Saturday, November 10, 2012

Jasmine's Episodes: Back To The Allergies Dilemma

For the longest time, Jasmine's vet and us couldn't come to an agreement whether allergies could be behind Jasmine's episodes (and some of her other off-and-on issues)


Allergies have always been one of the theories on the table, with our vet being quite convinced that this is at the root of the problem.

Allergies might be the most viable theory we have, at least one that couldn't be disproven—does that make it a good one, though?

It is true that Jasmine's past allergy test came back positive for all kinds of things. It is also true that long enough into an episode she will start licking and chewing at her front feet (the episode has to last at least 5 hours for that to happen). It is also true that release of histamine could lead to rise in temperature and the panting.

On the other hand, Jasmine is not an itchy dog! She is the least itchy member of the household! Her episodes seem related to weather changes but NOT seasons. Her appetite and stool quality doesn't seem to have any correlation to the episodes.

If this is a disagreement we've had for a long time, why does it matter now?

Because now the sublingual immunotherapy (SLIT) is available. It seems to have good results and it is way safer than the injections. So IF allergies were indeed behind Jasmine's episodes, this would be a good way to go.

So what's the problem?

Well, for one thing, I do agree with the philosophy “if it ain't broke, don't fix it.” Do positive lab results really always translate into actual problems? In the past, hubby had tested positive for about everything under the sun, and only couple of specific pollens actually give him real trouble.

Of course, there is no harm in testing, other than this test requires quite a large amount of blood, which will make Jasmine pretty unhappy, and one has to wonder how much being under stress may or may not affect the results.

Secondly, the lab that provides the SLIT for us up here in Canada has quite a stiff price for the testing bit.
  • allergy testing indoor, outdoor and common foods $398
  • optional, but recommended, allergy testing for uncommon foods $102
  • if a candidate for allergy drops, 12 allergens or less $135
  • 22 allergens or less $195.

This whole adventure could add up to $695.

If we were to do this, it would make sense to go with the whole shebang. Not that we haven't spent (and spend regularly) a whole lot more on Jasmine, but we don't have extra seven hundred dollars lying around. And if we do come up with it, what if something else crops up? (not unusual for Jasmine at all)

Here is the thing. If I were convinced that the allergies are the problem, we'd do it, no doubt.

But neither hubby or myself are convinced.

We love our vet. I know he has a picture in his mind, based on the available information and his experience. Unfortunately, this picture doesn't match to the one in our minds. On the other hand, he is an awesome vet and we put a huge value on his expertise; he's earned it. Otherwise we wouldn't be having a dilemma in the first place. But we see Jasmine 24/7.

My biggest concern is, and has always been, making a wrong call for Jasmine.

What if it really is allergies and the treatment could just be the miracle she needs?

What if it is not, or the treatment doesn't work (doesn't work in about 30% of dogs) and we spend all this money and won't have it to deal with something else urgent that comes up? Jasmine's maintenance doesn't come cheap. There is her chiropractic care, hydrotherapy and acupuncture she gets regularly. She does seem to be benefiting from those. Then there are all the supplements and goodies she gets. And then there is the precedence of something always cropping up.

For a fresh set of eyes, yet again, I turned to VetLive.

VetLive has become my go-to place when facing a dilemma or dealing with a problem when our vet isn't available.

They tend to agree that this doesn't look like allergies. You would think that would make me feel better and make my decision easier.

Interestingly enough, this did NOT make me feel better, or make my decision easier. 

Perhaps I was hoping they'd agree that it IS allergies? Is it possible that our observations are more truthful than our vet's conclusions? He is, after all, THE vet—REALLY smart, competent, experienced and invested in Jasmine's well-being.

Another thing is that we cannot take forever with our decision.

The treatment takes quite a long time, it is best done during allergy off-season, and I'd prefer to do this outside any vaccinations or other challenges to the immune system. Jasmine will be due for lepto as well as her 3-year rabies vaccine next spring. I would also like to keep these to apart and fit them into the allergy off-season. Which means we'd best start as soon as possible.

Presently we're having an ongoing dialog with Jasmine's vet. Somehow we need to come to an agreement. We have to come to a conclusion we can both be convinced is right.

What do you think? What is your experience with allergies in your dog?


***

Here is the conversation we had with VetLive.

