Veterinary Question and Answer
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Hi,
Welcome to the wonderful world of lick granulomas! They are an extremely frustrating disease to treat, not only for the owner but also for the veterinarian.
I could write an entire chapter on lick granulomas so I will have to abbreviate a little here. There are three very important things to think about when you are treating this disease. If you don't respect all three, then the outcome will not be as good and trust me, the odds are definitely against you with this disease.
Firstly, you need to address the infection. Usually, these granulomas are very deep infections, sometimes going all the way down to the bone. (Keep in mind that I haven't seen your pet so I'm going to talk in general terms here.) Long term antibiotics (sometimes six weeks or more) are often needed to get the infection under control. Ideally, a culture is done to make sure that the bacteria in the wound are sensitive to the antibiotics that you are using. I have had some dogs do very well on antibiotics alone.
Secondly, you need to prevent the licking. There are various ways of doing this and none of them work in every dog. I have used plastic medical collars, bandages, bitter creams and even "Bite Not" collars. Yes, the medical collars make the dogs look very pathetic but sometimes that is the only thing that will work. Of course, the goal is not to make your dog wear the collar permanently.
Thirdly, you need to find out the underlying cause. This is very important. Why is the dog eating itself?? In some dogs, it is a behaviour problem; these dogs may be a little high strung or easily bored or away from their owner too long or . . . . well, there can be many reasons why dogs are anxious. There are medications to help with these problems (clomicalm is one of these) but as with most behaviour problems, you need to do behaviour therapy as well. One of the most neglected aspects of owning a pet is exercise. How often do you take your pet for a good run or a long brisk walk? How often do you play ball? For some owners, I recommend getting a pet sitter who can come and entertain the dog in the middle of the day. A tired dog is less likely to lick itself constantly. (As an aside here, I had one dog who had a lick granuloma who briefly cured itself after it found a mouse in the owner's fountain. The dog spent hours trying to find the mouse and left his leg alone!)
Sometimes, these dogs are allergic and so must be treated for underlying allergies. Food allergies or pollen allergies can be the culprit. Even arthritis in the joint can cause a dog to lick at it. I often do an xray of the joint to check for this.
Lastly, it is SO important to find a veterinarian who is willing to take the time to guide you through these obstacles. I strongly recommend you seek the opinion of a dermatologist or a veterinarian who is very interested in dermatology.
Good luck with this very frustrating disease.
drphilvegasvet 
Where do you live? You need to go see a doggie dermatologist which shouldn't be a problem unless you live somewhere REALLY isolated.
Ask your vet for a referral. Don't hesitate to do it!
drphilvegasvet
You shouldn't have a problem finding a dermatologist near Atlanta.
Wishing you the best of luck,
drphilvegasvet
Thanks for the kind words.
Lick granulomas are frustrating for everyone. I hope you find a patient veterinarian who is willing to guide you through the obstacles.
Good luck and take care,
drphilvegasvet
Glad things are going well with Louie. Don't stop the antibiotics too soon! Get those sores healed before you even think about removing the collar.
Take care,
drphil
These stories are sooo sad. Lick granulomas are very difficult problems but it seems like you are a great mom so I'll try to offer you some suggestions without the benefit of a full exam and prior history.
It is essential that he not lick at that area. This will be the hardest part of the therapy. The tshirt is a great idea, even if it is not the most fashion forward statement. Bandages are fine, as long as he leaves them alone and you change them frequently (sometimes as often as once daily). You might want to ask your vet about telfa pads which don't stick to the wounds (ouchless!).
12 days of antibiotics are not very long although I would expect to see SOME improvement, especially if he is not licking at that area. Which antibiotic are you using? I have kept some dogs on antibiotics for six weeks, although this is "extra-label" use in most cases.
If you are not getting enough information from your vet, then ask about a referral. If this turns into a chronic problem, then it can be impossible to clear up completely.
Good luck!!
drphil
