Last week, I gave a lecture to 3 young people at my office. Two are young adults named Vanessa, Nicolas and one is a Myanmar employee Nyi Nyi. I asked Vanessa to write a report and this is given as follows:
How to succeed as an
employee
1.You must have a
target
To be able to produce
positive outcomes
2.Perfomance
Time equals to money and
performance equals revenue
3.Creating a list
To set a target for yourself
that can be achieved in the day itself
4.Distractions
They come in the form of
your phone, computer, customers etc. Try to minimize these distractions so that
you can meet your daily target.
5.Niche
Determine what you are
talented in/good at doing/ excel at and further your knowledge/skill of it.
6.Mindset
Change your mindset to suit
your job.
E.g. I don’t like to network
but I will do so for the sake of my company and to increase my performance.
7.Best person to
talk to
The best person is
definitely not your boss. Talk to your co-workers. E.g. In the healthcare sector,
talk to the stall holders in the staff canteen.
In the case of
veterinarians, networking during dog shows or SPCA functions. However, it is
not practical as a lot of time is wasted. It is slightly more applicable to
senior vets.
8.Added value to
the company
Employees should provide
timely performances with quick and efficient outcomes. It increases revenue as
time is money. Cross-selling is a good method as it shows initiative.
9.Upscaling
With more initiative, you
can start doing your own research through data bases or networks to find
clients/candidates or higher value.
10.Strong
competition in any industry
80% of business = 20% of the
employees. Employees must be motivated and be willing to take on hardship in
order to succeed in life.
Mar 22, 2014
Email from a hamster owner in the USA
Hello Dr. Sing,
Thank you for your generosity and willingness to speak with me on the telephone today. I have typed up the history below and attached photographs of my dwarf hamster in this email.
Past medical history:
My pet is a 2-year 3-month old dwarf hamster. His past medical history includes trauma to left eye approximately 1 year ago, which was subsequently prolapsed and was surgically enucleated without complication (Enucleation procedure was performed within 15-20 min, and he recovered within a week), and significant osteoarthritis for which he currently takes oral meloxicam.
Current issue:
For approximately the past 9 months, he has had a worsening cataract in his remaining right-eye. He has been followed by a veterinary ophthalmologist, and based on exam he has had no reflex to light in the remaining eye and is likely blind (although he manages to navigate his habitat quite easily) I've noticed increased vascularization over the past month, and within the past 24 hours, he has developed worsening hyphema of the right eye. The hamster does not appear to be in acute pain or distress, but I've found it difficult to assess pain in a hamster.
I've followed your website for the past year and I noticed that you had posted some pictures on a hamster with bilateral hyphema.
Consultations:
I consulted my veterinary ophthalmologist and small-pets veterinarian today, and they are not certain what the best course of action is at this point. The ophthalmologist recommended diclofenac (NSAID) eye-drops and to see if the condition resolves. The other veterinarian recommended corticosteroid eye-drops. I decided to proceed with the diclofenac 1 drop every 6 hours. The general veterinarian mentioned that because the hyphema is secondary to a long-standing cataract, increased intraocular pressure may be the cause. She mentioned that eye-drops are palliative, but enucleation of the eye would be the ultimate solution. They seems to agree that enucleation of the remaining eye will not affect his vision, because he cannot see out of his remaining eye. However, because of his age, there is an increased risk with anesthesia and surgery. Surgery is scheduled for tomorrow morning.
I wanted to seek your thoughts and opinion on the case of my pet. I am not sure what is the best course of action. My concern is that he may have developed an acute glaucoma secondary his cataract, or that his longstanding eye disease may have led to neovascularization. I am concerned about what will offer him the best quality of life (less pain), and whether enucleation should be the solution at this point. NSAIDs have the risk of increased bleeding, and long term use of corticosteroids can increase intraocular pressure. I am also unsure of the cause of the hyphema, and therefore unsure if the hyphema may acutely worsen, leading to severe pain or prolapse.
I would greatly appreciate you opinion and thoughts. Thank you so much for your help,
Steve
The photographs are attached in this email. The IMG_ named photographs show his eye condition today. The other filenames dated with when they were taken. I will also send you a video I took today in a separate email.
REPLY FROM DR SING DATED MAR 22, 2014
Thank you for your email, images and videos. You have been most caring. My preferred course of action will be enucleation to eliminate the intense pain inside the eyeball. Drugs will not work. Anaesthetic risks are high as the hamster is aged. Best wishes.
---------------
MARCH 23, 2014 EMAIL TO DR SING
Hi Dr. Sing,
Thank you again for your email and your time. I wanted to provide an update. Surprisingly, this morning I spoke with my veterinary ophthalmologist and took my hamster in to the senior general veterinary surgeon (specializing in exotics). Contrary to the junior vet I spoke to yesterday (who recommended surgery today), the senior operating vet examined my hamster this morning and decided that surgery was not indicated at this time.
The ophthalmologist told me he thought there was a reasonable chance that the hyphema may slowly resolve with diclofenac eye-drops. On pre-operative exam, the senior general veterinarian assessed that he was not in pain severe enough. He mentioned that hamsters usually stop eating when they are in pain, and based on my hamster's activity- he does not appear to be in severe pain. So, we decided to continue with the diclofenac drops, and the general vet added ciprofloxacin eyedrops as well. He recommended follow-up / re-evaluation in 2 weeks.
On my physical exam the hyphema appears to have settled at halfway filled up the anterior chamber of the lens. As of tonight the globe does not appear to be any more prolapsed relative to baseline. I will continue to monitor for any acute changes or worsening.
Are there any other particular signs or symptoms of pain (or specifically eye pain) in hamsters that I should pay attention to? I have read that these pets hide/tolerate their pain quite well, making it somewhat tricky to assess. My ultimate goal is to provide my hamster with the best quality of life.
I realize it's difficult without having examined the hamster, but if you have any input on whether this is a reasonable plan of action, I would love to hear your input.
