Tuesday, August 28, 2012

1063. Rainy morning and how many years of experience in spay

Tuesday, Aug 28, 2012

For the past months, I have been taking the bus 238 from the Toa Payoh bus interchange to outside the Polyclinic and then walking to the Surgery every weekday, at around 8.30 am. Today, it rained dogs and cats. I drank coffee at Ya Kun coffeeshop and waited till 9am.

It is important for a vet to be around to answer phone calls as many are technical questions. I usually attended to the phone calls instead of leaving them to the receptionist and there have been good responses in the sense that the new clients come for treatment after knowing the technical details which a receptionist will never be able to advise with authority.

However, this morning I received a most direct phone call with the following questions from a lady who wanted her 2-year-old Maltese to be spayed by an experienced vet.

1. Do you have an experienced vet to spay my dog?
2. How long is the spay operation?
3. How long is the whole process?
4. Can I bring her to spay and wait?
5. Can I bathe her?
6. How long will she recover from spay?
7. Since she eats several times a day, how is she going to eat after spay and not starve to death?
8. Can I spay her on Saturday or Sunday?
9. How many years of experience do you have?

ANSWERS
1. We do have experienced vets like Dr Jason Teo, Dr Vanessa Lin and myself (Dr Sing Kong Yuen).
2. For experienced vets, it should take less than 15 minutes for the surgery.
3. The whole process should take less than 30 minutes if there are no complications.
4. The owner can't wait and take the dog home immediately. The dog has to rest and recover for the next 3 hours post-op. "Sometimes, the dog may die during transportation as the dog is not fully normal," I said. "Really?" the caller asked. "The blood and body systems need to stablise after anaesthesia and that would take at least 3 hours of rest."
5. Yes if she covered the op area.
6. Around 10 days normally and without complications and infections.
7. The dog would not eat for the first 24-48 hours after spay and would not starve to death.
8. Best time to spay the dog is on weekdays as the weekends are usually busy. Make an appointment one day before. No food and water after 10 pm the previous day.
9. I have around 30 years of experience.



1062. Antisedan is the antidote to be given routinely

"No point giving Antisedan," Dr Daniel was behind me and saw the deep purplish blue tongue tip of the 8-year-old Jack Russell as I was making a post-op check on this beloved dog of a lady in her 30s. "The dog has died."

"Get the dog out of the cage," I said but did not waste time informing him that I could see the dog's eye flickering, meaning he is still alive. "I am getting the Antisedan injection." 30 minutes ago, the dog had 75% of my Dom+Ketamine IV formula and had dental scaling and ear irrigation. I did the ear irrigation personally as that was what the owner wanted me to handle her dog's ear itchiness problem which had persisted for the last 2 months after Vet 1 had been consulted and given her ear drops. The 8-year-old female Jack Russell was still scratching her ears and dark black pigment and rough skin developed near the ear canal opening.
Many of my old clients had disappeared as proximity is important for them since around 50 vet clinics have been opened in recent years. I checked my case records.

In Oct 30, 2005, this dog had vaccination and false pregnancy. No more visit till Mar 5, 2008 when I diagnosed false pregnancy as there was milk. "My dog had ear infection and you had treated her successfully," the lady said. Dog owners always remembered their pet's medical history and the vet who can deliver results and those who failed them. It is a tough competitive world in Singapore vet medicine and all over the world in 2012!

I reviewed my case sheets. Sure enough. In August 17, 2009, I did an ear irrigation of the left ear otitis externa and teeth scaling as well as vaccination and deworming. "Left ear drawing - I wrote "red+, pus, 1 week".

In Dec 13, 2009, I treated the dog for inflamed D3/D4 interdigital right hind lameness. That meant the ears were no problem anymore.

So, that was why she came to consult me after 2 months of ear drops cleaning from Vet 1.

