91. Importance of continuing contractions for stroke patients

"See his shoulder is sloped to one side," Mrs Lam pointed to a classmate who had a stroke on the left brain some 8 years ago and was now seated on a sofa, "I have the same condition and my head could not be upright." Mrs Lam lowered her head such that her chin touched her neck. Mrs Lam had physiotherapy in Australia where she migrated with her husband some 15 years ago.

The other stroke classmate had stopped going for physiotherapy in Singapore.

The other is around 70% recovered, judging from my observations of their ability to converse and walk normally but I am not professionally qualified to assess them.

It was a cool Saturday, Oct 27, 2007 evening to meet the classmate who had migrated to Australia some 10 years ago and is now retired with rental income and money and a good sense of humour. He referred to others commenting on his bowl-shaped hair cut with an even front horizontal fringe, said, "it is not what you dress but whether you can pay the bills."

He also said to me when I asked if his Australian house was big, "I guess all of you live in bungalows with swimming pools, landscaped gardens and ceilings higher than 2 stories as I have had been invited only to two classmate's houses."

Of the group, 3 are now living in bungalows with land of over 20,000 sq.ft, but the others had humble residences.

I attended a dinner meeting of a group of classmates from Raffles Junior College to catch up with one who had migrated to Australia. They were around 53 years old. I was the spouse.

2/3 lawyers in the group had a stroke. One was Mrs Lam who had stroke some 15 years ago and is around 90% recovered. She was driving some 9 months after the stroke as she had to take her children to school. The children are now grown up.

"I had 5 botox injections into my right arm," Mrs Lam told me. "I stop after this one botox injection as I don't want to get addicted to this drug."

Apparently, stress triggered her muscle rigidity. She was no longer working but stress could come at any time. She stretched out both hands and said in "sometimes a need to think first voice" that the normal left hand was "longer" than the right hand which was the result of her left-brain stroke.

"Do you still go for physiotherapy?" I asked. I mean, it was some 15 years since she had stroke as my lawyer in Singapore and I assumed that she did not need it. But she still has this muscle contraction in her right hand and arm. She needed physiotherapy and it seemed that she was fortunate that she had a good physiotherapist in Perth where she had migrated.

"How did you locate a good physiotherapist?" I asked.

"One day, an old Australian woman noticed me limping," Mrs Lam said. "She asked me what was wrong with me." The woman asked her daughter who recommended 2 names. As she had seen the doctor before, she chose the other. This is Ms Julie Peck in private practice using the "Feldenkrais" method. Half an hour of massage once a week would relieve her right hand muscle pain.

"Any oil used?" I asked. In Singapore, Chinese nationals and others doing massage for stiff neck for busy executive women use oil to rub out the muscular kinks.



"No," Mrs Lam said. She was satisfied with a physiotherapist. "It is hard to get a good physiotherapist in Singapore," she said. As for the other classmate, he stopped going to the physiotherapist.


From this encounter, I believe that muscles of one side of the body, after or with no stroke, need to be used continually or they contract from lack of use. Otherwise, the person cannot stand straight, like the tree in the picture. Muscles need continuing contractions, like professionals need continuing education.

89. Follow up on 87. Submissive urination.

DRAFT



I guess you do lots of writing in your present career. Are you a writer or in the mass communication business?
My replies to you are in CAPITAL LETTERS BELOW.

---...@singnet.com.sg> wrote:

> Dear Dr. Sing:
>
> Thank you so much for your kind advice on the
> situation, especially your taking time to answer my
> email before rushing to work this morning.
>
> Here are my thoughts on your very systematic pros &
> cons of whether or not to spay my dog.
>
> YES.
> > 1. Prevention of breast cancers and womb
> infections,
> > but not all intact female dogs get this problem.
> Only
> > that the probability is higher for intact females.
>
> I will ensure that my dog gets regular checkups at
> the vet. Only issue now is finding one vet/clinic
> we will stick to since my dog hasn't gone to the vet
> in so many years haha!
>
> > 2. Unwanted puppies/dogs being put to sleep or
> > abandoned. This does not apply to your situation.
>
>
> I will try every means possible to make sure my dog
> isn't accidentally mated. I would of course love to
> have her puppies, but I think she's too old to go
> through pregnancy at this age.

FEMALE DOGS OVER 6 YEARS OLD ARE ADVISED NOT TO BREED, GENERALLY.
>
> Are female dogs fertile only when they are on heat?

YES.

> Do they have urges and want to mate when they are
> not on heat?

NO. SOME 'MATING' BEHAVIOUR SEEN COULD BE DUE TO DOMINANCE BEHAVIOUR.


if my dog gets humped by a male dog
> (whether or not she wants it) when she is not on
> heat, will she get pregnant?
>
NO

> > 3. Dirtying the house with blood stains every 6
> > months. This problem does not bother you.
>
> Yes, I let my dog run about the house even when she
> is having her menses. Only thing is I wipe her
> before she sits down on her bed, but all these
> problems are solved with the sanitary pants.
> Amazing thing is one night she managed to get the
> pants off! This is the kind with a buckle strap and
> the pants/buckle were intact next to her bed the
> next morning haha! I didn't scold her or anything
> but kept the pants on and took them off only when
> she has her food or needs to relieve herself, so she
> learned very fast. She struggled when I tried to
> put on the pants at first, but later on, she would
> even stand still to let me strap on the pants!!
>
GOOD TEACHER. YOU MUST BE GIVING HER LOTS OF PRAISES AS REWARDS.

> > 4. Urine marking making the residence smell
> strongly
> > of urine. Very rare in female dogs. Your sounds
> like a
> > submissive urination case and not an alpha female.
> > Does she pee when excited or greeting you?
>
> Oh she is the sweetest and gentlest dog. She doesnt
> even struggle when you try something new on her e.g.
> tying her hair. Last night she won over our
> long-time lady friend who has been terrified of dogs
> all her life, but our friend was so smitten was our
> dog that she took so many pictures together so that
> she can use it as her handphone wallpaper.
>
> My dog is very afraid of my husband because he uses
> a loud and disciplinary tone when he talks to her.
> Nowadays he isn't fierce to her anymore, but she is
> still a little scared of him, so she often pees when
> he is trying to pick her up to put her back in the
> balcony.

SUBMISSIVE URINATION. YOUR DOG WANTS TO APPEASE YOUR HUSBAND SO THAT SHE WILL NOT BE BITTEN (THIS IS WHAT SHE WILL DO IF SHE LIVES IN THE PACK OF DOGS. YOUR HUSBAND IS HER PACK LEADER. You may be the subordinate or at most an equal. )

No problems with me though ... I know she
> won't follow me when she knows I need to go to work,
> so we have to put her in the balcony, so I just pick
> her up and hold her all the way from upstairs to
> downstairs balcony, with lots of hugs and patting of
> course.
>
> Oh I must share with you this about her toilet
> training. We sleep in the upstairs bedroom and her
> urine area is downstairs in the balcony. When I
> wake up to go to work in the morning, I used to have
> to carry her from her bed, put her in the balcony,
> close the sliding doors, and make sure she has
> relieved herself before letting her out again.
> Nowadays she knows when I have got out of bed, but
> she stays in her bed. I go downstairs to do my
> stuff and soon enough I hear her running down the
> stairs, she usually comes to see where I am, and
> then either she runs herself to the balcony or I
> tell her verbally to go pee pee, she runs to
> balcony, pees, comes out, and waits for me to wipe
> her. Then she will wait for me to go back up
> together to the bedroom.
>
> There are times when the dog has run up herself to
> rest in her bed and wait there for me when we have
> guests at our place till very late at night.

SEEMS TO BE TOILET TRAINED. SHOULD BE AT 8 YEARS OR SOMETHING IS TERRIBLY WRONG.
>
> > 5. Skin disease affected by hormonal imbalance.
>
> I will monitor her skin condition. Not a problem
> since I was terrified of dogs all my life until I
> decided to take care of her, so I read up online
> about grooming dogs and so now I groom her myself
> and bathe her weekly.

I GUESS YOU WERE BITTEN/LEAPT UPON BY A DOG WHEN YOU WERE YOUNG.
>
> > 6. False pregnancy. Dog gets moody, aggressive,
> not
> > eating and other behaviour.
>
> I didn't sense any change in her temperament during
> her recent heat. Only thing was more frequent
> urination and she even wet the pad in the sanitary
> pants without bothering to go to her urine tray.

HOW TO GO TO THE PEE TRAY WHEN SHE CANNOT PEE ONTO IT? SHE HAS A PAD, REMEMBER?

