In one article I read, it stated that the Y-generation is the Google generation as it searches information via googling instead of asking for advices from the seniors. . It has the following characteristics:
1. It is a generation that does not take instructions as willingly as my baby-boomer generation. When I instruct this generation to do something, it will do anything its own way and therefore I need to watch out. For example, my assistant Min. I told him how to restrain a ferocious cat in a certain way by first placing the crated cat on a table and not from the floor. By placing on a table, the human is in a better and comfortable position to handle the hissing cat. It so happened that we had two hissing cats for spay yesterday as they are stray cats. Usually, Singapore's cats are quite gentle. There is a community of cat lovers who will get stray cats sterilised and released to the wild and manage them and so Toa Payoh Vets do get some of these kind souls.
Yesterday, he would do his style and tried to get the ferocious cat (after spaying) out of the crate by bending down to the floor level where the crate was placed. He would then use a towel trying to get the cat out and risk being scratched. He tried but no way would the cat come out. He would not ask me for help or advice. Min had been bitten on both hands by a dog some months ago and had cat scratches. This is the risk of working in the small animal veterinary practice. But such risks can be dispensed with if Min knows how.
In this situation, Min had asked for the owner to take the cat out. However, the owners (a Malay mother and teenaged boy) who sent the cat for spay stood outside the Surgery as there was a big Golden Retriever in the reception room waiting to be discharged (after being clipped and de-ticked off thousands of small ticks).
The mother waved her hand at her nose indicating that the dog's tick insecticide smell was too much for her and that was why I asked her and the boy to wait outside the Surgery where the air is fresher.
After the Golden Retriever owner left, I asked the boy and later the mother to come into the Animal holding area to get the cat out. They failed to get the cat out to transfer her to their own carrier. Many minutes passed. So what should I do? Dr Vanessa came out to help after vaccinating six stray cats brought in by a lady in her 30s. This lady had specifically made an appointment to see her and I presumed this was a serious cat lady as I did not see her smiling when she came into the receptionist room.
Well, she seemed to be a cat handling expert. I asked her for help and she did. "Put some food on the floor," she said to the Malay woman. "Once the cat comes out, I will be able to catch her and put her in the carrier."
The problem was that no normal cat owner would bring the cat's favourite food with them when they come to take the cat home. Dr Vanessa came to help too as this was the cat she spayed. The dog with the bleeding nostril (now no longer bleeding) was barking till his lungs would burst and I asked Min to quieten him by being near to him and let the cat lady do her job.
No cat food. I asked Min for the cat food from the Surgery. What happened next? Well, the overweight hamster with two large tumours of over 4 cm long and 1 cm wide x 1 cm deep came to take the hamster home. This was around 5.30 pm and so I attended to him as it was I who operated the hamster. I had to advise him how to take care post-operation and to show him the tumour. "It is large," he said. "What's the cause? Is it genetic?" So, I was engaged and did not see how the cat lady take the cat out from the crate. Somewhere I heard about taking the crate up onto the table.....In any case, the cat lady succeeded where Min failed and I was grateful for her help. I will ask Min what happened later today as I was in a rush to to somewhere after spending time with the young hamster owner whose wife found me by googling "hamster tumour" or something.
I asked the husband to stop feeding the hamster too much food. "Is it the melon seeds?" I asked again.
"No," he said. "My wife gives her a lot of bread as the hamster simply loves eating bread." The dwarf hamster was 81 gram in bodyweight as I asked Min to weigh the hamster in the presence of the owner. Her belly was as rounded as a soft toy and she looked really cute. I was surprised she survived the anaesthesia and surgery. I remembered her very well as her spleen came out of the 1-mm thin abdominal wall when I removed the big tumours (likely to be mammary tumour). I had to push back the spleen and sutured the muscle defect with one 5/0 nylon suture. The suture was transparent and so it was quite difficult to see it. However, the gap was stitched up and the hamster was OK some 4 hours when the owner came. As if she had a slimming session with one of those numerous spa operators in Singapore and was active as before when the male owner came.
"No more bread. Target to reduce weight to 65 gram," I said. So I was rather busy myself while Dr Vanessa had to get the cat out of the bag, the crate, I mean. To transfer her to the carrier to go home. She did it as the Malay woman and the boy went home while I was still consulting the owner. I could see the cat lady hailing a cab and put the 4 cat crates in the taxi's boot for the short ride to a cattery. I had no time to thank her as I had to teach the hamster owner how to give antibiotics to the hamster. This hamster squeaked when handled. As I picked her up from the cage with my bare hand to demonstrate, she squeaked suddenly and instinctively I had to let go, for fear of being bitten. I got Min to give me the cotton hand glove to restrain this hamster for demonstration.
Everything ended fine with the hissing cat and the obese dwarf hamster. It was a good evening.
Tuesday, July 19, 2011
Saturday, July 16, 2011
504. Dog ticks suck plant sap?
E-MAIL TO DR SING DATED JULY 15, 2011
Dear Sir(s) and Madam(s),
We are a group of students looking for dog ticks for research purposes. The research is based on whether it is possible for dog ticks to adapt to plant sap. Hence, we kindly request for your help, and if you have any dog ticks, please contact us at zlwang916@gmail.com. If not, then kindly reply to this email at bobyu12334@yahoo.com . Any help would be greatly appreciated.
Thank you very much!
Warmest Regards,
Mr Wang Zi Liang, Zi Wei and Ace Tay
E-MAIL FROM DR SING DATED JULY 15, 2011
I am Dr Sing from Toa Payoh Vets, www.toapayohvets.com.
You can more likely to get ticks if you contact some pet groomers and be present to collect the ticks on the spot. This is because most Singapore dog owners go to the groomers for de-ticking. Or they just buy the de-ticking spot-on medication or wash and do-it-themselves. Include your phone number as I doubt anybody will e-mail to you to collect live and biting ticks for you. But there may be kind souls. Bring along your bottles.
Dog ticks have evolved to suck canine blood. I have great doubts that they will even sip one drop of plant sap but please do your research as many conventional thinking is incorrect.
Dear Sir(s) and Madam(s),
We are a group of students looking for dog ticks for research purposes. The research is based on whether it is possible for dog ticks to adapt to plant sap. Hence, we kindly request for your help, and if you have any dog ticks, please contact us at zlwang916@gmail.com. If not, then kindly reply to this email at bobyu12334@yahoo.com . Any help would be greatly appreciated.
Thank you very much!
Warmest Regards,
Mr Wang Zi Liang, Zi Wei and Ace Tay
E-MAIL FROM DR SING DATED JULY 15, 2011
I am Dr Sing from Toa Payoh Vets, www.toapayohvets.com.
You can more likely to get ticks if you contact some pet groomers and be present to collect the ticks on the spot. This is because most Singapore dog owners go to the groomers for de-ticking. Or they just buy the de-ticking spot-on medication or wash and do-it-themselves. Include your phone number as I doubt anybody will e-mail to you to collect live and biting ticks for you. But there may be kind souls. Bring along your bottles.
Dog ticks have evolved to suck canine blood. I have great doubts that they will even sip one drop of plant sap but please do your research as many conventional thinking is incorrect.
Thursday, July 14, 2011
Celebrate small successes in life - a Singapore rose
On July 13, 2011, at 1 pm, I went to lunch organised by one of my realtor classmates to celebrate our passing of the first REA (Real Estate Agency) examination conducted by the CEA (Council for Estate Agencies) and to thank our old lecturer. This class mate initiated the celebration as the rest would not be bothered to make contacts.
Yet, networking is a very important part of real estate work and in life and yet most of all are inert. It was an excellent Korean BBQ lunch at a restaurant opposite Novena Church.
"Did the prettiest girl in our class pass?" I asked my classmates.
"You can phone her," my male classmate wanted to give me her phone number.
"I better not," I said. "Her name does not seem to appear in the 41 names of persons to collect the REA certificate, in the list at Informatics. Besides, she has a Caucasian male friend. I may be bashed up! I had only spoken around 10 words to her during the whole 3 months of class."
"No, no, he is not her boyfriend," my class mate volunteered to give me her phone number and to recruit her as my salesperson.
I said to the lecturer who had told me that all ladies in the class are pretty when I enquired by e-mail whether she had passed: "You were the one who scolded her for coming to class one hour or more late."
"I did not do that," he protested. "I just said 'good morning'" He was correct. He did not really scold her or shut her out for being late at most times.
She was one of the few classmates who just sauntered into class late and interrupted his lessons. No apologies. No greeting of 'good morning to the lecturer'. In fact, all my classmates don't say that to my lecturer except for me.
All eyes had to focus on the pretty young thing as she looked for a spare seat.
Probably in her late 20s. Slim or I would say, thin. A clear fair face, bright friendly eyes that talk to you, good clothing sense, possibly high heels and a steady cat walk. She exudes confidence. A Singapore Rose. Just as Princess Diana was the English Rose.
"Who is the prettiest girl?" another male classmate asked. "Is she the one with the long hair and dresses up in designer clothes and carry designer handbags?"
"Most of the younger lady classmates have long hair," I said. It is a pity that my 40 classmates did not socialise much as we rushed back from lectures three times a week for 3 months from 10 am to 1 pm and discarded our lecture notes immediately to earn our living.
There were two lady classmates sitting opposite me and I asked them who was the prettiest girl and why. I wanted the female point of view. They gave me the same name as the one I mentioned. Why? She is young. She is good-looking.
Well, I was not the only one who spotted a pretty woman. Beauty always command attention. If beauty is combined with brains, the combination is just killing. I mentioned her as part of communications during our lunch. No ulterior motives of recruiting her as I am sure she has many offers. Of realtor jobs I mean.
It is good to celebrate small successes in life. My male classmate sitting next to me complained that the police phoned me to ask whether he had taken home the REA examination paper 1. He scolded the policeman. "The policeman is doing his job," I said. "I also got a phone call from the police and I asked the policeman why he is doing this loss of an examination paper when there are so many more important murders and cheating cases to do?"
"I know who took the paper," my lady classmate said to me.
"How do you know?" I asked.
"Well, she was sitting next to me during the examination. However, the policeman did not ask whether I know of anyone who took the paper and so I did not say."
Another classmate who was scolding the Informatics girl who would not give him any extra piece of writing paper when requested had been called up by the CEA for an interview, probably on a complaint from Informatics for swearing.
"You were the first suspect," I said. He had used the "F" word when the Informatics staff came rushing out to a group of us loitering after the end of Paper 1 examination and simply asked: "Did you take out the examination question paper 1?" So, he said: "F... you" and got to be on the top list of suspect.
"Actually two examination papers of Paper 1 were taken home," one lady classmate told me. "Informatics staff phoned everybody." The policeman phoned subsequently. However, the papers were recovered. For Paper 2 and Paper 3, no examination candidate was allowed to leave till all examination question papers were collected.
It was a time of laughter and joy for the group and the lecturer who said that the Batch 2 and 3 classes were quiet and did not ask many probing questions. My classmates were more vocal. "It is the Korean classmate," I said. "He asked too many questions about investments."
I said to the lecturer: "You did not lecture about stray cats and rats. We had a question on how he should handle a complaint of the restaurant who created smoke, had stray cats and rats. I was forced to answer this question as the other questions were harder."
"Well, you are a vet and should know," the lecturer replied.
"But what is the right answer? Just contact the AVA? The police? The NEA?"
There was another examination question which we do not know what is the right answer too. It referred to land acquisition and asked which "3 persons" are interested parties. "3 person" in quotes. Two of my male classmates at the lunch said it was the owner, landlord and somebody. My female classmate said it was government departments. I had replied: "Singapore Land Authority, HDB and National Heritage Board." Why National Heritage Board? Preservation and conservation of buildings in land being acquired.
We don't know the correct answer and I suspect our lecturer does not. We can't expect our lecturer to know everything when examination questions are so tricky. "Well, they still can pass when they write landlord, owner and tenant," my serious lady classmate who avoided this question said to me. She was sure that the "3 persons" in quotes refer to institutions rather than living souls.
It was one of those lunches full of laughter and noise for two hours and the staff must be waiting impatiently for us to get going as the place closed after lunch. It is good to celebrate little successes in life. We will have set backs in life and I hope the Singapore Rose will re-take the examination and pass.
P.S
Greeting the lecturer is good manners but this does not seem to be part of the Singaporean culture. Definitely the lecturer remembers you better when you pay respect to his position. You can't expect him to know every subject in the syllabus. You just have to do your own reading and research to pass the REA examination comfortably. There was an examination question on "Professional Etiquette" which I don't know much as it was not in the lectures. However, I had to answer this question. Maybe, "good morning" should be part of the answer.
It is best not to be rude to service staff as they are just doing their duty. Rudeness resulted in a record in the CEA files for this classmate of mine, I would think so since he was called up by the CEA.
For examiners, each examination question paper should be written with the candidate's reference number. Therefore any missing examination question paper can be traced to the candidate, my classmate who is a lecturer in China said to me. In Informatics, no candidate is allowed to leave the class till everybody has handed in their examination question papers and they are accounted for.
Yet, networking is a very important part of real estate work and in life and yet most of all are inert. It was an excellent Korean BBQ lunch at a restaurant opposite Novena Church.
"Did the prettiest girl in our class pass?" I asked my classmates.
"You can phone her," my male classmate wanted to give me her phone number.
"I better not," I said. "Her name does not seem to appear in the 41 names of persons to collect the REA certificate, in the list at Informatics. Besides, she has a Caucasian male friend. I may be bashed up! I had only spoken around 10 words to her during the whole 3 months of class."
"No, no, he is not her boyfriend," my class mate volunteered to give me her phone number and to recruit her as my salesperson.
I said to the lecturer who had told me that all ladies in the class are pretty when I enquired by e-mail whether she had passed: "You were the one who scolded her for coming to class one hour or more late."
"I did not do that," he protested. "I just said 'good morning'" He was correct. He did not really scold her or shut her out for being late at most times.
She was one of the few classmates who just sauntered into class late and interrupted his lessons. No apologies. No greeting of 'good morning to the lecturer'. In fact, all my classmates don't say that to my lecturer except for me.
All eyes had to focus on the pretty young thing as she looked for a spare seat.
Probably in her late 20s. Slim or I would say, thin. A clear fair face, bright friendly eyes that talk to you, good clothing sense, possibly high heels and a steady cat walk. She exudes confidence. A Singapore Rose. Just as Princess Diana was the English Rose.
"Who is the prettiest girl?" another male classmate asked. "Is she the one with the long hair and dresses up in designer clothes and carry designer handbags?"
"Most of the younger lady classmates have long hair," I said. It is a pity that my 40 classmates did not socialise much as we rushed back from lectures three times a week for 3 months from 10 am to 1 pm and discarded our lecture notes immediately to earn our living.
There were two lady classmates sitting opposite me and I asked them who was the prettiest girl and why. I wanted the female point of view. They gave me the same name as the one I mentioned. Why? She is young. She is good-looking.
Well, I was not the only one who spotted a pretty woman. Beauty always command attention. If beauty is combined with brains, the combination is just killing. I mentioned her as part of communications during our lunch. No ulterior motives of recruiting her as I am sure she has many offers. Of realtor jobs I mean.
It is good to celebrate small successes in life. My male classmate sitting next to me complained that the police phoned me to ask whether he had taken home the REA examination paper 1. He scolded the policeman. "The policeman is doing his job," I said. "I also got a phone call from the police and I asked the policeman why he is doing this loss of an examination paper when there are so many more important murders and cheating cases to do?"
"I know who took the paper," my lady classmate said to me.
"How do you know?" I asked.
"Well, she was sitting next to me during the examination. However, the policeman did not ask whether I know of anyone who took the paper and so I did not say."
Another classmate who was scolding the Informatics girl who would not give him any extra piece of writing paper when requested had been called up by the CEA for an interview, probably on a complaint from Informatics for swearing.
"You were the first suspect," I said. He had used the "F" word when the Informatics staff came rushing out to a group of us loitering after the end of Paper 1 examination and simply asked: "Did you take out the examination question paper 1?" So, he said: "F... you" and got to be on the top list of suspect.
"Actually two examination papers of Paper 1 were taken home," one lady classmate told me. "Informatics staff phoned everybody." The policeman phoned subsequently. However, the papers were recovered. For Paper 2 and Paper 3, no examination candidate was allowed to leave till all examination question papers were collected.
It was a time of laughter and joy for the group and the lecturer who said that the Batch 2 and 3 classes were quiet and did not ask many probing questions. My classmates were more vocal. "It is the Korean classmate," I said. "He asked too many questions about investments."