VetLive: Is there anything in Jasmine's history, other than the feet and occasional eye discharge that is making your vet think this [immunotherapy] is a good route (not saying it's not, I just want to make sure I have as complete a picture as possible).

As far as the panic and distress, what happens? Any idea what causes this? Is this a new problem?

Has the foot chewing gotten worse over time? Is it seasonal? Is it only after panic, stress, boredom, anxiety?

What treatment do you do for the pododermatitis?

Also, there is obviously no harm in doing the testing; do you want another opinion as if I think it is a good way to spend limited funds?  I have done some initial research on SLIT and so far, it looks pretty promising. I have no experience with it myself, so I would like to see if I can learn what a dermatologist or clinician with a strong interest in allergies has to say about it.

Jana: She does have eosinophilic gastroenteritis which was concluded a result of food allergies (SLIT environmental ones only, though)

It is true that the old test does list a number of allergies to all kinds of things.
It is also true, though, that she gets the episodes independent on seasons.

Her vet observed her during one of the episodes, when she was seriously going after her front feet.

It is true that she tends to eventually have raised temperature if the episode lasts long enough, which could possible be as a result of histamine release?)

These episodes can last anywhere from 30 minutes to 36 hours. There seem to be correlation between the episodes and weather changes (typically BEFORE, not DURING storm etc; weather change without storm, such as now Sandy, will likely lead to one also)

All other theories about what is causing the episodes on and off table (e.g. not Cushing's; I don't believe actual panic/anxiety ...). Atypical Cushing's considered but was told that effects of treatment likely make her more miserable than the problem itself if that was the case.

The episodes are not a new problem, started when she was about 2. Interestingly, when diagnosed with hypothyroidism and put on Thyrotabs, episodes disappeared for about half a year; just to return again (and this seems not related to her thyroid hormone levels)

Foot chewing only long into an episode. Some time back she was licking her foot a lot (that's when the swelling, fungal infection and furuncle discovered).

My observation is that
a) licking follows infection, not the other way around; of course I could be wrong
b) front feet start bothering her when episode lasts long enough

Feet were treated with either Dermacool, kept under control by spraying ear cleaner from all things, or 50/50 betadine/rubbing alcohol

There is no harm in the testing part (other than large volume of blood which she will hate having taken) other than the cost ($500) which is money we won't have available for other things. So question is whether this is a beneficial investment or taking resources from things she might need/benefit from more

There is slight potential harm from the treatment, for which this testing would be done, hopefully Jasmine might surprise us and have no reaction.

So the reason for asking mainly is - should we drain resources by doing this or should we keep for other things (e.g. she is getting regular chiro, hydrotherapy, acupuncture, supplements - all these things cost money, plus something new might crop up)

Strangely enough, we still don't grow money in trees ... ;-)

We find it difficult to invest $600 into something we are not convinced she needs. So the question is, does she need it and will she benefit from it?


I do think SLIT is a good thing to try IF dealing with allergies. (I do think that what they charge for the testing is rather criminal)

Reasons vet feels this better than injections
- lesser chance of adverse reaction (apparently no anaphylaxis reported with SLIT and only reports of minor local reactions such as mouth itching ...? Of course Jasmine's body has always its own ideas)
- apparently better outcome possibility with multiple allergens while traditional needle injection limited in results for multiple allergens?
- Jasmine hates needles


VetLive: When you did the testing in 2008, was any desensitization treatment pursued? If not, was there a reason?

As far as the testing, did you get a quote for intradermal testing? I know the Heska testing is expensive and the hospital I worked out that did intradermal was many years ago so I am not sure what the current costs associated with intradermal are but is considered superior.

Jana: No, on the premise that positive results unlikely with so many allergens and how does one pick just a couple? Also that one was MAINLY done in the process of coming up with the IBD management. Also too many other things on the table then.

Didn't consider intradermal, have to admit that I hate the idea of doing this to Jasmine, plus she has a hard time regrowing shaved fur.


You see, when I compare Jasmine with JD, for example, would have to be JD who suffers with allergies (scratching and licking himself way more than Jasmine). It is true he hasn't had any skin infections or any other secondary issues but he is 10x itchier than Jasmine is.

 VetLive: There are a couple of things that would make me "guess" more towards the side of no. It is such a tough call though because we know Jasmine isn't normal and doesn't tend to follow the typical information available.

Still, I am trying to be scientific and rational in my thinking. With just the foot chewing there, and it being year round, and associated at odd times, I am not convinced it is actual allergic chewing.

