Saturday, February 28, 2015

Sunday Mar 1, 2015, 6am

Sunday Mar 1, 2015

At 6 am, I make time for my morning exercise. Self-discipline to exercise at the public fitness area. Abdominal bender 100, cycling 40 steps, standing push ups 100 and bar bender 20 today. Midnight blue sky. Calm. No breeze. No bird chirping.

I walked past an Indonesian maid has already wakened up to wash the white Chervolet SUV. 99% of the residents in this landed property is asleep. The other maids are not washing cars today.

As I cycled, behind a 10-foot wall of a house, I heard "swish, swish, swish, swish, swish" as if a maid is scrubbing the floor of the house. At around 6.15 am, a resident walked his small breed dog. An occasional car passes by. All are asleep.

1130. A hen injured her back.

The rooster jumped on the hens. This hen, reared as a chick and has laid eggs for the family during the past 3 years could not stand up. She had pain in his back from my palpation and observation of her not able to stand. Her toes curled inwards.

1129. A green tree frog has closed eyes

Feb 28, 2015

I was surprised to see a green tree frog as a patient. This frog could not open his eyes. To me, it seems he had the 3rd eyelid covering his eyes. So he could not see and therefore would not eat the live cricket of 1.5 cm long at 1-2 crickets a week.

In the past 30 years, I never encountered one.
"How do you know he is a male?" I asked.
"Only male frogs croak," the man said. "He has bigger webbed feet."
"How about the genitals?" I asked.
"No need to check on that."

Interestingly, I had two in-patient terrapins with closed eyes too. Swollen upper and lower eyelids. The owner had bought eye drops from the pet shop but no success. He said he phoned the AVA vet to look for a frog vet. There was none the AVA vet could recommend.  Since he lives in Toa Payoh, he came to Toa Payoh Vets today. A green tree frog imported from Australia. Cost around $25.00.

"People will say that I should buy a new frog," he told me. "Cheaper than seeing a vet!" But he loves this frog. They could talk to each other. Animal-human communications. The human animal communicator advised him to consult a vet first before seeing him.

1128. Debarking a Miniature Schnauzer

Feb 25, 2015

This Schnauzer just barks as long as possible. The neighbours complain. The young couple wanted debarking. Yet they did not want debarking as it was deemed cruel. 

I advised them to use the "time out" method (put dog in a room for 10-15 minutes every time he barks) or "grip the muzzle and give a light smack, saying 'no barking' forcefully.

Finally the wife decided not to debark the dog.

1127. A father who has everything. What to give him on his birthday?


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Feb  27, 2015. This 9th day of Chinese New Year.

A father had his birthday today and his children bought him a branded wallet and a matching branded pen.

Most fathers don't get even one branded wallets from their children in their life. He got two. Of the same kind.

So he gave his feedback asking his son to exchange it for a belt

It must be difficult to buy birthday presents to a father who has everything.

If I were him, I would appreciate the gifts and thank my children instead of asking them to exchange the wallet for a belt.

 It is better to give a father who has everything a story, photo, painting or poem on his birthday. It mean more to him than material goods. Perhaps a hug and cheerful smiles every morning. As each morning may be the last with your dad.



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1126. The 9th day of Chinese New Year - Offers to the Land God

On Feb 26 morning (8th day of Chinese New Year), I saw the maid cleaning up the smouldering ashes from the pavement as I was doing my 6 am exercise in a public fitness area. She would sprinkle water onto the ash. Then a broom to sweep up the ashes and put inside a black plastic bag. 

This was the offer to the Land God, for the believers.

1125. Indancity Beyond 2015 on Feb 27, 2015 (9tth day of Chinese New Year)

Friday Feb 27, 2015

This is my 2nd SMU Indancity Beyond Dance attendance. The other one was in 2013 and it was good. The venue at Drama Centre Theatre (600 people max) on this Friday did not have the buzz of the crowded Kallang Theatre guests (1,600 people max).  The young ladies did not appear to be as well dressed up in evening dresses. Times have changed.

This time I was seated in D24 (corner), much nearer the stage and could appreciate the dances more. The best seats may be in the centre on 2nd level, if I am not mistaken as I had the best videos taken of the Flamenco Dancers in one in Spain (see my travel stories)

The dance with the subway theme and the one with the baggage travelers had lots of action. The opening dance with maid servants of the old era was most attention-getting.  I rarely attend dance performances. However, these dances broadens one's mind.  The dancers were perfect in their moves and did not collide with each other.

From my corner seat, the videos were not that great as there was obstruction. I hope readers will enjoy watching some videos done.  Hard work and sweat from the dancers.  Excellent performance but rarely do you see Silver Hairs there.  The choreographers were great. I had some great videos from my Canon D70 camera.

Wednesday, February 25, 2015

1124. Handphone caused an acoustic neuroma?

Thur Feb 26, 2015

I woke up at 6.45 am today as I had slept late. I had right calf muscle cramps yesterday and my left lower back ache had been present for some weeks. I decided to use the Japanese ointment applying directly onto the affected area. No more pain now.

