Be Kind To Pets

131. Hamster with rotting skin

2008-02-04T14:34:00.000-08:00

This case illustrates how the internet enables hamster owners to share information
from my hamster cellulitis case photographed 5 years ago.

I have not encountered any more such cases because hamsters in Singapore are low value pets and they seldom receive veterinary treatment.

Yet the owner based in Taiwan managed to ferret out my photograph of 5 years ago and contacted me.

This is the first e-mail from the hamster owner in Taiwan.

>>
>> ----- Original Message ----
>> From: A hamster owner in Taiwan
>> To: judy@toapayohvets.com
>> Sent: Tuesday, 29 January 2008 1:40:49
>> Subject: Hamster Cellulitis
>>
>> Hello,
>>
>> I found your site by searching for hamster symptoms online. One of your sites features a picture of a hamster with yellow/greenish rotting skin on the bottom right of the webpage: http://www.asiahomes.com/singaporerealty/last_word.htm

Picture of a hamster cellulitis case taken by Dr Sing in 2002, 5 years ago!
>>
>> This is the exact same thing that is going on with my hamster right now. Fortunately even though the skin on my hamster looks as awful as that little fella my hamster still looks quite healthy.

>>
>> I live in taiwan and unfortunately do not speak Chinese. The vets we have been going through have not been able to help a lot so far and the condition just seems to be getting worse and worse.
>>
>> They had us soaking the area with saline 3 times a day followed by covering it with iodine. It only seems to be spreading. I'm not sure about what kind of medicine the vet has given us but the hamster will no longer take it even if we try to trick him with treats or the sugar solution they gave us.
>>
>> The doctor just keeps guessing and admitting he doesn't really know what is going on and keeps shrugging it off as cancer but it looks like what your site says is Cellulitis. Is there anyway you could recommend the medicine the hamster should be taking so we can ask the doctor to subscribe it??
>>
>> I am also concerned about the saline since I've read getting hamsters wet can cause wet tail and I've read on another place in your website that iodine can poison the hamster.
>>
>> If you can help out you will be my hero!
>>
>> Your advice would greatly be appreciated! Please help!
>>
>> Catherine

>
> On Jan 29, 2008, at 7:13 AM, Dr Sing KY wrote:
>
>> I am Dr Sing from www.toapayohvets.com IF possible, email me the pictures of the actual infected area.
>>
>>

> ----- Original Message ----
> From: A hamster owner in Taiwan>
> To: Dr Sing KY
> Sent: Wednesday, 30 January 2008 12:42:48
> Subject: Re: Hamster Cellulitis
>

> Dr Sing,
>
> Thank you so much for taking the time to write me. I've attached pictures of the hamster's condition.

>
> It started as a spot as big as a (human) pimple on his left side in a day or two it was as big as a nickel (we took him to the vet that day) and since that time it has grown to what you can see in the pictures. We've been to the vet 3 times so far but no clues and it doesn't seem to be healing well. Some of the skin has broken away but it's hard to say it's getting better.
>
> The area has a really bad odor. The hamster is still eating and drinking and looks fairly healthy even though we're having a hard time giving him his medication. His eyes are a bit sleeping and if he's outside he'll tend to lift up his left front paw.
>
> I really really appreciate you taking the time to write me! You are extremely kind! I had a wonderful vacation in Singapore last year and was amazed at how friendly and kind people are in Singapore. I thought it was just because I was a tourist but I guess I was wrong. Thanks so much!
>
> Happy New Year!
>
> Sincerely,
> Catherine
>

On Jan 30, 2008, at 7:35 AM, Dr Sing KY wrote:

> 1. Thanks for your compliments.
>
> 2. The hamster has a severe bacterial infection that had not been responding to antibiotics (I assume the vet had given antibiotics). Or you may have not given the dosage required.
>
> 3. The infection spreads due to your continual swabbing and the hamster continual licking and biting the sore due to intense itchiness.
>
> 4. Can you locate another veterinarian who has experience with hamsters? Ask your expatriate community or Embassy.
>
> 5. On your side, are you prepared to sleep much less? Intensive nursing is required. Some tips are:
>
> 5.1 Remove dead smelly skin with clean scissors.
> 5.2 Put an Elizabeth Collar on the hamster (like in a dog, but you use a thick cardboard to fashion the Collar) at all times.
> 5.3 Cleanse skin with disinfectant and rinse off disinfectant as often at 10X/day. The disinfectant must be rinsed off thoroughly as it irritates the hamster.
> 5.4 Dry skin with tissue paper after cleaning.
> 5.5 Keep skin very dry and exposed to clean air and oxygen.
> 5.6 Hand feed the hamster by hand as many times as possible.
> 5.7. Ensure hamster drinks and measure amount.
> 5.8 Note stool amount and consistency of hamster. If loose stools, there is a problem.
> 5.9 Give oral appropriate antibiotics and low dose of anti-inflammatory (from the vet).
>
> 6. Can you tel me at +65 9668 6468 to discuss further ?
>
> 7. Pl let me know how you manage to fish out my website on the same hamster condition? What search engine you use and how you do it? I will appreciate this info. Many thanks.
>

----- Original Message ----
From:
To: Dr Sing KY

Sent: Monday, 4 February 2008 11:55:58
Subject: Re: Hamster Cellulitis

Dr Sing,

I apologize for the big gap in my correspondence. I ended up getting a really bad case of food poisoning and ended up in the hospital for a couple of days, and have spent a couple of days recovering.

Thank you SO SO SO SO SO much for your advice. We are FINALLY seeing some improvement in my hamster's condition. We found a vet who specializes in hamsters and she put him on better course anti-biotics and thankfully recognized and gave him the same diagnosis you did. She also told us he's a little under weight right now. She didn't want to cut off any of the rotting skin just yet because she said the area was too wide and it may be more difficult for him to heal.

After we rinse off the disinfectant we've been able to very gently rub some of the top loose stuff away (to his comfort level). We can now see an area in the middle underneath that has healed.

It's been a rough couple of weeks and I was sure it was a death sentence for him but it looks like he will pull through.

The only couple of questions I have for you if it's ok. You mentioned to check his stool. His stool color and consistency doesn't look very healthy but is it possible that this is the anti-biotics? I know in my own experience if I take anti-biotics it can mess up my digestive system a bit.

Also I'm still worried, when you say disinfectant is it still ok to use the iodine if we're thoroughly rinsing it? I forget if it was on your site or another I checked that it can potentially poison them if they ingest it.

As far as your website I found it via google and yahoo. On all of the hamster sites I found it impossible to find a picture of what he has and I really had no clue what it could be. I found different pages of your site on many of my searches like "hamster absess" "hamster cancer" "hamster skin cancer". The key that finally gave me your site was "hamster rotting skin". I figured because of the smell this must be what it was. I believe your site was at the top of the search engine for these key words too. If you would like to use my photos to help your article please feel free.

I also have a recommendation for your site. When I was doing my searches like I mentioned your website kept popping up for variety of keywords and I had a feeling eventually I would find my answer on your site because you had more medical photos and better information than most of the other sites but it was very difficult to navigate to find what I was looking for. I didn't want to have to click through all the vet entries to try to find my specific case because it would be time consuming and because as a non-doctor the photos are very disturbing to look at! :) So I would highly recommend you add a search engine onto your site. I've recently done this on my own website and it works beautifully. Through google you can add a free search engine and specify it to only search your domain or even specify a few domains for it to return search results for. The only branding google puts on it is to put inside the search field "google custom search" but this disappears as soon as you start typing in the field. The code is extremely easy to integrate and it can take as little as two minutes to add it in. Here's the website:

http://www.google.com/coop/cse/

Could you please send me your office mailing address so that I can send you a thank you?

Thanks again and have a wonderful new year!
Catherine

1. Thanks for your detailed reply, permission to use your hamster pictures and suggestions of a search engine. My site is disorganised as I need to use my spare time to edit and write to educate pet owners.

2. It is incredible that you can even locate my hamster picture of cellulitis. That was so long ago. In Singapore, more hamster owners in 2008 are getting the vets to treat their sick hamsters compared to 5 years ago. A kinder younger generation has grown up.

3. To answer your 2 questions (reproduced as follows):

The only couple of questions I have for you if it's ok. You mentioned to check his stool. His stool color and consistency doesn't look very healthy but is it possible that this is the anti-biotics? I know in my own experience if I take anti-biotics it can mess up my digestive system a bit.

ANSWER. Pl give me the name of the antibiotics being used. If the stools are loose, stop the antibiotics for the time being. Otherwise the hamster will get severe diarrhoea and die.

Also I'm still worried, when you say disinfectant is it still ok to use the iodine if we're thoroughly rinsing it? I forget if it was on your site or another I checked that it can potentially poison them if they ingest it.

ANSWER. I did suggest the use of any disinfectant but did not name the type to be used. A very mild disinfectant is to be used and this must be thoroughly rinsed off with clean warm water. The bedding must be clean tissue paper rather than wood shavings for the time being.

I disagree with the vet about cutting off the rotting skin. They contain bacteria and other micro-organisms and being around just simply affect the healing of the wound. That is why I ask you to snip them off.

Let me know the name of the antibiotics used. Thanks for taking so much time to reply to me. Hamsters are low value pets and most Singapore owners seldom bring them to see the vets. I am glad you bother with your hamster and will appreciate some pictures of progress in treatment. I like your blog. Keep up your good work.

130. Follow Up: Successful paper-training a Golden Retriever living in a Singapore apartment

2008-02-04T13:53:00.000-08:00

HISTORY:

July 7, 2006. Golden Retriever, Male, 7 months. Pees and poos everywhere inside the apartment. What to do? Dr Sing advised confinement and paper-training using positive reinforcement training.

Feb 5, 2008. Dr Sing followed up. Owner replied indicated that the dog is 100% successfully paper-trained. I hope this write up will benefit busy urban dwellers and owners trying to toilet train large breeds living in apartments.

----- Original Message ----
From: <...@singnet.com.sg>
To: Dr Sing KY
Sent: Monday, 4 February 2008 11:30:25
Subject: RE: Rocky's Toilet Training

Hi Dr Sing,

Happy New Year.
Please see my reply below.

(Name of owner)

-----Original Message-----
From: Dr Sing KY [mailto:ezyvets@yahoo.com.sg]
Sent: Sunday, February 03, 2008 6:59 AM
To: ...@singnet.com.sg
Subject: Rocky's Toilet Training

Hi
1. Happy New Year.

2. I am Dr Sing from Toa Payoh Vets. You brought Rocky to Toa Payoh Vets around July 7, 2006. I am still doing research on toilet training of puppies in Singapore and need some updates on your success with Rocky to help other dog owners.

3. I hope you have some time to update me on whether Rocky is now paper-trained?
3.1 Does he goes to eliminate on newspapers 100% in the kitchen area ? Or is his toilet area another place?
> Yes he now eliminates 100% on newspapers in the kitchen area only.

3.2 How many times is he fed?
> Twice daily.

3.3 Does he get canned food as well as dry food?
> Mainly dry food. Occassionally (probably once fortnightly) a mixture of dry + canned food.

3.4 What time is he fed?
> Around 7am and 7pm.

3.5 Is the feed given the whole day or for a short time of 20 minutes?
> He finishes up his food within a short time, so we have no problem with this.

3.6 Does he pee and poo within 30 minutes of being fed?
> Yes he does most of the time.

3.7 Does he eliminate outdoors?
> Yes sometimes he does when we bring him out for walks. But we did not intentionally bring him out to train him to eliminate outdoors.

3.8 How many times does he pee and poop for one day (24 hours)?
> Pee 5-6 times. Poop 2-3 times.

3.9 Any accidents - eliminate on non-approved toilet areas?
> No. Only eliminate on newspapers in kitchen. He will not do it without newspapers either. He will wait till the newspapers are laid.

3.10 Does Rocky urine-mark -- pee a bit here and there on vertical surfaces?
> At home, never. I used to see him marking at the beach or park, but I noticed he hardly do it after neutering.

3.11 Is Rocky neutered?
Yes. In Oct 2007.

Your feedback will be most appreciated. Best wishes for the new year!

Conclusion:

A busy working young couple. They take time to train the Golden Retriever.
I advised confinement to a small space (in the kitchen) and praise and give food treats on success. It takes some time (probably 4 weeks) to paper train him but once it is done, he is a great pet to be with.

Fortunately he was not easily bribed by food treats for successfully eliminating on newspapers, according to the owners.

In this case, it will be preferred that the big dog go to the guest bathroom to eliminate. Or a pee tray is used to hold the newspapers in the kitchen. To transfer toilet area to bathroom, slowly shift the papers to the bathroom from the kitchen.

I did not ask the owner why the kitchen was used. Sometimes owners are not aware of the preferred toilet location to be the guest bathroom. Or the bathroom is not available for the dog as there may be guests.

Replace soiled newspapers frequently --- an important factor in successful toilet training as most dogs and puppies dislike dirtying their paws and will avoid soiled papers. Some dogs bark to tell the owners to change. Others bark and get scolded for being a noise nuisance. So they give up communicating with the owner and eliminates outside the papers in the nearby areas.

PREVIOUS POST IN 2006
Toilet Training Your First Puppy in Singapore

The following report from the owner of Rocky confirmed that the "older" puppy (e.g. 7 months old) can be paper-trained if the owner knows how to do it. The puppy is into adolescence and is known to be "rebellious" and has a mind of his own at 7 months of age.

However, with time spent on training him, knowledge that he wants a fresh and clean toilet area, praise and treats, the following case was successfully paper-trained in around 2 weeks.

Basically, the puppy just wants a CLEAN toilet area to pee and poop.

Otherwise, he will avoid the soiled newspapers and poop elsewhere. In the first year of my research, owners complain that the puppy will usually "miss" its target (newspapers) and pee "outside" the newspapers.

The reason is that the papers have been soiled and the puppy is loathe to step onto them unless they are quickly replaced. Some puppies will "bark" to let the owner know that the papers must be changed after elimination, according to owners who tell me.

Some puppies do not provide feedback or the owners are not at home the whole day. Possibly, the owner is inside the crate and has stepped on soiled newspapers (in the petshop -- not sold early or the owner's crate). So, the puppy is used to soiled newspapers after some time.

I have no time to edit, but will do it in the new book.
The e-mail is as follows:

Monday, July 31, 2006

DRAFT - Why the puppy does not poop on newspapers

-------------------------------------------------------------------------

E-MAIL REPLY FROM DOG OWNER --- JULY 10, 2006.

> Dog owner wrote:
>
> Dear Dr Sing,
> We went to your clinic last Friday (7 Jul) with our
> 7-mth old Golden Retriever, Rocky for his 3rd vaccination and sought
> your advice on how to toilet-train him.
> After some thoughts on your suggestions, we decided
> to start off with neutralising his urine and poo smells in the house
> with white vinegar and water.
> On that same evening, we neutralised the entire living room and part of
> the kitchen area, leaving the unneutralised part of the kitchen as his
> intended toilet area (the spot that he frequents most). Then covered
> that area with fresh newspapers and some soiled ones. That weekend, we tried confining him to that specific kitchen area after his meals and monitored him, also tried bringing him
Out for walks and kept asking him to pee/poo, but were not successful.

> He did not pee/poo (on the toilet area)
> as we wanted him to. We gave up, but continued neutralising the floors
> every night as he still eliminates randomly at those 2 areas.
> On Tuesday (11 Jul) evening, > that the methods weren't working, we saw him pee-ing right in the
> centre of the newspapers. We quickly praised him and offered him a
> treat. This time, he took the treat happily and ran off chewing it.
> Initially we thought he had learnt to eliminate there, but later at
> night, we found his poo on the kitchen floor. The following days, as we
> continued with neutralising, we saw some improvement. We observed
> he has stopped eliminating in the living room, and does it only in
> the kitchen area, however, he only pees on newspapers, still poo
> everywhere in the kitchen.
> Last night we've decided not to neutralise the floors. This morning, to
> our surprise, we saw both his pee and poo on the papers. We're very
> happy to see that, and we'll continue to monitor him closely until he's
> really stable and makes no mistakes. Will update you again on his progress.
> Really appreciate your help and professional advice.
>
> Thanks,
Dog Owner.

E-MAIL REPLY FROM DR SING --- JULY 16, 2006.

> Sunday July 16, 2006. E-mail reply from Dr Sing
NLB Toa Payoh Library 10.30am.
>
> My computer is infested with viruses. It shut down and re-started
> several times earlier. After that it shut down completely. So, I am
> using the NLB library to reply to you. It is hard to
> find real computer experts in Singapore who can resolve this problem
> without having to re-format the whole hard disk.
>
> I am very grateful for your contribution to my research and a book on
> Singapore puppy toilet training.
>
> In reply:
>
> 1. My research and reading of other reports. It appears that white
> vinegar is effective only to neutralise the ammonia smell of puppy
> urine. Acid plus alkaline = water (NO MORE URINE SMELL), to put it simply.
> So, the puppy can't find the elimination area with his nose (to detect urine smell).
>
> I presume you used the same mop or had not rinsed off the urine smell
> thoroughly, so the puppy could detect the "accident" areas for the first
> few days. Corners or edges of doors may still have traces of urine. The
> sense of smell is very acute in the canine. However, after a few days of
> your hard work, you probably wiped out all urine
> smell. So, the puppy goes to the newspapers. I presume you did not use
> the soiled newspapers (2nd layer) but the floor is OK too.
>
> 2. White vinegar is said to have no effect on the poop as it does not smell of ammonia.
>
> 3. So your success later may be due to your monitoring and praises. Your
> puppy probably now expecting treat. Some will sit and wait for it after
> peeing. A few owners tell me that some even pee less but more often to
> get treats. I hope your puppy does not think this way.
>
> 4. Poop after feeding times. If you can have a regular schedule of feeding and exercise, without distraction of playing
> immediately after eating, you may be successful. Signs of elimination
> like sniffing, squatting and circling - bring puppy to newspapers.
> Praise and reward.
>
> 5. Will be most grateful if you let me know your progress in the pooping
> training aspect. It is from such case studies that I am able to advise
> as each situation and each puppy behaves differently.
>

E-MAIL REPLY FROM DOG OWNERR --- JULY 2006.
>
July 30, 2006 e-mail to Dr Sing>

> Dr Sing,
>
> We're still working on Rocky's poop training. Did not really have enough time to monitor him for the past 2 weeks due to our work schedules.
> We will continue with your suggestion in Point 4 below.
>
> Thankfully Rocky does not seem to expect treats after peeing. He just
> walks away. He has no problem with peeing on newspapers, i don't
> understand why he could not poo on the papers as well. So far only once or twice he pooped on papers, the
> rest of the times are done on the kitchen floor.
>
> We still do use vinegar to mop the kitchen floor on
> alternate nights. You mentioned in Point 2 that white vinegar has no
> effect on poop. Do you mean that white vinegar can only nuetralise
> urine smell, but not poop smell?
> Is there anything we can do to remove the poop smell?
>
> Hope your computer is fine now.
>
> Thanks,

E-MAIL REPLY FROM DR SING --- JULY 2006.

Date: Mon, 31 Jul 2006 e-mail reply.
04:32:18 +0800 (CST)
From: "Dr Sing KY" Add to Address BookAdd to Address Book
Subject: RE: Rocky's Toilet Training - Pooping on floor.

Thanks for feedback.

1. Most likely reason Rocky does not want to poop on the newspapers more often may be due to at least 2 reasons:

1.1 The papers had not been changed. Most dogs do not like to step on soiled newspapers as they are clean creatures. So, he chose the floor.

1.2 The papered area is too small. I remember he is a Golden Retriever. Correct me if I am mistaken. You may need to have double or triple the areas covered by the
newspapers or buy a big pee pan (to put newspapers on).

2. In many cases, vinegar:water mixture does not eliminate the smell of poop because the poop is not ammonical.

3. In your case, you said you had not much time. I
presume you had no time to change the newspapers more
often and no time to bring him downstairs. There is no
fixed schedule for exercise after eating. If that is
true, then he has no opportunity to poop 15-30 minutes
after eating (as most dogs do) on newspapers under
your training and supervision. You probably had gone
to work or are too tired to bring him downstairs. I do
not know the real situation.

4. If you want your puppy to poop on newspapers, you
need to SPEND TIME to train him to do so. WATCH for
signs of wanting to poop and bringing him to the CLEAN
newspapers for the first 2 weeks. Praise, pat and
reward with treats on success.

Otherwise, it is very difficult for him to know what
you want.

5. Let me know once your pooping training is
successful.

0 Comments:

129. New pup avoids peeing on newspapers of older dog

2008-01-31T13:26:00.000-08:00

E-MAIL NO. 1 FROM OVERSEAS TO DR SING

On 1/23/08, ...com> wrote:

Hi,

I read your notes on paper training more than one dog at a time.
I have a 6 month old American Eskimo who is paper trained in my daughter's room, she also has access to kitchen and my work area in the basement I noticed when she needs to use the bathroom she goes back to my daughters room upstairs and use the paper. She also shows signs of going to the door to go out.

Last week we purchased a Pek-a-poo, 3 months old male, however, he does not want to use the same paper even when cleaned and dry, he wants to do his business around the paper, on the floor under my daughter desk. He is confined to her room. I work from home part-time or 3 days a week. Any suggestions?

REPLY FROM DR SING TO E-MAIL NO.1

Subject

Re: Paper training more than one puppy

Thank you for your e-mail. I just read it today Jan 29, 2008 and hope it is not too late to reply to you with some tips.
Pl e-mail to judy@toapayohvets.com as I seldom access the gmail.com

Pek-a-poo 3 months, male puppy.
1. Do you know where he eliminates in the previous residence? Was his toilet area the tiled floor? If that is the case, he is conditioned to the feel of the tiled floor and
so he avoids the newspaper no matter how clean. Newspaper may feel not right to his paws as a toilet area. He has had never eliminated on newspapers before.

