Spuddy: Lymphoma And Chemotherapy

“Spud was diagnosed with lymphoma last August and nothing could have prepared us for this. We have always thought of her living her golden years with us and I even started preparing for that: a car that is easier for her to get into and a bed for her on the first floor, so she would not have to climb the stairs, in a hopefully remote future.” ~ Julie

While Spuddy is living bravely with lymphoma, it is important to make sure she is eating well, getting lots of rest and keeping to her normal routine to reduce stress levels. Spud loves going to work with her adopted sibling Elliot.

Last August, 12-year-old Spuddy was diagnosed with canine lymphoma – a cancer of white blood cells called the lymphocytes. Affected dogs are typically middle-aged and older. The cancer cells invade and destroy normal tissues,  most commonly the lymph nodes, and cause the nodes to swell and harden. As the disease progresses, internal organs such as the liver, spleen and bone marrow become affected.

the patient OFTEN PRESENTS WITH LUMPS OR SWELLINGS ON THE NECK, ARMPIT AND GROIN AREAS

Lymphoma is a common cancer in dogs.  When Spuddy was referred to Dr Cheryl Ho, her lymph nodes were enlarged. At one stage, her right submandibular lymph node (on the neck) measured 7cm x 6cm. Other signs of lymphoma include appetite loss, weight loss and fatigue.

Biopsy and other diagnostic test (such as complete blood count, platelet count, biochemical profile, urinalysis, ultrasound) allow vets to accurately diagnose lymphoma and stage the disease to determine how far the cancer has spread. Chemotherapy is a treatment choice to shrink enlarged lymph nodes and aim for complete remission.

“Facing the ugly truth revealed by the biopsy, we decided that if there were any chance of helping her through this, we would take it. Losing her in a couple of weeks or months was something we could simply not accept as we felt that she still had so much to live for. We set a simple rule: we would do anything, as long as it wouldn’t compromise the quality of her life. With that, we decided to put her through chemotherapy. We spoke to a couple of vets and an owner who went through chemotherapy with her dog, to gather as much information as we could. And so we took this route.”

Most dogs tolerate chemotherapy well. Regular monitoring and checkups are important to evaluate Spuddy’s response to treatment.

The goal of chemotherapy is to kill and slow the growth of cancer cells, produce minimal negative effects on normal cells and improve quality of life.

Most dogs tolerate chemotherapy well. Common side effects include appetite loss, decreased energy level, mild vomiting or diarrhoea over a few days. If serious side effects do occur, the medical team will review and adjust the treatment protocol.

Spuddy was started on cyclophosphamide, doxorubicin, vincristine (CHOP chemotherapy protocol). She was responsive to initial treatment and the enlarged lymph nodes became smaller. However when the protocol was completed, Spud only achieved partial remission.

rescue protocol

For dogs like Spuddy with chemotherapy resistant lymphoma, rescue protocols are available where different drugs or different combinations of drugs are given together with proactive supportive care to induce remission and maintain a good quality of life.

“Spud has had many good days and some not so good days since starting her treatment but for every extra day we get to spend with her, we are forever thankful. Spud is family, a great friend and a sweet, iconic presence in the house and even in the office. That is why we are resolved to see her through this difficult battle she has undertaken.”

Week 4 rescue protocol: Most chemotherapy drugs are given by intravenous (IV) injection. A few are given by mouth as a tablet or capsule. Doses of drugs and treatment schedules are carefully calculated to minimise any discomfort to Spuddy.

Together with veterinary oncologists, Dr Cheryl Ho and team at Mount Pleasant Central Vet Clinic (Whitley) worked out a rescue protocol for Spud. Dogs who failed to respond to initial chemotherapy have been known to achieve durable remission with rescue chemotherapy.

Am I making the Right Decision?

If your pet has been diagnosed with cancer, work closely with your vets to decide on a treatment plan that works best for your pet and your family. When chemotherapy is not an option, whether for emotional, time or financial reasons, discuss other treatment plans which can help your pet feel better and maintain a good quality of life.

“We have been very fortunate to have had great support from family, friends, medical staff and colleagues at work to go through this journey with us.” Spuddy’s BFFs Carol & Elliot

There is no absolute right or wrong along the journey and there may be moments we doubt ourselves and the choices we make. Hopes high – with support from family, friends and vets who do not give up too easily – dear Spuddy will have many more good days ahead of her.

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3 Reasons Why Health Screening Is Important For Our Dogs & Cats

Health screening is not just for seniors – it is for dogs and cats of all life stages. Many animals do not display signs of diseases that may have developed. Early detection, pain control and treatment can prolong the quality of our pets’ life. Contact any of our 9 clinics about our Annual Health Screen Programme in November and December 2017.

some signs that your dog or cat may be ill:
  • Bad breath or drooling
  • Excessive drinking or urination
  • Excessive panting or laboured breathing
  • Frequent diarrhea or vomiting
  • Unexplained weight loss or weight gain
  • Change in attitude or activity level
  • Strange lumps or bumps
Annual health screening programme at mount pleasant INCLUDES:
  • Physical Examination
  • Complete Blood Count
  • Blood Chemistry Panel
  • Urinalysis
  • Faecal Analysis
  • Heartworm Screen (for dogs)
  • Chest X-Ray (for dogs)
  • T4 Screen (for cats)

1. COMPLETE BLOOD COUNT & BLOOD CHEMISTRY PANEL

Complete Blood Count (CBC) can uncover hidden health problems such as anaemia (low red blood cell count), infection, inflammation, dehydration, autoimmune diseases, blood clotting problem (low platelet count).