I said to the lecturer: "You did not lecture about stray cats and rats. We had a question on how he should handle a complaint of the restaurant who created smoke, had stray cats and rats. I was forced to answer this question as the other questions were harder."
"Well, you are a vet and should know," the lecturer replied.
"But what is the right answer? Just contact the AVA? The police? The NEA?"
There was another examination question which we do not know what is the right answer too. It referred to land acquisition and asked which "3 persons" are interested parties. "3 person" in quotes. Two of my male classmates at the lunch said it was the owner, landlord and somebody. My female classmate said it was government departments. I had replied: "Singapore Land Authority, HDB and National Heritage Board." Why National Heritage Board? Preservation and conservation of buildings in land being acquired.
We don't know the correct answer and I suspect our lecturer does not. We can't expect our lecturer to know everything when examination questions are so tricky. "Well, they still can pass when they write landlord, owner and tenant," my serious lady classmate who avoided this question said to me. She was sure that the "3 persons" in quotes refer to institutions rather than living souls.
It was one of those lunches full of laughter and noise for two hours and the staff must be waiting impatiently for us to get going as the place closed after lunch. It is good to celebrate little successes in life. We will have set backs in life and I hope the Singapore Rose will re-take the examination and pass.
P.S
Greeting the lecturer is good manners but this does not seem to be part of the Singaporean culture. Definitely the lecturer remembers you better when you pay respect to his position. You can't expect him to know every subject in the syllabus. You just have to do your own reading and research to pass the REA examination comfortably. There was an examination question on "Professional Etiquette" which I don't know much as it was not in the lectures. However, I had to answer this question. Maybe, "good morning" should be part of the answer.
It is best not to be rude to service staff as they are just doing their duty. Rudeness resulted in a record in the CEA files for this classmate of mine, I would think so since he was called up by the CEA.
For examiners, each examination question paper should be written with the candidate's reference number. Therefore any missing examination question paper can be traced to the candidate, my classmate who is a lecturer in China said to me. In Informatics, no candidate is allowed to leave the class till everybody has handed in their examination question papers and they are accounted for.
502. Perineal hernia in a Boston Terrier one year ago
The Boston Terrier was operated one year ago. I review this case which was operated successfully (no anaesthetic deaths or complaint of recurrence) before I operate on the "mother of all perineal hernias" of the Silkie Terrier (described below) who is 10 years old and in a more risky anaesthetic position.
The pictures and more details of this record are at:
http://www.bekindtopets.com/animals/20100625constipation_perineal_hernia_old_Boston_Terrier_male_singapore_ToaPayohVets.htm
CASE 1
This Boston Terrier case was written: 25 June, 2010
Boston Terrier, Male, Not neutered, 7 years, 12.4kg
Big swellings besides the anus, the left swelling being bigger.
Difficulty in pooping for past 3 weeks.
A knowledgeable young man who has his own views of dog care.
He presented a Boston Terrier with constipation for the past 3 weeks. He went to Vet 1 who referred him to another vet after taking a blood test as she did not want to perform the surgery. She had given him a laxative for the dog and the dog had passed loose stools instead of hard ones.
"Why don't you see the referred vet?" I asked.
"The Surgery has a bad reputation," the young man had googled the name of the practice he was referred to by Vet 1. "There is a very bad complaint about the vets from one dog owner. So I better not go there."
"All veterinary practices will have one or two nasty complaints about service," I educated this young man. "The busier the practice, the higher the chances of getting complaints. This is because the vet has no time to handle each case as thoroughly as he or she would love to. This applies to over-worked doctors in human medicine too especially in the emergency wards."
VACCINATION HISTORY MUST BE ASKED
"Has your dog been vaccinated?" I asked.
"No vaccination for the past few years. Do you have parvovirus in your Surgery?" the young man asked me.
"Fortunately for your dog, my practice does not have parvo-viral cases for many months as I seldom provide service to the dog breeders nowadays. You have taken a big risk exposing your dog the risk of parvoviral and canine distemper infections."
PRE-OP BLOOD TEST IMPORTANT FOR OLD DOGS BEFORE SURGERY
I checked Vet 1's blood test results. It is wise not to trust the blood results of other practices based on one of my experiences (see one case I had written). However, he had paid $130 for the test and I would not insist as that would increase his vet bills. Overall, the dog was examined and was healthy. So I took the chance.
ANAESTHESIA
IV saline given. Then I gave Atropine 0.4 ml IV followed by Domitor 0.2 ml IV
Waited 10 minutes. Isoflurane gas mask. Dog struggled. So, I gave Zoletil 100 @ 0.1 ml IV. This sedated the dog who was masked and given isoflurane gas at 5%. The dog slept and was intubated. Isoflurane at 1-2% maintenance was done by my experienced assistant, Mr Saw. I asked him to increase the dose when the pelvic fat kept coming out from the hernia after pushing the fat into the abdominal cavity. The dog recovered smoothly.
SURGERY
I gave him antibiotics to take and schedule perineal hernia surgery 2 days later. The surgery took nearly an hour as the hernia was large. The hernia bulge with pelvic fat is large, around 4 cm x 6 cm. An electro-incision made a big cut to the left of the anus.
It was difficult to identify the medial coccygeal and levator ani muscles in this case as there is a lot of inflammation. The internal pudendal artery and vein and the pudendal nerve on the dorsal surface of the internal obturator muscle looked compressed as I showed to my assistant Mr Saw who nodded his head. Judging from his eyes, he did not believe they were what I said.
Is there a right perineal hernia too?
Electro-incision. Big amount of pelvic fat. A retractor enabled me to have a good field of view to stitch up the defect
See the big hole through which part of the colon and pelvic fat herniated through causing a big backside swelling
Left perineal hernia repaired. Neutering in 3-4 weeks if the owner wants to do it. The right perineal hernia may need to be repaired later.
The internal obturator muscle is on the ventral aspect of the pelvic diaphragm. This was a big fatty mass horizontally covering the muscle, unlike the no-fat muscles illustrated in Small Animal Surgery, T.W. Fossum 1997, pg 354.
I used a retractor to spread open up the operating area and to see the pudendal vessels and nerve just above the obturator muscles in this case. Do not stitch these vessels or nerves.
POST-OP
Dog woke up fast. Given tolfedine painkillers.
TWO HERNIAS TO BE OPERATED AT ONE GO
I doubt that it is possible to do two hernias at one go as the muscle stitching on one side (i.e. left hernia in this case) pulled the left anal area tightly to cover the herniated hole. Therefore doing two hernia repair at the same time just is not in the interest of the dog as he will feel very uncomfortable and painful.
LOOSE STOOLS leaking out from the anus. This must be plugged. The dog had been given an oil laxative by Vet 1 for 3 days and the loose stools start to come out despite atropine injection.
CONCLUSION
The dog was OK and was warded for at least 4 days as the owner did not have a crate to prevent the dog running loose. I checked the dog every day to ensure that he had proper nursing care and pain-killers. The boy's parents came to visit the dog yesterday. The dog should be back home after 7 days. He had managed to rub his backside onto the floor of the crate despite tolfedine 60 mg at half a tablet per day for 3 days. I decided to give him 1/4 dose of a 30mg phenobarb and then Rimadryl for another 3 days to prevent pain and inflammation.
P.S
1. Yearly vaccination is important. Fortunately this dog did not get infected with parvoviral disease in the practice of Vet 1 which is a very busy practice and in my surgery. Otherwise, I end up with a dog passing blood in the stools and dying later. At the time of writing this report, it is still early at Day 5 after visiting Vet 1. Parvoviral signs come in around 10-14 days after infection.
2. "Neutering the dog when he was younger would have decreased the chances of him getting perineal hernia," I said. "Perineal hernia is more common in non-neutered dogs." The young man said: "It is cruel and that is why I don't do it." He has been advised to neuter the dog around 2-4 weeks later. As for the right perineal hernia, it is a smaller one. Wait and see. If the dog is neutered and there is
no more swelling in the backside, then there is no need to do a right perineal hernia repair.
3. High anaesthetic risks. I don't enjoy doing high anaesthetic risk surgeries as they are very stressful for me. If the dog survives, everybody is pleased. There will be deaths and the owners may be very emotional and angry. Some may post a nasty complaint in the internet. To minimise risks of deaths of old dogs on the operating table, I don't force myself to perform hernia repair and neutering at the same time. The owner has to appreciate that I don't take risks unnecessary.
