313. Exporting dogs to Australia (continued)

1. E-MAIL TO DR SING DATED JAN 13, 2011

Hello Dr Sing,

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

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

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

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

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

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

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

http://www.csiro.au/resources/ps7p.html

Sincerely,
XXX


COPY OF REPLY FROM AUSTRALIA TO XXX



Dear XXX,



Thank you for your email regarding approved laboratories in Malaysia.



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



Veterinary Laboratory Branch

Animal & Plant Health Inspection Division

Primary Production Department

Central Veterinary Laboratory

13 Jalan Seranggong Kechil

Singapore

Telephone: 46 1867 4000

Fax: 46 1830 9162



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



Dr Stephen Prowse

Acting Director, AAHL

CSIRO Livestock Industries

Australian Animal Health Laboratory

Private Bag 24

Geelong VIC 3220

Australia

Phone: +61 3 5227 5000

Fax: +61 3 5227 5555

E-mail: _AAHL-Reception@csiro.au _

Web:http://www.csiro.au/places/aahl.html

Web page for import/ export blood
testing:http://www.csiro.au/services/ps62.html



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



I hope this is of assistance,



*Sarah Nash*

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

Phone: +61 2 6272 4454
Fax: +61 2 6272 3110
Email:animalimp@aqis.gov.au



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


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

*Page*:
http://www.daff.gov.au/aqis/cat-dogs/countries/cat4/info-pack-4#12

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



E-MAIL REPLY FROM DR SING DATED JAN 14, 2011

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

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


E-MAIL FROM XXX TO DR SING DATED JAN 25, 2011


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

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

E-MAIL REPLY FROM DR SING DATED JAN 25, 2011

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

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

312. Exporting dogs to Australia from Singapore/Malaysia

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


Hello Dr Sing,

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

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

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

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

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

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

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

http://www.csiro.au/resources/ps7p.html

Sincerely,

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

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

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


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

310. 24-hour service by a competitor

Wed Jan 20, 2011

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

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

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

A painter is angry at the vet

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

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

"How old is the cat? Did you tell her to put the cat to sleep?" I asked.
"4 years old. The vet should know that there was no hope in FIV. I don't buy animals. I adopt them. Now, this cat was already diagnosed as having FIV."
"Did you really instruct her not to treat but put the cat to sleep as there was no hope?"
"I did."
"How much were you charged?"
"$500."
I asked: "What does it include?"
"Treatment and some form of cremation."
"The charges are reasonable to me," I said.


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

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

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

Giving back to society

Tues Jan 18, 2011

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

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

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

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

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

Any readers interested, please e-mail judy@designtravelpl.com

307. Hamster loses weight after abscess treatment - email advices

E-MAIL TO DR SING DATED JAN 19, 2011

Good morning!

I have a worrying situation here.. :(

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

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

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

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

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

Thank you.

Yours sincerely
Name of Owner

EMAIL REPLY FROM DR SING DATED JAN 19, 2011

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

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

306, Divine play on the vet? puppy eyelid granulomas

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

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

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

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

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

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

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









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

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

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

The 72-year-old man didn't give a damn about Datuks.

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

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

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

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

At the lunch meeting, the GM of the hotel was very friendly. "Did the boss call about my request for 30 rooms?" Ben asked him. "Yes," he said. This showed that a rich business man can be rich because he personally is on top of things. 

Ben said: "He picked the furniture for the hotel by buying them himself." In this way, nobody could cheat him. No wonder he is rich. How did he become rich? Producing medicine in a factory in Indonesia. As for Ben, he sells raw materials to him and so is just comfortable.

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

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

"Do you drive a Mercedes to Johor?" I asked him. 

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

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

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

304. Caesarean section in a Maltese

Jan 15. 2011

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

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

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

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

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

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

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

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

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

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

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

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

http://www.bekindtopets.com/animals/
20081201PAGE2_Dog_Surgery_Anaesthesia_ToaPayohVets.htm

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

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

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

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

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

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

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