With heartlanders, the least cost veterinary medicine is practised. For one and a half months after the cat fainted from a blocked bladder, the white grey cat now had difficulty peeing for the last 5 days. Dr Daniel handled the case and he decided to catherise the urethra to unblock the bladder. There was great difficulty in catherisation. The cat had no complaints but she would stop feeding the 10 cans of C/D diet and feed other canned food since the C/D was expensive.
"Clear" urine leaked onto the table. "He was licking his penis," the owner said. I turned the cat upside down and noted that his penile tip was bright red. Clear urine dribbled onto the examination table.
I taught my new veterinary assistant Nai how to use the urine dipstick to check the urine for pH, SG, blood, protein, white cells and others. Nai is a young veterinarian graduated from Myanmar. He is new to this job and has lots to learn. It takes great patience to train a rookie from the internet generation. He would mumble in Myanmarese whenever I told him off for not doing a good job after I had taught him how it should be done. Many young people has a different mindset nowadays. They would do a task their own way and so needed to be supervised closely as a recordingsystem and process must be adhered to if the practice wants consistently a high standard of care.
One day I told him that he should quit as there are others who can speak good English. They have the advantage of being able to handle phone queries and client discharge. If he wanted to stay, he should not grumble as nobody wants to employ or train him if he has this attitude. "This is not your father's office," I said to him. Other practices would have sacked him.
Recently he understood that he had to change his mindset. Working in an established Singapore small animal practice like mine gave him the opportunity to see various cases and challenging surgeries as compared to working in a Yangon practice where it is difficult to handle complex cases due to financial constraints of the average pet owner. A cat spayed in Yangon costs S$20 which is at least 5 times cheaper than in Singapore. In 2 years, he would have gained much veterinary knowledge and would open his own clinic in Yangon. Presently there are around 100 small animal veterinary practices in Yangon from one of my sources. Singapore has more than 50.
Back to this cat. There was a need to cut medical costs as the owner was worried. In theory, this cat should be sedated and catherised as in the earlier incident.
To save costs, I gave injections to reduce pain and infection followed by oral antibiotics and 10 cans of C/D. The owner had complained that the C/D was costly as compared to the commercial canned foods.
It is like comparing apples to oranges. The C/D is specially formulated to prevent FLUTD (Feline Lower Urinary Tract Disease). .
The owner swore she had not fed the cat any dry food. But only canned food. But her other two cats were eating dry food. "Can you guarantee that this cat has not eaten any dry food?" I asked. She was not sure. Failure to comply with medical instructions lead to a recurrence of FLUTD.
This cat could have bladder stones but no X-rays were done to save money. If there is a 3rd recurrence, X-rays would have to be done.
Contrast this case to the other cat with bladder stone removed by me in an earlier report of these 2 cats. No news from the other cat at all. No problem. No news is good news.
See case at:
http://www.bekindtopets.com/stories/20130301cat_bladder_stones_toapayohvets.htm
Saturday, April 20, 2013
1377. Saturday's interesting cases. Let the cat see better. Horner's Syndrome in a young cat?
April 20, 2013 4.26pm NEX public library
Today is a bright sunny Saturday. At 9 am, I reviewed the two surgical cases done by Dr Daniel as he is off on Saturdays. Both will go home today. \
Case 1. Right Perineal hernia in an old male Pom. No more vomiting. The hernia repair tissues were weepy and the stitches were not holding well as the skin was gangrenous. The owner had waited 2 months. The dog had kidney disorder and vomited. The bladder was trapped inside the hernia and the dog could not poop. \
"Ensure the dog drinks at least 200 ml of water twice a day," I reminded the owner and offered to give her a 20-ml syringe. I escorted her to her car parked to the side of the surgery although she said no need to do so. Dr Daniel was not present and normally he would not have done it. Carrying a bigger-sized Pom and opening the car door would be difficult. She had a driver whom I mistook for her husband.
"Hand feed sufficient amount of food. Use clean water to flush away the blood and stools near the wound."
Case 2. This young cat of around one year old had a protruding 3rd eyelid since young. He came in to be neutered. The owner had sent it to another vet earlier. Then the kitten was treated by Dr Daniel for swollen conjunctivitis at the age of one month. The owner asked me what's wrong with the left eye? 3/4 of the eyeball was covered by a brown 3rd eyelid permanently. I could not see 60% of the eyeball and so I could not see the whole pupil.
I had not seen such an eye condition in my over 40 years of practice. "It could be a persistent 3rd eyelid," I said as it reminded me of the condition of "persistent pupillary membrane" in dogs. "During neuter and anaesthesia," a piece could be snipped off.
