Sunday, December 9, 2012

1213. Sunday Dec 9, 2012's interesting cases

Sunday Dec 9, 2012

I seldom have expatriates as clients and was surprised to encounter 3.
Case 1Shedding Husky. Buinsessman, his wife and pre-teen son who loves tennis.
Husky, female, 1 year 4 months. Shedding hair for last 2 weeks. "Hair all over the house," mum would say. Yet I did not see any hair loss as the son combs the dog daily.

"Hair shedding is common in Huskies," I said. "Causes include hot weather, ticks, recent heat and after birth."

"Was the dog carrying a toy in her mouth and protecting it?" I checked there was no milk in the nipples nor were they enlarged.
"Yes, one month ago. She would not part with it and was very possessive."
However, the left ear was very itchy and the dog would move her head away whenever I tried to examine it. A wet dark exudate presented on the cotton tip. The right ear was also itchy. So the dog tried to relieve her itchiness by using her hind legs to scratch the flanks and causing hair loss.

The solution was to treat the ears with proper ear drops and to plan to breed the Husky on the next heat. The father wanted a pup from her just for one litter. So I advised properly timing and everybody was happy.

Case 2. "Debarking" cats.
"I have never heard of anyone asking to debark cats," I said to the Caucasian caller over the phone today at 3 pm. He said that the cat would make loud noises and this may wake up his baby, due to arrive in May 2013.

"Other than this habit of making loud noises that may wake up the baby at 3a.m, he is a sweet gentle cat. I don't want to send him to the SPCA or get rid of him. Is it possible to debark him?"

"At what times is your cat vocal?" I asked.
"Early morning and late at night."
"Just like a cock crowing at dawn?" I asked.
"Yes, like a rooster but he does it at night too. What do you propose? I have him neutered at another vet at 5 months of age. Now he is 11 months old. He has been doing that since he is a kitten."
"You are the first person to enquire about debarking cats."
"That is why they refer to debarking. It is meant for dogs," he said.
I advised boarding the cat for one month to change his behaviour or crate him and cover the crate with a big towel to give him security and changing his routine. Will this work? The expat thanked me and might let me know.


Case 3. Two macadema nuts in a dwarf hamster.The Caucasian man brought his plump hamster for a review 2 weeks after treatment from Dr Vanessa. He had been to other vets but the hamster still has complete hair loss and redness on the lower body and the legs, on the back spinal area and left ear area. This has been going on for some weeks. The lower skin and neck were not so red but hairs did not grow back.

I saw scales on the shoulder area and the Mr Min could easily pluck out the hairs for a microscopic examination for ringworm. A few hairs had ringworm but most were OK. Was it skin mites? Or management? The hamster had been eating various kinds of food and had to climb into a feed bowl which was rather sharp. "Change to a lower feed bowl with smooth edges," I advised also putting the hamster on paper towels for a month."

This could be a case of management as the hamster was free to roam in the room. There are many causes and it will take time to know. In any case, I noted that the skin below the left ear was hairless and the left cheek pouch was hard. "There could be an impacted pouch," I said. "I need to give it a little bit of anaesthesia gas and check the pouch."
"Will it be safe for my hamster?" the man had said that his hamster had been passing blood for 5 days earlier.
"Yes, it will be safe as it is gas anaesthesia and takes a few seconds."
The left cheek pouch was impacted with two large cream-coloured macadema nuts and the hamster was trying to dislodge them by scratching till the skin below the left ear was bald.
"My wife is a pastry chef," the gentleman was surprised to see two big nuts of around 6 mm in length.
"No more macadema nuts or any other food other than a good quality hamster food," I advised bathing the hamster with the anti-fungal shampoo, clipping the hair, using paper towel as bedding for 4 weeks and reviewing after 4 weeks. 
 So, this Sunday was quite interesting with 3 different types of animals posing challenging problems for me. 

1212. "Tiny" ear tumour on dwarf hamster email query



 
On Sun, Dec 9, 2012 at 8:38 AM, Z..@gmail.com> wrote:
Dear Sir/Mdm,

I have just discovered a tiny growth on the ear of my hamster. Attached are the pictures for your reference.

