It’s a new Dawn for Dogs with Allergies

I am just back from a fascinating weekend at the Biltmore house in Asheville, NC where my sisters and I took the Butler’s tour. This basement tour took guests to the basement of this magnificent house to explore the staggering, innovative achievements of George Vanderbilt in 1895 (Otis elevator, coal-powered steam heat, indoor plumbing, and full electrical power which was both AC& DC wired due to suggestion of friend Thomas Edison.)  A surprisingly interesting  side note to our lesson in innovation was the medical recommendations for shock in the electrical room. A bit of a spoiler alert as it does not involve “mouth to mouth” but rather another orifice! 

As I witnessed the sunrise over the estate and took in all that I had learned, I reflected on new introductions in the veterinary world and at Creature Comforts in 2014. Probably the most significant new innovation available in 2014 for pet owners is allergy treatment. So for this week's blog I'd like to explore the topic of allergies allergies.

What are the most common signs & factors of allergies in pets?

These signs include chewing at the feet, rubbing at the face, inflamed/red ears, and licking of the rear end. Onset is under 3 years of age (unless moved to a new climate).This is due to environmental allergens and defects in the outer skin (epidermal) barrier. Pets living mostly indoors and are responsive to steroid use can be typically spared from itching. 

Although allergies to grasses and plants outdoors are often mentioned as causes of allergies & itching, why does my pet have skin issues year round?

Although in North Carolina allergies to grass, trees, and other plants are common sources of misery for pets, many dogs and cats are allergic to  house dust, mold spores, specific foods, and storage mites (mites found in pet food). Thus pets can itch year round, even in snowy weather. 

I have read bathing a normal pet too frequently could dry out the skin; yet, I was recently told to bathe my itchy pet weekly. Why?

The key words here are normal vs. itchy pets.  If a pet is itching it no longer is in the normal category. I advise clients that allergy pets are like giant “Swiffer mops” in the environment, thus maintaining a constant source of irritants on the paws, skin, and fur. By frequent bathing with non- irritating shampoos, owners are decontaminating the fur thus decreasing the cumulative irritant factors of allergens.

Besides bathing what are some of the traditional methods to deal with allergies in pets?

Once eliminating other causes of itching such as primary infections (mange mites, fleas, ticks, lice, ringworm, yeast, and bacteria), veterinarians start with supportive care such as anti-histamines (Benadryl, Zyrtec, & Chlortrimaton) and steroids (prednisone, prednisolone, Medrol, and triamcinolone) for specific, seasonal periods of the year. When pets are uncomfortable with prolonged itching, the self- trauma of scratching may lead to opportunistic skin & ear infections (yeast and bacteria).  Topical spot treatment steroids (Genesis spray) of non-infected areas such as the feet,  veterinary anti-bacterial  wipes (Preva & Malaket), and simply wiping off the feet, belly, and rectum with warm water wiping after being outside is helpful. Oral fish oil (wellactin) is another helpful product as well. Topical application of  a product to restore the lipid barrier  such as Douxo Seborrhea Spot-on  pipettes have added benefits.

What are some the concerns of prolonged use of steroids?

The increase in appetite leading to weight gain, urinary accidents as a result of increase in thirst, and silent urinary tract infections are the most frequent complaints.  Other concerns are changes in the behavior of pets that vary in the spectrum from depression to hyperactivity.  

With frequent bathing are there concerns that topical products for fleas & ticks could be washed off?

Yes, that is one of the reasons the new product, NexGard, was mentioned in the last blog.

What is a food allergy trial and how is it performed?

For pets showing specific signs of allergies, that are repetitive, a food trial that eliminates proteins that are in current or previous diets for 8 to 12 weeks is recommended.

What are some of the ingredients in these hypoallergenic diets?

For dogs that would typically be:  beef, chicken, soya, egg, and milk. 33 years ago, when I was first in practice, lamb was the typical main ingredient in these hypoallergenic diets.  For cats it is typically fish or chicken based diets. Currently, since lamb is in many pet foods, diets of rabbit, duck, and kangaroo are recommended. One new challenge is that specialty pet food companies are combining the multiple, innovative proteins in premium diets, thus finding a diet with novel proteins is often difficult. Working with veterinary nutritionists, some new possible food trials include such staples as fish, pinto beans and quinoa for dogs. In cat diets new proteins are often rabbit, pork, and venison. There are also available hydrolyzed diets with super small proteins the body cannot easily detect. The secret in these diets is lack of exposure  to  food allergens combined with similar avoidance in  chewable heartworm preventatives, treats, and edible toys.  The risk of pure food allergies  in pets are estimated to range from 12 to 33% in pets.

