683. Follow up - FIV in a stray cat

FIV in a stray cat with URTI & periodontal disease
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
13 October, 2011
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129

FIV in a stray cat - the interest of the stray cat is to get him eating and not sneezing
A mother with two young daughters found an adult stray cat. "Had runny nose and cough for the past 2 months," she said to me. "The cat follows us home. Must have been kept as a pet before. Just goes to the bathroom herself. Very gentle. I adopted her. But she can't eat now."

Dr Vanessa and I examined the cat. Deep yellow runny nose, saliva drooling from her mouth and her front legs were slimy by a thick crust of purplish red stains.

"How do you know this is a stray cat?" the mother asked.
"The left ear tip is clipped," I said. "There are kind people who get stray cat sterilised by the vet. The vet cuts a piece of the left ear off to show the law enforcement AVA officers that the cat had been sterilised and is a stray. Hopefully, this cat does not get netted and taken away to be put to sleep."

"I had intended to get a cat from the SPCA," she said. "But they charge for adoption."
"Well, you can adopt some from the roadside," I replied but actually, stray cats are quite uncommon nowadays, in coffee shops unlike 10 years ago. They are an endangered species.

I opened the mouth of the cat. Periodontal diseases with gum ulcers and loose teeth. That means painful mouth and so he can't eat properly. Saliva drooled continuously.

"It is best to get the ulcers treated and then the bad teeth extracted." This would be the most economical cost for a stray cat adopted by a family in the heartlands. There was a delay of 2 months in seeking veterinary treatment and I assess this as due to financial priorities as the cost of living in Singapore gets higher as the bureaucrats think of various ways to increase or introduce new regulatory fees every year.

"Stray cats do have FIV," Dr Vanessa said. "You should test the cat for FIV."
"What is FIV?" the mother asked.
"Cat AIDS," Dr Vanessa said.
"AIDS, like AIDS in people?"
"FIV is cat AIDS," Dr Vanessa explained.
"Will my children get AIDS from the cat then?" the mother was worried that she would also get AIDS if I could read her mind.
"No, no, cat AIDS don't infect people. However, the infected cat's life is short."
"How much to test for AIDS?" the mother asked.
"$85.00"
The mother hesitated. This money would be better spent on treatment as stray cat owners seldom want to pay much.
"It is better to get the infection of the nose and the mouth treated," I advised the owner and proposed a package of treatment and hospitalisation excluding FIV test.

Later I spoke to Dr Vanessa to think from the point of view and economics of heartland practice of stray cats in Toa Payoh area.

I asked her: "Assume I am the stray cat owner. Can you tell me that there a cure when I spend $85.00 and you diagnose that my stray cat has feline FIV?"
"No," she said.
"Therefore, in real world, it is in the best interest of the stray cat with or without FIV to get treated for her URTI (Upper Respiratory Tract Infection) - yellow nasal discharge and sneezing for the past 2 months with antibiotics and cleaned up her mouth.

"The cat will be able to eat and if not stressed out (by being a stray cat but housed and cared for), the cat will thrive. FIV does not need to be a terrible death for a cat that is well cared for. In other words, the limited money of the average heartlander is better spent on treatment rather than on blood tests."

Dr Vanessa nodded her head. The owner hospitalised the cat for the next 7 days as advised by me. Later she phoned to say she wanted the FIV and the blood test. Today, 2 days after antibiotic treatment, I asked Mr Min whether the cat had improved in health. Mr Min was non-committal. "Dr Vanessa tested the cat FIV positive," he said.

"Just see her nose," I said. "Any yellow discharge? Is the cat looking better? Has she got good appetite?"

The cat had clear clean nostrils and he looked bright-eyed and alert. Her front paws had less dark brown sticky stains as when he came in. Those stains were caused by his continuous and excessive salivation and her runny nose stuck onto and stained the front forelimbs when she failed to groom properly.

"Did you clean his noses?" I asked Mr Min.
"No," he mumbled. He just gave antibiotics as instructed by me. A normal cat always clean himself but definitely, the antibiotics had worked for him.

