Saturday, December 31, 2011
Overall, it had been quite a depressing tour - coldness, grey skies and the sadness of Auschwitz in Poland and the Berlin Wall in Germany. I prefer not to visit the "Killing Fields" of Cambodia, the "tunnels" of Vietnam as a person is expected to de-stress not to reflect on man's inhumanity. I had been to another Auschwitz some 40 years ago from London when I was much younger and one visit is enough. There are still atrocities and killings in some countries, even in this modern age and therefore I don't want to pay to see more historical killings.
It is better to write drafts rather than perfect reports as I don't have much time and if I have to publish only "good English" reports of my work and travels, I will not be able to be productive and will produce 10% of what you read.
Dec 31, 2011 Hotel ABACUS Tierpark Hotel Berlin 4.48 am Singapore time 11.48am
No free wireless even in reception space. In Berlin, I believe that most shops do not provide free wireless, including McDonald's. At Starbucks, one has to go to the Starbucks page and click "connect". If not, no free wireless. It was not automatic. I believe McDonald's has same situation for one hour surfing but I could not get into it "Hotspot".
TWO TIPS. Temperature 4 degree C and lower at night
1. This hotel has steam heating radiators. Don't forget to turn the dial as some of them are switched off and you wake up in a cold room.
2. In one Czech hotel, the maid had not closed the window 100%.. As the curtains were closed, I could not understand at first why the room was cold when I woke up and the thermostat did not seem to function.
Yesterday Dec 30, 2011
Berlin Wall - Guide Yoko - Drizzling
Afternoon - Shop at De Ka Wa. LV still popular. Rarely see Chinese national tourists in Belin today but Caucasian salesgirl could speak Mandarin having been to China for study. Her own sling bag (company staff only, not for sale). .
Dinner - Ming Garden Chinese Restaurant. I slipped when my right foot turned as I stepped on a tapering step downstairs to the Ming Garden Restaurant. One in the group disputed that dinner was in the itinerary as the first night, we had no dinner. Finally, we got Ming Garden and Marcus told us his efforts. He handed us the feedback form during lunch at another Chinese Restaruant. Today Dec 31, 2011, at 5 am we would wake up and leave Berlin at 7 am to drive to the Hamburg airport. Marcus would fly back to Singapore (tiring) and we would be in Dubai for two nights (free? accommodation at hotel). Apparently, a 10-hour flight (stopover in Colombo) instead of a 7-hour flight back to Singapore via Emirates. SIA is more expensive and so Emirates with its "free" stay n Dubai had our business for this East European Tour. Global competition for SIA is increasing as for all Singapore companies. Best Chinese dinner was at Ming Garden. Sweet and sour soup, green veg, pork, tou foo with chilli sauce, fruits (grapefruits, pineapples, oranges, apples). It was quite packed. The operator has some ideas on variety and good cooking.
Be frank and proactive and ask for good grades if you want a good feedback from your customers as Marcus had done so. Also he had served his free tea and home-made chilli. He had been extremely hardworking and entertaining. Not an easy job to handle 18 Singaporeans. He is a free-lancer. I gave him a point "5".in the feedback form sealed in a blue envelope. "You can always steam the envelope and open it," I said to Marcus. "Your company would never know." He also used blue envelopes to give tips to the local guides at 2 euros per tourist. Apparently, local guides (probably Gulliver Travels) are paid 200 euros/hour and so they are employed for half a day only.
Not a Japanese car is seen in Berlin's "Orchard Road." More Mercedes. VW
Dec 29, 2011
Prague to Dresden - Guide Sylvia - great story teller, enthralled group more than other guides. Natural. Examples:
1. A stork statute. I could not take a photo fast enough as the bus drove too fast or I was too slow.
"Stocks carry babies," she asked how many of us knew this. Four hands went up. I knew it too. Sylvia said: "In one tour, a gentleman asked what gender the stocks were," she asked us. We didn't know. "The gentleman said the stock was male," Sylvia said. "Female stocks can't stop talking and talking and would have dropped the babies!" Sexist reply? Sylvia said: "I slapped him real hard on behalf of all women."
2. Audi. Sylvia said that Audi was originally named Horsch. "Nobody could pronounce Hor.." she said in a coughing voice. "I want to buy a Hor..Hor.Haw..Haw." Since it was difficult, the prospective buyer would say "Never mind, give me a Benz!". So the name was changed to Audi which is easy to pronounce.
3. "Be careful, there is a dangerous shop there. Don't let the women go in!" Sylvia said as we crossed the road to more monuments. I was wondering whether the shopkeeper was going to scam us. Some foreign exchange shops in Prague would display a good exchange rate and when you enter, the rates would be different and unfavourable. The group paid attention to a small lit jewellry shop called "Lights" or some similar sound. Sylvia said" "It is dangerous for the men's (wallets) as the women would buy all the things there."
4. One luxury VW car shown by her. I took a picture. 65% are produced and sold to China. VW was profitable in 2011. It has acquired other car brands too and Audi is one of them.
5. FEEDBACK AND COMPLAINTS. Sylvia knows how to address any potential complaints by humour. As Marcus handed over his usual blue envelope of tips to her, she pointed to a gold figure on top of a statue and said that it can hear all complaints about her and report to her as this figure is omnipresent. I doubt anyone would complain about her efforts and humour as you can see from one image I took where she captured the attention and evoked the smiles of 15/19 of the group with her pictures of the history and her condemnation of the politicians who tore down heritage buildings in the recent years. "What was not bombed had been torn down by the politicians," she said. "So Dresden looks very modern and new."
Singaporeans seem to be her group. "You may see me in Singapore if I go there,"she told us. She's an architect and had lived in various cities but lived longer in Dresden. When I asked about the horse carriage tours, she said not to take the tour as the guide will not give accurate tour info. A man and a boy was playing an instrument on the road side. "Gypsies from Romania," she told me. "European Union permits free travel for EU citizens." I asked when she said hello to a big man at a stall: "Is the man selling mineral stones a gypsy?" She said: "No."
An image of Sylvia is posted for readers. You can learn much from Sylvia in your working life.
"Be passionate in your work" by research and know how to present in an entertaining relevant manner. The customer can sense or at least smile when you lecture on the dull historical facts. For example, "Ladies will like this handsome king..." We remember her and her presentation in our images and mine and none of the historical kings of Prussia etc. We had a fun time.
You can see my tour manager Marcos also listening to her stories. I was taking pictures as there was no time and did not appear in the picture. Another couple and one other Singaporean were wandering off taking pictures. That is why there were 15/19.
An image of a tour dog. Another tour guide with Caucasian tourists. Asian and Singapore tourists seldom are interested in European history, kings and queens. More into shopping and more shopping. So, the European tour guide may need to entertain rather than inform because arts and culture is not part of the Asian culture compared to the general Europeans and Americans, in my opinion.
WHAT MAKES THIS HOTEL SUCESSFUL AS A BUSINESS?
Abascus TierPark Hotel, Berlin, Away from downtown, Near Zoo. Has theme of animals e.g. dining table has a wooden elephant. Big framed close up of a cock, fish, fruits on walls.
1. First impressions of reception and dining room shows a well managed hotel.
2. Affordable to tour agencies. Top in travel tour gp revenue in Berlin? Least costly 4-star hotel for Gulliver and other travel agencies apparently.
Rates 99e single 120e double for walk in clustomers
3. Free car parking.
Free Independent Travellers around 30% estimated. Free car parking. Weekend v high occupancy tour gp (Europeans mainly).
4. Provides 8 lots for coach parking. Max 400 tourists if all 8 coaches come. Hotel has only 300 rooms and therefore occupancy rates can be 100%.
Hard to find free car park lots in Berlin and this is probably its selling point.
5. "A" introduced. ABACUS Tierpark Hotel. I noted that the neon sign shows only Tierpark. Therefore ABACUS must be a later addition to the name. "A" is top of phone listing advantage. Has a real abascus displayed at reception but hotel owner is not Chinese. "Abascus" is just for top listing
6. Robust revenue is dependent on buoyant tourist economy. Berlin's downtown and Brandenburg gate appeared to be full of Caucasian tourists in the time I was there. Long queue outside Madam Tussard Wax Museum.
7. Privately owned
No free internet access Around 50% of Berlin hotels do not provide free internet access
bedroom 2 single beds slide towards each other to form a double bed. One of the beds creak and squeak. No maintenance check as the Winchester Hotel in Dubai has good beds, mattresses and two solid pillows. European hotels provide one thin pillow and soft mattresses in general or is it the quality of hotels selected by EU tours? What to expect for packaged tourists on a lean budget?
Mainly Netherland tourists for this hotel.
