Yesterday, May 10, 2012 I spoke to a Myanmar business lady in her late 40s. "Why did you migrate to Singapore in 1995?" I asked as she was from one of those from a good family in Yangon and had a vast network of good friends in Yangon and had much to lose living in Singapore.
"I married a sea-man and I accept that he would be at sea for many months," she said. "I was working happily with UNICEF in Yangon and had my family and friends. My husband decided to start a business in Singapore and so he was not at sea for long periods of time. My mum said to me that marriage is not like a a ship. My husband is no longer sailing for months at sea. He, like any man would be susceptible to the charms of other women in Singapore.Therefore she advised me to stay in Singapore to ensure that my marriage is strong."
"Wouldn't a seaman be having other women when the ship lands at a country?" I asked.
"Well, that may happen but if a man is on land, far away from his wife, he has much more opportunities to break up his marriage by getting involved with other women.
"In Myanmar, husbands have been sent to other towns while their working wives stays back. In one of such frequentl occuring marriage breakup cases, the husband (teacher) fell in love with the food stall lady and left his wife.
"How did this happen?" she read my mind as a teacher falling in love with a food stall lady sounds incredible. But love conquers all.
"You see," she elaborated. "He has to eat outside as he does not cook and every day she sees this food stall lady. I have read a novel about an expatriate Caucasian who fell in love with his Filipino maid and divorced his wife. Such events happen in all countries, due to the loneliness of the man in a foreign land.
"You really read such novels?" I asked. On her table were some books written by a Myanmar author, selling for $30. The books were in Myanmar language but it was an expose of the wheelings and dealing done in Myanmar as written by this author who was the middle-man.
"Yes, I have read this novel. There are disadvantages of long separation from my family. Now my father in Yangon has dementia and can't recognise me. You can see also that Khin Khin's father died while she was working in Singapore. These are the trade-offs when the child migrates."
"How old is your mum now and is she having dementia?" I asked.
"My mum is 83 years old and her mind is as sharp as ever."
"Your mum is very wise," I said. "Nowadays, the multi-national corporations have a ruling that the expatriate man must be accompanied by his wife if he accepts a posting to Asia. So, your mum is very wise. "
Her marriage is very good as I have met your husband. One can see that a wife's marriage is good or not, sometimes from her facial features of contentment, very hard to describe in writing and she was happy, in my meeting with her over the past years.
She is also a good business woman as she took over her husband's Singapore business and expanded it. She switched on to google maps to show me where she lived and invested as I was enquiring about the property sector in Myanmar. Somehow, when an Asian wife who is smart in business, the family thrives.
PROPERTY INVESTMENT IN MYANMAR IN 2012
No housing loan for locals. Military bank gives loan to qualifed persons.
Business loan at fixed 15% previously, now 13% per annum. Not meant for housing loan.
Full redemption (cash) after one or two years and new loan contract may be given.
Loan at around 25% of house value, the house being the collateral but it is not a housing loan.
Foreigners can't buy land or houses.
Myanmar people don't like to "cross a river" to their house and so will not buy a house across the river. However, there was a successful project with well built houses attracting the upper end buyers.
Property prices have gone up 2-5X and prices are incredibly high nowadays compared to 2008. Just 4 years ago.
A project by YOMA launched in Singapore in April 2012 had excellent response from Myanmar people in Singapore. A 2-bedroom condo facing the river sold for S$120,000. $1,000 deposit. 10 monthly instalments of $5,000/month. Balance to be paid.
Friday, May 11, 2012
989. Update: Consent is the best form of defence
"The dog has been passing blood in the stools for 14 days. You don't just give a jab and ask the owner to go home, " I said to Dr Vanessa as the owner wanted treatment on the spot and no hospitalisation for the 13-year-old Beagle X. A gentle giant looking Beagle with a white face. I was also in the consultation room.
"Should the old dog die soon, the vet may be sued."
