1503. The wet market's provision shop operator

TOA PAYOH VETS toapayohvets.com Date:   14 July, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits A successful wet market provision store    Dr Sing Kong Yuen, BVMS (Glasgow), MRCVSDate:   14 July, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 Today Thursday July 4, 2013, I decided to visit the wet market and take some video of the scene at 6 am. I attended a real estate lecture on Outdoor Advertising and was told that signboards of hawkers and market operators are exempted from payment of fees. I thought every business must pay and pay but this is good.  The bright lights were switched on and there was no crowd. The fish mongers, pork and chicken and fruit sellers and the food stalls were open. The aquarium operators were just starting up. There were some empty stalls as many operators are senior citizens and may have retired. Suddenly, a man in his late 30s called me. Vincent could recognise me although the last time I patronise his provision shop stall was 5 years ago when he was at the temporary premises in the car park. A big fire had gutted the old market place and was being built. I was surprised to see him. My domestic worker had been buying the onions and garlic and stuff from him and so I guess he remembered me but to recognise me would be not possible. His stall was packed with provisions to the gills, providing a variety of goods. This means his business must be thriving, otherwise he would not stock a variety of goods. He has some good healthy stuff like non-salty small fish from Japan for omelette, Japanese mushrooms said to be insecticide free unlike those bitter China-originated mushrooms. "The plump sausages are from Hong Kong," he told me. "The thin dried ones are from Singapore as they are mostly lean meat and Singaporeans are health conscious." "What about the sausages used for char kway teow?" I asked. "The poorest quality type is used," he said.  I asked about his business. Two stalls each of around 100 sq ft would rent around $2,000/month. His fridge to keep some items would cost $300/month in electricity. "Do you intend to expand to a 3rd stall?" I noticed one stall had red banners indicating a new business. I asked him about that stall. "Not that stall separated from my stall by a walkway," he said. The takeover of a stall is $15,000 but one stall went for $25,000 in that stall you mentioned, as the buyer wanted it to store his goods. A middle-aged woman as a helper and a sister. A red line prohibits display of goods out of the line but this extra space is not practical as it is too narrow. I bought 8 items from him, totalling $34.00. The Japanese mushrooms, the export quality brown sauce, a bottle of brown beans to steam the type of fish used for nourishing Cantonese mothers after birth, fine Vermicelli from Thailand, curry paste packet from Vietnam? highly recommended by him, the smelly bean curd bottle from Taiwan to go with porridge and a can of barley. He has special rice for the thick porridge but I did not buy it. I did not buy the open sacks of barley from other countries but the canned one as there is less smell according to him. I was eating this brand as a child but seldom sees it nowadays. He had duck sausages inside his fridge for a client who walked in. He showed me the Australian abalones. What I thought were abalones inside the plastic bag hanging out were duck gizzards. The dried prawns were of a much better quality. The ikan bilis fishes look good. Overall, he seems to be selling better quality stuff. "Service is very important," he emphasized to me as he greeted his clients, mainly women. This was what he said to me 5 years ago. We had not met since and I thought he had gone out of business. His stalls are hidden further inside away from the main entrance. On passing by, one would see a seller of joss sticks and religious paraphernalia and would miss his stalls. He was sitting outside when I came videoing the joss sticks and called me. So that was how we met again. "Do you use Facebook to market your products?" "No need to," he had to start work at 5 am and finished at 2 pm. He had to source for goods 3x/week. He does not believe in social media marketing as he believes his clients are from his good service and in the neighbourhood. That is where he is mistaken. "If you have good stuff like the Hong Kong sausages, you should use the Facebook to advertise as many people may want to buy it and the internet will show the results of your product if you know how to use the social media. Do you sell Japanese Kinman sauce?" "No," he said. "The big supermarkets like NTUC prohibit the manufacturers to permit wet market provision shops to sell."  I was surprised as I thought Singapore advocates free market enterprise. By preventing small operators from being supplied, there is in effect a monopoly and price-fixing cartel. I hope this is not the case. I bought another premium brown sauce from him instead. Small wet market provision shop operators are usually senior citizens and I am surprised that Vincent is younger. There is another one competitor. This trade will die as the big supermarkets corner the business of provisions.             In Vincent's business, the social media will help considerably if he knows how to harness it. Together with his high energy, good service and niche products of good quality and advices, he will have no lack of the health conscious younger parents from further towns other than Ang Mo Kio. But it is very hard to change a person's mindset and time-consuming to maintain a Facebook page. Especially when the operator is not interested in social media. So I expect him to just provide excellent service and get loyal clientele from the aunties and housewives living in Ang Mo Kio Wet Market 628 area and earning a decent livelihood. Till the landlord increases his rentals or the big provision shops and supermarkets slash their prices. As it is, most young consumers just go to the air-conditioned supermarkets to shop and it is more important that the wet market provision store operator make use of social media to sustain his business.   Updates will be on this webpage: A successful provision store More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 Toa Payoh Vets Clinical Research

