Friday, July 22, 2011

514. The "reasonable" man test

The following is related to an old dog with a chronic ear problem. An earlier e-mail was posted in Blog No. 508 at:
http://2010vets.blogspot.com/2011/07/508-ear-canal-ablation-in-dog-email.html


E-MAIL TO DR SING DATED JULY 22, 2011

Hi Dr Sing,

Thank you for your reply!
(Ear Canal Ablation surgery is the only cure in chronic otitis externa with growths)--- URL is:
http://www.sinpets.com/F5/20110722vertical-total-ear-canal-ablation-surgery-chronic-ear-infections-tumours-dog-toapayohvets-singapore.htm


I am not confident with the surgery. Although he had one last year to laser which i mentioned, the vet used gas (i think) and promised to take less than an hour to minimize the risks, (he woke up immediately on the table and stood up wagging tail) his kidney suffered about 6-8 months after that (BUN was 188+ & before surgery 38). I don't know for sure if it was related to the surgery (or chemo) but I've read that it is possible. I cannot help but wonder if your 11-yr old patient died from post surgery...

May i ask, (I've not dared to ask other vets face to face) do you think the ear tumor is going to kill my dog if i leave it as it is...? How is it going to develop...? Will it go into the brain or pressing on it?

Thanks a million.

E-MAIL FROM DR SING DATED JULY 23, 2011

Thank you for your reply. Old dogs are at the end of their life-span and therefore are very high anaesthetic risks.

Any outcome in a complaint is judged by a "reasonable" man test in a court of law. Will a "reasonable" man think that the death of my 11-year-old dog patient that had ear canal ablation and passed away in his sleep 4 months later was due to the surgery?

A reasonable man will think that the death of patient that dies during or within a day or two after surgery is due to the surgery. After 4 months, a reasonable man does not think that the death of this 11-year-old dog is due to the surgery especially when he has been eating and drinking normally after convalescence.

As every dog is an individual and the exact nature of his ear growths are not known due to no histopathology results (as to whether the growths are cancerous or not) being available from you, it will be difficult to predict what will be the final outcome of your dog.

With chronic otitis externa and ear canal growths, infections of the ear canal get more severe, leading to the rupture of the ear drum and spread of the infections to the middle and inner ear may occur. If the growths are cancerous, they may spread to other areas including the brain.

Best wishes.

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