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Over the past 7mos my 10yr old male Havanese began to smell…

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Over the past 7mos my...
Over the past 7mos my 10yr old male Havanese began to smell sour almost immediately after a bath at the groomer I've trusted for years. She mentioned it may be from his saliva/overgrooming which I know can irritate dog skin (excess saliva) but then I noticed him chewing really bad at his backside (on trifexis, no fleas) and I found dozens of crusty patches and thick scabs. He's prone to cysts and had to have 2 removed from his tail a few years ago. He also had to have both anal glands removed. Other than that, he has a heart murmur and emotional issues (Katrina rescue) but has been pretty healthy. I'm currently renting and the carpeting is 30+yrs old and impossible to vacuum well because it's no longer attached to the floor and I have a slumlord who refuses any repairs unless the city forces him to. I was a zookeeper at the SF Zoo for several years and an 'avid cat lady' but this is my first permanent dog. Because of the severity/scratching/chewing I put his ecollar on and his skin redness went away and the scabs have mostly fallen off/no new ones but now he has patches of crusty skin that smells BAD. I've deduced that he may be allergic to dust mites since he scratched like crazy after I had the carpets ripped out of my mom's house to refinish the floors- I can imagine all the dust, mites, etc that unleashed. And the strong sour smell may be an opportunistic yeast infection? Friends think I'm nuts but I've seen yeast live on other species. I made a vet appt for Tues but it's a new vet and I'd like to go in informed (and not get the typical 'it's flea dermatitis' which my 16yr old cat has and I'm very familiar with). Thank you!
Submitted: 3 years ago.Category: Dog
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Customer reply replied 3 years ago
He is also 100% indoor so thinking more indoor related than outside.
Answered in 39 minutes by:
6/12/2015
Dog Specialist: Dr. B., Veterinarian replied 3 years ago
Dr. B.
Dr. B., Veterinarian
Category: Dog
Satisfied Customers: 23,592
Experience: Hello, I am a small animal veterinarian and am happy to discuss any concerns & questions you have on any species.
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Hello & welcome, I am Dr. B, a licensed veterinarian and I would like to help you with your wee one today.
Is his skin greasy?
Can you take a photo of his crusts? If you can do so and post them online, this will let me see what you are seeing. To post them, you can either use the wee paper clip on the tool bar above your text box. Or if you cannot see that on your computer/phone, then you can post them on an alternative site (ie Flickr, Photobucket, imgur, etc) and paste the web link here for me to check.
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Customer reply replied 3 years ago
Hello, his skin is actually the opposite- very dry and his für is "crunchy"/brittle given he normally "feels" similar to my naturally wavy/curly human hair (I'm greasier than him!)
I'll try to attach pics tomorrow when there's sufficient light but he's an Irish Pied (cream and pale orange/tan) so the scaly, rough patches blend in really well. I don't see the little paperclip on my tablet but I'll try my phone. My tablet actually takes much better pics but I'll figure it out. I should be able to upload/attach from Dropbox
Also, the only thing that's changed in his routine is his flea/heartworm control- he was on Advantage Plus and HeartGuard but switched to Trifexis only in April. No diet or environmental changes.
Given his skin is no longer pink and the bloody scabs are gone after just a few days with an ecollar on almost 24/7, I'm thinking that was from self "mutilation". But with the collar off to give him about 30mins/day to eat and run around the house (monitored) he will start to immediately chew his back and belly very aggressively so he's an itchy guy, not a neurotic guy. Aloe vera gel worked up until a point. He's always groomed/pawed his face (raised amongst 3 cats, do dogs mimic?) and grooms his front legs since a puppy and occasionally chews on his right hind foot but I've never seen any irritation. It seems like he's "checked out" while chewing his foot, like thumb sucking; he was born into hurricane Katrina then flown out to San Francisco (current location) and does suffer from moderately high separation anxiety and doesn't like strangers inside the house (OK outside). He's been on Prozac and Clomacalm/pheromone diffusers with very little benefit.
Anyhoot, to get back on topic, they rough patches will bleed if scraped (found this out while checking for flea detritus with a flea comb) if that's of any use. Thank you! Will take pics.
