"My dog is vomiting," Ms Alicia Yeo said. She had bought a 10-month-old Shih Tzu from a pet shop a few days ago and was worried. Yesterday was her last "O" level examination paper and she would be free of learning for examinations from the end of November till the new year. What greatly surprised me was the red blob of tissue protruding from one eye of the Shih Tzu. 

This was a serious emergency condition of a deep ulcer in the cornea of the eye, medically known as deep ulcerative keratitis.

And yet, in this dog, the eye was not inflamed. No redness of the sclera or eye white. No tearing and no pain. The eye looked normal as the other eye. But, normally, the eye would be red and the eye lids would be half closed as the dog rubbed the eyes to alleviate the pain.

"Your dog's eyeball is going to collapse soon when the ulcer in the cornea deepens a bit more and breaks releasing the inner gelatinous support." I said. "The red tissue is the basement membrane. It is the bottom layer of the cornea being pushed out by the vitreous inside the eye as the ulcer is deep." 

The girl's eyes blinked. It was as if I was talking Greek to her. Elaborating further, as she would not understand medical jargon, I said, "The circle of white area surrounding the red tissue is the ulceration of the cornea. A break down in the cornea is called an ulcer. A hole in the cornea if you know what a mean. An injury.  Was the red blob of tissue present when you purchased the dog?" 

"No," Alicia said. 

"Then, you must have used a potent steroid eye drops," I replied. "The steroid stops all inflammation but the side effect of suppression of healing of this ulcer is that the ulcer becomes worse and in the next few days, will burst and the eye ball will have a big hole and rupture. In that case, it will become infected by bacteria and the infected eyeball needs to be removed."

It sounded dramatic but it was true. Alicia was angry with her father. Eye sight was precious and if her dog became blind, this was the fault of her father. 

"He will not be aware of the side effects of the potent steroid dexamethasone," I said. "Besides, Singapore is suffering from so many bad news of economic recession. The recent increase in bus fares, car parking fees, subway fares, goods and service tax, electronic tolls, power rates and rubbish collection fees made the head of the house hold tighten his belt. The Central Provident Fund contributions by the employer for older employees were decreased to make such employees more affordable compared to the young ones. All these mean that your father is cutting down on expenses."

Teenagers are sometimes sheltered from the economic worries of the father as the latter seldom discuss such matters.  

It is hard to be a parent for a Division Three government employee whose highest income would be less than $1,500 per month. It is better not to have children as the governments all
over seemed unable to decrease unemployment and retrenchment and increase in taxation seemed to be the only way.  

"My father gave the eye drops prescribed for him by his doctor on the dog's eyes for the past three days," she said, a bit in annoyance as her ears glued to the handphone to listen to some calls. This teenager who had just completed her "O" levels examinations yesterday seemed to be always on the mobile phone, even during consultation at the veterinarian. 

One of the teenagers who would have plenty to talk to peers but nothing much to say to parents. Hours of non-stop chat, chalking up large phone bills. 

I hope she was subscribing to Starhub which was the only one of the three Singapore telecommunication companies to give complimentary incoming calls. And had the wisdom to get her friends to phone her instead so that her father paid less phone charges. 

"What should be done now?" Alicia asked. 

"The best recommendation is surgery to cover up the eye ulcer. However, the cost of anaesthesia and surgery of $200 may be considered expensive by your father."  

The other option is to get an Elizabeth collar to prevent the dog scratching his eye and keep the dark in a dark and sheltered cage and treat the eye with antibiotic drops regularly till the ulcer heals.  The important thing is to stop using the existing eye drops but the inflammation and itch will come and the dog will rub its itchy eye with its paws or simply rub the eye onto the carpet or chair causing the ulcer to deepen."  

Alicia's father could get the Elizabeth collar and she went home after the large amount of gas inside the dog's stomach and intestines were treated. The gas caused vomiting.
But the main worries were whether the eyeball would stay intact? Would the cornea rupture? Was $200 a lot of money to save an eye?

Yes, $200 is a lot of money for a Division 3 government officer with a large family. Yet, the mobile phone girl must have chalked up more than that in a month as each call is 0.20 cents per minute or so.  And the SMS or instant messages add up to the cost and the bill would be five hundred dollars a month for some of these teenagers! It is fortunate for the father that she does not have the latest multi-media mobile phone which can send pictures and voices and rack up phone bills for the father. 

I did not expect to see her anymore. At closing time, she brought her father and her dog to see me.  The dog was operated on and I offered three days free boarding and supervision at my surgery. For the sake of the dog. It should have cage rest and let the eye heal better.

The dog would be moving around at home and the sunlight and breezes at home would irritate the eye and make the dog scratch out the stitches by rubbing the stitched up eyelids on the floor, on the bed and on the chair. Anyway. 

Alicia would not want her dog to be away from home. It was her dog. The teenager was not interested in free veterinary supervision and boarding. The dog would be kept in a bedroom. She did not like to be separated from her dog even for one day.