Common Diseases in Pets H-L

Idiopathic Thrombocytopenia (ITP) is a serious immune-mediated disease in the dog.  It is caused by self produced auto antibodies against the bodies platelets.  Platelets are needed in the coagulation process.

Platelets are crucial for primary hemostasis.  They originate in the bone marrow from cells known as megakaryocytes.  In the absence of platelets, severe internal bleeding can occur with skin bruising known as petequia or ecchymosis.  Life can not continue without platelets.  It is this lack of platelets that produce associated clinical signs.

Clinical signs associated with ITP are due to a decrease in active platelet numbers.  Internal bleeding and signs can occur anywhere.  Weakness & lethargy are commonly seen.  Bleeding may be noticed in the oral cavity as well as blood passed in the feces.  Animals bruise easily and that may be noticed over the animals body surface.  Visible bleeding may also occur in the eyes.

A CBC and Chemistry profile are always performed.  The platelet count is the most important piece of data.  Normal dogs have a platelet count of about 225,000.  Whenever that level reaches 20,000 bleeding will occur.  Other conditions such as parasitic (babesiosis, heartworm and ehrlichiosis) can cause a secondary ITP.  A tick born profile would than be recommended plus an occult heartworm test.

Diagnosis is made by the history and physical exam plus the presence of associated clinical signs.  A diagnosis is confirmed by a platelet count of below 20,000. 

Regardless of the cause of the ITP, almost all dogs will require a whole blood transfusion.  This contains red cells and platelets.  A low platelet count is life threatening.  If the cause of the ITP is infectious, antibiotics will be given.  If it is caused by a parasitic blood infection, the appropriate therapy is applied.  If the ITP is immune-mediated, animals will be treated with corticosteroids and azothioprine.  Other supportive measures such as intravenous fluids and feeding support are important.

Although ITP is a severe life threatening disease, the majority of dogs do well and lead normal happy lives.  Those dogs that respond to therapy the quickest often have the best prognosis.  The goal is to wean the animal off of all medications.  In the case of infectious or parasitic causes, the platelet count should return to normal after appropriate primary treatment.  Immune-mediated causes have a good prognosis also.  An attempt is made to wean the animals off of corticosteroids and or azathioprine.  Some dogs may relapse and require the same treatment.  Prognosis for those animals is good as long as the owners are ultra vigilant about any changes in the dogs day to day life plus frequent medical visits for examination and multiple repeats of a CBC.

Idiopathic Thrombocytopenia

Inflammatory Bowel Disease (IBD) is often lumped into a host of different diseases.  This presentation will attempt to put the issue into a more focal context.  IBD is usually associated with an immune-mediated response to “something” in the body or digestive tract.  That “something” might be a bacteria, virus, food allergy or parasite.  The actual cause is unknown.  It is a disease associated with the digestive system and is usually seen in middle to older dogs and cats. 

IBD is a chronic disease process of the intestinal tract.  The autoimmune reaction causes a thickening of the bowel mucosal tissues.  This alters its absorptive and motility properties.  This whole reaction is an intense local inflammatory response that disturbs the normal intestinal physiology.  Clinical signs seen are all based on this precept.

The most common clinical signs noted are:  the presence of loosely formed stools (even diarrhea), whole blood in the stool, associated weight loss and poor coat condition, fever, lethargy and tenesmus (straining to defecate).

A CBC and Chemistry profile are drawn to assess the animal’s body wellness.  An inflammatory response may be noted on the CBC plus albumin may be low due to the digestive losses of it and other proteins.  Radiographs utilizing contrast media, such as barium, or an ultrasound may show a thickening of the intestine in question.  Fecal exams are done to rule out intestinal parasites.  On a laparotomy, a biopsy of the intestine may be required for a definitive diagnosis.

Diagnosis can many times be difficult because strict IBD can mimic many other disease processes or causes of intestinal upset.  A diagnosis can be at least tentative by historical findings in a middle aged or older dog or cat, clinical signs and supporting blood work and radiographs.  An intestinal biopsy would be diagnostic.  Most people do not go that far so one can many times only suspect IBD and treat it.

