Pawblems

JulesInKy

It's been a while since I've posted on Boards, but I'm genuinely at a loss as to what to do next.

Both my boys (goldenx's) are getting on a bit. Kuzco is now about 15, Max is gone 7. We've been through the mill the past couple of years. In August 2020 Kuzco developed a rapidly-growing testicular tumour that was so fast it burst the poor dogs testicle. Complete scrotal ablation with no further treatment necessary. Then in October Max had a lump on his toe that needed to be removed. Also benign. Shortly after that, December 2020 Max needed another surgery on his mouth to remove another benign growth and the tooth nearest it. Jump to April 2021 and Max is diagnosed with Cruciate Ligament Disease. Subsequent TPLO and recovery were successful.

We got through all of those. But for the past few months poor Max has had problems with his front paw pads. The webbing and the deep spaces between the pads and toes are all inflamed. At one point they were infected, but that's because he was licking them without me being aware (he's a smart dog, went to the garden to do it!) My vet has thrown every relevant antibiotic and ointment in his pharmacy at this. Antifungals cream only - the dog can't tolerate the tablets, he gets sick. Most recently we've tried high-dose prednisone, currently tapering down. Apoquel didn't touch it.

I'm washing the paws after every walk/potty break with a chlorhexadine solution, drying them off and putting cotton socks on him to prevent licking.

My vet now wants to try ciclosporin, but the price of the stuff here in Ireland is crazy - as ye can imagine, after all of the above, our finances are stretched about as thin as they can be, but we have to try So my question is this: is there a place that any of you use that will send this medicine to Ireland (prescription won't be a problem).

I need to get him right as the other leg now requires TPLO :(

DBB

What brand of cyclosporin? It's quite a bit cheaper than Apoquel!

It's definitely fungal or yeast, is it? No chance of it being uninvited passengers? Or a food allergy? Or even a pollen/environmental allergy?

10-10-20

It might be canine lupus and that's what the ciclosporin is for.

We have it on a female collie; causes nail bed issues and cracked nails, redness around the toes and lethargy or an unwillingness to move (due to pain?).

https://vcahospitals.com/know-your-pet/systemic-lupus-erythematosis-sle-in-dogs

"Some breeds are predisposed to developing SLE. They tend to be medium to large dogs. These include the Afghan hound, Beagle, Collie, German shepherd, Irish setter, Nova Scotia duck tolling retriever, Old English sheepdog, Poodle and Shetland sheepdog. The average age of onset is 5 years, but SLE has been reported in dogs as young as 6 months of age. Male dogs were more likely to develop systemic lupus erythematosus than female dogs in a single study."

JulesInKy

https://www.boards.ie/discussion/comment/118896425#Comment_118896425

He didn't say which brand, I can ask him next week at check up and steroid review. I do remember him saying it would cost approx 10euro per day and it would take 6-8 weeks before we would see if it had any effect.

Vet has done scrapings, biospsies, bloods, lymph. Nothing out of the ordinary showing. No mites or critters of any type. Both dogs get quarterly doses as well as annual boosters. There was no improvement using antifungal cream (he can't take oral antifungals). Canasten didn't have any impact. Other topicals: fucibet and fungicanazole and betnovate.

The allergy route is our final one. I'm researching foods. Rock and a hard place on this as he's got digestive problems and the only food he was ever able to tolerate was Burns Sensitive Pork & Potato. He also gets natural yoghurt every day and sardines every second day. Everything else gives exlplosive repercussions! I have one observation about the allergy theory though...why would it only affect the front paws and not all four.

https://www.boards.ie/discussion/comment/118896512#Comment_118896512

I'm sure that with all the tests that lupus was considered. Max doesn't show any other symptoms to indicate this though. Although ciclosporin is used to treat autoimmune conditions such as lupus, it is also used to treat other ailments such as inflammatory and dermatological problems. I do thank you for the suggestion though (I did have House M.D. in my head shouting "It's never lupus" LOL!!!)

Thank you both for your comments.

p.s. I have added Malaseb back into our routine as of today.

DBB

That seems an extraordinary price for cyclosporin! The 2 I've had experience with are Atopica, which comes in capsules, and Cyclavance, which is usually a little cheaper, and comes in a bottle with a dosing syringe.

There seems to be quite an individual difference in some dogs... some get better results from Atopica, some from Cyclavance. I've no idea why, as it's the same medication! But... I prefer Cyclavance because you can target the exact weight of the dog, whereas there's a fair range in the size of dog covered by the Atopica capsules. Cyclosporine is inclined to make dogs nauseous for a few weeks at first, and I've found that if your dog is at the lower to medium end of the weight range covered by the Atopica capsules, they're more likely to become nauseous... and there's little worse than watching a dog yakking up expensive medication! The accurate dosing allowed by Cyclavance tends to reduce the nausea problem.

