Archive for September, 2011

Lick granulomas: An annoying little problem that is difficult to solve

September 26, 2011

If you’ve no idea what a lick granuloma is, count your blessings! What a nuisance they can be.  The official name for this disease is acral lick dermatitis.  “Acral” refers to an extremity (leg) and “dermatitis” means inflammation of the skin. The “lick” is thrown in because incessant licking behavior is what causes the problem.

Acral lick granulomas are skin sores that typically occur in large breed dogs (Doberman Pinchers and Labradors are notorious) and more males than females.  For reasons we truly don’t understand, affected dogs pick a spot towards the foot on one or more of their legs and begin licking…… and licking, and licking and licking.  The effect on the skin is no different than if you picked a spot on your arm and scratched at it round the clock.  The chronic self-inflicted irritation can result in thickening of the skin, increased pigmentation (skin appears darker than normal), an ulcerated surface with bleeding, and infection complete with pus, redness, and tenderness.  The average lick granuloma varies from dime-sized up to the size of a silver dollar.

Acral lick granulomas may be initiated by something that traumatizes or irritates the skin such as infection, allergy, or an embedded foreign body such as a thorn or splinter.  The dog overreacts lingually (no tongue in cheek here) and, over time, a lick granuloma appears.  It’s theorized that incessant licking may represent a self-soothing behavior (like thumb-sucking) associated with release of endorphins.  This theory is supported by the fact that, if one is savvy enough to interrupt the licking cycle at one site, many clever dogs redirect their attention to a new site on a different leg. Another possibility is that arthritis is present in the joint underlying the affected skin surface.  Licking is tantamount to a person massaging a sore joint.  Yet another theory is that boredom is the culprit. Truth be told, there are likely many different causes for lick granulomas.

The diagnosis of acral lick dermatitis is officially made via skin biopsy.  Your veterinarian may also recommend a skin scraping (material is scraped from the skin surface for evaluation under the microscope to rule out mange mites) and collection of samples for bacterial and fungal cultures.  Some veterinarians feel comfortable making the call based purely on history and visual inspection of the affected skin site.

Making the diagnosis is the easy part.  Stopping the licking is notoriously difficult.  In fact it can be a nightmare because many affected dogs simply will not be deterred from this obsessive behavior.  And even when one thinks the problem is licked (pun intended), a year or two down the road, the self-trauma cycle may begin all over again.

The ideal therapy for lick granulomas is identification and treatment of the underlying cause (foreign body, allergy, infection). If the cause cannot be determined (true for most dogs with lick granulomas) and eliminated, here are some therapeutic options.  Keep in mind, what works well for one dog may not work for another.

– Keep the site covered with a bandage.  You can use standard bandaging material or one of your own socks might be suitable.  Simply cut off the foot part and pull the tube section up over the affected area.  Secure in place with some tape.  If the lick granuloma is low enough on the leg, you can slip the dog’s foot into the toe of the sock.  A product called DogLeggs  may be worth a try as well.  If you are really, really, really lucky, your dog who is obsessed with applying his mouth parts to the spot you’ve covered will leave the bandage in place.  Warning!  It is extremely easy to put a bandage on that is too tight (a recipe for disaster).  Practice bandaging with a member of your veterinary team watching before trying it yourself at home.  Second warning!  Your dog may go one step beyond removing the bandage- he or she may eat the darned thing.  Close supervision is a must for the first day or two after accessorizing your dog with a bandage.  The last thing anyone wants is for a lick granuloma issue to morph into a gastrointestinal foreign body issue.

– Taste deterrents work for some dogs and there are a variety of products on the market (Bitter Apple is the classic).  If this is to stand a chance of breaking the cycle, application must be frequent and consistent.  Most dogs are so determined to lick that they will persevere in spite of the adverse taste reaction, and in all honesty, the looks on their faces after licking the nasty stuff time after time suggests that this “solution” may be less than humane.

– Elizabethan collars work well for some dogs.  Don’t forget to rearrange your house in advance so that nothing valuable is damaged as your dog learns to navigate his surroundings with a satellite dish around his neck.  (No, your television reception will not be enhanced.)

– Medications can be applied to the site that are antinflammatory in nature and/or help rebuild healthy tissue.  These typically must be accompanied by a method for keeping tongue away from skin so the medication has a fighting chance.

– Acupuncture and/or chiropractic treatments are thought to work for some dogs.

– Laser therapy at the site is successful with some lick granulomas.

– See if keeping your dog super-busy for a week or two breaks the cycle.  The hope is to alleviate boredom and/or create a dog that is too tired to lick.  Try increased play/exercise, a large Kong toy filled with peanut butter, doggie day care while you are away from home, or adoption of a playmate (careful here- sometimes the stress of a new animal in the household amplifies licking behavior).

– Behavior modification medications work for some incessant lickers, but should be tried when other efforts have failed.  Categories of medications that can be tried include tricyclic antidepressants, serotonin-inhibiting drugs, and endorphin blockers.