> But she didn't like feeling the wetness in the pants
> after she did that, after a few times, she learned.

CAN'T FIGURE OUT WHAT YOU ARE WRITING ABOUT. YOU MEAN SHE CAN STILL PEE ON THE PEE TRAY WITH PADS ON?
>
> For her, the motivation is what she needs to do in
> order to be let out to be with us, so she tries her
> best to learn the behaviour expected of her ...
>



> > NO.
> > 1. Breast cancer and infection of the womb can be
> > detected if you take the trouble every week to
> check
> > your dog and get her examined by your vet 6
> monthly
> > during the senior years.
>
> OK I will make sure my dog gets regular checkups.

OBSERVE FOR CHANGE OF BLOOD COLOUR AND CONSISTENTCY. USUALLY BAD VAGINAL DISCHARGE IS YELLOWISH, STARCHY AND SMELLY IN PYOMETRA (WOMB INFECTION).
>
> > Or at least yearly. As puppies, there is plenty of
> > attention. As older dogs, many owners just forget
> > about them, esp. their dental infections and other
> > problems.
>
> My dog does have bad breath. I heard that most older
> dogs have bad breath. I am just starting to get her
> used to brushing teeth, but it's not easy training
> such an old dog ha ha! Other than toothpaste, are
> the dental water products (those that you add to
> their water) any help in preventing bad breath?

YOUR DOG NEEDS DENTAL SCALING AND CHECK UP BY YOUR VET.

I wonder how people in the past managed this when they
> didn't have the habit of brushing their dogs' teeth,
> yet the dog lived till old age ...
>
> > NO TIME FOR YOUR DOG - PYOMETERA (womb infection)
> in
> > older female dogs.
>
> This is my main concern that made me think seriously
> about whether or not to spay my dog.
>
> However I believe I can decide now that you've
> kindly laid out the pros and cons for me. I don't
> think I'll spay my dog, but I'll be extra diligent
> in monitoring her condition.
>
> There are a few more questions I would like to check
> with you though:
>
> 1) My dog tears often and has dried-up eye shit
> along her fur from the eyes all the way down to
> almost the nose.
>
> Is tearing common?

YES, IN SOME BREEDS LIKE THE POODLES AND MALTESE.
>
> 2) She also pants a lot sometimes. If at home, she
> tends to want to sit on the floor under the fan. So
> I guess she pants at those times because she's hot.
> However, there are times when I hold her in the
> front passenger seat and she snuggles up to me, the
> aircon is on but we can hear her panting. Why would
> that be since the aircon is on and she shouldn't be
> hot? She didn't seem distressed or anything. And
> after a while she would seem to be ok.

ANXIETY PROBABLY
>
> 3) Separation Anxiety
>
> My dog follows me around the house but doesn't
> disturb me when I'm home. When we take naps or
> sleep at night, she has her own bed on the floor in
> our bedroom. Again she doesn't disturb us, but just
> wants to be around us (me). The thing is we have to
> leave her alone during the day when we are working,
> so she is often alone in the balcony behind the
> closed sliding glass doors for 8 hours or so until I
> come home in the evenings. She senses we have
> returned even from the time we come out of the
> carpark which is right in front of our block and
> starts barking continuously when we are coming up
> the steps. The barking usually stops when we enter
> our flat and then my husband scolds her for being
> noisy.
>
> However, there are times when I come home alone and
> she doesn't bark at all until I have entered the
> house, and even then it is just a few barks, not
> continuous
=== message truncated ===
I GUESS THE EMAIL IS TOO LONG. YAHOO.COM HAS TRUNCATED IT.

Anaesthetic risks in Cat Spays

E-MAIL TO DR SING
Oct 24, 2007


<@....com> wrote:

Hello,

I have a cat that is over 1 year old. She has not been sterilised yet. I took her to ..... the age of 6 months to get sterilised and she was very slender but vet insisted she would be fine but instead she almost died.

Vet said that she was not breathing due to anesthesia, they do not know if my cat is allergic or if they gave her overdose. They were very rude and uncaring.

I can not imagine losing this cat - I love her dearly. I am now worried to get her sterilised but I must do so. Do you offer more than one type of anesthesia? Is there any advice you can offer for my situation?

Name given
HandPhone given.

REPLY TO E-MAIL

Wed, 24 Oct 2007 18:19:07 +0800 (CST)
From: "Dr Sing KY" Add to Address Book
Yahoo! DomainKeys has confirmed that this message was sent by yahoo.com.sg. Learn more
Subject: Re: REALLY NEED YOUR HELP FOR MY CAT
To: ....


I am Dr Sing from www.toapayohvets.com. Adverse anaesthetic reactions do occur in any person or animal and all practising veterinary surgeons will encounter at least one anaesthetic death.

Not all animals are healthy in the first place. It is up to the individual doctor to assess, examine accept or reject risky patients.

My advices are as follows:

1. If the cat is healthy --- e.g. normal weight, heart and lungs and temperature. Active, eating and drinking, normal stools and urine and young --- spaying usually presents no risks in most of the cases for most of the vets.

2. It is best to spay when she is NOT on heat (noisy cries --- caterwauling). But most owners spay when the cat is on heat. The ovaries, uterus and blood vessels are fragile and enlarged when the cat is on heat. Obviously, you ought not to get the cat spayed when she is caterwauling.

3. As regards anaesthetic, I use 3 procedures, depending on the health and age of the cat being spayed.

3.1 an injectable anaesthetic for normal cats based on weight.
3.2 injectable anaesthetic of less than half the normal dose plus anaesthetic gas to effect for cats that are of high anaesthetic risk including cats less than 6 months of age.
3.3 tranquiliser injection plus gas anaesthetic to effect for cats that are high anaesthetic risks.

It will be difficult for you to appreciate the technical details of anaesthesia unless you have medical knowledge and training.

4. You may need to talk to your friends to get referrals of their vets they can recommend for spaying your cat. It is the most common surgery and all practising small animal vets in Singapore are able to perform this surgery.
When your friends give you the referrals, you ask the particular vet to perform the operation for you as the practice may have several vets.

Best wishes.

87. Senior females be spayed or not?

E-MAIL TO DR SING

--- <...@singnet.com.sg> wrote:

> Dear Dr. Sing:
>
> I found your wonderful and informative site on the
> internet and sincerely hope you could give me some
> advice on whether or not to spay our senior dog.
>
> We have an 8-year old Lhasa Apso female dog who is
> not spayed. My husband bought her directly from a
> home breeder when she was a puppy in 1999 and she
> didn't have any vaccinations all throughout her life
> until I brought her for her combination vaccine
> recently. According to my husband, she has been
> healthy and even gave birth to a litter of 2 puppies
> in 2001. The only problem she had was perhaps a
> couple of years ago she came back from the groomer
> with an eye infection that got very serious and she
> had to undergo surgery to stitch up her eyes. I
> don't know what the exact diagnosis is anyway as I
> wasn't around at that time.
>
> Our dog is the sweetest dog, extremely well-behaved
> and only barks when people visit for the first time
> -- she doesn't bark when it's people who's visited
> before -- and when she wants to be let into the
> house to be with me. She recently went on heat from
> 23 Sep to 11 Oct. We bought sanitary pants for her
> and I changed her pads
> everyday. That isn't a problem at all as I love her
> very much, but I am worried that she will have
> problems with her reproductive organs as she grows
> older.
>
> My husband thinks our dog is too old to undergo
> spaying. I want the best for her, but don't want to
> put her through anything that will influence her
> health since she is so old. She is also extremely
> timid and gets frightened by the slightest noise or
> even when a leaf falls to the ground with a thud.
>
> My husband doesn't believe in preventive treatment,
> so I had quite a hard time convincing him when I
> brought our dog home after she had her jab.
> Therefore, convincing him that a spay surgery for
> our dear dog would be all the more harder. But I
> want to have my Lhasa with me healthy and happy for
> as long as possible.
>
> Would you advise whether our dog should be spayed or
> can we just leave her alone and let nature take its
> own course?
>
> I would really appreciate your advice and look
> forward to hearing from you as soon as possible.
>
> Thank you very much for your assistance.
>
> Best regards,
>

E-MAIL REPLY FROM DR SING
>


Date: Wed, 24 Oct 2007 07:35:14 +0800 (CST)
From: "Dr Sing KY" Add to Address BookAdd to Address Book
Yahoo! DomainKeys has confirmed that this message was sent by yahoo.com.sg. Learn more
Subject: Re: Spaying of Senior Dog
To: ...@singnet.com.sg

Thanks for your feedback about my website. In reply,
the answer is yes and no. Here are my thoughts before
I rush to work in 7 minutes.

