734. Educational videos produced by young Singaporeans for Toa Payoh Vets

E-MAIL FROM DR SING DATED NOV 21, 2011

Thank you very much for your help in producing the Responsible Pet video meant for the AVA Responsible Dog Ownership Road show. The KC video was also good thanks to your help. The voices of the narrators were distinct and clear, to my surprise and the narrative scenes were not boring unlike a power point presentation or a professor's lecture. I hope the vet students do learn a bit about complicated kennel cough.

I gave each party general guidelines as I want other views and presentation.
Each party brings in something new (ideas and presentation and music) in video production and that is why it is so interesting to watch them. Thanks again.

I am only worried about the microchip scanning pic and some other pic you put on the Responsible Pet Ownership video as they may be copyright. Pl confirm the source as we can get sued or get a legal warning to remove it! Pl look into this matter and it is best to remove them and put in original images.

On Sun, Nov 20, 2011 at 5:06 PM, Nicole Pereira wrote:

Hi Dr Sing, here's the links to the videos i uploaded to your 99pups account-
http://www.youtube.com/watch?v=tmTYP8T95V4 - Kennel Cough video the St Andrew boys produced
http://www.youtube.com/watch?v=FYeG9tUXp78 - Responsible Pet Ownership video
http://www.youtube.com/watch?v=ExTT2a8eUCs - Oronasal Fistula Follow Up
http://www.youtube.com/watch?v=9vKmXgAS_SA - FIV in stray cats 2

Sunday Nov 20, 2011 interesting cases

EYES
1. Pug with right eye perforated ulcer treated by me some months ago came in for annual vaccination. A young couple who remembered me as much as I remember them due to this serious eye injury drama as described in my case:


Ulcer healed very well but two very small green ulcers (fluorescein stain) seen to the 7 o'clock. Extraordinary amount of hairs clumped together on corneal surface when I cleaned it (see image). Dr Vanessa had applied the fluroescein strip and had flushed out the green dye. I took over while she checked another dog as the couple wanted to consult me.

Left eye - no ulcers but brown pigmentation covers 50$% of central area - friction from owner cleaning facial fold daily?

I advised facial fold excision as the hairs from the fold must have irritaed the corena (central area) and the pug must be rubbing the eye. "Alternative is to close the eyelids when cleaning the facial fold area," I said.

"Will the surgery affect the health of the pug?" the lady asked. "No," I said. Less itchiness and no more need to wipe the secretions off the facial fold. If irritation continues, the cornea will be seeded by brown black pigments over the years and the dog can't see clearly in front.

The owners would think about the surgery. Their other pug has no corneal ulceration problems. It is hard to foresee the future. "The facial fold is part of the pug's beauty but healthy is more important than beauty," I said.

2. CORNEAL DYSTROPHY
The miniature pinscher owner had texted to consult me yesterday to review the eye. She firmly believes that the circle of whiteness of the inside of the cornea had been reduced with the use of garasone eye drops daily with one small drop.

I will refer to the other picture I took some time ago and see. It seems that the circle has shrunk a bit and the edges are more firm. I need to review the old pic.


The left eye has some interesting developments when I view the images. The dog was fidgety and therefore no proper examination was possible. The owner did not want fluroescein eye stain test for the eyes and so I can't confirm whether the left eye still has ulcers in the upper half near the melanomas.
The pic traken toaday shows "crocodile skin" areound the eyelids. Must check previous pic soon.

CASE 3
A 13-year-old pug passed away after 11 pm yesterday. My assistant Min saw him alive and resting at 11 pm when he did his last checking.

"Why did you send a pug for grooming?" I asked the young couple who told me that the pug had never coughed once before going to the groomer two days ago (Friday). Then she coughed vigorously at home for a long time and so I was consulted on Saturday morning. The pug did not cough when I saw him. "The likely cause of coughing is due to kennel cough," I said as kennel cough is a common disease in places where dogs of various ages mix and it is a very contagious disease. The old dog had not been vaccinated forl many years. So, the primary diagnosis was kennel cough - a dry hacking cough.

I recommended to ward the old dog in a cage so she could rest. "Continuous coughing will result in blood vessel rupture in the lungs," I said to the young couple. Blood test was advised to check for infectious situation but the owners declined.

