Perry came into care in a truly sorry state, almost completely bald and with angry, inflamed and infected skin. Perry had been suffering hair loss and severe allergies for years without the owner’s being able to find a successful solution. Once in care, Perry’s situation took a considerable amount of time to unravel the many different issues going on. His skin had become tough and “elephant textured", and had rampant yeast and bacterial infections. In order to get on top of that, his foster had to give multiple medicated baths a week and work to slough off the dead skin each time. His environmental allergies also were difficult to unravel but testing showed him to have high reactiveness to just about every tree, grass and weed across the US as well as common household allergens like dust and molds. Targeted immunotherapy was required under the guidance of a specialized veterinary dermatology clinic. The final piece of the puzzle was Perry’s thyroid levels, which fluctuated widely and were very difficult to find the right dosages of medications to control. Like a puzzle with many interlocking pieces, once these elements were diagnosed and treated we were able to work with his vets to develop a routine that works for Perry, incorporating allergy shots, thyroid medications, medicated baths and foods that do not trigger reactions. His case is so complicated and the pieces so interdependent that Boykin Spaniel Rescue (BSR) designated him a Permanent Foster Care (PFC) dog so that he could receive the perfect balance of care needed to keep him on an even keel.