Every morning, I discipline myself to go to the fitness park to exercise on the bar bender, abdominal trainer, cycling machine, standing push up and bar bender. Poor quality machines provided by the government as they are for the masses - free. The cycling machine is loud and squeaky waking up the neighbourhood. It has no resistance and I just simply pedal noisily. The abdominal trainer has no resistance too. The bar bender is the only one with resistance.   
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At 6.45 am, the park's white lights were on. The sky was greyish blue and soon changed to light blue and then white. The park lights switched off at 7 am but the amber roadside lamps were still on. Today, I heard 3 types of bird sounds. One is tweet, tweet, tweet high above the trees on my left. One is like chirping twice. One is like coo-coo-coo.  At 64, I am sure I can hear such sounds clearly and am grateful.

A few days ago, I met an old friend from some 25 years ago, seeing her married, having a child, working hard in the corporate world in communications, divorced and is now a retiree. We did not keep in touch. Some 7 years ago, I was shocked to hear she had brain tumour but we were not close and so I did not pry.

However, she had recovered but must go for yearly MRI scans. "I still cannot smile normally," she said. "My left face was once paralysed after the surgery. Now, feeling has returned."

I did notice that she always look serious during the dinner organised to welcome another friend who came from Australia. This friend had breast cancer and has remission on chemotherapy.

"Is your tumour an auditory neuroma?" I asked her as I sent her home after dinner. She does not drive and wanted a lift to the subway to go home by herself. It would inconvenient me since I did not pass by her home but I said it was OK.

Peace had returned to her self as she sounded happier. "It is up to yourself to be positive," she told me. She was very fortunate to have found an experienced Australian surgeon who operated to remove the bigger than golf-sized tumour from her left brain. Her office colleague referred him to her and her office paid for the surgery. An American surgeon she found on the internet asked for US$500,000 and that was out of her budget.

"He drilled two holes in my brain. After the first hole, I went home to rest as staying in the Australian hospital cost $1,000 per day. The next hole, he removed the tumour but there is still a small piece left. He could not remove all as it would damage my brain. My left face was paralysed." A good friend housed her during her recuperation and had long walks and talks with her. 

It must be horrible for anybody. Some would have commited suicide. Must be a rough road to recovery, being jobless and "useless."

She discovered differences in hearing from an overseas phone call. The left ear could not hear well. She had lost her balance some time but did not think much about it. Some ear pain was ignored.

"Can you cycle now?" I asked as she takes long walks in the morning with a group of friends.
"I can, but I will fall down if I stop suddenly."
   
"What is the cause of the acoustic neuroma?" I asked. "What did your surgeon say?"
"He would not comment but I know it must be from my handphone radiation. Sometimes, I press the phone on my ear for 2 hours talking to people. Over the years, the neuroma developed."

"What about radiation as therapy?" I asked.
"My surgeon said surgical removal is best as the tumour recur after radiation. It is very difficult to operate then as the radiation had bombed the area into a mess."

I did some internet research. Surgical excision is the best. Radiotherapy does not eliminate 100%  of the tumours as some cells may be resistant.

With 7 years of survival, I am sure she has recovered. Acoustic neuromas are also known as acoustic schwannomas. These are slow-growing nerve sheath tumours. I had two schwannomas on my left wrist and left foot removed some 5 years ago. I ignored them as they grew bigger. The one on my left foot became 50% golf-ball size and I could not wear shoes and I decided to be operated. The left wrist's Schwannoma caused my left middle finger to suddenly contract, like a "trigger finger." I decided to be operated again.  They have not grown back. Much depends on the skill and expertise of the surgeon.

I had an experienced surgeon friend to remove them. He did warn me that the schwannomas may recur and he would have to chop off my left hand as he could not remove all without paralysing my hand. My left hand forefinger and middle finger was numb for some years but some feeling has returned now. As for the left foot, he said that it would not recur and I presumed he had got the whole nerve out.

She was fortunate and so was I, to get a very good surgeon and that our Schwannomas are not cancerous. There is much to be grateful in being healthy in autumn years. Many young men abuse their health. I saw one young man furiously gaming online with his legs at right angles to his body as he leant back to fight the computer demons. In a few years, he would have sore wrists and back ache. So what? Young men are invincible. Master of the Universe.

Monday, February 23, 2015

How to be productive and efficient in neutering a dog - injectable anaesthesia

Feb 24, 2015



SEEING IS BELIEVING

The textbooks have all their information but the hands-on practice, recording and observation of anaesthesia hones a vet's skill and expertise in anaesthesia and surgeries at least cost and provide a high level of safety for the pet.

I produce two videos to share my over 30 years of experiences on neutering a dog safely and efficiently with my Myanmar vet assistant with injectable anaesthesia. No isoflurane gas was used if the surgery is started and ended within 21 minutes from injection to final skin stitching



Sheltie, Male, 7 months, 5.6 kg. 38.7C

INJECTABLE ANAESTHESIA
For a young healthy dog, the formula is as follows:
10 kg, young    Dom = 0.4 ml   Ketamine =0.5ml in one syringe IV
Duration of analgesia (no pain, no movement) =  15 minutes 

This dog was given D=0.2 ml and Ketamine 0.25 ml IV. Very good analgesia and safety.


PRE-OP
Clip surgical area first. This dog was excitable and so this was done after the injection of anaesthetic.

