You're listening to In the Vets Office with doctor Josie Horchak. Welcome back to in the Vets Office everyone.
I am your host, Doctor Josie, and this is an amazing week because we are joined once again by doctor Isabella.
Hello. Hi.
We had such great feedback on our previous episode that I figured we had to get you back into the Vets Office to do another episode.
Yeah. I had a blast, so when you asked me to come back, I was ready to go. Really excited.
I'm excited to We're actually filming today's episode in my basement because the iHeart Studio is moving right now, and so we're really leaning into the podcast from home. Moment we are in I'm in my slippers and pretty much my pajamas, yeah, leggings, hoody. Yeah, we're chilling and Sia's on her a little best next to me, and I don't know if I'll ever go back to podcasting from
the studio after this. Just kidding, Morgan, our poor producer had to set up this whole thing, so we will in fact be going back to the studio, But until then, slippers and pj's for the win, all right, So we'll start our episode as always with with our case of the week, Doctor Isabella and I were putting our heads together thinking about some interesting cases we have seen, and we kept coming back to this one thing that we are noticing in practice. It's not so much a case,
but it's more of an observation. Yeah, if we see it all the time, all the time, and it really makes my day. And we have found that when we walk into exam rooms, we are addressing the pets and speaking to them directly, and then the owners will respond as though they are the pet in like very silly voices.
Yes, yes, all the time. And I don't know if every vet does this, but doctor Josie and I both agree like we are in there asking the pet, how are you? You look beautiful today? How's it going? And the owner inevitably will respond in some weird, high pitched voice, you said you have some like I do, certain accents.
I had an older lady that was convinced her shit so you had a lisp, so she'd like, doctor Josie.
I'm not feeling so well today. I'm telling me hers, I'm feeling thick.
Like she would talk to me as though she was her dog with a lip and it was amazing, doesn't You're a brother in law.
Yes, and we keep bringing up poor Ryan on these podcasts. But Ryan, he's an attractive guy, yes, and he is always the one who brings the cats into their vat. My sister said she gets embarrassed every time because they'll ask how their cat is doing, and Ryan will inevitably say, oh, you know, he's doing okay, just throwing up sometimes, but other than that, I'm good not throwing up. Throwing throwing up.
People really lean into it, oh, because I narrate my animals at home, like they teach you, have their own voices all the time.
And I just think that people.
Don't like they don't do that out in public often, but we get to see that side of them.
Yes, and it's amazing. It'll be a big burly man with a tiny little Yorky or you know, some like young attractive person and it's just fun to watch people let their guards down and be funny.
I do have an older gentleman who brings in his Persian cat. And Persian cats, for those of you that don't know, have those like smushed faces and they're like have a permanent frown on their face and he speaks, He narrates her as though she's.
An an old British lady. Nick Hello, doctor Josie, I ate.
Three kibble this week, like he talks to me the whole time as though he's the cat, but in a in a British accent. It's amazing, And I respond. I do too, respond as if we're having a normal conversation.
Back and forth.
I always say, our job is very weird, sometimes very some funny thing.
We're not afraid to let people see our side. For sure.
You've got to let your freak flag fly and that med you know, and I tell people it's a judge free zonees.
Yes, so you whatever, you be vulnerable. You talk to your pets. However, you need to show us pictures of poop vomit, and we no judgment whatsoever. We've seen it.
All, yes, exactly. All right, Well we'll dive into our listener questions. First up, at.
What point in a dog's life do you transition them from regular food to senior food.
That's a great question. I and doctor Isabella, you can tell you what you do. So I don't know that there is an exact time where it's like you need to get off adult food and onto senior food. But I do sort of have like a time frame where I think dogs and cats move from regular adulthood into senior hood. Dogs, I would say a rough age of seven.
To eight years old.
Yeah, And you were saying if they're really small, we probably can push that back a little.
Bit, right. It totally depends on the size of the pet times. The small breed dogs a little Yorkis toy poodles, they can live easily until sixteen seventeen years old, So senior for them is going to look a little bit different than senior for the great Dane like you had, who Senior for them is probably five five six. Yeah, i'd say like.
As an overall general rule, though like most dogs, we start to look at them as I hate to say senior. I feel like there's such a when owners here a senior you can just see it in their eyes. Yes, But I guess we'll say senior hood into their older years really like around seven or eight. And that's important because that's when we as vaterinarians really start recommending screening
lab work. We recommend it before then, but we really put an emphasis on it once they get a little bit older, so screening lab work and then touching their food as well.
Yeah, and once they get to that, like true senior age, I mean, before them, we're recommending annual adult blood work to monitor and get a baseline. But once we get to the senior it's like we might want to be checking things twice a year. So things change in terms of what our recommendations are at that point too. Yes, and not to leave out cats. Cats, cats are pretty standard. They like, you know, our stats have similar lifespans.
