A Myanmar fortune teller's accurate prediction

On Mar 15, 2012, I visited Khin Khin who operates the Khin Khin Employment Agency in Singapore. A fair lady in black with silky see-through on upper part was in sitting on a chair behind me in her room. "Can you remember her?" Khin Khin pointed her to me.

"Well, I do," I said. "She was the one working for an interior design company and wanted to quit within a few days of starting work because she had a hard time from the boss and her country-woman who did not want to teach her how to use the Auto-cad software."

Khin Khin always emphasized to employers the attractiveness of a prospective candidate looking for a job in Singapore. As if the physical appearance of a female job candidate counts and she considered this girl "pretty".

I had met this Myanmar girl in her office some weeks ago. She wanted to quit and I had advised her not to. "It is not easy getting an employer in Singapore," I said to her. Just wait. Your country-woman is going back for a holiday soon. Wait."

After that I did not see her till today.

As a picture is worth a thousand words, I have uploaded a picture of another lady whose facial features and fairness in complexion resembled this lady. A rectangular-shaped face, big eyes, porcelain complexion, beauty enhanced by a knowledge of how to use make up effectively to highlight the features. A black number of good quality dress material. Well groomed.

Khin Khin continued: "Her boss forced her to write a resignation letter. She cried in buckets of tears after that. Her mother took her to a fortune teller in Yangon. The fortune teller said that she would get a job in Singapore soon. She attended an interview. The new employer keyed in her details to MOM and she got the reply the next day. She got an S Pass within 24 hours."

I was much surprised as MOM does reject and delay applications for S Pass for many employers whose applications Khin Khin had submitted. Maybe these were "not strong" employers, according to Khin Khin.

I was more surprised that the fortune teller could predict so accurately.
"Well, she went to see Kuan Yin (Goddess of Mercy) in a temple in Bugis," Khin Khin said. "She promised to make an offer of $200 if she gets a job in Singapore."

"So was it the prediction of the fortune teller or the power of Kuan Yin?" I asked.
"Or both?"

Khin Khin is a Buddhist and does not believe in Kuan Yin's power. But she said: "It must be Kuan Yin."

The fair lady did not comment as I did not talk to her and she was in a hurry to go for another appointment. It was good news as it was practically impossible for her to work in the first employer's place without the depth of knowledge of Auto-cad and thereby needing the help of the incumbent. I could see that the incumbent would not teach her as that would mean being replaced by a lovely lady. Why should she? The working place is a ferocious jungle where good looks do count. So this young girl had no chance at all.

The boss forced her to resign possibly because the incumbent had threatened to quit. And it is not easy to find Singaporeans who can work in AutoCAD as employment is quite full in Singapore. Most young Singaporeans can find a job if they will work.

The next day, I phoned Khin Khin about other matters. She said: "The little girl asked me to accompany her to Bugis as she would be offering $200 to Kuan Yin. I went to pick up a stick from the container. Devotees throng this temple to ask the Kuan Yin for better business and health and would pick up a stick from the temple's container after praying.

The temple person said that it was "bad". What is "bad"?
"I don't know," I dared not say as I don't know the significance.
Khin Khin said: "I was asking for good reincarnation for my father." Her father of 82 years of age passed away last month.

"Since you don't believe in Kuan Yin," I said. "You don't have to worry about "badness" forecasted in the stick. Khin Khin had got a piece of paper from the temple and burnt it (to ward off the bad spirits?).

In any case, the story of this lovely girl getting an S Pass to work for another employer within the predictions of the fortune teller is true. If that fortune teller is so accurate, I should be flying to Yangon to consult him. But I rather not do that in case he predicted a bad future for me.

This is the 2nd incident I heard about an accurate prediction from a Yangon fortune-teller. The first involved a person having great difficulty in collecting a business debt in Singapore. He consulted the fortune teller who predicted that he would get his money back. When he came back to Singapore, the debtor agreed to pay him, by instalments.

In conclusion, is there any scientific explanations or do some Yangon fortune tellers have powers of predicting and changing the future?

910. Guinea pig websites

http://www.theguineapigforum.co.uk/

http://www.guinealynx.info/

http://www.rngp.org/ Rabbit and guinea pig welfare


http://www.catandrabbit.co.uk/html/guinea_pigs.html

909. Two guinea pigs not eating - white viscous urine, blood in the urine

Yesterday Mar 16, 2012 (Friday), I saw 2 cases of guinea pigs with urinary problems and reviewed the case with Dr Daniel as part of my mentorship program.

We had met an interesting and friendly experienced Australian banker who had travelled to all over the world to work, at Liang Seah Street at 11 am today. "How old are you?" he asked Daniel. He then told Dr Daniel that 20% of the young men of his age and new graduates are jobless in Ireland. He told me that my handshake was weak, compared to Dr Daniel. "Have you been to Timbuktu?" I asked him. "No," he said. "But I have been to various places in Africa. I was sad to see so many homeless children and the poverty."

P.S
I used to study English phases in primary school in the 1960s and there is a phase referring a distant place as Timbuktu which is actually present in Africa. I doubt I have a chance to visit it.

Case 1.
Not eating. Abdominal swelling obvious. The owner had seen me some months ago. "No more skin infection," she said. "My guinea pig is not eating."
Dr Daniel palpated the swollen abdomen. I did that after him. The swelling covered almost 90% of the abdomen. Soft distended bladder, in my opinion. I don't know what Dr Daniel thought. Was he thinking of ascites? Definitely, ascites present this pendulous abdomen.

Before I could speak further, the guinea pig squirted out white cloudy urine onto the stainless steel consultation table top. "The urine is not normal," I said. "I would take some for urine test." I took a new syringe to suck up some urine. The guinea pig voided much more urine. Thick cloudy liquid. As if the bladder had lots of white sand.

"Is it possible that my guinea pig has bladder stones?" the lady asked. "My other guinea pig had bladder stones. The vet removed it but then said another surgery had to be done."

"Why was there a need for a second surgery?" I asked.
"The first one was not done well," she said. "So, another one had to be done."
"What happened to the guinea pig after bladder surgery?" I asked.
"She lived for a few days and then died."
"In this case, the guinea pig might have or might not have bladder stones. We will wait for a few days and get the urinary tract infection treated first."

