Case written at Paya Lebar Public Library Mar 17, 2011 7.00pm
Takes an hour just to write this case of sibling illness!
Although the case was well handled by Dr Vanessa, I reviewed the case with the Australian owner as I am the licensee and have grave responsibilities to ensure that owners are satisfied with the services and to maintain the high standard of care expected by a reasonable man.
Continuing the review, I asked my assistant to take out the blood test results of Ragdoll 2 done recently by Dr Vanessa.
TWO BLOOD TESTS OF RAGDOLL 2.
March 9, 2011
Urea 6.3 (7.2 - 10.8)
Creatinine 89 (71-160)
Total White Cell Count 41.9 (5.5 - 19.5)
Neutrophils 93.32% Abs 39.10
Lymphocytes 4.25% Abs 1.78
Monocytes 1.77% Abs 0.74
Eosinophils 0.43% Abs 0.18
Basophils 0.12% Abs 0.05
Platelet 584 (300-800)
March 14, 2011
No kidney and liver tests done. The following were the results
Total White Cell Count 19.4 (5.5 - 19.5)
Neutrophils 80.41% Abs 15.6
Lymphocytes 13.30% Abs 2.58
Monocytes 3.87% Abs 0.75
Eosinophils 2.11% Abs 0.41
Basophils 0.67% Abs 0.13
Platelet 389 (300-800)
COMPARED TO RAGDOLL 1
BLOOD TEST OF RAGDOLL 1.
Date Mar 4, 2011 (date of admission to Toa Payoh Vets). Had 2 weeks of vomiting and treatment of 4X by another vet practice.
Urea 16.9 (7.2 - 10.8)
Creatinine 83 (71-160)
SGPT/ALT 91 (<121)
SGOT/AST 214 (<67)
Haemoglobin 6.6 (8 - 15)
Red cell count 5.1 (5 - 10)
Total white cell counnt 10.4 (5.5 - 19.5)
Neutrophils 95,00% Abs 9.88
Lymphocytes 2.50% Abs 0.26
Monocytes 1.44% Abs 0.15
Eosinophils 1.35% Abs 0.14
Basophils 0.00% Abs 0.00
PCV 0.21 (0.24 - 0.45)
Platelets 152 (300 - 800). No platelet clumps but few giant platelets present.
To cut a long story short, Ragdoll 1's lifestyle was to catch the gecko in the living area and ate it. No rats or cockroaches in the house. Ragdoll 2 does not catch but would eat part of it.
Therefore, Ragdoll 1 lost weight over time as some geckos could have had been poisoned by insecticide by neighbours as this Australian does not do it. When they come over, Ragdoll 1 pounced on them and ate them.
As evidence, the haemoglobin and platelet counts were low, meaning the bone marrow was depressed. A possiblity of toxaemia either from the bacteria and pesticide inside the gecko or both. The owner was quite satisfied with this epidemiological result and would keep the cat upstairs when he was not at home as there were no geckos upstairs. A chronic toxaemia would explain the weight loss in the young Ragdoll 1 and a big dose of bacteria in Ragdoll 2 from another gecko could explain its high fever from infectious bacteria. Would the reader agree?
Thursday, March 17, 2011
362. Sibling Illness 1 - The Vomiting Ragdoll - Part 1
When one young sibling is ill, will the other sibling get infected? This depends on the diagnosis. Recently I encountered two cases of sibling illness. One case was of two male ragdoll cats, 11 months old.
The other case was not under my care but the owner, being my wife's ex-classmate phoned me for a second opinion as she was worried that the living 6-month old Golden Retriever X, now healthy might suffer from the same disease. This would be written in Sibling Illness 3 - The Vomiting Golden Retriever X
CASE 1.
"My wife consulted Vet 1 and Vet 2 for 4 times in the past 2 weeks, but the cat continued vomiting. We told the vets that the cat was not putting on weight compared to his sibling." He consulted Dr Jason who took a blood test and gave the necessary IV drip. The cat died overnight. I saw the owner the next day. He appeared upset and so, being the Practice Manager which is equivalent to the KEO or licensee, I spoke to Dr Jason as to what was going on. Dr Jason said that the owner thanked him and was not unhappy. This is the type of emotional situation where a blood test gave clues to the cause of illness and satisfy the owner.
