Aural hematoma

[LyndseyM]

Hi @Dr. Jeff I know it has been awhile - we have been really going through some stuff this summer and Xander seemed to be doing well.

We have been working with Dr. Harmon, which has been great, but I believe there are some obstacles to curing him pertaining to our home - another chat for another time - but our home has been listed since May nothing yet, but hopefully soon.

I have an appointment with Dr. Harmon next Monday, but I noticed about 2 days ago Xander has an aural hematoma more mid ear, closer to the canal rather than primarily on the auricle, but it is not blocking the canal in any way. I want to say it is about 3-4cm wide and the same or height. It appears to be maybe 1-2mm thick. It doesn't seem to be bother him, but I ear this is a repercussion to his avid itching his ears on the ground, and quite ferociously in fact.

We had successfully gotten rid of his mites with the herbal protocol in conjunction with Dr. Harmon's homeopathic suggestions. The hair on his body grew back and his ears, too! He's truly a handsome devil. But of course, we're experiencing yet another setback. I know healing isn't linear but it is very frustrating to watch him experience this time and time again especially when he is in pain. So I decided I needed to do something stronger for his ears and purchased topical ear mite treatment with permethrin and aloe. I had been cleaning the ear and then applying the drops. But of course whether its cleaning or the drops, he just goes and rubs his head. By day 5 o the drops, which was yesterday, I noticed there was minimal debris, and it was brown rather than black so I feel we're making improvements there.

Additionally, his BEAM is excellent. He's eating as normal, he's more playful with the puppy, he's getting in the car without issue (previously he was very resistant to car rides) he enjoys being outside very much and his affect is good. So I'm not concerned there.

For the hematoma, of course I've ready horror stories, so not sure what to believe there. I started him on arnica 30C last night, dosed him them and just again this morning.

 

[Dr. Sara]

Dear Lyndsey,
It is excellent that you are working with Dr. Harmon to improve Xander's overall health.

I would not suggest using an insecticide such as permethrin in the ears without strong evidence of the presence of mites. If you feel you must apply something to relieve discomfort, a soothing herbal, strong black tea, or plain aloe would be preferable. This is of course, something that I am sure you will discuss with Dr. Harmon.

In order to know what treatment is most likely to resolve an aural hematoma, it is helpful to understand how and why they develop. Aural hematomas are caused by the inflammation and rupture of tiny blood vessels in the ear flap. The blood seeps between the ear cartilage and skin. The ear protrudes away from the body, so the animal may easily damage it further by shaking its head or rubbing the hematoma because it feels strange.

Vets used to believe that hematomas always occurred because of trauma: a bite from another animal, ear mites, or an ear infection. The animal then damaged the blood vessels of the ear by scratching or shaking its head. Trauma can certainly cause inflammation of blood vessels (vasculitis) and rupture of these vessels, but more research is pointing to an immune-mediated cause of the vasculitis. This immune-mediated vasculitis can occur when an animal has seasonal or food allergies, has a transfusion reaction, or has an immune reaction (allergic reaction) to any medicine or vaccine. The current conventional medical treatment for aural hematomas now focuses on treating them as part of an overall allergic process.

Allergic problems are all capable of causing vasculitis. Yeast ear infections are caused by an animal's excessive response to normal organisms, and seasonal and food allergies are also indicative of an excessive, abnormal immune response. Symptomatic homeopathic remedies may help alleviate symptoms of a hematoma in the short term, but a constitutional approach with a qualified veterinary homeopath will be necessary to get to the root of the problem. Careful homeopathic prescribing should gently resolve all of the signs of illness as the animal responds to the remedy.

Many remedies can be useful in symptomatic treatment of aural hematomas. Arnica is certainly the 'go to' remedy for trauma and bruising, and it does help many aural hematomas. However, there are a lot of useful remedies, and as symptoms change, the appropriate remedy may change also. You need to study the first aid remedies so that you can use them appropriately.

As an example, my own dog developed bilateral hematomas as part of a blood transfusion reaction. Initial treatment with Arnica did not help, so I changed to Hamamelis; it did not seem to help either. Two remedies which did help considerably were Crotalus-h, a snake venom remedy, followed by Silicea a week later. The biggest improvement, and final resolution, occurred when I determined what my dog's constitutional remedy was, and treated her with that. During this time, I carefully observed my girl to see which remedy was most appropriate, I never gave more than one remedy at a time, and I waited to see what was going to happen before switching remedies. This is why it is so important to work with a skilled practitioner who knows you and knows your pets.

