A: I appreciate what you have been through. We’ve worked with hundreds of cases as you describe, and receive similar referrals from many veterinarians. Skin issues are some of the toughest to manage and I say manage because often that is the best possible solution. Skin diseases are frustrating to veterinarians, their owners and most sadly to the animal. They are the reason many dogs are surrendered to shelters, due to owners not being able to take it any longer. They are costly on many levels.
In my experience with the symptoms you describe, I suspect your dog is Blood Deficient from a Traditional Chinese Medicine perspective. In addition, she is a blue, and I was just talking with my colleague yesterday, that blues—no matter the breed—so often have thin coats and problematic skin. Based on TCM theory, Blood Deficiency means she does not have enough healthy blood to circulate and nourish the skin and coat, nor prevent pathogens from attacking the skin. Blood Deficiency can be due to chronic health issues, trauma, inappropriate diets, and poor digestion. It’s also not uncommon to see behavior issues, such as anxiety, with similar skin problems. By using antibiotics, anti-fungals, topicals, etc., you have been treating the symptoms—plugging holes in the dam, but you are not reinforcing the structural foundation to prevent the dam from collapsing. Yes, diet is a key component, and figuring out the most appropriate is a challenge with today's many options. Raw is one I am in favor of, but choosing which one may be hard and with manufacturers changing formulas, or using so many ingredients, she may not handle well currently. So, it’s important to work with a pet food stores that understands the differences in the multitude of diets, and how to prescribe them therapeutically.
Based on her symptoms, I DO NOT recommend any dry food for her. Yes, this includes grain free as they can be even more inflammatory than your basic meat and grain diet. It the volume of carbs—not the type—and the over-processing of dry foods that trigger inflammation. Grain frees are typically not higher in meat, it’s just the grain has been replaced with another carbohydrate, such as potato. I have seen exponentially more dogs reactive to potato than grains.
My recommendation: make her food. It will be less costly, you will control the quality of the ingredients, and she will enjoy more. And, I bet you will see improvements almost immediately. There are recipes on our website under Resources. I suggest the Basic Dog Food recipe by Dr. Fougere, then try Dr. Basko's Big Liver stew. Both are easy if you cook for yourself. In my studies, I have found in most animals, protein allergies aren’t the major issue, it's more the carbs and the over-processing of commercial foods. Still for now, I would stay away from chicken unless organic, consider turkey or beef as meats and use organic or free range whenever possible. Stay with fish oils, but make sure it is a quality brand that uses reliable sourcing.
Once you've had her on home-prepared foods for a month, reconsider making an appointment and we can talk about herbal therapies for Blood Deficiency.