1152. Sunday Sep 22, 2013's interesting case. "Old or new hamster?"

Sunday Sep 22, 2013. Bright sunny day.

I was surprised to see a father and two  daughters of around 10 and 12 years old, bringing in a 1-year-old dwarf Winter White hamster with a right ear tumour for treatment as 99% of my clients are locals. The ear tumour was large and lobulated, around 8 mm x 6 mm and 5 mm deep and so the only treatment was to excise them using electro-surgery. 

"Hamsters cost $15 and your vet surgical fees costs $150-$200," the father said to his 2 daughters. "Shall we get a new hamster instead?" They were fair complexioned girls. One sister had a sharper chin while the younger one had a rounded face and was be-spectacled.

"Actually you can adopt a hamster for free," I said. The younger sister clinged to her father's trousers tighter.

"Do the two girls have savings to pay for the surgery?" 

The younger sister was clinging to the trouser of the father and  apparently sobbing with silent tears and so I assumed that the father was against payment for treatment on the way to the Surgery. The elder sister looked at Dad as solemnly as a judge prior to announcing her judgement. 

"They do have savings," he said but the daughters did not volunteer to part with their money. The father continued "What it is going to be? Shall we get a new Snowie or not?"

The younger sister grasped the father's trousers tighter as she sobbed.

"The vet fees are low compared to a similar operation in a dog or cat," I said. "There is the anaesthetic needed, otherwise the hamster would be in great pain when the lump is cut and the wound stitched. There is the cost of electro-surgery to excise this lump so that the hamster will not continue scratching his ear trying to get rid of this growing tumour."

"Shall we get a new Snowie or not?" the father teased the daughters. Caucasian fathers generally  never abandon the children's sick hamsters and I know he was teasing them. But they were taking him too seriously for not wanting to treat this hamster and it distressed the younger sister a lot. 

He gave permission for the surgery. I was surprised that the 2 daughters studied in local schools which they could pronounce in Mandarin and could write their names in Chinese as they did it for me on the case card. Good Chinese character strokes. "How about your father's name in Chinese?" I asked. They could not do it.  This father could see that Mandarin would be a good language to learn and so must have the foresight to educate the two daughters in local schools to prepare them for global competition.

"You can bring the hamster home before 5 pm today," I said to the father. "Provided you know how to clean the wound. Do not leave it to the maid."

"OK,' he was a busy man and so Sunday would be his day off work. However the 2 daughters   
 had no confidence in his nursing and so the hamster stayed one night and would go home on Monday. Dr Daniel injected an anaesthetic into the 35 g hamster, excised the big tumour using electro-surgery and stitched up the defect. He was OK and recovered well as I see him now at 1.10 pm today Monday.

Apocrine hidrocystoma in a 10-year-old dog's chest and cheek

The lady owner in her 30s was much worried about her 10-year-old female Yorkshire getting skin cancers as she discovered 3 skin lumps, on the cheek, chest and below the right ear.  I had seen Charcoal since 2004 and it is 2013 now!

I had written an interesting episode of blood machine failure in another vet practice in March 2010 stating very high levels of BUN and creatinine  and liver enzymes indicating serious kidney and liver failure. She sought my 2nd opinion and I said it was unlikely to be serious kidney failure as the dog was eating and vomited only occasionally. She was not satisfied and did not want another blood test so soon. She then went to a 3rd vet whose blood test indicated that the kidneys were OK and there was some liver infection.  She lost confidence in all vets and

Now 3 years later, the dog has 3 skin tumours. Dr Daniel excised all 3 by electro-surgery and sent two to the lab for histology. He put two tumours in one container and I advised that they should be separate. "The chest and cheek tumours should be in separate bottles so as not to confuse the lab technicians. After all, you assume they are the same tumours and that the bigger size would be the chest tumour but the lab people may not label caref

She was much worried and kept asking me how to detect new ones?    

1150. A woman who does not care for her health

An intelligent career woman who loved her two adult sons but who does not know how to take care of her health. She could not take statins to control her cholesterol levels which keep shooting up. She still ate her fatty and oily fried meats despite blood tests showing high cholesterol levels.
Exercise by walking outdoors? Like the typical Singaporean lady, this is considered too hot. Weighing scales. Don't want to look at it.