A follow up the next 2 - 7 days would be needed. X-rays would be needed to confirm bladder stones.


Case 2.
Not eating. Weight loss for 2 weeks. The owner had phoned me about bladder stone surgery. She had consulted Vet 2 recently and an X-ray had been taken. But two weeks ago, she consulted Vet 1 who gave a different diagnosis. Today she came with the X-ray as I had advised her to get it from Vet 2 to save her cost of the need to have another X-ray taken. Vet 2 had told her that the medical notes would be sent to me. "It is not the medical notes that is important," I said to the young lady. "It is the X-ray of the bladder stones and to see if there are other locations like kidneys and urethra where stones are lodged."

"The vet gave antibiotics for a gastric infection," the lady said. "But the guinea pig did not recover and was not eating. So I went to Vet 2 who took an X-ray and said there were bladder stones. She advised euthanasia."

"What was the original problem with your guinea pig when you saw Vet 1 as you said that your guinea pig was treated for stomach infection?" I asked.

"My guinea pig had passed blood in the urine."
"What did Vet 2 advise?" I asked. The lady was not so clear about this but she said: "I don't want the guinea pig to be put to sleep. She could not pee for the past few days and did not poop."

Smaller than normal 1-cm long faecal pellets were passed on the consultation table. I palpated the abdomen. "No swollen bladder," I said. "The guinea pig had passed urine and you might not have seen it."
"I saw a brown spot," the lady said. "Just that brown spot on the paper. I have separated her from the other guinea pigs"

"It is possible that you did not see the other spots if they are not coloured," I said. "Since I can't feel a swollen bladder despite you saying that the guinea pig had not peed, I would say that presently, the guinea pig had no urinary problem."

She phoned her mother regarding surgery to remove the bladder stones (> six of them). It was the cost of surgery quoted as $300. I advised against immediate surgery as the guinea pig was very thin and dehydrated. I asked her to syringe feed with the pink syrup, food and emergency care 6 times per day, as prescribed by Vet 2 for the next 2 days.

Doing bladder surgery today would have killed this poor-conditioned guinea pig. The antibiotics from Vet 1 and Vet 2 were working to clear the urinary tract infection for the time being. "Let her be much stronger to take surgery by nursing her the next 2 days," I said to her.

"In such cases," I said to Dr Daniel. "Immediate surgery is most likely to lead to death on the operating table." Sometimes, the guinea pig dies the next 2 days. So, it is better to get the pet stronger first.

A follow up 2-7 days is needed.

P.S. In Case 2, the worried owner did not say that the guinea pig had runny nose. I saw yellow fluid from the left nostril. "Your guinea pig has an upper respiratory infection and anaesthesia would be very risky. The guinea pig needs to recover from the infection." As you can see, an immediate operation would not be in the interest of the patient.

"Any death on the operating table is a very emotional affair for the owner and the operating vet," I said to Dr Daniel. "So, it is best to get the patient in the best possible health before any operation. Unless it is an emergency."

908. Rimadyrl for an 18-year-old Chihuahua with pain in the hips?

Yesterday I saw one case with Dr Daniel. The owner had been my old client for at least 18 years since his chihuahua is 18 years old.

WHAT IS WORRYING THE CLIENT?
This is the crux of the matter. I spoke to him. He said: "My dog was whining and crying the whole night. She couldn't sleep and therefore I couldn't sleep. She had constipation."

The dog was limping and had pain on the right limb. During X-rays, on extension of the limb, the dog bit the handlers. So, there was no problem with the cause of pain.

Now, prescribing Rimadyrl tablets. This is standard practice. "But this is an 18-year old dog," I said to Dr Daniel. "She is equivalent to a 100-year-old man. Rimadyrl has side effects on kidneys."

"Side effects of Rimadyrl occur only after taking the medication for some time," Dr Daniel said. "Not overnight."

"In Australia, the dog owners you saw practice with other vets, usually bring in their dogs for Rimadyrl earlier than 18 years old and so the side effects of long-term medication can be seen over time. This Chihuahua is 18 years old and has come in for the first time. In Singapore, many owners don't see the vet till a crisis happens. In fact, the owner said that the dog had no problems other than constipation. What if the dog dies when the owner gives Rimadyrl over the next 3 days? His kidneys and livers may not be that great at 18 years of age. Blood tests would show but why take the risk?"

I said: "What if the dog has an adverse reaction to Rimadyrl and die soon after consultation at Toa Payoh Vets? You will be accountable for the death from oral Rimadryl as this will be what the owner will say."

It is best not to prescribe NSAID orally for hip arthritis till the blood test results come in. Even then, pred would be safer.

Many new graduates think that pred should be avoided in all situations. So NSAIDs but in this case, it is better to be safe than have a dead dog dying of kidney failure due to Rimadyrl. Each vet has his or her own prescriptions and if you consult 3 vets, you may get 3 ways to treat your dog for "constipation:.

907. The veterinary prediction was inaccurate

One day in March 2012, I received a text saying that the rabbit was not eating or drinking. So I texted back that it needed to be examined. I thought it was a rabbit owner who had consulted Dr Daniel and me earlier. See the case of The Rabbit With A Tearing Eye at:
http://www.sinpets.com/F6/20120217cheek-teeth-ingrown-rabbit-eye-tearing-toa-payoh-vets_Singapore_ToaPayohVets.htm

She made an appointment via text. I confirmed similarly. A slim young lady in her early 20s came with a 5-month-old dwarf rabbit. She was a new client. "My rabbit is not eating and drinking. Could she be suffering from hairball? Could she be pregnant?"

Dr Daniel would be treating the case with me as the mentor. He palpated the abdomen. "Pregnant, with one (kit)," he declared. I palpated the abdomen and felt the soft 4x3 cm mass in the lower third of the abdomen. "Only an X-ray would tell how many kits there are," I said. "In an X-ray, you can see the number of foetal skeletons." And therefore the number of kits.

"When was the rabbit mated?" I asked the young lady who had said that there was a 6-month-old male rabbit living together with this rabbit. "Around 2 weeks ago," she said. "How long is the pregnancy?"

"Around 28 days," I said. In this case, the rabbit would be only 14 days pregnant.

