoma. Various cancers of the connective tissue. Locally aggressive. Recur as it sends tendrils of tumour cells. Surgery and radiation but recurrence is common. E.g. Haemangiosarcoma usually spreads from spleen. No symptoms till advanced. Spleen removal plus chemotherapy b ut less than one year of life.

6. Mammary cancer. Common in unspayed female dogs and those spayed after the first or second hea. 50% are malignant. Multiple glands. Early detection, simple surgery.

TREATMENT
Diagnosed, graded and stage. Low, intermediate and high grade cancers.
Grade - how much cancer has spread.
Staging - Tests done - blood test, chest X-rays, abdominal ultrasound, CT scans.
Treatment - type and stage of cancer. Those that behave locally are treated with surgery and radiation. Systemic cancers or those that have spread - chemotherapy, including steroids or non-steroids and immunotherapy. Option not to treat - quality of life - palliative care focused on symptom pain relief rather than cure - lower radiation doses, pain killers, steroids, holistic care including acupuncture and herbal medicine.
Immunotherapy - e.g melanoma vaccine. Needs to wait.

PROGNOSIS
Each dog is unique. Hard to predict.
Malignant cancers that can be completely removed - best chance
Aggressive systemic cancers like lyphoma, osteosarcoma and haemangiosarcoma - poorer prognosis.    

Thursday, August 23, 2012

1058. Adding value to your employer's services

Thursday, August 23, 2012

1058. Adding value to your employer's services

 
Macau
Aug 22, 2012

This is my first one-night stay at The Venetian Macao but my 2nd visit. I had a beautiful view of the new competitor, Galaxy Integrated Resort, from my 30th floor window, South Wing. The view just reminds me that competition increases over time and there will be better equipped and richer competitors to beat the incumbent as well as taking business away from the smaller players.

The same situation applies to veterinary clinics in Singapore as well financed (by parents) new clinics look so much prettier and do attract the younger generation who loves glitz and shine. Singaporeans love the attractive external appearance and the same applies to Hongkongers. Competition will become keener as more vets want to start their own practices after some years of experience. 

Galaxy provides 20 minutes free wireless internet access in its surroundings ground floor and a bus service to and from The Venetian Macao to its place across the road. The Venetian Macao charges $160/hour internet access in the room and does not provide complimentary wireless internet services unlike Hotel Panorama in Hong Kong. The Hotel Panorama is a 4-star hotel which charges $100/hour in the room but has free unlimited access in its lobby.

In the end, it is still the service and performance of the employees that count in sustaining the business. Provided the new businesses don't go bankrupt due to lack of revenues and capital to survive the start up period.  Managing the talented employees is not easy as experienced ones are "in demand."

In this visit, I have some pictures of employees who add value to their employers. One example is the Macau tour guide I saw in the Venetian Macao. She was my guide during my last 2 visits to Macau. It was such a coincidence that I saw her snapping pictures for her tour group in the Venetian Macao in which she would bring tourists to view. Tour guides need not bother volunteering photography for clients but she knew that the whole group would not be able to have a group photography without an outsider.   The Venetian Macao has many tourist attractions especially the enclosed shopping area with branded fashion shops and an artificial sky and so tour groups have something to show the visitors. The new Galaxy across the road has laser shows of crystals and singers performing on the stage inside the casinos.

 
tough competition between the new Galaxy Macau & The Venetian Macao    
   
     
tpvets_logo.jpg (2726 bytes) 5579 - 5587. Travel: Macau - The Venetian Macao's singing gondola rowers. Excellent added-value services from employees
This Macau tour guide was happy doing photography for her clients. I did not impose myself on her. She was in a hurry to go somewhere. At the Venetian Macao, I heard loud singing from some of the gondola rowers as they work at making the boat experience enjoyable. I don't hear singing amongst the original gondola rowers in Venice or those add at the Marina Bay Sands Singapore. The audience clapped their hands in appreciation.

Employees who add value to their employers are rare as it is not easy and is time-consuming to connect with the clients. These employees will be in great demand and will earn more in time to come as their reputation spreads to other prospective predatory headhunters and employers! 


