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any medical professional here, how come when she started coughing, he knows her vital signs were plummeting? how does coughing link to drop in oxygen level?

Sunday, Jul 07, 2013
The Straits Times
By Salma Khalik

SINGAPORE - A mother became the second patient in four years to die following liposuction - after doctors lost their battle to save her life.

The 44-year-old, who has two teenage sons, was rushed to hospital when she collapsed in a clinic after the cosmetic procedure to remove fat from her abdomen and use it to make her thighs smoother.

Doctors then fought for two hours to save her but she died without regaining consciousness.

Last Friday's tragedy comes less than four years after the death of property firm owner Franklin Heng, who suffocated after being given too much anaesthetic during liposuction.

The woman was undergoing the procedure at TCS at Central Clinic in Eu Tong Sen Street when the level of oxygen in her blood suddenly plummeted.

She sat up and coughed, before collapsing, said general surgeon Edward Foo. Doctors then tried to resuscitate her until an ambulance crew arrived five minutes later and took over. She was taken to Singapore General Hospital (SGH), with her husband also rushing to see her. But she never regained consciousness and was pronounced dead two hours later.

It was not the first time that Dr Foo had performed liposuction on the woman - who had also undergone the procedure at another clinic in the past but had been unhappy with the results.

Dr Foo said she had appeared to be a low-risk patient. He added that he had not given her a general anaesthetic but merely sedated her - just as he would when performing a colon scan. "Her vital signs were rock solid throughout the procedure," he said. And in a reference to the controversial sedative given to Mr Heng, he added: "I did not use propofol."

A spokesman for SGH said it could not comment as a coroner's inquiry is pending. The Ministry of Health said it was aware of the case and looking into the facts.

Officials turned up at the clinic last Saturday, taking all documents related to the death.


Woman first saw doc over 'dents'

The mother who has died following liposuction first saw Dr Edward Foo in 2011 after "dents" started appearing on her thighs.

She had undergone the procedure at a different clinic but was not pleased with the results.

The general surgeon took fat from another part of her body, using it to fill up the dents and give her thighs a smooth finish.

The results were good and the woman - who has two teenage sons - became confident enough to start wearing skirts again. But last month, she returned for further treatment as the dents were again appearing on her thighs.

Dr Foo, a general surgeon who carries out about 200 liposuction procedures a year at TCS at Central Clinic in Eu Tong Sen Street, said he did not think the patient was at a high risk of complications.

Ministry of Health rules stipulate that liposuction procedures involving a litre or more of fat must be carried out in a surgery centre or operating theatre. In this case, it was done in one of the clinic's two operating theatres - even though less than half of that amount was removed.

The fat taken out was put into the thighs to plump out the hollow parts.

But while the patient was lying down after the operation, she coughed. Dr Foo said he immediately noticed her vital signs plummeting.

He called for help and several doctors and nurses arrived.

Meanwhile, she sat up, said she had a lot of phlegm in her throat, and coughed - before fainting.

The clinic immediately called for an ambulance after her collapse, at 2.53pm on Friday. Five minutes later, Singapore Civil Defence Force paramedics arrived to find clinic personnel trying to resuscitate the woman.

They were administering oxygen and had also given her some medicine within minutes of her collapse.

The paramedics took over and continued with cardiopulmonary resuscitation all the way to the hospital, where doctors spent two hours trying in vain to revive her.


Dr Foo went with the patient in the ambulance while the clinic's medical director Chow Yuen Ho drove there. Her husband was called, and arrived before she died.

"We're very careful people," said Dr Chow. "We follow all the guidelines. It's unfortunate that despite all the precautions, something like this can happen."

Dr Foo, who spends his mornings in general surgery at Mount Alvernia Hospital and his afternoons at the clinic, said he has been carrying out liposuction for about eight years.

He is also accredited by the Ministry of Health to train other doctors in the treatment.

"I feel like c**p," he told The Straits Times last night. "I've done more than 1,000 cases and I've not had a single adverse event."

The issue of cosmetic treatments by non-plastic surgeons has been a thorny one here for some years.

Plastic surgeons who spoke to The Straits Times pointed to dangers that arise if non-specialists carry out liposuction - which they say carries a risk in inexperienced hands. Guidelines permit general practitioners to perform it.

Dr Seah Chee Seng, who works at Gleneagles Medical Centre, said: "When you allow a whole bunch of people with a variety of training to do cosmetic surgery, you'll end up with problems."

Dr Wong Chia Ho, who has a clinic at Mount Elizabeth Novena, added: "It makes a lot of difference. A plastic surgeon is trained to do liposuction. A general surgeon is not."

salma@sph.com.sg
Coughing is a reflex when there is irritation in the large airways in the lungs.

As there was a drop in the oxygen level after coughing this points most likely to a respiratory cause.

It is likely that she could have had a pulmonary embolus(fat or blood clot in the lungs) from the fat being accidentally injected into a vein in the legs or a blood clot just from being operated on, that went to the lungs..

other less likely post-operative causes could be spontaneous laryngospasm, a delayed anaphylactic reaction to the drugs she was given or even maybe too much fluids given to her via the drip before and during the operation.

Hopefully after this any procedures needing anaesthetics be carried out at hospitals with proper support.
for those who are observant enough, there was a millionaire doc by the name of richard teo who was diagnosed with terminal lung cancer when he was at the peak of his career. He was about to buy his land to build his gcb when that happened. he was the former director of tcs and seemed that this dr chow took over this tcs and hired the general surgeon to do lipo for him

sadly, its both willing parties involved.

one party willing to be lipoed on to get his/her desired shape, the other party willing to do it despite not being a plastic surgeon.

personally, i feel that all invasive procedures shd be done at the hospital with the doctors having the appropiate training and credentials.

the public should also be adequate warned of the risks of such procedures, however small they might be.

2 lipo deaths is certainly too many. just my opinion.
yes i remember Dr Richard Teo.. RIP...

youtube : "dr richard teo giving a speech to medical students"
Very gd observation indeed.th thanks
(08-07-2013, 01:28 PM)paullow Wrote: [ -> ]for those who are observant enough, there was a millionaire doc by the name of richard teo who was diagnosed with terminal lung cancer when he was at the peak of his career. He was about to buy his land to build his gcb when that happened. he was the former director of tcs and seemed that this dr chow took over this tcs and hired the general surgeon to do lipo for him

sadly, its both willing parties involved.

one party willing to be lipoed on to get his/her desired shape, the other party willing to do it despite not being a plastic surgeon.

personally, i feel that all invasive procedures shd be done at the hospital with the doctors having the appropiate training and credentials.

This is a very wise advice. The hospital have a complete team to deal with any emergencies. Those specialist clinics pale in comparison to the complete hospitals.

the public should also be adequate warned of the risks of such procedures, however small they might be.


Best is ask the doctors in restructured hospitals, do they need such procedures? Most of the time, people prefer fast method to natural method like exercising and dieting.

2 lipo deaths is certainly too many. just my opinion.
and a lot of these high end aesthetic clinics are "well-located" in the buildings in the heart of the city.

imagine a patient running into trouble in the 10th floor of a building in CBD or orchard area: the time that ambulance would take to get to the patient and to get him to the hospital amidst the vehicle traffic++ on the roads and the human traffic++ in the building in a typical síngapore working day, can really be a trying event.

the goverment (MOH) should really take action, IMO. It really a risky thing, don't you guys agree?