Friday, January 28, 2011

Animal activism in Singapore: difficulties of the volunteer webmaster


He explained to me that they have had bad volunteers who bad mouth them
and they are wary of accepting new volunteers. To ignore or turn off
potential volunteers is not helping them or the animals. If you treat
your volunteers like they are all bad people waiting to do something bad
to you, then who would want to work for free for you?


On 28/01/2011 03:29, Kong Yuen Sing wrote:
> You have done a good job and provided free service. That is good. The
> webmaster may be too old to learn new tricks or has no time. Well done.
> Volunteers come in different forms. Some are very dedicated but others
> quit after some time as no money is received. Pl be patient.

Hi Dr Sing,
> I only moved it to .... and imported
> the content over from
> Blogger. Then I organised the content, added some contact/adoption forms
> and left it to them to do whatever they want with it.
> I was planning to do more for the web site but I asked the webmaster if
> he is willing to use the new features I had planned for him.
> Unfortunately, he said he is unwilling to learn to use them and post
> better written content and photos.
> I told the webmaster they need to take better photos and organise the
> content in a certain way like how I have done it for them. Initially,
> there was some resistance but in the end, it seems like they have taken
> up the suggestions. The older photos were terrible.
> So I told him if that is the case, I won't invest my time to create
> better features for his web site if he is not planning to use them.
> I think I will not do anything more to help them for now because they do
> not seem co-operative or appreciative.


Thanks for feedback. Voluntary work is never free from criticism by armchair critics and that makes the volunteer sensitive to outsiders. I think this group does not want much widespread publicity as the whole of Singapore's animal welfare activists will dump all stray cats and dogs at its doors (but not the donations). This does happen in real life when I speak to two such groups.

Animal activism is highly stressful for the volunteer webmaster who is usually dedicated to help find homes for the home-less dogs and cats using his IT skills which may be outdated as IT keeps changing and he probably is holding a full-time job.

My new volunteer webmaster friend wants to change the whole format and system. There is simply no time for the incumbent webmaster to do what he wants(as physically, time is limited for all volunteers since they have got to earn a living). The young is idealisitic. The incumbent old webmaster is pressed for time and money. The two sides will never meet.

In Singapore, the voluntary organisation for the homeless dogs and cats are always short of money as the numbers of strays grow in number. Volunteers are a big headache because of their demands for attention and time. Bad-mouthing critics, prowling tabloid journalists - this whole area needs a Human Resource Department to handle but small animal activist groups with little funding cannot provide this service.

Is it possible to sterilise 9-month-old cats? E-mail query to Dr Sing

On Fri, Jan 28, 2011 at 1:44 PM,> wrote:

Dear Sir/Madam,

I would like to sterilize two of my nine month old kittens (Ragdoll and Ragamuffin). Is it possible? If yes, what are the available timeslots? Thank you!

With regards,

I am Dr Sing from Toa Payoh Vets. Thank you for your query.

It is possible to sterilise cats after 5-6 months of age. I don't advise sterilisation at 4-5 months of age although this is being done by some animal societies to prevent unwanted litter. Please make appointment at 6254-3326. No food and water after 10 pm the night before surgery. Appointment one day before surgery will be OK.

Thursday, January 27, 2011

re-train older dog to pee - email query to Dr Sing


I came across your webpage accidentally while looking for help.

My toy poodle (male) is currently 11 months old. He is trained to pee and poo inside his cage and he is not kept in the cage. However, he started to pee and poo everywhere since 2 months back. I tried re-training him to pee and poo inside his cage but failed. We have since keep his cage cos he has out-grown it and now we want to train him to pee and poo at 1 place. How do i re-train him to pee and poo at the correct place? Especially the sofa, he will jump up and pee there....he wont pee there again before we wash the covers but do so after we have washed the covers.

Your kind advice is greatly appreciated.

Thanks and regards,


I am Dr Sing from Toa Payoh Vets. The dog has taken a liking to pee on clean "fabric" through his sense of touch. To re-train, confine him to a small area (balcony, kitchen etc) and leash him (be careful of strangulation) for at least 2-4 weeks. No other way if you have no time to take him outdoors or train him daily by strict supervision of elimination. Hope this helps.


Hi Dr Sing,

Thank you for your reply.

When you say confine him and leash him, do you mean to the place where we want him to pee/poo?

Thank you and regards,


Yes. In that way, he has a restricted area to sleep and eat which will be his clean area. He will go to a nearby area to pee and poop. Since most dogs are clean creatures, they will not want to soil the sleeping area. Leash restricts his area. A small room or bigger crate will provide the same function.

Wednesday, January 26, 2011

Myanmar stories: A successful Myanmar entrepreneur

Jan 26, 2011


I met this successful Myanmar entrepreneur in Khin Khin's office today. Khin Khin and he were keying in employment data for S pass Myanmar prospect as he waited for his employment agency licence to be given to him 2 weeks later.

He started by giving entrepreneurship lectures some 10 years ago, charging around $10/person/hour. I remember one of my old clients doing the same and asked him: "Did you rent an office in Excelsior Hotel building to conduct lectures?" He laughed: "Yes." Now he has set up an Asian restaurant in Yangon and is in the midst of a building development project with Singapore partners.

Be focused on one aspect

"Why do you need to wait for 2 weeks to get your licence?" I asked him. Asking is when one learns. "Normally, the MOM renews the licence without you having to wait."

He said: "I have set up a private limited company. So, everything starts from the beginning."

"So, you have Singapore partners," I guessed. "What is your share of the company?"

"30%," he said. "The two Singapore partners take 70% but I do all the operational work running around."

"Why will you be doing all the work and give your partners 70%?" I asked. "It does not make sense to me. You should be the one getting the major share. Are you paid a salary to be the working partner?"

This where the financial structure is important. How much to pay a working partner equitably without exhausting the $50,000 all 3 parties had put in. Real capital, not just paper ones.

"No salary. I get $1,500 per case closed." The fee for securing an S Pass is $3,500. So, $2,000 goes to the company and he still gets 30%. This sounds OK to me.

"I just can't believe that the two Singapore partners are sleeping partners," I enquired. It is possible but why would this smart entrepreneur give them 70% of the shares? He would have his capital since he had been working for some years. And judging from his looks of a man who looks well fed, I know he would not have problems raising $50,000 or less. At 3 closings a month, he would have an income of $4,500. He would have other sources of income, being a diligent, friendly entrepreneur.

Why give 70% to 2 sleeping partners. Khin Khin supplied the answer. The partners (probably realtors) have connections with Singapore employers in the industrial park. They provided the important link as there are more prospective Myanmar employees than employers.

"Don't you provide Myanmar maids?" I asked.
"No," he said. "Income from one S pass is equal to 5 maids. And much less people problems."

So a higher value prospective employee and a private limited and collaboration with Singaporeans are some factors of success for this Myanmar entrepreneur. He invited me to dine at his Asian restaurant in Yangon.

Mum and two sons and a rabbit being neutered

"I live quite far away," the mum of two pre-teen sons of 1.5 years difference in age gap said. "Can I wait in the clinic for the neuter to be completed and bring the rabbit home?"

"Yes, you can do that," I said. "However, you bear the risk as the rabbit after anaesthesia has not waken up normally yet. If he dies at home later due to the stress of being transported home immediately after surgery, you will blame the vet. It is a risk but not a big risk. Rabbits are more sensitive than dogs to anaesthesia."

"The boys do not want to part with the rabbit," the mum said. She did not want to take the risk. "Here's some hay for the rabbit," she came back to the Surgery with a plastic bag of hay. "OK, I will put the hay and the pellets in the crate after neuter," I doubted that the rabbit would eat immediately. However it does eat if given pain-killers post-op.

At 7 pm, she took the rabbit home. I showed her the rabbit's bottom to confirm there was no bleeding. The rabbit had woken up. Rabbits don't wag their tail and so there was no good indications.

6 month old dwarf rabbit. male.
Domitor 0.1 ml ear vein. Isoflurane gas needed to top up. Rabbit OK and goes home 6 hours after neuter.

The mum told me that she came to this practice as Toa Payoh Vets has "good" vets from her internet research. I did not ask further. The internet can also say bad things about vets too.

muzzle to stop a shih tzu puppy barking?

On Wed, Jan 26, 2011 at 1:33 PM, Ang soon Lee wrote:

Hi Judy,
I am wondering whether i can buy and collect the cloth muzzle for my two month shih tzu puppy today? Can you call me on my handphone:xxx
Look forward to your reply soon.


I am Dr Sing. We spoke. A muzzle is not suitable for Shih Tzu's puppy or any dog for long periods of time. They may suffocate. You will need to train him from barking for attention and this takes practice (e.g. reward with treats, time-out system) and a "bossy" command of "no barking". I hope my advice will work. Some owners grip the puppy's muzzle when it barks and say firmly "no barking". You may find this approach useful if you are the "bossy" type as the puppy soon respects you. One working lady told me she has great success in using this approach and I believe it is her strong personality that helps too.

Best wishes.

3-year-old Pug with difficulty urinating


I asked intern, Michelle to write down the following rather than being an observer. She has just completed her A levels and is waiting for the A-level results and wants to study vet medicine. So, I spent some time on this case with her to make vet medicine alive for her when I am free as she does not really benefit from case studies as she is not in Vet course yet.

