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Best Advice for Dogs with Skin Issues

I still need to publish a real post about Mr. Stix's full backstory, but this feels more pressing. For nearly 18 months, Mr. Stix's permanent nakey spot (from unknown injuries before he was rescued, including 15 fractures and this big patch of coat missing) has featured several inflamed, peeling areas. Initially I tried to fix it myself at home with things like aloe vera, vaseline, a veterinary ointment called animax that the shelter had give us while we fostered him most of 2019, etc. It's sort of a combination of steroids, antibacterial, and antifungal stuff. I took him to see our main veterinarian in spring 2020, when there was a 2-month wait to get into see a board-certified veterinary dermatologist. It has been quite a journey since then, and it's nowhere near over. Here's my best advice for dogs with skin issues. 

Before I tell the ongoing saga with Mr. Stix's skin. Here is my best advice for dogs with skin problems.

    See a board-certified veterinary dermatologist as soon as you can. Yes, your main veterinarian can probably help, but it's honestly best to go right to the top experts. 


(Image: [[https://www.rover.com/blog/wp-content/uploads/2015/01/treat-1024x682.jpg|https://www.rover.com/blog/wp-content/uploads/2015/01/treat-1024x682.jpg]])
    Agree to whatever skin scrapings / cytology the veterinary dermatologist recommends. This provides information about what types of secondary infections currently grow on your dog's damaged skin. 


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    Do NOT assume every skin issue is allergies. It often is some sort of allergic process, but NOT always and assuming so (and acting accordingly may only delay real solutions and subject your dog to all kinds of quack advice and home remedies).



    Buy the best quality fish oil and Vitamin E supplements you can afford, if it's recommended for your particular case of a dog with skin issues. 



    When necessary, agree to the skin biopsies (yes, like minor surgery) and have them reviewed by a veterinary pathologist that specializes in dogs with skin issues. The one we used is at Texas A&M.



    Follow your veterinary dermatologist's advice and plans, and keep the faith. These dogs with skin problems often don't improve quickly. (I need to take my own advise. See below.)

Mr. Stix's Story as a Dog with Skin Problems

This is what Mr. Stix's nakey spot looks like when it's normal. Photo from May 2019 soon after his hip surgery. The bald patch is permanent. That's not the issue. 


This is how bad the red / peeling areas got in mid-2020 when we saw our main veterinarian, who added a low-dose of oral Vitamin E and some topical too and told me to keep using the animax. 


This is how it looked when Mr. Stix first saw the board-certified veterinary dermatologist in early August 2020, but the specialist had me STOP the animax and instead use a prescription anti-bacterial ointment (mupirocin) ... as well as add a better quality oral fish oil and continue both topical and oral Vitamin E (but at a higher dose twice a day). We knew from the skin scrapings / cytology they did onsite that Mr. Stix had a bacterial infection. 


But, without the daily topical steroids (which long term are a bad idea), Mr.  If you have any inquiries regarding the place and how to use [[https://Noderefund9.Bravejournal.net/post/2021/08/17/6-Awesome-Tips-About-when-Is-A-Dog-Too-Old-To-Train-From-Unlikely-Sources|how old is too old for dog training]], you can speak to us at our web-site. Stix's skin got much, much worse -- even breaking open and scabbing over.


Our veterinary dermatologist had recommended doing the skin biopsies right away in August 2020, and I *almost agreed to it then, but I was VERY worried about the cuts resulting in skin that would NOT heal. And, I figured it was at least worth a try to use the prescription antibiotic ointment and other supplements and stuff. 



But, by around Thanksgiving, it was clear we had to do the biopsy. That photo is kind of gruesome, so you can see it here, if you want. I wish I had done the biopsy sooner. I feel like I wasted time from August through November. 

Post-Biopsy Diagnosis

As I expected, despite all the know-it-alls trying to tell me it was an allergic issue, it turns out that Mr. Stix instead has an autoimmune condition called erythema multiforme. They believe it was triggered by the trauma of his earlier injuries. They don't think it is life-threatening. They don't think it will spread to other areas of his skin. Just the already damaged, permanent nakey spot. 



