Tuesday, December 31, 2013

1283. A cat with bald flanks, belly and tail

Dec 31, 2013

Last case of 2013.
I had operated on this 8-year-old cat that had a bladder stone. Now she comes to me with a bald tail, side flanks and belly.
"After your bladder stone operation, the belly area never produce hairs!" the gentleman told me as I advised clipping the cat bald as she had too many fur mites irritating her. The owner decided to take the Samsung smartphone video of this mite under the microscope.
"The whole tail is bald," I am surprised. "This could be due to the anal sac infections." I pulled up the tail and some light brown oil was expressed by the fingers releasing the oil. The cat turned his head and hissed at me

"The bald belly area will be due to the cat's continual licking daily," I said. "So no hairs can grow. As for both flanks being bald, this could be due to a hormonal imbalance condition called bilateral endocrine alopecia. Only that, the tail is not balding in such conditions."

As I looked closed at the upper neck area, there were specks of 3mm x 3 mm seen. Some specks were alive and kicking. So there were fur mites. The
What is the treatment for this cat?

An insecticidal wash in a bath tub after clipping off the contaminated coat.
"What if the hairs don't grow after clipping?" the owner asked.
So I dared not clip off the whole coat. I would sedate the cat and bathe him. The owner will need to decontaminate his big cage and the whole room. As to the source of the mites, the cat loves to lie down on cardboard boxes from China, stored in the room. This cat does not go out of the house or go boarding kennels.

"I live on the 17th floor and no stray cats ever visit him," the gentleman snapped video of the moving mite. Did the fur mites cause hair loss so extensively? What species are they? I need to identify them by doing some research.   

I took a video of the species for further research. 6.40 pm Dec 31, 2013. Will close shop to celebrate New Year.

1282. Urethral obstruction in a young male dog

Monday Dec 31, 2013

Last day of 2013.  The old cat with difficulty in urination and treated by Dr Daniel who had flown off to HongKong today is more lively (Blog 1281).

Suddenly an older Indian owner of a 3-year-old male Jack Russell that could not pee came into the Surgery. He had been boarded a few days ago as is the case with Blog 1281's old cat. Now he could not pee.

A 2nd case of urethral obstruction but in a dog. Same procedure.  Owner permitted X-rays and blood test. I got 20 ml of air pumped into the bladder. No radio-dense stones are seen. "Some stones are not seen on X-rays," the short and slim nurse at the vet practice reminded me.

Blood test and urine test are done. 

Monday, December 30, 2013

1281. Urethral obstruction in an old male cat

Rex, male, neutered cat, 11 years. Usually inactive, plump at 8.1 kg. Only active when given treats.
When young kitten, not active. Grouchy towards other cats.

Ate dry food since young

Boarded 6 days. On lst day home, went to cat litter, not much urine seen.
On 2nd day, did not want to eat treats or wet food. Recently tends to eat less dry food.

For next 3 days cannot pee. lethargic, anorexic.

Dec 29, 2013  See Toa Payoh Vets. Mango-sized bladder palpated.
Urethral obstruction first time, after boarding for 6 days  -- FLUTD. Change of environment.
Had not been to boarding for the last 5 years except recently.

Blood test - urea and creatinine very high    urea 119.0 (7-11), creatinine 2321 (71-160).
                 - glucose high     11.8 (3.9-6.0)
                 - total white cell count and neutrophils high, platelets low.

Urine test - glucose negative.
                - bacteria +, protein +, blood +, crystals nil, white blood cells 15, red blood cells >2250,

Dr Daniel had to sedate the old cat called Rex to insert the IV drip and take blood from the jugular vein. With the IV drip and medication, the cat responded well the next day. He sedated  the cat, flush open the urethra, sucked out the urine, irrigated the bladder (Intern Clara to insert video clip - VIDEO 1) 

Both cats were boarded but the 2-year-old male neutered cat is OK.

Dec 31, 2013 is day 3. The owners ( a lady and gentleman in their late 30s) came today. The cat greeted them and her eyes were bright and alert. The
owners commented on the brightness of the eyes (I took an image and video (VIDEO 2),4 pm Dec 31, 2013).

