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Dr. Susan
Dr. Susan, Veterinarian
Category: Vet
Satisfied Customers: 6785
Experience:  8 years of clinical experience with specialty in veterinary pain management, urology, and geriatrics
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I am from Bangladesh and am currently in London until 10th

Resolved Question:

I am from Bangladesh and am currently in London until 10th Feb. I am seeking advice about our 1 yr. old GSD, Jag who I purchased from India, and therefore was not able to see both parents. He has been diagnosed with demodectic mange. (On microscopy of skin scrapings. He is currently receiving Ivermactin injections weekly. He has been on treatment since beginning of December. Since vet facilities including treatment are quite rudimentary in my country, I am keen to meet up with a vet, being familiar with the high standards of practice here.
Jag is indescribably precious to me and indeed to my family. He has the sweetest nature and has kept a stiff upper lip, throughout! He is a very handsome young dog and my heart breaks every time I see him. I am confident that your advice will help him.
Looking forward to hearing from you soon.
Kind regards ***** ***** in anticipation
Kishu
( Dr. Kishwar Azad FCPS, Hon.FRCPCH)
Professor of Paediatrics
BIRDEM
Dhaka
Phone ***********
PS. I would like to buy the medicine/s from London, and am prepared to pay extra if that is required.
Submitted: 2 years ago.
Category: Vet
Expert:  Dr. Susan replied 2 years ago.
Dr. Susan :

Hi, I can help you with your question today.

Dr. Susan :

I would first like to make sure that the scope of this service is clear. I am a veterinarian in the US, and I am able to give advice regarding his case.

Dr. Susan :

I cannot examine Jag, and unfortunately cannot prescribe anything for him.

Dr. Susan :

However, I think I can help him!

Dr. Susan :

It sounds like your vet did a good job using the skin scrapings to diagnose his condition.

Dr. Susan :

Treatment for demodex, however, requires DAILY ORAL administration of ivermectin.

Dr. Susan :

We can also use a benzoyl peroxide shampoo to help.

Dr. Susan :

The shampoo has "follicular flushing" activity, which can help to expel the mites from the hair follicles where they live.

Dr. Susan :

In the US, you can purchase ivermectin at stores that carry feed and deworming products for cattle and livestock.

Dr. Susan :

I believe the same would be true in the UK.

Dr. Susan :

When you see my response, post back with Jag's weight and I can help you with a protocol.

Dr. Susan :

We start with a lower dose of ivermectin and increase it over about a week.

JACUSTOMER-lsuswset- : Thank you so much for your advice. Jag weighs 29 kg. I will check whether ivermectin is available without prescription in UK. I would rather Jag have the medicine orally instead of being injected.
JACUSTOMER-lsuswset- : Dear *****
JACUSTOMER-lsuswset- : Thank you so much for your advice, Susan. Jag weighs 29kg. I would rather he gets oral ivermectin than subcutaneously.
Dr. Susan :

Great!

Dr. Susan :

I am going to give you a different volume to use each day for the first six days, building up slowly.

Dr. Susan :

Day 1: 0.3ml

Dr. Susan :

Day 2: 0.6ml

Dr. Susan :

Day 3: 0.9ml

Dr. Susan :

Day 4: 1.2ml

Dr. Susan :

Day 5: 1.5ml

JACUSTOMER-lsuswset- : Hi Susan, thanks a lot for your quick response. Jag weighs 29kg. He had lost weight initially but has now got his appetite back and is his usual friendly, lovable self! I will find out if ivermectin is available without prescription here. I look forward to hearing from you! Thanks once again! Warm regards, Kishu (Jag's Mum)
Dr. Susan :

