1356. TRUST & AUDIT CASE. 2 years of itchiness in a 6-year old Shih Tzu

I vaccinated this male Shih Tzu in 2006. "For the last 2 years, my dog has been scratching," the lady manager in her late 40s said to me as she order 24 cans of Z/D diet for her dog today, April 8, 2013 as her dog would not eat the dry Z/D by itself. She had bought them in Feb 23, 2013 to consult Dr Jason Teo, to get a repeat of the anti-fungal tablet and shampoo which was prescribed earlier on Jan 7, 2013 by Dr Daniel Sing. "My dog is now so much better. Only some scales on her back," she pointed to her own spinal area."

I retrieved the medical records to review the case. We had not seen this dog since April 2009. The owner had done various treatments of the skin diseases by herself using pet shop shampoos and other means. With no success.

In the first visit since 2009, on Jan 7, 2013, Dr Daniel wrote 2-year itch/hair loss. Appetite good. Diet: dry/canned food (potato/lamb). The dog was clipped bald, washed thoroughly. His ears were irrigated, anal glands expressed and teeth scaling was done. It was a major overall of the dog. Medication and anti-fungal shampoos were given for the owner to continue treatment.

"His hairs are growing," she said today.
"That's good news," I replied. "Many owners do not have such good success in the Shih Tzu's skin disease cases!"

The owner came just to buy the Z/D diet and did not bring the dog for a review as she is a busy manager in charge of sales of office machines.  It would be ideal to review the real dog but it is hard to insist on it. Skin diseases in the Shih Tzu are hard to treat and this was deemed by the owner to be a successful outcome.

"I don't think this is just Z/D or simply ringworm infection," I said to the owner. "It may be both. You have to control the itchiness of the paws and the elbows. Do you give dog treats?"

"Yes, I do," she said.
"Strictly on Z/D for 3 months as this is a food trial. Not even a piece of cake, bread or treat. Allergies may return."

It is best to get the dog down for a review of skin disease rather than buying Z/D diets. In this case, my belief is that the dog is now much less stressed since his ears and anal sacs are no longer itchy and painful. Many dogs use their hind legs to scratch their flanks when their ears are itchy but many owners assume the cause is skin infections of the flanks. Other dogs keep licking their anal area, scooter and bite their tails due to anal sac impaction, infection and pain but many owners are not aware of this anal sacculitis condition. Resolving these two problems do help in "curing" the skin disease in many dogs, in my observations.

If a dog does not have otitiis externa and anal sacculitis, he can be much relaxed and happier instead of trying to alleviate his irtchiness by licking and licking. The immune system become stable and his skin condition improves. Early skin disease treatment and review are best for the dog.  

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