Back to the present situation, I injected Antisedan 0. 4 ml IM. The dog was walking and OK. I went out to buy surgical equipment and the surgical gloves at Jalan Besar. Later, the lady came and was most happy to see her dog. The dog's tongue was pink. As to why the tongue tip which protruding out and in between the teeth turned cyanotic, I don't know. The dog was resting on her chest and the head was on her paws. The teeth clamped on the protruding tongue tip. Cyanotic tongue colour meant no oxygen flow and in that stage, it would lead to death.

From now, I would insist on Antisedan to be given routinely. As the associate vets have their own judgment, they don't usually given Antisedan. I had advised but each vet has his or her own ideas as do all doctors. This case showed the importance of Antisedan as there would be no such drama if the associate vet under my mentorship had given Antisedan routinely as instructed by me.

It is not necessary to give Antisedan reversal in all cases, but in old dogs, this should be done. But my associate vets sometimes do it and sometimes don't and this case clearly illustrated the importance of getting the antidote and letting the dog recover faster from sedation.  




Monday, August 27, 2012

1061. Sunday Aug 26, 2012's interesting cases

I was away in Hong Kong from last Monday to Friday. So, I had to catch up with my admin work on Saturday morning. Sunday was a bright sunshine day.

CASE 1. Rabbit abscess
A vet (Vet 1) told the young couple today, that she was too busy to operate on their rabbit's abscess and gave some injections and medication. They could phone her on Monday to make an appointment a week later. I would have just asked the couple to go to another vet as abscesses will enlarge with time. So, the couple came to consult me and told me their encounter. Sundays are always busy for vets. I had 2 cat spays (noisy caterwauling), one dog spay booked in and I know that another associate vet would have to operate on the closed pyometra Schnauzer suffering from post-op complications of stitch breakdown. There were clinical cases waiting too.

The young couple were knowledgeable about the rabbit abscesses as they had surfed the internet and so it was easy for me. "The abscess would recur," the husband said. "Sometimes," I said. "It depends on whether the tooth root is still infected. Do you want an X-ray done?"

The rabbit was a gentle brown sturdy creature. Isoflurane gas by mask.
"Anaesthesia must be short and surgery must be fast," I said to Dr Daniel who was present. "Rabbits may die if anaesthesia is prolonged, although not every rabbit will be affected."
I incise the skin, undermine the subcutaneous and a big bulge popped out. "It looks like a tumour," Dr Daniel said. "There are numerous blood vessels and nerves in this neck area." The abscess was at the angle of the jaw near to the neck.

"Get a syringe and 18G needle to aspirate the abscess," I did not rule out tumour in this young rabbit, but the most common condition is abscess. Dr Daniel drew out 0.1 ml of yellow cheesy stuff and then nothing. I incised the muscles of the abscess which was 3/4 size of a golf ball. Thick cheesy yellow pus spurted out. The rabbit squealed as the anaesthesia was just sufficient. I top up the anaesthesia again and completed the pus aspiration within 2 minutes. I informed the owner who had earlier come again with the rabbit's pelleted food, squarish glass bowl, log of hay and his packet of white treats.

Rabbits are family members, just like dogs and in this case, this rabbit was free to roam around the apartment. As a new baby was present, the rabbit's old litter box was discarded and the rabbit lost interested in eating the hay. "We can't find another," the husband said. "Well, it may be the smell of the box," I said. "A new one may not help. Hay is good for rabbits."

In retrospect, as I review the case now, at 10.07 am on Monday, the cause of not eating hay or food could be the cheek abscess being formed. This lead to pain. "Did the rabbit eat after Vet 1 gave the injection?" I asked. "Yes," the couple said.

Large rabbit abscess are best operated as soon as possible. But Sundays are hectic days. Some vets may not wish to operate during lunch breaks as staff also need to rest. Much depends on the vets and the staff's attitude and their caseload.