I think the hypothyroidism is more likely—statistically speaking—to be the cause of the skin problems, which don't seem to be widespread skin problems. I also can't make sense of the episodes and foot chewing stopping when the hypothyroidism was first diagnosed and treated. Yes, allergies get worse with time, but why did they stop if mysteriously at that time? True, it could have been a coincidence, but I think other reasons are more likely.

I understand too many things were on the table then, and I completely understand your and your vet's reasoning. I also understand his reasoning of wanting to test to see if this is something. I wonder though, if she tests positive--mildly or strongly, whatever situation you want to imagine--how much is the SLIT going to cut into her other medical budget? Would you still pursue full on treatment if her conditions don't seem to be that severe (at least to me via an Internet consult). If it is going to cut money from chiro, hydro, etc. that you know helps her and she needs, I have a hard time putting foot itching above joint pain. I am not trying to belittle her foot itching, but with it being difficult to even classify it as true allergic itching, this is what brings me back to her needing the more concrete therapies that are keeping a dog with a plethora of ailments leading a happy and pretty healthy life, all considered.

It looks like SLIT is effective from the studies about 70-75% of the time. Some vets have raised questions about if this rate will be different for patients that have GI issues, like IBD. We don't have much data available on this. This isn't a reason to not try it of course and I know you aren't one to hold off because something is new. But, it is because we are picking and choosing with limited funds that to ME, it becomes a consideration that I don't believe I would pursue, at least at this time.

If her symptoms increased, changed, became seasonal, relentless, etc. then I think I would want to test. If she was itchy and as uncomfortable as JD even, then test. But I don't know that I would prioritize this as one of her biggest issues (budget-wise).

The episodes don't look like any allergies I've ever seen, heard of, or read about.

Related articles:
This Is What Jasmine's Episode Looks Like
Gotta Try Everything Once (Or Twice): On The Quest To Figure Out Jasmine's Episodes 
Thundershirt vs. Jasmine's Episodes
Jasmine's Mysterious Swelling And Another Experience With VetLiveThe Diagnosis Is In: Jasmine Has An Interdigital Cyst
Jasmine's Mysterious Swelling And Interdigital Cyst Update  
Is Crawling Under Things Some Kind Of Secret Physical Therapy?  
Is There No Place Safe? Jasmine's Acupuncture Session
Senior Sensory Systems Function: Zero Defects  
It Looks Like A Keeper: Jasmine's New Integrative Vet 
Jasmine's Acute Lameness
Jasmine Doesn't Like "Doing Time"
Our Of Jail Free Pass
When It's Looks Too Good To Be True … The Lameness Returns
The Day Of The Treatment
First Time For Everything: A Healing Crisis(?)  
From Zero To Sixty In Four Days: Stem Cells At Work
The Calm After The Storm 
If It Was Easy, It Wouldn't Be Jasmine
Practicing What I Preach: Jasmine's Semi Annual Wellness Exam  
No Skimping On Oral Care   

***
Meet Jasmine
I'm Still Standing! (Happy Birthday, Jasmine)
How Dogs Think (Well, Jasmine Anyway)
How The Oddysey Started: Jasmine's ACL Injury
Jasmine is Vet-Stem's poster child!
Rant About Quality Of Life Versus Quantity, And Differential Diagnoses
Jasmine Is Headed For Her Next Stem Cell Treatment
Jasmine's Stem Cells Are In
Arthritis? What Arthritis? 
Guess Who Is An Ever-Ready Bunny And Really Liking The Bit Of Snow We Got? 
Don't Knock It Until You Tried It: Animal Chiropractic 
Jasmine's Fur Analysis
Back At Chiropractic Care

14 comments

  1. This is probably not helpful at all and it's certainly not scientific... but I would go with your gut. Plus, I definitely think stress makes everything (everything!) worse. Not dog related, but my husband is struggling with an adverse reaction to a drug eluded stent (heart surgery). Every expert has different ideas. None help so far. Stress makes all the symptoms worse.

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    1. Hi Sue, thank you so much. The stress [Jasmine's] would of course be just temporary; but how much will it change what the lab results say? Some believe that it does.

      My gut is confused because in terms of allergies being the root of the problem my gut doesn't think so. In terms of trusting our vet, my gut normally trusts him.

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  2. Hey Jasmine, Jet here.