Treatment of IBD rests on trying to treat the primary cause and provide supportive care.  The goal of any therapy is to allow the animal to gain weight. The immune-mediated situation is usually taken care of by corticosteroids.  Many patients also benefit from the oral administration of budesonide; a non-systemic glucocorticoid that acts locally without any negative side effects elsewhere.  Dogs are also put on numerous types of broad spectrum antibiotics to take care of bacterial overload.  Good possibilities are fenbendazole (Panacur®) and metronidazole (Flagyl®).  Sulfasalazine is often used if the clinical signs are in the colon.  Dietary changes may help.  Chicken and rice diets or facsimile or a hypoallergenic diet may be tried if a food allergy is suspect by blood testing.  Carafate may be given to coat and protect the intestinal mucosal surface.  Animals that are dehydrated will require fluids. 

The prognosis for most patients is good but IBD can not be cured but only controlled and it is highly likely that there will be relapses at times in both dogs and cats.  Over time, an individual will respond better to one therapeutic regimen over another.  If there is a relapse and glucocorticoids have already been used, azathioprine (Imuran®) should be attempted in the dog but NEVER in cats due to toxic metabolites produced in a cats liver.  This is due to the lack of an enzyme named gluconyl transferase.

Inflammatory Bowel Disease

The inguinal area of the dog or cat is the groin area.  An inguinal hernia is one where abdominal contents pass through the inguinal ring and canal and become entrapped.  Inguinal hernias can be congenital or acquired.

1.  Congenital:  This type of hernia is one that the animal is born with where genetics play a role.  The majority of these are seen in young animals being vaccinated or examined for the first time.  Most can occur on one side or the other and contain omentum (abdominal fat).  These are uncomplicated hernias.

2.  Acquired:  This type of hernia is produced by blunt trauma, pregnancy or obesity.  Many of these are complicated.  Regardless of the cause of the acquired hernia, intestinal loops, uterine horns and other viscera can be entrapped in the inguinal hernia.  This is a life threatening problem.

In an uncomplicated inguinal hernia, the only clinical sign is a small protrusion or swelling in the groin area on one or both sides of the body.  In a complicated inguinal hernia, fever, inflammation and a painful groin area, vomiting and anorexia are seen.

In all cases of inguinal hernias, radiographs are taken to figure out what is enclosed or entrapped in the hernia.  Intestinal loops are gas containing and easy to see.  Many cases of uterine horn displacement are in dogs along with their pregnancy and visibly seen.  The issue is how long the organs have been displaced.  Often that is not known so a complete CBC and Chemistry are done to assess general body condition.  An ultrasound may also be performed.

Diagnosis is made by the presence of a soft, fluctuant swelling over the inguinal area in dogs or cats.  Deciding whether it is uncomplicated or complicated is determined on lab work performed.

Treatment is always surgical.  It can be approached several ways.  In uncomplicated hernias, an incision is made over the hernia and the contents (usually omentum) are pushed back into the abdomen and the hernia is closed.  In complicated cases, it may also require a caudal mid line abdominal incision to pull the intestinal loops and or uterine body out of the hernia.  Tissue than is assessed for viability.  Many times, the intestinal loops are twisted and blood supply is curtailed.  These require a resection and anastomosis (putting back together).  Regardless of the inguinal hernia contents, it is CRUCIAL that the caudal part (posterior) of the ring NOT BE CLOSED.  This is where the femoral vessels pass through to the hindlimbs.  Doing so, will choke off arterial and return blood flow from the hindlimb to the heart via the caudal vena cava.

The prognosis for the majority of inguinal hernia repairs is excellent.  The more complicated ones where the animal is septic or extremely ill from distended intestinal loops or uterine horns, have a more guarded prognosis until the effects of surgery and antibiotic therapy take hold.

