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.

"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.

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. Two videos are extremely well produced and narrated by a male and female Temasek Polytechnic 2nd year student who do not want to be credited. I thank them very much and we had some fun and big yawns (night owls?) from the two students producing these videos. These are: