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Questions to bring to your vet

One combined list from every chapter

itchydog.vetDr. Steve Pelton, DVMQR code for itchydog.vet

Circle the ones that fit, add your own at the bottom, and bring this page, your itch notebook and your photos.

Dog:Visit date:Vet:

What's going on

  • Based on where he's itching, are you most worried about fleas, food or atopy?
  • Is there a skin or ear infection on top of the allergy right now? Can we look under the microscope?
  • Does his pattern look seasonal or year-round to you?
  • What else should we rule out, especially since his itch started when it did?
  • Can you show me the itch scale you use, so we're scoring the same way? What score are we aiming for?
  • Which taps can we close cheaply before we talk about long-term medication?
  • What should I track in my itch notebook so it's most useful to you?

Fleas

  • Is my flea control good enough for an allergic dog in our area, and is every pet in the house covered with the right product for its species and weight?
  • Is an isoxazoline right for him, given his history? If not, what do I do differently?
  • How long should we run strict flea control before we look at food or atopy?
  • Could this be mange? Would a treatment trial make sense even if the scraping is negative?
  • Do I need to treat the house, or will treating every pet do it?

Infections

  • Is this staph, yeast, or both? Do we need a culture?
  • What shampoo goes with the antibiotics, how often, and when is the recheck?
  • Is his eardrum intact? Can I use the drops I have at home for the next flare?
  • If he needs antibiotics, how long, and when is the recheck?
  • This keeps coming back. What's driving it, and what should our allergy plan be?

Food

  • Should we do a food trial? Which diet, and why that one? What's the backup if he won't eat it?
  • Should he stay on his heartworm and flea chew during the trial, or switch to a topical?
  • Which week does the itch medicine come off, and when do we do the challenge?
  • Based on everything he's eaten so far, which proteins are still "new" for him?
  • Is his grain-free food a concern for his heart? Should we switch?
  • What protein is that diet made from? He might be allergic to chicken.
  • Is there a specific version (flavor or formula) I should make sure to order?
  • Do any of his other medicines or supplements have flavoring? Is there a plain version?
  • Should I switch to the new food all at once or over a few days?
  • If he flares on the challenge, which single ingredients should we test first?
  • If the trial doesn't help, what's our plan for atopy?

Home care: baths, wipes, ears, fish oil

  • Which shampoo is right for him right now, and how often should I bathe him? Is it the full 10 minutes?
  • Should I be using wipes, a spray or a mousse between baths? On which spots?
  • Does he need routine ear cleaning? Which cleaner, and how often? Is his eardrum OK?
  • Should he be on fish oil? How much EPA and DHA a day, and which product do you trust? Is it safe with his other health problems or during a food trial?
  • Is an antihistamine worth trying for him? Which single-ingredient product, and how much? (And is it free of decongestants, acetaminophen and xylitol?)
  • For a wrinkly dog: what should I wipe his folds with, and is any fold deep enough that we should talk about surgery someday?
  • Is a barrier spot-on worth the money for him, or would you spend it elsewhere?
  • Would a shirt, socks or a cone help while his skin heals? Which one, and for how long?
  • At what itch score should we add a medicine on top of the home routine?

Medicines

  • How does this medicine stop the itch, and how fast should I see a change?
  • What side effects should I watch for, and does he need lab work while he's on it?
  • What does it cost per month for his size, and is there a less expensive option with a real shot at working?
  • Does it affect his vaccines or any other medicine he takes?
  • If it seems to stop working, what flare factor should we check first?

The long game

  • What's our maintenance plan, and what's our flare plan? Can we fill in "My dog's itch plan" together?
  • Would he be a good candidate for allergy shots or drops? When would you refer us to a veterinary dermatologist?
  • We already did an at-home or blood allergy test. Should we set it aside?
  • If we start cyclosporine, what will we use to cover the first few weeks, and how will we step that down?
  • What should I do if he vomits after his cyclosporine? Can I give it cold, or with a little food?
  • If we start immunotherapy, how often are the rechecks, and what itch medicine will we use while we wait?
  • How will we know at 9 to 12 months whether it's working, and what's the plan if it isn't?
  • What would skin testing involve for him: sedation, which medications to pause, and the total cost?

Steroids

  • Which steroid is this, how long will he be on it, and what does the taper look like?
  • Should I give it with food? What do I do if I miss a dose?
  • If he needs this long term, what's the lowest dose we can aim for, and can it be every other day?
  • Is the shot he's been getting a steroid or Cytopoint? Is a pill an option instead of the long-acting shot?

Apoquel

  • Is Apoquel the best fit for my dog, or would Cytopoint work better for him?
  • What should I expect when we step down to once a day, and when should I call?
  • If he's on a food trial, should he have the tablet or the chewable?
  • Where can I fill the prescription most cheaply?
  • If we ever need to stop, what's the plan to keep him comfortable?

Cytopoint

  • Is Cytopoint a good fit for him, or is his itch the kind that a pill would handle better?
  • How will we judge whether it's working, and after how many shots?
  • What interval should we start with, and when could we try stretching it?
  • If it doesn't work, what's our next step?

The newest itch drugs (Zenrelia, Numelvi, Befrena)

  • How long has this drug been used, and in how many dogs?
  • Why this drug for my dog, instead of Apoquel or Cytopoint?
  • What does the long-term safety data look like? Is any of it from people who don't work for the company?
  • If it's Zenrelia: when are his next vaccines due, how long will he need to be off it, and what will we use to cover the itch in the meantime?
  • If it doesn't work, or he doesn't tolerate it, what's the plan B?

The itch ladder

  • Where is my dog on the ladder right now, and what's the next rung if this isn't enough?
  • Have we really finished fleas, infection and food? What's still open?
  • What score should I call you at, and is there anything I can start at home during a flare after I call?
  • Which maintenance tool fits him best, Apoquel or Cytopoint, and why? Would combining tools help him?
  • His ears keep coming back. Are the canals narrowing? Should we see a specialist?
  • What months should we get ahead of, and when would you refer him to a veterinary dermatologist?

Rechecks and the years ahead

  • Based on my notebook, how is he really doing? Is this as good as it gets, or can we do better?
  • Can we step anything down, and if so, which piece first and how?
  • Is there anything I should do before his bad season starts?
  • He's getting older. Is there anything about his skin you'd want to check differently now?

Getting a puppy (for the breeder and your vet)

  • Have either of the parents had itchy skin, allergies or repeated ear infections?
  • Is either parent on Apoquel, Cytopoint, steroids or an allergy food?
  • Have earlier litters from this pair turned out itchy?
  • Can I meet the mother, and the father if he's here?
  • When is it safe for him to be on the ground and around other dogs?
  • Which vaccines does he need for his lifestyle, and when are his boosters due?
  • He's small. Can we split his vaccines across more than one visit?
Before paying for any test

What will the result change? Do healthy dogs test positive? Would a veterinary dermatologist use it? Has it been checked in published research by people who don't sell it? Does it give the same answer twice on the same dog?

My own questions