Monday, December 31, 2012

1232. 2 years and 2 months old hamster with breast tumour

Dec 31, 2012
Last hamster case of the year.
"I still have to pay for cremation if the hamster dies on the op table?" the mother asked me about the chances of survival if I operated on her dwarf hamster with an infected black-scabbed leaking pus breast tumour below the neck.
"Yes, you need to pay or you can bury the hamster yourself," I noted that the hamster was alert and had passed several stools indicating he was eating.

"How long more can he live?" the mother asked me.
"Normally, dwarf hamsters live up to 2.5 to 3 years," I said.
"He is now 2 years and 2 months," the mother calculated that it was not worth the $200 to operate and stitch the tumour.
"One month of the dwarf hamster's life is equivalent to 2 years of the Singaporean human life," I said. "If he survives the surgery, he could live, provided the tumour does not come back again." The mother had waited 2 months before her daughter asked her to send him to Toa Payoh Vets for surgery. She could not decide what to do now. "I phone my daughter," she said. "He is her pet.". Her daughter would not decide in view of the high risks of death on the operation table. Finally her her husband said to proceed,

HOW MUCH ANAESTHETIC TO USE?
"Isoflurane gas will not give sufficient time to operate," Dr Daniel said to me.
"This is correct," I said. "Zoletil injection by IM will give you 60 seconds of operating time if the dosage is just right."
How much to give? This is where the judgment and experience comes in. Too little, the hamster needs top up with isoflurane gas to sleep. Too much, he dies.
"This is a very old dwarf hamster," I said. "His body weight is 54 g which is good sized. He is alert and eating and that is good. But he is aged and so the Zoletil dosage should be reduced so that the hamster is alive at the end of the operation."

The theory is easy. The practice is not. How much of Zoletil 50 to give by IM?
Dr Daniel decided on 2 drops which I approved. "They must be full drops," I said as I saw Mr Min's hand trembling as he held the 1-ml syringe to draw out Zoletil drops from Dr Daniel's 1-ml syringe.
"Hey, your hands are shaking!" I said to Min. "Shaky hands cannot be a surgeon! Rest your elbows on the op table to stabilise the syringe."

Dr Daniel injected IM. The hamster has very little muscle and so the needle must just get into the muscle and this can be difficult to assess. Practice makes perfect. "There is so blood on the operating cloth," Dr Daniel said after his injection. "Unusual to see it," I had never encountered such a situation. "It could be from the muscles after injection."

Soon the hamster felt sleepy. I asked Intern Gina to video this case study. The tumour was excised. Lots of yellow pus inside the tumour which was 1.5x1x1 cm globular in size which black scabs. The skin was excised and undermined. The tumour was cut off from the clamped area. Skin was stitched with 6/0 absorable sutures.

It was most likely a malignant tumour which was put nside a plastic bag for the owner to see. The hamster went home alive and that was what the owner wanted. Now, there was another subcut lump near the left inguinal area. "Never operate on two tumours at one time," I said to Dr Daniel. "The hamster will die as op time has been too long." So we left the other tumour  of around 0.8x0.8 x 0.5 cm alone. This was New Year's eve and the famiily wanted the hamster home to celebrate life and a new year.      
  

Saturday, December 29, 2012

1231. Hong Kong Dec 24-27 2012 stories & images

Hong Kong is a fascinating place to visit and for street photography if you look further than its shopping centres and its good food.

Up to Nov 2012, Hong Kong has 44 million visitors, up 16% from the same period last year, according to the Hong Kong Tourism Board. That means more revenue to Hong Kong's retailers, government and people.

Here are my observations on how Hong Kong has become more progressive:
1. Excellent communications with passengers.
Cathay Pacific Airlines staff would communicate their feedback to the passenger before the passenger leaves the plane. For some reason, I was given a feedback form and so I said that the "bacon and eggs" were of poor quality in that the bacon was not "real" bacon. It looked like ground meat with an even layer of fat in between. This roll would then be sliced to give the appearance of bacon. The English bacon and eggs will be the standard if the traveller knows it and so it was a poor quality breakfast. The manager told me she would speak to the food side. So this was immediate feedback on complaints. The overhead light was not working. One crew said I should have told her so that I could change seats or she could "reset" the light. Why not check before flying? This flight was an old Airbus (brushes like thick eyebrows seen at the emergency exit door for disarming or arming the door). The inflight stereo phone set had one plug instead of the usual two and so the adaptor for the head phone could not be used. Regional flights' passengers get poorer facilities.

2. Survey on efficiency
Wait times at the Immigration. There was a person who gave me an electronic counter at the start of the queue and at the end of the queue, I was to return the counter. There was a message saying that the waiting times are being surveyed. This would be good for feedback on management and be useful for any organisation interested in cutting down the waiting times.

3. Interest of the organisation in service staff
On Dec 25, I went to Peking Garden Restaurant for dinner. No prior booking. I was about to leave but the gentleman in charge said that I could eat if I could leave by 7 pm. It was 5.45 pm then. So, he was a flexible manager able to add revenue to his employer. I did not order the famous Peking duck as it was too big for me. The fish was great.

On Dec 27, I wanted to eat at Din Dang Fong near Regal Hotel Hong Kong. It was jammed packed with lunch people.  "It will only take a few minutes," the waitress said as I handed back the queue number. She had the interest of the organisation at heart as she could have not bothered. It seemed that F&B staff is highly motivated to increase the revenue for the company.
3. High rentals keep increasing.
Dec 24, 2012. I had dinner at the Sweet Dynasty Restaurant in Canton Street. The last day for the operator as the rentals were too high and the famous restaurant had relocated to Causeway Bay. "An Apple store" will be opening, according to one Langham Hotel staff.

Canton Street looks much like Orchard Road, only busier. It was closed to traffic on Christmas eve and there was a band playing. Crowds of few thousands stream from the subway and there was crowd control. Nothing like this in Singapore's Orchard Road on Christmas eve.

I saw some policemen towing away a scooter parked outside the shops on Haiphong Road near Canton Road at 5 pm. Serious business in crowd control. A few hundred thousands I would estimate for that Christmas Eve night.

4. Use of IT.
Hong Kong Tourism Board equips its staff with iPad at the branch outlets. More efficient as no staff can remember all info. The lady checked out opening times of Peking Garden Restaurant and location using her iPad. This was efficient and fast.

































1230. Posting to facebook of Stanley Veterinary Centre

Dec 30, 2012 From Singapore to Ms Rachel Woo with thanks
I am Dr Sing Kong Yuen, a veterinary surgeon from Toa Payoh Vets, (www.toapayohvets.com) Singapore. 

1230. Posting to facebook of Stanley Veterinary Centre

On Dec 27, 2012, I took a train and taxi to visit Stanley Veterinary Centre and was most impressed with its well designed layout and facilities and the friendly staff.
I write to say thank you to Ms Rachel Woo, Clinic Manager for her time and sharing of her vast knowledge of the various aspects of  practice management and veterinary medicine and the use of MRIs in Hong Kong. Hong Kong's veterinary services including SPCA's veterinary services appear to me to be most fascinating for closet writers, and more advanced at the MRI level compared to Singapore presently from my conversations with Ms Woo.    



On the way, I was shocked to see a mini-bus advertising a veterinary clinic ("Veterinary Light??) but before I could snap an image to prove that vets are allowed to advertise on buses, my taxi driver had zoomed downhill towards Stanley Village.

