"I did not want to spay her when you advised," the mother said. "I was worried about the death during anaesthesia." Now, the dog had lots of dirty vaginal discharge and I said; "She is suffering from pyometra - a womb infection." It is best to spay her as soon as possible"
The dog came in at night. My associate vet diagnosed pyometra and put her on a IV drip with antibiotics. He would operate the next day.
I had not seen this dog for some years after the initial first 3 vaccinations. The worried mum phoned me. "My associate vet is able to perform this surgery," I said. "Pyometra is one of the common surgeries."
However the mum insisted that I operate. So I took over the case from my associate vet who had no hard feelings over this as the dog was under my care since puppyhood.
PRE-OP
As the owner was very worried, I had the dog on IV drip and antibiotics for 3 days. She had an excellent appetite on 36 hours after being seen to, but still it was safer not to rush into surgery as scheduled. Total white cell count was high indicating a bacterial infection of the blood system. It would be best to kill all bacteria using antibiotics
ANAESTHESIA
Dog was 33 kg. Domitor 0.3 ml IV was given. Gas mask using isoflurane gas was inhaled for 15 minutes as this dog was now stronger now after the 3 days of IV and antibiotic. I intubated her and maintained her on isoflurane gas. In retrospect, Domitor could be given at 0.4 - 0.5 ml since no other sedatives like Zoletil were added. But isoflurane gas is the safest way.
SURGERY
A big swollen uterus, as in closed pyometra. As thick as the bigger hot dog you will see during barbecues. Some cysts appeared in one uterine horn near the ovaries. I took a picture for reference. Normally no cysts are seen but pyometra is cystic endometrial hyperplasia complex. So cysts are usually found inside the uterine tubes but these cysts were outside.
POST-OP
The dog was sent home 48 hours after surgery. She was not seen again as she had licked off her stitches on the 10th day. In any case, the stitches were self-dissolving.
CONCLUSION
Closed pyometra does present with vaginal discharge as the cervix opens during the later stages. Abdominal palpation in this dog did not reveal large uterine tubes. However the blood test with high white cell count was useful. In any case, purulent vaginal discharge in large amounts around 2 months after the heat is a quick diagnosis of pyometra. A rush into surgery is not advised as the dog is septicaemic. I would advise 3-4 days later.
ANOTHER CLOSED PYOMETRA CASE.
However, some owners want the dog operated and back home on the same day of diagnosis as they feel that the dog should not be separated even for one day. For such owners, the vet needed to use his common sense and judgment.
In this case, Vet 1 had X-rayed and took blood test and confirmed that the Maltese of 6 years had pyometra. Vet 1 phoned the next day for the dog to return for surgery. Pyometra is a much longer surgery than a normal spay and so the vet costs would exceed $1,000 with the x-rays and blood test. The surgery quoted by Vet 1 was $800 which was a reasonable cost. Unfortunately the owner felt it was too high.
"You will need to get the dog operated soon" I advised when the owner phoned me for a quotation. She wanted to wait till the weekend, 3 days later. After all, the dog looked well after Vet 1 had given antibiotics. "Delays mean more infections and complications. When the dog dies because you delay surgery, you tend to blame the vet as being incompetent in anaesthesia."
There was little difference but since I did not need to repeat the blood test nor take X-rays or ultrasound, my quote would be deemed lower.
The dog came in for surgery. An IV drip plus antibiotics was given 3 hours before surgery. Domitor 0.1 ml IV was given via the drip. The dog was masked and given isoflurane gas. She slept fast and was intubated. Isoflurane gas was given. I monitored this case very closely as it was a high risk case since the operation was done on the second day after Vet 1 had diagnosed closed pyometra. The 3rd day could be too late as the dog could die from septicaemia.
ANAESTHESIA TIP
The dog was not normal in the sense that the tongue was pale and bluish. Her re-breathing bag showed signs of very slow breathing and cessation of breathing. This was a touch and go case. The family expected 100% survival but this case could be the type of high-risk case best done by other vets. I disconnected the endotracheal tube when the dog was not breathing well and re-connected when the dog felt some painful reaction from the surgery.
OUTCOME
The dog survived and went home on the same day. She was OK.
Pictures will be at www.toapayohvets.com later.
Monday, November 15, 2010
A demanding dog breeder
Dog breeders in Singapore go for the cheapest vet and there will be new start ups that oblige. "It is better to have a case rather than have no business," this is the reality of life.
Yesterday was a Sunday. A dog breeder came in at 5pm saying that he had 4 pups born naturally from a Shih Tzu mated with a Poodle, producing "ugly crosses" that Singaporeans will not buy.
"I need an oxytocin injection for the dam. It is past 24 hours since the 4th pup was born. I could feel one pup still prsent"
I palpated a bony foetus, hard as a bone and said: "There is a pup in the right side, below the rib cage. The pup is dead as you had waited too long. Oxytocin injection may not help."
He insisted on the oxytocin injection. The dam contracted a bit and there was no puppy delivered after 30 minutes.
My first assistant was present. He told the breeder that a Caesarean section was necessary.
"I had an X-ray done at Vet 1," the breeder said. "Only 4 pups seen during the X-ray".
"Are you sure?" I had no X-ray from him since he did not bring it."Normally, at this late stage, you can see 5 foetal heads and skeletons."