1. Temp around 4 deg C. Can be quite cold inside the room
Steam heating in this hotel. Must check as the setting in room and bathroom. The setting may be zero and the room is cold. Setting no. 5 means a hot room.
Ensure windows are properly shut or cold air comes in.
Berlin has >1 million tourists a day according to desk manager and low unemployment rate of 7% (Dresden 17%).
NO English brochures for guest - Not interested in English-speaking or Asian groups as Europeans form main clientele
Free n lots car park spaces unlike Berlin's other hotels
Wednesday, December 28, 2011
One day, we had a meeting with the young newly recruited management committee of the newly formed Bukit Turf Club to talk about the Veterinary Department. He asked us to sit down and he placed his legs onto the coffee table. The others felt uncomfotable and some commented about this unusual behaviour. Do all Australians do that? I don't know.
Is it good manners to sit around the sofa set and you, the Chief Vet put your boots and legs to rest on the coffee table? I don't do it and I don't want any of my employees to do it as I don't think it is becoming of a vet or the manager. Sometimes, the young people do it without realising that it is not good.
Free wireless only at the reception area, not in rooms or even dining areas on 2nd level. The past days, my 5th floor room and another one had the smell of sewerage, as if there was a leak somewhere in the toilet. The smell disappeared later. From my experience in seeing the Sewerage truck coming to Toa Payoh outside my surgery to suck out the sewerage material, the smell was almost identical. This hotel is popular with Japanese and other Asians and boast gym, bowling ally, pool and casino and so is of a higher standard. I can't understand why there is this sewerage smell inside the bedroom on a 5th floor! Luckily, today Dec 29 morning, I would be leaving for Dresden, Germany. That smell is bad.
Yesterday, the others went to another shopping mall and then another one called Venezula Square with its boutiques from 10am to 6 pm. A free and easy day and so Marcus recommended this shopping as the group was not keen on another heritage castle some 3-hour drive away. Sick of castles, church and shopping.
Fortunately for me, I went with Daniel to the Jest ski resort. He was skiing. Patches of snow below the hill, due to global warming. On driving to the top, there was a sudden blast of air or wind. Visibility was 1 metre in front. Temperature was below zero. Was this man-made machine whipping up artificial snow or was it nature? I went into the tower to hide.
The resort was not open fully. Only a small lane was open for skiers. Some bumpy areas. A snowboarder hit Daniel and broke his ski. It was not fun skiing in such an area. So, at 1.30 pm, after the ghoulash steak lunch, the guide Katrina drove us back to Prague. I asked to meet her boyfriend Dr Tomas Stastny who does voluntary cat welfare work 3 evenings a week. "His practice is a small one. Not those with lots of equipment," she said.
"It is not the practice that is full of modern equipment that I will want to see," I said. "It is to know more about how the vet works in Prague."
"There are only 5 vet surgeries in Prague," Katrina said. "It is very expensive to buy equipment to set up a practice. There are 180 vets. For 2 million people." Katrina worked with international tourist and so her conversational English is good. Daniel said: "She means that there are only 5 vet hospitals in Prague."
Her boyfriend's practice is in a farm area. The town centre with the church (see image), the big land of farms and the row of shop houses remind me of James Herriot's practice some 50 years ago. I studied in Glasgow Univ in 1969 and had visited Thirsk, a village mentioned in James Herriot's novels. Katrina and Tomas are fans of James Herriot too and his Yorkshire vet stories must have been translated to Czech. Tomas' practice is located in similar farmland countryside small village as you can see from some pictures. His 12-year-old son wants to be a journalist and he could write stories of the stray cats and patients of Tomas if this young man can be motivated to do so.
Some pictures are shown:
Tuesday, December 27, 2011
Yesterday, another city tour, mainly Prague Castle and the churches. Christmas Market Fair and shopping in the afternoon. I am quite sick of this itinerary of shopping. But I had a chance to do street photography of the tourists. Only 3 are interesting to viewers and are as follows:
I like the "gray" colour theme of the distinguished gentleman with his gray poodle in similar stance and profile. His lady friend is also dressed in gray coat. There is a market square tower and when the clock chimes at the hour, the two windows open and some figures can be seen. A trumpeter will blow his trumpet! This seem to attract the crowd. A concert was shown for children too. Overall, this Christmas market fair is the most varied. Horse rides, concert, vintage car rides, hop on tours and lots of stalls. It seems that the food stalls do brisk business. The others are suffering.
Yesterday visited poland's salt mines n Auschwitz.
Hotel duo is busy but one male reception staff has poor service in telling me that there are 650 rooms n guests keep their laptops inside their rooms. Previous hotels permit me to accommodate my laptop with reception. Hotel Duo is near subway warm bathroom tiled floor. Surprisingly no free Internet access in rooms. Young adults congregate near reception to use their smart phones as free wi fi is only present in this small area
OBSERVATION. When a business is big and busy, service is bound to be poorer. Other hotels in Austria and Budagpest, before I came to Prague provide free wireless internet in the rooms for the smart phone and there is one desktop for free internet access.
In Hotel Duo, I have to pay for the desktop or use the free wireless only near the reception area. The staff was quite abrupt
OBSERVATION. PLAN B. After walking over 300 steps deep into the salt mine, we were told that we just needed to go back to the earth surface by the lift. The electrician was busy repairing the lifts. So, there was Plan B -the old lifts probably used by the miners. Small ones. The two doors could only open inwards and so it was fun. Emergencies do happen and Plans B and C must be in place, unlike the SMRT subway breakdown in Singapore recently. Obviously, no Plan B had been thought out and there was widespread panic.
PACKAGED TOUR'S HIDDEN COSTS
Told Marcus I do not want to pay n take 3 hours coach to the countryside to see another castle tomorrow free n easy. The ladies warmed to his new found big shopping mall to shop till they drop tomorrow.
I prefer to take a 50-min subway ride to ski resort tomorrow. Global warming may have no snow. I can't stand seeing more branded shops like Zara as I don't shop and it can be cold. Too much "free and easy" from this travel agency adds up to the hidden cost
Morning guided tour of castle church christmas market which has good ideas to make money. Vintage car rides horse n carriage children buy pellets to feed n pat goat sheep lamb kids donkey n miniature horse.
Sausage n food stalls v busy
2to5pm at this market sq then walk 30min to dinner place as coach not permitted into this area pollution
Sunday, December 25, 2011
Spent whole day in Kracow, Poland.
Gregory, a M.A degree tour guide provided a morning city tour with lots of history about Kracow and the Jews being sent away by during World War Two. Some old houses had been kept for the owners by the Polish Government are unrenovated as no owners had come to claim them. In Summer, over 20,000 tourists but now, not many. 8 Jewish synagogues, empty chairs as monuments of the War seen. In Budapest, along the Danube River bank, I saw the metallic shoes representing those Jews shot and pushed into the river during World War Two. Castles and churches again. Then to Christmas Market. Lots of history given by this guide. "Short but can really walk fast," one Singapore lady told me as this man in his 30s would walk so fast that none of us could be near him whenever he had to proceed to another spot to gather us to explain the history. I had not thought of why short people can't be fast pacers.
After lunch at the same restaurant, I asked the guide that I would prefer not to stay another 3 hours in the chilly air of zero degree C at the Christmas market. 14 Singaporeans elected to go back to the fair and then being picked up at 5 pm for dinner at China Palace. "The reason we can't have dinner at Hotel Sympozium is that the guide and driver will not be given free dinners unlike at China Palace," Marcos the tour manager told us."I hope you understand. The other group from 5-star you saw having dinner there yesterday paid themselves."
I had offered to stay in the hotel in the afternoon and pay for my dinner in this hotel. I was sick of walking around closed shops and watching another Christmas market stalls again. It is like walking around Orchard Road with shops closed for 3 hours in freezing cold. "Why not pack fried rice back for us, like you did for the driver?" the wife of the management consultant said. This middle-aged couple also did not want more wandering. For me, I had something to do - street photography. Otherwise I would be most bored to death listening to history of Poland for 4 hours.
Krakow's Market Square is the focal point for all tourists. Horse-drawn carriages, vendors of sausages, flowers etc on this Christmas Day. Mostly tourists were seen, as locals would stay at home on Christmas Day. A pigeon-feeder was seen, likely to be a local senior citizen.
I had gone to a McDonald for a warm cup of coffee at around 11.30 am with the guide and Marcos. This McDonald was the only one open (by law, only 3-employee shops and self-owned shops are allowed to open on Christmas Day. Even Tesco supermarket that opens 24 hours was closed on Christmas Eve and Day). It had a metallic gold "M" logo outside the entrance. A famous 136-year-old hotel cafe was open too. A few hundred tourists, mainly Caucasians at the Christmas Market seen. One man juggled balls with his body to get paid in coins. Another man dressed like a Ghenkis Khan statue moved when coins are dropped into his bowl in front of him. Horse and carriage for tourists seen. More famous old churches and different styles of architecture but it seemed that none of us were interested in the details.
