433. Blackness on paws of old dogs - email query

On Mon, May 9, 2011 at 4:11 PM, Gene Ho wrote:

Hi there,
I have a query and I seek your help.
My dog, currently aged around 12 years have had black/dark patches of skin area his paws. It was initially unnoticeable, but have recently became darker.
May I know if this is caused by aging in general? It doesn't seem to bother him nor itch.
Regards,
Name of Owner


REPLY FROM DR SING
I am Dr Sing from www.toapayohvets.com. Thank you for your email. If it is just black pigmentation, it could be due to paw licking or some itchiness due to something being there. It is best to ask your vet to check.

432. A cat owner's cat mouth ulcers posting in Geocities

Geocities webpages are no more. The following detailed website of cat mouth ulcers was previously published by a cat owner. After Geocities closed down, the webpage was gone. I managed to track it down to an archive and publish here for references


Wayback Machine

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Boot's Story:
Lymphocytic-Plasmacytic Stomatitis.
Feline Viruses, Auto Immune Diseases
& Interferon

"You Are The Wind Beneath My Wings"
from the movie Beaches


Sept 1996. Boots, shortly after he came home with us. Weighing about 7 lbs, and waiting for his boiled chicken.

Lymphocytic plasmacytic stomatitis (LPS) is thought to be an auto immune disease of the gums and lining of the mouth and throat, although the exact cause is unknown. It can only be confirmed through biopsy. Although the symptoms may appear the same, do not mistake this disease with chronic gingivitis which is almost always due to tartar buildup.

The first thing to understand about this condition is that this disease is generally a secondary symptom of a greater underlying viral infection such as Feline Immunodeficiency Virus, Feline Leukemia, Feline Herpes (aka Rhinotracheitis) or Calicivirus. Always, always have your kitty tested for FeLV and FIV if faced with this condition. Fortunately Boots tested negative, both at the shelter, and by our own veterinarian, however our vet did conclude that Boots was chronically infected with Feline Herpes.

These viruses may cause other symptoms besides the stomatitis. You may notice your cat is more susceptible to upper respiratory infections and eye problems. As this condition is also thought to be associated with auto immune deficiency, you are also dealing with a disease that is triggered by stress. The stress of being in a shelter for two years had eroded Boots' mouth and gums to the point where he couldn't swallow. He weighed seven pounds when we brought him home in August of 1996.

The single biggest thing we have found to make a difference in the management of this disease is Interferon, an anti-viral medication developed for use in humans. We now have three years experience with it, and we have seen a dramatic dramatic improvement with Boots.

Boots' stomatitis was very severe with involvement down the throat and into the larynx and the loss of 3 teeth, but we have managed to stabilize it to the point where he's now eating boiled chicken (spoiled cat) and has almost doubled his weight since we began this protocol.

Our initial routine with him was teeth and gum cleaning and cortisone if necessary every 3 months, Antirobe (Clindamycin) antibiotic 1 cc X2 daily, and 1 cc of diluted (30 units per 1 cc of sterile water) Interferon a day. Cortisone (Depo-Medrol) is also common therapy for this disease. But you want to try to minimize the amount you have to give as it has long term side effects. Used judiciously it helps to control the inflammation and pain. Some cats require cortisone on a monthly basis, however we have found that the Interferon has significantly reduced the progress of the disease, therefore we are giving it less often. Our doctor mixes the Interferon in the correct diluted dosage and freezes it in 10 cc syringes. Interferon has a very short shelf life and cannot be kept in the refridgerator over an extended period of time. We thaw one syringe and use it for 10 days. It is given orally, and is mostly water, so there's no taste. You can either syringe it directly into the mouth or mix it into food.

Regular teeth cleaning is necessary to control tartar buildup which can make the mouth and gum ulcers worse and also open the body up to serious infection, so its important that you monitor this closely.

Interferon is a drug that was originally developed for human cancer intervention, and is also being used in human AIDS treatment. It is the only known anti-viral medication mankind has developed. It has mixed success in humans, but veterinarians are having greater success with cats. Consequently it is being used to treat or manage many feline viral infections including calcivirus, herpes (both of which have stomatitis as a complication), Feline Leukemia, Feline Immunodeficiency Virus and even Feline Infectious Peritonitis.