I will describe the I/V anaesthesia in this case as Caesarean sections have had been written in many reports in www.toapayohvets. The black pup was smeared with dark green placenta melt-down. It was dead and stiff on taking out from the womb.
Domitor 0.1 ml. Then Zoletil 100 0.1 ml. Both were diluted with another 0.1 ml saline before IV injection via a drip line. Atropine 0.5 ml given. Dog was intubaed and given oxygen at high flow rate around 5 litres/sec.
CAESEAREAN SECTION
No pain problem. Towards the end, I increased the dosage of isoflurane for a brief few seconds. The dog woke up at the last stitch. The surgery took around 45 minutes and that was the duration of analgesia in this dam, weighting around 7kg.
The dam's tongue was initially pale but became normal pink at the completion of surgery.
ANAESTHESIA
Yesterday was a Sunday. A dog breeder came in at 5pm saying that he had 4 pups born naturally from a Shih Tzu mated with a Poodle, producing "ugly crosses" that Singaporeans will not buy.
"I need an oxytocin injection for the dam. It is past 24 hours since the 4th pup was born. I could feel one pup still prsent"
I palpated a bony foetus, hard as a bone and said: "There is a pup in the right side, below the rib cage. The pup is dead as you had waited too long. Oxytocin injection may not help."
He insisted on the oxytocin injection. The dam contracted a bit and there was no puppy delivered after 30 minutes.
My first assistant was present. He told the breeder that a Caesarean section was necessary.
"I had an X-ray done at Vet 1," the breeder said. "Only 4 pups seen during the X-ray".
"Are you sure?" I had no X-ray from him since he did not bring it."Normally, at this late stage, you can see 5 foetal heads and skeletons."
I will describe the I/V anaesthesia in this case as Caesarean sections have had been written in many reports in www.toapayohvets. The black pup was smeared with dark green placenta melt-down. It was dead and stiff on taking out from the womb.
Domitor 0.1 ml. Then Zoletil 100 0.1 ml. Both were diluted with another 0.1 ml saline before IV injection via a drip line. Atropine 0.5 ml given. Dog was intubaed and given oxygen at high flow rate around 5 litres/sec.
CAESEAREAN SECTION
No pain problem. Towards the end, I increased the dosage of isoflurane for a brief few seconds. The dog woke up at the last stitch. The surgery took around 45 minutes and that was the duration of analgesia in this dam, weighting around 7kg.
The dam's tongue was initially pale but became normal pink at the completion of surgery.
ANAESTHESIA
Friday, November 12, 2010
240. Email query about vaccination for cats
I am Dr Sing. Thank you for your email. The reply in CAPITAL LETTER is as follows:
On Thu, Nov 11, 2010 at 9:41 PM, ...@gmail.com> wrote:
Hi,
I recently took in a small black stray cat that a friend of mine had found and nursed back to health. I wanted to schedule some time to bring him in to get any required vaccinations and a general check up.
I have a few queries:
1. What vaccinations are normally required?
ALL CATS SHOULD BE VACCINATED AGAINST THE FOLLOWING FIRST 3 COMMON DISEASES IN SINGAPORE LISTED BELOW
* Panleukopenia virus (distemper)
* Feline calicvirus (FCV)
* Feline herpes virus (rhinotracheitis)
AS FOR RABIES, THERE HAVE BEEN QUERIES FROM CAT OWNERS.
* Rabies (NO NEED TO VACCINATE FOR CATS IN SINGAPORE AS THERE IS NO RABIES IN SINGAPORE)
* Panleukopenia Vuaccine (also called "Feline Distemper")
Panleukopenia is caused by a feline parvovirus (FPV), and is particularly vicious, capable of being spread rapidly, with a high mortality rate, especially in younger cats.
* Feline Calicivirus
This virus, along with the Feline Herpes virus, causes the majority of upper respiratory infections URIs in cats, and can be spread by "carrier" cats for years.
* Rhinotracheitis (Feline Herpes Virus)
Rhinotracheitis causes serious potential respiratory and neurological diseases, especially in kittens.
2. Do I need to make an appointment or can I just drop in?
Drop in is OK but sometimes the vet is operating and you need to wait a long time. It is best to make an appointment.
3. As it is a male cat I may need to consider getting it spayed. Would you recommend that?
NEUTERING IS ADVISED FOR THE MALE CAT to prevent caterwauling, wandering urges, urine marking and fighting. SUCH BEHAVIOUR IS COMMON IN MANY MALE CATS
4. What would it normally cost for all of that? VACCINATION IS $35.00 IF THERE IS NO CONSULTATION WHICH IS $35 - $40. Neutering, anaesthesia and post-op antibiotics and painkiller are estimated to be $110-$130.
Please let me know - many thanks.
Regards,
Name of Owner
On Thu, Nov 11, 2010 at 9:41 PM, ...@gmail.com> wrote:
Hi,
I recently took in a small black stray cat that a friend of mine had found and nursed back to health. I wanted to schedule some time to bring him in to get any required vaccinations and a general check up.
I have a few queries:
1. What vaccinations are normally required?
ALL CATS SHOULD BE VACCINATED AGAINST THE FOLLOWING FIRST 3 COMMON DISEASES IN SINGAPORE LISTED BELOW
* Panleukopenia virus (distemper)
* Feline calicvirus (FCV)
* Feline herpes virus (rhinotracheitis)
AS FOR RABIES, THERE HAVE BEEN QUERIES FROM CAT OWNERS.
