The 72-year-old man didn't give a damn about Datuks.

Ben is a 72-year-old man and had been in the pharmaceutical business for a very long time. He met an Indonesian Chinese who was very poor but is now worth over $700 million.

This contact bought a Singapore hotel for $35 million. "He just paid $4.5million for a Singapore apartment," Ben said to me as I picked him up from his house to visit the hotel to have lunch with the General Manager. "Everybody talked to him with respect, addressing him as Datuk but I don't give a damn," he said to me.

I had asked Ben whether he could refer a hotel with 30 rooms for 60 people from Myanmar performing in Singapore on Feb 3 and 4 (Chinese New Year). So he recommended this hotel which is 3-star and therefore affordable. At the same time, he would introduce me to the GM and all senior officers there. "The owner is my friend," he said. "Very smart and suspicious. He thought I was getting a commission or fooling around when I told him about 30 rooms requested by you."

"When people are so rich, they have to be suspicious. Everybody wants their money." The man had money embezzled by his staff before. If they have to remain rich, they have to be smart too.

At the lunch meeting, the GM of the hotel was very friendly. "Did the boss call about my request for 30 rooms?" Ben asked him. "Yes," he said. This showed that a rich business man can be rich because he personally is on top of things. 

Ben said: "He picked the furniture for the hotel by buying them himself." In this way, nobody could cheat him. No wonder he is rich. How did he become rich? Producing medicine in a factory in Indonesia. As for Ben, he sells raw materials to him and so is just comfortable.

"Do you want to attend the AA seminar on what to do when your car has an accident," Ben asked me. I should be less brutally honest but I said: "Don't waste my time!" Ben was shocked. "Well," I said. "If it was a fashion model show, I will go. What is there to learn from AA about car accidents?"

Ben was also not pleased with me when he declared to everyone at lunch that he bought two bags of rice and eggs (banned by the AVA, he pointed to me as if I was AVA vet controlling the import of food from overseas) from Johor. He said: "People say Johor is dangerous. Robbery. But I have not encountered any incident."

"Do you drive a Mercedes to Johor?" I asked him. 

"So you say to everyone that I have no Mercedes," Ben replied. "That I can't afford a Mercedes?"
"You say so yourself," I said. "I am sure you can afford a Mercedes. But it is a very common car in Singapore. I think you will own a Bentley like S.L Liem who was a big racehorse owner in Singapore many years ago when I was a horse vet. His driver drove him to the Turf Club in a Bentley or some rare luxury car."

Ben corrected me and gave the proper name of this rich Indonesian Chinese. It was a fun lunch. The GM was a very busy man with hotel occupancy 100%. "A 3-star hotel is affordable for many people, he said. "There are not many in Singapore as demand exceeds supply. So, no 30 rooms for you now. A 4-star is neither here nor there as its rates are unaffordable for this niche of tourist. Yet its standard not as high as 5-star." He recommended that I open a one-stop spa. Well, it was a good lunch. The GM would not permit me to pay for it. The 72-year-old man got me a free parking ticket from the hotel's sales manager as I had parked in the hotel.

"Use my card first," he said to me. He had an old card which I told him would have an expiry limit. He would not believe me. So I used his card. "Card expired," the machine said. The hotel guard came over, over-rode the machine and we left. I had told him so. He was born in 1932 and disliked all new technologies like facebook, blog, newer phone models. I can't blame him. There is so much to learn.

304. Caesarean section in a Maltese

Jan 15. 2011

A phone call from a breeder woke me up at 2.35 am. He is Dr Vanessa Lin's client but she does not do after midnight calls. "First-time giving birth. Straining but can't give birth," the breeder said.

I phoned Dr Jason Teo but he was sick. I was surprised that a young man like him could be sick. "It is food poisoning," he said. "I just did a Caesarean at 5 pm yesterday."

So I attended to this emergency. Warm cool night with cloudy skies. Definitely not freezing cold as in Europe.

DURATION OF SURGERY: Caesarean section times
Start of incision into skin: 3.35 am
End of last stitch: 4.08 am. It takes about 30 minutes to do an uncomplicated Caesarean section using my surgical approach.

ANAESTHESIA:
Isoflurane gas only. Maintain at 1-2%. No sedation. This is the safest method.
Dog masked and then intubated.
"The dog is going to vomit," I said to Mr Saw as I pulled out the endotracheal tube. The vet has to be observant. He hanged the dog upside down to get out all vomitus. Re-anaesthesize again. No problem.

SURGICAL APPROACH:
A caesarean section must be completed fast. Use less anaesthetic time and achieve a good outcome. Nothing is more stressful than a dam dying on the operating table. Efficiency is important. The skin and linea alba incisions were around 8 cm long between the midpoint of mammary glands no. 4 (see photo). I extended the incision a cm caudally as the pups were large.