If all else fails, removal of all the back teeth seems to provide relief. While this might seem extreme, cats can do very, very well without teeth as long as you feed them canned food, and the quality of their lives can be excellant.

I was reluctant to take home a sick cat, so soon after having lost my beautiful Tardy. But Boots caught my eye, and I know without a doubt it was Tardy who had pointed him in my direction. Boots was so pathetic looking, scrawny and haggard. I knew the wonderful volunteers at the shelter were doing everything they could to help him, but I also knew Boots was slowly failing, and that he would be hard to place. I couldn't leave him there, even though I thought at the time I was opening my heart to eventual grief. The shelter had been very, very careful to be sure I understood this was a lifetime problem. I took him on a foster basis, not yet ready to deal with what I thought was a terminal illness which would lead me to more grief. But after the first few hours of having him in a real home and watching him bound delightedly from empty room to empty room, I knew Boots was home, and I called to say he wasn't leaving. The shelter waved the adoption fee.

Not knowing anything about stomatitis, I had no idea how much could be done to manage this disease. Two years later Boots now weighs over 14 lbs. He purrs now, and he plays with the other cats. He rules the house. I know that God and my rainbow Tardy are watching over us, but I also know the real difference in these animal's lives has been the experience and the unbelievable knowledge of our vet. It has been the deciding factor in our ability to maintain their health.

If, for any reason you feel that your vet isn't dealing with this properly, I urge you to seek a second opinion. The key to our success lay in the fact that our doctor keeps up with current trends, and with the published literature, and we are the beneficiaries of his dedication to his profession.

I leave you with one final thought. Don't lose hope! Boots has taught me that although you might face the pain of losing an animal, it is always worth the risk to open up your heart, to love and to try. The reward is indescribable. I often wake up in the middle of the night to find Boots nuzzled against my face, purring.

Below you will find a number of links I have collected regarding Stomatitis, Viral diseases for which stomatitis is an opportunitistic symptom, and some info on Interferon. If you have any more questions, or comments never hesitate to e-mail me.


Boots today, at 15 lbs, healthy and happy.

Postscript: I have always believed that Tardy led us to Boots. On June 4, 1997 I finally trapped and took in a stray that had been visiting us for several weeks. The first thing our doctor did was look at his mouth. We now have two cats with this disease, and two cats who are thriving because of our vet's skill and Interferon. Sammy lives indoors with us now, and Tardy watches over us still.

September, 1999 Update: Boots continues to thrive. He is still on 30 units of Interferon daily and has been since August, 1996. Just recently I received an unexpected e-mail from the wonderful woman who worked with us on adopting Boots. One of her shelter co-workers had found Boots' Story on the web and printed out the information to help with one of their shelter cats. Jo sent me an e-mail asking if this was possibly the same Boots. We traded e-mails, and finally Jo came to visit us. I was so proud to show her how well he is doing, and we both shed a few tears of happiness. Life takes unexpected turns, and it is so fulfilling to have a circle completed.

November, 1999 Update: Sammy has developed a Herpes eye infection. We are treating it with two human Herpes medications - Viroptic and Chloroptic eyedrops 4 times a day, and 250 mgms of L-lysine amino acid twice a day. The Viroptic drops seem to sting, so I give him the Chloroptic drops first to water down the Viroptic side effect. This seems to work. After 4 weeks, the medication is having a noticeable effect. There is no more squinting and Sammy seems to have regained all his old habits and appears to feel no more discomfort.

February 28, 2000: Our vet has just returned from a conference and is hearing wonderful things about L-lysine and viral infections. I have continued Sammy on 250 mgms of L-lysine twice a day since his Herpes eye infection, even though that has resolved. I am convinced it is helping him stave off URI's when we take vet trips. Today our vet recommended we begin Boots on the same dosage.


Stomatitis Links

About Stomatitis:

Feline Stomatitis - site includes good photos of what this condition looks like.
Oral Ulcerations - Includes diagnostic procedures and drugs of choice for treatment
Feline Stomatitis - More on Stomatitis from Dental Vet
Mouth Problems in the Cat - from the Feline Advisory Board in the UK
Stomatitis - From the Cat Fancier's Association
Veterinary Dental Care & Problems of the Mouth
Understanding Your Pet's Immune System - a good basic explanation of how the immune system works. Warning! Its a little technical!!


