Just in time for Black Friday/Cyber Monday, Understanding Your Pet’s Labwork: A Guide to Communicating with Your Veterinarian is on sale for a limited time. Looking for the perfect holiday gift for the pet lover in your life? This unique reference book is designed for the discerning dog or cat lover who would like to understand in more detail what it means when your dog’s ALKP is high, or why imbalances in electrolytes are so concerning.
Empower yourself as a pet parent to ask the right questions when faced with certain test results, and have a better understanding of why your veterinarian recommends certain courses of action.
Veterinarians and veterinary professionals may also find this resource useful when explaining the implications behind certain test results, and open up a clearer dialog between you and your clients.
This is a reference book that can be used in many ways: as a resource when looking up specific test results, as a text to be read over time when you’d to know more how veterinarians view diagnostic testing, or if you’d like a simple analogy to explain how the kidneys or the pancreas works.
Understanding Your Pet’s Labwork has been discounted for this weekend alone, so grab your copy at this price while you can!
It’s a fact of veterinary medicine that sometimes we must muzzle our patients in order to have their cooperation and to protect the people handling them. This isn’t something we like to do as a matter of routine. For years, I’ve been using cheese and treats to make the vet experience positive for puppies and kittens, and many of those animals grow up being excited to see us.
But that method doesn’t always work. Farm dogs who only see a vet for the occasional rabies shot, dogs who have more important things to do and resist the notion of holding still, cats who never leave the house except when they are ill, animals that have had bad experiences elsewhere or are so terrified at the vet’s office they shut down, unable or unwilling to accept rewards–these are challenging patients. As are the aggressive patients or undersocialized patients: the feral tomcats, flock dogs that have never seen the inside of a building, animals who believe a good offense is the best defense.
It doesn’t help that the veterinary profession has been under a lot of strain for years–and only just now are getting the recognition of this fact. Job burnout is high. Clinics are chronically understaffed, staff members are chronically overworked. The job itself is fraught with emotional, physical, and mental stress. The veterinary profession must deal with what researchers call “the caring-killing paradox“, in which we are sometimes forced to end the life of a patient we’ve been taking care of since it was a puppy or kitten, even though this may be the humane, necessary, or only viable option. Clients blow up at staff members, accusing us of “only being in it for the money” when the costs of practicing high quality medicine are often outside our control and because if we can’t afford to pay our staff and our bills, we won’t be there for your pets. Cyberbullying has a huge impact on the mental health of those in the profession. Professionals have been literally threatened–even killed–by disgruntled clients. The suicide rate among female veterinarians is 3.5 times the national average, and male veterinary technicians are five times more likely to commit suicide. According to the CDC studies, one in six veterinarians has contemplated ending their lives.
As one article I read said, “You’re always failing someone.”
In the past, I have worked in practices where appointments were booked every 10 minutes, and the emphasis was on getting things done and staying on schedule. There is very little time in situations such as these to accommodate a fearful or aggressive pet. Thank goodness, by far and large, the profession has moved away from this model!
But often, it’s not a simple matter of slipping a muzzle on the animal and presto! You can suddenly draw blood samples or palpate a tense abdomen. Sometimes, even the most competent professionals cannot get the animal safely contained.
Fortunately, with the advent of Fear Free training and the emphasis on fear-free veterinary experiences, we’re seeing the tide turn when it comes to restraint practices. This often means using what we call the “chill protocol” (a combination of anti-anxiety and calming medications) prior to the vet visit, which not only brings the fear levels down in the patient, but also in the people who have to handle them in the clinic. We still have to use muzzles and restraint methods on many of these pets, but everyone is much calmer. This not only facilitates drawing lab samples, but performing physical examinations on some animals that will not allow anyone except their owners to touch them. If your veterinarian suggests something along these lines, please understand we are trying to create a more positive experience for all concerned.
Many of the patients we’re seeing now were pandemic puppies and kittens–an entire generation of undersocialized animals who saw only their own people during lockdown. While I wouldn’t wish this on any of us, one of the good things to come out of this is the recognition that something needs to change when it comes to handling such fearful pets on a regular basis.