A: Injection of Dom + Ketamine    10.47am
D: First skin incision                       10.56 am
E: Completion of skin stitching       11.08 am

E-D = 12 min  (neuter took 12 min).
E-A = 21 min

Each testicle from incision to the final cut = 3-4 min
lst testicle  10.56 am - 10.59 am
2nd testicle  10.59am - 11.03 am



Antisedan given at 11.30 am. Dog stands up at 11.35 am. All OK.

SURGERY
3-forceps method
Suture Caprosyn /0   absorbable nylon type.



CONCLUSION
No isoflurane gas top up is needed if the vet knows exactly the effects of domitor and ketamine for young dogs in neutering. Many pet owners ask how long it takes to neuter a dog. In this case, the whole process will be around 30 minutes. The surgery itself is around 12 minutes in this case.

Saturday, February 21, 2015

1122. An old Miniature Schnauzer has a tail lump. What to do?

Feb 22, 2015. 4th day of Chinese New Year.

A tail lump in an old Miniature Schnauzer - what to do?

When faced with a skin lump, veterinary opinions differ. Some vets will advise "wait and see", prescribing some antibiotics. I will advise excision as it may or may not be cancerous. It will be up to the owner to make the final decision.

The vet should NOT advise "wait and see". Give the owner the option to excise or not to do it as the lump may be pre-cancerous or cancerous.

In this case, the old dog had a circular skin lump 8 mm x 8 mm x 3 mm. It looked very much like a ringworm. Dr Daniel said it could possibly by a result of licking or biting as the old dog had anal sacculitis, with thick brown oil expressed by me earlier.

I advise the owner to get the lump taken out by excision with a 1-cm resection margin ideally. A 1-cm skin margin would permit any present cancerous cells, if any, be removed, leaving little chance of recurrence.

This was not possible as there was insufficient skin and the tail would have to be taken out. The owner wanted to keep the tail stump. She gave informed consent to excise the lump without the margin. Histology was approved.

Dr Daniel operated. The lump was not cancerous based on histology. Dr Daniel's opinion was that this could be due to the dog's anal sacculitis itchiness and licking and that the lump could be inflammatory.



In an old dog, it is best NOT to wait and see. If the dog's lump is cancerous or turn cancerous later, there will be no good words for the vet's competence from family members.      

In this case, the skin lump was not cancerous. Everybody is happy. This could be a case of tail gland tumour based on its location. I had seen one in a Siberian Husky some years ago.

Friday, February 20, 2015

1121. Born free

Feb 21, 2015
6.30 am exercise


Feb 21, 2015. 6.30 am
3rd day of Chinese New Year

I exercised in a public fitness area
The Bar Bender burned my upper arm muscles as I bent the two bars inwards and counted 1, 2, 3
Could do 10 now.
The Standing Push ups - could do 20
The Abdominal muscle bender - could do 100
The cycling machine - too creaky and noisy. would upset residents and so I did less cycling.
Daily workout, one at 6 am and one in the evening
Better than going to the air-conditioned gym once a while.
Self discipline needed. Fresh air.

Can see dawn breaking. Black sky to dark blue to light blue.
Today, a bird high up in the tree "tweet, tweet, tweet..." 10 times for some time. Born free. Shorter life.
Like some men. Addicted to coffee and late night online gaming to 4 am. Every night if possible.
Unable to wake up. A mean-looking grumpy face at the office.
Can never function normally or be kind to any one when deprived of coffee in the morning.

A bird in the nearby terraced house sang a melody every time. Caged. No freedom. Safety. But no worries of predators or hunger.
Like some women. Cannot survive without air-conditioning.
Unable to appreciate the wild flowers and flitting butterflies in the hot and humid countryside
Admonition on travel to undeveloped areas with no electricity and with no air conditioning     



 









Wednesday, February 18, 2015

1120. Peri-anal fistula or haematoma, anal sacculitis, or circum-anal tumour?

Dogs can't talk. So evidence must be circumstantial.

In this Golden Retriever with a pair of gigantic perianal swellings, I reviewed the video again.


1. Thickened pigmented peri-anal skin indicative of chronic licking or rubbing (scootering). They remind me of elbow hygroma or elbow sores in some big breeds. These are caused by licking.

2. Peri-anal laceration wounds x 2. May be self-inflicted by biting canines to relieve itchiness.

3. Bilateral symmetrical swelling below the anus and in the vicinity of the anal sacs. Possible right and left anal sac impaction and infection.

4. Dark creamy pus oozed out of the anal sacs.

5. Peri-anal haematoma, secondary to peri-anal licking and fiction. A needle should be inserted to check or in this case, I got both ventral ends lanced. Bloody fluid oozed out continuously for several minutes.



So, are these two swellings due to circum-anal tumours? I doubt it and so did not do a biopsy but treated conservatively by lancing and medication. On Day 4, the swellings have had subsided 30% and do this may really be an exaggerated case of anal sacculitis resulting in gigantic swellings, rarely seen in Golden Retrievers.



1199. Three Chinese New Year inpatients.

Chinese New Year, Feb 20, 2015 is a cloudy day.

There will definitely be no cases as the owners celebrate.

I came to check on the Jack Russell that had recovered from vomiting and diarrhoea, the terrapin that swam sideways and the kitten that had diarrhoea for over a week.

