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Ear cleaning can be incredibly important for dogs with ear infections and allergies. Pet owners may struggle with ear cleaning if the dog is fearful or painful. In this episode, Dr. Amy Pike, veterinary behavior specialist, discusses cooperative care techniques for low stress ear cleanings. This episode is a great resource if your dog has ever had an ear infection and you are looking for a method that decreases pain and anxiety for everyone involved.

Welcome Dr. Amy Pike, veterinary behavior specialist!

Dr. Amy Pike and Walter, the dog.

[00:01:06] Dr. Lancellotti: Welcome, everyone, to today’s episode of Your Vet Wants You To Know. I am so excited for today’s topic, which is cooperative care and ear treatments. This is really important for a lot of the pet owners that I talk to on a daily basis. Today, I’ve got with me an amazing behaviorist, who I first heard speak at one of our North American Veterinary Dermatology Forum conferences. She is just such a great wealth of information. Welcome to the show, Dr. Amy Pike.

[00:01:36] Dr. Pike: Thanks for having me.

[00:01:37] Dr. Lancellotti: Tell our listeners a little bit about your background and where you’re coming from as a veterinary behaviorist.

[00:01:44] Dr. Pike: I went to veterinary school in Colorado State and afterwards joined the Army as an Army veterinarian back in 2003-2004. I’m headed on 20 years out of vet school, this year. But this was the first wave of dogs being deployed to Iraq and Afghanistan, and several of my dogs came back having been involved in a roadside bomb incident, developing a post-traumatic stress disorder from that. Finding out that we could treat PTSD (not only in humans, but in our pet patients) was just mind-blowing to me, and we were able to give these girls better quality of life after their incident. I was like, “I have to do this for a living,” so I did a residency under the mentorship of Dr. Debbie Horowitz out of St. Louis, and the rest is history.

An Ear Infection From the Pool

[00:02:59] Dr. Lancellotti: You have a dog that is specific to this topic. Tell me a little bit about your dog and what your relationship has been like.

[00:03:07] Dr. Pike: Yeah. I think all of us have a breed that we either want all of or just adore and mine are Giant Schnauzers. So I now have a Giant Schnauzer named, Ike. Actually his true name is Dwight D Eisen-Schnauzer. We name all of our giants after presidents. And when this little dude came to me, as a puppy, I took him to the pool closing (all of the local pools around here close at the end of the year, and on the very last day, dogs get to come- which is really cool) when he was like 4-5 months old. I went with some colleagues from the specialty hospital (where I worked), and one of the surgeons that I worked with has had golden retrievers his entire life. And how you teach ‘goldens’ to swim is to just throw them in the pool and they start swimming. Well, guess what? Giant Schnauzers don’t do that. So he literally threw Ike into the pool and Ike sank to the bottom.

[00:04:03] Dr. Lancellotti: Oh no!

[00:04:04] Dr. Pike: I know. It was terrible. I couldn’t stop it before it happened, unfortunately. So he got water in his ears and subsequent raging ear infections that were very difficult to treat. He has had issues with his ears ever since, so I’ve had to work with him a lot and am constantly working with him to make sure that we maintain these behaviors, should (God forbid) he get another ear infection, which (knock on wood) has not happened.

[00:04:33] Dr. Lancellotti: Well. You are the perfect person to come on and talk about this topic, because not only do you have a lot of information as a specialist, but you’ve gone through this as a pet owner, as well. And I talk to clients all the time about my dog, Russell Sprout, because he’s had ear infections, he has allergies, Cushing’s disease, and he has behavior issues. It’s helpful to be able to relate to pet owners as one, yourself. I tell people, “I’m not asking you to do anything more than I’ve already done for my pet at home.” So, it’s really helpful to have that personal experience.

Swimming can be a predisposing factor to dog ear infections.

Cooperative Care for Vet Visits

Dr. Lancellotti: Do you have any specific patients that you think of when talking about cooperative care, ear handling, and things like that?

[00:05:14] Dr. Pike: Yeah. One of my absolute favorite patients is a Rotty, who came to me at about 6 months of age. Her name is Sergeant Daisy Mae. She goes by Daisy Mae, but she’s got a full name there. She had come to me because the owners had recently been to the veterinary office and it took five people to hold Daisy Mae down (as a six month old Rottweiler) to get a nail trim. And as the owners knew (because they were experienced Rotty owners), this was only going to get worse, so we had to start working with her on cooperative care. We taught her a ‘start button’ behavior (which we’re going to talk about today) and now she’s able to go to the vet. She performs her little ‘start button’ behavior and gets her full physical. She can have vaccines, blood draw, etc, but she is muzzled for safety purposes, and that is something that I absolutely recommend. She does fantastic now, at 5 years old, and actually loves coming to see us and her primary care vet too.

