1489. A continuously barking Beagle

The neighbour was most unhappy. The Beagle really would bark the whole day, even at the Surgery. It is a very difficult situation. The dog had been neutered but he continued his random loud barking many times a day. Devocalisation was the one solution.

1506. Update: Two old cat owners who care very much to feed special diet.

July 6, 2013

Many Singapore cat owners don't bother with the old cats when they get sick and not eating. After all, they are old. There are a few old cat owners who care very much. Yesterday I met two of them.

The gentleman in his late 30s phoned to buy the feline C/D food for his old cat that had bladder stones removed some weeks ago. "Be fast," I told my assistant. "The owner is a very busy man." He is a business man and there are not enough hours in the day. "Do you have a bigger bag?" he asked me. "I order the 2-kg bag as you had taken one before," I said. "Take two of the bags. Next time, I will stock the 4-kg bag." The cat was OK and so he did not say much. He has a vet near his apartment and I have asked him to order from the vet but he did not do so. Probably he needed a prescription from me but I told him I could phone the vet.  

A young lady in her late 30s had the 13-year-old white cat from Dakota. She had brought in the cat for not eating and had diagnosed "obsessive grooming." The thin cat became ferocious after my enema treatment and injections. Dr Daniel sedated her and got a blood sample from the jugular vein. The owner had given permission for a blood test and so the vet has to deliver. No excuses of ferocity. This evidence-based medicine must be practised. I palpated a hard lump in mid-abdomen and thought it was a hairball. The cat pooped a hard piece of stool later at home and so this could be the hard lump. The blood test showed kidney disorder and so I advised the lady to feed the cat feline K/D. She ordered a bag and so came today, Thursday. The supplier deliver on Thursday. I don't stock extra since many Singaporeans are still not well educated or willing to spend money to feed prescription diets and the stocks expire.

Since Dakota is quite far from Toa Payoh, I said: "You can get it from the vet near your apartment."
"The vet did not want to prescribe unless she has examined the cat. Do you have a bigger bag?" she was given a 2-kg feline K/D dry food as her cat eats only dry food.
"How long it takes her to eat 2 kg?" I asked.
"Three weeks."
"I will order the bigger bag next time," I said.
"How's the cat?"
"Eating and jumping," she said. "Is there a need for a follow up check?"
"Not necessary unless the cat has vomiting or not well."
"Are there medication for her and is there a cure?"
"No," I said. "Just feed the K/D diet for the time being and enjoy her company."
When the vet can deliver evidence-based medicine and restore an old cat's health, it is always a happy moment for both the cat and the owner. Most of the time, owners delay treatment but in these 2 cat cases, the owners were very prompt in seeking treatment.

The pressure is on the vet to deliver an accurate diagnosis and operate if he or she wants to build up a goodwill. 

1505. Blood in the urine - efficiency and systematic examination

I had not seen this Silkie Terrier since 2005 when she was a puppy.  On Jul 3, 2013, she was presented with complaint of blood in the urine for the last 3 days. A systematic process is best for haematuria and the following is done by me.

1. History of blood in the urine recently.
2. Examination. Dog, 5.7 kg active but rectal temp is 39.8C. Palpation of bladder - no big stones, no abdominal pain or mass.
3. Urine sample collected by the owner in a clean fruit bottle as requested from me, to save time on  catherisation.
4. Dipstick to test urine pH, protein, blood, and SG.
5. No X-ray advised pending urine test to lower medical costs. This ought to be done.
6. Blood test

7. Antibiotic inj and pain killer.


DIPSTICK
Sometimes I don't do the urine dipstick but send the urine sample to the lab for a comprehensive testing. This time I did.
pH=8, SG=1.010, protein 3+, blood 3+

URINE TEST
Yellow turbid
pH = 9, SG=1.034, Protein +, Blood 3+, White blood cells = 0, Red blood cells 126, Bacteria 3+, Crystals triple phosphate +, Amorphous phosphate 3+

ADVICES
"Did you feed dry dog food?"
"No, I feed rice and meat usually. The dog disliked dry food many years ago." the wife said. "But the dog had been greedy and I fed a lot of dog treats."

1. S/D diet for 3 months.
2. Urine test monthly
3. X-rays advised.
4. Stop all treats and home-cooked food when feeding S/D diet.

Will the owner comply? Are there bladder stones inside the bladder and kidneys?
This case will be followed up. A systematic process will be efficient and productive.

1504. A seminar on outdoor advertising

On July 3, 2013, I attended a seminar on outdoor advertising for realtors. The slides presentation did not excite the small group of around 15 realtors. More images of actual signboard types in Hong Kong and Singapore will have been more interesting. There were the occasional images of signboards advertising new condo projects for sale. The others were illustrations of the height and width permissible by the BCA. Real life signboards will complement the illustrations and make the lecture so much more interesting. My friend could not keep awake but he asked the most questions since the lecturer did not have much queries.

"Why don't you produce a video so that the audience will not fall asleep?" I asked him later.   
"All these slides are approved by the CEA and it takes a long time and many rejections," he explained. "Nothing can be given in the lectures unless approved."

However, this lecturer is an excellent story teller as regards leadership and positive mental attitude. If only he can translate the stories into a video. For example, bungee jumping. He accepted the $100 from his friend who asked whether he was fearless. The next early morning, his friend drove him to a place which was cold. It was a bungee jumping point. His friend had paid for his bungee jumping. Tourists were clapping their hands. Boats were below to catch the bungee jumpers who fall into the fast flowing river.
"You can give me back the $100 but you must go to town and shave your head bald," the friend said.
"Shall I jump Titanic style or roll over?" he stretched out his hands to demonstrate the Titanic style.
It would be shameful in front of the tourist to roll over.
"So I walked along the plank and shouted "1, 2, 3,". The echoes came vibrating into my ears."
We expected him to jump at the count of 3 but he said, "I turned back."
His friend said: "You are to jump."
"What shall I do?" he asked us.
"I decided to ask the bungee man to shove me down when I count up to 3."
We waited for him to continue.
"When I shouted one, the bungee operator pushed me down. My heart was in my mouth. But after a while, I felt free and happy. I was laughing away."
We don't know whether to believe him or not but kept silent.

There was another story on how to stand out from the competitors in producing flyers. He had sat in a coffeeshop from 9 am to 5 pm to observe the behaviour of residents towards flyers in their letterboxes. The flyers were generic boring ones. The residents just discarded them.

One Malay agent asked for his advice on how to succeed in flyer advertisement..
"If you do what I tell you," he asked the agent to bob up his hair in the centre, coloured it yellow. Then he took a picture. He insertsd prison bars such that the agent's hands were holding the bars. On top of the rectangular advert, he put the words "WANTED". Below he wrote the details of the property. The response was overwhelming.    

He asked for two coins from us. I thought he was going to double the number. He placed the coins in his right hand but they disappeared after a few twists and turns of his hand in front of vigilant eyes. Magic always wake up the students.

He asked for a birth date to assess the personality. I volunteered mine. He totalled and it ended in number 4. "Four means die in Cantonese," I said to him.
"No, it means success, a pro-active person, very calm in situations of panic."
That was good news.
For Elvis Presley, his birth date ending in number 9 indicated a short but prosperous life. The number 9 is the last digit from 1-9 and that explained Elvis's fate of being rich and successful but living a short life.

The word ATTITUDE adds up to 100 if A=1 and you add up. A positive attitude is 100 or something to that effect.

At the end of the lecture, I thanked him for his stories. His lecture was good but his story telling was first class. 
   

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.