1. The terrapin had been here for 2 days. Had lost 2 grams but is more active and no longer gasping as evident by the rapid throat movements of rapid panting. I noted the shell has had become greener instead of yellow green 2 days ago. He had not put on much weight as his two siblings, all originated from Florida, USA and sold by Pet Lovers' Centre. This batch looked good when I saw them some weeks ago at the pet shop. Now, the owner had a hideout which is a dome-shaped porcelain. Only 2 terrapins could hide inside as there is insufficient space now. Probably they bullied this 3rd one who is yellowish green in shell colour while the other two are dark green (see video).

Today, I tested this patient. He could swim with less frequency of right sided tilting after 2 days of inpatient treatment. He was exposed to sunlight as he never had ultraviolet light at home. The owner did phone yesterday but it takes time to recover from respiratory disease.

2. The Jack Russell had recovered from vomiting and diarrhoea some 2 days ago. The owner is very busy going all round Singapore to fix fibre-optic problems. He appeared on his bike at around 11.30 am and I saw him while I was monitoring this terrapin outside. He loves this Jack Russell and I offered to send the dog and him home in my car since he was riding his motorbike. He said he would drive his car here tomorrow. After much persuasion, he took the dog home on his motorbike (video). Some people work very hard for a living and I could see his weariness and bloodshot eyes. For the long hours he put in, he had no time to relax, let alone pick up his dog. Anyway, the dog went home today, on his bike.

4. The diarrhoeic kitten was still lethargy but still alive. Had drank water but did not want to eat. Handfeeding is done although he rejected after a few mouthfuls. Multivit, water and antibiotics are given.

Monday, February 16, 2015

Follow Up: A 7-year-old Shih Tzu 2 months post surgery to remove bladder stones. (Video)

Today, the Shih Tzu came in as he was limping from his left fore foot. A stitch still remains from his bladder surgery done on Dec 20, 2014 and I removed it.

This dog had blood in the urine in 2012 but the owner did not want surgery. The dog started vomiting once a month. X-ray showed numerous struvite stones inside the bladder and os penis. 

Now today, Feb 17, 2015, the dog is perfectly normal. Only home-cooked food.




Follow Up: A 7-year-old Shih Tzu 2 months post surgery to remove bladder stones. (Video)

Today, the Shih Tzu came in as he was limping from his left fore foot. A stitch still remains from his bladder surgery done on Dec 20, 2014 and I removed it.

This dog had blood in the urine in 2012 but the owner did not want surgery. The dog started vomiting once a month. X-ray showed numerous struvite stones inside the bladder and os penis. 

Now today, Feb 17, 2015, the dog is perfectly normal. Only home-cooked food.





Feb 2015 Video interview 2 months after urinary stone removal by Dr Daniel Sing
http://youtu.be/YYH6wQctLWk



1196. An apartment cat's lifestyle -obsturction of LI or torsion as seen on X rays?




Today, Feb  17, 2015, 2 days before Chinese New Year, I phoned the owner of this 6-year-old female spayed cat that was warded for vomiting frothy yellow stuff and passing watery reddish brown stools on 3 days earlier. The cat lived on the 2nd floor and would go outdoors every day for around 15 minutes. This was her routine but on Feb 5, 2015, her owner had to bring her for treatment of acute gastroenteritis.

"She has recovered  fully," the lady said. "What is the cause of her vomiting and diarrhoea? Dr Daniel did not give me the reasons."

"It is not easy to pinpoint the exact cause," I said. "The blood test was normal. The stools analysed did not show ova, cysts parasites, leucocytes and erythrocytes. The urine had some bacteria and blood.

"X-rays cannot show the cause. But I suspect large intestine obstruction as evident by the transverse colon showing lots of gas. Dr Daniel thinks it may be a torsion."

I had given the dog IV drip, baytril and spasmogesic SC and warded her overnight from Feb 4 to Feb 5, 2015.  Today, I phoned the owner and received the good news that the cat had recovered within 2-3 days of going home.

As to the cause of the gastro-eneritis, it would be related to the outdoor lifestyle of this cat. Perhaps she had eaten something poisonous or had cleaned her chemical contaminated paws. "Now she is kept at home and she is not happy," the lady told me that the cat would want ro go out whenever she opened the door.

"Best to keep her inside the apartment," I advised.  

Sunday, February 15, 2015

1195. Sunday's interesting case - The dwarf hamster has an everted pouch

Unbelievable vet stories: Three couplets of Golden Retrievers with connected links

Sunday Feb 15, 2015

Some of my cases come in twos within a short period of time?

In the first couplet, two 13-year-old  Golden Retrievers passing dark red vaginal discharge in December 2014 and January 2015. Both suffered from  the same diseases called open pyometra.

Then yesterday, a second incident of timing occurred. Two Golden Retrievers came in one after another, one with lameness and the other with gigantic swollen anal sac areas.  Being uncommon in urbanized Singapore where over 90% of the residents live in apartments, meaning that big breeds like Golden Retrievers are rare, I was surprised to see 2 goldies as my first 2 cases.

In addition, there are around 70 small animal practices and so this makes the chances of seeing 2 goldies in a row much less.

In the 3rd instance of couplets, it was as if some Divine powers gave me an opportunity to take images for my comparative anatomy of anal sacculities. The Golden Retriever in the 2nd incident has two bulbous anal sac areas - a very rare situation which I am sure most small animal vets would not have encountered came in. It was like finding treasure in medical research. I took images and a video to document this situation.

