Sep 1, 2015
The Straits Times report headlined "ICA explains why some Viet woman turned away at airport".
The Immigration and Checkpoins Authority (ICA) had sent back several Vietnamese women at Changi Airport as they could not explain to officers why they wanted to enter Singapore. The Vietnamese Civil Aviation Authority wanted to know why. The Vietnam Embassy's second secretary Nguyen Cong Huan met the ICA officials and was satisfied with the explanations on entry procedures which applied to visitors of all nationalities and that ICAhas interpreters to help those who cannot communicate in English.
"The ICA does not have interpreters. They don't care. No explanations are given. They just end the woman back," the Singaporean who married a Vietnamese wife said. Before he married her, the ICA had prohibited her from entering Singapore on two occasions. She was detained in a room and put on the plane home. She could not speak Mandarin or English. There was no interpreters."
"The ICA says they have interpreters," I referred to the Straits Times clipping he showed me. "Are you able to gather evidence like an investigative reporter? What do you want to get blacklisted now that your wife had been given a long-term pass to stay in Singapore?"
This man had to accompany his wife every month for 4 years to travel out of Singapore as she was given a monthly visitor stay. Four years. "According to the law, it should be 3 years," he said. "The ICA does not bother to check on whether mine was a sham marriage. They just give my MP the standard rejection letter."
"The ICA officers are overworked," I said. "It is up to the individual to persevere." He did and now his wife is on a long term pass. After 4 years and many petitions.
CHARITY WORK IN VIETNAM
The man wanted to build 10 houses and repair leaking roofs and tile the flooring of houses in the villages. The village headman told him to get approval from the District Officer. He wanted to do the charity work by himself. The District Officer wanted him to deliver the cash and goods.
"Unless you have a trusted respected person in the District," I advised. "You will not be permitted to do charity work all by yourself. This is the reality. The other way is to stay in the country for many years and get the connections and respect or partner with a local of good standing as some Japanese donors have had done in building schools in Myanmar villages. No do-it-yourself. It is not the way."
"The District Officer even checked whether I was living in the villages without permission," he said.
Doing charity work in Vietnam, as in all developing countries, is not so straight forward. You need the locals of good standing and influence.
Monday, August 31, 2015
Sunday, August 30, 2015
2979. A spayed female cat had recurrent breast tumour and died.
Sunday, Aug 30, 2015
Female spayed cat, 10 years old passed away at home. In the last 2 weeks, the breast tumour recurred and grew fast, the owner said.
HISTORY
Feb 16, 2015.
Mastectomy, Left mammary gland 1 enlargement, 8cm x 6 cm x 0.5cm excised. Invasive ductal carcinoma. Lymphvascular invasion is seen.
Mar 7, 2015
Thin, vomiting. Painful kidney (left). Total white cell count very low. Neutrophil % 24%, 0.55 absolute numbers low. Platelet very low. Had used tiger balm ointment on cat or surroundings.
TODAY
Aug 30, 2015
Left mammary gland 1 and another nearby.
Spayed cats may develop breast cancer but rarely.
Female spayed cat, 10 years old passed away at home. In the last 2 weeks, the breast tumour recurred and grew fast, the owner said.
HISTORY
Feb 16, 2015.
Mastectomy, Left mammary gland 1 enlargement, 8cm x 6 cm x 0.5cm excised. Invasive ductal carcinoma. Lymphvascular invasion is seen.
Mar 7, 2015
Thin, vomiting. Painful kidney (left). Total white cell count very low. Neutrophil % 24%, 0.55 absolute numbers low. Platelet very low. Had used tiger balm ointment on cat or surroundings.
TODAY
Aug 30, 2015
Left mammary gland 1 and another nearby.
Spayed cats may develop breast cancer but rarely.
Friday, August 28, 2015
2978. A cat has dislocated left hip
Aug 28, 2015. Yesterday, one 3-month-old rabbit dislocated his right hip. The owner wanted closed reduction rather than doing nothing as Vet 1 suggested. Vet 1 had said he could not reduce the hip joint and suggested doing nothing. The rabbit has a right hip sling after putting the femoral head into the hip joint. The owner did not want any surgery as the rabbit is only 3 months old.
Then another case of dislocation of the hip in a cat abused by somebody. He was missing and found to be lame.
The left hind leg was shorter than the right on extension. X-rays to confirm and taken today.
Sedation is necessary for proper X-rays as the hind legs must be extended.
