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THE ITCHING PET: ALTERNATIVES TO STEROIDS
Excessive licking, chewing, and scratching can make a pet’s life miserable for month after month, even year after year. For rapid relief of itch and inflammation, nothing matches the corticosteroid hormones such as cortisone, hydrocortisone, prednisone, dexamethasone, and others.) There are some animals that seem unable to live with any degree of comfort without these medications. Unfortunately, these hormones have widespread and potentially dangerous actions throughout the body when they are used for inappropriately long periods and it is generally desirable to minimize the use of these hormones when possible to do so. Ideally, corticosteroids are used for a few really tough itch weeks and other forms of itch management are used for “general itch maintenance.”
For more detail on long term corticosteroid use click here
This is, of course, easier to write about than to actually do. When one's pet is scratching and chewing raw spots on his or her skin, practical advice is what is called for. The following list includes assorted non-steroidal methods for relieving itch and reducing the amount of corticosteroid hormones needed.
ORAL MEDICATIONS
ANTIHISTAMINE TRIALS
Histamine, a biological chemical, is the chief mediator of inflammation in humans hence the proliferation of antihistamines available for people both by prescription and "over the counter." Histamine is not the major mediator of inflammation in the dog, thus these medications are not as reliable for dogs as they are for us.
The protocol recommended by this hospital is helpful to approximately 40% of dogs who try it. Four different antihistamines are used, one at a time, at least two weeks each, in hope of finding one that is acceptably effective. While the chance that an individual antihistamine will be helpful is small (about 15%), trying several antihistamines greatly increases the chance of finding one that works.
Antihistamines are not free of side effects; they are notorious for drowsiness in some individuals. Still, this is vastly preferable to the systemic disruption caused by the corticosteroid group.
Our hospital uses the following antihistamines in a typical antihistamine trial (click for more information):
Diphenhydramine (Benadryl)
Clemastine fumarate (Tavist)
Hydroxyzine (Atarax)
Chlorpheniramine (Chlortrimaton)
In the cat, antihistamines are substantially more reliable than in dogs so that the chances of a given antihistamine working are usually pretty good. For both cats and dogs, using antihistamines together with a corticosteroid hormone will decrease the amount of corticosteroid hormone needed to control the itching (i.e. less hormone is needed to get the job done if it is given with an antihistamine).
FATTY ACID SUPPLEMENTATION
The discovery of anti-inflammatory properties of evening primrose oils and fish oils in humans has led to similar products on the market for our pets. These products are not analogous to the oil supplements which are recommended as food supplements to make a pet's coat shiny; instead; these are true anti-inflammatory drugs capable of relieving joint pain, cramps, and itchy skin.
The supplement alone is helpful in 10-25% of itchy dogs; we often recommend its use in combination with antihistamines to boost the efficacy of the protocol described above.
CYCLOSPORINE (ATOPICA)
Cylcosporine is an immune system modulating drug originally developed for use in organ transplant patients but also useful in other immune-mediated diseases. Since allergy is an immune-mediated condition, cyclosporine was investigated as an alternative to corticosteroids and found effective for most patients. Currently this medication is being marketed only for dogs and one dog in three will develop an upset stomach when starting the drug (though this resolves or is manageable with dose modification).
For more information on Cyclosporine click here.
TOPICALS TO TRY
When using any dip on inflamed skin one should be aware that the use of cool water is considered much more soothing than warm water.
COLLOIDAL OATMEAL SHAMPOOS AND CREME RINSE - At first, these products were only available for human use, as powdered "soaks" to pour into bath water. Once their value in itch management was determined, their use quickly spread to the veterinary field. Colloidal oatmeal actually pulls inflammatory toxis out of the skin, generally yielding 1-3 days of relief. The creme rinses are meant to yield longer acting relief. They are available plain or combined with local anesthetic forumlas to soothe itch.