"Should I get the rabbit X-rayed?" she asked me.
"No need to do it," I said. "Just wait for a few days. In the meantime, remove the male rabbit. Keep her in a quiet dark place by herself and give her newspaper pieces to make a nest."

"We still have to check the teeth," I said to the lady and Dr Daniel.
"Scruff the neck," he said. That is the usual method of restraint of a rabbit.
"No," I noted that the young lady was particularly concerned about her rabbit and would misconstrue that the vet was rough handling her dwarf rabbit. If you think about it, a dwarf rabbit is very small. Her mouth is also very small. Scruffing the neck with a man's hand would practically cover most of the forehead, leaving little space to open the mouth.

I imagine that this might not be the most appropriate method to open the mouth for the dwarf rabbit but it would be for the cat or dog.

"Just wrap the rabbit inside a towel, like wrapping a present," I said. The young lady was watching apprehensively and this method would be more gentle. Perceptions of a client as regards the vet's "rough handling of their pets" are made and remembered when the rabbit struggles or squeals during scruffing. Sedation was not necessary in this case and in this situation of a pregnant rabbit.

It was obvious that the cause of not eating and drinking could be due to pregnancy. But the teeth must be checked for malocclusion or overgrown as this is a most common problem in the rabbit when it does not eat.

So, I wrapped the rabbit in a soft white towel with the head showing. The lady was watching quietly. Then I got the artery forceps to open the rabbit's mouth. I asked Dr Daniel or the owner to shine the white light as the rabbit resisted the mouth opening. "See the back teeth," I said. "Are they overgrown or short?". It took some time and patience but the lady was able to see that the teeth on both sides of the cheek were short and trimmed. The rabbit was not co-operating but could not move much. She did not squeal.

I thought the rabbit was around 14 days pregnant since the lady said the mating was seen around 14 days ago. Life is full of surprises as you can see from the text message of thanks I got from her 3 days later when I texted her as a follow up. In fact, the rabbit stopped eating and drinking because she was about to give birth!

Dr Daniel predicted one kit on abdominal palpation. I was very cautious and said that only an X-ray would tell how many kits were there from the number of foetal skeletons visible in an X-ray.

Well, veterinary medicine is always full of surprises. In this case, the rabbit gave birth to two kits. So, you know why I never predict the number of kits, puppies or kittens just on an abdominal palpation! It is just unpredictable usually. Unless it is a "single pup" syndrome in a chihuahua!

906. Starting a pet grooming business in Singapore - my observations

THE SINGAPORE PET GROOMING BUSINESS


It is relatively cheaper to start a pet grooming shop in Singapore as compared to a veterinary clinic. Still the following factors contribute to success or failure based on my observations of many groomers opening and closing shop in Singapore every year, for the past 30 years:

1. Location - convenient, easy to park

2. Capital - need a few thousand dollars to last one year to pay the high rentals.
Landlords have no mercy on tenants and will want more and more rentals esp. if the business is good. Assuming a small shop in a poor location rents around $3,000/month, the rental per year is already $36,000.

3. Clientele - new grooming graduate. No clientele of significant numbers to sustain the operations.

4. Marketing - not guaranteed but must be done. Cost money and time.

5. Pricing - cheap, will get many cases but can't make much. Market rates can be as low as $40 with transport and grooming/dog. Therefore, estimate maximum of 30 dogs, the maximum gross income per day is $1,200.

For new groomers without solid clientele, average 3 dogs per day, no dog transport provided, the income of $120/day x 25days worked = $3,000. This amount can't even pay the rent and utilities. Sales of dog food and puppies may attract walk-in but there is the additional cost and the need to go for a course and be certified by the AVA to sell puppies.

6. Skills - unproven for a new graduate. Therefore, no referrals of significance. Pet owners may have to try their luck.

7. Free Transport - Some groomers need to transport dog home as they can't afford drivers. Many competitors provide transport-grooming package.

8. Wrist pain. Limited number of pets to be groomed. I estimate that 20-30 dogs groomed will be the limit for each groomer. Hand sprain, tendinitis, back ache unless the groomer gets a proper table.

9. Administration. Make appointments, get payments, send dogs home etc. That means hiring one assistant whose pay is around S$1,500/month.

10. Intense competition. Many groomers have set up shop as Singapore develops. How many of those who opened 10 years ago are still around?

11. Work-life balance. Is the young groomer prepared to work the long hours and weekends?

Relationships, motherhood, financial strength, high energy levels and hard work and long hours. How many of the google generation Singaporeans can sustain through the years and be focused to build up a solid reputation and be able to survive when landlords start increasing rentals again and again? Singapore rentals just keep increasing because commercial shop spaces are seldom built and therefore in short supply, unlike in countries like Australia.

904. Sunday's interesting cases. Mar 11, 2012 - Sedation to last stitch

Sunday, Mar 11, 2012

Sunday's interesting cases.
Sunday Mar 11, 2012

Singaporeans hate long waiting times at clinics to see a doctor and so I have started procedures to ensure that the waiting times should be less than 15 minutes. Many vets don't realise that clients hate to wait too long on Sundays.

For example, a neuter case on a Sunday can take up longer than 30 minutes (from sedation to last stitch) if the younger vet has no sense of time management. Or it could be done in 15 minutes with planning and pre-op preparation. Now I monitor the younger vets' efficiency in veterinary surgery by using time of sedation to last stitch and review the outcome of their surgeries (repeat stitching, stitch breakdown, infections etc).

Vets who don't make the mark will be asked to go. There is no other way because a higher standard of care must be achieved if Toa Payoh Vets is to be ranked by clients as the top 5 in Singapore. There are SOPs (Standard Operating Procedures) to be adopted and stuck to and I don't tolerate any lapse. AMA (Against Medical Advices) have to be recorded and medical records are to be written in greater detail than in the past.

A pug came in for neuter. I assigned the surgery to Dr Daniel and monitored the time he took. I ensured pre-op planning and preparation. Domitor and Ketamine at 50% and isoflurane gas. The sedation time to last stitch was around 30 minutes. It was OK but I said it could be shorter.

