Toa Payoh
Vets Clinical Research Making veterinary surgery alive
to a veterinary student studying in Australia
using real case studies and pictures
Painful ears of Miniature Schnauzers - 2002 and 2010
case studies
Dr
Sing Kong Yuen, BVMS (Glasgow), MRCVS
First case was written: August 2002
Update:
26 March, 2010
EAR PROBLEMS IN
DOGS
Ear pain and scratching all the time is a cause for concern, but the
unenlightened Miniature Schnauzer owner
usually thinks that the groomer will be able to resolve the problem.
Besides, it
is cheaper to consult the groomer than the veterinarian. It is not
cheaper if the owner calculates the costs over the
lifespan of the dog, assuming the dog lives up to 15
years. Besides, painful ears are hellish for the dog
who tries its best to avoid the groomer as well, if
the owner really cares to find out the real situation
at the grooming shop.
Hairy ear canals in Miniature Schnauzers
trap water and dirt and obstruct ear ventilation. Bacteria, yeast
and fungus proliferates inside the ears. The painful ulceration
inside the ears causes the dog to bite people.
Lateral ear canal resection of the dog is the solution but many
Singapore dog owners are ignorant of this surgery. Vets seldom
recommend this surgery as many owners are price-sensitive.
Furthermore, it is cheaper for the owner when treatment is ear
cleaning and drugs. As Singapore evolves, the younger
generation of dog owners will be better educated and sophisticated
to understand that persistent and painful ears in their dogs are
not to be ignored and that groomers cannot resolve the problem
with cleaning and ear powders packed into the ear canal. This
article illustrates the typical thinking of the Singaporean dog
owner some 10 years ago.
Case 1 in 2002: Once Bitten Twice Shy
"We could not go back to
the first vet as our Schnauzer had bitten his nail off his
finger!" Mr Ho said as he wriggled his left forefinger. "The vet's
hand was trembling subsequently. But we had warned him that the
dog would bite. He still touched his ears and was bitten. This dog
dares not bite me as I will whack him." Mr Ho laughed.
I could feel the pain of the nail bitten off the finger in my
bones. Just a simple bite would be painful and if the nail was
bitten off, it must be excruciating for the poor vet.
This Schnauzer did not growl or give warning before biting. He
was the strong silent type. He put his head down close to
the floor, his tail turned sharply downwards and headed towards
the door to get out of the veterinary surgery. Some dogs do
associate the vets with pain and some would not enter the surgery
room. Their legs became wobbly as they reached the surgery.
Legs became so heavy that they glued the dog to the ground.
"Why not use the ear ointment regularly instead of putting him
under anaesthesia to open up his vertical ear canals?" I asked Mr
Ho as the Schnauzer was really pitiful at that moment. His greyish
white face with long hair made him looked very depressed.
Mr Ho had tried the ear ointment for the past 3 months but the pus
kept coming back inside the ear canals. He had to spend over three
hundred dollars for two ear irrigations and medication.
If the lateral ear canal resection surgery could solve his problem
once and for all, this dog would be euthanased.
This Schnauzer had ear canals choked full of ear hairs trapping
water during bathing. Furthermore, the ear pinnae or flap closed
over the ear canal opening. The closed ear canal was not
ventilated well. The dampness from bathing encouraged the
bacteria to grow and infect the ear walls. Pus formed as the
dog's white blood cells tried to contain the infection. The ears
became painful and inflamed. Therefore the dog bit anybody when
his ears were touched.
The dog was kept in the cage pending surgery. He was passive
and quiet in the
cage, a good patient. Just as I was going to take him out for
surgery, he bit my left thumb without warning. Fortunately my nail
was not ripped off. I washed off the red blood oozing from a small
puncture wound. I had to use the hand to operate. A
piece of plaster covering the wound stopped the pain. The dog had both ear canals opened up. I hope he would be
happy to see the veterinarian in later years and not associate
vets with pain all the time.
Left ear canal fully
covered by ear hairs over 1 cm long. Some Schnauzers
have very hairy ears and groomers keep plucking the ears
frequently. A permanent solution may be lateral ear canal
resection.
Side of left ear's
vertical canal removed showing opening of horizontal canal
as a hole at the lower part of the picture. Lots of ear
hairs obstruct the ear and prevent proper ventilation.
Right ear canal also
obstructed by a profuse growth of ear hairs. Very
uncomfortable for the dog as it traps water and become
ulcerated and infected.
Pulling out the long
ear hairs from the horizontal ear canal and cleaning up the
canal after removal of the side wall by surgery.
Should have no more ear problem now.
"I can give you a 90%
guarantee of success in this surgery," I said to Mr Ho who wanted
the dog back immediately after surgery. The family just loved this
Schnauzer and did not want him to be away from the best care at
home.
"Your dog will no longer suffer from pain and pus infections
inside his ear forever."
"This dog bit two vets," Mr Ho pronounced proudly to Nurse Ann.
It was an achievement to bite the dog doctor who is supposed to be
invincible and a controller of all dogs big and small, ferocious
and submissive. I was the 3rd vet to be bitten. A brown
waterproofed plaster wound round my left thumb as I washed out the
dog's canal.