* Rabies (NO NEED TO VACCINATE FOR CATS IN SINGAPORE AS THERE IS NO RABIES IN SINGAPORE)
* Panleukopenia Vuaccine (also called "Feline Distemper")
Panleukopenia is caused by a feline parvovirus (FPV), and is particularly vicious, capable of being spread rapidly, with a high mortality rate, especially in younger cats.
* Feline Calicivirus
This virus, along with the Feline Herpes virus, causes the majority of upper respiratory infections URIs in cats, and can be spread by "carrier" cats for years.
* Rhinotracheitis (Feline Herpes Virus)
Rhinotracheitis causes serious potential respiratory and neurological diseases, especially in kittens.
2. Do I need to make an appointment or can I just drop in?
Drop in is OK but sometimes the vet is operating and you need to wait a long time. It is best to make an appointment.
3. As it is a male cat I may need to consider getting it spayed. Would you recommend that?
NEUTERING IS ADVISED FOR THE MALE CAT to prevent caterwauling, wandering urges, urine marking and fighting. SUCH BEHAVIOUR IS COMMON IN MANY MALE CATS
4. What would it normally cost for all of that? VACCINATION IS $35.00 IF THERE IS NO CONSULTATION WHICH IS $35 - $40. Neutering, anaesthesia and post-op antibiotics and painkiller are estimated to be $110-$130.
Please let me know - many thanks.
Regards,
Name of Owner
Monday, November 8, 2010
Old dog with cheek tumour
The skin wound did not close entirely. This is a complication of surgery of the cheek tumour excised from outside the cheek. The Miniature Schnauzer of 11 years of age,10 kg bodyweight drooled saliva out of two gaps in the cheek. The young lady owner wanted surgery to close the holes as the right cheek keeps getting wet.
"It is lymph," my first assistant speculated. "Do you think so?" I asked him again. "It is possible as the surrounding area had a type of wetness that looked oily. Like melted butter. However, there was saliva from inside the mouth flowing out of the two gaps.
The old dog had 3 general anaesthesias and I did not look forward to a 4th. Try not to be complacent as deaths on the operating table of an old dog are always a possibility.
INJECTABLE IV ANAESTHESIA
This time, I do not use isoflurane gas as in the previous 3 operations as the endotracheal tube would get in the way of the surgical procedure of debridement.
For 10 kg, the formula for a safe dosage of injectable IV is 0.5 ml diazepam 5 mg/ml and 0.5 ml ketamine 100 mg/ml by slow IV injection.
I used 0.4 ml + 0.4 ml respectively. It was insufficient. As the needle was in the vein in case of the need for top up, my first assistant injected 0.02 ml Zoletil 100 mg/ml diluted in 0.18 ml saline to make it 0.2 ml. The dog was sedated but his eye reflexes were present.
6 DAYS PRE-OP.
Dog was on Baytril oral for the past 6 days. The young lady remembered the appointment as I do not phone or text message unlike the Singapore General Hospital staff of some medical departments. I ought to do it and will do it.
SURGERY
Snip off granulated edges, debride. Undermine skin to separate some areas from the underlying cheek muscles. New raw bleeding edges. I used simple interrupted sutures 3/0 at 0.3 mm apart. 1.0 ml atropine SC was given to reduce salivation as Zoletil does cause salivation as a side effect. Sent dog home to reduce vet cost as this young lady had used her savings for the operations.
Only time will tell whether the old companion finally has a healed intact right side of the cheek.
OBSERVATION
It was too early to see whether the cheek tumour had recurred again. For readers, it is best to get your dog over 3 years of age, annual dental check up for mouth tumours rather than not do it. Some do develop into cheek or gum tumours as in this old Schnauzer and would then cost a lot of worries and money.
"It is lymph," my first assistant speculated. "Do you think so?" I asked him again. "It is possible as the surrounding area had a type of wetness that looked oily. Like melted butter. However, there was saliva from inside the mouth flowing out of the two gaps.
The old dog had 3 general anaesthesias and I did not look forward to a 4th. Try not to be complacent as deaths on the operating table of an old dog are always a possibility.
INJECTABLE IV ANAESTHESIA
This time, I do not use isoflurane gas as in the previous 3 operations as the endotracheal tube would get in the way of the surgical procedure of debridement.
For 10 kg, the formula for a safe dosage of injectable IV is 0.5 ml diazepam 5 mg/ml and 0.5 ml ketamine 100 mg/ml by slow IV injection.
I used 0.4 ml + 0.4 ml respectively. It was insufficient. As the needle was in the vein in case of the need for top up, my first assistant injected 0.02 ml Zoletil 100 mg/ml diluted in 0.18 ml saline to make it 0.2 ml. The dog was sedated but his eye reflexes were present.
6 DAYS PRE-OP.
Dog was on Baytril oral for the past 6 days. The young lady remembered the appointment as I do not phone or text message unlike the Singapore General Hospital staff of some medical departments. I ought to do it and will do it.
SURGERY
Snip off granulated edges, debride. Undermine skin to separate some areas from the underlying cheek muscles. New raw bleeding edges. I used simple interrupted sutures 3/0 at 0.3 mm apart. 1.0 ml atropine SC was given to reduce salivation as Zoletil does cause salivation as a side effect. Sent dog home to reduce vet cost as this young lady had used her savings for the operations.