A dwarf hamster came in for left eye discharge and reddened left ear. Dr Vanessa was assigned the case. Not just some ear drops as the owner had been given such ear drops by the pet shop or Vet 1. Dr Vanessa scoped the ear. "A general anaesthesia had to be done to irrigate the ear," I said. The owner gave his consent. I asked Dr Vanessa to do a proper time management as she had other cases. In the end, I did the hamster myself with Dr Daniel as she other cases to attend to on this busy Sunday afternoon when clients came all together around 1-3 pm. I will have to follow up on this hamster.

A Schnauzer came in for a routine vaccination. Dr Daniel did it and told me that the dog had a black lump on the right of the backside and he had advised the owner to get it excised. It was good that he did a general examination and detected this lump. Some vets would just advise "wait till it grows bigger" but many tumours, if cancerous, grow bigger without the owner being aware of it, till it is too big.

The owner declined and wanted to wait and see. "The black lump is a melanoma," I said to the middle-aged couple with a teenaged daughter. "It has grown big but not that big yet. It is very black. Our advice to you is to remove it while it is easy to do so. And less expensive. You need not accept the advice. However, you cannot not say that the vets did not advise you during vaccination. When it grows bigger or spread to other parts of the body, you cannot blame the vets for not giving proper advice. Big tumours need big cuts and longer stitching. You have to pay much more. Older dogs like older people get tumours and it is better to get them cut away when they are small. Saves money and less worries of the tumours being cancerous and spreading later."

The couple was vacillating for some reasons. After all, they came to vaccinate their 5-year-old female Schnauzer. They were worried about the dog biting the wound and the lack of care-givers and wanted to wait later.

The vet's duty is to advise properly. "How much it will cost?" the father asked me. "$150 as it is a small tumour as anaesthesia will not be long and therefore the charges are less," I said. "Can surgery be done today?" he asked. "Yes," I said.

SURGERY
"This is a simple surgery," I said to Dr Daniel." It takes 5 minutes (from sedation to last stitch) to do the whole process." Dr Daniel looked at me incredulously. I was sure that he would adopt what the professors had taught him but that would be the traditional way. Sedate, intubate, use scalpel to make an elliptical incision with a wide margin. Undermine with scissors. Stitch up the two ends. How could the whole procedure take 5 minutes? I must be getting senile?

The dog was given Domitor and Ketamine at 50% IV. Isoflurane gas by mask was given though I would say it was unnecessary as you would see what I mean. From my experience, this dosage would be sufficient for a snip and a stitch.

"Pull up the elongated melanoma (1.5 cm x 0.5 cm, with a stalk) with forceps," I said to Dr Daniel. Snip it off with scissors around 3 mm away." Dr Daniel took a pair of curved scissors and snipped off the melanoma as advised.

The melanoma came off with about 50% of the dermis intact. There was the grey dermis but no subcutaneous tissues seen. "No need to stitch," I said as small bleeders ooze blood. "Just potassium permanganate powder to stop the bleeding. Cover the wound with plaster."

Dr Daniel had not seen such wounds being covered with plaster. This was the bulging backside area. Wouldn't the plaster just drop off, he must have wondered but did not speak his mind. I got two sticky plasters and covered the wound. The type you used when you cut your finger. They did not drop off.

This was one of those easiest surgeries in the world. Snip and stitch. But no need to stitch as the melanoma had a stalk and the skin was clear of melanomas by 3 mm. The owner did not want histopathology as they were also cost-conscious. So, none was done.

Veterinary surgeries present many variations. It is up to the vet to know what to do and how to do it efficiently. The surgery text book offers the standard method but there are better ways not described in the text book, as in this case.

904. DRAFT REPORT - The cat with the FLUTD - The beginning of the case

I will need time to review this case. Below is my earlier correspondence with the owners - after treatment of Tobi in April 2011.




Tobi's not peeing again ?!
2010emailsx


E-mails_Jun6,2009x


You Tubex


Owner
8/9/11

to me


Hi Dr Sing,

It's been a few months since i updated you about Tobi.
He was doing fine, up till 2 days ago.
Straining to pee and now vomitting after straining.
Some fur in his vomit too.
Very limited appetite too, as if he's scared to eat lest he throws it up.

I'll bring him to the clinic tomorrow morning.
Hope you can see him and advise what's troubling him.

Happy National Day !

J & S

-------------------------------------------------------------
Reply Forward


Owner S
8/10/11

to me


thanks. will try to be there by 1030. he managed to pee this morning!


On 9 Aug 2011 20:50, <99pups@gmail.com> wrote:
>
> Ok. 10am best
>
>
> Sent from my iPhone

>
> On Aug 9, 2011, at 6:02 PM, ...@gmail.com> wrote:
>
> > Hi Dr Sing,
> >
> > It's been a few months since i updated you about Tobi.
> > He was doing fine, up till 2 days ago.
> > Straining to pee and now vomitting after straining.
> > Some fur in his vomit too.
> > Very limited appetite too, as if he's scared to eat lest he throws it up.
> >
> > I'll bring him to the clinic tomorrow morning.
> > Hope you can see him and advise what's troubling him.
> >
> > Happy National Day !
> >
> > J & S
> >
> >
--------------------------------------------------
Reply Forward


Owner S
8/12/11

to me


Hi Dr Sing,

Tobi's much more alert and not hazy-dazy anymore.
Pee's ok although i didn't get to see it.
Taken his meds too.
Up till now, he's been confined to a room.

Thanks so much for ur treatment and advice.
Will keep him indoors and deny entry to the garden and car porch.

:) suzy



On Fri, Aug 12, 2011 at 7:14 AM, Kong Yuen Sing <99pups@gmail.com> wrote:

I spoke to your husband and fax copies of blood and urine test results to him yesterday.

1. Significant finding of the blood test is the low platelet count and the high glucose level. The low platelet count is probably due to the cat ingesting some toxic chemicals via grooming his coat. There was some "fur vomited" too. Abdominal pain was present.

2. For the urine test, there are bacteria, epithelial cells, white cells and red blood cells and a trace of protein present. This indicated a urinary tract infection involving primarily the bladder. A trace of protein may not be serious at this stage.

3. There is no kidney disease based on the blood and urine tests. No urinary crystals are detected. As for the high glucose level, a 2nd test is needed in 2 months' time to assess whether he has diabetes.