UPDATE AS AT JULY 11, 2011
No news from the owner since the surgery in Jun 2010. I presume all are OK as now news is good news.
CASE 2
ANOTHER MORE CHALLENGING CASE ONE YEAR LATER
THE MALE DOG HAD A VERY LARGE BACKSIDE SWELLING - PART 1
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case: Updated: 14 July, 2011
This Silkie Terrier case was written: 24 June 2011
Silkie Terrier, Male, Not neutered, 1- years, 6.5kg
Big swellings besides the anus, the left swelling being bigger.
Difficulty in pooping for past 3 weeks.
I have not seen perineal hernias since I operated on the above-mentioned Boston Terrier one year ago. Surprisingly, on Sunday, July 10, 2011, my assistant Mr Min said that a couple insisted on seeing me. Normally, all cases go to Dr Vanessa Lin but I was around at the reception to get a pulse of the grass-roots from 9 am to 6 pm and to ensure that the waiting times are kept to the minimum. Only at the receptionist's counter can I know what is the situation of the waiting time like, rather than depend on the receptionist to enlighten me.
The couple said to me: "My vet said that no vets in Singapore would operate on my 10-year-old Silkie Terrier. He had said that the dog is old and to leave the swelling alone. But it kept growing bigger!"
He was not neutered and had a backside lump 3/4 the size of the biggest mango you can see in Singapore. The dog had difficulty in pooping and the older parents were concerned about his quality of life. The dog could eat, drink, poop and pee without difficulty and was active.
"There will be vets in Singapore that will operate on this dog," I said when the couple brought the dog in later for examination. "The main issue is that the operation will take a long time and the dog may just die on the operating table. No vets want to do a dog that dies on the operating table."
I had asked them to illustrate as they did not bring the dog down at first. A male dog, not neutered, big swelling from below the anus (in this case) instead of to the sides of the anus as in unilateral perineal hernias. The couple had actually diagnosed perineal hernias via the internet education and so they knew what was wrong with their dog. The problem was that their vet did not want to operate and put his reputation on the line when the dog dies on the operating table. What should I do?
This was the "mother" of all perineal hernias. Both left and right perineal hernias have "amalgamated" to form a large 3/4-Taiwanese mango-sized lump to the right, left and below the anus. Taiwanese mangoes are gigantic but are not sweet and they measure around 25 cm x 10 cm x 7 cm. So, you can imagine that the swelling was really gigantic.
The surgery will take over 1.5 hours and the old dog's heart may just stop beating. The dog needs to be operated as he has had been licking his skin thin. Continuous licking to relieve his pain and irritation as the intestines and omental fat prolapse through the pelvic muscular defect from both the left and right side. It was hard for him just to sit down too.
http://www.kongyuensing.com/pic/20110713perineal-hernias-bilateral-silkie-terrier-male-10-years-toapayohvets-singapore.jpg
"Do your parents know that they may not see the dog alive once he gets operated?" I asked. The aged parents are the care-givers. The couple said: "My parents say it is better to take the risk rather than let the dog suffer with such a big dangling mass. The groomer had nicked the lump earlier and discovered this hernia. Otherwise, we would not know it exists!"
The dog was in good body condition. I checked his heart. His heart was surprisingly normal. He was alive and active now. As if he has not a worry in this world while his caregivers bear the burden and surgical risks on their shoulders. Should I pass the buck? And to whom? To my two associate vets? This is the type of challenging cases that I prefer not to take on and it will be most unkind to pass the buck to my two associate vets as there is the possibility of post-surgical complications like infections, bleeding and nerve damages in addition to death on the operating table. So, I did not refer the case to them. It is a moderately difficult surgery but it will take a long time to do. The longer the time of anaesthesia and surgery, the likely that the old dog's heart will just stop and the dog dies on the operating table!
If the surgery can be completed in 15 minutes, the old dog is very likely to survive the anaesthesia. Unfortunately, this surgery will take a long time as both hernias seem to be required to be operated on at the same time since the intestines and omental fat have leaked and spread to each other's sides! That is why I say that this case is the "mother" of all perineal hernias.
The dog was operated on July 13, 2011. The whole process started from 9 am and ended at 12 noon. The surgery itself started from 9.30 am to 12 noon. It was the type of surgery that most vets would prefer not to be challenged to do as there were 3 hernias. The main one was the left perineal hernia with defect from above the anal area to the ventral most part of the backside. This would be at least 6 inches long, 3 inches wide and 5 inches deep. (1 inch = 2.5 cm). The right perineal hernia was two smaller holes separated by a band of muscle.
In the left perineal hernia, the bladder and large intestines had prolapsed. Over time, the intestines have had shifted from the left half of the backside to the right half. The dog licked the swollen area (mango-sized) over the months and the skin had become very thin and about to rupture. You can see the intestinal coils more prominent on the right side. So, I thought this was a right perineal hernia. Actually, it was a left!
Details of the surgery and anaesthesia done on June 13, 2011 will be recorded in Part 2 at:
www.sinpets.com/F5/20110714perineal_hernia_old_Silkie_Terrier_male
_dysuria_painful_backside_singapore_ToaPayohVets.htm
The pictures and more details of this record are at:
http://www.bekindtopets.com/animals/20100625constipation_perineal_hernia_old_Boston_Terrier_male_singapore_ToaPayohVets.htm
CASE 1
This Boston Terrier case was written: 25 June, 2010
Boston Terrier, Male, Not neutered, 7 years, 12.4kg
Big swellings besides the anus, the left swelling being bigger.
Difficulty in pooping for past 3 weeks.
A knowledgeable young man who has his own views of dog care.
He presented a Boston Terrier with constipation for the past 3 weeks. He went to Vet 1 who referred him to another vet after taking a blood test as she did not want to perform the surgery. She had given him a laxative for the dog and the dog had passed loose stools instead of hard ones.
"Why don't you see the referred vet?" I asked.
"The Surgery has a bad reputation," the young man had googled the name of the practice he was referred to by Vet 1. "There is a very bad complaint about the vets from one dog owner. So I better not go there."
"All veterinary practices will have one or two nasty complaints about service," I educated this young man. "The busier the practice, the higher the chances of getting complaints. This is because the vet has no time to handle each case as thoroughly as he or she would love to. This applies to over-worked doctors in human medicine too especially in the emergency wards."
VACCINATION HISTORY MUST BE ASKED
"Has your dog been vaccinated?" I asked.
"No vaccination for the past few years. Do you have parvovirus in your Surgery?" the young man asked me.
"Fortunately for your dog, my practice does not have parvo-viral cases for many months as I seldom provide service to the dog breeders nowadays. You have taken a big risk exposing your dog the risk of parvoviral and canine distemper infections."
PRE-OP BLOOD TEST IMPORTANT FOR OLD DOGS BEFORE SURGERY
I checked Vet 1's blood test results. It is wise not to trust the blood results of other practices based on one of my experiences (see one case I had written). However, he had paid $130 for the test and I would not insist as that would increase his vet bills. Overall, the dog was examined and was healthy. So I took the chance.
ANAESTHESIA
IV saline given. Then I gave Atropine 0.4 ml IV followed by Domitor 0.2 ml IV
Waited 10 minutes. Isoflurane gas mask. Dog struggled. So, I gave Zoletil 100 @ 0.1 ml IV. This sedated the dog who was masked and given isoflurane gas at 5%. The dog slept and was intubated. Isoflurane at 1-2% maintenance was done by my experienced assistant, Mr Saw. I asked him to increase the dose when the pelvic fat kept coming out from the hernia after pushing the fat into the abdominal cavity. The dog recovered smoothly.
SURGERY
I gave him antibiotics to take and schedule perineal hernia surgery 2 days later. The surgery took nearly an hour as the hernia was large. The hernia bulge with pelvic fat is large, around 4 cm x 6 cm. An electro-incision made a big cut to the left of the anus.
It was difficult to identify the medial coccygeal and levator ani muscles in this case as there is a lot of inflammation. The internal pudendal artery and vein and the pudendal nerve on the dorsal surface of the internal obturator muscle looked compressed as I showed to my assistant Mr Saw who nodded his head. Judging from his eyes, he did not believe they were what I said.
Is there a right perineal hernia too?