Could this be the new kid in Stanley Village, Ms Woo?
In Singapore, bus adverts by vets are prohibited and so I was much surprised to see one in Hong Kong. Ms Woo says they are permitted in Hong Kong.  
I wish Ms Rachel Woo all the best in the years to come Happy New Year. Keep up your good spirits

Friday, December 28, 2012

1229. Veterinary matters in Hong Kong - visit to HK on Dec 27, 2012

Dec 28, 2012  5.50 pm

I visited Stanley Veterinary Centre yesterday 11 am to 12 noon. It is a well designed basement clinic as no space is wasted for veterinary use.

Three consultation rooms, 1 cardiology cum ultrasound room, one operating room, one dental area, one X-ray area, one laboratory, one pantry, one office cum pantry and one room for the boss. I like the elevator which is reserved only for large dogs with some diabilities. A very nice place to work. The hours are incredible good.

"No for people or dog owners? I asked the Manager Rachel who told me that Hongkongers love their pets very much.
"No, no," Rachel said.  I was most surprised. Lifts are expensive to build and to maintain and this is a good idea.

1228. Two videos produced by an intern - Urolithiasis &

By just being an observer is not good for the interns.
Interns learn better when they are hands on and do research as shown by the two videos:

Urolithiasis
http://www.youtube.com/watch?v=x6K4z3VtaXY&feature=youtu.be

Hamster tumours

http://www.youtube.com/watch?v=W4tSj8ubAyQ&feature=youtu.be


It takes a lot of time to mentor the interns and there is much editing and time of over several hours involved just to produce the two videos. The videos are not perfect but these are excellent ones produced by the young man.




Old female rabbit has "breast" tumours

 
 
 
 
 
Dec 28, 2012  4.57 pm. Spoke to owner who wanted a second opinion.

The vet had taken a biopsy, checked under the microscope and had diagnosed tumour. Anaesthetic consent form needed to be signed and as the rabbit is 10 years old, the owner is worried. As to the $1,000 veterinary costs, I explained that much depends on the surgery time, blood tests and histopathology tests and any other medication that the vet would do and the costs could add up.

The vet had lanced the "infected tumour" and the rabbit stopped eating after being fed some medication. However, it was active and eating when medication was stopped. I advised review and if the tumours were small, the surgical costs  would be much lower. Will see him tomorrow 9.30 am.
-----------

Dec 27 (1 day ago)
to me
 
Hi Doc,

3 years ago I brought my rabbit to your clinic to clear matted fur. Now I want to bring it to you for medical attention again.
Rabbit was diagnosed to have 2 cancerous small breast tumours about 2 cm. I need your opinion and about how much for the surgery ? The young unexperienced vet nearby my house quoted 800 to 1k !!!!
Also,when is the earliest appointment I can make with you?

Regards
 
 

--- On Wed, 3/6/09, Kong Yuen Sing <99pups@gmail.com> wrote:

From: Kong Yuen Sing <99pups@gmail.com>
Subject: Re: Enquiry on Rabbit
To: "A...>
Date: Wednesday, 3 June, 2009, 6:14 PM

Thank you. Will see you tomorrow.

On Wed, Jun 3, 2009 at 4:10 PM, A...> wrote:
I just called up your clinic to make appointment for tomorro 3pm. Thanks for your prompt reply.
Kind Regards

--- On Wed, 3/6/09, Kong Yuen Sing <99pups@gmail.com> wrote:

From: Kong Yuen Sing <99pups@gmail.com>
Subject: Re: Enquiry on Rabbit
To: "A...>
Date: Wednesday, 3 June, 2009, 3:06 PM
Estimated cost including anaesthetic, cleaning, dematting and antibiotics, bathing and exam is around $150. Staying for 2 days is $20.00 Pl tel for appointment at 6254 3326.

On Wed, Jun 3, 2009 at 2:17 PM, A...> wrote:
--- Message ---
I have a 4 yrs old female rabbit which has thick hardened clumps of matted furs at bottom area, may i kn do you provide shave down and checkup service? What is the approx cost and earliest appointment available?

Thank you
 

Sunday, December 23, 2012

1226. Trip to Hong Kong

On Dec 24 to 27, 2012, I will be taking a short break to see how Hongkongers celebrate Christmas. I will be visiting the Stanley Vet Clinic on Dec 27, 2012 from 11 am to 12 am and I am looking forward to meeting some Hong Kong vets and learning more.

Every vet practice I visit teaches me some angles and processes of veterinary practice. In this visit, I would like to know more about skin diseases in Hong Kong dogs and cats and the allergen testings.

1225. New microscope at Toa Payoh Vets

Dec 22, 2012

A new microscope with software to take images for research and to show clients was purchased by me today. It is able to display the images on the laptop screen. Unfortunately, its software works only with Windows XP while my laptop has Windows 7.0.


So I had to find older versions and older laptops to use this software. My intern Vanessa going to Melbourne Univ  3rd year in 2013 was very hard working and keen in veterinary science. I hope she would be able to complete her "ringworm" project  as her last day would be Dec 25, 2012. We had been working on this project and others for the past week. At first we used the iPhone but the images were not good.

Yet with this microscope under high magnification of 100X, the images were not clear. She used Photoshop on her own initiative and we could see the structures of the hyphae, microconnidia, macroconnidia and more. Wait for her report.

Digital imaging will not be taught in vet schools and this project broadened her skills and expertise and see some "cool" creatures of the fungal family in the Tricophyton genus.       

1224. Dog transport man's service was undercut by a vet

Today, Sunday, Dec 23, 2012, I spoke to a dog transport man who had transported a Sharpei to be put to sleep due to the fact that the owner was a 70-year-old woman who got bitten whenever she tried to clean his ears. She has 2 Sharpeis and her children from the US were worried about her safety and ability to cope with 2 dogs since she would be in poor health.

I had spoken to her and said it was her decision as to whether she wanted to euthanase 2 Sharpeis or the biting one or none . We had not met before and so I could not say whether the biting Sharpei with the infected ears could be treated for once and for all or would need repeated treatments which would mean veterinary and transport costs. She decided to have the biting Sharpei put down and her son would accompany the ferocious dog to the vet to be euthanased.

According to the transport man, the vet who was handling this case at an outside practice that was not his, said that this Sharpei should not be euthanased as it was just an ear infection. The dog could be sent to the SPCA. Better still, he would treat the dog at his practice as he has a bigger veterinary practice and has his own transport man and facilities.

His remark of having his own transport man made the tranport man wonder why he would be "stealing" his business from him and the other practice. There are all sorts of characters in this world and from some characters, one expect such undermining practices.            

1223. Eye specialist with defective software?

On Monday Dec 17, 2012, I was referred by my GP to an eye specialist in the Gleneagles Hospital as I told him I could see some "bubbles" floating in front of my eyes and an arc of white lights flashing in the left eye at the left side. It could be retinal detachment or worse.

The eye specialist was an experienced person of over 70 years of age. The nurses did the tests for glaucoma (eye pressure), macular degeneration (flashing lights and focusing on a bright central light) and dilated my pupils. Then the specialist put a ring to widen the eyelids and scan my eye retina.

I had asked to see an image of my retina and he said OK. He checked my eyes and said they were OK. What I saw would be floaters due to softness of the inner aqueous humour. I asked to see the images on his scan. I seemed able to see some retinal blood vessel branches when he scanned me.