Only time will tell whether the old companion finally has a healed intact right side of the cheek.
OBSERVATION
It was too early to see whether the cheek tumour had recurred again. For readers, it is best to get your dog over 3 years of age, annual dental check up for mouth tumours rather than not do it. Some do develop into cheek or gum tumours as in this old Schnauzer and would then cost a lot of worries and money.
238. Integrity of the vet
"No general anaesthesia," the young man suggested local anaesthesia as he was worried that his cat might die on the operating table. His cat was weak as he had been sneezing blood and had runny noses for the past 2 months. He wanted my second opinion after Vet 1 advised a CT scan costing $1,500 excluding surgery for 2 lumps above the right nostril and below the right eye.
"Local anaesthetic cannot be applied to this area as there is not much space due to the large size of the growth," I said. "The cat would feel the pain of injections of the local anaesthetic and scratch me." I had a feeling that this cat was suffering from tumour as he had around 3 grey melanomas in the ear pinnae. Both ears and melanomas may have spread to this nose area.
The following was briefly how I handled this case with the least cost as required.
PROCEDURES
1. History & Palpation of the tumour. Firm but no pain. The cat had 10 days of vibravet 50 mg at 3/4 tablet per day from Vet 1. Now he had yellow runny nostril on the right side. "Did he get nose discharge on the left nostril?" I asked the young man. "No," he said. But I could see the brownish stain not completely wiped out, below the left nostril (see picture). His mum later confirmed that the cat had discharge of both nostrils.
2. Aspiration with 18G needle. The quiet cat was held by my assistant (without wrapping him in a towel as it should be done. My right wrist was scratched). I aspirated 0.02ml of red blood from the bigger of the two lumps.
3. Incision for biopsy. I used the scalpel to excise the lump to see what is inside. As I had promised the young man, I did not use general anaesthesia. The cat raised his front left paws weakly a few times. I got scratched once as I took out 2 pieces of the greyish maroon muscle-like mass below the skin, put in formalin and sent them to the Laboratory.
4. Anaerobic bacterial cultures and Gram stain were not done as the cat just had been on 10 days of antibiotics from Vet 1.
5. I had asked my assistant to clip the hairs of the forelegs so as to insert the IV catheter easily. This was done with no prolem. Blood test and an IV drip was done. In the IV saline drip to be given as 500 ml, I put in baytril antibiotic according to weight, a small 0.2 ml dexamethosone anti-inflammatory and metronidazole according to weight.
RESULTS
Least veterinary cost is what the young man's father wanted. With the above procedures, the cost was "affordable" as it was well below $1,000 since there was no general anaesthetic and surgery. And no possibility of death.
24 hours later, the cat had no runny left nostril. I did not expect such drastic improvement. He went home on Day 3 with Baytril antibiotics. He had no problem with runny nose and was eating well. Lab reports indicate he had cancer - malignant cellular infiltrate with a differential diagnosis including malignant melanoma. I advised surgical excision but the father wanted to wait and see.
LAB REPORT. Cat, M, 6 years. Soft tissue lesion, near muscle. MALIGNANT CELLULAR INFILTRATE. Different diagnosis includes malignant lymphoma, malignant melanoma, carcinoma or sarcoma. Immunostains needed to delineate and type the tumour.
CONCLUSION.
A biopsy is important in growths. A CT scan of $1,500 is too costly for most cat owners. In chronic sinusitis as suspected in this case, a gram stain, a fungal and anaerobic culture would be good but these were not done as the cat had been on antibiotic in the past 10 days. There was a budget from the owner.
Metronidazole IV may be effective in this case when combined with Baytril. As there was no bacterial culture done, it was hard to say what caused the blood sneezing and nose discharge. Metronidazole is effective against anaerobic bacteria (unique anaerobic bactericidal activity). It seldom cause the pseudomembranous colitis sometimes associated with the use of clindamycin. Metronidzole is said to be potentially mutagenic (likely to cause cancer), but short-term use has not been shown to cause cancer.
"Local anaesthetic cannot be applied to this area as there is not much space due to the large size of the growth," I said. "The cat would feel the pain of injections of the local anaesthetic and scratch me." I had a feeling that this cat was suffering from tumour as he had around 3 grey melanomas in the ear pinnae. Both ears and melanomas may have spread to this nose area.
The following was briefly how I handled this case with the least cost as required.
PROCEDURES
1. History & Palpation of the tumour. Firm but no pain. The cat had 10 days of vibravet 50 mg at 3/4 tablet per day from Vet 1. Now he had yellow runny nostril on the right side. "Did he get nose discharge on the left nostril?" I asked the young man. "No," he said. But I could see the brownish stain not completely wiped out, below the left nostril (see picture). His mum later confirmed that the cat had discharge of both nostrils.
2. Aspiration with 18G needle. The quiet cat was held by my assistant (without wrapping him in a towel as it should be done. My right wrist was scratched). I aspirated 0.02ml of red blood from the bigger of the two lumps.
3. Incision for biopsy. I used the scalpel to excise the lump to see what is inside. As I had promised the young man, I did not use general anaesthesia. The cat raised his front left paws weakly a few times. I got scratched once as I took out 2 pieces of the greyish maroon muscle-like mass below the skin, put in formalin and sent them to the Laboratory.
