Skin Diseases Archives - Chappelle Veterinary Clinic

ABOUT THE DIAGNOSIS

“Ringworm” (dermatophytosis) is a skin disease that is caused by a fungus, not a worm. It can affect cats, dogs, other animals, and people. Long ago, it was thought that a parasite (worm) was responsible, but it is now known that ringworm is caused by a type of fungus called dermatophytes, which affect tissues containing keratin. Keratin is a protein produced by skin cells. The outermost layer of skin cells contains keratin. Hair and claws/nails are also made of keratin. Therefore, dermatophytosis is a contagious fungal infection that can affect the skin, hair, and claws.

Ringworm skin infections tend to enlarge in a circular pattern as the organisms continuously infect more skin and hair on the edges of the area—hence the “ring” in the name ringworm. Three types of ringworm/dermatophyte infections are common in dogs and cats. One, Microsporum canis, is usually transmitted from one pet to another. The other two, Microsporum gypseum and Trichophyton mentagrophytes, are normally found in soil and on rodents, respectively, but can infect pets as well. People can become infected with any of the three types of ringworm from contact with infected pets.

SYMPTOMS: Skin and hair ringworm infections cause hair loss in a circular pattern. The ringworm infection weakens the hairs, causing them to break off easily, leaving the skin bare in affected areas. Small red bumps, scales (dandruff), and hyperpigmentation (darkening) of the skin may occur. Infected nails become deformed and may have a fluid or gummy discharge at the base of the nail. Some infected cats show no symptoms at all but can be carriers, transmitting the ringworm infection to dogs or other cats. Other cats can develop miliary dermatitis, a condition where small crusts (scabs) can be felt beneath the hair coat.

DIAGNOSIS: The signs and symptoms of ringworm infection are similar to several other skin diseases so the diagnosis of ringworm cannot be made by appearance alone. Your veterinarian may use an ultraviolet lamp called Wood’s light to screen suspicious areas for ringworm. Some dermatophytes produce substances that glow with a green color under Wood’s light. However, this is a screening tool only, since not all dermatophytes show this response and conversely, some substances on the skin that are not ringworm can cause a false positive reaction. The best test for diagnosing ringworm infection is fungal culture. For this simple test, the hair- coat is brushed with a disposable toothbrush or a few hairs are plucked from the affected area, and the specimen is incubated in a special culture medium called dermatophyte test medium, or DTM. A ringworm fungus tends to grow slowly when it is off the body, so results will not be known for a few days or up to two weeks. Microscopic examination of the fungus growth on the DTM can identify which of the three dermatophyte organisms is causing your pet’s infection, which is helpful in determining the source (i.e., the risk of reinfection).

LIVING WITH THE DIAGNOSIS

Microsporum canis is the most contagious type of ringworm. It is important to realize that the environment and all infected pets in the household must be treated to eliminate ringworm and prevent its spread to other pets and to people. Dermatophyte organisms on shed hairs can remain infectious (contagious) for weeks. Other pets in the household should be inspected for infection. Since

asymptomatic cats may be carriers, they should be tested by sampling the hair (brushing the haircoat with a brand new disposable toothbrush) and then submitting the entire toothbrush and its collected hairs in a clean, zip-seal plastic bag for DTM culturing by your veterinarian. Infected pets should be isolated from other pets and from people, especially immunocompromised people including persons receiving cancer chemotherapy, people with human immunodeficiency virus (HIV) infection, and others. See the Treat ment section below for more information. If your pet has contracted ringworm due to Microsporum gypseum or Trichophyton mentagrophytes, avoiding exposure to contaminated soil and ro- dents or rodent burrows will help prevent reoccurrence.

TREATMENT

Most pets will have an immune response to the fungus that will eventually eliminate the infection. However, treatment is needed to speed the process and to prevent the spread of the ringworm organism to other pets and people. If for any reason, your pet is receiving any medications that suppress the immune system, such as corticosteroids, they should ideally be stopped; you should discuss this with your veterinarian to find suitable alternative medications as necessary. Long-haired pets should have their entire haircoats shaved off and the hair carefully collected and disposed of. Fungicidal dips (soaking the pet in diluted, purpose-made fungicidal shampoo or solution) help reduce the infectiveness of remaining hairs. Frequent, thorough vacuuming and cleaning of the area where the pet is kept are needed to remove infected hairs from the environment. All pet bedding and grooming equipment should be disinfected or destroyed. The entire house should be carefully cleaned to remove pet hairs. Consult your veterinarian for recommendations of cleaning agents that will destroy the organisms.

Pets affected with mild cases of ringworm (small, isolated skin lesions) can be treated with antifungal creams and lotions (prescription topical medications), which are applied directly to the affected areas of skin. It is important to wear gloves, such as disposable latex or rubber medical gloves, to avoid contracting the infection from the pet when applying these topical treatments. Oral antifungal medication is required for pets if topical treatment is not successful or if the hair loss and skin lesions are very extensive. Several oral drugs are available as well, and oral treatment, topical treatment, or a combination of both may be most effective de- pending on the case. NEVER give topical medications orally, as dips and ointments and creams may be harmful or fatal if swallowed.

Ringworm is often tenacious, and treatment typically takes about three months. Nail/claw infections require much longer treatment—often from 6 to 12 months.

A vaccine is licensed for control of Microsporum canis infection in cats. It has not proven to be very effective, and is not recommended for use except in some cattery situations.

DOs

Realize that hairless areas on the skin of dogs and cats, particularly if circular and reddened, may indicate ringworm infection, which is contagious to other animals and to people.
If ringworm is confirmed take steps to decontaminate your home as well as treating your pet(s).
Use topical treatments and oral medications exactly as directed.
- Some oral antifungal medications need to be given with food to enhance drug absorption; ask your veterinarian about this issue if oral antifungal medications are prescribed.
- Discuss with your veterinarian the possibility of a second opinion from a veterinarian specialized in skin disorders (veterinary dermatologist; acvd.org) if the problem is persistent, severe, or complicated.
DON’Ts
- Never give a topical medication by mouth. Most medications meant to be applied to the skin for ringworm are harmful if swallowed and some may be deadly if ingested.
- Don’t automatically assume that a round area of hair loss can only be due to There are many other skin disorders, especially in dogs, that have a similar appearance but are caused by a totally different, and usually non-contagious, skin problem. Basic tests can be performed by your veterinarian to confirm or exclude ringworm.
- Many antifungal medications should not be given to pets that are pregnant or to male animals that are being used for breed- ing. Check with your veterinarian if this is a relevant concern for you.
WHEN TO CALL YOUR VETERINARIAN
- When giving oral antifungal medication, if your pet has any of these problems: vomiting, diarrhea, lack of appetite, itching, depression, or incoordination. These symptoms can sometimes occur as part of intolerance to some medications, and your veterinarian can help determine if this is the case.
SIGNS TO WATCH FOR

As a sign of new-onset of ringworm, or of a ringworm infection that is worsening despite treatment:
- Circular areas of hair loss that grow
- Deformed nails/claws.

