Azza has always been a bit of a problem when it's time to go to the vet. She has to be muzzled, and I restrain her for procedures rather than risking her biting a vet tech. To my knowledge, she hasn't had her temperature taken in years. We have managed to get blood from her though. And vaccinations are routine. I always take treats, but with variable success. Sometimes she is just too stressed to take treats, other times she hoovers them up.
Azza has a protein allergy that cropped up in 2014 or so. I've tried numerous select protein and hydrolyzed diets, but the only one that keeps her gut calm is Royal Canin's Ultamino. Made from chicken and duck feathers, it is the only allergy diet that doesn't contain any protein sourced from animal flesh. It is freaking expensive, too.
I recently learned about Royal Canin's hydrolyzed diet made from soy protein. It is a lot less expensive than Ultamino. A test with a small bag and a few kibbles of SP mixed with her Ultamina seemed to suggest that she tolerated it well, and found it tasty. So I ended up mixing one bag of Ultamino and one bag of the SP diet for a 50/50 mixture.
This was in December. In January, I noticed that she was licking and scratching her inguinal area (the patch of skin between legs and torso that you see when a dog rolls onto its back) until the entire area was red and even bloody, that her inguinal lymph nodes were enlarged, and, more alarming to me, that the caudal-most glands in her mammary chain were enlarged, firm, and sort of lumpy (these would be located on either side of midline in the inguinal area).
Keep in mind that at my job, I see the worst cases of disease in all species. My mind always goes to the absolute worst diagnosis for every case. Fortunately, I've been able to train myself most of the time to take a step back and come up with a more workable differential list. But not this time. This was a problem in my own dog. And I had only one differential: cancer. Lymphoma, mast cell, mammary gland. It was all bad.
I monitored the lumps for a few weeks, and Azza's scratching intensified. I finally made an appointment at my vet. This was back in February before the pandemic was in full swing.
In the exam room at the clinic, I muzzled Azza, and amazingly managed to get her onto her back so Dr. Craig could do a quick physical exam. We got her back on her feet and removed the muzzle. She drifted over to sit next to the vet tech, who I had already schooled in how to behave around Azza. While the tech was petting Azza's head, Dr. Craig said, I see this kind of thing all the time. Like, 15 times a week. I think it's just atopy, basically seasonal allergies.
Whew. Big sigh of relief. Of course, atopy makes more sense than cancer. This is her first spring here, and literally every tree is spewing pollen.
But we couldn't for sure rule out the diet change as a possible contributor. So he recommended I stop feeding the soy diet, and start her on a short course of Apoquel. Apoquel was a real game-changer in vet med when it was introduced. It provides targeted immune suppression that isn't as harsh as giving immune-suppressive doses of steroids. Dogs taking Apoquel typically don't have the excess drinking, urination, and panting that are common side effects of immune-suppressive prednisone.
That weekend, I spent two hours sorting nearly 30 lbs of kibble into piles of SP and Ultamino. The kibbles are roughly the same disc shape but slightly different colors. It was incredibly tedious. I bagged up the SP and gradually mixed it in with the terriers' kibble.
Azza began to improve immediately. I finished the Apoquel, waited a few days, and she blew up again with scratching. So it probably wasn't the soy protein at all, but it was good to eliminate that as a variable. Azza is back on a longer course of Apoquel. Once the heavy pollen season is past us, she may be able to stop taking it until next spring.
Oh, and did you catch that little detail about our vet visit? That Azza let the tech pet her on the head? That was a miracle that I never expected to see. I will never be able to fully let my guard down when I take her to the vet, but this is a big step forward for her. And it also tells me that I chose the right vet for my pets!
