Twinkle: Feline Eosinophilic Gastrointestinal Sclerosing Fibroplasia (FEGSF)

Growing weaker, losing weight and unable to eat normally, 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 & 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 her initially but we learned along the way & got used to it. We named her Twinkle.

A year later, Heidi joined our family. She gets along very well with Twinkle. Like children playing together, no one tells them they are different. Same for Twinkle and Heidi. Ebony and ivory living 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. Early September, Twinkle was hospitalised for a few days before being discharged with a naso-esophageal feeding tube.

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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 very 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 very different compared to dogs or people. The consequences of not eating are much more significant. If your cat does not eat for as little as 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 abdominal palpation, there was a mass in the mid-abdominal region. Exploratory laparotomy was advised, with a possibility that surgical intervention could help Twinkle.

15 september 2016 – surgery by dr patrick maguire

Dr Patrick Maguire, veterinary specialist in small animal surgery, 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.

“Surgery is risky but there is a chance it would heal Twinkle so we go ahead. We will do whatever we can to give her a fighting chance.”

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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 her full-time best friend & part-time bodyguard!

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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 – back for review

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

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Dr Patrick Maguire examined the incision site at her abdomen which has healed nicely. The sutures were removed.

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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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“So what did you say I have…?”

Histopathology revealed feline eosinophilic gastrointestinal sclerosing fibroplasia (FEGSF), an uncommon inflammatory disease affecting the stomach or intestines. This condition is treated with steroids and antibiotics to control inflammation and prevent recurrence.

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Twinkle listens patiently as Dr Nathalee Prakash explains her condition

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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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Rest & recover, Twinkle!

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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. She is eating well on her own!

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Well done Twinkle. Keep getting stronger!

“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


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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No one tells them they are different. So they live together in perfect harmony – Twinkle & Heidi. Ebony & Ivory!

Bam Bam Says “Thank You Dr Nathalee Prakash”

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Bam Bam  is fighting a brave battle against kidney disease. He’s not out of the woods yet. But with such a band of brothers alongside him, he’s already a winner. These boys are so so loved. (L-R: Luke, Bacon, Astro, Bam Bam)

Bam Bam and Family would like to specially thank Dr Nathalee Prakash for all her care and meticulous attention and most importantly, her never give up character. Thank you!

And we would also like to thank all the nurses and vet techs who have helped us in so many big and small ways. It means alot to us. Also thank you for taking care of Bam Bam when he was hospitalised. Thank you. You all are awesome.

Annie Ho and Bam Bam

Elvis The Maltese: Thoracotomy (Open-Chest Surgery)

Note: The following images may be unpleasant for some viewers.

16-year-old Elvis the Maltese had been losing weight despite a normal appetite. He was also generally quiet and showing signs of respiratory distress with a grating cough throughout the day. 

Echocardiogram (ultrasound of the heart) and CT scan revealed a large mass in the right caudodorsal chest.

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A thoracotomy (open-chest surgery) was performed by Dr Patrick Maguire, Veterinary Specialist (Small Animal Surgery) & Dr Dennis Choi, Mount Pleasant Veterinary Centre (Gelenggang), to excise the mass which was compressing the right main bronchus & oesophagus. Following anaesthetic induction, a ventral midline approach was made to the thoracic cavity.

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A saggital saw was utilised to perform a caudal sternotomy – making an incision in the centre of the chest to separate the sternum (chest bone) & gain access to the heart & nearby organs.

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Upon entering the thoracic cavity, a large, slightly irregular but seemingly well-encapsulated mass was identified, associated with the right caudal lung lobe. [The colour in this photo has been toned down]

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The mass was removed from the thoracic cavity & sent to the laboratory for histological examination. A chest tube was placed to drain air or fluid from the thoracic cavity before the surgical site is closed.

“Histopathological findings are consistent with a pulmonary carcinoma in the lung lobe, and based on morphology of the neoplastic cells is most consistent with papillary variant of pulmonary adenocarcinoma. Pulmonary adenocarcinoma is associated with mucus production by neoplastic cells. Clinical signs include cough, pneumonia, dyspnea, cachexia.”  ~ Excerpt from lab report by Dr Ong Chee Bing

* Dyspnea: difficult or laboured breathing
* Cachexia: weight loss in patients with cancer or other chronic diseases

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Elvis may have been diagnosed with cancer but this little trooper is making every day count. Few hours after his major surgery, Elvis was eager to have a good dinner.

