Please help me help him?!? Should I give the steroid?

I'm pretty sure I've asked you this before, so sorry, but how did you test the adrenal system?  Is it a simple blood test?  I really want to talk to my derm vet about doing this (and try to keep from saying "why haven't we already done this?").  The best Sassy has been was right after we put her on thyroid meds last Sept.  Her values were near zero, so she showed immediate and significant improvement right away.  Her fur filled in, the rough patches on her elbows went away, and she was just healthier than I'd ever seen her.  In December, it was almost like it quit working and she hasn't been the same since.  I'm wondering now if we jump-started her immune system but not enough and maybe we need to be looking at more bloodwork.

Since the thyroid med was working there are a few possible scenerios I can think of as to why it no longer worked. The actual medication may not have had adequate levels of the hormone in the next batch. Many of the thyroid drug manufacturers talk about their drugs stability and shelf life. It seems there were issues a while back with some not maintaining an adequate level after manufacturing. My dog has done consistantly well with Soloxine for many years.

My other thought is that your dog just is not converting the T4 into T3. If she was on Soloxine, or L-Thyroxine, those are only T4 hormone. She may need a T3 also.
T4 just floats around and is really the storage level. It needs to go through 'transference' in order to be utilized by the body. That's why a dog can have an adequate  blood level of T4 but still be hypothyroid with a low level of T3 as the body is not getting the hormone it needs.

My other thought is she had adequate T4 coming from the medication and she was able to transfer it into T3 back when she started but it's a possibility another hormone is binding to it now (like estrogen) or even that she no longer makes enough healthy cortisol to aid with the transference of T4 into T3. A small amount is needed for the transference . Here is more info:[linkhttp://tinyurl.com/zcf4w]http://tinyurl.com/zcf4w[/link]

You could ask for an Endocrine-Immune blood test. It tests Blood Cortisol, Total Estrogen (estradiol, estrone, estriol) Immunoglobulins IgA, IgG, and IgM as well as T3 and T4. Prices vary vet to vet but the NVDS lab (www.national-vet.com) charges under $200 the last time I checked. The rest of the vet's fee comes from the price of taking the blood sample, spinning it down and overnight shipping. Different vets charge different prices (my vet is very reasonable though I've heard of some who charge a sky high fee). Only two other labs carry the panel (IDEXX and one other I can't think of). Here is more info: [linkhttp://www.drplechner.com/protocol.html]http://www.drplechner.com/protocol.html[/link]

Also testing for Addison's (ACTH stim test) will test adrenal cortisol function but it won't test adrenal estrogen or other estrogenic compounds and does not show other parameters in case the cortisol is bound. It may be very helpful though to find any adrenal insufficiency.

ORIGINAL: sooner

Thank you for all the excellent information sophia!

Oh you're welcome, sorry for the long post though!

Thank you for all that info.  I'm printing it out and will ask the vet about running the test.  I think it might provide some answers, and if not, at least it rules out some questions.  Sassy's on Soloxine as well and takes 8 mg twice a day.  We had her retested 3 weeks after starting and she was low-normal and the vet said that was okay.  She weighed 98 lbs then and is about 72 lbs now.  Obviously the thyroid meds worked wonderfully for getting the weight off.  The vet did say we should probably retest since her weight is so different, so I may have them do both the thyroid and the Endocrine-Immune blood test at the same time.
 
Thanks again!  I don't think I've seen you on the forum for quite some time, but it's good to see you're back.

Sometimes when the dog's skin is in crisis you gotta use pred for a bit just to get back to 'normal' and then you can begin to treat proactively.  But if you have to repeat that you're not being proactive ENOUGH and you gotta find out what it takes to get this dog to respond.  So sometimes (reluctantly) you do pred a couple of times while aggressively trying to find out what else to do.
 
You can try a vet skilled in traditional Chinese veterinary medicine.  Try the locator on the Chi Institute website -- I've found it really good as a source for people.
 
