921. The vet's suture protruded the skin - Good stitching patterns count.

921. The vet's suture protruded the skin - Good stitching patterns count.

Two days ago, two ladies and their father brought a 17-year-old cat to the Surgery. The cat had been pawing her neck trying to get rid of a nodule 1 cm x 1 cm. Dr Daniel handled the case. The over 70-year-old slim built father was at the waiting room and I was at the reception and since he was chatty, I had an interesting conversation with him.

"Why do you not go to the vet nearby your house?" the father mentioned that he lived near a vet. However, his daughter did not want to consult this vet.

"The vet spayed this cat. But the cut was very long," he said. "The skin protruded from the stitches. So my daughter did not want to go there."

"Standard spay wounds are around 2 cm long," I said. "Unless there are complications of bleeding or other reasons such as pyometra."

In this case, I did not know what had happened. This is one of the times that a neat and good stitching pattern does impress and count in retaining client loyalty. And this was 17 years ago when the daughter would be in her teens. This daughter-in-charge looked to be in her earlier 30s and was in the IT field, according to the father. So, the internet brought her to Toa Payoh Vets, according to the father. The internet is a double-edged sword and could drive clients away when there are bad reviews from one or two vocal unhappy owners or competitors.

Well, the 17-year-old cat had this irritating neck nodule (1 cm x 1 cm) that she scratched. Dr Daniel's advice of a blood test prior to surgery was accepted by the IT daughter. Serum urea and creatinine levels were above normal and though the cat was normal, the daughter was not in favour of surgery.

"This cat has white strong teeth," Dr Daniel told me. "Can this cat be younger?"
"Very rare for a 17-year-old cat to have good teeth," I said. "But many cat owners do know the age of their cats."

As the father was complaining about a specialist earlier, I asked him what was the problem. "The specialist told me what was the big fuss I was making about my health since the brain scan showed no brain tumours? Why would I pay for a brain scan?"

Sometimes, it is best for a doctor or vet not to comment on personal behaviour but stick to the medical facts.

"What's exactly happened to your father's eye?" I asked the IT daughter later as her father did not speak English but the Hokkien dialect. The daughter put her fore-finger on the lateral side of her left eye and pulled up the eyelid at 45 degrees. "His eyelid flicked sideways and upwards now and then."

"The specialist said he had no problem in the brain MRI," I said. "That may be because the problem could be somewhere between the eyeball and the brain!"

"We are not refined cultured people like the specialist," the father was still mad about the poor bedside manners of this specialist.

Yet he does have a real medical problem. Earlier he had a hard lump below his left eye but this lump had disappeared.

So, what was he suffering from? He had no diabetes, no hypertension and was not obese.

"He does have a medical problem," I told the IT daughter to do an internet search of nerve pathways between the eyeball and the brain. "It is likely that a small tumour had impinged onto the nerve in this pathway. It irritates the nerve and the left eye's upper eyelid twitches suddenly, pulling up the eyelid."

It must be embarrassing for the father when that happened.

"It is best to consult a good neurologist or eye specialist." I said. "The problem is to find that particular one in Singapore. It is extremely hard to find one with the experience with this problem."

I had a similar sudden flicking up of my middle finger of my left hand two years ago. It would flick up now and then. Finally I had a non-malignant nerve tumour behind my wrist excised and the problem disappeared. So, I could empathise with this senior citizen. It was no laughing matter for him. And he does have a medical problem. "Only that the particular specialist he consulted could not diagnose this problem!"

Life is hard for senior citizens when twitches and spasms of eyelids are not diagnosed and removed. A trigger finger is not so obvious to outsiders but a twitching upper eyelid could be most embarrassing when it occurs during a conversation with somebody. I hope this IT daughter will find the correct specialist - neurologist or Ear Nose and Throat surgeon probably, I advised her. If anybody can do it, it will be this IT daughter, but would she have the time to do it? I had pointed the direction to her. It is up to her to be diligent to find out the correct specialist to pin-point the tumour affecting the father's eyelid before it grows immensely.