Understanding Dog and Cat Ear Infections: Expert Veterinary Advice | SOP Ep. 124 - Dr. Emily Rothstein

Today's episode is sponsored by Dr. Tim's Pet Food. Until next time, keep asking questions, keep learning, and keep loving your pets. Learn more at DrTim's.com. - Welcome to Speaking of Pet. I'm Dr. Alice Navati-Jaroman, a board certified veterinary dermatologist. And I'm not. I'm Janet Navati-King, the Dr. Sister of Podcast Co-host, Pet Owner, Rescueer, and Learn. We're here to provide pet owners with science-based information to help them be the best pet parents they can be. - Here's today's episode. Create a just for you and your pets. - Hey everyone, welcome to the show. Today, it's all about ears. Ear infections in our pets. Why do they have them? What should we do? When should we go to the veterinarian? What not to put in the ears? You name it all about ears in dogs and cats today. With our special guest, Dr. Emily Rothstein, a veterinary dermatology colleague of mine. And I'm going to embarrass her because she was the award of excellence by the American College of Veterinary Dermatology Recipient in 2025. So Janet, what would daddy say? Smart cookie. - But you know, I really wish we could have a human ear doctor on to figure out why husbands don't hear you. - Well, that, no, and an ophthalmologist. Where's the mustard? And they didn't even open the fridge yet. Okay. - And sister. - Amen. - But shall we progress? Anyway, Dr. Emily Rothstein, so good of you to spend an hour with us today. And I know Janet, you probably won't get a word in edge wise because she and I are going to be like, "That, that, that, that, that, about ears." - Yep. Talk to Dr. - Keep it down, ladies. Keep it down. - And I'm going to have you start because it'll just be me and Dr. Emily like rehashing people we know. And I want it to be all about the pets and ears today. - Okay, so we all hear this, ear infections and pets are so common. So why? - Well, that's a good question. And in fact, about 15% of dog visits is a veterinarian or for ear infection. So diarrhea is probably the next piece. So it's, it's common for a couple reasons. One is there are primary factors. So you are a breed that has really pendulous ears and you live in the middle of a humid environment. There are predisposing factors like allergies. Allergy is probably the biggest reason. And so, and then there's perpetuating factors. So those are the factors that things happen with the infection and everything snowballs. And if you don't back all the way up and confer the first problem, your snowball will keep rolling till you know where. - Yeah. - So those ears create like a nice moist environment. - Yeah. - So that yeast growth. - When you think about it, have my little ear here. - It's a flying tunnel, right? So there's a canal like us. And then it doesn't go anywhere. It doesn't go to the other side. And in dog ears, their ears are shaped like an L. - Yeah. - So we have this part straight in. But dog have down and over. And so that's a lot of space. It's like a teaspoon or so, a broom and a big dog. So that's a lot of place for things to go wrong. - So what's a misconception for pet owners about ear infections in dogs or cats? That's a good question. Misconception is I guess the biggest might be and Dr. Alice can say, oh, I didn't know it was an infection. Even though they're doing this shaking or all of a sudden they're like, beep, beep. What is that smell? So that could be the biggest one. And I guess the second biggest and I think unfortunately some veterinarians too is that, oh, ear infection, just ear infection, when it's gone, you're good to go. But there's always something underlying. And if the underlying is in dealt with or if the infection is in dealt with properly, again, it becomes that snowball. - Yeah. Janet, I agree with Emily on that. Because to me, when I see people on Facebook asking questions about ear infections, they don't understand more often than not. It's not a one-time event. There's something feeding that and they think their vet is a failure because we gave me this medicine and it got better, but it's back again. And Emily, I read somewhere a long time ago that one of the number one, two or three reasons for an ear infection not to get better is lack of the owner or the veterinarian to have them come back to recheck. Because for example, you can get, there's a bad bacteria called pseudomonas, which by the way people, you can get from hot tubs. Because it likes a warm, moist environment. And so you get a dog in with this horrible, and you know it 'cause it smells horrible. Pussy, heavy pseudomonas bacteria ear, and I get rid of the pseudomonas and in two weeks when I check it again, they're back to yeast. I'm happy about that because pseudomonas will eat through into your canal. But had I not recheck that dog in two weeks, now it's something different. You see what I'm saying, right? People need to know it's not a, here's the medicine and bye bye. No, we've got to get to the bottom of this. Well, you know, though, it's like that in humans 'cause if your kid gets strep throat or ear infection, they'll treat them with what's the pink stuff of Moxasillin. And then the kid still has it. It's just that wasn't the right dose of the antibiotic. So sometimes you have to recheck. You went or dog or cat. I mean, it's just part of the system. It's not that it's magic. Medicine is not magic. It could be one thing can't fix everything. It's got to be a little bit so that the patient and the client can handle it. Sometimes the patient can't tolerate things. And