Cutie: Flash Glucose Monitoring System For Diabetic Pets

Joette with Cutie

how did cutie come into your life?

I was leading a busy and stressful life in the corporate world. The only thing I loved to do was visit the pet farms during my free time. I saw Cutie during one of my visits. She was at the back of the viewing room – her eyes so sorrowful. We both looked at each other for a long time. I could not stop thinking about her. Two weeks later, we brought Cutie home.

living with skin problems

When Cutie developed skin problems, we went to the vet very often but it just got worse. Then I met Dr Simon Quek at one of his talks. We did a skin allergy test to find out what Cutie was reacting to (e.g. pollen, dust mites, tobacco). It can be difficult to avoid exposure to certain environmental allergens. We started Cutie on immunotherapy and it has been working well.

living with blindness

Last year, Cutie was diagnosed with diabetes. Her condition worsened rapidly and within a month, she developed cataracts in both eyes. Cataract surgery was successfully performed by Dr Heng Yee Ling but unfortunately, Cutie developed glaucoma.

It was a very painful and difficult decision to go ahead with enucleation to remove both her eyes. You will find this silly – I actually let Cutie choose from 2 pieces of paper: ‘keep’ or ‘take out’. She kicked the paper with the words ‘take out’.

“We got the Muffin’s Halo to help Cutie get around. Now she is familiar with the surrounding – we do not move or add in new furniture – she can find her way around and even climb up and down the stairs. I guess she ‘activates’ her other senses and decided to move on with life.”

“I learnt something from Cutie: We don’t need a pair of eyes to see the world. We just need a heart to feel it.”

living with diabetes

We are very fortunate to meet Dr Nathalee Prakash and her team – their dedication, patience and commitment. To reduce stress in Cutie, Dr Prakash introduced us to a glucose monitoring device that is implanted into Cutie’s neck – no more poking of needles to draw blood.

Application of the sensor is relatively quick, painless and well-tolerated by diabetic patients.

“Now we can monitor Cutie’s blood glucose with ease at home. Cutie is the first dog to use this sensor!”

flash glucose monitoring system 

Effective blood glucose (BG) monitoring is essential for the management of dogs and cats with diabetes mellitus. BG readings can be affected by stress, food consumption and exercise. BG testing in a vet clinic can be stressful for our pets, especially cats. Under stressful conditions, the values obtained may not be an accurate reflection of the BG curve on a typical day.

A novel Flash Glucose Monitoring System is now available to measure interstitial tissue glucose levels every minute via a disposable sensor with a small catheter inserted under the skin. It can be worn for up to 14 days and eliminates the need for repeated blood tests at the vet clinic. The readings are collected, registered and stored automatically. Email or call 6251 7666 to find out more.

For patients living with diabetes, consistent, unchanging and constant are keywords to remember for lifestyle, diet and treatment.

Ideally, a diabetic dog or cat should be fed the same type of food, same amount, at the same time each day. A regular schedule will help minimise fluctuations in blood glucose so that the amount of insulin needed remains the same. Once the diabetes is properly regulated, our diabetic pets like Cutie can live relatively normal lives.

We always welcome medical stories of your animal friends which can educate and inspire others. Email us at if you have a story to share. Meanwhile, be part of Mount Pleasant community over at our Website and Facebook.

Thank You Thelma & Kerry May!

“It is very rewarding when a sick animal puts his or her entire trust in us. We do not share the same language but with our actions, we hope they understand we are doing them no harm.” Today we say THANK YOU to Thelma and Kerry May of Mount Pleasant Animal Medical Centre (Farrer)!


“I joined Mount Pleasant in 2002, with our very first hospital at Whitley Road. I’m a registered medical technologist and also a respiratory therapist when I was in the Philippines. I am curious and intrigued by animals – there are so many species and sizes!” ~ Thelma of Mount Pleasant Animal Medical Centre (Farrer)


“As with any job, it is always rewarding to feel appreciated and respected.”


