1348. How to succeed as a new employee

Last week, I gave a lecture to 3 young people at my office. Two are young adults named Vanessa, Nicolas and one is a Myanmar employee Nyi Nyi. I asked Vanessa to write a report and this is given as follows:

How to succeed as an employee

1.     You must have a target

To be able to produce positive outcomes

2.     Perfomance

Time equals to money and performance equals revenue

3.     Creating a list

To set a target for yourself that can be achieved in the day itself

4.     Distractions

They come in the form of your phone, computer, customers etc. Try to minimize these distractions so that you can meet your daily target.

5.     Niche

Determine what you are talented in/good at doing/ excel at and further your knowledge/skill of it.

6.     Mindset

Change your mindset to suit your job.

E.g. I don’t like to network but I will do so for the sake of my company and to increase my performance.

7.     Best person to talk to

The best person is definitely not your boss. Talk to your co-workers. E.g. In the healthcare sector, talk to the stall holders in the staff canteen.

In the case of veterinarians, networking during dog shows or SPCA functions. However, it is not practical as a lot of time is wasted. It is slightly more applicable to senior vets.

8.     Added value to the company

Employees should provide timely performances with quick and efficient outcomes. It increases revenue as time is money. Cross-selling is a good method as it shows initiative.

9.     Upscaling

With more initiative, you can start doing your own research through data bases or networks to find clients/candidates or higher value.

10.                        Strong competition in any industry

80% of business = 20% of the employees. Employees must be motivated and be willing to take on hardship in order to succeed in life. 

Hyphema in a dwarf hamster in the USA

Mar 22, 2014
Email from a hamster owner in the USA

Hello Dr. Sing,

Thank you for your generosity and willingness to speak with me on the telephone today. I have typed up the history below and attached photographs of my dwarf hamster in this email.

Past medical history:

My pet is a 2-year 3-month old dwarf hamster. His past medical history includes trauma to left eye approximately 1 year ago, which was subsequently prolapsed and was surgically enucleated without complication (Enucleation procedure was performed within 15-20 min, and he recovered within a week), and significant osteoarthritis for which he currently takes oral meloxicam.

Current issue:

For approximately the past 9 months, he has had a worsening cataract in his remaining right-eye. He has been followed by a veterinary ophthalmologist, and based on exam he has had no reflex to light in the remaining eye and is likely blind (although he manages to navigate his habitat quite easily) I've noticed increased vascularization over the past month, and within the past 24 hours, he has developed worsening hyphema of the right eye. The hamster does not appear to be in acute pain or distress, but I've found it difficult to assess pain in a hamster.

I've followed your website for the past year and I noticed that you had posted some pictures on a hamster with bilateral hyphema.

Consultations:

I consulted my veterinary ophthalmologist and small-pets veterinarian today, and they are not certain what the best course of action is at this point. The ophthalmologist recommended diclofenac (NSAID) eye-drops and to see if the condition resolves. The other veterinarian recommended corticosteroid eye-drops. I decided to proceed with the diclofenac 1 drop every 6 hours. The general veterinarian mentioned that because the hyphema is secondary to a long-standing cataract, increased intraocular pressure may be the cause. She mentioned that eye-drops are palliative, but enucleation of the eye would be the ultimate solution. They seems to agree that enucleation of the remaining eye will not affect his vision, because he cannot see out of his remaining eye. However, because of his age, there is an increased risk with anesthesia and surgery. Surgery is scheduled for tomorrow morning.

I wanted to seek your thoughts and opinion on the case of my pet. I am not sure what is the best course of action. My concern is that he may have developed an acute glaucoma secondary his cataract, or that his longstanding eye disease may have led to neovascularization. I am concerned about what will offer him the best quality of life (less pain), and whether enucleation should be the solution at this point. NSAIDs have the risk of increased bleeding, and long term use of corticosteroids can increase intraocular pressure. I am also unsure of the cause of the hyphema, and therefore unsure if the hyphema may acutely worsen, leading to severe pain or prolapse.

