Yesterday I spoke to a young man who cares and loves his mum very much. She has high cholesterol level over the years, but kept quiet regarding the results of a recent blood test which this young man had persuaded her to do it when she went to the clinic with him as he had a general headache for some time.
"Mum, what the result of the cholesterol level done by Dr Chua?" he asked at the dining table.
"269," mum had not volunteered the result.
"Less than 200 is normal," I said. "Her anti-cholesterol medication is not working. As she is allergic to the statin which would be effective, she was given an alternative which did not work or she had not cut down on her fried food. So, heart attack would be impending."
The youg man persuaded his mum to go to the gym on last Saturday morning and she had done around one hour of exercise.
"Your mum will find excuses not to go," I told the young man if he does not accompany her. "Now that your mum is a senior citizen, she becomes a child. Previously your parents sent you to pre-school and then the school when you were young. Now you send her to S.O.E as she becomes the child in her golden years."
"What is S.O.E.?" he asked.
"Like S.O.T.A, it stands not for the School of The Arts, but for the School of Exercise. So you now are grown up and need to care for the health of the aged mum who does not like exercise complaining of the heat and humidity."
"What about the other child?" he asked.
"What other child?" I replied.
"My father."
"Your father does not need to swallow pills and tablets for high cholesterol or high blood pressure and so he does not need to go to the S.O.E on an urgent basis. He does not eat fried food and is careful of his diet."
Wednesday, September 25, 2013
1156. Cerebellar ataxia in a poodle, female, 6 years
Sep 24, 2013
The lady owner phoned me to ask whether her poodle should receive more medication.
"Is the dog's head still trembling a lot?" I asked her to send me a video by email.
"Much less," she was happy that the dog was eating and putting on weight. This was the dog that was diagnosed as needing glucosamine by Vet 1 and referred for CT scan by Vet 2 as the dog was shivering and trembling fast in her body and would not eat or drink.
The husband remembered me as I had successfully operated on a bladder stone in another poodle in 2009 and asked for another opinion as the referral vet would charge CT scans from $1500 - $2000.
"I remember seeing such a case in a sheep with Scrapie in Glasgow University in my 3rd year at Glasgow University as the lecturer was demonstrating one case," I said to Dr Daniel. "The sheep was trembling in his head and body. In this dog, I would say she has cerebellar ataxia. Causes can be varied. There is no treatment for it in general."
Dr Daniel did a blood test which indicated a liver disorder or infection.
Other than preventing the dog from falling down and hurting himself as he is clumsy, there is apparently no treatment if it is an acquired cerebellar degeneration or tumour.
What is the cause of this trembling of the whole body? This condition is rarely seen in Singapore, in my experience of over 30 years and I did confirm with another vet who had 20 years of experience in small animal practice in Singapore. So Dr Daniel was fortunate to see one case.
"What is the treatment?" is what the owner wants.
"Just sending the dog home and waiting for another week to observe if the dog recover is not the solution," I said to Dr Daniel. "The dog is not eating and drinking the owner is worried."
I prescribed some anti-fits and other medication and asked the owner to call me in 7 days' time. She did it today. The dog was still clumsy but had put on some weight as she was eating. Cerebellar ataxia has varied causes including infections, degeneration and neoplasia and so it is extremely hard to cure unless the cause is known. For the time being, the dog is eating hungrily and that is what the owner is happy about. Some nervous system diseases have no cure and the intentional tremor symptoms can only be controlled by drugs. Only at necropsy or autopsy can the cause of this condition be diagnosed and euthanasia or death is not acceptable to the wife who loves this dog very much.
I will need to review again. It is such a rare case that I have not seen it for the past years of practice at Toa Payoh Vets. I doubt there are more than a handful of such cases in Singapore and so it is a big challenge to diagnose and treat
.
No cerebro-spinal fluid, CT scan and MRI scan were done owing to financial restraints and so the vet must practise within the means of the owner.
The lady owner phoned me to ask whether her poodle should receive more medication.
"Is the dog's head still trembling a lot?" I asked her to send me a video by email.
"Much less," she was happy that the dog was eating and putting on weight. This was the dog that was diagnosed as needing glucosamine by Vet 1 and referred for CT scan by Vet 2 as the dog was shivering and trembling fast in her body and would not eat or drink.
The husband remembered me as I had successfully operated on a bladder stone in another poodle in 2009 and asked for another opinion as the referral vet would charge CT scans from $1500 - $2000.
"I remember seeing such a case in a sheep with Scrapie in Glasgow University in my 3rd year at Glasgow University as the lecturer was demonstrating one case," I said to Dr Daniel. "The sheep was trembling in his head and body. In this dog, I would say she has cerebellar ataxia. Causes can be varied. There is no treatment for it in general."
Dr Daniel did a blood test which indicated a liver disorder or infection.
Other than preventing the dog from falling down and hurting himself as he is clumsy, there is apparently no treatment if it is an acquired cerebellar degeneration or tumour.
