2328. Rabbit with left mandibular fracture

Saw the rabbit on Oct 11, 2015


Dental work was done by another vet.
Oct 10, 2015 Drooling a lot


HISTORY
15 Jul 2015.  Dental. Right and left upper CT1 loose and moving towards cheek. Removed.
Spurs CT2 left upper and CT1 left lower, CT2 right lower. Multiple CT trimmed.

27 Aug 2015. Dental. Pus in left side of mouth. Dental rad - Osteolysis around left mandibular CT1,2,3. These were extracted. Pus seen. Post dental rad - no roots retained at left mandible. Dental disease - early abscess formation on left mandible.


Oct 10, 2015. Drooling a lot. Came to Toa Payoh Vets. X-rays taken. Under anaesthesia isoflurane, the left mandibular mid area had a large bony lump - a biopsy for bone cancer is advised.

2327. Myanmar travel stories - The taxi had no power uphill

Oct 10, 2015

At 5.30 am, Thin Thin hailed a taxi and got to my hotel, Royal Golden View. My Myanmar Airways International flight would be departing Yangon Airport at 8.30am.

"Taxi drivers had robbed passengers," Thin Thin ensured that I would be safe by sending me to the Airport. There appears to be thousands of taxis in Yangon and the common 2-hour downtown car jam is really there nowadays. So, how could a taxi driver earn a living by being caught in such a jam? There is no mileage meter as fares are fixed and negotiated before driving.
On the uphill road to the departure area, another car stopped in front of us. Our taxi driver found that he could not drive his taxi uphill.

"This car has no power," I suggested all 3 passengers alight. Thin Thin objected as this was not her style. The taxi driver smiled as he understood what I said but had never spoken a word. Since nobody alighted, he slowly reversed his taxi downhill to the level road.
Fortunately there was no car behind him. From the level road, he drove the taxi uphill to the departure lounge. He fulfilled his duty. He helped to take out the luggage. Such incidents make for  a distracting memorable experience of my Myanmar travel.

When there is life, there are challenges. This very trim and young taxi driver must be experienced to resolve the challenges.

P.S
There is a Ya Kun coffee shop in the Yangon Airport. But it was not opened till after 8 am unlike the other local coffee shop nearby. As I had to arrived at 6.30 am, I had no chance to sample the coffee. Yet in Singapore, Ya Kun opens before 8 am.  

Maybe Ya Kun finds it not worthwhile to open early.

A 6-year-old male neutered seal poiont Siamese cat dribbles urine again

Tues Oct 12, 2015

Today, the mother and son came to me with this Siamese cat that dribbled urine and lived with 2 other cats in the Singapore aparatment. She had consulted Vet 1 Toa Payoh Vets in 2012, then Vet 1 who started her own practice in West Singapore in 2013. The urinary problem recurred and Vet 3 in East Singapore was consulted in Sep 21, 2015.

Vet 3 treated the cat was an in-patient for 3 days at $50/day with the total bill approximately $600 (ultrasound - lots of sediment in thickened walled bladder; urine test pH 6.5, SG >1.050, Lecuo 3+, Protein +, Blood 3+, . struvite crystals 3+

Vet 3 catheterised the bladder and flushed 2X/day for 3 days. The cat urinated normally and went home on medication of curam antibiotic, phenoxybenzamine 10 mg at 1/8 cap sid, bethanechol 10 mg at 1/8 tablet with 1 tab in 2 ml water and giving 0.25ml.

The cat completed the medication. But today, Oct 12, 2015, the cat had difficulty peeing and so I was the Vet 4 to consult as the medical expenses were deemed high. 

Medical costs can add up when the cat has recurring urinary problem as in this common medical condition known variously by different vets as FIC, FUS or  FLUTD.
What are the solutions?

EXAM
I palpated the bladder. It was full as an orange. The prepuce was swollen and the penis bright red instead of the usual light pink. Slight kidney pain.

FEEDING
In 2014, no urinary problem. The cat was fed on Urinary S/0 dry food and canned food. Two new cats were introduced in July 2015 and the cat had to be crated inside a cage with his own litter box and water. "He is aggressive towards the new cat and did not drink much water," the mother said.


I did not do any test like X-rays owing to economic considerations. I prescribe antibiotics and painkillers meloxicam for 4 days course. The owner is to syringe water.  


. 

