Friday, September 13, 2013

1131. A 14-year-old jack russell has more and more grey circles - ageing?

tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS
toapayohvets.com

Date:   17 September, 2013  
 
Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
An old dog has more grey spots    
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   17 September, 2013  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

Thursday, September 12, 2013

1131. A 14-year-old Jack Russell has more and more grey spots - ageing?

 
"Vet 1 said the grey circular spots on his belly and body are due to ageing," the lady disputed this finding. She would bring her dog for check up only when she's back home from the U.S where she was an undergraduate.  .

I had said that such grey spots are present in some white-skinned dogs and are natural as they are born with them. As to them caused by ageing, I am not sure. Sometimes the owner did not notice the grey patches when the dog is a puppy. These grey areas are not inflamed when I saw them."But the grey circles keep increasing in number compared to last year," she also pointed to 2 grey circles behind the eyes and below the ears. These were new developments. How and why do they exist?

"Some are due to the application of creams for a long time to treat skin diseases," I said. "The cream causes hyperpigmentation or black pigments to be deposited under the skin. Some are due to continuous scratching by the dog as in the skin below the ears. The two ears are red and some edges have crusts. The redness gives a clue that the dog scratches them to relieve his itchiness.

"Skin diseases like generalised ringworm are expensive and hard to cure," I said. "The increasing number of grey spots could be due to the application of shampoos or creams to cure the skin disease by your family members when you were overseas. After some time, the skin disease get cured and the result is the grey circles. Another spot of ringworm appears as you can see a fresh red bleeding circular one on the right beside the inflamed armpit. So, when you come home once a year in September, you see more and more grey circles in this old dog!"

The explanation seems credible to her.

To show and tell, I switched off the room lights and shone the Wood's lamp onto the right armpit. "Not every ringworm-infested hair will fluoresce in green," I said. "Around 70% will do." Well, she saw the shiny green hairs scattered around this right itchy armpit.

In addition, I put some hairs from the bleeding circle behind the right armpit and showed her the fungus in the hair shaft, under the microscope. So, the evidence was there.

I also scraped the skin and crusts of both ear edges till they bleed. But no skin mites were seen. My explanation was that the dog was on FrontLine spot on and the mites could have died but not eliminated. "Normally 3 skin scrapings or more should be done." As the dog's ears were bleeding, the lady wanted to wash her hand stained by the blood.
 
Self treatment of generalised ringworm in an old dog for over 10 months. Grey spots appear in increasing numbers as ringworm lesions heal. The dog also had anal sacculitis with thick brown fluid expressed from the sacs  
It takes a lot of time to show and tell. "Much of the lack of recovery is due to the owner not following up one month later with the vet and not de-contaminating the environment or checking the dog for new infections," I said. "They go to the groomer monthly as in your case but will not consult the vet. I can understand as there is the financial considerations."

"The groomer provides free transport and so my dog sees the groomer monthly," she was surprised that the dog still had copious volume of grey anal sac secretions which were expressed by my assistant. She presumed the groomer would do it.          

"You can get a dog transport man to bring your dog to the vet for the one-month follow up on generalised ringworm," I advised. "When the dog's body is infected widely, it is a very difficult disease to cure but there are successes. It is an expensive disease to cure if it is widespread."

Success in treatment of generalised ringworm elicits referrals but the vet needs to spend a lot of time communicating with the owner and delivering results of cure. A good clinical outcome depends much on the owner's compliance actually, in medicating and shampooing the dog, following up and in decontaminating the environment! The vet has to follow up but most of us don't have the time to keep following up!  So, the owner goes to the groomer who provides "free" transport and shampooing and ear cleaning.

I emailed the lady to get her dog home:
Kong Yuen Sing <99pups gmail.com="">
10:33 AM (22 hours ago)

 
to m
Unable to contact your US phone directly. Sam can go home today Friday. You need to apply amitraz wash and give medication before you go back to the US to study vet medicine. follow up 1 month later is advised. Dog transport man available.
 
skin scraping 2 sites of left and right ears crustiness - no mites but Frontline had been used.
 
microscopic exam  ringworm +ve
UVL armpit (right) fluoresce +ve
G
6:04 PM (15 hours ago)

 

 
to me
Coming, flying over

Sent from my Sony Xperia™ smartphone
 
Updates will be on this webpage:
www.sinpets.com/F6/20130917grey_spots_old_dog.htm



More info at: Dogs or Cats
To make an appointment: e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
Clinical Research
Copyright © Asiahomes
All rights reserved. Revised: September 17, 2013

Toa Payoh Vets

Thursday, September 12, 2013

1130. September 11, 2013 - my eventful day - Plot ratio, Renouncing Singapore permanent residency and the other maid agent

September 11, 2013 was an eventful day for me as regards the interesting characters I saw again at Khin Khin's office in the afternoon.

