Also, to clarify, yeast overgrowth is virtually always secondary to something, like allergies or seborrhoea. That is, yeast overgrowth is a symptom rather than the primary condition. I'm saying this in response to "Can a vet derm tell if it's yeast or if it's another allergy?"




" So which allergy test is best and what is involved with getting it?"

This is approximately how I think it will go:

The derm vet will take a scraping (which is a simple lifting of skin cells to 'scope), using something resembling Scotch tape, or maybe a dull spatula-like blade.

You are describing what to me sounds like yeast, with the odor and the skin darkening and the body geography (toes, muzzle, around the anus), IMO, but yeast (like Malassezia) is very often part of a yeast-bacteria combo. A skin infection can encourage the yeast overgrowth --- and a yeast overgrowth triggered by, say, seborrhoea or allergies, can encourage a bacterial infection.

The cells the vet lifts and tests will tell him/her what is going on with the skin. As Lori says, there is a lot to try/do to provide immediate relief while the next step (determining the underlying trigger{s}) is considered.




PS
I'm not a health professional of any kind. All JMO.

Connie's opinions are almost always right!! JMO!!

Well we had him back to our regular vet today and he got a shot and also is on a combination of a few different antihistimines. She mentioned about allergy testing and I said I have read that blood tests are not reliable and she didn't disagree with me. I told her I read that intradermal testing was better and as soon as I said this she said she can suggest a derm vet in MD. that we could call and see if we would like to move forward with this. I did find a derm vet locally but he charges $375 for the intial visit and then $1200-$1400 for the testing. They told me they test for 56 different allergens and that he has to be put under. We can not afford this amount so I am going to call the vet derm in MD. to see if he is more reasonable with the cost. Does anyone think this the derm vets cost was high for this testing? I am not rich and I can't afford $1800 right now. I want to help my dog but my gosh are these the normal costs for a derm vet? He seems so confortable tonight. I wish he could be like this all of the time.

Cindy,

I took my GSD to the derm vet 1.5 years ago, the cost was $700, she was tested for 38 allergens, the fee included the visit, cytology testing (scotch tape between toes to look for yeast infection), the intradermal allergy test, a bottle of shampoo for the yeast infection, oral meds for the yeast infection, and allergy shots (enough for about 4-5 months, she is on a 2-week schedule, each additional refill of allergy shots costs about $200).

Just for your reference

A shot of what? If he seems comfortable already, I'm guessing more steroids. Did you talk about yeast and a skin scraping?

The $1200 isn't shocking to me if it includes the cost of the individually compounded immunotherapy (desensitizing injections). As I recall, I spent about $400 for the derm vet and $400 for the lab (latest one, but it was a few years ago).

We did not put the dog under (a big chunk of cost, I would guess), but just sedated her.

But again, there are steps to take short of intradermal testing, and I gotta say that your GP vet is not doing/suggesting any of them, even the most obvious (scraping).

One thing is that the derm vet would probably be more conservative with the Pred, using the lowest oral dose that was still effective to break an itch cycle and not resorting to injections except as a last resort. The derm vet would identify the skin infection (what bacteria and/or yeast) and would treat the infection(s).

The initial visit would probably take about an hour. The vet would review your dog's file from the GP vet and do a careful dermatologic examination. S/he will explain his/her tentative diagnosis and discuss tests and therapy. S/he will be able to help with short-term relief from topicals, and s/he will identify what infections need to be treated. All of this is both necessary before even thinking about scratch tests (intradermal) and also helpful in and of itself.

I would explain very clearly that I was not prepared to go the intradermal route at this time but that the dog was in dire need of help; he is not even being treated (or tested) for skin infections and he has had no antihistamine trials.

(What is a "combination of antihistamines"? Ten-day trials of each one along with fish oil are the usual protocol. Even though only about 30% of allergic dogs are benefited by antihistamines {and which one is VERY individual}, the rate goes up significantly when it's combined with fish oil and avoidance of the most common airborne allergens in your area {that is, a HEPA filter on your furnace, baby wipes or a foot bath before the dog comes in from grassy areas, frequent bathing {or rinsing} to keep the dog's fur relatively free of allergens that would otherwise be breathed in 24/7. etc.}).

