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Friday, September 27, 2013
Update: Sebaceous adenoma in the old Husky's right eye
UPDATE AS AT SEP 25, 2013
Thursday, September 26, 2013
1160. Seven days for the Maltese to live
On Wed, Sep 25, 2013 I received a phone call from a young lady for a 2nd opinion. Her 14-year-old male Maltese had breathing difficulties and was not eating. Vet 1 diagnosed anaemia and a big abdominal mass. She advised surgery but the owner did not want it. So the lady searched the internet forums and there were some recommendations for her to phone for Dr Jason Teo at Toa Payoh Vets.
"Dr Teo works at Toa Payoh Vets on Saturdays only," I said.
"Another vet at Toa Payoh Vets will be OK," she replied.
"What's the name of Vet 1 whom you first consulted?"
"I do not wish to disclose her name."
"Did she have X-rays and blood test results for your dog?" I asked as she was telling me the findings without the documentary evidence.
"Yes," she said.
"You can ask Vet 1 to fax or email to me at Toa Payoh Vets," I said.
"I don't think it is possible," she replied.
"Why not? Are the documents illegal?" I asked. "Vets do pass clinical records to each other when the owner seeks a 2nd opinion. I have done it before and other vets have done it. You just have to phone them and ask for the medical records."
She phoned later to say that Vet 1 would want her to go to the practice to take over the records and so would be late for the appointment. This was OK with me. Around 3 pm she came and saw Dr Daniel first. He had recorded "4 days of changed behaviour, increased breathing, decreased appetite and cannot walk. No vomiting, diarrhoea and no change in diet. Cheese treat for one week and polyuria and polydipsia.
Blood test from Vet 1. No abnormalities in the liver and kidneys or total white cell count. But RBC 3.37 (5.5 - 5.8), HGB 8.4 (12-18) and HCT 23.9 (37-55) were very low. I told the owner that the gums were purplish and the tongue was pale. This was not good.
The mid-abdominal lump was solid, painless and half the size of an orange. What is it?
Vet 1 was consulted for a "breathing problem". She had taken a lateral X-ray showing much fluid inside the swollen abdomen. Opaque areas obscured the views of intestines. Vet 1 said heart was enlarged. An abdominal mass pushed guts up and above. She recorded that the owner was not keen on surgery. Dog was anaemic and lung sounds were dry. She proposed pain relief since surgery was not acceptable.
Overall, Vet 1 was spot on in her diagnosis but the owner was not satisfied.
"Is it because you went when the practice was going to close?" I asked.
"Yes," she said.
Sometimes it is difficult to satisfy the owner on the first consultation in a medical condition with no cure except surgery. Yet this dog was 14 years old, very thin and I would say emaciated. Surgery would kill him. So I don't even want to propose surgery as this dog will never survive the long time needed to remove this large abdominal lump. In any case, the couple was never in favour of it.
But what is this large abdominal lump and what should the couple do?
"Euthanase the dog," one young vet suggested when I spoke to her after X-raying two views of the dog's chest and abdomen at her practice. "This dog is suffering and should not prolong her suffering"
"There was one government vet before your time," I said to this young lady. "He recommends euthanasia so many times that he has a reputation to be avoided. This is because the owners say that he will advise euthanasia in very sick cases. His intention was to save money for the owners but he gained the reputation of being an "euthanasia" vet to be avoided.
"In this case, the couple is against euthanasia. They want to know what is the nature of the abdominal tumour." Dr Daniel had proposed ultrasound scanning. From my reading of the couple, they want an acceptable solution such that the dog would live the last few days of his life without pain."
What more can be done other than ultrasound?
Dr Daniel elaborated on the causes of the swollen abdomen - bleeding, chyle, fluid from heart failure since the liver and kidneys were OK based on blood test from Vet 1, peritonitis. He also advised surgery to remove the abdominal mass as the only option. He advised abdomino-centesis to draw out the fluid to send to the lab for examination but sedation would be required and this would be risky as it may kill the dog. So the couple did not accept his suggestion and wanted to take the dog home.
I let Dr Daniel handle the case to the conclusion but I did give my take on this medical condition.