In this cat, 4.4 kg bodyweight:
xyla 0.5+Ket 0.3 IM
Reverzin 0.05 ml IV (or IM) given to reverse xylazine.
The owner wanted closed reduction and a sling was applied. The cat stained his bandage after peeing. I asked the owner to wash it off. For other "looseness" of bandage or hairs stuck, I asked the owner to bring the cat down as it is impossible to "diagnose" and "advise" over the phone. So far, the Cavalier King Charles and the rabbit, both given slings, had no complaints.
X-rays for this cat are as follows:
Thursday, August 27, 2015
Wednesday, August 26, 2015
Follow up: A 9-month-old Miniature Schnauzer cannot pee
Aug 26, 2015.
This case illustrates the typical challenges many Singaporean dog owners face.
Most vets have no time to follow up as it is time-consuming. Today, I followed up to find out whether this brown male Schnauzer stlll has difficulty in peeing. (Video done July 2015) since he was given dry Canine C/D, no dog treats and other food after 4 days of in-patient and catheterisation for urethral obstruction (small bladder stones around 4 mm across was flushed out). The owner did not want blood test or X-rays, but the clinic did a blood test free of charge.
"He pees a lot now," the mother of 2 boys, 10 and 11 years old was happy. "Neighbours said he has put on weight." That was good news. The stools are "nice" in a continuous roll when the dog was fed C/D.
FINDINGS
1. Jan 2015. Dog was purchased at 3 months of age. Fed dry food from pet shop.
2. May 2015. Changed to a different brand of dry food called Osbourne as pet shop operator said it is better, more protein. Dog vomited often after eating this dry food and the earlier brand. So added canned food. Owner thought the dog ate too fast, so vomiting occurred.
3. Jul 2015. Dysuria. Blocked bladder. Catheterised. Small bladder stones sucked out.
4 days of inpatient. Did not want x-rays or blood test.
4. Aug 26 2015. Follow up on dysuria and C/D diet. No more problems. He peed a lot for the last 2-3 weeks. Stools are well formed and in a roll
5. Urine test
pH 7, SG 1.020. Nitre +, Protein 4+, Ketones +, Blood 4+. White blood cells 576/uL. Bacteria +. No crystals. Yet around 3 small crystals were sucked out during catheterisation.
6. Blood test
Liver enzymes ALT/AST 159/102 (<59 br="">Urea 49.5 (4.2-6.5)
Creatinine 691 (89-177)
Total WCC 37.3 (6-17)
N 83% (60-70)
N absolute 90.96 (6-11)
Platelets 78 (200-500). The dog has sepsis and kidney failure.
DOG PYSCHOLOGY
1. The mother is the disciplinarian of the dog. Would crate him for most of the do. He will bite things in the apartment including the crate playpen and the younger son.
2. The younger son, 10 years old is bullied by this dog. He complained to his mum that his leg is painful from the dog's bite. There are bruises. The son would run when the dog is let out. The dog would chase him as a prey and bite him. The boy is encouraging this attack bite behaviour.
I advise:
1. grip the dog's muzzle and say "no biting" when he chases the younger boy.
2. place him into the play pen when he starts "bullying" the boy in Primary 4 class. .
3. Now the dog is nearly 11 months old. Not neutered as the owner did not want to do it.
He pees many x a day, every 20 minutes. The mother will estimate the 20-minute interval and placed him inside the playpen bought 2nd hand from the pet shop. It has a pee tray which she lined with pee pad. This routine is still present as other family members feel that the mother is too strict on this young dog.
CONCLUSION
No recurrence on C/D diet. Strictly no other food or dog treasts. Schnauzers are prone to urinary stone formation.
Early neuter will have prevented this need of the dog to urine mark. The owner has to place him into the play pen to pee every 20 minutes. She did not realise that he is urine marking.
This case illustrates the typical challenges many Singaporean dog owners face.
Most vets have no time to follow up as it is time-consuming. Today, I followed up to find out whether this brown male Schnauzer stlll has difficulty in peeing. (Video done July 2015) since he was given dry Canine C/D, no dog treats and other food after 4 days of in-patient and catheterisation for urethral obstruction (small bladder stones around 4 mm across was flushed out). The owner did not want blood test or X-rays, but the clinic did a blood test free of charge.
"He pees a lot now," the mother of 2 boys, 10 and 11 years old was happy. "Neighbours said he has put on weight." That was good news. The stools are "nice" in a continuous roll when the dog was fed C/D.