Inguinal Hernia

Kennel Cough is a severe respiratory disease in dogs.  It is caused by numerous pathogens but the most commonly diagnosed is caused by Bordetella bronchiseptica.  Parainfluenza is a viral cause of the disease and usually produces mild respiratory disease in dogs.  Kennel cough also goes under the name of tracheobronchitis.

Bordetella bronchiseptica is a gram negative bacterial organism that infects mainly young dogs or those that are immune compromised.  It is commonly seen in areas where animals are housed in close quarters or in direct contact with one another.  Examples are pet stores or shelters.  Both Bordetella bronchiseptica and parainfluenza are both transmitted to animals via nasal droplets or respiratory secretions.  Viruses can be transmitted on dust particles.  These are called fomites.

Clinical signs are always respiratory in nature.  Animals are anorexic, febrile and present with a hacky cough that sounds like a goose!  Many have eye secretions associated with conjunctivitis in both eyes.  They have difficulty breathing and many are presented with open mouth breathing or their forelimbs abducted making it easier to get air into their chest.  Some dogs have mild signs while others will be presented with bronchopneumonia with the entire bronchi and lung fields congested. 

Chest films are always performed initially and every day (to assess treatment) to check the severity of signs in the respiratory tract.  A CBC and Chemistry profile are drawn to assess white cell count and organ integrity.  The organisms can be cultured and isolated, if desired.

Diagnosis is made most of the time in a young animal from crowded conditions with associated clinical signs and or absence of parainfluenza or Bordetella vaccination.   Culturing the agent can also be diagnostic but most veterinarians base their diagnosis on the above.  Radiographs help instruct on the extent of the disease.

Treatment is based on the severity of clinical signs.  Many puppies start out with a mild cough or runny eyes.  These animals are usually treated with Clavamox® and Hycodan® syrup for cough.  Nebulization is recommended at home.  Many of these animals resolve but others get worse and need to be hospitalized.  This entails:  intravenous fluids and feeding, nebulization 4-5 times per day, treatment of the conjunctivitis with topical ophthalmic antibiotics and radiographs every day for clinical assessment.  Clavamox® and or Baytril® are usually the antibiotics of choice whether used separately or together for maximum bacteriocidal coverage.  Severe cough is controlled via parenteral butorphanol.  The latter also eases a lot of the chest pain associated with acute cough.  Once animals are breathing better with a clear lung field plus eating and drinking on their own, they are sent home on antibiotics, nebulizing supplies plus high caloric diets such as Hill’s® Prescription a/d.

The prognosis for the vast majority of clinical cases of kennel cough are quite good.  Tiny breeds such as Pomeranians or Toy Poodles with pneumonia are at a much greater risk due to their tiny lung fields. 

Kennel Cough really weakens an animal’s immune system.  Vaccination is important but the animal has to be built up first, otherwise the vaccine can do more harm than good.  All healthy animals should be placed back on a puppy vaccination program.  This program also includes vaccination for the common causes of kennel cough:  parainfluenza and Bordetella bronchiseptica.

Kennel Cough

Keratoconjunctivitis sicca also goes by the name of “dry eye”.  Tears are extremely important for eye functioning.  They clear the corneal surface of dust, debris and mucous plus also lubricates the eye and surrounding tissues to minimize friction when the eyelids blink or the third eyelid rises.  A deficiency in tear production in older animals is the most common cause of kerititis sicca in the dog.  Tear production decreases can be often congenital or immune mediated.  Medical induced KCS can be caused by the excision of the nicatating gland (cherry eye).  Other causes can be eye irritants.

When tear production decreases, lubrication of surrounding ocular tissues is affected; particularly the cornea.  The cornea can dry out and blinking can cause excessive friction and irritation.  Vessels in the white of the eye (sclera) are inflamed as well as the subconjunctival tissues.  Breed predisposition is always at play.  This condition is seen commonly in Pugs, Pekingese, English Bulldogs or any other breed with an exopthalmic (protruding) eye structure.