If you want to paper-train him, you will need to confine him in an exercise pen/small area in the daughter's room. Cover the tiled floor with 100% newspapers for around 2-4 weeks. If he does not shred the newspapers,
observe which corner he eliminates. You may also place the 2nd piece of a soiled newspaper with the Pek-a-poo urine to attract him to go to the newspapers in a particular corner.
Reduce the newspapered area to that corner where he eliminates. His clean area will be his sleeping and eating/drinking area which may occupy
50% of the tiled floor exercise pen.

Use white vinegar:water 1 part to 3 to neutralise all urine smell on the tiles of the floor of the exercise pen except for the area he is supposed to eliminate.
Feed him regularly and let him eliminate or poop before you allow him out. No distraction. Success in paper training varies from 2 - 8 weeks in Singapore. Much
depends on the owner being there to change soiled newspapers often and to praise and reward with treats when he eliminates.

Do let me know if you receive this e-mail and also your success result.
Best wishes.

E-MAIL NO. 2 FROM OVERSEAS TO DR SING

To: judy@toapayohvets.com
Sent: Monday, 28 January 2008 11:54:24
Subject: Re: Paper training more than one puppy

Hi Dr Sing, I really appreciate you getting back with me.

After reading several of your articles and suggestions, I realized that my daughter and I needed to replace the soiled newspaper more often. Ginger our White Eskimo has been with us for over 3 months, she is 6 mos old and my daughter was a bit lazy cleaning behind her so the Pek-a-poo decided to go elsewhere on my wood floors. So now that we replace the paper as soon as soiled, the paper is now on a first come first served basis.

My daughter has a extra desk in her room, the Pek-a-poo prefers to go under the unused desk and we don't have a problem. Thank you for your suggestions. Pek-a-poo has only been with us a week this past Saturday.

CONCLUSION

I hope this case write up will be of use to other owners with 2nd puppy.

All puppies by instinct want a clean toilet area to pee and poop.

In some single-puppy house-holds, the puppy may be extremely clean (cleanliness freak?) and will bark till the owner changes the soiled newspapers. Or the owner is aware of the need to change the soiled newspapers after elimination.

In the case when a new puppy is introduced and need to share the same toilet location, the puppy dislikes going to the soiled toilet area no matter "how clean the newspapers look after the urine has evaporated" as the puppy can smell the other dog's urine. Some owners just remove the poo from the newspapers but the puppy does not want to use the same newspapers again.

The puppy just eliminates "outside the edges of the newspapers". He is frightened by the possibility of spanking by the owner if he eliminates elsewhere and so, does it outside the paper edges. If the owner is not around, he may do it behind the sofa or some corners.

127. Animal shelter medicine - NANAS

2008-01-28T01:29:00.001-08:00

On Saturday Jan 26, 2008, I brought two 2nd-year vet students from Murdoch University to visit NANAS during my off-day. I hope that they would learn more about shelter animal medicine and I hope to see Bobby who was relocated from Yishun Fishing Pond to NANAS some months ago by Mr Raymund Wee and Ms Lynda Goh.

Much practical knowledge is transmitted from the older folks to young ones. But they need to record the knowledge rather than be an observer. I seldom see the young ones doing any writing. It is a pity that the two vet students did not bother to write how other vets or senior staff do the work at NANAS.

What drug they use? What is the dosage? How long will the drug take effect? Any side effects?

If they record such "meaningless" data during their visit to NANAS, they record Animal Shelter Medicine and Surgery for their storage of knowledge. When they study veterinary pharmacology in the 3rd year or so, the records will make their lectures alive. Much practical knowledge and short cuts get forgotten in the sands of time. It is quite sad to see young ones not knowing the value of practical knowledge which would help them later in life or in examinations.

I record the following to share with young vets doing animal shelter medicine.

ANAESTHESIA AND SURGERY OF 3-MONTH-OLD KITTENS AT NANAS.

ANAESTHESIA & SURGERY

1. Zoletil 100
2. Xylazine 100 mg/ml 2 ml
3. Ketamine 100 mg/ml 8 ml
Total 10 ml in Zoletil bottle.
Can be used for 50 cat spays and neuter?
0.01 ml /kg recommended? Did I hear this figure incorrectly from Raymond Wee?

In practice, 0.15 ml IM for 1 kg kitten was effective!
5-6 hours after being fed a bland diet.

Compare to my Toa Payoh Vets practice:
Adult cats are starved 12 hours before surgery in my practice. I don't spay cats less than 6 months old. I use xylazine:ketamine IM (0.5 ml IM combination/2 kg kitten). The NANAS combination method uses very little volume (0.15 ml IM/1 kg kitten). It appears economical for mass sterilisation? It seems effective after observing around 8 surgeries.

Milk bladder to empty bladder.
Tongue pulled out. I see that the tongue is bright red in colour with this combination.
Eye ointment applied to eyes.

Onset: If given IM correctly, less than 2 minutes.
Duration of anaesthesia: Said to be 35 minutes.
Spay surgery: Should be done in 15 minutes.

Incision: Anterior and around 1 cm from the last pair of mammary glands. Sort of divide umbilical area to last pair by three 1/3. Use the posterior most 1/3 area to incise the linea alba. This incision is just above the bladder. Therefore and in any case, all muscle layer must be pulled up before stitching. Otherwise, the bladder is punctured by the stitching needle.

In adult cats, the incision is also around that area. It can be quite difficult to ligate the ovarian ligament as the incision is too posterior, in my opinion.
As for me, I incise about 1 cm from the umbilical area and find this spot the best.

ANAESTHESTIC DRUG COMBINATION IF ZOLETIL 50 IS USED.

1. Zoletil 50
2. Xylazine 100 mg/ml 1 ml
3. Ketamine 100 mg/ml 4 ml
I presume this will be sufficient for 25 cat spays and neuter?

PAIN MANAGEMENT

Tolfedine ? I need to check on this drug.

0.3 ml SC given at the end of surgery. Apparently, the kitten or cat eats the next day. No pain. This is a non-steroidal anti-inflammatory.

ANTIBIOTICS
Amoxycillin suspension 0.5 ml SC.
I don't give antibiotics to cats after spay generally and seldom have complaints of fever. Cats eat after 1-2 days usually. But if pain management is used, they may eat a few hours after surgery based on feedback from NANAS?

3-MONTH-OLD PUPPY
Uterine horns will be 1/4 size of kitten of same age.
So, it will be very thin.

Incision should be one finger's width from umbilicus, not so posterior as in the kitten.

Bladder is expressed in a different way, said Mr Wee.

Will need to learn more about the NANAS method which has been shared by various vets from animal shelters in other parts of the world.

E-mail to judy@toapayohvets.com if you have any feedback to give to me.

127. The Golden Retriever puppy vomited and purged over 10X

2008-01-28T01:16:00.000-08:00

"For the past 2 weeks, she was all right. Then on Sunday, she vomited all her food and passed blood in her stools. Later there was no blood but she kept purging more than 10 times. Now she would not eat."

The puppy's stomach and intestine were full of gas.

"No new food or treat were given" the owner was insistent when I asked him many times over the half an hour. "The puppy goes to my office and there is nothing in the room. All my employees know that they don't feed him any chicken rice or any chicken. During exercise in the field, I observe her and she did not eat grass or soil."

Yet the puppy had this serious vomiting and diarrhoea. She was wagging her tail while standing on the examination table. Temperature was 38.8 deg C which was not very high fever.

I asked the owner again, "Any new product you purchased on Saturday or Friday?"

He shook his head. He was so sure that the puppy had gone to the Pasir Ris to play and swim. She had her 3 vaccinations done. Parvoviral infection was unlikely but could not be ruled out.

"Did you introduce new food or something to her?"

Finally, after more than 30 minutes, the owner recalled that the pet people had recommended the rawhide doggy bone. This was because the puppy ate all the previous dog treats.

"The raw hide doggy bone is more lasting and not chewed to pieces," the owner said. "That was on Saturday. The puppy chewed it in the afternoon on Sunday. It was durable, as the seller recommended.

The Golden Retriever had vomiting and diarrhoea a few hours later and on Sunday. He brought her to the vet on Monday morning.

So, the most likely cause of this acute gastroenteritis was the rawhide bone. It took so long to get this info!

126. Toilet training a pup who wants to be clean. Advice from the vet was good.

2008-01-28T01:02:00.001-08:00

The Spitz X does not want to eliminate inside the $400 stainless steel crate with a grating and pee pan. The puppy tries to hold his bladder as he considered the crate as his den (clean area to sleep and eat).

So, after meals, a family member will tether him in the kitchen and wait for him to eliminate. When he shows signs, the newspapers are put under him. However, he will frequently eliminate on the kitchen floor.

"He takes a long time to eliminate," the owner said.

"This is due to distraction," I explained. "Somebody is holding a newspaper and watching him. He can't perform under scrutiny and pressure."

I had an idea, "Why not put newspapers to cover the floor of the common bathroom, tether him inside after meals. At least the kitchen floor will not be soiled and smelly and it is easier to clean the common bathroom floor!"

I did not expect the owner to follow up on this advice. When I met her today as the puppy was having pimples in his thights, I asked about the toilet training. She said that the Spitz was successfully paper-trained inside the bathroom. He is nearly 6 months old and he will be passing a larger amount of poop and pee. So, it is good news that he is paper-trained. A lot of stress for the family if he is not paper-trained as he is much loved.

125. Toilet-training - 2nd pup avoids newspapers

2008-01-28T00:54:00.000-08:00

E-MAIL TO DR SING FROM OVERSEAS

American Eskimo - 6 months. Paper-trained in daughter's room. Will go to her room whenever necessary.

New Pek-a-poo pup - 3 months, male. Avoids newspapers as a toilet area. Elminates outside the papers or on the tiled floor under the daughter's study desk.

How to solve the problem?

1. Check history of Pek-a-poo. Previous owner must have had trained him on tiled floor and other surfaces. Definitely no newspapers. So the new owner is unsuccessful in paper-training him. Furthermore, there is no urine smell to attract the pup to use the new newspapers.

2. To paper-train this pup, need to confine him to a small area or exercise pen in the daughter's room as follow:

124. The dog that the Singapore Tzu Chi Fundation volunteers saved from lethal injection. Follow up to Case 110.

2008-01-25T15:22:00.000-08:00

"Since the dog may die on the operating table, put the dog to sleep," the dog owner wiped tears from his face. I had told him that the dog had less than 50% of surviving the anaesthesia.

The dog had not been eating for the past few days after the first consultation. The dog had been given antibiotics and the owner had not phoned me to schedule the surgery some 10 days later. The surgery and transportation of the dog would be paid by the Tzu Chi Foundation. Yet there was just absolute silence from the family.

The Singapore Tzu Chi Foundation Medical Secretary, Ms Ng had e-mailed to ask whether I had followed up on the case after the first consultation. She was the one who contacted me initially about this dog too.

I told Ms Ng that the family had to decide themselves. I could solicit the family. So, nothing happened on the owner's side. Ms Im and her volunteers numbering more than 10 had helped to bring the dog to the surgery during the first consultation. She and her volunteers contacted the owner and the dog came in for surgery in a worse condition than during the first visit. The dog could barely stand up.

"Are you sure that your over 70-year-old mother had agreed to euthanasia?" I asked. This dog was close to his mum and there was no way I could verify that all family members consented since the mum did not make it to the Surgery.

"I represent the wishes of my family," the man in his fifties was ready to sign the consent form. The Tzu Chi Foundation volunteers were shocked at his decision. Though there was a high anaesthetic risk of dying on the operating table, there was a probability that the dog might survive.

By euthanasia straight away, this dog had no chance of survival at all. One Tzu Chi volunteer, a lady in her late thirties and working for an advertising agency sat beside the dog owner and talked to him.

She talked to me. There was a surgery consent form informing the owner that he knew of the anaesthetic risks. This was a standard surgery form used in all hospitals to confirm in writing that the person had been aware of the risks. The clinical outcome of this case would be so poor that I would rather not risk my professional reputation to operate on this dog. A death of a dog spreads like wildfire to all family members and friends and all Tzu Chi Foundation members. Why take risk of ruining my hard-earned reputation over the years?

The owner agreed to the surgery after much discussion from the Tzu Chi lady. I put it on drips and operated the next day. The dog survived. The Tzu Chi volunteers prayed hard, according to the lady volunteer who spoke to the owner. Killing a life is never an option with the Buddhist volunteers. If there is a chance of survival, take the chance. Some 20 volunteers came to the Surgery to transport the dog back and forth and to see him. These volunteers are not paid by the Foundation. Their intervention save a dog from lethal injection which would have had happened.

Some 6 weeks passed. Did the dog survive after the surgery? I had not phoned the owner. If the dog survived, she could live for a few more years.

I asked Ms Im who reminded me that I had not billed the Foundation for the services. This Foundation is good at accounting and pays for services rendered.

Did the dog survive? Is she fatter? I asked Ms Ng.

Ms Ng said in her e-mail:

Follow-up on Jan 26, 2008

Hi Dr. Sing,

I heard from those who paid visit to see the dog and the owner. The dog looks good and better now. Thanks for your concern.

黄燕芯

慈济新加坡分会

电话：65829958 分机：204

This seems to be an incredible story. When the vet thinks the dog that is emaciated and weak has little chance of survival on the operating table, the dog proves the vet wrong and the owner will remind the vet of his bad prediction. When the vet thinks the dog has no problem under anaesthesia, he dies.

123. Apple cider vinegar to treat kitten ringworm?

2008-01-14T21:55:00.000-08:00

After surfing the internet, the owner of the Ragdoll kitten applied apple cider vinegar all over the tail and infected neck of the kitten, as advised by the internet information. The kitten was furiously trying to groom herself to get rid of the apple cider vinegar and started to lose weight.

Ringworm is a fungal infection of the skin. Itching, redness, peeling of the skin.

1. Ringworm thrives under warm moist condtions. Keep the kitten dry.
2. Clip coat short to discover where the ringworm lesions are.

3. For kitten and cat ringworm, do not use human alternative medicine to treat ringworm. These are:
3.1 Apple cinder vinegar soak. Make sure to dry your infected area with a clean towel.
3.2 Tea tree oil twice daily to the affected areas using a 25%-50% solution of tea tree oil twice daily to the affected areas.
3.3 Garlic, a strong antifungal agent boiled to make a garlic bath or solution. Then soak the fungal area.

4. If the fungal araas become red, hot and swollen or the blisters ooze pus, the areas are infected by bacteria. See the vet for antibiotics.

In the first place, it is best to consult the vet. In the case of the Ragdoll, I had it bathed so that the yellow apple cider vinegar solution was washed off. Treated it with antifungal tablets and wash. The kitten responded well. The owner had been given the drugs earlier but decided to use apple cider vinegar. For ringworm treatment, it takes at least 20 days before you can see signs of recovery. There is no fast treatment.

Negative reinforcement training - puppy toilet training

2008-01-12T16:12:00.000-08:00

Toilet training is a headache for most puppy owners all over the world. So many real-life factors adversely affect the learning of the new puppy.

----- Original Message ----
From: Name given
To: judy@toapayohvets.com
Sent: Saturday, 12 January 2008 7:21:03
Subject: Appointment

Hi,

I chanced upon your website. I would like to arrange an appointment for a checkup for my puppy. I think it has had his last vaccination in November. I believe the dog is about 5mths old now. I would also like to get some de-worm tablets.

Also, I am having some problem with the toilet training. We had initially taken the wrong approach at just scolding the dog everytime it peed, and now it seems to think that it is wrong to pee, and instead of doing it at the intended area, the dog would only do it when we are not around, in secret. Would also like to get some advice on this. Would like to check if you are available on Sunday 13/01/08 for appointment.

Many Thanks,
(Name)

E-MAIL REPLY

This Sunday, I will be on leave. Next Sunday will be good and we can talk about toilet training as regards your puppy. Each case is so much different as the players (you and family) and environment (housing etc.) varies!

121. Intern sprayed water onto client's T-shirt

2008-01-08T13:06:00.000-08:00

The 4th year vet student from Sydney University observed how I flushed out the ear wax from the Maltese ears. The two Malteses were on a grey table outside the Surgery. The lady owner and her 12-year-old talkative son were helping out.

I handed the 20-ml syringe to the intern as I presumed it was a simple matter. She squeezed the syringe perpendicular to the ear pinna. The dog could have moved her head suddenly as the owner insisted that no muzzle be used while she held onto the dog's mouth with her hand.

The 20-ml water squirted and bounced onto her spectacles. Worse of all, the water wetted the white T-shirt of the stern-looking lady owner! It was distressing for her but she was a good sport.

The owner did not complain but she was not smiling. I did not know what to say or where to hide my face.

To irrigate the ear well, the syringe must be held at an angle, not perpendicular to the entrance of the vertical canal.

I just read in a 8-Days Dec 13, 2007 magazine about an expert giving tips on make up. To blend the make up well, most brushes should be held at an angle, and not perpendicular to the face.

Same with the irrigation of the ears of the dog as well!

120. Tethered Silkie not toilet-trained

2008-01-08T12:44:00.001-08:00

The Silkie of 4 months, neutered recently, was tethered to the kitchen sink pipe but could not be paper-trained and is not putting on weight. Why?

There was no problem with the weight. The puppy was not thin. The tether method was not successful in this case for the following reasons:

DISTRACTION
Too much distraction from the family members wanting to play with him. He wanted to play and is let free in the apartment. So he does not know why his toilet location should be.

NO FIXED ROUTINE
The puppy was fed various brands of food as he is picky. When he stops eating a brand for a day or two, the owner buys another brand. Then he stops eating again and is offered another type.

PROPOSAL
Buy a crate with wire flooring and pee pan below and confine the puppy for 2-4 weeks. Feed regularly 3x/day and take away the food after 20 minutes. I doubt this puppy can be paper-trained so easily. Will follow up.

119. Follow up on 108: An excellent vet-client relationship is important

2008-01-08T12:12:00.000-08:00

The Angora Rabbit keeps losing interest in food. After the veterinary treatment, ate for 3 days and then stopped eating. Why?

Nothing specific during the consultation. Thin as a rake, loose stools, teeth grinding. Something had affected the digestive system. The rabbit was not losing hair. Just very thin and not eating much.

I had presumed that the rabbit would be eating hay and food pellets as other rabbit owners but I was mistaken. I asked the owner to send me some pictures of the rabbit at home.

The young lady sent some pictures of the rabbit's housing via e-mail as requested by me. From the pictures, this rabbit was very well cared for. It appears that the lady in her late twenties piled hay on top of the pellets in one feed bowl. So, the rabbit ate mostly hay and no pellets or little pellets. Over some months, this could be an imbalanced diet and there also could be toxins in the hay? Toxins not enough to kill the rabbit but did cause some loose stools.

Dec 22, 07
The owner noticed that the rabbit was not eating again. She text messaged for appointment. The rabbit ate a bit and she might sms to cancel the appointment.

The rabbit came the next day. She was warded for one day for observation and fluid therapy. The rabbit was given pellets and vegetables. She liked the leafy kangkong vegetables.

The owner was advised to give her a variety of diet and to get new hay from another brand. She bought the branded hay. The hay has to be put in a separate bowl.

"Pesticide free vegetables are best," I said. "Only certain supermarkets sell them and you need to look for them."

The rabbit was given a variety of food including apples. "Apple skin only," the lady said when I sms her one day. "She gets diarrhoea if given the apple itself."

"Apple skin may contain pesticide," I advised her not to give the skin as apple growers nowadays spray insecticide all over the apples to prevent insect damage. I did not know what she would be doing to source the pesticide vegetables. Christmas and New Year passed by fast. Then I got an sms from her on Jan 5, 2008.

Jan 5, 08

Sms from the owner.

Hi Dr Sing, how hv u been? To update u, I hv been feeding (name of rabbit)with pesticide free lettuce leaf n a mini carrot daily. She continues wif her new pellet n hay diet. She improves a lot n now i can feel her little tummy. She looks good. Thank you so much for your continuous care & attention.

It is important for the vet to follow up in cases where the pet is eating less and less everyday. The feeding management of the pet might be at fault rather than the disease.

With text messages nowadays, it is much more convenient rather than phone calls.

As this young lady owner has an excellent professional veterinary-client relationship, it was easy to follow up via sms. Sometimes I had to phone her for more details as sms can be quite brief.

If this case was not followed up by the vet and the owner had not bothered to e-mail pictures of the rabbit housing, the rabbit probably would have had died as she ate less and less.

This rabbit does not suffer from anorexia nervosa unlike young Singaporean girls. Most likely, the hay was toxic and the variety of diet was not eaten.

118. Hamster tumour - Teaching the intern

2008-01-03T15:01:00.000-08:00

"No anaesthesia?" the 2nd-year Murdoch Univ vet student asked me. All animals must be anaesthesized before surgery to avoid causing pain. This is generally observed by all vets as we don't want the animal to suffer.

However, in this case, the hamster was thin and not eating a lot. She had this glistening big skin tumour for some time and was not eating when brought to the Surgery. A dose of anaesthetic gas might kill her. Could not walk properly as the tumour irritated her. Probably could not sleep well too.

All clients want a live pet back after treatment. Death of a pet ruins a reputation of the veterinarian whatever the explanations.

In this case, the risk was extremely high. I noted a short stalk attached to the "tumour after 3 days of hospitalisation. A small scissor with curved blades snipped the tumour off in less than 1 second. The hamster would still be alive.

After snipping, blood splashed covering the whole area of more than 2 sq cm. What to do? This tumour had a large blood vessels connected to the skin. Would the hamster die? The young student held the hamster in the towel while I pressed a piece of tissue paper to stop the bleeding.

Bleeding is quite common in tumour removal of hamsters. They looked profuse and a lot because the hamster is so small, unlike a dog. It was not possible to clamp the stalk of the tumour as the tumour itself was small. The stalk was about 2 mm in width and because the tumour was no longer inflamed, I could see it.

If I had operated on day 1, I would not have had seen it. The hamster might not have survived as she was in a poor condition. Never operate on a pet that is not eating. Minimise the risk of death due to stress from surgery.

