Nasty dog with nasty Pseudomonas aeruginosa

RE: Nasty dog with nasty Pseudomonas aeruginosa

Anthony Todd — Mon, 20 Jun 2016 12:25:50 GMT

[quote user="Michael Woodhouse"]LWR is quick, cheap, safe and effective.[/quote]

Yup, and I have to add that, back in the day, they were done with a grotty canal, nowhere near normal and certainly infected but results always showed marked improvement.

Virtually impossible to get these canals anywhere near normal prior to LWR and a lot of them had a subsequent chronic gungy middle ear/horizontal canal discharge which didn't seem to worry them.

LWR made no difference at all in "allergic" otitis though!!

RE: Nasty dog with nasty Pseudomonas aeruginosa

Michael Woodhouse — Sun, 19 Jun 2016 22:34:21 GMT

I think we underestimate how painful these conditions are - some of these dogs have a complete personality change once you 'fix' their ears/skin.

Steroids - lots of steroids. Need to control inflammation and open up the stenotic ear canal.

I'm not a fan of sensitivity profiles in ears as we can achieve concentrations of antibiotic so much higher than the MIC achieved elsewhere in the body. Culture and cytology is useful IMO.

We do a reasonable number of LWR and get very good results. Never failed to get some improvement (not claiming 100% cure). LWR and Cortavance spray after healing works well - appreciate many of these dogs have atopy in this skin.

LWR is quick, cheap, safe and effective.

RE: Nasty dog with nasty Pseudomonas aeruginosa

grumpyoldman — Sat, 18 Jun 2016 13:49:15 GMT

TECA , hospitalise for a week , make sure the nurses get the drugs into it afterwards , those surgeries always do far better if the owners do not get the chance to screw up the post op care.

RE: Nasty dog with nasty Pseudomonas aeruginosa

Rob Davis — Sat, 18 Jun 2016 10:27:42 GMT

[quote user="Anthony Dennison"]

Osurnia doesn't have a license for treating Pseudomonas, and I know of one case I tried it in anyway because the dog was a little bugger and I didn't get anywhere.

+1 for an ear flush under GA. Once you get rid of all the crud blocking up the ear things will improve.

[/quote]

I have also tried it in one dog with pseudomonas (St Bernard belonging to elderly lady who weighs less than the dog....) and had good success. LWR was performed first but infection didn't clear so used osurnia and has been fine since then.

N=1 but may be worth a try.

RE: Nasty dog with nasty Pseudomonas aeruginosa

Anthony Todd — Fri, 17 Jun 2016 18:34:52 GMT

[quote user="Tim Browning"]In this breed and with this bug and with this temperament/compliance it would need a lateral wall resection as medical treatment doomed to failure.[/quote]

Glad to see the modvets seem to agree with the only dinovet game to express the obvious opinion as above.

Has anyone done surgery on these and not had, at least, a vast and quick improvement ??

How long has the medical treatment been going on so far....

RE: Nasty dog with nasty Pseudomonas aeruginosa

Tim Charlesworth — Fri, 17 Jun 2016 12:51:36 GMT

I completely agree that LWR usually worth a go if the horizontal canal isn't stenosed and this would be my usual approach for most dogs. In this case, however, if the owners aren't able to medicate at all in the postop period, I would worry that the infection would persist (esp because of the breed/conformation) unless treated. We would need the full history/otoscopic assessment/client discussion before making any definite recommendations - one of the many difficulties of giving advice on a forum!

RE: Nasty dog with nasty Pseudomonas aeruginosa

Tim Browning — Fri, 17 Jun 2016 10:23:04 GMT

if you do a LWR one can progress to TECA either directly when horizontal canal assessed or later as a final salvage procedure. I am more wary of TECA due to increased risks of surgery and follow up.

But in the hands of someone more skilled and qualified might be best referral option as all done in one go.

However I found most Pseudomonas ears are pussy and ulcerated but not severely hypertrophied and horizontal canals open. They do hold the residual infection for longer so in the case of really nasty dog where topical treatment difficult would agree TECA might be better option. But we have cured loads of Pseudomonas ears with LWR alone!

RE: Nasty dog with nasty Pseudomonas aeruginosa

Tim Charlesworth — Fri, 17 Jun 2016 09:29:57 GMT

From a surgical point of view - I agree that TECA+/-LBO would be a sensible way forward if the infection is not able to be eliminated medically (either due to resistance issues or dog's temperament). LWR can work well providing that there is no sig pathology in the horizontal canal but sadly there often is (but you need to assess under anaesthesia). LWR also needs a lot more aftercare than TECA including probable ongoing topical medications so I would proceed straight to TECA if in any doubt.

RE: Nasty dog with nasty Pseudomonas aeruginosa

Anna Battek-Kosiorowska — Fri, 17 Jun 2016 09:29:31 GMT

Thank you all for advice.