BLOOD TEST OF RAGDOLL 1.
Date Mar 4, 2011 (date of admission to Toa Payoh Vets).
Urea 16.9 (7.2 - 10.8)
Creatinine 83 (71-160)
SGPT/ALT 91 (<121)
SGOT/AST 214 (<67)
Haemoglobin 6.6 (8 - 15)
PCV 0.21 (0.24 - 0.45)
Platelets 152 (300 - 800)
The cat was recumbent. 2.5 ml of blood was taken from the femoral vein and put into 3 tubes for laboratory analysis. With the blood results, Dr Jason had supporting clues as to why the cat had died and the owner was satisfied and his unhappiness was "why the other vet did not take blood test".
His questions to me today, Mar 17, 2011 when I met him again while his 2nd cat had been treated by Dr Vanessa for constipation and 6 days of hospitalisation earlier for fever (very high white cell count) were as follows:
1. Why didn't the vets take a blood test? He said it could be that the cat was treated by different vets in the practice.
2. Would the first deceased cat be saved if a blood test was taken earlier?
3. What was the cause of the illness, leading to weight loss compared to his sibling? Both lived in a house, had freedom to roam, fed canned food and given dry food unrestricted.
I took out his case sheet for the Ragdoll 1 to review the case and asked him more history. This required time and so time is seldom available for most vets.
"Did your first cat prey on lizards and cockroaches?" I asked since the 2nd cat treated for a high fever had a very high white cell count.
The other case was not under my care but the owner, being my wife's ex-classmate phoned me for a second opinion as she was worried that the living 6-month old Golden Retriever X, now healthy might suffer from the same disease. This would be written in Sibling Illness 3 - The Vomiting Golden Retriever X
CASE 1.
"My wife consulted Vet 1 and Vet 2 for 4 times in the past 2 weeks, but the cat continued vomiting. We told the vets that the cat was not putting on weight compared to his sibling." He consulted Dr Jason who took a blood test and gave the necessary IV drip. The cat died overnight. I saw the owner the next day. He appeared upset and so, being the Practice Manager which is equivalent to the KEO or licensee, I spoke to Dr Jason as to what was going on. Dr Jason said that the owner thanked him and was not unhappy. This is the type of emotional situation where a blood test gave clues to the cause of illness and satisfy the owner.
BLOOD TEST OF RAGDOLL 1.
Date Mar 4, 2011 (date of admission to Toa Payoh Vets).
Urea 16.9 (7.2 - 10.8)
Creatinine 83 (71-160)
SGPT/ALT 91 (<121)
SGOT/AST 214 (<67)
Haemoglobin 6.6 (8 - 15)
PCV 0.21 (0.24 - 0.45)
Platelets 152 (300 - 800)
The cat was recumbent. 2.5 ml of blood was taken from the femoral vein and put into 3 tubes for laboratory analysis. With the blood results, Dr Jason had supporting clues as to why the cat had died and the owner was satisfied and his unhappiness was "why the other vet did not take blood test".
His questions to me today, Mar 17, 2011 when I met him again while his 2nd cat had been treated by Dr Vanessa for constipation and 6 days of hospitalisation earlier for fever (very high white cell count) were as follows:
1. Why didn't the vets take a blood test? He said it could be that the cat was treated by different vets in the practice.
2. Would the first deceased cat be saved if a blood test was taken earlier?
3. What was the cause of the illness, leading to weight loss compared to his sibling? Both lived in a house, had freedom to roam, fed canned food and given dry food unrestricted.
I took out his case sheet for the Ragdoll 1 to review the case and asked him more history. This required time and so time is seldom available for most vets.
"Did your first cat prey on lizards and cockroaches?" I asked since the 2nd cat treated for a high fever had a very high white cell count.
You can't teach an old dog new tricks?
Case study: You can't teach an old dog new tricks?
