Who has Depo Medrol in their pharmacy cabinet? I will admit I do!

In 2021, I used Depo Medrol two times. I do not use it often but have it on hand in case I have a FELINE case that the owner cannot administer medications orally.

Depo Medrol is methylprednisolone acetate- a repository glucocorticoid formulation.

Methylprednisolone by itself has a duration of 12-36 hours. With the addition of the poorly water soluble “acetate” it causes the methylprednisolone glucocorticoid to accumulate in tissues and slowly release over 3-6 weeks. The repository effect is the reason it should be used with extreme caution. The potential side effects of this type of glucocorticoid cannot be reversed once injected. Of concern, is its diabetogenic and cardiovascular effects.

If long-term use of a glucocorticoid is necessary for a pruritic cat, the goal should be to reach a point where the lowest steroid dose is achieved that will keep the cat comfortable without side effects. This is best done with an oral steroid. Of course, this tapering cannot be accomplished with Depo Medrol, and that is why it should be avoided for long term use.

I understand cats can be hard to medicate, but we should not assume that a pet owner is not willing to learn to give medications orally to their cat to avoid the side effects of a long action steroid like Depo Medrol.

In our practice, if a cat owner cannot pill, then we offer liquid, if liquid steroid is difficult then we consider compounding the steroid in a liquid flavored concentrated formula (so that client is only giving a small volume). Anything to avoid the use of injectable long-acting steroid.

Let us do things right and not run to Depo Medrol for every cat that is itchy. Let’s use it wisely.

#depomedrol #cats #catsofinstagram #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedicine #veterinarian #veterinario #veterinaria #medicinaveterinaria #petdermatologist

542 31

Here is product that I am a big fan of for my atopic dogs.

It is a leave on hydrocortisone conditioner. This is one brand, but there are many others. Hydrocortisone is a mild potency steroid and the percentage in this product is low at 1% that I rarely see any reactions.

I find this product a nice adjunct to the medicated baths the clients are already doing for their atopic pets. After the medicated bath they will apply a small amount to the frequent itchy areas of the body and leave it on to dry. I especially love this product for dogs with itchy paws.

Caution to not over apply to the ventrum, like the abdomen or inguinal region, where the skin is thin. Overuse can cause atrophy of the skin. I have clients apply it once a week.

#vet #vettech #vetdermatology #dermatologiaveterinaria #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #medicinaveterinaria #miamivetderm #gotitchypet #atopy #petallergies

320 7

Lichenification is typically known as hyperpigmented leathery appearing skin. However, it can also be leathery-erythematous skin as shown in the picture.

When lichenification is present on the skin we often think of it being caused by malassezia, but quite often there is a concurrent bacterial infection or it may just be bacterial. It is important to perform skin cytologies.

Lichenification develops more readily in certain breeds like Westies and German Shepherds, in comparison to other breeds.
When lichenification is present on the body, it is more common in certain areas like the ventral neck, chest, abdomen, inguinal, perianal and muzzle.

Lichenification should be equated with chronicity… the pet has had chronic infection and constant trauma (i.e., pruritus) on the skin for weeks to months to years.

When lichenification is present on the skin it means treatment will be extensive: from weeks to months of systemic and topical therapy.

It is hard to believe, but the elephant skin can go back to normal smooth skin by treating the infection appropriately and resolving/managing the underlying cause.

#vet #vetdermatology #dermatologiaveterinaria #vetmedicine #medicinaveterinaria #dogskin #elephantskin #dogskininfection

454 5

A question pet owners will often ask is if their pet’s red eyes, or excessive tearing or ocular mucous discharge is due to allergies. Allergies in pets does not typically cause red, itchy eyes like it will in people. There are other more common conditions that can cause these eye signs and are important to rule out first. One such condition are eye lid disorders, like entropion. Look at this video of an English Bulldog with entropion. Look at how the eyelid is rolling inward causing the eyelashes to rub on the eye, it is obvious why the eye is red. This rubbing of the eyelashes can also irritate the cornea and potentially damage it. This patient needs eyelid surgery. This English Bulldog has allergies that will need to be worked up as well, but first let us fix the eyelid abnormality.

