I attended her birthday. She sms to all employment agents she knew and they came. Khin Khin has the Myanmar nationals source and Singaporean agents need her. I am more a friend. "Have you been to the PAP smear?" I reminded her as her report 11 months ago said: "Atypical abnomal cells. Review 6 months later."
Many working women neglect their health. Intelligent but ignorant about personal health. "You know, cervical cancer can be cured if detected early." She had asked me whether stress can cause cancer. "Some stresses can," I said.
Tuesday, April 16, 2013
1369. Visit to the wet market
At 7 am, I visited the Ang Mo Kio wet market. I have not been there for months. I saw a few terrapins being sold at the pet fish shop.
Wet markets in Singapore are quite "sterile" compared to the messy smelly ones in other countries. Yet few of the younger Singaporeans visit them as they prefer to shop at air-conditioned supermarkets, not knowing that fishes are fresher at wet markets.
My favourite fish-monger is a couple in their late 30s. "Where's the type of fish that women eat after birth?" I asked. "The one with the bone in the middle?" Actually all big fishes have vertebral bones in the middle. I pointed to a mid-sized fish greyish in colour.
"No, no," the fishmonger's wife said. "This is the one." A bigger sized fish. I don't know as I don't cook. My Cantonese mother used to buy it and cook it with brown or black beans. I bought a red polka-dotted fish and a pomfret for steaming. Fishes can be very fishy and I dislike eating fishy ones.
"Any of those small fishes they sell with nasi lemak?" I asked.
"Not today. Quite hard to find."
"Do you put fishes in the freezer?" I asked.
"Of course," the wife said.
"Do you do it?"
"No need," the husband said. "We sell out the same day."
At my fruit seller called "Ah Pui" or "Fatty" in Hokkien, his neighbour did not open the fruit stalls. He was alone as there is a shortage of labour even for low end jobs.
"Why your neighbour did not open?" I asked.
"He has closed shop."
"You must have killed his business," I replied. Ah Pui has a large variety of fruits from various countries and he is at the corner. He seems to have lots of clients while the neighbour has less.
"He has closed shop."
"How much is the rental of one fruit stall?" I asked.
"$5,000 for my 4 stalls," he said. "My monthly expenses is $10,000. The neighbours could have closed for various reasons."
"Did he offer the stalls to you?"
"No," he said. "But too many stalls can make me bankrupt. He has 6 stalls."
Competition exists everywhere. The bigger the business, the more difficult to survive if there are few clients. The same applies to vet pracices.
I also bought my favourite leafy vegetables from another stall. "Singapore grown," the man said. I thought Singapore farms are non-existent.
It is nice to visit the wet market now and then. I went there to buy the fruits. Didn't bring my camera.
Wet markets in Singapore are quite "sterile" compared to the messy smelly ones in other countries. Yet few of the younger Singaporeans visit them as they prefer to shop at air-conditioned supermarkets, not knowing that fishes are fresher at wet markets.
My favourite fish-monger is a couple in their late 30s. "Where's the type of fish that women eat after birth?" I asked. "The one with the bone in the middle?" Actually all big fishes have vertebral bones in the middle. I pointed to a mid-sized fish greyish in colour.
"No, no," the fishmonger's wife said. "This is the one." A bigger sized fish. I don't know as I don't cook. My Cantonese mother used to buy it and cook it with brown or black beans. I bought a red polka-dotted fish and a pomfret for steaming. Fishes can be very fishy and I dislike eating fishy ones.
"Any of those small fishes they sell with nasi lemak?" I asked.
"Not today. Quite hard to find."
"Do you put fishes in the freezer?" I asked.
"Of course," the wife said.
"Do you do it?"
"No need," the husband said. "We sell out the same day."
At my fruit seller called "Ah Pui" or "Fatty" in Hokkien, his neighbour did not open the fruit stalls. He was alone as there is a shortage of labour even for low end jobs.
"Why your neighbour did not open?" I asked.
"He has closed shop."
"You must have killed his business," I replied. Ah Pui has a large variety of fruits from various countries and he is at the corner. He seems to have lots of clients while the neighbour has less.