So, my afternoon was spent in the hotel to catch up with jet lag. In this tour, the group stayed 2 nights in the same hotel. So, less rushing and packing. The group also had 18 tourists unlike last December's tour of Western Europe when there were 40 tourists crammed in tight seats of the coach. So, nowadays, many of us could sit by ourselves as there were more seats available. Four couples would sit together - a newly wed and two senior citizens.
iPhone does not seem to work in Kracow's Hotel Symposium. A free internet access is for laptops. Got a phone line from the hotel to connect. The young men Dan and Jason knew how to create a "hotspot" via Internet Explorer in the laptop and used the laptop as a router for their iPhones. Still, at certain times, they could not access the internet while the laptop was OK. "There should be no reason for this failure to access the internet," Dan told me when I said that the hotel could be using software to prevent signals going to the iPhone from the laptop so as to secure payment for wireless use by iphones. "After all, the hotspot is inside your laptop and it is accessing the internet."
I was thinking of the Allies jamming the direction of aircraft missles by releasing some bright metallic things when missles are fired at the aircraft. So, iphones could be jammed intermittently.
Now it is 2.29 am. I tapped my iphone 4 for access to www.asiaone.com.sg which I could read about the Singaporean couple being mugged in JB and the Orchard Road flooding. The "Cannot Open Page. Data Roaming is turned off" appeared on the screen. Why can't the iphone access the hotspot which was created again by the young men? I would not know. Something to do with iphone 4's technical aspects I would think. At night, I don't want to go out to Tesco even if it is opened just in case 5 men appeared suddenly to mug me, as happened to the Singaporean couple in JB. The world has become much less safe nowadays with many people preferring to rob rather than to work and the police being under-staffed while the politicians of democratic countries try to govern the country by giving goodies to the citizens to win their votes.
Enough of kings and queens, churchs, shopping malls for branded goods and Christmas Markets in Vienna, Budapest and Kracow and the cold winter air. I did not have runny nose today unlike in Budapest's Christmas Market yesterday. Why no cold air rhinitis? I do not know.
I will be visiting the salt mines today. Got to get up at 6 am and have breakfast at 6.30 am.
Saturday, December 24, 2011
Some travellers have dogs and so this is always an interesting topic when they meet a vet to share their stories.
STORY 1. An inexperienced or unscrupulous vet in Singapore?
"I feel that I had been taken for a ride," the 39-year-old man recently married said. "I paid $500 for 5 X-rays. After the X-rays, my dog no longer suffers from pain in his lower chest (sternum)."
"X-rays are costly," I said. "Why was there a need for 5 X-rays?"
"2 x-rays of the neck, 2 of the chest and one of the front legs."
"Why did you consult the vet?"
"The Golden Retriever cried when I carried him," he said. We brought him to X (an old practice which seems to be the first choice of first-timer dog owners).
"Where's the pain and how old is the Golden Retriever?" I asked.
"I don't know. He is one year old."
Later I asked Daniel. He said that the vet could be inexperienced rather than being unscrupulous in trying to maximise profits, this being a young vet. It is very difficult for vets. However, deep palpation and manipulation of the joints would have located the source of pain. In most cases, it would be traumatic injury on the sternal area (dog cries when lifted up by the 'chest'". The anti-inflam worked as the dog was no more painful "after the X-rays".
To this dog owner, $500 was too much to pay. All depends on communications. I had one paralysed Shih Tzu with the left eye pupils dilated and right eye pupil constricted when bright light was shone, treated by two vets (stories written earlier). "Did the vet advise X-ray of the neck and brain?" I asked the owner. "This could be a case involving the brain and neck causing the dog to be paralysed on 2 back legs and one front leg." The owners said: "The vets asked whether we wanted X-rays and MRI. How do we know as we are not vets!" In this case, X-rays of the brain and neck needed to be done. The back spinal X-rays were done too. CSF fluid could be tapped to check for meningitis but since the dog had been on painkillers and treatment by the previous 2 vets, including acupuncture and herbal drugs, I did not do it. The dog recovered by not being recumbent and was able to stand up while it was given a steroid injection. "Pug encephalitis?" or the GME? More reviews needed.
"My son is the real owner," the slim man in his 50s told me when he asked me where my practice was located and why his Golden Retriever had a bad smell. Marcos called him "uncle". Marcos is 45 years old and "uncle" means somebody older than him. "Don't call me uncle," he told Marcos who tended to call another woman "auntie."
"OK," he said. "Brother", he said to the man with the Golden Retriever.
"Just call her little sister (in Chinese) instead of auntie," I tried to joke. The older woman did not like to be called little sister. "Big sister (in Chinese, there is a different name for the two group" was OK with her.
"How old is the Golden Retriever and has it ever been treated for dental or ear infections?" I asked. "Not in his 7 years of living," the management consultant said to me. I asked him to make an appointment. Once I saw him writing on a pad. "Write my good ideas as they come," he said. "Good idea," I said. "Some wrirting books advise putting a writing pad and pen beside the bed when you sleep, and write down the ideas when they come forth during your sleep. I don't know if your wife will approve?"
Yesterday - 6-hour drive to Poland via Slovakia. White snow countryside. Cold.
Lunch at ski resort in Slovakia. Good place for overnight stay said the guide esp. for experience of snow for one afternoon, overnight and next lunch, rather than the usual shopping malls (free and easy) again and again. I had spent two afternoons on two or 3 shopping malls which is a waste of time for me except for some Singaporeans. Life is more than shopping for branded goods which are "slightly cheaper than Singapore." Just a 2-hour stop. I could see the ski schools, ski chairs, snowboarding, ski crafts and even "Husky" dog sledges for rides
Only 18 Singaporean tourists in this tour. I saw Chan Brothers and MAsia tour groups at Budapests. Around 18 people. No children. "Quite boring," said one lecturer as compared to last year 40 Singaporeans in Italy-Switzerland-France tour. One 5-star tour group arrived one day ahead of us. I saw the young man whose money was stolen in Vienna. He is OK now. He just had dinner at Hotel Sympozium and highly recommended the hotel's mushroom soup, beetroot (pinkish) and salmon. All restaurants are closed and our guide said we needed to eat 3 meals at the Chinese restaurant China Palace. The dinner in this China Palace was bad. Red snapper fish was not fresh, cooked in sauce. I avoided it. Singaporeans have a much higher standard of fresh fish.
Friday, December 23, 2011
Just heard from BBC News in hotel that a British man who toured Costa Rica had been missing for months and his family could not find him. Crime against tourists seem to be common as a Singaporean also disappeared in Greece recently.
Overnight at Budapest
Chilly. Snow flakes at 7 pm but no snow.
Morning - Erica, tour guide showed us a castle, church and briefed us on one-hour Danube River cruise and another church, souvenir stall. Too many Church visits for me but inevitable when doing a packaged tour to Europe.
Lunch at a busy Taiwan-operated restaurant in a good district. Some Hungarian name and Western old British Jane Austen-type paintings on curved ceilings. Quite good food although I did not eat the 3-layered fatty pork belly meat whole at my age. Young man Dan ate two pieces. I ate the meat part and left the skin and belly fat. Different dishes from previous Chinese restaurant but Chinese cabbage (easy to store long) and oranges are common with the two restaurants. Very salty braised fish - I did not like it. More salty than salted fish but excessively salty food is a common thing in Budapest.
Cycling lane again and we were advised not to stand on the lane.
Afternoon 2.30 to 5 pm. Shopping district and Christmas market. The salt-mine was closed and therefore cancelled. I have enough of mines but Dan was looking forward to it. This showed he has interest in nature. I prefer salt mines to another round of shopping as I don't shop for designer clothes. In any case, Singapore has most of the brands. So, I walked around and see the locals. They seem to like the sausages, pork chops. I noted a senior man standing at a shop like Zara and H&M entrance looking at a monitor. He was viewing the CCTV for shop lifters. This is good practice not found in Singapore as security is hidden somewhere.
Christmas market. A few hundred stalls. Food seem to have most customers. Sales seem difficult for those selling porcelain mugs and ornamental things and some other goods.
Two "statutes" of two men. One in dark brown and one in snow white would stand like statutes and move when money is dropped onto the box. With my runny nose in this cold weather, around zero degrees C, I can't last 5 minutes but these two men can stand for at least one hour. Shoppers do drop coins. One group of youths sang choirs outside Zara for more than one hour. They get some coins from the public.
