After a long journey to uncover the reasons why Maddie has been itching and scratching herself, and us, to near insanity we seem to have landed on an approach that has been working for the last 6 months.

First to recap.

The first phase was the elimination diet.

Which was accompanied by trying to use Benadryl to cure the scratching.

There was the Cushings scare.

And let’s not forget the Atopica treatments.

Finally we went for the dog allergy blood test.

And learned that Maddie was most allergic to us!

So, I did what any die hard dog owner would do, I ordered the serum that would allow me to give Maddie the allergy shots that she needed to hopefully desensitize her to the things she was most allergic to.

After getting a short lesson in how to administer shots to my dog I faithfully went home and started the process.

And it lasted for ONE DAY.

Why?

After I read all the accompanying documentation and learned that the success rate was under 60%, and that these shots could possibly be a part of our regular routine FOREVER I simply couldn’t commit to the challenge.

So here is where we are as of this writing:

Maddie remains on Royal Canin limited ingredient food – both wet and dry.

She is on an antihistamine, Hydroxzine 25 mg, which she takes once or twice per day.

In addition she is on a low dose of  Medrol 2 mg – a steroid that she takes 2-3 times per week.

Also, we find that Maddie is one of these dogs that really doesn’t do a great job of expressing her own anal glands so I make sure that this is done at least once per month.

And heaven help us if she gets a flea bite as that will assuredly lead to a hot spot – so we make sure her flea meds are given monthly.

Lastly, as you have likely read that her #1 allergen is Human Dander, we make sure to keep our bed linens as clean as possible.

So far we are doing fairly well and although Maddie does have occasional flair-ups her condition is under control for the time being.

Meanwhile, her brother Oliver has never had an ichy day in his life.

Luck of the pound puppy draw I guess…..

So Maddie is primarily allergic to her humans which, as you might imagine, is a reasonably rotten outcome. Especially considering that she is the sit in your lap and sleep glued to your hip in the bed variety of dog.

Having tried the home remedy route it was time to try something new. It was time to enlist the bigger allergy guns.

Our vet suggested that there was a newer medication on the market that was seeing great results in her other patients. The primary drawback was cost.

And when I say drawback I mean the ‘I’m not spending that kind of money’ kind of drawback.

She had said previously that a one month supply of Atopica (daily medication) was in the neighborhood of $130, and that my friend is a neighborhood I don’t live in.

Fortunately, as the story goes, the manufacturer had reduced the price of the drug (damn kind of a multi-billion dollar corporation like Novartis, no?), and she had also reduced her margin, thus making the medicine almost affordable.

Heck for $40 a month, with the promise of sleep, I’ll give it a shot.

We were warned that the primary side effects of Atopica were nausea, vomiting and diarrhea.  The vet suggested starting the medication with a side dose of an anti-nausea med – which I declined. Especially after she mentioned that most dogs do well on the drug even without the anti-nausea chaser.

Wrong choice.

Maddie was fine for about 4 hours. Then she started to vomit. That was followed by diarrhea. We’re talking about messing up the house style sick.

We were about the throw in the towel and resign ourselves to incessant itching when the vet pleaded with me to try it one more time – on a lower dose and with the anti-nausea chaser for the first 4 days.

The outcome?

Amazing.

I won’t say that she is 100% itch free – hell I’m not 100% itch free – but for the most part she is doing incredibly well.

Yes, I made the mistake of trying to put her back on regular food and learned the hard way that she is indeed still very allergic to chicken.

Dumb human.

When we last left the saga of Maddie and her awful itching self, I told readers about the ill-fated elimination diet that I had tried for what seemed like forever.

It was then that the vet informed me that there was a blood test available to determine the major allergens that were causing Maddie’s distress.

Veterinary Allergy Reference Laboratory (VARL) ran their Liquid Gold test. After having blood drawn and waiting a week for the results, we received the report.

On a scale of 1-6, with 6 being the worst, the allergens are ranked by severity.  The report says that we should “consider Class 2 level and greater for allergen immunotherapy”

Weeds:
W. Ragweed 2
Plaintain 2
Russian Thistle 2
Cocklebur 2
Scale 2
Pigweed 1

Trees:
Maple 2
Melaleuca 1
Oak 2
Eucalyptus 2

Grasses:
P. Rye 1

Epidermals:
HUMAN DANDER 3

House Dust Mites:
D. pteronyssinus 2
D. parinae 2

Molds:
Penicillium 2
Mucor 2
Cladosporium 2
Alternaria 1

Insects:
Cockroaches 2
Mosquito 1
Fleas 1

Wait, WAIT!