About Herpes and Calici Viruses:

Feline Herpes Virus - A veterinarian's explanation.
Herpes Virus, Stomatitis and Interferon - Dr. Mike Richards continues with an explanation of treatment
Herpes Virus: Symptoms and Treatment - Another good explanation of the relationship between Herpes and stomatitis.
Use of Interferon in Feline Herpetic Keratitis - corneal ulcers are another complication of Herpes virus
Calici Virus, Upper Respiratory Infections & Mouth Ulcers - Not so common a virus, but complications can include stomatitis. Excellent info on dealing with Chronic Repiratory problems!
Chronic Nasal Disease - Causes and Treatment
Upper Respiratory Infections - What to do when Kitty has a cold
Cat Colds - Causes and Treatment


About Interferon and its use in treating other viruses:

Interferon and FeLV / FIV - Using Interferon to combat leukemia & immunodeficiency viruses.
Newer Methods for Treating FeLV - Includes a link to an company manufacturing Interferon, and protocols for use.
Smudge's Story - Smudge has Feline Leukemia, and he is truly an Interferon success story.
Chloe's Story - An excellent site for info on FeLV, including Interferon treatment.
Dr. Mike Richards - using Interferon for FeLV
Dr. Richard C. Weiss - developer of the FeLV vaccine. A list of published articles on the use of Interferon in treating FeLV
Colorado State University - Study on the use of Interferon in treating FeLV

Living with the FeLV+ or FIV+ Cat. - How viruses affect the cat, False Positives, Treatment, Information and Support. See the treatment section.

Pyewacket's Story - FIV and Interferon. A genuine success story.
Felix's Story: FIV and Interferon

FIP and Interferon - The use of Interferon in managing Feline Infectious Peritonitis

What is Interferon? - This site is for Human Hepatitis, but does a good job of explaining how Interferon works.
Interferon:Patent claims

Resources:

Dr. Camuti Memorial Feline Consultation & Diagnostic Service - a wonderful resource for either you or your vet. For a $35 consultation fee you can talk to a vet at Cornell about diagnosis, treatment and the protocols involving Interferon.

431. GPs can't compete with subsidized health care at polyclinics in Singapore

SOME INTERESTING OBSERVATIONS AND COMPARISONS

Vets are equivalent to General Practitioners (GPs) in Singapore as both have first degrees. However, the Singapore GP have to compete with the subsidized health care at Polyclinics.

Some facts and figures from The Straits Times, April 25, 2011 - Let GPs handle the poor and polyclinics the elderly.

1. There are 1,600 GP clinics compared to over 45 veterinary clinics in 2011.

2. The PCPS is introduced by the Ministry of Health (MOH) 10 years ago for elderly patients to see a GP in a private clinic but pay subsidized polyclinic rates. The GPs get paid by the MOH.

Vets - More than 10 years ago, the Animal Infirmary at Kampong Java Road provides subsidized veterinary treatments to dog and cat owners. Subsidized in the sense that the cost of rental of the premises at Kampong Java were not included in the expenses of accounting. However, this is history. There were 2 or 3 private vet clinics as competitors.

There is a spay subsidized scheme for stray dogs and cats to be sterilised at private clinic. The vets get paid by the SPCA.

3. 200/1,600 GP clinics participate in the Primary Care Partnership Scheme (PCPS). Vets - those clinics participating are paid by the SPCA.

4. The PCPS is restricted to the elderly, the disabled and with low incomes. Those incomes at the bottom 30% of families, i.e.. a per capita income of $800 a month. Eligible are the disabled, unable to work due to old age, illness or disabled and those receiving Public Assistance.

Vets - no such scheme in Singapore although UK has the PDSA scheme similar to the PCPS. The PDSA does not restrict the scheme to only the low income group of the elderly and the disabled.

5. Consequently, more than 50% of the GPs provide aesthetic treatment to booster their income instead of focusing on practising mainstream medicine.
Vets - cosmetic surgeries are almost non-existent.

6. Polyclinic workload increase significantly in the past decade. In 2000, 18 polyclinics had 2.7 million consultations. In 2010, 4.3 million i.e.. 60% jump due to increased number of elderly people with chronic illnesses (high blood pressure, high cholesterol and diabetes).