LIME SULFUR DIP - This product kills parasites, ringworm fungi, and bacteria. It also dries moist, weeping skin lesions and helps dissolve surface skin proteins that are involved in itchiness. Many veterinary dermatologists recommend it regularly to control itch; however, it has several disadvantages. IT SMELLS TERRIBLE. The sulfur ingredient smells like rotten eggs and this is how your bathroom or bathing area will smell during the pet's bath. This dip can stain jewelry and clothing and will temporarily turn white fur yellow.
OTHER SHAMPOOS
Itchy skin can be the result of skin infection, excess oil accumulation, yeast infection, even parasitic infection. The list goes on. The shampoo products listed above can be used against any itchy skin disease but it should be noted that there are many other shampoo and creme rinse products that can be used against the specific skin diseases listed. If some other type of shampoo product has been prescribed to you for an itchy skin disease, it is important that you use it allowing at least a good 10 minutes of skin contact time before rinsing.
TEN MINUTES OF SKIN CONTACT IS THE MINIMUM REQUIREMENT FOR ANY MEDICATED SHAMPOO. PREMATURE RINSING WILL NOT ALLOW FOR THE THERAPEUTIC BENEFIT TO BE REALIZED.
OTHER TOPICAL PRODUCTS
COLLOIDAL OATMEAL SPRAYS AND LOTIONS - Same principle as above. These products pull inflammatory toxins out of the skin. Oatmeal products have become very popular and are available as shampoos, creme rinses, soaks, sprays, and lotions.
HUMILAC SPRAY - This is a moisturizer which may be applied as a spray or mixed in water as a dip. It is helpful for dry skin but can also be used in combination with lime sulfur as lime sulfur is naturally drying to the skin.
WITCH HAZEL - This product has a cooling effect on the skin which is soothing for both animals and for people with sun burn. It is available as a spray or lotion.
ALOE VERA GEL - If possible, obtain 100% aloe vera gel from a health food store. Products "containing aloe" are much more available but are generally not as effective and not meant to be licked away by a pet. Aloe vera gel comes from the aloe vera succulent and contains enzymes which break down inflammatory proteins and enhance healing. Pure aloe vera gel is not harmful for pets who want to lick it off.
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TOPICAL STEROIDS? - It seems clear that taking steroids orally may be harmful to the body with chronic use but are topical cremes safe for long term use? We now know that topical steroids (cortisone cremes and related products) are absorbed through the skin and into the bloodstream but the hormonal side effects with topical use do seem blunted. For small irritated areas (“hot spots”), topicals can provide excellent relief without the systemic effects of hormones.
RESPECT THE STEROID
Severe itching amounts to a reduction in life quality. It is important not to develop the mindset that corticosteroids should be avoided at all costs. This would not be fair to the itching pet. Steroids are valuable tools in the relief of pain and suffering and have an important place the therapy of the itchy pet. The goal is not to avoid steroid use if possible but to avoid long term dependence on steroids if possible. Despite all of the above management tricks, some pets will still require long term steroid use to achieve any reasonable comfort. There are monitoring protocols in place for such cases. It should also not be forgotten that underlying allergies and recurring skin infections can be addressed specifically and that as these conditions are managed, the itch is also managed.
Steroid hormones have many side effects and, as helpful as they are for allergic skin diseases, it is best to reserve them for only the most itchy episodes.
Dogs must be taught to NOT bite
How to do it depends on the dog's age
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Q: What can I do to make my dog stop biting the heck out of me?
A: This is a common question of many dog owners.
All dog biting springs from the same source rooted deep in canine behavior. To answer the question properly, I divide the people asking into three categories according to the age of their dogs. Methods of correcting this problem differ if the dog is a young puppy, around a year old adult (teenager), or a two-to-four year old adult. Beyond the age of four years old, most dogs who have viciously bitten someone have been euthanized or otherwise disposed of.