1. Felix. The businessman with multiple coronary bypass. He should be around 70 years old, 7 years older than me. I had written about his survival of 3 coronary heart attacks. I was surprised to see him at Khin Khin's office when I went there.  Khin Khin had a good contact who has a piece of land to build a 12-storey hotel and a 6-storey building to build offices, with 3 floors being given to the Ministry. He has interested Singaporean developers and so he could earn commission from the deal, together with Khin Khin.

I am a licensed Singapore realtor and a real estate agency owner and so Khin Khin asked me to help out. Some details were given in the email but Felix wanted more information.

"Who will own the hotel and? Why is the land valued at US$20 million? Where's the title deeds? Who is the actual owner?"

"The info is already in the email," I said.
"What's the plot ratio? What's the plot ratio? Let me talk directly to the Myanmar agent or type in the request via email."
"The Myanmar agent is not a realtor," I said. "He will not understand what you mean by 'plot ratio'. Even Singaporeans who are well educated will not know what it means. In any case, he had said that it is up to the Singaporean developer to design and plan on what to do, provided 12 storeys are for the hotel and 6-storeys are for the office building, with the land area given. In any case, much depends on the size of the hotel rooms and offices. 

The other party could not understand what "plot ratio" meant and stated the valuation of the land. He was a very keen agent wanting to close the deal.

I spoke to the other agent and asked: "How many hotel rooms and offices are permitted to be built by the Government?"

"It is up to the Singaporean investor," he said.
"How many car parks must be provided?"
"I will check for you."
Felix then left the office to contact his side.

2. Renouncing Singapore's permanent residency. The Myanmar father had kidney cancer some 10 years ago and now has lung cancer.  Both parents are now in their 70s and so would like their son to return back to Singapore to take care of them. The two daughters had married and were overseas.
"It appears that your son renounced his Singapore PR to avoid National Service," I said.
"No, no," the mother said. "He had to go back to Yangon to sort out the family properties."
"He has no University degree but he is fortunate to get an "S" pass."

The son is now in his mid 30s and had a job. He stayed one year managing over 200 shipyard workers. "Very tough job," he said. "The Blangadeshi workers just would not bother to clock in their cards for various jobs."
"How about the Myanmar workers?" I asked him.
"Same problem."
He quitted after one year and got a job delivering supplies to the ships docked in Singapore. He fell on his back one day and so the company sacked him as he was on medical leave. "My boss would not put up a case for me," he had told me the day before when I met him.  A gentleman who had started his own business in Myanmar but had to close them for some reasons. In Myanmar, the authorities keep changing policies, much more than in Singapore and I guess this adversely affected his restaurant and billiard business. The sharp increase in rentals is much higher than in Singapore nowadays due to great demand. His boss did not recommend him although he worked long hours, because the company was acquired and the new company demanded a level of profitability as part of the sale.

Now he is looking for another job or he would have to go back to Myanmar. Decisions made by parents to renounce Singapore permanent residency while the parents are Singapore citizens may be for the good of the child in the early years. When parents age and are sick, the child can't stay in Singapore.         

3. The other maid agent. As Khin Khin speaks the Myanmar language and works full time in this area of employment agency, she has lots of Myanmar nationals looking for jobs.  Trust is built when both parties are able to communicate. The Singapore maid agent will look to her for prospective applicant. I met one of them today. "Have you reached the top level?" I asked as he had convinced a mentor to coach him to success by payment of commissions on cases closed.

"What do you mean?" he was perplexed. He would drop by to ask for Myanmar maids as he had good employers who want quality maids and his good services. He wanted to be in the niche market of supplying good quality maids and that means higher fees.

"You said the mentor can transform a person to Level 3 from Level 5. It is like the stages in Buddhism. Have you got to the Nirvana level? You said he was pretty rough when you volunteer to be his disciple and he said you were obnoxious." He also stereotyped that all Raffles Institution graduates have that type of "don't waste my time" behaviour as this person has a $20 million turrnover in his recruitment business.
"He is a nice guy when I met him," Verge said to me. "I am grossing $12,000/month after his training. To manage 2-3 agents is not a problem, according to him. More than 8 is a challenge."
"Is the Caucasian guy still asking you for a loan?" I asked as he had told me one agent would introduce him to contacts aa he had the network.
"He paid me back the $1,000 loan after much chasing," he reported.
"He will ask for more loans," I said. "Paying you back is to give you confidence."
There are all sorts of people in this world. 





