How to Treat Hotspots – The (W)Holistic Vet Perspective
Here is a hotspot on my dog. This photo is dated April 12, 2020. I’ve been pretty under the weather the past few weeks. I noticed him licking/ chewing an area the night before but I just distracted him and he stopped. Apparently he really went after it sometime during the night because this was what I found Sunday morning, April 12:
A few notes about the patient, Splinter:
Splinter is a 13 (ish) year old castrated male Australian shepherd. He has chronic back pain, it started around the time he was 4 years old. I thought it was going to be his hips but his hips are lovely on Xray. It turns out, his spine is unstable and his body has been trying to stabilize it using new growth (spondylosis). These bone spurs are located where some very important nerves leave the spinal cord. Check out he area on his left side labeled L3-4 on both X-rays below: (note see Instagram post to be able to zoom on images:
Spondylosis (see extra bone arrows and red circle) medical definition:
Spondylosis refers to a degenerative process affecting the vertebral disc and facet joints that gradually develops with age. … The condition can narrow the spinal canal that results in the compression of the spinal cord and nerve roots.
For reference here is a normal X-ray (See no ‘bone spurs’ coming off of the rectangle shaped bones of the spine):
How was I taught to treat this hotspot in vet school?
(note this is not ‘wrong’)
Tape test cytology – see what is infecting the area – is it yeast, bacteria? If the pet has a history of hotspots, culture the area to see what bacteria and what antibiotic will work best. Both are very good medicine and are standard of care.
If the pet is bothering the area above a level of 5 or greater on a scale of 1-10, I should consider steroids – topical or oral. This is av very intense sensation causing the pet to chew the area – they are uncomfortable! And, because if the client does not perceive that this is better within 12-24 hours, they may not trust me/ may not feel like their pet is better. I should clip the hair away from the hotspot and clean it well. An E collar would also be recommended to keep the pet’s mouth from the area. Consider a discussion about flea, food and environmental allergies (atopy). If I don’t address the underlying skin allergy that likely caused the hotspot, it’s likely to recur. This is still true today. The difference is, allergies are not the only underlying cause! It is not common thinking in traditional veterinary medicine that a hotspot could be nerve pain or an acupoint, that for some reason licking this spot makes another place feel better etc. This is the point I’m making – not that traditional vet med is WRONG but that there can be more to it. We have to look at the whole pet, really know our patients, and connect anything we can to address any issue, not just hotspots. The only “problem” I have with the traditional veterinary care that it is “standard” that we look at one area and treat that area. Holistic medicine looks at the whole pet. There are no “protocols” in how I practice. Because no two pets are the same.
Traditional drug treatment protocol:
He would likely go home with terbinafine (anti fungal) if there are yeast present on cytology, cefpodoxime (antibiotic) whether or not bacteria area on the cytology, and prednisone oral tablets OR topical steroid powder or spray (note most of these sprays are alcohol based, can you imagine spraying alcohol on this open wound??). In addition, topical steroids are now known to have the same effects on many animals as oral steroids. Plus, humans generally use the “willy nilly” rather than as directed.
How do I look at this hotspot now that I have even more training?
In some ways it’s the same – to do a tape test cytology would be best to see what is infecting the area.
However, addressing the underlying cause is vastly different than what I was taught in vet school. So are my treatment options as far as treating locally for bacteria and yeast rather than orally and messing up his lovely gut flora (good bacteria in his gut) that I work so hard to keep normal/ healthy. (see this blog for more: ) https://nashvilleholisticvet.com/probiotics-gut-health-the-immune-system-anxiety/
I know this pet, I have looked at his Xrays and I know the areas where he’s the most painful on palpation and where he’s most sensitive to acupuncture needles. I also know from my motion palpation exams (chiropractic type of exam, feeling how the bones of the spine move or don’t move as they should) that he has a chronic restriction at L3-4. At times, this area is barely adjustable because there are so many bone changes here. I also know the dermatomal mapping that tells me this area of his spine is innervated by the genitofemoral and ilioinguinal nerves. Sure I learned this first year of vet school but I spent the next 15 years not knowing this. I was not taught to consider from a hotspot what nerves are here AND where on the spinal cord do they originate. Guess where the nerves that innervate the area of Splinter’s hotspot originate on his spinal cord? L3-4. Right where his worst pathology and pain have been for years. Right where you can see on Xray is the worst area of bone spurs. On the same side – the left side. This is not a coincidence and this is why integrative medicine is different, more complete and in my opinion – better. When I look at this patient, I have the entire picture in mind – and I have a very good grip on what is going to keep him from chewing on this area.
