Since I treated this 8-year-old as a puppy, the mother in her late 50s took her Jack Russell to consult me. Deep yellow pus flowed freely from the vagina. Vet 1 had diagnosed pyometra by palpation and blood test (high WBC and neutrophils) and quoted $2,000 - $3,000 for the surgery. As the tanned daughter was in Shenzhen, China, she decided to wait for her to come back. So, for the past one week, the dog rejected antibiotics and now was not eating. It was now risky to go into surgery on the same day.
"Costs of living have shot up a lot," I said. "There is a lot of expensive equipment to be purchased, replaced and the staff costs have gone up."
"How much do you charge?" the mother asked. "The pyometra surgery and anaesthesia is $500," I said. "This excludes charges for medication, the IV drip and hospitalisation." In any case, my fees would be less than $1,000.
"If you had spayed the dog at a young age, you will not have to pay so much. It will be around $300! Now there is the risk that your dog may die under anaesthetic as she is 8 years old. Some vets reject surgeries of dogs over 8 years old dogs to avoid the unpleasantness of emotional lashes when the dog dies on the operating table! " Nowadays I have given up advising sterilisation as Singapore owners deem it cruel.
I hospitalised the dog for 2 days to give intensive IV drip and medication and will operate 48 hours later on Sunday.
I spoke to Julia about the $2,000 - $3,000 surgery. "It seems expensive," she said. "You are a cheap po!"
Saturday, January 8, 2011
292. Dr Sing's Travel stories - Juliet's balcony, Verona
Scribbled during travel to remember clearly the events and interesting people I met. 4th day of European Tour
On Jan 8, 2011. I decided to post some pictures of my travel before I get caught up with the hassle of city living. So I am loading the following article of my travel written on the next morning after the visit to Venice and Verona for my readers.
Dec 17, 2010
My tour group of 49 tourists from Singapore left the impressive modern Novotel Hotel, a 15-minute drive outside Venice island at 9.30 a.m. It would be 3x more expensive to live on Venice island and so we were housed in this excellent hotel.
This new furnishing concept Novotel, a 4-star hotel, is very impressive to the tour-packaged tourist as all furnishings are modern. The bathroom has custom-made semi-circular shower tub which is a fake long bath. Too shallow as a long bath tub. The wash basin was of grey plastic material while there were branded taps and shower heads. Stainless steel handles. Small things like a kettle made this hotel stay a pleasure as the tourist can boil water to make tea or coffee as almost all the European hotels do not provide kettles. The TV clock was inaccurate and English programming malfunctioned in one room. One of the group said it was a pleasure to take a shower in this hotel as the previous hotel had cold water.
After Venice Island, the tour manager announced that the factory outlet in the shopping mall for leather goods was closed for lunch and so the Singaporean ladies were greatly disappointed. He made some phone calls and the shop was opened.
But the memorable visit for me was Verona (Juliet’s balcony visit in the evening with new snow flakes falling was a great experience for the group – snow ball fights and romance revisited).
Milan’s big Chinese Restaurant for dinner (corn soup again 2nd time in another Chinese restaurant). Venice island visit. Gloomy skies with few snow flakes.
Snow fell as we left Venice by coach to see the Coliseum at Verona (substitute for not seeing the real thing at Rome – student strike over university pay and research cuts by PM Berlusconi - burnt cars and injured policemen). The Tour Manager said we could claim some money back from travel insurance on proof of no show but I doubt he would follow up as we did not get any letter. In any case, the Coliseum at Verona was closed when we arrived. But it was more fun outside as I re-experienced the gentle snow flakes falling from the skies as I had not seen natural snow falling for over 30 years in tropical Singapore and I dislike winter travels.
TRAVELLERS’ TIPS
1. Jet lag still hit me even though I slept on and off in the coach. A young man had to carry the 20-kg 3-year-old whom I could see could not walk more. My own leg muscles felt cramped and so this little girl must be very tired and jet lagged.
A 65-year-old woman with a weak knee and other tourists advised the 2nd trimester (looks like heavily pregnant) wife to sit in the front half of the coach with the 3-year-old daughter as the back end seat was not said to be good for her, being bumpy.
I had a good chat with the 65-year-old woman whose 3 daughters cared for her very well. “Where did you go?” I asked the grandson as the grandma was calling out to the tour leader to help her alight the coach to get to the factory outlet selling leather goods.
The tour leader was further away and everyone (except me) seemed to rush to the leather factory outlet, being given 30 minutes to look and buy. The grandma had a stick for her weak left knee and so she needed help alighting. I was behind and helped her. She had been “warned” by her 3 specialists about her bad knee and advised her to carry a shiny pink walking stick during her European tour.
“You don’t need the walking stick,” I said to her. “The dependence on this tongkat gives you negative thoughts, making you a disabled person when you are not.” Her daughters had sent her to 3 specialists (must have cost a bomb but the daughters would not allow her to pay).
This was an independent intelligent woman whose marriage was till death parts us type unlike the younger generation and whose mother-in-law (during that period) was domineering and a fierce dragon. Daughters-in-law were not well educated and would not talk back, but her husband did not enforce her stay with his mum. “It could be due to the eating of salted fish,” I said, regarding the husband’s stomach cancer. “I read about it in some books in the National Library when I was in Secondary School. I do love salted fish and century eggs but they may cause cancer as they are full of preservative.” I ate minimal amount. She also love century egg porridge.
2. Her brother-in-law died of the same type of cancer although he was not related to the husband. I did not bother watching the glass-blowing in the factory above after the tour of the town square of Venice and she was downstairs. So we talked. “He never ate salted fish,” the widow said. “I don’t like it.” I said: “Out of love for you, he ate when he was overseas doing business,” I said. “The person who knows would be your sister who cooks salt fish for your brother-in-law”. But it was 10 years ago and it took her 10 years to be able to talk about her husband. This was the true love as in Romeo and Juliet.
She was a generous woman as she offered to me the walking stick when I said: “I need the tongkat as I am an old man.” She did not know I was just joking as I had walked well over the earlier 3 days.
I thanked her and said: “I am trying to get you to think positively by not relying on a walking stick. The 3 specialists had advised you to take a walking stick for this travel but Europe is not a undeveloped country. When there are hilly alleys as in the town of Senia, you don't venture there, aggravating the hip injury. She does not believe in taking pain killer medication and this walking stick was her saviour. Many Singaporeans trust doctors but some of their advices like the use of the walking stick make this widow take up a clutch mentality. She did not have osteoporosis, the eldest daughter had declared. So, what’s the worry?
“We may be old but are not dead,” I used to tell my receptionist James who recently walks with a hunchback and very slowly. He is 75 years old and sometimes I wonder why he still wants to work in my surgery. His mind is alert but my Surgery's impressions on the new clientele must be poor since other competitors have young pretty receptionists. Pretty young things sell and that is a fact of commercial life.
I hope this 65-year-old widow would be independent and just throw away the walking stick for the next few days. She listened to the doctors' advice and did not give up the stick. "In Singapore, I don't walk around with a walking stick," she assured me.
3. Snow flakes fell in millions of cotton pieces from the sky as we were leaving the leather factory outlet which was closed till 3 pm but the proprietors opened for us at 1 pm. There were a few sales. I was looking for good leather hand bags but I was disappointed. Where's the Prada? Italy is supposed to be famous for handbags.
The whole shopping mall looked dead. The tour guide asked: “Anybody want to see the Coliseum at Verona?” Sounds of silence. “Hands up if you want to go to the see Juliet’s balcony.” I was in the front 6th seat and saw no hands up.
I put up my hand and so the tour guide was disappointed. He had said: “At half the speed for 300 miles, it takes twice as long to reach Milan due to the falling snow. There may be traffic jam along the way...” meaning that we better skipped the Verona coliseum and Juliet’s balcony.
He said another tour from Singapore from Milan to Rome had got stuck in the snowed roads and the tourists were sleeping inside the coach instead of the hotel. It was just as well that we did not listen to his advice as Verona was such a beautiful evening visit with snow flakes falling down on us as we journeyed to see where Juliet declared her love for Romeo from the balcony.
As for the gondola ride, around 6 out of 49 of us wanted to ride the gondola as this was an optional tour and excluded in the tour package which I think is poor planning by the tour operator who probably wanted to provide the least cost tour for the masses. Venice is gondolas and the experience should be given as part of the tour package.
The guide had arranged for a big boat cruise on the river and strongly advised against gondola rides as he said: "You only see underpants hanging from the balcony." I did not see any underwear hanging out that day.
It was freezing cold but so what? I wished to do it but did not get to ride the gondola as Julia was against it. Venice is gondolas in postcards and movies (e.g The Tourist). And masks. Apparently there is a festival in Spring where everybody wears mask, a young lady lawyer told me as she was present as a backpacker.
“Are you a Singaporean backpacker?” I asked her about the dangers of backpacking in Milan and Paris. “No danger if you are careful. I am not Singaporean.” The trim lady was accompanying her mother who insisted on going to Venice. She said: “I am a Malaysian. Singaporean ladies are known as brat-packers.” I was astonished. I had never heard of this term. "What do you mean?" I asked as I know Singaporeans in general have gone soft due to the paternalistic government. A nanny state.