4. A test 2 months later is advised.

5 Advice: Keep the cat indoors and away from eating grass and soil. He has lost weight and this may be due to the ingestion of toxic chemicals tainting his coat and paws when he plays in the garden outdoors. Toxic chemicals may include insecticide and fertilisers and mosquito fogging chemicals. Some cats love to nap under the car, staining themselves with engine oil etc. So, it is best to keep this cat indoors all the time.

------------------------------------------

On Wed, Aug 10, 2011 at 9:49 AM, Owner S...@gmail.com> wrote:
thanks. will try to be there by 1030. he managed to pee this morning!

On 9 Aug 2011 20:50, <99pups@gmail.com> wrote:
>
> Ok. 10am best
>
>
> Sent from my iPhone
>----------------------------------------
> On Aug 9, 2011, at 6:02 PM, Owner S...@gmail.com> wrote:
>
> > Hi Dr Sing,
> >
> > It's been a few months since i updated you about Tobi.
> > He was doing fine, up till 2 days ago.
> > Straining to pee and now vomitting after straining.
> > Some fur in his vomit too.
> > Very limited appetite too, as if he's scared to eat lest he throws it up.
> >
> > I'll bring him to the clinic tomorrow morning.
> > Hope you can see him and advise what's troubling him.
> >
> > Happy National Day !
J & S
> >
>
-----------------------------------------------------------------
Owner S to me
8/13/11




yes, he does spend a good amt of time lying under the car.
he's more alert yesterday.
has started consuming more fluids and eating a little.
Pees fine too.
On 13 Aug 2011 07:35, "Kong Yuen Sing" <99pups@gmail.com> wrote:
> Did he go under the car to seek refuge in the past 2 months?

>
> On Fri, Aug 12, 2011 at 11:08 AM, Owner S...@gmail.com> wrote:
>
>> Hi Dr Sing,
>>
>> Tobi's much more alert and not hazy-dazy anymore.
>> Pee's ok although i didn't get to see it.
>> Taken his meds too.
>> Up till now, he's been confined to a room.
>>
>> Thanks so much for ur treatment and advice.
>> Will keep him indoors and deny entry to the garden and car porch.
>>
>> :) S
>>
>>
>>-------------------------------------------------
>> On Fri, Aug 12, 2011 at 7:14 AM, Kong Yuen Sing <99pups@gmail.com> wrote:
>>
>>> I spoke to your husband and fax copies of blood and urine test results to
>>> him yesterday.
>>>
>>> 1. Significant finding of the blood test is the low platelet count and the
>>> high glucose level. The low platelet count is probably due to the cat
>>> ingesting some toxic chemicals via grooming his coat. There was some "fur
>>> vomited" too. Abdominal pain was present.
>>>
>>> 2. For the urine test, there are bacteria, epithelial cells, white cells
>>> and red blood cells and a trace of protein present. This indicated a urinary
>>> tract infection involving primarily the bladder. A trace of protein may not
>>> be serious at this stage.
>>>
>>> 3. There is no kidney disease based on the blood and urine tests. No
>>> urinary crystals are detected. As for the high glucose level, a 2nd test is
>>> needed in 2 months' time to assess whether he has diabetes.
>>>
>>> 4. A test 2 months later is advised.
>>>
>>> 5 Advice: Keep the cat indoors and away from eating grass and soil. He
>>> has lost weight and this may be due to the ingestion of toxic chemicals
>>> tainting his coat and paws when he plays in the garden outdoors. Toxic
>>> chemicals may include insecticide and fertilisers and mosquito fogging
>>> chemicals. Some cats love to nap under the car, staining themselves with
>>> engine oil etc. So, it is best to keep this cat indoors all the time.
>>>
>>> On Wed, Aug 10, 2011 at 9:49 AM, suzy lau wrote:
>>>
>>>> thanks. will try to be there by 1030. he managed to pee this morning!
>>>>
>>>> On 9 Aug 2011 20:50, <99pups@gmail.com> wrote:
>>>> >
>>>> > Ok. 10am best
>>>> >
>>>> >
>>>> > Sent from my iPhone
>>>> >
>>>> > On Aug 9, 2011, at 6:02 PM, suzy lau wrote:
>>>> >
>>>> > > Hi Dr Sing,
>>>> > >
>>>> > > It's been a few months since i updated you about Tobi.
>>>> > > He was doing fine, up till 2 days ago.
>>>> > > Straining to pee and now vomitting after straining.
>>>> > > Some fur in his vomit too.
>>>> > > Very limited appetite too, as if he's scared to eat lest he throws it
>>>> up.
>>>> > >
>>>> > > I'll bring him to the clinic tomorrow morning.
>>>> > > Hope you can see him and advise what's troubling him.
>>>> > >
>>>> > > Happy National Day !
>>>> > >
>>>> > > J & S
>>>> > >
>>>> > >
>>>>
>>>
>>>
>>

Reply Forward


Kong Yuen Sing
8/15/11

to S


What is he eating now?