"The fastest way to wash away the blood was to flush the blood off under a tap. Just the area of surgery and not the whole hamster", I said to the student who had not spoken one word throughout the surgery. He must be wondering how I could wipe the messy bleeding as the hamster struggled to get free.

I don't know whether the young man learnt anything from this case as he was starting his second year. Did he learn something about the anatomy of the hamster's reproductive system.

"Is the tumour an enlarged clitoris?" I asked him.

"No," he said. He was correct. From close observation, it was a skin tumour very close to the vulval lips but definitely not the clitoris.

Is he the observant type I wondered? Why was the tumour located in relation to the vulva?

I asked him to illustrate the process of cutting the tumour as he saw it so that he could learnt something by participating in the whole procedure. He was a good illustrator.

The young man drew the tumour at the right side of the vulva.

"No," I said. "The location is not correct." I let him see the wound as he held the hamster. The location was now correct and he drew the illustration for me to include in the case study.

Hamsters are beloved family pets and the family was most happy to see her alive and without the tumour.

117. Don't take my picture!

2007-12-29T15:18:00.001-08:00

"Don't take my picture! No...no..." the Golden Retriever shifted and lowered and turned his head as his young lady owner tried to pry open his left eyelid for me to take a photograph of the bleeding conjunctiva for my educational purpose in the "Be Kind To Pets" community education project.

A gentle big dog. His lady owner could not position the eyelid, exposed it for me to photograph a wide bleeding strip of conjuncitiva -- reddish and swollen from 11 o'clock to 5 o'clock.

"I'll take the picture for you," the young man said. OK, it was best not to stress out this gentle giant who was attacked by a Border Collie. Two pictures were taken. One was good enough. Beggars can't be choosers! Thanks to the young couple. The dog was treated and should recover with nursing and medication!

Now, why would a Border Collie attack him? Dogs have nemesis too!

116. Words don't come easy.

2007-12-29T13:45:00.001-08:00

Tips for asthmatic suffers

"If you have to go, you have to," the young man said but his mum said, "This is not the order of life. Parents die before their children."

This young man, at around 21 years of life feel incredibly invincible. He ran the army marathon and got his award. He partied till the early hours of the morning though he was not seen intoxicated and drunk.

A few young men in Singapore had crashed the cars in the early hours of the morning and caused immense grief to their parents as they perished.

But this young man had a guardian angel. He escaped death in one car he drove at 4 a.m after driving friends home. The car did a somersault as it hit the central fencing separating two roads.

The car flew up, crossed the central fence, did a U-turn and landed upright on the only side of Thomson Road. A big hole in the roof and dented front door. The car was even facing the right direction. It did hit and dented the bumper of a taxi but the taxi driver was not hurt.

This young man did not have one wound. The police did not find him drunk. The car was a write-off. Nobody was killed. What an incredible tall tale, you would say. Yet it is true.

This young man ought to be dead. Crushed inside a burning exploding car. A young promising life snuffed out in a car accident involving young men who feel they are masters of the universe.

Yet he was much alive. If there was a guardian angel or God, he would be blessed with a new lease of life.

Now, he could not breathe well. Coughing non-stop for the past 2 days at least. The general practitioner had given him some tablets for his sore throat. Flu was suspected. Now, he could not sleep as he could not breathe.

Could he wait till the morning to see the doctor? It was 4 am and his mum was barely alert, being a night owl like him.

"Where's your inhaler," I asked him. The inhaler delivered drugs to open up his breathing airways. But he did not carry one with him although he was asthmatic and advised by me. After all, he did not suffer any ashtmatic attacks for some years. He won an award at the army marathon and he was invincible.

His mum fished out an inhaler kept for him. Mums are always a boy's best friend. He put the inhaler into his mouth and sucked in two puffs of the medicine. No effect.

"Well, the inhaler has expired in 2005," I said. I doubted that even a non-expired inhaler would be effective at this late stage of acute respiratory distress. It is best he gets to the Emergency Ward of the Hospital before he dies.

Can a young man die so easily? Yes, if his parents ignore his acute difficulty in breathing.

"It will be a very painful death as you can't breathe when all the airways have had shut down due to your asthmatic attack." I said to the young man. He ought to take personal responsibility of his health and carry the inhaler with him at all times. But he did not do it.

"I read in the newspapers that a qualified doctor had an asthmatic attack in an aircraft and died. All that was needed was the inhaler and she did not have it with her."

Mum would rather sleep. I beckoned to her to get up and get dressed. This young man was still standing and there would be some hope. It was fortunate that he was not in the cruise ship or airplane. What he needed was the emergency nebuliser with oxygen mixing the anti-asthmatic drugs and that was found in the hospital.

To make a long story short, this young man survived. This was his second lease of life. He has to be personally responsible for his own health and learn from this experience.

"When you have to go, you have to go," are brave words of masters of the universe. Try not to tempt fate, young man. Words don't come easy from your parents. This story is written for you. To ask you keep an updated inhaler by your side always and not cause intense grief to your mum when your life is cut short due to a lack of an inhaler and early use of it.

115. Neuter, microchip and vaccinate at one time?

2007-12-28T19:54:00.000-08:00

E-MAIL QUERY TO DR SING

----- Original Message ----
From: ...@yahoo.com.sg>
To: judy@toapayohvets.com
Sent: Friday, 28 December 2007 11:41:28
Subject: Services Enquiries

Hi,

I came across your website from the Spore Vet site. I just inherited a 4 year old wire-haired male fox terrier and would like to enquire some stuff. It has not been sterilised. Is it too late to sterilise him?

Is it ok to do sterilisation, mirco chipping and vaccination in one go? It'll be very inconvenient to bring him more than once as i dont have my own car.

How much would it cost to arrange for return transport?

Many thanks,
Name given

E-MAIL REPLY FROM DR SING

It is ok for a normal dog to get neutered, micro-chipped and vaccinated at the same time. Transport costs around S$50 depending on distance.

Some reasons for neutering a male dog is to prevent anti-social behaviour like urine-marking, gripping people's legs, humping onto pillows and mattresses, wanting to go out, aggressive behaviour and unwanted breeding.
Urine-marking behaviour may not be completely eliminated after neutering since your dog is now older.

114. Pus oozing out of an unopened puppy eye.

2007-12-18T15:30:00.000-08:00

Very unusual case. The young man who was on a break from his studies in Australia must have kept a close observation on the 6 Siberian Husky puppies. Most likely his maid. But he quickly consulted me about some pus in a puppy's eye.

Now, the puppy does not open their eyes till they are 10-14 days old. So, how could the eyes be infected?

I pried open the eyelids as the puppy's eyes were still not opened naturally. Swollen red conjunctiva. Thick creamy pus accumulated in the right eye. Wiped off the pus. Put eye drops. This puppy should have no loss of eye sight.

One would have thought that unopened eyes of a puppy ought not get infected. But there are always exceptions to the rule.

113. Toilet training: 5-year-old and 15-month-old apartment dogs

2007-12-18T14:52:00.000-08:00

Paper training an apartment puppy

Many Singapore apartment owners do not realise that the new puppy must be confined to a small room or crate for 2-4 weeks to achieve some hope of success in paper training.

The puppy at 2-4 months is at an impressionable age and can be paper trained if there is some consistency, perseverance and time spent in training it. As he grows older, it becomes more difficult as the hormones kick in and the older puppy rebels.

Parents with adolescent children who prefer not to be seen with the hand that feed them for the past 15 years will understand what I mean. Young adults, if not brought up with sound values experiment with alcohol and drugs and bring much grief and sorrows to the parents.

Toilet training of puppies use the same principles as bringing up a child. Time is needed. A sound knowledge is also required.

For puppies, toilet training begins when they are brought home at around 2 to 3 months of age in Singapore. They are easily toilet trained if time is spent with them and they are confined for 2-4 weeks.

We examine the 2 dogs in this case study.

Russell, Miniature SchnauzerXChihuahua, Male, 5 years, not neutered

Initially kept in a playpen when bought. Stepped on stools. So, let out of playpen after 2-4 weeks of no success in paper training. He was praised and rewarded with treats when he peed and pooped on the floor of the balcony which became the toilet and sleeping area for the past 5 years. Poop cleared using plastic bags. Floor of balcony flushed with water to clean it.

The dog never goes outdoors. At 3 to 4 years of age, he starts urine marking on vertical surfaces in the apartment. 2-3 times a day or sometimes not doing urine marking. Spanking him is ineffective.

Miniature Schnauzer, Female, 15 months.
"Not so intelligent," the owner said. "She pees and poos in the living area or bedrooms during daytime. She does not go to the newspapers in the daughter's bedroom to eliminate."

There are no newspapers in the living area.

During the initial 2 weeks, sleep in the daughter's bedroom. No crate or playpen. Newspapers on bedroom floor. Occasional elimination on newspaper. Bring her to the accident area where she had peed, said "No,", spanked her backside. But she would pee and poop on the newspapers sometimes. At night, sleep in one of the two beds in the balcony. Eliminate more onto the floor of the balcony now. Had been with the owner for the past 1 year.

Advices
1. Neutralise the urine smell in the living area with white vinegar:water 1:3.

2. Urine marking behaviour of the male dog onto furniture is difficult to eliminate. Neutering was an option but it might not be effective. If breeding is desired, no neutering is advised.

3. Paper training is too late now. The strong urine smell on the balcony floor far away from the beds may be the toilet area.

4. I forgot to advise that the pee pan with newspapers + urine smell be put on that area if the owner wants to do paper training and has less cleaning work to do. As the female dog is now a "young adult", it is much harder to paper-train her. She had used the same toilet area as the male dog. The male dog is a distraction in paper training a female dog.

As the mother and her daughter seem happy with the two well looked dogs, the toilet location will be the edges of the balcony floor. In retrospect, the male dog should have been paper-trained on a pee pan (with newspapers) and confined to the playpen and kept in the balcony for the first 2-4 weeks. He was in the bedroom at that time. He kept stepping on the stools because he wanted to get out and had no sense of cleanliness. So he needed bathing every day. The owner let him out of the playpen early and he eliminated everywhere in the apartment. Till one day, he went to the balcony floor and was not scolded. He was praised and given food treats and therefore he used the balcony floor (with no newspapers) as the toilet location.

Now, you can see that the sleeping area is kept clean by the dogs as they eliminate as far away as possible from their beds in the balcony.

112. Vet Ethics. Ambulance chasers for vets.

2007-12-08T15:36:00.000-08:00

"Sending condolence cards to dog owners whose dogs had died was a very good idea (to build up good will)." the 4th year Massey University vet student recalled a dog owner who mentioned about a vet who performed this practice. I was discussing with her the highly competitive nature of all Singapore businesses as Singapore becomes developed. The veterinary practices are not immune to competition. Price under-cutting by being the cheapest vet in Singapore is one strategy to capture more clients and increase turnover. The student mentioned condolence cards as one method.

"Yes, sending condolence cards is a good idea but it is better for a vet to send birthday cards for dogs" I said. "Have you heard of ambulance chasers?"

She shook her head.

"In the legal profession, there are laymen who specialise in informing the lawyer (for a commission) when there are traffic accidents. These ambulance chasers will go to the hospital and sign up the injured to get legal advice.

"From what the dog owner said, it seemed that the vet who sent condolence cards had excellent knowledge of any dog that had died and had been sent for cremation.

"The owner was saying how come the vet knew about dogs that had been cremated? He had no veterinary crematorium. The owner guess it must be his connections with the dog transport man.

"When the dog transport man sends the dead dog for cremation, he informs the vet and gives him the address of the dog owner. The vet sends a condolence card to the grieving owner.

"Is this a veterinary equivalent of ambulance chasing? In this case, the dog that was not under the vet's care had died. So I would not want to send condolence cards to such owners.

"The vet who sent the condolence card might not have paid the dog transport man for the addresses but if the transport man was not given a commission or payment, why would he bother to divulge such details to the vet. Is this ethical or not?"

It is good to discuss with 4th year vet student as they are more mature and had seen various practices. So they are able to discuss various aspects of the veterinary profession.

Out of this discussion with her, I said to the vet student that sending doggie birthday cards to my dog clients would be an excellent idea. Now, I must get on with the execution of this idea. It is not a novel idea in the sense that the NTUC Insurance Company sends birthday cards to their insured clients regularly! I wonder whether the vet who sent condolence cards do send doggie birthday cards as well?

111. Toilet-training a small breeds - Small breeds get away with murder.

2007-12-04T14:03:00.000-08:00

All over the world, small breeds get away with murder. What do I mean?

This little puppy had been given to the owner for the past one month. Pees and poops everywhere inside the apartment. As small breeds eliminates in small amounts, there is not much pressure or stress to the owners.

"How's the toilet training?" I asked the lady in her forties. Her husband was waiting outside the surgery, ready to pick up the daughter.

"Pees and poops everywhere," the lady said. "My husband is not so happy with the puppy."

Neither would I. This is what I mean. Small breeds get away with murder. I asked if she had time. Pulled up a chair opposite me across the consultation table. I attempted to give a quickie lecture and photocopied my scribblings in the picture below.

I hope the puppy can be paper-trained fast. Presently, the bedroom doors are locked to prevent accidents. Once paper-trained, the puppy can be trusted not to soil the whole residence! If only a dog manual on paper-training a puppy is available whenever a puppy is sold or given away, there will less problems for puppies.

110. A gigantic breast tumour in a dog

2007-11-30T03:45:00.000-08:00

E-MAIL TO DR SING DATED 4 DEC 2007

----- Original Message ----
From: ...@yahoo.com>
To: Dr Sing KY
Sent: Tuesday, 4 December 2007 12:50:40
Subject: Re: Please help the dog

Hi Dr. Sing,

I am Ms Ng here. So did you manage to talk to the dog`s owner?
How is it?

Did she agree to let the dog does the op? If yes, pls let me know the time? Thanks.

Regards,
....

E-MAIL REPLY FROM DR SING

No tel call from the owner although his friend who was present at the Surgery would have informed him of the high anaesthetic risk of surgery.

I did not tel the owner to talk to him because he will only think of one thing: The vet (me) is a salesman trying to sell my services.
Therefore I don't phone owners as they feel pressured to make a decision.

If the tumour is not removed, the dog is likely to die a slow painful death due to bacterial infection of the big tumour and the bacterial toxins inside this huge tumour affecting his heart over some weeks. If surgery is performed, the 20-year-old dog may die on the operation table.

The ill will created by a dog's death invariably harms a vet's reputation built up with great difficulty over the years. In my experience, when there is a death of a pet, the owner or his family and friends in Singapore usually blame only one person - the veterinary surgeon. They bad-mouth the vet for all who care to listen.

Seldom do they blame themselves for belated treatment. Some write malicious false allegations to the veterinary authorities to solicit and get an investigation. Some get lawyers to sue.

Personally, I had never seen or talked to the dog owner in person. I assess that the 8-year-old dog with mammary carcinoma bigger than the feet of an adult man has less than 50% chance of not dying under general anaesthesia.

Hence, I do not tel the owner to get the surgery done. This is a matter for the owner to decide as there is a very great anaesthetic risk of the 20-year-old dog dying on the operation table.

Singapore does not have a charitable animal foundation like the PDSA (People's Dispensary for Small Animals) in the UK. In the PDSA, low-income dog owners can get their dogs treated at low fees.

I distinctly remember the PDSA for one reason --- a Jaguar. No, they were not treating the big wild cat!

I was seeing practice with an Englishman, a private vet. He offered his services once a fortnight as a volunteer. He drove me to the PDSA. I was a fourth-year vet student. That was in 1973.

A big Jaguar car drove up to the PDSA clinic. The driver brought in a dog for treatment. The English vet told me that the PDSA was meant for disadvantaged families. Maybe your foundation may look into starting a similar project like the PDSA.

If this 8-year-old dog had been spayed and her mammary tumour removed earlier, she would be living a better quality and pain-free life now.

Best wishes to you.

109. Seeing practice: Can't force a horse to drink

2007-11-30T03:09:00.001-08:00

"Where would you incise the skin when you spay a cat?" I asked two vet students who had completed their first year at Murdoch University. They had passed some Anatomy tests on muscles and nerves and were back in Singapore.The girl would score high marks in Anatomy as she was very interested in Anatomy, the young man informed me.

So I expected the girl to give me the correct answer. The classmates hesitated. "Make a guess," I encouraged. "That is how you learn, by being hands-on." And making mistakes.

Spays are the commonest operations and both had seen cases of spay. So, this should be an easy question.

The girl whom all mothers would want as a daughter-in-law had a wind-swept natural brown hair parted with no fancy styling or make up pointed to the most posterior part of the cat's body off the midline, nearer to the tail area.

The classmate with the ear stud and reddish brown hair to make himself stand out from the crowd, pointed similarly but to the other side of the midline. They surprised me as they were miles off target and had just completed some Anatomy studies.

"The incision is about 1.5 cm from the umbilical scar," I showed them the almost invisible white spot on the cat's belly. Their incision would be 15cm away! I hope they learnt something.

The young man said, "Why do vets incise the linea alba during surgery?" This was an examination question in Anatomy.

The linea alba has no blood vessls and therefore no bleeding when incised," I said.

The young man was elated as he had got the correct answer. He would get 1 mark.

"1 mark out of 20?" I asked.

"No, no," the young girl sabotaged him from giving me a good impression. "1 out of 200 marks!"

I did not comment. This was a happy couple but they were just friends if you know what I mean. I continued my surgery. I said, "This is a human trachea hook to fish out the ovaries after the incision. I had just bought this hook as the usual veterinary spay hooks are hard to find in Singapore."

Unfortunately, I kept on hooking up the omental fat and the students were not impressed. The human tracheal hook is smaller and the hook is shorter too. I quickly changed to the cat spay hook and was successful in fishing out the right ovary.

Seeing practice can be quite boring if you don't know how to make the best use of the time by recording what you saw for your future years. Keeping a journal would be best.

I suggested taking pictures of the cat spayed for future reference. The girl did use her camera phone to take some pictures although the young man had to configure for her how to take pictures. If she could keep proper records of the good visual images, they would make her textbook studies come alive.

As for the young man, he was not that keen. One can bring the horse to the water but can't force it to drink!

I had a great roasted duck rice lunch with the couple at Blk 124 Toa Payoh. The young lady had a makansutra reference book with her and she drove us to this place. The young lady was as thin as a rake and enjoyed the duck rice while she chattered away about relationships. This was a new world to me as I had a glimpse into first year undergraduate life of young adults.

The young lady ate all the crispy duck skin, meat and poured the remaining black sauce onto her duck rice. Full of oil and cholesterol I presumed. As for me, I had to controlled my impulse to devour the crispy duck's skin, leaving them on the plate. I avoided pouring the black sauce onto my rice. The Singapore Health Promotion Board seemed not to have got its health prevention anti-cholesterol and anti-hypertension messages to the young chatterbox.

108. Follow-up to 103. .

2007-11-28T15:23:00.001-08:00

What's wrong with the Angora rabbit?

1. FIRST CONSULTATION:
Tuesday, November 20, 2007
Copy of Case 103. The bony Angorra rabbit will not eat.

"My rabbit has not been eating for the past 2 days," the first-time rabbit owner took leave to seek veterinary treatment. "She just sits around and will not greet me when I come home."

"Has she got diarrhoea?" I asked. "This Angorra has a beautiful coat which camouflages her lack of weight gain. She is as extremely thin and can die anytime due to lack of health." I taught her how to feel the spines of the thin rabbit. Sharp spinal process poked at her index finger as she felt the whole length of the spine. There was no fat layer.

The lady said, "My rabbit eats all day. At times he has loose stools. Why is he not putting on weight?"

"Much depends on the quality of food and the rabbit's lifestyle of gnawing at objects that may cause watery stools. Did you smell the rabbit pellets to get an impression whether they were of poor quality?". A smelly pellet or hay pieces may indicate something is wrong. You will need to know how to judge by the smell.

I tried to take the temperature. A few pellets of stools and some wet faeces matted the swollen anal area. The rabbit disliked this handling. So, I stopped taking the temperature from the rectum.

This is the type of case where the rabbit appeared healthy and alive. If the vet gave an injection and the rabbit dies due to pre-existing diseases, he gets the blame. The owner needs to be warned.

I gave the rabbit an antibiotic and dextrose saline injection and asked the owner to hand feed the rabbit with rabbit food pellets slowly as whole pieces or wet ones.

"Hand feed?" the career lady queried me. "I don't know how to do. In any case, my rabbit does not stay still."

"Put the rabbit on the table. Grip the upper jaw with your left hand. Push a small pellet inside his mouth." I said. "Do you have any pellets?"

"No," she said. I saw the teacher with her pet rabbit of around 4 months in the waiting room. She might have some. She took out a small plastic bag of pellets to help me out as I did not have any. That was kind of her.

I demonstrated to the Angorra rabbit owner by pushing a pellet into the mouth, close the jaws and tilt the head. The rabbit wrinkled her lips and swallowed it. Now, it was the lady's turn. The rabbit was held but she was wiser. She would have none of the nonsense of being force-fed. She just turned his head away and would have stomped her foot if she was well.

"Let her smell the pellet," I advised. The rabbit was not interested in food and just turned his head.

Now, will the rabbit die if she does not eat for another day? She would have a gut infection or intoxication. I gave her the injections of antibiotics and dextrose saline and advised the owner to tel me if the rabbit did not eat the next day. Hand feeding was out of question.

Early the next day, she text messaged me "this morning she goes back to be an active hungry rabbit as usual. I will monitor her condition and will give her another 2 days antibiotics. Thank you very much."

That was good news. Seldom do I get feedback. Text messages are best and effective. As to the cause of the suspected fever, it would have to be something upsetting the rabbit's gut.

2. SUBSEQUENT CONSULTATIONS BY SMS, E-MAILS AND TELEPHONE

E-MAIL TO DR SING DATED NOV 21, 2007
Hi Dr Sing

> > > Here are a few of Rabbit's photographs for you.