Yeah, it's not like our tiny dogs versus our big dogs. So I would say ten years of age is usually when I deem them moving into their senior years.
I agree. And cats we have to be extra cautious with because oftentimes we'll see kittens and then we don't see them again until they're seniors because they're fine. Owners don't bring them in and then we see them when you know kidney changes are happening.
Part of my French. But when shit hits the fan is when we see them. Yeah, a lot of time.
Yeah, and cats can hide things until it is not okay right, so things can be brewing, and that's why we recommend even for cats, checking bloodwork to monitor kidney values, get their baselines when they're young or middle aged, and.
At least do a really good physical exam on them once a year. Yes, absolutely, I agree. I hope that answers the question. And to be fair, I do think it's important to get them from adult to senior food. It's way more important to get them off puppy food, yes, and onto adult food. But if your older pet is eating adult food, it's probably not the end of the world.
Yeah, totally agree. And sometimes we get to the point where seniors are really picky and I'm like, honestly, I just want them to eat, so we find that. I totally agree. All right, let's do question number two.
Hello, my question is I have an aggressive mixed dog. I do not know why she's aggressive. I've had her since she was a puppy. We do live out kind of far and don't get a lot of visitors, so and she hasn't had a lot of interaction with people, so maybe that's why. Anyway, she needs to get her nails trimmed, and I'm afraid to do it because sometimes she gets this look in her eye like she would bite me. She has not bitten me, but I'm just I get afraid, so I want to take her to
the VET to get them clipped. But in order for her to go to the VET, she has to be tranquilized, and I have to start to tranquilize her probably I think two days before she goes to the VET, so she's super drunk, and I'm just worried that I have to do that. Anytime she goes to the VET for a heartworm test, for anything, I have to tranquilize her. And I'm worried about doing it for her nail trimmings. I mean, can that be bad for her? Or should I just let them grow until they're so long that
we can't stand it and then do it. I just don't know what to do. If you could help, that would be great. Thank you so much, and thank you for what you do.
Another great question. This owner is using the word tranquilize. I think what she is intending to say as the veterinarian wants to give some oral sedation prior to her dog's VET visits.
There are some dogs.
Out there that are extremely fractious, and we do have to give them injectable sedation at the vet hospital. But I think more commonly, and I think what she's saying is, hey, I have to give my dogs oral medication prior to every vet visit. And I understand, especially not knowing, like is that safe for my dog? I just want to get a nail trim on her? Do I really need to give her these medications? And I understand where owners
are coming from. With that being on the other side of the coin, I would say it is very safe and helps us times a million get our job done.
Oh yeah, And I honestly feel awful seeing a pet come into the clinic who is terrified scared, you know, and the way that dogs and are stressed, they can manifest that in different ways. Some cats are going to rip our face off. Other pets are hiding in the corner, and in either of those scenarios, that's not an enjoyable visit for them exactly and us and we use it very very commonly now, the oral sedatives just to take
the edge off. It's not going to knock them on their butt, but it will help us get done what we need to get done. It's super safe, and yeah, I feel like I try to tell owners just because I'm recommending this to you does not mean, you have a bad pet, exactly, it's just to take their edge off. And quite frankly, when I go to the dentist, I'm like, can I have like happy gas or laughing gas? I want a good experience. So I just think of it kind of in that way.
I totally agree, and I think there's been a huge shift in our field. I started working in vet med in a vet hospital. I was fifteen, which was almost twenty years ago. Wait was that twenty years ago? Twenty my very yeah, wow, oh my gosh, I'm getting old.
And I realized, you know, back then, we didn't use medications to help take the edge off prior to pets coming in, and so it was a lot of physical getting physical with them and having to like hold them down and have like a big guy sit on top of them so that we could get done what we needed to get done. And the days of doing.
That are over.
We're really in the majority of modern animal hospitals are not using that kind of restraint anymore. We're really taking into consideration like our pets fear levels and stress levels and trying to mitigate those. And so if I have to give my pet a little something to take the edge off, and that means that they don't have a horrible traumatizing experience at the vet.
I'm okay with that absolutely. I give it to my own dog, And it's also something to bring up to your veterinarian if your dog gets anxious at the groomers or for travel perpose, we can use these oral sedatives for all those instances. And yeah, I think if a dog comes in and we are body slamming them to the ground to get their nail trim done, the next visit is not going to be pleasant. It's going to be even worse. So we just got to set them up for success.
And then just to reiterate, the safety profile on these medications is huge. I mean, these medications are so safe, They're tried and true, they're used in human medicine all the time. I can honestly say, I don't think I've ever seen an adverse reaction to them. So I understand, like, oh gosh, I'll have to give them multiple times, you know, for multiple visits.
