Sunday, July 7, 2013
Saturday, July 6, 2013
1507. The 13-year-old Shih Tzu from Bedok could not stand
The Shih Tzu from Bedok was treated previously for skin diseases but did not seem to improve. I diagnosed generalised ringworm and it took a second treatment before the skin became clear. The problem is re-infection from the environment - the flooring and sleeping areas. Hence most ringworm lesions were found on the belly area. Vet 1 had treated but the problem persisted and so the adult daughter got the dog to me for second opinion as her parents were using off-the-counter shampoos to treat the skin disease without success. Skin diseases like ringworm and yeast infections are hard to cure if the other factors like environmental contamination are not eliminated and this is the responsibility of the owner. Vets may advise but may not have time to follow up regularly as there are so many cases to do.
The younger generation is much better educated and concerned about the old companion.
One week ago, suddenly the dog could not stand up on all four legs. "What's the cause?" the parents asked. X-rays showed L3/L4 disc rupture. However the front legs of the dog were not moving and had little pain sensation in the paws too.
"It is possible that the old dog suffers from a stroke," I said. "A brain scan will be useful, but it is costly." The owners would try to help the dog pee and poop. He is a clean dog and could not stand up on his own to do it. The parents and two adult son and daughter were very concerned and took the dog for treatment immediately.
I would need to follow up.
The younger generation is much better educated and concerned about the old companion.
One week ago, suddenly the dog could not stand up on all four legs. "What's the cause?" the parents asked. X-rays showed L3/L4 disc rupture. However the front legs of the dog were not moving and had little pain sensation in the paws too.
"It is possible that the old dog suffers from a stroke," I said. "A brain scan will be useful, but it is costly." The owners would try to help the dog pee and poop. He is a clean dog and could not stand up on his own to do it. The parents and two adult son and daughter were very concerned and took the dog for treatment immediately.
I would need to follow up.
1489. A continuously barking Beagle
The neighbour was most unhappy. The Beagle really would bark the whole day, even at the Surgery. It is a very difficult situation. The dog had been neutered but he continued his random loud barking many times a day. Devocalisation was the one solution.
Friday, July 5, 2013
1506. Update: Two old cat owners who care very much to feed special diet.
July 6, 2013
Many Singapore cat owners don't bother with the old cats when they get sick and not eating. After all, they are old. There are a few old cat owners who care very much. Yesterday I met two of them.
The gentleman in his late 30s phoned to buy the feline C/D food for his old cat that had bladder stones removed some weeks ago. "Be fast," I told my assistant. "The owner is a very busy man." He is a business man and there are not enough hours in the day. "Do you have a bigger bag?" he asked me. "I order the 2-kg bag as you had taken one before," I said. "Take two of the bags. Next time, I will stock the 4-kg bag." The cat was OK and so he did not say much. He has a vet near his apartment and I have asked him to order from the vet but he did not do so. Probably he needed a prescription from me but I told him I could phone the vet.
A young lady in her late 30s had the 13-year-old white cat from Dakota. She had brought in the cat for not eating and had diagnosed "obsessive grooming." The thin cat became ferocious after my enema treatment and injections. Dr Daniel sedated her and got a blood sample from the jugular vein. The owner had given permission for a blood test and so the vet has to deliver. No excuses of ferocity. This evidence-based medicine must be practised. I palpated a hard lump in mid-abdomen and thought it was a hairball. The cat pooped a hard piece of stool later at home and so this could be the hard lump. The blood test showed kidney disorder and so I advised the lady to feed the cat feline K/D. She ordered a bag and so came today, Thursday. The supplier deliver on Thursday. I don't stock extra since many Singaporeans are still not well educated or willing to spend money to feed prescription diets and the stocks expire.
Since Dakota is quite far from Toa Payoh, I said: "You can get it from the vet near your apartment."
"The vet did not want to prescribe unless she has examined the cat. Do you have a bigger bag?" she was given a 2-kg feline K/D dry food as her cat eats only dry food.
"How long it takes her to eat 2 kg?" I asked.
"Three weeks."
"I will order the bigger bag next time," I said.
"How's the cat?"
