Friday, October 31, 2014

Urine-marking and caterwauling male cat

Hi,
I have a male cat, 8 months old now. For the past few months he has been very good & well toilet trained.  Recently, for about almost 2 weeks now, he has been meowing loudly at night especially, as if he wants to go out. Also, he litters everywhere in the house when actually for the past few months he always do it in his litter box. Is it advisable to sterilize him? Will it reduce the litters? It is getting more frequent now. Also, may I know the quotations for sterilization in your clinic?
Thank you for taking time to answer my queries.

Regards,
Name of owner
Sent from my iPhone

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REPLY FROM DR SING


Oct 30, 2014
Neuter will help stop urine marking n caterwauling meowing loudly. Cost is $150 including painkiller  antibiotics. Pl let me know or tel 62543326

Email query on guinea pig's vocalisation and urinary stones


Hello,
 
My husband and I have two male guinea pigs – Fred (2 ½ years old) and Alvin (1 ½ years old). About a week and a half ago, we noticed that Alvin (who is usually a very quiet piggy) started to become very vocal. Although there was nothing alarming about the noises he was making, we picked-up on the fact that Alvin was making the noises while he was going to the bathroom (usually while peeing).  Again, there was nothing concerning about the noises -  in fact, he makes the same noises when cuddling with us or while romping around the cage.  
 
Just to be safe, we decided to bring him to our local vet.  After examining Alvin, the Vet said he was likely suffering from a Urinary Tract Infection and gave us a 14 day supply of Baytril SA.  After being on the Baytril for 48 hours, we noticed that Alvin was making less noises while peeing.  We assumed the Baytril was working, but just to be sure, we brought a urine sample to the Vet (about 48 hours after Alvin started on the Baytril).
 
The urine results showed: a PH of 8.5, Blood at 3+; Calcium Carbonate Crystals at 11-20; and Amorphous Phosphate Crystal at 4-10.   I've attached a copy of the full urine analysis.
 
At first, we were told that the results had to be “re-run,” because the Vet’s staff entered in the wrong species and the lab could not properly test the urine.  Despite being told this, the Vet himself said that the results would be the same no matter what. 
 
The Vet concluded that Alvin did not have a Urinary Tract Infection, but instead had stones and would require surgery.  He called a specialist and made us an appointment for the very next morning.  It’s bewildering to me how he could come to such a conclusion, since he himself did not feel any stones and Alvin, to our knowledge, was actually doing much better.  It also begs to question why Alvin would respond to the Baytril altogether if he in fact did not even have a Urinary Tract Infection to begin with. 
 
The last three days specifically, Alvin has been 100% back to normal – he eats well, urinates without noises, poops without any problems and plays with his brother as usual.  There are no unusual urine smells (or color) and the urine itself does not feel gritty.  
 
Rather than immediately having him undergo more tests unnecessarily, we've decided to monitor him closely (my husband works from home and can watch him throughout the day).  Alvin (and Fred) are currently on a diet of Oxbow Pellets, Timothy Hay and leafy green veggies.  Admittedly, prior to this ordeal, I was feeding them far too many baby carrots (approximately 8 each – 16 total - for the entire day).  I know now those amounts were far too much and have now eliminated carrots altogether for the time being (despite having two very angry piggies on my hands).    Coincidentally, Alvin’s improvement seems to have happened at the same time as the elimination of carrots from his diet, in addition to an increase in the amount of Vitamin C he's fed. 
 
Although Alvin’s health is our top priority, and we will move mountains to ensure he is taken care of, I do not want to create any undue stress on him.  In addition to finding some fault in how the Vet handled the situation from the beginning, I also have very little faith in him, or anyone he recommends, at this point.  I have spoken with two Specialists (one of which the Vet referred us to) and they will not give us any information, let alone review the prior urine analysis, unless we pay $100+ for re-exams, plus the cost of another Urine Analysis and the cost of x-rays (that’s in addition to the $200 we've already spent going nowhere). 
 
Based on this information and the urine test results, what would you recommend is the best route to take at this time?  Any help you could provide would be so greatly appreciated. 




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REPLY FROM DR SING

Nov 1, 2014

I am Dr Sing Kong Yuen from Toa Payoh Vets. 
Are you from Singapore?
Each vet has his or her own way of diagnosis and treatment. However, diagnosis of urinary stones are best done on X-rays and/or ultrasound. Some urinary stones can be seen on X-rays. Were there any X-rays done by your vet who recommends surgery? If the guinea pig is "normal" now, it is best to wait and see. 

Wednesday, October 29, 2014

Ethics?

October 30, 2014

Today, an old client told me that she had received vaccination reminder card from a lady vet who was employed by me some 2 years ago. She commented that this vet was unethical and she would not go to consult her.

Is this practice ethical? There was a bank case in which the employee joined another bank and took the employer's list of clients to contact them. This employee was sued in court.

Employee vets will continue to use the employer's list of clients before they set up their own practice.     

Singapore stories. Mr Han goes to Phuket

Oct 30, 2014

Mr Han goes to Phuket today. His boss Joe asked me to a farewell breakfast at the usual food court. Mr Han had his laksa while Joe, for the first time, order beef ball and fish ball soup noodles. "I have never seen you order this dish," Mr Han commented. "Usually it is laksa and you drink all the gravy!"
I ordered the chee chiong fun with sesame seed and sweet sauce at $1.60.

I thought yesterday's breakfast was the last till Mr Han comes back from Phuket on Tuesday. As he had to go for his routine blood test for diabetes yesterday, he did not eat breakfast and was grouchy. He was at the food court and dozed off. The hawker lady from China, selling laksa, came to the table and curled her right index finger, indicating that Mr Han must have passed away. This was her sense of humour learnt from Joe.

