Focused Energy – Microwave Assisted Surgery

Ron Hines DVM PhD

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I wrote this article many years ago. Focused microwave energy never lived up to the potential that I once thought it might have, although it led to microwave ablation and ultrasound ablation of tumors which is now in common use. Today, I believe that Monoclonal antibody medications and CAR-T therapies that seek out and destroy cancer cells as well as Gene editing techniques such as CRISPR 9 offer greater precision and greater hope for us and our pets than what I describe here:  

Many years ago, I owned a veterinary hospital in a small village in the Galilee named Kiryat Tivon. 

From time to time, my neighbor, Alex Potok, would keep his radio blaring day and night. When Alex heard the DJ utter a specific string of words between tunes, he would unceremoniously walk the short distance to our water tower (the one on the upper left) and flip a the switch that set off our town’s air raid sirens. When he heard another coded phrase on the radio, he would turn it off. Every so often he forgot to fill the tank. Then the whole of the town had no water. That was the state of technology in October of 1973. The incoming missiles were gifts from Damascus, courtesy of their president, Hafez al-Assad.

During one such fusillade, a young woman roused me out of bed late one evening carrying her bloodied dog. The collie, Aphrodite, had the misfortune of being too close to the spot where one of the Katyusha rockets exploded. I sewed the dog back together. she, healed well and remained the talk and pride of our Town.  That is because katyusha rocket shrapnel is razor sharp and sterilized-hot. So, it produces wounds that heal well when they do not kill you outright. 

Fast-forward forty years to August 21, 2013. President Obama has threatened to destroy the chemical warfare missiles of Hafez’s son, Bashar al-Assad. Rather than retaliate against the USA, he threatens to lob missiles into the Galilee and points south.  

In the midst of that crisis, I received an email here in Texas from the owner of Pizza, a cat living in Rosh Ha’ayin, a village not that far from my old home. Pizza was in the midst of a uremic crisis. But why was the cat’s owner more concerned about the cat’s current predicament than her own safety? Because during the intervening 40 years, technological advances were protecting both of them. Pizza and her owner were safe under the activated Iron Dome.

Who is at fault and Who struck John aside; there is no greater motivation for innovation than the threat of one’s personal annihilation. In the near future, a technology, conceived to shield one population from the incoming missiles of another might affect you and your pet’s health as well. I call it focused energy. This adaptation defense industry’s technology to focus energy beams precisely might allow for ultra-precise incision-free surgery that has so many conceivable uses.

Dogs and cats might be spayed without an incision. Arthritic conditions could be treated and all manner of manipulations could be performed with little or no collateral damage to the patient. Perhaps ways will be found to interrupt the ovulation (heat) process and breeding potential of male dogs in ways that preserve the positive hormonal balance of your pet intact. The potential seems almost limitless.

Click on the video below if you would like to know more.

Dear reader, Besides your donations, visitors to the products that Google and others display on my website help me defray the cost of keeping my articles on the Web – and keeping you informed. As you know, sites like mine that intentionally use no AI texts or conclusions and are not written to Sell You Things are getting very hard to find, Best wishes, Ron Hines (2nd Chance)

Please let me know how well Apoquel® worked for your dog

As you read the emails below, please remember that cause and effect are sometimes an illusion. When things occur, one shortly after the other, we call them cause and effect when we believe the first event caused the second event to happen. If we feel that the two incidents were not related, we call the second event a mere coincidence. Cause and effect and mere coincidence can be very difficult for us humans to sort out. It is only when they occur repeatedly in pets receiving a medication that we can be reasonably certain that we are not dealing with a mere coincidence. Also, just because something occurred in one dog does not mean it will occur in your dog. RSH

Many owners of allergic dogs who once gave their pets Apoquel® have now decided to give their dogs Cytopoint®  instead. That is either because Apoquel® lost its effectiveness or, more likely, because they or their veterinarian thought that Cytopoint® was less likely to cause negative side effects. To read the stories of dogs that receive Cytopoint®,  go here. When Apoquel is given, it is not unusual for the amount of itching your dog experiences to increase when your veterinarian attempts to lower its twice-a-day dose to once a day (rebound pruritus). Adding prednisolone during its first few days of Apoquel might avoid that. (read here) 

Apoquel® Dog Owner’s Comments:

Owner email in black, follow-up emails in purple, my comments in green

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 Jan 12, 2026

My dog, Sam is now 7 years old. He is a neutered rescue from Kuwait. We, adopted him even though his . His SDMA level was elevated. When he was thought to be ~2 years old. Continuing monitoring of his kidney tests are recommended by our regular vet and also by the vet dermatologist due to his Apoquel® usage for our peace of mind. Sam is on Simparica Trio® for flea and tick prevention and has not had fleas since I’ve had him).  We tried Zyrtec®, which didn’t help.  Then Cytopoint®, which didn’t help.  We put him on Apoquel® (actually started on a very low, even sub-therapeutic level dose) and his itching/licking resolved..  Used it to get through allergy season then took him off. Allergies came back the next year, even worse, so we tried Apoquel® again and it didn’t help this time. Upped the dose, still no help. Tried a few other things the didn’t help (steroids, topicals, etc) so our regular vet recommended a dermatologist. It took six months to get an appointment, so I decided to try and elimination diet in the meantime, using novel proteins and using rigorous protocols (even switched to a non-chewable flea and tick preventative and heartworm).  None of this helped. Sam’s symptoms were so severe that he would lick all the fur off his back toes, paws, up the legs, and his front legs, until he would bleed in spots. Our vet dermatologist determined it was due to the allergic skin disease, it wasn’t that the Apoquel® stopped working like we thought, but that he was developing secondary yeast infections (took skin scrapings) on top of the allergies.  So put him back on Apoquel® and a course of anti-fungals which was when he finally had full relief.  He stays on Apoquel® about 8 months of every year, I take him off during winter months when he’s never exhibited symptoms.  He did need to go up the the middle of the therapeutic range after a couple of seasons when his symptoms flared and there was no secondary yeast infection present.  He also has a topical cream to help during mini-flares.  Because we had identified which seasons he had allergies and it has been relatively well controlled, I opted not to do the full specific allergy testing, though I might this year just to see. I wasn’t crazy about using Apoquel® long-term, but it really has been the only thing (in conjunction with other therapies when needed for yeast) that saved him.  He was truly miserable for close to a year before all other approaches failed and we got on a good regime with the veterinary dermatologist.  

Your article about SDMA  was absolutely invaluable and saved me a ton of stress. My vet’s take on SDMA, while not as thorough as your explanation, was that he’d seen plenty of patients with elevated numbers that never went on to develop kidney disease, so we could monitor and wait to pull the trigger on a special kidney diet until something in addition to the SMDA seemed to indicate a kidney issue. And magically his SDMA number dropped into the normal range.  I’ve been trying to remember to add water to his food dish at dinner time, since he cleans out the entire bowl water and all, in an effort to increase his hydration.  Maybe it was that or had nothing to do with it, who knows. But my boy is in good health 🙂 Thanks for what you do,

Brenda M.

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February 14, 2024

Hi Dr. Hines, I have two French Bulldogs. One Bullet, is 11, and the other, Wilbur, is 12 years old. They’ve both always suffered from allergies but presented differently. The 12 year old had super bad itching, constant licking his paws until raw and runny eyes, right out the gate. He lived in his cone when we weren’t around. Allergy testing revealed that he was allergic to everything under the sun, including human dander (though pollen and cats were higher on the list!). From a young age, he was intermittently given prednisone to calm some of the symptoms… until we realized the concern of Cushing’s disease and sought an alternative.
Our 11 year old would lick his paws, but not to the same extent. He would develop atopic dermatitis and eventually yeast infections on or near his tail nub when allergens became unbearable. Needless to say around 2 and 3 years of age, Apoquel entered as the knight in shining armor. They have taken this medication like clockwork, daily, 8mg each, up until two weeks ago. For at least 4 years, Apoquel gave significant relief. When seasonal allergens became really bad, there was paw licking, but not to the extent of open sores. Some time after that, Apoquel’s efficacy began to wane. Especially for the now 12 year old. We would have to supplement with additional medication such as diphenhydramine or chlorpheniramine  which maybe took the edge off. I still didn’t doubt the medication [Apoquel] until we ran into problems. These are dogs from different breeders. They eat the same grain-free diet. They took the same allergy medications.

The 11 year old for the past 5 years has developed annual bronchitis. The first time around, it became pneumonia and we wound up having him in an oxygen bubble at the emergency vet. Consecutive years, we’ve been on alert and caught it sooner when still in the bronchitis phase. Hindsight – he’s always dealt with ascites and pleurisy…. And I’ve read about this being linked with Apoquel. About 4 years ago, the 12 year old had bloody stool and ended up needing a colorectal polyp removed. We thought nothing of it. The last 3-ish years, it has been a may-lay [mix] of intermittent diarrhea for both dogs. So began the episodes of feeding chicken and rice and then trying a different food. Of course including Pro–Pectalin and FortiFlora in the regimen [treatment]. Side note – their behavior had changed. Not as playful, moody and withdrawn. I figured it was old age. About 6 months ago, they both started eating their stool. Fast forward to about 3 months ago, with one dog and then the other developing colitis. Uncontrollable diarrhea in the house. We thought it was the end. The vet suspected malabsorption. We ended up doing a GI panel on one of them to learn of a couple deficiencies…. but while we were waiting on the results, the 11 year old passed 10 polyps over the course of two bowel movements. That’s when I started looking further at why both dogs were suffering in the same way…. what was the bottom line…. I had figured it was diet related until we ran out of options. Apoquel. I immediately stopped the drug. Found a supplement to deal with the allergies. So far, their appetite is back. Their stool is normal. And their mood and behavior is vastly improved. Long term – to be determined if the damage is done or if they truly bounce back. But I firmly believe my findings to be true. I’m disappointed it took myself this long to get here [since] I naturally question the safety and efficacy of pharmaceuticals anyway [in general ?].

L. H. New York

French bulldogs have the shortest average lifespan of all dog breeds, according to a UK study. Jack Russell Terrier have the longest.

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January 15, 2024

Our Goldendoodle Lui was 2.5 years old. [In April of 2022, he developed a cough or snort that came and went]. [The veterinarian we use] suggested that Lui had seasonal allergies and put him on apoquel. We accepted that [although] he never scratched or was itchy. [ ] On Tuesday, August 16, we took Lui to our local dog park [ ] and he played like he always did. That night he didn’t want to go out [to] tinkle. We called the vet the next morning and they suggested we observe him for the next 24-hours to see if he improved. He did not and could hardly move [by] Wednesday.  We took him to the animal hospital where they told us he had a massive infection- catastrophic pneumonia – and [placed] him on IV antibiotics [and] kept him overnight.  We got a call the next morning that they were doing CPR – that Lui’s heart had stopped.  Never in a million years could I imagine losing a 2.5-year-old dog like this. I work for the FDA and so got their help [in performing] a necropsy and [I] got in touch with Zoetis.  The necropsy confirmed catastrophic pneumonia [but] there was nothing that could [definitely] tie his death directly to the drug. My take is that Apoquel completely depleted Lui’s immune system -and that he had some underlying infection that just blew up when he couldn’t fight it.  Zoetis took an interest but ultimately only paid for what was left of Lui’s hospital bill after insurance. [Our] vet never called us after they learned about Lui’s death. We [are] new dog owners and put way too much faith in the vet we chose who it situated in a very affluent community where pet owners will pay just about anything for their pet’s care. I am ridden with guilt that we didn’t seek different care for Lui. Thank you for the work you do.

S. L., Bethesda, Maryland

1-15-24 At least in some dogs, Apoquel has the ability to suppress various elements of a dog’s immune system, other than those responsible for allergic itching. Veterinarians and physicians are no different than supermarket fruit in at least one respect. Unfortunately, sometimes you get a rotten one.

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August 12, 2023

Our vet has had our 8 year old pug, Elliot, on Apoquel for a few years now to stop him licking his paws and waxy ear’s but the last six months he has started getting these black growth’s on his paws they really look unsightly getting quite big. Then we noticed he had one under his chin and one growing on his face now. The vet said he didn’t actually know what they were but took a few off and sent them away and they are not [malignant], thank god. He is still on Apoquel but constantly licking at these black lumps on his feet to the point where he makes himself sick The vet doesn’t seem to think it’s a side effect from years of being on Apoquel but after reading many reviews I’m not so sure. When I asked him about removing some more from his legs and paws he said he could but he wasn’t sure if they would just grow back. We have considered stopping the Apoquel simply because [it doesn’t] seem to be doing what they were intended for, he is licking these black lumps on his paws continuously now to the point where he makes himself sick so we have to continually watch him he can’t be left on his own. Elliot received two Cytopoint injections about a month apart too along side of the Apoquel. At the moment we are working on a Herbal remedy and looking to see if his diet needs attention. (See Elliot’s lumps here)

 S., Westmidlands near Birmingham, UK

Dear Mr. S.,

I have not heard back from the virologist I wrote to at the RVC. I still think you should seek a second opinion regarding options for Elliott that do not include immunosuppressive medications such as Apoquel or Cytopoint. Or, perhaps if none are suitable, attempt to lower the doses of those medications. But I am far away and unable to size up Elliot or the challenges you face over there. I will try to find another veterinarian at the RVC who might be willing to discuss Elliott’s situation and your options. It might come down to some physical method to keep him from bothering his toes. Often, there are a bit of psychological issues in addition to allergies that come into play. At first glance, these “lumps” appear to be papillomas. (read here) Once exposed to the virus, various factors, including  immunosuppressive medications and advancing age, can cause them to reappear. 

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May 24, 2023

My husband and I had to put down our beloved 13 year old Cairn terrier Elvis, last Friday. We believe Apoquel was the reason that he started having multiple health issues. He began taking Apoquel March 2018 because of his constant itching and scratching. I tried medicated shampoos and home remedies and nothing was working. We were so relieved that our Elvis was finally free from all of the painful itching. In 2021 Elvis developed a tumor in his neck area. His vet did a biopsy and it came back benign. In May 2023 Elvis started showing blood in his urine every time we took him out to urinate. We made an appointment that very day to see his vet. The vet diagnosed him to have a UTI and gave him a 1 week foil pack of antibiotics. The next day we walked him and he was urinating and his other business like normal and eating and drinking his water like always. But on the 15th we noticed he would have some dribble of blood towards the end of urinating. Our vet called us 4:30pm and told us that Elvis had an enlarged right kidney, an abnormal left kidney and that his prostate is enlarged and she was almost sure it was cancer. A few hours later she called again and said that there was nothing they could do other than send a referral to Texas A&M to put a stent bypass in so he could urinate again.

