1137. Email query on cost of spaying female cats at Toa Payoh Vets

On Mon, Oct 8, 2012 at 11:58 AM, ...inn@hotmail.com> wrote:
Hi Ms Judy,

I have 2 female cats, both about a year old. I would like to know what are the charges for stabilizing both of them and how soon I can get an appt with your doctors. Please advise. Thank you.

Regards,
K


E-MAIL REPLY FROM DR SING DATED OCT 10, 2012
I am Dr Sing. Pl accept my apologies for the late reply. The fees for spaying one female cat is from $120 - $180 (with painkillers and antibiotic medication and e-collar home). If the cat is pregnant, the cost is an additional $50.
Pl phone 62543326 for appointment or just come at 9.30 am on a weekday preferred. No food and water after 10 pm, the next before.

1136. Hamster food for the new Syrian hamster

On Mon, Oct 8, 2012 at 7:23 PM, J@hotmail.com> wrote:

Hi Dr Sing,

This is J... We spoke just now about the Vitakraft food for Syrian hamster. I got this ingredient info from the website. The brand originates from Germany. Is this acceptable?

Thanks!

Regards,

J

EMAIL REPLY FROM DR SING DATED OCT 9, 2012

to daniel, Joycelyn






Good research on your proposed purchase of the Vitacraft hamster food for your new Syrian hamster. The alloe vera concentrate and the "approved additives" are the parts I will not feed my hamster as I don't know what long-term effects they will produce.



It is your own preference. If I have to buy only from this Vitacraft manufacturer, I will choose





Emotion ® Nature Dinner Emotion ® Nature dinner

Artikelnummer: 24306 Item number: 24306



There is an English translation at:

http://translate.google.com.sg/translate?hl=en&sl=de&tl=en&u=http%3A%2F%2Fwww.vitakraft.de%2F



The following is copied from this website:

Mit Emotion® Nature Dinner bieten Sie Ihrem Hamster Natur pur im Futternapf! With emotion ® Nature dinner offering your hamster pure nature in the food bowl! Knackige Kürbiskerne, leckere Kolbenhirserispen, gesunder Dinkel ... Crunchy pumpkin seeds, Kolbenhirserispen tasty, healthy spelled ... Die Mischung enthält die reine Vielfalt der Natur — die Rohstoffe werden frisch geerntet und schonend verarbeitet. The blend contains pure natural diversity - the raw materials are freshly harvested and carefully processed.

Emotion® Nature Dinner ist mit vielen energiereichen Zutaten perfekt auf den natürlichen Speiseplan Ihres Nagers abgestimmt und enthält zudem wertvolle Omega-3-Fettsäuren zur Unterstützung eines gesunden Fells. Emotion ® Nature's dinner with many energy-rich ingredients perfectly adapted to the natural diet of your rodent and also contains valuable omega-3 fatty acids to support a healthy coat. Natürlich versorgt das Naturfutter Ihr Tier auch mit allen lebenswichtigen Vitaminen und Mineralstoffen — mit speziellem ACE-Komplex zum Schutz der Zellen. Of course, the natural food supplies your pet with all essential vitamins and minerals - with a special ACE complex to protect the cells. Für ein natürlich gesundes Hamsterleben! For a naturally healthy hamsters life!

Pure Nature: Mit hochwertigen Komponenten aus der Natur Pure Nature: With high quality components from nature

Vitamine : Enthält Vitamine und Mineralstoffe Vitamins : Contains vitamins and minerals

Omega 3: Essentielle Fettsäuren unterstützen eine gesunde Haut und ein gesundes Fell Omega 3: Essential fatty acids support healthy skin and a healthy coat

Cell Protect: Mit ACE-Komplex zum Schutz der Zellen Cell Protect: With ACE complex to protect the cells

Für alle Hamster For all hamsters

Von Tierärzten und Nagerexperten entwickelt Developed by veterinarians and rodent experts

Artgerecht, hochwertig, ausgewogen Arthritis, high quality, balanced

Zuckerfreie Rezeptur Sugar-free recipe

Ohne künstliche Aromastoffe No artificial flavors

Ohne künstliche Farbstoffe Free from artificial colors

Ohne künstliche Konservierungsstoffe No artificial preservatives

Inhalt: 600 g Content: 600 g





Complete food for hamster

Zusammensetzung: Composition:

