Jul 28, 2008. I make time to update and organise some of my ear surgery reports, hoping
to bring veterinary surgery alive via narratives
o a veterinary student now studying in Australia


EAR SURGERY (Lateral ear canal resection) is one of those effective operations to resolve the chronic ear infection and pain of certain dog breeds like the Miniature Schnauzer and the Cocker Spaniel. Miniature Schnauzers tend to have lots of ear hairs inside the canal trapping water and preventing ear ventilation . Plucking of ear hairs is very painful.

Continued addition of ear powder by the groomer to pluck the ar hairs and to neutralise the smell is not the long-term solution. The ear powder just clogs up the horizontal ear canal and cause ear shaking as the dog tries to get rid of the powder by shaking to older age.

But most Singapore dog owners are not keen on the surgery for various reasons. Probably the main reason is the cost but the frequent ear cleaning and trips to the groomer leading to ear scratching for many years is tolerated by the owner as he or she is not the one suffering daily from ear pain. 

The cost of operation and general anaesthesia for both ears is estimated to be around S$600. Total costs will be around $800 - $1,000 at the Toa Payoh Vets for small breeds like the Miniature Schnauzer. 
 

Case 1.  PICTURES in 2002 - Lateral canal resection - Miniature Schnauzer

The left ear. No ear problem on the left ear in this old dog. The ear canal consists of a vertical and a horizontal canal joined together. The right ear. Infections of ear for four years lead to thick growth of skin blocking the vertical ear canal.  The canal is very narrow and smelly now. An operation is needed to open up the ear canal to drain the pus, debris and water from the vertical canal (forceps inside the vertical canal). A rectangular piece of skin is cut out from the side of the ear. The vertical ear canal is seen after the skin is removed. The outer half of it has been cut and discarded leaving a big gap. The horizontal ear canal can be seen as a circular hole at the bottom of the ear.  The vertical canal's side wall has been removed. Therefore, the ear now has open ventilation and does not trap water and dirt now.     The vertical ear canal opened up. The stitches hold the side of the vertical canal to the skin. First day after surgery. Swelling of tissues but no paralysis of the eye lids or lips. The vet has to be careful of the facial nerve is near the horizontal canal. An elizabeth collar to prevent ear scratching. Went home as owner did not want the dog to be warded.   Wound cleaning. 5th day after surgery. Cotton bud shows the horizontal canal opening. 14th day after wall of ear canal has been removed. Stitches taken out.   Follow up. No more consultation from the owner.  I presumed his problem has been resolved to his satisfaction.  Ear surgery done at a younger age would have given the dog many years of freedom from ear pain, foul ear discharge, ear shaking and daily ear scratching! Case 2.  PICTURES in 2005 - Lateral canal resection in a Cocker Spaniel Left ear before surgery.  Every day for many years, a yellow white ear discharge oozes out of the right and left ear canals. Head shaking, ear scratching.  Seen a few vets. A very busy owner. The uncle had no time to clean and check the ears daily or weekly. He wanted to euthanase the dog as the ear stench was persistent and unbearable even after bathing. Left ear prepared for surgery. General anaesthesia gas. The side wall of the vertical canal is the rectangular area to be cut away. A hole will be seen. This is the opening of the horizontal canal.   Left ear after surgery.  7 days after surgery and more drug treatment, cleaning and washing.  The owner may not be able to nurse the dog if sent home immediately. This would be one reason for "unsuccessful" ear operation. Right ear before surgery.  Cocker Spaniel warded for 2 weeks of treatment before the ear surgery can be done. The skin was intensely red, wet and soft, unlike what you see now. Full of yellowish white raw skin of infection. Not advisable to operate immediately. 2 weeks' antibiotic and cleaning treatment is the minimum.   Right ear after surgery.  Yellowish white raw skin areas finally gone away.  More normal skin grows to replace ulcerated skin. At least 4 weeks of stay at Toa Payoh Vets before the dog can be sent home in this case. The owner does not know how to take care of the ears post-operation. Follow-up. The Cocker Spaniel led a ear pain-free life to old age. Occasionally in the past years, the young lady owner who rescued this dog from the uncle who wanted euthanasia for smelly ears, brought the dog in for consultation of some horizontal canal cleaning.   Other ear surgery cases performed by Dr Sing Kong Yuen: See right column   Educational stories for startups by asiahomes.com Tips for the new asiahomes realtor  Written 6 August 2002 for new partners of www.asiahomes.com.  