You mean the number ONE allergen causing Maddie to lick and scratch herself, especially at night, is ME?

Seriously?

flickr credit

So it has been another 5 weeks since I started the amended elimination diet with Maddie.

Today the vet and I had our call to evaluate the progress.

Note that I called her today for a few very specific reasons:

1. Venison roast at $10.99 a pound is not sustainable for this family’s budget
2. I have boiled and chopped enough potatoes to feed the National Army of Kazakhstan (pretty flag, no?)
3. Last night, for the 5th (or was it 50th) night in a row Maddie has awakened me licking and scratching her vulva and accompanying regions

The conversation went something like this:

Doc: How’s the scratching?

Me: On the margins somewhat better but she still wakes me up scratching.

Doc: Next step would be an allergy test.

Now at this point I am waiting for her to describe the scratch test. You know the one where they inject small amounts of the allergen and monitor the bumps that form.

But noooooooo……

Me: So the scratch test right?

Doc: No, they now have a blood test that looks at 40 different allergens and it is specific to Southern California (grasses, plants, etc.)

Me: How long have they had that test?

Doc: About 15 years.

What? Wait. WAIT! I have been doing the whole elimination diet thing as a way to try to figure out what is causing Maddie (and me) to be miserable and to save the $1800 plus dollars for allergy testing.

Me: So how much is the blood test?

Doc: $231.00

Me: WHAT? WHY DIDN’T YOU TELL ME THIS $231 TEST WAS AVAILABLE BEFORE I FED THE ENTIRE ARMY OF KAZAKSTAN POTATOES AND VENISON???!!!

Maddie went for her $231 allergy blood test today.

The results are back in two weeks.

My money on still on the fact she is allergic to the cat.

It’s been six weeks since I started Maddie on the elimination diet in the hopes of controlling her itching and scratching.

And for that six week period I have been diligently making the food mention in Dog Food Allergy Elimination Diet.

Maddie loved it.

Could not wait to eat.

Licked the design off the bowl!

Yesterday it was time for a chat with the vet to discuss the progress of the diet. It was during this discussion that she asked exactly what I was making.

As soon as I said ‘chicken’, she interrupted to inform me that chicken is the number one protein that causes allergic reactions in dogs.

What?

You mean that was six weeks of cooking dog food for no results?!

She went on to tell me that the true elimination diet had either duck, rabbit or venison as the source of protein.

And, no, chicken would not work.

Well I don’t know where you live but duck, rabbit and venison are not real prevalent in my local supermarket.

The vet suggested that Pinto beans are a great source of protein and that I could substitution a meat protein with Pinto’s.

Faithfully I remade the recipe mentioned above and replaced the chicken with Pinto beans. It was actually easier to make since there was no chicken to cook.

I dished out a batch to Maddie and instead of licking the bowl clean she looked at me with an expression that simply said “Really? You expect me to eat this?”

So there I am with a HUGE pot of potatoes, pumpkin, peas and Pinto beans with a dog that has no interest in eating any of it.

So I start to Google local meat markets to see if they had duck, rabbit, or venison.

Fortunately I found a shop up the steet that sells venison patties.

So I microwaved (sorry folks, that the method of cooking I’m left to after this fiasco) the patties, poured the juice into the pot, and crumbled in the venison.

Whoa! Home run!

She loved it.

Only 4 more weeks of this until the next vet discussion.

You watch. It will turn out that she isn’t allergic to any food – she’ll turn out to be allergic to the cat!

Previously I’ve shared the challenges of Maddie and her rather recent flair up of scratching.

Last week, while I was at the vet for the cat I asked the doctor about food allergies.

Mind you, I’m no rookie when it comes to dogs that can’t stop licking, scratching, creating hot spots, or otherwise making themselves, and me, miserable.

This time out the vet and I spoke about diets that would help to eliminate the causes of food allergies that Maddie might be experiencing.

In the past I was used to switching the overly aggressive scratcher, or a dog who was suffering from gastrointestinal issues, to a diet of only boiled chicken and whole grain rice.

The doctor explained that a true elimination diet would consist of a protein, namely rabbit or venison, and a starch, potato. This limited diet would be fed for 6-8 weeks after which we should be able to determine if the scratching had stopped.

She recommended Royal Canin Limited Ingredient food.

Knowing that the likelihood of Maddie liking this concoction was slim I still bought 6 cans of the rabbit formula. At $2.91 per can I already knew that, even if she adored it, it was a not an affordable alternative for the next 6 weeks – but I committed to giving her a taste.

As I suspected the reception was, well, unenthusiastic.