After the breakfast today, Joe said I should take a photo of Mr Han as the "last" image.. In case his plane crashed. "It is best not to say such things," I tried to educate Joe who has this type of humour.
Yesterday Joe was on the same topic of plane crash and asked Mr Han to visit him after the crash and let him know he had come from heaven or hell. "Is there such a place as heaven or hell?" Joe asked.

"There is a supernatural but you need to encounter to believe," I narrated a story of my client who asked me to help her design a logo. Blood spots appeared on the table and draft logo papers when the design was not satisfactory to "datuk". A Caucasian employee had brought in a draft logo on his own initiative and designed by somebody while I was in the room. Blood spots appeared in this draft logo paper. Finally, there was a draft logo design done by me and the client with no appearance of blood and this would be deemed approved.  

"I am more the scientific-evidence type and this encounter would be hard for anyone to believe," I said to the two senior citizens. "I don't believe if I have not witnessed this event."

Monday, October 27, 2014

Anaesthetic risk in dental scaling A 7-year-old Sheltie with bad breath

Oct 28, 2014


A new client - father and young adult daughter brought in a 7-year-old male entire Shetland for dental scaling.  Their friend's Maltese had died after dental scaling in another vet practice and so they did not want to go to the practice.

"Very rarely do dogs die after waking up from anaesthesia given for dental scaling," I said. "Was the Maltese having heart diseases?"  The owners of the gentle full sized Sheltie did not know but they would avoid this friend's vet

No vet can guarantee no anaesthetic risk. Even people do die.

PHYSICAL EXAMINATION
Other than periodontal disease grade 4 (tissue attachment loss over 50%), I noted that this Sheltie had congested maroon red gums, not the normal pink ones. You can see this in the video. Why? The capillary refill time was longer than the usual 2 seconds. Blood test showed that this dog had a higher than normal amount of haemoglobin in his blood at 19.1 (12-18).  The total red cell count was normal. The haematocrit was normal too.  Platelets were normal. What does it mean? Was he fed some supplements?


BLOOD TEST on 27.10.14  Abnormal values

Urea 12.3  (4.2 - 6.3)
Creatiine 65  (89-177)
Haemoglobin 19.1 (12-18)

All the other blood values within normal limits.


 
Sedation was 50% of normal dog. Isoflurane gas to minimal amount.




FOLLOW UP - Day 2 after dental scaling
The dog was a bit tired yesterday but is Ok and eating today.

"Tartar started to build up fast in last 3 years," the father said that the dog was not given meat. "Could it be the milk making the kibbles soft?". This dog had the biggest crusty tartar I had ever seen in a dog (see image/video).

The dry dog food was  Science Diet Lamb and Rice with a brand of dog's milk since young. Dog treats were given.


ADVICES
No milk and treats to prevent tartar build up.
Eat dry food without milk and drink water.
Blood test 4 weeks later to check on the urea levels.

This case shows that a blood test is important for screening the health of an older dog. The owner was given the option. The blood test was done by me as this dog had an unusual congested gums.

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VIDEO

Oct 28, 2014.  A father and young adult daughter presented this gentle 7-year-old male Sheltie for dental scaling. A friend's Maltese had died after dental scaling by another vet and so the owners were worried about anaesthetic death. "Dogs usually do not die under anaesthesia or after anaesthesia," I said to the father. "Unless the dog has heart disease or poor health."
A thorough physical examination showed that this Sheltie with bad breath was generally healthy in heart and lungs. The heart beats were irregular. 50% sedation  of domitor and ketamine IV calmed this nervous Sheltie.
In this case, I gave an IV drip, with IV baytril, frusemide and Vit B complex.  
It is very important to provide a very close monitoring of the maintenance of isoflurane gas at 0-2%, oxygen flow rate at 2 litres/minute to ensure that minimal anaesthesia is being given. The dog did wake up in the midst of dental scaling as the maintenance dose was 0.5%. He was intubated again and maintained at 2%. The dog woke up fast and went home 3 hours later.  Follow up 2 days later showed that the dog is OK. The dog had been given dry dog food and milk since young. He likes only certain brands of milk. Well beloved family dog and in excellent body condition.





The Jack Russell keeps vomiting for 2 days.

Tuesday, Oct 28, 2014
Breakfast with 2 senior citizens, Mr Han and Joe .

Mr Han, the 67-year-old man related the following stories again to me today:

Story 1. $40 consultation fee for no consultation.
His friend wanted to renew his driving licence but had to see a general practitioner to sign the form.
"Did you have any heart surgery," the doctor asked.
"Yes," his friend said. "I have a pace-maker."
"In that case, you need to go to the Tan Tock Seng Hospital to be certified fit for driving!"
"But you can certify that I am fit at the time of examintion," the friend said.
The doctor refused to do so and the consulation fee was $40 for "doing nothing."
He advised his friend not to pay but the friend did.
"There was consultation," I said. "Though not in his favour."

"Why not go to the next doctor and tell him you do not have heart surgery," the 2nd senior citizen suggested.
"He did," Mr Han said. "Exactly the same reply and the doctor filled up the form."
"How much was the fee?" I asked.
$25.00"

Story 2. The 14-year-old daughter has late nights.
Mr Han's daughter goes out after 11 pm every night and comes home past 3 am.
"Don't go out at this time," Mr Han said. "What will neighbours think? Leave the house at 7 pm."
The daughter ignored him. He slapped her once. She called the police and he was put in jail.
"It is a case of assault," I said.
"If you have a well brought up child, you are lucky," Joe said to me. Joe has a son who graduated from an American University and has an excellent relationship with him.
"If the father cuts off the allowance to the daughter," Joe said that a solution is to stop giving the daughter her financial support. "If Mr Han does that, she will blame him as she earns money from prostitution."