#vet #vetdermatology #dermatologiaveterinarian #vetmedicine #medicinaveterinaria #petdermatology #vetophthalmology #entropion

263 8

The Collaborative Care Coalition is an organization that aims to improve the relationship between primary care veterinarians and specialists. To carry out their goal, they have been working on studies that compare the outcomes of primary care alone versus collaborative care in various medical situations.

One of these studies retrospectively looked at the medical records of 65 dogs with otitis and compared the outcomes for the treatment of chronic otitis externa when managed by primary care alone or working together with a specialist. The results showed that dogs had better long-term outcome when collaboration with a dermatologist was initiated within 6 months of treatment. Therefore, referral or consultation is advised for patients with recurrent otitis that has been present over a 6-month period.

But, a striking finding for me in this study was that the proliferative ear canal changes improved by 91% when the patient care was teamed with a specialist versus just primary care alone at 13%. I will often talk about how chronic changes to an ear canal perpetuate infection and can eventually lead to end stage ears, and then finally total ear canal ablation surgery. This just highlights the importance of reaching out to your local dermatologist for help with those tough ear cases. Let’s work together to save those ears.

Article: JAAHA (2021) 57 (5): 212-216

#vet #vetdermatologist #dermatologiaveterinaria #vetmedicine #medicinaveterinaria #otitis #dogears

64 2

What is your favorite topical ear medication?

I am a big fan of Virbac’s Easotic. I like this product for several reasons, and no, Virbac is not paying me to say this…

👍🏼 The pump bottle makes administration easy peasy. The client just presses the pump and it delivers 1 ml of medication straight into the ear canal. No need to count drops or make sure those drops went down the ear canal. This delivery system alone makes it a great product, because as we know client compliance is always a concern with otitis treatment

👉🏼 It is a once- a- day treatment. Easy for pet owners to remember to do

🙌🏼 The bottle only has 10 ml or 10 dose treatments, so there is usually not any left -over medications that pet owners will use at a later time

✊🏼 The hydrocortisone aceponate (HCA) is a potent new generation glucocorticoid. It is 60x more lipophilic than hydrocortisone and due to this it has a rapid absorption into the targeted tissue for fast acting anti-inflammatory effects. HCA when reaches systemically is converted to weaker metabolite- hydrocortisone, therefore less systemic side effects

👏🏼 The miconazole and gentamicin are good combo of broad- spectrum antimicrobial and antifungal ingredients for treatment of simple staphylococcal and malassezia infections

Client compliance and improper treatment of an otitis can be a reason why the ear infection in a pet is not resolving. Consider using this product and see if your compliance improves and otitis cases are resolving quicker. Of course, don’t forget to look for the underlying or primary cause of the ear infection.
Who is using Easotic? What are your thoughts on it?

#vet #vetmed #veterinarydermatology #dermatologiaveterinaria #medicinaveterinaria #otitis #dogear #dogearinfections

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Severe case of superficial spreading pyoderma. A number of my patients present with skin infections that look like this, and I am sure you are seeing these cases as well. These cases appear daunting when they walk into your door, but they don’t have to be.

Things to remember, infections on the skin like this contribute to pruritus, it makes these pets uncomfortable and sometimes unsightly, it is the cause for the pigmentation, the crusts, the hair loss and odor. You can definitely make a difference in these patients by treating the infection correctly (i.e. appropriate dose and length of antibiotics and medicated baths).

It is important to discuss with clients how skin infections are secondary and why it is important to look for the primary cause. Keep allergies and endocrine disorders in mind, when investigating those primary causes. I always check for demodex mites, as well.

Eager to see what this pet looks like in a few weeks.