ROUTINE FOLLOW-UP

Some oral antifungal drugs can cause bone-marrow suppression or liver Periodic blood tests are needed to check for these side effects.
Fungal cultures should be repeated before stopping oral anti- fungal medications to be certain the infection has been completely eliminated.

ADDITIONAL INFORMATION

If any people in the household develop areas of red, itchy skin, consult a physician.
Individuals who are immunocompromised should seek guidance from their physicians and avoid contact with the pet or its surroundings if there is a suspicion or confirmation of ringworm in the pet.

ABOUT THE DIAGNOSIS

Eosinophilic granuloma complex includes three distinct skin dis- eases in cats. All are thought to be either a result of allergies or reactions to parasite infestations and all respond to similar treatment.

The name of the disorder comes from the observation that in all cases, microscopic examination of the affected tissues reveals large numbers of eosinophils, a type of white blood cell that is involved in allergic reactions. In cats, allergies often produce skin itchiness and skin lesions as the predominant symptom. In cats with any of the eosinophilic granuloma complex diseases, the underlying trigger may be allergies to fleas or other parasites, to food ingredients, or to environmental substances such as pollens or house dusts. Studies have shown that, at least in some cases, the tendency to develop eosinophilic skin diseases is inherited genetically. This observation means that both genetic predisposition, an environmental trigger, seem to combine to play a role in causing eosinophilic skin diseases. The fact that these disorders are rarely caused by a single trigger helps explain why eosinophilic granuloma diseases may flare up despite treatment, and may persist for months or years.

At least three specific types of skin lesions make up the eosinophilic granuloma complex:

Eosinophilic plaques are hairless, flat, raised areas on the skin that are often red, moist, and Plaques are most often found in the groin or axilla (armpit) or on the outside of the thigh. The condition seems to be very itchy, and cats often will lick the areas constantly.
Eosinophilic granulomas are hairless, raised, yellow areas of skin or of the mouth; they often have sores on the The most common site is along the back of the thigh, although other areas of the body can be affected. Eosinophilic granulomas can occur inside the mouth and on the tongue. Cats with mouth involvement may drool and be unable to eat.
Indolent ulcer, or rodent ulcer, affects the upper lip. The lip becomes swollen, and a sore develops where the skin meets the mucous membrane of the inner lip.

LIVING WITH THE DIAGNOSIS

Skin problems caused by the eosinophilic granuloma complex tend to wax and wane. If the underlying allergic cause can be determined and controlled, the problem can be prevented from reoccurring. Therefore, one aspect of dealing with eosinophilic granuloma complex should be to discuss with your veterinarian how to control some of the more common culprit allergens, such as initiating a diet that contains ingredients with a low likelihood of triggering an allergic response.

In some cats, the problem is seasonal. If fleas are present, a rigorous flea control program should be started. Seasonal problems may be due to bites of insects, such as mosquitoes, or to environmental substances that trigger allergic skin responses, such as inhaled pollens. Environmental allergies are identified by intradermal skin testing. Consulting a veterinary dermatologist may help in determining and eliminating underlying causes.

TREATMENT

All three forms of eosinophilic granuloma complex respond to treatment with corticosteroids (cortisone-like drugs). Administration may be either by mouth (pills/tablets) or by long-lasting injection. Long-lasting injections are much more convenient but they

carry a greater risk of causing adverse effects, including diabetes and unmasking (emergence of symptoms) of heart disease. There- fore, these sustained-release injections should be used in moderation, if at all, and only once an effort has been made to find the underlying cause of the allergic reaction and to eliminate it. If corticosteroids are used, whether given by you at home (orally) or by your veterinarian (injection), they should be given for as short a period of time as possible. The skin problems tend to wax and wane, so reoccurrence is unpredictable except in cases that tend to reoccur seasonally.

Since corticosteroids mask the problem rather than eliminating it, a reasonable effort should always be made to identify the cause and possibly use other types of treatment if effective. Here, too, a veterinary dermatologist may be extremely helpful.

DOs

If giving medication by mouth, follow directions
Realize the value of seeking a second opinion with a veterinary dermatologist for confirmation of the diagnosis and the most recent forms of Veterinary dermatologists are known as Diplomates of the American College of Veterinary Dermatology; your veterinarian can suggest a referral to one of these specialists. Directory: www.acvd.org.

DON’Ts

Do not use lotions, ointments, or other topical medications on the areas unless directed to do so by your veterinarian. Cats quickly lick off topical medications, and some may be harmful if swallowed.

WHEN TO CALL YOUR VETERINARIAN

If the areas do not heal with the prescribed
If the condition
If your cat is having difficulty eating due to eosinophilic granulomas in the mouth.

SIGNS TO WATCH FOR

See the description of each form of eosinophilic granuloma complex in the About the Diagnosis section for initial symptoms, which are also the signs to watch for as an indication of recurrence if treatment is not working.

ROUTINE FOLLOW-UP

If your cat needs long-term corticosteroid treatment to control its skin disease, periodic testing, including blood samples, may be recommended to monitor for side effects.

ABOUT THE DIAGNOSIS

When a dog or cat has fleas, the degree of itchiness and discomfort is often very different from one individual to the next. This variability exists because some dogs and cats are allergic to flea bites whereas others are not. Flea bite allergy (also called flea bite dermatosis, flea allergy dermatitis, or flea bite hypersensitivity) is a common skin condition in dogs and cats. It occurs when a flea bites an animal that is allergic (hypersensitive) to one or more proteins (allergens) in the flea’s saliva. Nonallergic animals usually develop very mild itchiness at the site of a flea bite for only a brief time after the flea bite. However, animals with flea bite allergy can develop intense itchiness anywhere on the body, regardless of where the flea bite occurred, and the intensity of the itchiness tends to progressively worsen with continued exposure to fleas, leading to hair loss and other skin problems. One or two flea bites every week can be enough to trigger and perpetuate an allergic reaction and near-constant itching. Animals of any age can develop flea bite allergy, but it is typically seen in dogs and cats that are 1 to 5 years old. It most often occurs in the summer but can occur year-round in more tropical or subtropical climates since warm weather favors flea reproduction.