YES.
1. Prevention of breast cancers and womb infections,
but not all intact female dogs get this problem. Only
that the probability is higher for intact females.

2. Unwanted puppies/dogs being put to sleep or
abandoned. This does not apply to your situation.

3. Dirtying the house with blood stains every 6
months. This problem does not bother you.

4. Urine marking making the residence smell strongly
of urine. Very rare in female dogs. Your sounds like a
submissive urination case and not an alpha female.
Does she pee when excited or greeting you?

5. Skin disease affected by hormonal imbalance.

6. False pregnancy. Dog gets moody, aggressive, not
eating and other behaviour.

NO.
1. Breast cancer and infection of the womb can be
detected if you take the trouble every week to check
your dog and get her examined by your vet 6 monthly
during the senior years.

Or at least yearly. As puppies, there is plenty of
attention. As older dogs, many owners just forget
about them, esp. their dental infections and other
problems.

NO TIME FOR YOUR DOG - PYOMETERA (womb infection) in
older female dogs.

I note that time-pressed Singaporean owners even put
up with bad breath of their senior dogs and let their
decayed teeth drop one by one.

So, infections of the womb are ignored till the dog
becomes seriously ill and about to die from severe
womb infection.

The dog is rushed to the vet.

The unlucky vet gets blamed for doing the emergency
operation on the dog that dies after surgery to remove
the infected womb.

Even if the dog does not die, but continue vomiting
(kidney failure), the poor vet gets the blame for not
doing a good surgery and gets bad-mouthed.

2. Putting on weight. Being less active, many do put
on weight. Latest research findings seem to indicate
that many neutered breeds do get acquired
hypothyrodism.

3. Anaesthetic risk of death. Rare but always possible
even in young dogs at 6 months of age. Heart failure
during anaesthesia seldom happens nowadays even in
older dogs if there is no health problems.

4. Infections after surgery. Rare but does happen once
in a few hundred cases, sometimes due to the dog
licking and biting the wound. Also lack of care by the
owner.

5. Financial problems. This should not be ignored by
the vet. Some families seem to have difficulties in
paying for vet treatment. Maybe there ought to be a
charitable organisation?

The above are major issues. Got to go. Best wishes.

86. The Shih Tzu had bad bladder and teeth

Office Manager Mark said, "The Shih Tzu had been kept in the veterinary surgery for 48 hours without food and teeth scaling still had not been done."

I had a busy morning neutering 2 Shih Tzus as owners rushed to sterilise them in order to qualify for the $14 instead of $70 dog licence fee. The law with a fine of $5,000 for no licence was announced on Sep 1, 2007 and now it was 1.5 months later. $5,000 was too worrisome and some dogs had been abandoned.

Apparently the Shih Tzu was supposed to be booked in on the morning of yesterday. She came in the evening and was no dental work could be done. So, the owner complained that she was "48 hours without food."

Not advisable to retort. The customer is king? This Shih Tzu had a bladder stone and was booked in for surgery after a course of antibiotics. The Shih Tzu did not turn up. Maybe I ought to send a "surgery reminder card"? The owner had complained of her passing blood in the urine again. Finally the stone was removed and she was normal.

Now, she was late for her dental appointment. I checked her temperature. It was normal 38.6 degree C. Put her on gas. The teeth were all loose. Many owners hate the idea of the teeth being extracted as they seem to be "all right, hanging loose in the mouth".


It would be unethical just to scale the loose teeth as bad breadth would recur. Many Shih Tzus and small breeds seem to have bad teeth by 6 years of age as in this case.



Singapore owners seldom bother with their teeth or dental check up yearly. These decay and needed to be extracted or they just dropped out themselves. It is sad.



Dogs could have kept their teeth to old age if owners would have time for them or brush their teeth. Bad teeth with bacteria and toxins affect the heart valves and damage them. Bad health means shorter life span. A simple dental check up every 1 to 2 years would have prevented bad teeth.



By being observant, blood in the urine of the dog is not normal. Early veterinary check up may prevent bladder stone from forming and an operation.

83. Follow up to 82.

DRAFT

Sat Oct 20, 2007

E-MAIL TO DR SING.

Thanks for the useful real life feedback.
I will reply in CAPITAL LETTERS to your queries below.

...@gmail.com> wrote:

> Dear Dr Sing,
>
> Many thanks for replying, it's pretty much spot-on
> whatever you have Mentioned and enlightening for me. Please see my
> responses to your suggestions as I'm keen on getting some of the
> suggestion to work better and succeed.
>
> Appreciate your patience and help!
> Regards
> Namge given.
>
>
> On 10/17/07, Dr Sing KY
> wrote:
> >
> > Thank you for your email to Judy. I am Dr Sing
> from
> > Toa Payoh Vets and will attempt to reply to your
> > queries.
> >
> > PROBLEM:
> > Your Pomeranian urine-marks in the house as well
> as
> > outside. Urine-marking is often mistaken by many
> > owners as a relapse in toilet training and
> therefore a
> > toilet-training problem. Urine marking in male
> dogs is
> > a normal behaviour especially for alpha
> > males---dominant males. Some alpha females do
> > urine-mark too.
> >
> > They want to make sure that other dogs or
> subordinate
> > 'dogs' in the pack (including, forgive me for my
> > frankness, your family members and possibly your
> good
> > self, as less than his equal in status).
> >
> > SOLUTIONS:
> >
> > 1. Neutering of male dogs at 6 months of age
> usually
> > stops urine marking. This is the usual solution
> > besides agressive training.
> >
> > If the surgery is done much later, e.g. at 3 years
> of
> > age, some dogs continue to urine-mark.
>
>
> *[COMMENTS FROM DOG OWNER] I'm definitely considering this option, but how long does the
> surgery and healing process last? I have heard that
> owners who brought their
> pets to be neutered have to stay home and look after
> the dog. also what is
> the average cost?*



SURGERY 5 MINUTES. HEALING AROUND 10-14 DAYS. NORMALLY NOT EATING FOR FIRST 2 DAYS. IF WOUND IS INFECTED, DOG NOT SO ACTIVE OR EATING FOR >2 DAYS --- CONSULT YOUR VET.

NO NEED TO STAY AT HOME BUT NEED TO OBSERVE WOUND. MALE DOGS LIKE TO LICK WOUND. ELIZABETH COLLAR USED FOR 10 DAYS.

AVERAGE COST OF NEUTER IS AROUND S$200 IN TOA PAYOH VETS.

>
> 2. NEUTRALISING URINE SMELL WITH VINEGAR. As the
> > motivation for urine-marking is territorial
> > acquisition and not a natural need to pee, your
> dog
> > will seek new areas to urine-mark. Or go back to
> the
> > same areas again later.
> >
> > In toilet-training, the smell of urine is used as
> a
> > training aid. In urine-marking, it plays a great
> part
> > too and you will find the male dog urine-marking
> on
> > same areas but in a few drops. The male dog goes
> for
> > places with vertical planes like walls, legs of
> tables
> > and beds. Am I correct that your dog is seeking
> such
> > objects?
>
>
> *[COMMENTS FROM DOG OWNER] They are all correct. So far I have been using the vinegar concoction, but as you mentioned Junior will look for new places to mark.*
>
> 3. CONFINEMENT TO CRATE OR SMALL ROOM LIKE THE
> > BALCONY. This anti-social behaviour is hard to
> > suppress. In my survey, most Singapore owners of
> > apartment dogs simply crate the dog at night or
> when
> > they are not around. The let him urine-mark in a
> place
> > like the balcony or utility room as they feel that
> > neutering is cruel.
> >
> > This may be the best solution for your case.
>
>
> *[COMMENTS FROM DOG OWNER] How do we 'crate' a dog? Since young we
> did not provide a 'bed'
> for Junior for him to identify as his own 'home'.
> Can we still do that? At
> night, to prevent him from doing what he likes in
> the living room when no
> ones around, we leash him to the toilet door, and he
> sleeps just outside it.
> Once when I tried confining him inside the toilet,
> he kept barking.*

> *For this solution, by confining in small room at
> night and when I'm ard
> even though my grandmother is, does it mean that I
> have to keep Junior for
> long periods of time and until he gets used to
> marking inside and stop
> barking?*

YOUR METHOD IS PRACTICAL. YOU JUST PRAY THAT YOUR POM DOES NOT STRANGULATE HIMSELF ONE DAY WHEN HE GETS ENTANGLED IN THE LEASE AND NOBODY IS AT HOME.