Fortunately one son persuaded her to exercise at the gym. "You have to be there," I said to him. "Otherwise, it is back to sedentary life for you mum. Older women have very high risks of heart attacks in Singapore although we always think that it is men who have heart attacks.

Dietary control will help but some educated mothers just don't bother till they get a heart attack. Same for the older generation of fathers too. So it is up to a caring adult child who will take time to care for the senior citizens by accompanying her to the gym at least once a week. .   

1149. Health care of a 60-year-old client with a twisted 2nd toe and an aortic aneurysm

Saturday Sep 21, 2013.

Today one broad-shouldered man in his 60s came to buy Z/D big bag. "I just sold the big bag," I said to him. "I don't stock more than 2 as I have no shelf space."  He told me that he had gone for his foot operation at Alexandra General Hospital one month ago after I had advised him to go take care of his health. He was limping badly and I noticed his left foot's 2nd toe turning upwards and onto his 3rd toe. Normally 2nd and 3rd toes point straight ahead and so it was abnormal. He had a large bunion a the side of the big toe and he had worn thin sharp shoes when he was younger, resulting in this abnormality..

The foot surgeon operated and he felt so much better. I was happy for him. But he had a much more serious condition. He had phlegm in his lungs. "Could be TB or the start of lung cancer," I advised him to seek medical help as the condition lasted more than 4 weeks. "Early detection means early cure."

"My wife always felt distressed when she hears me having great difficulty in breathing," he said. He then told me he had a 5-mm aneurysm in his aorta as diagnosed by the National University of Singapore doctors.

"I read from a newsletter from Singapore General Hospital or some newspapers that there is now a cure nowadays for aneurysm," I said. "If you don't go for treatment, this weakening of the aortic blood vessel will rupture when you cough a lot and you will die from internal bleeding to death. I am surprised you survived the general anaesthesia for your un-twisting your 2nd toe. Did you let the surgeon know about the aneurysm?"
"No," he had not bothered with his health. He had to work though the foot surgeon advised him to put up his foot and take medical leave for some weeks.
.
"Singapore is a developed country and there are excellent medical facilities. You are not living in an undeveloped country and yet you don't bother with your health care, causing worries to your wife."  He is working and should he die due to neglect of his health, a family loses a breadwinner and a husband and father.

He said he would seek prompt advice on his aneurysm. I still remember once I had a dog that suddenly died. All his membranes and tongue became white. I suspected this dog died from a rupture of an aortic aneurysm.

He had a painful right knee which he attributed to gout as it occurs when he drank mutton soup. His other foot had slightly twisted 2nd toe and bunion of the big toe but that should not be a surgical priority for him, The aortic aneurysm is a potential killer and I hope he seeks good advice to stop the 5-mm swelling of the aorta from bursting and draining his body of blood.
           

1148. Essential social media for local businesses

Ref: iPhone Life May June 2012 Vol 4 No. 3. Pg 16. iphonelife.com by Phyllis Khare

Prospects need to find you from their computer or iOS devices.
3 sites important -
Google Places, Bing Business Portal and Yahoo Local Listings.

Applications
1.  Facebook, free. Like a local newspaper. Announce events and try to sell things.
2 ways. Official business page, a personal accuont with the Subsciption button gturned on (check out why: bit.ly/AIVVhO)
Have your best fans write recomme3ndations on your page.
Always ask customers if they are on Facebook and ask for a recommendation right after a sale.

2. Twitter. free. Instant updates. Promotions.

3. Google +. You need to connect Place to Google + company page. Via G+ app.

4. YouTube
Highlight products, testimonials, cusomer questions, FAQs, new product releases, local event promotions and more. It is the 2nd largest search engine. Top of the list for any local business looking to increase their visibility.

Goto m.youtube.com and work from there as it will not be in iTunes (Google not on good terms with Apple).

POST ANY YouTube video you ceate on allyour other social accounts esp. Facebook and Twitter. Inlcude link to business website in Description area of your video in all posts.

5. Linkedin. Think as your official business listing. Personal account and a company page.

6. Pinterest. Free. The fastest growing social site. Visually appealing items, must have account so people can "pin" the images of your products.

