Sorry -- I'm going to state it right here -- wrong veterinary approach.
There are TWO TYPES of ear infections -- most of us that have had dogs with long-term long running "always something with the ears" infections typically have the vet "clean out the ears" and often just hand you tube after tube after bottle after bottle of "stuff" for the ears. But **typically** it's for yeast ear infections. Hot moist place that IS truly the perfect place for yeast to grow (and that's why Zymox is for - it's an enzyme).
That's fine -- BUT -- it isn't far enough.
Because very often there is a **bacterial** infection deep in the ear. Not just yeast. (that's what the vet is likely seeing saying there is "infection in there";).
But honestly it was likely time *years ago* for the vet to do a test called a "culture and sensitivity" -- literally they take a swab of the gunk deep DEEP in the ear and send it to be cultured. The lab "grows" whatever will grow from that specimen -- and **then** the lab subjects it to several different antibiotics to see what will actually KILL it for sure.
Clavamox is a good antibiotic (it's a penecillin derivative with a stomach soothant in it). But it may not be the right antibiotic to kill whatever is in there.
See it may not be just typical staph. it can be anything from strep to e-colo it pseudomonas and beyond.
The vet needs to know **exactly** what will kill THIS bacteria. (and it's a bacterial infection causing the pain -- and frankly it's likely to be pretty far advanced).
In honesty this vet should have done this LONG ago. You can't just continually treat a dog for concurrent ear infections. You have to get to the bottom of it.
I speak from sad sad experience, unfortunately. I had a cocker who had ear infections when we *got* him (at 18 months old). And frankly I messed around with the wrong vets for THREE YEARS. Always one more tube of yeast stuff, and the vet giving me this and that antibiotic ear "stuff" (usually with something like Genticin in it which is flatly a NOTHING drug - it's great for certain stuff but it is NOT strong). But altho he cultured it, he would come back and say "Yeah, there's some bacteria in there" and I **NEVER KNEW** he could send it out for this type of test.
Finally -- I got mega disgusted and went to another vet. By this time Muffin's ears were mostly swelled shut. The problem is -- that by the time that happens the ear is usually beyond hope.
Huh? you ask?? What do I mean "beyond hope"??
Because as ears as inflamed over a long long period of time the ear canal itself literally begins to turn to bone. it "ossifies" as a result of the inflammation (similar to the process of arthritis in a way - that's a Callie explanation)
But once that flexible ear canal turns to a boney substance the normal veins and arteries and capillaries that FEED the ear blood and carry away waste and provide "life" to those ears -- those blood vessels get shut off.
Literally -- oral drugs won't work at all any more -- and the inside of the ear simply putrefies.
This can result in an abscess (which is also painful) and if there IS an abscess, and that abscess ruptures and goes to the brain it will kill your dog.
So how do they fix it?
You have to remove the ear. Literally -- it's a process called a bi-lateral ear ablation -- they go in and surgically remove the outer ear (the hole), the inner and middle ear -- the entire ear mechanism is cut out. Then they flush the surgical area with antibiotic rinse and sew the head shut.
Ok -- please don't panic and DO read to the end of this.
It's a difficult surgery but often a life-saving one. The biggest risk is the fact that there are all sorts of tendons and nerves that go TO the brain thru that little hole it the skull behind the ear. These tendons and nerves can be encased in that boney substance that used to be flexible ear canal.
So when the surgery is done they literally have to scrape that substance off those nerves and tendons --if they inadvertently cut or nick them it can mean the dog won't be able to open/close the eyes or the facial muscles may droop. Nothing fatal but possibly unsightly.
Once they close the wound and it heals -- once you lift the ear flap they look sorta like they came from FAO Schwartz (the toy company). There's no "hole" for the ear any more because it's gone. Muffin was a cocker and unless you lifted his ear flap you didn't know there was a thing different.
But he was deaf.
NOW -- KEEP READING -- if a dog's ear has become **this** infected and the ear has ossified to this point -- trust me, they aren't hearing a thing anyway. But a dog who has gone deaf "gradually" gets REALLY adept at hiding their deafness. They feel the vibrations of you walking up on them and know where you are, they feel the air move when a door opens, they feel the air from a squeaky toy and know it's there -- all sorts of things. But usually they are profoundly deaf **already**.
When we discovered Muffin's ears were THIS bad, the vet told me the only thing that could really be done was the bi-lateral ear ablation.