The most commonly seen signs are:  squinting of the eye, inflamed conjunctiva and vessels of the sclera, elevated third eyelid, presence of yellow, greenish mucous over the cornea and often the animal will paw at its eye trying to relieve the irritation.  Severe cases can lead to corneal ulcers with possible loss of vision in the affected eye.

The most important test to perform is the Schirmer Tear Test.  This is a dye impregnated strip that is inserted in the lower conjunctival sac that will monitor tear production.  Normal readings in the dog or cat are about 18-20.  Severe KCS produces reading in the 3-5 range and intermediate cases in the 8-16 range.

It is extremely important that the animal be screened for glaucoma at the same time by the use of a tonometer.  Many dogs will have both dry eye and glaucoma presented at the same time!

Diagnosis is made by historical findings plus a complete physical examen.  A Schirmer Tear Strip confirms the diagnosis.  Clinical signs also lead towards a tentative diagnosis.

KCS can be present in one eye or both eyes at the same time.  This is why both eyes are checked even though only one eye may be showing clinical signs.  The other may be normal or a bit behind the other eye in clinical signs.  Most treatments start with tear supplementation done 2-3 times per day.  The patient is than reevaluated via a Schirmer Tear Test strip.  If tear production has not been bumped up into normal ranges, 1% or 2% Cyclosporine drops are prescribed.  Cyclosporine is an immuno-suppressant  drug used in transplants and skin conditions but when applied to the eye, will stimulate tear production.  Once Schirmer strips are normal, medication is continued life long with periodic Schirmer Tear tests performed.

If a corneal ulcer is diagnosed via a fluoroscein stain, the ulcer must be treated with appropriate antibiotics and restained in two weeks to check for corneal healing.  All corneal ulcers heal from the outside in.

As long as there is no vision loss from an untreated corneal ulcer, most cases of KCS respond extremely well to medical care.  It can not be cured but controlled with medical care.

Keratoconjunctivitis Sicca

The kidneys are extremely important for mammalian life.  Their main function is to secrete urine which contains waste products (mainly urea) dissolved in water.  They also regulate sodium and water re-absorption (via ADH).  Urine is than passed through the ureters to the urinary bladder for storage.  When the micturition (urinating) urge arrives, the urine is voided to the outside.  Anything that upsets the apple cart will cause signs of renal disease.  Renal disease can be broken down into:  pre-renal, renal and post-renal.  Causes of renal failure are many.  Congenital, amyloidosis, bacterial, viral, toxins (anti-freeze), secondary to heart or liver failure are just a few of the causes.  Renal failure can be acute or chronic.

The kidneys depend upon a consistent and reliable blood flow to and through the organ.  This flow goes by the name of the Glomerular Filtration Rate (GFR).  When it is interrupted, problems arise:

1.  Pre-Renal Failure:  In this type there is a clinical disease before the kidneys.  This often includes heart, liver or circulatory issues.  Insufficient waste products are delivered to the kidney producing signs of kidney disease.

2.  Renal Failure:  This is when the anatomy and or physiology of the kidney is altered.  This prevents the normal production of urine leading to signs of kidney failure.

3.  Post-Renal Failure:  This type of failure is always below the kidneys and is produced by some obstructive disease of the lower urinary tract; either in the ureters, bladder or urethra.

In acute renal failure, damage to the kidneys is often minimal and will improve rapidly with appropriate medical care.  Dogs or cats with chronic renal failure are usually suffering from parenchymal damage to the kidney itself.  It barely functions.  Acute failure dogs will produce very little urine initially. This is a survival response.  In chronic failure the animals drinks excessive amounts of water and since kidney function is basically non-existent, produces urine concentration just a step above straight water.

Animals with renal failure are sick and I mean sick. They all have elevated Blood Urea levels.  Urea is a depressant of the Central Nervous System (brain).  Animals are sluggish, vomiting a yellow bile and have a characteristic halotosis associated with their renal failure.  They rarely have an appetite.  Animals may drink more water and urinate more.  There may be blood in the urine.  In severe cases, animals will be presented completely recumbent with typical Kussmaul respiration;  deep and labored.  These animals are extremely ill.

