Helicopter Head

I've been pretty surprised lately how many clients will have questions or concerns about things I have just recently blogged about. I guess it shows how common some of these issues are. Grass eating, medicating your pet with human medicines, anal glands, separation anxiety and weight issues were all brought up again just today! It was fun to be able to refer those concerned owners to the link for my blog-I'm oh so computer savvy.

A very common medical problem, one that we see at least daily if not multiple times each day, is an ear infection in dogs. Cats get them, too, but we see dogs much more often, especially those dogs with floppy ears-Labs, Golden Retrievers, Poodles, Shih Tzus, and most notably, Cocker Spaniels. An owner of an affected dog might notice the pet scratching at the ears, might smell a bad odor about the head, or could see or hear the tell-tale flapping of the ears against the head that my husband calls "helicopter head." It sure does sound like the beating of the blades of a rotating helicopter-you can imagine how uncomfortable a poor dog is if they are doing this constantly.

Otitis externa, or infection in the outer ear canal, can be caused by inflammation from allergies, bacteria, yeast or fungus, or by tiny insects called mites. It is essential to know which is present in an affected ear because the treatments are very different for each condition. Your veterinarian will perform a microscopic examination of the debris that comes out of the ear canal to make the diagnosis. Some dogs will have mixed infections; it is not uncommon for them to scratch ear mite-infested ears and cause secondary bacterial infections from the dirt under their toenails. Bacterial infections can challenge the immune system, causing the natural balance of organisms you would usually find in an ear to be interrupted, resulting in a yeast invasion.

There are some traits of the different problems that may be apparent on the physical exam. Mite infestations do not usually cause an odor, but they are accompanied by a lot of dark, dry, crumbly debris, almost like coffee grounds. They are severely pruritic, (itchy) often resulting in scabs or alopecia (loss of hair) behind the ears or on the pinna (ear flap.) When they shake or scratch so dramatically and get "helicopter head," an aural hematoma or giant blood-filled pocket can form from ruptured blood vessels between the skin and cartilage of the pinna. This can add to the discomfort and must also be treated.

"Allergic" ears are often inflamed-very red and swollen deep down into the canal. There may or may not be debris associated with the inflammation.

Bacterial infections often are accompanied by white blood cells which are trying to phagocytose or eat up the invaders and then become overwhelmed. This becomes pus, and can have a thick, creamy appearance with or without a strong odor.

Yeast or fungal infections often have a sickening "sweet" sort of smell-kind of like fermenting organisms. They will often have a dark, brown, moist debris-but not always. The most common yeast found in dog ears and skin is Malassezia, and can often be caused by exposure to water-baths or swims. When a dog with floppy ears gets water in its ear, it has a hard time drying out. Malassezia loves that dark, moist, and warm environment. That is why it is important to use an ear cleaner that also dries out the canal after any bath or swim.

Most ear infections, after being diagnosed correctly, and getting to the underlying cause, (such as food allergies, particularly common in breeds such as Golden Retrievers) can be cleared up after a good ear cleaning and a course of medication. Oral medications rarely reach therapeutic levels in the ears, thus topical preparations are utilized. Medications may be prescribed for owners to apply once or twice a day to the affected ears, often containing an antimicrobial (antibiotic or antifungal) and an anti-inflammatory medication to help calm the itching. We have been using a kind of "timed-released" plug of medication, instilled into the infected ear(s.) Owners love this treatment because they don't have to do anything except show up for a recheck in 2 weeks to see if the infection is cleared up completely. No chasing the dog around, pinning him down, fighting and making your buddy cringe at the sight of you and the bottle of medication. Some dogs may need an e-collar or cone around the head to protect their ears from themselves;self trauma from scratching or rubbing can wipe away medication and delay healing.

Speaking of the recheck, this is an essential part of the treatment of otitis due to any cause; if we stop medicating before all the organisms are gone, the infection may rear its ugly head soon after we stop treatment. This can lead to a more aggressive, chronic disease and medication resistance may develop. We may need to culture the debris if the infection just isn't clearing up. We will discuss allergies at this time if the patient seems to be getting frequent infections, or they are accompanied by other symptoms of food allergies such as chewing at the feet or rubbing the face. If all is well and the infection is gone, we certainly go over preventive measures-using ear drying solutions in our floppy-eared dogs after any bath or swim to wick moisture from the canal and make it a less hospitable environment for microorganisms to survive. Keeping hair plucked out of the canals may decrease the chance of debris hanging up there and will allow it to "air out."