I discussed the case with Dr Daniel. He said: "This could be Horner's syndrome in the cat. The 3rd eyelid protrudes as the eyeball shrinks or is pulled inwards."
Horner's syndrome is due to brain injury. The upper eyelid droops (the upper eyelid is wet at the margin compared to the right eye). The eyeball does not look shrunken but then this is not so obvious. There should be miosis (constriction of the pupil) but I could not see the whole pupil as it is the eyeball is around 60% covered and only a slit of the pupil could be seen.
Somehow I don't think this is Horner's Syndrome although it has some of the elements. To me, it looks like a developmental defect with the dorsal upper end of the 3rd eyelid stretched out and fixed to the lateral canthus (see images). "The purpose of excising the 3rd eyelid is to let the cat see better," I said to Dr Daniel. He voiced his opinion that it would not work as the cat has a shrunkened eyeball and so the 3rd eyelid would still cover the eyeball due to muscular pull.
"We could test for intra-ocular eye pressure," I decided. "In any case, snip off the triangular piece between the upper and lower corners of the 3rd eyelid so that the cat can see as this area obstructs the vision of his pupil. Dr Daniel neutered the cat and did accordingly yesterday.
This morning, I looked forward to seeing whether this cat can see better. What do you think? I will let the images tell the story.
.
Today is a bright sunny Saturday. At 9 am, I reviewed the two surgical cases done by Dr Daniel as he is off on Saturdays. Both will go home today. \
Case 1. Right Perineal hernia in an old male Pom. No more vomiting. The hernia repair tissues were weepy and the stitches were not holding well as the skin was gangrenous. The owner had waited 2 months. The dog had kidney disorder and vomited. The bladder was trapped inside the hernia and the dog could not poop. \
"Ensure the dog drinks at least 200 ml of water twice a day," I reminded the owner and offered to give her a 20-ml syringe. I escorted her to her car parked to the side of the surgery although she said no need to do so. Dr Daniel was not present and normally he would not have done it. Carrying a bigger-sized Pom and opening the car door would be difficult. She had a driver whom I mistook for her husband.
"Hand feed sufficient amount of food. Use clean water to flush away the blood and stools near the wound."
Case 2. This young cat of around one year old had a protruding 3rd eyelid since young. He came in to be neutered. The owner had sent it to another vet earlier. Then the kitten was treated by Dr Daniel for swollen conjunctivitis at the age of one month. The owner asked me what's wrong with the left eye? 3/4 of the eyeball was covered by a brown 3rd eyelid permanently. I could not see 60% of the eyeball and so I could not see the whole pupil.
I had not seen such an eye condition in my over 40 years of practice. "It could be a persistent 3rd eyelid," I said as it reminded me of the condition of "persistent pupillary membrane" in dogs. "During neuter and anaesthesia," a piece could be snipped off.
I discussed the case with Dr Daniel. He said: "This could be Horner's syndrome in the cat. The 3rd eyelid protrudes as the eyeball shrinks or is pulled inwards."
Horner's syndrome is due to brain injury. The upper eyelid droops (the upper eyelid is wet at the margin compared to the right eye). The eyeball does not look shrunken but then this is not so obvious. There should be miosis (constriction of the pupil) but I could not see the whole pupil as it is the eyeball is around 60% covered and only a slit of the pupil could be seen.
Somehow I don't think this is Horner's Syndrome although it has some of the elements. To me, it looks like a developmental defect with the dorsal upper end of the 3rd eyelid stretched out and fixed to the lateral canthus (see images). "The purpose of excising the 3rd eyelid is to let the cat see better," I said to Dr Daniel. He voiced his opinion that it would not work as the cat has a shrunkened eyeball and so the 3rd eyelid would still cover the eyeball due to muscular pull.
"We could test for intra-ocular eye pressure," I decided. "In any case, snip off the triangular piece between the upper and lower corners of the 3rd eyelid so that the cat can see as this area obstructs the vision of his pupil. Dr Daniel neutered the cat and did accordingly yesterday.
This morning, I looked forward to seeing whether this cat can see better. What do you think? I will let the images tell the story.
.
1375. Talk to prospective undergraduate vets at Raffles Institution
EMAIL TO DR SING DATED APR 15, 2013
Dear Dr Daniel Sing and Dr Sing Kong Yuen,
|
Apr 15 (5 days ago)
 | | ||
| ||||
I
am Suzanne Ou, Chairperson of the Raffles Society of Biological
Sciences in Raffles Institution (Junior College). As the largest Science
Club CCA in RI, we aim to offer members a broad view of all fields of
Biology, as such, we hope to invite you down to for a talk on veterinary
sciences on 25th April 2013, Thursday, 5.30 - 6.30 pm.
