I met this senior citizen of 66 years. As thin as a rake but Singaporeans will not know what a rake is.
"Far East Organisation pays licensed estate agents $50/day for new property condo sales exhibition," he said. "My estate agent charges me money to be at its exhibition! They queue me at No. 40 and give me only weekday daytime slot. When my queue is reached, I have only done 2 prospects. And you know what?"
"What?"
"The estate agent reserves all night and weekend viewings for themselves and their friends! So, they never phone me to sell the condos during these busy times!"
I said naively: "Why don't you just join Far East and you need not pay?"
The senior citizen laughed: "They don't accept me. They want only young girls!"
So, here we have a Senior citizen who passed the CES examination of 200 questions at 2 minutes per question with only 5/50 candidates including his manager failing with no job.
"I have no contacts," he said to me. I was surprised as he has the badge and has given up.
"Farm for contacts," I said. "Be more presentable. Look at your spectacles. There are colourful oil reflections in your glasses. It is just not creating good impression." He was just not bothered with how he presents himself. The real estate firm, a brand-name one was also taking him for a ride by charging a rookie licensed agent for being present at new project sales.
Wednesday, May 11, 2011
434. Be prepared.
I interviewed one Filipino vet graduate by phone after receiving her email. I asked her to come for an interview. "Where's your address?" she asked me. I was so surprised that she would not even know which prospective employer she was talking to!
Many things are not taught at Vet Schools. Read more about preparation for job interviews and be prepared.
Many things are not taught at Vet Schools. Read more about preparation for job interviews and be prepared.
Tuesday, May 10, 2011
Market Segmentation in Singapore politics
On the eve of Polling Day on May 6, 2011, I predicted that Prime Minister Lee Hsien Loong and his team would win 70% of the votes cast. The PM had apologised for the failures of the government in not building sufficient HDB flats to stop the rapid rise of housing, the Orchard Road floods, the escape of a terrorist from detention and some of his ministers had apologised too. Some cynics think that this strategy was to get sympathy votes but I believe the PM was sincere. No government is perfect.
"Do you agree?" I asked Julia. She shook her head. "But he would win," she said. "The Reform Party could not even afford to put up their party posters in the neighbourhood."
"Didn't you see the posters of the Reform Party on the main road?" I asked.
"Yes, but only on the main road and nowhere in the neighbourhood."
"I fear that the PAP would be wiped out in this election," I could feel the general frigid atmosphere whenever I surveyed some of my clients as to whether they would vote for the PAP. The massive crowds at the Worker's Party and other opposition rallies were better than rock star concerts were well photographed by the Press and shown in the internet. One of the opposition's new candidates was young female in a group fighting the established Minister Mentor Goh Chok Tong who also had an equivalent young female in his group. However, the opposition young female was able to speak very well in public and the press had given her favourable coverage unlike the PAP's young lady candidate. Sometimes it appeared to me that the press was pro-opposition and the reporters were fanning the cries of the "non-silent majority" for voices to be heard to blow away the "arrogance" of the PAP government. A government that had performed very well for Singapore's development in social and economic areas when you compare to other governments in other countries like Taiwan where legislators were telecast live showing how they fought each other during Parliamentary sessions.
The opposition parties alleged that ministers replied to the public unsympathetically when small disasters like the Orchard flooding occurred.
This 2011 election was for a generation that "forget whence we came from," according to MM Lee Kuan Yew. The hardships, high unemployment rate, lack of public safety and racial riots were forgotten as the Y-generation enjoys the fruits of success of Singapore being a first world country and wants more goodies without having to work hard. 5-day week even for civil servants, 4 months of paid maternal leave. An internet forum writer replied that his generation does not forget owing to many reminders during school days but he or she does not want to go back to "whence we came from."
Unbelievable housing benefits not present when I started working in the 1970s as follows:
SINGAPOREANS EARNING LESS THAN $8,000 BUYING RESALE HDB FLAT IN THE OPEN MARKET
$30,000 to $40,000 subsidy to buy a resale flat if your household income is less than $8,000 per month (to be increased to $10,000 as a result of the feedback and unhappiness about the rise in public housing during the elections).
SINGAPOREANS EARNING LESS THAN $8,000 BUYING NEW HDB FLAT (BUILT TO ORDER) FOR THE FIRST TIME
No subsidies if the Singaporean household purchases a new HDB flat which looks much better than a condo in the same locality but cost 10-30% cheaper for Singaporeans only. These flats are known as Built To Order (BTO) flats and will take time to be completed since property is inelastic.
