Thursday, October 31, 2013

1142. Follow up on the Bichon - Nov 1, 2013

Friday Nov 1, 2013  2.49 am
I woke up at 2.49 am to check on the Bichon, housed in the back patio overnight. "In," I said several times before he would walk down the flight of 4 steps to the small grass patch. He looked at me again. No more urgency to urinate as in some days ago when he was closed indoors.

He did not stand like a statue and raise his right leg against the wall as in earlier nights. This means he has no more urination problems.

When I came back from home at 8.30 pm yesterday, he was in the living room and barked loudly again. I banned him into the kitchen area whenever he barked at anybody coming to the house. This is part of training over several months and is not 100% successful.

Yesterday there was the caregiver at home and so he did not urinate on the kitchen floor. No more urinary cathether. He is fed canned chicken gourmet food (Science Diet) and medicine to dissolve his stones. So far, so good.   

1141. A 16-year-old cat stops eating and hides from the family member yesterday

Oct 31, 2013

TP 43110

I treated this reddish brown Persian cat, 15 years old, emaciated at 1.7 kg on Jan 24, 2012 (2nd day of Chinese New Year). Temp at 38 deg C. Severely dehydrated, cysts on both sides of the tongue, drooling, mouth ulcers, black molars. Anaemic. She had been wandering outdoors and drank pond water. This cat needed grooming too. The mother did not want blood test.

"You said my cat will not live long," the mother told me today. "We fed her a few times a day and now she is still 22 months later! But she stopped eating yesterday and hides in a corner as if she is going to die. Do cats about to die behave this way? The other younger cat is now inactive too."

I asked the mother to send the cat in the afternoon instead of waiting till the evening.
Apparently the cat lost weight 2 weeks ago and is now 1.7 kg. But the rectal temp is low at 36.3C. Blood test was taken this time. No more cysts beside the tongue. Gums were pinker.  The mother did not want X-rays to check for abdominal tumours

At 7.30 pm, I had a long telephone chat with her on the cat management. Actually this cat had been drinking a lot of water and had been peeing a lot (3 areas of litter instead of usual 1 time. Yet on first consultation today, the daughter said No PD/PU to Dr Daniel who had examined the cat earlier as I was out.

I discovered the son's insisted Royal Canine Fit dry food had a protein % of 32%. Too much protein for a 16 year old cat.  Will this cat live? It is hard to predict. Wait for blood test results. 

Wednesday, October 30, 2013

1140. Follow up on Bichon with urinary stones - Oct 31, 2013

Oct 31, 2013  4.30 am
I checked on the Bichon. He was housed on the back patio with 4 steps down to access the garden. "In," I commanded him to get down the stairs to the grass to pee. He went down the stairs and looked at me. "In," I said again. He went to the grass but did not pee. After a while, he tried to poop by lowering his backside. This time, he did not have to rush to pee as when he was confined indoors as in the previous years.

Medical dissolution of triple phosphate stones using diet or acidifying medicine takes a lot of time and patience. The caregiver must know what to do. Yesterday, the caregiver went out the whole day and I had no time to go back during lunch. I had explained to her that the dog must be in the back patio whenever he is home alone. He should not be inside the living and dining area for the time being as he would dribble urine all over, owing to his urinary stone irritation of the bladder.

But the dog would sneak into the kitchen when the back kitchen door is open. The caregiver did not comply with my instructions and kept the door inside the kitchen with food and water. So the dog was home alone from 12 pm to 9 pm. When I came back, the whole kitchen floor was wet with urine. The dog had also peed vertically on the side of the fridge.

It is important to know what to do when treating such cases medically instead of doing surgery to remove the bladder stones. However caregivers and owners do ignore instructions as in this incident of urine-splattered kitchen floor.    

1139. Shih Tzu takes a long time to pee in the morning and passes blood at the end of peeing

Dr Daniel advised an X-ray for this 6-year-old male neutered Shih Tzu, much loved by his owner.
"He is the king in the apartment," she said. "He would bite me when I discipline my son and similarly will protect me when he thinks I am threatened by biting my son."
"He is fair and good protector," I said.

The X-rays showed stones in the bladder and at the bend of the urethra.
"What to do?" she asked. "My dog died under anaesthesia when I was a young girl and I do not want surgery."

Methods of treatment
1. Medically to acidify the urine and to dissolve the stones if they are struvites.
"How long does it take?" she asked.
"Ir the stones are small, it may take from one month onwards."

2. Surgery to remove the stones via the bladder. A syringe pumps normal saline to flush the urethral stones into the bladder.
"How long is the surgery?"
"Around 40 minutes."