2324. Alms to 2700 monks

Oct 7 and 8.
Benefactors Drs Thein Tun Aung and Thin Thin Soe donates food and rice to 2700 monks, the 25th year of donation from the family.  

2323. Myanmar travels - Hinthada - primary school

Sep 10, 2015
Room 205, Hotel Royal Golden View, Myanmar


I checked in late at night after a long drive from Hinthada to Yangon from 1 pm to 9 pm. The sole driver Dr Thein Tun Aung was very sleepy and so we had a few stops rather than encounter an accident. I had a chance to video a riverside village while he had a 30-minute nap inside the car. A chance to appreciate the village way of life. (Video).



August to October, in Buddhism  are the months of donations in Myanmar. Benefactors will offer alms to monks and nuns during this period. There are two towns where the practice is performed. One in Hinthada and the other in North Myanmar.

From Oct 5 - 10, I was in Myanmar and got an opportunity to witness and understand this practice in Hinthada by participating in Dr Thin Thin Soe's 25th donation to the Myint Kway Monastery. I offered to present exercise books and pencils to a Government Primary School via Dr Soe. She contacted the Head monk who made the arrangements. The monks play a significant role in the community and they do help out the very poor children to be educated. If benefactors want to donate to the school, it is best to contact the Head Monk or collaborate with a local organization rather than giving money.

The headmaster said that a water tank was more pressing need to give the children filtered clean drinking water instead. Dr Soe got my permission and so that was how a water tank was presented.

I prefer to remain anonymous as it was such a small gift but August to October are the months of donations in Myanmar. The school had requested a water storage tank instead of my proposed books and pencils for the primary school children. As I was visiting Hinthada to witness Dr Soe's donations of food and rice to 2,700 monks, I was asked to be present in this school.  

The school was re-built with private donations. It would be the typical old one with zinc roofs and sandy floors. Now it has concrete floors with 165 school children from Grade 1 to Grade 6, all housed in one building and having lessons next to each other. These are chhildren from the surrounding villages. The head monk said some words and the children repeated after him. Only one child in Grade 1 was indifferent and did not stand up. She just remained seated. After the recitals, the donors including me were asked to distribute 2 exercise books and a packet of soft drinks to the 165 children.

At the end of the presentation, I noticed that this girl who remained seated was crying her heart out, with her face on her desk. I asked what happened.  "She's has some mental problems and so the teachers did not present her the two exercise books," Dr Soe said.

Due to practicality and a shortage of funds to buy exercise books, the teachers would rather keep the 2 exercise books for the other normal children.

Illiteracy and poverty are bed fellows in many villages and exercise books are a premium. I persuaded the teacher to give this little girl the two exercise books but her tears would not stop flowing. This was a sad ending for me. I was the one who wanted to donate books to all children and for practicality, this little girl did not get her present.       

2322. A photographer's pictures of Daniel and Jason

1.  Picture Dec 2009.
The left diamond stud caused mum considerable emotional distress. What's next?
Will he be getting tongue and belly studs? Tattoos on his biceps and legs?

A wish from Dad in 2009.
"Create" when you have spare time
Make this world a better place

2. Picture April 2010.
Happy Birthday when Dad and Mum visited this undergraduate in Perth, Australia.
Dad is reminded of the song in his era. This song is about love,   "Smoke Gets In Your Eyes".
I doubt Dan has ever heard of it.

3. Picture June 2011

Dad picks him to go home on the last day of the Singapore Turf Club internship. He would be going back to Perth to complete his study. A candid shot. Sharp chin. Lean and muscular look.
Dad is reminded of the song in his era. The song is about love, "I can't find the words to say goodbye."

4. Picture 2012 at the cousin Vincent's wedding dinner. Vincent and his bride.

Who amongst the 3 cousins is the most handsome
For Dad, the most important value for a man is "Who is the kindest to his parents, his family members, to animals and to disadvantaged people?"

5.  Picture June 2011 of Daniel. 

In the traditional Chinese family in the 1960s, "Words of love from the Dad don't come easy". No hugs and kisses at bed-time unlike the many Caucasian families in UK and the USA. So when the Chinese children grow up, it is extremely difficult to get hugs from them.  This reminds Dad of another love song, "Words Don't Come Easy" by F R David.

 
6.  Picture Oct 2010.  Daniel as an undergraduate.
Visit by mum and dad in Perth.  This waiter knows how to communicate with the diners and make the dining fun.