Blood Chemistry Panel measures a variety of chemicals and enzymes in the blood to detect liver disease, kidney disease, diabetes mellitus, pancreatitis and other hormonal diseases.

For young healthy pets, CBC and chemistry profile help establish baseline values for comparison with future test results.

2. HEARTWORM screen FOR DOGS

Heartworm disease is a serious, progressive and potentially fatal disease. It is caused by a parasite Dirofilaria immitis which is transmitted by mosquitoes. All dogs who are not on heartworm prevention are at risk of heartworm infection. Dogs living in landed properties and those who regularly walk in mosquito-prone areas are at higher risk.

Heartworm disease occurs mostly in dogs and less commonly in cats. Ref: dogaware.com

An adult heartworm can grow up to 30cm long.

Heartworms live in the heart, lungs and associated blood vessels where they mature and reproduce. In the early stage, your dog may not show any symptoms. As the number of worms increases, signs of heart failure develop. E.g. weakness, exercise intolerance, coughing, decreased appetite, weight loss.

The earlier the disease is detected, the better the chances of your dog’s recovery. Learn about prevention and treatment. 

3. T4 SCREEN FOR CATS

Hyperthyroidism is a common disease in older cats over 10 years old. The most common cause is a non-cancerous change to the thyroid tissue (thyroid hyperplasia) causing excessive thyroid hormones to be produced. Cancer of the thyroid glands (thyroid carcinoma) is rare.

The thyroid hormone has multiple functions, primarily involving the metabolic system, e.g. regulation of heat production (a person with hyperthyroid perspires a lot) and the control and “burning” of fat, protein and carbohydrates.

Too much thyroid hormone results in increased metabolism & hyperthyroidism. Too little causes hypothyroidism. Ref criticalcaredvm.com

Blood tests can be done to check for elevated levels of thyroxine (T4) in bloodstream. In early stages, total T4 level may be within normal range. Retesting should be done in 3 to 6 weeks, especially when clinical signs are present. Read more about “Hyperthyroidism In Cats”.

Common clinical signs include weight loss despite increased appetite, increased thirst and urination, vomiting, diarrhea, hyperactivity. The coat may appear matted and unkempt.

our SENIOR PETS SHOULD SEE THEIR VETS EVERY 6 MONTHS

Our dogs and cats age much faster than we do and are usually considered seniors when they are 7 years old. As our pets enter their golden years, twice yearly health screenings are recommended to detect age-related diseases at an early stage. We can help our pets stay healthy and pain-free for as long as possible.

Contact any of our 9 Mount Pleasant clinics for more info & make an appointment.


We welcome medical stories of your animal friends to educate and inspire others. Email us at comms@mountpleasant.com.sg and be part of Mount Pleasant community over at our Website and Facebook.

Urinary Incontinence In Our Senior Dogs

Urinary incontinence is the inability to control urination, a common problem in ageing dogs. You may notice drops of urine on the floor, a wet dog bed, urine smell on your dog or wet inflamed skin around your dogs’ genitals.

Urinary incontinence can be frustrating but please do not punish your dog. This is a medical – not a behavioural – condition. No matter how well your dog has been potty trained, he may have an accident in the house if he is suffering from a bladder or urinary tract infection.

Consider using doggie diapers to prevent skin infections.

Frequent and painful attempts at urination can be due to:
  • hormonal imbalance
  • weak bladder sphincter
  • polyps or cancerous growths in the urinary tract or prostate
  • bladder infection
  • urinary tract infection
  • bladder stones
  • spinal injury or degeneration
  • diseases that cause excessive water consumption (e.g. diabetes, kidney disease)

If your dog has been diagnosed with bladder stones, the ultimate goal is to dissolve or surgically remove the stones via a procedure called cystotomy, and prevent them from recurring. Read more here.

Signs of Urinary Incontinence in Dogs
  • dribbling urine when walking around
  • leaking urine when resting
  • urinating in large amounts
  • excessive licking of the genitals
What Should I Do If My Dog Is Incontinent?

Consult your veterinarian to confirm a diagnosis. A urinalysis can be performed to check if your dog is suffering from a bladder infection. Other tests may include a urine culture, blood work, radiographs and ultrasound.

Most bladder stones are visible on X-ray. Stones or sediments that are not radiolucent can be detected by ultrasound.

How Is Urinary Incontinence Treated?

Treatment depends on the underlying cause. Medications can often manage the problem effectively. In cases of incontinence due to bladder stones or a protruding disc, surgery may be recommended.

How Can I Manage Urinary Incontinence in my dogs?
  • Take your dogs for more frequent walks: first thing in the morning and shortly after they wake up from naps.
  • Place clean towels or pee pads in your dog’s favourite sleeping areas.
  • Clean and dry the skin around your dog’s genital area, abdomen and legs more often to prevent skin infection.
  • Consider using doggie diapers.

Do not restrict your dog’s water intake without first consulting your vet.