They were all blurred, like a rose bud closing. He said that the images were blurred. Somehow, this made me wonder whether his software was defective or do all eye specialists have this problem of not being able to show the images of the retina in this modern world?   

Saturday, December 22, 2012

1222. Internship - video production educational videos for vet students and owners

Internship at toa payoh vets



 
Dec 23, 2012
 
Dear Gina

Pl get some videos completed with Vanessa while I am in Hong Kong from Dec 24 to 27, 2012. Vanessa will be completing her internship in 1 day's time. Pl let Vanessa see this email.

VIDEOS NEEDED ARE:

1. Microscopic examination of ringworm in the dog.
Similar format and narration as to what has been produced in the video below:







That means Vanessa has to illustrate (draw) normal hairs and infected hairs as well as show magnified images (1000X) from the new microscope of both types with reference to the Siberian Husky case.
 Include the following 4 images with your other images:


2. Swollen eyes in a red-eared slider in Singapore and the latest video on Dec 22, 2012.
DIAGNOSIS, DIFFERENTIAL DIAGNOSIS and TREATMENT of one case study must be clearly written and videoed. Seven images of feeding multivitamins to the slider by mouth are at: www.toapayohvets.com and they must be used as well as the videos. 4/7 are shown below:











OTHER CASES AT:
2.1  http://www.sinpets.com/F5/20110344swollen-puffy-eyes-red-eared-slider-singapore-toapayohvets.htm

2.2  http://www.bekindtopets.com/stories/20110435puffy-swollen-eyed-red-eared-slider-turtles-drsing-toapayohvets-singapore.htm
Use the images

In the CONCLUSION, provide advices on prevention of swollen eyes and also on "How to tell whether the slider is male or female and its life cycle e.g. male matures at ... years and females at ... years. Some research is needed.

3. Electro-surgery in a hamster. TOOLS, PROS AND CONS COMPARED TO SCALPEL BLADE EXCISION. Most young people will find electro-surgery as a dull subject as they have so many more interesting distractions. Therefore, produce a video fascinating and compelling to educate vet students and pet owners with images, audio and a strong  narrative.

USE THE FOLLOWING IMAGE AS A HOOK - THE HAMSTER WITH AN ARMPIT FULL OF TUMOURS
http://www.kongyuensing.com/cgi/20121133dwarf_hamster_warts_electrosurgery_toapayohvets.jpg

The case is at:
http://www.asiahomes.com/singaporetpvet/misc/0762dwarf_hamster_breast_tumour_Singapore.htm. Expand on this case. Is it a simple surgery?

There is another case of the nose swelling too. Use the images of electro-surgery.

How you are able to integrate the images and tell a good story depends on you.

TOOLS OF THE TRADE

PROS AND CONS COMPARED TO SCAPEL

CASE STUDIES OF INTERESTS (see URLs below) including a guinea pig case.

CONCLUSION. Electro-surgery will not electrocute the hamster or the persons involved. It is a safe technique for certain types of surgery where the scalpel blade cannot be used or used efficiently. If the vet knows how to use the equipment properly and has a sound knowledge of the electro-surgical process to avoid electrical burns and shocks to the persons or animals involved, electro-surgery is a very useful process in veterinary surgery.   

URLs of cases done  at Toa Payoh Vets


Cases and images should include:
3.1 A case to remove a hamster's ear tumour. Extract the essence of the technique and provide visual images. The case is at:
http://www.bekindtopets.com/animals/20100129Electro_surgery_dwarf_hamster_ear_tumours_ToaPayohVets.htm

3.2 Another case at:
http://www.sinpets.com/stories/20090621Electrosurgery_Hamster_Nose_Wart_ToaPayohVets.htm



An example of electro-surgery In another animal is the guinea pig operated by me at Toa Payoh Vets.   e.g. a guinea pig (illustrate with the following case study).
Electro-surgery in a guinea pig at Toa Payoh Vets.
http://www.sinpets.com/F5/20120246electro-surgery-tumour-ear-guinea-pig-singapore_ToaPayohVets.htm


3.2  Other cases done by me at Toa Payoh Vets. Get the "relevant" images onto the video. The images are at:

3.2.1  Scalpel blade excises the tumour
http://www.sinpets.com/hamsters/20121005dwarf_hamster_hand_tumour_toapayohvets.htm

3.2.2  Images of one case of electrosurgery at:
http://www.kongyuensing.com/pic/20110823warts-electro-surgical-excision-dwarf-hamster-toapayohvets-singapore.jpg

The case report is at:
http://www.sinpets.com/F5/201108028electro-surgery-excise-hamster-warts-singapore_ToaPayohVets.htm



3.2.3  A recent case of ear tumour removed by electro-surgery by Dr Daniel is at:





http://2010vets.blogspot.sg/2012/12/1215-are-dwarf-hamsters-dumb.html

Pl let me know by email if there are queries.

Tuesday, December 18, 2012

Building trust - an old poodle snored loudly making mum's sleep impossible.

Dear Gina

Narrate this case study - Building trust and use the video you had done for me so beautifully. Many thanks.  Let Vannessa know and edit this article as I have no time and have to rush to the airport today Dec 24.  Have a good holiday. It is very rare to have two interns who are so diligent and interested in veterinary medicine. Best wishes.


REVIEW -  A loud snoring old poodle affects working mum's sleep. What to do?

The Patient
Male poodle, 14 years old, sneezing, snoring and difficulty in breathing
1. Jul 29, 2012. Toa Payoh Vets, associate vet reported glaucoma and cataract. Right canine tooth root abscess extracted under general anaesthesia.  Most decayed teeth had dropped out. (In Dec 18, 2012, the mum said to me there was a smaller swelling below the left eyelid at this time).

2. Nov 2012. Consulted another vet at another practrice. He accepted medication but not advices on surgery and other tests.

3. Dec 15, 2012. The son consulted me. Blood from nose as he fell yesterday. Sneezing, snoring, breathing difficulty. Heart and lung sounds normal. Surgery advised but worried about risks.

"What are the chances of surviving the anaesthesia?" the young undergraduate was told it was slightly more than 50% after I examined the heart of his mum's very old poodle and found it to be in good state. He said: "50% is not good enough. The poodle could just die on the operating table. Would you say 20%? I have not got the dog operated because the other vet said the same 50% as you. My mum's dog is here today and gone tomorrow if he dies on the operating table! How about some medication?"

"As your dog has normal heart sounds, I assessed his survival as more than 50% but I can't say it is 80% as he is very old. He is blind and has fully developed cataracts in both eyes.

I believe that your dog's snoring is due to an infection of the sinuses near the left eye. Your dog has a large 'eye-bag' below the length of the lower eyelid. It is around 3 cm in lenght. It is most likely an infected tumour. An abscess in this left eye. It spreads the bacteria from there to the sinuses and to the back of the nostrils. The sinuses will be the maxillary sinuses which get infected and blocked as well." I said. "This obstruction and inflammation causes pain and snoring."

"How can that be?" the young man questioned my hypothesis. "The nose is quite far from the left eye!"

"The maxillary sinuses are connected to the nostrils. The inner side of the left eye connects to the nostrils through the lacrimal or tear gland ducts. Any bacteria from the left eye's lower eyelid will spread from there to the tear gland ducts and into the maxillary sinuses and into the back of the nostril. This causes sneezing and painful breathing difficulties."

