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Thursday, September 28, 2006

Case Study: PitBull & Aural Hematoma

Note: Small change made for clarity - thank you Catbird!! :)

Patient and Symptoms:
A 2 1/2 year old female American Pit Bull Terrier presents with a swollen ear. She seems to be in some discomfort demonstrated by shaking her head and flapping her ears vigorously. Then again, the patient does that periodically - especially when tired but trying to wake herself up to be part of the action - so examiner draws no conclusions.

About half of the ear flap is puffy and looks like it's filled up with air. The examiner uses the snack method to distract patient for ear observation. The ear feels full, almost, if the examiner remembers correctly, like a water balloon not full enough to break unless thrown really hard. Examiner notes patient's appetite undeterred by ear problem.

Diagnosis via Google:
Aural Hematoma
The various descriptions of the condition seem right but are finally clinched on the aural hematoma page of the Mar Vista Animal Medical Center. Although a technical medical description, it is the confirmation the examiner is looking for: "The ear flap will feel fluctuant and fluid-filled, like a water balloon."

Diagnosis via Veterinarian:
The patient is brought by examiner to Channel Islands Veterinary Hospital for a consult. Everyone is very nice and examiner makes an additional note that patient's tail is functioning normally - even exceptionally well if encouraged by office staff and free treats.

Dr. Anderson comes in for the consult and listens carefully to examiner's assessment, (proving, yet again that Patience/Good Humor 101 is a required course for vets -- not the elective it seems to be at some other medical schools.) He does a quick exam and verifies the aural hematoma. He also examines the ear canal to make sure there is no infection causing patient to traumatize ear and to show that Google can't do everything. The ears are reported to be clear, heart beat is good, etc.

Treatment Choices Offered:
1) Not recommended - do nothing. The ear can eventually heal itself. This will probably leave the ear cauliflowered and uneven and could even affect patient's hearing. (Examiner has brief flashes of ears she pictures as cauliflowered: Rocky, Someone Up There Likes Me, Raging Bull.) Before the possibility of hearing loss is mentioned, examiner has dismissed this choice.

2) Perform an aspiration (drain it) and inject it with some anti-inflammatory to take the swelling of the blood vessels down. This treatment doesn't have the highest rate of success and there is a good chance the condition will recur. It is usually the first method tried, though.

3) Surgery. The patient is put under....The examiner's brain again short-circuits and tunes out the next part of this choice.

Option 2 is selected.

Treatment and Outcome:
The ear is aspirated and 6mls of fluid are drawn out. It is reinjected with 1 mg anti-inflammatory.

After a week and a half with one re-check, the area of concern is looking good. The ears are still very cute and floppy but there is a very small fluid build up which finally disappeared a few days later.

No calls from the veterinary medical journals yet but other floppy-eared dogs might like to take notice.



Anonymous catbird said...

So does that mean that Patience/Good Humor 101 was a required course at Dr. Anderson's veterinary school, or was it altogether not offered?

8:00 PM  
Anonymous catbird said...

Additionally, this reader would like to inform said examiner that were she to ever have children, the term "meddler" would switch over to "The mother who won't leave well enough alone." I know this from personal experience as a prior dog-owner/meddler, and now as a mom.
Just FYI.

8:03 PM  
Blogger jill bryant said...

Oops...too coy for my own good. I didn't think of the not offered option. Yes, definitely required. The vet was so patient. I think a lot of medical people want to turn and run when you say "I looked this up on the Internet...." and he actually listened.

Now - I did not know meddler is a beginning course....I just know when a meddler meets medical person who skipped the Patience/Good Humor 101 class - well - no one leaves that room happy! Ha! Doctors must love when meddlers graduate to Moms!

9:23 PM  
Blogger Carina said...

Heh. Doctor types had better get used to clients coming in with a sheaf of stuff they've printed off some website or another! I'm sure it happens a lot and imagine it might be frustrating - but honestly, if one is careful about where to find information it's a wonderful resource.
Daphne (who has atopic allergies and gets random, occasional and sometimes alarming swellings of various body parts) has had the puffy ear thing too but there was no trauma, just fluid retention and Benadryl Is Our Friend in times of need.
It is always an encouraging sign when the tail and appetite functions are fully operational, isn't it? :)

6:15 PM  
Blogger jill bryant said...

Ah - Benedryl. I agree - it is a wonder drug.

