21. Defensive Medicine Costs More

From: ...@starhub.net.sg>
Subject: Bill for treating wound and removal of maggots
To:
Date: Monday, December 28, 2009, 12:08 PM

As spoken, I enclose a copy of the bill itemizing the treatment of my Husky. In your professional opinion, is the bill justified? I know there is nothing I can but at least I want to know that I have been overcharged or not?
 
Thanks.
 
Regards
Name of owner
E-MAIL REPLY FROM DR SING

1.  It was nice talking to you yesterday. Thank you for your e-mail of your vet's bill. As I have not seen the extent of the wound and was not present, I cannot say definitely whether you have had been overcharged when you said you were billed over $600 for treatment of a maggot wound in your large breed dog. The total bill was $641.20.

2. My comments are that I don't usually conduct the following for the treatment of maggot wounds performed by your vet, viz.,

2.1  Heartworm test  $50 (not relevant to maggot wound treatment).
2.2  General Health profile $150 (some vets perform this test to screen the dog's health prior to sedation). 
2.3  (Insecticide) Interceptor Spectrum $65
2.4  Buster Collar 25 cm $23
2.5  (Insecticide) Negasunt powder  $18
2.6  (Pain-killer) Rimadyl Inj $30
2.7 (Pain-killer) Carprofen 50 mg $9

Therefore, the costs would be reduced $345 and your final bill might be $641 - $345 = $296 assuming I used the same procedures as your vet. No 2 cases are exactly alike, just as no two condos for rent are exactly alike. I am using condo rentals are an illustration since you are familiar with this industry.
 
3. However, I do hospitalise the dog for 2 days for observation if the maggot wound is deep and large. I don't know how deep is your dog's maggot wound. In addition my consultation fee is $10 more than your vet. If you shop around there is at least newer vet practice charging consultation fee at $18 which I believe to be the lowest in Singapore. 

3.1 If you deduct $296 for the above case, my fees may be considered cheap at $200-$300 range, since I don't use items in paragraph 2. But some owner may have the perception that I am not a good vet since I don't give the extra drugs what all good vets should give and I had not practised defensive medicine by doing general health blood test and heartworm test.  

4. I use the real estate rental of a condo as an example since you are familiar with this topic. An owner in the same condo may rent out his apartment for $5,500 per month and you would get a rental of $6,500 per month.

4.1 Will you be considered a greedy landlord since you are overcharging by $1,000 compared to your neighbour?  You may claim that your quality of renovation, furnishing and furniture is vastly superior in quality and this may be true. Prospective tenants usually view various condos. This would probably be the case, as I know that is a common practice. No tenant will rent the first condo they see in Singapore. Supply is greater than demand. On the other hand, your tenant at $6,500 rental for your condo has the company budget fixed at $6,500 and may have other disbursements from you. So, your $6,500 rental may be justified. Still it appears you are overcharging if the market rental is $5,500. If there is such a thing as market rental. There is no fixed charges for veterinary treatment by the way.

5. Some dog owners do phone up vet practices to get quotations and then go to the cheapest vet in town. When the fees need to be kept low, obviously, the dog does not get general health blood test, painkillers and Buster collars. Some owners have built a client-veterinary relationship of trust and goodwill and the vet will act according to the owner's financial means in the best interest of the pet and the client.  

6. Back to the condo rental industry, if the tenant wants a low rental, he has to sacrifice for the poorer quality of furnishing. If the pet owner wants the least veterinary cost, he has to scout around and find the least cost veterinary practice and there are such practices if you do your research. 

7. I am sure that this dog with maggot wound will heal beautifully and that your daughter will be most happy. Call for quotations from vets all over Singapore next time.

8. In conclusion, I would say you are overcharged by $50 since vets in general don't consider the heartworm canis test necessary in the treatment of a maggot wound.