Since the cat was eating,drinking, pooping and peeing as normal
before boarding, this problem would have been avoided if the old cat was not boarded. The couple had to go overseas and the mother could not take care of two cats - this old Rex and the young cat. So both were boarded.

Rex will be warded for 3 more days for antibiotic injections & drips to flush out the toxins from the blood via the bladder. He should recover. No more boarding days as some cats cannot adapt to new environments and develop FLUTD (Feline Lower Urinary Tract Disease) which has many causes..

Friday, December 27, 2013

1280. How ro be an excellent tour guide

Dec 28, 2013

I toured Turkey from Dec 17 to 26, 2013 on a packaged tour. Packaged tours tend to be quite boring as tourist sleep while the coach passes various towns and villages as the Singaporean tour leader would not have comments nor knowledge of the places passed by.

However, this tour to Turkey was unusually fun as the Turkish tour guide, Mr Serkam could connect with the Singaporeans and gave comments on the cities passed such that one Malay mother with a 26-year-old career daughter who is still single told me that she had "no time to sleep during the journey."

Here are the best practices of Mr Serkam

1. Greeting the tourists every morning in their languages - Malay, Chinese and other foreign languages.

2. Diction. Use of a microphone and speak clearly in English.

3. Making eye contact with the tourists is important to him. Towards the end of the travel, our Singaporean tour leader slipped and hurt his knee and was sitting down on the front of the coach, obstructing his eye contact with the back of the coach. After enqniring about his injury, the Singaporean tour leader sat down on the aisle to ease his pain. He politely asked him to walk to the back so that Mr Serkam could see the tourists.    

4. Getting up to point out various characteristics of towns and villages. For example, heavily polluted industrial area in Turkey where people are not expected to live past 65 years of age. A corporate logo of Noah's Ark on the side of a wall belonging to a corporation. Taxi drivers being ex-criminals and not to be honked at. The coporate SASA logo of the richest man in Turkey, Salt Lake's dimensions much bigger than the State of Singapore. This was why the travellers had no time to doze off for long periods of time as for other packaged tours led by Singaporean tour laaders.

5. Informing the travellers that the whole journey was 3,000 miles.

6. Recap the places visit at the last day. This seemed to be appreciated by Mr On who mentioned this to others. Mr On is the "vocal minority" who filled up the tour feedback forms for his Hokkien group
of 14 senior citizens.

7. Cracking numerous jokes at the expense of his Singaporean tour leader who did not mind.
Two videos of his jokes is uploaded. Some tour guides can't joke as it is not part of their personality and so the tour is serious and the travellers just sleep. No person can sleep when he cracks relevant jokes.

8. Connecting with the travellers by applying "organic olive oil" personally to moisturise their hands at the start of each day's journey. The other coach's tour guide did it once only. This daily contact with the travellers put them in a good frame of mind. So his optional tours are highly subscribed to as compared to the other coach. However, in the other coach, the large proportion of travellers were senior citizens with at least 14 of them being Hokkien speaking friends including Mr On. Mr On and myself were allotted to the first coach where our Turkish guide was not cracking jokes as that was not his character to do so.
It so happened that Mr On and I decided to pay $55 for the optional tours. We had to join the other coach led by Mr Serkam as there were around 8/35 opting for such tours. The others in the 2nd coach not opting for the tours came over to take our seats. As explained by our Singaporean tour leader, there were two coaches and so optional tours could be conducted. If there was one coach, there needed to be 100% opting in or no optional tours as in previous single-coach packaged deals.

"$55 is worth it," Mr On kept telling anyone who will listen to how he got a fun journey with Mr Serkam. He is 63 years old and has travelled much in his retirement years.  He commented on one China Tour where the Chinese tour guide would not speak to Singaporeans if they didn't patronise the souvenier stalls. One had told me that he would not be able to make it up the high wall of a place. So he bad-mouthed this Singaporean travel agency.

