I have learned from wild and zoo animals—who could have killed me if I had hurt them—that you don’t always have to cause pain to find the source of pain.
RABBITS FREQUENTLY SUFFER FROM EAR INFECTIONS. THEIR FAmous long, cute ears can be a problem area. In the wild, the predominant ear invaders are mites. In pet rabbits common infections include bacteria and yeasts, as well as mites.
During vet school, I learned the typical protocol for dealing with ear infections. Take a sample from the ear; examine it under the microscope to find out what mite, bacteria, or yeast was to blame. Then clean out the crusty brown debris with an ear cleaner and cotton swabs and treat with appropriate medication.
In practice, however, I found out that this is not such a good idea. The action of rubbing and cleaning out the crusty brown debris is not only painful for the rabbit, but counterproductive. It may seem like it makes sense to clean the rabbit’s ear. And it certainly provides a feeling of accomplishment to remove aural gunk. But it really can be a form of torture, and making a rabbit scream feels like a crime. But vets do it anyway, because it is what we are taught to do. Eventually I decided to rethink this practice.
Rabbit ear tissue is extremely sensitive. Cleaning out the infected ear makes the ear, in fact, more raw and painful. The earwax system exists in order to push things out of the ears. The crusts, earwax, and discharge are beneficial because they move the infection out of the ear. I finally realized that it makes much more sense to help nature do its job than to go against it.
Now I rarely clean rabbits’ ears, and never dig deep into the ear canal with a swab. I determine the culprit of the infection and start the drops, trusting in the capacity of the medication I’ve chosen and the rabbit’s own immune system to restore equilibrium.
Whenever I am training a new tech, I teach them to go against their need to fully clean out the ears of dogs and cats. “Don’t make the rabbit scream,” I tell them. We all use this phrase in my clinic now. Feline and canine ear skin is not as sensitive as a rabbit’s, but being gentle is still essential. Judiciously done, ear cleaning when needed can accelerate recovery.
Cleaning Cat and Dog Ears
Clean the infected ear every other or every third day.
CLEANING METHOD
1. Apply and fill the ear canal with appropriate astringent ear cleaner.
2. Gently massage the base of the ear.
3. Stand back for a moment, because your pet is going to shake the fluid and some debris out of his ear.
4. Take cotton balls and wipe out what you can see in the ear—gently. Do not dig in with a cotton swab. Repeat if there is excessive debris.
5. If you are applying meds or other topical treatments, wait thirty minutes to let ear fully dry. This will ensure that the treatment is undiluted and will be more effective.
Always be gentle, even though dog and cat ears are not as sensitive as rabbit ears.
Early in my career, I watched an orthopedic specialist confirm for himself—three times—that a dog’s lumbosacral pain was real by lifting that region and making him scream. The owner and I nearly screamed as well.
There are much more subtle and comfortable ways to locate pain. My technique is to move my hands along the animal’s body, feeling the heat on the skin, and muscles for spasm and tension. It is not as dramatic, but it is effective.
In one clinic rotation we were taught a technique to locate spinal pain that some vets call “white-knuckling.” This involves repeated, intense pressure placed on each vertebra. It becomes apparent when the animal screams or flinches which vertebra has an issue. This is a standard of practice, but when I lecture to veterinarians, I beg them not to do this. A lighter touch can often show just as much.
Painful areas are screaming—the animal doesn’t need to. As owners and vets, our hands must be sensitive enough to “listen.”
Sign of Painful Areas
Increased heat on the skin’s surface suggests recent injury
“Guarding,” or when an animal repeatedly tenses the muscle as a hand moves gently toward a certain area
Decreased range of motion or lameness/gait change/weight shifting
Nervous head turn or moving to avoid contact with a certain area
Licking or chewing around the area
With some chronic conditions there can be significant decreased circulation and the affected area will feel cooler than surrounding areas
Note: Sometimes they’re just ticklish, so don’t overinterpret reactions
If an exam or medical procedure is hurting your pet, ask your vet the following questions:
Is there another, less painful, way to do this procedure?
Will the result of this type of exam/procedure change the treatment or outcome for my pet?
Is everything being done to manage the pain for my pet?
Giving Medication in Ears and Eyes and Nose
When giving ear drops, don’t be tentative: Make sure you have put in enough medication to reach the ear canal, and then rub around the base of the ear (on the outside) to promote circulation and distribute the meds inside. Do not force the drops in. Let gravity work, and the massaging will help.