G. B., East Texas

5-27-23 Hello Mrs. B., I was so sorry to read about Elvis. After reading your email, I want to tell you and your husband that you did the only kind thing that there was to do. I am so glad you did not take him to A&M. That would have caused extended grief to Elvis, and to both of you. Veterinarians are obligated by State Boards of Veterinary Medicine to mention all options – even the ones that offer no real hope and are inherently cruel. I took portions of your email and posted them on this webpage today. I am glad that you and Elvis had 13 precious years together. Best wishes, R. H.

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May 17, 2023

My dog, Oscar, who is 8, has been on Apoquel x 5 years, with moderately good results related to his itching. A week ago he developed a deep infection in his left front paw, with multiple cysts between his toes, and multiple papilloma growths all over his paw pads, in between toes, and under his toenails. He will not bear weight on the paw. The paw is extremely swollen, and it is obviously painful. Initially the vet started him on basic antibiotics for skin issues. Currently Oscar is on azithromycin and Tagamet x 2 days without any improvement. I am holding pending update to vet in AM.
Mid-panic here. :/   A., and Oscar, Central Ohio

5-19-23 His care plan has changed due to Oscar being unable to tolerate oral meds (he has a ridiculously sensitive stomach). Today, an injectable antibiotic (Convenia) and a long acting steroid injection. So far he continues to have a very swollen painful paw with many papillomas, mostly between toes and under toenails. 

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August 20, 2022

We rescued our German shepherd when she was about four years old. We had her for about three years. Nala always had a problem with allergies and scratching. She chewed on her feet constantly. We tried several medicines and gave her medicated baths. Nothing helped much.  She was a very healthy dog except for the itch. I heard about Apoquel and thought about talking to the vet, but I decided against it because I read many reviews including a few bad ones, and I decided to wait. I waited two years and decided it was time to try Apoquel. I followed the instructions for about three weeks, and her itching stopped. I was so happy. However after those three weeks, Nala could not get up and walk straight. She wobbled and fell over. She stopped eating and would drink little water. I stopped her Apoquel, took her to the vet, and they made an appointment with a neurologist. He did over $7000.00 worth of tests and determined Nala had meningoencephalitis. He said that he didn’t know why. He put her on a bunch of medicines, but Nala passed away one week later. No one can tell me what happened. Apoquel was the only thing different in her life.

D.S., Grant, Florida   Sent from Mail for Windows

What a heartbreaking experience. No one can prove that Apoquel was responsible. But I agree that the timing was suspicious. Unfortunately, we veterinarians are dealing with two unknowns: We don’t know what causes meningoencephalitis; and we don’t know what the full ramifications of disabling portions of the immune system might be. Physicians do know that their patients facing health issues that weaken the immune system, such as organ transplants, HIV or chemo have a higher likelihood of developing meningoencephalitis. RSH

February 26, 2022

My 2-year-old springer spaniel, Sadie, suffered from itchy paws and skin. She was constantly at the vets. But with a good routine, keeping her away from certain food and the odd medicated shampoo etc., it calmed down. We would often just opt for using a cone when she was itching badly and make sure her skin and paws were clean and dry until the itching subsided. She was prescribed Apoquel®. The dose was 1 tablet a day for 6 days. We soon noticed that her breathing was slightly faster but we had a follow up appointment for her skin the following morning. The vet said she had a fever. We took her home and checked her temperature hourly, used cold cloths, a fan and opened the windows to cool her down. But by 6 AM her temperature had climbed to 41.5 (106.7 F) so back to the vet. She was kept overnight for monitoring and an (IV) drip. They did (ultrasound) scans and x-rays and found that she had fluid in her abdomen and presumed she had septic peritonitis. They explained that she likely had swallowed a foreign object that had cut her intestines and caused a gap/split that was allowed fluid to leak into her abdomen and that they would perform emergency surgery to find the tear and fix it. The vets didn’t find any foreign body. They didn’t find a gap, split or tear in her intestines. They found that her intestines had become fused together (adhesions). They separated the adhesions and hoped that the issue was fixed. Unfortunately the fluid built up again and entered her lungs. She was put to sleep 3 days after her original vet trip. It wasn’t until I came across a similar occurrence on Apoquel regarding unknown cause of fluid build up in a dog that had been taking Apoquel for 450 days. Although I can’t say for certain that Apoquel was the cause, I won’t be using it ever again.

C.M.326@hotmail.co.uk

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October 2, 2021

I have been giving my English Bulldog, Dallas, who is almost 8 yrs old Apoquel® 16 mg tabs once a day for approx. 2 years now. Suddenly, in May of 2021, he had was diagnosed with Dilated Cardiomyopathy. Strange thing was in March of 2021 he was in for a checkup with the same vet & everything was normal. He is an extremely playful dog who brings anyone his toy once they walk into my home. That’s how we realized immediately that something was wrong. He now has to take Pimobendan 15 mg & Sotalol 40 mg daily. So far he has been stable since the cardiomyopathy diagnosis. I don’t know if any other people’s animals have been affected with heart issues while taking Apoquel®. As I mentioned earlier, this condition came on so sudden in a dog that was constantly running up & down the house from the age of 1 year old till May 2021. And the only medication he was taking daily is Apoquel. Hopefully my response may be helpful if any other animals have similar symptoms while using this medication.
Thank you, E.S.124@aol.com

10-3-21 At the time of the cardiac visit the vet who we see was Shocked & especially since we were just in to see him 3 weeks prior. Nationwide pet insurance even searched every vet that my dog had seen in the last 5 years to see if anything was written with anything that would possibly have caused this. That I know was not for my dog’s benefit but only so they could deny the claim. That is how sudden this was. He is not my first English Bulldog & none ever had this problem. 

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September 6, 2021

I started my 24 Kg English setter on Apoquel®. He has been taking it twice a day now for 6 days. He is now lethargic and has had possible petit mal seizures. He is 11 years old and had seizures once 5 years ago. Can I stop the Apoquel now?

A. A. Sent from  Mail  for Windows

9/13/21  I’m giving him a lower dose of Apoquel now and the seizures stopped. Ann

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August 30, 2021

We started our two dogs, Ellie and Hydro, on Apoquel® Sunday morning. They were given a loading doses of twice a day. It’s now Monday evening and they both have such horrible diarrhea that I am going to stop the meds until we talk to the vet tomorrow. I may start again as they both have such horrible itching problems… or may have to try something else. There were no changes in their food or medications. They didn’t get into anything that I am aware of… there are usually indications with these two! Ellie is pure Australian Shepard, she is 4 years old and does have chicken allergies. She eat prescription food (rabbit). She has always had some issues with her belly being red, break outs around her mouth and some kind of dermatitis on the back of her legs. But nothing horrible. Hydro is an Australian Shepard mix, he is 3 years old, no known allergies. He started chewing his paws and scratching his muzzle to the point of drawing blood and deep tears in his muzzle. We had been using Benadryl for quite some time and intermittent rounds of prednisone for both. The prednisone works great while they are on it. Takes about 2 days after last dose before the signs/symptoms return. There was a lot of hair loss for both of them this time as well. Recurrent ear infections included. The vet indicated that diarrhea wasn’t a side effect (it’s in the med insert) and that we could come get some meds for their stomachs. I have decided to not do the loading doses and to try just one pill a day for a couple of days and see what happens. 

P.S.@yahoo.com Sent from my iPhone

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July 2, 2021

Apoquel and lethargy

My service dog, Jack, was prescribed Apoquel® on May 24th, 2021.  He was very active (for an 8 year old Golden Retriever) until 4 days after starting the Apoquel®. I noticed he wasn’t quite as perky. This has progressed until now he is really lethargic.  He will get up to eat and drink, lay down by a vent for several hours, go out to relieve himself, come back in and lay down again by the vent. He doesn’t want to play anymore and does not bring us a shoe or blanket in the morning as usual. Today I even clipped his nails (which is not his favorite activity) and he didn’t flinch or bat an eye. I contacted my vet who lowered his dosage to 1 pill a day (from the initial 1.5 pills bid) two days ago. But Jack is still lethargic. I realize lethargy is a side effect, but when will this end?
R.P., Chesterfield, Missouri

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July 2, 2021

Our yellow Labrador retriever, Finn, who we adopted at the age of 5, developed panhypoproteinemia (low blood protein) caused by inflammatory bowel disease. He has been a poop eater his entire life and had episodes of diarrhea and weight loss his entire life. Finn has responded well to a low fat diet, steroids and chlorambucil. He discontinued Apoquel® when he started chlorambucil at his internal medicine specialists’ recommendation. However, this summer his hot spots were out of control without it so she authorized us to use it but actually recommended Cytopoint®. When Finn added Apoquel® to budesonide and chlorambucil, his stools got firmer and less frequent. Finn was getting manic after taking Apoquel® so I discontinued it for 4 days and his stools got looser and more frequent. It could just have been coincidence. Finn did find and eat another dog’s poop while off the Apoquel® and that could have caused is softer stools. I would be very interested to know if anyone has written you to tell you that Apoquel® helped their IBD dog?

S. F., Washougal, Washington

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May 20, 2021

Hello, Have found/heard of dogs gaining weight on Apoquel®?  Our male Polish Lowland Sheepdog was prescribed Apoquel® in March of 2020 after a trial on Cytopoint® failed.  At that time, he weighed 58 lbs which is within the standard for his breed.  Ten weeks later, he weighed 70 lbs.  We asked the vet about this and she didn’t seem concerned.  4 months later, he weighed 77 lbs. Last Saturday we had to take him to the ER VET because he ran for a ball and came back limping on his right rear leg.  They suspect a CCL tear. He’s going to see an ortho specialist in the morning.  At the ER Vet, he weighed 88.18 lbs pushing almost 35 pounds over his optimal weight!  I have called the makers of Apoquel and they denied EVER hearing about weight gain. We feed him 1 level cup of limited ingredient “clean” food in the morning and another at night.  He runs and runs during the day in our large fenced yard. Treats are very limited to 2 small treats per day.  Now I fear if he has a tear and need to have surgery, the weight gain will be worse.

D.S., Wrigley, Minnesota

Dear D.S. I do not recall anyone reporting this to me before. However, Apoquel® (oclacitinib) works because it blocks portions of the JAK signaling pathway. In mice, loss of JAK3 is associated with obesity. ( read here,  here , & here ) In humans given Apoquel’s “sister” drug Xeljanz® (tofacitinib) body fat mass significantly increased. (read here)I cannot say if Apoquel® had anything to do with your dog’s weight gain or torn cruciate ligament. But all dogs are unique and each is going to react differently to this drug than another.

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April 16, 2021

I have been a Board certified MD for over 20 years.  Our beloved German shepherd, Juno, was a vibrant, intelligent and healthy 11-year-old dog.  She did however have numerous environmental allergies, which were to a large degree unavoidable.  Our veterinarian recommended Apoquel®. We tried it with good efficacy relating to her itching. Juno was on Apoquel® for roughly 4-5 years.  One evening while playing with her, I noticed that she had a 1-2 cm growth on her left lower gum line. The area was biopsied by our veterinarian and sent to the University’s pathologist.  Unfortunately, the growth was a very malignant melanoma tumor.  We chose surgery and chemo. After two surgeries and two rounds of chemotherapy, the tumor returned.  She was euthanized in my arms several weeks later. Apoquel® is a potent JAK inhibitor that significantly cripples a dog’s immune systems’ ability to fight infections and cancer. There is no doubt in my mind that her rapid tumor growth was facilitated by the drug crippling her body’s ability to mount a defense and slow the growth of the tumor. The oncologist instructed us to IMMEDIATELY stop the Apoquel® and never use it on any dog. There are many other treatment options for atopic dermatitis in dogs, and I strongly recommend to dog owners to exhaust all other safer treatments.  After over a year following the loss of our beloved companion, I still lament the decision to give her Apoquel®.  That is a pain I hope to keep from ever happening to other dog owners.
T. H, MD, US Gulf Coast, Sent from my iPhone

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April 5, 2021

I wanted to add my experience treating my dog’s allergies with Apoquel®. Heidi is a 13-year-old husky mix. She began to show allergy symptoms when she was about 6 months old. It is seasonal, usually starting in July (I live in Michigan) and continues until the first hard frost usually in December. She was first treated with Temaril-P®, which made her very lethargic and she gained a lot of weight. Then we put her on Atopica®, which worked very well for about 6 months. Then it stopped working. Back to Temaril-P® until Apoquel® became available. Heidi has been taking Apoquel® for around 8 years now. Over these years I have continued to look for supplements to help reduce her reliance on Apoquel®. July through December I have her on half the recommended daily Apoquel® dose — that is half of one pill a day. I also do not put her on the double dose for two weeks when I start her back on Apoquel® in July. I start with one pill a day for about a week then reduce it to one-half pill. So far, she has not had any negative effect from the Apoquel®, other than that two years ago, for the first time, she had slightly elevated liver enzymes. Last year, they were normal again. So far, I think Apoquel® has been a good option for her and has helped her live a better quality of life, which has always been my first priority.   

R. S., Michigan

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February 15, 2021

I have been looking for some natural treatments to replace Apoquel®. And I’ll be damned: A vet who quit the biz because he was tired of pushing Big Pharma’s pills launched a series of videos on natural treatments. So there I was last night feeling like a fool while peeling and crushing the ribs of a raw cabbage leaf to extract as much moisture as possible and then applying the leaf to my Min Pin, Louie’s, underarms — and it’s just past 7 pm here and Louie hasn’t started his merciless scratching yet, something he does every day by 5-6 pm. It is nothing short of a miracle. I will let you know if this really works. Stay tuned.
Best,
Joan,  Rehovot,  Israel 

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November 24, 2020

My 12 year old cocker spaniel, Jake, had been on Apoquel® for about 2 years and its [effectiveness] had started to wear off. My vet added antibiotics which worked really well. But when he stopped taking them he was back to itching again. Then my vet suggested Cytopoint® which I tried and paid £166 for. It made absolutely no difference to him. He is now worse than ever. His skin is raw and his ear problems are flaring up. I asked the vet to put him back on Apoquel® but they are not keen on doing so until the Cytopoint® is out of his system. I now face 4 weeks of a suffering dog and sleepless nights. Not impressed at all. Bathing him with Malaseb™ twice a week has helped. 