I would like to know if there is any treatment for my hamster and the cost of it.

If so, pls advise on an appointment date and time. Thank you.




Regards,
Z
 

EMAIL REPLY SUNDAY DEC 9, 2012  9.28 AM FROM TOA PAYOH VETS
I am Dr Sing from Toa Payoh Vets. Thank you for your email. The "tiny" ear tumour needs to be removed by surgery and under anaesthesia. The ear canals need to be examined for other growths.

The approximate cost is $150-$200 for consultation, anaethesia, surgery (+/- stitching) and medication. Appointment is by phone 6254-3326. Bring hamster at 9.30 am and it goes home by 4 pm usually. Best wishes.   

Friday, December 7, 2012

1211. Straits Times Classified to sell mini-maltese


A silver Mercedes parked outside my Surgery. A fair lady in her 40s, wearing sparkling diamond ear rings and low cut  came to my surgery with 2 mini-Maltese pups and their parents for vaccination and her domestic worker. She was referred to me by Boon who I believe to be a dog breeder.

I could just vaccinate and she would rush home but I am concerned she is keeping too many puppies.
"The mini-maltese pups are getting bigger," I said. "Are you selling them?"
"I sold one at $1,500," she said. "But my son is in the US studying and does not help me to advertise in the internet."
"As they are young, it is best to sell them to a pet shop if you don't want to do it yourself," I said.
"Pet shops offer me $400/pup," she said. 
I advised her to advertise 3 lines in the Straits Times, Classified 74, Pets/Pets Care, preferably on a Saturday.

2 Mini-Maltese pups for sale. $1.2-$1.6K. Vaccinated. Tel: XXX
This classified cost around $39.00 and should get much response.

"You may get con-men who takes your pups outside the house and run away," I warned her.
"I will ask my two maids to be careful," she said. "I don't accept deposits."
"Not many people carry a thousand dollars. You can keep the mum till the buyer returns with the balance of payment."

Grown up sons overseas nowadays are too busy to help mum to advertise the puppies for sale.  Vets must be proactive to help clients who have excess pups. Otherwise they end up with too many as the laws permit 3 dogs/private residence and 1/public residence. 

1210. Follow up: British Bulldog - stone analysis is struvite stone

Dr Daniel made a follow up phone call to the owner yesterday Dec 7, 2012.

"Lots of bleeding from the operation area," the lady owner said. So, she brought the dog over to the surgery at 7.30 pm. Dr Daniel took out the plaster. I noted there was no bleeding. The dissolvable stitches (simple interrupted) were in place. Dr Daniel took out the stitches.

"You should be feeding the Bulldog 1 and 1/2 cans of S/D per day based on her weight instead of 2/3 cans".  The dog is now trim and on the thin side.

"I feed one can only," she said. "I note that the Bulldog no longer pants and is more energetic. So, I feed 1 can so that she would not put on weight!"

Owner compliance is much difficult. At least there is no blood in the urine so far. The stone analysis show struvite stone. A peculiar spiky one.

The dog had dry dog food when she was around one years old but the owner claimed that the dog was on home-cooked food from year 1 to 4 as a vet had told her that the skin disease would go away when the dog is fed home-cooked food. Yet such a large stone of 1.5 cm x 1.5 cm x 1.5 cm  could not be formed overnight. It would take months to form.

Webpage:
http://www.sinpets.com/F5/20121206_bulldog_urinary_stones_toapayohvets.htm

1209. Hamster from Malaysia email query



On Fri, Nov 30, 2012 at 5:01 PM, F@hotmail.com> wrote:


Hello Dr Sing Kong Yuen,

I'm from malaysia and i came across your site everytime i need to search information whenever i suspect my robo hamster are not feeling well which is not a good things. Past few weeks my 2 years old robo hamster been sctraching more than usual & i notice some bald patch. I took him to vet & the vet told me that my robo hamster are having demodex mites if i'm not mistaken. I couldn't find much information about this mites. If you could kind enough to explain more about this mites to me as It's kinda hard to find vet that take small animals as hamster at malaysia here.

