Witchy Over Itchy

As a new mom at Little League, I was relieved to bump into an acquaintance mother in the stands. She had brought her adult Boxer and my American Bulldog puppy was enamored of her.

As the two dogs rough-house in the grass near us, the woman suddenly announces how angry she is at her current veterinarian (always dangerous territory)! Turns out her veterinarian said not to breed her female dog because she has allergies. Before I can respond another mom interjects dismissively, "Pfht! All dogs have allergies." Feeling ambushed, my veterinarian instincts overcome my social delicacy instincts and I blurt out "No! Allergies-are-an-expensive-and-difficult-problem-for-many-owners-and-terrible-for-dogs. I-even-know-of-one-dog-who-was-put-down-because-of-her-suffering!"

You could hear a pin drop.

While the Boxer's owner stares at me with mouth slightly agape, I try to salvage the conversation by asking calmly about her dog's symptoms and severity. To no avail. The conversation has died and cannot be resuscitated. At least for this baseball game, I have become a pariah among Little League moms.

Having had some time to reflect on the scene, I find myself agreeing with Second Mom's statement that "all dogs have allergies." It certainly seems that way some days as dog after dog visits my veterinary clinic with complaints of painful ear infections, inflamed paws and uncontrolled itching.

Yes, many dogs like people have mild seasonal allergies. We don't discourage people who suffer from hay fever from procreating. We don't even stop people with life-threatening peanut or shellfish allergies from marrying and having kids. The thought is just plain ludicrous. But dogs are not people, obviously. It is our responsibility in this age of pet-overpopulation to be cautious and judicious about which dogs we allow to reproduce and why. Many allergies in pets have a hereditary component. If not breeding a known allergy sufferer might prevent similar suffering in future canine generations, all the veterinarians I know would be in favor of that.

Canine allergies vary in cause and severity. Like bee sting reactivity in people, canine allergies may worsen with time. A mild seasonal allergy causing red, itchy eyes for a few weeks in a puppy can worsen with successive allergy seasons. The season itself may lengthen to all year round as the pet accrues additional allergy triggers including house dust mites and other unavoidable airborne particles. Symptoms too may worsen with some dogs living their entire lives with expensive, difficult-to-manage chronic ear infections, anal gland problems, and skin disease. Gastrointestinal upset ranging from picky eating, frequent vomiting and soft stools may indicate food allergy, which are historically difficult to diagnose and very expensive to manage.

Yes, Second Mom, so many dogs suffer from some degree of allergies I think most pet owners do consider it normal. The constant foot licking some dogs do, for example, may not be merely boredom. Butt scooting, reported with hilarity as if the dog performs the act for comic relief, may actually signal a food allergy. And let us not forget cats whose allergies are perhaps more challenging to manage than dogs': the puke piles you step in several times a week are not strategically placed to annoy. And not all bald cat bellies and legs are due to obsessive-compulsive disorder. Just because these things are common does not make them normal and acceptable in our pets!

Faced day-after-day with disgruntled, frustrated pet owners and miserable pets who hate taking the medicine that will provide merely temporary relief from their allergy symptoms, I forgive myself the "faux paw" of erupting at my fellow Little League moms. I hope they will forgive me knowing my rudeness is just exuberance on behalf of my afflicted patients.

P.S. Some breeds of dogs are more commonly affected by allergies than others (remember, that hereditary component of allergies?) so do your research befor acquiring a new pet. Ask the breeder or former owner if the dog or its parents have a history of allergies or allergy symptoms (itchy skin, excessive licking, ear or anal gland problems, chronic upset stomach) so you can go into the adoption with eyes wide open.

Hear Ye! Hear Ye! Facts about Ear Infections

I gave my spiel on ear infections so many times this week I can't help but write it down for posterity. 

