2307. No terrapin books in the Bishan library

Sep 24, 2015

The 11-year-old boy was responsible for the upkeep and health care of the adopted terrapin. For the past 2 months, the terrapin had lost appetite. He was very thin. So the father took him and the terrapin to consult me after checking out the Youtube. 

"Any stools muddying the water in the tank?" I asked since the boy said the terrapin did eat around 3 pellets.
"Quite clean," he said. "His left eye is swollen. He closes his eyes when he is under water."
"How long has this situation been occurring?"  I asked.
"Past 2 months."


Lethargy. No appetite for 2 months.
Severe weight loss - no fatty bulge under armpit and thigh area.
Breathing rapidly.

"Any basking area to dry out?" I asked as the owner had adopted the terrapin, tank and a mouldy wooden block from another person.
"The wooden block is small than him," the father said. "I threw it away as it was mouldy."
"So the terrapin had been submerged in water for the past year. How often do you change the water?"
"Once in every 3 days."

The terrapin had a good appetite after adoption, eating many dried shrimps and disliked the pellets. He was fed fresh prawns twice only in the past months. The father bought from the pet shop a bottle of medicine to eliminate flat worms, tapeworks and flukes in fish and poured into the tank. No improvement in appetite.

As for sunlight, recently he exposed the terrapin to direct sunlight for 4 hours. But the terrapin still would not eat any shrimps.  Lethargy.




As the boy was not permitted internet surfing to prevent addiction, I asked if he had loaned terrapin books from the public library.
"None available," he said.
Actually, there was none available for loan when I asked again.
Terrapins are a popular niche pet and the library books would probably be borrowed or the boy had no time to persevere and does not know how to make a reservation.

"Usually it is the owner who is at fault when the pet is sick," the father said to me. "Same as for misbehaving children."  This is a rare parent who stopped his 11-year-old son from surfing to prevent internet addiction and deprivation of sleep gaming till 4 am every night. This is what happens to some young Singapore men even at the age of 30 years.

2306. A cat jumped from 5th storey - multiple right femoral fractures - x rays

SURGICAL TREATMENT
1. Pin plus wires around fragments.
2. Screws.

The cost would be from $2,000. The owner said he had paid $1,000 to a vet who smoothen the molar spurs of his rabbit, saying this was a large amount.

He took the cat home. 

2305. A cat and dog has difficulty peeing - follow up perineal urethrostomy in the cat

Thursday, Sep 24, 2015. Public holiday

I review the two in-patients

1. A 3-year-old male cat has dysuria after removal of the bladder and urethral stones around 2 weeks ago.
"He had never been able to urinate normally after the surgery," the owner said. Dr Daniel had prescribed the medication but the cat keeps going to the litter tray. The cat had been housed separately from the other 2 cats and had eaten his own Prescription C/D diet.

The cat came in 2 days ago. I palpated his bladder. It was swollen moderately, around the size of half an orange. Yesterday, Dr Daniel performed perineal urethrostomy and the cat now pees normally.

Urethral stricture was the cause of dysuria after bladder stone removal. The cat did not pee normally. The stone had lodged at the perineal urethra earlier and had caused obstruction. It was flush back into the bladder and removed with the bladder stones, but the cat had problems peeing post-op. So the solution was to do perineal urethrostomy and now the cat is OK.  

2. The 13-year-old Chihuahua had scrotal ablation and neuter yesterday.  He was seen by Vet 1 who had x-rayed which showed bladder and urethral stones. The urethral stones were packed tight behind the os penis (see x ray) and so the urine flow was obstructed. The bladder swelled to a mango size. The prostate also enlarged like a fish ball (see x ray). Too old for anaesthesia. Vet 1 inserted a syringe and sucked out 15 ml of the urine. But the dog still could not pee but dribbled urine.

Today, I checked on him. His urine was clear as seen at the catheter. No full bladder. His scrotum was cut away as they were swollen. The wounds are healing well.The dog goes home on Sep 27, 2015. Another dialysis SC before going home.

Sep 27, 2015
No problem peeing now. Cause of dysuria in the cat was urethral stricture. In the dog, it was urethral obstruction behind the os penis. X-rays

2304. BKTP story -- A little boy's 14-year-old dog is going to die soon

Sep 22, 2015

The little boy listened to every word but said nothing. He was 12 years old, trim and be-spectacled and studying  in Primary Six of the school. He comprehend what his father and the vet was saying.  If his best friend, a dog he had loved since babyhood, did not get operated upon within 2 days, she would die. If she were to be operated, she might die too as the odds were stacked against her. But she might live.

