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 titled “The Itchy Dog: A Multimodal Approach and Behavioral Considerations.” I’m Dr Ashley Bourgeois. I’m a board-certified veterinary dermatologist and a co-owner of Animal Dermatology Clinic, practicing in Portland, Oregon. I like to educate veterinarians through my podcast and social media platform, 

. I am very fortunate to have this discussion with 1 of my favorite colleagues, Dr Christopher Pachel. He is a board-certified veterinary behaviorist and the owner of the Animal Behavior Clinic in Portland, Oregon. You can find his additional content on his website, www.drpachel.com. In today’s discussion, we’re going to provide insights into the itchy dog and the multimodal approach necessary for appropriate management long term. We should just get started and jump in because we have a ton to talk about, and we’re both very passionate people on our specialties.

Let’s start easy. We’ll ease our way into it. How can a dog exhibit itch or pruritus? It’s going to make sense if I take the lead on that first because we’re diving right into the heart of dermatology. Then we’ll bring in the behavioral component because there are definitely some considerations for that. How can a dog exhibit itch or pruritus? This is an important question. When I’m talking to a client, I oftentimes just ask if the dog is itchy, because the way a client perceives itch can be much different from what a dog actually does. For example, I have had numerous cases where I will just say, “Is your dog itchy?” And the client will say, “Not really. I don’t really consider them to be a particularly itchy dog.” Then I’ll rephrase it, “OK, so you don’t notice any paw licking, head shaking, scratching, chewing, overgrooming, or anything like that?” And they’re like, “Oh, they lick their paws incessantly. They just won’t stop.” There are a lot of ways that we can see dogs exhibit itch. Make sure to be specific about that and lead your questions into what the client is saying. For example, scooting is a way that they can exhibit itch. If I’m doing an exam on a dog, and I start to notice the peri-anal region is really inflamed, I may ask, “Do they tend to scoot? Do they lick toward their rear?” Because those can be ways of exhibiting pruritus. But clients also often think of this behaviorally. They think, “Well my dog is showing these OCD [obsessive compulsive disorder] tendencies. They’re incessantly doing this, and it’s because they’re stressed.” Dr Pachel, I’d love to hear your take on this. How do you correlate something when a client has ended up in your hands and is starting to mention these behaviors? How do you start to distinguish the behavior changes vs true pruritus?

That’s such a great question, Ashley. We’ve got so many things to be able to tease out within that. Especially if we pull that lens back, even just a little, with an acknowledgment by saying that anything the animal does is behavior. Itch is 1 of the possible explanations that a client might create for that. If we ask itch, we’re expecting them to funnel all that together into that particular label. In fact, if we start getting to the actual licking, scratching, scooting, and chewing, those are a lot more easily identifiable. They’re more observable characteristics. What I love about that, in the beginning our conversation, is that it not only starts to narrow that conversation of, “We’re skewing our conversation toward itch,” but it also establishes our clinical baselines that we can then refer back to later on: “When we met 3 weeks ago, you told me that licking was happening 3 times a day,” or whatever the baseline happened to be. We’re establishing a barometer in the process of establishing a communication. I love being able to make sure that the client and I are talking about the same thing from the get-go, and that our interpretations are as close to being on the same page as they need to be for us to start moving into the clinical conversation.

That’s an important point, because of how behaviors change. We’re going to dive into history soon, but how is that behavior a year ago vs now? A lot of times I’ll hear things like, “We moved, and then it got worse. I think it’s just because they’re stressed.” Are they doing that methodical licking vs are they whipping their head around and chewing quickly at their rump? Those can all be things that are quite different. But you’re right: It’s a change in that pet’s behavior, even though it might not necessarily be because of a behavior problem. It’s just a different way that they act. When I think of behavior changes and the mimicry with that, within dermatology I think of severe otitis. I’ve had patients who come in and they have a very severe otitis, it’s really cyanotic, it’s really edematous, it’s swollen, and they’re super painful. I will barely palpate that ear, and they’ll try to bite or scream or not act like themselves. But it’s not because of behavior problem. It’s because of a manifestation of their dermatologic disease. I’ve seen cases completely change their behavior, whether we’ve treated a really deep pyoderma or a really nasty, swollen edematous otitis. All of a sudden, within a recheck or 2, they couldn’t care less if I go in their ears or touch their paws. They’re not trying to bite me. Their behavior changes are all reflection of other problems. Just recognizing that is extremely important in these pets.

