1433. Owner Education: Recurring ringworm on belly area

Sunday May 26, 2013

The 13-year-old had been to 2 vets. Vet 2 diagnosed ringworm. The owner started self-treatment since the skin disease was not cured. Cream and a blue lotion from over the counter was applied on the skin. Still the dog was itchy. The daughter sought an opinion from me in April 2013. I followed up with the mother and advised review but she did not come.



The mother went overseas for 4 days and came back to see the belly full of reddish rashes and ring-like lesions.

"Generalised ringworm is not easily cured if the environment is still contaminated," I said.
recovered after medication and treatment for generalised ringworm as evident by new hair growth and clear skin.

1432. Vesak Day Friday May 24, 2013 - availability and referrals

TOA PAYOH VETS toapayohvets.com Date:   27 May, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits A Vesak Day's availability and referral Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   27 May, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 1432. Vesak Day Friday May 24, 2013 - availability and referrals The first case on this Vesak Day, a public holiday was from a family who wanted to euthanase their thin 14-year-old Miniature Schnauzer. The young lady had phoned me the previous night to make an appointment: "It will be Vesak Day, tomorrow. Not so good to put down my dog." But she came as the dog was not eating. Her vet closed today and so she came to me. Her father said to me: "I had worked in the tyre shop 4 shops away some years ago when the industrial park was set up in 1980." It was especially sad for a little girl of around 6 years old with two side pony tails as she cried loudly when she was not permitted to view the dog after euthanasia. The old dog was on Vetmedin and frusemide medication prescribed regularly by their vet (Vet 1). Most owners don't bother to bring their dogs for reviews and just get the heart medication. Proper dosage and review will prolong the dog's life till end-stage heart failure. "Why did you go to Vet 1 all these years when you live so far away and there are clinics nearby?" I asked. "My relatives go there."   In the last case, there was an emergency Caesarean section as the Chihuahua, mated to a larger Jack Russell X had the first puppy stuck and pulled out by the owner 3 hours ago. I palpated the abdomen and there was another one. No X-ray or ultrasound is necessary as palpation can confirm. This saves costs for the owner. "Is there another alternative to C-section?" the slim young lady asked me. "Yes," I said. "An oxytocin injection. Wait and see. However, by delaying C-section, now 3 hours later after the birth of the first pup, the 2nd pup will die if the dam can't push it out! It is up to you to decide." She decided on the C-section which would cost her around $1,000 as compared to an oxytocin injection. Dr Daniel operated while I assisted. There was only one pup, weighing 150 g. It cried and moved vigorously when the water bag was ruptured by me. This means that it would live. "It is not as big as the first pup," the young lady said. "The male dog was interested in her and we separated them till the end of her bleeding," she said to me. "Yet she became pregnant." "In female dogs, the fertile period is towards the end of bleeding," I said. "Unlike in the female person whose fertile period is before menses." So that was how the female dog got pregnant. "Why do you come so far for Caesarean section as you are living in Bedok and there are vets nearby?" I asked her.    "My friend whose poodle you treated recommends you," she said. As the young lady did not delay further, the pup was not suffocated inside the water bag. He was crying immediately. So, no problem of survival. I let him suckle the dam for 10 minutes. TIPS 1.  As the owners were away, I took out the pup and put it in a box instead of leaving it alone with the dam. The dam may bite it since she is a first-time mum and the owners will be most unhappy. I would not have time to monitor it. 2. Three hours after the birth of the last puppy would be the limit to vigorous survival (cries immediately on delivery) generally. If there is a delay of more than 5 hours, the pup will not be vigorous as fluid from the water bag clogs up the lungs. Such pups will need swinging (see other video of Toa Payoh Vets) to revive, not just hope for the best as they will die if not swung. Vets need to be the surgeon and the midwife when pups are distressed!   These two cases illustrate that referrals are most important in veterinary practice. So is being available when your services are required. It is difficult for vets to be available during public holidays but these are the days when owners need the services. Update will be on this webpage: www.sinpets.com/F6/20130527referrals_toapayohvets.htm More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 Toa Payoh Vets Clinical Research