The Pug had a complaint as follows:
Not able to pee normally for past 2 days. "But he pees normally at one big lot yesterday," the lady who loves pugs wanted to consult me as she had a black pug seen by me some 18 years ago. The black pug had passed away from old age and she never had such problems for the 3 pugs she had. Now, this pug that does not look like a "pug" because he had a longer body and not broad chested had dysuria (difficulty in urination). He had been operated on by an expensive vet one year ago ($2,000 for the whole urinary stone surgery case etc).

"The vet removed the kidney stones," the lady told me but had no medical records from the vet.

"Are you sure it is kidney stones?" I asked her as she was satisfied that the dog had recovered and that was what mattered. The dog had been on S/D diet for one month and C/D diet for 3 months. Then only home-cooked food for the last 8 months. Dysuria occurred 2 days ago. So she consulted me as she surfed the internet.

I was in charge of this case working closely with my associate Dr Vanessa Lin.

1. Empty bladder. So, I asked the owner to let me keep the dog till his bladder is full and I can collect urine for analysis of urinary stones and crystals as well as other tests. There is no point catheterisation at this stage to collect urine as the bladder was emptied recently. Blood was taken. An IV drip was given to get some urine produced.

Dr Vanessa told me that the catheter could not be passed through for more than 10 cm, i.e.. beyond the os penis. I advised X-ray and a spasmogesic injection to be given to relax the bladder muscles. She gave the spasmogesic injection and did the X-ray before 5 pm. She used a smaller hard-catheter and could get the urine out (around 20 ml in a collection bottle) for laboratory analysis.

I checked the pug at 6 pm with the owner who came to visit. The pug was put on the floor. He was very happy. He lifted his leg and peed around 20 ml of dark brown urine. The nurse matron apologised but I said it was OK and a common incident. The intern mopped away the urine.

The following is Michelle's case report is as follows:

3) Pug with difficulty urinating

Catheter could not go through; obstruction in the urinary tract; small bladder stone detected using x-ray

Urinated at 6.30pm; dipstick test:

pH 7.0

WBC 1.00+

Blood ±

Colour of urine: orange-yellow

Protein 2.00+

Specific gravity: 1.015

"The dipstick results are not as accurate as urine analysis," I told Michelle. "The urine test report will be in tomorrow and compare the results."

Each vet has his or her own method of treatment. For me, the diagnosis is urethral obstruction behind the os penis (based on catherisation mainly). "The X-ray showed some opaque sand behind the os penis," I said to the owner. "What happens is that it causes pain and so the dog has dysuria. After the pain subsided, the sand particles go back to the bladder and so the dog could pee a large amount of urine at one go. Till the next episode."

"What is the treatment?" the lady asked me. "The dog can't be peeing with difficulty now and then."

"Be patient," I said. I advised a low dose of prednisolone and let Dr Vanessa Lin know about this approach. Pred brings down inflammation and let the sand particles be passed out. This is my rationale for the treatment but each vet will have his or her own approach.

Antibiotics for the next 2 days. The dog would drink water and urohydropropulsion can be used to flush out the sand particles. This would be tried first before another bladder surgery which the owner was not keen to do. This case may not need the bladder surgery but the owner must be patient for dietary and medical treatment. This is where many owners want fast results. Bladder surgery would resolve the problem fast but there is the owner's wish not to have it. It would not cost her $2,000 but economics do play a great part for the owner.

This is Day 1. The pug had passed urine at 6.30 pm with some difficulty (leg held up for more than 60 seconds). Will wait and see.

Dr Vanessa phoned the previous vet and was told that the urinary stone removed was 95% struvite. As every urinary case is different and every vet has his or her approach, my management of this case may differ from that of my associate vet. The urinary pH on dipstick is 7.0. So, a vet could argue that the urine is not alkaline. Struvites stone form in alkaline ph but a pH 7.0 on urine dipstick shows neutral pH.

Dietary and medical management, instead of surgery may be possible. Will update when urine test pH and crystal results come in today.

313. Exporting dogs to Australia (continued)


Hello Dr Sing,

I just brought my pets to a Malaysian government clinic to get samples
of their blood.

At first, I was told that I could do the RNATT at this Shah Alam clinic
but when I called the second time to confirm, the person on the phone
told me it is not possible.

I was told people usually send the blood serum to the UK for testing
because it is cheaper and also because Australia does not approve of any
lab in Malaysia.

I sent an email to the AQIS department of Australia to find out where I
could send my dog's blood serum for testing and they gave me this
address in Singapore!

Veterinary Laboratory Branch
Animal & Plant Health Inspection Division
Primary Production Department
Central Veterinary Laboratory
13 Jalan Seranggong Kechil
Telephone: 46 1867 4000
Fax: 46 1830 9162

Have you heard of this laboratory in Singapore? I will call them next
week to find out more about them and whether I can take my dog's blood
serum to them for testing.

If you look at the Australian rates for the Ehrlichiosis, Brucellosis,
Leptospirosis and Leishmaniosis tests, it is quite a rip off and I hope
I can get my tests done in Singapore.



Dear XXX,

Thank you for your email regarding approved laboratories in Malaysia.

Unfortunately AQIS has not approved any laboratories in Malaysia and we
recommend sending the blood samples to one of the following:

Veterinary Laboratory Branch

Animal & Plant Health Inspection Division

Primary Production Department

Central Veterinary Laboratory

13 Jalan Seranggong Kechil


Telephone: 46 1867 4000

Fax: 46 1830 9162

Alternatively, you can send samples to the Australian Animal Health
Laboratory (AAHL) at:

Dr Stephen Prowse

Acting Director, AAHL

CSIRO Livestock Industries

Australian Animal Health Laboratory

Private Bag 24

Geelong VIC 3220


Phone: +61 3 5227 5000

Fax: +61 3 5227 5555

E-mail: _


Web page for import/ export blood

Please contact AAHL regarding the box to store your pets' serum in.

I hope this is of assistance,

*Sarah Nash*

*Live Animal Imports
Australian Quarantine and Inspection Service – AQIS
Biosecurity Services Group - BSG
Department of Agriculture, Fisheries & Forestry – DAFF*

Phone: +61 2 6272 4454
Fax: +61 2 6272 3110

*Sent:* Wednesday, 12 January 2011 1:36 AM
*To:* DAFF Public Relations
*Subject:* Ehrlichiosis, External Parasites , Brucellosis, Leptospirosis
and Leishmaniosis Tests - A message from the DAFF website feedback form

*Subject*: Ehrlichiosis, External Parasites , Brucellosis,
Leptospirosis and Leishmaniosis Tests


*Comments*: Good day, I will be importing a dog from Malaysia to
Australia some time this year. Could you let me know the exact
laboratory that I need to send my dog's blood serum for the
Ehrlichiosis, External Parasites , Brucellosis, Leptospirosis and
Leishmaniosis tests? I was at a government vet yesterday to collect
blood samples from my dog so that I can send them to a lab in the UK for
the RNATT test. According to the vet's assistant, it seems like Malaysia
does not have the facilities to do the required tests. I was also told
that I need to purchase a special box to store my pets' serum when I
send them to Australia for testing. I would appreciate it if someone
could point in me in the right direction even though I have to wait
about 150 more days before I can take my pets into Australia. Sincerely,


Lab in Singapore is an approved lab. It is a government lab and therefore trusted by the Australian government. You need to find out exactly what this lab needs and whether they will accept your blood samples from Malaysia.

Also, proper storage conditions and sampling are needed to be done. Otherwise you waste money sending blood samples which are rejected as being "not suitable for testing".


I have about 140 days before I can move my pets to Australia because
they only accept animals with a valid RNATT result, 150 days from the
date of the blood sample.

I hope the Singapore lab will be easier to deal with.


Lab in Singapore is an approved lab. It is a government lab and therefore trusted by the Australian government. You need to find out exactly what this lab needs and whether they will accept your blood samples from Malaysia.

Also, proper storage conditions and sampling are needed to be done. Otherwise you waste money sending blood samples which are rejected as being "not suitable for testing".

312. Exporting dogs to Australia from Singapore/Malaysia

There are many procedures needed to export dogs to Australia as evident from the following difficulties encountered by a dog lover:

Hello Dr Sing,

I just brought my pets to a Malaysian government clinic to get samples
of their blood.

At first, I was told that I could do the RNATT at this Shah Alam clinic
but when I called the second time to confirm, the person on the phone
told me it is not possible.

I was told people usually send the blood serum to the UK for testing
because it is cheaper and also because Australia does not approve of any
lab in Malaysia.

I sent an email to the AQIS department of Australia to find out where I
could send my dog's blood serum for testing and they gave me this
address in Singapore!

Veterinary Laboratory Branch
Animal & Plant Health Inspection Division
Primary Production Department
Central Veterinary Laboratory
13 Jalan Seranggong Kechil
Telephone: 46 1867 4000
Fax: 46 1830 9162

Have you heard of this laboratory in Singapore? I will call them next
week to find out more about them and whether I can take my dog's blood
serum to them for testing.

If you look at the Australian rates for the Ehrlichiosis, Brucellosis,
Leptospirosis and Leishmaniosis tests, it is quite a rip off and I hope
I can get my tests done in Singapore.


Friday, January 21, 2011

311. Be hands on and learn from mistakes in video production

On Fri Jan 21, 2011, I was happy to meet the ex-intern who completed her first year of vet studies at Sydney Univ. She had done a video of pyometra for me and so she did contribute to the company and that was good.