 One last thing that I’ll mention is that we’re often looking at the outward sign. They’re doing something unusual: licking, scratching, biting. They’re doing something there. It can go in the other direction too. If an animal is uncomfortable, we may see behavioral inhibition, where walking around the house is now uncomfortable because we’ve got some degree of a photo dermatitis. We can see it going the other direction too, where the animal is just not themselves, but it’s the lack of normal behavior, as opposed to a new expression. What I really try to get to the heart of what the differences are. What are the deviations in behavior from what we consider to be normal or appropriate for that animal, that may start to tip us into 1 direction vs another in our explanations?

 I love that. You’re absolutely right. There are a lot of pets where the owners start to say, “’They’re not as social. They’re not going to play with my kids. They’re not running around the backyard.” You’re absolutely right. When you get those swollen cases of photo dermatitis, you can see that. I’ve recently seen a dog who all of sudden was attacking the other dog at home, and that wasn’t like him. He had really swollen nasty photo dermatitis. Unfortunately, this owner has 2 dogs with terrible allergies and the other dog self-isolates. When his disease is really bad, he won’t play as much with his brother because he’s in so much pain. That’s a super important point: we can see both ends of the spectrum, not from that primary problem but from the secondary issues they’re showing us from their behavior changes.

Videos

Signs and Symptoms of an Itchy Dog

With summertime on the horizon, we remain dedicated to providing you with a robust mix of the latest (and greatest) industry news.

, plus ways veterinary business leaders can help improve their team's overall happiness and motivate them to succeed.

 has kicked off its second mobile relief tour by returning to the west coast to provide free veterinary care, food, supplies, surgeries, and more to vulnerable pets.

 with these 3 insightful articles that cover diagnosis and treatment methods for common eye diseases and disorders.

This hospital administrator shared his journey of discovering self-acceptance and finding his 

 by nourishing an inclusive, diverse environment where everyone can thrive.

As the weather continues to get warmer, here are a few 

crucial tips and cooling therapies to conside

r for patients who suffer from heatstroke.

On this episode of The Vet Blast Podcast, Billie Groom, the creator of UPWARD Dogology touches upon 

why cognitive behavioral therapy can be beneficial

 to fund the Urban Resource Institute’s study to better understand the relationship between pets and domestic violence victims.

Stay tuned on our social media pages and here at dvm360.com for more veterinary news.

Articles

News wrap-up: This week’s veterinary headlines, plus why veterinarians are unhappy  

The worst nightmare occurred at Brock Veterinary Clinic. Gofers had invaded the lameness pad. I got to work one morning and noticed mounds of dirt neatly piled up in the area we trot horses to evaluate lameness. These rascals dig sub-terrain tunnels so shallow that if a horse steps over the top of one, it will cave in and possibly break a leg.

Now I don’t condone killing any creature. I went to veterinary school to learn how to fix critters, not harm them. However, we also can’t have horses breaking their legs during a lameness evaluation because of some hardheaded and elusive gofers who chose to dig up the area. So, I set out to run them off. My first attempt to rid the land of them was by using gas capsules. I had hoped the terrible smell would make them head to the vacant pasture. Instead, they just built more holes.

I then tried putting garlic in the holes. Yes, you read that right. I went to the grocery store and purchased 10 lbs. of garlic cloves, dug up the entrance to the burrows, put in 5 or 6 cloves, and then covered it up. Alas, they just dug even more holes. I even tried pouring a gallon of bleach in the hole...they just dug more holes. Okay, time to get serious. I cannot have horses breaking their legs trotting at the clinic. Now, it is war.

The clinic is located on a highly traveled road that runs through the center of Lamesa. Every evening I would be on the lameness pad digging holes and trash-talking gofers. It never crossed my mind that people passing by would even notice me. But my pal Mark did. Oh boy, did he.

Because I didn’t want to use poison, I decided to go with traps. (Yes, there are many types of traps that you can purchase that will snare, pinch, poke, or grab a gofer.) I purchased several different types of traps and went to work putting them in place.

It had become somewhat of a ritual for me. I would set the traps in the evening when I left the clinic, and then I would check them early in the morning before things got busy. Around 8 o’clock every evening I was digging and rooting through the lameness pad and then again around 7 o’clock every morning I was back and checking things out.

I wasn't having one stroke of luck. Those gofers kept outsmarting me and it was infuriating. I had already gone through 4 different trap styles and now I was on trap type number 5 (and having high hopes). I had attached 6 of those traps to a 6-foot piece of baling wire before placing them in the gofer tunnels. I left that evening feeling optimistic.

The next morning, I entered the lameness pad bright and shiny. I began digging up the new traps. The first 2 had nothing. As I approached the third trap, I noticed it looked different than the last 2—could I have finally got one of those rascals?

The dirt was really packed around this trap. I was feeling good about it, this was the moment I had been waiting for. For so long, these gofers had outsmarted me—I figured they were hosting meetings as a group every afternoon and made fun of me for being such a buffoon.

My heart was racing as I followed the wire down into the tunnel. It was packed with dirt and hard to move. I dug gently as I pulled. I could see signs that something had packed the dirt. As I was uncovering the trap more and more, I started to see some hair. These gofers were not gonna’ best me this time. I was about to dig up the first victim of my “gofer eradication program.”

Something was wrong. The hair I first saw caught in the trap was attached to something that didn’t resemble a gofer. It was sort of pink and felt way too firm to be a dead gofer. The more I pulled, the more I realized that this was no gofer at all. In fact, I had no idea what it might be.

I was removing dirt slow and carefully. The more I removed, the more I knew that I had been outsmarted again. This thing, whatever it was, ain’t no gofer. And once I removed more of the dirt, I had even more questions.

Are you kidding me? I had snagged a naked Barbie doll with gopher-colored hair? Where did that come from? I looked around. I just knew these gofers were peering out another hole somewhere and laughing their tails off at what they had just done to me.

A few days later I got a call from my buddy Mark. He asked if I had caught anything unusual in a gofer trap. He said he had seen me digging around every morning and evening while he drove by and decided to give me a surprise one night. All he could say was he wished he had been there to see me dig it up.

Bo Brock, DVM, owns Brock Veterinary Clinic in Lamesa, Texas.

I learned a valuable lesson when dealing with gophers: always check your surroundings. 

Mark versus gofer: A battle of wit

Often, all the time and training pet owners invest in their puppies can go right out the window once their furry friend reaches adolescence. According to Billie Groom, the creator of 

—a scientifically proven formula adhering to the principles of cognitive-behavioral therapy—that is where incorporating cognitive-behavioral therapy (CBT) comes into play.

In this episode of The Vet Blast Podcast, Groom tells Adam Christman, DVM, MBA, that while canine CBT works to “retrain the brain” of a dog 6 months or older, teaching the concepts of it can also help retrain the brains of their owners too. 

“So, it’s really interesting working with clients and it’s really interesting applying cognitive behavioral therapy because you always adhere to the principles, but it allows for creativity and to adjust to individual dogs,” she says.

Listen below to learn more about Groom’s 30-year background in dog training, plus the benefits of CBT training for dogs.

Podcasts

On this episode of The Vet Blast Podcast, Billie Groom, the creator of UPWARD Dogology, reveals the secrets behind why cognitive behavioral therapy (CBT) for dogs over 6 months is effective.


Episode 55: Retrain your (and your dog’s) brain with canine CBT

It’s that time of year when the temperature is rising and many veterinary hospitals are treating patients affected by heatstroke. Heatstroke is defined as severe pyrexia, with a dog’s body temperature rising to 104.9-109.4 °F.

This results from exposure to elevated ambient temperatures that impair the patient’s ability to dissipate the heat. These temperatures may be seen in pets that have been exposed to prolonged heat, such as those left in turned off cars or those exercised outdoors on dangerously hot days. As a result, they are less able (as seen in brachycephalic breeds) or unable to cool themselves down.

A dog’s normal temperature is maintained by a thermoregulatory center in the hypothalamus.

 As a dog’s temperature increases, the thermoregulatory center sets into motion the various methods for cooling the animal: evaporation, conduction, convection, and radiation.

 Panting is one way in which the pet can cool itself through evaporation; a second method is achieved when the pet lies on a cool surface and is cooled by conduction. Furthermore, the hypothalamus triggers a response to the increased body heat. The body constricts blood flow to the kidneys and spleen, the heart rate quickens, the blood vessels in the cutaneous tissue dilate, and panting and respiratory rate increase—all in an attempt to cool the body.

Multiple systems contribute to the risk of heatstroke and are negatively affected by it. The risk factors include but are not limited to brachycephalic syndrome, obesity, laryngeal paralysis, cardiac disease, and tracheal collapse.

 The degree of damage to the body correlates with the body temperature attained and sustained, along with the span of time during which the body had been under stress. Generally, these patients present with a history that can lead to a diagnosis of heatstroke; careful consideration should be given if the information doesn’t coincide with the patient’s history. Other conditions such as meningitis, encephalitis, toxicities causing seizures, and brain lesions may be the cause of hyperthermia.

Clinically, these patients will often present acutely panting, tachycardic, with bounding pulse, and temperatures above 104.9 °F.

 These signs can progress to weak pulses; muddy, dry mucous membranes; vomiting; diarrhea; seizures; and central nervous system depression.

Time is of the essence in such cases, because it is paramount to begin therapy/cooling to stabilize the patient and bring their temperature down to 103 °F, at which point therapy can be stopped.

Foremost, consider whether the patient is out of the heat and in a cool area before administering treatment. Then begin to saturate the patient’s fur with cool water, because the goal is to reduce body temperature by increasing peripheral blood flow and dilating peripheral vessels. It is important that cooling measures employed do not make the patient too cold, because it could result in more vasoconstriction, which is known to shunt blood to the patient’s core, resulting in further increase of the core temperature and additional damage.

 Cool compresses or soaked towels placed over axillary areas and femoral vessels, with the addition of circulation air provided by a fan, will make significant differences in cooling efforts.

Although these methods of cooling are being initiated, an intravenous catheter should be placed to administer fluids or emergency medications, taking into consideration the individual needs of the patient. As the body responds to heat by vasoconstriction, care must be taken to prevent fluid overload, which can negatively affect the lungs and brain.

 When treating acute heatstroke, evaluation of the patient’s needs for fluids should be determined on an individual basis. Fluids should be administered at room temperature or through a cool water bath in order to be effective. Fluid rates and administration should be continually monitored, because the hemodynamic state of the patient may change depending on the patient’s physiological response to therapy/cooling.

After identifying the individual needs of each patient, note that there are various classes of medications that can be used or considered when treating heatstroke. The use of nonsteroidal anti-inflammatory drugs is contraindicated. Nonsteroidal drugs act to adjust the hypothalamic set point for temperature and therefore may cause more harm than good.

They also may create further damage to the already stressed kidneys and stomach. Corticosteroids may be used on a case-by-case basis for complications of heatstroke like cerebral edema. The use of antibiotics has been proven beneficial, because the risk of translocation of bacteria from the gastrointestinal tract is high.

The selection of antibiotics should be directed toward a broad-spectrum option that should be administered until the patient’s gastrointestinal signs have resolved and appetite and bowel movements have returned to normal.

 With antibiotic support, gastrointestinal protectants may also be considered, because the goal of these medications should be to prevent gastrointestinal ulcers and alleviate nausea and acid production.

