Allergic Reaction Survival Kit, the Pet Parents Guide

Daisy

This lovely girl is Daisy. Her contagious smile should be the poster representation for the pit bull breed. She loves everyone and couldn't be more docile, affectionate and loving. She is the epitome of the majority of the rest of the pitties I know, an affable girl who prefers belly rubs to silly stick throwing or ball chasing.. What she lacks in drive and ambition she more than compensates for in charm.

Daisy is an interesting case for a few reasons. She came to see me about a year ago for her first cruciate repair presenting with the typical presentation of lameness, knee swelling and joint laxity. She was a young, healthy, active girl who slipped and blew out her knee. We did our routine blood work and x-rays and set her up for her surgery.

Her knee surgery started out routinely. The knee was indeed missing its complete cruciate ligament, but her thick, muscled, robust body compensated for her injury well after the knee was stabilized. She did very well under anesthesia but as she began to breathe deeper and faster while waking up from the anesthesia she also started to turn from her normal pink to a bright red. It was as if the shades of her skin were transitioning from quiet pink to raging lipstick red! I quickly grabbed a bottle of diphenhydramine and gave her an intramuscular injection. We watched her breathing and heart rate very closely and within minutes she blushed back into her placid pink without any further episodes. I made a note in the chart to forewarn us in the future and called her parents to report on her surgery and the mysterious red flush. They told me that "she did this pretty often and that nothing ever seemed to come of it."

She limped back into the clinic in December. This time holding up the other knee. She is yet another pup who met the 80% bilateral cruciate rupture statistic, (not exactly what her parents were rooting for I'm sure). But, sure as she flopped over for a belly rub she also had blown out the other knee!

The approach to her second surgery was a little more proactive. As a precaution we gave her a dose of diphenhydramine before we started her surgery. This time no redness occurred at all.

About two weeks after her knee surgery, on a Saturday night, Daisy's mom called worried because her eyes were very red, she was lethargic, and was covered in hives. She also sent me this photo;

This is what we call angioedema (swelling of the deep layers of the skin), and uticaria (hives). The skin swells and gets erythematous (red). It is not comfortable and therefore pets are usually quiet and subdued. We also usually see concurrent pyrexia (fever).

I sent Daisy's mom to the pharmacy to pick up diphenhydramine (generic Benadryl, an antihistamine). I told her to start Daisy at 1 mg/pound, or about 50 mgs. I also told her to get her in a bathtub to help lower her fever (I guessed based on her redness she would be hot) and in the rare case that she was having some contact allergic reaction to something in her environment it might help her if we could wash it off. I told her that she could give the diphenhydramine every 8 hours. I also instructed her to watch very closely for trouble breathing and worsening of her quietness. I didn't want her to become anaphylactic. If he started panting, fainting, or looking distressed they were to go to the ER immediately!

The next day I saw Daisy looking like this;

The raised hives had turned into welts (red spots) in her axilla (armpit). The facial swelling had resolved and she was her normal bright, happy, wagging girl waiting for a belly rub.. which gave me a good view of this..

OUCH!

It was time for a steroid to tell her skin to chill out!

It was also time for us to investigate anything that might be causing her problem.
I instructed her family to stop using the antibiotic and NSAID that I had prescribed after her knee surgery.

Her at home plan involves;
1. Monitor for flare-ups and try to correlate them to a source.
2. Keep a Daisy Emergency Kit on hand. It needs to contain diphenhydramine and her steroid.

If she continues to get these reactions we will prescribe an epinephrine pen to have on hand. I always worry that one adverse reaction might lead to an anaphylactic reaction. These can only be treated by an injection of epinephrine and you only have minutes to administer it.

Treatment Costs;

Daisy's cruciates were about $1100 per knee. We use the extracapsular lateral fabellar suture technique.

Allergic Reaction Exam, Free, she was at two weeks post-op so those are free.
Injectable steroid, $29.
Injectable diphenhydramine $24
Go home steroid $16

If you have a pet question, pet experience you would like to share, or a furry family member that you are devoted to please visit us at Pawbly.com. We are an open community dedicated to empowering and educating pet parents so they can take better care of the companions they share their lives with. We are free and open to anyone who loves pets.

You can also find me at the clinic, Jarrettsville Vet in Jarrettsville Maryland, or on Twitter @FreePetAdvice.

Bulldogs, The Good, The Bad, and the Skin

I saw a Bulldog yesterday that prompted me on the importance of "an educated consumer is our best customer." (I borrowed that tag line from the long run advertisements, and now I think defunct? chain of stores in the Philadelphia-Maryland area called Syms). Before you fall prey to the incredibly charming and sweet  captivating persona of a Bulldog you have to know what you are getting yourself into.