She presented me a "Soo Kee" jewellery paper bag with a yellow ribbon. So I thought I must have got a present of diamonds or gold.
"Can I open it?" I asked her. "Thank you for the jewellery".
"The bag is nice and so I used it. It is nouggats from Australia."
I was just jesting with her.

"Did you score high distinctions in all subjects?" I asked.
"No," she said. "There are so many topics to study and learn."
"I hope you don't have to re-sit papers," I said.
"No," she replied.
"That's good. It seems to me that a student whose parents save and sacrifice their personal pleasures to send a child overseas should not fail in exams. What topics will you be studying in 2nd year?"
"I have not checked the syllabus," she smiled.
It would be new subjects and I am sure she would be doing well.
"Well, don't spend too much time on online farmville, as I noted from your Facebook," I said. "Time is better spent doing some reading or acquiring new skills like improving your video skills with better software. The one you did for me was using plain software which could not be used to vary font size or change font types."
She would be doing another video educational project for me. "Do it," I said. "There will be mistakes made. This hands-on experience makes you learn and be better at documentary production. There is no other way to learn except to do it."

Thursday, January 20, 2011

310. 24-hour service by a competitor

Wed Jan 20, 2011

I got a phone call from the 72-year-old man. He said: "You got big competition. A new vet opens 24 hours. Did you read the Straits Times today - half a page of advertisement?"

"No, I did not read the newspapers," I said. "There will always be competition," I said. "Younger vets open their own. There are more than 40 vet practices in Singapore now."

Much success depends on whether the vet can provide satisfactory outcomes to the owners at affordabale prices. There is a vet who tereats high end clients and difficult eye and spinal cases. He is said to be quite busy.

Tuesday, January 18, 2011

A painter is angry at the vet

The painter introduced herself when she saw me taking pictures of lotus flowers as I practised my photography of flowers and compostion. She lamented that she had not brought her camera. I offered to let her take some pictures and would send them to her in a CD later.

As she discovered that I am a vet, she started to say: "My vet is money-faced (or some expressions to that effect). She ought to have put the cat to sleep. All white gums. My cat was dying. He had the human equivalent of HIV. It is called FIV. Yet my vet went on a rescue mission and charged me a lot of money."

"How old is the cat? Did you tell her to put the cat to sleep?" I asked.
"4 years old. The vet should know that there was no hope in FIV. I don't buy animals. I adopt them. Now, this cat was already diagnosed as having FIV."
"Did you really instruct her not to treat but put the cat to sleep as there was no hope?"
"I did."
"How much were you charged?"
I asked: "What does it include?"
"Treatment and some form of cremation."
"The charges are reasonable to me," I said.

Her point was that no treatment ought to be given. Just advise euthanasia. Or let her know the total costs of survival treatment.
For cats with poor prognosis, I would normally be brutally frank about the economics of treatment. In this case, the painter suffered an allergic reaction (numb lips etc) and was warded in the human hospital. She phoned this vet about antibiotics given to the cat. She thought it was tetracycline and was then not sure.

"So difficult to extract info from her," she complained. Fortunately she survived.

Last week, an aunty of a niece with a young guinea pig passing blood phoned me to say I ought to advise euthanasia. "I can see that the guinea pig is brain dead similar to what happens to people." The guinea pig had recovered from the bloody diarrhoea and was at home on medication and electrolytes. The niece was to nurse it and was told that the prognosis was very poor. Yet, the aunty interferred by saying that I should advise the niece to get rid of this guinea pig as it had no chances of survival. It is hard to say in this case as this guinea pig was young. As vets, we try to save lives. "Put to sleep" advices are not to be given lightly. Except in recurring FIV cases in cats. Talk about costs to the owner.

Giving back to society

Tues Jan 18, 2011

I was surprised that this successful Myanmar accountant of around 40 years of age gave back to his community by building a school in a very remote rural area 4 hours by car, boat and motor-bike from Yangon. He donated some $30,000 to build the school.

I asked for pictures and he showed me the primary school. The school desks would be of antique value. They were wooden and I believed I saw them some 50 years ago in Singapore when I started Primary School!

There are other Myanmar doing their bit for fund raising but this is the first one who does build a school and maintains it. He showed me a picture of a golden plaque in memory of a Japanese man who built another school nearby. This Japanese man is around my age of 60 years but has passed away.

After building, the school will be handed to the Ministry of Education. "How do you know money and things donated to the school is really given to the children?" I asked him.

"The volunteers bring themselves and give directly."
"Who are the volunteers?" I asked.
"They are the people in the movie industry," he said.
In March, I will be arranging a trip to this place to help out or donate educational materials.

Any readers interested, please e-mail

307. Hamster loses weight after abscess treatment - email advices


Good morning!

I have a worrying situation here.. :(

My 19 months Syrian had his abscesses drained out on Sunday ( 16 Jan ). The vet at Vet XXX discovered some dry blood on his upper chest. When they press it, there are pus. So they drained it out and put some gel on it so that bacteria will not go in the wound. The funny thing is that my hamster stay alone.I dont understand how he can get hurt coz when i checked the website, it was stated that "abscesses occur when a bite, scratch or wound become infected". Maybe he hurt himself while running around freely in my living room when I give him playtime?? I never know... :(

Anyway, the vet drained the pus off and I have been going to the vet since Mon daily to have his wound clean up. I also have been giving him benepac (probiotic ) and a drop of baytril daily.

The problem is his weight was 164g on 9 Jan 2011 and it dropped to 154g on 16 Jan 2011 ! yesterday, I weight him and he is 153g !! I am so worry about his weight lost...
Other then that, he is fine. He still play on this wheel, climbing the cage etc....

I noticed that he is not eating much. He is on soft diet ( such as mashed sweet potatoes, eggs, coconuts , organic baby cereal etc ) since June 2010 as he doesnt have his upper teeth ( which required me to bring him to the vet at least once 7-10 days for his teeth trimming too.. haiz...

What shall I do? Is he in pain and that's why he doesnt have any appetite?

Thank you.

Yours sincerely
Name of Owner


Weight loss is serious if it continues. If the hamster is not having good appetite after abscess drainage, there may still be residual abscess and bacterial infections. As each vet has his or her own method of treatment of abscesses and I have NOT seen the hamster and therefore is speculating that the infection is still there. Depending on the size and extent, some large abscesses need more than one surgical drainage.

You may need to give his hamster pellets and seeds and electrolytes (mashed food) and syringe feed every 2 hours 6x/day in small amounts for the next few days. Review with your vet again your concern. Diagnosis and advice by e-mail is never good nor accurate.

Sunday, January 16, 2011

306, Divine play on the vet? puppy eyelid granulomas

If you believe in Divine Powers playing fun and games with vets, this case must surely be one of them.

The puppy was purchased with no obvious eyelid growths. Then the puppy started rubbing her eyes all day long as 3 large eyelid growths appear. Why? There is no rational explanation. Tearing stained the left lower eyelid.

Electro-excision is the cure. As the puppy is a high anaesthetic risk, two vets prescribe eye drops. Vets seldom do anaesthesia in puppies, not even once a week, as there are usually no indications. The same applies to Toa Payoh Vets and I am sure for the other 40 veterinary practices.

But these eye drops would not reduce the large inflamed granulomas and will not resolve the puppy's problem of itchy eyelids and continuous scratching. A puppy in distress worries the owner as a puppy can easily die if not treated. What to do?

"Give an eye ointment and ask her to come back one month later," my assistant suggested. I said: "The lady had seen two vets and had got an eye drop. This growths need to be cut off. Preferably by electro-excision. However, the puppy may die under anaesthesia and then we get a big problem. Some owners demand compensation. New puppy deaths are extremely emotional and unpleasant."

I did not further stress the lady by requiring her to sign the consent form for anaesthesia as I noted that she had many questions with no answers from the vet. Why did the eyelid growths occur? What is the cause? Will a new eye drop work? What is the best drug? Why is the paw itchy? For the paw itchiness, I could tell her the cause was ringworm. Will the itchiness disappear with this Surolan ear drops given by Vet 2?

So, I used electro-surgery, a bit of Zoletil IV and isoflurane gas to excise 3 eyelid granulomas (histological confirmation). Then 7 days later, the owner returned. "The puppy is still scratching the eye (despite wearing an e-collar). I found a tick in the face." Therefore the tick must be from the vet. It was likely but it is hard to prove its origins. So I said: "It is possible that the tick came from the grooming as the puppy was clipped bald all over."

"What to do with the open wound? One stitch had come off," the owner pointed to the medial canthus (see picture). The correct method would be to re-stitch under anaesthesia. But that would mean another risk to be taken. Eye drops again? It would not help. I noted a 4th eyelid swelling on the upper eyelid to the right of the previous one. "There is a 4th eyelid growth," I said. "It is best to remove it as it may be the cause of eye rubbing."

This time, I just gave isoflurane gas and excised the big granuloma. Stitching should be from muscle to upper eyelid edge rather than lower eyelid edge to upper eyelid edge to prevent ectropion. The puppy went home with no complaints for the next 10 days. I hope all would be well.

Through my 30 years of small animal practice, I had not encountered this problem in such a young puppy. So, was it Divine play? It is hard to say. I doubt other vets all over the world encounter such a problem. The eyelid granulomas appear some days after purchase, as if by magic.

Friday, January 14, 2011

The 72-year-old man

Ben is a 72-year-old man and had been in the pharmaceutical business for a very long time. He met an Indonesian Chinese who was very poor but is now worth over $700 million.