Alkaline pH, amorphous phosphate crystals, blood +

The owner decided on surgery 5 days later. I advised 4 days of antibiotics to clear the bladder of infections.  Urine test will be done soon. 

Tuesday, October 29, 2013

1138. Follow up on the 14-year-old Maltese with "7 days to live".

Yesterday Oct 29, 2013, I was much surprised to find this Maltese still alive when I predicted "7 days to live" one month ago. The Maltese had great difficulty breathing and her abdomen was tense and swollen. There was this large orange-sized tumour in the front half of the abdomen and a balloon-like swelling of the abdomen. 

The young lady owner had come to me after Vet 1 had diagnosed a massive anterior abdominal tumour and the blood test had shown anaemia. She had recommended some pain killers and gave a poor prognosis. Her diagnosis was spot on as regards this massive tumour. It could be a spleen or liver tumour. However the liver enzymes in the blood test were normal. My prognosis of "7 days to live" was also grim. After treatment and drainage of the 20 ml of fresh blood from the abdomen, an iron injection and giving drips and heart disease medication, the dog went home.

Yet 30 days later, this old Maltese was alive. She no longer panted as she was on heart medication. "She would not eat by herself for the last 2 days," the young lady who came with her mother and brother said. "The gums are pink.The heart and lungs are OK.," I said after examination. "There is no abdominal swelling. The abdominal lump is as firm and as large as an orange and this may press onto the diaphragm, stomach and chest causing pain. Yet this Maltese did not feel any pain when I palpated the abdomen.The left kidney was enlarged to around 3 cm x 3 cm and there was no fluid at all. "The rectal temperature at 37.2 C is low," I said.

Under gas anaesthesia, I used a fine needle to aspirate 0.5 ml of blood from the edge of the tumour. After the drip and medication, the dog started to bark and was more active.

In this case, I did check on the IV drip which had stopped flowing for some reasons. Dr Daniel had inserted the IV catheter well with sticky elastoplast as there was still blood flowing out when he took out the blue bandage wrapping the tubing. My assistant had flushed saline to clear the blockage 3 times but I could still see blood at the one end of the catheter indicating there was no IV drip flow.
After checking, the IV drip flowed and so the dog had his glucose and salts and hence was feeling well to bark.

Surprisingly the body weight was 3.4 kg, about 0.1 kg more than 30 days ago. I advised the lady owner to hand feed the food as well as the medication and prescribed pain-killers this time. I got a blood test done. To save money for the family, I did not ask for another X-ray or ultrasound. The mother was surprised that the dog had a large abdominal tumour the size of an orange when I spoke to her as well. The daughter had not told her. 

1137. Abandonment of a German Shepherd

For the last 3 days, the man who brought in a German Shepherd for "de-ticking" would not respond to my phone calls.  In the first day, he said he would be coming. His brother said the father's car had been involved in an accident and was toured away and asked for my bank account to pay for de-ticking. I asked him to come to the Surgery and he said he would in 15 minutes. He did not turn up nor did his brother phoned up about the dog. On the 2nd day, I sms his brother to say I would report him for abandoment of the dog. He texted back to say "Busy at work. On the way." But he did not turn up. Today is the 4th day.

This seems to be an abandoment of a young German Shepherd. The brothers had told me that they want the dog but behaved differently without a concern about his well being. The father was against this dog. Dr Daniel has arranged for new homes.  

1136. Follow up on Bichon Frise Wed Oct 30, 2013

Wed Oct 30, 2013

At 5.30 am, I woke up and checked on the Bichon. This time the caregiver complied with my instructions to let him sleep in the sheltered area outside the kitchen so that he has access to the grass to pee anytime. He would be taken to the grass at other times in the day. This morning, he had no need to rush to the grass. I said "In" which is a command to move "forward" to any place I wanted him to. He has this habit of barking loudly whenever anyone comes to the front door as he positions himself in the living room. It is good but as some family members come home at 3 am, his loud barking disturbed my sleep. Whenever he barks in this way, I will get up and train him by depriving him of the privillege of being in the living room. He would have to go to the kitchen and stay there whenever he barks in this way in my presence. My family members do not adopt this method of training and so he is 70% trained. Yesterday when I came back in the afternoon, he barked again.

In medical dissolution of the struvite stones, the Bichon must also have access to the grass to pee and that is why he cannot stay indoors. We lock our front and back doors to prevent burglaries and so the dog will not pee for more than 10 hours per day till he is let l oose  outdoors to the grass.   

