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Roger L. Welton, DVM
Roger L. Welton, DVM, Veterinarian
Category: Dog
Satisfied Customers: 1403
Experience:  Licensed Veterinarian, Practice Owner, and Book Author
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Hi there! Male Chocolate Lab, 4 yrs, has a history of Eosinophilic

Resolved Question:

Hi there!

Male Chocolate Lab, 4 yrs, has a history of Eosinophilic Granuloma (confirmed through cytology and biopsy). Allergy skin test shows no major allergies. Most recent flare up is severe, covering most of the body (see photo link) and features a Methicillin Resistant Infection. Lesions are oozing fluid and eyes nearly swollen shut. Elevated pulse (150) and relatively normal breathing. He does not play anymore but still gets excited for walks and treats. Weight loss due to lowered appetite. Bowel and urine functions are both normal. Lupus is not suspected because the tip of the nose is not affected (though the bridge and eyes are). Thyroid not suspected because of weight loss.

Blood work overall normal with slightly elevated liver enzymes and white blood cells (due to medication, his vets say).

- 6 week trial of Atopica (100mg twice daily) showed no improvement; EG continues to spread.
- 2 weeks of Prednesolone (20mg twice daily) showed initial improvement and then no improvement.
- Clindamycin (300mg twice daily) for infection - does not seem to be helping.
- Hypoallergenic Vegetarian Prescription diet
- Bi-weekly dose of Revolution
- Chlorhexedine 4% shampoo twice weekly
- Dermatologist just added Minocycline (200mg twice daily)

The animal dermatologist and regular vet are stumped. I don't want to give up on the poor guy yet because he is so young. I would love to hear any suggestions you have.

Thank you so much!

Link to photo: http://i44.tinypic.com/2ngelvc.jpg

Best,
Dan
Submitted: 1 year ago.
Category: Dog
Expert:  Roger L. Welton, DVM replied 1 year ago.
Hello,

I admire your dedication to your dog, as this is a very advanced case...in my experience and based on the history you provided (and the picture you provided), this is the worst case of EG I have ever seen. You have really run the gamut of treatment at this point, but I have some additional suggestions you may want to take back to your primary veterinarian and dermatologist:

1.) EG is an autoimmune disease, meaning that the primary cause is the body's own immune system is attacking its own tissues, in this case, the skin. As such, in cases of severe autoimmune disease less than ideally responsive to prednisone, I have had success in adding an additional immunosuppressive (and generally pretty well tolerated) drug called azothiaprine. This would be given once a day in addition to, not in lieu, of the prednisone.

2.) I am not certain how much more aggressive you want to get at this point given all you and your dog have been through, but re-biopsying to confirm that EG remains the primary (and only) problem in multiple locations given the vastness of the lesions. This would help you to make certain of the diagnosis, as well as hopefully know that there are no mitigating factors like malignant cancer.

3.) I would submit a fungal culture to make certain there is not an additional infectious component not covered by the antibiotics.

4.) I would consider increasing the chlorhexadine baths to every other day, leaving the shampoo on for 20 minutes or as long as possible.

5.) Consider adding an antihistamine like hydroxyzine at 1 mg/pound of body weight, administered 3 times daily by mouth. An antihistamine may synergize with the prednisone to make it more effective.

I wish you an Jack the very best. Again, I respect and admire your tenacity and dedication to your dog...many would have given up long ago.
Roger L. Welton, DVM, Veterinarian
Category: Dog
Satisfied Customers: 1403
Experience: Licensed Veterinarian, Practice Owner, and Book Author
Roger L. Welton, DVM and 6 other Dog Specialists are ready to help you
Customer: replied 1 year ago.

Dr. Welton,


 


These are excellent suggestions. Thank you so much for taking the time to answer in such detail! I am going to take these in to my vet tomorrow.


 


One more quick question: In your opinion -- and I know there's no way to know for sure outside of a guess -- do you think Jack is in a great deal of pain from these lesions? I know with a dog it's often hard to tell.


 


Best,


Dan

Expert:  Roger L. Welton, DVM replied 1 year ago.
Good question...based on the demeanor of cats and dogs that I have seen with large or diffuse EGs, it seems that there is a significant level of discomfort associated with these lesions. Since your dog's case is the worst I have have ever personally seen, it is reasonable to assume he is probably in discomfort or even pain. As such, you may want to consider some pain management for him. Tramadol is a very mild narcotic pain reliever that should not react adversely with any of the medications he is on.

Best of luck. If you have any follow up, please do not hesitate to drop me another line.

Best regards,

Dr. Roger
Roger L. Welton, DVM, Veterinarian
Category: Dog
Satisfied Customers: 1403
Experience: Licensed Veterinarian, Practice Owner, and Book Author
Roger L. Welton, DVM and 6 other Dog Specialists are ready to help you
Customer: replied 1 year ago.

Thank you so much for your time. Jack and I really appreciate it!


 


All our best,


Dan and Jack

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