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#48103 - 03/03/18 11:09 AM Yo, grelber! Second opinion requested.
ryck Online


Registered: 08/04/09
Loc: Okanagan Valley
My four year old German Shepherd, Abby Roade, started licking her anal area a few weeks ago and I thought it was a bit excessive. I kept an eye on things but it persisted so I took her to the vet.

A digital examination showed that, internally, things like anal glands were okay. However, she had some redness at her anus. A prescription was issued for 12mg Apoquel, two tablets per day - to continue for 14 days. However, after a couple of days the licking had not subsided, so a second prescription was added to the first - Vanectyl P, six tablets per day for 5 days, then 3 per day for five days, then 3 every 2 days. There seems to be a reduction in the licking but it’s early and more observation is needed to confirm.

I have two worries about the amount of medication. First, Abby is out in the woods at least twice a day playing with other dogs, many of whom I don’t know. Plus she is exposed to all kinds of things left by wild animals like coyotes, deer, sometimes bears and innumerable rodents. If both of these medicines goof around with her immune system, could she acquire something much worse? Am I taking a chance that the cure could be far worse than the illness?

Secondly, I lost a Shepherd to osteosarcoma a few years ago and, during the remaining time with Roxy, I did a lot of reading about dogs and cancer. The alarming statistic that popped up a few times was that 1 in 4 dogs will die of some form of cancer. Although there was no empirical evidence, the most accepted theory was that we tend to over-medicate them. So, when my dog is put on two meds at once, I worry.

Thoughts?
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#48104 - 03/03/18 04:58 PM Re: Second opinion requested [Re: ryck]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
On the face of it two or more medications at the same time would not be dangerous or contraindicated (unless there were definite/known adverse reactions associated with their combination).

The symptoms (redness and licking) — your vet's having ruled out anal sac impaction or infection — could be merely due to the excessive licking (ie, merely a mechanical sequela which would resolve if the licking ceased).

I would have liked to know if there was a definitive diagnosis (or even a putative diagnosis) for the problem which would have warranted the use of either or both medications. Keep in mind that I cannot second-guess your vet who actually examined the dog.

Apoquel (oclacitinib) is a newer non-steroid immunomodulatory drug to treat allergy and atopic dermatitis and the pruritus (itching) that often accompanies same. (I have no experience with this product; the best I can do is suggest that you check out Zoetis's product information for potential adverse side effects.)
Vanectyl-P (likewise from Zoetis) is used in much the same fashion, but it contains trimeprazine (a phenothiazine with antihistaminic activity) and prednisolone (a steroid with antipruritic properties).
To my mind neither of these is a first-line drug (especially absent a definitive diagnosis).

Another possibility (which needs to be ruled out) would be intestinal worms. Since that wasn't part of the discussion, I'm going to assume that she's on appropriate anthelmintics for your area — especially given the possibility of her picking up parasites and parasite eggs in the wild.

I'm also going to presume that other perineal, including vulvar, problems have been ruled out on examination. And I'm also assuming that Abby is spayed (otherwise you wouldn't be allowing her to run loose in the woods with other dogs).

Back to the primary issue: Without a definitive diagnosis and especially given the minor aggravation (except to you wink ), I would have first tried a relatively innocuous topical, in particular Variton Cream (diphemanil methylsulfate), which is a very good antipruritic, in addition to which it tastes terrible to most animals. (As an aside, I have found it to be invaluable in treating psychogenic licking in both dogs and cats because of the latter effect.)

As for cancer, I think that you answered your own question: There is no empirical evidence that (over-)medication has any relationship to the development of cancer. If that were the case, huge numbers of humans who engage in polypharmacy (by their own hand or that of their physicians) would be developing cancer at astronomical rates.

By the bye, osteosarcoma is one of those neoplastic diseases that GSDs (and many other breeds) are at higher risk for.

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#48111 - 03/04/18 08:55 AM Re: Second opinion requested [Re: grelber]
ryck Online


Registered: 08/04/09
Loc: Okanagan Valley
Thank you very much for the comprehensive reply. I do have a couple more questions.
Originally Posted By: grelber
The symptoms (redness and licking) — your vet's having ruled out anal sac impaction or infection — could be merely due to the excessive licking (ie, merely a mechanical sequela which would resolve if the licking ceased).

Originally Posted By: grelber
Back to the primary issue: Without a definitive diagnosis and especially given the minor aggravation (except to you wink ), I would have first tried a relatively innocuous topical, in particular Variton Cream (diphemanil methylsulfate), which is a very good antipruritic, in addition to which it tastes terrible to most animals. (As an aside, I have found it to be invaluable in treating psychogenic licking in both dogs and cats because of the latter effect.)

I like the idea of a topical much better than popping in pills.

Originally Posted By: grelber
Apoquel (oclacitinib) is a newer non-steroid immunomodulatory drug to treat allergy and atopic dermatitis and the pruritus (itching) that often accompanies same. (I have no experience with this product; the best I can do is suggest that you check out Zoetis's product information for potential adverse side effects.)
Vanectyl-P (likewise from Zoetis) is used in much the same fashion, but it contains trimeprazine (a phenothiazine with antihistaminic activity) and prednisolone (a steroid with antipruritic properties).
To my mind neither of these is a first-line drug (especially absent a definitive diagnosis).