For the past 7 years, he lived indoors and would hold his bladder till it is full and go to the grass in the evenings once a day. This is quite common for dogs as they don't want to soil the inside of the house or apartment and are not paper trained. Urine stasis leads to urinary stone formation in this Bichon as he was fed mainly dry dog food and given treats by family members daily. He prefers to be indoors and so would not pee till brought to the grass outdoors. Sometimes after work past 8 pm, I would take him to the grass. His usual habit would be to raise his right leg and urine marked the lamp-post and other places. A few drops of urine here and there peed out within a second or two.    

This morning at 5.30 am, after complying with my "In" command, he gave up thoughts of coming into the house and walked down the steps to the back garden grass. He stood like a while looking at me and then raised his right hind leg and stood like a statute.

I counted "1, 2, 3......." till he stopped peeing by putting down his right leg. Today, he took just 13 seconds approximately. His urinary catheter was removed by Dr Daniel yesterday evening as it is not advisable to put it in for more than 2 days to prevent bladder infection. He is still under medical treatment as an alternative to bladder stone surgery and so he must be allowed access to the grass at least 3  times per day nowadays. The caregiver is the one who must be trained to understand the rationale of ths need to access the grass to pass out any crystals dissolved by special diet. As for today's observation, it seems he can pass urine much faster than yesterday 2.30 am at around 55 seconds from raising to lowering of his right leg.

There needs to be a lot of work to get this dog to pee and the responsibility is great.     

Monday, October 28, 2013

1135. Travel story. Purchase of a How-To You Tube book in New York

On my last day at New York, I did not want to go to the top floor of Rockerfeller Centre where I can see the panaromic view of the city at "The Rock". I had only 2 hours before going to the airport to go back to Singapore. So I took off to Barnes and Nobles nearby. It is a small 2-level store with basement and does not sell veterinary books or even "The Pill Book for the Dog and Cat owner".The employee checked her computer and said that she would order from Ohio. I had bought "The Pill Book" for human beings earlier at a supermarket where the tour guide took us to. There was "Medi-Sleep" which he recommended for those who can't sleep. It contains 50 mg diphenylhydramine which is for cough mixture.

I had no time to visit another Barnes and Noble 30 blocks away which was half an hour's walk. I bought a "How to You Tube book" and went back to the tour group at 4.30 pm to go to the airport for home to Singapore.  It is a pity that I did not know the Public Library of New York is at 5th Avenue too and so did not visit it. The tour group leader was giving what the Singaporean tourists want - the malls of 5th Avenue and said nothing about the book stores or libraries. So we all went on our materialistic ways to one side of 5th Avenue where the upscale shops are. The other side is where the bookstores and Public Library are and the tour guide did not mention this. He simply stated that the other side had no upscale shops.  It is like Ion Shopping Centre in Singapore's Orchard Road with upscale shops. Don't go to Plaza Singapura side as the tourists will see "nothing" of interest. The National Library will be at that dull side.        

1134. Follow up on Bichon Frise at 2.30 am. 55 seconds to complete peeing

Monday Oct 29, 2013

At 2.30 am, I woke up. I took the Bichon to the grass as that is his usual elimination area. He has a urinary catheter bandaged since 2 days ago, on Sat evening.

He stood, raised his right hind limb while balancing on3 legs. I counted 55 seconds before he put down his right hind leg indicating he had peed.

He will not pee indoors and will hold his urine for around 12 hours till he is ler outdoors. Urine stasis encourage crystal deposits and infrection as in people, leading to UTI and stone formation.
He does not pee on newspapers or pee tray and so he had been holding onto the urine for the past 7 years. When he goes to the grass, he will urine mark a few spots, esp. the lamp post although he had been neutered as a young dog.

Therefore, the lifestyle of the male dog - holding back urine to urine mark, leads to stone formation and UTI.

Sunday, October 27, 2013

1133. Follow up on Bichon Frise Oct 27, 2013

Oct 27, 2013 was a Sunday. In the early morning, I got the Bichon Frise to go to the grass. I noted that the Bichon Frise whose urinary catheter was taken out the previous evening, strained but no urine came out. His bladder was distended about the size of 2 golf balls. He was given canned S/D diet but would not eat it. Many dogs don't eat it. The trick is to give 90% of canned A/D and 10% of S/D initially if this happens, increasing daily to 100% of S/D. But few owners comply with such instructions and would not bother.

In the evening after I returned from the Jurong Bird Park dinner hosted by the SVA till 11 pm, Dr Daniel had just taken the dog to Toa Payoh Vets to irrigate his bladder under sedation. A urinary cathether was used to flush out the bladder. "I used a bigger catheter," he said. "There was no urethral obstruction. There are only two stones and he gets obstructed again."

"From the X-ray, the urethral stone is the one causing the problem. It is small, about 3 mm across and will lodge inside the urethra near the bladder, causing difficulty in urination. When you used the small cathether, it by-passed this urethra but did not dislodge it, as evident from its presence in the X-ray."