E-MAIL FROM DR SING DATED NOV 21, 2007
> > --- Dr Sing KY wrote:
> > > Thanks for very beautiful pictures of the rabbit.
Thanks for report on progress of Royal. Most owners have no time to do it. Stop medication now. She is fully recovered. Looks like she has all the good housing and
food. Can't understand why she gets loose stools or get sick. Unless she gnaws at some toxic objects like plastic spoon (the other rabbit owner who gave
you the rabbit food at the clinic) gave a plastic spoon for the rabbit to gnaw.

Thanks again.

3. E-MAIL TO DR SING DATED NOV 25, 2007

> > Hi Dr Sing
> >
> > Apologize for unable to reply earlier. Was quite
> > busy for my handover of work scope to my people
> > last week,as last Friday was my last day in that
> > Company,didnt have much time to login to my email.
> > Tomorrow will be starting in the new Company.
> >
> > Rabbit's cage is a 3ft(L) x 2ft(W) x 2ft(H), I
> > guess thats the largest size in the market so
> > far I see. Yah, I always have her cage clean
> > every once a week, I also dont understand why
> > this rabbit is having weak stomach..very poor
> > thing. Yesterday till today, I notice Royal's
> > appetite seems starting to reduce again 3 days
> > after her injection, again heard some grinding
> > of teeth occasionally, hmm..my worry comes back.
> > Moreover, starting on my new job, I will not be
> > able to apply urgent leave to bring her to you
> > during daytime, and what timing I will be able
> > to leave work is still unknown...
> >
> > Rabbit dont have habit of chewing plastic, as I
> > dont see her biting her plastic house. There's
> > no other plastic items in the cage.
> > There's no way she can chew on any newspaper too.
> > I am also still thinking what had she took to
> > upset her stomach, hope its not due to more
> > complicated illness.
> >
> > I really appreciate you for helping to get
> > Rabbit well. It heartpain me to see her
> > suffer, keeping her & she's just like one
> > of my family member,if I dont love her, who will?
> >
> > Have a nice Sunday.
> >
> > Thanks & Regards
> > ...

E-MAIL FROM DR SING DATED NOV 25, 2007
>
> --- Dr Sing KY wrote:
>
> > 1. Quickly change the food as your food may be contaminated. Buy a fresh batch.
> > 2. Check the water quality.
> > 3. I don't see any water bottle in your pic.
> > 4. Give me an sms if he gets stomach upset again.

E-MAIL FROM DR SING DATED NOV 26, 2007

--- Dr Sing KY wrote:

> As there are many factors involved and there are
> many questions not able to be covered in text
> messages, it was good that we spoke by phone.
> From your email I can suspect that the new hay of 3
> weeks old may be contaminated.
> As we spoke yesterday, stop all hay. Just feed
> pellet and let me know.

E-MAIL TO DR SING DATED NOV 28, 2007

Hi Dr Sing

Thank you so much for your attention on Rabbit's
condition.

She's mischievous and playful now when I
reach home and play with her. Just appetite
is not high.

I will continue to monitor her till
this weekend and will update you on her condition.

Once again thank you.

Most likely, there may be something contaminated/toxic in the hay which was purchased 3 weeks ago. Since you stopped feeding hay for past 2 days, she seems to be more active. Toxins can make the rabbit inactive and pass loose stools. For 3 days after treatment, the rabbit ate and was active. After 3 days, she had good appetite because of the injections. After 3 days she was inactive. This led me to suspect that you had fed food of poor quality and I suggested no feeding of hay. Now, after another 3 days, there was some good news. Her appetite will return.

Thanks for your pictures of Royal zipped to me. I note that there is a lot of hay on top of one bowl, with the pellets below he hay.
I presume she eats more hay than pellets for the past months. Pellets are important in nutrition. If she eats hay mainly, she cannot put on weight. Therefore she is extremely thin when I examined her.

Separate pellets from hay in 2 different bowls to observe the rabbit's eating habits. Get rid of the blue litter tray so as to give the rabbit more space to exercise. I know you had told me you had done it as the rabbit does not use it as a toilet area. A good bed if the rabbit does not gnaw on it. Tel me if you can about any changes. Your generation loves thumbing text messages and they are great. Though detailed, a telephone call can answer more questions and give us a fuller picture of the management of your rabbit as a rabbit's life is at stake.

Best wishes.

> >

Rabbit presumed OK after the hay was not given to the rabbit. No news as at Nov 30, 2007 9 p.m.

107. Summer jobs: Love is A Butterfly

2007-11-24T16:13:00.000-08:00

Saturday, November 25, 2007

The personable Filipino waitress in her twenties, held a pad and pen and stood beside the young man who had completed his first-year veterinary studies in Australia and arrived home today.

From across the table of four, the white words on her pure black T-shirt sang to me:

LOVE IS A BUTTERFLY
Which when pursued is just beyond your grasp
But if you will sit down quietly
It may alight upon you.

The first line was in bigger fonts and was easier to read. I could read the following 3 lines while she took the orders with a smile. She was one of those fortunate girls who are born with a happy countenance, unlike her lady boss whose facial lines tell of a thousand worries and stress.

"Is love like a butterfly or is love a butterfly?" I asked her. She did not reply but her eyes sparkled as she took the orders.

The boy's mother admonished me: "It is not nice to stare at a lady's chest." Prim and proper.

I had not thought of the sexy implications and the waitress was not Dolly Parton whose bosom demanded attention. I said, "I was reading the words of a poem."

It is always good to make a happy connection with the serving staff as they work very long hours. She could be a student who needed to work. How do I understand their working life?

Well, I was a waitress during the 3 months of summer holidays during my first year veterinary studies in Glasgow University in 1969. I could not go back to Singapore unlike this young man I was dining with. My parents had no money. It was out of question.

At that time, the University bookshop had notices of summer jobs offered. I got a job as a waiter in an upscale hotel opposite St Andrews' Golf Course. After 2 days, I got the sack. Probably too slow to serve or not up to the mark, I guessed in retrospection.

I went back to the University bookshop and applied for another job. A small hotel catering to tour groups accepted me. A small seaside town called Dunoon, in Scotland. I had never worked before I went to Scotland on this veterinary scholarship. In a way, I was like this young man I was dining with.

After the termination of my first job, I decided to work harder. Worked 7 days a week and overtime. The tour groups would come in for breakfast, lunch and dinner and the waiters and waitresses would have to rush in and out fast to serve them. Then they would go out on their tours.

Now, how to serve fast for a table of 10 people? The British way of dining is so much different from the Chinese way which is a communal way of dining. For the British dinner, for example, there was the soup first. Then the main course followed by the dessert.

Each person had his own bowl or plate. So, 10 people would need to be serve 10 plates of the main course. And we had to serve fast as they needed to go for their tours.

The head waiter taught us how to balance the plates for the main course on our left hand. The waiter bent his elbow to hold one plate and his right and left hand hold two plates. A total of 3 plates. That meant rushing up and down to the kitchen 4 times to serve 10 plates per table. Some tables have more than 10 diners and we had to service more than 1 table.

Remembering my premature job termination, I resolved to work harder and smarter. All waiters and waitresses were of my age and undergraduates from various places in the U.K. We improved our serving technique to serve much faster.

After some time, we challenged each other as to how many plates we could serve at one go. We were young and energetic. Do you know how many big plates holding the main course could be served by a waiter?

Give me a number. Say it loud. Write it down.

Now, it is 2007. Almost 38 years had passed. I wonder whether the Glasgow University bookshop still exists and whether there are still vacancies for summer jobs.

The young undergraduate I had dinner was really fortunate that he did not have to work during his 3 months of summer holidays and could come home. His mum missed him a lot, so if I advised him to stay back to work in Australia to understand more about the Australian way of life would cause disharmony with his mother.

Back to the number of plates I could carry. It was 7. Two hands held 2 plates. Of the remaining 5, the left hand's elbow area held 3 plates in tiers. The right hand's elbow area held 2 plates. When I reached the table, the diners would help me to unload. Two trips would do for each table. The customers sometimes clapped their hands. I didn't know my fellow waiters and waitresses and I were so entertaining to them. The folks were the heartlanders and very kind. There was interaction between the customers and the staff and we did some tips at the end of each week.

Occasionally one of us dropped a plate during the rush, but that was not common. In that 3 months of summer job, I went out with my colleagues to the pubs. I witness one young man called Bill.

Once after our drinking at a pub, he stole a traffic hazard warning light and brought it back to our hotel accommodation. A blonde undergraduate waitress taught me what "mascara" meant when I asked her what she was applying to her eyelashes as all of us went to the pub. She would hum to this top of the pop song starting with the lyrics: "They paved paradise and put in a parking lot...".

At that time, I could not understand the slang of the singer till some years later. Sometime to do with yellow taxi and old man dying and taken away.

Recently, the young man's radio played this song which has the "Save the environment" theme. Which brought me back some 3 decades ago to this blonde undergraduate girl.

If you need to know, she was friendly but I did not date her. Love is a butterfly but it did not alight upon me in Dunoon.

106. The best spay I had - a smooth operator

2007-11-23T01:55:00.000-08:00

When the dog owner is well informed, a spay operation in the female dog can be a very smooth operation taking less than 30 minutes.

Today was such a day. The Miniature Schnauzer, born in Dec 3, 2005 was on heat 4 months ago. She was spayed today Nov 23, 2007 as the owner was advised to do so 3-4 months after heat.

My assistant Mark talked to the dog as he put the face mask over her muzzle. She did not struggle and went to sleep under 8% gas anaesthesia within 10 minutes. No tranquilisation. I inserted the endotracheal tube to connect her lungs to the anaesthetic machine, maintained the anaesthesia at 1.5%.

Incision was 2.5 cm from the umbilicus. 1 cm incision cut. The spay hook was inserted towards my right at 45 degrees posteriorly. It hooked out the left uterine horn. I pulled the left ovarian ligament. Pulling caused the dog to breath much faster as he felt the pain.

I increased the gas to 8% for a minute so that he had more gas. The minimal amount of gas given will lead to no deaths and that was why I used 1.5%.

No more rapid breathing observed. I cut the ovarian ligament with the scalpel. Clamp the ovarian stump. Ligate the stump.

Pulled the left uterine horn out of the body and saw the right uterine horn at the uterine body junction popping out. Use forceps to pull it out.

Then I pulled the right ovarian ligament and repeated the same procedure. No bleeding but the blood was normal red with oxygen. The dog was breathing regularly. The uterine body was pulled out and clamped.

The skin and muscles were stitched up. Anaesthesia switched off as I stitched the skin. No bleeding from the ovarian and uterine tissues at all as the dog was no longer on heat.

The dog woke up smoothly after 3 minutes. An Elizabeth collar was given to prevent licking of wound.

QUESTIONS THE OWNER ASKED:

1. Bathe the dog? Yes, but make sure the plaster is not wet.
2. Can the dog eat any food? Yes.
3. When to come back to remove the stitches. No need. The absorbable stitches will dissolve and fall off in 14-28 days.
4. When to remove plaster? 7 days later.
5. Can give antibiotic tablet crushed and mixed with water inside a syringe? Yes. 7 days. Normally I don't give antibiotics but lately, I do so as the dog may lick her wound or irritate it.

Overall, this was a most satisfying spay I had ever done. I had time for the first consultation at 10 a.m

105. Green vaginal discharge, no puppy seen. What to do?

2007-11-23T01:40:00.000-08:00

"My Labrador Retriever passed green discharge all over the kitchen floor. What to do?" the teenaged girl asked me. The female dog had no active contractions and half a day had passed with no puppy seen.

I said, "Wait, the puppy should be out within 30 minutes of the rupture of the water bag."

She did not know what I was talking about. All she knew was that there was green discharge all over the floor.

Telephone diagnosis is best avoided. Normally all Retrievers can give birth naturally. However, in this case, a green discharge meant that the placenta had separated and the puppy had not passed out. There might be some problem.

In such situations, if I advised waiting for an hour or more and if all the puppies die, I get the blame. I had encountered such a situation before from an unknown caller.

The person complained to the veterinary authority about me as one puppy or more had died. He had a Caesarean done at another vet surgery.

"Did you ask about the green vaginal discharge?" the authority called me by phone telling me there was a complaint about my phone advices.

So the best advice is to get the dog down to the surgery for observation or necessary Caesarean. Do not assume that every Retriever would give birth naturally. In this case, the girl was told to contact the parents. I got the dog transport woman to go to the house after talking to the mother.

When the transport woman reached the house, one puppy was born. Another came out within 30 minutes. The father asked me why I sent the dog transport woman to the house? The dam was suckling the 2 puppies!

I advised "wait and see" and asked the dog transport woman to leave. It was a very stressful situation for the teenaged girl as this was her first time. I should expect the Retriever to give birth naturally as almost all do so.

However, in life, there are always exceptions to the rule and the vet should not be too complacent.

104. BIOLOGICAL OR EMOTIONAL? Submissive urination in dogs - is there a cure?

2007-11-22T03:08:00.000-08:00

"Must I put a parking coupon?" the young lady asked me. It was 10.30 am on a weekday and she had to get her Maltese vaccinated the 2nd time.

In the past month, the car park wardens had "thought out of the box" and had came for surprise booking of cars without parking coupons at 9 a.m. They tried to sneak in from various ends of the road and did have some successes. Previously they would come at 5p.m. They were out-sourced private corporate "wardens" and the office must have a brain-storming to get more bookings.

"The car park wardens don't come at this time," I assured the lady. She brought the puppy into the consultation room.

"My puppy pees when I pat her head or when friends come to visit me," she said. "Is there something wrong with her?"

"This is a case of submissive urination or excitation urination," I said to the surprise of the young lady who replied, "I do not know there is such a condition."

Yet this puppy did not pee on the examination table when my assistant Mark held her for vaccination. I have had submissive urination cases of puppies dribbling urine at the Surgery as well as at home.

"Is there a cure?" she asked.

"You have to train her to be confident," I said. "This condition is reported to be hard to cure."

"How do I train her?" she asked.

"When you go home, ignore her for a while. When your friends visit, ask them not to greet her. Do not pat her head or you will reinforce this submissive urination. Bring the puppy out to socialise with people and other dogs. It takes a long time to cure and many grow up without being cured."

IS SUBMISSIVE URINATION A BIOLOGICAL OR AN EMOTIONAL DISORDER?

Autism is believed to be a biological rather than a mental disorder. Is Submissive Urination a biological disorder?

Are there therapies that can help? So far, the dog books do not advocate more than what I had told the lady.

Today, I read in alternativemedicine magazine April 2006 issue about APPLIED BEHAVIORAL ANALYSIS (ABA) which appears to work well for children who have Asperger's syndrome (a form of autism).

ABA is a set of behavioral modification techniques. Teach the child to learn the real world by breakind down tasks in simple steps. Reward the child with the tiniest success. Slowly the therapist weans him from the rewards as he succeeds in each task. The disadvantage is that ABA is time-intensive and very expensive.

For submissive urination in dogs, the owner may use alternative treatments such as the ABA's methods to see whether it is successful to cure submissive urination in the dog.

You will need to spend a lot of time gaining the trust of the dog and making her or him self-confident. Praise and rewards for small successes. Keep accurate records of the dog's response (no drops of urine). It is a trial and error as each submissive urination puppy is different. I don't know whether ABA's methods will work in the dog.

Autism Resources:
www.autismwebsite.com
www.autismtreatmentcenter.org

103. The bony Angorra rabbit will not eat.

2007-11-20T20:37:00.000-08:00

"My rabbit has not been eating for the past 2 days," the first-time rabbit owner took leave to seek veterinary treatment. "She just sits around and will not greet me when I come home."

"Has she got diarrhoea?" I asked. "This Angorra has a beautiful coat which camouflages her lack of weight gain. She is as extremely thin and can die anytime due to lack of health." I taught her how to feel the spines of the thin rabbit. Sharp spinal process poked at her index finger as she felt the whole length of the spine. There was no fat layer.

The lady said, "My rabbit eats all day. At times he has loose stools. Why is he not putting on weight?"

"Much depends on the quality of food and the rabbit's lifestyle of gnawing at objects that may cause watery stools. Did you smell the rabbit pellets to get an impression whether they were of poor quality?". A smelly pellet or hay pieces may indicate something is wrong. You will need to know how to judge by the smell.

I tried to take the temperature. A few pellets of stools and some wet faeces matted the swollen anal area. The rabbit disliked this handling. So, I stopped taking the temperature from the rectum.

This is the type of case where the rabbit appeared healthy and alive. If the vet gave an injection and the rabbit dies due to pre-existing diseases, he gets the blame. The owner needs to be warned.

I gave the rabbit an antibiotic and dextrose saline injection and asked the owner to hand feed the rabbit with rabbit food pellets slowly as whole pieces or wet ones.

"Hand feed?" the career lady queried me. "I don't know how to do. In any case, my rabbit does not stay still."

"Put the rabbit on the table. Grip the upper jaw with your left hand. Push a small pellet inside his mouth." I said. "Do you have any pellets?"

"No," she said. I saw the teacher with her pet rabbit of around 4 months in the waiting room. She might have some. She took out a small plastic bag of pellets to help me out as I did not have any. That was kind of her.

I demonstrated to the Angorra rabbit owner by pushing a pellet into the mouth, close the jaws and tilt the head. The rabbit wrinkled her lips and swallowed it. Now, it was the lady's turn. The rabbit was held but she was wiser. She would have none of the nonsense of being force-fed. She just turned his head away and would have stomped her foot if she was well.

"Let her smell the pellet," I advised. The rabbit was not interested in food and just turned his head.

Now, will the rabbit die if she does not eat for another day? She would have a gut infection or intoxication. I gave her the injections of antibiotics and dextrose saline and advised the owner to tel me if the rabbit did not eat the next day. Hand feeding was out of question.

Early the next day, she text messaged me "this morning she goes back to be an active hungry rabbit as usual. I will monitor her condition and will give her another 2 days antibioitics. Thank you very much."

That was good news. Seldom do I get feedback. Text messages are best and effective. As to the cause of the suspected fever, it would have to be something upsetting the rabbit's gut.

102. "Buy a new dog!" the daughter said.

2007-11-18T22:09:00.000-08:00

I can remember this dog. He bit me towards the end of surgery to remove his lip and face wart. So did groomer Mark who had also been bitten last year. Now the tumours had regrown and are bigger. Much bigger than last year. The girl's mother wanted surgery now as the dog kept pawing the tumours and they bled all over the floor.

"This must be the oldest English Cocker Spaniel in Singapore," I said. "Cocker Spaniels seldom live past 12 years of age. He is overweight and may not survive anaesthesia this time, so you have to take the risks if you want to operate."

We did not talk about the cost of surgery.

"Just buy a new dog!" a young girl of around 12 years old suddenly interjected. Mum was shocked at this discard the old and buy a new one consumerism. She was shell-shocked at the young girl's remarks, so was I. She responded: "It is my obligation to get him treated."

What happened to this little girl? Why did she said to get rid of the old dog? He can still eat and walk. Sometimes he leaked urine.

"He coughs at night last year," the mum said. "Like old people. I presume it is normal for old dogs to cough at night."

"It is not normal for old dogs to cough at night or at any time," I advised and checked his heart.

"Why don't you just use gas anaesthesia like the last time," the mum recalled. "No tranquilisation injection. He survived."

"OK," I said. I put the dog on antibiotics so that the wounds would heal well. The surgery would be next week.

The mum has a name card

2007-11-16T01:49:00.000-08:00

The Shih Tzu came for his annual vaccination booster during lunch time as the neighbour referred the mum to me. The mum had got a vaccination reminder card from a vet clinic and came here with her daughter. Referral clientele are the most precious and hard to get.

"Two front teeth dropped off as he bites iron gate," mum laughed. "What can be done?"
I said, "I don't think Singapore has the capablility to put on 2 false teeth for him." I checked his other teeth.

This 4-year-old Shih Tzu weighs 8 kg. Not obese. Yellowish white tartar accumulates on 4th premolar.
No bad breadth and no loose decayed dark brown teeth. Dog had been fed on dry dog food and the best steamed fish and chicken.

"Best to get a dental scaling done," I advised. "The tartar brings in bacteria to the gums and then the roots get decayed. After scaling, brush the teeth or give him some ropes to chew or dry dog food."

With yearly dental check up, the teeth can last till he is 15 years old.

The daughter worked in a bank. "Banks pay the most nowadays according to the Straits Times. Change job and get $1,000 pay rise. Change jobs a few times a year and get more pay. Do you have any name card? I asked.

The daughter apologised for not carrying one.

"Do you have one?" I asked the mum. She was conversant in the sale of funds as she was doing it. I was impressed.

Her son qualifies as an accountant, did not practise but works in the hedge fund.

"He is earning at least $10,000 a month," I said.

"More than that," Mum said. I ought to have studied finance and banking. It is too late but young people choosing their degree course ought to go for finance and banking studies if they want to earn much more than a professional.

Paper training --- One month later. What to do?

2007-11-16T01:31:00.000-08:00

Nov 16, 2007. Case study. Vaccination 3rd done today.

Questions asked by a young couple:

1. Should we restrict the feeding amounts? The pet shop seller advised leaving the food all day as the Shih Tzu was small sized.

2. How many times a day should we feed?

PUPPY
Shih Tzu, Male, Born Aug 2, 2007. 2.4 kg. Now 14 weeks old. Small sized. Pet shop puppy seller advised to leave feed bowl for 24 hours. Active.

HOUSING
Playpen.
1. Lower left quadrant --- Pee pan with newspaper. Urine spray liquid at one end (left most).
2. Front middle --- Water bottle. Middle because water seepage will go onto tray instead of the floor.
3. Upper right corner. Feed bowl. Feed topped up. Free feeding.
4. Upper left quadrant. Basket bed --- sleeps in bed or corner of bed outside at night.

POOPS 3x/day. No specific time. Poops onto pee tray as well as lower right corner. Pees many times on tray and on lower front half of the playpen.

"Did you change newspapers every day and regularly?"
"Once a week," the young man said.

I repeated my question.

"Once a week," the young man said. "Sometimes we change papers after 3 days."

