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Date:   03 September, 2008
Focus: Small animals - dogs, cats, hamsters & rabbits
*10 a.m - 5 p.m (Mon - Sun, except Sat). Dr Sing Kong Yuen. By Appointment Only.

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Be Kind To Pets
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Toilet training your puppy in Singapore  Dr Sing's research book to be published

Toa Payoh Vets Clinical Research
Making veterinary surgery alive
to a veterinary student studying in Australia
using real case studies and pictures

A bloodless surgery
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
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.

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