MONDAY JAN 10, 2010 - INTERESTING AND ROUTINE CASES
Nowadays, I don't accept Junior College students who have NOT been accepted by Vet colleges for internship as a lot of time and resources are spent on students coming for work attachments.
However, JC2 students with initiatives can still e-mail to me. Good work attitude, excellent testimonials from teachers and chances of getting into Vet colleges in Australia (must have at least 3 As in JC2 preliminary exam) may be accepted as is the author of the case study report below.
Last month, I rejected a student who had top grades. She did not have time to come for an interview as she had to study for her A levels. I was OK with that. After her exams, she did not bring in copies of her testimonials during the interview. She promised to do so personally but a few days later, text me to ask if she "could fax them." I told her not to come for the work attachment.
ADVICE TO THE YOUNG ADULTS
If you are NOT meticulous by forgetting to comply with requirements and is accepted, you will need to know that you have been given a 2nd chance. If you expect an organisation to suit your time management (by faxing and saving your precious time), you may not realise that you have a poor work attitude. Excellent academic results definitely opens doors to what you want to do, but the commercial world does not owe you a living. Therefore, be realistic and humble. It is not what the organisation can do for you as a Junior College student or undergraduate vet. It is your work attitude and what you can contribute to the organisation.
For this first day, the report of this Junior College 2 student who has not taken Biology during her A levels is good. The info is as follows:
Case studies with Dr Sing
1) 1-year-old female hamster with right breast tumour
Diagnosis
Lump under the armpit was ~0.8 - 1.0 cm in size. It weighed about 38g. It could either have an abscess or tumour. Without an operation, the skin would eventually tear, revealing a large open wound.
Treatment
Surgery was performed to remove the tumour. It was required to stay in the clinic for 7 days.
DR SING'S COMMENTS
Infection and death follows when the tumour enlarges and gets ulcerated due to friction and self-induced trauma.
NOT REQUIRED TO STAY. HOWEVER THE OWNER WOULD BE GOING TO JAPAN FOR THE NEXT 7 DAYS AND THERE WAS NOBODY TO NURSE AND GIVE MEDICATION POST-OP. SURGERY - Zoletil 100 given in 3 drops + SALINE. Effective. Excise at base of tumour. Continuous 5/0 absorbable stitches.
2) 1-year-old male guinea pig with paralysed hind legs
Diagnosis
Guinea pig’s hind legs were immobile and it was described to be lethargic. It registered a low temperature of about 37°C. It weighed about 777g and was eating and drinking normally. However, there was pain between the shoulders, indicating possible nerve damage.
Treatment
An injection was administered to relieve the pain.
DR SING'S COMMENTS
Traumatic injury most likely due to a fall inside the crate. Sudden onset.
I asked: "Any sudden loud noise?". The young lady said: "Yes, at 2 pm. I was sleeping. I saw my guinea pig running fast (pacing) and hoping energetically."
She had consulted Vet 1 earlier. The vet clipped the front teeth and probably could not find out what was wrong.
Sometimes, the 2nd vet gets the diagnosis due to the GP not getting so excited and the medication of the first vet.
I suspected sudden onset traumatic injury. Palpation of the spinal area is important in this case. The GP shivered when C3-C5 was pressed and squealed when the area between the shoulders was palpated. Paraparesis. No placing reflexes. GP hops instead of walks.
Besides anti-inflammatory injection SC to relieve the pain, the guinea pig was given electrolytes. Vet 1 had prescribed Fibreplex and the GP was able to move the bowels. Was eating and drinking normally but getting weaker.
3) 12-year-old crossbred male dog
Diagnosis
It weighed about 17.4kg. It was described to have been scratching its face and legs, as well as shaking and having difficulty in walking properly for the past few months. It also had skin and ear infections and dental problems, thus experiencing toothache and earache. It had a painful anal sac.
Treatment
Ear injection had to be administered for ear mites. A blood test was to be taken to check for kidney and liver problems. Complete shaving was needed before treating the skin infections.
DR SING'S COMMENTS
A 12-YEAR-OLD CROSS-BRED WITH PAINFUL MOUTH. Not groomed for several months. Ears full of black wax, inguinal area black. Mouth painful when touched (quite dramatic as the dog bites). This was due to dental decay esp. the upper PM4 teeth. A risky thing to do to open the mouth but this needs to be done as part of diagnosis. Quite smelly. The Junior College student has to be hands-on. But this dog is a gentle one and so I know he would not bite when I lifted his side muzzle to show the grey receding gum upper PM4 to the owners (father and young adult daughter).