8.1 On the other hand, your vet may need to know that your senior dog did not have heartworms as he could have died when given sedation and the Interceptor Spectrum. Your vet could be sued for "medical negligence" for not checking whether your senior dog had heartworms and pre-sedation blood test first before sedation was given.

Defensive medicine is a good defence against litigation and veterinary complaint investigation. This apparently had been practised by your vet and you were charged for the higher costs.   

8.2 Your dog was given the best things in veterinary medicine and it burnt a small hole in your pocket. You said that the practice was not a famous one equivalent to the human "Mount Elizabeth Hospital", but had you gone to Mount Elizabeth-equivalent, your bill would be more than $600.

8.3 It is really hard to compare as there is a vet practice that will treat a maggot wound for around $100 - $150.      

9.  Shop around if you want the cheapest service provider. Inform the vet that you are in dire straits so as to get the least cost treatment. No frills. A house brand rather than branded goods. Ask for steep discounts and drive a hard bargain before the treatment. Risk being blacklisted or shown the door for a few dollars less.

9.1 I relate a personal incident I suffered recently. One day, a door-to-door vendor came to my surgery to sell goods. I bought a "Made in China" belt from him for $10.00 to give him some business since I know he needed some income as door-to-door sales are extremely hard work with more rejections than sales.



The next day, the buckle fell off and threads start peeling off the belt. I had to throw away the belt. So, was I being cheapskate? I should have bought a Pierre Cardin belt at $58.00 and would not have to show my clients that I wore a belt without buckles. It looked as if I was down and out. In dire straits. But my clients did not say a word and I shopped around for a "branded" belt 2 days later. Prices of goods and services vary greatly and if one goes for the cheapest, one should not be surprised at getting shoddy goods or services.

10. I hope my reply is entertaining and to your satisfaction and put a smile on your face. I wish you a Happy and Prosperous Chinese New Year.

20. Against Medical Advice

Profuse salivation after de-ticking by the groomer yesterday. The owner sent the dog to the emergency vet. Dog was given charcoal tablets and sent home. The owner was told to return in 2 to 3 days' time for a blood test.

Yet the dog started to salivate again in the morning. I was consulted. No more ticks. The owner was worried about the salivation and some shivering.

"Did you apply a 'Spot-On' insecticide onto the spinal area earlier?" I asked.
"Yes," the owner said. But ticks were still present and so she went to the groomer to get de-ticking done.
"The groomer must have applied a tick wash," I said. "Did the dog lick his paws and body?"
"Yes," the lady replied. The dog looked all right. There was some wet whiskers seen, due to salivation.

The dog was bathed thoroughly before its coat was clipped short. An IV Hartmann's solution was given. It was bathed again after clipping. Around 1,000 ml of IV drip was given to dilute the poison if possible. The owner wanted the dog home on the same day despite my advice to wait for one day for observation.

So the dog went back at 9 pm. This was one of those cases that should be warded for one or two days for observation, but the owner decided against medical advice and must be respected.

Day After My Treatment
The owner phoned me to say that the dog was not behaving normally. However he was eating and had no vomiting, salivation, shivering or diarrhoea. "It will take around 7-14 days to recover if the insecticide poisoning has not affected the brain, liver and kidneys," I advised.

The groomer phoned me and so I was able to know what had been used. The owner had phoned him earlier and so he phoned me to find out about the dog. He had used 1 cap of the Carrington Dog Wash Concentrate in around 800 ml of water. "No complaints from most owners," he told me. "Except for a few cases of salivation."

"This dog could have licked the insecticide from the matted hairs in its paws," I said. "The owner did not accept my advice to de-matt the paw hairs," the groomer said. So, the insecticide could have accumulated inside the paw's matted hair and the dog could have licked it and started salivating. However salivation is a sign of insecticide poisoning.

This is a case likely to result in negligence complaints and litigation if the dog has died. The vet and groomer have to be very careful nowadays. So far, so good.

