Saturday, October 30, 2010

232. Brand name opens the door

I would teach Mr Saw, my assistant whenever I had a good case. He would be going back to Myanmar in April 2011 to start-up a vet surgery in Yangon with a friend. He had been working for me for nearly 3 years and he would be considered an "experienced vet from Singapore" in Yangon.

I said to Mr Saw: "You can have a good name - experienced vet who has worked in Singapore, but remember one thing: if you can't give what the owner wants, your brand name is no use to him.

"See this case of the cat (with a problem that the brand name practice vet was not given a second chance to review). He takes his ten cats to this famous and big vet practice for the past years. He could have consulted Toa Payoh Vets as he lives in Toa Payoh. But he would never do it for some reasons.

"His wife had consulted Toa Payoh Vets once, the husband had said to me. That means there is something I had not done correctly or given to what the wife wanted. So I have to improve my services or the facilities and review my operations.

"Brand name opens the door for you, but if you can't give what the owner wants, you can be the most famous vet practice in Singapore and he will go elsewhere. You must be able to resolve his cat's problem at the price he can afford. If your practice is famous, you cannot solve his problem and you quote him a high vet cost, he will not come back to you the second time. This applies only to those who don't want to spend and spend on their pets' veterinary treatment."

Mr Saw nodded his head and appreciated the advices I gave him regarding competitiveness, the need to save on costs so as to give affordable vet treatment and not waste materials and medicine as many vet employees are prone to do so. He learns the running of the practice by working for an old vet who has been battle-tested. He was fortunate in this aspect as I had time for him to mentor him knowing that he has a good work attitude.

Thursday, October 28, 2010

231. Brand name v. benefits to the customer

My vet assistant, Mr Saw had worked with me for nearly 3 years. As he will be leaving next year to work in Yangon, I shared experiences of cases with him today and whenever we work together.

Case 1
Tumour in gum of Chihuahua, M, Neutered, 6 years.
"It is best to advise histopathology of this tumour," I said to him. "Some owners are not aware of the need to get this test. We want to lower our vet costs by not advising this test. However, the tumour may be cancerous and if we do not advise, the next time the tumour comes back, the owner will not have confidence in the vet.

The owner is a young woman with internet knowledge and so she will know many things by researching the internet for gum tumours. She had asked whether I would be doing a histopathology and I said yes. Not every owner wants the lowest price.

Case 2
Urinary stone stuck inside the penis. "Different vets will operate differently to take out the stones jammed packed behind the os penis, inside the penis ," I said to Mr Saw. "In this Yorkshire, the vet leaves the urethra wound open by NOT stitching the incision. I will not operate this way. Why?"

Mr Saw did not know. "Well, this is a male dog. So he usually lifts his one leg to pee. When he pees, his urine will leak out from under his penis where the urethostomy incision has not been closed. So he sprays urine or dribble urine all over the apartment. In Singapore, 80% of the people lives in apartments. By NOT stitching up the urethra, the male dog may pee from his penile end and from below the penis. If you are the dog's owner, you will be very unhappy as you have to clean up. Worse still, the dog dribbles urine all over the whole floor due to urine marking.

Case 2.1
"Don't let the dog go home on day 3," I advised my associate. "The catheter may be rubbed out at home or pulled out as the dog will be roaming all over the apartment. In the Surgery, he is confined and monitored and nursed every day. At home, most owners don't bother. Things become nasty when the catheter is pulled out and the urethostomy wound at the bottom of the penis has not healed yet. Worse of all, the urethostomy wound closes and cause obstruction before the 10th day as recommended. The owner will want 'free' surgery or treatment. In any case, you get an unhappy owner."

The dog was put in for at least 10 days as this was a serious case of bladder and lower urethra being cut to take out the stones. (see X-ray).

Case 3
Skin disease.
"What the owner wants is a cure after payment and not have to come again," I referred to a case. "Vet 1 had treated and prescribed anti-fungal drugs and washes for the last 14 days. You saw the owner who was very unhappy as the dog was very itchy in the elbow, backside and lower body."

Mr Saw learnt from how I handled this case.
1. Skin scraping
2. Ultra-violet light. This was most impressive to the owner as ringworm hairs flouresce in the umbilical area and backside.
3. Communication with the owner. "You need to clip the dog bald," I said. "Otherwise you will curse me 2 weeks later when the disease is not gone away."
4. Clipping bald.
5. Anti-fungal wash.

After clipping bald, I discovered scabies mites on the ear edgess. So this dog had arcptic mange as well. No wonder he was so itchy and wanted to bite the owner!

Wednesday, October 27, 2010

230. The ends justify the means

What is the meaning of "the ends justify the means?" I will illustrate. A father who is the sole breadwinner earns $3,000 a month. His daughter failed to get into the Singapore University due to not having straight As.

But she is accepted into an Australian University to pursue her dreams. The yearly cost of accommodation and tuition fees around $50,000. The mum does not work. So the source of income is around $36,000 from the father's earnings as an employee.

The company permitted the father to do outside work. He did manage to pay for the daughter's first year of overseas education through a stroke of luck. In the second year, Lady Luck enabled him to rent and sell a $3 million condo, thereby giving the daughter sufficient funds. But the timing was not right. So the father issued 2 cheques of $5,000 and $1,500 for an interest-free loan in cash. The cheques were dud ones as they could not be banked in. So, he got part of the money for his daughter. His "ends justify the means". Without the money, the daughter would be evicted from the course. Lady Luck had been kind to him again as no complaints to his company were made about his dud cheques. He repaid the monies 3 months later when the sales of the condo was completed. But there are two more years to go. Will Lady Luck still favour the brave father? Can he go round issuing dud checks to get money for his daughter and his own expenses? Is this an honest way to live? I don't think so. But there are such people using dud cheques to get the money. It is best not to lend any money to anybody.

Tuesday, October 26, 2010

New puppy health check


I am looking to adopt a new dog into my house, she is currently 1month old and still being weaned.

As i already have a 5 year old dog, i want to ensure that the newest addition is healthy and free from any disease.

Please let me know what tests which need to be run and at what age.
And also how long in advance would i need to make an appointment.

Thank you,

Name of owner

I am Dr Sing. My advice is to isolate the puppy from the adult dog for one month. Get the adult dog vaccinated 2 weeks before the puppy arrives if it is not vaccinated for the past one year. The puppy can be sent to me for general examination, testing of parvovirus +/- distemper and general examination after weaning and one day before going to your house. A blood test may be requested to check for liver and kidney disorders and blood status.