So Mr Min could see that there is an improvement if he was observant. The cat had no fever at admission. Despite having been tested for FIV positive, she had shown health improvement. A few days later, I will get his dental work done. So, she had a fair chance of leading a normal life if well cared for.

I need a lot of patience to mentor Mr Min as he is new to small animal medicine and surgery. Overall, I respect him as a veterinarian graduated from Myanmar and working in Singapore enables him to see the varied cases of dogs, cats and small animals that he has no opportunity to see in Yangon which does not have that large number of pet lovers as in Singapore in 2011. But I predict Yangon's small animal veterinary medicine and surgery should be expanding in 5 years' time as Yangon is growing fast and prospering.

In heartland practice of stray cat, the financial considerations are very important and expensive FIV tests take up the budget. So, in the best interest of the cat, I prefer to get her treated for her bacterial infections and periodontal diseases first rather than confirming the diagnosis of FIV. Of course, in an upscale practice, FIV is routinely done without a thought as the owners don't worry about a cent.

Follow up on the stray cat with FIV 5 days later
"Do you know how to open the cat's mouth to check the gum ulcers?" I asked the Temasek Poly lady who was volunteering and had chosen "pneumonia" as her first case study. This was the stray cat with the FIV and she had to write a report and produce a video.

No point just see like a tourist. Writing will bring vet medicine alive to a student and so I do insist on such recording. Her writing was excellent as I admire good neat handwriting. She had not come for the past 3 days and in that time, the stray cat made excellent progress.

I got the 3 classmates together to review this stray cat's case with them and come to a conclusion. First, I asked Min to get the cat out and demonstrated how to open a cat's mouth.

The student tried while her male classmate was positioned to video the mouth. The cat swung out her right hand and claws came out. She withdrew her hand to prevent being scratched.

"This is a gentle cat," I could see that the cat had not hissed or moved away. She just did not want her mouth to be opened. "Try again," I encouraged this lady. She did not succeed 100%. The cat swung out her left hand and claws came out.

"Lift the upper lip at the side," I said. "You will see that the gum ulcers have healed a lot." The students were convinced by seeing.

Blood tests were normal. No immuno-suppression and no systemic infection by bacteria despite having a FIV positive test. The 2 months of yellow nasal discharge was gone. The mouth ulcers had healed. The drooling of the past 2 months had ceased. The two teenaged daughters visited this cat daily, brought the canned food. This was a family that cared very much for this stray cat.


Deep purple saliva stains on the forelimbs are evidence that the cat had been unable to groom herself as there were continuous and excessive nasal discharge and drooling of periodontal diseases for the past two months. The cat looked normal now as she had 5 days of antibiotics and was able to groom herself
Dr Vanessa had the cat's dental work done on the 7th day and the cat went home to a happy family on the 7th day after hospitalisation.

This was an excellent case study of "pneumonia" for the lady student from the Polytechnic. It is a case of an upper respiratory tract infection rather than pneumonia. The cat also had periodontal disease. The FIV test was positive.

As a student, learning is best when real cases are studied in detail and written up. Being an observer leads to superficial knowledge because such knowledge is forgotten soon. I will see how she produces the video. She had produced an excellent video on "urinary tract infection in a dog". See:
Urinary Tract Infections & Cystitis - case study video production by two students
She would make a good video-journalist if you watch her video.


Toa Payoh Vets webpage at:
http://www.sinpets.com/F5/20111021stray-cat-runny-nose-drooling-FIV-singapore-toapayohvets.htm

Abercrombie & Fitch advertisement in Orchard Road, Singapore

Abercrombie & Fitch Advertisement - Young & Sexy?
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
12 October, 2011
toapayohvets.com
Be Kind To Pets
Veterinary Education
Project 2010-0129
I did not bother with the big advertisement along Orchard Road, Singapore until recently when the Advertising Regulatory Body asked the advertiser to take it down in response to a Straits Times reader's complaint about its vulgarity or something similar.
Abercrombie & Fitch said they would take down the advertisement as their store's renovation is nearly completed. It is not due to the complaint as they had got the proper permission to put up the advert.

