1170. Update on 2nd cat not eating. Blood test

2nd cat, boarded for 2 weeks with a friend, was eating and went home yesterday sunday.


Blood test results:

High urea and creatinine, low platelet count.
Neutrophils high % but total white cell count normal.
A kidney infection.

1169. Incredible Singapore stories - "Ah Pek"

Monday Sep 30, 2013

This is the 2nd incredible story I hear from one of my clients. The first was regarding drops of blood appeared out of thin air onto the glass table top, fore-head and clothing when one of my clients, a successful businesswoman asked me to help her in the placement of design for her new company logo. 

Today, my client in his 40s, of medium height and solid build works in a logistic firm. He came to buy medication for his old dog having serious coughing. The dog would not cough if he was given this medication.  This Indian man was an excellent story teller spinning an incredible tale of "Ah Pek" which I saw on the dashboard of his 5-year-old shiny Subaru sportscar, immaculate polished shiny with wheel rims very clean, just like a new car.  

"How come you have the figures of two "Ah Peks" glued onto your dashboard?" I noted one Ah Pek wore white and one wore black robes. Both had long black beards and wore hats. The colours had faded to silvery and blue respectively. I must confess ignorance of this Chinese belief of "Ah Peks". According to him, "Ah Peks" ranked 2nd and below were 5 dieties including the monkey god. Above them was another level and the 4th tier was the Judge.  


BIKE ACCIDENT
The client said: "On a rainy day, a lady dashed across the road. I braked my bike and my whole face hit the road as I swerved to avoid this lady. I was in intensive care with tubes into my mouth. I had head and facial fractures. I vomited blood daily as I had internal injuries. The doctor said that he needed to open my skull to operate and remove my injured left eye.

"Those are serious injuries," I said. "Yet you look normal today."
"I was lying in the hospital bed and I asked my friend to ask 'Ah Pek' to help me before the operation.

He gave me a piece of paper blessed by the Ah Pek to put under my pillow.
 I did not interrupt his narrative but I had no reason to doubt his integrity of the events happening to him personally. He was seriously ill and the doctor had given him a poor prognosis for recovery.

He continued: "At night, 'Ah Pek' came to the hospital."
"You really saw him?"
"No, at night,  I heard the dragging of chains of somebody walking into my room. The next day, when I came out from the operating table, there was no skull operation. Two titanium plates are now fixed on either side of my nose but you don't see it. My left eye was OK as I have normal vision."

Certainly this was a tall tale.

"I offered my thanks to Ah Peks via my friend at a medium's house."

"Where's the house? Is it an HDB apartment as I had seen some of such places of worship."
"In Woodlands," he mentioned a place which believers would know.
"Did you have to pay money to the medium?"
"No, just two bottles of beer and fruits," he replied. "The lady who dashed across the road had only a small wound on her right arm. She was quite plump and I guessed she had been cushioned."

DRIVING TEST
He had another tall tale. After the bike accident which nearly snuffed out his life, he decided to drive a car.  He failed his driving test for 6 times. So he sought the help of "Ah Peks" via his Chinese friend who translated the "Hokkien" speech from the medium. "The Hokkien is too cheem (of a high standard) for me."

"I was given a green piece of paper which I had to drink part of it and to smear on my face." 
"Just a green piece of paper? What type of paper is it?" I asked.
"The green paper had signature and chop on it" he said. "One has to believe and I did accordingly. The driving test was in Circuit One at Ubi."

To me, I do not know why Circut One is so fearsome as I took my driving test in the UK. "What's so fearsome about Circuit One?" I wondered but did not interrupt his story telling.
"I hit the kerb during the test," he told me. "The tester would usually fail the driver. Hitting the kerb is like hitting a person's leg. So, I should fail. But the tester did not inform me immediately. He was having a discussion with somebody. I was waiting nervously. Just tell me I had failed so that I can book for another test. The waiting was terrible."

"Why did you hit the kerb?" I asked.
"Circuit One has a road full of bends and if the driver hits the kerb, he or she fails. No mercy from the tester."I was thinking that "Ah Peks" had failed him this time. According to him, the Ah Pek in white extends life and the one in black takes away a person's life.

"After some time, the tester told me I had passed!"
It is hard for me to believe that this is because of "Ah Pek's" blessings.

SPEED TRAPS
Another story he told me as that he had been advised to "Ah Pek" to drive fast as he tended to be collided often when he drove slowly. 
"Once I sped along the straight stretch of Mandai Road. At one end, I saw a motorist being booked before me. Then I sped back to the other end. Another motorist was booked before me."
This sounded too hard to believe. Twice not being caught as if he had a protective order. He had a mat blessed by Ah Pek inside his car to protect him when he drove in Malaysia.
"Speeding can kill people," I said to him.
"I don't do it often."

PEEING ON BROKEN GODS
This was the most incredible of his stories. "During my brash younger days, I purposely peed onto the broken idols discarded near a tree," he told me. "The next day, my right arm burst out with big swellings as big as a 5-cent coin. All over the arm. No itchiness. No pain. The doctors could not diagnose what's wrong and hence they could not prescribe a cure."