October 28, 2013
At 6 am, I got the Bichon to the grass. He stood a long time like a statue trying to pee. He had the urinary catheter bandaged and wrapped around his waist. After a while, he went indoors and ate only the canned A/D food. "Given 10% of S/D mixed with A/D 90% until he eats all S/D," I advised the caregiver. The canned S/D was offered in full and was discarded for the past 2 days as the caregiver said the dog would not eat it.


1. No stones were recovered for analysis as no surgery was done.
2. Uro-hydropropulsion using catheter and syringe did not recover the small stones.
3. CATHETER-ASSISTED RETRIEVAL OF STONES. The bigger urinary catheter was used yesterday to irrigate and flush out the stones using normal saline. The recommended saline infusion is 4 ml/kg bodyweight so as not to overdistend the bladder. The bigger urinary catheter may need to be slit open at one end to permit that small stone to be aspirated out.

The diameter of the hole at the end of the catheter should be around 5 mm. This is easier said than done. The aspirated saline into the glass cup should be checked for the stone which can be retrieved for analysis.
As this dog is not my patient and each vet has his or her own way of treatment, the point No. 3 regarding enlargement of the "eye" of the end catheter is my opinion.

This dog has only two stones (triple phosphate) and high alkaline urine, with bacteria 2+. It is the smaller urethral stone that causes difficulty in urination due to obstruction. Some reports claim* that it takes 2 weeks to dissolve struvite stones medically in immature dogs. It is hard to say as the stone may not be just triple phosphate crystals and no actual stone is available for analysis. This case will be monitored closely for medical treatment without surgery.

Reference: Small Animal Clinical Nutrition   Hand, Thatcher, Remillard, Roudesbush, Novotny 5th Edition, Pg 830-831.

5. Medical dissolution using acidifiers rather than S/D diet may be used for 4 weeks but it is better to use S/D diet for 4 weeks.
6. Bacterial infection of the bladder (UTI) to be treated.

7. Urinalysis to be done weekly.


Saturday, October 26, 2013

1132. Follow up: Bichon Frise has difficulty peeing once catheter is taken out

I observed the 7-year-old Bichon has great difficulty peeing this morning and kept licking his lips.
From the X-ray, the stone has lodged and obstructed the urethra once the catheter is taken out. So, an op is necessary. No point trying to acidify the urine and dissolve the struvite stones which can be done if there is no obstruction.

The dog seems to be losing weight. I am worried that the kidneys would be affected. Dr Daniel has scheduled tomorrow for surgery.

The X-ray did not show clearly the stone in the urethra. The other young vet who took the X-ray said there was one and I could see it too. It was faint and not radio-op on the lateral view. None seen on the V/D view. So, Dr Daniel was not fully convinced.

"Is there difficulty in passing the cattheter?" I asked.
"Yes," he said.
"So, there would be the stone inside the urethra before the bend," I postulated   

1131. Earn more when you have your own vet practice?

I had this comment with a young vet when I asked if she would be opening her own practice.
"You earn more when you have your own practice," she said.
"This is not correct," I said. "There are over 60 practices in Singapore. Unless you have no nearby competitors in the housing board estate as in Woodlands, you will not generate income. With investments and equipment and overheads, you will lose money!"

Vet students are never taught the economics of practices in the Vet School and so they have no idea of depreciation of equipment and other costs which make suck in the expenses, leading to low net profits or even losses. More than one practice has just closed down.

1130. Retained abdominal testicle in cats

I seldom see such cases. It appeared to be common when I spoke to two young vets at other practices.

1. Vet 1 has many stray cats brought in for sterilisation by activists. "Very common," she said. "Do you hook out the testicle inside the abdomen" I asked.
"No, the vas deferens may be ruptured."

2. Vet 2 saw her 2nd case as she consulted me.. 
"Just open up the abdomen and the smaller retained testicle is lying near the bladder area," I said.
"I watched a video where a hook is used to pull out the testicle," she told me.
"It is theoretically possible as in a spay, but I have not done it."
"How many cats have you seen?"
"This is the 2nd one."
"What did you do for the first one?" I asked.
"It was rejected as my senior vet asked me not to do it."
"Are you sure it is not the same cat?" I asked as I thought this was a rare condition in cats.
"It was a domestic shorthair and the present one is a Persian."
I would like to video this case if possible.

