$10,000 for a young lady

Dec 8, 2014

I find it hard to believe that this 64-year-old grandma was sold for $10,000 when she was 17 years old. "I still keep the receipt," she said to me.

Her mum married a man 20 years her senior. She had 10 children - 7 girls and 3 boys. She was the 3rd child. There was never sufficient money to feed so many.








"One day, my brother said that a tree branches had fallen and obstructed the entrance to the pig pen," she related this story. "My father chopped the tree down. Instead of chopping the trunk nearer to him, he chopped the other side. The tree fell onto the roof of the pig pen. His mouth was slashed and he became giddy and fainted one week later. When the doctor said he needed an operation to remove the blood clot in his brain, he ran away from the hospital. Another 2 weeks later, he fainted and was operated."

"Did he survive?" I asked.
"Yes, he did but was never the same again as he could not work much. Lying around the house. My mum was forced to go out to work to feed him and the 10 children."

"What did she do?" I asked.

"She was a pig middle man, earning $0.50 to $1.00 per pig sold to the butcher. At that time, 0.15 cents could buy you a bowl of noodles and so this amount was big. Nowadays, children would not even pick up a $1.00 coin on the road!"

"Did you go to high school?" I asked.
"No, my family was living hand to mouth every day. I stopped studying at Sec 2 to help my family. I had to shoulder the porker (6 months) with my father to sell it at the market!"

That would be before 1967 as she was 17 years old and sold to the butcher.

"My mum was pestered for payment as Chinese New Year was near. The builder of the pig pens had supplied sand and concrete and had agreed to receive payment when the piglets were sold but he came early and pestered for money."

"Pigs can only be sold at 6 months of age," I remembered my veterinary work as a government vet in the PPD Extension Centres when I started work in 1977 after National Service.

"You know this arrangement?" she was surprised.
"Yes, I was in this government service and there were a few small pig farms then.
"The government took back the farm land," she said. "They just leased the land to us and paid us some money,"
"Yes, yes. For every standing tree you had planted, the government would pay accordingly". This was the era that the younger generation was never aware. The farmers had political clout in the early years before 1967. " 
"How many children did you bear from this butcher?" I asked. "Was he married?"

"I had 2 children. I told him I would leave him after 10 years. He was married but he was also a womaniser."   

"Why didn't you not marry him?" I asked.
"I was a country pumpkin and knew nothing of the world. My mother had to clear the debts and the $10,000 would pay the builder and other debts. The butcher promised to settle all her outstanding debts."

"Was there a wedding? I asked.
"No, no. A sales and purchase agreement. I still retain the copy."
"It is a surprise that you stayed with him for 10 years."

"Did your children give you money?" I asked since both daughters were house-wives.
"My younger daughter gets her husband to give me $300. But I save the money for her." She was still working as a bus driver and so was heavily made up like an opera singer. This was a fashion in the old days for women.
Her mobile phone was clicking and clicking while I examined the poodle puppy that had sore throat after attempting to swallow a button. This was her daughter's puppy and she was the caregiver as the daughter was in Korea on holiday.

"The puppy's throat is painful on palpation," I showed the gagging sound. "You better answer your phone."
"Oh, those are pictures from my daughter in Korea. Young people will send every item of food they eat in the restaurant to me!"

"You are a lucky mum," I said. "Your daughter sends you such pics. Some children going overseas on holidays rarely remember their parents at home, let alone send any pics.  The puppy should be OK but an X-ray would be needed if you want one."

She decided to wait. She cared for a stray cat last week and had it spayed. That was when I first met her. Her grandson adopted the spayed cat.
 

1126. Dental extrraction of a 16-year-old dog

 

 

 

 

 

 Hello!
My name is M B and I came upon your article about the 16y/o Pomeranian you performed extractions on without sedation and was wondering if you might have any colleagues in the Los Angeles, CA area that might be willing to attempt the same procedure on a 9y/o Cavalier King Charles Spaniel with a grade 5/6 heart murmur, mitral valve prolapse as well as lymphoma.

Her health issues make any sort of sedation impossible but she has a few wiggly teeth as well as two cracked lower molars that I just found out are creating open sores on the roof of her mouth.  So it is something that really must be addressed.  Is there any advice/guidance you can give me to find someone that could help us?

Thank you so much doctor,
M and T

http://www.asiahomes.com/book2/20100664dental_extraction_16-year-old-Pomeranian_dogs_singapore_ToaPayohVets.htm

 

 

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EMAIL REPLY BY DR SING KONG YUEN

 

Dec 8, 2014

Hi
I am Dr Sing Kong Yuen from Toa Payoh Vets. I don't know any vet in LA. You may need to search for an experienced vet.

