Italian Greyhound Skin Cancer or Infection or Autoimmune Pemphigus In the Ear?

February 2013 UPDATE BELOW.  We took Marty, our little eight year old Italian greyhound Angel,  to the vet today because of several skin lesions that showed up on his ear during the course of the last week.  As an internist, I had my own differential diagnosis running through my mind. Marty's lesion started as one solitary pearly bordered lesion.  I thought for sure  it was a basal cell cancer when Mrs Happy first pointed it out to me.

Iggys are prone to skin cancer and other conditions such as hypoglycemia, seizures and broken bones.  Over the course of the week, he got two more spots in his ear as well as several hot spots on his legs and back.  This isn't a classic skin cancer presentation.  I wasn't sure what was going on.   Was the vet going to freeze these things off?  Was Marty going to be a cancer survivor?  I'd never lived with a cancer survivor.  How was he going to take it?  Would he ever be the same?

Marty was scared.  His poor little legs shook while the vet examined him.  After his exam,  he ran into my arms for comfort.  It turns out the vet says these common lesions were consistent with a staph infection.  The vet sold us five tablets of Albon (sulfadimethoxine) for $8.  Patient Marty took half of a scored tablet once a day for ten days, wrapped in a piece of cheese.

Italian-Greyhound-Staph-Infection-Ear

I don't know how Marty got the staph infection.  I don't know if staph is ubiquitous on dogs' skin like it is on humans.  I hope it isn't MRSA.  After hours of intense internal debate and deep thought, I have come to the only possible correct conclusion.  Marty lives in America.  There's only one possible way Marty got his staph skin infection.  He got it because someone else screwed up.  He must have picked it up three months ago at his last visit at the vet's office.   I know our vets are nice, but I know they are to blame.  It's the doctor's fault my Marty is suffering greatly today.  How do these people get licensed to treat my loved one?  It's a travesty of justice.

With all those sick dogs floating around, I've never once seen a vet wash their hands when we enter the room.  Dogs coughing everywhere without covering their mouths.  No isolation rooms. No gowns.   What kind of racket are these vets running? They should be ashamed of themselves.   I'm thinking it's time to lawyer up and demand payment for all the mental anguish, lost wages, pain and suffering Marty and us have experienced at the hands of a staph infection obviously contracted by poor vet clinic hygiene.

Don't you worry Marty.  We're going to make things right for you.  We're going to get to the bottom of this terrible injustice and make sure no Italian greyhounds or their masters ever suffer again at the hands negligent doctors.

I just hope you don't got colitis from antibiotics, because then we'll have to sue them twice for negligence.

UPDATE 20 days later:  After 10 days of antibiotics, Marty wasn't getting better, so we took him back to the vet.  His skin lesions seemed to be spreading.  The vet's partner suggested the possibility of pemphigus, an autoimmune skin disorder which often improves with steroids.  We put Marty on a tapering dose of prednisone 5 mg twice a day for a week, then 5 mg once a day for a week and then 5 mg every other day for a week and then stopping.  We are also withholding his Italian greyhound vaccines as they can exacerbate some skin conditions. 

This is a huge dose of prednisone for an Italian greyhound.  It's equivalent, on a weight basis, to at least 50mg twice a day for a normal sized human.  Wouldn't you know it, within three days of starting the steroids, Marty's lesions were rapidly healing and resolving.  They went away completely!  We've been told to finish off the prednisone taper and watch to see if the skin lesions come back.  These things, apparently, can resolve or recur.  Hopefully, little Marty won't have to be on suppression treatment for ever.

One interesting side effect, that the vet warned us about, was he may have to pee more than usual.  We hadn't seen that until these last few days when he's been getting up 4-5 times a night needing to go outside to pee.  Perhaps, the twice a day steroids caused him to retain significant amounts of fluid and now that we are at once a day treatment, he's starting to urinate out the excess volume.  We shall see if this continues...

UPDATE February 2013.  It's now been over 18 months since Marty was originally treated.  A lot has happened. After the original burst of steroids were completed we were unable to taper Marty off completely without having the lesions return with a vengeance.    We tried and tried and tried, but to no avail.  In fact, Marty was on a prolonged course of steroids, to the point where he lost his greyhound shape and actually took the form of a bullet.  That's right, his skinny 9 pound Marty ballooned into 11 point Cushingoid Marty. It was so sad.  He couldn't roll himself over from his back.  We finally said enough was enough.  I know all the devastating side effects of long term prednisone.  I see people with it every day.

We went back to the vet and told them we wanted a different plan.  They suggested using stronger immune suppression drugs such a cyclosporine and the likes.  We decided against it and made a decision to use a topical steroid cream on Marty's ears and hot spots.  It has now been over 18 months and I am happy to say that this cream did miracles.  Marty lost all his prednisone weight and fat rolls and looks like an Iggy again.  Every month that went by, his outbreaks declined in frequency and severity.  He no longer gets the hot spots on his limbs.  His outbreaks on his ears respond to one application and he can go a month or longer without any problem.  I don't know if Marty's ailment  was set off with the arrival of our baby Zachary or not. Whatever the cause, if it is autoimmune pemphigus, it is being held in place quite nicely with a topical steroid cream that we only have to apply ever so often.  And Marty is back to his normal silly self. 

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