I am reminded of an English idiom I had to memorise and understand for my PSLE (Primary School Leaving Examination) exam in Primary Six in 1962 when I was 12 years old. The only dogs I saw in the Redhill area I lived (there was actually a real red hill) were stray dogs and no resident in the S.I.T (Singapore Improvement Trust) apartment keep dogs as pets. It was the 1960s and the residents were the working class. I am sure the rich families living in Cluny Road or the other areas keep dogs as pets. As for me, I had never seen dogs performing as there was probably no TV yet or at the most, a black and white one.
This idiom was: "You can't teach an old dog new tricks". What did it mean to a 12-year-old boy whose life was decades from being an old foggy.
When I encountered the real situation yesterday, March 16, 2011 during a class I had to attend at 60 years of age, I could understand the meaning of the idiom. See whether you agree with me as to whether the story explains the idiom succinctly?
On March 16, 2011, I attended a REA course which lasts 2 months with lectures 3x/week from 10am - 1 pm. A fair lady in her late 30s who is in the family of developers said: "I am too old to study. When is the examination? I have to go overseas in May."
"The exam is in May," I said. "After the end of the course, you will get a completion certificate (75% attendance needed). Then you can register for this examination conducted by Informatics. It is best to take this May exam after the lectures if you wish to have a better chance of passing."
Our lecturer, white-haired and trim in his late 60s said: "I can pass the exam and you are much younger. If you put your mind to it, you will pass. My student studies 3 hours/day and he passed."
I said: "You must have missed renewing your real estate licence with the IRAS (Inland Revenue of Singapore) before the CEA (Council of Estate Agents) takes over the regulatory functions in 2010. Otherwise, you will not need to take this course."
"Yes, for the last 3 years, I did not renew the licence with the IRAS."
All licences must be renewed but in this case, the IRAS did not provide the electronic debiting of licences unlike the CEA. The IRAS declared that all realtors had to self-renew and no reminders would be sent.
There were those who did not do so. When the CEA took over, these were the fishes trapped in the net and if they want to be the KEO (Key Executive Officers) of their realty firms, they have to take this REA examination. No mercy or compassion from the CEA even if you have the CEHA certificate. I had the CEHA but I had not renewed my licence. Bad luck to me. So that is why I am in class studying the laws of tort, contract, architecture notes and more regulations.
My class-mates appear to be over 30 years mainly and I presume we are all in the same boat as this developer.
The mind must not think "old" if one wants to live longer and be successful in examinations. Otherwise, the self-fulfilling prophecy kicks in - you think you are old and can't pass the exam or be successful. So, your mindset becomes negative and you really age soon.
The lecturer had 5 shophouses to sell at $14 million for re-development. He asked this developer firm for her name card. Then he threw his name card onto her table.* I asked for one too. One must network and think positively.
P.S. In some cultures, throwing the name card to another person may not be polite. It should be handed with two hands. You will see Japanese businessmen handing name cards with two hands as that is their way of doing things.
This lecturer was very supportive and encouraging. He is a very good lecturer. He said to me: "Just study my CD. Or you can download to your phone for reference." I was surprised that this could be done. He showed me his Nokia phone and there were the notes. According to some classmates, the notes in the CD needed to be printed in 400 pages! There are so many new technology and if one knows how to use it, one could just study from the smartphone when one is free. This may be a useful tip to veterinary undergraduates. The old lecturer had someone to download the CD for him as I asked how he did it. Always ask and you will find that people usually are kind and will answer your "stupid" question.
From this experience, write down a list of licences to be renewed on a piece of paper and display in front of your desk. Nowadays, most Singapore government departments don't do what the IRAS did to the realtors. They send e-reminders and that should be the way to serve the tax payers.
I am reminded of an English idiom I had to memorise and understand for my PSLE (Primary School Leaving Examination) exam in Primary Six in 1962 when I was 12 years old. The only dogs I saw in the Redhill area I lived (there was actually a real red hill) were stray dogs and no resident in the S.I.T (Singapore Improvement Trust) apartment keep dogs as pets. It was the 1960s and the residents were the working class. I am sure the rich families living in Cluny Road or the other areas keep dogs as pets. As for me, I had never seen dogs performing as there was probably no TV yet or at the most, a black and white one.
This idiom was: "You can't teach an old dog new tricks". What did it mean to a 12-year-old boy whose life was decades from being an old foggy.
