2337. A gentle 6-year-old female guinea pig has a doublel chin?

Oct 20, 2015

The busy working couple came at 6 pm with this 6-year-old guinea pig after making an appointment yesterday. I was talking to a dog owner who came to buy the L/D diet for his old female dog with liver disease and breast tumour.

For this dog owner, he had not wanted surgery when his old dog had a small breast tumour. He said he worried that the dog would feel very painful after the surgery.
"There are pain-killer drugs after surgery," I said frankly. "You were able to afford the surgery which cost around $300 to remove a small breast lump, but you proscrastinate." Sometimes, it is possible to be blunt if the vet knows the client well. It was just a fatal decision as the dog's breast tumours had grown and spread but no surgery could be done now as there was liver disease leading to very high anaesthetic risk.

Blood test had revealed liver disorder and so the dog was given the special liver diet L/D to prevent further liver damage. This dog had a very high anaesthetic risk as her liver was not normal and so no surgery to remove the breast tumour and spay was to be done.

As for this old guinea pig, the owners had to decide on operation. There is excess skin hanging down and the lump was soft. It could be a tumour or consolidated abscess. I will do the surgery today Oct 22, 2015 to incise and check what was inside this left chin swelling with loose skin.

TREATMENT
Isoflurane gas only.Large lipoma excised electro-surgery by Dr Daniel. No histology.

2336. An 11-year-old Golden Retriever has a large ear tumour

Monday, October 19, 2015

54. An old Golden Retriever has a fast-growing ear tumour. What to do?

Oct 19, 2015 I got an email today. Dear Judy, Thank you for taking time off your busy schedule to look at this email. I am writing to understand about the possible procedure that can be administered on my golden retriever.

He is a 11 year old boy and has got a large cyst/growth on his right head, near to the ear area (3cm In diameter). I understand from another vet that his condition will require him going through GA and he might not wake up due to his age. Therefore the vet suggested us to not do anything. However, the growth has been growing day by day and it is a worrying scene. I am hoping that you guys can assist to see if there are any possible medical treatment for him. Please see attached photographs for his Cyst/growth.

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

The young man's 11-year-old Golden Retriever has a large growing ear tumour. His family vet said that the dog was too risky to operate when consulted one month ago. "In my experience," he said, "Golden Retrievers live up to 15 year at the most. So risky to operate as the dog may die under anaesthestic." But the ear tumour doubled its size to a fish-ball now. The young man googled "veterinary surgery Singapore" or some words and consulted me. "It is risky if the dog is in poor health," I said. "If not, short surgeries are safe. Have you done as blood test?" "Yes," he said. "One year ago by this vet. Nothing abnormal." There is no guarantee of no-death anaesthesia in old dogs. So, he has to decide. "Presently, the ear tumour does not bother the dog," he said. "When it grows much bigger and ulcerated," I said. "The irritation and inflammation will cause the flies to buzz onto it and lay eggs forming maggots. The dog will be bothered."


I met the young man on Oct 19, 2015.
The family vet had warned him about death of old dogs on the op table and so the tumour, from a small pea size became a golf-ball size and he sought other vets via the internet and chanced upon Toa Payoh Vets.

"There are anaesthetic risks for old dog surgeries," I said. "However, old dogs with good health do not die from this short anaesthesia to remove the ear tumour. No vet can guarantee no death on the operating table. The owner has to make the decision."

The alert and active dog was small sized but his heart was good and his femoral pulses were strong. The rectal temp was 39.9 which was slightly higher

He decided on the surgery to be done today Oct 21, 2015. I operated on the dog after 2 days of antibiotics. 0.1 ml domitor + 0.15 ml ketamine IV and isoflurane gas maintenance. The surgery took around 17 minutes and the dog was smoothly anaesthesized.

Electro-surgery sliced off the big tumour measuring at least 5 cm x 5 cm x 4 cm. The owner did not want histology. 

Antisedan 0.1 ml was given to reverse th e effect of domitor. The dog woke up.The ear was bandaged and the dog went home with medication and painkillers.

FOLLOW UP
Sunday Oct 25, 2015
I tel the owner. "Everything is fine," he said. "The bandage of the ear came loose on the  evening of the day of discharge." He will email to me the image.

2335. Daniel's images photoshopped

It took 2.5 hours just to edit and touch up the images. The time taken by non-experienced digital photographer will be terribly long.

Oct 19, 2105. Tripod stand took the images with late afternoon sun onto the actual prints.
Young people should learn digital photography seriously as memories once gone are lost forever if not captured digitally and posted in the cloud. Hard disk storage unreliable as they need to be warmed up and deteriorate over the years.

Only cloud storage in google and you tube are likely to last longer, in my opinion. I was surprised that the mummy had not thrown out the photo albums during the recent house-keeping .

Sunday's rare pets - A Chinese soft-shelled turtle and a pet fancy mouse as patients

Sunday Oct 18,  2015. Still hazy with sun obscured by grey clouds.

2 rare pets in Singapore seen today at Toa Payoh Vets. 

The younger generation in their 30s were the pet owners.  It was fun talking to the two types of owners and knowing more about the lifestyle of the pets. The information is shared in the images below and in the you tube videos.

