Aggressive Diagnostics Pay Off

Frugality or shortsightedness?

Queenie came to see us yesterday with a complaint of hair losson one toe. 

By visual examination only, the hair loss on this toe could be just about anything.

Several people had told her owner that it was “a fungus.”

I examined Queenie thoroughly, and was unconvinced.  However, I gave her master options in approaching this dermatologic abnormality.

People often ask, “Dr. Randolph, if she were your dog, what would you do?”

So, after the examination, I said, “We have options in approaching a situation like this.  We can do it right, or we can treat it symptomatically.  Symptomatic treatment for a fungal infection would simply have us dispense an antifungal ointment for you to apply for three weeks.  If the hair loss resolves, we celebrate.  If it doesn’t, we’re back at square one.”

“I want to know what’s wrong with the toe.  What are the alternatives?” Queenie’s owner asked.

Beautiful and smart, Queenie is a highly-trained hunting dog.

“Doing it right would have us look for the cause with three tests.  First, we would obtain a specimen for
fungal culture.  If there is fungus there, it should grow in 3-21 days when we feed it the right nutrients and keep it in a dark, warm place.  Second, we would obtain DuroTack cytology by using a microscope slide with an adhesive on it to look at the organisms growing on the surface of the skin.  Third, we would obtain a skin scraping to examine for the presence of Demodex canis, the causative agent of Demodicosis.  The specimens have to be obtained in that order.  Obtaining the skin scraping first removes the material we need for the other two tests.  Obtaining the DuroTack cytology specimen first contaminates the skin, which could lead to a false test result for the fungal culture.”

“Let’s do it right,” the owner said.  I saw you have today’s paper in the lobby, I’ll wait there while you take the samples.”

That turned out to be a wise choice.  Our skin scraping revealed the presence of nymph, young adult and mature adult stages of D. canis mites.  As we have only one lesion, treatment can be localized with a daily application of ointment.

Symptomatic treatment for fungal infection would have wasted three weeks and the condition would have worsened.

Oftentimes in health care it pays to be aggressive in the beginning.  This was one of those times.

See you tomorrow, Dr. Randolph.

PS:  Queenie is one of the Octomom offspring.  Click here to read about them.

 

 

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