Story 3. The neighour had stomach cancer.
The neighbourhood doctor was sued by the neighbour for not diagnosing stomach cancer as he would prescribe some medication during every visit. The neighbour's wife suggested that the husband seek a second opinion and was scolded. Finally, the husband got a second opinion and engaged a lawyer to sue the doctor.
"Ironically, the lawyer is another neighbour," Mr Han said.
"Did he win the case?"
"No, no," Mr Han said.
"The doctor might have suggested visit to the specialist and had written this advice in his medical records," I said.
"You can't expect a general practitioner to diagnose stomach cancer," Joe said.
"But he should have referred for further investigations at the hospital and he probably had done so."


Story 4. Charcot's foot.
Charcot's foot is said to be a progressive degeneration of the joints of the foot. One cause is diabetes and Mr Han had diabetes. Initially, Mr Han consulted the general practitioner who prescribed some medication without even looking at his foot.
"Maybe your foot was smelly," I said.
"Not at all."
He was diagnosed Charcot's foot by the specialist and had a special shoe made.
 

2015Singapore stories: Charcot Foot and other stories

Tuesday, Oct 28, 2014
Breakfast with 2 senior citizens, Mr Han and Joe .

Mr Han, the 67-year-old man related the following stories again to me today:

Story 1. $40 consultation fee for no consultation.
His friend wanted to renew his driving licence but had to see a general practitioner to sign the form.
"Did you have any heart surgery," the doctor asked.
"Yes," his friend said. "I have a pace-maker."
"In that case, you need to go to the Tan Tock Seng Hospital to be certified fit for driving!"
"But you can certify that I am fit at the time of examintion," the friend said.
The doctor refused to do so and the consulation fee was $40 for "doing nothing."
He advised his friend not to pay but the friend did.
"There was consultation," I said. "Though not in his favour."

"Why not go to the next doctor and tell him you do not have heart surgery," the 2nd senior citizen suggested.
"He did," Mr Han said. "Exactly the same reply and the doctor filled up the form."
"How much was the fee?" I asked.
$25.00"

Story 2. The 14-year-old daughter has late nights.
Mr Han's daughter goes out after 11 pm every night and comes home past 3 am.
"Don't go out at this time," Mr Han said. "What will neighbours think? Leave the house at 7 pm."
The daughter ignored him. He slapped her once. She called the police and he was put in jail.
"It is a case of assault," I said.
"If you have a well brought up child, you are lucky," Joe said to me. Joe has a son who graduated from an American University and has an excellent relationship with him.
"If the father cuts off the allowance to the daughter," Joe said that a solution is to stop giving the daughter her financial support. "If Mr Han does that, she will blame him as she earns money from prostitution."

Story 3. The neighour had stomach cancer.
The neighbourhood doctor was sued by the neighbour for not diagnosing stomach cancer as he would prescribe some medication during every visit. The neighbour's wife suggested that the husband seek a second opinion and was scolded. Finally, the husband got a second opinion and engaged a lawyer to sue the doctor.
"Ironically, the lawyer is another neighbour," Mr Han said.
"Did he win the case?"
"No, no," Mr Han said.
"The doctor might have suggested visit to the specialist and had written this advice in his medical records," I said.
"You can't expect a general practitioner to diagnose stomach cancer," Joe said.
"But he should have referred for further investigations at the hospital and he probably had done so."


Story 4. Charcot's foot.
Charcot's foot is said to be a progressive degeneration of the joints of the foot. One cause is diabetes and Mr Han had diabetes. Initially, Mr Han consulted the general practitioner who prescribed some medication without even looking at his foot.
"Maybe your foot was smelly," I said.
"Not at all."
He was diagnosed Charcot's foot by the specialist and had a special shoe made.
 

Friday, October 24, 2014

2015 Vets - The dog groomer and the Judge

Friday Oct 25, 2014
A couple with over 10 years of dog grooming and pet shop operation experience shared with me their grooming situation.

"Vets are making good money compared to groomers," Jim Mandalay said. "In one practice, the vet bills are not less than $200/customer. In another practice, they are over $500/customer. My grooming charges are $60 and I take at least 2 hours to groom one dog!"

"The pasture is always greener on the other side," I said. "There are vets who charge less than $100/customer," I named one practice that advised blood tests and even weekly blood tests for ill dogs. 

"With blood tests compulsory at the first clinic, at $140/blood test, the bill would be more than $200/customer," I said. "The customer can always go to another vet and there are over 60 vet clinics in Singapore nowadays!"

"The other vet also charges high fees," Jim laughed. Jim knows about vet charges as he transport pets to the clinic for treatment, charging $100/trip. His wife would do the grooming while he would answer calls and do the transport. In Singapore, competitors charge $10 for dog transport and $60 for grooming. So, Jim said that he could not increase the costs as that would drive customers to the arms of another groomer.

"Proximity and convenience are what the dog owner wants," I said.
"There is no loyalty from the customers," Jim and his wife were exhausted from so many years of grooming and the great difficulty in retaining a Singaporean receptionist.

In Singapore, the receptionist would be young ladies. They would work for a few months and change jobs or find a downtown office with lots of colleagues to work. Not content with being a receptionist in a small pet shop. So, the couple had to work by themselves. Or close shop.

"How about selling puppies?" I asked as they used to sell puppies. With puppy sales, they can retain clients as groomers.

"No, no," Jim said. "The consumer is now well protected with one year's return policy. That is the lemon law."

"Are you sure?" I asked. "In one year, the puppy can be returned to the Seller with money back? A person can buy a new car and can return it back within one year if there is a defect?"

"Yes, yes," Jim said authoritatively as regards puppy sale.
Jim related his personal experience. He sold a poodle some years ago with a sales contract between the husband buyer and himself.