The main point was missed by the Junior College girl. Dental treatment needs to be done after 2 days of IV drips with antibiotics and painkiller first.
4) Sterilisation of male stray cat
Diagnosis
Ear mites and a 0.5 cm wound were observed.
Treatment
It had just eaten; hence it was unable to be sterilized on the same day. It had to stay for at least 1 night and an injection was administered.
DR SING'S COMMENTS
Stray cats. Infected bite wounds, ear mites and skin infections need to be treated first before neuter. Economics is the big problem in cat activists. Toa Payoh Vets do give discounted rates.
5) Vaccination lump in puppy
Diagnosis
Small abscess observed in the vaccination area.
Treatment
It was massaged to reduce the size of the lump and antibiotics were administered.
DR SING'S COMMENTS
It would be some bleeding as the puppy moved a lot during vaccination. So the pet shop owner had to bring it in for free treatment. Antibiotics must be given.
Tuesday, January 11, 2011
295. Permission to use photo from toapayohvets.com's dystocia case
Dear Judy,
I was reading with interest your website, and noticed this photo of a fox terrier pup stuck in the birth canal:
http://www.asiahomes.com/dogpix/030930tn_fox_terrier_dystocia_Singapore.jpg
I was wondering if it’s possible to get permission to use this in a first aid workshop in a remote community?
I work for a not-for-profit organisation that supports dog health in Australian Indigenous communities, and would like to use the photo to illustrate a discussion on birth problems and the benefits of desexing.
Please let me know if this is ok,
Sophie Constable
Education Officer
0418699627
cid:image003.png@01CB9B6A.8A6821F0 P.O.Box 1296 Ph (08) 8941 8813 DARWIN, NT, 0801 www.amrric.org
...I acknowledge the Traditional Elders, past, present, and future, on whose land I live and work...
Kind regards,
JAN 11, 2011. Permission has been given to use photo with acknowledgement as follows: Photo: toapayohvets.com
I was reading with interest your website, and noticed this photo of a fox terrier pup stuck in the birth canal:
http://www.asiahomes.com/dogpix/030930tn_fox_terrier_dystocia_Singapore.jpg
I was wondering if it’s possible to get permission to use this in a first aid workshop in a remote community?
I work for a not-for-profit organisation that supports dog health in Australian Indigenous communities, and would like to use the photo to illustrate a discussion on birth problems and the benefits of desexing.
Please let me know if this is ok,
Sophie Constable
Education Officer
0418699627
cid:image003.png@01CB9B6A.8A6821F0 P.O.Box 1296 Ph (08) 8941 8813 DARWIN, NT, 0801 www.amrric.org
...I acknowledge the Traditional Elders, past, present, and future, on whose land I live and work...
Kind regards,
JAN 11, 2011. Permission has been given to use photo with acknowledgement as follows: Photo: toapayohvets.com
Monday, January 10, 2011
294. Sunday Jan 9, 2010 interesting cases
Sunday Jan 9, 2010
Interesting cases
As Dr Vanessa Lin will be back on Monday, Jan 10 after 10 days' break, I will not be working usually from 9.30 am to 11 am and by appointment. Younger vets will need to take over so as to continue Toa Payoh Vets' vision and mission.
INTERESTING CASES
1. Open pyometra. Only isoflurane gas was given to the Jack Russell who had pus dripping from her vulva and was hospitalised for 2 days and given IV drip and antibiotics. "The faster the surgery, the better the chances of survival," I reminded my two assistants. "If the vet takes his time to operate an old or sick dog, the dog's heart may fail and the dog dies."
It is too easy to be complacent when the vet does such surgeries routinely. Pyometra is a serious illness and is not an ordinary spay. "No point using a spay hook," I said as my assistant looked for one. I noted that the vulval dicharge, though clearer (picture taken) was still copious. Therefore, the uterus must be quite swollen. Palpation could not reveal swelling. No x-ray was taken to save the owner some money. The history of recent heat and the purulent vaginal discharge of an unspayed female dog would confirm a diagnosis of pyometra.