PB44, Lanarkshire, Scotland 

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September 19, 2020

My Labrador retriever is nearly ten months old and three weeks ago he was prescribed Apoquel®.  I had looked up the side effects but his itching was so bad I didn’t know what else to do. He’s only been on the drugs a week and a half, yes the itching stopped but he throws up three or four times a day.  We stopped the Apoquel 48 hours ago and he’s still throwing up. I don’t know what to do because after he throws up he’s completely fine. I’m terrified we haven’t seen the worst of it and don’t want to lose my puppy.  I’ll keep you updated.  Please pray for our Ryder
J.I….21@gmail.com, Sent from my iPhone

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June 16, 2020

I thought our experience with Apoquel® might be useful. My 3-year-old dog, George, had dermatitis and was started on Apoquel in March of 2016. He took the initial 16 mg oral tablet/day for two weeks followed by 8 mg/day ongoing. In November of 2016 he developed a growth on his rectum that was initially treated as an infection. Over two weeks it did not respond to antibiotics and it had grown. Cytology ultimately revealed a B-cell lymphoma. He had been on Apoquel approximately 222 days – beginning at age 3. He began CHOP protocol chemotherapy within the week. His oncologist believed George’s best-case scenario was [to live another] 6 months. Unfortunately he had no therapeutic response to the chemo. We ultimately had to euthanize George several weeks later in his third year before he had even finished the first round of chemo. He had progressed from completely asymptomatic at the time of diagnosis to suffering in a matter of weeks. George had no [known] underlying health problems or genetic issues [nor] did any of his breeder’s line. His breeder has done all available genetic testing and has found no abnormalities. My current dog is George’s nephew. He too has some dermatitis issues and is managing well enough after having received two Cytopoint injections. In my experience the Cytopoint has not been as effective for him as the Apoquel was for his uncle (100% near-immediate effective at itch suppression) but the immunosuppression I am now aware of is not worth the risk.

J.N. Sent from my iPhone, Wyckoff, NJ

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June 13, 2020

My dog Coco is an 8-year-old ~10lb Chihuahua/Terrier mix. She suffers from a terrible itching problem. We hesitated treating her with drugs since she periodically has to take meds due to her contracting Toxoplasmosis/ Meningitis.  When we heard about Apoquel® we took her to our vet and were advised that she should be on Apoquel®, but should also receive the Cytopoint® shot every four weeks.  The combination worked very well for the first month.  Immediately after getting the second shot (about two weeks ago) her personality changed dramatically. She used to spend her days with her brother looking out the front window and barking at anything that walked or flew by.  Now she hides in the tiniest and darkest places in our house and will not come out when called. If we turn a light on in the room where she is hiding she runs to a different darker room. We aren’t sure, but it seems she has become extremely light sensitive. Her appetite has increased dramatically, although, I have to find her to feed her.  We stopped the Apoquel® about ten days ago. We are hoping that after the Cytopoint® wears off she will return to her normal self.  If she still continues to hide after another two weeks we will take her in for blood tests.  I pray that I have not doomed my little girl by choosing to have her injected with the Cytopoint®. After reading other’s stories and knowing what I now know, I would caution anyone considering the drug to try anything and everything else first.

J.G. San Antonio, TX

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May 6, 2020

Hello Dr. Hines.  We moved to Houston 2 years ago with our perfectly healthy labradoodle, Max. He never suffered from allergies in Chicago (or any health issue), but in Houston was another story.  He scratched constantly.  Our vet put him on Apoquel® about 15 months ago and his health immediately took a hit. It never occurred to us that it may have been caused by the drug.  He started having foot issues – infected nail beds that required first one toe amputation then two more. The infections were virulent so he was on very strong antibiotics, which did not cure the infections.  His biopsies came back showing possible cancer cells but the samples were so [difficult to for the lab to interpret]. The biopsies have now been sent to A&M Veterinary School because they can’t quite tell what is going on with him. Right now he’s had 3 toes amputated and his remaining nails are disintegrating and painful. He pants constantly and has lost any desire to exercise. He is clearly sick and it seems systemic but so far no certain cause. The vet’s best guess is that he has a rare form of cancer. The last vet visit it was suggested that there have been problems with Apoquel. REALLY???  We are heartbroken and will probably have to put Max down. Please inform others that this drug is po***n. Thanks,

C.McM. @icloud.com

Max was euthanized on 5/11/2020. His immune system could no longer fight the common bacteria that all dogs are exposed to. 

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November 4, 2019

October 17, 2019

My Chinese crested dog, Pippin, was prescribed Apoquel for itch.  After a couple of days his skin was a mass or sores, he had mites and warts between his paws that prevented him walking comfortably.  We pushed on and after 7 months of intense treatment his skin has cleared up.  Simple over the counter antihistamines would have sufficed.  Now he has developed a lump on his side I have no doubt will turn out to be tumor.  The tests come back today. He is seven years old and has been to hell and back.  Now he faces cancer.  How do these drugs get on the market?

K.S. @iinet.net.au

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August 29, 2019

Hi Dr. Hines,

My dog was given Apoquel® for 2 years + 10 months.  Immediately after starting Apoquel®, he began to become more clingy, nervous, lethargic, restless. I found him laying in strange places, under the bed or hiding behind the toilet. He occasionally had difficulty making his usual leap up on to the couch. A couple of times he missed the second stair between the family room and kitchen, plowing face/chest first into the riser. There were a couple of episodes of extreme shaking/ trembling and anxiety…also blatant loss of appetite. Lastly, his eyes appeared glazed and he seemed increasingly nervous/ anxious. He had to be euthanized after 2 yrs+10 months on Apoquel® after he developed 2 cancerous ulcers that burst on his intestine.As well as, vomiting, diarrhea, appetite loss, lethargy, hot spots, bladder infection, increased water intake, development of watery eyes/runny nose, one instance of skin change, and finally the development of fatal cancerous ulcers, I forgot to mention weight gain and will post on your link regarding Apoquel® + mood/behavior changes to describe anxiety/shaking/hiding and occasional disorientation.

E. M.  ********97@gmail.com

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August 15, 2019

 [In] May [of] 2016, after appropriate tests, we put our 9-yr old male Shih Tzu/chihuahua mix [on Apoquel because he] had experienced some itching. [While on the drug] he [twice] developed hot spots on his paws. It took over 2 weeks to clear [them] up properly. [In] March, 2019 (he had been on Apoquel 2 years + 10 months) 2 cancerous ulcers (diffuse neoplasia) burst on his intestine. [ ] We had to euthanize him. [I believe as a dog-owner that] Careful candidate selection, accurate risk/benefit explanation, owner/vet education and monitoring, access to drug data and labeling updates are crucial here. I absolutely believe that adverse events are under-recognized and under-reported regarding Apoquel. Similar to steroids, Apoquel should only be prescribed as a “last resort” for dogs who have no other alternative.

E. S. , Sent from Mail for Windows 10

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August 13, 2019

Hi Dr. Hines,

I came across your web page about Apoquel and thought maybe my story has some value to you since my dog, [Ziggy] has been on Apoquel for some time. [He] is a little over three years old and has been on Apoquel for a ~2.5 years. He has allergies to ragweed and mites. He gets really red and itches until he bleeds and scabs up. We manage the allergies by keeping the house as clean as possible, and the daily Apoquel. We notice it gets the worst in his armpits, around his mouth, and feet.  The Apoquel seems to do a good job controlling the allergies most of the time. However, there are sometimes of the year they will flare up for a few days and then get better. [he weights ~65-70 lbs and gets 16mg once a day in the morning] I haven’t tried a dose reduction recently, but when I have in the past the allergies seem to be worse. So for now we plan on keeping him on the meds indefinitely, and monitor his bloodwork. As far as side effects, there aren’t really any that I notice, overall he seems to be a healthy energetic 3.5 year old boxer/rott/pit/chow/hound mix. 

Cheers, I.I. , Philadelphia, PA area

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August 6, 2019

Hello

My Pit/heeler dog started Apoquel approximately 2 years ago at age 11 or 12. She [has] had allergies all her life and it had gotten worse as she got older.  Initially her vet wanted to put her on Apoquel but decided not to because she had a few warts and some bumps and a non-[malignant] tumor on her cheek.  One day I brought her in because of a suspected ear infection (it was just wax build up). Her regular vet was on vacation. The new vet saw her chewed up paws and red skin and was eager to prescribe Apoquel. I was undecided but he asked me if my dog had ever had cancer and [I said] a no, so he told me there should be [no] problems. Apoquel worked, all symptoms disappeared. I thought at least she [won’t] have to [end her life] with itchy and infected skin. Well, at age 13 1/2 I noticed that she was uncomfortable and seemed to be really sensitive to [the] touch. I blamed it on her old age until she turned 14 and one day started peeing a lot of blood with big clots and got really weak all over. She was diagnosed with bladder cancer. We had to euthanize her last week. I’m sharing my story in case there are other people with a similar experience of long-term use of Apoquel. I’m not blaming Apoquel at this point, but after reading what it really does to a dog’s immune system I’m extremely skeptical. I wanted her to have happy golden years which did not happen. 

D. H. , California

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October 21, 2016

My six yr old mix breed took Apoquel for six months this summer. I didn’t want to give it to him as the prednisone worked very well last yr and he didn’t have to take very much. We had to use the Apoquel because he was scratching a lot and was about to have ACL surgery and couldn’t take the pred. He now has a tumor (just removed and sent for histopathology) on his neck that looked cancerous under my Vets microscope when she aspirated it. We will know more next week when the pathology report comes back. It was attached to the muscle so she couldn’t get margins in that area. I am very upset. I am not convinced that the Apoquel caused this tumor but I am quite certain that it exacerbated it. My husband found it three months ago and thought it was nothing and said nothing to me. He said it was about the size that it was when we had it removed. I found it three days before she took it off so I don’t know how much it grew or if it was there before we started the Apoquel. It was under the skin [] and kind of flat and wide so it didn’t show to the naked eye, only when felt. Chauncey has had no other side effects from the Apoquel and it worked very well. I will never use it again.

10/24/16
We received VERY GOOD news this morning from our Vet. Chauncey’s mass was a benign basal cell tumor which was completely removed. We are thrilled!

A.S. , Marquette, Michigan

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September 16, 2016

You asked for positive or negative feedback from users and I have some positive comments. We have an aged [] Cavalier King Charles Spaniel.[] Recently, after trying antihistamines, corticosteroids, Temaril-P, and various medicated shampoos, all to no avail, our vet has put him on Apoquel. He has been taking one to two 5 mg. pills most days for several months with no side effects whatsoever so far. Perhaps the most amazing thing is — that much of his itching/scratching seem[ed] to be neurological rather than allergy and yet Apoquel works, it works fast, and it keeps him comfortable. It has been a miracle drug for him and us.[] Whatever we can do for this little guy who has been through so much to make his life more comfortable is worth the risk of side-effects, of lowered immune system and so forth at this late stage in his life. He is a happy, loved dog, and every day is precious for him.  Sincerely,

Judge A.G. , Ft. Worth, Texas

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September 3, 2016

My dog, Moby, is a 2 year old cross-breed rescue dog []. He showed inflammation and increased itchiness, especially in summer. Our local vet gave him steroids and that calmed it down, but I was concerned about long term usage. She switched to Apoquel and claimed it was a wonder drug vets couldn’t keep in stock as it was so successful. Moby began his course and it worked a treat. No redness. No itching. A happy dog. Then he started showing signs of discomfort walking. I checked his paws and they were riddled with warts. At least ten on each paw. They bled when he walked and he became unwilling to walk. His toes also flared up red. [] I turned to the vet to help and she didn’t agree that they were warts as “he was too old”. She gave me Imaverol® [enilconazole] to treat a “fungal infection” on his toes and “ringworm” that appeared on his leg. She also prescribed antibiotics and wants to treat him for parasites (scabies). He had no signs of fungus or parasites previously. I took him back to the vet and insisted she look at the warts. She did and agreed with a glance that they definitely WERE warts. He tries, every day, to walk but can only manage 200 meters or so. I carry him home. I stopped the Apoquel at the first signs of problems.The itch is the least of his problems now. My vet claims he is “unlucky” to have reacted so badly and that the fungal infections are coincidental. I don’t buy this.

D.S. , Dublin, Ireland

Six days after sending me the above email, the owner reported that since discontinuing the Apoquel, the warts were shrinking, the possible “ringworm” was gone and the dog was walking normally. Two weeks after that, he informed me that veterinarians at the vet school in Dublin had decided that the problem was demodectic mange which, they believed, was activated by the Apoquel. After two Bravecto (fluralaner) treatments, the mange problem was on the way to resolution and Moby’s feet had returned to normal.

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May 31, 2016

We had an adopted beagle, Cooper,[about 6 years old]. We had him for 4 years. He had allergy problems for much of his life. We took him to 4 vets with four different treatments. The last sent him home with Apoquel. That was May 9, 2016. His raw skin calmed down [] and his itched [got better]. We thought we were on the road to [recovery]v. Then around May 27th 2016 he wasn’t as hungry as he normally was, he would drink water [] but his appetite diminished drastically. Late on Day 2 he was drinking water and then vomiting, his nose was running. He still seemed alert and content. We just thought it was [the weather] change we were experiencing. Later that night he got sluggish and tired and he went to bed. He had been outside earlier in the day doing his normal howling and Beagle barking in the yard. By day 3 he looked as if he had aged 10 years overnight. He was able to walk, but wobbled. He tried to drink a little water, but couldn’t really manage. He had bright green loose stool. My wife got him [to the vet] at 10 am on May 30th, By 12 pm [we agreed to have him] put down. His liver [had failed] and his spleen was enlarged and his bloodwork wasn’t good.
S.C. , Egg Harbor Township, NJ

I try to publish all emails that pet owners send to me regarding Apoquel without putting a spin on them. This last email was upsetting to me because of the owner’s obvious grief. So I exchanged a series of emails with him and explained that with the information at hand, there was really no way of knowing if Apoquel played a part in this dog’s crisis. The human ‘sister’ medication to Apoquel, Xeljanz, has an FDA warning that it can cause or exacerbate liver disease. But this dog had also been given cefpodoxime, a cephalosporin antibiotic. On extremely rare occasions, that group of antibiotics have also caused liver failure. However, Cooper had received another cephalosporin on a prior occasion without problems. We also cannot know what other undiagnosed health issues this dog might have faced.

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May 31, 2016

I meant to update you at the end of last year. We used Apoquel again, starting when our dog’s itchiness started (end of July) and ending at the beginning of December (after hard frosts). We only did a 7-day loading dose instead of 14 days.[] Again the effect was quick and amazing with no side effects. His itchiness wasn’t eliminated completely, but he was overall pretty normal and happy. He still got weekly baths and we wiped him down after he went outside, but he didn’t chew/rub any skin raw or need his comfy cone. He stayed fluffy all season (his tummy was almost bare when we adopted him due to his scratching and rubbing). Our veterinarian is thrilled with how well he’s doing.