Electro-incision. Big amount of pelvic fat. A retractor enabled me to have a good field of view to stitch up the defect
See the big hole through which part of the colon and pelvic fat herniated through causing a big backside swelling
Left perineal hernia repaired. Neutering in 3-4 weeks if the owner wants to do it. The right perineal hernia may need to be repaired later.
The internal obturator muscle is on the ventral aspect of the pelvic diaphragm. This was a big fatty mass horizontally covering the muscle, unlike the no-fat muscles illustrated in Small Animal Surgery, T.W. Fossum 1997, pg 354.
I used a retractor to spread open up the operating area and to see the pudendal vessels and nerve just above the obturator muscles in this case. Do not stitch these vessels or nerves.
POST-OP
Dog woke up fast. Given tolfedine painkillers.
TWO HERNIAS TO BE OPERATED AT ONE GO
I doubt that it is possible to do two hernias at one go as the muscle stitching on one side (i.e. left hernia in this case) pulled the left anal area tightly to cover the herniated hole. Therefore doing two hernia repair at the same time just is not in the interest of the dog as he will feel very uncomfortable and painful.
LOOSE STOOLS leaking out from the anus. This must be plugged. The dog had been given an oil laxative by Vet 1 for 3 days and the loose stools start to come out despite atropine injection.
CONCLUSION
The dog was OK and was warded for at least 4 days as the owner did not have a crate to prevent the dog running loose. I checked the dog every day to ensure that he had proper nursing care and pain-killers. The boy's parents came to visit the dog yesterday. The dog should be back home after 7 days. He had managed to rub his backside onto the floor of the crate despite tolfedine 60 mg at half a tablet per day for 3 days. I decided to give him 1/4 dose of a 30mg phenobarb and then Rimadryl for another 3 days to prevent pain and inflammation.
P.S
1. Yearly vaccination is important. Fortunately this dog did not get infected with parvoviral disease in the practice of Vet 1 which is a very busy practice and in my surgery. Otherwise, I end up with a dog passing blood in the stools and dying later. At the time of writing this report, it is still early at Day 5 after visiting Vet 1. Parvoviral signs come in around 10-14 days after infection.
2. "Neutering the dog when he was younger would have decreased the chances of him getting perineal hernia," I said. "Perineal hernia is more common in non-neutered dogs." The young man said: "It is cruel and that is why I don't do it." He has been advised to neuter the dog around 2-4 weeks later. As for the right perineal hernia, it is a smaller one. Wait and see. If the dog is neutered and there is
no more swelling in the backside, then there is no need to do a right perineal hernia repair.
3. High anaesthetic risks. I don't enjoy doing high anaesthetic risk surgeries as they are very stressful for me. If the dog survives, everybody is pleased. There will be deaths and the owners may be very emotional and angry. Some may post a nasty complaint in the internet. To minimise risks of deaths of old dogs on the operating table, I don't force myself to perform hernia repair and neutering at the same time. The owner has to appreciate that I don't take risks unnecessary.
UPDATE AS AT JULY 11, 2011
No news from the owner since the surgery in Jun 2010. I presume all are OK as now news is good news.
CASE 2
ANOTHER MORE CHALLENGING CASE ONE YEAR LATER
THE MALE DOG HAD A VERY LARGE BACKSIDE SWELLING - PART 1
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case: Updated: 14 July, 2011
This Silkie Terrier case was written: 24 June 2011
Silkie Terrier, Male, Not neutered, 1- years, 6.5kg
Big swellings besides the anus, the left swelling being bigger.
Difficulty in pooping for past 3 weeks.
I have not seen perineal hernias since I operated on the above-mentioned Boston Terrier one year ago. Surprisingly, on Sunday, July 10, 2011, my assistant Mr Min said that a couple insisted on seeing me. Normally, all cases go to Dr Vanessa Lin but I was around at the reception to get a pulse of the grass-roots from 9 am to 6 pm and to ensure that the waiting times are kept to the minimum. Only at the receptionist's counter can I know what is the situation of the waiting time like, rather than depend on the receptionist to enlighten me.
The couple said to me: "My vet said that no vets in Singapore would operate on my 10-year-old Silkie Terrier. He had said that the dog is old and to leave the swelling alone. But it kept growing bigger!"
He was not neutered and had a backside lump 3/4 the size of the biggest mango you can see in Singapore. The dog had difficulty in pooping and the older parents were concerned about his quality of life. The dog could eat, drink, poop and pee without difficulty and was active.
"There will be vets in Singapore that will operate on this dog," I said when the couple brought the dog in later for examination. "The main issue is that the operation will take a long time and the dog may just die on the operating table. No vets want to do a dog that dies on the operating table."
I had asked them to illustrate as they did not bring the dog down at first. A male dog, not neutered, big swelling from below the anus (in this case) instead of to the sides of the anus as in unilateral perineal hernias. The couple had actually diagnosed perineal hernias via the internet education and so they knew what was wrong with their dog. The problem was that their vet did not want to operate and put his reputation on the line when the dog dies on the operating table. What should I do?
This was the "mother" of all perineal hernias. Both left and right perineal hernias have "amalgamated" to form a large 3/4-Taiwanese mango-sized lump to the right, left and below the anus. Taiwanese mangoes are gigantic but are not sweet and they measure around 25 cm x 10 cm x 7 cm. So, you can imagine that the swelling was really gigantic.
The surgery will take over 1.5 hours and the old dog's heart may just stop beating. The dog needs to be operated as he has had been licking his skin thin. Continuous licking to relieve his pain and irritation as the intestines and omental fat prolapse through the pelvic muscular defect from both the left and right side. It was hard for him just to sit down too.
http://www.kongyuensing.com/pic/20110713perineal-hernias-bilateral-silkie-terrier-male-10-years-toapayohvets-singapore.jpg
"Do your parents know that they may not see the dog alive once he gets operated?" I asked. The aged parents are the care-givers. The couple said: "My parents say it is better to take the risk rather than let the dog suffer with such a big dangling mass. The groomer had nicked the lump earlier and discovered this hernia. Otherwise, we would not know it exists!"
The dog was in good body condition. I checked his heart. His heart was surprisingly normal. He was alive and active now. As if he has not a worry in this world while his caregivers bear the burden and surgical risks on their shoulders. Should I pass the buck? And to whom? To my two associate vets? This is the type of challenging cases that I prefer not to take on and it will be most unkind to pass the buck to my two associate vets as there is the possibility of post-surgical complications like infections, bleeding and nerve damages in addition to death on the operating table. So, I did not refer the case to them. It is a moderately difficult surgery but it will take a long time to do. The longer the time of anaesthesia and surgery, the likely that the old dog's heart will just stop and the dog dies on the operating table!
If the surgery can be completed in 15 minutes, the old dog is very likely to survive the anaesthesia. Unfortunately, this surgery will take a long time as both hernias seem to be required to be operated on at the same time since the intestines and omental fat have leaked and spread to each other's sides! That is why I say that this case is the "mother" of all perineal hernias.
The dog was operated on July 13, 2011. The whole process started from 9 am and ended at 12 noon. The surgery itself started from 9.30 am to 12 noon. It was the type of surgery that most vets would prefer not to be challenged to do as there were 3 hernias. The main one was the left perineal hernia with defect from above the anal area to the ventral most part of the backside. This would be at least 6 inches long, 3 inches wide and 5 inches deep. (1 inch = 2.5 cm). The right perineal hernia was two smaller holes separated by a band of muscle.
In the left perineal hernia, the bladder and large intestines had prolapsed. Over time, the intestines have had shifted from the left half of the backside to the right half. The dog licked the swollen area (mango-sized) over the months and the skin had become very thin and about to rupture. You can see the intestinal coils more prominent on the right side. So, I thought this was a right perineal hernia. Actually, it was a left!
Details of the surgery and anaesthesia done on June 13, 2011 will be recorded in Part 2 at:
www.sinpets.com/F5/20110714perineal_hernia_old_Silkie_Terrier_male
_dysuria_painful_backside_singapore_ToaPayohVets.htm
Wednesday, July 13, 2011
501. The mother of all perineal hernias
Yesterday, Tuesday, July 12, 2011, at 7 pm, I reviewed the Silkie with the bilateral perineal hernia. He had passed stools and the owners were there and had fed chicken. "It is OK to feed till 10 pm," I said and took away the water bowl. "I will be operating on him tomorrow at 10 am."