Mr Ho turned to me and furrowed his forehead, "Your guarantee
better works. Otherwise it would be a lethal injection to kill it
as I can't afford to spend more money on veterinary fees."
As for me, I hope this dog would never bite the 4th veterinarian.
I have to be super alert whenever I encounter dogs with ear
problems.
From this Miniature Schnauzer and a sore thumb, I now appreciated
the meaning of the English idiom "Once bitten, twice shy."
One of those idioms I memorised for the English test during the
Primary School Leaving Examination. That was 3 decades ago,
but the Miniature Schnauzer refreshed my English idiom swotting by
biting me and making me avoiding him.
UPDATE IN 2010: No further complaints about the
ear or visit from Mr Ho for many months after the
surgery. I presume the Schnauzer has had recovered.
Case 2 in 2010: A caring lady owner
I have stopped advising
lateral ear canal resection surgery for dogs
with chronic otitis externa as I find that
Singaporean owners in my practice are
price-sensitive and cannot see the big picture
when it comes to chronic otitis externa and pain
in their Miniature Schnauzers with hairy ears.
If I am calculating, the surgery is not worth
doing as it takes a long time to do it. It takes
around 1.5 to 2 hours. In that time, I can do
more consultations or recover from a day's hard
work. If you think about it, the surgery
actually resolves the dog's ear problems and
well, no more need to consult the vet.
Therefore, no more income from one dog owner, if one is
business-minded in veterinary medicine.
Therefore I was much surprised that a lady owner
referred by her sister to me accepted my advice
to perform surgery. Her sister came to have her
dog spayed and to ask me about the licking of
the ventral aspect of four paws. This sister
wanted me to spay her dog myself and I assured
her it was me who would be doing the spay.
"You had consulted a vet
before?" I asked the second sister who
looked so much like a twin of the first.
Siblings should look alike as they come from the
same mould.
"Yes," she said. "The vet
took out a long stick to clean the ears and
showed
me how to do it."
"She gave you a lot of medication
for the ears?" I asked. "Yes," she said.
"Does the treatment work?" I asked a stupid
question. Obviously, she would not be seeing me
if the treatment was effective. The dog now had
a very painful hyperpigmented right ear canal.
The left ear canal was reddish and also choked
with hairs.
Some dogs just would not allow their owners to
clean their painful ears regularly and so the
regular ear cleaning and treatment might have
had worked. But no self-respecting dog would
tolerate ear hair plucking by the owner. It is
extremely painful. A torture. The dog would try
to run away. At the groomer, the dog had no
choice and "behaved" well for ear hair plucking.
"Only the right ear need to be operated," I
advised as it is best to save the owner some
money and to present a lower veterinary bill. "You have to clean the left ear and
pluck its hairs monthly." The right ear was
extremely painful but this dog did not bite me.
Well, I muzzled the dog first. Can't afford to
be bitten as I need my hands to perform surgery. However,
the owner preferred 2 ears to be operated upon.
I gave medication and injections and asked the
owner to come back in 2 weeks for the surgery.
I don't
expect her to be back. Many Singaporean owners
don't come back after the first treatment as
they are price-sensitive or too busy. There is
always the groomer and heck, the dog has to go
to the groomer every 2 or 3 months anyway. So,
why bother to spend money on surgery?
But the woman brought the dog for surgery as
scheduled. The right ear was less painful but
the left ear was normal. The lateral ear canal
resection surgery is documented for the benefit
of veterinary undergraduates in their 4th and
5th year. I hope to bring boring veterinary
surgery lectures alive for them.
Now, I am a better photographer now compared to
my pictures taken some 8 years ago. Better
photographs are a joy to see and I hope the
students in their rooms, eating fast junk food
and trying to fight sleep after slaying virtual
dragons online, will benefit from the picture
story of how lateral ear resection surgery is
done in practice.
The veterinary surgery books only show
illustrations. The lecturer is doing his best
but you can't blame him or her as it is not
possible for him or her to show a real dog being
done. The dog was given Domitor 0.15 ml IM
(preanaesthetic dose). There was vomiting. After
15 minutes, the dog was anaesthesized with
isoflurane gas at 1-2%. The surgery was
time-consuming as the vertical ear canal was
narrow, esp. for the right ear. Electro-surgery
was effective and useful as there was little
bleeding unlike the use of the scalpel blade,
especially for the left ear.
In the right ear, there was bleeding from a
bigger subcutaneous blood vessel nicked.
Ligation should be done but this might not be
possible. Try and do it. Be careful not to
over-cut the lower part of the vertical canal as
there is a branch of the facial nerve and the
salivary gland. Damage to the facial nerve
branch can lead to the dog not being able to
move its eyelids, that is paralysis. Check out
which branch of facial nerve before your
external professor tests you at the oral
examination!
The dog surgery took around 1.5 hours. The
writing of this article including creating
pretty pictures to wake up sleepy undergraduates
took 3 hours and lots of discipline. I hope the
students learn something for their veterinary
surgery examinations.
TOA
PAYOH VETS