>
> 4. POSITIVE REINFORCEMENT TRAINING. Some dogs
> respond
> > well to commands (e.g "No pee here"/hand
> > signals/clicker and food treats for not
> misbehaving
> > like barking. Train 4-8 times a day at short
> intervals
> > of 5 minutes, making training fun.
> >
> > I doubt you have time for such in-house training.
> > Instead of food treats, take him out for exercise
> when
> > he performs. Obviously, you need a lot of time
> and it
> > is not practical advise for you.
> >
> > 5. NEGATIVE REINFORCEMENT TRAINING. In your case,
> it
> > works when you are around. However, family members
> (I
> > presume you have family members) are not so
> "fierce"
> > and so he urine-marks as he considers the house as
> his
> > territory and family members excluding the
> "fierce" as
> > his subordinate canine members of the pack.
> >
> > So many words. In conclusion, unless the family
> > members can make Junior accept that he is really
> > "junior" in the ranking of the pack, the
> urine-marking
> > problem in an intact male will persist till the
> end of
> > time. When you are not at home, Junior is the
> senior
> > or top dog.
>
>
> *[COMMENTS FROM DOG OWNER] sometimes, even when I'm at home, just
> that I'm not really
> noticing him or upstairs in the room, he will pee
> too. How do I make it
> known that I'm above his rank?*
>
SPEND MORE TIME TRAINING HIM WITH POSITIVE REINFORCEMENT AND FUN, USING FIRM TONE OF VOICE, PRAISES AND TREATS.

NOT PRACTICAL ADVICE AS YOU ARE WORKING LONG HOURS (I PRESUME). SO, THE DOG CONSIDERS YOU AS THE OUTSIDER INVADING HIS TERRITORY. YOU ARE LIKE A HOTEL GUEST TO HIM. HE IS THE INNKEEPER!

>
> > Neutering may or may not help at this age but it
> is
> > better to do it now than wait till another year if
> you
> > want to resolve Junior's behavioural problem. In
> many
> > Singaporean families, there is great resistance to
> > neutering by one member (the alpha homo sapien?).
> >
> > So, the rest of the family just tolerate the urine
> > smells and mops or wipes diligently, to keep peace
> > within the family. It is an extremely interesting
> > finding of human-dog relationship in my survey.
>
> >

82. Urine marking is not a toilet-training problem

E-MAIL TO DR SING


Oct 15, 2007
--- ...@gmail.com> wrote:

> Dear Judy,
>
> I chanced upon
> http://puppytoilettraining.blogspot.com and found
> your email
> to contact. I've been reading the entries with
> interest, but I might need
> something more specific to my problem.
>
> My Pomeranian, Junior, is abt 1 yr 4mths old now.
> When he was younger, we
> successfully garden-trained him and at age 8 mths,
> we hired a personal dog
> trainer to teach basic obedient skills to control
> his other behavioural
> problems,. As lessons were conducted outdoors,
> Junior learned to pee outside
> of the house at parks and trees, and I noticed that
> he had the habit of
> marking territory indoors as well. It was as if the
> garden-training was
> totally forgotten. Now to make sure that he doesn't
> pee as much in the
> house, I have to make sure to bring him to pee
> outdoors as much as possible.
>
> I've tried negative reinforcement, like questioning
> him when I see pee in
> the house (both marking, spraying and large puddles)
> and also use rolled-up
> newspaper to whack him. Jr will only slink away and
> hide cos he knows I'm
> angry, but still repeats the acts. If I do not bring
> him outdoors, he pees
> even more at home.
>
> I've also tried countering with vinegar, but it will
> still only work for
> awhile until the vinegar effect wades off, in the
> meantime he finds new
> places to pee. When I place newspaper over
> acceptable areas he happens to
> pee at, Junior actually avoids those areas, as if
> newspaper means he can't
> or won't pee there!
>
> Junior has not been sterilised yet too - I've heard
> that sterilised can
> somewhat curb the territorial instinct to mark.
>
> I live in a terrace house and the only time I can
> spend with the dog is in
> the morning and night for weekdays, and weekends are
> for earlier parts of
> the day. When I'm ard, Junior is careful not to pee,
> and only does so when
> I'm not really looking or upstairs while he is alone
> in the living room.
>
> Thank you for your time and I look forward to
> knowing how I can better train
> Junior to be paper-trained or garden-trained again.
>
> Regards,
>

E-MAIL REPLY FROM DR SING.

Thank you for your email to Judy. I am Dr Sing from Toa Payoh Vets and will attempt to reply to your queries.

PROBLEM:
Your Pomeranian urine-marks in the house as well as outside.

WHY SOME BUT NOT ALL MALE DOGS URINE-MARK?
Urine-marking is often mistaken by many owners as a relapse in toilet training and therefore a toilet-training problem. Urine marking in many male dogs is a normal behaviour. This behaviour is very common amongst alpha males---dominant males. Some alpha females do urine-mark too.

They want to make sure that other dogs or subordinate 'dogs' in the pack (including, forgive me for my frankness, your family members and possibly your good self, as less than his equal in status).

SOLUTIONS:

1. NEUTERING of male dogs at 6 months of age usually stops urine marking. This is the usual solution besides agressive training.

If the surgery is done much later, e.g. at 3 years of age, some dogs continue to urine-mark.

2. NEUTRALISING URINE SMELL WITH VINEGAR. As the motivation for urine-marking is territorial acquisition and not a natural need to pee, your dog will seek new areas to urine-mark. Or go back to the same areas again later.

In toilet-training, the smell of urine is used as a training aid. In urine-marking, it plays a great part too and you will find the male dog urine-marking on same areas but in a few drops. The male dog goes for places with vertical planes like walls, legs of tables and beds. Am I correct that your dog is seeking such objects?

3. CONFINEMENT TO CRATE OR SMALL ROOM LIKE THE BALCONY. This anti-social behaviour is hard to suppress. In my survey, most Singapore owners of apartment dogs simply crate the dog at night or when they are not around. The let him urine-mark in a place like the balcony or utility room as they feel that neutering is cruel.

This may be the best solution for your case.

4. POSITIVE REINFORCEMENT TRAINING. Some dogs respond well to commands (e.g "No pee here"/hand signals/clicker and food treats for not misbehaving like barking. Train 4-8 times a day at short intervals of 5 minutes, making training fun.

I doubt you have time for such in-house training. Instead of food treats, take him out for exercise when he performs. Obviously, you need a lot of time and it is not practical advise for you.

5. NEGATIVE REINFORCEMENT TRAINING. In your case, it works when you are around. However, family members (I presume you have family members) are not so "fierce" and so he urine-marks as he considers the house as his territory and family members excluding the "fierce" as his subordinate canine members of the pack.




So many words. In conclusion, unless the family members can make Junior accept that he is really "junior" in the ranking of the pack, the urine-marking problem in an intact male will persist till the end of time. When you are not at home, Junior is the senior or top dog.

Neutering may or may not help at this age but it is better to do it now than wait till another year if you want to resolve Junior's behavioural problem. In many Singaporean families, there is great resistance to neutering by one member (the alpha homo sapien?).

So, the rest of the family just tolerate the urine smells and mops or wipes diligently, to keep peace within the family. It is an extremely interesting finding of human-dog relationship I discovered during my toilet-training research of over 500 dogs in Singapore in the past 3 years.

It seems that the human family nucleus in Singapore also has a pack leader. He or she decides whether the male dog can be neutered or not. If the answer is no, all members listen to the head of the household and do whatever they can to keep the house or apartment free from urine smell. Sometimes it can be studious effort as the male dog urine marks several times a day.

I vividly remember an aged mother who personally thanked me for proposing to the daughter who talked to the brother to neuter the male dog. The poor woman in her sixties had devoted so much time to cleaning up after the naughty canine and I told the daughter frankly that the mother ought to have her own free time after having spent so many years raising the children.

I hope this email answers most of your questions.
Best wishes.

80. Are mothers of undergraduate sons from another world?

"One of my client's daughter slashed her wrist," the family dentist continued scaling the youth's teeth. "Her steady boyfriend of a few years graduated, went to work and married another woman. Therefore, it is so important that you don't get a steady girlfriend till you have had graduated from your veterinary studies. The girlfriend's parents demanded to meet the parents of the boyfriend."