He was the type who would share his views. He told us to claim back the over-charging of $35 in airport tax by our tour company. He had done so before the trip. It is not right for the tour company to keep quiet as airport tax is not part of the packaged tour cost. On returning home, I discovered that he was correct and the company agreed to give back the excessive paid. It is surprising to me as I trust this travel agency and did not query when asked for payment of the airport taxes.

9. Communicating well with travellers is not easy as it is part of the DNA of a service provider. There are doctors with excellent bedside manners and there are others who can't please the clients no matter how he or she tries. 

10. "The other tour guide is old and therefore tired," Mr On was frank in his perception of the oldies. There will be such comments from a group of travellers. Such comments can influence the silent majority. In this first coach, the tour guide with 20 years of experience did his best, in my opinion. It would be out of his character to joke and he had no "clown" in the Singaporean tour leader who was only one instead of two for two coaches. This gives the impression that our company is trying to make more money by not providing one tour leader per coach of over 35 people. So, the one Singaporean tour leader in the first 3 days was absent as he decided to stay one day in one coach. Later, he decided to spend half a day in each coach and that would be better than being absent for the whole day.

From Day 3-10, Mr On and I had opted for the 4 optional tours and so was in the 2nd coach of Mr Serkam. We did not opt for the 5th optional tour - air balloon led by Mr Serkam but he had quite a good number. There was the optional Bosphorous River Cruise which Mr On and I subscribed to
and had another 8 of the Hokkien group from Coach 1 deciding to join.

11. Optional tours provide additional income for the tour guides. By getting the travellers in a right frame of mind to buy the tours, Mr Serkam was very successful in getting a coach full, not an easy task with previous tour leaders of single coaches.

One successful strategy used and encountered by me in a European tour was to thrown in another "free tour" if the whole coach agreed to the optional tour or letting the Singaporean tourists know that they would just be loitering in the shopping mall if they don't opt 100% for such tours. The optional tours permit the guide to earn some income as many are free lancers but some guides just can't sell the optiional tours. Some can do it as they are able to earn the trust and get the traveller in the buying frame of mind by communications. Life is unfair if the service provider's personality is such that he or she is not able to connect to close sales. 

12. Providing statistics to tourists. Mr On asked the other coach friends whether the guide mentioned about the dimensions of the Salt Lake. He said Mr Serkam said it was of dimensions that are bigger than the State of Singapore.

13. Language barrier. Also Mr Serkam had better English diction but Mr Serkam had studied in the US for one year, in my talk to him.

14. Stereotypes of the old being tired and not energetic. Unfortunately this stereotype of the worn out oldie is quite common. Mr Serkam is in his late 30s and is deemed energetic.   

15, Telling personal life stories. This can be difficult for some tour guides but those who do it, get some attention. The average people like gossips of lifestyles of the tour guides too. So, gigolo jokes from Mr Serkam about his Singapore counterpart, Sebastian, being a busy "gigolo", caused much laughter in the coach. I had a short video clip on this joking laughter in one of the 3 videos posted below.

14. Be proactive. Mr Serkam chartered the whole boat for the Bosphorous River Cruise and personally pointed out the various interesting aspects of the European side and the Asian side of the River. This is better than the usual taped recording of Boat Cruises on the River Seine in Paris.  

3 videos to illustrate what I mean about being an excellent tour guide:




Thursday, December 26, 2013

1279. Underground City, Turkey

1278. Slides for Myanmar Veterinary Association 2013 Annual Conference - Social Media video

1277. Create a fun experience to close sales

It is difficult for a doctor to create a fun experience to close sales as medicine is a serious matter. For the Spice Market salesperson in orange uniform, the competition is intense. By creating a fun experience, the Singaporean tourists stay longer and he closes sales. His boss will find him a high performer

Monday, December 23, 2013

1276. Travel Stories - Matching civilian and military fashion - Turkey

A rare image

Changing of the guard at the Ataturk Museum, Turkey
attracts some tourists to pose with the soldier. One Asian tourist told another that  the soldier
would feel irritated by their posing. What do you think? I think it is a peaceful distraction

