Today we drove about 50 miles one way to a recommended Vet Dermatologist. She has been in the practice of small animal dermatology for about 40 years experience. She has three offices ranging from the coast in Long Beach to the desert in Palm Springs, a distance of about 150 miles. She holds a clinic at least one day a week in each office. She is considered the premier small pet dermatologist in SoCal.Regarding Apoquel: My Vet gave me a 30 day supply (one a day) with no refills. He said I should use this until I see the dermatologist and then stop after their recommendation.
We were not allowed into her clinic because of Covid. RICKY's exam and treatment took about 90 minutes of which 30 minutes was on the phone talking to me. There was so much information imparted to me, I had trouble keeping up with notes. If I get some of the terminology incorrect, please don't flame me, I was doing the best I could. That women talks fast! Here are the main takeaways.
Staff picked up RICKY at the car and we were given a VERY extensive survey and medical history to fill out while in the car. Momi suggested we take his medications, flea/tick meds, anti-itch spray, etc. so we could be precise. She hit the nail on the head, just what the doctor wanted! Staff picked up the survey. A few minutes later, Dr. called and I got a real education. First she hoped that there was a LUCY in our home! (there isn't) She said she shares a birthday with Lucille Ball! She said that RICKY RICARDO is one of the finest, most well maintained, most beautiful Havanese examples she has ever seen in her years of practice and that includes a couple of Havanese that she worked who were Westminster veterans. She said he is 15.8 lbs. of lean muscle mass, very well toned. Physiologically, muscle weighs more than fat. She said he is very intelligent, follows basic commands from her staff without hesitation, compliant, composed, and cooperative. (as @GoWithTheFlo says, "they will tap dance and do circus acts at the Vet just to prove you're wrong!") She congratulated me on being a responsible dog owner. It made me feel good and that all our hard/fun work together is paying off.
She is 99% positive that RICKY does not have a food allergy because he shows no signs of diarrhea, vomiting, excessive thirst, etc. She is sure he has "environmental allergies" (it is no longer called seasonal allergies because of allergies to items inside the home). She called his case mild to moderate.
To put things into context, she discussed scientific predictive indications. In science, there needs to be a 95% predictive indication of something to be considered reliable and predictive. That includes a reaction to something, a cure for something, a cause of something, etc. (side note: I think it is interesting the Covid vaccines are 95% effective in preventing Covid.) She says she is a bit more conservative than most Vets and she considers a lower standard of 80 -90% predictive indication depending on a particular indication (see more below).
Small dogs with relatively short legs (e.g. Havanese, Corgi, Doxies, etc.) tend to have more problems with allergies to grasses of all types because they are built lower to the ground with more exposure to grasses. Generalizing, dogs tend to absorb allergens through their skin rather than through nose and eyes like humans.
Small dogs have a higher rate of metabolism than large dogs because of less body mass which can diminish immune levels.
Dogs have something called "skin barrier" that is a natural prevention of environmental allergies. Some dogs have compromised skin barriers (for unknown reasons, probably heredity) and therefore more susceptible to allergies. The purpose of treatment(s) is to rebuild those skin barriers.
Some specific allergens within the home are down pillows/quilts and smoking tobacco products. These should be eliminated from the household to prevent allergic reactions in small domesticated pets.
She said fleas and ticks are not a big threat in the specific area where I live. They're most active in August and September in my area. She said I should try eliminating flea and tick treatment on a monthly basis year round and only administer his treatment monthly from about mid-July to mid-October. (your recommendation will be different depending on what geographic you live, the type of environment, urban or rural, and how much time your dog spends in wild areas)
She provided a hypoallergenic shampoo and finish spray called DermAllay. He is to be bathed once a week for the next 4 weeks with this shampoo and spray.
We are to stop all medications immediately including Apoquel and an antibiotic (see below).