"He has closed shop."
"How much is the rental of one fruit stall?" I asked.
"$5,000 for my 4 stalls," he said. "My monthly expenses is $10,000. The neighbours could have closed for various reasons."
"Did he offer the stalls to you?"
"No," he said. "But too many stalls can make me bankrupt. He has 6 stalls."
Competition exists everywhere. The bigger the business, the more difficult to survive if there are few clients. The same applies to vet pracices.
I also bought my favourite leafy vegetables from another stall. "Singapore grown," the man said. I thought Singapore farms are non-existent.
It is nice to visit the wet market now and then. I went there to buy the fruits. Didn't bring my camera.
1368. Follow up: The old rabbit with sarcoma above the left eyelid has 2 more lumps
April 15, 2013
Yesterday, the rabbit with sarcoma above the left eyelid was operated by Dr Daniel. "There may not be sufficient space to stitch after excision of the two lumps above the upper eyelid of the rabbit's left eye," he said. The lumps were growing fast and were 5 mm x 5 mm x 3 mm and the two ladies came early this time instead of "wait and see".
The first lump, diagnosed as a sarcoma by histology was 10 cm x 8 cm x 8 cm, in the front part of the upper eyelid. It was excised over one month ago. There seemed to be a recurrence as there was a sharp lump on the operation site. It turned out to be a bony prominence when Dr Daniel operated.
"If there is insufficent skin to stitch," I said. "Let the skin wound heal by granulation. It is better to excise a wide margin to get rid of the cancerous cells in the area."
This would be my approach. It is easier said than done.
As each vet has his or her own approach, much depends on the vet. Dr Daniel excised the two lumps and stitch up the skin wound. This time the two ladies seek veterinary surgery early but not early enough. I had told them to scrutinise for lumps daily. Apparently the first lump did not recur but only time will tell. The grey and white rabbit is 10 years old.
He had jaw abscesses (see my earlier case report somewhere in the blog) and now has fully recovered after drainage. The older baby-boomer generation would likely have abandoned this rabbit and euthanase it rather than spending money on surgeries.
Yesterday, the rabbit with sarcoma above the left eyelid was operated by Dr Daniel. "There may not be sufficient space to stitch after excision of the two lumps above the upper eyelid of the rabbit's left eye," he said. The lumps were growing fast and were 5 mm x 5 mm x 3 mm and the two ladies came early this time instead of "wait and see".
The first lump, diagnosed as a sarcoma by histology was 10 cm x 8 cm x 8 cm, in the front part of the upper eyelid. It was excised over one month ago. There seemed to be a recurrence as there was a sharp lump on the operation site. It turned out to be a bony prominence when Dr Daniel operated.
"If there is insufficent skin to stitch," I said. "Let the skin wound heal by granulation. It is better to excise a wide margin to get rid of the cancerous cells in the area."
This would be my approach. It is easier said than done.
As each vet has his or her own approach, much depends on the vet. Dr Daniel excised the two lumps and stitch up the skin wound. This time the two ladies seek veterinary surgery early but not early enough. I had told them to scrutinise for lumps daily. Apparently the first lump did not recur but only time will tell. The grey and white rabbit is 10 years old.
He had jaw abscesses (see my earlier case report somewhere in the blog) and now has fully recovered after drainage. The older baby-boomer generation would likely have abandoned this rabbit and euthanase it rather than spending money on surgeries.
1367. Veterinary jobs in Singapore
On Mon, Apr 15, 2013 at 8:41 AM, Suzanne Ou <ou.suzanne@gmail.com> wrote:
Dear Dr Daniel Sing and Dr Sing Kong Yuen,
I
am Suzanne Ou, Chairperson of the Raffles Society of Biological
Sciences in Raffles Institution (Junior College). As the largest Science
Club CCA in RI, we aim to offer members a broad view of all fields of
Biology, as such, we hope to invite you down to for a talk on veterinary
sciences on 25th April 2013, Thursday, 5.30 - 6.30 pm.