We had to alight from the coach and walked through the X-ray machine minus our metallic objects left inside the bus. Then we would go up the bus. "Yet the coach is not searched," our guide said. Our coach's gear level suddenly froze and the driver could not move it. So fortunately, there were 2 coaches in this tour and the other coach driver picked us up to drive to the Museum. The luggage compartment of our coach was opened and the problem was resolved. Some tied up mechanical problem fixed at the luggtage area to free the clutch which was a long "manual" type lever unlike modern ones with short lever as in the other Mercedes coach. Ours was a Mitsubishi or some model.

Dec 24, 2013
Koru Otel

Small room, elevator has a door which opens outwards, but internet connections in the room excellent compared to other modern 5-stars


Saturday, December 21, 2013

1274. Travel Stories: Efes, Turkey

Dec 21, 2013

I visited the of the Virgin Mary and saw this squirrel who was being hand-fed a piece of bread by a person familiar to him. As a young tourist girl from Singapore walked towards him within 0.3 metre  foot, he grabbed the bread and scootered up the tree for safety.

Location plays a great part in getting customers. This stall is located next to the zebra crossing where the tourists, after visiting "Seven Sleepers" site in Efes (Ephesus) will walk to, to wait for their coach. So this stall gets all the business of my tour group buying pomengranate juice while the other 2 competitors on the left are quiet.  

Once in a while, I get a picture I appreciate. The sunlight is good. The modern Japanese or Korean woman faces the same way as the ancient woman or goddess.  Much has changed for the better for women in many countries.

My Turkish tour guide was quite frustrated with the Singaporean tourists who are more interested in taking pictures of the approved 180 street cats than listening to the wonderful history of the old days.  This feline distraction is common with other Asian tourists esp. the young ladies as in this photo of a Japanese or Korean girl eyeing the cat. Usually these cats have their left ear edge snipped or tipped to indicate they are "sterilized".  The cats add colour to dead archeological monuments. I doubt 5% of the Asian tourists are interested in the Ottoman or Roman imperial history.  


Pictures with explanation. My favourite is the one with "sunlight in her hairs"

Travel Stories: The man with the blue lips

Dec 22, 2103
Hotel Dinler, Room 447, Urgup, Turkey

This morning, I joined a couple from our packaged tour for breakfast at Hotel Dinler. I noticed that the 63-year-old man's lips are blackish as compared to every person's in the dimly lit dining room. I had talked to Mr Ci and another 63-year-old Mr On 2 days ago and discovered we three men were of the same age. Yet I did not notice Mr Ci's cyanotic lips at all.

"How about your conjunctiva?" I asked and he pulled down his lower eyelids. They were normal orange pink ones.

"Whenever I bring my grandchild to see the doctor for flu," he said. "The doctor would want to examine me first. At the hospital, all the doctors wanted to do is to use their stethoscope to listen to my heart. I was born a blue baby and many doctors had shaken their heads saying I would not live long!"

"Did you do National Service?" I asked as Singaporean men born after 1948 would need to enlist. He was born in 1950 and so was I.
"I was a blue baby," he said. "The Army did not want me!"
"Not even as a clerk?" I asked as Mr On worked as a signaller while I was an Infantry Officer.
"Not wanted at all!"
Now I could see clearly why. No one wants to take responsibility for his demise during military training.
"My mother brought me to the temple to pray as the doctor said I would not live long," he elaborated that the temple god adopted him.
"If I live past 16 years of age, I would survive."

So here he is, much alive. He is a very rare person with cyanotic lips due to an enzyme deficiency in his blood but does not know his medical term. For dogs, cyanotic lips are hard to see but a cyanotic gum is a great cause for medical concern. I wonder whether dogs have this medical condition or not.

We had a group photo on the last day and coincidentally I had an image of his blue lips. He is a very nice gentleman and I just can't believe his story of being born blue lips (with no hole in the heart or heart disease). All doctors will also not believe my story too. Just not medically possible to have no serious heart disease with blue lips! 

