Hot Spots In Dogs

Acute moist dermatitis or hot spots are a common skin condition in dogs with double coats such as Golden Retrievers and Bernese Mountain dogs. An inciting factor such as an insect bite, allergy, chemical burn or sticker irritates the skin. Then the dog licks, scratches and chews the area further inflaming it. The traumatized skin in combination with the moisture from licking gives bacteria a perfect place to grow. The infection makes the skin even more itchy causing the dog to lick, scratch and chew more until it develops a hot spot.

This is a hot spot on the neck of a dog was recently groomed.
This is a hot spot on the neck of a dog who was recently groomed.

Hot spots commonly occur on the checks, neck and thighs of dogs during period of hot and humid weather. Treatment starts with shaving the area to reveal the full extent of the dermatitis. I often start by numbing the area with a topical anesthetic. For some dogs, this won’t be enough and I will have to give them more medication to control pain as well as a tranquilizer before clipping. The infection causes a thick yellow tan discharge that sticks like glue. It can be difficult to remove because it gums up the clipper blades.  After the hair is removed, the area is cleaned thoroughly, rinsed and dried. It is important to treat this area of dermatitis as gently as possible. Blot to dry, never rub or use a blow drier set on cool if the dog will tolerate it.

Once the initial treatment is finished, the dog is sent home with the following:                                                                                                                               1) E-collar to prevent further licking.                                                                    2) Antibiotics to treat the infection.                                                                      3) Medication for pain relief. In mild cases, a topical numbing medication such as Dermacool is usually enough to keep the dog comfortable. In more severe cases, I add an oral pain medication as well.                                                                                                                                           4) Other treatments based on the inciting cause including steroids or antihistamines for allergies, flea and mite treatments.

With treatment, most hot spots heal in three to five days. If not, the dog needs further tests to rule out conditions such as deep pyoderma and ulceration caused by cancer.

Source:                                                                                                                           -Holm, Kristen. Acute Moist Dermatitis. Canine Associate, VIN, 2009.

You Make The Diagnosis: Abnormal Dog Nose

Pictured below is a close up of a dog’s nose. This dog had a black nose until it suddenly started to blister and peel. Eventually, all of the normal tissue was gone, leaving the dog with an open wound over the entire nose. With treatment, the condition improved to what is pictured below. What medical condition does this dog

Diagnosis: Discoid Lupus Erythematous (D.L.E.)

Lupus is an autoimmune disease in which the patient’s own immune system attacks free DNA. It most commonly affects the nose but I have also seen it on the ears and inside of the mouth. It is very common in collies which is why it has the nick name, ‘collie nose’.  Although this dog’s nose will never be completely normal again, treatment with doxycycline and fatty acids keeps him comfortable.

You Make The Diagnosis: Name This Itchy Skin Condition In Dogs

***Please Note: On June 25th, 2014, Dr. Nelson’s Veterinary Blog will be changing to the WordPress format. All of the blog posts can be found there but the comments were lost in the data migration. BUMMER! If you are a subscriber, please go to and re-subscribe. (This is the temporary address until 6/25/14 when it will be again.) I am sorry for the inconvenience. -Dr. Nelson***

Pictured below is a close up of an area of dermatitis on a dog’s neck. The dog was fine when his family left for work in the morning. When they returned, he had a raised patch of hairless skin on his neck right below his collar. The dog paced about rubbing his neck on anything he could find. He only stopped to scratch his neck. The nails on his back paw were covered with a sticky, smelly yellow material. Study the image then answer the following question: What is this condition?

Diagnosis: Hot Spot (Acute Moist Dermatitis)

Hot spots are areas of moist dermatitis that are extremely uncomfortable for the dog. They usually occur in breeds with double coats such as Golden Retrievers, Great Pyrenees and Bernese Mountain Dogs. My patients seem to experience them in the summer, when the heat and humidity are high. 

Hot spots can be caused by a number of things including fleas, allergies, mites and lice. Basically, anything that irritates the skin can cause a hot spot. Once the skin is irritated, bacteria move in and cause an infection. The dog scratches the area causing it to grow rapidly. 

If your dog has a hot spot, please seek veterinary care right away. This is a painful condition that needs aggressive treatment.   

Special Needs Kitty Seeks A Home

Several weeks ago, I performed surgery on a kitty named Ghostly after she sustained serious injuries from a car’s fan belt. The cat was inside the engine when it was started. Two good Samaritans saw her run from the car leaving a trail of blood behind her. They searched and searched knowing her injuries she might die without medical care.