She explained: “Singaporean ladies don't like discomfort. They take out their credit cards when they travel. However I do have Singaporean lady friends who backpack.” I said: “Probably those are the physical type, you know. Those who are into sports.” She nodded her head.
4. No traffic jam for this group. Slow but flowing traffic as our coach ploughed on freshly fallen snow to Milan. The Chinese food was slightly better than the other Chinese restaurant as there was more meat (one small fish for 10 people, pork with vegetables, cauliflowers alone, sweet fried chicken, the corn soup and mandarin oranges. 5 tables of 10. Everybody froze in the cold outside the restaurant as the coach took around 5-10 minutes to arrive, picked us up (as the nearest parking lot was 10 minute walk away in slippery ice-melted pavements) and we went back to Ata Hotels.
5. TRAVELLER’S TIPS
This Ata Hotel in Milan or Milan has poor roaming connections. I had to use the public phone as it has no business centre. My handphone could not work to call Singapore. “You need a phone card,” the duty officer whose eyes were tired, told me. You got to dial “0065” on the public phone. I put in 1 euro coin and the other party in Singapore, being long-winded, made me impatient. Overseas call must be to the point.
Free internet access. You need to pay. However, emails can be checked at a desktop on the table in the hotel lobby.
“Venice is more expensive than New York and London,” one proprietor of a souvenir shop told me. He was a Bangladeshi, now operating his souvenir shop at the ferry terminal. A 9-year-old Singapore girl said: "How much?” and paid 9 euros for a small porcelain model of Venice town square for her mummy. The mother had a son 18 years old and this daughter 9 years old. Migrated from China some 17 years ago. The older adult ladies bargained to buy the masks and T-shirts. Daniel bought a mask.
Lunch in Venice Square was at a Kiro Restaurant which had a variety of sea food. The male waiter saw us and came out with a name card saying: “The fish soup is good.” My family wanted to wander more to find out other eating places. Three locals scattered white salt on the pavement. I asked the family to patronize this place as we were short of time. Lunch for 4 of us cost 71 euros compared to half the price in Siena, but this was Venice Town Square. Venice is a lagoon of 500 sq km with 3 sea inlets. Ballasts are being constructed to prevent flooding. “Much more flooding incidents since last November,” the Italian tour guide said to me. “Could it be global warning and climate change?” She did not know what I was talking about and did not reply. “The Square used to have flood 2-3X per year but now, there are so many.” So is Venice sinking? “You can’t completely wall up the 3 inlets as the sea water is needed to flush out the debris and smells of the inhabitants. Many canals are man-made but some are natural.
Did my laptop function after being stored inside the coach at -3 degrees C for the whole day? Well, it does work as I am typing this.
Charge your camera battery daily if you have no spare. Coldness drain batteries. Download pic daily as this is good advice. I kept my camera dry from the snow flakes by covering it with a plastic bag and making a hole at the lens end. I got this tip from the photographers’ magazine but had not prepared for snow flakes or rain. Fortunately, I found a plastic bag and it was an extremely pleasant and fun experience walking in the fresh snowflakes in Verona which has a high city wall preserved.
As for Juliet’s balcony, some skeptics said it could not be real. Just a tourist attraction. There was a statue of Juliet in gold. Walls of graffiti or love messages at the entrance.
Verona is for those who had read Shakespeare’s Romeo and Juliet as it brings literature alive. Since I took my A level literature examination studying Shakespeare's "Romeo and Juliet" as an impressionable young man of 18 years of age, Juliet's house and courtyard brought literature alive to me during the visit. And this was some 40 years ago but I can still remember Shakespeare's most famous work.
Romantics don't care that this Juliet's house is not the real McCoy (if you research the internet to read the comments) as thousands of young lovers come to this place. On this snowy drizzling evening, the group walked several minutes to visit Juliet's house, see her gold statute. The young ones threw snow balls, the older ones tried to avoid the slippery road as cottony snow flakes glided down from the heavens. There were many visitors to Juliet's house that evening. The surrounding houses were boutiques and shops. For me, English literature came alive that evening. For the others, it was just another tourist attraction.
UPDATES AT:
-----------------------
Charge your camera battery daily if you have no spare. Coldness drain
batteries. Download pic daily as this is good advice. I kept my camera
dry from the snow flakes by covering it with a plastic bag and making a
hole at the lens end. I got this tip from the photographers’ magazine
but had not prepared for snow flakes or rain. Fortunately, I found a
plastic bag and it was an extremely pleasant and fun experience walking
in the fresh snowflakes in Verona which has a high city wall preserved.
As for Juliet’s balcony, some skeptics said it could not be real. Just a
tourist attraction. There was a statue of Juliet in gold. Walls of
graffiti or love messages at the entrance.
Verona is for those who had read Shakespeare’s Romeo and Juliet as it
brings literature alive. Since I took my A level literature examination
studying Shakespeare's "Romeo and Juliet" as an impressionable young man
of 18 years of age, Juliet's house and courtyard brought literature
alive to me during the visit. And this was some 40 years ago but I can
still remember Shakespeare's most famous work.
Romantics don't care that this Juliet's house is not the real McCoy (if
you research the internet to read the comments) as thousands of young
lovers come to this place. On this snowy drizzling evening, the group
walked several minutes to visit Juliet's house, see her gold statute.
The young ones threw snow balls, the older ones tried to avoid the
slippery road as cottony snow flakes glided down from the heavens. There
were many visitors to Juliet's house that evening. The surrounding
houses were boutiques and shops. For me, English literature came alive
that evening. For the others, it was just another tourist attraction.
--------------------
Verona is often referred to as "little Rome" for the abundance and state of preservation of its artifacts. As such it also has its own "little Colosseum", namely the Arena.
The Verona Arena (Italian: Arena di Verona [aˈrɛːna di veˈroːna, aˈreːna -]) is a Roman amphitheatre in Piazza Bra in Verona, Italy built in 30 AD. It is still in use today and is internationally famous for the large-scale opera performances given there.
It is one of the best preserved ancient structures of its kind. In ancient times, the arena's capacity was nearly 30,000 people. The stage for concerts and opera performances decreases the available places to a maximum of 22,000.[1]
Friday, January 7, 2011
291. Jan 5 & 6 2010. Interesting cases
Case 1. Collapse, panting and high fever on Sunday Jan 2, 2010 like a dog having heat stroke.
Yesterday, Thursday, Jan 6, 2010, I phoned the owner of the 10-year-old Bull Terrier yesterday to enquire how was his fever. The dog was sent home yesterday after 4 days of intensive IV treatment and drugs. The owner took out his phone and played the video clip of his dog crying continuously for several minutes. "This is a cry of pain," I said. "Most dogs done whine like that unless they are in great pain." The owner said: "My dog was not active for the past 10 days, but I did not think he was sick."
Now, after 4 days of treatment, the dog could stand and walk a few seconds. His tongue colour was normal pink. I asked the owner to bring him home to nurse as I doubted that the dog would survive the next 7 days due to his poor blood test results. The dog's blood test showed septicaemia (high WBC to 39, low platelets to 6, increase in urea and creatinine and SGPT). 10 days before coming here, the dog had been boarded at a friend's laundry place.
The owner was to feed him AD diet and other food personally and gave him the drips SC and check his fever. "Spend time with him," I advised as there was not much time left, in my opinion. "Some owners do nurse the dog back to health when the dog is at home rather than being hospitalised," I said.
"He's the same but no fever," the man said when I phoned. "I force feed him the 4 cans of AD diet and eggs." That was good news as I expected the dog to be worse and to have fever returning.
As to the cause of the undulating fever, it could be bacterial or tick fever. There was no tick found on the dog and the owner did not know whether it had ticks in the friend's place. All he knew was that the dog went in healthy and came back sickly. In the 4 days at Toa Payoh Vets, his fever returned the next day and receded when given tolfedine anti-fever. I treated him with different antibiotics for bacterial infections and tick fever before sending the dog home as a dog with no fever.
Will wait and see. Blood test showed that he had a bad bacterial infection and toxic blood due to extremely low platelet. Without intensive IV drips, he would be dead within 24 hours. It was a miracle he was alive at all.
Case 2. A Cocker Spaniel came in with 3 days of purging. "We saw blood in her stools," the couple in their late 30s had boarded the dog at Pasir Ris boarding kennels. The dog had its yearly vaccination. "Why diarrhoea?" the owner asked. "The kennel operator had told me and had asked me if I wanted to send the dog to a vet."
"It is hard to know the cause," I said as the owner declined blood tests to save cost. "There are many reasons. The vaccination protects against the serious viral and bacterial infections." The dog was eating. I hospitalised it and treated it with IV drips, antibiotics and anti-diarrhoea IV. Should be OK after 2 days as the intestines get to recover without food intake irritating their surfaces.
Case 3. A thin 1-year-old female Shih Tzu kept vomiting for the past 10 days. Yesterday, the owner agreed to blood tests and X-rays. X-ray showed small white globular object inside the stomach. Another opaque one in the bladder. Could this be the cause? This is an extremely high risk anaesthetic case as the dog was very thin. So I did not dare to operate as the death was almost guaranteed. Yet, the dog continued vomiting daily. She vomited blood. I thought it was pyometra as there were vulval discharge. Was it kidney disorder? Will wait for the blood test as the owner agreed finally to the blood test.