Thursday, December 19, 2013

1272. Travel Stories: "Pretty Girl"

Dec 20, 2013
Hotel Tatlises, Kusadasi, Turkey
Room 1321. A bigger spacious room with balcony. Heating is good as the floors don't feel cold to the bare foot.

Yesterday, visited Troy which was built around 5000 years ago. Helen of Troy was the face that launched a thousand ships but Troy was a most important city economically, attracting conquerors.
My packaged tour group (flying by SIA) consisted of 38 people while the other group from the same travel agency (flying by Emirates) had 32 people and more younger people including good-looking girls. Hence, an aunty asked her 17-year-old nephew to tackle the "liang ray" (pretty girls in Cantonese) of his age in the other group.     

Good looks are much valued as in the days of Helen of Troy.  So are good photographs. Hundreds of images are taken by me, but only one shown below can be considered attractive.

What makes a very good travel photo?
1. The light is most important. Bright sunshine on a cold winter's day can be appreciated in this image.
2. The composition. Framed by trees, branches and leaves.
3. The people. A "pretty girl" who is well groomed and dressed on a winter's day never fail to attract viewing by most people.

I hope this image will inspire one of the young men who spent most of their spare time viewing movies and gaming learn how to take excellent images during travel.and for work to market themselves.

The original large images, not photoshopped is below:

The original image was snapped from afar using Auto focus. I find this camera lens mentioned below, good for videography at autofocus mode unlike my other lens which "clicked and whirled" to autofocus on various people, producing much more blurred video images. This image is best taken without video as this is only a few seconds before the travellers move to another spot.

Photoshopped images are below:


Compact cameras and handphones cannot improve one's imaging skills
The camera information I used for the above images are:

Canon EOS 700D
Canon EFS 18-135mm Macro Lens 0.39m/1.3ft
with image stabiliser
"P" program mode
"AF" autofocus

Many photographers prefer "MF" Manual focus, but with this image, the pretty girl would just disappear by the time one manually focus. So, I don't use MF! The lighting may change in seconds too.

This image is framed by the tree (right), branches (left), leaves (above), reading plaque (below). It manage to capture the intense seeking of knowledge by the man with the green iPad while the pretty girl has matching handphone cover, grey gloves and coat and sunshine from the 10am sun shines in her hair.

It is very difficult to capture good travel photos and this is a rare one out of thousands.
As to the pretty girl in this image, she flies Emirates while I took the SIA and so we never got acquainted. I doubt the aunty's advice to the nephew was taken seriously by her nephew too.

Message to all young men obsessed with gaming till 3 am daily and looking sleepy at work.
CREATE, NOT CONSUME. My advice to the young men in their late 20s. Make time to study digital photography and you will appreciate life and the world much more with digital photography skills. 


Wednesday, December 18, 2013

1271. Travel stories - Istanbul's kindness to stray dogs and cats: Let Sleeping Dogs Lie


MVI 8003
Dec 19, 2013. 11.14am. Iris Otel Rm 209, Turkey.

Yesterday, visited Istanbul. Then by coach of over 4 hours to the Iris Otel which is located after the ferry crossed Gallipoli town river. Gallipoli is significant historically for ANZAC troops as many had died in battles there during the First World War.

This video shows that Istanbul is caring for stray cross-bred dogs although it is predominantly a Muslim city.

Outside the beautiful Blue Mosque where there were a few thousand international tourists on Dec 18, 2013, Bright sunshine and blue skies yesterday, unlike one week ago when there was fog and snow in Istanbul!

I saw  around 5 stray dogs with the left ear tagged. No barking. Some mingle with the tourists. They were friendly and don't mind being patted and would walk along with the tourists.

One veteran was seen sleeping at around lunch-time near the Sophia Museum. He reminds me of "Let Sleeping Dogs Lie" in my primary school English lessons, That was in 1962, a time when the English idioms and correct grammar were   seriously studied by Primary Six students in Singapore as we would be tested in the PSLE examinations to qualify for the top secondary schools.

