Annoyed, slightly embarrassed and not sure I've done the right thing

[LaurieFairyCake]

My dog has a horrible skin condition - after 2 courses of different antibiotics it's done nothing so they took swabs and ruled out infection.

They said it's not mites and not infection leaving auto immune (and nothing else) but they want a diagnosis before treatment

So after reading everything I was a bit forceful on getting steroids as that's the treatment for all auto immune (and it's been 3 weeks and the dog is miserable and in horrible pain and waking me all night with his constant cone licking as it's all round his mouth)

But the vet isn't entirely happy and wanted to wait (at least 2 weeks) for a skin specialist

If there is no other treatment and auto immune is the only thing remaining, what am I missing ?

[SpicyPear]

Would the steroidal dose possibly vary depending on the specific auto immune diagnosis? Have they ruled out allergy?

[LaurieFairyCake]

No difference apparently with the dose - standard 1mg per kilo twice a day

Not ruled out allergies but he eats no grains so really unlikely to be food related - and not grass seed as he's too old for long walks and just does a 5 minute concrete walk twice a day

[LEMmingaround]

Get a second opinion - skin conditions are notoriously difficult to get on top of but if your vet is out of his/her depth with it, find a local vet with an interest in skin conditions in leu of a specialist - they must be able to give soemthing to help alleviate it. poor dog. :( The issue i suppose with the steriods is that it can bugger the immune response, if its auto-immune i guess that would complicate it but i'd want faster results than watch and wait.

[ender]

If dog's on steroids, and symptoms clear up, it'll be more difficult for skin specialist to diagnose which auto immune disease.

[Floralnomad]

My dog has been diagnosed with SLO today ,which is an auto immune thing that affects nails ( he had a biopsy 2 weeks ago) and he is on coatex spray and is starting nicotinamide ,have you tried that?

[LaurieFairyCake]

No, the vets suggested no treatment until the skin specialist saw him in a month

I didn't think about calling other vets - it would be a bit complex as it's obviously an insurance claim now - the referral to the specialist is probably about £500 for the consultation

Is the steroids job to suppress the auto immune system though Lem - if that's the standard treatment for all auto immune conditions then I don't really care about the diagnosis as long as it works - he's old, almost blind, hard of hearing and really I'm just focused on relieving his pain enough to clean up the pus

He's now flinching from me and the last 3 weeks have been shit - I'd rather he was pts than spend my whole time trying to clean him up while he was in pain

[affafantoosh]

So no biopsies have been taken? In an old dog with these issues I'd do full bloods and take biopsies before considering referral. Do you have a good relationship with your vet?

[LaurieFairyCake]

I thought I did

They did full bloods today and he's totally fine which is why I pushed for steroid treatment as he said he was healthy enough to take it

The biopsy is a bit difficult as he has a pronounced heart murmur and sedation is a risk

[affafantoosh]

I think a dermatologist is likely to want biopsies.

The reason I ask about the relationship is that you said you were forceful about getting steroids, and that you did research on the treatment options - nothing wrong with that but I wondered if you didn't trust them all that much, which might have implications for the next steps.

It may be an allergy (most food-related allergies arise due to the protein source in the food rather than the grain, and it's obviously the right time of year for environmental allergens such as pollens to cause problems) but it would be unusual for such a severe problem to develop in an elderly dog, and I would expect the steroids to have helped.

It's possible that they will be able to collect biopsies with very mild sedation and local anaesthetic, depending on your dog's temperament. If you're considering PTS then it's a risk you have to take really.

[LettertoHerms]

It may be allergies, either environmental or food. Grains are not the only culprit.

We've also added fish oil to our dog's food in the past, which has helped his skin. He eats a high quality kibble and we're careful about him not having poultry or any amount of sugar, both cause flare ups.

It can be awful. Sometimes it's down to trial and error, especially with allergies.

[LaurieFairyCake]

Thanks. I'm hoping the steroids do work, he took the first one this evening.

It isn't that I don't trust them exactly just that they always want a diagnosis before treatment - that has never benefitted any animals I've had.

I know that sounds mad but my cat with cancer had two unnecessary surgeries when it was obvious it has metastasised somewhere else and he only had weeks to live.

My other cat (aged 18) had a mass in her stomach - they wanted surgery before providing palliative treatment - I said no and she was dead within 2 weeks from the obvious cancer

The same dog had a scan to check his heart and they found 2 stones in his stomach - I'm just about to sign the £3000 surgery form which would have been 50/50 with death from the general anaesthetic when it suddenly occurs to me that we hadn't tried an emetic to make him sick - £4.50 tablet, 10 minute wait - 2 stones, one healthy dog

I just think they want diagnosis before try

[LaurieFairyCake]

Thanks. I'm hoping the steroids do work, he took the first one this evening.

It isn't that I don't trust them exactly just that they always want a diagnosis before treatment - that has never benefitted any animals I've had.

I know that sounds mad but my cat with cancer had two unnecessary surgeries when it was obvious it has metastasised somewhere else and he only had weeks to live.

