Veterinary Medicine - April 2008 - (Page 202)

Repetitive licking PEER-REVIEWED and two-hour postprandial total serum bile acid concentrations to detect occult liver disease.3 If the results of the initial tests are all normal but clinical signs suggestive of Cushing’s syndrome are present, consider measuring a urine cortisolcreatinine ratio.4 In addition, measure fasting serum concentrations of trypsin-like immunoreactivity, cobalamin, and folate to rule out exocrine pancreatic and small intestinal disorders.5 If the results of these tests are normal, consider a hypoallergenic diet trial to rule out dietary intolerance or hypersensitivity.5 If the history, clinical signs, and signalment are still strongly suggestive of a medical cause for the excessive-licking behavior, ultrasonography and possibly gastrointestinal contrast studies may be indicated to rule out conditions such as neoplasia. Primary neurologic problems such as hydrocephalus or brain tumors should be ruled in or out based on an animal’s age and breed, the presence or absence of other neurologic problems, and, in the case of a brain tumor, the progressive nature of the condition. A diagnosis of neurologic problems will be more likely if the licking behavior is virtually impossible to interrupt and if, while licking, the dog acts as if it is unaware of its surroundings. With partial seizures, the owners, with thorough questioning, may also describe preictal and postictal periods associated with the surface licking behavior.6 suddenly in a geriatric dog, question the client closely about other clinical signs suggestive of cognitive dysfunction. In my opinion, it is unlikely for a middle-aged or older dog with a placid temperament and no history of anxiety-related behaviors to suddenly develop a stereotypy or compulsive disorder. Most repetitive behaviors in people develop at or before adolescence.7 Barbering in mice and feather plucking in psittacines (behaviors that are being considered as possible models for some human repetitive disorders) develop before or around the time of sexual maturity.8,9 Although it is possible that an adult animal might experience an event leading to an anxiety- or con ictrelated disorder (e.g. displacement or redirected behavior), in older animals, consider a medical cause more likely than a compulsive disorder. Narrowing testing because of ﬁnancial constraints Many clients have nancial constraints that limit the diagnostic tests that can be done on the rst visit. However, a patient’s signalment, history, and other factors can guide you in determining whether a medical or behavioral cause is more likely. Breed and temperament. Many breeds may have a genetic predisposition for certain compulsive disorders (Table 1).10 Although excessive licking of surfaces is not a compulsive disorder that has been observed more in a particular breed, a dog that is susceptible to one type of oral compulsive behavior may be at risk for other anxiety-related behaviors. In addition, in my opinion, some dogs are born with a shy or fearful temperament that can predispose them to anxiety-related behaviors when faced with frustrating or con icting experiences. So when presented with a dog that has a history of other anxiety-related behaviors, a behavioral cause for the licking could reasonably be moved higher on the differential diagnosis list. Persistence of the problem. If the behavior has been present for an extended period (months to years), then a medical cause is unlikely. If a medical cause were contributing to a licking behavior that has been present for several months, clinical signs suggestive of an ongoing or progressive disease process should have already developed or worsened. Age. If the dog is middle-aged or older, evaluate medical causes most closely. If the licking behavior appears 202 April 2008 VETERINARY MEDICINE

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Veterinary Medicine - April 2008 Contents Letters Leading Off The Veterinary Medicine Interview: Dr. Barrak Pressler Idea Exchange Help! My Dog Licks Everything An Update on Anaplasmosis in Dogs CE Form Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - April 2008

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