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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Vet
Satisfied Customers: 60395
Experience:  University of California at Davis graduate veterinarian with 48 years of experience.
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My shih tzu is 10 y/o and has usually licked her paws in a

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Hi, my shih tzu is 10 y/o and has usually licked her paws in a cleaning manner, and itched/scratched the tops of her paws perhaps through anxiousness or skin allergies. However the past couple of weeks we have seen her scratching and biting her paws a lot more often. Her front paw especially until it had swollen up into almost a balloon. I have been treating the paw with tea tree cream from pets at home, after speaking to a member of staff there. She still continues to be licking and scratching her paws, and itching more in general, so is there perhaps a bigger problem I should be looking into? Thank you
JA: I'll do all I can to help. The Expert will know if your Shih-Tzu will be able to digest that. What is the Shih-Tzu's name?
Customer: coco
JA: Is there anything else important you think the Veterinarian should know about Coco?
Customer: She also has always had bad ears - they have gotten darker with srak spots over time and seep from time to time. we have a ear serum for this when it becomes inflamed and smelly dark spots*

Dr. Michael Salkin is typing. Please be patient.

I'm sorry to hear of this with Coco. A paw that "had swollen up into almost a balloon" is likely to be an infected paw from bacterial or yeast infection or perhaps a penetrating foreign body and needs the attention of Coco's vet at your earliest convenience. I'll post my synopsis of the types of allergic dermatoses that cause pruritus (itchiness) of the extremities and her "bad ears": atopy and food intolerance.

Environmental allergies (atopy) are usually initially addressed with a glucocorticoid (steroid) such as prednisone. In some dogs an over the counter antihistamine such as chlorpheniramine (many generics) at a dose of 0.2 - 0.5 mg/kg (maximum) every 8-12 hours or diphenhydramine (many generics) dosed at 2-4 mg/kg every 8-12 hours (maximum dose of 50 mg at any one time) may be effective. Antihistamines, however, aren’t reliably effective. Adding fish oil to the diet at a dose of 20mg/lb daily of the EPA in the fish oil might synergize with antihistamines to provide better anti-pruritic action. The omega-3 fatty acids in fish oil are anti-inflammatory but may take 8-12 weeks to kick in. The cytokine antagonist oclacitinib (Apoquel) is likely to revolutionize how we address atopic dogs and should be discussed with Coco's vet. Oclacitinib works as well as a steroid but without a steroid's adverse effects. The injectable Cytopoint is another good immune mediator to consider.

Food intolerance/allergy is addressed with prescription hypoallergenic diets. These special foods contain just one novel (rabbit, duck, e.g.) animal protein or proteins that have been chemically altered (hydrolyzed) to the point that Coco's immune system doesn't "see" anything to be allergic to. Over the counter hypoallergenic foods too often contain proteins not listed on the label - soy is a common one - and these proteins would confound our evaluation of the efficacy of the hypoallergenic diet. The prescription foods are available from her vet. There are many novel protein foods and a prototypical hydrolyzed protein food is Hill’s Prescription Diet z/d (I prefer the hydrolyzed protein diets because they lessen the possibility of my patient being intolerant to even a novel protein.) A positive response is usually seen within a few weeks if we’ve eliminated the offending food allergen. Food intolerance can arise at any age and even after our patient had been eating the same food for quite some time.

Please respond with additional questions and concerns if you wish.

Customer: replied 1 year ago.
Thank you so much for your response Dr Salkin. We have Coco on a Hypoallergenic wet food diet (James Wellbeloved) and also give her half a hayfever tablet now that its summer and she itches more regularly, so what you have said is all very reassuring! What would be the main foods/proteins you suggest she absolutely should not have? Our vet way back in the past had told us Ham or Pork would give her allergies, but are there any popular intolerances?

You're quite welcome. Yes, beef, chicken, corn, wheat, eggs, rice, and soy are the most common offending food allergens in dogs. Please continue in this conversation if you wish.

Customer: replied 1 year ago.
adding fish oil into her diet in some way will help her itching in general? Even rectal itches? She does also get these too but on the odd occasion we are used to. However when I say she has been itching a lot more lately, her normal 'scratching behaviour' has increased a lot all over (ears, paws, legs, bum). Otherwise we would see her scooching her bum every so often on the occasion, but now more than normal. Do you think there is a bigger issue she may be suffering from other than skin allergies?

Yes, the fish oil is anti-inflammatory. Anusitis is another clinical sign of both atopy and food intolerance. No, she doesn't need another disorder to explain her clinical signs but it's important that her vet performs cytology (microscopic exam of a small sample of affected skin surface looking for abnormal numbers of both bacteria and yeast). These infectious agents will need to be eliminated before treatment for allergic dermatitis can be completely effective.

Customer: replied 1 year ago.
Okay brilliant, thank you Dr Salkin for your help. I will make an appointment with Coco's vet to carry out cytology so we can treat her accordingly for any yeast or other infection, or continue to do what we are doing with regards ***** ***** her diet and behaviour.

It's my pleasure. I can't set a follow up in this venue and so please return to our conversation with an update at your convenience - even after rating.

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Thank you for your kind accept. I appreciate it.