But we still have pets who freak out when muzzled–an apparent panic attack–even with anti-anxiety medication on board. It wasn’t until an experience at the dentist several years ago that I figured out why. Like some animals and vet visits, many of us have a fear of going to the dentist. We’ve felt extreme pain, or our jaws ached for days after having work done. I don’t like going myself, despite the fact I have an outstanding dentist. (In fact, I drive almost an hour to see him because I trust him when it comes to painful procedures).
At that time, I had to have an impression mold done for some dental work I needed. This required filling a tray with what seemed like Silly Putty and having me bite down on this until the jelly-like mass filled my mouth. Then I had to sit there for several minutes, breathing through my nose, while the molding putty hardened. The glutinous mess filled my oral cavity and pressed on my upper palate. It obstructed the back of my throat. And while I labored to pull air in and out of my chronically inflamed, allergic nasal passages for those two minutes I had to endure the process, I gripped the armrests of my chair until my fingers ached and drummed my heels on the seat, all the while my adrenaline surged. I thought I was going to die.
I came away from the experience understanding why some dogs flip out when they are muzzled. See, the type of muzzle most often used in vet med is a nylon or mesh muzzle which holds the mouth tightly shut. Dogs cannot pant wearing this type of muzzle. We can only leave it on for brief periods of time, as the patient is at risk of overheating. It’s not the sort of muzzle for home use, and so animals learn to associate it with vet visits as well. There are different muzzles designed for the flat faced breeds and cats, but I’d observed that some animals with regular snouts didn’t breath well when muzzled (so we worked very fast).
My experience at the dentist changed everything. Now I got it. I really got it. Some muzzled animals believed they were going to die.
The first thing I did was begin instituting the use of basket muzzles for those highly fearful dogs that needed to wear a muzzle for their entire visit. These are plastic or wire muzzles that allow the patient to open their mouths, pant, drink water and accept high-value treats but not bite. (I prefer the plastic ones for veterinary use because getting punched with a wire muzzle still hurts a lot!)
The difference in some dogs was amazing. They still weren’t happy about their vet visits, and most still needed medication to make things easier for everyone involved. But that level of panic that would make us abandon further attempts to perform our exam, draw blood, etc. wasn’t there. Best of all, clients could order their own muzzles and practice habituating the dogs to them at home. They could arrive wearing a basket muzzle because overheating wasn’t an issue. And we didn’t have to start our visit trying to corral a patient into wearing a safety device. Frankly, I wish I’d instituted basket muzzles sooner.
The brand I recommend most often is made by Baskerville. They are well constructed and come in a variety of sizes. (The one linked here is for a medium sized dog–make sure you read the specs before ordering any for your own dog). I recommend placing a little squeeze cheese or peanut butter inside the muzzle and encouraging your dog to place his snout inside, holding it in place for short periods while he gets his treat, and gradually working up to buckling it on and having him wear it for longer increments of time at home. This is the sort of training that needs to be done well in advance of vet visits. But training your dog to wear a muzzle and the use of the chill protocol can ease the trauma of vet visits for these pets–and it is a trauma to them. But having less terrifying experiences over time lessens the fear and aggression for many of these dogs, and these visits become less traumatic for everyone.
I recently had to have an emergency root canal. I told my dentist up front about the fact I didn’t breathe well through my nose and the panic that ensued when I thought I couldn’t breathe. He took these things into consideration, and we arranged a sort of “safe signal” so I could tap out when I needed a break. We got through the procedure, even though I wouldn’t wish it on even my worst enemy. Afterward, speaking slowly in an attempt to enunciate with half my face numb, I told him what I’d learned at his hands.
He laughed. I’m sure he’ll be dining out on that story in the future.
Recently, I had a client come in with her senior dog, concerned because he wasn’t eating with the same enthusiasm as he did before. This is not uncommon in senior pets, and can be rooted in medical problems, which should be ruled out. But after determining that her dog’s lab work was normal (CBC, chemistry panel, urinalysis and fecal), and performing a complete physical to rule out underlying conditions that might affect his appetite, such as heart disease, or dental disease affecting his ability to chew, we came to the conclusion that her dog Sonny simply needed more supportive care around the house.
Not all that long ago, I took an online seminar on aging pets with speaker Dr. Mary Gardner, and I was pleased to find out I was already implementing many of the things she suggested in her talk. So the first thing we looked at was Sonny’s feeding arrangements.