But there is no, no, nothing wrong with that. Yeah no, I do it for monkey. Yeah me too. I do it for my dogs when it's thunderstorming outside and they are so much happier. Assuming Bigie needs something, then he goes to the vent. Yes, big he needs the whole shit inject the whole shabang. He is a bad boy. All right. Well, those are great questions.
When we come back, we are going to dive into our main topic of the day, which is allergies. A lot of you have been asking about it, and so this is a huge topic in veterinary medicine and something that really requires a sit down conversation like this. So we'll be right back and we'll dive into it.
Awesome.
All right, you guys have asked and we have heard. We are going to do the whole shabbang allergy talk. And I posted on my Instagram that I was really dreading this episode because the allergy talk is so.
I don't know what the right word is.
It can just be complex and it can be really frustrating for owners. And I said I might need to bring a bottle of wine to this episode, and I have, in fact brought a bottle of wine. So without further a deal, we're just gonna pop this for this talk. I'm trying to pop it.
Woo. All right, let's get a crack in I wish we could have this in our exam room.
I know, right, what if we brought a bottle of wine into the exam room. I feel like owners would love it.
Oh yeah, oh yeah, definitely.
Okay, So here, Morgan, would you like to drink out of the bottle?
Okay.
So when I sit down with an owner, and Isabelle and I were talking about this, when you have a pet come in and you're like, this pet has allergies, it usually looks like you say.
Because you brought up a really good point. The pet that comes in with multiple ear infections, Oh oh yeah. This is like the classic established care new client, new patient. They're coming in for a second opinion on there were current ear infections, and they've been giving drops yep all the time to no avail, And now they're coming in to figure out why I keep having to do this over and over again.
And when I sit down with them, I say, I think your pet has allergies. I think that's the underlying issue here. And I just want you to know as an owner, this sucks. This is far and away the worst thing to work up. It takes time. There is no easy fix. We can't just slap a band aid on it. We're going to have to do some trial and error, so like just you know, buckle up because we're kind of in for the long haul.
Yeah, And oftentimes when we see these people for that first appointment, can't we don't even have the time to go into the full detail that we will on this episode. So we have to focus on treating their secondary infections that they come in for first, and then ultimately rechecking the skin and the ear infections are going to be so so so important because then we can get them back to ground zero and transition to like addressing their underlying cause exactly.
And that brings me to a great point, which I think the first thing is what do allergies? And also I just want to say I'm really sorry for all our cat owners out there. This is primarily for dogs out meat can't touch a little bit. Cats do suffer from allergies, but I'd say dogs tend to be our most common offender. We can well bring up cats as needed. Definitely, the big thing for me is how do they How
are we typically seeing allergies present in our pets? And I think for us it's sort of unusual because when we have allergies. We have a sniffy nose, we have runny eyes, we might have a claw or a sneeze, And that's not typically the way that it can but not typically the way the allergies present in our pets.
Right more more commonly, I mean most of the time we don't even notice until we see the secondary infections or they smell like yeast and they're scratching. But predominantly we're going to see chewing and looking at the paws, which super itchy. That is like slam dunk allergies. My own dog, when I come home and our foot is soaked, I'm like, I know, you've had your foot in your mouth all day, chewing it like a corn cobs, chewing it like a corn cob, licking their feet, scratching their ears,
scratching their armpits, scratching everywhere. I feel like those are the most common ear infections or current ear infections. And one other weird one is recurrent anal gland issues. Yes, I feel like we don't focus on that as much, but a lot of dogs with underlying allergies will need their anal glands addressed more often than more often ones that don't.
I agree with that, and then from there, once we've kind of established okay, this pet has the signs of allergies, the next the next question is, well, what is causing allergies in our pets? And there's really three big things that cause allergies in our pets. Number one is fleas, number two is something in their food, and number three
is something in the environment. Environment can be anything from like something seasonal like grasses, trees, pollens, to something that's there all year round like dust, mites, mold spores and those kinds of things.
Yeah, and I think that's a good point to bring in our cat population because a lot of cats are indoor only, they can still have environmental allergies to things that are going on in the house.
Absolutely, or even like if it is high grass season and trees and pollens. We're bringing that in on our clothes and our shoes, and so it definitely can affect our kitties as well, for sure. And we see a lot of kiddies get fleas, Yes, I feel like they get fleas more often than our dogs do. Yes, And they absolutely have food allergies. So this applies to cats for sure, definitely. So we know as muginarians. Okay, your pet comes in, it's itching. It's one of these three things.
Where do we start with trying to figure out what the underlying issue is? And this is where it gets a little bit more complicated. The first thing is we do a really good physical exam and we take a really good history from the owner. And it's quite doing a physical to rule in or out fleas. Right, if you don't have fleas on yet, you probably don't have the flea issue right.
