atopic dog, drug averse owner

Re: atopic dog, drug averse owner

Mark Holmes — Thu, 31 May 2012 23:14:56 GMT

[quote user="Hannah Bose"]

Sometimes I'd love to be able to talk to clients like doctors on television programmes talk to patients! One example that springs to mind is from House where a mother of an asthmatic child says she doesn't like her child using the inhaler, having heard that steroids are bad for you. Dr. House's response:

"Oxygen deprivation is also really bad for you. Fatal even." (Or words to that effect; I'm not conscientious enough to look up the quote).

[/quote] I've used that one. "Aren't steroids bad for you?" "Not as bad as lymphoma"

Re: atopic dog, drug averse owner

Anthony Todd — Thu, 31 May 2012 20:27:46 GMT

[quote user="Alet Engelbrecht"]It sounds like she is really determined not to treat the dog, which, according to welfare organisations, is cruelty by neglect. The only 'nice' thing she has done, is to bring her dog to a vet (although in doing so, flaunting her lack of ?care) - many owners don't even bother.[/quote]

Ah, glad to see someone, at last, has considered the poor dog!! I'd relieve it's suffering with something [daren't say steroids] and tell her it's derived from flax [remember Betsolan?]

Re: atopic dog, drug averse owner

Martin Atkinson — Thu, 31 May 2012 14:02:14 GMT

[quote user="Virginia Campbell"] She seems willing to at least listen and I'd rather deal with this - as a sort of challenge - than the sort who just wants the depomed jag and none of that there other expensive stuff and continues to feed the Westie on Caesar.[/quote] Notwithstanding the fact that I was the first to say ditch this client as she she will be nothing but a pain in the proverbial, I wholeheartedly agree with this statement.

Re: atopic dog, drug averse owner

Jo Cobbett — Thu, 31 May 2012 13:24:00 GMT

It might be worth mentioning to her that Spinosad is used in organic farming as an alternative to insecticides, so might not fall into the 'drugs' category in quite the same way as spot ons, particularly if she is already veering towards oral flea medication.

Re: atopic dog, drug averse owner

Virginia Campbell — Sat, 12 May 2012 17:17:28 GMT

[quote user="Mark Hedberg"]If she's very pro-natural and anti-artificial, she'll eventually search the internet and will eventually find out about RMB diets (whether from you or the internet) so if she brings it up make sure you explain about scrupulous food hygiene when she decides to make it at home, and insist on routine parasite control.[/quote]

Ha! Too late! Although according to her other dog's record, they are off RMB and on Origens now. Didn't have the food conversation as the 15 mintute slot was up, but will ring her soon to see how the dog is getting on and book her in with our dermatologist, who makes short work of non-compliant clients. Normally I wouldn't have much time for this type but she does worm her dogs - with milbemax - and this one got cephalexin at the time of castrate a few months back when the original raging ventral pyoderma was found. Think she did give the cephalexin...don't know how long for, I don't have the notes in front of me now. She seems willing to at least listen and I'd rather deal with this - as a sort of challenge - than the sort who just wants the depomed jag and none of that there other expensive stuff and continues to feed the Westie on Caesar.

Anyway thanks for all your suggestions and thoughts, if it stays my case I will let you know how it goes.

Re: atopic dog, drug averse owner

Martin Atkinson — Thu, 10 May 2012 18:30:31 GMT

[quote user="John Rimmer"]

Martin - I"ve read all of your articles but haven't spotted the funny one. Which one was it?

[/quote] OK maybe not funny but I try to make them entertaining, even amusing, of course that is all a matter of opinion!

Re: atopic dog, drug averse owner

John Rimmer — Thu, 10 May 2012 18:08:56 GMT

Martin - I"ve read all of your articles but haven't spotted the funny one. Which one was it?

Re: atopic dog, drug averse owner

Martin Atkinson — Thu, 10 May 2012 10:54:35 GMT

[quote user="Hannah Bose"]Sometimes I'd love to be able to talk to clients like doctors on television programmes talk to patients! [/quote] I occasionally do! Although like most of us I bite my tongue most of the time, I have been known to let rip and although it usually results in the client leaving never to darken my door again one time it bore dividend - albeit temporarily. One client, whom I made subject of one of my Vet Times (funny) articles had numerous cats, all un-neutered, un-vaccinated, and several with retrovirus infections. When he brought one un-neutered male with FIV in for the umpteenth abscess I let rip and left him in doubt as to how irresponsible I thought he was. To my surprise he didn't turn tail but started a program of vaccination, neutering, correct management of the retro-virus situation, correct feeding and parasite control. For a while he was almost a model client but eventually returned to type as would really be expected from a vegan, ant-vivisectionist, animal-rights supporter. The article was called, 'Leopards don't change their spots' and I feel your client is a leopard Virginia.

