Removing barriers to relieving skin and ear problems

Understanding the top driver to your business is crucial in any field, and you likely know what it is

If you consider pet insurance claim data, skin issues—including those affecting ears—are the number one reasons people bring their pets to the veterinarian. Clients might be able to ignore other pet health concerns, such as periodontal disease, arthritis, colitis, or heart disease, as they’re less obvious and in your face. However, itching can quickly drive an owner nuts with the sound of ID tags jingling, the slurping, the sight of raw skin and/or scabs, the smells, and the near-constant scratching. And it’s often because dermatitis drives the owner crazy—more than driving the dog mad—that they find themselves at the veterinary hospital.

Understanding the top driver to your business is crucial in any field, and you likely know what it is. Yet, we also know the top barriers that prevent people whose pets have skin problems from coming to see us.

While I haven’t seen studies, in talking with hundreds of veterinarians over the years, ranging from general practitioners to boarded specialists, the top reasons are:

1) The pet owner decides, without any diagnostic testing, that food allergies are the culprit. And even though food allergies are rarely the primary cause, the client gets roped into expensive foods at pet stores. Sometimes they convince themselves the dietary changes have helped, and maybe now and then they do. But mostly the pet keeps suffering.

2) They trust their social media networks, Dr. Google, and retail salespeople who convince them one of a myriad of over-the-counter products ranging from supplements to shampoos to herbal rinses will do the trick.

3) This is a big one: They’ve taken this pet or a previous one to the veterinarian in the past, and the problem was never resolved.

For our own welfare, we can tackle all three of those obstacles. For the welfare of our patients, we must address them.

Educating the client is the first step

First, we have to communicate the pain and suffering pets experience as a result of skin and ear conditions. I recommend talking to pet owners about how they’ve felt in their own lives if they ever experienced severe itching from poison oak or ivy, a sunburn, or a bad case of athlete’s foot or eczema. Now ask them to imagine they have their dog’s skin condition. How long could they stand it without relief or a cure?

Second, we need them to understand the health consequences of untreated skin and ear conditions, including infection and hearing damage.

Third, we need to educate them about the improved diagnostic testing we have to help their pets, the powerfully more effective therapies (e.g. oclacitinib tablets) that can give their pet rapid relief, and how they can be part of a sustainable ongoing treatment plan. For many of your clients, those options are unknown, and it’s up to us to make them aware they’re available.

We also need to use the educational process to let them know atopic dermatitis, allergies, and other skin and ear issues are lifelong conditions. Manage their expectations from the beginning by letting them know what all the steps might be, from initial diagnostics to the first treatment steps, to referral to a veterinary dermatologist and beyond. Make sure they know something “not working” isn’t a failure or dead end; it’s information you can use to create a personalized treatment plan.

That’s not the whole story, however. As with many conditions, pet owners don’t follow through with repeat visits for dermatological problems because they don’t want their pets to be traumatized by experiencing fear, anxiety, and stress (FAS). The painful pet hurts at the clinic, the pet associates FAS with the veterinary staff and the hospital, and the owners don’t want to subject their pet to that suffering. That’s why Fear Free visits for skin cases are so important.

“I’ve been involved in veterinary medicine for 32 years, as a full-fledged veterinarian for 23 and veterinary dermatology specialist for the last 15,” says John C. Angus, DVM, Diplomate ACVD, a Fear Free Certified boarded veterinary dermatologist. “A few years back, I was lecturing in Las Vegas, coming on stage after Dr. Becker who was discussing fear, anxiety, and stress. I’m a dermatologist; we don’t have those things in practice, right? Turns out dermatology patients experience fear, anxiety, and stress just like the patients Marty sees. And while many animals can be put at ease by scratching where they itch, once pain enters the picture, the story changes.”

Dr. Angus has a special interest in ear pain. “There is a simple test for ear pain,” he explains. “If you rub the ear and they lean into your hand, they are pruritic; if they pull away, dodge, vocalize, or bite, they are painful. However, many dogs with otitis anticipate the pain on entry to the exam room and are already pulling away, vocalizing, and communicating ‘stay away’ the moment I pull out the otoscope and reach for the ear.”

By using muzzles and harsh restraint to complete otoscopic exams and in the face of the pet’s FAS, we end up reinforcing that negative emotional state. “So stop and take a moment,” he says. “Don’t think of the ear as your patient. Think of the patient. If a patient is in pain, do not force an otoscope into the ear, don’t force a swab, and don’t force a cleaning. Give the dog a treat, remember to use a gentle voice, and implement a solid pain management plan. Ear pain can be extreme, so multimodal pain protocols are appropriate. Reassess the patient two to three days later, use sedation or anesthesia, and the results will undoubtedly be much more rewarding.”

A rewards system

Not every pet is too painful for an exam, of course. “For dogs less painful, pruritic, or with normal ears, we should use simple rewards during ear exams to examine today and prepare patients for future visits. Start with showing the otoscope, give them a treat, pet the head, give them another treat, rub the pinna, treat, lift the pinna, treat, touch the opening to the canal with your finger, treat, touch otoscope to ear, treat, and so on.

“Life gets a lot easier for everybody involved, when you manage the patient as a patient, rather than an infected ear or a series of tasks to be performed before you send them home.”

Marty Becker, DVM, writes every other month for Veterinary Practice News. He is a Sandpoint, Idaho, practitioner and founder of the Fear Free initiative. For more information about Fear Free or to register for certification, go to fearfreepets.com. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News.

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