Pflanzliche Nebenerzeugnisse Vegetable by-products

Getreide (Kolbenhirse 5%, Dinkel 5%) Cereals (millet 5%, 5% spelled)

Gemüse Vegetables

Saaten (Kürbiskerne 3%) Seeds (pumpkin seeds 3%)

Nüsse Nuts

Fleisch und tierische Nebenerzeugnisse Meat and other animal products

Mineralstoffe Minerals

Öle und Fette (Sonnenblumenöl 0,06%, Rapsöl 0,02%) Oils and fats (sunflower oil, 0.06%, 0.02% rapeseed oil)

Hefen Yeasts



Zusatzstoffe/kg: Additives / kg:

Ernährungsphysiologische Zusatzstoffe: Nutritional additives:

Vitamin A (E672) Vitamin A (E672) 11429 IE 11,429 IU

Vitamin D3 (E671) Vitamin D3 (E671) 875 IE 875 IU

Vitamin E Vitamin E 770 mg 770 mg

Vitamin C Vitamin C 638 mg 638 mg

Selen (E8) Selenium (E8) 010 mg 010 mg

Eisen (E1) Iron (E1) 14.215 mg 14,215 mg

Jod (E2) Iodine (E2) 406 mg 406 mg

Kupfer (E4) Copper (E4) 469 mg 469 mg

Mangan (E5) Manganese (E5) 4.334 mg 4334 mg

Zink (E6) Zinc (E6) 3.547 mg 3547 mg


Drinking and peeing a lot is not normal in your hamster. Be observant.

Updates & images will be at:
http://www.sinpets.com/hamsters/20121009hamster_food_quality_toapayohvets.htm

1135. Hamster with sticky rat glue on its body

Today I got a phone call regarding a hamster with sticky rat glue stuck on its body. "Will vegetable oil remove the glue?' the young man asked me as he had researched the internet. "I don't know," I said. "Apply a small part first and see."  

1134. A constipated star tortoise who eats only French beans

Oct 8, 2012
I was surprised that this 7-year-old star tortoise has eaten solely French beans and nothing else for the past 7 years. Now, he had not pooped for the past 2 weeks. His shell is very soft, due to poor nutritional balances.

What to do with a constipated turtle?
"Give one ml of the enema into his anus," I said to Dr Vanessa. "Put him in the blue tub with water inside."
"Is the enema contra-indicated for tortoises?" Dr Daniel asked.
Dr Vanessa gave one ml and the tortoise popped out 2 cm x 1 cm brown stools in the water.
The owner was most happy but as he had to work late, he would bring the tortoise home tomorrow.
"What to do to improve his shell?" he asked.
"You need to give a variety of food," I said. "French beans for 7 years cannot be good for the shell."

Case study of male cat's blocked bladder - struvites urolithiasis

Cat, Male, Not Neutered, Ginger, 10 months old.

"I was renting an HDB flat and living in Toa Payoh," the slim Malay woman said. "You gave me a car ride home as I was pregnant. Now her big son came with me to consult me regarding her orange male cat born on Dec 23, 2011 as her cat could not pee again after treatment by Vet 1. She had bought her apartment in North Singapore and went to the vet near her home. 

"I went to Vet 1 because the clinic is just downstairs," she said. "I can't afford the treatment again as I had already paid $240.00 on Sep 29. Vet 1 wanted around $800 but I can't afford the fees. Yesterday (Oct 1), my cat can't pee again."

"It is not cheap to treat this blocked bladder disease," I said. The owner wants an excellent outcome for one treatment. Is it possible? Yes, in some cases if the owner complies with vet instructions.

VET 1'S TREATMENT ON SEP 29, 2012
Urolithiasis with urethral obstruction
Cat has not urinated for 2 days.
Rock hard fist-sized bladder
IV catheter. valium 0.5 ml slow IV. Methone 0.08ml IM. Alfaxan 0.7 ml slow IV. Iso/O2 maintenance. Urethral obstruction unblocked. Copious saline flushed and emptied bladder.