"For negligence," the young lady asked whether the dog had colitis as there was fresh blood in the stools and I had said that the likely area of bleeding would be in the colon. This indicated a young lady with knowledge and the vet must be able to provide the standard of care expected by his peers in such situations.
"Consent is the best form of defence," the young fair lady in her late 20s said.
"This case is more a standard and duty of care rather than (informed) consent (to specific treatments as requested by the owner," I said. "A dog that had diarrhoea for 14 days resulting in more frequency of diarrhoea and blood loss and loss of appetite cannot be treated as a simple case with one injection and sent home. The dog may die due to dehydration and that would be negligence on the part of the vet who had not given the IV drip and relevant medication inside the drip. Just one injection and some medication home will not be the reasonable standard of care in this (severe gastroenteritis) situation."
Actually I can't figure out where "consent " comes into play in this situation. This must be a lawyer or legally trained owner. Later I saw her studying her book placed on a brown table in the waiting room as she waited for the treatment of IV drip. I had instructed what type of treatment to be given inside the IV.
The 500-ml 5% glucose saline IV drip normally runs over one hour. As this lady seemed capable and knowledgeable, I advised her to continue the IV drip at home as this would take around 2 hours.
She said she was OK. So, I helped her to take the dog to the father's car. The father would drive the car closer and reversed at the front of the clinic and open the back left door.
I held the IV drip bag high up and she carried the dog of 18kg out of the Surgery as we walked together closely. "Put the dog on the floor of the car," I said as she noted that the bright red blood gushed back into the drip set due to the lack of gravity for the drip to flow. The front car seat was pushed forward by the father. She entered the left front door and held the IV line as high as possible. In this small car, she held the IV bag at the ceiling of the car and her father zoomed home.
The IV drip droplets flowed again pushing the blood back into the system. We rarely asked the owner to go home with the IV drip bag as many owners would not know what to do if the dog moved and the drip fell out, oozing lots of blood. But this lady had medical knowledge and was capable and so after some education on the taking out of the drip, I got her and the dog home.
FOLLOW UP AFTER 2 DAYS
I phoned today Day 3. Dr Vanessa had phoned earlier twice. The dog was OK. "The dog can only be certified OK if he has passed normal stools," I said to Dr V at 2pm. "Due to the spasmogesic drug, he had not passed stools for 2 days. That does not mean he is OK." The lady returned my call at 3.30pm and provided the following feedback:
Day 1. Had diarrhoea for 14 days with increasing frequency of diarrhoea. Dog would drink but pushed away the food. Sought vet treatment at Toa Payoh Vets. Bundled home with IV drip set in car as the owner did not want to leave the dog in clinic. According to the owner, vomited lst day, diarrhoea for one week 1-2x/day, then more and blood seen. last few days, diarrhoea 4-5X.
Day 2. No stools. Ate plain rice and chicken.
Day 3. Ate plain rice and chicken. At 3 pm, normal stools passed. "The first faecal pellet was firm, then semi-soft but no blood," she said.
1. Blood test - Neutrophils 47%, Lymphocytes =17% but the total White Blood Cell Count was normal. Normal % of Neutrophils and Lymphocytes should be higher. Was there some pathogens affecting the ratio of N/L? A subclinical parvo-viral infection? It is hard to say. Liver enzymes were high.
2. Stool examination - Erythrocytes +. No leucocytes, ova, cysts, parasites seen.
3. Parvovirus test on faeces. Owner did not want it. This was recorded. No more vaccination for this dog for some years. Old dogs can still be infected by parvoviruses causing diarrhoea and blood in the stools. In this case, there was fresh blood and so "colitis" was correctly stated by this young lady owner. But what was the cause of colitis?' There is no answer. Practise evidence-based medicine unless the owner is against it.
This case was done by Dr Vanessa. As it was one of those cases of "Trust and Audit" I have instituted at Toa Payoh Vets, I was present to monitor and ensure that a high standard of veterinary care is presented. Later, the owner told me she was not too happy with "mis-representation of the cost of spay or some surgery" by a vet who has a practice nearer her home and that was why she did not go there for this treatment. It is extremely difficult to be a vet nowadays with the government increasing the cost of doing business. For example, the Health Services decided to have every imported medical device to be certified and that means hefty "certification" fees.