Isoflurane gas is needed in your case and usually this is safe. Is your dog undergoing chemotherapy and on heart medication? 

In the 16-year-old dog, all teeth were loose owing to aging and so were easily extracted promptly. Your dog will be more energetic and have stronger molar roots. Therefore gas anaesthesia is necessary to do the extraction without the dog biting or closing the mouth.

Best wishes.     

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COPY OF WEB ARTICLE

DENTAL WORK WITHOUT ANAESTHESIA IN A VERY OLD POMERANIAN WITH HEART DISEASES Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Written: 04 September, 2010

toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129

Can an old vet (>50 years old) change his mindset of not using general anaesthesia and sedation for very old dogs so that she has a high probability of being alive at the end of dental work? The only chances of her dying would be from fright (heart failure) due to the stress of the dental work without general anaesthesia. Seldom are such old dogs healthy. They usually have heart disease and general anaesthesia kills them as they are also very old. Is it possible to perform dental extraction with no general anaesthesia for such very old dogs with heart diseases and a mouthful of decayed and rotten teeth as shown in the pictures of a case of a 16-year-old Pomeranian below?  16-year-old. Home cooked food. Teeth encrusted with tartar but surprisingly there was no strong bad breath smell. An I/V glucose drip is important for aged dogs during operation. Emergency Lasix was given I/V when the dog coughed trying to clear her throat. Dog goes home with no teeth left.  Vet Intern Ms Toh arranged the teeth neatly for photography. "How many teeth has an adult dog?" I tested Ms Toh who had great interest to study veterinary medicine. She shook her head. The answer is 42.  If she survived, her quality of life (no daily oral pain and infection and hence able to enjoy her food and put on weight). She would be more active and alert. She might live to a ripe old age the bacteria in her mouth had been rid of. Bacteria constantly produce toxins and lower her immune system.  In the above case, the Pomeranian was in good condition for her age. She looked like an 8-year-old dog rather than an ancient canine. She had no fever and no abnormal respiratory rate. The pulse pressure was lower. The dog was on heart medication prescribed by Vet 1 for some years.  However, she was underweight. Her mouth was not smelly despite the presence of large amounts of tartar. The owner requested "manual scaling" as she had discovered in the internet forum that I was highly recommended as I do "manual scaling" (without general anaesthesia). "I don't do manual scaling," I told her that there was a mistake in the internet forum she had researched. "How many manual scaling in dogs have you performed?" she asked. "None," I said. Ultrasonic dental scaling is the method I use. However, this old dog needed dental extraction and not dental scaling. The roots of the teeth were all loose and infected. "Manual scaling" (without general anaesthesia) would not be in the interest of this dog as the bacteria still would be multiplying under the roots below the gums. Dental scaling  would be what the lady wanted but this was not the right thing to do for the dog.  "There is a risk that your old dog may die from fright due to the pain of tooth extraction without general anaesthesia," I informed the lady. She was surprised and said, "Let me have some time to think as to what to do." I expected the lady to go home on this sunny Sunday afternoon of May 3, 2009. I had my hands full on this busy Sunday. However, she returned and decided to take the risk. THE PROCEDURE An I/V glucose drip was given to help to increase the blood pressure as the pulse was weak. Into the drip set, I gave Baytril antibiotic to reach the dog immediately to kill the bacteria. The dog was quite docile and so there was not much worry.  Two front incisor teeth were extracted. The dog started coughing as if to clear phlegm in her throat.  This indicated that the oral heart medication given to the dog was not effective to remove the fluid in the lungs (pulmonary edema).  What now? Cease operation? Going back to the basic of veterinary pharmacology, I needed a drug to clear the water from the lungs quickly. I broke a vial of Lasix and injected it into the IV  drip. The drug would take away fluid from clogging the airways by taking it into the blood-stream. I waited 5 minutes   before continuing dental extraction. One or two teeth were extracted at 1-2-minute intervals. The teeth were so loose that most of them could just be pulled out easily. There was little bleeding. Tissues were used to control the bleeding. When the bleeding had stopped, the other teeth were extracted. The dog had not even coughed throughout the process of dental extraction. He was apprehensive.  Suddenly the dog shifted and the IV catheter came out. Intern Ms Toh had informed me that there was a skin swelling above the catheter. 3 Elastoplasts strips and a wrap-around bandaged had been used to fix the catheter in place but we had anticipated that this would happen. The dog had around 100 ml of glucose and that would be sufficient. Since the catheter had popped out of the vein, the rest of the fluid was given subcutaneously. Caution would be the key and there was rest in between each dental extraction, dragging the process to over one hour. Prevention of heart failure due to fright was paramount. After all, the owner wanted an effective veterinarian who would produce a live dog at the end of the day, not an efficient one with a dead body.     CONCLUSION The dog had 23 loose and rotten teeth extracted with little pain and little bleeding. The lady's eyes brightened when she returned later and was told that her dog was OK.  