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Dr. Louis Gotthelf
Dr. Louis Gotthelf, Veterinarian
Category: Dog
Satisfied Customers: 2438
Experience:  Doctor of Veterinary Medicine, Owner of a small animal clinic and an ear/skin clinic 35 years
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I have a Golden Retriever, 7 yrs old, my 1st dog of this breed,

Resolved Question:

I have a Golden Retriever, 7 yrs old, my 1st dog of this breed, as my prior 5 dogs were all German Shepherds who had never had a hot spot. I have been going to the same vet since 1978 and have always been satisfied with his care.
My dog Riley got his annual hot spot later than usual this year. He would usually get one under one of his ears in May/June but this year, he got one on his front left leg around his knee in late June. We got him to the vet, as always within 24 hrs of identifying the wound which was about 1.5in-2inches in length and about 3/4 inch in diameter. It was shaved and immediately treated with IV steroids with I believe oral cefazolin and a steroid taper over an month or so, since the associate vet had experience with his former hot spots and the needed treatment, he would usually be all healed up in 6 weeks or so. Our dog would occasionally scratch at his ear but for the most part, one course of steroids and antibiotics would resolve the situation. We are very good about cleaning his ears with a drying solution because the hot spots would often appear with an ear infection. We would faithfully clean his ears and his wound per the Dr's direction, a diluted solution of water and H2O2, pat dry and apply an antibiotic powder. Have not yet needed a neck lampshade to resolve.
In late June, we discovered a wound approx. 1.5 in length x .75 in wide, swollen and weeping on his L front leg below the knee and he received an immediate steroid injection with an oral steroid taper, 2 cefazolin 2x/day since was started last June and re-ordered in late July for lack of any real improvement (we finished the 2nd course yesterday) and brought him to the vet today in follow-up.
Largely the wound is dry with a small area still weeping a little serosanguinous drainage after re-shaving.
Another vet in the practice, who has successfully treated Riley in the past with a month long need for resolution of these hot spots saw him for his 3rd visit today and the wound is less reddened, less swollen but not at all looking healed, it appears dry but reddens as the steroid taper is ongoing. She switched him to Cipro today 500 mg 1 tab bid, continue prednisone now off taper and on a new 2x/day 10 mg dose BID x 10 days, daily x 10 days then QOD til doses are complete.
I am getting worried. The pattern of usual treatment and resolution is not happening this time around. Riley does lick his wound a lot (in the past he couldn't reach it to lick it) so the vet started alprazolam 1/2 tab-1 tab BID to help decrease his licking of the wound, which started today as benadryl 25 mg bid for the past 2 mo had no helpful benefit.
The chief vet, who I admire & respect after many years, saw Riley back in June for the initial apt and Dr Ruth who has treated Riley in the past for this condition, has seen him in the last 2 f/u appointments. The chief vet said sometimes when dogs get these wounds in an accessible licking zone, that the wound may never completely heal.
I live on the north shore of Boston. We have accessed a local animal hospital once in the past for an acute care need (diarrhea as a puppy) but this seems to be a chronic condition now, so have not sought out the animal hospital.
Have I given you enough info for you to make a recommendation?
My questions are:
1. Today the f/u vet said we would have to bring Riley to a vet allergist due to the ongoing nature of this stubborn wound which isn't responding to prior successful treatment plan. I am willing to do this if it will really help but have reservations about how this could positively impact this input in the future (what if he is allergic to dust?) We have a clean house and bathe him regularly and the local allergist is $500 per appt. so I don't want to go broke if this is not likely to have an appreciable impact.
2. We have never resorted to just shaving Riley at the beginning of our New England summers and have noticed he is very sensitive to heat so we keep him in during hot days and keep the A/C at 70 degrees. He lies in front of the A/C on warm days so it seems it help. Friends with Goldens say they shave their dogs every May and that it helps prevent hot spots.
3. We feed Riley Merrick's American made pricey canned/dry combination. He weighs about 85 lbs but is not overweight and he gets daily running walks which result in the vets stating he is an "athletic" Golden. He probably could use to lose some pounds though which would probably help.
What recommendations do you have? He is the sweetest dog in the world. We would be willing to change wound treatment, diet, whatever it takes to get him over this.
Thanks so much.
Submitted: 1 year ago.
Category: Dog
Expert:  replied 1 year ago.