Less likely for sure. I do really really focus on their history with these pets, and if they are not on flee in tick prevention, I tell those owners like, theoretically, even if we don't see a flee today, it's still possible. So we can't rule out flea allergy in pets who are on prevention. I agree with that.
And they can get bit by a flea and then have this long lasting allergic reaction just from one flea bite.
Yes, And what people don't realize is that dogs and cats are actually allergic to the saliva from the flea. So a flea can jump on the pet, leave some saliba kiss ye, leave some saliva behind, jump off. We see no fleas but they're presenting for a flea allergy.
I agree it can be obscure because if they're not on prevention and we don't see fleas on them, then we just have to treat them as though maybe this is a allergy.
But it also could not be right. And I tell owners like, honestly, you we don't want like our fleas in our environment, but a diagnosis of a flea allergy is kind of a good thing. Slam dunk. Yeah, we can treat them. We can. Hopefully this is a one off, and it's significantly less expensive than going down a diagnostic rabbit hole. I agree with that for the other causes.
Sadly though, I feel like that is one out of every ten allergy cases, maybe even less than that.
We see, Yeah, and our pets coming into the hospital, I agree those pets do present with a very specific physical exam. Though, yes, I'm sure we probably learned the same way invet school that these pets are itchy, they have scabs, they can have live fleas predominantly in what we call the pants region. Yes, did you learn it less where they would put their pull their jeans up. Yep, So imagine a dog wearing pants or cat and basically near their butt based of their tails. The tail, Yes,
that is where we predominantly see the symptoms. So if a dog comes in, even if they don't have fleas, but they're not on prevention and their pants region is angry, then I'm like, Okay, this is probably flee we got a problem.
We're like Sherlock Holmes, Yes, so that that kind of explains fleas. And like I said, that's I don't do you think one out of ten? Do you think I'm over guestimating that over?
I think it's more common than we think it is, especially because like again cats specifically, yeah, and cats, we have a lot of people who live in apartments. Your cat could be indoor only they go outside, but the dog in the apartment next door could have fleas and they can get that just from living in the apartment. So we don't talk about this as much, but keeping even cats on flea intent prevention year round is gold standard. I agree.
So if we do the exam, we don't, you know, and take a history and we don't think that fleas are involved, the next place that we start is thinking about a food allergy ninety nine point nine nine nine nine nine percent of the time. If a pet is allergic to something in their food, it's going to be
the protein. Two of the really big things that I hear owners say that don't really apply to a food allergy are number one, Fluffy's been eating the same food for years and years and years, so it couldn't possibly be a food allergy. Into that, I say, sadly, that's not true. They can develop a food allergy really at any point in their life. It's kind of like my twenty five year old cousin who never had an allergy and then woke up one day and Ada Carrott and
her lips blew up. The humans also develop allergies later in life, definitely. And then number two, the other one is well, I've tried switching up the food multiple times and I haven't seen any improvement, So I don't think it's a food allergy. Both of those things I hear them, and well, it's great to know. They doesn't really sway me one way or another.
Definitely agreed if it's a food, they have the right thought process do, but they just need a little little extra help exactly.
And so what we tell owners is could this be environmental? Yes, could this be food? Yes, we don't really know until we do additional testing. And so the first place to start is to rule out or potentially rule in a food allergy. And the only way to do that is by doing a diet trial.
Yes, and diet trials are not fun. They're not They're definitely harder on the owner than the pet. I agree with that, But environmental allergies, unless you're going to the veterinary dermatologist and getting testing, it's a diagnosis of exclusion, which means we have to rule out every other possible cause before just being confident and saying your dog has
environmental allergies exactly. And again, wouldn't it be nice if it was as easy as switching up the food and putting them on a different diet and you don't have to worry about their allergies over again exactly? So the diet trial is very strict. We have to feed them a very specific type of food. There's kind of two different options. What I most commonly recommend is a diet
called a hydrolyzed protein diet. That is where the protein's broken down super small so the body should not react to it as foreign and they have to be on a strict hydrolyzed protein diet, which you could talk about the other option, for a minimum of eight to twelve weeks. No other food should go in that dog's mouth.
Nothing flavored at all. None, no treats, no bones, no flavored medications. And this is why doctor Isabella says, Hey, this is really hard because you have to get everyone in your family on board. If you have a toddler throwing things over the high chair, that can ruin the diet trial and your back at square one starting all over again.
Yes, and this is exactly what we do for cats to for everyone who has cats. Yes, we do diet trials for cats. Sac same and you said it's for eight full weeks. Eight full weeks, and then by that point we kind of go in one of two directions.
