Pet skin sagas: Managing emotional veterinary clients for better dermatology examinations

Dermatology cases can be frustrating: there's usually no quick fix, they can require considerable time and attention during the examination and talking to clients, and, perhaps worst of all, a cure is often rare. But as difficult as these cases can be for veterinarians, they're equally hard on the pet owners, who can feel helpless and ill-prepared to deal with their pet's itchy, painful skin. This is exactly why excellent communication and a thorough approach to obtaining a diagnosis is key.

It happened to me: A skin saga

My Border Collie-Pit Bull mix, Ike, had had some skin irritation and flare-ups before. But late last year, the skin on his belly and groin seemed to erupt overnight. Suddenly it was red and angry, hot to the touch and nearly hairless. His biting, licking and scratching was endless, and within two days the area was covered in pustules, scabs and other such crustiness. I was worried and upset over how uncomfortable he was.

Ike, in a rare moment of relaxation, during the worst of his dermatology woes.

After a one-two punch of steroids and antibiotics, things calmed down. But soon the same symptoms were back. I spent hours giving Ike long baths that required him to remain in the tub, covered in medicated shampoo for 10 minutes (you might imagine the success rate there). For eight straight weeks I brought him to my veterinarian, who diligently questioned everything about his diet, his environment, his behavior, what changes I'd seen, what I'd done when things got better, on and on. I made lists, I took notes; I was terrified I'd forget some minute detail that could have unlocked the entire mystery.

And yet it remained a mystery. On my veterinarian's recommendations, we continued his antibiotics course, changed his food and removed his dog beds from the house. Things were looking up, and finally he went the past two months without a single patch of redness on his belly. His leg-thumping, house-shaking, incessant scratching dropped to the occasional quick itch behind the ear. He flops carelessly on the floor, no longer treating his belly like it's radioactive.

Although we never quite arrived at a cut-and-dry diagnosis, it was invaluable to have my veterinarian's unwavering support and commitment to relieving Ike's pain and discomfort. She took time to explain why she was asking her questions-anything and everything could be a clue. With her guidance, I feel more in control and better prepared to handle Ike's skin issues in the future, and now that I understand the pain and frustration that goes along with dermatology issues, I'm even more committed to helping other pet owners find answers.

- Adrienne Wagner, content manager, dvm360.com

Dr. Ian Spiegel, DACVD, a board-certified dermatologist who practices in veterinary specialty centers in New Jersey and Pennsylvania, stresses the importance of gathering the most information possible by asking veterinary clients open-ended questions about:

> Type and duration of clinical signs

> Whether they occur year-round or seasonally

> Whether other pets or people in the house are affected

> Whether the pet has been responsive to treatment.

Need more structure than that? No problem. Download this free dermatology history form, to be completed in advance by the client (in the waiting room or perhaps even at home). The big advantage of a history form is that you now have all the information for every patient all in the same location in the record. Months later, if you need to look back to see how the client rated the dog's pruritus or whether other diets were tried, you'll know exactly where to find the information.

Dr. Andy Rollo, a Veterinary Economics Editorial Advisory Board member and an associate at Madison Veterinary Hospital in Madison Heights, Michigan, follows these important steps when making a diagnosis and focuses on communicating openly with the owners. “There are so many possible differentials-parasites, atopy, food allergies,” he says. “It's important to discuss the differences in signs with the owners and really enlist their help to get to a diagnosis.”

Click to download this handout for a better dermatology examination.

But how do you get clients to assist you in the diagnostic process? Easy! Have them read throughthis helpful handoutprior to their next dermatology exam. Here Dr. Rollo offers his tried-and-true tips to pet owners on how they can be best prepared to answer your questions.

Pets' skin conditions can turn into an emotional thing-see "It happened to me," right-and have the potential to drive an entire household a little crazy. If you have a pet owner who's on edge over a diagnosis or worried about managing a condition,point them to this handoutwith advice on keeping calm about pet's skin, plus Dr. Rollo's top four things owners should know about dermatology.

Give this handout to clients who are feeling panicked about their pets' skin.Taking time to work with pet owners on dermatology cases can be your ticket to a lifetime of compliance-as was the case with dvm360.com Content Manager Adrienne Wagner. "I was so impressed by my veterinarian's commitment to my dog during the worst of his skin problems. She was exhaustive and relentless in her approach, and when it finally cleared, she was as I excited as I was, which made me feel as though he got the best care possible."