They are the cutest puppies on the planet, (I know I already said this about Bassett Hounds, but I do think Bulldogs are just as cute, OK maybe a little cuter). Those smooshy round faces, that rolly-polly body, and the adorable-ness is impossible not to make even the most rigid person melt to their knees. At 0 to 12 months old there is nothing but cute bounding abundant love, smiles, laughing, joy, an internal self affirmation that this was the best decision you ever made in your life, and you KNOW that you will never love anything more than this puppy!


Here I am as a fourth year vet student on medicine block (rotation) with my two very sick bulldog puppy patients. Those guys were in the ICU for weeks, but thankfully made a full recovery.

After 14 months things start to go very slowly downhill.. It starts with a very gradual almost undetectable scratch every so often. Or maybe a "little pinker than normal" ear. After a few weeks the itch becomes an incessant "thump-thump-thump" of the foot hitting the floor all night and this really starts to annoy you. So, you naturally make an appointment at your Vet's for "itchy skin." At this first visit I will listen quietly and write down everything that you are saying and doing to try to get the itch to stop. I will ask "what you are feeding? how much? how often? and what you use for flea and tick prevention?" I also will ask if "You have ever had a Bulldog before?"




My best friends baby. On his first Christmas.

 

After a thorough physical exam I will sit down and start to discuss everything that is about to follow in this story. I will admit to you that "Bulldogs are one of my favorite breeds of dogs." "They are gentle, friendly, affectionate, great with children, and usually have few to no behavioral issues. BUT, they are probably the most expensive breed of dog to own." I will explain my bold statement with, "they are expensive because there is no other dog breed that requires more time and attention and has more long standing issues than the average Bulldog." Your heart will sink a little, and you will hope that "your dog will prove me wrong." I won't blame you and I will keep my fingers crossed for you that you are right and I am wrong.


Here is a list of the common Bulldog problems I see:


1. Skin. 
This is the most common Bulldog problem that I see. Many Bulldogs that I treat need chronic medications to just "control" their itch. The skin gets thicker, and bacteria and yeast overpopulate, they get itchier, and scratch more, and traumatize their skin, and then develop wounds, etc. The cycle gets more severe and the interval between the outbreaks becomes shorter. If you have a "quick" first visit at your vet's office I would be willing to bet that they just put you on a steroid (most likely prednisone) for a few weeks. the itch will quickly go away and you will feel as if it is behind you. I really hope that at that first visit your Vet warns you about the likelihood that this problem will be chronic, and that long term steroids are dangerous. when I say "skin" here I am talking, feet, face, ears, butt, belly, and everywhere!.

2. Entropion. 
This is a condition where the excessive heavy haired skin around the eyes rolls inward. The constant rubbing of hair on the cornea causes excessive tearing and trauma to the cornes. It is like ALWAYS having hair or an eyelash in your eye, annoying and painful as your cornea is worn away. It is usually corrected surgically by giving the Bulldog a face life. We actually remove some of the excess skin so the skin roll doesn't rub the cornea of the eye. I have done a lot of face lifts (eyelid tacking) on 3 to 8 week old puppies. If the entopion is not corrected the dog can go blind from the cornea getting damaged beyond the point of being able to see through the eye anymore. (See Levi's story.)

This is Corky. His entropion surgery story.

3. Joint problems. 
When you mutate any animal as much as we have selectively bred the Bulldog you get genetic problems. The elbows and shoulders carry a very heavy load because these guys are so front heavy. Most dogs carry about 60% of their weight on their front legs but Bulldogs can carry up to 70%. Those broad thick shoulders cause an immense amount of joint stress on the elbows which are already bowed out. And just for fun try to look at a hip x-ray of a Bulldog. Most of them don't even look like they have a hip socket.


4. Brachycephalic Syndrome. 
(Aka short skull) Our term for what happens when you shove the nose up into the brain. Dogs were supposed to have a nose. When you breed for no nose the anatomical architecture has to go somewhere so the following things happen to the Bulldog.

• The soft palate, (the fleshy part of the back of the roof of your mouth gets pushed down your throat which makes it harder to breathe or pant.
• The trachea gets weaker. So what should be a hard cartilagenous tracheal tube is instead a soft collapsible straw. If you breathe in to hard it is like trying to suck an very thick milkshake up a straw. The straw collapses instead of the milkshake going into your mouth.
• The laryngeal saccules become everted. These live in the back of your mouth on both sides. They are supposed to live in little pockets sort of in the cheek area. But if there is enough stress in your mouth to breathe they become everted. They look like a grape on the walls of your mouth.
• The wings of the nose are excessive and narrow the noses ability to bring air into the nose. Try to hold your nose about 90% closed and then take a deep breath, impossible right? 