Yesterday, Thursday, Jan 6, 2010, I phoned the owner of the 10-year-old Bull Terrier yesterday to enquire how was his fever. The dog was sent home yesterday after 4 days of intensive IV treatment and drugs. The owner took out his phone and played the video clip of his dog crying continuously for several minutes. "This is a cry of pain," I said. "Most dogs done whine like that unless they are in great pain." The owner said: "My dog was not active for the past 10 days, but I did not think he was sick."
Now, after 4 days of treatment, the dog could stand and walk a few seconds. His tongue colour was normal pink. I asked the owner to bring him home to nurse as I doubted that the dog would survive the next 7 days due to his poor blood test results. The dog's blood test showed septicaemia (high WBC to 39, low platelets to 6, increase in urea and creatinine and SGPT). 10 days before coming here, the dog had been boarded at a friend's laundry place.
The owner was to feed him AD diet and other food personally and gave him the drips SC and check his fever. "Spend time with him," I advised as there was not much time left, in my opinion. "Some owners do nurse the dog back to health when the dog is at home rather than being hospitalised," I said.
"He's the same but no fever," the man said when I phoned. "I force feed him the 4 cans of AD diet and eggs." That was good news as I expected the dog to be worse and to have fever returning.
As to the cause of the undulating fever, it could be bacterial or tick fever. There was no tick found on the dog and the owner did not know whether it had ticks in the friend's place. All he knew was that the dog went in healthy and came back sickly. In the 4 days at Toa Payoh Vets, his fever returned the next day and receded when given tolfedine anti-fever. I treated him with different antibiotics for bacterial infections and tick fever before sending the dog home as a dog with no fever.
Will wait and see. Blood test showed that he had a bad bacterial infection and toxic blood due to extremely low platelet. Without intensive IV drips, he would be dead within 24 hours. It was a miracle he was alive at all.
Case 2. A Cocker Spaniel came in with 3 days of purging. "We saw blood in her stools," the couple in their late 30s had boarded the dog at Pasir Ris boarding kennels. The dog had its yearly vaccination. "Why diarrhoea?" the owner asked. "The kennel operator had told me and had asked me if I wanted to send the dog to a vet."
"It is hard to know the cause," I said as the owner declined blood tests to save cost. "There are many reasons. The vaccination protects against the serious viral and bacterial infections." The dog was eating. I hospitalised it and treated it with IV drips, antibiotics and anti-diarrhoea IV. Should be OK after 2 days as the intestines get to recover without food intake irritating their surfaces.
Case 3. A thin 1-year-old female Shih Tzu kept vomiting for the past 10 days. Yesterday, the owner agreed to blood tests and X-rays. X-ray showed small white globular object inside the stomach. Another opaque one in the bladder. Could this be the cause? This is an extremely high risk anaesthetic case as the dog was very thin. So I did not dare to operate as the death was almost guaranteed. Yet, the dog continued vomiting daily. She vomited blood. I thought it was pyometra as there were vulval discharge. Was it kidney disorder? Will wait for the blood test as the owner agreed finally to the blood test.
Wednesday, January 5, 2011
290. Jan 4, 2011 interesting cases
Tues Jan 4, 2011
INTERESTING CASES
Case 1. The 15-year-old Beagle with mouth pain. I was worried that she might not make it under anaesthesia. The dog was hospitalised overnight. Had IV drip and antibiotics IV. At 9.30 am, I had her under surgery.
No sedative. Just straight isoflurane gas mask and intubated as this was the safest method. But quite troublesome as the dog puts up a strong struggle to be given gas without sedation injection.
Gums were very pink. Painful mouth due to long ulcers at the gum/teeth line. Only 2 teeth extracted. The 15-year-old has better teeth than most 10-year-old dogs. The gentleman owner came at 10.30 am while I was operating the 2nd dog with testicular tumour. He brought a pillow. I told him not to visit the dog. The dog was OK. Shivering and drowsy due to anaesthetic effect and her old age (not recovering as fast as young ones). Dog went home to a happy couple.
Case 2. The dog with testicular tumour was hospitalised yesterday and given IV drip and antibiotics. 12-year-old is a big anaesthetic risk. I was not looking forward to doing this surgery. The big testicular tumour was stuck to the underside of the scrotum. It would not be the simple testicular neutering surgery which would take less than 30 minutes.
Yellow white fluid shot out from the tunica and later from the testicular tumour. The other testicle was shrunkened. So, this was not only a tumour but an infected nasty growth. I needed to cut off the whole scrotal skin as the tumour was sticking to the scrotum (due to infection probably. INTERESTING HISTORY. 4 weeks ago, had high fever and Vet 1 gave antibiotics without examining the testicles - vets seldom inspect testicles actually. 2 weeks ago, visited Vet 1 to consult about testicle size. Couple consulted me yesterday as I had removed bladder stones from this dog in 2007!).
Dog groggy. I gave Antisedan to revive him. Overall, he was alive but I wanted him to be hospitalised as he had a 15-cm incision wound (will post pic later) after cutting off the sticky scrotum and base. If he went home and jumped about, the big hole will be hard to stitch again. The surgery is called SCROTAL ABLATION.
Other medical cases were the usual vaccination and not interesting to readers.
VISIT TO A PET SHOP
"What do you want me to do?" the 9-year-old girl pulled my hand. She was the intelligent one I mentioned in my writing sometime ago and I had asked the mother to send her to a better neighbourhood school. The mother said to me: "I have a client who is a teacher there. She tells me that the principal will need to interview and then there will be a test before admission. But my daughter does not want to go. So the teacher advised that it is better for my daughter to be happy where she is rather than be unhappy in a better school."
What kind of advice is that? I did not comment. Environment plays a big part in nuturing a child's academic performance. Many Singaporean parents go to great lengths, even renting a condo to be near a good school (2-km ruling gives advantage).
So, this girl had lost the opportunity to excell. Anyway, her mother saw her tugging my hand and said: "You can't do this. It is not good manners."
I said to the little girl: "I want to buy an exercise book. Can you buy for me from the bookshop nearby?"
"No bookshop. Must go to the school. Must cross road. So I can't go."
Her older brother of 10 years volunteered to buy for me. She has 4 siblings and she is No. 2 in age. Her friend Christobel was with her. So we went to the school.
The guard permitted me to enter.
1. Book shop closed. "What time does it close?" I asked. The children dashed inside the dentist's room. Why? There was a clock there. I went in the room after them. A dental nurse was shocked. It was past 4 pm. So the shop was closed.
2. Catching tadpoles. The big brother suddenly said: "Dr Sing, you pay $1.00 to buy a bottle of drink. I can use the bottle to catch the tadpoles (in the school pond). I took out $1.00 coin but the children did not want to buy. I saw a dustbin and got out a discarded water bottle for him. "Very dirty," the children refused to touch it as it was from the dustbin. "Just go to the bathroom to wash it," I said to the brother. He did it and used the cap to catch 2 tadpoles.
The little girl also wanted to catch tadpoles now.
INTERESTING CASES
Case 1. The 15-year-old Beagle with mouth pain. I was worried that she might not make it under anaesthesia. The dog was hospitalised overnight. Had IV drip and antibiotics IV. At 9.30 am, I had her under surgery.
No sedative. Just straight isoflurane gas mask and intubated as this was the safest method. But quite troublesome as the dog puts up a strong struggle to be given gas without sedation injection.
Gums were very pink. Painful mouth due to long ulcers at the gum/teeth line. Only 2 teeth extracted. The 15-year-old has better teeth than most 10-year-old dogs. The gentleman owner came at 10.30 am while I was operating the 2nd dog with testicular tumour. He brought a pillow. I told him not to visit the dog. The dog was OK. Shivering and drowsy due to anaesthetic effect and her old age (not recovering as fast as young ones). Dog went home to a happy couple.
Case 2. The dog with testicular tumour was hospitalised yesterday and given IV drip and antibiotics. 12-year-old is a big anaesthetic risk. I was not looking forward to doing this surgery. The big testicular tumour was stuck to the underside of the scrotum. It would not be the simple testicular neutering surgery which would take less than 30 minutes.
Yellow white fluid shot out from the tunica and later from the testicular tumour. The other testicle was shrunkened. So, this was not only a tumour but an infected nasty growth. I needed to cut off the whole scrotal skin as the tumour was sticking to the scrotum (due to infection probably. INTERESTING HISTORY. 4 weeks ago, had high fever and Vet 1 gave antibiotics without examining the testicles - vets seldom inspect testicles actually. 2 weeks ago, visited Vet 1 to consult about testicle size. Couple consulted me yesterday as I had removed bladder stones from this dog in 2007!).
Dog groggy. I gave Antisedan to revive him. Overall, he was alive but I wanted him to be hospitalised as he had a 15-cm incision wound (will post pic later) after cutting off the sticky scrotum and base. If he went home and jumped about, the big hole will be hard to stitch again. The surgery is called SCROTAL ABLATION.
Other medical cases were the usual vaccination and not interesting to readers.
VISIT TO A PET SHOP
"What do you want me to do?" the 9-year-old girl pulled my hand. She was the intelligent one I mentioned in my writing sometime ago and I had asked the mother to send her to a better neighbourhood school. The mother said to me: "I have a client who is a teacher there. She tells me that the principal will need to interview and then there will be a test before admission. But my daughter does not want to go. So the teacher advised that it is better for my daughter to be happy where she is rather than be unhappy in a better school."