What should be done for this dog if surgery was not an option? "There is no need for sedation," I said to the couple. "We need to draw out the abdominal fluid so that your dog can breathe easier at least for the next 2 days and start eating." Each vet has his or her own opinion and my opinion was that abdomino-centesis could be done without much pain on this ill dog and so without any risk of death.
The only risk is in putting the needle into the abdominal mass. This was what I was concerned and so was the thinking behind the young lady vet who looked at the X-ray with me earlier. The needle might puncture this big lump.
"Not if you slide the needle under the umbilical skin," I did that with a 19G needle and fresh blood came out.
"Dr Teo works at Toa Payoh Vets on Saturdays only," I said.
"Another vet at Toa Payoh Vets will be OK," she replied.
"What's the name of Vet 1 whom you first consulted?"
"I do not wish to disclose her name."
"Did she have X-rays and blood test results for your dog?" I asked as she was telling me the findings without the documentary evidence.
"Yes," she said.
"You can ask Vet 1 to fax or email to me at Toa Payoh Vets," I said.
"I don't think it is possible," she replied.
"Why not? Are the documents illegal?" I asked. "Vets do pass clinical records to each other when the owner seeks a 2nd opinion. I have done it before and other vets have done it. You just have to phone them and ask for the medical records."
She phoned later to say that Vet 1 would want her to go to the practice to take over the records and so would be late for the appointment. This was OK with me. Around 3 pm she came and saw Dr Daniel first. He had recorded "4 days of changed behaviour, increased breathing, decreased appetite and cannot walk. No vomiting, diarrhoea and no change in diet. Cheese treat for one week and polyuria and polydipsia.
Blood test from Vet 1. No abnormalities in the liver and kidneys or total white cell count. But RBC 3.37 (5.5 - 5.8), HGB 8.4 (12-18) and HCT 23.9 (37-55) were very low. I told the owner that the gums were purplish and the tongue was pale. This was not good.
The mid-abdominal lump was solid, painless and half the size of an orange. What is it?
Vet 1 was consulted for a "breathing problem". She had taken a lateral X-ray showing much fluid inside the swollen abdomen. Opaque areas obscured the views of intestines. Vet 1 said heart was enlarged. An abdominal mass pushed guts up and above. She recorded that the owner was not keen on surgery. Dog was anaemic and lung sounds were dry. She proposed pain relief since surgery was not acceptable.
Overall, Vet 1 was spot on in her diagnosis but the owner was not satisfied.
"Is it because you went when the practice was going to close?" I asked.
"Yes," she said.
Sometimes it is difficult to satisfy the owner on the first consultation in a medical condition with no cure except surgery. Yet this dog was 14 years old, very thin and I would say emaciated. Surgery would kill him. So I don't even want to propose surgery as this dog will never survive the long time needed to remove this large abdominal lump. In any case, the couple was never in favour of it.
But what is this large abdominal lump and what should the couple do?
"Euthanase the dog," one young vet suggested when I spoke to her after X-raying two views of the dog's chest and abdomen at her practice. "This dog is suffering and should not prolong her suffering"
"There was one government vet before your time," I said to this young lady. "He recommends euthanasia so many times that he has a reputation to be avoided. This is because the owners say that he will advise euthanasia in very sick cases. His intention was to save money for the owners but he gained the reputation of being an "euthanasia" vet to be avoided.
"In this case, the couple is against euthanasia. They want to know what is the nature of the abdominal tumour." Dr Daniel had proposed ultrasound scanning. From my reading of the couple, they want an acceptable solution such that the dog would live the last few days of his life without pain."
What more can be done other than ultrasound?
Dr Daniel elaborated on the causes of the swollen abdomen - bleeding, chyle, fluid from heart failure since the liver and kidneys were OK based on blood test from Vet 1, peritonitis. He also advised surgery to remove the abdominal mass as the only option. He advised abdomino-centesis to draw out the fluid to send to the lab for examination but sedation would be required and this would be risky as it may kill the dog. So the couple did not accept his suggestion and wanted to take the dog home.
I let Dr Daniel handle the case to the conclusion but I did give my take on this medical condition.
What should be done for this dog if surgery was not an option? "There is no need for sedation," I said to the couple. "We need to draw out the abdominal fluid so that your dog can breathe easier at least for the next 2 days and start eating." Each vet has his or her own opinion and my opinion was that abdomino-centesis could be done without much pain on this ill dog and so without any risk of death.