Dinner. Walk to a restaurant. Pork chops. Some of us cannot eat beef stew. Dance
Thursday, December 22, 2011
Singapore time 8.50 am
Yesterday, I was in Eastern Austria and visited a church where one young monk had made a youtube of the monks' chant viral, tying up with Sony to market to the world in large numbers. Visiting Europe means visiting churches as a tourist attraction. The 18 members of my tour group in general seem more interested in photo-taking. I entered the chapel and attempted again taking photos of the Christ and chapel mosaics together, with little success. A lady in her late 50s was using her new Canon camera and did not succeed in taking any good picture. "My hands are shaking," she said. She was a novice with a 18mm to 200 mm Canon lens and did not know how to use it. It was not possible to take the whole image of the inside of the chapel by hand. I told her to rest the camera on the gate's bars. Still she had poor focussed images. The priest came to open the gate and admitted two young ladies. He smiled at us tourists. "A good picture is one with the priest and his believers as compared to an empty chapel," I said to the two Buddhists. "Frame the picture and increase the ISO to 1600 instead of using 200 in this dark place." She got some good pictures. Point and shoot cameras are easy to use but do not produce the sharpness.
The guide Gertrude was hired by the E.U. Tours for the morning only. She was excellent in relating stories of the church (majority of Austrians are Roman Catholics), later showing a church with a wall painting of a saint for travellers' safety (usually present at road junctions in Austria), the underground mines where the Red Army or Hitler used to make aircraft, Saint Barbara shrine where all miners used to light a candle before entering the dangerous mines, the horse stable where all working horses were blinded to prevent them being shocked by flashes of lighting inside the mine. The air was cool and fresh inside this mine.
A Chinese restaurant called Mandarin for lunch was packed unlike the Sapporo Inn and Restaurant Chinatown yesterday. Why? It is the same with some doctors' or vets' clinics being packed and the nearby competitor being empty.
DESIGNER OUTLET IN VIENNA - Lots of "brands"
After lunch, we had one hour at a Designer Outlet which was insufficient for some ladies. "All goods are made in China" one Malay tourist said. "I had to compare the prices and need time to try. The most stressful shopping I had." I spent my time taking pictures of the shoppers and the windmills as there was good sunshine. "Will there by LV?" I asked Marcus when he mentioned the brand names like Reebok and others but omitted LV which is a big thing in Paris' Galeries Lafeyette shopping mall and which I witnessed seeing the Singapore ladies of my tour group last December, queing up like pilgrims to enter the shop as prices are cheaper than in Singapore. "No,"he replied. "LV is too high class to be in this location." POSITIONING is one aspect of the 4 Ps of marketing and LV definitely wants to position itself as high class and will not be in factory outlets like Mango. There was no ZARA but a SARAH in this fully packed car park designer outlet on Dec 22, 2011. Mainly Caucasians with a few Asian Chinese but there were more empty shops than buyers at this time.
CHRISTMAS MARKET IN VIENNA
Yesterday, she was quite vocal about visiting the shopping mall instead of the Christmas market when our guide Marcus gave an option. "Why not get a vote?" she asked. The silent majority did not say anything. I said: "Why not some go shopping and some go to the Christmas market?" In the end, Marcos was just teasing and decided that it would be the Christmas market after lunch (2 pm to 5 pm) as there would be more shopping malls and outlets in the next few days. This was only Day 3 and he wanted us to experience the Christmas market which was an excellent option.
ACCIDENTS FOR SINGAPOREANS
A few flakes of snow and then all sunshine. One of us slipped and fell on her backside while walking down a slippery iced road to view the "fairy-tale" church later on. Could have died but luckily no worries. In Europe, one has to be careful of iced roads. I fell once on my back in Switzerland last year and survived. There are other who knocked their heads and die.
Last December, a young Singaporean cut his eyebrows as he fell off the sledge downhill but he was OK.
This reminded me of my early years when I permitted my son of around 8 years to ski from the mountain chalet downhill to his ski instructor at the bottom of the hill. He remembered vividly. Just step out the door early at 9 am, put on your skis and with his younger brother, paddled a bit and he was downhill. "How did you manage to get a chalet on the hill?" he asked me yesterday. He is a young adult now. "Well, in those days, I do not book hotels early till I reach the Whistler Mountains. I asked a young Caucasian how to book a hotel and he said he had a time-share. I don't know him at all. He was a stranger I met at Whistler and he booked for me."
"Since his wife was pregnant, he could not use this and asked if I wanted to buy the vacation stay for that Christmas," my wife added. I had forgotten the finer details but I was quite adamant not to book hotels in advance when I travelled in the early years. There was no internet and that would be before 1997 I recall. 1994?
Now I can't imagine Singapore parents permitting 8-year-old and a 10-year-old sons to ski downhill by themselves
as there would be padeophiles and predators. It was 6 days of going out the door and ski downhill bliss for the two young ones I guessed since he could recall vividly. It cost a bomb for the ski lessons if I remember correctly. In retrospect, I was too trusting as that Caucasian could be a con man taking my money for the time-share but he was not dishonest. Nowadays, one cannot trust strangers offering their time-shares portion for sale. More scammers have surfaced as many people prefer to earn a dishonest livelihood.
BUDA AND PEST
"Was Marcos joking about Buda and Pest being two separate cities?" one tour member asked me. "He likes to joke."
"I don't think so," I replied. I do not study the itinerary nor read up on Budapest and so was as ignorant as her. According to Marcos, the area around the Mercure hotel we stay is a safe area. "A lot of homeless people at the railway station and a bit dirty area," he said. "But you can go out at night to see the place after dinner."
In view of the young Singaporean NUS-Duke University medical student who had disappeared and not found (since some 6 months ago), in his going out to some Greek islands by himself, I did not venture into the dark of the night.
Dinner was 3 course - salad, salty chicken with golden cheese sauce and pasta pieces and ice-cream. Marcos forgot to tell us about the 250-ml water bottle as being payable and it cost 2.50 Euros. This is poor organisation of E.U holidays as meals usually include water or tea and here, the guide did not let us know early.
HIDDEN COSTS - DANUBE RIVER CRUISE
Singapore's travel agencies try to be competitive with costs and so cut out many necessary tours. "If not, you will be charged $4,000 instead of $3,000" Marcos elaborated in anticipation of complaints. So, in Budapest, he recommended a tour of the Danube River and visit to the salt mines for 85 Euros. This was not in the travel package which just stated a city tour in the morning. If the E.U. management keeps to just a city tour at Budapest and free and easy in the afternoon, after all the way from Singapore, most sophisticated younger Singaporeans will avoid this company. There is something not right with the management. A Danube river cruise should be included as this permitted a view of the city, just as in the Seine River Cruise in Paris.
I can't remember whether E.U. also excluded the Seine River Cruise in Paris last December when I toured with this company too as I usually don't bother reading up the itinerary. It showed the majority of important buildings in Paris including Eiffel Tower and it was snowing flakes, making it a memorable Winter visit.
AGENT'S NAME CARD
In the marketing book, the author always advises to give name cards to customers. I had asked name cards from 3 tour guides recently. One was from Macau and one was from Singapore's ASA travel agency. The latter gave me the ASA calender name-card and her name. Yesterday, Gertrude the Austrian agent came to meet us at the hotel to go to the church. I spoke to her about skiing in Innsbruck and she said she could arrange for it. "Have you got a namecard?" I asked. She went back to the bus to get one. It had her photo of her. This was unusual as Singapore's tour agents don't have photos. In any case, I said to her in front of Marcus: "Singapore tour agents don't give name cards when asked. I expect Marcus to do the same." True enough, Marcus stated: "I don't have namecards." He is a free lancer and you would think that he will give namecards to market himself. But no. His customer was the travel agency bosses who phoned him to lead the tours. So the individual "cheap-skate" packaged tour travellers would have no business for him. Yet, this may be true in 99% of the cases. But that 1% may bring him referrals and businesses for his good services. A namecard costs 0.20 cents and I guess he does not want to waste money on poor prospective clientele like me. Gertrude said to me: "Travel agents who don't give namecards do not want to have to reply to too many complaints!" I said: "Complaints are part of the job in the travel industry. Singaporeans are great complainers and so this explains why Marcus avoids giving namecards! As vets, do we give namecards to every pet owners who consult us? I do not. Well, they do get it from the receptionist counter.
MARKETING TIP FOR VETS
Why not produce a bigger namecard to illustrate surgical approaches or write advices and give to clients? I do produce receipts for writing and giving advices for follow up. If used properly, it can be a great marketing tool as most clients (I presume) keep the receipts, but my associate vets do not know how to use it correctly!