This will be around 6-8 weeks. First vaccination is at 6 weeks.
Appointment 24 hours earlier by phone 6254 3326 can be made. Best wishes.

228. Exploitation of a top performer

The following is my advice to any person who wants to be a joint-venture partner without putting down cash.

In this case study, I shall call this person Alan. In this private limited company, there are 2 directors at 50:50 share. Alan feels that he should be paid $5,000 per month as a "salaried" director as he brings in the bacon. The other director, Bernice puts in the money 100%.

So, Alan will get $60,000 per annum for the first year of operation. Bernice does not get paid but contributes in administration and management of the staff and office. At the end of one year, Alan wants 50% of the net profits but he will not be responsible for any loss. He thinks that there will never be losses since he has a wide network of prospective and loyal clientele. Bernice is only a "godmother" who pays for everything including his "salary".

The important issue is that he wants to consider $5,000/month to be classified under "operating manpower expense". That means he gets $60,000 per annum for the first year whether the company makes a profit or loses money.

After deduction of this expense and other expenses like salaries of supporting staff, office rental, utilities and miscellaneous expenses which may amount to around $72,000 per year, the estimated "operating expenses" will be $72,000 and with Alan's "salary", the total will be $132,000. Bernice does not get a cent for that first year.

Therefore the total loss to the investing director for this first year, will be around $132,000 in the worst case scenario of losses.

Alan, the paid director projects "profits" based on his extensive network of relevant clientele and your more than 30 years specialising in the industry. He brings in the bacon (as the clientele and expertise are his initially), but he does not bear the financial losses if the business fails.

There may be SARS virus equivalent or long periods of haze when nobody travels, a regional war, Singapore being attacked by terrorists. Money is needed to keep the business going during such unforeseen times and also to advance to him as the "directors' fees" which he wants to considers as his "salary".

Now, if Alan is merely an employee of the start up agency, the $5,000/month is classified as "salary." If not, it is considered "director's drawings".

Man proposes. God disposes. If the reader does not understand this idiom, I clarify that there is no sure thing as success in any start-up business. If there is, why are there so many more employees than self-employed?

With Alan's proposal to get $60,000 and 50% of the net profits (if any) but not the losses, Alan is effectively taking more than 50% of the net profits if the business makes profits. He does not take the losses and so he can just say goodbye and look for another job by becoming another employee after one year.

I told Alan that his proposal is unfair and unacceptable to any investor. "Obviously, you have considered that Bernice, the investing director doesn't deserve any monthly payment as she does not bring in the bacon. Well, she does the necessary administrative work saving time that permits you to do business development and she is putting down the money where her mouth is."

I elaborated: "Both directors in this 50:50 share holdings must be fair. When 2 people start up, they put in money and their initial shares are based on the monies they invested. They may pay themselves a small salary or forgo salary. Certainly, $5,000 a month is not the amount the start up will pay the partner as that depletes the operating capital.

"Bernice also thinks she deserves $5,000/month too as she bears more responsibilities being answerable to the regulatory authority as the key executive officer, her valuable time spent in administration and in bringing some business (though Alan presumes he will be the only one doing it). The investing director is also responsible for the family money invested ($100,000 paid up capital). $100,000 is not a small sum."

Alan said" "I can easily get a 80:20 deal with established agencies whereby I get 80% of the commission as a referring agent."

I replied: "Well, you should do what gives him the highest financial benefit."
Alan did not like the idea of sowing his odds to various agencies as he would not be able to project a solid reputation.

Alan said: "My friend runs an agency himself. He is given a salary and a share of the profits."

I said; "You can be sure that it will not be 50% of the net profits in the general cases. Do check with him. If he gets 50% of the net profit and does not put his hands inside the till, he must be a very lucky person."

I continued: "I doubt it. It is just not financially viable for the investing partner to give such a big share when he does not put up a dollar.

"A start up is like a baby. It needs a father and a mother ideally. Obviously, a mother (in this case, Alan) can do it alone. Many single mothers have raised children to be outstanding graduates. But we hear of such success stories. Many more single mothers have had failed miserably and we don't hear sad stories. We don't want to hear sad stories."

In conclusion, I spent much time elaborating the realities of commercial business life to Alan. "You have had been a very good employee for much of your life time by being honest and able to deliver the sales without the company getting into bad debts. Such employees are in great demand but there is a limit to what most agencies can afford to pay.

"See the other side of the coin. Business is feast and famine. When there is feast, you, as an employee feels "exploited" as a top performing employee bringing in 6 million dollars worth of sales income. You don't get to share the fruits of your big deals or get "appreciated" by being given some percentage of the revenue generated. But how much of the crumbs will satisfy you?

"You feel exploited as you feel you deserve high financial incentives that the company should give you for generating the six million dollars' revenue. You do not realise that the net profits may be as little as 5% as there are lots of overheads of a company. You feel that the net profits from your sales are 15-20% but you don't take into account the cost of overheads of the company and other factors like depreciation.

"The company may give you some bonus but it can't be lavish on you alone as there are the managing director, the finance director, the accounts director and others to pay. These are the supporting staff.

"A business development person brings in the bacon but they do the support. If the business development person gets exceptional big bonuses out of his performance, what about the supporting staff and the Chairman who invested in the infrastructure of the business. Without his investment, this person will not have been employed in the first place. You contracted as an employee with an agreed salary and you had been paid for that amount. Any bonus would be up to the boss.

"When there is famine or office politics, you seek other employers. This is also the reality of the life of an employee. In a start up, you needs to understand that you are no longer an employee and must get rid of your "exploitation" mindset.

"There will be no more exploitation of you by anybody because you are your own boss. Bernice does not give you targets since she knows that a start up is an uncertain business, no matter how optimistic projections of past performance you have made. If you are so sure that the start up agency is going to be profitable, why not sell your HDB apartment, rent one for the family for the interim period and go all out guns blazing. Sure to win. In no time, you have made millions."

In conclusion, I reminded Alan the harsh reality: "A start up is not a sure to win business. Even a successful business will have its ups and downs. There will be economic recessions and Bernice has to continue payment to tide over the bad times. This is the other side of the coin that you, a long-serving honest and productive employee cannot understand as you have not suffered considerable losses of a business set up and encounter stiff competition to lower pricing and high demands for cheap and good services from Singaporeans and elsewhere."