If their symptoms have resolved, then we can do what we call challenges, where we reintroduce certain ingredients or foods back into their diet, and if they are itchy again within a week or two, then we know, okay, we can't be feeding them that, and we just kind of do a trial and error until we get to the right I really want to emphasize too that the food that we are using in diet trials are prescription based.
There are other food brands out there that will label foods hypoallergenic, but they're not truly that hydrolyzed, very very small protein based veterinary food that really can only be used in a diet trial.
So that's a really a big thing.
And four weeks into the diet trial, I tell my owners, you not be seeing any improvement at all. There's still there's still some leftover protein from the food they were eating before that may be causing that residual allergy flare up. And so you really can't deem whether or not it's working until you hit week eight.
Definitely, they have to be in it for the long run, and I'm like, let's just like put our all into this for two months, and then after that, let's say they're itching, just continues, then we know, okay, you can eat whatever he want, it's probably not the food, right, And then you brought up challenging.
I am sort of of the mindset where I feel like I think owners are like, oh my gosh, I don't want to just feed them this hydrolyzed protein food. But if it was my dog, I would just keep them. I usually say, just keep them on the hydrolyzed protein food because a it's healthy, it's well balanced, They're going to do great for the entirety of their lives on it. And if you want to like start adding maybe a
treat in. But as far as like changing up their diet and going back to something over the counter, that will makes me very taken a risk.
My personal my dog Monkey is on a hydrolyzed protein diet. She's been on it since she was like a year old and now she's four. She loves it, so yeah, I've kept her on that long term. It is prescription, so it's going to be a little bit more pricey. So if I have owners who are, you know, trying to be a little bit more financially conscious, then we
can talk about other options. But even for example, the sensitive skin and stomach diets that are over the counter, those can be contaminated in the factory, so with other proteins, with yes, with other producterior or anything. So we cannot assume since our dog's been on a sensitive skin and stomach diet and nothing's helping, we can't assume that right. The other thing, too, is if you think about it.
If yes, prescription food is going to be a little bit more than your regular run of the mill food, but if they respond really well to it, ultimately you're probably going to save money because you're going into the vet less to or check ups and skin rashes and
infections and ear infections. So that's one one factor. So if we do the diet trial, or even if we don't do the diet trial, we'll say, then the other thought that we have is it could be environmental and like doctor Isabella said, that primarily is a diagnosis of exclusion ideally gold standard. We would love to do the eight week diet trial. Your pet is still itching, then we say, okay, we've ruled out fleas, we've ruled out
a food allergy. It probably has environmental allergies. And that can, like I said, manifest in a lot of different ways. It can be all year round. If they're allergic to something like dust mites, it can be really bad in the spring and fall when it's hey season. So it's not like a one size fits all by any means. Oh, definitely not.
And there is a way to definitively diagnose environmental allergies. Yes, and that requires consultation with a veterinary dermatologist.
Yes, if we're going gold standard, we refer you to the dermatologists and they do intradermal testing where they take these tiny little needles and they poke the dogs with all the different allergens, just like they do in humans and see how they react, and depending on what they react to, they will formulate allergy injections like a protocol, and they also have drops that go underneath the tongue and from there we help them lessen their allergies with
these these special formulations based on what they're allergic to.
Yeah, it's truly just like if you were to go to the allergy doctor and they were to formulate an allergy shop for you. Yeah, identical. But that's a big commitment.
H It's not inexpensive you're looking at It depends on where you live, but probably thousands of dollars, right, I see, Like, I don't know three thousand dollars, but you can probably around there also we need to ask.
But yeah, yeah, so it's a big commitment, and you're also going to have to do multiple rechecks with the dermatologists throughout the process.
We're not saying that's wrong, Like, if you want to get to the bottom of it, I love that, Like we support you, Yeah, definitely, but just understanding that it's not going to be the most inexpensive route.
And if you can't do that or don't want to for whatever reason, like we've got other options, So you should feel bad for not being able to take your dog to the dermatologists. I agree with that.
I'd say the majority of owners don't. Oh yeah dermatologists, No, not unless it's very severe. But I agree just like regular run of the mill seasonal allergies, No, they're not doing that. I agree with that. So that really brings us to it. I feel like then we end up with a set of clients that fall into a bucket of Okay, my family can't possibly do a food trial.
I've got seven kids, We're going to fail it. It's going to be a waste of my money to do a diet trial, or I just simply don't want to do that.
And then we've also got the bucket.
Of my pet we are pretty sure has environmental allergies, but I, for whatever reason, don't want to go to the dermatologist. And then that leaves us with Okay, we know your pet has allergies. We're not entirely sure which kind of allergy, but we're going to we have options as far as treating it and keeping them comfortable.