7. Oink. Customer reviews and ratings can be reviewed.

8. Foursquare. Check and discover what's nearby. Share experience with friends. Search and claim your business on 4s in your own town. Add special promotions to your check-ins.

Don't be overwhelmed. Take one at a time.

1147. Surgery - eyelid tumour

1146. Anaesthetic risk for old dog surgery to remove eyelid tumour

TOA PAYOH VETS toapayohvets.com Date:   20 September, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits Anaesthetic deaths     Dr Sing Kong Yuen, BVMS (Glasgow)  Date:   20 September, 2013     Sep 15, 2013 Dear Dr Sing Kong Yuen  We – my wife Pri and I - have been at your clinic half a year ago with our two Huskies. Cee - 6 years old, the male Husky, had strained his back legs muscles, but slowly he can run again after you had advised us what to do and how to treat him. It is still not perfect, but we get him there. Our female Husky Al, now 9 years old,  has at her right upper eye-lid an abscess since some years (please see picture 6996), but we get the impression it is growing and causes her some problems, because sometimes she is scratching it and the eye ball is inflamed. We hope it is not malignant. Nonetheless we think it must be removed now somehow. Therefore we are asking you to get us an appointment for Friday, 20th September, at any time, but best would be in the morning. We are prepared to take all the time it would need to stay with April at your clinic. Please get us your answer by email. Thank you for your attention and I am looking forward to hear from you soon. With warm regards EMAIL FROM DR SING DATED SEP 16, 2013 Thank you for your email. Pl bring Al in at around 11am on Friday. Surgery and anaesthesia will be done using electro-surgery in the afternoon. She goes home at around 6 pm after recovery from anaesthesia. No food and water after 10 pm the night before. Please note that old dogs undergoing anaesthesia are at risk of death from anaesthesia. In most cases, there are no deaths if the dog is healthy and the surgery is short duration as in this case. The dog will be examined before surgery as there is inflammation and infection in the eye.  Pl give antibiotic eye drops for at least 3 days before surgery as I don't advise operating on an infected area.  Sep 19, 2013  Dear Dr Sing This afternoon we have been at your clinic and discussed with Dr Daniel the operation of Al’s eye lid tumour, he took a blood sample and checked her general health which should be OK.   Everything is clear and we fully trust to be in good hands due to your experience. However, having in mind yours and Dr Daniel's repeatedly mentioned remarks that Al could die due to the anaesthesia, even afterwards, you may understand that we are still concerned that the worst could happen to our precious dog Al. Both our dogs are like children to us. That’s why we are still reading everything about this surgery and found the below article of a dog clinic from Washington D.C. May we ask you, what is your opinion regarding  local anaesthesia after drug sedation and the described “freezing” of the wound? Please forgive us our nervousness. QUOTE: 2.   EYELID TUMORS. Older dogs commonly develop eyelid tumours (cancer). As in humans, cancer can be either benign or malignant. Fortunately, eyelid tumours in dogs are usually benign and do not spread to distant tissues.  However, eyelid tumours do slowly or quickly grow, and can destroy the structure of the eyelid, in addition to rubbing on the eye. It is usually best to remove them when they are still small. Eyelid tumours are treated by surgical removal. While there are many different surgical procedures possible, most eyelid tumours in old dogs can be removed at Animal Eye Care without requiring general anaesthesia.  The patient is given a sedative, and then a local eyelid anaesthetic is given to numb the eyelid. The tumour is removed and the site frozen with liquid nitrogen (cryosurgery) to kill any remaining tumour cells.  Tumour cells are usually very sensitive to freezing, and normal eyelid tissue is more resistant. After surgery, the eyelid margin turns pink (de-pigmentation), but usually re-pigments within 4 months. ------------------------------ EMAIL REPLY FROM DR SING DATED SEP 19, 2013 I can understand your concerns as the dog is old and thank you for your research in the article on eyelid tumour removal by one vet practice which claims that general anaesthesia is risky and the practices claims that it uses sedation and local anaesthesia to avoid the risks.  Updates will be on this webpage: www.sinpets.com/F6/20130920 anaesthetic_risk_old_Husky.htm