This contact bought a Singapore hotel for $35 million. "He just paid $4.5million for a Singapore apartment," Ben said to me as I picked him up from his house to visit the hotel to have lunch with the General Manager. "Everybody talked to him with respect, addressing him as Datuk but I don't give a damn," he said to me.

I had asked Ben whether he could refer a hotel with 30 rooms for 60 people from Myanmar performing in Singapore on Feb 3 and 4 (Chinese New Year). So he recommended this hotel which is 3-star and therefore affordable. At the same time, he would introduce me to the GM and all senior officers there. "The owner is my friend," he said. "Very smart and suspicious. He thought I was getting a commission or fooling around when I told him about 30 rooms requested by you."

"When people are so rich, they have to be suspicious. Everybody wants their money." The man had money embezzled by his staff before. If they have to remain rich, they have to be smart too.

At the lunch meeting, the GM of the hotel was very friendly. "Did the boss call about my request fore 30 rooms?" Ben asked him. "Yes," he said. This showed that a rich business man can be rich because he personally is on top of things. Ben said: "He picked the furniture for the hotel by buying them himself." In this way, nobody could cheat him. No wonder he is rich. How did he become rich? Producing medicine in a factory in Indonesia. As for Ben, he sells raw materials to him and so is just comfortable.

"Do you want to attend the AA seminar on what to do when your car has an accident," Ben asked me. I should be less brutally honest but I said: "Don't waste my time!" Ben was shocked. "Well," I said. "If it was a fashion model show, I will go. What is there to learn from AA about car accidents?"

Ben was also not pleased with me when he declared to everyone at lunch that he bought two bags of rice and eggs (banned by the AVA, he pointed to me as if I was AVA vet controlling the import of food from overseas) from Johor. He said: "People say Johor is dangerous. Robbery. But I have not encountered any incident."

"Do you drive a Mercedes to Johor?" I asked him.
"So you say to everyone that I have no Mercedes," Ben replied. "That I can't afford a Mercedes?"
"You say so yourself," I said. "I am sure you can afford a Mercedes. But it is a very common car in Singapore. I think you will own a Bentley like S.L Liem who was a big racehorse owner in Singapore many years ago when I was a horse vet. His driver drove him to the Turf Club in a Bentley or some rare luxury car."

Ben corrected me and gave the proper name of this rich Indonesian Chinese. It was a fun lunch. The GM was a very busy man with hotel occupancy 100%. "A 3-star hotel is affordable for many people, he said. "There are not many in Singapore as demand exceeds supply. So, no 30 rooms for you now. A 4-star is neither here nor there as its rates are unaffordable for this niche of tourist. Yet its standard not as high as 5-star." He recommended that I open a one-stop spa. Well, it was a good lunch. The GM would not permit me to pay for it. The 72-year-old man got me a free parking ticket from the hotel's sales manager as I had parked in the hotel.

"Use my card first," he said to me. He had an old card which I told him would have an expiry limit. He would not believe me. So I used his card. "Card expired," the machine said. The hotel guard came over, over-rode the machine and we left. I had told him so. He was born in 1932 and disliked all new technologies like facebook, blog, newer phone models. I can't blame him. There is so much to learn.

304. Caesarean section in a Maltese

Jan 15. 2011

A phone call from a breeder woke me up at 2.35 am. He is Dr Vanessa Lin's client but she does not do after midnight calls. "First-time giving birth. Straining but can't give birth," the breeder said.

I phoned Dr Jason Teo but he was sick. I was surprised that a young man like him could be sick. "It is food poisoning," he said. "I just did a Caesarean at 5 pm yesterday."

So I attended to this emergency. Warm cool night with cloudy skies. Definitely not freezing cold as in Europe.

DURATION OF SURGERY: Caesarean section times
Start of incision into skin: 3.35 am
End of last stitch: 4.08 am. It takes about 30 minutes to do an uncomplicated Caesarean section using my surgical approach.

Isoflurane gas only. Maintain at 1-2%. No sedation. This is the safest method.
Dog masked and then intubated.
"The dog is going to vomit," I said to Mr Saw as I pulled out the endotracheal tube. The vet has to be observant. He hanged the dog upside down to get out all vomitus. Re-anaesthesize again. No problem.

A caesarean section must be completed fast. Use less anaesthetic time and achieve a good outcome. Nothing is more stressful than a dam dying on the operating table. Efficiency is important. The skin and linea alba incisions were around 8 cm long between the midpoint of mammary glands no. 4 (see photo). I extended the incision a cm caudally as the pups were large.

I incise at the uterine horn bifurcation on the midline of the uterine body. Extended incision to near cervix as pups were large in this case as I could not pull out the first pup via a shorter incision. I pulled out 3 pups head first, one with meconium (brown stools inside amniotic fluid). The last one was back legs first. Each uterine horn has 2 pups and they were larger. "Give all 4 pups to the breeder," I said to my assistant as he would normally do the puppies with my associate vets.

The breeder took the pups inside the amniotic sac and this saved at least 6 minutes of anaesthetic time if my assistant and I had to do it. In Caesarean, the shorter the better for survival outcomes.

3/0 absorbable on uterus used. 2 rows of inverting suture. The first row was parallel to the incision. The second row was at right angles to the incision. Two artery forceps clamp either ends. Then I used 2/0 absorbable simple interrupted sutures to close the muscles and the skin (horizontal mattress). The four pups large and OK. The dam appeared frightened of pups, being first-time mother.
I incised the skin and linea alba as short as possible (XY), sufficient to pop out the puppy's head or backside.

Uterine body is incised. Amniotic sac with pup inside pops out (left). I pull out the sac if not ruptured and clamped the umbilical cord. Cut off the cord. Gave the pup to the breeder. Pulled out the placenta.
The uterine horns with no more pups is pulled out entirely to check for hidden pups
This procedure is not applicable if the vet had pulled out the whole uterus prior to incision. This approach requires a much longer skin and linea incision which may irritate the dam and cause stitch breakdown
Uterine body stitched with 2 rows of continuous sutures 3/0 absorbable. 2 artery forceps anchor both ends
Maltese pups look overdue as they have a thicker coat and are larger than others

Oxytocin, tolfedine and baytril injection SC. Breeder asked for pain-killer tolfedine as I usually don't give it as a routine and in the past. Trimethoprim syrup given for post-op antibiotics. I don't irrigate the abdomen after surgery as some vets do and such actions do impress some breeders. Introducing saline into the abdomen, no matter how sterile, risk introducing bacteria. There was little bleeding in this case as I incised the midline of the uterine body and avoided the blood vessels at the side.

A Miniature Schnauzer had dystocia. I gave 1.0 ml oxytocin IM before I started Caesarean of the Maltese. She gave birth to one pup in the Surgery. "Should be OK," I said. The breeder said: "The first pup died as I arrived home too late." He had his cigarette smoke outside the surgery as I hurried him away so that my assistant can go back to sleep. It must be hard to be a breeder. I don't know him well but I had 2 years of Caesarean section and vaccination experiences with the Pasir Ris breeders in 2005 to know that dog breeding is a heart-breaking and back-breaking business. Some of my interesting Caesarean surgeries are at:

I could not drive out as the road was blocked with whole-saler vegetable sellers from Malaysia. At least 50% less crowded than in 2005 when I did a lot of Caesarean sections for Pasir Ris breeders. I walked to see their activities. Younger men in bare top bodies. A few younger ladies. There was an old hunch-back woman picking up discarded red peppers and others in a plastic bag. Tinted bronze hair, weather beaten face, blouse and black pants.

The truck people (a young lady in pony tail looking at her mobile phone and two young bare-back muscular men) ignored her. It is always sad to see a senior citizen having to scavenge. Has she got children? Where had all her savings gone?

An alert Jack Russell from the truck looked at her and at me. The dog was still working at this hour! Most Singapore's Jack Russells would be sleeping in the apartments and houses.

I walked to a far away block of apartments and tried to shoot a picture of the dog with my zoom lens. Some 500 metres away. I went up the 2nd floor of an apartment.

It was very far away so that the wholesale vegetable people would not strangle me. Surprisingly, I saw a picture of this short-legged Jack Russell.

A Caesarean after midnight takes around 2 hours (from first phone call to waiting half an hour for the breeder who came late). The whole process ranged from 2.30 am to 4.30 am). Singapore was still a busy city at this time with many taxis prowling the roads. A McDonald bike was seen from my car at 5.30 am.

Some 5 hours later in the morning, the breeder phoned to say that there was another pup not born. Dr Jason Teo did the Caesarean to save the pup. It was alive.

Thursday, January 13, 2011

303. Upgrading and best practices

There is always a generation gap between old and young vets. However some young vets have this confidence to communicate with older vets and that is good for them. Young vets who naturally want to group around with their peers and age group. This is commonly seen.

On Jan 13, 2011, I visited two competitor vet practices. It was great that the two younger vets I met were good at communication. One was clean shaven in his head. "Are you helping 'Hair for Hope - Singapore'?" I asked him to be bald to raise fund for the Children's Cancer Foundation? I had not seen a young vet bald in Singapore and he was the first one.

The second vet has 9 years of experience and was excellent at communications. First class, I would say. She offered me a cup of coffee as she could get rid of me after some conversation. She shared some interesting cases of pyometra (photo with yellowish disc in a spleen of a dog with pyometra - splenic abscesses?). She showed me an X-ray of a dog with a 20-cent coin in the stomach in which the endoscope of a referred vet was ineffective. It still needed gastrotomy after endoscope failure. "Is an endoscope so expensive?" I asked her when she mentioned $100,000 for one. I do not think it would cost that much unless it is for racehorses.

