Business success and worries

Yesterday, I met a young lady from Myanmar who speaks excellent English. She wants to start a dream business bringing artistes and singers from Myanmar to perform in Singapore.

"I have no contacts with the Esplanade and Integrated Resorts," she told me and I was surprised by her remarks. "It is quality of CONTENT not contacts that is important in any business", I advised her. "CONTENT means that your artistes can provide the services that the public wants so that you can make a profit," I said. "As an example, If you represent Michael Jackson, you have CONTENT and there is no shortage of venues."

I define a business as one that is for profit and for non-profit.

All business have the same worries of failures of not being able to pay the varied expenses, whether it is a veterinary practice, travel agency, real estate agency, an animal shelter, entertainment company or non-profit organisation or your own start up.

The following report applies to Travel Agencies but you can see that the factors I wrote is appropriate for the veterinary business in particular but will apply to all business start ups.

Over the last 2 years, I surveyed and observed the many interesting travel agencies in Peninsula Plaza. I also spoke to some of my interesting and successful veterinary clientele in their own and travel business and asked how they can survive the ever increasing intense competition. For the travel agencies, I enquired how they can survive in the cut-throat, price undercutting travel business with hotels and airlines provide direct internet purchase. Here are the main factors which were from an online survey I participated.

FOR THE TRAVEL AGENCY TO WIN AGAINST COMPETITORS

1. PRICES - Cheaper air tickets and hotels.
Vet example: New vet practices under price everybody. At least there are customers rather than no business. The sustainability of the business is not possible unless the vet has deep pockets and net losses are incurred per year.

2. VALUE - Better value or more interesting travel packages.
Vet example: Better equipped like CT scan, ultrasound, digital X-rays, blood testing and others.

3. SERVICES - Providing extra services such as insurance, visa application, vehicle rentals.
Vet example: Blood transfusion, acupuncture, holistic vet.

4. BRANDING - Better reputation and value.
This takes time and relies on the vet's bedside manners, ability and competence. See: A brand name vet practice opens doors...


Some agencies have loyal clientele if they provide 1 and 3 but the business may not be sustainable. The operator keeps looking for loans to cover the operating costs and this results in a bad reputation amongst the community.

FOR THE TRAVEL AGENCY TO FAIL
1. GIVE CREDIT TO CORPORATIONS AND OTHERS. One bad debt in big amount is enough to wipe out all the small margins of profit. Don't be a banker. Collect money first before starting the tour or travel.

Another factor for business success is a good updated website as a marketing and branding tool. I will tell this to the young ones who want to start a business. Many do start a website but fail to nurture and maintain it with CONTENT of relevance and interest every day. Updating of websites is time-consuming. There are better things to do in this time-pressed world of Singapore.

WEBSITE
This is important for any business. The following is my response to an online a survey I participated today.

CONCERNS WHEN STARTING A WEBSITE FOR THE COMPANY
1. High cost of starting up. The problem with the few webmasters I encountered is that the webmaster/company has no relevant experience as justified by portfolios of past clientele. I have not approached the big boys as I just can't afford their services.

2. High cost of maintenance. The webmaster disappears or his company increases fees over the years, just like accountants and auditors.

3. Lack of technical expertise. The start up business owner needs to do his own updating as it is costly to get the webmaster to do it.

4. Lack of traffic and sales from website. This is the least of the worries if the CONTENT is relevant to the prospective clients, is updated and interesting. Search engines do pick out the relevant topics. You can also pay www.google.com
and www.yahoo.com to be listed in the top 10.

Comments: In Singapore, my experience is that affordable webmasters are hard to find. Webmasters charge a lot of money due to the high cost of rentals. It is hard to locate an experienced webmaster with relevant experience. Or at affordable cost unlike in South Korea where I read that many small companies have websites due to lower costs of webmasters and broadband fees.

MY THREE MOST IMPORTANT FEATURES IN A WEBSITE
1. To be able to safely, securely and automatically accept payment online.
2. To increase sales and recognition through social marketing (like Facebook).
An interesting example is http://www.facebook.com/home.php?#!/philea.resort

I was a guest at the Philea Resort and Spa on Nov 6, 2010 and stumbled on its Facebook webpage as I submitted some photos of the Bridal Fair 2010 held at the resort to the marketing manager to forward to the models. It has a facebook page which I believe it common with all good hotels nowadays. Facebook viewing can waste a lot of time but the young generation loves it and are a source of new generation clientele.