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Elvis during one of his reviews with Dr Sebastien Monier, 6 weeks post surgery.

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Elvis continues to be on medication for his existing bilateral uveitis (inflammation in the eye) & heart condition.

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“I was very apprehensive about putting Elvis through surgery until I spoke with Dr Sebastien to understand how he’d be carefully monitored under general anaesthesia. Elvis is happier & more active after surgery. He coughs much lesser & it’s not the grating painful cough he had before. His coat is also healthier & he has a good appetite. We celebrated his birthday on 10 November. He is 16 now.” ~ Justine Duerden

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.

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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.

WHAT IS NOT A CATARACT? 

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

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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.

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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.

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“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
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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).

 

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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.

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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.”

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“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.

http://www.youtube.com/watch?v=KC6bTpOamq4

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.

http://www.youtube.com/watch?v=rj09QI1yf6E

Ref: discovery eye.org

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.

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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

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Teamwork at Mount Pleasant Animal Medical Centre (Farrer)

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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.

Does Your Pet Need To See A Specialist?

A veterinary specialist is a veterinarian who has completed advanced training in the form of a 3-year residency under a registered specialist in an accredited institution. They would have had to demonstrate their expertise in the area of specialisation by examination and publication.

There are currently three veterinary specialist clinicians in Singapore.

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Dr Nathalee Prakash, Veterinary Specialist in Canine Medicine, Mount Pleasant Veterinary Centre (Gelenggang)


Dr Nathalee Prakash
graduated from Murdoch University in 2002. She obtained her membership in Canine Medicine in 2008 with the Australian and New Zealand College of Veterinary Scientists (ANZCVS) and completed a three-year residency in Small Animal Medicine with the University of Melbourne in 2014.

In the same year, she obtained her specialist qualifications with the ANZCVS and is aiming for Board-certification with the American College of Veterinary Internal Medicine (ACVIM) in 2016. She has published in the area of veterinary gastroenterology and immunology and is currently completing her PhD on inflammatory bowel disease in dogs.

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Dr Patrick Maguire, Veterinary Specialist in Small Animal Surgery, Mount Pleasant Veterinary Centre (Gelenggang).

Since he joined Mount Pleasant in October 2015, Dr Patrick Maguire has been kept busy. One of his first patients is 16-year-old Elvis the Maltese who needed an open-chest surgery.

Dr Maguire is a Veterinary Specialist in Small Animal Surgery. He graduated from University of Sydney in 2006 with first class honours and worked 9 years in the USA, where he completed 2 years of surgical internship training and a 3-year small animal surgical residency programme at a veterinary referral centre in New York. In 2015, he obtained his specialist qualifications with the American College of Veterinary Surgeons. His areas of interest include trauma and reconstructive surgery, orthopaedics, soft tissue surgery and neurosurgery.

Dr Maguire lives with his wife, a specialist in exotic companion mammal medicine, two children and a parrot named Tweety!

REFERRAL SERVICE FOR INTERNAL MEDICINE

We provide a referral service for internal medicine, which focuses on the diagnosis and management in areas of cardiology, endocrinology, gastroenterology, haematology, infectious disease, medical oncology, nephrology and neurology.

REFERRAL SERVICE FOR SURGERY

Our surgical team works with state-of-the-art surgical equipments and facilities including Synthes® (Swiss precision instruments) orthopedic and neurosurgical units, Valleylab® electrosurgery unit, operating microscope and a Cardell® multifunction digital anaesthetic monitoring system. We are also equipped with digital radiography and a CT( computed tomography) scan unit for better surgical planning and access to top of the line 3 Tesla MRI.


You may be referred to a specialist if your pet’s health problem is more complex and requires additional expertise and/or specialised equipment. Your pet may be referred for a diagnostic procedure, or for both investigation and treatment.

