01 February 2012
This month's Star Pet is Kylie, an elderly black Labrador recently adopted from the Dogs Trust in Roden. Kylie's adopters also took on her kennel mate - Paddington - they came as a pair!
Kylie was seen at the practice recently as her adopters were worried about her having developed a very swollen ear.
On examination by the veterinary surgeon it was very obvious that Kylie had developed an aural haematoma most likely secondary to an ear infection which had resulted in Kylie shaking her head a lot. An aural haematoma is a collection of blood and serum within the pinna (earflap) which is composed of a layer of skin on each side of a layer of cartilage (the cartilage giving the ear flap its stiffness and shape). Fluid collects under the skin and causes the flap to become swollen and thickened. This occurs as a result of an irritation to the ear (such as an ear canal infection) which results in scratching and shaking the head. It is the excessive shaking that causes blood vessels in the ear flap to burst and leak fluid. If the haematoma is small then they often resolve themselves or can be drained via a needle but if the swelling gets bigger the ear becomes heavy and a cause for the dog to shake more. At this stage surgical intervention is often needed to manage the problem and prevent puckering of the ear flap. It is often necessary to sedate or anaesthetise affected animals, (whether the haematoma is to be surgically rectified or not) to address the underlying cause - most often an ear canal infection which requires careful cleaning and examination of the ear canal.
After discussing the findings with Kylie's owners it was decided to book her in the following day so that she could be given a full anaesthetic and have the haematoma operated on, whilst examining and treating her ear canal infection at the same time. Kylie is an elderly dog and had always been thin since being adopted from Dogs Trust so we advised to run a pre anaesthetic blood test to ensure her major organ function was normal and could cope with her having a general anaesthetic.
Kylie's surgery and liver problems
The following morning and Kylie arrived back at the practice for her blood test and surgery. A blood sample was run through our in-house lab and the results revealed that Kylie had significantly elevated liver enzymes (proteins which leak out of damaged liver cells and can be measured in the blood). Given her history of chronic weight loss it was felt this was probably as a result of a chronic liver problem such as cirrhosis or a slow growing tumour. Having discussed the results with her owner it was decided that as she was in real discomfort with her ear, it would be appropriate to continue with the operation as planned. Kylie was however placed onto intra-venous fluids to support her organ function throughout the operation and anaesthetic recovery period.
In order to minimise the time Kylie was under anaesthetic, as much as possible was done to prepare her for surgery before she was anaesthetised. Her premed had produced a good level of sedation and it allowed us to clip her ear flap ready for surgery prior, saving vital anaesthetic time. A swab was taken from her infected ear canal and sent to an external laboratory for analysis - with the aim of establishing the exact nature of the ear canal infection which would be useful in guiding treatment.
The first aim of treatment was drain the haematoma to relieve the pressure and pain associated with the build up of fluid. In Kylie's case 80ml of serum was removed by placing a needle into the ear flap and draining the fluid away. The next stage of the operation involved the veterinary surgeon making an incision on the inside of the ear and removng out any further fluid or blood clots. Sutures were then placed a little way from the edges of the incision using tubing to prevent the sutures digging in to the skin. The sutures would help the layers of the ear flap heal together whilst keeping the wound open for a period allowing any further fluid to drain away freely. A temporary dressing was placed over the wound and a buster collar was then fitted to prevent Kylie from scratching at her ear.
A short while later and Kylie was waking up from her operation. She was allowed home later that day when her intra-venous fluids had finished. At a post operative check up the following morning her owners reported Kylie had a settled night and was coping well. Her dressing was removed and the ear was looking good - although still a little bit swollen as was to be expected. It was advised to continue with her prescribed antibiotics and pain relief and further post operative checks will be needed.
With regard to Kylie's liver function this will also be closely monitored but hopefully her quality of life can be maintained and her body condition improved. Kylie's owners are keen to take a pragmatic approach towards her liver disease - and we will aim to support Kylie conservatively with nutritional support and dietary supplements aimed at improving liver function.