Veterinarians often diagnose flea bite allergy based on symptoms, evidence of fleas in the hair coat, and improvement of the animal’s symptoms with treatment. Evidence of fleas consists of finding adult fleas, “flea dirt” (brown-black specks that consist of flea excrement containing digested blood) and/or flea eggs (white specks) on the affected pet or other pets in the household. Animals with flea bite allergy often have only a few fleas or sometimes no fleas on them at all at the time of examination because the fleas are often dislodged as a result of the animal’s excessive scratching, chewing, and licking of the skin. For these suspect cases where fleas are not found, an intradermal skin test and a blood test are available to help confirm a diagnosis of flea bite allergy, but these tests are not 100% accurate. A positive result confirms flea bite allergy, but an animal that tests negative on either test could still have flea bite allergy in some instances. A more practical approach is to treat the pet with anti-flea products very consis- tently for a period of several months in a row and monitor for improvement. Other tests may be necessary to eliminate other causes of skin disease and itchiness because several types of skin diseases unrelated to fleas can produce a similar degree of itchiness and the same symptoms overall, but require entirely different forms of treatment.

LIVING WITH THE DIAGNOSIS

DOGS: Symptoms of flea bite allergy consist almost entirely of scratching of the skin and the consequences of damage to the skin if itchiness is severe. The intensity and extent of scratching can be variable in degree, from very mild to severe, and generally worsen over time as the dog ages. Areas of skin most often affected are on the lower back, tail head (where the tail attaches to the body), hind legs, and belly, although the dog’s entire body may be affected in severe cases. The affected skin is very itchy and may show small bumps, scabs, abrasions, redness, and hair loss; the inflamed skin may become infected with bacteria. Some dogs may develop a “hot spot” lesion (acute moist dermatitis), which is a well-demarcated patch of very inflamed, moist, hairless skin

caused by the animal’s excessive chewing, licking, and scratching of that particular area. The animal’s skin may thicken and darken from repeated scratching and chewing.

CATS: Symptoms of flea bite allergy can be variable in cats. Cats may have a skin lesion pattern similar to dogs as described above, but more often cats with flea bite allergy develop little bumps and scabs around the head, neck, and belly (miliary dermatitis). Some cats develop a round, reddish-yellow plaque (eosinophilic plaque or granuloma) on the groin area, belly, or inside part of the hind legs. The affected skin is usually very itchy; cats may scratch and or lick these areas of skin excessively, causing hair loss. Some cats have a symmetric loss of hair affecting the mid to lower back and hind legs, with no other obvious signs of skin irritation (symmetric alopecia). Cat owners may often think that the itchiness is simply normal grooming behavior, and the most common tip-off that flea bite allergy exists is visible loss of hair from excessive licking of an area of the skin.

TREATMENT

Treatment and prevention of flea bite allergy consist of taking measures to prevent an allergic pet from being bitten by fleas. This usually requires the elimination of fleas from the flea allergic pet, the pet’s immediate environment (yard, house), and other dogs and cats in the household with products that kill the adult flea (adulticide therapy) and prevent fleas from reproducing (insect growth regulators, borax products). Flea collars are usually not effective. In the past, extensive spraying of the home and premises was common, but nowadays, oral or topical (applied to the skin) prescription anti-flea products are given to the pet at home once or twice a month and are very effective. Be sure to use the treatments exactly as prescribed; misuse, or using over-the-counter (nonprescription products from a grocery store or pet store, for example) are common reasons for failure to eliminate fleas.

Your veterinarian may also prescribe antiinflammatory medication such as corticosteroids (cortisone-like medications), antihistamines—usually given orally, or similar treatments on a short-term basis, to decrease the allergic response in the skin and provide immediate relief from itchiness. Orally administered antibiotics may be needed if there is a bacterial skin infection (pyoderma). Much less preferable is the long-term use of antiinflammatory medication, which is associated with greater negative side effects. In rare cases, such treatment is used if it is not possible to prevent exposure to fleas.

The expected outcome with flea bite allergy is good: virtually all affected dogs and cats can be relieved of itchiness and the constant desire to scratch, but only if flea elimination is pursued regularly and correctly by their caretakers. All allergic reactions can be triggered by a single re-exposure, so one flea bite can set back days or weeks of successful care. For this reason, it is essential to continue to give anti-flea medications as prescribed, whether they seem to be working (stopping prematurely can lead to a recurrence of itching and scratching) or even if they do not seem to be working (it may take several weeks for the allergic reaction to subside, and stopping treatment only allows fleas to return). Successful treatment leads to a comfortable pet and less scratching that is bothersome to the pet and to the family.

DOs

Consult with your veterinarian about treatment options for your pet (several excellent, safe prescription products recently on the market) and if necessary, for the home/yard (self-care, professional exterminator, alternatives to insecticides).
Use insecticides according to directions and with caution around pets and people.
Discuss with your veterinarian the possibility of a second opinion from a veterinarian specialized in skin disorders (veterinary dermatologist; acvd.org) if the problem is persistent, severe, or complicated, or if it is not clear whether fleas are the sole cause of the symptoms.

DON’Ts

Do not use flea products containing permethrin, pyrethroids, or chrysanthemum derivatives on cats (potentially severely toxic).
Do not apply flea products designed for the environment on animals directly.
Do not assume fleas are not the problem just because no fleas are immediately visible.

WHEN TO CALL YOUR VETERINARIAN

If the condition does not improve with appropriate
If your pet has a reaction to any medication(s) or flea product(s). Signs of a reaction may include: drooling, vomiting, hives, ab- normal behavior, restlessness, increased itchiness, and hair loss or irritation of the skin where a flea product was applied.

SIGNS TO WATCH FOR

As signs of a new or recurrent flea problem:

Live fleas, flea dirt, or flea eggs on an affected pet, the pet’s bedding, or other pets in the household; a flea comb can be very helpful in finding evidence of fleas on the pet.
New bumps or scabs on the pet’s skin; these may indicate a recurrence of the allergy.

Other information that may be useful: “How-To” Client Education Sheets:

How to Deal with Incessant Scratching

How to Deal with Severe, Self-Inflicted Skin Erosions

ABOUT THE DIAGNOSIS

CAUSE: A food allergy is a reaction of the body’s immune system in response to particular foods or food ingredients. For unknown reasons, in some dogs and cats the immune system mounts an unusually strong response to some foods. The most common causes for both dogs and cats are proteins found in beef, chicken, dairy products, eggs, wheat, corn, or soy. In cats, fish is also a common offender. Some breeds of dogs and cats appear to be predisposed to developing food allergies, implying that there can be a genetic predisposition to food allergy. It is important to understand that food allergies develop only after the immune system has been previously “exposed” to a food. In fact, most dogs and cats have been eating a particular food for months or years before adverse reactions like allergies to it are first apparent.