It is 3.10 am now. So far, the two hotels I stayed for 2 nights each, gave free internet access. Great for the young ones with iPhones as they don't need the laptop to connect with their friends and could just thumb away their text. I write on this laptop which can be quite a heavy burden. Julia wanted me to store it inside the coach storage with other luggage. I did it last December. The computer did not malfunction although the temperature was below zero and freezing. But this December, I carry it along as I don't want to test my luck as this is my work tool to type and to store images from my camera daily via this laptop. The temperature is 4 degree C or lower.
IS IT POSSIBLE TO DOWNLOAD FROM THE CANON CAMERA DIRECT TO THE TWO PORTABLE HARD DISKS? I have not thought of this method. Lots of new things to learn and this takes so much time. There is just insufficient time in a day and I hope to focus on the important things but new technology, like the iphone demands time to learn. Now I can see why most young people cruise along in life with just their smart phone instead of using more advanced cameras. They just don't have time and patience to learn the software. Just click and shoot with the iphone and get good pictures in general.
Will sign off now at 3.25 am which is 10.25 am in Singapore. Only BBC in Buda. Must pay for English TV programmes. So, watch your movie videos on the wireless iphone, my elder son advised yesterday. I don't bother with small screens. I will read my crime story book or just do nothing till breakfast.
CYCLING AND PEDESTRIAN PAVEMENTPATHS ARE MARKED AND DIVIDED BY TWO
As there is no such demarcation in Singapore, cyclists here tend to get quite angry at our Singaporean tourists walking along the whole width of the pavement as the cyclist has to slow down or detour!
WIND MILLS and factories with pipings and hot steam or gases sprouting out of chimmneys seem to predominate in Vienna's outskirts. Greenhouses and farmland seen too. Good for picture taking.
Seen quite a few dogs being walked. A tan and black Sharpei said to be a rare colour. My best picture of a few hundred for the first 3 days in Austria and Dubai is posted here
Tip: Street photography. Focus on eyes. Zoom lens. One shot only. No second chance. Your hand must be steady.
Wednesday, December 21, 2011
Yesterday, the morning was spent touring the Summer Palace and as I had studied European history in my school days of the 1960s, I could appreciate the history of the Austrian kings and their families. After lunch at Sapporo Restaurant (run by Chinese Nationals), whole afternoon wandering around the area - market place, Parliament house. Wanted to drink coffee at 4 pm at the famous cafe where S.Freud wrote his book but it was full house. For dinner, Restaurant Chinatown. Guide Marcus could not locate the place earlier, so some walking around and losing him. "Same braised pork knuckle, vegetables and oranges as for lunch, but we had fish, prawns." The restaurant had buffet BBQ meat and oysters but not one customer while we ate. Same with the lunch at noon in Sapporo restaurant. Could it be the Euro crisis and recession?
He had initiative, bringing his home made chilli and making tea for us at his own expense. Able to joke and converse in any topic - important attributes of a guide.
Austrian guide told me that this was the warmest winter - climate change as there ought to be snow from November. Not a flake of snow. "What's the lowest temperature?" I asked. "Minus 15 deg C," she said it was some years ago after 2006 when she started work, after having been with Austrian Airlines in Singapore (office closed now).
"The snow was ankle-deep," she showed me her shoes. "The Malaysian tourists s could not walk through the snow in this garden to see this golden Mozart statute as they had no boots. They asked to buy boots but it was a Sunday and all shops were closed. So, they " In Vienna, shops close early apparently.
For this second day in Vienna, the temperature was around 5 degrees C. Bright sunshine. The bus driver was late (traffic jam) as I waited outside with a Salem-smoking couple, appreciating the chilly air. A police car arrived. Two Singapoerans from the 5-star tour had their cash stolen from their rooms at around 7 pm while they were having breakfast and they had to make a police report to claim insurance. So they would hitch a ride from us of E.U. Tours to the Summer Palace as our driver was late.
The young man with central elevated hair and two balded sides was quite mad as he had lost over 1,000 Euros, 500 US dollars and 2 Sing dollars as well as his keys to the luggage. His room was further in while mine was near the escalator. I recalled having seen a trolley used for house-keeping by maids when I left my room 406 at 7.30 am for breakfast and was puzzled. No maids around but Daniel said he saw two men, one in pony-tail. The policemen came and took some statements and left without interviewing any one of us. "It is an insider job, if you ask me," the be-spectacled young man said to me and the smoking couple outside the hotel entrance. "The receptionist would view the cameras and know I had left the room. Then the thieves would enter my room and took the cash." His credit cards and wallet were left untouched. An older Singaporean in his late 50s in another room nearby also had lost his cash and had initially not wanted to report to the police.
"Is there any CCTV in this hotel?" I could not see any bulbs or cameras in the corridors. I still don't know. I doubt it.
There was a note on the writing table informing guests not to leave valuables in the room but in the room safe or hotel safe free of charge. Singaporeans need to know that there is another world where people make a living out of stealing or scamming and therefore need not be employees even in developed countries like France and now Austria.
Will go to Budapest today. Had some phelgm of yellowish colour. Cold air affected throat and cause upper respiratory tract infection. Must keep warm or get pneumonia and die. Take health seriously.
Punctuality is not the strength in Eastern Europe apparently. Salty food and pork are the main things.
Tuesday, December 20, 2011
7 hours flight from Singapore to Dubai
7 hours flight from Dubai to Vienna
Compared to Dec 2010 when I also flew Emirates to Dubai, this year, the Dubai Airport looked subdued in lighting by 50% at 6.30 am. Not so bright. The Christmas trees were not decorated or lit. Lesson to be learnt.
1. Changes is the constant in life. Last year, Dubai airport must be at its top. Then it had to cut cost.
2. Free breakfast. Big place in the upper floor last year with choices of fruits, cakes and meat. This year, coupons to 3 cafes. I went to "Thai Express" with the coupon. A plate of rice with veg curry and one fried pop piah and one bottle of water.
3. Airport crowd. Less crowded but the Emirate plane from Singapore is still full of passengers as in last year, at around 100% full in economy class.
I sat on one side of the consultation table facing 4 of them and the main door. Since this was a very small room of 8 sq me, all 5 of us filled up the space. I prefer not to hold such management and performance meetings as I usually speak one-to-one but each internet employee has his own mind and personality and sometimes do not comply with instructions. Early Min was clicking his pen obsessively while I spoke one-to-one with him about his performance. "Stop clicking your pen," I said. "You may think that you can always go back to Yangon and get a job at a vet practice. Maybe US$500 a month but with not many variety and interesting cases to give you the hands-on experiences. Let's say you prefer not to work. One month finishes very fast and you get no income. If you want to start your own practice like Dr Saw who had worked for me for 3 years, you do not really have sufficient experience to be a good vet. Here, you learn from me as do teach you, especially in anaesthesia and surgery. No other vets will want to waste time teaching you.
"You also can see the cases of Dr Vanessa and Dr Jason. In a small practice like Toa Payoh Vets, you have lots to do. Unlike X (a famous practice), where you will be given one thing to do. For example, you will do ultrasound and lab test or you just do past mid-night assisting the vet. At the end of one year, you are only good in ultrasound and nothing else. Vet practice is much more than that, as you can see, if you want to open your own practice in Yangon.
"Of course, if you don't follow instructions, you get scoldings. You are not the only one 'scolded' for poor or lack of performances. When you needed a job, you phoned the agent daily enquiring about a job at Toa Payoh Vets.
"Now, you have a job but you start comparing to what others do in other clinics. Just complete the one-year contract and look for better employers," I said. "Just give me 2 months' notice like Dr Saw and we part amicably and happily." Myanmar vet graduates can't converse well in English and are seldom in demand compared to Filipinos whose command of English and service are top notch. I don't take Filipinos as this is part of my philosophy of 'making a difference' by mentoring Myanmar vets. It is a great disadvantage as regards poor service and interaction with clients as Singaporeans can't understand Myanmarese English. But this is part and parcel of my community service. Just like employing old man James till he was hunched double and could not work anymore. It is not that I can't afford to employ younger and smarter office assistants. It is part of a philosophy of giving back since I was a recipient of a Colombo Plan scholarship from the British government to study vet in Glasgow Univ. Every vet can make a small difference in this world and it is up to each vet to do what he can. For me, it is to help the Myanmar vet and Min is the 3rd one. All he needs is to stay one year and there will be other clinics who will pay him much more as Dr Saw was said to be offered $3,000 by Dr Jason Teo who had started his own practice.
Back to my meeting with all 4 today, I covered the topics of office attire, self-respect, initiative, eye contact by the vet with clients and productivity and performance expected of a vet, assistant, intern and employee. All these will make a long story and I will cover one topic - first impressions.