Lastly, I wanted to thank you again for your generosity and time spent speaking with me yesterday. I truly appreciate it. I also want to add that your website may very well have saved my hamster's life when he had his first enucleation. My local vet who was less experienced had urged a 45min-1hour enucleation procedure, but after reading your website and learning about hamster anesthetic risks, I opted to search the entire city for a vet who had experience operating on exotics. The enucleation was performed swiftly and he concurred that a 45 minute operation would have likely been lethal. I just wanted to let you know that someone across the world was able to benefit from the wealth of information on your website. And not to mention, as a hamster owner, I find the info and pictures to be fascinating as well. Also, please let me know if your animal clinic accepts donations of any sort, as I would be happy to make a small-donation as a token of appreciation for your time.
Thank you again,
Steve
REPLY FROM DR SING DATED MAR 23, 2014
Thank you for your feedback and good news. I always tell my clients that each vet has a different approach to the treatment of diseases and so this results in conflicting advices to the pet owner. There may be more than one way to treat a disease.
In your case, I thought the hamster was suffering great pain and hence advised enucleation. This episode shows that long-distance telephone diagnosis without physical examination is not advised.
Since the hamster is not in pain, then enucleation is not necessary. Generally, frequent rubbing of the eye are signs of painful eyes or inflammation around the eye areas. There will be acute conjunctivitis and hair loss around the upper and lower eyelids.
The best indicator of the hamster's health (and lack of pain) is the number and size of faecal pellets passed per day. If he normally passes 40 large pellets per day for example and now passes less and in smaller sizes, then he is sick. The amount of water drunk per day is another good indicator of health. The owner must be disciplined to monitor 24-hourly and some owners do that.
I thank you for your offer of a donation. The service is free to all hamster owners.
Are you an engineer or IT person as you are able to locate my hamster's hyphema images from the internet. How did you do it?
From my experience, the analgesic effect of the xylazine 0.15 ml and ketamine 0.6 ml IM will last around 30 minutes for a young 3.6 kg Maine Coon. Provided the vet is well organized.
Today Sunday Mar 16, 2014, the Woodlands family brought in the Maine Coon who had been rolling and yelling (caterwauling since 3 days ago). "But she is quiet now," the lady said.
The following are my performance indicators
Inj of xylazine + ketamine 10.13 am
No isoflurane gas
First skin incision 10.26 am
Completion of skin stitching 10.56 am
The cat started moving at around 10.55 am.
The cat was rather plump and I took some time to hook out the ovary as there was abdominal fat in the way of vision and obstruction was caused.
lst ovary hooked 10.34 am after 5 attempts.
2nd ovary hooked 10.41 am from the uterine body area
Uterus being ligated 10.43 am
Abdominal muscles stitched with 3 interrupted sutures 10.47 am
Skin stitched 10.55 am
Cat started one movement when stitching muscle 10.49 am
Cat started more movements 10.54 am
Skin stitched 10.56 am
Conclusion
For a 3.6 kg young cat, xylazine + ketamine at 0.15 + 0.6 ml IM in one syringe provides sufficient analgesia for spay provided it can be completed within 43 minutes from start of IM injection. There will be no need for isoflurane gas top up. If the first ovary can be hooked out at the first attempt, the duration of analgesia is more than sufficient for spay. One packet 3/0 absorbable polysorb is sufficient. Incision length about 1.5 cm long. 2 horizontal mattresses close skin wound.
This cat wore pampers for the last 3 months after adoption as he was paraplegic, with back legs stretching forward.
As the paraplegic cat needs leg massage to pee, his bladder gets filled with urine last week but did not have any problem of urination for the last 3 months after adoption. Thick red urine from the infected bladder filled his bladder again, after the first clearing of the obstructed bladder. Now the cat vomited twice. The urine test had shown proteinuria 2+, lots of red blood cells and white blood cells.
I informed the owner of the costs of X-rays to check for bladder stones. The cat has poor chances of recovery of a normal bladder owing to urine stasis causing infections. The wife was most sad. Euthanasia.
This couple in their late 20s or early 30s love this Ragdoll X, bought from a Malay family that has many pedigree cats, producing pretty cross-breds.
"This cat is quite angry today," I said. "So I shall not take his rectal temperature." I asked the husband to talk to the cat and stroke his chin so that I can vaccinate without the cat getting furious.The cat was given the 2nd vaccination.
INTERESTING ASPECTS OF THIS CAT
1. Oct 23, 2013 Stranguria. Dr Daniel Sing sedated, catheterised and treated. Urine test showed pH 6.5, SG 1.049, Protein 3+, Glucose +, Blood 4+, WBC 126, Bacteria+
No crystals. No X-ray done.
I advised C/D x 10 cans and phoned on Jan 9, 2014. "The cat took 1 week to recover," the owner said.
FLUTD? Stress. 4th day after shifting to new house. For the past year, the owners were staying in a friend's house and shifted recently.
2. Today, no more urinary problem. Fed canned food. Will always groom himself after eating.
3. The owner wants to clip him bald (except for head and tail) as hairs fly all over the house.
"Regular brushing will do," I advised.
"The cat grips the brush and runs away," the husband said.
"If the comb is sharp like wire, it will be very painful," I advised buying round-tipped brush and give him his favourite treat while brushing from a small area initially. So, no need to clip bald for life.
4. Vomits around 1x/month. "Could be due to hair ball," I said.
"No hair seen in the vomitus," the wife said.
"Cats are very clean and will groom esp. if shampoo once weekly."
"He grooms after eating rather than the weekly bath."
5. This cat will poop only when the owner returns home at around 9 pm. Some friend's cats do the same.
6. "Nowadays, no more scattering of new litter and peeing a bit of urine on the litter," the husband told me. "He must be checking whether the litter is soiled or not."
"Male cats urine spray to mark the litter," I said. "You will note that there will be no more such behaviour after neutering."
The husband agreed as this cat stopped doing after neutering.
Yesterday, I was at Changi Airport and noticed those pink-jacketed customer service counter ladies.
