Ear Infection Cases

Just writing with an update on Liberty, under the care of your former student, Dr. Casey.  We have followed your advice. She has been on Lift the Qi since August 31. She had been on plant sterols and her ear looked great.  After she was weaned off those, she developed what I thought was another severe ear infection about a week ago. Pain and inflammation. I gave her some herbs for pain and inflammation at home as I couldn't get in to see Dr. Casey until yesterday. Surprisingly, it was only inflammation ....no infection, but a very small amount of yeast.  She also had a very bad case of conjunctivitis which we are treating with Neo Poly Dex Ophth. Dr. Casey also put her on Sodium Butyrate which she started on August 25. Se continues to take Cessorex and Halscion.  She is on a 10 day course of prednisone now.  Yesterday she suggested a trial of cyclosporin which I so do not want to do. But nothing we have tried has worked long term.  She told me she has several dogs that the cyclopsporin has helped without long term effects. I'm so afraid of giving an immune suppressant but feel like I have to try. I don't want to do another ear ablation on her. I was reading Dr. Judy Morgan's new book last night and felt a little better when she stated that some dogs have to be on immune suppresants. I'm so torn. Do you think it's too early to stop the LIfit the Qi...Dr. Casey said to give it two months and it's only been one. Other thoughts??  I'm so thankful for Dr. Casey's guidance with Liberty. She spends so much time with me at each appointment and answers every question. Yesterday's appointment was my 115th claim to my pet insurance...and she just turned three!!

Dr. Steve's Advice - if the ears aren't growing anything, then it's not an immune deficiency anymore. If it's pure inflammation, then the Lift the Qi may have outlived its usefulness and you might want to take a break from it, so it doesn't contribute to any revving of the immune system.

Instead, I would obtain Cool the Blood from the same place as you got Lift the Qi and give that a try. It's a more aggressive anti-inflammatory.

As always, use a probiotic containing Lactobacillus, and ensure that your real fresh food diet contains at least a fifth - maybe even a quarter - by volume of plant material to support the bacteria in their efforts to modulate the immune system and inflammatory response.

Hopefully your vet will agree with that advice. If you have to give an immune suppressant, and pred isn't working, then cyclosporine is better than Apoquel for sure.

If the pred is helping a lot, but your dog is reliant on it, instead of Cool the Blood, try Four Marvels from Kan Essentials and see if that helps. Especially use it if there are side effects from the pred use

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Hi Dr Steve, this is our 2 year old Newfiedoodle, Ruger. He has had an ongoing ear infection we just can't kick. We tried homeopathy, medicated flush, zymox, and then an antibiotic pack. We see an integrative vet but the ear infection was pretty bad when we went so they went ahead and did the pack. He also had a skin irritation that we treated with a cream. He went back a few weeks later and it had all seemed to clear up and he was neutered.

We started off feeding him raw food until around 1.5 years old and we switched to dry food. When we went in for the ear infection we started a crockpot diet feeding the amount the vet recommended. He lost about 15lbs and we doubled how much he was eating. We also cut out all meat aside from pork for now to see if there's a food allergy. He has not gained the weight back yet.

His ear infection came back, had it cultured, they flushed it with ozone, put an ear pack in. We are going back for a more specific antibiotic as the culture showed 4 different strains of bacteria. His pupis and skin was also irritated/infected. They rinsed both with ozone. They also put him on an oral antibiotic, probiotic, mushroom blends, pre/probiotic spray for his skin.

We decided to neuter him because he was very hyperactive and would nervous pee often. We were moving into an RV and expecting a baby and needed to curb both of those. He still nervous pees often. The last time he was groomed he peed a ton, three different times and they said to mention it to his vet.

I have no idea why he's having such a hard time with his immune system and what is going on or how to fix it. The vet said it could take two months to get his ear cleared up but I'm more wondering the why and how to prevent it from coming back.

Dr. Steve's Advice - it's not clear from your post if your boy is still on raw, but if he is, the weight loss suggests he is a 'carb dependent' dog and will need at least a small amount of cooked grain in his food, like oatmeal or barley. You should probably also be adding some vegetables and or fruit. 

Carb dependent dogs are the ones that appear to have evolved to need support from their microbiome to control their immune systems. Probiotics containing Lactobacillus and Bacteroides can help re-establish those healthy bacteria, especially if given along with an immune stimulant of some type.