 Severely compromised patients may need both central nervous system and cardiac support. Mannitol or hypertonic saline may be used to decrease intracranial pressure and improve coronary, microvascular, and cerebral blood flow, but it should be used with caution when the patient is dehydrated.

Diazepam may also be used to assist in controlling seizures in patients.

Ventricular arrhythmias, the most common arrhythmia seen in patients with heatstroke, should be treated with lidocaine.

Ideally, patients should be monitored using electrocardiography, a pulse oximeter, a thermometer, and a blood pressure monitor. A baseline of temperature, pulse, respiration, capillary refill time, and mucous membrane color should be documented and the parameters serially recorded as the patient responds to treatment. If available during hospitalization, packed cell volume, total protein, prothrombin time, partial thromboplastin time, blood glucose, electrolytes, urine output volume, and lactate tests are recommended.

The prognosis for patients with heatstroke is dependent on the degree of hyperthermia and the time it takes for the patient’s body temperature to return to normal.

 The owners should be informed that the prognosis is considered guarded to poor.

 Patients that do not do well within 24 hours of presentation do not survive. Some of the negative prognostic indicators include arrhythmias, coagulopathies, and a poor neurologic response to treatment.

As we are all aware, client education regarding the prevention of heatstroke is of utmost importance and can be lifesaving. This education should start during puppy visits and should be revisited with the change in season on a yearly basis. It is often helpful to post warning signs in the veterinary clinic and on social media. Some patients living in different climates may acclimate better than others but, overall, erring on the side of caution is always best.

Patricia M. Leff, who earned her DVM degree from the University of Florida College of Veterinary Medicine, practices at Brick Town Veterinary Hospital in Brick, New Jersey.

Hackett T. Life threatening emergencies. In: Wingfield WE, ed. 

Canine Heat Stroke. Iowa Veterinary Specialties. Accessed August 16, 2020. 

http://www.iowaveterinaryspecialties.com/student-scholars/canine-heat-stroke-literature-review

https://todaysveterinarypractice.com/todays-technician-heatstroke-in-dogs/

Emergency Procedures for the Small Animal Veterinarian.

During the hot months, it’s important to know which cooling therapies prove most effective in pet patients.


Heatstroke involves multiple risk factors

 is an overarching term that encompasses all uses of technology to deliver health information, education, or care remotely.

 is a subcategory of telehealth that involves the delivery of information specific to a particular patient and is allowable only with an established VCPR. Many services are possible with telemedicine, as long as a VCPR that satisfies state and applicable federal requirements is in place, and the attending veterinarian is comfortable assessing the patient remotely and feels able to exercise good clinical judgment in caring for the patient. The VCPR protects patients and clients by setting clear expectations for the delivery of veterinary services.

Many veterinary practices implemented or expanded telehealth services in response to COVID-19 restrictions. As we start to welcome clients back into exam rooms, we’ll be wise to think about these technology offerings as more than stop-gap solutions. Beyond the pandemic, telehealth and telemedicine can augment and add value to traditional clinical services — enhancing the client-practice bond, improving compliance and patient health, and providing other benefits to the veterinary team and bottom line.

Veterinarians and clients both benefit from telemedicine tools because they create additional pathways for communication and data exchange between veterinarians, clients, and veterinary specialists. Additionally, they allow for integration with artificial intelligence, thus helping to identify issues earlier and increasing diagnostic accuracy. Remote monitoring can also assist with case management and provide added information about client compliance with veterinary recommendations.

Quality patient care is always paramount. The same standard of care applies whether a visit is conducted virtually or in person. It’s important to note however that telemedicine isn’t a replacement for in-person exams. That’s why honest communication with the client about what is and is not possible with telemedicine is crucial.

Delivering great service to patients and clients

When used appropriately, telemedicine can 

 Veterinarians and our teams can check in more frequently on patients, and telemedicine tools can help us identify opportunities for earlier intervention when needed. For example, a video check-in can be used to evaluate the healing of incision sites or wounds, monitor changes in mobility, and observe a patient's general demeanor and evidence of a return to normalcy after treatment.