“I believe in thinking positive. Someday, everything will make perfect sense. For now, laugh at the confusions, smile through the tears, and always keep reminding yourself that everything happens for a reason.” With Big Man who was rescued by Noah’s Ark CARES after he was hit by a truck. He is now the resident bouncer, greeter, food taster, dancer and Mount Pleasant Hero!


“I enjoy cross-stitching and making trinkets and giveaways. If I can be anything in the world, I would be an astronaut – I want to see the universe!”


“In the beginning, cute furry animals were the appeal. As time goes by, it becomes apparent that as stewards of this earth, it is our responsibility to take care of helpless animals.” ~ Kerry May


“I joined Mount Pleasant in October 2015. Working with animals is a challenge I enjoy taking on. It is very rewarding when a sick animal puts his or her entire trust in us. We do not share the same language but with our actions, we hope they understand we are doing them no harm.”


“If I can be anything in the world, I would be an animal whisperer! To understand the needs of animals. If I did not have this opportunity to work with animals, I would most probably be a chef.”


“We adopted Teddie about 2 years ago. He’s not the most well behaved fur sibling I could ask for but I cannot imagine life without him now. He taught me patience, which is especially helpful when I deal with nervous patients.”


At a farm in Taiwan


“My colleagues are my inspiration. Their passion and love for their jobs and animals is my motivation. (We all know what is Big Man’s motivation!) I believe in giving my best in all that I do.”


A common – make it very common – scene during meal times!


Part of the big happy family at Mount Pleasant Animal Medical Centre (Farrer)!


Opening ceremony of Mount Pleasant Animal Medical Centre (Farrer) in March 2015!


Team bonding!


Forest Adventure!


Dr Heng Yee Ling and her team have a special interest in veterinary ophthalmology. The clinic is equipped to treat a variety of eye conditions like glaucoma and corneal ulcers. Dr Heng also performs cataract surgeries.

Hershey Says “Thank You Dr Heng Yee Ling”


First week after Hershey’s cataract surgery, praise God! She is recovering really well. And beginning to be more active than usual. I love how she walks more confidently now.

Thank you everyone for your continuing prayers and support. Big thank you to Dr Heng Yee Ling of Mount Pleasant (Farrer) for her professional care post-op! We are truly blessed and grateful.

Dom and Hershey

Dandelion’s Enucleation (Eye Removal)

Dandelion (formerly named Baileys) the Shih Tzu was bought from a petshop as a puppy. When she developed pneumonia and severe ulceration of her left cornea, her family wanted to give her up to a shelter.


One night, Baileys could hardly move and was rushed to Mount Pleasant After Hours Emergency Clinic. Baileys’ family did not want her anymore. Thankfully, she was adopted by Ms Wong Fang Juin and for a new beginning, renamed Dandelion.

corneal ulcers

The cornea is the outermost covering of the eye. Corneal ulcers are painful wounds to one or more layers of the cornea. They are often caused by abrasions or scratches. Read more about corneal ulcers hereOther causes of corneal ulcers include:

  • entropion (rolling in of eyelids)
  • ectopic cilia (abnormal eyelashes rubbing on cornea)
  • keratoconjunctivitis sicca (dry eyes)
enucleation – surgical removal of an eyeball

When deep ulcers cause scarring or perforation of the cornea, the eye may need to be surgically removed. The eye may also need to be removed due to other conditions like:

  • uncontrolled painful glaucoma (increased pressure in the eye)
  • severe infection
  • cancer
  • trauma or injury (puncture or perforation of eyeball)

Brachycephalic breeds like Shih Tzus, Pekingeses, Bulldogs and Persian cats are more vulnerable to corneal damage due to their flat faces, shallow eye sockets and prominent eyes.

Symptoms of corneal ulcers include:
  • red or watery eyes
  • squinting
  • eye discharge
  • rubbing eyes with paws (which causes further trauma)
Some of you have asked if little Emma's right eye is still any good. Here you can see the extent of scarring on her right cornea. There is no reflex to light or objects.

Emma, a Shih Tzu, was rescued from a breeding farm 3 years ago. See the extent of scarring on her right cornea – there is no reflex to light or objects.

