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A number of things. 6 year old welsh terrier. Very itchy…

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A number of things...

A number of things. 6 year old welsh terrier. Very itchy skin but no sign of sores. Very random yelps of pain. Hurt her back in spring but seems to move and play okay. Sometimes has offensive Uriny smell. Eats well, plays well, pooping okay.

Veterinarian's Assistant: I'm sorry to hear that. Using the wrong medication for fleas can be dangerous. You should definitely talk to the Veterinarian. What is the dog's name?

Sophie. That is interesting. She is currently on no flea medication. Gave her the one that last three month at the end of June.

Veterinarian's Assistant: Is there anything else the Veterinarian should be aware of about Sophie?

Nothing I can think of

Submitted: 7 months ago.Category: Dog
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Answered in 9 hours by:
9/29/2017
Dog Specialist: Dr. Michael Salkin, Veterinarian replied 7 months ago
Dr. Michael Salkin
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Dog Specialist: Dr. Michael Salkin, Veterinarian replied 7 months ago

I'm sorry that your question wasn't answered in a timely manner. I'll address your concerns as you presented them.

1) Pruritic (itchy) dogs are suffering from an allergic dermatitis in the great majority of cases. Allergies to flea saliva, environmental allergens (atopic dermatitis) such as pollens, molds, dust and dust mites, and foods should be considered. (Paw and extremity licking indicates both atopy and a food intolerance and so it behooves vets to distinguish one from another.) In many instances, a concomitant pyoderma (bacterial skin infection), yeast infection (Malassezia), or mange mite (Demodex or Sarcoptes) might be contributory.

Sophie's vet can check a sample of Sophie's skin surface microscopically (a “cytology”) for abnormal numbers of bacteria and yeast and skin scrapings can be taken in an attempt to find mites. Pyoderma is treated with a minimum of 3-4 weeks of an antibiotic in the cephalosporin class such as cephalexin (Keflex) plus antimicrobial shampoos containing either chlorhexidine or benzoyl peroxide and yeast is addressed with ketoconazole plus shampoos containing either ketoconazole, miconazole, or clotrimazole for at least a month.

Our dermatologists tell us to provide one of the newer prescription products available from Sophie's vet even if fleas aren’t seen. Over the counter products containing imidocloprid (Advantage, e.g.) or fipronil (Frontline, e.g.) may be ineffective because many populations of fleas have developed resistance to those chemicals. Consider products containing a different class of insecticide such as Bravecto, NexGard, Simparica, Comfortis, and Vectra. Dogs can be such effective groomers so as to eliminate all evidence of flea infestation. Dogs who remain primarily indoors can contract fleas because we walk them in on us and flea eggs and larva can remain viable in your home for months. As the weather warms or you turn on heaters at this time of year, egg hatches are common. If the area between the edge of her rib cage and tail (the “saddle” area) is particularly excoriated, a flea saliva allergy should be the most important differential diagnosis. In severe cases, an anti-allergenic prescription glucocorticoid (steroid) such as prednisone will work wonders for dogs allergic to the saliva of the flea. If you have other pets they may have fleas too but may not be allergic to the flea’s saliva. Be sure to treat your premises with an over the counter area treatment spray that contains an insect growth regulator (IGR) such as Siphotrol Area Treatment Spray containing the IGR methoprene. The IGRs don't allow flea eggs and larvae to develop into adult fleas and so the life cycle of the flea is broken.

Environmental allergies (atopy) are usually initially addressed with prednisone as well. In some dogs an over the counter antihistamine such as clemastine (Tavist) at a dose of 0.025 - 0.75mg/lb twice daily or diphenhydramine (Benadryl) dosed at 1-2mg/lb twice daily (maximum dose of 50 mg at any one time) may be effective. Antihistamines, however, aren’t reliably effective. Adding fish oil to the diet at a dose of 20mg/lb daily of the EPA in the fish oil might synergize with antihistamines to provide better anti-pruritic action. The omega-3 fatty acids in fish oil are antiinflammatory but may take 8-12 weeks to kick in. The new oral immunotherapy using the cytokine antagonist oclacitinib (Apoquel) is likely to revolutionize how we address atopic dogs and should be discussed with Sophie's vet. Oclacitinib works as well as a steroid without a steroid's adverse effects. The new injectable immunotherapy with the monoclonal antibody IL-31 (Cytopoint) should also be discussed with her vet. Please note that atopy, at least initially, should have a seasonality to it while a food intolerance should cause pruritis regardless of the season. Chronically atopic dogs may be pruritic year round.