"Eating and jumping," she said. "Is there a need for a follow up check?"
"Not necessary unless the cat has vomiting or not well."
"Are there medication for her and is there a cure?"
"No," I said. "Just feed the K/D diet for the time being and enjoy her company."
When the vet can deliver evidence-based medicine and restore an old cat's health, it is always a happy moment for both the cat and the owner. Most of the time, owners delay treatment but in these 2 cat cases, the owners were very prompt in seeking treatment.
The pressure is on the vet to deliver an accurate diagnosis and operate if he or she wants to build up a goodwill.
Many Singapore cat owners don't bother with the old cats when they get sick and not eating. After all, they are old. There are a few old cat owners who care very much. Yesterday I met two of them.
The gentleman in his late 30s phoned to buy the feline C/D food for his old cat that had bladder stones removed some weeks ago. "Be fast," I told my assistant. "The owner is a very busy man." He is a business man and there are not enough hours in the day. "Do you have a bigger bag?" he asked me. "I order the 2-kg bag as you had taken one before," I said. "Take two of the bags. Next time, I will stock the 4-kg bag." The cat was OK and so he did not say much. He has a vet near his apartment and I have asked him to order from the vet but he did not do so. Probably he needed a prescription from me but I told him I could phone the vet.
A young lady in her late 30s had the 13-year-old white cat from Dakota. She had brought in the cat for not eating and had diagnosed "obsessive grooming." The thin cat became ferocious after my enema treatment and injections. Dr Daniel sedated her and got a blood sample from the jugular vein. The owner had given permission for a blood test and so the vet has to deliver. No excuses of ferocity. This evidence-based medicine must be practised. I palpated a hard lump in mid-abdomen and thought it was a hairball. The cat pooped a hard piece of stool later at home and so this could be the hard lump. The blood test showed kidney disorder and so I advised the lady to feed the cat feline K/D. She ordered a bag and so came today, Thursday. The supplier deliver on Thursday. I don't stock extra since many Singaporeans are still not well educated or willing to spend money to feed prescription diets and the stocks expire.
Since Dakota is quite far from Toa Payoh, I said: "You can get it from the vet near your apartment."
"The vet did not want to prescribe unless she has examined the cat. Do you have a bigger bag?" she was given a 2-kg feline K/D dry food as her cat eats only dry food.
"How long it takes her to eat 2 kg?" I asked.
"Three weeks."
"I will order the bigger bag next time," I said.
"How's the cat?"
"Eating and jumping," she said. "Is there a need for a follow up check?"
"Not necessary unless the cat has vomiting or not well."
"Are there medication for her and is there a cure?"
"No," I said. "Just feed the K/D diet for the time being and enjoy her company."
When the vet can deliver evidence-based medicine and restore an old cat's health, it is always a happy moment for both the cat and the owner. Most of the time, owners delay treatment but in these 2 cat cases, the owners were very prompt in seeking treatment.
The pressure is on the vet to deliver an accurate diagnosis and operate if he or she wants to build up a goodwill.
Thursday, July 4, 2013
1505. Blood in the urine - efficiency and systematic examination
I had not seen this Silkie Terrier since 2005 when she was a puppy. On Jul 3, 2013, she was presented with complaint of blood in the urine for the last 3 days. A systematic process is best for haematuria and the following is done by me.
1. History of blood in the urine recently.
2. Examination. Dog, 5.7 kg active but rectal temp is 39.8C. Palpation of bladder - no big stones, no abdominal pain or mass.
3. Urine sample collected by the owner in a clean fruit bottle as requested from me, to save time on catherisation.
4. Dipstick to test urine pH, protein, blood, and SG.
5. No X-ray advised pending urine test to lower medical costs. This ought to be done.
6. Blood test
7. Antibiotic inj and pain killer.
DIPSTICK
Sometimes I don't do the urine dipstick but send the urine sample to the lab for a comprehensive testing. This time I did.
pH=8, SG=1.010, protein 3+, blood 3+
URINE TEST
Yellow turbid
pH = 9, SG=1.034, Protein +, Blood 3+, White blood cells = 0, Red blood cells 126, Bacteria 3+, Crystals triple phosphate +, Amorphous phosphate 3+
ADVICES
"Did you feed dry dog food?"