we have to tailor their treatment to what they'll tolerate. So can food allergies lead to ear infections or? Oh, sure. Oh, interesting. In fact, Alice and I have a dog that we share. So that's right. I wish she was up here. I can call her. So I'm on the guiding eyes medical release thing. So when they have a dog that has a medical reason that they can't continue in guiding eyes for the blind, they say, hey, do you want it? And here's the thing. And so I adopted shoes about eight months old, the Black Lab puppy from Ohio, which is where Alice practice. And Alice happened to see this dog as a puppy to start her workup. And she had chronic ear issues and runny eye issues. So she was a food allergic dog or is a food allergic dog? And she's on a special diet. She probably has a little environmental allergy stuff too that I periodically have to work on her ears. But yeah, so we share a patient that actually ended up being my own dog. But yes, food allergy is one of the allergies that kind of lead to ear infections. OK, so what if my dog is a swimmer? And you know, particularly like labs or swimmers, they just love it. They're a swimmer. What do I do after they get out of the lake or the pool or whatever? Well, you'll probably have different answers with different dermatologists. My thought is, if swimming doesn't cause a problem, let's not put anything in there and mess with it. If it ain't broke, don't fix it. If they seem to be irritated, then there are drying solutions that you can do. There's even the old-fashioned vinegar and water that you can rinse their ear with that will be drying, as long as they're not red and irritated. Because imagine sticking a cut finger into some vinegar. Yeah, that's an owl. So, and then just sometimes a dry cotton ball can help. But you don't want to do the screw in like a light bulb thing, because if there's something in there, you don't want to jam it in further, right? So white, what you can reach is what I would always tell my clients, white, what you can reach. And if they're little dogs, you use little or cotton balls, a little or piece of the cotton. If they're bigger dogs, you probably just stick their whole finger in there with cotton. You know, we're talking about swimmers here. You know, Emily, I'd be interested to hear, what do you think about these poodles that go to the groomer, they have all this hair inside the ear? I love to hear your opinion on that, because we all-- I think-- well, actually, I think we all think the same on that, all of us are dermatologists. But talk about that. Well, there are a lot of that on Instagram. They go in and they twist-- I know. I know. And I want to scream. It looks like they're hurtful. Yeah. Well, and there are a couple things, again, if the poodle doesn't-- they need air at the outside. So if they can-- you can sometimes even just use your fingers and just get a starting point so that the ear can breathe, so to speak. Yeah. But some of them need to get more renewable or plucking. And yeah, that's irritating when I would sometimes get a poodle in under anesthesia to pluck them. And then I would put a cortisone or steroid joint drop in there to soothe it down because of the urge-- I mean, think when you pluck your eyebrows. And that's one hair, right? - A bikini wax, that'll kill ya. - There you go, a bikini wax. So, and you can't, there've been numerous reports and trials of using epilating products in dog ears like Nair, but it's not a good thing 'cause you can hardly ever rinse it out, and it doesn't really work, 'cause just 'cause you stick it in, you can't get it back out. So, I think when it's appropriate, they should have a little bit of air removed and more air, sometimes the veterinarian needs to get them all. - And I don't think owners should try to do it themselves. - No, not unless a veterinarian has the time to show and be careful, because I know I've done it with chemistats and accidentally pinched the skin, and then you feel bad too, the dog nates you now, and it's really irritating. 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For every pet, not just the athletic ones. - Head to Dr. Tim's pet food to find the formula that fits your pet's life. - Can you leave an ear infection untreated? What happens? - Oh, well, probably the worst thing that happens is you get a middle ear infection. It goes through the eardrum into the middle ear, and God forbid it travels further in like otitis-internet, and you get a brain infection, which I never had happened, thank goodness. But if you don't treat, it's like if you, I can't think of a good example. If you don't treat it, one, it hurts. - Yeah. - Right? - Yeah. - So if you've ever, you know, cut your finger, and go, wow, that's really red, and you touch it. Ow, think of it if it was in your face, or it hurts. And what do you do next to your ear? You chew, and so dogs that have to chew hard food, or pets that chew hard food, that's like, put extra pressure right on that ear. So not treating an ear infection is not a good idea. - I can't even imagine the pain that, you know, Emily, you and I see the worst of the worst, and I can't even imagine the pain of these ear infections that have let go. And the show notes, I put a picture of, we used to see a lot of it in Cocker Spaniels, right Emily? Where you get hyperplastic ears, Janet. You know, as I tell owners, skin lines your ear canal. It has these sebaceous glands in there, it has sweat glands in there, and the longer the infection is in there, those glands get bigger to try to fight it off. Then you have, it almost looks like babies, and