Did you not have to aspirate, though? Did it go down on its own? A lot of the sites seemed to expect you need surgery, too!

Sounds like Daphne knows how to keep you entertained... :)

7:46 PM  
Blogger Carina said...

Nope - it's happened three times. First time I took her to my vet, we didn't know if she'd been stung by something or not...he didn't see a need to aspirate and my morning it was back to normal. That time the side of her face was a bit puffy too....still don't know what was going on! The other two times it was just her ear, Benadryl (or maybe just tincture of time) got it back to normal within hours.
Luckily I have a conservative and commonsense vet who actually will suggest herbal-type remedies (or Benadryl)if he thinks
it appropriate.
It's called "idiopathic" which means "we don't know what or why this is but we are calling it something fancy so we can bill you for our advice." LOL.
Most likely it's just a weird histamine reaction to something airborne...these things only happen in summer.

2:16 AM  
Blogger crazycorkymom said...

You said benedryl helped. I have a 5 year old Alaskan Malamute and she is suffering from this problem. I need to find something to help her, vet is not an options as to she hates them. If you could tell me the dose of benedryl you used that would be great.

11:35 AM  
Blogger Jill Bryant said...

Crazycorkymom -
I didn't say Benedryl helped - Carina said it helped her dog. (I just said it was a wonder drug). What she said is her dog got different swellings from allergies and that helped. What it has done for Honey in the past is alleviate some itching (from allergies) and that might help them shake their head/ears less (In Honey's case, though, I think it was an exposure to fleas that got her shaking her head like crazy - keeping the flea problem down is important, too.) Benadryl does also calm Honey. I don't know if any dogs have problems with Benedryl (you might want to call your vet just to make sure there is no problem). The vet will probably tell you the dosage at the same time but I'm pretty sure they say one pill for 25 pounds (if they are normal size pills which I think are 25 mg). But, I give Honey one pill even though she is 60 pounds (so would technically take two). That seems to be enough for her and I don't like giving medication so....

12:20 PM  
Blogger crazycorkymom said...

As I said before a vet is out of the question unless it is a last resort. We think she was mistreated by one when she was a pup. Do you have anyother suggestions? We have heard witchhazel, peroxide and white vinegar.
Thanks for the help.

2:18 PM  
Blogger Jill Bryant said...

Oh - I didn't know if you have a vet you can call. Honey is good with the vet but I have another rescue more like your pup and I do call to get advice for Buddy. I don't really have any other solutions. I think they told me ice but Honey ended up having several recurrences later and she did end up with some cauliflowering of both ears (the hematomas would first be on one, then the other side). Of course, most important is finding out what is making them shake their head like that. As I said, with Honey, I believe it was fleas - a flea-covered cat moved into the same house and she'd never had a problem before that. When I finally stopped having them aspirated, they ended up cauliflowering but, luckily, not too seriously so it had the same effect as the surgery to scar the ears would have (and they're still pretty darn cute). I'm not sure if this is helpful or not. I notice there is more stuff on the internet now about aural hematomas than when I first wrote this which might help?

12:11 AM  
Blogger Jill Bryant said...

Oh, wait, I did use arnica, too. Try that. The dogs like it because it's kind of sweet. It's an anti-inflammatory. Some people don't think homeopathics work but it seems like I have pretty good results with arnica.

12:13 AM  
Blogger crazycorkymom said...

Where can I get arnica? I tried to look at her ears tonight and she would not let me touch them. On the other hand she will let my hubby touch them and do just about anything with her.
Thanks for all the help.

5:48 PM  
Blogger Jill Bryant said...

I don't know where you live - some drugstores carry it, healthfood stores, too. Here's the url to Amazon I know this brand and it's not in the little bead shaped pills - it's more a powdery tablet and is faster dissolving so I like that for dogs but it really doesn't matter....They say to give it to them when they haven't eaten or drunk anything for 15 min. (and for 15 min. after). I wish I had a better memory for all this but there have been so many other problems since then - it's all a blur... From what I've read, the most important thing is finding out the cause.

I don't remember Honey being in pain from the hematoma but pits tolerate a lot of pain (which has not ended up being a benefit for them when they fall into the wrong hands....I can't even think about it.) Hard to tell how your pup feels if she lets your husband touch...and we certainly know who's the pack leader there :)

Good luck!

8:29 PM  

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