Biting is very basic canine dominance behavior used from the time a puppy is able to move around in its litter. Biting among wild and domestic canines is used as communication to establish standing within the pack. This pack may be an extended family of wild canines, a litter of puppies with its mother, or your pet dog intermingling with your family. Dogs live so well with humans because they regard all the members of your family as fellow pack members.
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The puppy biting dog
If the biting dog is a puppy under six months old, the biting is very correctable. Pups this young rarely bite hard enough to break skin, and many people start out thinking their new pup is simply playing. Your young pup may or may not have risen to the status of pack leader within its litter of puppies. Moving into your house, the pup is introduced into a new pack and is unsure of his ranking within the group. No matter the reason for biting, young pups should never be allowed to playfully use their teeth on human skin.
There are hundreds of tapes and books available on how to train your dog. While tapes and books are a start, there is no substitute for face to face sessions with a qualified obedience instructor. Puppy kindergarten and basic dog obedience are good classes to take. Professional trainers can not only answer the question of why the pup is biting but can show you how to use various exercises to communicate to the new pup that the people rank above it in the pack. Most of these exercises mimic the way your pup was disciplined by his mother and other litter members. Performing these exercises tells your pup that you are the leader in a manner well understood by dogs. A good trainer will also go over small changes you should make in your everyday life. These changes may mean little to you, but to a dog they govern every aspect of life. Establishing a correct relationship between a pup and its human family will lead to years of enjoyment of each other’s companionship.
A list of Dog Owner's Guide training articles is available in the Manners and training section.
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The teenaged biting dog
Older puppies (around a year old) who have intimidated their owners through their early puppy months will progress to what most refer to as “play biting.” By this stage, the biting no longer looks like a cute puppy game; even if the dog is not breaking the skin, the problem is becoming serious. The dog is making it clear that, as far as he’s concerned, the owner is stepping out of line. However, with obedience training, and by learning to modify certain daily living behaviors, this is still quite correctable. A formal obedience class, with a qualified instructor, will teach you to substitute desirable behaviors for the dog’s aggression, and how to modify existing behaviors. Such seemingly unrelated things as the games you play with your dog, where your dog sleeps, and when he is fed may be contributing to the biting problem. Allowed to progress, play biting can become vicious biting.
Obedience training is the quickest way to overcome play biting. A dog that learns to obey commands begins to understand that he cannot bully people. Management of biting teenage dogs includes many of the same or similar techniques that are used with puppies: sit before getting petted or eating; no freedom to roam the house unattended until he learns to come when called; use of a crate for time-outs and when he cannot be supervised; no games (tug-of-war especially) where he wins; and no sleeping in a family-member’s bed.
(More on obedience training)
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The adult biting dog
This is the category where you hear on the news about a dog who “turned on his master.” In reality, the owner was never the master; and the problem did not develop over night. These dogs have gradually reached the status of pack leader. In the dog’s eyes he owns the house, and all the possessions within, and it is his responsibility to protect his pack. If they gave in to the younger dog’s play bites and stopped doing obedience or grooming because the dog didn’t like it, the humans in the family may be demoted to subordinate pack members.
Dogs who achieve pack leadership will relish an opportunity to bite, drawing blood if necessary, if they perceive a human as getting out of line. Dogs who have reached this stage are dangerous and a liability suit waiting to happen. Most of these dogs end up euthanized or given away (to a good home); in the latter case, the problem is passed on to an unwitting new owner.
All is not lost, and dogs who reach this stage can be corrected. A qualified obedience instructor or dog behaviorist must intervene. The humans in the family must adopt a new regimen of behaviors to interact with the dog. The professional’s suggestions must be followed to the letter, because there is little margin for error. This modification period is usually more hard work than the humans care to undertake, and Fido will find the process unpleasant too. Special considerations must also be taken during the retraining, to confine Fido to prevent him from seriously biting someone. The family must also understand that the changes in day-to-day living with Fido apply for the rest of his life.
Yes, dogs bite, and for good dog reasons. Correcting the problem early, learning to communicate is highly required positively not negatively.
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