The aim of our referral service is to complement or be an extension of veterinary care already provided by your veterinarian. As we do not replicate services of your regular veterinarian, specialists do not usually provide basic care such as vaccinations, spays or neuters, etc.

IF YOU WOULD LIKE A REFERRAL, PLEASE SPEAK WITH YOUR VETERINARIAN.

Your pet receives the best care when you, your regular veterinarian and the veterinary specialist communicate and work together.

We will communicate with your regular vet regarding our clinical findings and ongoing treatment for the referred problem.

Dr Nathalee Prakash and Dr Patrick Maguire are available for referral at Mount Pleasant Veterinary Centre (Gelenggang). If you have any queries, contact our centre at 6251 7666.

Dr Nathalee Prakash: Be Thankful

There is no fast track to true success. And that is a good thing.

Because along the journey, we grow through lessons of faith, courage, sacrifice. And maybe, most important of all, gratitude. 

Love what (and who) you have. Be thankful for everything in your life. 

I WANTED TO BE A VET AS IT COMBINED MY LOVE OF PROBLEM SOLVING & PASSION TO WORK WITH ANIMALS.

Now I am thankful that I am able to care and give back to the animals that do so much for our society. Being a veterinarian is not just another job. It is a vocation.

Later, when it became a serious consideration, I chose to pursue a veterinary degree because I enjoyed problem solving.

I spent my childhood trying to convince my parents it was feasible to have a horse tied to a tree below my apartment block.

My parents finally allowed us to get a dog when I was 17. Ember loved to swim in the ocean, destroy walls, furniture and paper, and steal food off tables. He had eaten things he shouldn’t have including clothes pegs, porcelain figures, pencils and Chinese herbs, all of which fortunately passed out uneventfully.

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“Ember was a free-spirited & rambunctious Cocker Spaniel.”

I got Tate, my second Cocker, after I started my residency in Melbourne. An accident as a pup resulted in three surgeries on his leg and residual joint issues. Tate has been by my side throughout my residency – sitting patiently under my desk and sacrificing his walks and beach outings whilst I studied for exams.

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“I love being around water. I unwind by going to the beach or to the lakes for walks & watch Tate run like a crazed nut. “

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“Unfortunately, he also loves mud & rolling in smelly things!”

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“Participating in Obedience & Rally-Obedience with Tate allows us to work as a team. It teaches me patience, trust, discipline & understanding. Tate won his first ribbon in 2012!”

I chose to do a residency & PhD to further develop myself in the area of veterinary medicine I was interested in, particularly gastroenterology, neurology & urology.

Internal medicine provides the intellectual challenge of problem solving, as well as the ability to develop a relationship with owners and their pets. It involves further training in various medical sub-specialties including cardio-respiratory medicine, endocrinology, immunology, nephrology and urology, gastroenterology, neurology so that we can assess our patients holistically to make appropriate recommendations for each individual.

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With the team from Mount Pleasant Veterinary Centre before leaving for a 3-year residency in the University of Melbourne. [Dr Dennis Choi, Dr Anthony Goh, Dr Nandini Mudeliar, Dr Nathalee Prakash]

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“My aim was to essentially become a good clinician & provide the best standard of care I can.” Dr Nathalee Prakash is a Veterinary Specialist in Canine Medicine & is available for referral at Mount Pleasant Veterinary Centre (Gelenggang).

Being good at something requires sacrifice.

I had to sacrifice money, time with family and friends, and the opportunity to do surgery, which I used to enjoy. Preparing for Board exams is a stressful process. But in return, I gained friends, created wonderful memories and have been given opportunities I never would have had as a non-resident.

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“I draw strength from family & friends in Singapore & Australia, resident mates & supervisors. I would not be where I am today without them.”

Music has always been a part of my life.

I enjoy concerts and playing duets and trios with friends. I was in the band in secondary school and college and have been studying the flute since I graduated. This has been put on hold due to residency and exams but I will be picking up on my passion next month!

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I focus on goals rather than tasks. So if there are road bumps along the way, I won’t lose sight of where I’m headed.
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“Many have gone before me & succeeded. I really have no excuse. I remind myself to be thankful & not take for granted the things that are going well in my life.”