So, a small dental instrument or a cathether must be "certified" or prohibited from being imported although it had been certified in the developed countries. The Singapore supplier must pay and pay the fees for every piece of equipment to be imported. This leads to high increase in health care costs but it seems that the bureaucrats are unaware of the implications.
This webpage:
http://www.sinpets.com/F6/20120437diarrhoea-with-blood-2weeks-toapayohvets-singapore_ToaPayohVets.htm
"Should the old dog die soon, the vet may be sued."
"For negligence," the young lady asked whether the dog had colitis as there was fresh blood in the stools and I had said that the likely area of bleeding would be in the colon. This indicated a young lady with knowledge and the vet must be able to provide the standard of care expected by his peers in such situations.
"Consent is the best form of defence," the young fair lady in her late 20s said.
"This case is more a standard and duty of care rather than (informed) consent (to specific treatments as requested by the owner," I said. "A dog that had diarrhoea for 14 days resulting in more frequency of diarrhoea and blood loss and loss of appetite cannot be treated as a simple case with one injection and sent home. The dog may die due to dehydration and that would be negligence on the part of the vet who had not given the IV drip and relevant medication inside the drip. Just one injection and some medication home will not be the reasonable standard of care in this (severe gastroenteritis) situation."
Actually I can't figure out where "consent " comes into play in this situation. This must be a lawyer or legally trained owner. Later I saw her studying her book placed on a brown table in the waiting room as she waited for the treatment of IV drip. I had instructed what type of treatment to be given inside the IV.
The 500-ml 5% glucose saline IV drip normally runs over one hour. As this lady seemed capable and knowledgeable, I advised her to continue the IV drip at home as this would take around 2 hours.
She said she was OK. So, I helped her to take the dog to the father's car. The father would drive the car closer and reversed at the front of the clinic and open the back left door.
I held the IV drip bag high up and she carried the dog of 18kg out of the Surgery as we walked together closely. "Put the dog on the floor of the car," I said as she noted that the bright red blood gushed back into the drip set due to the lack of gravity for the drip to flow. The front car seat was pushed forward by the father. She entered the left front door and held the IV line as high as possible. In this small car, she held the IV bag at the ceiling of the car and her father zoomed home.
The IV drip droplets flowed again pushing the blood back into the system. We rarely asked the owner to go home with the IV drip bag as many owners would not know what to do if the dog moved and the drip fell out, oozing lots of blood. But this lady had medical knowledge and was capable and so after some education on the taking out of the drip, I got her and the dog home.
FOLLOW UP AFTER 2 DAYS
I phoned today Day 3. Dr Vanessa had phoned earlier twice. The dog was OK. "The dog can only be certified OK if he has passed normal stools," I said to Dr V at 2pm. "Due to the spasmogesic drug, he had not passed stools for 2 days. That does not mean he is OK." The lady returned my call at 3.30pm and provided the following feedback:
Day 1. Had diarrhoea for 14 days with increasing frequency of diarrhoea. Dog would drink but pushed away the food. Sought vet treatment at Toa Payoh Vets. Bundled home with IV drip set in car as the owner did not want to leave the dog in clinic. According to the owner, vomited lst day, diarrhoea for one week 1-2x/day, then more and blood seen. last few days, diarrhoea 4-5X.
Day 2. No stools. Ate plain rice and chicken.
Day 3. Ate plain rice and chicken. At 3 pm, normal stools passed. "The first faecal pellet was firm, then semi-soft but no blood," she said.
1. Blood test - Neutrophils 47%, Lymphocytes =17% but the total White Blood Cell Count was normal. Normal % of Neutrophils and Lymphocytes should be higher. Was there some pathogens affecting the ratio of N/L? A subclinical parvo-viral infection? It is hard to say. Liver enzymes were high.