Food allergies can develop in dogs and cats ranging in age from several months to any stage of adulthood. Symptoms include itchiness of the skin (pruritus), dry or crusty skin, and hair loss (alopecia). Just one area of the body may be affected, such as the paws, or itchiness and skin lesions can be spread over various regions of the body. These include the ears, face, paws, the area around the anus, armpits, and groin, and others. Secondary infections (bacterial, yeast) of the skin can develop as a common complication of self-induced trauma of the skin. Intestinal disturbances including frequent bowel movements, loose stools, diarrhea, or vomiting occur in some cases, when the allergic process affects both the skin and the digestive system. Food allergies cause skin-related symptoms similar to those seen with several other allergies such as flea and airborne (atopic) allergies, and for this reason, certain tests, and a dietary elimination trial, are generally needed to pinpoint food allergy and determine the right treatment to follow.

DIAGNOSIS: Your veterinarian will perform a thorough physical exam and take a complete medical/dietary history. Be sure to list everything that your pet ingests—food and treats, but also heartworm medication, hairball treatment, feces (coprophagia), etc. It doesn’t matter if it has been consumed for years or only just recently—be sure to mention everything. To diagnose this disorder, the suspected food ingredient or ingested substance is completely eliminated from the diet for approximately 4 to 12 weeks. During this time, your veterinarian can provide a commercially- prepared diet that is nutritionally complete. Home-prepared diets are another option. It is essential to consult with your veterinarian in order to ensure that any home-made diets contain all nutrients, to avoid serious health problems related to nutritional deficits. Your veterinarian can discuss diet options with you. It is important that your dog or cat has never had any ingredient in the diet before and that this is the only food offered during this trial period. If your dog or cat improves while on this diet, then a food allergy is very likely the cause of the symptoms. At this time, they are “challenged” by reintroducing the ingredient or substance that had been eliminated from the diet, to be sure improvement was not just the natural course of some other skin or intestinal disorder. If symptoms worsen or return, then that ingredient/substance is considered the trigger and it must never be fed again, so as to avoid recurrent symptoms.

LIVING WITH THE DIAGNOSIS

Avoid giving the allergenic food in any amount whatsoever. Even a small amount can cause full-blown symptoms in some dogs and cats. You may need to read ingredient labels carefully before buying food and treats. All family members need to observe this rule, and if your pet is kenneled, be sure that the kennel employees are informed so they know to avoid feeding other foods or treats. If you have more than one dog or cat in the household, adherence to the specific diet may require changing the diet for all to prevent the possibility of consuming the others’ food.

Give all medications as directed and know the possible side effects.

TREATMENT

Antihistamines or corticosteroids may be prescribed (usually as pills/tablets) to control itching. Antibiotics or other medications help to control secondary infections when present. Special shampoos may make your dog or cat more comfortable. These are temporary solutions, and tackling the root cause of the allergy is the best way of eliminating symptoms. When the allergenic food or food ingredient is identified, it must be strictly avoided to ensure the best result. Rarely, severe reactions to food (anaphylaxis) occur. Hives, facial swelling, and/or breathing problems result. This can be an emergency; take your pet to your veterinarian or to the local veterinary emergency clinic immediately if you see these symptoms regardless of whether food allergy has been confirmed before; anaphylaxis may occur in a dog or cat that has had longstanding food allergy in his or her medical history, or as the first sign of food

allergy ever (extremely rare).

DOs

Provide a thorough list of all things that your dog or cat eats to your veterinarian when first evaluating the possibility of food
Inform your veterinarian if your dog or cat has ever been diagnosed with a medical condition and is taking medication, as these could influence the response to treatments or mask
Realize that even one exposure (one nibble) of a food or treat that is allergenic can cause days or weeks of symptoms, and that strict adherence to a hypoallergenic diet is essential in pets with food allergy.
Give medication exactly as directed by your veterinarian, and if you are concerned about possible negative effects, discuss them with your veterinarian immediately rather than simply discontinuing the treatment.
Discuss with your veterinarian the possibility of a second opinion from a veterinarian specialized in skin disorders (veterinary dermatologist; acvd.org) if the problem is persistent, severe, or complicated.

DON’Ts

Do not give any other foods (including treats, chewable medications like heartworm preventative flavor cubes, etc.) than the one selected by your veterinarian when you are feeding the hypoallergenic food.

Do not give medication that you have at home that has been prescribed for human use; some of these may interfere with treatment or cause even more severe problems.

WHEN TO CALL YOUR VETERINARIAN

If your dog or cat will not eat the trial diet—cats that don’t eat for more than 24 hours can develop liver problems that must be avoided.
If you cannot keep a scheduled
If you are unable to give medication as

SIGNS TO WATCH FOR

As indicators of general health, especially if taking medications:

Watch for general signs of illness, which include vomiting, diarrhea, decreased appetite, weight changes, and changes in behavior such as hiding more than usual and aggressiveness.

Specifically if suspecting food allergy, or when food allergy has been confirmed in the past and as a sign of recurrence:

Watch for signs of food allergies, which include itching, red- ness, crusts or scales on the skin, frequent bowel movements, loose stools, vomiting, and diarrhea.

ROUTINE FOLLOW-UP

Follow-up appointments are scheduled during the food trial and subsequent challenge to monitor progress.

ADDITIONAL INFORMATION

Although one food or food ingredient may be identified as an allergen, allergies to other foods can develop later in See your veterinarian if symptoms return.

Other information that may be useful: “How-To” Client Education Sheets:

How to Deal with Incessant Scratching
How to Deal with Severe, Self-Inflicted Skin Erosions

ABOUT THE DIAGNOSIS

CAUSE: Dogs and cats of both sexes have breast tissue that lies as two series or “chains” of mammary glands along the midline of the belly and chest, with a nipple for each of the ten mammary glands. Like in people, it is possible for tumors to develop within these mammary glands in dogs and cats. These tumors may be benign (harmless) or malignant (cancerous).

The vast majority of mammary tumors that occur in dogs occur in females (99%) versus in males (1%), and mammary tumors are the most common tumor of female dogs. Spaying (also called neutering, ovariohysterectomy, or having the uterus and ovaries surgically removed) of female dogs appears to provide a strong protective effect when performed at a young age. Dogs that are spayed before their first heat/estrus, which generally means before the age of 7 to 8 months, have less than a 1% chance of developing mammary gland tumors. The risk increases to approximately 8% after the first heat and 26% after the second heat, which typically occurs around 1 year of age or slightly later. Therefore, it appears that female hormones are a strong influence on the development of these tumors.

If not removed early, approximately 35–50% of mammary gland tumors in dogs are—or become—malignant and spread to other parts of the body (metastasize), most commonly to the lungs and lymph nodes. Once this has occurred, it is very difficult to remove the tumor tissue entirely. Therefore, as in human beings, if a lump is seen or felt in the area of the mammary tissue in a dog or cat, early assessment is essential to reducing the risk of cancerous spread. This is felt as a firm lump on the underside of the chest and belly of female dogs.