Day 6 (and every day thereafter): 1.7ml

Dr. Susan and other Vet Specialists are ready to help you
Expert:  Dr. Susan replied 2 years ago.
If you see any side effects at any point during this dose increase, go back down to the previous dose. Side effects might include vomiting, stumbling, lethargy, hypersalivation, dilated pupils.
Give the highest volume that he can tolerate each day.
After that, your vet should recheck the skin scraping every 3-4 weeks. We do not consider stopping the oral ivermectin until we have TWO CONSECUTIVE negative skin scrapings.
Dr. Susan and other Vet Specialists are ready to help you
Customer: replied 2 years ago.
Thank you! You are most helpful! How can I come back to you for further advice?
Expert:  Dr. Susan replied 2 years ago.
You can request me specifically, or you can start your question with "For Dr. Susan only..." and the other experts would leave it for me.
:)
Customer: replied 2 years ago.
Great!
Customer: replied 2 years ago.
For Dr. Susan onlyDear *****Ivermectin injection 1% is available in Bangladesh, thanks to Mr. Google! Can it be given orally as well? Jag's vet in Bangladesh has been giving it as a weekly injection. I am not quite certain about the dose.Thanks, Susan.BestKishwar
Expert:  Dr. Susan replied 2 years ago.
Yes, the ivermectin should be given ORALLY, following this schedule:
Day 1: 0.3ml
Day 2: 0.6ml
Day 3: 0.9ml
Day 4: 1.2ml
Day 5: 1.5ml
Day 6 (and every day thereafter): 1.7ml
Then have your vet recheck a skin scraping every 30 days. Remember, it takes two consecutive negative skin scrapings before we can call him cured.
:) I'm glad you were able to find the ivermectin!
Customer: replied 2 years ago.
Thanks! I am really very grateful for your help. I have a few more queries.
How long can Ivermectin be continued for?
Can treatment be stopped immediately after 2 consecutive scrapings are negative? Or does it need to be tailed off?
In your experience, how long does it take a dog to respond to the drug?
Expert:  Dr. Susan replied 2 years ago.
We can use the ivermectin as long as necessary as long as he isnt having any adverse reactions. You can stop the medication immediately once the 2 scrapings are confirmed negative.
As long as he is otherwise healthy, I would expect significant improvement in the first month.
Customer: replied 2 years ago.
Jag is much better now but his last scraping still showed the presence of mites. Do you think that once weekly injection may be responsible for this incomplete response?
He is a big dog and had lost a lot of weight but has regained his appetite and is regaining weight. We also give him Pediasure as he was not eating well initially and he loves it! Can I continue with Pediasure?
Thank you for your advice. Wish Jag well. He is the apple of our eye (although I shouldn't really have a favourite) We have quite a menagerie: 8 gorgeous cats, 3 dogs and 5 goats. Among the cats Snowflake, a mostly Persian-and some Siamese mix is odd eyed with one blue and one hazel eye. She is my hubby's favourite! May have bored you... Sorry!
Expert:  Dr. Susan replied 2 years ago.
Well, I think his partial response is due to a couple different factors:
1) weekly injections just aren't enough
2) demodex is a mite which is normally present in small numbers on all dogs. The overpopulation of mites causes the clinical signs that you are seeing. That happens when a dog's immune system isn't strong - common in older dogs that are sick, and common in young dog's that have an immature immune system. His improvement can also be related to his age and increased maturity of his immune system.
In fact, puppies that only have 1-3 small areas of hair loss are often not treated. We monitor them for change or worsening, but usually they resolve on their own given time.
You can continue the Pediasure for now. For putting on weight, I usually try mixing puppy food with regular food for increased fat and calories.
Don't worry, I have a favorite too! I've had her for 14 years in May. Had her longer than my husband!
Customer: replied 2 years ago.
Thank you! :)-
Expert:  Dr. Susan replied 2 years ago.
You're welcome ;)
Customer: replied 2 years ago.
Hi Susan
May I ask you what the dose of Ivermectin is in microgram/kg?
I must pass on your practice of treating demodectic mange to Jag's vet.
Another thing that has been troubling me is the question whether Jag's breeders would have known about the risk he had of developing the condition. Is it true that one of the parents had the condition?
I had specifically mentioned to the breeder that I wanted puppies. I had already purchased a female from the kennel in India, and she is fine. Jag was apparently from a different line (his pedigree certificate hasn't reached as yet!). He cost twice as much as the female (equivalent to £700, which is quite a lot for our end of the world!) but money is not the issue here.