The most important tests are the CBC and Chemistry profile.  Renal patients may be anemic since the kidneys are unable to produce the hormone, erythropoietin.  This hormone stimulates the bone marrow to start manufacturing red cell precursors.  The chemistry will show electrolyte imbalances (sodium and potassium), elevated phosphate levels PLUS an elevation in the BUN and Creatinine.  Those tests determine renal function but the creatinine is the most important.  BUN can vary even in normal individuals. Animals fed a low protein diet will have a low BUN.  Regardless, these tests will be elevated when there is about 75% of renal tissue that is failing so therapy must be aggressive to save lives.  A urinalysis is important.  It will usually show a more dilute urine (normal is 1.025-1.030).  Urine strips will show high protein concentrate in the urine.  An ultrasound may be performed to visualize the form and structure of the kidneys.  A Urine Protein Creatinine Ratio (UPC) is important.  It will show if the animal is showing signs of glomerulonephritis.  The glomerulous is like a drain in a kitchen sink.  If debris is clogging the drain, water will not pass and will back up in the sink.  This is exactly what happens in glomerulonephritis which makes renal failure even worse.  In immune-mediated cases, antigen/antibody complexes “clog the drain”. 

A diagnosis of renal failure is made by a complete physical exam, history of clinical signs and particularly from the CBC and Chemistry profile.  Diagnostic imaging may also suggest renal failure.

Treatment of renal disease depends upon the type of renal failure and whether it is acute or chronic.  Many of these therapies will overlap in many circumstances.  The most important treatment is trying to get the renal tissue functioning again, making sure obstructions are relieved plus eliminating as much urea waste as fast as possible.  This involves intravenous fluids that are run at a relatively high rate without fluids backing up in the lungs.  Diuretics such as furosemide are given intravenously to produce more urine and out through a urinary catheter placed earlier.  Input/Output can be calculated by measure fluids in and fluids (urine) out.  Nutritional feeding can be performed by a esophageal or stomach tube.  All of these animals are vomiting and can not keep food down.  They need combinations of Cerenia® with famotidine to keep vomiting under control.  Urea not only depresses the CNS but is an extreme irritant of the mucosal lining of the intestinal tract.  If there is no vomiting, the animal can be given carafate liquid or tablets orally. Phosphate levels are quite high so phosphate binders such as Aluminum Hydroxide are administered via a tube or orally when the animal can keep basic foods down.  In acute failure dogs, animals respond reasonably quick.  When they are not vomiting, a bland diet is attempted such as chicken and rice or Hill’s® Prescription Canine k/d.  To make these diets more palatable; sprinkling them with some Nutrical® or tuna juice will make it more palatable. 

Many dogs with chronic renal failure will need off and on fluid support as well as phosphate binders and periodic injections of erythropoietin for bone marrow red cell precursors.  These dogs drink a lot and urinate a lot so a large bowl of fresh water should always be present.

Most pre-renal failures are treated the way mentioned above.  If there is concurrent heart or liver issues, those must also be addressed.  In cases of post-renal failure, the obstruction has to be relieved surgical or medically so that there is no impediment of the flow of urine to the outside.  In renal failure, what to do with the injured kidney varies with the cause.  With renal amyloid, the entire renal architecture is one big glob of muck.  Surgical excision is recommended.  In pyelonephritis the above therapy plus intravenous antibiotics may work.  In renal abscesses, an exterior drain or surgical removal may be necessary.  When one kidney is removed leaving a healthy one, this is a classical case of normal hypertrophy.  The remaining kidney enlarges taking on the physiological function of two.  That is why all mammals can live with just one functioning kidney.  Many of these animals will also undergo dialysis or abdominal lavage and drainage to control levels of urea. 

The prognosis for rapidly treated straight acute renal failure is very good be it pre-renal or post-renal.  The prognosis for renal failure due to tissue damage varies with the cause and treatment selected.  Chronic renal failure has a overall long term poor prognosis.  The animal becomes more debilitated over time with worsening renal functioning.  There comes a time when medical therapy does not work anymore.