When I encountered the real situation yesterday, March 16, 2011 during a class I had to attend at 60 years of age, I could understand the meaning of the idiom. See whether you agree with me as to whether the story explains the idiom succinctly?
On March 16, 2011, I attended a REA course which lasts 2 months with lectures 3x/week from 10am - 1 pm. A fair lady in her late 30s who is in the family of developers said: "I am too old to study. When is the examination? I have to go overseas in May."
"The exam is in May," I said. "After the end of the course, you will get a completion certificate (75% attendance needed). Then you can register for this examination conducted by Informatics. It is best to take this May exam after the lectures if you wish to have a better chance of passing."
Our lecturer, white-haired and trim in his late 60s said: "I can pass the exam and you are much younger. If you put your mind to it, you will pass. My student studies 3 hours/day and he passed."
I said: "You must have missed renewing your real estate licence with the IRAS (Inland Revenue of Singapore) before the CEA (Council of Estate Agents) takes over the regulatory functions in 2010. Otherwise, you will not need to take this course."
"Yes, for the last 3 years, I did not renew the licence with the IRAS."
All licences must be renewed but in this case, the IRAS did not provide the electronic debiting of licences unlike the CEA. The IRAS declared that all realtors had to self-renew and no reminders would be sent.
There were those who did not do so. When the CEA took over, these were the fishes trapped in the net and if they want to be the KEO (Key Executive Officers) of their realty firms, they have to take this REA examination. No mercy or compassion from the CEA even if you have the CEHA certificate. I had the CEHA but I had not renewed my licence. Bad luck to me. So that is why I am in class studying the laws of tort, contract, architecture notes and more regulations.
My class-mates appear to be over 30 years mainly and I presume we are all in the same boat as this developer.
The mind must not think "old" if one wants to live longer and be successful in examinations. Otherwise, the self-fulfilling prophecy kicks in - you think you are old and can't pass the exam or be successful. So, your mindset becomes negative and you really age soon.
The lecturer had 5 shophouses to sell at $14 million for re-development. He asked this developer firm for her name card. Then he threw his name card onto her table.* I asked for one too. One must network and think positively.
P.S. In some cultures, throwing the name card to another person may not be polite. It should be handed with two hands. You will see Japanese businessmen handing name cards with two hands as that is their way of doing things.
This lecturer was very supportive and encouraging. He is a very good lecturer. He said to me: "Just study my CD. Or you can download to your phone for reference." I was surprised that this could be done. He showed me his Nokia phone and there were the notes. According to some classmates, the notes in the CD needed to be printed in 400 pages! There are so many new technology and if one knows how to use it, one could just study from the smartphone when one is free. This may be a useful tip to veterinary undergraduates. The old lecturer had someone to download the CD for him as I asked how he did it. Always ask and you will find that people usually are kind and will answer your "stupid" question.
From this experience, write down a list of licences to be renewed on a piece of paper and display in front of your desk. Nowadays, most Singapore government departments don't do what the IRAS did to the realtors. They send e-reminders and that should be the way to serve the tax payers.
Wednesday, March 16, 2011
Sunday Mar 13, 2011's two interesting case
CASE 1. The case of pug with the swollen male private part.
The lady owner who has nursing knowledge apologised for phoning me on Saturday and said: "Remember my pug with the urinary stones? But now, my pug has a big swollen penis for some time. He could be humping. Is it serious? Will he recover with time? What is the cause? It can't be urinary tract infection as his urine is OK."
This is the type of question that is very difficult to answer. If I said yes and the pug self-mutilated his penis by further licking causing bleeding, I would get an unhappy owner who would lose confidence in my judgment. So, it was wiser to get her to bring the pug for examination and treatment to bring down the penile engorgement.
"I don't know," I said. "It is best to send the pug down for treatment."
The pug was still having the big swelling when the lady brought him to consult Dr Jason Teo who was on duty on Saturday. His injection brought down the swelling. I did advise collection of urine for analysis and hospitalisation for one day. It would be negligent not to do so.
Urine test showed no bacterial infection or urinary crystals with the pH being 6.5. However blood in the urine was 4+ (a lot) and there were protein casts.
