Friday, November 25, 2011

Ears, Everyone has 'em, no one treats 'em right

My Jekyl. His morning ritual. Jumping on the bed to say "Good Morning!"
The famous saying in vet school is that "90% of the problems we see as Vets is skin and gut." Problem is that every vet student  bitches about Derm (dermatology) and GI (gastroenterology) class because they are so hard. It's the bread and butter of vet business, the demise of a few vet students, and the frustration of many an owner and their pet.

At the average skin/derm appointment I have to tell my owners to be patient, talk to me alot, and try not to get frustrated. Sometimes the road we get on has many a twist, turn, pit stop, pit fall, and sometimes you just want to drive off a cliff. It can be a life long problem for many dogs and cost their parents a small fortune in the process.

I love Derm and I like GI (well I love GI surgery, does that count?), and I agree it is the bread and butter.

So I thought I would talk about a dermatology topic that I see and live everyday; Ears. You see my adorable floppy eared beagle pup Jekyl has weekly cleaning sessions because those big adorable floppy ears keep the dirt and wax in and the sunshine and air out. Versus my pit bull pup Charlie who has more erect ears.

Anatomically the bigger and floppier your ears are the more likely you are to have ear problems. The Cockers, Bassetts, and Hounds tend to have yeasty ears. The darkness, moisture, and wax (food) make the perfect environment for the yeast (aka bugs) to thrive. The Labs and Shepherds have a predisposition for bad skin, so their ear ailments arise from their skin problem. Then there are the Shar Pei's and Bulldogs who because of their smooshy faces end up having stenotic (narrow) and tortuous ear canals. Ontop of that  many of these guys have ear flaps that are jammed to their head and you get narrow, moist, dark, "I already have bad skin" and being unable to get to their closed ear canals and you have big ear problems!

Here is my ear problem kid, and his brother with out ear problems. See what I mean, genetics dictate!

I want to start with the most basic advice on ears. Keep them clean! Sounds so simple. We all wash our ears, swab them, and maintain our own personal ear hygiene, so why do we wait until our pets are fire red and stink so bad I can diagnose them from the other end of the vet hospital. Or let those ears go to the point of hematoma (the ear flap swells like a pillow). Or progress to deafness? I think it is because many people are scared to clean ears. So for every ear appointment I get I give a demo on how to clean ears.

I gave this demo the other day. I asked what they do? And got the answer that I usually get. "I squirt in some cleaner and then swab out with Q-tips." "OK," I say, "I know that most of us have been taught this way and you see us do it, but I think that there is an easier and more effective way." Then I go onto to explain, "Doctors have their own opinions on how to do everything. I mean they are entitled to them, but they are wrong with ear cleaning." I always say it jokingly, (OK, half-jokingly). I then go get a big bottle of cleaner, (I only sell the big bottles), because if you are here for an ear problem you will very likely have an ear problem again soon, so I want you to be ready before you call me.

My hope is that you won't ever have to call me again. My hope is that when your dogs ears start to bother him, (when he is at the initial inflammation stage), that you at home can clean your way out of the inflammation stage and avoid the (next) infection stage all together. My job is to educate you enough that you can keep your pet healthy and avoid seeing me.

Ok, here is the "primer" on ear cleaning. If all else fails, read the label! The label on our ear cleaner reads. "Fill ear canal until overflowing and then gently massage into ear. Let pet shake out excess." See? very simple. No poking, no swabbing, no fighting, no biting, and no hurting. Now, many pets have ears that hurt, so anytime you touch a painful ear you are hurting your pet. I don't want the ear cleaning to be a torture process that your pet hates because then it won't ever get done. So be gentle, be patient, and don't scare or upset your pet.

