Got an itchy pet? Losing hair? Diagnosed with “allergies” or “allergic skin disease”? Are the summer months causing your pet especial distress? Then you’ve likely been offered “allergy testing.” But what, exactly, does that mean?
For starters, it means we rule out all other potential causes of skin disease to make sure we’re not all hung up on the allergy thing for no good reason. This includes serial skin scrapes to look for bugs, superficial skin cell testing (cytology, usually via “impression smears”), ear swabbing for cytologic (cell) evaluation and cultures and blood testing––typically for hormonal diseases (like Cushings or thyroid disease). For some kinds of lesions, skin biopsies are sometimes in order as well.
Then we go for basic palliative care to see what tends to work. What’s the response to shampoos, dietary supplements judiciously chosen drugs (like antihistamines, steroids, flea meds, other insecticides, cyclosporine, antibiotics, antifungals, local treatments, etc.)?
So you know, this isn’t necesarily done just to take the easy way out. Response to treatment can be a significant indicator of what’s up with the skin. It can also power you through the short seasonality of your pet’s problem––if, indeed, it’s seasonal.
Next up, we’ll try food trials to determine whether one or more proteins and/or carbohydrates are stimulating the immune system at the level of the skin. Here’s a complete post on this.
Once all this has been accomplished, we may recommend you see a dermatologist for allergy testing. Sometimes we’ll recommend a dermatologist even before all this intensive testing. For my part, I tend to refer to a dermatologist the problem is severe and/or intractable and if I’m uncomfortable with or confused by the test results or a pet’s clinical response to treatment (which happens with occasional regularity).
At this point, we can elect to go one of two ways: Depending on your pet’s response to treatment and your comfort level with drug therapy (and its expense) we can either choose to stick to what we know already works or we can move on further testing.
Here’s where things can get tricky. It’s ime to bring out the big diagnostic guns: skin testing and/or blood testing to determine which specific allergens are causing the problem. This is most helpful for inhalant allergies (also referred to as “environmental” allergies, “seasonal” allergies or “atopy”). Food allergens may be tested, too, but these tests are very insensitive and non-specific relative to inhalant allergen testing.
(In fact, recent studies show that food allergy testing through skin or blood can be downright wrong, which is why we like to stick to well-run food trials for food allergies.)
Some vets use skin testing (dematologists, usually) some use blood testing (as I do when I haven’t referred to a dermatologist) and some use both, knowing that both tests have their limitations.
If you’re like most of my clients, you’ll think it a bit above-and-beyond-ish to test your pet for allergies in the way we do for humans. It’s expensive to have skin tests performed. It’s also pricey (though usually less so) to go for its alternative: blood testing.
Skin testing: $500 to $1500, depending on the number of allergens tested and the priciness of the hospital. Blood testing (or “serology”): $100 to $800, depending on the same above factors.
Nonetheless, a pet’s allergic skin disease is often severe enough to warrant these advanced tests. (I perform about one to three every month).
Problem is, pricey as they are, they’re not perfect. Though they grant you a formidable glimpse into the categories of allergens that are most responsible for a pet’s individual allergic profile, they’re “off” in many cases. Here are some limitations:
For both kinds of skin testing, pets must be off all immune system-affecting drugs for six weeks. That means no steroids, cyclosporine or antihistamines (though antihistamines may be continued up until one week before testing). No changes must be made in the animal’s basic routine (feeding, environmental exposures, etc.)
Moreover, even when we think everything’s well controlled in the pet’s environment (same food, same shampoos, same everything), pets can have different immune responses to allergens on different days or different times of the year. Stress can interfere with responses, too.
For skin testing, veterinarians clip the fur, inject a small amount of each of up to 50 allergens into the skin and record the size of the swelling (indicating the immune response).
The problem is that different vets will have different ideas as to what constitutes a high or low degree of skin response. Human error and inconsistency, even on the same patient, is always a factor.
For blood testing, the issue is that different labs will come up with different results. Blood handling, human error, allergen purity, etc. can all interfere. For that reason, dermatologists often claim these tests are poor substitutes for skin tests. The skin test is the “gold standard” because it’s carefully controlled by a specialist.