Sarah, ….Madison, WI

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May 24, 2016

I just read your article online about Apoquel. My dog has been through everything including environmental changes, skin and blood tests, diet restriction and reintroduction. She has tried Atopica tabs, steroid creams, sprays and potions. After a particularly nasty flare up recently, the vet recommended Apoquel – 14 days at half tab twice daily and then 14 days half tab daily. It made her better! She finished the tabs about 2 days ago and the telltale itching is already [reduced to] a bearable level, sore toes and itchy eyes have [stopped]. [] I’d prefer my dog to live a shorter happier life than an uncomfortable longer one with suffering. I’ll be calling the vets tomorrow for some more tabs!

E.J.

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May 16, 2016

I came across your page back in July, 2015 to review Apoquel]. My dog Boo had really bad allergies and would get yeast infections. So we placed her on [it]. She was on Apoquel for 5 months. Everyday she would take one. But her yeast infection would always come back. Towards the end of her 5th month, she started to get sick. She wouldn’t eat and she would throw up bile. I noticed when I took her off the meds she got better. We decided to see a allergy specialist [] because I couldn’t see her taken a pill every day and becoming sick. I also didn’t want to risk her getting a cyst even thought her vet said it’s rare. In the 6th month, the allergy Dr. placed her back on Apoquel for a couple of weeks. She started to get sick again, so we stopped the medicine and started giving her allergy shots. This time she didn’t get better when we removed the Apoquel. We did several test to figure out why she was sick. [] We visited 3 vets and finally the last one decided to do an endoscopy. She had a tumor in her belly and would have needed surgery to remove part of her stomach. We put her down [] because even with surgery she only had a couple of months to live. The surgeon said it was most likely because of the Apoquel since she was on that when she first started getting sick but he had no proof. [] She was a 5 year old dachshund-yorkie mix.

Amanda L.B. , Plano, TX

I reviewed Boo’ s records. As is often the case, it can be very difficult to know if a medication causes a disease, compounds a pre-existing disease or just happens to be given when an unrelated problem occurs. It is only over time that trends and links become apparent. Apoquel is oclacitinib. Xeljanz, a similar human medication, is tofacitinib. Through 2015, there is no evidence that Xeljanz increases the risk of cancer. ( read here )

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May 10, 2016

I wanted to share our story with Apoquel use in our dog, a 6 year old, male, bull terrier mix. He has been on Apoquel for approximately 3 months due to chronic atopic dermatitis, yeast infections and secondary skin infections from scratching his skin open. We had tried many, many different options – multiple protein changes with his food, gluten free, potato free, etc…, different shampoos specifically for atopic dermatitis, yogurt, vinegar and peroxide mixes on the feet, fragrance and dye-free detergents, [cortico]steroids, antibiotics, Benadryl, Zyrtec, nothing worked. The [cortico]steroids helped, but each time he was on them, he had an injury to his CCL [knee cruciate ligament], and as soon as he stopped, the itching returned. And he scratched constantly, everywhere, and his skin pigment was darkening. So we tried Apoquel on recommendation from our vet. The itching stopped the first day on it. He took 2 pills a day for 14 days, then a 16 mg pill once a day. Fur grew back, his skin looked healthier, but I noticed he had a growth in the muscle of his front leg after 2 months on it. It hasn’t gotten any bigger and is about the size of a pea. And then a toe swelled on his front paw. I initially thought he injured it somehow. After a week and a half, the swelling went away and he seemed fine. Then just a few days ago, a toe on one of his hind legs swelled so large that the skin broke open and bled. The entire foot swelled. I immediately suspected the Apoquel and stopped giving it to him. I called the vet and scheduled an appt. She fully agreed that it was due to the Apoquel. His foot has multiple cysts. He is now on antibiotics [] He is finally starting to put weight on it after being off the Apoquel for almost 3 days. I would rather have him scratch and keep looking for something that will help him than have him ever on this drug again. He was in terrible pain and couldn’t even stand. What seemed like a miracle at first surely was not. I think this drug is good for very short term use, no longer than a month, but is definitely no cure for allergies. Our vet has shared this side effect with Zoetis and the FDA. 

H.S., Palmerton, PA

Sent from my iPad

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April 18, 2016

I [] have a six year old terrier/lab mix — about 50 pounds. He [has] suffered from allergies since we adopted him at 8 months. We’ve done the usual [ things]: limited ingredient foods, bath once a week with medicated shampoo, he had allergy testing and shots a few years ago. We try to keep him out of dog parks with grass and away from what really bothers him. We dip his feet in water EVERY time we come in from outside. [] He has been on alternating rounds of antibiotics,steroids and benadryl. Then we tried Apoquel — we noticed a change in the first week. He no longer fussed over his feet []. His hair stopped falling out and his coat grew thicker. His usual issue [before Apoquel] was infection — lots of round, red, hivey looking spots, which would then turn flaky, and lead to hair loss. No more infections since he’s been on [Apoquel]. [] He has been on it about 3 months now. 2x/day at first, now 1x/day.
He had a small growth on his leg long before the apoquel — the vet said it was a wart and not a cause for concern. But since putting him on this medicine, it has grown pretty fast – from the size of a nail head to the size of a dime. We’ve had it tested, It’s benign, but the vet thought it was infected (the dog licks at it constantly). He’s on antibiotics to see if that helps, but we will probably have to have it removed. He also has a small growth on the outside of his upper lip that’s new. [It came up] within the last couple of weeks. I’m thinking it’s Apoquel related. Behavior-wise, we’ve noticed him be a little more ‘amped up’ … he’s barkier toward other dogs (which he wasn’t when he was on steroids). Maybe related, maybe not. Hard to know or prove. Overall, I believe the quality of his life is better due to the reduction in itchiness. But I am concerned about the growths on his leg and lip and how that will ultimately affect [him].

P.D. , San Francisco

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March 24, 2016

I have a 5 year old American bull dog X. She weighs 38# []. She has been on Apoquel since June 2015 – 5.4 mg – 1 1/2 pills [] per day. Within the last 6 mths we have cut her back to 1 pill daily and we split it morning and night. [] Although we have cut her back [] she still itches, but I believe at a level that acceptable. Just within the last week I noticed some warts around her eyes. I seen where you had posted something about warts and infections being a problem. She also has severe problems with infections between your toes constant[ly] reoccurring not so much within the last three months but up until then quite frequently.
Also most recently she seems to be very fearful of things and more insecure, she’s been laying in places in the house that she never has before? I don’t know if any of these are due to this medication or not.

Sincerely, K.B.
Sent from my iPad

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March 15, 2016

We have a 4 yr old shiba inu who has been on apoquel for 2 years. He constantly chewed on his feet and up his legs. Our vet recommended Apoquel, and it has completely stopped the chewing. His fur grew back, and he looks great. We have noticed no side effects at all. He is on 5.4 mg a day. We tried cutting the dosage in half, but within 48 hrs, he was back to the chewing. He is a very happy and active pup.
L.H.
Laguna Niguel, CA
Sent from my iPad

Thank you for that information. I will post it without your name on my website. As with all things, people tend to respond online when things do not go as they anticipated. So I am sure my comments page has more negative responses than positive ones. That is why I value your information on the success of Apoquel in your pet so much. RSH

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February 23, 2016

My [12 year old male Shiba Inu, Fox] started off on a pretty high dose of 16 mg [Apoquel], and then we tapered down to 8 mg, and finally 4 mg as a maintenance dose. Occasionally, when his allergies start to act up a bit we might bump up his dose to 8 mg for a couple days, but then taper back to the 4 mg.[] Fox did develop a small tumor in the brisket area under his right front leg that had to be removed. [] I can’t help but wonder if maybe the Apoquel was the cause. Another thing that has happened much more frequently on Apoquel is ear infections. (one of the most common side effects of Pfizer’s “sister” human medication, Xeljanz is nasal and sinus infections) Fox has never had an ear infection in his entire life, but the past year we’ve had two pretty bad ear infections, all while on Apoquel. The last thing that I have noticed with Fox is that his personality has really perked up. He’s always been a bouncy happy guy, but this past year he’s just had a renewed spirit and has really returned to his younger days. I love him so much and I want to make sure that his final years are spent enjoying his couch potato status and not spent chewing the fur off of his paws. His fur is so full, soft, and fluffy, something that has been missing for years. Even though he’s an old man he looks and acts so much younger. For anyone who may be on the fence with this medication, please let them know to give it a try and do please share our success story with others.

C.C.

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February 14, 2016

Dear Dr. Hines – In 2011 I lost my entire family [ ]- I only have my female Cocker and she takes 8 mg. Apoquel sometimes up to one every 12 hours (BID) – I really don’t want to lose her prematurely – she is the last vestige I have of any family. I read where you said that Apoquel shortens a dog’s life span. Are we talking months or years – She is 9 1/2 years old and 24 pounds – She has been on Apoquel for nearly 2 years and it has solved her constant scratching problem. I also read that the dosage for her weight should be 5-6 mg. Please let me know what you think with regard to life span and dosage.
Thank You, P.D. Wilmington, NC

Dear Dr. D.,
I can not tell you that taking Apoquel will shorten your dog’s life. What I was attempting to say was that the long-term side effects and consequences of tinkering with the immune system in that way are unknown. Apoquel turns down the volume of the immune system regarding many things. One of them is a positive thing, it turns down the volume or intensity of immune systems that have mistakenly identify harmless things in your dog’s environment as potential threats. However, the drug affects other positive aspects of the pet’s immune system as well. It comes down to this. You love your dog. Is it more important that its days be happy or that its life might be longer (perhaps but uncertainly so) if it was not taking this medication? Compare it to people who have had a kidney transplant. Other than the very rare “perfect” match, that person must take drugs that also turn down the volume and intensity of their immune system in order to prevent organ rejection. The drugs that person must take also turn down the intensity of the entire immune system. But people generally make the decision that that risk is worth taking because they want to live a more pleasant life – whatever length God grants them. Every year the enormous complexity of the immune system becomes more apparent to us. I pin my hopes on the Broad Institute and their pioneering work on gene editing. It is in its infancy, but I have faith that some day we will be able to edit out immune system errors with something similar. Broad has a particular interest in the genomes of dogs and cats and their health problems since they are so similar to ours.

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January 27, 2016

Hi I am getting back with you, as promised. Took my 7 y/o female cockapoo off of Apoquel about 3 wks ago. She had been taking it daily for several months for chronic dermatitis, and ear infection. The medication did not help her skin allergies, but did well to keep her ears clear. Off of the meds for 3 wks, I have noticed signs of a brewing ear infection . ..redness, and slight inflammation. Since this problem is chronic, I have decided to treat her ears prophylactically with an otic solution. I don’t like what I have read about long term use side affects of apoquel, and, since is so new on the market with small population studies, I have decided that the benefit does not outweigh the cost of harmful affects on her overall health.

M.J.
Edgewood, KY

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December 31, 2015

My 5 year old Havanese suffers from what began as a seasonal allergy in the fall and seems to now have become an all year problem. She weighs 14 pounds and was prescribed 5.4 mg pills. The first 2 weeks she got half a pill twice a day. But when I switched to the maintenance dosage, the itching returned. I find that giving her one whole 5.4 pill every day is effective, but I am worried about over dosing. She has now been taking it for more than a year. By the way, I notice that her tear stains returned when I decreased her Apoquel dosage. Thought you might like to know.
Sent from my iPad
Joan, NYC

With any medicine, the standard suggested dose is what the Company believes is an average effective dose. There will be dogs that require less than that, those that require more and some may require the medication more frequently than others. Zoetis, the FDA and the EMA suggest a long-term dose of 0.18 to 0.27 mg/lb body weight per day (0.4 to 0.6 mg/kg body weight). The first thing to do when a drug does not live up to expectations is to be sure the dog is not receiving less than that. Apoquel was tested using a relatively small number of healthy beagles. There are purely physical reasons why one dog may absorb more of a drug than another. Apoquel was designed to be absorbed through the small intestine where acidity is normally lower. Perhaps some dogs have higher intestinal acidity than others. The medication has an enteric coating – perhaps some dogs dissolve that better than others. Apoquel is only at high levels in your pet’s blood stream for 4.1 hours. Although the Company does not recommend it, perhaps some dogs would do better if the total daily dose was divided into a morning and evening portion. Apoquel is eliminated from the pet’s body through its urine (kidneys) feces and bile (in that order). Perhaps some dogs are more efficient at that than others.
When any medication must be used at a higher-than-average dose to control a disease, increased monitoring and watchfulness is always a good idea. That can be hard with medications that influence complex processes like Apoquel. But any increase in skin tags/warts (dermal papillomas), respiratory infections, skin infections or other infections, or changes in your pets white blood cell count and differential count might be an early warning that the dose is too high. So would the development of infections between the toes (interdigital cysts), diarrhea and soft stools or increased susceptibility to giardia or coccidia infections. A decrease in the pet’s blood albumin and/or globulin levels might also be a warning that the dose is excessive. 

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December 18, 2015

I have a 5 year old chocolate lab. She has had extreme itching and feet chewing for 4 years. Nothing helped her until Apoquel. She did have serum allergy testing and has been on allergy shots/serum for 3 years for many environmental allergies. She also has many food allergies with frequent ear infections. She had immediate itch relief with the first dose of Apoquel. I find that 1/2 tab only lasts about 8-10 hours and so most days I have to give her 1/2 tab every 8-10 hours. My concern is that extra dose she is getting and if I am hurting her in anyway. Her blood tests have been normal to date. She has been on Apoquel for 2 years and so far I have seen no side effects. I care more about the quality of her life than the quantity at this point as she is absolutely miserable without Apoquel.

K.S.@hotmail.com

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December 12, 2015

We have a five-year-old boxer bitch (weight about 30 kg) that developed severe atopic dermatitis when only a few months old. She was treated with all the usual meds (steroids, Atopica, desensitization plus numerous topical lotions and creams). She scratched badly all year round, developing a scarred face, swollen and raw paws and clearly was not enjoying life. Then Apoquel appeared, which gave welcome relief, when available, but we went through lengthy periods of rationing and consequent relapses in her symptoms. For the past three months supply has been plentiful and she has been on 32 mg per day. It has completely transformed her life. Her scarring has healed, her paws are normal, but most of all she is now a lively playful dog again. Her quality of life is so much improved that even if the treatment shortens her life, we could live with that. She is regularly monitored for suspect lumps, of course.