FINDINGS
1. Jan 2015. Dog was purchased at 3 months of age. Fed dry food from pet shop.
2. May 2015. Changed to a different brand of dry food called Osbourne as pet shop operator said it is better, more protein. Dog vomited often after eating this dry food and the earlier brand. So added canned food. Owner thought the dog ate too fast, so vomiting occurred.
3. Jul 2015. Dysuria. Blocked bladder. Catheterised. Small bladder stones sucked out.
4 days of inpatient. Did not want x-rays or blood test.
4. Aug 26 2015. Follow up on dysuria and C/D diet. No more problems. He peed a lot for the last 2-3 weeks. Stools are well formed and in a roll
5. Urine test
pH 7, SG 1.020. Nitre +, Protein 4+, Ketones +, Blood 4+. White blood cells 576/uL. Bacteria +. No crystals. Yet around 3 small crystals were sucked out during catheterisation.
6. Blood test
Liver enzymes ALT/AST 159/102 (<59 br="">Urea 49.5 (4.2-6.5)
Creatinine 691 (89-177)
Total WCC 37.3 (6-17)
N 83% (60-70)
N absolute 90.96 (6-11)
Platelets 78 (200-500). The dog has sepsis and kidney failure.
DOG PYSCHOLOGY
1. The mother is the disciplinarian of the dog. Would crate him for most of the do. He will bite things in the apartment including the crate playpen and the younger son.
2. The younger son, 10 years old is bullied by this dog. He complained to his mum that his leg is painful from the dog's bite. There are bruises. The son would run when the dog is let out. The dog would chase him as a prey and bite him. The boy is encouraging this attack bite behaviour.
I advise:
1. grip the dog's muzzle and say "no biting" when he chases the younger boy.
2. place him into the play pen when he starts "bullying" the boy in Primary 4 class. .
3. Now the dog is nearly 11 months old. Not neutered as the owner did not want to do it.
He pees many x a day, every 20 minutes. The mother will estimate the 20-minute interval and placed him inside the playpen bought 2nd hand from the pet shop. It has a pee tray which she lined with pee pad. This routine is still present as other family members feel that the mother is too strict on this young dog.
CONCLUSION
No recurrence on C/D diet. Strictly no other food or dog treasts. Schnauzers are prone to urinary stone formation.
Early neuter will have prevented this need of the dog to urine mark. The owner has to place him into the play pen to pee every 20 minutes. She did not realise that he is urine marking.
2975. INTERN. A 17-year-old Shih Tzu barks all night long
Aug 25, 2015
The parents and the young adult son came in to euthanase this 17-year-old Shih Tzu who barks all night long. The parents have to work and have no rest. They used to bring the dog down the apartment to the grass to pee at 5 am and 10 pm but now, they had to do it at 2 am.. The dog would not pee at home even at 17 years of age. He was kept in a very good condition although he had difficulty standing up.
Vet 1 had prescribed heart, liver and joint disease medication. Most likely, Vet 1 did not want to put the dog to sleep. The frequent night barking led to this decision to euthanase as the parents have to work.
"Take time to think about euthanasia," I do not advocate euthanasia for dogs that can eat. Is there another solution?
I advised:
1. No water after 6 pm so that the dog does not need to go downstairs.
2. Antibiotics for possible bladder infection due to holding of urine for long periods of time. No urine test is done to lower medical costs.
3. Medication. Sleeping tablets adjusted for effect at 10 pm.
The owners decided to accept the medication and the dog barks less. The dosage is being adjusted and it is only 3 days since I saw the dog. This family loves this old dog very much to undertake this solution.
The parents and the young adult son came in to euthanase this 17-year-old Shih Tzu who barks all night long. The parents have to work and have no rest. They used to bring the dog down the apartment to the grass to pee at 5 am and 10 pm but now, they had to do it at 2 am.. The dog would not pee at home even at 17 years of age. He was kept in a very good condition although he had difficulty standing up.
Vet 1 had prescribed heart, liver and joint disease medication. Most likely, Vet 1 did not want to put the dog to sleep. The frequent night barking led to this decision to euthanase as the parents have to work.
"Take time to think about euthanasia," I do not advocate euthanasia for dogs that can eat. Is there another solution?
I advised:
1. No water after 6 pm so that the dog does not need to go downstairs.
2. Antibiotics for possible bladder infection due to holding of urine for long periods of time. No urine test is done to lower medical costs.
3. Medication. Sleeping tablets adjusted for effect at 10 pm.
The owners decided to accept the medication and the dog barks less. The dosage is being adjusted and it is only 3 days since I saw the dog. This family loves this old dog very much to undertake this solution.