I would greatly appreciate you opinion and thoughts. Thank you so much for your help,

Steve

The photographs are attached in this email. The IMG_ named photographs show his eye condition today. The other filenames dated with when they were taken. I will also send you a video I took today in a separate email.

REPLY FROM DR SING DATED MAR 22, 2014

Thank you for your email, images and videos. You have been most caring. My preferred course of action will be enucleation to eliminate the intense pain inside the eyeball. Drugs will not work. Anaesthetic risks are high as the hamster is aged. Best wishes. 

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

MARCH 23, 2014 EMAIL TO DR SING
Hi Dr. Sing,

Thank you again for your email and your time. I wanted to provide an update. Surprisingly, this morning I spoke with my veterinary ophthalmologist and took my hamster in to the senior general veterinary surgeon (specializing in exotics). Contrary to the junior vet I spoke to yesterday (who recommended surgery today), the senior operating vet examined my hamster this morning and decided that surgery was not indicated at this time.

The ophthalmologist told me he thought there was a reasonable chance that the hyphema may slowly resolve with diclofenac eye-drops. On pre-operative exam, the senior general veterinarian assessed that he was not in pain severe enough. He mentioned that hamsters usually stop eating when they are in pain, and based on my hamster's activity- he does not appear to be in severe pain. So, we decided to continue with the diclofenac drops, and the general vet added ciprofloxacin eyedrops as well. He recommended follow-up / re-evaluation in 2 weeks.

On my physical exam the hyphema appears to have settled at halfway filled up the anterior chamber of the lens. As of tonight the globe does not appear to be any more prolapsed relative to baseline. I will continue to monitor for any acute changes or worsening.

Are there any other particular signs or symptoms of pain (or specifically eye pain) in hamsters that I should pay attention to? I have read that these pets hide/tolerate their pain quite well, making it somewhat tricky to assess. My ultimate goal is to provide my hamster with the best quality of life.

I realize it's difficult without having examined the hamster, but if you have any input on whether this is a reasonable plan of action, I would love to hear your input.

Lastly, I wanted to thank you again for your generosity and time spent speaking with me yesterday. I truly appreciate it. I also want to add that your website may very well have saved my hamster's life when he had his first enucleation. My local vet who was less experienced had urged a 45min-1hour enucleation procedure, but after reading your website and learning about hamster anesthetic risks, I opted to search the entire city for a vet who had experience operating on exotics. The enucleation was performed swiftly and he concurred that a 45 minute operation would have likely been lethal. I just wanted to let you know that someone across the world was able to benefit from the wealth of information on your website. And not to mention, as a hamster owner, I find the info and pictures to be fascinating as well. Also, please let me know if your animal clinic accepts donations of any sort, as I would be happy to make a small-donation as a token of appreciation for your time.

Thank you again,

Steve

REPLY FROM DR SING DATED MAR 23, 2014

Thank you for your feedback and good news. I always tell my clients that each vet has a different approach to the treatment of diseases and so this results in conflicting advices to the pet owner. There may be more than one way to treat a disease.

In your case, I thought the hamster was suffering great pain and hence advised enucleation. This episode shows that long-distance telephone diagnosis without physical examination is not advised.


Since the hamster is not in pain, then enucleation is not necessary. Generally, frequent rubbing of the eye are signs of painful eyes or inflammation around the eye areas. There will be acute conjunctivitis and hair loss around the upper and lower eyelids.

The best indicator of the hamster's health (and lack of pain) is the number and size of faecal pellets passed per day. If he normally passes 40 large pellets per day for example and now passes less and in smaller sizes, then he is sick. The amount of water drunk per day is another good indicator of health. The owner must be disciplined to monitor 24-hourly and some owners do that.

 

I thank you for your offer of a donation. The service is free to all hamster owners. 

 

Are you an engineer or IT person as you are able to locate my hamster's hyphema images from the internet. How did you do it? 

Audit of KPI. Spaying a caterwauling Maine Coon 3.6 kg using IM anaesthesia

From my experience, the analgesic effect of the xylazine 0.15 ml and ketamine 0.6 ml IM will last around 30 minutes for a young 3.6 kg Maine Coon. Provided the vet is well organized.