Sunday, August 26, 2012

1060. Follow up: Another Beijing hamster with a fast growing lump

EMAIL TO DR SING DATED AUG 21, 2012
Hi Dr Sing,
Thank you very much for your time to reply. I will discuss this with the vet accordingly.
I'm very sorry I will have to trouble you with another question for my other hamster Yoda. He is also 2+ years old, currently on Itraconazole treating a recurring fungal infection (ringworm).
I noticed he had a soft moveable lump underneath (from chest to flank) him early this week and yesterday we went to the vet. The lump wasn't noticeable 2 weeks ago.
Attached is the pics of him, you can see part of the lump. Unfortunately this is the best shot I could get of him.
My hamster went under isofluorane over his head for almost 4-5 mins (I think this was too much?) and the vet aspirate very very little liquid from the lump. It is not blood.
The samples was sent to the lab but it will take about 10 days before we know what it is.
I'm afraid with the lump will be much bigger by then and the risk to remove it is higher.
Is there an absolute need to wait for the results from the lab before surgery? Or can we do an xray or ultrasound to determine more?

Would you please be so kind to advise me. I will present your reply to my vet and I'm desperate to cure Yoda's condition before it gets worse.
Appreciate your reply, thank you again.
Name of owner


 EMAIL TO DR SING DATED AUG 22, 2012
As each vet has his or her own professional opinion on how to treat a hamster case, it is best you do not impose my advices onto your vet as he or she may be most unhappy.

From my knowledge with the younger vets trained overseas, usually in Australia, I note that the vets have been trained to take a biopsy of the tumour first, send to the laboratory to check whether it is cancerous or not. Then they will advise further. Unfortunately, the lab results may take over 7-14 days. But it can take one day, depending on the laboratory. The owner may also procrastinate. Soon, the tumour, if malignant, grows fast and becomes inoperable in a small creature, like the dwarf hamster's subcutaneous tumour, as that was probably present in your hamster.

My approach is to take out the tumour early, send to the laboratory for histopathology after surgical removal. As each vet has his or her own idea on what to do, the fate of a pet depends on the action of the vet consulted and on the pro-activeness and knowledge of the owner.

I am presently in Hong Kong and may not reply to you. My advice is still to be pro-active to seek a vet who is comfortable with hamster anaesthesia and surgery. Best wishes. 

Saturday, August 25, 2012

Common cancers in dogs

According to the National Canine Cancer Foundation (USA), 1 out of every 3 dogs get cancer which is fatal in >50% of the cancer cases.

COMMON CANCERS

1. Lymphoma. Cancer of lymphocytes - the immune system cells. Swollen lymph nodes, skin lesions, mass in the abdomen. Usually detect by owner or groomer - lump around the neck, in front of the shoulder or behind the knee. Chemotherapy can extend life and make the dog feel better and eat.

2. Mast cell tumours. 20% of the skin lumps and bumps. May be localised or metastasize (spread throughout body). If not spread, surgical removal witho or without radiation is sufficient.

3. Osteosarcoma. Bone cancer. Long leg bones of large dogs. Amputation and chemotherapy. Signs - limping. Usually has spread when discovered.

4. Skin cancer. Melanoma and squamous cell carcinoma most common. If latter occurs in the mouth or toes, it is more aggressive.
5. Soft tissue sarcoma. Various cancers of the connective tissue. Locally aggressive. Recur as it sends tendrils of tumour cells. Surgery and radiation but recurrence is common. E.g. Haemangiosarcoma usually spreads from spleen. No symptoms till advanced. Spleen removal plus chemotherapy b ut less than one year of life.

6. Mammary cancer. Common in unspayed female dogs and those spayed after the first or second hea. 50% are malignant. Multiple glands. Early detection, simple surgery.

TREATMENT
Diagnosed, graded and stage. Low, intermediate and high grade cancers.
Grade - how much cancer has spread.
Staging - Tests done - blood test, chest X-rays, abdominal ultrasound, CT scans.
Treatment - type and stage of cancer. Those that behave locally are treated with surgery and radiation. Systemic cancers or those that have spread - chemotherapy, including steroids or non-steroids and immunotherapy. Option not to treat - quality of life - palliative care focused on symptom pain relief rather than cure - lower radiation doses, pain killers, steroids, holistic care including acupuncture and herbal medicine.
Immunotherapy - e.g melanoma vaccine. Needs to wait.