Dog Specialist: Dr. B., Veterinarian replied 3 years ago
Thank you,
Now that is not a bad thing if he is isn't greasy, since it does allow us to rule out underlying seborrhea being an issue. As well I would note, yeast overgrowth was also my first thoughts as well when you mentioned his odor (so those friends likely have it wrong and I'd argue with the groomer that while saliva may irritate skin, they need a reason to be chewing the skin in the first place), but we do have to consider what is making the skin vulnerable to such an overgrowth. And I would note, the scabs and bleeding will be very much his doing (which is why he needs to keep the ecollar on while we try to narrow his signs or at least wear a tshirt and a pair of reversed boxer shorts +/- socks to cover his feet) but are a sign that something is triggering an itch and these other skin changes that are then driving him to do it.
Therefore, if you can post those photos (even on an alternative website and the paste the link here), that would be grand. That way I can see what you are seeing and we can put together a suspicion list and plan of action.
I shall keep an eye out for your photos,
Dr. B.
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Customer reply replied 3 years ago
I didn't even think of seborrhea. Dolly, the groomer, knew he was itchy and mentioned that maybe his whole belly was pink from the excess saliva from him licking/chewing. It took me 2 years to find a groomer who returns not just a clean with the requested cut but he's always happy. I had groomers assure me they were "hairy dog" experts but they would just shave him and I like to keep very short ears/open brow/short muzzle but with beard/"large" sanitary clip/and a "poodle puff" plume tail. I sound crazy, I know, but it was a nightmare finding an honest groomer who has the expertise to use shears for detailing. He usually only gets shaved down 2x/year just because his coat grows so fast and gets very long (then the matts start and he can really headbutt when I go near his butt). But I'm disappointed with my local petco- Dolly was booked up so I took him there and she obviously either cut corners or gave up on his idiosyncrasies because she didn't even mention the scabs and crusts! And he seemed glum afterwards. How can you not see that especially while bathing him?! Ugh. I managed to get some good pics yesterday but he had a huge potty accident in my room. He peed in his bed and left a trail of quite large poop nuggets on the rug runners I use to try and cover up the disgusting carpeting in my room. My upstairs tenant mentioned Rocket peed on his slipper while he was wearing them while washing dishes. Luckily he's an animal person. Rocket is very serious about his "business" and is fully housebroken. He gets let out to use synthetic dog grass and also will signal to be let down. He uses pee pads during the night and rarely misses. He's a smart guy! But I think his ecollar occludes his vision so he won't go to the bathroom "unattended". I tried his different clothing combos but he pulls legging off and rips thru shirts and the only option that works best is a pajama onesie but it's made of thick fleece and he pants and still chews on it. He accepts the collar well, but he looks so defeated :( I'm rather bedridden and he's been my ESA so he knows as soon as I start to swing my legs over the bed and put my slippers on/reach for my cane that it's time to eat and play then relieve himself downstairs. Last night he had the aforementioned accident while I was in the bathroom for just 10mins. I now will be letting him down first but I think he only drinks once or twice a day with the collar on and combined with being on "cat lookout" he chooses a known "safe spot" to eliminate. I'll just be more diligent. The cats mainly ignore him, they're too busy cataloging the house to bother him except when he tries to get a good cat butt sniff in :) I lucked out that way! Ok, here's the pics, I noticed he does have really thick "dandruff", hope they upload. I picked the best quality but have about a dozen or so more, he was very cooperative- I think my parting of his coat/feeling around for the very bad areas felt good to him....
20150613_014821.jpg2015061...jpg20150613_020346.jpg2015061...jpg20150613_021236.jpg2015061...jpg20150613_021411.jpg2015061...jpg20150613_021443.jpg2015061...jpg20150613_021900.jpg2015061...jpg
Customer reply replied 3 years ago
(Above pics are from Oct 2013; I had just lost my mom suddenly and I had a memorial birthday for her with my fur family)
Customer reply replied 3 years ago
I found a couple more, but they're different files and keep rejecting. I'm trying one last time.* Note to short term memory troubled self: need to remember to ask about Early (in a different question) and his chemical burn from Advantage Plus Cat. Bayer denied it was a chemical burn (said it's not common but mild irritation is a normal side effect) but it was about 2" round and deep. Treated it as previous chemical burns and it healed after a month (hair still sprouting in tho 2mos after initial first month) No trip to the vet, had all the supplies to care for the wound at home.
