There are several subjects discussed in this newsletter. First will be useful info on meetings we have and will attend. Then we will report on Deafness, the Ron Whitford Report and on an handling a Pseudomonas infected wound. Our all new folder and VIN web connection began on 10-1, so fellow VINers should visit us there; please feel free to ask questions about derm cases. For those who want to read previous Newsletters, please go to http://www.dermapet.com.

We sell direct and through select distributors.

We are just back Orlando-the Florida State meeting, and from the Colorado State meeting in Vail where we experienced all 4 seasons -including a surprise snowstorm-in 2 days. We are off to Atlantic City and Reno next week for the Wild West and Atlantic Coast Conference. Then we go to Lancaster for the Pennsylvania meeting.

NEW PRODUCTS- the TrizEDTA will be in a convenient to use 16 ounce clinic size later in October. We are also introducing an entirely new and easy to use turn-of-the-century delivery system due out by Y2K.

For our Canadian friends, Central Sales has just taken on the DermaPet line replacing the Virbac/Allerderm products that they no longer will sell. We have always felt that if looked at closely, DermaPet products match up quite well to DVM and Allerderm . The fact that we have natural products is differentiating point.

I've been writing and lecturing about how our products-DermaPet Ear/skin Cleanser and TrizEDTA are not ototoxic. Now, world experts address this subject. Linda Vogelnest BVSc MACVSc of Sydney, Australia reported on iatrogenic deafness on the Dermatology Listserv. Those of you who wish to join please email me for instructions. There were many replies to my query about sudden deafness following ear flushing or medications ( My questions....how often is sudden onset, profound deafness being seen: 1. After ear flushes - and if so, what agents used for flushing? 2. Associated with any particular otic medications (I have heard directly of one case here in Australia, and reportedly others with Surolan use)? Replies as follow:

A dermatologist from Studio City, CA - I have had only a few cases of sudden deafness in dogs with otitis externa. The most recent, and profound, was in a German Shepherd with chronic otitis externa that became acutely deaf after using a miconazole otic solution. Hearing is slowly coming back over the course of a few months. I cannot say that it was this particular medication -- but the timing was suspect. I still use this drug with tremendous frequency in the treatment of ear disease.

Lynn Schmeitzel, Univ. of TN - I saw one case in a cat. It had been flushed with Chlorhexidine (unknown strength) and treated with Otomax (with gentocin). The cat had vestibular signs, anorexia (probably secondary to the vestibular signs) and was totally deaf. Finally, after bilateral ventral bulla osteotomies and nutritional support, her vestibular signs and anorexia resolved. The deafness persists. At the time our electrophysiologist said he knew of other cases that had gone deaf from Otomax therapy.

Di Lewis, Florida - has seen a few cases of deafness, some temporary and others for over 2 weeks (then euthanized by owner due to multiple problems). This can occur even when water is used for flushing. We routinely use either saline or vinegar and water to flush and have seen deafness. It may be related to the amount of inflammation already in the middle ear and the sensitivity of the structures. I always warn owners that deafness may result and it is usually temporary. When it occurs I use oral pred hoping to decrease inflammation.

Brad Easton, Australian Vet working in Hong Kong - I can report one on case I saw personally. My memory is vivid as owners were threatening legal action etc. Was acute (according to the owner) otitis in a middle aged bull terrier we couldn't examine. Presented for head shaking and little inflammation around the pinna/vertical canal. I elected a short thiopentone/halothane anesthesia (less than 15 minutes) to check the ears for grass seeds (rural area at that time of the year). Instead I saw the horizontal ear canal full of waxy discharge (couldn't visualize either ear drum). I flushed the ear canal GENTLY with very dilute iodine solution (barely orange) through a 1 inch catheter and started on surolan and enrofloxacin (like I'd done many times before). Was surprised to get an abusive phone call a few days later saying the ears were fine but the dog couldn't hear. Was treated with systemic corticosteroids by a colleague (owner refused to ever see me again) and never heard the outcome although the dog was still reported to be deaf months later.

Steve Melman, DermaPet - recommended checking website - specifically both neomycin and miconazole in your Surolan mix will cause ototoxicity. Of course, some will cloud the issue by saying the dog already had a history of ear disease. Erythromycin, salicylic acid, alcohol and all aminoglycosides are ototoxic as well. (I also referred people to my web site http://www.dermapet.com for an article by Mansfield on Ototoxicity)

Also - personal communication with Georgina Child (neurologist) in Australia - hears of perhaps 5-6 cases per year - can be associated with flushing, aural medications, or systemic medications alone - almost any product. Hearing can return after some months in some, but others remain permanently deaf. She recommends flushing with sterile saline is safest agent - and would avoid chlorhexidine or iodine in any dilution.

The Ron Whitford Report We all read Ron's monthly column in Vet Forum and have heard him speak virtually at every major and minor meeting on Veterinary Business.

The following is on a Pseudomonas infected wound being handled by a veterinary dermatologist who will be using TrizEDTA as a flushing solution. This solution, perhaps with antibiotics added, can also be used for abscesses especially in cats.

I have a 12 year old, male-castrate Australian shepherd with a three month history of festering wounds on the left aspect of the chest and left foreleg. Consistent care by the owner has been sorely lacking. Therefore the veterinarian had treated the case with cephalexin and prednisone for the past three months -- until the disease continued to worsen, and the dog became septic and recumbent (and then was referred).

At presentation, the dog was recumbent with pressure wounds on its right side, corneal abrasions, and facial swelling. A large (10 cm by 20 cm) open, odiferous, purulent and swollen wound was present over the left thorax near the axillae. The wound was deep enough to nearly expose the ribs. Large, necrotic, and full-thickness lesions were also present on the left forearm near the elbow.

The dog was hospitalized and treated with IV enrofloxacin, oral metronidazole, and oral pentoxifylline. Anaerobic and aerobic cultures grew a Pseudomonas species that was resistant completely to all antibiotics, including enrofloxacin.

After one week of wound care, and these antibiotics, the dog is walking, eating, gaining weight, and recovering well -- until today, when edema and cellulitis (presumptive), with pyrexia developed on the neck and head. The original wounds are contracting and granulating better than I had expected.

PART 2 --REPLIES. The use of TrizEDTA topically has also been suggested and will be tried.

Please send me the email address of (or forward this to) any other vets that you feel might be interested in this or further 'newsletters'.

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