J.G., Nottinghamshire UK

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October 14, 2015

Insights of a Physician and his Dog [edited for non-medical readers]

My dog: A Miniature Schnauzer
Its age:10 years
Positive benefit of Apoquel: Excellent for a few months, then diminishing observed benefit. Has used the medication for more than 1 year.
Potential adverse effects:
1. rapid growth of a nodule on his left shoulder, excised [removed].
Pathology report: Hemangiopericytoma tumor
2. Six months later: Progressive growth of a previously noted soft, cyst-like 1.5 cm mass on left lower chest wall, into a firm, inflamed mass 3.5 x 2 cm mass. Surgically excised.
Pathology Report: Grade 3 Mast cell tumor with positive margins, not fully resectable without rib resection.
Comment:
We stopped the Apoquel when we began prednisone [to treat] the mastocytoma.
His itching is more or less under control. We can’t be certain if that is because of the prednisone [he is on now], which did not work before, if is working now because of his prior Apoquel use or if it is because of a possible reduction in histamine, or other other inflammatory mediators with significant debulking [removing most of] of the mast cell tumor. Prior cetirizine and diphenhydramine [antihistamines] were also of little benefit for his itching, but did allow him to sleep.
Granted, mast cell tumors are common, so its occurrence may be just be a coincidence, though the growth rate of the mast cell tumor seemed very rapid, after being a soft cystic structure for years.

We are just waiting for the symptoms of metastatic or invasive disease, then we will do the appropriate next step quickly, as we do not want to see any creature, anywhere, at any time in distress. Yes, the decision to use Apoquel was for that same purpose…to relieve discomfort.
Though our single experience does not establish a causal link, we hope it at least gives one more weak nudge to researchers to further question side effect profiles of all meds, especially immune modulators, before coming to market.

If I had to do it over, based on this one experience, I would exhaust all other measures before I gave Apoquel, and use that as a last resort only. I would also give it as a pulsed treatment…..maximum 1 month (nothing scientific to base that on), and do a thorough exam, possibly labs (as suggested in another user’s comments), and wait several months before another brief course – if needed. For now, that is the current practice used for treating humans with a variety of immune modulating drugs.

M.V. MD, Birmingham AL

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October 2, 2015

Hi- thanks for the very valuable information about the drug Apoquel. My vet prescribed it for my shitzu, who had been unresponsive to other medications for his incessant itching. At the point of prescribing, the poor dog had itched out swaths of fur and actually all fur on his neck and tail.
The vet put him on Apoquel 5.4 mg daily (halved for a.m. And p.m. Dosing). While he was on it, it was a miracle drug. My very itchy dog (all seasons, all day, and we had tried everything from foods, antihistamines, and steroids and topical creams and shampoos) completely stopped itching and licking his paws, and his fur started to grow back. It was a blissful 2 weeks for everyone.
Now she has pared him back to 1/2 dose daily, but he has started itching, licking, and chewing. I’m taking him in for a vet check and hope he can go back to a full dose daily. For a 10 year old dog who has suffered for so many years, the medication is a godsend. He has a quality of life now he hasn’t had in years.

Thanks for posting what you learn. I’ll post a result later as well if he is able to stay on it.
Amy
Sent from mobile

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September 1, 2015

Our dog, an American Hairless Terrier, had severe food allergies and skin allergies. We did all the testing for allergies and the [desensitization] shots – nothing worked. Our Vet recommended using Apoquel, we did and followed the suggestions for doubling up on the pill dose, twice a day for two weeks; then went down to once a day. It seemed to [be] working until we went to once a day and [then] the itching started back. We then took our dog to a veterinary dermatologist for testing. We were told to keep the dog on Apoquel, but because he was in the upper thirty percentile [most difficult to treat successfully], he required the pill twice a day and [because of that we should] then do blood tests every six months.

We were about into the third month and our dog died today, we were told he had aspiration pneumonia and that his white blood count was severely low. I have no doubt that the Apoquel helped with the itching but am also convinced ……….. .
E.B.
Sent from my iPad

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June 25, 2015

Dear Dr. Hines,

This is my experience with Apoquel. I adopted my French Bulldog when he was a year and 7 months old. When I got him he was in a very poor state. Some of his symptoms appeared to be from allergies such as scratching resulting in hot spots, watery eyes, ear infections and chronic diarrhoea etc. When we moved onto a fish based diet the worst of the diarrhea stopped and he began putting on weight. The dog however was uncomfortable and we kept having incidences of him licking his feet to the point of them swelling up like balloons and scratching his face to the point of his jowls swelling up massively with nasty infections. We went through food trials and ended up on an an-allergenic [hypoallergenic] diet on which the symptoms continued eg. sporadic diarrhoea, scratching and skin infections. We then saw a dermatologist who conducted blood tests which revealed allergy to dust mites, storage mites and various trees. This explained the constant nature of his symptoms. We started him on 5.4mg per day of Apoquel (double in the first week) and the scratching was greatly reduced. Everything seemed to go well for 2 months until the dog once again had to be admitted to the vets with a skin infection to the folds of his face. Since then the vet took him off Apoquel and onto steroids every other day. Today we decided that we would try him again on Apoquel in the hope that it would be controlled enough to start immunotherapy to try to bring some relief. The long term effects I have read on this website are horrifying but we cant keep sprinting to the emergency vet every time he scratches himself and ends up with a massively swollen face from a horrible infection ):

E.H., Lecturer FMPE Department
Northbrook college, Worthington, UK

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June 20, 2015

Hi!
My 6 year old Boston Terrier was prescribed Apoquel and has been on it for exactly one week. I am definitely not an advocate of using drugs to treat side effects of a problem, but rather finding the root of the problem and fixing the cause. Allergies and skin issues have been a chronic problem his entire adult life. He has always been on high quality food and had consistent flea prevention. In an effort to eliminate his problems we went from Fromm Duck and Sweet potato (with some rice), to grain free Taste of the Wild (tried various protein sources), to grain free starch free Nutrisca, and now am feeding raw diet. Each was tried for several months. I have switched to dye free, fragrance free laundry detergent and have used various natural treatments (Apple cider vinegar, coconut oil with lavender oil, skin rescue lotion; and have also tried Benadryl and cortisone creams. He has definitely required his fair share of steroid treatments and antibiotics due to severity. We are at the end of week 1 and have seen vast improvements. He is no longer red, he no longer itches constantly (or really at all), and does not lick himself. While I am not a proponent of drug therapy, I feel such a sense of relief for my baby. I always felt so bad for him. I am interested in any of your thoughts, opinions, and suggestions in use of Apoquel as some of the risks are serious and quite concerning.
Thank you,
B. L. Sent from my iPad

Dear Ms L.,
I think you are doing the right thing. You already know that the things veterinarians offered before for allergic, itchy dogs rarely if ever solved the problem. These hypoallergenic diets only improve a tiny tiny percentage of itchy dogs and blood-based allergy tests are, in my opinion, close to worthless. Vets dispense them and companies profit from them because owners and their veterinarians are desperate to do something – anything! Please do not feel guilty about using this new medication. None of the alternatives have worked for your dog. Sure, there are probably risks in the long-term use of Apoquel. But there were health risks – probably just as severe – if your dog remained ill with the skin damage, infection and chronic immune system stimulation that itching causes. And the other drugs that could stop the itching, corticosteroids and cyclosporin, have as many or more potential side effects as Apoquel. With those drugs, the long-term side effects are already known because vets and human physicians have used them for years. With Apoquel, a new class of medication, we have not used it long enough to know. If your dog is happy now, that is the number one thing to concentrate on. The only medications that have no side effects are the worthless ones that have no benefits either.

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June 17, 2015

[excerpted for brevity]

Dr. Hines –

I have been working with many rescue dogs over the years with many forms of skin and allergy issues. We current have a surrendered 7.5 yr old [ ] Cocker [ ]. They had seen the McVet (they were banfielded) who had prescribed a bunch of expensive and useless medications. After a few years they could not go on with the costs and gave him up to our Cocker Rescue. [ ] We turned to a pet dermatologist in our area that works with our rescues to address his allergies. [ ] We started Apoquel in March and the change was DRAMATIC! His itching stopped in days. Now after a few months, he is a comfortable dog. He sleeps through the night. And other than pulsing ketoconazole to control the yeast, he is on only a 1/2 tablet of Apoquel daily [wt=35.2 lbs]. His coat has cleared up and all the staining is gone. And a dry eye issues I had not mentioned that was treated with Optimmune® is now discontinued as his tears production is normal in both eyes. And no more ear infections either. I am convinced all those pluses (good eyes, ears, fur) is due to resolving all the skin issues. I only wish Apoquel would have been in veterinary medicine chest YEARS ago.

C. Greater Minnesota Dog Rescuer

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June 6, 2015

We have a six year old German Shepherd who started itching / chewing at about age 2+. Feet and skin gradually became worse and worse. We tried all the usual treatments up to and including daily shots etc. Very early in 2014, our vet told us about Apoquel and we started with it then. The change has been something remarkable. His feet are completely healed up, and this coat which was always thin and washed out is remarkable. He now has a full coat with brilliant color. We are carefully monitoring him for side effects and have found none to date. He is active and happy. During a shortage of the drug in late 2014 we missed about 10 days. He started slowly with a little itching, a little chewing on his feet. As soon as we started his dosage again all of that stopped. This may not be the results everyone gets, but for D this has been a life saver, he is one happy, active and good looking dog.

N.F., Sylmar, CA

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May 16, 2015

Our 5 year old female bichon frise has had allergies for couple of years. The vet put here on steroids that worked until she developed diabetes 3 months ago. We have been struggling with trying every know allergy medicine to no avail. We were waiting for the release of Apoquel to our vet and now, after considering putting her down many times, after 3 days using Apoquel we are seeing a great change back to nearly normal. So far we are very happy with the results. We would have never imagined to see a change so [quickly].

20841@messaging.sprintpcs.com

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May 14, 2015

[Abbreviated]
In May 2014 my 7 yo lab developed itching that was not normal for her. We had just came up from Florida for the winter and we spend our summers in Missouri. My vet said it was the allergies in MO and offered us Apoquel which was wonderful, I could touch her back within a few hours. Unfortunately after the 2 weeks of 2 pills per day I was told that’s all we could get. I was on the fence about switching vets and eventually went to another recommended [vet] after a couple months of the scratching, biting, sores and bleeding. To my surprise this vet had Apoquel and was willing to give me enough to get me to Florida in October 2014 [ ]. 2 days after arriving in Fl and no more Apoquel she started right up again! She did receive 3 steroid shots over the winter which helped less each time [ ]. To make a long story short after spending $1,000s at our vets and hours on line researching food, allergies, yeast infections (which she had a bad one) and holistics I have to come to the conclusion that she is sensitive to Lamb, Chicken, all grains, all potatoes and krill oil. [ ] I was at my wits end and tried to figure it out, even sent in a sensitivity test with her saliva and hair! I called my Vet in MO and now that he had Apoquel again he gladly sent me a bottle, my Vet in Fl still can not get it. Within 6 hours I could touch her again without her going into spasms and scratching. We are only a week into the first 2 weeks and just got back to MO. Immediately she’s got one spot behind her front shoulder she’s scratching, but in all she’s a different dog meaning happy and energetic like she used to be. I hope this works and maybe after a couple months I’ll take her off [ ]. I will be aware of the long term use after reading your article but am hoping this can get us into a better situation!

K.S., Key West & Missouri ……………..Sent from Windows Mail

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May 13, 2015

Dear Doctor Hines

[abbreviated]

Our Cockapoo, Mollie is twenty months [old]. When Mollie was about six months [old], she began itching her paws. We thought it could be mites and used an alternative produce called Canker. However, this didn’t work so we went back to the vets. [ ] The vets did a swab test of her paws and found her to be very yeasty. The prescribed Malaseb shampoo and to try to avoid ‘polleny’ areas. [ ] We returned to the vets because her paws were really sore and she was getting pretty distressed about it. I think at this point they gave her a steroid shot to see if the skin would calm and we would continue with Malaseb and trying to manage it topically as we were reluctant to use long term steroids. We began to explore many other kinds of alternative medicine, such as coconut oil, grain free food, turmeric, and some others I can’t remember. [] The results did not show [improvement] in anything[]. She then went on a short course of oral steroids and we were recommended a homeopathic tablet as well continued use of Malaseb and now also Sebocalm, to build up a barrier on the skin. This didn’t work either and we were back at the vets. She went on steroids for the rest of the season. Whilst we were able to lower the dose, she wasn’t able to be sustained on half a tablet a day, she had to have at least one. [ ] We had also heard about Apoquel but this wasn’t available at that time. So we phased out the steroids in October, but Mollie’s itching returned with a vengeance and she even got an infection with her anal glands. The vets suggested Atopica and she also had another steroid shot to calm the skin. We were then sent to a specialist. [ ] She found that Mollie was quite yeasty. This has to be managed topically and it is often ineffective. [desensitization] serums, whilst they can be given were said to be ineffective. Allergy testing could reveal further allergies but the specialist said again, the effectiveness is low. She recommended changing her diet to Royal Canine even though she was sure the itching was not food related and gave up some hibiscrub infused wipes. [ ] But come January, after only a few months of improvement, it got much worse. It was at this time she was able to go on Apoquel. The results were immediate on two tablets a day for two weeks. But when we lowered the dose to the maintenance dose, the itching returned. Our vets suggested we build the dose up by a quarter of a tablet at a time. We tried to maintain her on one and a half but after about 8 hours on the half dose, the itching starts. [ ] As of the last three days, she is taking one tablet and three quarters. It’s the first time she has slept through the night since we’ve been back.

Lisa, Greater London, UK.

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May 7, 2015

Hello Ron,

The pattern we are seeing here at Tufts is that the incidence of cutaneous tumours seems to be higher than average in dogs that have been on Apoquel. There is no hard evidence to back this up, but this is our clinical suspicion and we are currently gathering data for analysis. In cases of histiocytomas, yes, they have regressed on their own once the Apoquel was discontinued.

