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Part 5
Part 6
Part 7
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Dermatology Photo Gallery
The Sixth Week Report - A Major Setback
The Dogs: this is the worst week since the start of the diary. Early in week 6 Asia had a major flare-up, with large red raised patches appearing under her arms; her neck is also red and raw. She is itchy. Very itchy. So is Simba. A bath helps a bit, within a couple of days they both developed red skin, and sores and scabs. They are not as bad as at the beginning of the trials, but this is by far the worst they have been. To make matters worse, I was low on the antihistamine and had to go to every other day over the weekend; so they were kind of a mess when I visited Dr. G on a Monday.
Recheck Visit: Dr. G is a bit surprised at how awful they look today, and gently hints that maybe I should have come in sooner. I do explain that these symptoms have been off and on and only got this bad the few days before our visit. We discuss the nature of their symptoms; the sudden worsening of both dogs (which seems to coincide with a change in weather) despite continuing anitibiotics and a food trial, points in the direction of atopy rather than a food allergy. Atopy is the term for environmental or inhaled allergies (could be pollen, mold, dust, or any number of other things).
I do ask if apples might be allergenic... Dr. G. feels this is a very low possibility. The dogs love their crabapples, and I would hate to take away their one remaining treat (not to mention I would have to pick up apples before the dogs went outside multiple times a day). They also stand on their hind legs and try to knock apples off the low branches with their paws.
We discuss the pros and cons of another immunosuppressive drug used to treat atopy, cyclosporine. While prednisone is great for controlling symptoms but the long term possible side effects make it a poor choice for long term use. Cyclosporin has a lower risk of side effects, but is also very expensive. Apparently, some dermatologists have, in some cases, skipped intradermal testing and going straight to cyclosporin. Dr. G thinks that for 2 large dogs, the cost of cyclosporin long term would be prohibitive as anything but a last resort. We will continue working with intradermal skin testing as the next step, and hope that they are the kind of dogs that respond to immunotherapy ("allergy shots").
Modified Plan:
- antibiotics will be finished within 2 days of visit (end of 6th week)
- start oral prednisone to get itching under control. We will start with high dose but lower the dose as quickly as possible. We have to start thinking about taking them off any type of corticosteroid in order to do intradermal testing in the future.
- recheck in 4 days to see if steroids help and/or whether stopping antibiotics makes things worse.
- continue baths and topical medication as needed.
- will continue plan to switch to goat meat as soon as available.
After a couple of doses of the prednisone they look remarkably good again, especially Asia. It is hard to say if it is just the on-again, off-again nature of their problem, or if the medication is working that well. They are also less itchy - it must be a relief to them.
On a positive note, Asia's suspected histiocytoma, which looked so awful last week (it was getting so big I was sure surgery was going to be next for her), is now about half the size it was at the end of week 5. It gets noticeably smaller every day!
To be continued...
