"Bluish black ear tips. What did you do to Gom's ears?" I asked the well groomed young Korean lady. Her English was excellent and so it was easy to communicate.
 

"I tied her ear tips with a rubber band," she had watched and adopted the same procedures done in a Korean TV program on Malteses. Shih Tzus do get their long hair tied up above their forehead so that they can see and look pretty.

"The blood supply to the ear tips is no more," I explained. "The ear tips have no blood supply due to the rubber band cutting off the flow of blood. Now the tissues are dying. This is called gangrene. Did you use a groomer's rubber band for Shih Tzus?"

"No," the lady showed me a red rubber band normally used for tying things.

What to do with these two dying ear tips? Nothing much could be done to reverse the cell death.

3 days later, the young lady came as the left ear tip had become black and hard. I asked Groomer Aung to clean it.

"The ear tip dropped off," Groomer Aung showed to the dead triangular piece to me and the lady owner. She cupped her hands to cover her eyes. It was too much for her to see.

I took away the gangrenous ear tip. What to do now?

"The right ear tip is becoming black," I showed the owner. "It will also drop off in a few days' time. I advise cutting it off now."

"How much it will cost me?" the lady had a tight budget as she was studying in Singapore. Many foreign students in Singapore survive on a tight budget as their middle class parents skim and save every penny to pay for their expensive undergraduate fees and accommodation overseas. Hoping that their progeny would pass their examinations, take their studies seriously and graduate. Get a better future with a university degree. Such are the high hopes of parents.   

In theory, such students ought not keep any dogs to minimise expenses. But they are not from the frugal baby-boomer generations that have had experienced the deprivations of World War Two. So, some of these Internet Generation young adults do buy puppies and they do make great companions in a foreign land where friendships are transient. If pet dogs  don't fall sick, expenses are affordable.

"$60.00 to cut off the gangrenous right ear tip," I said. It was take less than 10 minutes of anesthesia and cutting off the tip would be two seconds. Potassium permanganate powder applied on the wound would stop bleeding. Hence the quotation was low. 

"Can you make both ears of the same size?" the fair lady assumed that cutting off a larger piece of the right ear tip instead of the small gangrenous tip would be the same effort and expenses.

To the owner, aesthetics are important. Which owner wants to see her companion with uneven sized ears every morning? Friends would ask awkward questions too.

I assessed this fair Korean lady's parents must be giving her sufficient funds to study and little else. Certainly not to own a puppy in expensive Singapore. Fortunately she did not buy a car in Singapore. But taxi fares to the veterinarian for a budget conscious pet owner do add up and increase her expenses. Pet dogs are not permitted on buses and the subway in Singapore and so taxis are the sole transportation for her sick pet going to the veterinarian.

I did not explain that it wound take 20 times longer to give Gom ears of equal sizes. Anaesthesia would need to be longer. The left ear tip needed to be cut again to get rid of the gangrenous edge. The right ear tip with a much small gangrenous patch needed to be measured and cut to the same size and the left ear tip. There would be stitching and lots of bleeding. The total time taken would be so much longer. Therefore, the veterinary fees would be much more at around $300. 

As she was on a tight budget, I did not revise my original fees. Gom needed surgery now. She could still survive after both gangrenous ear tips dropped off but it would be quite distressful for his owner to experience the sight of right dead ear tip falling away in a few days. 

I masked him and tubed him to give him the isoflurane gas anaesthesia. He did not sleep well under intubation and was gagging as if he did not like the endotracheal tube.

The anaesthesia was uneven and delayed my surgery. I had to worry whether he would die on the operating table since he could not get to the surgical stage of anaesthesia unlike other puppies.

When I took out the endotracheal tube and just gave him gas via the mask, he slept like a baby. The gangrenous left ear tip was placed against Gom's right ear to get the area to be cut. I drew the incision line with a marker pain. Pulled back some skin so that I could suture over the cut cartilage. It was not possible in Gom as her skin was taut. A curved artery forceps was clamped below the black marker line and the cartilage was covered with an inverting 5/0 absorbable suture, as in stitching the uterus during Caesarean sections.

The left ear tip was clamped and similarly cut to remove the gangrenous edges and dead cells. There was much less bleeding and the suturing stopped the bleeding. The right ear tip area bled a lot as it was normal tissues cut by me to ensure that both ear had equal sizes. The bleeding was not serious, so I did not bandage up the right ear to stop the bleeding. I would have had done in a Doberman after ear cropping.

Ear cropping by vets for cosmetic reasons is prohibited in Singapore in the past decade or so. However, it was not prohibited when I started practice some 25 years ago.

"Gom has to stay one night for observation," I said to the fair lady as she would not be used to the bleeding over the side of the right ear and onto the ear. "Gom would be active at home causing more right ear bleeding."

Gom would keep her owner awake the whole night. She would be worried about the bleeding as Gom would be active. Both would not sleep. Gom's owner might dial for emergency veterinary treatment. This would considerably increase her expenses. By staying overnight at the Surgery, Gom would just rest, eat and sleep. Not being active, the bleeding would stop naturally. 

"How much does it cost me?" the lady asked. As the $10.00 was affordable, she agreed. Early the next morning at 9 am, the lady suddenly appeared while I was starting my work.

Well groomed and attired in a striking multi-coloured striped blouse she always presented well whenever I saw her at the Surgery. No casual T-shirts. First impressions are important for her.  

Gom's bleeding had stopped but large brownish red blood clots that have had dried up blanketed the top of her forehead and the sides of both ears. I took wet tissue papers to wipe away the blood clots on top of Gom's head and side of her right ear while Gom's owner watched. 

"What does 'Gom' mean in Korean?" I thought this Maltese might be named after one of the gnomes in the 'Lord Of The Rings' movies. This young mini-Maltese was no ageless and deformed dwarf guarding her mistress' treasures.

"'Gom' means 'Bear'" the young lady in her early twenties taught me my first word in the Korean language. She scrutinised the puppy's ears without saying a word. I presumed she was satisfied with the almost equal sizes of the ear tips bordered with dark red brown clots.

I had her holding Gom take a good photograph for the reader's appreciation and for record purpose. As Gom had not scratched his ears, I did not recommend an Elizabeth collar.

Bathing of the ears would only be done10-14 later. Antibiotics would be taken for 7 days.

It is hard times in November 2008. The big bankers played around with financial derivatives and caused considerable damages to ordinary people. Gom's owner need to save every dollar as her parents have a limited budget for her to get a good degree in Singapore and be proficient in English.

Once she graduates, her parents would be able to worry much less. To save money, I used absorbable sutures during skin suturing so that Gom's owner need not return for stitch removal.   The sutures would dissolve, saving Gom's owner some money in taxi fares. I expect Gom to be all right and hope that her owner will be more careful when prettying up Gom with rubber bands.

NOTES: General anaesthesia of puppies under 3 months of age can be risky according to some veterinary reports. Gom was 4 months of age but still there was the worry.