The husband told me that many are from Myanmar, speaking good English and trained by SATS. I thought they were Singaporeans. Nowadays Singaporeans don't want to work the shifts and weekends and so it is much harder to employ them. "There is a very high turnover with Singaporean employees," the husband said. Singaporeans job hop as there are many jobs available and so Singaporean customer service officers don't stay long in the job.
Filipinos are hard to recruit too. Times have changed. An "S Pass" applicant must be earning $2400/month nowadays," the husband told me. "Rejection will be given if the salary is $2,200". I guess Singaporeans must be paid $3,000 and given office hours and no week end roster before they will stay in the job.
"My dwarf hamster passed blood in the stools for the last 2 days," the gentleman said.
"Did she pass the normal stool pellets?" I asked.
"None at all in the last 2-3 days. Maybe, a small pellet recently."
"Any urine passed?" I asked as this hamster had a swollen abdomen as if she was pregnant.
"I was overseas for the last 2 weeks and my family members fed her chym sim instead of the normal hamster pellets and seeds."
Blood appeared in the vulval area but the owner said the hamster passed blood in the stools. So, there should be blood in the anus. A case of wet tail well known amongst hamster owners. Yet I saw blood in the vulval area and the anal opening appeared abnormally small. After all, this was a dwarf hamster and I don't see anal openings in all hamsters I examined, unlike in the dog and cat. So, I did not think of atresia ani - the failure of the anus to open during development. This was a 2.5-year-old hamster with no complaint of stools or diarrhoa.
No stools were passed but bloody diarrhoea for the past 2 days. An old female dwarf hamster. Bleeding from the vagina. This would be a case of pyometra as in old female dogs not spayed.
The high risk solution would be to spay the dwarf hamster to stop uterine bleeding and death. I have never spayed a hamster. I doubt almost all vets do not spay dwarf hamsters. It is just too risky. I asked Dr Daniel if he would do it. "No," he said firmly. I told the owner that this hamster is old and the risk is just too high. She would die. He said to go ahead. I said this was inoperable.
The hamster's abdomen was very swollen. She would die if not operated. If operated, she might or might not die. Likely to die. An exploratory laparotomy to open the abdomen to check and remove the uterus. The anaesthesia must be just right. Not too little as the hamster would move. Not too much as the hamster would be dead. How much is not too little or too much?
I gave Zoletil 50 0.01 ml IM. Insufficient. Too little. The hamster looked at me. I put her under 5% isoflurane gas + Oxygen till she appeared drowsy. Not more than a few seconds. She did not struggle during the surgery.
The colon was over-distended, probably due to twisting. I massaged it and copious amount of red bloody stools flowed out (see image). I closed the abdomen with 6/0 sutures interrupted. The hamster was drowsy. I injected 0.2 ml Hartmann + glucose + baytril. It was already 5 pm on this fine Sunday afternoon of Feb 23, 2014. The hamster was alive but for how long?
On Monday, at 9 am, she was alert and walking. The tissue papers were blood stained in several areas. Those were bloody stools still passed out after surgery. I took videos.
On Thursday, I met an employment agent at Khin Khin Employment Agency. Vitalline would be around 60 years old and specialises in placement of nurses and nursing assistants.
He came to get a letter from Khin Khin's company in Myanmar to apply for a business visa to visit Myanmar to interview nursing assistants. A business visa permits mulitple entries but he had not been to Myanmar for the last 2 years since he had a good supply. But in 2014, he has a drought as the government tightens the rules owing to social discontent with too many foreigners.
"When I asked the Myanmar agents, they would supply me one or none," he lamented. So, he sought Khin Khin's help, offering $600 in wages and $500 for accommodation. Khin Khin, being a Myanmarese, knows all the employment agents in Yangon and could communicate with them anytime. She said she could get at least 20 prospects. The veteran would meet the agents when he goes to Myanmar on Feb 27, 2014 but he needed a Myanmar company to sponsor him for the visa application. So, Khin Khin asked me to help write this letter and I had the draft to her manager Soe. .
I re-typed Soe's letter to inform the embassy that he would be invited to Myanmar for a business discussion as her assistant could not or would not learn how to type a business letter. His layout of the letter was bad. He typed Vitalline's name in Capital letters. Instead of wasting time, I just typed the letter for him.
"Your letter is written well, like a Singaporean," he complimented me. He was a busy man and any person in Khin Khin's office must be Myanmarese since they appear to speak Greek amongst themselves. English grammar is hard to master but the Myanmar language is even harder.
Singapore's population is aging and locals don't want to be nursing assistants. So, there is a great demand for such workers. Myanmar is prospering in the last 2 years and so only high wages would attract some to come. The worry is people trafficking and Vitalline could be charged for that offence if he goes toYangon to do his own interviews without licensed employment agents there. He can't just advertise and meet the prospects.
On the very next afternoon, I was at Khin Khin's office. Two ladies working in Singapore as nursing aides came to enquire about jobs. Khin Khin shouted at them for some reasons. "They are just wasting my time fishing and asking lots of questions," she told me.
"How do you expect them to get jobs if they don't ask questions. Be patient," I advised. "These are 2 prospects for Vitalline and you need not share the commission with your Yangon agent!" Sometimes, I think Khin Khin has no business acumen. Or she just want mega deals like the real estate development of $45 million dollars she had handled, taking so much time and not closing.
I talked to the 2 ladies asking them how much they are paid as work permit holder and how many years they had worked. "$350 with free food and lodging," the younger one had worked a few months.
"The offer is $600 and $500 for lodging," Khin Khin had a carrot for them. So they would be referred to Vitalline and would get better pay.
I took the subway since my car is being borrowed by a young man whose friend is getting married. It is refreshing and good exercise to walk in the bright sunshine morning, taking bus and train to my office.
On the train, I saw a "red head" slim girl in bright green dress, fair complexion, eye lashes long, her reddish brown hair shining in the sunlight. Finger nails with the additional false patterned nails, except her forefinger. Blue shoulder bag on right shoulder and left shoulder has a black bag. Pink slippers. Toes painted green. I noticed Digit 4 on both legs were clubbed. From the right side, I thought she wore an unusual sleeved blouse with a fierce-looking skull and grinning teeth. It was a tattoo on her right upper arm. The left arm was bare. A tattoo appeared from the left cleavage, peeping from the neck line of her dress. 2 red ear pieces attached to her smartphone as she furiously scrolled the screen. Age around late 20s. Unlikelys to be going downtown to work. I alighted at Toa Payoh station and she was still scrolling.