Kidney Failure

Laryngitis is defined as inflammation of the larynx.  This is commonly known as the voice box and serves as a conduit for air entering and leaving the lungs plus preventing inhaled food and water into the lungs.

Laryngitis is often secondary to a respiratory infection.  It can also be caused by the inhalation of toxic fumes and smoke.  Trauma to the area can cause laryngitis.  Improper removal of endotracheal tubes after a surgical procedure can also cause the problem.

Laryngitis is the most severe in bracheocephalic dogs that have a short tortuous sinus cavity and a scrunched up flat head like an English Bulldog.  With any cause of laryngitis, the mucosal tissues lining the larynx become reddened, thickened and inflamed.  This leads to the production of mucous.  In severe cases, it can actually inhibit air from entering the lungs or at the least, a stenosis (narrowing) of the larynx.

The most commonly seen signs associated with laryngitis in the dog or cat is a dry, hacky cough.  Some animals may regurgitate some mucous or phlegm.  Dogs may have have a weird sounding bark.  This is seen all the time with cats where they squeak like a mouse.

A CBC and Chemistry Profile are performed in most cases to check the white cell count and organ functions.  Endoscopy is performed in severe cases to visualize the anatomy of the larynx.

A diagnosis of laryngitis is made on history and a physical exam.  Just touching the laryngeal area will elicit a severe cough in most animals.  Clinical signs and lab work will guide the veterinarian to a diagnosis.

Treatment varies with the severity and causal agent.  If it is secondary to a bacterial or viral infection, antibiotics, cough suppressants and nebulization will be provided.  That will take care of not only the primary cause but the associated laryngitis.  Animals are than put on a soft diet that is easy to swallow such as warmed up chicken and rice.  In more severe cases, diuretics may be given to dry out the laryngeal area making it easier to breathe.  Some animals warrant corticosteroids when a strong anti-inflammatory effect is needed.  In extreme cases where the larynx is closed a tracheostomy tube is inserted in the trachea just distal to the larynx.  As with any laryngeal disease, a harness should be used instead of a collar when walking the animal.

The prognosis for most basic cases of laryngitis is excellent.  If there are complications such as laryngeal stenosis or collapse, the prognosis is guarded until the airway issues are resolved.

Laryngitis

Leptospirosis is a disease caused by a bacterial spirochete that lives in areas with high rainfall and in the soil.  The most common pathogens causing the disease in dogs are:  Leptospira grippotyphosa and Leptospira pomona.  It is seen in dogs throughout the world but rarely seen in cats.  It is a zoonotic disease, meaning there is a possibility of it being transmitted to humans. A spirochete looks like a corkscrew.  Another disease causing spirochete is the one causing syphilis in humans;  Treponema pallidum.

Dogs that hunt and or spend the majority of their time outdoors are at a higher risk of getting leptospirosis.  The corkscrew shaped organism penetrates a scrape, cut or any other mucosal surface and reproduces in the kidney, nervous system and liver.  Where the infection goes from there, depends upon the animal’s individual immune system.  In many cases the animal self resolves by producing antibodies to the spirochete hence eliminating it from the blood.  If the liver is affected it can produce several hepatitis.  If the animal clears the bacteria, it can be a dangerous carrier of the disease.  Even though the fever and infection have cleared, the leptospira organism can still reproduce in the kidneys and be passed in the urine to another susceptible animal (dog).

Leptospirosis has a wide variety of clinical signs that can be associated with many diseases in the dog.  Fever, anorexia, lameness, weakness, hematuria, vomiting, diarrhea and depression can be seen amongst others.

A CBC and Chemistry profile are ordered since many body systems can be damaged by the organism.  A fluorescent antibody urine test is the lab test usually used to diagnose the disease.