If the ear is relentless despite the use of real food diets, step 1 so far as supplements are concerned is to try Cessorex      (https://goldstandardherbs.com/products/Original-Cessorex-85g-p647327434) from Gold Standard Herbs to start boosting local immunity, helping shift the microbiome, and calming any overactive systemic immune system. If the ear has flared while he's been on kibble, and he's not eating real food, then the first step is to try to get him off kibble. Even freeze-dried food would likely be better than kibble.

Regarding the urination, Cessorex may address that as well, or you may need to team it with Lift the Qi Combination by Kan Essentials. The latter can be found online usually, at Amazon if you're in the US. I wouldn't use it while the ear looks especially inflamed, though, but only after the inflammation has died down, so its powerful immune stimulating problems don't aggravate the ear. In addition to helping the ear, Lift the Qi can greatly help inappropriate urination in anxious animals.

Hope this helps you out!

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We've been battling a Psudomonis bacterial infection of the ears for some time now. It took 4 different vets to finally swab and find out what it actually was.  We are finally seeing some good progress after switching antibiotics. (Gentromycin injections and ear drops) I also give herbal biofilm busters, binders, and probiotics made to go with antibiotics to protect the gut. We tried the homeopathy route prior to the antibiotics with no success. Her ears no longer have black tar discharge and ear color looks good again. Our regular vet also has her on prednisone which I hate having to do but with out it she starts itching and chewing on herself aggressively and doesn't sleep at night. I believe this may be a seperate issue from the bacterial infection ? The itching has been an issue since she was a puppy after her vaccines were given. I've been trying to go to every other day desperately trying to get her off of the prednisone but I can't see that happening right now. She is starting to lose some fur on her elbows and back feet.She also is thirsty and hungry all the time, has accidents while sleeping or if she is not let out enough. Is there anything else I can give other than prednisone? Any natural alternative? I suspect she may have some sort of autoimmune issue on top of the infection. The vet checked thyroid. We have done elimination diet and allergy panel so I don't think we're dealing with allergies. She is raw fed 80/10/10 for 4 years. We have spent so much $ on this dog and she is still itching and miserable as soon as she goes of the medication. I just want her to feel better without taking a bunch of gross medication with so many side effects if possible. 

We have 5 more of the antibiotic injections and then will be re-evaluating what  the plan is. 

Any advice would be greatly appreciated.

Dr. Steve's Advice - the immune system is generally at the bottom of skin and ear problems in a raw fed dog with chronic skin and ear issues. The two possibilities are immune deficiency or immune excess. If the Pseudomonas only showed up once the pred was on board, then your dog is likely immune deficient. It sounds from your description, though, that pred has not aggravated the ear inflammation and infection, and has only been helpful. In that case, the dog has an immune excess, regardless of what elimination diets and allergy panels have shown. 

Allergies are really just leaky gut situations, in which the immune system is over-reacting to everything as a result of being prodded into a panic state by too much exposure to gut microflora, not food antigens. There isn't really a test for detecting antibodies to gut microflora, so many dogs get presumed to not be allergic, when they really are. The inflammation in the skin that results from the immune excitation secondary to leaky gut is cell-mediated, not antibody-mediated, so likewise it can't be ruled out by the tests people are using.

If this were my dog, I would use Cessorex (https://goldstandardherbs.com/products/Original-Cessorex-85g-p647327434) by Gold Standard Herbs and I would further add soluble fiber and fermentable carbs to the raw food to better support the probiotics you're using. Make sure the probiotics contain species known to help regulate the immune system, including Lactobacillus and/or Bacteroides.

If your dog is currently itchy even on the pred, but then improves after a couple of weeks on Cessorex, you can start slowly lowering the pred dose. Every time you lower the dose, the itch will flare a bit, but then continued use of the Cessorex should resolve it, allowing you to slowly wean your dog all the way off pred. The Cessorex will likely also help prevent the otitis from coming back.