"After one year, the wife phoned me to ask what compensation I would give her as the poodle had become 2 inches taller than the standards stated in breeders' books and had changed to a lighter colour."

The Buyer brought the case to the Small Claims Court and Jim had to attend the hearing.
"The judge dealt with the case although the complainant was the wife who was not the one signing the sales contract with me!" Jim said. 
"It is up to the judge as he has the power," I said. "Maybe the wife is family. Who knows what the the judge based his decision upon. Did you win the case? After all, you were not selling a pedigree dog for dog shows but a pet quality dog. The coat colour could fade or darken when the dog grows older."

"Poodles have different shades of brown," Jim said. "But the judge does not know it. Photos were submitted by the wife as evidence! She even had an expert witness to testify for her as regards the standard height of a poodle! Another pet shop owner!"

"Was the expert witness paid by her?" I asked.
"No, no," Jim said. "That poor fellow had to close his pet shop to attend the hearing! He was suppoenaed by the court to attend the hearing. No need for this woman to pay him. That was the price of him voicing his opinion on the height of what a poodle should be as an adult dog!"

This experience should teach readers not to venture any opinions in cases of disputes as the complainant can ask the Court to subpoena us for expert testimony.
"This woman would cancel the hearing and I would have to wait for another day, cancelling my grooming and transport appointments again! She knows the process of the Small Claims Court of last-minute cancellations.
"You know, she is the wife of one of those rich developers in Singapore and must have good experience of making puppy sellers pay for defective puppies. That was before the lemon law was introduced in Singapore and my case was that the puppy had been sold to her for over a year! Now, with the lemon law which states that there is a one year of guarantee, I do not sell puppies anymore!" 

"I don't agree that there is a one-year-guarantee for puppy purchase. He could have bloody diarrhoea from parvoviral infection 2 months after purchase and died. So the owner cannot claim that the puppy was bought with parvoviral infections. The incubation period for parvovirus would be around 14 days, that is, signs would appear 14 days after infection and 2 months equal 60 days. So, the Buyer cannot claim losses and medical treatment costs." 
"I am telling you it is one year," Jim insisted.
"What happened to the expert witness for the Buyer?"
"He was not even called in to testify," Jim laughed. "He had to cancel his grooming appointments to attend the hearing, making him lose income! Serves him right for being a smart aleck.

"As for me, the complainant cancelled the hearing at the last minute and so I had to close shop a second time and lose income!  The Buyer certainly knows how to make me suffer losses of income!"

I usually do not comment on competitor's treatment of a case and that would not be subpoenaed as a witness.

"So what happened? Did you lose the case?" I asked. "I think the judge would not more than you think, about dog's standard height and colour. A lighter colour could be due to bleaching shampoo and I don't think he would be fooled by the Buyer. How much did she ask for compensation?"

"The judge asked her. She wanted much more than what she paid me for the puppy. For emotional distress, you know. So much worries when the poodle became taller by two inches and losing the redness of the coat!"

"How much she paid for the puppy?" I asked..

"$1,900. She wanted much more. To be a puppy seller, you must have a good lawyer. Refer all complaints to the lawyer.

"There was this big puppy seller who had this good lawyer. One day, a very rich lady was dissatisfied with the puppy and he referred her to his lawyer. But the rich lady did not proceed with the 'see you in court' threat."

"That is why she is rich," I replied. "No point paying lawyers to sue as the legal costs would be more than the cost of the puppy! She is from the elite family of Singaporeans and she certainly can afford it but she did not do so."

But Jim could not afford to retain a lawyer as he sold only a handful of puppies from his own pets some years ago. I opened the can of drinks he offered me and it was getting dark now, closer to 7 pm when he should be sending the groomed dog home to Woodlands.
"So what was the verdict?" I reminded him that he was late for his transport.
"The rich woman lost her case."
"Why?" I asked as the government is deemed to be pro-consumer.
"She placed the photo evidence of the coat of the puppy not in chronological order, hoping to fool the judge."
"Really? How did she do it?"
"She placed the older dog's photo as the first photo. The judge said the coat colour was light and it could be due to the flash bulb!"

Thursday, October 23, 2014

1082. Just microchipping

A 7-year-old male Westie came for microchipping only as the vet authorities are more active in checking unlicensed dogs.

The previous owner had migrated. The dog had thick tartar, an undescended testicle and had no vaccination. The vet has to record that the owner does not want any dental scaling and neutering or vaccination in the record in case of misunderstanding later. The new owner said that the dog, being old, would feel the pain of neutering. 

Dogs that are fortunate have owners who would have done the dental scaling at least once in 7 years and this prevents heart valve infections (endocarditis). However, not all owners care.      

An old golden retriever has an eyelid tumour

 23, 2014 was Deepavali, was a rainy morning. I did not expect any customers. A car parked outside and a man with a young adult son brought in a 9-year-old golden retriever with an eyelid tumour.

"It looks like a cauliflower wart, " I said. "How long has he got this lower eyelid tumour?"
"I saw it this morning," the father said. "Probably 2 weeks. He has been tearing and rubbing his eyes."
"The only cure is V-shaped cut to remove it. Has he got a blood test recently?".
"OK," he said.I "He was not eating and had a blood test done by Dr Daniel, but there was no problem."

I showed him the blood test results of 2 months ago and explained: "The total red blood cell, haemoglobin and platelets were low."
"He had anaemia probably due to tick bites," I said. "Did he have a lot of ticks 2 weeks before you consulted Dr Daniel?"

"Yes, yes," the father said. "The anti-tick spot on was not effective but now he has no ticks as I have had changed to a new brand."

"Your dog is thin although his gums are not pale now and has better appetite. The low platelet count in his blood showed that he was likely to have been poisoned at that time too. It also could be due to the tick-borne disease attacking his red blood cells."