Best,
Cummings School of Veterinary Medicine
North Grafton, Massachusetts

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May 6, 2015

Hi,

We began giving [Apoquel] to our mini dachshund a year ago. He is 12 years old, and had been itching so badly and biting his skin raw for the past 5 years that we felt we might need to put him down. The skin on his legs was puffy and baggy and encased in a thick layer of crust—or the parts of it that weren’t bleeding from his having bitten them raw. He would be constantly hot to the touch, and he would smell terribly within 12 hours after a bath. Needless to say, we tried everything, natural and unnatural. Any remedy we could find, we tried, with no luck. Prednisone would help for a bit, but only for a bit and it wouldn’t help that much. Atopica was a big waste of time. And good luck with all of the different shampoos with all of their amazing claims. We’ve tried them all. Apoquel has been a Godsend. The dog had no quality of life, and now he does. We hope it will keep working and we hope we don’t see any of the unfortunate side effects that would require to take him off of it. But so far, so good. The only issue we have is the $400 the dermatologist charges us every 3 months on top of the cost of the Apoquel. I wish I were kidding. None of our local vets can get it, in spite of the so-called freeing up of supply in April.
Paul, Corvallis, Oregon

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May 5, 2015

I have a 5 yr old black lab who has been on [Apoquel] for exactly one 1 year. About 3 months into the medicine, we noticed a lump on [his] neck. It appeared to [] get smaller- [at first, so] we thought it was just an irritated hair follicle. I am terrified to think the medicine we thought was a miracle drug- may have caused my dog / family member- to now suffer from cancer. My Vet is [] reaching out the distributor []. I guess I am just looking at your articles and hoping for some insight on the long term effects of Apoquel. I realize there have not been to many findings as the drug is new. However if there is any insight- or advice you can give. [] Even if it’s merely a little direction as to how I can approach the developers of Apoquel to get some real answers. I am not giving up on my dog – and I am determined to have him around for many many many more happy years.
Thank you for your time,
A. & W. Boston Massachusetts

Dear A.,
You have one of the most knowledgeable veterinarians in the World regarding Apoquel at Tufts University in Grafton. Her name is A. L. We have exchanged emails on the subject of tumors that have occurred subsequent to Apoquel. You can tell her I suggested her. She said that most resolve on their own when the drug is no longer given. But we don’t really know what that lump on W. is. It might just be an infection or some other process that may or may not be related to Apoquel. There is really not much more I can tell you without examining the dog. But lumps and lesions of many kinds often look the same superficially. What needs to be done is to have that lump biopsied. The biggest veterinary diagnostic laboratory in the USA is Antech Diagnostics.They charge me $95.45 (includes postage) for one of their pathologists to tell me what a lesion is. Let me know how things develop. RSH

4/24/16 update…..
Hi Ron,
W. went through the surgery like a true champion! I think I was more stressed than he was! The vet noted [], that this was one of the more difficult surgeries he had ever done – due to size, location-and because the mass had formed its own blood supply. He noted a large white “growth” that basically rooted itself inside his body. Although the vet urged me to do so – I opted not to have diagnostics done on the mass. As previously mentioned-I would not want to place W. on treatments that would effect the quality of his remaining life. His allergies are a battle alone. As curious as I am – I also do not want to know. As of today – its like I have my puppy back!

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April 27, 2015

Dr. Hines

Thank you for the extensive information regarding Apoquel.
My 11.5 year old Bichon Frise started on Apoquel a year ago. She has had severe itching since she was about a year old that began as seasonal but after only a couple years, progressed to year-round. She has tried everything except allergy testing. Some of the things we tried were food restrictions, Atopica, steroids – injections and pills, behavior modification, over-the-counter medications, topical medications, special shampoos and such, oil and nutritional supplements, etc. Steroids helped but the side effects were bad and we experienced horrible long-term side effects (Cushing’s disease) from steroids with our previous Bichon. I wanted to avoid that with this Bichon although she had already been on steroids for several years.In light of nothing else working, the severity of my dog’s allergies making her miserable, and the need to get her off steroids, Apoquel has been an answer to prayer. Her dosage begins to wear off before 24 hours, but I supplement with Benadryl or an OTC medicine to get her through the last few hours until it is time for her daily dose of Apoquel. So although she is on Apoquel long-term, I try to keep the dosage as low as possible. She takes half of a 5.4 mg tablet per day. For the first time in her life other than her first few months of puppyhood, my dog is not constantly scratching, nibbling and driving herself crazy with the itching. Nor is she drinking excessive amounts of water and constantly begging for more food as she did with the steroids. Her quality of life is worth the risks of Apoquel and I hope she continues to benefit from this medication without having side effects.

K.C., Claremore, Oklahoma

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April 18, 2015

My French Bulldog suffers from allergies and was scratching himself raw behind his front legs and chewing up his paws. We too tried many things including Atopica but they were either too strong to use for any length of time or caused a bad reaction… mostly throwing up, listlessness, and diarrhea. We switched his food to Kangaroo and oats which helped. Then we tried Apoquel. He has been on it for just about a year. He only needed 1/2 of the 5.6 (28 lbs). It was a miracle. No more scratching or biting and no side effects….until about a month ago. He started throwing up just about 10 hours after his pill. After 4 nights in a row we stopped giving him the medication (went back to Benadryl as needed). No more vomiting. So after a week we tried the Apoquel again and the vomiting came back. We are very sad that we have to discontinue the Apoquel after working so well for almost a year, especially at the beginning of his worst allergy season. The vet gave us a spray called Atop7 (basically all natural) and Muciprocin cream for bad breakouts (a mild antibiotic). These do help. Good luck to everyone else using Apoquel.
Ari is six and a male. We have had blood work done twice since he started and everything was fine. We will be trying a smaller dose and every other day. No diarrhea or change in weight. His appetite has always been good. I will write again in a few weeks after trying a different dose and at varied intervals.

C.B., Rhode Island
Sent from my iPad

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April 8, 2015

My chihuahua Peanut is 14 years old, and has always had skin allergies. We called her insistent foot licking “foot maintenance”, since she always licked her feet after a walk. Recently, it’s became really bad. She had some “hot spots” on her front legs that I just could not get her to stop licking and nibbling, even with baths, Benadryl, hydrocortisone, bitter sprays, bitter wraps. Nothing worked except the cone of shame and even then she would find something to scratch or lick. In the past, she would have a flare-up, and we would go to the vet for creams, lotions, and antibiotics to treat the resulting yeast and other skin infections.
I also have environmental allergies, and am old enough to remember life before Claritin™, and it SUCKED. Well, imagine my great delight when our yearly trip to the vet ended up with a bottle of Apoquel. She takes 1.8 mg daily. It worked almost immediately. Suddenly she can rest comfortably without jumping up to scratch, nibble, lick, etc. She is even playing a little! She’s resting on my lap as I type, a favored activity that she hasn’t been able to do for years. I’m so pleased, and happy for her. I hope we don’t see any of the possible immune issues. Hopefully she’ll be with me for several more itch-free years. Thank you for your very informative, evidence-based website. I so appreciate your references. I wouldn’t have known anything about this drug’s history or side effects without your website.

Best wishes,
Laurie and Peanut, Bellevue, WA

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April 5, 2014

Dr. Hines,

Our 6 yr old Shih Tzu, Figgy used Apoquel for about a year.We tried to take him off once, and he got a bad ear infection. The 2nd and last time we pulled him off of this drug was after we found a mass on him – which is cancerous (salivary gland)
We had the mass removed and now are starting radiation and hopefully we can stop it from spreading. I read similar findings about other young healthy dogs on other websites about this drug with similar result. After reading your site and others, how can this drug still be prescribed?

Also how come you only have positive posts on your feedback site. I find this unusual. Please post my experience with this drug on your website.

Sincerely,
S. R. Figgy’s Mom

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March 22, 2015

Hello Dr Hines,

My name is Lana and have a 9 years Maltese, Lexie. We have been fighting allergies and skin infections for about 8 years. Lexie has been on all kinds of treatments for the problem, cortisone shots, steroid shots and pills, shampoos, lotions, antibiotics, etc. Lexie is also one of the dogs who participated in the blind study of Apoquel in 2012. And she was the first dog that our vet prescribed it to once it became available in the fall of 2013. So, a year later, I think we have a big problem. She has been monitored all the time she has been on it, and every 6 mo’s they did blood work, and her liver enzymes gradually increased. Back in August of 2014, the levels were slightly elevated, in March of this year they are doubled. The vet suspected Cushing disease at this time and we have done all the tests and now it is confirmed that she has a tumor on her left adrenal gland (ultrasound showed that the left gland is twice bigger in size than the right one). And now we have no choice other than to go for a surgery to remove the gland. I am very unhappy and I am very concerned if this is will go ok for her, and if she can survive it, as I have read a lot about this procedure and know that this is a very delicate surgery to have… And I am not sure if this is what we should do at all. She does have some of the other symptoms of Cushing’s disease, such as in increase appetite and thin skin. She has repeated ear infections and stiffness in her body. She had an infection in her toe in January, something she never had before. I am so worried about my dog… [edited from non-native English]

Thanks,
L.S., Noblesville, Indiana

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March 17, 2015

My dog has had problems with itching, razoring off the hair on legs and feet and chewing until sores appear. He can do this in less than 10 minutes. He is an eight yr old Bearded Collie. It started with itching and diarrhea as a young dog less than 1 yr old. He came from Canada to the US, Florida. It has been seasonal and I had him tested and treated by holistic vet for years until now when they no longer make the homeopathic combos to treat his itching. He is now undergoing the allergy shots and taking Apoquel for a month. This is the time of year in Central Florida where our cars and anything outdoors is yellowish green with heavy pollen. We live in an area loaded with Oaks and that is something he particularly seems to react to. I’ve booted him on walks and wiped him down with wet cloth after being outside which helps some. He was living in a Cone of Shame for awhile in February as he razored all the hair off a back foot and the foot was very swollen from chewing on it. So far the Apoquel has made a new dog of him. Not restless at night as he used to be. Finally getting a good night sleep. I thought he was fatigued but actually he was more relaxed for the first time. He played and was excited when called for. It was amazing to see the results.
After reading your articles, I wouldn’t leave him on it , but give during peak pollen times if needed. Right now if I skip a night giving him the pill he starts scratching the next day, but not chewing. I think it’s quite remarkable and like you said he has more quality of life.

J.A., Winter Park Florida
Sent from my iPad

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March 2, 2015

Our 4 year old [] female spayed Llewellin Setter has been on Apoquel, prescribed by a canine dermatologist, since February 2014. We adopted the female setter in October 2013, when she was a little over 3 years old. [] She was in bad shape when we took her from an Iowa kill shelter. We thought it was fleas and immediately took her to our vet who found no parasites, did the normal topical sprays, multiple prednisone treatments and antibiotics for secondary infections. The dog was tearing herself apart. After two months we sought out a canine dermatologist who immediately told us the dog was in bad condition. [] The dog was so bad that she was put on Apoquel in Feb 2014 [] done to essentially save her. Apoquel had only been available a few months at that time. As other have said, it has been a miracle drug. Within an hour or so all itching, scratching and digging stopped. Antibiotics cleared her secondary skin infections. [] The dog went thru allergy testing and the results indicated numerous normal environmental suspects and several specific grass and tree allergies. She was on allergy shots for about 10 months with no real improvement seen when temporarily taken off the Apoquel. The dermatologist recently stopped her desensitization shots. Today she is on Apoquel and Revolution. So what we have to present covers a canine that has had 12 months of constant Apoquel, probably longer than most canines given the newness and availability of the drug.The dog has shown no side effects of the Apoquel. Her blood test have been normal, her weight, appetite, and digestion are fine. All her hair grew back and is in good condition. We are now entering that stage of concern over the long term effect of Apoquel, if any. [] There is no question that Apoquel is providing her with a high quality of life although after a year she still will start to itch after about 20-22 hours after she has had her daily dose. There are certain times during the past 12 months she shows itchiness more than others even being on the Apoquel. [] As you can tell, we are searching for improved solutions. She has regular care to watch for long term Apoquel issues, but the drug has probably saved her life.

E. and S., Lakeville, MN

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February 16, 2015

My 9 yr old bull terrier who weighs 46 lbs was prescribed Apoquel (16 mg) which she has been taking for a year. I get the Apoquel from Germany at a considerable cost because my vet gets it sporadically. I just learned through reading that the
recommended dose for Abigail is 8 mg and not 16. Her allergies are under control now and she no longer is miserable. She could not tolerate Atopica. We notice that her behavior is changing in the last 2 months. She no longer wants to eat at her usual place and appears fearful if we put her metal bowl in the stand where she ate for 9 years, so we moved her bowl into another room and stand next to her while she finishes. She will not finish her food if we just put the bowl down. She wanders around the house more ( she has always been a lap dog who sits close to us). She has been non aggressive her whole life but she now growls and barks more and is less tolerant of our other rescue, a 3 yr old female bull terrier and of other dogs in the park and visitors. She only gets Apoquel — I reduced the dose to 8 mg — so I believe that these must be side effects; is this something other owners have experienced? Abigail gets regular check-ups at Vet. Her temperature was elevated for a day or so but went down to normal. There is also a change in bowl movements. She no longer regularly defecates but needs to be coached. She grinds her anus into the ground before and after pooping but Vet cannot find reason. He prescribed a pill to increase bowl motility but I have not given it.

J.S., Central Florida

Sent from my iPad so never mind typos !

[Dear J.S., I can not tell you if these changes relate to Apoquel.The only way to determine that would be to discontinue the product for a period of time to see if these mood changes resolve.]

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February 6, 2015

Hi Dr. Hines –

I’ve been researching Apoquel and came across your very informative site, thank you! My elderly Scottie, Molly, developed itching that couldn’t be traced to anything, and eventually we tried Apoquel. Within 24 hours she was a different dog. After two weeks of 2 doses daily, we went to 1 dose daily. After the second month, the itching returned. i upped the dose to 2 x daily with no improvement, and now the itching is getting worse again. Since Apoquel is still in short supply, our vet has run out so Molly will be off it when this bottle runs out. I was wondering if anyone has reported any behavioral changes when their dog is on Apoquel? At first we just put her increasing mischievousness down to feeling better that she wasn’t itching, but she’s been off the charts goofy. She used to just sleep all day and be pretty laid-back barring the odd squirrel to chase, she’s almost 13 and not terribly active. But in the past couple months she’s been acting almost puppy like – she ate a whole stick of butter, got into a Christmas stocking and ate a giant block of cheese and a pound of chocolate (milk, fortunately, but still), she dug a hole and buried candy inside a houseplant. She got into the fireplace and hid something. I know these are all relatively normal dog behaviors, but she has NEVER done this kind of stuff. And she doesn’t do it when we’re
home, she definitely waits for the opportunity, it’s just weird, and the only thing that’s changed is the Apoquel. I’d love to hear if you’ve heard any similar stories.

All best,
K.M. Chicago, IL

[Through 4/6/15, there are no reports in the literature of any of this class of compounds affecting mood in humans]

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February 4, 2015

Dear Doctor,

Our mini-Schnauzer Curly has just been discharged after 4 days in the hospital. He was hospitalized due to a mysterious 105F fever, lack of appetite, huge papilloma lesions in his mouth, vomit,and abdominal pain. He has been on Apoquel for almost a year. It worked only in the beginning, and now it barely provides some mild relief to his itch; he chews his paws raw and no his face and legs and tummy itch a lot, too. Despite the potential side effects of Apoquel, we had to try it because the steroids, special diets and allergy shots have not worked. Curly is allergic to dust mites and all types of mites; the itch was becoming increasingly more severe, to the point that we started considering euthanasia. That’s when Apoquel came to the rescue, but at a price. For the first couple of months, Apoquel worked like a dream; he only needed one pill pill once a a week. Over time, Apoquel became less and less effective, requiring daily doses for the last 5 or six months; nowadays, such doses only provide a 40% relief -if any- so we have to supplement with Benadryl; all along, he has continued his Heska allergy shots once a week.