P.S.
Carrington Dog Wash Concentrate contains pyrethroid insecticide and is sold in some Singapore pet shops. Not all dogs need to be warded for suspected insecticide poisoning but some dogs such as this case would be advised as the IV drip needs to be given over 24 hours. If owners go against medical advice, give the owner a release form stating that the owner wanted the dog to be discharged immediately and by 9 pm in any case. I did not give the release form in this case and sometimes this omission would haunt me if there was litigation.

Spot-on insecticides are said to be ineffective for some dogs but effective in others. A spot-on insecticide and a tick wash sometimes cause profuse salivation in dogs, depending on dosage. Owners who acted against medical advice should be given a release form to sign to protect the veterinary practice against litigation.

12. Paraphimosis in a 5-year-old Cavalier King Charles. What to do?

DRAFT
Updates at: www.toapayohvets.com. Goto DOGS - Surgery webpage - balanoposthitis.


Paraphimosis - protrusion of the penis with an inability to retract the penis into the prepuce.

Causes:
1. Idiopathic - No known causes
2. Small preputial orifice
3. Weakened preputial muscles
4. Trauma
5. Shorter prepuce

Possible medical conditions
1. Posthitis - Inflammation of the prepuce.
2. Phalitis - Inflammation of the penis.
3. Balanitis - Inflammation of the head of the penis (glans penis).
4. Balanoposthitis - Inflammation of the head of the penis and the internal layer of the prepuce.

Treatment:
1. Surgery to prevent balanoposthitis?
2. Retract prepuce to the level of the bulbus glandis and wash it with soap and water every day.
3. Others?










Dec 16, 2009.
The case is being reviewed for the next 2 weeks as the dog is given medication.

The small preputial orifice got swollen 6 weeks after the first treatment. This could be due to the dog's lifestyle - humping on cushion though he is neutered at 2 years of age (belated) and sunbathing for 15-20 minutes a day nowadays.

When the inflammation is gone, surgery may be the only option as daily pulling back of the internal layer of the prepuce to wash away the smega and pus may be too much work for the young working lady owner.

18. Ticks in Singapore dogs

Non-chemical control is safe for the dog, the family and the environment but many time-pressed Singaporeans do not think this way. They just buy an insecticide from the pet shop or the internet, apply it on the skin between the shoulder blades of the dog and this method may keep the dog tick-free for a month. In time to come, they find that the insecticide does not work.




Non-chemical control is as follows:
1. Dog booties. The dog wears "shoes" when taken out to dog parks or outdoors to exercise.
2. On coming home, examine all the toes carefully for any small ticks attached to the skin between or below the toes. This simple method reduces tick infestation considerably in houses with gardens.
3. Groom the dog daily but this is asking too much.
4. Cut the grass short and trim the lawn.
5. Keep the dog in one part of the garden or kennel so that any tick infestation will be in one area.
6. Clip long coat short if there are many ticks.

Pest controllers in Singapore do a roaring trade fogging and spraying insecticide into every park and space to kill mosquitoes. All these insecticide just goes to our reservoirs and kills us in years to come.

As a dog owner, you can play a small part in not introducing more insecticide in your home or garden by using non-chemical methods to control ticks in your dogs. Surprisingly, fleas are uncommon in dogs as we don't use carpeted floors unlike the culture in Australia.

16. Stray cat with large growth

Sep 30, 2009
To:
...@gmail.com>
Thank you for your follow-up. There are at least three courses of action for you.

1. Discuss with your parents as to why they object to the surgery. Is it due to religious reasons or due to the surgery being a waste of money since this is not your cat? Much depends on whether you are a good negotiator. Negotiating skills are not inherited - young adults in Singapore seldom have such skills, in my opinion. Read books on this subject. as the library has many. I hope you can acquire such skills early.

2. Ask your friend to bring the cat to a vet for surgery and adopt the cat. I presume it is a stray cat that is unfortunate to get an abnormal lump.