2. Stool examination - Erythrocytes +. No leucocytes, ova, cysts, parasites seen.
3. Parvovirus test on faeces. Owner did not want it. This was recorded. No more vaccination for this dog for some years. Old dogs can still be infected by parvoviruses causing diarrhoea and blood in the stools. In this case, there was fresh blood and so "colitis" was correctly stated by this young lady owner. But what was the cause of colitis?' There is no answer. Practise evidence-based medicine unless the owner is against it.
This case was done by Dr Vanessa. As it was one of those cases of "Trust and Audit" I have instituted at Toa Payoh Vets, I was present to monitor and ensure that a high standard of veterinary care is presented. Later, the owner told me she was not too happy with "mis-representation of the cost of spay or some surgery" by a vet who has a practice nearer her home and that was why she did not go there for this treatment. It is extremely difficult to be a vet nowadays with the government increasing the cost of doing business. For example, the Health Services decided to have every imported medical device to be certified and that means hefty "certification" fees.
So, a small dental instrument or a cathether must be "certified" or prohibited from being imported although it had been certified in the developed countries. The Singapore supplier must pay and pay the fees for every piece of equipment to be imported. This leads to high increase in health care costs but it seems that the bureaucrats are unaware of the implications.
This webpage:
http://www.sinpets.com/F6/20120437diarrhoea-with-blood-2weeks-toapayohvets-singapore_ToaPayohVets.htm
Thursday, May 10, 2012
988. Follow up on ascites in an old Miniature Schnauzer
The 13-year-old Miniature Schnauzer had panting and a big swollen tummy. X-rays and blood tests were done. There was a swollen liver and distended abdomen. Some opacity in the front part of the lungs.
Vet 1 suspected liver tumour and attempted to draw some fluid from the abdomen but according to the owner, nothing came out. I was consulted and confirmed liver disorder from the blood test.
I phoned yesterday. "The dog drinks 1,200 ml of water a day," the mother said. "The stomach is getting bigger." She knew the prognosis was poor as there was no cure. Is there anything to relieve the swelling? I advised increase in frequency of the medication for the next few days.
Vet 1 suspected liver tumour and attempted to draw some fluid from the abdomen but according to the owner, nothing came out. I was consulted and confirmed liver disorder from the blood test.
I phoned yesterday. "The dog drinks 1,200 ml of water a day," the mother said. "The stomach is getting bigger." She knew the prognosis was poor as there was no cure. Is there anything to relieve the swelling? I advised increase in frequency of the medication for the next few days.
987. The Golden Retriever with two fractured upper premolars. What to do?
E-MAIL TO DR SING DATED MAY 10, 2012
Dr Sing,
I have started some preliminary research and it seems the procedure we are looking at is called "vital pulpotomy with pulp capping". It is outlined on this vet website
http://www.mypetsdentist.com/site/view/113265_VitalPulpotomy.pml
You can access the site as a vet, by contacting them for a password or something.... I have also written an email to them asking if they are willing to work via correspondence with us... I am not sure how they seal up the one that is fractured all the way up though - wouldn't the risk of infection still be there?
Here is what they had to say about Summer's type of injury -
http://www.mypetsdentist.com/site/view/113061_BrokenTeeth.pml
I spoke to a vet tech friend in the US and she said most likely we will get the best outcome if you can try and contact a vet directly? She said they are more likely to help rather than if I wrote to them. I will continue doing my homework and research though!
Thanks!
Smile,
Cheryl
E-MAIL REPLY FROM DR SING DATED MAY 10, 2012
Dear Cheryl
It was great to meet you in person after our e-mail correspondence regarding the rescue group who had a stray dog with tick fever of Babesia gibsoni that your first vet said that imidocarb would not be effective and only the use of the expensive Atovaquone and azithromycin would cure this dog. You got the dog treated by a sponsor of an online request for help and the second vet had successfully treated it with imidocarb with two injections and the dog is now healthy.
Thank you for your detailed research on the dental procedures for your naughty young Retriever who has fractured both upper pre-molars 4.