I was wondering how I could compare this dual swelling with another Golden Retriever with anal sac impaction but not with such a gigantic swelling. The next day, a Golden Retriever came in came in with anal and tail end skin inflammation.

This was a case of anal sac impaction as the smelly brown oil expressed by me from the anal sacs shot out with a buzzing sound. This presence of oil astounded the owner and splattered onto my white polo shirt sleeve. I had used tissue papers to cover up the anal area before expression of the sacs but still, the volume of dark brown thick smelly oil was copious and explosive. This Golden Retriever permitted me to take an image of anal sac impaction without the gigantic swelling as in the other Golden Retriever in the second occurrence of couplets.

These are true but unbelievable vet stories of Golden Retrievers cases in Toa Payoh Vets. I have the images and the videos to substantiate my findings.

Friday, February 13, 2015

Two Golden Retrievers in a row

Friday, Feb 13, 2015

This morning, I had two Golden Retriever patients one after another. This is rare for me as Golden Retrievers are rare in Singapore, with the vast majority of dogs, about 99% being small breeds.

GOLDEN RETRIEVER NO. 1
The backside had two large swellings below and on the sides of the anus. "They appeared overnight," the owner said. "These are anal sac impaction with pus," I expressed yellow pus out from one side. "This case needs a finger to be inserted into the anus to expel the anal sac oil and pus. The dog needed to be sedated."

Dr Daniel expressed the pus digitally and the swellings shrunk. "No more anal sac oil," he said to me. "Flabby swellings now!" 

"It is best to incise at the lowest point to release any remnants of the pus and dead cells," I said.

Dr Daniel excised 1 cm at the ventral area of both swellings. Blood oozed out for several minutes.
"Let the contents flow out," I said. Later, Dr Daniel would stitch up the two incisions and the dog went home.


GOLDEN RETRIEVER NO. 2
"He is lame again on the back leg. I think it is the left one. Or is it the right?"
I had the dog trotted outside the clinic. His right hind leg was up while his left hind leg was down as he was trotted by the maid who did not wear slippers.
"Looks like he is not bearing weight on his right hind," I said. "The only way to tell is to flex and extend the joints on the consultation table. The dog refused to trot anymore.


My medical records showed the dog had a spinal pain at one time and a left medial thigh swelling and pain at another time.

Now he had spinal pain and very painful left hip. "He wrinkled his muzzle and that is a warning that he would bite." I flexed and extended his left hip twice. The dog did wrinkled his muzzle and turned to face me. So the dog was in pain.

"He would go under the sofa every day," the owner said. Such a big breed would injure his back and sprain his hips on getting out.  The sofa had a hollow just sufficient to squeeze in this dog.

"The solution is in your hands," I said. to the owner. "Close the gap or get worse hip pain next time!"

The second 13-year-old Golden Retriever with open pyometra

I had 2 Golden Retrievers with open pyometra recently. Both were very thin and in poor health, but the second dog was panting a lot for the duration of more than 15 minutes of consultation.

"She's frightened at the vet," the man said. "That is why she panted a lot."

"It is unusual for a dog to have such a fast respiratory rate, as if she had sprinted ," I said. "Such panting is a sign of very poor health.  Her heart is failing. There is also the blackish-red vaginal discharge. She has open pyometra and should be operated the next day, after one day of IV drip and antibiotics."

"She is too old for anaesthesia," the man did not want any surgery and I prescribed some antibiotics for the dog. "Feed her 6 times per day to let her regain her weight."

But the dog shut her mouth tightly and it was extremely difficult to hand feed her. The vaginal discharge came out every day for the next 7 days and the owner texted me. "The solution is to remove the bleeding womb," I texted back. "But she is unfit for anaesthesia and would likely die on the op table."

The dog was not panting so fast but she would not want to eat. Her vaginal discharge came out thick and dark red, soiling the floor. The owner decided to get her operated. I told them that the chances of survival are slim as she had heart disease causing the continuous panting. She also would not want to eat.

The dog kept passing vaginal blood. The couple decided on the operation. The dog was inpatient for 2 nights and given SC and IV drip for 2 days. "Her pulse was not palpable," I told the owner. "That means she has very low blood pressure and should not be operated. Her gums are purplish and so there was some difficulty in getting oxygenated blood into the gums. Are you sure you wanted the operation?" He gave his informed consent by texting me.


The dog was operated using just isoflurane gas. The uterus had a big sac around 20 cm x 10 cm of darkish red blood. This reservoir released the dark red blood every day out of the vagina.



The surgery was done by Dr Daniel who had warned that the dog was unfit for anaesthesia. "The owner had given his informed consent," I said.  I texted the owner that she had been operated but was panting a lot after surgery and sent him an image of the uterus with the cysts and the sac of dark red blood. Around one hour later, the dog panted much fasted and suddenly the dog passed away. There was heart failure. I informed the owner.

The parents and two daughters aged 10 years and 4 years came promptly. The 10-year-old felt the loss badly but the 4-year-old still could not understand that death was a permanent loss. "This dog is very old," I said to the 10-year-old. "Around 91 years in human age. She had lived a long life much loved by all in the family. Most Golden Retrievers don't live up to such an old age.. Many men alos die before they reach 70 years, not 91 years."  