I walked him to a chart illustrating the effects of tick bites explaining that Babesia parasites could destroy the red blood cells causing anaemia.

"Yes, it was possible that he could be poisoned. We used a lot of ant poison to get rid of the ants and he might have consumed it."
The dog was anaesthesized and operated upon by Dr Daniel. He used electro-excision to cut out the tumour in a V-shaped incision.. Then he stitched the two ends.

Histopathology showed that this was a meibomian gland epithelioma, not malignant.

The dog went home at around 3 pm. The father and two grown up adult sons came to bring the dog back home.

It was great to see a father who bothered to treat the old dog. Just two days ago, a lady told me that her husband refused to give the 9-year-old Schnauzer dental extraction as he would not pay for it. The Schnauzer had come for vaccination.

"How much would he pay for dental scaling and extraction?" I had quoted around $300 for anaesthesia and dental work.
"Less than a hundred dollars."
The dog had periodontitis Stage 4 with some teeth dropped. He had a hole below his right eye. A carnaissal tooth abscess opening up a hole below the right eye.
"Maybe the carnaissal tooth had dropped off," she said.
had

Sunday, October 19, 2014

A Jack Russell has a large liver tumour

A 12-year-old Jack Russell came with a much swollen abdomen.

She was not spayed and so I thought she could have closed pyometra. This is a common problem of unspayed old female dogs. Yet the dog was active and could even walk 30 minutes to the Surgery. She had a very good appetite and drank a lot of water. She peed a lot. So, closed pyometra was ruled out.


Could there be an abdominal tumour since a vet had removed a breast tumour (MG 5 left side) some 8 months ago? Or metastasis of this breast tumour?

Could there be an ovarian tumour?

Next was ascites. On percussion of the abdomen, there was no tympany of gas or fluid thrill when I tap the right side of the abdomen and let my fingers of the other hand feel the other side.

I gave fruesemide to bring down any abdominal fluid and took an X-ray 12 hours later. There was the classical splenic neoplasia as diagnosed by Dr Daniel. This image was similar to the image in the Vet Surgery book which showed the lateral abdomen with the tail of the spleen being a globular shape.

According to an experienced older vet, an ovarian cyst would be higher up in the anterior abdomen.

So, the X-ray diagnosis is a splenic tumour. Could it have metastasized to the atrium causing an atrial tumour?











Exploratory surgery showed that the abdominal mass was a liver tumour, not a splenic tumour. Blood test showed liver hepatitis. The dog had a mammary tumour by another vet 8 months ago. No histopathology was done. It is likely that this liver tumour was a metastatic tumour from the breast. Prevention of this liver tumour might or might not be possible if the dog had been spayed at a young age. Spayed dogs seldom develop breast tumours. Primary malignant liver tumours (hepatocellular carcinoma) are rare in dogs and they are usually due to the spread from other organs with tumours. In this case, histopathology is in progress as at Oct 24, 2014.  













OCT 20, 2014. Exploratory laparotomy. Low dose of domitor + ketamine IV and isoflurane gas.

SURGERY
The large globular tumour was at one end of the lobe. The lobe was taken out. A scalpel blade cut one side of the lobe like "fracturing" the liver.  That meant that the liver was incised on one side while the assistant could hold up the liver for ligation of the parenchyma blood vessels.

Bleeding inside the parenchyma area where the one side was cut was profused. The suture needle is put inside the parenchyma and ligation was carried out..

3/0 absorbable "gullotine" ligatures were placed inside the parenchyma to ligate the blood vessels and bile ducts. Electro-coagulation was done. "Gullotine" ligatures were put on the other side of the lobe 2 cm below the tumour to control bleeding.

The liver tumour was then excised, using electro-excision needle to cut and coagulate the stump. Surprisingly, there was no bleeding after this electro-excision.

HISTOPATHOLOGY. Malignant tumour composed of anastomosing traeculae, nests and pseudoacinar structures. The tumour cells are plyonal with mildly enlarged round nuclei, vesicular chromatin and small round nucleoli. Areas of tumour necrosis are seen. The uninvolved liver shows evidence of steatosis.
Diagnosis: Malignant tumour, favour heptocellular carcinoma  

Liver neoplasia with multiple abscesses.
One 70% size of a tennis-ball-tumour in one lobe. Abscesses have spread all over the liver.
Another ping pong ball tumour in a smaller lobe.  Histopathology in progress - whether it is simply abscesses or abscessed tumours.

24 hours post-op, the dog was eating and very active. I advised in-patient for 10 days as the other dog at home would play with this dog, causing suture breakdown.

The owner asked about prognosis.

Poor prognosis.
1. Locally advanced stage of liver neoplasia with abscesses. This is to be confirmed on histopathology of samples sent..

BLOOD TEST.
No leucocytosis. No "neutrophilia",  but neutrophils % was 92%. (60-70% normal).
Liver enzymes SGOT and SGPT were raised.

TREATMENT IN DOGS.
In people, a combination of chemotherapy or radiation therapy to down-stage the cancer to a more early stage so that surgical resection can be done to provide a long-term survival or cure.

CONCLUSION
8 months ago, another vet had excised a breast tumour but did not send it for histology. This tumour was large and could have spread to the liver.  No lung X-rays were done to lower medical costs. If the dog had been spayed young, it is possible that she would not have breast tumours which could have spread to the liver, now at 12 years of age.

SEVEN DAYS POST OP.
The dog is presently eating and drinking and is active as at Oct 28, 2014. But she panted a lot when taken out for a short walk. Will go home on Day 14 when stitches are removed. As to life span, it is unlikely to be more than 6 months.    