"The puppy likes a clean newspaper to eliminate," I explained. "He will poop on the lower right corner or pee throughout the lower half of the playpen to avoid stepping on the soiled newspapers if he can help it."

Change newspapers daily or more often.

CONCLUSION
1. It has been one month. The puppy was not paper-trained as soiled papers were not replaced regularly (several times a day).

2. At one month, the puppy would be paper-trained if it has access to clean papers and the playpen could be removed. The puppy should go to the pee tray's newspapers to eliminate.

3. Give sufficient feed 3x/day. Remove the feed after 10 minutes. This encourages the puppy to poop after eating (in many cases). Do not distract the puppy before he poops.

4. Exercise. Evening outdoors. The puppy will eliminate downstairs. Get a fixed timing. Let it eliminate on newspapers after dinner before going downstairs.

5. A time-table for feeding and exercise is necessary for early success in paper-training. Pee tray is a good idea as this prevents the tiled floor of the living area from being soiled. But the puppy does not go into it if the papers are soiled. Changing papers a few times a day and praises and treats on successful elimination on newspapers are needed for early success.

99. The Pom's face wound would not heal --- Oronasal fistula.

2007-11-15T00:09:00.000-08:00

"Why didn't you come for the surgery?" I gently admonished the lady owner of the Pomeranian. "You wasted more money buying antibiotic powder to dust onto the facial wound after consultation."

Her dog had a weeping wound of around 5 mm in diameter below the left eye, above the maxillary 4th premolar tooth. It did not heal over the past weeks despite various medications and powders she had sprinkled on. Pet shops sell wound powders.

Some 14 days ago, I had patiently explained to her that there was an infection from the root of the maxillary 4th premolar. The infection went through into the nose below the eye. The bacteria from the decayed roots of this premolar attacked the nasal bone area and made a hole. This was an oronasal fistula and surgery to remove the infected premolar would resolve her Pomeranian's non-healing wound problem once and for all.

I guessed she could not understand how a rotten tooth inside the left upper jaw could be related to a hole on the skin below the left eye. Her husband thought, "This doctor is nuts. Mouth and nose. So far apart. How could there be a connection?"

"Surgery was to be done 7 days ago after antibiotics were given but you did not turn up till today --- 14 days later. Why spend more money on wound powders when they don't work?" It was not good for the dog. The anaesthesia and tooth surgery was $200 which was affordable for most pet owners. If it was $2,000, it would be high.

Sometimes it is good bedside manners not to elaborate in such situations and just simply accept the case. There was an optimal time to do extraction of the infected and decayed tooth. It was after 7 days of antibiotics and she had been given an appointment. She did not turn up and now the effects of antibiotics were no more. The bacteria in the infected teeth had returned.

The lady smiled sheepishly. "My husband wanted to use the $200 for the anaesthesia and surgery to go to India lah!"

Now that the dog is no longer on antibiotics, should I operate? There was no urgency in the sense that it was an emergency.

But it would be in the best interest of this poor dog to be cured as soon as possible.

The decayed 4th premolar and lst molar were loose as their roots had shrivelled from bacterial attack. They were extracted.

The wound should heal and the Pomeranian should have a face with no wet weeping hole.

98. The big-eared dwarf hamster

2007-11-14T23:45:00.000-08:00

"The hamster is sleepy now," my assistant said as the owner and myself were observing the hamster inside a transparent anaesthetic container in the surgery room. This was part two of the procedure. In part one, the owner was absent and the large lump beside the hamster's left ear had been removed. Now, the owner was present for the stitching of the wound as he was interested in seeing it.

This container had a hole through which a breathing tube carrying anaesthetic gas was pumped in. The hamster breathed the gas and would fall asleep, permitting me to operate. The problem with anaesthesia of the dwarf hamster is that the vet needs to be very careful. A bit too much or a few seconds more of the anaesthetic gas means that the hamster dies.

No second chance. No cardiac massage or emergency resuscitation unlike the dog or cat.

The hamster closed his eyes. I picked him up to stitch the wound of his left ear area. A big fat tumour, globular in shape and 5mm in diameter had been removed some time ago. There was now a big gaping hole of around 8 mm exposing the pink flesh. Bleeding was profuse but had stopped.

The young entrepreneur in his thirties was in the operating room as he wanted to watch the surgery after I had removed the tumour.

His wife waited outside as she could bear to see blood spurting over the hamster's head. She would not want to see the hamster bathed in red blood covering his whole head and neck.

I picked up the hamster and put him on a face towel held by the owner. This 'portly' hamster was tame and did not bite me. As I put in the first stitch, the hamster squeaked and moved. The pain of the needle had wakened him from his drowsiness.

How could that be? The hamster had been in the gas container and should be anaesthesized. I ran through my check. My assistant James had switched off the oxygen which would have mixed with the anaesthetic gas to make the hamster sleep. He was 71 years old but had not done this before. The presence of the owner had distracted him and me.

"Damn it, the gas was not given," I said. I apologised to the owner. It is important that the owner not be present during surgery as he could be distracting as in this case. It could be humiliating and humbling too.

The hamster was put back into the container to breathe the gas. Then as his eyelids closed, I took him out, placed him on the towel held by the palm of the owner and stitched him. 3 fine stitches of 5/0 absorbable. He squeaked at the prick of the needle uniting his torn skin. He was fine and alive.

I taught the owner how to wipe off the blood from the hamster's body. "Use a cotton bud and do it slowly so as not to stress the hamster."
"What about the ear lump?" the owner asked.

"If it grows so big and so fast in the last 5 days," I said, "It would be cancerous and would re-grow." I did not suggest sending the lump for histopathology to confirm whether it was malignant or not as total costs would add up and the results would not help the hamster to survive longer. Cancer treatment for a dwarf hamster is out of question.

The histopathology analysis of a tumour would cost over $200. The hamster's operation and anaesthesia was kept as low as possible at $75.00. Now, the cost of a new hamster would be around $10.00.

The owner and his wife appeared satisfied as they packed the hamster in his cage to bring home to their daughter. From this experience, it is best not to permit owners to observe surgery as they can be distracting to the assistant.

97. The teacher's pet

2007-11-14T14:39:00.000-08:00

Dr Sing Kong Yuen
www.toapayohvets.com

“My rabbit keeps biting his toes,” the young teacher cradled her 3-month-old Netherlands dwarf rabbit in the nook of her left hand. “What is the cause?”

“Put the rabbit on the table so I can examine properly." I advised.

The young lady took out 2 bottles of medicine from her plastic bag, “As you were on leave, I consulted a vet when my rabbit leapt and then limped. The vet diagnosed a leg sprain.”

“The rabbit looked thinner since I saw him 6 days ago.” I encircled the rabbit with the fingers of my left hand as he tried to scamper away. The teacher’s pet was fighting to be slimmer than the teacher.

“He’s very picky and eats only the green dry food,” the teacher laughed. “I don’t know what to do to make him eat more.”

The rabbit’s crusty toes caused by the scabies mites, except for two, were now normal skin. That was good news as the scabies mites had stopped multiplying and burrowing under the skin of the toes. The scabies mites caused considerable itchiness in the rabbit, leading to licking and biting to relieve the itch.

“But why was the rabbit still biting his toes?” the teacher asked when I declared that his mite infestation was no more.

I removed a scab on the right fore paw. There was a red 4-mm diameter wound. I pressed the lower part of the skin below the wound. Thick creamy pus oozed out. The rabbit squealed suddenly. The teacher uttered a sharp cry as if she was stabbed. Sometimes it is best not to have owners around but their presence and interaction educate them more on pet care than talking and books.

“It is best to clip off all the hairs of the paws,” I advised. “In this way, we can examine all toes thoroughly. Can you do it?” Most Singaporeans of her generation do not have contact with Nature and animals and she was not able to restrain the rabbit, afraid of hurting the little one. The teacher, in her early thirties cradled the rabbit. She scissored the paws in vain. The rabbit shifted and withdrew his paws.

“Grip the skin with the fingers of your right hand,” I demonstrated. “The fingers curl onto the scruff of the neck. Hold the rabbit upside down, like what his mother would have done to carry him. He would be quiet.” The rabbit appeared ‘hypnotised; as I snipped the hairs off the paws.

“Can you do it?” I asked the teacher. She tried but the rabbit would move. “It is cruel,” she must have thought. Her groomer would take care of the entire nail clipping and grooming.

To save time, I cut off all the hairs. There were 2 more abscesses with pus.

“What do secondary school children read nowadays?” I asked. “Do they read books about animals as I am thinking of writing one for the children and want to know the prospects of sale?”

“I doubt my students read. The English teacher gives them books to bring home to read. They return the books. No questions asked. I teach Mathematics and Chemistry and so do not know about their reading habits. But I know many spend lots of money to buy gaming books.”

Maybe there is no audience for the animal story books for children in Singapore.

“Thank you for your feedback. Fiction like ghost stories seems to be preferred by the Secondary school students.”

I advised observation of the rabbit’s appetite, daily cleaning of the wounds, removal of the chewed-out plastic spoon and stopping the medication meant for another 6 days.

The thin rabbit must eat good food. So should this ultra slim educator but it would be rude of me to say so.

"No plastic spoons as the bits and pieces of gnawed plastic ingested will kill the rabbit," I reiterated. The teacher's pet was not thriving.

In the 1960s, a student who carried books for the teacher to the common room to mark was called “the teacher’s pet.” Was it a privilege? What do you think? I was proud to be a teacher’s pet in primary school.

Do secondary school students carry books for this teacher in 2007? I did not ask her. I hope she learnt something today on rabbit care and that the dwarf rabbit would eat all day to gain weight and thrive.

96. Follow up on 94. The stars of timing.

2007-11-13T14:44:00.000-08:00

"The vet must guarantee that the dog will not die under general anesthesia," the owner of the Yorkshire Terrier told the pet shop girl who had referred the case to me. Should I handle this case or not?

If the dog has an inherited poor heart condition and dies under anaesthesia, the owner is sure to tell everybody about the vet. No doubt about this.

Anasesthetic death opens the door to litigation and demands for explanation from the veterinary authority should a complaint be made. So much emotions are involved in an anaesthetic death. Family members may want to sue.

Why risk my reputation built over a life-time? Just pass the case to another veterinarian. This should be a wise decision. Pass the buck of potential death.

Yet this Yorkshire Terrier was young, active and examined. He was apparently healthy. Still, there may be hidden heart arrhythmias or ventricular tachycardia which manifests during general anaesthesia resulting in heart failure and death.

I did not pursue the matter as I asked the pet shop girl to let the owner decide. Maybe she had her own vet.

The owner decided to operate on an auspicious day and time and told the pet shop girl. I had never met the owner.

This auspicious day would be a Sunday and the pet shop girl made an appointment. Sunday is a busy time for vets as most Singaporeans are free. I did not object to surgery on a Sunday. But the Sunday happened to be busy and I could not finish the cases before noon.

"Doc," the owner said to me as I was in the middle of consultation. "I understand that you have to clear your consultation cases. Please make the first incision before noon."

Her adviser had given her the safest time for surgery of her dog. It ought to start before noon and on this Sunday. Wow, I did not know about the time.

It was obvious to her that I could not complete my morning consultation in time to start surgery.

"It is best you postpone the surgery to another day, after consulting your adviser," I said to the owner. She had this kind and pleasant personality when we talked. I would sense that she was not the litigious type.

But the stars of timing are now against me. I don't want to claim to be superstitious but it is best not to antagonise the stars of timing.

"Why not wait?" I asked the owner.

"It will be 2 weeks later," she sighed. She decided on the operation in the afternoon. She did not tell me then but she was worried that the leakage of "mercury" from the defective chip would kill her dog if she waited much longer. She had already two weeks of worries and hassling the pet shop owner to get remedial action.

The pet shop girl had warned about the "lighter patch" of hair colour for the Yorkshire Terrier at the surgically shaved area. So, the owner asked me not to shave too much of the hair so that the new hair colour patch would not be so obvious.

"No," I said. "I need a large area to operate to remove the chip fragments. If I cut a small area, I may stitch the hair into the wound. The best is to shave the whole body bald and the new hair growth would be of the same colour."

The owner agreed. I asked my groomer Mark about the pricing. $60.00 was too much for her. So she drove to her pet shop to get it done. When she came back, it was still before noon, but the Surgery was crowded.

I must say that not all my Sundays are bustling and I could complete the cases before noon on most Sundays. This Sunday was an auspicious operating date for the owner of the Yorkshire Terrier. Many Chinese pick auspicious dates for marriages too and so I am not a bit surprised that operating dates must be auspicious for the best result of the Yorkshire Terrier.

"My mother's poodle died under anaesthetic at the vet," the owner explained to me although I never asked her as to why she wanted a guarantee that the vet who operated on her Yorkshire should guarantee against any death. "She still keeps the dog's accessories and renew his dog licence."

I did not comment as anaesthetic deaths happen to all vets for various reasons. Now, I am in this situation where the auspicious time had passed. I should not operate. Choose another day.

But the owner had concerns about the toxicity of the fragmented microchip. Not one hard lump under the neck. Two lumps. And 2 weeks had passed. She had not told me about her concerns nor did I have much time to talk to her on this Sunday morning as I was busy with cases.

I did not have any prayers to any God as I operated during lunch time. Used gas only. Intubated the dog in case of the need to give emergency oxygen should the heart fail. Nothing eventful. The lightest anaesthesia was given. The dog woke up before the last stitch was inserted.

The dog came around 3 pm. She was the happiest pet owner in the world as she held her dog up for me to take a picture.

95. The hatchet man

2007-11-06T14:54:00.001-08:00

"My son told me he got 16 out of 20 marks for his essay, no thanks to you," the mum spoke to me as a matter of fact. "You had severely criticised his writing when he asked you to review his essay."

Mother Juliet is a very good people manager in a corporation. I believe the her subordinates love her and wants to work with her when she is transferred out of the section.

As for me, I don't have time for being nice to students who need to complete their writing project. I just have little time for myself.

Juliet's son had not written an essay which was easy to read. I said it was written as a quick draft and needed to be re-written with more references.

Why not let Mum Juliet review his essay? She would not do it. So, the hatchet man gets the blame and no credit for his success!

In another case, a mother asked me to help her polytechnic son who wanted to profile me as a "successful" professional. The son had to write on "industry, person or company" success story. The poor teenager, probably around 17 years old interviewed me. We went to a puppy pet shop. I read his second draft after a good lunch treat from the mother and met the family at Crystal Jade in Toa Payoh. The mother had presented me mooncakes and a nice grasshopper present.

Still the poor boy's draft of me was not reading smoothly. I had to tell him to re-write the 3rd time if he wanted good marks. He is still at it. I spent some few hours with him.

Writing is hard work. A hatchet man's job for students of writing is even harder and time consuming!

94. The petshop girl was between the devil and the deep blue sea.

2007-11-06T14:17:00.000-08:00

"It was silly of her to tell the dog owner that she had micro-chipped the dog," Mark said to me.

"It is good for her to be honest. If she said a vet did it, the owner would sue the vet or ask for clarification and she would be found defective in her character." I said. "I believe there is no legal requirement that vets must do the microchipping."

Now that the owner was vigorously pursuing this matter of the big lump and the dog crying all the time, the pet shop girl had to do something. She consulted a vet, namely me.

"She is between the devil and the deep blue sea," I said to Mark. Meaning that she had to decide to tell a lie or a truth. They were both difficult choices for her.

I had told the pet shop girl that the big round 0.5 mm swelling at a grain of rice was a microchip which had caused reaction after implant into the dog. The owner had complained that the dog was crying all the time after micro chipping as the dog had a big lump under the skin above the shoulder area.

I examined the active dog. There was no fever or pain in the area between the shoulders.

"The microchip scanner did show pick up the digits," the pet shop girl told me. "When I asked the seller about defective chips, he said I ought to scan first before implant."

"Well," I said. "My scanner cannot show the digits. It is most likely a defective chip but was it defective before the implantation or after?"

"Oh, this dog moved quite a bit during implantation" the pet shop girl said.

"It is possible that the microchip was not intact or well manufactured. After implantation, the body tissue fluids leaked inside the wall of the microchip and so the chip was spoilt. The scanner would not be able to scan it."

She had not thought of the "after implantation" possibility although she did mention about the chip breaking up during implantation.

So there were 3 possibilities of defects - before, during and after. It was good to brainstorm.

But now the owner was not happy. What should the vet advise?

"It is best to remove the big lump," I said. "Though the dog appears healthy today, what happens if he dies in the next few weeks. The owner could attribute to the toxic release of the substances inside the defective chip. Soon you would be sued."

The pet shop girl was vacillating, "I have to pay for the surgery. How much is it?"

"$150 is the cheapest I can offer to help you," I said.

"Can you do it now?"

"Better ask the owner first," I said. This is a potential litigation case. Mark volunteered to talk to the owner.

"It is best that the pet shop girl talk to the owner," I assessed the situation correctly. "Otherwise, the owner thinks there is something she is hiding."

The pet shop girl nodded her head. She had an half-an-hour teleconversation with the owner while I cancelled my lunch appointment! All because of a microchip!

The pet shop girl said gravely, "The owner wants you to guarantee that the dog will not die during the anaesthesia and surgery to remove the chip. Otherwise she would sue your pants off. I told her no vet in the world can guarantee that!"

So that was part of the long teleconversation she had with the owner.

I felt sorry for the dog owner, the pet shop girl and the dog.

I would like to help out. Another case of "Fools rush in where angels fear to tread"? This seems to be such a case. I should opt out. Where taint my reputation for $150 and a potential litigation.

"Chances are good that this young active dog would not die during anaesthesia," I said. "I will use just gas anaesthesia and no tranquilisers. It is much safer." There was an excellent pet shop girl-veterinarian relationship and I would help if I could.

The pet shop girl was "between the devil and the deep blue sea", I think. It was no longer a matter of her paying for the operation. It was whether the dog would die under anaesthesia or should the dog not be operated and die later and get sued for alleged intoxication from leakage of the microchip.

I was encountering a case of "Fools rush in where angels fear to tread".

"Let the owner think about it," I said. "In any case, the dog had eaten and would not be suitable for the anaesthesia. It is best to starve the dog 12 hours before anaesthesia. I want to maximise my chances of success."

So, the pet shop girl reluctantly went back and would let the owner decide. An hour was spent for this matter! The pet shop girl text-messaged to me that I had not charged her for the consultation. Now, how much should I charge for an hour of worries - of the dog owner, the pet shop girl and the vet? Life is full of problems and is not a matter of dollars and cents sometimes!

93. The 21-year-old veterinary student had to choose his knife to defend himself

2007-11-05T14:02:00.000-08:00

"Choose your knife!" the young undergraduate's eyes narrowed as venomous rage accumulated over some months pierced into my eyes. He spluttered "Why you keep ignoring me? Why? Why?"

Two post-graduate Malaysians and I were in the kitchen pantry of the Dalrymple Hall of Residence eating supper and chatting before retiring for more studies. We toasted bread or cooked our instant noodles when this young man from Malaysia, in his early twenties confronted me.

Our routine during term time after dinner was to have a game of darts or to play snooker for half an hour. Then we would get back to our rooms to study. At around 10.30 p.m, we would meet for supper.

It was a monk's life during term time. No girl friends as we were in foreign territory and Glasgow was not as popular as London with Malaysian and Chinese nurses studying in the United Kingdom. Female undergraduates in Glasgow or Strathclyde Universities in 1971 coming from Malaysia and Singapore were as extinct as dodos. We did not drink beer and so were not as sociable as we ought to be. Beer and girls did mix well during my time and it was a great time for British undergraduate youths living away from the eyes of spying parents.

Yet the youths of Asian and British Caucasian cultures at that time were barriers to cross-border undergraduate romance, at least in my case.

We were to study hard and make a better life for ourselves by getting a British degree. Yet here there was one Malaysian Chinese youth who wanted to commit murder by provoking me to a fight.

What provoked this young man to pick on me I don't know even some 36 years later. Did I ignore him during dinner? Our group usually sat together. The only Malaysian Chinese who ate dinner with the Caucasians was my class-mate as he could drink beer and enjoyed the company. One ought get to know the natives but then I had no social skills at the age of 21 years old.

Now, I encountered a dangerous situation my parents or teachers had not taught me how to handle. I would pay a terrible price if I mis-handled this situation. That was the price of death. And I would have missed the internet and so many advances of 2007.

It was 1971 and I was a second-year veterinary undergraduate. I stayed in Dalrymple Hall of Residence as my Colombo Plan Scholarship paid one pound a day for my food and lodging and I did not think of sharing apartments with other Malaysians.

In the Hall, breakfast and dinner were catered for and the central heating during the coldness of winter was reliable. I disliked waking up in the middle of the night to shiver as that would be in sharing apartments that had only an electric filament for heating the room.

Now, there was a challenge to a knife fight. The antagonist took out a kitchen knife and poked at me as I did not reply to his queries. He puffed his face and raised the tone of his voice. He waved the butter knife in front of my face and in the air defiantly, "I fight you with one hand tied up. Now, you go and choose your knife! You got no balls? You are so sissy swaying your hips as you walk down Saucihall Street?"

He was short broad shouldered and slightly muscular in his biceps and triceps. His face became redder as the pocked marks scarred by many pimples radiated a pinkish red glow. I really had no idea why he said I ignored him so many times. Probably, at dinner time, I chose to sit with other members of the Asian group than to sit next to him.

A youth financed by his parents to study in Glasgow University to upgrade himself and earn more after getting a degree. Now he was about to commit murder.

"Singapore student murdered in the U.K." would be the headlines if I mis-handled this situation. I had not trained in unarmed combat although I spent 9 months in the Special Constabulary as part of my national service in Singapore, before embarking to Glasgow for my veterinary studies. There was a lesson or two in unarmed combat. Useless lessons when a national serviceman of 21 years old was confronted with a raging bull.

