Part 4: Finding What Worked
By this point, we knew a lot about Peaches. We knew allergies were driving many of her skin and ear problems. We knew recurrent infections were often a symptom rather than the disease itself. We knew helping her feel safer was improving her quality of life.
What we still didn't know was exactly which combination of treatments would give her the long-term control she needed.
If you're hoping this is the part where we reveal the one medication that solved everything, I'm afraid that's not how Peaches' story goes.
Like many severe allergy patients, finding what worked involved a lot of trial and error.
Some treatments helped. Some helped, but not enough. Some caused side effects that made them impossible to continue. If there was an uncommon side effect for a medication, it seemed Peaches was going to have it.
At one point, Peaches' owner was giving medicated baths three times a week just to help keep her skin under control.
We tried diet changes with various prescription diet options and allergy targeted supplements. We tried medications for both her secondary problems (the infections) and to control her allergies. We tried allergy desensitization.
And each time we learned something new.
Prednisone helped, but it wasn't the long-term answer we were looking for, and Peaches pants away when she takes it. Apoquel appeared promising, but Peaches didn't tolerate it well enough to stay on it. Cytopoint helped but wasn’t enough.
We then turned to cyclosporine. Unfortunately, the first brand we tried caused vomiting and loss of appetite. For many dogs that would have been the end of the story, but in Peaches' case we felt the medication still had potential. Eventually we found a formulation that she tolerated much better.
That turned out to be an important breakthrough.
At the same time, we pursued allergy testing and allergy desensitization. We were hopeful that immunotherapy would become an important part of her long-term management, as it does for so many very allergic dogs. Unfortunately, every time we increased the dose beyond a certain point, Peaches' allergies would flare. We backed up. We slowed down. We adjusted the plan. The same thing kept happening.
Eventually her owner made the decision to stop immunotherapy and focus on the treatments that were providing more consistent results.
Successful allergy management isn't about following the same plan for every dog. What works well for one patient doesn't always work for another. We needed to find the allergy management plan that worked for Peaches.
Over time, the pieces started fitting together. We found a diet that helped Peaches. We found a version of cyclosporine that she could tolerate. Cytopoint became an important part of her management as well.
We also continued treating her skin and ear infections when needed. Slowly the flare-ups became less severe and the infections became less frequent. Her skin became healthier. And slowly, we started seeing a dog living a healthy life.
In our final post, we'll look at what success actually looks like for a dog like Peaches—and why success doesn't always mean perfection.
Continue Peaches Story in Part 5: What Success Looks Like.
About the Author: Dr. Denise Melton is the owner and veterinarian at Tamberly Animal Hospital in Milton, GA. Learn more about Dr. Melton here.