The itchy dog and the caregiver's burden

Kicking off her lecture, Natalie Marks, DVM, CVJ, CCFP, Elite FFC-V, shared the story of her "heart dog" Samantha. When her son Evan was young, he and the family dog both went to grab a toy, and the dog accidentally hurt him. Because of this incident, Evan developed a fear of dogs, leading him to therapy and desensitization.

One day, the local shelter sent out an email about an adoption event and Marks invited her son to go along to meet one of the dogs in the email—Samantha. At the event, Samantha immediately walked right up to her Evan and put her paws on his legs. Evan picked her up and announced she was coming home with them, beginning Samantha’s journey in the Marks family. Evan and Samantha became joined at the hip; whatever one felt impacted the other. Marks shared that when Samantha was itchy, her son was upset, which inspired her to present this lecture and gave her a new perspective on clients with an itchy pet.

“I have, through this experience, created this very different viewpoint on what families go through with allergic dogs. I used to be like...give me a bleeding spleen, give me something exciting and sexy. Oh, it's an itchy dog? Great. I didn't realize the impact truly that it has on families until I had one this bad,” Marks expressed.

“I want to give you this story, so that if you are already an dermatology lover, you understand this burden. But if you're sort of like, 'Dermatology, I guess I could go and learn about this,' think about [how] every one of you have Evan in your practice, and every one of you has [a pet] close to Samantha at your practice...Everybody has a pet parent where this impacts them greatly,” she said.

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During her lecture—The practical canine allergic patient workup: Who has time for everything else?—Marks discusses ways to use your time in the exam room with patients to help get their pets the relief they need and help the clients regain some peace.

In the exam room

If you are lucky, you may be able to witness the itching firsthand in the exam room. If not, Marks told attendees to have their clients take videos and bring them in. She explained that this is not only to see the intensity of the itch but could help identify if the problem is something else, such as an itch that can be a seizure. Another example she provided is when Cavaliers comes into the clinic and their owner complains that the dog is itching its ears. They are doing syringomyelia movements to cervical pain, making it a neurology case, not dermatology.

Marks said: “[A] couple of things I want you to do in the exam room: First look for the dog to be itching. Where is the dog itching? What's the intensity? Because you're going to ask that client on a 1 to 10 scale...You'd be surprised at how many clients are going to be like, 'Oh my God, it's 27'...Or you ask one partner, they might say a 10, and the other partner says a 3.”

To make these appointments even more efficient, Marks encouraged the audience to get a shower caddy and fill them with things needed for the dermatology exam, including a laminated checklist. This can stop staff from running in and out of the room, which can cause stress and anxiety in patients.

For a first-time itchy dog, or one that presents only once or twice a year, Marks suggested abbreviating the usual 5-step diagnostic approach in favor of 3 steps, to save time and help keep the patient comfortable.

“The first thing we always do is stop the itch. We need those dogs comfortable, not just for [them], but also so those pet parents keep going with us. Then the only 2 things we have to do are rule out parasites or yeast or bacteria, and treat them. That's it. So if we have...those chronic cases that are repeat offenders, then we need to move on to our food trial, and then we finally get atopy,” Marks explained.

Marks also warned that even though there are a lot of atopic dermatitis patients out there, veterinary professionals need to break the habit of going straight to atopy with these itchy patients. Infectious, parasite, food allergies, and other causes need to be ruled out prior to atopy diagnoses, so she said don’t start at atopy and work backward, work up to atopy.

Takeaway

An itchy pet is a burden for everyone, not just the animal. By being efficient and remembering the human-animal bond, clinicians can help treat their patients and alleviate the stress on pet parents—ultimately fostering trust, reducing anxiety, and improving the overall quality of life for both pets and their families.

Reference

Marks N. The practical canine allergic patient workup: Who has time for everything else? Presented at: Fetch dvm360 Conference; March 14-16, 2025. Charlotte, NC.