We usually recommend surgery to correct any and all of these so that the dog can breath better.




I will go on to say that in most cases these guys have chronic "atopy". This means that these dogs are genetically  predisposed to inhaled or absorbed environmental allergens. To make it simple anything in your environment can set these guys off. Because we can't live in a plastic bubble we try to "minimize" how many things these guys react to. 

So, our basic advice is to;

1. Keep them on a GOOD flea & tick preventative monthly year around. This is a REQUIREMENT! There can't be any missed doses. We know that the one thing most dogs are allergic to, or can trigger their itchiness is flea. And 1 flea bite can start the whole cascade of itchiness. We all also know that once you start scratching you get itchier.

2. Keep the skin as calm and quiet at home as possible in the hopes that it will reduce the severity and duration of your "bad flare-ups." I ALWAYS go over the things that an owner with a dog with atopy should have at home. These include ear cleaners, Benadryl, medicated wipes, Fatty acid supplements, sprays and shampoos. I do a lot of training of my clients to try to minimize the flare-ups.

3. We always talk about food. I want people to understand that about 12% of the dogs with allergies have a food component to their allergies. I get soo much resistance from owners to try a hypo-allergenic diet. The first thing that they always reply is, "he has been on the same food his whole life." To which I reply, "you develop allergies over time. So although he may have been fine eating beef, chicken, or dairy for the last few years he may now be allergic to them. And, if we can just keep that food out of his body then maybe we won't have the allergy anymore?' "If someone told you that you were allergic to bees then you would stay away from bees right?" I also tell my clients that we want to find something that is curable. Not eating a food that causes your skin to itch is a cure for itchy skin. "You should hope for food allergy, because the rest of the list probably isn't curable."

Hives

As a last few pieces of advice I will say; it is very important to know your dog, pay attention to them, watch for any signs of things being abnormal and don't dismiss them. If you see hives give Benadryl. If you have very itchy skin give a bath. If you see your dog is lethargic, having trouble breathing, swelling up like a cartoon character get in your car and go to the Vet NOW!


An allergic reaction can kill.


And lastly, know what you are getting into. Those sweet adorable round snuffly faces and genetic disasters that can cost a fortune. But lord knows I love them!

Remember Pudgie? the bulldog. She came to us with terrible skin.

Emergency Kit. The Veterinarians At Home Kit.

I was asked by a follower on Twitter for "my best pet advice," so I had to think about this open ended question for a moment and decided that one of my best pieces of advice was that every pet owner should have an at home emergency kit.

Here is what I think it should have in it;

1. A list of emergency phone numbers. 

I give out business cards so that my clients have one for their regular vet and also a card for our emergency clinic. (It has their number in very big NUMBERS so even in the emergency you see it). I also want the directions to be on the card. When you get stressed you forget to listen or pay attention to anything.

Pet Poison Hotline. Their number is 1-800-213-6680, a fee applies for their services.

2. A big blanket. 

It can act as a straitjacket, a warming blanket, and absorb fluids if needed.

3. Thick absorbent bandages and Tape. 

Some people actually use women's maxi pads. They are cheap, and highly absorbent, and pre-packaged. Vets love Vetwrap. You can find it pet supply stores, or stores that sell horse products. It sticks to itself but not your pet, or their fur.

4. 3% Hydrogen Peroxide. 

If you are concerned that your pet ingested something toxic or dangerous you need to have this on hand. Call your vet or the Pet Poison Helpline BEFORE inducing vomiting. Their number is 1-800-213-6680, OR call your vet, OR local pet emergency clinic. DO NOT WAIT. Seconds count, and hours can kill. (For more information on when to use this please see my blog, To Puke Or Not To Puke, That Is The Question..)

5. Benadryl (generic is called diphenhydramine). 

You need this anti-histamine for bug bites, (or if you are my dog Charlie, eating frogs) or any other allergic reaction. If your pet gets red skin, or hives, or is even having a worse allergic reaction it is your go to drug to try to slow or stop the progression of the reaction. If your pet is having trouble breathing, get in the car and go immediately to the closest ER.

6. Eye wash. 

Over the counter generic eye wash, sterile saline, is fine. Cheap stuff. Use it to flood the eye if the eye looks inflamed, has any abnormal discharge, or is being held shut (squinting). If the eye doesn't appear to be improving after an hour, or if it is painful, or you see yellow or thick discharge you need to go to the vet ASAP.

