Pyoderma, Otitis, and Pododermatitis: On Labs and Food Sensitivities

WARNING: This post contains graphic photographs of Stella's skin infections.  One person's fascinating medical info is another person's gory nightmare.  If you are the latter, you might want to skip this post.

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Stella was and remains an incredibly easy dog to train. In classic labrador fashion, she has always wanted to please us, those big brown eyes scanning for positive reinforcement. More importantly, however, this dog lives to eat. Biscuits, jerky, bananas, popcorn, turkey slices. Fancy dog bakery cookies or cheap-o milk-bones.  Human, dog, or cat food. Even better? Cat poop (aka: kitty crunchies)!  Early crate training was invaluable to us for keeping Stella safe.  Until she learned to wait and ask before eating, it was a challenge to keep her from hoovering up anything and everything in her path. Stella was an indiscriminate scarfer right from the get go.

At ten weeks old, she was terrified of walking down the stairs from the main floor of our house to the front entryway, so I put tiny bits of turkey jerky on each step and then waited for her at the bottom.  Stella cried while taking a tentative step towards the first piece of jerky, unable to resist following her nose, then took a colossal header down the carpeted stairs, rolling ears over little fat butt, somehow managing to snatch each piece of jerky as she flew by.  I caught her at the bottom, telling her what a good, brave girl she was, then chased her up the stairs to do it all over again.  She never again balked at the top.

A few days later, we brought her to the park down the street to try out the recall we had been practicing in the living room.  Jim and I stood 50 feet apart, each with a pocket full of jerky, as Stella sniffed the grass between us.  I held out my arm, opened my hand to show a nibble of jerky, and called her name.  She came flying towards me, her soft ears flapping up and down wildly, like Dumbo about to take flight, her mouth open in what looked like an insane smile (I so wish I had filmed that).  She made a bee line for the jerky, then stood in front of me, wagging her tail, begging for more.  Jim called, "Stella, come!"  She whipped around, the name-jerky connection visibly clicking.  Seeing his outstretched hand, she bolted back to him, ears flapping, mouth wide open, tongue bouncing, her tail wagging furiously.  Back and forth she flew between us, jerky nibble to jerky nibble. We carried bits of treats with us everywhere those first few months, but she had it down right from that first day.  Snacks trumped all distractions.  Stella would do just about anything for food.

Even with all the reading and training classes, vet visits and dog advice we solicited along the way, we had a huge, gaping hole in our parenting skills: nutrition.  I can't believe how many years it took for me to understand the role food played in her her odd health quirks.  I can't believe the crap we gave her to eat those first few years!

Stella always had soft poops.  We tried adding different fiber sources (green beans, pumpkin, psyllium, inulin), all resulting in various degrees of diarrhea disaster. We tried yogurt (hello, gas!). We tried probiotic powder (nothing).  We just assumed that was how her gut was designed and because we lived up in the woods, easily being able to pick up her poop in dainty little plastic bags wasn't an issue (boy, oh, boy would that change when we moved to Atlanta).

At about a year old, Stella went to stay with her Oma for a few days.  When she returned home, her normally pink puppy belly was completely black.  It didn't seem to bother her, but the skin was dark and rough.  My brother said it was probably yeast and, sure enough, after a week of soaks in an anti-fungal solution, it receded.  This would happen just about every time she visited her Oma and we thought there must be something environmental up at her house to which Stella's skin was sensitive (we discovered much later, when Jim's mom told us how much Stella loved her grilled salmon, that she was getting table scraps at her Oma's house.  No wonder she freaking loved going to Vail).

Then came the red, crusty, ulcerated circular patches on her belly.  They would appear in waves, sometimes just one, sometimes a half dozen of them.  Again, they didn't seem to bother her, and she didn't lick or notice them at all.  My brother was certain they were Staphylococcus pseudintermedius infections, perhaps even an allergy to the staph itself.  Sure enough, a course of antibiotics would clear it up, but it wouldn't be too long till they returned and we would start the process all over again.

The circular infections on Stella's belly

Summer of 2007, when Stella was two years old, she started to lick her feet.  On closer inspection, she had red, bulbous sores between or adjacent to her toes.  As it was high summer, Stella's vet thought she had caught a few foxtails in her paws and dug around to remove any foreign matter.  He found none (poor little girl!).  More antibiotic followed and they cleared up nicely.  But just like the sores on her belly, they returned at seemingly random times.  When they popped up the following winter, I knew for certain it wasn't foxtails.  Another call to my brother (our hero) and he named them for what they were: Interdigital pododermatitis.