"Would it make any difference if she was operated on the first consultation?" the man asked me. "I don't know," I said. "She was already having heavy panting then."

"I doubt it would make any difference if my dog was operated earlier on the first consultation," he replied. "But the solution to this heavy vaginal bleeding and reluctance to eat was surgery and I told my wife." 

If the dog survived the surgery, like the other 13-year-old Golden Retriever, she would live longer although she would need heart disease medication..  

In conclusion, this dog was likely to live longer if she had been spayed at one year of age. There would be no pyometra leading to dirty continuous vaginal discharge. There was also a swelling of the left posterior two mammary glands, possibly a sign of breast tumours. Early spaying might have prevented such tumours from developing.
   
 

Wednesday, February 11, 2015

Final Video: How I spay a cat using injectable anaesthetic

Apr 4, 2014 Singapore, Toa Payoh Vets
Spaying a caterwauling cat on a Sunday. Owners cannot stand the noisy caterwauling of the female cat and got her spayed.
I am Dr Sing Kong Yuen, veterinary surgeon from Toa Payoh Vets, www.toapayohvets.com.
In use xylazine + ketamine injectable anaesthesia for all my cat spays and neuters and find this combination to be effective and safe. The duration of analgesia is around 30 minutes, 5 minutes after the time of injection. Isoflurane + oxygen gas top up is given if necessary.
In this case, for a 3.6 kg Maine Coon, I used xylazine + ketamine 0.15 + 0.6 ml in one syringe IM to be effective. I always place two horizontal ;mattresses in the 1 cm skin incision.
I gave baytril and tolfedine inj SC after the spay and the cat goes home with 4 days of tolfedine and 5 days of antibiotics. Usually I don't prescribe e-collars but taped up the surgical wound. With post-op painkillers and antibiotics, I find that there were no complaints from the spayed cats as exemplified in this case. 
I phoned the owner on the 18th day (April 3, 2014), to follow up as Intern Nicolas would be completing this video. He was most happy with the surgical outcome as there was no post-op complications.  
More Be Kind To Pets veterinary educational videos are at:
www.toapayohvets.com/videos.htm


FINAL VIDEO:  SPAYING  A CAT AT TOA PAYOH VETS
http://youtu.be/KustPeoh5M8

Sunday, February 8, 2015

1190. The 8-year-old Schnauzer had a circular skin lump

This 8-year-old Miniature Schnauzer had a circular skin lump, 1.5cm across, located at the tail end. I advised removal as it could be a skin tumour growing bigger as this dog is old.

"It could be due to biting from anal sac infection," Dr Daniel expressed his view. "8 years is not old for a dog."

"Dogs over 7 years old are considered old," I said. "This skin lump may be inflammatory but nobody can tell. It may develop into a cancerous skin tumour later if not removed early. If you wish, do a biopsy to check."

I did not propose biopsy in this case as the owner was willing to get it cut off. Biopsy will take some time and cost money. Even if the tumour is benign from a biopsy, there is no guarantee that it will become malignant.

Dr Daniel operated and the lump was sent for histology on Monday Feb 9, 2015.

Referral - The Dachshund took revenge squirted anal sac oil onto the camera

Feb 8, 2015

Referrals are most important to vets but the vet must deliver. The owner of this itchy Dachshund came because of referral from another Dachshund owner that was treated successfully.  Posh was this dachshund's name.

The present dog was itchy all over the body. I was teaching my vet assistant and video-taped the consultation.

The anal sacs were expressed 3 times and the yellowish oil with some white granules were stinking. Rancid vinegar smell of over 5 ml in volume. Quite a lot as evident in the video..

After ear irrigation under a slight sedation of Zoletil 100 ml at 0.2ml IV, I videoed again the anal sac. I videoed the expression of the sac. Suddenly another explosion of yellow anal sac oil squirted out and soiled the camera lens. Fortunately, I had a lens protector. 

I assumed no more anal sac oil but the Dachshund exacted his revenge onto the vet for expressing his glands by shooting out the oil onto the lens and camera! Video footage is the evidence!   

I spoke to Intern Phyllis who told me that vets at a certain clinic routinely use the rectal expression using the fore-finger and asked me whether I do it. "It depends on the breed. In some dogs like the French Bulldog, the anal sac opening are hidden deep inside the anus and the finger expression had to be used.".


https://www.youtube.com/watch?v=mS1aIsxPvXk&feature=youtu.be

https://www.youtube.com/watch?v=ntAA6oBDYVo


1188. The dog breeders' treatment for ringworm is salt

Article written by Dr Sing Kong Yuen in March 8, 2004.


Active ringworm lesions in a dog that had been clipped 10 days ago.COMMUNITY EDUCATION OF DOG OWNERS SPONSORED BY WWW.ASIAHOMES.COM

The breeder's treatment for ringworm is salt.

Suddenly she put her finger on her upper most button of her blouse and said,  "I have the rings here too."  3 circular rings of around 2 cm in diameter, like those seen in the picture on the dog in the picture (left) flashed out from the pale skin of the lower neck.   

Her husband had presented this puppy to his wife and had no time to object to the display of her upper chest. It was still within the bounds of decency. I did not want to be practising human medicine and diverted her to her hands. 