And I would tend to agree. Nonetheless, I’ve had great results on the many blood-based allergy tests I’ve performed. My local dermatologist, Dr. Millie Rosales, concedes that she sometimes uses serlologic testing, too, and that certain labs seem to produce excellent results––results comparable to skin testing. Still, all allergy tests––skin or blood-based––need to be taken with a hefty grain of salt.
So why go through with it at all? What does it help to know what you pet is allergic to? For two reasons:
Because knowing what’s causing the problem can help you avoid some of them. Sure, you won’t be able to avoid pollens, but wool, jute, cotton and fleas? Your knowledge of their allergenicity can make a huge difference to how carefully you approach these substances. Because we can always formulate a custom-made vaccine against the allergens your pet can’t avoid (molds, trees and grasses, for example), this is an excellent option––if you’re willing to assume the additional expense and the work required by regular allergy shot administration.
It may sound like a lot of work, these allergy shots. But they’re really not. Subcutaneous injection is easy in pets. We can teach you how to have it done. And we’re always happy to do them for you if you’re willing to come in on a regular basis (frequently at first then only once a month).
The best part about an allergy vaccine protocol is that no drugs are administered (though many pets may need drugs to remain comfortable until the vaccines kick in). These are natural substances that work because the gradually increased levels of allergens in the shots are helping the body’s immune system become acclimated to them––instead of producing the aberrant immune response responsible for the allergies.
The trouble with this approach is four-fold:
1-Pets can over-react to the increased levels of allergen, resulting in more itching, redness or even anaphylaxis (though this latter issue is rare). In these cases we back down on the rate of allergen increases.
2-Pets can develop allergies to new substances over time, requiring that we re-submit blood samples or re-do skin tests periodically (often every 12 months or so, though some pets may never need a re-test and may even have their vaccines successfully discontinued over time).
3-Some pets (about 40%, it’s estimated, may not respond well enough to allergy shots to warrant the work and expense (about $100 to $500 every 9 months or so).
4-As mentioned before, tests may not provide accurate results––which may account for vaccine failure as discussed in #3.
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That’s it for now. Phew! Have anything to add or ask? I’ll take it all up, but give me a few hours to respond, I’m wiped out for the moment.
An eBay savvy, Maryland veterinarian is offering a spay or neuter to anyone willing to bid on it. Really.
Dr. Marcella Bonner used to auction purses on eBay to supplement her income. These days she’s got a new practice and a nut to cover. So she’s taking her well-honed eBay techniques to places veterinary services once feared to go.
Well beyond a sophisticated website, an attention-getting blog or crafty tweets, she’s drumming up business––offering the basic spay and neuter procedures some extra press, while she’s at it.
What’s the going rate, you ask?
$250 to spay any size female dog and $100 to neuter her male conspecific. $100 to spay any size female cat and, for the boys, $40 to neuter.
Any way you slice it, it’s a bargain. Especially since she’s offering a complete service with anesthetic monitoring and equipment during the spay and surgery and pain medication before, during and after. Though there are extra charges for those who are older or pregnant.
In a statement to DVM Newsmagazine she had the following to say:
"We, as a profession, are not helping with the pet overpopulation...The price for a spay or neuter is very high. Shelters are overpopulated because people can't afford to pay $600 to $800 for a spay. It's unbelievable what people are charging.
...Some of the animals that have been coming in as a result of the auction are anywhere from 3 to 6 years old. The pet owners are saying that they just couldn't afford to do it before."
OK but...I still think $600 to $800 is a fair price. For some hospitals. For some patients.
I’m excited to hear she’s bringing attention to the pet overpopulation problem and building her practice while she’s at it. It’s the kind of socially conscious entrepreneurial spirit we should all applaud.
But...does it devalue our services to offer them on eBay? Some veterinarians think so. I mean, would you bid on breast implants? Liposuction? Gall bladder surgery?