it closes off the ear canal. These poor dogs, it's just horrible. And then, of course, surgery is the only option. They have to cut all that out. - Oh, God. - And then they can possibly, depending on what surgery they would be deaf. - Yeah. - Yeah. - So, you know, it, okay, and that's the snowball effect. - What over-the-counter products should never go in and that's ear. - Everything, everything. - Everything, everything, everything. - You got two hours? - Yeah. (laughing) - One thing that I really think shouldn't go, and people think, oh, hydrogen peroxide kills everything. I'll put hydrogen peroxide in there. You know what hydrogen peroxide does when it hits blood, but can you imagine, you'd be going, (laughing) magnified in your ear. So what, it's not going to help. But, too, it's got to be just distracting to the pet to have all that, no blankness. - Yeah. - So that's not a good thing. And then like your mom used to say, "You never put anything smaller than your elbow in an ear." - Yeah. - So, you don't want your little kids trying to put beret on the hair of the ear. You don't want to stick cute tips down in there. You don't want to, even using ear flushing bulbs can be a concern because if you insert it all the way, you're not going to hurt at the tip, but you're going to block the airflow that needs to come back out. - Yeah. - You know how ketchup always pours better when you let a little air back in the bottle, hold it on the side. Same thing with an ear bulb. If you include that canal and you squeeze, all that pressure goes to the ear gromm, and that's bad. So, I'd be very careful having a client flush with ear bulbs. - Okay, here, we have some mythbusters for you. True or false? Dirty ears always mean infection. False. - False, am I allowed to vote too? - Yes. - Okay. - Okay, true or false? - True or false? - Go ahead, tell us why. - Because some dogs are just being earwax producers, like some people have greasy hair. So their glenins produce more wax. For longer wax, six there, it potentially acts as food for the normal organisms that live in the ear, like yeast and bacteria, and they go, ooh, look, it's a buffet. Let's eat this wax. Let's cause an infection. But you can have dirty ears. What if your dog does what mine sometimes do, and you know, get that dirt nest going in the summer, so they're getting to the cool ground, and then they stick their head and they come inside and they got all this junk. So, you know, dirt is not infection. Dirty is not infection. Refection usually has a nodar, you know, which is not convenient if you don't have a sense of smell, like my mentor, Danny Scott, and I'm good sense of smell. And initially there's redness and/or tenderness that goes with the redness. - All right. - Okay, next. - Number four. Ear mites are the most common cause of ear infections. - Okay. - You have to narrow down the age of the species. How's that? - Yeah. - Yeah. So is it ear mites are more common in older dogs or what? - No, young cats, 100%. - Yeah. - Young kittens, nothing more rewarding than cleaning out an ear mite ear and a kid. - Oh yeah. (laughing) - You know, as far as echoes, Emily, I can't remember the last time I saw ear mites in a dog. - Divided X ear mites, but not auto depties. - No, and it could be that it was probably even before the new fleet control, the Isoxasolins came out. - That's true. You know, dogs don't get ear mites. Your regular ear mites that look like coffee grounds, like kittens. So kittens, yes, others, no. - Hey, Jen, while we're on the subject, I want to switch to cats because cats' ear anatomy is different than dogs and what we use in dogs, we can't use in cats. So would you come in on that, Emily, cause I've seen some really screwed up cat ears even by a regular vet's office because they're so delicate. - Yeah, well, I think the big things is that, and there are a lot of ear medications that are labeled for dog use only. And a lot of veterinarians for some reason don't read label. Now, sometimes there's nothing that's approved and you have to do what's called off label treatment. So this says treat, you can treat dogs, but I have to use it in the cat because there's nothing else on the market. And I know that it'll work and I know that it's safe, but it's just because it's made for a dog, doesn't mean it's made for a cat. And that goes, that's across the board. That's dog food and that's flea and tick. That's any medicine. Cats are not small dogs. Yeah, cats have the same L shape, but you know, they're much smaller. So if you were an aggressive large dog, cleaner with a q-tip, which you don't want to be. And you stick it in a cat ear, you can do some damage. I hope the cats didn't hear you say that. Well, cats are not small dogs. They would say dogs are not big cats. They would say dogs are all mine. You know, or dogs are stupid. Yeah, I've seen problems in cats. It's when they've been at a certain vet that they've had an ear flush. And that pressure was way too much. And the cat ends up with a head tilt because of that nerve damage. So that's why to me, cat ears should be handled very gently. And I don't like to put a lot of meds in cats ears. I just don't. Well, that's my thing. Well, an interesting lady, you know, I could almost count on one hand how many times I actually saw a cat for chronic ear infection. Right. Right. You know, it's it's just not nearly as common. The only time that it's more common is when they have ear polyps, which are little growth that can either be in the canal or in the middle ear or even up behind their soft palate. Yeah. Those