Little Emma, we thought maybe, possibly, you still have some sight in your eyes. But today it is confirmed that you are totally blind. Your left eye is dead and dried up like a prune. You need special eyedrops for your bulging right eye, to bring down the pressure.

Dr Heng Yee Ling, Mount Pleasant Animal Medical Centre (Farrer), examined Emma. Her left eyeball has already ruptured and shrivelled up. Due to increasing intraocular pressure in her right eye, Emma later went through enucleation to remove both eye balls.


(Dandelion) In surgery, the eye is removed and the eyelids are permanently sutured closed. An Elizabethan collar is put on to prevent rubbing or scratching of the area. Stitches are removed 10 to 14 days post-surgery.


(Emma) There may be swelling and bruising of the eye area which will subside with time. Some owners choose to have a sterile prosthetic sphere inserted into the eye socket (orbit) mainly for cosmetic reasons. It is not recommended for patients with eye infections, cancer or very shallow eye sockets.


Over time, the swelling will subside and the socket will flatten out. Hair will grow back over the area.


Pets like Emma will need some time to adjust to their blindness and learn to find their way around. Avoid startling them. Be patient and let them know you are approaching by calling their names or lightly clapping your hands.


“Dandelion adapted well. She doesn’t seem to know that she has lost an eye.” ~ Ms Wong


“I have adopted another Shih Tzu, Yuki, 13 years old She is also blind in her left eye like Dandelion.” ~ Ms Wong


“If you have blind dogs, you should not have too much furniture in the house. Avoid moving the furniture around.”  ~ Ms Wong


Most blind dogs and cats learn to form a mental map of their environment. Help them adjust with the following tips:
  • Keep your blind pets safe in smaller areas until they are more comfortable to explore.
  • Remove extra furniture or potentially hazardous objects.
  • Keep the layout of your house constant. Avoid moving furniture around.
  • Leave food, water bowls and litter trays (for cats) at the same place.
  • Water fountains may be helpful. Your pets can hear and locate the water source more easily.
  • Use scent markers or tactile clues (floor mats) at certain areas.
  • Before petting or picking up your blind pets, let them know you are approaching by calling their names or clapping your hands.
  • Create a quiet and safe spot where your blind pets can retreat.

Emma may not be able to see the world but she is having a wonderful life with Florence Bong who went beyond looks and age when it comes to adopting a best friend.


Emma is a very spunky gal. Watch the video of her taking a walk outdoors!

Other patients who have had successful enucleations

Hapi Pepi after enucleation and implantation of an intrascleral prosthesis

Little Angus


Helping Nala See Again

Cataract is the leading cause of blindness, especially in senior dogs. Once a cataract has developed,  no eye drops or medication can reverse it. Thankfully, surgery can remove cataracts and help blind dogs see again.

what is a cataract?

The lens is a clear structure inside the eye that focuses light and images on the retina. It is made up of clear protein surrounded by a very thin and elastic capsule.  A cataract is an opacity or cloudiness that forms within the lens.


Very small cataracts would not affect vision too much. However, as the cataract progresses, it can cause uveitis (inflammation in the eye), retina damage or glaucoma, leading to permanent blindness. Signs of uveitis include increased eye redness, squinting, excessive tearing and light sensitivity.


Senile Nuclear Sclerosis is commonly seen in dogs 7 years and older. Lens fibers are continuously being produced. As older fibers are compressed in the nucleus, the lens take on a bluish-grey hue. No treatment is required as light can pass through a sclerotic lens. The cloudiness does not impair vision.

Mount Pleasant Newsletter - Apr to Jun 2015


Coco the Jack Russell Terrier, 5 years old. When the cataract is mature, the lens becomes opaque. It is like looking at the world through frosted glass.


Bebe the Poodle, 8 years old, adopted from SOSD. Poodles are prone to retinal detachment if the cataracts have been present for a long time.


“We adopted Nala 6 months ago. Because of her cataracts, she knocks into things, especially white walls or chairs, and when she gets excited playing ball.” ~ Rachel Tan

What Causes Cataracts?