What kind of advice is that? I did not comment. Environment plays a big part in nuturing a child's academic performance. Many Singaporean parents go to great lengths, even renting a condo to be near a good school (2-km ruling gives advantage).
So, this girl had lost the opportunity to excell. Anyway, her mother saw her tugging my hand and said: "You can't do this. It is not good manners."
I said to the little girl: "I want to buy an exercise book. Can you buy for me from the bookshop nearby?"
"No bookshop. Must go to the school. Must cross road. So I can't go."
Her older brother of 10 years volunteered to buy for me. She has 4 siblings and she is No. 2 in age. Her friend Christobel was with her. So we went to the school.
The guard permitted me to enter.
1. Book shop closed. "What time does it close?" I asked. The children dashed inside the dentist's room. Why? There was a clock there. I went in the room after them. A dental nurse was shocked. It was past 4 pm. So the shop was closed.
2. Catching tadpoles. The big brother suddenly said: "Dr Sing, you pay $1.00 to buy a bottle of drink. I can use the bottle to catch the tadpoles (in the school pond). I took out $1.00 coin but the children did not want to buy. I saw a dustbin and got out a discarded water bottle for him. "Very dirty," the children refused to touch it as it was from the dustbin. "Just go to the bathroom to wash it," I said to the brother. He did it and used the cap to catch 2 tadpoles.
The little girl also wanted to catch tadpoles now.
Tuesday, January 4, 2011
Spelling mistakes and grammatical errors
Many of my posts have spelling mistakes and grammatical errors. I have not much time. It is either produce perfect English or creating content. Sometimes I revise and see "catch catcher" in one article. It should be "cat catcher". I will edit when free. For now, it is better I create imperfect writing in many numbers rather than one. I have around 3 hours of free time to write and this may seem a lot of time, but it is not.
288. Jan 3, 2011 interesting cases
Jan 3, 2011
My car's dashboard showed "check coolant level" again after repair last month. The mechanic had replaced the pump and had said the radiator was OK. It was a poor diagnosis as now the problem re-surfaced. I had to send the car down again. It was a radiator leak.
On the way, I visited my mentor, a senior vet to wish him a Happy New Year. "Where's XXX?" he asked about the 4th year vet student who was supposed to do internship. "He's got to re-sit his exam and has to study." I said. I asked about his son who had started an ice-cream production using artificial sweetener. He was already producing the ice-cream. The nurse brought in two cones in the vet's office where a fish tank of ordinary small golden fishes were kept (to give life to the office, the father said). "How's the ice-cream?" the son asked me later. "Too sweet," I said. "That's strange. The others said it was not sweet." I said: "Not as sweet as The Magnum ice-cream but I prefer less sweet so as not to over-work my pancreas and get diabetes at my age." He asked: "Take a tub back to the vet office." I declined as I did not have a big fridge there. I advised him to accept investors and not worry about "dilution of the brand." I said: "Cash flow is important. If investors provide the cash flow, you can invest in better equipment and retail stores." At the moment, he is selling it online.
INTERESTING CASES
Case 1. The 12-year-old Silkie with two firm and enlarge testicles.
"You removed his kidney stones 5 years ago," the young couple said. "It cost us $600." I looked at the 2007 records and yes I did the surgery for $300. "Any difficulty in peeing?" I asked. "No more. Sometimes we see blood in the urine."
4 weeks ago, Vet 1 had treated the dog for fever. 2 weeks ago, Vet 1 gave some medication for the testicular problem but the size of the two testicles did not reduce. They were 3x the normal size. "Did Ve1 1 propose surgery?" I asked. The couple went to Vet 1 as it was nearer to their place but had wanted me to operate in 2007 as I was cheaper. "I think so," the young man said. I scheduled the dog for surgery the next day. "No other way to cure" I said. "Likely to be testicular tumours or cancer. You need to pay for histopathology lab to check out."
"What if I don't want the lab test?" the young man asked. "It is a personal decision," I said. "What advantages in having a lab test?" he asked. "If the growth is not cancerous, the dog will live to its normal life." I said. "If cancerous, medication may be needed."
"There are only 3 types of testicular cancer in the dog," the young man said.
"No, there are more but 3 main types," I said. "Only a histopathology will tell. In your dog, he is very old. You may not see him alive again if his heart fails during anaesthesia," I warned the couple. "I will try to shorten the surgery. I still need to cut off the whole black scrotum instead of just taking out the testicles. It will take some time to stitch."
The young man asked: "Why?"
I said: "Just in case there is cancer and the scrotum, if not removed, still harbours the cancerous cells."
I hope all will be well during the anaesthesia.
Blood and urine tests are done. "It costs $600 like last time," the young man said. "You are fortunate that your dog costs you so little over the last 12 years as he needed only a bladder stone surgery," I replied. "For some owners, they spend thousands of dollars for treatment of their sick dog. The $600 include histopathology, blood and urine tests which should be done." I did not include consultation fees for this couple. It was a joy to see the dog again. I do recognise him now as he has that golden hair in his head.
I was thinking sadly of the 12-year old Schnauzer Cross admitted yesterday Sunday due to fits and recumbency. He died at 4 a.m today. His owner had spent some money trying to prolong his life and would be getting TCM (Traditional Chinese Medicine) from Vet 1 today, Monday. He had chronic kidney failure and was gasping and recumbent and had fits and was hospitalised. He vomited food and died around 4 am. "How do you know it was 4 am?" the owner asked when he came at 11 am to make cremation arrangements. "My staff was on duty," I said.
Case 2. As regards a dog in recumbency (unable to sit or stand up), an older man and a gentleman friend brought in his Mini-Bull Terrier with pus in the eyes and flat out. His dog was OK and was boarded at a friend's place. Such old dogs are seldom vaccinated. "Very high fever" I said. "Was he boarded in a dog kennel?" I asked. "No," he said. "A laundry." I took the blood test, gave the dog IV drip, anti-fever and anti-antibiotics. The fever went down and the dog sat up and looked around at around 6 p.m. I was glad he was OK for the time being. As to the cause of his very high fever, it is hard to tell.
Case 3. The 15-year-old Beagle with a painful mouth.
A couple in their late 50s asked: "Is it possible just to give antibiotics every time the dog has painful mouth instead of anaesthesia and extraction? We don't want the dog to die on the operating table!"
"Antibiotics will not work over time," I replied. "They will not be effective. The bacteria will spread all over the dog's body. As he gets much older, his immune system will not cope. He will die of toxaemia and bacterial infections." Sounds dramatic? The husband showed me his iPhone picture of the dog's teeth. They were clear pictures and showed tartar and red ulcers at the gum level. He lifted the dog's side and showed me the real gum and teeth.
"You are aware of the high risk of anaesthesia in dogs over 8 years of age," I advised. "This dog is 16 years old." I checked the heart. He did not have serious heart murmurs. "There is one swelling below his right eye and a smaller one in his left," the husband pointed the lumps to me. "Yes," I said. "They will be the starting of the carnaissal tooth abscess. The bacteria from the root of the teeth had punctured the facial bone and abscess will pop out below the face some time later. It is also called an oro-nasal fistula." I took out the Hills' Anatomy book and showed the picture of the carnaissal tooth abscess.
Anaesthesia and dental work would be done tomorrow. It would be very high risk and the owners had expected a good outcome.
Case 4. Pyometra? A very thin Shih Tzu female around 1 year old had been vomiting for the past 6 days. "What's the cause?" the owner asked. There were no diarrhoea or abdominal pain or swelling or fever. The owner did not want blood test. This was difficult. The only finding was that the vulval area was inflamed and wet. "When was the dog on heat?" I asked. "Some 4 weeks ago." he said. So, the probable diagnosis was open pyometra. I put the dog on IV drip and antibiotics and kept her for 2 days. Owners don't like longer hospitalisation.
Case 5. Luxated lens. The father did hit the dog on the head 2 weeks ago. The dog had been rubbing his left eyelid area and it was red. "Is it glaucoma?" the owner asked me yesterday and pointed to a black spot in the upper eyelid. I examined the dog properly under general anaesthesia (domitor and isoflurane). There was a slight increase in intro-ocular pressure in the left eye. The main problem was that the lens had luxated into the anterior chamber, causing pain and eye rubbing. Surgery was advised. Much depends on the owner.
Case 6. 12-year-old dog with teeth extracted.
The young man and his father brought the old dog for dental extraction (periodontitis Grade 4 - the worst of the disease) and was boarded yesterday. They bargained hard. "$400 is the lowest rate for everything including hospitalisation, IV drips and antibiotics, anaesthesia and surgery," I said. The dog survived the anaesthesia. The 10 rotten teeth were kept but my man did not show him at first. He phoned me as I was off work. "I pay $400 just for some dental work and one day stay," he said over the phone in an "taken for the ride" tone of voice. This is the type of calculating client I dislike a lot. This is not the way to conduct business.
I said: "The fees have been agreed. I cap it at $400 for you so that you know the costs. It should be much more. I charge $20/tooth extracted." I asked my assistant to get the teeth out to show him. It is best to attach all evidence next time. Later he text messaged me to apologise. I text back "Thanks." All vets get all types of personalities a day and some of them can be abusive to staff.
