Question Details
Itchy Paws In A Dog
by DrLaura - October 4, 2021    View Case Report
106lb lean 1.4yr old GS M/N

Dog has suffered his whole life with itching on kibble since he was born. He changed his diet 5 months ago
Since 5 months ago was on pure rabbit and dermatologist said switch to kangaroo- has been 3 weeks of pure lamb raw Big country raw.
Very gassy and no vomiting
frequent Bm and very constipated at first and 5 mins later goes again and normal
Typically suffers from constipation. After he introduced him to raw.
takes dexamethazone 4mg. Owner gives opposite to ketoconazole- Ketoconazole makes it worse? according to owner
Adorned beast yeasty beast protocol for 14 days. did well- no itching and now 2 days of really bad.
Got into a beef bone from the treat box and he ate it.
All day long pruriritc
Started at the flank and bald on both flanks
2nd episode his head and lost hair
then belly and blisters and was all over lastly his paws.- owner still uses shampoo’s
bloodwork has been done and liver enzymes ok. 4-6 months.
Current supplements:
Hemp seed oil
Dex calms down for a day.
Doesn’t scoot much
Owner got him in winter time. and now summer so unsure- says worse in winter
not outdoors much
Has had heartworm and topical 1 x monthly.
Dreams and is restless a lot
Used to eat grass a lot when on kibble and used to vomit on kibble (stopped at 7 months old)
Seems depressed and hard to motivate, low energy for a young dog
drinks large amount of water less often
prefers the cold
ear tip scales, crusting and redness and alopecia present
Confident/fearless and also affectionate to owner but suffers from separation anxiety as well

Tongue : red, enlarged, white coating
Pulse: didn't assess at first visit, turns out dog was ok for blood collection back leg.

Bloodwork: TG increased, amylase low, lymphocytes low (likely from dex), cobalamin,& folate normal, Diarrhea PCR panel small amounts Clostridium p alpha A nega for rest.
Responded to dex and apoquel. Apoquel seemed transient according to owner.
I was going to try Si Miao San
I feel there is a blood deficiency (dreaming) damp heat/phlegm - coating on tongue, red

not sure where to go with this. What does the worsening response to ketoconazole mean?
Thank you so much!
by naturevet
October 4, 2021
Hi Laura,

I agree that Si Miao San is probably the place to start, since it has 'yeasty beasty' (YB) all in one - meaning supportive tonics (like Pau d'arco in YB, or Atractylodes in SMS) combined with cold bitter herbs (like Huang Bai in SMS, and choleretic liver herbs in YB). If the dog did better on raw than kibble, that is a good sign that SMS will help. The history isn't clear on that.

There are aspects that aren't as good a fit, like being worse in winter, unless the dog is also Blood deficient. Using a Blood tonic right out of the gate with SMS isn't always wise, though. If SMS is right for the dog, you'll see some initial positive signs, even as some signs of dryness worsens. That will be your cue to add Dang Gui. The ear tips are probably a sign that a Blood tonic will be needed eventually. Also, the worsening during winter, and the dreaming. And the worsening on ketoconazole, presumably because from a Chinese medical point of view, it is drying.

If SMS doesn't help, then Xiao Chai Hu Tang + Si Wu Tang is a runner up consideration, given the Blood deficiency, lesion locations and food sensitivity.

Hopefully this helps you out. Please let us know how it goes!

by DrLaura
October 25, 2021
Hi Steve,
Thank you for all your help. Owner needs to be more consistent with herbals and I've talked to him about that. As soon as he can be compliant at least for 3 weeks I will post an update.
Thank you
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