Vulva problem

If you have a dog with a known liver problem please consider trying a holistic vet who practices "traditional Chinese Veterinary medicine" -- [linkhttp://www.tcvm.com]http://www.tcvm.com[/link] -- there are several Chinese herbs that can help detox the liver AND regenerate it.  Milk thistle is a western herb and also extremely helpful but you really need a tcvm vet to do this justice.  Acupuncture also is extremely helpful for liver problems.  There is a locator on that website -- I'm not suggesting you leave your regular vet -- not at all.  But adding tcvm can often work incredibly well with western veterinary medicine. 
 
There are Chinese herbals that work similarly to antibiotics and are great for skin problems.
 
Could this possibly be a contact allergy?  Has the vet investigated it?
 
Have you tried plain aloe (like freshly harvested from an aloe plant?)  That should help enormously to cool and heal. 
 
Has the vet investigated the possibility that the urine is too acidic or too alkalyne?  This seriously sounds like a kidney issue.
 
Is she spayed? 

Have you tried an antibiotic/anti-yeast shampoo? Is she overweight?

Have you tried an antibiotic/anti-yeast shampoo? Is she overweight?

 
Yes, this is what we use when we soak in the tub and during the nightly washings.
 
She is not as lean as she use to be but I still think she is okay.  She weighs 80lbs and is 26 1/2" tall at the withers. 
 

Could this possibly be a contact allergy? Has the vet investigated it?

Have you tried plain aloe (like freshly harvested from an aloe plant?) That should help enormously to cool and heal.  
No is it toxic to dogs?  I will try it but I also don't want to risk anything because she does lick the area if it bothers her.  Hence adding to the irritation problem. 

Has the vet investigated the possibility that the urine is too acidic or too alkalyne? This seriously sounds like a kidney issue.
 
We have been through many things.  The vet said she is not sure anymore.  She said if it continues we could go to a dermatologist but we are still finishing off all the bills from Madi's liver issues.  Thousands of dollars later they still don't know what caused it and what we should do from here.
 
Here is the story on her liver:  Madi had to go to the vet for a check up because she was working on her Therapy certification.  As a result of the blood test we learned her liver counts were over 480. (they should be around 80).  We immediantly did an xray and her liver was an odd color and small.
 
So we did a biopsy/ultra sound and several other tests.  Final diagnosis...
small liver that was bright red. No cancer, no hepatitis no cause.
 
I changed her diet, increased the walks and she is now on a liver medicine.
 
Three months later her counts dropped to 180+.  She does not act sick we just know it is there and I have to watch what she eats and she can't have pain medication, antibiotics etc.  I was told that when she acts sick we are in trouble.
 
Worst part of the story is that the vet would not release Madi to be a therapy dog for fear she might catch hepatits from a human or other animal at the hospital.


Is she spayed?

 
Yes.

I am a vet tech.  If this were my dog I would, First, I would have your vet run a urinalysis to see if anything in the urine could be causing this.  When the urine is obtained, have the vet do a cystocentesis (needle inserted directly into the bladder to get a urine sample) instead of just catching a sample (contamination is more likely this way).  If the UA comes back normal, your will have to move on to other options
 
Next, you may want to consider a biopsy of the affected skin.  Our clinic sends all biopsies to an outside lab (why have a gp read them when you can have a specialist read them?)  A gsd that comes in our clinic had vulvar lesions and biopsy confirmed lupus.  The dog was diagnosed 3 years ago, and is still doing well due to excellent care by her owner.  Callie definately has a great point about both milk thistle and accupuncture to help with liver issues. 
 
Keep in mind that if the dermagen is not helping there are other things that you can try.  Our clinic has been using silvadene cream (cream used for burns in humans) as well as human grade collagen (the spray is easier to manage than cream) on skin lesions with really positive results.  If your vet thinks that either of these are a good idea, have the vet order them for you instead of calling them in to a pharmacy.  Pharmacies in my area at least have a huge markup on these items.  I paid $106 for a bottle of collagen for myself and then 1 week later found out that one of our drug distributers sold the exact same product for $11.25 so waiting a day or two for your vet to get these drugs in would be worth it.
 
I hope that this helped you a little, sorry if it's a bit long.

I like the silvadene cream idea. There are also several antibiotics on the market that are excreted via the kidneys only, so antibiotics aren't totally out of the question if she has a skin infection... but I agree, they aren't a first choice option.

Have you thought about seeing a board certified dermatologist?

The liver problem was only diagnosed last year -- however you say this has been going on for 'years' and I have a feeling you're gonna ultimately find that the vulvar skin problem is RELATED somehow to the liver problem. 
 
When she 'acts sick' that's because the liver isn't filtering out the toxins.  When a dog is in renal failure (kidneys) and the kidneys don't filter out toxins the dog gets nauseus because the toxins pour into the stomach, ulcers develop etc. 
 
However, liver toxicity is 'different'.  Liver toxins actually shunt directly to the brain -- so when liver toxicity becomes evident (and the dog 'acts sick') it's really the brain TELLING the gut there is nausea, not that there IS true nausea.  Fine difference but one to be treated completely differently. 
 
There is a medicine called "lactulose" -- it's actually a laxative, BUT it's often used in liver problems because it binds liver toxins and helps get them out of the body RATHER than them ending up shunting to the brain and staying there.  It's a tough med to take -- they can take pretty huge doses of it BUT it **IS*** a laxative, so of course the more they take the more diarreha they get so it's pretty well a double-edged sword.
 