Such publicity is worth much more than the large advertisement put up for many weeks along Orchard Road as the Straits Times is read by the majority of Singaporeans!

Now I pay more attention to the words "Abercrombie & Fitch" fashions! As I walked along Orchard Road last Saturday afternoon, I was at an angle where the afternoon sun rays shone on parts of the "bare body" and took 2 pictures.

I hope readers appreciate the picture of the advert and the video. The video song of the Beatles, I mean!

Video at: http://www.youtube.com/watch?v=CK5ippOwA9s


Toa Payoh Vets website:
http://www.sinpets.com/F6/20111020Abercrombie-&-Fitch-Orchard-Road-Singapore-advert_ToaPayohVets.htm

681. A Tourist Under Suspicion - Part 2

For some reasons unknown to me, on August 20, 2011, I was interviewed for 3 hours by the Hong Kong Airport Immigration Office from 6 am to 9 am. My visit was said to be "not in the national interest of Hong Kong." I had not visited Hong Kong since it became a Special Administrative Region (SAR) of China and that would be many years. I have no friends in Hong Kong when the Officer asked me. I was on a 4D/3N tour of Hong Kong and Macau. I just wanted to re-visit Hong Kong since the last visit as a member of the Bukit Turf Club task force to review the racing decline in Singapore. And that last visit was in 1988!

"Since the fish is in the net," I said to the Immigration Officer as I answered all his questions in a cordial manner and nearly 3 hours had passed, "Why not ask your relevant Department to interview me?"

"It is not so easy as you said," the Immigration Officer spoke to me courteously. "What offence did I commit?" I asked as the Officer persisted in advising me to by-pass Hong Kong by proceeding to Macau directly. In this situation, he would not stamp my passport as being "denied entry into Hong Kong."

"Why is my visit not in the national interest of Hong Kong?" I can't imagine me being the master spy or terrorist.

"I am sorry I can't tell you," the Officer implied that I would be sent back on the next plane to Singapore but did not say directly. "I am trying to make it easy for you by asking you to go direct to Macau."

My wife was waiting outside at the Baggage area as she usually walked fast and did not know I was detained. And 3 hours had passed so fast.

"If I accept your advice to go direct to Macau, how do I know that I would be denied entry to Macau, since Macau is also under China's control?" I asked as Macau is also a SAR of China.

"Macau's Immigration system is different from ours," the Officer implied that both SARs don't share the same data about me as a threat to the national interest of Hong Kong. However, I would not believe him.

"If I am denied entry to Hong Kong and just leave and go to Macau, I will have a black mark and will be denied entry into China."

"No," the Officer said. "I see that you had visited Hainan two years ago and had no problem."

"That was two years ago," I said.
"Things may change," the Officer said. "You may be able to visit Hong Kong another time. For today, I advise you to proceed to Macau directly from the Airport."

"Time is not on my side," I said sadly to the Officer. "I am 61 years old. "Have you spoken to your superior officer about my case?"

"Yes, I had discussed your situation with two levels above me," the Officer held his ground. "I am sorry you cannot enter Hong Kong."

"But what offence did I commit?" I asked.
"You did not commit any offence. You are more the 'victim'."
"Did somebody use my name and passport to commit a crime?" I asked.
"I am sorry I cannot reveal more to you,"

A victim of circumstances? Three hours had passed. I saw the light at the end of the tunnel. Each country has a right to reject tourists, no reasons need to be given. I said: "OK, ask my wife to come back to the Immigration Office and we proceed directly to Macau."

Her passport had been stamped as being permitted to enter Hong Kong. Mine was not stamped.

The Immigration Officer went to a room to speak to another person. Then he came to me and said: "You are permitted to enter Hong Kong."
I thanked him and asked that my wife be permitted to come back to the Immigration Counter.
"I am surprised that you did not get angry over this matter," the Officer said to me as a parting shot.
"Every country has a right to deny entry to tourists," I replied. "Thank you for your help."

