Posts Tagged ‘veterinary specialist’

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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What is a Veterinary Specialist?

March 21, 2010

I participate in a list serve for veterinarians who specialize in internal medicine. The list serve “topic de jour” concerns veterinarians who are general practitioners (also known as family veterinarians), yet bill themselves as “specialists” in specific venues such as surgery, dentistry, or cardiology.  The responses have been strongly disapproving, and here is the reason why:  The American Veterinary Medical Association dictates that the term “specialist” be reserved only for veterinarians who have completed all of the requirements to become a “diplomate” within a specialty organization. What must a veterinarian do to become an official specialist/diplomate? Trust me, it is a long and arduous process! After graduating from veterinary school, wannabee specialists must complete a minimum three-year internship and residency training program, author publications in peer reviewed journals, and pass some insanely rigorous examinations specific to the specialty they are pursuing.  (Note that the requirements differ for those who become specialists in complementary/alternative medicine fields of veterinary medicine such as homeopathy, acupuncture, chiropractic, and Chinese herbs.) If one is successful in completing this rigorous and extensive training they achieve “board certification” status and are deemed to be “specialists” or “diplomates” within their chosen specialty.  This is much like the process physicians go through to become specialists.

The world of veterinary specialists has grown by leaps and bounds.  Much like Starbucks®, if there’s not already a group of specialists in your community, there likely will be soon!  Veterinary specialists are found in university teaching hospitals and in some private practices.  They often “cohabitate,” sharing specialty staffing, equipment and laboratory services with specialists in different areas of expertise.  When this is the case, you, the lucky client, end up with access to multiple specialists under one roof.  Not only is this convenient, it also focuses a lot of brainpower and experience on your pet- group discussions about patients (medical rounds) typically occur daily in such specialty hospital settings.

When might you need the services of a veterinary specialist? Just as your family physician refers patients to specialists, your family veterinarian should be considering referral in the following three situations:

  1. A second opinion is desired by you or your veterinarian.  Yes, you definitely have the right to request a second opinion.  I know it can be tough telling your vet you would like a second opinion, but as your beloved pet’s medical advocate, you are obligated to do so just as soon a your “gut” starts suggesting that a second opinion makes sense. I encourage you to read the chapter called, “A Second Opinion is Always Okay” in Speaking for Spot- it will provide you with plenty of helpful coaching about how to tactfully broach the subject with your veterinarian! Hopefully your vet has established relationships with local specialists- the kind she would trust to take good care of her own dog should the need arise. Not all family veterinarians are keen on “letting go” of their patients, so self-referral might be your only way to seek out the help of a specialist.
  2. Help is needed to figure out what is wrong with your pet. Specialists have advanced diagnostic tools (ultrasound, endoscopy, CT imaging, MRI scans, etc.) and have developed the skills to use them. Additionally, because of their extensive experience with challenging cases, specialists often have the ability to hone in on a diagnosis in the most direct and expedient manner.
  3. Your vet doesn’t specialize in the disease your pet has or the therapy he needs.  Just as with our own health issues, treatment is ideally managed by someone who works with that particular disease issue day in, and day out, and regularly pursues continuing education pertaining to that disease.

How can you tell if a particular veterinarian is truly a specialist?  Simply examine the initials following his or her name. See the list of specialties and their corresponding initials below. For example, if you look at the initials following my signature (ACVIM), you can tell that I am a specialist in The American College of Veterinary Internal Medicine. To learn more about any of these areas of specialization, pay a visit to the websites.  Those listed below are within the United States, but you will find comparable organizations in many other countries or continents.

Have you ever taken your pet to a veterinary specialist?  Have you ever wanted to do so, but had trouble getting “buy in” from your family veterinarian?  If so, please share your experience.  I’d love to hear from you.

Diplomate, ACVIM Internal medicine (acvim.org)
Diplomate, ACVIM, Cardiology Cardiology (acvim.org)
Diplomate, ACVIM, Oncology Oncology (acvim.org)
Diplomate, ACVIM, Neurology Neurology (acvim.org)
Diplomate, ACVS Surgery  (acvs.org)
Diplomate, ACVD Dermatology (acvd.org)
Diplomate, ACVR Radiology (acvr.org)
Diplomate, ACVO Ophthalmology (acvo.org)
Diplomate, AVECC Emergency and critical care (acvecc.org)
Diplomate, ACVA Anesthesiology (acva.org)
Diplomate DACVB Behavior (dacvb.org)
Diplomate, ACVN Nutrition (acvn.org)
Diplomate, AVDC Dentistry (avdc.org)
Diplomate, ACT Theriogenology (theriogenology.org)
CVA Veterinary acupuncture (Ivas.org)
TCVM Chinese veterinary medicine (tcvm.com)
AVH Homeopathy (drpitcairn.com) or (theavh.org)
ACVA Chiropractic (animalchiropractic.org)
CCRP Canine rehabilitation (caninerehabinstitute.com)

Best wishes to you and your four-legged family members for abundant good health,

Nancy Kay, DVM
Diplomate, ACVIM
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life

Website: http://www.speakingforspot.com
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, or your favorite online book seller.