20 dermatology tips to boost your practice

The dermatologic effects of flea allergy dermatitis are evident in this cat. (Photo courtesy of Christina Restrepo, DVM, DACVD, Naples, Florida)Manage insecticide-wary clients who own pets with flea allergy dermatitis

An important part of treating a pet allergic to fleas is keeping the pet on year-round flea control. But you've likely encountered owners who have expressed concern they'll be giving their pets an insecticide-whether orally or topically-and they say, that can't be safe! To calm their fears, explain the following:

• It's anatomically and physiologically impossible for these products to kill a mammal the same way they kill fleas. Adverse reactions may occur as they can with any oral or topical product of any kind, but they're typically not serious and the benefits far outweigh the risks.

• Point out that flea prevention is a lot safer than repeated courses of corticosteroids and antibiotics to manage the clinical signs of flea allergy dermatitis.

• Are they still spooked by an orally administered insecticide? These clients may feel more comfortable with a topically applied product. Some topical products, such as imidacloprid, are not systemically absorbed and may better suit this type of owner.

• If the allergic effects don't convince owners of a flea-allergic pet to provide flea control, tell them about the diseases that can be caused and transmitted by fleas: iron deficiency anemia and infection with Rickettsia typhi, Rickettsia felis, Bartonella henselae, Mycoplasma haemofelis, Yersinia pestis (that's the plague!) and Dipylidium caninum.

- CVC educator Allison Kirby, DVM, DACVD

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Avoid these cytology slip-ups

• Choose wisely-glass slide or a piece of clear packing tape? Slides can be easily pressed onto moist or gooey lesions and can also be used to lift the edge of a crust to maneuver underneath. Tape is most helpful when collecting samples from dry lesions and from areas too small for the glass slide.

• Stain smart. Tape does not need to be dipped in a fixative and should not be heated.

• Throw out the trash. Your ability to evaluate cytology improves with time, but you can set yourself up for better results by getting rid of your dilapidated microscope. (Maybe consider a new one.)

- CVC educator Darin Dell, DVM, DACVD

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A dog with sterile nodular panniculitis. (Image courtesy of Dr. Darin Dell)6 tips for a better biopsy

A biopsy is the ultimate dermatology test, but it won't always give you a straight answer. Here are six tips for better results:

1. Collect multiple samples. Aim for four to six pieces of tissue.

2. Center your biopsy punch on the lesion (see here). Do not send normal tissue to the pathologist. If you send in the margin of a lesion and include normal tissue, there's a risk that the lab technician will not “cut in” the diseased tissue for examination.

3. If you see an infection on cytology (see here), consider resolving it before collecting biopsy specimens. Infection can obscure the primary disease and make the pathologist's job much more difficult.

4. Send a thorough history along with your samples.

5. Include clinical photographs with the samples when possible (see here).

6. The right eyes on your sample is the difference between the right answer, the wrong answer or no answer at all. Send your tissue samples to a dermatopathologist.

- CVC educator Darin Dell, DVM, DACVD

Look pet owners in the eye and force them to be straight with you: Can you handle this otitis externa medication at home? (Getty Images)Talk clients out of a coverup!

• Start at the beginning: a dirty ear, a lot of discharge, an active infection.CVC educator Jim Noxon, DVM, DACVIM, recommends client educators say something like: "There's a what, and there's a why. The what is what's happening right now. If we treat the what and fail to address the why, the what will come back. We'll have treatment failure, because we'll still have all that stuff on top that covers up the underlying issues.'"

• Then think about the future. Noxon tells clients, "Today we'll address the what, and you'll come back for an appointment in this much time. At that time, we'll start talking more about the why."

• And ask for the recheck. "The reality is, if they don't come back and they don't address the underlying why, everything you do to treat is wasted," Noxon says. "I tell clients, 'If you don't come back for a recheck, even if the animal looks good, then you've wasted my time, your time and your money.'"

Finally, are you sending ear medication home for clients to administer? Dr. Noxon always asks, "'Can you do this?' And then when they say, 'Yes,' while you're watching their eyes, you ask, 'Will you?' Those are different things. If they won't, I'm not gonna be judgmental about that, but I need to find something else to do."

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Image courtesy of Bekki Thompson.Peas, beans and grapes

After hearing numerous arguments between my coworkers over perception differences between pea-sized, bean-sized, small grape-sized and large grape-sized growths, as well as complaints about never having a ruler handy when taking a history or examining a patient, I printed out millimeter rulers for our doctors and staff to tape to their favorite pens. Now we can quickly and accurately notate the size of growths and wounds.

- Bekki Thompson, head technician Pet Haven Veterinary Clinic Wichita, Kansas

Put out the trashcan and clean Rex's ears

When I tell clients to clean their pets' ears, give medications or perform other procedures twice a week, I tell them to do it on garbage pickup days, which are Tuesdays and Fridays in our area. Giving clients a real-life reminder on a schedule they're used to has helped with compliance.

- Dr. Paul Wolff, Palm City, Florida

A tisket, a tasket, an ear care basket

We place all our ear care items in a basket, so we know exactly where to find what we need when we need it. The basket includes ear cleaner, saline solution, hemostats and bulb syringes. A drawer under the basket is filled with cotton for cleaning pets' ears.

- Brenda Girard, LVT St. Clair Shores, Michigan

Easy-does-it ear wash cannulas

We reuse intravenous sets to create soft, flexible cannulas for ear washes. Cut a 6- or 7-in section from a used intravenous set, and push one end over a 12-ml syringe. Quickly burn the end with a lighter to soften the cut edges.

- John Young, practice manager, Truth or Consequences, New Mexico

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