I incise at the uterine horn bifurcation on the midline of the uterine body. Extended incision to near cervix as pups were large in this case as I could not pull out the first pup via a shorter incision. I pulled out 3 pups head first, one with meconium (brown stools inside amniotic fluid). The last one was back legs first. Each uterine horn has 2 pups and they were larger. "Give all 4 pups to the breeder," I said to my assistant as he would normally do the puppies with my associate vets.

The breeder took the pups inside the amniotic sac and this saved at least 6 minutes of anaesthetic time if my assistant and I had to do it. In Caesarean, the shorter the better for survival outcomes.

STITCHING. 2 PACKETS WERE USED.
3/0 absorbable on uterus used. 2 rows of inverting suture. The first row was parallel to the incision. The second row was at right angles to the incision. Two artery forceps clamp either ends. Then I used 2/0 absorbable simple interrupted sutures to close the muscles and the skin (horizontal mattress). The four pups large and OK. The dam appeared frightened of pups, being first-time mother.
DR SING'S CAESAREAN SECTION AT TOA PAYOH VETS
I incised the skin and linea alba as short as possible (XY), sufficient to pop out the puppy's head or backside.

Uterine body is incised. Amniotic sac with pup inside pops out (left). I pull out the sac if not ruptured and clamped the umbilical cord. Cut off the cord. Gave the pup to the breeder. Pulled out the placenta.
The uterine horns with no more pups is pulled out entirely to check for hidden pups
This procedure is not applicable if the vet had pulled out the whole uterus prior to incision. This approach requires a much longer skin and linea incision which may irritate the dam and cause stitch breakdown
Uterine body stitched with 2 rows of continuous sutures 3/0 absorbable. 2 artery forceps anchor both ends
Maltese pups look overdue as they have a thicker coat and are larger than others

Oxytocin, tolfedine and baytril injection SC. Breeder asked for pain-killer tolfedine as I usually don't give it as a routine and in the past. Trimethoprim syrup given for post-op antibiotics. I don't irrigate the abdomen after surgery as some vets do and such actions do impress some breeders. Introducing saline into the abdomen, no matter how sterile, risk introducing bacteria. There was little bleeding in this case as I incised the midline of the uterine body and avoided the blood vessels at the side.

A Miniature Schnauzer had dystocia. I gave 1.0 ml oxytocin IM before I started Caesarean of the Maltese. She gave birth to one pup in the Surgery. "Should be OK," I said. The breeder said: "The first pup died as I arrived home too late." He had his cigarette smoke outside the surgery as I hurried him away so that my assistant can go back to sleep. It must be hard to be a breeder. I don't know him well but I had 2 years of Caesarean section and vaccination experiences with the Pasir Ris breeders in 2005 to know that dog breeding is a heart-breaking and back-breaking business. Some of my interesting Caesarean surgeries are at:

http://www.bekindtopets.com/animals/
20081201PAGE2_Dog_Surgery_Anaesthesia_ToaPayohVets.htm

I could not drive out as the road was blocked with whole-saler vegetable sellers from Malaysia. At least 50% less crowded than in 2005 when I did a lot of Caesarean sections for Pasir Ris breeders. I walked to see their activities. Younger men in bare top bodies. A few younger ladies. There was an old hunch-back woman picking up discarded red peppers and others in a plastic bag. Tinted bronze hair, weather beaten face, blouse and black pants.

The truck people (a young lady in pony tail looking at her mobile phone and two young bare-back muscular men) ignored her. It is always sad to see a senior citizen having to scavenge. Has she got children? Where had all her savings gone?

An alert Jack Russell from the truck looked at her and at me. The dog was still working at this hour! Most Singapore's Jack Russells would be sleeping in the apartments and houses.

I walked to a far away block of apartments and tried to shoot a picture of the dog with my zoom lens. Some 500 metres away. I went up the 2nd floor of an apartment.

It was very far away so that the wholesale vegetable people would not strangle me. Surprisingly, I saw a picture of this short-legged Jack Russell.

A Caesarean after midnight takes around 2 hours (from first phone call to waiting half an hour for the breeder who came late). The whole process ranged from 2.30 am to 4.30 am). Singapore was still a busy city at this time with many taxis prowling the roads. A McDonald bike was seen from my car at 5.30 am.

P.S
Some 5 hours later in the morning, the breeder phoned to say that there was another pup not born. Dr Jason Teo did the Caesarean to save the pup. It was alive.

303. Upgrading and best practices

There is always a generation gap between old and young vets. However some young vets have this confidence to communicate with older vets and that is good for them. Young vets who naturally want to group around with their peers and age group. This is commonly seen.

On Jan 13, 2011, I visited two competitor vet practices. It was great that the two younger vets I met were good at communication. One was clean shaven in his head. "Are you helping 'Hair for Hope - Singapore'?" I asked him to be bald to raise fund for the Children's Cancer Foundation? I had not seen a young vet bald in Singapore and he was the first one.