As you can see, there is a variety of conditions encountered today, even in one species, the canine. No cats or hamsters came today.
My car's dashboard showed "check coolant level" again after repair last month. The mechanic had replaced the pump and had said the radiator was OK. It was a poor diagnosis as now the problem re-surfaced. I had to send the car down again. It was a radiator leak.
On the way, I visited my mentor, a senior vet to wish him a Happy New Year. "Where's XXX?" he asked about the 4th year vet student who was supposed to do internship. "He's got to re-sit his exam and has to study." I said. I asked about his son who had started an ice-cream production using artificial sweetener. He was already producing the ice-cream. The nurse brought in two cones in the vet's office where a fish tank of ordinary small golden fishes were kept (to give life to the office, the father said). "How's the ice-cream?" the son asked me later. "Too sweet," I said. "That's strange. The others said it was not sweet." I said: "Not as sweet as The Magnum ice-cream but I prefer less sweet so as not to over-work my pancreas and get diabetes at my age." He asked: "Take a tub back to the vet office." I declined as I did not have a big fridge there. I advised him to accept investors and not worry about "dilution of the brand." I said: "Cash flow is important. If investors provide the cash flow, you can invest in better equipment and retail stores." At the moment, he is selling it online.
INTERESTING CASES
Case 1. The 12-year-old Silkie with two firm and enlarge testicles.
"You removed his kidney stones 5 years ago," the young couple said. "It cost us $600." I looked at the 2007 records and yes I did the surgery for $300. "Any difficulty in peeing?" I asked. "No more. Sometimes we see blood in the urine."
4 weeks ago, Vet 1 had treated the dog for fever. 2 weeks ago, Vet 1 gave some medication for the testicular problem but the size of the two testicles did not reduce. They were 3x the normal size. "Did Ve1 1 propose surgery?" I asked. The couple went to Vet 1 as it was nearer to their place but had wanted me to operate in 2007 as I was cheaper. "I think so," the young man said. I scheduled the dog for surgery the next day. "No other way to cure" I said. "Likely to be testicular tumours or cancer. You need to pay for histopathology lab to check out."
"What if I don't want the lab test?" the young man asked. "It is a personal decision," I said. "What advantages in having a lab test?" he asked. "If the growth is not cancerous, the dog will live to its normal life." I said. "If cancerous, medication may be needed."
"There are only 3 types of testicular cancer in the dog," the young man said.
"No, there are more but 3 main types," I said. "Only a histopathology will tell. In your dog, he is very old. You may not see him alive again if his heart fails during anaesthesia," I warned the couple. "I will try to shorten the surgery. I still need to cut off the whole black scrotum instead of just taking out the testicles. It will take some time to stitch."
The young man asked: "Why?"
I said: "Just in case there is cancer and the scrotum, if not removed, still harbours the cancerous cells."
I hope all will be well during the anaesthesia.
Blood and urine tests are done. "It costs $600 like last time," the young man said. "You are fortunate that your dog costs you so little over the last 12 years as he needed only a bladder stone surgery," I replied. "For some owners, they spend thousands of dollars for treatment of their sick dog. The $600 include histopathology, blood and urine tests which should be done." I did not include consultation fees for this couple. It was a joy to see the dog again. I do recognise him now as he has that golden hair in his head.
I was thinking sadly of the 12-year old Schnauzer Cross admitted yesterday Sunday due to fits and recumbency. He died at 4 a.m today. His owner had spent some money trying to prolong his life and would be getting TCM (Traditional Chinese Medicine) from Vet 1 today, Monday. He had chronic kidney failure and was gasping and recumbent and had fits and was hospitalised. He vomited food and died around 4 am. "How do you know it was 4 am?" the owner asked when he came at 11 am to make cremation arrangements. "My staff was on duty," I said.
Case 2. As regards a dog in recumbency (unable to sit or stand up), an older man and a gentleman friend brought in his Mini-Bull Terrier with pus in the eyes and flat out. His dog was OK and was boarded at a friend's place. Such old dogs are seldom vaccinated. "Very high fever" I said. "Was he boarded in a dog kennel?" I asked. "No," he said. "A laundry." I took the blood test, gave the dog IV drip, anti-fever and anti-antibiotics. The fever went down and the dog sat up and looked around at around 6 p.m. I was glad he was OK for the time being. As to the cause of his very high fever, it is hard to tell.
Case 3. The 15-year-old Beagle with a painful mouth.
A couple in their late 50s asked: "Is it possible just to give antibiotics every time the dog has painful mouth instead of anaesthesia and extraction? We don't want the dog to die on the operating table!"
"Antibiotics will not work over time," I replied. "They will not be effective. The bacteria will spread all over the dog's body. As he gets much older, his immune system will not cope. He will die of toxaemia and bacterial infections." Sounds dramatic? The husband showed me his iPhone picture of the dog's teeth. They were clear pictures and showed tartar and red ulcers at the gum level. He lifted the dog's side and showed me the real gum and teeth.
"You are aware of the high risk of anaesthesia in dogs over 8 years of age," I advised. "This dog is 16 years old." I checked the heart. He did not have serious heart murmurs. "There is one swelling below his right eye and a smaller one in his left," the husband pointed the lumps to me. "Yes," I said. "They will be the starting of the carnaissal tooth abscess. The bacteria from the root of the teeth had punctured the facial bone and abscess will pop out below the face some time later. It is also called an oro-nasal fistula." I took out the Hills' Anatomy book and showed the picture of the carnaissal tooth abscess.
Anaesthesia and dental work would be done tomorrow. It would be very high risk and the owners had expected a good outcome.
Case 4. Pyometra? A very thin Shih Tzu female around 1 year old had been vomiting for the past 6 days. "What's the cause?" the owner asked. There were no diarrhoea or abdominal pain or swelling or fever. The owner did not want blood test. This was difficult. The only finding was that the vulval area was inflamed and wet. "When was the dog on heat?" I asked. "Some 4 weeks ago." he said. So, the probable diagnosis was open pyometra. I put the dog on IV drip and antibiotics and kept her for 2 days. Owners don't like longer hospitalisation.
Case 5. Luxated lens. The father did hit the dog on the head 2 weeks ago. The dog had been rubbing his left eyelid area and it was red. "Is it glaucoma?" the owner asked me yesterday and pointed to a black spot in the upper eyelid. I examined the dog properly under general anaesthesia (domitor and isoflurane). There was a slight increase in intro-ocular pressure in the left eye. The main problem was that the lens had luxated into the anterior chamber, causing pain and eye rubbing. Surgery was advised. Much depends on the owner.
Case 6. 12-year-old dog with teeth extracted.
The young man and his father brought the old dog for dental extraction (periodontitis Grade 4 - the worst of the disease) and was boarded yesterday. They bargained hard. "$400 is the lowest rate for everything including hospitalisation, IV drips and antibiotics, anaesthesia and surgery," I said. The dog survived the anaesthesia. The 10 rotten teeth were kept but my man did not show him at first. He phoned me as I was off work. "I pay $400 just for some dental work and one day stay," he said over the phone in an "taken for the ride" tone of voice. This is the type of calculating client I dislike a lot. This is not the way to conduct business.
I said: "The fees have been agreed. I cap it at $400 for you so that you know the costs. It should be much more. I charge $20/tooth extracted." I asked my assistant to get the teeth out to show him. It is best to attach all evidence next time. Later he text messaged me to apologise. I text back "Thanks." All vets get all types of personalities a day and some of them can be abusive to staff.
As you can see, there is a variety of conditions encountered today, even in one species, the canine. No cats or hamsters came today.
Monday, January 3, 2011
287. Jan 2, 2011 (Sunday) cases
Bright sunshine day. Sunday. Most vet clinics are closed but Toa Payoh Vets has traditionally been open on Sundays. As Dr Vanessa is on leave till Jan 10, 2011, I work the whole day. If not, I will work from 9 am to 11 am on Sundays and weekdays.
INTERESTING CASES
CASE 1. GUINEA PIG NEUTER
A young man wanted his 2-day-purchased male 6-month-old guinea pig to be neutered. "The female is still with Pet Lovers' Centre," he said. "I don't want her to get pregnant. So I keep her there first." It is best not to neuter so soon after purchase.
"Is the guinea pig adjusted to your new home? Is he passing stools?"
"Yes," the man said. "Lots of stools. Too much. He is running around happily. In fact, I purchased the anti-stress powder as advised by Pet Lovers' Centre."
Since the guinea pig was OK, I agreed to neuter him. There is no point rushing to neuter newly purchased guinea pigs or pets as demanded by owners as they may be incubating diseases. After the surgery, the disease shows the symptoms and the vet gets the blame.
ANAESTHETIC RISK
This guinea pig weighed only 500g. What anaesthetic to use? The following was done successfully.
PER KG Bodyweight, Domitor 0.2 ml and Ketamine 0.1 ml in one syringe, totalling 0.3 ml.
I prepared the above and shook the syringe a few times. In this 500g guinea pig, I injected 0.15 ml SC. The guinea pig squealed during injection. 5 minutes later, surgical anaesthesia was excellent for the next 5 - 10 minutes. Neuter using 1 ligature (twice knotted) on the close tunica was done.
