Wednesday, July 27, 2016

Ear Hematoma. The Complete Veterinarians Guide To Understanding, Treating and Avoiding Them.


I get these shaking head painful and swollen dog ear questions too often. Perhaps for me the 'old hat stuff' has progressed into dismay that I haven't adequately gotten the word out? Maybe the whole pet loving world doesn't know what an ear hematoma, or, aural hematoma is yet?

So here I go... pull out soapbox and cross fingers that I can spare a dog the excessive expense of an emergency visit, or, the worsening of a condition that allows the snowball to escalate in to needed a TECA (total ear canal ablation), and maybe even help a pet parent out there thwart a bug at the pass and save their pet from having an ear that resembles the one above.

If you think this is painful, you would be right! A hot, swollen, tender, blood filled pillow hanging off the side of your face blocking your ears from any kind of basic function, usually corking off infection inside your ears so it can stealthily fester and ferment while the world is far beyond reach, IS ouchy!

Note the perpendicular ear pinna and the head tilt.
I have seen many of these and in each case the degree of pinna damage, area of the swelling (base of ear or tip of ear), chronicity of disease (how many times has this ear flap been down this road?), and patient and client abilities and expectations.

I always discuss how the hematoma happened, or at least why I think it happened?

Possible causes include;

1. Ear Infection (about 40 % of the time). The ear is usually smelly and full of fluid, goopy soupy discharge, red, and painful. If your dog fits this description spend time talking to your vet about how the infection happened and how you can avoid it from happening again. Most of the repeat hematomas are infection or allergy. Your pet is very likely to be back here again. Avoid this if at all possible.

2. Allergies, about 40 % of the time. The ears are usually red but are not smelly or have any fluid in them. If your dog has allergies ask for a referral to a dermatologist sooner versus later.

3. Trauma, about 15 % of the time. The puppy and the adult dog are playing and the next thing you know someone needs an e-collar.

4. Idiopathic,, also known as, "we don't know?" I would guess these are about 2%

Here is a start to finish overview on Daisy's ear hematoma. There is a lot of helpful information in this. I hope it helps.


At the clinic I usually use a teat canula (this is what the dairy farmers place in the nipples of a diary cow with a clogged gland) to correct the severely swollen full pinna hematomas. For the very small fluid pockets at the ear base I remove the fluid and add a dilute steroid to stop the inflammatory process. For cats I use a through and through suture technique after an "S" incision is made on the medial side of the pinna.








This is what the ear looks like after three weeks of the canula being in place. The wrinkling and thickening of the ear pinna in these cases may be due to the chronicity of this ear hematoma, delay in seeking medical therapy, or not addressing the underlying problem adequately. This is why I advise getting these cases early and aggressively.



After 3 weeks the teat canula is removed. There should not be any discharge or swelling during the last week.





The ear is painful. We numb it with a local lidocaine block, but, we still place a muzzle.

The most important part of the treatment of an ear hematoma is to figure out what caused it. Both ears should be examined with an otoscope to look for infection, parasites, debris, polyps, and even tumors. I have found some crazy stuff in those ears, and every pet was telling me there was a problem by shaking, rubbing, or tilting their head to the side.


In many cases cytology of the ear may also be done. This allows us to diagnose the infection and more appropriately provide a focused treatment option.



The teat canula is sutured and glued into place. 

The end of the canula needs to be checked twice daily to make sure it doesn't get clogged. It is after all there to drain the fluid.




Daisy gives a shrug and smirk of disapproval.


Daisy is ready to go home.


A teat canula should stay in for three weeks. The e-collar should stay on for the first 3-5 days, and then if the head continues to shake, or the pet rubs or paws at the ear.

Here is the break down of Daisy's ear hematoma repair;
 Exam $50
 Aural Hematoma Repair $65
 Medications; NSAID and ear antibiotic $50
 E-collar $20
 Ear Cleaner $22
In most cases with client compliance we do not charge for re-checks or the canula removal.

For those pups who have itchy painful ears, or for those who have not progressed to hematomas (but are well on their way) I wrap the ear to the head. The disadvantage of this is if there is an infection in the ear. A wrapped ear needs air, monitoring, and care. Only wrap an ear that is NOT infected. And, be very careful to NOT cut these bandages off (you don't want to add injury to insult).