It’s a given that the more treatment options there are for a particular disease, the less we know about how best to treat it!  Lick granulomas are a classic example.  If your dog is afflicted, I strongly encourage you to enlist help from your veterinarian.  If, together you try two or three things without success, please consider consultation with a board certified dermatologist.  To find one in your neighborhood visit the American College of Veterinary Dermatology website.

Although a lick granuloma looks like a small problem, it can be downright difficult to cure.  If your dog’s lick granuloma remains small and clear of infection, and if the sound of licking is not keeping you awake at night, simply living with the problem is a reasonable choice to consider.

Has your dog had a lick granuloma?  If so, please tell us what you tried, what worked well, and what didn’t.

Best wishes for good health,

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

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AHVMA 2011 Pearls

September 18, 2011

I recently had the pleasure of lecturing on veterinarian/client communication skills at the American Holistic Veterinary Medical Association (AHVMA) annual conference. Dr. Doug Knueven, a holistic veterinarian (combines Eastern and Western medicine) in Beaver, Pennsylvania was the conference coordinator.  Much to my delight, Dr. Knueven has graciously offered to provide you with some pearls from the conference (thank you Doug!).  Take it away Dr. Knueven!

Before I give you the goods, I’d like to start with a little background. The AHVMA was founded in 1982 by a hand full of veterinarians who were interested in complementary medicine. It has grown to an organization that is almost 1,000 members strong. AHVMA members practice diverse therapies including acupuncture, chiropractic, herbal medicine, homeopathy, natural nutrition, massage therapy, energy medicine and much more. Most of us continue to practice Western medicine as well (we haven’t thrown the baby out with the bath water) using an integrative model of health care.

The AHVMA 2011 conference provided 122 hours of continuing education for veterinarians and veterinary technicians. Lectures spanned the range of therapies mentioned above as well as client communication (thanks Dr. Nancy!), integrative oncology, nervous system issues, emergency preparedness, and electromagnetic biophysics (Yikes!!). Most lectures applied to pets but we also had a stampede of information for vets who work on horses, cows, and goats.

Approximately 400 professionals attended. Most were AHVMA members but a fair number were conventional practitioners who were interested in learning more about some of our fascinating topics. Attendees came from as far away as Europe, Japan and Australia. Our lecturers had varying backgrounds and areas of expertise. We had several veterinary speakers who are board certified specialists.

So here are some pearls of wisdom from the AHVMA conference:

Dr. Greg Ogilvie, who specializes in both internal medicine and oncology, spoke about how diet influences cancer:

Cancer cells have a “sweet tooth.” Pets with cancer should be fed a low-starch diet.

Docosahexaenoic acid (DHA), an omega-3 fatty acid can help prevent cancer, fight cancer, increase the effectiveness of chemotherapy, and decrease the side effects of chemotherapy. The best source of DHA (highest concentration of active ingredient) is from oils that come from algae.

Do not give your pet high doses of anti-oxidant vitamins A, C, and E concurrently with chemotherapy as they can interfere with the action of the drugs.

Dr. Mona Rosenberg is a conventional oncologist who works with holistic veterinarians to provide an integrative approach to treating cancer.

She turned me on to a great website for the Society for Integrative Oncology (www.integrativeonc.org). Although this group is meant for human patients, most of the basic concepts are equally true for pets.

Dr. Barbara Royal addressed pet diets.

She uses integrative therapies with zoo animals and found lessons for pets from problems encountered while working with wild animals kept in captivity. The bottom line is that zoo animals encountered health problems when their diets varied from what they would get in the wild. Mother Nature is not easily fooled. Many pets benefit by being fed diets with little to no heat processing since this is what they evolved eating.

Dr. Lea Strogdale, an internal medicine specialist discussed diseases common to cats.

It turns out that slow motion video reveals that cats are inefficient at drinking water. This is why some cats like to drink from faucets or fountains. This makes sense since cats evolved from desert creatures where puddles are scarce. Because they do not drink efficiently, cats are prone to chronic dehydration. The bottom line is that many of the chronic diseases we see in cats, such as urinary crystals, chronic kidney disease, and constipation, may be due to the dehydrating effects of dry cat foods.

Do not feed your cat dry food. Many cats benefit from high-moisture canned or raw diets.

To entice your cat to drink more water, keep the bowl topped off or use a very broad bowl so she does not bump her sensitive whiskers against the sides.

I hope you have found these holistic pearls helpful. One final note, if you would like to find a holistic veterinarian in your area, check out www.ahvma.org and click on the “find a holistic veterinarian” button.

Dr. Doug Knueven

_________________________________________________________

Now, Dr. Knueven will be happy to entertain your questions!

Best wishes for good health,

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

Puppy Mill Awareness Day – September 17, 2011

September 10, 2011

Photo Credit: Susannah Kay

Heads up everyone! This Saturday, September 17th is Puppy Mill Awareness Day.  I’ve spent plenty of time on my soapbox in an uproar about puppy mills  and I will continue to do so until I no longer have to witness the physical maladies, behavioral nightmares, and broken hearts created by those who profit from the mass production of puppies.