Cats develop mammary tumors less often than dogs. Mammary tumor development in cats is also hormone-related. In fact, nearly all mammary gland tumors in cats occur in females that have not been spayed. The majority of mammary tumors in cats are cancerous, and they spread (metastasize) to the lungs and lymph nodes. Cats spayed before 1 year of age have less than a 1% chance of developing these tumors.

SYMPTOMS: Symptoms of mammary tumors include swelling, sores (ulceration), and/or masses on the underside of the chest or belly, namely where the mammary glands are found. If the disease is very advanced, other symptoms such as weakness, decreased appetite, weight loss, and/or breathing difficulty are possible, but these symptoms are vague and may be caused by other illnesses altogether.

DIAGNOSIS: A suspicion usually first arises when either you (the pet’s caretaker and companion) or the veterinarian feels a nodule, lump, or growth on the chest or underbelly. However, there are many impostors for mammary tumors, including some processes as simple as the accumulation of normal fat within the breast tis- sue. Therefore, one or several tests can be used for helping to diagnose mammary gland tumors. Your veterinarian can discuss with you which tests are appropriate for your dog or cat. X-rays of the chest and abdomen can help to determine if metastasis has occurred. An ultrasound examination of the abdomen (belly) can give more specific information regarding the organs that are involved. To definitively diagnose the tumor(s), tissue biopsies of the area are taken under general anesthesia and sent to a laboratory

where the tissues are examined by specialists. To assess your pet’s overall health, which is required if surgery is performed, routine blood tests such as a complete blood count (CBC) and serum biochemistry profile and a urinalysis are necessary.

LIVING WITH THE DIAGNOSIS

When a dog or cat is diagnosed with a mammary gland tumor, surgery is usually recommended. The intention is to remove as much of the tumor tissue as possible, in the hope that it is removed entirely before it becomes inoperable (as tumors enlarge, they can send tentacle-like projections to surrounding tissues) or spreads to other organs. The outlook (prognosis) depends on many factors including the size and location of tumor(s), whether metastasis has occurred, and the general health of the pet before surgery. The prognosis is better if metastasis has not occurred. Surgery is not helpful for a few types of mammary gland tumors. Your veterinarian can discuss these matters with you before treatment.

After surgery and once your pet is home from the hospital, it is important to give pain medication exactly as directed if any was prescribed, and to keep your dog or cat as comfortable as possible during the recovery period (usually several days to a week or so).

TREATMENT

Surgery is performed to remove all of the affected tissue, if possible. The size, number, and location of the tumor(s) generally determine the amount of tissue and the number of the ten mammary glands that needs to be removed (mastectomy). Your veterinarian may recommend that an ovariohysterectomy be per- formed at the time of tumor removal to prevent diseases of the uterus and further hormone release by the ovaries. This is the same surgery as spaying/neutering. An ovariohysterectomy cannot pre- vent onset of mammary gland tumors unless performed at an early age (see above). Chemotherapy, radiation therapy, and hormonal therapy for mammary tumors are very rarely recommended after surgery because they are not highly effective. Therefore, the cornerstone of success with mammary tumors in dogs and cats is prevention through spaying/neutering, and early identification and surgical removal when present.

After surgery, a bandage may be placed around the patient’s chest and/or abdomen to absorb any fluid discharge from the surgery site, to gently compress the surgical area, and to keep it as clean as possible. The bandage should be kept clean and dry at all times and should be snug, but not too tight to make breathing uncomfortable. The bandage typically will be changed as often as needed (at least daily) for the first several days after surgery. You should monitor the bandage for a foul smell or signs of in- creasing discomfort or pain around the area of the surgery, which could indicate an infection. If you notice any of these changes, or your dog or cat is not recovering to normal within 24 hours of surgery (or seems to be feeling gradually weaker or more sluggish, rather than more alert and returning back to normal during that period), you should contact your veterinarian to determine whether an immediate recheck is necessary.

A small drain may also be placed in the surgery site at the end of surgery to help evacuate fluid from the tissues under the skin, a normal process in healing. This drain is usually removed after several days.

DOs

Inform your veterinarian if your cat or dog has ever been diagnosed with a medical condition and is taking medication, be- cause past medical problems and current medications can alter the medications that a dog or cat can take concurrently.
Give medication exactly as directed by your veterinarian, and if you are concerned about possible negative effects, discuss them with your veterinarian immediately rather than simply dis- continuing the treatment.
Do realize the similarities and differences between humans and pets regarding this condition: the importance of early detection and treatment is an important similarity, whereas the extent of mammary tissue (every dog and cat has ten mammary glands) and the very infrequent use of chemotherapy in veterinary patients are important differences.
Do seek the opinion of a specialist if there is any doubt regarding diagnosis (Is it a mammary tumor or not?) and treat- Specialists in this field are veterinarians who are certified as Diplomates of the American (or European) College of Veterinary Internal Medicine, Specialty of Oncology (directories: www.acvim.org and www.ecvim-ca.org).

DON’Ts

Do not delay contacting your veterinarian if you think you can feel a lump, swelling, or mass on your dog’s or cat’s mammary Early detection and treatment can improve the prognosis.
Don’t confuse normal structures (like the nipples) for If there is any uncertainty, be sure to note exactly what you feel and where; otherwise, during the appointment, it sometimes might be difficult for you to find the nodule or mass, especially if it is small.

WHEN TO CALL YOUR VETERINARIAN

If you cannot keep a scheduled
If you are unable to give medication as
If your dog or cat is not improving after
If the surgical site (where the stitches are) becomes increasingly red, swollen, painful, or discharging of fluid.

SIGNS TO WATCH FOR

As a possible indicator of mammary tumors:

At any stage: discoloration and/or bleeding on one or more mammary glands, swollen mammary gland(s), discrete tumors that you can feel or see.
If advanced or during the postoperative recovery period (1 to 2 weeks after surgery): general signs of illness, including lethargy, weakness, decreased appetite, weight loss, and other behavior changes.

ROUTINE FOLLOW-UP

Patients diagnosed with malignant tumors should be examined by their veterinarian every few months for recurrence of the tumors or metastasis.
Surgery is usually followed by suture removal (stitches removed) 10 to 14 days later.

ABOUT THE DIAGNOSIS

Mast cell tumors are growths that commonly affect the skin of dogs and, less commonly, cats. They are potentially serious, since some mast cell tumors are malignant (cancerous). However, many mast cell tumors are benign (not malignant), and additionally, there are many, many other types of benign skin growths that can occur that resemble mast cell tumors outwardly but are in fact different. It is not possible to tell with the naked eye alone whether a specific skin growth is a malignant mast cell tumor or not, and therefore, some diagnostic tests are always necessary to confirm whether a skin growth is a mast cell tumor.