I always instruct my ear clients on how to clean their pets ears. Here is a video on how I recommend doing this. It should be quick, easy, stress and pain free. I also advise them on what to have ready at home if head shaking starts again. I typically advise keeping diphenhydramine on hand and starting to clean the ears as soon as a problem seems eminent. Red ears, head rubbing, pawing or scratching at the ears all indicate that it is time to look and smell under the hood.





Related blogs;

Ear Cleaning blog.

Ears; How to Treat 'Em Right.

There is a blog on cat (feline aural hematomas) here.

Another part of keeping ear healthy is removing excessive ear hair. Blog on Ear Hair Removal here.

If you have a pet question please find me on Pawbly.com. The Pawbly community is free for all to use. We hope to help pets in every walk of life and in every corner of the globe. If you don't have a pet question please just stop over and give a hello to someone in need of a friend or some free advice on how to care for their companions.

If you would like to meet me I am available for appointments at the clinic, Jarrettsville Vet, in Jarrettsville Maryland. Our prices are posted every year. Here is the 2016 Jarrettsville Vet Price Guide.

I am also on Twitter @FreePetAdvice. You can also find helpful tips and more videos on my YouTube channel. 

Sunday, July 17, 2016

Open Admission Shelters are NOT Safe Houses


People should be told the truth. Regardless of whether they can face it, deal with it, or do something about it. We all deserve honesty and transparency. Wouldn't you want to know what was going to happen to your pet if you dropped it off at a shelter? Shouldn't this sign be the first notification that you see? 

I have a very deep troubling sense of despair over open admission shelters. I will also be the first person to admit that I do not know how resolve the problem. 

In too many places of this world you will find the face of poverty, struggle and suffering. There are millions of lives on the brink of death in every corner of the globe. Compassion in some places has manifested into "open admission shelters". Shelters to house and feed and provide the very basic of care so that these animals are not on the streets, in the elements and at the mercy of predators. It sounds like a good answer doesn't it? It shields us from seeing and facing the stark divide between the "haves" and "have-nots". Wouldn't you rather be in a room with a meal then on the merciless ground without? Seems sensible? But what happens when the line at the door is too long for the number of rooms available to lodgers? It is a dilemma faced daily at open admission shelters. The dilemma of what to do when you have a contractual obligation to be the safe house for the lost and the unwanted. If your room is needed and your contractual obligation time frame to hold and house you is up you are most likely going to be killed. In medicine we call it euthanasia. In reality euthanasia is a kinder, more compassionate description of terminating a life. In the shelters the majority of euthanized animals are healthy and killed due to lack of space or resources. 

Buster. Our newest JVC addition.
Owner unable to pay for the cost of his chronic dermatology care.
He is being treated by us and with the help of  the folks at Long Green Dermatology.

He is a happy engaging pup in foster and looking for a new home.

Let's talk about why people surrender pets. Here is the data from PetFinder.com

Dogs:
  1. Moving (7%)
  2. Landlord not allowing pet (6%)
  3. Too many animals in household (4%)
  4. Cost of pet maintenance (5%)
  5. Owner having personal problems (4%)
  6. Inadequate facilities (4%)
  7. No homes available for litter mates (3%)
  8. Having no time for pet (4%)
  9. Pet illness(es) (4%)
  10. Biting (3%)
Two of the 14 homeless kittens we placed so far this Summer

Cats:
  1. Moving (8%)
  2. Landlord not allowing pet (6%)
  3. Too many animals in household (11%)
  4. Cost of pet maintenance (6%)
  5. Owner having personal problems (4%)
  6. Inadequate facilities (2%)
  7. No homes available for litter mates (6%)
  8. Allergies in family (8%)
  9. House soiling (5%)
  10. Incompatibility with other pets (2%)

Does it seem odd to you that these numbers don't even come close to approximating 100 %? It does to me too. I can say that after a decade in practice I have seen too many people turn to a shelter when they can't face the other options. What are the other options? Abandonment or euthanasia. (Perhaps there are others but those are too awful to even contemplate). 


It is inconceivable to me that some of these are on any list.

  • If you are moving you bring your pet. Period. 
  • Landlord doesn't allow,, well, what are you doing there to begin with? 
  • No homes for litter mates, no time, inadequate facilities, and too many pets all sound like lapses in good mature adult judgement.
  • Cost, well, cost is  something we can do something about. Cost is a relative, manipulative entity. There are options when it comes to this. This is where rescues, vets, and society can make a dent in shelter admissions. 
The list of reasons cats and dogs are surrendered is fraught with pet parents who either weren't prepared, weren't making decisions that put their four legged kids first, or simply are irresponsible. This notion that pets are peripheral disposable replaceable accessories is part of the reason there are so many pets in need. This mind set has got to change. How do we do that? We teach respect for life, love for each other, and manifest, nurture and foster kindness to all others. 

