Saturday, December 30, 2017

3332. A poodle bites the groomer

"The groomer refused to clip his inflamed muzzle area," the owner brought the 5-year-old poodle in for neuter as he is aggressive towards the groomer during the 2-monthly grooming. Now his lower paw area in the front paws is itchy. His groin is very itchy and the skin is black and thickened like crocodile skin. His right eye is tearing now.

 Dog was neutered.

Friday, December 29, 2017

***3331. The female, not spayed Silkie Terrier had seen many vets for urinary tract infection without cure

Challenging case. Recurring urinary tract infection in a female not spayed dog.

Dec 27, 2017. TP 46126

A 2nd challenging case of recurring urinary tract infection and treated by several vets. I had one such case many years ago (lady in red case). See below.

Dec 2017 Case.  SILKIE TERRIER F, NOT SPAYED, 9 YEARS OLD. Born 2008.

Dog came in today Dec 29, 2017
Strong smelly urine again in this 9-year-old female, not spayed dog. Heat period stopped around FEb 2015 for 1.5 years. False pregnancy presented and milk seen in Dec 2017 examination.

2010.  At 2-year-old, consulted Vet 1for UTI, cured for 1-2 years.
2012.  At 4-year-old, strong smelly urine. Saw Vet 2 4-5X and Vet 3 for 1X
   X-rays - no urinary stones by one of the vets

Aug 15, 2015  lst consultation at Toa Payoh Vets.
7 years old  female not spayed. smelly urine
The young lady consulted me. Smelly urine plus blood and pus for the past few years and treated by several vets. After treatment, will be ok for a while. Then smelly urine again.
Palpation - pain + in letf kidney area. Bladder mass 2 cm x 2 cm.
Vulval area was hyperpigmented black due to long-standing licking.
False pregnancy seen with milk present. Urine pH 8. SG 1.0, Protein 3+.

I advised spay as the bacteria from womb infection goes into the bladder due to the dog licking her vulva frequently (evidence from black skin pigmentation). The lady did not want to spay her dog. 
Bought canine k/d x 1 small bag.

Sep 18, 2015. Strong smelly urine. Seen 3 vets. Treatment. I advised Canine C/D diet and spay.
Nov 30, 2015 and Feb 4, 2016.  Buys canine k/d

Apr 27, 2016. No more smelly urine for past 7 months. since first visit unlike other vets - smelly urine after 2-3 months.
Advised urine test and X-rays but owner did not want to do the tests.

July 27, 2016   dysuria, haematuria
Sep 7, 2016      dysuria, haematuria, stranguria
May 28, 2017      Buys canine C/D x 1 bag 17.6 lbs.
Sep 16, 2017   recurrent UTI. Declined tests. Wants medication only.
Dec 29, 2017   recurrent UTI. blood and urine test.

X-Rays by Vet 1 before Aug 2015. Said to be normal. No urinary stones.

 1.  Aug 16, 2015.  Glucose less than 0.1  (3.9 - 6)

kidneys normal
haematology normal

2.  Dec 29, 2017.  
kidneys normal
haematology normal

 1.  Aug 16, 2015.  pH 9. SG 1.035. Nitrite positive. Protein 4+. Blood trace
                         WBC 9 +ve, RBC 0, Epithelial cells 0, bacteria Nil,
Crystals Amorphous phosphate 3+, triple phosphate +
Possible haemolysis of RBC in urine

2.  July 27, 2016.  pH 6. SG 1.017. Nitrite positive. Protein 2+. Blood 4+
                         WBC over 900 +ve, RBC 127 +ve, Epithelial cells 5, bacteria +
Possible haemolysis of RBC in urine

3.  Dec 29, 2017.  pH 9. SG 1.022. Nitrite negative. Protein 2+. Blood 3+
                         WBC 75 +ve, RBC 55 +ve, Epithelial cells 0, bacteria 3+

                        Advised spay and X-ray but owner felt the dog might die under anaesthesia during spay. No more porridge water and treats. Strictly Canine C/D.


This Sep 2011 case shows a female spayed corgi with recurrent UTI with a happy outcome after consulting so many vets.

The 2017 case - the old dog was not spayed. The owner did not give canine K/D or C/D solely and did give treats. The urine was alkaline instead of acidic at the latest time of examination in Dec 29, 2017. 

Friday, December 9, 2011

767. No more smelly urine after the end of antibiotics for an old corgi


A fair lady in red sheath dress, with black eyeliner suddenly came into the waiting room and waved at me from the outside. My consultation room's door has a glass window on the top half and so I could see who was coming into the waiting area. This lady, in her prime at around early 30s, looked quite familiar and since she waved to me, she must have met me. 