It turns out his owner was using a slow feeder bowl for Sonny because he used to gulp his food ravenously. Hey, I’ve been there! My previous German Shepherd definitely needed a slow feeder bowl, but when I got my current dog, it took him over an hour to eat his dinner out of the same bowl! Clearly Captain didn’t need a slow feeder, and likewise, Sonny didn’t either. The needs of your pet can change over time. Most likely, Sonny found getting food out of the slow feeder bowl too challenging, and as a result, gave up on eating while there was still food left.
Another thing we observed in the exam room was that Sonny had mobility issues on slick floors, and seemed to have difficulty lowering his head to eat and drink while maintaining his balance. Many dogs are less active with advanced age, and the hair on the bottoms of their feet can grow excessively long, acting like little slippers on slick surfaces. Sonny definitely had fuzzy feet, so we shaved the bottoms of his paws between the pads to help with traction. Dogs who get groomed regularly usually get this treatment, but Sonny had never been groomed before. I suggested to his owner that she invest in a small cordless trimmer like the one we used in the clinic.
I also like to make safe pathways through the house and around feeding stations. Yoga matting can be ideal for this situation. You can even purchase it in commercial rolls to cut to the size needed.
If altering the flooring situation isn’t feasible, there are several products out there aimed at improving traction. I frequently recommend Dr. Buzby’s toe grips for dogs. They aren’t for every dog–some resent having anything on their nails and will chew them off–but for many dogs the improvement in traction greatly improves their desire to be more mobile, which in turn helps maintain muscle mass.
Another type of traction device are these pad grips. Just like slipper socks worn in hospitals or by elderly people at home, these pads provide little friction bumps on the bottoms of the feet. Dr. Gardner suggests actually cutting them and adhering them separately to each pad so they fit better, which is an excellent suggestion and one I utilize now. There are many different brands out there; I’m linking to one here.
The other thing I recommended for Sonny was to consider an elevated food and water bowl. Arthritis in his neck was probably impacting his ability to stand with his head lowered for a significant period of time, and he would just give up. It wasn’t worth it to him to continue trying to eat under those circumstances. Again, there are a wide variety of options out there, I am just linking one as an example.
One of the most valuable tools I got out of Dr. Gardner’s webinar, however, were the journals and guides she’s created for the senior dog and cat. I’ll do a separate post on the special needs of cats in the future, as well as one on sundowning behavior in our senior pets, but I found both of these products very useful.
As someone with a senior dog who is starting to slow down, as well as show signs of some hearing loss and cognitive changes, I think having the means to track these changes will be very useful. Speaking of which, I was one of the beta testers for Suzanne Clothier’s Functional Assessment Tracking app for dogs. FAT is a unique tool for tracking a dog’s cognitive, physiological, and social well-being. It’s not just limited to senior dogs, however. The implications for its use are widespread among trainers, veterinarians, service dog handlers, boarding facilities, you name it! I highly recommend you check it out.
By the way, a week later, Sonny’s person called with an update: after instituting some changes, Sonny was back to cleaning up his meals with gusto!
The second announcement goes hand in hand with the first: I’m so pleased to be offering a digital course on Understanding Your Pet’s Labwork in conjunction with Suzanne Clothier on October 12th, at 3 pm EST.
If you’re not familiar with Suzanne, she is a highly respected dog trainer, international speaker, the bestselling author of Bones Would Rain From The Sky, and the founder of Relationship Centered Training.
I met Suzanne many years ago when I had a German Shepherd named Abbey, who’d become dog-reactive after being attacked by a neighbor’s pack of dogs that had every intention of killing her. As far as Abbey was concerned after this event, a good offense was the best defense. At the time, Suzanne was running Camp Dances with Dogs, and she agreed to have Abbey and I join as participants. I’ll never forget watching Suzanne assess my dog very accurately within a matter of minutes and determine that she wasn’t aggressive–she was terrified of being jumped again. I could scarcely believe it when Suzanne was able to select dogs out of the group that would be non-threatening to Abbey and introduce her in a controlled setting. I watched my dog relax and play for the first time in years.
My experience at Camp DWD that year had a profound impact on my life. I came away from camp not only wanting to have a different kind of relationship with my dog, but wanting to practice a different style of medicine too.