7. Now the polyclinics try to assign repeat patients to the same doctor and to cut down waiting time. That means more consultations, taking patients away from the GPs.

Vets - no subsidized vet health care from the government.

8. Polyclinics doctors have o follow a set of treatment guidelines given by the specialists. E.g. diabetic patients must have blood tests, feet screened and eyes checked regularly. Well equipped with staff and equipment to do it. Polyclinics become centres of excellence for treating chronic diseases.

9. Rapidly aging population. One in 5 will be aged 65 years and older by 2030. So, polyclinics will have more patients, treating the poor and the chronically ill since healthcare is subsidized. Therefore GPs will likely get fewer patients. With high rentals as there are not many commercial properties being built, I don't know how GPs can survive in the next decade.

Vets - those renting are at the great mercy of landlords due to scarcity of commercial properties. No choice but to pay whatever amount the landlord wants. I think the new vet clinics will be able to survive as Singaporeans are time-pressed and prefer to go to a vet nearby. So, there is great hope for new vets who also charge lower fees. Unfortunately, it may not be economically feasible to go for low pricing and low workload to open a vet clinic. In 2011, it is believed that there are 600 pet shops are having difficulties surviving. Some 5 years ago, there were 200 pet shops and half close per year, according to one salesman.

Perhaps, it is better to be a commercial property landlord than to be a GP or vet if the person has no interest in practising.

There are some trends for GPs that need to be researched if the GP wants to sustain his business in the near future. The Animal Infirmary and its proposed privatisation are history now. It is unlikely that there will be a PDSA or equivalent PCPS concept as the government's priority is in food health and hygiene.

For the older vets, under-pricing by new vets is not an issue confined only to the veterinary business. The internet empowers pet owners and some know more than the vets as the pet owners focus on one issue discussed at forums and do order products from the internet freely and from pet shops to treat their pets or ask the pet shop operator to do the treatment.

Older vets may need to review their operations by knowing the trend. Do one or more of the following in the marketing grid. Provide new services, develop new products, increase market share by improving existing services/product range or diversify into other fields?

Personalised and excellent customer service are now more important. The same vet assigned to provide a continuity of treatment is what the sophisticated Singapore pet owner nowadays. Branding may also be more important now. In the final analysis, a good clinical or surgical outcome breeds referrals. Performance still counts as in all professions and for the vets, that means accurate diagnoses and knowing what to do in the treatment at affordable competitive costs. Merely being the cheapest vet in Singapore seeking high turnover may not be sustainable for the clinic business in the near term.

430. REA Examination - Net Present Value etc.

It is difficult for the lecturer to explain Net Present Value in real estate investment, part of the REA examination syllabus.

I got some info from ROI For Nonprofits by Tom Ralser

Chapter 8. Suggested Methodologies For Developing nonprofit ROI scenarios. The result allows the value of the outcome to be shown.

PRESENT VALUE BASICS

Situations can present value of future benefits e.g. enhanced earning potential for high school graduates or changed to present value of the costs avoided eg. disease prevention value. They involve the time value of money, a discoutn rate that reflects the risk and cost of funds and a series of cash flows.

CASH FLOWS
are periodic (usually annual) outlays required to get the nonprofit project underway and inflows (benefits) expected over the life of the project.

e.g. Cost at time zero = $100,000
Cash flow at time zero = -$100,000

DISCOUNt RATES
are like interest rates in reverse. The cash flows need to be brought back to the present day at a discount rate, with the present value being smaller. In present value terms, an apples-to-apples comparison can be made. The actual cost of money used for the project is also included.



NET PRESENT VALUE

Present value becomes net present value when the initial cost is included which is usually a negative flow. The basic formula is:


NPV = Sum (n)/t=0 CF1/(1+k)power of 1

where CDF=cash flow at period t and k is the cost of capital or the cost of money for the organisation.

In English, Net Present Value (NPV) is the sum of all of the periodic cash flows brought back to today at the appropriate discount rate.

Can anyone understand this?


CASH FLOWS



DISCOUNT RATES



This reflects the cost of capital for the organisation if gthe result is positive.