The second vet has 9 years of experience and was excellent at communications. First class, I would say. She offered me a cup of coffee as she could get rid of me after some conversation. She shared some interesting cases of pyometra (photo with yellowish disc in a spleen of a dog with pyometra - splenic abscesses?). She showed me an X-ray of a dog with a 20-cent coin in the stomach in which the endoscope of a referred vet was ineffective. It still needed gastrotomy after endoscope failure. "Is an endoscope so expensive?" I asked her when she mentioned $100,000 for one. I do not think it would cost that much unless it is for racehorses.

I learnt a few veterinary communications and related matters from her and the other competitor. It is good to see other practices in Singapore and in other countries to upgrade oneself and know the industry's best practices as no one vet can have all the vet knowledge in this world.

302. Taking advantage of distressed art

Jan 13, 2010

Khin Khin phoned me to say that the artist was selling her artwork I like (Myanmar market scenes) at fire-sale prices. "Give her $150 per painting," she advised. "She needs the money to pay the rent."

It is not good to take advantage. "No," I said. "I want to hang the art on my Surgery walls or home. I don't want to see it as one that is bought from an artist in distress. It is just not what I will do."

Artists need to sell. Vets need to diagnose and treat. It is just sad that this artist could not sell her artwork internationally. Much promotion and creating awareness is needed. I think an art gallery sponsor or patron is what make some talented artists successful. Talents can only go a short distance.

Follow up on maltese peeing just outside the pee tray

E-MAIL TO DR SING DATED JAN 13, 2011
Hi Dr Sing,

Above attached are the photos of my dog's pee tray and the surrounding of it.

The first pic is the tray.
2nd pic is the newspaper i put below it. And as you can see the urine patch there.
3rd pic is the floor where he will urine there at times, he will stand on the newspaper there and aim on the floor.

Btw, there is no change of environment or situation. Most probably i guess is because we hardly accompany him and hardly bring him for a walk.

Is there any effective ways to solve this problem? And, if i neutering him at the age of 3, will it be too late?

Thank you
Name of owner

REPLY FROM DR SING DATED JAN 13, 2011

You did change his routine by cutting down the regular outing. So he can't urine-mark downstairs and dare not urine mark the whole apartment (in fear of punishment). So, he made do with just outside the pee tray. I presume he will urine-mark the whole apartment if nobody is around and if he has not been confined to the crate.

Urine marking occurs in your dog due to deprivation of doing it outdoors. This is main reason as all dogs, like young children, are used to a routine and in some children's book, a routine makes a child feel more secure and happier.

Neutering may reduce this urine marking as the testosterone production is shut down. However, you still need to re-train the dog (routine to go downstairs after neutering for some weeks or months). Many still urine-mark but with reduced frequency. Neutralise the urine smell.

Go back to the routine or neuter. It is also possible that the pee tray is too small or the dog just does not want to dirty his paws. If only dogs can talk.
- Show quoted text -

E-MAIL TO DR SING DATED JAN 14, 2011
He will not urine-mark the whole apartment,only will pee outside the tray.
What should I do to neutralise the smell?

E-MAIL FROM DR SING DATED JAN 14, 2011
He may not do it now. If you leave him home alone in the apartment for the next few weeks, you may be surprised. That is why some male dogs in Singapore are crated when home alone or at night (to prevent urine-marking).

Try white vinegar + water at 1 part of vinegar to 3 parts of water and use tissues with this solution to wipe off all urine smells.

300. Soliciting for a veterinary job - poor resume introduction

I got a resume by e-mail as follows:


EMAIL TO DR SING DATED JAN 13, 2011

Greetings!

Im XXX. I am applying as "Veterinary Assistant" in your good clinic. Attached here in with is my resume.Thank you very much and more power!

MY COMMENTS

I don't bother to reply. This is an example of a poor introduction in a resume. More power? Is she referring to the "People Power" toppling Marcos or the blue pill power for erectile dysfunction?

DBS Corporate debit and credit card: 2nd opinions from the same bank

Jan 12, 2011

In Dec 2010, I opened a company bank account (Design Travel Pte Ltd, www.designtravelpl.com at DBS Toa Payoh. The helpful customer service officer told me that it was almost impossible to get a corporate credit card unless one is chosen. It was by invitation only. Two days ago, I asked her about a debit card in which I put money into the current account. She phoned the DBS banking somewhere and was told there was no such instrument. I was surprised that DBS is so provincial.

Then today, I went to DBS Bishan. Imagine my surprise when Ms Irene Foo there told me that there was no problem opening a corporate debit account for a private limited company and gave me the forms to sign and documents required. She said the corporate credit card might be given to a company with proof of income and a bank officer would check this.

So, I wasted 2 months believing there was no such thing as a DBS corporate credit and debit card.

This episode shows that one must be proactive to search for info. It is obvious that I was barking up the wrong DBS tree in Toa Payoh.