Earlier I said a spay hook might create a smaller skin incision compared to the usual method of pyometra surgery which needed a big incision. The dog was spayed in 25 minutes. An incision sufficient to put a forefinger in to hook up one swollen uterine horn (3 cm wide, pic taken) was used. Double ligature of ovary with 1/0 catgut. Transfixing and ligature of uterine body. My assistant prepared sterile saline for me to flush the abdomen. "There is no need to do it," I advised. "All my pyometra surgery over the years are OK without this." I noted that some vets do irrigate the abdomen after pyometra surgery. It does not make sense. Why introduce something into the abdomen when there is no contamination and instead, the vet can introduce bacteria all over via the saline solution? Keep it simple and the dog will recover. After all, this dog had pre-op antibiotics and post-op.
The dog's anaesthesia was shut down when the muscles were stitched and only skin sutures remain. The dog woke up peacefully and fast. 15 minutes later, I could see her wagging her cropped tail, as if happy to see me. This was a very gentle Jack Russell and no wonder the daughter who had to work in the Shenzen area, China had come back to Singapore to get her admitted for surgery by a "cheap-po" vet as this was what Julia described me. Vets of my age should charge double due to some 30 years of experience but it does not work this way in veterinary practice. Lawyers and doctors in branded hospitals will be able to do it. The dog was alive and could go home the next day.
2. KIDNEY FAILURE. The thin 2-year-old Shih Tzu that vomited daily for the last 4 days died. Blood tests show very high creatinine and urea levels. X-rays showed enlarged kidney (left) and what appeared to be urinary bladder stone. But the main finding was the blood test.
"The dog could develop kidney failure when he grows older, due to hereditary reasons of not proper development. The kidneys could not cope with the clearing of the toxic urea waste anywmore and therefore becomes sick and vomits," I explained to the owner whose niece was sobbing. "That is the reason why this dog does not put on weight. It was a sad Sunday for me and everyone. Vets can't cure all diseases.
3. TOILET TRAINING A GOLDEN RETRIEVER. A nice family of two parents and two boys in primary school. The 2 boys were 2 years apart. "No online gaming for them or permit them one hour," I advised the young parents as I had not been strict on my two sons. "Online gaming is the heroin of young boys. They sleep late and fall asleep during school. My son's teacher has to phone up to tell me," I said. "They are permitted to play only during holidays." the mum said. "Read 10 books a week," I advised. The younger one did not do it. So his command of English was not so good.
As for toilet training, the father asked me advice. The puppy would pee on the pee grate but poop on the tile floor at the side when confined. The only solution is to increase the grate area by buying another grate if they want to do grate training. As for paper training, no use. The puppy shreds papers. As for going to the garden to poop and pee as for most big breeds, the parents did not want the grass to die from dog's urination. So the other solution would be to leash the puppy to a confined area. "But be aware that the puppy may get strangulated and die," I said. Buying a pee pan and putting some stool smells on the newspapers in the pee pan which is placed near the area where the puppy poops may be an alternative. That means the puppy will be trained to poop on the pee pan keeping the floor tiles clean. I wonder which solution the parents will use. Will ask them if we meet again.
ANAL SACCULITIS.
"Milk seen but a tiny drop from one nipple," I said. The dog was spayed by me in May 2009. That was strange as spayed dogs usually don't show milk. But the owner did not complain about bleeding or heat. Their complaint was that the dog was biting the backside and inside thighs. The wife wore a bright green dress which is an uncommon colour. The husband was casual and a foreign trained lawyer. "She is in a cool job," he said. Working in NGO or voluntary organisation is always a better work than in money-making enterprises. The dog had anal sacculitis. Grey particles and oily grey anal oil in abundance.
Interesting cases
As Dr Vanessa Lin will be back on Monday, Jan 10 after 10 days' break, I will not be working usually from 9.30 am to 11 am and by appointment. Younger vets will need to take over so as to continue Toa Payoh Vets' vision and mission.
INTERESTING CASES
1. Open pyometra. Only isoflurane gas was given to the Jack Russell who had pus dripping from her vulva and was hospitalised for 2 days and given IV drip and antibiotics. "The faster the surgery, the better the chances of survival," I reminded my two assistants. "If the vet takes his time to operate an old or sick dog, the dog's heart may fail and the dog dies."
