Ruffly Speaking

When my Dane Tess was a maybe ten months old, I noticed her licking her flank a little too much.

I checked and there was a very small red patch on the skin of her belly, right where the hair ended on her naked little puppy tummy (yes, she weighed about 100 lb by then, but Danes have cute little puppy tummies anyway. They're just the size of a dinner plate).

I didn't think much about it but checked it again a few days later. The rash had doubled in size. And that began six months of fighting what became known in our house as "Tess's Itch."

As soon as I saw it spreading, I took her to the vet in town. He thought it was a minor issue I'll call A. He gave her medication for A. Medication A seemed completely ineffective. Back we went. He still thought it was A and I just wasn't doing the meds correctly.

When the Itch took over half her belly, I took her to the second vet in town. The second vet said no, of course it's not A, it's B. Here's a medication for B. Medication B put black flecks all over her skin but the Itch continued unabated.

I called the holistic vet a half-hour away and made an appointment. Holistic vet said it needed C and D. Combined medications B, C, and D, and now the Itch completely covered the hairless skin and was climbing its way up toward her legs and vulva.

By this point I was well and truly freaking out; it had been months of the Itch laughing at any medication or combination thereof. Nobody seemed to know what it was, though they were all very sure they knew, and the poor dog was miserable. So I packed her up and took her three hours away to vet D, who had a board certification in Itch.

Vet D took one look, said "Here, give her this vitamin for two weeks." I thought good grief, where are the antibiotics, the prednisone, the probiotics, all the stuff I'd been giving her for six months?

I paid my $300 for the consult and the vitamin and drove three hours home. Gave her the vitamin and, I kid you not, she slept through the night for the first time in six months. Twelve hours later the redness was pink. Three days later we were back down to the tiny patch of original rash. In a week it was gone.

Tess went on to live (and still lives) a wonderful life and never had a recurrence of the Itch. I still have no idea what the Itch was, if it even had a name. All these years later I have never seen it again on any dog. It was (for those of you familiar with skin stuff) like a truly terrible juvenile pyoderma that got colonized by yeast/staph. But it didn't respond to pred or keflex. Skin scrapings were negative. What I remember was that the vitamin had b-complex. So maybe it was an immune deficiency, comparable to mange? I don't think I'll ever know.

That experience was tremendously valuable to me because that dog was failed by THREE vets. I don't think they were bad vets or dumb people; they just didn't know what she had, and weren't particularly interested in digging any deeper than telling me that I wasn't giving the meds correctly. None of them advised me to escalate her issue to a specialist or gave me any more options than "She has this; give her this."

It made me a much better consumer of veterinary care, and ever since I have insisted on a much more questioning role as I asked for a vet's opinion. Here are a few things I learned, some through personal experience and some from the great advice of good friends, and have been a huge part of getting good care for my dogs.

- Vets are not magic. They are just people who went to grad school. Having been to grad school myself, I can tell you that there are people there who are good, kind, caring and intense people. And there are some who shouldn't be allowed to drive a car, much less practice medicine on your dog. If you have a bad feeling, obey it. Virtually any vet is going to be good enough to diagnose a broken bone, stitch up a cut, and give you antibiotics. Their competence, as a group, gets lower and lower as your dog's problem becomes rarer or more complex. Some have the imagination and the drive to tease out a problem, or the commitment to stay up to date on changing practices; others do not.

- Know your breed. There are hundreds of breeds with very specific issues and requirements and no vet could possibly keep up with the nuances of every single one. If you own a Dane, know about anesthesia reactions and DIC and Addison's disease. If you own a Dalmatian, know about the symptoms of uric acid issues. If you own a breed with copper storage diseases, you need to become familiar with the symptoms and if your dog starts losing weight you need to insist on the testing even if your vet says "Oh, he's probably just been running around a lot; feed him more and let's worm him." Ninety-nine percent of all dogs your vet sees who have weight loss need worming and to be fed more. It's not dumb of your vet to hear hoofbeats and suspect horses and not zebras. But every breed has a few zebras and it's your job to keep them in mind.

- Know the difference between best practices and what has been done to improve compliance. "Compliance" is medico for "Those idiots never show up or do it right." There is an institutionalized mistrust of any owner (or parent, or caretaker, or individual) when they promise to come back to get the next series of shots or the next batch of medication or to dose more than twice a day or to apply something correctly.

