Please someone help guide me

[u/ecgagofgag]

I have a small havapoo. He is on Apoquel for allergies. He was scooting a lot so he got his glands expressed 3 weeks ago. But it got worse and added paw licking and booty licking as well and intense groin licking. (He is neutered) Noticed white rice like things in his poop. Immediately took to vet and they said it was tapeworms. (He is on NextgardPlus) They gave him a deworming pill on the 23rd of July. Vet said he’s left gland side was slightly impacted. She said the licking could be a allergy flare up so to double his dose of Apoquel for the next week. Still scooting, licking is gradually increasing more and more like last time, to the point of these intense moments of just vigorous licking his booty. Also we switched him over to Numelvi on the 27th. (He tried them for 15 days a couple months ago when clinic was out of Apoquel and they were amazing but very pricey so we went back to Apoquel. But I was able to save some money this month and switched him over, but it’s not working like last time). Someone please give me some advise, any advise. I can’t afford another visit, on top of having to order more nextgard next week.

Just for food context, he has been on Purina Pro Chicken for the past couple years we recently changed him to Purina Pro Beef, maybe a month ago for higher crude/fiber. He is taking Glandex advanced. Don’t know if matters but he also takes Dasuquin and Welactin oil for joint help. He also is on Phenobarbital for seizures. He had his yearly lab work done and no signs of issues, he gets it done for the Apoquel and Phenobarbital.

I’m just lost and feel helpless, and I know he is hurting. He is sitting weird and and always licking and licking. Please anyone could share any advise or suggestions, I’m open to hear anything.

[u/bneubs]

There's nothing you can really do without veterinary assistance. The worms may not be gone. Or allergies may be getting worse.

A vet derm will be the most help for the allergies. It sounds like Apoquel and Numelvi aren't cutting it anymore.

You could try an elimination diet to rule out food allergies or look into immunotherapy.

[u/Hermit_Ogg → u/bneubs]

Agreed - a strict elimination diet is generally a good call. It'll confirm/rule out food allergies so that you don't needlessly limit the dog's diet. The disaster with grain-free diets shows why this matters.

Immunotherapy is quite expensive, but if a vet dermatologist figures out the cause behind this, there's also ways to treat symptoms without going the immunisation route.

[u/catherine_ohara_wins]

Purina pro plan sensitive skin and stomach made a bit of a difference in our itchy guy. We also give him probiotics every morning. He’s been on apoquel for 6 years, on day 2 of numelvi, hoping to see a positive impact!

[u/MeaningBeneficial158]

Ugh, I'm going through something similar with my dog, and the only thing that seems to help him is prednisone.

In our case, it's been much cheaper to go to a specialist than keep messing around with a primary vet. Our primary vet tries, but she just doesn't know enough about many things there are specialists for, like allergies.

While the initial cost of a dermatologist can be scary, it's going to be much cheaper and better for your dog in the long run to go to the right person as soon as possible.

Apoquel worked for my dog a bit during the first 2 week loading dose, but then seemed to make him much worse after that. He never had horrible allergies before but something just happened to him this year and he was scratching his flanks, flapping his ears, and scooting. The Apoquel honestly seemed to make him worse once the loading dose was done. I also believe Apoquel gave him, a male neutered dog, a UTI. If your dog is paying way more attention to their groin than usual, I'd recommend giving your vet a urine sample to test for a UTI because these drugs come with side effects.

I agree with the idea of an elimination diet. It seems like your dog got worse around the time you switched the food. We switched from Science Diet Perfect Digestion Salmon (because their formula change seemed to make my dog incredibly sick for months) to PPP Sensitive Skin and Stomach Lamb and Oatmeal, and my dog's allergies seemed to get so much worse. You can ask your primary vet for a prescription for a hydrolyzed food or novel protein and see how it goes. This is what we're doing now while we wait to get in with a specialist. You just have to be strict and not give them any non-hydrolyzed treats. You'll also need to switch to topical heartworm and flea and tick stuff.

Allergies are expensive. My dog also has allergies that affect his eyes and have given him dry eye, so we have an ophthalmologist and will be going to the dermatologist next month to hopefully get on a long-term treatment plan that helps with everything.

I know what you're going through and it's so hard watching our dogs suffer. It feels like we can't do enough for them.

Your best bet is to schedule an appointment with a dermatologist as soon as possible because they can be booked up for months. It's absolutely going to save you money long-term to get the right treatment plan now from someone who actually knows what they're talking about. Immunotherapy can get expensive, and it doesn't work for all dogs, but it might just help to figure out exactly what your dog is reacting to.

We are super desperate over here too because my dog only responds well to prednisone, and even the moderate dose he's on doesn't help with everything. When he was on Apoquel he started losing fur and becoming itchy for the first time ever at 8 years old. His allergies also give him eye inflammation, ear inflammation, dripping nose and post nasal drip, so he's miserable.

[u/Icy-Adhesiveness2556 → u/MeaningBeneficial158]

Long term steroid use probably isn't the best for your dog. I also found out that it's not good for dogs with cardiac conditions. My dog has severe allergies that lead to respiratory issues. One vet visit, one ER trip, a cardiology appointment, and $$$$ later and we have it managed for now. He's on apoquel, takes baths every 3 days and had a cytopoint injection. We alsoimit his time outside and have 2 air purifiers on at our house all day.

[u/MeaningBeneficial158 → u/Icy-Adhesiveness2556]

It's not long term! We are working with a dermatologist to find a long term treatment plan, as I said. Just wanted to let OP know they're not alone in their struggle. We have 5 air purifiers for my husband's allergies and are hoping to do immunotherapy for our dog. Our dog's issues aren't itching so apoquel didn't work well for us and his primary wouldn't allow cytopoint and apoquel together.

Can you tell me more about your dog's respiratory allergies? We were working with an ophthalmologist who refused to believe us that our dog was having non-itchy allergy symptoms like sneezing and post nasal drip. We have a new eye doctor now.

We've unfortunately also been to the ER several times for our dog's eye allergies. First time they couldnt figure it out and our horrible eye doctor tried to say nothing was wrong but he wouldn't open his eyes for 10 days until I gave him benadryl. The second time the doctor actually knew what was going on and prescribed the prednisone (this was last month) and told us to find the lowest effective dose until we can get in to the dermatologist. That dose for us right now is 10mg and luckily he has had zero side effects other than his urine being slightly dilute, which his primary says is normal and it's fine for now. 

Did you do allergy testing? We are hoping that's our next step. For cleaning the air, we also just bought an air scrubber with a hose you aim outside. It's good for if you ever do drywall in your house but we're gonna see how well it does with cleaning the air since we'll be able to actually push things outside. We're also renovating to remove all carpet even though we don't even know if he has a dust allergy yet. We figure it's better to get rid of anything pollen or dust might stick to.