photograph by bcy909 / dreamstime
Like many dogs — and humans — in Memphis, Cocoa suffers from allergies. Tell-tale signs for her owner Bethany Paulus: The 11-year-old Pomeranian was itchy, scratching her eyes and mouth, and constantly chewing on her paws. After being treated with medicine for years through her veterinarian, the problem persisted. In March, Paulus noticed an irritated, discolored spot on Cocoa’s stomach and took her to Memphis Veterinary Specialists (MVS) — the only practice of its kind within hundreds of miles, with a team of board-certified veterinary specialists in a variety of fields — for a check-up.
For the first time in her life, Cocoa was given an allergy test — the same kind that would be conducted on a human. Dr. Tina Brown, a dermatologist at MVS in Cordova, shaved a small patch of hair off Cocoa’s side and injected her with trace amounts of about 60 common local environmental allergens — ragweed, Bermuda grass, molds, etc. — to check for allergic reactions.
In all the years Cocoa had allergies, Paulus’ regular vet had never done a test to pinpoint specific allergens. “They’d look at what was on her skin under a microscope,” Paulus says. And Cocoa had been given Apoquel for atopic dermatitis, but the medicine was not targeting her specific allergies: “She really wasn’t getting the relief she needed from that.”
At MVS, via intradermal testing, Dr. Brown is able to determine exact allergens and create an individualized serum — to be given via subcutaneous injections or by mouth — which is formulated and filled in-house. “[Brown] was able to tell me all the things Cocoa was allergic to,” Paulus says, “which was a lot.” After just a couple of weeks on the serum, Paulus believes it’s “definitely helping her already.”
Skin Deep
Dr. Tina Brown has worked at MVS for 10 years and specializes in diseases of the skin, ears, and claws. Many cases she sees involve allergies.
Brown jokes that while in general practice/primary care veterinary medicine, she decided to go back to school to focus on dermatology because no one had warned her that every animal she’d see was going to come in for scratching. While it wasn’t actually every animal, “Allergies are so common,” she says, “and I didn’t feel like I was well-prepared with just four years of vet school.”
After a one-year rotating internship in companion medicine and surgery, Brown was accepted for a dermatology residency at Louisiana State University and completed her training in 2008. Today, she is board-certified and a Diplomate of the American College of Veterinary Dermatology (ACVD). She’s been at MVS for 10 years and specializes in diseases of the skin, ears, and claws caused by allergies, parasites, infections, and autoimmune or endocrine issues. Still, most cases she sees involve allergies.
“What I see primarily are dogs that have had recurring skin infections or ear infections,” Brown says. “It’s normal to have some yeast and bacteria on the skin, but if the skin’s inflamed with allergies, that’s why those infections occur. A lot of people don’t realize that ear and skin infections are often due to underlying allergies.”
For those cases, as with Cocoa, Brown conducts intradermal allergy testing, which is thought to be the most accurate way to test — more so than a blood test. “It’s a dynamic reaction, the reaction takes place in the skin,” Brown says, “versus when you draw blood, it’s just looking for high levels of antibodies. But we know now that even high levels of antibodies, that’s just what’s circulating in the bloodstream. It doesn’t necessarily mean that’s one of the top allergens; it shows exposure.”
Following the skin test, patients are prescribed an allergen-specific serum to work on desensitization. “We look at short-term things [like medicated bath soap] to help them feel more comfortable, but long-term if you can treat the underlying problem, then hopefully you can make every year better,” Brown says. “Also, that’s the safest way to manage them long-term. Because it’s not anything that suppresses their immune system or just blocks the signs; it actually retrains the immune system.” Currently the serum is available for dogs, cats, and horses, and MVS is the only practice in the region to formulate and fill those prescriptions on site.
With dogs, allergy symptoms are typically more obvious, but, Brown says, “Cats can present a little differently.” Cats with allergies will often over-groom, removing patches of hair from their stomach and sides. Some pet owners will assume it’s a result of nervousness or anxiety. “A lot of cats get medicated with anti-anxiety meds, but they’re actually just allergic,” says Brown.
Other somewhat common cases Brown sees are crusting or nodular autoimmune diseases. In those cases, a biopsy is taken to confirm disease and determine long-term management options. For those, “We’ll often reach for medications that suppress the immune system because it’s an autoimmune disease, and more than likely, those patients are going to be on medications for life,” says Brown. “So we need to make sure that it’s very safe. We don’t want to make the treatment worse than the disease."
Seeing Clearly
Dr. Jane Ashley Huey’s first patient in clinics at vet school at Auburn University was her 14-year-old horse Lady, who’d had a severe, deep wound on her cornea, called a melting corneal ulcer. With her own animal suffering eye problems, Huey developed a special interest in ophthalmology.