[00:06:14] Dr. Lancellotti: Oh, that’s great. Especially, after having a tough experience like that, for her to be able to come so far and completely turn around and actually enjoy getting that full medical care that we can give to animals when they’re comfortable.

[00:06:27] Dr. Pike: Yeah, it’s amazing.

How to Teach Your Dog to Clean Their Ears

[00:06:28] Dr. Lancellotti: I ask my clients to do a lot of ear medications and ear cleaning at home. I see tons of animals with ear infections as a veterinary dermatologist. But in order for them to do those treatments, the pets have to learn to be comfortable with the owners doing it. Can you talk to me a little bit about the different types of learning in pets and how we can use these different learning styles when we’re teaching cooperative care?

[00:06:53] Dr. Pike: There are a number of different learning styles that go across all animals. All animals, including humans, learn the same way. But when we’re talking about ear cleaning and things like this, dogs can habituate (get used to something over time, so there’s no real effort by the owner or the pet), but this is really unlikely to happen unless the stimulus (what they have to get used to) is really strong. If they already have issues with handling, or their ears are already painful from an ear infection, habituation is unlikely to take place. So these animals need to learn through desensitization and counter conditioning, which are strict protocols of teaching the dog that ear cleaning isn’t a big deal. And we use food in order to do that, because that’s how we’re going to change emotions in our animals. Food is a primary reinforcer in animals in the same way that money is a primary reinforcer in humans. You go to your job and you get paid for it, right? How much ear cleaning has been problematic in the past and how painful those ears are will both determine how long this process takes. It can take a while, for some of these animals, if they’ve had a lot of traumatic experiences.

[00:08:08] Dr. Lancellotti: Yeah, absolutely. The worse they associate ear cleanings to be, the longer it’s going to take to change that association. But you’re absolutely right. Food is a big driver for these animals to work on creating that positive association.

[00:08:23] Dr. Pike: Yeah. Absolutely.

Dog getting a treat
Make sure to use lots of rewards when training cooperative care.

Train your dog to wear a basket muzzle

[00:08:24] Dr. Lancellotti: As much as I love my allergic dog, Russell Sprout, he has been a struggle for me with some of his behavior, including for ear treatments, when he first started to get ear infections. If we do something that he’s not comfortable with, he gives us very little warning before he turns around and tries to bite. It’s not as big of a deal for Russell because he’s like 14 or 15 pounds. For plenty of other dogs (I’m sure), that would be a big deal (especially, German Shepherds, Rottweilers, etc). Before we go into teaching these behaviors, let’s talk about some safety tips that owners should consider when they’re starting this training process.

[00:09:03] Dr. Pike: We train all of our dogs to wear a basket muzzle from the get-go. In fact, we train puppies in our puppy classes to wear basket muzzles, because you just never know when you might need it as a tool. If something hurts, or you have to get a thorn or a piece of glass out of their paw, or they strain their cranial cruciate ligament (or the ACL from the human standpoint), they have to go into the vet and it’s going to be painful. Dogs will bite when they’re painful or uncomfortable. Training them to wear a basket muzzle is key so that we can safely either train or treat them, so that if we accidentally push beyond what they’re comfortable with, at least we aren’t going to get bitten. Also, as veterinary behaviorists, we use medications like trazodone, gabapentin, clonidine, and our benzodiazepines can and absolutely should be used prior to training or during treatment, if the pet is too fearful for the training to even happen. One of the most common things I hear is, “Oh, my dog isn’t food motivated.” Well, that’s because they’re anxious. Anxiety suppresses appetite in dogs, so if they’re too anxious, they’re not going to take that food and they’re not going to be able to train through this.

[00:10:14] Dr. Lancellotti: Yeah, I love that example so much. And that’s a big reason why I have owners use a lot of medications to decrease anxiety before the animal comes into the exam with me. I want to be able to create a positive association to my office and to me doing a physical exam, and if the animal is too stressed or anxious, they’re not going to be interested in any food that I have to offer them.

[00:10:38] Dr. Pike: Absolutely.

Dog wearing muzzle on its snout
Training your dog to wear a muzzle is a helpful way to provide care, stay safe and give treats.