Hence this video to "bring English idiom" alive to the viewer - "Let Sleeping Dogs Lie" .

There were around 2 stray cats outside the Blue Mosque and two at the Palace. They like to be petted by visitors and many visitors including Singaporean ladies have their photos taken. Many young Singaporeans nowadays care much for the disadvantaged stray cats and dogs unlike the baby boomer generation.

The stray cats looked in excellent health with the thick winter coat. It can be as cold as 5 deg C during daytime and freezing at night.  Their ears are NOT tipped unlike in Singapore and so it is not possible to see from afar whether they have been spayed or neutered
As for this Istanbul rusty-brown and white og, I let "sleeping dogs lie" and continued with my tour to see the racehorse track that existed around 500 years. It is presently a tiled rectangular area.

It will be a surprising change of mindset one day in the future if the Singapore Government & Tourism Board permits around 5 stray sterilized dogs to live around the Esplanade or Resort World area, enhancing the visiting experience of international tourists, many of whom do not have pets as they live a hectic city life, like many Singaporeans.

These strays are inexpensive to maintain and are not a danger to visitors. Certainly they add that contacting animal experience for the younger tourists living in urban jungles do not get and the make great photo opportunities.

If I remember correctly, I don't see such strays in famous historical sites in Paris or Rome. Singapore's stray dogs appear to be hiding during the daytime as the environment is apparently hostile towards them. There are also fewer stray cats seen in public places but one does encounter the rare ones.

A generation of urbanized Singaporeans has grown up without contact with animals as there was mass culling of strays using pest control companies at one period of time when town councils were all out to eliminate all stray dogs and cats. Now, there are "trappers" who bring them to vets for sterilization and the volunteers then feed them. Videos are still the best form of educating the young ones as compared to text and stories. The young just do not read much nowadays!  

Monday, December 16, 2013

1270. Video Husky eyelid tumour vet surgery

Video not made by previous intern owing to lack of time.
Pl get video created



MVI 1009, 1010, 1019, 1020, 1021, 1043

Title: Veterinary Surgery video; How a Husky's eyelid tumour is removed.

Date: September 2013 case study.
Breed, age, gender
1. Hook.  Irritating. Keeps rubbing right eye. Eye inflamed. Consult vet for advice.

Clara to draw an illustration of how the surgery is to be done. .

2. Anaesthesia gas by mask and sedation by injection IV. 

3. Cut 1 cm incision in the lateral canthus to enlarge operating area

4. Cut around upper eyelid tumour with electro-incision electrode.
    An inverted "V" skin incision is made to remove the tumour

5. Ensure as much of the tumour area is removed by cutting off irregular skin edges at the margins of the excised tumour area.

CONFLICT 1. Profuse bleeding. What to do?
6. Electro-coagulation electrode is used to seal off bleeding vessels
7. Undermine skin below eyelid to reduce skin tension and prevent stitch breakdown. 
The skin edges are stitched. Blunt edged scissors is used.

8. Bleeding present again.  
9. Electro-coagulation takes longer time as bleeding is profuse. Increase coagulation power to No. 2 (vet's voice)
10. Swabs to clear operating area of blood for stitching
      Takes a long time to coagulate blood vessel as it is large. Continue electro-coagulation.

CONFLICT 3. Insufficient skin area to stitch eyelid area if a wider margin of the tumour is excised. A margin of 1 cm is advised in vet text books but this is not practical here as there will be no skin to stitch up.
11. Tumour excised. Check again for remnants of tumour. Trim edges to provide a straight regular skin edge to stitch up for proper healing.
12. Skin now stitched with 3/0 absorbable sutures. Two interrupted stitches.
13. The lateral canthus is stitched now with one stitch. isoflurane and O2 gas anaesthesis is switched off during the 2nd last stitch (vet's voice to switch off anaesthesia).