Copyright © Asiahomes All rights reserved. Revised: May 27, 2013 Toa Payoh Vets

1431. Mum's ferocious anorexic cat

TOA PAYOH VETS toapayohvets.com Date:   24 May, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits Mum's ferocious anorexic cat Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   24 May, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 Thursday, May 23, 2013 1431. Mum's ferocious anorexic cat I asked the daughter to sms me regarding the progress of her mum's cat as this was a ferocious cat that would not eat when hospitalised for the past 3 days. When he came in, he was quiet and I gave him an antibiotic injection as he had yellow nasal discharge. I warded him since the mum said that her cat had not been eating for some weeks. The mum had asked for some medicine 7 days ago, but the cat still would not eat. So I advised her to send the cat in for detailed examination including blood test and X-rays where relevant. After my first injection, the cat would attack any staff going near him. So my new vet assistant could not give him medication. How to solve this problem? "Mix the powdered medication with brown sugar and smear on his body," I said to my assistant. After 3 days, I phoned the daughter to take the cat home as the cat would be happier at home, be given antibiotics and recover. She was to let me know by phone but I did not expect any feedback as most owners don't do it if the pet is recovering. I got her SMS yesterday.   3.40 pm May 23, 2013 Hi Dr Sing. Gd afternoon. XXX from stc (Singapore Turf  Club) here. Updating you on d progress of YYY, my mum's cat. He is getting better, active n started eating whiskas (can food) not d ones fm ur clinic. She also can meow now. Thanks lots, 9.12pm May 23, 2013 I SMS back, short and sharp as I don't do long texting. Thanks for good news. He recovered from nose discharge? 10.56pm May 23, 2013 She SMS back Yes recovered. Tq Dr Sing Not a spoken word with the younger Singaporean clientele nowadays. But there was a happy clinical outcome and that was what matters. Vets have to deliver, to perform too, not only salespersons. A ferocious cat is a good experience for Dr Daniel and my new assistant to handle. I asked Dr Daniel to take blood for testing and give the drip. This was mission impossible if you see this ferocious cat pawing anyone going near him!  This is the reality of practice. In the University, the professors teach how to diagnose. But now how to treat a clawing ferocious anorexic feline that would die if he continues not to eat? "Sedate him lightly, take the blood for testing and give a SC antibiotic drip,"  I said to Dr Daniel.  This was done. Blood test showed a high total white cell count and this was indicative of bacterial infection. The daughter was satisfied with this evidence-based medicine being practised. The next day, I sent the cat home on medication as I felt he would do better at home ground. My intuition was spot on when the cat started eating and meowing, he is on the way to recovery. Update will be on this webpage: www.sinpets.com/F6/20130524ferocious_anorexic_cat.htm More case studies at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 Toa Payoh Vets Clinical Research

Copyright © Asiahomes All rights reserved. Revised: May 24, 2013 Toa Payoh Vets

1430. Update: The young lady with a Terrier X with multiple bladder stones

Thur May 23, 2013  Toa Payoh Library 2.30 pm

I believe that the Terrier X was operated on Sunday,4 days ago by Dr Daniel and I. Thousands of stones. Millions if you count those peed out over the past 9 years!

http://www.kongyuensing.com/cgi/20130555Terrier_F_9years_bladder_full_stones.jpg

http://www.kongyuensing.com/cgi/20130522bladder_stones_female_terrier_toapayohvets.jpg

This morning, 9.49 am,  I phoned the lady owner of this Terrier X. No response. Could be sleeping or working. I sms her:
"May 24. Is C eating n normal now? Dr Sing Toa Payoh Vets"

At 12.19 pm, sms reply

"Hi yes she is...:) pee is clear and just passed motion today too...so she's recovering really well! Results for the stones will be out on Sun?

2.33 pm I reply:
"Not so soon. Will inform u."

Nowadays, it is better to text or send images of X-rays, lab reports by phone. Not a word needs to be spoken and no time wasting.

