In the afternoon of
June 3, 2010, I had taken out the files of the old Shih
Tzu with gigantic perianal tumours and gave a review of
this case to a new intern who was a Junior College Year
student from Raffles Institution.
I had driven back to the surgery with an old Shih Tzu
that had large perianal tumours excised by me four
months ago. However his tumours had not recurred, so the
old illustrations in my case sheets would be the only
way to educate her. I do illustrate my surgical cases
for review and to give to my clientele to educate them
and their families.
For the benefit of readers, the tumour case is described
Buying Time For An Old Companion - Cicum-anal (perianal) tumours in a male
"I have not seen many cases of perianal tumours as they
predominantly occur in male un-neutered dogs," I said to
the intern. The old Shih Tzu I drove back in my car now had a
normal backside and so I could not show her the real
thing. "Perianal tumours, also know as
circum-anal tumours seldom present themselves in
neutered male dogs or female dogs. Many Singapore dogs
are sterilised as dog licence fees are much lower. This
is why there are so few cases."
In the evening, I visited a veterinary surgery whose
founder was a colleague of mine during our
employment by the Primary Production Department (PPD),
Singapore as SPPO (Senior Primary Production Officer) . The PPD is now called the AVA (Agri-Food and
"How many cases of perianal tumours have you seen?" I asked the
founder's son who was on duty. His mum had not been in
good health and was not in the practice.
The son would be at least 30 years old. I could remember
him as a 10-year-old running around in his mum's surgery
when I was doing locum some two decades ago. Now he is
a young father and have to bear the responsibilities of
taking over the practice.
On this fine evening,
I was shocked to see that he had both sides of his head
shaved bald, leaving a central high turf of hair
bleached brown. I could never imagine he would be this
fashionable when he was half my height during his
The son said: "I don't see many cases. There is one
Alsatian in the Army having this anal problem. The Army
would not send it for treatment and I donated some of my
cream for the dog."
"Is the dog suffering from anal fistulas? Or
tumours? Why don't you get him treated?" I asked.
"The Army takes a long time to decide on treatment," the
son said. "There are many considerations before a sick
dog can be sent to the vet for treatment. The Army sends
their dogs to two veterinary practices if necessary."
"Why don't you ask the Army to send the old dog to me for
surgery?" I asked him. "I will charge $100 for everything to be done."
The son who was doing reservist duties in the
Singapore Armed Forces Provost Unit's Dog Company. I was
a veterinarian in charge of the health of guard dogs and
tracker dogs in this Dog Company when I was doing my
National Service in the early 1970s and am concerned
about the health of this old guard dog.
"It is not so easy to send a sick dog to the vet
for treatment," the son said. "The Army has to be
careful of expenditure and has to justify."
This is a sad state of affairs as Singapore is a
developed country and a retired guard dog's painful
backside does not get treatment.
One can be idealistic but in reality, any complaint from
me to the Commanding Officer would likely lead to euthanasia of
the old dog. For $100, a retired dog's life is
terminated by the bureaucracy. But which is worse?
Suffering from a painful backside daily but being
alive or death by lethal injection? Has the dog any
choices? Is there public funding for such cases for
retired army dogs? There must be a fund to
treat retired military dogs. In the meantime, I have to
store away my idealism by keeping quiet. Rocking the
boat will mean death of this dog as I doubt that the
Army would even organise transport to get the dog
treated for free.
At the surgery,
I borrowed the son's new thick cat medicine book
"Problem-based Feline Medicine" by Jacquie Rand, Edition
2007. I wanted to read more about a condition in cat where the
mucous membranes of the cat's fauces are
swollen and edematous. This surgery had many stray cat cases
and this was why I came to ask the founder and her son about one case
I encountered recently. It was an immune disease as
prednisolone reduced the swelling by 50% the next day.
The name of the condition is
plasmacytic-lymphocytic stomatitis/faucitis. My case was
severe faucitis as the cat did not have inflammation of
the tongue or gums. What a name for vet students or even
vets to remember.
"Where's Dr Sing?" the receptionist said in a
loud voice. I was sitting
on the sole chair at the waiting area to her left but
she could not see me. She had phoned a young couple to
come to the surgery me after
asking me how much I charged for surgery to excise the
The couple had been to another vet
since this surgery did not provide this service. The
fees quoted was over a $1,000 and the couple must have
sought the advice of the receptionist who asked me about
my fees since I was present.