Pet Fancy Mouse has swollen upper eyelid of the left eye. Why?
Hard to say but there was a much bigger room mate at 4 months of age and mature.
A territorial fight or accidental injury during grooming by the bigger mouse? I had the video of the bigger grooming the smaller one after the examination. The smaller one just kept still. So, was there bullying or not as the older one matures at 3 months and is now 4 months and will want
more territory.

One week ago, the tank water was very smelly and probably had much fetid gas. The water was usually changed every 3 days. So this Chinese Soft-shelled turtle could have been badly infected. He stopped eating. When given new brands of pellets, he ate but then stopped eating.

From the history, I suspected it was acute gastroenteritis, probably from poor pellet quality as Taiwan had a series of bad quality food scares last year, with re-cycled oil being used for sale as cooking oil.

"Are the stool quality and colour back to normal?" I asked.
"Yes," the young man said. "But very little."
This turtle dislikes being handled and splashed about. I could not see his small eyes since he usually hides his head showing his nose.

 

2333. A tumour 3 times larger than the hamster's head

Saturday Oct 17, 2015 morning.

"Think about the high anaesthetic risk resulting in death on the operating table," I advised the father who brought in a 1.5-year-old Winter White dwarf hamster with a left chest subcutaneous tumour as big as a golf ball. Its size was 3 times the size of his head.

Such gigantic tumours send shivers down my spine if surgery is to be done as the death rate exceeds 90% in such cases, in my experience. Death could be post-operation as the hamster might not recover from the anaesthetic drug Zoletil given IM.

"What would you advise?" the father of the 10-year-old girl asked me. "To operate may lead to death. If no operation, the hamster will die of infection and breathing difficulty."

"I would have got the lump removed when it is very small," I said.  "For now, surgical removal is the only option as drugs will not shrink the tumour."


"The lump was small, but 2 months ago, it ballooned and grew bigger and bigger!"

The parents and the little girl sat in the waiting room to ponder over the fate of this hamster.
They decided to go for the operattion. Dr Daniel operated. The hamster had a large stitched area on the left chest to neck over 4 cm long!

Bleeding and more bleeding from the wound post operation. The hamster was barely awake when he went home to Pasir Ris in North Singapore as this was a day surgery.


FOLLOW UP ON OCT 18, 2015 11.30 AM
"The hamster slept the whole night," the mother answered my phone call. "Now he is running around, trying to scratch his itchy left neck. He could not reach the stitches as the loose neck skin prevented him from doing it!"
"Keep the wound very clean and give the medication," I advised. "It may recur as it is likely to be cancerous since it grows so fast in the last 2 months."
"Where will the tumour exist?" the mother asked.
"In the same area."
"When?" she asked again.
"As early  as 2 months after surgery. Observe for any small lumps."

"Pasir Ris is distant from Toa Payoh. Is there a vet clinic nearby?"
"No," the mother said. "We googled hamster tumour surgery and found Toa Payoh Vets' you  tube video of a similar case of hamster tumour operated. That is why we went to you."

This hamster is carefully and daily cared for by the little girl who is only 10 years old. Every day, she will clean up the cage and ensure that the hamster has food. This will be the reason that the parents decide to get the hamster operated.

Oct 19, 2015
I googled "hamster tumour surgery" and found the following:
YOUTUBE VIDEO SEEN BY THE FAMILY OF A DWARF HAMSTER WITH A GIGANTIC TUMOUR EXCISED AT TOA PAYOH VETS
https://www.youtube.com/watch?v=EVD1SMDzAFw&feature=youtu.be

OTHER CASES
http://www.asiahomes.com/singaporetpvet/misc/0721hamster_tumour.htm

http://www.toapayohvets.com/surgery/050609PAGE1_hamsters_ToaPayohVets.htm

http://www.sinpets.com/F6/20111009unacceptable-veterinary-advices-hamster-tumouors-singapore_ToaPayohVets.htm

2332. Singapore stories: The 76-year-old cardboard woman

Sunday Oct 18, 2015

"Can I buy you a cup of Ya Kun coffee?" I asked this sunburnt 76-year-old cardboard woman busily sorting out and flattening the cardboard boxes and piling them on the trolley. Cropped white haired, slim and be-spectacled, like one of those kindly grandmas we all love, she pushed her trolley past Ya Kun Cafe Toa Payoh Hub. That was where I just had my $4.80 breakfast of coffee, 2 bread spread with kay but without butter and two half-boiled eggs. I came to clinic early at 8 am to check on the 3-month-old kitten that had an operation and she was OK and decided to buy my Straits Times and drink Ya Kun coffee to keep me awake.

The haze blown by the strong winds from the forest fires in Sumatra had shrouded the sky, making it grey and the sun invisible.   

"Give me the money," she replied. I handed her a $10.00 note.
"Just $2.00 will do," she said she had coffee.
"Why do you need to work at your age?" I asked when she said she was 76 years old.
"I need the money," she was forthright.
"Don't your children support you?"
"My only son has not worked and even pester me for money!" she spied a Burger King employee carting a few cardboard boxes to the bin and left to intercept him. He gave her the cardboard boxes.
"How old is your son?" I asked her.
"He is 30 years old, but now he is working as a seaman. It is better for me that he is not at home (as he often asks her for money)."

