Her nose has been slowly healing since she made it bleed on the front window over the weekend. But that is life with DLE. Fingers crossed it heals up fast for her. She is able to do some bed making (flipping blankets with her nose) without it bleeding so that is good.
She left another blood streak on the window this morning. Unfortunately there is no way to block her from the window that wouldn't result in her injuring the skin even more. We've got her beds moved away from the window as much as we can without risking a leg injury when she sees something exciting.
We’ve reduced the amount of fish oil she’s getting by 1 capsule after her Saturday vet visit just in case the spots in her eye are lipid deposits caused by high triglycerides. She’s still getting a high therapeutic dose of Omega-3 fatty acids, just not as high a dose. We will be keeping an eye on her nose to see if less fish oil negatively impacts the healing process. I don’t think it will since she gets such a high dose.
Essential Oils I Have Been Using For DLE
I have been using essential oils with Chance since around May of this year. The main goal with the essential oils is to reduce stress and help support the immune system.
These include chamomile, rose, frankincense, cistus, and citruses.
I have also been using homeopathic remedies added to her drinking water. I focus on the remedies that most closely match what we are seeing on her nose at that time.
Remedies that have been indicated based on her symptoms have included: Mercurius Vivus, Phosphorus, Sepia, Calcarea Carbonica, Pulsatilla Nigricans, Rhus Toxicodendron, Sulphur, Graphites, Petroleum, Antimonium Crudum, Dulcamara, Causticum, Aurum Metallicum, Kreosotum, and Belladonna.
Chance’s holistic vet put her on and recommended quite a few things for her DLE.
Probiotic: She wants Chance on probiotics for the rest of her life. Chance was already on a probiotic due to being on the Doxycycline antibiotic.
Probiotics seem to be a standard recommendation for lupus.
Standard Process Canine Immune System Support: Chance’s vet was the 2nd vet to recommend this product. The 1st vet didn’t stand to make any money off the recommendation.
Chance currently gets 3/4 tsp. twice a day.
Vetri-Science Antiox-50: An antioxidant was added to protect against cell damage caused by free radicals. The initial dose was 1 capsule twice a day for 10 days.
Chance currently gets 1 capsule once a day.
Vitamin E: An antioxidant that has anti-histamine and immunostimulant properties and it helps to stabilize cell membranes.
Natural Vitamin E is considered to be more effective than synthetic Vitamin E. Natural tocopherols are labeled “d” and synthetics are labeled “dl.”
Example: d-alpha tocopherol is a natural tocopherol; dl-alpha tocopherol is a synthetic tocopherol.
Natural mixed tocopherols are considered to be more effective than a single type of natural tocopherol.
Vitamin E was recommended for topical use on Chance’s nose to aid in healing as well as for internal use by her vet. The Vitamin E I found is sourced from non-GMO sunflower oil and not from soy. Most are soy-based. We have not used it topically because it has a sweet taste and we know Chance would lick her nose until there was no skin left on it.
Chance currently gets 400 IU of Vitamin E twice a day.
Jing Tang’s Blood Heat Formula: The vet said the DLE is a sign of “too much heat in the blood” so she put Chance on a Traditional Chinese Medicine herbal formula. They didn’t have any at the vet clinic so we picked this up a week later.
I don’t quite understand the whole TCM heat stuff but it has seemed to help. The initial dose was 0.75 grams twice a day for 2 weeks.
Chance currently gets 1.5 grams twice a day.
Aloe Vera: Topical use on the nose as needed to help soothe and heal the skin was recommended.
It is safe to be licked off.
From a plant is best.
We have not used any yet but we did buy an Aloe plant the next day.
Sunscreen: Because lupus and sun exposure don’t mix, sunscreen use on the nose is recommended.
It must be something zinc free and non-toxic/no harmful ingredients as it will be licked.
Raw Diet Change: Chance's vet wants all dogs on a raw diet. Because of the TCM/too much heat in the blood thing, the vet recommended we switch Chance’s raw diet from red meat proteins to raw turkey, duck, rabbit, fish, and occasional chicken if possible.