This was the best opportunity to give advice to the young man. He could open his mouth but he could not reply, as the sizzling dental scaler swept away the tartar on his teeth. He was a captive audience sitting in the $30,000-dentist chair. He was all ears.

"What happened to the girlfriend?" I asked the dentist.

"It was like a meeting of warlords in Afghanistan," Dr Tan adjusted her scaler and suction tube to suck out the water from the youth's mouth. "It was very much like a meeting with the Mafia godfather! The girl had threatened to jump down from the 20th floor of the HDB apartment but the what could the parents do?"

"What happened to the girlfriend?" I asked. "Did she commit suicide due to unrequited love?"

The family dentist continued in a maternal voice, "I have had known you since you were in primary school. I regard you as my own son. Listen to my advice. Focus on your undergraduate studies in Murdoch University in Australia and excel academically. Don't go steady. Girls distract you from your studies."

Juliet, the youth's mum nodded her head vigorously in concurrence with Dr Tan's view but had not interferred with her son's romances. The dental assistant did not comment.

"Hey Dr Tan!" I objected above the whine of the dental scaler. "Why are you not supporting your own gender? Here, your advices are going to break the heart of a Singapore girl!"

Dr Tan ignored my protest. She is a mother of a son and would have had put her foot down on puppy love before graduation.

What happened to mothers of undergraduate sons? Weren't they girlfriends once and in first love once? Hm, probably their puppy loves faded away and they knew that puppy loves would not last. Now that they have become mothers, they did not want their undergraduate sons to be distracted and to fail their studies.

"Perhaps," I threw out a proposal which I knew would find favour with the youth's mother. "Juliet ought to retire. Go to Perth to cook, keep the place clean and look after the young man."

Juliet's eyes brightened. She pursed her lips and closed her eyes as she gave her sweetest happiest smile. She could see her son growing up instead of suffering the 'empty nest syndrome'. No more corporate politics and the need to reply to nonsensical e-mails in the office. No more long hours of work going home till past 8 p.m. She could wake up, breathe in fresh countryside air of the suburbs near the Murdoch University. Do nothing. Less stress. Her white hairs now growing in leaps and bounds, all camouflaged by the hair dyes would revert back to the natural black as stress levels plummet.

"An excellent idea!" Juliet said solemnly.

The dentist nodded her head vigorously in assent as she continued scaling. Mothers are really from another world! They haven't a clue about the intensity of puppy loves of youths.

This time the youth was no longer docile. He gurgled some words, shook his head as vigorously as he could and said, "No, mum."

He had just turned 21 years old and legally, he was independent. He did not want to be tied to the mother's apron's strings. What would his classmates think of him?

The jolly dentist laughed heartily at the youth's reaction. I was sure that the patients waiting outside must have heard her happy laughs resonated in the small cramped dental room.

I knew the futility of advising youths not to fall in love.

I said, "Singapore girls are nowadays more 'aggressive' and forward than during my time some 30 years ago. They get their men, like the Canadian Mounties are famed to do so. They make the first moves and why not? It's every girl for herself in competitive Singapore".



"Well," I threw in my 2 cents' worth of advice to the youth and in support of the two mothers fighting an uphill battle and losing the war of emotional young loves.

I said to the young man, "If you focus on your studies, you will be successful after graduation. There will be many fishes in the ocean.

"One day, you will meet and marry a high-powered woman like your mum. Somebody who has a doctorate in Physics. A lady with beauty and brains."

"What rubbish are you talking about?" Juliet protested. "I don't have a Ph.D in Physics."

"OK, I exaggerate. Your mum has a First Class honours in Physics."

"What nonsense!" the mother muttered. The dentist and her assistant were all ears as my silence was deafening and Juliet did not care to clarify and elaborate.

"OK, OK," I said. "Your mum has a Second Class Upper Honours in Physics. In Singapore during her time, only top students were permitted to go to study the Honours degree in the 4th year. I would say that women who studied Physics are very intelligent and high-powered mentally."

I continued, "However, you may find such high-powered women too smart and hard to handle! Maybe it is better not to marry one."

The youth could not comment as Dr Tan took a dental mirror which reflected blood-red ulcers in the gums below his incisor teeth and said, "You had not been brushing your teeth properly since you went to Australia."

Would this young man forsake his Singapore girlfriend? Not likely but who knows?

There was no turning back to abstinence for the youth despite the good maternal advices of two graduate mothers.

I just hope that he would remain faithful to his Singapore girlfriend and not play the field in Australia. I guess all's fair in love and war in the Murdoch University campus and 'out of sight, out of mind'. Thank god there is Skype and the text messages.

But nobody can foresee the future? One thing I know now.

Mothers of undergraduate sons are from another world. They are not supportive of their gender. They don't want their youthful sons to fall in love while still studying. They believe that first loves are transient and will distracting their sons from achieving academic success. As for Dr Tan's client's daughter who threaten to kill herself when jilted, the dentist did not know what happened to her.

79. Follow-up on Case 76. The banker wins.

Thursday, Oct 11, 2007 1.34 pm.
However, on a fine sunny Thursday morning of October 11, 2007, the puppy's temperature was below 39 degrees Celsius. He did not have any fever by late afternoon as I typed this report.

The Miniature Schnaucer sat up, scratched his armpit and ears and though he did not eat, I could safely assume that his fever had broken and he would be recovering. Assumptions and presumptions can be risky. I took the puppy for photography. The puppy could stand up.

The he wagged his little stubby tail, cropped a bit too long. That was a good sign. His brown whiskers and the way he was groomed made him look like a sharp triangular faced fox.



Not all high-fevered puppies can recover as predicted. The presumed virus which attacked him had been eliminated by his resistance. The veterinary staff felt great too when they saw him eating later in the day.

In this case, the banker had quite promptly sought veterinary advice when he saw that the puppy was lethargic. He took the puppy home to nurse him but was wise enough to relinquish the care to the vet as the high fever returned again.

The virus had dealt the card of death on the table of life and death. The puppy was not recovering by day 3 as he was sleepy and not eating. Electrolytes sustained him. But on day 4, the puppy did not have any fever. The banker, through his proxy, the veterinarian wins this time.

78. Shopping around for a vet to remove an encapsulated abscess

The queue slip with the number 5, today's date and name of a veterinary practice dropped on the floor as the woman registered her puppy for surgery if she could get a quotation to her satisfaction.

Mark picked it up and showed me. I ignored it. Later on, he still showed me that the prospect had been to the competitor.

"It is quite normal for prospective clients to shop around," I said. "The cost of living is very high for the heartlander and in this neighbourhood."




I did not tell Mark, but I thought: "The Singapore bureaucrats think of ways and means of increasing fees for licensing products and services in the name of safety and other reasons. These bureaucrats don't need to worry.




"At the end of the month, they get their salary and bonuses at the end of the year. But every now and then, they will announce a new ruling to safeguard consumer interest."



With the new ruling, fees have had to be paid for new services and so the costs of living go up yearly.

It is tough for many ordinary pet owners and for many vets as they struggle with higher costs of licensing fees, salaries and other mandatory payments too. There is an economic boom on the stock and property market but I doubt many heartlanders who don't work have much benefits.

"The fee including general anaesthesia and surgery is $150." I said to the lady in her late forties.

"Any discount?" she asked as she showed me a card from a pet shop I vaccinated puppies.

"It is as low as possible." I said. The reason for the lump was an encapsulated abscess and it was growing bigger, according to the lady. Antibiotics would not work in this case. This is an area of injection, so my first diagnosis would be an encapsulated abscess rather than a tumour in this puppy.

"No pain for the puppy at all," the lady said. "But it grows bigger day by day."

I palpated the lump. Pressed it. It was hard as a rock, but the puppy did not bother with the pressure.

In any case, it would be best to remove it if it was growing bigger.

77. Singapore Vets "overcharging" to take advantage of the new licensing law?

A journalist, referred by somebody I trust, phoned me to ask about my views about a complaint that vets overcharge for spaying and neutering, being opportunistic in the fact that all dogs must be licensed and microchipped after September 1, 2007. Owners of sterilised male and female dogs need only pay S14.00 instead of $70.00.

"It is utter rubbish of a vocal minority who likes to complain. There are so many vets in Singapore. True-blue Singaporeans know where to get the lowest rates, just by phoning all clinics. Rates are mandated by the authority to be posted on a big notice board in the clinic waiting area and some are accessed at the clinic's website," I said.

"Why don't the Singapore Veterinary Association produce a scale of fees?" she asked.

"Not advisable. It will be equivalent to price-fixing. Have you heard that the Singapore Medical Association had dispensed with this procedure in the last year or two?

