A recent request by a Bark reader was, “how can I treat a hot spot at home without seeing a vet?” Hopefully I can begin to answer this, but first, one must be able to “spot” a hot spot.

A hot spot is a superficial skin infection that happens when normal skin bacteria overrun the skin’s defenses as a result of damage to its surface. This damage is most often started by the dog chewing, scratching, licking and gnawing at itself. In the first stages of the formation, the skin becomes moist, red, itchy, and infected. Pus begins to ooze from the traumatized skin as infection sets in. Then, the dried pus and damaged skin surface will work to form a tightly-adhered crust, and you will likely notice hair loss over the infection site. This can be a very painful process, and frequently, dogs will show pain when the area is touched.

Dogs are their own worst enemy when it comes to hot spots, and they are generally created by their own over-zealous self-licking and chewing. They can arise surprisingly quickly: a few minutes of “work” can create an impressive area of self-inflicted trauma. The good news is that they almost always look worse than they actually are, and infection is usually superficial—often resolving with topical treatment alone.

So, what causes our dogs to begin self-chewing and licking in the first place? Good question, with a common denominator being anything that creates irritation to the skin, causing the dog to chew or scratch at the site, can cause a hot spot. Think insect bites (fleas, flies), skin allergies, excess skin-surface moisture, dogs with heavy or dense hair coats, matted hair, saliva accumulation under the fur (think of the pet that is always licking its feet), skin scrapes, or excessive humidity in the environment can all be sources for a hot spot to develop. Another interesting cause: good old-fashioned boredom.

The location of the hot spots may help your veterinarian determine the underlying cause of the problem. For example, a hot spot over the hip area could indicate flea infestation, hip arthritis, or an anal gland infection. Similarly, a hot spot near an ear could indicate an ear problem, an allergy, or a dental/nerve irritation. 

What you can do at home:

If the hot spot is small, non-painful, recognized early, and is uncomplicated, it may be possible to begin treatment at home with over-the-counter products made for this use. There are an array of topical sprays, medicated shampoos, and herbal therapies available—too expansive a list to discuss here. The important thing is to ensure that it is a pet-approved/pet-safe product and it is always a good idea to call your veterinarian and ask if your choice seems reasonable. You need to be very careful not to use human topical products as these may be toxic to pets when licked and ingested.  For example, zinc oxide can be toxic when ingested and it is a common carrier in many human skin ointments.

The basics of home hot spot treatment are:

• If the area is small and non painful, carefully and gently clip the fur that is covering the area—this allows air and medication to reach to wound (word of caution: use approved grooming clippers, not scissors! I see many “accidental lacerations” in the ER because of this.)
• Keep your pet from licking the area—you guessed it, get out that cone of shame.
• Apply a warm, moist compress to the area 3 times daily for 5-10 minutes to keep the area clean, to calm the tissues, and to encourage good circulation; allow the area to fully dry before applying anything topically.
• Use only pet safe, veterinary approved, over-the-counter treatments; as always, it is best to consult with your veterinarian prior to starting any home treatment.
• Do not place any bandages or wraps to cover the area—you want the area to “breathe.”
• Alleviate the itching or irritation that started the whole thing in the first place—get to the bottom of the source, otherwise you will be faced with a loosing battle.

Tips on prevention:

• One of the things that can’t be stressed enough is appropriate flea control! Good flea control is important for any itchy pet and is the foundation of “itch prevention.”
• In hot, humid weather, always thoroughly dry your heavy-coated dog after bathing or swimming.
• Make sure your dog is groomed on a regular basis.
• Keep boredom and stress at bay—provoide adequate exercise and opportunities for mental stimulation and play.
• Introduce essential fatty acids into your pets diet to help keep a healthy coat.

When you can’t do it alone:

The bad news is that about 30% of the pets who develop hot spots actually have some other kind of skin disease such as a deeper skin infection, a bite wound or other trauma, or even immune-mediated disease. If you have any concerns whatsoever, it is best to have your veterinarian assess them.

Another time that veterinary intervention is needed is when the hot spot becomes so big and painful that it requires sedation to properly clip and clean it (can you imagine what it would feel like to have running clipper blades go over raw flesh? Ouch!). 

An additional potential concern is if a hot spot is accompanied by deeper skin infection, which would require more extensive therapy such as oral pain medications, oral anti-inflammatory medications and oral antibiotics in addition to topical treatments. The treatment your veterinarian chooses will depend on how bad the problem is, how much pain your dog is in, how long the problem has been going on, and if the problem is a recurring one. Some dogs may get one or two hot spots and then never get another one again (luck dogs!), while some may have frequent recurrences. 

Hopefully this helps take off some of the heat of hot spots, and thank you for the suggestion, Mona J!