The only risk is in putting the needle into the abdominal mass. This was what I was concerned and so was the thinking behind the young lady vet who looked at the X-ray with me earlier. The needle might puncture this big lump.
"Not if you slide the needle under the umbilical skin," I did that with a 19G needle and fresh blood came out.
Audit of a pyometra case done by my associate vet in Aug 14, 2012 - TP43135
Sep 26, 2013. I am unable to contact the owner by phone. I review the surgery done by an associate vet on Aug 14, 2012.
TP 43135. Mini Schnauzer born in Jan 2003, 9 yrs old. Abdominal distension on Aug 10, 2012. 5.1 kg, 37.1 C. Associate vet recorded suspect pyo, not eating 3 days, weak, mm pale, not spayed on case sheet after talking to lady owner. Warded.
I had recorded from the father's comments on vomiting watery fluid 1 week, drank a lot, anorexic.
Blood test of interest in this pyometra:
Urea 44.7 (4.2-6.3)
Creatinine 153 (89 - 177)
Total WCC 150 (6-17)
N 92% Abs 138.45
L 0.7% Abs 1.05
M 5% Abs 7,8
E 0%
B 1.8% Abs 2.7
Platelets 458 (200-500)
"Pyometron" removal
Fluid therapy, suture x 3 packets, hospitalised 4 days and went home.
As each vet has his or her own way of writing medical records, this "pyometron" scribbling on the case sheet is written. I would write closed or open pyometra in my case records but each vet stamps his or her own individual character when it comes to veterinary recording.
TP 43135. Mini Schnauzer born in Jan 2003, 9 yrs old. Abdominal distension on Aug 10, 2012. 5.1 kg, 37.1 C. Associate vet recorded suspect pyo, not eating 3 days, weak, mm pale, not spayed on case sheet after talking to lady owner. Warded.
I had recorded from the father's comments on vomiting watery fluid 1 week, drank a lot, anorexic.
Blood test of interest in this pyometra:
Urea 44.7 (4.2-6.3)
Creatinine 153 (89 - 177)
Total WCC 150 (6-17)
N 92% Abs 138.45
L 0.7% Abs 1.05
M 5% Abs 7,8
E 0%
B 1.8% Abs 2.7
Platelets 458 (200-500)
"Pyometron" removal
Fluid therapy, suture x 3 packets, hospitalised 4 days and went home.
As each vet has his or her own way of writing medical records, this "pyometron" scribbling on the case sheet is written. I would write closed or open pyometra in my case records but each vet stamps his or her own individual character when it comes to veterinary recording.
Wednesday, September 25, 2013
1158. Z-plasty is needed to close wounds of large skin tumours
Sep 25, 2013
A sudden downpour lasting less than half an hour. A 14-year-old Jack Russell with a golf-ball tumour on the left elbow came in for surgery. The dog had cataracts in both eyes and had been my patient for many years.
"Rusty trembles only in the Surgery," the maid who loves this dog like her child for over 10 years said to me as she cradled the old canine.
I scheduled the dog for surgery tomorrow while I give the IV drip and medication to strengthen this old dog. High anaestthetic risk but there is no coughing or respiratory distress in this old dog. Still, the vet must be very careful in operating on such oldies. A Z-plasty will be best.
Another Z-plasty was done by Dr Daniel in another dog with similar skin tumour as big as a fish ball. See image below:
A sudden downpour lasting less than half an hour. A 14-year-old Jack Russell with a golf-ball tumour on the left elbow came in for surgery. The dog had cataracts in both eyes and had been my patient for many years.
"Rusty trembles only in the Surgery," the maid who loves this dog like her child for over 10 years said to me as she cradled the old canine.
I scheduled the dog for surgery tomorrow while I give the IV drip and medication to strengthen this old dog. High anaestthetic risk but there is no coughing or respiratory distress in this old dog. Still, the vet must be very careful in operating on such oldies. A Z-plasty will be best.
Another Z-plasty was done by Dr Daniel in another dog with similar skin tumour as big as a fish ball. See image below:
1157. S.O.E (School of Exercise) for the senior citizen mother
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."
"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."
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.
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