"This scale of fees method is deemed a price-fixing practice. What if a doctor wants to charge much lower than the scale of fees---he would be brought up before the Disciplinary Committee for breach of regulations."

"I understand," the other party said.

"I hear that some clinics are full having a long waiting list." the journalist asked.

"I have heard about it too," I said. "How long have you been in journalism? Did you research the cause?"

The journalist said, "I am new to this animal topic and find it very interesting."

"Yes," I said. "Animal stories are always fascinating to many people."

I postulated, "Vocal owners who may be on the waiting list know what to do to avoid being fined $5,000 for not getting a licence at the appropriate time. By appropriate time, they want their dogs to be sterilised first and save some money.



"So they complain to the press about overcharging. The authorities take notice and therefore can be more sympathetic in case they catch such people. An amnesty would be given."

The journalist asked, "Did you have a surge in the number of dogs sterilised? How much?"

"If you compare this month to the same month of last year," I said, "It is 100 percent." Was she impressed?

I said, "The percentage is impressive but the absolute numbers are not what you think!"

The journalist laughed, "I will not quote numbers." It is risky dangerous talking to journalist as there is the danger of being misquoted.

So, are the vets overcharging or not? It is not possible to overcharge because there are more than 25 small animal veterinary practices in Singapore. Free market forces come into play. The dog owner has choices as there is no price-fixing cartel by the vets nor by the government or association. So, this allegation of overcharging is baseless.

76. Follow-up on Case 72. The virus deals the card of death.

Wednesday, October 10, 2007 6 p.m

"What are the chances of recovery?" the banker came to visit his Miniature Schnauzer puppy after work. The puppy was lethargic since Sunday. 3 days had passed without full recovery. This evening, the 15-week-old puppy would not greet him but just wanted to be left alone, lying at the corner of the crate. The puppy just did not feel good and did not care about any food or visitor. He was given electrolytes and medication by mouth on a schedule, to keep him alive.

A handsome 'sun-tanned' slim lady in her late twenties and wearing a contrasting pure white dress as if she had come from a big corporate office where every lady dressed to impress or kill, accompanied him to visit the puppy.

The banker did not introduced her to me and she did not introduce herself. This is a common happening in the Singaporean culture. So I presumed she was his wife, working in the same bank.

The gentleman was worried about the sleepy puppy. The puppy wrapped his front legs around his head, as if having a headache and laid against the right inner corner of the crate. The puppy's temperature was 39.2 deg C at the time of visit. But he was not active. He just slept and had not eaten for the past 24 hours.

Yesterday, around midnight, the puppy's temperature was 40.1 deg C. He was given anti-fever medication. At 8 am today, his temperature shot up to 40.9 degrees C. The fever was brought down by bathing and anti-fever medications.

Who was the lady visitor? Impertinent curiosity would not be appropriate at this time.

As if reading my mind, the gentleman banker said, "She comes to visit the puppy because she had purchased a female sibling from the same pet shop. She had also left the puppy at the pet shop for 4 hours waiting for the vet (myself) to do the 3rd vaccination. She was groomed in the pet shop as well. Yet this sibling is in perfect health. How come the male sibling was hovering at death's door?"

"The male sibling could have had picked up a virus or more than one during the four hours inside the grooming room of the pet shop," I said. "The sister could be more resistant to the viral infections and remained healthy."

"Is there any hope and how long will the puppy recover?" the gentleman sat in the air conditioned waiting area as the animal holding area was too warm as he was wearing a long sleeved shirt and tie, as befitting a banker of the financial district of Singapore.

"The puppy's resistance to viral infections is the key to recovery. If the puppy is strong, he will recover." I said. "However, the vet or owner must be able to control the fever. If not, the puppy's brain and internal organs get burned out and the puppy goes into fits and possibly death."

"He had lost a lot of weight," the banker referred to the slim waistline of the puppy earlier.

"This puppy is not thin at all," I said. "The spinal area still had the layer of fat."

The banker asked again, "When will the puppy recover?"

"From past puppy fever cases, it should be 3-5 days after the onset of fever. Today is the 4th day. Wait and see. I will give him the anti-fever injection for the 3rd time since the anti-fever medications work for very short periods of time. Usually I try not to give more than two times the anti-fever injection. The puppy's liver may not be able to handle too much of the anti-fever drug."

There were many things the vet could talk about. The gentleman banker knew a Singapore veterinarian who was also studying in Australia's Murdoch University at the same time. "Now, he makes lots of money in Singapore---like nobody's business," the gentleman said. "He has a big crowd of patients every day."

"How are veterinary students in Murdoch University?" I distracted him from thinking that all Singapore vets mint gold from pets.

"They are a dull lot. Not much of a life. They seem to have no time to play. Their studies take up too much of their time. Unlike Finance and Banking undergraduates, we had much more time to do other things."

"Did you join the Association of Singaporean students or something like that?" I asked.

"No," he said. "A waste of time. I had some Australian friends."

"Do you need a car if you study in Murdoch University?" I asked.

"Yes," he nodded his head emphatically. "For example, I need a car to borrow books from another Australian University. I will copy the book and return them as I can't borrow for a long period of time."

"Do you find pages missing from the text book, such that you can't read or photocopy them?" I asked.

"No," he said.

Text books are expensive in Australia. Cars are relatively cheap compared to Singapore. Do students really need a car? I don't think so as many Singaporean parents have to sacrifice a lot of money just to pay for the veterinary school fees totalling at least A$30,000 - $40,000 a year.

"What do you do with your text books after graduation?" I asked him. I thought he might be able to sell them.

"All books and notes are donated to the ... (name of the Murdoch University Drinking Pub) so that the new students can benefit. That was a great idea for recycling. I wonder if Singapore University does such things.

Next, I talked to the presumed wife. I was surprised to discover that the lady's dad was a Malaysian veterinarian and would take home injured dogs to nurse back to health.

"Very rarely do I meet or know of small animal veterinarians in Malaysia", I said.
"Is he an animal welfare activist, like those at NANAS (Noah's Ark Natural Animal Sanctuary)?" I asked her.

"No," she said. "He's retired at 60 years of age." We talked a bit more into the evening. The banker looked at the puppy after the anti-fever injection was given. No instant leap to activity. The puppy just huddled in a corner of the crate. |

The two bankers had to go home as it was 6.30 p.m and they had been here for at least an hour.

"Going back to see your daughter after a hard day's work?" I asked the lady in the white dress. The gentleman banker had told me he had monitored the puppy's temperature at home on day 1 till 9.30 p.m when he had to tuck his daughter in bed. The puppy did not have a fever on day 1 till the next day. Subsequently, the puppy was warded at Toa Payoh Vets.

"Oh, that's his daughter," the lady with the most beautiful brown complexion pointed to the gentleman banker. Assumptions of martial relationships can be dangerous. So, was this lady his girlfriend?



As for the puppy, I dare not assume that the puppy would recover in the 3-5 day period of time. I told the banker accordingly. For all I know, the puppy could be dead. The only good signs are that he no longer vomited and he did not have diarrhoea or blood in the stools. Whatever virus was attacking him had so far, gained the upper hand.

The viruses had put out the card of death on the table of life and death at 6.00 pm on day 3 of fever. The gentleman banker now took his card---an anti-fever injection and electrolytes given by his veterinarian proxy. Who has the stronger hand?

75. The American Cocker Spaniel is high maintenance, like some girlfriends

In Singapore, the common causes of itchiness in the puppy are skin infections and ear infections caused by mites and bacteria and a lack of grooming.

In many cases, the child for whom the high-maintenance puppy, like the American Cocker Spaniel, Shih Tzu, Poodle, Bichon Frise and other thick-coated breeds, is given as a present soon forgets that daily grooming is required.




The child does not spend even 5 minutes to groom and brush the puppy. Just feed it and clean up the stools. Just bathe once a week. Soon, the ears get itchy. The skin under the long hairs gets damp and infected. The puppy bites and licks the intense itchy area. Rubs its neck and floppy ears.

The groomer would be consulted to get some advices. The groomer with the pet shop advised, "Buy these shampoos, chicken-based dog food is never good---chicken is the cause---change to this brand, rub on this good ointment on the affected skin, give this ear drop---very effective...."

Sometimes, these advices were excellent.

In the end, it is still the daily grooming, inspection and brushing that prevents many of the skin problems of the high-maintenance breeds. At least a grooming once every 2 days.