As the seniors are preparing for A levels and
choosing a career path, we hope that you will be able to share about
what is it like being a vet as well as studying for it in university.
One of our alumni, Gina Ng, mentioned that her internship with your
clinic was very interesting, and we hope to know more about the
surgeries you conduct and about the cases you encounter.
We sincerely hope that both of you will be able to come and we look forward to your favourable reply.
Thank you!
Regards,
Suzanne Ou
Chairperson of Raffles Society of Biological Sciences
--------------------------------
April 16, 2013
Thank you for your invitation. I am Dr Sing Kong Yuen, from Toa Payoh Vets, www.toapayohvets.com. It is a small animal practice.
I have asked Dr Daniel Sing to be present and give a talk on the small animal practice if he agrees to it.
Briefly, some information is provided.
Veterinary science offers numerous opportunities for Singaporeans. The field of work involves the regulatory aspect (e.g Agri-foold and Veterinary Authority and other institutions), research (pharmacology companies, sales, laboratory animals), education (teaching and universities, case studies and research) and clinical work (avian, fishes, small animal, large animals practices e.g small animal practices, aquariums, the zoo and bird park). There are overseas work opportunities if the country's immigration laws accept that foreigner veterinarians are welcome. Some countries like the UK have closed the doors in 2013.
Renumeration as a new employee graduate in Singapore 2013 ranges from S$3,000 - $4,000/month. The cost of a 5-year overseas undergraduate veterinary education as in 2013 will be from S$300,000 - S$600,000. Academic excellence as a veterinary graduate, as in all professions, still opens doors to choice employers. There are over 50 small animal practices in Singapore in 2013 with more being opened. Vacancies for new graduates are low presently if the graduate wants to work in small animals (mainly dogs and cats).
Singaporeans can only study in AVA-accredited vet universities overseas if they want to practise in Singapore as a licensed vet. The countries are usually Australia, New Zealand, UK and the USA.
I hope the info will be of use for your talk.
Monday, April 15, 2013
April 13, 2013. Saturday's interesting case: A transgender or bisexual Japanese spitz?
I work from 8.30 am to around 11 am on Saturdays and sometimes encounter interesting cases.
On this Saturday, April 13, 2013, the owner brought in the 2-year-old Japanese Spitz for vaccination.
"It is abnormal to see dark reddish hairs around the vulval area," I said to the lady owner and spayed the dog two weeks ago.
"My other Spitz that had died had this too," she replied.
I noted that this dog had a much smaller vulval lips, almost hidden unlike normal female dogs. Why would this young female dog be continuously licking her private parts several times a day for many months? The saliva stains tainted the hairs around the region to a dark red brown.
"Is there a urinary tract infection (UTI)?" I asked the owner. "Does she pee a lot?"
"Not a lot, but she sometimes lie on her urine."
"If the dog keeps on licking for many years, the vulval area would become black and scaly like a crocodile skin," I said. "I had seen such cases in one old female dog."
I turned the dog upside down with the help of the owner and my assistant. I parted the vulval lips and there inside the vestibule was a large mass of around 1.5 cm x 1 cm. Was this the irritating cause of the licking? I had images taken. This appeared to be an enlarged clitoris. So was the dog self-stimulating or was she trying to lick away the abnormal sized organ?
Is this a transgender or bisexual dog? What's the solution? I advised surgical excision of the swelling so that the female dog can pee normally. Surgery is scheduled 3 weeks later. Usually I don't perform a much more detailed visual examination of the inner parts of the vagina and I believe most vets don't do it too. So some of such cases are mis-diagnosed as UTI which was what I suspected.
On this Saturday, April 13, 2013, the owner brought in the 2-year-old Japanese Spitz for vaccination.
"It is abnormal to see dark reddish hairs around the vulval area," I said to the lady owner and spayed the dog two weeks ago.
"My other Spitz that had died had this too," she replied.
I noted that this dog had a much smaller vulval lips, almost hidden unlike normal female dogs. Why would this young female dog be continuously licking her private parts several times a day for many months? The saliva stains tainted the hairs around the region to a dark red brown.