The dog was alert and her excellent coat shone golden in the evening rays of the evening sun as I took her photograph. As the dog was not vaccinated, I did not want the dog to be hanging around the Surgery. The lady put the dog in her car while she paid the bill. Well, the dog peed inside her car, but she was not upset. Her best friend was alive and that was what mattered to her.   This is the sole case of me doing dental work without general anaesthesia in my 2 decades of small animal practice. I record this in detail to share my unusual experiences with other veterinarians. If the dog had kicked the bucket, the owner would be very unhappy as she had 14 years of companionship with this old friend after adoption from the SPCA as a 2-year-old. It was fortunate that the old Pomeranian did not die of fright on the operating table.  I don't want to do any more such cases as this will tempt the God Of Death. This was not a simple case as the dog was coughing. If the coughing continued, the dog was be stressed out and die of heart failure. Therefore, the vet must know what to do when things don't proceed smoothly. Of course, the best way is not to accept such a high-risk case as deaths of companion animals on the operating table are never forgiven or forgotten by the owner and her family.       NOTE: It would be wise for dog owners to get the dog's teeth check every year and get dental scaling done when the dog is young and fit. Continue with tooth brushing after dental scaling. UPDATE IN SEP 4, 2010 FROM OWNER: The dog lived to a ripe old age and passed away in April 2010. The post-operation feedback from the owner indicated that the dog had oral pain and low blood sugar.          E-mail to Dr Sing dated Sep 2, 2010   bekindtopets.com/dogs/20080828Dog_Dental_Problems _Singapore_ToaPayohVets.htm Dear Judy,  I saw the case study on the above website.  I am the owner of this dog. Her name is She. She passed away this year 11 April. It was a Sunday morning.  Please send my regards to Dr Sing.  On the case study, I would also like to update you what happened after I got home.   The surgery was a success as my dog was indeed alive and well. Just like any other beings, they need rest after surgery. However dogs will always attempt to walk or run as its part of their nature, not knowing itÂ’s exhausting. One the first night after the surgery, my dog collapsed suddenly and started to whine. I picked her up and gave her a massage, which she was able to stand on her feet soon after. This happened for another 2 times in a day.  I realized it may be trauma and shock, and maybe low glucose level. She is also not eating well. Where is she going to get the “energy”? She was already on long term medication for heart, plus after surgery medicine. I was not prepared for more medication for my little 16+ yr old.  I brought her to TCM. I think this doctor is the only doctor in SG who provides acupuncture for dogs. He is (Name given). I asked this doctor to also do treatment for her appetite, her heart, and other senses such as hearing and sight. She responded very well after the first treatment. She was also beginning to eat! And best part is she and I had eye contact, it shows that sheÂ’s getting more alert.   She continued the treatment for about 1 month, about 5 consultations. She recovered very well. Soon after she starts to bite all people who attempt to touch her, including myself. I think itÂ’s the surgery trauma and old age crankiness. But I also think that if she bites it means she is alert to her surroundings. I see it as something positive, sometimes, funny. Because, no teeth still want to bite people? No more bad breathe and no more toothache. I was not worried about bacteria possibly worsening her heart condition anymore. Without teeth, her tongue always sticks out! Amazingly she looked even younger and cuter!   I wrote this to you because as fate has it, Dr Sing has indeed changed the quality of her life.   But he is also right, itÂ’s very risky. What if the owner did not take precaution AFTER the surgery?  I have attached 4 pictures. 1 taken in May 2009, 1 in Sep 2009 and 1 less than a month before she left in 2010.  She was very lucky, to have met the right people.  Thank you.   Best Regards,   E-mail from Dr Sing dated Sep 4, 2010   I am Dr Sing and got your good news of your dog living to a ripe old age.  Thank you for your email and important feedback post-operation as I seldom get any feedback. Most likely it was low blood sugar as you diagnosed. It could be the post-dental extraction pain.  Your pictures are great. Pl give permission to post the pictures.  I hope all are well with you.   E-mail to Dr Sing dated Sep 4, 2010   Hi Dr Sing, Great to hear from you!  Sorry I would like to rephrase, I meant her fear and anxiety on the surgery table would definitely caused that “weakness” which makes her faintish. Yes, I should write as low blood sugar. ItÂ’s a normal after-surgery process. I remember feeding her sugar/glucose water.  I am well, thank you. I guess this is one thing all dog owners have to go thru.  Until yesterday, I could never have imagined how hard you guys work over the metal table, while I was stoning in your clinic. It was a very detailed re-enactment. Thank you for sharing. It was heartwarming for me.  I hope my feedback could help you and your furry patients. Please feel free to use the pictures, itÂ’s my pleasure. Best Regards TIPS FOR VETS: POST-OPERATION PAINKILLERS I did not give the dog pre-op NSAID pain-killer nor after the dental extraction as I would do for a younger dog. This is because this dog's kidneys would not be as good as a younger dog to withstand any adverse reactions on the kidneys from NSAID drugs. NSAID drugs are not to be given to dogs with kidney disorders and though no blood tests to ascertain renal function were taken, I expected the kidneys and livers of a 16-year-old dog not to be as normal as to metabolise NSAID drugs without dying of side effects and thereby distressing the lady owner. As for post-operation sugar paste, this would be given for old dogs. In very old dogs, it is very risky to use injectable anaesthesia. In this case, isoflurane gas would be safer but it was not used as the owner