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Five year old male aussiedoodle, neutered at age 2, raised by a breeder who fed raw/high quality food, only given puppy vax- titered and no additional vax since, came to live with us about three years ago. No flea/tick/heartworm meds given (he's tested every 6 mo). He's had recurrent ear issues ever since we got him. He will scratch and shake his head and whimper and clearly is in discomfort at times. There's often brown, rusty gunk in his ear. We've done an otic ear solution before, but it never really seems to get rid of the issue. Vets have had difficulty getting cultures because he's very high anxiety, but pictured are the most recent results which show two strains of staph.He's definitely Water personality. He's been tested for allergies via blood test and does not eat anything that came back positive (sweet potato, peanut, milk, pork). Recently switched from Allprovide Beef to Viva Raw Chicken due to beef possibly being part of the problem (Trying a protein I've never fed him and trying to see if the "cheaper" proteins will work first as we are trying to stay within a budget. We have spent soooo much money already.)The TCVM/holistic vets that we have used are both at least a two hour drive from our home and this little guy gets car sick, so it's tough to transport him.The mobile vet that took this recent culture recommended antibiotic/steriod otic solution which also has ketoconazole for the yeast. He can't get Amikacin, but wanted to try Florfenical (2nd/3rd gen to the chloramphenicol listed on the sensitivity results). I do not want to use this antibiotic/steroid unless it is absolutely necessary and also asked for experience/advice in Dr. Judy Morgan's group. Based on reccs from there, I'm currently doing SilverSol from Adored Beast in his ear 2-3x/day and using a little witch hazel in between applications to clean. Also using Adored Beast Gut Soothe and Long Dan Xie Gan Wan (Dr Judy's suggestion). Someone there suggested I also ask you, Dr. Steve. So, my main questions are:

1. What's your opinion of the interventions we are doing now (diet change, silver, herb, gut support)

2. How long should we wait before changing/adding anything else to assess if any of this is working?3. How likely is it that once we get his ear issue resolved that the car sickness issue might be resolved? Thank you so much!

Dr. Steve's Advice - the herbal formula you're using treats Liver Damp Heat causing Liver Fire. In the past, I might have tried the same thing myself, but dogs on raw diets almost never experience Damp Heat. Damp Heat is essentially a moniker for 'inflammation caused by too much food'. Too much food is facilitated by the feeding of processed diets or ones that are too high in calories. Raw diets, unless very high in fat, don't cause this. I don't see a guaranteed analysis on the Viva page, but given the number of raw foods you've used over the years, it's hard to imagine that all of them would be high in fat. So we're looking at something else.

More than likely, your dog is lacking immune modulating species in its microbiome that control the immune system and prevent leaky gut. This makes the situation ripe for the systemic immune system getting too good a look at the bugs in the gut, getting nervous, and then overreacting. Every inflammatory response going on at the moment gets ramped up as a result of that nervousness, whereas without the priming of the immune system, you might not see a visible inflammatory response at all.

Why would these species be lacking? They can't survive on strict raw diets. Even if those species (namely Lactobacillus and Bacteroides) are in the Adored Beast product, they are likely dying immediately as they have nothing to eat. Those species are reliant on soluble fiber and fermentable carbohydrates to do their good works, none of which are in raw meat diets. Ensure that 1/5 to 1/6 of the diet at least is composed of vegetables, beans, berries or cooked whole grain to help your probiotic get established. Make sure the Adored Beast has at least one of those species. If not, get a hold of something like Gussys Gut: https://gussysgut.pxf.io/c/4643206/1738316/19832

Herbally, I would use two Kan Essentials products; Harmonize the Qi, and Lift the Qi. You can get bonafide versions of those from Aleksandra Topic at aleks.topic1@gmail.com. The first product will help temper excess systemic immune responses. The second will help rally the local immune response in your dog's ears to conquer any overgrowth.

Lastly, I would get a 0.2% chlorhexidine ear wash, and to about 10 oz of it, add 1 ml of tea tree oil. That will provide broad spectrum antimicrobial activity without getting into some bizarre and potentially more dangerous antibiotics. The topical colloidal silver is fine to use with it, but the ear wash is more broad spectrum and reliable.

How long to see improvements once the above is instituted? Hopefully just two or three weeks. How long it takes to resolve is up to your dog. The herbs will help reduce anxiety and nausea in the car, so if you have to go see your holistic vets, your dog should be a bit more tolerant of the car ride. Hopefully that won't be necessary though.

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Bear is our beloved 4 year old, 75 pound male Standard Poodle, who has had ear infections over and over since he was six months old.  He has been fed a commercially prepared 80/10/10 raw ground diet since he was 11 weeks old - predominantly grass fed beef, but rotated with pastured turkey or chicken as well.

At age 6 mos., he was groomed by someone new to us, and without consulting us, she plucked all the hair from his ears.  When I picked him up, he was shaking his head constantly.  We got him in to our holistic vet the next day, and it took 3 more visits and treatments to resolve the acute inflammation from that event.  Over the next couple of years, we tried many different ear meds.  Bear has very, very hairy ears, and our vet determined that it would probably be necessary to deep clean and remove hair under sedation several times/year.  In Oct. 2021, the holistic vet was out of the country, and Bear had a raging ear infection.  We took him to a conventional vet close to us.  At our request, she did cytology and confirmed it was bacterial as well as yeast overgrowth.  Over the course of several months, she treated Bear, changing meds and repeating cytology.  In Feb. of this year, she referred us to a canine Dermatologist.  Bear was a patient of the Dermatologist from early March to late July, 2022.  He was prescribed several different meds, lots of labs, a CT of his skull, and a video otoscopy with deep cleaning.  Cytology was done at every appointment.  Prednisone was prescribed as well as Cyclavance.