When cataracts occur in younger dogs (less than 6 years of age), it is usually hereditary. Cataracts can also develop from:

  • diabetes: early detection and surgery is especially important with diabetic cataracts which can progress rapidly
  • old age
  • nutritional deficiencies
  • toxins
  • trauma

If your dog’s eyes look cloudy or bluish-grey, have her examined by a veterinary ophthalmologist. A series of diagnostic tests will be performed (e.g. check tear production, measure intraocular pressure (IOP), stain the eye with a fluorescein dye to evaluate ocular surface).



Advanced testing may include electroretinography (ERG) to evaluate the electrical activity of the retina. If the retina is not functioning properly, cataract surgery will not visually benefit your pet.


Nala the Dachshund, 3 years old. Her cataracts developed when she was just 1. A year later, she was blind.

“My mom insisted on Nala having cataract surgery. It is costly. But knowing Nala will regain her vision is more important to my family. My mom, sis and I saved over 6 months for this surgery.”


“We started performing cataract surgery once a week but due to an increase in demand, we have to create more slots for surgery. Many of our patients are Toy Poodles and Miniature Schnauzers.” ~ Dr Heng Yee Ling

Preparing The Eye For Cataract Surgery  

Under general anaesthesia, the eyeball usually rolls back into the socket, making it inaccessible to the surgeon. An intravenous nerve block is administered which makes the eyeball rotate to the centre.

Staining The Lens Before Phacoemulsification

A small corneal incision is made to gain entry into the eye and a blue dye injected to stain the lens to make it clearly visible. Then a small window is created in the lens capsule through which the cataract is broken apart and removed via a procedure called phacoemulsification.

Inserting The Intraocular Lens (IOL)

Once the cloudy lens material is removed, the capsule is cleaned and polished. An artificial replacement lens is then inserted into the lens capsule. This will improve the vision of the patient tremendously.

Ref: discovery

Suturing The Corneal Incision

After the corneal incision is closed up with absorbable sutures, the patient is monitored closely as she recovers from anaesthesia. Post-operative eye medications are administered. Intraocular pressure (IOP) is measured at regular intervals to ensure it is within normal range.

how do i Care for my pet after surgery?

Vision usually improves within 24 hours and continues to improve over several weeks. Your pet will require the following:

  • oral medication
  • medicated eye drops
  • an Elizabethan collar to prevent self-trauma to eyes
  • re-examination of the eyes within 1 to 5 days, then 1 week after surgery, and again 2 weeks after surgery. Thereafter, the schedule for reviews is determined by the vet and progress of your dog’s recovery.
Before & after cataract surgery. Rachel & family has not only given Nala the gift of a new home, they have given her the gift of sight. We will follow up to see how Nala progresses over time!

Before & after cataract surgery. Rachel & family has not only given Nala the gift of home, they have given her the gift of sight!

“When Nala got home last night, she started barking at everyone, probably because she has never seen us & our house before. We comforted her with our voices which she is familiar with. Today, she is much calmer.” ~ Rachel


Teamwork at Mount Pleasant Animal Medical Centre (Farrer)

robin stanley jp

Whether it is Xiao Hei the bunny, Noah the Cocker Spaniel, Nala the Dachshund, Bebe the Poodle, Ming Ming the Chihuahua or Coco the JRT, there is something comfortingly the same – you can feel it in the air. The guardians love their pets. So very much.

No matter what our pets are living with, Dr Stanley says it beautifully: “We humans may feel sorry for ourselves. These animals, they just make the best of every situation.” But what a wonderful gift it is, to be able to help the blind see again!

Dr Heng Yee Ling, Mount Pleasant Animal Medical Centre (Farrer), graduated from the University of Edinburgh. During the course of her studies, she realised her interests in soft tissue surgery and in particular, veterinary ophthalmology. In 1997, she completed the Post Graduate Foundation Course in Veterinary Ophthalmology and has been performing cataract surgery for the past 3 years.