The vet giving us some oral medication to be feed to our hamster with syringe twice per week. Today was my hamster 2nd medicine after last 3 days we have feed him with his 1st medicine. I have not seen any improvement on our hamster. Am i over worried dr. sing? When i'll see improvement on my hamster after the medicine? Is this demodex mites dangerous? is it serious? Can it be cure? He is my 1st hamster & it's very sad to see him suffer. It's worse than having myself to sick Sad smile

Thank you.

Regards,
F


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

Dec 7, 2012 REPLY FROM DR SING

Pl accept my apologies for the late reply.

Skin diseases in hamsters are due to many causes including trauma, mites, fungal, bacterial, allergies and poor management. I am sorry I can't help you via the internet correspondence. 

Thursday, December 6, 2012

1208. Calcium oxalate stones in a 10-year-old Jack Russell


The Jack Russell had difficulty urinating. X-rays showed two small stones. Urine analysis showed no bacteria but calcium oxalate crystals 3+. Blood was present in the urine.

"U/D will not dissolve the calcium oxalate stones," I said. "Unlike S/D diet which can dissolve small struvite stones."

Not every dog with calcium oxalate or other urinary stones need surgical removal. However, in this case, blood is still being passed with the urine and there is urethral obstruction of urine flow. Since U/D diet does not dissolve the calcium oxalate stones, but just prevent formation of more stones, it is best to remove such stones in this old dog and be careful.

1207. 12-year-old cat with two ingrown toe nails

Dec 6, 2012

Many phone queries cannot be answered by the receptionist as they are technical. Should the vet answer phone calls? That sounds a bit inappropriate for the top dog in a veterinary practice. However, answering phone calls should not be a shameful task as many prospects who receive satisfactory answers to their technical queries will turn up.

Sometimes, I think they are sophisticated pet owners who want to test the veterinary practice staff before they part with their hard-earned money. An old experienced vet nurse who have worked in practice for more than 10 years should be able to handle such queries but they are now as extinct as the dodo.

Two days ago, I had a phone call from a lady who asked if I declaw cats.
"Not as a routine," I said. "Only in exceptional circumstances where there is a need to do it. It is considered cruelty."
"Do you declaw the back legs as well?" she asked.
"Not necessary to do so," I said. "The cat uses his front legs to claw sofas, curtains and furniture, not the back legs."
"Well, I had a cat who uses her back leg to scratch my parquet floors!"
"Life is full of surprises and behavioural changes," I said. "This is the first time I hear a cat using the hind legs to scratch."
She thanked me and I learnt something new about cats.
Yesterday, the tanned lady in her late 30s came with her black and white cat. Her cat had two ingrown toe nails on the right fore paw. She work overseas and her maid did not dare to clip the nails till the dew claw and the 2nd digit claw curved into the flesh. The nails had exploded in width and the cat was not happy if you touch it. She was still a gentle female spayed cat though.

"A vet told me to just clip the nails and if the nails over-grow, to clip them again."
"That is the standard treatment," I said.

She wanted a permanent solution as she worked overseas and had no time to get the cat to the groomer or vet to trim off the ends of the overgrown nails. Time is short for city living folks and it is short for me too. So, I understood her situation but she had to decide whether to get the cat declawed.

"Only the two claws need to be removed," I said. I did not warn her that her cat might die under the sedation as this was a very short surgery and no cats ever die when the anaesthesia and surgery is as short as less than 5 minutes. For legal reasons, the vet has to inform the owner of the risks of anaesthesia and death on the operating table and asked her to sign the "informed consent" form.
I did not think this was necessary in this case.

"Remove the Phalanx one at the P1 and P2 joint," I said to Dr Daniel. This surgery should be a piece of cake for him unlike cystotomy or perineal hernial repair.  He operated and on the 2nd day, the lady came at 5 pm.

I was present as Dr Daniel had gone to the SAFRA gym. "Check the left front paw," I said to the sun-tanned lady with shoulder strapped blue dress. She had purchased a large luxurious towel bought from IKEA to cover the carrier.