Today's telecommunication tools and software applications also can 

for clients to seek veterinary care. Particularly for clients who embrace new technologies, and in areas with reliable, high-speed internet—telemedicine services can simplify the process of consulting the veterinarian. Being willing and able to offer telemedicine in appropriate situations can be a value-add that strengthens your bond with both clients and patients.

Technology also can help integrate veterinary specialists into patient care. Not only does it simplify consulting between a general practitioner and specialist, but it also supports 3-way conversations that can help bridge gaps when an in-person visit with the specialist isn’t an option.

Another advantage of telemedicine is convenience and improved staff efficiency. Client expectations for after-hours care and consultations can take a toll on even the most dedicated team. Telemedicine can help you deliver after-hours services while still allowing your team members to manage work-life balance.

Telemedicine technologies also can help you better utilize veterinary technicians. For example, a technician can use text messaging to answer post-operative questions, or video chat to demonstrate medication administration or deliver education that supports the veterinarians’ nutritional or behavioral recommendations. These activities support quality patient care and deepen the connection with clients and patients, while also freeing up veterinarians’ time.

Find these and other resources to implement and optimize your telehealth offerings in the AVMA’s Telehealth Resource Center, at 

Guidelines for use of telehealth in veterinary practice

Patient-specific telemedicine services are just one part of telehealth. Veterinary practices also can have opportunities to use technology to deliver general education that is not specific to a particular patient. Your technicians, for example, could lead webinars that support a healthy start for new puppy and kitten owners or share the significance of preventive care and can team with veterinarians to deliver information about conditions like hypothyroidism, diabetes, or Addison’s disease. This can help introduce your practice to more people in the community and position your clinic as a valuable resource for non-clients and clients alike. 

Establishing trust between the veterinarian and client is always key to the successful delivery of veterinary care. Telemedicine is no exception. Creating a veterinarian-client-patient relationship (VCPR) is the first step in building trust, and conducting an in-person exam or premise visit is an important opportunity to get to know both patients and clients. Once that relationship has been suitably established, telemedicine can support and deepen the connection.

One way we see interplay between the VCPR and telemedicine is in the connection between the value pet owners place on telemedicine and their relationship with the veterinarian on the other end. Research shows consumers place 

 on telehealth services offered by their own veterinarian than by a veterinarian they’ve never met.

A recent study conducted by Purdue University economists, in partnership with the AVMA, looked at pet owner attitudes and valuation of telemedicine services. It found that pet owners valued an average telemedicine call 1.5 times more when the platform connected them with a veterinarian in their community, rather than a random veterinarian located anywhere nationally. Moreover, pet owners valued the telemedicine service 2.5 times more when it connected them with their specific veterinarian.

These findings demonstrate the importance of the relationship between veterinarians and clients, especially in the context of telemedicine.

Table 1.  Relative Value of Telemedicine by Relationship Against the Baseline of "Any Veterinarian."

 also indicated a significant demand for telemedicine services, though that demand varied by age. Younger clients with children were the peak demographic desiring telemedicine options. And once again, the research revealed that what is in demand is the ability for clients to reach their specific veterinarian.

As a profession, we’re still exploring telehealth and the opportunities it presents. While we’ve learned a lot this past year, that education occurred during a pandemic, with both clients and practices under duress. So there’s a lot of “statistical noise” in what we know about telemedicine demand.

What we do know is that practices implementing telemedicine should deliver what clients want—the veterinarian with whom they already have an established relationship. Nurturing that connection—via telehealth and face-to-face—will lead to improvements in both patient health and practice growth.

Widmar NO, Bir C, Slipchenko N, Wolf C, Hansen C, Ouedraogo F. Online procurement of pet supplies and willingness to pay for veterinary telemedicine. 

Find out how virtual care is enhancing client relationships and supporting stronger businesses.


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IDEXX: Contributing to something bigger