Wednesday, September 11, 2013

1129. The 4-Digit striking cat has blood in the urine





tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS
toapayohvets.com

Date:   12 September, 2013  
 
Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
The 4-Digit Striking Cat has FLUTD    
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   12 September, 2013  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

Tuesday, September 10, 2013

1126. The 4-Digit striking cat

"I can't see any digits on his coat," I said.
"Some can see, some can't see," the husband replied. "My wife struck lst, 2nd and 3rd prizes from reading the numerals on his coat. He is a precious cat to us."
"It is like that particular fish with numerals on its back," the wife commented. "Some people can see the numerals and strike rich by buying the 4-digit numbers."

In Singapore, the 4-Digit (4D) lottery is very popular with the public with long queues being seen at the shops. At one time, many Singaporeans betted on 4-Digit numbers seen from the back of a certain species of fish. 

My best advice is that it is best is not to delay treatment as the infection inside the bladder can spread to the kidneys. In this case, the high urine protein levels indicated that the kidneys have been damaged.
 
tpvets_logo.jpg (2726 bytes)6369 - 6370. This male cat had peed bloody urine for many weeks. He does not respond to treatment so fast now.
Owing to financial constraints, the owner did not want a blood test to be done.

The cat had been peeing blood in the urine for the past weeks as compared to April 2013 when he suddenly could not pee and the owners brought him to me for treatment promptly.

This time in September 2013, the cat did was not treated promptly. During the first treatment, had advised canned C/D diet but the cat would not eat it. So, the owner fed the usual commercial dry food and the problem recurred.

Now, the cat is not recovering so promptly as I phoned 3 days after treatment. Still having difficulty peeing. Hospitalised for 2 days with catherisation of urethra. In April, was hospitalised for 6 days and treatment was prompt.

Blood in the urine is one of the most common urinary problem in cats seen at Toa Payoh Vets. This condition is also known as FLUTD (Feline Lower Urinary Tract Infection). The causes are varied.
Updates will be on this webpage:
www.sinpets.com/F6/20130912haematuria_male_cat.htm


More info at: Dogs or Cats
To make an appointment: e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
Clinical Research
Copyright © Asiahomes
All rights reserved. Revised: September 12, 2013

Toa Payoh Vets

Old cat with bad breath

tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS
toapayohvets.com

Date:   12 September, 2013  
 
Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
The old cat has an oro-nasal abscess    
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   12 September, 2013  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

Tuesday, September 10, 2013

Old cat with bad breath

As cats are seldom hugged by owners in Singapore as compared to dogs, bad breath can be present for many years. Bacteria multiply and attack the roots. In this unusual case, the cat owner was advised to do dental in 2012 but she did not want to do it. Blood test did show a slight increase in urea and creatinine levels indicating abnormalities in the kidney.

In early 2013, I saw the cat with a swollen left eye with the conjunctiva much swollen. I had taken an image. I treated the conjunctivitis. Then in Sep 2013,  Dr Daniel was handling the case and advised X-ray.

I got the cat X-rayed on Sep 10, 2013 at 9 am, on behalf of Dr Daniel who starts work in the afternoon. The young vet at the other practice used xylazine (1.1 mg/kg)  and reversin to sedate the cat to get good X-rays done. I had told her that there was no point struggling with the cat to open the painful mouth to X-ray in the rostro-caudal position. "It is better to give a light sedation and get a clear view rather than no sedation and get a blurred X-ray," I advised.

 "I would say that this cat has an abscess in the sinus," the slim young lady vet told me. "Her teeth are all rotten too." I thanked her for her X-ray interpretation. It is always good to have opinions from other vets too.

"It was a tooth root abscess, lanced," Dr Daniel reported to me. "The facial swelling you saw in April was due to this problem." I reviewed the medical records. If only the owner had accepted dental scaling in 2012, there would not have been this left eye conjunctivitis in April 2013 and the recent lancing of the oro-nasal abscess.

In April 2013, the cat could have felt the painful infected molar tooth root and rubbed her left eye to relieve the pain. For the owner and for me, it was an eye problem. Actually, in retrospect, it could be a decayed tooth root abscess.  It is easy to be wise on hindsight. This case could be the feline equivalent of the dental fistula of dogs with carnaissal tooth abscess. Only that in the cat, it is rare and it was in the early stage such that I missed its presence. Time and space leads to correct diagnosis by Dr Daniel.  

Regular dental checkup and scaling when advised by the vet would have saved this owner much time and money.