A mast cell tumor is often a surprising diagnosis to pet owners and family members because these tumors often seem unremarkable: they simply look like innocuous skin masses or, if affecting internal organs, are hidden from view. In this way, mast cell tumors are misleading because they may become serious or devastating health concerns if not identified and eliminated early on.

While most mast cell tumors affect the skin (cutaneous mast cell tumors), sometimes they may affect internal organs (visceral mast cell tumors). In cats, for example, up to 50% of mast cell tumors occur in the spleen, whereas this form is rare in dogs. Another uncommon form is mast cell tumor of the intestines. Un- like mast cell tumors affecting the skin, which are visible as skin growths, visceral mast cell tumors generally produce vague symptoms, and the diagnosis is only reached after extensive testing.

When mast cell tumors of the skin are more advanced or aggressive, they may spread to the internal organs, producing a combination of both cutaneous and visceral mast cell tumors. For this reason, if your veterinarian identifies a skin growth as being a mast cell tumor, he/she may recommend assessing the internal organs further to screen for internal mast cell tumors.

Most dogs and cats developing mast cell tumors are middle- aged or older adult pets. Of the various dog breeds, boxers and Boston terriers are more likely than average to develop mast cell tumors in general, and Siamese cats are predisposed to mast cell tumors of the skin.

Mast cells, which make up the bulk of the tumor tissue in these masses, contain histamine, heparin, and other substances that are responsible for the specific problems associated with these tumors. These substances, called vasoactive agents, cause tissue damage by making blood vessels (like veins and capillaries) dilate and become “leaky.” When the substances are released from mast cell tumors, which happens either spontaneously or when a mast cell tumor is firmly touched or handled, the affected tissues be- come swollen and warm within a few minutes—the classic inflammatory response. This reaction is a result of the action of the substances released from the tumor this way. The tissue reaction and inflammation may occur directly around the tumor in cases of mast cell tumors of the skin, or if large amounts of these sub- stances are released into the bloodstream, blood vessels may dilate in the entire body, resulting in extremely low blood pressure and possibly a state of hypotensive shock. This is similar to the response seen in severe allergic and hypersensitivity (anaphylactic) reactions. Therefore, a skin growth, lump, or mass on a dog or cat should not be handled unnecessarily until it has been brought to veterinary attention and properly evaluated, in case it is a mast cell tumor.

CLINICAL SIGNS: Frequently, mast cell tumors of the skin will be noted as small lumps that have not changed for a long time, but which suddenly become larger. Sometimes the lump will appear red and inflamed. It is worth remembering that many, many other types of skin growths (be they malignant or benign) can behave this way, too, and that an enlarging skin growth is a good reason for a veterinary visit but no reason for premature concern. Less commonly, when a mast cell tumor affects the internal organs, the main symptom may be vomiting (because the vasoactive chemicals the tumors release can cause nausea) or vague signs of not feeling well such as decrease or loss of appetite or loss of energy/sluggishness.

DIAGNOSIS: Mast cell tumor of the skin can be diagnosed by a fine-needle aspirate. With this minimally-invasive technique, a very thin needle is inserted into the growth to remove some cells from the tumor tissue for microscopic examination. The procedure is not painful, and no anesthetic is generally required, since the needle itself is of the same small size as the needle for a local anesthetic. The drawback of such a minimally invasive and simple procedure is that it may or may not yield enough of a tissue specimen for the laboratory to give an answer, and if the sample is too small, a surgical biopsy (under general anesthesia) may be necessary. It is worth knowing that a common aftereffect of fine- needle aspiration of mast cell tumors is external oozing of blood from the site of aspiration for several minutes to 1 hour, which may be messy but is not a cause for alarm unless it persists or worsens.

When visceral mast cell tumors are suspected, radiographs (x-rays) or ultrasound examinations may be used. Routine laboratory tests are necessary to identify a dog or cat’s general health status and suitability to receive medication if needed. Typically, these laboratory tests require a blood sample (for complete blood count, serum biochemistry profile, and in cats, tests for feline leukemia virus [FeLV] and feline immunodeficiency virus [FIV]) and a urine sample for urinalysis. If the decision is made to remove a mast cell tumor, a sample, or biopsy, will be taken of the removed tumor and sent to a laboratory to confirm the diagnosis of mast cell tumor and to determine whether the tumor is more likely to be malignant (reappears or spreads) or benign (removal is curative). This information helps determine if treatment in addition to surgery, or sometimes reoperation, is needed.

The surgical removal of mast cell tumors always involves wide resection, meaning removal of a large region of tissue (skin and surroundings of the tumor) out of proportion with the size of the visible tumor itself. This is because mast cell tumors tend to extend deep “fingers” of tumor tissue into their surroundings, like the roots of a tree extending into soil. These tumor extensions mean that simply removing the visible mass is not enough: the roots left behind are still made up of tumor tissue and can immediately start to grow and spread like the original mast cell tumor.

LIVING WITH THE DIAGNOSIS

The outlook (prognosis) for pets with mast cell tumor of the skin depends upon the stage of the tumor (see Diagnosis section). Mast cell tumors that are malignant may spread to multiple areas of the body and cause symptoms such as vomiting that continues to get worse over several weeks’ time. However, patients with mast cell tumors may be cured just by removal of the mast cell tumor if it is both benign and operable (in other words, can be removed completely without harming vital organs).

Be alert for new skin masses and have them checked by your veterinarian as soon as possible. Some pets can develop multiple mast cell tumors, so a thorough evaluation is necessary.

The prognosis, or outlook for a normal healthy life, for pets with visceral mast cell tumors depends upon the affected organ and whether the affected pet is a dog or cat. Cats with mast cell tumor of the spleen often survive 1 year or more after removal of the spleen. Pets with mast cells in the bloodstream or an intestinal mast cell tumor may have shorter survival times of only several months on average, but as with any illness, there is a great deal of variation from one individual to another and specific predictions of survival depend on several factors, especially an individual’s response to treatment.

TREATMENT

The mainstay of treatment is surgical removal of the tumor. A pet with suspected or confirmed mast cell tumor is pretreated with antihistamines immediately prior to surgery, to prevent the poten- tially dangerous effects of histamine and heparin release when the tumor is handled in surgery. As mentioned above, the surgeon will try to remove a large amount of tissue around the tumor, in addi- tion to the tumor itself, to reduce chances of missing any micro- scopic segments of involved tissue. Biopsies of lymph nodes or internal organs may also be taken to screen for tumor spread. The entire spleen is removed in cats with mast cell tumor of the spleen, but the spleen is not essential to life. For skin tumors, radiation treatment may be advised in addition to surgical removal, especially if the mass was in a location where surrounding tissue could not be easily removed. Radiation therapy, and a second opinion if the diagnosis of mast cell tumor is uncertain (or for the latest treatment options), your veterinarian may refer you to a veterinary oncologist. These board-certified veterinary cancer specialists can be found in most large urban centers in North America and Europe (directories: www.acvim.org, www.ecvim-ca.org) and are called Diplomates of the American (or European) College of Veterinary Internal Medicine, Specialty of Oncology.