Either way, a tenner a day is a lot more than I'd be expecting to pay for a lab sized dog. I'd be thinking more along the lines of €3 yo €5 per day, unless cyclosporine has suddenly become hugely more expensive since I last bought it!

6 weeks is the timeframe that you need to fire cyclosporine into them daily, but... you'd expect to start seeing that it's working within a couple of weeks.

Front foot itching does seem to be a thing, weirdly enough, with food allergies. I wonder how you'd get on with a wet/raw/home cooked approach for a while?

JulesInKy

Vet wants me to use Royal Canin Hypoallergenic Moderate Calorie. I'm reluctant to contradict him on the recommendation as he's working so hard to get to the bottom of this. Max did weigh 39kg when this all started, but he's lost 4kg and is now 35kg, which is being attributed to the steroid treatment. His appetite is good (actually in overdrive with the prednisone!) Now that we're tapering I expected this to diminish a bit, but not happening yet. All the other undesirable side effects started to abate almost immediate to the initial lowering of the dose!

I have no problem with home cooked and I did ask the vet about raw a few years ago, but he didn't recommend it given Max's digestive issues. When we got him, Max was a sick lil thing and suffered terrible diarrhea for months after we brought him home.

I will ask vet about Cyclavance, as with his history, it looks like it would suit the dog more. It's hard to find information about the pricing of it online. I can find dosage charts but no prices.

Faith

Is there any chance it's environmental? Does he dig in the garden at all? Could there be fertiliser or weed killer or something in the soil that he digs up or gets mainly on his front paws?

JulesInKy

Sorry for the late reply. Poor Max put down a rough couple of days. The steroids have his appetite in overdrive so he snaffles anything he comes across (even on leash I'm not quick enough to hook it out before it's down the hatch). The ingestion of uknown (bone dropped by crows by the crunching noise) combined with the cocktail of meds he was on, he got a crazy bout of Gastro and was pooping blood :( A shot of antiobiotic and following course at home, further tapering of prednisone, and some homecooked chicken broth with rice seem to have sorted that issue. Unfortunately there is a new development now, there seem to be small "lumps" in the affected areas of the paws and one on his tail. We're not sure if these are related to the high doses of steroids and are just watching them for now until we get the other issues sorted.

@DBB I asked about the ciclosporin. To start with, it will be Atopica so that a couple of doses can be administered to see if there's any adverse reaction from Max. If dog can tolerate, vet said he's happy to source the Cyclavance if it's cheaper. I was wrong earlier, he reckons the Atopica is currently running at about €5.00 per dose for a dog Max's weight. Just FYI, the Apoquel was 2.65 per 16mg tablet, so a month was costing me €79.50. In the long run the ciclosporin may possibly run cheaper than that for me per month when the dose starts to taper.

@Faith Environmental was ruled out. We changed walking routes three times over the months: bog, street, woodland and no improvement. Also, only front paws are affected. Topical treatment didn't help. He's not a digger either, he follows his nose.

I also asked vet about antihistamine, he told me that he doesn't think it will make any difference but that he has no objection to me trying one. He did say that he reckoned that first gen will most likely only make Max drowsy. Have any of you had any experience of OTC anti-histamines with dogs?

JulesInKy

So Max started Atopica @ 50mg once per day for 5 days (Mon-Fri). On Saturday the dose was upped to 50mg twice per day. So far so good, it doesn't appear to be having any major adverse effects. This evenings walk did show soft stool with a bit more volume than usual. Those of you with experience of ciclosporin - how long was it before side effects such as vomiting etc set in, if at all?

DBB

Hi JulesInKy,

Thanks for the update! It's usually pretty quickly that the vomiting starts... more or less within a day or 2 of starting the meds. Side effects, including vomiting, are generally expected to fade after about a fortnight. So it would seem that you're doing OK so far... hopefully the meds will do the job now🤞

JulesInKy

Another quick update:

The Atopica dose was increased to 200mg once per day. Following reading I had frozen the capsules and allowed for 2.5 hours before and after giving dose before food. Even with this, about three hours after eating, Max did vomit (or yak!) his breakfast for two days.

I split the dose again. So now our routine is

• Evening meal at 8.00pm. Steroid and antibiotic.
• 100mg Atopica at about 11.30pm.
• Sleep.
• 100mg Atopica at 6.30am.
• Breakfast at 11.00am. Antibiotic. Probiotic.

This seems to be working well. No side effects and I'm already seeing a huge improvement in the condition of Max's paws. As previously stated, I've also added natural yoghurt and sardines to his diet, his coat is coming back and glossy again.

New Home

I would administer the probiotics as far away from the antibiotics as possible - the antibiotics kill them. So, on the basis of your schedule, I'd give the probiotics at half past three. Ditto for the natural yoghurt.

JulesInKy

https://www.boards.ie/discussion/comment/119017974#Comment_119017974

So much going on that this never occured to me! I have another dog with health issues also, and I'm dogsitting a little poodle for a friend!

I'll adjust to allow for this! Thanks!