1429. Cost of canine bladder stone surgeries in Singapore - 2 case studies from other vets

The costs of canine urinay stone removal in Singapore

Breast cancers in dogs

I was operating on some mastectomy cases with Dr Daniel recently. Older unspayed dogs with mammary tumours. It is hard for the owners as anaesthetic risks are high and who would want a dog to die on the operating table? So, the owners generally will not want any surgery when the breast tumours were detected as small nodules as in one case. 7 months later, one tumour had exploded and there was an emotional decision to get the exploding tumour removed.

I am scared of doing such old dog anaesthesias as deaths are always round the corner, due to old age and poor health as well as the presence of spreading breast cancer cells in the old dog's body. Possibly to the lungs. Owing to economic reasons, no lung X-rays are usually done before surgery as heartlanders frequently complain about the high veterinary cost of surgery.  Prices keep going up as evident by the Car's COE prices having shot up today to over $65,000. At its lowest, it was $1.00. So you need another $65,000 on top of your car purchase price. Dr Daniel showed me a video clip of famous US actors e.g. Fast & Furious being asked about the prices of Singapore cars. They underestimated by over 50% when they compared to US car prices.

For heartlanders, it will be much cheaper to get the female dogs spayed when they are young as they seldom get breast cancers in old age. So less expenses and worries. But many don't do it and as a vet, we try to minimise costs but not to the extent of losing money. Young vets don't know how expensive it is to maintain a vet practice with the bureaucrats thinking of ways of adding costs like having to get an autoclave certified for safety every year. Why don't they get those gas cylinder valves in Singapore residences to be certified for safety yearly? There will be much unhappiness as this will add up the costs to the people.  

 

1427. The runaway horse and other stories

TOA PAYOH VETS toapayohvets.com Date:   23 May, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits The horse who got away & other stories   Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   23 May, 2013  toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 1427. Veterinary stories from a young vet May 23, 2013 Seldom do I meet young vets as we have our own business to attend to and there may be a generation gap. I had some interesting conversations with one young vet I met yesterday. Case of a female cat has a distended bladder. It is very hard to catheterise a female dog or cat, unlike a male dog. In the female cat, it is much more difficult. "Use a speculum or otoscope with magnifying glass," I advised this young vet who would have known what to do from internet research. "The dog's legs must hang down the table." she said. "But I can't locate the urethral opening." The dog must be anaesthesized. She had a case of a female cat with swollen bladder and asked the owner to visit another vet. "There is a possibility that you use a syringe to suck out the urine and whatever is lodged inside the female urethra would be dislodged," I said there was no need to send the patient away. "Make a small incision after aspiration of the urine deflating the bladder. Place the catheter into the urethra from inside the bladder and syringe in the saline to dislodge the urethra or use a forceps to extract it. You can then stitch up the small incision. The same process applies to the female dog with urethra obstruction." Case of a runaway neutered horse. IV anaesthetic was used and she was monitoring the horse anaesthesia. "The eyelids were blinking and I asked the operating vet whether I should top up," she was doing internship in Australia and the horse was being neutered in an open field. "No need to," the other vet said. "In a second, the horse got up and ran away!" "It is very difficult to catch a runaway horse," I remembered my days as a racehorse vet at the Singapore Turf Club. "How did you two do it?" "The horse was still wobbly and we caught him." In any horse story, a pregnant vet was standing near a horse and got kicked. She had a miscarriage. "Fortunately she did not die," I said. "I hear stories of vets killed by kicking horses." I was telling this young vet that I prefer to visit the old vet practices as many of them have excellent veterinary lessons to learn from. Not the fanciful high tech expensive vet practices where money is not a problem.  "There is an old practice in Australia where the vets don't use isoflurane gas, one young vet told me," I said. "It was a fun practice to do internship. The vets were around 70 years old. A James Herriot type of practice. I would like to visit it. At first the vet who told me of its existence did not want to reveal its name and I told her it was a legal practice. So what is there is hide? Her University lecturers frowned at this practice and could not believe it existed in Australia. I guess it is one of a kind." I went to visit an industrial shop making gold rings and other accessories with this young vet as the operators were her parents. The workers had gone and now the parents were doing the work themselves. The over 50 years of industrial knowledge were not fully passed on as there were no successors as the elder brother is making more money in IT and the younger one is a vet earning $4,000 a month. "How many thousands of gold ring need to be sold to make $4,000," I said to this young vet. "At 3% of selling price of $200 for a gold ring as profit as your mum said, she needs to sell over a thousand rings." "But she can sell many rings and make more money than me," the young vet knows the inside of the industry as she was a little girl who was brought to the industrial shop by her parents.  The good times might have gone by. Gold prices have dropped but there is always innovation and a new mindset to revive her parents' business. If only she was interested. "Studying TMC is a waste of time if you want to make money," I said. "Apprentice yourself and improve your parents' business bringing it to a higher level," I advised. Only she and her brother would have the insider's knowledge on what ails the industry but has she the motivation?  "Earning $4,000 a month by being an employee has its limits on earning more," I said. "If you can improve your parents' business and expertise, the income will definitely be more than $4,000!" The prices of making such rings are much cheaper in Malaysia, China and Hong Kong and the workers are nowhere to be found. The founders who are over 60 years old still carry on.  "It is from such hard work that the parents send a princess to study vet medicine in Australia," I said. The second brother who is keen on continuing this business called this young vet a princess of the family. "You ought to help sustain the family business, but with innovations and new ideas," I said. "Rather than continuing making the usual gold rings or sourcing them. For example, online sales, using an English name. Not a Chinese name like Hong Hong gold as the global consumers prefer English-sounding brands."  The small animal veterinary practices on the other hand had grown to over 50 in number while such gold producing shops had shrunk in numbers in Singapore. Bali is famous for its gold craftsmanship and Singapore is now not competitive at all. Life is full of changes and one can become redundant or bankrupt with global changes in one's industry and government policies.  Update at: www.sinpets.com/F6/2013023vet_stories_toapayohvets.htm More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 Toa Payoh Vets Clinical Research