"He passed blood in his soft stools," the lady said.
"Could it be the colour of the reddish sticks (treats) you feed him?" I asked.
"No," she said. "He did not have this stool colour previously."
So, the dog may be having colitis due to the accumulation of stools in his rectum as you can see from the palm-sized hernia. Will post photo later. This means that there cannot be a delay in surgical repair of the mother of perineal hernia. I will start at 9.30 am today. It is 4.37 am now. Will review the photos back, side and front for the best approach as this surgery is much more challenging than a simple small perineal hernia.
"You will see a messy big hole with ill-defined muscles," I said to Dr Vanessa earlier. I thought of asking her to perform the surgery. I said to her: "It will be very difficult to stitch up the muscles as they don't exist normally due to atrophy and pressure over many months from the hernia. On the lower 1/3, the pudendal nerve and blood vessels are supposed to be located. If the vet stitches up the pudendal nerve while closing up the big hole, I don't know whether the dog will be paralsyed or not!" This is what I fear most. The nerve just can't be seen now since the muscle anatomy is no longer normal.
So, it is not just an old dog with high anaesthetic risk. It has also surgical risk as the defect is more than 6 inches long, 3 inches deep and 3 inches wide. (One inch = 2.5 cm). I really prefer not to perform such a surgery. If a vet picks and choose, then the mother of all perineal hernias will not be chosen. And the poor dog will suffer from soft stools to bloody diarrhoea, dehydration and death from intestinal strangulation.
So, there is no time to spare. I need to operate today Wednesday 9.30 am as scheduled.
"He passed blood in his soft stools," the lady said.
"Could it be the colour of the reddish sticks (treats) you feed him?" I asked.
"No," she said. "He did not have this stool colour previously."
So, the dog may be having colitis due to the accumulation of stools in his rectum as you can see from the palm-sized hernia. Will post photo later. This means that there cannot be a delay in surgical repair of the mother of perineal hernia. I will start at 9.30 am today. It is 4.37 am now. Will review the photos back, side and front for the best approach as this surgery is much more challenging than a simple small perineal hernia.
"You will see a messy big hole with ill-defined muscles," I said to Dr Vanessa earlier. I thought of asking her to perform the surgery. I said to her: "It will be very difficult to stitch up the muscles as they don't exist normally due to atrophy and pressure over many months from the hernia. On the lower 1/3, the pudendal nerve and blood vessels are supposed to be located. If the vet stitches up the pudendal nerve while closing up the big hole, I don't know whether the dog will be paralsyed or not!" This is what I fear most. The nerve just can't be seen now since the muscle anatomy is no longer normal.
So, it is not just an old dog with high anaesthetic risk. It has also surgical risk as the defect is more than 6 inches long, 3 inches deep and 3 inches wide. (One inch = 2.5 cm). I really prefer not to perform such a surgery. If a vet picks and choose, then the mother of all perineal hernias will not be chosen. And the poor dog will suffer from soft stools to bloody diarrhoea, dehydration and death from intestinal strangulation.
So, there is no time to spare. I need to operate today Wednesday 9.30 am as scheduled.
500. Changing a vet's mindset on 2 injections for cat anaesthesia to 1 injection
I visited a vet whom I saw growing up as a little boy some 35 years ago. "His head was up to the level of the operating table," I said to the mother. His mother said: "His daughter's head is now up to that level!" How ancient I must be.
The vet uses xylazine IM, wait and then Zoletil IV (rubber band) in elbow cut off before injecting the Zoletil. This means two syringes and needles are needed and two injection sites. And a longer waiting time prior to surgery.
The vets find this method very safe and efficacious and so have no interest in my recommendation of xylazine + ketamine IM in one syringe. I find this much more efficient. Why change when nothing is broken?
I said: "I used to use xylazine IM and then give the cat isoflurane gas by mask previously." It was an excellent method but now I use xylazine + ketamine IM which is excellent and time-saving. Top up with isoflurane if my dosage is lower or there is some delay.
"Using isoflurane gas by mask onto the cat will also anaesthesize the vet," the mother laughed.
"Yes, yes," I said. "I fall asleep during surgery!" This is meant to be a joke. Sometimes vets must have a sense of humour too.
The two vets were not interested in my advice to save some money and be more productive. But their method of anaesthesia had worked well for so many stray cats and therefore, why take the risk? I can understand that.
It was great for me to meet them and exchange ideas on veterinary treatment of cases.
The vet uses xylazine IM, wait and then Zoletil IV (rubber band) in elbow cut off before injecting the Zoletil. This means two syringes and needles are needed and two injection sites. And a longer waiting time prior to surgery.
The vets find this method very safe and efficacious and so have no interest in my recommendation of xylazine + ketamine IM in one syringe. I find this much more efficient. Why change when nothing is broken?
I said: "I used to use xylazine IM and then give the cat isoflurane gas by mask previously." It was an excellent method but now I use xylazine + ketamine IM which is excellent and time-saving. Top up with isoflurane if my dosage is lower or there is some delay.
"Using isoflurane gas by mask onto the cat will also anaesthesize the vet," the mother laughed.
"Yes, yes," I said. "I fall asleep during surgery!" This is meant to be a joke. Sometimes vets must have a sense of humour too.
The two vets were not interested in my advice to save some money and be more productive. But their method of anaesthesia had worked well for so many stray cats and therefore, why take the risk? I can understand that.
It was great for me to meet them and exchange ideas on veterinary treatment of cases.
499. Neutering an adult Syrian hamster - information
E-MAIL TO DR SING DATED JULY 11, 2011
Hi Judy,
I saw a story about yr clinic on the web about hamster neutering.
How much do you charge for such an operation?
Pls kindly let me know. Thanks,
E-MAIL FROM DR SING DATED JULY 11, 2011
Around $75 for male hamsters neuter and anaesthesia. Add $30 for post-op antibiotics and medication
E-MAIL TO DR SING DATED JULY 11, 2011
Oh, ok. Mine is an adult Syrian male hamster of about 7-8 months.
I am hoping to sterilise it so it can keep the female company. Does that work?
E-MAIL FROM DR SING DATED JULY 13, 2011
Adult Syrian Male Hamster can be neutered. Pl note that there may or may not be surgical complications post-op in neutering adult hamsters as the surgical wound will be much longer than a 3-month-old dwarf hamster.
In the dwarf hamster, the wound is around 4 mm long. In your Syrian hamster, it will be around 8mm - 12 mm long depending on the size of the testicle. It is possible that the Syrian hamster may bite off the stitches and cause infections and distress to you as it is not possible for hamsters to wear e-collars around his neck unlike dogs and cats.
Anaesthetic risks for your young Syrian hamsters are low in my opinion. After neutering, your hamster needs 2 weeks to recover from the wound.
Then you will need to slowly re-introduce the hamster to the female by housing them separated by a grate for a 2-8 weeks so that they can see and smell each other but not bite. You need to be monitoring the reactions for the first 2-4 weeks. Give a bigger cage than the usual one.
The neuter cost of anaesthesia, surgery and antibiotics for an adult Syrian hamster is around $150.
Best wishes.
Hi Judy,
I saw a story about yr clinic on the web about hamster neutering.
How much do you charge for such an operation?
Pls kindly let me know. Thanks,
E-MAIL FROM DR SING DATED JULY 11, 2011
Around $75 for male hamsters neuter and anaesthesia. Add $30 for post-op antibiotics and medication
E-MAIL TO DR SING DATED JULY 11, 2011
Oh, ok. Mine is an adult Syrian male hamster of about 7-8 months.
I am hoping to sterilise it so it can keep the female company. Does that work?
E-MAIL FROM DR SING DATED JULY 13, 2011
Adult Syrian Male Hamster can be neutered. Pl note that there may or may not be surgical complications post-op in neutering adult hamsters as the surgical wound will be much longer than a 3-month-old dwarf hamster.
In the dwarf hamster, the wound is around 4 mm long. In your Syrian hamster, it will be around 8mm - 12 mm long depending on the size of the testicle. It is possible that the Syrian hamster may bite off the stitches and cause infections and distress to you as it is not possible for hamsters to wear e-collars around his neck unlike dogs and cats.
Anaesthetic risks for your young Syrian hamsters are low in my opinion. After neutering, your hamster needs 2 weeks to recover from the wound.
