Dr. Angie (00:01.056)
Welcome back to Tails of Truth. I'm Dr. Angie, and this is my veterinary nurse JoJo. And this is where we tell the truth about veterinary medicine. And today we're going to be talking about itchy dogs. This is one of my favorite subjects, and I could talk for hours about this, but we're going to try to condense it down into some pretty good highlights. So if you have an itchy or allergic dog, this is going to be one you don't want to miss.

JoJo Smith (00:31.698)
I feel like we see more itchy dogs in the practice than anything else. Do think that's fair?

Dr. Angie (00:37.822)
I think that's true. And I think it's one area where people really shy away from traditional treatments because they feel like they're not really getting to the root cause of the disease and they're just suppressing symptoms. So I think most people that hire us are wanting to get more to the root cause. And I feel like we have a great system to do that and we see really great results.

JoJo Smith (01:05.766)
We do see really great results with this. And we see it near and far. It's not just patients that you see in Boulder. Like these are some that we see through telehealth that you're able to manage these cases.

Dr. Angie (01:15.33)
Yes.

Yes. And I want to start by saying there's so many holistic veterinarians out there that are selling supplements or gut healing protocols to people with itchy dogs. And for the most part, they just don't work. And I see so many people spinning their wheels thinking, if I just can add one more supplement on my dog's

guts going to heal and they're no longer going to be itchy and it just does not work like that.

JoJo Smith (01:52.178)
will tell me why the initial thought is there's something going on with my dog's gut because he if he's itchy and not not I mean my my non veterinary mind would go huh I wonder if she's in the grass I wonder if you know what she's allergic to like dust mites but you went to gut

Dr. Angie (02:00.449)
That's such a good question.

Dr. Angie (02:17.205)
Yes, well, I think in the alternative world, it's so easy for people to blame everything on gut health. And I understand why they do that because gut health is so important and influences every other system of the body. So I think it's important, but it's not necessarily the place to start or the only thing to blame.

And so I think people waste a lot of time and money trying to heal their dog's gut and they're not really addressing the root cause. And the immune system doesn't just live in the gut. And so just because your gut's perfect, doesn't mean your immune system is perfect too. It can be very overactive and you can have decent gut health. And some people are going to disagree with me. So that is definitely a hot take.

But I've tried, you know, when I was a baby vet and I just started doing Chinese medicine, a lot of the professors, teachers, people that were giving us this information about Chinese medicine were like, yeah, you can use these herbs to fix these allergies. And then I just did it over and over again and I did not see the results that I wanted.

JoJo Smith (03:37.81)
And it's really hard to keep practicing medicine in something that's not working

Dr. Angie (03:42.378)
It's really hard. People get really frustrated and they want to have their dog have symptom relief right away. And their dogs deserve that. And so over the last 18 years, I feel like I've created a really good system that helps get to the root cause, but also rescues dogs from their itchy state. I can't imagine being as itchy as they are. The worst.

JoJo Smith (04:03.73)
It's can't, right, it's gotta be the worst. One of the worst. Do you remember, this is a side note, we had a patient who had like an itch counter. Do you, like how many times they would scratch in a day and it had like a.

Dr. Angie (04:19.447)
Were they wearing it like a watch?

JoJo Smith (04:21.202)
It was something that they wore. I don't know exactly how it worked. We never actually got to see it, but she's like, Oh, his itches are up by this number. I just thought that was such an interesting. So they could graph. Is it seasonal? Is it what was happening? Anyhow, that was a side note. It's just something I remembered. So the protocol, what is it if a dog came to a traditional fet being itchy? What would the traditional protocol be?

Dr. Angie (04:31.373)
Brilliant.

Dr. Angie (04:36.011)
Right.

Dr. Angie (04:39.978)
Yes.