This Silkie Terrier was 14 years old.  If she was  an old lady, she would be 98 years old in human years. She was in poor health as her blood test showed she had sepsis with total white cell count and neutrophil count way off the charts of normalcy.  

I had examined her and  had told Mr Tan that there would  be an  anaesthetic risk of her dying during surgery. "What are the chances?" the father asked. "Less than 50% based on the two criteria of old age and septicaemia. The good news is that she is not suffering from kidney disease. You will need to sign  a consent form stating that you have been informed and  understand the risks."

Every dog owner knows the procedure of informed consent. Mr Tan would still have to pay the surgical fees even though his dog had died. He  was dealt a poor hand. The other party was the divine powers that had the good cards. The vet would represent the dealer in a casino.  He would earn his fees whichever party won.


What should Mr Tan do? His son was quiet as most boys of that age would be. His mother remained silent too. He did not voice his opinion as he deferred to the head of the household.

Mr Tan hesitated: "Why throw away good money after bad?  The dog had a poor chance of survival. She was aged, being 14 years old. He might not live another year. 14 years is a ripe old age for any small breed.

"There are many expenses such as the $300 tuition fees for my two  children. A baby is on the way. Why spend money to save a dog? The human beings need to survive in this harsh urban jungle of rising costs every year".

The bureacrats increase the fees to justify their existence while the private sector increases its fees to retain the loyalty of the job-hopping employees who will leave for a few dollars more.

But This Silkie was active although she had eaten much less and licked her back area to keep herself clean and not dirty the home. She was house-proud and would run to the papers on the toilet floor to avoid dirtying the den when she was doing her normal peeing and pooping. Now, she could not cope with the copious flow of brownish sticky pus dripping from her vagina as she tried to run to the toilet to pee. But it was not urine. It was bacterial pus from the womb.

Only during the last one week, she had this brownish-red vaginal discharge. Non-stop bleeding. Drip, drip, drip. She just could not cope with licking and swallowing the infected uterine discharge, poisoning herself. Now her blood had bacteria as shown by the high increase in white blood cells.

A dog soiling the floor of the apartment needed the mother to mop and clean up. So Mr Tan  had no choice but to consult the vet. Last year, this dog had breast tumours removed. Another vet had removed them and the fees opened a big hole in the financial pocket.

Now, there would be a medical cost of more than $500. There was a doubt that this dog would survive. So why throw good money after bad?

"Is there an injection and antibiotics to treat pyometra?" Mr Tan wanted this option. I gave the dog the IV drip, pain-killer and antibiotics as an in-patient for 2 days. She was barking wildly and loudly to greet the little boy and Mr Tan. She had no vaginal discharge.

"Her vaginal discharge has stopped temporarily due to the effects of the medication," I said to the father. "Soon, it will recur if the dog is not spayed." The father decided to bring her home.

Normally, I do not follow up as there would be considered soliciting. However, I could feel that the little boy's dog is going to die soon if there is procrastination in getting the surgery. I phoned Mr Tan.       
"My dog is now lethargic and not eating again," he said. I advised immediate surgery. As this was a little boy's best friend, I decided to lower my fees to the minimum. The dog recovered, stayed one night as an in-patient and as I walked the family to their small car, I asked the little boy: "Are you happy now?"

He nodded his head and gave me his widest smile. No words. This was one of the happy outcomes of pyometra surgery. Not every pyometra  case will survive an operation. Much depends on the progress of the disease. In  this case, this dog had not suffered kidney failure and was treated quite early before vomiting and collapse occurred. The dog was running out of time but not out of luck. Sometimes, luck plays a part in successful surgeries as in success in life and love.

2303. Asking for $3,500 salary

Sep 21, 2015
Singapore has a very low unemployment rate as compared to Greece where it is said that 25% of the young people are unemployed. However, there is intense competition for business as rentals keep increasing every year and local employees asking for more pay and less work, preferably no work on Sundays and public holidays. Singapore appears to be going into economic recession as I notice more clients ask for discounts and delay treatment of their pets.

"My Chihuahua is 13 years old," one man said to me. "Unlikely to live many years. So, no need treatment."  But the dog could not pee and the alternative is to let the dog die from bladder rupture as the bladder swelled to the size of the  mango. The first vet had inserted a needle and withdrew some urine but the bladder continued to fill with urine. The dog just could not pee.

"Whether the dog is young or old," I explained. "If it needs treatment which can save its life, it must be done."  

The economy is bad but you will see that the Certificate Of Entitlement (government permit to buy a car)  of cars has not dropped. A permit is now around $60,000. "There are many rich people around," I said to a client who commented on this. The government is the one making the money and raising rentals amongst its own properties, increasing the cost of living every year. The private landlords raise the rent much more and so the government officers raise the rent too, but not to a greedy extent.