Copyright © Asiahomes All rights reserved. Revised: July 14, 2013 Toa Payoh Vets

1502. Trust & Audit Case & Clinical Research - Dissolving struvite stones - Golden Retriever, M, 4 years

This is a case study of using S/D diet to dissolve struvites in a Golden Retriever.  I will check on the size of the bladder stone as I have not seen the X-ray of Vet 1.

Vet 1 who x-rayed the dog and discovered a small bladder stone. The owner consulted Dr Daniel on  April 4, 2013 who advised a urine test to confirm struvites. Another urine test was performed one month later.

FIRST URINE TEST  April 5, 2013
pH  8  (5-8)
SG 1.030  (1.005-1.030)
Protein +
Urobilinogen +
Blood 3+
White blood cells 3
Red blood cells >2250
Epithelial cells 3
Bacteria Occasional
Crystals Triple phosphate +




SECOND URINE TEST  May 13, 2013
pH  9  (5-8)
SG 1.019  (1.005-1.030)
Protein 2+
Urobilinogen  Normal
Blood Nil
White blood cells 10
Red blood cells 0
Epithelial cells 0
Bacteria 2+
Crystals Amorphous phosphate 2+

FEEDING OF CANNED S/D
April 4, 2013  Canine C/D dry prescribed pending lst urine test.
April 20, 2013  S/D x 24 cans
April 27            S/D x 24 cans
May 11             S/D x 12 cans  (2nd urine test on May 13, 2013)
May 18             S/D x 12 cans"
Jun 27            S/D x 12 cans
Jul 4                S/D x 12 cans

A third urine test is being done today Jul 4, 2013.



CONCLUSION
It appears that the S/D is not working so far. S/D is recommended for 3 months but it is still early. I phoned the home and the husband answered. The wife came to buy the S/D and said it was already 3 months of trial but it wasn't.

"Did you feed any other food beside the canned S/D?" I asked.
"No," he said.
"Did you feed apples?"
"Yes," he said.
"Some chicken from the dining table?"
"Yes,"

There was no blood in the urine as evident in the 2nd urine test.
I advised strictly no other food or dog treats or vitamins and only S/D from now on. Plain water. Will wait and see.

Much depends on the size of the bladder stone and it may take several weeks to dissolve it. Clients do forget that they can't feed other types of food while on the S/D diet as illustrated in this case.

Taking out the bladder stone by surgery is often the better way to resolve the problem of blood in the urine. I have a feeling that the bladder stone is large (>5 mm across) and have asked the husband to email to me the X-ray.

1501.The panting 13-year-old Silkie Terrier - Right submandibular tumour has increased 4X in size

Lately I seem to be getting 13-year-old dogs and the white cat.
This Silkie Terrier is much loved as family members take time off to send the dog to me when she is sick.

On Jul 1, 2013, the father consulted me. The spayed female dog was panting for the past week.

HISTORY. This dog had a benign breast tumour (adeonoma) removed in Mar 29, 2010. She has a large submandibular lymph node on the right side and another breast tumour in Sep 2012 and fits started. The fits were controlled by anti-fits medication. She had panting and fits in Oct 13, 2012. I detected let heart murmurs and the dog was OK after treatment.

The anti-medication drugs were given once daily after stabilisation on two times per day but on  July 1, the dog had panting again. The right submandibular tumour had increased 4X, being much more distinct and most likely cancerous. Being such an old dog, I did not recommend surgical excision.  A blood test was done in Sep 27 2012 and in July 1, 2013.

In July 1, 2013, the platelet count was 843 (200-500) as compared to Sep 2012 when it was also high at 550, but not alarmingly high.  In July there was kidney disorder with urea 32.2 (4.2-6.3) and creatinine 195 (89-177). Other blood cell values were within the normal range.

So, what is the cause of this high platelet count and the panting?
The heart, loose stool gastroenteritis or insufficient fit medication? Financial restraints mean no further testing. I gave the heart medication, an IV drip and advised correct timing of the anti-fit medication.