Cats that have mast cells circulating in their blood or pets whose tumors cannot be controlled by surgery alone may be given predni- sone (similar to cortisone) tablets (pills) by mouth as home treat- ment. A newer and very specific treatment for mast cell tumors in dogs is toceranib (Palladia), a medication that both kills mast cells directly and depletes their blood supply. Some dogs feel nauseated or sluggish when taking this medication, and you should contact your veterinarian if this occurs, to discuss decreasing the dosage or stopping it altogether. Other anticancer medications are sometimes used along with prednisone to prolong the life of pets with a tumor that could not be adequately removed or that had spread to the lymph nodes. Histamine-blocking medications, such as antihistamines, may also be prescribed to control side effects associated with histamine release from mast cell tumors.

DOs

Give medicine(s) exactly as
Check your pet’s healing surgical incision daily for redness, swelling, or discharge if surgical biopsy and/or mast cell tumor removal was performed.
Check your pet’s skin for new growths and bring them to vet- erinary attention should they occur.
Understand that it will be necessary to perform tests such as a fine-needle aspirate and sometimes a surgical biopsy to de- termine whether a skin growth is a mast cell tumor.
Realize that many different types of skin growths occur in dogs and cats and that finding a new skin growth should not im- mediately be interpreted as the presence of Conversely, mast cell tumors may sometimes be ignored or considered “just fatty tumors” until tests reveal that they are actually potentially serious. Consult your veterinarian and err on the safe side by having fine-needle aspirates done (simple, painless) of skin masses.

DON’Ts

Do not handle or press upon any tumor suspected to be a mast cell tumor; damage to the cells could cause histamine and heparin release, which is uncomfortable and can sometimes carry serious consequences.
After a surgery: do not bathe your pet until the sutures/stitches have been removed, do not let your pet lick or chew the inci- sion, and do not allow your pet to exercise vigorously until sutures are removed.

WHEN TO CALL YOUR VETERINARIAN

If there is swelling at or drainage from the surgical incision or if your pet is licking the incision.
If you notice new skin lumps, have them evaluated Some pets develop multiple mast cell tumors.

SIGNS TO WATCH FOR

Vomiting or sudden weakness may occur due to histamine release from a If this occurs and a mast cell tumor was diagnosed at any time in your pet’s past, notify your veterinar- ian. Additional medications and/or testing may be worthwhile.

ROUTINE FOLLOW-UP

Have surgical sutures (skin stitches) removed in 10 to 14 days if any are on the skin.
If your pet’s biopsy shows an aggressive mast cell tumor, regular follow-up examinations are recommended to check for reoccurrence of the tumor.

ABOUT THE DIAGNOSIS

Otitis externa is inflammation of the outer ear canal. It occurs very commonly in dogs (especially “floppy-eared” breeds like cocker spaniels and Cavalier King Charles spaniels) and rarely in cats, except when cats have ear mites. In dogs and cats, the outer ear canal is a tube that has two components: a vertical part and a horizontal part. The opening in the ear that we see when we look at the inside surface of a dog or cat’s ear leads immediately to the vertical part. This vertical part of the canal extends inward and bends to become the horizontal part, which is narrower in most animals. At the end of the horizontal part of the external canal is the eardrum (tympanic membrane). On the other side of the ear- drum are the middle and inner parts of the ear. The outer ear has an overall funnel shape that has the important function of conducting sound waves to the eardrum. The outer ear is lined with skin that contains glands that produce wax and other substances.

SYMPTOMS: In animals with otitis externa, the skin that lines the outer ear often becomes red, itchy, and painful. Pus, waxy material, and other debris can accumulate. Otitis externa can be very uncomfortable for your pet and should be treated as soon as possible. Otitis externa can cause head shaking, scratching and rubbing, a foul odor, abnormal behavior or even irritability, and hearing loss in long-term situations.

POTENTIAL CAUSES: In many dogs, the ear appears to be an “Achilles’ heel” that can show inflammation or discomfort before any other part of the skin. For example, allergies to foods or air- borne allergens in the environment commonly cause skin problems on various parts of the body, especially the external ear canal. Often, the ears are the only part of the body showing outward symptoms of allergy and inflammation (redness, pain). Less commonly, some animals with weakened immune systems (e.g., pets undergoing chemotherapy treatments) and those with autoimmune diseases are more susceptible to otitis externa. Hormonal imbalances (hypothyroidism and others) have also been associated with otitis externa as a side effect.

Many disorders that cause otitis externa are confined to the ears. Parasites (e.g., mites) can live in the ear canal, and this is a common cause of otitis externa in cats but less so in dogs. Foreign objects such as grass awns (foxtails) or other plant material can become lodged in the external ear canal and produce similar symptoms.

Some animals are inherently predisposed to otitis externa. For example, animals with narrower than normal ear canals and with long, hanging (floppy) ears like many spaniel or retriever breeds are more likely to develop otitis externa. Debris can accumulate more easily in these ears, creating an environment in which organ- isms (bacteria, yeast, fungi) can thrive and trigger intense inflammation. The presence of tumors or growths in the canal can also lead to a secondary otitis externa. Moisture in the ears of animals that swim may increase susceptibility to otitis externa. The use of inappropriate cleaning methods and solutions can lead to otitis externa and other external ear complications. For example, pluck- ing hairs out of your pet’s ears can trigger inflammation in some cases, which may make otitis worse rather than better.

DIAGNOSIS: If your pet has ear problems, it is critical that you thoroughly discuss your pet’s medical history and daily routine with

your veterinarian. For example, it is important for the veterinarian to know if your pet hunts in the woods, swims in lakes or ponds, has ever been diagnosed with a medical problem, and if your pet is taking or has taken medication. If the problem occurs only during certain times of the year, this is important and can indicate an underlying allergic basis to the otitis externa. Your veterinarian should ask if and how you clean your pet’s ears at home and what you feed your pet, because these factors can be linked to the cause of otitis externa. Bring any medications and cleaning solutions that you use on your pet to the veterinary clinic. This information is essential in determining whether an underlying problem exists and whether advanced testing or treatment is necessary in managing the condition.

After obtaining a complete medical history, your veterinarian can perform an otoscopic exam in which a tiny light source and cone are gently placed in the ears to look down the ear canal. It may be necessary to numb the ears by placing drops of a topical anesthetic solution into the ears. In some pets, the condition has produced so much inflammation that this simple examination is unacceptably painful, and they may need to undergo general anesthesia for a thorough examination of the ear canals. This allows your veterinarian to assess whether the eardrum is intact (because there are certain medications that must not be placed in the ear if the eardrum is injured) and to look for underlying problems such as foreign bodies, polyps, or pus. Treatment without complete examination may be tried, but an underlying problem may be ongoing. Further testing is always warranted if the condition is not improving with treatment.