Sunday, October 24, 2010

227. Oronasal fistula in a dog - veterinary costs

Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case written: November 15, 2007
Update: 25 October, 2010
Be Kind To Pets
Veterinary Education
Project 2010-0129
I am Dr Sing from Toa Payoh Vets, Thank you for your email. Your dog is suffering from oro-nasal fistula caused usually by the abscess in the root of the big cheek tooth, the 4th premolar. In reply to your queries, see CAPITAL LETTERS below.



I have a jack russell of 7 years old, lately, we have been noticing small bumps on her face, right under her right eye. We have brought her to a vet and was told that it was due to gum problem, and this was further caused by tooth decay.
In that case, if we would like to proceed with a tooth extraction, how much would that cost?


and what are the procedures?




Two of my pet owner educational cases of canine oronasal fistula are  at: A Pomeranian's facial wound that never heals
When is the soonest that we can have it done? Cause my dog seems to be in great pain.

Name of Owner 

Thursday, October 21, 2010

8-year-old neutered male cat can't pee

"I know my cats well," the lady said when I asked whether 8-year-old her male neutered cat was having constipation instead of having difficulty in urination. "I have 5 of them. I can differentiate constipation from urination difficulty."

She had consulted Vet 1 twice on Monday and Wednesday but the cat still had dysuria (difficulty in passing urine). She said: "I find that the vet is not sure of what's happening to my cat." When the cat does not get well, many Singapore owners will lose confidence and seek another opinion. Diseases take time to resolve with antibiotics and the second vet usually benefits from the passage of time to deliver an excellent outcome.

Vet 1 had told her that there was no major problem after palpation of the bladder. She said that her maid had kept a close eye on this cat and was sure that the cat had not peed a drop of urine for the past 2 days.

I said: "I have the same finding as Vet 1 in that the bladder is not full at all. So there is no urethral obstruction. If there is urinary sand obstructing the urethra, the bladder should be as big as a mango. If the cat had not peed for 2 days, the bladder should be swollen and can be felt easily."

The maid was holding the cat upside down for me to examine his private parts. There was a purplish red tip of the penis which was otherwise not swollen and normal in size and colour. The cat had medications from Vet 1 and the "normal finding" of the penis must be taken into account.

The lady was in the subway train on the way to the surgery after work. Her mum and maid had brought the cat in first. The cat had lost appetite today and had dysuria. She was insistent that the cat had a problem with urination.

1. Cat standing on the examination table. Palpation of the bladder. Not swollen at all. Slight pain around the bladder area but not

2. Cat turned upside down. The penile length was extruded. Except for a purplish red tip due to traumatic licking, there was nothing abnormal. I asked the maid: "Is it possible that the cat peed when every family member including you were asleep? The bladder pain may have gone for a while and the cat pees most of the urine." The maid did not object to this comment. "Did you see blood in the cat's urine earlier?" I asked the maid. "No," she said.

There was no doubt that the owner knows best. The cat does not have constipation as the palpation does not reveal hard faecal stools. Yet the cat does not have a full bladder or blood in the urine history.

An accurate diagnosis on what's wrong with her cat. In the male dog, it is much easier to catheterise the dog's bladder and get the urine out for examination of blood and bacteria.

I asked the maid to bring the cat to the operating room for a re-examination of the penile area again under the bright operating lights. My assistant pushed the penis out from the prepuce. The prepuce and penile body were normal pink. Only the penile tip was purplish red in colour as seen in traumatic licking.

The cat was now getting angry with all these manipulations. Suddenly the maid pointed to her right side of her T-shirt and shouted: "The cat peed onto me!" She managed a twist and turn. Much of the pee bombed onto the floor. There was a big drop of blood-stained urine remaining on the preputial area.

"Get a one-ml syringe," I shouted to my assistant. "Suck out the urine for examination." In the meantime, I took out my digital camera to take evidence for the owner who was rushing to the surgery.

"You need a 2-ml syringe," my assistant went to the chest of drawers to get one. That drop of urine would fill the 1-ml syringe. While my assistant was looking for the syringe, the cat gave a turn to be upright. So, there was no more bloody urine evidence. The maid was the witness. The bloody urine on the floor was of no use as the floor tiles were greyish in colour and anyway, the amount was not that much. It was around 20 ml spread out on the tiles.

The owner arrived. "The cat had blood in the urine," I said. She looked at me for proof. I took out the digital camera and got the image for her to see. Dark red blood at the penile tip. She seemed satisfied. Nothing can convince the doubting owner than real physical evidence of bloody urine.

The owner reluctantly agreed to the cat being warded one day. Blood test would be done. The urine would be collected the next day while the cat had a IV saline to produce urine. I will then catheterise the cat and collect the urine. After that, the bladder would be flushed well with saline to get all urinary sand out.

In dysuria and haematuria in an 8-year-old cat of recent onset, the possible causes are:
1. FIC (feline idiopathic cystitis). This is the most common cause.
2. Urolithiasis (stone or sand in the bladder). Usually in cats over 10 years old.
3. Urethral plugs.

In this case, the tentative diagnosis is FIC but it may be a combination of 3 causes. After manipulation of the penile tip, the urethral plug was loosened and the cat peed onto the maid.

1. Blood test
2. Urine test - cystocentosis, catheterisation or voiding. I prefer catherisation although some vets advocate cystocentosis is said to prevent introduction of bacteria into the bladder.
3. Urolith analysis (struvite & calcium oxalate usually).

"Stop feeding dry cat food," I said to the owner firmly. "If you feed dry food, the cat may suffer from the same lower urinary tract disease again and you will have to spend money for treatmen. Don't say I did not tell you."

The lady said: "My cat loves dry food. The other 4 cats are also eating dry food. One of them is older than him and has no such problem."

I said: "Not every person or cat will suffer from the same disease or condition. This is the diversity of life."

This is one of those cases where the cat is presented with no swollen bladder. So any vet will say that there is no urethral obstruction. So the owner will lose confidence in the vet and seek a second opinion. The second opinion was no better than the first opinion till the cat delivered the blood urine as evidence of a lower urinary tract disease! Luck does play an important part in living and in veterinary diagnosis sometimes.

Tuesday, October 19, 2010

Toa Payoh Vets - Dietary management to dissolve struvite stones in dogs

Dietary management to dissolve struvite stones in the bladder & voiding urohydropropulsion
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Written: Perth, 29 September 2010
Update: 11 October 2010
Be Kind To Pets
Veterinary Education
Project 2010-0129

After the surgical removal of the struvite urinary stones or for medical and dietary treatment, how much of the prescription diet should the owner give the dog/day?