"I thought you use the towel to wrap the cat," I said.    
"No," she laughed. "Once this cat peed through the door of the carrier onto the car seat. So, now I wrap the carrier with this big towel to prevent such incidents!"
A red car was waiting outside my Surgery. After she settled her bills with her credit card, she wrapped the carrier with the towel and went to the car. An elderly man came out and opened the door. "You must be the father," I guessed as the age difference would be twice. "Yes," he nodded his head. I said goodbye to the happy lady.

This old cat now has no kidney disorders as she had a blood test but the lady would continue feeding her the kidney diet. "The eosinophils at 9.6% is high. The platelets at 194 (300-800) are low."

"Why?" she asked.
"It is possible that the cat had ingested some poison or some application had been put on the ingrown toe nails."

This was a mystery as she said she did not do it. 
The backside hair loss on both sides would be less of a mystery. I massaged the anal sacs and 1 ml of dark chocolate oil shot out. "This would be impacted anal sacculitis," I said. "The hair should grow back after some time."


 






   

1206. Closed pyometra in an old Shih Tzu X

Dec 6, 2012
Ideally, it is best to use evidence-based medicine to get a diagnosis of closed pyometra. X-rays and blood tests are what the vet professors teach the new graduates.

However, in real life, there are clients who can't afford the tests. In this case, I usually get a good history and abdominal palpation of a big swollen uterus and operate to remove the uterus. There is always a possibility of no pyometra but a swollen bladder or an abdominal mass but economics prohibit more exploratory tests.

"It is how you present your case," I said to Dr Daniel. "If the owner has budget constraints, two X-rays add to the vet costs. There is a big orange-sized swelling in the abdomen. It could be the bladder but you said Mr Min had seen much urine being passed. Therefore, this globular swelling could be the uterus distended with pus."

The owner did not know when the last heat occurred. However there was vomiting yesterday and a complaint of sticky matter in the "urine." The dog was not eating much for the last 10 days. These clues point to pyometra. X-rays and blood tests will confirm.

The owner decided on X-rays.




There is closed pyometra, according to the X-rays. The uterus had swollen so much that the intestines were displaced forwards.

"Don't operate immediately," I said. "Give the IV drip and antibiotics 24 hours and operate after that. This ensures a better chance of survival, in my experience."

The owner will discuss further at around 7pm. There is no alternative but surgery to cure this dog. However, there is financial hardship for some owners and the newly graduate vet must the heartlander economics and provide the least cost surgery.


---------------------------------------------
Friday. Dec 7, 2012. The dog is better after IV drips yesterday but the rectal temp is below normal at 37.7 C.


The owner agreed to a blood test.
1. Kidney disorders. Urea 22  (4.2-6.3). Creatinine 188 (89-177).
2. Total WCC 62 (6-17) with N=98%. L=1.7%, M 0.3%. E & B =0%
3. Platelets 191 (200-500).
4.  Haemoglobin 9.9  (12-18)
5.  Red cell count 4.8  (5.5-8.5)

Surgery is necessary today but the risks are high as the dog has septicaemia and may die on the op table.

Wednesday, December 5, 2012

1205. Mynamar stories - An unhappy girl

On one afternoon in Dec 2012, I was at the office of Khin Khin Employment Agency. A thin fair lady in her late 20s came into the office to ask her to find an employer after working 6 months with the present employer who had told her that her services would end on Dec 15, 2012.

"Why do you want to spend more money in agency fees when you have a job now. You just put back $500 into your POSB account, apologise to your employer and complete your S pass contract," Khin Khin said loudly. "You should not have taken out the money as your boss had told you not to."

I was surprised that she could be sacked just for this $500. "Can you find the $500 to put back into the account?" I asked. "How much agency fee did you pay to get this job?" She said she had the money and had paid $4,500 agency fee.