You know when you feed your dog something and they look at you with expression that says, “That’s it? That’s the best you’ve got?”

I knew it was time to make my own ‘limited ingredient’ batch of food.

Here’s what I made:

• 2 packages Trader Joe’s frozen chicken breasts (approximately 20 breasts)
• 2 – 13 oz. cans of Libby’s Pure Pumpkin (note that this is not the garbage filling that you make pumpkin pie out of)
• 8 medium Russet potatoes
• 3 tablespoons of olive oil (I’m not sure of this was the right amount as I think a bit more would have also been o.k.)

Boil the chicken until cooked. Then, in the same water as the chicken boiled in, boil the potatoes.

It’s important not to boil the potatoes too much. The cut potato should be able to hold a firm ½ inch dicing without crumbling.

The chicken was chopped until fine in a mini Cuisinart food processor.

In the same pot that the ingredients boiled in, after the water has been removed, mix the chicken, potato chunks, olive oil and the two cans of pumpkin together.

As all of this was being cooked Maddie stood by my side trying to control her excitement and the drool.

When I served it to her I thought she was going to eat the bowl that it was served in!

We’re on day three of the diet and it’s clear that I need to make more.

I’ll keep you posted on the results.

flickr credit

In the last post Maddie’s incessant licking and scratching was discussed.

A new development is that she has now added licking her paws to the mix.

The last time I was at the vet she suggested Benadryl. As an antihistamine it was supposed to help, along with bathing with a gentle oatmeal based shampoo.

Truth be told I was not committed to the use of Benadryl until I did some additional reading today.

Importantly you should check with your vet to see if they advocate the use of Benadryl for your dog. Included in their consideration will be the types and amounts of other drugs that are being administered to your dog.

Special consideration should be given to dogs that have thyroid issues, glaucoma and cardiovascular disease to name few.

What I found is that Benadryl is used for a host of purposes including:

• Controlling itching
• Help stop vomiting
• Motion sickness
• A mild tranquilizer
• Snake bites
• Vaccination reactions
• Insect bites or bee stings
• Blood transfusion reactions

The type of Benadryl that you give should be the name brand.

Alternately it you choose to use a generic brand, which would be cheaper, close attention should be paid to the ingredients.

Diphenhydramine is the active ingredient in Benadryl. Generic brands may have ingredients that will cause your dog harm. For instance acetaminophen, a common added ingredient in some generics, can be lethal to dogs.

Some people are giving their dogs Benadryl in liquid form. This might be o.k. but only if you can verify that the liquid version does not contain any alcohol. For that reason the pill form is preferred.

At one point I was concerned that the amount of Benadryl I was giving Maddie was excessive. She was receiving 25 mg once per day. It seems that the guidelines vary by very small amounts.

As such I plan to administer every 8 hours using these guidelines:

• Dogs under 30 lbs = 10 mg
• Dogs over 30 lbs and less that 50 lbs = 25 mg
• Dogs over 50 lbs = 50 mg

Others have suggested 1 mg per pound of dogs weight.

Given what I’ve learned I will continue to give Maddie Benadryl .

The dose will be 25 mg.

Instead of once per day I’m going to move to twice per day.

Next thing to try to ease her discomfort will be adding oil to her food. Salmon oil, omega 3, olive oil are all possibilities.

As if one dog in the house was not enough fun, recently we added a second.

Meet Maddie.

As a rescue from the Orange County Animal Shelter (aka Death Row), she was in beat up condition when I rescued her. Not that she was injured per se – she had just had a rough life to that point.

Since she was a rescue of course there is no way to plan for any of the health concerns that might be plaguing her. After all the shelter simply guesses her age, does a cursory health examine and then either adopts her out or kills her.

For the first 3 months of her time in our house Maddie was as normal as most rescue dogs could hope to be.

Tired, scared and simply getting used to her new surroundings.

At about that three month mark she began to get skin rashes.

And then she began to scratch.

And then she began to lick her vulva.

Multiple trips to the vet have yielded the following insights:

1. Through a couple of courses of antibiotics the rash has gone away – and mostly stayed away. As a result it does not appear that her scratching was being caused by a single incident skin ailment, such as a run in with a pack of hungry fleas or contact with a plant like poison oak.

2. After an unsuccessful course of steroids I determined that a bitchy, thirsty, constantly peeing dog (who was still learning house training) was not the right solution.

3. The food she is eating is top of the line. She and her partner in crime, Oliver, only eat Evo or Merrick. Recently they have also added Homemade Doggy Dinners to the mix. This recent addition has had no effect either way regarding her scratching and licking.