I took some time just to read about Canine Struvite Urolithiasis case studies in the thick book "Small Animal Clinical Nutrition" by Hand et. al, 5th Edition and the following is some general guideline for Toa Payoh Vets in advising on Prescription Diet s/d to dogs in 3 case studies.

How much of the s/d diet to be given:
1. Puppy X-breed, 9 weeks,
5 kg.
700kcal (2.83MJ)
1/2 can 3x/day
2. Rottweiler, 5 years, 41 kg
1,800kcal (7.5MJ)
1.5 cans 2x/day
3. German Shepherd, 12 years, 27 kg
1,150kcal (4.8MJ)
1 can 2x/day
Other procedures to ensure compliance from the owner:
1. Antibiotics from 14-30 days and review using urine cultures
2. Monthly urine analysis (check for UTI) and blood tests (esp. serum urea nitrogen, magnesium, phosphorus and calcium and alkaline phosphatese)
3. Monthly x-rays of kidney (V/D view), bladder (lateral views)
Back to normal commercial food for the puppy as soon as X-rays show no stones. For adult dogs, give prescription food for one more month after negative X-ray results. No commercial dog treats or snacks during the period of treatment.
Specialised tests like double-contrast cystography (to check out anatomic abnormalities of the bladder, obstruction of urine flow from kidneys), retrograde positive-contrast urethrocystography (to check out anatomical abnormalities of the urinary tract to the prostate gland area) if there is recurrent uroliths or UTI.
Very few Singapore clientele comply with the above instructions. It could be due to economic reasons. Urine is taken by cystocentesis. Voiding urohydropropulsion is used in cases where the uroliths are small. The owner must be informed that it takes 2-4 months or longer to get all struvite stones dissolved. The owner must be aware of the need for reviews and to note the costs involved in the dietary management to dissolve struvite urinary stones.

What is urohydropropulsion? During my undergraduate days some 30 years ago, there was no such term.

Basically it means pumping saline into the bladder (3ml/kg) and suck out the fluid together with the small uroliths (urinary stones) with a catheter. The stones in the bladder are too small and therefore no surgical removal is needed.

ANAESTHESIA. May or may not be need.
POSITION. 2 methods described in Small Animal Clinical Nutrition 5th edition.

POSITION 1. Hold the dog or cat upright so that the vertebral column is upright. The urine and stones will be at the bottom (neck) of the bladder.

POSITION 2. Lateral recumbency.

In both position, catheterise, irrigate with saline (3ml/kg), massage or press bladder to shake up the stones, suck out the saline + stones with a syringe. X-rays to check if all are taken out but not all small ones can be seen.

Dietary and medical treatment.
More information is at: Small Animal Clinical Nutrition" by Hand et. al, 5th Edition

This webpage:

222. Defensive Medicine at the 49th day of pregnancy

The owner said that her British Bulldog was 49th day pregnant. Dr Vanessa Lin was the vet in charge. She palpated the abdomen and declared that the dog was not pregnant. I palpated and agreed with her. There was no big foetal lump or lumps in the abdomen. A simple case of pregnancy diagnosis. Not pregnant.

But veterinary medicine can throw out surprises for the vet who wants to provide least-cost veterinary services.

"There is a possibility that the foetal lump is positioned cranially below the diaphragm such that the vet can't feel it," I cautioned. I had read some dog breeding reports on this type of situations.

"If the dog is diagnosed as not pregnant now and she loses her sole pup due to this diagnosis, there will be a lot of unhappiness. Bulldogs usually need a Caesarean section as the puppy's head is too big. Since the vet has diagnosed this dog as non-pregnant, the owner would not have had prepared the dog for an elective Caesarean section as veterinarians are trusted professionals.

I related an incident to Dr Lin about the single pup syndrome case in a Pomeranian. A vet diagnosed the Pom as not being pregnant by abdominal palpation. The breeder who brought in the dog agreed with him. The vet assistant supported his diagnosis. Three people with experience said not pregnant.

The Pom had a difficult birth and required Caesarean section. The pup died after the Caesarean section. The dam died a few days later. The death of the beloved dam evoked much anger and resentment. If only an X-ray or ultrasound were done as part of defensive medicine, this sad outcome would not have occurred. This pup would probably had been located as a small foetal lump in the most cranial position behind the diaphragm.

Dr Lin advised an ultrasound. The dog was confirmed not pregnant. Defensive medicine is needed in many cases. When the owner is unhappy or provoked by the competitor vet, many complaints are made. A simple X-ray or ultrasound taken should have been done as part of defensive medicine as vets are not Gods and variations in medicine can sometimes ruin a hard-won reputation.

Updates at

Monday, October 18, 2010

A vomiting Chihuahua (Impaction of the stomach)


Chihuahua, Male, 6 years. Vomiting and not eating. What is the problem? The dog was warded for observation.


A soft mass in the stomach. No pain on palpation. The intestines were firm as if they were "sausage" rolls.

Lateral view:

The stomach was impacted with some foreign body. The white arrows showed a fullness of the stomach pressing against the diaphragm (which separates the chest cavity from the abdominal cavity). The white foreign body inside the stomach and intestines (black arrows) would be fibers from the chew rope. The dog had been swallowing chew ropes for many months based on the owner's report. Chew ropes are commonly sold at Singapore's pet shops. This dog prefers to eat the pieces and they accumulate and fill the stomach. This medical condition is called impaction of the stomach.

Laxatives given showed fibers and hairs inside the stools. The owner told me the dog farted. He did not pass stools for the first 4 days. I/V drips and antibiotics prevent dehydration and death.

Ventral-Dorsal view
The full stomach is not so easily seen by the layman. There is no solid foreign body such as a bone or stone and so interpretation of this view is difficult without the clinical examination and history.

The outline of the stomach is shown by the black arrows. White foreign body of fibers impact the stomach. There is a dark area in the lower half of the stomach. This will be the gas. "Sausage-like" rolls of the intestines can be seen below the stomach. I have not marked the rolls.

The bladder shows a opaque urine which is not normal. Urine tests confirmed a moderate amount of struvite crystals which cause this whiteness of the bladder. On discharge of the dog, the dog peed with difficulty on the grass. This was seen by the owner.

Dietary management to dissolve the struvite crystals
is an alternative to surgery. However the owner must know that it may take 2-4 months to see results and there must be strict compliance with veterinary instructions including diet and urine tests and X-rays of the bladder till no struvite crystals are present.

Two blood tests were taken. The second blood test showed liver disorder. In conclusion, the dog recovered after 4 days and went home. Dietary management to dissolve the stones had been discussed with the owner. A follow-up by the owner must be done in the next few days.