As for high-maintenance girlfriends/boyfriends, nothing much needs to be done about their grooming. They know what to do. If you can't afford their life-style, they just dump you.

74. Follow-up on case 72. Advices to pet shop operators

The banker monitored the Miniature Schnauzer till 9.30 p.m. The puppy was ok. He got his daughter to bed and retired for the night. The next morning, the puppy was lethargic and had high fever. The puppy had also vomited once overnight.

Could this be the start of the parvoviral infection? The puppy was warded. Given an anti-fever injection and fluids. He was normal again for the rest of the day. Active and ate. But confined to the crate.

"How much it is going to cost me?" the banker asked.

Veterinary costs can add up and anything over $100 seem to be 'expensive' to many owners.

"Should be around $150 if the puppy was not staying more than 2 days," I said. "Usually the fever lasts for around 3-5 days if the puppy is strong and can fight the virus."

Costs can come to over $1,000 if blood tests and other tests were done. This seemed to be a viral fever as the puppy was in the pet shop for his 3rd vaccination.

"I saw you at the pet shop," the banker said.

"Sorry, I can't recognise you," I said. I had seen him at the pet shop but had not talked to him. I did not know he was bringing this Schnazuer back to the pet shop for the 3rd free vaccination.

I said, "This puppy was in the pet shop where there are other puppies 8 days ago. So, he must have got exposed to the viruses when you took him back. The puppy was in your home for 2 weeks before you brought back to the pet shop. The viruses took around 7-10 days to cause him fever. As to what type of virus, it is hard to tell. The puppy killer virus is the parvovirus, but he had at least 2 vaccinations earlier."

I said, "Maybe it is best not to bring the puppy back to the pet shop again for any vaccination as it would be exposed to the viruses."

The banker said, "The sibling of this puppy, a female, from the same pet shop did not suffer a fever. She is OK."

"Like people, puppies have different resistance to infections," I said. "Your puppy could have lower resistance."

"Would he die?"

"Hard to tell for the time being," I said. "Vomiting is one first sign of the start of parvoviral infection."





VACCINATION SCHEDULE OF THIS PUPPY.
Date of Birth: June 22, 2007
lst vaccination by another vet: August 2, 2007 (Week 5).
2nd vaccination by me: August 29, 2007 (week 9).
3rd vaccination by me: Sept 29, 2007 (week 13).

ADVICES TO PET SHOP OPERATORS

Vaccine manufacturer recommended 2-3 weekly intervals.
Week 6, 8 and 10 would be recommended for a pet shop as it gets puppies from various sources, usually breeder. The parvoviral infections can come in and stay at any time. It is best to vaccinate within the 2-3 week intervals as advised by the manufacturer. That means you have to be organised.

73. Mothers know best

I went to see the young vet whom I had mentored on a bladder stone surgery yesterday to thank him for referral of the old dog with the ear haematoma. He did not know anything about it. It was his mum who did it but mum had gone out for a while.

"How's the Miniature Schnauzer with the bladder stones removed by you?" I asked.
"Very good," he said. "A bit of swelling on the lower abdomen after the surgery and that was all. The owner is here," he pointed at a tall broad-shoulder bright-eyed girl in her early twenties working in the Surgery. No formal introductions.

It was good to hear good news that the vet's first bladder stone surgery was successful and to meet the owner too. I still remember him as a 12-year-old walking around the Surgery some 20 years ago.

Somehow we don't seem to see the young children as adults even though they are now.

His mum came back as the Surgery was closing soon at 8 p.m. I thanked the mum for the referral. Mum said, "Very old dogs are great anaesthetic risks. I refer such cases to other vets.

"Do you spay dogs of big breeds?" the mum asked me. "Lots of bleeding if the ovarian pedicle slipped after ligation. Emergency post-operation calls may be required. I usually refer big breeds to other vets."



"Yes, I do spay big dogs" I said. "Actaully, big dogs are easier to spay as the ovaries and the uterine horns are bigger."



The bleeding, if it happens, is much more profuse and frightening. A very long skin and midline cut is needed to look for the bleeding area. Usually it is the ovarian blood or uterine vessel with slipped ligature. It takes more time to look for the bleeder. The owner becomes dissatisfied with such a long incision of over 15 cm. All practising vets will encounter such unpleasant situations.

I said of the young vet who was doing consultation in the room, "Your young vet here can do it as well."




The mum sat down on the bench and put her left hand to cover her ear and said solemnly, "I will pretend that I did not hear you saying that."

Well, mum knows best. Big breed spays are actually not worth doing if one is calculating earnings/time spent. They take longer to spay. The risks of death from bleeding may be higher as the blood vessels are much larger and unlikely to contract unlike the small breed's blood vessels? Definitely, bleeding during the spay of a big breed is horrible. Fat big breeds can take a much longer time to spay as the fat layers hide the ovaries. The time to spay one big breed is equal to the time taken to spay 2 small breeds.

The young vet had interest in surgery. He has done lots of spays in cats and small breeds. He is quite busy. Spays of big dogs and big fat dogs take a lot of time. This would eat up the time and stress him out.

Definitely, mothers know best after all.

72. The banker who loves his Miniature Schnauzer

Immaculately well dressed with a striped long-sleeved shirt and blue tie, the young man in his late twenties put his 15-week-old salt and pepper Miniature Schnauzer puppy onto the consultation table and said, "My puppy just was not active yesterday. Not interested in food. Just wanted to sleep the whole Sunday yesterday."

The 6-month-old puppy had all her 3 vaccinations and a microchip implant at the pet shop. He was from a batch of 3 Miniature Schnauzers.

"Has he any contact with other dogs or was she at the groomer during the last 7 days?" I asked.

"No," the earnest man said. "No dog contact at all."

The puppy had 40.7 degree Celsius. I palpated the abdomen. There was some pain in the stomach and liver area but nothing else. What caused the high fever?



"Did the puppy eat something new?" I asked.

"No," the man said.

"Did you buy puppy treats from various sources?" I asked.

"Yes," the man said. "Different types of chew bones and treats."

"It is possible that the puppy treats had been contaminated with bacteria and the infections caused high fever. It could be a virus. The puppy was at the pet shop some 8 days ago when he was vaccinated for the 3rd time by you."

I gave the anti-fever injection and treatment. The puppy would need to rest at home and take medication. If I don't see her tomorrow, she would have recovered. The banker would use the digital thermometer to monitor his fever every 3 hourly. If the fever returns, he should come back to the Surgery the next day.

"Aren't you supposed to be working in the morning?" I asked the young man.

"Yes, I took time off. I rushed from the bank to bring the puppy to see the vet."

Nowadays, puppies are like family members. Sick and fevered puppies are like babies --both can't tell you what's stopping them from eating. Neither could their caregiver too. This seemed to be a viral fever case due to the sudden onset.

"Do you want to do a parvoviral test?" my assistant Mark asked two times.

"No," I said. Laboratory tests add up to the veterinary costs and increase the revenue for the practice.

However, many puppy owners appreciate minimal costs of treatment. It is understandable as the costs of living in Singapore keeps going up every year and there are various family expenses to consider.

71. Man proposes. God disposes. The Shih Tzu nearly died during spay.

TO: THE BOY WHO WANTS TO BE A VET.

"Is the dog breathing?" I asked my assistant James whose sole job was to monitor the dog's breathing as evident in the expansion and contraction of the anaesthetic rebreathing bag and by checking the colour of the tongue. He would alert me when there was something wrong and he had at least 5 years of experience monitoring general anaesthesia in the dog. But age was catching up with him. But his mental faculties were still good.

"No, she is not bleeding," he said. With so many years of experience, he could still hear me incorrectly. But he did not have hearing problems. So, it must be my diction.

"Damn it. I mean 'breathing'...why would I ask you about the dog bleeding when I can see it for myself?". One has to be patient with senior citizens.

I noticed that the left ovary I had hooked out was blood-less. Attached to the left ovary, the uterine horn was not the usual bright red. A paler shade of bluish red.

Spaying a female dog is such a common operation. It could be done in less than 10 minutes. A vet could become complacent if he relied on his assistant. There was something not right.

"The dog stopped breathing," James reported.



I stopped the surgery. Yes, James was right. The dog's tongue had changed to light purple and soon become white. It was a few seconds to death's door.

This is where veterinary anatomy and physiology studies come in useful for the veterinarian and such subjects are boring for first-year vet students.

Without the knowledge of these 2 subjects, this dog would just die.

