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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.

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.

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. 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 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/

You Can Have A Dog In The Home

A dog is a man's best friend, but how do you know that you are properly taking care of your dog if your dog doesn't speak the same language? Learning how to take care of your pet is very important. You need to consider the following helpful advice for taking care of your dog.

Groom your dog regularly. A dog requires constant grooming to keep his coat in tip top condition. Make sure that your dog is completely relaxed before you start the grooming session; this is especially important if he is excitable. Keep the session quite short (5 to 10 minutes at most) until he is comfortable with the idea of being groomed. Most importantly - be sure to praise him and offer a treat after a successful grooming session!

Groom your dog regularly. A dog requires constant grooming to keep his coat in tip top condition. Make keep cats away from sandbox that your dog is completely relaxed before you start the grooming session; this is especially important if he is excitable. Keep the session quite short (5 to 10 minutes at most) until he is comfortable with the idea of being groomed. Most importantly - be sure to praise him and offer a treat after a successful grooming session!

As soon as you notice your dog engaging in bad behaviors, immediately try to correct them. If you ignore it, it will be hard to contain it later. This could lead to huge problems down the road.

Don't assume your toy-sized dog's bite isn't dangerous, just because he's little. A lot of owners brush-off training, thinking that the smaller breed dog can get away with a little bad behavior and this isn't true. As a responsible canine master, you've got to make certain your dog does not pose a threat to anyone by having him well trained.

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.

Determine your dog's specific exercise regimen. Dogs have different fitness needs based their sex, overall health, age, breed mix, or breed. Every dog should have a couple 10-minute walks a day around the block. Dogs between 6 and 18 months, active breed or mixed breeds, terriers, hounds, and herding dogs will most likely require more fitness than others types of dogs.

If you are thinking about adopting a dog, try taking a couple of weeks off work so you can spend some time with your puppy and teach it a few good habits. Training your puppy and helping it get used to its new environment will be much easier if you are home.

Yelling at your dog or displaying any other violent behaviors are not good options. Your dog will fear you and establishing a bond with your pet will be very hard. The best way to train your dog is to use positive reinforcement and simply say no in a firm voice when you catch your dog misbehaving.

When it comes to buying food for your dog, don't skimp by buying the cheap stuff. Your dog will enjoy greater health benefits from nutritious food. It costs more, but you'll save money on vet bills for health issues down the road.

Clean up after your dog when they go to the bathroom in public. Many dog owners let their dog do their business wherever they please whether its on a sidewalk, neighbor's lawn, etc. They can do their business in public, but you must take a bag with you to clean it up when they're done so that it doesn't cause an unsightly and smelly mess for someone else.

The pads of your dog's feet can become dry and cracked, so make sure that you moisturize them regularly. Ask your veterinarian for advice on which product to use. Avoid using moisturizers that are intended for humans, because they can make the pads too soft and your dog may get hurt.

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.

When training your dog, always make sure that you enter a room before allowing the dog to. This is important because it is an obvious form of dominance that your dog will understand. Establishing dominance will help with your ability to train your dog and with its overall behavior patterns.

Some vitamins are not beneficial for dogs. If your dog already has a good diet, avoid giving him supplements. Too many vitamins can damage his body, particularly the bones, joints and blood vessels. Before giving your dog vitamins, speak with your vet.

Make sure that you spend adequate time on each thing that you try to teach your dog. Even though your dog might catch on to something, for example the "sit" command, it may not be mastered. You'll want to make sure that the command is done every time that you ask no matter what situation you are in before you move onto a new command.

Be thoughtful about breeding your dog. Repeated breeding of a female can evetually lead to severe health problems for both the dog and the puppies that is born from her. If you plan to breed be sure to do your research first so that you can be sure that you are doing the right thing for your animals.

Make sure that you carry small bags and gloves with you while you are out walking your dog. If he uses the bathroom outside, it is your responsibility to clean up the mess. It is unsanitary for you to leave it there, and it some places you may receive heavy fines for that.

Dogs make great pets. The more you know, the better the experience of having a dog will be. You ought to have gained lots of tips from this piece that can be put to use for the benefit of your dog. It is time to get the best friend you've wanted for awhile.
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