So, how did I treat it?
(an example of how I can be more complete now)
- Clipped the hair from the area as much as I could. I even looked at the area with him standing walking and lying down to see if some of the longer hair from other areas of his body would touch it when he was moving or standing.
- Cleaned with alcohol free witch hazel solution.
- Applied my skin irritation spray (recipe here https://nashvilleholisticvet.com/wound-treatment-the-myths-of-hydrogen-peroxide that I make from DoTerra Essential oils, aloe and colloidal sliver (see this blog for recipe
- Applied thin layer of Calendula ointment by Boiron
- Full physical exam in three ways: TCVM (Traditional Chinese Veterinary Medicine, Motion palpation exam (chiropractic) and traditional vet school physical exam
- Acupuncture and spinal manipulation to treat the underlying spinal pain/ problems likely causing him to chew this area.
- Increase in gabapentin dose for the nerve pain – given at night since increased dose causes sedation.
Exam Findings– pain in the areas of the lumbar spine from L1 all the way to L 7 area , worse L3 to L5 ; restrictions in this spine at L3 L4 and L2 (adjusted L2, L3 and 4 were too sensitive to adjust today). Acupuncture treatment along the bladder channel in the areas where he was hurting in his spine and other ares on his feet and legs that also helps with back pain.
Integrative / medical treatment: That night, I gave him 300 mg of gabapentin, 100 mg above his typical dose for pain. This is known to help with wind up pain as well as nerve pain – the very thing I deducted was causing him to chew this area.
Within 12 hours he was no longer licking the area. Today April 15, it is completely healed and he is resting comfortably.
Fortunately, I was able to manage this hotspot without the use of any systemic drugs. Don’t get me wrong here. Hotspots are one of the most common, painful, and even chronic conditions in veterinary medicine. And had I waited two days before addressing any of this, it’s likely he would have needed systemic drugs. BUT I HAD A PLAN for immediate action. I didn’t wait a day or five. If you wait a day with a hotspot to get help, it’s very likely you are going to need all of the drugs mentioned above to help your pet be comforttable. This is not an “anti drug” blog post. It’s a be complete, look at the whole picture, have a plan and treat the whole pet blog post. Keep in mind, this isn’t my first rodeo with him having nerve pain. I had this skin soothing concoction on hand
link to recipe here:
And Calendula ointment is always around in my house (replaced Neosporin long ago)
Here is the resolved hotspot April 15, 2020 no antibiotics, steroids, E collars or anti fungal drugs etc were used in the treatment protocol:
And most of all, I am his holistic/ integrative veterinarian. Holistic medicine isn’t a cheap nor is it a type of medicine that is free of diagnostic testing. It’s just better and more complete if you ask me. I would not be using diluted DoTerra Essential oils on him if I didn’t have recent lab work for him. Note that I also have recent X-rays of him, I know his body, his spine, his tendencies. I don’t like to just assume that because his spine has looked like this for 8 years that nothing has changed. These X-rays are from just over a year ago and I have Xrays of his spine every 12-18 months for several years running. I want the same information and testing on my current patients when this is possible. I prefer to know my patients with this amount of detail. It’s why we see each other monthly for spinal manipulation, TCVM exams and treatments. We should not shy away from diagnostics – this is where holistic medicine is weak and traditional/modern medicine is very strong! I know my dog (as I know my patients) because of these diagnostic images and other testing he has had at his regular veterinary hospital. Should any of my patients start to lick their foot, or belly, I’m not only considering that they may have allergies, but do they have any issues with their spine? What nerves innervate that spot they are licking? Where on the spinal cord do those nerves originate? Could this be related? Is there an acupoint where they are licking? If so, what type of discomfort does that acupoint typically alleviate? Pain in the neck? Anxiety? Stomach pain? etc.
This, my pet loving friends, is why I recommend everyone had an integrative / holistic vet on your pet’s health care team. That’s how it works! With Nashville or Savannah Holistic Veterinary care, I work with your regular veterinarian to offer you a holistic perspective on anything from back pain to hotspots. To schedule an appointment – house call or even an online consultation – click here now:
Is your pet living their best life??
Thanks for reading!
A post script for veterinary professionals:
If you have any questions or issues with what I wrote about our traditional treatment of hotspots – the very acute type- consider reading the most recent recommendations. Even traditional vet med is pulling away from systemic antibiotics and topical alcohol based steroids for these conditions. See clinicians brief pod cast episode #41 with Erin Aufox, DVM, DACVD (dermatologist). When we know better, we do better!