Dr. Angie (04:51.074)
The traditional protocol is about symptom suppression, which I definitely don't want to give symptom suppression a bad name because these dogs need to have some relief from their itchiness. but most veterinarians will say, we can just suppress the symptoms. And there aren't enough veterinarians saying, let's figure out what your dog's allergic to. And dogs can be allergic to things in the environment, like pollen, grass, trees.

JoJo Smith (05:12.882)
Hmm.

Dr. Angie (05:20.225)
dust mites, or they can be allergic to proteins in their food, whether it be the protein from a carrot or from chicken or from rice. They can be allergic to any of those. And some dogs are allergic to both environmental allergens and food allergens.

JoJo Smith (05:41.49)
of a double whammo.

and it's a little harder to sift apart when that's happening.

Dr. Angie (05:47.638)
Yes, I always start with food. Unless my patient has symptoms that are seasonal, I always start with food because that's the first thing we can control. And that's usually where I see the fastest results.

JoJo Smith (06:07.026)
So what I heard you say is in traditional veterinary medicine, they might bring their dog in for itchiness and be given a bandaid for that in terms of like probably Apoquel or something of that sort. But if they were to see an integrative vet, well, depending if they were to see you, your first inkling is let's let's talk about your dog's diet. Okay.

Dr. Angie (06:20.405)
Mm-hmm. Yep.

Dr. Angie (06:26.381)
So you're going see me.

Dr. Angie (06:32.918)
Yes, I would be doing a diet trial right away. And I'm not against using some of those symptoms suppression medications like ApoQuil, like Cytopoint. So I still use those because I need to rescue my patients. But the first thing I look at is let's figure out if your dog has food allergies.

And there are lot of ways to do that. And over the span of my 18 years of practice, I've done them all, but I've kind of settled out into the fastest and the easiest. So when I first started practicing, I would say, let, let's take out grains. You know, we were really villainizing grains and you know, for some dogs that would actually be quite helpful. And so there were just subset of dogs that would be helped just by taking out grains.

We now know we might have introduced some other problems, but that's for another episode. And then I would say, dun, dun. then I would say I take, you know, the next kind of iteration of my practice was like, let's do a homemade limited ingredient diet, which is, yeah. Can you imagine if I prescribe that to you right now?

JoJo Smith (07:31.9)
Dun dun dun.

JoJo Smith (07:44.58)
I would hate that. So much work. I just felt the heaviness in my body of the work of that, but I'm always happy when people have the capacity to do that.

Dr. Angie (07:57.27)
Yeah, it's not me. I mean, I've done all of my own elimination diets and they are so time consuming. So I spent a lot of time doing that. And then I spent a lot of time trying different foods or single ingredients. And what I settled out to was my favorite diet or is my favorite diet.

JoJo Smith (08:18.546)
Hold it, it's a controversial topic, what you're about to say. As an integrative veterinarian, you recommend.

Dr. Angie (08:21.426)
I know, Everett.

Dr. Angie (08:27.625)
Ultimino by Royal Canaan. I recommend, I know, fire me now. Hire me now. It so works. So for those of you that don't understand hydrolyzed or amino acid based diets, think of proteins as a string of pearls and every

JoJo Smith (08:31.762)
The gasp.

Or hire you now because it works

Dr. Angie (08:55.79)
Pearl is an amino acid and the longer the string of pearls, the bigger the protein, the more likely your body or your dog's body is going to react to it. And so there are some diets that are hypoallergenic diets that they cleave the pearls or the amino acids into smaller groups.

And so like HP, think Royal Canaan makes an HP. I don't remember all of their names. so they'll often use soy, which I'm not a huge fan of anyways. Sometimes they use chicken, but, and so they call these hydrolyzed diets and I don't really like those unless I use them sometimes with my patient won't eat an amino acid based diet.

JoJo Smith (09:26.256)
I think they do.