#vet #vetdermatology #vetmedicine #medicinaveterinaria #dermatologiaveterinaria #dogskininfections

251 6

I speak Spanish. I thank my parents for making sure I learned to read and write my native language. Actually, Spanish was my first language as a young child and then it became second when I entered grade school. I’m fortunate I can communicate the complexities of allergies to my Spanish speaking clients, a skill necessary in my community. Now … speaking to my veterinary community in Spanish is another thing- I will admit it’s daunting. I can use common terms for my clients, but medical terminology is hard because my brain only knows it in English. I know some terms are similar in both languages, like atopy in English is atopia en Spanish, but some terms are not. So next week I will be presenting a lecture in Spanish. At my ripe age of 48, I feel like I am learning a new skill. It’s kind of exciting, but also scary at the same time. I have wanted to share my derm knowledge with my Latin American colleagues for some time and I am fortunate Zoetis and @dr.calad gave me this opportunity. My parent’s legacy of language will continue to thrive. #vet #vetdermatology #vetmedicine #medicinaveterinaria #dermatologiaveterinaria ...

152 25

Seasonal flank alopecia or canine flank alopecia

This is an English Bulldog, the poster child for this condition.

The hair loss occurs in the lateral flanks, and it is typically symmetrical. The area of alopecia is hyperpigmented and irregularly shaped with well demarcated borders. There is no pruritus associated with this condition.

The cause for this disorder is unknown. However, there is an association with daylight cycle. Dogs will lose hair with a change in season and then regrow hair next season. Some dogs will skip a season and it can take time for the hair to completely regrow. It is possible in individual cases for the hair to never completely regrow.

Diagnosis is based on clinical signs and breed predisposition. Other differentials to consider are bacterial infection, dermatophytosis, demodex or endocrine disorders like hypothyroidism or Cushing’s.

This is a cosmetic condition, and it will not affect the pet. No treatment is necessary. Melatonin, a natural biochemical that can help regulate circadian rhythms, may help some pets regrow hair.

#englishbulldog #dogsofinstagram #vet #vetdermatology #vetmedicine #veterinarydermatologist #vetmed #flankalopecia

226 4

This is an epidermal collarette, a sign of a bacterial infection. It is often confused for a dermatophyte “ringworm” lesion. How do you tell the difference? Perform a skin cytology. If you are still in doubt, send out a fungal culture.

I will often get referrals of pets with lesions like this that have been treated with antifungal medications for weeks with no improvement. What the patient needed was antibiotics.

Don't underestimate the value of a skin cytology.

#dogpyoderma #dogskin #dontmakethismistake #vet #vetdermatology #vetmedicine #veterinarydermatologist

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Another English Bulldog whose ear canals lost their fight to chronic otitis externa.

English Bulldogs, like many brachycephalic breeds, have their ear canals normally narrowed. This conformational change can predispose an English Bulldog to ear problems. The key word here is predisposed. Imagine those narrowed ear canals becoming inflamed from atopic disease and then further inflamed from secondary infection. It is easy to see how an ear infection repeated over a period of time in these types of ears, can become a severe problem for this breed as the canal closes more and more.

Repeated insult to the ear canal also causes the ear canal epithelium to change from a smooth surface to a cobblestone texture that perpetuates the infection as organisms become trapped in the microfolds within the abnormal ear canal. The ear canal can eventually become fibrotic, then the cartilage mineralizes and then becomes bone, reaching end stage ear disease.

I often hear that it is the narrowed canals and lack of air flow that causes Bulldogs to get ear infections. These changes are a predisposing factor, but they are not the main cause. The primary cause is typically allergies to either food or environmentals. It is important in this breed, to take the initiative early on to find and resolve the primary cause, and hopefully prevent total ear canal ablation.

Lets save these ears!

#englishbulldog #englishbulldogofinstagram #vet #vetdermatology #dogears #otitis

209 5

This kitty has a 6 month history of head/face and paw pruritus. She came in to see us today already on a diet trial. The pet owner had been seeing good improvement since starting the prescription food. However, the kitty was having mild flare ups that the owner thought could be due to the kitty eating the other cat’s food. Could a few bites of kibble from the other cats food be enough to cause a reaction? Yes! most certainly can.

