10 steps for dogs and cats with ear conditions
Today is the day, I have decided to jump off the cliff of veterinary knowledge and plunge into the depths of the world of ear infections – one of the most daunting of subjects.
One may wonder why today is the day. It is an evening and I originally thought I would write about cancer and how there may be some clear or clearer ways of preventing it. Then the inner voice that I sometimes try to resist so stubbornly whispered in my EARRRRRRRRRRRS. Write about earrrrrrrrrrrrrrs.
“Are you kidding me,” I started arguing, “I am not even going to go there. Last time it took me three days of preparation to justify my treatments in front of the Provincial Veterinary Association. Forget it!” I barked back.
“But people need to know,” my inner voice replied.
“Ok ok, I give up. I will write about ears if you promise that you will not get me in trouble,” I negotiated.
If you have been reading my blogs for a while, you are probably expecting a story, right? Why not? Please note the names and times are fictional for privacy protection.
Ursula and Tamara
The clinic was crazy busy, it was the beginning of the summer and a time when dogs and cats started venturing outdoors after the torrential rainy season in Vancouver. The most common problems are sprains, cuts, injuries, swimming, dog and cat fights and also ear problems.
Ursula loved her dog Tamara and was a first-time client. She had just moved to Vancouver to start her new life and brought Tamara with her across the Coast Mountain range, the Western 'foreplay' to the mighty Rockies.
Tamara had a history of ear problems in the past and this time was shaking and scratching her pointy, cropped ears.
“When will we humans stop mutilating these poor animals,” flashed through my mind.
“Imagine the pain she went through after the surgery. Ouch!” I shivered.
I examined Tamara’s ears and found only a mild redness at the earflaps, which likely came from the scratching, and the ear canal was clean and calm.
“But there must be an infection!” Ursula exclaimed with a tone of irritation in her voice. She was obviously unhappy with me because I didn't say what she wanted to hear. I examined Tamara further and learned that she was being fed poor-quality, processed food, had a history of ear problems that were treated by topical steroids and her liver points were activated. This suggested some general signs of toxin build-up and the need for cleansing.
I explained to Ursula, as tactfully as I could, that because of Tamara’s history of traveling in high altitudes that changed rapidly, she most likely experienced middle ear pain similar to what people experience when flying.
However, based on the examination, the ear health was likely affected by the state of her digestive tract and liver. I recommended a diet change, liver cleanse and some exercise to shed off the 'love handles.'
My client sense told me that Ursula was not convinced with my recommendations and I wondered if I'd ever see her again.
Two weeks later, they showed up at the clinic for a re-check.
“Doctor, you said that there was no infection and look at Tamara’s ears, they are horrible," she exclaimed victoriously. “Look at the discharge and the smell! I was right last time! In fact, I didn’t tell you,” she continued. “Last time, I wanted to go to your neighbouring clinic and mistook the address so I decided to give the natural treatments a try. Look at my poor girl now. She is not happy at all. I will give you one more chance and that is it!"
Talk about no pressure, I thought. Ears are some of the most complicated problems to treat at the best of times and they can be just a nightmare if a client doesn’t understand the whole scope.
“Ursula, have you used any cleaning solutions?” I asked gently.
“Oh well, I found this stuff in the pet store. It was supposed to work well but look at it, my girl is a mess!” she responded again.
She was right, the ear canals were moist and full of discharge and coated with a gray layer of dead skin. I have seen these situations, where the ears were over-cleaned, leaving the ear canal raw and vulnerable to bacterial infections. Now we most likely had some bacteria munching on the raw skin. Bacteria loves to party where tissue damage and inflammation are present.
I sometimes compare the physical body to trees. If it is healthy, unstressed and well nourished, parasites stay at bay. If stressed and malnourished, all sorts of bacteria, parasites and fungi come to the feast.
In Tamara’s case, over-cleaning, the stress of the move, ear pain when traveling, carb-rich, processed food and obesity all played a role.
Knowing that Ursula went to a conventional clinic before and ended up at my practice only by accident, I decided to combine the conventional approach, herbs and homeopathy, plus send a bacterial culture to the lab.
I saw that Tamara’s body was too depleted and toxic to fight on its own and reached for an anti-fungal and antibiotic treatment, the only one on the market that didn’t come with steroids. We cleaned her ears with an herbal solution and gave a homeopathic prescription to ease the discomfort.
A few days later, I received a call from Ursula that Tamara was better, happier and how much she appreciated my help. However, the improvement didn’t last long. As Tamara’s body gained strength and vigour on a better diet, her immune system woke up and decided to do a spring cleaning.
Because she had been treated with topical steroids in the past, whatever was suppressed was coming back to the surface. Tamara’s immune system revved up in a desperate attempt to give us the signal that more than the ears needed attention.