UA.
pH 6.5  SG 1.05  Blood 3+, Protein 3+. WBC 3+, Urobilingoen 2+
Sediment:  struvites 4+, Bact +, RBC+, WCC+, yaline casts +
Advised hospitalisation and urinary catheter in the bladder for 2 days but owner was not in favour owing to budget constraints.
.
Owner was warned that bladder would be blocked in the next few days and the consequences of
cat dying. Home on clavomox for 5 days. RC urinary S/O diet for at least 6-8 weeks and re-check urine.

TOA PAYOH VET'S TREATMENT ON OCT 2, 2012
Owner agreed to the cat being hospitalised.
Case handled by Dr Daniel and his written plans were:
Cat 4.9 kg, 39.2C
1. Sedation xylazine 0.2 ml + ketamine 0.8 ml IM

Cat, Male, Not Neutered, Ginger, 10 months old.

"I was renting an HDB flat and living in Toa Payoh," the slim Malay woman said. "You gave me a car ride home as I was pregnant. Now her big son came with me to consult me regarding her orange male cat born on Dec 23, 2011 as her cat could not pee again after treatment by Vet 1. She had bought her apartment in North Singapore and went to the vet near her home.

"I went to Vet 1 because the clinic is just downstairs," she said. "I can't afford the treatment again as I had already paid $240.00 on Sep 29. Vet 1 wanted around $800 but I can't afford the fees. Yesterday (Oct 1), my cat can't pee again."

"It is not cheap to treat this blocked bladder disease," I said. The owner wants an excellent outcome for one treatment. Is it possible? Yes, in some cases if the owner complies with vet instructions.

VET 1'S TREATMENT ON SEP 29, 2012
Urolithiasis with urethral obstruction
Cat has not urinated for 2 days.
Rock hard fist-sized bladder

IV catheter. valium 0.5 ml slow IV. Methone 0.08ml IM. Alfaxan 0.7 ml slow IV. Iso/O2 maintenance. Urethral obstruction unblocked. Copious saline flushed and emptied bladder.

UA.
pH 6.5 SG 1.05 Blood 3+, Protein 3+. WBC 3+, Urobilingoen 2+
Microscopy: Struvites 4+, Bact +, RBC+, WCC+, yaline casts +

Advised hospitalisation and urinary catheter in the bladder for 2 days but owner was not in favour owing to budget constraints.
.

Owner was warned that bladder would be blocked in the next few days and the consequences of

cat dying. Home on clavomox for 5 days. RC urinary S/O diet for at least 6-8 weeks and re-check urine.

TOA PAYOH VET'S TREATMENT ON OCT 2, 2012
Owner agreed to the cat being hospitalised.
Case handled by Dr Daniel and his written surgical plans were as follows:
Cat 4.9 kg, 39.2C

1. Sedation xylazine 0.2 ml + ketamine 0.8 ml IM

2. Catherisation + lavage + indwelling
3. Baytril + tolfedine inj
4. e-collar
5. vibravet 50mg 1 tab sid x 10
6. multivit x 1 bot

Urethral obstruction
Cat has not urinated yesterday. .

UA.
pH 7.0 SG 1.015 Blood 4+, Protein 2+. , Urobilinogen Normal
Microscopy: Crystals Nil, Bact Occasional, RBC >2250, WCC 198, hyaline casts Nil, spermatozoa +

Advised hospitalisation and urinary catheter in the bladder for 2 days but owner was not in favour owing to budget constraints.
.

Owner was warned that bladder would be blocked in the next few days and the consequences of

cat dying. Home on clavomox for 5 days. RC urinary S/O diet for at least 6-8 weeks and re-check urine.


CONCLUSION
There have been a few cases of urethral obstruction in male cats seen by me recently. It is a common condition in cats. As to the cause, it is difficult to say.

In this case, struvite urolithiasis has the same conditions of alkaline pH, bacterial infection and struvite crystals. It can be prevented by the use of anti-struvite reduction diet like C/D but most owners are not educated sufficiently to get the cat to switch over to C/D for at least one month and then to maintenance C/D. For economy reasons, I advise C/D for at least one month and then canned food. No dry food at all times. This cat was fed dry food (Snappy Tom) since kittenhood as his dam is also eating the same. No urolithiasis problem for the female.