On July 2, 2013, the next day I phoned the father at 6 pm. "Normal. Walking about," he said. "But not much appetite." This case is likely due to the spread of cancerous cells from the submandibular into the lungs and elsewhere but there is financial consideration so more tests cannot be done for heartlanders, a situation similar to the 13-year-old white cat with "obsessive grooming". 

Blood test is the minimum procedure to screen the old pet's health. Practisc of evidence-based wedicine gives the owner confidence and knowledge of what's wrong with their old pet. In old cats, sedation may be needed.  

 

1500. Dwarf hamster with corneal ulcer stained fluoresdein green

Left eye tearing. Has corneal ulcer as evident by the green fluroescein stain covering a vast area
Dwarf hamsters intensely dislike e-collars and will pull it off by hook or by crook!

Jaguar images for video production

1498. Myanmar stories: Advising a 37-year old father

Today I visited Khin Khin's office and met a 37-year-old Myanmar man who absented himself from work for 3 days at the vegetable wholesale market in Pasir Panjang. His agent was present. He had worked for around one month and wanted to go home. He had worked his first job at a car repossession shop taking images of re-possessed cars and being on overnight security duty but found the work too stressful as he dislike working with computers. So he quitted and got this job which required more manual work."

"I can't stand the boss," he said. "He shouts at me. I work from 6 pm to 3 pm the next day. I am very tired. I want to go home."

"The boss is an old man," the agent said. "Probably his children do not work with him and he is alone. He shouts as he may be busy and you would not hear him."

"Let him talk," I said to the agent as this man wanted to pour out his grievances. Life is not good for him.

"Do you have a wife and children in Yangon?" I asked.
"Yes," he said his wife worked as a phone operator and earned S$120 (6000 kyats) a month.  He has a 9-year-old daughter.
"So, you prefer to go home and be jobless?" I know it is extremely difficult to find a job esp. for a 37-year old man.  His fingers are rough from handling the boxes. He sends home S$700 a month.

"The most important thing is that the boss pays you at the end of the month. Did he do that?" I asked.

He nodded his head.
"Your daughter needs money to go to school. To buy pencils and books. Your $700 is a lot of help. So you want to go home and let your wife work?"

He seemed to reconsider. The boss had not sacked him because it is extremely hard to find replacement. Only the two Chinese Nationals seem to soldier on. "They need the money for their families at home," I said to this Myanmar man. "Otherwise, they would have left." The Chinese Nationals could communicate with the old man.

Before I left at 5.30 pm, I shook his hand and told him:
"Remember. You are a father first. A husband second. Don't think of yourself. There are dependents who need your money. When you stay on, you may find other better bosses and then you ask the agent to change jobs. Just like what my worker did. He worked for 2 years and when he got a better pay, he asked the agent quietly to apply for him the work pass! Be like him. Don't just quit when you are not happy. If you are back in Yangon, you can't go for interviews with better Singapore bosses and nobody will hire you."

Khin Khin's manager said: "Private companies don't like to hire ex-civil servants like him. They are hard to control."

He has decided to resume working.

The old Jack Russell coughs "to get attention"

"Dogs seldom if ever coughs to get human attention," I said to the gentleman whose 9-year-old female Jack Russell has been coughing for the last 3-4 months.

"She coughs when awake but not when she's sleeping," he said.  
"Could she be suffering from kennel cough?" he speculated.
"Unlikely as she had not been to boarding," I said. "Let me check the heart and lungs."
I used the stethoscope on the heart and lung areas. There were heart murmurs but the most notable sounds were wet swishing sounds called rales inside the lungs.
"Is she breathless after exercise?" I prescribed heart disease medications.
"Yes. How's the blood test results"

JUNE 30, 2013 BLOOD TEST RESULTS WERE "WHAT'S APP" TO HIM
SGOT/AST  96  (<81 p="">Urea 4.0 (4.2-6.3)
Creatinine 67 (89-177)
Platelets 91  (200-500)





"It is unusual to get platelets so low at 91," I said. Also, SGOT has increased to 96, indicating some liver inflammation or damage. "Did you feed Chinese drugs for the cough?"

"I fed the Chinese herbal cough medicine for one week," he said.
"Did it stop the coughing?"
"No," he said. I advised him to stop this Chinese medicine.


UPDATE ON JULY 2, 2013
I phoned at 7 pm to follow up.
"Is the dog still coughing?"
"Yes," he said. "But the cough is softer".
"Is she coughing a lot?"
"Once in a while."