14. Dog recovery stage MVI 1043.  No complaints from owner for the past 3 months.

Operating surgeon; Dr Sing Kong Yuen
Assisting surgeon: Dr Daniel Sing

1269. The 17-year-old Shih Tzu vomited green stuff and had diarrhoea for 2 days

Sunday, December 15, 2013

1268. Open pyometra with uterine torsion in a 13-year-old Jack Russell X - images for video production

An unusual case in an old female dog pyometra as the uterus was twisted and entangled with omentum and intestines. Blood tests showed total white cell count as below normal as usually it is above normal.

The uterine horns were trapped inside the omentum as they had been twisted with the intestines. So time was needed by Dr Daniel to cut away the adhesions, leading to prolonged operating time and much bleeding on the operation site.

I have encountered such a torsion case and the interns had made an interesting video.
Intern Clara will need to think how to  make this video themed "Early veterinary surgery saves lives" as interesting and instructional as possible..  

The gentleman owner noted that his old dog with dirty vaginal discharge was lethargic and not eating for the past 2 days and so he sought early veterinary consultation. I diagnosed open pyometra based on abdominal pain on lower 1/3 of abdomen  and a dirty brown vaginal discharge after a recent estrus. There appeared to be swollen uterine bodies but they were not 100% bloated
"My dog had previous vaginal discharges but she was more alert and the discharge disappears, but this time, she looked very ill," the gentleman told me.

Dirty gritty dark reddish brown blood dripped all over the examination table and consultation room floor. "Open pyometra" in an old unspayed dog is usually the instant diagnosis.

I got the dog operated on the same day after around 3 hours of IV drip & medication. The dog has recovered. Many Singaporean dog owners feel that they should not spay the female dog as it is cruel to do so. This is a common mindset but as the dog ages, the owner does not bother much with her health deterioration.

When the old female dog exhibits dirty brown vaginal discharge with mucus, some procrastinate, hoping that the discharge would disappear and the dog would not have the discharge at the next heat as in this case. The womb infection gets worse at the next heat and fortunately, this dog was operated early and survives. If the dog is not operated or treatment is delayed, there will be vomiting and death on the operating table. Sometimes, the vet is blamed for the death. Spaying the female dog when she is young prevents many female reproductive problems like pyometra and breast tumours.  A kinder and better educated generation of Singaporeans may be against sterilisation but they must be caring as to seek prompt veterinary surgery when breast tumours and dirty brown mucoid vaginal discharge appears in the old companions.

Saturday, December 14, 2013

1267. Strands of caseous pus keep oozing out from the Pom's skin

Usually pus is liquid in a dog but cheesy in the rabbit as the latter is said not to have certain enzymes to liquefy the pus.

Below is a case of a caseous pus in a dog.

1266. Buying traditional cakes for a 92-year-old grandma


A short video clip on what I did on Saturday Dec 14, 2013. I went to buy cakes for a 92-year-old grandma who would have eaten them from a young age and would therefore appreciate them.

1265. The itchy 6-year-old pomeranian has skin disease again

The itchy

Part 1

Part 2

Part 3

Friday, December 13, 2013

1264. Itchy ears in a young beagle and a poodle

Saturday Dec 14, 2013

"Floppy eared dogs like the beagle, cocker spaniel and poodle tend to have ear problems," I said to a young fair lady with a heart-shaped face. She would be in her mid 20s.

"This is because the ears are covered up, being floppy eared. So there is no ventilation. Water from the shampoo and broken hairs are trapped inside at the horizontal canal," I explained.  The dog also had anal sac infections with lots of dark brown oil expressed. 

This morning, I had another case of ear scratching using the back legs.

1263. "Judgement Day" for a closed-pyometra dog


The video was produced by Intern Clara as part of her internship training to be a vet. Images are blurred for some technical reasons although most of the other interns do not have this problem..

She was not comfortable with the use of "Judgment Day" but that is the theme of the story. Judgment Day for Christians has a much different meaning but many phrases in writings have been taken from the Bible and they are not meant to denote the same interpretations.

A concise video clip. However, the 2nd and 3rd alternatives to make a judgment call by the owner were confusing and is given below.  


The old female dog had a bloated abdomen. Closed pyometra was diagnosed on history, palpation x-rays and blood tests.