Yesterday, a  21-year-old new  polytechnic graduate with no veterinary experience asked me for $3,500 per month after the interview and tentative agreement of $2,000 and a one-year-contract. I was looking for a full-time veterinary assistant who can work weekends and public holidays and asked how much she was looking for. She said $2,000/month and for a one-year-contract. I was Ok with that.

She had been doing some weeks of paid internship to learn more about veterinary medicine. She wanted to become a vet.

I just cannot understand what made her ask $3,500. I just could not afford her and know that she would not be committed to work. I told her to shop around for employers who pay more than me as she will not stay long. She will be looking for jobs while working for me and there is a waste of time training her as a veterinary assistant.

Sometimes our impulse side makes us do things which are not realistic and honest. After gaining experience, we can job hop for a few dollars more.   

You wasted your time. Work till you die?

Sep 20, 2015

Recently, I had two over 70s male retirees who spoke to me:

1. A man whose shares pay him a $9,000 interest a month and he lived in a big house. He had only a Secondary one education and became a police constable. He became a businessman selling what was needed in small undeveloped countries like Papua New Guinea. There was no future in the police force as he was not a graduate. He built relationships with the natives and travelled most of the time.

I met him because the breeder packaged her Schnauzer sale with 3 free vaccinations. Otherwise, convenience and proximity would mean he would go to the nearest clinic in North Singapore. 
"Anyway, the clinic there wanted me to pay more to consult the senior vet," he complained about the junior vets who were present to treat his other dogs.

"May I be frank with you?" he asked me in later visits after his female Schnauzer was spayed and I had drafted a letter for him to the Vietnamese embassy.  "I cannot write very well as I studied up to Sec 1," he said. This letter was to inform the embassy that the ICA (Immigration and Control Authority) at the Singapore Airport did not have interpreters as stated in the newspaper. His Asian wife who came to visit him, before he married her, was detained and sent back on the next plane. "She is a good girl but she could not speak Mandarin or English. So, the ICA put her in a detention cell at the airport overnight and sent her home by the next plane." 

He thanked me for drafting the letter and was frank with me about my practice at Toa Payoh Vets. Other vets have very long queues and waiting lines or several branches. My location in an industrial park did not inspire confidence and was inconvenient. So he said: "You wasted your time over the last 40 years at this industrial park, a god-forsaken place."


2. The retiree had worked for an airline dealing with stocks and shares on behalf of the airline. He came with his young adult daughter whose hyperactive dwarf hamster was losing weight and now was scratching her right face. It was an impacted pouch and right lip commissue ulcer. I evacuated the pouch and advised 10 seeds and pellets a day instead of a full bowl.  

"Do you intend to work till you die?" the father asked me. He was 63 years old but had retired to smell the roses.

"I am self-employed and I enjoy my work," I consulted usually in the mornings usually 7 days a week. I ought to be smelling the roses, wake up late on weekends.

2301. Lip commissure ulcers in a hyperactive dwarf hamster and a syrian hamster

Saturday Sep 1, 2015

Bright sunny day with clouds greyed by the haze coming from the forest fires in Sumatra. I dare not exercise in the public park for fear of breathing in the micro particles.

Today, I have another case of two. Coincidences. 2 hamsters with lip commissures  


CASE 1. 
2 sisters brought in Haku (white in Japanese), 4-month-old Syrian hamster.
"Sure does not look white at all," I said.  "It is more a tricolor."
"The sides of the mouth have bleeding. Sometimes they heal and come back again."
The hamster wriggled and turned and even bit the lady owner. She had to wash her hands.
"I need a bit of gas anaesthetic to check the mouth and trim the lower teeth," I asked permission from the owner as anaesthesia can be risky. "Without sedation, I can't do a proper examination and trim the teeth!"
She could see the hamster was extremely firsky.

Video:  Two lower divergent teeth trimmed off by 3 mm. Upper teeth trimmed 1 mm to even them.
             Lip commissures ulcerated at 3 mm across, cleaned with disinfectant.
             Cheek pouch surprisingly empty but clean and not inflamed.


CASE 2.
I saw this hyperactive dwarf hamster 4 days ago for a very itchy body. I got the hairs clipped and there was a big wound on the back spinal area. This could be bacterial or fungal infection. I gave the medication to wash the skin. Now, he is scratching his left cheek again. I call him the most hyperactive dwarf hamster.    

"He still weighs 40 g, same as 4 days ago," I said. "There is a yellow pus on the right cheek commissure."

