Veterinarian work is somewhat akin to solving a crime. Sometimes making a diagnosis and a treatment plan is really easy. We see a dog limping, we find a thorn in the foot. So we remove the thorn and the dog stops limping. Sometimes, however, it takes a little bit of investigative work to make sure we are not being led astray. Take the case of dermatology. It should be a simple open and shut case. The skin is right there on the surface. We can all see it with our own eyes. So why do we need to do any testing? It’s a mystery.
Simple Clues. Skin can only react to insults from various causes in a few ways- getting red, scabbing, making crusts, developing pimples, losing hair, or laying down pigment. These are clues that there is a problem, but there are numerous causes that can result in any or all of these changes.
Lots of Suspects. Parasites, including fleas, lice, and two types of mange can result in all of these symptoms. Skin infections that are a result of scratching and licking due to an itch can cause all of these symptoms. Diseases such as Cushing’s disease that cause a skin infection that then causes an itch can cause all of these symptoms. Itching related to allergies to any common pollen, dust, dust mite, fungus, yeast, saliva, animal, protein, and so on and so forth can cause the itch that causes the infection.
Is your head spinning yet? Do you feel like you’re in a bad itchy circular argument? Sometimes it feels that way to us too!
Detective Work. In order to prevent spending time running in circles, we have a method to attack skin and ear diseases. Although it may seem simple, sometimes starting with the most obvious is best. We will begin by questioning you about your pet’s ectoparasite (flea/tick) prevention. Lucky for us, the newer flea and tick products don’t just eliminate fleas and ticks, but may also carry some activity against mites and lice. Sometimes, just a simple shift to a newer and more complete parasite prevention program is all it takes to find the culprit.
If you’ve already done your homework and are on an appropriate prevention, the next suspect we examine is infections. This will help us provide relief to your pet as skin infections can be itchy and painful. Infections usually are related to some underlying condition, but we may not be able to find the underlying condition until we get the infection resolved.
The Crime Lab. Using microscopy, we can find bacterial or yeast infections in a matter of minutes while you wait. Ringworm involve a fungal PCR and culture in case of ringworm, and tests can take a few days at the lab. Finding out if your pet has a skin infection, how bad the populations are and what types of organisms you have can help us formulate a specific plan for your pet using a combination of oral, injectable, or topical therapies to kill the infection.
Catching the Perpetrator. Once your pet is free from parasites and microbiology, we can finally turn our attention to the root of the problem. Is there a seasonal pattern? Have you switched any foods? Did you just buy a down comforter? These are the kind of allergies which commonly affect our patients.
Most of our patients spend plenty of time indoors and indoor allergens can be potent stimulators. It could be where you least expect it. Think about the dust under your bed. If Fluffy likes to sleep next to your bed, maybe she’s allergic to dust!
If you get to this step you may choose to have allergy testing performed. This is a great plan because it allows you to know what your dog is allergic to, and when you might see him or her start to break out. If the allergy load is high, you may choose to try and have a desensitization treatment set developed unique to your dog’s allergies to help them be less affected. If you don’t choose to do allergy testing, you might choose to start a medication to counteract the effects of allergies (Apoquel or Cytopoint). We can discuss the pros and cons of each and help you make the decision that is right for you and your pet.
What if We Still Haven’t Solved Anything? Sometimes we get to this point and we may still be stumped. There are some rare diseases out there, and doing blood work or skin biopsies can fill in the blanks. Sometimes a veterinary dermatologist may be helpful to visit. Just know that we apply the same problem solving skills as much to a dermatology case as we do an internal medicine case.
Thankfully, with a good exam, the history you provide, and a cytology, we can be on our way to finding the culprit, solving the issue, and helping your pet feel much better. We think McGruff would be proud.