Copyright © Asiahomes All rights reserved. Revised: May 23, 2013 Toa Payoh Vets

Surgical cost of bladder stone removal surgery from two vets in 2 cases.

CASE1. Vet 1 quoted $1850 for removal of above bladder stones. The bladder is packed full. et 2

CASE 2. Vet 2 quoted $1,000 for removal of bladder stones. Both owners want payment by instalments but most times, the instalments don't get paid as the owners forget.

I had one couple who did not pay a cent for the Caesarean section of a Jack Russell some years ago. I did not get a deposit as I trusted them. So, nowadays, it is full payment at some clinics.

1425. New maid for Mrs Robinson

Yesterday, May 20, 2013, I visited Khin Khin's office. Her neighbour whose husband will not tolerate any man talking to her passed by with two tall glasses of water and came in to talk to her. One glass had 3 stalks of roses and the other was a leafed plant. "Don't call her Aunty," Khin Khin said. "Call her Ayi".  I took over the glasses and put them on the table and smelled the roses.

"You don't smell the roses as these are for Buddha," Khin Khin said. "Now you have to pay $5.00 to buy replacement ones." The Ayi did not mind. All Buddhists offer flowers in front of the Buddha picture.   

I noted a thin dark girl sitting quietly in the room. "Mrs Robinson's new maid had arrived," she said. As I was going back to the clinic, I offered to send her to Mrs Robinson's condo in Cairnhill Road, saving Khin Khin some time. "Mrs R is not in," she said to the new maid who had just arrived and carried a back pack and two plastic bags. One plastic bag had a frame of the Buddha. She showed me a photo of her parents. The father is 75 years old and is normal health in mind and body. The mother is 59 years old.

"Why don't you just work in Myanmar and be with your parents?" I asked her. She had worked in Singapore for a family in Bukit Panjang 3 years ago. "I can't save money," she had worked in a hotel in Yangon for around S$150 per month. Here, she would earn $500 with free board and lodging and would have some money to ha.   

 

1424. "Expiry date" of a Cocker Spaniel - to euthanase or not?

Case of euthanasia or not?  May 20, 2013. 8 pm duty. Dr Sing Kong Yuen

THE CASE FOR OR AGAINST EUTHANASIA -
THE DOG HAS LIVED PAST THE EXPIRY DATE

14-year-old.male Cocker Spaniel. 
Profuse salivation and "bad breath" now.