2974. INTERN. . Time is running out - Case 3. A Maltese became comatose and had pyometra
The owner did not want the dog to be spayed nor the encrusted tartar in the teeth to be cleared when advised some 2 years ago.
The dog came to the clinic comatose and had fits (video). Blood test showed low glucose and extremely high total white cell count and neutrophils. The diagnosis was bacteraemia and sepsis. Based on the history of the dog having heat 4 weeks ago, a swollen vulval area with some discharge, a tentative diagnosis of pyometra was made by me.
On the 2nd day of IV drips and antibiotics, the dog could stand up. On the 3rd day, she did. Reddish brown pus leaked out from the vagina. This was a case of closed pyometra.
Time has run out for this 9-year-old Maltese. A spay at a young age of 1 year old would have permitted her to live much longer than the 9 years.
REFER TO POST NO. 2968.
The dog came to the clinic comatose and had fits (video). Blood test showed low glucose and extremely high total white cell count and neutrophils. The diagnosis was bacteraemia and sepsis. Based on the history of the dog having heat 4 weeks ago, a swollen vulval area with some discharge, a tentative diagnosis of pyometra was made by me.
On the 2nd day of IV drips and antibiotics, the dog could stand up. On the 3rd day, she did. Reddish brown pus leaked out from the vagina. This was a case of closed pyometra.
Time has run out for this 9-year-old Maltese. A spay at a young age of 1 year old would have permitted her to live much longer than the 9 years.
REFER TO POST NO. 2968.
2973. INTERN. An emaciated "anaemic" terrapin
This terrapin has loose flabs of skin in the thigh area and looks very pale compared to normal terrapins. The owner had confined him to a small plastic tank and he had stopped eating for some months. Antibiotics, tank hygiene, sunshine and a much bigger tank are advised.
Video
Video
2972. INTERN. Time is running out - Case 2. A female Pekinese passes foul-smelling vaginal discharge
August 25, 2015
Two years ago, I had this female Pekinese's breast tumour removed and advised spaying the dog as some breast tumours are more likely to develop in dogs not spayed. The dog's teeth were enveloped in thick tartar and I advised dental work to get rid of the bacteria inside the tartar. The lady owner did not accept my advices.
Today, the dog came with a dark brown vaginal discharge. The rotten meat smell of the discharge filled the consultation room. "I know she is suffering from uterine infections," the lady said. "I have researched the internet." The dog had a prominent spine, indicating a loss of weight but she did not have other breast tumours developed in the past two years.
Now a life-threatening condition of pyometra. This was one of the worst cases of open pyometra based on the bad odour and copious brownish vaginal discharge.
"The treatment is spay but she is so thin and will likely die under anaethesia," I prescribed oral antibiotics and gave an injection of antibiotics."So I will not advise surgery to remove the badly infected womb. She may die in the next few days despite antibiotics as she is not eating."
This Pekinese who strongly resisted swallowing the antibiotic capsule I gave to her through the mouth. She snapped at my fingers. I had put her on the consultation table. I decided to grasp the capsule with a pair of forceps and inserted the capsule into her snapping mouth, far back in the tongue and closed her mouth. She swallowed one capsule and there would be 13 more, at twice a day. The owner would have to hand feed her and give her water to drink.
Time is running out for this Pekinese. If the owner had at least spayed her 2 years ago, this dog would not have pyometra and causes so much emotional distress for the owner and the vet. Time has run out for this Pekinese as death from sepsis could be imminent. No blood test was taken to lower medical costs. This type of against medical advice to spay a dog after removal of a breast tumour is quite a common occurrence.
Pyometra that could have been avoided by a spay operation after breast tumour removal makes me feel sad for this Pekinese. She had lost a lot of weight but could still fight to avoid oral medication. If she is stable after 7 days, she could be spayed. But her emaciated body may not take anaesthesia well and she may die on the operating table. The stench of rotting uterine lining is an indicator that spaying cannot be delayed. Many owners will not accept their dog dying on the operating table and will blame the vet. So, it is best for the vet not to undertake such high risk surgeries.
Two years ago, I had this female Pekinese's breast tumour removed and advised spaying the dog as some breast tumours are more likely to develop in dogs not spayed. The dog's teeth were enveloped in thick tartar and I advised dental work to get rid of the bacteria inside the tartar. The lady owner did not accept my advices.
