921. The vet's suture
protruded the skin - Good stitching patterns count.
Two days ago, two
ladies and their father brought a 17-year-old cat to
the Surgery. The cat had been pawing her neck trying
to get rid of a nodule 1 cm x 1 cm. Dr Daniel handled
the case. The over 70-year-old slim built father was
at the waiting room and I was at the reception and
since he was chatty, I had an interesting conversation
"Why do you not go to the vet nearby your house?" the
father mentioned that he lived near a vet. However,
his daughter did not want to consult this vet.
"The vet spayed this cat. But the cut was very long,"
he said. "The skin protruded from the stitches. So my
daughter did not want to go there."
"Standard spay wounds are around 2 cm long," I said.
"Unless there are complications of bleeding or other
reasons such as pyometra."
In this case, I did not know what had happened. This
is one of the times that a neat and good stitching
pattern does impress and count in retaining client
loyalty. And this was 17 years ago when the daughter
would be in her teens. This daughter-in-charge looked
to be in her earlier 30s and was in the IT field,
according to the father. So, the internet brought her
to Toa Payoh Vets, according to the father. The
internet is a double-edged sword and could drive
clients away when there are bad reviews from one or
two vocal unhappy owners or competitors.
Well, the 17-year-old cat had this irritating neck
nodule (1 cm x 1 cm) that she scratched. Dr Daniel's
advice of a blood test prior to surgery was accepted
by the IT daughter. Serum urea and creatinine levels
were above normal and though the cat was normal, the
daughter was not in favour of surgery.
"This cat has white strong teeth," Dr Daniel told me.
"Can this cat be younger?"
"Very rare for a 17-year-old cat to have good teeth,"
I said. "But many cat owners do know the age of their
As the father was complaining about a specialist
earlier, I asked him what was the problem. "The
specialist told me what was the big fuss I was making
about my health since the brain scan showed no brain
tumours? Why would I pay for a brain scan?"
Sometimes, it is best for a doctor or vet not to
comment on personal behaviour but stick to the medical
"What's exactly happened to your father's eye?" I
asked the IT daughter later as her father did not
speak English but the Hokkien dialect. The daughter
put her fore-finger on the lateral side of her left
eye and pulled up the eyelid at 45 degrees. "His
eyelid flicked sideways and upwards now and then."
"The specialist said he had no problem in the brain
MRI," I said. "That may be because the problem could
be somewhere between the eyeball and the brain!"
"We are not refined cultured people like the
specialist," the father was still mad about the poor
bedside manners of this specialist.
Yet he does have a real medical problem. Earlier he
had a hard lump below his left eye but this lump had
So, what was he suffering from? He had no diabetes, no
hypertension and was not obese.
"He does have a medical problem," I told the IT
daughter to do an internet search of nerve pathways
between the eyeball and the brain. "It is likely that
a small tumour had impinged onto the nerve in this
pathway. It irritates the nerve and the left eye's
upper eyelid twitches suddenly, pulling up the
It must be embarrassing for the father when that
"It is best to consult a good neurologist or eye
specialist." I said. "The problem is to find that
particular one in Singapore. It is extremely hard to
find one with the experience with this problem."
I had a similar sudden flicking up of my middle finger
of my left hand two years ago. It would flick up now
and then. Finally I had a non-malignant nerve tumour
behind my wrist excised and the problem disappeared.
So, I could empathise with this senior citizen. It was
no laughing matter for him. And he does have a medical
problem. "Only that the particular specialist he
consulted could not diagnose this problem!"
Life is hard for senior citizens when twitches and
spasms of eyelids are not diagnosed and removed. A
trigger finger is not so obvious to outsiders but a
twitching upper eyelid could be most embarrassing when
it occurs during a conversation with somebody. I hope
this IT daughter will find the correct specialist -
neurologist or Ear Nose and Throat surgeon probably, I
advised her. If anybody can do it, it will be this IT
daughter, but would she have the time to do it? I had
pointed the direction to her. It is up to her to be
diligent to find out the correct specialist to
pin-point the tumour affecting the father's eyelid
before it grows immensely.