I learnt a few veterinary communications and related matters from her and the other competitor. It is good to see other practices in Singapore and in other countries to upgrade oneself and know the industry's best practices as no one vet can have all the vet knowledge in this world.

302. Taking advantage of distressed art

Jan 13, 2010

Khin Khin phoned me to say that the artist was selling her artwork I like (Myanmar market scenes) at fire-sale prices. "Give her $150 per painting," she advised. "She needs the money to pay the rent."

It is not good to take advantage. "No," I said. "I want to hang the art on my Surgery walls or home. I don't want to see it as one that is bought from an artist in distress. It is just not what I will do."

Artists need to sell. Vets need to diagnose and treat. It is just sad that this artist could not sell her artwork internationally. Much promotion and creating awareness is needed. I think an art gallery sponsor or patron is what make some talented artists successful. Talents can only go a short distance.

Wednesday, January 12, 2011

Follow up on maltese peeing just outside the pee tray

Hi Dr Sing,

Above attached are the photos of my dog's pee tray and the surrounding of it.

The first pic is the tray.
2nd pic is the newspaper i put below it. And as you can see the urine patch there.
3rd pic is the floor where he will urine there at times, he will stand on the newspaper there and aim on the floor.

Btw, there is no change of environment or situation. Most probably i guess is because we hardly accompany him and hardly bring him for a walk.

Is there any effective ways to solve this problem? And, if i neutering him at the age of 3, will it be too late?

Thank you
Name of owner


You did change his routine by cutting down the regular outing. So he can't urine-mark downstairs and dare not urine mark the whole apartment (in fear of punishment). So, he made do with just outside the pee tray. I presume he will urine-mark the whole apartment if nobody is around and if he has not been confined to the crate.

Urine marking occurs in your dog due to deprivation of doing it outdoors. This is main reason as all dogs, like young children, are used to a routine and in some children's book, a routine makes a child feel more secure and happier.

Neutering may reduce this urine marking as the testosterone production is shut down. However, you still need to re-train the dog (routine to go downstairs after neutering for some weeks or months). Many still urine-mark but with reduced frequency. Neutralise the urine smell.

Go back to the routine or neuter. It is also possible that the pee tray is too small or the dog just does not want to dirty his paws. If only dogs can talk.
- Show quoted text -


He will not urine-mark the whole apartment,only will pee outside the tray.
What should I do to neutralise the smell?

He may not do it now. If you leave him home alone in the apartment for the next few weeks, you may be surprised. That is why some male dogs in Singapore are crated when home alone or at night (to prevent urine-marking).

Try white vinegar + water at 1 part of vinegar to 3 parts of water and use tissues with this solution to wipe off all urine smells.

300. Soliciting for a veterinary job - poor resume introduction

I got a resume by e-mail as follows:



Im XXX. I am applying as "Veterinary Assistant" in your good clinic. Attached here in with is my resume.Thank you very much and more power!


I don't bother to reply. This is an example of a poor introduction in a resume. More power? Is she referring to the "People Power" toppling Marcos or the blue pill power for erectile dysfunction?

DBS Corporate debit and credit card: 2nd opinions from the same bank

Jan 12, 2011

In Dec 2010, I opened a company bank account (Design Travel Pte Ltd, at DBS Toa Payoh. The helpful customer service officer told me that it was almost impossible to get a corporate credit card unless one is chosen. It was by invitation only. Two days ago, I asked her about a debit card in which I put money into the current account. She phoned the DBS banking somewhere and was told there was no such instrument. I was surprised that DBS is so provincial.

Then today, I went to DBS Bishan. Imagine my surprise when Ms Irene Foo there told me that there was no problem opening a corporate debit account for a private limited company and gave me the forms to sign and documents required. She said the corporate credit card might be given to a company with proof of income and a bank officer would check this.

So, I wasted 2 months believing there was no such thing as a DBS corporate credit and debit card.

This episode shows that one must be proactive to search for info. It is obvious that I was barking up the wrong DBS tree in Toa Payoh.

298. Toilet training email query

E-MAIL TO DR SING dated Jan 12, 2011


I have 1 maltese cross, age 3 years old. He used to pee at the pee tray correctly. But for the recent months,he started to pee outside of the tray. We tried to place newspaper underneath the tray , but he will still pee outside the tray. Is there any solution for this problem? Will Neutering cure the problem?

kindly reply me asap as i need to solve this problem fast.


E-MAIL REPLY FROM DR SING dated Jan 12, 2011
I am Dr Sing from Toa Payoh Vets. Most likely there has been a change of environment (new tray, room, etc) or situation (new pets, baby, dog next door or corridor etc) making him want to either get attention from you (by peeing outside the tray) or he wants to mark territory (outside the tray but can't do it further because of your scolding or spanking).

Neutering does help to reduce/stop territorial spraying when done at a young age. Pl email 2 images of your pee tray and surroundings. It is hard to advise without seeing the location and tools you use.

Tuesday, January 11, 2011

297. Jan 11, 2011. Resume is important

Jan 11, 2011

I met an old friend who used to have little time for me just to keep in contact. He was extremely hard working and had a lot of contacts. After retirement, he has more job offers and one important interview this Friday. "No need to bring a resume," he said. I advised him to do it as this is the way a corporation management can assess you. My reasons are as follows:

It was great meeting you yesterday and to know you have reduced weight since retirement.

Although your proven performance in your old company and your network is well known to the prospective recommending person in the same field of work as you were in, the general manager and other big shots know little about you and may be apprehensive as to whether you can perform for the new company. The advantage is that you have a proven track record and there is no need to hold your hands or worry about blunders.

A resume with relevant and excellent testimonials is important to carry along during the interview because it helps the general manager to approve financial compensation and benefits to you, without insulting you by under-paying nor over-paying you. A graduate degree is never important as many graduates actually can't perform in the field you are in.

A resume submission is part of hiring administration of a corporation. Resume should include your personal particulars and relevant work experiences (newspaper clippings, letters from bosses, customers, suppliers). Cases done per year and impact on the old organisation will be most relevant and useful. You just need to get your homework done and smoothen the path for your recommending person to hire you. I have young adults and veterinary undergraduate students who don't bother to submit a proper resume and assume that they will get the work attachment and internship based on their excellent academic grades or the fact that they are veterinary students.

The schools seem not to have taught them that excellent grades and in your case (experiences) open the door only to get you the interview. If you go to the interview without a resume, your behaviour implies an arrogance and that the world owes you a living. And since you are not hungry and have sufficient wealth, this may be true actually. If you are not hungry and do not need the income, why go for the interview? Just do nothing at home and smell the hibiscus flowers and let your brain cells deteriorate.

Best wishes.

Monday, January 10, 2011

Work attachment for JC 2 students at Toa Payoh Vets


Nowadays, I don't accept Junior College students who have NOT been accepted by Vet colleges for internship as a lot of time and resources are spent on students coming for work attachments.

However, JC2 students with initiatives can still e-mail to me. Good work attitude, excellent testimonials from teachers and chances of getting into Vet colleges in Australia (must have at least 3 As in JC2 preliminary exam) may be accepted as is the author of the case study report below.

Last month, I rejected a student who had top grades. She did not have time to come for an interview as she had to study for her A levels. I was OK with that. After her exams, she did not bring in copies of her testimonials during the interview. She promised to do so personally but a few days later, text me to ask if she "could fax them." I told her not to come for the work attachment.

If you are NOT meticulous by forgetting to comply with requirements and is accepted, you will need to know that you have been given a 2nd chance. If you expect an organisation to suit your time management (by faxing and saving your precious time), you may not realise that you have a poor work attitude. Excellent academic results definitely opens doors to what you want to do, but the commercial world does not owe you a living. Therefore, be realistic and humble. It is not what the organisation can do for you as a Junior College student or undergraduate vet. It is your work attitude and what you can contribute to the organisation.

For this first day, the report of this Junior College 2 student who has not taken Biology during her A levels is good. The info is as follows:

Case studies with Dr Sing

1) 1-year-old female hamster with right breast tumour


Lump under the armpit was ~0.8 - 1.0 cm in size. It weighed about 38g. It could either have an abscess or tumour. Without an operation, the skin would eventually tear, revealing a large open wound.


Surgery was performed to remove the tumour. It was required to stay in the clinic for 7 days.

Infection and death follows when the tumour enlarges and gets ulcerated due to friction and self-induced trauma.

NOT REQUIRED TO STAY. HOWEVER THE OWNER WOULD BE GOING TO JAPAN FOR THE NEXT 7 DAYS AND THERE WAS NOBODY TO NURSE AND GIVE MEDICATION POST-OP. SURGERY - Zoletil 100 given in 3 drops + SALINE. Effective. Excise at base of tumour. Continuous 5/0 absorbable stitches.

2) 1-year-old male guinea pig with paralysed hind legs


Guinea pig’s hind legs were immobile and it was described to be lethargic. It registered a low temperature of about 37°C. It weighed about 777g and was eating and drinking normally. However, there was pain between the shoulders, indicating possible nerve damage.


An injection was administered to relieve the pain.
Traumatic injury most likely due to a fall inside the crate. Sudden onset.

I asked: "Any sudden loud noise?". The young lady said: "Yes, at 2 pm. I was sleeping. I saw my guinea pig running fast (pacing) and hoping energetically."