ANTIDOTE. Many guinea pigs will wake up slowly by themselves. As the guinea pig was young, I decided to wake him up after surgery. He was breathing but not standing. I gave Antisedan 0.1 ml (with saline) SC. Within 2 minutes, he was awake and squealed when carried to the crate.
When the owner came, the guinea pig was standing. Pain-killers, antibiotic and Fibreplex were given. This was the ideal treatment regime for this guinea pig.
CASE 2. 8-YEAR-OLD SCHNAUZER HAD FITS AND VOMITING. The young couple had been giving, at home, the Hartman and saline drips SC from Vet 1 who had diagnosed chronic kidney failure. Since Vet 1 was closed today (Sunday), I was consulted as the dog had 3 episodes of fits and was gasping for breath. Vomiting had occurred.
"Vet 1 would be giving TCM tomorrow," the couple said to me. I had to be frank with them that their dog will not live long once fits are seen as the toxic blood from the kidney failure causes uraemic fits. "It may be kinder to let the stop more suffering as some dogs die violently vomiting blood." It was bad news. In any case, I advised that the dog be given IV drips (glucose of 50 ml, dextrose saline, antibiotics, anti-fits, anti-diuretics and painkillers).
"Vet 1 had not given antibiotics but this is a matter of judgment," I said to the owners. "Each vet has his own way of treatment and I don't want to cause blame on Vet 1 nor do I want other vets to cause blame to me."
The dog was hospitalised and we would wait 24 hours. Economics play a great part. The couple did not want blood tests and so the present treatment would suffice. There is no kidney dialysis and transplant for dogs in Singapore and if there were, the costs would be too much for the ordinary folks. This was a very sad case.
CASE 3. The black cat bit the lady's nose.
A handsome couple. I noted the bespectacled fair lady had a 2-cm scratch on the left side of her pale white nose and kept quiet. She had came with her husband to visit the hissing black cat hospitalised and given treatment by my associate Dr Jason Teo yesterday (Saturday).
"How's the cat today?" the slim lady in her 30s asked me. "No more high fever," I replied. "She can go home to her safe environment as she looks stressed here."
There is no pure cat clinic in Singapore and some cats may not be happy to be hospitalised with dogs. I put sick cats in a different location away from dogs but still there are dogs around.
"What's the cause of the fever?" the young lady lawyer said that the cat was brought outdoors on a leash the day before. The cat was reluctant to go out and rushed to hide inside a shrub. She had been frightened sometime ago when a dog came towards her. She was perfectly happy in the apartment but the owners wanted to give her some outdoor exercise. "Is she suffering from a viral infection?" the young lady asked. The cat had her vaccinations.
"Some bacterial infection from the soil," I speculated. "Then you put more chemicals on her body by using body wipes and she tried to lick the perfumed smell away. Together, with the stress of outdoors, she developed fever as her immune system must be down."
As my associate did not take a blood sample, I did not confirm the bacterial infection but the sudden onset of high fever and outdoor exposure to soil would point to a bacterial infection rather than a viral infection.
"Did the cat scratch your nose?" I asked the lady.
"She bit me on the nose when I said hello to her," the lady laughed. "Just a gentle bite and she did not dig her teeth into my nose."
"Fortunately you are married," I presumed. "If not, your marriage prospects are poor!"
It would not be true as the lady had that innate inner beauty expressed through her communication, facial gestures, physical attributes and voice. It is hard to describe this inner beauty presented in some handsome young ladies. Charisma? You just feel the good and gentle vibrations.
The cat went home. Later the gentleman phoned: "The cat is not eating." I said: "Wait another 24 hours. She may be recovering from her stress."
CASES 4 & 5. BACK SPINAL AREA ITCHY IN 2 CATS. Two cats, with back spinal area itchy. One grey cat had grown a different golden brown patch of hair but was still itchy. I could not find any fleas as I thought it could be flea-bite allergy. The owner could have given treatment. I checked the anal glands. Dried, black grey particles of oil. This could be a cause. It is hard to say. I gave an anti-itch injection. As for the second cat, its back area was matted. It was fat and had dirty years. It was constipated despite being fed "hair ball diet" from Royal Canin. I got the groomer to clean her up, clip her coat and hospitalise her one or two days to treat the constipation and observe her.
CASE 6. PERIODONTAL DISEASE STAGE 4. The father and son tried to delay dental treatment but now the old 8-year-old Silkie had pus in the mouth and lost weight. "My cat must be in Stage 5," the son said when I showed them the pictures of Stage 4. "No more stage 5," I said. "The worst stage is Stage 4." I hospitalise the dog for IV drip and antibiotics treatment before doing dental work the next day (Monday).
CASE 7. TRAUMATIC INJURY IN LEFT EYE. "Can it be glaucoma? Do you do eye glaucoma test?" the lady presented me an old mixed terrier with a white cataract eye. The dog had been scratching the left eye as I noted that the eyelid areas were reddish.
"Did this acute conjunctivitis happen after the injury?" I asked. "Yes," she said. "In this case, it is best to check for traumatic injuries in the upper eyelid." The lady said: "There is a black spot inside the upper eyelid." Indeed there was if you evert the upper eyelid fully. I took some pictures. "This could be a foreign body stuck inside, making the dog crazy and painful in the eye. Therefore he rubs his eye trying to get rid of it."
I will be examining the dog under anaesthesia on the next day and cut off the black spot. Sometimes, the cause is not obvious and we think of glaucoma which may still be present.
I finished work at 6 pm and went to watch "Gullivers' Travels" at Ang Mo Kio Hub with my family. It was probably more interesting to a child.
INTERESTING CASES
CASE 1. GUINEA PIG NEUTER
A young man wanted his 2-day-purchased male 6-month-old guinea pig to be neutered. "The female is still with Pet Lovers' Centre," he said. "I don't want her to get pregnant. So I keep her there first." It is best not to neuter so soon after purchase.
"Is the guinea pig adjusted to your new home? Is he passing stools?"
"Yes," the man said. "Lots of stools. Too much. He is running around happily. In fact, I purchased the anti-stress powder as advised by Pet Lovers' Centre."
Since the guinea pig was OK, I agreed to neuter him. There is no point rushing to neuter newly purchased guinea pigs or pets as demanded by owners as they may be incubating diseases. After the surgery, the disease shows the symptoms and the vet gets the blame.
ANAESTHETIC RISK
This guinea pig weighed only 500g. What anaesthetic to use? The following was done successfully.
PER KG Bodyweight, Domitor 0.2 ml and Ketamine 0.1 ml in one syringe, totalling 0.3 ml.
I prepared the above and shook the syringe a few times. In this 500g guinea pig, I injected 0.15 ml SC. The guinea pig squealed during injection. 5 minutes later, surgical anaesthesia was excellent for the next 5 - 10 minutes. Neuter using 1 ligature (twice knotted) on the close tunica was done.
ANTIDOTE. Many guinea pigs will wake up slowly by themselves. As the guinea pig was young, I decided to wake him up after surgery. He was breathing but not standing. I gave Antisedan 0.1 ml (with saline) SC. Within 2 minutes, he was awake and squealed when carried to the crate.
When the owner came, the guinea pig was standing. Pain-killers, antibiotic and Fibreplex were given. This was the ideal treatment regime for this guinea pig.
CASE 2. 8-YEAR-OLD SCHNAUZER HAD FITS AND VOMITING. The young couple had been giving, at home, the Hartman and saline drips SC from Vet 1 who had diagnosed chronic kidney failure. Since Vet 1 was closed today (Sunday), I was consulted as the dog had 3 episodes of fits and was gasping for breath. Vomiting had occurred.
"Vet 1 would be giving TCM tomorrow," the couple said to me. I had to be frank with them that their dog will not live long once fits are seen as the toxic blood from the kidney failure causes uraemic fits. "It may be kinder to let the stop more suffering as some dogs die violently vomiting blood." It was bad news. In any case, I advised that the dog be given IV drips (glucose of 50 ml, dextrose saline, antibiotics, anti-fits, anti-diuretics and painkillers).
"Vet 1 had not given antibiotics but this is a matter of judgment," I said to the owners. "Each vet has his own way of treatment and I don't want to cause blame on Vet 1 nor do I want other vets to cause blame to me."
The dog was hospitalised and we would wait 24 hours. Economics play a great part. The couple did not want blood tests and so the present treatment would suffice. There is no kidney dialysis and transplant for dogs in Singapore and if there were, the costs would be too much for the ordinary folks. This was a very sad case.
CASE 3. The black cat bit the lady's nose.
A handsome couple. I noted the bespectacled fair lady had a 2-cm scratch on the left side of her pale white nose and kept quiet. She had came with her husband to visit the hissing black cat hospitalised and given treatment by my associate Dr Jason Teo yesterday (Saturday).
"How's the cat today?" the slim lady in her 30s asked me. "No more high fever," I replied. "She can go home to her safe environment as she looks stressed here."
There is no pure cat clinic in Singapore and some cats may not be happy to be hospitalised with dogs. I put sick cats in a different location away from dogs but still there are dogs around.
"What's the cause of the fever?" the young lady lawyer said that the cat was brought outdoors on a leash the day before. The cat was reluctant to go out and rushed to hide inside a shrub. She had been frightened sometime ago when a dog came towards her. She was perfectly happy in the apartment but the owners wanted to give her some outdoor exercise. "Is she suffering from a viral infection?" the young lady asked. The cat had her vaccinations.