Dr Robin Stanley graduated with first class Honours from the University of Melbourne in 1984. He undertook an ophthalmology residency from 1987 to 1989, and in 1990, obtained his Fellowship of the Australian College of Veterinary Scientists in the field of ophthalmology. Dr Stanley is registered as a veterinary eye specialist and works in a dedicated ophthalmology-only practice in Melbourne. He consults and performs eye surgeries at Mount Pleasant Animal Medical Centre (Farrer) every quarter. Contact 6271 1132 for more info.

Megan’s Excessive Tears


Megan the super friendly Lab came to Mount Pleasant Animal Medical Centre (Farrer) to check on her excessive tearing.

Epiphora is an abnormal overflow of tears from the eyes. It is usually caused by:

  • obstruction of tear drainage system.
  • overproduction of tears, often due to irritation or inflammation of the eye.
How are tears drained from the eyeS?
  • Two small openings called punctae are present at the inner corners of each eye.
  • Tears flow down these drainage holes into the lacrimal sac.
  • From this sac, a small tube called the  nasolacrimal duct carries the tears into the nose.
  • The tears then drain to the outside through the nose.

If the tear ducts are blocked (like a blocked plumbing system), tears in the eye back up and overflow down the face, usually from the inner corner of the eye.

Tears are drained through the nasolacrimal duct (tear duct) into the nose. The tears also help to keep the nose moist. Reference:


A piece of blotting paper containing fluorescent dye is applied to the surface of Megan’s eye.


A fluorescein eye stain can also reveal any corneal ulcers or lacerations.


The dye will be left in Megan’s eyes for about 5 minutes before Dr Heng Yee Ling assesses if the tears are flowing normally through the tear ducts.


After 5 minutes, the dye applied to Megan’s eyes has flowed through her tear ducts and can be clearly seen in her nose. Her tear drainage system is functioning properly.

A thorough examination shows that Megan’s eyes are looking good. The excessive tears could be due to a temporary irritation. For senior dogs like Megan, it is advisable to see the vet twice a year for a general health check.

what can be done for a blocked tear duct?

If your dog does have a blocked tear duct, the vet can perform a nasolacrimal flush. Eye drops may be prescribed. If the problem persists, a nasolacrimal catheter (small plastic tube) can be passed through the tear duct into the nose under general anaesthesia.

Megan is well and healthy. most importantly, happy! It is her birthday tomorrow. So from all of us AT MOUNT PLEASANT, HAPPY 10TH BIRTHDAY BEAUTIFUL MEGAN! 🙂

Lucky The Beagle – Glaucoma

Glaucoma is a condition where there is increased pressure within the eye.

Inside the eye, cells produce a clear fluid (aqueous humor) that nourishes the tissues and maintains the shape of the eye. When there is proper drainage of the fluid into the bloodstream, normal pressure is maintained within the eye.

The problem starts when the drainage is partially or fully blocked. As the fluid continues to be produced but does not drain properly, pressure within the eye increases.


Left untreated, increasing pressure within the eye can damage the optic nerve and cause irreversible blindness. The pressure also stretches and enlarges the eye, as can be seen in Lucky’s left “bloodshot eye”.

Glaucoma can be inherited or caused by different conditions including uveitis (inflammation of the eyes), lens displacement and retinal detachment. Lucky’s condition is caused by advanced cataracts which were untreated.

Being a painful condition, dogs with glaucoma may partially close or rub their eyes and avoid being touched. There may be eye discharge and the sclera (white of the eye) may look red.

Veterinary ophthalmologist measures the Intraocular Pressure (IOP) using a tonometer. Normal IOP is between 10 and 20mmHg.

Dr Heng Yee Ling, Mount Pleasant Animal Medical Centre (Farrer), measures the pressure within the eye – Intraocular Pressure (IOP) – using an instrument called a tonometer.

The IOP in Lucky’s left eye is 34mmHg. Normal IOP is between 10 and 20mmHg.

Unfortunately, Lucky is already blind from advanced cataracts. Although his sight cannot be restored, medications can provide pain relief and offer him some comfort. Lucky will be on longterm medicated eyedrops to reduce both the inflammation and pressure within his eyes.