    Oh darn, wish we had pearls of wisdom to share. We can understand your dilemma... Mom asked me to share that just like K9s, go with your instincts. You already have intentions for the highest possible good. :)

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    1. Thank you, Jet. My deep down instinct says it's gotta be something other than allergies. My instinct feels it has to do with one hormone or another. But no other theory could have been confirmed and this one cannot really be disproven. At least I wouldn't know how.

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  3. I agree...go with your instincts. You've done an amazing amount of research that should help in the decision-making.

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    1. Thank you. I did learn a lot but it's not really helping me much in this case :-)

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  4. Could the foot chewing be related to a pins & needles or tingling feeling in the extremities after an episode (and if so, how the woof would you test for that?)

    Felix was foot chewing again last summer and my immediate though was "Oh, here we go again with his allergies!" He had a chiropractic appointment anyways (unrelated to the foot chewing) but after that, the foot chewing stopped. The vet supposed that perhaps the spine being a little out of whack was giving him an odd sensation in his paws?

    At any rate, this SLIT testing sounds really interesting!

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    1. I know, right? There is no way to determine whether the feet are actually itchy or tingly! To my mind there is also no way to determine whether whatever sensation that is isn't brought on by whatever else is causing the episodes or simply by the stress of it. (such as people can get hives when stressed) And the reasons why feet would be tingly would be completely different reasons.

      Very interesting about Felix's feet! Jasmine sees her chiropractor every 3 weeks, though, and there is no pattern to be detected in relation to those either. However, Jasmine does have some abnormalities in her neck, perhaps those could be aggravated by weather changes? But why wouldn't the episode start with the feet, then, instead of it taking quite a long time in?

      Mild episodes respond to massaging of left elbow and shoulder area ...

      Yeah, SLIT sounds really great, if we were convinced Jasmine's problem lies in allergies, we'd be all over it.

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  5. Woof! Woof! We can relate to your allergy problems. As a Golden I suffer with allergies. During my early years it was difficult to figure out why and what. We are very fortunate that our vet was very patient and worked with us. Yes we spend numerous vet visits and of course it was very costly. Basically trial n error. It took many many years to elevate the major allergy issues I had. mom had to change my food to grain free and she started to make my own treats. Regular washing of my feet after a walk or just being outside is really important (has been a ritual since I was young so been used to it). Extra/daily grooming is also important.
    It's hard to judge ... since every dog is different. Sometimes you think it is under control but there time it will just reappear. Yes it can be stressful for both you but just have to be strong that it will be resolve soon. Lots of Golden Woofs, Sugar

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    1. Hi Sugar, thank you for visiting! So were you itchy all the time with those allergies? Or just sometimes?

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  6. Jana - I think you are the most responsible dog owner I've come across and I truly believe that the research you do along with your experience with your dog will definitely help. Trust your gut.

    The only allergies we've experienced is with Rodrigo's paws. Our veterinarian told us that it was because he was allergic to grass, but an interaction I had with you made me question that.

    I did more research and learned that all the things that caused him to lick his paws like crazy (fresh cut grass, wet grass, snow) had one thing in common and we tried something new that solved the problem. We wipe off and thoroughly dry his paws when he comes inside.

    This probably isn't helpful in your situation, but I do appreciate you prompting me to dig deeper. And that gives me faith that you'll find an answer here.

    Kimberly

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    1. Thank you, Kimberly. How did the problem present? (sorry if I should have remembered) Was it constant? Directly after walks? Or random?

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  7. It's such a tough decision, we don't have a lot of experience in this area…..

    We just remember that Mum's parents Jack Russell suffered from allergies for such a long time, the vet said it was probably grass as her belly was so itchy and she would rub it on the carpet until it was raw, they tried everything including steroids. My Mum eventually convinced them to try grain free food and it was the perfect answer and now she doesn't need medication and is so happy!! I guess they just got lucky and eventually worked it out….

    Good luck with the decision,

    Your pal Snoopy :)

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    1. Hi Snoopy, thank you for stopping by! Well, it's not the toughest decision but it is tough.

      You see, you just described it, "Russel was rub his belly on the carpet until it was raw." Jasmine is not exhibiting such symptoms, rubbing, scratching, licking ... with the odd time during a long episode ...

      Glad grain-fee food worked for Russell! Jasmine has already been on grain-free diet for quite some time, though.

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