3. To increase repeat customers with email promotions and newsletters

OTHER FEATURES
4. To increase customer conversion rate with multimedia presentations
5. To gather feedback and response from customers through company forum. This is interactive and very useful.

6. To build customer loyalty with reward points
7. To survey customers with online quiz and polls
8. To communicate with website visitor with live chat. I find this feature very useful when I had questions about my web hosting with Earthlinks.net in the USA.
9. Others - BRAND BUILDING. I will think a website builds a brand reputation.

HOW MUCH I WILL INVEST IN THE TOP 3 FEATURES
S$3,000. I doubt Singapore webmasters will take this amount. In Singapore, the Landlord keeps increasing rentals and the government agencies keep thinking of new ways to collect fees from the businesses. So, it is difficult for start ups to pay and pay.

The above replies were my participation in an online survey. It was powered by Qualtrics. www.qualtrics.com. I hope this info is useful for the young ones who want to start their dream business.

I asked the young lady who is doing her 3rd year of undergraduate studies in Economics and Finance: "Have you got a name-card?" She said: "No." Well, young lady.

A name card needs to be printed and presented if you want to start a business. This name card permits others to contact you when they need your singers and dancers or refer to the powerful ones at The Esplanade and the Integrated Resorts via networking!

Updates are at www.toapayohvets.com

245. Neutering risks for a 4-year-old male cat email

E-MAIL TO TOA PAYOH VETS DATED NOV 19, 2010

Hi Judy,

I would like to know if a cat that's 4 years old still suitable to do neutering? Will there be any risk? How's much will be the operation cost?

Regards,
Name of owner



E-MAIL FROM TOA PAYOH VETS DATED NOV 19, 2010

I am Dr Sing from Toa Payoh Vets, www.toapayohvets.com

Thank you for your email. A healthy cat at 4 years old can be neutered.

There is normally no risk if the cat is healthy (take blood test to check liver, kidney and complete blood test if you want to, before operation.The cost is around $150). In 100% of the cats neutered by me in the past 30 years (Toa Payoh Vets) was started by me in 1982, I have no male cats dying after neutering and I am quite sure this is the same with other vets in Singapore.

Prior to surgery, the cat will be examined for general health before surgery by taking a history of his past health, a general examination, palpation for abnormalities inside the cat, taking of temperature, pulse and respiratory rate and weighing him. If he fails the general examination, he will not be operated.

The main risk will be infection after surgery, from my observations of cats spayed in countries where there are no facilties for aseptic surgery and no antibiotics post-operation. Infections can kill a cat after surgery.

Surgery and anesthesia at Toa Payoh Vets for male cat neutering costs around $75.00. Add $30 for post-op antibiotic and pain-killer injection.
Estimated total will be around $105 for most clients who don't want blood test done. A pre-op blood test at this age or before anaesthesia and surgery is advised. The complete blood test costs around $150.

Please make appointment by tel 6254-3326. No food and water for the cat after 10 p.m, the night before the surgery and give the cat a good wash at the scrotal area.

244. At death's door - 3 cases

1. Case 1. The aggressive self-diagnosing breeder. I had stopped providing vet services to all dog breeders for the past 2 years. What most of them want was usually very cheap services.

This particular breeder brought in a Shih Tzu on Sunday at 5 pm. His vet was not available. He said he had X-rayed the dam at another practice but the X-ray showed 4 pups. He did not bring the X-ray saying he was busy. He suspected there was a 5th pup and could feel it. 4 pups were born naturally on Saturday and were OK. That was 24 hours ago.

I palpated a bony mass. "The pup is dead," I advised as it was past 24 hours from the last pup and the foetal lump felt 'bony' and that meant the water bag had broken.

"There is no point in giving oxytocin injection. Your dam needs a Caesarean section." This breeder was insistent in having an oxytocin injection. I did not throw him out as he did not accept my advice. I gave the injection. After one hour, the dog did not produce any pup. My first assistant advised a Caesarean and he accepted the need for one since no pups were produced.