I thought it was urticarial weals but it happened only on his right arm and no other parts of his body.
"Well, I asked my friend for help. He consulted the medium. I went to the idols to ask for forgiveness and offer them some fruits and food. The next day, all my skin swellings disappear. My experience illustrates than we must respect the religions of others."

"What type of Gods were they?" I had to ask as I had read of a similar incident in a book called "32 true stories of Ghosts and Spirits & Gods Plus Questions & Answers on the paranormal" by Andrew Tan Chee Khoon, born in 1939.

"Guan Yin (The Goddess of Mercy), the Judge and others, like those you see under a tree in some places."

"Yes, I have seen them and  I don't disturb them."


FACE IS ALL BLACK
He narrated an incident which I cannot recall when the cleaner told him that his face is all black.
"What do you mean 'black'?" I asked him. He has dark complexion because he is Indian, more towards dark brown.
"Very black, the colour of black"
"Like Kiwi black shoe polish?" I asked.
"Yes. Yes."
After he made some apologies to the dieties, the cleaner said his face was back to normal colour.

A clientj with a Yorkshire Terrier had come to the clinic and so I could not talk further.

1168. Update on large abdominal mass in an old Malese

TOA PAYOH VETS toapayohvets.com Date:   30 September, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits The old Maltese with breathing difficulty has 7 days to live     Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   30 September, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 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. A large opaque areas obscured the views of intestines. Vet 1 recorded that the 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 young couple was never in favour of it as they must have done their internet research and know the high risks involved.. But what is this large abdominal lump and what should the couple do? "Euthanase the dog," one young lady et 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 the owner should not prolong her suffering." "The owner does not want euthanasia," I replied. "Why? Is it for religious reasons?" "It is for personal reasons," I know of owners who rather not put the old companion to sleep by lethal injection at the onset of signs and symptoms of difficulty in breathing. In this case, there might be medication to alleviate such a condition. "There was one government vet before your time," I said to this young lady vet who had worked for over a year in another practice. "He is now retired. He recommended euthanasia so many times that he has a reputation to be avoided. This is because the owners would forecast that he would advise euthanasia in many sick cases. "His intention was to save money for the owners but he gained the reputation of being an "euthanasia" vet to be avoided at all costs by pet lovers with sick pets. "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 after X-ray. "The needle might puncture this big lump," she said.. "Not if you slide the needle under the umbilical skin area," I did that with a 19G needle and fresh blood came out. Dr Daniel inserted a finer butterfly clip needle and withdrew another small amount of blood. Total amount was around 20 ml. The blood clotted soon indicating that bleeding was very recent. This blood collection in a bottle was shown to the couple as they wanted to know the cause of anaemia and the nature of the abdominal tumour. No exploratory surgery but just to know what the abdominal mass is.     3806 - 3809. Large abdominal mass palpated and seen in the X-ray. Blood tests showed liver and kidneys were normal. The heart is enlarged and lung sounds were "dry" on auscultation. l Friday, September 27, 2013 1164. Update on old Maltese. Abdomino-centesis shows bleeding inside the abdomen - old Maltese Maltese, M, 14 years Large abdominal mass 50% size of orange Breathing difficulty around last 4 days Abdomino-centesis drew out 20 ml of blood which clotted soon, indicating fresh blood from abdominal mass. Probably a splenic tumour starting to bleed. The kidney and liver enzymes were normal. IV drip with amino acids and vitamins given. Dog went home and was active pacing the next day. Surgery is too risky. Owner does not want surgery anyway. Prognosis poor if bleeding continues. Dog does eat but is emaciated. Sep 28, 2013  Saturday 10.15 am Spoke to the husband Dog has much less breathing difficulty. Active. Gums pinker. "Any abdominal swelling?" I asked. "No," he said. That means the bleeding of the tumour has stopped but in any case, the abdominal swelling was not that large since the dog was sent for treatment early.. Will not want to eat the egg yolk or chicken liver. Husband asked whether he can get repeat medication in 7 days' time. I had advised hand-feeding of egg yolk to build up red blood cells. The lady owner asked whether liver was OK. "Chicken liver would be good," I said.   Feeding 6x/day in small amounts and electrolytes. Heart medication given as well. For this dog, a blood transfusion would be normally advised. In this case, after the amino-acid, glucose and electrolyte drip IV, the dog was much alert and with home feeding and medication, the dog lived a comfortable life as at Sep 30, 2013. I hope the dog lives longer than 7 days.   Updates will be on this webpage: www.sinpets.com/F5/ 20130930abdominal_tumour.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: September 30, 2013 Toa Payoh Vets

1167. A stray male cat smelt of urine has lots of blood inside the bladder

On Saturday, Sep 28, 2013, a woman brought in the stray male cat that would go to her house to eat only and would disappear for the whole day. She found him having blood in his backside and brought him in for treatment. The bladder was slightly swollen and urine leaked continuously.