What is the cause of this trembling of the whole body? This condition is rarely seen in Singapore, in my experience of over 30 years and I did confirm with another vet who had 20 years of experience in small animal practice in Singapore. So Dr Daniel was fortunate to see one case.
"What is the treatment?" is what the owner wants.
"Just sending the dog home and waiting for another week to observe if the dog recover is not the solution," I said to Dr Daniel. "The dog is not eating and drinking the owner is worried."
I prescribed some anti-fits and other medication and asked the owner to call me in 7 days' time. She did it today. The dog was still clumsy but had put on some weight as she was eating. Cerebellar ataxia has varied causes including infections, degeneration and neoplasia and so it is extremely hard to cure unless the cause is known. For the time being, the dog is eating hungrily and that is what the owner is happy about. Some nervous system diseases have no cure and the intentional tremor symptoms can only be controlled by drugs. Only at necropsy or autopsy can the cause of this condition be diagnosed and euthanasia or death is not acceptable to the wife who loves this dog very much.
I will need to review again. It is such a rare case that I have not seen it for the past years of practice at Toa Payoh Vets. I doubt there are more than a handful of such cases in Singapore and so it is a big challenge to diagnose and treat
.
No cerebro-spinal fluid, CT scan and MRI scan were done owing to financial restraints and so the vet must practise within the means of the owner.
Tuesday, September 24, 2013
1155. Daughters who care for the 12-year-old Retriever X
The 12-year-old Retriever X panted and stopped eating. The mum had to bring the dog to consult.
"Have you continued with the heart medication?
"Have you continued with the heart medication?
1153. Daughters who adopt pets from leaving expatriates
Today the mum brought in a skinny (hairless) guinea pig for consultation of a large submandibular tumour, the size of a fish-ball, around 3 cm x 3 cm. Expat children who goes back to their country will leave their rabbits, guinea pigs to this daughter and so she has 6 GP.
"The condo management permitted two dogs per unit," mum said. "So no dogs can be housed. She is allergic to cats."
It is extremely difficult to be a mother nowadays as the younger generation will buy or adopt pets and the mother is left with the burden of caring for them when they go for holidays.
It is tough for her and I said I would find a home for this GP as she did not want surgery which is the only treatment. Medication will not work as it is a big tumour.
"The condo management permitted two dogs per unit," mum said. "So no dogs can be housed. She is allergic to cats."
It is extremely difficult to be a mother nowadays as the younger generation will buy or adopt pets and the mother is left with the burden of caring for them when they go for holidays.
It is tough for her and I said I would find a home for this GP as she did not want surgery which is the only treatment. Medication will not work as it is a big tumour.
Monday, September 23, 2013
1152. Sunday Sep 22, 2013's interesting case. "Old or new hamster?"
Sunday Sep 22, 2013. Bright sunny day.
I was surprised to see a father and two daughters of around 10 and 12 years old, bringing in a 1-year-old dwarf Winter White hamster with a right ear tumour for treatment as 99% of my clients are locals. The ear tumour was large and lobulated, around 8 mm x 6 mm and 5 mm deep and so the only treatment was to excise them using electro-surgery.
"Hamsters cost $15 and your vet surgical fees costs $150-$200," the father said to his 2 daughters. "Shall we get a new hamster instead?" They were fair complexioned girls. One sister had a sharper chin while the younger one had a rounded face and was be-spectacled.
"Actually you can adopt a hamster for free," I said. The younger sister clinged to her father's trousers tighter.
"Do the two girls have savings to pay for the surgery?"
The younger sister was clinging to the trouser of the father and apparently sobbing with silent tears and so I assumed that the father was against payment for treatment on the way to the Surgery. The elder sister looked at Dad as solemnly as a judge prior to announcing her judgement.
"They do have savings," he said but the daughters did not volunteer to part with their money. The father continued "What it is going to be? Shall we get a new Snowie or not?"
The younger sister grasped the father's trousers tighter as she sobbed.
"The vet fees are low compared to a similar operation in a dog or cat," I said. "There is the anaesthetic needed, otherwise the hamster would be in great pain when the lump is cut and the wound stitched. There is the cost of electro-surgery to excise this lump so that the hamster will not continue scratching his ear trying to get rid of this growing tumour."
"Shall we get a new Snowie or not?" the father teased the daughters. Caucasian fathers generally never abandon the children's sick hamsters and I know he was teasing them. But they were taking him too seriously for not wanting to treat this hamster and it distressed the younger sister a lot.
He gave permission for the surgery. I was surprised that the 2 daughters studied in local schools which they could pronounce in Mandarin and could write their names in Chinese as they did it for me on the case card. Good Chinese character strokes. "How about your father's name in Chinese?" I asked. They could not do it. This father could see that Mandarin would be a good language to learn and so must have the foresight to educate the two daughters in local schools to prepare them for global competition.
"You can bring the hamster home before 5 pm today," I said to the father. "Provided you know how to clean the wound. Do not leave it to the maid."