During one of my camp attendances, Suzanne invited me to be a guest speaker. I chose to talk about lab work, and why I thought it was important for pet owners to have a basic understanding of the most common test run and the implications of their results. Afterward, she encouraged me to write a book about it, and Understanding Your Pet’s Labwork was born.
It was many years in the making, however. At the time, self-publishing wasn’t possible, and I had a hard time finding a publisher who didn’t want to reduce the text to a series of bullet points. When self-publishing became widely available, it still wasn’t possible to format the charts and tables I needed. When the industry changed to accommodate such needs, it had been so long since I’d written the original material, that I had some serious editing and updating to do. In the end, I’m glad it was such a lengthy process because I’m a much better writer now than I was when I first started this project.
So I am greatly honored to be doing this webinar in conjunction with Suzanne. I’ll be hitting the highlights of the book, explaining the CBC, the chem panel, the urinalysis, and other common lab tests run. There will be a Q&A at the end, too! Not to worry if you can’t make it to the seminar live: everyone who signs up for the course will have access to the recorded material later. Win-Win for everyone!
It can be one of the most challenging things I’m asked to do as a veterinarian: Could you trim my dog or cat’s toenails?
Frequently, by the time a client is bringing a pet to us for a nail trim, it’s because no one else can do it. The expectation that somehow our staff will magically be able to perform this task after half a dozen or so other people have tried and failed is a tough one to overcome.
What many people don’t realize is can take up to one thousand good experiences to negate a single negative one. And once an animal has experienced being muscled down in order to facilitate a nail trim, the process of retraining your pet to accept this without fear or aggression may well mean that for the time being, your pet won’t be getting the nails trimmed the way you’d like them to be.
Before we discuss the re-training process on a failed nail trimming pet, let’s talk about starting out on the right paw, so to speak.
If you are fortunate enough to have adopted your pet as a young puppy or kitten, you’re in luck. You can start out teaching your young pet to accept nail trimming with lots of treats and gentle handling. I usually recommend using a human toenail trimmer at this stage, as you are both learning this process at the same time, and I find you have better control with a human nail clipper. Your pet’s nails are quite small at this juncture, and it is easier not to take too much off with the human nail clippers. As my pet gets larger (especially big dogs), I tend to switch to a scissors-type clipper. I’m not fond of the clippers that have a blade that slides forward to cut the nail, as many animals seem to act as though this pinches the nail. I prefer continuing to use human nail clippers even on adult cats, though at times cat-specific clippers may be needed, especially for ingrown nails.
Because cat’s nails are retractable, it helps to gently squeeze the paw to make the nails extend, and then you can just tip them with the clippers. Cats need access to scratching poles to shed the nail caps of old growth, and older cats no longer using poles will frequently get painful ingrown nails. Cats with extra toes frequently have similar issues with ingrown nails as they often can’t scratch with the extra toes, and even though declawing in general is not recommended, there are times when your vet may recommend declawing just the extra toes to prevent recurrent issues with growth.
Ideally, during the training process, it is helpful to have some assistance: one person to hold the puppy and give out treats while someone else trims the nails. The most important part about these sessions is that you don’t frighten the pet, or attempt to do too many nails at one time if you are meeting resistance on their part. You don’t want to teach your pet that fighting is the way out of doing something they don’t want to do, but you also don’t want nail trimming (or anything else for that matter) to turn into a major battle. I recommend starting the training within a day or two of adoption, and plan in advance to only clip one or two nails, with lots of praise and treats. Then come back again the next day and attempt a few more. Take your time. Also, choose your time wisely–a good time to attempt nail trimming is after your puppy has been playing hard and is tired.
The nails of young animals frequently have a defined “hook” at the tip that makes it easy to judge how much to take off. Just be sure to trim less than you think you can at first until both you and your pet are comfortable with the process.
I sometimes use a grinder or nail file post clipping, but not at first (one lesson at a time, build up to grinding) and not as the sole means of keeping the nails short. Used incorrectly, a grinder can overheat and burn the nail, and make your pet fearful of not only grinders but motorized clippers/shears too. The length of time it takes to grind down a long nail is longer than you realize. Best to shorten the nail first and take down the sharp edges with a grinder or file.
Just like us, animals have a nail that extends beyond the pink fleshy bit. If you’re lucky and your pet has some white nails, you can use those to judge how much to trim off the others. Cutting the nails too short WILL hurt and can make them bleed as well. This is something you want to avoid during the training and trust period so be very conservative at first. Nails grow at the rate of roughly 1/4 inch per month. You have plenty of time to go slow and teach good experiences from the start.
