Approaching the history in a logical way in veterinary dermatology to come to a diagnosis

An example using sarcoptes scabiei With veterinary dermatology there are certain cases that always stick out in the mind and one such recent case is as follows. One of my favorite little dogs that had been in to see me in the late part of last year was Sophie, I won’t give the second name or I will be breaking confidences. And so Sophie had come to see us – she’s a four-year-old cocker spaniel – and she had been having skin problems for about six months. And it was very interesting. She had moved up from down south up to the north. And they’d recognized that she’d started to itch, she’d had various injections of steroids and steroid tablets, which had helped. But the problem kept on coming back and was becoming less and less responsive to the steroids. And by this time the poor dog was looking in a bit of a mess. Now this veterinary dermatology case had been referred across to me, and one of the first things that I did was to simply take a history. And it was very interesting. You know, I sat the clients down, leaving the dog to do whatever it wanted. I didn’t stick it on the table right away. I start writing my history and then I start moving into various questions. Whilst I was doing that I had a sneaky look at the dog and this dog was a very, very itchy dog. It was also not responding particularly well to steroids. When I questioned the client more, I discovered that the client also had lesions and was quite itchy themselves. So within five to ten minutes I was pretty sure I knew what this diagnosis was. And I hadn’t even looked at the dog at that point. I decided that this was a lazy way of approaching it, so I decided to do some skin scrapings. And I did manage to find some scabies mites. And the reason that mentioned this case is that this had been six months with the other vet. It was interesting that they’d recognized that it was an itchy dog. They’d recognized that things weren’t going well, and that’s why they’d referred it. They’d been using Frontline about every three months. And this is something I commonly see, because people read the package and see that a three-packet gives you fifteen weeks’ worth of protection. And they think they think that this means that you use it on the pet every three months. And as we know, Frontline possibly has a bit of action against scabies mites, but isn’t terribly good. As we clipped away the hair, we could see lots of evidence of this little papular rash, also on the ears. We decided, having scraped it and found the scabies mite, that a good idea would be to get that dog onto antibiotics and shampoo. And it was also put on Stronghold and given steroids because we’d made our diagnosis. And five weeks down the line, this looked a completely different dog. And I wanted to just bring that case in at this point to show the importance of just having a logical approach from the start. The dog still wasn’t a hundred percent. We still needed to do a few more things to it. It had been affected by these mites for six months. And so this dog needed a longer course of antibiotics than just a month. But, you know, from being a dog that was ripping itself to bits, it was virtually not scratching any more. But the skin still needed a bit of attention and time to recover after that length of insult.