Food intolerance/allergy is addressed with prescription hypoallergenic diets. These special foods contain just one novel (rabbit, duck, e.g.) animal protein or proteins that have been chemically altered (hydrolyzed) to the point that Sophie's immune system doesn't "see" anything to be allergic to. The over the counter hypoallergenic foods too often contain proteins not listed on the label - soy is a common one - and these proteins would confound our evaluation of the efficacy of the hypoallergenic diet. The prescription foods are available from her vet. There are many novel protein foods and a prototypical hydrolyzed protein food is Hill’s Prescription Diet z/d ultra. (I prefer the hydrolyzed protein diets because it avoids the possibility of my patient being intolerant to even a novel protein.) A positive response is usually seen within a few weeks if we’ve eliminated the offending food allergen. Food intolerance can arise at any age and even after our patient has been eating the same food for quite some time.

We need to consider seborrhea in such a patient as well. This is skin disorder of keratinization and maturation. It's a diagnosis of exclusion of the above mentioned skin disorders and can be suggested by skin biopsy.

You also have the option of having a specialist veterinary dermatologist (please see here: www.acvd.org) attend to Sophie. You can expect some combination of skin scrapings, cytology, bacterial culture and sensitivity, fungal culture, skin biopsy, intradermal or blood allergy testing, or presumptive hypoallergenic diet trials to be performed.

2) Those yelps of pain aren't pathognomonic (specifically indicative) of any one particular disorder but the history of a "hurt back" in a middle aged terrier suggests that

degenerative disk disease (a "slipped disk") should be an important differential diagnosis. Supportive evidence of a disk may include vocalizing when approached or lifted, having trouble jumping up or down and navigating steps, ataxia (“drunken sailor”), trembling/shaking (pain responses), a change in posture such as the neck held rigidly and head lower to the ground or a "hunch" in Sophie's back, and a change in behavior - a normally social dog becoming aloof or, conversely, a normally aloof dog becoming "clingy". Her vet will want to carefully palpate (feel) about Sophie's spine looking for areas of hyperpathia (increased sensitivity) suggestive of a disk. Conservative care involves the use of a nonsteroidal antiinflammatory drug (NSAID) such as carprofen or meloxicam, a narcotic analgesic such as tramadol, and a skeletal muscle relaxant such as methocarbamol or diazepam. These drugs are usually administered for at least ten days. Most simple disks will remiss within a few weeks. It's important to keep these dogs as quiet as possible lest they hurt themselves further.

Should paresis (weakness) or paralysis arise in any limb(s), Sophie would need the attention of her vet at your earliest convenience. Such dogs are then surgical candidates for spinal cord decompression. Please respond with further questions or concerns if you wish.

3) Odiferous urine often indicates a bacterial urinary tract infection. Her vet will want to obtain urine by cystocentesis (percutaneous aspiration of Sophie's bladder through her abdominal wall) and perform a complete urinalysis looking for the tell-tale signs of infection - the presence of bacteria and abnormal numbers of either red or white blood cells. If found, a broad spectrum antibiotic is usually prescribed for 10-14 days and the urine is rechecked 2 days after the course of antibiotic is done to make sure that her urinary tract has been sterilized. Alternatively, the urine might be cultured to identify just which bacteria are present and which antibiotic would be the very best to prescribe. This is called a bacterial culture and sensitivity and is particularly useful when the urine is quite dilute making finding of bacteria and cells in a urinalysis difficult.

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