Short, frequent sessions with lots of praise and high value rewards (usually the kind of treat reserved for this procedure only) is the best, most reliable way to teach a puppy or kitten to have their nails cut. They now make “lick it” type cat treats that work very well for this sort of thing too. Once I teach my pets to have their nails trimmed, I usually don’t need any assistance whatsoever. I still be sure to reward them during the clipping process and again when we’re done.
Many people don’t realize that the pink part visible inside a white nail will bleed if cut, and that the blood supply can extend further than readily visible to the naked eye. We often get requests for nail trims “as short as possible” and then clients are disappointed when we don’t cut the nails back the way they would prefer. ‘Stop Quik‘ and styptic pencils used to stop bleeding if you get the nails too short can sting when applied, and this just compounds the negative experience. When in doubt, take off less.
I also prefer to have someone suspend a small dog or puppy in their arms when I’m trimming nails. This allows me to get beneath the paws and have a clear visual on how much to trim while at the same time preventing the patient from pushing off the table or floor with their feet. Again, someone is giving out treats the entire time–usually something high value like squeeze cheese or peanut butter. We have to be careful using peanut butter in a clinical setting as we must be cognizant of clients with peanut allergies, but this is certainly something you can try at home. I personally think most dogs get tired of peanut butter quickly, and it may be hard to perform a complete nail trim using it. Experiment with treats to find the one your dog really likes for this procedure. It may not be the same thing you’d use in different circumstances.
I’m sure you’ve seen or heard of people putting peanut butter on Saran wrap on their foreheads or on a hat and trimming their dogs nails without assistance while the pet licks their heads. I’m not a huge fan of this myself, as I think there is a risk putting your face that close to an animal who may or may not tolerate nail clipping. This is definitely not something I would try with an adult animal who has issues with nail trimming. I have, however, put peanut butter, squeeze cheese/cream cheese, or canned cat food on the wall at nose level while someone holds the pet in place and I clip nails.
Why does “slinging” a pet seem to work? Because in order to prevent a dog from wiggling out of your grasp, or pulling its paw away just as you go to snip, or worse, trying to bite you during the process, we typically hold the dog in a precise manner: one arm stabilizing the body, and one arm around the neck to control the head and keep the dog from biting at your hands. This is a common position for many procedures during the course of examining a dog, administering vaccinations, taking temperatures, placing a catheter, drawing blood samples, and yes, clipping nails…
Teaching your young animal to accept being held in this manner by a variety of people, including lots of high value rewards during the process is something I highly recommend. I encourage clients with new pets to practice these techniques regularly with young animals to develop trust even when it comes to performing unpleasant tasks.
But if your pet has a bad experience during nail clipping, in which several people attempt to forcibly hold your pet in place to perform the trimming, this will not only teach your pet to become highly resistant to nail clipping, but to ALL the procedures we need to perform at the vet’s office. Some animals seem more comfortable and less panicky in a sling than being body-hugged by several people. Slinging controls the body while keeping the trimmer’s hands to stay out of reach of the dog’s mouth and allows for excellent visualization of the feet. Sometimes, less is more when it comes to necessary restraint for medical procedures.
Sometimes, less is more when it comes to necessary restraint for medical procedures.
In order to take the “less is more” approach, however, and still ensure the procedure is performed (whatever that may be) as well as maintain the safety of all involved, sometimes this means muzzling your dog (or putting a specially-designed globe on your cat’s head like a spaceman’s helmet) so that only minimal restraint is necessary. Muzzling + high value food reward (such as fresh cooked chicken or tuna) + minimal restraint (someone lightly keeping the animal in one place or using a sling) can be more effective and less traumatic for EVERYONE than calling in three or four people to man-handle the pet into compliance. Most animals will fight even harder if forcibly restrained, to the point of injuring themselves and those holding them, and you’re teaching them that such procedures are bad, scary things. Animals with flat faces (such as Pugs or Persians) who can’t breathe well in the first place, justifiably panic if you attempt to keep their mouth closed during a nail trim.