1129. TIPS - LONGER LIVES FOR PETS - Delayed treatments

It is best to seek prompt treatment for your pets when they have small tumours or swellings as their health deteriorates when there is delay in treatments or seek treatments from other vets as illustrated in the following cases:

Case 1. Syrian hamster with a massively swollen right hind limb showing only toes much bigger than her head. Abandoned in a bottle with wood shavings. The old mother and son brought the hamster for consultation.

"Very slim chance of survival as removal of the whole right hind limb to the hip level - amputation involved a big loss of blood. The hamster is likely to die on the op table." The mum was very sad as the hamster was eating and adorable. "Spend a few days with her," I said. "This operation has very slim chances of survival."

"Is there other ways?" the son asked.
"No medication will resolve this problem. The leg is becoming gangrenously black."
The man left without the surgery.

Case 2. Rabbit with left upper jaw abscess below the left eye. Thick pus clog the left nostril when I started to dig and clear the pus. 

"The other vet did some test and said the rabbit was not fit for surgery. So we cleared the pus. But in the last 2 weeks, she became very thin, though she is eating."

"It is likely that the rabbit is poisoned by the bacterial toxins inside the jaw abscess. The thick creamy pus flowed into the nose and got breathed into the lungs. That is why the rabbit cannot breathe normally."

I got the pus dug out from the jaw abscess. Some rotten pieces of teeth were extracted out too and the big hole thoroughly flushed. The thick pus inside the left nostril was cleared when it seeped out later.
I took an image to educate and show the owner the presenting pus in the left nostril when she came for the rabbit.
"You don't need anaesthesia?" the lady asked me later.
"The rabbit is so weak and is at death's door. So, she did not respond much to pain."
In this case the rabbit was alive and went home to intensive nursing.

The first vet had said that the rabbit was not fit for anaesthesia and would die. So the owner did self treatment which was ineffective. The jaw abscess is usually a curable condition esp. when in its early stages and the rabbit is strong but it requires veterinary treatment rather than home treatment to suck out the thick pus.

Case 3. Dwarf hamster 2.5 years old, male with big chin tumour. "The hamster is at the end of life. He is so thin although he can eat. The chin tumour 8 mm x 8 mm involved the lower lip. So, it is not possible for the hamster to eat normally after excision of such a large area. No surgery was done.

Case 4. However Case 3 has a daughter of one year. On her right side, the skin ballooned out softly. "It is one sided," I said and so it may be a cyst.
The owner was warned of high anaesthetic risk as the hamster was very thin but young. "She is not fit for anaesthesia," I said. However the wife decided on surgery. The hamster bit anyone who touched her and was not moving much although she ate. "She looked fat," the wife said. In the op room, the whole swelling ruptured spilling over 20 ml of unclotted blood. A haematoma. The hamster was barely breathing one hour later. "Chances of survival are very slim," I warned the father and wife and 2 young daughters. . "There is a big loss of blood. Where it came from, is a mystery. Probably some ruptured big blood vessel."  The hamster was not active and the breathing movements were barely visible when the owner brought her home. Usually the hamster is awake and running 30 minutes after anaesthesia and surgery.  

Friday, October 25, 2013

The vet's bichon frise has difficulty in urination


1.  Timeline

A bichon frise puppy was purchased by a young vet student studying in Murdoch University
5 years of stay in Perth. Dry food convenient.

SINGAPORE. Back. Now the young vet student has graduated. 
Dry dog food. Lots of treats from family members. Go outdoors in the evening and mornings. urine marking.

2013 October. 22.  Cannot pee. Obstructed

Oct 25, 2013 video
Bichon frise, male, neutered, 7 years
difficulty in peeing
obstruction of urethra - vet catherised and bandaged to hold cathether. E-collar to prevent the dog from pulling the catheter out.

Lateral view shows two urinary stones. Kidneys OK.
Ventral dorsal view - no stones visible
Syringed 20 ml air into bladder via catheter.
Different vets have their own views for and against this procedure. Pumping air may cause bacterial infection of the bladder and so two vets I spoke to don't want to do it.

My view is that air contrast radiography is useful to show bladder wall tumours as this is an older dog. Urine of this dog has bacteria. Antibiotic is given


Any breed of dog can be affected but the following breeds are likely to be affected

Urinalysis   pH alkaline  bacteria +    triple phosphate crystals

1127. My Jack Russell has a "fistula" - oro-chin fistulas?

Friday Oct 25, 2013

As there was no need for 2 vets on this Friday evening, I asked Dr Daniel to brief his client about the treatment and medication and to go home early at around 7.15 pm. We close at 8 pm. One of his clients came in a white Mercedes at around 7.45 pm to pick up his Jack Russell that had dental scaling.

I thought it was an ordinary case of dental scaling. He pointed to an open wound of around 8 mm x68 mm on the right lower jaw below the right lower premolar tooth.