cats will get chronic ear infections. But yeah, and that's mostly young cats, right? For people listening, usually young cats. Yeah. Yeah. So are some dog breeds or cat breeds more prone to ear infections? Or so I'm assuming is, I guess yeast isn't infection. So that because okay, two two infections to ear infections. Well, if you look at the breeds that more commonly have, for example, environmental allergy, then those breeds are the ones that are more likely to get ear infections because that's part of environmental allergy, one of the most common reasons. People would always say Cocker Spamiels because they have floppy ears and it holds some moisture, but they're also one of the higher allergic breed. Yeah. And then some other things that their ears produce a lot of wax, some of them. And so again, the wax feeds organisms. So yeah, some you think of more commonly. The most common ones nowadays are also some of the most popular breeds. So it's hard to really tell. The biggest is probably French bulldog. Wow. Little French. They have funny ear anatomy. They have funny face anatomy. Their whole head is a disaster. And English bulldog. But both of those breeds are also really allergic breeds that are going to have these secondary problems. Wow. And you know, I don't want head owners to think that they're a failure when they can't treat the pets here. You know, when the pet, especially dogs, it's so painful that and they should tell the veterinarian that because then we can maybe use more of a long acting so that when, you know, I remember one time my cat was on an oral sulfa antibiotic. And when I would reach for the vial, she'd run away. Well, that'll happen when when the poor dog is so painful and they see you coming at him with the earwipment. So you need to tell your veterinarian that, hey, listen, this, I don't know that I can do this because then Dr. Rostin and myself, then we take that into consideration. If the dog doesn't get treated, they're not going to get better. So you guys need to be frank with us and let us know what you can and can't do. Then you're right. Then we can tailor the treatment program to what's available. There have been a couple studies of a quality of life of pet owners with dogs with chronic allergies and chronic ear problems and it really depletes an owner's quality of life. So if you don't voice, you know, I can't, for example, my brother, they just got a puppy who's maybe six months old now. And they called me last weekend, the weekend before and said, oh, she has an ear infection and we can't get the medicine there. And she, because she was being a little nippy as a, even as a puppy. And I said, all right, well, here's some suggestions. One is get her out of her comfort zone. So if you put their take their feet off the ground, so either have someone hold them or put them up on the watcher or a counter or something, they're in that weird place and they're wondering what's happening. They don't pay as much attention. The other is some dogs need a muzzle. I mean, it's a fact of life. So if you said, get a tie or a long sock and just we're put around her little Chinather and then do it and then release her and give her cookies and tell her she's a good girl. And her here wasn't apparently very bad. They don't like it. Well, and you're right. And the muzzle thing is, is my technician used to say, I've got to show you, I've got two dogs. Yeah. And they're biting each other. This one's biting the other one's like, a muzzle actually is my technician used to say, give some something to focus on so that they're not obsessed with. But you know, that's, you're right. Sometimes just a few little suggestions to be able to do it because they, they're afraid they're going to hurt the dog, you know, that kind of thing. Well, they don't want to be mean. You know, you know, my dogs run for me because I'm always the medicator. You know, I'm the meatmurmy that's right. That's a wrench or with the earflut or with foot pads or whatever. And, you know, you feel bad and we don't want clients to feel bad because they're doing a great thing, helping to treat their pets ear. But if the animal hates it for whatever reason, I don't want to be still. I don't like your perfume smell. So get away from, you know, whatever the reason we got it, we will tailor to help you. Are there any veterinary medical advancements that you guys are excited about to treat ear infections? Like is there anything good on the horizon? Well, I think one thing that's pretty new, I mean, a lot of ear preps are what we call polyphyracy. So they have a steroid for inflammation, something for bacteria, something for yeast, because often those are to bacteria and yeast infections are together. But they're often not. And so there are few companies in the last year or two who have now made solely steroids, which is very important for the inflammation and either an antibiotic or an anti yeast medicine. So you're not treating bacteria that don't need to be treated and you're not getting resistant. So you're not treating yeast because yeast start the problem. The bacteria is, but we didn't have any choice before. So that's, I think, one of the big advances advances. One of the things I'm not sure how much I like, they make these leave-in products that can treat for seven days, up to 14 days. And those patients need to be selected carefully because you're not allowed to clean between installation of those men. So if you put this thick stuff and the dog already has a bunch of junk in there, you're adding soup to the sewer, it just fester. So although for