1035. Email - hamster swelling in lower body

E-MAIL TO DR SING DATED AUG 11, 2011

...@hotmail.com

Aug 11, 2011  12:41 PM (17 hours ago)

Dear Judy,
can you help me with what this swelling is and does it need professional attention?
It 's at the hind end of the hamster
The female hamster is otherwise well.

Thank you
(Name)

E-MAIL FROM DR SING DATED AUG 12, 2011




I am Dr Sing from Toa Payoh Vets. Thank you for your email query. The big swelling is likely a tumour. As it is pinkish and hairless, I would say that your hamster has had been "licking" it to get rid of it. I advise prompt surgical removal before it grow bigger and gets infected. Pl make appointment with me or one of the vets at Toa Payoh Vets by tel  6254 3326 to get it excised under anaesthesia. The estimated cost of anaesthesia and surgery is $150-$180.

1034. The father said: "Send the vomiting dog to the SPCA"

1034. The father said: "Send your vomiting dog to the SPCA"




Friday Aug 10, 2012, 8 pm



It is difficult getting a taxi at 8 pm on Fridays and so I was glad to see a cab coming to Toa Payoh Vets. A young lady stepped out to visit her sick Miniature Schnauzer, 9 years old, female and having a belly as swollen as a Schnauzer with 6 big pups.



She had sent in her dog earlier to my associate vet. I noted in the vet case notes that "the dog had been not been eating for 3 days, was very weak and had pale mucous membranes, not spayed. Pyometra?"



The taxi-driver was her father. He agreed to be hired and on the way to my home, I asked him regarding this dog that was being operated by my associate vet. He was 60 years old but his white hairs and wrinkled face aged him to 70 years.



"Parents end up looking after the children's dog," he said. "During the last 3 days, the dog just was not interested in the food, unlike other days. She would just lie down as if she was tired when my wife put the food bowl on the floor in the morning."



"Did she drink a lot of water?" I asked.

"Yes,"

"Did she pee more than normal?" I asked.

"Yes."

"How many days had she been vomiting?" I asked again.



"Seven days," he said. "She vomited every day. We thought she had stomach upset. My wife gave her bits of apples as these were her favourite. She would not eat more than a piece and then would vomit them out."



"What was the colour of her vomit and how long she been vomiting?" I asked.



"She vomited water for 7 days. I told my daughter that she ought to send the dog to the SPCA!"



She said to me: 'When you are old, I will send you to the old folks home!"



"The younger generation loves their dogs very much. SPCA does not treat sick dogs normally. Sending the sick dog to the SPCA means a death sentence and therefore, you ought to advise her to send the dog to the vet. Vomiting for 7 days every day is serious."



"I did tell her to send to the vet," the father said. "But she did not do so. That was why I said to send the dog to the SPCA."



The dog's temp was 37 C when she was examined by my associate vet.



The dog was operated by my associate vet yesterday at 7.30 pm. The daughter came at 8.15 pm and would have seen the infected womb which was larger than the biggest German sausage on sale at the supermarkets.



Today, this sunny Saturday morning at 9.35 am, I saw her standing up and wagging her tail on seeing me. I phoned the young lady at 9.40 am and let her know: "Chances are good that your dog will recover." She asked if her dog was eating and I said: "No, but she had her IV dextrose saline drip and would be OK." She thanked me with a sleepy voice as this was Saturday morning and young ones in developed countries don't wake up till noon time, having partied till 5 am on Fridays to Saturdays. She was most happy.



Blood test results were typical of pyometra in that the total WCC was extremely high at 150  (6-17). Nearly 10 x higher than the higher range of normal. This confirms an overwhelming bacterial infection. Any delay in surgery for 2 more days meant death for this gentle Schnauzer.



The differential cell count was even more interesting as Neutrophils (N) = 92% when the normal is around 70%.