"I was so happy when I saw similar cases of fistulas in your website," he pointed to this sore. "Now I know that my Jack Russell has a fistula".

"Why do you say that?" I doubted he knows what a fistula is but many Singapore dog owners are much more knowledgeable and informed nowadays.

"This wound has pus. It takes a long time to heal. It disappears and then appears. I have 6 Jack Russells and only this one has the problem. Sometimes the wound appears on the left side and also in the back side."
"Are you sure it is not due to a dog bite or self-inflicted scratching from the paws?"
"No, I am sure of that. My two female Jack Russells do fight with each other. Over him, I suppose."
"Do you have a video camera switched on 24 hours to monitor them since you are frequently overseas on business?"
"I am sure the sore is a fistula, as in your cases. I have consulted two other vets in the past 4 years but the sores below the side come back now and then. Now, it is the right side. It is a fistula!"
"What did the other vets recommend?" I asked.
"They said nothing is wrong and prescribe some mouth wash. But it is a fistula!"

I was skeptical.
But vet medicine is full of surprises. An oro-chin fistula is possible in theory.
"I have not seen fisulas on the lower jaw," I replied. "Almost 100% are from the upper jaw below the eye! They are oro-nasal fistulas. But it is possible."
I asked if the dog bites and since he appeared docile, I opened the mouth to examine the white teeth scaled by Dr Daniel in the afternoon.  The teeth were sound in this 6-year-old dog. Except for 4 canine teeth which had decayed brown as their sharp tips had been cut off by somebody to prevent this Jack Russell from inflicting deep bite wounds on family members. This was done some 5 years ago.
Decay had set inside the four canine teeth. The lower right had a cracked side of 3 mm x 2 mm brown exposed dentine.

It is just possible that the infection had gone inside the pulp cavity of the lower canines and into the side of the gums. I asked my assistant Naing to flash his phone light onto the right lower gum. There was a small hole with blood. This hole was 3 mm x 2 mm and was bleeding.
"Check the other left lower gum as well," I said to Naing. "This is for comparison."
There was also a much smaller hole also below the first lower premolar. So, it is possible that infection had gone into the roots and seeped out through the gums laterally.

The owner would return 10 days later and get X-rays done. He was a busy man in his 50s but he loves the dog very much and is confidently sure he has a fistula! An oro-chin fistula due to decay in the fractured canine. Their pulp cavity in the long root became infected and the bacterial infection seeped downwards to the tip of the roots over the last 4 years. The infection leaked out from the long root and into the skin causing open sores with pus.

It is a hypothesis. The treatment is to extract the whole planed canine teeth of the left and right and there should be no oro-chin fistulas. Does it sound logical to readers?  .


1126. Protected by "Ah Pek"

On my return to Singapore on Oct 24, 2013, after a tiring 14-day packaged tour to visit the Niagara Falls and New York, my first client was the man who believes in "Ah Pek".  He parked his shiny blue car and came in to buy the 2nd bag of H/D dry food for his 10-year-old Chihuahua with heart disease.

"How's the old dog?" I asked.
"Much more active and energetic," he had given the furosemide tablets regularly nowadays.
He had just returned from Thailand and had donated some money for 30 coffins for the poor. I introduced him to Dr Daniel to open his mind. I asked him to relate his personal stories of "Ah Pek", such stories being unbelievable as compared to hard science, facts and empirical evidence of training of Dr Daniel. I had written some of his encounters in an earlier report.

He was an excellent story teller using hands to illustrate and Hokkien slangs to emphasize his experiences and spoke for over 15 minutes. I doubt Dr Daniel believed in his testimonials of being protected by "Ah Pek" and so I switched his focus to talking about Porsches, Maseratis, Lamborghinis, Ferraris and BMWs, a subject of interest to young men particularly. This was his niche as he was into advising rich car owners who want to buy those sports cars, boost them, modify them and race them in Johor. He was a sports car consultant as he had in-depth knowledge and was owning one Japanese brand modified to give off those "voom" sounds from the exhaust pipe and attracting LTA and Traffic Police cops on bikes.