Assuming the food trial makes no improvement in a pet itching, what is the next step?

 Blood testing for offending allergens after being off oral anti-histamines for 7 to 10 days, and steroids for at least a month is recommended. This may be combined with a skin patch test as well. There is no conclusive blood or patch testing for food allergies at this time. Then a vaccine will be formulated based on the test results. It may take up to 6 months to prove that the immunotherapy works.

What if the blood testing fails to make a conclusive diagnosis, or the allergy vaccine fails, what are the next options?

Besides long term use of bathing, anti-histamines, and steroids along with good flea/tick control, up until this point immune-suppressive therapy with cyclosporine (Atopica) has been suggested. Atopica (first came to the veterinary market in 2003) is administered daily for up to 45 days, then alternate day dosing (on an empty stomach) is recommended to find the lowest dose that works. Atopica may take up to a month to work and can result in vomiting ( try freezing capsule and give with a small amount of food), skin warts (viral), swollen gums, reddish ear flaps, and thickened foot pads. By suppressing the immune system this may allow hidden infections to develop and in rare cases, some cancers.  Another drawback is the cost.

What is the new medication for controlling allergies, Apoquel? 

It is an oral medication for dogs over 6 lbs, at least 12 months of age, that may be administered with or without food. It has not been approved for breeding dogs or those nursing puppies. It starts working within 1 to 2 days, a distinct advantage over Atopica. It may be administered with vaccines, antibiotics, and other medications.  It does suppress the itch response, but in a manner different from Atopica. It is also cheaper than Atopica but more expensive that steroids/anti-histamines.  It is administered orally twice a day for 14 days, then once a day. Supplies currently are limited as the manufacturer cannot keep up with demand. Note as in any veterinary product, the FDA advises washing of the hands after administration.  It is not recommended to pre-split tablets at the office.

Dr. Betsy Sigmon

Veterinary News

It’s a Snow day, My Wedding anniversary tomorrow and Valentine’s Day. So what’s news in Veterinary Products?

As a child growing up in Wake County, snow days meant no school, sledding, test rides on my parent’s old skis, plywood jumps, sitting by the warm fire, TV marathons selecting from (gasp!) only 4 channels, and plenty of junk food. As a small business owner, it means the re-scheduling of appointments & staffing hours, walks in the snow,  sitting by the warm fire, TV marathons selecting from 600 channels ( my son and I picked House of Cards), and plenty of my Sister Joanie’s Coffee Cake.

For those recently at the clinic, she is the one that makes the dog biscuit samplers, including now a gluten free variety at the front desk.  Taco Belle only comes out from under the blanket twice a day, settling in for the duration lying beside my son Jason, back from Hong Kong for the week.

So since we all have some time on our hands, let's chat about an exciting new product coming soon to Creature Comforts. 

What is the news about a new oral flea/tick control product, NexGard by Merial? Are there any cautions?  

NexGard is the first oral veterinary product labeled for adult flea and tick control in dogs at 8 weeks of age or older.  It is NOT labeled for use in cats nor in pregnant, breeding, or lactating (nursing) dogs.  It is administered once a month, with or without food, year round.  I would use it with caution in dogs with a history of seizures. It is for dogs 4 lbs and up and does not contain heartworm preventative at this time.

Why is oral prevention such a revolutionary approach for control?

In the south, frequent water exposure through weekly bathing or swimming has the potential to dilute out topical flea/tick control concentrated in surface oil glands and thus lose its efficacy. By administrating orally, and concentration of the product in the bloodstream, not the oil glands, it remains effective even in water exposure.  For parents with children and the concern of topical product exposure, NexGard offers protection against the diseases carried by fleas and ticks without concerns of children touching pets after recent administration.

How quickly may I switch to this product if I recently applied a topical flea & tick control product and am still noting fleas?

Since it is a totally different method of action, there should be no adverse interaction to switching products within a week of each other.

In other products, insect growth regulators are important to control hatching of flea eggs? What makes this product different?