The young man was not convinced. So I advised a blood test to screen the health of the old dog and if the dog is healthy, the blood test will show it. Then he can decide whether to permit anaesthesia or not.

"The dog did survive one anaethesia in July 2012 to extract the rotten right canine tooth," I said.
"I don't think he will survive another anaesthesia," he said.
"Surgery is the solution. I can give you the medication which would just be a waste of money." A vet can't build trust if he milks the patient just to make his money. But here, the issue is of anaesthetic risk and veterinary competence. Every vet will say this is extremely risky and so most owners will procrastinate till they can't wait any longer.

The blood test showed normal results and the dog was operated on Dec 18, 2012. The dog now objected strongly to direct isoflurane gas by mask before intubation. What to do? I decided on 25% of the dosage for domitor and ketamine IV. The dog needed just less than 5 minutes of isoflurane gas and he was knocked out. Electro-surgery acrosss the lower abscess shot out lots of yellow pus. I used the electrode to cut off as much of the tumour under the skin as possible. The tumour had 4 holes with pus leaking outwards. Pus also leaked out from inside the eye at the medial canthus but this was  going on for some days (the owner wiped it off every day, she told me after my surgery but more pus oozed out again). The old dog did not wake up despite me switching off the isoflurane gas for some 5 minutes as I electro-excised the tumour. A spurting arteriole on the lateral canthus area sprayed me like a machine gun. I used the electrode to coagulate and quickly stitched up the cut with 3/0 absorbable sutures interrupted.

The tip for success in old dog surgery is to operate in as short a time as possible. In this case, the time had stretched to over 15 minutes. If more time is spent, the heart may fail as this is an old dog and other blood vessels may not be as strong as a young dog. Rupture of arteries may happen. The dog may die. So, surgery must be very fast. Bleeding was profuse. There was not much time to be wasted on catching all the bleeders. I closed the wound. As the dog could not get up, I gave 0.1 ml of the Antisedan antidote IM. He got up within 2 minutes with a profusely bleeding eye. I used a bandage to cover the wound. Still the bleeding continued. I used cold compress. However, such bleeding would be controlled by the closure of the wound and so I was not worried. 

Today was a bright sunny morning of Dec 19, 2012. I phoned the mum. She sounded quite happy when I asked about the dog's snoring. "Will you say the snoring is less than 50% as compared to the night before surgery?" I asked. "Yes, yes," she said that the profuse bleeding had stopped, the dog had eaten and thanked me.

In private practice, building trust is important. But good surgical outcome and performance are still very important.

In old dogs, the client considers only one matter. His or her old companion is alive at the end of surgery. No excuses. There was no point doing a perfect surgery removing all bleeders and presenting a dead old dog with no post-op bleeding due to meticulous ligation and coagulation. In this case, the bleeding would stop by pressure control after stitching and it did so by the next morning when I phoned the owner to check on the bleeding status. I told the owner that it was not possible to remove 100% of the tumours and that only 80% of the tumours were electro-excised. As to whether the tumour below the eyelid was malignant or not, I advised sending the tumour to the laboratory as this is part of professionalism. The owner did not want histopathology but she had been informed and that is important for the veterinary surgeon.  

Speed, accuracy and completedness are hall-marks of a good surgeon. In this case, speed is most important.

Saturday, December 15, 2012

New idea from Intern V

Sunday Dec 16, 2012
As part of her internship, I asked Intern V to illustrate the ringworm arthrospores etc. She came out with a new idea, using her iPhone to take images of the microscopic examination of the infected hair. I was most impressed. No more laborous inaccurate drawing.


I could use software to capture the images but I need a special microscope and this costs money. So her use of iPhone was great. Some images will be shown later.

1218. Intern does not write post-card

Sunday Dec 16, 2012

A retiree puts a stray cat here for treatment as the cat had no appetite for over two weeks. The cat was syringed fed and given fluids and was better for a day or two. He drank a lot of water and today he was very ill despite supportive treatment for the past 5 days.

I tried to phone the owner, but his mobile phone was terminated according to the phone service provider. What to do? I asked Intern V to write a postcard in Chinese to post to him. She wrote in Chinese language covering the top right corner.

"Where do I paste the stamp?" I asked her. Young Singaporeans never send post cards nowadays and so they are not aware the position and space for a stamp!  

1217. An old female dog had difficulty peeing. Pyometra or urethra obstruction or both?


Sunday, December 9, 2012

1214. Follow-up. "Closed pyometra" case

 
Two days ago, this 11-year-old female Maltese was operated by Dr Daniel and me. This was a strange case. Total white cell count was very high in the blood test. A swollen abdomen with a globular lump. I said it was a very full bladder on first palpation but Dr Daniel said the dog had peed all urine. An X-ray showed a big globular swelling and I was quite sure it was the bladder. Or was it a large uterus filled with pus since the owner had said that the dog had passed "sticky urine".

Some owners are not very correct with their signs and symptoms of their dog and "stickiness" in urine could be pus being discharged from the infected uterus in this old dog. The owner agreed to X-rays and blood tests. No radio-dense urinary stones were seen but this just meant that the stones would not be visible in the X-rays as not all urinary stones are. The blood tests showed a severe bacterial infection with the dog being toxic.
 

BLOOD TEST ON DEC 6, 2012

Serum urea 22 (4.2 to 6.3), creatinine 188 (89-177).
RBC 4.8 (5.5-8.5), Haemoglobin 9.9 (12-18).
Total WCC  62 (6-17),  N=98%, L 1.7%, M, E, B.
Platelets 131 (200-500) was low suggestive of toxaemia
But what cause this bad infection and how to resolve the dog's problems? As the dog was old, any delay in treatment of toxaemia would result in death. Antibiotics would give a reprieve but there was more to the health of the dog than just bacterial infection. Closed pyometra was a possible diagnosis but the X-ray of a large swelling appeared to me to be that of a swollen bladder.  My abdominal palpation was that of a swollen bladder, as big as an orange. Of course, it could be a grossly swollen uterine body as well.

The next step would be surgery and after 24 hours on an IV drip and medication, the dog was operated by Dr Daniel and myself. Time was of the essence. An old dog was high anaesthetic risk but there was no option other than surgery to resolve the health problem.

SURGERY ON DEC 7, 2012

The biggest bladder ever seen. Like 3/4 of a Thai mango. The dog had been given IV drip 12 hours ago to pep her up for surgery and increase her chances of survival.  More than 15 cm long. I aspirated the urine with a sterile syringe from the apex of the bladder and sent for urine analysis. You can see that the urine is colourless from the images in this webpage.
 

Urine colour: Colourless.
Clarity: Slight turbid.
pH 5.0 (5-8).
SG 1.012 (1.005-1.030)>2250. RBC 90 (Possible haemolysis of RBC in urine).
Bacteria 2+. Crystals Nil.
"Urinary stones might not be radio-dense and so would not be seen in the X-rays," I said to Dr Daniel who was operating. "Flush out the bladder, irrigate it. Put a catheter into the bladder and pass it out through the urethra from the bladder." There was cystitis. Negative crystals in urine do not mean no urinary stones.





 




When Dr Daniel tried to pass the catheter out from the neck of the bladder, there was obstruction. "It is possible that there could be a urinary stone stuck inside the short urethra and not visible on the X-ray," I said. After a few attempts, he managed to pass the catheter out of the urethra and the vulval lips. "There could be a urethral obstruction in the female dog as well." There could be urethral spasms as well but I would bet that there was an urethral obstruction.  Most vets don't pass the urethral catheter via the vulval vestibule as they deem it difficult to do it, unlike in the dog. Dr Daniel irrigated the bladder with saline and stitched the 1-cm incision with two layers of 3/0 mono-syn sutures.