clients, it's nice, they don't have to do anything, but that's not always a good thing. And that's like it because they just put it in and then they get them back in a week or two and put another one in. But you have to adjust that to what ear you're treating. So although that's considered in advance, I don't know that I would think all the same time. And Janet, I want to add to what Emily said, you know, the sad part is some of these are jack-of-all-trades master of none. And that's why, you know, when I'll have a client that contacts me now that I'm retired as is Emily, although we're busier than I'll get out, I'm doing other stuff. I'll say, well, when you took your dog in, what did they find on the ear smear? Okay? Also called ear cytology. Very important to have that done. Okay? So you can have your mites, i.e. epidemics, you can have yeast, you can have bacteria. You don't know which one of those you have, unless you get in there, look under the microscope and then pick the appropriate product, anti yeast for yeast, anti-biotic for bacteria. So an ear smear is so important to have done. And I don't know about you, Emily, but I didn't take a lot of histopathology in vet school. I took the required one. I taught myself, because I love finding out what's in there and treating accordingly. And sometimes when Emily and I lecture to regular vets, they'll say, well, why do I need to do that when I can reach for the product that has steroid, anti yeast, and antibiotic in there? Because you may not need the antibiotic, because it's all yeast. Well, and you're inducing resistant strains of bacteria, which is a big deal right now. And the other one that I always hated was, well, it smells like yeast. I mean, you can be fooled. Yeah, I can't tell you how many, I'm like, wow, that smells like yeast, and then you look in a bacteria, although I did have almost the full-true in the room technique. Oh, so I would get ready to take my swab to put on the slide for diagnostic. And if the dog licks it, this doesn't count for Latin English bulldog. If Donald licks it, then it's usually bacteria. And that's probably what we call it, is bacteria. That is ineffective. But don't do that at home. You need to write that up. What is the weirdest thing, or strangest thing you've ever found in a pet's ear? I try to send a video to Alice. Oh, what is it? It was a cock or spaniel with a ruptured eardrum. And when it would be panting, you could hear it out through the ear. Yeah. That's close. Yeah. Yeah. It frees out through its ear. I took a video, but it never was visible. Oh my gosh. And then I sent a picture to maybe be posted about a blob of earwax, remember what that was? Like as big as there in these fingers. The weirdest thing I had-- and it's really not weird, according to a veterinary dermatologist-- I have a lovely-- when French bulldogs first came out, because now they're rampant. But it had what we call-- well, we used to call it a coliestaeatoma, which is like a big blob of wax and goo. And I could diagnose it on an ear smear, because that's all you saw. There was no bacteria, no yeast there. It was just all waxy keratin cells. And we didn't know much about it then. And now you read about-- I think what do they call them now? Tim Pano. Panoe. Panoe. Panoe. Yeah, yeah. There have just been two recent articles about that, too. But I never-- I don't think I ever saw one in practice, at least. I saw one. Like you in 35 years or 30 years, one. Yeah. It's earwax. I'll let you get the whole one. It's just the secretions of the glands that line the ear can have. And it's full of wax, because it looks like wax. So that's how it's-- yeah, it feels waxy like soap. That's another thing you never want to put in an ear, detergent of any sort. Or mineral oil. Or mineral oil. Remember the old thing when you were a kid, you had an ear infection. Warm mineral oil. Oh my god. Yeast love oil. If you put warm mineral oil in a dog's ear, that yeast is going to be loving it. It's a party. It's a party. It's a party. It's a party. It's an oil bath party. Yes. So let me tell us about your pets. My pets? Yeah. They're usually right behind me. But one can't come upstairs anymore. My dog, my princess, my love of my life, Holly. Holly is 13 and 1/2, and a month. Oh. This is coming. She came to me from guiding eyes with a leg injury at a very young age that was never-- they didn't know about it at the time. Because how do you tell how well a puppy walks? Because they're all legs anyway. Yeah. Anyway, it wasn't diagnosis or managed. So she's my princess. She's a yellow lab. And then my next one is Garland, who we finally call Gigi. That's the one that Alice saw. She's a black lab. She's just-- we call her Ms. Kissie face, because if you get any close to her-- [INAUDIBLE] --I tell people, she can't hold her liquor at all. And then our newest addition, as of a couple years, is Fresco. Fresco was an early release from guiding eyes. He was-- sound a bird had sound aversion, the loud noise. And which is much better now that he's grown up. That was when he was younger. But so you can imagine if you're walking in the city as a guide dog, and you hear a backfire, and your dog jumps and knocks you over. Not such a good guiding eye. He has a little food sensitivity. So they're all on special diet. Okay. Fresco is about 90 pounds. He's massive. Wow. He looks like he has hound. Hey, hi, everybody. Looks like he's got hound in him. Is a yellow lab with a black lab? Yellow. I got his pedigree, and they're all letters. So whether someone's snuck a little-- Yeah. And who cares? Emily, how