"He keeps drooling and he has bad breath. Is it worth treating him?" the gentleman owner consulted me for the first time at 7.30 pm on Monday May 20, 2013, half hour before my closing time. ""I read from the internet that Cocker Spaniels live up to 12 years and he is already 14 years old."
 
"This Cocker Spaniel is active. Is he eating or not?" I wanted to confirm. 
"He eats a lot," the man said.

"One of the main reasons Singaporean dog owners put an old sick dog to sleep is financial," I said.

"Oh, I can afford the fees. Is it value for money? Will there be more medical problems down the road if you treat this drooling?"

"The decision to euthanase has to be made by the owner," I replied. "If he is my dog, I will get him treated for drooling and bad breath." Actually, there was no loud stench. I reviewed the medical records as the dog had been treated by my associate vets in the past 2 years. In April 2012, my associate vet had operated on the right ear for aural haematoma, excised a big skin wart and did dental scaling under anaesthesia. The costs amounted to $751. In May 2012, the dog was hospitalised 7 days for a ruptured skin abscess, costing $315. So, in 2012, the owner had spent around $1000 whereas for the past 11 years of the dog's life, he did not have to pay for veterinary costs except for the $35 annual vaccination from 2009 - 2012. In April 2013, he paid around $744 for dental and removal of skin lumps. Now there is profuse salivation.   
  
So, I can understand that he is worried that there will be more veterinary bills and since the Cocker Spaniel is expected to live for 12 years, his dog had exceeded the life expectancy. So, he asked me whether he ought to euthanase him. The cost of living had shot up incredibly high with car, rental and property prices too high as there seemed to be a group of rich consumers. Many heartlanders are affected and so are their pet's health care treatment being delayed.

It is like my 8-year-old car. It cost me a bomb to repair the leaked radiator and yet after spending $6,000 over a period of one year, the radiator system still leaked. I had to rent cars while it was in the workshop. Recently, I scrapped it as the leak continued.

But this dog was drooling for the first time. What was the cause?
"If the dog does not drool till Christmas, it will be great," the owner said.
"Why not give him 2 weeks' chance?" I asked. "I give the medication and you stop feeding dog treats. Just canned food - no dry food and water for two weeks."
"Are you sure you can stop the drooling permanently?" the man asked.
"I don't know. If the gum ulcers heal and you don't feed abrasive food or treats, there may be a chance."
This was the live or die situation for this friendly big-sized Cocker Spaniel with white beard. At 13 kg, he was thin and he had a rectal temperature of 39.5C which might be a sign of fever. Due to economic reasons, I did not ask for a blood test to screen his health. I gave two injections and medication. "Strictly just canned food and water for the next 2 weeks." I said. "This is his last chance to live."

The next sunny blue sky morning of Tuesday, May 21, 2013 at 10 am, I phoned the gentleman. His sleepy voice over the phone told me that the dog had considerably reduced his drooling. "Last night, he did not drool at all. Maybe a drop or two! Wait, I will check him now."

He examined the dog and replied: "The drooling absolutely stopped. Will this be permanent?"
"Much depends on the cause of the gum ulreration," I said. This viscous salivation reminds me of cats being given some drugs they dislike and so they produce viscous salivation and drooling.

"Did you use alcoholic wipes to clean your dog's mouth?" I asked by the way.
"Yes, I do," he had bought some commercial wipes. "But there is no alcohol."
"Are those the baby backside wipes?" I asked.
"Yes," he said.
So, this follow up is useful in that the cause of salivation could be his habit of wiping the dog's mouth twice a day to clean him. The chemicals inside the wipe cause gum ulcers and evoked viscous salivation. There would be a smell of "bad breath."
"Do you think the wipes cause this drooling?" the man asked me.
"It is possible. Stop all wipes. Use paper towel or tissue paper."

I have to wait and see for 2 weeks. If there is no more drooling, this dog has a reprieve and may live up to 20 years of age. Much past his expiry date of 12 years according to the internet.