When the pug died, both her nostrils had red blood. Her tongue was cyanotic. So there was some respiratory damage and bleeding. "An independent post-mortem by the AVA will be needed to ascertain the cause of death," I said to the lady whom I phoned. "The dog is old and her immune system would be weak and she was not able to fight off the viruses and bacteria of kennel cough," I said. Cremation was arranged and the urn would be available in 2 days' time. It is one of the cases where old dogs without vaccination should not be exposed to other dogs. The pug was having her nails clipped and she panted at the pet shop. It was a sad Sunday for me as the pug had not shown any signs of impending death at the Surgery. In fact he had eaten some food after treatment with antibiotics and a drip. However, I had warned the owner of a possible death and the owners were understanding.

736. Health of Westie

The Westie Foundation of Amercia - health matters funded.

Atopic dermatitits (an allergice skin disease)
Bladder cancer
Idiopathic pulmonary fibrosis (lung scars)
Copper toxicity (hepatitis & liver failure)
Legg-Calve-Perthes disease (hip joint degenerative disease)
Luxating patellas (dislocating knee caps)
Addison's disease
Inflammatory bowel disease
Cataract
Dry eye (keratoconjunctivitis sicca)
Cranio-mandibular osteopathy (painful bone growths in the skull and jaw b ut usually OK by 12 months of age)
White shaker dog syndrome (entire body shakes or trembles - appear in other small white breeds - immune system disorder suspected - successfully treated with steroids).

735. Inspirational picture

MESSAGE TO AN ENTREPRENEUR

As regards your water project, I am reminded of this martial arts movie "Dead Or Alive" which is free online and just watched by me as I do my early morning internet work. In the movie, the antagonist mentioned 3 words about the Japanese lady not up to the mark as her brother. She needs "Skills, Timing and Strength" but she has no "strength".

Somehow, these 3 words seem apt for your project in wanting to expand your business from Singapore to China and Indonesia. I was wondering what to write in a picture of flowers I just took last Saturday at Sentosa. Now, I know and I produce a picture to encourage you.

1. The timing is right (environmental health concern for clean water), the skill is there (your brother) but the strength (of the parties doing marketing) is to be established and you have got the expatriate

and others you are networking to build up a team to increase your strength.

2. Thinking of making money all the time will not make one be successful in business, in my opinion.

734. SOP - Lameness in a Golden Retriever

Thursday, Nov 17, 2011
9.30 am

I usually consult from 9.30 am to 11 am.
A lady owner and two friends consulted me for a 2nd opinion as regards her 9-month-old male Golden Retriever. born Feb 2011, limping on right hind for the last few weeks. Vet 1 had been consulted earlier regarding some skin disease.

Below are my Standard Operating Procedures for examination of canine lameness at Toa Payoh Vets for this case as a real case example as it is easier for reader to understand. Basically it is similar to examination of a lame horse.

1. HISTORY OF LAMENESS - Right Hind lamenss
Purchase - 3 months old from a Pasir Ris breeder
Onset - RH lame seen at 7th month
Duration - 2 months
Further questioning: The puppy does not jump up or down car and does not hop down stairs since purchase. Pain in hip and other joints likely to be present before purchase as most normal puppies will do the jumping.

2. LAMENESS EXAMINATION - Outside the Surgery. As in the racehorse lameness exam.
2.1 Walk
2.2 Trot
2.3 Turn
Limping on right hind obvious as the dog did not put weight on this leg and the left hind hip dipped on trotting.

3. PUT ON EXAMINATION TABLE - Do not examine on the floor!
3.1 Pain check of dog standing esp. spinal area. Spinal T5-L5 slightly painful.

3.2 Pain check by palpation of joints with dog lying down sideways on the table.
Slight pain on extension of right hip and right knee.

3.3 Dog recumbent on right side. Extend and flex all joints vigorously. The owners were worried about my vigorous manipulations but the dog did not react since he had no pain from the extensions and flexions. Some vets do gentle manipulations and mis-diagnose.

3.4 Dog standing on table. Compare length of right and left hind limb by extension and show to the owner the lengths of two hind limbs. In this case, the owner could see that the riight hind was noticeably shorter by 2-4 cm. Subluxation? Mild pain only. To X-ray both hip joints later.
3.5 There are other reflexes to be checked if the dog is paralysed but in this case, it is not. Refer to your neurological exam book.

4. TENTATIVE DIAGNOSIS
Right hip dysplasia likely as this condition is better shown at the 9th - 12th month than as a young pup. To X-ray hip joints at a later date.

