Friday, December 12, 2014

Living with Bleeding on the Edge, Ear Tip Dilemmas

This is Domino. He is an older lab mix who got himself into a tussle with his brother. Truth be told he is not always the first to give a wag and head bow. He is more likely to give a shifty eye and hackle raise. He probably instigated the argument.

As with most quick dog fights there is usually a lightening fast eruption of fury and then it all dissipates and life goes back to normal. For most domestic disputes I don't get a phone call or a visit unless there appears to be one of two things;
  1. Limping, Or,
  2. Bleeding

For Domino there was still a little pesky bleeder on his ear tip that even after one trip to the ER wouldn't stop.

The bleeding from the ear can be profuse and frightening. It is best treated by two simple steps;
  1. Clean the tip with soapy water.
  2. Apply direct and constant pressure. Hold a paper towel, gauze, or wash cloth on the end of the ear for 15 minutes. Do not look at the ear tip, do not blot, just firm direct pressure. (Oh, and use a clock, it really can take this long to stop a bleeder).

The two places that I most commonly see incessant bleeding are;

  1. The ear tip, and 
  2. The tip of the tail. 
Both places are problematic for exactly the same reasons. They are almost impossible to keep still and almost impossible to keep from banging around and rupturing the delicate blood clot that is vital to allowing a wound to heal.

Dominic had been to the ER the night before. Not because his mom feared that he would bleed to death overnight,, (although many of my clients fear this when they see blood splatter from flinging a tail or an ear),  but simply because it looked like he might. 

At the ER Dominic's mom stated exactly what was obvious,  that the end of is ear would not stop bleeding.

At the ER he was sedated and the inside of the ear pinna was sutured to the outside of the pinna. (Think of it like sewing the edge of the pillow back together). Here is the problem; There is a thick piece of cartilage (like the stuffing of that pillow) that lives in between the soft velvety pieces of the inside and outside of the ear flap of a dog. To close this successfully the skin needs to be longer than the cartilage and be sutured in a super-meticulous sewing pattern. This is difficult to do without a perfectly still patient and about an hour of anesthesia time. Dominic got a quick couple of sutures to hold the edges together and the ER vet bandaged the ear tip.  It didn't hold longer than a few hours. A few shakes of the head and that attempt at stopping the bleeding was kaput. Bandages on ear tips or tails are a difficult beast to tame into submission for longer than a moment.

I only know this because I too have failed in the debacle of bleeders that drive clients to the doors of emergency clinics  in the wee hours of the morning after awakening to a blood bathed  room.

A  few important reminders to readers: blood looks scary. But you can't bleed to death from a tail or an ear, or a toenail, (well, it is very, very unlikely). Apply pressure and be calm. Go to see your vet in the morning. If an ear or tail continues to bleed there is no bandage, no glue, and no amount of trying to restrict motion that will stop them from bleeding. If you can keep the clot on the ear tip or the tip of the tail it will heal. If they continue to be banged around, by either head shaking or tail wagging then I just don't think much else works except for crazy proactive measures.

Here is my answer for problematic ear tips. I suture the ear to the head. Here's how I do it;
  1. Identify where I want to suture the ear tip to the head and clip the hair there.
  2. Apply a topical anesthetic to the  ear tip and a local anesthetic to the point  on the top of the head that I suture to. Wait about 5-10 mintues.
  3. Have a good pet restrainer. We use a muzzle and a firm hold. We also give a very deep scratch, or use treats to distract and encourage allowing us to make two quick sutures.
  4. I place two quick holding sutures between the ear and the head. The sutures do not have to be deep, but they are easier to remove if they are large enough to see and cut at healing time.
  5. If the ear tip (or tail tip) can be kept quiet it ill heal in about 2-3 weeks. A wound will always heal if kept clean, healthy, and just allowed to rest.

Now I know that many people love sedation. I, in many cases, do not feel as if the expense and the time delay warrant the use of a possible cardio or respiratory depressant. As long as I know I can perform the procedure quickly and safely I use a local anesthetic and a well-trained assistant.

E-collars are vital to the success of these cases. One foot rub, face rub, or inquisitive friend and all of your endeavors are put into repeat mode.

I recommend that the patient return in 2 weeks for a re-check. IF the wound is completely healed I quickly cut the two sutures and send them on their way. If not, wait until the wound is completely healed. One tiny little edge of a scab can quickly return you to blood bath state.

The cost of his treatment at my clinic, which included an examination, e-collar, topical antibiotic cleaner, sedation and suturing was about $150. He returned two weeks later for his suture removal. His ear was completely healed and the re-check (as with almost all of our re-checks) was free.

For those of you pet lovers out there I invite you to visit me on Pawbly is a place where anyone and everyone can meet to exchange pet care information and advice. It is free to use and provides quick, credible information to anyone in need.

If you are looking for help from me in person you can find me at the clinic at Jarrettsville Vet, in Jarrettsville Maryland. Or, find me on Twitter @FreePetAdvice.

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