Because we want to take our time with a fearful, aggressive patient that presents for a nail trim, I usually recommend the client purchase a basket muzzle and teach the dog to accept wearing it at home in a non-scary situation. Basket muzzles are designed to allow your dog to pant, drink water, and accept treats. They can wear these muzzles for a longer period of time than the traditional cloth muzzles, which can cause a dog to overheat quickly and is disastrous for a dog who can’t breathe through its nose. I also advise the client we many only get one or two nails done–our goal is to make the visit as happy as possible. I may recommend anti-anxiety medication or tranquilizers as well. I tell people up front that it is more important that we have a good nail clipping experience than to get all the nails trimmed.
I often see resistance on the part of owners to the idea of using a basket muzzle on their fearful or aggressive dogs for vet visits. I can understand their concern. We aren’t saying your dog is a bad dog, however. We’re recognizing the anxiety your pet experiences coming to the vet for medical procedures and by taking the option of biting out of the picture–as well as lowering the risk to all handlers–we’ve seen HUGE differences in the level of comfort and cooperation many of these dogs exhibit when someone tries to hold them safely. It’s the restraint for the procedure that is often the biggest problem, not the act of drawing blood or administering vaccines. Wearing the muzzle while not being forcibly held in place allows for positive reinforcement and reconditioning of a negative experience.
Unfortunately, by the time I see a pet for a nail trim, it is often because several other people have tried to manhandle the pet into compliance. Now the pet is fearful and aggressive about nail-trimming–and justifiably so. Nail trimming is often the one thing that even when we practice all the fear-reducing and safety protocols recommended, we still might not be able to do the nail trim. Remember, it can take a thousand good experiences to negate a bad one, and re-training a dog to accept nail clipping is a long, painstaking procedure that is not always successful. Some dogs need medication to manage their anxiety during the training process. Some dogs, due to the potential for human injury, can only have their nails done under general sedation, which is not practical on a regular basis.
The key to having a dog or cat that allows you to trim their nails is start early and practice regularly. You can’t wait until a dog is nine months old and then decide to take it someplace to get a supershort nail trim because the dog is scratching you when it jumps on you or damaging your flooring. Teach your dog not to jump or paw people. Teach your puppy to have its nails clipped frequently as a baby and practice on a regular basis as it grows up.
What if you’ve adopted an adult or adolescent animal who has never had its nails done and won’t allow you to do so? My recommendation is start out as though they were puppies: have a person help with holding and giving out treats while someone clips one or two nails and then STOP. Come back and do a few more the next day. Be very conservative with your trimming, especially rear nails, which are often worn shorter or black nails when you can’t judge how much to take off. You must build that level of trust in order to successfully teach nail trimming. And if your new dog gives you indications this is not something they are comfortable having you do–or you yourself are not comfortable attempting a nail trim–seek professional help. But be your dog’s advocate. Tell whoever it may be that your goal is teaching a happy nail trim–NOT forcing your dog into submission to “get the job done”. That may work once… but never again.
I train all my dogs to have their nails done as puppies. I train them to trust that whatever I do, good things will follow–including cleaning ears, opening their mouths, trading one toy for another, standing for examination, etc.
I used to have one of my dogs professionally groomed. Every time I dropped him off at the groomers, I made a point of telling them not to do his nails; I do them myself.
I forgot ONE TIME to mention this at drop off. When I came to pick my dog up, the groomer met me at the door. “We don’t normally do his nails, do we?”
“Oh no,” I said. “I take care of those.”
She made a face. “I didn’t think so. We tried, and he wasn’t very good about it, so we quit.”
I didn’t think much about it at the time. A few weeks later, when I went to trim his nails, he whined and pulled his feet away and was generally uncooperative, but I eventually got them done. I was probably sterner than I should have been, not recognizing his anxiety or why he was behaving like that but it didn’t dawn on me what was going on, in part because no one was holding him for the procedure. I didn’t think too much about it until a month later when he had to be sedated for a biopsy. When the assistant put her arms around him in the typical position to restrain for an injection–similar to the position when someone holds for a nail trim–he screamed like he was being boiled alive in oil. If ever a dog had a PTSD flashback, that was what it would look like. His eyes dilated to black holes and his gums went white. He clearly didn’t recognize me or anyone working with him. We couldn’t calm him down until we let him go. It was a horrible thing to witness. Worse to know that I’d somehow allowed this to happen to him without even realizing it.
