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@britt Garlic is sooooo lucky to have you perservering to find a solution to his discomfort. What a lucky dog. You’ve brought up a number of potential reasons here and it would be too complex to break everything down in a chat. Have you considered consulting with a veterinary behaviorist to try to narrow the possibilities? There may yet be a medical explanation, or maybe not, but a veterinary behaviorist would be the one professional qualified to help you sort that out. They will take a very complete history and spend time discussing all the possible diagnoses and symptoms and then come up with a plan of action with you. Do you have one in your area? Here’s a search to use.