Webpage is at:
http://www.sinpets.com/F6/20120827venetian_macao_competitors_toapayohvets.htm



 










Readers who know how to make the images upright, please let me know as blogger.com does not post my upright images the correct way.    

1057. Toilet training an adult male dog - urine & poop marking?

Need Advise on Toilet training
EMAIL TO DR SING AUG 21, 2012


Hi Dr Sing,
I have recently purchased a Pomeranian (9 months). I was hesitant at first as it was a male and was worried about it marking... 2 months have passed and I can only say that it hasn’t progressed much…I am writing to you as i know you have recommended to many in your blogs etc. and also that my Mom's Scnhauzer is actually seeing you for its skin problem.
Noting that this puppy would have spent 9 months in a cage and all things done inside it (Pee, Poo, Play, Eat, Sleep) I went on a reading spree and tried to gather as much information I could to rectify its toilet training. I have bought a pee pan… those elevated meaning it would not soil its own paws with urine.
The setup at my place is as such. The dog is confined to my bathroom in the shower area. Let’s just visualize. Drawing a square. Divide the square into 9 smaller sections equally and in running order.. Top left being quadrant 1, middle is quadrant 2 and top right is quadrant 3.. So the dog is kept in the shower area… quadrant 2,3,5,6… quadrant 1 is the toilet bowl… quadrant 9 is the sink.. The rest is open area.

For about a month, its in the shower area with 80% covered by pee pan.. it poos and pees on it.. but it steps all over it and dirties itself.. 1 full month of  cleaning up everyday after a long day at work. (I was telling myself I needed to be patient)2nd month still no progress.

So a little background to my daily schedule… 7pm – 8pm dinner and at around 9.45pm – 10pm it goes down for its walk… (dog only urinates but doesn’t poo) Then water bottle is removed before I sleep. IT defecates twice.. and pees a number of times… from 8am – 7pm all of us are working and it is confined to that area. Feeding takes place in that area and also the sleeping.
So till now, it still pees and poos outside of the shower area and on the floor.. and it steps and sometimes even lie on its own poo… considering 9 months of ingrained behavior.. it is going to be a daunting task for me.

I am considering, feeding it outside of its confined area to disassociate feeding and playing is going to be same as peeing and pooing. Also I may have to factor in a morning walk.. (problem is it doesn’t do its business outside – so far only twice and its in the afternoon)

Is there any advise you can give? Also is my area to big? I seriously think that I might have to re-train and I am prepared to do so.. I am a little lost and have spent a fair bit getting those trainers to come access my place. And I am sad to say it isn’t working.. My dog is not neutered. It’s about 10.5 months old now. I have also tried laying newspaper all over and it just ends up shredding and making a mess. I am committed to training my puppy and I wish that I could be a good owner and master.





EMAIL REPLY FROM DR SING DATED AUG 24, 2011 
Aug 24, 2012 HK Hotel Panorama lobby lst floor. 7.16am

Hi
Thank you for your email. I am still in Hong Kong today and will be back this evening.

My comments are as follows:

1. Age of dog. Your dog is no longer a puppy. His male hormones have made him a "rebellious" adolescent equivalent. Therefore, it will difficult to train unlike a 3-month old puppy with an impressionable mind, generally. You may need to neuter him.

2.  He has been lying in soiled areas inside a confined cage (in a pet shop?) before you purchased him and so his "cleanliness" instinct had disappeared.

3. A different method of toilet-training may be needed. The following is just my suggestion as each dog is unique and there is no fixed guideline in toilet-training an adult dog.

Assuming the use of a formula of "N-1" where N=number of years, your 9-month-old dog should be taken out of a confined crate with pee pan, to pee and poo every 8 hourly. In your case, I would advise close monitoring as to his elimination habits and time. Take him out to eliminate every 6-hourly. This is not practical if you are working and nobody is at home. That means asking a friend to do it during lunch-time, for example. 

In this method, the dog is fed and then taken outdoors to a place where he can smell his urine/poop daily. Usually this is done after eating or after waking up. This depends on your observation and time. A regular fixed time and routine. Lots of peserverance. Reward with food treat or praises every time on success. If your dog loves food treats, it will be much easier.

