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Ask the Veterinarian/Disturbing symptoms in a dog with history of chronic ear infections

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First off, I am going to due my due diligence and try to get an appointment with the vet ASAP today (they open in an hour). I was looking here at similar problems (and I'm always reading stuff to scare myself), but also noticed your specialty and thought you might have some ideas that my vet might have missed.

I have a 20 month old (if breed matters) Boxer mix (probably mixed with some kind of bull dog or pit bull type dog, but the "father" was unknown). He has a history of chronic ear infections which have been diagnosed as being caused by yeast. I assume he also gets "yeasty" paws due to frequent chewing and slight reddish brown discoloration. The paw issue is less concerning as we treat flareups with an antimicrobial wash (KetoChlor, I believe), and the vet has never really been concerned with the paw issue. I mention this only because up until now the vet has suspected the underlying cause of both issues is allergies. I am told the dog is too young for allergy testing and it's not very reliable anyway. We've tried the obvious and easiest method of switching foods (grain free, limited ingredient, various protein sources) giving enough time to adjust to each food. No diet change has helped. The vet has pretty much shrugged it off as some sort of environmental factor which could be "impossible" to identify or eliminate.

The ear infections are more concerning, as they flare up rather frequently. So far, the vet has provided a standing prescription for Mometamax. Since she already knows he has a history of ear infections, she doesn't want to examine him (and charge more money) every time, so I can just pick up a new bottle once the old runs out. With this, we'll "get rid" of an ear infection temporarily, but it seems to never be gone for very long before we have to start treating him again. The vet says there's not much else we can do without eliminating the allergy causing it, but we don't know how to do that, so all we can do is treat the flareups. We actually just recently (about 2 days ago) stopped a round of ear drops as his ears are looking clear and healthy and he has not been scratching at them.

The disturbing behaviors began last night. Our dog generally sleeps in bed with us (sometimes moving to the floor for parts of the night). Last night, he began having symptoms that seem possibly neurological. Of course my first thought, given his history, is middle or inner ear infection, but he doesn't seem to meet the more serious symptoms. Obviously, this requires a vet visit (which we will do ASAP), but in case this is still related to his ears, I feel like our vet is somehow missing something, or could be doing more. Maybe you have some insight here.

What happens is that after resting for a bit, he will suddenly jump up, and sort of run to one or the other of us humans. He will actually physically try to climb on top of us and press as close to us as possible. Sometimes it is in response to an obvious noise (i.e. the air conditioner kicking back on), other times, it seems random (or not something I can hear). Sometimes, he spins in a quick circle immediately after the sudden jump up. Sometimes, he looks around quickly. If the startle response is triggered by a noise, he usually darts his head from side to side a time or two as if trying to identify where/what the noise is. He has done the "head shake" a time or two where he flaps his ears pretty hard, but is actually doing this less often than when he has an active ear infection, and not more than one or two shakes at a time. However, there is no repetitive circling, no head tilting, no loss of balance, etc. I would consider this a behavioral change, but there are zero indications of aggression. It's more like he NEEDS comfort and reassurance.

He is trying to stay as close to us as possible, and tends to not lay back down unless we physically hold him. He does seem to get some comfort from physical contact, but no real relief. He is obviously distressed, and not resting well. He's nervous and sometimes trembles a little before relaxing again. I don't believe the trembling is seizure like (having had a Cocker Spaniel with seizure disorder before), but more run of the mill frightened "shaking" (the same way he might tremble if a strange cat is on the fence, or a particularly violent thunderstorm is going on). He doesn't go more than 30-60 minutes before he "startles" again. I don't think whatever is going on is even subsiding in between the jumps, because he's not sleeping, and just seems distressed, even when not having a "freak out" moment. If I hold him, he stays a little stiff, and eventually I can feel him relax a bit (his head gets heavy, his eyes start slow blinking as he closes and reopens them), but before he gets fully back to sleep, he starts in with another sudden jump and more obvious distress.

Could this be related to his ears, or are we on the wrong track altogether? Is there anything else we could be doing for the chronic ear infections? Is there anything specific I should ask my vet to look into that she might be missing?

Answer
Dogs with yeast infections are allergic. It is very rarely food allergies that cause foot itching.  You can have your dog tested with a blood test for environmental allergens....there is no good test for food allergy.  If he is allergic, then you can desensitize him with allergy shots or the new oral allergy medications, like RESPIT  (www.vetrespit.com). I am very surprised that your vet has not tried some low dose continuous anti-inflammatory therapy to decrease the allergy symptoms.  We often use steroids, Atopica, or Apoquel (if your vet can get it) for this.

Mometamax contains a powerful topical steroid which will make the dog more comfortable because it relieves the ear itching.  It also has gentamycin, an antibiotic, which can be ototoxic, causing diminished hearing, which may be part of the behavioral issues. .  An antibiotic is not needed in a yeast infection at all.  I actually have just developed a new ear packing called KETOCORT OTIC (www.ketocortotic.com) that does not contain an antibiotic.  The problem is that the infection does not go away.  It is just that when you stop the mometamax, there is no more steroid to make him comfortable and his symptoms return.

As far as the behavioral change. Without a good exam, I cannot be sure why he is acting this way.

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Dr. Louis N. Gotthelf

Expertise

Dermatology and ear diseases of dogs and cats

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I am the author of "Small Animal Ear Diseases; An Illustrated Guide" published by W.B. Saunders. I have over 25 years of clinical experience with a special interest in dermatologic conditions and ear diseases.

Organizations
American Academy of Veterinary Dermatology

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Veterinary Forum
Veterinary Medicine
Waltham Focus

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