"OK,' he was a busy man and so Sunday would be his day off work. However the 2 daughters
had no confidence in his nursing and so the hamster stayed one night and would go home on Monday. Dr Daniel injected an anaesthetic into the 35 g hamster, excised the big tumour using electro-surgery and stitched up the defect. He was OK and recovered well as I see him now at 1.10 pm today Monday.
I was surprised to see a father and two daughters of around 10 and 12 years old, bringing in a 1-year-old dwarf Winter White hamster with a right ear tumour for treatment as 99% of my clients are locals. The ear tumour was large and lobulated, around 8 mm x 6 mm and 5 mm deep and so the only treatment was to excise them using electro-surgery.
"Hamsters cost $15 and your vet surgical fees costs $150-$200," the father said to his 2 daughters. "Shall we get a new hamster instead?" They were fair complexioned girls. One sister had a sharper chin while the younger one had a rounded face and was be-spectacled.
"Actually you can adopt a hamster for free," I said. The younger sister clinged to her father's trousers tighter.
"Do the two girls have savings to pay for the surgery?"
The younger sister was clinging to the trouser of the father and apparently sobbing with silent tears and so I assumed that the father was against payment for treatment on the way to the Surgery. The elder sister looked at Dad as solemnly as a judge prior to announcing her judgement.
"They do have savings," he said but the daughters did not volunteer to part with their money. The father continued "What it is going to be? Shall we get a new Snowie or not?"
The younger sister grasped the father's trousers tighter as she sobbed.
"The vet fees are low compared to a similar operation in a dog or cat," I said. "There is the anaesthetic needed, otherwise the hamster would be in great pain when the lump is cut and the wound stitched. There is the cost of electro-surgery to excise this lump so that the hamster will not continue scratching his ear trying to get rid of this growing tumour."
"Shall we get a new Snowie or not?" the father teased the daughters. Caucasian fathers generally never abandon the children's sick hamsters and I know he was teasing them. But they were taking him too seriously for not wanting to treat this hamster and it distressed the younger sister a lot.
He gave permission for the surgery. I was surprised that the 2 daughters studied in local schools which they could pronounce in Mandarin and could write their names in Chinese as they did it for me on the case card. Good Chinese character strokes. "How about your father's name in Chinese?" I asked. They could not do it. This father could see that Mandarin would be a good language to learn and so must have the foresight to educate the two daughters in local schools to prepare them for global competition.
"You can bring the hamster home before 5 pm today," I said to the father. "Provided you know how to clean the wound. Do not leave it to the maid."
"OK,' he was a busy man and so Sunday would be his day off work. However the 2 daughters
had no confidence in his nursing and so the hamster stayed one night and would go home on Monday. Dr Daniel injected an anaesthetic into the 35 g hamster, excised the big tumour using electro-surgery and stitched up the defect. He was OK and recovered well as I see him now at 1.10 pm today Monday.
Apocrine hidrocystoma in a 10-year-old dog's chest and cheek
The lady owner in her 30s was much worried about her 10-year-old female Yorkshire getting skin cancers as she discovered 3 skin lumps, on the cheek, chest and below the right ear. I had seen Charcoal since 2004 and it is 2013 now!
I had written an interesting episode of blood machine failure in another vet practice in March 2010 stating very high levels of BUN and creatinine and liver enzymes indicating serious kidney and liver failure. She sought my 2nd opinion and I said it was unlikely to be serious kidney failure as the dog was eating and vomited only occasionally. She was not satisfied and did not want another blood test so soon. She then went to a 3rd vet whose blood test indicated that the kidneys were OK and there was some liver infection. She lost confidence in all vets and
Now 3 years later, the dog has 3 skin tumours. Dr Daniel excised all 3 by electro-surgery and sent two to the lab for histology. He put two tumours in one container and I advised that they should be separate. "The chest and cheek tumours should be in separate bottles so as not to confuse the lab technicians. After all, you assume they are the same tumours and that the bigger size would be the chest tumour but the lab people may not label caref
She was much worried and kept asking me how to detect new ones?
I had written an interesting episode of blood machine failure in another vet practice in March 2010 stating very high levels of BUN and creatinine and liver enzymes indicating serious kidney and liver failure. She sought my 2nd opinion and I said it was unlikely to be serious kidney failure as the dog was eating and vomited only occasionally. She was not satisfied and did not want another blood test so soon. She then went to a 3rd vet whose blood test indicated that the kidneys were OK and there was some liver infection. She lost confidence in all vets and
Now 3 years later, the dog has 3 skin tumours. Dr Daniel excised all 3 by electro-surgery and sent two to the lab for histology. He put two tumours in one container and I advised that they should be separate. "The chest and cheek tumours should be in separate bottles so as not to confuse the lab technicians. After all, you assume they are the same tumours and that the bigger size would be the chest tumour but the lab people may not label caref
She was much worried and kept asking me how to detect new ones?
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