So, what was the problem? Self-stimulation? Kidney trauma causing bleeding inside the urinary tract?
The dog developed fits during hospitalisation. So, could the dog have injured his penis when he had fits or penile engorgement due to fits? Since most fits have unknown causes, it was hard to say. I phoned the owner who had not witnessed any fits said: "So the cause was due to fits."
This was a strange case. I did advise neutering but she would not do it.
CASE 2. Left thyroid malignant tumour.
The couple had this Beagle for 15 years. When she was not eating properly, he sent to me for dental scaling last month. Then, last week, he showed me the video of the dog gulping and "snorting" after swallowing. A left throat lump, the size of a 50-cent coin
The lady owner who has nursing knowledge apologised for phoning me on Saturday and said: "Remember my pug with the urinary stones? But now, my pug has a big swollen penis for some time. He could be humping. Is it serious? Will he recover with time? What is the cause? It can't be urinary tract infection as his urine is OK."
This is the type of question that is very difficult to answer. If I said yes and the pug self-mutilated his penis by further licking causing bleeding, I would get an unhappy owner who would lose confidence in my judgment. So, it was wiser to get her to bring the pug for examination and treatment to bring down the penile engorgement.
"I don't know," I said. "It is best to send the pug down for treatment."
The pug was still having the big swelling when the lady brought him to consult Dr Jason Teo who was on duty on Saturday. His injection brought down the swelling. I did advise collection of urine for analysis and hospitalisation for one day. It would be negligent not to do so.
Urine test showed no bacterial infection or urinary crystals with the pH being 6.5. However blood in the urine was 4+ (a lot) and there were protein casts.
So, what was the problem? Self-stimulation? Kidney trauma causing bleeding inside the urinary tract?
The dog developed fits during hospitalisation. So, could the dog have injured his penis when he had fits or penile engorgement due to fits? Since most fits have unknown causes, it was hard to say. I phoned the owner who had not witnessed any fits said: "So the cause was due to fits."
This was a strange case. I did advise neutering but she would not do it.
CASE 2. Left thyroid malignant tumour.
The couple had this Beagle for 15 years. When she was not eating properly, he sent to me for dental scaling last month. Then, last week, he showed me the video of the dog gulping and "snorting" after swallowing. A left throat lump, the size of a 50-cent coin
359. Mis-treatment by a famous surgeon
This was a story related to me by a 30+ lady who had her rabbit treated by me. Her friend, also 30+ had a tumour near her heart and consulted a famous experienced surgeon in a government hospital.
"This surgeon had done many of such cases before and they were benign tumours. So he opened up the chest but the tumour was malignant," the rabbit owner said. "Worse of all, he could not remove all the tumour tissue. Imagine my friend's distress. If it is diagnosed malignant before the operation, chemotherapy could be used to shrink the tumour before operating. Now, my friend could not be given chemo-therapy and must wait 6 weeks."
"Waiting with malignant tumour inside her chest was very stressful. And the surgeon is a well known doctor in this hospital."
"Could a biopsy of the tumour be done to see whether the chest tumour is cancerous or not before proceeding to sugery?" I asked. She didn't know and neither did I.
"Did your friend seek a second opinion to get an earlier date for chemotherapy?" I asked.
"No," the owner said.
"So, what happened?"
"Well, my friend had chemotherapy 6 weeks after the operation. She is recovering in Europe."
Medicine springs some surprises to doctors and veterinarians. It is wise to do biopsies for chest tumours unless the owner does not want it done. The common practice for surgeons may be just to take out the tumour and send for histopatholgy test, rather than wait for biopsy results.
"This surgeon had done many of such cases before and they were benign tumours. So he opened up the chest but the tumour was malignant," the rabbit owner said. "Worse of all, he could not remove all the tumour tissue. Imagine my friend's distress. If it is diagnosed malignant before the operation, chemotherapy could be used to shrink the tumour before operating. Now, my friend could not be given chemo-therapy and must wait 6 weeks."
"Waiting with malignant tumour inside her chest was very stressful. And the surgeon is a well known doctor in this hospital."
"Could a biopsy of the tumour be done to see whether the chest tumour is cancerous or not before proceeding to sugery?" I asked. She didn't know and neither did I.