What must be done before it is too late? The heart has failed. No blood is pumped to the lungs. No oxygenation. The blood colour changes to purplish or cyanotic as seen in the tongue. Then no blood or less blood reaches the tongue as blood circulation is shunted to vital areas like the brain from peripheral areas.

First, get the heart pumping. No time for heart stimulant drugs. I used the fingers to compress the heart. 3 times massage. Stop anaesthetic gas flow. Blow air into the endotracheal tube to inflate the lungs 3 x. Connect emergency oxygen if necessary. The dog started breathing as her chest rib cage expanded and contracted. There was no more anaesthetic gas required as I completed the surgery.

The dog's tongue was still cyanotic. The Shih Tzu breed has been reported to have breathing problems and is an anaesthetic risk.

Still the dog would not wake up at the end of spay, unlike other dogs. Most likely, the xylazine tranquiliser had a sedative effect. Sometimes it would be best just to give straight gas to Shih Tzus for surgery.

I put the dog inside the crate and asked Mark to observe for another 30 minutes and give cardiac massage 3x intervals. The dog was sitting on her chest but that did not mean that one could be complacent. Suddenly the dog stopped breathing!



What to do? This dog was already awake.

Blow air into the mouth. Hang the dog upside down. Pull her tongue out as she might have obstruction of her airways. Cardiac massage. The dog revived within one minute of entering the twilight world between life and death.

A simple spay operation. The owner had instructed that the dog transport woman get an experienced vet to operate as soon as possible so as to get the dog licensed. A $5,000 fine with effect from Sept 2007 if owners are caught for not having a dog licence has sunk into many worried minds of Singapore dog owners.

Spays are urgently required nowadays as the dog licence fees for sterilised male and female dogs are around $14.00 compared to $70.00 per year with effect from Sep 1, 2007. No blue-blood Singaporean should be caught with his pants down, in this case, unsterilised dog whenever the authorities checked his four-legged companion at any time! This new law and financial costings highly motivated many owners to go for sterilisation even if the dog was into senior citizen categories. Some owners would just microchip and leave the pet in its natural state.

Now, this case was the standard picture of a healthy Shih Tzu. Young, fit, slim at 5kg. Only 2.5 years old. Not expected to pose any problem in anaesthesia. I thought: "Spaying her is a piece of cake. Won't take more than 10 minutes." I asked James to time my surgery so as to make myself more productive, since I was onto my staff to be productive and not spending time at www.facebook.com whenever I was not around.



This showed that Man proposes, God disposes. No matter how experienced one is, there will always be unexpected situations that teaches a vet not to be complacent during anaesthesia and surgery.

For a first-year vet student, anatomy and physiology are very important foundations for your future as a competent veterinarian. With such knowledge, you can understand about the workings of the heart and anatomic difficulties in breathing for a short-head (brachycephalic) breed like the Shih Tzu and take appropriate precautions and emergencies to prevent deaths during anaesthesia.

As for me, this spay took over 15 minutes. The dog was normal and went home to a happy owner whom I had never met. The middle man was the dog transport woman!

70. When to spay a pregnant cat?

Oct 5, 2007 E-MAIL QUERY TO TOA PAYOH VETS

Dear Judy,

I found your address on a Singapore animal lovers website, I'd appreciate your comments on a situation my wife and I have.

A very young, presumably abandoned, kitten found us some 8 months or so ago, decided to move in (!!), is now a very well adjusted family pet, was described by cat loving friends as definitely spayed, but is now clearly pregnant. I don't have too much problem with the future kittens - which I think will arrive in the next couple of weeks or so - either we find them genuine homes or they will have to be euthanased (much as I hate to have to do the latter).

We'd like to hear your advice as to what, if anything, we should do regarding vaccinations etc before the litter is born, and when is the correct time to have the mother spayed after the litter is born.

The mother is actually a lovely natured cat, we want to do the best for her, but future pregnancy must be avoided.

In advance, thanks for whatever advice you can give us.




E-MAIL REPLY FROM DR SING

1. NO VACCINATION FOR PREGNANT CAT. Give high quality cat food.

2. Two to four weeks AFTER WEANING THE KITTENS TO SOLID FOOD. That means the kittens are weaned at 4-6 weeks of age. Stop suckling so that no more milk is produced. When there is no more milk (observation), spay the cat. This may be around 2-3 MONTHS AFTER the birth of the kittens.

Many owners spay the cat that she is still producing milk wanting to get the spay done urgently to prevent pregancy. There is the slight risk of the milk seeping into the abdomen causing peritonitis. In an ideal world, it is best to spay her when she has stopped milk production.

69. Is Every Customer The King? --- The veterinary staff is badmouthing the pet shop?

"I am not happy with one of your veterinary staff," the pet shop girl phoned me. "He told my client that my shop has many puppies dying of parvovirus. My client's friend wanted to return the puppy and the puppy had been with her for 2 weeks! I had a big row with my client."

I said, "It is best to get your client, my staff and you together to know what has been alleged. In this way, you get to hear all sides of the story."

The pet shop girl did not accept this method of resolution.

"How can I refer my clients to your Surgery if your staff bad-mouths my business?" the pet shop girl throws down the gauntlet. "So, are you going to tell your employee or not?" the pet shop girl's tone went up a notch, impatiently and demandingly. Her shop had "The Customer is King" reminder to employees on a list of duties and I could understand her apprehension.

"I will talk to Mark urgently by phone as he is not around," I said, not wanting to add oil to the fire of anger. "In my experiences, there are a few customers who twist and turn, leading to conflicts and tension between the veterinary staff and the pet shop."

Pet shop operators are quite demanding. They are seldom loyal to the veterinarian in my experience and so this threat of cutting off referrals did not cut ice with me.

When I went to the pet shop for vaccination on the same day, the pet shop girl did not bring up the subject and I did not pursue the matter. Since there was no need to drag up the dirt and accusations of bad-mouthing, let sleeping dogs lie.

Mark must have had contacted her client who had denied any badmouthing. Mark was angry at being accused of this matter. The client must have had spoken to the pet shop girl.

As for me, I said to the pet shop operator when I saw her, "I have stopped going to many breeders and pet shops for vaccinations nowadays due to such conflicts and conflicts of interests."

I was brutally frank, "I have had terminated my services to your competitor who has ten times more dogs than you for me to vaccinate. It was a large loss of potential source of doggy clients to me. But I had to do it."




"Why?" the pet shop girl asked.

"According to one client from your competitor, the competitor told the puppy owner that she she ought to come to me to use the free vaccination voucher given by the pet shop on purchase of the puppy. But the puppy owner must go another veterinarian for all consultations."

With such a silly advice, the puppy buyer gave us the feedback. The buyer felt that there was some dubious inexplicable behaviour on the part of the seller and expressed her feelings to my staff. Why would the seller recommend her to come to me for free vaccination and not for other services? This was a case of a pet shop seller bad-mouthing a veterinarian and yet using her extension service to vaccinate his puppies? Was there really something wrong with the veterinarian? Human behaviour is hard to explain in many circumstance.

I said in a lecturer's voice to the pet shop girl, "Now, whether the puppy buyer was twisting and turning in her comments to my staff, I don't know. It was an odd behaviour of the pet shop puppy seller. I do not just confront the pet shop operator to demand an explanation. I just stop doing business with him."

To make her appreciate that I don't really need her business if she becomes unpleasant and awkward, I said, "Your competitor has many more puppy vaccinations for me than you!"

The pet shop girl was silent.

In fact, this pet shop operator has notices of other veterinarians except mine on her notice board. I did not want to tell her to include my name on the board too. She has her right to do what she wants with her shop's notice board. A clever pet shop operator would do the necessary to promote the veterinarian's business or at least not to put up notices of other veterinarians.

I do not enjoy being brutally frank in business, but sometimes this is the best way to handle pet shop operators and breeders. A veterinarian going to the pet shop to vaccinate their puppies is "perceived" as being "desperate".

Many pet shop operators and breeders look down on such veterinarians. It is a sad fact of life. They think, "After all, if the vet is that good, he would have a heavy caseload. Why spend time driving to a pet shop to vaccinate one or two puppies?"

Time is money. Is it worth the trouble if you are really a good veterinarian? Is the quality of such clients really up to par when they press the vet for cheap services and get free consultations? I doubt it and am taking pet shop services only where both parties are happy to see each other. I will stop my vets providing such services when necessary. Sometimes, it is best to serve with happiness. The Customer is not always the King. Many behave rudely and are no better than peasants. Peasants are uneducated but such boorish customers and tried to get fake quotations said to be offered by my staff in order to obtain cheap services or run away without payment!