There are four that work with dogs (far fewer than than the number that work with humans), and they are hydroxyzine, chlorpheniramine, clemastine fumarate, and diphenhydramine (Benadryl). Benadryl has the lowest success rate, but that would not matter to the dog who is helped by it. The first two I named have the two highest success rates. Again, the rate of success goes up when long-chain 3s and avoidance are employed concurrently.

Cyclosporine, or Atopica, is also pretty successful in treating seriously allergic dogs.

The derm vet would understand that oral Pred, if needed, allows a much more accurate and individual dose. It's true that sometimes instant relief is needed, and it's a balancing act, but a derm vet is going to take into account that a shot cannot be un-given, with its possible side effects. With pills, side effects can be monitored and the dose can be adjusted (or the kind changed, like from Pred to betamethasone, dexamethasone, or others) or, if need be, the protocol can be stopped.

The glaring omissions that I see from here (I am NOT a health professional, so this is JMO), are that no diagnoses of either the infection(s) or the trigger are underway. The bacterial and yeast infections that commonly "come with" allergies need to be treated -- not just the atopy.

For a bacterial infection of the dog's skin, a culture and sensitivity can help suggest the right antibiotic to use.

For a yeast infection, there are antifungal medications and even pretty good topicals (several of which I keep in the house, such as anti-fungal shampoo and Chlorhexidine pledgets). There are RX medicated bathing protocols, involving lathering the dog and keeping him occupied in the tub, maybe with a marker session or a toy or just tiny treats, in order to let the med permeate the skin before it's rinsed off, and then applying a leave-in rinse for additional protection.

Obviously, I can't suggest that any of these will be what your dog needs or your derm vet advises, but he (the dog) needs these options to be available and considered. Again, JMO.

I would arrange for a complete copy of the dog's chart to be made and I would start notes and a log about when, where, how bad, etc., for the time between now and a derm vet visit. That is, on a scale of 1 to 10, how bad was the dog's itching on a given day, and had he been outside, was it raining, was it windy, had he had an antihistamine, and so on. I would ask for phone consults with the derm vets available (not a "can I talk to him now for ten seconds") to explain the financial limitations and the dog's need for immediate interim help.

Anyway, that's what I would do.

And like several others here, I speak from more experience than I would wish to have.

 Quote: Melissa Hau

Cindy,

I took my GSD to the derm vet 1.5 years ago, the cost was $700, she was tested for 38 allergens, the fee included the visit, cytology testing (scotch tape between toes to look for yeast infection), the intradermal allergy test, a bottle of shampoo for the yeast infection, oral meds for the yeast infection, and allergy shots (enough for about 4-5 months, she is on a 2-week schedule, each additional refill of allergy shots costs about $200).

Just for your reference

Oh, right, thanks, Melissa, for the reminder! I also refilled the final 4 vials twice, I think, for $100 each.

We saw results start with the last dog doing this in about 3 1/2 months. The injection protocol was 6 months, if I remember right.

I agree with everything Connie said (like always, LOL)

My GSD started seeing the derm vet May 2009, we did a 6-month follow-up, at her 6-month follow-up, she was already 90% better, so the derm vet told us to just follow up annually, we already made an appointment for next month.

I am not sure how long the dog is supposed to be on the allergy shots, but I do know her derm vet may drop her down to once a month because she has been symptom free since Nov 2009.

It took me 1.5 years to get a good handle on my dog's allergy problems. Her vet initially gave her steroid shots, when I realized that he was planning on giving her monthly steroid shots, I asked for other options.

He suggested allergy shots (based on blood work), we tried that for several months (almost 9 months?) and it didn't do anything. We also tried Atopica, she was on it daily for 9 months to a year, it was moderately helpful, but it never made her symptoms fully go away.

Don't waste your money on the blood work for allergy shots, my dog had allergy shots made based on blood work and intradermal testing, looking at the results of the two tests, they matched 50% at best.