--------------------------
NOTES

In people, liver cancer (HCC or hepatocellular carcinoma) is the 6th most,  important cancer in the world and the 3rd most important cause of cancer mortality. 80% of all HCC patients are found in the Asia Pacific region because of the high incidence of viral hepatitis. In Singapore, it is the 4th most important cancer and the second cause of cancer death after lung cancer.


Reference; Down-staging of liver cancer to allow curative surgery: An emerging paradigm. Prof Pierce Chow, Pg. 2, Salubris Issue No. 30, Jul - Sep 2014

Tuesday, October 14, 2014

A hamster in Africa



Hello,
My name is XXX and I need help with with hamster.
My girlfriend currently live in Mozambique is taking care of hamsters from a school there. Looks like one of them, L has the wet tail. I'm attaching the photos, that she send me.
She is asking for a favour - its almost impossible to get veterinarian help for small animals in Mozambique.

L (the hamster from the photos) doesn't seem to have wet tail disease, as she doesn't have diarrhoea. Also her wet back was from the spilled water. The problems with her that require treatment are :
- red mole or a tumour that is visible on the photos
- left eye irritation (infection?) - also visible on photos
- her bum is quite dirty - she doesn't seem to groom her butt area

If there is medicine or antibiotics needed to treat the problems,then I can pass it to her.
The drops for the wet tail, would be needed rather to prevent the disease, as there are multiple hamster under her care and it could be useful. 
Thanks,
XXX









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

Oct 16, 2014
REPLY FROM DR SING
Hamster appears to have skin infections and abscesses, possibly from bite wounds. She is unable to groom her backside. Some images are not clear.  Pl tel me for further discussion.

1078. A stray cat welfare activist

Today, an elderly lady who rescued stray cats and had 11 in her apartment brought in an old stray cat that had been vomiting yesterday. An old lady feeding this cat had asked her to help.

"I spent over a thousand dollars feeding the strays every day, twice a day," she said. "Yet the prices of canned food keep increasing!"

"Rentals have had shot up considerably as there is a grave shortfall of commercial properties," I explained to her. "So, the cost of doing business keeps going up. The Landlords keep increasing the rentals."

As to her view on stray cat activism, she said she would operate alone and not get into problems with the other activists.

There is a vet who used to charge male cat neuter at $40. Female cat spay at $50, on heat at $55 and pregnant one at $60. "The vet is a butcher," she was referring to the thicker sutures used by one vet providing cheap sterilisation, as compared to another vet who hides her sutures under the skin.

"Prices are different for the vet who used the fine sutures," I said. "Definitely she would not be charging $50 to spay a female cat."

"She charges high," the activist said. "But those cats spayed by her are my personal cats, not the strays. I have to get somebody to queue at SPCA fo.r the free spay vouchers"

She gave some cost figures:

Stray cat trapping $70
Cat transport to vet $35/cat or $30 by a lady.
Boarding after spay for 3 days and neuter for 1 day  $5.00/day

"Do you know about this person who was fined heavily for sterilising cats? I had sent over 100 stray cats to him over the past 3 years. Fortunately, none died. Well, except a pregnant one."

"Yes," I said. "I know the incident. He did not sterilise cats. He was transporting cats to a lady who sterilised them."

    

Monday, October 13, 2014

1077. What makes a wedding dinner interesting?

aSunday Oct 12, 2014

I attended a unique wedding dinner on Sunday Oct 12, 2014.

A wedding dinner can be interesting if there are some elements of entertainment and audience education. It is like a movie with a compelling story.

USUAL ROUTINE
1. A bride in white with bridegroom enters the hotel and walk in the central walkway.
2. Stage - cage cutting action
3. Couple returns to stage for champagne pouring.
4. Later, bride in red gown with groom enters the hotel and walks the central walkway
5. Family on stage to say "cheers" once or "yam sing" 3 times.
6. Walk round tables and photography of each group by couple. The photographer was not present for my table for some unknown reason. I don't get to see the couple too. There were 70 tables and I was was the bridegroom father's friend.

At the end of dinner, photos of diners were printed on the spot and handed out to the guests. This was unique service not present in other weddings.

SCREENS on the left and right showed the history of the couple. Unfortunately, the screen does not show the actions on the stage when there is "cheers" as there seem to be no projection from this top hotel in Singapore. The screens display the slides which had already been viewed.

STORY TELLING BY COUPLE AND THE BRIDE'S FRIEND. At least 5 minutes per person. Interesting anecdotes of the couple's life. Public declaration of love and thanks to parents.



 

2014 Bodley Head/Finaicial Times esssay prize

http://www.ft.com/cms/s/2/f1c7d1f6-3f53-11e4-a5f5-00144feabdc0.html#axzz3GAQCSUZL

Sunday, October 12, 2014

Script for Phyllis. Sunday's 4 interesting cases Oct 12, 2014

1. The blinded Siamese cat, male, 2 years old.
The other male cat clawed him. 3 male cats. 5 female cats.
"The females don't like him," the breeder said to me.
"He has stronger competitors and so the female cats usually prefer the stronger males."
"The males start to bully him nowadays and that is why his right eye was injured by claws."
The owner decided on the removal of the badly damaged eyeball but wanted to wait for 2 days.


VIDEO OF CAT'S EYE 

"The house wives who buy my cats are cheapskates. They want instalments, " the home breeder said. " Should I breed dogs instead? What breeds will you recommend?" the lady asked me.

"Breeding of cats and dogs are not a profitable business as the AVA will penalise anybody who tries to sell kittens and puppies without a licence to sell," I said.
"Yes, yes," the lady said. "My friend's HDB flat was raided as she was selling puppies through the Straits Times Advertisements." 
"How do you advertise without the AVA officers coming hard on you and knocking on your doors to investigate?"
"I use the internet or place the kittens in the pet shops but now I cannot even produce one kitten."