The pup was smeared with dark greenish glue from the melted placenta. It had no amniotic sac and was stiff as in rigor mortis. This breeder wanted no more veterinary treatment like IV drip and antibiotics IV. He wanted to bring back the dam and wanted to pay only $250. "The new vets are charging less," he said. He became aggressive as his demands were not agreed upon. It was unpleasant. This is the reason I have had stopped dealing with dog breeders.

The next morning, the dog died. The owners were very unhappy. A dog's death is an extemely emotional experience for the owners and for the vet. This was a case where the owner entrusted this breeder to handle their dog's accidental pregnancy. He said he had X-rayed but would not produce the X-ray.

I have barred this breeder from coming to Toa Payoh Vets and told my associate vets that it would be best not to accept breeders at all. It was just not a sustainable practice to offer $250 Caesarean sections and lose money and respect from breeders who want to cut corners.


Case 2. The cat with nasal cancer. The cat went home the next day after surgery to excise most of the tumours. The owner phoned me today and said that the cat was eating. The nose bleeding on Sunday morning after I had pulled out the swab which stopped inside the nose bleeding was no more. The family had decided on no chemotherapy. "Can you do surgery when the cancer returns?" the father asked. "No," I said. "There is a big hole on the top of the nose, now covered by the skin. This malignant tumour doubles in size every 7 days and I expect that the cat will not live long." Chemotherapy is not guaranteed and may cause the cat to lose appetite. So, what's the advice?
"Try chemotherapy in low dosage first," I advised. There was nothing to lose as the wife was quite close to this cat. Chemotherapy does not cost thousands of dollars unlike the case in human cancer treatment. "Euthanasia will be the only option when the cancer recurs and bacterial infections of the right nostril causes pain and suffering," I said. This cat had no infection from this surgery because she had been on antibiotics 6 days before surgery and after surgery. So she responded well and could eat and drink normally at home post-operation, much to the happiness of the wife. But death is really at the door. If chemotherapy helps, it will be a happy ending.

FOR MY RECORD
Weight: 3.5 kg. Cat.

Anaesthesia. Domitor 0.1 ml IV. Zoletil 100 0.1 ml IV. Atropine 0.5ml SC. Intubate. Gave oxygen. Duration of anaesthesia was nearly one hour. A few seconds of isoflurane gas was given towards the end of surgery. It was taking one hour to do it. IV saline and baytril drip given 24 hours.

Post-operation.
No Antisedan antidote was given so that the cat could be sedated and wake up with less pain. The cat was observed breathing normally through its left nostril (forceps into nostril confirming no cancer cells from right nostril). He slept for many hours and was fresh as a daisy on the next morning after surgery.

Surgery on Friday at 4 pm. Incise with scalpel. Undermine skin. Nasal tumour grows from inside the nose, break through nasal bone is 2.5 cm x 1 cm long and much deeper inside the nose.

Electro-surgery separates tumour as much as possible from nasal bone. Excised. Large hole in nasal bone eaten by the tumour seen. Around 1 cm x 0.5 cm. Round fatty tumour cells seen from inside the nose and excised.

I put a gauze swab into the nasal hole and pull it out from the nostril using forceps (see picture at www.toapayohvets.com). This stops bleeding. Electro-coagulation of the tissues inside the nose helps but does not stop the bleeding.

Goes home on Sunday at 10 am after I pull out the gauze swab. I smelled the gauze swab. Not smelly and this is a good sign that there is no bacterial infection. Red blood oozed out of the nostril. Owner asked to wipe the blood off regularly. (The bleeding stopped on Monday).




Case 3. The dog with white gums
The thin, hunch-backed 10-year-old Miniature Schnauzer with white gums would not eat. She had been treated 4 times by Vet 1. ACTH tests were normal. Ultrasound indicated possible tumours of the liver, pancreas and spleen. So, the owner was very worried and wanted surgery.

"The dog is not fit for surgery," I advised. "She will just die on the operating table. Look at the white gums. She has severe anameia. I will do a blood test."

The anaemia was due to low red cell count, low haemoglobin and very low platelet count. She was attended to by Vet 1 from August to November for 4 times and was not eating when the owner consulted me, being referred to by one of my clients.