So here is our challenge: It seems that Apoquel has greatly contributed to weaken Curly’s immune system to the point that his platelets and also his red blood cell count is considerably low. At the same time, he is experiencing very little relief by taking it. The internist believes that continuing the Apoquel any further wreak havoc in his immune system, that we can only expect more papilloma lesions, further inflammation of his lymph nodes, lower platelet cell cell count and so on.

So, I thought you would like to know about our experience with sweet Curly, who is turning 3 years old this month .Apoquel provided him with awesome 100% itch relief for a few months, which resulted in a great quality of life, while it lasted. And now… I am beginning to plan Curly’s memorial, as things are not looking good for this little boy.

Thank you Apoquel for buying my dogs at least a few months of relief, so that he could enjoy his beloved park and his loving home.

G.M., Bothell, WA

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January 27, 2015

I want to first thank you for Apoquel. I went through allergy shots, antibiotics, prednisone, bacteria baths, etc. Roscoe was a rescue that was abused and abandoned. He has been on the 5.4 mg pill – weighs 19 pounds. If I lower it he starts eating his feet. He has a few skin tags since he started taking it and he smells of medicine. I am trying to slowly lower the meds just to see if he stops smelling, it might be to much for his system. His lower part of his body hurts when I wash him but I think that might be from the prednisone because it started before the Apoquel. Again thank you and I will get back to you if any change.

Thank you

J. R., Cleveland, Ohio

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January 27, 2015

I just read your article on Apoquel. My golden retriever mix, Lilly, has been on Apoquel for a year now. After suffering both food and seasonal allergies, this has been the only medication that has worked. Her energy is way up and she has hair on her feet now! I now don’t have to freak out if she does eat a piece of chicken or a grain on accident. She does not flare up within the hour with a rash and hives anymore. There is no reaction what so ever. We have had a very positive experience with Apoquel. It has improved the quality of life for my dog greatly. She has no health problems or symptoms caused by taking Apoquel. We went down the route after consultation with our vet of 4 years (was with us through the whole allergy process) and after our vet discussing this drug with specialists at Texas A&M University College of Veterinary Medicine and Biomedical Sciences.
She just turned 6 years old. She began having allergy issues around 1.5 and worsened as she got older.

E.E.M., Greater Chicago, Illinois

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January 21, 2015

My Maltese has been taking Apoquel since the end of summer 2014.

This medicine has been wonderful for her. She has not had an allergy break out since she has been taking the medicine. She has been a happier dog, not irritable, does not itch (the itching gave her knots in her fur), she seems to feel good. Before the Apoquel she had horrible break outs of sores. The sores would even be between her toes and made it painful to walk. The breakout would come on fairly quickly, mainly on her tummy, rear and feet. I am concerned about the long term effects, side effects and availability. If I change the veterinary she is currently going to will I be able to continue getting the medicine?

K.B.L., Littleton, Colorado

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January 16, 2015
Hi Doc,

I just read your excellent article on Apoquel and wanted to give you our experience. We have a black lab / mastiff mix dog that my wife and I rescued 5 1/2 years ago when he was about 3 1/2 (best guess). When we got him the only hair on his body was on his head and he had a smell you wouldn’t believe. We spent literally thousands of dollars to get him well, and, although his hair grew back, he itched constantly. By constantly I mean sometimes he would scratch 30 or 40 times per hour. The hair and skin in our house was unbelievable. No matter what we did the vets could not stop the itching (he was lastly on a combination of Wellactin and a steroid that I don’t remember the name of). We moved here (Wichita Falls, TX) from Hawaii and found a young vet at xxxxx xx xx (Doc xxxx) and she recommended Apoquel (started July, 2014). I must say, it has been a life changer for our dog Kodi. The very first day he literally stopped itching and has rarely (as in once a week maybe?) itched since. We did notice a few things that you brought up in your article: He developed a small “bubble” on his left hind leg (about the size of a quail egg) and Doc Lucy said she thought it might be cancerous tumor but we would need surgery and a biopsy to find out (more than we can spend at the moment, we’re honestly more than $6,000 into this dog as it is) and it didn’t seem to bother him much. He also had a sore (big, red and bled a bit; about the size of a large pea) on the bottom of his left rear foot, but that healed with a topical medicine and I’m not sure it was related (we were walking him on some concrete at the time). Lastly, he seems to have gained 5 lbs or so but, as he weighs 95 lbs when he looks perfect, at 100 lbs that’s not alarming – again, he’s half black lab and half mastiff so I think the mastiff side is manifested by his size. We can live with that. In any case, the Apoquel has certainly improved his quality of life. We’re worried that it may have shortened it some, but he’s happy now and he was miserable before. He’s coming up on 9 yrs old, getting a little white under the chin but still runs when he wants and has no limp. Our one year old loves to play with him and Kodi doesn’t seem to mind. We have hardwood floors and occasionally he slips a bit getting up or down, but I think that would happen anyway since there isn’t much to grip. Oh, and he doesn’t much like the UPS man…or anyone who rings the doorbell! In any case, I wanted to give you some feedback from our experience. Thanks again for writing the article and if you have any questions, please let us know. Thanks!

Lt Col x.x.x, Sheppard AFB, TX

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December 1, 2014

I have a mini long haired Dachshund who has been on Apoquel since june of 2014. I have been unable to sustain her on 1 dose a day. She has gained almost 3 pounds, and has become very yeasty and smelly. She also has pain going down stairs and playing. In reading about Xeljanz in an advertisement in a magazine, I noted that this drug is an immunosuppressant. Yes it works for the itching, but I am concerned about the changes in her health since taking this drug. I now question the efficacy of taking this drug and what to do to help her get back to good health again. HELP!

L.W., Vermont

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November 24, 2014

I came across your article on Apoquel while looking for information on the drug. There is very little out there, so I appreciate all of the info in your article. [abbreviated] We adopted our 6 year old Shiba Inu last February. We were told he was surrendered due to his previous owner’s inability to care for him due to her own medical problems, that he had food allergies, but that he was on a restricted diet and things were under control. [abbreviated] It is clear from his records that they could not get his allergies under control even with steroids, and every year things just got worse and he got harder to treat. He was on various antibiotics for skin infections due to licking/chewing, as well as drops for an eye infection.
He was doing great until the beginning of August, when we noticed him start to scratch more and rub his face on the carpet. I bought a comfy cone in case it got worse, and it got much worse. We tried baths and home remedies and OTC antihistamines without success. We put the cone on when he started damaging his feet and took him to the vet. She told us about Apoquel, and at that point it was already back ordered and scarce.But they had a stash of pills for larger breeds, so all we had to do was cut the pills into thirds and we would have enough to get us through allergy season. We were so lucky that our clinic had some of this drug, because it worked. Our vet called it a miracle drug, and it sure seems that way to us. She said we should start to see improvement within 4 hours, and her other patients had improved significantly in 24 hours. It was true. It was amazing how quickly it worked. We did the loading dose of two pills per day for 14 days, then once per day after that. We were told some dogs got itchier when going to once per day, but that didn’t happen with our dog. We stopped the Apoquel after we had days of freezing temperatures and snow with no significant warm-up in sight, so he was on it for just under 3 months. He was our vet’s first patient to go off the drug, and he was perfectly fine. He had no side effects while on it.

Next year we can start the Apoquel as soon as his allergies start.It will be his first summer in years that won’t end with a comfy cone and chewed up feet and sad, itchy dog. Are there potentially bad long-term side effects? Sure, but there are known bad long-term side effects for steroids and other options, steroids didn’t seem to be working for him anyway, and we were able to avoid the antibiotics he had needed in previous years. He was completely miserable. Who wants to live like that for 3 months each year? I would much rather he be happy and have a great quality of life now, and then we’ll deal with whatever problems may come if/when they come. [abbreviated] Please let me know if you have any questions. I have never seen a drug work so well with no apparent side effects. I don’t know how many dogs at our clinic are on Apoquel, but our vet said only one owner stopped it because it didn’t seem to be working, not because of any side effects.

S. H., Madison, WI

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October 8, 2014

For the past eight months my bichon has been taking 8mg daily of Apoquel. The drug has given my dog (four years old) a quality of life I never thought was possible. He also receives an allergy serum injection every ten days. However, for the past several weeks his nose has been running constantly and as of late he has been gurgling rather than breathing. Two days ago, his nose was bleeding. I stopped the Apoquel immediately and will see the allergist this week. Most importantly, two days after I stopped the Apoquel, his nose dried up, no more running and no more blood. I cannot help but assume that the Apoquel
was the cause of his misery. After I see the allergist I will send another post of his findings. I know the angst of an allergic pet and was so thankful for the relief Apoquel gave my dog – but now, who knows.
B., Charlotte, NC

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September 5, 2014

Apoquel works like nothing else we’ve tried. It is like magic – but
what it will do to him if he’s on it long term I may never truly know. 

M.W. , Charleston, SC

 Dear reader, Besides your donations, Visiting the products that Google chooses to display on this webpage helps me pay the cost of keeping this article on the Web. As you know, sites like mine that are not designed to make money are getting harder and harder to find. Best wishes, Ron Hines

  

Why Does My Dog Or My Cat Have Diarrhea?

Ron Hines DVM PhD

  Portal to all of Dr. Hines’ animal health care articles

   Portal to donation page for devices that don’t display it

  A chronic problem in your dog? or Your cat?

  Diarrhea in cats from Tritrichomonas + Giardia –  Ronidazole cures them

Parasites often cause diarrhea too. In Dogs here  –  In Cats here

Do not give reformulated kaopectate with bismuth subsalicylate to cats. 

Hopefully this article gives you a general outline of how  veterinarians might go about discovering the cause of diarrhea in your pet and some of the ways they might treat it. I can’t write about every possible cause of diarrhea, test or useful medication  – but many of the most important ones are here. Often my links to other articles go into greater detail.

Why Is Diarrhea Happening?

Anything other than a blockage that inflames or irritates the lining of your dog or your cat’s intestine is likely to cause diarrhea. When your pet’s body senses that something is in its intestine that shouldn’t be there, it tries to get it out as rapidly as possible. If it is high in your pet’s digestive tract the pet will vomit. If it is lower in the tract it will come out as watery stool (aka diarrhea).

How Might My Veterinarian Find The Cause Of My Pet’s Problem?

I am always delighted when a client actually brings me a sample of the mess that their pet has made. In more than half the cases, the diagnosis can be made from that fecal specimen and the pet’s history alone. Try to bring your vet a fresh specimen – no need for more than a few tablespoons full to examine under the microscope. But when one is searching for foreign objects the pet may have grazed on, I usually sift a much larger quantity through a sieve.

Because our furry patients can’t talk, the history that you provide to your veterinarian is extremely important. That is why it is important that the person who knows the pet best accompanies it to the vet’s office. Third hand information is never as good. The first question I often asked is whether this is a sudden acute problem or if it is chronic and has been going on quite a while. The next thing often asked is if you fed something unusual to your pet or if torn remnants of some household object were strewn about the house. Pets get bored, pets get anxious. And when they do, they often eat inappropriate things.

 Is This A High Intestinal Problem Or A Low Intestinal Problem?

First we need to get a general idea as to what part of your pet’s intestine is inflamed or has been irritated. Cases of diarrhea fall into two general groups in approximately equal numbers. In the first group, the problem is in the small intestine (the higher portion closer to the stomach where most food nutrients are absorbed). In the second group hypermotility of the large intestine (colon) is expelling feces before enough water has been extracted. High diarrheas tend to pose the most acute danger. Sometimes, the problem is a combination of both types.

When the problem is high in the small intestine your pet is likely to eliminate large amounts of stool, but the frequency of its bowl movements will not have increased that much. If there is blood in this stool, it will be chocolate-colored, not bright red. That is because enzymes in the digestive tract have had time to digest the blood. There won’t be much straining when those pets defecate. The stool in cases of high diarrhea is not thick, sticky or mucoid. Mucus is generally a sign of a lower irritation in the colon. Vomiting may also accompany high small intestinal problems. Your pet may also have a tummy ache. In the group of pets with lower intestinal problems, eliminations tend to be uncomfortable and urgent. When they go, the amount of stool is small and often covered with a mucus film. They tend to take a long time to poop and try several times. If the colon is inflamed enough, the stool may be coated with flecks of bright red or rust-colored blood. Pets that have eaten bones, sharp or gritty objects can have a mixture of diarrhea and constipation. The material passed is a combination of hard lumps and soft or watery stool. These pets often need laxatives or enemas to clean their digestive tract out.

 The Dehydration Problem:

This is the most serious complication of severe diarrhea. Severe diarrhea is most serious in very young, very old and very small pets. They can become severely dehydrated very quickly. Dehydration in small pets and frail elderly animals can be fatal because their surface area is large in proportion to their body weight. As dehydration progresses these pets have trouble maintaining their body temperature and may lapse into coma. Only the rapid infusion of intravenous fluid will save them. When the problem is minor, giving fluids such as Pedialyte™ is sufficient. When the dehydration is severe, the pet needs to be hospitalized and the fluids given by intravenous drip.

 Body Temperature

The body temperature of your dog or your cat should be about 101.5 F (38.6 C). In some cases of severe diarrhea and dehydration, their temperature will drop below 100 F (37.8 C). These pets need to be warmed. In fewer cases, their body temperature will go above 102. 6. F (39 C). These pets need to be cooled – or they need to receive medications to lower their body temperature. You can read about proper body temperature in dogs and cats here.

What Complications Might Occur?

Intestinal inflammation in young pets with diarrhea occasionally causes the intestines to thrash about so vigorously that the intestines tie themselves in knots (volvulus) or fold in upon themselves (intussusception). Both these conditions can be life-threatening.

 What Non-Specific Treatment Are Available To Me At Home When This Is A Minor Problem?

Diarrheas in dogs and cats that were caused by eating the wrong foods or transient stress often improve if you withhold food for 24 hours, confine the pet and perhaps give it an over-the-counter pet diarrhea remedy. These patent remedies (like kaopectate) are rarely required. The problem is that these transient, mild diarrhea cases can look quite the same as the early stages of considerably more serious cases. If your pet has had multiple cases of transient, mild diarrhea, you may have the confidence to make that decision yourself. But it is always safer to consult your veterinarian.

Diarrhea that contain blood, persists more than 24 hours or affect your pet’s general activity and perkiness needs the immediate attention of a veterinarian. So does diarrhea that rapidly dehydrates your pet. So does diarrhea in pets with other health issues. It is also more dangerous in the very young and the very old. When you visit your veterinarian, be sure to bring along several tablespoons full of the pet’s stool in a sealed baggie. I know this is an unpleasant task. But I often find the cause of the problem right away by passing the stool through a sieve or examining it under a microscope. Your veterinarian may be able to obtain a stool specimen directly from your pet, but it might not be enough for all the examinations that should be done. Wash your hands well – because some of the infectious causes of diarrhea can affect you too.