4. She gets shampooed once per week with either earthbath Tea Tree Oil & Aloe Vera or earthbath Oatmeal & Aloe. These baths seem to calm down the scratching and licking for a day or two but not more.

5. She is on a 25mg dose of Benadryl per day. Maddie is a, how do I say it, nasally dog. She sounds like she needs to clear her throat and cough up a phlegm ball. It seems that this treatment is helping – if only on the margins.

Our most recent trip to the vet ended with her suggesting that Maddie had allergies of varying varieties. And, like humans, those allergies can manifest themselves in a host of ways.

Scratchy throat, watery eyes, runny nose, skin itches, ear itches and eye itches can all be signs of allergies in people.

All of these and itchy vulva, ear irritation, skin irritation and more are signs of allergies in dogs.

The worst part about her scratching and licking, for both of us, is the fact that for some reason it is worse at night and Maddie sleeps on our bed. That means that at least once per night I wake up to the sound of a dog aggressively licking her vulva and scratching herself. Needless to say it irritates me and it is making her miserable to.

Hopefully we’ll get to the bottom of her skin allergy issues soon. I need the sleep and I’m not sure her poor vulva can take anymore of the licking!

Poor Annie

In the latest round of skin issues we went to the vet with another flare up of her skin.

Her belly was bright red and she was miserable. And so were we, since she would lick all night long.

The vet decided that it was time to take a culture of the infected area and see what would grow in a petri dish.

Three days later she called to say that there were two skin bacteria growing.

One that was related to the Mursa staph infection.

The solution was for her to have shots one a day for five days administered by us. These were to be 5 cc shots which represents a fairly significant dose.

We were warned to keep an eye out for increases in water consumption and urination as this drug had negative indicators for the kidneys.

Sure enough 5 days in Annie started to drink like a fish and and pee like a horse.

We were advised to stop treatment and come in for a ‘recheck’.

Over the last 6 months Annie (pictured at right) has been in, what we thought, was a simple aggravating battle with skin allergies. Just another annoying case of dog allergies that often plague our pets, right?

Her symptoms at various times were:

• chewing herself, primarily around her rump
• dandruff which would not be washed away
• skin pustules: small round spots all over her back that would flake, turn red, and then potentially bleed and get infected
• increased water intake
• increased food intake
• abdominal enlargement

We explored solutions that included:

• testing her diet for allergic reactions by eliminating treats, canned food and dry kibble and moving to a rice and ground turkey diet
• periodic treatments with prednisone – steroids
• ten day doses of Cipro – antibiotic
• medicated shampoos

While most of these provided some form of temporary relief, none of these resulted in sustainable solutions to Annie’s problems.

Shortly after the loss of our Golden Retriever we decided to get more aggressive with finding out what was causing these outbreaks.

Annie was taken to a veterinary practice that specialized in animal dermatology and was given a blood workup, to check liver value, along with biopsies of 3 of the skin sores. The results showed signs of Cushing’s disease. As a follow up, and to confirm the diagnosis, an ACTH Stimulation Test was performed.

This lead to a positive diagnosis for Cushing’s disease.

In order to identify whether the disease was caused by a tumor on the adrenal gland, 20% of cases, or over secretion of ACTH by the pituitary gland, 80% of cases, additional testing was required. There are a number of possible tests including an abdominal ultrasound to determine the size of both of the adrenal glands and to compare the glands against each other.

Abdominal ultrasound is helpful in three respects. First, it is a good test to evaluate all of the abdominal organs in the dog. Secondly, it is used to study the size and shape of the adrenal glands. The adrenal glands in pituitary dependent Cushing’s are usually normal in size or enlarged. If a tumor is present however, one adrenal gland is often abnormally large or of uneven shape. Finally, if a tumor is suspected, ultrasound can help identify any metastasis to other organs.

In Annie’s case the ultrasound had good news…..and bad.

The good news was that the root cause of the disease was not based on a tumor on her adrenal gland.

The bad news is that during the ultrasound a mass was detected on her spleen

Splenic tumors are treated as a fairly serious condition as the spleen can rupture due to the mass and causes massive bleeding. This meant Annie would need immediate surgery to have her spleen removed, a splenectomy.

The operation was complicated as the mass had grown in a star shaped pattern over and around her spleen. The fortunate news is that no other organs appeared to be affected by the mass.

The patient is resting comfortably as we nervously await the results of the biopsy that was performed on the mass to determine if it will be benign or malignant.

All dog owners are recommended to have their dogs properly evaluated by veterinary professional for root causes to allergy symptoms. What may appear to be one heath issue related to dog allergies may reveal another issue that may save your dogs life.