I resisted this with every cell of my body. To ME it sounded like cutting off your arm at the elbow for a hangnail. If it was an infection WHY can't they get antibiotics in there?
All I told you above about how it shuts off the blood to the ear, etc. -- no vet told me that before Muffin's surgery. I found it out myself.
They never do these surgeries two at a time -- they're too severe.
BUT I can tell you that after the first surgery, Muffin was like a puppy again!! Literally -- he started chewing everything in sight -- why? Because it didn't HURT any more!!
Most of the time the thing that keeps these ears all riled up all the time is allergies. Ear canals are mucus membranes and they are just the LOVELIEST tissues for allergies to attack. That's the reason why your dog's ear problems have seemed to "come and go" iwth a vengeance -- why you can tell when it got "worse" -- simply because it was when whatever he was allergic to flourished (outside or inside -- can be anything from grass/hay fever to dust mites and wallpaper dust, etc.)
What to do?
A DIFFERENT VET. If your regular vet had this kind of knowledge they would have done it before now. That doesn't mean they are bad (and they're pretty good if they know to use Zymox -- it's a darned good product to use on allergy ears).
BUT -- at this point you need a specialist. Now if you have read ANY of my posts you will know I tend to be the one on here who uses an herb or an alternative method if one is available.
But it's VERY likely your dog is actually in a serious danger zone. Because of the pain you are indicating -- THAT is serious. It honestly may be the ONLY big huge clue you'll get of how extremely severe these are at this point.
My first suggestion would be to tell you to go to your nearest vet school It's likely to be WAY more cost-effective. At a regular specialist vet ... ear ablation surgery is pricey.
It honestly should be -- the **good** surgeon will take about 3-4 hours PER SURGERY to do this. Because it's not just cutting away the ear tissue. It's what I described above where they have to free each tendon and each nerve very very painstakingly in order to preserve the facial musclesl
I discovered long ago that it can be enough cheaper to go to a good vet school than to use a "specialty" local (big city usually) vet. Even by the time you consider having to take off work for a day, drive to wherever, and maybe even spend the night -- you can still be a TON of money ahead going to a vet school. They tend to be cutting edge and yet, since you deal with students, they tend to be very reasonable.
PLEASE email me if I can help you. I'm not trying to be an alarmist but frankly I have a really hard time not hating the vet who played with Muffin's ears for so long and never told me there was a TEST (under $100) that would be zeroed in on what antibiotic we should have used.
Now -- the other thing
Eastern medicine is good. If you go to http://www.tcvm.com you will find a locator on the left. The Chi Institute is a qualifying agency for vet acupuncturists and those who use Eastern herbals. I honestly doubt that you will completely clear the ears with eastern medicine however, you can go a LONG way to reducing the inflammation.
In Eastern medicine, btw ... chicken AND rice are considered inflammatory foods. Meaning -- if there is already inflammation they will make it worse and if the body is merely looking to BE inflamed they'll oblige and make it so.
Yes, food allergies can cause ear problems HOWEVER, they are not seasonal in nature. I've homecooked for years -- and honestly, altho there truly *are* food allergies, they are typically secondary. Seasonal "atopic" allergies are still #1 in amount and will do the most damage to ears (and other parts of the body). Man you could set your watch by Muffin's (and Billy's - my current cocker).
You may find this vet on the Chi Institute's list -- they may practice solo or elsewhere. But you may also find another vet who does Eastern medicine.
btw -- Denamarin is a combo drug -- Denosyl and Marin. Denosyl is a pharmaceutical grade of SAM-e (a detox for the liver), and Marin is a pharmaceutical grade of milk thistle. This vet likely prescribed the Denamarin because the practice you go to may not countenance using herbs.
It tends to be pretty popular right now for larger practices to have vets on staff who can offer "holistic" stuff. But generally that doesn't free that vet to truly follow a holistic path. Does that make sense?
Seriously -- I suspect the ear problems are urgent. You need to get that infection specifically diagnosed -- that is truly Job #1.
I suspect that this vet is right -- the dog isn't utilizing it's food and that may simply be because the body is having to deal on such a deep level with severe infection (from the ears).
I would wholeheartedly tell you to pursue TCVM (Traditional Chinese Veterinary Medicine) once you get the ear problem diagnosed and dealt with. Even doing TCVM **with** whatever ear treatment you do will help hugely to give the body the strength to kick off this infection.
Please don't give up - don't assume your dog is too old to treat. That's likely NOT the case.
Holler if I can help. Callie