429. The pet transport man was frustrated

Yesterday I apologised to the pet transport man for scolding him. 2 days ago, I came back from my REA lectures and saw him clipping a cat in the operating room. The cat was anaesthesized with isoflurane gas via a mask. I was furious as I don't permit such procedures to be held at any time in the operating room and through all my 30 years of vet practice, I have always got the dirty part outside the operating room.

"It is not your fault that your cat was not sedated sufficiently for clipping," I said. "It will be a veterinary surgeon's fault. Now, a very clean operating room is necessary in any vet practice. Aseptic techniques in surgery may nothing to you as you are not a surgeon, but I am very fussy about making the operation room as clean as possible. By clipping the cat or dog inside, the room gets contaminated with hairs and dust and such matters will dirty the environment.

"That was why I was so surprised to see you clipping the cat's coat and so angry with you. So, I hope you will understand this."

The transport man had exchanged some angry words with me and said: "I don't have to come to your surgery (for my cases)." In reply I said: "Don't ever come again!"

The fault lies with the veterinarian. Xylazine 0.1 ml and Ketamine 0.8 ml IM just did not sedate a 8.5 kg cat. So the transport man had to drive back to Toa Payoh Vets to seek another sedation. Isoflurane gas was given by the vet and when I arrived, I saw the clipping just being started.

P.S.
Xylazine 0.2 and Ketamine 0.8 ml in one syringe IM would be excellent in my experience. Half the above dosage in cats less than 4 kg. As I had said, each vet has his or her own method of sedation. Some like just IV sedation. In my case, I prefer IM. The most important thing is not to let the customer feel frustrated for not having the outcome he desired. As veterinary medicine is learnt over the years, I did not comment much to the vet who had provided the service while the transport man suffered the brunt of my anger.

SOLVING THE TRANSPORT MAN'S PROBLEM.
After chasing the transport man out of the operating room, I had to bear the responsibility as to help him. He had come for sedation of this wild cat prior to clipping bald and the vet did provide him the service. It was unsatisfactory to him and now the baby was thrown out with the bath tub.

What I did was to get the cat clipped outside in a quiet room. The cat would be given isoflurane gas 5% by mask for around 1-3 minutes in the operating room. This was sufficient. A big barking dog in the animal holding area woke up the cat and therefore I got it into a quiet room to be clipped. There was no need to put it inside the operating room as isoflurane gas top up at 5% for 1-3 minutes is extremely effective in a sedated cat. Obviously, a better practice would be to give xylazine 0.2 ml + ketamine 0.8 ml in one syringe IM and the pet transport man would not be frustrated as he had to come back again.

428. FLUTD - 3rd case. Incontinent and dysuria male cat

Things do come in 3s. This is the 3rd case within a short period of 7 days of a cat unable to pee normally. Dr Jason Teo saw the case at night on April 3, 2011. The owner called in the daytime to know about the progress as she was a student and worried about the veterinary costs. I do follow up during the day time as well as to teach my new assistant Mr Min in cat handling as he seemed to have a few cat scratches on his right hand. I did not ask how he got them yet but I know he has no experience handling cats.

"For the past 1 week, my cat could not urinate normally," the young lady said over the phone. "He dripped urine all over the apartment."

This is the 3rd case of FLUTD. Typical. Male, neutered, 5-year-old cat fed dry and canned food. A young cat inside the apartment sometimes fought with him but other than that, there was apparently no change in diet or environment. The owner did not want to pay for the urine and blood tests and so they were not done yesterday.

The owner needed to be educated that urine test must be taken to assess for the type and presence of urinary crystals (calcium oxalate as in my 2nd of 3 cases, none in my lst of 3 cases). Without urine testing, the vet just could not know recommend prevention programs effectively. Urine could be collected during catherisation as the cat was tranquilised, as part of the standard operating procedure for examination and to prevent misunderstandings from family members who might be misled that the vet was incompetent for not doing a urine test as expected of a reasonable vet in the same situation.

EXAMINATION 12-HOURS AFTER CATHERISATION LAST NIGHT
"The cat is fierce," Min said as the cat extended his claws when picked up for examination. I could see that this cat did not claw unless provoked further. I sedated him with the minimal dose 0.05 ml xylazine and 0.2 ml ketamine. He was quiet and isoflurane gas by mask anaesthesized him. I checked his bladder. It was empty and so I could not collect much urine. I could see red blood in the urine and he cat was slightly dehydrated. I gave him dextrose saline and antibiotics SC. The cat was given isoflurane for less than 5 minutes. After taking the gas off, the cat woke up fast and started to claw.