Today, the dog came with a dark brown vaginal discharge. The rotten meat smell of the discharge filled the consultation room. "I know she is suffering from uterine infections," the lady said. "I have researched the internet." The dog had a prominent spine, indicating a loss of weight but she did not have other breast tumours developed in the past two years.
Now a life-threatening condition of pyometra. This was one of the worst cases of open pyometra based on the bad odour and copious brownish vaginal discharge.
"The treatment is spay but she is so thin and will likely die under anaethesia," I prescribed oral antibiotics and gave an injection of antibiotics."So I will not advise surgery to remove the badly infected womb. She may die in the next few days despite antibiotics as she is not eating."
This Pekinese who strongly resisted swallowing the antibiotic capsule I gave to her through the mouth. She snapped at my fingers. I had put her on the consultation table. I decided to grasp the capsule with a pair of forceps and inserted the capsule into her snapping mouth, far back in the tongue and closed her mouth. She swallowed one capsule and there would be 13 more, at twice a day. The owner would have to hand feed her and give her water to drink.
Time is running out for this Pekinese. If the owner had at least spayed her 2 years ago, this dog would not have pyometra and causes so much emotional distress for the owner and the vet. Time has run out for this Pekinese as death from sepsis could be imminent. No blood test was taken to lower medical costs. This type of against medical advice to spay a dog after removal of a breast tumour is quite a common occurrence.
Pyometra that could have been avoided by a spay operation after breast tumour removal makes me feel sad for this Pekinese. She had lost a lot of weight but could still fight to avoid oral medication. If she is stable after 7 days, she could be spayed. But her emaciated body may not take anaesthesia well and she may die on the operating table. The stench of rotting uterine lining is an indicator that spaying cannot be delayed. Many owners will not accept their dog dying on the operating table and will blame the vet. So, it is best for the vet not to undertake such high risk surgeries.
Saturday, August 22, 2015
2971. INTERN Time is running out - case 1. An 11-year-old Jack Russell has false pregnancy and 4 breast tumours
Aug 21, 2015
TIME LINE
10 years ago, I advised spay 2 months after the end of the heat bleeding. The owner did not turn up.
5 years ago, the owner noticed a small breast lump in the dog. His son told him to seek veterinary attention. He did not want the dog to suffer post-op pain. The dog had surgery to remove a pebble in the intestines by another vet and his wife had to take leave to care for her. So no more operations.
TODAY Aug 21, 2015
The dog was not eating much. I examined her and found 4 breast lumps (video). I expressed some milk from one of the breasts. There was no vaginal discharge now. So, false pregnancy and/or pyometra is diagnosed. The hormonal changes of false pregnancy would affect the dog's appetite and behaviour.
"Did she carry a soft toy or blanket to a corner and was protective of it?" I asked. "As if she had a newborn puppy?"
"Yes," the owner said. "She carried a towel and went to a corner. What do you advise about the breast tumours? Do you advise euthanasia?"
"The decision for euthanasia is up to the owner," I said. "This dog is still active. She needs spay and breast tumour removal but at her age of 11 years old, you may want to think about her few remaining years, the medical costs and the post-op pain. Generally, most dogs do not suffer from post-op pain as they are given pain-killers."
The owner will decide with his wife.
Blood test, X-rays of the lungs, spay and breast tumour removal, high anaesthetic risks and post-operation complications and pain. Whether it is worth doing the operation as the dog is near the end of the life span. These must be considered.
Aug 25, 2015
Blood test showed high cholesterol and very high liver enzymes.
"This dog cannot be spayed now as the risk of anaesthetic death is very high," I said. Five years ago, the dog had a single breast tumour but the owner chose to ignore this growing tumour. He said that his wife had to take leave to take care of this dog after a pebble was removed from the intestine. So, he did not want the dog to suffer post-operation pain again, if she had her breast tumour surgery.
Time is running out now as the dog now has 4 growing and big breast tumours, 3 on the left side and 1 on the right side. Their sizes were more than 5 cm across. No biopsy was done to lower medical cost. So, it was not possible to state that these tumours were malignant or not. I had advised a spay to remove the ovaries which produce hormones encouraging breast tumour growth in some cases. Not every case as you can see in the case of the Pekinese that did not develop breast tumour after tumour removal and without the owner spaying her as advised.
"My dog recovered her energy and appetite after consulting you," the man said. On superficial appearance, the dog is normal, with good food like roasted pork pieces being fed when she had lost appetite a few days ago. A high cholesterol level and liver disorder now presented itself.