On alighting from the bus 238 opposite the Hindu temple, I met one industrial park tenant who sells plumbing and pipes."What's happened to the old man book-binder?" This man wanted to retire and had asked me for $40,000 to take over. New HDB rulings say that the new tenant will have to return the shop and not assign. So we thought he would have no takers. He had an offer of $25,000 from the air-cond neighbour.
"Well, he does not open on Saturday. In fact he will close in July."
"How much did he sell his shop?" I asked.
"$45,000," he said. "Two lady realtors came and got him to close the deal."
The 75-year-old man got what he wanted and $5,000 more. He did not need to work and his children had asked him to stop work. He was working half-day anyway and had some orders from the government to bind books for funeral services of important people. There was no more apprentices like him to learn the trade and so all skills are gone. At least he has got $45,000 to smell the roses. Realtors who walk the neighbourhood can be quite successful in closing deals too.
I was surprised to see this 14-year-old Terrier X from Bukit Batok again, as many dog owners will go to the nearest vet and now there are 60 vet surgeries in Singapore.
The dog recovered the next day and I sms the young lady owner as she did not answer her phone. She sms back. We don't talk by phone nowadays, esp with busy young people.
Khin Khin had profuse bleeding in her mouth, with "large clots" coming out while she was in Myanmar for a few weeks to attend to her 92-year-old aged mother's affairs and business. She consulted the famous fortune teller whom I had met in Feb 2014 on a visit to his farm with Khin Khin. "He said not to worry, nothing serious."
I have an open mind. Some people may have the gift of telling the future. In Singapore, the kind-hearted Dr Chan from SGH's Otorlaryngoloy Department examined her early instead of Mar 19, 2014. She was worried about oral cancers growing in her mouth and sought my help to get an earlier appointment. "Nothing to worry about," Dr Chan told her. "If you wish, go for a neck MRI but it is not necessary. You have got a tonsillolith in your right tonsils." That is the diagnosis. For Khin Khin, the explanation was a "stone". A stone in the crypt of the tonsils causing bleeding which has stopped recently.
"Why is it that I can get a tonsil stone?" Khin Khin asked me.
"I don't know," I viewed the image of the tonsils taken by Dr Chan's nasal endoscopy to look for the stones. "Some people get bladder stones or gall bladder stones. I have not heard of anybody getting tonsillar stones. His report says it is on the right tonsil. Did you bleed from the right side of the mouth? "
"Yes," she felt her right mandibular area. "Right side."
Feb 18, 2014. Owner came to buy a small 2 kg bag of canine C/D. His last purchase of a small bag was in Nov 29, 2013. I met him and he explained that he purchases C/D from the associate vet in Jurong whose practice is near his office and only when there is no stock, he would come to Toa Payoh Vets.
So far the dog is OK but no urine tests have been done.
"It is difficult to collect the urine from a female dog," he said today when I advised urine test.
Some owners can do it but it needs patience. The vet could collect using urethal catheterization but most owners are not keen.
"Use a syringe to suck up the urine after she pees," I said since this was a compromise. "Will it be suitable for testing?"
"It is cheaper to buy the C/D diet," the man in his late 50s told me. "The operation done by your vet in Jurong costs me $2,000. A big stone of over 2 cm plus several small ones were removed and also seen in the X-ray." I got the clinic to send over to me the stone analysis and tests. The stones were struvites. The dog could not pee and so the owner wanted an urgent operation in April 5, 2013.
On review of the medical records, the dog had "smelly urine" in Aug 3, 2008. The owner had some antibiotics and did not have any complaints till April 2013 when the dog could not pee. It is hard to get owners to do the urine tests which will be best practice to check for urinary tract infection and pH.
They prefer just to buy the prescription diet and that's it.
TP XX803 Male, toy poodle, white, not neutered
Feb 17, 2014
"My dog passes blood in the urine at 7 am today. Not eating today too. Very tired looking." the woman said. "Did he drink a lot?" "I don't see him drinking but the stools are OK." I palpated the bladder area. The dog winced in pain. The owner did not want a blood test but gave permission for the urine test and X-rays.
"My dog had a blood test before," she said. I checked the records. The dog had a high total white cell count of 49.2 (6-17) on Sep 8 2013. The complaint was blood in the urine, licking of the penis, diarrhoea and not eating for 2 days. Two years ago, Vet 1 had said that the dog would die under general anaesthesia if dental extracton of the rotten loose teeth was performed. Vet 1 said she was old, had heart disease and so would die on the operating table.
The owner did not do it. The dog had foul breath for the past 2 years and was drooling in this Sep 2013 visit. But drooling was present in the past 2 years too. Regular dental check up from 2 years of age every year would have prevented this situation from developing. Dr Daniel had the loose teeth extracted and the dog was OK as the owner said: "It is the bad teeth causing drooling and the high white cell count!" Owners are quite sophisticated as regards blood test results.
"Just have a look and tell the AVA that the dog is OK," the man brought in a very thin rib-showing cross-bred. He finally had a summons if he did not get the dog a veterinary examination.
"The dog is paralysed in his hind legs with two foot sore but that does not mean that she will become so thin," I got some pain in the thoraco-lumbar region and weak pedal reflexes of both hind limbs. "Unless he is not given sufficient food or has a disease. Paralysed dogs can gain more weight as they don't walk much. I need to do a blood test. "
"Please don't tell the AVA that I have ill-treated my dog," the man had reared the dog from puppyhood and now she is 13 years old. That would be considered aged.
"Was there a car accident earlier?" I asked.
"She ran out of the house 2 years ago but came back OK. Later she was wobbly and after that paralysed."