She had consulted Vet 1 earlier. The vet clipped the front teeth and probably could not find out what was wrong.

Sometimes, the 2nd vet gets the diagnosis due to the GP not getting so excited and the medication of the first vet.

I suspected sudden onset traumatic injury. Palpation of the spinal area is important in this case. The GP shivered when C3-C5 was pressed and squealed when the area between the shoulders was palpated. Paraparesis. No placing reflexes. GP hops instead of walks.
Besides anti-inflammatory injection SC to relieve the pain, the guinea pig was given electrolytes. Vet 1 had prescribed Fibreplex and the GP was able to move the bowels. Was eating and drinking normally but getting weaker.

3) 12-year-old crossbred male dog


It weighed about 17.4kg. It was described to have been scratching its face and legs, as well as shaking and having difficulty in walking properly for the past few months. It also had skin and ear infections and dental problems, thus experiencing toothache and earache. It had a painful anal sac.

Ear injection had to be administered for ear mites. A blood test was to be taken to check for kidney and liver problems. Complete shaving was needed before treating the skin infections.

A 12-YEAR-OLD CROSS-BRED WITH PAINFUL MOUTH. Not groomed for several months. Ears full of black wax, inguinal area black. Mouth painful when touched (quite dramatic as the dog bites). This was due to dental decay esp. the upper PM4 teeth. A risky thing to do to open the mouth but this needs to be done as part of diagnosis. Quite smelly. The Junior College student has to be hands-on. But this dog is a gentle one and so I know he would not bite when I lifted his side muzzle to show the grey receding gum upper PM4 to the owners (father and young adult daughter).
The main point was missed by the Junior College girl. Dental treatment needs to be done after 2 days of IV drips with antibiotics and painkiller first.

4) Sterilisation of male stray cat


Ear mites and a 0.5 cm wound were observed.


It had just eaten; hence it was unable to be sterilized on the same day. It had to stay for at least 1 night and an injection was administered.
Stray cats. Infected bite wounds, ear mites and skin infections need to be treated first before neuter. Economics is the big problem in cat activists. Toa Payoh Vets do give discounted rates.

5) Vaccination lump in puppy


Small abscess observed in the vaccination area.


It was massaged to reduce the size of the lump and antibiotics were administered.
It would be some bleeding as the puppy moved a lot during vaccination. So the pet shop owner had to bring it in for free treatment. Antibiotics must be given.

295. Permission to use photo from's dystocia case

Dear Judy,

I was reading with interest your website, and noticed this photo of a fox terrier pup stuck in the birth canal:

I was wondering if it’s possible to get permission to use this in a first aid workshop in a remote community?

I work for a not-for-profit organisation that supports dog health in Australian Indigenous communities, and would like to use the photo to illustrate a discussion on birth problems and the benefits of desexing.

Please let me know if this is ok,

Sophie Constable

Education Officer


cid:image003.png@01CB9B6A.8A6821F0 P.O.Box 1296 Ph (08) 8941 8813 DARWIN, NT, 0801

...I acknowledge the Traditional Elders, past, present, and future, on whose land I live and work...

Kind regards,

JAN 11, 2011. Permission has been given to use photo with acknowledgement as follows: Photo:

Sunday, January 9, 2011

294. Sunday Jan 9, 2010 interesting cases

Sunday Jan 9, 2010
Interesting cases

As Dr Vanessa Lin will be back on Monday, Jan 10 after 10 days' break, I will not be working usually from 9.30 am to 11 am and by appointment. Younger vets will need to take over so as to continue Toa Payoh Vets' vision and mission.

1. Open pyometra. Only isoflurane gas was given to the Jack Russell who had pus dripping from her vulva and was hospitalised for 2 days and given IV drip and antibiotics. "The faster the surgery, the better the chances of survival," I reminded my two assistants. "If the vet takes his time to operate an old or sick dog, the dog's heart may fail and the dog dies."

It is too easy to be complacent when the vet does such surgeries routinely. Pyometra is a serious illness and is not an ordinary spay. "No point using a spay hook," I said as my assistant looked for one. I noted that the vulval dicharge, though clearer (picture taken) was still copious. Therefore, the uterus must be quite swollen. Palpation could not reveal swelling. No x-ray was taken to save the owner some money. The history of recent heat and the purulent vaginal discharge of an unspayed female dog would confirm a diagnosis of pyometra.

Earlier I said a spay hook might create a smaller skin incision compared to the usual method of pyometra surgery which needed a big incision. The dog was spayed in 25 minutes. An incision sufficient to put a forefinger in to hook up one swollen uterine horn (3 cm wide, pic taken) was used. Double ligature of ovary with 1/0 catgut. Transfixing and ligature of uterine body. My assistant prepared sterile saline for me to flush the abdomen. "There is no need to do it," I advised. "All my pyometra surgery over the years are OK without this." I noted that some vets do irrigate the abdomen after pyometra surgery. It does not make sense. Why introduce something into the abdomen when there is no contamination and instead, the vet can introduce bacteria all over via the saline solution? Keep it simple and the dog will recover. After all, this dog had pre-op antibiotics and post-op.

The dog's anaesthesia was shut down when the muscles were stitched and only skin sutures remain. The dog woke up peacefully and fast. 15 minutes later, I could see her wagging her cropped tail, as if happy to see me. This was a very gentle Jack Russell and no wonder the daughter who had to work in the Shenzen area, China had come back to Singapore to get her admitted for surgery by a "cheap-po" vet as this was what Julia described me. Vets of my age should charge double due to some 30 years of experience but it does not work this way in veterinary practice. Lawyers and doctors in branded hospitals will be able to do it. The dog was alive and could go home the next day.

2. KIDNEY FAILURE. The thin 2-year-old Shih Tzu that vomited daily for the last 4 days died. Blood tests show very high creatinine and urea levels. X-rays showed enlarged kidney (left) and what appeared to be urinary bladder stone. But the main finding was the blood test.

"The dog could develop kidney failure when he grows older, due to hereditary reasons of not proper development. The kidneys could not cope with the clearing of the toxic urea waste anywmore and therefore becomes sick and vomits," I explained to the owner whose niece was sobbing. "That is the reason why this dog does not put on weight. It was a sad Sunday for me and everyone. Vets can't cure all diseases.

3. TOILET TRAINING A GOLDEN RETRIEVER. A nice family of two parents and two boys in primary school. The 2 boys were 2 years apart. "No online gaming for them or permit them one hour," I advised the young parents as I had not been strict on my two sons. "Online gaming is the heroin of young boys. They sleep late and fall asleep during school. My son's teacher has to phone up to tell me," I said. "They are permitted to play only during holidays." the mum said. "Read 10 books a week," I advised. The younger one did not do it. So his command of English was not so good.

As for toilet training, the father asked me advice. The puppy would pee on the pee grate but poop on the tile floor at the side when confined. The only solution is to increase the grate area by buying another grate if they want to do grate training. As for paper training, no use. The puppy shreds papers. As for going to the garden to poop and pee as for most big breeds, the parents did not want the grass to die from dog's urination. So the other solution would be to leash the puppy to a confined area. "But be aware that the puppy may get strangulated and die," I said. Buying a pee pan and putting some stool smells on the newspapers in the pee pan which is placed near the area where the puppy poops may be an alternative. That means the puppy will be trained to poop on the pee pan keeping the floor tiles clean. I wonder which solution the parents will use. Will ask them if we meet again.


"Milk seen but a tiny drop from one nipple," I said. The dog was spayed by me in May 2009. That was strange as spayed dogs usually don't show milk. But the owner did not complain about bleeding or heat. Their complaint was that the dog was biting the backside and inside thighs. The wife wore a bright green dress which is an uncommon colour. The husband was casual and a foreign trained lawyer. "She is in a cool job," he said. Working in NGO or voluntary organisation is always a better work than in money-making enterprises. The dog had anal sacculitis. Grey particles and oily grey anal oil in abundance.

Friday, January 7, 2011

$2000 - $3000 for pyometra surgery

Since I treated this 8-year-old as a puppy, the mother in her late 50s took her Jack Russell to consult me. Deep yellow pus flowed freely from the vagina. Vet 1 had diagnosed pyometra by palpation and blood test (high WBC and neutrophils) and quoted $2,000 - $3,000 for the surgery. As the tanned daughter was in Shenzhen, China, she decided to wait for her to come back. So, for the past one week, the dog rejected antibiotics and now was not eating. It was now risky to go into surgery on the same day.

"Costs of living have shot up a lot," I said. "There is a lot of expensive equipment to be purchased, replaced and the staff costs have gone up."

"How much do you charge?" the mother asked. "The pyometra surgery and anaesthesia is $500," I said. "This excludes charges for medication, the IV drip and hospitalisation." In any case, my fees would be less than $1,000.

"If you had spayed the dog at a young age, you will not have to pay so much. It will be around $300! Now there is the risk that your dog may die under anaesthetic as she is 8 years old. Some vets reject surgeries of dogs over 8 years old dogs to avoid the unpleasantness of emotional lashes when the dog dies on the operating table! " Nowadays I have given up advising sterilisation as Singapore owners deem it cruel.

I hospitalised the dog for 2 days to give intensive IV drip and medication and will operate 48 hours later on Sunday.

I spoke to Julia about the $2,000 - $3,000 surgery. "It seems expensive," she said. "You are a cheap po!"