Maybe not. You’d question the ethics, the quality and the professionalism of those that did. How is that different for veterinarians and spay neuter? Is it a commodity like toilet paper or purses...to be auctioned off? Or does it get a pass due to its socially conscious message? Or maybe you think it's a tacky marketing ploy to get pets inside her freshly-painted doors?
So what about you: What do you think? Would YOU buy a spay on eBay?
Everyone thinks it always comes down to the heat stroke nightmare scenario. But it doesn’t––not always. Hot weather hazards are seriously diverse. And here’s a listing of what you need to look out for––beyond the heat stroke, which all of you should avoid like the plague, anyway:
1-Burnt pads
My burnt pad patients almost invariably come attached to owners who profess ignorance of this possibilty. Anyone who’s walked barefoot on a hot, sandy beach in mid-summer, however, can attest to the horrors of surface temperatures. Why should it be so different for dogs walked on scalding asphalt? Pads can only do so much to protect them.
2-Skin cancer
Why not? Indeed, pets get skin cancer quite readily as a result of UV radiation. Though most cancers of the skin are unrelated to the sun’s rays, a large percentage of white or light-colored sunbathers (especially in more tropical latitudes) suffer solar-related skin cancers.
3-Pool hazards and other drowning possibilities
Heading out to the beach? BBQ poolside? Lakeside vacation? They all present the possibilty of drowning. And it’s more common than you might think. Debilitated pets, those with vision problems or seizure disordes, non-swimmers (especially those in unfamiliar environments)––they can all drown easily. Here are some ideas to help avoid the possibility as best you can.
4-Sunburn?
Yes, it happens. And apart from being uncomfortable, it’s a big risk factor for skin cancer. Protect your pets with a liberal application of sunscreen, 30 SPF (or greater) kid’s stuff is what veterinary dermatologists recommend. Ears, the bridge of the nose and other sparse haircoat areas are the target zones for a liberal slathering of sunscreen. But belly-up sunbathers tend to lick it off their most exposed parts. That’s why, for them, I recommend...
5-Sunblock T-shirts
Or any T-shirt at all. They help block those nasty UV rays without the vagaries of lickable sunscreen and its dubious SPF protection.
6-Too hot for anyone
Avoid the sun during peak times of the day. Not only is heat stroke more likely at these times, pets exposed to these solar rays are more at risk of sunburn and skin cancer––of course.
7-Water, water, everywhere
Always travel with water for your dog. Know where the hoses, water fountains and other sources of water are along your regular walks and at your dog parks.
8-Know the signs of heat exhaustion
Bright red gums/tongue/eyes, excessive panting, sudden exercise intolerance. Of course, all of these must be assessed relative to your dog’s normal exercised state. Pay attention to what she usually looks like so you don’t push her to walk all the way back home once you start to notice the obvious signs of heat exhaustion (mild to moderate hyperthermia). Because the next step is too often...
9-Heat stroke
Here’s where his temp has climbed into the 105-and-above range (severe hyperthermia). Here are some do’s and dont’s, thanks to VIN’s VeterinaryPartner (one of my favorite comprehensive online resources for pet healthcare):
“What to Do
Remove the pet from the environment where the hyperthermia occurred. Move the pet to the shade and direct a fan on him. If possible, determine rectal temperature and record. Begin to cool the body by wetting with cool (not cold) water on the trunk and legs. It is helpful to use rubbing alcohol on the skin of the stomach and allow the fan to speed evaporation. Transport to a veterinary facility.What NOT to Do
Do not use cold water or ice for cooling. Do not overcool the pet. Do not attempt to force water orally. Do not leave the pet unattended for any length of time.”
10-Protect your pets indoors, too
Heat stroke can happen indoors, too. On extra-hot days our homes can turn into ovens should our AC go out or our power browns out. That’s how one Frenchie died a couple of weeks ago. In his crate. When the AC compressor went out.
Keep this possibility at bay with a fan trained on the crate, a generator or a spare AC wall unit set on low in the room the crate lives in. I like the idea of a frozen gallon jug of water placed behind the fan for maximum cooling power while you’re gone––just in case. Refreeze it overnight and repeat.
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Any of you have some other tips for us?
