I listen to your show on Sirius and love it. I am hoping you can help me.

I have a 40 lb male, mixed breed dog 12 years old.  About 7 years ago he developed a problem with the tips of his nostrils. They get very inflamed and bleed.  Other times they will get crusty and stay that way for awhile.  It appears when there are weather changes the nose gets irritated and red and almost raw on the tips.

When this first happened, we took Maxx to the vet.  The vet thought it was lupus and something of a immune disorder.  He prescribed steroids.  After giving Maxx the medication, we noticed his behavior became very aggressive.  We immediately stopped giving him this medicine. 

Over the years it does not appear that he is bothered or in pain.  We have had Maxx on a raw diet including plenty of vitamins and minerals over the past year.    He is extremely healthy, except for his tiny nose.  Do you have any suggestions, or something holistic that might help?

Thank you,
Michelle

Dear Michelle,

What struck me right away was that it didn’t sound as though the vet performed a biopsy of his nose – without which, he was just groping in the dark for a solution without knowing what problem he was trying to solve. Steroids work on nearly every skin condition but the symptoms only, rarely the cause.

So I wrote to the wonderful Official Vet of Dog Talk®, Phil Padrid in Chicago, and this is his reply. [Please note that he generously offered to look at a photo of your dog’s nose so if you want to take advantage of that, send me that picture and I’ll share it with him.]

Here is Dr. Phil’s reply to my question whether a biopsy is indicated:

Yes, a biopsy is needed because the most important thing is to rule out an immune mediated disease like pemphigus or lupus. This REQUIRES a biopsy of the nose- not nearly as big a  deal as it sounds- does not require general anesthesia- usually done in a few minutes with one or two stitches to close.

If it is one of these diseases, there are drugs besides standard steroids that can be very effective without the side effects of steroids.

Not usually a food related allergy in my experience -- ideally a dermatologist is seen and the diagnosis is made.

If they want to take a picture of the nose and email it to you, you can forward it to me and it might be easier to give you a more complete answer then

My best,
Phil

FOLLOW UP from Michelle:

Thank you so much for your e-mail.  I have attached the photo of Maxx's nose for Dr. Phil.  I am so grateful for his help!  I will wait for the reply and then go forward with the biopsy.

Thank you so much for sharing Maxx's photo with Dr. Phil!!!!
Best wishes,
Michelle

Dear Michelle,

Here is Dr. Phil’s evaluation of your photo -- isn’t it amazing how the miracle of email and an extended family of caring people can solve a problem?!

Please put his suggestions to work as soon as you can - and let me know how it works out

[ Dear Tracie & Michelle -
That looks like what is called "desquamation."It is not a typical lesion for lupus or pemphigus (immune diseases) and looks more like what a dog can do to itself with chronic licking. Having said that, it would be a simple thing to get excellent biopsies of those sites and then you have your answer.

If they go ahead with this, there are specific pathologists called dermatopathologists who specialize in looking at skin. I would request of whatever lab the biopsy is sent to that they give it to a dermatopathologist- if one is not available at their lab they should ask for a referral so that the right pathologist reviews it.

My best.
Phil ]