Multiple Issues this Summer: Allergies?

[Nicole and Teddy]

Hi all! I've been following all the posts about allergies this summer with intense interest. This has been a really challenging summer for Teddy and I'm hoping for some advice on next steps. It seemed to start in May after a week long beach trip in Florida. Teddy ended up with hot spots, yeast between the toes, etc. The vet put him on a course of metronidazole as one of the spots was infected. Since then it's just been downhill. We live in South Carolina and Teddy has battled itching, licking, hot spots for the whole summer. I've tried fish oil, Benadryl, and vet prescribed Hydroxizine. In addition he's had one bacterial ear infection - for which the vet prescribed another course of metronidazole. Amazingly during the antibiotic rounds he hasn't really suffered from stomach issues. I've sporadically supplemented with Klaire probiotic powder. Teddy eats a homemade diet of mostly beef, rice, beans, veggies, and multiple vitamin supplements. Through all of the posts on here, I am fairly certain this isn't a food allergy issue because he's had good luck with this diet until this summer (he's 4 years old). However, about a week ago he did have a bout with diarrhea - for which, you guessed it, the vet prescribed another round of metronidazole. I only gave him 2 days worth of pills and took him off of it. This past week, he's vomited 3 times - mostly undigested food about 10 hours after eating.Normal energy level, eating, playful, drinking water, no diarrhea with the vomiting. And finally, he has anal gland issues. I don't know how it happened but, thinking I was helping, we began getting them expressed when he was a puppy and he's been pretty regularly getting them expressed once a month. Well, last month when he went in to get expressed, they ended up inflamed and on the verge of infection - for which, the vet prescribed metronidazole! He's had a normal expression between that bout and this week- 2 weeks later...and now he's back to incessant licking in that area - which tells me they are bothering him again. I just don't know what to do - i don't want to have them expressed because i know that can (and probably has) lead to all sorts of issues but we're headed into the weekend and I'm at a loss. I don't want him to be uncomfortable and I'm kind of losing confidence in my vet because her answer seems to be antibiotics for everything. However, I did call her for a referral to a dermatologist and am waiting to hear back. I also am speaking with a more holistic vet who agrees it may all be a case of allergies, but she's already mentioned starting with the M word for his anal gland issues. I've heard how expensive allergy testing can be so am also looking into this product: https://market.dogsnaturallymagazine.com/products/pet-wellness-pet-...

If anyone has any advice/experience, I sure would appreciate it. Thank you!

Nicole

[Nicole and Teddy]

My mom actually has a bottle of VSL in the fridge - she has stomach issues too. I don't think she's using it anymore so maybe we will use that. What is an appropriate dose for a 58 lb dog? I'm taking Teddy to the internist today - hopeful that we get some answers! Thanks, all!

[Karen, Jasper and Jackdoodle]

1 capsule per day.

[Nicole and Teddy]

Does it matter if it's given with food or without?

[Karen, Jasper and Jackdoodle]

Nope. It's one of the few that can be given any time, with or without food.
It's truly amazing. 

[Nicole and Teddy]

Just got back from the internist. Teddy's abdominal ultrasound was normal and we are waiting for blood test results - they did a GI panel and cortisol to test for Addison's. Should get results next week. Pending blood test results, she is thinking he might have a food sensitivity and is recommending a novel protein trial along with the probiotics. I know that is a whole separate conversation though. I will let y'all know what happens with the results next week and start a new discussion (and will research) about the diet issues. My main concern is, since he is on a home cooked diet, how I will introduce a novel protein! Oh well, one step at a time, I suppose. 

[Karen, Jasper and Jackdoodle]

Having been through the novel protein diet dilemma myself, I can be of some help with that. Doing it with a home cooked diet is going to be rough, but it can be done. A number of people in Jack's IBD support group were able to manage it. A lot is going to depend on what proteins Teddy has been exposed to in his lifetime, and how much you can invest in it, both in time and money. I'll be watching for the results of his blood work and your new discussion. 

[Nicole and Teddy]

OK, thank you so much, Karen!

[Nicole and Teddy]

The GI panel results are in and cobalamin and folate are slightly low. Pancreatic lipase and TLI elevated. Findings are consistent with small intestinal disease like IBD, dietary hypersensitivity, small bacterial overgrowth, and others. They are recommending we begin a novel protein or hydrolyzed protein diet trial that has a lower fat content, starting vitamin B12 (either by injections or oral supplement), a good probiotic (he's on VSL), and folic acid supplement. Folic acid supplement seems easy - they said OTC is fine, but not sure on the B12 deal. Have a call in to internist to see if they have the oral supplement. The novel protein diet is another story - my regular vet said they are able to consult with a vet nutritionist in Atlanta and will let me know cost if I want to continue on home cooked. Torn between trying to maintain the home cooked diet or switching to a regular dog food. Karen - should I start a new post in the food group? Thanks!

[Karen, Jasper and Jackdoodle]

We did B12 injections. If you use an oral supplement, it has to be one with something called an intrinsic factor; your IMS will know about this. I do not believe you can buy it OTC. For us, the injections were simpler and I feel they are more reliable, since you don't have to worry about absorption through the gut. 

SIBO and dietary hypersensitivity are both parts of Inflammatory Bowel Disease; and as I mentioned earlier in this discussion, IBD and Atopy seem to coexist in a lot of dogs, including my Jackdoodle. Both products of a hyperactive immune system. 
I think it's best if you do start a new discussion in TFG to talk about possiblities for dog foods that might work for Teddy.
I'm sorry you have to deal with all this, Nicole. I know how overwhelming it can be. I;m happy to do anything I can to help. 

[Karen, Jasper and Jackdoodle]

Jane's Murphy is on oral cobalamin supplentation for IBD. This is the product he takes. http://www.cobalequin.com/

I don't know about pricing, but the B12 shots are cheap, and with JD having to take so many pills every day, I liked not adding more. He got a B12 shot every week for as month and then he got them monthly. 

[Nicole and Teddy]

Thank you so much, Karen - I was just telling my mom how awesome this forum is - to have people who love their doodles so much and are so knowledgeable to boot. It is a lot to digest and I've been giving everything a lot of thought to say the least. Honestly, I am happy to finally have a diagnosis. At least we finally know what's going on and have something to work towards. I'm leaning towards the B12 supplements - looks like it contains the folic acid too so maybe 2 birds with one stone? Though I'll do some research to see what level the IMS recommends vs what the supplements contains. Question - Teddy has a dermatologist appt in November for all the hot spots, skin issues he's had this summer. Any thoughts on whether the new diet/supplements will help with those issues? If they recommend immunotherapy, is that something you would do in conjunction with the IBD treatment? I am seriously considering getting him back on "regular" dog food. Will create a post in TFG now. Thanks again!

[Karen, Jasper and Jackdoodle]

The new supplements will not do anything for the allergies, unfortunately. And the diet will only help IF (and as you know, that's a big if) Teddy is allergic to something he is currently eating. Since most allergic dogs (and people) have multiple allergens, it's doubtful that a diet change is going to help much with his skin issues.

I'm not sure about starting immunotherapy in conjunction with the IBD treatment. The supplements would not interrfere with it. At this point, Teddy's IBD treatment does not include immunosuppressant drugs, which would interfere with immunotherapy. Whether the immunotherapy could interfere with the IBD treatment is something I don't know.  I think the best thing would be to ask both specialists; ask the IMS when you talk to her and call the dermatologist's office, explain the current situation, and ask if they think you should put off his visit. The only thing about delaying is that IF you are going to start immunotherapy, you really want to start it at a time of year when his symptoms are mildest, which is usually winter.