 Checking Your Pet’s Stool Specimen:

Depending on the history you give about your pet’s lifestyle, I often pass the material you brought through a kitchen strainer to hunt for objects such as chicken bone fragments, leaves, sticks, bug parts, glass, sand, Christmas tinsel, aluminum foil, etc. that are the source of the problem. Over the years, I have found every imaginable thing. In cats, sewing thread (sometimes with the needle still attached) is a common discovery. Vets or their technicians then prepare slides of the material to examine under the microscope. Some of these cases show a normal digestive process where food is being digested and absorbed. In others, fat globules are present, and protein particles are sharp – evidence of poor digestion. These are either cases of maldigestion or malabsorption. They can be due to a hypermotile intestine or the lack of normal liver and pancreatic enzymes. Some stool is abnormally light in color due to a lack of these enzymes. This can be a hint of liver, pancreatic or gall bladder disease. Other times common intestinal parasites or their eggs are visible under the microscope.

 What Are Some Of The Most Common Causes Of Diarrhea?

Pet Food Quality And Constituents

Buying that marked-down, generic brand of dog or cat chow instead of your regular name brand is a very common cause of diarrhea. Actually, any time you switch brands of food, a period of diarrhea is apt to occur. Quality costs money – when you go below a certain price, the quality of the ingredients suffer. The words “High Protein” mean very little. Feathers, hooves and beaks are all protein. But they are not digestible protein, and they will cause diarrhea. Once you find a brand of food your pet likes and does well on, stay with that one brand. Pets rarely if ever become “bored” with a quality food. Little companies that market their products through specialty stores have a hard time screening their ingredients or producing a product that does not vary from batch to batch. So, I generally suggest you feed your dog and cat a diet produced by a large company that makes other products that you trust – not one sold by your groomer, only online or by some other niche marketer.

 Overeating

Some dogs and many cats over-eat when they are fed just once a day. This can result in diarrhea, colic and vomiting. I suggest feeding dogs and cat with this problem three times a day or leaving the food where they can munch whenever they please. Just don’t let them become over weigh like these two.

 Foods That Don’t Agree With Your Pet

Some pets are intolerant to certain ingredients in pet foods. This can be beef, liver or chicken, preservatives, dyes and the like. Very few pets are actually allergic to pet food ingredients. You can try a diet made with different ingredients, or you can make your own at home. (read here)

 Stress

Some pets – toy dogs, nervous cats and ferrets in particular – vent their stress through their intestines. This can take the form of vomiting, refusal to eat, diarrhea or blood in the stool. After this occurs several times, owners usually draw the connection between events that upset the pet and bouts of diarrhea. These pets should be checked to be sure they are not suffering from Addison’s Disease.

 Dietary Indiscretions

The most common cause of diarrhea in dogs and ferrets (not so much in cats) is dietary indiscretions – the eating of garbage, grass, plant leaves, etc. It is amazing the things pets will eat! Many of these cases are actually separation anxiety cases where a panicky pet eats everything in sight. Placing these pets on a large dose of petrolatum-based cat laxative may help slide this material out with the stool. These pets need to be monitored carefully for seventy-two hours to be sure the intestine does not block. And they need to be confined in an area that can be easily cleaned up. I sometimes feed them art glitter and wait for it to come out the other end. At the first sign of abdominal distress, depression, general weakness, fever or blood in vomitus or stool, they should be rushed to a veterinarian for further testing. They also need immediate veterinary care if you suspect that they ate something dangerous or sharp.

 Diarrhea Caused By Medications And Chemicals:

Antibiotics

Many antibiotics and sulfas kill the normal, helpful bacteria in the pet’s intestine as well as the dangerous ones. There was a time when neither veterinarians nor physicians understood the importance of a healthy, diverse microbiome. We do now. When the normal bacterial flora of the intestine is destroyed diarrhea may result. This problem can occur with injected antibiotics as well as oral ones. Giving your pet yogurt or bacterial gel pastes, decreasing the antibiotic dose, or changing to a different antibiotic might all be helpful. But do not do any of those things without your veterinarian’s knowledge.

 Other Drugs From The Pharmacy As A Possible Cause:

Many medications that we dispense to your pet can cause diarrhea. Thyroid medication, NSAID drugs such as Rimadyl® and aspirin, worming medications, and topical insecticides are only a few of the many medications that can be responsible. Some pets are just sensitive to a particular medication or need a lower or less frequent dose. Others do better when a smaller dose of the medication is given – but more frequently.

 Diarrhea Caused By Parasites:

Intestinal Worms:

Hookworms, roundworms of dogs, roundworms of cats, whipworms and strongyloides are some of the common nematode parasites that cause diarrhea in dogs and cats. Read about them in dogs here,   in cats here. These organisms are the most common causes of diarrhea in puppies and kittens. They are also a threat to children who are accidentally exposed to your pet’s stool. You can read about these parasites and how I deal with them in other articles on my website. If there are enough parasites to cause diarrhea, their eggs or larva are usually seen when the stool is examined with a microscope.

 Protozoan Parasites:

Some protozoa are parasites. Protozoa are all single-celled microscopic organisms and some live as parasites of a pet’s intestines. Diarrhea is their primary sign. This group includes coccidia and giardia. We treat them with bland diets, sulfonamides and metronidazole. Giardia can cause similar problems in pet owners – particularly children.

 When diarrhea persists in your cat, despite giving worming medications, metronidazole and probiotics, your cat should be examined for Tritrichomonas foetus. This is particularly so if the cat was obtained from a shelter, group home, cattery or if what was thought to be a giardia or coccidiosis problem fails to respond to the usual medications. You can read more about Tritrichomonas in cats here. Diagnosing this problem requires a specific test (PCR, or InPouch tests) and a specific medication (ronidazole). You can read more about those procedures here. Tritrichomonas can cause similar issues in cats. (read here)

Diarrhea Caused By Viral Infections:

 Parvovirus Of Dogs

Parvovirus infection of dogs causes severe foul-smelling diarrhea. Mature dogs recover after a period of diarrhea, but the disease is often fatal in young unvaccinated pups or very small breeds. Parvovirus attacks the lining of the small intestine causing bloody diarrhea and vomiting. Dogs are severely depressed, dehydrated and in much pain. These pets die from fluid loss and shock, so most of my efforts aim at replacing these fluids. Parvo-infected dogs cannot keep oral fluids and medicines down, so I give our fluids and medications by injection. vaccinate puppies against. Read about parvovirus of dogs here.

 Panleukopenia Of Cats

This is another parvovirus that can cause similar symptoms to parvovirus in dogs. Read about feline panleukopenia in cats here.

  Coronavirus Of Cats

Feline enteric Coronavirus is highly contagious among cats but rarely fatal. The virus is shed in the feces of carrier cats causing erosion of the lining of the intestine. Recently weaned kitten have fever, vomiting and diarrhea that lasts 2-5 days. They lose their appetite. I treat them with fluids, antibiotics and medications to slow the diarrhea. This virus is widely dispersed among the domestic cat population of the world. It is the same virus that occasionally mutates into the much feared and dangerous FIP.

 Diarrhea Caused By Bacterial Infections:

Spoiled Food – Food Poisoning

 Spoiled food is often contaminated with toxins and bacteria that cause pets to have diarrhea and vomit. Food poisoning usually resolves itself after diarrhea purges the contaminated material from pet’s the body. That is why it is unwise to give these pets medications that prevent that diarrhea because that traps harmful bacteria and their toxins within the body. Just be sure the pet stays well hydrated to make up for the water lost to vomiting and diarrhea. The treatments for spoiled food and for eating toxic products are quite different. Two bacteria that are commonly involved in these cases are staphylococcus and Escherichia coli (E. coli). Dehydration is the most serious side effect of diarrhea and vomiting. Infant animals can quickly go into shock from dehydration. Threateningly low body temperature is also common in these infant animals. Products such as Pedialyte™ are excellent for preventing or correcting mild dehydration. But intravenous or subcutaneous fluids administered by your veterinarian can save the day when dehydration is severe.

 Salmonella And Campylobacter Bacteria In Dogs And Cats

Feeding poorly cooked meat products and chicken pass these unwanted bacteria to humans dogs and cats. As with all food poisonings, keeping your pet well hydrated during an episode is extremely important. In catteries, adult cats carrying salmonella often pass it to their kittens with sometimes fatal results. It can be quite difficult to get Salmonella out of a group of cats once the bacteria have become established in a cattery or cat colony. Batryl (enrofloxacin) has been an excellent drug to use in adult pets with diarrhea, but it must be used with caution in growing animals. Salmonella and campylobacter are my chief concern in feeding RAW diets to your dog or cat. That is why I do not recommend them. Read about salmonella in pets here.   Read about raw diets here. 

 Diarrhea In Cats Caused By Bartonella:

An organism call Bartonella has been implicated in chronic gastrointestinal infections in cats and occasionally dogs. Until recently, Bartonella was primarily associated with Cat Scratch Fever. Your veterinarian diagnoses a Bartonella infection using a sensitive laboratory PCR test. When a cat (or dog)  is positive for this organism it can usually be successfully treated using azithromycin, doxycycline or rifampin or a combination of them. Bartonella is spread by fleas. 

 Poorly Understood Causes (Idiopathic causes):

Inflammatory Bowel Disease (IBD)

Dogs and cats sometimes develop intestinal inflammations, diarrhea and vomiting for causes that are not always clear. For more information on Inflammatory Bowel Disease in your dog, go here. For more information on Inflammatory Bowel Disease in your cat, go here.

 Hemorrhagic Gastroenteritis Of Dogs

Toy breeds of dogs are susceptible to bloody diarrhea the cause of which remains unknown. No doubt many of these cases fall into other groups I have mentioned but were not diagnosed. Many of these cases were probably due to stress or stress was a compounding factor. Some emotional dogs exhibit stress through their intestines. In other dogs, the problem is probably undiagnosed Addison’s disease in which the body is deficient in cortisone production. Most of these cases respond well to IV fluids, food deprivation for 24-48 hours and then a gradual increasing amounts of bland diet fed. Many vets give these cases the oral corticosteroids, prednisolone or prednisone and place them on the metronidazole, sulfonamides or tylocin. These problems tend to reoccur in the pet from time to time. If they do reoccur, extensive blood tests are often required to get to the root cause of the problem.

 Eosinophilic Enteritis Of Cats

This is sometimes considered a type of eosinophilic complex of cats. It shares a lot of characteristics with inflammatory bowel disease of cats (IBD). The signs of eosinophilic enteritis are diarrhea, weight loss and vomiting. Some veterinarians suspect the problem is due to food allergies, others believe flea bite allergies are a cause. Cats with this problem often have elevated numbers of white blood cells called eosinophils. These cells are associated with allergic conditions in pets and people. Sometimes the skin is ulcerated as well or ulcers are present on the lips, tongue, mouth and toes. The disease responds to injections and oral forms of corticosteroids such as methylprednisolone acetate (“Depo”). The human birth control medication, Depopovera® (medroxyprogesterone acetate) also seems to relieve the problem temporarily. Moving the cat to a different home or environment and/or feeding bland diets also help bring the disease into remission in other cats. I have also seen the skin and oral forms of this disease disappear when fleas were eliminated from the cat and its environment.

 Lymphangiectasia Of Dogs

Sometimes called plasmacytic enteritis, this condition is diagnosed by a pathologist’s examination of snippets of the wall of the small intestine which are removed at surgery. Lymphangiectasia is an improperly formed intestinal lymphatic system, which results in protein being lost from the body (protein-loosing enteropathy). We think that in some cases the pets were born with this disease and in others they acquired it later in life. Most affected pets respond to a combination of bland diet and anti-inflammatory doses of corticosteroid drugs such as dexamethasone or prednisolone, but the disease is never completely cured. Diets you prepared at home can help. Read about them here. They should contain minimal amounts of fat with ample amounts of high-quality protein. 

Ferrets

Many of the issues I mentioned that can cause diarrhea in cats and in dogs can cause diarrhea in a pet ferret too. But the following two problems are most associated with ferrets and the cause or causes are still poorly understood. Ferrets appear to react through their digestive system to more of life’s stresses than dogs and cats do. Probably due to differences in their gut to brain axis. 

 Inflammatory Bowl Disease Or Ferrets

In this condition, the lining of the stomach and small intestine becomes inflamed and may also ulcerate. Some feel that this condition is a form of autoimmune disease – others that it is due to allergies to various ingredients in ferret diets (possibly chicken). Perhaps both can play a part. Ferrets with this condition pass frequent loose watery stools and may also vomit. They become very thin. Diagnosis of this condition is often made by elimination of other causes. Exact diagnosis can only be made from biopsies of the pet’s intestine, which may require surgery. Because the symptoms are quite similar to acute and chronic bacterial gastroenteritis of ferrets, stool samples need to be cultured for these bacteria. When these causes of similar disease have been eliminated, the ferrets usually improve on a regimen of amoxicillin, metronidazole (Flagyl®) and prednisolone. This disease is rarely cured, but it can be managed. I usually also put these pets on Pepto-Bismol® and Tagamet®. It is hard to put weight on them because food moves too rapidly through their intestines and much of the absorptive power of the intestinal lining has been lost. This is why additional vitamins help these pets.

During flare-ups, liquid diets such as AD® can be feed. Then, feeding one of the bland diets marketed for similar conditions in dogs and cats (i/d®, EN®, ZD®, etc.) often minimizes this problem. Bland diets marked for cats have sufficient protein, but those manufactured for dogs contain less than the optimal amount for ferrets. If dog products are used, I suggest that they be supplemented with vitamins, cooked egg whites and cottage cheese. Low intermittent oral doses of corticosteroids such as prednisone are also helpful.

 Acute Gastroenteritis of Ferrets

Several bacteria cause infections of the gastrointestinal tract of ferrets that appear as bloody diarrhea, vomiting and dehydration. Stress is often the precipitating factor in these conditions. Ferrets that vomit and pass fluid stools rapidly dehydrate. Dehydration can be fatal in these pets. The first thing I do is give the ferrets large doses of intravenous and subcutaneous fluid. (5% dextrose). I place them on injectable antibiotics, keep them warm and withhold all food and oral liquids. Bacteria most often associated with this problem are salmonella, helicobacter and campylobacter. Because diarrhea and vomission remove these bacteria and their toxins from the body I rarely attempt to lessen them. Instead, I replace the fluids and nutrients, as they are lost.