Follow up education for struvite urolithiasis is essential to ensure that the owner complies with the feeding of C/D. In this case, the cat rejected the C/D when given 100%. I had to educate the owner to give 5% of C/D + 95% of the commercial canned food and slowly increase to 100% over a period of two weeks. She was willing to listen as recurrence will involve costly vet treatment. She was able to medicate the cat with antibiotics given via the food. Many cats will not take antibiotics and many owners simply give up easily.

In strurvite cases, bacterial infection of the bladder needs to be eliminated and an acidic pH of the urine is maintained by feeding of C/D diet. It is extremely difficult to educate most Singapore cat owners and vets don't have much time to do so. Urine checks should be done monthly and 3-monthly but none will be done in most cat cases. The theory is sound but in reality, the Singapore cat owners generally are not interested in follow up urine analysis in 2012.

I noted that owners may buy one can of C/D and then no more news from them.

1132. Struvite urolithiasis in cats

.
Cat, Male, Not Neutered, Ginger, 10 months old.

"I was renting an HDB flat and living in Toa Payoh," the slim Malay woman said. "You gave me a car ride home as I was pregnant. Now her big son came with me to consult me regarding her orange male cat born on Dec 23, 2011 as her cat could not pee again after treatment by Vet 1. She had bought her apartment in North Singapore and went to the vet near her home.

"I went to Vet 1 because the clinic is just downstairs," she said. "I can't afford the treatment again as I had already paid $240.00 on Sep 29. Vet 1 wanted around $800 but I can't afford the fees. Yesterday (Oct 1), my cat can't pee again."

"It is not cheap to treat this blocked bladder disease," I said. The owner wants an excellent outcome for one treatment. Is it possible? Yes, in some cases if the owner complies with vet instructions.

VET 1'S TREATMENT ON SEP 29, 2012
Urolithiasis with urethral obstruction
Cat has not urinated for 2 days.
Rock hard fist-sized bladder

IV catheter. valium 0.5 ml slow IV. Methone 0.08ml IM. Alfaxan 0.7 ml slow IV. Iso/O2 maintenance. Urethral obstruction unblocked. Copious saline flushed and emptied bladder.

UA.
pH 6.5 SG 1.05 Blood 3+, Protein 3+. WBC 3+, Urobilingoen 2+
Microscopy: Struvites 4+, Bact +, RBC+, WCC+, yaline casts +

Advised hospitalisation and urinary catheter in the bladder for 2 days but owner was not in favour owing to budget constraints.
.

Owner was warned that bladder would be blocked in the next few days and the consequences of

cat dying. Home on clavomox for 5 days. RC urinary S/O diet for at least 6-8 weeks and re-check urine.

TOA PAYOH VET'S TREATMENT ON OCT 2, 2012
Owner agreed to the cat being hospitalised.
Case handled by Dr Daniel and his written surgical plans were as follows:
Cat 4.9 kg, 39.2C

1. Sedation xylazine 0.2 ml + ketamine 0.8 ml IM

2. Catherisation + lavage + indwelling
3. Baytril + tolfedine inj
4. e-collar
5. vibravet 50mg 1 tab sid x 10
6. multivit x 1 bot

Urethral obstruction
Cat has not urinated yesterday. .

UA.
pH 7.0 SG 1.015 Blood 4+, Protein 2+. , Urobilinogen Normal
Microscopy: Crystals Nil, Bact Occasional, RBC >2250, WCC 198, hyaline casts Nil, spermatozoa +

Advised hospitalisation and urinary catheter in the bladder for 2 days but owner was not in favour owing to budget constraints.
.

Owner was warned that bladder would be blocked in the next few days and the consequences of

cat dying. Home on clavomox for 5 days. RC urinary S/O diet for at least 6-8 weeks and re-check urine.


CONCLUSION
There have been a few cases of urethral obstruction in male cats seen by me recently. It is a common condition in cats. As to the cause, it is difficult to say.