Re: atopic dog, drug averse owner

HMC — Thu, 10 May 2012 10:34:33 GMT

"Oxygen deprivation is also really bad for you. Fatal even." (Or words to that effect; I'm not conscientious enough to look up the quote).

Re: atopic dog, drug averse owner

Alet Engelbrecht — Thu, 10 May 2012 08:59:18 GMT

[quote user="Kate Richardson"]It depends on at what point you see the animal- if its the first or second time its had a raging otitis/pyoderma then sure, treat the problem effectively, but if it keeps recurring, I would start a diet trial immediately whist again treating the otitis/pyoderma effectively and concurrently performing other tests such as cytology/skin scrapes/thyroid status etc.[/quote]

My point is still: you cannot focus on diet only at the beginning of a skin workup - without addressing other concerns. By all means, start eliminating some of the 'special' treats early on. But this lady even refuses flea treatment - for me that is essential in ANY pruritic dog - unless it lives in a bubble, which this one clearly doesn't. I think a lot of dogs are mistakenly diagnosed as having a food allergy by starting a diet trial too early alongside other treatment - I am no innocent bystander either. How many of you rechallenge with the original diet?

I saw a dog with recurrent hotspots on Tuesday. He had been treated by several vets, including myself, in the past. I combed for fleas every single time and only on Tuesday did I find live fleas. The environmental burden may be extremely low, but it just takes ONE flea (and it is not always that easy to find) to lower the pruritic threshold.

[quote user="Andrew Kent"] And if your food rep is telling you that a diet trial needs to be 12 weeks then they are just flogging diets![/quote]

PS: Of course the rep is trying to flog her diets, I'm not that gullible. I merely stated it as she refreshed my memory from the sentence in Ettingers 'However, cases of food-allergic skin disease may require up to 10 weeks to respond.' Therefore, I prepare my clients for the possibility of feeding an exclusion diet for 12 weeks - be it a hydrolysed protein diet or a home-prepared diet - it takes long term commitment.

Re: atopic dog, drug averse owner

Andrew Kent — Thu, 10 May 2012 08:29:05 GMT

There are lots of studies showing how rubbish blood food allergy testing is so I think that would be one way to make the client have even less faith in you!

Re: atopic dog, drug averse owner

Louise6732 — Thu, 10 May 2012 07:46:52 GMT

Sorry if someone else has already said but skimmed over thread as not much time to read it all!

A food trial may help, although as has already been mentioned if has Sarcoptes etc then won't help.

One of our vets has had a lot of success with the Avacta Sensitest, it is a blood allergy test which I was skeptical about, but it seems to work very weel for food allergies, the nice thing about it is it gives you a list of commerical foods you CAN have eg if beef allergy, supplies JWB, RC etc with no beef in it. Is worth a shot with this one?

Re no drugs at all, if the dog is suffering as a consquence you need to tell her this, poss get another vet from your practice in as 2nd opinion on the no drugs thing? Not to gang up on her, just to labour the point that it is unacceptable to leave a condition untreated and she is breaking the welfare laws (I'm not massively up on the wording of this so excuse me!)

I'd interested to hear how this one pans out.

Have you contacted the RCVS for advice?

Louise

Re: atopic dog, drug averse owner

Kate Richardson — Thu, 10 May 2012 00:54:21 GMT

Have you done any work up so far? Have you discussed allergy testing? She may feel this is an acceptable treatment to pursue as its not a drug per se. Although best make sure she is aware of how effective or not it may. Empathising with her may help to slowly get her on board (I am an eternal optimist ) so try EFAs and beetroot (must try this) and if doesn't work then she may listen to you more because you have listened to her and tried it her way so to speak. If it works you will be a goddess in her eyes! But otherwise ditto what Lorna and others have said re continuing to treat this dog, I would really push for a referral but if not, have a very frank talk with the owner, book extra time to do so if nec, get her to put herself in the dogs shoes and see how she would feel being constantly itchy yet even worse not being able to understand why you are feeling itchy, explain atopy fully until she really gets it and if she doesn't, then advise she seeks a different vet. Its hard, cos you really want to help the dog, and she is seeking advice so if you totally piss her off she may never seek veterinary attention again as she will tar all vets with the same brush but unless you can convince the owner how to best treat it, you will only end up frustrated and angry with her.