4. Anaerobic bacterial cultures and Gram stain were not done as the cat just had been on 10 days of antibiotics from Vet 1.
5. I had asked my assistant to clip the hairs of the forelegs so as to insert the IV catheter easily. This was done with no prolem. Blood test and an IV drip was done. In the IV saline drip to be given as 500 ml, I put in baytril antibiotic according to weight, a small 0.2 ml dexamethosone anti-inflammatory and metronidazole according to weight.
RESULTS
Least veterinary cost is what the young man's father wanted. With the above procedures, the cost was "affordable" as it was well below $1,000 since there was no general anaesthetic and surgery. And no possibility of death.
24 hours later, the cat had no runny left nostril. I did not expect such drastic improvement. He went home on Day 3 with Baytril antibiotics. He had no problem with runny nose and was eating well. Lab reports indicate he had cancer - malignant cellular infiltrate with a differential diagnosis including malignant melanoma. I advised surgical excision but the father wanted to wait and see.
LAB REPORT. Cat, M, 6 years. Soft tissue lesion, near muscle. MALIGNANT CELLULAR INFILTRATE. Different diagnosis includes malignant lymphoma, malignant melanoma, carcinoma or sarcoma. Immunostains needed to delineate and type the tumour.
CONCLUSION.
A biopsy is important in growths. A CT scan of $1,500 is too costly for most cat owners. In chronic sinusitis as suspected in this case, a gram stain, a fungal and anaerobic culture would be good but these were not done as the cat had been on antibiotic in the past 10 days. There was a budget from the owner.
Metronidazole IV may be effective in this case when combined with Baytril. As there was no bacterial culture done, it was hard to say what caused the blood sneezing and nose discharge. Metronidazole is effective against anaerobic bacteria (unique anaerobic bactericidal activity). It seldom cause the pseudomembranous colitis sometimes associated with the use of clindamycin. Metronidzole is said to be potentially mutagenic (likely to cause cancer), but short-term use has not been shown to cause cancer.
Dry lips
Cause varied. Sjogren's syndrome (an autoimmune disorder associated with dry mouth and dry eyes), hypothyroidsim, drugs in the treatment of hypertension, acne (Roaccutane). Most common cause is environment like cold dry weather. Allergy to metal canister. Treatment is frequent application of misturisers or lip balms containing beeswax (good moisturing properties) +/or topical steroids in allergies. More detailed medical test if problem persists.
236. Sleep bruxism
Sleep bruxism - grinds one's teeth involuntarily during sleep. One in 3 children and some adults. Causes - stress, anger, trauma, some drugs, genes. Leads to jaw pain, tense facial muscles, head and ear aches, worn out teeth.
Does this happen in dogs and rabbits during sleep? In people, treatment of underlying conditions, pain relief and mouth guard to wear during sleep.
Does this happen in dogs and rabbits during sleep? In people, treatment of underlying conditions, pain relief and mouth guard to wear during sleep.
235. Uterine Artery Embolisation (UAE) shrinks fibroids
Reference: The Straits Times Mind Your Body, Oct 21, 2010
Fibroids are benign tumours in women and affect 40% of women aged over 40. Cause pain and heavy bleeding or prevent pregnancy if inside the fallopian tubes. It will not eliminate all fibroids unlike surgical removal but does not require surgery with its complications.
UAE is a non-surgical way using a tiny catheter to block the blood flow in the artery that supplies blood to the fibroids. It is done by radiologists but Dr Bruce McLucas, an American gynaecologist wants to train gynaecologists to do it. In SGH, Prof Tan Bien Soo, senior consultant radiologist said it is team work between different specialists that matters. He says there is "continuity of care" in SGH where the procedure is currently done by radiologists who usually don't follow up on the patient, unlike the gynecologist.
Done under sedation, UAE leaves no scars and no blood loss. Outpatient procedure, less cost and recovery time. In 9/10 women, UAE shrinks the fibroid by 60% within 6 months, sufficient to stop pain and other compications. UAE is less damaging han myomectomy (surgical removal of fibroids) or hysterectomy (entire womb with or without ovaries and fallopian tubes surgically removed).
Fibroids are benign tumours in women and affect 40% of women aged over 40. Cause pain and heavy bleeding or prevent pregnancy if inside the fallopian tubes. It will not eliminate all fibroids unlike surgical removal but does not require surgery with its complications.
UAE is a non-surgical way using a tiny catheter to block the blood flow in the artery that supplies blood to the fibroids. It is done by radiologists but Dr Bruce McLucas, an American gynaecologist wants to train gynaecologists to do it. In SGH, Prof Tan Bien Soo, senior consultant radiologist said it is team work between different specialists that matters. He says there is "continuity of care" in SGH where the procedure is currently done by radiologists who usually don't follow up on the patient, unlike the gynecologist.
Done under sedation, UAE leaves no scars and no blood loss. Outpatient procedure, less cost and recovery time. In 9/10 women, UAE shrinks the fibroid by 60% within 6 months, sufficient to stop pain and other compications. UAE is less damaging han myomectomy (surgical removal of fibroids) or hysterectomy (entire womb with or without ovaries and fallopian tubes surgically removed).