The blood test showed high ALT and urea levels but the haematology was normal. There was spinal pain at the T9-11 area and the pedal reflexes of the hind paws were poor. Two bed sores on each hind paw were large at 2 cm x 3 cm. The dog looked alert and her coat was in good condition.
"My dog does not like dry food," the man said that his dog at 50:50 wet and dry food. He would bring samples for me to see. It is hard to assess whether this is a case of under-feeding or the dog being a fussy eater over the years, leading to this condition.
I advised more dry food of good quality to be fed and warm water to shampoo off the urine smell off the back area. I would submit a report to the AVA care of him. X-rays, faecal worm tests, neoplasia checks of abdomen, exocrine pancreatic deficiency were not done as medical costs were a concern. This is a case where the owner shows that he cares for the old dog as others would just euthanase her.
"Some concerned animal lovers may have reported you to the AVA," I said to the man. "Your dog is paralysed and very thin. It can be a case of dog abuse and so the AVA needs to respond to the public complaint. The AVA is very busy with budget cuts nowadays. So I don't think the officers go around Singapore checking on the dog's health."
Overall, the dog is in "good" condition as regards blood test and alertness. It is just that she is very thin.
On Feb 20, 2014, I submitted a veterinary report to the owner for the AVA. This is a strange case as paralysed dogs do put on weight if they are in good health or fed much more. I can't say whether he has underfed his dog or the dog is a finicky eater.
"Do you remember my old dog with fits for 2 days and kidney failure?" the woman in her late 30s walked in and told me the name of her dog. "A small black and white dog" she held both hands apart to indicate the size of the Papillon.
"I can't remember as there are many old dogs with kidney failure and fits," I took out the medical records while the lady had her own 2 receipts. The dog had 12 rotten teeth extracted on Jan 12, 2014 by me. Blood test had indicated kidney failure with high counts of urea at 64 and creatinine 260. Neutrophil % was high at 86% but total white cell count was normal. Blood calcium was low but glucose was normal.
"Cha Cha has good appetite and is very active," she said. "Luckily I didn't put her to sleep!" She syringed 50 ml water 2x/day daily and fed k/d canned food with rice and minced chicken. The dog just ate all.
I did not expect to hear from owners. After all this dog was aged at 13 years old. But he is as active as can be.
"I think the fits are due to his rotten teeth," the lady said. I agreed as there were no more fits since dental extraction. No more lethargy and staggering. A positive outcome and no euthanasia as advised by her friends justifying that the dog was old and had fits.
I advised k/d for 3 months and take a blood test. It is difficult to advise based on recovery. This was a case referred by her friend to me and only positive outcomes can generate referrals in medicine and surgery. Fortunately the dog did not die under general anaesthesia (using isoflurane gas only). Otherwise, no happy ending from the lady in Tampines as the vet gets the blame when death on the operating table occurs.
Yearly dental check up will be best for dogs over 5 years but Singaporeans are too busy to do it. So, many aged dogs have foul breath and loose teeth. Painful mouth ulcers and tooth ache can lead to fits. This was a surprisingly good outcome case as I thought old dogs with fits will not live long. But here he is. Good appetite and active.
Likely a malignant mast cell tumour as it reappears at its original site on the left hind limb. 5 years ago, Vet 1 excised a small tumour with 1-cm resection margin. Histology shows neoplastic cells at the edges of the excised tumour.
5 years later, a grape-sized tumour was discovered on the same spot. Vet 2 did a fine needle aspirate which drew no cells. The tumour grew from small grape sized to kiwi ro apple and now mango-sized when they came to Toa Payoh Vets.
Vet 2's senior surgeon said that FNA could have caused the tumour to expand. I disagreed as it was a recurring malignant tumour and so do grow aggressively. The senior surgeon gave 2 choices with no guarantees of success: 1. amputate the left limb 2. excise the tumour. The dog could die on the operating table owing to old age high anaesthetic risks. The owner decided not to operate and the tumour grew to the mango-sized when they came to Toa Payoh Vets. Dr Daniel was the surgeon for this case.
Feb 14, 2014. Valentine's Day & 15th day of Chinese New Year.
The dwarf hamster had been scratching for the past few weeks. "Keeps scratching her elbows. Very itchy," the lady took leave from work in her Jurong office to send the hamster for treatment. I checked the past records and on Sep 8, 2013, there was an inflamed right elbow.
Now both elbows and inside the two thighs and above the knees are hairless and red. There were bite marks. The hamster was anaesthesized and the hairs around the inflamed joints clipped and washed. Oral pred was given and the hamster is restricted to eating seeds but no more orange and green coloured pellets common in the hamster food. The bedding is paper now.
It is hard to know the cause of the allergies. The colouring in the food pellets may be a cause as the hamster is not given sand bath nor shampoo or spray.
"Is it serious? Is it serious?" the young lady asked me. "Yes, if the hamster keeps scratching non-stop to relieve the itch. Sometimes, they pull out their body hairs as I had one case earlier!"
TP XX988
Maltese, female, not spayed, born Feb 20, 2000
An elderly couple takes care of this dog as the daughter has married and left her dog to parents.
On Feb 12, 2014, the dog had eaten very little for the past 6 days. Yesterday, heavy breathing, limping and was unable to stand up on hind legs. Could walk but slowly. Had "fits" lasting few seconds. What's the problem?
"When was the last menses bleeding?" I asked as the dog was not spayed and I detected some mammary gland swelling and dirty black brown nipple discharge which I showed the couple. .
"No more bleeding for a long time," the wife said.
"Is there a period of time when the dog was continuously cleaning her private parts?"
"She cleans herself after urination," the wife said.
"Any cleaning even though there was no peeing? For example, 2 months ago, before Christmas?"
"Yes, sometime in December. She was busy cleaning herself."
"14-year-old dogs still can cycle," I palpated the lower abdomen and the spinal area. The uterus was swollen at around 1 cm in diameter and the T/L spinal region was painful on palpation.
"Your dog has pyometra and false pregnancy," I said. "A hormonal imbalance. If she had been spayed at a young age, there will be no problem."