Today Sunday Mar 16, 2014, the Woodlands family brought in the Maine Coon who had been rolling and yelling (caterwauling since 3 days ago). "But she is quiet now," the lady said.

The following are my performance indicators
Inj of xylazine + ketamine   10.13 am
No isoflurane gas
First skin incision  10.26 am
Completion of skin stitching 10.56 am
The cat started moving at around 10.55 am.

The cat was rather plump and I took some time to hook out the ovary as there was abdominal fat in the way of vision and obstruction was caused.
lst ovary hooked   10.34 am after 5 attempts.
2nd ovary hooked 10.41 am from the uterine body area
Uterus being ligated   10.43 am
Abdominal muscles stitched with 3 interrupted sutures  10.47 am 
Skin stitched  10.55 am

Cat started one movement when stitching muscle  10.49 am
Cat started more movements   10.54 am 
Skin stitched 10.56 am


Conclusion
For a 3.6 kg young cat, xylazine + ketamine at 0.15 + 0.6 ml IM in one syringe provides sufficient analgesia for spay provided it can be completed within 43 minutes from start of IM injection. There will be no need for isoflurane gas top up. If the first ovary can be hooked out at the first attempt, the duration of analgesia is more than sufficient for spay. One packet 3/0 absorbable polysorb is sufficient.  Incision length about 1.5 cm long. 2 horizontal mattresses close skin wound.

Dr Sing Kong Yuen

The paralysed cat has thick bloody urine again.

This cat wore pampers for the last 3 months after adoption as he was paraplegic, with back legs stretching forward.

As the paraplegic cat needs leg massage to pee, his bladder gets filled with urine last week but did not have any problem of urination for the last 3 months after adoption. Thick red urine from the infected bladder filled his bladder again, after the first clearing of the obstructed bladder. Now the cat vomited twice. The urine test had shown proteinuria 2+, lots of red blood cells and white blood cells.

I informed the owner of the costs of X-rays to check for bladder stones. The cat has poor chances of recovery of a normal bladder owing to urine stasis causing infections. The wife was most sad. Euthanasia.

A Ragdoll X had UTI in Oct 2013.

Saturday Mar 1, 2014

TP...472
Ragdoll X, MN, DOB Nov 12, 2013


This couple in their late 20s or early 30s love this Ragdoll X, bought from a Malay family that has many pedigree cats, producing pretty cross-breds.

"This cat is quite angry today," I said. "So I shall not take his rectal temperature." I asked the husband to talk to the cat and stroke his chin so that I can vaccinate without the cat getting furious.The cat was given the 2nd vaccination.

INTERESTING ASPECTS OF THIS CAT

1. Oct 23, 2013  Stranguria. Dr Daniel Sing sedated, catheterised and treated. Urine test showed pH 6.5, SG 1.049, Protein 3+, Glucose +, Blood 4+, WBC 126, Bacteria+
No crystals. No X-ray done.

I advised C/D x 10 cans and phoned on Jan 9, 2014. "The cat took 1 week to recover," the owner said.
FLUTD? Stress. 4th day after shifting to new house. For the past year, the owners were staying in a friend's house and shifted recently.

2. Today, no more urinary problem. Fed canned food. Will always groom himself after eating.
3. The owner wants to clip him bald (except for head and tail) as hairs fly all over the house.
"Regular brushing will do," I advised.
"The cat grips the brush and runs away," the husband said.
"If the comb is sharp like wire, it will be very painful," I advised buying round-tipped brush and give him his favourite treat while brushing from a small area initially. So, no need to clip bald for life.

4. Vomits around 1x/month. "Could be due to hair ball," I said.
"No hair seen in the vomitus," the wife said.
"Cats are very clean and will groom esp. if shampoo once weekly."
"He grooms after eating rather than the weekly bath."

5. This cat will poop only when the owner returns home at around 9 pm. Some friend's cats do the same.

6. "Nowadays, no more scattering of new litter and peeing a bit of urine on the litter," the husband told me. "He must be checking whether the litter is soiled  or not." 
"Male cats urine spray to mark the litter," I said. "You will note that there will be no more such behaviour after neutering."
The husband agreed as this cat stopped doing after neutering.