Incredibly, after an intensive IV drip of saline, glucose, protein, Vit K1, antibiotics including baytril and metronidazole, B complex and iron injections s/c, the dog that lost 1 kg (25% of her weight in the last 4 weeks) was thriving. "She ate a lot and pooped a lot for the last 2 days," the young lady said. "Today, she is not eating. Shall I give her the Re... from Vet 1? It is said to improve her appetite."

What was the cause of this severe anaemia and the low platelet count? I suspect it was either some drugs or septic infection (from virus or bacteria) when the dog was brought downstairs in recent weeks.

During the first consultation with me, the dog screamed when I pressed the very painful disc pain at T/L area and bit me when I palpated the moderately enlarged left submandibular and popliteal lymph node. Her bladder was painful on palpation. Her left kidney was slightly painful. Her left tongue had some ulcers at the back and I took digital pictures to show the owner.

So what was happening to this dog? The lady had only one wish - that this dog would not die on her as she had a recent family bereavement. Yet, the dog's gums were as white as snow when I saw her at first. I did not take a picture then but her gums became a bit pinker 24 hours after the intensive care and injections. So, this dog had come back from death's door. But she is not out of the woods yet. Only time will tell.

Photography tips:Bridal Models

PHOTOGRAPHY TIPS

November 6, 2010. Philea Resort & Spa, Melaka, Bridal Fair 2010 Photography Contest. I was a guest at the Philea, taking a 3-day 2-night break from my veterinary work. The pro-active marketing manager saw me at the ballroom where the Bridal Fair was held and invited me to register for the Photography Contest. The bridal models in the ballroom showed off the bridal dresses. The Contest was outdoors at 6 p.m. It started to drizzle around 6 p.m.

The evening sky was gloomy. Lighting was poor as the sky was overcast at 6 p.m. It was my first time photographing bridal models or any human models. I wanted to give up. But a Muar photographer encouraged me to get on with it.

Tips from this Muar photographer were helpful. These were "focus on the eyes" and "eye contact" to get a lively and sharp picture. "Shout 'hello' just before you click to get the model's attention and her eye contact," he advised me.

I didn't dare to shout "hello" before clicking. I waited for the eye contact to happen by chance and there were 3 below.

One photographer shouted "Marina," and the model turned her head in his direction. I learnt about the tricks of the trade in Malacca. For my animal photography, shouting at a cat or dog for eye contact photography usually does not work!

I did not submit any photo for the Contest which had the theme of "Highlight of the beauty environment and exciting premises together with beautiful model as bridal". To satisfy the theme, a close-up of the bridal models would not qualify. It would need to show the environment and premises of the Resort and the best picture I had was that of the bridal couple directed by the photographers to stand at the edge of the pool. I captured this picture as I was moving away to take pictures of other models up the hill. I quickly snapped this scene. To me, it had an excellent composition, action of the pro-active photographer risking his camera to command the hard working bridal couple to take a risk on the rocky pebbles which are meant to discourage people walking on them. The lone photographer faced the bridal couple, reminding me of the famous Tiananmen Square Protests of 1989 photo of a man facing the army tanks, as in: http://en.wikipedia.org/wiki/Tiananmen_Square_protests_of_1989.

You can see that the photographer near the model was a pro-active type. The one in orange T-shirt ventured out a bit to risk his camera falling into the pool with him should he slip and fall. The others (hidden in the right) preferred not to take risk and stayed on firm ground. This picture shows the beautiful pool and the cascading waterfall features of Philea Resort and Spa and the bridal model. It might be on the final list to win a prize, in my opinion. Maybe not. One has to be hands-on to learn a new trade as reading all the photography magazines will not be sufficient as to go to be battle-tested.

I used "P" Mode and set the ISO to 3200. I was surprised to get some "good pictures" for my readers. These were the pictures where I was at the right place at the right time and got the right point of view without obstruction from the various Malaccan photographers.




Update and more photos are at:

www.toapayohvets.com/philea.htm

http://en.wikipedia.org/wiki/Tiananmen_Square_protests_of_1989

 

--------------------

6 MAR 2024 PHOTO OF TIANANMEN SQUARE

Photo taken from drive-by taxi using Canon R5. Use TV Mode. I doubt the iPhone 15 can take sharp images from a moving taxi.