Then you will need to slowly re-introduce the hamster to the female by housing them separated by a grate for a 2-8 weeks so that they can see and smell each other but not bite. You need to be monitoring the reactions for the first 2-4 weeks. Give a bigger cage than the usual one.
The neuter cost of anaesthesia, surgery and antibiotics for an adult Syrian hamster is around $150.
Best wishes.
498. Neutering a Yorkshire Terrier at Toa Payoh Vets
E-MAIL TO DR SING DATED JUL 12, 2011
On Tue, Jul 12, 2011 at 6:39 PM,...@bigfishes.com> wrote:
Dear Judy,
I have a one year old Yorkie that we want to neuter.
Please advise how much will the procedure be and when is the earliest time that we can bring him down.
You can reach me at ... if you need any further info.
Thank you.
Best regards,
Name of owner
E-MAIL REPLY BY DR SING
Hi
Thank you for your email I am Dr Sing from toapayohvets.com
The cost of anaesthesia, surgery and post-op pain-killer and antibiotic injection is estimated to be around $150-$200 for dog breeds less than 5 kg and without surgical complications and have two descended testicles. You have a choice of 3 vets, namely myself, Dr Vanessa Lin and Dr Jason Teo.
If you want me to neuter him, please bring him down at 9.30 am from Monday to Friday. No food and water after 10 pm the evening before surgery. Phone 6254-3326 for appointment. The dog will be operated at 10 am and goes home around 12 noon or later in the day if you are not free. The dog should preferably be vaccinated within one year and in good health. Bathe the dog first and clean up his lower area.
Best wishes.
On Tue, Jul 12, 2011 at 6:39 PM,...@bigfishes.com> wrote:
Dear Judy,
I have a one year old Yorkie that we want to neuter.
Please advise how much will the procedure be and when is the earliest time that we can bring him down.
You can reach me at ... if you need any further info.
Thank you.
Best regards,
Name of owner
E-MAIL REPLY BY DR SING
Hi
Thank you for your email I am Dr Sing from toapayohvets.com
The cost of anaesthesia, surgery and post-op pain-killer and antibiotic injection is estimated to be around $150-$200 for dog breeds less than 5 kg and without surgical complications and have two descended testicles. You have a choice of 3 vets, namely myself, Dr Vanessa Lin and Dr Jason Teo.
If you want me to neuter him, please bring him down at 9.30 am from Monday to Friday. No food and water after 10 pm the evening before surgery. Phone 6254-3326 for appointment. The dog will be operated at 10 am and goes home around 12 noon or later in the day if you are not free. The dog should preferably be vaccinated within one year and in good health. Bathe the dog first and clean up his lower area.
Best wishes.
497. The oldest candidate for the first Real Estate Agent Exam in May 2011
At the age of 60 years, I am most likely the oldest candidate for the first Real Estate Agent Exam conducted in May 2011. I can see the youthfulness of my 40 classmates who are on the average, estimated to be half my age and radiate the full bloom of roses. Not that I am withered and limping.
Of the 40 classmates, I estimated that around 20 or less took the brutal 3-evening examinations relating to the law, real estate matters and investments. The condition is that all 3 papers must be passed at one sitting. I considered the examinations brutal because of the 8 questions, I had to choose 5. I found that if I had to take all 8 questions, I would fail as many topics were not in the lectures or that the examiner had set some out of the syllabus questions. For example:
1. Write short notes on "market volatility".
2. What is the impact and implications if the income ceiling for eligible HDB flat buyers is raised from $8,000 to $10,000. Or increase government land sales. I attempted this question because I had read the newspaper reports and all the opposition's views on affordable public housing.
3. HDB QUESTION. Calculation of down payment and monthly less CPF contributions for an HDB flat including CPF contributions for a couple purchasing a 4-room flat. This was a killer as I had not practised any calculations nor done more than a handful of HDB sales transactions! But I did read about Minister Mah Bow Tan's illustration of a similar example in the Straits Times during the political hustlings as elections were held around April/May 2011. Unfortunately, I could remember probably 50% of his calculations.
4. What is the main grievance when the Land Acquisition Act was introduced. And what were the "three persons" involved in the Act. Apparently this info was in the CD given by my lecturer and though I had the CD printed to a 1,000-page book, I did not read and remember all the notes. I was forced to answer this question as the others were worse.
I had read 20 years ago that the main grievance was that the land was acquired below market price and so I wrote this. As for the "3 persons", I presumed it was not real people. My classmate wrote the Landlord, Tenant and Owner. I wrote "Singapore Land Authority, National Heritage Board and HDB". Up to now, I still don't know the correct answer.
5. Diversification of investments is bad. Comment. Fortunately, I have read a lot of financial matters as the Straits Times seem to publish endless articles.
6. Leverage, Hedge Against Inflation, Asset Classes, Types. I could write much more than the student who dislike reading the financial news.
7. Positioning of shop front in a shopping mall and the demand of rentals. I had not got any lecture on this. But I had to answer this question since the others would give me a failing grade. Nothing much to write about except human traffic, tenant mix, anchor tenant nearby and demand by competitors. Or maybe I did not know what to write.
8. My favourite question. Two daughters inherited a bungalow from their father and decided to rebuild to a "3-storey dwelling" which was built. One daughter migrated to Australia and gave up her Singapore citizenship. The other passed away in a car accident and her husband said that he inherits everything from her. The foreigner daughter disputed. What is the situation? The answers involved tenancy in common, joint tenancy, intestate, foreign ownership of Singapore Property and the relevant act and maybe more. In real life, the case is referred to a lawyer, my classmate told me!
Yesterday, July 12, 2011, I went to collect my "Real Estate Agent Examination" certificate issued by the CEA (Council for Estate Agencies).
I remember 6 of my younger classmates celebrate the ending of the 3rd examination at a McDonald's in Jurong, nearby past midnight.
I wrote to them as follows:
I am David Sing Kong Yuen, probably the oldest examination candidate in the first REA Exam May 2011. I have passed the exam.
I fondly remembered 7 of us celebrated the final day of exam at McDonald's in Jurong with a treat given by Mr Steven Koh.
I met our Korean classmate Mr Kang while collecting my REA Exam certificate yesterday. I was informed by Mr Kang that there would be a lunch organised by Mr Steven Koh of Hans and Boon 91509317 somewhere in Novena. Pl phone him for the place. I did not receive Steven Koh's sms for this lunch as I was changing phone cards and phone at that critical time. It will be safer to e-mail too but I do get a few hundred spam mails a day (not a few) and your e-mail may have gone to SPAM.
I hope all of you have had passed the exam. Please let me know the good news. My phone is 9668-6468 and I should be able to receive your sms.
There were 41 persons who passed. I estimated that at least 100 sat for the exam (in Paper 2). In Paper 1 and Paper 3, I estimated around 25 candidates were present. Not all were from our class as there were two REA courses being conducted. One of the courses was conducted by Spencer Ng of REMAX connections. I think the other course was conducted by the IEA. Those who failed CEHA courses could re-take the single paper they had failed. However, for the REA course, all 3 subjects must be passed at one sitting. If not, must take the 3 tests again.
Probably around 10 of our classmates of around 40 have had passed the exam. I am anxious to know all of six of you have had passed the exam. Our Korean classmate who was a Professor in undergraduate financial courses (MAS students etc) was scanning for the 41 names for the name of Margaret Liew and could not find her name of "Margaret".
Therefore, Margaret, please let me know if you have passed the exam. I hope to see all of you at the lunch on Wed. somewhere in Novena. Contact Mr Steven Koh for details. I know that Spencer Ng has been invited.
Best wishes to all of you in your KEO career.
Of the 40 classmates, I estimated that around 20 or less took the brutal 3-evening examinations relating to the law, real estate matters and investments. The condition is that all 3 papers must be passed at one sitting. I considered the examinations brutal because of the 8 questions, I had to choose 5. I found that if I had to take all 8 questions, I would fail as many topics were not in the lectures or that the examiner had set some out of the syllabus questions. For example:
1. Write short notes on "market volatility".
2. What is the impact and implications if the income ceiling for eligible HDB flat buyers is raised from $8,000 to $10,000. Or increase government land sales. I attempted this question because I had read the newspaper reports and all the opposition's views on affordable public housing.