 I had to stop the meeting which had taken over 30 minutes as I guess my assistants had enough of my reiterations of things to do, government and legal processes to be complied with and records to be written meticulously. Reminders to staff appear to be part of a manager's job and it is a role I rather not be involved in. But I was the licensee and the ultimate responsibility of any clientele complaint, investigation and litigation is with the licensee.

I said hi to the lady in red. Fairness and bright red always demand attention. The lady in red said: "Do you remember the Corgi? I am coming for the S/D diet."

"I am sorry I can't recognise you," I said. "But I do remember Oreo. She had seen a few vets and always passed smelly urine after a course of antibiotics. For at least 2 years or so. Is she OK now?" I had thought of following up but had not done so and now one month had flown by. Just like that.

"Well," the lady beamed. "She is no longer passing smelly urine after one month of treatment. Your medication has been taken and is no more. Her urine is clearer. Best of all, I don't have any smelly urine in the apartment after the end of antibiotics as in the past."

"How many times does Oreo pee and how much does she drink per day?" I asked. "Did you measure the amount of water she drinks a day?" It was difficult for her to answer precisely as she did not take note. She said: "I can't measure the amount because Oreo drinks only fresh water and so the bowl of left over water has to be replaced."

I was surprised that her female spayed dog peed all over the apartment at such an old age. "An adult dog usually pees twice a day, in most cases," I said. "The fault lies with the owner if she pees many times a day," I said. "The owner has no properly house-training the dog as a puppy." This frankness was not good bedside manners.

"Well, I did," she said. "She would hold her urine and then let go a lot." She spread her arms wide. "Is it common for dogs to pass a vast amount of urine every day"

"A dog would pass a lot of urine in the morning for one time," I said. "But not several times. Your dog has been withholding the urine until she can't stand it anymore. You must be beating her up when she had peed all over the apartment when she was younger," I said. "Holding urine leads to bladder infection and the smelly urine that the various vets you consulted before could not cure. Your dog is not fully cured yet. It is only one month.

"You need 3 months of S/D diet to know whether she will be free of urinary tract infection as the S/D diet acidifies the urine and prevents bacteria forming struvite sand in the bladder, leading to bad smelly urine. No other food, dog treats or any other pills."

"My dog loves apples," she said. "Can I give her apples? She looks at me appealingly for apples when I eat one."

"It is best not to," I said. "You had suffered over 2 years of this problem of smelly urine after antibiotics after seeing a vet. Now, her urine is not smelly without antibiotics. Why take risks? Let her urinary tract system stabilise over 3 months of eating S/D diet and drinking plain water. Then you may give her apples."

As regards whether the Corgi was harshly disciplined when she was younger, the lady in red said: "Yes, she got spanked when she peed everywhere." the lady said. "This may be why she withholds her urine till the last moment and urinated a very large puddle of urine onto the floor. What do you suggest I do now?"

At first I advised confinement and removing the urine smell in the floor apartments using white vinegar + water at 1 part to 3 parts water.

As she was moving to a new apartment away from Woodlands soon, I advised: "Complete confinement for 24 hours in a room, with a baby gate, for 4-6 weeks. Newspapers with her urine smell on one side and bed on the other. Confinement is the key to success. Let the dog out when you are at home and pick her up when she is about to pee on the floor and put her into the confined area. Say in a firm tone 'Pee here.' Give a treat if she does that or a praise. Persevere. Old dogs can learn new tricks too especially when you start from a new house."

This case of recurrent UTI seems to be successful but urine monitoring per month should be done. I gave her a urine collection bottle and asked her to know volume of water drank per 24 hours. I hope the new apartment will be free of dog urine smells as friends can smell it but owners who live there will not smell it as their noses are used to it.

Will wait and see. The "living happily ever after" story has not concluded but it seems that there is a good clinical outcome of my recommendations and that is what the lady in red wanted and what all owners whose pets have long suffering diseases demanded. 

UPDATE IN DEC 31, 2017
I have not seen Oreo since writing this Dec 2011 case study. I presume the lady had gone to a nearby vet to purchase the Hill's urinary diet S/D or C/D. It is very common for Singapore owners not to provide feedback or return to the vet if the urinary tract infection is resolved.  

Written in Oct 31, 2011 (>1 month ago), Recurrent UTI in an old Corgi is at:

The blog has brief version:


3330. God of Fortune

Dec 30, 2017

I spoke to my 2 assistants today about work process and saving up for their old age.
One assistant is single. The other sends almost all her salary to support her nieces and nephews as she has no children and just got married recently.

"In Chinese beliefs, the people pray to the God of Fortune for money" I said to the married assistant. "In your religion, there is no such God. But you are the real God of Fortune."

I continued, "You send money to your nephews and nieces to support them. So, you are stressed out having to earn more and more each year and have no savings. Then, more children are born. You have to support more and money. When you are old, you have no savings and they don't care two hoots about you as they enjoy their lives!"