292. Dr Sing's Travel stories - Juliet's balcony, Verona

Scribbled during travel to remember clearly the events and interesting people I met. 4th day of European Tour
On Jan 8, 2011. I decided to post some pictures of my travel before I get caught up with the hassle of city living. So I am loading the following article of my travel written on the next morning after the visit to Venice and Verona for my readers.

Dec 17, 2010
My tour group of 49 tourists from Singapore left the impressive modern Novotel Hotel, a 15-minute drive outside Venice island at 9.390 a.m. It would be 3x more expensive to live on Venice island and so we were housed in this excellent hotel.

This new furnishing concept Novotel, a 4-star, is very impressive to the mass-tour-package tourist as all furnishings are modern. The bathroom has custom-made semi-circular shower tub which is a fake long bath. Too shallow as a long bath tub. The wash basin was of grey plastic material while there were branded taps and shower heads. Stainless steel handles. Small things like a kettle made this hotel stay a pleasure as the tourist can boil water to make tea or coffee as almost all the European hotels do not provide kettles. The TV clock was inaccurate and English programming malfunctioned in one room. One of the group said it was a pleasure to take a shower in this hotel as the previous hotel had cold water.

After Venice Island, the tour manager announced that the factory outlet in the shopping mall for leather goods was closed for lunch and so the Singaporean ladies were greatly disappointed. He made some phone alls and the shop was opened.

But the memorable visit for me was Verona (Juliet’s balcony visit in the evening with new snow flakes falling was a great experience for the group – snow ball fights and romance revisited).

Milan’s big Chinese Restaurant for dinner (corn soup again 2nd time in another Chinese restaurant). Venice island visit. Gloomy skies with few snow flakes. Snow fell as we left Venice by coach to see the Coliseum at Verona (substitute for not seeing the real thing at Rome – student strike over university pay and research cuts by PM Berlusconi - burnt cars and injured policemen). The Tour Manager said we could claim some money back from travel insurance on proof of no show but I doubt he would follow up as we did not get any letter. In any case, the Coliseum at Verona was closed when we arrived. But it was more fun outside as I re-experienced the gentle snow flakes falling from the skies as I had not seen natural snow falling for over 30 years in tropical Singapore and I dislike winter travels.

1. Jet lag still hit me even though I slept on and off in the coach. A young man had to carry the 20-kg 3-year-old whom I could see could not walk more. My own leg muscles felt cramped and so this little girl must be very tired and jet lagged.

A 65-year-old woman with a weak knee and other tourists advised the 2nd trimester (looks like heavily pregnant) wife to sit in the front half of the coach with the 3-year-old daughter as the back end seat was not said to be good for her, being bumpy.

I had a good chat with the 65-year-old woman whose 3 daughters cared for her very well. “Where did you go?” I asked the grandson as the grandma was calling out to the tour leader to help her alight the coach to get to the factory outlet selling leather goods.

The tour leader was further away and everyone (except me) seemed to rush to the leather factory outlet, being given 30 minutes to look and buy. The grandma had a stick for her weak left knee and so she needed help alighting. I was behind and helped her. She had been “warned” by her 3 specialists about her bad knee and advised her to carry a shiny pink walking stick during her European tour.

“You don’t need the walking stick,” I said to her. “The dependence on this tongkat gives you negative thoughts, making you a disabled person when you are not.” Her daughters had sent her to 3 specialists (must have cost a bomb but the daughters would not allow her to pay).

This was an independent intelligent woman whose marriage was till death parts us type unlike the younger generation and whose mother-in-law (during that period) was domineering and a fierce dragon. Daughters-in-law were not well educated and would not talk back, but her husband did not enforce her stay with his mum. “It could be due to the eating of salted fish,” I said, regarding the husband’s stomach cancer. “I read about it in some books in the National Library when I was in Secondary School. I do love salted fish and century eggs but they may cause cancer as they are full of preservative.” I ate minimal amount. She also love century egg porridge.

2. Her brother-in-law died of the same type of cancer although he was not related to the husband. I did not bother watching the glass-blowing in the factory above after the tour of the town square of Venice and she was downstairs. So we talked. “He never ate salted fish,” the widow said. “I don’t like it.” I said: “Out of love for you, he ate when he was overseas doing business,” I said. “The person who knows would be your sister who cooks salt fish for your brother-in-law”. But it was 10 years ago and it took her 10 years to be able to talk about her husband. This was the true love as in Romeo and Juliet.

She was a generous woman as she offered to me the walking stick when I said: “I need the tongkat as I am an old man.” She did not know I was just joking as I had walked well over the earlier 3 days.

I thanked her and said: “I am trying to get you to think positively by not relying on a walking stick. The 3 specialists had advised you to take a walking stick for this travel but Europe is not a undeveloped country. When there are hilly alleys as in the town of Senia, you don't venture there, aggravating the hip injury. She does not believe in taking pain killer medication and this walking stick was her saviour. Many Singaporeans trust doctors but some of their advices like the use of the walking stick make this widow take up a clutch mentality. She did not have osteoporosis, the eldest daughter had declared. So, what’s the worry?

“We may be old but are not dead,” I used to tell my receptionist James who recently walks with a hunchback and very slowly. He is 75 years old and sometimes I wonder why he still wants to work in my surgery. His mind is alert but my Surgery's impressions on the new clientele must be poor since other competitors have young pretty receptionists. Pretty young things sell and that is a fact of commercial life.

I hope this 65-year-old widow would be independent and just throw away the walking stick for the next few days. She listened to the doctors' advice and did not give up the stick. "In Singapore, I don't walk around with a walking stick," she assured me.

3. Snow flakes fell in millions of cotton pieces from the sky as we were leaving the leather factory outlet which was closed till 3 pm but the proprietors opened for us at 1 pm. There were a few sales. I was looking for good leather hand bags but I was disappointed. Where's the Prada? Italy is supposed to be famous for handbags.

The whole shopping mall looked dead. The tour guide asked: “Anybody want to see the Coliseum at Verona?” Sounds of silence. “Hands up if you want to go to the see Juliet’s balcony.” I was in the front 6th seat and saw no hands up. I put up my hand and so the tour guide was disappointed. He had said: “At half the speed for 300 miles, it takes twice as long to reach Milan due to the falling snow. There may be traffic jam along the way...” meaning that we better skipped the Verona coliseum and Juliet’s balcony. He said another tour from Singapore from Milan to Rome had got stuck in the snowed roads and the tourists were sleeping inside the coach instead of the hotel. It was just as well that we did not listen to his advice as Verona was such a beautiful evening visit with snow flakes falling down on us as we journeyed to see where Juliet declared her love for Romeo from the balcony.

As for the gondola ride, around 6 out of 49 of us wanted to ride the gondola as this was an optional tour and excluded in the tour package which I think is poor planning by the tour operator who probably wanted to provide the least cost tour for the masses. Venice is gondolas and the experience should be given as part of the tour package.

The guide had arranged for a big boat cruise on the river and strongly advised against gondola rides as he said: "You only see underpants hanging from the balcony." I did not see any underwear hanging out that day.

It was freezing cold but so what? I wished to do it but did not get to ride the gondola as Julia was against it. Venice is gondolas in postcards and movies (e.g The Tourist). And masks. Apparently there is a festival in Spring where everybody wears mask, a young lady lawyer told me as she was present as a backpacker.

“Are you a Singaporean backpacker?” I asked her about the dangers of backpacking in Milan and Paris. “No danger if you are careful. I am not Singaporean.” The trim lady was accompanying her mother who insisted on going to Venice. She said: “I am a Malaysian. Singaporean ladies are known as brat-packers.” I was astonished. I had never heard of this term. "What do you mean?" I asked as I know Singaporeans in general have gone soft due to the paternalistic government. A nanny state.

She explained: “Singaporean ladies don't like discomfort. They take out their credit cards when they travel. However I do have Singaporean lady friends who backpack.” I said: “Probably those are the physical type, you know. Those who are into sports.” She nodded her head.

4. No traffic jam for this group. Slow but flowing traffic as our coach ploughed on freshly fallen snow to Milan. The Chinese food was slightly better than the other Chinese restaurant as there was more meat (one small fish for 10 people, pork with vegetables, cauliflowers alone, sweet fried chicken, the corn soup and mandarin oranges. 5 tables of 10. Everybody froze in the cold outside the restaurant as the coach took around 5-10 minutes to arrive, picked us up (as the nearest parking lot was 10 minute walk away in slippery ice-melted pavements) and we went back to Ata Hotels.

This Ata Hotel in Milan or Milan has poor roaming connections. I had to use the public phone as it has no business centre. My handphone could not work to call Singapore. “You need a phone card,” the duty officer whose eyes were tired, told me. You got to dial “0065” on the public phone. I put in 1 euro coin and the other party in Singapore, being long-winded, made me impatient. Overseas call must be to the point.

Free internet access. You need to pay. However, emails can be checked at a desktop on the table in the hotel lobby.

“Venice is more expensive than New York and London,” one proprietor of a souvenir shop told me. He was a Bangladeshi, now operating his souvenir shop at the ferry terminal. A 9-year-old Singapore girl said: "How much?” and paid 9 euros for a small porcelain model of Venice town square for her mummy. The mother had a son 18 years old and this daughter 9 years old. Migrated from China some 17 years ago. The older adult ladies bargained to buy the masks and T-shirts. Daniel bought a mask.