Similar to the lights on your car’s dashboard, the ears were signalling that something deeper was wrong. If steroids are used in such situations this can be compared to taking a sleeping pill when your favourite dish on the stove is about to burn.
The sleeping pill gives you temporary relief, but the consequences will be very clear and smoky at best. You would either need a new pot, or in the worst case, a new house.
Similar to the sleeping pill, steroids put the immune system to sleep and give us the illusion that all is fine. They bring the inflammation down, the comfort is temporarily regained until the next flare up that is usually more difficult to treat.
I explained to Tamara that the culture came back with no pathogens growing in the ear canal and only a small amount of yeast, which is very common. I suggested she continue the conventional anti-fungal medication and address her nutrition, do a detox and make sure that she gets out more often and loses some weight too. In other words, I suggested that chronic ear treatment is not a quick fix and that weeks and months were needed. There was also a high chance that the ear problems may come back as part of cleansing and must not be suppressed by steroid medication.
I was thrilled to see an email a few days later in which Ursula reported an improvement and appreciation for my work. She also commented that her own stress affected Tamara, plus her anxiety around ears was related to excruciating ear pain that she experienced as a child.
I didn’t hear from her until a year later when I received my very first complaint letter since my graduation 21 years earlier. It was filed with the veterinary association conduct review committee.
In the letter, Ursula wrote, that she spent too much time and money in my office and then she went to another vet. Tamara miraculously recovered after a prescription for drops which included, guess what, yes, steroids. The doctor did say that the medication would likely have to be prescribed for a lifetime. There was also the possibility that her ear canals would have to be surgically removed if they closed up due to chronic inflammation.
Ursula also requested that the association stop me from practicing…
I had two choices. Either I could focus on the negativity, or compassionately acknowledge the relative nature of perception and do my best to defend my work. I knew I had to stay true to what I believed was the right treatment, which is contrary to the conventional view. Based on my experience, I rarely saw ear patients that would require continuous treatment after the initial regimen was completed.
I spent the whole weekend going through files and notes to ensure that I would be able to provide the Conduct Review Committee the best report. I felt it was important to convey my message that we veterinarians need to look outside the conventional scope of treatments for the welfare of our pets. I wanted the committee to understand that using homeopathy, herbs and natural nutrition is nothing more than using another form of the medical language. It is just another route to healing and can be compared to the variety of languages that we humans speak on the global level. English is not the only one, neither is the conventional view of medicine.
After an hour of questioning by 15 committee members, I made them laugh by saying: “Oh boy, did you make me sweat answering all these questions. It felt like another round of licensing exams.”
In a way, I appreciated the committee’s thorough work and hoped they would see I practiced according to the highest medical standards. The next day, I received a call that they had found nothing wrong with my treatment of Tamara. I accepted the news with great relief and was happy that I was still a vet.
That day I decided I would post a blog on ears. I was also very tempted to call and see how Tamara was doing because, from the files of the other reporting vet, I knew she had ear medication dispensed several times that year. Perhaps Ursula, who’s name here is fictional, will run into this blog by accident or someone will send her a link. In the past, I tried to open some people’s minds by conviction. Now I know that the mind only opens if it is ready. When that time comes and how much tough learning we need to go through before it happens is a mystery.
We all have something to learn….I just hope that Tamara is well.
Peter Dobias (still DVM)
10 steps for dogs and cats with ear conditions:
- Proper assessment is always necessary.
- AVOID corticosteroid based medications, such as Otomax, Panalog or Surolan. They appear to block the healing process and often make the ear condition incurable.
- Remember ear inflammation is a result of other underlying issues – the most common areas to address are:
- Bacterial infections or mite infestations are usually secondary problems. Sometimes they disappear when the underlying issues are addressed, sometimes herbal solutions or conventional medication may be used at the beginning to ensure comfort. Once again, avoid steroids. Antibiotics are not ideal, but sometimes are necessary and less damaging.
- Routine ear cleaning in a healthy dog should not be necessary. The skin in the ear canal grows up similar to nails and carries wax and impurities to the surface. It functions as the ears 'conveyer belt.'
- Some breeds have a tendency to have a certain amount of ear wax. If the ear is fine otherwise, leaving them be is safe.
- If you try to clean out the ears frequently, you will likely make them worse. The natural self-cleaning ability of the ears is lost. It is similar to frequent hand washing.
- Initial ear cleaning should be done professionally, the use of individually selected homeopathic remedy, nutritional plan, herbal preparations and a good dose of patience is important.
- It takes one to three months on average for chronic, medication suppressed ears to get better, sometimes even longer. It is reasonable for this to take longer as most ear conditions take months or years to get to the point of physical manifestation.
- The good news is that there are very few dogs and cats that would need ongoing treatment for life.
© Dr. Peter Dobias, DVM