The options for the owner were:
1. No operation. The dog will die from septicaemia.
2. Operation on the same day after I/V drip & medication of around 3 hours. Higher anaesthetic risk as the dog is lethargic and unfit for anaesthesia. But delay of several hours may result in the swollen uterus rupturing, spilling out the bacteria and toxins into the abdomen, killing the dog.
3. Operation on the next day after I/V drip & medication. This stabilises the dog's health as the drugs have time to take effect to kill off the bacteria inside the blood stream. However, the uterus is about to burst anytime and an emergency spay is strongly advised (Option 2) with its much higher risk of anaesthetic death on the operating table .

This is a judment call for the owner and the vet. The owner bears the responsibility for the dog's death. She selected took option 2. The dog survives the operation. She comes back on Day 11 for stitch removal. Everybody has a happy ending in this case but not all closed pyometra dogs survive.  Many die as the owner delays several days seeking veterinary treatment or the vomiting dog has had been mis-diagnosed for gastro-enteritis when the owner does not permit blood testing and X-rays. Spaying your dog young would have prevented pyometra, higher medical costs and much emotional distress when closed pyometra occurs and remain neglected resulting in the dog's untimely death.

1262. Two veterinary stories for video production/e-book

Thursday, December 12, 2013

1261. Audit of case of kidney stones causing kidney failure

tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS toapayohvets.com
Date:   15 November, 2013  
Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
The Silkie had double kidney stones Dr Sing Kong Yuen, BVMS (Glasgow), MRCVSDate:   15 November, 2013   toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129
Silkie Terrier, F, spayed, 13 yearsFed dry food + bread since 5 years of age (adopted from another owner who migrated).

2 days ago, presented with vomiting and diarrhoea. I treated and advised blood tests and X-rays if the symptoms persisted. The dog came back yesterday, "dying" according to Dr Daniel who got the X-rays and blood tests done.
A rare case of kidney stones in the 2 kidneys was diagnosed based on evidence. Dogs usually suffer from bladder stones. No urine tests done in this case. 

Blood urea and creatinine are extremely high. The dog vomits dark brown fluid in the crate and has heavy abdominal breathing as at 11.14 am Nov 13, 2013 when the lady owner came to visit as I phoned her to say that the dog was suffering in pain and was on the last leg of his life. The dog vomited white froth on the reception room floor.

The owner will bring home for today and had decided on euthanasia later in the day.
Two kidneys are packed with stones
Vomiting and diarrhoea can be a sign of kidney failure although most cases are due to gastroenteritis. This dog was treated for gastroenteritis at the first consultation without blood test so as to reduce medical costs. As the vomiting persisted, I advised a blood test and Dr Daniel took it since I was out. This was a case of renal urolithiasis resulting in kidney failure. 
Updates will be on this webpage:

Dec 13, 2013
I review the case medical records today to do a retrospective study.

41099 Silkie, Female, spayed, Born 2000.
Aug 23, 2010. First consulted Toa Payoh Vets. 10 years old.
                        Left ear tumour at base of ear and rotten teeth. Advised treatment. Just wanted antibiotic.

Sep 3, 2010    Treatment done for above conditions.
Nov 11, 2013  13 years old. Bloody diarrhoea. Vomited greenish stuff 2 days. Not eating and drinking.
Does not want blood test (recorded in case file). Wanted I/V drip & medication.  Vet is myself (Dr Sing Kong Yuen)

Nov 13, 2013
Respiratory distress. Dr Daniel Sing
Blood test - severe azotemia
ALT 73 (<59 br="">Urea 86  (4.2-6.3)
Creatinine 1129 (89-177)
Total white cell count 11.9 (6-17)  -- OK

   Neutrophils 86%   Abs  10.18
   Lymphocytes 6%   Abs 0.70
   Monocytes  8.3%   Abs 0.99
   Eosinophils 0%
   Basophils 0.1%

Platelets 459 ( 200-500) -- OK

X-rays - calcified cores in both kidneys

Owner elected euthanasia.