The dog is much happier and so is the owner.

This case illustrates the danger of giving unknown Chinese herbal cough mixtures to dogs as the platelets have had dropped drastically due to toxaemia. Seldom do I get to see such low platelet count yet normal red and white blood cells in a coughing dog as most owners do not want blood test. But this dog was coughing 3-4 months and the blood test provides evidence of good health. Except for the low platelet count which would be lead to serious internal bleeding if the count drops much further as in people with dengue haemorrhagic shock syndrome which is fatal. 

1496. Update: Ventriculocordectomy - The barking Beagle

This morning, at 9 am,  the lady owner phoned to enquire about the dog. "He ate his canned food and can go home," I said. "No running around for the next 10 days. Give medication."

1495. Adhesive peritonitis and closed pyometra - a rare case in a 13-year-old Pom

TOA PAYOH VETS toapayohvets.com Date:   05 July, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits The old Pomeranian has adhesive peritonitis & closed pyometra     Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   05 July, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 1495. Adhesive peritonitis and closed pyometra - a rare case in a 13-year-old Pomeranian In my over 4 decades of practice in dogs and cats, I had never seen such a case of a "spider's web" of strands sticking intestines to the swollen uterus and the bladder to the uterine body. This shows that diseases of pyometra can present in various unexpected structures, adding to the challenges of veterinary surgery. In normal pyometra cases, no matter how swollen the uterus, it is always easy to pull them out. In this 13-year-old recumbent lifeless Pomeranian, I operated with Dr Daniel yesterday watching the isoflurane gas + O2 anaesthesia. Normally Dr Daniel can handle such an operation as this is a common problem in unspayed old female dogs. But I took over this emergency spay as I would be speedier and the shorter the anaesthestic, the higher chances of survival. The dog was put just on isoflurane gas mask and intubated. "No sedation must be given in such ill cases," I said to Dr Daniel. "The dog is practically lifeless and a small dose of isoflurane gas would be sufficient." The owner had consented to the surgery despite the odds as his wife and young adult son were for the gamble. "What are the chances of survival?" the father had asked me. "Very slim," I said. "It is either euthanasia, let the dog die on her own or take the surgery." I was not too keen on this type of high risk surgery and I would rather not let Dr Daniel stain his reputation on doing it. SAC - Speed, Accuracy and Completeness in this surgery will require experience and fortunately he did not need to do this surgery. This was an unusual rare case of closed pyometra. The whole abdomen was dry, as if there was a drought. In other dogs with pyometra, there is peritoneal fluid inside the abdomen and the organs are wet. In this dog, besides dryness, there are fibrin strands bundling up the swollen uterine horns such that a portion of the horns can be seen at any one time. On first incision, I saw a swollen portion of the right uterine horn . Normally I could hook it out with my forefinger and the rest of the uterine horn would follow. In this case, only this portion was exposed and I had to snip off the web of red fibrinous strands to loosen it. I had to extend my skin incision cranially by 2 cm and still had difficulty hooking it out. A younger vet would really be stressed out as this was out of the world experience. The parts of the left horn was stuck to the dry pinkish small intestines and I had to carefully separate the intestinal adhesions. The omental fat was practically non existent. After taking out the left uterine horn with its several lobes of reddish brown pus and thin walls likely to rupture anytime, I went for the right uterine horn. The cranial parts of the horns were buried deep inside as I could only see the caudal parts of smaller lobulated pieces. As I dissected away the intestinal and other adhesions, I saw a large swelling. "This is the right swollen kidney," I said to Dr Daniel. On further dissection, it was just another swollen lobule of the right uterine horn. I dissected away the adhesions. There was not an ounce of blood throughout this surgery. "What's the maintenance dose?" I asked Dr Daniel.. "Maintain at the lowest dose."  "0.25%," he said. "The dog is breathing normally. Any lower and the dog's breathing would increase." Overall, the whole uterus weighed 750 gram, packed with reddish brown fluid. The dog was still breathing slowly half an hour after the surgery and had an IV drip running. The dog was sleeping as before the surgery. I phoned the owner to inform him that the surgery was completed and the dog was still alive but barely. It was 8.33 pm when I went home with a worried heart. Chances of survival post op were not good. As at 9 am the next day, the dog passed away. The owner understood the challenges and was not angry. This was such an unusual case in that all organs had dried up entirely, as if the car engine oil has leaked out, leaving no oil inside to lubricate the engine parts. No glistening peritoneal fluid lubricating the organs and preventing them from sticking to each other. The thinning of the uterine walls indicated a long-standing infection and swelling of the uterine horns. Some lobules had shrunk, indicating leakage of toxins to the abdomen. The dog was said to have stopped heat for the past one year. She had heat last year. P.S Isoflurane + Oxygen were given for 26 minutes The first incision to last stitch was 28 minutes. Speed, Accuracy and Completeness still needed time.  A normal dog would wake up on completion of the last stitch and would need around 2% maintenance dose instead of 0.25%. The dog did not die on the operating table and was maintained on a IV drip post-operation.. No blood test was done as the owner was not in favour of it. I could diagnose closed pyometra in this thin dog as the gigantic uterine lobules could be felt easily with my hands as soft lumps. The chronic peritonitis could be due to the rupture of the toxins into the abdomen and the self-repair of the body to stick the omental fat into the holes over a period of time. This resulted in a "spider web" of fibrinous strands constricting the uterine horns and burying parts of the horns. So there were large and small uterine lobules  HISTORY July 1, 2013. The boarding kennel operator brought in the dog saying she was vomiting for the last 2 days. She was weak and unable to stand. However she was eating and during the past 7 days of boarding while the owners were overseas. The owners would return today. They took the gamble to operate although the chances of survival were slim. May 18, 2013 A right Mammary Gland 5 breast tumour was advised to be removed. Sep 15, 2012 Urine dribbling and breast tumour. Owner was advised about possible pyometra by my associate vet but did not want blood test done. Many owners in Singapore feel that the female dog should retain her reproductive system as in normal people. This dog was well loved and had her annual vaccination and dental work was done. Breast tumours and pyometra develop in older age. Treatment has to be done early when the dog is still alert, eating and drinking normally, to give a better chances of survival. TIPS It may be wise to get the female dog spayed when she is young so that she can live to a ripe old age without this closed pyometra problem. So much financial expenditure, sadness and worries can then be avoided. Even at an older age of 8 years, the healthy female dog can still be spayed safely but most Singapore owners are inert and don't see the need to spay her since she has no problems.   Updates will be on this webpage: http://www.sinpets.com/F6/20130705 closed_pyometra_peritonitis.htm More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 Toa Payoh Vets Clinical Research