Yesterday, I was at Changi Airport and noticed those pink-jacketed customer service counter ladies.
The husband told me that many are from Myanmar, speaking good English and trained by SATS. I thought they were Singaporeans.   Nowadays Singaporeans don't want to work the shifts and weekends and so it is much harder to employ them. "There is a very high turnover with Singaporean employees," the husband said. Singaporeans job hop as there are many jobs available and so Singaporean customer service officers don't stay long in the job. 

Filipinos are hard to recruit too. Times have changed. An "S Pass" applicant must be earning $2400/month nowadays," the husband told me. "Rejection will be given if the salary is $2,200".  I guess Singaporeans must be paid $3,000 and given office hours and no week end roster before they will stay in the job.  

1343. Closed pyometra & uterine torsion & other images

Vomiting many times 2 days. Swollen abdomen. Yellowish vaginal discharge.




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A Singapore Rose

 

1341. Exploratory laparotomy in an old dwarf hamster - recto-vaginal fistula - a rare case

Sunday Feb 23, 2014's interesting case.

TP 44844

Dwarf hamster, F, 2.5 years, 39 g

"My dwarf hamster passed blood in the stools for the last 2 days," the gentleman said.
"Did she pass the normal stool pellets?" I asked.
"None at all in the last 2-3 days. Maybe, a small pellet recently."
"Any urine passed?" I asked as this hamster had a swollen abdomen as if she was pregnant.

"I was overseas for the last 2 weeks and my family members fed her chym sim instead of the normal hamster pellets and seeds."

Blood appeared in the vulval area but the owner said the hamster passed blood in the stools. So, there should be blood in the anus. A case of wet tail well known amongst hamster owners. Yet I saw blood in the vulval area and the anal opening appeared abnormally small. After all, this was a dwarf hamster and I don't see anal openings in all hamsters I examined, unlike in the dog and cat. So, I did not think of atresia ani - the failure of the anus to open during development. This was a 2.5-year-old hamster with no complaint of stools or diarrhoa.  

No stools were passed but bloody diarrhoea for the past 2 days. An old female dwarf hamster. Bleeding from the vagina. This would be a case of pyometra as in old female dogs not spayed.

The high risk solution would be to spay the dwarf hamster to stop uterine bleeding and death. I have never spayed a hamster. I doubt almost all vets do not spay dwarf hamsters. It is just too risky. I asked Dr Daniel if he would do it. "No," he said firmly. I told the owner that this hamster is old and the risk is just too high. She would die.  He said to go ahead. I said this was inoperable.

The hamster's abdomen was very swollen. She would die if not operated. If operated, she might or might not die. Likely to die. An exploratory laparotomy to open the abdomen to check and remove the uterus. The anaesthesia must be just right. Not too little as the hamster would move. Not too much as the hamster would be dead. How much is not too little or too much?

I gave Zoletil 50 0.01 ml IM. Insufficient. Too little. The hamster looked at me. I put her under 5% isoflurane gas + Oxygen till she appeared drowsy. Not more than a few seconds. She did not struggle during the surgery.

The colon was over-distended, probably due to twisting. I massaged it and copious amount of red bloody stools flowed out (see image). I closed the abdomen with 6/0 sutures interrupted. The hamster was drowsy. I injected 0.2 ml Hartmann + glucose + baytril. It was already 5 pm on this fine Sunday afternoon of Feb 23, 2014. The hamster was alive but for how long?

On Monday, at 9 am, she was alert and walking. The tissue papers were blood stained in several areas. Those were bloody stools still passed out after surgery. I took videos.

. 

1340. Myanmar stories - The nursing aide shortage in Singapore

Saturday Feb 21, 2014

On Thursday, I met an employment agent at Khin Khin Employment Agency. Vitalline would be around 60 years old and specialises in placement of nurses and nursing assistants.

He came to get a letter from Khin Khin's company in Myanmar to apply for a business visa to visit Myanmar to interview nursing assistants. A business visa permits mulitple entries but he had not been to Myanmar for the last 2 years since he had a good supply. But in 2014, he has a drought as the government tightens the rules owing to social discontent with too many foreigners.

