eighteen months into chasing my 3 year old goldendoodle pretzels itchy skin across three different vets, two prescription food trials that i now think i botched, an eight week home elimination diet that got contaminated by my mother in law slipping her a piece of pizza crust twice in week six, and my current GP just said "consider a derm referral" with a shrug that did not fill me with confidence, i cannot tell anymore if this is food, environmental, or a shampoo issue, and i need the actual sequence someone should run through and how you know when to give up on the general practice route

Pretzel is a 3 year old F1 goldendoodle, 48 pounds, we picked her up as an 11 week old puppy from a small breeder in january 2024, and she was fine for about the first year. things started in march of 2025 with what our first vet called "seasonal itch," a couple of ear infections, some paw licking after walks, we thought spring. by july it was full body scratching, hot spots opening up under her front leg, and a smell coming off her ears that i cannot describe politely. we are now eighteen months into this and i genuinely do not know what we have anymore, i have spent probably $2400 on food trials and vet visits and topical treatments and a $180 cytology swab, and Pretzels quality of life is somewhere between "manages, mostly, with a lot of tools" and "bad night in the fall," and i want the honest answer on whether i am running the right playbook or making it up as i go, which is what it feels like.

the timeline in case anyone wants to reverse engineer it. march 2025 first vet visit, ear cytology showed yeast, ten days of malaseb wipes and an ear cleaner, cleared it. june 2025 recurrence plus paw licking, we started a hills z/d hydrolyzed protein trial for six weeks, i thought i was being strict, in retrospect i probably was not because we had treats from our old bag in the pantry that my husband did not know were off protocol until week 4 and he confessed. august 2025 second vet visit, second vet said "the trial wasnt clean, do another one," we did a purina HA for eight weeks starting september, this one my mother in law slipped Pretzel a piece of pizza crust twice in week six that i only found out about at thanksgiving because she thought i was being "dramatic," so that trial is also compromised. december 2025 into january 2026, third vet visit at a different practice because we had moved, this vet did apoquel for six weeks which worked amazing then rebounded within four days of stopping, then a two week prednisone taper for a bad flare, which worked and which i now understand is not a solution. through april and may 2026 we have been on and off cytopoint injections every 4-6 weeks, $85 each, which take the edge off and buy me maybe 3 weeks of a comfortable dog before the itch comes back, and my new GP mentioned "consider derm referral" at our last visit in a tone that i could not read, was that a genuine recommendation or a polite exit from a case she does not want.

things i genuinely cannot answer despite reading a lot. one, do i even know if this is food, environmental, or contact, and is there a way to tell without a proper elimination diet that i now have zero confidence i can execute, my household has two other people and a mother in law nearby and treats are a love language i cannot stop cold. two, is the derm referral the answer or is my GP passing me off, and if it is the answer, what does the derm visit actually look like, do they do intradermal testing on the first visit or is there a workup, and what does it cost roughly because im already $2400 in on the GP path. three, the cytopoint / apoquel / prednisone question, what is the actual protocol here, are these bridges to a longer term plan or are we just symptom managing forever, my new GP has been vague on this and i cannot tell if that is because there is no long term plan or because she does not know. four, the practical question, what do i actually change tomorrow, do i keep doing cytopoint every 4-6 weeks and book the derm, do i do another elimination diet first, do i stop everything and see what her baseline is, what is the sensible next step for someone this far into this without knowing what they have.

i know this is a lot. Pretzel is a great dog, she is not miserable most days, but i can see her being uncomfortable and i can also see the money and time going into a plan i am not sure is a plan. anyone who has been in this and come out the other side, or anyone who runs this workup for a living, i would really love the honest version of what to do next