"Cover him with a big towel," I said to Min. A big towel must be ready for cats as it is hard to gripe an angry cat. This cat was the type who was not aggressive towards people. I saw that Min already had three fresh skin scratches on his hands and presumed he had got injured when holding some cats for my associate vets.

"Stroke the cat's chin," I taught Min to tickle the lower neck/jaw area. He felt strange and alien doing such an act. He had never heard of such soothing treatments. I presume that Yangon in Myanmar where he stayed does not have many cats. The cat quietened. I cut one of the two catheter' stitches while Min held the cat wrapped in a towel. Then we reversed roles so that he could gain some hands-on experience.

INITIATING CAUSE.
Unknown. There is another younger cat in the apartment. The urine and blood is being tested.

I phoned and discussed with Dr Teo the case to send the cat home to his familiar surroundings of food and litter box and to observe. The owner would be taking him home at night. She had given permission for blood and urine tests and these would be given to her the next day.

For all FLUTD cases, a urine test is advised. The young lady had a lot of questions as to what's happening. Without a urine test, it is very difficult to substantiate. Evidence-based medicine is good medicine. Follow ups will be done. Related themes happen in threes and since this is the 3rd FLUTD, I don't expect a 4th FLUTD soon.

P.S The other 2 recent cases are:
1. The hissing cat has difficulty peeing again
Initiating Cause - shift to new house recently.
Was treated by Vet 1 whose medical records did not indicate struvite. Cat was on Hills' S/D canned food for around 2 weeks as prescribed by Vet 1. No crystals found in the urine tested.
2 The cat cannot pee normally - 2 cases (the 2nd case in 2011)
Initiating Cause - humping by the other male cat for the past months is likely to traumatise this cat's penile area but the owner does not agree with this hypothesis. Calcium oxalate ++ present in the urine tested. This case shows that a urine test is very important for preventive measures.


For updates, goto www.toapayohvets.com, goto CATS --> Urinary Tract Problems

The neutered male fights for his life

"He's an alpha," the cat lady said to me. "I adopted him from the SPCA. He is neutered as the SPCA does not release cats that are not sterilised. However, he goes around the neighbourhood fighting with other cats and at home, he is the boss of my other 2 cats.

"But he is a very protective and caring cat. When we had a puppy, he would prevent the other cats from going near the puppy! Once he saved my husband from a viper attack! That is why we all love him so much."

"Are there still vipers in Singapore, a concrete jungle?" I was surprised as one sees HDB flats and condos every where. They house almost 95% of the population.

"Yes, where we used to live. Cobras and pythons too. That is why we shifted out from the Seletar air base."

This white cat is 7 years old and he certainly has the size and standing to command respect from the neighbourhood cats. He did not come home one day and when he did, he just flopped on the floor and passed a lot of blood in the urine. T

"The grandmother thought he had died. He had no movement. He just lie on the floor. It was after midnight. We quickly phoned for the vet and got Dr Jason Teo to attend to the cat."

Now 4 days later, the cat looks bright but will not eat. The parents and a teenaged boy visited him daily. I explained the progress of the cat as I do day duty. "The figures for the white cell count, the blood urea and creatinine are doubled the upper end of the normal range," I showed the blood test report. It is likely that a type of bacteria had severely infected the cat's kidneys. Does he hunt rats and mice outdoors?"

The mother said: "He does catch geckos, but he does not eat them. I don't think there are rats and mice in our neighbourhood. Will he survive the kidney failure?"

"It is hard to say," I said. "A younger cat may have better chances of survival. He does not vomit but he also does not eat and he eats everything when he was normal." Dr Teo had advised them the prognosis and it was bad.

We will have to wait and see. The owner brought the cat's favourite canned food. The cat thumbed his nose at the food. He would rather drink. He is still being treated.

This case shows the importance of taking a blood test before treatment. The owner asked me: "Was the blood test taken before or after the treatment?" I showed her the date of the report which was the day the cat came in for emergency treatment. That satisfied her.