On Sat, Aug 13, 2011 at 10:09 AM, Owner S...@gmail.com> wrote:
yes, he does spend a good amt of time lying under the car.he's more alert yesterday.
has started consuming more fluids and eating a little.
Pees fine too.On 13 Aug 2011 07:35, "Kong Yuen Sing" <99pups@gmail.com> wrote:
> Did he go under the car to seek refuge in the past 2 months?
>
> On Fri, Aug 12, 2011 at 11:08 AM, suzy lau wrote:
>
>> Hi Dr Sing,
>>
>> Tobi's much more alert and not hazy-dazy anymore.
>> Pee's ok although i didn't get to see it.
>> Taken his meds too.
>> Up till now, he's been confined to a room.
>>
>> Thanks so much for ur treatment and advice.
>> Will keep him indoors and deny entry to the garden and car porch.
>>
>> :) S>>
>>
>>
>> On Fri, Aug 12, 2011 at 7:14 AM, Kong Yuen Sing <99pups@gmail.com> wrote:
>>
>>> I spoke to your husband and fax copies of blood and urine test results to
>>> him yesterday.
>>>
>>> 1. Significant finding of the blood test is the low platelet count and the
>>> high glucose level. The low platelet count is probably due to the cat
>>> ingesting some toxic chemicals via grooming his coat. There was some "fur
>>> vomited" too. Abdominal pain was present.
>>>
>>> 2. For the urine test, there are bacteria, epithelial cells, white cells
>>> and red blood cells and a trace of protein present. This indicated a urinary
>>> tract infection involving primarily the bladder. A trace of protein may not
>>> be serious at this stage.
>>>
>>> 3. There is no kidney disease based on the blood and urine tests. No
>>> urinary crystals are detected. As for the high glucose level, a 2nd test is
>>> needed in 2 months' time to assess whether he has diabetes.
>>>
>>> 4. A test 2 months later is advised.
>>>
>>> 5 Advice: Keep the cat indoors and away from eating grass and soil. He
>>> has lost weight and this may be due to the ingestion of toxic chemicals
>>> tainting his coat and paws when he plays in the garden outdoors. Toxic
>>> chemicals may include insecticide and fertilisers and mosquito fogging
>>> chemicals. Some cats love to nap under the car, staining themselves with
>>> engine oil etc. So, it is best to keep this cat indoors all the time.
>>>
>>> On Wed, Aug 10, 2011 at 9:49 AM, Owner S...@gmail.com> wrote:
>>>
>>>> thanks. will try to be there by 1030. he managed to pee this morning!
>>>>
>>>> On 9 Aug 2011 20:50, <99pups@gmail.com> wrote:
>>>> >
>>>> > Ok. 10am best
>>>> >
>>>> >
>>>> > Sent from my iPhone
>>>> >
>>>> > On Aug 9, 2011, at 6:02 PM, Owner S...@gmail.com> wrote:
>>>> >
>>>> > > Hi Dr Sing,
>>>> > >
>>>> > > It's been a few months since i updated you about Tobi.
>>>> > > He was doing fine, up till 2 days ago.
>>>> > > Straining to pee and now vomitting after straining.
>>>> > > Some fur in his vomit too.
>>>> > > Very limited appetite too, as if he's scared to eat lest he throws it
>>>> up.
>>>> > >
>>>> > > I'll bring him to the clinic tomorrow morning.
>>>> > > Hope you can see him and advise what's troubling him.
>>>> > >
>>>> > > Happy National Day !
>>>> > >
>>>> > > jeffrey & suzy
>>>> > >
>>>> > >
>>>>
>>>
>>>
>>


Reply Forward


suzy lau
8/15/11

to me


SD canned food.
becos he doesn't drink fresh water from bowl nor pet fountain, i add water to his food.
he laps up the soup but leaves the harder meat bits alone.
he can pee in a stream but only for a few seconds, then stops and come out of tray to lick his penis.
then he goes back again into the tray.
in out 4 or 5 times like that, then goes off elsewhere to lay down.
his antibiotic of half a tablet of baytril finishes today.
should i still continue his quarter tablet of prednisolone?
thank u so much for advice.

903. DRAFT - Searching for answers - The cat with the FLUTD - partial report

I am writing a draft of searching for answers in the case of the cat with the FLUTD that died after 5 days of hospitalisation at Vet 2. It is quite an emotional case for the young couple and for me too as the cat had been my patient too in April 2011 and I had written a case report to bring veterinary medicine alive for the poor vet students who are studying so hard to pass their examinations. Case studies will help them learn better than thick notes from their lecturers.

Tobi was one of those cats who hates vets and was outstanding for his hissing behaviour to warn vets and assistants not to touch him. See my report at:
http://www.sinpets.com/F5/20110437urinary-tract-infection-amitriptyline-cystitis-toapayohvets-singapore.htm

Suddenly I received an email from the owners that the cat had died and the email is as follows:

E-MAIL FROM OWNER DATED FEB 9, 2012

On Thu, Feb 9, 2012 at 4:12 PM, ...@yahoo.com.sg> wrote:
Dear Dr Sing A belated Happy Lunar New Year to you. I trust this email finds you in good health and standing. Its been quite some time since our male cat Tobi was treated at your wonderful practice. Unfortunately our beloved Tobi has passed away on Saturday, 4 February 2012. Just a bit of history. Tobi was admitted to your care on 24 April 2011. His case is listed in your website under cat cases-UTI -1st FLUTD.The cat can't pee again dated 12 June 2011. Shortly after his discharge, we moved into our new home. Tobi recovered well as there were no territorial cats and stress was kept to a minimum. He was maintained strictly on Hill's C/D wet food. However, sometime from October 2011, he seemed to be licking his private area again though not as frequently as when he had UTI , he was also peeing normally with good volume. His disposition and general health was very good. This continued until February 2012 when we noticed his urine volume seemed to have lessened somewhat and his penis appeared to be inflamed. We brought him to a vet(shall not mention the company name) who gave him an injection of antibiotics and anti-inflammation and discharged. Two days later, it did not seem to get better, we brought him back to the vet again, a blood test was performed with several struvite crystals detected. The vet advised us that a similar injection could be given or a catheter could be inserted. We chose the injections as we were trying to avoid Tobi being warded as it may be more stressful. In order to give the injections, Tobi had to be put under G.A. as he was putting up such a struggle.

Anyway it was done and he went home. Yet again two days he was still having difficulty peeing, this time we opted to bring him to another branch (this branch was 24 hrs with larger facilities). Tobi was sedated, warded with a catheter inserted and put on a drip via a Y-site. He was also given daily IV feeds with Cephalexin and calcium, diazepam amongst others. He seemed fairly alright the first two days, it was only on the 3rd day that we noticed he appeared rather "subdued", quiet, not he's normal fiesty self. By the 4th day ,he was lying down the whole time and didnt seemed to respond to us. We attributed this to possible lethargy and medication. The next day, his blood tests were normal and after a cursory examination he was declared fit for discharge despite the fact that by now he could not even stand up or move, we bascially had to carry him into his carrier to be brought home. We reached home in the mid afternoon and put him in the room, again we had to carry him out of the carrier.

From the time we reached home right until 10 pm, Tobi condition just deteriorated, once in while he would sort of jerk himself to another area in the room, Im not sure how he did this as he was immobile from the front quarters, his eyes could not track movement, he was drooling brown liquid and had raspy breathing. We took him back to the 24 hr branch at around 10.30 and the vet on duty arrived about 15 mins later,another blood test was conducted plus a chest x-ray, all looked normal, tests for leukemia and FIV was also done, clear as well. At about 11.30am, Tobi convulsed, expelled fluid and stopped breathing, we had opted for DNR.

