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Mike McIntyre
Mike McIntyre,
Category: Vet
Satisfied Customers: 13349
Experience:  Veterinarian at Sioux Nation Pet Clinic
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My boxer who is 3 and a half years old has a serious skin

Customer Question

My boxer bitch who is 3 and a half years old has a serious skin allergy that we can’t have seem to get on top of. She is on apoquel but it does t seem to be working. Her ear is red raw, she is constantly chewing her paws and her skin all over is itchy. I would like to use natural alternatives which are safe and effective
JA: I'll do all I can to help. Do you know when the Boxer started chewing her skin?
Customer: she’s been chewing and scarring since she was a puppy, maybe 6 months old she had red ears but mainly scabby chin and around her mouth, but it’s got progressively worse and spread all over her body really
JA: Does she also have a rash or other skin-related symptoms?
Customer: It’s hard to tell if there is a rash on the white patches of fur or if it’s sore from scratching
JA: What's the Boxer's name?
Customer: Ruby
JA: Is there anything else the Vet should know?
Customer: she is generally very fit and healthy, it’s just this allergy that is driving her crazy
Submitted: 12 days ago.
Category: Vet
Expert:  Mike McIntyre replied 12 days ago.
Hello and welcome to Just Answer. This is Dr Mike and it will be my pleasure to assist you with your questions today. I have over 20 years of experience in small animal medicine and surgery. I am sorry to hear that you are having trouble with your little one, I can understand how stressful it is for you. I will do my utmost to assist today and to see if we will be able to resolve this quickly for you. Please be patient with me as it takes time to review and write detailed recommendations. Shortly you will receive an offer from Just Answer for a phone call, this is not directly from me and you do not have to accept it. If you prefer we can continue this whole conversation here. I will begin our discussion today with some questions to better understand your concerns.
To start with, have  there been any changes in eating, drinking, defecating or urinating most recently?
Are there any underlying medical conditions or medications that I should be aware of?
Will it be possible to send some photos of the affected area?
Expert:  Mike McIntyre replied 12 days ago.

There may be an underlying condition that is occurring and leading to the repeat skin and ear issues.  The following discussion will focus on the skin, then the ears and then the potential underlying conditions.

The concern is the in the skin there can be opportunistic bacteria and yeast that can proliferate to higher levels and can potentially cause skin problems. This is seen more often when there is skin damage by way if moisture or damage. The excess moisture can allow the normal yeast and bacteria that colonize and to proliferate to higher levels, as these levels increase then more issues may arise. Topical shampoos with chlorhexidine and climbazole  can assist with yeast and bacteria control. When shampooing it is best to allow for a minimum of 10 minutes of contact time with the skin before rinsing it off. This contact time is critical to provide good kill down and penetration to the area for potential organisms. These topical items like chlorhexidine and climbazole can also be sprayed on the skin. (Duoxo spray is an example ). This can be applied to the area 2-4 times a day. They can kill the yeast and bacteria as they are applied.  This can be done in conjunction and between the shampooing. The chlorhexidine can address yeast and bacteria and the climbazole  will also will address yeast. The following are some example to look for, these can be found over the counter like at pet stores, pet section in some stores or online like at Amazon.

Duoxo pyo shampoo (these items all have Chlorhexidine and Climbazole in them)

Duoxo pyo spray

3. The Triz Chlor line also has these Ingredients also. Here is a link to review.

https://www.dechra-us.com/Files/Files/SupportMaterialDownloads/us/US-025-DET.pdf

Until able to acquire the above items, the area can be cleaned with dilute Chlorhexidine.  This  can be found at the pharmacy over the counter.  It may go by the name Hibiclens or Hibiscrub. Then can apply triple antibiotic ointment to assist with potential infection.  Topical  hydrocortisone or lidocaine can assist with itch and inflammation.

Expert:  Mike McIntyre replied 12 days ago.

This can help with the ears: The ear canal is in the shape of an "L", this allows for the ear canal to become very moist and warm, then the opportunistic yeast and bacteria that normally live in the ear canal can start to grow to higher levels. The key is to need to flush the ears twice a day to start with. An ear flush with  chlorhexidine can also assist with potential yeast and bacteria. This will remove the debris and the chlorhexidine will also kill the yeast and the bacteria in the ear canal. Then once the ears get healthier can decrease on an as needed benefit. You may need to do from time to time to keep the ears healthy. The miconazole will also help with the yeast too. Below are some examples or items to that can be looked for.

1. Trizchlor flush has chlorhexidine that will address both bacteria and yeast.

Most flushes just get there material out and do not kill the yeast and bacteria. This also kills yeast and bacteria too.

https://www.dechra-us.com/Files/Files/SupportMaterialDownloads/us/US-025-DET.pdf

Customer: replied 12 days ago.
Thank you. She is generally very healthy, but the past week or so her skin irritation has got worse all over but in particular her right ear which is very red and inflamed. She has 16g of apoquel daily and only has royal canine hypoallergenic hydrolysed biscuits and hills hypoallergenic hydrolysed treats. However this is not what I want her life to be, I am open ta raw feeding and natural remedies but don’t know where to start and what is safe.
Expert:  Mike McIntyre replied 12 days ago.

Often when underlying conditions are occurring Apoquel does not work so well to address itching often is seen.