As regards first impressions, I looked under my table to see what footwear all four were wearing. Dr Vanessa had her clogs, a grey blouse and pants, Nicole wore slippers and no collar T-shirt, Intern Lim wore sports shoes and jeans and Min wore normal shoes and jeans.
"This is not your father's clinic," I said to all four. "Or your grandmother's office. I expect common sense as to what to wear to the office as an employee or intern, without me having to spell out the dress code. Clients who see you all dressed casually will think that their pets are also treated casually when they compare to other clinics with uniforms. This is what they think but they will not say it loud.
It has also to do with self-respect if you don't respect others. As a qualified vet, you set an example. Wearing slippers, sandals and clogs to work are not getting you the respect of others. You may not care. Self-respect is hard to define but it includes certain types of behaviour that is expected of a professional vet or employee. As for Min, he wears jeans. It may be because he has few clothing as he comes from Yangon but Mr Lim wearing jeans to the office is not acceptable.
I had to be frank with them. It is hard. "I have better and many things to do than to check on you," I said. "In 2012, I expect common sense and knowing what to do." If not, I will wield the big stick and start firing or replacing people who will not do what is right in the office. Otherwise, Toa Payoh Vets will just go down the drain and cease to exist as more than 50 vet practices will be set up in 2012. Firm leadership and good management is needed to improve business performance and sustainable profitablility. No short cuts. No casual and loose management anymore.
Vienna, Hotel Bosei, Austria Trend, Austria
Singapore time 11.40 am
Monday Dec 19, 2011 was a dark thunderstorm day. I was at the office at 9.30 am to review the hospitalisation cases. A tall matronly Caucasian lady in a big SUV parked outside. I had seen her before some 3 days ago as Caucasian clientele form less than 1% of Toa Payoh Vets' practice and so they are outstanding.
"Good morning. Dr Vanessa will be in only after 11.30 am," I said. "Is there anything I can help you with while you wait for her. Has your dog recovered from diarrhoea?"
"Yes," she said. "For the past 4 days, he had not pooped. Shall I use the tube which is for treating people with constipation?"
"Yes,"I said. "Use the enema tube for children. You do know how to use it?"
"Yes," she told me. "You know, after the dog went home after treatment for diarrhoea, he had to go to the toilet so many times at night and past midnight to pee. I was so worried."
"That would be due to urine produced. When Dr Vanessa gave your dog the IV drip, your dog would produce more urine as the IV drip water was filtered by the dog's kidneys."
She said: "Nobody told me to expect this. I was very worried that my dog had to go to the toilet so many times after midnight! Now I am worried that he had not pooped for the past 4 days." Later I spoke to Dr Vanessa who told me that she had received a phone call and had settled the matter with her client.
"Stop the medication that Dr Vanessa gave and the dog should poo," I advised. "What is your dog's reference number so that I can take out his medical record. It is written inside the receipt."
The lady put her handbag on the green cloth of the receptionist table. The ccloth covered a plywood counter as the glass pane had cracked and Dr Teo had got a carpenter to put on plywood. As the plywood looked bad for a vet practice, I covered it with the big green towel. Overall, it was not a good impression unlike other new practices. But I had plans to renovate the receptionist room in 2012 and so the overall impression was not too good. I mean, no receptionist counter has a big green or blue towel covering the top! The clients would not comment but the poor impression was there as you would deduce later from this Caucasian lady's comments to me.
The lady digged deep into her bag and produced two veterinary receipts of another practice. Lots of things inside a lady's big bag. "I am sorry I can't find Dr Vanessa's receipt," she said.
I don't comment on seeing receipts of other practices as doctor-hopping is not uncommon in Singapore as this would be inconsiderate. Out of the blue, the lady said: "I use to go to X (name of a famous practice) for many years. It is nicer and has many equipment and doctors. But I prefer the services of Dr Vanessa." I deduce that Toa Payoh Vets need some more painting and repair. It is just not practical to rebuild again as the Surgery has to close for 2 months. In any case, a nice veterinary clinic is like a beauty without brains. The brains are that of the veterinary surgeon who must know what to do and arrive at a correct diagnosis and good clinical outcome. The brains are more important than the physical appearance but that does not mean that tthe practice is like a bombed out dirty place. Toa Payoh Vets need another consultation room and a new receptionist area and this takes time to plan as the space of 60 sq m is very small for dogs that need hospitalisation after surgery, unlike some newer parental financed practices which renovate at over $500,000.
A famous practice with vets that cannot meet the higher expectations of some clients like this European lady would lose such clients to the newer clinics and others. However, since Singaporeans are impressed by brand name (see my conversation with the taxi driver below), a famous established practice will unlikely close down unless it is poorly managed.
In the evening, I got a cab to go to the Changi Airport for my European travel. The taxi driver of around 60 years old was quite chatty and asked Daniel what job he was doing. On hearing that Daniel had graduated as a vet, he spoke about his old dog that his daughter had adopted and now he had to care for it. "The dog is famous amongst the senior vets in X," he said. "I spent $3,000 to fix his broken jaw. Recently he went to another branch of X for passing urine many times. All tests were done. I got some medication for two weeks. But my dog still cannot control his urine. It must be old age," he concluded.
"He will need to be reviewed again," I said softly. He was not interested in listening to outside vets and so I let it be. Unlike the European lady, this taxi-driver would not seek another opinion other than the brand name and this is why I say that brand name still pulls in clientele. But performance counts in the end. A beauty without brains is no good for the dog if the owner is sophisticated to know what to do and to seek a second, third or foureth opinion rather than going for the brand name mindlessly."
Sunday, December 18, 2011
Young employee vets who don't have to worry about the bottom-line will need to be properly assessed as regards their work performance and client outcomes. If the practice's business performance in a lull period is poor, young employee vets and staff will be out of jobs too as they become a liability.
The owner of vet practice needs to use analytics to make sense of large amounts of data from customers and business partners and social media like Facebook. If he knows what to do, he can improve business performance.
1. Highlight often-used products and services
2. Identify which market segment is growing and worth focusing on sales
3. Sales and marketing department to identify new customers, imp0rove cost control and increase sales
4. Banks to identify fraudsters - Vets to identify non-paying clients
5. Brand and reputation monitoring
6. Manage risks - credit given to pet shops and breders. Below cost services given by employee vets to breeders who don't bring in any referrals. Just taking advantage of below cost discounted vet services.
As pet owners are likely to spend less in 2012 recession, vet practice owners must use analytics to improve business performance and improve future business outcomes. Not doing it will cause the practice to decline and go into bankruptcy.
- CORPUS LUTEUM
On Dec 18, 2011, a fine Sunday morning, I spayed a cat. There were 2 cats that came in for spaying. Normally my cat spays without complications take less than 15 minutues but this cat had some bleeding complications, being pregnant and has the corpus luteum.
Kim, the intern was able to see her first spay done by me. She sees practice on Sundays only whenever she is free. I asked her to write a report as writing can make her learn more. Here is her report (with my amendments in CAPITAL LETTERS):
Cat early pregnancy spay
Start time: 9.45am (SEDATION GIVEN IM. XYLAZINE 0.15 + KETAMINE 0.6 ML IM)
Start of surgery = SEDATION GIVEN
Cut the skin (FIRST INCISION SKIN)
Left ovary hooked out
Scapel blade was used to cut off left ovary (CUT OFF LEFT OVARIAN LIGAMENTS AFTER LIGATION OF LIGAMENTS AND BV)
Front paws were untied and body lifted up, cat started meowing (THE CAT WAS TILTED UPWARDS TO ASSESS THE RIGHT UTERINE HORN EASIER)
Right ovary cut out
Scapel blade was used to cut off Right ovary
Extend incision bleeding (COPIOUS HAEMORRHAGE OBSERVED, USUALLY OMENTAL FAT BLEEDING)
Slow breathing observed (I CAN'T FIGURE WHY INTERN KIM WROTE THIS AS CAT WAS UNDER INJECTABLE ANAESTHESIA)
Ligate individual uterine twine (UTERINE HORNS)
Check breathing again
Extend incision around 5mm
Clamp Uterine body
Suspect torn uterine blood vessel
Transfixing ligature uterine body to control bleeding
(Cat on heat)
Bleeding again from ovarian fat
Cut off uterine body
Simple interrupted suture
Linear alba 3 stitches 3cm (LINEA ALBA 3 SIMPLE INTERRRUPTED SUTURES. 3 CM LONG)
Check linear alba for hole
Stitch skin using horizontal mattress 2 stitches
Skin incision estimated to be around 3cm
End of suture
Surgical time: First skin incision –> last stitch = 9:59- 10:33= 32mins
Operation time: Sedation-> Last stitch = 9:45- 10:33= 47mins
Suture used: 3/0 (ABSORBABLE PDS)
Amount used: 1 packet
Sedation dose: Isoflurorane gas 2% (NO ISOFLURANE GAS WAS GIVEN. XYLAZINE AND KETAMINE IM).