5. ADVICES
5.1 No weight gain throughout his life, thereby avoiding surgery
5.2 No slopes or stair climbing or jumping from sofas etc

6. SKIN DISEASE. A separate case study and procedure which will not be written up here. Generalised pustular dermatitis, elbow and hock sores. Dog likes to sleep on wet floors. Anal sacculitis (pink hairless areas below anus pointed out by the owner). Rashes seen on elbows and hock area pigmentation suggested licking and early onset of elbow and hock sores. Preventive measures including moisturers for a time. The owner asked for Neoderm cream. No cream advised by me as the hair will not grow if the cream is used for a long time.

Best is daily grooming and inspection of the coat for this Golden Retriever and know where the "hot spots" will occur. Dog is clipped bald. Generally, the skin infections are due to bacteria but the vet cannot rule out ringworm and demodectic mites. Vet 1 had scraped skin and found no mites but there was no medical report given to the owner.

733. Kennel cough follow-up by text message

The young generation prefers to text but it is not good when it comes to your pug's illness as illustrated in the following case.

Nov 13, 2011 10.59 am
Good morning Dr Sing.This is ... the owner of Zorro (Pug). We visited your cllinic on 8th. My puppy was having kennel cough and runny nose. He used to eat well and was active but this morning, he is not having any food and keeps on sleeping. When he walks, he has difficulty walking due to heavy coughing. So he walks a bit and then just sits down and he is not active anymore. Antibiotic has not been finished yet but since he seems not well, should I bring him back to the clinic?

It would be much appreciated if you could reply to my sms

Nov 13, 2011 12.04 pm
Pl tel me

NO REPLY. I PHONED. NO REPONSE.


Nov 13, 2011 9.31 pm
Dr Sing, I really need your help now with my pug. For all day, he rarely moved and seems no energy with him. Is there any chance we can bring him for emergency now?

I PHONED THE OWNER. As the pug was ok, I advised giving him a teaspoonful of honey + water and bring back to the clinic at 10 am on Nov 14.

On examination, the pug had copious amounts of nasal discharge. Difficulty in breathing. Some lung sounds, but no fever. I gave treatment and cough mixture.

"It is not possible to cage him 100% at home," I had advised the couple who brought the pug to me for examination one day after purchase on Nov 8.

"Play with the pug for only 5 minutes after meals which were given twice a day," I had advised. "Kennel cough is caused by virus and bacteria. Viral diseases do not have antibiotics but resting the puppy by confinement strictly in a cage will help speed recovery. Some cases take up to 3 weeks to recover."

In this case, the pug had space to run around as all puppies take advantage of freedom at a new house. He also hated taking medicine as he fought me when I syringe him 0.05 ml of the cough mixture.

"It is difficult to give him medicine by mouth," the young man said. "My pug rests his head on a soft toy," the gentleman said.
"Puppies do that when they can't breathe properly," I said. I rolled up a towel like a small pillow. The pug rested his neck on the edge of the pillow. Eyes bright but he was tired.

"Can we visit him for 15 minutes?" the gentleman asked.
"Yes," I said. "But this pug must be inside the cage for the next 2-3 days to rest." The couple came at 7 pm on the same day. Nursing, feeding, electrolytes and observation are made every 2 hourly to ensure that the pug is OK.

731. Animal Welfare Activists

On Mon, Sep 5, 2011 at 12:39 PM, ...@gmail.com> wrote:

Attention to the Veterinary Head of Toa Payoh Vets,

My name is ... and I am working full time for a church in Singapore.

Our church is currently in the process of getting a new animal shelter set up in Singapore. We are waiting for tenders from AVA or SLA for dog farms in Sungei Tengah. The shelter should be up and going in about 1 or 2 year's time. Our emphasis will specifically be to help stray or abandoned dogs. We are serious about this ministry and is looking forward toward setting it up as soon as possible.

The reason for writing to you is to ask if your clinic would be be interested to participate in the sterilization, vaccination and medical treatment program of our dogs.

We hope that you could partner with us in this good cause.

If so, please let us know how much you will charge us (roughly) for the following services so that we can better estimate our financial planning. We would greatly appreciate if you could give us a subsidized rate that is lower than the market.

Vaccination of a dog (regardless of size & inclusive of medication)
Sterilization of a dog (regardless of size & inclusive of medication)
Microchipping
Consultation fee
Medication discount
Essential Products such as heartguard, frontline
Medicated shampoos

Hope to hear from you soon. Thank you.

Alternatively, if any of your vets are interested to help on an individual, voluntary or private basis, please also respond to me.


God bless you,
...



On Mon, Sep 5, 2011 at 4:00 PM, Kelly Lim wrote:

Dear Dr Sing

Thank you for your prompt reply. We will contact you again when we have the latest update.

