We have been dealing with allergy issue in our 5.5 month puppy since bringing him home at 8 weeks.
I posted in this thread about our Vet's disregard for the nutriscan test I decided to do for food allergies:Nutriscan test, Vet doesn't trust results, Help?
After seeking a second opinion from Vet #2 on the nutriscan results and best course of action and then trying to enlist Vet #1 on a team approach because I liked some of the ideas Vet #2 had. I decided on the following course of action which Vet #1 didn't necessarily agree with and tried to talk me out of, but grudgingly decided he could support.
The plan was to do the following for 6 weeks:
Oliver was put on a on a lamb & tapioca diet (dictated by the nutriscan test, the only things Oliver didn't react to based on the test were beef and lamb). He was put on 100mg of cyclosporine (atopica), 25 mg Ketoconazole, and 50 mg of hydroxyzine (as needed) daily. Weekly baths with chlorhex shampoo. For chews he has been getting lamb ears & lamb leg bones. I try to supplement his dinner meal with ground lamb (grass fed, anti-boiotic free) that I cook for him and I make dog treat for him out of a thinly sliced lamb roast (which is a total pain) for his puppy class. Initially he had trouble keeping the meds and food down (he threw up his food and meds for a few days in a row) until I started giving him his pills at midnight. After that he seemed to tolerate them ok.
During this time his dermatophyte culture came back negative so we really have ruled out everything but allergies as the cause (mites, skin diseases, fleas not an issue in UT, etc).
We are almost through the 6 week plan. Oliver's itching has decreased. He still itches, but no more bald spots and it isn't constant like it was before. He is more itchy than the other pups in his obedience class (which we have been using as our gage to normal scratching), but it isn't a major distraction like it was 2 months ago. His stools have become firmer over the last 6 weeks. His coat looks much better, no more dry dandruff flakes, has some shine to it. His red bumps haven't returned since finishing his simplicef prescription. I suspect he may have some environmental allergies because I have kept track of pollen spikes and noticed he was slightly more itchy when sagebrush and ragweed spiked last week in our area. We feel like he has made a big improvement and we could like with this level of itchiness if we had to.
When I took Oliver in for his heartworm shot last week with Vet #1, he wanted to do the following at the end of the 6 week food trial. Stop all meds cold turkey at beginning of 7th week. If Oliver's itching went back up, go in immediately for skin testing with dermatologist and get started on serum. In his opinion, puppies that have allergies this young, only get worse with time and we should get to the serum shots ASAP. Since the itch returning after stopping the drugs while staying on lamb diet would indicate environmental as well as food allergies. He also said that if the itching flared, we would start prednisone and cyclosporine combo immediately after the skin testing until the serum started to work.
My husband and I are a little worried about this plan and skin testing, so I took Oliver for a visit to Vet #2 this afternoon for a check-up with him.
Vet #2 suggests a different approach. He disagrees with cold turkey approach strongly. He wants to step Oliver off cyclosporine & ketoconazole over 2-3 weeks and ultimately use only hydroxyzine to control itch. His experience has been that puppies sometimes outgrow allergies and we should put off skin testing for a while longer unless the hydroxyzine isn't enough to control the itch. He is worried about long term use of prednisone and cyclosporine and cartilage damage/growth issues. Oliver is going to be big. At 2 weeks shy of 6 months, he is 70 lbs (!!) so I too am worried about impacts to his cartilage/growth pattern for what is likely to be a 100+ lbs dog (so much for picking the runt of the litter). He also would like to see if we can introduce more diverse foods back into Oliver's diet so he is getting proper nutrients, possibly go to a hydrolyzed protein prescription puppy food so he can get more nutrients (there isn't a hydrolyzed lamb based food, so this would mean a leap of faith switch to a food with ingredients the nutriscan test says he will react to). He wants to keep up the weekly baths. So basically a more mellow approach.
So what to do and who's medical direction to take?
Vet #1 is older, have know him since I was a kid, have his cell number. He took care of our previous dog and my dog growing up. Good guy, but sometimes he dismissed my concerns or ideas like I just found weird woo-woo stuff on the internet. Sometimes I wonder if he sees me as though I am still his daughter's high school friend and not an adult in my mid-30's
Vet #2 don't have a very long history with although referral from trusted friends, but have liked our 2 visits (both time he spent an hour with us and spent a lot of time examining Oliver). He is younger my guess is mid to late 30's and a more into nutrition. Seems concerned about heavy drugs in young puppy which is a concern I share. He is very interested in the proper nutrition. And most importantly, he didn't poo-poo the nutriscan test but considers it a useful tool.
After Vet #2 visit today, I sent Vet #1 a question about whether we should try the stepping slowly off approach from the cyclosporine and ketaconazole (without telling him where I got the idea- just another of my woo-woo internet ideas) and he said no need to step down and cold turkey was best, stick with the plan.
I decided to call the dermatologist office (we only have 1 board certified dermatologist in our state). Oliver could be on cyclosporine and ketaconazole and do a skin test without it skewing the results. He can't have had hydroxyzine for 10 days though prior to the test though.
So I'm back to wondering which course if the best one to take next week when we conclude our 6 week "food trial." Should we wean him off the cyclosporine/ketaconazole and see if we can use a lesser drug to control his symptoms while seeing if he outgrows some of this.
or: taking him off everything and be ready for skin testing if the itch flares up? Do serum and see if it solves the problem for good.
or: the option no vet recommended--take him off hydroxyzine, but leave him on the cyclosporine/Ketoconazole and just go for skin testing to see what it says without leaving Oliver open to a period of possible miserable-ness by being off all drugs?
The poor pup has been to the Vet and had way more tests than he should have for his age. I don't want to put him through unnecessary tests or drugs or pain. Money isn't an object since we have already spent a few grand on his medical care and he has a pet policy which should kick in if they don't decide this is some weird pre-existing condition issue.
Any wisdom from the internet or other owners of dogs with allergies? Anyone had experience with the same list of drugs or dogs outgrowing allergies? Should I stop being so worried about skin testing?