4. Urine marking or poop marking. It is most likely that your male dog is urine-marking or poop-marking as well. To you, he is not toilet-trained. Therefore, you have not succeeded despite hard work. Neuter him as soon as possible. Neutralise urine smell of flooring and confine to a crate as a start. There needs to be a fixed routine of eating, drinking and elimination every day till you succeed. But if you have no time, you need help to do the lunch-time training.

5. Alternatively, send him to a professional dog trainer who knows about toilet training. A boarding kennel  operator (dog must have proper vaccinations) or  trainer's home. You may get good results but you need to continue the routine at home for many weeks after successful training by outsiders.

I hope my advice is practical and useful.    

1056. Hong Kong's "Adopt A Pet. Save A Life" bus advert

August 23, 2012

I was at The Sweet Dynasty restaurant having a birthday celebration dinner. A waitress asked me to fill up a survey form in exchange for a free red bean desert. The restaurant was doing a roaring business despite intense competition from shopping malls and smaller restaurants around this Canton Road area. Large upscale stalls with more variety of shops and eateries than the ones at Ion Orchard, Singapore.

So why the survey? The paper reported that the Sweet Dynasty would close on Dec 31, 2012 due to high rents! In Hong Kong, as in Singapore, the Landlords and REITS are the ones laughing all the way to the bank because rents keep going up every year. "Many Chinese restaurants are lucky to be still around," one waitress at Causeway Bay told me of her 8-year-old restaurant still existing. "The Landlord keeps increasing the rent. Now, this place rents around  HK$400,000 - 500,000/month! The income goes to pay the Landlord!"

In 2011, Hong Kong was reported to receive 28 million Mainland China tourists. This group makes up 61% of the tourists. There seems to be no recession in the tourism sector.

After dinner, I saw a bus stopping near the restaurant and was surprised to see the educational advert (3 images posted here). I have not seen such a bus advert in Singapore.

At the subway, there were adverts "Adopt A Dog As Unique As You Are from the SPCA".   
The bus advert shows that the veterinary authority is pro-active in helping the strays.




Hong Kong on Aug 23, 2012 was hot and sweaty, like Macau. The sky was hazy and so I could not take sharp images from the 40th floor of Hotel Panorama.

1056. Vermicomposting. Create a business out of hobbies




A young woman in the USA has a hobby. In Singapore, a few Singaporeans used to have an idea to breed pedigree small breed puppies for sale some 20 years ago. A puppy was selling for around $500. Now I doubt there are many left as the Singapore government clamps down on home breeders, requiring licences.


vermicomposting!

I have started my worm box! I just bought 192 worms from a fish bait and tackle shop yesterday. The worms are Red Wrigglers. They are now living in a plastic box in the soil/ peat which they came in. I fed them some carrot peel and banana peel today! Also covered the top of the soil with shredded newspaper and pieces of a paper egg carton. I’ll keep you updated on how they grow. I found a small yellow vermipod today in the soil. This means that they are reproducing. I’m excited!


EMAIL FROM DR SING DATED AUG 24, 2012

OK. Young people should get into a business mode when they have hobbies. As for you, it would be to create "worms" to sell to the fishermen. . 

Hobbies can also be businesses if one has the energy and knowledge. After all, one needs money to buy tools and equipment to be proficient in one's hobbies e.g. digital photography in my case. But nobody wants to buy my veterinary digital images!

Do you need a government licence? I read in the Straits Times recently regarding a young lady who started a "nanny-matching" business online without a licence from the MOM. She got fined $2000. Now MOM requires $60,000 instead of $20,000 deposit if anyone wants to start up an employment business. I think the Singapore bureaucrats are killing entrepreneurship and increasing the cost of business start ups

1055. Mast cell tumour in a Maltese

On Aug 22, 2012, at 18:20, ...@gmail.com> wrote:

> Dear Dr Sing,
>
> My pet maltese is diagnosed with malignant high grade anaplastic mast cell tumor. A first operation was performed to remove a tumor from her left thoracic flank. The histological report revealed that there is no margin of tumor-free tissue along the deepest border.
>
> Two months after the surgery, a new lump developed on the right neck and was surgically removed. An ultrasound abdo scan also showed that the cancer has metastasized to the spleen.
>
> She began her first chemotherapy: Prednisolone and Vinblastine (8 sessions; 4 x weekly, 4 x biweekly). Her second chemotherapy: Palladia was on for two weeks and interrupted due to a swollen right eye lid.
>
> We seek a vet with special interest in ophthalmology today and she was definite that the swollen eyelid is a malignant tumor, without doing any biopsy. Surgically removal of the entire eye is the only option but the tumor is likely going to reappear. My pet is given a prognosis of 3 weeks.
>
> Aside from the swollen right eyelid, she is still a very active pet and has good appetite. The tumor in the eyelid has pushed her eyeball to the side and looking very uncomfortable. She is given Prednisolone for now.
>
> After doing some research online, most commented that eyelid tumor is benign.
>
> Given that my pet is still in good spirits, I am not willing to put her down in any case. However, the unwelcome tumor in the eyelid seems like an time-ticking tumor. It is getting more inflamed as each day passes.
>
> With your vast experience, I hope to hear from you.
>
> Thanks.
>
> Regards,
XXX
>



E-MAIL REPLY FROM DR SING DATED AUG 23, 2012
Subject: Eyelid tumor in Maltese: Pls help to advice



I will be back from HK on Friday aug 24. It will be best to tel me 96686468 on Sat 10am. Most likely eye tumor is malignant.
Sing K Y



Tuesday, August 21, 2012

1054. Veterinary Images from Hong Kong



I advise all vets to get dwarf hamster tumours excised promptly rather than do biopsy first as this is what the professors may have taught them and as written in the vet text books.




I encourage the internet generation to create beautiful images, but it seems this generation has too much to text and enjoy to do the hard work to create attractive images. I hope the following will be of interest to readers. They took me >1 hour, from 5.30 am to 7.20 am at the reception of the Hotel Panorama, Hong Kong (free wireless only in lobby, HK$100 charge for 24 hours if inside the room where the others are sleeping).

TIPS FOR BETTER IMAGES OF VET CLINICS

1. Sunlight at an angle is best. No sunlight, the image looks dull. It was drizzling in Northpoint, Hong Kong one hour earlier but no heavy rain as in Disney Land on Aug 21, 2012




2. If a passer-by is shown, it makes the image much more attractive. An old woman happened to walk up the clinic. I thought she was a customer. Earlier, a lady with 4 Corgis walked by, but my camera was inside my camera bag!





3. A car obstructed the front view earlier.


4. Suddenly the dark clouds parted and the 3pm sunlight shone at the clinic. There was no time to waste.
5. I sat on the stool of a food stall opposite the clinic and clicked fast. Luckily the stall holder did not chase me away. 











1053. Follow up on the Beijing hamster owner

E-MAIL FROM DR SING DATED AUG 22, 2012 to the Beijing hamster owner
7.39 am, first floor, reception lobby, Hotel Panorama, Hong Kong

 
As each vet has his or her own professional opinion on how to treat a hamster case, it is best you do not impose my advices onto your vet as he or she may be most unhappy.

From my knowledge with the younger vets trained overseas, usually in Australia, I note that the vets have been trained to take a biopsy of the tumour first, send to the laboratory to check whether it is cancerous or not. Then they will advise further. Unfortunately, the lab results may take over 7-14 days. But it can take one day, depending on the laboratory. The owner may also procrastinate. Soon, the tumour, if malignant, grows fast and becomes inoperable in a small creature, like the dwarf hamster's subcutaneous tumour, as that was probably present in your hamster.

My approach is to take out the tumour early, send to the laboratory for histopathology after surgical removal. As each vet has his or her own idea on what to do, the fate of a pet depends on the action of the vet consulted and on the pro-activeness and knowledge of the owner.

I am presently in Hong Kong and may not reply to you. My advice is still to be pro-active to seek a vet who is comfortable with hamster anaesthesia and surgery. Best wishes.