In cases of an underlying low thyroid condition, this can be called hypothyroid. When the thyroid level gets low, the hair goes into the resting phase, when this happens it falls out very easily, then it does not grow back in as well. Our metabolism will slow down, this will cause weight gain. The skin becomes poorer quality, this then leads to the invasion of opportunistic yeast and bacteria deeper into the skin. This leads to intense itching and terrible yeast odor to the whole body. Worsening infections particular of the ears and paws occur. To assess for this, we can have the thyroid level tested on the blood, if it is low, then we start on a thyroid supplement. Typically after 4-8 weeks we can have the thyroid level tested, as long as the level is in the range we want it to be in. Then we continue at that dosage. As the level comes up, we become more active, the skin and hair coat become more healthy and we have less skin infections an less smell. In short, it is like we almost have new dog. However the key is we have to find out what the underlying condition is. Many times starting with a thyroid test at your veterinary clinic may be the next step to have this assessed.

Below is brief discussion also of Cushings (Hyperadrenocorticism)

Many of these conditions can be caused from underlying issues, like hypothyroidism. Many times if the hormone levels on a dog are off, that area of the tail can bald also. There is what is called the caudal tail gland there, when hormonal levels are off it can be common to have the balding area over this area of the tail. Low thyroid can cause nerve degeneration. Hypothyroid induced neuropathy, you can look it up on the internet. It can cause them to become less active, less energetic, weaker on the back end also. There can also be some laryngeal paralysis which can make to cough more after drinks. Another condition that can cause many of these signs is CUshings ( hyperadrenocorticism), This is where the body produces too much natural steroids. It can cause many of the same signs, as both can cause poorer skin and hair coat. Cushings also can make for more drinking, urinating, and panting too. This can also cause muscle loss which will also lead to potential weakness to the back end too. These can be looked at with bloodwork at your clinic if you decide to work these up more.

https://www.dechra-us.com/therapy-areas/companion-animals/endocrinology/canine-hyperadrenocorticism

https://www.dvm360.com/view/hypothyroid-associated-neurologic-signs-dogs

With low thyroid there can be nerve degeneration over time, one of the first nerves affected can be the ones that control the larynx, the opening to the airway. When this happens often it sounds like collapsing trachea too. However you notice more coughing as drinks as the larynx does not close as well and then water can get into the trachea. Then as the nerve degeneration continues there gets to be more weakness to the back end also. As the nerves have to travel farther to the back end than to the front end. This is why often they may try to put on anti-inflammatories or steroids to reduce inflammation in this area too. However over time the weakness to the back end worsens often to the point that the dog no longer can get up well, jump on the bed, even simply climb the stairs. The haircoat also goes in the resting phase and more hair starts to fall out and it grows back in more thinner. The good news is that if this is the case it is reversible. Testing the thyroid level to see where it is at, if it is low or low/normal then starting on thyroid supplement. Within a few months of being on the supplement nerve healing and degeneration can be reversed. My last German Shorthair Ruger had this same condition. He could not jump onto the couch even and then within a few months of being on the supplement. He was able to jump back into the trucks and couch again. I just mention this as I not only see this in cases but however see it in my own pets too.

Often the thyroid level may be in the low/normal range of under 2. Many clinics will call a dog normal at a thyroid level of 1-2. However studies show that these dogs do better when the thyroid level is up to 2.1-5,4. This is why I am interested in the thyroid level.

https://www.dechra-us.com/therapy-areas/companion-animals/endocrinology/canine-hyperadrenocorticism

Expert:  Mike McIntyre replied 12 days ago.

Will it be possible to send some photos of of the skin and ears ?

Customer: replied 12 days ago.
File attached (2LTM5QL)
Customer: replied 12 days ago.
File attached (P35PPS2)
Customer: replied 12 days ago.
File attached (1Z7ZT71)
Customer: replied 12 days ago.
I’ve attached some photos, although they don’t really show the severity of her itchy and sore ear
Expert:  Mike McIntyre replied 12 days ago.
Have they ever tested the thyroid and adrenal levels? Is there a strong yeasty or musty odor ?
Customer: replied 12 days ago.
No, I don’t believe they have ever tested for thyroid or adrenal levels, they always said it is likely to be a good allergy but that bloody tests for these can be expensive and inconclusive as to whether it is good or environment. Her ears do smell a little and so do her paws, but she’s always been a little smellier than her sister but has different type fur
Expert:  Mike McIntyre replied 12 days ago.
In USA as an example thyroid test is between $50-80 and most clinics run it in clinic, takes about 30 minutes. The adrenal test may be $150-200. Results back the next day. I mentioned this as generally if allergies then Apoquel works very well. When Apoquel does not work well, then in my experience there are other underlying issues.
Customer: replied 12 days ago.
This is a red bit on her neck where she has been scratching, I don’t think it is rash but just sore skin from scratching. Her flare ups do seem when she has had treats the she wouldn’t normally have like ham, chicken, sausages, normal dog treats
Expert:  Mike McIntyre replied 12 days ago.
That is why above I discussed what can assist with the skin and the ears, however looking for the underlying cause and not just treatment of clinical signs is most beneficial for a happier and itch free life.
Expert:  Mike McIntyre replied 12 days ago.
Most often when there is food allergies the food resolves it quite well, there is also GI issues like vomit and diarrhea too.
Customer: replied 12 days ago.
Ok, you have been really helpful. Thank you, ***** ***** discuss these tests with my vet. Thanks again
Expert:  Mike McIntyre replied 12 days ago.
You are more than welcome. We can keep this message open for some days also, I am here daily and am readily available for follow-up. Please keep me updated as to any changes or concerns that may arise. If you wish for my help in the future. You can ask customer service to forward your questions to me, Doctor Mike. Start the questions “For Dr Mike only and no other expert” I am here daily and will be happy to follow up. It has been a pleasure assisting you and Ruby today. I wish Ruby a speedy recovery and have a good day. Thank you for using Just Answer. Dr. Mike.