Anti-anxiety treatments for ear cleaning

[00:11:29] Dr. Lancellotti: There is a previous episode on Gabapentin and Trazodone, specifically, if you want a little bit more information about those medications. But particularly for ears, which can sometimes be really painful, I really like Gabapentin. Not only are we treating the anxiety, we can also decrease some of the pain, which makes these dogs extra anxious.

[00:11:49] Dr. Pike: Exactly. I love Gabapentin. I call it my “double duty medication.”

[00:11:54] Dr. Lancellotti: Nice!

What is a start button behavior in cooperative care

Dr. Lancellotti: So I really love the concept of cooperative care and the pet as this willing, active participant in their treatments. I find that it’s so much easier than having the owners try and chase the pet down and forcefully hold them still to accomplish medical treatments at home. Tell us a little bit about how to begin cooperative care and what a ‘start button’ behavior is.

[00:12:18] Dr. Pike: ‘Start button’ behavior is a way for the pet to basically opt in or out of training and treatment. Basically, if the dog is willing to participate, they’re going to perform that ‘start button’ behavior, and if they aren’t, then they’re going to say, “No thanks,” by walking away. So it teaches the pet that they have options that don’t involve aggression as a behavioral strategy. Some of the most common ‘start button’ behaviors that we use are settling on a mat, or a ‘chin rest’ behavior, where the dog places its chin in your hand or on your lap. If the dog is unwilling, then they’re saying, “No thanks. I don’t really want to do that, today. Either I’m too anxious, the environmental setup is not appropriate, or maybe I’m too painful.” So that also gives us information about what’s going on with the animal.

[00:13:03] Dr. Lancellotti: Yeah, I love the ‘start button’ behavior. I try to have my technicians (or myself even) work on starting this and giving the owners the tools to make that first step while we’re still in the vet’s office. I’m just training the dog to be okay with me putting my hand underneath its chin. Then, it’s going to get a treat. Eventually, the dog starts to associate, “Okay. If my chin is on the hand, I’m going to get a treat.” It’s a start button behavior, but it is as simple as beginning with just touching the animal and making sure the animal’s comfortable with that specific touch. But I love the chin rest. I think that’s an excellent ‘start button’ behavior.

[00:13:39] Dr. Pike: Yeah. It works great. When the animal’s on the table, that’s a really nice one to use.

Dog rests chin in person's hands
Chin rest is a simple start button behavior for your dog when doing cooperative care ear cleaning.

How to clean your dog's ears

[00:13:44] Dr. Lancellotti: So once an animal is comfortable offering these ‘start button’ behaviors, how do we build on those behaviors and incorporate ear treatments?

[00:13:53] Dr. Pike: You have to break the entire process down into the tiniest little steps. So the first step may just be merely working on that ‘start button’ behavior with the ear cleaner present beside you. Or maybe if the dog is so nervous about that ear cleaner bottle (because they’ve seen it so many times before and they know what’s going to happen when it’s there), you might actually have to put it all the way across the room. Next, you’re going to start by moving your hand closer to the ear flap, and once they’re comfortable with you touching and lifting the ear flap, then you incorporate touching the ear cleaner with the other hand, slowly moving it closer and closer to the dog. If at any time the pet gets upset or breaks the ‘start button’ behavior, you will need to go back a few steps until they’re totally comfortable with the process prior to that breakdown point. It can be really time consuming, which is why it’s so important to train these types of handling behaviors before you need them- like when they’re puppies.

[00:14:48] Dr. Lancellotti: Absolutely. If they’re already used to it, they’re not going to have as much of a concern when you start to do these behaviors with actual medical treatments. Sometimes, I will tell pet owners who have animals that are reactive to the bottle as a source of stress to take a big chunk of some rolled cotton from the bandage section of the pharmacy and just soak it with the ear cleaner, using that to gently press up against the dog’s ear canal, rather than trying to get the dog comfortable with squirting the ear solution directly from the bottle. Some of those animals find that the bottle of ear cleaner is enough to trigger a major stress response. But you’re right. When you’re training them, make sure you’re rewarding calm acceptance of what you’re asking them to do, rather than ‘escape’ behaviors. If the dog’s walking away, that’s the dog telling you, “Alright. I’m done for right now.” You just have to take a step back and work on the last step that the animal was comfortable with before trying to progress further.

[00:16:00] Dr. Pike: Exactly. Some people want to push way too fast, myself included.

[00:16:04] Dr. Lancellotti: Yeah.

[00:16:04] Dr. Pike: Especially, with my own pets. I know their limits much more than I do with my patients, so I tend to push a little bit too hard, sometimes. I have to remind myself to go slow.