Since Chance doesn’t really like raw fish or rabbit, I started doing some research on TCM hot/neutral/cool foods. And came away more confused than before I started. Very few sites were in agreement on what is a cooling food, a neutral food, etc.
Chance’s diet has not changed at this time.
Essential Oils: I had printed out information on all the essential oils I have or had been using and faxed them to the vet office prior to the visit. The vet liked everything and said to make sure we kept using them.
Acupuncture: The vet said acupuncture focusing on immune system points would be beneficial if it doesn’t stress Chance out.
Next post: The essential oils I have been using on Chance.
Update On Chance: October 22 - 25
The scabs are pretty much gone now. The skin is still a little fragile in a couple of spots though. Today she made her nose bleed when FedEx delivered a package. She got excited and was barking at the front window but was too close and was dragging her nose across the glass.
Yesterday was her 1-month re-check at the rehab vet. Her rehab vet was the one who made the diagnosis on September 22. The improvement in her nose surprised the vet tech and the vet. We now have a plan for seeing if we can take her off the Doxycycline.
Today she saw her holistic vet to have a spot on her left eye checked out. The vet was amazed at how good her nose is looking (and she thinks the spot is a lipid deposit.)
What Is Discoid Lupus Erythematosus (DLE)?
DLE is more correctly called Cutaneous Lupus Erythematosus. I’ll continue referring to it as Discoid because that seems to be the most commonly used name.
DLE is an autoimmune disease thought to be a non-systemic version of the much worse and potentially fatal Systemic Lupus Erythematosus.
DLE does not progress to SLE.
The way DLE was explained to us is the immune system has decided it is allergic to part of the skin structure and mounts an “appropriate” response in order to destroy the “foreign invader.” Unfortunately the “foreign invader” is part of the skin so it starts destroying the skin.
It is typically confined to the nose. Symptoms include loss of hair on the bridge of the nose, complete loss of nasal pigment, pigment may also become gray-black and shiny, the texture on the nose goes away, the skin cracks and/or becomes scaly and scab-like, painful and hard to heal lesions appear on the nose.
These skin problems can move to the eye area, ears, mouth, and, occasionally, the genital area.
Sun exposure can worsen an existing flare up of DLE or even trigger one if it is remission. The use of a pet-safe sunscreen on the nose is recommended. If this isn’t possible, avoid exposure to strong sunlight.
Lupus is a lifelong disease. There is no cure.
How Is It Diagnosed?
The only true way to diagnose DLE is via skin biopsy of the nose. This has to be done on areas that are not affected by lesions and have minimal flaking. More than one area of the nose may need to have a biopsy sample taken.
Since the biopsy is painful, and done on the nose which is already a sensitive area, sedation or anesthesia will likely have to be used.
Stitches to close the biopsy site, or sites, will be needed.
With Chance, the rehab vet did not think a biopsy would be a good idea. Her nose was very inflamed and painful plus she had the painful lesions she was dealing with.
Based off her classic DLE symptoms (which matched no other skin diseases or conditions), the rehab vet opted to start treatment and see how she responded. A definite improvement would show that it was DLE.
Conventional Treatments And Therapies For DLE (As Described By Chance’s Vets)
Initial: An antibiotic/B vitamin supplement combination. The purpose of this combination is to stop modulate the immune system response and to stop the immune system’s attack on the skin. This combination helps about 70% of dogs. Some dogs go into lifelong remission and never need the antibiotic again. Some may need antibiotics periodically for flare ups. Some dogs may never be able to stop the antibiotics.
1.) Steroids: Prescribed for their immunosuppressive properties. They do have unwanted side effects and should only be used in conjunction with other therapies and only when absolutely needed.
There are many “alternative” treatments and therapies that can be used in conjunction with the conventional ones. The ones Chance is on will be discussed in the next post.
I’ve decided to keep a blog on Chance’s DLE. Mainly to try to help me remember when things happened, how it responded to various courses of treatment, etc.
If it helps others deal with this, that’s great. If not, that’s fine too!
My 1st post is a timeline of events.