Some tips to consider for an effective diet trial in cats:

😺 Make sure the cat is indoors only. Outdoor cats have access to other outdoor cat’s food, garbage and can scavenge or hunt, this could all negate the diet trial.
😺 For cats that are picky eaters I recommend a slow transition period into the new food. Where in a non picky cat I might say 7-10 day transition, a picky cat eater may need 2 or more weeks.
😺 For multi-cat households it is easier for all cats to eat the same food, especially if the cats have free choice feeding. If this is not possible, then cats should be fed in separate rooms. If separating is not possible consider the use of collar activated feeders.
😺 Cats can be picky about their food texture. Some like dry kibble, some canned, some want gravy in their wet food. Find out what your cat patient likes and then see if there is a prescription food option that works for him/her.

Any other tips? Please share.

#catsofinstagram #cats #catfood #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology #dermatology

86 0

There are so many reasons to honor veterinary technicians this week, but one reason that stands out for me is how much they’ve taught me in my veterinary career path… taught me skills that I now take for granted.

Before I entered vet school, I worked as a vet technician in a small animal clinic. It was another vet tech that taught me how to draw blood, how to put an iv catheter, how to read a fecal test, how to get a TPR on a pet, how to administer meds to a pet, how to do an xray on a pet’s limb and the list can go on and on. I had a wealth of knowledge before starting vet school all thanks to technicians that took me under their wing.

During vet school, it was a vet derm tech that taught me how to do a good skin scrape, how to do skin and ear cytologies and how to read them.

After I finished vet school, I went into general practice before my residency. It was a veterinary technician with over a decade of veterinary surgical experience that was by my side during my first solo spays and neuters. If it wasn’t for her, I am not sure how I would have made it thru surgery days. I can still recall my first foreign body removal and enterotomy and the incredible confidence this technician had in me… she boosted my ego.

I am grateful to veterinary technicians for the impact they have made in my career and for just being one of my best cheerleaders when I needed them most.

Happy Veterinary Technician Week!

What has a veterinary technician taught you? How have they impacted your career?

#vettechweek #vettech #vet #vettechlife #vetmed #vetdermatology

599 7

What is your favorite antifungal medication for malassezia cases?

Mine is fluconazole. I have been using it for several years now and like how it works for my malassezia cases. I rarely ever see gastrointestinal side effects. I combine it often with an antibiotic without any issues. I like that it is a once a day medication which is easy for clients to remember. Fluconazole is minimally metabolized thru the liver. It is primarily excreted thru the kidneys, therefore be cautious of kidney function.

What about ketoconazole? I am not opposed to ketoconazole, I used it quite often for malassezia during and after my residency. However, I did have cases that had GI issues or inappetance on it, and I had to discontinue it in those patients. My other option at the time was itraconazole which was pretty expensive for some clients. Therefore, when fluconazole became generic, I switched over to it and rarely ever now use ketoconazole.

What about terbinafine? I actually did my residency study on terbinafine and malassezia. I think terbinafine is an good option for malassezia, but I find it works for mild to moderate cases. Anecdoctally, I can say that in my “too numerous to count”malassezia cases I didn’t feel terbinafine did enough to eliminate infection. However, I often think that the malassezia I see here in South Florida are just super powerful Malassezia.

If you haven't used Fluconazole, consider it as another option for your Malassezia cases, especially if the pet didn’t tolerate ketoconazole. #fluconazole #malassezia #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology #dermatology #skin #miamivet

399 16

The hair like frond projections on this foot pad is hyperkeratosis. Hyperkeratosis is an abnormal growth of keratin. This may occur due to an underlying medical cause or for no reason at all.