Dr. Angie (09:45.806)
But what I really like about Ultimino is that they've taken the diet down to the individual amino acids. And so we can tell if your dog with probably like 90 % accuracy, does your dog have a food sensitivity? And if your dog symptoms go away while they're eating Ultimino and only Ultimino, which is like a boring month for everybody, they need to be eating this diet for four to six weeks.

JoJo Smith (10:12.731)
is.

Dr. Angie (10:16.109)
Usually we see results within a couple of weeks, but if they're eating that for four to six weeks and their symptoms do not change, the cool thing is that we get to abandon food trials and we just get to move on. I've spent so many months and sometimes years with my clients and patients that have just been rolling through diets, diet after diet. And what I love about Ultimino

is it makes it fast and easy for us to figure out if food is a component and then we move on.

JoJo Smith (10:51.442)
So you're using the food as a diagnostic tool, but beyond that, talk about the healing aspect of it, that it actually has healing aspects for the gut.

Dr. Angie (10:55.179)
Yes.

Dr. Angie (11:01.961)
Yeah. So we know when dogs eat Ultimino for 14 weeks or longer, that there's some aspect of gut healing that happens because some dogs that could not eat a protein before this 14 weeks can eat it afterwards. And so this is where I think true gut healing does begin. When you remove an allergen and you remove the inflammation that it's causing, then the gut

hand seal up and be healthier.

JoJo Smith (11:36.498)
That seems like a lot of bang in a bag.

Dr. Angie (11:40.0)
I think so. I think it's worth it. And some people are like, I would never feed my dog kibble. And I just invite them to reconsider that their dog might feel better faster. We might get to the bottom of it more quickly and that there is room and space for gut healing to happen. That wouldn't be happening if your dog was eating entire proteins that were continuing to inflame their gut. doesn't matter how much broth.

JoJo Smith (11:41.468)
Yeah.

Dr. Angie (12:09.773)
how much probiotic, how much, you know, glutamine, whatever you're putting down, you know, into your dog's gut to heal it. doesn't matter how much of that you're doing if they're everyday eating proteins that are inflaming their gut.

JoJo Smith (12:28.454)
Well, the tricky part that we hear a lot of is once someone has read the ingredient deck of the Royal Canaan Old Tamino, it's a little frightening and anti those who are wanting a cleaner diet. But not only that, they'll be like, really feel my dog is allergic to chicken and this has chicken.

Dr. Angie (12:48.524)
Right. And that's fair. And I went through this journey with my own dog, my last pug, and I literally did everything else before I started Ultimino. I tried everything I cooked for him. I tried all these other commercial diets. I tried raw diets. And it's so understandable to look at an ingredient deck and think, I don't want to do this. But dogs that are allergic to chicken are not allergic to Ultimino because the

body does not recognize it as chicken.

JoJo Smith (13:23.292)
Why do you think that more traditional veterinarians are not immediately going to the prescription diet as a diagnostic tool?

Dr. Angie (13:30.303)
I don't know. You know, I'm not, I'm not sure. I think the conversation takes a long time. I'm the followup. Yeah, it definitely takes a long time, but I'm not sure. I feel like most practices that I do relief work in are not using old Tamino. They're open to me using it, but I see a lot of hydrolyzed diets offered first and now.

JoJo Smith (13:39.886)
Mm-hmm, the follow-up.

JoJo Smith (13:58.451)
Mm-hmm.

Dr. Angie (13:59.362)
Hydrolyzed diets do taste better than ultimino. So if you have a really picky dog, it might be the ultimino. They won't eat the ultimino because it when you cleave proteins down into individual amino acids, it has kind of like a vitamin like smell. Have you smelled ultimino?

JoJo Smith (14:15.986)
I haven't smelled it and you know I smell everything but I have not opened a bag of ultimino

Dr. Angie (14:19.093)
Yeah.

Yeah, it's got a funny smell. so most dogs eat it. I wouldn't you say 90 %?

JoJo Smith (14:26.034)
Hmm.