do you apply for one of those? Because Janet, that would be a great idea for Anne. Yeah, I mean, Emily gets one every, you know, hunter-hooded lab who's needed to apply for one of those. Well, one, you can get me-- well, to apply for a released puppy that doesn't pass training that's normal to lift his ears won't. Oh, okay. You can do that on guiding eyes for the blind. Okay. For grammatical releases, you can give me your email, and I can pass it along to the coordinator and that. Because they do have dogs. One of the people that runs our veterinary association, the Hanna's Re company that runs-- I have placed two dogs with her. Oh. So she just got her second one, Sean. And Otto was her first. And you know, when you get them, they're so well trained. Yeah. Had little seizure things, so again, not a good guiding eyes. But when you medicate them, they're totally just like my dogs. And they're on their special food. They don't have any problems at all. And you're in Connecticut, right? I mean, Connecticut. Because Janet's friend is in New Canaan. And she's-- yeah, right over there, right over the border. Yeah. Something heights. Games town heights. We're by Stanford. Yeah. So they're in-- they're up like west of Danberry, where they're guiding eyes in New York. Because our friend Melanie, she gets one every-- whenever her lab passes, she gets one. Now she has Rosie. Who's adorable. Big black lab. And she did puppy racing. She does puppy racing. And then she does adoption. Right. She's always had one from there. So Ann knows about it. I'll tell her again. Oh, OK, OK. Where are you? And where are you, Emily, in Connecticut? Mac in the middle, in Southern Tins, on like dead center of the middle of the state. I'm in DREAM. Oh, yeah. My brother is in Greenwich. There you go. Well, we say it Greenwich. Yeah. Greenwich. Well, I don't want to change it to what it's going to storm. Oh, gosh. I don't want to change the subject. But Emily, would you comment what's your opinion, and then I'll give my opinion on like the new medications for allergy, the monoclonal antibody, and the jack inhibitors. How do you feel they work for ear infections? OK, what are the next-- OK. That's an excellent question. But what are those, whatever you want? I'll let Emily take that. So there is a new, a new wish. One's been around for about 13 years. Family of drugs that inhibit an enzyme within the cell so that the itch pathway gets stopped early. And those are called back inhibitors. I mean, people are probably seeing cars with their apocryl, a lot on TV. And now there's two newer ones out. And so those are given on a daily basis to stop the itch before the snowball happens. The monoclonal antibodies, those are antibodies that are designed to target a specific chemical in the body, even before it gets to the cell to start this. And you've probably heard a lot of one online. There's key truda for non-small cell lung cancer. So there are lots and lots used for rheumatoid arthritis and humans and all sorts of things. And so these are given in veterinary medicine by injection. And the idea is that you block all those little chemicals that are flying around, they're called cytokines, before it even gets to the cell to bind, to have anything triggered. So that's the very targeted therapy, right? You're only going after that itch chemical. So those are really, really in advance and they're coming-- there's two of the injectable and now three of the built for that are quite good. So nothing is guaranteed right every patient's individual, sometimes it works, sometimes it doesn't. And then I forgot with the other part of your question, Martin. Oh, what's your opinion on do those help for ear infection? For the first years. Because a lot of that thinks they do in certain-- yeah. Well, I would have to say that they are somewhat but not super effective in treating, I would tell clients anything in front of the head, in front of the neck. So ear infections runny eyes. They just don't really do much. Some dogs, there's enough anti-inflammatory in the pill form to help a bit. But then you're also medicating an entire pet, whether they lick their feet or not, if you only need to medicate it to your 701, to spend the money and/or medicate the entire body if you're only focusing on ears. Now, granted, most allergic dogs At ears and feet and belly and armpits and you need to medicate the whole dog. But still, these newer meds are not super effective at dealing with otitis external in the dog and they're not any cat approved pill forms, although it's used off labeling cats and there are no injectable that go after one side of kind or that one thing but that binds before it gets to sell. There are no cat ones of that yet. Is there a particular age when a dog or cat becomes more allergic? So in fact, I was just listening to a couple of C.A.'s this week and what I was taught was if something starts between the age of one and three more or less, then it's more likely to be environmental allergy. So environmental allergy doesn't start typically before one year of age because you need a whole season to expose and react or over the age of three unless you move pollen zones, right? So if you're from Texas and you're four and you move in New England, you're start your book all over. Yeah. Happened to me in California. Yeah. Food allergy on the other hand can start six months till the day before you die. So any age or people are always, oh, but I'd feed in the same thing. Yeah. Well, that's what happened. That doesn't mean it's good to switch it up because I need to get the