There were 2 instances when the green paper given by his medium protected him. He would have to burn the paper, mix the ashes with water and drink it.
1. After a severe bike accident in Bugis in which his forehead hit the road, his doctor had told him that his head needed to be opened up to access and repair his fractured facial bones below both his eyes. He asked his friend to consult the medium and was given the green paper with its chops and was asked to drink the ashes.
"Bro," he said to Dr Daniel. "In the early hours of the morning on the day of the surgery, I was asleep in the hospital. I heard loud foot-steps outside my room, as if there was dragging of chains. I closed my eyes tightly and prayed that my brain would not be opened up for the surgery. After the surgery, the doctor told me that I did not need my forehead to be cut open and my facial fractures were repaired!"
Since he was normal now, I don't know whether Dr Daniel was skeptical or believed in him.
"Bro," he said to Dr Daniel. "My chest was injured and I was coughing blood often. After drinking the green paper ashes, there was no more blood. Just unbelievable." We did not comment. It is hard for Singapore mediums to validate and have great credentials as there is no research done unlike some counterparts in the Western world as in an example of Debra Martin at

2. The other instance where the green paper ashes protected him was when he passed the driving test despite hitting the kerb. In Singapore, hitting the kerb means instant failure."
"Why?" I asked as I took my driving lessons and tests in the UK.
"f you hit the kerb, that eans you can kill people too!"

"Bro," he said to Dr Daniel. "The medium had told me that I would pass the test and now I hit the kerb. The instructor stopped the car and had some discussions with someone. Get on with it and tell me I have failed instead! I want to rush out to book another test. The instructor returned and said I should continue driving and passed me."

I doubted Dr Daniel believe his "Ah Pek" story although he did not say anything. Communication with the spirit world is extremely hard for many to believe. He seemed quite consistent in his recounting of his accident experiences with "Ah Pek" I had written some time ago.
The one instant he narrated about "Ah Pek" protecting him from being caught for speeding at Mandai Road was incredible.
"Bro," he said to Dr Daniel.
"Do you know the stretch of Mandai Road where it goes uphill? When your car speeds and goes downhill, the traffic cops would point their speed meter and book you as you can't see them!"
"How does Ah Pek help?" I asked.
"My heart became hotter and hotter and so I slowed down. The cops were downhill!"   

My report does not do justification for his narration, his tones, gestures and use of Hokkien slangs to emphasize the points. His stories of survival from accidents are just incredible, as if there is a guardian angel healing him fast. Many of such incidents have no scientific explanations.  




1125. Listing of vet clinics on the SVA webpage

Oct 26, 2013
I am Dr Sing Kong Yuen from Toa Payoh Vets.

If it is not too late, please bring up the subject of "Veterinary clinic" listings in the SVA webpage under AOB at the AGM tomorrow.
As at Oct 26, 2013, there are 11 clinics listed out of a estimated 60 licensed practices in Singapore. 1/11 has closed down. I know it is extremely difficult to provide updated information on veterinary clinics. I believe there are some criteria that must be met before a clinic is listed on the website but I cannot find this information today as I visit the webpage.
Is it possible for the SVA to find another way of providing a more comprehensive list of clinics to the members of the public? Members at the AGM or of SVA may be asked to provide feedback. This is the reason I ask for the matter to be discussed under AOB at the AGM tomorrow.
Best wishes.    
Dr Sing Kong Yuen

1124. Blood transfusion in dogs


Dear ToaPoyahVets,

My dog has contracted Babesiosis and her HCT is only 15%. The vets that I went to recommended to perform a blood transfusion for her. (I went to 2 different clinics to confirm her illness.) However, she is blood type of DEA 1.1 negative, which I had difficulty finding. Most donors are positive. Vet 1 said there would be any severe problems for first timers if both are of different blood type. Vet 2 advised me not to as negative and positive will cause more problems. I would like to seek your opinion regarding this matter. I would greatly appreciate any feedback you have.

Thank you and sorry for any inconvenience caused. 
I am Dr Sing Kong Yuen from Toa Payoh Vets. I apologise for not being able to give you advices as I don't perform blood transfusion in dogs. 

Monday, October 21, 2013

DoubleTree Hilton Somerset New Jersey
Rm 376

 The coach took around 2 hours to go to New York's downtown as the hotel was in New Jersey.

Last of 3rd day to visit New York was Oct 23, 2013

Visited Times Square and had a good lunch there at Bubba Gum.  Good service Walking tour to see the financial district including Wall Street & Stock Exchanges and the new World Trade Centre building. No time to visit Barnes & Noble on 18th at 5th Avenue (text books) but saw another one and bought a You Tube How to book.

Back to Singapore on Oct 24, 2013 at 6.57 am and back to work.

Tiring journey. I wasted one whole morning and afternoon at the Factory Outlet but the ladies were all for it. I should have visited the Barnes & Noble bookshops in 5th Ave and the Public Library. None of the 35 tourists from Singapore would be interested. 

Sunday, October 20, 2013

1122. An 87-year-old woman at DoubleTree by Hilton, Somerset, New Jersey

Oct 20, 2013

Had breakfast at DoubleTree by Hilton. The white haired slim woman Flo is 87 years old, no need for drugs, can walk and talk normally. Hearing aid and new eyes. Incredibly healthy.