A broken toe nail can be a painful and potentially expensive injury for our furry friends, and it is something that I often see in the ER. A common scenario is a pet suddenly begins to limp while out playing, and upon closer inspection, an injured nail is seen.  Some nails have just a minor crack with some bleeding, while other injuries put a toenail at a 90-degree angle (ouch!). Because they can be painful or have bleeding, a cracked or broken nail may be best treated by a veterinarian. With that being said, it may not necessarily require an urgent trip to the emergency room. A broken nail may be something you can care for at home, or, depending on the degree of injury, it may be reasonable to wait to see your regular veterinarian in the morning.   

So, what to do if your pet is suddenly favoring a paw and/or you see bleeding?  First, get a good look at the paw—including in between the toes and webbing—to see if it is a cut, foxtail or other foreign object, insect stinger, or (you guessed it) possibly a broken nail. When doing so, be sure to look closely at the nail bed, as I have seen cracks and injuries in the nail that were actually hidden underneath the fur line, where the base of the nail goes into the toe. There are 3 general “types” of nail injuries: one where the nail has been completely broken off and is bleeding, one where the nail is cracked or broken but is loosely attached, and one where the nail is cracked or broken but remains firmly attached. 

Usually, the best case scenario is when the nail is fully broken off and some bleeding is noted. In these cases, bleeding is usually mild but can be worrisome if it continues.  These are the easiest types of injuries to treat at home as you generally only need to apply pressure with a gauze or clean cloth to the nail to stop the bleeding. The key is to hold pressure for at least 5 to 10 minutes with no “peeking to see” if the bleeding has stopped before this time is up. It is important to keep your pet calm during this time, as excitement increases blood pressure and works against a good clot forming. If bleeding continues despite applied pressure, you can apply styptic powder (such as Kwik Stop) and resume applying pressure for another 5 minutes or so. If you do not have styptic powder at home, sometimes a little baking soda can do the trick. If the bleeding continues despite these measures, then I would go to the ER rather than wait.

If you do happen to find a nail that is very loose and dangling, then you can attempt to remove it at home.  It is important to have someone help restrain your pet safely while you gently try to remove the nearly broken off nail with a quick pull motion. Caution: only attempt removal if the nail is very loose!  Think “loose wiggly tooth” like when you were a kid. Also, be careful during your inspection or attempt to remove a loose nail as this can cause a sudden and unpleasant pain sensation in which some dogs may nip or bite in surprise.  If bleeding is noted following the removal, you can then use some gauze and light pressure, and/or Kwik Stop, as previously discussed.   

Lastly, there is the type of broken nail that would ideally be treated by a veterinarian.  These are nails that are cracked, continually painful, may be bleeding, and are still firmly attached. Treatment for these stubborn injured nails is typically some form of sedation with pain medication followed by cutting off the damaged nail just above the level of the crack. Sedation is needed because you are cutting through the very thick part of the nail with a live blood vessel and nerve, which is very painful. This is usually followed by styptic powder application and a bandage that is left in place for about 24 hours. The bandage promotes a day of rest so that a solid clot forms and the minor wound does not continue to bleed if it gets bumped on something. Although these types of injuries require professional care, it is something that can wait to be seen the following day if you are unable to get an immediate appointment with your veterinarian (unless your dog seems excessively painful, then I would not wait).

Whatever the type of nail injury, dogs are very good at keeping the area clean all on their own with licking, and antibiotics are not needed. A little licking is OK, and it is what a dog would do “in the wild” to keep it clean. With that being said, some of our babies get a little obsessed, and their good intentions can actually make the area more irritated by their constant worrying at it. Because of this, you should continue to monitor the area for any signs of redness, increased swelling, cloudy discharge, or increasing discomfort.  The development of these complications is rare in my experience, but if noted, then an e-collar, pain medications and possibly some antibiotics may be indicated. No matter what kind of damage has occurred to the nail, it will generally regrow normally in all but a few situations. Sometimes the nail will regrow with a slight curve or different pigment, but usually returns to its normal appearance over several months - kind of like when us humans lose a nail. 

As always, it is best to seek veterinary care if you are uncertain about the severity of any injury, but hopefully this may save you an unnecessary trip to the ER if this happens to your dog during a weekend while you are out having fun!

ASPCA Poison Control Center, 888-426-4435: 10 digits every dog owner should know!

A number of calls we receive in the ER are inquires about whether or not a substance is toxic to their pets. These inquires can include questions about specific pet or people medications, vitamins and supplements, both common and unusual household items, as well as various food stuffs.

With literally thousands of medications and oddities that our pets can get into, it becomes nearly impossible to know what is toxic, at what dose toxicity becomes a concern, and the treatment for each of these substances. Because of this, when we receive a call, we frequently refer pet parents to the Animal Poison Control Center for further information regarding the “dietary indiscretion.” This amazing service provided by the ASPCA is truly invaluable when there are questions or concerns about the potential for toxicity of any given substance. The center is staffed 24/7 by veterinary toxicologists who have at their disposal an expansive data base that includes every imaginable substance ever to have been known to meet a dogs mouth.