"Didn't you talk to
the vet about the cost of over $1,000 perianal surgery?"
I asked the couple.
"No," the young-looking wife whom I estimated
to be in her 30s said. "A driver sent our
dog to the vet." She looked young as
contrasted to her husband who has many silvery grey
"Veterinary costs are now higher as many younger vets are
more careful about litigation and demand blood testing
prior to surgery." I said. "My generation appears backwards as
we would have simply operated. However, nowadays, in a
litigious society, there is no strong defence
against professional negligence if the dog dies under
anaesthesia if blood tests have not been done."
I asked the wife about the size of the tumour and to
illustrate on a piece of paper. It was around 2-cm in
diameter and was located below the tail and above the
anus. This is a very difficult area to do surgery as
there will be insufficient skin to stitch up. No wonder
the founder did not want to perform this challenging
The continuous dripping of blood from the backside of
their old Husky had caused the couple much distress.
"Did you talk to the vet about the breakdown costs of
over $1,000 for the surgery?" I asked the couple.
"No blood test
will be done for the fee quoted by Dr Sing," the
receptionist interjected. "I will not send the
excised tumour for histopathology to check whether it is
cancerous," I said to the couple. "That would bring down
a few hundred dollars of veterinary costs."
"Blood test is important to screen the health of the dog
before surgery. If the dog dies under
anaesthesia, the owner may complain that the blood tests
ought to have been done so that they would know the
risks involved before surgery. The owner may sue the
vet." I explained to the couple.
Blood tests would be useful as they can tell the vet
that the dog is having a serious bacterial or viral
infection or a liver or kidney disorder. Treatment would
be done first if the health screening showed
abnormality. A complete blood test would normally cost
"Is the Husky neutered?" I asked. "She
has been spayed," the wife said.
I had been presumptuous. This was a female dog.
Perianal tumours are rare in females dogs but this was
one of them. The world of veterinary medicine and surgery is
full of surprises everyday.
"Get your dog's infected backside treated at this
surgery first," I advised grooming, clipping of the
backside and Baytril antibiotics for 6 days. "Otherwise
the wounds will not heal well." The receptionist took
out the case card and recorded what needed to be done.
She calculated the cost and gave a fee estimate. This
was the most efficient veterinary receptionist I had met
and was definitely an asset to the founder of this
practice. Knowing what to do and not wasting time is
rare in many young receptionists. This receptionist was
able to create loyalty in the founder's clientele from
the way she cared about this customer by solving their
problem. She must have overheard my conversation about
perianal tumours with the founder's son as the door of
the consultation room was open to the reception and knew
what to do.
chemistry between a new vet and the prospective
clientele is good and this was the case after several
minutes of discussion and preparation for the surgery.
This is important. The wife offered to shake my hands with me
before she left.
There was a
young girl in pink overalls working in this surgery. Her
pink apron was unusual as I seldom see veterinary
receptionist in pink. A slim quiet girl who would be
learning from this receptionist on how to do things. I
was introduced to her after her Miniature Schnauzer's
bladder stone were removed by the son at my surgery (Toa
Payoh Vets) some three years ago.
son had operated on the dog. This was his first urinary
stone removal surgery and his mum had asked me for
assistance. So I was his mentor. See:
Mentoring a younger vet
Now three years later, the Schnauzer
is OK and has no bladder stones although he has been eating
dry dog food. "Are you feeding dry dog food to your
dog?" I asked the girl in pink in a serious voice. She
nodded: "Dr ... said it was OK." I was surprised that
this Miniature Schnauzer did not get a recurrence of
urinary stones despite being fed dry dog food after
surgery and for the past three years.
"It is best not to as the bladder stones may recur
unless the dry food is meant for dogs with urinary
stones," I said to the young graduate.
There seems to be
a high staff retention rate in this surgery. "Girls who left to work in
banks would come back during Saturdays to work," the
receptionist announced to me with maternal pride and to
say that the founder was very caring about her staff.
I was most impressed with the management of the founder.
It is hard to retain staff nowadays as many Singaporeans
have lots of choices and are picky.
Good service helps to retain and grow clientele too. I
was most impressed with this receptionist as she
knows what to do to solve a client's problem on
behalf of her employer without the need of prompting and
reminders. She is worth her weight in gold. Gold prices
are high and she is worth at least 80 kg worth of gold.