"Some bacterial infection from the soil," I speculated. "Then you put more chemicals on her body by using body wipes and she tried to lick the perfumed smell away. Together, with the stress of outdoors, she developed fever as her immune system must be down."
As my associate did not take a blood sample, I did not confirm the bacterial infection but the sudden onset of high fever and outdoor exposure to soil would point to a bacterial infection rather than a viral infection.
"Did the cat scratch your nose?" I asked the lady.
"She bit me on the nose when I said hello to her," the lady laughed. "Just a gentle bite and she did not dig her teeth into my nose."
"Fortunately you are married," I presumed. "If not, your marriage prospects are poor!"
It would not be true as the lady had that innate inner beauty expressed through her communication, facial gestures, physical attributes and voice. It is hard to describe this inner beauty presented in some handsome young ladies. Charisma? You just feel the good and gentle vibrations.
The cat went home. Later the gentleman phoned: "The cat is not eating." I said: "Wait another 24 hours. She may be recovering from her stress."
CASES 4 & 5. BACK SPINAL AREA ITCHY IN 2 CATS. Two cats, with back spinal area itchy. One grey cat had grown a different golden brown patch of hair but was still itchy. I could not find any fleas as I thought it could be flea-bite allergy. The owner could have given treatment. I checked the anal glands. Dried, black grey particles of oil. This could be a cause. It is hard to say. I gave an anti-itch injection. As for the second cat, its back area was matted. It was fat and had dirty years. It was constipated despite being fed "hair ball diet" from Royal Canin. I got the groomer to clean her up, clip her coat and hospitalise her one or two days to treat the constipation and observe her.
CASE 6. PERIODONTAL DISEASE STAGE 4. The father and son tried to delay dental treatment but now the old 8-year-old Silkie had pus in the mouth and lost weight. "My cat must be in Stage 5," the son said when I showed them the pictures of Stage 4. "No more stage 5," I said. "The worst stage is Stage 4." I hospitalise the dog for IV drip and antibiotics treatment before doing dental work the next day (Monday).
CASE 7. TRAUMATIC INJURY IN LEFT EYE. "Can it be glaucoma? Do you do eye glaucoma test?" the lady presented me an old mixed terrier with a white cataract eye. The dog had been scratching the left eye as I noted that the eyelid areas were reddish.
"Did this acute conjunctivitis happen after the injury?" I asked. "Yes," she said. "In this case, it is best to check for traumatic injuries in the upper eyelid." The lady said: "There is a black spot inside the upper eyelid." Indeed there was if you evert the upper eyelid fully. I took some pictures. "This could be a foreign body stuck inside, making the dog crazy and painful in the eye. Therefore he rubs his eye trying to get rid of it."
I will be examining the dog under anaesthesia on the next day and cut off the black spot. Sometimes, the cause is not obvious and we think of glaucoma which may still be present.
I finished work at 6 pm and went to watch "Gullivers' Travels" at Ang Mo Kio Hub with my family. It was probably more interesting to a child.
Sunday, January 2, 2011
multi-media stories compared to photo stories
Almost all my articles at www.toapayohvets.com and in this blog have been photo stories as it takes a lot of time to produce photos and to write.
Multimedia stories - more demanding. I will need character-driven narratives, strong personalities whose issue can connect to readers and globally via the world wide web. Audio needed. Scenes with impact and evoke feelings. There is a need for collaborators from animators and multimedia graduates and money. So, it may not be financially possible as such projects are very expensive and time-consuming. Producing one project may take months.
Producing a simple educational video may be possible as one done on dental scaling in dogs. See www.toapayohvets.com.
Any volunteers interested, please contact me at judy@toapayohvets.com
Multimedia stories - more demanding. I will need character-driven narratives, strong personalities whose issue can connect to readers and globally via the world wide web. Audio needed. Scenes with impact and evoke feelings. There is a need for collaborators from animators and multimedia graduates and money. So, it may not be financially possible as such projects are very expensive and time-consuming. Producing one project may take months.
Producing a simple educational video may be possible as one done on dental scaling in dogs. See www.toapayohvets.com.
Any volunteers interested, please contact me at judy@toapayohvets.com
285. Factors for success --- Chinese saying: tian shi, di li, ren he
Chinese saying: "tian shi, di li, ren he". This means the factors for success are time, place and people.
You still got to be energetic and hardworking even if you have the 3 factors.
You still got to be energetic and hardworking even if you have the 3 factors.
Saturday, January 1, 2011
284. Dec 31, 2010 cases: rare puppy eyelid growths & Others
Dec 31, 2010. Last day of the year. I was on duty and finished work at 6.40 pm.
Bright sunshine and blue skies while some European and American airports are filled with snow and cold winds.
Traffic Warden. I happened to be in the waiting room and saw a parked golden car with its left side door at the side of the surgery marked: "Chubb and Enforcement". A slim bald man in his late 30s, wearing sunglasses, in white shirt and blue trousers stepped out of the car. I snapped a picture of him. He strode towards my car which was parked beside a fire hydrant as I was to go out soon and it was a shaded lot. I went out of the surgery and apologised to him. I drove my car away and put a parking coupon on my car dashboard. He drove off with his driver. So, it was all clear? Some 15 minutes later, I saw the same car in the same location (round the bend, at the side of the Surgery). The same warden was inside the car and looking at the rearview mirror. I was surprised. It seemed sneaky business. Why not use an unmarked car?
Only yesterday, 2 lady traffic wardens in similar starched white shirt and blue pants but from another private enforcement company (Certos?) were around in the afternoon. I saw them as I was in the waiting room and managed to avoid being booked. They were kind people and forgave me for not displaying a parking coupon. My parking area is one of the last rare lots in Singapore not boxed in by automated barriers and so these private wardens are employed to catch offenders.
Back to some interesting cases
Case 1. PROBLEM SOLVING IS WHAT THE OWNER WANTS
Shih Tzu of 3 months old has 3 eyelid growths in the left eye. Veterinary medicine is full of surprises. I am 60 years old and have seen 30 years of small animal practice. But a puppy with 3 eyelid growths is a rare occurrence. Older dogs do have them but "never" puppies. So, this was a big surprise on the last day of the year.
"I am still searching for a vet," the mother of 4 children said. Her puppy had 3 eyelid growths of around 3 mm x 2 mm. What were they? They exploded during the last 2 weeks. She bought the puppy 4 weeks ago.
"The first vet gave me an eye ointment tube to apply," the young-looking mother in her 40s said. "The growths were still there and I consulted Vet 2. He gave me this Surolan ear drops to apply. Not effective. That is why I am still looking for a vet!"
As the puppy is young and small, weighing around 1.3 kg, the eyelid growths look prominently big. "They look like warts. Give eye drops," my assistant gave his advice to me quietly. "Eye drops will not work," I explained to him. "These are solid growths on the eyelids."
Another merry-go-around with a different brand of eye drops would not do for this first-time puppy owner. "Surgery is needed to excise the 3 growths," I said. "There are no other solutions for this problem."
I knew that the other 2 vets did not want to suggest surgery as a 3-month-old puppy is a very high anaesthetic risk. According to one vet report I read, this is because the liver of the puppy is still immature and unable to clear the anaesthetic drug normally. So, the puppy dies.
You can't excise without anaesthesia as it would be painful and impossible. My assistant produced a anaesthetic consent form as he does for my associate vets. "No need," I usually don't use this form. I usually explain clearly orally the risks involved in any anaesthesia. As the mother was quite stressed out (going to a vet the 3rd time, puppy keeps rubbing the left eye), I did not tell her it would be high risk. If anaesthesia is done carefully, the risk is minimal.
ANAESTHESIA
"What anaesthesia will you use?" I asked my assistant (as part of mentoring process). "Diazepam and Ketamine," he said.
"You don't use two sedatives in the puppy," I advised. "One is already risky."
My assistant said: "Domitor?"
"Zoletil will be the best as it is said to be the safest. In the past I use xylazine with no problems."
So, Zoletil 100 at 0.01 ml with saline was injected IV. Isoflurane gas by mask was given at 5% to effect. "Don't wake till the eyelid reflexes are totally absent," I advised. "The puppy may be dead!".
I used electro-surgery to excise the 3 growths. (Pictures taken). Then 5/0 absorbable sutures to close the wound. E-collar and medication. Problem solved. That is what the owner wants. This is what I learn from my 30 years of experience. The same applies to car owners or other services.
INTERESTING OBSERVATION. I noted that the puppy kept pushing its tongue out and licking its nose, as if yawning, during Zoletil and isoflurane anaesthesia. This happened a few times. Could it be the effect of Zoletil? "Shivering" was the complaint of the owner some 1 hour after surgery. She had bought a puppy coat as the whole puppy had been clipped bald (ringworm infection of one toe and right neck). "This shivering is normal after anaesthesia in some puppies," I said as we put the puppy coat on. "It will go away soon.
Case 2. WILL MY FEMALE DOG BE PREGNANT AFTER SPAYING?
"I feel lucky today," the lady owner in her early 30s said when I told her that there was a small risk of bleeding in spaying a female dog in the middle of heat. Her male Jack Russell dog was pestering the female poodle and she could not sleep the whole night trying to ensure no mating. "The male dog just persists in smelling her backside," the owner explained. She had many questions to ask, like the owner of the Shih Tzu with the eyelid growths.