Nobody had ever thought me how to handle such situations. All my classmates in Raffles Institution over the last 6 years of study were genteel. I did not mix with street gangs of Singapore and was not street-smart. I was a provincial guy. A bookworm. A lover rather than a street fighter.

Here was a youth ready to kill and bring shame to his own family. The dark forces had overtaken his mind. How would I respond?

He said again as he put his right hand behind his backside. "One hand tied behind his back...come...choose your knife...

I could not think clearly nor did I justified my boycott of him. One arm tied behind his back. That seemed like an advantage to me. I had two arms and he had one arm to fight.

Wow, he wanted to be the "One-armed Swordsman" --- a popular Chinese film during that period. The Swordsman had one arm hacked off but he trained hard with one arm to go after his enemies and to right injustices. Any adversary seeing his one arm sneered at him as they over confidently fought with him. They were invariably killed.

Young men are over confident. This youth offered to have one arm tied behind his back before we commenced. Would the two post-graduates obliged? They were mature men and would have not been accessories to murder.

What did I do? I ignored this chap and walked away.

Was it the pyschology books at the National Library that subconsciously taught me to walk away from a fight rather than stand up to the adversary? I don't know. I read a lot of books in the National Library during my teenaged years. They were free and answered many questions on growing up, making friends and how to behave in courting girls. Court ship knowledge was of no use as I could not put into practice as my secondary and pre-university school was an all-boys' school and the convent school girls across the road were frightening.

Now, in Britain in 1971, I had a menace more frightful than girls in blue pinafores. This Malaysian youth was more powerful than me as he had been doing body building while I did not. He would prevail over me in the fight. Probably he would stab my abdomen as his rage was out of control. A dark force overwhelmed him that winter night, asking him to kill as a "one-armed swordsman". I don't know anything about his background but he probably was involved in "staring incidents" in Malaysia.

At that time and even in 2007, male youths accused each other of staring. They would return with back up gangsters just to pick up a fight and cause grievous bodily harm. Such youths are no better than animals and all societies probably have such gangs.

Sending youthful male students overseas to study is a very worrying matter for Malaysian and Singapore parents. They don't know whether they will mis-behave now that are free from parental and societal restraints and supervision. Especially nagging mothers!

I recall sadly a case where 2 Singaporean undergraduates of New South Wales University were said to be murdered by their Singaporean flat mate in 2004. Could the murder have been prevented. What were the causes that led one flat mate to kill two?

Could there be an accumulation of tensions over some months. The accumulation of rage enable the dark forces of the mind to take one direction --- to kill the flat mates. If only the signs of rage were recognised in the 3rd flat mate, could proper advices be given to prevent the murders?

Youths sharing an apartment overseas can be easily stressed as flat mates share the common bathroom and kitchen. One party might want cleanliness of the bathroom and the other would soil it. There would be tension and nagging to convert the untidy one, without success.

I am able to write today because I was not provoked so easily during that period of time although my male hormones were raging as part of my development. Praise be to the Lord, you would say.

Or was I a coward? A lover and not a fighter? I would have been murdered, no doubt about it as this antagonist was superior in brawns than me --- a scarecrow of a youth. I still have not learn martial arts. At my age of 57 years old, yoga would probably be beneficial for me, rather than karate.

All young men must be taught to walk away from a fight. But who will teach them? By reading books. Lots of books. Pyschology books from the National Library. But Singapore youths dislike reading books. Read from the internet.

Let your parents especially your nagging mums know if you have financial or personal problems. Try not to fight for your rights by provoking your flatmates to behave. Move out. Do other things. Read books. Well, no. OK. Just go to your addictive online gaming and slay dragons! Hormonal changes and an assertion for your rights may cause you to commit murder or get murdered. Remember that your parents have limited wealth. Their life savings enable you to study overseas.

Study hard and bring glory, not shame to the family.

92. Cat with fleas - to spay or not?

2007-11-04T14:17:00.001-08:00

It is a hard decision. Some flea dirt on the face. An active flea seen clearly against the white hairs of the back of the leg speeding faster than sound and so was not caught.

If the cat is sent back to be defleaed, it costs the owner time and money. Few owners appreciate this procedure. The caterwauling cat continued to make lots of noises, offending neighbours in the HDB apartments and stopping the owner and family members from having a good sleep.

There was only one flea seen. About 4 mm long and very highly mobile. Singapore cats still have fleas but rarely are they seen in domestic cats housed at home. So, it was a puzzle to me why this cat had some fleas. It was possible that she was allowed freedom outside the house and had contacted fleas from other cats.

My decision was to spay her as Singaporeans are living in a time-pressed world where the cost of living shoots up every year. Another increase in the electronic road pricing rates. Some increase in bus fares. Of course, salaries of civil servants are also increased. The private sector employees in the lower ranks, such as cleaners, do not seem to benefit from the economic boom as there is massive underpricing of fees from contractors.

I don't know the earning power of the cat owner. The cat was brought in for spaying. If there are too many fleas, I would stop the spay. This would be negligent. What if one flea hop into the incision and contaminate the inside of the cat?

This was a clean cat, except for some flea dirt on the face and the only flea I saw at her backside. It was not possible to catch this flea as it had bolted inside the coat. Such a small cat yet it is not that easy to catch a single flea.

After spaying, the flea re-appeared and I caught it.

On camera.

I was taking picture of the swollen ovaries and uterine horns for research. The owner had got rid of most of the fleas before sending in the cat for spay.

93. Fools rush in where angels fear to tread

2007-11-03T14:52:00.001-07:00

"The Toy Poodle has not passed stools for the past 6 days," Mrs Lee, a friend of the owner said. "The owner is worried. Her vet had referred her to another practice because this dog is aged and has heart disease. Besides the owner is a good friend."

Friendships built over a life-time, like reputations, can be destroyed in one incident over the death of a beloved Toy Poodle. So, it was prudent for the first vet to avoid treating this 15-year-old for constipation.

Mrs Lee lamented: "The second vet charged the consultation fee and sent her home. She still has constipation. Do you make a house-call or should I bring the dog to your surgery?"

An old dog that can die anytime from a severe heart disease is a challenging case. To be frank, it is a nightmarish case in a litigious society that Singapore has become. It was therefore prudent that the second vet sent the dog home without doing "anything" according to Mrs Lee.

I presumed the 2nd vet wanted to avoid writs and complaints to the veterinary authorities or press from disgruntled owners should the dog die during treatment.

The background picture gets complicated as I asked more about this dog before treatment. A lean Toy Poodle with bluish tongue tip hanging out of his lips. I put her on the table. Her temperature was normal. Her heart was very bad as the machinery heart murmurs bounced off my stethoscope. She was on heart drugs prescribed by the first and second veterinary practice.

"The drugs made her drink a lot of water," the owner said over the telephone in between serving customers. It is best to phone the owner for the history of the case.

If the dog was drinking water, she should not be constipated. When I palpated her abdomen, she had a big soft mass of around 10 cm x 10 cm in the large intestine not too near the anus. Constipation stools are usually hard as stone normally.

So, how did this senior constipation?

A prescription diet for heart disease, prescribed by the second vet practice was not eaten by the dog. The owner accepted the advice to discontinue the feeding of the usual brand of dog food. Unfortunately, the dog disliked the taste of the prescription diet and would not eat. So, the owner fed her pieces of chicken meat instead. The dog urinated a lot but did not pass any stools for 6 days.

"Why did the locum not treat this dog for constipation?" I asked Mrs Lee as the first vet who was overseas and had engaged a locum.

This case appeared convoluted.

Fools rush in where angels fear to tread. If the locum vet of the first practice and also, the vet of the second practice, did not want to treat this constipation case, there must be something that needed to be known.

Was this owner a potential litigant or had shown litigious behaviour? If there was a possibility, it would be prudent to pass the buck to another practice.

I did not ask Mrs Lee about this aspect of the owner. Instead I asked: "Why did the locum not treat this case?"

Mrs Lee's bright eyes set against a chocolate brown face lit up as she said: "At one time, the locum expressed the anal glands of this Toy Poodle. No anal oil came out. The owner remarked that the first vet who engaged this locum could express the glands."

Mrs Lee still had not answered my question as to why the locum did not want to handle the case of constipation. I thought, "Well, if the dog did not have anal gland impaction, no oil would come out. What is the big deal?"

Mrs Lee was matter of fact as she shook her curly haired head: "The locum was angry with this comparison remark and henceforth refused to handle the dog of this owner."

This was understandable and right for the locum not to take up this case. If the owner has no respect, it would be best not to handle the case.

But why should the second vet at the referred practice not handle the case? Had the owner's infamy preceded her to the second practice?

Can there be no smoke without fire? I was apprehensive. If the dog dies during treatment, reputations built over a life-time get destroyed in one reckless acceptance of a case in which the owner is likely to sue for negligence. Bad press publicity is not good even if the vet is found not guilty.

As if to answer my question, Mrs Lee said, "The younger vet rejected this case after charging $25.00 for consultation. The older vet who sees this dog was on leave at that time."

So, what should I do now since the dog is in my surgery. I had the impression this was a simple case of constipation and had asked Mrs Lee to come to the Surgery.

Not a conflict canine constipation. This dog could die anytime as her tongue was moderately cyanotic. Tongues should be pink. Her nose had lung water bubbling out. The heart drugs were doing a good job. The owner and Mrs Lee could not give me the names of the 2 out of 3 drugs being taken by this dog.

This was a risky case of possible sudden death from heart failure. Any restraint of the dog for treatment would precipitate heart failure and then death. A decision had to be made as Mrs Lee and her husband had taken so much trouble and a taxi to come to the Surgery.

"Let my husband hold the dog as she is familiar with him," Mrs Lee said as she did not want to be present in the treatment room. The stools were quite deep inside the large intestine and around 25 cm away from the rectum as I pass the catheter into the colon over 15 cm deep till I met the obstructed stools.

I pumped in 10 ml of soapy enema water from the syringe after mixing the soapy liquid and water in a bowl.

Mr Lee held the dog on the table. He was a man of few words unlike Mrs Lee. The room was deafeningly silent as we waited for instant results. No stools came out of the anus onto the newspapers on the table. The dog was all right. Not panting excessively or collapsing. He just would not poop.

Was there a hope of her passing out the stools at all? This was a case where performance counts. Action speaks louder than words. If no stools come out, it was a failure of the vet to perform.

Somehow I envisaged the owner saying to me as she did to the locum: "The first vet will be able to do it. Why can't you?"

Mrs Lee stated that the first vet refers old dog with heart disease to the second vet. Heart disease, old age and constipation --- this case would be referred to the second vet practice. So the question of the first vet treating this case is moot.

Have I rushed in where angels fear to tread? The Toy Poodle looked at us in apprehension, shivering a bit as her legs trembled. She did not pass out stools. Neither did she die of heart failure.

Should I give a second dose or not take the risk? I waited 5 minutes. No poop. This time, I withdrew the catheter slowly as I pumped in 2 ml of the 10 ml of soapy enema. I had increased the concentration of the soap by adding more soap. This is no formula to share with you readers as this was not a commercial enema.

Commercial enemas come in a tube for one to insert inside the rectum of constipated babies. These are handy. They may not work in this case as the stools are deep away from the rectum. I was doing a type of colonic irrigation and had to be careful in case I perforated the colon with the catether.

The Toy Poodle still would not pass stools for the next 5 minutes. She evoked a soft cry as she strained her anus slightly. No stools came out. From my experience, I ought to wait a while.

I put the Toy Poodle inside the crate and talked to Mrs Lee about her son. Mrs Lee was in her fifties and would only work part-time at night. Her husband who looked as slim as a teenager had recently retired.

I asked: "Any grandchildren to look after?"

"No, my son presented me 2 cats from Australia," she sighed as she told me about the cat's health. Her son was doing a Ph.D and had been a small property developer in Australia. He would build 4 houses and sell them.

This was an unusual son. I would say that 99% of Singaporean parents had sons and daughters going to Australia just to study and enjoy life. Consume, not create wealth. And here, a Singapore boy who made his own money.

"Has he got any housing agents in Singapore?" I asked Mrs Lee. "I would like to meet him and talk about being his agent." Of course, I would learn more by meeting this man.

This constipated Toy Poodle brought me an opportunity to meet Mrs Lee who had a son who set an excellent example of what I mean by "Create, not consume" when I advise the youths of today that venture overseas to study. But many will not know how and will be consumers.

We were in the waiting room and there was no clients. So we could talk. After some 15 minutes of conversation, we went to the holding area to check out the Toy Poodle. She had passed a big piece of soft stools onto the newspapers and had gone to the other side to avoid stepping on the stools, well formed of around 6 cm in 2 pieces each.

She went home to Mrs Lee's house first before handing over to the owner. I advised the owner to give the old dog food that the dog was used to as it had fibre. The heart disease prescription diet could be given if the owner started with small amounts.

As the Toy Poodle had lost considerable weight, according to Mrs Lee and would not eat the prescription heart diet, it would be pragmatic to feed her the old dog food rather than pure chicken meat. The dry dog food had fibre but chicken meat had no fibres to stimulate the large intestine to move the stools.

"It is possible that the large intestines are not good at peristalsis or moving the stools out of the body despite the presence of lots of water being drunk," I explained to Mrs Lee. "The cause of partial paralysis of the intestines could be due to the old age as this dog is as old as a 100-year-old person if you use 15 years of the dog x7. This is equal to 105 human years."

The dog has not long to live in view of her serious heart murmurs. Maybe 1 or 2 years more but I may be mistaken.

For some reason, her intestine was not so active as to pass out stools after eating chicken meat. If she did not have fibre, she would get constipation again. And so, it would be best to feed her what she wanted to eat and relieve the owner of her worries.

Many Singapore owners are not aware of the need to feed the prescription diet in small amounts, adding more and more over a period of weeks.

They give the dog large amounts to replace existing formula food. Obviously, the dog does not want to eat the new food especially when he is used to table or people food. The prescription diet is abandoned and deemed no good.

Much education needs to be done to follow up with her in the use of the heart dieseaseprescription diet. It is difficult for the vet to do so. So chicken meat was substituted for the previous dry dog food or other food as the dog would eat the meat.

I never met the owner as she was busy working. I just hope that her dog would not get constipation again. I may not be second time lucky if I rush in where angels fear to tread and get slapped with litigation and demands for explanations from irate family members if the old dog's heart stopped beating during the treatment. The probabiity of this happening is very high and it would be prudent not to handle such cases.

91. Importance of continuing contractions for stroke patients

2007-10-27T15:00:00.000-07:00

"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.

2007-10-24T16:10:00.000-07:00

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

2007-10-24T03:22:00.000-07:00

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
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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?

2007-10-23T16:39:00.000-07:00

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

2007-10-22T15:10:00.000-07:00

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.

2007-10-19T17:53:00.000-07:00

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

2007-10-16T13:25:00.001-07:00

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?

2007-10-14T14:52:00.000-07:00

"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.

2007-10-12T16:23:00.000-07:00

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

2007-10-11T16:40:00.000-07:00

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?

2007-10-10T22:35:00.000-07:00

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.

2007-10-10T22:03:00.000-07:00

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

2007-10-10T15:37:00.001-07:00

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

2007-10-09T16:08:00.000-07:00

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

2007-10-08T14:51:00.000-07:00

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

2007-10-08T04:12:00.000-07:00

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.

2007-10-07T15:47:00.000-07:00

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?

2007-10-05T16:11:00.000-07:00

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?

2007-10-04T14:48:00.000-07:00

"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!

68. Too young to spay? 5-month-old Singapore cat

2007-10-04T14:43:00.000-07:00

"I can't risk her being pregnant," the owner said. The cat was 5 months old but there were many male cats around. So, it was best that this smallish cat be spayed.

For owners who can wait, 6 months of age would be better as the cat would be bigger. In this cat, the ovaries and uterine bodies were flushed red indicating that the cat was able to conceive.

67. Advices for the home-breeder - puppies on consignment.

2007-10-04T14:11:00.001-07:00

"Tap,tap,tap," sounds made by the 8-year-old girl distracted me. As I cut the dew claw, there would be a sharp tap on the door.

The little girl was outside the surgery room, standing on tip toe to watch my surgery with her father who requested viewing. My surgery door had a glass window on the top half and the girl with the squarish fair face and deep brown eyes was not tall enough. So, she tip-toed and must have banged onto the glass door.

"Come inside the surgery room," I said to the father and daughter. "If she is not afraid of blood. It is hard for me to concentrate on my surgery with all the tapping sounds." The father laughed. He was in his forties. I seldom see father and young children at my surgery and it was good to see them bonding.

The Jack Russell puppy was held by my intern with one hand. It was wriggling and trying to get out of her hand and I was afraid she would grip too hard. I was observing her as well and could not afford to be distracted. Usually, it would be best not to have any spectators during surgery. But a child might learn something and might want to become a veterinarian later if she could see what a vet does.

The child was not frightened of blood. She turned her head away as I snipped off the tail and put on potassium permanganate powder to stop the bleeding.

"I read that the dew claws (thumbs) ought to be removed to prevent injuries," the father asked.

"Sometimes, the Jack Russell's dew claws get cut or torn at the dew claws because this breed is an extremely active one. I will remove them."

"Who are you selling the puppies to?" I asked.

"It is very hard to sell puppies nowadays," the man said. "Many Singaporeans are not buying in view of the $5,000 fine for having no dog licence."

I said, "Those 400 dogs abandoned by people after the introduction of the September 1, 2007 law requiring microchipping and dog licence or a $5,000 fine are not really dog lovers or they may not be able to afford the fees."

Unsterilised dog licence fees cost around $70.00 while a sterilised one costs $14.00.
But now around 400 dogs were abandoned after the introduction of the law.

I asked the man "Why do you dock tails of the Jack Russell?"

"I sold a previous batch to the pet shop but the pet shop owner said the 3 puppies were very difficult to sell as Singaporeans do not want to buy Jack Russells with long tails."

"How much did she give you for the 3 puppies?" I asked.

"$700. I would have a better price if I had the puppies tail-docked. In that batch, the pet shop owner took the puppies on consignment and paid for the vaccinations."

For the good of the puppies, I said, "Do you know what is the meaning of consignment?"

The man had got the $700 as the puppies were sold and so he did not give the meaning of consignment much thought.

I elaborated, "Consignment means that you don't get paid if the puppies don't get sold or die. Since your 3 puppies did not die, you were paid. You gave the pet shop unvaccinated puppies. A pet shop brings in puppies from all sources. If there is a parvoviral infection of your puppies, they could have died and you would get nothing."

The owner's eyes were incredulous, "Do puppies die?"

I said, "All pet shops suffer from the problem of puppy deaths due to the puppy killer virus known as the parvovirus now and then. This virus attacks the intestines and the heart of the puppy. Bloody diarrhoea and death is quite common in unvaccinated puppies.

In your first batch, your puppies were brought to the pet shop. The vet goes there to vaccinate. As they were not infected prior to vaccination, the puppies survived. Even with 1 vaccination, many puppies still die when exposed to the parvovirus. The puppies are protected 2 weeks after the 3rd vaccination in most cases. Usually 2 vaccinations are the minimum."

"How much is one vaccination?" the man asked.

"It is $35 for the 8-in-one vaccine. It will be best for the puppies if you vaccinate them at week 6 and 8 and wait one week at least, before selling."

I think he is a dog lover and will be careful now. It is extremely traumatic for the owner and their children to see their puppies dead from parvoviral infections after caring for them up to 6 weeks old and bonding with them.

66. The 7-year-old Jack Russell needed urine-stained newspapers

2007-10-04T13:46:00.000-07:00

He had a sad face now greying with white whiskers on his chin. He had the unusual multiple brown spots like a Dalmatian, but he was supposed to be a Jack Russell and yet he did not look exactly like one. He had more of the elongated head of a Bull Terrier.

He would not make eye contact in the surgery for microchipping. Singapore's new law regarding a $5,000 fine if you are caught without a dog licence was biting hard at the population. Mark, the dog trainer told me that a newspaper report last Sunday said that the people just simply abandoned over 400 dogs rather than risked being fined $5,000 for keeping a dog without a dog licence and a microchip.

Previously the fine was just $500 and I thought it was very stiff fine. Now, it was 10 times. Singapore is not known for being a "fine" city for nothing.

"Can you still remember how you toilet train this Jack Russell?" I asked the lady owner who was in her fifties. "It is so long ago!"

"I remember very well," the lady said. "This dog was adopted at 6 months of age. He had been crated. So, during week 1, he would always go inside the crate. From week 2 to 3, I took out the urine-soiled newspapers and put it inside the bathroom. After some time, he would just go to the bathroom and has been doing it for the past 7 years!

That was good news. I thought, "This Jack Russell is successfully paper-trained."

"Does he go to pee on the newspapers whenever you visit friends?" I asked.

"I always bring a piece of newspaper with his urine smell with me when I visit my son or friends. Otherwise he will pee anywhere."

"Can't he just pee or poop on a fresh newspaper?" I was surprised. I can't imagine anyone carrying a soiled newspaper during visits.

"No," the lady said. "At home, the bathroom would have his urine smell and so he just went into the bathroom."

So, this Jack Russell was not really paper-trained in the strict technical sense. He needed the smell of his urine to eliminate. He proved that all dogs are unique in toilet training.

"Does he urine mark at home?" I asked.

"No," the lady owner said. "Otherwise we would have given him away."

"That's good news," I said.

The husband added, "The dog understands what we tell him."

"Really? What do you mean?"

The husband explained, "If we don't talk to him when we go out, he will spray urine onto the washing machine. When we come home, he would run away to hide!"

What a strange behaviour you would think. This dog must be angry for being left home alone.

The husband explained, "We said to him 'If you are naughty, we will not buy back some food for you. When we said that, he would not mess up the apartment with his urine."

Talking seemed to work for this dog. It was good news. I don't know whether it was talking or the positive reinforcement training of a food reward for being a good dog?

65. Death is not an option.

2007-10-03T15:37:00.001-07:00

Singapore is getting to be a litigious society. So, it is safer not to take risk putting a 14-year-old dog under general anaesthesia to perform a surgery. This dog is near the end of his life span. He was a bit on the plump side and would expect to live not more than 1 or 2 years as he had outlived his contemporaries.