"No, I feed rice and meat usually. The dog disliked dry food many years ago." the wife said. "But the dog had been greedy and I fed a lot of dog treats."
1. S/D diet for 3 months.
2. Urine test monthly
3. X-rays advised.
4. Stop all treats and home-cooked food when feeding S/D diet.
Will the owner comply? Are there bladder stones inside the bladder and kidneys?
This case will be followed up. A systematic process will be efficient and productive.
1. History of blood in the urine recently.
2. Examination. Dog, 5.7 kg active but rectal temp is 39.8C. Palpation of bladder - no big stones, no abdominal pain or mass.
3. Urine sample collected by the owner in a clean fruit bottle as requested from me, to save time on catherisation.
4. Dipstick to test urine pH, protein, blood, and SG.
5. No X-ray advised pending urine test to lower medical costs. This ought to be done.
6. Blood test
7. Antibiotic inj and pain killer.
DIPSTICK
Sometimes I don't do the urine dipstick but send the urine sample to the lab for a comprehensive testing. This time I did.
pH=8, SG=1.010, protein 3+, blood 3+
URINE TEST
Yellow turbid
pH = 9, SG=1.034, Protein +, Blood 3+, White blood cells = 0, Red blood cells 126, Bacteria 3+, Crystals triple phosphate +, Amorphous phosphate 3+
ADVICES
"Did you feed dry dog food?"
"No, I feed rice and meat usually. The dog disliked dry food many years ago." the wife said. "But the dog had been greedy and I fed a lot of dog treats."
1. S/D diet for 3 months.
2. Urine test monthly
3. X-rays advised.
4. Stop all treats and home-cooked food when feeding S/D diet.
Will the owner comply? Are there bladder stones inside the bladder and kidneys?
This case will be followed up. A systematic process will be efficient and productive.
1504. A seminar on outdoor advertising
On July 3, 2013, I attended a seminar on outdoor advertising for realtors. The slides presentation did not excite the small group of around 15 realtors. More images of actual signboard types in Hong Kong and Singapore will have been more interesting. There were the occasional images of signboards advertising new condo projects for sale. The others were illustrations of the height and width permissible by the BCA. Real life signboards will complement the illustrations and make the lecture so much more interesting. My friend could not keep awake but he asked the most questions since the lecturer did not have much queries.
"Why don't you produce a video so that the audience will not fall asleep?" I asked him later.
"All these slides are approved by the CEA and it takes a long time and many rejections," he explained. "Nothing can be given in the lectures unless approved."
However, this lecturer is an excellent story teller as regards leadership and positive mental attitude. If only he can translate the stories into a video. For example, bungee jumping. He accepted the $100 from his friend who asked whether he was fearless. The next early morning, his friend drove him to a place which was cold. It was a bungee jumping point. His friend had paid for his bungee jumping. Tourists were clapping their hands. Boats were below to catch the bungee jumpers who fall into the fast flowing river.
"You can give me back the $100 but you must go to town and shave your head bald," the friend said.
"Shall I jump Titanic style or roll over?" he stretched out his hands to demonstrate the Titanic style.
It would be shameful in front of the tourist to roll over.
"So I walked along the plank and shouted "1, 2, 3,". The echoes came vibrating into my ears."
We expected him to jump at the count of 3 but he said, "I turned back."
His friend said: "You are to jump."
"What shall I do?" he asked us.
"I decided to ask the bungee man to shove me down when I count up to 3."
We waited for him to continue.
"When I shouted one, the bungee operator pushed me down. My heart was in my mouth. But after a while, I felt free and happy. I was laughing away."
We don't know whether to believe him or not but kept silent.
There was another story on how to stand out from the competitors in producing flyers. He had sat in a coffeeshop from 9 am to 5 pm to observe the behaviour of residents towards flyers in their letterboxes. The flyers were generic boring ones. The residents just discarded them.
One Malay agent asked for his advice on how to succeed in flyer advertisement..