Dr Sing Kong Yuen is the founder of Singapore licensed housing agency, asiahomes.com  Real Estate & Veterinary Relationship - Is Image Everything?  There are four legs to establishing a solid relationship in any  business, whether veterinary, investment banking or real estate. These are: 1.  A continuity of relationships and trust built over time. This will take more than a year. Unfortunately, for many reasons, many startup realtors and private veterinarians, being self employed, do not have the money to last that long.  2.  Being able to offer a wide range of products and services. One-man-operators (OMO) in real estate and veterinary surgeries cannot compete effectively with bigger firms as he or she does not have a wide range of products and services. Setting up practice away from the big firms and opening long hours till past midnight may be a solution as Singaporeans prefer convenience.  However, your Landlord will want to increase your rental, take over your premises to get the higher paying tenant. The big firms may set up next door to you as you have been successful. 3.  Provide an excellent personal relationship. This may involve entertaining clients to a round of golf or treating clients to Starbucks coffee after house-hunting for realtors. Vets seldom build this relationship traditionally as they don't take clients out for the whole day (to view houses as rental realtors do). They need to clear the day's surgeries but they can spend more time getting to know the pet owner and his children during consultation. Some pet owners are in a great hurry to rush off and they are more time-pressed than the veterinarian.   4.  Being able to give advice, solve problems and find solutions. I consider this to be most important of the four factors. If you can't cure the dog or find a house the expatriate likes, the client goes to somebody else. See story below.  Therefore image is almost everything. Your client's perception of you can make or break you. If the vast majority feels you are impatient and hard selling, then it is unlikely that you will get referrals. In the end, it may be better to be an employee or be unemployable.  A veterinary example of "Is Image Everything?" The 10-year old dog had excessive wax in his right ear around 4 years ago.  I advised ear drops to be given to clear the infection and regular ear cleaning as the first step in the treatment.  This would be the least expensive veterinary treatment and most of the time, the advice worked. The brown smelly ear discharge indicated bacterial and possibly fungal infections.  As I did not solve the problem of excessive ear wax production immediately, the owner went to consult other vets.  Doctor hopping is common in Singapore and probably all over various urban areas in the world. Now the owner consulted me 4 years later.  I guessed that the other vets did not solve his problem too.  In the meantime, the right ear canal's skin had proliferated with big lumps which covered the whole canal. The dog could not stop scratching the ear daily.  In this case, image could be everything.  Bigger veterinary firms and newer firms with modern premises have better image than a 20-year-old veterinary surgery which looked dated.  The glitz and newness attract the internet generation and Toa Payoh Vets' premises were a dinosaur in appearance (picture of dated premises, left. Renovated premises, picture below). Image was not everything.  The important point was that I did not solve the problem of this dog owner 4 years ago.  The long-standing ear canal infections meant frequent ear pain, ear scratching and head shaking. With the passing of years, the ear canals react to irritation by forming growths.  The canals became narrowed with large numbers of skin growths looking like ear tumours.  The dog could not sleep properly as the moist ear ulcerations and white fungal plaques inside the ear caused intense pain.   The solution was to open up the ear canals to permit proper drainage and ventilation.  But was it too late?  I could only assume that the problem was resolved as I did not see the owner anymore. A healthy dog could live up to 15 years and I hope this dog was all right. Image is not everything. But first impression counts a lot. Being able to solve problems is a skill very hard to teach.  Some people have it naturally. Others don't have it at all.  However, read widely business articles and talk to many people including strangers on various ways they resolve their work problems.  Surprisingly, some of the solutions are applicable to your work as a housing agent or for me, as a veterinary surgeon.      Educational stories for startups by www.asiahomes.com Tips for the new asiahomes realtor  Written 6 August 2002 for new partners of www.asiahomes.com Dr Kong Yuen Sing, founder of Singapore licensed housing agency, www.asiahomes.com