"Is there a urinary tract infection (UTI)?" I asked the owner. "Does she pee a lot?"
"Not a lot, but she sometimes lie on her urine."
"If the dog keeps on licking for many years, the vulval area would become black and scaly like a crocodile skin," I said. "I had seen such cases in one old female dog."
I turned the dog upside down with the help of the owner and my assistant. I parted the vulval lips and there inside the vestibule was a large mass of around 1.5 cm x 1 cm. Was this the irritating cause of the licking? I had images taken. This appeared to be an enlarged clitoris. So was the dog self-stimulating or was she trying to lick away the abnormal sized organ?
Is this a transgender or bisexual dog? What's the solution? I advised surgical excision of the swelling so that the female dog can pee normally. Surgery is scheduled 3 weeks later. Usually I don't perform a much more detailed visual examination of the inner parts of the vagina and I believe most vets don't do it too. So some of such cases are mis-diagnosed as UTI which was what I suspected.
Update: The Yorkshire wakes the owner up at 3 am - false pregnancy
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Sunday, April 14, 2013
Fri April 12, 2013. A visit to Johor vet and Iskandar area
On Friday April 12, 2013, I visited a Johor vet and Iskandar area with another vet who shared his experiences about vet practices.
1. "TKX" Anaesthesia for Caesarean section is safe for puppies, said the experienced vet. Seldom used gaseous anaesthesia. If IV anaesthesia is effective, why bother with the costly gas?
Mixture of TKX is as follows:
1. Zoleteil 50 or 100 - One bottle. I thought it should be Zoletil 100.
2. Add in 2 ml of Xylazine 100 to 8 ml of Ketamine 100 to the Zoletil bottle.
Average 20kg dog, use 2 ml SC, IM, or IV according to requirements and topping up when needed. I need to check the above further. I have written another report on this TKX in my website on Anaesthesia.
I use gas for Caesarean section and most surgeries as there is no need to top up. The cost is much higher.
2. Oral ivomec for poulty - kills beetles. May be useful for dog demodectic mange. Dutch company produces it. Should be useful for vets as this is an oral ivomec.
ISKANDAR area
Great investment potential but prices seem to have shot up.
A 3-bedroom 2-storey semi-detached of around 4000 sq ft of land at Bestair, near Giant supermarket, costs S$500,000. Security guards are present at the entrance but anyone can climb over the low walls at the side of the development. Capital gains 5-10 years later may be the reason to invest for younger Singaporeans who don't need to be lavish in buying expensive cars and speculating in shares hoping to make a fast buck.
If the house is rented out, most tenants will NOT bother to maintain it in excellent state. Many Singaporeans are investing in properties overseas but Johor is a good bet for Singaporeans who are not having lots of money, in my opinion. Capital gains should be the objective. Renting out will cause damage to the beautiful house as I note that most tenants do NOT care and will sublet to friends who abuse the interiors. In investment theory, the house should get rental income. If the investor takes the risk of damage, the house should be rented out. Borrow 80% and pay the instalments monthly. This Bestair area is what I think will be a growth area and not just any development in Johore. I can see many banks setting up shop here. There is the Giant supermarket, the Tesco market within 1 10-minute walk. This seems to be the beginning of "Orchard Road" of Singapore of 30 years ago. Orchard Road houses are out of the average Singaporean.
GLOBAL PETS
A concept of pet shop and vet. In the unit I visited, the quotation for spaying a dog is RM 250-500 or S$100. The unit has a vet but no surgeries are done there. Global Pets has a good one-shop animal care and accessory concept.
VETERINARY HOSPITAL IN JOHOR
I can see there is a need for a vet hospital. No selling of pet products or grooming. Who dares to invest and can provide the deeper surgical skills for dogs and cats will be in a niche position. Most dogs seem to be large breeds but I don't know. Johor is said to have 3 million people. It is prospering.
1. "TKX" Anaesthesia for Caesarean section is safe for puppies, said the experienced vet. Seldom used gaseous anaesthesia. If IV anaesthesia is effective, why bother with the costly gas?