If the pressure remains elevated, enucleation (surgical removal of the eyeball) may have to be considered.

How is Lucky coping? As with most blind dogs, he is adjusting quite well to blindness by depending a lot more on his sense of smell and hearing. Once your blind dog has “mapped out” the house, try not to move furniture or other items around. Unique scents or little bells can also help your blind dog locate different areas or objects in the house.

Indolent Ulcer: The Ulcer That Won’t Go Away

The cornea is the clear, transparent part of eye that lets light into the globe, much like the aperture in a camera . The outer layer comprises several layers of epithelial cells which protects the rest of the cornea.



Corneal ulcers are painful defects to one or more layers of the cornea – like a scrape wound on your skin.

  • Superficial ulcers involve just the outer layer – epithelium. Uninfected ulcers heal rapidly (within 5 to 7 days) as the epithelial cells grow into the defect and new skin sticks to the underlying tissue.
  • Deep ulcers extend into the middle layer – stroma – and take longer to heal. With deep ulcers, vision may be severely compromised or even lost. Often, intensive antibiotic therapy and surgery is required.


  • ­Trauma: scratches, abrasions, puncture wounds
  • Entropion: eyelids rolling inwards
  • Keratoconjunctiva sicca: dry eyes
  • Ectopic cilia hairs: fine eye lashes that point inwards
  • Foreign body: an object sitting on the eye surface, e.g. a seed
  • Squinting
  • Excessive blinking
  • Tearing
  • Eye discharge
  • Pawing at the eye
  • Redness of the conjunctiva

Corneal ulcers are painful. Your dog will be squinting and tearing. There may also be eye discharge.

fluorescein stain test

Most ulcers can be diagnosed using a fluorescein stain. A green, non-toxic dye is applied to the surface of the cornea. On normal healthy eyes, the dye does not stain the corneal layer. If there is an ulcer, the dye adheres to the ulceration and illuminates bright green under a special light.


Fluorescent dye sticks to the area of the eye that has a wound


A slit lamp allows our vet to evaluate your pet’s cornea with a high degree of magnification & resolution. It helps determine the extent & depth of an ulcer.

what is an Indolent corneal ulcer?

Indolent ulcers are usually superficial and non-infected but take a very long time to heal. New skin tries to grow over the ulcer but fails to adhere to the underlying tissue. With careful examination, a thin layer of loose tissue can be seen surrounding the ulcerated area.

Because the epithelial cells do not stick down to the tissue underneath, it is not possible for indolent ulcers to heal with just the use of antibiotic eye medications and artificial tears. Without appropriate treatment, indolent ulcers persist for months and cause ongoing discomfort.



Indolent ulcers are also known as chronic epithelial erosion, refractory superficial ulcer, Boxer ulcer and epithelial basement membrane dystrophy.

corneal debridement

In order for an indolent ulcer to heal, the loose tissue needs to be removed in a process called debridement. After local anaesthetic eye drops are applied, dry sterile cotton-­tipped swabs are used to gently remove the loose abnormal epithelium surrounding the ulcer. This procedure may have to be repeated several times.

For the indolent ulcer to heal, loose epithelium needs to be removed for normal healthy epithelium to grow and spread across the defect to allow healing.


Sometimes, a surgery is performed to suture the third eyelid across the defect to help the cornea heal faster.

grid or linear keratotomy

If needed, grid or linear keratotomy is performed after debridement. A hypodermic needle is used to make superficial parallel incisions in the underlying exposed stroma. Simply put, we scratch the cornea with a needle to provide a rough surface for new epithelial cells to anchor onto and allow for proper healing.


Grid keratotomy can be performed on calm and cooperative patients like Bonsi under topical anaesthesia. Otherwise, sedation or general anaesthesia is necessary.

Medications will be dispensed to prevent infection and control pain, and your dog will return for reviews until the ulcer is fully healed. Surgery for an indolent ulcer has to be considered if it fails to heal after several attempts at debridement and keratotomy.