N=92%, Absolute 138

L=0.7%, Absolute 1.05

M=5.2% Absolute 7.8

E=0% Absolute 0

B=1.8% Absolute 2.7



KEY PERFORMANCE INDICATORS

ANAESTHESIA & SURGERY FOR A CLOSED PYOMETRA CASE

Surgeon: An associate vet of Toa Payoh Vets



Domitor + Ketamine  0.24+0.30ml IV for 6 kg, 9-year-old dog vomiting for the past 7 days.



First sedation injection to last stitch: 70 minutes

Isoflurane gas maintenance:  45 minutes

First incision to last stitch: 41 minutes

Monosyn 2/0 x 2 packets absorbable



This report is my continuing efforts to audit veterinary surgeries done by my associate vets to achieve my vision of making Toa Payoh Vets the top 5 veterinary surgeries in Singapore.

As a licensee, I am responsible for the overall standard of care in Toa Payoh Vets.



Today, Saturday, 10.39 am, I have audited this case as regards the operational process and record keeping.



INCORRECT RECORDING. The suture used was not 3/0 as recorded by my assistant Min in the anaesthetic records. Min writes the details but the operating vet is responsible for the accuracy of the anaesthetic records. This case shows that a "trust and audit" process is necessary to maintain a high standard of care in any profession as human beings are not Gods.



The sutures used should be 2/0, Min told me. I did an inventory check of the sutures. There was no 3/0 stock of Monosyn. One associate vet uses Monosyn although the PDS is excellent too.



As the uterus was grossly enlarged (the biggest German sausage you can find), it would take 41 minutes to remove them. However, the time to achieve should be 30 minutes. The shorter the anaesthesia, the lower the risks of death of an old dog on the operating table and a dog alive is what makes or breaks a vet's reputation over the years.



OTHER KPI OF CASES RESEARCHED AT TOA PAYOH VETS ARE AT:

http://www.bekindtopets.com/animals/20081201PG9standard-operating-procedures-vets_ToaPayohVets.htm

1033. Maltese shivering and not eating

August 9, 2012's interesting case

A young couple phoned one hour before closing at 5 pm. They wanted to consult Dr Jason Teo as they knew his brother. But Dr Teo could not be contacted on handphone. So, they don't mind any vet or Dr Vanessa.

As Dr Vanessa was busy with dental scaling, I did not want to delay the closing of the Surgery at 5 pm as this was a public holiday and I try to let Mr Min off to celebrate. Working over time can be de-motivating for most staff and so I ensured that this does not happen. So, I handled the case with Dr Daniel.

The 7-year-old female, not spayed Maltese had a swollen tense abdomen.  The vulva was swollen 10X.
"When was her last heat?" I asked the lady in her 30s.
"She has once a year and so far, I don't see any bleeding or spotting on the bed."

I checked the milk production but there was none except for a black "inverted" nipple which secreted yellow "milk."

"Has your dog been behaving strangely like carrying a towel around recently, vomiting, scratching the floors or hiding in a corner?"

"She did carry a soft toy yesterday," the lady said. "Scratching of the floors is her common habit. No vomiting except for last month. She did hide in a corner yesterday."

I diagnosed this dog as having her heat 1-2 months ago and was now suffering from a closed pyometra (womb infected with pus). The dog did not have a fever. The owners were not convinced although the wife said that the stomach was swollen. A blood test was taken.

"The blood test may be normal," I said to Dr Daniel. "If the closed pyometra has just commenced."
 

1032. August 9, 2012 - National Day - 47th birthday of Singapore

August 9, 2012
National Day

I started work at 8.45 am and finished at 5.30 pm. A bright sunshine morning. I was photographing a yellow hibiscus flower with deep purple central when another fellow tenant - a contractor in his late 50s came to me and said: "It is very sad. Our founding father (ex-Prime Minister Mr Lee Kuan Yew) had passed away on Aug 5. He had not been seen since he paid a visit to his elder brother who passed away recently. You know, he had been hospitalised in July and passed away on the 5th of August."

"How come there is no news?" I said. "Nobody can hide such news."

"Well, announcing his death would dampen the happy spirits of the National Day and so his death was kept secret. Flags have to be half-mast as he had died and that would not do for National Day celebrations today."