A week later, they found her lying under a bush. Her left back leg dangled lifelessly from her body.  A thick scab covered what remained of her left eye. She purred all the way the veterinary hospital. Physical exam revealed that Ghostly has lost her left eye.  X-rays of her leg revealed multiple fractures with pockets of gas. The next day, I amputated her left leg at the knee and cleaned out her left eye socket. Ghostly did remarkably well after her surgery. She learned to walk on three legs right away and didn’t seem bothered by losing one eye. Now, this sweet girl needs a forever home.

ghost 039 (659x645)

Ghostly did remarkably well after her surgery. She learned to walk on three legs right away and didn’t seem bothered by losing one eye. Now, this sweet girl needs a forever home.

ghost 022 (800x486)

Even though she is missing her left eye and back leg, she still gets around without any problems. As you can tell from the images, she is a beautiful cat. She is very loving as well.  Now I ask for your help in finding this  kitty a home. If you or someone you know would like to adopt Ghostly, please contact me though the blog. Thank you!

Ghostly two weeks after her surgery.
This girl loves attention!

Treatment of Valley Fever in Dogs

***Please Note: On June 25th, 2014, Dr. Nelson’s Veterinary Blog will be changing to the WordPress format. All of the blog posts can be found there but the comments were lost in the data migration. BUMMER! If you are a subscriber, please go to and re-subscribe. (This is the temporary address until 6/25/14 when it will be again.) I am sorry for the inconvenience. -Dr. Nelson***

Once a diagnosis of valley fever has been made, treatment with fluconazole is started. Fluconazole is an anti-fugal medication that targets the membrane of susceptible fungi including Candida, Cryptococcus, Histoplasma, Coccidioides and Blastomyces. It penetrates tissue much better than its predecessor, ketoconazole. Fluconazole is excreted through the kidneys. Adverse reactions include vomiting, diarrhea and nausea. In rare cases, liver toxicity, skin reactions and decreased platelets have been reported. Most dogs with valley fever will need months of treatment with fluconazole. I recommend regular blood tests to monitor liver and kidney function as well as platelet levels.

Other medications that can be used for valley fever include ketoconazole, itraconazole and amphotericin B. I rarely use these medications because fluconazole works well with the fewest unwanted side effects.

-Brooks, Wendy. Valley Fever (Coccidioidomycosis), The Pet Health Library, VIN Published 9/26/07 and reviewed in 12/1/09.
-Plumb, Donald. Veterinary Drug Handbook, 4th Edition, Iowa State Press.

Diagnosis of Valley Fever in Pets

Blood testing is the most common method used to diagnose Valley Fever. A sample of the pet’s blood is sent to the lab.  They look for the presence of antibodies for Valley Fever. If antibodies are present, the lab will then perform a titer test which involves diluting the sample to determine the amount of antibodies which are present. Unfortunately, the titer test is not perfect. It must be interpreted based on other factors. Here’s my general rule for interpreting valley fever titers:

1) No titer – If the lab reports there were no antibodies present it can mean one of three things. a. The pet does not have the disease. b. The pet has the disease but is unable to generate an immune response because it is immunosuppressed. c. The pet hasn’t had the disease long enough to mount an antibody response. That’s why I often recommend rechecking another titer in a few weeks if the pet’s clinical signs fit with Valley Fever.

2) Low titer – People and animals who live in the Sonoran Desert are exposed to the spores all the time. It is common for them to have low titers to Valley Fever. These are referred to as ‘background’ titers. The problem is differentiating a background titer from one that is rising. Again, if the pet’s clinical signs make me suspicious of Valley Fever, I retest these animals at a later date.

3) High titer – A high titer with clinical signs makes the diagnosis easy.  

In addition to blood work, X-rays are often helpful in diagnosing Valley Fever. In the lungs, I often seen signs of pneumonia early in the disease. In more chronic cases, circular lesions called granulomas appear. These white lumps are often confused with tumor metastases. Granulomas may appear anywhere in the body. If it is possible to aspirate a granuloma, the diagnosis is made after seeing the organism in the debris.

-Brooks, Wendy. Valley Fever (Coccidioidomycosis), The Pet Health Library, VIN Published 9/26/07 and reviewed in 12/1/09.

National Cancer Survivors Day

Congratulations to all my fellow cancer survivors!  This past Saturday, I had the honor of serving as the keynote speaker for National Cancer Survivors Day at Scottsdale Healthcare.  What made the event incredibly special is that over three years post chemo, several of my nurses were in the audience.  The care they provided and the love I felt again this past Saturday is hard to put into words.