It was only then I connected the dots. That “attempt” to clip his nails had to have been a bad one. I had to retrain him from the ground up to accept being held for various procedures and the only reason it worked is because the groundwork for trust had already been laid in the first place. We just had to uncover it again, slowly, with lots of love and patience. As it was, the rest of his life, I had to be present for any sort of procedure that required his being held. He wouldn’t let anyone else do it.
If the trust isn’t there to start, then you may never be able to undo a bad nail trimming experience. For some reason, this seems to apply more to nail trimming than almost any other medical procedure we perform on animals. Perhaps it is because animals are instinctively foot-protective. Perhaps it is because a broken nail is very painful. I think a large part of it is because many people do not lay the proper groundwork for this procedure and then don’t understand what went wrong when your pet won’t allow it. You may not have been the one to violate your pet’s trust in the first place. But trust is the foundation for successful nail clipping.
Last week we addressed the fact that allergies in pets tends to fall into two broad categories: seasonal and all-year-round. In the previous post Help! My Dog is Itchy! Part 1: Fleas and Food, we discussed two types of allergies that were examples of each category. One could argue that in some areas, fleas would be considered a year-round problem as well, but for the purposes of our discussion, we’ll leave it as previously listed.
Even though allergies tend to fall into those overall categories, we also know it is possible to be allergic to multiple things, and there can be a degree of overlap when trying get to the bottom of an allergy. So instead of discussing this topic in terms of seasonal vs all-year-round, I chose to break up the discussion along the lines of how someone would work an allergic case up rather than strict categories.
ALWAYS rule out ectoparasites first. Fleas, ticks, lice, mites… you can’t assume that your flea product is working. You might have forgotten to apply it, or accidentally washed it off, or there is resistance developing to the product you’ve used for years, or it simply isn’t that good in the first place. Most of time, it’s necessary to use an actual flea/tick medication to have effective control. Essential oils, diatomaceous earth, borox powder, garlic and brewers yeast all carry potential risks with their use and are unlikely to be effective. And unlike fleas, lice, or ticks, mange mites are not visible to the naked eye and usually must be diagnosed with a skin scraping.
Secondary yeast infections are also common, which is one of the reasons the itchy dog smells bad. Unlike bacteria, we don’t see yeast being resistant to medication–but damaged skin is a good environment for yeast to grow, and recurrent yeast infections are common in allergic pets. Sometimes antifungal medications or shampoos are part of the primary treatment as well. If your pet isn’t responding to treatment with some of the newer allergy treatments, it may be because of concurrent skin infections.
Keep in mind too, that it takes time for new skin/hair cell turnover to take place, and we have to give allergy management enough time to see if it will make a difference. Sometimes the best we can do it calm things down to a flare once or twice a year rather than all year long.
We also talked extensively about food allergies in the last post, and why your vet may choose to rule out a such an allergy by recommending a hypoallergenic food trial before attempting to rule out environmental causes of a year-round allergy.
That’s because it can be challenging to determine what the underlying allergen may be.
There are a couple of ways you can try to figure out what may be causing your dog to itch. The gold standard in veterinary dermatology is to do the skin patch test, where the fur is clipped off one side of your dog and the dermatologist injects tiny amounts of the most common allergens under the skin. Over time, if your dog is allergic to say, flea saliva or ragweed, a wheal will develop around the site of the injected material. The bigger the wheal, the stronger the allergy.
An alternative method is to draw a blood sample and have it sent out for serum allergy testing. The lab is looking for specific IgE antibodies to indicate an allergy to a specific agent. Most labs have region-specific panels, as there is no reason to test for Kentucky Bluegrass if it is not common in your area. Like the skin testing, these tests also include common allergens such as house dust, mold, and flea saliva.
It is also possible some of these allergen panels may include food. I don’t usually recommend doing a serum food allergy panel over an actual food trial. The hypoallergenic food trial seems to be more accurate to me.