Puppy Mill Awareness Day is all about educating as many people as possible about the inhumanity and insanity of puppy mills.  Might you know someone who is thinking about adopting a puppy?  If so please counsel them on the importance of avoiding an impulsive pet store purchase (guaranteed the “livestock” there were born at puppy mills).  Also, teach them that purchasing a pup online, sight (and site) unseen just about guarantees they will be providing income to a puppy mill. Rather, encourage them to adopt from a rescue organization, shelter, or reputable breeder.

About the only thing that keeps me sane when it comes to puppy millers are those wonderful souls who reside at the opposite end of the human spectrum- namely those who work in shelters and rescue organizations because they are passionate about giving animals a second chance.  As a way of honoring these folks and “celebrating” Puppy Mill Awareness Day, I hope you’ll help me out with the following plan.  Please tell me about your favorite rescue or humane organization and why you believe it is special.  Provide me with the group’s email address and contact information. From the list of responses I receive I will choose 10 organizations to receive a free copy of Speaking for Spot  and when I mail the book to them, I will let them know it was a gift from you (so be sure to include your full name).  Thanks ever so much.

Now get out there and spread some puppy mill awareness!

Best wishes for good health,

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

 

Murphy and Ruska

September 5, 2011

I refer to my last week at work as the “Murphy and Ruska Show” in honor of two delightful patients who arrived at my doorstep one day apart, each with a life-threatening disorder called pneumothorax. “Pneumo” means air and “thorax” refers to the chest cavity, so “pneumothorax” is air within the chest cavity.  If you’re scratching your head wondering, “Isn’t there supposed to be air in the chest cavity?” here’s what you need to know.  While the lungs are air-filled, the space surrounding the lungs, known as the pleural space, is normally devoid of air.  Pneumothorax refers to the accumulation of air with the pleural space. In order to understand how a pneumothorax causes difficulty breathing, it helps to think of the chest cavity as an empty barrel into which the lung lobes expand as they inflate (like balloons filling with air).  The lungs readily inflate with minimal effort because negative pressure (a vacuum effect) normally exists within the pleural space.  Fill the pleural space with air and the negative pressure is disrupted resulting in more effort required for lung expansion.  Make sense?

Murphy and Ruska were both observed by their families to experience an abrupt onset of labored breathing. Murphy also became subdued, a marked deviation from his normal wiggly-waggly Labrador self and he was unwilling to lie down.  Clever Murphy figured out that lying down makes labored breathing even more of a struggle.  In addition to working extra hard to breathe the normally ravenous Ruska refused her breakfast, a sure sign that this sweet Shepherd was off her game.

Normal Chest

The two most common causes of pneumothorax are penetrating chest cavity wounds that allow external air to enter the pleural space and leakage of air from the surface of a diseased or injured lung lobe.  Pneumothorax is readily diagnosed with a chest x-ray.  Have a look at the accompanying normal and abnormal x-ray images. In both views, the dogs are lying on their sides with their head end to the left and their tail end to the right.  You can see the spines at the top of the images.  Note the heart, the whitish round structure in the middle of the chest cavity. Air shows up black on an x-ray. Now notice how much more black (air) there is surrounding the heart in the pneumothorax image compared to the normal chest. Makes you want to become a radiologist, eh!

Pneumothorax

Murphy and Ruska were referred to me to figure out why they had leaky lung lobes.  The most common cause of pneumothorax is a blunt blow to the chest cavity (hit-by-car trauma is classic) forceful enough to tear a lung lobe and allow leakage of air into the pleural space. Ruska and Murphy were both closely supervised with no known trauma history.  Computed tomography (CT scanning) is my test of choice for solving the mystery of the leaky lung lobe. Murphy’s scan revealed multiple small blisters (aka, blebs or bullae) on his lung lobe surfaces.  Just as in people with this abnormality the blisters are thin-walled and capable of spontaneous rupture allowing air to leak into the pleural space. Fortunately, as was the case with Murphy, most lung blisters are self-sealing within a few days. Worse case scenario, a stubborn leaker can be surgically sealed. Murphy’s family has been forewarned that his multiple blebs will likely mean multiple penumothorax episodes.  They know what to be watching for and will return with Murphy any time, day or night, should his labored breathing recur. Murphy is now home, happy as can be with instructions to be a couch potato for the next two weeks with hopes of avoiding disruption of the body’s “bandaid” on his leaky lung blister.

Ruska’s CT scan documented a small walled off abscess on the surface of one lung lobe.  Given the time of year and where Ruska lives and plays, I’d be willing to bet my first born child that a foxtail plant awn is living within that abscess.  Fortunately, Ruska’s lung lobe leak resolved itself, and the pros and cons of surgically exploring the site versus long-term antibiotic therapy (foxtails shuttle bacteria wherever they migrate) were discussed and are still being considered.  I should be hearing back from Ruska’s mom sometime this week.  For now, this big girl is back home and, like her friend Murphy, she is doing her best to be a cooperative couch potato (easier for a Shepherd than a Lab!).

Our emergency room vets are used to seeing pneumothorax patients because hit-by-car trauma is so prevalent.  As a small animal internist I rarely see them, yet here were two within one week! (I suspect the third is on its way.)  Have you or a loved one (human or canine) experienced a pneumothorax?  Please do tell.

Best wishes for good health,

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.