Conclusion by Dr Sing.
A good first draft written under time pressure. Vet interns are to write on their own first draft instead of being spoon-fed and then I will amend their report.
Corpus luteum yellow seen. Also small foetal lumps of 8 mm inside the uterine horns seen (Images taken). The cat owner was adamant that her cat Manja, 6 months old, had never been out or mated with another cat!
Dear Dr Sing
I have attached a document on the case studies I have seen on the 2nd day of internship, 18 December 2011. Is this what you want of the daily case studies or does it have to be more detailed?
Name of Intern
REPLY FROM DR SING DATED DEC 19, 2011
Thanks for email. During internship, one case study per day is to be recorded for me to review and discussed with you. Otherwise, being a bystander standing around the vet will not enable you to appreciate the diverse aspects of vet medicine and surgery and its varied clinical presentations and challenges to a correct diagnosis.
Evidence-based medicine and knowing how to arrive at a correct diagnosis is not so easy in some rare cases as in this Sheltie whose condition may be mis-diagnosed as ringworm when the actual cause of the hair loss is due to hormonal factors.
One Case study should be written with the following format using the Sheltie you saw yesterday Sunday as an example. You re-write your case study with as much info of the case under the following headings:
CASE NO. 1 DATE:
1. Description of patient - breed, gender, age, colour. Not spayed.
2. Chief complaint - hair loss. Other complaints -
3. History - Hair loss for the last 5 years. Hair grows back after the heat and problem of hair loss recurs. Not fully recovered. Seen 2 vets.
4. Presenting sign: Vulval enlarged over 20X normal. Hyperpigmented black.
5. Examination and tests (blood, urine, skin etc).
8. Review/Outcome/Follow up - 2 weeks later. Date to be written on medical record.
8. Against Medical Advices - to be written down
As reviewed by me, what should have been included in this case were:
1. Where were the medical records of other vets? This should be recorded if the owner does not bring them. If owner said "Blood test of other vet is OK," the vet should not take the owner's word for it and ask for the blood test results. Some owners do NOT want to pay for another blood test and this should be recorded under "Against Medical Advices".
2. When was the last heat? This should be asked.
From my review of the above case, the main diagnosis would be a case of hyperestrogenism rather than fungal infections of the dog. Fungal infections are present but the dog's problem will not be cured even if the ringworm is eliminated. So, the owner goes to another vet later for a 4th opinion or just accept that nothing can be done. The dog was put on a hypo-allergic diet by the previous vet for one month. This would be too early to eliminate dry food allergy as a cause of the hair loss.
Now, the Presenting Sign of a swollen vulva 3 months after the end of heat and its presence for over the last 5 years point to a high probability of hyperestrogenism.
The solution for this owner is to spay his dog after the skin infections are resolved in around 4 weeks' time. However the dog is old and there are high anaesthetic risks. This case is quite rare. I had seen less than 10 cases over the past 30 years of small animal practice. So a mis-diagnosis can easily be made as the skin signs of recurring hair loss distracts from the PRESENTING SIGN. A blood test for hormonal levels should be advised in theory and as part of the practice of evidence-based medicine.
Saturday, December 17, 2011
Lady 28 years, single, Myanmar National
Had working experience of 2 years in Malaysia and 8 months in Singapore on a "S" pass. Her Singapore company was acquired and she was retrenched. She worked in the administrative side of both companies and has a good command of English and works hard. Presently she pays $500 to attend a diploma in business course but the college told her that the course would be 2 years. That is a lot of money as she is from a poor family.
My advice to her and all young people, including Singaporeans are:
1. Acquire important IT skills like a detailed knowledge of how to use Excel, Word,
video production and digital imaging. Real depth of knowledge of these software in database management and accounting. Not just superficial as many young people even from the Junior Colleges have. This makes you useful to prospective employer.
2. Willing to work hard and the longer hours. Yes, she does.
3. Can converse in English well. Yes. Written English is not so good as to be expected.
4. Positive outlook and lots of energy. Yes, as expected of a young person.
5. Get the testimonials of previous employers esp. the Singaporean company.
6. Unique Strength - Myanmar culture and language and speaking good English.
7. Be proactive. Do your own search and write to hundreds of employers (target 14 per week for example). Do not give up hope.
8. Resume must be up to standard and relevant. This needs outside professional help.
As "S" pass now require $2,000 payment by the employer, it is much more difficult to justify employing new graduates from Myanmar. But much depends on the education and skills and the demands of the relevant industry.
9. Do not job hop. Last month, I met a Filipino who switched to a Korean company for more pay. "However, I have to work on Sundays too," she told me as she visited Khin Khin Employment Agency to look for a job before her visa expires. It was too late. She had a earlier job which satisfied her work hour demands but the money was not there compared to the Korean company which told her that there would be no Sunday work. So this young lady resigned and without another employer, looked for a new employer. This is quite common. But her visa expires and her skills are common (administrative and sales). So, she had to go home.
10. Also save your network phone numbers in duplicate. This girl lost her old phone and all contact numbers esp. of the Accountant in the Singapore company. The Accountant was happy to give her and help. As is the case for young people, such contacts are not valued and phone number had disappeared. I advised her to be more proactive in searching for this mentor who could find jobs for her.
11. Many young people just do not bother with networks and people who will be of great help in their future job search. In conclusion, this case illustrates the importance of duplicating network contacts and being organised and careful. Young people with no specialised degree like accountancy will need to be more alert and pro-active in seeking work attachments and testimonials. New employers want testimonials and character references. "The Accountant told me that I can contact her anytime if I need help," she told me today as I met her at Peninsula Plaza while looking for a Myanmar travel agent. But she lost the phone.
12. Try and get along well with Singaporean colleagues of old job. Some may provide character references for you.
13. "Get married to a rich husband," I said to the young lady. Many Singapore wives stop work to look after their families if their husbands earn a good income. So this is what I advise her. "You are already 28 years old," I said. "How's your Italian boyfriend who contacts you daily from the UK?"
"It is not that easy," she told me. As I am more than twice her age, she does not feel offended in my advices. She needs to be more proactive in finding an employer who will apply for her the "S" pass.
Friday, December 16, 2011
The dog barks at Min and at me whenever we go to the consultation room to talk to her about the cases. Dr Vanessa would just keep quiet and not discipline the dog as I had advised her. So the dog became bolder and barked to drown out any talk from me or Min. I just can't understand why she would permit such behaviour. This is just not appropriate behaviour for a vet.
The dog also barked at clients. Some Muslim clients cannot be near this dog but he was let loose and so wandered to sniff them or their cats.
It is over one year tolerating this dog's behaviour and copious urination. I hav e to decide as to whether to terminate Dr Vanessa's association with Toa Payoh Vets. Just last month, her dog charged at me when she and I were discussing a case of a dog warded. I just could not believe that she did nothing. Not even a word of scolding at this dog. She just held back the dog in time.
This story is so incredible that readers may think I have a fertile imagination.
A young man who had completed his A levels started first day as intern till his National Service in May 2012. He surprised me by turning up at 9 am today as I told him I had an ear operation on a dog and he would be welcome to see how it is done.
"This ear canal resection surgery is seldom performed as most Singapore owners don't want to do it," I told this young man. "So, a vet undergraduate who studies 5 or 6 years may not have seen such an operation performed in real life. It costs money and that is why many Singapore dog owners don't want to do it."
Since he appeared keen by being present so early, unlike most of my interns who would be clock-watching, I shared with him some tips. He recorded the following for me:
Dear Dr Sing
Sorry to have to send you an email at such a time as I only got home by 10 p.m.. I have attached a report for 16 December 2011. The following is the timeline of the dog ear electrosurgery operation.
Dog Ear Operation (Electrosurgery)
Age: 10 Years Old Weight: 9.5kg Temperature: 38.5 Degree Celsius
10.15am: Clean flush the ear
11.13am: Sedation of the dog ( D and K)
11.35am: Electro incision
11.37am: 1% isoflurance
11.46sm: Stitching Right Ear
11.47am: 1% isoflurance
11.50am: 1% isoflurance
11.55am: 1% isoflurance
12.00pm: 1% isoflurance, 30 rr per minute
12.05pm: 1% isoflurance, 24 rr per minute
12.08pm: Finish Suture
12.10pm: Weat Exercise
12.11pm: Eye Blinking
12.11pm: increase to 4% isoflurance
12.11pm: Two clamps on the left ear
12.13pm: 1% isoflurance
12.15pm: electro incision
12.17pm: 2.5% isoflurance
12.19pm: 1% isoflurance
12.20pm: First Stitch on the left ear
12.22pm: 24 rr, per minute
12.25pm: 1% isoflurance
12.30pm: 0.5% isoflurance
12.34pm: 0.25% isoflurance
12.35pm: 0% isoflurance, remove electrode
12.39pm: End of stitch, End Of Operation
I did not edit his email report. rr=respiratory rate. isoflurance = isoflurane + O2 gas. D=domitor IV K=ketamine IV
From the above, it could be seen that two-ear canal resection surgery in an old dog with skin disease started from 11.35am and ends 12.39 pm. Total is around 1 hour just for the surgery.