OTHER WAYS TO MAKE LIFE BETTER FOR OUR SENIOR dogs
  • Provide a quiet space with a comfortable but firm bed.
  • Divide a meal into smaller portions throughout the day.
  • Provide easy access to the garden for elimination (e.g. gently-sloped ramp).
  • Provide non-slip floor surfaces to help your senior dog get up and walk more easily.
  • Raise food and water bowls to a comfortable level.

preventive health care can add good years to our best friend’s life

Our dogs age much faster than us and also tend to hide their pain. Most of the time, we do not realise they are in discomfort or fighting an illness until it is too late. Some common age-related health problems are osteoarthritis, kidney/liver/heart diseases, tumours or cancers, hormonal disorders like diabetes or thyroid imbalance. Yearly health screening can help detect diseases in the early stages, giving our best friends the best chances of a full recovery.


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

Caring For Our Arthritic Dogs

Is your dog moving around more slowly? Is he having difficulty lying down and getting up? Is she reluctant to climb stairs or hop into cars? Your dog may be suffering from osteoarthritis – a painful degenerative joint disease.  Osteoarthritis is more common in older, larger and working dogs due to wear and tear. It can also arise from obesity, trauma or birth defects such as abnormally formed hips. 


SIGNS OF PAIN can be SUBTLE AND DIFFICULT TO DIAGNOSE

Chronic pain due to age-related disorders like osteoarthritis usually develops slowly. It can be hard to detect because some animals learn to tolerate and live with the pain.

Chronic pain can create a “stress response” associated with elevations of cortisol. This may reduce the patient’s immune response, leading to infection & slower healing. “Our goal in pain management is to always improve patient comfort, mobility and quality of life while minimising the risks of side effects from medications.” ~ Dr Kasey Tan

Osteoarthritis or degenerative joint disease occurs with age when the cartilage between bones wears down over time.

OUR PETS CANNOT TELL US IN WORDS WHEN THEY ARE IN PAIN

Watch our pets closely to detect signs of arthritic pain:

  • reluctance to walk or play
  • stiffness and lameness
  • difficulty lying down or getting up
  • difficulty climbing stairs
  • unusually quiet or withdrawn
  • biting or snapping when touched
  • appetite loss

Have your vet perform a physical examination & take X-rays to check for degenerative joint changes.

SPEAK WITH YOUR VET ABOUT MANAGING ARTHRITIS WITH:
  • Medications (anti-inflammatories and pain relief)
  • Cartrophen injections (a disease modifying drug to reduce adverse effects of osteoarthritis)
  • Supplements (e.g. glucosamine, chondroitin, omega oils)
  • Physical therapy (e.g. hydrotherapy, physiotherapy, massage)
  • Acupuncture

“Acupuncture has been used in animals for at least 3000 years. It is commonly used to manage conditions such as degenerative joint disease (arthritis) and intervertebral disc disease. A typical session, including a physical checkup, lasts up to 30 minutes.”

Acupuncture is available at Mount Pleasant (East) with Dr Audrey Loi,  Mount Pleasant (North) with Dr Kasey Tan. Read more about veterinary acupuncture

Hydrotherapy with trained hydrotherapists can help your arthritic dogs lose weight (if they are overweight) & strengthen leg muscles. The buoyancy of water reduces stress on joints & relieves pain & stiffness.

IF YOUR dog SUFFERS FROM CHRONIC arthritic PAIN, BASIC LIFESTYLE CHANGES CAN OFFER RELIEF.

  • Extra weight increases stress on the joints. Keep your dogs trim with a healthy diet and low impact exercises.
  • Provide gently-sloped ramps to access gardens or get in and out of cars.
  • Raise food and water bowls to a comfortable level to reduce neck or back strain.
  • Lay non-slip mats around the house to help your dog get up and walk more easily .
  • Provide comfortable and supportive beds.

There are ready-made elevated bowls & stands or you can place the bowls on non-slip stools.

A note on EXERCISe – too little or too much
  • Regardless of age or extent of arthritis, it is important to keep our dogs fit and mobile. Engage your dogs in regular low impact exercises to reduce stiffness and improve flexibility. Massage their muscles daily to relieve any tightness.
  • Follow your dog’s pace.. Take it slow and easy. It is better to do a few short sessions of exercise (e.g. three 10-minute sessions a day) rather than one long session.

Do not over-exert our dogs no matter how enthusiastic they appear. Excessive running, jumping or swimming can cause injuries to joints & bones.

Check & trim your dog’s nails regularly. Overgrown nails can cause pain, change the way your dog walks & place abnormal stress on the joints. Take your dog to the vet or groomer if you are inexperienced in nail trimming.

5-month-young Capers went through a surgery called Juvenile Pubic Symphysiodesis

Some puppies, unfortunately, are genetically predisposed to hip dysplasia. Capers’ hind legs were stiff and he was bunny hopping more frequently. X-rays confirmed he had mild hip dysplasia which can lead to painful arthritic hip degeneration in later years. Treated early, dogs like Capers can lead a full life. Get behind the scenes here.

(Left): Dog with normal hips versus (Right): Dog with osteoarthritis

“Prevention is better than cure” is especially true for senior pets as age predisposes them to certain diseases. At Mount Pleasant, we emphasise total wellness & preventive healthcare so that our pets live longer, healthier lives. Speak with our vets about annual health screens for our cats & dogs.

Palliative Or End Of Life Care For Our Pets

Every season serves a purpose, perhaps especially the last one we walk with our best friends. A season with profound lessons – of accepting “there is nothing we can do” about the disease. But knowing “there is always something we can do” to help our best friends feel more comfortable and pain-free.


what is palliative care?