With that information in hand, we updated the treatment plan to include a topical, non-steroidal [[http://kscripts.com/?s=anti-inflammatory%20ointment|anti-inflammatory ointment]] (tacrolimus -- often pricey, but we used a Good RX coupon at Costco to get the cost down). They use a version of this medication orally for people who have had various kinds of transplants. It's the smallest / safest option for treatment, and that's where we started. 



I was so hopeful it would work at the once-daily application, but the skin still didn't heal completely. 



So, in early 2021, we started applying it twice daily on the advice of our veterinary dermatologist.



But, it still hasn't healed completely. It often improves a lot and then comes roaring back, so we had another appointment to see the specialist last week. We had to try something new. 

Enter the Big Immune-Suppressing Drug

Despite my concerns and form of veterinary PTSD about major immune suppression drugs (after our experiences with Lilly), I agreed last week to add oral cyclosporine, which is also a drug that people get after various transplants. Mr. Stix would need to take it daily for life. 



It smells like it's made from skunk butts, so each gel-cap pill is individually packaged, and you keep them in the freezer because that can help with nausea it can cause (since it's recommended you give on an empty stomach). 



I found some good info on this med, and our veterinary dermatologist assured me that it has been safely used in veterinary medicine for like 20+ years, etc.



The med only comes in doses of 25 mg, 50 mg, and 100 mg, and at his size Mr. Stix's ideal dose is around 88 mg once a day. So we went with 75 mg (25+50) to err on the lower side. 



It takes like 3-7 days for the med to build up in the blood to therapeutic levels, but it takes more like 4-6 weeks to know if it's going to help the skin (or not). 



We made it to day 4, then the barfing started. 

Anxiety

I wish I could say that this is all going to be fine, but I just don't know. I feel like I just have to accept that the skin will never fully heal, even though seeing his raw spots up close while applying the topical med twice a day and topical Vitamin E once a day causes me so much angst and anxiety. 



I supposed to check in with our veterinary dermatology team next week to confirm that Mr. Stix's weirdness and apparent suffering has improved. 



It took a lot of convincing to get Mr. Champion of My Heart to agree to try the cyclosporine, so even if the specialist comes back and recommends maybe a lower dose, I doubt we'll want to risk it ... because Mr. Stix sure seemed to be having some neurologist issues to me, and after the Lilly situation, I just cannot do that again. 



He is only 3 years old. I don't want to make anything worse. It honestly felt like I'd poisoned him.



The good news is that most of the time his skin doesn't seem to hurt or itch or anything -- though I do have pain meds, if he needs them. It mostly just looks bad, and he has to wear a no-lick collar for about 20 minutes after I apply his meds so that he doesn't lick it off. 



His nakey spot is prone to sunburn anyway, and the topical tacrolimus increases the risk of burning, so I used his earlier sun-reflecting coat (which started to look ragged) as a pattern and sewed him a new / light sun protection coat. He looks very cute in it. 

 [[https://championofmyheart.com/2021/08/05/dogs-with-skin-issues/|https://championofmyheart.com/2021/08/05/dogs-with-skin-issues/]]

(Image: [[https://drive.google.com/uc?id=1o3gkncomnLvDPdzsZfL_zvlFRknWrVfi|https://drive.google.com/uc?id=1o3gkncomnLvDPdzsZfL_zvlFRknWrVfi]])
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Have Some Dog-related Questions? We Have Answers


The domestication of dogs began thousands and thousands of years ago. Humans and dogs are great companions for each other. However, your dog must be properly cared for. Here are some tips to help you to know what you can do to ensure your dog is a healthy dog.

Your dog has teeth just like you, so it makes sense that he needs proper dental care. Invest in a dog toothbrush and brush his teeth often. Simply allowing the vet to do it at his regular checkups is not enough. You can also purchase treats that are specifically meant to help with your pet's teeth.

When you take your dog with you on vacation, take a picture and save it to your phone. In the event that he gets separated from you, you have easy access to a current photo to put on flyers that will help identify him.