1125. The man with 5 tattooed Schnauzers on his back

Today, Dec 5, 2014, this man, around 70 years old came into the clinic. I had known him some 15 years ago when he and his wife had purchased Miniature Schnauzer puppies. Over the years, he went to other vets as his dogs age.  Now he is retired to take care of his 5th Schnauzer, 16 years old and unable to stand up. He has sufficient income from his wife working in China and with rental income from a condo.

Today he spoke to me about 3 types of vets he encountered for his old dogs.

1. "The con vet". This vet operated on his old Schnauzer with nasal squamous carcinoma. A tube ran from the forehead to inside his nose and the nasal turbinate cells were removed. "I spent $4000 but the cancer came back. Soon after treatment, my dog's left eye bulged out as there was a swelling below it. My poor dog started bleeding from the mouth and nose!"

"Did the vet explain to you the success rate of surgery?" I asked.

"No, no. He said it was up to me if I wanted to put my dog to sleep.This con vet should have told me that there is no cure and now I asked my friends not to go near him." His wife had recommended him to see this vet. I did not comment.

2. The good vet. His other old dog had liver cancer and this vet explained to him th details of the blood tests. 8 months of chemotherapy by injection cost him $8000. "At least I had an extra 8 months of time with my old dog," he said.

3. The vet whom his colleagues recommended him to consult for the Schnauzer with ear problems. "His father is my colleague. The father must have spent half a million dollars to renovate the place. After one month, my dog was diagnosed with kidney failure and died. Surely, he could have told me when he did a blood test when he checked my dog for ear problems!"

"The blood test may not reveal kidney failure at that time as I am sure he would have had told you." I said. "Do you have the report?"

"No, no," the tattooed man said.

. 

1124. A Golden Retriever had squamous cell carcinoma

Dec 2, 2014
The 10-year-old Golden Retriever came in with a big patch of ulcerated nasal tip. She kept licking it. The couple said she had a cut some weeks ago and now the whole tip is raw. 

"It may be squamous cell carcinoma," Dr Daniel said.
"Do a biopsy," I said. "We use the biopsy punch." 2 pieces of tissue measuring 0.9 cm x 0.5 cm x 0.3 cm were submitted after the dog was sedated.

The dog was also given dental scaling as she had very bad breath and exposed roots of molars.

Lab report of nose lesion on 1.12.14
Two pieces of skin show a proliferation of atypical squamous cells arranged in anastomosing cords and trabeculae. The lesion is seen invading in between fibrohyaline stroma.  Diagnosis: Compatible with squamous cell carcinoma.

VIDEO

1123. A lethargic anorexic Husky that had vertical ear canal ablation 5 months ago

The Husky had a vertical canal ear tumour. The owner took the dog back after ear surgery (vertical ear canal ablation). He did not come back for post-op and said the dog was OK.

Dec 2, 2014. The 13-year-old dog came in as he was lethargic, not eating and had diarrhoea
The horizontal canal opening had an area of pus and exudate.

BLOOD TEST
The total white and red blood cell count was in the normal range.
Neutrophils 95.3% (60-70%). Absolute 9.2 (3-11.5).
Platelets were very low at 8  (200-500). 

Liver enzymes high
Kidney enzymes high

So was the dog toxic?  Was he poisoned by chemicals? The caregiver had not washed the wound around the horizontal ear canal opening as the hairs had covered it.

The dog was given the IV and antibiotics with Vit B12.  He vomited black stuff twice in 2 days here. The owner decided to euthanase him.