Montana Vacation: Chance causes a little damage to her nose digging for gophers in the decomposed granite soil. Nothing bad, no real wounds, no blood, no scabs.
July: The nose was healing and looking good.
July 29: My husband had a life-threatening medical emergency. Ambulance and fire department came around 2:30 a.m., taken away via ambulance. 3.5 weeks of high stress.
1st Full Week August: Chance had hair loss on bridge of nose. Skin of nose pink and raw from bridge towards nostrils. 1 open sore over the top of each nostril. Noticed me leaving to go to hospital caused her to lick nose obsessively, tongue hit open wounds each time. Thought due to stress.
August 11: Rehab vet dispensed an herbal tincture to soothe the raw nerve endings and help prevent scar tissue formation. Recommended Prozac if couldn’t reduce the Chance’s stress level and stop the stress licking cycle.
Week Of August 11: Able to bring piece of clothing from husband home, used essential oil calming blend, stress licking stopped. Tincture seemed to be helping.
August 22: Husband discharged.
August 23: Chance swam. Scabs over wounds softened, nose bled a little when she rolled in back of vehicle.
September 4: Chance seen by regular holistic house call vet. Asked her if it could be something other than stress licking that caused it. She said if the tincture was working to keep using it and to have rehab vet recheck and she had no ideas for anything else to do to treat it.
1st Weekend In September: Cut swim short because the scabs softened and got lifted, started bleeding.
September 8 – September 19: Nose continuing to heal.
Weekend of September 19: Canceled swim session because nose was looking good, wanted it to continue to heal. Then nose went from almost healed to horrible looking with huge open wounds, loss of pigment, horrible scaling, started seeing a spot on lip loosing pigment. Pretty sure was seeing DLE.
September 22: Rehab vet. She came in, saw the nose, and said it was most likely DLE.
Cautioned against biopsy due to the inflammation and rawness of Chance’s nose, the impossibility of keeping her from licking the biopsy stitches out of her nose, the damage she would do licking the biopsy sites, etc.
Recommended a 6-week course of treatment to see how she responded. If her nose began to heal, we’d know it was DLE.
Contacted regular vet. Her response: Was sure it was DLE on September 4 but didn’t say anything, doesn’t like long-term antibiotic use.
September 23: Saw a huge amount of improvement.
September 24 – 28: Nose looking fantastic compared to it had looked. Lesions healing, little scaling, hair regrowing, pigment returning, nose texture returning to black areas, lip pigment back.
Week Of September 29: Pink spot developing below nostril followed by lesions breaking open, scaling, etc.
Contacted regular vet repeatedly with no response.
Contacted the conventional vet we keep for the medical facilities/equipment to see how much experience and success they have with DLE. Only response was they would have to biopsy before treatment and then they could treat.
Contacted a holistic vet clinic, found out they have a vet who has treated many autoimmune disease dogs, got appointment for next day.
October 3: Appointment with new vet.
She said we would see periods where it was doing really good, then would look bad, then look good, etc. She also said that what we were seeing – when it would get bad, it was still better than the bad time before it – was promising.
She liked that I was taking pictures weekly so I could compare because it is hard to see improvement from day-to-day.
She recommended several things she has seen help during her treatment of other DLE dogs.
The clinic had the antioxidat and the Standard Process but had to order the Blood Heat.
I found a Vitamin E that was sourced from non-GMO sunflowers and ordered that from Amazon.
October 4: Bought Aloe Vera plant
October 5: Vitamin E arrived. Decided against using it topically because it tastes good and Chance would lick her nose until it bled.
Found a sunscreen to try once the lesions heal up.
October 10: Picked up Blood Heat Formula from vet.
October 11 – October 16: Nose looking better every day
October 17: Nose started looking really bad that night.
October 18: Nose looking better in the morning.
Swam for 1st time since 1st weekend in September. Nose looked great afterwards!
October 19 – October 22: Nose continues to improve. Will it stay that way? No clue.
These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease. The information contained in these blogs is not meant as a substitute for veterinary care or as a replacement for advice or instructions given by a veterinarian. Contact your veterinarian before starting any over-the-counter products.