"Check the neck of the bladder for tumours," I said. "Extend the incision of the skin and linea alba caudally. As Dr Daniel pulled up the bladder, we could see a large reddish lump at the neck of the bladder on the outside. I took an image for the owner to see as it was not possible for her to be at the operation room.  This swelling of around 8 mm x 8 mm x 4 mm could be the cause of difficulty in urination.


A swollen abdomen Massive bladder Bladder incised to check for non radio-dense stones Urethra catheterised. There was an obstruction
 
Bladder sutured. A growth is seen at the neck of the tumour Pus in infected uterus removed Dog has no difficulty peeing after surgery  
DISCUSSION WITH THE OWNERS
Today was the first time I met the father and two young adult daughters as Dr Daniel was the vet in charge of the case. "Did the dog have difficulty passing urine?" I asked.
"Yes," one daughter said. "She took a long time to pee and only a few drops of urine came out."

I reviewed the record on Dec 6 when the dog was admitted. "Urine sticky. Stools red and yellow past 2 weeks. Appetite decreased. Vomited once."  Pyometra was suspected but the onset of heat was unknown. In conclusion, there was a case of pyometra and urethral obstruction caused either by a non-radio-dense urinary stone in the urethra or the neck of the bladder tumour. The "urinary stone" was not seen as the urinary catheter appeared in the vulval area as there was flushing of the urethra from inside the bladder before removing the obstruction.

Many old intact female dogs do suffer from pyometra and in this case, there was pyometra with the uterine body wall being as thin as a piece of paper, leaking out the bacteria into the blood stream as well as into the bladder, in my observation. Fortunately, the uterine bodies were removed before they ruptured. Similarly for the bladder as it would rupture if the urine could not be passed out, as you can see how thin the wall was, from the images.

More than 7 days had passed, now being Dec 16, 2012 as I edit this report. The owners were happy that the dog leads a normal life and has no difficulty in peeing. Two weeks had passed before the owners consulted the vet. Fortunately, the dog did not suffer kidney damage in the delay in seeking treatment and that the appropriate treatment was given. The old dog has a new lease of life.

Updates and images will be at:
http://www.bekindtopets.com/dogs/20121216dysuria_pyometra_toapayohvets.htm



UPDATE:
Dec 21, 2012. The dog came for stitch removal as there was a slight stitch breakdown in the last stitch nearer to the vagina. Dr Daniel removed the stitches which were absorbable.

"There is some sticky dicharge from the vagina," the lady owner said that the dog now could pee normally and was OK.

"Most likely the vestibule in the vagina still has some pus left over from the uterus," I told her. "Since the infected womb has been removed, this pus would disappear soon. There is nothing to worry and is a common occurrence in some post-op cases of dogs with pyometra spayed."

In conclusion, the surgical outcome was good and the 11-year-old dog was alive. It would be a happy Christmas for the family.    

Thursday, December 13, 2012

1215. Are dwarf hamsters dumb?

Yesterday Dec 14, 2012, I spoke to the lady owner about her hamster's tumour below the right ear. Dr Daniel had done electro-excision. For such small tumours and for ear warts, he was not in favour of electro-surgery. A scalpel blade would be just as effective. "No," I told him. But it will take time and patience for me to show that electro-surgery is useful in some hamster tumour excision.

I discovered that Australian vet students don't get lectures on hamsters as nobody in Australia is allowed to keep hamsters as pets! So, a vet graduates without any hamster lectures. This happened to me as a vet student in Glasgow University in 1969-1974. My professors did not mention the "hamster" word too! But in Singapore, many dwarf hamster owners are around although I don't know how many.

I would have taught dwarf hamsters are dumb. But this Indian lady in her 40s told me that she had 3 hamsters and they were clever creatures. Hamster No. 1 was bought 2 years ago against her father's objection of keeping any pets. The older generation of Singaporeans deemed pets as a waste of money when so many people are starving i this world. Yet 2 weeks later, the retiree father was very fond of this hamster. Hamster No. 2 was bought from another place. This hamster was the most intelligent. He would not try to escape or hide under fridges. When placed on the dining table, he would inspect the dishes of the adults and then go to his own plate to eat his food. I saw her mobile phone video of this hamster on the dining table.

Presently, Hamster No. 3 with the tumour on the skin below his right ear. He would show his anger by climbing up the crate's railing and jumping down or refused to come out from his house. For example, if he was not given the correct brand of brand. "He likes only Gardenia," the lady told me. "If I give him another brand, he would go wild and climb up the railings and jump down many times."
The lady continued: "On another occasion when I used the pink colour of the cottony bedding instead of blue, he would scatter the pink ones and would not settle down. I had to go to NEX shopping mall to buy the blue ones."

"Every morning, my sister had to tell him that she is going to work as he rushes out excitedly to greet her," the lady said. "He even knows when my sister is coming back from work as if he has a clock."

"Is he the most intelligent of the 3?" I asked. "No," she said. "Hamster No. 2 was the most intelligent."
Hamster No. 3 would run to hide under the fridge if let to roam free, unlike Hamster No. 2 who harboured no thoughts of escaping under door gaps or into corners. So, I guessed that was why she considered Hamster No. 2 as most intelligent of the 3.

"Do you believe in reincarnation?" I asked.
"Sometimes I think our relatives have been re-incarnated as hamsters."
She could narrate more stories and such stories should be recorded in audio as the flavour of the actions of Hamsters 2 and 3 could not be captured in  text.

 (LATER)

1. Weight 69 g. The 2nd heaviest in the last 3 days since the black and white one we operated upon was 71 g.
2. Zoletil 50 IM not 100% effective. "Top up with isoflurane gas," I advised.
3. Electrosurgical excision was in <1 bleeding.="bleeding." nbsp="nbsp" no="no" second.="second.">4. A 3rd-year student for 2013 studies from Melbourne Univ was on internsihp for 2 weeks and I have asked her to  write about this electrosurgery in the dwarf hamster. The hamster with the ear growth was also operated using electrosurgery. 


Website and updates will be done later at www.toapayohvets.com --- goto hamsters.


   

1215. Follow up on the epulis Golden Retriever - ticks

I reviewed this case of the 12-year-old Golden Retriever who came in as he was "panting" after eating and after exercise walking for the past 3 days. No such panting before that. What was the cause?

This dog was operated in July 2012 for a large epulis which was bleeding.
See case at: http://www.sinpets.com/F5/2012072gigantic_epulis_labrador_toapayohvets.htm
He had a "gingival biopsy" of the mass in 2009 by another vet. The report stated "fibromatous epulis of periodontal origin". It said that it is generally a benign entity in the dog and complete surgical excision isusualy difficult due to indistinct boundaries between the epulis and normal gingival tissue. That was in Dec 2009. However, the lump bled a lot and so the owner came to me and I advised surgery n July 2012. 2.5 years had passed. Gum tumours are best excised when they are small.

Taking a sample for tissue biopsy is part of the process to ascertain whether it is cancerous or not.  This adds to the cost and so I usually do not advise it. Just excise the mass and send to the lab for checking of its cancerous nature or otherwise.