I was so glad that I finally learned about the derm vet from one of Connie's posts.

My dog used to lick her paws until they would become raw, after the derm vet visit, I started her on the medicated shampoo, it helped tremendously! I used it every 3 days, I had to leave the shampoo on her paws for 10 minutes. If I recall correctly, her paws looked much much better within two weeks, I didn't even have to give her the oral medication.

My dog's derm vet, like Connie said, was very conservative about steroids, in fact, she did not even want my dog on Atopica long term. She was worried about the long term effect of Atopica on a young dog. She educated me on fish oil (which I already learned from here) and antihistamines (which I learned from here as well :grin.

And I want to add that finding a derm vet sooner rather than later is going to limit the amount of cash you are now pouring into the GP vet visits for almost nothing. Steroids not only cannot cure anything (although they can be an awesome magic bullet), but they have very serious potential side effects (especially with shots).

The dog is not being tested, not being diagnosed, not having his infected skin treated ....

If he does need a heavy-duty steroid, he can at least get it along with some long-term help.

I hope that Mike Armstrong sees this thread. He's another very experienced dog-allergy guy, and he will probably remember stuff I am forgetting about management without (or until) intradermal testing. He has his dog's symptoms about 90% controlled with careful and constant management.

Thanks for the prodding, Connie. I haven't spent as much time on the board lately as I have in the past, but glad to jump in with a little different perspective. I quickly skimmed the posts to get the general gist - allergies - and the preferred treatment - derm vets, so, sorry if I missed some of the fine points. I'll be glad to go into more details but will make this short. I never got around to going to a derm vet with this dog. I did many years ago with a previous GSD, wasting $ on blood testing. My current GSD is the 2nd in a row (both were rescues) to have really bad allergies. Over the years, I had managed to control the problem reasonably well with a raw food diet, regular antihistamines and fairly regular prednisone. Then I discovered the probiotic approach.

Successful treatment of allergies requires a two-prong approach. First, and most commonly, we try to control the environment - different food, cleaner bedding, wiping down their feet, more vacuuming/dusting/bathing, etc. Helpful, but very rarely a success.

To me, the crucial 2nd part of the treatment is building up the immune system. From Huffnagle's Probiotic Revolution,
"Allergic reactions are the result of yet another immune system mistake. They occur when the immune system's database classifies innocuous particles from the environment - allergens - as threats. The particle could be a perfectly healthy food. Or it might be something we inhale, such as pollen, cat dander, mold spores, or dust mites. . . The problems described - autoimmune diseases, allergies, out-of-control inflammation - have a single cause: regulatory T cells didn't do their job. Either they didn't develop properly, or they didn't develop in sufficient numbers to counterbalance the activity of the helper T cells. . . we already know that probiotics can help the immune system develop regulatory T cells, the white blood cells that travel through the body and turn off inflammation."

Through months of experimentation, I found a combination of supplements that finally got me a symptom-free dog. What's working for us is daily yogurt (a good brand of plain) and kefir, a probiotic supplement (Culturelle caps) and LB's "Clear Allergies" (some kind of funky Chinese herbs.) This is a highly individualized approach, so I wouldn't suggest that this same combination would be equally effective in another dog. But the same concept can work just as well.

In the last 15 months, we've used absolutely no antihistamines and 2 or 3 pred tablets. . . and, as Connie said, careful and constant management.

HTH

Mike

 Quote: Mike Armstrong

... In the last 15 months, we've used absolutely no antihistamines and 2 or 3 pred tablets. . . and, as Connie said, careful and constant management.

HTH

Mike

Can I just add that graduation to NO antihistamines says a LOT.

I'm glad you emphasized the probiotics, Mike, because I haven't mentioned that again since page one here.

My very allergic dog gets a lot of fish oil and a lot of good yogurt. In his worst season he also gets one of the best-tested (ConsumerLab) powdered probiotics, capsule opened and stirred into the yogurt.

We have another probiotic thread going on here right now, in fact.

Of course, none of this replaces diagnosing the skin infection(s) and yeast and getting them treated asap.