On Tue, Aug 21, 2012 at 3:14 PM, Y@gmail.com> wrote:
Hi Dr Sing,
Thank you very much for your time to reply. I will discuss this with the vet accordingly.
I'm very sorry I will have to trouble you with another question for my other hamster Yoda. He is also 2+ years old, currently on Itraconazole treating a recurring fungal infection (ringworm).
I noticed he had a soft moveable lump underneath (from chest to flank) him early this week and yesterday we went to the vet. The lump wasn't noticeable 2 weeks ago.
Attached is the pics of him, you can see part of the lump. Unfortunately this is the best shot I could get of him.
My hamster went under isofluorane over his head for almost 4-5 mins (I think this was too much?) and the vet aspirate very very little liquid from the lump. It is not blood.
The samples was sent to the lab but it will take about 10 days before we know what it is.
I'm afraid with the lump will be much bigger by then and the risk to remove it is higher.
Is there an absolute need to wait for the results from the lab before surgery? Or can we do an xray or ultrasound to determine more?
Would you please be so kind to advise me. I will present your reply to my vet and I'm desperate to cure Yoda's condition before it gets worse.
Appreciate your reply, thank you again.

----------------------------------------------------------------------------------------------------------------------------------------------


------ Original Message ------
From: "Kong Yuen Sing" <99pups@gmail.com>
To: "Y@gmail.com>
Cc: "Kong Yuen Sing" <99pups@gmail.com>;"daniel sing" <singdaniel@gmail.com>
Sent: 21/8/2012 5:10:25 AM
Subject: Re: Hamster wart
The risk of anaesthesia is high in the older dwarf hamster compared to a younger one.

Much depends on the experience of the hamster vet and the method of anaesthesia being used. If the vet uses isoflurane gas, it depends on the methods used, based on size of tumour and time taken to operate and/or stitch up. Therefore it is hard to let you know how much and how long.

In my experience, this tumour, if it has a stalk, will take 2 seconds to cut it off and therefore anaesthesia by 5% isoflurane gas in a container and not using gas mask is around <60 an="an" anaesthesia.="anaesthesia." br="br" close="close" depth="depth" do.="do." experienced="experienced" fixed="fixed" formula.="formula." hamster="hamster" is="is" know="know" no="no" observation="observation" of="of" on="on" seconds="seconds" the="the" there="there" to="to" vet="vet" what="what" will="will" with="with">

On Sun, Aug 19, 2012 at 3:32 PM, Y@gmail.com> wrote:
Hi Dr Sing
Thank you so much for your quick reply. I will approach a vet who can help me with my hamster's toe.
You mentioned that the high risk lies with the anaesthesia, how much/long of those can be applied to ensure that it will not harm my hamster?
Again, thanks very much!

 

------ Original Message ------
From: "Kong Yuen Sing" <99pups@gmail.com>
To: "@gmail.com>
Cc: "daniel sing" <singdaniel@gmail.com>;"Kong Yuen Sing" <99pups@gmail.com>
Sent: 18/8/2012 6:46:18 AM
Subject: Re: Hamster wart
Thank you for your e-mail.
Surgical excision under anaesthesia is the solution.

1. If there is a stalk attached to the skin, the vet will just cut off the stalk, apply potassium permanganate powder to control the bleeding or apply pressure bandage.
2. If there is no stalk, there will be a big piece of skin cut off, exposing the bone, muscles, ligaments and tendons. If the wound is <5mm after="after" be="be" br="br" cared="cared" for="for" infection.="infection." it="it" needs="needs" prevent="prevent" surgery="surgery" to="to" well="well">3. If there is no stalk and the tumour has invaded deep into the bones, then amputation of the 5th digit + tumour will be the solution. 6/0 stitching may be needed to close the skin wound.
4. Electro-excision, using electricity is an excellent procedure for this case. Electro- excision controls the bleeding.

Overall, the surgery is low risk and is done in 2 seconds. The anaesthesia is the high risk in old hamsters. The bleeding in this surgery usually does not kill the hamster as the bleeding can be controlled. You may need to locate a vet who is comfortable in performing hamster surgery.

Please let me know the good news after surgery.