I was sure I was videoed as there was already a written notice on the wall about being under closed-circuit television survellance of interviewees.

My wife was angry when she was brought back to the Immigration counter as she had waited at the Baggage Area for 3 hours. I quickly asked her to cool down, as a favourable situation can become disadvantageous to me if she made a lot of noise.

"Just focus on sight-seeing," the Officer advised me as we parted. I still can't figure out why he said that. Life is full of surprises. It is always best to keep cool in difficult situations.

In Singapore, I discovered that my younger brother had also been denied entry to Hong Kong 2 years ago and he just proceeded to Macau. He had not told me earlier. I wrote to the Hong Kong Immigration Officer, as advised by the Singapore's Ministry of Foreign Affairs. The reply is as follows:





Our reference : L/M in CD/HQ/23 Pt. 52

Dear Dr. Sing,

Thank you for your e-mail of 6 October 2011.

Persons arriving in the Hong Kong Special Administrative Region are subject to immigration examination under the Immigration Ordinance, Laws of Hong Kong. Each and every case will be considered and determined on its individual merits.

The Immigration Department attaches great importance to providing a courteous and efficient service to the public. It is regretful that you have encountered inconvenience at our control point.

Thank you for bringing the matter to our attention. Proper action has been taken. Hoping that your next visit will be a pleasant one.


Yours sincerely,

Mrs HO TSE Bing-yee
for Director of Immigration

CONCLUSION
Keep cool in difficult situations so that you can analyse and argue your case constructively will at least not burn the bridges. Showing anger and being abusive to civil service officers will not get you anywhere in this world. Not being proactive to argue your case courteously when you have had not done anything wrong is also not good for you.

680. Cystitis, lower urinary tract infection, upper urinary tract infection

Tuesday, Oct 11, 2011

"Both of you better go home in the afternoon," I said to the two young adults who kept yawning as I discussed the case of the Maltese that urinated dark red urine. I guess a Maltese peeing blood in the urine is not exciting as the dog belonged to somebody else.

"I stayed up late to produce the video," the young lady said. "It is a good video," I commented as she showed it on the monitor, "The hook is missing." The hook is the image of a bottle of dark red blood and that image was with her classmate. This was her first draft. I asked her to e-mail it to me. The final draft will need to include the hook, the X-rays and urine test results which I had created and more text. How to make it interesting to the pet owner is the challenge.

I asked the two students to tell me the difference between cystitis, lower urinary and upper urinary tract infections. I hope this case study will make their lessons on urinary diseases much more alive and interesting when they go back to the Polytechnic soon.

679. A dog and a cat hate each other

I got a phone call today from a young lady who has a 2-year-old male dog and a male cat.

Questions:
1. Why should I neuter my cat?
Answer:

678. The male Maltese pees thick dark red urine. Why?

Case teaching for 3 Temasek Polytechnic students 2nd year. Students should research write up a case rather than seeing many cases as an observer if they want to excel in veterinary medicine. I asked them to produce a video of the case. No need perfection. Just a first draft and we discuss further to bring vet medicine alive to pet lovers. So far, 5 days had passed. Not a frame of video!

676. Advices from a friend at Raffles Town Club

A man aged 63 years, retired from the civil service.

1. Success in private sector requires good EQ, IQ, networking, hard work. Be able to control one's anger even though the person is disliked. Success is not guaranteed in private sector.

2. He said that generally the smartest employees are in the private sector, followed by the civil service and then the welfare organisations. E.g. smartest people work in banks as bankers where they are paid most.

3. I should write courteous letters if I want favourable response to situations from civil servants. Anger will be unproductive. I was asking him some advices on a business project.

4. In PR, prepare your story and your angle rather than let the press decide the angle, but somertimes, the press editor has the last say and change the whole point of view.

