Saturday, August 31, 2013

1111. Saturday Aug 31, 2013 continuing education & client communication

Dermatology Talk by Dr Gregg Takashima on Saturday, 31st August 2013

I attended this talk at 7 pm - 9 pm organised by Hills. It is good to know more about how an American vet treats skin diseases in dogs and cats as skin diseases are No. 1 cases in Toa Payoh Vets.

Clients are getting more sophisticated as they trawl the internet and diagnose their skin diseases in their pets. Some are spot on as they diagnose ringworm and scabies correctly.

In fact, in this bright clear blue-sky morning today, an Accountant came to me for a 2nd opinion as the first vet told him that his 5-year-old male cross-bred with a very black hairless inguinal area was normal.

"I have done research on the internet and I think my dog has thyroid disease," he said to me. "How long has the hyperpigmentation been present?" I asked him.
"During the last 2 years."
All the other parts of the body had hairs except this black groin area. Just jet black.
"Usually this groin area has hairs," I told him.
  He did not think so judging from his facial expression.
Fortunately I have another patient, a Husky with vaginal bleeding for over 4 weeks and I asked its owner to permit me to show him the dog's groin area. The thick coat of hair present convinced him.

Client education with show and tell is important.

"Your dog must have licked this area daily for many months," I said. "Licking irritates the skin which becomes black due to melanin cells being migrated to this area. Initially, the skin was in contact with some moist flooring or soil. It becomes a skin infection causing pain and inflammation, leading to itchiness. The dog keeps licking."

I expressed the anal sacs. Thick granular grey brown oil came out in copious amounts and smelled badly. The dog also had a painful left ear. Overall, his coat was good except for that unsightly black groin area. What to do?

I suggested a blood test and also a check for thyroid hormones T3, T4 and TSH since he was worried about thryoid hormones. The dog was slim and otherwise normal. I advised avoidance of contact with soil as the dog loves rolling onto soil. A rubber mat on the car porch area and confining the dog to that area. This sounded impractical.

The skin was dry and thickened due to irritation. I did not do any skin scraping, impression smears or fungal culture for today. The dog was given a wash, an anti-inflammatory and antibiotics and would be reviewed after one month. Meanwhile 5 ml of blood was taken for the thyroid hormone analysis and another set of blood was collected for basic health screening.

As for the talk by Dr Gregg, it was interesting to know about oral papillomas being common in dogs that have been sent to the dog-day-care centre in his American practice area. These dogs lick each other and develop the contagious oral tumours. "Any cases in Singapore?" he asked. None of the 20 vets present said yes.
As for the potentiated sulphonamides, he mentioned about the need for the dog to drink lots of water while on medication as there is the side effect of dry eyes and kidney damage. So he uses this drug as a last resort.
He uses the cattle or horse ivermection for demodectic mites (miniumun of 3 skin scrapings) by giving it into ice-cream. Check for mites every 2 weeks till 2 consecutive samples are negative. He advocates diagrams to illustrate areas of body affected and digital images to document skin diseases. I do use illustrations and sometimes digital images. Ivomectin affects the brain of collies and collie X as he had one case of a Collie that went comatose and took some weeks to recover. Amitraz or others would be given instead of ivomectin.

Cases of deep ear irrigation, yeasts seen on paws and ears, demodectic mange in an old dog and other interesting cases were shown. MSRA skin ulcers in vet staff, allergy tests, food elimination trials, regional formulated injections to treat skin diseases and trends were discussed.

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