God bless you,
....


E-MAIL REPLY FROM DR SING DATED SEP 5, 2011

I am Dr Sing. As there is inflation and prices go up yearly, it is not possible to quote now and there will be misunderstandings when your shelter is built in 2-4 years' s time. Please let me know when the tender has been successful.



E-MAIL TO DR SING DATED NOV 11, 2011

On Fri, Nov 11, 2011 at 10:40 AM, ...gmail.com> wrote:

Dear Dr Sing

I am .., who have previously communicated with you over a few emails regarding our church's planned shelter for stray dogs. We have confirmed with AVA about the timing of the tender. It will probably be open only in 2013.

However, in the meanwhile, we can't just sit and wait for the land to come and ignore the terrible plight of the stray dogs. For the past 2 years, a few of us have already been feeding about 70 strays here and there, as well as actively putting up adoption for the puppies. We have our puppies screened for parvo virus, vaccinated & dewormed before giving them away for adoption. For the grown dogs, we have also got a few happily adopted. So far they are all success stories. We also sterilize the females. Many of them are sterilized except for about 10 more because they are very smart. Yet 10 females can reproduce beyond what we can cope. Still trying our best to patiently gain their trust.

Occasionally tragedies still happen. This year, we lost 2 batches of 8-9 puppies (could not catch them in time when they were about 5 weeks old and started running around in the open) that were in one night swept by the China and Thai workers for their "makan". These workers usually congregate over weekends and that is when they will notice the puppies and gang up to catch all of them.

Recently 1 black mongrel puppy was kicked to death at 3 month old and the other one blinded by the impact but a miracle happened and his eyesight is restored. Now he is in a foster home. They were the only ones left un-adopted because they were black in color.
So far I have visited ... and .... They do have 10% discount for strays but the bills still come up to an exorbitant amount for so many dogs.

Would you be able to propose a medical service package for us during these 2 years of transition before our shelter is formally up?

Looking forward to your reply.


God bless you,
...



E-MAIL REPLY DATED NOV 13, 2011
I am sorry I can't help you as my clinic is very small with 1 full-time vet, unlike ... and ... and other clinics who have many vets. In any case, I advise you to contact the newer clinics (there are over 40 clinics) in Singapore and these may be able to help you. You just need to do so personally. E-mails save time but not so good if you want to be an activist.

730. AVA Reponsible Pet Ownership Roadshow 2011 - Toa Payoh Vets

TOA PAYOH VETS
Block 1002, Toa Payoh Lor 8, 01-1477, Singapore 319074
6254-3326, 9668-6469, judy@toapayohvets.com, www.toapayohvets.com

Speaker: Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Founder & Practising Veterinarian, Toa Payoh Vets
Saturday, November 12, 2011

Nov 10, 2011

AVA Responsible Pet Ownership Roadshow 2011
Saturday, November 12, 2011, 1.30 pm - 2 pm, Changi Expo

"SOME COMMON DISEASES IN DOGS"

I accepted two slots on Saturday and Sunday to present a talk on dogs and hamsters respectively. However, the AVA cancelled my Sunday talk scheduled from 3.30 pm to 4 pm and offered me another slot at 1.30 pm. I am unable to take up this slot.
Therefore, I will talk about common diseases in hamsters on this Saturday as dwarf hamsters are quite popular with Singaporeans.

In short, I will be presenting some health care cases mainly in dogs. However, the responsibilities of health care and ownership in canine cases apply to the care of cats, hamsters and rabbits.

I apologise for the inconvenience caused to the audience who expect only canine matters to be presented.

As Power Point slide presentations of "Responsible Pet Ownership" can be extremely dull and sleep-inducing in my experience, I have just got videos produced and hope all of you will enjoy the stories based on some common real life cases encountered at Toa Payoh Vets. The stories cover some common cases seen at Toa Payoh Vets from the birth to old age of the pets from around 1980 to 2011.

If you have any questions about responsible pet ownership as regards health care matters or the the cases in the videos, some details are available at www.toapayohvets.com.

If not, tel me at the Surgery at 6254-3326, 9668-6469 or e-mail judy@toapayohvets.com

729. Right ear weeping in a Westie - an unusual case

"I have seen 3 vets. One of them said there might be a tumour inside the right ear," the young lady said to me. "The last vet advised ear surgery." From my impressions, the young couple wanted a permanent solution to this one-year problem of the Westie with the itchy right ear and they came to see me.