How long should I train ear cleaning with my dog?

[00:16:15] Dr. Lancellotti: Speaking of pushing a little bit too hard- the length of the training session is important to keep in mind, as well. A lot of people want to do as much training as absolutely possible, but these animals learn better if it’s in very short training sessions. How long would you recommend an owner actually work on a behavior for in one sitting?

[00:16:35] Dr. Pike: 5-10 minutes, at most. There’s research that shows that multiple 5-10 minute sessions per week, versus just one long session, is going to be much more effective.

[00:16:47] Dr. Lancellotti: Yeah, the animal can focus well during that short period of time. They’re not getting overwhelmed. It’s just a quick little thing. You can squeeze in 5 or 10 minutes throughout your day, making your life a lot easier in the long run.

[00:16:59] Dr. Pike: Absolutely.

How can I best train my dog?

[00:17:00] Dr. Lancellotti: What are some of the big takeaway points that you’d like pet owners to remember about cooperative care, particularly with ear cleanings?

[00:17:07] Dr. Pike: I really can’t stress enough how important puppy socialization classes that focus on handling are, so that later on, treatments for these dogs won’t be so scary. And if the owners are struggling to treat the pets for anything (ears, foot soaks, insulin injections, etc.), a referral to a veterinary behaviorist or a qualified positive reinforcement trainer is so key (sooner than later) because you can sensitize them, versus desensitize them- making them get worse, versus better. And that can be a point of no return for some of these pets.

[00:17:40] Dr. Lancellotti: Yeah. We want to catch those behaviors, early on, so that we can work on training what we want the animal to be doing, making them a lot more comfortable with things that are going to make their life better.

[00:17:50] Dr. Pike: Exactly.

How can I learn more about cooperative care for my dog?

[00:17:51] Dr. Lancellotti: Dr. Pike, you did a webinar about cooperative care for pet owners. Can you tell us a little bit about this?

[00:17:58] Dr. Pike: Yeah. I gave a webinar on this very topic called Low Stress Handling For The Home. There are tons of videos of Ike and my mini Schnauzer, Scooby, doing some cooperative care types of things. It’s a really good resource that owners can watch and get the foundations for how to start and to know what exactly I am talking about. I can talk about this all day long, but sometimes, a video is worth a thousand words.

[00:18:26]Dr. Lancellotti: I’ll have the link to that webinar on the website. As far as being able to handle your pet at home, a lot of family veterinarians are comfortable managing behavioral problems, but the link to find a veterinary behaviorist near you is on the website under the resources tab, if you’d like to consult with a specialist. There is also a link to find a veterinary dermatologist near you, if you’ve been struggling with skin or ear infections in your pet. You can view the references for today’s show in the show notes on the website, as well. We have a Facebook group, Your Vet Wants You To Know. You can join us and tell us about your experience with using cooperative care and how you’ve been able to work on ear treatments at home. We’d love to have you join this support network of pet owners.

Scratching the Itch

[00:19:13]Dr. Lancellotti: I like to end each episode with a segment called Scratching the Itch. This segment is designed to highlight something- either a human interest story, a product, or a website- something that provides relief or just makes you feel good. Hence, scratching the itch. Dr. Pike, do you have a ‘scratching the itch’ for our listeners, today?

[00:19:32] Dr. Pike: I do. So, everything in veterinary behavior really comes down to understanding our pets. Lily Chin, who’s quite famous for some of her drawings (whether they be commercially or on posters that many veterinary behaviorists use), has come out with one book and another one is coming soon. Her book is called “Doggy Language” and inside, there is a pictorial guide to help owners understand and communicate with their best dog friend. “Kitty Language” is coming soon and you can pre-order it now. I believe it will be out this summer.

[00:20:07] Dr. Lancellotti: Oh, that’s so exciting! It’s a great resource for pet owners who want to understand a little bit more about their animal’s behavior.

[00:20:14] Dr. Pike: Exactly.

[00:20:15] Dr. Lancellotti: Great. Thanks so much for sharing that with us.

[00:20:17] Dr. Pike: Yeah, you’re welcome.

[00:20:18] Dr. Lancellotti: And thank you so much for taking the time to join us, to talk to the listeners and make their lives easier at home. I really appreciate your time.

[00:20:25] Dr. Pike: Yeah. Thanks for having me. It was great fun.

[00:20:27] Dr. Lancellotti: And for everyone listening, I look forward to your next visit with Your Vet Wants You To Know.

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