"Shih Tzus appear to be a very popular breed in Singapore," I replied to her queries. "Since you work long hours and leave the operation to your helper, the breeding will never be successful," I said. "There is much more knowledge and expertise required with the management of 3 male cats and 5 female cats and you have not produced any kitten.  Normally 1 male cat will do."

"The first male cat had become fat and lazy," the woman said. "So I got the second male. Somebody gave me this 3rd male Persian cat whose right eye was injured by the second male."

"A fat cat could be due to over-feeding," I said. "In any case, 3 male cats will not live peacefully and so they fight to become dominant and cause injury."

The couple decided that breeding was not profitable and would not do it.  They were busy with their meditation exercises in their spare time. So, they have no time for this breeding business. Every venture needs full attention to even have a chance of success and in this case, asking a helper to do it is the surest way to financial ruin.  Helpers are never passionate nor knowledgeable about the art of breeding dogs and cats.

CONCLUSION
A friend of the owner wanted to take over the cat and seek a second veterinary opinion on the eye problem.


2. A black dwarf hamster has an impacted cheek pouch.



HOOK with subtitles
"His right cheek pouch is swollen again," the lady owner placed her beloved hamster on the palm of her hand (video footage). "Her mouth is becoming smelly."

A BKTP VET EDU ....... TITLE ..IMPACTED CHEEK POUCH AGAIN



HISTORY AND EXAMINATION

"5 months ago, his right cheek pouch was packed to the maximum and I had evacuated the thick grass-like material," I showed the medical illustrations (IMAGE OF ACTUAL ILLUSTRATION IN CASE SHEET) in my case sheet to the lady teacher. 


"Yes, her cheek pouch was back to normal size for the first few weeks but become filled up again," the lady said. "I emptied the cheek pouch for her but now I could not do it. This time, her mouth had become smelly." (VIDEO VERY ACTIVE HAMSTER OBJECTING TO POUCH EMPTYING WITHOUT SEDATION)

I weighed the hamster. She was 41 g as she wass 5 months ago. I checked that the cheek pouch area in the face was inflamed and some areas were hairless owing to scratching (VIDEO).

ANAESTHESIA AND SURGERY
I sedated the hamster with Zoletil 50 IM (VIDEO). When she was less active, I emptied the cheek pouch. There was an ulcer at the lip commissure (VIDEO) causing the bad smell.

POST OP
The hamster recovered fast 15 minutes  after the sedation. She was very active. (VIDEO). She would be given the oral antibiotics and painkillers for the next 7 days. 


TIPS AND ADVICES TO PREVENT RECURRENCES

"Some hamsters prefer the right cheek pouch to store food," I said to the owner. "Just like some people who grind food more frequently with one side of the mouth."

 CHEEK POUCH IMPACTED



CHEEK POUCH EVACUATED







"What should I do to prevent recurrence?" the teacher used her handphone to photograph the "grass-like" roll of soft material of around 5 cm lodged taken out from the right cheek pouch (VIDEO). This was similar to the greenish roll removed 5 months ago. 

"You can empty the cheek pouch every 2 days. Give her just sufficient amount of food in the bowl. In that way she has not sufficient amount to store." 


CONCLUSION
Impacted cheek pouches can become infected causing pain, infection and loss of appetite. Some hamsters try to clear the food inside by hand. Sometimes they evert their cheek pouches as shown in the images below. These everted cheek pouches need to be put back inside the cheek by the vet.  Always consult the vet early when your hamster has impacted cheek pouches for more than 3 days.


PAST CASES OF CHEEK POUCH IMPACTION AT TOA PAYOH VETS



VIDEO
http://www.youtube.com/watch?v=pzL_tjwv0g0&feature=youtu.be

IMAGES FROM CASE STUDIES AT TOA PAYOH VETS
http://www.toapayohvets.com/surgery/050609hamsters_ToaPayohVets.htm



IMPACTED CHEEK POUCH
EVERTED CHEEK POUCH DUE TO IMPACTION
EVERTED CHEEK POUCH DUE TO IMPACTION
IMPACTED CHEEK POUCH









3. BKTP......        TITLE: A CAT HAS BUMBLE FEET

"A very rare case in Singapore cats, similar to the condition of bumble foot in rabbits" I said to the young couple who was present at 9 am on this fine Sunday Oct 12, 2014 morning.

"Do you house your cat on  a wired-floored cage with no bedding or pads?" I asked.
"No, no, she has the freedom to run around the apartment!"

"Was there something sharp she stepped upon?" I asked.
"No, no," the couple said.
Yet the underside of both hind feet showed one swollen wound each (VIDEO). There was bleeding and pus oozed out in one of the feet. What was the cause? The cat's hind feet were injured by something sharp but the couple could not feedback any possible cause.

"We did buy an anti-cat mat from the $2-Daiso store," the wife showed me her phone image (IMAGE). "It has sharp ends to prevent a cat from accessing the area behind the sofa. But the cat persisted in getting under the sofa!"   

"This mat would be the cause of traumatic injury to the underside of the hind feet," I said. "The cat was careful with her front feet but the hind feet would be pricked as she walked over the mat to hide under the sofa. Parts of the spike could have penetrated the underside of the two hocks of the hind feet. This resulted in inflammaton and infection with pus formation.

"The treatment is to sedate the cat and drain the infected skin wounds (CLIPPER, CLEANING VIDEO CLIPS). The cat was sedated with xylazine and ketamine IM and a thorough irrigation of the leg wounds was done. The cat's ears were cleaned. The anal sacs were expressed with lots of foul-smelling oil oozing out from the right anal sac (VIDEO). 
 


OTHER PROBLEMS IN THIS CAT
1. Hair shedding is more frequent nowadays. No more soft coat
2. Loose stools now and then in the past 2 months
3. A hairless brownish nose tip is not normal for any cat.