Updates at

222. Misalliance (accidental mating) of dogs



I have 2 chihuahuas, they are both siblings from the same parent (just a batch difference). My female Chihuahua which I recently adopted after being used for breeding by pet shop and pretty much traumatised with low self esteem is on heat recently, and this has gone on for a few days to about a week. Just an hour ago I heard my female Chihuahua yelped and I found that the two of them were in the midst of a sexually engagement, it was impossible to separate the two. Could you please advise me on the next course of action to take as we are not ready for puppies especially when there’s a chance of the puppies being deformed due to the same family line of breeding, which can be very heartbreaking.

When we first adopted the female Chihuahua which was on 28 July 2010 (less than 3 months), her heat was already clearing up. We brought her to a clinic in hope of having her spayed, but the vet advised that we wait a few months to let her build some self confidence first, so we brought her home instead. So we didn’t expect her heat to come in less than 3 months time, and this had to happen when we were caught off guard with our work.

We would really appreciate all advices from you, in the best interest of the two Chihuahuas. Thank you!

Lots of Love,


I am Dr Sing from Toa Payoh Vets. I offer the following advices.

1. If you don't want the offspring from the recent mating, please make an appointment with me to get the female dog spayed as soon as possible. If the female dog is healthy, there should be no anaesthetic problems during spay.

2. If you want breeding at a future date, come for an anti-conception injection promptly. This is effective if the injection is given within 3 days after mating. After the injection, you have to separate the male from the female and the heat period will be prolonged.

3. Come for pregnancy diagnosis around 3-4 weeks after mating to check if the dog is pregnant. Spay the dog when she is pregnant. There is a higher risk of spaying a pregnant dog but usually there should be no anaesthetic or bleeding death.

4. Come for an elective Caesarean section at the 60th - 65th day or when there are signs of impending birth. If the puppies are deformed, you have to decide what to do. This requires more than one consultation with the vet if you want to have good results.

5. Neuter the male Chihuahua if you don't future misalliances (accidental mating) and lots of worries.

Let me know if you more queries or phone the Toa Payoh Vets at 6254 3326.

Sunday, October 17, 2010

Continuing Education and networking at SVA Conference 2010

Continuing education by attending seminars can provide useful knowledge in veterinary medicine and surgery as the speakers share experiences and latest knowledge in their field.


1. The Australian vet aged around 69 years old has a large cat practice in Australia. He shared lots of useful experiences about cat surgeries and anaesthesia, pain killers and dosages. I asked him whether he has a book about his lectures.

It is a pity he has no time to record his experiences with dosages and effects of drugs in cats in a book as he has better things to do. His presentation was not boring as he inserted humourous video clips so that the audience does not fall asleep. I took images of his slides for knowledge management. Many of his surgical info can be applied to dogs, rabbits, ferrets. He does not favour domitor. Prefers methadone, fentanyl patches and meloxicam for cat analgesia.

2. An American vet from Guam has set up a top vet hospital in Guam though he was the last to set up. He has a vet who goes around the islands to do sterilisations and treat animals. He treated 7 dolphins.

Most common case is dog bite wounds. The vet bill would be around US$400 as they are serious wounds. Sterilisation is around US$30-35 payable in advance and no refunds. There are 5 practices in Guam which has a population of 170,000 and includes 42 islands nearby. Two vet practices may be closing down. "Are they backwards?" I asked. "Yes," he said. "They don't have gaseous anaesthetic machines."

I think success in vet practice is not a given as there are many factors involved. As at Oct 2010, Singapore's 41st small animal practice will be set up, one Hills' representative told me when he visited me.

The American vet has a sense of humour. Dr James Tan and I had the impression of him as the stereotypical Harley Davidson biker zooming on the highways of Guam in leather jackets and helmets. He looked like one. White haired, pony-tailed, white beard, a big sized belly and a commanding presence. Dr Tan expressed his thoughts of him as a HD biker. "No," he said. "I don't ride bikes since I had falls when I was 17. It is too painful." He is in his 50s. I will like to visit Guam one of these days and see his hospital.

Once he performed a Caesarean on a cow in Guam. "I had not done Caesarean for over 43years. So I phoned my friend in the U.S for help. Then I tied the cow to the tree while I operated. As I cut, the cow moved sideways. Coconuts started to fall from the tree."

"No coconut fell on your head?" I asked.
"No, no," he replied. "My assistants held up two umbrellas while I operated."
Cow caesareans are traditionally done in the field with epidural anaesthesia during my internship in Scotland in the early 1970s. Anaesthesia may have changed. The incision is from the flank. It is non-sterile surgery but the cow usually is OK with antibiotics.

Attending local conferences can be very interesting if the vet bothers to get to know the foreign vets instead of sitting with their friends.

Thursday, October 14, 2010

Starting up a company at the age of 50 years

An old friend (Allan) wanted to be free from office politics and to start his own company at the age of 50 years.

He asked me for advice on his proposed event management company start-up with two trustworthy partners (Brian and Charlie). All 3 will have equal shares in a private Limited Company. Since he would be the one bringing in most of the business via his old clientele while the other two provides administrative and backup services, all 3 agreed to the respective following distribution of profits at 40:35:25 with Allan getting 40%. There will be no salary for the first 3-6 months. After 3 months, all 3-6 months, all 3 will get a salary based on 40:35:25 formula every month.

1. How much are Brian and Charlie earning now? Brian is unemployed, having left his food and beverage (F&B) hotel job in Vietnam. Charlie is earning around $5,000 a month as an employee in the F&B business.

2. What amount of revenue can Brian and Charlie generate? Practically none. They just provide the support services as they do not have business development experience or important decision-making clientele to generate business.

3. Is Charlie an IT expert? He has some information technology (IT) knowledge but is not an IT experienced. Therefore he has no valuable contribution and in any case, an event-management business does not depend mainly on IT skills and expertise.

1. Brian and Charlie have 66.6% of the shares. In any company resolution, they can out-vote or frustrate Allan's plans for the business expansion or changes. Allan will be unhappiness when they do that since they don't generate income and are more like "sleeping partners".

2. Since Brian and Charlie will not be generating income, they are not worth being given 35% and 25% of the net profits.

3. What happens if Brian and Charlie find better job prospects since they don't get salaries for the first 3-6 months? Or they take long leave, die or become sick? They still get their 60% every month as agreed, assuming the company is profitable.

4. In the end, Allan will feel very unhappy as he brings in practically 100% of the revenue and gets 40% of the net profits. If he is that good, he should be getting the lion's share of the profits.