PROGNOSIS
Each dog is unique. Hard to predict.
Malignant cancers that can be completely removed - best chance
Aggressive systemic cancers like lyphoma, osteosarcoma and haemangiosarcoma - poorer prognosis.    

Friday, August 24, 2012

1058. TRAVEL STORIES by Dr Sing. Adding value to your employer's services.

TRAVEL STORIES BY DR SING K Y.
Adding value to your employer's services. 2 case studies.

 
Macau
Aug 22, 2012

EMPLOYEES WHO ADD VALUE TO THEIR EMPLOYERS - Gondola singers

This is my first one-night stay at The Venetian Macao but my 2nd visit. 
 
I had a beautiful view of the new competitor, Galaxy Integrated Resort, from my 30th floor window, South Wing. The view just reminds me that competition increases over time and there will be better equipped and richer competitors to beat the incumbent as well as taking business away from the smaller players. 
 
 The Venetian Macao has many tourist attractions especially the enclosed shopping area with branded fashion shops and an artificial sky and so tour groups have something to show the visitors. The new Galaxy Macau across the road has laser shows of crystals and singers performing on the stage inside the casinos.
 
 
 
 


 


Galaxy Macau Hotel provides 20 minutes free wireless internet access in its surroundings ground floor and a bus service to and from The Venetian Macao to its place across the road. The Venetian Macao charges $160/hour internet access in the room and does not provide complimentary wireless internet services unlike Hotel Panorama in Hong Kong. The Hotel Panorama is a 4-star hotel which charges $100/hour in the room but has free unlimited access in its lobby.



Case Study 1. I have some pictures of employees who add value to their employers. 
 
One example is the Macau tour guide I saw in the Venetian Macao. She was my Hong Kong guide during my last 2 visits to Macau. It was such a coincidence that I saw her snapping pictures for her tour group in the Venetian Macao in which she would bring tourists to view. 
 
Tour guides need not bother volunteering photography for clients but she knew that the whole group would not be able to have a group photography without her. So she snapped photos for the group and for individuals.
 





 


   
   
 
 Travel: Macau - The Venetian Macao's singing gondola rowers. Excellent added-value services from employees
This Macau tour guide was happy doing photography for her clients. I did not impose myself on her. She was in a hurry to go somewhere. 
 
 

 
 
 
 
 
 
 
At the Venetian Macao, I heard loud singing from some of the gondola rowers as they work at making the boat experience enjoyable. I don't hear singing amongst the original gondola rowers in Venice or those at the Marina Bay Sands Singapore. The audience clapped their hands in appreciation in this case.

Employees who add value to their employers are rare as it is not easy and is time-consuming to connect with the clients. These employees will be in great demand and will earn more in time to come as their reputation spreads to other prospective predatory headhunters and employers!
 
 
In the end, it is still the service and performance of the employees that count in sustaining the business. Provided the new businesses don't go bankrupt due to lack of revenues and capital to survive the start up period.  Managing the talented employees is not easy as experienced ones are "in demand."
















1057. Toilet training an adult male dog - urine & poop marking?

Need Advise on Toilet training
EMAIL TO DR SING AUG 21, 2012


Hi Dr Sing,
I have recently purchased a Pomeranian (9 months). I was hesitant at first as it was a male and was worried about it marking... 2 months have passed and I can only say that it hasn’t progressed much…I am writing to you as i know you have recommended to many in your blogs etc. and also that my Mom's Scnhauzer is actually seeing you for its skin problem.
Noting that this puppy would have spent 9 months in a cage and all things done inside it (Pee, Poo, Play, Eat, Sleep) I went on a reading spree and tried to gather as much information I could to rectify its toilet training. I have bought a pee pan… those elevated meaning it would not soil its own paws with urine.
The setup at my place is as such. The dog is confined to my bathroom in the shower area. Let’s just visualize. Drawing a square. Divide the square into 9 smaller sections equally and in running order.. Top left being quadrant 1, middle is quadrant 2 and top right is quadrant 3.. So the dog is kept in the shower area… quadrant 2,3,5,6… quadrant 1 is the toilet bowl… quadrant 9 is the sink.. The rest is open area.