As our animal friends approach their golden years, they may develop terminal illnesses like kidney failure, heart disease or cancer.  When we understand that the condition is not treatable or the decision is made not to treat it – yet our pet still has “that light in her eyes” – then we talk about palliative care.

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Some animals are not good candidates for surgery or chemotherapy. Palliative care provides an alternative to premature euthanasia. Dr Cheryl Ho @ Mount Pleasant (Whitley)

The primary aim of palliative care is to provide comfort to the terminally ill. Relieve pain for the dying. Maximise quality of life in the final days. Until death occurs naturally or humane euthanasia becomes necessary.

From the moment we decide to share life with our animal friends, the day will come when we have to watch, with breaking hearts, as they grow old and die.

In the last walk leading up to that, we have a moral duty to not prolong suffering. To learn to manage chronic wounds and administer medications. To know when to drop ‘cure’ from our vocabulary and start palliative care. And most importantly, to realise when it is time to stop.

managing pain

Pain is debilitating. Chronic pain can create a “stress response” associated with elevations of cortisol, reducing your pet’s immune response, leading to infections and slower healing.

In palliative care, we manage pain with various drugs (e.g. steroids, opioids, non-steroidal anti-inflammatory drugs) and holistic therapies (e.g. acupuncture, massage, physiotherapy, hydrotherapy).

Consider acupuncture to relieve pain from old-age conditions like osteoarthritis. Acupuncture may also relieve nausea which may then improve your pet’s appetite. Dr Audrey Loi @ Mount Pleasant (East)

How do i know if my pet is in pain?

Firstly, animals tend to hide their pain – an instinctive survival advantage. Secondly, they cannot verbally communicate their pain. Watch your pets closely to detect any changes in behaviour:

  • unusually quiet or withdrawn
  • hiding and avoiding human interaction
  • restless, pacing, trembling
  • whining or whimpering
  • biting or snapping when touched
  • licking or biting a body part excessively
  • limping or exhibiting stiff body movements
  • having difficulty lying down or sleeping
  • refusing food

* Read more about MANAGING PAIN.

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A “preemptive” approach to pain – using analgesics before the onset of pain – is most effective. Animals who receive post-surgery pain control heal faster & eat sooner than those who don’t.

my pet is not eating, what can i do?

We tend to get upset when our pets will not eat. The immediate urge is to force feed them so they do not go hungry or lose weight. But this might make them even more averse to eating.

Most of the time, our pets are feeling pain or nausea which makes them withdraw from food. It takes a combination of appetite stimulants, medications to relieve pain and nausea, and novel ideas to tempt them to eat.

  • If you are feeding dry kibbles, soften them in water or broth or mix in canned food to make it more appealing and easier to eat (especially for senior pets with dental problems)
  • Warm up the food to make it smell tastier
  • Feed small amounts throughout the day instead of one big meal
  • Offer strong-smelling foods like cheese or tuna or even small amounts of burgers and bacon if your main aim is to have your pet eat something (always consult your vet about appropriate diet for your pet’s condition)
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Feeding tubes are useful for animals who are ill & have lost their appetite, or are keen to eat but have difficulties swallowing or keeping food down. For chronically ill animals, discuss with your vet if force-feeding or tube-feeding will actually improve quality of life. Twinkle was treated by Dr Nathalee Prakash for FEGSF.

my pet is not drinking enough water

Dehydrated animals lose elasticity in their skin. Their gums become pale and dry, the saliva is thick and sticky. They are listless and their eyes may appear sunken. If not corrected quickly, the condition becomes life-threatening.

  • Flavour the water with some broth to tempt your pets to drink more
  • Syringe-feed fluids at regular intervals throughout the day
  • Hydrate your pet subcutaneously, especially for animals who are losing water from frequent urination, diarrhea or vomiting. 
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Some cats & dogs prefer to drink from automatic water fountains

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Your vet can teach you how to administer subcutaneous fluids at home & depending on the medical condition, advise if fluid administration will make your pet feel better or worse. Dr Gloria Lee @ Mount Pleasant (Mandai)

stay as active as possible

When our pets are ill, they tend to rest a lot more. However, light regular activity is important to keep them mobile, increase circulation and prevent pressure/bed sores.

Engaging in day to day activities also keeps them mentally alert. So continue short play sessions and go on leisurely walks if your pets are up to it. Drive them to the parks and beaches or simply enjoy car rides.

Some basic lifestyle changes can offer relief for pets suffering from chronic pain which affects mobility:

  • Control weight and incorporate light exercises (e.g. hydrotherapy) to decrease joint stress and improve muscular support of the joints.
  • Provide easy access to litter boxes or garden for elimination (e.g. gently-sloped ramp)
  • Raise food and water bowls to a comfortable level (e.g. place bowls on non-slip stools)
  • Provide non-slip floor surfaces to help arthritic pets get up and walk more easily (e.g. yoga mats)
  • Provide comfortable firm beds for arthritic pets
  • Use body harnesses, slings, wheel chairs or carts for animals who have trouble getting around

keep clean and comfortable 

Maintain your pets’ grooming routine to keep them clean and happy. Use pee pads or diapers if they are incontinent. Brush their fur and clean their face and body daily with a warm damp cloth, especially for cats who have stopped grooming themselves.

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Prepare comfortable sleeping spots in quiet areas & keep them clean & dry (especially if your pets are incontinent). Surround your pets with their favourite blankets & toys. Ming Ming @ Mount Pleasant (Mandai)

prevention is really better than cure

Very often, we only take our pets to the vet when signs of illness become obvious. Sometimes, that can be a little too late. As our pets approach their senior years, regular health screenings can help us detect age-related diseases at an early stage.

when to let go – choosing Euthanasia

There is a period of time between the first thought of euthanasia and actually choosing it. When we are unsure if it is the right thing to do (for moral or religious reasons). When we wonder if we should wait awhile longer because he looks brighter today. When we simply need time for closure with our beloved friends who have shared our life for the past 15 years.

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We all know one day death will come. But perhaps, we are not prepared for how dying looks like.

We may say that based on medical tests and reports, your vet knows best when is the right time to euthanise. We may also say that based on years of living so closely with your animal friends, who knows better than you?

Because we are so emotionally bonded with our pets and fearful of the flood of grief that follows, it helps to have a daily record of their activities so we can be objective in deciding when it is time to end life.

When our animal friend is no longer responsive to his surroundings nor recognise us. When she refuses to drink or eat, even her most favourite food. When they are constantly crying in pain. When breathing becomes laboured. When he seems anxious and confused. When bad days outnumber good days.

You see, living longer does not always mean living better. As much as we want our best friends to have a good life, it is just as important for them to have a good death. Love them enough to give them that.

Dear Faye-Faye @ Mount Pleasant (Mandai)

Twinkle: Feline Eosinophilic Gastrointestinal Sclerosing Fibroplasia (FEGSF)

Vomiting frequently, growing weaker and losing weight, Twinkle was a far cry from her chubby cheery self. At her lightest, she was 2.92kg. Twinkle’s family fought alongside her, through sickness and surgery, until she was fit to go home.  

“One night 11 years ago, we were driving when a kitten dashed across the street. My husband got out immediately and found the kitten huddling in a drain. We are not cat people but we just had to take her home. It was difficult caring for Twinkle initially but we learnt along the way.  A year later, Heidi joined our family. Like ebony and ivory, Twinkle and Heidi live together in perfect harmony!” ~ Julie

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Few months ago, Twinkle started vomiting frequently (vomiting is the primary sign seen with a variety of diseases affecting the GI tract). She was losing appetite & losing weight.

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A naso-esophageal feeding tube is passed through the nose into the esophagus. Only very liquefied food, water & some medications can be given through the narrow tube. An Elizabethan collar is necessary to prevent Twinkle from interfering with the tube.

feeding tubes are useful for animals who are ill & have lost their appetite

The sight of your cat or dog with a feeding tube might be unpleasant. However, feeding tubes are useful for animals who are ill and have lost their appetite, or are keen to eat but have difficulties swallowing or keeping food down. 

13 september 2016 – consult with dr nathalee prakash

Twinkle was referred to Dr Nathalee Prakash, veterinary specialist in canine medicine, at Mount Pleasant Vet Centre (Gelenggang). Cat physiology is  different compared to dogs or humans. The consequences of not eating are much more significant. If your cat does not eat for forty-eight hours, she can develop a potentially life-threatening form of liver malfunction known as hepatic lipidosis.

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“Twinkle has always been healthy. When she started losing weight, we have to find out what was wrong & do whatever we can to help her get better.”

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Twinkle’s body condition score was 3/9. Upon palpation, a mass was detected in the mid-abdominal region. Exploratory laparotomy was advised, with a possibility that surgical intervention could help Twinkle.

15 september 2016 

Dr Patrick Maguire performed exploratory laparotomy to examine Twinkle’s abdominal organs. A mid-jejunal mass was identified, measuring 1 to 2cm in diameter, which appears to be causing partial obstruction. A jejunal resection and anastamosis was performed – fully excising the diseased section of the intestine and suturing the remaining sections together. The mass was sent for histopathology examination, together with the mesenteric lymph node and a section of the liver. 

Note: The small intestine is the major digestion and absorption site. It is divided into three sections – duodenum, jejunum and ileum. The jejunum is the longest section of the small intestine.

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To provide nutritional support, an esophagostomy feeding tube is inserted when Twinkle was still under GA. This tube is slightly larger than a naso-esophageal tube & enters the esophagus through a small incision in the neck.

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Back home with Heidi

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The larger diameter of the esophagostomy feeding tube allows thicker food to be fed, in lesser time & with fewer clogs.

proper nutrition is critical for successful recovery from any disease

If your cat refuse food for more than two days, consult your veterinarian immediately. Force-feeding is unpleasant for cats. There is an increased risk of your cat inhaling food into the trachea or windpipe and developing aspiration pneumonia.

how to encourage your cat to eat
  • Slightly warm the food prior to feeding.
  • Offer frequent, small meals of odorous, highly palatable food.
  • Hand feed or gently place small morsels of food on your cat’s tongue.
  • Feed in a quiet and comfortable area.
26 september 2016 

Twinkle is eating about 20g of kibbles on her own daily, supplemented with tube feeding.

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The area where the tube enters the skin should be checked every day to make sure it is not clogged Any sign of infection (e.g. pus-like discharge or foul smell) requires veterinary attention.

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Histopathology revealed feline eosinophilic gastrointestinal sclerosing fibroplasia (FEGSF), an uncommon inflammatory disease affecting the stomach or intestines.