"My sister will give birth next year," she said. Another mouth to support. There is no end to the sister giving birth to more children as the Singapore "aunty" remits money.

3229. A poodle has eye discharge - Evidence of corneal ulcers

Dec 29, 2017

Tearing is due to corneal ulceration of both eyes.  Some vets prescribe eye drops but not test for corneal ulcerations. The use of fluorescein stain test showed green corneal areas indicating ulcers.

For pet owners, evidence is important to substantiate diagnosis and gain their confidence. Eye discharge for many days would be due to corneal injuries leading to ulcers. Photographic evidence after fluorescein test provides the confirmation.

Rabbit 5 year old with eye discharge and eyelid itchiness and swelling

3228. An 18-month-old roborovski hamster has "lumps" on backside. Tumour or abscess?

Dec 29, 2017

"Is it lump or abscess," the lady who kept only roborovskis as pets showed me the bald backside with scabs lasting the past 2 months. She had not mentioned that this hamster was bitten by another during changing of the litter 2 months ago.

Under gas anaesthesia, this hamster cooled down and was clipped, washed and examined. The lumps were the normal testicles. The backside area was infected by bite wounds. No anal sacculitis.
So the owner was satisfied.

The owner had not sought treatment for the past 2 months of backside hair loss and saw the testicles which she diagnosed as tumours or abscesses. Nowadays, many young Singapore pet owners are well educated and do diagnose their pet's diseases. 

Wednesday, December 27, 2017

3226. "No corneal ulcers!" my assistant saw no green cornea in the rabbit's eye

Dec 27, 2017

2 similar medical cases arrive around the same time. A rare occurrence.


On Dec 27, 2017, I did dental work for 2 dogs coming on the same day. The poodle was 7 years old and had one loose tooth extracted. The 15-year-old foul breath Jack Russell had 15 teeth extracted and took a high anaesthetic risk. He survived and should feel better and be able to eat. Never had a dental check up for 15 years despite bad breath stinking the room.


2 rabbit cases with eye problems within a short period of time is rare occurrence for me.
One came on Dec 24, 2017 from referral by a vet clinic
This one came on Dec 27, from an existing client not seen since 5 years ago.
Both had female owners needing to look after their baby and so did not come themselves at the initial consultation.


Monday, December 25, 2017

3224. Gigantic breast tumour with stalk

Dec 26, 2017
The young man's Silkie terrier I see today had a gigantic tumour with a stalk. This is the 2nd case I encounter and is rare in the sense that most  breast tumours in the dog are non-sessile and take a longer time to excise.

2017 CASE

 Owner wanted to bring the dog home after operation. Large skin wound. Asked him to wait till next day and get a cage to confine dog.

2007 CASE
The first case I saw and operated in 2007 is taken from my Toa Payoh Vets website and shown below:

Massive tumour. Singapore Dog. Toa Payoh Vets

----- Original Message ----
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. 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, please let me know the time can? Thanks.

Ms Ng (Volunteer)
Singapore Tzu Chi Foundation
Gigantic mammary tumour. Old dog. Singapore. Toa Payoh Vets
Tzu Chi volunteers brought the dog to Toa Payoh Vets for first consultation. Dog was sent home on antibiotics. Surgery was scheduled in 10 days' time
No telephone 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 phone the owner to talk to him because he will only think of one thing: The vet (me) is a salesman trying to sell his 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 8-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 the 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 8-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
Friday, January 25, 2008
after the follow-ups by Ms Ng from Tzu Chi Foundation, Singapore

"Since the dog may die on the operating table, put the dog to sleep," the dog owner wiped tears from his face. Men usually don't cry at the veterinary surgery.  I had told him that the dog had less than 50% of surviving the anaesthesia and he felt it was better put to sleep with lethal injection rather than being operated on the table. 

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. No financial burden for the family if the dog got her gigantic breast tumour removed by the vet. 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 not solicit the family. In the interest of the dog, I ought to.

So, no response from the owner since I did not sell myself, I mean my services. Not a good businessman. 

Ms Ng 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. The dog came in for surgery in a worse condition than during the first visit.

Dog 20 years old. Mammary tumour. Toa Payoh Vets
Tzu Chi volunteers send the dog
to Toa Payoh Vets for surgery
The dog could barely stand up.

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

8-year-old dog, gigantic mammary tumour. Singapore. Toa Payoh Vets
On arrival, the dog was barely able
to stand outside the Toa Payoh Vets
"I represent the wishes of my family," the man in his fifties was decisive but his body was trembling. He wiped tears streaming down his face.

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 electing for euthanasia by lethal injection straight away, this dog had zero chance of survival. As to why the decision to elect for death by lethal injection was made, I cannot understand to this day. Maybe it was economics. 

One Tzu Chi volunteer, Ms Seow, a lady in her late thirties and working for an advertising agency sat beside the dog owner in the consultation room. She talked to him quietly for some time.