If you are planning to take your dog on an extended car-ride, talk to your vet about motion sickness medication first. Avoid feeding him before setting out to prevent queasiness and vomiting and make sure you buy him bottled water if you are traveling to any destination that is known to have issues with water quality.

When training your dog, consistency is everything. You must be consistent at all times. If your dog is not allowed to jump on people as they walk in, don't allow your dog to do it even if a person says they don't mind being jumped on. You should also make sure that everyone that's around your dog understands your rules and are consistent with them.

Unless you're okay with your dog playing with your shoes and other things around your home, buy him some toys. He will enjoy having things of his own, particularly if they are interactive like pull-toys you can use together. Also buy him things he can use to occupy himself and stay out of trouble!

It is very common for objects to get lodged in the pads of your dogs paws. Check them regularly to make sure that nothing is in there. If you see something, be very careful about taking it out, or it may become lodged even deeper. It is a wise to use tweezers for this.

Be consistent when giving your dog commands. This is an area where a lot of dog owners have a problem, especially when you won't feed your dog from the table but your spouse will. Make sure that everyone in your home understands what's acceptable so that the dog will receive a clear message. That will make him more likely to obey.

Be strong when the time comes to say goodby to your beloved dog. Many owners keep the animal suffering to keep them in their lives and that's not fair to the dog. Consult with your vet, then talk it over with family. If it's time to part ways with your dog, do what's best for him.

Try to provide your dog with plenty of opportunities to socialize. Take him on walks to the park or beach where he will be around people and other dogs. Encourage his interactions with others and praise him for good manners. He'll be much more comfortable in any setting and generally happier too.

If you breed your dog, do so responsibly. The AKC advises all owners of pure-bred dogs to make an effort to advance the breed and discard all other motivations, such as money or experimentation. Consider the repercussions of your actions before allowing your dog to mate and create a litter of puppies.

If you have younger children in the home, make sure that you try to teach them what behavior is appropriate with your dog. Let them know the rules and what they are allowed to do. Some dogs are more tolerant of being jumped on, pulled on, and played with than other dogs.

When taking your senior dog to the vet for an annual visit, make sure to request senior blood work. A blood panel can help your vet to identify any kidney, heart or vascular concerns. If caught early, treatment is often minimally invasive and less costly. This is a great way to keep your pet healthy for years to come.

If you have a hard time with keeping your dog from chewing your possessions or your furniture, use a taste deterrent. Most pet stores sell bitter apple sprays or other products you can use to keep your dog from chewing. Choose a product that does not contain any chemicals if possible.

If you want your dog to learn to "sit", start by holding a cookie, or other treat, above his head. This will cause him to look up. When he looks up, gently push his hind end down, and give the command to sit. Give him the treat, and praise him. Soon, he will sit just by hearing the command and seeing your hand go up, and eventually will obey to the "sit" command alone.

Keep your dog safe from dangerous chemicals. Similar to kids, cleaning chemicals and any car maintenance substances are harmful to them. These substances are poisonous, so if a dog gets any on them or ingests any, they could get burned, become very sick, or die. Store your hazardous chemicals in a place that your dog can't get to, or keep them in a closed area using a child-proof lock.

If training your dog is more than you can handle, you should consider sending it to obedience school. Do some research to find out more about the different obedience schools in your area and talk to other dog owners to find the best school possible. It is best to send your dog to obedience school while it is still a young pup.

Where will your new dog sleep? Never let your dog sleeps with you or inside the house if you want to keep it in a crate. If you do let your dog sleep with you, be prepared to let him do it every night.

All of these hints are now at your fingertips, so it is time to make use of them. Take them each, one by one, and start using them every day. The more you change about your dog's life, the better it will be overall. A happy dog makes for a happy owner, after all!
(Image: [[https://drive.google.com/uc?id=1yBNZdT9q3dqE1rIIawZxJKOefz0g1l4a|https://drive.google.com/uc?id=1yBNZdT9q3dqE1rIIawZxJKOefz0g1l4a]])
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