Re: atopic dog, drug averse owner

Kate Richardson — Thu, 10 May 2012 00:35:23 GMT

[quote user="Alet Engelbrecht"]I was of the opinion that a diet trial is done at the end of a skin workup - not the beginning. For several reasons - if the dog has a raging malassezia otitis/dermatitis, mange, fleas, and/or pyoderma, diet is going to struggle to control it if the owner refuses to bath/treat the dog. Apart from that, not many owners are truly committed to feeding 12 weeks (spoke to a eukanuba rep last week) of a novel diet without ANYTHING else.[/quote]

It depends on at what point you see the animal- if its the first or second time its had a raging otitis/pyoderma then sure, treat the problem effectively, but if it keeps recurring, I would start a diet trial immediately whist again treating the otitis/pyoderma effectively and concurrently performing other tests such as cytology/skin scrapes/thyroid status etc. Getting them to try the diet is one thing though, and getting them to stick to it and really appreciate that no extras, that means NO extras is very different!

Re: atopic dog, drug averse owner

Lorna McHardy — Thu, 10 May 2012 00:06:12 GMT

[quote user="Virginia Campbell"]

She's a nice person though and I'd like to keep her custom.

[/quote]

She may be a very nice person, but she's still wasting your time; and meanwhile, her dog isn't getting any treatment. I'd make an effort to find out why she's so anti-drugs and try to address that, advise to the best of my ability and also spend time trying to find a way to reach her, but I wouldn't fiddle about with stuff I don't think will work when the dog needs something that does; and there's a limit to how long and how often I'd advise a client who ignores everything I say.

Re: atopic dog, drug averse owner

Michael Woodhouse — Wed, 09 May 2012 22:56:13 GMT

[quote user="John Rimmer"]Sorry but I think you should advise that you have to treat as properly as not to do so is a welfare concern. If she refuses she should be reported to RSPCA under animal welfare act. It is no better than not seeking veterinary attention to begin with,[/quote]

[quote user="David Mills"]Why not inject the dog with dex, say its homeopathic; fruit bat will be none the wiser.[/quote]

My thought was a 10ml syrings, 2ml depomedrone. Dillute it 4 times with 2ml of saline, do a bit of shaking...............

Re: atopic dog, drug averse owner

Andrew Kent — Wed, 09 May 2012 22:31:53 GMT

The point was that the owner was declining medications do diet may be easier to convince them of. I agree that secondary issues need to be controlled but actually diet should also be addressed early on. And if your food rep is telling you that a diet trial needs to be 12 weeks then they are just flogging diets!

Re: atopic dog, drug averse owner

Alet Engelbrecht — Wed, 09 May 2012 22:02:52 GMT

[quote user="Andrew Kent"]Agree with others that diet trial would be good to start - needs doing and no drugs![/quote]

I was of the opinion that a diet trial is done at the end of a skin workup - not the beginning. For several reasons - if the dog has a raging malassezia otitis/dermatitis, mange, fleas, and/or pyoderma, diet is going to struggle to control it if the owner refuses to bath/treat the dog. Apart from that, not many owners are truly committed to feeding 12 weeks (spoke to a eukanuba rep last week) of a novel diet without ANYTHING else.

'Treat what you can see, then see what you're left with' to quote our dermatology lecturer...

Re: atopic dog, drug averse owner

Andrew Kent — Wed, 09 May 2012 21:42:23 GMT

Agree with others that diet trial would be good to start - needs doing and no drugs! Other than that I have come across a few of these clients and give them 2 choices - follow my advice and I will control the condition or ignore me and do what they want but it is their choice if they want the condition controlled or not!

Re: atopic dog, drug averse owner

John Rimmer — Wed, 09 May 2012 21:32:48 GMT

Sorry but I think you should advise that you have to treat as properly as not to do so is a welfare concern. If she refuses she should be reported to RSPCA under animal welfare act. It is no better than not seeking veterinary attention to begin with,

Incidentally, why was she given Piriton. No evidence that it works in dogs and as much a drug as anything else. The fact that it doesn't work doesn't per se make it homoeopathic y'know!

*Awaits red stars* Just saying what I think.