Singapore does not have a veterinary dental specialist and your research on procedures will be most helpful and useful for Singapore dogs with similar problems. Dental extraction has been advised by vets you had consulted. Your dog's right upper premolar is definitely sensitive as the pulp is exposed partially.
You live in a golden age where internet info is easily available if a person takes the time and trouble to research on a specific medical or surgical problem. We will plan what to do with your Golden Retriever's fractured premolars within 14 days and after you have completed your research. Thank you for doing the research.
As there is no veterinary dental specialist in Singapore, the owner (a young energetic kind lady in her late 20s) and I will be collaborating on finding the best treatment for her Golden Retriever.
UPDATES ON THIS DOG'S FRACTURED TEETH WILL BE FOUND AT:
http://www.sinpets.com/stories/20120435dental-fracture-premolars-fourth-golden-retriever-toapayohvets-singapore_ToaPayohVets.htm
Dr Sing,
I have started some preliminary research and it seems the procedure we are looking at is called "vital pulpotomy with pulp capping". It is outlined on this vet website
http://www.mypetsdentist.com/site/view/113265_VitalPulpotomy.pml
You can access the site as a vet, by contacting them for a password or something.... I have also written an email to them asking if they are willing to work via correspondence with us... I am not sure how they seal up the one that is fractured all the way up though - wouldn't the risk of infection still be there?
Here is what they had to say about Summer's type of injury -
http://www.mypetsdentist.com/site/view/113061_BrokenTeeth.pml
I spoke to a vet tech friend in the US and she said most likely we will get the best outcome if you can try and contact a vet directly? She said they are more likely to help rather than if I wrote to them. I will continue doing my homework and research though!
Thanks!
Smile,
Cheryl
E-MAIL REPLY FROM DR SING DATED MAY 10, 2012
Dear Cheryl
It was great to meet you in person after our e-mail correspondence regarding the rescue group who had a stray dog with tick fever of Babesia gibsoni that your first vet said that imidocarb would not be effective and only the use of the expensive Atovaquone and azithromycin would cure this dog. You got the dog treated by a sponsor of an online request for help and the second vet had successfully treated it with imidocarb with two injections and the dog is now healthy.
Thank you for your detailed research on the dental procedures for your naughty young Retriever who has fractured both upper pre-molars 4.
Singapore does not have a veterinary dental specialist and your research on procedures will be most helpful and useful for Singapore dogs with similar problems. Dental extraction has been advised by vets you had consulted. Your dog's right upper premolar is definitely sensitive as the pulp is exposed partially.
You live in a golden age where internet info is easily available if a person takes the time and trouble to research on a specific medical or surgical problem. We will plan what to do with your Golden Retriever's fractured premolars within 14 days and after you have completed your research. Thank you for doing the research.
As there is no veterinary dental specialist in Singapore, the owner (a young energetic kind lady in her late 20s) and I will be collaborating on finding the best treatment for her Golden Retriever.
UPDATES ON THIS DOG'S FRACTURED TEETH WILL BE FOUND AT:
http://www.sinpets.com/stories/20120435dental-fracture-premolars-fourth-golden-retriever-toapayohvets-singapore_ToaPayohVets.htm
Wednesday, May 9, 2012
986. Old Beagle panting
The dog transport man Martin phoned me in the morning to ask if there is a slot for dental scaling for a dog would be transporting to Toa Payoh Vets. "No problem," I said.
After dental scaling by Dr V, the Beagle panted loudly inside the crate. Non-stop. I said to Dr V: "This is not normal. Has he got heart disease?"
"No, but he was panting when he came in."
"Continuous panting will lead to high body temperature and death later. Give some medication to stop the panting." I said.
"It is important that the dog not die later at home after dental scaling."
Continuous panting is not normal in a normal dog. "Was the dog panting when he was transported?" I asked the transport man. "No," he said.
It is important that the dog go home with no panting and I advised Dr Vanessa to treat this panting. It could be pain from dental extraction. I need to look into this as this is a rare occurrence.