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FEGSF is treated with steroids and antibiotics to control inflammation and prevent recurrence.

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“Twinkle is family. When we choose to welcome an animal friend into our lives, we have to commit to the animal for the rest of his or her life.” ~ Mr Chia & Julie

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One of her favourite spots

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Still thin but we will get there!

18 October 2016 – recovering well

Twinkle now weighs 4kg (up from 2.92kg). She is eating about 80g of dry food on her own in addition to 4-hourly liquid food and medication through tube feeding.

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“Twinkle has started to venture out of our study room/recovery room to the living room & various favourite spots.”

24 october 2016 – off with the feeding tube

Twinkle returned for review and ultrasound. The feeding tube is removed as her appetite is good and she is eating well on her own!

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Well done Twinkle. Keep getting stronger!

Before (right) and After (left)

Beautiful Twinkle in May 2018

In the earlier days…..
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Ebony & ivory

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Twinkle’s 1001 positions!

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“It fits I sits”

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“Let me out. I smell dinnerrrr!”

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“Let meow help you…”

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Twinkle & Heidi living together in harmony

Baffy: Oral Squamous Cell Carcinoma

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Baffy on Friday morning, the day of his surgery. “We wish to thank each & everyone of you who have come forward to help Baffy during his difficult time. Despite a horrible past, we hope he can feel all the love now.” (Photo: Gwen)

“We adopted Baffy from Causes for Animals. No one knew his history. He was found in a forested area with a string around his neck. He must have been tied to a tree and while struggling to get free, hurt his neck badly. Although he was skin and bones, this boy has never shown any aggression to human being or dog. All he does is love unconditionally.

We are sharing Baffy’s story to highlight the plight of pets being abandoned. There is no good reason to give up a pet. You can fail in all the progress of technology and comfort of living, but you cannot fail in being a good human. One with compassion and loyalty. Pets are part of family and they deserve love, respect and most importantly health care from their care giver. The abandoned dogs often suffer in silence and most of them cannot survive in the wild. 

Not all dogs are lucky like Baffy to  get a second chance at life. Baffy now has a family who loves him and his future couldn’t be brighter with so many people rooting for his recovery. If there is anything our dogs teach us, it is to Leave No Man Behind. Whatever life throws at you.” ~ Gwen


Squamous cell carcinomas are malignant cancers originating from the lining cells of the mouth

They are locally invasive and occur mostly in the gums or tonsils. In Baffy’s case, a tumour located in the rostral oral cavity (towards the oral or nasal region) has a lower metastatic rate (lower chance of spreading to other parts of the body).

"About 6 weeks ago, we noticed a lump in Baffy's mouth. It was small and we thought it was an ulcer. When it did not subside, we took him  to the vet for a biopsy. He still seemed healthy but was losing weight." 

“About 6 weeks ago, we noticed a lump in Baffy’s mouth. It was small & we thought it was an ulcer. When it did not subside, we took him to the vet for a biopsy. He still seemed healthy but was steadily losing weight.”

Clinical signs include
  • difficulty eating (especially with tumours in the back of the throat)
  • drooling
  • bleeding from mouth
  • weight loss despite normal appetite
  • displacement or loss of teeth
  • facial swelling
  • swelling under the jaw

A thorough physical examination, complete blood count and biochemical profile were done and chest X-rays taken to determine if the oral tumour has spread. These tumours may provoke an inflammatory reaction that causes pain, and while controlling inflammation may help reduce superficial swelling and pain, it does not cure the cancer. Surgical removal of the tumour is the treatment of choice. 

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Computed tomography (CT) is helpful to define the extent of the tumour before surgery.

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If the tumour has not spread to other locations, surgery is the treatment of choice. Dr Dennis Choi, Mount Pleasant Vet Centre (Gelenggang) prepares to perform rostral mandibulectomy to surgically remove the tumour, including the extensions into underlying tissue & part of the jawbone, together with the incisors & canines.

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Surgery is considered successful if the tumour is completely removed. If the tumour has not spread, surgery is curative & can extend the animal’s life.

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Dogs adapt quite well to partial jaws. They may need to be hand-fed for a period of time before they learn to eat on their own again. Most importantly, they are no longer in pain or discomfort.

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Day after surgery. “Visited our Big Baby Baffy. The nurses said that he has good appetite, vitals are all good but not ready to come home yet. He is happy to see us & made a whole lot of noise when we left. We are very glad he is still his usual naughty self.” (Photo: Gwen)

“With Dr Dennis’ clear explanation of Baffy’s condition, we understand that surgery will save his life, even if it means removing part of his jaw. Otherwise we might have been more paranoid and perhaps too late to help Baffy. It is Dr Dennis’ confidence that helped us make the right decision for Baffy.

Baffy is now back home enjoying meat balls and soft foods, knocking everything down with his cone! Almost back to his usual self. We cannot be more thankful. Never give up on your pets, especially when they are ill. They need us even more then.” ~ Gwen

4 july 2016
You know what they say when you have been so near death that when u have been given a chance to live again, you just keep counting your blessings and live day by day to the fullest? It's all true. Baffy is as of today 45 days cancer free, and he is living his every moment to the fullest by being the naughtiest he could be. But we will take all the naughtiness at any moment. We want to Thank you for loving him!