For all the medical professionals who work to give us life and hope, thank you barely captures my gratitude.  To those who survive and thrive following cancer, congratulations and please make each day count.  Finally, for those who lost the fight, I pray for you and hope you knew love and support during the battle.

Animal therapy helped me a great deal both at home and in the hospital.  The hospital security dogs were frequent visitors – thanks Kaos & Athos!  At home, my cats, dog and birds brought comfort during four long months of chemo.  That’s why it was so great to have Pets On Wheels of Scottsdale there this Saturday during my presentation.  So many patients benefit from your pet therapy and on behalf of all of them, please accept my appreciation.

Thank you again to everyone at Scottsdale Healthcare for the extraordinary support, care and medical skill you brought to my double hit lymphoma.  For more on my own experience through this journey please see earlier posts on the topic.

With love for all human and animal survivors of cancer,

Dr. Kristen L. Nelson   

Seattle Pacific University

I am a proud graduate of Seattle Pacific University.  So today’s tragedy is especially sad.  I spent many hours in the building where the shooting occurred.  It is the science building where I had many biology, chemistry and math courses.  We called it “The SLC” for Science Learning Center.  As someone who spent considerable time both on campus and in that building, my heart breaks for the loss of life and for all who are effected by this senseless act.

Please know I am praying for all of you.  I deeply hope our shared faith brings comfort at this difficult time.  

Clinical Signs of Valley Fever in Animals

Valley Fever is a fungal disease caused by the organism Coccidioides immitis. This organism lives in the dry alkaline soil which is found in the Sonoran desert areas of the southwestern U.S. It is also found in Central America and the Middle East. When the soil is disturbed from building, gardening or strong winds, spores are released into the air. The disease is transmitted by inhalation of the spores, not by contact. Valley Fever was originally diagnosed in a group of farm workers in the San Juaquin Valley of California.

A few weeks ago, the Phoenix area experienced strong winds that lasted several days. Now, I am seeing a spike in Valley Fever cases in dogs. One of the newly diagnosed cases was in my own dog! A week ago, he came to me in the middle of the night. He was shaking and holding his neck in a strange position. When I tried to move it, he yelped. I gave him some medication for pain and then held him until he fell asleep. Three days later, a blood test confirmed the diagnosis of coccidioidomycosis (Valley Fever). 

Clinical signs of Valley Fever vary greatly. Most exposed animals and people get mild flu-like symptoms of aches, chills and a dry cough which resolve after a few days. Forty percent of the exposed animals and people become sick. The fungus can settle anywhere in the body. In humans, the lungs are the most common site. In dogs, I have seen Valley Fever affect almost every organ in the body. Here is a list of the more common sites I see in dogs:

1) Lungs causing pneumonia characterized coughing.
2) Brain causing seizures.
3) Bone and joints causing lameness and arthritis.
4) Eyes causing anterior uveitis.
5) Spinal cord causing pain and problems walking.
6) Internal organs such as liver and kidney. Blood work reveals elevated enzymes associated with the affected organ.

Since most of the cats in my area are kept indoors, I rarely see Valley Fever in this species. When I do, the cat usually presents with fever, weight loss and a skin lesion.

When I started practicing in Arizona, a wise veterinarian told me, “If a pet sneezes, check it for Valley Fever.” It was great advice!

-Brooks, Wendy. Valley Fever (Coccidioidomycosis), The Pet Health Library, VIN Published 9/26/07 and reviewed in 12/1/09.

Bite Wounds in Dogs

Bite wounds in dogs remind me of icebergs because the damage beneath the skin if often much worse than the surface damage. During a bite, the teeth are inserted below the dermis (skin), then two things can happen. First, the teeth can sink deep into the underlying tissue causing damage and injecting bacteria from the mouth. Second, if the biter twists their head while the teeth are inserted, the skin is ripped off the underlying muscle and bone leaving a pocket. If this pocket is not drained, a horrible abscess can form. Whenever I see bite wounds, I always probe the puncture wounds for pockets. If a pocket is greater than an inch, I put a drain in to prevent infection.

The biggest mistake people make is to look at the small puncture wounds and assume that is the extend of the damage. As the following images demonstrate, the superficial wounds do not indicate how much damage rests beneath the skin. Look at the first image and note the two puncture wounds.

Now l have inserted a cotton swab beneath the skin to demonstrate how much damage occurred. The tongue depressor is positioned at the end of the pocket.

To treat this condition, I inserted a drain to prevent an infection. The drain is the tan colored rubber tube sticking out of the skin.

After three days of antibiotics and medication to control pain, the drain was removed. The dog finished its medications and made a complete recovery.