"My son noticed her elbows and her sternal area were yellowish," the man said.
"He is very observant young man," I told him I had noticed a yellowish strip of sternal skin on that day but had not pointed this to him. "I thought he had stained himself but this yellowish skin do look like jaundiced skin."
As the eye white was not yellowish, I ignored this finding and did not tell the owner. Usually jaundice presents itself as yellowish eye white. Now, the blood test had shown that this dog has a severe liver disease. The total white cell count was normal, but the neutrophils were higher. This could be a start of bacterial infection and my antibiotic medication had eliminated the bacteria based on the dog's rapid recovery of appetite.
"What can be done now?" the owner asked. Dr Daniel had advised him on a prescription liver diet for the next 1-2 weeks and he had come for the canned food. Unless the dog's health deteriorate, this would be the course of action. I agreed with him.
Time is running out for this dog. There is no point saying that she should have been spayed 5 years ago when she had only one breast tumour as in the case of the Pekinese with foul-smelling vaginal discharge.
TIME LINE
10 years ago, I advised spay 2 months after the end of the heat bleeding. The owner did not turn up.
5 years ago, the owner noticed a small breast lump in the dog. His son told him to seek veterinary attention. He did not want the dog to suffer post-op pain. The dog had surgery to remove a pebble in the intestines by another vet and his wife had to take leave to care for her. So no more operations.
TODAY Aug 21, 2015
The dog was not eating much. I examined her and found 4 breast lumps (video). I expressed some milk from one of the breasts. There was no vaginal discharge now. So, false pregnancy and/or pyometra is diagnosed. The hormonal changes of false pregnancy would affect the dog's appetite and behaviour.
"Did she carry a soft toy or blanket to a corner and was protective of it?" I asked. "As if she had a newborn puppy?"
"Yes," the owner said. "She carried a towel and went to a corner. What do you advise about the breast tumours? Do you advise euthanasia?"
"The decision for euthanasia is up to the owner," I said. "This dog is still active. She needs spay and breast tumour removal but at her age of 11 years old, you may want to think about her few remaining years, the medical costs and the post-op pain. Generally, most dogs do not suffer from post-op pain as they are given pain-killers."
The owner will decide with his wife.
Blood test, X-rays of the lungs, spay and breast tumour removal, high anaesthetic risks and post-operation complications and pain. Whether it is worth doing the operation as the dog is near the end of the life span. These must be considered.
Aug 25, 2015
Blood test showed high cholesterol and very high liver enzymes.
"This dog cannot be spayed now as the risk of anaesthetic death is very high," I said. Five years ago, the dog had a single breast tumour but the owner chose to ignore this growing tumour. He said that his wife had to take leave to take care of this dog after a pebble was removed from the intestine. So, he did not want the dog to suffer post-operation pain again, if she had her breast tumour surgery.
Time is running out now as the dog now has 4 growing and big breast tumours, 3 on the left side and 1 on the right side. Their sizes were more than 5 cm across. No biopsy was done to lower medical cost. So, it was not possible to state that these tumours were malignant or not. I had advised a spay to remove the ovaries which produce hormones encouraging breast tumour growth in some cases. Not every case as you can see in the case of the Pekinese that did not develop breast tumour after tumour removal and without the owner spaying her as advised.
"My dog recovered her energy and appetite after consulting you," the man said. On superficial appearance, the dog is normal, with good food like roasted pork pieces being fed when she had lost appetite a few days ago. A high cholesterol level and liver disorder now presented itself.
"My son noticed her elbows and her sternal area were yellowish," the man said.
"He is very observant young man," I told him I had noticed a yellowish strip of sternal skin on that day but had not pointed this to him. "I thought he had stained himself but this yellowish skin do look like jaundiced skin."
As the eye white was not yellowish, I ignored this finding and did not tell the owner. Usually jaundice presents itself as yellowish eye white. Now, the blood test had shown that this dog has a severe liver disease. The total white cell count was normal, but the neutrophils were higher. This could be a start of bacterial infection and my antibiotic medication had eliminated the bacteria based on the dog's rapid recovery of appetite.
"What can be done now?" the owner asked. Dr Daniel had advised him on a prescription liver diet for the next 1-2 weeks and he had come for the canned food. Unless the dog's health deteriorate, this would be the course of action. I agreed with him.
Time is running out for this dog. There is no point saying that she should have been spayed 5 years ago when she had only one breast tumour as in the case of the Pekinese with foul-smelling vaginal discharge.
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