"If you do what I tell you," he asked the agent to bob up his hair in the centre, coloured it yellow. Then he took a picture. He insertsd prison bars such that the agent's hands were holding the bars. On top of the rectangular advert, he put the words "WANTED". Below he wrote the details of the property. The response was overwhelming.
He asked for two coins from us. I thought he was going to double the number. He placed the coins in his right hand but they disappeared after a few twists and turns of his hand in front of vigilant eyes. Magic always wake up the students.
He asked for a birth date to assess the personality. I volunteered mine. He totalled and it ended in number 4. "Four means die in Cantonese," I said to him.
"No, it means success, a pro-active person, very calm in situations of panic."
That was good news.
For Elvis Presley, his birth date ending in number 9 indicated a short but prosperous life. The number 9 is the last digit from 1-9 and that explained Elvis's fate of being rich and successful but living a short life.
The word ATTITUDE adds up to 100 if A=1 and you add up. A positive attitude is 100 or something to that effect.
At the end of the lecture, I thanked him for his stories. His lecture was good but his story telling was first class.
"Why don't you produce a video so that the audience will not fall asleep?" I asked him later.
"All these slides are approved by the CEA and it takes a long time and many rejections," he explained. "Nothing can be given in the lectures unless approved."
However, this lecturer is an excellent story teller as regards leadership and positive mental attitude. If only he can translate the stories into a video. For example, bungee jumping. He accepted the $100 from his friend who asked whether he was fearless. The next early morning, his friend drove him to a place which was cold. It was a bungee jumping point. His friend had paid for his bungee jumping. Tourists were clapping their hands. Boats were below to catch the bungee jumpers who fall into the fast flowing river.
"You can give me back the $100 but you must go to town and shave your head bald," the friend said.
"Shall I jump Titanic style or roll over?" he stretched out his hands to demonstrate the Titanic style.
It would be shameful in front of the tourist to roll over.
"So I walked along the plank and shouted "1, 2, 3,". The echoes came vibrating into my ears."
We expected him to jump at the count of 3 but he said, "I turned back."
His friend said: "You are to jump."
"What shall I do?" he asked us.
"I decided to ask the bungee man to shove me down when I count up to 3."
We waited for him to continue.
"When I shouted one, the bungee operator pushed me down. My heart was in my mouth. But after a while, I felt free and happy. I was laughing away."
We don't know whether to believe him or not but kept silent.
There was another story on how to stand out from the competitors in producing flyers. He had sat in a coffeeshop from 9 am to 5 pm to observe the behaviour of residents towards flyers in their letterboxes. The flyers were generic boring ones. The residents just discarded them.
One Malay agent asked for his advice on how to succeed in flyer advertisement..
"If you do what I tell you," he asked the agent to bob up his hair in the centre, coloured it yellow. Then he took a picture. He insertsd prison bars such that the agent's hands were holding the bars. On top of the rectangular advert, he put the words "WANTED". Below he wrote the details of the property. The response was overwhelming.
He asked for two coins from us. I thought he was going to double the number. He placed the coins in his right hand but they disappeared after a few twists and turns of his hand in front of vigilant eyes. Magic always wake up the students.
He asked for a birth date to assess the personality. I volunteered mine. He totalled and it ended in number 4. "Four means die in Cantonese," I said to him.
"No, it means success, a pro-active person, very calm in situations of panic."
That was good news.
For Elvis Presley, his birth date ending in number 9 indicated a short but prosperous life. The number 9 is the last digit from 1-9 and that explained Elvis's fate of being rich and successful but living a short life.
The word ATTITUDE adds up to 100 if A=1 and you add up. A positive attitude is 100 or something to that effect.
At the end of the lecture, I thanked him for his stories. His lecture was good but his story telling was first class.
1503. The wet market's provision shop operator
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TOA PAYOH VETS
1502. Trust & Audit Case & Clinical Research - Dissolving struvite stones - Golden Retriever, M, 4 years
This is a case study of using S/D diet to dissolve struvites in a Golden Retriever. I will check on the size of the bladder stone as I have not seen the X-ray of Vet 1.
Vet 1 who x-rayed the dog and discovered a small bladder stone. The owner consulted Dr Daniel on April 4, 2013 who advised a urine test to confirm struvites. Another urine test was performed one month later.