SOLUTIONS
PROBLEM NO. 1 - MORE HAIR SHEDDING. The cat may be stressed by the bumbled feet pain and infections and the stomach upset. The cause of bumbled feet was finally found to be the sharp ended mat bought from the $2-store Daiso. This mat was meant to prevent the cat from stepping onto the area behind and below the sofa. (IMAGE FROM OWNER'S HANDPHONE).

The cat would step over the mat but his hind feet were injured by the sharp ends. Over time, part of the plastic spikes entered the lower feet causing abscess. Treatment was to clip the hair and express the pus and foreign bodies. (VIDEO)

2. Stop using perfumed spray over the cat litter to keep it "clean" and to stop using perfumed shampoo very two weeks for the next 4 weeks. Use a mild shampoo or just brush the cat. The cat could have licked off the perfume, causing gastroenteritis now and then after the young couple had used the spray or shampoo. This is another form of stress leading to more hair shedding.

PROBLEM NO. 2 - LOOSE STOOLS
I advised the feeding of W/D, a high fibre prescription diet (canned) to be introduced slowly at 90% of old food and 10% of W/D initially till 100% for the next 4 weeks to stabilise the intestines and producing solid stools to clear the anal sacs. The right anal sac was impacted with black anal anal oil and infected. I expressed and around 1 ml of foul-smelling thick grey oil was taken out (IMAGE & VIDEO).



A high fibre diet which produces solid stools will help in evacuation of the anal sac oil daily during pooping.

PROBLEM NO. 3. The cat purred whenever the husband stimulated the nose tip for the past year. Daily rubbing caused friction and led to hair loss and brown pigmentation. The wife would tickle the neck area and the cat would purr with happiness. The husband would cease this nasal rubbing and hair would likely regrow some months later. (VIDEO CLIP OF NOSE). A review in 4 weeks time.

CONCLUSION
This was a rare case of bumble foot but the cat had other health problems like anal sacculities and management issues like spiked mat injury.

It was great that the other problems were discovered during this bright Sunday morning and the cat would live a happier pain free life after treatment of the pododermatitis with drainage, antibiotics and pain-killers.

The outcome of treatment should be good as the couple had not delayed seeking veterinary treatment. Delays would have led to tendon and bone infections of the hock resulting in poor prognosis. 


CASE NO. 4. A LABRADOR RETRIEVER HAS OPEN PYOMETRA
Infection of the womb in the older female dog is a common condition in Singapore. The owners came to Toa Payoh Vets as the first vet had prescribed antibiotics but the dog was still passing sticky brown red vaginal discharge during the past 2 days. IV drips and antibiotics were given. The dog was spayed the next day. Image of pyometra uterus. Follow up on Day 3.  VIDEO BEFORE AND AFTER SURGERY.    

Wednesday, October 8, 2014

1074. Travel Images - Spain - dogs - tail docking







A tail-docked Doberman Pinscher, Sergovia, Spain


Tourists love taking pics of Dalmatian in the Royal Palace, Madrid, Spain



Play ball retrieving, German Shepherd, Toledo, Spain

A Westie in Sergovia, Spain







1073. Travel images - Portugual and Spain





Toledo - Posing travellers do not wait too long. One shot.
Should have excluded tower on left. Original image. Zoom 55mm - 250mm
"P" Mode. Autofocus, Auto ISO. 

Image has been rotated 1 degree CCW, cropped and photoshopped as seen below









Always sharpen your image, using "Unsharp Mask"







Monday, October 6, 2014

1072. Travel images - good composition of two people being photographed


Sometimes, a fellow tourist can give good tips on posing for a good photograph.
The Portugese tour guide in Lisbon is used to being asked for photographs.
"Sometimes, my left eye will see left while my right eye will see right," she said as she posed for several tourists.
It is good to have a sense of humour. My tour manager is high energy as she stretches her left hand and smiled



   Selfie by the younger lady with fellow tourist in winery
I was opposite. Used zooms lens. "P" Mode, Autofocus, Auto ISO and high speed continuous clicking





Oct 7, 2014
Holiday Inn, Madrid
Watched NHK World on a programme about a company being entrusted with items for safe keeping. It takes photos of items inside the box. A big white sheet is clamped on a stand and the item is photographed against a white background. Tripod. The items are posted online in this portal to be shown to others in the "fun" community. Probably same category and an auction of items for sale.   

Sunday, October 5, 2014

Travel images - Spain and Portugal using Canon EOS 55-250mm lens



A dog is a man's best friend. No complaint about over-time work in downtown Portugual at 9 pm .
Zoom lens 55-250 mm, "P" Mode. Fast clicking as the basker packed up.

This zoom lens produces quite sharp portraits if there is good sunlight.





10 am sunlight brings out sharp images. Need to click fast as eyes may close.



In downtown Lisbon.
A waiter is happy to pose for me, sitting from my chair, in low evening light,
using zoom lens 55-250mm
and the usual "P" Mode. No waste of time. Click the three adverts on his T-shirt. Focus on eyes.








Moving coach. Zoom lens focus on "castle".  "P" Mode and high speed continuous clicking. 



A "gypsy" sells stalks of flowers to 2 male tourists in Spain.
If you accept her offer, she will read your palm and asks you for money. As much as 20 euros. You can give her one or two euros, the local guide said to me or walk away. My tour leader warns not to accept any offer or communicate with "gypsies" who are also present in other parts of Europe.  Notice foreground, a tourist is clicking the tool used in "Flamenco" step dancing.





A Canon EOS 55-250mm lens and a Canon EOS 70D camera are used. Photoshopped images compared to original ones. 

"P" Mode, Autofocus, AutoISO, high speed continuous shooting -- produce above images.
No need to miss shoots due to the need for setting aperture and shutter