C O L D  R I V E R  V E T E R I N A R Y  C E N T E R

Colitis, otitis in a dog

CASE REPORTS

• Allergies in a dog

• Allergies in a cat

• Arthritis

• Colitis. otitis

• Cushings disease

• Ear infections

• Feline chronic renal failure

• Heartworm

• Inflammatory bowel disease

• Kennel cough

• Kidney failure, disc disease

• Lymphangitis

• Lymphoma

• Oral papillomas

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Chronic ear infections are one of the most common reasons for dog owners to seek veterinary care. Numerous products are sold for cleaning and treating inflammatory and infectious diseases of the ear. Left untreated, the worst cases may require surgery to obliterate the vertical ear canal (ear canal ablation), a horrible conclusion to an already painful condition. Dog ear infection or otitis externa is treatable without resorting to cleaning products, medications, or surgery. This case shows how one incidence of intestinal and skin inflammation can spiral into a costly endpoint for dogs.

Colitis

Kerry is an 8-year-old spayed female Cocker spaniel whose extensive medical problems began at age 8 months when her stomach became impacted with gravel. One month later she was back at her local veterinary clinic after vomiting dry dog food. On suspicion of an internal parasite infection, she was treated with 2 worming medications and an antibiotic. Her gastrointestinal distress would resolve when she was fed hamburger and rice, but reoccurred when dry dog food was introduced. Two months later she was back at the veterinarians for pruritis (itchy skin) and was treated with a steroidal anti-inflammatory medication, dipped for external parasites, and injected for possible Sarcoptes mite infection. Despite 3 treatments for mange, Kerry remained pruritic. One month later, she was back at the clinic for flea infestation. At age 2 she was diagnosed with colitis, was straining to defecate, and passing mucus with blood in her stool. She was treated with Tylan (a tetracycline antibiotic) and Hill's prescription diet i/d. She remained on Tylan for treatment of ulcerative colitis for almost 7 years. She continued to have episodes of itchy skin and pyoderma over the next 4 years, and was given more than a dozen prescriptions for antibiotics and prednisone.

Ear disease

The external ears are an extension of the skin, and many dogs with generalized skin disease will also have otitis externa. Kerry's inflammatory ear disease started at age 3 with a yeast infection (Malassezia). She received Staph phage lysate injections for pyoderma and months of hyposensitization injections for atopic dermatitis (allergic skin disease). The allergy injections, medicated shampoos, prednisone, and antibiotics did not resolve her chronic skin disease.  One year later, she still had copious yeast in her ears. Kerry received distemper vaccine boosters annually and monthly heartworm preventive as well. She weighed 45 pounds at 7-1/2 years of age (obese), had experienced 6-1/2 years of allergic dermatitis, continuous antibiotic therapy (Tylan) and was still passing blood in her stools.

Ear canal surgery

Kerry's left ear (shown at left) had developed polyps from the chronic inflammation. A lateral ear canal resection surgery was performed in January, 2001. She had lost her hearing in that ear. The right ear had chronic hypertrophy (thickening) due to allergic skin disease. Kerry was on the verge of having to undergo another surgery, this time on the right ear, when her caregiver contacted Cold River Veterinary Center in late June, 2001 for an alternative course of therapy.

A true health plan

On physical exam Kerry was a sweet dog with multiple polyps measuring 2-5 mm in her right ear canal. Passing a cotton swab into the ear canal was impossible. Her hair coat was dry, with generalized seborrhea sicca (dander), scale, and an unpleasant odor. Her anal sac glands were impacted with a viscous brown secretion. A chemistry profile, blood cell count, and thyroid profile were performed to establish a baseline and prepare a nutritional treatment plan (BioMedical Profile). Her initial test results and response to our therapy are summarized in the table below.

Kerry was started on a fatty acid supplement, an adrenal gland concentrate, a probiotic, and a sulfur-based nutritional supplement for her dry, itchy skin. We recommended a diet of fresh, whole foods and discontinued the Tylan antibiotic. Blood tests confirmed our suspicion that Kerry was hypothyroid and suffered from chronic antigenic stimulation from vaccines, foods, bacteria, yeast, and environmental allergens. Food allergy IgE testing revealed sensitivities to beef, turkey, chicken, beet, and yeast. Three weeks after starting our treatment plan the owner reported that Kerry was much better, and loved her home made food! She had lost 4 pounds in 3 weeks, her red, inflamed skin had returned to a normal color, and she no longer had a foul odor.

We recommended repeating Kerry's blood tests and nutritional analysis after 3 months. On recheck, Kerry had a small amount of yellow-green sour discharge from her right ear and left anal sac gland. An ear culture revealed a mixed population of 3 antibiotic-resistant pathogens: Proteus mirabilis, Psuedomonas aeruginosa, and Streptococcus. From the antibiotic sensitivity tests we learned that there were no veterinary otic antibiotics that would be effective against the mixed infection. Indeed this population of antibiotic-resistant bacteria had been selected by frequent administration of antibiotics and other ear medications until the drugs were no longer effective. Now we had a huge challenge: the owner did not want Kerry to have surgery on her remaining intact ear, the bacteria were resistant to all the conventional antibiotics, and the ear canal was too painful and narrow to allow the ear to be flushed clean.

Natural medicine

Dr. Kruesi prescribed thyroid replacement hormone, homeopathic remedies for weak adrenal and thymus activity, and 5 nutritional supplements based on Kerry's blood tests. We asked the owner to fill the ears with a natural ear medication (antibacterial and antifungal) called "Zymox-E" once a day for 5 days. On recheck 12 days later, Kerry's ears were better. A repeat ear culture showed a persistent infection, however. A second course of Zymox was administered for 7 days. Systemic therapy was begun using bovine colostrum, 3 capsules every 12 hours for 2 weeks. Two months later the infection in Kerry's right ear had resolved. Her left ear (the one with the ear canal surgery) was little more than a peep hole at the base of the ear canal. It had a sour odor and white discharge. The entry point was so small as to make ear flushing and drying impossible. We asked the owner to infuse Zymox-E using a soft rubber catheter and syringe, for 2 weeks. On recheck 2 months later, the drug-resistant bacteria still showed up on microbial culture, though she appeared clinically normal. The entire lining of the ear (acoustic meatus, auricular folds, vertical canal) had returned to a healthy appearance. The thyroid medication, nutritional and immune support worked together to help her overcome chronic ear inflammation and allergic dermatitis.  Her hair coat is soft, full, and she no longer has itchy, red skin. 

Serum chemistry profiles

    *These values are at one end or outside of the reference range for dogs.

For more information

To learn more about our integrated approach to ear and skin disease in pets see the proceedings from the November, 2001 seminar:  Concepts of Nutritional Medicine.

William K. Kruesi, M.S., D.V.M., C.V.A.  /2002