After dental scaling by Dr V, the Beagle panted loudly inside the crate. Non-stop. I said to Dr V: "This is not normal. Has he got heart disease?"
"No, but he was panting when he came in."
"Continuous panting will lead to high body temperature and death later. Give some medication to stop the panting." I said.
"It is important that the dog not die later at home after dental scaling."
Continuous panting is not normal in a normal dog. "Was the dog panting when he was transported?" I asked the transport man. "No," he said.
It is important that the dog go home with no panting and I advised Dr Vanessa to treat this panting. It could be pain from dental extraction. I need to look into this as this is a rare occurrence.
Follow up on chihuahua spay done on May 6, 2012 by Dr Sing KY - Compliance
Today May 9, 2012, I phoned the father and daughter of the Chihuahua 8 months, Female, I spayed as a benchmark and example to Dr Daniel on May 6, 2012. It is very interesting to know the effect of pain-killers and compliance by the owners.
MAY 6, 2012
Sunday
I spayed Chihuahua, Female, born June 18, 2011, said to be 10 months old, 1.7 kg, good bodily condition,38.7 deg C. Vulva slightly enlarged.
Bleeding heat said to be 2 months ago. Health check by Dr Daniel, . Hx:. Ab E/D/T Well. No V+/D+/C/S. PE: BAR, active. heart/lungs normal. GIT normal (abdo palp - no pain). menses 2 months ago. Does not want blood test screening of health.
Dom and Ket Sedation at 50% and isoflurane gas maintainence
Ovaries and uterine bodies enlarged and congested as if on heat/infected (see images)/0 absorbable suture x 1
Post op tolfedine + baytril injection SC
Home medication
1. tolfedine painkillers x 3 tablets (not given at all). Now Day 3. Advised owner to give. Owner will give crushed tab in banana.
2. trimeth x 1 bottle, multi-vit x 1 bottle. Owner had given. almost all completed.
Post-op observations by owner reported to me.
Day 1 and Day 2 after op. Not active but can walk to pee and poop as normal.
Will eat dry food if the owner added chicken wing meat
Day 3 - Not eating since chicken wing meat not added. I advised the owner to continue with chicken wing meat as an eating dog recovers faster.
Will give crushed tolfedine powder with bananas as dog like bananas
Bandage changes advised but owner is afraid the stitches will come off. "No problem with the stitches as they are quite tight," I said. "Wash away the dried blood clots and replace with new bandage on Day 4 or 5.
It seems like this spay has no post-op complication despite the owner not giving the tolfedine tablets. But there was a tolfedine and baytril injection post-op.
CONCLUSION
Liquid is easier to give in this case.
Crushed tablet with meat may be advised.
Bandage changing may be difficult for the owner
lst day is always the inactive day. By Day 3, the female spayed dog should be eating normally.
In this case, she was eating when chicken wing meat was added, even on Day 1.
MAY 6, 2012
Sunday
I spayed Chihuahua, Female, born June 18, 2011, said to be 10 months old, 1.7 kg, good bodily condition,38.7 deg C. Vulva slightly enlarged.
Bleeding heat said to be 2 months ago. Health check by Dr Daniel, . Hx:. Ab E/D/T Well. No V+/D+/C/S. PE: BAR, active. heart/lungs normal. GIT normal (abdo palp - no pain). menses 2 months ago. Does not want blood test screening of health.
Dom and Ket Sedation at 50% and isoflurane gas maintainence
Ovaries and uterine bodies enlarged and congested as if on heat/infected (see images)/0 absorbable suture x 1
Post op tolfedine + baytril injection SC
Home medication
1. tolfedine painkillers x 3 tablets (not given at all). Now Day 3. Advised owner to give. Owner will give crushed tab in banana.
2. trimeth x 1 bottle, multi-vit x 1 bottle. Owner had given. almost all completed.
Post-op observations by owner reported to me.
Day 1 and Day 2 after op. Not active but can walk to pee and poop as normal.