I checked the gums. They were OK and reddish pink.
"Has the dog been exposed to ticks recently?" I asked. The two gentleman owners had said that their dog never had ticks for many years but he had a lot of ticks just 2 weeks ago. "Every day, we pluck out the ticks," the owners said. "But now he is tick-free."
"You could have used a tick bath or dip," I said.
"Well, I bought a tablet from the internet and all the ticks died. There are various suppliers and prices vary."
It seems that this tablet worked well. The owner sms me the name: Nitenpyram. by Bob Martin. Owners nowadays do their research and experiment.  They should check out the effects and side effects of the medication.


http://www.drsfostersmith.com/Rx_Info_Sheets/rx_nitenpyram.pdf has info on Nitenpyram. Its use to kill ticks is not known. It is effective to kill adult fleas only.

So what is the cause of the panting? The dog does not have heartworms nor severe heart disease. No fever. Could it be tick fever?  The owners did not want a tick fever blood smear test. Nowadays, owners with research knowledge can be demanding. It is up to how the vet is able to communicate with such well informed owners. If the vet does not know how to communicate and if this dog comes down with tick fever later and dies, the owner will not blame himself as he had sought the vet's opinion. As at yesterday, there was no anaemia and no fever. So, it couldn't be tick fever. It is not as simple as that as tick fever could be at its first stage.   

Sunday, December 9, 2012

1214. Follow-up. "Closed pyometra" case

Two days ago, this 11-year-old female Maltese was operated by Dr Daniel and me. This was a strange case. Total white cell count was very high in the blood test.. A swollen abdomen with a globular lump. I said it was a very full bladder on first palpation but Dr Daniel said the dog had peed all urine. An X-ray showed a big globular swelling and I was quite sure it was the bladder.

BLOOD TEST ON DEC 6, 2012
Serum urea 22 (4.2 to 6.3), creatinine 188 (89-177).
RBC 4.8 (5.5-8.5), Haemoglobin 9.9 (12-18).
Total WCC  62 (6-17),  N=98%, L 1.7%, M, E, B.
Platelets 131 (200-500) was low suggestive of toxaemia


SURGERY ON DEC 7, 2012
The biggest bladder ever seen. Like 3/4 of a Thai mango. The dog had been given IV drip 12 hours ago to pep her up for surgery and increase her chances of survival.  More than 15 cm long. I aspirated the urine with a sterile syringe from the apex of the bladder and sent for urine analysis.

Urine colour: Colourless.
Clarity: Slight turbid.
pH 5.0 (5-8).
SG 1.012 (1.005-1.030)>2250. RBC 90 (Possible haemolysis of RBC in urine).
Bacteria 2+. Crystals Nil.
"Urinary stones might not be radio-dense and so would not be seen in the X-rays," I said to Dr Daniel who was operating. "Flush out the bladder, irrigate it. Put a catheter into the bladder and pass it out through the urethra from the bladder." There was cystitis. Negative crystals in urine do not mean no urinary stones.

When Dr Daniel tried to pass the catheter out from the neck of the bladder, there was obstruction. "It is possible that there could be a urinary stone stuck inside the short urethra and not visible on the X-ray," I said. After 2 minutes, he managed to pass the catheter out of the urethra and the vulval lips. "There could be a urethral obstruction in the female dog as well." Most vets don't pass the urethral catheter via the vulval vestibule as they deem it difficult to do it, unlike in the dog.

"Check the neck of the bladder for tumours," I said. "Extend the incision of the skin caudally. There was a large reddish lump at the neck of the bladder on the outside. I took an image for the owner to see.


DISCUSSION WITH THE OWNERS
Today was the first time I met the father and two young adult daugthers.
"Did the dog have difficulty passing urine?" I asked.
"Yes," one daughter said. "She took a long time to pee and only a few drops of urine came out."
I reviewed the record on Dec 6 when the dog was admitted. "Urine sticky. Stools red and yellow past 2 weeks. Appetite decreased. Vomited once."  Pyometra was suspected but the onset of heat was unknown.
 

Saturday, December 8, 2012

1213. Sunday Dec 9, 2012's interesting cases

Sunday Dec 9, 2012

I seldom have expatriates as clients and was surprised to encounter 3.
Case 1Shedding Husky. Buinsessman, his wife and pre-teen son who loves tennis.
Husky, female, 1 year 4 months. Shedding hair for last 2 weeks. "Hair all over the house," mum would say. Yet I did not see any hair loss as the son combs the dog daily.

"Hair shedding is common in Huskies," I said. "Causes include hot weather, ticks, recent heat and after birth."

"Was the dog carrying a toy in her mouth and protecting it?" I checked there was no milk in the nipples nor were they enlarged.
"Yes, one month ago. She would not part with it and was very possessive."
However, the left ear was very itchy and the dog would move her head away whenever I tried to examine it. A wet dark exudate presented on the cotton tip. The right ear was also itchy. So the dog tried to relieve her itchiness by using her hind legs to scratch the flanks and causing hair loss.

The solution was to treat the ears with proper ear drops and to plan to breed the Husky on the next heat. The father wanted a pup from her just for one litter. So I advised properly timing and everybody was happy.

Case 2. "Debarking" cats.
"I have never heard of anyone asking to debark cats," I said to the Caucasian caller over the phone today at 3 pm. He said that the cat would make loud noises and this may wake up his baby, due to arrive in May 2013.

"Other than this habit of making loud noises that may wake up the baby at 3a.m, he is a sweet gentle cat. I don't want to send him to the SPCA or get rid of him. Is it possible to debark him?"

"At what times is your cat vocal?" I asked.
"Early morning and late at night."
"Just like a cock crowing at dawn?" I asked.
"Yes, like a rooster but he does it at night too. What do you propose? I have him neutered at another vet at 5 months of age. Now he is 11 months old. He has been doing that since he is a kitten."
"You are the first person to enquire about debarking cats."
"That is why they refer to debarking. It is meant for dogs," he said.
I advised boarding the cat for one month to change his behaviour or crate him and cover the crate with a big towel to give him security and changing his routine. Will this work? The expat thanked me and might let me know.


Case 3. Two macadema nuts in a dwarf hamster.The Caucasian man brought his plump hamster for a review 2 weeks after treatment from Dr Vanessa. He had been to other vets but the hamster still has complete hair loss and redness on the lower body and the legs, on the back spinal area and left ear area. This has been going on for some weeks. The lower skin and neck were not so red but hairs did not grow back.

I saw scales on the shoulder area and the Mr Min could easily pluck out the hairs for a microscopic examination for ringworm. A few hairs had ringworm but most were OK. Was it skin mites? Or management? The hamster had been eating various kinds of food and had to climb into a feed bowl which was rather sharp. "Change to a lower feed bowl with smooth edges," I advised also putting the hamster on paper towels for a month."

This could be a case of management as the hamster was free to roam in the room. There are many causes and it will take time to know. In any case, I noted that the skin below the left ear was hairless and the left cheek pouch was hard. "There could be an impacted pouch," I said. "I need to give it a little bit of anaesthesia gas and check the pouch."
"Will it be safe for my hamster?" the man had said that his hamster had been passing blood for 5 days earlier.
"Yes, it will be safe as it is gas anaesthesia and takes a few seconds."
The left cheek pouch was impacted with two large cream-coloured macadema nuts and the hamster was trying to dislodge them by scratching till the skin below the left ear was bald.
"My wife is a pastry chef," the gentleman was surprised to see two big nuts of around 6 mm in length.
"No more macadema nuts or any other food other than a good quality hamster food," I advised bathing the hamster with the anti-fungal shampoo, clipping the hair, using paper towel as bedding for 4 weeks and reviewing after 4 weeks. 
 So, this Sunday was quite interesting with 3 different types of animals posing challenging problems for me. 

