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Questions for Dr. Shawn - Skin, Behavioral Problems, Hot Spots, Allergies

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"Dear Dr. Shawn:
"I am hoping you can offer some help regarding my ragdoll cat, Seal. She is 5 years old and quite skittish. Along with her "nervousness", she pulls out clumps of hair while she's grooming. This is a regular occurrence and she has done this all her life. She also has some flaky skin. I haven't been able to get a satisfactory solution from my regular vet. She is currently eating Science Diet dry food (light hair ball formula). Although I've tried other foods, she doesn't particularly care for other dry foods and won't eat soft canned foods at all. Can you make any suggestions for her? It breaks my heart to see her suffering."

Answer:
"If she’s pulled out her hair her entire life this may be a normal, although overzealous, grooming pattern for her. Flaky skin can be simple dandruff (mild seborrhea,) or the sign of underlying diseases (any skin or internal disease can cause flaky skin, so a proper diagnosis is needed.) For cats in my holistic practice with mild flaky skin without other problems, I recommend the following approach.

First, feed a good natural food(homemade or processed) free of byproducts and chemicals (this means finding Seal a new diet; your veterinarian may be able to help with this, or you can find help in my award-winning book The Natural Health Bible for Dogs & Cats.)

Second, try bathing her with a hypoallergenic or anti-seborrheic shampoo followed by a conditioner (this is tough for cat owners but I always encourage owners to try bathing their cats unless they know the cat will become difficult to handle.) Bathing several times a week will help.

Finally, a good fatty acid supplement (fish or flax oil) is also useful. This protocol has worked well for many of the dogs and cats in my practice and I encourage you to give it a try!”


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"Dear Dr. Shawn:
"My dog Dred has a bad skin problem. His doctor said he has a skin infection and has been using antibiotics (different ones) for the last 5 months, but nothing seems to help. Can you offer any advice? We’re desperate as he is not getting better and seems uncomfortable."

Answer:
”There is no reason to treat a pet for 5 months without obtaining the proper diagnosis or referring you to another doctor who can help. If your veterinarian’s diagnosis of skin infection is correct, Dred would have already recovered! I’m glad you’ve contacted me, as it’s now time to properly assess this case and begin the correct therapy.

First, a correct diagnosis must be made. I would suggest a complete blood and urine profile and then a skin biopsy. My guess is that Dred does not simply have an infection or he would have responded to the antibiotic therapy. I won’t know exactly what’s wrong until we have the test results, but from your description I wouldn’t be surprised with a diagnosis of mange, fungal infection, or autoimmune skin disease. The treatment will vary with the diagnosis, but general therapy would include supplements to boost the immune system and heal the skin. Topical therapy with soaks or creams may also be indicated. And of course, do not give him any vaccinations until this problem is corrected. Let us know how things turn out with Dred.”


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"Dear Dr. Shawn:
"My chihuahua CoCo is 6 years old, and weighs 3.5 pounds. He has progressively been losing his hair over the past year. I took him to the doctor to get every test you can imagine, only to be told the tests don’t reveal a cause for his problem. The hair loss started in his rear end and now it's moving up his back to his neck .Some of the patches that are missing hair seem to be in places he couldn't possibly reach with his mouth to chew. Could he be hypothyroid or have a neurological problem? I've tried bathing with oatmeal shampoo and tea tree oil. Can you help my little baby?"

Answer:
”I know you’ve spent a lot of money, but I truly wonder if “every test I can imagine” has really been done. For example, you ask if CoCo could be hypothyroid, but if thyroid testing was done we’d already have an answer to that question. For chronic skin disease, including hair loss, a skin biopsy should be performed if other tests have failed to reveal a cause.

Since so many doctors don’t perform skin biopsies, I also doubt that this test was done or we’d probably have an answer by now. Most skin diseases are not the result of internal disease and don’t cause systemic signs like weight loss. Therefore, I wonder what else is going on inside CoCo. Have radiographs (X-rays) or ultrasounds of his chest and abdomen been performed? What about an endoscopic exam and biopsy of his stomach and intestines? While some pet problems elude all of these advanced diagnostic tests, in most cases having these tests run will give us a diagnosis and help plan our treatment.

Finally, keep in mind that many pets that lose weight do so because they don’t eat enough (the owners under-feed them) or they have oral or dental disease which makes it painful to eat. Once you get the correct diagnosis, we can work on finding a holistic approach to CoCo’s problems.”