The reason that vaccines are combined instead of being given individually has absolutely nothing to do with health; in fact, the combination vaccines are much more immunosuppressive than single vaccines and provide lower levels of protection than single vaccines. They're combined purely because the industry is convinced that no owner will show up for six shots.

Antibiotic regimens are geared to twice a day at the most and the push is toward once a day, even if the effectiveness of the medication is not as great. Revolution isn't more effective OR safer than giving Heartgard + Nemex + Frontline; it's just more convenient.

You need to know this, and a standard question to your vet should be "Is this the best/gentlest/most effective treatment? I would be happy to do a three-times-a-day medication/clean it more frequently/come back next week/spend a little more."

- Distinguish between actions that benefit your dog and actions that benefit "society." Neutering is the major example of this. Neutering is actually harmful to the individual dog, but even if your vet knows and believes this they will often push for it because of the problem of unwanted puppies.

Kennel cough vaccines are another – KC is almost always harmless; the vaccine is given to try to prevent outbreaks that can be harmful to the few dogs would who get super sick from the bacteria. It's up to you to do enough research to understand the impact on or benefit of those certain decisions and, where you feel it's important, put your dog above the herd.

- You are your dog's best advocate. Even if you flew out to LA to see the world's top authority on toenail fungus, there is one thing that he's not an expert in, and that's YOUR DOG. If you "just know" something is wrong, don't let anyone ignore you. If you're uncomfortable with a treatment, research it and then be obnoxious about questioning it.

If you think that a different medication should be considered, tell the vet that. Don't say "Well, she didn't mention it, so I'm sure she doesn't think it's the right choice." She could have forgotten, she could have never considered it, she could have had bad tuna for lunch and barely be making it through the afternoon. The worst thing that's going to happen to you is that you feel embarrassed. The best thing that's going to happen is that you save your dog's life.

- Never be afraid to research. If you take ten hours to read fifty studies on pemphigus, congratulations, you are now more educated on pemphigus than the vast majority of vets out there. And, again, that's not a criticism of vets. There's simply no way for them to be on the cutting edge of every rare or unusual disease and how that rare or unusual disease may manifest in your breed as opposed to another breed. The more of an expert you can become, the better you'll be able to partner with your vet in coming up with the best solutions for your dog. And research doesn't just mean studies; seek out experienced breeders or other vets or even human doctors. The more ways you can find of attacking the problem the better.

- Escalate to specialists. I LOVE my vet; she's the best vet we've ever had in a lot of years of owning dogs and a LOT of vets. But if I think that one of my dogs may have an autoimmune disorder, a complicated fracture, a tendon tear, a heart murmur, or an eye disease, I run them in to her to make sure I'm not imagining things and then I call Tufts. I will choke on the money but it's going to be less than it would be for me to dither around trying stuff that doesn't work. My vet may see dilated cardiomyopathy twice in a career; the specialist at Tufts sees it twice a week. Because his department, or for the orthopedists, or for the immunologists, do not have to also take on general medicine cases, they stay on the bleeding edge of diagnosis and treatment and they don't need to try a treatment out or experiment to get the right dose.

- Never be intimidated. There is nothing that is more infuriating to me than a vet who thinks that the way to get me to stop asking questions is to scare me. For example, one time when I refused a leptospirosis vaccine that a vet wanted to give as part of the puppy shots, the vet said "OK, but you're risking liver failure; if you're all right with that, I won't give the vaccine."

I smiled and said thank you, but we never went back.

If a vet gives me a balanced picture – Lepto is a very serious disease, though rare; it has the highest incidence of fatal vaccine reactions; it needs to be given every six months to be effective – I can make a good decision. By basically telling me that not giving a vaccine I was wishing liver failure on my poor innocent puppy, she lost my respect immediately.

I don't want you to ever think I am anti-vet. I am most vehemently PRO-vet. I also know that every vet has people come in there and say "Hey, I read this on the Internet…" and they have to hold their breath and work really hard not to roll their eyes to the ceiling. But you must know this: There is only one person standing between your dog and that waterfall. And it's not your vet; it's you.