In this case, struvite urolithiasis has the same conditions of alkaline pH, bacterial infection and struvite crystals. It can be prevented by the use of anti-struvite reduction diet like C/D but most owners are not educated sufficiently to get the cat to switch over to C/D for at least one month and then to maintenance C/D. For economy reasons, I advise C/D for at least one month and then canned food. No dry food at all times. This cat was fed dry food (Snappy Tom) since kittenhood as his dam is also eating the same. No urolithiasis problem for the female.

Follow up education for struvite urolithiasis is essential to ensure that the owner complies with the feeding of C/D. In this case, the cat rejected the C/D when given 100%. I had to educate the owner to give 5% of C/D + 95% of the commercial canned food and slowly increase to 100% over a period of two weeks. She was willing to listen as recurrence will involve costly vet treatment. She was able to medicate the cat with antibiotics given via the food. Many cats will not take antibiotics and many owners simply give up easily.

In strurvite cases, bacterial infection of the bladder needs to be eliminated and an acidic pH of the urine is maintained by feeding of C/D diet. It is extremely difficult to educate most Singapore cat owners and vets don't have much time to do so. Urine checks should be done monthly and 3-monthly but none will be done in most cat cases. The theory is sound but in reality, the Singapore cat owners generally are not interested in follow up urine analysis in 2012.

I noted that owners may buy one can of C/D for a trial and then no more news from them. Unfortunately, most vets just don't have the time to educate their clients. The younger generation will be more sophisticated and educated by the internet and be more demanding for results and excellent outcome. Struvites are easier to dissolve by dietary management rather than surgery but it is up to the owners to accept vet advices for preventive check ups.

1130. Urban stress & barking dogs

On Saturday, Oct 6, 2012, I was having a business meeting with a 62-year-old slim man who was introduced to me by an old acquaintance realtor. This businessman had this offer of a S$150,000 rental commission per year from an oil rig company sending expatriates to Singapore. As he is not a licensed Singapore realtor, he could not handle this "lucrative" account. S$150,000 is a large source of revenue for a small-time realty.

My acquaintance said I needed only to pay 15% of the commissions to this man and to house the expats in serviced apartments. I agreed to meet him.   

During the meeting, he said the 15% would go to the American who would give him the exclusive deal. "I will get 40% of the commissions from you," he said. "This is a $150,000 yearly income. Both sides will sign an agreement to pay a penalty of 10% if they don't fulfill their obligations. However, you and I have to pay this American $6,000 upfront, otherwise, he will not give us the deal. You foot $3,000. This $3,000 is deductable from the 15% of the commissions you get. I give you 2 days to consider before I contact my other agents."

So, I was to pay $3,000 to somebody I don't know. I have to pay this American 15% and then 40% of the commissions to this broker. The expat arrivals would live in long term housing which means I have to co-broke with other agents at 50:50.

Assuming $150,000 commissions per year and 2/3 of it is due to co-broking as the other agent represents the Landlord. The gross income from co-broking will be 50:50 and this equals to 2/3x$150,000/2 = $100,000. 50% is given to the co-broker. So, the balance will be $50,000 for me. 15% goes to the American. The balance for me is $42,500. 40% goes to this man. I get $25,500.

Assume 1/3 of $150,000 is full commission to me.  Following the above formula, I get $25,500. The estimated income per year is $50,000. This assumes that there is $150,000 worth of business. I would have to provide 24-hour services to pick up the expat on arrival in Singapore at any hour of the day and give advices on education and provide after-sales services.

The man gets $50,000 for introducing this expat to me. He wants the $3,000 upfront and 2 days to decide.

Suddenly a thin balding man with a worried look passed by.  I knew him as an industrial park tenant and as a Landlord of a cluster bungalow in Punggol for many years. He had come to my Surgery 3 weeks ago to complain that the dogs were barking and depriving him of sleep. Now he brought up the same topic that I was not feeding the dogs and that was why they barked all day long.