Dog Specialist: Dr. B., Veterinarian replied 3 years ago
Hi again,
I agree that his toileting hiccups will likely be just secondary to the annoyance of the collar (a necessary evil if he is being too smart for his own good and removing clothing).
Now that aside, based on your photos, I have to say that it looks like your lad has a diffuse staph (bacterial) infection present. With this overgrowth present, we can see odor changes but we can often see yeast join the party as well. Furthermore, as he sounds to be diffusely itchy, we'd also have to be wary of a possible underlying allergy triggering this for him.
With all of this in mind, if you are seeing lesions all over, then he may benefit from a course of antibiotics to clear this +/- a low dose of steroids to soothe the itch. Otherwise, I do just want to note some supportive care options that could also help reduce these signs for him. First, since we suspect an overgrowth of yeast and bacteria, you may want to consider using the shampoo Malaseb. You can get the full strength version from your vet, but there is also a mild version that you can purchase online (ie Amazon). This product is very good for mild situations of this nature, tackles yeast as well as bacteria, and can soothe that itchy skin as well.
As well, for the itchiness, we can consider trying him with Benadryl (Diphenhydramine). Of course, you do need to speak to your vet first if he has any pre-existing conditions or is on any other medications but often we can give 0.5- 2 mg per pound (1 -4 mg/kg) orally every 8-12 hours to help soothe itchiness. Do note that we can see drowsiness and sedation with the higher end of the dose (just like people). But this would help soothe itchiness and reduce the effects of any allergies.
Finally, since we have dander/crusting, I would note that you may also want to consider essential fatty acid (EFA) supplementation with him. EFA’s are the fats that are part of skin cells composition and play a role in their health and coat growth. They are often used therapeutically in the management of a number of irritative skin disorders. Commonly we can supplement this by adding oily fish (ie salmon, a common EFA source) to their diet. As well, we can supplement using Omega 3 + 6 fish oil or even evening primrose oil. Further to these, there are also OTC oral EFA supplements like Viacutin or Yumega. So, these would be of benefit for him too.
Overall, based on your photos and history, I do suspect we have a bacterial based skin flare-up here. With the odor, it is possible that the bacteria are also to blame but yeast often co-infect in these cases. Therefore, I would advise the above at this stage. But if severe, then we'd want to speak to his vet about oral/systemic treatment to soothe his signs quicker and get his skin settled.
I hope this information is helpful.
If you need any additional information, do not hesitate to ask!
All the best,
Dr. B.
PS- We do on rare occasions see skin reactions to the spot-ons, so that is likely that was what you saw even if the company denied it. And it'd make us wary of using that product or similar ones in the future.
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Customer reply replied 3 years ago
That all makes sense. Thank you. He's very difficult for me to wash- especially drying- on my own due to physical handicaps but I can try and find help. Aside from my usual groomer and self-wash stations, the places close to me refuse to use product I bring in. I have Clobetasol propionate in lotion form that I'll bring to the vet appt with me, it may help him and it is a lotion so no need to rinse/wash everyday/week, etc. Hopefully they will have a similar topical medication or something better suited. I tried benadryl since I already had the dosage for Rocket from a previous vet visit 2yrs ago and it didn't help much, just made him drowsy for about 2hrs then back to itching. I do have hydroxyzine hcl though, read that dogs are able to take it. It's expensive for me since my insurance refuses to cover it even tho it's proven benadryl and other anti-allergics don't help my spider bites, but I couldn't find a safe dosage since many websites had very differing dosages. I did read up about the fatty acids and my sub-tenant takes it religiously since he has really bad eczema looking patches exacerbated by cancer treatment. Rocket is a good candidate for EFA supplements, I'll find out more on that. But what really concerns me is how did he get the staph infection to begin with. I know it normally lives on our skin and usually an allergy, cut or illness can set it off. I'm a clean freak in the sense that I'm very 'germ aware' from my zookeeping days and cancer research days at UC. I wash my hands after touching anything dirty or questionable as well as trying to prevent cross-contamination in most every facet from clothing/laundry to food. Since Rocket is an indoor dog, could something have been brought home? I had to have several uncomfortable talks with my current sub-tenant about hygiene and housekeeping and he's improved but still far from clean (only washes bedsheets a few times/year, uses same bath towel for weeks in a row and such). He also takes public transportation everyday and the subway/buses are really filthy here in San Francisco. Roommate means well but he didn't grow up in a big city like I did/learn basic cleanliness. He's the only one who touches Rocket, usually scratching his butt and ears with his fingernails. Now I'm wondering if he's got staph dermatitis and not eczema and possibly scratched himself and then scratched Rocket right after? Iirc, it's not zoonotic but are my cats at risk from Rocket at all? Am I? I know Rocket's chewing started it and need to pin down the trigger whether filthy fingernails or allergies but I'm just pulling blanks unless he's actually allergic to staph which would be a nightmare. I'll have to get advice on how to prevent reinfection too. I can replace bedding and such but I can't do anything about the carpet. I already have carboard covering the area under Rocket's bed and given the carpet's condition, I'm thinking just pouring a diluted bleach solution all around the area may be best since the owner can't make any claims against carpeting/flooring that old/in such decrepit condition. As far as the vet visit, I'm guessing they'll want to do a CBC w/chem and a skin scraping but that's going to cost a pretty penny. What are the usual steps a vet would take to diagnose if it's diffuse staph? Could a bacterial culture be done instead? His CBC was normal 2yrs ago when he had his tail cysts surgically removed but I guess things can always change. And I have your tx advice above but what else should I expect to need/have prescribed aside from a corticosteroid and long course of antibiotics (which I hope isn't a liquid requiring refrigeration given QID or I'll need a mini fridge given my mobility handicaps in/out of bed!) That's what a vet prescribed when he had his anal glands removed- liquid Clavamox; said the tablets were ineffective in that situation. I don't know why tablets were nixed but it was a 7 day nightmare! I'm hoping a bacterial culture would help in deciding which antibiotic is best and how long? As far as the possible fungus/yeast, are there any cross-contamination concerns?
Dog Specialist: Dr. B., Veterinarian replied 3 years ago
Hi again,
First, shame on the local groomer for not being willing to use what one would request, as it would really be of benefit for him. Otherwise, you could use the Clobetasol, but there are better antibiotic/steroid combination creams that we use if treating topically. Otherwise, if Benadryl didn't help him, then alternative antihistamines can be tried. In regards ***** ***** Hydroxyzine, this tends to be used in dogs at a dose of 1 mg/lbs (2 mg/kg) every 8-12 hours. So, you could trial this with the the EFAs for him.
Otherwise, you sound to have a good grasp of there being a natural bacterial microflora on skin, but remember that these bacteria are predominately Staphylococcus. So, if we have those ideal parameters for infection, these guys are positioned perfectly to cause these skin issues. So, you haven't likely brought it home, the subtenant is likely innocent, he likely isn't allergic to the Staph, and instead he likely always had it. But the skin changes ( itching, yeast, etc) just allowed them to overgrow and cause this. We could of course have this cultured by his vet to ID the species (and then appreciate if its one natural to dogs), but as the treatment tends to be the same, we often don't carry out those tests unless requested. Though you could choose to and this would be cultured for bacteria and also the yeast and any other agents. And you could, if you were concerned he was allergic to the bacteria; but I would be more suspicious of allergies to environmental allergens (ie dust mites, storage, mites, carpet powders, laundry soap, etc), pollens (which can be carried in on the air), or food protein based allergies.
In regards ***** ***** visit, as I noted we just tend to treat the Staph overgrowth (with antibiotics). Otherwise, a CBC wouldn't be indicated unless you suspected organ issues (which doesn't really fit with what we are considering). Instead, the ideal skin work up would be to scrape (for mites), tape impressions (to check for yeast and gram stain for the bacteria), and allergy testing (either via blood test or intradermal skin testing). Allergy testing tends to be the most costly but can let us know what is present so we can address it or start immune-vaccinations to desensitise the immune system. Otherwise, if that is not an option, then further to antibiotics, they may dispense steroids or an immune modulating drugs (ie Atopica, Apoquel) to soothe that itch. And just to note, you can request tablets instead of liquid medication as there is no reason they cannot be used.
All the best,
Dr. B.
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Dog Specialist: Dr. B., Veterinarian replied 3 years ago
Hi Alex,

I'm just following up on our conversation about your pet. How is everything going?

nekovet
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