His wife's arms were dotted with at least 8 of the rings.  Her general practitioner had prescribed 2 types of pills and a cream. 

"The doctor said I could have got the skin problems from my dog," she said. "I have changed the shampoos as I think that the shampoo was causing me skin allergies."

The poodle was licking its right wrist as there was a squarish patch of dead skin covered by scales.  A very itchy area.  There were at least 5 spots of ringworm-like lesions on its lower neck, tip of the right ear, right shoulder and chest. The skin lesions were unlike those reddish ones seen in the owner.

"I have this poodle for 3 weeks and the skin problems are much better than before," the owner said. "Some hairs have grown, but it is too long."    

"What did the breeder give you?" I asked as I examined the black poodle with the softest coat.  Some breeders provide after-sales veterinary services to save some money for the new dog owner.  If they ask the owner to consult the vet, the owner may not buy the puppy as that means it has veterinary problems.  

The owner said, "One big white tablet which I have to break into 4 pieces and which causes the poodle to pass a lot of water. One bottle of brown medicine with your faded surgery label and unclear wordings stuck on it.  One bottle of lotion to apply.

I said, "Definitely, I have not given the breeder to dispense medicine on my behalf and I have not seen this poodle, except for the vaccination." 

So, what was the cause of the skin problems in this 4-month-old poodle?  It was ringworm. However, the drugs given by the breeder had partially solved the problem.  There were no new ringworm areas like those seen in the owner.  New ringworm lesions would be like those with a red ring seen in the picture of the dog.

What shall I do?  "Clip the poodle to reduce the contamination of ringworm fungal spores in your house," I advised. "There may be other new active lesions which we can't see under the lush coat."

The owner was not agreeable as she continued to stroke the puppy. It has that type of fine coat that was a pleasure to touch.

The alternative treatment was to wash the puppy with the anti-ringworm shampoo and give medication for the next twenty days diligently.  The owner was happy with this. 

Some dog breeders in Singapore believe that salt would kill the ringworm. Salt is cheap compared to veterinary consultation and treatment.  Some breeders have learned from experimentation that salt applied directly on the skin lesions for long periods of time, the ringworm lesions will disappear.  But how long will this take?  Ringworm is one of the commonest problems affecting breeder's puppies and it takes time to cure it.  By the time it is cured, the puppy is no more cute and marketable at a premium price.  After the sale, the new owner may find it best to consult the veterinary surgeon regarding skin problems rather than the breeder or pet shop owner.
 

Saturday, February 7, 2015

1187. No free lunch - wrong assumption

Feb 8, 2015

"She will stay at home from tomorrow," the husband was unhappy that his wife received no pay for being present at the office. I had arranged for the Myanmar employment agent to come to my office to let the husband speak out in his Myanmar language as there may be miscommunications and a 3rd party is best. This meeting was held yesterday at nearly 11.30 am after a busy morning of consultations.

The wife had stayed in Singapore for one month. She got a Dependent's Pass from the Ministry of Manpower. But the approval to work will be given only after 3 months in Singapore. A Letter of Consent needs to be applied by an employer. So, she could not be employed. Neither do I need any new hires.

"Your decision is OK with me," I said. "The English people will say that there is 'no free lunch'. As a husband, you are the head of the household. You are the leader and you have decided."

So the wife stays at home waiting for her husband to come home, instead of acquiring some work skills, experience in computer use and understanding Singaporean English. The present generation of the Myanmar people had graduated with a poor knowledge of English and computer literacy owing to its history. If they want to learn, they can do it in Singapore.

"I am the leader of this company and I have to make sure it earns some income to pay the employees and overheads. I can go bankrupt if I don't manage well. I make work decisions to make sure that the office is run properly to survive the competition. In 2015, there are over 70 vet clinics in Singapore and business per clinic must be lesser.

The husband understood the highly competitive nature of the veterinary industry in Singapore as he was here for over one year.

Some of my employees may not be happy with such decisions. I have explained again and again why I make the decisions to sustain the business. Employees want the best work conditions but they need to be realistic. They can always resign and join another company if they are capable and experienced.

"What is it in for me?" an employee will always think. "I don't care if the employer loses money or go bankrupt."  There is not always another job waiting nowadays for most people.     

WRONG ASSUMPTION
My employment agent had spoken by phone to my vet assistant the day before and assumed that he was happy with her explanation. Yet I don't think so and wanted a face-to-face meeting today, Saturday. This gives the employee a chance to voice out his side of the story as regards his wife's employment situation. The agent had already told him and he was aware that there would be no employment for the first 3 months after getting a Dependent's Pass. His wife was free to stay at home all day long.



1186. Instagrams@hampigs - the guinea pig had diarrhoea



Sunday Feb 8, 2015

The adopted female guinea pig recovered from watery diarrhea. She lived with another female. Both chased each other in a small pen. A few days earlier, she had blood in the urine and urine tests showed bacteria and blood in the urine. She recovered but had watery stools yesterday. After SC dextrose, anti-diarrhea and antibiotics, she passed lots of normal stools. Hay was given overnight.
The lady owner really researched on the best bedding for the guinea pig via her Instagram account. "The video is only for 1 minute," she showed me 2 guinea pigs on the "fleece blanket bedding" bought from IKEA chasing each other round and round in a crammed central space. Like cars going round a circle.