On Sunday, Dr Daniel catheterised this cat and sent the urine for testing. "This is a case of FLUTD in a male cat and is quite common," I said to the intern Daniel. He had not seen such cases before.

For the woman, it is difficult for her to ignore the cat's plight and to pay for the veterinary treatment. After all, this is a stray cat.



 

1166. A second cat had poor appetite.

Sunday Sep 29, 2013

Yesterday, I had another cat not eating. The first cat was the one-eyed cat that did not eat for 5 days and recovered after treatment for a kidney infection as shown by blood tests and palpation of swollen kidneys. The kidneys were 3x the normal ones.

Now this 2nd cat had poor appetite for the last 3 days after being boarded for 2 weeks with a friend as the owner was overseas. What's the problem? The rectal temperature was 36.6 C and the cat was dehydrated. Her right eye was tearing but the left was OK. So, what's the problem?

It is hard to say. I asked Dr Daniel to come in to take blood and gave the IV drip. The cat clawed anyone and so needed to be given anaesthesia gas. She recovered the next day. When the Caucasian couple who boarded this cat came to take her home today, the cat was eating the A/D canned food and this was the best evidence of recovery. 

1165. Sunday Sep 29, 2013's interesting cases

1.  I was surprised to see the young couple from Tampines as they had brought in their rabbit for treatment of scabies after purchase and I did not expect to see them again since many Singapore pet owners go for proximity and Tampines is a 20-minute drive to Toa Payoh. 

"How long did it take the rabbit to recover from the scabies and ear mites after the injection?" I could see that the rabbit is fully cured. They had bought the rabbit with scabies in the ears, nose and paws and had consulted me some weeks ago. The rabbit seemed to have changed coat colour as I remembered he was grey and not brown. I wondered if it is a replacement rabbit. I have a video of it as it was used as a case study of the Lemon Law by Intern Terrence. The video is "Lemon Law for diseased/defective pets in Singapore" and is at:

 http://www.youtube.com/watch?v=uHXcYlGmvOI&feature=youtu.be



"We complained to the Seller. He sent the rabbit back to the breeder who kept him for 3 weeks before returning to us!" the slim young lady said.  

"Did you use a pee grate and tray for this rabbit's toilet?" I noted that the rabbit has urine-stained fur in the lower part of the four feet. 

"No," the slim young man said. "We used one but it was so small in area that the rabbit stepped on it and peed outside the tray!  So we put the brown cat litter pellets at one corner of the playpen and he would go above the cat litter to pee and poop."

"That explains why he has four paws urine stained. There should be a larger grate like the plastic one in your rabbit carrier you are carrying your rabbit to the vet. In this way, the urine can flow through onto the cat litter which would be enclosed by the tray. Go to the pet shop to buy one pee tray + grate for puppy toilet training. "

"The reason for the urine stain could be that we have not placed sufficient litter and so he stepped on the urine. We find it very difficult to wash off the urine stains."

"I will get the yellow urine-stained hairs cut off. Also the matted hair near the scrotum. It is important that your rabbit be free of urine and matted hairs, otherwise he may become sick."

The couple purchased a puppy grate + pen when they come to collect the rabbit at 4 pm. I asked Dr Daniel to hold the rabbit for them to check the absorbable stitches after neutering by Dr Daniel to make sure there is no bleeding. They were quite happy.

"Place urine-stained litter inside the tray and smear some smell at the corner of the grate," I advised. "Usually the owner will spread all litter covering 100% of the tray. You may find that the rabbit pees out of the tray as he has no clearance of the non-urine-stained area."  The couple wanted to cover the whole tray with cat litter but this may not work as the rabbit may pee outside the tray owing to his positioning.

It was great to see this rabbit again and I did take some images. Certainly he looks like the same rabbit that had gone to live with the breeder for 3 weeks to get cured but it is hard to tell since there is no micro-chipping in rabbits! The couple was inexperienced in rabbits and so a replacement rabbit will be the same as the other one.   

1164. Update on old Maltese. Abdomino-centesis shows bleeding inside the abdomen - old Maltese

Maltese, M, 14 years
Large abdominal mass 50% size of orange
Breathing difficulty around last 4 days
Abdominocentesis drew out 20 ml of blood which clotted soon, indicating fresh blood from abdominal mass.

Probably a splenic tumour starting to bleed. The kidney and liver enzymes were normal. IV drip
with amino acids and vitamins given. Dog went home and was active pacing the next day. Surgery is too risky. Owner does not want surgery anyway. Prognosis poor if bleeding continues.

 Dog does eat but is emaciated.

Sep 28, 2013  Saturday 10.15 am
Spoke to husband

Dog has much less breathing difficulty. Active. Gums pinker.
"Any abdominal swelling?" I asked.
"No," he said. That means the bleeding of the tumour has stopped.

Will not want to eat the egg yolk or chicken liver. Husband asked whether he can get repeat medication in 7 days' time.

Advised hand-feeding of egg yolk and liver to build up red blood cells. Feeding 6x/day in small amounts and electrolytes. Heart medication given as well.