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Dr. Gary
Dr. Gary, Cat Veterinarian
Category: Cat Veterinary
Satisfied Customers: 19798
Experience:  DVM, Emergency Veterinarian, BS (Physiology)
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My 3 year old house cat Julius has a severe ear hematoma. He

Customer Question

My 3 year old house cat Julius has a severe ear hematoma. He has had it for about a week. It was not red, nor did it seem to have any pus/etc but it did have a needle size hole (maybe our other cat hit him with a sharp claw?).
We had have been out of town and came for several days and now the ear has a bloody discharge so we went to vet.
I did some online research while waiting and it said cat hematomas are more rare than dog etc and often caused by shaking their head due to some kind of ear infection (i now realize he has been doing this past couple of months).
It indicated it could be a typical bacterial infection (he has had an eye infection in the past) or possibly caused by ear mites.
It also indicated it would need to be professionally drained and/or require surgery to eliminate the possibility of reswelling.
However, when I took my cat to the doctor, the vet walked in and without looking at my car immediately said
"Must do surgery."
I asked about determining the Cause of the hematoma and the vet proceeded to talk to me like I was an idiot and said there was no way he could determine the cause ... I asked "can't you look in his ear? Take a swab? Do a culture? Check for ear mites or other sources of infection? Look to see the Cause otherwise it might happen to his other ear or my other animals. Also, if we identify the Cause and find its treatable he may not need surgery, he may just need antibiotics and to have the ear drained. I understand surgery May be needed but it May Not and no need to put him through that much less the expense."
(FYI I had just seen a vet do a culture which identified ear mites on YouTube so I know it's possible).
He kept saying Surgery Surgery Surgery and left us with the nurse.
I explained my concerns to the nurse who left to relay my concerns and they the vet came back to say that After the surgery, for an additional fee, he could do a test on the ear to determine the source of the infection ... ?
I had already paid the office visit and needed to get Julius his rabies vaccine (a renewal for his license) so asked if we could get his vaccine today and do surgery tomorrow (I gave the excuse he had been eating all day but really I wanted a second opinion).
The nurse said no problem but then the vet came in to say he couldn't do the vaccine before the surgery as there may be complications.
He says we needed to come in for surgery tomorrow then several weeks after he was healed we could come back for a vaccine.
I called several other vets but they were closed/closing.
Any suggestions?
I understand Julius May need this surgery but without looking I think it's premature and feels like money-grubbing reflex instead of legitimate concern for my cat.
Submitted: 8 months ago.
Category: Cat Veterinary
Expert:  Dr. Gary replied 8 months ago.

Hello, I'm Dr Gary. I've been practicing veterinary medicine since 2007. I look forward to helping with your questions/ concerns.

Expert:  Dr. Gary replied 8 months ago.

I'm working on your answer right now, it'll just be a couple minutes.

Expert:  Dr. Gary replied 8 months ago.

I kind of agree with your vet that surgery is the best option, although it sounds like the bedside manner is lacking, to say the least.

The underlying cause is usually an ear infection and shaking to cause the hematoma or potentially a scratch and abscess. I would lean more toward an abscess given the puncture that you saw and the fact that he's a cat. These can be a bit more tricky to treat as you really have to flush them out vs just draining and tacking down the tissue like we do in dogs.

If you just drain it and do antibiotics, there is a good chance that it'll come back within the next few days. It's easier and can be done without full anesthesia, but you run the risk of it costing more money and taking more time if it comes back. For those reasons, I usually recommend the surgical repair right off the bat so we don't have 2 procedures over the course of a few days.

When doing the surgery, we basically make a slit in the ear skin and drain the hematoma or abscess- whichever it is. We then flush it out and then suture the skin down to the underlying ear cartilage. This prevents it from ballooning out again and the skin scars to the cartilage. Once that swelling is gone, we can get a good look into the ear canal and clean it out. I'll usually look at the bacteria and check for mites then. It's tough to get a good look in the ear when it's swollen as the ear canal is closed and painful, and there's often times a lot of debris so you can't see all that far down into the canal anyways.

I hope this helps clear things up a bit more. Let me know if you have any other questions.

Customer: replied 8 months ago.
Thank you for your response.
I know fees vary but in general how much does this procedure run?
We are in California ...
The doctor gave us a quote including the antibiotics, pain meds, anesthesia, after care meds etc and wanted to know if it was a general ballpark normal quote or not.
He then said we should get general blood work done for an additional $85/$150 and the ear exam would be $60.
Also, should we wait on rabies vaccine or is it ok to give now?
(Need it to get his county license renewed ... he's had it before with no reaction).
Expert:  Dr. Gary replied 8 months ago.

I practice at a 24 hour ER in Michigan, and our ear hematomas run ~ 500-700. That includes the exam fee (115), anesthesia, surgery, medications going home and any other diagnostics. We typically run ~ 2-3 times what a day practice would cost in the same area.

California prices are like Chicago or NYC, which is often times a good 50% higher than us, even at a day practice.

I wouldn't wait on the rabies vaccine. It would be fine to give any time.

Expert:  Dr. Gary replied 8 months ago.

I'm just following up on our conversation about your pet. How is everything going?

Dr. Gary