Instagram connects guinea pig lovers and she has 55 likes in her @hampigs posting. I did not know that Instagram can be used to share info on guinea pigs care. "You have to open an account under "pets"," she said.  She had done her research and the "fleece polyester blanket from IKEA" is the best to prevent underfoot sores! It absorbs the urine and she can sweep away the faecal pellets. The 2 guinea pigs have their own pee pans too. I asked her to send me a video later although her account showed the bedding.

"Don't they gnaw the bedding?" I asked.
"I fix it properly to the grid," she said. The grid was bought from DAISO but now they don't stock it. The grid are wire squares for the kitchen wall, to hang things.

Thursday, February 5, 2015

1185. Employment agency has "no business"

Wed Feb 4, 2015

Khin Khin's Employment Agency had no income for the past 2 months in December and January. The manager blamed this on the holidays but not himself. The Government had slashed many work permit and employment pass applications leading to a labour crunch. Certain jobs like construction and food and beverage industries do not attract most Singaporeans and so it is bad luck to such investors or employers.

I had a chat with the manager as he was not performing despite 3 years of experience. "The fault lies with your leadership," I said to Khin Khin who is the licensee. "It is rare to employ a manager who is self-motivated and driven and since you were in Yangon for the last 2 months, your manager would not close sufficient cases to cover the rental and his salary!     

Wednesday, February 4, 2015

Tuesday, February 3, 2015

1183. Another 13-year-old Golden Retriever has open pyometra

Feb 3, 2015

Yesterday, I had a very thin and panting female 13-year-old Golden Retriever that had become lethargic and had not been eating for 2 days. Not spayed. Like the other one who is now back to normal. I had expected that one to die after surgery as she was very ill.

Now I had this contemporary. This one was panting continuously. Treatment given included drips, spasmogesic, baytril, amino acids, vitamins, frusemide and an Haemoplex (iron vitamin injection) IV.  Nutriplex and antibiotics for 14 days. First time I give iron IV.

Continuous panting is a bad sign as this precedes death.  Best to wait 14 days and spay the dog once she is healthy but this is my advice as the womb infection will recur. See video.







FOLLOW UP TODAY
10.57 am. SMS. Is Daisy still panting? Eating more?
10.58 am  She's started eating. Panting is almost all not visible. She ate 4 pieces of bread and an egg this morning.
10.59 am.  Feed 6X/day or have food available.

If both female Golden Retrievers had been spayed at a young age, they will be in good health as they live longer than the average. I believe most live around 10 years of age.








THE OTHER 13-YEAR-OLD GOLDEN RETRIEVER video. A very thin dog too.

Cambodia produces the cheapest rice

Feb 3, 2015

I spoke to a Singaporean who helped the Cambodian agro-industry in the following project.

Cambodia, Thailand and Vietnam are 3 biggest rice growers.
Cambodia (15 million people, size of Malaysia) produces the cheapest rice.

AGRO-TECH CHALLENGES 
Owing to its history of Pol Pot killing the educated amongst the population, there are very few educated farmers to adopting agro-technology. The main worry is scam and so the farmers cannot accept new knowledge which may benefit their rice production. Wholesalers and traders are the other group.

The rich and the poor wealth gap is very wide. It took 40 years to get the whole rice production community to accept IR8 strain of rice.

EFFICIENT PRODUCTION OF RICE

Rice production by the big rice millers needs a lot of power (electricity) to dry the rice and crush the paddy which then comes out as rice. The husk, after crushing, is too voluminous and light and contains silica.

Traditionally, the husk is burnt, contaminating the environment with silica as it is a poisonous waste and cannot be used as fertiliser. 1 tonne of paddy produces 100 kg of rice and a large and light volume of husks. If the silica is extracted, the by product can be used as a fertiliser and the silica can be sold.

In this project, Angkor Wat Mills, the largest rice miller in Cambodia, is privately owned. It has a plant which extracts the silica on a large scale. It has a British company to document the process (safety and SOP operation etc). It and another company is doing this project (paddy-dehusk-rice).

Vietnam had a US$20 million ADB loan but the plants are not operational now. Thailand used to have privately funded research centres to provide free services to the farmers by the Thaksin and elite group. Now it had no operational plants now. So, Cambodia is the only one doing it in 2015. The Singaporean says that the tuning of the plant must be done right to execute this process although the agro-technology knowledge is well known. Rice husk is converted to biogas

For every tonne of rice produced, Angkor Wat Rice Mill donates a gas stove to the farmer. The farmer is to use the gas stove to calcify silica and take back 95% of the hydroxide.  No need to buy hydroxide. Control of CO2 is important.  

A plant needs US$2.5-3 m to be set up. Control of CO2 and the need to purchase hydroxide. A chemical process basically to extract the silica for sale, and to prevent environment contamination.

Education of the farmer is needed to use gas stove provided to farmers by Ang Kong Rice Mills (2.5 years in existence).

The technology is there. But the execution is the challenge and it appears that Cambodia has successes to lower the cost of production.  Can this process be done in Myanmar? The stage of development - not possible now.

RICE VARIETIES
2 main strains. Jasmine and Thai Hong Ha.