The opposition had asked for lower prices for new HDB flats and more help for those affected by the high prices.
According to the Minister Mr Mah Bow Tan, increasing the household income ceiling for buyers of new HDB flat from $8,000 to $10,000 would make it eligible for 50% of those who currently buy resale flats to switch to buying the new HDB flats. He said this would lead to a decrease in demand and therefore value of resale flats. Therefore present owners of HDB resale flats would have capital depreciation instead of "asset enhancement." So, another market segment is affected when the government changes housing policies.
SINGAPOREANS EARNING LESS THAN $10,000 TO BUY NEW FLATS BUILT BY PRIVATE DEVELOPER'S
Or purchase of an executive condo (EC) or design, build and sell scheme (DBSS) flat with similar $30,000 to $40,000 and no resale levy for Singaporeans earning less than $10,000 per month. This scheme caters to the "sandwiched middle class" who can't afford private property. The ECs have condo facilities and if it is bought to live in rather than speculate, it is value for money since $30,000 to $40,000 subsidies are given by the government to buy the EC and live a lifestyle of private condo owners. ECs are not built by the HDB and are said to be much better designed by private developers. After selling, the HDB and Town Councils will manage them. There will be not be a condo management committee unlike private condos.
SINGAPOREANS EARNING LESS THAN $5,000 BUYING A NEW 2- OR 3-ROOM HDB FLAT
In addition to the $30,000 to $40,000 subsidy, an ADDITIONAL HOUSING GRANT (AHG) and another SPECIAL HOUSING GRANT (SHG).
SINGAPOREANS GET TWO CONCESSIONARY LOANS TO BUY NEW HDB FLATS. Lower interest rates. They can get more concessionary loans but must sell back the flat to the HDB at posted prices (below market prices). Obviously nobody does that.
SENIOR CITIZENS WITH NO INCOME LIVING IN 3-ROOM HDB FLATS
Lease-buy back scheme. The government buys back the HDB apartment (tail end of the lease of 30 years), gives $5,000 cash upfront and then another $5,000 for the purchase of a CPF Life Annuity. This annuity provides an estimated $300-500 monthly income for life. Subletting the whole flat (and staying with the family), subletting a room, downgrading or cashing out are areas where the senior citizens can earn income.
So it seems all market segments in Singapore are politically covered by the PAP. The opposition's complaint was that the prices of the HDB flats have shot up and the mortgage payment is now 30 years. To me, it is better to have 30 years to reduce the monthly mortgage payments freeing cash for other expenditure.
Well, the PAP got 60% of the vote, down from the previous election. PM Lee got 69.3%. My prediction was not spot on but was close.
"You need not worry about that PAP would not form the government," Julia replied to my opinion that the PAP government could be wiped out this time, since there is great anti-PAP sentiments judging from the internet postings and the high turnout in opposition rallies as compared to the PAP rallies. Well, she was correct in that the PAP got 81 of the 89 seats in the Parliament. By any international standards of democracy, this is an incredibly good election performance in a fair and open election.
Singapore's Polling Day was May 7, 2011. Around 2 million voters, half of them from the younger generation voted.
P.S. Political intervention. The government introduced property cooling measures before the elections to reduce the cost of housing. These are:
1. For private properties, a Seller has to pay stamp duty of 16% during the first year of sale and lower percentages for year 2-4. This means that it is not worth speculating in private properties. This process is called "flipping."
2. Owners of private properties are NOT allowed to buy HDB resale or new flats anymore.
3. Permanent Residents (PR) who purchase HDB flats must sell off their private properties here or in their countries within a period of time or face penalties.
4. Property owners buying another property but has an existing housing loan will now only get 60% of the loan. Property owners with no housing loan gets 80%. In the past it was 90%. (I need to verify the %).
5. Commercial property buyers can only get 70% of the housing loan. (I need to verify the %). This is to discourage more demand for private properties increasing prices.
6. New HDB flat buyers (Built To Order), Executive condo and DBSS condo buyers (restricted to Singaporeans or Singapore + 1 PR as spouse) are not affected by the stamp duty on selling as the minimum occupation period is 5 years. The first-time buyer still gets the concessionary housing loans and the CPF housing grants of $30,000 or $40,000.
7. Market segmentation according to my lecturer's REA notes.
Market segmentation is a process in which a company divides the market into distinct groups of customers whose want different products or services. The intention is to identify groups of similar customers - to understand their behaviour and respond with appropriate marketing strategies.
