976.  Hamster's neck swelling may or may not be cancerous - E-mail query from Malaysia 

E-MAIL TO DR SING DATED MAY 4, 2012

Dear doctor,

My sister's Syrian hamster (about 2 yr old) is having a neck tumour and both the vets that we consulted advised that it is cancer, and there is nothing that they can do about it. Is there anything that we can do to reduce her suffering to the minimal? For example special diet or anything to watch out. I saw from your blog that you had performed surgery for similar cases too, unfortunately my sister and the hamster reside in Malaysia so we are unable (prohibited) to bring the hamster oversea for your consultation.

Thank you very much

Regards,
X

Sent from my iPad

E-MAIL FROM R SING DATED MAY 4, 2012

If possible, send 2 images if possible. There are no drugs that are effective...

May 5 (2 days ago)

If possible, send 2 images if possible. There are no drugs that are effective against tumours.

E-MAIL TO DR SING DATED MAY 6, 2012

On Sat, May 5, 2012 at 12:22 PM, ...@hotmail.com> wrote:

Dear doc,
I'm X's sister, the owner of the hamster. Attached herewith the pictures of my hamster who suffers from cancer

E-MAIL REPLY FROM DR SING DATED MAY 6, 2012

Thank you for 3 images. Neck swelling is large. Is it hard and firm or soft and cystic? Have you got the vet's report.

It may or may not be cancerous as it is hard to diagnose just by size. In some cases, it may be a haematoma, an abscess or soft tissue growth under the skin. As the hamster is old, cancer is likely but not definitely.

To confirm whether it is cancerous, the swelling has to be sent to the lab for histopathology. Therefore, the diagnosis is based on FNA (fine needle aspiration) of the swelling to be sent to the lab for histopathology.

Surgery by excision is the only option but the anaesthetic risk is much higher. Any medication like pain-killers and antibiotics from your vet can be given but will not resolve the problem.

975. Testicular tumours in old Papillon

This Saturday, May 5, 2012, I worked as Dr Jason Teo is off in Batam.  Dr Vanessa covers him.

Papillon with big testicular cancer (more than 10 cm). Not eating 2 days.
"Yesterday, Dr Daniel gave an injection. I noted some improvement. My dog ate the chicken later. I gave another piece. He ate all overnight."
"Dr Daniel is not working today," I said.
"You have seen my Papillon before," she replied. "What is the cost as I can't afford $3K to $4K for the surgery. My niece's Jack Russell went for an operation at a vet and was charged $3k to $4K."
"Where did she go?" I asked. She mentioned a name of an old practice.

"Each practice charges differently. If she preferred a brand-name like being treated at Mount Elizabeth Hospital as a patient, she would have to pay top dollars. Your dog's operation to remove testicular tumour is probably around $300 - $400. Don't take the blood test as suggested by Dr Daniel to assess the risk of anaesthesia, to save some money. In any case, you have to decide to take the high anaesthestic risk of the dog dying on the op table as you don't have a choice of whether to operate or not. If the dog survives the anaesthesia, he can live a normal pain-free life, provided the cancer has not spread to the lungs and elsewhere."

"I am very close to my dog," she said. "I don't know what to do."
"Now the dog eats as the bacteria inside the tumour cells is gone and the dog feels better," I said. "But the pain and infecton will come back as the cancer cells are rotting."

So, the lady decided to wait one more day as I could operate on Sunday morning tomorrow. I have 2 spays lined up tomorrow Sunday.

P.S Neutering the male dog early would have removed all worries and frustrations of testicular cancer in an old age. Blood test for health screening is good but in this case, the dog has to be operated to remove the disease cancerous cells. It should be a simple short operation but the risks are still there. The shorter the anaesthesia, the lesser the risk. But the vet must know what to do.

In this case, no other way to help this dog but removal of the enlarged testicular tumours.  So blood test results indicating poor health is not going to be useful.     

974. Veterinary audit of one case TP 43569

TRUST & AUDIT PROCESS AT TOA PAYOH VETS

Saturday, May 5, 2012
10.25 am
I did a veterinary audit of one surgical case done at Toa Payoh Vets as part of my management of the practice to make it as one of the top 5 vet practices in Singapore. This is to ensure a high standard of veterinary care from vets at all times especially in veterinary surgery.

TP ...569
Chihuahua, Male, 10 years
Complaint: Blood in the urine.
Blood in the urine. X-rays and blood tests done by another practice (Vet 1) on Mar 31, 2012

Admitted: April 16, 2012.
Cystotomy: Bladder stones removed by Dr XXX: April 18, 2012
Neuter by Dr XXX: April 18, 2012
Sent home: Apr 18, 2012
Owner returned dog for hospitalisation as the dog screamed when touched or given medication:
Apr 19 - May 3, 2012.

AUDIT PROCESS - LIST OF RECORDS MAINTAINED
Veterinary Surgeon - Dr XXX
1. Follow up. I phoned owner today to find out about the present situation. No response on this Saturday morning.
2. Outpatient record  - Yes.
3. Anaesthetic and surgical record - Yes.
Anaesthetic dosage recorded. Number of packetes used and type of sutures not recorded. 3 packets were used.
4. Inpatient record - Yes.  2 days. Apr 16-18, 2012
5. Hospitalisation record - Yes.  Apr 19 to May 3, 2012
100g dry food given and consumed per day. I checked on weight of food given by Mr Min.

TESTS DONE AS AIDS TO DIAGNOSIS
6. Blood test - done by Vet 1. Nothing abnormal discovered.
7. Urine test - not done by Dr XXX. Reason being that there was urethral obstruction. In this "audit and trust" procedure, I informed the vet that urine test should be done in all cases and could be collected during cystotomy. This is to enable us to know the pH of the urine and whether there is bacterial infection.
8. X-ray of bladder - done by Vet 1  - 6 small stones seen on hard copy kept by the owner.
9. Bladder stone analysis done by Dr XXX - Yes. Mainly calcium oxalate with trace of phosphate and magnesium.

