Allergies, Hot Spots and Tail Amputation. Oh, and Get Pet Insurance!
(Warning. This article contains some graphic images of a dog tail in a state of deterioration and infection).
My dog Lulu has been with me since October 2018 when I adopted her at 2 or 3 years old. Then last April of 2022 she seemed to be scratching a lot, had a couple of ear infections and was licking her paws so I started her on Apoquel for allergies prescribed by her primary vet. That seemed to help and all was well until September when she had another ear infection
and was constantly licking her paws and biting at her tail. She went in to see her primary vet twice and we temporarily increased her dose of Apoquel, I scrubbed her paws with an anti fungal agent and wiped her tail with anti-bacterial wipes daily. (She had yeast in her ears and on her paws, but only bacteria on her tail). This seemed to help and we were all good again until January of this year (2023). She started biting her tail again. It was a vicious attack, I was sure she must have fleas or mange despite being on monthly flea and tick preventive and not having any of the other signs or symptoms of mange. Back we went to the primary vet who again temporarily increased her dose of Apoquel and gave us a steroidal/antibacterial spray for her tail. They checked her for fleas and she had none, nor any flea "dirt". I asked about Cytopoint injection, but they thought she mostly did well on Apoquel and that this was just a flare and that Cytopoint wasn't needed. I used the spray diligently, but she continued biting her tail and within a week she had developed 2 hot spots on the upper third of her tail.
Back to the primary vet we went and got the area around the hot spots clipped, bandaged and she was started on oral prednisone and an antibiotic. I also made her an appointment for a dermatology veterinary specialist. The next few weeks became an escalating game of trying to keep Lulu from licking and biting her tail and her outwitting me at every step. I kept a plastic cone on her and she could swing her tail to fit inside the cone right under her mouth. I tried a cervical collar that was supposed to prevent her from being able to bend her neck, but that didn't work. I bought something called a K9 Tailsaver suit on line and followed the instructions provided in their packaging and their on-line video tutorial on how to properly adjust the straps for a good fit. (https://happytailsaver.com) Unfortunately, I didn't follow their advice to keep a cone on for the first few days of her wearing the suit because she looked so sad and pathetic with the suit on that I didn't think that would be necessary. I came home to find she had chewed through the straps on the suit, the tail sleeve had slipped off and she had licked her tail again. I started bandaging her tail which worked for about a week. Then we had our appointment with the dermatology specialist. They took a culture of her tail, a scraping to look for mange under the microscope (they didn't see any mites, but treated her with Nexgard as a precautionary measure), looked for fleas (didn't see any), they did a thorough physical exam. They gave her a Cytopoint injection, started her on oral Gabapentin in case the tail biting was due to nerve pain rather than allergies and gave me an antibiotic cream to apply to her tail twice a day. They gave her a second, heftier dose of oral prednisone and advised she needed to be kept from licking at it, but didn't have any better suggestions for how to make that happen. We somehow muddled through with bandages and a cone for about another week. The results of the culture came back showing 2 different bacteria and she was started on Clindamycin and Doxycycline orally twice a day which the bacteria were sensitive to. Then she started biting the bandage off even with the cone on. I slathered the bandage with VicksVapo Rub, but she just bit it off anyway and had tears running down her face from the fumes of the Vicks.
I gave the antibiotics, pain meds and steroid as directed and changed her bandage daily to put the topical antibiotic on the site, but nothing was getting better and she was still getting to the tail every few days. I do not think I can underscore just how depressing these events were and how much it affected our relationship. Not to mention trying to balance work with all of these vet appointments and daily wound care. Finally the dermatologist recommended coming back in for repeat cultures, X-rays (to look for physical causes of pain that could be causing the tail biting) and a tail biopsy (to look for cancer). In addition to doing all of that they also gave her a ketamine injection which they said would help if the constant licking and biting were due to neuropathic pain (it didn't help). They gave us an extra long cone which they were sure would prevent her from getting to her tail (it didn't). She could just swing her tail along to her side and then contort her head around and just plop the cone down on top of her tail. In desperation I sewed the straps of the tailsaver suit and started keeping her in that along with the giant cone and that did help. Meanwhile I made an appointment with our primary vet to discuss tail amputation which seemed inevitable to me at this point and would have seemed unthinkable at the beginning of all of this.
Our second visit to the dermatology vet was on a Friday and we saw the primary vet the following Monday. He agreed that her tail looked bad, but thought we needed to wait for all of the results from the derm visit before doing anything. Mostly because he was afraid of making things worse if the infection was still out of control (at least that was my understanding). On Friday (a week after our appointment) we got the results from the specialist. The tail biopsy showed no cancer, but overwhelming infection and tissue necrosis. The X-rays showed left sided hip dysplasia which was a surprise as Lulu exhibits no symptoms of that, but otherwise was negative. And the culture continued to show the same 2 bacteria, but now resistant to the Clinda and Doxy antibiotics. So we immediately started her on 2 new antibiotics. But in the meantime her cone had somehow slipped off in the middle of the night Wednesday night despite being tied through her harness and she had licked her tail bloody and raw AGAIN!
She took the new antibiotics and didn't get to her tail again through the weekend and finally Tuesday, the day of surgery rolled around. 8 weeks after the start of everything. I had so many emotions. Anxiety about whether I was doing the right thing, relief that this might finally all be over, guilt that I hadn't done enough to prevent this. I dropped Lulu off at the vet in the morning and went off to do my daily round of pet visits. She was out of surgery by 1:00 and ready for pickup later that afternoon. They were able to salvage 5 inches of her tail, but the rest had signs of inflammation and they didn't want to leave any infected part. She was very happy to come home and was a little nauseous and subdued the following day, but in the 72 hours since the surgery hasn't tried to lick or even look at her tail area. Several times I was cautioned that if the tail biting was due to anxiety or neuropathic pain that amputation wouldn't fix the problem. But, look at that last picture of her tail! There simply was no other option at that point. Thankfully she seems to be recovering well. She still has a bandage on her little tail nubbin, but she is wagging it and seems fine.
Finally, a word about the practical side of all
this. This has been expensive! $5,714 for the vet visits, tests, medications and surgery. That is not counting the cost of the supplies I bought like the Tailsaver suit, the cervical collar and all the bandaging supplies. Thank goodness I had insurance for illness care through Nationwide. They have covered everything at 90%. I submit my receipts on line and within days there is a deposit in my bank account. There are many different insurance plans for pets available and I highly recommend considering one. Because I wouldn't want cost to prevent being able to treat this type of condition.
We still need to figure out if there is more we should be doing about her allergies in the first place. We will follow up with dermatology when her tail is completely healed and go from there. Apparently the majority of allergies (80-90%) are environmental and not food related. But we'll see what the work up entails because I don't ever want to go through something like this again.