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"Dear Dr. Shawn:
"Is there anything I can do to prevent hot spots on my dog this summer? Ever since we moved to Texas several years ago, she gets really itchy and then scratches herself so much that she develops open sores. My doctor said we can’t prevent them. However, since she is treated with steroids and antibiotics whenever she gets the hot spots, I’d be willing to try whatever you recommend if we can prevent them."

Answer:
”Hot spots are real common in many pets. The exact cause is not always known, but in general something causes the pet to itch. With constant itching, large weepy sores (hot spots) quickly develop. Treatment involves carefully clipping hair from around the spot, cleaning the spot with an antibacterial soap, and then using a combination of antibiotics and steroids (a short term of both) to quickly stop the itching and heal the lesions. Due to the pain involved with these sores, sedation is often needed to allow them to be thoroughly cleaned. While there are no guarantees, I think there are some steps you can take to decrease the chances of your dog developing hot spots.

First, even though you may not want to do this, clipping your dog’s hair short can help a lot (many long-haired dogs seem to itch more in the summer if their coats are not clipped.) Second, regular bathing (several times per week) with a gentle cleansing shampoo will keep the skin and remaining hair clean and remove any irritants that might cause the pet to itch. Third, many pets develop hot spots after flea infestation. If fleas are a potential problem for your dog, preventing fleas might be very useful. Finally, various supplements such as antioxidants and fatty acids decrease inflammation and itching and can be used to maintain healthy skin. If any readers would like my protocol on preventing hot spots, feel free to contact me by email.”


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"Dear Dr. Shawn:
"Our mix-breed dog Drew has chronic skin infections. At least once every 1-2 months, we take him to the doctor for antibiotics. He takes these for 10-14 days, gets better for a few weeks, then develops his infection again. Do you have any suggestions for us? Can these be treated naturally? We hate to keep giving him antibiotics, as he’s only 2 years old."

Answer:
"Many dogs and some cats are afflicted with chronic bacterial infections of the skin. While I’m not opposed to using antibiotics a few times a year when they’re really needed, I get worried when pets are taking them long-term. Not only does this never make the pet better, but it hurts the GI tract (contributing to leaky gut syndrome, which requires treatment in order for the pet to heal) and sometimes causes other skin problems (pets on long-term antibiotic therapy often develop yeast infections of their skin, urinary systems, or GI systems and require additional treatment.)

Here are a couple of things to keep in mind. First, only a few antibiotics are effective against skin infections. For example, penicillin, amoxicillin, and ampicillin are ineffective, will not cure the skin infection, and will only make the pet worse. So we want to make sure the proper antibiotic is prescribed. Second, skin infections require a MINIMUM treatment of 3 weeks; treating for 10-14 days will not work and only make the problem worse. Third, pets with chronic skin infections often have underlying problems such as allergies, thyroid disease, mange, or immune system deficiencies. These problems must be diagnosed and treated or the pet’s skin will never improve.
In my practice, I often have success treating minor skin infections with a combination of homeopathics (such as Echinacea Comp, Psorinoheel, Gallium Heel, or Engystol;) herbs (A product called Herbal ABX works particularly well;) OliveVet; and immune-enhancing supplements (Immunosupport, Immune Plus.) Finally, bathing the pet with a medicated shampoo is particularly important. Shampoos such as Etiderm, Pyoben, Oxydex, and Chorhexiderm used every 1-2 days for 2-3 weeks is essential in allowing us to minimize the use of antibiotics.

Regardless of the treatment chosen, pets with skin infections should not be vaccinated while the skin is healing. Once cured, pets can then be vaccinated if needed based upon titer testing."


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"Dear Dr. Shawn:
"My beagle chews her paws to the point they are swollen and noticeably uncomfortable when she walks. She is better during the winter months; although she chews less, her paws are still swollen. I'm afraid it's arthritis. Is there something we can give her to stop the chewing and reduce the inflammation?"

Answer:
”This actually sounds more like allergies to me (although most allergic pets don’t have swollen feet unless they are really inflamed.) That said, certainly radiographs (X-rays) of her feet won’t hurt to make sure it’s not something deeper like arthritis (anesthesia will be need to get proper positioning.) Most dogs with arthritis don’t have foot problems but rather have inflammation of larger joints like the hips, spine, or knees.

Let’s assume she has allergies. First, as bad as she is, she’ll need some type of medication (probably a short term use of something like prednisone to give her immediate relief.) Dogs that chew this much may also need an Elizabethan collar to stop self mutiliation. While the prednisone is relieving her immediate symptoms, I would also recommend a natural diet. No vaccines should be given anytime soon, as we don’t want to give her even more foreign proteins that can cause itching. Daily bathing for a few weeks will be needed, and possibly soaking her feet several times a day as well. A health maintenance supplement, plus herbs and homeopathics for itching, will help reduce her need for medications (steroids) for the rest of her life. Finally, many dogs with severely itchy feet actually have demodectic mange or a fungal infection rather than simply allergies. She MUST be checked for these other possible problems BEFORE prednisone is used.

