Dear Tim…

Can you tell me why Wag Friendship Dogs require the Lepto4 vaccine when I’ve heard that the previous one, Lepto2, is better for the dog?
The Lepto 4 vaccine gives protection against more types of Leptospira bacteria than the Lepto 2 vaccine. The latter now has significant gaps in coverage and the Lepto 4 vaccine is strongly advised.  No vaccination is entirely safe (for instance some humans have reactions to vaccinations before holidays)  but the risks are very low and substantially less than the disease. The published data shows that the prevalence of adverse effects is very similar with both vaccines.
Vaccines are used not only to protect the individual but also to give (in the infamous phrase) ‘herd immunity’. This means that the disease declines in prevalence because there are fewer vulnerable individuals that it can circulate in.  This then protects those individuals that can’t be vaccinated including the people we visit. 
While the risk is low the consequences are potentially catastrophic. Zoonotic Leptospira infections do occur – i.e. infections that transfer from dogs to humans – so we must do everything possible to reduce any risks.

Can you give us some advice on ear infections and yeasty ears?

Every dog can have a one-off ear infection. However, recurrent (i.e. repeating) or chronic (i.e. non-resolving) ear infections are always secondary to underlying causes. Simply using medicated ear drops over and over again will never resolve the problem. It is essential that the underlying causes are diagnosed and managed for a successful long-term outcome.

Most dogs have multiple triggers for their ear infections. We divide these into:

  • Primary conditions that trigger the ear inflammation and infections – common problems include atopic dermatitis, food allergies, foreign bodies, ear mites, and (less commonly) tumours, scaling diseases and hormonal problems.
  • Predisposing factors that rarely (if ever) cause the infection by themselves but make ear problems more likely to occur and progress in an individual dog – common factors include pendulous ears, hairy ears, swimming, plucking and over cleaning. Cocker spaniels have a higher density of ceruminous (wax) glands than other breeds – this makes them prone to more rapid and severe ear problems which need addressing quickly.
  • Perpetuating factors that prevent resolution – these are acquired pathological changes such as thickening of the ear canals, increased gland production and discharge, narrowing of the ear canals, ear drum rupture and middle ear infections. These will eventually become so severe that surgery (a total ear canal ablation/TECA) is needed.

Most TECAs are avoidable if the underlying triggers for the ear problems in each dog are identified and managed. This is easier early on before severe chronic changes develop. The approach will vary in each case, but will usually include:

  • A full history and complete clinical examination (not just of the ears).
  • Appropriate tests to diagnose the underlying conditions.
  • Otoscopy and (where necessary) x-rays or CT scans to determine the extent and severity of the chronic changes.
  • An ear flush under anaesthetic to thoroughly clean the ears and remove all the debris.

Treatment is in two phases:

  • Induction to get the ears back to normal. This will normally include drops to manage the infection and inflammation but systemic steroids may be necessary in more severe cases to reverse chronic pathological changes (the perpetuating changes).
  • Maintenance to continue the remission and prevent relapses. This will vary between dogs, but common treatments include:
    • Managing the underlying problems (the primary and predisposing factors).
    • Regular ear cleaning with an appropriate cleaner.
    • Topical steroid drops 1-2 times weekly (Apoquel and Cytopoint are good for itch but much less effective for ear inflammation).

With early intervention and effective treatment the prognosis is good. However, referral to a specialist dermatologist is appropriate for more complex and challenging cases.