Aural hematomas. Anyone I interact with in real life (and some people I don’t see that often these days) are already very much aware of my sentiment here. Normally, I forget all about them. Most days, my least favorite appointment to see on the schedule is cat diarrhea. (Sorry to anyone reading with an adult cat with diarrhea: this is your life now. It will never get better.) Right now, if an aural hematoma turns up on my schedule, I may be found in a corner crying. I predict PTSD for the foreseeable future.
To be clear, I have never liked aural hematomas. They are difficult to manage. As my (sadly, former) colleague pointed out to me this morning, “I swear hematomas are ‘damned if you do, damned if you don’t’ situations.” The reason they are on my radar and considered my personal hell at this moment is that Rook has one. Treatment is not going well. This hematoma brought me to tears in the doctors’ office yesterday morning. Today, I am trying to come to terms with my defeat and accept that the hematoma has won the war.
It all began while half-watching the Super Bowl. Rook was in my face, as is his custom, and I was playing with his normally smooth and silky hound-dog ears, as I so often do. I got to the end of his left ear, looked at him and very seriously asked, “why is your ear fat?!” You see, aural hematomas are frequently, although not always, associated with ear infections and the excessive head shaking +/- scratching that accompanies them. Rook is turning 12 in May. He has no history of allergies. He has never had an ear infection in his life. He and Magic are wild animals, so perhaps there was trauma, although we can’t say for certain.
One valid treatment for a hematoma like Rook’s is benign neglect. It’s relatively small and at the tip of his ear pinna. If you just leave it alone, his body will eventually resorb the blood that has pooled there, and he’ll have a crinkly ear but be otherwise just fine. He did not care about this hematoma. His mother, however, could not stop thinking about it, being irritated by its presence and poking and prodding it. If he belonged to a client, I would have recommended leaving it alone, but because I am a crazy person, I could not do that.
For three consecutive days, I brought him to work, drained (or at least attempted to drain) the hematoma, injected steroids into it and used the cold laser on it. After day one, it was half the size. No change on days 2 or 3, so I decided to leave it be and see how things progressed.
It got bigger over the weekend. I took him to surgery last Wednesday, cut open his ear, drained and flushed it, and placed through-and-through sutures in his ear at the site of the hematoma. I made him wear his No Flap Ear Wrap more consistently. I started using the laser daily. It looked great for 2 days.
Last Saturday, his ear was puffy again. Sunday, it was red and hot and bigger still. Some believe oral steroids help. I have never had success with them and generally try not to give dogs steroids unless they really need them. I had avoided using an NSAID post-op, just in case I decided to give oral steroids a go. Sunday, he needed an anti-inflammatory. Carprofen was all I had on hand, so NSAIDs it was, along with cold compressing. I tried an acupuncture session. Rook normally doesn’t really enjoy acupuncture, but he actually was very relaxed during and afterwards this time around It did not, however, help reduce his ear swelling.
On Tuesday, I got the opinion of one of my colleagues. She used to do this surgery all the time and swears she usually had good outcomes. Another of my colleagues tells me the same thing. I performed it once before on a cat, years ago, and it was the prettiest resolution to an aural hematoma I’ve ever had. My colleague said if this was her patient, she would open the granulation tissue at my surgical site and keep it open for as long as it wanted to drain.
I opted to try this approach. I opened it back up at lunch time, much to Rookie’s displeasure. His ear was almost flat following my attempt. Great. Everything will be great from here. Fast forward approximately 5 hours…
We get home. I remove his “hat,” as we have been calling it. The incision has granulated in again and is closed. I try to massage around it and separate it manually. No luck. I try a warm compress, and all I get is some mild drainage from around two of the sutures I have placed in the ear. Same thing with another warm compress at bedtime.
Yesterday morning, same result with the warm compress. The ear is, of course, more swollen again. I get to work, and my colleague asks how things are going. Cue my frustrated tears.
The whole situation, tears included, is ridiculous. It a hematoma. My dog is not dying. He will be fine. It will heal eventually, in some capacity. However, I am absolutely dying inside for several reasons: 1. He should not have a hematoma. He should never have had a hematoma. 2. I have tried almost everything I can try to treat it (the exceptions being oral steroids and placing a drain, which I thought about before deciding instead to try reopening the incision on Tuesday). 3. I feel like I am absolutely torturing my dog and that every single decision I have made about treating this stupid problem in the past two and a half weeks has been 1000% wrong. Yesterday afternoon, I came home from work in the late afternoon to take the dogs out before evening appointments. We came in from our walk, and Rook began full-body trembling before I even removed his leash because he expected me to do something to his ear immediately afterwards.
That brings us to today. He got both of his ears free of his hat overnight. His ear is more swollen this morning than yesterday with no evidence that it would drain anywhere if I even wanted to try another warm compress (which I don’t because I don’t want my dog to hate me forever). Could I still try and place a drain? Sure. I also don’t want him to hate coming to work or to hate all of my techs. He is fine. He is still handsome. It is just going to take even longer to heal than I want, and he will definitely have a wrinkled left ear when this is all finally over and done. It is all incredibly aggravating.
I am done with aural hematomas. If I never see another one, it will be too soon. I hate them with the fire of a thousand suns. Cat diarrhea has, at least temporarily, been dethroned as the worst appointment to see. (Ferne, do not get any ideas, or you are moving to the shed.) Thanks for taking the time to read my rant. Send healing thoughts for Rookster and calming thoughts for me.
The End.
“I have not failed. I’ve just found 10,000 ways that won’t work.” ~ Thomas A. Edison
