Page 25 - Summer 21

Currently 9.1 lbs / 4.1 kg, BCS 5/9
castration / Rabies vaccination, and he is especially itchy at night. He has seborrhea, patchy alopecia, and a yeasty odor, the signs are worst on his back, and in his axillae. V reiterated that they do not intend to keep Fletch, so they don’t want to feed raw or take the time for a homeopathic intake. V gave Apis for itch with no effect. Antihistamines and medicated bath help somewhat. I recommend adding fish oil, vitamin E, antioxidants, quercetin and bromelain gradually to the diet.
V asks for symptomatic homeopathic treatment, so I give a split dose of Thuja 30 C to help with all the effects of conventional medicine. There is little change, so I provide Sulphur LM 1, and V feels there may be less itch.
V continues supportive treatment for Fletch with weekly baths, and herbal skin spray, or oilated oatmeal spray to use symptomatically for itch.
V is frustrated because she is doing a lot of supportive care, and Fletch is still itchy. She asks to try ketoconazole 4 Dec 18, and the itch greatly improves, then worsens again after the course of treatment is complete. She would like to know why he is itchy, and I suggest seeing a dermatologist for skin testing. The dermatologist, seen 15 Feb 19, does not skin test. He diagnoses pododermatitis, pyoderma, otitis externa, +/- atopy, +/- food allergy, anal sacculitis, and possible primary seborrhea. He gives Cytopoint, ophthalmic & otic antibiotic/steroid, enrofloxacin, and
This is an itchy skin case with which I have had little progress. I presented it at our 26 Feb 2021 case conference. I present the case below, followed by the fantastic input that I received at the conference. The case is a work in progress, as I implement my new ideas.
Fletch is a male Shih-tzu, whelped 1 December 2014, and surrendered to a rescue in the summer of 2018. Fletch’s history is unknown: at surrender he was underweight at 3.5kg, had a scar on his left cornea, and was intact, so he probably was obtained as a puppy, as virtually all US rescues neuter all adult dogs. He received Distemper – Parvo vaccination and multiple antibiotic treatments for a UTI in June 2018. V & K (V is the primary caregiver) take him as a foster dog; they are unwilling to definitively commit to another dog. I have treated seven of their previous pets over the past 20 years. They live 90 minutes from my practice, and the rescue will pay for the local vet treatments, so Fletch is treated conventionally for a number of ailments. Fletch is castrated and receives a Rabies vaccination in September 2018 from the rescue.
Conventional treatments:
Pre-existing corneal scar – antibiotic / steroid ointment Back pain after grooming – analgesics July & September 2018
Clostridium dif diarrhea – metronidazole September & November 2018, July 2020
Castration and Rabies vaccination September 2018 Ear infection – otic antibiotic / steroid drops Weekly baths in medicated shampoo
Thyroid hormone replacement therapy
I first examined Fletch on 7 Nov 18. His skin worsened after
23
continued on p22