I'm really struggling with a skin case - Curlie is a 5 year old Kelpie, the owners have had him for 2 years, and he has had severe pruritus since then. Prior to this he was at a rescue centre mainly on concrete and apparently his skin itching was not as severe.
He has a dominant personality, when he was first rehomed he mounted owners and other dogs (despite being desexed), would growl when disturbed from sleep and was generally grouchy. He was also hyperactive and hyper excitable. This has improved but he is still a strong personality, stubborn and dominant. The owners describe him as very confident, he doesn't care about danger and he will fight back if another dog has a go at him.
They have tried several different diets for his skin, most recently on a single protein goat BARF diet for last 3 months with no improvement.
I really thought he was the poster boy for Shao Yang Disharmony with underlying Blood Deficiency;
no improvement on a low carb/high protein real food diet
some signs of Blood Deficiency (dry coat dorsum with fine dander) and Stomach Yin Deficiency (heat and redness groin and ventral abdomen)
alopecia around the eyes with occasional greenish ocular discharge
irritated ears prone to dry discharge
chewing at feet++ but minimal changes to skin - mild redness only on ventral surface
tongue was pale pink with lavender centre
pulse was wiry, forceful, mid - deep level
AP BL 19
I started him on CHLJGMLT + YGJ. I recommended to add vegetables to make up 15-20% of diet and added a probiotic. he is also on omega fatty acids and zinc supplementation.
Revisit 2 months later - no improvement. At this time he also had a wound on front leg and he was on Cephalexin antibiotics. Once they finished owner noted itching worsened.
I continued CHJLGMLT/YGJ and added XCHT/SWT and BZYQT
I also left her with QYT to start if itch worsened.
Revisit 1 month later (which was today) - worse!
The owner had added in the QYT about 3 weeks ago. She also described him as being super hot on his body especially groin, and sweaty on dorsum.
He now has an E collar on all the time to stop him from chewing. If this is off he will chew his feet until they bleed - but surprisingly there is nothing to see on exam, no redness, no obvious infection.
Skin generally looks fairly normal, still dull coat on dorsum with fine dander. Pulse was still strong, toned, possibly slippery (I'm not great on diagnosing that one). AP BL 18 and BL 25.
I stopped the BZYQT in case this was worsening feet itching
I still think he fits SYD type of case, but I'm not sure where to go next - whether to continue the QYT and Halscion/Cessorex, or change tacks completely and try something like LDEMS. This could fit some of the behaviours / feet eye and ear issues, but he just didn't strike me as a Damp dog, more dry and Blood Deficient.
He's been on the QYT for 3 weeks, Halscion for 3 months, and Cessorex for 5 weeks... does he just need longer despite things looking worse? It is spring time here so perhaps this is his flare up time?
Thanks so much for your help, Curlie's a tough case!
Sophie