3. HDB QUESTION. Calculation of down payment and monthly less CPF contributions for an HDB flat including CPF contributions for a couple purchasing a 4-room flat. This was a killer as I had not practised any calculations nor done more than a handful of HDB sales transactions! But I did read about Minister Mah Bow Tan's illustration of a similar example in the Straits Times during the political hustlings as elections were held around April/May 2011. Unfortunately, I could remember probably 50% of his calculations.
4. What is the main grievance when the Land Acquisition Act was introduced. And what were the "three persons" involved in the Act. Apparently this info was in the CD given by my lecturer and though I had the CD printed to a 1,000-page book, I did not read and remember all the notes. I was forced to answer this question as the others were worse.
I had read 20 years ago that the main grievance was that the land was acquired below market price and so I wrote this. As for the "3 persons", I presumed it was not real people. My classmate wrote the Landlord, Tenant and Owner. I wrote "Singapore Land Authority, National Heritage Board and HDB". Up to now, I still don't know the correct answer.
5. Diversification of investments is bad. Comment. Fortunately, I have read a lot of financial matters as the Straits Times seem to publish endless articles.
6. Leverage, Hedge Against Inflation, Asset Classes, Types. I could write much more than the student who dislike reading the financial news.
7. Positioning of shop front in a shopping mall and the demand of rentals. I had not got any lecture on this. But I had to answer this question since the others would give me a failing grade. Nothing much to write about except human traffic, tenant mix, anchor tenant nearby and demand by competitors. Or maybe I did not know what to write.
8. My favourite question. Two daughters inherited a bungalow from their father and decided to rebuild to a "3-storey dwelling" which was built. One daughter migrated to Australia and gave up her Singapore citizenship. The other passed away in a car accident and her husband said that he inherits everything from her. The foreigner daughter disputed. What is the situation? The answers involved tenancy in common, joint tenancy, intestate, foreign ownership of Singapore Property and the relevant act and maybe more. In real life, the case is referred to a lawyer, my classmate told me!
Yesterday, July 12, 2011, I went to collect my "Real Estate Agent Examination" certificate issued by the CEA (Council for Estate Agencies).
I remember 6 of my younger classmates celebrate the ending of the 3rd examination at a McDonald's in Jurong, nearby past midnight.
I wrote to them as follows:
I am David Sing Kong Yuen, probably the oldest examination candidate in the first REA Exam May 2011. I have passed the exam.
I fondly remembered 7 of us celebrated the final day of exam at McDonald's in Jurong with a treat given by Mr Steven Koh.
I met our Korean classmate Mr Kang while collecting my REA Exam certificate yesterday. I was informed by Mr Kang that there would be a lunch organised by Mr Steven Koh of Hans and Boon 91509317 somewhere in Novena. Pl phone him for the place. I did not receive Steven Koh's sms for this lunch as I was changing phone cards and phone at that critical time. It will be safer to e-mail too but I do get a few hundred spam mails a day (not a few) and your e-mail may have gone to SPAM.
I hope all of you have had passed the exam. Please let me know the good news. My phone is 9668-6468 and I should be able to receive your sms.
There were 41 persons who passed. I estimated that at least 100 sat for the exam (in Paper 2). In Paper 1 and Paper 3, I estimated around 25 candidates were present. Not all were from our class as there were two REA courses being conducted. One of the courses was conducted by Spencer Ng of REMAX connections. I think the other course was conducted by the IEA. Those who failed CEHA courses could re-take the single paper they had failed. However, for the REA course, all 3 subjects must be passed at one sitting. If not, must take the 3 tests again.
Probably around 10 of our classmates of around 40 have had passed the exam. I am anxious to know all of six of you have had passed the exam. Our Korean classmate who was a Professor in undergraduate financial courses (MAS students etc) was scanning for the 41 names for the name of Margaret Liew and could not find her name of "Margaret".
Therefore, Margaret, please let me know if you have passed the exam. I hope to see all of you at the lunch on Wed. somewhere in Novena. Contact Mr Steven Koh for details. I know that Spencer Ng has been invited.
Best wishes to all of you in your KEO career.
496. Export of dog to Bahrain
E-MAIL TO DR SING DATED JULY 12, 2011
On Mon, Jul 11, 2011 at 10:15 PM, ...@singnet.com.sg> wrote:
Hi Judy,
Good day to you.
I am in the process of relocating my pet dog from Singapore to Bahrain therefore would like to send my dog for the vaccinations that is required by the authorities in Bahrain and at the same time, have other procedures done as well.
According to regulations in Bahrain, our dog needs to have 2 sets of Rabies + DHLP (Distemper, Hepatitis, Parvovirosis, Leptospirosis) jabs before we can apply for documentation. In addition, we like to have him neutered and dental cleaning done. Can you kindly advise how much these will cost and what will be the best sequence for these to be done (e.g., Neutering and dental cleaning / 1 week later, 1st set of jabs / 3 weeks later, 2 set of jabs)?
Below are the details of my dog for reference.
Name: ............
Breed: Red Toy Poodle
Age: 3 years of age as of 2 October
Birthdate: 2 October 2008
Gender: Male
Medical: He gets yearly booster shots and his last visit to the vet was in May 2011. Health status is good
Weight: 5.2kg
Microchip: Yes
I am currently in Bahrain therefore it will be great if you can reply me soon so that I can make arrangements for my dog on the above.
Thank you.
Regards,
Name of Owner
E-MAIL REPLY FROM DR SING
On Tue, Jul 12, 2011 at 2:17 PM, Kong Yuen Sing <99pups@gmail.com> wrote:
Approximate costs as follows:
Rabies vaccination $65/vaccination
DHLP $40/vaccination at same time as rabies
2 weeks apart for 2nd set of jab
Estimated total = $210 for 4 vaccinations
Neuter and dental can be done at same time. Male dog of small size e.g. chihuahua - Maltese will be around $150 for neuter and $200-$250 depending on decay teeth condition for dental.
Vet exam certificate of health around $60 if needed.
Pl phone 9668 6468 for appointment
E-MAIL TO DR SING DATED JUL 12, 2011
On Tue, Jul 12, 2011 at 4:08 PM, ..@singnet.com.sg> wrote:
Hi Dr Sing,
Thank you for your reply.
I will make necessary arrangements and have my family member bring my toy poodle to you.
Regards,
On Mon, Jul 11, 2011 at 10:15 PM, ...@singnet.com.sg> wrote:
Hi Judy,
Good day to you.
I am in the process of relocating my pet dog from Singapore to Bahrain therefore would like to send my dog for the vaccinations that is required by the authorities in Bahrain and at the same time, have other procedures done as well.
According to regulations in Bahrain, our dog needs to have 2 sets of Rabies + DHLP (Distemper, Hepatitis, Parvovirosis, Leptospirosis) jabs before we can apply for documentation. In addition, we like to have him neutered and dental cleaning done. Can you kindly advise how much these will cost and what will be the best sequence for these to be done (e.g., Neutering and dental cleaning / 1 week later, 1st set of jabs / 3 weeks later, 2 set of jabs)?
Below are the details of my dog for reference.
Name: ............
Breed: Red Toy Poodle
Age: 3 years of age as of 2 October
Birthdate: 2 October 2008
Gender: Male
Medical: He gets yearly booster shots and his last visit to the vet was in May 2011. Health status is good
Weight: 5.2kg
Microchip: Yes
I am currently in Bahrain therefore it will be great if you can reply me soon so that I can make arrangements for my dog on the above.
Thank you.
Regards,
Name of Owner
E-MAIL REPLY FROM DR SING
On Tue, Jul 12, 2011 at 2:17 PM, Kong Yuen Sing <99pups@gmail.com> wrote:
Approximate costs as follows:
Rabies vaccination $65/vaccination
DHLP $40/vaccination at same time as rabies
2 weeks apart for 2nd set of jab
Estimated total = $210 for 4 vaccinations
Neuter and dental can be done at same time. Male dog of small size e.g. chihuahua - Maltese will be around $150 for neuter and $200-$250 depending on decay teeth condition for dental.
Vet exam certificate of health around $60 if needed.
Pl phone 9668 6468 for appointment
E-MAIL TO DR SING DATED JUL 12, 2011
On Tue, Jul 12, 2011 at 4:08 PM, ..@singnet.com.sg> wrote:
Hi Dr Sing,
Thank you for your reply.
I will make necessary arrangements and have my family member bring my toy poodle to you.
Regards,
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