Dawg Business: It's Your Dog's Health!: Atopic Dermatitis? Billy's Story (Part IX)

Tuesday, October 4, 2011

Atopic Dermatitis? Billy's Story (Part IX)

By Dr. Jonathan Mitelman and Barbara Kelly

Continued from part 8

When we last left Billy, the side effects of a steroid given for skin allergies had become pronounced, leading to another change in approach.

Dr. Mitelman: No doubt we were frustrated with night after sleepless night of itching and agitation. Convinced that Billy's clinical signs were in fact a manifestation of skin allergies, we pressed on with further diagnostic protocols.

We were disappointed that, unlike most other cases as bad, or worse, than Billy, steroids delivered both systemically and orally could not provide even short-term relief of itching without the penalties of severe side effects.

For Billy, steroids took a toll on his comfort, water consumption, urination, and his liver.

Barbara: The side effect of the steroids that worried me most was the ever-increasing liver values. I was unhappy that Billy's liver was unhappy. I asked for monthly blood work to be done, despite the costs involved, because I was concerned about the long term effects of this.

The constant trips out to relieve himself in the middle of the night, waking all of us from the already limited sleep we were getting, also became hard to deal with. Billy's water intake probably tripled, and that meant his urgency to urinate did too.

He couldn't be left at home without supervision for even short periods of time.

And there was his restless behaviour and growing agitation. All in all, the limited relief from the itchy skin did not outweigh the side effects of the steroids.

Dr. Mitelman: We felt we needed to hone-in on diagnosing his skin condition more carefully. We had eliminated some of the common external triggers that could cause and perpetuate itchy skin including mange, fleas, and yeast growth on his skin (via topical medications and shampoos).

We had changed his diet to one that contains a novel protein, a food source he had not yet eaten.

A balanced veterinary commercial diet made by IAMS, called KO. Not 'knockout' or 'knackwurst and oranges', but rather kangaroo and oats.

Fortunately, Billy didn't even flinch. He would out-compete a billy goat for tin cans. Glad he likes it. But it takes at least 2-3 months to see if any changes were effected.

Barbara: I knew Billy would eat any food we gave him, but was happily surprised that he didn't have any tummy upsets by the abrupt change from his life-long lamb and rice diet.

I must admit when we first switched foods, I still permitted dog biscuits and the banana he so loved. And the odd mini wheat the family 'dropped' while pouring their breakfast cereal into their bowls.

But all that changed, in order to see the results of the Iams KO we had to eliminate all other food sources. I became a tyrant around Billy's food intake. Kibble and only kibble. Billy took awhile to adjust to this change.

So did my husband and son.

Dr. Mitelman: I was thinking that Billy might have "atopic dermatitis", also called atopy or allergic dermatitis.

It is an umbrella term describing a patient that reacts inappropriately and excessively to foreign proteins (allergens), and it's often manifested as itchy skin with variable locations around the body, pathology and intensity.

It's not very specific because it covers a wide range of allergic causes, but it may be appropriate because often the causes are in fact many and have interactive effects.

So, we embarked on the atopy cruise with Billy. He's itchy, he's painful, and perhaps he’s so agitated he trembles. We had eliminated external parasites as a possible cause, and then we changed his diet. We were using cleaners, shampoos and topical treatments.

But what was he allergic to?

Blood was submitted for testing. And thus we discovered what he was allergic to. Everything. Pollens, molds, grasses, dust mites, the whole kit and caboodle.

And not just a little allergic. The numbers were off the scale. That's Billy. Superlatives and over-reactivity comes as no surprise.

No doubt an old cliché comes to mind. "I have never seen these kinds of numbers before.”

Barbara: It took a few weeks to get the results of the allergy testing back. But I was feeling hopeful, at least we might have some answers. Having that hope was important as we still weren't seeing any improvements in Billy's condition.

Dr. Mitelman: Discovering the high numbers and the numerous allergies he had, I suggested we try something to get his immune system to back off.

Atopica is touted as one of the latest and greatest in the management of canine dermatitis.

Atopica is cyclosporine, an immunomodulating drug that messages inter-immune cell communication to limit immune response. It is used in organ transplant therapy as an anti-rejection drug.

Atopica is deemed effective for airborne and contact allergens, but it has no effect on food allergens or skin barrier defects.

Barbara: I was still shocked by how much Billy was allergic to and to what extent. How would we modify our lives to accommodate such sensitivities and what could we do to make Billy more comfortable? Trying the Atopica sounded like a good place to start.

But what about the allergens that this would not cover?

Dr. Mitelman: Acknowledging that even the Queen's mansion has molds and dust mites, I jokingly said, "Maybe you should move house?"

And she did. Now that's commitment.

***

The Kingston Road Animal Hospital, and its founder Dr. Morris Samson, are celebrating the clinic's 25th anniversary this year. VETSToronto, the veterinary emergency trauma service, is housed in this location in the Beach area of Toronto.

The hospital is a full service emergency/after hours/critical care facility that provides around the clock care. There is a doctor on site 24/7/365. Owners Dr. Samson and Dr. Mitelman oversee all cases, providing continuity of care.

Referrals from other hospitals are examined, stabilized and treated, then returned to their regular clinic. Follow ups are done with both the referring veterinarians and the pet's owners.

As a full service hospital we have the following:

on site ultrasound
on site endoscopy
laser and orthopedic surgery
emergency/critical care specialists, internal medicine specialists, and surgeons on call

Tuesday, October 4, 2011

Atopic Dermatitis? Billy's Story (Part IX)

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