Paisely needed a surgery that only JVC was willing to try.
She is Harford County shelter rescue who has since been adopted and is doing great!

There has to be a better way? Has to be! There needs to be a shelter to serve as a holding facility for lost pets where people can bring them. For the few pets who are found and need a place to stay while mom and dad remain frantically searching the neighborhood there needs to be a safe house available. Some sort of central location for reuniting pets and their parents. The only justifiable existence is as a halfway house, a sheltering holding facility for reunions.


Laura (JVC Rescue coordinator) and Sammy.
Cecil County Animal Shelter rescue.
They closed their doors and she would have been euthanized if we didn't rescue her.

The old adage holds true. "You are either a part of the solution OR you are a part of the problem." 

How does my clinic, Jarrettsville Vet, become a part of the solution, if we are, as I believe every clinic is, a part of the problem? We are not going to be the place that decides, influences, or confers that veterinary care and the cost of it is too excessive for parents to provide. There is a considerable amount of fluff in the medical estimates we provide to parents. We, the vets who have been taught by the hand of the specialists at the Ivory Tower should always offer the Gold Standard of care, and we too, need to remember that Gold Standard is not always attainable or financially feasible. We are forgetting that if our client walks out of our hospital without an affordable AND agreed upon treatment plan that some of these pets will be euthanized or surrendered. We are a big part of this problem, and we have to take responsibility in being the force of change that provides for a solution.  

Laura and Chico.
Owner surrendered whose only other options were euthanasia or shelter.
He is now also in a new home
In the last year Jarrettsville Vet has gone to every emergency clinic and shelter in our area and left them with a plea; If any of our patients end up in their lobby for any reason with their parents feeling like they have no options other than surrender or euthanasize call us. Have the person surrendering call us, give our name and number to any of our clients who thinks that there isn't another option. We will do whatever we can to help, and, we will help.

Petey and Dr Allen, his new mom.
Owner surrender or would have been euthanized.

How has this been received? Sadly with disbelief and a deaf ear in some cases. In others with a rapid phone call, Facebook message, or even a behind the scenes emergency hotline call to one of the staff. Jarrettsville Vet has helped many pets get out of a shelter and into a home. Some of these have even been the original home. The majority of the surrendering desperate pet parents just needed help and a shoulder to lean on. Sounds incredibly easy, and it really is just that easy. 

Tanner, Number 2 Cecil County Animal Shelter shut down rescue.
Currently in foster. Ready for a new home soon.

To all of my friends, colleagues, neighboring vet clinics and those of you who think that there has to be a better way and more options there are. Jump in, lend a hand, stick your neck out, and save your patients life. I know you are not a rescue, I am not either. BUT, these pets come through our doors. Their stories are ones we know. We feel and hear our clients frustrations. We see their despair, and often participate unquestioningly in their final decision. We can do better, and we owe our patients more.

Talking about other options can be a difficult task in a time of emotional turmoil. Have I lost clients because I have offered other options? Yes. Of course. What I see as offering their pet a second chance they see as a possession they are determined to decide for. I may never see them again, and I am OK with this. Their anger at me is their shame in being unable to see a different option exists. My obligation is to my patients. They are not disposable, replaceable, and dismissed. Other clients know and believe us when we say that we are here to help, especially even when there are lots of bumps and tears in the road.


Murray and  Diedra.
Owner surrender.
Each owner surrender has been a euthanasia request replaced by a second chance. Every client was offered financial assistance, veterinary services at no cost, and options to keep their pet in their home. Every pet, just like every one of us, deserves a second chance and a friend in your corner at your darkest hour.

Thank you to those clients who help us in offering options that aren't routine. Thank you to the clients who help in providing foster care, making donations, volunteering their time and reminding all of us that this village can care for its own.

If you are interested in learning about different options to running a vet hospital out of the corporate box find me at the clinic, Jarrettsville Vet, on Twitter @FreePetAdvice. Or on our Facebook page.

If you want to help a pet in need please join me on Pawbly.com. We are a village of volunteers to help provide guidance and assistance in the virtual space of pet lovers worldwide.