An immediate autospy was done, organs again were all fine. Nobody seems to have an answer for his death. Needless to say, we are extremely saddened as well as puzzled by his sudden demise, more so when he was brought in for what ought to be a routine treatment for am inflamed penis. Instead five days later, we are having to cremate him. We have since search everywhere for anything information that might explain his sudden death. From what we found, we suspect, of course this may speculative at best, but it appears to be anaphylactic shock ( the question is what was the cause). Again we suspect it could he may have been allergic to one or more of the medications prescibed via the IV drip. Admittedly there could be numerous other possible causes. However we feel it seems to fit the symptoms Tobi displayed - pale gums, immobility, drooling, low temperature, increased heart rate. We are not ones to assign blame or find fault. Nonetheless, suffice to say we are disappointed with the level of monitoring at the vetirinarian branch Tobi was in. We are well aware that cats are notorious for masking pain and discomfort but honestly to discharge a cat that can't even stand on its feet! It would be like a doctor discharging a patient who can't walk and asking him to go home. While Tobi's blood tests looked fine, a more thorougly physical examination would have raised one or more red flags. From the time of his passing, not one person from the vet had called to offer their condolences or at least offer some theory as to Tobi's death. It's as if that there was no obvious cause, so nobody can be bothered about it. My wife and I are still coping with his passing but we are doing well. I just thought that since you treated Tobi twice and did such a wonderful job each time, we would like to let you know what has happened since then. Thank you for taking time to read this long email. Meanwhile, we wish you all the best in your practice and your great care towards all animals, big and small. P.S. we would have like to gone back to you but the distance was a bit prohibitive. Anyway we thought it would be just a routine treatment but...... Best Wishes & Regards J & S



E-MAIL TO OWNER DATED FEB 10, 2012

Further to my email,
1. was there an X-ray of the kidney and bladder done?
2. I can review, free of charge, the treatment records and procedures done on Tobi for you and your wife to understand more of what had been done and to learn from the case. I do not do it for litigation or complaint to AVA purpose. If you want the review, you will need to get the vets to give you a detailed report and they should have no problems doing it.





Dear Dr Sing

Our profound appreciation and thanks for your condolences and offer to review the case.

In response to your first email,

1. Yes it was a urine test that showed the struvite crystals.
2. DNR - do not resuscitate
3. Two X-rays done on Sat (approximately an hour before he died)
4. Urine test - Sorry I'm not sure at which point in time you may be referring to. When he was warded or on the day of his passing?
Even though we are still coming to terms with Tobi's death, we are at peace. Our intention to learn what happened was never about assigning blame or instituting litigation. If there is an practice that could perhaps be improved or certain medications that may cause potential complications, we would like to highlight to the veterinarian concerned so that it may something they could look out for in the future that may help prevent another unfortunate outcome. Tobi's death, tragic as it is, may perhaps prove beneficial in providing valuable lessons so that a similiar result can be avoided in the future. We would like to think that a vet practice or any business for that matter would welcome feedback for the betterment of their business and ultimately better care and results for their patients.

We had already obtained most of the work that was done except for the X-rays shortly after Tobi's passing. We have also scheduled an appointment with the owner of the practice this coming Tuesday. Again, we are meeting him not to lay blame but to gain a better understanding of why certain things were done and to address certain issues which we feel could be improved on. We hope that by doing so, all of us can learn from this experience and hopefully make a difference in the quality and care for all animals.

I will discuss with my wife to arrange a time to meet you. We hope we are not putting you throught too much trouble in reviewing this case as I know you are very busy and what little spare time you have is limited.

Best Regards
J & S




E-MAIL FROM DR SING Friday, 10 February 2012, 7:32
Subject:Re: UPDATE ON TOBI


Further to my email,
1. was there an X-ray of the kidney and bladder done?
2. I can review, free of charge, the treatment records and procedures done on Tobi for you and your wife to understand more of what had been done and to learn from the case. I do not do it for litigation or complaint to AVA purpose. If you want the review, you will need to get the vets to give you a detailed report and they should have no problems doing it.




E-MAIL FROM DR SING DATED Feb 10 2012




All vets learn from experience including me. I am most interested in reviewing your case for my own learning and to make improvements in the processes of FLUTD.

Presently, I am writing SOPs (standard operating procedure) for some procedures like urinary stones in dogs to ensure a consistent practice amongst the younger Toa Payoh Vets' vets as I cannot live forever.

Urine tests and X-rays (2 views) on the day of consultation or next day will be most useful. Urine bacterial culture and antibiotic sensisitivity tests as well.

Best wishes.

DRAFT REPORT - NEEDS TIME TO REVIEW AND COME TO A CONCLUSION.
TODAY'S MARCH 13, 2012 FINDINGS BY ME ARE:

On 4.2.12, on emergency admission and around 45 minutes before the death of Tobi,

1. the blood test did show an abnormally low platelet count. This may be a cause internal bleeding or may lead to internal bleeding, gasping for air and death. Lymphocytes % was below normal (immuno-suppression?) but total WCC was normal. RBC was normal. FeLV and FIV tests were negative. So, was there a starting viral infection acquired? Hard to say.

2. The BUN and CRE values were still normal but trending towards the higher end of the range of values just before death.

3. The necropsy result stated that the cause of death was unknown. However, necropsy should be done by an outside party to avoid conflict of interest. There were interesting necropsy findings such as patches of atelectasis in lungs, haemorrhages in the bladder (indwelling catheter? intra-bladder injection of baytril and Vit C?).

4. Intra-bladder injections of baytril and Vitamin C on the first day of admission. As each vet has his or her own method of treatment, I would only say that I do not practise such procedures and cannot comment further.

5. Salivation in the cat on the 5th day of hospitalisation was recorded in the case report. As to its significance, it is hard to say.

6. Sedation was given several times via the IV during the first 4 days of hospitalisation to control the "fiesty kitty". This leads to a loss of control of the reflexes leading to asphyxiation?

A combination of the above factors could contribute to death.