NexGard kills fleas within 24 hours, before they have a chance to produce eggs, thus breaking the life cycle from a different manner of action.  This dramatically reduces repeat infestation in the environment. In homes with chronic flea issues in carpeting or bedding, it will reduce fleas by 98% within 3 months of monthly oral treatment.  A female flea can lay 40 to 50 eggs a day that morph into adult fleas within 3 weeks thus monthly treatment is critical to lower risk of environmental contamination by fleas.

I am disgusted by the appearance of fleas on my dog. Where do pets get fleas and what diseases do they carry?

 Fleas are not only gross in their blood sucking leading to anemia pets and subsequent “flea dirt, bloody poop found on pets”, they also carry a variety of illnesses: plague, cat scratch disease, and tapeworms among others. Feral cats and wildlife such as opossums, foxes, and raccoons, infest the environment around pet homes with fleas  that ride into the home on human clothing or pets themselves. In addition, any place dogs congregate can be a potential exposure site such as dog parks.

Why does the label indicate 98% control of only one variety of ticks for a month Dermacentor variabilis?

Stay tuned, the process to have labeling across all species is time consuming and expensive for product manufacturers.

For dogs that have food allergies, are there any concerns about the mentioned beef flavoring?

No, it is not a labeled concern.  In my dog Taco Belle, who is beef intolerant, I have witnessed no GI Signs.

May it be administered with other medications such as pain meds, steroids, dewormers, vaccines  and antibiotics?

There are no labeled contraindications.

When will it be available to Creature Comforts Patients?

I would like to use NexGard one more time in my own dog and then make it available after the first of March 2014.

I have no concerns with my current use of frontline for topical flea control. Do I need to switch?

No, if you are happy with your current product there is no need to change.

Enjoy the moments with your family,

-Dr. Betsy

Side note: Taco Belle reminds owners of indoor dogs , especially the small ones to make a tarp cover so "tush" does not contact snow during bio breaks. She also warns of toxic ice melts and to watch licking of paws and outdoor water on sidewalks after snows. When possible, use non-toxic ice melts on your own sidewalks such as  calcium magnesium acetate (CMA). This biodegradable  material is one of the safest deicing products because it has very low corrosive potential, meaning less damage to cars, vegetation, sidewalks etc. It costs more than salts such as sodium chloride (rock salt) or potassium chloride(potash), but you use less.  

Dr. Betsy, “What’s The Strangest Thing You’ve Seen As A Veterinarian?”

Dr. Betsy, “What’s The Strangest Thing You’ve Seen As A Veterinarian?”

When in casual social settings in the Cary community one of the most common statements made to me is, “I bet you see some unusual things in veterinary practice!” 

Of course it is true! I have enough stories of veterinary oddities to cover a five course meal and then some. Today, with Valentine’s Day right around the corner, I will share 2 particularly memorable ones. 

As usual at the first part of the business day at Creature Comforts, we check our after-hours messages and receive calls from clients with emergency pet concerns. On this particular day, a pet owner called concerned about breathing issues in her small dog. It didn’t sound good from her description, and I instructed her to come to the office right away. Upon arrival she rushed into the waiting room with her beloved pet clutched to her chest and was immediately instructed to go the exam room. When met by staff members, there was indeed a crisis, but it was not the pet in crisis! In removing the dog from the clutches of the owner’s arms it was glaringly evident she had forgotten to put on a shirt! The dog had no major issues.

The second episode was in my own household. It was Valentine’s Day and our first since adding Taco Belle, my dachshund-chihuahua mix, to our family. Although she was 10 months old and in our “puppy proofed” house, my teenage son had not “received the memo” about keeping his room puppy-proofed. I always get concerned when the house is too quiet with a puppy around. I decided to make a quick inspection. Sure enough, there was a trail of candy wrappers and candy coming out of my son’s room where a stash of Valentine’s candy had been casually left on the floor. And there she was – Taco Belle – standing in the middle of the collection with a guilty look. You know the look… the “I have been a bad dog” look. 

Of course dog behaviorists tell us they are simply reading their owner’s body language, but however you interpret it, Taco Belle definitely had the “guilty as charged” expression. It was evident something was in her mouth.  As the good dog she is, she immediately dropped the item on command. It was a candy heart that said “I love you.” I laughed and hugged her and all was forgiven.  No harm done, the amount of candy consumed was minimal, and my son had a lesson that was quickly forgotten on the risks of leaving things on the floor with pets around. 