If these other conditions exist, let me know and we’ll discuss natural therapies for them in a future column. Good luck. Conditions like this require immediate attention as they are very painful for the pet.”


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"Dear Dr. Shawn:
"One of my kitties, Savannah, is a 4-year-old pure bred British Shorthair. She's had constant skin problems. We've tried everything to help her and nothing seems to be working. She's had a skin biopsy done and it was determined that she has allergic dermatitis. The problem is that no one can seem to figure out what makes her itch. We've done food trials, given flea medication and steroids (which I hate!) and on and on. I've taken her a few times for acupuncture but it hasn't made a difference. The acupuncturist has her on an herbal vitamin but again, nothing has really changed. I only feed my cats the best quality foods with no by-products or artificial ingredients. I'm thinking that Savannah has an extremely poor immune system and that she's either allergic to everything or has a lot of anxiety. Do you have any suggestions for us? The last thing I want is for her to be on medication for the rest of her life."

Answer:
”It sounds like you’ve tried a lot of both conventional and complementary therapies. As you know, treating allergies does involve some trial and error in order to find the best treatment. Here’s what I suggest. First, frequent bathing (if she’ll tolerate it) is very important in removing the allergens on her skin that make her itch. Try for at least 1-2 baths per week using a hypoallergenic shampoo such as aloe vera and oatmeal. Don’t vaccinate her anytime soon. Vaccines contain foreign proteins, and in my practice administering vaccines to an itchy pet often makes them itch more.

Supplements can be helpful, including a health maintenance formula (especially one that contains tryptophan which helps calm itchy pets,) antioxidants, and omega-3 fatty acids (fish oil.) I also use various herbal and homeopathic remedies based upon the pet’s overall condition and response to my treatment protocol. Finally, short term use of oral steroids or antihistamines is usually safe and can decrease itching while waiting for the natural therapies to kick-in."


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"Dear Dr. Shawn:
"My cat Mr. Boots is really itchy. He especially itches around his head, face, and ears. He sometimes scratches so much that he develops scabs which then bleed. So far his doctor has tried prednisone and Benadryl, but he still itches. Is there a natural remedy for this? I don’t want him to suffer any more."

Answer:
"While prednisone, Benadryl, and other conventional medications are usually very effective in most pets with allergies (atopic dermatitis,) Mr. Boots may in fact not have typical allergies. Whenever I have a pet that I suspect to have simple allergies, and that pet does not improve with what appears to be the correct therapy, I always reevaluate my initial diagnosis. In general, because these drugs are so effective in controlling itching in allergic pets, I suggest that more diagnostic testing should be done to get the correct diagnosis.

Two specific conditions come to mind. The first is notoedric mange, a very itchy parasitic disease of cats. Demodectic mange is also a possibility. Secondly, Mr. Boots might have food allergies. Cats and dogs with mange or food allergies will not improve with even high doses of steroids like prednisone or antihistamines like Benadryl. Rarer causes of itching around the head and bleeding scabs include autoimmune diseases like pemphigus.

Here’s what I suggest. Have your doctor do a skin biopsy, a minor surgical procedure. The removed tiny pieces of skin are examined by a pathologist, who can determine the cause of Mr. Boots’ problems in most cases. If the diagnosis is mange, treatment is usually quite straight forward but will take several months for complete healing. Food allergies are tougher to treat; special diets must be fed for 2-3 months to determine which foods cause Mr. Boots to itch. You should note that blood testing will NOT correctly diagnose food allergies. Once the diagnosis is made a combination of conventional medications plus natural therapies can help Mr. Boots live comfortably."


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"Dear Dr. Shawn:
"When do you recommend a skin biopsy? My cat Felix has crusty skin around her mouth and is not improving with her therapy (antibiotics and steroids.) A friend asked if her doctor had recommended a skin biopsy, but so far he has not. Is this something I should have done for her? She has had this problem for over 2 months."

Answer:
"In my opinion, a skin biopsy is a very valuable tool in medicine. Unfortunately, it is seldom used by many doctors. A biopsy is a simple procedure that can be done in most cases with mild sedation or light anesthesia combined with a small dose of a local anesthetic. The procedure usually takes about five minutes, and in most cases stitches are not even necessary. While not always 100% diagnostic, in most cases a skin biopsy is the best test that can be done to determine the cause of your pet’s skin condition.