Example of small pododermatitis, emerged after feeding Stella food that contained turkey

Up until this point, her local vets had been dealing with the various infections as they popped up, but we hadn't put together that they were all symptoms of a single, whole body issue.  Her vets simply said, "Labs have skin issues," but it was beginning to dawn on me that there had to be a connection between what she was eating and the multiple staph infections she was regularly experiencing.  We peeled off treats and the Natural Balance turkey tube that she loved so much (that was a sad day for Poopy, but, jesus, why were we giving her snacks loaded with sugar?), we ceased buying the ridiculously expensive handmade cookies from the boutique dog bakery in Boulder and banned the milk bones.  Per Scott's recommendations, we moved her to a single, novel protein source dog food (lamb and rice).  The infections dod not disappear entirely, but they seemed to be less severe and less frequent.

Skip forward to Spring 2010.  We had been living in Atlanta for nearly a year and Stella had been doing pretty well on Natural Balance Limited Ingredient Potato and Duck dry dog food (for three years, we had been skipping from one protein source to the next when the staph would pop back up).   I opened a new bag and could immediately tell something was different about the kibble.  It smelled different and the color of the kibble was much lighter.  Sure enough, the ingredient list now showed duck meal ahead of duck meat and included potato protein, an ingredient that had not been in the recipe prior.  Ugh.  Within two weeks, Stella not only had a belly full of red staph coins, but pododermatitis between her toes.  Enter Dr. Stacy!  She looked over our girl and declared, "Food allergies!"  With two words, she confirmed what I had been suspecting all along.  Plus, we finally had a name to those nasty ulcerated sores on her belly: pyoderma.  Dr. Stacy referred us to an allergy specialist, Dr. White, who patiently guided us through the months long elimination diet required to weed out aggravating foods.

What did we learn?  Stella can not tolerate poultry of any kind (including hydrolyzed chicken protein), beef, venison, salmon, rice (brown or white), wheat, or corn, most Omega 3 fish oils (cod especially).  These foods set off an inflammation process in her body that permits an over growth of yeast on her belly (and sometimes in in her ears, known as otitis) and allows Staphylococcus pseudintermedius to turn ugly on her belly and between her toes.  What protein does her body accept easily?  Bunny!

We began feeding Stella Royal Canin hypoallergenic Rabbit and Potato dry dog food in early 2011 and the change was incredible.  No more staph infections anywhere (apparently, we should have let Stella catch and eat those bunnies she has been chasing all these years!).  Whew!  It hasn't been without kinks. Three summers in a row, Royal Canin ran out of the rabbit based food and we had to suddenly feed Stella an alternative diet (each time resulting in a bloom of pyoderma, yeast, and pododermatitis requiring antibiotics).  Last year, Royal Canin suddenly changed their recipe/formula by adding hydrolyzed soy protein and removing whole rabbit entirely (it now contains rabbit meal only).  The shift obviously changed how it tastes or feels, because Stella immediately started licking her mouth uncomfortably after eating (though she still tore into it as if we were starving her by making her wait SIX WHOLE HOURS between meals).  Honestly, I am not convinced it's a high quality product (Royal Canin was involved in the massive 2007 melamine pet food recall), but it did eliminate Stella's frequent need for antibiotics.

Of course, we're now tossing that to the wind by home cooking for her, but that's a subject for another post.

I can't help but wonder if there is a connection between Stella's life long issues with inflammation/allergies and her early bout and continued fight with mast cell disease.  Those little cells that have so much to do with inflammation, allergy, and tissue growth seem to have been working overtime her entire life.

December 11, 2013: Discovery Day

I didn't realize how hard it would be to look back on that day in December when we discovered her tumor and write about it.  Stella has now shallowly outlived all initial prognoses and as days turn to weeks turn to months, I have reached a tentative detente with her cancer (though I still give it the side eye and refuse to lay down arms).  When I look at my sweet girl today, I can see her as the big personality she is rather than frantically searching for signs of something amiss or only seeing her as  a collection of difficult health crises rising up to swallow her whole.  A few quiet weeks with no imminently mortal dangers have permitted this brief period where I can look at the experience and write about it without grief overwhelming and obliterating everything I do.  Who knows when that will change?  For now, as I type this, Stella rests her head on my leg and whines for another walk, another meal, any kind of attention that involves a ball or perhaps stalking squirrels ("But don't pet me, for god's sake!  Ugh!"). The fact that she's up and about making her little noises and insistent demands sets the clocks and proves that, this day at least, all is well in our little neck of the woods.