Lunch in Venice Square was at a Kiro Restaurant which had a variety of sea food. The male waiter saw us and came out with a name card saying: “The fish soup is good.” My family wanted to wander more to find out other eating places. Three locals scattered white salt on the pavement. I asked the family to patronize this place as we were short of time. Lunch for 4 of us cost 71 euros compared to half the price in Siena, but this was Venice Town Square. Venice is a lagoon of 500 sq km with 3 sea inlets. Ballasts are being constructed to prevent flooding. “Much more flooding incidents since last November,” the Italian tour guide said to me. “Could it be global warning and climate change?” She did not know what I was talking about and did not reply. “The Square used to have flood 2-3X per year but now, there are so many.” So is Venice sinking? “You can’t completely wall up the 3 inlets as the sea water is needed to flush out the debris and smells of the inhabitants. Many canals are man-made but some are natural.
Did my laptop function after being stored inside the coach at -3 degrees C for the whole day? Well, it does work as I am typing this.

Charge your camera battery daily if you have no spare. Coldness drain batteries. Download pic daily as this is good advice. I kept my camera dry from the snow flakes by covering it with a plastic bag and making a hole at the lens end. I got this tip from the photographers’ magazine but had not prepared for snow flakes or rain. Fortunately, I found a plastic bag and it was an extremely pleasant and fun experience walking in the fresh snowflakes in Verona which has a high city wall preserved.

As for Juliet’s balcony, some skeptics said it could not be real. Just a tourist attraction. There was a statue of Juliet in gold. Walls of graffiti or love messages at the entrance.

Verona is for those who had read Shakespeare’s Romeo and Juliet as it brings literature alive. Since I took my A level literature examination studying Shakespeare's "Romeo and Juliet" as an impressionable young man of 18 years of age, Juliet's house and courtyard brought literature alive to me during the visit. And this was some 40 years ago but I can still remember Shakespeare's most famous work.

Romantics don't care that this Juliet's house is not the real McCoy (if you research the internet to read the comments) as thousands of young lovers come to this place. On this snowy drizzling evening, the group walked several minutes to visit Juliet's house, see her gold statute. The young ones threw snow balls, the older ones tried to avoid the slippery road as cottony snow flakes glided down from the heavens. There were many visitors to Juliet's house that evening. The surrounding houses were boutiques and shops. For me, English literature came alive that evening. For the others, it was just one tourist attraction.

Travel Story is Written for Design Travel Pte Ltd, a licensed Singapore travel agent. Webpage is:

Enquires about Myanmar tour and travel organised by Design Travel Pte Ltd, Singapore: e-mail tel: +65 9668 6468.

Thursday, January 6, 2011

291. Jan 5 & 6 2010. Interesting cases

Case 1. Collapse, panting and high fever on Sunday Jan 2, 2010 like a dog having heat stroke.

Yesterday, Thursday, Jan 6, 2010, I phoned the owner of the 10-year-old Bull Terrier yesterday to enquire how was his fever. The dog was sent home yesterday after 4 days of intensive IV treatment and drugs. The owner took out his phone and played the video clip of his dog crying continuously for several minutes. "This is a cry of pain," I said. "Most dogs done whine like that unless they are in great pain." The owner said: "My dog was not active for the past 10 days, but I did not think he was sick."

Now, after 4 days of treatment, the dog could stand and walk a few seconds. His tongue colour was normal pink. I asked the owner to bring him home to nurse as I doubted that the dog would survive the next 7 days due to his poor blood test results. The dog's blood test showed septicaemia (high WBC to 39, low platelets to 6, increase in urea and creatinine and SGPT). 10 days before coming here, the dog had been boarded at a friend's laundry place.

The owner was to feed him AD diet and other food personally and gave him the drips SC and check his fever. "Spend time with him," I advised as there was not much time left, in my opinion. "Some owners do nurse the dog back to health when the dog is at home rather than being hospitalised," I said.

"He's the same but no fever," the man said when I phoned. "I force feed him the 4 cans of AD diet and eggs." That was good news as I expected the dog to be worse and to have fever returning.

As to the cause of the undulating fever, it could be bacterial or tick fever. There was no tick found on the dog and the owner did not know whether it had ticks in the friend's place. All he knew was that the dog went in healthy and came back sickly. In the 4 days at Toa Payoh Vets, his fever returned the next day and receded when given tolfedine anti-fever. I treated him with different antibiotics for bacterial infections and tick fever before sending the dog home as a dog with no fever.

Will wait and see. Blood test showed that he had a bad bacterial infection and toxic blood due to extremely low platelet. Without intensive IV drips, he would be dead within 24 hours. It was a miracle he was alive at all.

Case 2. A Cocker Spaniel came in with 3 days of purging. "We saw blood in her stools," the couple in their late 30s had boarded the dog at Pasir Ris boarding kennels. The dog had its yearly vaccination. "Why diarrhoea?" the owner asked. "The kennel operator had told me and had asked me if I wanted to send the dog to a vet."

"It is hard to know the cause," I said as the owner declined blood tests to save cost. "There are many reasons. The vaccination protects against the serious viral and bacterial infections." The dog was eating. I hospitalised it and treated it with IV drips, antibiotics and anti-diarrhoea IV. Should be OK after 2 days as the intestines get to recover without food intake irritating their surfaces.

Case 3. A thin 1-year-old female Shih Tzu kept vomiting for the past 10 days. Yesterday, the owner agreed to blood tests and X-rays. X-ray showed small white globular object inside the stomach. Another opaque one in the bladder. Could this be the cause? This is an extremely high risk anaesthetic case as the dog was very thin. So I did not dare to operate as the death was almost guaranteed. Yet, the dog continued vomiting daily. She vomited blood. I thought it was pyometra as there were vulval discharge. Was it kidney disorder? Will wait for the blood test as the owner agreed finally to the blood test.

Tuesday, January 4, 2011

290. Jan 4, 2011 interesting cases

Tues Jan 4, 2011

Case 1. The 15-year-old Beagle with mouth pain. I was worried that she might not make it under anaesthesia. The dog was hospitalised overnight. Had IV drip and antibiotics IV. At 9.30 am, I had her under surgery.

No sedative. Just straight isoflurane gas mask and intubated as this was the safest method. But quite troublesome as the dog puts up a strong struggle to be given gas without sedation injection.

Gums were very pink. Painful mouth due to long ulcers at the gum/teeth line. Only 2 teeth extracted. The 15-year-old has better teeth than most 10-year-old dogs. The gentleman owner came at 10.30 am while I was operating the 2nd dog with testicular tumour. He brought a pillow. I told him not to visit the dog. The dog was OK. Shivering and drowsy due to anaesthetic effect and her old age (not recovering as fast as young ones). Dog went home to a happy couple.

Case 2. The dog with testicular tumour was hospitalised yesterday and given IV drip and antibiotics. 12-year-old is a big anaesthetic risk. I was not looking forward to doing this surgery. The big testicular tumour was stuck to the underside of the scrotum. It would not be the simple testicular neutering surgery which would take less than 30 minutes.

Yellow white fluid shot out from the tunica and later from the testicular tumour. The other testicle was shrunkened. So, this was not only a tumour but an infected nasty growth. I needed to cut off the whole scrotal skin as the tumour was sticking to the scrotum (due to infection probably. INTERESTING HISTORY. 4 weeks ago, had high fever and Vet 1 gave antibiotics without examining the testicles - vets seldom inspect testicles actually. 2 weeks ago, visited Vet 1 to consult about testicle size. Couple consulted me yesterday as I had removed bladder stones from this dog in 2007!).

Dog groggy. I gave Antisedan to revive him. Overall, he was alive but I wanted him to be hospitalised as he had a 15-cm incision wound (will post pic later) after cutting off the sticky scrotum and base. If he went home and jumped about, the big hole will be hard to stitch again. The surgery is called SCROTAL ABLATION.

Other medical cases were the usual vaccination and not interesting to readers.


"What do you want me to do?" the 9-year-old girl pulled my hand. She was the intelligent one I mentioned in my writing sometime ago and I had asked the mother to send her to a better neighbourhood school. The mother said to me: "I have a client who is a teacher there. She tells me that the principal will need to interview and then there will be a test before admission. But my daughter does not want to go. So the teacher advised that it is better for my daughter to be happy where she is rather than be unhappy in a better school."

What kind of advice is that? I did not comment. Environment plays a big part in nuturing a child's academic performance. Many Singaporean parents go to great lengths, even renting a condo to be near a good school (2-km ruling gives advantage).

So, this girl had lost the opportunity to excell. Anyway, her mother saw her tugging my hand and said: "You can't do this. It is not good manners."

I said to the little girl: "I want to buy an exercise book. Can you buy for me from the bookshop nearby?"

"No bookshop. Must go to the school. Must cross road. So I can't go."

Her older brother of 10 years volunteered to buy for me. She has 4 siblings and she is No. 2 in age. Her friend Christobel was with her. So we went to the school.

The guard permitted me to enter.

1. Book shop closed. "What time does it close?" I asked. The children dashed inside the dentist's room. Why? There was a clock there. I went in the room after them. A dental nurse was shocked. It was past 4 pm. So the shop was closed.

2. Catching tadpoles. The big brother suddenly said: "Dr Sing, you pay $1.00 to buy a bottle of drink. I can use the bottle to catch the tadpoles (in the school pond). I took out $1.00 coin but the children did not want to buy. I saw a dustbin and got out a discarded water bottle for him. "Very dirty," the children refused to touch it as it was from the dustbin. "Just go to the bathroom to wash it," I said to the brother. He did it and used the cap to catch 2 tadpoles.

The little girl also wanted to catch tadpoles now.