[linkhttp://www.chi-institute.com]http://www.chi-institute.com[/link]
 
Chinese medicine treats the papules you see in allergy skin differently -- by helping stimluate the various organs (mostly the spleen) to help control "dampness" (Chinese term)  in the body.
 
There are a lot of modalities of different alterative things you can do for allergies -- acupuncture, herbals, homeopathics and others. 
 
But the best luck I've had with thyroid testing was to use Dr. Jean Dodd's protocols.  They test the blood a bit more carefully but specifically they use a different system for tabulating the results.  The basic premise is that it's kinda silly to think that a rottweiler, an akita, a chihuahua and a cocker spanel are all going to have the 'same' metabolic thyroid needs/actions.  So she's developed specific scales for different breeds.
 
My Billy was tested THREE TIMES in a year - he'd come up "low but within acceptable norms".  According to Dr. Dodd's he was just plain LOW -- low enough to need supplementation.  Wow -- whatta difference.  Once the thyroid was balanced the body began to respond to the other things we WERE doing.
 
Dr. Dodd's built the lab at Michigan State -- it's often easier to convince a vet to sent a thyroid test to a university testing lab than just to some independant vet.  Michigan has nationwide great reputation -- Cathy that might be the argument to sway your vet -- or just plain send blood to Dr. Dodd's YOURSELF.  You'll have to pay a vet to draw the blood, spin and freeze it, but the rest you can do on your own if need be. 
 
The supplemment Billy is on is Armour Thyroid -- it's not a synthetic -- it's 'real' thyroid (porcine thyroid in fact).  So it's a glandular and you get a more natural reaction to it.  He's had no problems and gosh his coat has been great. 

Thanks Callie - I know you've got your own issues with Billy, so I appreciate you taking the time to post.  We did the Michigan State Univ. testing (full panel) and I also think we're using the Armour thyroid meds.  I wish that were enough, but it hasn't been.  We did a short round or oral pred (thank goodness my vet wants to be as conservative as possible with using pred), and it helped minimally.  It does make me wonder a little about the benefit we might see if we choose to use Atopica.

You know we have a good holistic clinic here in Sacramento and I've considered it, but I feel, in some ways, I don't have the time or money to pursue the various methods (herbs, etc.) they might offer.  Maybe that sounds crazy, but I have a dog who is sliding from serious infection to another and I don't have time to mess around...on the other hand, maybe I don't have many options.  I don't know and I wish someone would just say "okay, here's what we need to do to take care of this".  Unfortunately, that's not going to happen, so I'm trying to figure it out on my own.

Problem is, I am pathetic when it comes to decision making.   If I have to make the decision on should I buy this shirt I like or a) is it like 100 other tops I have, b) is it too expensive or c) will it go with anything else I own????....well, I tend to get stuck sometimes.  So, now I need to make some expensive decisions on what step to take next and since nothing has worked so far, I'm very ambivalent and my vet isn't sure either.  So, I'll chat with her about some of these things next week, and hopefully she'll have more of an opinion than I do.

Sorry, Now I remember you said you did the MS testing -- but honestly I would be super astonished if you were using the Armour Thyroid -- that' s just rare for regular vets to even know about it.  Sure not common.  Has worked for us well tho.
 
But the thyroid won't 'fix' the skin -- it only balances the body so the *right* treatment will work.
 
But honestly I'd tell you that you've done so many things with regular vets that you might find it would radically change things to get a whole different perspective on it.
 
Holistic vets that are GOOD aren't necessarily expensive.  Particularly not the TCVM becuase you get 'treatment' thru the acupuncture so the cost of the visit IS treatment -- not just the office visit plus plus plus (plus tests, plus meds, plus more tests and then meds to counteract the side effects of other meds).
 
The herbs tend to be way cheaper than drugs.  But the whole principle of the TCVM is to balance the body -- so you don't treat a symptom but rather stimulate the organ that isn't pulling it's weight. 
 
