Sometimes we simply have to throw up our hands in defeat.
As regular readers know I love a bad ear.
I love to take an ear problem that is brand new and, starting from scratch, build a strong foundation. We start with an accurate diagnosis, using Cytology, bacterial culture and sensitivity, where indicated. Proper treatment of the ears is crucial, meaning the right medication based on testing, and the right volume and duration of medication.
I love to take an ear that has given trouble “all his life” and cure a problem so that the patient doesn’t have to suffer any more.
I love to find an underlying cause that may not be in, around or even near the ears. Underlying causes may include allergies, hormone imbalances or immune system dysfunction that keeps the body from doing its part to help heal the ear.
I love to teach a pet owner how to properly clean her pet’s ears, so that she can prevent ear problems from coming back.
Sometimes, though, we do everything we’re supposed to do, and pet owners do their part at home faithfully, and we still are left with an ear problem that won’t stay away.
In those case I throw up my hands, I feel defeated, but I don’t give up.
Instead, I turn to pulse therapy.
Pulse therapy is a way of giving intermittent therapy, but in a manner that doesn’t predispose a patient to resistant organisms.
There are as many ways to use pulse therapy as there are patients, doctors and days of the month. Let’s look at how we used pulse therapy for Tippy’s chronic ear problem.
Tippy is typical of patients with chronic, recurrent ear problems in that she had the most common progression seen in ear infections. She started with getting yeast infections over and over. We stayed on Tippy’s family about cleaning her ears weekly and after every bath, swim, or any other exposure to water. Sometimes these problems have to come back quite a few times before pet owners understand that cleaning the ears is the most crucial step to prevention of future ear problems. Now Tippy’s family is faithful about ear cleaning.
She eventually progressed to adding round bacteria, cocci, to her ear infections. Fortunately, most cocci infections are relatively easy to treat and respond to a wide range of antibacterial medications.
As commonly occurs with ears that simply won’t stay well, though, eventually they became infected with rod-shaped bacteria and when we saw her last week her ears were red, painful, crusty and draining.
We threw up our hands in defeat and decided on pulse therapy. Some key foundational points must be followed with pulse therapy:
- Medication must be given as directed.
- You may not lower the dose. If your pet’s doctor directs you to use 20 drops of medication, use 20 drops. Using less may well leave behind the strongest organisms to become resistant to the medication.
- You may not decrease the frequency. If your pet’s doctor directs you to use the medication twice daily, don’t instill it once a day, or worse, once every few days.
- Initial treatment will follow a “usual dosage” routine. For example, Tippy’s initial treatment is 25 drops of medication in each ear twice daily for four weeks.
- Treatment will be repeated on a regular basis. Tippy will have her medication administered twice daily for the first seven days of each month, for life.
- Pulse therapy is not intermittent treatment. Intermittent treatment is putting in a drop or two of medicine when you think about it, or once a week. Intermittent treatment is a technique often accompanied by not using enough medicine. Intermittent treatment is an invitation to disaster.
“Disaster” takes the form of organisms that become resistant to all medications. It’s a sad day when we receive a bacterial culture and sensitivity report and the organism(s) is resistant to every antibiotic listed. At that point we can only throw the kitchen sink at the infection and hope to knock the organism down to a controllable level. At some point those resistant organisms will cease to respond to anything. That is when we may lose the patient to infection that spreads throughout the body or have to euthanize him because of uncontrollable pain.
Such a thought gives a whole new meaning to the term “Use As Directed.”