CONCLUSIONIt is extremely difficult to effect changes as each vet has his or her own mindset and way of practising veterinary medicine and surgery. The Domitor and Ketamine IV sedation formula, much discussed in my case reports, is now accepted by Dr XXX after many months as being scientific, effective and safe. Formerly Dr XXX would use Domitor in low dosages irrespective of weight of the dog.   

973. The circling dog (clouds)

I seldom travel by plane, but in the many years, I had not seen such beautiful clouds from a plane. I was on the way to Phomn Penh from Singapore on April 30, 2012.

The image of one cloud reminds me of my patient - a 12-year old Miniature Schnauzer whose head tilted left and who circled anti-clockwise for the past 2 weeks. I wonder how the dog was as the chances of recovery to normal are very slim. Would he still be circling anti-clockwise? Or would the drug be temporarily effective? 

P.S. google and the mobile phone tends to display a portrait image sideways for some unknown technical reasons. Probably some software bug.

972. Make money from google and youtube - create niche info

May 4, 2012




To: Two young men of less than 30 years old



REF: Make money from your pictures - google ad sense and youtube



You are living in a golden age and in a country where peace has been present for over 70 years allowing you to grow up in an era of abundance, consumption, no worries about hunger and much comfort. Your parents work very hard to get you educated at great expenses which they will never recover.



Generally, I notice that many of your peers trend towards more consumption and pleasure rather than suffer the pain in the creation of artwork, products and services to better yourself and your community.

However, only in recent years, can you actually create and make money from the internet from google and youtube. But you need to put in the effort and hard work and learn a new skill (video production, digital photography and writing). If you want to be rich as well as be smarter than the 80% of your peers, start spending time creating niche and interesting webpages with videos and images.



1. google ads pay you money when viewers click on your webpages.

2. youtube may pay you for good videos



For point no. 1, goto

https://mail.google.com/mail/?shva=1#inbox/13713f5ac6042ab5



Spend much less time watching videos and TV. Produce niche interesting videos and be "rich" in time to come. Wealth comes from knowledge gained, positive results and community education and services rather than just making money. Best wishes.

971. The circling dog

"Though glucocorticoid works in enabling the circling dog to straighten its neck and look left and right, it is not easy for any vet just to prescribe such medication," I explain to Dr Daniel Sing when I asked him to handle any query from the owner of the circling Schnauzer while I was away in Phnom Penh.

"In this case, there was marked improvement as the dog had been circling anti-clockwise in tighter and tighter circles for 2 weeks," I said. "I gave dexamethasone IV twice. If given orally, it may not work effectively. Therefore, the dosage must be not too little nor too much. To the owner, the clinical outcome is whether the dog still circles and in this aspect, performance counts.

Two vets may prescribe the same medication but the dog may not respond to the medication or respond to one vet's medication. Therefore, follow up to know and adjust the dose-response effect is so important. Many owners don't provide feedback as the dog is old. 

The increase in eosinophil count is mentioned in the following relevant article:
http://ezinearticles.com/?Vestibular-Disease-in-Dogs-and-Cats&id=494854
In the above-mentioned article, circling in tighter circle (vestibular disease?) v. wider circles (brain disease?). This dog circled in wider circles initially. So, was the brain area involved originally?

970. Travel Stories - Phnom Penh Apr 29-May 2, 12

This is my first time to visit Phnom Penh, Cambodia. I am not keen in visiting the "Killing Fields" or the temples as I had seen the best ones at Angkor Wat in Siem Reap. Street photography is my hobby and Phnom Penh with 80% of its 16.5 million inhabitants should have much more interesting scenes than sterile Singapore. I was not disappointed.

Sisowath Quay in Phnom Penh reminds me of the Esplanade of some 40 years ago where young couples meet for a date and view the lappng sea waves and see the ships. Maybe ordered some satay to eat. It is not the present day "Esplanade Theatre". I did invite my pen pal to walk along that Esplanade and we were so young then. Sisowath Quay so much reminded me of those days gone by.

My impression of Phnom Penh is a city of high competitivenss. I met a very old white-haired gaunt-looking sharp faced woman and her thin grand-daughter at "The Central Market" and she asked for some money. "Give her some money," I said to Julia as we boarded the tuk-tuk to go to Nagaworld for lunch. "No," she said. "If I give her, many beggars would rush forward." Actually, I don't see any beggars. In any case, she handed her a note and the woman clasped her hands in grateful thanks. Beggars are rare in Singapore too but they do exist. Recently, one older woman asked me for some money to buy food when I had lunch in the coffee shop near Courts Furniture in Toa Payoh. I did not encounter other beggar in Phnom Penh during my 4days/3nights' stay and I would say they are rare too.

As for competitiveness, I note that Nagaworld is probably No. 1 in earnings power as it has a casino and many food outlets compared to Phnom Penh Hotel where I stayed since Nagaworld's rooms were fully booked. I booked the land tour package at the last minute as I don't believe in early bookings. So, I had to pay more for Phnom Penh Hotel which is 4-star compared to my desired Nagaworld which is 5-star and cheaper. But, like any professional, what is the point of being cheaper when one is unavailable?

Soliciting for business is important for tuk-tuk transportation, boat cruise operators, small boys and girls who sell Lotus fruits, drinks, magazines. I saw one teenaged boy still at the roadside selling Lotus fruits at 9 pm
yesterday (May 2, 12). It was so dark on the distant Sisowath Quay area but he was still around. 

A Lotus fruit vendor is shown in the images below.

Will upload more pic when I am back in Singapore.