An easy method of giving eye ointment: Put a small amount of ointment on a clean index finger. With your other hand, pull down the lower lid. Then use the index finger to wipe the ointment into the pocket of the lower lid.
Some nasal concoctions—decongestants in particular—are more easily administered in the eye. Gravity allows the meds to drip down the nasolacrimal duct and end up in the nasal passages. Make sure, however, that any meds used are safe for ophthalmic usage before employing this method. (I have used a single drop of pediatric NeoSynephrine nasal drops in the eyes of congested pets, but be careful of the concentrations and dosing! Ask a vet before doing anything contrary to the instructions given with that medication!)
It may seem obvious, but don’t forget to calm your terrified pet when you are trying to medicate or examine her. Here are a few nonpharmaceutical tips to alleviate your pet’s anxiety:
A Thundershirt or a tight-fitting garment or a wrap can ease anxiety in a pet. Highly effective and rooted in neurological science, it draws on the idea that if you are being hugged, you can’t be anxious. This works very well for many nervous animals.
During an exam, I sometimes wrap an anxious animal in a towel to calm him down. You can do the same thing for your pet at home during nail trims and while giving them medications.
A T-shirt or boxer shorts worn by your pet can be used to prevent him from nervous gnawing on the skin and fur or from chewing on surgical sites or allergic skin.
An E-collar (or “Elizabethan collar”) or muzzle provides gentle control of the head and mouth and serves as a protective barrier between you and the animal’s teeth if you have an animal that gets anxious to the point of biting. In vet visits, if the doctor or the tech has control of the head, the animal may feel calmer. The E-collar is also used to prevent self-chewing.
Just before my junior year of vet school, we were told we would be practicing surgical techniques on dogs that were purchased for that reason. We would perform several procedures on them, sometimes with minimal pain medication. They would recover and then be euthanized. Ostensibly, they were dogs that would otherwise have already been euthanized at pounds or otherwise.
Dog theft by dealers had been in the news at that time. The rules against that practice were not very strict. Proof of where they had obtained the dogs was not always clear, and we heard that dealers could profit about four hundred dollars per dog, so I was concerned. Many of the dogs my university bought responded to commands, were delighted to see anyone, and wagged and wagged their tails. I worried that they had been stolen from loving homes. We had seen several upperclassmen crying about these euthanasias and I started to wonder if I could do this.
There were, in the end, eight of us who couldn’t. It didn’t make sense to any of us that they would require future veterinarians to ignore the grim reality of this situation. In order to further our knowledge, we were preparing to sacrifice the lives of healthy animals in a manner that was painful and prolonged. In addition, we didn’t know where they came from or who benefited from their sale. It was argued that there was no other way—that surgical experience with live tissue was essential.
I doubted very much that those poor dogs would find it a compelling argument. The proposition seemed to me to be directly in conflict with the Hippocratic first principle—to do no harm. It was an untenable situation in every way, not the least because of the possibility that we could be supporting or at least turning a blind eye to trafficking in lost or stolen animals.
This issue kept me up at night. I didn’t want to begin my fledgling career at the expense of these dogs. There had to be a better way. We told the administration that since shelter animals needed surgery, practicing on them would be a win-win situation. As for the other course-required surgeries, we asked if it would be possible to practice on animal cadavers.
The response was mixed. Many professors were furious. Some insinuated that we were afraid to do surgery. A few strongly suggested we leave vet school. One, in particular, suggested that certain professors who were against the idea of change might take their disapproval out on my grades. Even one failed class in vet school means you’re out, and I was diligent in keeping a high grade point average.
This had become a serious problem.
After many difficult meetings, I began to worry that I might never be able to become a vet if the administration didn’t come up with an alternative. Many of our classmates even signed a petition against us, publicizing their disapproval of what we were trying to do.
In the end, an alternative surgical track was established for us. All eight of us completed our surgery course with flying colors. In fact, during my surgical rotation my senior year, one of the soft-tissue surgeons commented that my surgical technique was so strong I should consider applying for a surgical residency.
Since then, many vet schools in the country have banned the practice of buying student surgery dogs from disreputable dealers. Veterinary programs like the alternative track we helped establish at our school are increasingly becoming the norm.