Saturday, September 11, 2010

193. Dry itchy skin in a veterinarian

Saturday Sep 11, 2010

I was surprised to meet an ex-colleague near Centrepoint Shopping Centre yesterday afternoon. He was graduating from Glasgow University while I had just entered first year. That was in 1969. I was assigned to the Veterinary Diagnositic Labaoratory at Kampong Java Road while he was in the Vaccine Production Unit. Now, the whole area is the Kandang Kerbau Hospital. As a new vet, I knew nothing about poultry and swine virology and I learnt much from him and another vet.

The striking memory of him was that he was always scratching his hands and neck daily and many times. Then he would scratch his back. He was allergic to horses and so could not be near them when he was in the final year at Glasgow University. I wondered how he passed his horse examination.

I remembered more vividly the one day when we went to the poultry farm to collect blood as from vaccinated and unvaccinated chickens. The blood would be tested for antibodies called HI (haem-agglutination) titres which I was lectured about in my vet school.

The presence of HI titres and clinical signs of egg production drop and poor egg quality in non-vaccinated chickens indicated that the farm had this EDS (Egg Drop Syndrome). Actually this disease was present for the past 5 years in Europe but the veterinary authorities wanted to confirm its presence in Singapore's chickens before permitting import. Obviously this would take a long time and clever poultry farmers could not wait that long. However, this particular farm was more law-abiding and so we did the test with half of the poultry house not vaccinated and half vaccinated with the commercial EDS vaccine.

The trial confirmed the efficacy of the vaccine which was then approved for import into Singapore. This evidence-based veterinary medicine had cost the farmers much losses as EDS' 76 was a well known disease for the past 5 years in Europe. Yet the authorities had this ruling for this new "disease" in Singapore. I think the trial was done in 1980 and brought veterinary medicine and virology alive to a young vet. I was 30 years old then.

Time had flown by. But I had vividly remembered this vet who once thanked me for saving his life. How did I do it? It was a fine morning at Jalan Lekar. He inserted the needles into the chicken's wings and collected the blood in the blood collection tubes. The farmer's young daughter held the chicken while I assisted him by recording. We needed many chicken blood to get statistically significant results. I noticed that this vet started to have runny noses. After some time, he had difficulty breathing and his back hunched. He persevered in collecting blood. His eyes teared and reddened. He wiped off his runny nose. This was a shock to a young vet like me.

I had never encountered such a situation but I knew he was allergic to the chicken feathers and atmosphere as he was OK when he drove me to the farm. I had no car and he drove. "Stop blood collection, stop blood collection" I said to my senior. "Let's go back to the Vet Lab!". He had forgotten to bring his nebuliser on that day he told me later and thanked me for saving his life.

On this Saturday, he was fine and his hands were no longer itchy. "I don't have psoriasis," he corrected me. "It was dry skin." The following is the knowledge he imparted to me and which I hope will be of use to vets who suffer from dry skin in the whole body.

1. Aqueous cream BP must be applied to all the affected area daily, without fail. There are many types of aqueous cream which is a mixture of oil, water, emulsifier + a little preservative. If the person is allergic to preservative, then use ones without prservative.

2. Avoid aqueous cream with fragrance or preservative if possible.

3. In countries with low relative humidity, apply the cream more than 3 times. In Singapore, one time may be sufficient.

4. Sweat out at the club so that the skin pores open. A sauna bath perhaps?

5. Sources: Pharmacy. The cheapest source is in Johor Bahru at Jenski in Taman Sentosa. A big jar costs $18.00.

6. Alternative. The safest is vaseline which is petroleum jelly. But it is sticky in Singapore.

The aqueous cream is for "dry skin". That includes "dandruff" in the scalp which appears every 2 to 3 days despite anti-dandruff shampoos.

I know the water massage spa machine used daily as a 10-minute bath might be an easier solution for this vet as the heat opens the skin pores and the water currents massage the whole body. Do it every day for 10-15 minutes. De-stress at the same time. I did not mention this to him as he seems to be doing OK with his aqueous cream routine and I don't have evidence-based medicine to convince him to give it a trial!

I record this for a young veterinary undergraduate who is allergic to horses. You may suffer from dry skin itchiness as part of the syndrome later in life. Always carry a nebuliser all the time if you want to live past 60 years of age as your immune system reacts violently and fatally to allergens in the atmosphere.

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