Dr. Louis Gotthelf :

Hi. I'm Dr. Gotthelf. I have been a skin and ear vet for 35 years and I would like to use my experience to help you with your pet's medical problem.

Dr. Louis Gotthelf :

Being a Golden retriever makes Riley in the category of an allergic dog. Hot spots are usually the result of an allergy. That's probably the reason for the allergy test request. However, with the treatment of steroids and antibiotics, this should have healed up very quickly. When they show up on the leg and they don't heal, it could be something else entirely. What starts as a hot spot can become something called an acral lick granuloma. The dog licks the area and it feels good to the dog. Endorphins are released from the brain that make the dog feel great (like you scratching a mosquito bite). In many cases, antibiotics and Prozac are needed. The dog keeps an infection going in the scar tissue and an antibiotic that has good penetrating properties is necessary. Cipro may be good, but most dogs do not absorb cipro from their intestines, so it is not recommended to give to dogs. Enrofloxacin (Baytril) or Marbofloxacin (Zenequin) are so much better for this. Fluoxetine (prozac) takes away the psychological need to release endorphins. It can take up to a month to start working. I have used it in about 200 dogs and it is magical for these lick granuomas. Please discuss these possibilities with your vet(s).

Customer:

Thank you so much Dr Gotthelf. I really appreciate your time & expertise to help Riley. I was wondering are the allergies mostly food-related or can it be an environmental trigger (pollen, etc) as well? I will def schedule an allergist evaluation. If the allergist identifies a specific trigger, rather than a multitude, can there be a treatment plan to avoid the hot spots in the future or do they usually find many triggers? And you are right, every other hot spot has resolved quickly in response to antibiotics and steroids which is why this episode has me so concerned. I would be so willing to try the Prozac, despite the lag-time in it becoming effective. Any further guidance you can provide regarding the above questions will help me prepare myself for what the allergist recommends.

Dr. Louis Gotthelf :

There are so many things in the environment that could be causing his allergies. Testing will reveal those things that his immune system reacts against. That does not mean that any one in particular causes the skin problem, but more than likely several of them. Some allergens that show positive on the test may not be in your area or has a very short season. The allergist will be able to intelligently discuss this with you after they get the results. The allergy tests we do evaluates environmental allergens. There is no good test for food sensitivities except to use a special type of a hypoallergenic diet for 6-8 weeks to see if there is any change in the skin condition.

Customer:

Hi Dr Gotthelf,

Customer:

Thank you so very much for your expertise. I took action since your initial answer earlier today. There is a Board Certified Canine Dermatologist about an hour away and I made an appt for Riley 10 days from now. I will also consult an allergist for him but right now, I wanted RIley to be seen with someone with your area of expertise first. You have no idea how grateful I am to you for your help in this matter. I just knew we were not on the path to getting Riley well, esp given the Cipro issue. You are a credit to your profession and my family thanks you. I also am so grateful that Just Answer sent this question to you, someone completely qualified to help us in our decision-making. I will never forget you and the great help you have provided. Thank you so much!!!

Dr. Louis Gotthelf, Veterinarian
Category: Dog
Satisfied Customers: 2438
Experience: Doctor of Veterinary Medicine, Owner of a small animal clinic and an ear/skin clinic 35 years
Dr. Louis Gotthelf and 6 other Dog Specialists are ready to help you
Expert:  Dr. Louis Gotthelf replied 1 year ago.
Hi Brenda,

I'm just following up on our conversation about Riley. How is everything going?

Dr. Louis Gotthelf

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Dr. Louis Gotthelf
Dr. Louis Gotthelf
Chief Staff Veterinarian
1100 Satisfied Customers
Doctor of Veterinary Medicine, Owner of a small animal clinic and an ear/skin clinic 35 years