3. Do nothing till the cat falls sick when the growth is very large, rubs against the floor. Friction causes open wounds. Wounds get badly infected with maggots or bacteria and becomes very smelly. Maybe your parents have no objections at that time. Or the cat needs to be put to sleep due to ill health and pain.

It is extremely hard to diagnose over the internet or to see pictures. Therefore I will not hazard on the nature of the growth - tumour, encapsulated abscess, cysts, haemotoma, hernia and other conditions.




Subject: Re: Fwd: Cat with tumour on the belly
To: "David Sing"
Date: Tuesday, September 29, 2009, 12:28 PM

Hi Mr.Sing

I am not able to bring the cat for surgery as my parents are against the idea even though I am willing to pay for the surgical fees. Nonetheless, I would like to thank you for the detailed information on the tumour/hernia. The cat is constantly under my supervision and she is in a good shape.
I have a distant cousin from Malaysia and he is a vet too. He examine the cat and touched the area of the tumour. He said that it feels lumpy and it is as if there is water inside. He's not really to sure either. He said that I should bring in for surgery.

If you could advise on this matter, I would be grateful.
Many thanks,



On Mon, Sep 14, 2009 at 7:07 AM, David Sing wrote:

Pic shows a big tumour or inguinal hernia. Cannot tell from viewing pic. Tumours are found in middle to old aged animals. Cause of breast tumour in cats unknown. Continue with existing feeding as the cat may not eat if you change brand. Change later. No food and water after 10 pm the night before surgery and on day of sugery. Bring in the cat at 9 am if possible. Last week of Sep OK if cat is not in pain.




Subject: Fwd: Cat with tumour on the belly

To: "David Sing"
Date: Sunday, September 13, 2009, 2:50 PM

Hi Mr. Sing

Attached for your reference.
Yes, it's a female cat. I'm not sure about the age of the cat, though.
I will try to bring her for the operation asap.

What's the cause of the breast tumours? Is it deadly?
In the meantime, what are the recommended food should I give her? I've been
giving her Whiskas all these while but I heard from a friend of mine, who
is a cat lover herself, that Whiskas are considered fast food for cats. Is
it true? She told me to buy the can food, Fussies for Cats. However, I have
not feed her with that yet.

What are the procedures to take before I bring her for the operation?
Will the last week of September be okay?

Hope to hear from you soon.

Many thanks.

Regards,




On Sun, Sep 13, 2009 at 8:22 AM, David Sing wrote:

> thank you for pics. looks like one or more big breast tumours. I need a pic
> from below, not just side view. is it a female cat? $300 is the lowest fee
> for such an operation for you. Hospitalisation and nursing for a week will
> be free if this is a stray cay.




> Subject: Re: Cat with tumour on the belly
> To: "David Sing"
> Date: Saturday, September 12, 2009, 3:25 AM
>
>
> Hi Mr Sing,
>
> Attached for your reference.
> Hope it helps.
>
> Thank you.
>
> Regards,



> On Sat, Sep 12, 2009 at 7:18 AM, David Sing
> > wrote:
>
>> pictures will save time



>> Subject: Re: Cat with tumour on the belly
>> To: "David Sing"
>> >
>> Date: Friday, September 11, 2009, 2:08 AM
>>
>>
>> Hi Mr. Sing,
>>
>> The tumour is inside the cat's stomach, to be exact. It's quite huge and
>> it dangles when the cat walks.
>> I'll try to get a picture of it.
>> The problem is, it's not my cat.. So, my parents and I are contemplating about the fee. But i'll try to talk it out with my parents.
>> Thanks a lot.
>>
>> Will get back to you soon.