I refer many of my patients to specialists. I consider them my partners in practice, people who bring more to my patients than I can offer. They’re tools every veterinarian needs to learn how to wield wisely on their patients’ behalf.
But sometimes, they’re our spouses, friends and lovers, too. Which can sometimes raise eyebrows, along with some very obvious ethical concerns.
After all, there’s a reason for the “no kickback” rules that govern how we work with specialists. We’re not to be remunerated by specialists because this kind of relationship means we might be sending you to someone because we know they’ll pay us...not because they’re the very best for your pet. Same goes for nepotism and cronyism.
Sure, these rules aren’t exactly hard and fast ones. For example, it’s OK for you to hire a veterinarian to come to your practice and perform surgery or ultrasounds––because keeping your patients “in house” means you’ll earn more. And that’s unethical when you know your patients will receive better care––often for less money––when you refer them to a full-service specialty facility.
But it’s not necessarily unethical. Not if you believe that it’s what’s best for your clients and patients. And it’s certainly not illegal.
Same goes for referring patients to your spouse or love interest. It’s not illegal, but it’s ethically fraught, to be sure. And that’s why I often find myself in a pickle:
How can my clients trust that I’m sending them to the best surgeon in town for their pet’s specific needs?...when that surgeon happens to be my long-time boyfriend.
Tough one, right?
Though I confront this problem at least once a week, I typically know my clients well enough that they trust in me anyway. Whether I disclose the relationship or not, it’s a foregone conclusion (at least in my mind) that I’m doing my best for my patients by sending them to the best surgeon I know.
After all, I’d been referring to this surgeon––exclusively––for two years before I ever met him personally. His results, my clients’ universal satisfaction with his work, and his responsiveness with written reports and telephone feedback gave him a leg up on every other surgeon I’d ever worked with...then or since.
Which is why I asked him out more than five years ago after a friendly client suggested I’d be stupid not to. Sight unseen, I made the call. You can guess the rest.
But yesterday’s new client raised the issue for me more acutely. They had no reason to trust me. They had no reason to believe me when I recommended they see the surgeon of my choice (for their lame dog with no clear site of pain or injury).
So I disclosed the relationship and explained why I thought they should still consider him tops. They smiled...and told me their previous veterinarian had already recommended him. :-)
It’s been two weeks today since Sophie’s been gone. I’ve been working hard, away for a spell (a weekend vacation I thought she’d attend), and immersing myself in random books and old miniseries.
Though lots of intense work keeps me busy, The Book Thief and The Shadow of the Wind were superb, my cooking time has skyrocketed (all these mangoes) and early Battlestar Galactica has it’s charms...
...truth is, we’re all still hurting (badly) over Sophie Sue’s demise. Not an hour goes by that I don’t remind myself she’s no longer here after looking for her in that weird way we pet lovers are wont to do at any given moment...for no reason at all. Just to feel them near.
It’s a comfort, knowing she’s always with me in that strange spiritual sense. But, at present, it’s kind of a burden, you know? I don’t enjoy the thoughts, when they come. And I can only be thankful for not having too much time to dwell on how much I miss her.
The receipt of her ashes, however, kind of brought it all back.
I knew her cremains had to have arrived by now, but I wasn’t ready to ask my staff for her. Knowing, as they did, that it might not be wise to inform me, they waited for my request. And now what’s left of her physical body is here with me. I can handle it now.
But what to do with these cremains?
My son voted for a ceremony. And we'll have one as soon as the whole family returns from their summer trips and we do our belated Father's Day dinner at my house.
But what about the ashes? Will we spread them?––and where? Will we urn them?––and in what?
Again, my son had the best idea: We'll plant a Sophie tree in the front yard near her favorite poopy corner. And because I don't think I can part with her should I ever move, I'll keep some in a little box, too.
So weird, this need to keep a bunch of crunchy debris in my possession. Especially since I'm big on being scattered in the Everglades, myself. But we all have our very human and individually unique attachment to things.
What are yours? How would you handle them?
PS: Thank you all so much for your condolences––posted online and delivered by email or snail mail. My family and I truly appreciate them.