Sunday, November 7, 2010
Holiday at Philea
I had a 3-day 2-night stay at a brand new resort in Melaka and shares my experiences with readers
MARKETING INFO FOR DESIGN TRAVEL PTE LTD, www.designtravel.com.sg
1. Philea Resort & Spa, Ayer Keroh, Melaka. I arrived on Friday (Deepavali), 5 Nov 2010. There was a Bridal Fair 2010 at the Philea Ballroom which can seat a maximum of 500 people for weddings. For 200 people, the ballroom can be partitioned. There are small meeting rooms which seat around 10-20 people.
2. All info on the Philea Resort is at:
http://www.phileahotel.com/resort_melaka_malaysia/index.html
3. MARKETING SEGMENT. I believe that the type of corporate customers for this resort is:
3.1 Not those on budget like young adults who want to shop and dine till past midnight as they will need a taxi to come back to the Philea Resort & Spa which is not in the down-town location.
It will be OK for expatriates who can afford taxis and I have seen 2 older Caucasian expats in their 30s, returning by taxi at around 9pm.
3.2 Prospects with spending power including families and professional bodies. According to travel agency owner, Mr Richard Goh who picked me up from Equatorial Hotel on arrival in Melaka to send me to Philea Resort, thinks that church people may not have the spending power to host the retreat in Philea Resort & Spa.
3.3 If you send corporate customers, they will be those that appreciate the finer things in life like living in a spacious all-pinewood rooms including flooring and walls, new bathroom with long bath and showers rustic environment far from the city crowds and noises and villas instead of apartment-type or room-type hotel, low rise low density resort alternative to hotel high-rise of around 200 units or as pre-arranged.
3.4 Caucasians will definitely like this wooded villa ambience and the Russian-sourced pinewood buildings. Pictures are at the website.
3.5 Food & Beverage was generally good. During my 2 nights stay, the buffet dinner was excellent. The baby lobster was great on the first night but not so good on the second night. The satay of beef and chicken was consistently great. I like the braised beef. No pork is served. So this resort may appeal to the Singapore Muslim community for retreats.
3.6 50% F&B discount for senior citizens is a great incentive. The buffet dinner had 2 types of soups. There was a great interest in baby lobsters, prawns, shell fish, squids, Italian food, cakes, ice-cream etc was around RM26.00 per senior citizen. The breakfast coffee was bad and tasted like charcoal. Waiters' service was great. Dinner may be outdoors with no air-condition as the air conditioned cafe can seat around 100 people.
3.7. New resort. This is a selling point. Opened around June 2010.
3.8 Around 10-minute drive to the town centre. There are taxis available. For our corporate clients, you will need to provide a shuttle service and driver. I know of one operator who picked me up from Hotel Equatorial to this place. He is a travel agent and is contracted to Transtar. He has his own coaches and tour guides as well as taxis. Will give you the email later.
3.9 A Butterfly farm is just 5-10 minute walk by the back gate from Philea Resort. I will go there today, Sunday morning before I check out.
4.0 3-4 hour coach ride from Singapore to Melaka. There was an accident somewhere during my departure from Singapore to Melaka on Friday, Deepavali. The Causeway jam was from 9 am to 1.30 pm. I reached Philea Resort & Spa at around 6 pm.
4.1 The coach could have dropped me at the last toll gate which is a short walk to Philea Resort & Spa. Instead Transtar arranged for me to go to Hotel Equatorial. The taxi driver and travel agency owner, Mr Richard Goh was not around. I had to ask the Equatorial hotel receptionist to phone him. Transnational Travels had not made any arrangments for delayed arrivals nor give me instructions on what to do or tel when there is a delay in arrival. This was bad planning. Mr Richard Goh said it was unusual as most people from Singapore took 3-4 hours to reach Melaka by 3 p.m. So, he left the Equatorial Hotel which was just a drop-off point.
5. Room in the Pavillion Villa (180 units - 2 storeys bungalows, each with 4 units, upper and lower separated by a central staircase). Spacious and is bigger than some Singapore's 5-star hotel rooms like Westin. Pinewood flooring looks clean and bright. It feels great to walk upon, without the need to wear shoes. Bathroom has pinewood doors, rectangular white porcelain basin top, no-closed up screen on long bath, spacious shower area with glassed partition, big mirror and black tiled flooring giving a luxurious appearance. No adjoining room for big families but the central staircase of each level has doors facing each other and therefore the families with children can connect via the staircase landing.
6. Possibly Philea Resort & Spa has only two competitors. One in the same class will be A' Famosa Resort Malaysia, http://www.afamosa.com/main.php?m=Content&op=page&id=160. Philea Resort is not a theme-park concept unlike A'Famosa. It is said to be the only resort with pinewood logs (inter-locking, no screws and nails) with logged villa accommodation in Malaysia. There is one new development with villas built over the sea in KL I can't recall its name.
I hope the above info helps.
Best wishes.
MARKETING INFO FOR DESIGN TRAVEL PTE LTD, www.designtravel.com.sg
1. Philea Resort & Spa, Ayer Keroh, Melaka. I arrived on Friday (Deepavali), 5 Nov 2010. There was a Bridal Fair 2010 at the Philea Ballroom which can seat a maximum of 500 people for weddings. For 200 people, the ballroom can be partitioned. There are small meeting rooms which seat around 10-20 people.