>>
>> On Fri, Sep 11, 2009 at 7:04 AM, David Sing
>> > wrote:
>>
>>> Estimated fee is around $300 if tumour is on the skin. best to let us
>>> examine and give quotation



>>> Subject: Cat with tumour on the belly
>>> To: judy@toapayohvets.com
>>> Date: Thursday, September 10, 2009, 11:56 AM
>>>
>>>
>>> Hi,
>>>
>>> I would like to enquire on the surgery price of removing a tumour on a
>>> cat's stomach.
>>>
>>> Thank you.
>>>
>>> Regards,




FINAL REPORT AT:
www.toapayohvets.com

15. Heart failure in a young Pom

"Your Pom has less than 1 week to live," I examined the one-year rapid panting and gasping for breath open-mouthed Pomeranian with a pad wrapped around her backside. "If you can't help her to breathe normally."

2 days ago, the Pom coughed blood, splattering red clots onto the apartment's floor. Vet 1 had warded her and advised euthanasia a few times while the dog was treated past midnight, according to the owner. "Your dog would need to be hooked up permanently to an Oxygen mask," Vet 1 had said. "Yet, I did not see the dog with the oxygen mask all the time during treatment," the boyfriend commented to me. I did not say anything as it was one side of the story.

In the morning, Vet 1 discharged the dog while another Vet 2 from the same practice gave a second opinion and medication. Vet 2 said: "This dog will live from 1 month to 1 year."

48 hours later, I was consulted, being referred to by the owner's 2 friends. It was kind of Vet 1 to give the two X-rays of the heart to the owner so that there was no waste of time for second opinions. Even the Singapore General Hospital where I had a chest X-ray recently does not do release X-rays to the patient.

"The vets said that this tablet will reduce the size of the enlarged heart." I shook my head. "Or stop it becoming more enlarged." I did not comment as there might be some mis-communication. I need to check this medicine out.

The dog's heart was beating too fast. I passed the microscope to the Temasek Polytechnic Vet Technician intern so that he could hear abnormal heart sounds. "Can you hear the 'whooshing' heart sounds in the stethoscope?" I asked him. "Normal heart sounds are distinct." He nodded his head. I offered the stethoscope to the young lady. She declined. This was too stressful. The dog was about to die from heart failure soon. His tongue was purplish.

However, I immediately gave an injection of 20 mg furosemide from the one ampoule of Lasix IM in the left muscle of the thigh. There was hope. Then the dog was crated while I showed the lady pictures of the normal heart in X-rays from Ve Medicine text book.

"Is it dangerous to the heart if the dog has more than 1 X-ray?"

"No," I said. "Your dog had only 2 X-rays at Vet 1 and never had X-rays before."




"Please take another X-ray," the lady said. I was surprised by this request.

"The X-rays from Vet 1 are excellent," I advised that there was no need for more X-rays. However the lady insisted. It was 10 minutes after my Lasix injection. The young Pom was barking loudly and her breathing was normal. She passed out a lot of urine. Lasix had reduced the amount of water in the lungs by getting the kidneys to increase urine floe. The onset of diuresis is within 1 hour. So the dog felt normal now.

As the duration of action is 6-8 hours, I got the Pom X-rayed 4 hours later by Vet 4. It was also good to discuss this case with him. Vet 4 proposed cardiac ultrasound to check whether there was pericardial effusion which could be treated via ultrasound imaging. Also, ultrasound could reveal any disorder of the tricuspid valve.

"Would the Lasix resolve any pericardial effusion?" I sought his opinion. He nodded his head. He had one case of success in draining the pericardial fluid from a dog who is still alive.

"The owner is concerned about the cost, saying she had spent $800 at Vet 1 and 2." Now, X-rays and a cardiac ultrasound could add up to $400. Vet 4 reduced his fees while I forgo my consultation fee so that this Pom could get the ultrasound done.His fees were a low $171.00. I appreciated his kind gesture. I charged $96 for the medications. The dog went home on a strict advice to stay at home and 3-hourly medication for the first week and communication with me. No no more fun and exercise at East Coast Recreation Park.

"How log will this dog live?" I asked Vet 4. "Vet 2 had said up to one year."
"Vet 2 is a bit too optimistic. This dog is unlikely to live past his 2nd year birthday."