I'm pretty famliar with liver problems AND with the remedies that go with them.  I had a dog who virtually in a few hours developed a ENORMOUS liver infection.  It was at first diagnosed as "liver failure" -- old dog, looked like cancer, gee take him home and get him put to sleep (that's what they told me at the e-vet).  They put him on an IV drip with antibiotics *just in case* and essentially didn't bother to listen to me.  The x-ray of the liver was DIRE.  It looked so bad -- truly it did.  How could he survive with a liver that looked like that!!  (swollen, uneven, bad bad texture, generally looked really horrific)
 
But they weren't listening to me when I told them he'd eaten something extremely toxic -- I knew the dog I knew the symptoms I saw and my own vet (the next morning) and HE ... knowing me and how incredibly hands-on I am and how much I 'notice' -- essentially he put him on antibiotics just to pacify me.
 
I took him to my holistic vet the next day -- and she confirmed everything I already suspected.  She looked deeper into the records -- that there were dozens of small signs that this WAS an infection.
 
So -- to supplement what the regular vet gave him, she added liver supplements, and milk thistle AND A chinese herb that mimics milk thistle.
 
WHOA -- in a few days I had a new dog.  Well still a 17 1/2 year old dog at that time but an almost completely recovered dog.
 
My point is this -- PLEASE don't sell integrated medicine short.  I'm not telling you to leave your regular vet.  I'm telling you to AUGMENT the care -- acupuncture helps healing, acupuncture helps detox the body, and acupuncture can generally put the body on a faster track to heal.  I've had incredible experiences with Chinese herbs (both with the dogs AND me) and how they can *augment* regular veterinary medicine. 
 
My other thot on this one is the thyroid.  The thyroid is a body balance thing -- and it can feed into liver problems and adrenal problems (Lupus, Cushings -- yep, diseases like that which can be fatal if untreated but which can be incredibly well managed if caught).  But if the thyroid is 'off' nothing you do will help.
 
DON'T just have the vet send a lab test in -- it's pointless.  A regular lab assumes all breeds are 'alike'.  You get back one result that's a pass/fail for all breeds.  A chihuahua and a labrador are completely different metabolically.  A rottie and a vizla ... a cocker and a whippet -- none of them are the same -- size doesn't matter -- body metabolism does.
 
have the vet send the results to either Dr. Jean Dodds directly or to Michigan State University -- Dr. Dodds set up MI's lab and they use her protocols.  This isn't weirdo stuff -- this is just incredibly accurate. 
 
Your ID says you are in NV -- again I'm going to ask a couple of questions.  Would you happen to have St. Augustine sod?  Would you happen to have night-blooming jasmine, wandering jew (any one of 100 varieties either as an indoor houseplant or as a climbing weed, planted as ground cover, etc. outside or anywhere one of the resident HUMANS could possibly have contact with anything like that?), or poison oak?
 
The 'root' of the skin problem could well be contact allergy.  She's thick-coated and may not 'show' irritation elsewhere -- but it sure could bother a female who dips and squats in/on a plant that is an irritant, OR who may lay on her belly IN THE HOUSE where someone has walked who has walked thru an irritant. 
 
The fact that you bathe her frequently may keep it from spreading elsewhere.  But that skin is SO tender and sore and bless her heart she's gotta pee.
 
That's just another 'thot' for you in any event.
 
There are two ways a sterile urine draw can be done for a urinalysis and honestly, I think the above is right -- you probably DO need a sterile urine culture done.
 
The second way is by cathether (and most vets generally prefer to do it that way -- at least ones I've worked with and my Billy has had probably 6 or 8 of them in the past 6 months).  The big deal is when you take a 'caught' urine specimen, the urine is going thru the urethra that's essentially passing over sore skin that may also be infected.  So doing the sterile urine draw is likely the ONLY way you'll get a true sample. 
 
A culture & sensitivity doesn't just look to see if there are infection cells present.  It actually cultures the urine to see what will 'grow'.  THEN after they see what will grow they see what different drugs will KILL whatever grew.  Not just one drug but many -- so the vet gets back a report that says ok, amoxyl, cephalexyn, Baytril, Cipro, etc. will all work, BUT drug B was fastest or whatever.  Then the vet looks to see which drug goes thru what organs and which one is the hardest/least nasty on the liver.  It gives you very specific results.
 
Did they ever come up with what caused the liver to be so insufficient??  That would concern me -- that could also be your target as to why the body was putting out so many toxins that could have started this skin infection that you never get rid of.
 
The biopsy idea also may have merit but it's hard on the dog -- biopsies don't just diagnose cancer -- they take an actual section of skin (not just a scraping but a cross-section of skin) and analyze it.  Not cheap again, but it gives you more definite results.
 
See, I'm not anti -traditional medicine, but I can promise you that PARTICULARLY when you are dealing with an organ like the liver which can be encouraged to regenerate boy I'd be at a TCVM vet in a heartbeat if I were you.  It could potentially make the problem go away from the inside. 
 
And bless your heart -- you bathe this girl every day -- I KNOW what kind of a commitment that is to a dog.  I KNOW how much time that takes.  What I'm saying may actually ultimately reduce all that effort and concentrate it where it will make a huge difference.  Even if you've never 'been a believer' in alternative medicine -- I can cite you time and time again when I've seen it do awesome things.  All my experiences started at the U of Florida where they actually teach both acupuncture and Chinese herbals.  That's pretty broad-thinking for a 'state university'.  But they see it work.
 
Good luck.

Melissa; I don't have any advice to offer but I hope some of the advice the others offered helps; poor Madi. Please update us if you find anything that helps her; I'll be sending healing vibes.

Madismom, a friend of mine has a dog who had vulvaplasty also. I would be happy to put you both in touch with one another through email if you'd like. Just let me know []
I actually talked about your post with her and she gave me so much info but I really didn't retain it.