Will eat dry food if the owner added chicken wing meat
Day 3 - Not eating since chicken wing meat not added. I advised the owner to continue with chicken wing meat as an eating dog recovers faster.
Will give crushed tolfedine powder with bananas as dog like bananas
Bandage changes advised but owner is afraid the stitches will come off. "No problem with the stitches as they are quite tight," I said. "Wash away the dried blood clots and replace with new bandage on Day 4 or 5.
It seems like this spay has no post-op complication despite the owner not giving the tolfedine tablets. But there was a tolfedine and baytril injection post-op.
CONCLUSION
Liquid is easier to give in this case.
Crushed tablet with meat may be advised.
Bandage changing may be difficult for the owner
lst day is always the inactive day. By Day 3, the female spayed dog should be eating normally.
In this case, she was eating when chicken wing meat was added, even on Day 1.
16-year-old cat with blood in the urine
The owners were two sisters and were retired nurses whose cat had attended to for the past 16 years.
Nothing heard from them since 2009 when the cat had high kidney enzymes and a kidney prescription diet was recommended by me. But they fed fish as they felt the cat needed more nutrition. The cat thrived. Till now. Blood in the urine appeared when the antibiotics were not given or injected.
Vet 1 did a house call after office hours. The cat scratched the owner.
Vet 2's place was blaring with music after office hours. The cat scratched the nurse.
The reputation preceded her.
Yet when the owners held the cat for blood collection by Dr Daniel Sing, she did not object. "This is surprising," the older sister said. I asked whether the abdomen was palpated for bladder stone or tumour as the cat is very old.
"I don't feel any," Dr D said.
I got the cat out of the cat by asking the sisters to take her out. Unscrewed the top and sides. I lifted the cat out from the open side. The cat hissed. "Didn't like you," the sisters said. I quickly palpated the abdomen. There seemed to be a soft mass in the bladder area, around 2 cm x 2 cm. Could this be a bladder tumour?
"Stones are rare in the female cat," Dr D said. "Vet medicine is full of surprises," I replied. "Female cats do suffer from bladder stones. Only an X-ray or ultrasound will tell." The owners didn't want the tests. So, wait and see. One sister asked Dr D about testing the blood for cancer markers. The test may not be available. This is a 16-year-old cat. We wait for the blood test and urine test results first.
"The meticulous recording of the two sisters ought to be inside the case file" I said to Dr D.
"He had recorded it," the sisters told me. Nothing as good as the original notes of the owners as their observations tell much about the condition.
Nothing heard from them since 2009 when the cat had high kidney enzymes and a kidney prescription diet was recommended by me. But they fed fish as they felt the cat needed more nutrition. The cat thrived. Till now. Blood in the urine appeared when the antibiotics were not given or injected.
Vet 1 did a house call after office hours. The cat scratched the owner.
Vet 2's place was blaring with music after office hours. The cat scratched the nurse.
The reputation preceded her.
Yet when the owners held the cat for blood collection by Dr Daniel Sing, she did not object. "This is surprising," the older sister said. I asked whether the abdomen was palpated for bladder stone or tumour as the cat is very old.
"I don't feel any," Dr D said.
I got the cat out of the cat by asking the sisters to take her out. Unscrewed the top and sides. I lifted the cat out from the open side. The cat hissed. "Didn't like you," the sisters said. I quickly palpated the abdomen. There seemed to be a soft mass in the bladder area, around 2 cm x 2 cm. Could this be a bladder tumour?
"Stones are rare in the female cat," Dr D said. "Vet medicine is full of surprises," I replied. "Female cats do suffer from bladder stones. Only an X-ray or ultrasound will tell." The owners didn't want the tests. So, wait and see. One sister asked Dr D about testing the blood for cancer markers. The test may not be available. This is a 16-year-old cat. We wait for the blood test and urine test results first.
"The meticulous recording of the two sisters ought to be inside the case file" I said to Dr D.
"He had recorded it," the sisters told me. Nothing as good as the original notes of the owners as their observations tell much about the condition.
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