She convinced me to go ahead to operate.  The representative signed the surgery consent form. This form informed 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. But the Tzu Chi volunteers were now waiting.

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?

There was no turning back. To operate or not?

I gave the 500 ml of 9% dog dextrose saline and amino acid drip overnight.  It was so difficult for the volunteers to get the dog for surgery. So, no delay is best for the dog. 

I operated the next day. I dissected the skin carefully. Don't just snip off the tumour at the stalk as this will be the normal approach in a case of a very small skin tumour.

There was a monstrous blood vessel bringing in nutrients to grow the tumour and this was ligated twice. The operating field was bloodless as if all blood vessels had been commandeered by the tumour warlord to nourish him only. Not a drip of bleeding in the big cut of the skin. Incredible. Usually there is lots of bleeding from the subcutaneous blood vessels.  

The dog survived the anaesthesia which was just gas. No tranquiliser. Just straight gas. 

Female, 8 years old, dog, large tumour, general anaesthesia. Toa Payoh Vets
A monstrous artery and vein in a sheath of over 3 cm in diameter is present at the stalk of the tumour at (X). They  supply nutrients to the breast tumour, enabling it to grow to such a large size. Be careful. Dissect the skin, undermine the skin with scissors. Identify, isolate and ligate the big blood vessel. Then cut off the tumour. No bleeding in this approach. 
Female, 8 years old, dog, large tumour removed. Toa Payoh Vets
Not one drop of blood oozes in such a big skin wound during and after removal of the tumour. As if the tumour has had requisitioned 99% of the blood supply from the surrounding tissues. Or was it the power of the collective prayers of the Tzu Chi volunteers to ensure a safe surgery? 
"Our volunteers prayed hard last night that the dog would live." Ms Seow told me later. Do prayers work?  Do you believe in miracles?

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 were not paid by the Foundation. Their intervention save a dog from death by lethal injection or a horrible painful death from the infected breast tumour.

Some 6 weeks passed. Did the dog survive after the surgery? I had not phone the owner. What if the dog had died after the surgery? 

If the dog survived, she could live for a few more years keeping the aged grandmother company every day.

Ms Ng reminded me that I had not billed the Foundation for the services. This Foundation is good at accounting and pays for services rendered promptly even to the extent of reminding the tardy veterinarian to send the invoice.   

Did the dog survive? Is she fatter? I asked Ms Ng in the reminder e-mail. Ms Ng wrote:

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.


电话:65829958 分机:204
This incredible story is hard to believe. No bleeding during surgery. No death. The old dog just woke up after surgery and was able to walk normally. Freed at last from a 2.2 kg encumbrance. She wagged her tail and looked much younger when I put her on the table to take a picture. This was the first time she had wagged her tail. As if she was so glad to be free of a heavy burden. Was it her destiny to survive?

When the vet thinks the dog that is emaciated, weak and has been sick for a long time has little chance of survival on the operating table, the dog proves the vet wrong. When the vet thinks the dog has no problem under anaesthesia and surgery is a piece of cake, the dog  dies on the operating table.

If one believes in fate and prayers, this dog was destined to live. However, without the care and follow-ups of the numerous Tzu Chi Foundation volunteers, this dog had little chance of survival. Bacterial infection and sepsis would have killed her in the next 1-2 years as the ulcerated tumour starts rotting spreading toxins into her liver and kidneys.
110. An 8-year-old dog's destiny
124. The dog that the Singapore Tzu Chi Foundation volunteers saved from lethal injection. Follow up to Case 110.

Sunday, December 24, 2017

3223. A 1-year-old ragamuffin scavenges and ate chicken offals - diarrhoea for 2 days.

Dec 25, 2017
Christmas Day.

I was surprised to see a young lady with a ragamuffin that had diarrhoea for the past 2 days.
Abdominal palpation showed that the cat had abdominal pain. It was Christmas Eve yesterday and the lady had bought chicken to celebrate. Locals rarely eat turkey for this occasion.

The cat had upturned the garbage bin and ate some chicken liver or gizzard. "No chicken bones," the lady said.

"She also sat in a corner by himself," the young lady showed me the mobile phone image of the cat in an unsual position with the back laid on the corner of the wall and the belly upwards yesterday. "Was she in pain?"

"Possibly, " said. "Did she hide in a corner or under the table or bed?" I asked.
"Yes," she replied.

The cat was given the IV drip and pain-killers and one day of in-patient observation.

Thursday, December 21, 2017

3221. Images of adverts/artwork in Singapore malls - Raffles City on Saturday 16, December 2017

Raffles City
3rd image is of advert of products of Reese Witherspoon who has started her own beauty and fashion business in addition to being a very successful actress



HEADWARE. Very few shops sell headwear in Singapore