I recommend a skin biopsy in several instances. First, if the skin lesions look strange and not typical of common skin disorders. Second, any time a pet has not responded to what I think should be the “correct” therapy. Finally, anytime I see a pet with a chronic skin disease (usually several months old) that has not improved or has worsened. I would suggest talking with your cat’s doctor as enough time has transpired for her to improve by now with the therapies your doctor has used for treatment."


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"Dear Dr. Shawn:
"My 5 year old collie Geoff is always itchy. His doctor did a blood allergy test which showed he is allergic to corn, wheat, and chicken. We changed his diet to an expensive allergy food but he still itches. Should I try cooking for him? Would anything else help?"

Answer:
"Allergies are a very common cause of skin disease in dogs and cats. Most of the time, the allergies are due to environmental allergens such as various pollens, molds, and house dust mites. While many pets have food sensitivities, true food allergies are quite rare. Since I started in the veterinary profession, I’ve seen less than a handful of pets with true food allergies. That’s not to say that pets like Geoff might not itch less when switched to a better diet. I think a better more natural diet is important for all pets. I just doubt that a dietary problem is the cause of his itchiness.

Most pets with allergies to environmental allergens have normal skin (unless they have secondary infections or the allergies are a chronic problem that have never been treated.) Most pets with food allergies are not only VERY itchy, their skin is abnormal; usually they have severe ulcerations with bleeding and crusting. Blood allergy testing can be helpful in diagnosing environmental allergies in pets, although skin testing is considered the gold standard. However, blood testing is useless in diagnosing food allergies. Instead, a food trial in which a hypoallergenic diet is fed exclusively for 8-12 weeks is the proper way to diagnose this problem.

I suggest you talk with Geoff’s doctor about getting the correct diagnosis and therapy. If you or any reader would like a list of my favorite natural diets, please see my article on recommended foods.”


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"Dear Dr. Shawn:
"I enjoy reading your column and have used your advice to help several of my pets. Here’s my current problem. I have an 8 year old golden retriever who always has chronic ear infections. I am feeding Iams Lamb and Rice Weight Control. His prior ear treatments is basically some type of ointment but it only seems to work for a short period of time before his ears are infected again. Please help. He cries sometimes when I am putting the medicine in his ears. Do you think changing his diet will help?"

Answer:
”Chronic ear infections are common in dogs, especially in spaniels and retrievers. Whenever I consult with an owner whose pet has a chronic infection of any type, I always think of several things. First, while true food allergies are rare, a natural diet can help some pets, and the food you are currently feeding is not one I recommend. A better diet is always indicated even if the pet doesn’t get better simply by switching diets.

I also worry about an underlying immune problem which predisposes to chronic infections. Therefore I always do something (herbal or homeopathic) to support the immune system, and I make sure the pet is not suffering from allergies or adrenal or thyroid disease. I also make sure the current treatment is correct. So often the incorrect drug, dosage, or dosing interval and length of treatment are incorrect. Most of my patients with ear disease do respond to therapy with topical medications, immune support, and natural antimicrobials. Don’t get discouraged as I think your pet can respond to a similar treatment.”


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"Dear Dr. Shawn:
"In prior columns you’ve mentioned bathing pets with dermatitis frequently. I’ve always heard not to do this, as it dries out the pet’s skin. Why do you recommend frequent bathing, and how frequent is too frequent?"

Answer:
"Frequent bathing is essential in allowing damaged skin to properly heal. It also allow us to use less medication as the disease is treated externally (via bathing) and internally (by giving medication orally.) Look at it this way. If you have dandruff, shampooing your scalp once a week or once a month won’t work. You need to use the correct shampoo at least daily (sometimes twice daily) until the dandruff is under control.

The same theory is true for pets with skin disease. The more the pet is bathed the sooner the dermatitis is under control. I’m not sure why doctors and pet owners follow the incorrect advice of not bathing pets regularly. You will not dry out your pet’s skin no matter how frequently the pet is bathed if the proper shampoo is prescribed.

Regarding frequency, it depends upon the skin condition. For severe dermatitis, daily bathing is recommended. For chronic problems like allergies, bathing on an as-needed basis (usually 1-3 times per week) is fine to maintain the pet at a comfortable level of itchiness. For my patients with skin infections, often frequent bathing plus natural supplements are needed to heal the pet, making antibiotics unnecessary. Finally, make sure you use only pet shampoos on dogs and cats for regular use."

 

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