1212. "Tiny" ear tumour on dwarf hamster email query



 
On Sun, Dec 9, 2012 at 8:38 AM, Z..@gmail.com> wrote:
Dear Sir/Mdm,

I have just discovered a tiny growth on the ear of my hamster. Attached are the pictures for your reference.

I would like to know if there is any treatment for my hamster and the cost of it.

If so, pls advise on an appointment date and time. Thank you.




Regards,
Z
 

EMAIL REPLY SUNDAY DEC 9, 2012  9.28 AM FROM TOA PAYOH VETS
I am Dr Sing from Toa Payoh Vets. Thank you for your email. The "tiny" ear tumour needs to be removed by surgery and under anaesthesia. The ear canals need to be examined for other growths.

The approximate cost is $150-$200 for consultation, anaethesia, surgery (+/- stitching) and medication. Appointment is by phone 6254-3326. Bring hamster at 9.30 am and it goes home by 4 pm usually. Best wishes.   

Thursday, December 6, 2012

1211. Straits Times Classified to sell mini-maltese


A silver Mercedes parked outside my Surgery. A fair lady in her 40s, wearing sparkling diamond ear rings and low cut  came to my surgery with 2 mini-Maltese pups and their parents for vaccination and her domestic worker. She was referred to me by Boon who I believe to be a dog breeder.

I could just vaccinate and she would rush home but I am concerned she is keeping too many puppies.
"The mini-maltese pups are getting bigger," I said. "Are you selling them?"
"I sold one at $1,500," she said. "But my son is in the US studying and does not help me to advertise in the internet."
"As they are young, it is best to sell them to a pet shop if you don't want to do it yourself," I said.
"Pet shops offer me $400/pup," she said. 
I advised her to advertise 3 lines in the Straits Times, Classified 74, Pets/Pets Care, preferably on a Saturday.

2 Mini-Maltese pups for sale. $1.2-$1.6K. Vaccinated. Tel: XXX
This classified cost around $39.00 and should get much response.

"You may get con-men who takes your pups outside the house and run away," I warned her.
"I will ask my two maids to be careful," she said. "I don't accept deposits."
"Not many people carry a thousand dollars. You can keep the mum till the buyer returns with the balance of payment."

Grown up sons overseas nowadays are too busy to help mum to advertise the puppies for sale.  Vets must be proactive to help clients who have excess pups. Otherwise they end up with too many as the laws permit 3 dogs/private residence and 1/public residence. 

1210. Follow up: British Bulldog - stone analysis is struvite stone

Dr Daniel made a follow up phone call to the owner yesterday Dec 7, 2012.

"Lots of bleeding from the operation area," the lady owner said. So, she brought the dog over to the surgery at 7.30 pm. Dr Daniel took out the plaster. I noted there was no bleeding. The dissolvable stitches (simple interrupted) were in place. Dr Daniel took out the stitches.

"You should be feeding the Bulldog 1 and 1/2 cans of S/D per day based on her weight instead of 2/3 cans".  The dog is now trim and on the thin side.

"I feed one can only," she said. "I note that the Bulldog no longer pants and is more energetic. So, I feed 1 can so that she would not put on weight!"

Owner compliance is much difficult. At least there is no blood in the urine so far. The stone analysis show struvite stone. A peculiar spiky one.

The dog had dry dog food when she was around one years old but the owner claimed that the dog was on home-cooked food from year 1 to 4 as a vet had told her that the skin disease would go away when the dog is fed home-cooked food. Yet such a large stone of 1.5 cm x 1.5 cm x 1.5 cm  could not be formed overnight. It would take months to form.

Webpage:
http://www.sinpets.com/F5/20121206_bulldog_urinary_stones_toapayohvets.htm

1209. Hamster from Malaysia email query



On Fri, Nov 30, 2012 at 5:01 PM, F@hotmail.com> wrote:


Hello Dr Sing Kong Yuen,

I'm from malaysia and i came across your site everytime i need to search information whenever i suspect my robo hamster are not feeling well which is not a good things. Past few weeks my 2 years old robo hamster been sctraching more than usual & i notice some bald patch. I took him to vet & the vet told me that my robo hamster are having demodex mites if i'm not mistaken. I couldn't find much information about this mites. If you could kind enough to explain more about this mites to me as It's kinda hard to find vet that take small animals as hamster at malaysia here.

The vet giving us some oral medication to be feed to our hamster with syringe twice per week. Today was my hamster 2nd medicine after last 3 days we have feed him with his 1st medicine. I have not seen any improvement on our hamster. Am i over worried dr. sing? When i'll see improvement on my hamster after the medicine? Is this demodex mites dangerous? is it serious? Can it be cure? He is my 1st hamster & it's very sad to see him suffer. It's worse than having myself to sick Sad smile

Thank you.

Regards,
F


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

Dec 7, 2012 REPLY FROM DR SING

Pl accept my apologies for the late reply.

Skin diseases in hamsters are due to many causes including trauma, mites, fungal, bacterial, allergies and poor management. I am sorry I can't help you via the internet correspondence. 

1208. Calcium oxalate stones in a 10-year-old Jack Russell


The Jack Russell had difficulty urinating. X-rays showed two small stones. Urine analysis showed no bacteria but calcium oxalate crystals 3+. Blood was present in the urine.

"U/D will not dissolve the calcium oxalate stones," I said. "Unlike S/D diet which can dissolve small struvite stones."

Not every dog with calcium oxalate or other urinary stones need surgical removal. However, in this case, blood is still being passed with the urine and there is urethral obstruction of urine flow. Since U/D diet does not dissolve the calcium oxalate stones, but just prevent formation of more stones, it is best to remove such stones in this old dog and be careful.

1207. 12-year-old cat with two ingrown toe nails

Dec 6, 2012

Many phone queries cannot be answered by the receptionist as they are technical. Should the vet answer phone calls? That sounds a bit inappropriate for the top dog in a veterinary practice. However, answering phone calls should not be a shameful task as many prospects who receive satisfactory answers to their technical queries will turn up.

Sometimes, I think they are sophisticated pet owners who want to test the veterinary practice staff before they part with their hard-earned money. An old experienced vet nurse who have worked in practice for more than 10 years should be able to handle such queries but they are now as extinct as the dodo.

Two days ago, I had a phone call from a lady who asked if I declaw cats.
"Not as a routine," I said. "Only in exceptional circumstances where there is a need to do it. It is considered cruelty."
"Do you declaw the back legs as well?" she asked.
"Not necessary to do so," I said. "The cat uses his front legs to claw sofas, curtains and furniture, not the back legs."
"Well, I had a cat who uses her back leg to scratch my parquet floors!"
"Life is full of surprises and behavioural changes," I said. "This is the first time I hear a cat using the hind legs to scratch."
She thanked me and I learnt something new about cats.
Yesterday, the tanned lady in her late 30s came with her black and white cat. Her cat had two ingrown toe nails on the right fore paw. She work overseas and her maid did not dare to clip the nails till the dew claw and the 2nd digit claw curved into the flesh. The nails had exploded in width and the cat was not happy if you touch it. She was still a gentle female spayed cat though.