For the first few times it is a 2 person job. The first person holds the right hand on the pets collar and left hand firmly on the nose. Keep the nose up and don't let your pet fight out of the position hold. Be firm, be kind, be patient and be gentle, and don't let your pet fight. The second person then takes the ear flap (aka pinna) firmly and gently pulls it straight out away from the face. (Perpendicular to the eye so that you open the "L" shaped ear canal into moee of a straight line). Then fill the ear with the cleaner until it overflows. (No one ever uses enough). You want to "FLOOD" the ear canal, and that's another reason I sell the big bottles only. Remember your pet's ear canal is about 3 inches long. You need to get the cleaner to fill the whole canal. Then fold the ear flap like a burrito (always a reference to food ;-)), and massage into the head. You should be massaging against the skull and you should hear a squishy sound. It is the same concept as the agitator in your washing machine. This should not hurt. Actually, most pets love the ear massage. If it hurts then it means one of two things; 1. The ear is infected and you need a vet appointment, or 2. The ear drum is ruptured and you DEFINATELY need a vet appointment.

I don't want owners to swab the ears because if the ears are red then the swab feels like sandpaper. And a dog with a hurt ear won't want to let you clean them ever again. And the other reason we don't swab is  that we are trying to get rid of the junk in those ears, not shove it back down the ear canal. Let your pet shake out the excess ear cleaner and the junk that is causing the problem.

I also tell people that you cannot over clean, but you absolutely can over medicate. I don't care if you clean the ears daily. Some pets need daily cleaning, some weekly, some yearly. 

Everyday I see a dog in the clinic for "itchy ears." Most often these guys are here for their umpteenth time. There is a huge subset of clients who only come in because their dogs ears are to the point that their dog keeps them up all night, has blood coming out of their ears because they have been itched raw, smell like infection started brewing in them last month, or the ears are so infected and painful that the owner is in fear for their life when they try to put the medication "in that small tube I got last time," in their pets ears.

Oh, the frustration of the phone call that starts as "Hey Doc, I know we haven't been in in awhile, but Sam's ears are bothering him again, and I was hoping I could get more of that medicine he got last time?" Argh, it's a hard call to answer somedays. Firstly, because I would like to see your dog outside of the disasters so that maybe we can find an answer to the problem before it hits catastrophe stage. Secondly, because that little tube you have been using on and off over the last year is a whopper of a steroid with a big gun antibiotic/anti-fungal and I am afraid you are acting like Dr. Frankenstein and inadvertently growing a batch of superbugs in those ears. You see when you have a legitimate infection (most of the time you don't, because most of the time you simply have inflammation.) We are supposed to treat twice a day until the clinical signs (redness, itchy, smell, etc) are gone for at least three days. That way you have killed all of the bugs and not just the weak ones. If you only treat intermittently you are killing the weak bugs and allowing the most powerful bugs to reproduce. Eventually you get what we call "antibiotic resistence." The only treatment after you hit this stage is surgical removal of the entire ear canal. This is called a "salvage procedure."

I have done many ear canal resections to relieve pets of the constant pain of ear infections. It is the only way to stop the pain, and these guys are long deaf by then already.

I met one little Yorkie a few months ago with terrible chronically infected ears. She had just been rescued from a hoarder. Her ears had been so infected (a combination of ear mites and infection) for so long that one of her ear canals had closed already. She had a persistent head tilt and difficulty walking because her balance was off from her ear being so damaged for so long.

The next week I removed her unsavable ear canal. She was 4 pounds and had a tough time with her surgery and recovery. It took a few weeks before she could stand up, walk, and blink normally. Thankfully we were able to save the other ear with very aggressive steroids and antibiotics. She is a very gentle shy girl and her new family gave her the complete opposite life from where she had come from. She receives endless amounts of care, love, time, and she is finally healthy. She will probably never come out of her quiet reserved shell, because was raised being outnumbered and overlooked but she is happy and finally living the life she always deserved.
Post-op, Left TECA, aka Total Ear Canal Ablation

For more information on ears I really like the book "Small Animal Ear Diseases" by Gotthelf.

Here are some of my favorite Big-eared pictures and patients. Oh, I can't resist the ears!

Baby Jekyl, the first week we got him. Note the Sutured butt..

Jekyl, OMG do I love this beagle!

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