This article gives a good discussion of the conventional approach to the treatment of aural hematomas:
Aural hematoma and it’s treatment: A review

I hope this is helpful!
Dr. Sara

 

[LyndseyM]

Hi @Dr. Sara thank you that makes a lot of sense. He errs on the more atopic side of things and now that you mention it, maybe he is having a reaction to the permethrin - I did consider this but wasn't entirely sure since I was getting mixing information on the causation of the hematoma. To be quite honest, given the length of time we have been battling this, I would have surely thought he would have developed one sooner. Since that is the only change since its eruption, I believe you to be right.

We have gone through Pulsatilla and now Sulphur as constitutional remedies. I will re-dose him with sulphur and give his ears a nice clean with a cleanser we have containing witch hazel and aloe.

I guess my big fear is the surgical aspect everybody floods the internet with and how long is too long ?.

Thank you again.
Lyndsey

 

[Dr. Jeff]

Wow, thanks for your awe-some replies Dr. Sara!

Lyndsey, I'm so glad to get to hear about Xander, tho am super sorry about his hematoma, and your challenges this summer.

After 37+ years of seeing dogs with aural hematomas, only a few actually needed surgery. Many guardians elected for a non-anesthetic (just local) ear drainage or bandaging.

Most of my clients opt for the approach that Dr. Sara described (homeopathy and soothing topicals prn).

Usually the "worst" case scenario is a gnarled, but otherwise empty, ear pinna. Concurrent homeopathy, as you are doing, helps guide the body to healing without the gnarling.

 

[LyndseyM]

@Dr. Jeff thank you! That really puts my mind at ease. I've officially limited his meals for the next few days to bone broth, pumpkin, and coconut oil. We literally have no idea what he's allergic or sensitive to and the only canine elemental diet on the market is purina where the second ingredient is canola oil, no thank you.

Do you have any other suggestions for an elemental diet for dogs or what do you think about this?

 

[Dr. Jeff]

Great question, thanks for asking Lyndsey!

I think any ultra-processed dry or canned food is lower vitality and energy than a fresh diet. The ultra-ultra processed hypo allergenic diets (if indeed that's what you mean by elemental), like Hills z/d food, may be even lower.

How about using the freshest local meats, organs, eggs, etc. from places like Sport Hill or Sherwood farms?

Perhaps focus on frequent short followups with Dr. Judy combined with your great topical ear care.

For wiping out of any ear discharge, these work well and are very soothing:

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[LyndseyM]

@Dr. Jeff All we feed is raw in this house, the last time Xander ate anything processed was the kibble his breeder mixed in with the raw meat. We don't even give our dogs "treats" from a package - they get marrow bones, bully sticks, or chicken feet.

When Brynn started having seizures this time last year, we decided to do a hair test for sensitivities - as a human doc I cringe at this - but we were at a loss. He literally came up with everything, which meant "leaky gut" so I decided to do gut healing herbs and even after a month of doing that he seemed to regress. Now I don't give much credence to "sensitivities" but it turned out some of nutrients in his supplements were things it turned out he was sensitive to so we equated his regression with that.

We're back there now, uncertain as to what he can and can't eat. We're pretty sure our horrible neighbors are leaving things around the property - things that contributed to Brynn's death - that he consumed recently which could only help to explain his (yet again) regression. He was truly doing well this entire summer until about 2-3 weeks ago.

I typically use elemental diets in humans - the most basic forms of nutrients - amino acids instead of proteins, fatty acids instead of fats, and then mono and di-saccharides instead of carbs. Its typically what they feed people in nursing homes with gut dysfunction so that they can at least absorb some nutrients.

I figured with the pumpkin, bone broth and coconut oil (we got some goat kefir, too) this keeps it simple so that if he is reactive we know it can only be one of 4 things. We started him on this for dinner last night and I didn't wake up to him licking his paws not once - when I tell you this is akin to nails on a chalkboard for me, it can wake me up out of the deepest of sleeps! A couple of head shakes, but I calmed him down and he settled into bed quickly.

I meet with Dr. Judy next Monday to discuss but of course still need to make some attempts with him before then.

 

[LyndseyM]

@Dr. Jeff his hematoma appears to have gotten a little bigger. It doesn't seem to be blocking his ear canal but not sure what to do in between now and Dr. Judy on Monday. I'm, of course, worrying..

 

[Dr. Jeff]

If his BEAM is unchanged then perhaps just focus on what makes her happiest this weekend.

Please let us know what Dr. Judy says on Monday.

Xander will be fine...