He needed an operation to remove the blood clots inside his left ear. But he is past 91 years old if he was a man.

Barely able to see through his cataract eyes. Why should a vet risk his reputation for a $150 surgery and anaesthesia?

The second vet gave medical treatment but the dog was still shaking his head and scratching his left ear till the blood swelling under the skin turned bluish-black. As if he was irritated with a heavy appendage stuck in his left ear.

"Will the dog die on the operating table?" the owner asked. He and his wife, in their late fifties did not know what to do. 2 vets had advised against anaesthesia. This dog had not long to live as he was very old. But he could eat and do most things, except see clearly.

"Nobody knows," I said. "I will check his heart first." His heart was normal, surprisingly. Usually old canines have some heart problems.

"Do you want to take the risk?" I asked the couple. It was Hobson's choice for them.

"I will just use gas," I said. "No tranquiliser injections. This will at least be safer."

The couple was aware of the risk and gave their consent.

The old dog was given anaesthesia by gas mask. He fought hard wanting to bite.

"Take away the mask when he struggles," I spoke to the intern I was training. The intern was gripping hard and trying not to get bitten. The dog pawed the mask trying to get it off. A tranquilised dog would be much easier to anaesthesized.

But a tranquiliser and a gas anaesthetic might finish him off. Death is not an option when the vet undertakes this anaesthesia.

"Put at 8% gas first," I explained to the intern. I loved this 8% gas vaporiser which may be hard to find nowadays. It delivers a higher concentration of gas than the usual 5% vaporiser normally sold.

The old dog still struggled.

Mark was present and he talked to the dog. The dog relaxed. The gas mask was put onto his face. His eyeballs rotated downwards as he went into deep surgical anaesthesia.

"Reduce the gas to 1%" I said. This would minimise risk.

Mark clipped the hairs. It took some time. I washed the area. Started to incise the swelling to get the blood out. The dog flinched and moved. He made noises as if he was crying.

"Increase the gas to 8% for a minute," I said.

The variation of gas based on response is the best way to minimise risk. The surgery will take a longer time. The dog would wake up. Increase the gas and observe the eyelids blinking. Once there is no eyelid blinking, reduce the gas.

In this way, the dog was operated and recovered.

Death is not an option because family members badmouth and never forgive or go back to the vet once there is a death. It is a sad fact of life. Litigation and complaint to the veterinary authority takes up so much time. It is foolish for a vet to undertake this old-dog anaesthesia. I don't look forward to it too.

64. Veterinary Anatomy and an "MRT spay"

2007-09-30T16:17:00.001-07:00

THE BOY WHO WANTS TO BE A VET

"A bone has so many prominences and holes and I need to know and identify the various apsects," the first-year veterinary student was trying to tell what he was studying to his mum. Mum had managed to get him away from his girlfriend to have dinner with her. She said to the boy who wanted to stay trim and slim and was careful of his intake of calories, "A bone is just a bone. Eat the last pork rib."

Veterinary Anatomy studies can be a very boring subject to the first-year veterinary undergraduate.

But it is a matter of life, death and sound reputation to a practising veterinarian.

Last week, I was vaccinating puppies at a Pet Shop. For want of some common topics to converse with her, I asked her whether she would refer her clients' dogs for spays to me. The recent law that Singapore dogs caught with unlicensed dogs would be fined $5,000 had led to an increase in spay operations for vets. A sterilised dog's annual licence fee is $14.00 compared to $70.00.

Do I sound a bit desperate by soliciting from the pet shop? Or is it good business practice?

The pet shop girl arched her eyebrows and frowned, "I never recommend any of my customers to a vet for spay. One of my customers was so angry recently. She kept complaining to me that the veterinarian had cut a very long wound on her female dog. She said that it was an MRT (subway) line! So, I don't refer any customers to any vet."

At least I know her position and policy. I must work harder to build my practice on my own merits.

"Sometimes, a very long incision into the skin may be necessary. There may be bleeding or some complications of surgery and a long skin incision is needed to locate the bleeder. If not, the dog bleeds to death after the spay." I replied. Every vet would encounter this situation once in his career.

The pet shop owner had her reputation to protect, "This customer was still angry yesterday, at the extremely long incision on her poor dog---an MRT line. Kept moaning about it.

"By the way, how long an incision you cut during spay?" she asked me.

I replied, "Usually 1.5 to 2 cm long if there are no complications like bleeding. I usually advise 3 months after the end of heat so that the ovaries and womb are not fragile and bleed easily. It is much safer."

The pet shop girl was not convinced about my experiences or lack of. I could not convince her.

"Is there a portfolio of spay done?" Vets usually do provide portfolios of work done like models or plastic surgeons.

I said, "Maybe you can see some pictures at my website." She was surprised I had one.

I was there for the vaccination and microchipping of puppies and some free consultations. Nowadays, I seldom provide such services as they are time-consuming. But it is good to get out of the surgery to feel the 'pulse' of the pet market place.

Veterinary anatomy is a very boring and difficult subject for the first-year student because they don't see the relevance. A sound knowledge of veterinary anatomy is essential as the veterinarian is also a surgeon.

I hope this story will make the study easier and have included pictures of the anatomical positions to spay a big Golden Retriever and the follow-up.

63. A Jack Russell made the bean curd man smile

2007-09-29T15:06:00.000-07:00

No doubt, he made excellent bean curd and I had patronised his stall many times. He has a steady stream of buyers. He closes the stall in the afternoon.
Each time he or his wife would ask what I would be ordering. No smile and no remembrance of my order. I was a non-entity to him. Faceless and nondescript.

A slim man in his fifties. His wife was slim too. No small conversation as he dispensed the bean curd in a bowl and collected his 40 cents. Another customer would be waiting. Most would buy the bean curd home. He dispenses the bean curd into plastic bags, pour in the syrup and twist the rubber band to seal the bags.

One weekday morning I asked him, "Why do you open your stall half a day?"

The bean curd man said, "I start work at 2.30 a.m. I have to grind the Canadian-imported beans to prepare the bean curd. It is too tiring to work the whole day."

"How long since you open this stall?" I asked this man as I perceived that he was in a rut and was not enjoying his trade.

"Since I completed my National Service full-time some 30 years ago!"

I was impressed that he stuck to this trade for so many years.

"Why don't you do other business?" I asked.

He said, "I did MLM (Multiple Level Marketing) selling health products. I could earn as much as $4,000 a month but my downline of agents were not productive. So I gave up the MLM as it took a lot of time."

I doubt that honest money can be earned so easily but I did not say so.

"What business are you in?" the bean curd man suddenly asked me.

I said, "I am a veterinarian in Lorong 8 Industrial Park in Toa Payoh."

The bean curd man smiled, "Do you remember vaccinating a Jack Russell? My second son brought the dog to your Surgery."

"Sorry, I can't remember as there are too many Jack Russells. Did he cycle to the Surgery as that was one young man who did it.

"No," the bean curd shook his head.

"How did you all toilet train the puppy?"

"This puppy is just too active," the bean curd man's eyes widened and shone, "Running in and out. Here and there in the apartment like a sports car. He was peeing all over the apartment during the first few days. We put him inside the crate with pee pans below the flooring.

He paused and his facial muscles relaxed into a smile. "Later on, he went to the newspapers on a pee pan and pee there." the bean curd man recalled the actions and nonsenses he had to put up with the high dynamo.

That was good news. The bean curd man had 2 sons and they were working. The younger one was the one who bought the Jack Russell puppy. The bean curd could not talk more because more walk-in customers came in. It was the antics of a Jack Russell puppy that brought out his smiles of happiness when we talked.

62. Can't hold a candle

2007-09-28T16:54:00.000-07:00

"They can't hold a candle to you" I said, not quite sure whether this fair lady would understand the English idiom involving candles. She was a healthy young woman in her late twenties. Slim and a wash board tummy that did not need hours of gym workout. Not a gram of fat like so many Singapore girls before marriage.

A pair of large brown eyes that sparkled when she talked to you. A pair of reddish brown rectangular framed spectacles illuminates and magnifies the friendliness of her eyes. A lovely small sharp proportioned nose like some English belles, so unlike the usual rounded-ended ones of most Chinese women. An oval face so much desired by the Chinese. A sharp chin and lips that are not too large. Shoulders that were not too broad and masculine.

I elaborated without flattery, "I mean you will not lose out (in beauty) to the starlet or the daughter of the owner of Hartman's International Jewellers. It is just that you don't dress up or use make up." These were her two significant rivals.

"I used to dress up during work," the fair lady with the fairest complexion of which the China's Swatow girls are famous for, said. "But many men come into the shop but they do not buy anything. They just waste my time chatting to me. So, nowadays, I just dress casually."

Whenever I went to her shop, she was shabbily dressed. What's wrong with being dressed to kill and attract moths to the candle? Increase the walk-in traffic. Men with ulterior motives are always a nuisance and a health hazard of beauty. But some men may buy something.

Her fashion boutique shop was profitable probably as it had existed for some years.

"If you procrastinate, he may marry one of them and it will be too late for you," I said. "It is better to be loved than to love. Marrying this man means that you need not work anymore."

She did not respond to my simple outlook about love, materialism and marriage. Financial security and a family were not what she wants, I discovered further into our conversation. It was just that so many marriages ended in divorces and bitterness. That was her main concern.

I had met this boyfriend in her fashion boutique. I shook my head in disbelief as my informant said, "I do not think a young man in his early forties can afford three upscale automobiles in Singapore. Each exotic branded sports car costs over half a million dollars and much more to maintain."

"But it is true," my informant insisted.

I asked the fair lady when I met her in her shop. She affirmed and since I was quite interested in dream cars, said, "The Maserati showroom is just a short drive. Why don't you drop by and see the Maseratis"

Now I realised how provincial I had become after spending so many decades with animals. Why can't a Singapore man be extremely successful financially in his own right when he is in his early forties? There would be many of them that my network had no contact with.

I have no reason to doubt my informant as he had no motive to deceive me.

While I was in the shop, the fair lady answered a phone call "I am busy now. I can't go out." She crinkled her forehead and put down her phone promptly. No 'goodbye honey' and 'I love you' talk as she was not a Caucasian.

"Why don't you close the shop and have dinner with him?" I suggested.

"I have to deliver some wedding accessories after closing the shop," she said sharply.

How could a young man with financial success win the heart of this fair lady? A Maserati might impresss her. A Ferrari did not make her swoon. There are 400 Ferraris in Singapore, a source told me. Perhaps a Lamborghini which is less common would win the heart of this fair lady? A Lotus car perhaps? There are only a handful of such cars in Singapore as they are over a million dollars to buy.

She knew a rising starlet and a jewellry heiress were her competitors in love. How she knew and how many more rivals in love, I did not ask her. She had seen many friends getting divorced over the past years and was now cautious as she approached her thirties.

"How come your marriage can last so long?" she asked me.

"I don't know the secrets," I said. "Maybe my wife and I spent so much time in our careers and bringing up two kids and time just flew by."

This boyfriend is very successful if one measures his material wealth.

"Why didn't he marry you during the early years of courtship?" I asked this fair lady.

"I would have said yes," she said. "But he had his plans to be successful in his business ventures and was not ready to commit." A successful man's secret was perhaps revealed. Make your fortune without the distraction and nagging of a wife first. Then get married. This is too simplistic a statement.

The boyfriend did not strike while the iron was hot. He had good intentions. Now, she was not sure that marriage and children are that great in a Singapore that sees the rising number of divorces every year.

Is it possible that she has other fishes in the pond of love? I dare not ask her as I did not know her sufficiently well.

Perseverance and persistence may yet win the heart of the fair lady. What is that something that can win her heart? I don't know. This fair lady has her worries and if he can address her concerns about the increasing divorce rates in Singapore, he might win her heart.

61. A Dr-Jekyll-and-Mr-Hyde Chihuahua

2007-09-26T15:48:00.000-07:00

"Be careful, she bites!" the lady in her forties warned. A small less than 2-kg 5-month-old female Chihuahua with the golden brown coat trembled as the maid held her. The dog's eyes widened and focused on Mark and myself. Her ears folded backwards and her short hairs on her back stood up like soldiers at attention.

"Can you handle her?" I asked Mark who does obedience training of the fiercest dog such as the Rottweiler. I wanted Mark to be hands-on and learn how to restrain this dog. It should be nothing difficult when he is 100X bigger. Hands-on experience under my supervision would be easier for him to learn.

"No," Mark had decided firmly. "I don't want to be bitten." Sharp white canine teeth can tear the flesh of one's fingers and Mark was not going to risk it.

What to do?

"Actually, all you need to do is to wrap the Chihuahua's head loosely with a towel," I said. "I can then vaccinate and microchip her from behind the head. Most likely, she will bite the towel or just keep quiet." From September 1, 2007, all new Singapore puppies needed to be microchipped and licensed. The penalty for disobedience to government orders would be a fine of $5,000. It was no small change.

Mark brought in one big thick cotton bath towel and started covering the face. It seemed to be out of proportion in size for such a small breed. I meant a face towel would do.

The Chihuahua turned and twisted as the maid held her and nothing could be done.

"No need to use the towel," the lady suggested. "The Chihuahua will not bite my maid. She bites only men. At home, she would bark at my husband or son when they go home. Then she runs away to hide under the bed before they can touch her. Why?"

That was a surprise to me. "Most likely she had been abused by a man or boy during her fear imprint period and hated all male members of the human race. She was reared by a home-breeder.

"It will not be the home breeder," the lady said.

"Maybe it is a naughty boy trying to pull her tail or cause her pain and fear," i guessed. "Now, all men are enemies."

"How do you solve this problem?" the lady asked.

"Ask Mark," I said as this was an opportunity for Mark to gain a new client.

"No, ask Dr Sing," Mark declined.

I explained, "Maybe Mark does not want to provide free advice. Dog obedience training is his bread and butter and love."

I could not command Mark to dispense any advice if he decided not to. Much depended on his mood too. Here, I was stuck as the lady looked at me for help while Mark talked to the dog.

This was just a vaccination and microchipping session and not dog counselling.

"Talking to the dog in a low friendly voice to gain her trust is one way to stop her biting," I said. "But your husband and son need to spend time like 5 minutes 4x day doing it."

"They are quite busy," the lady shook her head after considering my impractical advice.

"Any ideas?" I asked Mark but he remained silent. The Chihuahua had been biting male family members for the past 3 months if they wanted to pat her head.

"Well," I said. "The positive reinforcement training method is the best way as in all other aspects of training the puppy."

The lady was perplexed as to what was positive training.

I said, "Basically, the dog is rewarded with a food treat, praise or playtime for performing what is required of her."

The lady asked, "You mean my maid gives the dog a food treat for not barking or biting at my husband and son?"

"No, no," I said. "Your husband or son gives the reward."

"How do they do it? The Chihuahua barks at them when they come home and runs away quickly to hide under the bed!"

"What a clever little rascal", I thought. "Now I have a problem."

I said, "In this case, fence up an area behind the main door so that she cannot run away to hide. When your husband or son comes home, she can bark at them. They give a firm command "No barking" but do not touch her. This is repeated for many days. If she stops barking, offer a food treat.

The lady did not comment but it was "easier said than done."

"You know," the lady said, "The Chihuahua will greet my maid in the morning and pees a bit of urine on the floor. She pees a bit whenever my daughter or I pat her too."

"This is a submissive urination behaviour!" I was surprised that this dog could exhibit fear aggression towards the male members and submissive behaviour towards female members of the family. Dual personalities like Dr Hyde become Dr Jekyl.

I said, "This dog will turn on her back and expose her belly for you to stroke," I said.

"Yes," the lady affirmed and laughed. "If we don't stroke her belly, she will use her paws to hook our hand to do it."

"Well," I said. "If you don't stop this behaviour, she will pee lots of urine as she grows bigger. The bigger the dog, the more urine is peed. The apartment will be most smelly."

"What to do?" the lady asked and answered her question at the same time, saying "When I ignore her, she would not pee a bit of urine."

"The best way is by not petting her or touching her when the maid gets up in the morning."

"Bangun...tidak ..." the lady gave her instructions in Malay to the maid. The maid understood that she must not pat the dog in the morning.

It is believed that if you building self confidence in a submissive puppy while she is still impressionable, the urination will stop. Avoid greeting her when coming home or touching her. Avoid loud commands. Take her out to meet people and other environmental situations like noisy roads etc. With a proactive approach while this puppy is young, the submissive urination behaviour may disappear.

As for the biting of the male of the Homo Sapien species, a positive reinforcement training program carried out persistently at 5 minutes 4 times a day for many days, for example, will help.

This Chihuahua is unusual in that she has a "split personality" just like Dr Jekyll and Mr Hyde in the story written by Louis Stevenson. Most submissive urination dogs are females and do not bite people!

60. "Is my dog going to be all right?" the tall sun-tanned man asked.

2007-09-25T22:55:00.001-07:00

"Will my Jack Russell be all right?" the tall sun-tanned blond-haired young man was worried as he checked his dog into the Surgery. "This 7-month-old dwarf Jack Russel is like a son to me."

I was surprised as so far, nobody asked this question. But then, nearly all my clients were non-Caucasian.

"Neuter is a very common surgery," I said. "It takes a short time unlike those complicated surgeries. Normally the dog does not die during anaesthesia." His dog was in excellent body condition and well muscled too.

Xyla 0.2 ml and gas anaesthesia. The dog was put under 1% maintenance although 2% would be better.

Suddenly the dog moved as I incised the skin. I stopped the surgery as he was on the borderline between surgical anaesthesia and waking up. The gas dosage was increased for a minute to 8% and then dropped to 1.5%.

He went back to sleep at 1.5%. No more problem. He woke up at the end of the surgery, as if he had a good nap.

As for the owner, I asked what he was doing in Singapore. His profession of fashion photography must be glamorous---travels and seeing the world and photographing models for magazines like Vogue! This is one lucky dog as he gets to see the world and meet fashion models with his master who cares a lot for him. Mark is supposed to get a "passport" for the Jack Russell.

"Never heard of an animal passport?" Mark shook his head.

"There is such a thing," I said. "Check it out with the dog transport people!"

57. Follow up to Case 51. The stray cat

2007-09-21T16:32:00.000-07:00

E-MAIL TO DR SING

...@yahoo.com.sg> wrote:

Hi Dr Sing
so much has happened since our last email. You could say it was a whirlwind. Let me fill you in with what's happened.

On Monday midnite, we were feeding M2 as usual and realised that he wasnt eating or drinking. Actually, he had some sticky film on his lower jaw on Sunday and didnt want to eat or drink either. I decided to monitor him closely to see if it was a toothache/ulcer/glue from rubbish. By Monday midnite, he still had not eaten or drunk (which is highly unusual cos he LOVES his food), the sticky film had now progress to a gooey brown patch on his chin and he wasn't even grooming himself (this was the last straw cos he is very particular about his appearance).

So my hubby and I brought the carrier down and some catnip and cat pheromone spray (yes, we have been prepared for a few years now, just needed M2's consent, heheh). Lo and behold, my fears were unfounded cos in he went! We brought him to the emergency clinic.

To cut a long story short, M2 had a mouth wound and infection which they couldnt really diagnose cos it was clammed shut. But blood tests later revealed that he has FIV. So he was given a jab, and given a course of antibiotics.

Needless to say, it is now Friday and M2 is with us at home. He responded to the meds very very well cos by Tuesday, he wasnt salivating anymore and was able to eat wet foor (handfed by me) and drink water. By Wed he was eating dry food and grooming himself.

Anyway, my hubby and I read up alot on taming and homing feral cats so we put into practise what we had learnt. I must happily report that M2 was a fast learner. He now uses the kitty litter to pee and poo with no messes or accidents. He has found his favourite spot in his own room in our flat. He is also a lot tamer and lovable, wanting us to stroke him, caress his belly and love him. He used to be a wiry and defensive when he was outdoors and would lash out without warning amidst our strokes. But now, he lets us stroke his paw, clean his ears etc.

Well, the vet advised us the precautions of FIV. On the grim side, it's like HIV and life expectancy is short. M2 will be prone to infections, recurrence of mouth wounds etc. But we are determined to keep him and shower him with lotsa love. We were told that he shouldnt be released into the wild again, and that he should be the only cat in the household, all this to avoid infecting other cats. Plus, if we are exposed to other cats, we should wash ourselves before we touch M2.

All this is well and good but I have a problem. When night falls, round about midnite up till 8am, M2 is quite active. He has now left his safe room and begun exploring the living room. All this while, we have kept the windows closed. The window in his room is left slightly ajar and the grills are wiremeshed up. Unfortunately, between midnite-8am, he is very vocal, from mewing to meowing, to yowling, to howling. Usually the yowls and howls will come when he comes to the main door or he catches sight of the outside through the windows.

I know he wants to get out. He misses the blue sky, his night "clubbing".....but I know that if he leaves, he will prob never come back. He might return to his usual routine of waiting for his food but being FIV positive, he can just turn up with a wound and infection again. I can't bear to see that and expenses will be high.

I'm just wondering if the yowling and howling is a phase that will pass or is it gonna be permanent until we give in and let him out? Im afraid that the neighbours might one day complain about the incessant howls. Is there any way to appease him?

Thanks in advance and I apologise for my longwindedness.
Warmest
(Name)

E-MAIL REPLY FROM DR SING

Sat Sep 22, 2007 7.27 am

It is nice to hear good news from you and a well-written report. Every case of handling a feral cat is unique and a learning experience for me too.

I did think of pheromone as it has been used widely in the U.K for dogs, but somehow forgot to mention it.

I just had an owner with a similar situation as your--- a case of the same problem with a male stray cat adopted some months ago.This cat hissed and clawed when brought in for neutering. He was as fierce as a leopard as he was ready to fight his way out.

I believe the reason for your cat's (and most cats') past midnight anti-social behaviour is that he hears the street cats downstairs. In theory, soundproofing his room will likely resolve your problem. I know this is not practical.

