Epi4Dogs

Bruce is a 6yr Shepherd/Malinois mix. He was diagnosed with EPI about 2-3 weeks ago. We feed him RC HP (mostly dry but add some soft). He is on 6X powder and takes mycophenolate for IMHA. The only other food he gets is raw pumpkin with his meds. Over the last 7 months he will randomly get a swollen lip (always in the upper right, same exact spot, roughly the size of a grape) This swelling appears very quickly (as in over 20 mins) and then will slowly go back down over the course of 24 to 48 hours. This has happened 4 or 5 times in the last 7-8 months. He has seen a dental specialist, who found nothing except extremely healthy teeth and gums. He has been tested for all kids of cancer and come up with nothing. While we have sent photos of the swelling to the vet, she has never seen it in person (Given it is not an emergency, it is impossible to get into the vet on such short notice and the swelling is gone by the time she examines him). The current thought is maybe it is some dermatological issue. Could this be related to his EPI and if so, any ideas on what might be happening? Could this be some other autoimmune issue?

Hi Jen does that swelling cpincide with something you feed him only seldom? Just thinking of allergic reaction.

Jill

Does he have blackheads or a greasy chin? Sometimes acne can cause swelling.

Bruce is on a strict diet, so it doesn't coincide with anything he eats. It usually happens within a few minutes of coming in from being outside. I am also thinking possibly some sort of allergic reaction. However, it happens in all seasons from snow to summer, so likely not insect bites or any plants/foliage. We don't use anything/spray anything outside at all. My daughter has eczema so we mostly use vinegar and water to clean with, so it is not something we spray or use inside either. He is not one to eat things he shouldn't and since I work from home, I keep a close eye on that type of thing. We gave him some benedryl and that started to help within the first hour of taking it, which points to some allergy. I wish we could figure out what it is though.
Our cat had those blackheads/acne years ago, so we know what that looks like and it does not appear to be that. We use metal bowls and clean them after every meal. The frequency has no pattern either. The first time was mid December and he has had them as close together as 2-6 weeks through March/April. Then nothing until yesterday. The only thing that seems to be consistent is that it happens after he has been outside and playing (we have another large dog).
The strange thing is that this is the same time line as when we first noticed his EPI symptoms. So I am not sure if this is another autoimmune problem or what. His immune system seems to be at the root of all his issues (IMHA, EPI, SID).
Our vet is not equipped to deal with such unusual issues, the specialist we took him to is 90 mins away, but it is a teaching hospital and never seems to have the same drs. We have a new vet appointment set for one of the Vet's on the EPI vet list (thankfully she is only 10 miles away) but first availability for a new patient was end of sept. So I am hoping she can guide us on the best treatment plan for him. He is doing much better now that he is on the 6x powder and b12 shots. But I still feel like there are other things we can/should do to help him. He has been through so much these last couple of years and I just want him to have a normal happy dog life.

Sounds like you've got all the usual suspects covered. Since it happens after rough play with his brother, could there possibly be some sweat gland or other gland located near that spot on his lip? Or a salivary gland that has a blockage? It's not like he would always get bumped or nipped in the exact same spot. And the fact that it goes down seems like it fills & drains, or swells & reduces. Interesting.---Pam

Has anyone mentioned hair follicle cyst? I would think that the vet who looked at him for cancer would have covered that, but just thought I would throw it out there. These cysts usually last longer than what you describe and don't disappear quickly or at all, but there could be exceptions. It definitely sounds more like an allergic reaction. I hope you get to the bottom of it.

Barb

I will add follicle cyst and obstructed saliva gland to the list of questions for the new vet. I would think if it were a cyst it would not go away so fast. Obstructed saliva gland might come and go, it has been really warm here lately so that could cause the gland to produce extra spit.
Since neither are emergencies and the benedryl seems to be helping, I think I will keep a close eye on it over the next day. If it gets worse, I can take him to the emergency vet. There doesn't seem to be any infection, he doesn't have a fever and he seems to act fine. He is eating, drinking and going to the bathroom normally. So for an EIP dog, that is really good. If the bendryl doesnt help, we can do a round of pred if we have to. He isn't having any issues with breathing or swelling in his mouth or throat, so I think it is just uncomfortable at this point. I feel like he never has any "normal" dog issues. His are all strangely unique.