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About one month ago, I had a couple come in to see me desperate for alternatives to the crippling doses of steroids their little terrier hound mix had to be sustained on to manage his Systemic Lupus Erythrematosis (SLE). What’s more, the disease was barely managed with their sweet little dog still having to contend with skin lesions, fever spikes, and swollen joints, all common clinical manifestations of SLE.
Systemic Lupus Erythrematosis is a rare severe autoimmune disease that strikes an affected patient in multiple organ systems with varying degrees of severity that range from chronic moderate disease to debilitating disease. Autoimmune disease refers to diseases where abnormal immune system mounts an attack against its own tissues. This particular patient was bordering on the severe debilitating range of SLE and the owners were on the verge of justifiably, mercifully considering euthanasia.
Upon review of the records, beyond repeated course of antibiotics and high doses of steroids, not much else had been visited in terms of management of disease. On physical examination, the patient presented with a low grade fever with sores on his paw pads, ulcerations and crusts on his nose and the bridge of his nose, and an enormous pot belly (a side effect from long term high doses of steroids).
I briefed the owners that there is no single magic holistic option for SLE, and that some level of traditional, immune suppressive medications would be necessary, but that my focus would be to maximize topical therapy and reduce steroid doses through ancillary less toxic systemic immune suppressive medication and natural antioxidant and anti-inflammatory supplementation.
The first order of business was to deal with the infected sores with a 2 week course of doxycycline, an antibiotic that not only has an appropriate spectrum of antibacterial coverage these types of lesions, but also has intrinsic anti-inflammatory properties for infections triggered by inflammation. I also advised for the skin and nose sores, topical management with an anti-inflammatory immune suppressive ointment called Protopic.
Next, I added the less toxic systemic immune suppressive drug azathioprine to use concurrently with the steroid for one week to hopefully enable us to begin weaning back significantly on steroid doses which have far more severe potential long term deleterious side effects. From the natural side, I advised treatment with high doses of niacin (vitamin B3), as well omega-3 fatty acids derived from a high quality fish oil supplement. To minimize the generation of inflammation at the level of the gut, I recommended a prescription hypoallergenic diet and probiotic therapy to maintain a healthy bacterial balance of good bacteria in the gut.
Over the course of the next 4 weeks, we were successfully able to reduce steroid dosing from 20 mg per day to 5 mg per day, representing a 75% decrease in overall dosing. At the 4 week medical progress examination, the dog’s pot belly appearance had diminished significantly, his fever was gone, and he was far more energetic, wagging his tail and moving with purpose. The skin sores had all nearly completely resolved, especially his nose that even regained its beautiful original liver color. My patient’s owners felt that they had finally gotten their dog back and were the most hopeful for his future than they had been in months.
Per the title of this article, this case is a perfect example of integrative medicine, the combination of the best of all worlds of both holistic and traditional medicine to maximize outcomes with minimal dependence on medications that come with adverse side effects. Was I able to eliminate the need for drug therapy? Obviously not, but through integrative veterinary medicine, I was able to profoundly decreases drug doses to the benefit of the patient.
Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms. In addition to being passionate about integrative veterinary medicine for which he is a nationally renowned expert, Dr. Welton was also an accomplished college lacrosse player and remains to this day very involved in the sport. He is president of Maybeck Animal Hospital , runs the successful veterinary/animal health blogs Web-DVM and Dr. Roger’s Holistic Veterinary Care, and fulfills his passion for lacrosse through his lacrosse and sport blog, The Creator’s Game.