Also, she says, “The eye is the most beautiful structure in the body. It’s really cool to see that anatomy — the nerves and vessels. And [ophthalmology] incorporates internal medicine, emergency medicine, and surgery all together, and allows me to work on multiple species.”
After her three-year residency in ophthalmology at Kansas State University, Huey moved to San Diego, California, where she practiced veterinary ophthalmology and helped care for animals at the San Diego Zoo Safari Park. There, she performed surgery on an ailing rhinoceros’ eye. The rhino was given heavy sedatives, and Huey had to “go, go, go, hurry, before the rhino wakes up!”
Huey, a Diplomate of the American College of Veterinary Ophthalmologists (ACVO), has been with MVS since 2016. She recently consulted on the CT scan of Benjamin — a baby primate at the Memphis Zoo. Of course, she doesn’t work with exotic animals on a daily basis. Her typical work consists of helping pets with eye problems, such as corneal wounds, cataracts, glaucoma, and congenital or developmental abnormalities.
Cataracts are quite common, especially for dogs with diabetes. “There’s no treatment to delay the onset of cataracts or to reverse cataracts,” Huey says. “But cataracts can cause inflammation inside the eye, and that is important to control because it can cause significant damage and lead to other problems like glaucoma and retinal detachment.”
Topical anti-inflammatories are available and can help prevent long-term complications, but some dogs may be candidates for cataract surgery. They have to pass several tests, “to make sure they’re ready for surgery and that they’re good candidates to have the highest prognosis possible for a good outcome,” Huey says. If tests are passed, Huey uses an operating microscope to magnify the eye while she works. “We use a human cataract surgery machine that removes the cataracts so they cannot come back, and we implant artificial lenses into the capsular bag so we can try to restore the dog’s vision to near perfect.”
While cataract surgery is possible on cats, felines rarely develop cataracts. Many cases with dogs are a result of diabetes, but diabetic cats naturally have a lower risk for diabetic cataracts. In dogs, “There’s an enzyme that converts blood sugar, which filters into the eye,” Huey says. “The sugar goes into the lens and is sent through a pathway, and in dogs the normal pathway is overwhelmed, and so it has to [redirect], and it makes these fat sugar alcohols in the lens that draw fluid. So dogs get tons of fluid in the eye, which swells and ruptures the lens fibers, and they get cataracts. Cats naturally have a lower level of that enzyme, and that enzyme decreases as they age.”
Owners of elderly dogs may notice a blue haze develop on the eye lens, but that doesn’t necessarily indicate cataracts or blindness. As with humans, dogs will begin to develop nuclear sclerosis — a change in density of the crystalline lens nucleus — as they age. People can begin to see these symptoms around the age of 40. “The center of our lens hardens, dehydrates, and consolidates and becomes more opaque and less flexible,” says Huey. “In dogs, that happens at age 6 and becomes progressively more dense and dehydrated and opaque.”
When that happens, the dog may have an issue with depth perception, but a veterinarian or veterinary ophthalmologist can determine whether or not a cataract is present. The vet will use a slit lamp or examine the back of the eye via a fundic exam. “If I can see into their eye and see their retina with pretty good detail, then they should be able to see out,” Huey says.
Other cases Huey sees involve glaucoma, retinal disease, and removal of tumors. Recently, Huey performed a lip-to-lid surgery on a dog name Dutchess, who had a rapidly progressing tumor on her eyelid. To avoid damaging Dutchess’ lid, “We had to graft tissue from her lip,” says Huey. “It mimics the lid margin. [After three weeks], we rechecked her and removed her sutures. She can blink her eye fully, the tissue is in place, and the swelling is down significantly.
“That is a surgery we don’t do very often, but she is doing well, and we got clean margins on the tissue and removed a really bad tumor.”
Specialized Care
Dr. Huey and Dr. Brown are just two in a team of experts at MVS. Presently, MVS employs nine board-certified veterinary specialists, nationally known as leading specialists in their fields, which include dentistry, dermatology, diagnostic imaging, internal medicine, oncology, ophthalmology, and surgery (with a focus on neurologic, orthopedic, and soft-tissue surgeries).
MVS’ services, most of which are offered by referral only, treat a variety of health conditions and injuries. MVS is the partner hospital for all first responder animals in the region and offers free annual eye exams for certified service animals. After-hours emergency services are also available.
For Memphis’ beloved pets, like Bethany Paulus’ Pomeranian Cocoa, MVS doctors have been life-changing. Last year, specialists there performed a successful hip surgery on Cocoa, and earlier this year, removed her gallbladder.
“I would never go anywhere else,” Paulus says. “They really care about what they do, and you can tell. They treat it as seriously as a pet owner, like they’re caring for their own animals.”