As the seniors are preparing for A levels and
choosing a career path, we hope that you will be able to share about
what is it like being a vet as well as studying for it in university.
One of our alumni, Gina Ng, mentioned that her internship with your
clinic was very interesting, and we hope to know more about the
surgeries you conduct and about the cases you encounter.
We sincerely hope that both of you will be able to come and we look forward to your favourable reply.
Thank you!
Regards,
Suzanne Ou
Chairperson of Raffles Society of Biological Sciences
------------------------------------------------------------------------------------------------
Dear Dr Sing,
| Kong Yuen Sing |
| Apr 16 (4 days ago) | ||||||
|
2:57 PM (15 hours ago)
| | ||
| ||||
Thank
you for your reply and information! We will be faxing the official
invitation to your clinic for confirmation along with the information of
time and venue.
Would it be possible if he
were to share photos and videos of surgeries? We hope to be able to hear
your stories as well as for our members to get a better understanding
of the profession.
Thank you and we look forward to having Dr Daniel Sing to speak!
Thank you and we look forward to having Dr Daniel Sing to speak!
Regards,
Suzanne Ou
-----------------------------------
EMAIL FROM DR SING DATED APR 20, 2013 6.02 AM
to Suzanne, bcc: daniel
Pl confirm whether your people has facilities to show the following veterinary surgery and medicine educational videos (Emergency Caesarean section) videos directly from youtube to the audience?
The videos are:
http://www.youtube.com/watch?
http://www.youtube.com/watch?
http://www.youtube.com/watch?
Pl phone me at 9668 6468 rather than email as time is short.
Thank you.
1374. How to medicate your gasping turtle?
|
Apr 18 (2 days ago)
| | ||
| ||||
Dear Dr Sing,
I
brought my pet turtle Toe to you for treatment of pneumonia last Monday
(TP Ref. No. 44319; Invoice No. 21954) and I've followed your
instructions of quarantining it from swimming, basking for 30 min every
day, and feeding it with medicine by dripping near its food while it
eats.
I noticed that its appetite has improved significantly, but it still seems to gasp occasionally.
It still shows the swelling action in its throat area. It has not been easy feeding Toe with the antibiotics as it gets suspicious of its food and will avoid the water and food once it tastes the medicine. Hence I am not sure if it has been taking the medicine effectively.
I have yet to place it in a tank of water to see if it would be listing while swimming. Can you advise me on an effective way of feeding with with the medicine please? May I also know if it is necessary to get a basking lamp for the turtle in addition to the daily routine of basking in sunlight for 30 minutes every day? Thank you for your kind attention to this email.
I noticed that its appetite has improved significantly, but it still seems to gasp occasionally.
It still shows the swelling action in its throat area. It has not been easy feeding Toe with the antibiotics as it gets suspicious of its food and will avoid the water and food once it tastes the medicine. Hence I am not sure if it has been taking the medicine effectively.
I have yet to place it in a tank of water to see if it would be listing while swimming. Can you advise me on an effective way of feeding with with the medicine please? May I also know if it is necessary to get a basking lamp for the turtle in addition to the daily routine of basking in sunlight for 30 minutes every day? Thank you for your kind attention to this email.
Yours sincerely,
K
---------------------------------
EMAIL REPLY FROM DR SING DATED APR 20, 2013 5.45 AM
April 20, 2013.
I just got your email today Apr 20, 2013. Pl phone if you have queries instead of email or sms as I have numerous spam emails and have had missed out yours.
In reply, your turtle has a respiratory tract infection and is gasping for oxygen (gasping and throat swelling of dyspnoea). This infection is hard to treat because turtles dislike medication via the feed or water but yours seem to have taken some antibiotics.
Many young and old turtles die of respiratory infections owing to the owner's difficulty in compliance with medication at home. Yours appear to be a success story.
1, Injections are an alternative if they are bigger in size. In some cases,
2. I advised covering the nostrils with your finger and when the turtle opens its mouth to breathe, squirt the antibiotics into the front of the mouth, via an eye dropper or syringe. This method works sometimes.
3. A basking lamp will be good.
4. No swimming till the turtle has recovered fully. This may take a few weeks.
5. Ensure that the turtle is fed and given water daily.
Pl phone the Surgery if you have more queries rather than email. Best wishes.