These customer groups are as follows:
1. Geographic
2. Demographic
3. Psychological
4. Behavioural
Details of each group are as follows:
1. Geographic segment. Each locality has different groups of property buyers. Consumers in different areas show certain characteristics and behaviours. For example Districts 9, 10 and 11 are where the affluent customers are the rich and famous buying expensive ($ per sq ft) properties. Downtown Singapore has a population consisting of commercial and residential properties.
2. Demographics is the study of the population by age, gender, income and family life cycle amongst other variables. They respond to different needs and wants.
For example,
age groups - fashion or magazines for teenagers only. Toys are developed for children of certain age groups.
gender - cosmetics and clothing for women. A male lifestyle magazine covering male fashion, films, cars, sports and technology. Certain bars attract high-income female patrons who enjoy 'social drinking.'
income - I use this example of the Singapore government as regards to "affordable housing for the citizen". The low income group (earning up to $5,000) can get Additional Housing and Special Housing Grants if they buy new 2- or 3-bedroom HDB flats. This is in addition to the CPF housing grant of $30,000 or $40,000 for first-timers Singaporeans who earn less than $8,000 buying resale HDB flats. In effect, this group does not pay any cash in getting a new HDB flat.
Psychological segmentation involves the social class, lifestyle or personality characteristics.
The lifestyle, daily activities, interest, opinions and beliefs on various issues make up the characteristic of each group. For example the lifestyle segment of young professionals (able to take risk in investment) and retirees (frugal, least expensive tours). Marketers understand their lifestyle profiles to develop products and services to enhance their lifestyle.
Behavioural segmentation refers to why people buy a product or service. For example, what is the benefit they seek from the purchase and how it will enhance their overall lifestyle. For example,
1. brand loyalty (drinks only Coca Cola),
2. occasion increases the reason to buy certain products or services (Valentine's Day - buy more flowers and chocolates, Christmas Day - turkeys).
3. usage rate divides customers into the frequency of purchase. Heavy users contribute more to the company's turnover than light or medium users. No example is given by the lecturer. I will say examples of heavy users of products or services are women readers who buy and read romance novels and therefore the publisher of romance novels will ensure that more authors of romance genre are advertised and promoted than writers of scientific papers.
An example in the political area may be the "sandwiched middle class" of Singaporeans whose income have shot past the $8,000 household income ceiling. They prefer to buy new HDB flats but can't owing to their promotion in their career but private housing is out of their reach. If the government changes its policy of increasing the income ceiling to $10,000, this class will buy new HDB flats which are 10-30% cheaper than resale HDB flats on the open market and are brand new too.
My REA examination will be on May 25, 26, and 27 at 2 hours/examination. The above article may help those studying for the REA or RES examination understand the complex rules and regulations including the AHG, SHG (introduced in 2011), CPF Housing Grants, BTO, DBSS, EC, 120% Valuation Loan Limit, Minimum Sum Scheme, Additional Housing Withdrawal Limit after the age of 55 years (AHWL), Leverage Buyback Scheme (LBS), CPF Ordinary Account, Special Account and Medisave Account.
My lecturer said that there is no such thing as a Retirement Account as it is part of the Special Account but there is the mention of "Retirement Account" by the CPF board in newspapers. All of these rules and regulations will make an ordinary person go crazy trying to understand all of them and being tested. Sometimes my lecturer also can't keep up to date with the new policies.
P.S
Marketing segmentation also applies to veterinary medicine and surgery. Some pet owners prefer a practice where they see the same doctor for their pets (behavioural segmentation?). Some cannot be bothered but want a practice next door (geographical segmentation).
Some go for brand-name vets as they believe the vets there are the best money can buy (behavioral segmentation?). Some want old and experienced vets to handle their pet surgeries (psychological segmentation?). Young pet owners are internet savvy and will research their pet's problems on the internet first before seeking out a vet (demographic segmentation?)
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.
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.
Saturday, May 7, 2011
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
Jan Feb JUN
Previous capture 29 Next capture
1999 2000 2001
69 captures
29 Feb 00 - 28 Oct 09
sparklines
Close Help
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.
Wayback Machine
Jan Feb JUN
Previous capture 29 Next capture
1999 2000 2001
69 captures
29 Feb 00 - 28 Oct 09
sparklines
Close Help
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.
Friday, May 6, 2011
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.
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.
Thursday, May 5, 2011
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.
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.
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