Getting in the business and sustaining the profitability of any business is extremely hard work while administrative services can be outsourced. If the business really generates $6 million in revenue as projected by Allan, there is no problem employing good people to do administrative work. Of course, Allan must be involved in ensuring that the accounts are properly kept.

Allan should be getting the controlling share of at least 51%. There are the operating costs to think about.

I know Allan has the clientele and can generate the $6 million revenue he projected since he is battle-tested for the past 30 years. He is now around 50 years old. He had started up two small businesses before and knew success in earning big money is not guaranteed. That was why he worked for others as there is a steady income every month.

With a large clientele who trust him, he ought to have the confidence to start up small. He needs to change his mindset that there must be a big office, top IT facilities and supporting staff as in established event management companies to be able to succeed as an entrepreneur.

He had seen too many people failing in businesses and that was why he worked for hotels and resorts for the past 30 years as an employee. There will always be office politics in corporations from employees and if he really can bring in a $6-million event management business, I don't see why he cannot be successful on his own now that he has been "battle-tested".

A better business model will be to give Brian and Charlie a commission based on each project they successfully completed. If they can't do the project, there are many others who can be out-sourced to do it. Otherwise, they still get paid a combined 60% of the net profit every month. This is a large amount if the revenue generated is $6 million a year. Assuming conservatively 5% as net profits, the income will be $300,000. Allan will get $120,000 but his non-income generating administrative partners making the connections get $180,000! He will not be happy to continue the business relationship and there will be nasty feelings when the business breaks up.

The $180,000 can be used to employ good energetic people who have been battle-tested in the getting more business deals. In business, it is how much profits you can generate for the company, not how good your administration is. Without income, top companies close down even though they are well administered. An ability to bring home the bacon is what counts in business start ups, whether one is a private veterinarian opening his veterinary clinic or an event manager.

P.S. "Bring home the bacon". Singaporeans generally don't eat bacon and eats for breakfast unlike the English and so may not appreciate the title of the story. I studied in Glasgow in the late 1960s and my favourite breakfast in the hall of residence was bacon and eggs. "Bring home the bacon" means to "achieve desired results or have success" in this story.

Sunday, October 10, 2010

219. Malignant cheek tumour & accountability of a vet
Be Kind To Pets
Veterinary Education
Project 2010-0129
The miniature schnauzer had a malignant cheek tumour which was removed twice. See:
Malignant cheek tumour in an old Miniature Schnauzer

The tumour grows back a second time two months later. It was excised. It recurs for the 3rd time. The dog could not eat normally and had a painful mouth. The young lady owner wanted another operation without the dog dying on the operating table.

"It is highly risky to do anaesthesia on an old dog," I warned her of the possibility of death again. "This old dog had survived two general anaesthesias. His cheek tumour is malignant as it keeps doubling in size every week. Why don't you consider chemotherapy?"

The young lady did not want chemotherapy for her beloved companion as it had side effects and was not guaranteed to work. I told her that I needed to remove the cheek tumour from outside by blunt dissection from the skin.

"Your dog may be paralysed," I said. "There will be a lot of bleeding."

The lady said: "Why don't you operate from inside the cheek to remove the cheek tumour as you had done before?"

"I need to cut away as much of the cancer cells as possible. There may be a root of the tumour and I need to access the root from the skin to dissect away the tumours. If all cancerous cells can be removed from the skin approach, it will be good for your dog. Provided he survives the operation which will take a long time compared to the previous two excisions"

The lady was worried about deaths on the operating table. Every time an old dog is put under general anaesthesia, the chances of dying are increased. Every time a vet operates on such high-risk dogs, he or she is bound to suffer fatalities and damage to his reputation.

The dog was given antibiotics and painkillers for the next 2 weeks. The lady did not turn up on the appointed day and so I thought she decided to opt out of the surgery. Then she turned up. She was a busy working girl.

Antibiotic and anti-inflammatory pred injection on day 1 and antibiotics after Day 1. On Day 2, tolfedine pain-killer oral. No pain in the cheeks on Day 3. Surgery on Day 4 after admission. An IV drip is very important in case emergency drugs are needed.

Domitor 0.2 ml IV from the IV saline drip line. The dog had a cyanotic tongue. It was not a good sign of health. I had a premonition that he would die on the operating table.

Teamwork is essential in this high-risk anaesthestic case. I had two experienced assistants who are old experienced Myanmar vets with over 20 years of experience combined and Dr Vanessa Lim to assist.

1. "I don't need the scalpel blade," I said to my assistants. "An electro-surgery electrode needle incises the skin."

2. "Dissection with scissors is not advised," I explained to my assistants. "I will use the electrode to separate this hard mass of tumour from under the skin. The tumour has a capsule."

3. Bleeding. Electro-surgery reduces bleeding considerably. There was a small bursting artery which was clamped. I could not find the big vein or artery supplying blood to the tumour nodules. There were 3 nodules inside the cheek muscles.

4. "Where to incise?" I asked my assistants as part of my mentoring process. "A horizontal cut or vertical curved cut or both?" They had to think.

The surgery took more than 30 minutes. The shorter the better survival rate for an old dog. "The dog has died," my second assistant pointed to the dilated pupil which now showed a whitish cataract. A matted white. The isoflurane gas was given at a minimum. Too little, the dog's cheek muscles would twitch and so I had asked for an increase. There was no twitching and surgical dissection proceeded smoothly. Too smoothly.

Now the dog had stopped breathing. He had not died as my first assistant in charge of anaesthesia had much experience and had observed regular breathing. A dilated pupil is common in the deepest surgical anaesthetic stage.

A big dilated pupil could also mean imminent death or death. Whatever it was, I stopped the anaesthesia, blew air into the trachea tube and started cardiac massage immediately. Three cardiac massages and blow three times. My second assistant flushed out the isoflurane gas by pressing the red button and gave me the tube to connect oxygen to the dog. "It is better to blow air in and massage the heart," I advised. The dog was not breathing normally. A stethoscope to check the heart beating showed no sounds. My lst assistant injected Doxapram respiratory stimulant 1.0 ml into the IV line. I continued cardiac massage and air blowing into the tracheal tube. My 2nd assistant injected 0.2 ml Antisedan which is the antidote for Domitor.

It took more than 5 minutes but it seemed like eternity. "There was no hope," I thought as I could not hear the breathing sounds when I put my ears to the endotracheal tube after several cardiac massages. At one time, my first assistant would compress the heart from the top while I put my hand on the lower part of the dog's chest. It was touch and go. The dog started breathing.