5. Be available when needed by the press and help the rookies.

675. Synovial cyst on thumb

Today I had my bandage changed, 6 days post-surgery by Dr Foo Chee Liam, at SGH. Histopath results said it is not malignant. Dr Foo had diagnosed it as a synovial cyst (will post picture). My GP diagnosed it as part of an auto-immune disease which fortunately is not.

SURGERY
Dr Foo outlined a rotating flap. I told him earlier: "I need the right thumb for surgery in small animals." A rotating flap cutting a very incision (the whole length of the thumb at the medial side would be over 5 cm, width 2 cm). from the medial aspect of the thumb to close the circular wound after removal of the cyst (0.8 x 0.8 cm in my estimation.)

Fortunately, he took a full thickness skin graft from my wrist to cover the wound. I thought he had a fantastic solution as my thumb had not been cut to produce a rotating flap.

This case shows that the patient's interest and care is at the heart of the surgeon. I presume my synovial cyst behind the nail bed on top of the thumb was one of those rare presentations. Services were excellent from the front line to the surgeon.

674. Taxidermy but not for dogs and cats

Hi Dr Sing Kong Yuen,

My name is ..., a taxidermist operating in Singapore and is featured in ... (...). I read with regret your blog posting on 2010vets that a client had a taxidermied chihuahua by a local taxidermist that did not met his/her expectations.

I'm trained in my trade in New Zealand for a long time and can guessed what the problems your client have for the chihuahua. This is coming from my background in taxidermy and, more importantly, knowledge and skill in tanning animal skins with fur/hair on! However, I don't do dogs or cats out of personal principles (see ... report), but will still help out if sorely requested.

Being a current member of the Taxidermy Association Of New Zealand (www.nzta.co.nz), I'm in constant update of the state-of-the-art in taxidermy.

I hope to put right whatever misgivings you have regards taxidermy in Singapore. If you or your clients do have taxidermy needs in future, please do not hesitate to contact me. I'm sure your opinion will change once my work is seen by you.

Regards,

673. Pet Carnival in Singapore in Nov 2011

Dear Dr Sing,

Thank you very much for your advice previously. I would like to invite you to a Pet Carnival organised by my company.

First, allow me to introduce myself. My name is ...

My company is organizing a Pet Carnival.

The Pet Carnival will be conducted in late November as we are planning, and the location is still to be confirmed. Currently we are sincerely seeking for joint organizers, sponsors, and passionate participants of any form. All of the participating companies must be pet related, and we will allow only one company from each area to eliminate competition and increase the benefit for participating companies. The planned areas of pet industry include pet service, pet clinic, comprehensive pet store, pet online forum, pet online store, pet training/consulting, pet hotel and pet mover. Thus, we will only allow around 8 companies as either joint organizer or sponsor.

We are expecting to draw a population of 200 people with pets, and another 100 people who love pets but currently do not own one. The marketing power is projected to expand to around 1000 people. As my company is specialized in marketing and consulting, after the carnival, we are hoping to build long-term relationship to help the participating companies to expand their business. Thus, this is not just a pet carnival with tons of fun, opportunities and sales, but also a platform to help your company grow in the future.

Thus, on half of ... and as the organizer of the Pet Carnival, I am inviting you to join our event, as a joint organizer, sponsor, or any other form of participants, at your own choice. If you are interested, we can set up a meeting and further discuss about it.

Should you have any inquiries, please feel free to contact me.

Look forward to your response!

E-MAIL REPLY FROM DR SING DATED OCT 9, 2011

Thank you for your invitation. Will be glad to meet you to discuss further. Can make a lot of money (not really millions of dollars) if you know how to do it as pet ownership has increased.


In November, 2 "big" veterinary events in Singapore in which I am participating are:
Nov 5+6 - Singapore Vet Association Seminar and AGM
Nov 12+13 AVA Responsible Pet Ownership Roadshow 2011 - giving 2 talks or videos on Nov 12 + 13.

Therefore do be careful that you do not clash with above events and others I don't know. Phone me 9668 6468 to meet on weekday.