Blood test showed an elevated AST/SGOT of 106 (normal <81 89.4="" at="" but="" cell="" count="" glucose="" high="" neutrophils="" normal.="" normal="" p="" the="" total="" was="" white=""> "This is the start of pyometra," I said. "The dog is aged too but the blood test is normal except for increase in neutrophils.Did the dog vomit?" "No," the wife said. "She vomited once and was not eating for 2 days in Feb 6, and Dr Daniel had a blood test done."
The blood test was normal except for glucose at 9.4 (3.9-6.0) and Neutrophils at 86.4% similar to the recent one.
The owners did not want an X-ray.
It was lucky that I could show the nipple discharge of false pregnncy. "The hormonal imbalance can cause the dog to lose appetite as in this case. The dog would eat a bit of the canned A/D diet and nothing else. I advise spaying to remove the abnormal ovaries but the anaesthetic risks are very high as the dog is 134 years old now."
The couple would let the daughter decide. Strangely, without eating much, the Maltese came in for the 3rd injection (today) was much alert and walking with unsteady gait. Her rectal temp was normal at 38.3. The husband remarked that she was much stronger now. Dental scaling by Dr Daniel yesterday appeared to be good for the dog as she permitted me to open her mouth unlike previous days.
Today I would give the antibiotic and S/C amino acids. The problem is that the owner cannot syringe feed he dog with antibiotics and canned food as the daughter lived far away. Without hand or forced feeding and electrolytes, this dog will soon get emaciated.
Feb 10, 2014 Monday
Hotel Grand United Rm 709. 6.30 am
Yesterday, I had a Myanmar breakfast at a monastery and saw a local wedding in the monastery. The bridal costume was white but was not a "real" wedding dress according to Thin Thin. It was a white Myanmar dress.
My friend Khin Khin is a benefactor to the monastery and has donated money to build a library cum bedroom for the monk. "Don't use the monk's bathroom," Khin Khin advised me. I used the common public bathroom in another building. It was dark and needed renovation.
Donors are appreciated and their names are shown on the buildings. Her grandparents and parents had been donating money to help this monastery. Recently, her mum and she donated $80,000 to build a new 2-storey building. The head monk showed us the location of the building to be built. "Plan for 3-storeys," I advised. "In case there is another donor with $40,000 later."
This monastery has a school to educate around 140 student monks as in the traditional monastery made of wood and housing student monks, seen in Inle Lake area. I was surprised to see the young student monks reciting their mantras in a big class-room.
Lucky Two Guest House in Hintinda is a guest house. Next to it is a shop selling Myanmar silk and longi. Bought 2 blouses for two Myanmar friends in Singapore. Singapore ladies will never wear these traditional Myanmar blouses with shiny sequeins, so I don't waste money buying for them.
A straight road to Yangon from Hintinda cut travelling time by 1-2 hours but being unpaved, it was rocky bumpy ride for over 1 hour. Saw some sunflowers on the way. Lunch in a restaurant where the food is so good that local wealthy people send their staff to take away.
Prices will be higher but there is this niche for good food with good cooking oil, according to Thin Thin. She bought me some fish "stomach" dish which is expensive but I did not eat it. Went to Royal Asia Veterinary Surgery in the afternoon to visit the vet. A 2-seat ride around the back lanes in the evening. New apartment blocks of 3 storeys exist with run-down houses. The land in this suburb is so expensive. Had dinner at Coca Restaurant set up by a Singaporean. The family had a trusted Myanmar employee who now runs the show after the passing away of the founder, according to Thin Thin. A graduate in history who can speak English and had worked in Singapore as a domestic worker earned around 0.8 laks was serving us in a room since Dr Aung always bring his foreigner friends for dinner and is well known. She is worth more since she can understand and understand English. Poaching for good English-speaking staff will continue in modernising Yangon.
Got to go. 6.45 am. Breakfast and out at 7 am as Khin Khin has a driver to bring me to see some travel agents and a realtor.
May I ask some details? How long will it take from I bring it in the vet to everything finished? And pre health check? And how long should the cat fasting before and after neuter?
In reply to your above questions, the answers are: 1. The cat is brought to the clinic in the morning and spayed in the afternoon. The cat is not neutered immediately unless there is no consultation at that time.. The time of injection of sedation to completion of spay is around 20-30 minutes. The cat is given time to wake up from anaethesia and goes home at around 6 pm.
2. A pre-health general physical examination is done to check especially the heart, lungs and abdomen.. However no pre-anaethestic blood testing is done for the average normal cat. If the owner wants it done, the cost is $150 for a complete blood test.
3. Fasting will be no food after 10 pm the night before the operation. After neuter, the cat will be given food the next day.
"Lucky Two is a brand new hotel," my friend Khin Khin told me. "Just like Ocean Blue. I hope you are not afraid of ghosts!" I had completely forgotten about ghosts in this Feb 8, 2014 hectic visit and here she reminded me again.
Yesterday, I had a most enjoyable time being able to re-visit nature, to meet a Myanmar-English translator scholar, a famous fortune-teller whose clientele includes the top military brass and to visit a 140-year-old monastery, another monastery with the Buddha made from cane by Shan State people and an older monastery with two Buddha trees and a good artist. There were art pieces of landscape and farms on the wall of this older monastery painted by a monk and I could see that the art is of a good standard.
I wanted to visit a village far away from the city or town. "Why not visit the family of her daughter's uncle?" I presumed he was a farmer. Khin Khin tried to discourage me as it would be dusty but I was used to dust as a national service soldier many years back. "I can wear mask," I said. So, she arranged for me.to visit this village of Karen people. It was sunset when I sat on the bullock cart to view the bean fields which stretched as far as the horizon as the two bullocks pulled 7 adults on the dirt track between bean plants for a tour of the farm land.