Great idea from Kat to take photos from a taxi as tight security prevented tourists from getting near the Square where the Communist Party was hosting its annual political event "Two Sessions" with President Xi Jinping.

202. Golden Retriever with yellow discharge

"I did not want to spay her when you advised," the mother said. "I was worried about the death during anaesthesia." Now, the dog had lots of dirty vaginal discharge and I said; "She is suffering from pyometra - a womb infection." It is best to spay her as soon as possible"

The dog came in at night. My associate vet diagnosed pyometra and put her on a IV drip with antibiotics. He would operate the next day.

I had not seen this dog for some years after the initial first 3 vaccinations. The worried mum phoned me. "My associate vet is able to perform this surgery," I said. "Pyometra is one of the common surgeries."

However the mum insisted that I operate. So I took over the case from my associate vet who had no hard feelings over this as the dog was under my care since puppyhood.

PRE-OP
As the owner was very worried, I had the dog on IV drip and antibiotics for 3 days. She had an excellent appetite on 36 hours after being seen to, but still it was safer not to rush into surgery as scheduled. Total white cell count was high indicating a bacterial infection of the blood system. It would be best to kill all bacteria using antibiotics

ANAESTHESIA
Dog was 33 kg. Domitor 0.3 ml IV was given. Gas mask using isoflurane gas was inhaled for 15 minutes as this dog was now stronger now after the 3 days of IV and antibiotic. I intubated her and maintained her on isoflurane gas. In retrospect, Domitor could be given at 0.4 - 0.5 ml since no other sedatives like Zoletil were added. But isoflurane gas is the safest way.

SURGERY
A big swollen uterus, as in closed pyometra. As thick as the bigger hot dog you will see during barbecues. Some cysts appeared in one uterine horn near the ovaries. I took a picture for reference. Normally no cysts are seen but pyometra is cystic endometrial hyperplasia complex. So cysts are usually found inside the uterine tubes but these cysts were outside.

POST-OP
The dog was sent home 48 hours after surgery. She was not seen again as she had licked off her stitches on the 10th day. In any case, the stitches were self-dissolving.

CONCLUSION
Closed pyometra does present with vaginal discharge as the cervix opens during the later stages. Abdominal palpation in this dog did not reveal large uterine tubes. However the blood test with high white cell count was useful. In any case, purulent vaginal discharge in large amounts around 2 months after the heat is a quick diagnosis of pyometra. A rush into surgery is not advised as the dog is septicaemic. I would advise 3-4 days later.

ANOTHER CLOSED PYOMETRA CASE.
However, some owners want the dog operated and back home on the same day of diagnosis as they feel that the dog should not be separated even for one day. For such owners, the vet needed to use his common sense and judgment.

In this case, Vet 1 had X-rayed and took blood test and confirmed that the Maltese of 6 years had pyometra. Vet 1 phoned the next day for the dog to return for surgery. Pyometra is a much longer surgery than a normal spay and so the vet costs would exceed $1,000 with the x-rays and blood test. The surgery quoted by Vet 1 was $800 which was a reasonable cost. Unfortunately the owner felt it was too high.

"You will need to get the dog operated soon" I advised when the owner phoned me for a quotation. She wanted to wait till the weekend, 3 days later. After all, the dog looked well after Vet 1 had given antibiotics. "Delays mean more infections and complications. When the dog dies because you delay surgery, you tend to blame the vet as being incompetent in anaesthesia."


There was little difference but since I did not need to repeat the blood test nor take X-rays or ultrasound, my quote would be deemed lower.

The dog came in for surgery. An IV drip plus antibiotics was given 3 hours before surgery. Domitor 0.1 ml IV was given via the drip. The dog was masked and given isoflurane gas. She slept fast and was intubated. Isoflurane gas was given. I monitored this case very closely as it was a high risk case since the operation was done on the second day after Vet 1 had diagnosed closed pyometra. The 3rd day could be too late as the dog could die from septicaemia.

ANAESTHESIA TIP
The dog was not normal in the sense that the tongue was pale and bluish. Her re-breathing bag showed signs of very slow breathing and cessation of breathing. This was a touch and go case. The family expected 100% survival but this case could be the type of high-risk case best done by other vets. I disconnected the endotracheal tube when the dog was not breathing well and re-connected when the dog felt some painful reaction from the surgery.