I will record my surgery for the benefit of others. The vet surgery textbook can only give the theory but the practice of vet surgery is so much different in old dogs with generalised skin diseases.
EAR CANAL RESECTION IN AN OLD COCKER SPANIEL
Cocker Spaniel, 9.5 kg
Generalised skin diseases for many years. Scratching whole body, neck. Dandruff. Oily skin. The busy owner would send to the vet for treatment but the skin disease re-appears again after a few months. I believe that no vets had suggested ear canal resection to him. This was the cause of the skin disease, in my opinion. Ear infection --- painful, itchy. Dog scratches ears and neck, bites flanks - skin trauma, bacterial infections, more body itchiness, more scratching --- whole body skin inflamed. Finally, left ear had a big ear wart. Dog bites. Nobody at home cleaned the ear canals. Pus, bacterial, dampness as ear flap floppy covers ear canal --- no ventilation -- dampness inside ear canals -- bacteria grows ---pain and irritation --- dog scratches ear neck and bites flank. Uses back paws to scratch flank and chest --- oily infected red skin all over the body including forehead. Will post some images later.
1. PRE-OP PREPARATION
Dog with serious skin diseases was warded for over 2 weeks for treatment and fed proper food to gain weight. Monitored. Good appetite. Skin condition less dandruff but still oily. No yeast inside ear canal (ear canal smear). Owner gave permission for ear surgery. On day of op, dog bites esp. when left ear is touched. So my assistant only bathed him.
1.1 Sedate with Domitor and Ketamine at 50% of calculated dose IV. Very weak. Sedated within 2 minutes.
1.2 Put dog on table and flush, irrigate ear canals vigorously.
1.3 I washed his outer ear skin area thoroughly with cloth and antiseptic myself.
The oily skin was scrubbed well. I did not permit my assistant Min to do it in this bad skin diseased case as I must be sure that the area is cleaned.
1.4 Dog went to surgery room. Mask with isoflurane and O2 for <2 minutes. Intubated with size 8.5 endotracheal tube. This size fitted tightly so no leakage of gas during surgery.
1.5 Ensure set up of electrosurgery machine, big towel, moist saline on swab for indifferent plate, cotton bud, marker pen and surgical equipment and suture. "Check isoflurane level inside the machine," I said to Min after checking oxygen amount. He had to top up the isoflurane liquid.
1. Full power setting for electro-incision. I fitted the electrode into the handle.
2. Towel covers steel operating table to prevent electric shocks to staff and vet
3. Marker pen defined lowest level of vertical canal.
4. 2 forceps clamp either vertical side of canal.
5. Electro-incision of skin
6. Skin flap elevated and cut.
7. Arterioles shoot out blood into me. Clamped arterioles. Venous bleeding controlled by clamp.
Described in detail in www.toapayohvets.com, goto DOGS, goto EARS. 3/0 nylon 2 packets used in this surgery for 2 ears.
How long it takes to do the surgery? Should be around 1 hour for both ears. More experience and planning carefully, less than 1 hour in younger dogs with no skin diseases. Good assistant to monitor vital signs and the vet is to keep proper anaesthetic record
Tolfedine 1 ml + Baytril 1 ml SC
Wash ear bleeding thoroughly at end of op and not wait.
Dog OK. Woke up with no need for Antisedan reversal. Will check on Day 2 (Saturday 9.44 am as I write this report). This surgery ought to be done for dogs with recurring ear infections and floppy ears, when the dog was much younger, e.g. 3 years old but most Singapore owners will not do it. Breeds commonly affected are Cocker Spaniels and Miniature Schnauzers with hairy ears. Some Shih Tzus. Other breeds seldom have chronic otitis externa that can't be cured.
Tuesday, December 13, 2011
When the right eye was injured and treated by tarsorrhapy by Vet 1, the owner wanted the dog home AGAINST medical advice. On day 2, she phoned me to say that the eye was swollen and bleeding. I advised immediate bringing the dog to Toa Payoh Vets for me to check. She did not do so. Around Day 7, she said the suture had broken down and the eye was swollen and bleeding. This time she brought the dog down and was very unhappy as the first left eye with tarsorrhapy recovered without problems.
"There is no guarantee that every surgery is going to be successful everytime," I said. "I do have cases where there are similar problems. In the first case of the injured left eye, I did advise NOT taking the dog home for 3 days but you did not accept my advice."
There was a lot of unhappiness and blame onto the vet when the owner does not heed medical advice. Vet 1 is not to be blamed as the dog's eye was not well cared for post-op by the maid and mother. The dog was not confined but left to wander around the house and could have rubbed his eyes against sofa sides and beds, leading to stitch breakdown and bleeding.
I advise a repeat tarsorrhapy as the ulcers were deep and would need to be covered up to heal. Or a second opinion from another vet as to whether to leave the eye alone. If the owner has her way, she would rather not have tarsorrhapy. If the eye cornea subsequently ruptures or get pus infection, she would again blame the consulting vet for not having given proper advice! All advices must be RECORDED in the medical records nowadays although sometimes my vet just will not do it.
I will perform tarsorrhapy on Dec 14 and follow up.
More images and update will be at:
HOW ARE EYE INJURIES TREATED AT TOA PAYOH VETS?
Dr Sing Kong Yuen, BVMS (Glasgow).
1. General examination of the dog and eyes.
2. Detailed examination of the eye injury.
3. Pupil examination - Pupillary light reflex - direct and consensual.
4. Cornea examination - Fluorescein stain strip on both eyes and inform owner of the extent of the green stain.
5. Record and illustrate extent of ulcers (green stain) and advices on treatment in the medical record.
6. Diagnosis – For example, superficial keratitis, ulcerative keratitis, descemotocoele as shown in images below.
7. Advices on treatment and costs.
7.1 Extremely itchy eye. E-collar and eye drops. Eye irrigation of 3rd eyelid if acute conjunctivitis, under sedation is strongly advised.
7.2 Corneal ulceration surgery. Tarsorrhaphy under general anaesthesia.
7.3 Corneal ulceration surgery. Tarsorrhaphy and 3rd eyelid flap under general anaesthesia.
7.4 Corneal ulceration surgery. Conjunctival graft. Needs 7/0 sutures under general anaesthesia.
8. Digital images before & after treatment preferred or illustration to be recorded in the medical record.
9. Post-op warding in Toa Payoh Vets for 3 days mandatory for tarsorrhapy and conjunctival flap. Owners who insist on bringing the dog home are strongly advised not to do so. The "Against Medical Advice" instruction is to be clearly recorded in the medical record to avoid disputes of post-op stitch breakdown.
10. Pre-op preparation for surgery. Ensure area is shaved clean. Bigger facial area to be clipped short on both eye area. Eye lashes to be clipped short.
11. Eyelid eversion and irrigation must be done.
12. Sub-conjunctival injection of gentamycin may or may not be done, depending on the vet.
13. Advices: Treat the cause of corneal ulcerations. Traumatic injury caused by the protruding eyeball in the Shih Tzu, Pug, Pekinese ensures that such eye injury cases are common in the three above mentioned breeds in Singapore and elsewhere. Another cause is nasal fold hairs irritating the eyeball and nasal fold excision surgery is recommended. Ectopic cilia is another cause of eye corneal irritation and ulceration.
Case studies at Toa Payoh Vets:
1. Perforated corneal ulcer in a pug
2. Descemetocoele in a Shih Tzu
3. Most of Dr Sing's case studies will be filed at:
Eye problems seen at Toa Payoh Vets:
IMAGES OF CASES SEEN AT TOA PAYOH
VETS ARE SHOWN BELOW:
SUPERFICIAL ULCERATIVE KERATITIS
DEEP ULCERATIVE KERATITIS
CORNEAL ULCER PERFORATION
Conjunctival graft. A strip of conjunctiva is freed and rotated so that it covers the ulcer, then stitched into position using very fine dissolvable suture material. The conjunctival graft provides a blood supply and physical support to the ulcer to allow it to heal.
Typically, the cornea will heal in 6 to 8 weeks. A follow-up appointment is necessary to monitor your pet's healing.