JoJo Smith (14:29.912)
I was gonna say, can't even think of maybe but one or two that have declined. I mean, they've been wanting for other things, because it is sad as a guardian when you have to feed the same food over and over the same bland food, and then come up with creative ways to give it as a treat. Because it's the only treat they get. So it can feel sad.

Dr. Angie (14:34.434)
Yeah.

Dr. Angie (14:52.342)
Yeah.

Dr. Angie (14:58.57)
It can feel sad. Food is love and that gets pretty rough. I, when Pugsley was on it for his food trial, I would mash up the ultimino kibbles and then add water and then put it in Kongs and freeze it. Cause I felt so bad. But the thing is it became so quickly worth it because for the first time he didn't have terrible gas.

JoJo Smith (15:00.092)
Yeah.

JoJo Smith (15:13.884)
Mm-hmm.

JoJo Smith (15:23.024)
Hmm.

Dr. Angie (15:23.189)
He felt so much better. His stomach didn't hurt all the time. Like, I don't think I understood how poorly he was feeling until he felt good.

JoJo Smith (15:32.678)
That makes a lot of sense.

Dr. Angie (15:34.173)
Yeah. And then he had more energy and, he was a different dog when I put him on ultimino. And I wish I would have done it sooner to know. Yeah. You don't know what you don't know. Yes. And now I can tell everyone.

JoJo Smith (15:45.064)
huh.

right but you don't know what you don't know and then once you know you know yes so in these situations too people would not be supplementing like they're really bare-bones diatribe

Dr. Angie (16:04.407)
bare bones and if it works and the symptoms are resolving or resolved, then the next big ask is stay there for 14 weeks. Most people don't make it 14 weeks, but most people make it a long way before we start adding other foods on.

JoJo Smith (16:24.466)
Mm-hmm.

They're always surprised by the first foods too. They're like, wait, what? Just like a vegetable? Yeah.

Dr. Angie (16:31.826)
I know. Yeah. So after that time, then we add one food per week to see if we can build back an ingredient deck. So maybe if someone wants to feed, you know, a certain wellness kibble or whatever, then we'll start one at a time, except for the vitamins and minerals. We just put back the food one at a time to build an ingredient deck. Now, most people will do a few ingredients and be like, I'm sorry, I just had to feed the food.

And sometimes that works and sometimes it doesn't, but it's definitely a hard, it's a hard test. It's a test of patience in the sense that your dog feels better and you want to get them off of this kibble, maybe for your own philosophical beliefs. And then you have to just go so slowly and people are like, I just want to be done with this.

JoJo Smith (16:59.9)
Hmm.

JoJo Smith (17:26.066)
I bet I I feel like though it's not quite as painful and slow as an elimination diet which you're just removing everything and Trial testing one ingredient at a time or I guess you couldn't do it one ingredient at a time, but your trial testing

Dr. Angie (17:35.788)
right.

Dr. Angie (17:43.958)
You're trial testing in the whole time though, your dog has felt better. And if you do inflame them with a, an ingredient, you can go back to the old Tamino. And so it's nice. Cause then you have this place where your dog feels good and then it, you know, space opens up, time opens up for you to figure out the next step. And some people never move on to the next step. Some people say, my dog feels so good on old Tamino. I'm going to do this.

JoJo Smith (17:53.894)
Mm-hmm.

Dr. Angie (18:14.209)
and they don't rock the boat.

JoJo Smith (18:16.274)
What did their stools get like on Old Tamino?

Dr. Angie (18:19.213)
Yeah. So old Tamino is very absorbable. And so their stools get really small and tan and infrequent. It's kind of like feeding a raw diet. It's a win. Yeah. Every once in a while we'll have a dog that gets a little constipated. but for the most part, they just have little tiny poops and they're tan. They look like old Tamino and some dogs do gain a little bit of weight.

because for the first time they're really absorbing everything. They have less inflammation in their gut. And so my personal opinion is that's why they gain a little weight. So sometimes we have to reduce the calories or increase the exercise, but not always.