Only one molar tooth was extracted but root has blood and no obvious pus. Pus accumulated mainly inside the left maxillary sinus. An incision into the facial skin over and into the sinus was made and the pus was drained by Dr Daniel. The skin was stitched and the cat went home feeling much better.
 
Updates will be on this webpage:
www.sinpets.com/F5/20130915oro-nasal_abscess_old_cat.htm

More info at: Dogs or Cats
To make an appointment: e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
Clinical Research
Copyright © Asiahomes
All rights reserved. Revised: September 12, 2013

Toa Payoh Vets

Tuesday, September 10, 2013

1127. Flowers are a dancer's best friend


tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS
toapayohvets.com

Date:   12 September, 2013  
 
Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
Flowers are a dancer's best friend    
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   12 September, 2013  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

1121. Contemporary Dance - SMU INDANCITY - Beyond 2013

It appeared to me to be full house at this SMU Indancity - Beyond 2013 on Friday Sep 6, 2013 especially on the first floor of the Kallang Theatre. Full of the young Singaporean couples and men and women seldom seen by me as I don't attend such performances.  

99% of young adults probably around 20 years old. Incessant chatter of the young and laughter made the atmosphere alive. 80% came on time. Some had to be admitted in between shows.

I sat at the recommended seat level, around 15 rows from the front, said to give the best views of the dancers as it was "premium seating".

I could barely see their faces as it was distant. There was a dancer who invited me to the SMU Indancity Beyond 2013. I have not been to watch contemporary dances as it was not an area I was interested.

"Buy a bouquet of flowers for this dancer," I told a dancer's boyfriend. His mum had to pick up the large bouquet and carried for him to the Theatre as he was busy working. I challenged him to be brave saying: "Present the bouquet to her at the end of performance. Run up to the stage before the curtains fall."

This was very romantic but not for the Singaporean young men in general. This act would be too risky for this young man to do. All eyes would be on him. The dancer would be pleased with the gesture, I was sure. Big applause from the young ones in the audience, I was sure as they were idealistic and romantic.

But this young man would not do it. It was a daunting task. More than 1600 pair of eyes from a full house would be on him. Who knows what the reaction from the audience would be? Would there be boos if he stumbled? Or a standing ovation and clapping?

What if he stumbled? There was no way except to leap onto the stage. No side-kick to help him. Any volunteers from his male friends from junior colleges? No, it was just too risky and he put the bouquet onto a seat for the time being.

So I took some images of this dancer from afar using my zooms lens and risking being expelled as video-photography was prohibited and nobody in the audience did it.

Was she the right one? She would be delighted with the this heavy and gigantic bunch of flowers if this young man would be so adventurous as to risk jumping onto the stage and presented to her. I believe that flowers are a dancer's best friend. The more flowers, the more appreciation of the hard work put into practices. Diamonds are a girl's best friend but flowers mean more for a dancer steeped in the Western dance cultures.

If this young man stumbled on leaping up the stage, everyone would laugh and the dancer could be embarrassed! Too much of a risk and so the dancer got her flowers after the curtains fell and she had her briefing and came out.

The contemporary dance in the images below was choreographed by Mr Dan Kwoh and titled "Her Rite." The info from the brochure said that the dance "showed the struggles of women for freedom in third world countries, as they fight to change the seeming inalterability of their fates. They first have to overcome the shackles and binds of their own fears of discrimination and oppression."
 
 
tpvets_logo.jpg (2726 bytes)6369-6370. Contemporary dancing of "Her Rite" raise awareness of social issues affecting women
Updates will be on this webpage:
http://www.sinpets.com/F5/20130909
contemporary_dancers.htm


More info at: Dogs or Cats
To make an appointment: e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
Clinical Research
Copyright © Asiahomes
All rights reserved. Revised: September 12, 2013

Toa Payoh Vets

1126. The 4-Digit striking cat

"I can't see any digits on his coat," I said.
"Some can see, some can't see," the husband replied. "My wife struck lst, 2nd and 3rd prizes from reading the numerals on his coat. He is a precious cat to us."

Best is not to delay treatment. The cat had been peeing blood in the urine for the past weeks as compared to April 2013 when he suddenly could not pee and was treated promptly. This time, the cat did not recover so promptly. I had advised canned C/D diet but the cat would not eat it. So, the owner fed the usual commercial dry food and the problem recurred.

Now, the cat is not recovering so promptly as I phoned 3 days after treatment. Still having difficulty peeing. Hospitalised for 2 days with catherisation of urethra. In April, was hospitalised for 6 days and treatment was prompt.