"Please have a seat," I said to him. He did not want to sit.
"Why are you confrontational?" I asked him. "You came suddenly to complain about the dogs barking as they did not get fed some 3 weeks ago. I invited you into my Surgery to see the dogs. You saw the feed bowls were filled with dog food. Water bowls were full. "
"Your dogs are still barking today. They are not fed."
I was patient with him as I understood he had some loss in his business in this extremely competitive world where China is the world's factory, leaving little for the small-time businessman or manufacturer.
    

1129. A schwanoma in a dwarf hamster?

"Why didn't you see such a large tumour on the hamster's hand?" I asked the mother who brought it in for surgery and hoped that it would not die under anaesthesia as the one.
"Usually he hides inside the litter and eat and so we didn't see it."

Big tumours in the hand or leg may be inoperable. The whole paw will then need to be amputated. Front paws are like our hands and are very important for the hamster.

"What is your surgical approach to this case?" I asked Dr Daniel.
"Amputate the paw," he replied.
"That's what I thought at first," I asked him to hold the gentle 18-month-old dwarf hamster for me to take digital images of various positions of the hand tumour. The hamster was put in a bowl and we observed him climbing out of the bowl.

The tumour was gigantic. Imagine your hand having the biggest durian growing out of it.
"It is possible to excise the tumour without amputation," I said to Dr Daniel. "But the vet needs to produce a live hamster at the end of the surgery. To succeed, the surgery must be short and the anaesthesia must be sufficient to prevent pain. Severe pain may kill the hamster as in the bird."

No point doing an excellent surgery and showing a dead hamster on the operating table. "Isoflurane gas anaesthesia is too short and too risky if prolonged," I said to Dr Daniel. "I will use Zoletil  50 IM."

In a cat and dog, IM injections are common and routine. In a dwarf hamster, the needle must be just into the thin backside muscle. Not much of the muscles. Dr Daniel held the hamster while I injected 0.02 ml Zoletil 50 diluted with 0.03 ml saline and injected IM.

"The hamster will become groggy if the IM injection is given correctly," I said. In 60 seconds, the hamster stumbled. Dr Daniel operated. "Give isoflurane gas top up when the hamster moves," I said. "Otherwise he may die from fright and severe pain." The whole procedure took less than one minute.

"Should more tumour tissues be cut off," Dr Daniel asked. "No," I said. "The area is down to the bone and tendons. Any further incision will damage the superficial flexor tendons and the hamster will not be able to hold his seeds and grains with the right hand."

The hamster appeared groggly during the first hour after anaesthesia and this is a common observation. The mother was very happy to see him alive as her son was the one most concerned. Produce good anaesthetic outcome and you get more referrals. It is extremely risky to anaesthesia hamsters for long surgeries as they don't survive. Be observant and be careful.

The owner did not want histopathology as it would cost money. It was a firm white tumour. Could it be a schwannoma? A nerve sheath tumour?  Examine your hamster daily and get small tumours excised by your vet early. Tumours don't disappear with antibiotics and so, find a vet who operates on hamsters.

I saw another case of a lady who brought in a hamster saying there was a small lump on the belly area. This hamster had been licking bald the lower part of the belly, below the navel. I held the hamster and felt the nodule which was around 2 mm in diameter. The hamster squealed. However, the owner's preferred vet could not feel any nodule and so sent the hamster home with oral medication and asked to review it in 2 weeks' time. Owners know their hamsters best and if they find a nodule, it is usually there.   

More pic at
 http://www.sinpets.com/hamsters/20121005dwarf_hamster_hand_tumour_toapayohvets.htm

1128. A guinea pig drools for weeks and loses weight

The young couple's guinea pig kept losing weight and kept drooling despite treatments and 5 X-rays in a veterinary practice. "What is the cause?" the wife asked. "I hand feed the critical care but she loses weight to 370 g. She had given birth to two litters and her offspring is 800 g. She would be interested in food but wouldn't eat it."

This is a very complex and emotional situation for the wife. What more could be done? They consulted me for a 2nd opinion. I said: "Anaesthesia is necessary to examine the mouth properly." But the guinea pig is so weak and so thin. So the wife deferred any such examination and went home 2 days ago. I asked her to get all the medical records from the other vet who was most helpful. Today, she came with her husband at 2pm sharp. I reviewed the records. "Very good records," I said. "Dr X is a very good vet," the husband replied. "But she just can't put her finger on what causes this drooling."