Right, And our goal from the general practitioners standpoint in those situations is basically just to manage their symptoms so that they don't end up with those secondary ear infections, skin infections, anal gland issues exactly.
And I think that's like the big takeaway point for me as a general practitioner is I know your pet has allergies, but we are not treating the underlying cause. If we haven't done a diet trial, we haven't done the intradermal testing. We are simply keeping your pet's itchiness at bay, trying our best to prevent those infections. But they will be times when those infections break through, and there are going to be times when hey, you couldn't get here on time for it's side A point, which
we'll talk about it's side A point injection. And so it's going to be a constant battle of doing our best to manage the symptoms. It's not going to be a cure though, right exactly. I wish it was.
Yeah, me too. I mean, it's kind of like with people. A lot of times we don't figure out exactly what we're allergic to. I don't know what I'm allergic to outside, but it's something, yeah, and I take an antihistamine. Yeah, exactly basically what we're doing with the pets. I agree.
So first things first, we treat if your pet comes to us and looking like it's having an allergic flare up, we treat the underlying infection. Like doctor Isabella said, We're going to treat that your infection. We're going to treat that skin rash. A lot of times, that's going to include an antibiotic and potentially like something that treats east whether that is like a shampoo or a moose or an oral medication. We're going to really target whatever is causing the infection on your pets skin.
Yes, so yeah, that's what we want to do first and foremost, but ultimately and depending on how severe their problems are when they come in, we are not going to get rid of these secondary infections without treating an underlying itch exactly because it's when they itch themselves, lick themselves to themselves raw that they get those secondary bacterial or yeast infections.
So I think that's a really good point to make, is I think people are always like, well, why is my dog my dog has allergies? Why is it getting an infection? And so much of it is because they're so they're traumatizing their own skin, which is already angry right that it's just making it so susceptible to bacteria and yeast coming in and causing infections.
They hone in on that. I mean, I have a dog who licks her paws, So I'm sure there are pet owners out there who can agree with me that in the middle of the night, when you're trying to sleep in all you hear, is there anything worse that licking sound? It is the worst. So yeah, that ultimately their mouth is full of bacteria, and they just focus in on one point. They get into a frenzy, and that's when we get those infections.
Yeah, So treating that infection first and foremost, and then from there we really have to think about interrupting that itch cycle. And I say, we have two main medications on the market currently. It used to be we didn't have them really when I first came out of at school. The first medication came out which is called apoquel. But
prior to that, everyone was using steroids. Yes, and not to say that steroids are wrong, and in really severe cases we do use them, but nowadays we tend to steer a little bit away from steroids right at the start of treatment. And so the two main options are Apoquell and side a point. Yes, and they both are different medications, but they both similarly try to interrupt the itch cycle. They turn off different receptors that are associated
with itch and our pets. And I know it sounds crazy, like just sitting here being like, how does that work? But they are amazing and that pets can get pretty immediate relief when starting these medications.
Yeah, and both side a point and apple quil they have their own individual pros and cons, So we can kind of talk about both of those. I think we both agree that our general first line, if we're going to recommend one of those, is going to be side a point. Absolutely, It's what I give to my own dog. It just has a higher long term safety profile. So side a point is a injection that goes under the
pet skin. What Jack doctor Josie was explaining, it's a monoclonal anti body, so it just binds to a certain receptor that tells them they're not itchy at a point. Is great because it's an injection that will last a minimum of a month. For some dogs it'll last eight to twelve weeks or longer. And then you don't have to give anything at home.
Yes, you just have really nice anything at home, but it is a pain in the butt because you have to come.
Back to the clinic.
Yes, I have some pets that come every four weeks on the DOT to get their sidle point injection, and then like monkey, we have some that can last eight weeks, twelve weeks yea.
And sometimes it depends on the time of year too. If it's the sea, you know, the spring and the fall, you might have to be bringing your dog every month on the DOT. But in the winter maybe if they have something to grasses and pollens, you might not have to bring them in so frequently.
And whether it's a food allergy or an environmental allergy, they all tend to respond very well. I find definitely these medications decide a point specifically.
Because again we're just targeting their itch right.
Definitely puts a little bit more onus on the owner of having to keep an eye on your pet and be really diligent about being compliant, like, oh, okay, I can tell that Fluffy's having a flare up or just a little bit more itchy today, I should get them in for a side of point.
Yes, and one of the I would. I wouldn't say it's a downside, but in comparison to aplequoil, it does take probably like a day I agree to kick in, so it's not gonna give us like I'm going to give this shot and they're gonna feel better in the next hour, but usually by next day I feel like usually see next day, and to me, that is worth it for long term use and how safe it is. I agree with that.
The other big thing that I tell owners is after the first shot, you may see some improvement, but you may not see the full effects. It does take a time or two, like after a couple of them, to really see how well your pet's going to respond.