The hyperkeratosis is often seen on the foot pads and nose of dogs. It is common in certain breeds like Bulldogs, French Bulldogs, Cocker spaniels, Labradors and Boxers. It is also often seen in middle aged to older dogs. In most cases, the hyperkeratosis doesn’t affect the pet. In some, however, it can be painful and cause lameness, which means treatment is necessary to manage the condition.

The keratin growths can be softened with warm water bath for 15-20 minutes. Some recommend adding Epsom salts to the bath water. Follow this with moisturizing topical agents to soften the pad, like Vaseline or bag balm, these will also help remove the keratin material. Veterinary products like, Bio Balm from Dermoscent, also work great.
Other differentials to consider for hyperkeratosis are: pemphigus, hepatocutaneous syndrome or nutritional deficiencies like zinc.

The dog in this picture is an atopic dog that has been stable on its immunotherapy. Most recently she started to develop pododermatitis and interdigital cysts of one paw, that was managed with antibiotics, topical steroids and cyclosporine. At first, I thought her discomfort in the paw was the cyst and infection, but now that this is controlled, I had to focus on how much this hyperkeratosis was the issue.

Don’t forget to examine the nature of the paw pad on a lame dog.

#dogpaw #englishbulldog #frenchie #dogsofinstagram #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology #dermatology

771 17

Is Cyclosporine in your medicine cabinet?

Cyclosporine, or Atopica under its brand name, was the main drug for managing environmental allergies in dogs about a decade ago. With the advent of oclacitinib and lokivetmab, the use of cyclosporine has diminished in dogs. A big reason for its decreased use comes from the fact that cyclosporine can take up to 6 weeks to work, therefore not a medication that is good for acute pruritus. Cyclosporine’s gastrointestinal side effects and it’s cost in large dogs have also made it unfavorable over Apoquel and Cytopoint.

However, with that said, cyclosporine still has value in some of our atopic dogs. Apoquel and Cytopoint are known for their targeted actions. Cyclosporine has more wider effects. Cyclosporine is a calcineurin inhibitor that works by suppressing T cells and IL-2. It also inhibits IL-4 and TNF-alpha, leading to reduced T-cell function and inflammation. Cyclosporine acts on immune cells: it inhibits mast cell and eosinophil function and degranulation, inhibits monocyte/ macrophage activation, decreases the number of Langerhans cells on the skin and decreases keratinocytes activation and release of cytokines. All this gives it its broader action.

I like to use the brand Atopica for bioavailability concerns with the use of generic. I personally do not combine cyclosporine with ketoconazole to lower the dose of cyclosporine, as my experience has been more GI side effects. Watch for gingival hyperplasia with the use of cyclosporine.

Have you had an atopic case where you properly eliminated infection from the skin, but the dog was still pruritic on Apoquel or Cytopoint? Consider cyclosporine. Have you had an atopic dog with interdigital cyst or pododermatitis as a part of its atopic signs? Consider Cyclosporine. Or how about an otitis patient with already chronic changes to their ear canal, consider cyclosporine.

Keep cyclosporine in mind when Apoquel and Cytopoint don’t work

#atopy #vet #vetdermatology #dermatologiaveterinária #cyclosporine

415 35

Anyone using Chloramphenicol?

As we see more and more infections caused by antibiotic resistant-bacteria we may need to consider the use of older drugs. I have reached for this medication on several of my canine MRSP cases. This is a broad spectrum antibiotic, relatively inexpensive and can be given orally.

I am not as afraid to use it now, as I was when I first started. I do council the client well on possible side effects of which gastrointestinal (vomiting, diarrhea) is the most common in my experience. Other side effects I have seen are inappetence and lethargy. In the literature you may also read about hindlimb weakness. The risk of bone marrow suppression in pets is rare, and really should not preclude you from using this medication if you have an MRSP case with no other oral antibiotic options. Since the risk of aplastic anemia in humans is real, I do have clients wear gloves when administering the medication.

I make sure the pet takes the medication with a full meal. I have my staff do recalls to make sure the pet is tolerating the medication well throughout the treatment process. I dispense it in small quantities (2-3 week intervals) so that owner doesn’t keep administering the medication without informing us of side effects. I find that if the client discontinues the medication as soon they see side effects that the symptoms resolve.

