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Week 12 Progress Report
The Dogs: the beginning of this week marked the dogs being completely weaned off their prednisone. All looked well -- good enough that I cancelled a recheck visit due to nasty weather as it didn’t seem urgent enough to risk the roads given their condition. Unfortunately this meant waiting 5 more days to re-book, due to days off and another long weekend. I guess my dogs and long weekends do not get along. Within a couple of days of ending the prednisone, Asia was getting reddened, itchy skin more often, and had developed a red rash on her belly. For a couple of days Simba held his own, then took a remarkable turn for the worse a couple of days into this week. It was a Friday night, and over the course of that evening and the next day, he went to shaking his head and scratching his ears repeatedly (though inside they looked clean and normal; no sign of infection). Then he started rubbing his muzzle a lot, including on his paws, something I hadn’t seen him do for weeks. He also started dragging his belly on the floor. By the time Monday’s appointment rolled around, he looked almost as bad as he ever did, and Asia didn’t look much better. Having had the dogs feeling so much better, it broke my heart to see them feeling so bad. Once again I was surprised at how used I got to their itchiness; it seems so dramatic now since they were good for a bit, but I realize they were this bad – probably worse – before we started this work-up.
Recheck Visit: I told Dr. G. that we seemed to be back at square one now that they were off the prednisone (only 5 days now) – they had red, itchy skin and must have been feeling quite miserable. After a quick look she agreed. As we were a couple of days shy of a 12 week food trial (not perfect, but I’m proud of how well we restricted their diet), they should not have been so bad again; if the food was a big issue, they should have improved much more than this. Options at this point include antihistamines or cyclosporine, as our next step will be intradermal skin testing and they cannot be on prednisone anymore if that is our path. Antihistamines are somewhat hit-or-miss when it comes to atopy in dogs: one dog might respond to any given antihistamine while the next dog won’t respond at all. So, to try antihistamines we have to be prepared to try a few to see if any will help. The other option is cyclosporine, a very effective and very pricey drug. Pricey enough that it is almost not an option (nearly $500 for a months supply for my two dogs, at the cheapest pharmacy in town). I kind of knew this was coming, but it is a lot of money (on top of the costs of everything so far). I asked Dr. G. what she feels the success with antihistamines would be, and she was frank: dogs as bad as Asia and Simba rarely get relief with antihistamines. The thought of watching them deteriorate while trying to find an antihistamine that is effective swayed me, and I agreed that cyclosporine would be the best option. We have come so far (and spent so much already), that backtracking seems very unpalatable, despite the cost.
Food Trial: the bright spot this week was that the food trial was officially over! Yay! We are going to switch them to a food called Royal Canin Skin Support. This is not a hypoallergenic or food trial type of food. The theory behind this food is that it makes the skin less permeable to allergens that cause atopy. Dr. G. has had some dogs respond well with this diet so she felt very strongly that it was the best option. However, since we were not as worried about food allergies anymore, they could go back to having treats. They celebrated with carrot sticks and all natural peanut butter in their Kongs. They were very happy!