In early June, the Dermatologist prescribed a strict 8 week diet trial using Purina Pro Plan Elemental.  My instincts were very much against this, but she was insistent.  Mid way of the trial, we had a normal result from cytology.  We resumed his raw diet at end of trial.  Due to philosophical differences, we determined NOT to continue with the Dermatologist.  We discontinued the Cyclavance (which bear absolutely hated taking) and tapered off the prednisone as previously directed.

We began Dr. Peter Dobias' published protocol of liver cleanse and detox.  Bear was doing very, very well until last week of September.  He began producing chunks of black wax in both ears.  We asked our conventional vet to flush his ears, and began using 8 drops of Zn4.5 Otic as indicated in the Dobias protocol.  The ears improved over 3 days, but then worsened.  Bear was then producing a great deal of liquid and his ears became very inflamed.  I have ordered Cessorex - expecting delivery this week.  I sill have some 20 mg prednisone on hand.  Should we resume?  Bear is 75 lbs - dosage?

Thank you for any help you can give us.  Bear is taking Dr. Dobias' "Fab 4" supplements, which includes a pre and probiotic.  Bear's photo included.  You would love him... everyone does!

Dr. Steve's Advice - The worsening you're seeing in late September and October each year is consistent with an allergy. Sometimes these only affect the ears and can be associated with yeast or bacterial overgrowth. The fact that he only improved when the immune suppressant drugs were prescribed also suggests this is an allergy.

If that is the case, Cessorex should help. Hopefully you've received it by now. I'm not clear what an 80/10/10 raw diet is, but you should make sure you have ample fruits and vegetables in there (excluding grapes), to make up perhaps a sixth of what is in the dish. As well, you should supply a probiotic like Lactobacillus.

Topically clean the ears as needed while you wait for that to kick in. I just use 10 oz of chlorhexidine to which 1 ml of tea tree oil is added. I fill the ears to the brim once a day (assuming the eardrum is still intact after all those infections), and then massage it in. Let him shake, wipe away what comes out to the surface, and the repeat the next day.

The Cessorex may need a few weeks to show that it is working. I will be surprised if it does not. Meanwhile, if your dog is going crazy, you can also use 20 mg pred as needed. I'd probably start once a day, so that it doesn't mask the symptoms completely. If and when the Cessorex kicks in, you'll start to see the itch subside. Once it's gone, go to every other day with the pred. At that point, the itch will come back for a bit, but then slowly abate. Once it's gone yet again, you can stop the pred hopefully for good.

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My 3 year old Golden Retriever has had one yeasty and dark discharge ear for almost a year and half on/off. It’s only in his left ear. Last year he broke out in a full yeasty rash on his chest but has since healed and never came back. He also has what looks like a rash or little bumps on his lips and nose that come and go. Pics of that below. 

I see a homeopathic vet and together we have been trying remedies this whole time, but nothing seems to clear the symptoms for good. (I can list the remedies if that’s of interest to you.) 

I have read your other leaky gut/yeast posts and started him on Cessorex (has been on it for about 15 days), increased his vegetables in his diet (he’s already been on a raw diet since he was about 6 months old), started a probiotic the Four Leaf Rover: soil based probiotic, and give him the second dose of Cessorex in the afternoon in either yogurt or cultured cottage cheese. I also went and bought Clorhexis and am going to add the tee tree oil today to clean the ear with. 

I’m just wondering if there is anything else I can do at this point? I bought a month’s worth of Cessorex so once that’s gone I’m wondering if I should continue or add something new? I haven’t seen much change with the ear yet, it’s still pretty wet and sloshy. 

Thanks for your time!

Dr. Steve's Advice - hopefully you're finally seeing some progress. A formula that sometimes works better for refractory ear issues than Cessorex is Halscion (https://goldstandardherbs.com/products/Original-Halscion-85g-p647327436) by Gold Standard Herbs. Keep that in mind if you're still struggling, but I would hope the chlorhexidine plus tea tree oil has shifted things. 

The other thing to do is have your vet take a look deep inside the ear, in case there is a foreign body like a grass awn in there. It may necessitate sedation to get it out, or even just do a proper exam.

Hope that helps!

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