"How much are you getting?" I asked. She said she got a good pay but she could not tolerate being scolded by her boss and colleagues.
"How many days off per month do you get?" I asked.
"4 days off," she said.
"So you have a good working condition," Khin Khin and I said. But there must be more to it than the $500 disobedience. I tried to help her by asking for her boss phone number since Khin Khin might not have the patience or ability to salvage this job loss situation with a Singapore employer.

The girl did not have the phone number. So I surfed the internet, got the company name and phoned the mobile number displayed.  It was her boss. "Who are you?" she asked me. "I am Dr Sing from Toa Payoh Vets," I said. "I am just trying to help your employee who said she would put back the $500 into the savings account and I hope she would get her job back."

"It is not the $500 which she already withdrew since the first month of work. Her agent had talked to her and I had waited for 6 months but her work attitude was bad. She swept the dirt under the table and this is 'pantung' (bad luck) to a Peranakan. She also smashed the curry puffs. I have given her Dec 15 as her last day and she has one month to look for an employer."

So this was an unhappy girl who had her first job in Singapore. A job so difficult to get nowadays as the Government clamped down on approvals even for employers who have the quota. Just a rejection letter for most employers. And there are so many young Myanmar ladies who are looking for a job in Singapore to support their families and to improve their standard of living. Yet, this unhappy girl showed her tantrums and misconduct.

She nodded her head when I told her that she had swept the dirt under the table and smashed the curry puffs in anger. "You must be from a rich Myanmar family," I said. Spending $4,500 on agency fees and more expenses just to get a job in Singapore cannot be affordable to the average Myanmar girl. "No, I am not", she said. A graduate in Myanmar with a good command of English and good looks may earn US$300-500 per month in a big company. It is just not easy to get a job in Yangon for higher pay. There are 60 million people in Myanmar and competition for jobs must be much more intense unlike the young Singaporean counterparts who can pick and choose their employer.

Poor work attitude afflicts many from the younger generation in their first job when the employment vacancies are high. As for this unhappy girl, I don't see any hope of her getting another job as there will be newer girls with no "leaving the Singapore employer before the end of contract - a red flag for employers" arriving in Khin Khin's office to look for jobs. Many of them can converse in good English and Mandarin, esp. from the Kachin State which is near to China.
P.S. According to one Myanmar lady in her 50s, she said that the Myanmar government stopped the teaching of English in primary schools in 1962. Those who studied English were ridiculed. So, the new generation of Myanmar nationals can't speak English proficiently.

1204. Integrity, meticulousness and bungling

Some young men are accident prone. I know of one young man. Whenever he plays football, he ends up with broken toe nails and lameness most of the time. I was surprised to encounter another young man in a similar predicament.This young man wanted to study vet medicine and he interned at my place. He got As for O level and is in a top Junior College and so he should be an intelligent young man.

Yet some forces affect his work as an intern.
One day, I asked him to pull out the plastic tab of the IV drip bottle as part of his hands on work. It is like pulling the metal tab of a can of Coke. I had already said he is a bungling person. He pulled the ring. The ring came off but the circular plastic cover still covers the IV drip bottle. It is like pulling out the ring of the Coke can but you can't drink because the circular piece didn't come off.

On another occasion, he showed me a video production. I encouraged interns to do it. "How come you showed the owner going away from Toa Payoh Vets when he is supposed to enter the Surgery to consult the vet?". He said: "Nobody will know. It is done in movies."

"Integrity of a production or any work process is very important," i said. "You think viewers are stupid but many will point this out. I don't want this Toa Payoh Vets video to be a multi-media class-room case study of the lack of integrity in production. In the National Service, we call bungling person cocked up." The young man laughed. Somehow fate seemed to be against him.

So he changed the scene. The video now showed the owner walking the dog into the Surgery to consult the vet. Great. "But how come the owner coming to see the vet wears a blue T-shirt and yet in the consultation room, he wears a yellow shirt?"  There is a need to be meticulous in a person's work esp. for a top school student.

After producing the video, he asked me to view it. I could see that the wording "subtitle/text" appeared again."Something wrong with the software," he said to me.

In the end, no video was produced.  A lot of time was spent by me too.