The lady owner was extremely sad. This was a young dog. A present from her boyfriend. With compliance to taking drugs, a proper diet and giving medication when the dog started panting past midnight, the Pom is still alive at this time of my record today, Sunday Sep 27, 2009. It is only 7 days since the Pom coughed out blood, but there was no more horrible panting episodes.

Full record and updates will be at www.toapayohvets.com

14. A canine coup d'etat

"Why did you go to the SPCA at 2 pm to abort the scheduled euthanasia of this old dog?" I asked the couple who requested me to euthanase the dog as it was in poor haelth. One lethal injection and the vet gets his payment for his services.

"It was mum who sent the dog to the SPCA," the wife said. "She is very old and is unable to take care of the dog for my brother who is in hospital now."

This case reminded me of the various coup d'etat in Thailand. A coup is the sudden unconstitional removal of a legitimate government. In this case, the legitimate owner is in hospital. If his faithful companion who sticks to him through thick and thin is put to sleep suddenly, there will be reactions.

I asked the couple to ask the two pre-teen children to wait outside the examination room and advised: "The owner will find that the veterinary certificate of euthanasia with the cause that the dog is in poor health or cancer is incredulous. There will be high emotions and possibly bodily harm to family members. High emotions may lead to mental instability and murders."

The couple was silent for a while. They had not anticipated such extreme possibilities.

"You know the owner's temperament well," I said. I could also foresee litigation and even my demise by attackers unknown, due to acts of vengeance. My retribution for euthanasia of an old dog in a canine coup d'etat. This scenario sounds hilarious to you readers, but murders of passion do occur in any society.

Such cases must be handled carefully by the vet. Written permission must be obtained from the real owner. Analyse what is the problem. The main problem seems to me that the mum could not care for the dog. The solution was for me to board it at minimal cost. The couple took the dog home after 7 days.

I did not follow up such cases since I don't have the funds to help out the owner. A "PDSA" institution like that in the UK for dog owners unable to pay private vet fees will be good for such cases but nobody in Singapore has got one started.

13. Heath Screening 7-month-old Golden Retrievers

--- On Fri, 9/11/09, ...@gmail.com> wrote:


Subject: health screening for new dogs
Date: Friday, September 11, 2009, 12:39 AM

Dear Doc,

I want to adopt a 7 month old golden retriever (local cross breed
maybe) from my friend. It's not microchipped yet, so we want to implant
one for it and have a health screening.
Our most concerned disease is parasite toxoplasmosis gongii. I heard
this parasite can infect human and result in miscarriage. Although my
wife and I don't want to have baby yet, we don't want to have this
risk in future.
Hence, besides this T. Gongii testing, what else testing do you suggest?

We really love dogs. I also bought another pedigree golden retriever
from a renowned pet shop. They are specialized in golden retriever
breeding. This dog is also 7 month old, female as well. I want to have a health
screen for her too, cause people from pet shop said they can only
garantee me 24 hours for refund. So can you give me some suggestion
about how to test it?
I have checked her body. She looks quite good, but I am afraid of her
teeth. The last few teeth look like in grey color. I am not sure it's
due to some disease or just hygiene problem. As a matter of fact, I
did ask them to brush her teeth for me, but after that, the
improvement was negligible and bad breath still present.


Thank you doctor for your help! They are coming next week Thursday,
therefore I need to make sure we have enough preparation.

With kind regards,
Name


E-MAIL REPLY

Re: health screening for new dogs - dr sing
Friday, September 11, 2009 11:34 PM
From: Dr Sing

To:
...@gmail.com>
1. Thank you for email.
2. Regarding pedigree golden retriever with bad teeth and bad breath at such a young age of 7 months, it is best you don't buy her.
3. A general health examination including eye exam will be done. Cost is S$65.00/dog. Blood test to check blood system, liver, kidney and diabetes cost $150/dog. Toxoplasmosis blood test is separate charge, estimated to be around $100.
4. A 24-hour guarantee from the dog seller does not give you much time to know whether the dog has had been infected with the serious parvoviral disease if the dog is just infected prior to purchase. Disease shows itself 7-14 days after infection.
5. In 7-month-old dogs, you may need to check for stomach worms (stool sample), heartworms (blood test) and parvoviral infections (blood test). Approximate costs for the 3 tests $150.