He was the second man to inform me. Yesterday at 9 pm, I went to buy some fruits from the fruit seller in the wet market in Ang Mo Kio. He also spread the rumour as he said: "Mr Lee died at 5 pm yesterday. But his death is a secret as the government does not want to spoil the happy mood of Singaporeans for National Day tomorrow."

I was surprised as this rumour seemed to be widespread, apparently on Facebook.

I asked my wife and she said she knew about Mr Lee's death. She did not tell me.
So, I was the last to know.

"Well, if he had passed away," I said. "He would not be present at the National Day Parade this evening and I would not see him on TV. Unless a look-alive can represent him but I don't believe the Singapore Government would do such deception."

So, I watched the National Day Parade. The TV showed the ministers coming into the stadium. Then switched to showing the crowds. Most of the PAP ministers no longer wore their white uniforms this year. Some men wore pink shirts. A lady was in all white. Still no signs of Mr Lee appearing.

"He must be dead," my wife said. Another person said that if Mr Lee was not dead, he would have issued a public statement to say he was alive. Why should he?

"Well, Mr Goh Chok Tong (ex-Prime Minister) had not appeared too," I said. "He can't be dead at the same time."

It seemed the TV station was keeping the audience in suspense as they switched to views of the crowds and no more glimpses of the ministers.


Suddenly, the TV zoomed on a door. There was Mr Goh Chok Tong and Mr Lee Kuan Yew. The TV zoomed on his face - rosy pink under the evening sun set rays. In the pink of health.

Well, so much for this national rumours. 

1031. Photo-essay of a case of squamous papilloma in a Cavalier King Charles

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PHOTO ESSAY

FAST GROWING  ORAL TUMOUR OLD DOG

Differential diagnosis - epulis or papilloma?
Cancerous or not cancerous

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http://www.sinpets.com/dogs/20120725squamous_papilloma_older_Cavalier_King_Charles_toapayohvets.htm

is the full report, as blogger.com can't publish in the format for easy reading.

The text is as follows:

1026. How to make a compelling photo essay in the internet age - Michael Freeman   Ref: Digital photopro  Feb 2012    digitalphotopro.com A photo essay or picture essay is a sequence of photos telling a story.  It has: 1. A theme and the following fundamental structure 2. The Opener - The opening shot 3. The Body 4. The Closer 5. The Key Shots ( = climax or climaxes in short stories) The Opener is the "hook" or attention grabber of the reader. Openers are not where you place the key shots. The Body has a definite storyline. The Closer - end with a bang or whimper? Ending with a bang is better choice. The Key Shot. Not all images are fantastic. Be ruthless in weeding out images that do not make a photo essay strong. A high impact or key shot need to be part of a paced rhythmic photo essay. Earlier images need to build toward it. The internet. The future is in the form of the online slideshow. The tools are almost cinematographic, including strictly linear sequencing, transitions like cross-fades, audio, pans and zooms and more. BASIC BUILDING BLOCKS FOR A PHOTO ESSAY Title sequence Opener (Opening image) Establishment, setup Buildup (= minor climax?) Counter story, Second situation Continuation Climax, Key Shot Resolution Closer (Closing Image) e.g. LIFE magazine 1948  "The Country Doctor" show young dedicated smart doctors like Dr Ceriani can handle everything without federal interference. Opening image -  rural doctor walk down a road, doctor's bag to house call. Closing image - modern surgeon exhausted after a late-night op but completely dedicated. (Code) www.michaelfreemanphoto.com