Let’s say your dog’s testing comes back with really high titers to house dust, fleas, and ragweed. It’s possible that by controlling the dust in your house (which can be extremely difficult) with HEPA filters and cleaning, maintaining good flea control, and proactively managing the allergies during the ragweed season, your dog’s allergies may not be that bad. It’s also possible that your dog is so sensitive to house dust, that your vet may recommend desensitization allergy shots, in which a tiny amount of the allergen is given by injection to deaden the body’s reaction to it, and then in increasing strength over time. The vials of injectible “allergy shots” are custom made around your dog’s allergies, and will change in strength as your dog becomes less sensitive to the triggering allergen. Giving these injections is something you as an owner must learn how to do, as the process often takes at least a year to see signs of improvement and frequently has to be maintained indefinitely.
I had severe allergies as a child to many, many different kinds of pollen, grass, and weeds. I took allergy shots for seven years, and as an adult only have issues when we put up hay for the horses. This kind of success isn’t guaranteed by any means, but it’s an example of how desensitization shots work.
Sometimes the tests come back indicating your dog is allergic to a whole slew of things. I tested one dog once that was positive for over 24 items. There are only so many allergens you can put into a serum for injection–usually 6-12–so in this case, we picked the 12 allergens that were the most severe to control to create the allergy shots.
Unfortunately, the term “allergy shot” is also used by some people to describe moderate to long-acting steroid shots vets sometimes give to animals to break an itch-scratch cycle. These steroid injections, while sometimes medically necessary, are not an appropriate means of controlling allergies long-term, nor is administering steroid tablets. Steroids have their place in vet medicine, but they also have a lot of negative side effects.
Why do we use them, then?
Well, dogs don’t have the same histamine receptors as people do, so antihistamines don’t always work in dogs. We try them, however, because if they do help, they are an inexpensive means of helping the itchy dog with few side effects. However, once your dog reaches a certain threshold of itchiness, even those dogs that benefit from antihistamines can have breakthrough itching. Which is why prednisone and other steroids have been used to stop the itch. Sometimes clients–or veterinarians themselves–don’t want to put the time, money, or effort into controlling the allergies in a better way, and steroids wind up being an effective, but risky shortcut to long-term management.
Up until recently, veterinarians really didn’t have many options to treat allergic animals if the underlying allergen couldn’t be identified or avoided. You might know your dog is allergic to pollen, but that doesn’t exactly help you when everything outside is covered with green and yellow dust.
We also used to think that the respiratory system was the biggest source of exposure–that is to say, we thought environmental allergies were an inhalant problem. We know now in animals, the problem is largely due to absorption through the skin, and this is why the cycle of allergies> damaged skin> immune effects > allergies is a vicious circle.
Fortunately, we have more choices for managing the itchy, allergic dog now.
One of the first products that was an alternative to steroids and antihistamines in dogs was Atopica. The clinical name for dogs with skin allergies is atopic dermatitis. Atopica is a cyclosporine based medication that inhibits the function of the T-lymphocytes, so there are conditions in which it is contraindicated (such as dogs with cancer, or pregnant dogs). It comes in a capsule form that is typically given daily all year round or during the allergy season affecting your pet.
More recently, we’ve seen the arrival of Apoquel tablets and Cytopoint injections which both work on cytokines which interact with allergens (though in different ways), to prevent the allergen from triggering a reaction in the body. Apoquel, like Atopica, is given daily, or seasonally. Cytopoint injections last anywhere from 4-8 weeks depending on the dog and the number of allergens involved. I’ve seen good success–as well as side effects–with all three of these products. There is also individual differences in response to treatment, so your vet may have to try different things to find the best treatment for your dog.
Remember when we said itching leads to skin damage and allergies lead to chronic skin changes? Your dog may not have a food allergy, but could still benefit from being on a prescription skin support diet to improve the health of its skin from the inside out. There are also shampoos, mousses, and fatty acid supplements designed to improve skin health from the inside out. These topical products are often used in support of the bigger agents in our arsenal, such as Cytopoint or Atopica. Improving the health of the skin improves the barrier of the skin to allergens.
If you read the previous post (linked above) you’ll know the reason I posted about the management of itchy dogs in the first place is because of someone online asking for help with her dog’s chronic ear infections. I find that chronic, severe, ear infections frequently have an underlying allergy as the problem (even if it is only one ear). This is even more frustrating because agents like Cytopoint and Apoquel, while often stopping the itch, may not help with ear problems.
As frustrating as it may be to have an itchy dog, there is hope with the newer treatments available, so talk to your vet to lay out a logical plan of action. Just understand that even with combination therapies, it may still be difficult to completely control the allergies.