1. Ear mites primarily cause infections in kittens or outside cats and are almost certainly not the reason your Cocker Spaniel is scratching her ears, so don't bother with the OTC ear mite remedy from the pet store.
2. Moisture is the enemy of ears, so don't clean those dirty ears with soapy water. Dogs who get a lot of baths or swim often (especially the floppy-eared variety like Labradors) should have their ears cleaned regularly with a veterinarian-approved cleanser. These products are specially formulated, pH balanced and may contain enzymes to improve the health of the ear canal. Please don't use straight alcohol, vinegar, or hydrogen peroxide. Also, I find OTC ear wipes are completely useless for this purpose. 
3. Another culprit behind itchy ears and infections is allergies. If your pet has a history of itchy ears at certain times of year you should discuss seasonal allergy management with your veterinarian. Finding a hypoallergenic food is tricky, and frequent diet changes without guidance from your veterinarian can lead to GI problems. Worse, over time, random exposure to many different foods may make your pet allergic to more and more ingredients!
4. Most early ear infections involve overpopulation by yeast. Yeast love moisture after all. Over time, ears that do not receive proper treatment and never fully resolve start growing bacteria. There are many types of bacterial ear infections, with the most difficult to treat infections involving rod-shaped bacteria. That's because these types of bacteria become resistant to antibiotics quickly. If your veterinarian suspects bacterial otitis she will want to look at some ear discharge under the microscope to get an idea how aggressive therapy must be. In fact, the presence of rod-shaped bacteria often warrants bacterial culture and sensitivity testing to ensure the most effective medicines are used.
5. The amount and type of microorganisms growing in the ear canal indicate how long treatment should be. Two weeks of treatment is a bare bones minimum!  I have seen bad bacterial otitis cases take over six weeks to clear up. For severe or chronic ear infections, rechecks by your veterinarian every two weeks is essential. I know it might seem expensive and time consuming, but if you don't follow up now you'll end up wasting a lot more money and energy on those problematic ears over time, your pet will have chronic pain and may even have diminished hearing. 

This week I gave a second opinion on Arnie, an adorable, good-natured pug whose previous veterinarian had given up hope that the chronic ear infection could be resolved and had discussed lateral ear resection with the owners. Lateral ear resection is a last ditch effort to clear up infection. The dog's ear canals are literally surgically removed! The problem is that I've treated "ear infections" in dogs who've had their ear canals removed, so it's not a sure cure. Arnie had a history of yeast otitis and microscopic evaluation of his ear gunk showed nothing but yeast. Turns out that over the course of Arnie's life the owners were prescribed one two-week ear treatment after another and the ears were never rechecked! After 10-14 days of medicine Arnie's ears felt better, the smelly brown gunk inside decreased, and the owners believed the infection was gone. I imagine Arnie's yeast enemies singing Chumbawumba's "I get knocked down, but I get up again" deep inside his ear canal about a week after the treatment stopped. 

We are currently treating Arnie with a leave-in ear treatment that eliminates the need for daily cleaning and treatment at home. Arnie's happy because he doesn't have to have his painfully inflamed ears messed with at home every day. The owners are happy because they don't have to do anything with Arnie's ears at all. I'm happy because I know the medicine is exactly where is should be and is assailing the yeast around the clock for two weeks straight (no skipped treatments, no inexpert medicating). We have a recheck appointment scheduled for two weeks, and the owners have been  prepared to expect 4-6 weeks of treatment if all goes well.  

While I fear Arnie has had a smoldering yeast otitis for years, I'm looking beyond simply killing resilient yeast to identify the underlying cause(s) of his original infection. Arnie is quite roly-poly and a breed that often suffers from allergies. He has dry skin and the fat in his face scrunches up his ears so they tend to trap moisture. I've started Arnie on a fish oil supplement, discussed weight management and questioned closely about possible food allergies. Treatment of severe, chronic ear infections and identification and management of the health conditions that cause them require patience, ingenuity and dedication. Luckily for Arnie, his family is motivated to resolve his ear problem once and for all.