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Dr. Andy
Dr. Andy, Medical Director
Category: Dog Veterinary
Satisfied Customers: 29992
Experience:  UC Davis graduate, emphasis in dermatology, internal medicine, pain management
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28AUG15 Direct this question to Dr. Owner:, USofA Problem:

Customer Question

28AUG15
Direct this question to Dr. Andy
Owner: David XXX
XXX, USofA
XXX
Problem: Canine Dermal Lesion
Breed: Australian Shepherd/Blue Heeler/?
Sex: MN
Age: 9 in Nov15
Wt: 95lbs; Measures 27" to top of back at front legs.
Defects: Blue eyes, Iris Coloboma. Redness around eyes is normal.
He has had successful TPLO surgeries on both Left and Right legs (Jul14 and Feb15). Each surgery was preceded by a thorough exam - All normal/no parasites (I have about 2 more years of payments!).
He's active, we play fetch 3-4 times a day; has very acute hearing; normal bowel and urination function; normal appetite. No changes in routine or diet.
Recent changes:
Over past 6mos Redness developed between Toes on Left Rear Foot along with Dermal problem on Left Front of Muzzle. Vet assumed Allergy and treated with Steroid Injections. Foot problem was resolved and Muzzle Lesion was receding. After third injection, the Muzzle Blistering started anew. A Leathery Blister (keratosis?) would quickly appear; the dog would scrape it away with no apparent Pyoderma; it would appear to be healing but soon a new Blister would appear! The Blistering stopped moving from Front to Rear and is now moving from Bottom Up. Used ??, an antibiotic, with no results, just begun new treatment with Cephalexin 500mg. He doesn't seem to be in any Pain, but new Blisters appear to Itch.
I'm concerned because my vet has prescribed applying Miconazole Nitrate 2%, an anti-fungal, to the lesion. Considering the site of the problem, it does not seem to be a prudent use of this particular medicament!
Any insight would be most appreciated. I could have a biopsy performed, but, coupled with the TPLO's, this whole mess is getting extremely expensive. On top of all this, he has a fibroma on one foot!
Any insight that might bring a successful conclusion would be much appreciated. This may be one for Dr. Andy!
PHOTOS AVAILABLE
Submitted: 1 year ago.
Category: Dog Veterinary
Expert:  Dr. Andy replied 1 year ago.

Hello,

Sorry for such a long delay in replying. I have been in the process of purchasing a animal hospital, which is very time consuming.

A few things to comment on:
The miconazole is fine to use, but my concern is that if this is more bacterial, the ointment will be worthless. So, I would generally prefer a topical preparation that is at least both antibacterial and antiyeast.

The steroid injections are not ideal. Why?
Well, allergies don't come and go. Most of the time, they persist for at least several weeks if not for an entire season. So, personally, I prefer to use oral steroids like prednisone. Giving tablets gives you far more flexibility in steroid use, where you can wean the steroid down to the lowest effective dose. A shot may work great, but what do you do in 10 days when it wears off.

So, I wouldn't necessarily keep giving steroids. Ask about doing only pills instead. More cost effective as well.

Even if some of the ointment got licked/consumed, it would unlikely be any problem. I tend to recommend applying products really early in the AM when sleeping or late at night, to try and reduce licking of the area.

Or, possibly using a medicated "wipe" instead.

Also, if doing any excessive licking or chewing of the legs or paws, that is a very common symptom in 50% of dogs suffering from allergies. Just FYI

Hope that info helps

Good Luck

Dr. Andy

Customer: replied 1 year ago.
Thanks for the steroid advice. Pills it will be!Since using Cephalexin and applying Neosporin, the scab formation has ceased and healing seems to be starting.
My wife just informed me this morning that Max has been helping himself to the dry cat food at night. He hasn't been able to access it since starting the new medication.I'm going to continue as if it were bacterial at this point. I don't believe it's a fungal problem.Thanks for the reply. Somehow, we were disconnected at the first contact. The web site needs to be a bit more user friendly, especially when a reply may be delayed.I'm getting worm pills tomorrow. Giving pills is a snap. Soak 1/4 slice of bread in chicken fat and roll up over the pill.Good luck on your hospital.
Expert:  Dr. Andy replied 1 year ago.

Thank you. I hope everything works out okay.

Dr. Andy