There were 5 x-rays. Only one showed the head. "There seemed to be a curved "tooth" coming from the hard palate to the floor of the mouth," I said to the other vet. She looked at her X-ray copy simultaneously and said it could be the maxilla. In any case, I advised another X-ray of the side and bottom top view of the skull and also the chest and abdomen. I told her I do not have X-ray facilities and she was happy to help out.

The couple went there and then phoned me to say they would not want any anaesthesia to open the mouth for examination today. They would go home to feed the guinea pig. I said it was OK with me.

This guinea pig had drooling, slobbering (wet chin), runny nose, loss of weight, not able to eat. These are signs of dental problems in the guinea pig. So, what is the cause of the dental problem? Malocclusion? Another "entrapment of the tongue" by the arching cheek teeth? Protrusions of the cheek teeth not obvious?

This is a complete mystery till I see the X-rays tomorrow. As the X-ray did not require anaesthesia, the couple was happy. Still, the mouth cannot be examined properly just by opening it. It needs anaesthesia. But the risk is so high. So, we are back to square one.

NOTES
1. Dental disease. Runny eyes, runny nose, drooling, teeth grinding, selective eating, not eating, weight loss, slobbering.

2.  Guinea pig may not have the palpable protrusions at the ventral aspects of the mandible or at the lateral aspects of the maxilla as in the rabbit or chinchilla. Therefore, it may be hard to detect malocclusion.

3. GP + chinchilla
2(I1/1, C0/0, PM 1/1, M3/3) = 20 teeth.

Rabbit has I2/1 in case you don't know. It has 4 obvious front teeth and 2 more shorter and smaller upper front teeth behind the front teeth!  

1127. Follow up: 3rd sister and 13-year-old X with 3 bladder stones

Oct 2, 2012, a Tuesday. I took time off and went to Khin Khin Employment Agency at Peninsula Plaza to teach her manager more about the management of the business. The Government had increased increased the foreign worker quota and clamped down on phantom workers.

Now, a company must employ 5 Singaporeans before it can employ 1 foreign worker instead of 4 to 1. In addition, many companies have been fined for using "phantom workers" who are mainly retirees and others not gainfully employed by the company to make up the 4 Singaporeans to get approval for 1 foreign worker.

After the elections in which foreign workers were said to depress wages of Singaporeans, the foreign worker quota is raised and the foreign worker levy on employer is increased.   "Many of the retirees are now out of CPF contributions since they were phantom workers," I observed.

The euro crisis and economic recession reduced the demand for foreign workers. Some have to be sent home due to the increased quota and loss of phantom workers. So Khin Khin and other employment agencies find that they have little demand for their services from the small businesses looking for waitresses and drivers. No quota at all. Close shop or do other services.

As Khin Khin is in Yangon, I dropped in to check on her manager Ni Ni. He had been working 6 months on the S Pass and is supporting his wife and son in Yangon.

Suddenly a young lady in her late 20s and wearing greyish dental braces appeared at the door. Khin Khin's office door does not shut unlike other offices. She came closer and said to me: "Have I seen you somewhere before?" I was astonished. I could not recall. I did see her somewhere. "Are you Dr Sing?" she asked. "Yes," I said.
"Do you remember my dog Brandy?"
 "Yes," I said. "The 13-year-old cross bred with three bladder stones.
What a coincidence. I phoned her earlier to tell enquire about her dog's urination situation. The dog was OK but not eating the S/D.

I did advise neutering to reduce the enlarged and inflammed prostate to be done on Monday. But it is Wednesday today. The dog was no longer painful in the prostate when I discharged it 3 days ago but it was very painful when I took over the case. An enlarged painful prostate with bacteria in the bladder can cause painful and difficult urination, other than the 3 bladder stones. But it is hard to explain to the 3 sisters. After all, the dog is peeing normally. Owner compliance is much more difficult.

I did not remove the bladder stones because this dog was so skinny and might die under anaesthesia. Neutering is a short surgery and so I advised it to prevent prostate enlargement and inflammation. But it is extremely difficult to convince the owner to do it and this is a common situation in all medical practices.