All of my MRSP cases are receiving frequent medicated baths, which if I have to use Chloramphenicol in conjunction, helps lessen the time the pet needs to be on this medication.

Chloramphenicol should be a medication that is used based on culture. Most of the MRSP cases I see are sensitive to Chloramphenicol, but I have already seen several that are resistant 🤦🏽‍♀️

Whose using chloramphenicol? What has your experience been like?

#antibioticresistance #MRSP #Chloramphenicol #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario

175 10

The classic just rear end itchy dog may be a no brainer for flea allergy.

However, I will often see dogs with combination of allergies.

For example, a dog with pedal pruritus and rear end itchiness. The paw issues likely not flea related, but the rear end distribution yes.

Make sure anytime you see rear end itchiness that the pet is on good flea control.

#fleas #fleaallergy #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology #dermatology #skin

81 3

Pseudomonas otitis infections are challenging otitis cases. Clinically these cases present with purulent to black tarry exudate (as seen in this picture) and erosive to ulcerative otic canals of one or both ears.

The intrinsic multi-resistant genes of this bacteria, plus their gram-negative cell wall, efflux pumps, and biofilm production contribute to their natural resistance to antibiotics. Their destructive enzymes (i.e., proteases and collagenases) cause significant epithelial damage to the ear canal and will often rupture the tympanum. It is for this reason that most Pseudomonas cases are otitis media cases. The majority of these cases need to be treated as middle ear disease.

Treatment involves a middle ear flush under general anesthesia, this is important to remove all the exudate that is in the ear canal and middle ear. After the procedure, the client will clean the ear daily to twice daily with an ear cleaner that is good at breaking up biofilm. Ear cleaners with triz edta are good for this. The constant cleaning is crucial. Systemic antibiotics will depend on culture. I will often use a polymyxin otic topical as my first line. Anti-inflammatories, like steroids, in both oral and topical forms, are a must for these cases. Pain control is also helpful. These ears freaking hurt!

Pseudomonas infection in the ear is serious, and needs to be treated quickly and aggressively. These cases should be referred to a dermatologist.
#dogears #otitis #miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology #dermatology #skin #miamivet

421 14

When faced with recurrent ear infections in a dog ask yourself these questions:
1) Have I addressed the primary cause to this ear infection? Allergies are a very common cause

2) Has this ear infection turned into a middle ear infection? Look at the ear drum: is it intact ? If the ear drum is not present then that’s middle ear disease. If the tympanum is bulging or discolored that can also mean middle ear infection.

3) Do I have a resistant infection in this ear? Do your cytology and if you see rods then it’s important to rule out Pseudomonas with culture.

4) Is the ear canal stenotic? An ear canal that has been scarred due to repeated infections can predispose the ear to continued infections. Organisms will become trapped in that abnormal ear canal. The normal self cleaning mechanism of the ear is disrupted in these ear canals. Try steroids to see if the ear canal will open up.

5) Is the client applying ear medications properly? I often find this is a common cause. Either the client doesn’t know how to apply it, or the pet doesn’t allow them to apply it or the client is not applying enough meds. Teach the client how to apply. Consider pain meds or anti inflammatories for these pets. Make sure the client is putting enough volume of med in the ear. Two drops of ear meds into a Rottweiler ear is not enough meds to fill the ear canal and treat the ear.

##miamivetderm #gotitchypet #allergies #vetdermatology #veterinarydermatology #petowner #veterinarydermatologist #dermatologiaveterinaria #vetdermatologist #vet #veterinarymedicine #vetmed #vetmedworld #vetmedicine #veterinarian #veterinario #veterinaria #prevet #vetschool #vettechlife #vettech #medicinaveterinaria #petderm #petdermatologist #petdermatology #dermatology #skin #dogearinfections #dogears #vet #veterinarian

243 1