"No, the dog will not be pregnant after spaying," I assured her. "But the male dog will persist in wanting to mate with her for the next few days." There was no need to neuter the male dog for the time being as she was so desperate to prevent aother pregnancy. The puppies had died due to being stuck and delays in seeking a vet. They were born in Sep 2010. Now, the female had an extremely swollen vulva but no bleeding. "So was she in heat?" the lady asked. "Well, she would be in heat in July 2010. Pregnancy in September would be correct as that would be 2 months. From July, 6 months of interval between heat. Now it is nearly Jan 2011. So that is 6 months and she is definitely on heat."
The female was spayed. Domitor and isoflurane gas. I incised at MG 4 and MG 5 which was too low. I hooked up the two uterine bodies and horn from the 1-cm incision. The whole space was crowded and I had no space to pull out the ovary (which was large at 8 mm long when I saw it later). What to do?
The normal procedure is to extend the incision cranially by another 5 mm. Or I could push back the uterine bodies and hook again. Another solution was to ligate the uterine body first. The uterine blood vessels were 3 mm thick and the dog would bleed to death if they were not properly ligated. So, clamp, transfix ligature below the clamp. Unclamp and ligate again. Then excise uterine stump. Now there was space to pull out the ovaries and ligate once the cranial end by pulling the ovary out more. Check PROPERLY that the ligature was tight before putting the ovary inside the abdomen.
The dog was OK and the owner came later in the evening wanting to bring the dog home. She had no crate and reluctantly accepted my advice to hospitalise the dog for one night as the male dog would be frenzied in looking for the female. She would also have sufficient rest. All should be well by the next day.
Case 3. A cat with a badly infected left eyeball was operated. The eyeball had to be taken out.
Case 4. A woman who wore head scarf and her young adult daughter (studying political science) brought in a fat cat for spaying. She had booked an appointment for the spay at Vet 1 (who had rejected the Golden Retriever neuter case). So, she came to me. She had several stray cats neutered and ear clipped at her own expense.
"Are you sure you spayed her?" she asked me when she saw that the wound was around 8 mm in length. "One vet cut 3 cm long," she extended her thumb and forefinger. "Another did longer than yours."
I assured her that the cat was properly spayed. Each vet has his own method of incision but the owner makes comparisons.
Bright sunshine and blue skies while some European and American airports are filled with snow and cold winds.
Traffic Warden. I happened to be in the waiting room and saw a parked golden car with its left side door at the side of the surgery marked: "Chubb and Enforcement". A slim bald man in his late 30s, wearing sunglasses, in white shirt and blue trousers stepped out of the car. I snapped a picture of him. He strode towards my car which was parked beside a fire hydrant as I was to go out soon and it was a shaded lot. I went out of the surgery and apologised to him. I drove my car away and put a parking coupon on my car dashboard. He drove off with his driver. So, it was all clear? Some 15 minutes later, I saw the same car in the same location (round the bend, at the side of the Surgery). The same warden was inside the car and looking at the rearview mirror. I was surprised. It seemed sneaky business. Why not use an unmarked car?
Only yesterday, 2 lady traffic wardens in similar starched white shirt and blue pants but from another private enforcement company (Certos?) were around in the afternoon. I saw them as I was in the waiting room and managed to avoid being booked. They were kind people and forgave me for not displaying a parking coupon. My parking area is one of the last rare lots in Singapore not boxed in by automated barriers and so these private wardens are employed to catch offenders.
Back to some interesting cases
Case 1. PROBLEM SOLVING IS WHAT THE OWNER WANTS
Shih Tzu of 3 months old has 3 eyelid growths in the left eye. Veterinary medicine is full of surprises. I am 60 years old and have seen 30 years of small animal practice. But a puppy with 3 eyelid growths is a rare occurrence. Older dogs do have them but "never" puppies. So, this was a big surprise on the last day of the year.
"I am still searching for a vet," the mother of 4 children said. Her puppy had 3 eyelid growths of around 3 mm x 2 mm. What were they? They exploded during the last 2 weeks. She bought the puppy 4 weeks ago.
"The first vet gave me an eye ointment tube to apply," the young-looking mother in her 40s said. "The growths were still there and I consulted Vet 2. He gave me this Surolan ear drops to apply. Not effective. That is why I am still looking for a vet!"
As the puppy is young and small, weighing around 1.3 kg, the eyelid growths look prominently big. "They look like warts. Give eye drops," my assistant gave his advice to me quietly. "Eye drops will not work," I explained to him. "These are solid growths on the eyelids."
Another merry-go-around with a different brand of eye drops would not do for this first-time puppy owner. "Surgery is needed to excise the 3 growths," I said. "There are no other solutions for this problem."
I knew that the other 2 vets did not want to suggest surgery as a 3-month-old puppy is a very high anaesthetic risk. According to one vet report I read, this is because the liver of the puppy is still immature and unable to clear the anaesthetic drug normally. So, the puppy dies.
You can't excise without anaesthesia as it would be painful and impossible. My assistant produced a anaesthetic consent form as he does for my associate vets. "No need," I usually don't use this form. I usually explain clearly orally the risks involved in any anaesthesia. As the mother was quite stressed out (going to a vet the 3rd time, puppy keeps rubbing the left eye), I did not tell her it would be high risk. If anaesthesia is done carefully, the risk is minimal.
ANAESTHESIA
"What anaesthesia will you use?" I asked my assistant (as part of mentoring process). "Diazepam and Ketamine," he said.
"You don't use two sedatives in the puppy," I advised. "One is already risky."
My assistant said: "Domitor?"
"Zoletil will be the best as it is said to be the safest. In the past I use xylazine with no problems."
So, Zoletil 100 at 0.01 ml with saline was injected IV. Isoflurane gas by mask was given at 5% to effect. "Don't wake till the eyelid reflexes are totally absent," I advised. "The puppy may be dead!".
I used electro-surgery to excise the 3 growths. (Pictures taken). Then 5/0 absorbable sutures to close the wound. E-collar and medication. Problem solved. That is what the owner wants. This is what I learn from my 30 years of experience. The same applies to car owners or other services.
INTERESTING OBSERVATION. I noted that the puppy kept pushing its tongue out and licking its nose, as if yawning, during Zoletil and isoflurane anaesthesia. This happened a few times. Could it be the effect of Zoletil? "Shivering" was the complaint of the owner some 1 hour after surgery. She had bought a puppy coat as the whole puppy had been clipped bald (ringworm infection of one toe and right neck). "This shivering is normal after anaesthesia in some puppies," I said as we put the puppy coat on. "It will go away soon.
Case 2. WILL MY FEMALE DOG BE PREGNANT AFTER SPAYING?
"I feel lucky today," the lady owner in her early 30s said when I told her that there was a small risk of bleeding in spaying a female dog in the middle of heat. Her male Jack Russell dog was pestering the female poodle and she could not sleep the whole night trying to ensure no mating. "The male dog just persists in smelling her backside," the owner explained. She had many questions to ask, like the owner of the Shih Tzu with the eyelid growths.
"No, the dog will not be pregnant after spaying," I assured her. "But the male dog will persist in wanting to mate with her for the next few days." There was no need to neuter the male dog for the time being as she was so desperate to prevent aother pregnancy. The puppies had died due to being stuck and delays in seeking a vet. They were born in Sep 2010. Now, the female had an extremely swollen vulva but no bleeding. "So was she in heat?" the lady asked. "Well, she would be in heat in July 2010. Pregnancy in September would be correct as that would be 2 months. From July, 6 months of interval between heat. Now it is nearly Jan 2011. So that is 6 months and she is definitely on heat."
The female was spayed. Domitor and isoflurane gas. I incised at MG 4 and MG 5 which was too low. I hooked up the two uterine bodies and horn from the 1-cm incision. The whole space was crowded and I had no space to pull out the ovary (which was large at 8 mm long when I saw it later). What to do?
The normal procedure is to extend the incision cranially by another 5 mm. Or I could push back the uterine bodies and hook again. Another solution was to ligate the uterine body first. The uterine blood vessels were 3 mm thick and the dog would bleed to death if they were not properly ligated. So, clamp, transfix ligature below the clamp. Unclamp and ligate again. Then excise uterine stump. Now there was space to pull out the ovaries and ligate once the cranial end by pulling the ovary out more. Check PROPERLY that the ligature was tight before putting the ovary inside the abdomen.
The dog was OK and the owner came later in the evening wanting to bring the dog home. She had no crate and reluctantly accepted my advice to hospitalise the dog for one night as the male dog would be frenzied in looking for the female. She would also have sufficient rest. All should be well by the next day.
Case 3. A cat with a badly infected left eyeball was operated. The eyeball had to be taken out.
Case 4. A woman who wore head scarf and her young adult daughter (studying political science) brought in a fat cat for spaying. She had booked an appointment for the spay at Vet 1 (who had rejected the Golden Retriever neuter case). So, she came to me. She had several stray cats neutered and ear clipped at her own expense.
"Are you sure you spayed her?" she asked me when she saw that the wound was around 8 mm in length. "One vet cut 3 cm long," she extended her thumb and forefinger. "Another did longer than yours."
I assured her that the cat was properly spayed. Each vet has his own method of incision but the owner makes comparisons.
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