It is too easy to be complacent when the vet does such surgeries routinely. Pyometra is a serious illness and is not an ordinary spay. "No point using a spay hook," I said as my assistant looked for one. I noted that the vulval dicharge, though clearer (picture taken) was still copious. Therefore, the uterus must be quite swollen. Palpation could not reveal swelling. No x-ray was taken to save the owner some money. The history of recent heat and the purulent vaginal discharge of an unspayed female dog would confirm a diagnosis of pyometra.
Earlier I said a spay hook might create a smaller skin incision compared to the usual method of pyometra surgery which needed a big incision. The dog was spayed in 25 minutes. An incision sufficient to put a forefinger in to hook up one swollen uterine horn (3 cm wide, pic taken) was used. Double ligature of ovary with 1/0 catgut. Transfixing and ligature of uterine body. My assistant prepared sterile saline for me to flush the abdomen. "There is no need to do it," I advised. "All my pyometra surgery over the years are OK without this." I noted that some vets do irrigate the abdomen after pyometra surgery. It does not make sense. Why introduce something into the abdomen when there is no contamination and instead, the vet can introduce bacteria all over via the saline solution? Keep it simple and the dog will recover. After all, this dog had pre-op antibiotics and post-op.
The dog's anaesthesia was shut down when the muscles were stitched and only skin sutures remain. The dog woke up peacefully and fast. 15 minutes later, I could see her wagging her cropped tail, as if happy to see me. This was a very gentle Jack Russell and no wonder the daughter who had to work in the Shenzen area, China had come back to Singapore to get her admitted for surgery by a "cheap-po" vet as this was what Julia described me. Vets of my age should charge double due to some 30 years of experience but it does not work this way in veterinary practice. Lawyers and doctors in branded hospitals will be able to do it. The dog was alive and could go home the next day.
2. KIDNEY FAILURE. The thin 2-year-old Shih Tzu that vomited daily for the last 4 days died. Blood tests show very high creatinine and urea levels. X-rays showed enlarged kidney (left) and what appeared to be urinary bladder stone. But the main finding was the blood test.
"The dog could develop kidney failure when he grows older, due to hereditary reasons of not proper development. The kidneys could not cope with the clearing of the toxic urea waste anywmore and therefore becomes sick and vomits," I explained to the owner whose niece was sobbing. "That is the reason why this dog does not put on weight. It was a sad Sunday for me and everyone. Vets can't cure all diseases.
3. TOILET TRAINING A GOLDEN RETRIEVER. A nice family of two parents and two boys in primary school. The 2 boys were 2 years apart. "No online gaming for them or permit them one hour," I advised the young parents as I had not been strict on my two sons. "Online gaming is the heroin of young boys. They sleep late and fall asleep during school. My son's teacher has to phone up to tell me," I said. "They are permitted to play only during holidays." the mum said. "Read 10 books a week," I advised. The younger one did not do it. So his command of English was not so good.
As for toilet training, the father asked me advice. The puppy would pee on the pee grate but poop on the tile floor at the side when confined. The only solution is to increase the grate area by buying another grate if they want to do grate training. As for paper training, no use. The puppy shreds papers. As for going to the garden to poop and pee as for most big breeds, the parents did not want the grass to die from dog's urination. So the other solution would be to leash the puppy to a confined area. "But be aware that the puppy may get strangulated and die," I said. Buying a pee pan and putting some stool smells on the newspapers in the pee pan which is placed near the area where the puppy poops may be an alternative. That means the puppy will be trained to poop on the pee pan keeping the floor tiles clean. I wonder which solution the parents will use. Will ask them if we meet again.
ANAL SACCULITIS.
"Milk seen but a tiny drop from one nipple," I said. The dog was spayed by me in May 2009. That was strange as spayed dogs usually don't show milk. But the owner did not complain about bleeding or heat. Their complaint was that the dog was biting the backside and inside thighs. The wife wore a bright green dress which is an uncommon colour. The husband was casual and a foreign trained lawyer. "She is in a cool job," he said. Working in NGO or voluntary organisation is always a better work than in money-making enterprises. The dog had anal sacculitis. Grey particles and oily grey anal oil in abundance.
Saturday, January 8, 2011
$2000 - $3000 for pyometra surgery
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!"
"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!"
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:
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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.
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