"Did your friend seek a second opinion to get an earlier date for chemotherapy?" I asked.
"No," the owner said.
"So, what happened?"
"Well, my friend had chemotherapy 6 weeks after the operation. She is recovering in Europe."
Medicine springs some surprises to doctors and veterinarians. It is wise to do biopsies for chest tumours unless the owner does not want it done. The common practice for surgeons may be just to take out the tumour and send for histopatholgy test, rather than wait for biopsy results.
Sunday, March 13, 2011
358. Malignant tumour left neck - disc shaped
Sunday Mar 13, 2011 Blue skies, white clouds, sunshine
2 interesting cases
CASE 1. Beagle, 16-year old.
The owners, a couple in their 40s, were kind enough to permit me to use their dog case for education of vet students.
HISTORY
In
2 interesting cases
CASE 1. Beagle, 16-year old.
The owners, a couple in their 40s, were kind enough to permit me to use their dog case for education of vet students.
HISTORY
In
Tuesday, March 8, 2011
357. Singapore's education system data
Reference: Straits Times, Mar 7, 2011 A19 "An education in mobility"
What is the actual situation of the Singapore's education system? Does one's family background - rich v. poor parents affect the child's ability to stay at the top or bottom of the social ladder respectively? This means that the rich becomes richer and the poor becomes poorer in Singapore.
MINISTRY OF EDUCATION'S STATISTICS
said that students from poor homes can still move up, giving example that the top 5% of the Primary School Leaving Examination pupils are consistently distributed among the 95% of the primary schools and not just the elite ones. In addition, >90% of each cohort goes to publicly funded post-secondary institutes and almost 50% of students who live in one- to three-room HDB flats make it to universities and polytechnics.
In my opinion, almost 80% of the population lives in HDB apartments. How many % of the HDB group goes to universities which exclude long-distance studies? Did the MOE provide such figures? Unfortunately, I don't know.
Education is a priority for Asian families. The children from disadvantaged homes cannot afford the expensive early, pre-primary education and so, will be always at a disadvantage. But is it necessary that 80% of the students go to universities when there are not sufficient places and ability?
Reference Straits Times Mar 8, 2010 frontpage
Education Minister Ng Eng Hen said:
1. One in 10 children from one- to three-room flats goes to University. 4 in 10 goes to polytechnic.
2. 1 in 6 children from the bottom third of the socio-economic ladder scored in the top third of the PSLE (Primary School Leaving Exam) cohort. 1 in 2 scores in the top two-thirds.
3. Every primary school produces at least 10 pupils who score in the top third of the PSLE.
So, better opportunities for every child, said the minister.
What is the actual situation of the Singapore's education system? Does one's family background - rich v. poor parents affect the child's ability to stay at the top or bottom of the social ladder respectively? This means that the rich becomes richer and the poor becomes poorer in Singapore.
MINISTRY OF EDUCATION'S STATISTICS
said that students from poor homes can still move up, giving example that the top 5% of the Primary School Leaving Examination pupils are consistently distributed among the 95% of the primary schools and not just the elite ones. In addition, >90% of each cohort goes to publicly funded post-secondary institutes and almost 50% of students who live in one- to three-room HDB flats make it to universities and polytechnics.
In my opinion, almost 80% of the population lives in HDB apartments. How many % of the HDB group goes to universities which exclude long-distance studies? Did the MOE provide such figures? Unfortunately, I don't know.
Education is a priority for Asian families. The children from disadvantaged homes cannot afford the expensive early, pre-primary education and so, will be always at a disadvantage. But is it necessary that 80% of the students go to universities when there are not sufficient places and ability?
Reference Straits Times Mar 8, 2010 frontpage
Education Minister Ng Eng Hen said:
1. One in 10 children from one- to three-room flats goes to University. 4 in 10 goes to polytechnic.
2. 1 in 6 children from the bottom third of the socio-economic ladder scored in the top third of the PSLE (Primary School Leaving Exam) cohort. 1 in 2 scores in the top two-thirds.
3. Every primary school produces at least 10 pupils who score in the top third of the PSLE.
So, better opportunities for every child, said the minister.
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