My draft script for this photo-essay STRUCTURE OF A PHOTO-ESSAY - ORAL TUMOURS 1. Opening shot - TUMOUR 2. Middle - Contents - Diagnosis and treatment 3. Closing Shot -  NO TUMOUR 4. Key Shots x 2 5. Theme - Be Kind To Older Pets - Examine her mouth weekly The older dog is a family member. Externally groomed, eats and drinks normally Mouth seldom examined A lump appears. It grows bigger and bigger Is it cancerous? Doubles in size within a week. Likely to be cancerous. How to find out? Anaesthetic risks in old dogs. Blood test to screen health. Health OK. Take the risk. Yes. Biopsy as recommended by the vet professors during undergraduate studies. This is the usual practice. No. Fast growing tumour may be malignant. Anaesthesia. What type? Intubation normally. But this endotracheal tube blocks the view. IV Anaesthesia. Effective? Yes if you know the dosage. 50% will do. Electro-surgical excision including extraction of teeth Send to lab for histopathology  -  Squamous papilloma. So not an epulis. Good news. Not cancerous. Goes home happy owner. Examine your older dog's mouth weekly for oral tumours THE PHOT0-ESSAY IS SHOWN BELOW:   The older dog is a family member for most Singaporeans nowadays. Visits to groomers regularly, good food, dog treats of various brands and plenty of water available at all times. The dog's mouth is seldom examined by most dog owners and bad breath is usually tolerated.  Dental check ups are not usually done and the rotten teeth drop out and oral tumours develop in many dogs that are now not so much cared for as they are much older.  The older dog is always happy to greet the owner and is a good companion to the senior citizen parents and retirees.   PROBLEM.  One day, the owners of a male, 10-year-old Cavalier King Charles saw a pinkish lump appearing on the front of the lower jaw covering two of the front teeth. It grows bigger and bigger. "Is it cancerous?" the owners asked Dr Daniel and me.  "If it doubles in size within a week, it is likely to be cancerous," the vet said. How to find out whether it is cancerous? What can I do to resolve the dog's oral tumour problem?   CONFLICTS NO. 1. Biopsy as recommended by the vet professors during undergraduate studies will be adopted by most vets especially the recent graduates. This is the standard practice as taught in the University. A small piece of the oral tumour is cut out and send to the laboratory for analysis of its type - cancerous or benign? If the biopsy shows that it is not cancerous, then, there is "no" need to do any surgery. But biopsy takes time and involves anaesthesia. Sometimes as long as 7 - 14 days. Not much time is available in this case as the tumour was said to be fast growing. It may be malignant and must be excised within 24 hours.   CONFLICTS NO. 2. Anaesthetic risks are much higher in old dogs. There is always the possibility that the older dog may die on the operating table. "I advise a blood test to screen the health of the Cavalier King Charles," Dr Daniel said. "OK," the patriarch said. The owners must consent to take the anaesthetic risk and they gave permission for the surgery.   Anaesthesia. What type? Intubation is normally done as there will be dental scaling after surgery. This will take up to 30 minutes of operating time. CONFLICTS NO. 3.  But this endotracheal tube blocks the operating view. "IV Anaesthesia is the best," I said to Dr Daniel. Will this be effective? Yes if you know how to use the appropriate drugs. The dosage must be just sufficient for surgery but safe for the older dog.  50% of the Domitor & Ketamine IV formula was used in this case SOLUTION - Electro-surgical excision including extraction of 3 incisor teeth enclosed by the papilloma. The owner consented for the gum tumour to be sent to lab for histopathology  - a microscopic examination of the tumour to check its cells as to whether the tumour is cancerous or note. Lab Report:  Squamous papilloma. So it is not an epulis as I thought it would be except that it had various finger-like projections as in a wart. The owner was happy with the good news. Not cancerous.     CONCLUSION.  The dog goes home 24 hours after surgery on the next day. There was no more gum bleeding.  BE KIND TO YOUR OLDER DOG.  EXAMINE YOUR OLDER DOG'S MOUTH WEEKLY FOR ORAL TUMOURS. SMALL TUMOURS ARE EASIER TO REMOVE AND THERE IS A MUCH LOWER ANAESTHETIC RISK. END OF PHOTO-ESSAY ------------------------------------------------- Wednesday, August 1, 2012 Blog No. 1022. The Cavalier King Charles has a gum tumour that grows very fast Aug 1, 2012 Cavalier King Charles, Male, 10 years "Most likely cancerous," I said to the owners of a gentle distinguished-looking Cavalier King Charles . "If a gum tumour doubles in size every week, it is cancerous and needs early removal." Blood tests were not normal. Surgery was done the next day. Unlike the Lab Retriever's epulis which is usually not cancerous unless it is an acanthomatous epulis. This case seems to be poor prognosis. Electro-surgery by Dr Daniel. "Transect at least 2 mm from the tumour and remove the entombed incisors," I said. The owner agreed to sending the tumour to the lab for check whether it is cancerous or not. BLOOD TESTS Total WCC  17.8 (6-17) N 81%, L 15%, M 3.2%, E 0%, B 0.4%. Indicative of a bacterial infection going on. RBC 5.6 (5.5 - 8.5) Platelets 81 (200-500). No platelet clumps seen but few giant platelets present. HISTOPATHOLOGY Squamous papilloma with reactive atypia and chronic inflammation. No definite dysplasia or malignancy. Good news for the owner. However, the papilloma may return as it is extremely difficult to completely excise it. ANAESTHESIA & ELECTRO-SURGERY The old dog survived the anaesthesia and that was what counted for the owners. Dom + Ket at 25% was sufficient for electro-surgical excision. "No intubation, as we need good access to the gingival tumour and to excise all, if possible. It is growing fast."  Dental scaling was done too. Older dogs must be checked by the owner daily and any mouth tumour be removed when it is small. In this case, the tongue covered the papilloma till it became chronically infected and swollen. It could have existed for some weeks without the owner seeing it. ---------------------- 16 jun 2021. instagram pics. photo essay.