Mixture of TKX is as follows:
1. Zoleteil 50 or 100 - One bottle. I thought it should be Zoletil 100.
2. Add in 2 ml of Xylazine 100 to 8 ml of Ketamine 100 to the Zoletil bottle.
Average 20kg dog, use 2 ml SC, IM, or IV according to requirements and topping up when needed. I need to check the above further. I have written another report on this TKX in my website on Anaesthesia.
I use gas for Caesarean section and most surgeries as there is no need to top up. The cost is much higher.
2. Oral ivomec for poulty - kills beetles. May be useful for dog demodectic mange. Dutch company produces it. Should be useful for vets as this is an oral ivomec.
ISKANDAR area
Great investment potential but prices seem to have shot up.
A 3-bedroom 2-storey semi-detached of around 4000 sq ft of land at Bestair, near Giant supermarket, costs S$500,000. Security guards are present at the entrance but anyone can climb over the low walls at the side of the development. Capital gains 5-10 years later may be the reason to invest for younger Singaporeans who don't need to be lavish in buying expensive cars and speculating in shares hoping to make a fast buck.
If the house is rented out, most tenants will NOT bother to maintain it in excellent state. Many Singaporeans are investing in properties overseas but Johor is a good bet for Singaporeans who are not having lots of money, in my opinion. Capital gains should be the objective. Renting out will cause damage to the beautiful house as I note that most tenants do NOT care and will sublet to friends who abuse the interiors. In investment theory, the house should get rental income. If the investor takes the risk of damage, the house should be rented out. Borrow 80% and pay the instalments monthly. This Bestair area is what I think will be a growth area and not just any development in Johore. I can see many banks setting up shop here. There is the Giant supermarket, the Tesco market within 1 10-minute walk. This seems to be the beginning of "Orchard Road" of Singapore of 30 years ago. Orchard Road houses are out of the average Singaporean.
GLOBAL PETS
A concept of pet shop and vet. In the unit I visited, the quotation for spaying a dog is RM 250-500 or S$100. The unit has a vet but no surgeries are done there. Global Pets has a good one-shop animal care and accessory concept.
VETERINARY HOSPITAL IN JOHOR
I can see there is a need for a vet hospital. No selling of pet products or grooming. Who dares to invest and can provide the deeper surgical skills for dogs and cats will be in a niche position. Most dogs seem to be large breeds but I don't know. Johor is said to have 3 million people. It is prospering.
Saturday, April 13, 2013
1363. Final script for video production - Descemetocoele
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Friday, April 12, 2013
1362. 3rd case of Shih Tzu with skin disease. The good daughter
Married daughters don't live with the family but they are usually very close to their mum. In this 3rd case of the Shih.Tzu with skin disease, I received a phone call from a lady for an appointment regarding skin disease of her mother's Shih Tzu. The dog had been treated by Vet 1 for ringworm several times in 2011 and 2012 but the skin disease persisted. The father said there was no point throwing good money as the dog did not recover and was itchy. So, the mother applied the blue solution of chlorhexidine on the skin. "The dog does not scratch after application," the mum in her late 50s told me.
"Other dog owners would have put the Shih Tzu to sleep," the mother said to me. "But we don't do it."
"Other dog owners would have put the Shih Tzu to sleep," the mother said to me. "But we don't do it."
1361. Cat beaten or kicked by an HDB cleaner
April 11, 2013 9.30 am review of hospitalised case
Toa Payoh Vets
"The day before, he was OK and came to me for food," the angry man in his late 50s, carrying his 3-year old grand-daughter in his left hand said to me on this morning of April 11, 2013. "Now, he can barely stand up. He passed "
Due to the sudden onset and the very low rectal temp of 33.9 deg C, I suspected trauma. "Did somebody kick the cat or did the neighbours poisoned him?" I palpated a full bladder about the size of an orange. The penile tip was bloody. I asked Dr Daniel to review the case.
"My neighbours feed him and don't do that. He has been around for the last 3 years going out to the 2nd storey but never to the 6th storey.