I have to admit I was toying with the idea of using Osurnia, we may consider that at some point but sedation is an only option here. That will give us an opportunity to check the ear canal as none of us had a chance to have a look at it so far. I may start preparing the owner for TECA decision but my worry here is we have quite a bad pyoderma around ear an on pina now.

I guess it is not going to be easy to sort that dog out. Hmm...not possible maybe?

RE: Nasty dog with nasty Pseudomonas aeruginosa

Tim Browning — Fri, 17 Jun 2016 09:15:45 GMT

In this breed and with this bug and with this temperament/compliance it would need a lateral wall resection as medical treatment doomed to failure.

It might break down due to infection but will heal eventually and Pseudomonas will disappear with the exposure to air and certain topical treatments including dilute distilled vinegar, if they could do it.

It won't be much fun and would need owner to be prepared for multiple treatments. Euthanasia in such cases is an option as untreated ears compromise QOL severely.

RE: Nasty dog with nasty Pseudomonas aeruginosa

Anthony Dennison — Fri, 17 Jun 2016 08:58:50 GMT

Osurnia doesn't have a license for treating Pseudomonas, and I know of one case I tried it in anyway because the dog was a little bugger and I didn't get anywhere.

+1 for an ear flush under GA. Once you get rid of all the crud blocking up the ear things will improve.

RE: Nasty dog with nasty Pseudomonas aeruginosa

Virginia Campbell — Fri, 17 Jun 2016 00:12:20 GMT

If it comes down to it, which it probably will if the dog doesn't have something permanently controllable like food allergy underlying or if ears too calcified and irreversibly stenosed, I know the prospect of TECA and aftercare in a savage dog doesn't fill everyone's heart with joy. It is doable though. We had an ear surgery Shar Pei in last year that was such a kennel guarder that the owner had to come in twice daily to extract it from the cage to look at and replenish feed and water. Went home earlier than most and did well.

RE: Nasty dog with nasty Pseudomonas aeruginosa

Virginia Campbell — Fri, 17 Jun 2016 00:00:58 GMT

[quote user="Martin Atkinson"]Anyway, I think any treatment is doomed to failure unless the dog is sedated/GA'd and the ears thoroughly cleaned to remove the biofilm [/quote]

+1. I would be another person who would choose Osurnia and start pred. And a food trial. If the canals are calcified would be pushing the idea of TECABO once the mess is cleaned up a bit.

RE: Nasty dog with nasty Pseudomonas aeruginosa

Andrew Henfrey — Thu, 16 Jun 2016 20:05:16 GMT

I'm fairly sure CAPL laboratory told me no Pseudomonas isolates are likely to be sensitive to florfenicol.

RE: Nasty dog with nasty Pseudomonas aeruginosa

KMurphy — Thu, 16 Jun 2016 18:24:24 GMT

At least one flush/exam UGA would be helpful. How chronic is the infection?

We inherited a similar case with a Westie. We made some progress initially with weekly flushes UGA with drops instilled then and high doses of systemic antibiotics and steroids. Ultimately, we persuaded the owner that a bilateral TECA-LBO would be beneficial for this dog. He's been a much happier little dog since that was done.

Imagine how grumpy you'd be with chronic sore ears!

RE: Nasty dog with nasty Pseudomonas aeruginosa

Martin Atkinson — Thu, 16 Jun 2016 18:23:06 GMT

[quote user="Bob Russell"]Bite the bullet and try Osurnia. Not a perfect choice perhaps but only needs to go in once a week. So far has not let me down, much to my surprise![/quote]Did you ask the lab to test for florfenicol in the sensitivity panel? Axiom don't routinely add this and I keep forgetting to ask but the two occasions I did the infection was resistant. I have a patient which is not as evil as the OP's but the owner finds it very difficult to give any drops at home so Osurnia would be ideal if the psuedomonas was sensitive.

Anyway, I think any treatment is doomed to failure unless the dog is sedated/GA'd and the ears thoroughly cleaned to remove the biofilm and flooded each time with drops rather than the usual 5-10 drops the bottle suggests, with an ear cleaner incorporating trisEDTA instilled once a day a couple of hours before the antibiotic dose.

However if the case is that difficult it might be worth a pop with Osurnia (after cleaning) installed under sedation even if it is resistant in vitro as prolonged contact in vivo may be effective. Little to lose in this case I'd say.

RE: Nasty dog with nasty Pseudomonas aeruginosa

Bob Russell — Thu, 16 Jun 2016 17:57:02 GMT

I have a few challenging dogs in the practice! Systemic medication often fails. Bite the bullet and try Osurnia. Not a perfect choice perhaps but only needs to go in once a week. So far has not let me down, much to my surprise!