August 4, 2012

 

As a veterinarian experienced in dermatology, I often have to face and solve very complex cases, which sometimes are also very interesting.

I want to tell the story of Jack.

Jack was a 5 year old dog, very frisky like all dogs of the Jack Russell breed.

The first time he was taken to my clinic, I immediately liked him; he had a curious look, but at the same time he was proud and brave.

The owners had made a long journey to reach my clinic, and they were very tired.

Jack instead was as fresh as a daisy. He sniffed everybody; he wanted to play with everybody.

But he had a really bad disease.

Everybody who looked at him asked me what was wrong with his hair and whether his disease could be contagious.

Actually I had not seen him yet, but I got worried thinking of some kind of scab or dermatophytosis which could also contaminate the whole waiting room.

So I immediately decided to let Jack in and examine him.

When Jack’s owners called to make an appointment, they just said that their dog had a problem with his skin; they didn’t expatiate upon the subject. Besides my secretary was used to making appointments like that so she didn’t ask for more details either.

Jack’s owners were two young lawyers. They were very careful and scrupulous about anything concerning their dog. They paid special attention to the quality and quantity of Jack’s meal and to his flea treatment.

Jack had already been examined by many vets before me, always for his skin problem.

He had undergone many tests and followed many therapies.

Sometimes he had also improved and was fine for some months, but then his problem began again.
Jack’s problem was a severe itching all over his body which he didn’t hide. On the contrary, as he finished sniffing something, he started scratching with a hind paw. By then he was so skillful in scratching that he could smell another dog scratching his belly at the same time.

His owners told me that his itching worsened at night.

Jack slept with them and as they turned off the TV, he started licking his feet very carefully. In those moments, he made a particular sound that his owner hated by now.
Despite the reprimands, Jack stopped for a few minutes, but then he continued relentlessly all night long.
The various vets who examined Jack tried to find out the cause of his problem and Jack had also taken many medicines.

Some years before, the owners had run a checkup for the scab. The owner told me that despite the negative result of the analyses for the scab, she had decided to treat him anyway for that disease; obviously, without any result.

They decided to change veterinarian. So they went to see another doctor, who thought that Jack had dermatophytosis, especially in the skin between the paws’ fingers and that this could be the reason of the itching.

So Jack took a pill for funguses for 2 months, and every week he had a bath with a disinfecting product. The owner told me that on that occasion she really thought they had resolved the problem, inasmuch Jack soon got better and for a while he seemed not to scratch himself anymore. Then, after some months, the problem reappeared.

Therefore Jack changed vet again.

Jack’s new doctor thought that Jack had a bad bacterial skin infection resistant to antibiotics. He took a skin sample to look for this bacterium. The owner showed me the analyses results. Jack had a serious skin infection.

Even this time, at the end of the cure, Jack started scratching himself again.

As you may guess, Jack changed vet again.

The last doctor before me reached a compromise with Jack’s owners: he would had given a cortisone injection to Jack every month, to stop Jack from scratching; but they had to be aware that, in the long run, Jack could have some problems because of the continuous use of the cortisone.

For almost six months everything was fine. Jack slept at night, sometimes he just had to get up to go pee, as the cortisone makes one very thirsty, but he looked fairly well.

In the last months however something strange was happening.

Jack had started suffering from bad otitis. A lot of pus came out of his ears and despite the therapies the otitis didn’t heal.

The edge of his ears had started forming SCABS all around; as soon as they were grazed, they started bleeding.
Also his little hind paws were not good at all. The pads became swelled and bled very often.

At the sides of the thighs, Jack had some areas without hair, with wounds and scabs.

All the neck hair had fallen, as well as the belly hair.

Even the edge of the eyelids had scabs.

I had to do something for Jack and his owners.

When I meet owners so fond of their pets, I always fear I might not help them, or have to tell them that the disease their dog suffers from cannot be healed; or worse, their dog is bound to die. But I really had the feeling that for Jack I could do something.