Copyright © Asiahomes All rights reserved. Revised: July 05, 2013 Toa Payoh Vets

1494. Case of the Dakota cat --- A 13-year-old cat's "excessive grooming"

"Excessive grooming," the young lady brought in a recumbent white cat, female, 13 years.  "Not eating for the past 7 days."
The lower body of the cat was stained yellow with urine. This is not normal for any healthy cat. I felt an enlarged lump the size of a kidney or hairball in the anterior abdomen. She was very thin, severely dehydrated as her skin  folds stood up but temperature was normal at 38.1C. I gave the cat an enema but no stools were passed. The cat got angry after that.

What was the problem?
"Kidney failure," Dr Daniel told me based on colourless watery urine passed out.
"The owner has agreed to a blood test," I said that the cat needed a drip. "But the cat is very angry and fierce."
"Give Zoletil 50I M," I said. "Take blood from the jugular vein and the drip."
This cat weighed only 2.5 kg. 0.2 ml Zoletil IM sedated the cat fully.

The blood test showed:
urea 46.8 (7.2-10.8), creatinine 532 (71-160), glucose 10.2 (3.9-6), total white cell count 23.8 (5.5 -19.5) but neutrophils was 78% and absolute was 18.56. Platelets were 149 (300-800).

Blood test is important in aiding the diagnosis of kidney failure and satisfying the owners. Practise evidence-based medicine whenever possible, even in ferocious cats where blood taking will never be tolerated. Use safe sedation.

In conclusion, the "excessive grooming" was due to the cat trying to clean her belly of urine. She could not stand and so stained her lower half. After treatment for one day, the cat was standing now and the two ladies were quite happy when they took her home in the evening on Day 2.  However the cat needs to be on a special kidney diet. 

The owner phoned me back. The cat would only eat dry food. She had pooped one hard stool. "Any hair inside the stool?" I asked.
"No," she said. So the hard abdominal lump could be this hard stool.
"Did you bathe the cat and wash away the urine stain in the lower body?" I asked.

She had bathed his lower part. The cat was eating and had been drinking a lot. Thirst confirmed kidney disease. I advised slowly changing to the dry feline k/d diet which is meant for bad kidneys. So far, there is no vomiting and we hope for the best.