I note that there hasn’t been any change in her behaviour even though the Apoquel touts results within the first four hours.

Originally Posted By: grelber
Another possibility (which needs to be ruled out) would be intestinal worms. Since that wasn't part of the discussion, I'm going to assume that she's on appropriate anthelmintics for your area — especially given the possibility of her picking up parasites and parasite eggs in the wild.

She is not on any worm medicines. I always thought they were used if there was evidence in the stool, and her’s has never shown anything. It sounds like I should be changing my approach. How much exposure does she need to a carrier to acquire something?

Originally Posted By: grelber
I would have liked to know if there was a definitive diagnosis (or even a putative diagnosis) for the problem which would have warranted the use of either or both medications.

There were only the visual and digital examinations….no tests, et cetera.

Originally Posted By: grelber
And I'm also assuming that Abby is spayed (otherwise you wouldn't be allowing her to run loose in the woods with other dogs).

That is correct. Spayed after her second heat.


Edited by ryck (03/04/18 08:59 AM)
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#48113 - 03/04/18 11:54 AM Re: Second opinion requested [Re: ryck]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
Originally Posted By: ryck
Originally Posted By: grelber
Another possibility (which needs to be ruled out) would be intestinal worms. Since that wasn't part of the discussion, I'm going to assume that she's on appropriate anthelmintics for your area — especially given the possibility of her picking up parasites and parasite eggs in the wild.

She is not on any worm medicines. I always thought they were used if there was evidence in the stool, and hers has never shown anything. It sounds like I should be changing my approach. How much exposure does she need to a carrier to acquire something?

If she hasn't been dewormed, given her lifestyle, I would bet that she's got at least roundworms at home in her gut which could in turn be causing perianal irritation.
As suggested in my previous comment, her outdoor activities dictate regular prophylactic use against roundworms especially which can be found in the soil everywhere. There is no evidence of eggs shed in the stool because they're microscopic; they can be tested for, but the cost of the various tests is way more expensive than the relatively cheap and effective medications (eg, pyrantel pamoate) which have a wide margin of safety.
Tapeworms will usually make themselves known by excreted segments adhering to the perineal area/fur and in the dog's bedding; fresh they look like cucumber seeds and are motile, dessicated like toasted cumin seeds. They can be treated as necessary.
In all cases there is zoonotic potential. So if you entertain small children or immunocompromised persons, you'd do well to act on the cautious side.

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#48116 - 03/04/18 12:36 PM Re: Second opinion requested [Re: grelber]
ryck Online


Registered: 08/04/09
Loc: Okanagan Valley
Well, there's a mouthful (to use a totally inappropriate phrase). Thank you. I'll be on this right away.

Just a thought....this thread started as a dog's issue but we also have cat lovers in the group (you and Jon come immediately to mind). Should they be taking similar precautions?
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ryck

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OS High Sierra 10.13.6
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#48118 - 03/04/18 02:15 PM Re: Second opinion requested [Re: ryck]
grelber Offline


Registered: 08/05/09
Loc: North of 49th ||
Originally Posted By: ryck
... this thread started as a dog's issue but we also have cat lovers in the group (you and Jon come immediately to mind). Should they be taking similar precautions?

Absolutely ... if not more so, since cats spread roundworm eggs ubiquitously wherever they defecate and others pick them up by digging in the same soil, plus the fact that most use litterboxes in the home which are attractive to rugrats and toddlers.

(By the way, well before you joined the FTM ranks, back even to the days of MacFixIt, I was pretty much the 'cat whisperer' to the assembled multitudes here. There may even be a few threads still floating around to attest to that.)


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#48119 - 03/04/18 04:30 PM Re: Second opinion requested [Re: grelber]
ryck Online


Registered: 08/04/09
Loc: Okanagan Valley
Originally Posted By: grelber
(By the way, well before you joined the FTM ranks, back even to the days of MacFixIt, I was pretty much the 'cat whisperer' to the assembled multitudes here.

I was a member of MaxFixit except it was "rick". When we started FineTunedMac somebody had grabbed "rick", so I went with ryck. Funny, I've never seen rick post anything in FTM.


Edited by ryck (03/04/18 04:30 PM)
_________________________
ryck

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#48903 - 05/21/18 07:49 PM Re: Second opinion requested [Re: grelber]
ryck Online


Registered: 08/04/09
Loc: Okanagan Valley
Originally Posted By: grelber
......back even to the days of MacFixIt, I was pretty much the 'cat whisperer' to the assembled multitudes here.

Then you might be interested in these two lynx, who are definitely not whispering.


Edited by ryck (05/21/18 07:50 PM)
_________________________
ryck

iMac (Retina 5K, 27", 2017), 3.4 GHz Intel Core i5, 8GB RAM, 2400 MHz DDR4
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