If I wanted to be exact as to what he is allergic too, which would be helpful but not absolutely necessary at this time, it would require either a skin test or a blood test. Both are equally efficacious. A skin test would require that half his chest be shaved down to the bare skin. The blood test is more expensive but it is a simple blood draw. She said if RICKY were her dog, she wouldn't want to ruin his beautiful coat. I didn't even have to think about it, I said, "blood draw." There is the basic blood draw to analyze allergies to pollen and grasses. There are additional "add-ons" to analyze specific localized factors. In addition, I selected two add-ons, one for Pines and one for Palms.
Yes, my vet considers Apoquel the “court of last resort” for itching because of some links to cancers. We’ve had great success with Cytopoint injections with Kodi for seasonal environmental allergies. It’s like a miracle.
My vet told me that her experience is that it doesn’t work for all dogs. For about 60% it is a miracle drug. For another 20% “it helps”. For the remaining 20%… “you might as well inject saline”. But you can’t tell until you try it, which dogs it will work for.
I discussed these points in detail with the Doctor.I meant to say that it sounds like Apoquel can damage the immune system whereas Cytopoint does not. That is my understanding anyway based upon what I have read. A dog with allergies does not need their immune system fired up more than it already is. However, I encourage Popi to discuss this with his vet and canine dermatologist. Just throwing this out there for consideration.
She said it is incorrect to say that Apoquel "damages" the immune system. She said Apoquel alters and modifies the immune system to be more resistant to allergies. She said that is what it is designed to do. It does fire up the immune system to be effective against fighting off various allergens. However, there has been recent research that Apoquel is about 80% predictive indication that Apoquel can cause cancer when administered long term, specifically lymphoma in dogs. Although it has not yet reached that 95% level that most Vets would consider serious, at 80% is enough to give her concern and she doesn't prescribe it if there are alternatives.
Cytopoint is extremely controversial within the veterinarian community because so little is known about it and it is not widely prescribed. Apolquel is pill manufactured from inert chemical compounds. It has a 95% predictive indication to prevent allergic reactions. Cytopoint is an injection manufactured from biological compounds and is non-toxic. According to the most recent studies, it is 90% effective to prevent allergic reactions to one extent or another. That is close enough to 95% for her to recommend it to her clients. However, if a dog is in a life or death situation with an environmental allergic reaction, she does recommend Apoquel. I elected to have a Cytopoint injection.
Leptospirosis: She said this has nothing to do with allergies but she is very familiar with the issues surrounding the disease and prevention. It is found in the urine, but not feces, of wild animals year round. It has a predictive indication "seroprevalence" of 80% in my specific area, among the highest in the U.S. Since we have a protected wildlife wet lands in our immediate community inhabited by coyotes, bobcats, racoons, rats, etc., Doctor warns not to let RICKY drink any of the water in the wetlands and to stay out of the brushy areas (also to prevent fleas and ticks). She said if I commit to do this, we can go without the Lepto vaccine. I said we had Cottontail rabbits that pee and poop in the grassy lawn park areas and RICKY is always stopping to eat grass in random areas. In that case she recommends the Lepto vaccine because the risk of infection far outweighs the statistical predictive indication of significant side effects.
And that was it, RICKY was returned to the car by the Vet tech. He was happy and tried to jump back in her arms. She said all the staff wanted to take him home with them. On his discharge papers was written, "RICKY did great for us today! He is the perfect gentleman!" (Little do they know)
We have a follow up appointment in one month to assess the various treatments for further resolution and review lab results. Here is the bill to put things into perspective.
- Examination $180
- Allergy Blood Test with two add-ons
- Cytopoint injection $65
- Shampoo and spray $43
Total = a bit over 9 dog dollars! We don't have insurance on him, we don't think it is cost effective for RICKY.
Today is our ?? Wedding Anniversary. I guess we'll skip the Steak and Lobster dinner tonight! 😲 I keep saying we spend more on RICKY each YEAR than we paid for him originally when you add everything up.