Thursday, April 18, 2013
1373. Right perineal hernia in an old Pom
"It is your decision and judgment," I said to Dr Daniel. The male Pom had a hard swollen right perineal hernia and had not pooped for the last 2 days. Difficulty in urination. The swelling was bigger than an orange and the skin was cyanotic and shiny.
Dr Daniel felt that the bladder was obstructed while prolapsed inside this hernia and if the operation was not done, the dog would die.
"The rectal temp is below normal," I had advised IV drips, antibiotics and painkillers. It was an emergency surgery done after the IV drip and medication. The owner said the lump was like a marble two months ago, but ignored it till now.
POST OP
24 hours after surgery- I noted that the dog was not able to stand. He had pooped. Urine catherisation. relieved the bladder. His cyanotic skin near the anal area turned black as there was no more blood supply. Much of the other cyanotic and shiny skin were cut away as they were necrotic.
Dr Daniel felt that the bladder was obstructed while prolapsed inside this hernia and if the operation was not done, the dog would die.
"The rectal temp is below normal," I had advised IV drips, antibiotics and painkillers. It was an emergency surgery done after the IV drip and medication. The owner said the lump was like a marble two months ago, but ignored it till now.
POST OP
24 hours after surgery- I noted that the dog was not able to stand. He had pooped. Urine catherisation. relieved the bladder. His cyanotic skin near the anal area turned black as there was no more blood supply. Much of the other cyanotic and shiny skin were cut away as they were necrotic.
1372. Two new lumps above the old rabbit's left eyelid - sarcoma?
|
Apr 9 (8 days ago)
| | ||
| ||||
Hi Dr Sing,
my rabbit Xiaoban, has who had recently been to your clinic for removal of her sarcoma near her left eye.
Today
we
again felt a small spherical lump around 0.3-0.5cm in diameter big in
an area just a little higher up the previous area, this time its sitting
quite near the eye (just a little above the eyelid). Do you think we
should just bring her over this sun for you to take a look and discuss
what is best for her?
Otherwise
she is eating well and elated to be just reunited with her companion.
Her stitches are still there, has not dissolved yet, but since the boy
has no lower teeth, he can't do anything to it.
Regards,
A...
|
Apr 10 (7 days ago)
| | ||
| ||||
DISCUSSION WITH THE OWNER
APRIL 15, 2013
Female rabbit was spayed by me 8 years ago. "The next day, the rabbit jumped and was very active," the medical technician lady told me as I sent her friend and her home to Toa Payoh Lor 1. She came to take the rabbit home and since I was closing at 8 pm, I gave her a lift.
"How are the younger doctors in the General Hospital?" I asked. "Do they arrive late for work? Do they spend lots of time texting and viewing movies on their mobile phone or laptop? This is my observation of the staff who worked at Toa Payoh Vets.
"Yes, they do that. Sometimes text us too!" she said. "The senior doctors come to work early!"
"What makes a good doctor?" I asked when the two ladies was saying that there was one doctor who was a good doctor.
"He cares for his patient and waive off his fees for those in need," the medical technician said. "Sometimes we feel that we spent so much time on the patient and he just waived the charges!"
This female rabbit had no problem since spay, till recently. The two ladies had sent me an e-card of thanks some 8 years ago. I still have it somewhere.
Sarcoma diagnosed in upper eyelid (more cranial) was excised by Dr Daniel last month. Now the present 2 lumps under the skin above the upper eyelid have been excised and sent for histology.
The ladies brought up the fact that this rabbit had false pregnancy last year when I asked why a small area of the skin near the vulval area was bald. "Last year, her whole hind legs were as bald as a chicken! She chewed the hairs off as she had false pregnancy."
"No rabbit can have false pregnancy when she is spayed," I said.
"Well, the internet sites said it is possible. Even the House Rabbit website says so."
This is news to me. The younger generation of owners possess niche knowledge. I must check this out.
There is another rabbit which had jaw abscess. "How is he now?" I asked. "It is hard to tell one rabbit from another," I said. "I guess it is the same with people e.g. all Asians look the same to Caucasians?"
"We can tell," the ladies said. "He has no more jaw abscess after two treatments by your clinic. Maybe the rotten tooth root had dropped off! Every 8 weeks I clip his upper teeth as they overgrow. He has only one lower front teeth, deviated." These two rabbits in old age seem to require more info.
The ladies were waiting for me to finish my consultation on a guinea pig which had rapid breathing on that evening. They had palpated a lump on the left mandible, around 8 mm x 8 mm. "Could this be another sarcoma?" they asked. "It could be a developing jaw abscess," I palpated this lump which was absent in the right mandible.. The two rabbits were well loved.
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