“You know what they say about being so near death that when you are given a chance to live again, you just keep counting your blessings & live day by day to the fullest? It’s all true.
Baffy is 45 days cancer free & he is living every moment to the fullest by being the naughtiest he can be.”

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“But we will take all the naughtiness at any moment. We want to thank you for loving him!”

4 NOVEMBER 2016 

Like time and tide, cancers wait for no man. In May, Baffy went through rostral mandibulectomy to remove an oral tumour. He lost part of his lower jaw but is no longer in pain, and happier and more energetic than ever. His family’s prompt decision has added many good days to this big baby’s life!

"After Baffy's surgery, we were advised to watch out for any strange lumps. On Sunday, we felt a growth on his chest. A large amount of pus was discharged & today the growth is much smaller. It's good to have Baffy checked by Dr Dennis Choi so we have peace of mind. We're thankful he is alright. He's very happy everyday & has put on 3kg!" ~ Gwen

“After Baffy’s surgery, we were advised to watch out for any strange lumps. On Sunday, we felt a growth on his chest. A large amount of pus drained out & today the growth is much smaller. It’s good to have Baffy checked by Dr Dennis Choi so we have peace of mind. So thankful he is alright. He has put on 3kg!” ~ Gwen

Note: An abscess forms when bacteria enters a wound, even a tiny break in the skin. Abscess “pockets” are filled with pus. Depending on the extent of infection, the wound can be properly cleansed, drained and flushed by a vet, and a course of antibiotics prescribed.


Pain is common in pets with cancer, with some tumours causing more pain than others. Our pets may also experience pain associated with cancer treatments such as surgery or chemotherapy. Untreated pain decreases our pet’s quality of life. Read about “Managing Pain In Our Pets”.

Managing Pain In Our Pets

Our pets  may feel pain when they are sick or injured. However, recognising pain can be challenging as animals instinctively hide their pain and exhibit symptoms differently from us. It is important to understand species differences and observe our pets’ behaviour to know if they are hurting.

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Pain can be caused by physical trauma, e.g. being hit by a car, resulting in painful fractures & injuries. Brownie, rescued & rehomed by Causes For Animals.

Pain can be caused by:
  • physical trauma, e.g. falling from a height or being hit by car
  • disease or illness of internal organs, e.g. pancreatitis and blocked urethra
  • surgical procedures, e.g. sterilisation or bone surgery
  • spinal problem, e.g. intervertebral disc disease
  • degenerative changes, e.g. osteoarthritis
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Proptosed eye (displacement of eye ball out of the socket) due to dog fight injury. Although the dog was still active & bright when presented, pain relief was administered immediately to provide some comfort.

Our pets cannot tell us in words when they are in pain

It is important for us to watch our pets closely to detect any changes in behaviour. Your pets may be in pain if they are:

  • unusually quiet or withdrawn
  • very restless or trembling
  • hiding and avoiding human interaction
  • whining or whimpering
  • biting or snapping when touched
  • licking or biting a body part excessively
  • refusing food
  • limping
  • having  difficulty lying down or sleeping
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Increase in heart rate & breathing rate, higher body temperature & blood pressure, or dilated pupils may also be signs of pain.

Sometimes signs of pain are subtle and difficult to diagnose

Chronic pain due to age-related disorders like arthritis or cancer usually develops slowly and is hard to detect because some animals learn to tolerate and live with the pain. Chronic pain can create a “stress response” associated with elevations of cortisol. This may reduce the patient’s immune response, leading to infection and slower healing. 

Animals suspected of experiencing pain (e.g. limping due to strained muscle/ligament) are treated with adequate pain relief and symptoms are monitored for improvement. If undesirable side effects develop, treatment should be stopped or altered accordingly.

Pain management is crucial in managing a patient as it alleviates discomfort and helps the animal recover faster

Pain relief medication is usually administered before, during and after surgery. This helps reduce stress and pain associated with surgery, allowing the animal to rest better and recovery faster. It is always better to start on pre-emptive analgesia than to control pain once it has started.

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For older animals suffering from chronic pain (e.g. osteoarthritis) or patients with terminal illnesses (e.g. cancer), long term pain relief is administered to provide a better quality of life. 11-year-old Babe, gone over the Rainbow Bridge after a short battle with hemangiosarcoma.

If your pet suffers from chronic pain (e.g. osteoarthritis), some basic lifestyle changes can offer relief.
  • Control weight and incorporate light exercises (e.g. hydrotherapy) to decrease joint stress and improve muscular support of the joints.
  • Provide easy access to litter boxes or garden for elimination (e.g. gently-sloped ramp)
  • Raise food and water bowls to a comfortable level 
  • Provide non-slip floor surfaces to help your arthritic pet get up and walk more easily
  • Provide comfortable but firm beds to help your arthritic pet get up more easily
there are many different pain management protocols and there is no “best” one.

We will assess your pets to determine a good pain management plan, taking into account factors such as their history, current condition and physical examination.

Pain relief medications are available in pill/liquid/gel form or skin patches. Do not  medicate your pet yourself. Some painkillers for humans can be toxic to animals even in very small doses.

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This patient underwent a surgical procedure called enucleation (removal of the eye). A fentanyl patch is applied on the left side of her body. The fentanyl patch is a transdermal pain relief drug that provides relief for about 3 days.

The importance of prevention

We can take steps to reduce the risk of painful conditions in our pets. Regular dental checkups can help prevent the development of painful oral diseases. Maintain a healthy weight to reduce the incidence and severity of osteoarthritis. Schedule yearly health checks to detect any health issues early and give your beloved pet the best chance at a long, healthy and pain-free life.