"A vet told me to just clip the nails and if the nails over-grow, to clip them again."
"That is the standard treatment," I said.

She wanted a permanent solution as she worked overseas and had no time to get the cat to the groomer or vet to trim off the ends of the overgrown nails. Time is short for city living folks and it is short for me too. So, I understood her situation but she had to decide whether to get the cat declawed.

"Only the two claws need to be removed," I said. I did not warn her that her cat might die under the sedation as this was a very short surgery and no cats ever die when the anaesthesia and surgery is as short as less than 5 minutes. For legal reasons, the vet has to inform the owner of the risks of anaesthesia and death on the operating table and asked her to sign the "informed consent" form.
I did not think this was necessary in this case.

"Remove the Phalanx one at the P1 and P2 joint," I said to Dr Daniel. This surgery should be a piece of cake for him unlike cystotomy or perineal hernial repair.  He operated and on the 2nd day, the lady came at 5 pm.

I was present as Dr Daniel had gone to the SAFRA gym. "Check the left front paw," I said to the sun-tanned lady with shoulder strapped blue dress. She had purchased a large luxurious towel bought from IKEA to cover the carrier.

"I thought you use the towel to wrap the cat," I said.    
"No," she laughed. "Once this cat peed through the door of the carrier onto the car seat. So, now I wrap the carrier with this big towel to prevent such incidents!"
A red car was waiting outside my Surgery. After she settled her bills with her credit card, she wrapped the carrier with the towel and went to the car. An elderly man came out and opened the door. "You must be the father," I guessed as the age difference would be twice. "Yes," he nodded his head. I said goodbye to the happy lady.

This old cat now has no kidney disorders as she had a blood test but the lady would continue feeding her the kidney diet. "The eosinophils at 9.6% is high. The platelets at 194 (300-800) are low."

"Why?" she asked.
"It is possible that the cat had ingested some poison or some application had been put on the ingrown toe nails."

This was a mystery as she said she did not do it. 
The backside hair loss on both sides would be less of a mystery. I massaged the anal sacs and 1 ml of dark chocolate oil shot out. "This would be impacted anal sacculitis," I said. "The hair should grow back after some time."


 






   

1206. Closed pyometra in an old Shih Tzu X

Dec 6, 2012
Ideally, it is best to use evidence-based medicine to get a diagnosis of closed pyometra. X-rays and blood tests are what the vet professors teach the new graduates.

However, in real life, there are clients who can't afford the tests. In this case, I usually get a good history and abdominal palpation of a big swollen uterus and operate to remove the uterus. There is always a possibility of no pyometra but a swollen bladder or an abdominal mass but economics prohibit more exploratory tests.

"It is how you present your case," I said to Dr Daniel. "If the owner has budget constraints, two X-rays add to the vet costs. There is a big orange-sized swelling in the abdomen. It could be the bladder but you said Mr Min had seen much urine being passed. Therefore, this globular swelling could be the uterus distended with pus."

The owner did not know when the last heat occurred. However there was vomiting yesterday and a complaint of sticky matter in the "urine." The dog was not eating much for the last 10 days. These clues point to pyometra. X-rays and blood tests will confirm.

The owner decided on X-rays.




There is closed pyometra, according to the X-rays. The uterus had swollen so much that the intestines were displaced forwards.

"Don't operate immediately," I said. "Give the IV drip and antibiotics 24 hours and operate after that. This ensures a better chance of survival, in my experience."

The owner will discuss further at around 7pm. There is no alternative but surgery to cure this dog. However, there is financial hardship for some owners and the newly graduate vet must the heartlander economics and provide the least cost surgery.


---------------------------------------------
Friday. Dec 7, 2012. The dog is better after IV drips yesterday but the rectal temp is below normal at 37.7 C.


The owner agreed to a blood test.
1. Kidney disorders. Urea 22  (4.2-6.3). Creatinine 188 (89-177).
2. Total WCC 62 (6-17) with N=98%. L=1.7%, M 0.3%. E & B =0%
3. Platelets 191 (200-500).
4.  Haemoglobin 9.9  (12-18)
5.  Red cell count 4.8  (5.5-8.5)

Surgery is necessary today but the risks are high as the dog has septicaemia and may die on the op table.

Tuesday, December 4, 2012

1205. Mynamar stories - An unhappy girl

On one afternoon in Dec 2012, I was at the office of Khin Khin Employment Agency. A thin fair lady in her late 20s came into the office to ask her to find an employer after working 6 months with the present employer who had told her that her services would end on Dec 15, 2012.

"Why do you want to spend more money in agency fees when you have a job now. You just put back $500 into your POSB account, apologise to your employer and complete your S pass contract," Khin Khin said loudly. "You should not have taken out the money as your boss had told you not to."

I was surprised that she could be sacked just for this $500. "Can you find the $500 to put back into the account?" I asked. "How much agency fee did you pay to get this job?" She said she had the money and had paid $4,500 agency fee.

"How much are you getting?" I asked. She said she got a good pay but she could not tolerate being scolded by her boss and colleagues.
"How many days off per month do you get?" I asked.
"4 days off," she said.
"So you have a good working condition," Khin Khin and I said. But there must be more to it than the $500 disobedience. I tried to help her by asking for her boss phone number since Khin Khin might not have the patience or ability to salvage this job loss situation with a Singapore employer.

The girl did not have the phone number. So I surfed the internet, got the company name and phoned the mobile number displayed.  It was her boss. "Who are you?" she asked me. "I am Dr Sing from Toa Payoh Vets," I said. "I am just trying to help your employee who said she would put back the $500 into the savings account and I hope she would get her job back."

"It is not the $500 which she already withdrew since the first month of work. Her agent had talked to her and I had waited for 6 months but her work attitude was bad. She swept the dirt under the table and this is 'pantung' (bad luck) to a Peranakan. She also smashed the curry puffs. I have given her Dec 15 as her last day and she has one month to look for an employer."

So this was an unhappy girl who had her first job in Singapore. A job so difficult to get nowadays as the Government clamped down on approvals even for employers who have the quota. Just a rejection letter for most employers. And there are so many young Myanmar ladies who are looking for a job in Singapore to support their families and to improve their standard of living. Yet, this unhappy girl showed her tantrums and misconduct.

She nodded her head when I told her that she had swept the dirt under the table and smashed the curry puffs in anger. "You must be from a rich Myanmar family," I said. Spending $4,500 on agency fees and more expenses just to get a job in Singapore cannot be affordable to the average Myanmar girl. "No, I am not", she said. A graduate in Myanmar with a good command of English and good looks may earn US$300-500 per month in a big company. It is just not easy to get a job in Yangon for higher pay. There are 60 million people in Myanmar and competition for jobs must be much more intense unlike the young Singaporean counterparts who can pick and choose their employer.

Poor work attitude afflicts many from the younger generation in their first job when the employment vacancies are high. As for this unhappy girl, I don't see any hope of her getting another job as there will be newer girls with no "leaving the Singapore employer before the end of contract - a red flag for employers" arriving in Khin Khin's office to look for jobs. Many of them can converse in good English and Mandarin, esp. from the Kachin State which is near to China.
P.S. According to one Myanmar lady in her 50s, she said that the Myanmar government stopped the teaching of English in primary schools in 1962. Those who studied English were ridiculed. So, the new generation of Myanmar nationals can't speak English proficiently.