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I wrote to Dr. Kara about my dog and got response about a…

Hi there ,I wrote to...
Hi there ,I wrote to Dr. Kara about my dog and got response about a month ago and got thorough response. I realise from the answer that I had left out some information which may have helped the diagnosis. As my membership expired on the 30th I thought I;ll give it another go.
My dog began scratching his chin/jaw a lot around May/June 2017. Gradually his ear began to scratch too and by mid June he had a full on ear infection - with bad smells. The vet took a swab from his ear for testing and it came back saying there was bacteria in the ear, cause unknown - maybe allergies. He prescribed Otifin PD antibiotics (we live in Holland) and it did cure the ear infection in 2 weeks. The chin/jaw scratching also decreased but has never gone away since. He doesn't have acne on his skin and his chin insn;t red or inflamed in any way (which made me think it may be a tooth/gum issue but the vet doesn;t think so - though he's only looked at the mouth and not taken any xrays ).
Around mid march 2018 his chin/jaw scratching increased a lot again. And by April he got an ear infection again. Again the doctor prescribed Otifin PD. After one tube was finished the ear scratching and infection restarted. After a couple of days we started with the 2nd tube and again the ear and chin are calmer. Today is the last day of the 2nd tube and I don't think the problem has been totally resolved. So my questions are:
- Is it ok to go continue the treatment and administer a 3rd tube or will his body stop responding to it (and develop side effects?)
- The antibiotics do seem to solve the ear infection. They also help with the chin/jaw scratching but don't seem to totally get rid of it. Does this indicate that the chin scratching is also caused by bacteria?
What should we do next?
- Continue with the Otifin PD till the chin stops itching too?
-Try a different antibiotic ?
- Go down the anti-histamine / fish oil path?
- Take tooth xrays?
- Take the path of food allergy treatment? (the vet tells us that would take 6 weeks before any results can be seen) Is this also your experience?
REgards,
Clair and Shadow the dog
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Answered in 1 hour by:
4/28/2018
Dr. Kara
Dr. Kara, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 19,012
Experience: Over 20 years of experience as a veterinarian.
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Hello, I'm Dr. Kara. I'm sorry to hear that Shadow's itchy chin and ear troubles are continuing despite your best efforts. Please give me a moment to read about your concerns and write up my thoughts.

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Since your fellow has multiple allergic symptoms that seem to affect his face and ears, and aren't fully responding to treatment, there is likely some sort of underlying predisposing factor.

In most cases it is allergic inflammation, particularly food allergies when we see repeated ear infections and an itchy face. I think it is time to consider feeding him a prescription hypoallergenic diet, and you should discuss that with his veterinarian. I recommend Hills z/d, Purina Pro Plan Veterinary diets HA or Royal Canin restricted protein diets. It is true that it may take 8-12 weeks to see good resolution of symptoms with a food allergy, but we often see some improvement in 4-6 weeks.

If this were purely a gum issue or an infected tooth root I would not expect repeated ear infections.

It is fine to treat the ear infection with the medication that has worked previously while we wait for the hypoallergenic diet to start to help, but I would take an ear swab to make sure that there isn't another factor (like a resistant bacterial infection) complicating our ability to clear the infection fully. In most instances with food allergic dogs it isn't that the medication doesn't work, so much as there is simply too much allergic inflammation and secondary wax production and that leads to the perfect environment for another infection to start. It should help to flush his ears and keep them very clean.

Even after the infection is cleared I would use an anti-inflammatory drop for a good 6 weeks to give the hypoallergenic diet time to start working. I use a product called Synotic which contains FLUOCINOLONE ACETONIDE AND DIMETHYL SULFOXIDE. I don't know if that is available in the Netherlands, but I suspect that there is a similar medication available if that particular one isn't sold there.

It has been my pleasure to help you today, and I hope that I have earned my 5 star rating. Please remember to rate my service by selecting the 5 stars at the top of the screen (rating me now does not close your question). You are welcome to ask follow up questions about my response here until you are satisfied, simply use the reply box and let me know. Thank you!

Dr. Kara
Dr. Kara, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 19,012
Experience: Over 20 years of experience as a veterinarian.
Verified
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Hi,

I'm just following up on our conversation about Shadow. How is everything going?

Dr. Kara
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