JoJo Smith (18:49.97)
Mm-hmm.

JoJo Smith (18:58.162)
Hmm.

JoJo Smith (19:03.922)
Well, at what point in this, because if you're starting here, but the dog actually has environmental allergies, how like at what point in the ultimino trial or the diet trial are you like, okay, it's not actually food. Do you have to go the full 14 weeks or?

Dr. Angie (19:18.294)
Okay.

Nope, just have to go, the dermatologist would, I think they want you to go six weeks. I usually cut it off at four and now all the dermatologists are gonna be mad at me.

JoJo Smith (19:30.482)
That's okay. You probably take off a subset of lots of people. All the holistic people are mad that you're promoting a prescription diet. Yeah.

Dr. Angie (19:36.469)
I probably sound-

Dr. Angie (19:41.472)
A prescription diet. I know I want to make everyone's life so much easier. I'm like, I know how to do this easier. This is the ultimate hack. Yeah. So I, if they, after four weeks, if they're not doing better, then we move on and we move on to immunotherapy.

JoJo Smith (19:57.362)
Okay.

Which, it's interesting that you said a dermatologist, which I'm surprised how many people are shocked that they're a dermatologist for animals. And it's a business. I mean, they are busy.

Dr. Angie (20:08.287)
I know.

Dr. Angie (20:13.217)
They are busy. Our favorite dermatologist, Darren Dell at Wheat Ridge, I think has like a three month wait list right now. Yeah. So he's booking three months out and then you have to be on a wait list if you want to get in sooner. But.

JoJo Smith (20:22.084)
Often, yeah.

JoJo Smith (20:29.798)
which is a long time to wait when you have an itchy dog. You could have done a whole trial in your wait period before you've seen Dr. Dell, which is fantastic. You go in with more information.

Dr. Angie (20:32.543)
It is a long time and that's why.

yeah.

Dr. Angie (20:40.054)
That's why, yes, you should always do your food trials before you see your dermatologist. They're going to start you there anyways. So you might as well just, just do it. And what's so great about immunotherapy is that it's actually determining what proteins or antigens your pet is allergic to. So is your pet allergic to pollen, trees?

grass, dust mites, and then they're basically creating a little potion that you're either putting under the tongue or injecting, teaching the immune system to not be so overreactive. And while it takes a long time to work, so it can take up to a year to work, it's very effective and it's worth doing if you have the money to do it.

JoJo Smith (21:33.019)
Is it expensive?

Dr. Angie (21:34.478)
I think, yes, I think it is expensive to start with. imagine this, the skin testing. Yeah. Just to see a specialist and then you're doing skin testing, which for a lot of our patients requires a little sedation. And then sometimes they're doing blood testing as well. And so I would say, I mean, I can't imagine you'd get out the door for less than $1,500. What do you think?

JoJo Smith (21:38.573)
probably initially, yeah.

JoJo Smith (22:00.37)
I don't know, but this just brought up in my head our insurance conversation. I'm like, I wonder if insurance covers this.

Dr. Angie (22:05.953)
I wonder if, yeah, I would assume that if it wasn't pre-existing that insurance would cover it.

JoJo Smith (22:07.794)
immunotherapy.

JoJo Smith (22:14.546)
then that kind of makes a win for insurance check. Because that's, I got some talking to you after I talked about insurance. So we may have to go back, we may have to go back on like other episodes and be like, okay, I've changed my mind. I know I said this, but anyhow, that's another subject for another day. Itchy Dogs is a subject for today.

Dr. Angie (22:17.49)
Win. Check.

Dr. Angie (22:24.683)
You got a talking to.

Dr. Angie (22:29.517)
Ha ha ha!

Dr. Angie (22:40.118)
Yes, yeah, so I think, you know, immunotherapy is worth doing. And I usually do that. Now, some people know if their dog has both. Sometimes we know that there's a food sensitivity, but then there's also an environmental sensitivity. So I don't wait for immunotherapy. And usually we tell people to make their appointment with Dr. Dell now anyways.

