Ashley Bourgeois, DVM, DACVD: When we start thinking about general practitioners managing these cases, where we can speak from our perspective specialties, but we’re hyper-focused. When they come to see us, we’re hyper-focused: me on dermatology, you on behavior. We know general practitioners are going to have to manage these cases from a whole dog picture. We still do, I talk about behavior and get advice from you on these cases, but the general practitioner is really going to have to do that.
When we talk about a general practitioner working up a pruritic dog that may also have behavioral concerns, from my standpoint, I’m going to want the dermatologic disease controlled the best that we can. I’m sure you’re not going to be super thrilled if I refer a dog to you that’s completely itchy, uncomfortable, tearing themselves apart, and then I’m asking you to work with their behavioral modifications. We need to calm, I would imagine, the outliers down. Not that you can’t do both at the same time, but we can’t ignore the skin to work up a behavioral disturbance that might be related to the skin.
Going back to that minimum data base, making sure we’re treating infection. Making sure we’re getting the animal’s comfort, at least from a medical standpoint, controlled the best we can, and then seeing what we’re left with. From your standpoint, I’m going to assume if they see you and they’re uncomfortable and having flares and an allergic reaction, that’s going to make your job difficult to know what truly is the primary behavioral part of this. Would you think that making sure we control the dermatological disease with the behavior, but focusing on calming that skin down would be important for the general practitioner?
Christopher Pachel, DVM, DACVB, CABC: I’m going to go back to my history on that one truthfully. If I have an animal, let’s say it’s a dog that’s had low level chronic anxieties for 2 years, just as an example, and it’s now acutely flaring with a dermatological condition, flea allergic dermatitis, let’s say. Now it appears that the anxiety level has dramatically flared as well. My first thing is going to say, maybe we need to treat the anxiety, but maybe treating the dermatologic piece gets us back to that previous baseline, maybe it will, maybe it won’t. That would be a case where I would likely say, “Hey, let’s see what we can do to get that animal comfortable, and then let’s not rest there, let’s keep pushing.” In other cases it might be exactly the reverse. Where we may say, “Yes, we’re going to get the dermatology stuff under control, but right now the manifestation of that has the animal engaging in particular behavioral patterns that aren’t sustainable.” We need to focus on that first. Or maybe it’s the case where we say, I’ve got fair reserves in terms of the client’s willingness and ability, so we may be working on those plans simultaneously and parallel. It’s going to vary a little. My history is going to, not necessarily dictate, but it’s at least going to guide how I’m going to approach that conversation with the client.
Ashley Bourgeois, DVM, DACVD: It’s that age-old answer, “it depends.” We can’t have that clear-cut answer. I tell clients this all the time, “it depends,” and yet I’m trying to get you to give me a clear answer. I still can’t get one. What you’re saying is, “it still depends.”
Transcript edited for clarity.