On Sat, Aug 18, 2012 at 2:12 AM, Y.com> wrote:
Hello Dr Sing,
Thank you for sharing priceless info regarding hamster's condition on the website. I found you on this site and I'm relieved to know that there is a possibility to address the condition.(http://www.bekindtopets.com/animals/20090122Hamster_Roborovski_Wounds_Warts_ToaPayohVets.htm).
I'm writing from Beijing and I seek some advise regarding a growth on my hamster which I now know is called a wart. My hamster is 2+ years old and he had this wart growing on the side of his toe since January this year. Occasionally there is pimple-like 'head' that pokes up, and I have tried to extracted it myself. We also did consulted a vet and she content is skin cells & sebum related.
The wart seemed to have steadied in size, but the pimple-like thing would come back after we extracted it.
I've attached a picture of the wart, and the size of it. Please have a look.
I would like to know if its possible to surgically have this removed safely - cut off at wart stalk?
Will there be a lot of bleeding and is it high risks?
I understand that we have to put him under gas isofluorane.
I appreciate your time and advise, and look forward to hear from you regarding this matter as I will talk to my local vet to have this administered.
I go to an international vet, but hamsters are not common patients here. So I would like to be informed and perhaps refer my local vet to your website for references as well.
Thank you in advance and I really hope to hear from you soon.

Regards,
Y M

Monday, August 20, 2012

1052. Email about hamster's ear "growth"



On Sun, Aug 19, 2012 at 5:20 PM, ...@gmail.com> wrote:
Hi there, I would like to know how much it would cost to check on my hamster's ear. It has a thing sticking out of it an it grew a little bit bigger over the weeks.

Thanks for the help. Hope to get your reply soon.

EMAIL REPLY FROM DR SING DATED AUG 21, 2012
 If it is just examination, it costs $25. I think it needs surgery to remove the wart or tumour. Tel Dr Daniel 9664 0404 to get the quotation and appointment. Thanks.

1051. Holiday in Hong Kong - Aug 20 - 24, 2012

August 21, 2012  Tuesday at 4 am, Hotel Panorama, Hong Kong

I am on holiday in Hong Kong from Aug 20 to 24, 2012. I understand Cantonese and so Hong Kong is an interesting place for me but not for the other two Singaporeans with me.

The Hong Kong tour guide would lapse into Cantonese even though she was supposed to speak Mandarin. This trip, I did not go on the packaged tour as I had gone on it for 2 times previously.

Hong Kong's Hotel Panoram (4-star) was full yesterday Aug 20, 2012 according to the front-line staff. Tourism from China is the main revenue earner for the tourism industry. Some Chinese tourists even asked me for directions to the subway or out of it! 

I flew by Cathay Pacific Airways from Singapore and reached Hong Kong at 12 noon. After checking into Hotel Panorama, I went to the Yung Kee Restaurant in Queens' Road for the famous roast goose. One article in Cathay Pacific's in-flight book mentioned that the actor recommended Yung Kee's goose meat to Angeline Jolie who was very pleased with this dish. Other Hongkonger clients of mine had mentioned this same restaurant for roast goose meat.  I also checked with the staff of the hotel and the gentleman said that locals also go to eat the goose meat and therefore, the price must be affordable.

I reached there at 3 pm. "Sorry to inform you," Julia laughed and pointed to a notice outside the door expressing regrets for the inconvenience caused. "Your goose meat is sold out!". All the way from Singapore and of all days, this was the date and time that the much hyped roast goose meat was sold out. I did not wait for the 5 pm goose and my 2 Singaporeans were hot and sweating and decided to go back to the hotel to rest.

I continued with my walking and street photographs, two of which I am posting for readers to appreciate.



 

Hong Kong is vibrant if you can sense it. There was a woman with her bags sleeping outside the high class departmental shops in Central and no policemen came to move her away. The location is excellent, at a corner of the famous roads of Stanley Street, Queens' Street. Somewhat equivalent to Singapore's Raffles City central business district.

Another good corner location is a fruit vendor near Graham Street. She does not seem to have much business.

I may visit a veterinary surgery in Northpoint today. A break from my daily routine of morning to evening work every day including public holiday gives me a chance to review my practice's future directions and its management in a highly competitive environment where 50 vet clinics are said to exist in Singapore now.