The second option will be to neuter him as soon as possible. Pheromones and/or tranquilisers/hormones may help temporarily.

56. Follow up to Case 34: A mother's love

2007-09-21T04:48:00.000-07:00

Friday Sep 21, 2007, Bishan Community Library, 8.02 pm.

The mother must have asked her son who is a veterinarian to present me 2 boxes of mooncakes as a gesture of thanks for mentoring her son in the bladder stone surgery. I phoned her Surgery for past 2 evenings but got no pick up. Tonight the son returned my call. Mum was sick due to diarrhoea and so it was not possible to thank her.

"Struvite crystals as analysed by Science Diet," the young man in his late twenties said. A quiet person of few words. Science Diet has a free analysis of bladder stones for Singapore vets. These are sent to the U.S. So, the spiky stones are struvite.

"Is the dog ok?" I was more interested than the nature of the bladder stones.

"Yes," the young man said.

"How do you know?" I queried.

"The dog belongs to the girl working at my Surgery," he explained.

"That's good news and your surgery was good."

It was good to know that the dog no longer passes blood in the urine. It was around one month ago that he had the surgery done.

Bladder stone surgeries in male dogs for young vets are a bit complicated. It is always best done under the guidance of an experienced vet. The alternative is to refer to other vets and not gain any surgical experience. As I said to this young vet, you send the cases to other surgeries---their young vets gain experience and it will always be a one-way street. You never learn anything and you lose clientele too.

In my experience, it will be a rare veterinarian or specialist who will bother to pick up the phone and tell the referring doctor what happen.

In this case, the mum had asked me to mentor her son for bladder stone surgery and Caesarean section. There are not many such cases but if there are, I am most happy to mentor him.

Mothers always love their children---most mothers anyway. They have their welfare at heart even though the baby is a parent and a veterinarian of some years! This mother of the veterinarian is very unusual in that she seeks out a mentor for her son.

55. The inventor of hospital bed lights

2007-09-20T15:53:00.001-07:00

2 clear cupped goggles covered his 2 bandaged eyes as he walked to the Head Nurse's station. The man was in his late fifties, of medium height, broad shoulders and receding hairline and was dressed in blue uniform.

The inventor of hospital bed lights had finally made an appointment for me to see the hospital bed lights he had invented and installed in a private hospital. I had known him for over 20 years as he provided veterinary anaesthetic machines for my surgery. He had a workshop at one time and then he disappeared for some years overseas and running an Indonesian restaurant.

Now, he was back in Singapore again and back to his love of making and maintaining medical equipment. A biomedical-engineer type of person, a profession rather rare in Singapore.

What's the big deal in inventing and designing a hospital bed light? I had to see the real thing as his photographs did not impress me. In any case, there is nothing like seeing the real invention. So, he made this appointment for me to see it.

The hospital bed light must be safe for the patient and must be easy to maintain. It has an upper reflection light, a reading light and a night light all in one tube. He had worked closely with the hospital for the past years and finally his invention was approved.

The hospital seemed to be full house. However, he arranged for me to view one light. The man with the space-age eye googles left his bed for a minute for me to see the operation of the light.

"There is a wired remote control too," the inventor's assistant pressed a console and the lights went off. Some gadget similar to the nurse-call light.

"Why not invent a wireless remote control?" I asked the inventor.

"No," he said. "The electrical intereference may affect patients with heart pacemakers."

The lights looked plain but it was what the customer wanted. His manufacturer took his designs to other countries to market and not pay him some royalties. It is the dog-eat-dog world. There was not much he could do.

I said, "From what I read in some business entrepreneur magazines, it is best to let different manufacturers from different countries do certain parts. You then assemble the whole lot."

Manufacturers and/or their staff have no qualms about stealing the designs and making money for themselves. This makes the inventor unwilling to do more research. Setting up his own factory could be an answer but that still would not solve his problem of intellectual property theft.

I asked one intellectual property lawyer who happened to take his dog to me for microchipping. A lawyer will charge a trademark registration cost around S$1,000 but a patent cost at least $10,000 in Singapore. It is just too expensive for a small inventor of hospital bed lights to patent one's invention!

54. Behavioural problems - "sibling rivalry" from a new puppy?

2007-09-18T15:25:00.000-07:00

Children less than 5 years old are often hyperactive and inattentive. Some are energetic and outgoing, some are passive and reserved and clingy.

Puppies behave similarly when they are less than 6 months old, depending on breed. Jack Russell puppies are hyperactive compared to the Cavalier King Charles. The latter may follow the owner everywhere, even to the bathroom.

Hyperactivity and distractibility may be also a temperamental trait. If there are communication problems in addition, appropriate intervention and behavioural management strategies from the professionals may be needed.

The 4-year-old girl lifted up her mum's front half of her blouse many times while the vet discussed treatment of her Jack Russell.

"It is not a nice thing to do," she looked at the girl after she failed to stop her by ignoring her. She pointed her finger at the child and said, "Mummy is not pregnant." She was wearing an "empire" blouse or something of that fashion.

The daughter stopped doing it. The mum had to talk to her. I continued discussion with the 17-year-old son on how to care for the puppy's ears and some skin disease leftover from the sarcoptic mange infection of the ears.

I wonder whether this is a case of "sibling rivalry" --- the sibling being a new puppy taking up attention from the mother. Her only son was 25 years old. Yet the mother looked in her thirties.

"What is your age?" Mark asked. She was not hesitant to reveal her exact age. As expected she was young at forty. Full of energy and sociable. She took her daughter to the Supermarket while she worked. The daughter was confident child. But at her age (less than 5 years old children), hyperactivity, inattention and sibling rivalry from a puppy are to be expected. The mother handled her well.

The mother had a top salesperson temperament. High energy as the Jack Russell as she worked hard at insurance and real estate. I expect her to be very successful in her life.

53. Pee off target - clicker training to correct his problem?

2007-09-18T03:33:00.000-07:00

Tuesday Sep 18, 2007
NLB 6.34 pm
Dr Sing Kong Yuen, www.toapayohvets.

A VERY COMMON COMPLAINT that is encountered during toilet-training by Singapore pet owners during my case studies:

The puppy steps onto newspapers or pee tray. He pees outside the edges.
Why? How to solve this problem?

Why?
1. Most likely reason. Owner does not change soiled papers frequently. Puppy dislikes being dirty. Puts 2 front legs at clean part of paper. So the back half of the body is outside the papers. Eliminate at outside as hind legs are out of the paper.

2. Peeing liquid sprayed in centre of paper. Puppy smells it, but its body is longer. So back legs are outside the paper.

3. "Wants attention". Owner makes a lot of fuss. Puppy wants attention. Does deliberately.

How to solve this problem?
1. Clicker training. I doubt Singaporean puppy owners have time for such training.
Put pee tray/newspapers between owner and puppy.
Puppy steps onto tray with front feet.
Click. Food treats given to puppy at tray level.
Repeat 4x/day at 5 min duration to train. Not >15 min.

Now, puppy goes inside tray with back legs (front legs may be outside tray now).
Click. Food treats given to puppy at tray level and so on.

Puppy wakes up or after meals. Goes to tray with back legs inside.
Puppy eliminates.
Click. Food treats given to puppy at tray level and so on.

2. I think the simplest method is provide clean tray or newspapers.
Neutralise urine smell outside tray area with vinegar:water 1:3.
Say firmly "Pee here", praise and food treat on success.
Remove soiled papers/clean tray.

3. Urine-marking of male dogs is a separate problem as urine is sprayed onto vertical surfaces like legs of tables or walls! May happen as early as 5 months of age. Neuter early at 6 months of age and not at 3 years of age as habit may be established.

52. Somerset Maugham, Lee Kuan Yew and Raffles Hotel

2007-09-17T14:27:00.000-07:00

One August 2007 day, I chanced upon Raffles Hotel's 120th Anniversary advertisement in the Straits Times---120 people would be invited to the 120th Anniversary Celebration if they win the "What Raffles Hotel Means to Me" contest. What attracted me to participate in the contest was a chance to be briefed by the Hotel historian and I thought, there would be a tour of the room that Somerset Maugham stayed or the place where he wrote his stories.

Raffles Hotel was just next to Raffles Institution (now Raffles City Shopping Mall) where I started my Secondary One studies in 1963.

During my Secondary and Pre-University studies at Raffles Institution, the Raffles Hotel was not of any interest to a teenager. The girls of the Convent of the Infant Holy Jesus school (now no more) and the St Anthony's Convent (now no more) were forbidden fruits and much more interesting.

Over the next 5 decades, Raffles Hotel was just a luxury hotel, out of bounds to most Singaporeans. It did not have the tim-sum lunches like Shangri-la Hotel, a place that I could invite a special friend to lunch with and maybe impress her.

However, Raffles Hotel has the historical romance of famous writers like Somerset Maugham and others. I used to read Somerset Maugham stories and so must be many others during my era, as Minister Mentor Lee Kuan Yew mentioned in his speech at the 120th Anniversary Celebrations on Sep 16, 2007.

This is what I believed Mr Lee said.

Those important people who met Mr Lee had asked him to arrange for a drink at Raffles Hotel during the 1980s. "They must have heard of Somerset Maugham and other writers having stayed at Raffles Hotel," Mr Lee said. "This means that Raffles Hotel had a good name. However, I did not recommend them to stay there. Raffles Hotel was in a period of decadence."

He told the management that the government would acquire Raffles Hotel if the management continued their existing way of doing things.

Renovations were done and a piece of land behind the hotel was given to them.

(In 2006 and 2007, it received awards of "Best Luxury Hotel in Asia" and "Best Hotel in Asia" respectively.)

Mr Lee began his speech which captured the attention of the audience crowded inside the lobby. There was a drizzle in the outdoor stage and so all went indoors to the large lobby.

"The reason I am invited is because I got married in Raffles Hotel," Mr Lee said, without the need to refer to written notes. This was the only time I saw him giving a speech in person although I have lived in Singapore for the past 5 decades. Most business people in the audience would have more contacts with him.

This must be the only occasion he got the audience of several hundred people clapping their hands spontaneously at the commencement of his speech and his first sentence. (He was 84 years old on this 120th Raffles Hotel Anniversary Celebration day, according to a Business Times report on the Raffles Hotel Anniversary celebration on Sep 17, 2007, it was also his birthday.)

He ended his speech with an indirect advice to the audience of business people something along these lines of thought: "A famous name (such as Raffles Hotel) is insufficient nowadays with so many top class hotels as competitors. The guest must receive an experience he will not forget while staying at the hotel (so that he will recommend the hotel to others and return to stay)."

To me, this event was very interesting. A guide took us to visit the inside of the hotel. The romantic honeymoon suites which are in great demand, the spas, the swimming pool and its presidential suites at $7,500 per night? The "Original Raffles Hotel" moon-cakes presented to us were the first time I had tasted it. I must say it ranked top, as good as those from Shangri-la Hotel I tasted a few years ago when a client presented them to me.

Now, which room did Somerset Maugham live in when he stayed in Raffles Hotel? That was what I wanted to see. Well, I guessed the tour guide forgot about this most important aspect for the "120 writers" who participated in the writing contest.

Raffles Hotel Singapore has another famous living writer that it ought to consider mentioning in its history book. It was the hotel where this writer had his wedding reception on Sep 16. He went on to manage a country called Singapore, making it world class.

P.S.

"WHAT RAFFLES HOTEL MEANS TO ME" IN 120 WORDS.

“My husband always stays at Raffles Hotel,” the attractive hatmaker had invited me for my first-time tea at Ah Teng’s Bakery in 2006. “One day, I’ll ask my connections to show you where Somerset Maugham and Rudyard Kipling lived!”

I had told her that I enjoyed visiting Shakespeare’s birthplace in Stratford-upon-Avon when I studied to be a veterinarian in Glasgow 3 decades ago.

Her global business expands explosively. I cannot impose on her promise. Raffles Hotel today means more than a memory of a most beautiful hatmaker-veterinarian friendship. Its “Best Hotel in Asia” award and the success of the hatmaker teach me that I must provide the highest quality services or products to be a top dog in my profession.

51. Building trust in an abused cat takes hard work

2007-09-15T15:21:00.000-07:00

E-MAIL ON SEP 16, 2007

Hi Dr

I would like to ask you for some advice on how to adopt a feral cat. I hope you don't mind if I give you a history and background of our situation first. It looks pretty long but I believe it will help you better understand our situation. I have been reading your case reports on the website and find them very enlightening and honest. I greatly appreciate that you care to discuss real every day animal cases, both good and bad. Thank you for sharing your knowledge and experience and thank you for your invaluable service to animals.

OKAY, here goes. My husband and I live in an HDB flat and we've been feeding a feral cat called M2 for the past 4 years. Her ear was already clipped when we first met her. Let me give you a little backgrounder on her.

M2 is a feral cat who used to hang around our HDB block void deck. She took to us very well and would wait for us punctually for our regular feeding times. Then with the coming of other more dominant cats, she was eventually chased away from her roost at the void deck. She now naps and hangs out in a little garden patch (next to a power station) of shrubs and roses behind my flat. She doesn't stray far, always within calling distance. She is quite a scaredy cat, easily flustered by the slightest sound, sudden movement and intimidation of other cats. That she makes up for by using her claws in any iffy situation.

M2 can scratch quite vehemently when she's overly excited or agitated.She is a rather skittish cat. We know she has probably been through alot and is just trying to be defensive. We think she may have been roughly Handled by humans last time and hence her insecurity.

Over the years M2 has grown accustomed to our strokes and pets. In the beginning, she would not let us touch her, let alone approach her. Today whenever she see us, she will come to us with an upright tail, roll over on her back, expose her belly and let us rub her. We've been meaning to adopt her but trying to find the right time and not lose her trust.

However, she does not like to be carried at all. Once I carried her and she gave out this yowling meow before struggling out of my arms. We even managed to carry her into the lift and up to the 7 floor where we live. But once the doors opened, she bolted out of my arms and down the stairs.

Seeing that she is such a timid soul and often bullied by other dominant feral cats who usurp her territory and chase her out, we have always wanted to adopt her. Right now, she is at risk of being chased out of her garden patch by a very bossy and aggressive female calico cat who is a "newcomer" with unclipped ears.

A big problem is that if i were to adopt M2, given her temperament and dislike to being carried, how am I going to bring her to the vet for an all-over medical checkup as well as a one-time grooming before she becomes an indoor cat? I played around with the idea of sedating her with tranquilizers. Can I get these over the counter at a vet clinic? Will they sell it to me?

Another alternative people offered was cat trap. But M2 might
completely lose the trust we built over 4 whole years and be mad at
me, and won't come near me at all.

To tell you the truth, I had called a professional cat catcher (recommended by an animal shelter) to try and capture M2 after she had hurt her leg. To cut a long story short, after 5 hours, he failed. He also said when people call him to catch a cat, it's 100% success that he catches them.

Needless to say, M2 recovered from her "injury" and she was so mad
at us (or scared) that she disappeared for 2 wks. When she finally re-appeared, she was so suspicious of us that she didn't come close or let us touch her. She kinda knew we had a hand in the attempted capture even though we didn't personally catch her ourselves. So our 3 years of gaining her trust went down the drain.

As you can see, due to this episode, we are hesitant to use any force on her for fear of another episode.
What should I do? Don't tell me to ignore her or forget about her just cos shes feral, we love her like she was part of the family. We want to give her a home and not relegate her as a statistic. Thank you in advance.

Warmest Regards
Name given

E-MAIL REPLY

Date: Sun, 16 Sep 2007 06:12:18 +0800 (CST)
From: "Dr Sing KY" Add to Address BookAdd to Address Book
Subject: Re: How to take in a feral cat we love so much
To: ...@yahoo.com.sg>

Thanks for your compliments and detailed background of M2. I presume you are a journalist to be able to write so well. Here are some quick suggestions as I have never been asked to resolve this problem by any cat lover.

1. Tranquilisers from the vet. Your vet should be able to help you if both of you have a business relationship of integrity and trust. However, the cat is very smart and will not take the drug if you put it inside the food. There are other ways which your vet will explain to you. Obviously, if you don't have this relationship, it will be foolish of the vet to help you as you may be an undercover journalist interested solely in yellow journalism.

1.1 Tranquiliser dart. This is the best method but there are legal requirements in its use. The AVA may or may not have this dart. The vet in Singapore does not have it. Maybe the zoo vet? This person must be good at it. No second chance of blowing the dart as M2 would have sprinted off.

2. Professional Cat Catcher. I don't know if there such a profession. I will think that the best one in this business is actually from the AVA's dog and cat control unit. If you really spend time with these people, they may or may not be kind enough to help you to trap this cat. This depends on how good you are at people relationships.

3. Cat trap. I doubt M2 will get into the typical cat trap as she is street-wise after so many years of human abuse. Such cages usually smell of 'death' and 'fear' as these cat traps are usually used many times. A cat netting method is probably the best if it can be done by an expert.

4. Trust. During that period of time when the cat trusted you, you did NOT gradually hold her for short periods of time. Put food on your lap and let her eat from there for few days. Then slowly hold her for a few seconds.

Instead, I presume and I may be incorrect in my presumption, you suddenly carried her to your apartment one day? It was as if one is being kidnapped and being murdered. This act triggered in her the recollections of bad experiences with human beings.

5. How much time you have to re-gain the trust of the feral cat? In the final analysis, how much time/day did you spend with M2? Is it 3x per day? Or just feeding time? The more time you spend with M2, as with human relationships, the opportunities for the other party trusting you are higher. The only problem may be whether M2 has time for you? I think she will have.

Lots of time/day spent to gain the trust of a feral cat is probably my answer to your problem. Play time and fun time using toys that the cat likes must be included, not just feeding time.

5.1 Routine and priorities in your day.

My suggestion is that you write a time-table of action and priorities for the day (I sound like a teacher as I often suggest this method to some of my clients as well but they don't do it!). Below are my quick thoughts on this rainy Sunday morning.

You spend 3 or more times a day with M2, if she is available. Do you know where she wanders about? That is what I mean---getting to know her well. I know this is asking for the impossible. Who cares where M2 spends the whole day?
Start playing with her and getting her used to be carried. Feed from your hand and then from a tray (which may or may not evolve into a cat trap or cat net). One of the methods of catching her is a new well designed cat trap set by you, not one from the AVA or others.

I have an inspiration which may sound nutty to you and which I write below:

Feed her from the void deck, moving the food plate to the floor step of the staircase going to the 2nd floor. Then feed on the 2nd step and so on to the first floor. Feed her favourite food and milk, let her go. Repeat many times. Play time and fun time must be included when M2 runs down the stairs. Old cats may not want to play with the "catch the mouse toy" but who knows. Carry her from a low height, not high up standing. Put her down after a few seconds. Repeat and so on.

Feeding continues to the 2nd floor (this will take some weeks I guess). By the time you reach the 7th floor of your apartment and into your apartment, it may be 7 years later!

The above ideas are adapted from the puppy toilet training advices asked by an American yesterday. The American wanted to know how to get the Shih Tzu peeing and pooing from the indoors to outdoors for her adult Shih Tzu. It seems the method for the Shih Tzu can be applied to your case?

The above are my suggestions. Time is of the essence for you now. Let me know if you succeed. Best wishes.

50. The ex-dog breeder shares his experiences

2007-09-14T02:37:00.000-07:00

He saw the opportunity in the new microchip law effective from Sep 1, 2007. All Singapore dogs must be microchipped before they can obtain their licence. Otherwise a fine of $5,000 for not possessing a dog licence. Apparently all dogs 3 months and above. Spayed and neutered males are charged around $14.00. Intact ones pay around $75.00.

Now, the dilemma of the Singapore puppy owners is that they can't get the cheaper rate of $14.00 because the puppy is too young to be sterilised at 3 months of age. Maybe they can't find a vet who is willing to do it. So there must be some grumbles at the need to pay $75.00 in this case.

From what I hear from a pet shop operator, they now pay $14.00 from month 3 - 6, get the dog sterilised and extend the "validity" of the licence. Failing to sterilise means that they have to pay $75 at month 6. I don't know whether this is a new policy?

In any case, one ex-dog breeder sourced his microchips and got them approved by the regulatory authorities with letter of proof to show me. He dropped his price lower than his competitors. He went to all pet shops, vets and every relevant prospect.

I had a microchip scanner which could not read. I rushed out to NTUC Toa Payoh and bought a battery. The scanner could not work. The message said "powering down" after one successful scan.

I asked my man to look into it. He sent it to Funan computer centre and was told that the scanner needed to be sent to the U.S as there is no spare part.

The ex-dog breeder was willing to help. He took out his "Made in USA Energiser battery", 9V from his scanner which he also sells. His diagnosis was spot on. There was nothing wrong with the scanner!

"You bought a rechargeable battery," the ex-dog breeder patiently explained. Maybe it was not charged. Buy a 'Made in the U.S' battery similar to mine." A very helpful salesperson. He built a lot of goodwill and it was quite embarrassing.

He was a breeder of 50 dogs 8 years ago but his advices still remain relevant today. These are:

1. Hygiene is paramount. Weekly disinfection of the crates and the floors below because parvovirus are "air borne" in big breeding areas.

2. Crated dogs above ground level. So, easier to disinfect flooring below.

3. Vaccination must be done regularly. Many breeders forget after a while. So more viruses come in.

4. Good quality breeds. No point breeding Jack Russells. Maltese and Shih Tzus of good quality are in demand.

5. 24-hour or very close monitoring of breeding dams 58-60 days. Be available to help the dam not able to give birth. Every puppy lost is money down the drain.

6. "How do you control ticks?" I asked.
Use a brand (name given). Not toxic to dogs and puppies (that what the brand label stated). Wash dog frequently. So tick population reduced. So, less ticks.

7. Crates above floor level is one way to reduce tick population but regular check up is necessary.

Subject:	RE: 2007 Update:: Rocky's Toilet Training - Pooping on floor.
Date:	Wed, 6 Jun 2007 00:48:17 +0800