Weeks 19 and 20: Dermatology!

These past two weeks, I had the opportunity to sharpen my dermatology skills. Heading into this rotation, I was excited to become more comfortable talking to clients about common skin conditions as well as better understand treatment protocols and how to select the best product for each individual patient’s needs.

Dermatology had a fairly standard 8-5/5:30 schedule, and on Wednesdays we were usually done around 1:00 because the residents had their rounds and journal club activities that afternoon.

While I have not personally had a bad experience with any client during my time in the VMTH, I can say that the clients I met in dermatology were some of my favorites. During my rotation, I had the privilege of working with a sweet Aussie who had an unfortunate run-in with a foxtail.

After some frustrating vet visits and a lack of clinical improvement, his family decided they wanted to pursue further care at UC Davis and made the trip from Washington. Over the course of two days and some advanced imaging, we were able to fully assess the extent of Aari’s condition. The CT scan of his skull helped rule out an issue with his inner ear, and we were able to thoroughly clean the external ear canal and make sure that there was no foxtail remnants left. During his time under anesthesia, we also found a gnarly tooth fracture, which could have also been linked to the pain he was experiencing. Throughout his time at UC Davis, it was evident how much his amazing owners cared about him, and their appreciation was shown through a multitude of snacks, flowers, and cards. We had discussed their experience at other hospitals, and a general theme of a lack of communication or compassion emerged.

While it may not seem like a big deal, the details matter, and we need to ensure that we are listening to our clients and validating their feelings. This should be obvious, but they are at the hospital because they care about their animals and want to help them. Regardless of how busy things get, we have to be able to provide the best level of care possible for each animal and make sure that we are working as a team with the owners and providing options that are feasible for them.

Working with Aari’s wonderful family was a solid reminder of just how far compassionate care can go, and I am grateful I had the privilege of being a part of Aari’s story. It is not every day that you get to work with people who love their pet enough to travel across multiple states to seek care and I will forever remember Aari and his amazing care team.

The amazing Aari!

Another awesome part of the dermatology rotation is the ability to work with a plethora of species. During my first week, I had the opportunity to work with a horse, and the second week involved a fun procedure on a Koi fish. This fish had a mass on its back, and we used a CO2 laser to remove the mass and provide some relief for the fish. This was the first time I had seen a fish get any type of procedure, and it was wild to watch the laser work on its scales.

Dermatology also allowed me to have nutrition-related conversations with clients since one of the three main allergies our patients deal with is food allergies. Navigating food allergies is quite the commitment and requires a strict elimination diet trial lasting 8-10 weeks. This involves eliminating everything the dog has had exposure to in the past and feeding only a novel protein or hydrolyzed diet. The novel protein we use is typically rabbit-based, but due to the emergence of boutique diets, some dogs have already been exposed to rabbit protein and will need to be placed on a hydrolyzed diet. The protein in these diets is processed to a point where the body is unable to mount an immune response to the molecule, and if the dog’s allergies have a food component, they usually will improve on this diet. Diet trials are not feasible for everyone, so selecting the right client to pursue this option is crucial. If the owner is unable to guarantee that the prescribed food will be the only thing the dog consumes, it is not worth the expense and effort needed to complete the trial. Over the past two weeks, I was able to see different patients at various times during their diet trials, and while it is somewhat unusual to see a dog fully respond to a diet trial, there was one patient who seemed to primarily have their allergies controlled via a diet change.

The other main allergies we address are flea allergy dermatitis and environmental allergies. As with humans, allergies are never fully “cured”; they are managed. With proper flea control and a diet trial, we can often manage a lot of our allergic patients. However, most patients also have an environmental component to their allergies and require additional treatment, whether that is frequent bathing, oral medication, or injectable immunotherapy. Over the course of two weeks, I became more comfortable having these types of discussions with owners and have a much better understanding of what treatments are being used to manage this condition.

Additionally, I had the opportunity to practice running a plethora of different skin cytology samples as well as performing a skin biopsy.  I also had the chance to witness the huge overlap with other services, specifically internal medicine and neurology. Many cases were shared between services, and it was interesting to watch the clinicians work together to treat different conditions.

Sweet Jello Pudding!

Overall, I thoroughly enjoyed my time on the dermatology service and walked away with a plethora of new knowledge in addition to some important life lessons on the importance of communication. The residents and faculty were truly wonderful, and I appreciate the effort they put in to enhance our learning experience.

Quote of the rotation: “He controls my lifeeee” – One sweet owner

*The images in this post were used with consent from the owners ◡̈