Check out the Chi Institute website for your area.  The first visit is pricey but the vet will spend about 1 1/2 hours with you and the dog.  Not 10 minutes and a ton of tests.  The next visit -- if you run out of an herb fine -- but mostly you're paying for the actual treatment of acupuncture -- I've never had a visit last less than 45 minutes to an hour. 
 
[linkhttp://www.chi-institute.com]http://www.chi-institute.com[/link]
 

[linkhttp://www.sacvetrehab.com/IVCStaff.htm]http://www.sacvetrehab.com/IVCStaff.htm[/link]
 
Callie - this is the clinic I've had bookmarked for over a year now.  It was recommended by a woman, Gina Spadafori, who writes articles on pets, etc.  Maybe a visit is in order and knowing that they do spend a lot of time working with you, would probably make the price worth paying.  We're pretty frustrated with the way things have been going, so a change is in order.

The closest TCVM vet to me according to Mapquest is a little over 4 hours, there's one other listed in the state but she does equine medicine. I'll be happy to drive out there if our situation gets that bad - how would you all suggest I check this person out beforehand?

Has anyone had good luck with the AHVMA vet locater?

ORIGINAL: cakana
The best Sassy has been was right after we put her on thyroid meds last Sept.  Her values were near zero, so she showed immediate and significant improvement right away.  Her fur filled in, the rough patches on her elbows went away, and she was just healthier than I'd ever seen her.  In December, it was almost like it quit working and she hasn't been the same since.  I'm wondering now if we jump-started her immune system but not enough and maybe we need to be looking at more bloodwork.

 
I just wanted to add to the other reply about the thyroid meds no longer working.
 
My vet had the same explanation that I found on the following link (the link pertains to people but he was speaking of dogs)

 Supplemental thyroid given to patients who are both hypothyroid (low thyroid) and hypo-adrenal, who are not first provided with adrenal support, will often suffer from a worsening of their symptoms. However, despite this warning in the Physician#%92s Desk Reference (“Thyroid hormones are generally contraindicated in patients with uncorrected adrenal cortical insufficiency.”), it is an extreme rarity for physicians to evaluate adrenal function prior to prescribing thyroid hormone replacement. 

 
 
 
 
 
 

Thanks for that extra info.  I've just left a msg for my derm vet to both let her know that Sassy isn't doing better and might be a bit worse and that I wanted to chat about running the Endocrine-Immune blood test.  I think it's worth checking into and/or ruling out and I'd actually be very relieved it we found out it was the problem.  At least we'd know how to treat it.  Thanks again!

You're welcome [] I hope you can find a way to help Sassy. I know how hard it is watching them suffer. Persistance often does pay off though and many people have found various ways to help thier dogs live happy, comfortable lives. It can get discouraging at times, but don't give up, the answer is out there.

It will be interesting to see what your derm vet thinks about doing the test; keep us posted. I'm sorry that the antibiotic isn't helping her anymore.

sophia; It's really nice to have someone as knowledgable as you are on the forum; have you studied veterinary medicine or do you work for a vet?

Has anyone had good luck with the AHVMA vet locater?

 
 According to the AHVMA locator there is one holistic vet in our area and I'm skeptical of her method for treating allergies:            
                           [linkhttp://www.naet.com/subscribers/index.html]http://www.naet.com/subscribers/index.html[/link]
 
 
 How is Boomer doing? Are you sure he has allergies?
 
 
 
 
 

This discussion is enlightening and interesting to me.  My Golden, Gumbo, will be 4 yrs. old next month and has never had skin issues.  We moved about 9 months ago into another house and about 2 mo. later he started getting little itchy spots that were kind of scaley.  I took him to the vet and was told it was an allergic reaction and since he had an area of infection he was given antibiotics, steroid and an antihistimine.  The problem went away only to return soon after.  I just changed his food from what he has eaten all of his life to an anti allergen food.  We'll see.
 
The thyroid issue is interesting.