On July 9, 2008, I was attending a breakfast Oracle Seminar on "Innovation in Asia" at St Regis Hotel to gain some knowledge outside the scope of veterinary medicine and surgery - a continuing education from the point of view of the business management operators in other industries. Sometimes the secrets of success from non-veterinarians are applicable to my profession and very useful.

In the midst of a very interesting presentation by successful applications of SAP, my phone vibrated.
 

The owner phoned me at 9 a.m to say that his 11-year-old Silkie Terrier passed away in his sleep. His dog just stopped eating for 2 days. The dog had grown hairs and was free of ear pain after my vertical canal ablation surgery in March 2008.

So we thought he would live for some years. Then in June 2008, the dog injured his left foreleg's toe. The owner tried to treat it himself but the dog just gnaw at his toe till it became much swollen. He had to be operated under general anaesthesia again. I prefer not to operate an old dog a 2nd time. He survived the first general anaesthesia for his ear canal removal and it is better not to take the risk again as old dogs are high risk patients. He was 11 years old and he has reached the limit of his life span.

Now, this dog has a blood clotting disorder. His blood just does not clot easily during surgery. I did not do a blood platelet test to confirm that he had a low platelet count to save on costs for the owner. There is no cure for the idiopathic thromobocytopenic purpura. Idiopathic means that the cause is unknown although it is believed that the body makes antibodies to destroy its own platelet.

This dog would be suffering from a chronic idiopathic thromobocytopenic purpura and like the disease in people, he could live to an old age.

He had a left severe ear pain. Hard as a rock - that's what his left ear vertical canal felt to me. The cure was removal of this vertical canal, a surgery called vertical canal ablation. Now, would he die under general anaesthesia - being aged and thin? At the time of surgery, I did not suspect he had chronic idiopathic thromobocytopenic purpura. In retrospect, some blackish bruises on his bald body could be a tell-tale sign but old dogs may have such blemishes.

In any event, he survived the ear and toe amputation surgeries under general anaesthesia. He lived the last few months of his life without pain in his left ear and for that the owner was very happy that the dog passed away peacefully. I only talked to the owner by phone and had never met him as he is a busy person.

Tentative diagnosis of chronic idiopathic thromobocytopenic purpura in this case as blood samples were not taken to reduce veterinary costs to the owner:

1. blood does not clot in the ear canal before vertical canal ablation surgery (see pictures).
2. a large haematoma after surgery (swelling above his left parotid salivary gland and where the vertical ear canal was removed, under the healed wound). At the toe amputation surgery, I checked the left facial swelling which was painful if palpated. It was just blood that did not clot. It was around 30 ml of liquid blood.
3. some purplish blood when the bandage wrapping the toe area is removed (see picture).
4. bruises in his body.

The dog was an extremely high anaesthetic risk and yet he survived two anaesthesia. Gas anaesthesia at the lowest dose was given. Intubation was done. No tranquilisers or pre-anaesthetic medication was used. No problems encountered during the anaesthesia although this was an old dog nearing the end of his life span. Pain-killers were given for 7 days after surgery.

Vertical Ear Canal Ablation surgery in an old dog
was my first meeting with this gentle dog. I thought he was a hairless Chinese crested dog cross bred as he had not much hair. I was glad that the owner did not rush to put him to sleep on March 31, 2008. His wife was against euthanasia and well, this dog spent his last 4 months having a good time with the owner. We just did not expect him to pass away so soon as we got to know him more and his hair was growing back. He looked younger and handsome as his golden Silkie Terrier hair grew luxuriantly in his face and I thought he was rejunvenated.

So his early passing away saddened me too. In a way, I was grateful that he did not die on the operating table. This type of high risk case can be ruinous for the veterinarian's reputation if the dog had died on the operating table. Therefore it may be wise to pass such cases to other vets as word of mouth referrals of poor clinical outcome like "death at the veterinarian" is not good for any professional.