Vet Advice with Dr. Liz Bales – Itchy Last Straw

Itchy Last Straw!

My Boston Terrier has been suffering from allergies for a few years now. Her back paws are extremely red and she licks at them constantly. We’ve done allergy testing (lots of grass allergies), and have tried hypoallergenic diets (allergic to most meat sources), apoquel, cytopoint, topical creams, flea medications, Heska Allercept immunotherapy drops, special shampoos, just about everything and she gets no relief. The only thing that partially helps her (pink skin instead of red, but still licking) is prednisone; I don’t want her to be on that long term. Are there any other options we can ask our vet about? What about CBD oil for allergies? Thank you!
 

Dear Itchy,

First let me say how sorry I am that your and your dog are going through this.  Itching is one of the most common reasons that people bring their dogs to the veterinarian. Itching makes life miserable for dogs and the people who love them. And, getting to the bottom of the problem can be difficult and expensive. It sounds like you have tried just about everything.  I can only imagine how frustrated you and your dog must be.

I like to go to a systematic approach and start with the science. Itching can be caused by many things, including allergies, bacterial infections, yeast infections, parasites, autoimmune diseases and more.  Often allergies, parasites or autoimmune diseases start the problem and then a secondary bacterial, yeast infection and/or other parasites take over.  Steroids and other immunosuppressive drugs that are used to treat the itch may actually cause a parasitic infection with a skin mite called demodex.

Complicated, right?!?!  And, no doubt, expensive.

You did the right thing by seeking treatment with your local veterinarian. Often, a skin work up includes a thorough physical exam and history, a flea comb and deep skin scrape for parasites, impression smear to look for yeast and bacterial infections. Further tests include skin testing or blood tests to check for environmental allergies and a food elimination trial.  Finally, a skin biopsy may be necessary to check for autoimmune conditions or other systemic diseases. 

While you are in the testing and treatment process, secondary bacterial infections, yeast infections and parasitic infections can pop up and need retreatment or the itching will continue. So, your veterinarian may need to recheck for these with skin scrapes and impression smears.  Additionally, if secondary bacterial or yeast infections are persistent, skin cultures are required to choose the appropriate antibiotic/antifungal.

In short, this is a very difficult and expensive problem.  If it was straightforward to fix, you and your dog would have gotten relief by now. 

Someone like you and your dog, that have “tried everything” will benefit by seeing a board-certified veterinary dermatologist.  You can find one in your area by clicking this link. https://www.acvd.org/tools/locator/locator.asp?ids=16_Find_Dermatologist

Just like people who go to your primary doctor for screening and treatment, then on to a specialist if they do not find relief, your dog may be best served by a specialist right now.

Hang in there!  We will all be thinking of you and your dog.  I hope you both find relief very soon.

Waggs and purrs,

Dr. Liz Bales

Written by Dr. Liz Bales, who we are excited to announce will be collaborating with Modern Dog for all things dog health-related, stay tuned!

The University of Pennsylvania School of Veterinary Medicine graduate, Dr. Liz Bales, has only ever wanted to be a veterinarian. She has such a passion for her job, that she says if she weren’t a vet, she would be studying to become one. She loves “helping pets and the people who love them be happy and healthy!  Helping people translate complicated medical information into practical tips on how to care for, and connect with their pets is the best part of her job” Not just a veterinarian, Dr. Bales shares her passion through writing, giving speeches, and appearing on shows such as Fox and Friends, ABC News, and Cheddar. She has even started her own company, Doc and Phoebe, and invented a revolutionary cat product—the Indoor Hunting Feeder.

Dr. Bales’ favorite quote reflects her love and compassion for animals: “When a human dies there is a bridge they must cross to enter into Heaven. At the head of the bridge waits every animal that human encountered during their lifetime. The animals, based on what they know of this person, decide which humans may cross the bridge…and which are turned away.” With this in mind, Dr. Bales tries to live every day by her grandfather’s advice: “These days are precious. Don’t waste them.”

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