My other cat (aged 18) had a mass in her stomach - they wanted surgery before providing palliative treatment - I said no and she was dead within 2 weeks from the obvious cancer

The same dog had a scan to check his heart and they found 2 stones in his stomach - I'm just about to sign the £3000 surgery form which would have been 50/50 with death from the general anaesthetic when it suddenly occurs to me that we hadn't tried an emetic to make him sick - £4.50 tablet, 10 minute wait - 2 stones, one healthy dog

I just think they want diagnosis before trying anything and in elderly pets a whole load of invasive treatments to get a diagnosis takes too long and is distressing

The vet said it's not infection and not mites so the most probable cause was auto immune - but he wanted that confirmed with a long delay and an expensive referral first. And from my perspective 3 weeks of no treatment and them
a further month is too long.

[affafantoosh]

Sorry my mistake entirely. I thought you meant the dog had been on steroids with no effect for 3 weeks.

Usually with skin problems steroids are an absolute last resort, not least because they screw up further diagnostics as someone had already mentioned. However ...

I totally wouldn't push you to see a dermatologist in your situation! He's old, you just need him to be comfortable. :) I'd give him the pred and cross my fingers, in your shoes.

Sorry for my confusion.

[LaurieFairyCake]

Letter - he only eats Vets Kitchen Salmon and rice. Has done for 5 years. I'm guessing that probably takes care of the fish oil.

He only walks for 5 minutes a day on concrete so unlikely to be environment ?

[LaurieFairyCake]

Oh god don't apologise - I'm so grateful you're listening and offering me help

That's exactly what I'm doing - giving him the steroid and crossing my fingers

[polkadotdelight]

We used Atopica on our old cat with an immune problem. It was more expensive than steroids but worked really well.

[affafantoosh]

It could still be pollen but this is unusual in an older dog with no previous history of allergic skin problems.

I'm going to be blunt ... worst case scenario is a cancer. If it is that (which would be rare) then steroids may be helpful anyway in terms of reducing inflammation, maintaining appetite and in a few cases slowing a cancer's progress. If it's autoimmune, as you rightly point out, steroids will work to control it. There are other immunosuppressant drugs available too but steroids are cheap and work quickly.

Good luck - let us know how you get on. I think you're doing the right thing in avoiding further treatment - at this stage the steroids have the best chance of helping him :)

[SpicyPear]

Hi. If it was my dog I would do the same if they were old. Are there any other vets in the area? You shouldn't be having to suggest lesser interventions to them for things like the stones.

[affafantoosh]

I'm not so sure about the stones to be fair. Emetics carry a risk and I wouldn't have chosen that course of action as a first line myself.

[nooka]

Vets seem to vary enormously in their approach. When we were in the UK we had a slightly brutal (but great) Aussie vet who told us with our older cat who was suffering from some sort of paralytic problem that he thought it was probably a tumour, that we could send her for an MRI which would be hugely expensive and likely result in treating her with steroids, or we could just give her the steroids and see how she did. She lasted another six months before the dose got too big and she was just too wobbly and we had her PTS.

Our vet now is definitely more keen on treatment, and I do slightly wonder whether that's because so many people have insurance that it is expected you'll go for treatment. Having said that we were very greatful that our dog got referred to a neurosurgeon last year to have what we thought was a tumour on his spine biopsied but turned out to be a cyst. But we wouldn't have decided on surgery with an old dog.

[Lonecatwithkitten]

Steriods will make diagnosis a lot more complex and most skin specialists specifically requests that patients are free of steriods before they see them.
You don't mention allergy testing has this been done ? As allergy would be more common than autoimmune disease and would also cause the signs you are describing.
If it is autoimmune disease steriods are rarely used now more often azothioprim and cyclosporine are used before steriods. However, all of these are pretty nasty immunosuppressive drugs and should be used with caution.
They will also be very cautious about using steriods in a dog with a heart murmur as there is some evidence that they may induce congestive heart failure in these dogs.

[affafantoosh]

In the same way as two owners may have different ideas about how much intervention they want for pets, vets also have a range of attitudes towards treatment options. The important thing is that they present all those options to the owner, whose decision it is.

[Lonecatwithkitten]

With regard to the stones often what goes down often gets stuck when it comes back up to become a thoracic foreign body which is a whole other problem. It would be very rare to use an emetic to treat a foreign body, because of this.

[SpicyPear]

I would agree with that as a pet owner affafan. My impression from OP's posts is that her vet isn't presenting and explaining all the options though, or adequately justifying their recommendations. I'd want to know and consider other options before a survey with 50% risk of death and wouldn't expect to have to suggest ideas myself.

I have vet friends and will always defend vets when they are criticised for their charges, but equally I do expect a high standard of care and advice for the money.

[MewlingQuim]

My dog had skin problems that sound similar when she was younger. The vet said she would need life long steroid treatment.

I gave her cod liver oil every morning in her food. Skin problem went away but don't give too much or there will be diarrhoea problems instead

We also assumed that her food would contain enough oils, but obviously it doesn't. She has sensitive skin and needs extra.