To my right, a large reddish orange golden sun was setting, making the sky pink. Acres of short green bean plants on all sides. A few trees. A special tree with reddish flowers stood out. I tried to video the beautiful sun setting onto the green plantation but it was all shaking as the bullock cart undulated. The farmer could not converse in English but he was most happy to meet me. Villagers are mostly friendly towards foreigners in general. He plucked the bean pods, a thorny plant to prevent cows eating the beans or for some purposes and a bunch of red flowers from the tall tree with red flowers able to forecast rainy seasons. Much laughter. Clean air. Two black pigs, two mongrel dogs, a few chickens and some ducks. Mango flowers just forming buds. This is a really big farm just like some of those sprawling ones you see in the USA.
I had some stiffness in my back and the 50-year-old farmer got a stool for me to climb up onto the back of the cart. The others and a young monk just climbed up from the spokes of the wheel nimbly. I was worried about falling and breaking my legs, being quite ancient at 63 years. I know cows could kick, being a vet student in Scotland which has cows unlike Singapore. So, I was careful not to climb up the front of the cart where the two bullocks were tethered. The farmer was especially worried for this ancient. So he held my hand as I walked, in case I stumbled as I proceeded to the bullock cart area and his family and children looked on..
Such a beautiful green land stretching infinity while the large reddish-pinkish golden sun started dropping down at this time of 6.00 pm. A lone tall tree with red flowers. Cloudless grey skies streaked in hues of pink. Only a city dweller like me will appreciate this scenery, all too common for the farmer.
Then Khin Khin told me that he is a very famous fortune teller and even the top military brass consulted him. I can't image the Brigader-General in Singapore consulting a fortune teller but this is part of the culture in Myanmar. Khin Khin had consulted him several times as regards imminent personal and work challenges and had received excellent accurate predictions and advices.
Recently, she had serious bleeding from a mouth ulcer or a hard palate ulcer. "Big clots inside my mouth," she told me. "Continuous bleeding. I thought it was oral cancer." She consulted the fortune teller who told her not to worry and that the bleeding would stop. She got a biopsy done in Yangon and the test was negative for cancer and the bleeding has stopped.
"Since the fortune teller had seen you, I will ask him to tell you your future esp. your health," she volunteered. "No," I said. "I don't want to know that I will be dying soon." .
At around 3 am, I woke up suddenly as I heard a cracking sound, as if a balloon had burst. Just before I went to sleep, I heard an identical sound and thought it was from the TV program as I had not switched off the TV. All lights were switched on as well as the TV as my friend Khin Khin told me that there could be ghosts in a new hotel with only 3 rooms occupied.
Ocean Blue, Ngwe Suang Beach Hotel at had just opened for business 2 days ago and the 3 rooms were rented by me, Khin Khin and her daughter and the driver Sonny for one night. After a 6-hour drive, we had reached Ngwe Suang, a fine-sand beach very popular with Caucasians from Europe. We ended in Aureum Resort - Spa Ngwe Saung. Such a beautiful luxurious hotel with villas, manicured lawns and palm trees very close to the beach. The villas or bungalows has two rooms at US$195/room and an additional US$80 for the communal living room between the two rooms.
"You can share your room with Sonny," Khin Khin said. "My daughter and I will be in the other room." So, the total rental for just one night would be US$390 without the communal room. She would have to pay US$470 for the whole villa out of her own pocket. That is a lot of money as a Myanmar graduate earns around US$300 per month.
"I need my own room," I told Khin Khin who wanted to give me a treat as I seldom visit her in Myanmar declining her many invitations. "I wake up at 3 am to do my computer work and switch on the TV. I will be disturbing Sonny." Khin Khin then decided that Sonny ought to stay in a cheaper place. "I don't mind," Sonny said. He is around 50 years old and is a close friend of her husband for many years. He had volunteered to drive me from Yangon to Ngwe Saung and so he is more than a driver to Khin Khin's husband. It just did not seem the right thing to do. He was not a paid driver from a rental car company and such drivers do stay in much cheaper accommodation.
"Why not go to Ocean Blue hotel and check it out?" I suggested after we found that the other 2 hotels nearer to Aureum Resort - Spa Ngwe Saung were fully booked. "Brand new hotels are much better than old ones," I said. "The bathrooms would be newer and there should be no malfunctions of the shower. Yesterday, I stayed in Grand Palace Hotel Yangon and the shower could not be switched on when I wanted to bathe before breakfast!"
"So what did you do?" Khin Khin asked as it was too late to switch rooms as I had not checked on the functions of the bathroom tub with shower. After all, Grand Palace Hotel looks new and impressive. The rental was US$90 and as it has many Caucasian clientele, we presume it must be good.
"I have to bath sideways inside the bath tub!" I joked. The shower had lost its "button" and so I could not push or pull to activate the shower.
"Furthermore, I woke up to the sounds of dripping water, as if an invisible tap had been turned on and somebody was having a bath! That is why I don't want to stay in this hotel again."
"How long did these sounds last?" Khin Khin wanted to know. "Maybe 10 minutes. It could be somebody next door bathing. But at 2 am in the morning. It is possible that the guest could have come back from the night club."
I didn't think much about it until Khin Khin mentioned that it could be ghosts. So, now we were checked in at the brand new Ocean Blue with a 10% discount US$90 for my bigger corner room with a large living area and a balcony facing the ocean waves and sunset, I thought this would be a good arrangement with all of us living in the same hotel, rather than banishing the driver to Ocean Blue while we indulge in the surroundings of the Aureum. I bargained but got 5% for the other two rooms as Khin Khin did not bargain. After all, this hotel was not opened to receive guests till the next day although it was opened 2 days ago. Kind of confusing, isn't it? The supervisor had to decide as the manager was not around and he gave us the rates we bargained for. So, we took Rooms 213, 215 and 216.
"Don't take 214," I advised. "The digit '4' means death in Chinese."
"I am afraid of ghosts in this new hotel," Khin Khin said. I did mention death in numerology of "4" and this must have had triggered her phobias. Yet she has her daughter sharing the room 215 with her and the driver would be in 216. Of course 214 was vacant and the ghosts could lurk there.
"Talking about ghosts," I added fuel to fire and joked. "I have two beds in Room 213. A ghost could sleep on the other bed and would really frighten me when I wake up!"
This was really a frightful thought. Do I believe in spirits and ghosts? I do when I sleep alone. To allay me fears, I sleep with all lights switched on. As if ghosts are deterred by lights. It is hard to sleep with lights on and I cover my eyes with the spare pillows.
"What's those sounds of bells tinkling?" I frightened Khin Khin more as we came back from a wonderful sea food dinner at the restaurant favoured by many Caucasians. "Why is it so popular with Europeans?" Khin Khin asked me. "It could be from the websites as Caucasians always consult the travel websites" I told Khin Khin. "There is the band of two men singing English songs and the food is good and cheap." This beach resort restaurant seems to attract Caucasian couples young and old as I saw them streaming in while the competitors were not full on this February 7, 2014 fine evening.
Back to the tingling sounds of bells after we returned from dinner back to Ocean Blue and climbing up the stairs to the 2nd level. "These tingling sounds appear to be bells around the cow's neck. As the cows walk, the bells ting and ting!" Her daughter was carrying the metallic Ocean Blue disc with key and when these two collide, the tingling sounds commenced. I knew about it but not Khin Khin and so she was worried. More tingling sounds as her daughter walked behind her up to the rooms on the second floor, with the balcony facing the sea. This aggravated her fears of ghosts and put the chills in my spine too as I would be sleeping alone in a big room of some 250 sq ft. Room 214 would be vacant and so I had no buffer as the others would be in Rooms 215 and 216 while I would be in 213!
I could sleep with the TV on but there would be some creaky noises in some TV programs and it would be worse than ghosts walking about in my room. So I switched off the TV. All dead silence as the balcony was closed and there would be no sound of waves or insecurity from burglars.
Khin Khin discovered the source of the tingling sounds but was not secure from ghosts. "I paid 5,000 kyats one hotel staff to sleep outside the corridor," she told me. She really meant business. The appearance of "water flowing from taps" sound in my Yangon hotel at 2 am waking me up was so frightening an experience. A new hotel with no other residents. Rooms would be slept in by "nyats" or ghosts. So, she paid a hotel boy to sleep outside the corridor.
Of course, I was worried about the supernatural. Before I slept, I heard a cracking sound as if a balloon had burst which I thought was from the TV program. Then I got waken up by the same cracking sound. I dared not sleep. I went to the writing desk to download my images to the hard drive. On the brand new tiled floor, to the left of my small writing desk of about 4-foot in length, there were a row of blood-like stains. Could these be the trail of the bleeding ghost who arrived while I slept? This was really frightening as I had not been observant enough to see them when I checked in. This sighting meant that I should not sleep anymore. I was not sure whether the blood stains existed when I checked in as I was more interested in knowing that the shower was working and it was functional.
Then, I withdrew the sun curtains and stared out of the locked sliding glass doors to the blackness of the sea beyond and in between tall trees. Any spirits floating around. One should be more worried about human burglars in a deserted new hotel as they would be more dangerous.
I decided to open the sliding doors, seeing no human on the balcony. Spirits from the blackness could drift into my room. I took the risk. After all, there were lights of bulbs along the perimeter of the building facing the beach. Any spirits or ghosts would glide into the room in any case. The swishing of the sea waves pounding the beach was OK with me as I have heard such sounds before. I videoed the blackness, not expecting any ghosts to be around.
Suddenly, to the right side of the ground, near the main lobby and reception area, there loomed a big figure. Tall and stout. Silent and staring up at me as my video camera panned to his area. I did not drop my camera but was shocked. Was this the real ghost? At 4.30 am in the morning. Sounds of waves, blackness in the background and now a big figure looking up at me. Solid like the old teak wood tree of Myanmar.
What should I do? Quickly depart from the balcony, close the sliding doors and draw the curtains immediately. IA - Immediate Action during military training. No, I did not do that. It would be too late as ghosts flit in faster than the speed of sound. Really? I don't know.
I waved to this figure and he waved back at me. It could be the security guard. Otherwise why would a ghost wave to me. In any case, I have the evidence on video. I could not sleep anymore. I opened the door to check whether the hotel staff was sleeping outside the corridor to guard us. Sure enough, there was protection from the spirtis or "nyats" in Myanmar culture. Not one hotel boy but two sleeping on mattresses at the corner. Two is for protection. One is vulnerable should ghosts appear. Even the hotel boys were worried too.
It is nearly 6 am now and the hotel supervisor had said electricity to the rooms would be from 6 am to 6 pm. I can't understand why. I had bathed at night and so would not be shrouded in darkness when the room lights were off at 6 am. Better save this story to the cloud. The two hotel boys have had rolled up their two mattresses as I could hear the clicking sounds outside and some voices.
Ocean Blue Ngwe Saung Beach Hotel is a great place to stay, in my opinion. The beach is clean and has fine sand tingling the toes as you walk on it. The surroundings make you closer to nature and tranquility.
Feb 6, 2014 Grand Palace Hotel, Yangon, Rm 343 US$90, single
A new hotel with bright clean lobby. One block with lifts is for foreigners. The other block is without lift and is for locals, according to my friend. Room is very spacious with king-sized bed. Wireless connection was excellent at 4.30 - 6 am when I used this computer but was limited after 6 am.
Surprisingly, the room has no power point near the writing desk where I use the computer. Only one power point near left side of the bed. This may be owing to great demand for electrical supply in Myanmar and I presume the room is limited to one power point. So I can't charge my camera battery and the laptop at the same time as the points are far away. Could use an extension cord.
Visited 3 Veterinary Clinics in Yangon, Myanmar. There is said to be around 100 such clinics in Myanmar in 3 different townships.
1. Royal Asia Veterinary Surgery.
2. Forever Vet Clinic
3. Excellent Care Vet Clinic/ Hospital started by an accountant employing 4 vets. Just opened one month ago. US$450 rental/month for a 3-storey house with roof terrace. Will buy land to build own clinic.
With strong financial support from the accountant, X-ray machines, ultrasound, ultrasonic nebuliser, desktop and gaseous anaesthetic machines are purchased. Software development is being done.
Will visit Irrawaddy and Bay of Bengal today Feb 7, 2014.
ote
