A Repeat Offender. The Ear Hematoma

How miserable does this poor kitty look? When I entered the exam room I was met by this uncomfortable face. She was a quick easy diagnosis.

I skimmed through her medical record.

• indoor cat
• spayed
• friendly
• up to date on all veterinary care
• new patient to our clinic
• previous history of ear hematomas

Her ear is full of fluid and looks like a pillow. The fluid in the ears is making them hang. Instead of having normal looking ear flaps that stand up (erect ears) she looks like a Scottish Fold that just spent ten rounds in the boxing ring.

The veterinary terminology for this condition is aural hematoma. A hematoma is a collection of blood that is stuck in a pocket. It is like a bruise.

Hematomas happen due to trauma. Either self induced trauma like scratching your ears, or shaking your head so violently that the blood vessels in your ear rupture. The blood then pools between the front and back skin and around the thin piece of cartilage in the ear flap. The pool of blood resembles a pillow. The problem with a hematoma in your ear is that the blood has no place to go. The hematoma gets stuck. Without some way to provide drainage for the hematoma it will just sit there. Over time the blood coagulates, solidifies and causes the ear flap to scar and distort. In people (boxers in particular) we call it 'cauliflower ear." In pets the ear flap contracts, shrivels, and calcifies. Pets with chronic recurrent ear hematomas develop scrunched deformed ear flaps that close off the ear canal, precluding air circulation, and trap dirt, debris, moisture, and other gook inside.

I see ear hematomas primarily for the following reasons;

Dogs;

1. Ear infections.
2. Allergies.
3. Fleas.
4. Scabies.
5. Playing or rough housing with another pet and they either run into some hard object, or the other dog is playing/biting on the ears.

Cats;

1. Allergies.
2. Fleas.
3. Ear mites.

Although if it is a wild/feral cat the above is reversed.

When this kitty came to see me her dad knew what the diagnosis was and he already knew what the treatment plan would include. He had been down this road before. 

Before I could say anything he said, "So, is it OK if I just leave her here until you can do her surgery?"

Many of us vets are happy to have a client that already understands and accepts the diagnosis and treatment plan, it saves us lots of talking and explaining.

But this vet likes to talk. More accurately I like to educate.

"Well, I think that we do need to drain this ear, but I wonder how this happened? Can we talk about that?"

He looked at me quizzically?

"Umm?...Well?...I don't know how it happened?" He replied hesitantly.

We began a discussion of her history, her diet, her in home care, her previous veterinary care and her environment. Initially her dad seemed a bit put off by the barrage of questions. He was here to drop her off and get on with the rest of his day.

We discussed the cat list above. Why would an inside, parasite free, only pet in the household have bilateral ear hematomas? Why would she get them again after a year?

He started to see the reason for my questions and the Q & A turned into a round table discussion.

Isn't it far better to not only treat this episode, BUT also prevent the next one?

Seeing your vet for a problem shouldn't be just about getting a diagnosis and a treatment plan, BUT also preventing?

Next time you are in your vets office ask them about preventative care, it's part of the healthcare plan.

Here is an article on aural hematomas, but I would not recommend treating this at home, and I do not inject steroids into ears.

If you have any questions about this or any other pet care items you can ask me, or any of the other Advisors at Pawbly.com, or @pawbly.

Other blogs on this subject: Aural Hematomas. The veterinarians guide to treating. Dog version.

When You Only Have One Chance Left To Get It Right

Sometimes you get it right the first time. Sometimes your client wants you to just get it done right now and right cheap. Sometimes these things are not feasible to do together.

The "real-world" of veterinary medicine is often one of listening to the clues your client gives you, looking, listening, feeling, and smelling for the ones your patient gives you, and then the tricky scenario of recommending diagnostics, summarizing the costs of the items involved in your plan, and the statistics for recovery.

It's a sort of dance, a courtship in a way. The pet that needs help, the advice of the specialist, and the willingness of the client. The complexities of the process dictated by the findings, the answers, and the resources.

This is the tale of Cali. A barn cat. (Argh, how I hate that label. Like, they are some subclass of feline). Cali was accompanied by a young sweet girl. Seems Cali had been in a few months ago for a wound to the right side of her face. It was along her neck and under the base of her ear. Her family had tried to treat the wound at home for a few weeks before she was brought to us the first time. After trying ointments of varying sorts she remained itching the wound and it remained open.

A few weeks back Cali was brought in by the young girls mom. She had been insistent on not spending much time or money on figuring out the root cause of the wound, she just wanted it fixed. Cali was on a budget, a tight budget. 

Cali was scheduled the next day for a wound debridement and drain placement. The plan was to freshen (our veterinary terminology for livening up the stagnant tissue to try to coerce it to start healing like it is supposed to). A chronic wound sometimes has a residual nidus (a sort of thorn that won't let the wound close). Often a non-healing wound has a source of infection that precludes the body from healing normally. For these wounds we often recommend and exploratory surgery to look for the source, freshen the tissue, place a drain to allow a flushing agent, or good old air, to motivate final resolution to the wound. 

With that plan went four weeks. The drain had been removed one week post op, and things were looking like they were officially, and finally, on the mend.

Then Cali came to see me with the daughter. Cali is a three year old outdoor cat. She is sweet, gentle, purrs at a glance and loves any tiny bit of attention she can get. 

Cali had returned with the same wound and the same budget. Second times around are a whole lot harder to resolve. Our first guesses and first chances of getting a cure are usually the best case scenario's and the cheapest options. The more times we swing at the bat the less likely we are to get it done "quick and easy."

Cali's wound looked just like it had from the time her family started treating it. A fleshy subcutaneous wound without any hair surrounding it.

After a thorough examination I found the following; Cali had dirty itchy ears. Because she is an outside cat I suspected some of the dirt, debris, itchiness, and ear problems might be due to ear mites.

I suspected that the source of her wound was her chronic itching at her ear. I hoped that I was right..I was on a very tight budget, a family that was getting a little frustrated by the clinic, a cat with any already exhausted slim chance.

After a topical flea preventative, (that treats intestinal worms and ear mites), an injectable antibiotic, a thirty day steroid shot to stop the itch.

I also gave that bearer of her parents barn cat a small promise. I won't give up on you or your kitty. If I don't get this right this time we will get it right the next time, or the next time, until we get it right together.

That's what being a vet is about.

Ear mites are tiny ectoparasites (live on the outside of the body) that live in the ears of a host. The hosts are usually young cats and kittens. They can occur in many other species like dogs and rabbits but seem to be the biggest problem in cats.

Cats with ear mites have dirty black debris in the ears (I think it looks like very fine coffee grounds). They also scratch, sometimes to the point of causing wounds to the sides of their face. The mites are transmitted to other pets that they are in close contact with. The scientific name for ear mites is Otodectes cynotis in dogs and cats, and Psoroptes cuniculi in rabbits. For a definitive diagnosis your veterinarian can take a sample of the ear debris and examine it under the microscope.

Luckily, there are many treatment options available. Some are more expensive and very convenient, (like a one time topical), others are very inexpensive but need to be done daily for three weeks.