Community educational stories for pet lovers, sponsored by  AsiaHomes Internet  

No third chance for a vet

"Certain skin diseases require more than one veterinary visit," I said to Mr Chow who put a dog with itchy ears on the examination table.

Mr Chow replied in his patient voice. "I had seen the veterinarian twice. She did skin scrapings, examined them under the microscope and said there were no mange mites seen. She gave me anti-flea capsules for the dog to take orally and two bottles of shampoos. My dog still scratches day and night." 

He continued, "I went to my groomer to clip the coat and the groomer says that my dog is suffering from mange."  

"As many as six to twelve skin scrapings of various spots of infested skin may reveal no mange mites but this does not mean that your dog is not suffering from Sarcoptes scabiei var. canis mange," I tried to educate Mr Chow, a man who loved his grey and white dog very much and could feel the discomfort of continuous itchiness in his dog's scratching sounds, day and night. 

"Based on the distribution of the areas infected, your dog is suffering from Sarcoptic Mange" I said as I pointed to the prominent crusting of the ear margins, the hair loss around the eyelids, nose and belly rashes which looked very much like the bacteria Staphyloccocus infection. It was possible that the bacteria had infected the skin too, after much damage by the mites.

I continued, "I will need to take skin scrapings deeper into the skin surface as the mites tunnel into the deeper layer of the stratum corneum, lay eggs in the skin tunnel and die there. They may or may not be present on the skin surface and therefore deep scrapings will be necessary. There will be bleeding. Is that all right with you?"  Some owners can't bear to see traumatic injuries to their pets and just opt for the anti-mite injections and shampoos.

Mr Chow said it was all right. He just wanted his dog to be cured of the intense itch. He just could not bear to see his dog suffering every day and night. And he had seen a veterinarian twice but his dog was suffering from intense itch. Sarcoptic mange mites are sometimes called the "itch mite" as they provoke intense skin inflammation by their tunnelling and laying eggs inside the tunnels. Bacteria infects the skin forming pus and there would be more scratching until the serum (the clear component of blood) seeps out of the tunnels to the surface of the skin. The serum dries up and form thick crusty skin scabs which are obvious in this dog's ear margins.  

The female mites burrows into the skin, lay eggs and die. The eggs hatch into larvae which molt into nymph stage and then become adult mites on the surface of the skin, feeding on the serum. The male and female mites mate and repeat the life cycle. Dogs get infested by direct contact with another dog and dogs with poor immune systems are more likely to get mange. 

I took only two skin scrapings instead of at least six as I did not want to traumatise the dog further. There was bleeding as I scraped deep at the edge of the ear margins where the mites are active mating and to get the female mites inside the honey-comb of extensive spread of skin tunnels. 
  
No mange mites were seen under the microscope as the dog had an anti-flea insecticide treatment although I should have taken at least 6 - 12 skin scrapings. In private practice, the owner and family members would be more traumatised to see so many bleeding scraped areas in his beloved pet and therefore I had to restrain myself.

Diagnosis would best be confirmed by seeing the presence of the mites although the distribution of the skin lesions and rashes were typical of a Sarcoptic Mange infestation.

"The anti-mite injection may or may not need to be repeated in 7 days' time," I said. "Please telephone for a review."   

Once the mites are killed by the insecticide injection, the constant scratching which results in hair loss and damage to the skin by self-mutilation will cease. If not, the mites will infest the whole body besides the thinly haired areas such as the ears, muzzle and around the eyes."

When Mr Chow left, I reviewed the skin scrapings under the microscope again. Hidden amongst the hair, red blood cells and skin cells, a plump globular mite with six legs moved nonchalantly. "Bloody s.o.b (son of a bitch)," I cursed although the mite might be female scrapped out from the skin tunnels.

It would be better if Mr Chow had seen this mite. I phoned Mr Chow to confirm the presence of Sarcoptic Mange. Since I did not see him after seven days, I presumed his dog must be recovering. There would be no second chance for me if the dog was not cured. 

The dog did recover in 2 weeks as Mr Chow came for a second injection. Most Singapore owners do not follow up when they see their dog recovering. Mr Chow was one of those who had time for his dog to get the second injection and to review the results of treatment.  

"Is the dog still sleeping in the same area? And you are still using the same brush to groom the dog?" I asked.

"Yes," Mr Chow said to both questions. It never occurred to him that the mites would be present in these areas and would cause a problem. 

"It is best to move the dog away from its present area for 1-2 months, as the mites may still be alive on the bedding and brushes. You can sun the brushes and mop the floor but it helps to avoid such areas and equipment for 2 months " I advised. 

Otherwise it may be re-infested by mites again." Mr Chow appeared satisfied with his dog's recovery from the pesky microscopic mites which could never be seen by the human eyes. 

Recently, a Singapore doctor specialising in arthritis mentioned in the Straits Times the tendency of Singaporeans to practise doctor hopping. I guess veterinarian hopping is equally as common. If the cure is not immediate, there will be no second chance!

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