My second assistant offered me the anaesthetic tube to connect to the endotracheal tube as the surgery was only 95% complete. There was the stitching to be done.
"God may not give 2nd chances," I pointed above my head and declined the anaesthetic connection to the gas machine. The Antisedan had reversed the Domitor sedation and the dog's head started to move. There was little time to stitch up. Subcutaneous stitching in certain areas could be done. Horizontal mattress stitches quickly closed up the skin incision. The dog put up his head in around 3 minutes as if he had a long nap. He did not cry or whine. Dr Vanessa Lin gave me the meloxicalm pain-killers. "It is best not to inject any drug to this old dog as he might just die after the pain-killer injection," I thanked her.

fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore
antibiotics for 10-14 days before surgery as tumour is badly infected 3 hard nodules in the cheek muscles. Domitor 0.2 ml IV given malignant tumours as they double in size every week
fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore
the owner did not turn up for appointment till 2 days later. Tumour is infected electro-incision close to the skin. Thoroughly remove remnants of cancer cells 3 cheek tumours excised leaving a big hole in the cheek but there is the skin to close up the wound
fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore fast-growing malignant cheek tumour miniature schnauzer with poor oral hygiene toapayohvets singapore tpvets_logo.jpg (2726 bytes)3827 - 3834. Malignant cheek tumours excised via the skin approach.
a third nodule is not shown here. Histopathology is being done <1 hour after completion of surgery. Dog is ok

A dog alive is what the owner wanted. Nothing more. No excuses. The dog ate 2 days after surgery and should be going home soon. In high-risk anaesthetic cases, it is best to have a team of experienced assistants. The brain dies when it is deprived of oxygen and in this case, a team definitely helped to revive this old beloved companion for the young lady.

The anaesthetist is more important than the surgeon as anaesthesia deaths are fatal. An experienced team is advised in high anaesthetic cases. Intubation and IV drip line are essential in such surgeries. If the surgery can be completed in less than 154 minutes, old dogs seldom die but in this case, the 3 tumours were large and time had to be spent on bluntly dissecting them to prevent excessive bleeding. Surgery took more than 30 minutes to complete. It was through teamwork that the old dog did not die on the operating table.

Pictures and details are at

Thursday, October 7, 2010

Sense of humour with two generation gaps

Sunday, Oct 3, 2010

How do I connect with a group of undergraduates who are at least 26 years older than me? I would say that this group of 3 vet students would be from 22 to 24 years of age and I am 3 times older and how should I carry on an easy conversation with them?

A common interest in veterinary medicine mixed with a sense of humour is the key to interactions during a meal. But it is not easy to make the young adults feel that there is a two-generation gap between them and me making their acceptance to a farewell lunch a boring event with an old foggie.

It was a sunny Sunday afternoon and this Northbridge Chinese Restaurant in Perth was packed. We were given a smaller room away from the noise of the main eating area. The others at the two tables in this room were quietly eating.

It happened that one of the 3 vet students was not aware of my concept of a veterinary talk show that I deemed great for one of the vet students (not present at this lunch and whom I will name as Boo for the purpose of this story) I had shared with the other two yesterday. So I told him.

"You know," I said to this serious young man whom I shall call Ashton. "The name of the veterinary clinic should be 'Boo Clinic.' Dr Boo would host the veterinary talk show in Singapore. There would be an audience of pet owners at the show. One of them would ask her pet care questions related to a theme, for example skin diseases. She would examine the pet and give her advices.

After that, the audience will clap their hands in appreciation. Dr Boo will stand on a stage and sing a love song of unrequited love. That will make the young girls in the audience weep. A group of dancers will appear and swing with her as she sings. Another singer appears and there is more dancing. The audience claps their hands on cue in loud applause!"

The young man's eyes opened and shook his head as if he was saying: "What sort of whacky concept is to propose to Boo?"

I continued: "The veterinary clinic should be named "Peek-A-Boo" as it is such a good name to remember. The classmates will work in the background as more pet owners come to patronise this clinic. No need to worry about no business or falling turnover as Dr Boo brings in the fame and fortune.

The veterinary talk show should be called 'Peek-A-Boo' as I connect the surname with this English phrase I learnt in primary school. All dancers should wear a mask to peek at each other as they turn to face each other during dancing....

The young man's two classmates laughed loudly. Except for this serious young man. "I don't want to be associated with your mad scheme!" he exclaimed.

We had so much laughter. Laughter is the best medicine. Fortunately for me, Boo was not present at this lunch as I don't know whether she would appreciate the sense of humour at the use of her name. We ended the lunch on a happy note for my guests and I hope for this serious young man.

217. A sense of humour in a child

A sense of humour is much appreciated during social interactions such as wedding dinners and meetings. But how does one acquire a sense of humour? Is humour inherent in a person's DNA or is it acquired through a good command of English in an intelligent person? I have no answer.

Yesterday, I was at a pet shop which sells rabbits, guinea pigs and hamsters. The pet shop owner has two daughters, Jane and Juliet aged 6 and 7 years old respectively. "Jane is a monkey," the mother told me when Jane showed a black face, put her hands on both sides of her waist and narrowed her eyes as the shop assistant disallowed her to take her lunch out of the shop to eat with other friends. She refused to eat lunch. Her mum explained to me: "Jane throws tantrums when she is not allowed to do what she wants. She was born in the year of the monkey and is a monkey. I give her three warnings to behave. Then I will give her a canning."

There was really a cane with a pink hook in the pet shop. As for Juliet, the mum's face brighten as she said: "Yesterday, Juliet told her brother that he needs to learn how to bottle fed the baby brother so that he can help his wife." I saw Juliet helping the mum to scan the pet products for sale.

This was a 7-year-old studying in Primary Two in a neighbourhood school in the heartlands. Not one of those fancy high-pressure primary schools of Singapore. I asked Juliet whether she had a story book for me to read and she took out "Under The Sea" published by Usborne as a beginner's series for young readers, level 1.

Every few seconds, Julie would ask to take back her book to keep inside her school backpack. Mum explained: "She will keep her story books in a good condition."

On the table where I read her book were three plastic containers with longan desserts and ice. The table was wet due to the melting of the ice causing dripping of water onto the table. Juliet came again to ask for her book back. "Let Dr Sing read your book," Mum said. Finally she got her book back. She put it on the table for a while. "Hey," I said. "Your book is now wet. You need to dry the cover up with a piece of tissue paper. Ask your mum for the tissue paper."