Saturday, October 19, 2013

Embezzlement tales

Travelling broadens your mind if you do talk to the others or listen to stories of experiences. For example, tales of embezzlement are:

1.  The partner of this Chinese Restaurant was sacked for dipping his hand into the cash register. He opened a restaurant down the road. Our tour guide switched to him. "He actually told you he stole money from his partners' business?" I asked him as he was narrating this story to us. "The previous place will close down soon."

Heavy reliance on a working partner who embezzles is what happens to most businesses. Best to keep your own money and not invest if you are not working or having a proper accounting system. Even then, the partner can still take cash without giving receipts.

2.  I met a 60-year-old American sales person at the Williamsport's Wegans. He was friendly and I asked why he still worked as a retiree. He told me he had to work because the stock broker embezzled all his savings. "How much?" I asked. him. "$250,000".  He was a medic during the Vietnam War but he was posted to Korea. "Many medics were killed," he told me. Yet he was killed by embezzlement in his autumn years. He did blame President Bush for some reasons I did not ask.
Many Singaporeans have lost money in shares of well known branded US companies.

So, it is hard for the common man to place his savings in stocks and shares, hoping to beat inflation. Property bubbles are also not safe for the younger ones. 

3. A Singapore vet started a practice in China. His groomer and probably others "embezzled" and he had to close the practice.

1120. Smithsonian National Museum of Natural History - science, facts & evidence

Oct 19, 2013
Hilton Gaithersburg  Rm 316, 6.05 am

Yesterday, I visited The Smithsonian National Museum of Natural History. Evolution of man and animals is detailed and much interesting. The Earth is around 3 billion years old, Man is around 3 million years old from evolution. The racehorse evolved from earlier ones with shorter molars.
Climate changes and disasters led to new species.

Hard Science, facts and evidence are presented. So, is there a Creator of life? A Destroyer of life?

Friday, October 18, 2013

1199. Two white cats for adoption by owner

Contact Dr Sing, 9668 6469 if interested. The owner posted the following info:.

1198. Wegman's lessons

Williamsport, Pennsylvannia

I have not known about Wegmans. Wal Mart is global and I know of its existence. Wegmans in Williamsport, Pennsylvannia is a huge market with food 3x much bigger than any in Singapore. Source locally and supports local produces.  3 children take over the business. It is said to be a 3rd largest and expanding to a 2-storey building in New York, according to one employee selling grapes and apples.

Founder at entrance

Retiree works 4 days/week

Two marketing lessons from this successful businesses are:

1. Charge buffet food by the weight rather than by person. Probably makes more money as people eats more. My tour guide narrated that once had to pay much more out of his pocket as he treated the coach driver to a buffet lunch at Wegmans over his budgetted expenses. The American driver ate a lot and incurred a large cost for him as food is payable by weight, not by person.  Increased expenses for a travel agency by the tour guide mean reduced net profits and so the guide had to pay for his mistake, not the company.

2. Thermal paper to print out the receipt instead of an A4 paper. It is much faster, saves money and save more trees from being cut to make paper. An expense item e.g. one bottle of shampoo is printed in an A4 paper is a waste of resources and money when printed in some vet practices.

Seen on the road, a Wegmans' truck  2-in-1 container saves transport cost

1197. Niagara Falls. Living life to the edge

It is not easy to live to a ripe old age, with diseases, cancers and accidents happening anytime. 

It is part of the character for some young people. They want to live life to the edge, taking great risks like standing on the edge of a parapet wall to dare the Gods.

Wednesday, October 16, 2013

1196. Travel stories from Montreal

Oct 16, 2013
Delta East Toronto Hotel Rm 303

Will be going to the Niagara Falls today. Left Sheraton Hotel near Montreal Airport yesterday after staying 2 nights.
For one 60-year-old widow, it was 2 nights of pain as she had to walk at least 200 strides to the receptionist to and fro. The 200 strides are mine with full leg extension. My room is around 180 strides.  It was most stressful for her and we cursed the agent for not being caring. But he was also unaware and offered to change the room the next night. I noticed that packaged tour companies who don't know how to negotiate, get the ground-floor rooms for their Singapore guests, facing the highway or road level.

"I will not live long," the disabled traveller told me. Her SGH specialist had told her that her knee pain is due to old age. So she took many Pannadols up to 8 per day. Her right eye popped out 7 years ago when she fell and she was blind for 25 days. The right eye had a corneal transplant and she had to take cyclosporin tablets twice a day for the past 7 years  

1000 Islands homes for the film stars

Nearest to the USA. Most popular with the mega rich.