If a veterinarian suspects leptospirosis in your pet, it is extremely important that he and or other veterinary personnel are protected from coming into contact with ANY secretion and that means:  urine, feces, vomit or diarrhea.  All exams are performed with gloves.  A diagnosis is made by obtaining a history of a dog exposed to the outdoors on a regular basis.  A little Maltese sitting on a couch all day is not going to get leptospirosis.  Clinical signs plus a positive titer to leptospirosis is diagnostic of the disease. 

Animals that are severely ill are hospitalized and given intravenous fluids and other supportive care.  Dogs that are not severely ill are put on antibiotics for a minimum of 4-8 weeks.  The most commonly used antibiotics to treat leptospirosis are the quinolones:  Baytril® or Zeniquin®.  As long as there is no major organ involvement, most animals do well. 

Prevention is the best bet.  Vaccination has been available for the most common causes (strains) of leptospirosis for years.  They are combined with other vaccines such as distemper or adenovirus or administered separately on a case by case basis.  All large dogs, hunting dogs or others that spend a lot of time in the outdoors should be vaccinated and boostered in a year, if an adult.  If it is a puppy, the animal is vaccinated for it monthly until a minimum age of 16 weeks has been reached; than vaccinated annually.  Even if a dog is vaccinated, keep it away from areas of standing water and wash your hands as a preventative.  Never come in contact with an animal’s urine.

The prognosis for most cases of leptospirosis is very good as long as there is no major organ involvement.  The dangerous part of this disease is the presence of untreated dogs that are carriers of the spirochete.  They can cause massive infections in susceptible animals that have not been vaccinated or those with a compromised immune system.

Leptospirosis

Lick granulomas may seem to be a simple thing to treat but they are not.  A lick granuloma is composed of scar tissue.  This is what a granuloma is.  It is a condition that produces scar tissue that is exacerbated by licking the area.  Suspected causes of lick granuloma are boredom, a persistent itch or separation anxiety produced by whatever stimuli.

A lick granuloma starts out as a small sore.  If the animal would leave it alone, it would heal in two seconds!  It does not!  Instead of healing in a primary way, it is never allowed to heal correctly due to the constant licking of the lesion.  This produces scar tissue that is extremely THICK.  It is always seen over the wrist joint of the animal on either forelimb or over the hock (tarsus) of the hindlimbs.  They seem to appear figuratively and literally overnight.

Clinical signs seen are the rapid presentation of a circular or oblong, inflamed lesion over the wrist or hock joint of the dog.  It is usually moist due to the constant licking of the lesion by the animal.  It is a psychological issue with the dog but it drives clients nuts particularly if the animal sleeps in bed with the owners.  All they hear all night is….slurp, slurp, slurp.  These lesions can become infected.

Most dogs with lick granulomas are not really sick.  If the lesion is infected a CBC may be drawn to check the white cell count.

Diagnosis of a lick granuloma is by the presentation of a dog with characteristic lesions over the hock or wrist joint that suddenly appeared.

Over the years, I have heard of and tried many remedies to beat lick granulomas.  I have tried injecting corticosteroids around the lesion.  That helps a bit but does not get rid of the lesion.  Owners have applied a sock and held it up with duct tape.  The dog chews off the sock.  Tabasco sauce, bitter apple, bitter orange have been applied with no luck.  Dogs actually love the taste of tabasco sauce.  Some owners, in jest, want the veterinarian to place the dog in a complete body cast.  The best way to treat these lesions, from my own experience, is using laser surgery.  This is called surgical ablation of the tissue.  With the laser in hand, the doctor goes back and forth, back and forth over the entire lick granuloma over and over.  The goal of this is to reach the nidus or irritating tissue way below the skin surface.  It heals well and the dog stops licking.  If the psychological issue is not resolved, the granuloma can pop up somewhere else in a month or so. 

The prognosis for lick granulomas treated with laser surgery is quite good but they can occur elsewhere.  Treating dogs with old remedies sometimes work.  I feel those worked not because of the treatment employed but the psychological status of the dog improved.  Improvement means it leaves the lesion alone to heal by itself. 

Lick Granuloma