It was time to roll up my sleeves.

From the long story the owners told me, I could see that Jack’s itching was not seasonal, at least before they used cortisone. Therefore I could  exclude an allergic reaction to pollen.

His itching had always been localized at his head, his belly, and the space between his fingers.
I explained to Jack’s owners that I should had run some analyses like the previous doctors, but I also told them that I was very confident, I thought I could heal him.

From the first analyses I found that Jack had a very common kind of mange; this could give an explanation for the shortage of hair, but not for everything else.

The kind of mange I found on Jack is a type that all dogs get, and us too.
It consists of a little tick called Demodex which cleans the excess material from the roots of the hairs. Sometimes it happens that puppies’ immune system could clash with the tick, but in the case of Jack he was an adult by now.

So I thought that the continuous use of cortisone had weakened the immune system to the point that even this innocuous cleaner had become a problem for him.

From the ear drum and from the samples taken from the armpit, where the skin was dark and thickened, I found a yeast. This finding was important too. The owners had talked to me about a dermatophyte found in their dog, so I was following a path already beaten. Then I saw that even in that case the cortisone had quickened the growth of the dermatophyte and went on with my search.

I analysed the scabs on the thighs and found a bacterial infection.
So I had found all the three infections my colleagues had found too, but I did know for sure that even if I had treated them they would have come back. There had to be something which tied them together.

I contacted Jack’s owners and told them what I had found; I also informed them about my suppositions.

I learned almost by chance that sometimes jack suffered from severe bouts of diarrhea which also required antibiotics to heal. On those occasions, his owner prepared him a rice diet for a few weeks.

I got my confirmation.

I asked the owners whether they remembered if Jack’s itching reduced during the period he ate just rice.
The owner seemed to remember that actually it did, even though she thought that Jack, not feeling well, just wanted to rest.

I still had a trump to play: maybe Jack had an adverse reaction to food.

The adverse reaction to food is a type of allergy which affects dogs. Because of some proteins contained in the food, a slight, but annoying, chronic allergic reaction makes the skin very itchy.

Usually the first symptoms are rash and the appearance of very little red marks. Then, scratching himself, the dog causes injuries in the skin which get infected and look much more serious.
It is very common to find yeast and otitis in dogs affected by adverse reaction to food. Actually otitis is maybe the most frequent symptom.

The differential diagnosis for Jack’s disease included also the atopy, another type of allergy.

It may also be a case in which both the diseases were involved.

All the infections I had found could be subordinate to the allergy, and partially worsened by the inaccurate use of cortisone.

I explained that very clearly to the owners. I told them that we had to treat the secondary infections and to start a special diet in the meanwhile.
For 2 months Jack would have to eat only a special kind of kibble.

If after these two months Jack would have not been itchy, we could say we won.

Jack was discharged.
He had to take three pills a day for about one month to treat all the infections. He had to eat three times a day the special kind of kibble. He could absolutely not taste anything different, otherwise the test would have failed.

I saw him again after 15 days. He had improved a lot, the hair had started growing again and the itching eased a lot.

I saw him again 45 days later and, to be honest, I didn’t recognize him at first. He was a Jack Russell like all the others, and he was also nice. His hair was shiny and healthy.

I explained to the owners that now we had to find out which food was bad for Jack’s health; reintroducing the foods one by one, we could find the “guilty one”.

Jack’s owner would have none of it. She would have never ever substituted the special kibble.
Masters rule, so we decided  to go on with that kibble, having seen the excellent results.

After much time, the owners still send me pictures of Jack. They became very keen on trekking, and every moment is a good time to leave.

Lucky them, let’s hope they’ll never forget the kibble for Jack.

Written by

Dr Gianluca Barbato

Veterinarian Specialist in Dermatology and Medicine of the dog and cat.

Translated by

Maria Cristina Parisio

Graduate Professional Translator