Your veterinarian may gently swab inside the ears and examine the contents under a microscope to look for parasites, bacteria, yeast, fungi, and abnormal cells.

In some cases, a small sample of skin (biopsy) can be removed while your pet is anesthetized and submitted to a laboratory for microscopic analysis (here again, attempting to identify an under- lying cause).

In very severe cases of otitis externa, special radiography tests (CT or computed tomography, “CAT scan”) can be taken to determine if the middle and inner ears are affected.

If your veterinarian suspects that a generalized disorder (e.g., hypothyroidism) might be part of the cause of the ear problems, specific blood tests that screen for these disorders may be warranted.

Overall, with otitis externa, the goals of veterinary care are twofold: to control the inflammation and pain as quickly as possible for comfort (short-term solution) and to attempt to identify any underlying causes in order to prevent the problem from flaring up as much—or at all—in the future (long-term solution).

LIVING WITH THE DIAGNOSIS

Depending on the cause, treatment of otitis externa can be a nothing more than matter of placing medication in your pet’s ears and performing regular cleanings, or it can involve a long-term commitment to treating recurrent problems. There is tremendous variation from one to the next in terms of the cause of otitis externa, so the level of treatment and the expected outcome and long-term need for care can range from serious to trivial. Occasionally, the cause of ear problems may never be found. In this case, the symptoms are treated initially and again whenever they recur.

Keeping your pet’s ears clean is important because it helps pre- vent an environment in the ears that promotes inflammation. Your veterinarian or veterinary technician can show you how to properly do this and which ear cleaning products are safe to use with your pet.

For some dogs, a simple lifestyle change can help. For example, if swimming causes moisture in the ears that perpetuates otitis externa, then reducing or avoiding swimming may help tremendously.

TREATMENT

The treatment for otitis externa requires controlling the inflammation and then treating the underlying cause of the otitis externa, if the cause can be determined. Drops and ointments are available to control parasites such as mites as well as bacteria, yeast, and fungi. Medication is available to remove wax (ceruminolytics). If your pet’s eardrum is damaged, or if inflammation is so severe at first that the ear cannot be handled painlessly, your veterinarian may prescribe pills that must be given by mouth instead, to avoid having medication reach the middle or inner ears.

For animals with narrow ear canals and very severe, treatment- resistant otitis externa, surgery may be a necessary option to re- move part of the external ear canal. This procedure is often performed by veterinary surgical specialists, and it allows the ear to drain and be ventilated. It is not a cure-all, since many underlying causes of otitis externa, such as allergies, will persist despite surgery; rather, surgery is a means of opening the funnel-shaped ear canal if the narrowing causes recurrent, painful impaction and inflammation in the deepest part of the ear canal next to the eardrum.

DOs

Give medication exactly as directed by your
Talk to your veterinarian before placing any medicine or cleaning products in your pet’s ears. Some products can cause more severe problems if they are used under the wrong

DON’Ts

Never insert anything (Q-tips, cotton-tipped swabs) into the ear Cotton balls may be used for wiping dissolved wax and cleaning fluid from the surface of the pinna (ear flap), but cotton swabs/Q-tips only push debris back into the deeper parts of the canal, which is counterproductive and could be dangerous.

Do not pluck hairs from your pet’s ears. This activity can traumatize the skin and lead to more inflammation, not less

WHEN TO CALL YOUR VETERINARIAN

If you cannot keep a scheduled
If you are unable to give the medicine as
If the problem worsens despite giving
If you see signs that may suggest worsening of the condition (see below)

SIGNS TO WATCH FOR

Head-shaking, rubbing of the ears on the ground, constant pawing or scratching at the ears, or signs of pain on touching the ears indicate an ongoing disease process, and likely inflam- mation, in the ear. Visible improvement in comfort should be apparent within 24-48 hours of beginning treatment for otitis externa (be it liquid in the ears, an injection, or oral tablets/pills at home), and if this improvement is not occurring, you should contact your veterinarian.
Symptoms such as constant, sustained head tilt (holding the head rotated with one ear pointing toward the ground), turning constantly in the same direction or losing balance and falling to one side, even to the point of not being able to stand, or other general signs of not feeling well such as lethargy or loss of ap- petite can indicate that inflammation has entered deeper in the ear canal and is causing a middle ear infection. Any of these symptoms warrants a recheck with your veterinarian.

ROUTINE FOLLOW-UP

As dictated by the initial exam and response to treatment. Other information that may be useful: “How-To” Client Education Sheets:
How to Give Ear Medications
How to Clean the Ears

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ABOUT THE DIAGNOSIS

LIVING WITH THE DIAGNOSIS

TREATMENT

DOs

DON’Ts

WHEN TO CALL YOUR VETERINARIAN

SIGNS TO WATCH FOR

ROUTINE FOLLOW-UP

ADDITIONAL INFORMATION

ABOUT THE DIAGNOSIS

LIVING WITH THE DIAGNOSIS

TREATMENT

DOs

DON’Ts

WHEN TO CALL YOUR VETERINARIAN

SIGNS TO WATCH FOR

ROUTINE FOLLOW-UP

ABOUT THE DIAGNOSIS

LIVING WITH THE DIAGNOSIS

TREATMENT

DOs

DON’Ts

WHEN TO CALL YOUR VETERINARIAN

SIGNS TO WATCH FOR

ABOUT THE DIAGNOSIS

LIVING WITH THE DIAGNOSIS

TREATMENT

DOs

DON’Ts

WHEN TO CALL YOUR VETERINARIAN

SIGNS TO WATCH FOR

ROUTINE FOLLOW-UP

ADDITIONAL INFORMATION

ABOUT THE DIAGNOSIS

LIVING WITH THE DIAGNOSIS

TREATMENT

DOs

DON’Ts

WHEN TO CALL YOUR VETERINARIAN

SIGNS TO WATCH FOR

ROUTINE FOLLOW-UP

ABOUT THE DIAGNOSIS

LIVING WITH THE DIAGNOSIS

TREATMENT

DOs

DON’Ts

WHEN TO CALL YOUR VETERINARIAN

SIGNS TO WATCH FOR

ROUTINE FOLLOW-UP

ABOUT THE DIAGNOSIS

LIVING WITH THE DIAGNOSIS

TREATMENT

DOs

DON’Ts

WHEN TO CALL YOUR VETERINARIAN

SIGNS TO WATCH FOR

ROUTINE FOLLOW-UP

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