At the end of the spring term, Azza and I were bouncing back and forth between her regular vet and the emergency vet clinic. It was an expensive round of visits. I've always been worried about how to handle Azza if she got sick. Well, I got a chance to find out.
She doesn't allow many people to touch her even when they are here in the house and she's seen them several times. There are some visitors that she quite likes but she is selective. Even though I muzzle her before we enter an exam room, it takes a vet with a calm and sure hand to even get close enough to listen to her heart and lungs, or dog forbid, touch her as part of a physical exam. Forget about that rectal temperature business. Not happening. So when she began to vomit blood and pass fresh blood and mucus instead of stool, my first thought was how to manage the inevitable vet clinic visits. It really helps that I have continued to introduce her to new things (agility trials, for example, which she only views from afar but that is quite enough for her) and to new people. During our various vet visits, it was of course necessary to draw blood for testing, and she would have to be touched by at least one other person besides me. I would muzzle her and hold her, instructing techs that they had one shot so bring all the tubes they think they might need. On one visit to the emergency clinic, the tech brought in five vacuum tubes of various sorts. I laughed and said, she'll be light headed after you pull that much blood out of her (not really, but it's a good vet med joke).
Her symptoms were frustratingly non-specific: episodic inappetance, vomiting, and bloody stool every few months over a period of a couple of years that suddenly and dramatically increased in frequency and severity. I acted so quickly when things got bad that she wasn't even dehydrated yet. Coming up with a definitive diagnosis was difficult. Lots of things had to be considered and ruled out: pancreatitis (she did in fact have acute pancreatitis but it was secondary to the real problem), Addison's or hypoadrenocorticism, parasites, ingested toxins, even salmon poisoning (which isn't from the salmon but from the Neorickettsia bacteria that lives in flukes that infect the liver of the salmon), and so forth.
We eventually came up with a presumptive diagnosis: IBD, irritable bowel disease caused by food allergy and an out-of-control auto-immune response. It's presumptive because a definitive diagnosis would have required a biopsy of her colon. I did not want to subject her to that procedure. Somehow, even though her symptoms were pretty severe, we managed to give her temporary relief without ever hospitalizing her.
This IBD is particularly pernicious because her own immune system is attacking the digestive epithelial cells that line her gut. Fortunately, medical diets for our companion animals have become quite sophisticated, and it turns out that we were able to resolve her problems by switching her to a hydrolyzed protein diet. Although Hill's makes one called z/d, and the terriers are thriving on Hill's Ideal Balance kibble, I chose to feed Azza Royal Canin's Ultamino. Proteins in the hydrolyzed diets, usually chicken, are broken down from very long chains of amino acids into small groups of a few or even just singlet amino acids. That's what happens in your gut when you eat chicken: your pancreas releases proteases that break the chains into smaller and smaller pieces, eventually breaking them down into individual amino acids which pass into your gut epithelial cells. Azza's body doesn't have to do that now. Her gut doesn't even register these little bitty groups of amino acids as "chicken" so she can eat protein without triggering an auto-immune response.
Her improvement upon switching to Ultamino was amazing. We had her on quite a few drugs to calm her gut down but those were all finishing up just as I started her on the new diet. She loves the taste of the kibble and eats it with gusto. Her symptoms resolved in just a few days. She's been through most of a 25-pound bag now and I was relieved that she was doing so well.
She was doing well until I gave her a new flea treatment last night. See, fleas are becoming resistant to fipronil, the active ingredient of Frontline. I've used Frontline for years but I knew that I was rolling the dice since fipronil-resistant fleas were becoming more widely reported in Oregon. And sure enough, those little fuckers showed up in my back yard. So after doing some research, I decided to switch the dogs to Nexgard. It uses a different chemical to kill the fleas (afoxolaner), and it is an oral medication (Frontline is a topical).
I gave each dog a Nexgard chewable last night after dinner. Within one hour, Azza was scratching her belly, neck, and head incessantly, chewing on her skin on her legs, and had a head tilt and was shaking her head constantly. Her neck, chest, belly, and inside her ears were bright, inflamed red. I managed to get her to her regular vet this morning (saving the emergency clinic visit fee) just as her scratching began to break her skin. She got a diphenhydramine shot (you know it as Benadryl) plus some prednisone. Since she'd never had antihistamines before, I was curious to see how she would react. It will either makes dogs sleepy or it will make them hyper (same for people too). Turns out it makes her sleepy. I'm now giving her diphenhydramine orally every 8 hours. Combined with the prednisone, her symptoms have become greatly reduced. Not gone, she is still scratching and licking but it's not as frantic, and her skin is not so red (ah, the immune-suppressing magic of corticosteroids). Her head tilt and head shaking seems to be gone. If I can keep her quiet, she sleeps.
So what caused this allergic reaction? It could have been the beef flavoring since we know she has problems with proteins, it could have been the coloring agents, it could have been the medication itself. All I know is that I am switching back to a topical flea treatment (I'm looking into Activyl, which has a completely different chemical that disrupts the life cycle of the fleas; fipronil and afoxolaner are flea neurotoxins). Nothing more by mouth for this delicate little flower!
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