 

7.  Picture of Daniel as an undergraduate.  Sep 2010.
When life was just passing examinations in Perth. No worries in this aspect.

8. Picture of Daniel's mum in Hong Kong. Aug 2011.
A bus flashed by. This image reminds Dad of a love song "Sunlight in Your Hair" by Lionel Richie

 

9. Picture of Daniel, his brother and mum in Perth. May 2011

This image is my favourite and probably most romantic.
Lean and muscular young men escorting their mum to a function in Perth. The one on the right looks mean. Not a gram of fat in their pectorals and abdominal muscles. Trim and solid muscles.

Mum's "knights in shining armour", protecting her against any bad people. Actually, on the way to an animal and flower fair in Perth.

Readers who love reading English Romance Novels and King Arthur may appreciate why I name the picture "My White Knights In Shining Armour". For those who don't care about romance, this image shows a mother who once takes good care for the toddlers is now towered over by two young adult sons who love her very much and are now her protectors - her "knights in shining armour". The caption should read "My Knights In Shining Armour" on 2nd thoughts.  

Mum and Dad are always aware of sibling rivalries. With both now graduates, the parental responsibilities have been fulfilled and each son has to achieve their dreams. Also to  make the world a better place. All these cannot be achieved without hard work.


10. Picture of Daniel's younger brother. Sep 2010.

Dan's younger brother as an undergraduate in Perth. A boy who once said to Dad's clients that his dad was using him as a "child labour". He was in the clinic after school and was told to sweep the clinic floors.  Many years later, the client told Dad what the Primary School Boy Daniel had complained to him.

2321. Legally threatened

Oct 2, 2015

"I will make a complaint," the dog owner threatened when I said I would not pay for the bills of another vet (Vet 2) who had hospitalised and treated her dog for paraplegia on Sep 30.

On Sep 30, 2015, at around 11 am, I had given a subcutaneous injection of antibiotic and anti-inflammatory above the neck area as the dog had multiple skin lumps. The owner attributed the lumps to a new shampoo. The dog had painful ears and I prescribed an ear ointment to be given at home. The dog was normal on leaving the clinic and at home.

In the afternoon, the owner phoned me to say that her dog was lame in the left hind leg. I advised her to wait and see as she had no time to bring the dog in for an examination. In the evening, the dog was lame in the right hind leg. She phoned and said that it must be my injection hitting a nerve, hence causing the dog to be paralysed. "I don't trust you," she declined my advice to bring the dog for an examination.    

I referred to Vet 2. She phoned me again to say that Vet 2 would charge for after-office hours. Then she suggested that I examine the dog. I did not retort that she had shouted that she did not trust me. Now she asked me to examine the dog. 

I went to the clinic to examine the dog at 9.30 pm with Dr Daniel. The dog was paralysed in the hind limbs. I palpated the spinal area. There was a pain reaction on the T10-L4 area. The husband could see the reaction. The dog's hind legs had no placing and pain reflexes.

"There must be a traumatic injury to the back," I said. "Some heavy objects had fallen on her back or she had fallen down injuring her back."

The husband recalled that the dog had struggled vigorously when ear drops were applied onto the ears.

"Was the dog on the floor when you applied the ear drops?" I asked.
"Yes," the husband demonstrated how he held the dog around the back of the rib cage area with his hands to apply the ear drops.

He accepted the referral to Vet 2 who took X rays and warded the dog overnight with a drip.
The dog tried to stand on her left hind leg the next day but not on the right hind leg.

The owner then phoned me demanding that I pay for Vet 2's fees. When I said no, as my injection was not the cause of this hind limb lameness, she threatened me legally. She said that the dog was normal before my injection and wanted to show me proof.

"No need to show me the pictures," I replied. "Your dog was normal at the clinic and when leaving the clinic walking to your car. She was normal at home till the late afternoon."

As the owner was insistent that I was the cause of the dog's lameness, it was best for me to shout up and not provoke further anger.  I had not given any injections in the hind limbs. The dog had pain in the back spinal area. Vet 2's X-rays did not show any slipped disc and he had told the owners that my injections are commonly given by vets without any injection causing paraplegia.

When an owner said "I don't trust you", I should have asked her to seek a second opinion. I did not charge for the after-hours evening examination when she did not want to consult Vet 2 so as not to pay Vet 2's fees. Now, she threatened to make a complaint.  This is one of the sad cases all vets must handle with empathy with the interest of the dog in mind.