Yes, I recently learned from a dermatologist that it has an additive effect, so up to three doses can make their response even better. So don't knock it on the first try if it didn't work one hundred percent. I agree The.
Other option is apquel and this is a medication that targets something called a jack.
It's a jack inhibitor.
And so again just kind of interrupting that it's cycle in a different way than sido point. It's a great option. It is a tablet, so it is a little bit more labor intensive for owners at home where I've always been taught. The first two weeks you give it twice daily, that's called the loading dose, and then from there you can drop to once daily. Sometimes that loading dose can be a week or two weeks, and then from there you drop to once a day long term as maintenance,
and it is a great option. I just find long term safety wise, I think sido point has a little bit less side effects.
Definitely. Apoquil, as opposed to side a point is an immunosuppressant. Correct side a point really isn't so kind of similarly to a steroid. It can suppress the immune system a little bit long term, it's a weird side effect, but they can actually be more prone to secondary infections. It's not common, no it's not, but it's still it's still possible. So if your pet responds great to side a point, I would stick with that. But if your pet has to get aboquil, that's fine.
Yes, I'd rather have them take abuquel, and it would be unlikely for them to be the one out of hundreds that has those side effects but also has a great quality of life because they're not itching themselves to death. Definitely, this is not to scare you away from apoquil by any means.
No, And at what I love about apaquil is how quickly it works. It starts working within four hours, and I love it just for like little bursts of like short term treatments, like I'm going to put you on apa quoil for two weeks while we have this infection. Once you stop it, I'll be curious to see if you're noticing more itchiness.
Again, we do have those patients that have acute allergic flare ups like and they don't I wouldn't put them in the category of having allergies where for whatever reason, maybe they got stung by something, or they rolled in some grasses that they don't usually go in, where just one week out of the year of their whole life they've had an allergic flare up and apicquil works great for.
That right, I love it, But yeah, there's and I also think, and we've talked about this before, there's just certain patients who respond better to apicquoil than side A point. I will never forget you told me. You just feel like the like dooly poodly breeds do really well with side A point, and then the like labs hid hip balls, they are.
Not great and some some allergy cases are so severe that we have to do both.
Right and ultimately to what's important to note is the cost that it takes for a side point injection per month is about equal it is the cost of apicquil per month. Yeah, I was gonna say, cost wise, there's not a huge difference, and they're not. Just to be fully transparent, they are not inexpensive medications, but they are far and away the most effective with the least amount
of side effects. So you know, going and getting a steroid like predno zone will be will be cheaper for sure, but long term is probably not the best solution for your pet. Agreed sadly. Yeah.
So, one other thing I just want to touch on before we jump to upawn order is we do have over the counter anahistamines for our pets, they're what we use as humans will recommend Benadryl or Zirtech. I know, Doctor Isabella and I tend to lean more towards Zyrtech because they don't make them as drowsy as benadrel does, and I mean they be completely transparent and that I don't think these work very well for the types of
allergy that dogs have. If it's like a really minor issue and I sense that the owner doesn't want to do side a point or apple quail, they're just like, not really sure, then I'll say, hey, why not take a zerotec a day, Let's see.
How it goes.
But I'm almost always going to see them back because it doesn't work very well.
Yeah, and I can attest to this directly because I did it with my dog. If you can't tell, she's an allergic mess and it might have helped. I'm like, is this just placebo effect? Probably, but it wasn't enough to you know, make a few worth it. And depending on the size of the pet, you might have to give multiple tablets a day, Like for my dog it
was like three tablets once a day. I'm going to run through that zerotech so fast for something that's not even going to be as effective as side a point right as well.
Yeah, you'll be two bottles of zertech later. You might as well just one side a point right.
But I definitely think it's a good option, especially for like my dog's sneezing a little bit more than usual, and maybe it's just for this.
Like short little I agree with first of pollen, but you're like really itchy dogs though that have recurrent allergies.
I'm like, throw it out the window. It's probably not going to work. I wish it was. Yeah, I hate to be the bearer of bad news.
And I've said this before and I'll say it again, and I'm going to die on this hill, but do not give your dogs or cats and a histamines with the D ingredient in them so zir tech D vinadreal D, a lagrid D. That d ingredient is incredibly toxic. And I've had a patient who passed away because the owner gave it a lagri d oh one dos. So that is a really key point to take away. Yeah, I guess really, So, I think we've kind of covered all the things.
I hope this is helpful.
I would say the big key takeaways are rechecks are super important, super important. Come back in that way we can see how your pet is doing. Do we need to change things, do we need to add in certain medications. It's not a one size fits all, So rechecks are super important. And then if I could do anything, it's just setting expectations with owners that if your pet has allergies,
we will we will get through it. But it's going to take a little bit of time, and it's going to take time on our end to figure out what's going on, and it's going to require compliance on your end to keep bringing them back so we can get to the bottom of it.