other complaint to see a veterinarian which is diarrhea. They're changing their food all the time. But yes, so food, any age, environmental usually between one and three and some clients don't even realize that there are other things besides the ears because they hear the doglaw and flappy flappy flappy or they smell the ear infection, but they don't know that when dogs in the other room. Yeah, it's fee or scratching its armpits so that the veterinarian needs to do a full dog exam, make sure none of these other signs of allergic disease are present and not just hone in on the ears. And speaking of ears, what is a ear hematoma? Oh, that's a good white. So when I, I got my first veterinary related job when I was 18 and a high school that I did a program that allows you to work part-time to gain high school credits. Cool. And so I went to a veterinarian's office. And the first surgery I ever saw was that ear hematoma. And for those that don't know, ear hematoma is a little pocket of blood between the outside flap part of the tissue of the ear and inside. Let me see if my little friend it can help us here. Yeah. So a hematoma would be between this part of the ear and this part of the ear and it looks kind of like that just a big balloon. Does it feel like a bubble in there? Like it can feel like a bubble or it can feel harder and can be painful or some dogs don't even know it's there. But they're filled with blood. And so my first job, the first surgery I saw, they have to anesthetize the patient and then they open it up to get all the blood out. And there's a lot of blood in there. Oh, man, I forgot that. People think hematomas are only from shaking their head really hard. Excuse me, when they have an infection or things like that, but it's caused by leaky blood vessels and other things can make the blood vessels leak. Certainly trauma can be one of the things that causes it, but it's not the only thing that causes it. And they're often not always, but they're often something that needs surgery to fix because the pocket is so big. If you don't, if you don't sew the pocket together, then it just fills right back up. There's nothing to stop it from filling up. You know, Emily, I agree. I always was under the understanding that it wasn't always due to trauma. And there's one paper on that. And it's very old. The Japanese, it was a Japanese study where they did ear trauma to dogs. It was like 10 dogs. And I think one of them developed a hematoma. So I agree with your with the leaky vessels. I think it could even be immune mediated for all we know. Yeah, that the blood vessel cells that keep the blood vessel intact start to separate. Yeah. So the blood has nowhere to go, but to wherever else it can go. Yeah. Oh, I don't think that study would fly any more with the ethics. Thank God. You know, when I read about it, I could just picture that I don't even want to talk about it. Yeah. Yeah. Um, so hematoma is when I was in regular bet, not before I started dermatology, we also would do things where we would put a little cannula or tube in the bottom of the ear and sew it in. So you bring the blood and you put this in and then the owners would unscrew the cat, the kind of milk out the blood and unscrew the back on periodically. But obviously messy. You gotta have very quiet. The ones to do it. You got to have the dog that tolerates this thing. It's like wearing an earring. If you've never had an earring in your ear, you're going to be doing this. Yeah. Um, yeah. And Janet, we wouldn't ask you to do that. Um, and there are sometimes you can do topical treatments and and oral treatments to help with the inflammation related. Oh, I know what I wanted to mention too. Have you? I probably had maybe three cases in 30 years contact allergy to the actual medication. Talk about that multiple and one of one of the most common contact problems. So you use a product in an animal just like if you touch poison, I before times, you're fine. The fifth time you break out. I know I pulled a weed yesterday and I have all these little vesicles. Yeah. I got it. Yeah. So you don't always react right away. You react later. So one of the most common things, um, can be a reaction to the topical medication. And that can either be the product you're trying to treat the infection with. So a lot of dogs can be sensitive to neomycin, which is an antibiotic. That's one of the more common or they're sensitive to something in the ear cleaner and the most common is called propylene glycol. And that's a preservative that's needed in these products so that they don't go bad really fast. But it's also the most common thing that sensitizes dogs to a contact reaction. So sometimes when I would see a dog and I'm like, wow, it sounds like everything was going, you know, was going well. And then something turned the corner. First thing I do is say stop everything. Let's just use saline for cleaning and let's see what happens. And a lot of times they improve just because they're not being tested with this product or this substance that's causing more harm than good for that pet. But it's not super common. But I've seen it enough that I had this little list of on the on the wall, propylene glycol, glycol-free cleaners because it didn't happen all the time. So was it at the tip of my tongue, so to speak? And I always tell people when I dispense ear meds, if this looks worse to you in a day or two, stop it and call me because sometimes Janet, they're so sensitive because by the time they get to Emily and me, they've had a bunch of products dumped in that ear. And that's the other