JoJo Smith (22:58.194)
Mm-hmm.

JoJo Smith (23:03.046)
Yes, even if so if your dog is better you can cancel. Yeah.

Dr. Angie (23:06.305)
You can cancel someone, someone's waiting for that spot. So yeah.

JoJo Smith (23:09.998)
Absolutely, yes. I love our itchy dogs. Because I always feel like, not always, but I do feel that we are gonna be successful in helping ease their symptoms and really, for life. know, like it might get flared, but it's a lifelong, like their whole life got better. The extension of their life got better. It's just, I don't know, it's always a feel good moment.

Dr. Angie (23:21.13)
Yes!

Dr. Angie (23:27.26)
life.

Dr. Angie (23:36.194)
Yes, yeah. And if you do have to use immunosuppressants, like symptom suppressors like ApoQuil and Cytopoint, I think what I want people to understand is that those medications are so much safer than the medications we used to use. And I don't want them to be scared of using them when they need to. They're so much safer. Everyone's like, I don't want to...

You know, the long-term effects of some of these haven't been studied, but yes, they have. with every, you know, Apoquel is safer than steroids. Apoquel is safer than cyclosporine. Cytopoint is safer than Apoquel. Like we have, we have come so far in kind of getting more specific about how we are stopping your dog from feeling itchy.

So instead of suppressing the immune system across the board, we're getting very particular. So we see less side effects and less like overall immunosuppression.

JoJo Smith (24:44.402)
But how about over the counter in terms of on an as needed basis, like a Benadryl type? Is that very effective?

Dr. Angie (24:52.758)
Yeah, it's really not. think there are very few dogs, they are out there, but there are very few dogs that respond to antihistamines like we do. And it's so unfortunate. I think Benadryl could work a little bit only because it's sedating.

JoJo Smith (25:11.858)
So it's just kind of slowing down the itch rather than is that what you mean like it's just soothing the whole system It's soothing the wrong word Like they're too tired is what you're saying to just scratch they're gonna sleep through the itch

Dr. Angie (25:15.848)
Yeah.

Dr. Angie (25:20.253)
Yeah, just making your dog sleepy. they're too tired. Yeah. They're going to sleep through the itch a little bit more. I mean, we've definitely over the years had some patients that do well on the newer generation, anahistamines like Claritin and, those sorts of, what's the one that begins with a Z?

JoJo Smith (25:47.983)
Zyrtec?

Dr. Angie (25:48.937)
Zyrtec, yeah, that's the other one that some dogs do well on, but for the most part, they don't.

JoJo Smith (25:56.954)
Okay, that's good. I feel like when I first was out of school that was the go-to. Like just just go to Walgreens and get your Benadryl.

Dr. Angie (25:57.783)
total bummer.

Dr. Angie (26:01.781)
Yeah.

Yeah, no, it just doesn't help so much.

JoJo Smith (26:06.95)
Yeah, I'm glad we have more tools.

Dr. Angie (26:10.709)
We have more tools and if you are listening and want to learn more about itchy dogs, I have a course at boulderholisticvet.com that you can buy and I take you through my whole system step by step. And if you have any questions about your itchy dog, feel free to leave a comment wherever you are watching this.

And we'd love to hear from you. Anything else, JoJo? Anything else we need to talk about?

JoJo Smith (26:40.572)
Well, I feel like that topic is endless. My goodness is a subset of that. It was fantastic. That's a great place to start talking with your veterinarian.

Dr. Angie (26:43.501)
It's endless.

Dr. Angie (26:50.518)
Yes, absolutely. Okay, well be sure to give us a review. We really depend on the feedback and we appreciate you helping us get more listeners and we will talk to you soon. Bye.

JoJo Smith (27:06.322)
Bye.