Best wishes

P.S. Don't buy a dog with bad breath.

13. Create attractive graphic designs to educate pet owners

Graphic Design Essentials: Skills, Software and Creative Solutions
Joyce Walsh Macanio

LAYOUT - Path Layouts

A good path displays the objects of the page or print such that the reader's eyes read all its contents in a meaningful sequence. Start with a focal point to hook in the reader.

Focal points can be formed by:
1. Make an object a bright colour
2. Make an object dark.
3. Emphasie a compelling image or word
4. Sharpen one object and the others softly focused.
5. Object has a different texture or gloss.
6. Object has colour but background is black and white.
7. Change the value of the object to create contrast with the background
8. Unusual direction or position on the page for the object
9. Object isolated on the page.

Integrate Type and Image
1. Readers will read if you place your headline near the focal point or along the path.
2. Accents such as supporting images and text are placed to lead the eye through the page. Repeat colours, shapers and textures to create flow.
3. Vary size and color of text. Headline is the largest and brightest. Yellow against blue for example. Small logo in corner in white. Small dark copyright info at bottom left or right.

11. The Case of the Rat-Catching Westie

"I have no objection to letting you have the blood samples to give to Vet 1" I said to the two women in their 20s on this fine sunny morning at 9.30 am. My associate who consulted in the evenings and Saturdays had treated the Westie yesterday and told the owners that he suspected liver and kidney diseases. He had told them that the blood samples would be sent to an outside laboratory today. My associate had said that the results would be available after 2 days.

However Vet 1 could produce instant haematological results and the 2 women now wanted the blood to be given to Vet 1 whose instant blood test results would tell them whether the Westie was suffering from liver and kidney diseases.

I checked the case card. The complaint was that the Westie had stopped eating. I had given this 10-year-old Westie dental scaling 2 months ago and he was all right during general examination. I had not requested blood test prior to dental work as that meant extra expenses to the dog owners. Most don't like to pay more and many Singaporean dog owners don't even send their dogs for dental check up and would live with their bad breath for years.

"I am open to owners wishing to have 2nd opinions. But have you considered that Vet 1 may not be elated to receive your blood samples collected by his competitor? He may want to collect blood again as he may not trust the blood from my Surgery. He may say that the blood collected overnight will not be good for the test and therefore he has to collect fresh blood for analysis.

Human behaviour is unpredictable. If he is not happy, do you expect your dog to be well looked after? I had bad encounters with 2 vets in this practice before. When two of my owners wanted the dogs to be treated by them, I made prior phone calls. The two vets were very busy and judging from their phone conversation and mannerism, they would rather not get 2nd hand cases.

The 2 ladies had not thought of such behaviour but they do exist. "In any case, your Westie had been barking for at least half an hour and he sure did not look as if he was going to die soon." My associate had given the necessary IV drips and treatment yesterday evening and I would rather not interfere with his case to avoid confusion.

The apparently elder of the two ladies asked, "If Vet 1 collects blood again, will the blood test be different and affected by the treatment given?"

"Yes," I said. "Your Westie in the animal holding area was barking non-stop for at least 30 minutes this morning. He did not look as if he was going to die soon and therefore needed instant blood tests. In any case, blood test results from this laboratory can be available within 24 hours if we request urgent results"

The ladies vacillated. To go to see a new vet or not to go. Doctor hopping leads higher expenses.