2. All info on the Philea Resort is at:
http://www.phileahotel.com/resort_melaka_malaysia/index.html
3. MARKETING SEGMENT. I believe that the type of corporate customers for this resort is:
3.1 Not those on budget like young adults who want to shop and dine till past midnight as they will need a taxi to come back to the Philea Resort & Spa which is not in the down-town location.
It will be OK for expatriates who can afford taxis and I have seen 2 older Caucasian expats in their 30s, returning by taxi at around 9pm.
3.2 Prospects with spending power including families and professional bodies. According to travel agency owner, Mr Richard Goh who picked me up from Equatorial Hotel on arrival in Melaka to send me to Philea Resort, thinks that church people may not have the spending power to host the retreat in Philea Resort & Spa.
3.3 If you send corporate customers, they will be those that appreciate the finer things in life like living in a spacious all-pinewood rooms including flooring and walls, new bathroom with long bath and showers rustic environment far from the city crowds and noises and villas instead of apartment-type or room-type hotel, low rise low density resort alternative to hotel high-rise of around 200 units or as pre-arranged.
3.4 Caucasians will definitely like this wooded villa ambience and the Russian-sourced pinewood buildings. Pictures are at the website.
3.5 Food & Beverage was generally good. During my 2 nights stay, the buffet dinner was excellent. The baby lobster was great on the first night but not so good on the second night. The satay of beef and chicken was consistently great. I like the braised beef. No pork is served. So this resort may appeal to the Singapore Muslim community for retreats.
3.6 50% F&B discount for senior citizens is a great incentive. The buffet dinner had 2 types of soups. There was a great interest in baby lobsters, prawns, shell fish, squids, Italian food, cakes, ice-cream etc was around RM26.00 per senior citizen. The breakfast coffee was bad and tasted like charcoal. Waiters' service was great. Dinner may be outdoors with no air-condition as the air conditioned cafe can seat around 100 people.
3.7. New resort. This is a selling point. Opened around June 2010.
3.8 Around 10-minute drive to the town centre. There are taxis available. For our corporate clients, you will need to provide a shuttle service and driver. I know of one operator who picked me up from Hotel Equatorial to this place. He is a travel agent and is contracted to Transtar. He has his own coaches and tour guides as well as taxis. Will give you the email later.
3.9 A Butterfly farm is just 5-10 minute walk by the back gate from Philea Resort. I will go there today, Sunday morning before I check out.
4.0 3-4 hour coach ride from Singapore to Melaka. There was an accident somewhere during my departure from Singapore to Melaka on Friday, Deepavali. The Causeway jam was from 9 am to 1.30 pm. I reached Philea Resort & Spa at around 6 pm.
4.1 The coach could have dropped me at the last toll gate which is a short walk to Philea Resort & Spa. Instead Transtar arranged for me to go to Hotel Equatorial. The taxi driver and travel agency owner, Mr Richard Goh was not around. I had to ask the Equatorial hotel receptionist to phone him. Transnational Travels had not made any arrangments for delayed arrivals nor give me instructions on what to do or tel when there is a delay in arrival. This was bad planning. Mr Richard Goh said it was unusual as most people from Singapore took 3-4 hours to reach Melaka by 3 p.m. So, he left the Equatorial Hotel which was just a drop-off point.
5. Room in the Pavillion Villa (180 units - 2 storeys bungalows, each with 4 units, upper and lower separated by a central staircase). Spacious and is bigger than some Singapore's 5-star hotel rooms like Westin. Pinewood flooring looks clean and bright. It feels great to walk upon, without the need to wear shoes. Bathroom has pinewood doors, rectangular white porcelain basin top, no-closed up screen on long bath, spacious shower area with glassed partition, big mirror and black tiled flooring giving a luxurious appearance. No adjoining room for big families but the central staircase of each level has doors facing each other and therefore the families with children can connect via the staircase landing.
6. Possibly Philea Resort & Spa has only two competitors. One in the same class will be A' Famosa Resort Malaysia, http://www.afamosa.com/main.php?m=Content&op=page&id=160. Philea Resort is not a theme-park concept unlike A'Famosa. It is said to be the only resort with pinewood logs (inter-locking, no screws and nails) with logged villa accommodation in Malaysia. There is one new development with villas built over the sea in KL I can't recall its name.
I hope the above info helps.
Best wishes.
233. Hamster vets
E-MAIL TO DR SING DATED NOV 7, 2010
I am writing to you because I have a dwarfhamster that has not emptied
his cheek pouch in two weeks not even when I gently press on the back
of his pouch. It also seems that his teeth might be too long, although
I am not quite sure how long hamster teeth should be. On your website
you have many stories about how you have treated hamsters, and it
seems that you have a lot of knowledge on this subject therefore I am
asking you for your help.
I live in the Netherlands where it is very hard to find a veterinarian
that knows how to treat small animals. I have called the vet and they
said they could not say anything without seeing the hamster first and
that they do have knowledge of hamsters. I have had several small pets
and this is their usual reply and when I bring my pet over the vet
usually knows a lot less than I do and always recommends just putting
it to sleep. The consultations are quite expensive therefore I really
would not like to go unless I would find a doctor that actually knows
something about small animals, they always say they do on the phone
but a soon as you stand in front of them they do not even know its
head from its tail.
