Saturday, November 18, 2017

Allergies and Itching

Most of the itching stems from allergies which are ever-present in Middle Tennessee.  We also have external parasites such as the flea that is competing for our state insect, and its close second of a different class the eight legged, blood sucking tick, plus a host of other fun critters like chiggers and mites, both sarcoptic and demodectic, which can also be a blast at an itch party.  

Where does one start?  Start with the obvious, cheap, and easy.  It is quite embarrassing to have someone make an appointment for an itching dog, drive a long distance, and the dog has the tell-tale signs of fleas, complete with flea dirt and a red, raw itchy place on his tail head.  The quickest and surest results are from Comfortis.  If the pet has a percentage of obvious signs it makes sense to eliminate sarcoptic mange.  In times past it used to be more common and in some cases was not detected in animals and misdiagnosed for years. Sarcoptic mange has been misdiagnosed by board certified dermatologists and even myself.  It is easily treated and best eliminated because the treatments are cheap and easily applied. 

Hypothyroidism is often a complicating factor in itchy skin

Itchy infections encouraged by a hypothyroid condition add insult to injury as a scratch mark from a flea then becomes infected because the immune system in the skin is down because of low thyroid.  When I first graduated in 1973 we were at a disadvantage in diagnosing hypothyroidism.  No one had the expertise to commercially do an accurate thyroid test on a dog.  In the late 70's Michigan and Auburn both developed the techniques for doing accurate T3 and T4 determination in dogs.  I being a somewhat loyal Auburn fan used Auburn.  I use the term somewhat because my undergraduate degree was from the University of Alabama.  After several years, in the early 80's, I received a strange report from Auburn University.  The normals had changed.  What would have been abnormally low the week before was now within the normal range.  A normal T3 was originally 100 - 200 with 100 - 110 considered borderline.  I had many patients with thyroid values in the borderline range that had improved significantly with T3 supplementation.  The new levels were now 75 - 200, since that time it has further been lowered to 45 - 150.  I called the lab at Auburn and inquired if they had changed their test, to which the answer was no.  I asked where they got their new samples to redetermine the normal values, and received no answer.  I reminded them that if they were using as normals the serum that we were sending them they were using eschewed samples, that we vets were pretty good at picking up hypothyroidism out here in the field.  So I have continued to use the original normals when they formulated them by testing normal animals.  I have since found out that not only reformulating normals from eschewed samples is normal, but in some areas the law.  The question is, how many hypothyroid animals are misdiagnosed as normal and would improve if properly treated?  I would suggest that applied kinesiology (AK), by essentially asking the animal his desired requirements or needs is probably a more organic, holistic, accurate method of testing for thyroid shortages, dosages.

For example, if an animal has a cortizol level of 9 when the reference range is 1 - 5, is it cushingnoid or trying to control runaway inflammation?  We in medicine always seem to think these bodies we have been given have no idea what is best for them and try to fight whatever our bodies are doing.  If we have an infection and our bodies raise our temperature to by heat kill or slow down the reproduction of bacteria, we take drugs to lower the temperature and make us feel better to get back to work, and thus not rest.  Thank goodness in more recent years there have been more doctors working with the body.  Back to the cortizol question.  Does it make sense to give drugs to destroy the adrenals or more steroids to help control the inflammation?  AK will give the practitioner the information and the protocol he should follow to help the body accomplish its goals.  This was all to give a path on how to negotiate the jungle of thyroids disorders and how we approach them and why.

Now to the most common cause of itching... allergies. 

This can be allergies to food, which is the most easily determined, or allergies to pollens from trees, grasses, crops and weeds, household insects, house dust, molds, household items, clothing, animals, etc.  The gold standard has been intradermal injections of a small amount of dilute antigen and judging the body's reaction at 15, 30 minutes, and the next day for delayed reactions.  Short-cuts have been used which are not as accurate, but are much more popular because of cost, pain, and time.  To me one of the most useless and confusing, though popular, is drawing blood and sending it off to a lab to have it checked for antibodies to the antigens.  It seems to be forgotten that the whole purpose of desensitization is to build up antibodies to the offending substance.  How does one know if it is an offending or protecting antibody?  They all combine with antigens.  AK seems to be the most accurate, painless, and quickest method of detection and the one we now use.  Gone are the days of shaved bellies, numbered squares, and painful intradermal injections and 25 gauge needles and sterilizing glass syringes.  Good riddance! 

In the late 70's I was one of the first, if not the first to do a complete gamut of allergy testing in the state of Tennessee.  I quickly learned not to use mixes, but to test for each antigen separately, and had much success with dogs, cats, and horses, desensitizing and making their lives easier.  Because allergies are cumulative, the straw that breaks the camels back, in most cases we don't have to find every offending antigen, just enough to lower them below the itch threshold.  We are then able to gradually return them to a happy state of life.  Since this can take up to eight weeks or longer, to rid the body of an offending eaten antigen we often speed the process with herbal anti-allergy and anti-inflammatory agents. To this is usually added aloe vera for its known soothing-healing properties and gut-calming effect for two to four weeks.  In our research we discovered a particular brand  which will not cause diarrhea and tastes good, so the animals do not object to it.  We have found that most of the time if we remove the offending food the animal's skin, organs, and well-being return to normal.  I am not even sure one can get an accurate blood chemistry, hormone levels, or blood pressure test if the animal is in a reactive state due to allergies.  Much of our energy is spent trying to find this state of well-being for our patients.  It is crucial to everything.  Further, if the food allergens are eliminated the animal can tolerate the seasonal pollens etc. and all are happy.  We have sometimes, on rare occasions had to search much deeper, such as testing offending toys that the animal mouths on a daily basis.  It is surprising how many good diets are undermined with awful treats.  Fortunately this is also something that can be done long distance.  We do have a method of detection long distance and has been very successful.  Please see the write up about Samantha Jane under Inflammatory Bowel Disease.

In some cases our clients want to be able to feed the offending food and we can desensitize them to it so they can eat it once again.  An example is the lady with a young, great dane allergic to chicken.  As she envisioned her mounting dog food bills and useless chicken quarter sales, she made an appointment for the desensitization procedure and was able to secure both financial stability for her household budget and peace for her dog.  She thought desensitization was quite an economic bargain.  Most just switch to a non-offending food and gain peace.  It should be remembered that because allergies are a body defense mechanism that sometimes gets out of hand, we sometimes become allergic to teach us to avoid a traumatic situation.  This can be either physical or emotional trauma.  Getting a disease, being hit by a car, or undergoing the abandonment of your family putting you in jail while they go have fun without you for no reason that you can discern would be trauma. 

I do believe that some animals become so traumatized while boarding that they develop allergies.

This might be especially true with an insecure, rescued dog.  We should try to make our outings less emotionally traumatic to keep them healthy.  There are amino acids and homeopathic treatments that can ease their anxiety.  The good news is a body is often forgiving and in a few years will lose its allergy if it does not come into repeated contact.  So there is hope that Spot can one day eat brown rice again, but it was not that good for his carnivorous body anyway.