OUTCOME
The dog survived and went home on the same day. She was OK.

Pictures will be at www.toapayohvets.com later.

A demanding dog breeder

Dog breeders in Singapore go for the cheapest vet and there will be new start ups that oblige. "It is better to have a case rather than have no business," this is the reality of life.

Yesterday was a Sunday. A dog breeder came in at 5pm saying that he had 4 pups born naturally from a Shih Tzu mated with a Poodle, producing "ugly crosses" that Singaporeans will not buy.

"I need an oxytocin injection for the dam. It is past 24 hours since the 4th pup was born. I could feel one pup still prsent"

I palpated a bony foetus, hard as a bone and said: "There is a pup in the right side, below the rib cage. The pup is dead as you had waited too long. Oxytocin injection may not help."

He insisted on the oxytocin injection. The dam contracted a bit and there was no puppy delivered after 30 minutes.

My first assistant was present. He told the breeder that a Caesarean section was necessary.

"I had an X-ray done at Vet 1," the breeder said. "Only 4 pups seen during the X-ray".

"Are you sure?" I had no X-ray from him since he did not bring it."Normally, at this late stage, you can see 5 foetal heads and skeletons."

I will describe the I/V anaesthesia in this case as Caesarean sections have had been written in many reports in www.toapayohvets. The black pup was smeared with dark green placenta melt-down. It was dead and stiff on taking out from the womb.


Domitor 0.1 ml. Then Zoletil 100 0.1 ml. Both were diluted with another 0.1 ml saline before IV injection via a drip line. Atropine 0.5 ml given. Dog was intubaed and given oxygen at high flow rate around 5 litres/sec.

CAESEAREAN SECTION
No pain problem. Towards the end, I increased the dosage of isoflurane for a brief few seconds. The dog woke up at the last stitch. The surgery took around 45 minutes and that was the duration of analgesia in this dam, weighting around 7kg.

The dam's tongue was initially pale but became normal pink at the completion of surgery.







ANAESTHESIA

240. Email query about vaccination for cats

I am Dr Sing. Thank you for your email. The reply in CAPITAL LETTER is as follows:



On Thu, Nov 11, 2010 at 9:41 PM, ...@gmail.com> wrote:

Hi,

I recently took in a small black stray cat that a friend of mine had found and nursed back to health. I wanted to schedule some time to bring him in to get any required vaccinations and a general check up.

I have a few queries:

1. What vaccinations are normally required?

ALL CATS SHOULD BE VACCINATED AGAINST THE FOLLOWING FIRST 3 COMMON DISEASES IN SINGAPORE LISTED BELOW

* Panleukopenia virus (distemper)
* Feline calicvirus (FCV)
* Feline herpes virus (rhinotracheitis)

AS FOR RABIES, THERE HAVE BEEN QUERIES FROM CAT OWNERS.

* Rabies (NO NEED TO VACCINATE FOR CATS IN SINGAPORE AS THERE IS NO RABIES IN SINGAPORE)


* Panleukopenia Vuaccine (also called "Feline Distemper")
Panleukopenia is caused by a feline parvovirus (FPV), and is particularly vicious, capable of being spread rapidly, with a high mortality rate, especially in younger cats.
* Feline Calicivirus
This virus, along with the Feline Herpes virus, causes the majority of upper respiratory infections URIs in cats, and can be spread by "carrier" cats for years.
* Rhinotracheitis (Feline Herpes Virus)
Rhinotracheitis causes serious potential respiratory and neurological diseases, especially in kittens.




2. Do I need to make an appointment or can I just drop in?
Drop in is OK but sometimes the vet is operating and you need to wait a long time. It is best to make an appointment.

3. As it is a male cat I may need to consider getting it spayed. Would you recommend that?
NEUTERING IS ADVISED FOR THE MALE CAT to prevent caterwauling, wandering urges, urine marking and fighting. SUCH BEHAVIOUR IS COMMON IN MANY MALE CATS

4. What would it normally cost for all of that? VACCINATION IS $35.00 IF THERE IS NO CONSULTATION WHICH IS $35 - $40. Neutering, anaesthesia and post-op antibiotics and painkiller are estimated to be $110-$130.

Please let me know - many thanks.

Regards,
Name of Owner