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http://www.sinpets.com/dogs/20120725squamous_papilloma_older_Cavalier_King_Charles_toapayohvets.htm

An old dog is much loved, usually by the elderly mother, providing companionship while the children are out most of the time. “What is that fast-growing lump on the front lower gum enclosing the three teeth?”

DIAGNOSIS

An oral papilloma.
1. Cancerous or not
2. Fast growing
3. Biopsy

     

      PROBLEMS - Anaesthetic death

     

SOLUTION
1. Surgery only option.

1. Procedures:  1.1  Health check.  

                            1.2 Gas or IV anaesthesia.

                            1.3  Dental work

TREATMENT
Surgical excision - scalpel blade or electro-excision

CONCLUSION

1. Lab test - not cancerous

2. Follow up. 

3. Outcome excellent
   
   

4. Prevention - weekly check up of mouth. Tooth brushing.

1031. Singapore bats - do they have rabies?

 On Thu, Aug 9, 2012 at 12:57 AM, Harpreet wrote:

Hi just wondering if the bats around my house can pass rabies to my dog!! Why no rabies vaccine in Singapore??

Sent from my iPad

E-MAIL REPLY FROM SINGAPORE DATED AUG 9, 2012

Presently, Singapore is free from rabies. There have been no rabies in people and animals including bats. Therefore, local dogs are not permitted rabies vaccine. Rabies vaccine is available in Singapore and is permitted for dogs that are exported and therefore  need to be vaccinated against rabies as required by the country of export. 

On Thu, Aug 9, 2012 at 1:24 PM, Harpreet Kaur  wrote:

But also if I want to put rabies vaccine just in case for my dog am I allowed? Cos there are too many bats around my house and just in case one of them has rabies ?

 

E-MAIL REPLY FROM SINGAPORE DATED AUG 12, 2012

Sorry, the authorities presently disallows rabies vaccinations in Singapore dogs

1030. Email about euthanasia

E-MAIL TO DR SING DATED JUL 25, 2012

Hi Judy,

I have a 17 yrs old dog and she is partially blind, cant hear much as well.

She whines alot and we feel it's a torture for her, so we have decided to put her to sleep.

May I know how much is the fees and if we can make an appointment for end of this month?

Cheers,

XXX

E-MAIL FROM DR SING DATED JUL 25, 2012

I am Dr Sing from Toa Payoh Vets. The cost is $60 for euthanasia. Cremation may be around $200 depending on the size and breed. Appointment ok for end of month. Pl phone 6254-3326.  

E-MAIL TO DR SING DATED JUL 25, 2012

	Jul 25
to me

Thank you Mr. Sing.