The daughter had come. She phoned her mum which area was itchy. It was the right side under the neck. I could see inflamed skin around the right cheek pouch. There was an impacted cheek pouch. Lots of seeds were fished out.
"Ration the hamster to 10 'seeds and pellets a day," I advised. "He likes to hoard and his right cheek pouch was bulging full with seeds."  I got the seeds out.

Video
Lip commissures are common in some dwarf hamsters. As to the cause, it is hard to say. Traumatic injury from sharp sunflower seeds? Gripping iron wires or metallic things?

2300. The 17-year-old Shih Tzu barked and barked the whole night.

Sep 17, 2015

The parents came yesterday after phoning me to confirm that the urn was ready the day after euthanasia and cremation. The dog was put to sleep as he barked the whole night every night. The parents had to work but they could not sleep.

"We tried your medication for the past 5 weeks," the mum said. "But he became groggy and could not go to pee. In any case, it was not very effective."

The young adult son, now 25 years old was very upset and wanted the urn as soon as possible. So the parents had phoned me twice.

"How old was your son when he got this Shih Tzu as a puppy?" I asked.
"He was in Primary 6," the mum said. "At 12 years of age."
"The dog has been his best friend for 17 years and he was very sad."

2299. Unbelieveable story. The sudden death of a retiree who was certified healthy

Sep 18, 2015




The Primary Production Department employee retired at 55 years of age in the old days some 20 years ago. He worked in the Extension Centre dealing with pigs and poulty. One day, he came to see the vet who had his practice in North Singapore.

"I have just passed my health screening test including threadmill. I am certified fit and healthy!". He was still interested in animal husbandry and borrowed a book from the vet.

As he left to go home, the vet joked: "Give me a 4-digit number to buy the 4-D lottery!"
"Nonsense, you may pass away first," he said to the private vet.
The next day, his son phoned the vet to say that his father had died at night.  
"It could be an aneurysm (rupture of the blood vessel)," I said. "He could have gone for the threadmill test and over-exerted." Nobody knows the cause of his sudden death. 

2298. Referral. A 13-year-old cross bred had a "water-melon" lump

Sep 18, 2015

I had laksa with this practising 76-yerar-old senior vet at Potong Pasir this morning. He would be opening a vet clinic in Johor and decided to focus on surgery.

"Many young vets do not want to perform complicated surgeries," he said. "So they will refer to others."

"That's true even in Yangon," I said. "One experienced vet who had worked in Singapore got all the surgeries referred to by the other vets. Even in Singapore too."

"Swee also wanted to refer one case of a dog with a very large cyst, as big as a water melon to other vets," he recounted a 13-year-old cross bred dog that the owner wanted him to treat. "I am an old vet and I refer to a young vet to do the surgery!"  This old vet practised vet surgery for over 50 years but this was the first time he encountered such a large abdominal cyst.

Once I saw him operating to remove a gigantic tumour on the submandibular area of an old dog. The tumour was the size of an orange. Electro-surgery and keeping a lookout for bleeders, he removed this tumour. But the abdominal tumour was a large water-melon size.

"Did you draw out any fluid after inserting a needle?" I asked.
"No fluid," he said. "There was a thick wall and it was enveloped by some lace-liked tissue (the mesentery).

"It is a matter of common sense. I dissect slowly using electro-surgery. I reached a drainage tube. Suddenly, thick viscous fluid shot out, deflating the lump!" 

"This would be an abdominal cyst that grows slowly over 10 years," I recalled my Taenia tapeworm from sheep to dog transmission lectures in Glasgow University some 50 years ago. "It could be a tapeworm cyst. Cysticercus species."

"There were many smaller cysts and it would be too risky to remove every one." he said. "The fluid inside the cyst was not clear but thick and cloudy."

"These would be the other younger cysts developing," I said.

"After the surgery, the dog was jumping and running normally," the vet laughed happily. "The owner was very happy!"


And to think that his senior nurse who had been with him for many years, asked him not to operated and to refer to other vets or the expatriate specialist. I just cannot understand. Some 50 years ago, when I was in National Service full time in 1977, this vet operated on a Patent Ductus Arteriosis in a SAF Provost Unit guard dog that would be put to sleep as it was lethargic and useless. There was no sophisticated hospital equipment like the automatic ventilator to prevent the lungs deflating when the chest is cut open.

I assisted by pressing the anaesthetic vet while he located the shunting blood vessel and ligated it. No young vet would do this surgery. He was 38 years old and had his own practice and at least 10 years of experience.  I was 27 years and doing my National Service, with no canine surgical experience.

A sound knowledge of anatomy is needed. The dog recovered and was back on guard dog duty.