Yeah. I think setting that expectation right off the bat, it just it makes everyone happier. Yeah, because it can be a long road, sets us all up for success. Yes, it's not like a hey, here's a bill, You're going to be fine. You know, it's going to be a bit of a journey, but not one that we can't do. I mean we especially here in Nashville, I feel like we're in the allergy capital of the country. Yeah, and so so many of our patients have allergies and are
doing amazing. I know, we make it sound pretty daunting, but we can get them comfortable and get them taken care of and they will do great. Oh yeah, we have our regulars who come in for just their tech appointment side of point shots and they're cruising. They're great, they're cruising. All right. Well, that concludes our allergy talk.
As always, if you have follow up questions, please let me know. You can find me at doctor Josievett on Instagram. And then we're gonna take a quick break and then we'll be back with our paw and order. All right, we are back with our paw and order for the week number one on the list. I would never ever do the saliva and blood testing when testing for allergies, and my pets agreed.
I there are so many like over the counter, yes, blood, you can buy them on the internet. Saliva, the hair, yeah yeah, those tests and they're just we don't have any evidence that those are accurate. And then ultimately it just makes it more challenging for us trying to interpret them when we don't know what's real and what's not.
I totally I think you're wasting your money. If you're going to put your money towards something, I would not put it towards that these are we don't even like the people that are making them aren't like vetted. So you're just buying something on the internet. You're getting caught in an Instagram scam. Definitely, and I'm the queen of that people. Yes, but this is one I would not fall for.
Yeah, no, never, all right.
Number two, I would not put anything in my pet's ears that is not veterinary recommended.
This one's very popular. Yes, we have clients coming in all the time for with dogs with ear infections, and we ask are you using anything for maintenance ear cleaning, and they say, oh, yeah, yeah, I've been putting in my vinegar.
And when I hear vinegar going in the ear, I think I die a little inside.
Yeah, people have some weird concoctions. I'm sure it's on TikTok, but on most slow is another thing. Coci. Yes, and the ear is already hot, hot, dark, moist, so you're just adding more moisture in there. It can be tearing up the ear canal.
Yes, and that ear drum is so sensitive and if there's a little tear this might be getting too scientific.
But if there's a little tear in your pet's.
Ear, drum that is a whole leading into the inside of the pets, you know, ear canal and then it can affect their brain. I mean, we have to be really careful with what we put into the ears.
Yes, so don't use anything that isn't prescription or something that your veterinarian is specifically recommending from Chewy or pet Smart. Yes, I agree. There's one drop that I see a lot, which is called ziemox. Yeah.
I feel like bad, like I'm calling out drug companies, but I mean it's the true. If we see zymos and people will use that like, oh, I've been trying this, but it's not really working.
And that is just a steroid.
So it's gonna help bring down a little inflammation and help with itchiness, but it will not work with an ear infection.
It's not gonna treat the bacteria or the yeast. It's just gonna help with some of the redness. But you need antibacterials or anti fungals. Yeah, You're not ever treating the underlying issue until you get that. So we're just like the bearer of bad news on this episode. Yeah, And unfortunately a lot of clients they always ask if we can put them on an oral antibiotic or medication
for the ear infections. And it's the topicals. Eardrops are like really the only things that are reaching enough of a concentration to treat those penetrating that that thick ear wall.
Yeah, that's very true. It's different than in humans. Humans can take oral antibiotics or ear infections, but in our pets they cannot.
Okay, last, but not least.
I would not, and I'm pretty sure I've already said this, I'm gonna say it again because we're own our allergy talk. I would not continuously switch the proteins in my pets food. I hear so many owners say, oh, my pet gets bored, so now I have them on chicken. Now I have them on salmon and beef and rabbit, an alligator and all the things.
And if your pet is doing great on the protein they're on, stick with it, yes, agreed. If for some reason, I mean, this is just setting them up to develop a food allergy correct and GI issues too if you just keep switching it up. So stick with what they like, stick with what you know, and if they do develop a food allergy in the future, it will make it much harder for us to try and figure out a protein that works for them since they've been exposed to so much.
Exactly, if it ain't broke, don't try and fix it. Definitely, And that is the end of our pond order and the end of our episode.
Thank you so much for coming back. Thank you. I'm sure we'll be having you in season three. We've got a lot more to cover.
And as always to the listener, if you have any questions, please leave them on our voicemail app. You can get that in the bio of my instagram. You can DM me your questions. It's at doctor Josie Vett on Instagram. And please rate, review and subscribe. Every single star accounts, every review counts. We really appreciate it and we'll see you next week.