Referral dermatology in canines and felines with atopic / allergic skin conditions yields good results but at what cost and using what technologies? All of them?
A typical dermatology referral:
The itchy dog with chronic red, itchy flakey skin goes to the referral dermatologist and undergoes testing for mange, ringworm, and allergies. These tests are almost always negative as they’ve already been ruled out by the referring vet. Allergy testing can be full of holes (not testing for everything, detecting antibodies without allergy*) and isn’t something to hang your hat on. That said: Pets usually end up on EVERYTHING the profession has to offer*.
Here’s a typical case:
The itchy dog with chronic red, itchy, infected, flaky skin:
- Cytopoint AND Apoquel
- Simplicef antibiotic
- Bathing in antibacterial/antifungal shampoo 2x weekly, on Monday and Thursday
- Rabbit-protein diet
- Doubling up flea control NexGard and Vectra (Vectra claims to have a side benefit to mange, is used “just in case”)
There is LITERALLY nothing else you can treat skin diseases with.
Dogs LITERALLY end up on EVERYTHING a person can treat their dog with, every day.
They are simultaneously treating all of:
- Ringworm
- Malasezzia Yeast
- Food Allergy
- Adverse Food Reaction,
- 2 kinds of Mange
- Bacterial infection
- Immune Dysregulation
– All at the same time, AND all the time.
I said all that to say THIS:
They get good results, and for good reason. They treat every known skin disease all at the same time.
So because of the predictable results, I think a Dermatology-referral is a Good Thing. I’m never in the way on those. There’s no sarcasm.
Question: Why send the dog or cat to someone else just to treat for literally everything?
Answer: I could NOT rest easily handling a case by treating every known skin disease at the same time, with everything on the shelf, all the time.
If we talk, and you’re interested in this, I’ll prescribe it. We will discuss the risks, the costs and the “overkill” it may or may not represent.
What Drives This in Referral Dermatology? Money? Lack of Integrity?
Absolutely NOT. It’s something honorable, but also, a ‘necessary evil’.
ACCOUNTABILITY.
- First, dermatologists have a tough audience. When they inherit a skin case they KNOW right-off-the-bat they have an armchair quarterback over their shoulder: The referring vet. The worst critic. Things need to be ‘by the book’, thorough, and unimpeachable. I get it.
- They can’t be wrong. As a referral specialist where: “Skin is literally all they do” – they can’t “miss something.” So their approach has to be thoroughly diagnostic to rule (literally) everything out, and then treat. Successfully.
- Results have to justify the price. Imagine seeing a dermatologist and spending funds like that, just to come home with the same results the regular vet got? I mean, in EVERYONE’S mind, including mine, if you’re going to the trouble and expense to see a referral dermatologist, GET RESULTS at (almost) any cost. Again, I’m not being sarcastic.
* If we talk, and you’re interested in this, I’ll prescribe it. We will discuss the risks, the costs and the “overkill” it may or may not represent. But the approach “covers ALL the bases” and there’s THAT alone, to recommend it. Why would I do this? Because it works and doesn’t the owner have a say in what we do, unless it’s flagrant malpractice?
.**
“False Positive” Results (click)
About 50-60 percent of all blood tests and skin tine tests will yield a “false positive” result. This means that the test shows positive even though the pet is not really allergic to the food being tested. These results occur for two reasons:
- The test may be measuring their response to undigested food proteins. It is possible that after digestion, the food protein that enters the bloodstream is no longer detected by the pet’s IgE.
- The test may be detecting proteins that are similar among foods but do not trigger allergic reactions. For example, if a dog is obviously reacting adversely to chicken, their tests may show a positive response to other members of the poultry family, even if eating turkey has never been a problem for them.
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