902. Searching for answers for a FLUTD cat that died after 5 days at Vet 1

It had been more than a week since I met the couple who was searching for answers to their cat's death and had written a report at:
http://www.sinpets.com/F5/20120235FLUTD-cat-died-searching-answers-Singapore_ToaPayohVets.htm


It was an emotional meeting for all of us as I did know Tobi too.
After some time to let sadness go away, today, at 5.30 am, I spared some time to review the case to find some more answers.


The cat was hospitalised by Vet 1 for 5 days to treat what the owner had diagnosed was a FLUTD recurrence. The cat was sent home on day 5 and he died at home. I am reviewing the case to search for the answers as to why he died. Experiences are learnt from failures or a death in this case. Every vet will have deaths and many times, the answers are not present.







Toa Payoh Vets webpages in chronological order

1. http://www.sinpets.com/F5/20110437urinary-tract-infection-amitriptyline-cystitis-toapayohvets-singapore.htm

2. http://www.sinpets.com/F5/20120235FLUTD-cat-died-searching-answers-Singapore_ToaPayohVets.htm

A review may give some answers and to prevent other deaths. Unfortunately, vets are not Gods and deaths will occur for various reasons.

HISTORY:

1. April 2010. The owners referred the cat to me for treatment after being treated by Vet 1. The cat recovered from the FLUTD. I treated the cat a second time in Nov 2010 and did not see the cat anymore. The case is recorded at:
http://www.sinpets.com/F5/20110437urinary-tract-infection-amitriptyline-cystitis-toapayohvets-singapore.htm

2. Feb 2011. The owners brought the cat to Vet 1 who then referred the cat to the main surgery and there the cat was treated by various vets (collectively called "Vet 2"). The cat was "fiesty" according to the medical reports of Vet 1 and was given sedatives IV and an indwelling catheter over the 5 days of hospitalisation. The cat was discharged on Day 5. He went home, had breathing difficulty and was sent back to Vet 2 for an emergency treatment. The cat was X-rayed to find out whether the chest had any problems causing respiratory distress. The X-rays were done around 45 minutes before the cat passed away.

The husband e-mailed to me about the cat's death and since the couple was not going to litigate, I volunteered to help to search for answers as to why a cat with a simple medical condition called FLUTD (Feline Lower Urinary Tract Disease) could just die and to give advises as to how to prevent a similar occurrence should they get another cat. The wife must have loved the cat a lot and that was 7 years of companionship. The husband was sad too as he just could not understand why the cat would die. I spared some time to meet and talk to them. This was the least I could do for a nice couple who cared very well for this hissing cat.

SOME E-MAIL CORRESPONDENCES
Fw: tobi's 11 page report + 2 x-rays
E-MAIL TO DR SING FEB 27, 2012


Dear Dr Sing

Please find attached copies of Tobi's reports and X-Rays (X-Rays were taken apprx 45 mins before his death)

Additiional information and our observations that are not in the attached reports


27/1/2012 - Tobi was given Convenia & Dexaason injections & injectable sedative29/1/2012 - Tobi was given Dexaason & Diazepam injections & Anaesthesia (Gaseous)
31/1/2012 - Tobi was Anaesthesia (Gaseous) - in attached report

31/1/2012 - ate a little, never ate again after this, behavior still normal
31/1 to 1/2/2012 - behavior still normal
2/2/2012 - lethargic, unusually calm
3/2/2012 - lethargic, urine scalding, disinterested,lying down the whole time
4/2/2012 - before discharge - could barely move, nose & ears cold, dried drool (brown colour), breathing slightly shallow
4/2/2012 - at home after discharge - hind limb paralysis, laboured breathing, eyes could not track movement
4/2/2012 - few minutes before his death at the hospital- somehow struggled out of his bed, gave a slight meow, convulsed, threw up and shortly after passed away

Thank you once again for sparing the time from your busy schedule to review. Even now, we are still coming to terms with the suddeness of it. I will call you tomorrow and perhaps we can arrange a time to meet at your convenience.

Best Regards
Name of husband




E-MAIL FROM DR SING DATED FEB 28, 2012




Please accept my condolences again.
1. I cannot understand why the X-rays are taken
2. Why were X-rays not taken earlier during admission?
3. Any urine analysis report?
4. How about the preceding vet's treatment report?

Were X-rays taken of the bladder area or not? There seems to be a big abdominal swelling in one X-ray. I will talk to you when we meet. Pl bring printed out copies.


SUMMARY OF SIGNIFICANT FINDINGS ON MEDICAL RECORDS
Cat admitted: 31.1.12. Owner complaint: Keeps licking on his penis.
Cat discharged: 4.2.12
Cat re-admitted: 4.2.12 after hours emergency. Died.


Cat behaviour: Hissing, fiesty, growls when approached from 31.1.12 to 4.2.12.

Sedatives given, mainly via IV:
31.1.12 Ketamine 0.2 ml, Valium 0.2 ml, Atropine 0.1 ml IV. Isoflurane gas to induce, local anaesthesia for urinary catheterisation, PDS 3/0 stitching catheter
Torbugeic 10 mg 0.5 ml IV

1.2.12 Valium 0.2 ml IV twice a day

2.2.12 Valium 0.2 ml IV 6 am and 0.3 ml at 11 pm. connect tom catheter to urinary bag.

3.2.12 Removed cathether.
4.2.12 Not as fiesty as first day. Salivation seen. Able to urinate normally.
Blood test significant findings: BUN 27 (10-30), CRE 2.1 (0.3 - 2.1)

4.2.12 After hours emergency. 36.2C . Very lethargic. FIV/FeLv test negative. X-ray lungs. Blood test significant findings: Lymphocytes % 9.6 (20-55), Neutrophils 79% (35-80), Eosinophils 10.4% (0-10). Platelets 140 (300-800)

Necropsy as requested by the owner:
Cause of death: unknown
All NAD except bladder wall thickened, slightly haemorrhagic.
Lungs with patches of atalectasis - PM change or secondary to dyspnoea towards the end??

Drugs used:
31.1.12 Inject baytril 0.3 ml intrabladder,Vit C 3m intrabladder. torbugesic 10 mg 0.5 ml IV.

Vit C 1000mg + 0.5 ml cefaxone IV BID, Ornipural 1 ml, Vibion l ml IV BID for first 2 or 3 days of hospitalisation.