"No need," she said. "The book is under the sea." The title of the book was "Under the Sea" and I was surprised that this 7-year-old girl had that sense of humour to surprise me. I advised the mum that she should switch this child to a better school to give her the opportunity to grow intellectually as she has what it takes to be a scholar.

Saturday, October 2, 2010

216. A vet talk-and-sing show in Singapore

Saturday, Oct 2, 2010

Spring in Perth this past week was blue skies and brilliant sunshine during the daytime and coldness at night. Saturday would be my last day of visit to Perth. A choice of dinner at a popular small Italian restaurant packed mainly with young Asian people was excellent. Wood-fried pizza, noodles full of cheese and thick creamy tiramisu cakes would not be advised for the health conscious.

The Caucasian waiters interacted with the young adults very well, sat on the dining chair to take orders, posed for pictures and engaged in conversation, making the experience of eating there fun.

Can this be done at the vet surgery? I don't think any vet would do it. However much depends on the personality of the vet. I would say one particular lady vet student would be the ideal candidate as she had that type of extrovert personality. She was said to be the school cheerleader and was able to converse well.

"I have a good idea for you," I said to her at the end of the gathering. "Forget about being an eye specialist in Singapore. Be a talk show veterinarian. You'll make more money than operating on dog's eyes." To be a canine eye specialist, she would need to study post-graduate as a resident for another 3-4 years. To be a talk show veterinarian, she could do it after graduation. 99% of the vet cohort would not be able to do it. She was that rare bird that would be able to make it in the entertainment industry.

"Singapore is not US," her friend said. "There is no Oprah Winfrey show and therefore no prospects."

"I don't know about that. Singapore has no vet that is passionate and able to host a talk show. She has to start somewhere and that would be in Singapore as the testing ground.

"My idea for this half-an-hour veterinary talk show is for her to discuss one case with a real pet owner, take some questions about pet care from the audience, do a sing and dance routine with dancers with her being the star."

"Is there such a programme in Australia?" I asked the friend.

The friend said: "There is the Bondi Vet on TV."

"Does he look handsome and sing?"

"He is said to be handsome. He does not do any singing."

"If this vet is successful, her vet surgery will be packed with fans. You and the others may be her supporting vets and will not be jobless. Collaboration benefits everyone as each party in the team has his or her own strength."

Singapore might have tried to do some reality TV vet shows. One of them was a concept to follow up on a pet owner who would be present when her dog was put to sleep. I was approached for help in getting an owner who would consent to such a show. I declined. A dog trainer agreed. But the administrative arrangements or a poor script. The dog trainer gave up after some time.

Execution is the key to success in any venture. No money was paid to the dog trainer and there were so many delays. What do you expect the poor dog trainer to live on? The whole project was most likely ditched.

Friday, October 1, 2010

Buying products for others

A 71-year-old friend of Dr J asked me to buy hair growth products and glucose strips for him from Perth citizens thinking they would get them cheaper under the National Health Service. My contact said there was no NHS in Australia for citizens according to her search on the internet.

My mission was to buy the cheaper version of the hair loss. However, I don't use his product nor do I know which is the cheaper generic. "Hair A Gain" is what the buyer sms me as to what he has been using and he asked me to look for cheaper generic brands of minoxidil. On the 4th day of my stay in Perth, my contact had no success or advice for me. After dinner, I went to the Pharmacy in the mall. As it was a Thursday, the mall closes at 9 pm. The first product I bought was Men's Regaine Extra Strength as this pharmacy has only this product. This was the expensive original product, around 100% more expensive than "Hair A Gain" and this would not be what the buyer asked for.

It is best to get the Buyer to specify in writing what not to buy and what brands to buy. Now what should I do with Regaine as I don't have hair loss?

Vet specialists in Singapore

Is there a need for a veterinary specialist centre in Singapore, one 4th-year vet student asked me.

"Yes," I said.

"Will only expatriates use vet specialists as they are the ones able to pay for the services?" she asked.

"No," I said. "Singapore has locals who are prepared to pay provided they see value for their money."

"So, in 2 years' time, you will be able to be a vet specialist and your husband will be shaking his legs staying at home to look after the babies," I said to the girl. If she undertakes specialist training after graduation, she will be qualified as a specialist in 2 years. Actually it will be more than 2 years but sometimes we must not take life so seriously during dinner conversations.

"No, no," she said. "It will be 10 years." I don't know where she has this 10-year-forecast.

As a vet specialist or referral centre, much depends on the skills of the vet. More important it is the public relations. If such vets are arrogant, no other vets want to refer any case to them at all.

213. Vet Surgery - Fusion podoplasty - interdigital cyst

Perth Saturday

Interdigital cysts in dogs are sometimes ignored by the owner. The dog keeps licking till the cysts become infected. Conservative medical treatment does not help after a while.

SURGICAL EXCISION. Normally I advise surgical excision for infected i/d cysts. No more problems usually. But how about three big ones with all i/d webs affected and big scar tissue on the palmar aspect of the paw bridging the 3rd and 4th digit? A successful case report is at: Australian Veterinary Practitioner Vol 40 (2) June 2010, pg 53 - Fusion podoplasty in a dog with inter-digital furunculosis.

I will summarise the case. 10-year-old Collie X, chronic pododermatiiws of the right forepaw unresponsive to conservative treatment.

I/v cephazolin (20mg/kg) at anaesthetic induction. Tourniquet 0.4 Penrose drain clamped with a heemostat distally to the riht carpus. Marker outline the dorsal i/d skin to be removed, leaving 2-3 mm of digital skin adjacent to the nail. Dissection was kept close to the dermis (to preserve e dorsal and palmar digital nerves and bv). All abnormal tissues excised. Tourniquet removed. Bleeding successful controlled by electrocoagulation. Skin 3/0 simple sutures. Surgical time of one hour. Fusidic acid-containing onitment and non-adherent dressings wrapped with an absorbent bandage extending to above the elbow. A plastic spoon-like splint up to the elbow secured with adhesive tape. Bandage and dressing changed twice daily for 7 days and once daily for a total of 15 days. Discharged 3 days with antibiotics and carprofen (2mg/kg po bid).Suture removal 19 days afer surgery. Good granulation tssue.

Conclusion - fusion podoplasty is an effective procedure for the permanent cure for chronic i/d furunculosis in the dog. Considerable bandaging and maybe additional surgeries if more than one paw is affected.

Many dog owners will be unlikely to pay for the vet costs involved. In above case, detailed blood tests, histopathology tests and bandaging post-op. Surgical excision is successful but how many owners will want to pay for the costs?