thing. If they've overused a cortisone containing product, then it sends the skin and then you got to stop everything and let that get back to normal. Yeah. Yeah. Yeah. So I have a question for you as a two-timer. When you enter a party room on the two-timer? Yeah. Two-timer. Better than a two-verte. When you enter a party room, what is your entrance song? Well, vets don't go to parties for two. I've met Emily at a party. I know in Boston. I had band advertisers. I was gonna say one, you never tell anybody you're a veterinarian because the first thing they did was they come up with all the, well, my dog got spayed. I'm like, I'm a dermatologist. I'm not even a veterinarian, but people know my sister is and I'll get texts. Can you ask your sister about that? I know. Well, and we get, you know, one of my relatives, when my dog's vomiting, I'm like dermatology. not gastroenterology. Of course, you know, I can give an answer, but a good entrance song. What's your favorite like you would enter a party in? Depends if I've had a party. party cocktail. When COVID was out and we had our answer machine at work being used way more because we were down on staff. What song did we have? Something like sting. Don't stand so close to me. That's really cute. That's really cute. I actually have a sting story. I went to see some somebody had a ticket to go see the Jimmy Fallon show to taping and you don't know who you're seeing, right? You just go. We ended up, we decided we'd split up the reformists because you get better seats because they want to film you know down front. So I'm sitting there and there's a guy sitting in there with the roots you know the band. Oh yeah. He looks so familiar and they so they do that. Entrance song you know and Jimmy comes out and does this thing and then Jimmy sits down and says hey we want to thank our special guest and they use sting's real name like Bob Johnson's know because I love him dearly and my husband will be embarrassed that I don't know it. He has a name and so the whole crowd goes nuts and I'm kind of like who is it and it was sting was already out there playing with it. It's kind of cool. That is cool. It was very cool. He's very talented. He was a good guest. I enjoyed it. Who's your most famous client family or if you're allowed to say? I guess. Well I had a famous for a bad reason. I probably don't want to say. Oh okay. We do have one of the wrong stories in Connecticut. I'm not gonna remember. I had a somebody that was on a soap opera. A guy like guiding eyes or something. Not guiding eyes. Not guiding eyes. Not guiding eyes. But don't you take my mom or mom? Our mom is to say young in the restlessness. Oh I never knew that. Oh she used to say I'm watching young in the restlessness. I don't know that I saw that really any famous people. Oh I did see the dog trainer who trained a lot of dogs for plays who trained theater dogs. Theater dogs thank you. Yeah with one of his dogs. So Emily what are you doing this summer? You got any plans? Yeah actually about six weeks we're leaving for an African safari. Oh how cool. Are you going with Valerie Fadak? Oh tell Val I said hi. Oh my gosh. So we're going there's going to be four veterinary dermatologists. Who else is going? Teresa Manuel and Catherine out of bridge. Okay. There's going to be a veterinary interest which is kind of a co-worker, Teresa. Okay. A veterinary ophthalmologist from D.C. who a friend of Val. How cool. Oh my god. Let's not talk veterinary medicine. One I know you won't. It'll be so much fun. Oh and a veterinary surgeon. Catherine is a surgeon. Okay. Wow. Say your proctologists. And then no one will talk to you. That is going to be such a fun trip. Yep. So two weeks of that other than that people say it's life changing actually. Now that's what Val and Catherine have said. Yeah. Oh yeah. I'll put up Val. So we got to say thank you to our listeners and thank you to Dr. Emily. I learned a lot about ears. Janet I'm just going to have people call you instead of me or Emily because why not? You're learning on each podcast about all these organs. But first of all I can't pronounce those words. Well that's okay. We didn't say any big words today. Colise the atoma. Look, she's like stop using big words. Stop using big words. She likes words like treat. Dog. Her teacher. Wow. Biscuits. Don't say DADDY because I'm going to pick him up at the airport after this. And so they'll get all excited thinking he's home but he's not yet. So I'm the QT. You're all dirty. And thank you for listening. We appreciate our listeners and keep sending in those questions to soppodcast.com and check the show notes because Dr. Rostin has sent us some really good pictures of good ears, bad ears, hyperplastic ears. I've thrown a couple on there myself video Toscopies. So check it out at soppodcast.com show notes. And if there's something I've learned from meeting all these fabulous veterinarians as an average pet owner and lover is if you send something's wrong there probably is so you better make the appointment. And anything out of their ordinary behavior because dogs are creatures of have it just like we are. You have it. Check it out. Absolutely. Absolutely. Thank you so much. Thanks for listening. The pleasure is always. Thank you, Emily. Bye, everyone. Hey, thanks for watching and listening. We like likes. Don't forget to like, share, and subscribe. You can follow us on social media at speaking of pets and give your pets a big kiss from the Novotny sisters. The speaking of pets podcast is an SLA video production. Tim's pet food. Learn more at drtimz.com.