Contributed by Dr Teo Jia Wen, Mount Pleasant Animal Medical Centre (Farrer) with inputs from editor

Dental Care For Our Pets

It is estimated that 85% of all pets have periodontal disease by the time they are 3 years old. Even with regular brushing, we should be visiting our dentist every 6 months. Same for our beloved pets.


Periodontal disease

Bacteria combines with food particles to form plaque on the teeth. Minerals in the saliva bond with plaque to form tartar. The bacteria works its way under the gums, causing gingivitis (inflammation of the gums) and destroys the supporting tissue around the tooth, leading to tooth loss. The bacteria can also travel in the bloodstream to infect the heart, kidneys and lungs.

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A professional veterinary dental cleaning is the best way to remove plaque & tartar from your pet’s teeth, below the gum line & check the overall dental health.

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11 teeth extracted from an 8-year-old Maltese.


How Do I Know if My Pet Needs Dental Cleaning?

Our pets are very good at hiding pain. You may not know if your dog or cat is suffering from a painful dental disease. Regular inspection of your pet’s mouth is important to catch dental disease in early stages. Signs of dental disease include:

  • bad breath
  • red and swollen gums
  • tartar buildup
  • bleeding along gumline
  • excessive drooling
  • pawing at mouth
  • difficulty picking up food and eating
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Cats with dental disease may exhibit excessive drooling & bleeding from gums. They may be reluctant to eat, play with toys or groom.

What Are the Benefits of Dental Cleaning?

A professional dental cleaning, performed under general anaesthesia, removes plaque and tartar on teeth surfaces and bacteria under the gums. This prevents infection to the mouth and other organs, and protects your pet from pain and tooth loss.

can my pet’s dental be done without anaesthesia?

Even when we brush our teeth twice daily and our teeth look healthy, our dentist still needs to remove plaque and tartar from below our gum line during our 6-monthly dental. Without general anaesthesia, it is not possible to ensure that tartar is completely and safely removed from below our pet’s gum line and from their back teeth.

Pet dental should only be performed by trained veterinary professionals to prevent injury, infection and tooth fractures.

is general anaesthesia safe for my pet?

Modern veterinary anaesthesia is considered very safe. The risk of losing an animal under anaesthesia while going through routine procedures, such as dental and sterilisation, is very low. Read more about general anaesthesia if you are concerned.

how can i Keep My Pet’s Teeth Clean?

Left untreated, gingivitis and plaque will worsen over time. Your pet will eventually develop cavities, gingival recession, bacterial contamination, loose teeth and root exposure. This can be painful for your pets and also more difficult and expensive to treat. Regular at-home dental care and a 6-monthly dental check by your vet is the best way to maintain your pet’s dental health!

  • Get your dog or cat used to brushing from a very young age.
  • Use pet-appropriate toothpaste and toothbrush.
  • Feed good quality pet food.
  • Provide safe and good quality chew toys.
  • Oral rinses may help decrease plaque. Speak to your vet about safe dental products.
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Anaesthetic drugs are processed & removed by the liver & kidney. Pre-anaesthetic blood testing is important before any dental or surgical procedures, especially in senior pets, to rule out underlying health issues & determine the safest dose & type of anaesthetic drug to use.

CALL our clinics TO MAKE A DENTAL APPOINTMENT FOR YOUR DOGS & CATS in june!

Mount Pleasant Veterinary Centre (Gelenggang)
2 Jalan Gelenggang Singapore 578187
Tel: 6251 7666

Mount Pleasant Veterinary Centre (Changi)
969A Upper Changi Road North Singapore 507667
Tel: 6546 0166

Mount Pleasant Vet Centre (Mandai)
5 Mandai Road Singapore 779391
Tel: 6451 5242

Mount Pleasant Animal Medical Centre (Clementi)
Blk 105 Clementi Street 12 #01-18/20 Singapore 120105
Tel: 6776 8858

Mount Pleasant Animal Medical Centre (Farrer)
Blk 3 Queens Road #02-141 Singapore 260003
Tel: 6271 1132

Mount Pleasant Animal Medical Centre (Bedok)
Blk 158 Bedok South Avenue 3 #01-577 Singapore 460158
Tel: 6444 3561

Mount Pleasant Animal Clinic (East)
152 East Coast Road Singapore 428855
Tel: 6348 6110

Mount Pleasant Animal Clinic (North)
Blk 151 Serangoon North Avenue 2
#01-59 Singapore 550151
Tel: 6287 1190

Whitley Animal Medical Centre
232 Whitley Road Singapore 297824
Tel: 6250 8333

 

Bambalina Says “Thank You Dr Anthony Goh”

Ravi & Bambalina

Ravi & Bambalina

“Thank you my friends from far and near for your kind words of condolences. Our sincere heartfelt appreciation and thanks to Dr Anthony Goh and his fabulous team from Mount Pleasant (Gelenggang) for taking care of our girl.

Bambalina crossed the Rainbow Bridge to Heaven on Friday night (18 March). She gave us 10 years of Heaven on Earth.

We shall always cherish her love and memories and she will remain in our hearts and minds forever .”

Skorpio Boy (Pack Leader), Nancy Neo (Pug Leader) and Ravi Velu (Pug Man)