Here in 2014, this is what Maddie's front left paw looked like at the start of the lick granuloma. This wasn't caused form an injury, thorn or bug bite. It was from nervous, habitual licking.
She did the topical and oral antibiotics and the Elizabethan Collar. Maddie also had a little OCD during the non-hunting season which is very typical for hunting dogs that are used to having an outlet for their energy while hunting, but then become very neurotic during the off-season. She was put on fluoxetine (Prozac)...but the veterinarian wasn't too clear with my parents on how Prozac should be taken. Anti-depressants for dogs that have OCD licking habits are actually very effective when taken appropriately. Anti-depressants are very different than most drugs. You can take ibuprofen and feel the effects within 30-45 minutes. Anti-depressant, however, do not really start having an effect until 2-4 weeks of having taken it every day, and the full effects might not be realized until 4-8 weeks of having taken the drug consistently. Also, the drug can not be abruptly stopped as the anxiety, OCD symptoms will come back, and a lot of times worse. Because Maddie wasn't taking the Prozac appropriately, this is what her foot looked like after a few weeks:
This lick granuloma spread viciously as you can see, and thickened dramatically. It was at this point that the vet suggested laser treatment, and I believe some nerve endings were cauterized to decrease the sensation in the spot (in theory, dopamine won't be released from the brain because the nerves will not sense the licking which triggers the dopamine). After laser treatment and a few weeks of wearing the e-collar, here's what Maddie's leg looked like at the start of the hunting season in 2014.
Week 1: Vixie has an acral lick granuloma on her front right paw that I've been treating for a week now. I first noticed it as a small red, beefy hard nodule that was not painful or tender to the touch and also did not have fluid in it (see first picture below...its not her leg but found this picture that most closely resembled what it looked like at first).
I took her to the vet the first day I noticed it and he gave me this diagnosis. Relieved to hear it was not cancerous I was not so relieved to know the work I have in store for myself to keep this from spreading and becoming a nightmare as we experienced with Maddie a few years back.
The vet started her on Keflex 500 mg orally 2x per day for 10 days. This is a common, broad-spectrum antibiotic used for skin infections. Vixie has never had this antibiotic before so I gave it to her when I knew I'd be able to monitor her for the next few hours (in case of allergic reaction). The vet also wanted me to put topical antibiotic (Neosporin, Bacitracin, etc) on the wound and then either cover it or put an Elizabethan collar on her. Vixie is one dog that holds the biggest grudges in the world and I knew she wouldn't look at me for days if I put that collar on her. So I've opted to wrap it and see how she does but if she started chewing the bandage up, I would have no other choice. I also asked the vet about topical steroids as I work in dermatology and for our granuloma annulare patients we use topical steroids to shrink the lesion after a course of antibiotics. The vet said that I could do that and that would decrease the inflammation and itching, but I would have to make sure she did not lick it because your pet will be ingesting steroids (that's not good). After a few days of just topical Neosporin, I started mixing the Neosporin with Hydrocortisone 1% (that's over the counter) and then wrapping the wound up (see second picture below).
After one week of this regimen, this is what her granuloma looks like now:
You can see that the redness has gone down significantly and that it is starting to flatten out and shrink a little bit. After she finishes the oral antibiotics I will only put the topical steroid on. I'm applying the Neosporin/Hydrocortisone onto the lesion 2x per day. I will only do this for about two weeks and reassess the lesion as you never want to use topical steroids on any one spot for long periods of time. Topical steroids thin the skin. Hydrocortisone is the weakest topical steroid you can use, but I don't like to take chances. I also want to note that Vixie is getting a 1/2 cup of natural yogurt per day while she is on the antibiotics as these kill that natural flora in the GI tract and yogurt restores them (thus preventing GI upset). Vixie isn't too impressed with the treatment regimen, but it seems to be working.
Check back in a week for week 2 progress!
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