This dog had lots of "water" inside the ear canal. I palpated the right ear. There was some pain as the dog moved his head away. But not great pain. As I pressed the ear, more "watery" discharge come out. As I cleared the discharge with a piece of tissue and then pressed the ear, more "watery" discharge comes out. Not those thick yellow pus, but watery. Why?

It was as if the horizontal ear canal was a deep well with lots of water. "Did your father apply the commercial ear drops recently?" I asked.

"No," the young lady said. "No more ear drops left."
This was a most unusual case. It was as if there was "underground" water.
"This ear needed to be irrigated," I advised.

I collaborate with Dr Vanessa on this case as part of my mentorship and succession program for Toa Payoh Vets.

Each young vet has his or her own idea of treatment and I wanted to make sure that this dog had a treatment that I would be doing and to maintain a standard of care that would be satisfactory to dog owners who come to Toa Payoh Vets for second or more opinions.

TREATMENT
Domitor IV sedated the dog partly. Muzzled. Dr Vanessa put in the pink antiseptic solution into the ear canal, massaged it to clear the debri. That is the standard way and that would be what the other vets had been doing. Nothing wrong with that.
But it might not be effective compared to ear irrigation.

So I intervened and demonstrated how the ear irrigation ought to be done. There is a technique. I had shown this in my video at:
http://www.youtube.com/watch?v=xhZ5eGJdwnY

Dr Vanessa used the 20-ml syringe to flush the ear. "You need to exercise your thumb muscles," I said as she injected the water into the ear without much force. "The irrigation angle has to be at 45 degrees to the horizontal canal and with speed," I demonstrated. It is easier said and demonstrated than done.

White tissue pieces from the walls of the vertical canal came out. Large extensive ulcers. As I irrigated more, a small piece of brown tissue came out. Then a few more brown bits. Strange. No pus.

I left the room to talk to the couple. Then I returned to the room to continue working with Dr Vanessa. She had extracted a big amount of brownish fibres from deep inside the ear. Good work. "What are these brown stuff?" I asked her.
"It could be tumours," she said. We showed the brown fibres to the young couple who was equally as perplexed.

"Did your father use cotton buds to clean the right ear?" I asked.
"Yes," the lady said. Later she said that her father used cotton wool wrapped around a pair of forceps to clean this ear.
So, the clue was given. The father would have used lots of cotton wool over the past year to resolve the ear problem. The fibres loosened and got impacted inside the horizontal canal. The whole canal filled up. The fibres absorbed the "water" of the commercial ear drops. At the same time, the bleeding from the canal wall due to aggressive ear cleaning by the father stained the fibres into dark brown as red blood becomes brown over time. These were the fibres or "tumours" pulled out.

Is this hypothesis sound? It is an unusual case as there was no pus. No time for pus to form too as the father must be doing ear cleaning every day. Sometimes, the grown up children don't know what the father is doing in the care of the dog as they work long hours.

Dr Vanessa extracted as much as possible. Evidence shown. She showed the couple the ear canal via the auroscope.
Ear swab for bacterial culture. Blood test.

SOLUTION
My advice was to lateral canal resection to resolve the dog's problem once and for all. The impacted cotton wool is deep inside the horizontal canal and opening up the vertical canal to get the hidden wool is the best solution. Owners want one treatment not several visits. This is understandable for every one. I advise surgery one week later.

728. Scupturing dogs with veggie dyes and making them look like pandas etc - animal cruelty?

MY REPLY TO COMMENTS ON DOG DYED TO LOOK LIKE PANDAS AND OTHER ANIMALS

Thank you for your email. I have not seen one client Toa Payoh Vets with coloured/dyed dogs from 1982 to 2011. It is surprising.

If I do, I will advise the owner to check whether the dye is carcinogenic, allergic or toxic to the dog when licked and in the long term.

Nowadays, what is deemed animal cruelty in subjecting a dog to being dyed to one person is not cruel to another. As long as the quality of life of the pet is good and the pet is healthy despite "vegetable-dyed", I am not against this practice which you may consider cruel.

Older men and women dye their white or grey hairs to look younger. Young people dye their hair to look different. Such hair dyes may have long term toxic effects on the kidneys and livers as they are used for a long time to maintain youthfulness esp. in older people. This is my opinion that is not supported by scientific evidence, if any.

But most people don't bother about the safety aspects and that is why so many "herbal" and "nutritional/vitamin" pills with possible harmful effects to the liver and kidneys have great sales.

I hope my reply is satisfactory to you.