I really feel sorry for the puppies who develop the condition.
Thanks again for your help!
Expert:  Dr. Susan replied 2 years ago.
No problem! The step-wise plan is:
1) 100 mcg/kg
2) 200 mcg/kg
3) 300 mcg/kg
4) 400 mcg/kg
5) 500 mcg/kg
6) 600 mcg/kg and continue the 600 mcg/kg each day until resolution.
Also, let your vet read this page: http://www.vetmed.wsu.edu/depts-vcpl/
It discusses a particular gene mutation found in herding breed dogs like Collies, Shetland Sheepdogs, Australian Sheepdogs, Old English Sheepdogs, etc. This gene mutation makes it UNSAFE to use the ivermectin protocol with them.
Yes, there *can* be a genetic component to demodex. However, this is not always the case. As I mentioned previously, all dogs have a small population of demodex mites on their skin. The problem just occurs with an overgrowth of demodex, which is not uncommon in pups. If he has a case of generalized demodex (affecting larger areas of the body), we do not recommend breeding as this could have a hereditary aspect.
Customer: replied 2 years ago.
Thanks! Very thoughtful of you to send the link. I will add it to my reading list. Have been reading on the web about demodectic mange. Jag has the horrible generalised form. From a gorgeous young dog, he was transformed into a smelly one with extensive skin lesions. He lost a lot of his hair etc etc.
When can he be neutered?
You are such a sweet person! 😘
Expert:  Dr. Susan replied 2 years ago.
I would neuter him prior to resolution of the skin lesions. Otherwise, stress from his surgery could cause recurrence, and we will have to start his treatment all over again!
Customer: replied 2 years ago.
Thanks Susan for the advice. Yet another question!Do you use oral Ivermectin? Apparently Ivermectin tab is available in 3mg and 6mg preps. Jag's vet prescribed 6mg twice daily. I have asked for the tablet to be withheld and I will go by your advice.
Expert:  Dr. Susan replied 2 years ago.
To be honest, I have never used an ivermectin tablet. I have only used injectable ivermectin - hence the volume dosing that we had discussed.
As long as the tablets are truly the same as the injectable, I would still like to slowly step up the dose. Of the 6 mg tablets, I would use:
day 1: 1/2 tablet
day 2: 1 tablet
day 3: 1 and 1/2 tablets
day 4: 2 tablets
We can continue at the 2 tablet dose each day after that. If Jag is not continuing to improve, we can increase his dose to 2 and 1/2 tablets. I would not want to go up to a full 3 per day.
Customer: replied 2 years ago.
Thanks, ***** ***** are a Star ⭐️You have made my day....☀️
Expert:  Dr. Susan replied 2 years ago.
You are the sweetest :) I really appreciate that you take the time to say such kind things. It makes this job so worthwhile!
Customer: replied 2 years ago.
Hi Susan
I realise I am bombarding with questions! But you are so efficient! Here is a cat question! I have a very handsome Tom, Toffee, (5yrs old) who was neutered at the appropriate age. He gets haematuria from time to time, most of the time associated with straining. He doesn't seem to be in any pain and his bladder has not been palpable in between peeing. I have had his urine examined, apart from red cells there is nothing of note. In particular he has never had UTI. There is no history of fever. Toffee is a biggish cat weighing about 5kg and has a healthy appetite. The vet advised to give him extra water, which is impossible as he spits it out, but drinks on his own. He prefers dry cat food. He has a very sweet nature and is a big softie! Any advice will be most appreciated.
I heard that Jag has new lesions. I will start him on daily treatment when I get back home on 12th Feb. I don't trust him with anyone. Will waiting the extra few days make much difference? He is eating well. I have git hold of the shampoo in London.
Thanks as always! Take care!
My email is *****@******.***. Will it be possible to have yours? 😻
Expert:  Dr. Susan replied 2 years ago.
Oh no! More spots on Jag! I'll be glad once we start his ivermectin treatment.
With regard to Toffee, I am suspicious that he has FIC - feline idiopathic cystitis. This is a chronic disease that cannot be cured, but can be managed. Here is a handout to read more about this condition: http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=612
Unfortunately, I can't view your email address - it is automatically blocked by the site. I cannot give out personal information per rules of the site! Sorry!
Customer: replied 2 years ago.
Thanks, Susan! I appreciate the rules of the site.
It's a nuisance about the spots on Jag. I can't wait to be home!
Best.