FIRST URINE TEST April 5, 2013
pH 8 (5-8)
SG 1.030 (1.005-1.030)
Protein +
Urobilinogen +
Blood 3+
White blood cells 3
Red blood cells >2250
Epithelial cells 3
Bacteria Occasional
Crystals Triple phosphate +
SECOND URINE TEST May 13, 2013
pH 9 (5-8)
SG 1.019 (1.005-1.030)
Protein 2+
Urobilinogen Normal
Blood Nil
White blood cells 10
Red blood cells 0
Epithelial cells 0
Bacteria 2+
Crystals Amorphous phosphate 2+
FEEDING OF CANNED S/D
April 4, 2013 Canine C/D dry prescribed pending lst urine test.
April 20, 2013 S/D x 24 cans
April 27 S/D x 24 cans
May 11 S/D x 12 cans (2nd urine test on May 13, 2013)
May 18 S/D x 12 cans"
Jun 27 S/D x 12 cans
Jul 4 S/D x 12 cans
A third urine test is being done today Jul 4, 2013.
CONCLUSION
It appears that the S/D is not working so far. S/D is recommended for 3 months but it is still early. I phoned the home and the husband answered. The wife came to buy the S/D and said it was already 3 months of trial but it wasn't.
"Did you feed any other food beside the canned S/D?" I asked.
"No," he said.
"Did you feed apples?"
"Yes," he said.
"Some chicken from the dining table?"
"Yes,"
There was no blood in the urine as evident in the 2nd urine test.
I advised strictly no other food or dog treats or vitamins and only S/D from now on. Plain water. Will wait and see.
Much depends on the size of the bladder stone and it may take several weeks to dissolve it. Clients do forget that they can't feed other types of food while on the S/D diet as illustrated in this case.
Taking out the bladder stone by surgery is often the better way to resolve the problem of blood in the urine. I have a feeling that the bladder stone is large (>5 mm across) and have asked the husband to email to me the X-ray.
Vet 1 who x-rayed the dog and discovered a small bladder stone. The owner consulted Dr Daniel on April 4, 2013 who advised a urine test to confirm struvites. Another urine test was performed one month later.
FIRST URINE TEST April 5, 2013
pH 8 (5-8)
SG 1.030 (1.005-1.030)
Protein +
Urobilinogen +
Blood 3+
White blood cells 3
Red blood cells >2250
Epithelial cells 3
Bacteria Occasional
Crystals Triple phosphate +
SECOND URINE TEST May 13, 2013
pH 9 (5-8)
SG 1.019 (1.005-1.030)
Protein 2+
Urobilinogen Normal
Blood Nil
White blood cells 10
Red blood cells 0
Epithelial cells 0
Bacteria 2+
Crystals Amorphous phosphate 2+
FEEDING OF CANNED S/D
April 4, 2013 Canine C/D dry prescribed pending lst urine test.
April 20, 2013 S/D x 24 cans
April 27 S/D x 24 cans
May 11 S/D x 12 cans (2nd urine test on May 13, 2013)
May 18 S/D x 12 cans"
Jun 27 S/D x 12 cans
Jul 4 S/D x 12 cans
A third urine test is being done today Jul 4, 2013.
CONCLUSION
It appears that the S/D is not working so far. S/D is recommended for 3 months but it is still early. I phoned the home and the husband answered. The wife came to buy the S/D and said it was already 3 months of trial but it wasn't.
"Did you feed any other food beside the canned S/D?" I asked.
"No," he said.
"Did you feed apples?"
"Yes," he said.
"Some chicken from the dining table?"
"Yes,"
There was no blood in the urine as evident in the 2nd urine test.
I advised strictly no other food or dog treats or vitamins and only S/D from now on. Plain water. Will wait and see.
Much depends on the size of the bladder stone and it may take several weeks to dissolve it. Clients do forget that they can't feed other types of food while on the S/D diet as illustrated in this case.
Taking out the bladder stone by surgery is often the better way to resolve the problem of blood in the urine. I have a feeling that the bladder stone is large (>5 mm across) and have asked the husband to email to me the X-ray.
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