Wednesday, September 21, 2011

624. Ear infections in an old German Shepherd

Although German Shepherd dogs have erect years, some do suffer from ear infections but most don't. I have a case where the dog keeps rubbing his infected years for several years. The condition becomes chronic otitis externa. The owner pours in ear drops, ear oil, ear powder and anything as can be purchased from the pet shop. But the condition does not improve because the owner had not got rid of the dirt, hairs and dead cells inside the horizontal ear canal. Vets have had been consulted but the problem persists. So the owner tried another vet.

What to do in such cases?

Ear irrigation under sedation by your vet and medication. Follow up in one month's time but few Singapore owners bother to do so.

Usually such dogs are old but they need not suffer if the owner gets a vet who treats the dog with ear irrigation and follow up rather than some injections, medications and ear drops. The following is an example of a case I treated.

Right ear full of smell and blood. Scratching all the time.
The owner was in a hurry. "No quick solution," I said. "The ear canal needs to be irrigated thoroughly and that means the dog has to be sedated. There are anaesthetic risks involved."

The owner was aware of the risk. I gave the following.
37.2 KG

Domitor 0.4 ml + Ketamine 0.5 ml IV = 0.9 ml IV
For 37 kg, the dosage should be 3.7X but not for old dogs.

Domitor 0.8 ml + Ketamine 1.4 ml IV = 2.2 ml IV
Good sedation.
Atropine 1.5 ml IM

Both ears were irrigated more than 30 times with 20-ml syringe with the dog in dorsal recumbency (on his chest).

After that I gave Antisedan 1.0 ml IV to reverse the effects of Domitor. The dog took 10 minutes to wake up but was very weak. We carried him to the owner's car. Medication, ear ointment. I doubt I will see him again. A follow up one month later will be necessary but almost 100% of the owners don't bother.

My brother had a German Shepherd with the same problem. Usually he consulted other vets for some reasons I did not ask. However, he would order Hills' anti-allergy dry dog food for this dog through my practice.

One day, I told him that his dog's chronic ear infections would be likely due to an infection and not just due to "dog food allergy". He brought his dog in for treatment of ear irrigation under sedation to flush out all debri and dead cells, some 5 months ago. I must ask what happened now as I did not see him recently and forgot to follow up. No news is good news?

The complaint is that the skin disease does not cure despite spending lots of money seeing the vets. The sides of the chest become bald. This was generalised ringworm. I advised clipping and gave medication for 20 days. I asked for review 4 weeks later. The owner did not turn up. The dog also had difficulty peeing and I detected an enlarged prostate and advised neuter if it is enlarged. The ear flaps were black due to continued scratching over the years of suffering.

2 months later, he turned up to say that the dog still has scales but the hairs had grown back on both sides of the chest. Ringworm was detected. The dog's ears were full of liquid sounds. The wife poured pet shop ear drops almost daily. No ear pain. Much improved ear flap in that the black colour was gone by 80%.

Reviews are necessary in skin diseases. Otherwise, the owner keeps vet hopping and spends a lot of money. Who to blame? But the vet! It is best to communicate repeatedly to the owner that not all skin diseases may not be cured with one visit. However, a vet who fails to perform (by producing a cure in one treatment) will lose the client and this has happened to me too. No second chances from some owners in private practice. Cure or no cure.

P.S. In xylazine + ketamine IV sedation, the guideline is less ketamine proportion for dogs. More ketamine proportion for cats. Does it apply to domitor + ketamine sedation? I need to do some research on this. In cats, I give xylazine 0.1 ml + ketamine 0.4 ml IM for less than 5 kg spay. I have not used the combination in dogs.

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