The hamster seems to be doing fine, he does not look in distress and
he still eats and drinks. However, he seems to have slowed down.
Normally he is a very active animal that runs in his wheel for hours
and moves everything around in his cage but lately he is less active
and he seems to keep tripping and falling over when he is climbing
around on his toys, in such a manner that I have actually removed most
of his toys so that he would not be able to hurt himself. He is almost
two years old now, so maybe him slowing down is just because he is
getting older. Although my previous hamsters would remain active until
their death.
Another of my concern to bring the hamster to the vet is because he is
getting older and I am afraid that maybe the stress of being there and
maybe being handled by an inexperienced vet would make him die from
stress. Therefore, I hope you will be willing to give me advice on how
to take care of my hamster myself so I can do it in the comfort of his
own home. I would be very grateful! Could you tell me step by step how
to clean out his cheek pouch? Also how I could locate it, because when
I hold him by the scruff of his neck which makes him "smile" I cannot
see any entrance to his cheek pouch. Would you maybe be able to send
me a picture of how long the teeth of a dwarfhamster should normally
look like? I can find a lot of pictures online where the teeth are
extremely long and curled up, but my hamster does not have this. Oh I
almost forgot to say that my hamster also does not drool from the
mouth but he has not closed his mouth in a couple of days its always
just open for a little bit.
I really hope you can help me quickly before he gets sicker, I am of
course willing to pay for your consultation.
Kind regards,
Name of Owner
E-MAIL REPLY FROM DR SING
If the cheek pouch is impacted, you need to empty it. Usually I put the hamster under gas anaesthesia as it will be stressed and may die.
As for your case, your hamster may be comfortable with you. You need to restrain him and this is not easy, to empty his pouch. Use a blunt ended forceps to do it in this case. If the cheek pouch is inflamed and infected, you will need to look for an experienced hamster vet to use anaesthesia and do surgery.
I hope this advice will help. Impacted and/or infected cheek pouches are sometimes very difficult to empty as some seeds may have stuck inside and become embedded causing great pain in the mouth. If there is no anaesthesia and you try to force the hamster to empty its pouch, it may just die during your manipulation. That is why many vets don't like hamster treatment. No vets want to damage his reputation when the hamster dies during treatment. Best wishes.
I am writing to you because I have a dwarfhamster that has not emptied
his cheek pouch in two weeks not even when I gently press on the back
of his pouch. It also seems that his teeth might be too long, although
I am not quite sure how long hamster teeth should be. On your website
you have many stories about how you have treated hamsters, and it
seems that you have a lot of knowledge on this subject therefore I am
asking you for your help.
I live in the Netherlands where it is very hard to find a veterinarian
that knows how to treat small animals. I have called the vet and they
said they could not say anything without seeing the hamster first and
that they do have knowledge of hamsters. I have had several small pets
and this is their usual reply and when I bring my pet over the vet
usually knows a lot less than I do and always recommends just putting
it to sleep. The consultations are quite expensive therefore I really
would not like to go unless I would find a doctor that actually knows
something about small animals, they always say they do on the phone
but a soon as you stand in front of them they do not even know its
head from its tail.
The hamster seems to be doing fine, he does not look in distress and
he still eats and drinks. However, he seems to have slowed down.
Normally he is a very active animal that runs in his wheel for hours
and moves everything around in his cage but lately he is less active
and he seems to keep tripping and falling over when he is climbing
around on his toys, in such a manner that I have actually removed most
of his toys so that he would not be able to hurt himself. He is almost
two years old now, so maybe him slowing down is just because he is
getting older. Although my previous hamsters would remain active until
their death.
Another of my concern to bring the hamster to the vet is because he is
getting older and I am afraid that maybe the stress of being there and
maybe being handled by an inexperienced vet would make him die from
stress. Therefore, I hope you will be willing to give me advice on how
to take care of my hamster myself so I can do it in the comfort of his
own home. I would be very grateful! Could you tell me step by step how
to clean out his cheek pouch? Also how I could locate it, because when
I hold him by the scruff of his neck which makes him "smile" I cannot
see any entrance to his cheek pouch. Would you maybe be able to send
me a picture of how long the teeth of a dwarfhamster should normally
look like? I can find a lot of pictures online where the teeth are
extremely long and curled up, but my hamster does not have this. Oh I
almost forgot to say that my hamster also does not drool from the
mouth but he has not closed his mouth in a couple of days its always
just open for a little bit.
I really hope you can help me quickly before he gets sicker, I am of
course willing to pay for your consultation.
Kind regards,
Name of Owner
E-MAIL REPLY FROM DR SING
If the cheek pouch is impacted, you need to empty it. Usually I put the hamster under gas anaesthesia as it will be stressed and may die.
As for your case, your hamster may be comfortable with you. You need to restrain him and this is not easy, to empty his pouch. Use a blunt ended forceps to do it in this case. If the cheek pouch is inflamed and infected, you will need to look for an experienced hamster vet to use anaesthesia and do surgery.
I hope this advice will help. Impacted and/or infected cheek pouches are sometimes very difficult to empty as some seeds may have stuck inside and become embedded causing great pain in the mouth. If there is no anaesthesia and you try to force the hamster to empty its pouch, it may just die during your manipulation. That is why many vets don't like hamster treatment. No vets want to damage his reputation when the hamster dies during treatment. Best wishes.
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