There are some dogs that develop such severe infections that they can not be controlled with medication and diet alone. Deafness can occur. In these extreme cases, surgery may be needed to open the vertical ear canal, enabling it to "breathe" better and stay free of debris. If it really becomes scarred down, ablation of the entire ear canal can be performed, usually by a veterinary surgeon. Abnormal tissue is removed, allowing for the growth of healthy new tissue.

As common as ear infections are, they are not "routine"- any more than spays or neuters are routine procedures to the individual animal experiencing the surgery. Each patient must be evaluated for all potential causes of the infection, treated for the underlying and overt causes, and counseled on means of prevention. The lucky ones have observant owners who see those ears flapping or smell the sweet-ish odor and get them to their veterinarian right away. The helicopters never get a chance to get airborne.

Peace,
DrReneigh

Help For That Itchy Dog

We saw Tinkerbell this morning, a sweet little Cocker Spaniel cross dog, who was shivering and trembling in her owner's arms. Some pets can be pretty scared at the vet's office, but I don't think nerves were Tinkerbell's problem. It seems Tinkerbell had been scratching and biting at her skin and had pulled patches of hair off all over her body. On this frosty November morning, being without her nice warm fur coat, poor Tinkerbell was cold!

I combed through what was left of her hair and checked for evidence of a flea infestation. I didn't really expect to see one; if you were a flea, you would probably pick a much better place to live, one where there actually was hair, and where the skin wasn't hot, inflamed, infected and under attack from chewing teeth and scratching claws all the time. But flea control is essential for any itchy dog and I didn't want to miss something so obvious. Tinkerbell had been in earlier this summer for virtually the same problem. The prime targets on her body are her feet and her ears, although her entire body was now affected. Since this wasn't a seasonal issue, and sure enough, no fleas or flea"dirt" (dried feces) was seen, I suspect she has a food allergy. It isn't one of my favorite diagnoses to make since it requires a huge commitment in time and energy for owners and is a life-long management issue-there is no "cure" for allergies.

Few people realize that dogs rarely get eye or respiratory issues when they have allergy problems like people do; they get itchy! Sometimes their itchiness shows up as the dog licking or chewing the feet or shaking their head. Chronic ear infections often have allergies as the underlying cause. The immune system is "over-reacting" to some stimulus, and if it is a particular food, can do so for 6 WEEKS after ingesting that food. That is how good (or bad) the immune system is. Then because of the self-trauma of licking and chewing, secondary infections will develop, often with bacterial or yeast organisms taking hold. It is important to treat ALL of the problems as well as the underlying cause or the pet will never get better.

Now, it isn't a specific brand of food that is the problem; it is usually one or more ingredients in that food that causes the immune reaction. It seems that in humans, I hear most often about wheat or gluten or corn-type allergies or sensitivities. In dogs and cats, it tends to be animal protein sources, especially chicken, beef and dairy. And it is important to note that you can't be allergic to something you haven't been exposed to before, so that old food you have always fed your dog with no problem is exactly what is most likely to be the culprit. It had to take time for the immune system to build up antibodies against the particular antigens or allergens.
There are two ways we might go about diagnosing and treating a food allergy in pets. The first is to feed a "novel" or new protein source, one the dog has never been exposed to and has therefore not had the opportunity to build antibodies against. Foods such as venison or rabbit or even kangaroo are now formulated for just this purpose. The second way is to feed a hydrolyzed protein source, one where the protein has been broken down to the smaller amino acid components so is not recognizable by the immune system as a problem. We have to feed either of these ways EXCLUSIVELY for a minimum of 8 to 10 weeks in order to get all the old antigens or allergens out of the system. Everyone in the family has to be on board, no treats or snacks at all. By that time, the pet may be feeling so good that the owner may not want to change foods ever again, and that might be just fine. Some pets could eventually develop allergies to the novel protein, so we discuss what to look for down the line. But if the owner wants to chance it, we can then do a challenge-feed one type of protein for a week or so and see if the pet's skin or ears react.

Tinkerbell went home with some information about food allergies in dogs, as well as antibiotics for the secondary bacterial infection we found. Her owners will treat her ear infection with some drops to put in the ears every day. They will use an oral antihistamine to help alleviate her itchiness, as this has helped her in the past. (We had to increase her dose a bit as Tinkerbell's weight really snuck up on us this year. We will really have to work on that, too!) She has an antibacterial shampoo, as topical therapy is often beneficial for these dogs, and, of course, her new food. See what I mean about a big commitment for her owners? It will be a challenge, for sure, but I am optimistic that her owners want the best for their friend and will call if any problems come up. We set them up for a recheck for the infections in a couple of weeks and will touch bases on the allergy issue at that time. She is a lucky dog to have such devoted humans caring for her.

Peace,
DrReneigh