For about a month, its in the shower area with 80% covered by pee pan.. it poos and pees on it.. but it steps all over it and dirties itself.. 1 full month of  cleaning up everyday after a long day at work. (I was telling myself I needed to be patient)2nd month still no progress.

So a little background to my daily schedule… 7pm – 8pm dinner and at around 9.45pm – 10pm it goes down for its walk… (dog only urinates but doesn’t poo) Then water bottle is removed before I sleep. IT defecates twice.. and pees a number of times… from 8am – 7pm all of us are working and it is confined to that area. Feeding takes place in that area and also the sleeping.
So till now, it still pees and poos outside of the shower area and on the floor.. and it steps and sometimes even lie on its own poo… considering 9 months of ingrained behavior.. it is going to be a daunting task for me.

I am considering, feeding it outside of its confined area to disassociate feeding and playing is going to be same as peeing and pooing. Also I may have to factor in a morning walk.. (problem is it doesn’t do its business outside – so far only twice and its in the afternoon)

Is there any advise you can give? Also is my area to big? I seriously think that I might have to re-train and I am prepared to do so.. I am a little lost and have spent a fair bit getting those trainers to come access my place. And I am sad to say it isn’t working.. My dog is not neutered. It’s about 10.5 months old now. I have also tried laying newspaper all over and it just ends up shredding and making a mess. I am committed to training my puppy and I wish that I could be a good owner and master.





EMAIL REPLY FROM DR SING DATED AUG 24, 2011 
Aug 24, 2012 HK Hotel Panorama lobby lst floor. 7.16am

Hi
Thank you for your email. I am still in Hong Kong today and will be back this evening.

My comments are as follows:

1. Age of dog. Your dog is no longer a puppy. His male hormones have made him a "rebellious" adolescent equivalent. Therefore, it will difficult to train unlike a 3-month old puppy with an impressionable mind, generally. You may need to neuter him.

2.  He has been lying in soiled areas inside a confined cage (in a pet shop?) before you purchased him and so his "cleanliness" instinct had disappeared.

3. A different method of toilet-training may be needed. The following is just my suggestion as each dog is unique and there is no fixed guideline in toilet-training an adult dog.

Assuming the use of a formula of "N-1" where N=number of years, your 9-month-old dog should be taken out of a confined crate with pee pan, to pee and poo every 8 hourly. In your case, I would advise close monitoring as to his elimination habits and time. Take him out to eliminate every 6-hourly. This is not practical if you are working and nobody is at home. That means asking a friend to do it during lunch-time, for example. 

In this method, the dog is fed and then taken outdoors to a place where he can smell his urine/poop daily. Usually this is done after eating or after waking up. This depends on your observation and time. A regular fixed time and routine. Lots of peserverance. Reward with food treat or praises every time on success. If your dog loves food treats, it will be much easier.

4. Urine marking or poop marking. It is most likely that your male dog is urine-marking or poop-marking as well. To you, he is not toilet-trained. Therefore, you have not succeeded despite hard work. Neuter him as soon as possible. Neutralise urine smell of flooring and confine to a crate as a start. There needs to be a fixed routine of eating, drinking and elimination every day till you succeed. But if you have no time, you need help to do the lunch-time training.

5. Alternatively, send him to a professional dog trainer who knows about toilet training. A boarding kennel  operator (dog must have proper vaccinations) or  trainer's home. You may get good results but you need to continue the routine at home for many weeks after successful training by outsiders.

I hope my advice is practical and useful.