"When I asked the Myanmar agents, they would supply me one or none," he lamented. So, he sought Khin Khin's help, offering $600 in wages and $500 for accommodation. Khin Khin, being a Myanmarese, knows all the employment agents in Yangon and could communicate with them anytime. She said she could get at least 20 prospects. The veteran would meet the agents when he goes to Myanmar on Feb 27, 2014 but he needed a Myanmar company to sponsor him for the visa application. So, Khin Khin asked me to help write this letter and I had the draft to her manager Soe. .

I re-typed Soe's letter to inform the embassy that he would be invited to Myanmar for a business discussion as her assistant could not or would not learn how to type a business letter. His layout of the letter was bad. He typed Vitalline's name in Capital letters. Instead of wasting time, I just typed the letter for him.

"Your letter is written well, like a Singaporean," he complimented me. He was a busy man and any person in Khin Khin's office must be Myanmarese since they appear to speak Greek amongst themselves. English grammar is hard to master but the Myanmar language is even harder.  

Singapore's population is aging and locals don't want to be nursing assistants. So, there is a great demand for such workers. Myanmar is prospering in the last 2 years and so only high wages would attract some to come. The worry is people trafficking and Vitalline could be charged for that offence if he goes toYangon to do his own interviews without licensed employment agents there. He can't just advertise and meet the prospects.

On the very next afternoon, I was at Khin Khin's office. Two ladies working in Singapore as nursing aides came to enquire about jobs. Khin Khin shouted at them for some reasons. "They are just wasting my time fishing and asking lots of questions," she told me.
"How do you expect them to get jobs if they don't ask questions. Be patient," I advised. "These are 2 prospects for Vitalline and you need not share the commission with your Yangon agent!" Sometimes, I think Khin Khin has no business acumen. Or she just want mega deals like the real estate development of $45 million dollars she had handled, taking so much time and not closing.

I talked to the 2 ladies asking them how much they are paid as work permit holder and how many years they had worked. "$350 with free food and lodging," the younger one had worked  a few months.

"The offer is $600 and $500 for lodging," Khin Khin had a carrot for them. So they would be referred to Vitalline and would get better pay.
   

1339. Singapore stories. The girl with a tattooed "sleeve"

Saturday Feb 21, 2014  9.20am

I took the subway since my car is being borrowed by a young man whose friend is getting married. It is refreshing and good exercise to walk in the bright sunshine morning, taking bus and train to my office.
On the train, I saw a "red head" slim girl in bright green dress, fair complexion, eye lashes long, her reddish brown hair shining in the sunlight. Finger nails with the additional false patterned nails, except her forefinger. Blue shoulder bag on right shoulder and left shoulder has a black bag. Pink slippers. Toes painted green. I noticed Digit 4 on both legs were clubbed. From the right side, I thought she wore an unusual sleeved blouse with a fierce-looking skull and grinning teeth. It was a tattoo on her right upper arm. The left arm was bare. A tattoo appeared from the left cleavage, peeping from the neck line of her dress. 2 red ear pieces attached to her smartphone as she furiously scrolled the screen. Age around late 20s. Unlikelys to be going downtown to work. I alighted at Toa Payoh station and she was still scrolling.

On alighting from the bus 238 opposite the Hindu temple, I met one industrial park tenant who sells plumbing and pipes."What's happened to the old man book-binder?" This man wanted to retire and had asked me for $40,000 to take over. New HDB rulings say that the new tenant will have to return the shop and not assign. So we thought he would have no takers. He had an offer of $25,000 from the air-cond neighbour.
"Well, he does not open on Saturday. In fact he will close in July."
"How much did he sell his shop?" I asked.
"$45,000," he said. "Two lady realtors came and got him to close the deal."
The 75-year-old man got what he wanted and $5,000 more. He did not need to work and his children had asked him to stop work. He was working half-day anyway and had some orders from the government to bind books for funeral services of important people. There was no more apprentices like him to learn the trade and so all skills are gone. At least he has got $45,000 to smell the roses. Realtors who walk the neighbourhood can be quite successful in closing deals too.