I asked my assistant to bring the Westie into the consultation room for me to examine and then release for the 2nd opinion. There was no point in retaining this client. Mr Saw brought in the Westie and put the dog on the consultation table. The dog stood quietly as I opened his mouth. I showed the gums to the ladies and they could see that the dog had almost white gums. "Your dog has severe anaemia and blood tests would be very useful to help the vet know what is the cause of the anaemia."

Then I palpated the anterior abdominal area. As I felt the stomach area, the Westie shivered and gave a grunt of pain. The two ladies could hear and see his reaction.

"Did you feed chicken bones to this dog?" I asked. "Does he pass black smelly stools and had difficulty passing stools sometimes?"

"Yes," the older lady nodded their head in reply to the 3 questions. "I feed him chicken bones every day."

"Some chicken bones could have lacerated his intestines over the years causing bleeding in the intestines leading to black smelly stool formation. Some fragments of bones could be passed through undigested and got stuck in his rectum temporarily causing pain in passing motion. The prolonged episodes of bleeding would have caused severe anaemia. Of course kidney disease and other internal organ diseases can cause anaemia too."

"What else do you feed this dog?" I asked.

"Well," the older lady said. "He likes to catch rats when I exercise him around the coffee shop. Sometimes he would bring me the rats behind the coffee shop."

I was surprised that this 10-year-old senior could still hop around to catch rats. But he looked compact and solid. Some incipient cataracts but he was living his life to the fullest by catching rodents.

"Have you read in the newspapers about two people dying after eating rojak in a Geylang Serai food court?" I asked the two ladies.

"Yes," they could not connect the topic of food poisoning deaths in two human beings with their Westie's severe anaemia but were too polite to tell me.

"Well," I said. "Some patrons of this food court said that there were many rats in the food court running around."

Rats are common in food courts and they can be large and plump. They hide inside the sewers near the food court.

So what has rats in Geylang Serai to do with this Westie's severe anaemia?

I postulated, "The government authorities instituted a cleaning up. I am sure that the pest exterminatiors would be called in to get rid of the rats. Other food court operators in Singapore would take similar actions. They would use rat bait poisons to kill the elusive and fast-running rats beside other methods.

"So what?" the ladies sent me their thoughts by telepathy and awaited patiently for the connection.

"It is possible that your Westie had eaten rats poisoned by rat poison. More rat bait poison granules would have been placed on the areas where the Westie went hunting. They are attractive to dogs too. So, it is possible that your Westie had ingested them. The poison went to his blood system and destroys his red blood cells. So, he developed internal bleeding and showed this severe pallor of his gums and tongue. The blood results should come in within 24 hours if you are still interested in me sending the samples this morning."

The ladies spoke to each other and decided to wait. In the meantime, I gave this Westie 2 ml of Vit K1 subcutaneously. My associate had given the Westie intensive IV drip and that was OK.

Later in the evening, the blood results came in by fax and I informed the ladies that the Westie had very low red blood cells and platelets.

The next morning, the ladies visited the Westie. Mr Saw brought the dog onto the consultation table. The Westie moved his head away and struggled and preferred that I did not open his mouth. But I had to. What would be the colour of his gums?

The ladies gasped in surprise. Not really as Chinese ladies seldom express their feelings so opening unlike Caucasians. There are a reddish glow in the gums compared to 24 hours ago. As if the Vit K1 was an antidote and had helped to produce more blood. Of course there was the protein and other IV drips given to this dog. But the results were spectacular. From snow white to a reddish tinge. This was what counted.
Not just talk and talk.

To cut a long story short, the Westie was warded for around 5 days. His blood tests showed he had kidney and liver malfunction as well. This could be related to his suspected rat bait poisoning.






The important thing for the two ladies was that the Westie had regained his gum colour at the end of 5 days and could go home much alive and eating.

As for his rat-catching days, I guess that the ladies would retire him. In this economic depression, the Westie would be considered retrenched as his services were no longer required. But he would never be homeless or be deprived of tender loving care till the end of his life.

UPDATED STORY
goto www.toapayohvets.com or www.bekindtopets.com May 2009 serial.