Leprachaun Movers, a group of really big Irish ex- rugby players, showed up on December 10th to move us the 1 mile from our old house to the new house.  Stella loved them immediately, each stopped to pet her and even throw the ball a few times (nothing pleases me more than a big dude who makes coo-ing noises to my girl).  She did really well that day, even though it could have been confusing for her.  We had been coming over to the new house for a couple of weeks by then, feeding her dinner where she would be eating from the move on, and all her beds were in place so she always had a good comfy spot to safely sit out of the chaos.

It took about ten hours, but by the end of the day, all the boxes were in the right rooms, all the furniture was in place, and we collapsed into bed in the guest room, which I had set up the day before so that we could be out of the wood floor fumes.

I don't remember much about the next day.  Jim went back to work and I am sure I walked Stella and then got to work on the boxes.  There was still a lot to do over at the old house and our dear friend Craig was over there helping us patch nail holes and repaint.  I do remember talking to my girlfriend Jenny on the phone about how happy I felt and what a relief it was to be beyond the blues that were brought on by the other house, that we could finally just land and be happy here. 

It was pretty late when we finally went to bed. I was already undressed and Jim was somewhere else when I realized Stella was really going at her neck.  I was sure either dust from the move or the fumes from the new hardwood floors were being a bother.  I got down on the floor with her and I could feel immediately that her neck was warm. What she was scratching was a hard swollen lump the size of a freaking orange on her neck, close to where it meets her chest.  Jesus Christ, what the hell was that?  The skin beneath her heathered yellow hair was a fierce, angry red and it was very hot to the touch.  I felt a catch in my heart come loose and I knew, I knew it was a tumor.  It was a big fucking angry tumor.  In a panic I called out to Jim and he came running from the bathroom, frightened by the tone of my voice.  "Stella has a lump," I cried, very close to hysteria, but doing my utmost to remain calm.  "There is a really big lump on Stella's neck."

"Let me feel it." Jim was not a stranger to my inclination towards hyperbole. "Jesus, that is big."

"We need to take her to the emergency vet right now, Jim.  Right now."

"She doesn't seem to be in distress.  She seems fine.  It might be a spider bite."

"It could be a spider bite or she could be having an allergic reaction to something.  But, I think it's a fucking tumor." In case you haven't caught on to the fact yet, I swear like a sailor.

When we took a step back form her, we could clearly see it protruding from her neck, pushing the hair around her normally pretty Elizabethan collar in a messy, awkward manner.  How had we not seen this before?  How had we not felt this before?  I ran my fingers along her old incision regularly and never felt anything, but it never dawned on me to palpate just up and over six or ten inches.  

I hit the internet like it would save my life, googling tumors, spider bites, allergic reactions, you name it.  There was no sleeping for me.  At about 4am, I came up onto the main floor, lay down on the couch in the darkness and surrounded by cardboard boxes, sobbed till I was wrung out, dehydrated and exhausted.  When 8am finally rolled around, bleary eyed and hoarse, I called the local vet and the receptionist said we wouldn't be able to be seen that day.  I protested in the most polite manner I could muster, sleep deprived and a little nutty with worry.  She said if I just came around 11 and was patient, she would see about fitting me in around other patients.  I thanked her, overwhelmed with relief, and then gave in a took an ativan.  

The local vet did finally see me that first day.  She said the same exact thing that Dr. Stacy did back in 2011, "I don't like the look of that."  When she tried to palpate beneath it, Stella squealed and I had to squelch a scream.  She decided to take a fine need aspirate biopsy of it, and after feeling as if she didn't get a good sample the first time, pricked her again.  She said the slide was too bloody for her to have a look at it, but that it's proximity to her pre-scapualar lymph node made her think it was lymphoma.  And with that, she sent us home. 

I walked out of the vet office feeling utterly lost and rudderless, not knowing what the hell I could do for our girl and feeling sure certainty that we were going to loose her.  I called my sister and wept.