At this age, it was tiring for her to wheel the trolley loaded with cardboard boxes to Toa Payoh Lorong 8 where the karang guni man will buy her goods more than once daily, she told me. The time taken would be over an hour. A full trolley of cardboard boxes may give her $3.00.

She appeared fit and had no dementia as she conversed with me in Cantonese and  English,. She could approach her Member of Parliament for some monthly assistance of around $200, but she had not done so. Perhaps she could work at Changi Airport to gather the trolleys if she was acceptable at 76 years of age. 

Nowadays, there is a trend that a group of young Singaporean couples do not want children. Other than the increased stress and financial costs, some adult children have no respect for their parents and cannot support the aged parents. Some even migrate to Australia and other countries.

Perhaps, this group is wise as they could have savings in their old age.    

Myanmar Travel Stories - Alms to monks and School Boat for children

Oct 5 - 10, 2015

Oct 5.  MAI to Yangon by afternoon flight

Oct 6. Ygn to Hinthada by car. A-Z Guesthouse reluctant to accept foreigners. Went to another guesthouse with no English name.

Oct 7. Hinthada. Lucky Guesthouse. Cooked Food to 2700 monks

Oct 8. Hinthada to Ygn. 4am rice to 2700 monks.
                                        River boat for school children living near river bank.

                                        Royal Golden View Hotel. US$55 for suite Room 206.
Oct 9. Ygn. Royal Golden View Hotel. US$55 for suite. $45 for ground floor near guest bathroom

Oct 10. Ygn to Singapore by morning flight

                                          4am  2,700 monks collect rice. Yesterday afternoon, they collected cooked food (meat, vegetables) from the same temple.

2329. KPI for 4 dew claw removal in a Yorkshire

Oct 14, 2015

Today I demonstrated to my assistant Naing how to be efficient and prompt in removal of 4 dew claws in an adult Yorkshire. From IV sedation to last stitch, the operation was 11 minutes.


11.19 am Inject domitor and ketaimin IV  D+K 0.1 +0.12 ml IV, 4 kg Yorkshire
11.30 am First skin incision
11.42 am Last skin stitching

As the dog was excitable, 11.19 - 11.30 am were 11 minutes used to clip hairs off 4 feet and prep for surgery. This delay caused the dog to wake up at around 11.39 am and isoflurane gas had to be used to top up anaesthesia.

IMAGE OF ANOTHER CASE OF INGROWN TOE NAIL IN 23 NOV 2021:

Curled toe nail (arrow) snagged into the skin had been clipped short

2328. Rabbit with left mandibular fracture

Saw the rabbit on Oct 11, 2015


Dental work was done by another vet.
Oct 10, 2015 Drooling a lot


HISTORY
15 Jul 2015.  Dental. Right and left upper CT1 loose and moving towards cheek. Removed.
Spurs CT2 left upper and CT1 left lower, CT2 right lower. Multiple CT trimmed.

27 Aug 2015. Dental. Pus in left side of mouth. Dental rad - Osteolysis around left mandibular CT1,2,3. These were extracted. Pus seen. Post dental rad - no roots retained at left mandible. Dental disease - early abscess formation on left mandible.


Oct 10, 2015. Drooling a lot. Came to Toa Payoh Vets. X-rays taken. Under anaesthesia isoflurane, the left mandibular mid area had a large bony lump - a biopsy for bone cancer is advised.

2327. Myanmar travel stories - The taxi had no power uphill

Oct 10, 2015

At 5.30 am, Thin Thin hailed a taxi and got to my hotel, Royal Golden View. My Myanmar Airways International flight would be departing Yangon Airport at 8.30am.

"Taxi drivers had robbed passengers," Thin Thin ensured that I would be safe by sending me to the Airport. There appears to be thousands of taxis in Yangon and the common 2-hour downtown car jam is really there nowadays. So, how could a taxi driver earn a living by being caught in such a jam? There is no mileage meter as fares are fixed and negotiated before driving.
On the uphill road to the departure area, another car stopped in front of us. Our taxi driver found that he could not drive his taxi uphill.

"This car has no power," I suggested all 3 passengers alight. Thin Thin objected as this was not her style. The taxi driver smiled as he understood what I said but had never spoken a word. Since nobody alighted, he slowly reversed his taxi downhill to the level road.
Fortunately there was no car behind him. From the level road, he drove the taxi uphill to the departure lounge. He fulfilled his duty. He helped to take out the luggage. Such incidents make for  a distracting memorable experience of my Myanmar travel.

When there is life, there are challenges. This very trim and young taxi driver must be experienced to resolve the challenges.

P.S
There is a Ya Kun coffee shop in the Yangon Airport. But it was not opened till after 8 am unlike the other local coffee shop nearby. As I had to arrived at 6.30 am, I had no chance to sample the coffee. Yet in Singapore, Ya Kun opens before 8 am.  

Maybe Ya Kun finds it not worthwhile to open early.