"An HDB official had visited him recently. The cleaner had complained that his cat had pooped on the 6th storey corridor. I suspect it is the cleaner!"
In the afternoon, Dr Daniel catheterised and unblocked the bladder. Lots of pinkish red urine. "Urinary tract infection" he said to me. "The cause is likely to be due to traumatic injury to the kidneys or bladder as the cat is very depressed. It is of sudden onset and unlikely to be UTI". Dr Daniel works in the afternoon and therefore he did not meet the owners when the cat came in at 10am.
URINE ANALYSIS
Evidence-based medicine is practised. Urine sample sent to the lab.
Urine red, turbid. pH=8.0 (5-8), SG 1.015 (1.005-1.03). Protein 2+ (Negative), Blood 4+, WBC 252, RBC >2250, Bacteria Occasional. Crystals nil.
From these results and based on history of a suspected cleaner and sudden onset lethargy and inability to stand up, I would say there is kidney trauma as the Protein 2+ should be negative. UTI would be a secondary finding.
In the evening, the family came. The cat was still depressed and did not meow. The grandpa said that the friend of the cleaner had asked for his forgiveness. He had lodged a complaint against the cleaner with the town council manager. "I will record his confession when I meet him. He abused cats and this recording would be reported to the police. He should be sacked."
APRIL 11, 2013 9.45 AM
I reviewed the case. Bright. Not eating. T= 38.4C. Bladder orange-sized. Still peeing blood. Kidney trauma suspected based on urine analysis of Protein 2+.
The cat would be going home this afternoon and would need to be indoors for the next 10 days if not forever. The cat was not neutered and was fed dry food. FLUTD is usually not of sudden onset and does not give rise to hypothermia. So, this was a case of renal and bladder traumatic injuries.
.
Toa Payoh Vets
"The day before, he was OK and came to me for food," the angry man in his late 50s, carrying his 3-year old grand-daughter in his left hand said to me on this morning of April 11, 2013. "Now, he can barely stand up. He passed "
Due to the sudden onset and the very low rectal temp of 33.9 deg C, I suspected trauma. "Did somebody kick the cat or did the neighbours poisoned him?" I palpated a full bladder about the size of an orange. The penile tip was bloody. I asked Dr Daniel to review the case.
"My neighbours feed him and don't do that. He has been around for the last 3 years going out to the 2nd storey but never to the 6th storey.
"An HDB official had visited him recently. The cleaner had complained that his cat had pooped on the 6th storey corridor. I suspect it is the cleaner!"
In the afternoon, Dr Daniel catheterised and unblocked the bladder. Lots of pinkish red urine. "Urinary tract infection" he said to me. "The cause is likely to be due to traumatic injury to the kidneys or bladder as the cat is very depressed. It is of sudden onset and unlikely to be UTI". Dr Daniel works in the afternoon and therefore he did not meet the owners when the cat came in at 10am.
URINE ANALYSIS
Evidence-based medicine is practised. Urine sample sent to the lab.
Urine red, turbid. pH=8.0 (5-8), SG 1.015 (1.005-1.03). Protein 2+ (Negative), Blood 4+, WBC 252, RBC >2250, Bacteria Occasional. Crystals nil.
From these results and based on history of a suspected cleaner and sudden onset lethargy and inability to stand up, I would say there is kidney trauma as the Protein 2+ should be negative. UTI would be a secondary finding.
In the evening, the family came. The cat was still depressed and did not meow. The grandpa said that the friend of the cleaner had asked for his forgiveness. He had lodged a complaint against the cleaner with the town council manager. "I will record his confession when I meet him. He abused cats and this recording would be reported to the police. He should be sacked."
APRIL 11, 2013 9.45 AM
I reviewed the case. Bright. Not eating. T= 38.4C. Bladder orange-sized. Still peeing blood. Kidney trauma suspected based on urine analysis of Protein 2+.
The cat would be going home this afternoon and would need to be indoors for the next 10 days if not forever. The cat was not neutered and was fed dry food. FLUTD is usually not of sudden onset and does not give rise to hypothermia. So, this was a case of renal and bladder traumatic injuries.
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