1122. My cat has "constipation".

Nov 29, 2014

"4 days ago, my cat was not eating and was straining to pass motion," the young couple consulted another vet. The vet inserted his index finger into the cat's rectum and there was blood seen but no stools. "He asked us to come back the next day for a blood test to check for kidney disease. But we researched the internet and our cat was not drinking or passing urine excessively. so we did not go back."

There were medical cost considerations of the blood test as well as the couple's internet diagnosis. They believed that the cat was "straining" as he did not pass stools. As for urine, they had seen it in the cat litter and so presumed that the dog had no urinary tract infection.

"The cat was not happy when I palpated the kidney and abdominal area," I said. "However, there are no hard stools in the large intestines and so this cat does not have constipation. The straining would be due to urinary tract infection. Some male neutered cats suffer from FLUTD (feline lower urinary tract infection) when there is a change of management or environment from the usual daily routine. Did you change the cat food brand recently or introduce a new cat?"

"We ran out of the previous brand and gave him a new brand," the couple said. "He ate the new brand but then we gave him the previous brand. He vomited and did not like it."
So, there was a change in dry cat feed causing "stress".

"Are you sure you did not touch any new cat?" I asked the husband.
"Well, lthere was a stray cat who would appear in front of my apartment despite a solid outer door. I had patted him and fed him outside the apartment. I live on the 3rd floor and yet this stray cat knew how to come to my apartment through a solid door with no openings!"

"The stray cat is no longer coming, " the husband said. "I have put him back on the streets."

So there was a history of a new cat being handled, causing "stress" to this cat based on the smell of the new cat in the husband's handling. The cat could have stopped drinking and then have difficulty in urination. Hence the straining.

"Although urine was seen in the litter, this could be due to the cat finally being able to pee after some straining," I said to the couple.

FLUTD was my tentative diagnosis and the wife had considered this condition. There was no constipation. I prescibed medication and to feed only canned food.
For the last 3 days, no news from the owner. I will follow up again on this case..


CONCLUSION. FLUTD in neutered male cats fed on dry cat food do occur but the exact cause is unknown. One reason is the change in the cat's daily routine e.g. change of cat food brand or a new cat is introduced. So the owner sees the cat straining in the litter box. In this case, the cat stopped eating for 4 days ago and the couple decided he was "constipated".  

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1121. A shih tzu had kidney and bladder stones again

I was referred to give a second opinion on this case. The vet had scheduled bladder stone removal. 3 years ago, the same practice had removed calcium oxalate stones from the bladder. Three urine test monthly showed calcium oxalate crystals initially as the owner had fed the same dry food. After switching to U/D diet, the urine was negative and two tests. No more tests done and the dog was on U/D diet during the past 3 years.

"Did you feed treats during the last 3 years?" I asked.
"No," the owners said. "We did give dog biscuits and sometimes bread. This dog was given a health screening and the bladder stones were discoveed."

Blood tests, including biochemistry taken one month ago by the vet were normal. I reviewed the report and the owner had to phone the vet for the urine analysis. This was faxed over. Urine pH was alkaline at 6.0 with few calcium oxalate crystals, few red and white blood cells. 

"There is sore throat and mild abdominal pain in the kidney and bladder area," I palpated the dog's throat and abdomen. Based on some urination difficulty, this dog could have urinary tract infection. Antibiotics were prescribed.

As regards bladder surgery to remove stones, my opinion was that this dog would have a higher chance of survival from anaesthesia above 70% after antibiotics and recovery of full appetite and no peeing problems. However, I warned that this dog had kidney stones as well as bladder stones. Surgery was only for bladder stones. 

The dog went home with antibiotics for the next 10 days. No more dog treats, biscuits or bread or any additional food.

The U/D diet does not dissolve the calcium oxalate, but alkalines the urine to prevent any formation of the crystals. Yet, in this case, the urine was alkaline but the crystals were still present.   .
Now the dog had lost appetite recently but was still active. The wife said that the dog was peeing smaller puddles of urine unlike previously but there was no blood in the urine.

CONCLUSION
The first X-ray and medical record of the urinary stones were no longer available at this first vet practice, according to the owner. So, we don't know whether kidney stones were already present when bladder stones were removed.

RECOMMENDATIONS - Monitoring the dog's health
1. Urine tests 6 monthly after stone removal.
2. X rays yearly after stone removal and after surgey to remove the stones
3. Only U/D diet is fed exclusively with no other dog treats or food.
I would say that the vast majority of dog owners in Singrapore do not adopt such recommendations and so recurrence may be presented.