7. Thermometer and Lube. 

Please use a digital thermometer. The old mercury ones are too dangerous and fragile. What would happen if your pet sat down while you are trying to take their temperature? The normal temperature of a dog or cat is about 100.5  to 102.5 degrees F, or 38.5 to 39.2 degrees Celsius. If your pet is below 98 or above 104 degrees F go to the vet immediately. DO NOT WAIT! It is very likely the temperature is on its way to worsening, and seconds count!

8. Nail trimmers and Quik-Stop.

It is important to have the right trimmers for your pet. Ask your vet to show you what they use, and how to use them. Kwik-Stop is the product we use to stop the bleeding if we accidentally cut the nail too short. Here is my primer on How To Trim Nails.
I swear I have had this same bottle since 1995. It is still full, it takes forever to go through a bottle, and you get better at trimming nails with practice.

I also have very definite opinions on nail trimmers. Don't buy the cheap guillotine kind. Buy spring loaded heavy duty nail trimmers if your dog is over 30 pounds. ALWAYS have quik-stop standing by JIC.

9. If your pet has any medical issues you may need other drugs in this kit. 

I keep an NSAID, (old dog pains), and ear wash for floppy eared Beagle-pup. Along with previously prescribed drugs, ointments, etc. Always ask your vet before using old medications. many expire, and often clients inadvertently use the wrong drug on the wrong species or at the incorrect dose. I also keep heartworm, flea and tick preventatives close by in a locked container.

Please remember to not use prescription medications, (or ANY medications) without your Veterinarian's "OK" first. Many clients over use and abuse the prescription ear medications and over time make the ears much harder to treat.

Always use the medications given to you completely and exactly as directed on the label. I also have unfortunately seen many owners give their pets "human drugs" that are toxic to pets. I have actually lost pets due to owners giving medications that are toxic, and/or giving doses of drugs that are way over what a pet can tolerate. If you are in doubt, "Don't give it!"

10. I also keep my pets medical records with the medical kit. 

So if you need to run to the emergency Vet you have your pets records.

11. A Leash, Harness, Collar, and/or Pet Carrier.

If you need to get your pet somewhere fast it really helps to have these things at your finger tips.

12. Something to use as a Muzzle.

Also, some dogs do not do well with shock collars, or invisible fences. Please seek advice before purchasing products that might be potentially harmful and/or not work for your pet.

In the event your pet is hurt, or scared be prepared with a soft cloth muzzle. You can make one yourself with a long scarf, leash, a necktie, or pantyhose (if you use this don't pull it too tight this stuff is hard to get off and can act like a tourniquet) or length of gauze. I promise you your pet will bite if they are in pain and you are trying to do anything to them. When you are in pain you are not the same individual. Ask any woman who delivered a baby what came out of their mouth in the delivery room. A dog, or cat, or anything reacts without thinking if you touch them, and they are in pain. So just put one on and then don't get upset if they resent the muzzle. Improvise your own muzzle by making a noose by tying a loose knot in the middle of the length of the strip, leaving a large loop. Approach the dog quietly from behind and slip the noose over their nose. Do not block the nose, they need to breathe through this. If your dog is really struggling to breathe then do not tie the noose so tight. It should only be tight enough to not allow their mouth to bite you. Put the noose about mid-way on their muzzle/nose. Pull the know tight with the know on the chin, then pull the ends behind the ears and fasten a bow.

 The following picture is from "The Dog Lover's Companion," Fog City Press, a great resource for all dog owners.

Here is a picture of Savannah, my dog, modeling, (unhappily) an improvised muzzle.

And here is Joe, my husband, being a goof, because I asked him to show me how put it on ( a little quiz to see if he was paying attention), after I had put it on Savannah.

Here are some of my pets. I promise you that I have used my emergency kit on every one of them. (Did I ever tell you about the time my whole staff came over to our house to go fishing and my dog Charlie bit into the 3 pronged barbed fishing hook? That was emergency sedation, first-aid, and surgery. I'll tell you that story later.)


Ms. Pig just saying "hello"

Miss Pig, Ambrose, and Savannah on a perfect summer day. That's Ms. Pigs house. It is insulated and cozy year around.

Here is Squeak Box, DC, and Donner. We only go out on supervised outings. They are indoor kitties. But they love to go for walks with us and think of themselves as vicious predatory jungle lions.

Ambrose looking for attention.

Lilly, my moms dog. She's another story. In this photo she has Cushings disease. It was not treated at this point. Now she's an Addisonian. I'll explain her saga someday.