I was fortunate that Taco Belle’s potentially toxic episode was minor. Bottom line: Keep candy away from your pets! But in practice, I see many more poisonings that are catastrophic and fatal. 

Several of my clients have questions about Melamine poisoning and Xylitol poisoning. Today I’ll touch on both. 

QUESTION: I thought melamine was a dinnerware. Why was it in the news in 2007 with pet food poisoning?

ANSWER: Melamine is a component in dinnerware, whiteboards, insulation, and laminate flooring.  In 2007, there were many unexpected death of pets due to kidney failure.  During the process of the investigation, it was discovered that many respected brands of pet food were contaminated with melamine.  China (the world’s largest exporter of melamine) some exporters of wheat, corn, and rice gluten illegally added melamine to cheaply elevate the detectable, nutritional protein levels (for which they were paid). Later investigations exposed contamination in fish, livestock feed, eggs, and baby formula. Recent discoveries of small amounts of melamine in food from animals and crops treated with the insecticide cyromazine, also warrant further study.

QUESTION: How many pet foods were recalled, and how many dogs and cats were actually poisoned?

There is no centralized government database of animal sickness or death in the United States as there is in people. The on-line self-reporting hotline reported 3600 sickened pets, while the US Food and Drug administration reported only 14 confirmed cases. A startling 180 pet food brands were recalled.

QUESTION: What was the outcome of the public outcry from such gross negligence by chemical manufacturers?

After the death of Chinese children in 2008 from melamine tainted baby formula, new standards of laboratory detection of melamine were developed. Melamine can be found in some food packaging & dinnerware where it may leach from such materials in storage, hot food use, and microwaving. This has led to recommendations to not microwave food or use foods with high acidity (ex. tomato sauce) in these containers.  There are ongoing investigations as to the amount of melamine that in cumulative exposure places pets and people at risk for bladder stones, behavioral changes, and certain cancers. Thus, always read recommended uses of plastic dinnerware before random use or switch to ceramic or metal products.

From a veterinarian’s standpoint, the melamine incident was when consumers started looking for grain free ingredients in their pet foods. Although this has evolved into a concern for food allergies (for which the risk is small, and low carbohydrate diets for cats to lower the risk of diabetes), the melamine catastrophe of 2007 was a tipping point.

While the 2 men responsible for the melamine scandal were executed in China, the whistle blower in the infant formula contamination, Jiang Weisuo from Shaanxi province, was stabbed and eventually died as a result of  the injuries in a suspected cover up by authorities.

And now about Xylitol...

QUESTION: What is Xylitol and why is so toxic to dogs and cats?

Xylitol is a naturally occurring sugar substitute in many gums, baked goods, and medications (prescription, vitamins, tooth paste, and mouth wash among others) that lower calories in products made for human consumption. Unfortunately, in dogs and cats  that inadvertently  consume such products, the body falsely recognizes the chemical as high sugar content. The pancreas then releases massive amounts of insulin based on the amount of xylitol consumed and the pet’s body weight. Subsequently seizures, liver failure, and death may occur. 1 piece of 1 gram Xylitol sweetened gum can cause significant low blood sugar in a 20 lb. dog within 1 hour of consuming the gum out of a purse. It is much more toxic to pets than chocolate.

QUESTION: I understand about the consumer goods when it comes to Xylitol, but, should I be concerned about human liquid medications prescribed by my veterinarian, especially generic ones?

Yes. You should talk to the pharmacist before giving a human medication to a pet. It is not always clearly labeled on a medication written for human usage that it contains Xylitol, and there may be no veterinary product substitute for the dosage needed. Take, for example, a nerve pain reliever “gabapentin” that is a 100 mg capsule for people. A 10 lb. dog may start with a ¼ capsule. That is difficult to score, so the liquid version of the medication maybe offered as a substitute. However, the sweetener in liquid gabapentin is xylitol, unless it is specifically compounded for pets. In addition, medications such at OTC children’s vitamins chosen by pet owners for senior pet supplementation may also contain xylitol.  Signs of Xylitol poisoning include weakness, vomiting, staggering, seizures, and depression. The poison pet hotline is 800-213-6680. There is no antidote, only supportive care. Thus prevention of exposure is critical.

Thank-you for any feedback and please let me know any topics of interest.

-Dr. Betsy