There is a nominal fee of $65 for this service, but a call might actually save you a trip to the ER or to your veterinarian, as well as give priceless peace of mind. When you call from home, you will actually be able to find out whether or not your pet needs medical attention, if you can induce vomiting at home (this becomes especially important for those people who live far away from veterinary care), or if you can potentially give some other home treatment. At the completion of the call, owners are given a case number that can be referenced again later should your pets condition change or clinical signs develop. If your pet does happen to need medical attention, once you arrive at the hospital for treatment, your veterinarian can call the center, also referencing this number, and can continue your pets care based on the toxicologist's recommendations.

This is truly priceless information, especially considering all the misinformation you can come across during a consult with Dr. Google. In fact, I have had to treat pets whose condition actually worsened because of an inappropriate treatment given at home. A situation that comes to mind was a good-intentioned owner who induced vomiting at home, based on what she read, after her dog ate Tide laundry detergent. Detergents can be very caustic (making vomiting a big no-no) and her dog subsequently suffered from erosive ulcers along the entire length of its esophagus as a result. Her pup required the placement of a feeding tube to bypass the esophagus, allowing it to heal. 

I would also like to add that part of our responsibility as veterinarians is to call back the toxicologist and report the response to treatment. This follow-up information continues to help others in the future as each toxic exposure, treatment and response to treatment gets added and stored in the ever-growing data base.

I cannot say enough good things about this invaluable pet resource. Every pet owner should have the ASPCA Poison Control number (888-426-4435) on their speed dial or refrigerator—this number may save your pets life as well as help other pets in the process.

Leptospirosis is a bacterial disease of great importance as it can affect both humans and animals, and can readily be spread from one species to another (i.e., from our dogs to us). For many years the occurrence in pets was rare, however, in the past few years, the disease has become diagnosed more frequently-I myself have treated four dogs suspected of having Leptospirosis just this past year. The disease is caused by a bacteria that is spread through the urine of infected animals into the soil and water where it can survive for up to 180 days, given the right conditions. Then, as other animals come in contact with this contaminated area, the bacteria can then be taken up through their skin and mucus membranes (gums, nose, eyes) or through drinking the contaminated water (another reason to stay clear of puddles!).  

There are several environmental factors conducive to letting this bacteria flourish and increase risk of exposure. Warm, moist environments favor this bacteria, and they especially love stagnant water. With that being said, Leptospira do need water or damp soils to survive, and they will rapidly die on dry surfaces. The density of animal population, such as kennels and urban settings, also increases urine contamination and thus exposure. Also, areas that are heavy populated with rodents or wildlife also increases risk; they serve as “innocent hosts” meaning they are not affected by disease, but they continue to spread it to the environment through urination.    

The clinical signs of disease can be vague and mimic many other disease processes.  Signs can include fever, lethargy, loss of appetite, muscle stiffness or soreness, or vomiting and diarrhea to name a few. If the liver is involved, a yellowish discoloration of the gums or whites of the eyes can also be observed. Because Leptospirosis can look like any other disease, confirming the infection is generally not an “ah ha!” diagnosis when your pet walks into the exam room. This is something I tend to diagnosis by a “second round of tests” when the initial blood work and urinalysis look suspicious for disease. What can raise a suspicion of a Leptospira infection is an elevation in both kidney and liver values and sometimes the white blood cell count. If this is observed, your veterinarian will then recommend a special blood and urine test be sent to an outside laboratory. These results can take several days, and so antibiotic treatment is often started prophylactically pending the confirming results.

Most infections are subclinical, which means no signs of disease will ever develop and your pet will never experience illness. However, if your pet does develop sudden signs of disease, and those signs appear severe, we generally give a guarded prognosis (50/50 chance of survival). If your pet becomes ill, the extent of care needed depends on the severity of disease, but in my personal experience, the treatment generally requires a hospital stay with extensive supportive therapy. Without treatment, Leptospirosis can lead to kidney failure, liver failure, and even death. Blood or plasma transfusions are sometimes needed if the body losses its ability to clot due to liver compromise. Yes: this can be one bad bug.  

So, how can you keep you and your pets safe? In addition to good sanitation practices and limiting your pets access to areas with standing water, there is a vaccine available. Vaccines contain what are known as “serovars,” which are “components” of the bacteria used to stimulate protection from disease. However, there is a catch. There are at least nine serovars, or strains, that can cause disease, yet the vaccine contains only a fraction of these, offering incomplete protection. Often people think their dog is safe from disease because it has been vaccinated, but sadly, this is not the case.  Additionally, immunity may only last 6-8 months, and some veterinarians recommended that you should vaccinate high-risk dogs (such as dogs who hunt, show dogs, dogs with access to lakes and ponds, and endemic areas) every 4-6 months. Vaccines do not come without risk, and the use of this vaccine with regards to risk vs. benefit is definitely a conversation to have with your veterinarian. Your veterinarian can assess your dog's risk of exposure, discuss the most common “local” serovars found in your specific area and can recommend a vaccine protocol that makes sense for your pet.