Re: atopic dog, drug averse owner

Gillian Mostyn — Wed, 09 May 2012 21:07:48 GMT

JHL - I really really hope that the tongue-in-cheek smilie was for the whole post.......

Re: atopic dog, drug averse owner

John Rimmer — Wed, 09 May 2012 21:06:43 GMT

[quote user="Rob Davis"]

If this was a child, would it be acceptable for her to prevent her doctors from treating her?

[/quote]

In the name of religious tolerance, yes.

Plenty of Jehovah's witnesses' children die when a simple blood transfusion would've saved them. Parents should be charged with murder IMHO.

Re: atopic dog, drug averse owner

james herriot lied — Wed, 09 May 2012 20:49:02 GMT

EFAs: the human peeps are all going for hemp oil at the moment - apparently the best balance of 3/6/9s. You can get it from the supermarket oil aisle as a cold food oil. Ensure the owner also takes a daily dose.

Garlic in moderation for flea control. Ensure the owner also takes a daily dose.

Thornit for ear cleaning (NOT treatment). Owner optional

Sudocrem for topical patches. Make sure the owner self-tests first

Zinc supplementation, through diet. Owner again.

Avoid preserved aloe vera preparations as the active ingredient destabilises fairly quickly, but start with home-grown aloe. Make sure the owner looks at relevant refs and, again, self-medicates.

Please do understand that I'm NOT endorsing these as sole treatments (I'm a long way from being a steroid-free zone), but I do often find that a bit of bargaining works wonders: meet me half-way here - we need just a short course of steroids/drops/ flea control to get you started, not enough to cause any lasting effects, and we'll wean off fairly quickly to leave these in place. In actual fact, all of the above are reasonable measures which (garlic dose being important) won't be harmful in themselves. Equally, you start to look as though you're actually engaging with the client's needs.

Which do I use? Hemp oil, zinc, garlic and aloe.

Re: atopic dog, drug averse owner

Alet Engelbrecht — Wed, 09 May 2012 20:22:33 GMT

[quote user="Virginia Campbell"] Very anti-drug. No colvasone, no cortavance, no advocate, no malaseb etc.[/quote]

[quote user="Virginia Campbell"]So....assuming we start with skin workup and get the environment under control as much as poss first....what else works?[/quote]

I cannot see how you can get the environment under control (unless it is the swimming, which may also be difficult to completely eliminate as it is a labrador) if she refuses to even use flea control.

[quote user="Virginia Campbell"]She's a nice person though and I'd like to keep her custom.[/quote]

From your post, I find it very difficult to believe that she is really a 'nice' person - certainly not nice to her animals. Admittedly, their parvo titres are low, yet she refuses to vaccinate, the dog has an ear infection which we all know is not pleasant, yet she refuses to treat. I don't think oral flea control was ever intended to replace topical flea control, merely to be used as adjunctive treatment where there is a high environmental load. She may be friendly and possibly even pleasant, but I would not want to be her dog.

Have you asked her why she comes to a vet? I am just wondering what she expects you to achieve when she does not want to use any medications or vaccinations. If she refuses core vaccines, do you really think she will go for immunotherapy? It sounds like she is really determined not to treat the dog, which, according to welfare organisations, is cruelty by neglect. The only 'nice' thing she has done, is to bring her dog to a vet (although in doing so, flaunting her lack of ?care) - many owners don't even bother.

Re: atopic dog, drug averse owner

Rob Davis — Wed, 09 May 2012 19:56:26 GMT

[quote user="Martin Atkinson"]

[quote user="Virginia Campbell"]She's a nice person though and I'd like to keep her custom.[/quote] Sounds like the client from hell - is it really worth it? She'll dump you and move on to her next victim when whatever you do doesn't live up to her expectations. I can't blame her if she doesn't want to use steroids and is prepared to try other avenues first but it sounds like you're not going to get far with anything. I would take her aside and be quite frank in asking her if she wants to work with you to treat her dog then if she does say she needs to trust you not to give her dog anything that will harm it, if she doesn't then suggest she is better moving on now rather than later.

[/quote]

I agree with Martin. If she is tying your hands behind your back before you start, it is unlikely you are going to sort the problem, and she is likely to end up going elsewhere anyway. Being continually pruritic must be horrible for the dog, and she has a duty under the Animal Welfare Act to ensure that it receives appropriate treatment. If this was a child, would it be acceptable for her to prevent her doctors from treating her?