Dr Ruth Clark
BVSc MRCVS
VVS Commercial Manager
Veterinary surgeon Pascal Hoberg, from Wylie Veterinary Centre, called VVS to ask specialist Andrea Volk (European Specialist in Veterinary Dermatology) for advice regarding a difficult dermatology case he was dealing with. Otto, a 2 year old German short-haired pointer, had come to see him for a second opinion.
Otto had a 3-month history of non-healing skin lesions to the scrotum post-castration, which had also started to affect other parts of the body. His previous vet had sent samples off for histopathology and severe, diffuse necrotising granulomatous and lymphoplasmacytic dermatitis and panniculitis had been diagnosed. It was believed that this was most likely a foreign body reaction associated with the suture material used during the castration surgery. The previous vet had surgically debrided some masses and treated with amoxicillin/clavulanic acid, enrofloxacin, cephalexin and prednisolone, but Otto’s conditioned had worsened.
Otto presented to Pascal with multiple erosive fleshy masses over his body and face.
This image shows the lesion associated with the castration site.
Pascal had an initial advice call with Andrea, where she discussed the differential diagnoses to consider and the most appropriate course of action to reach a diagnosis and formulate a treatment plan.
Pascal and Andrea then arranged to undertake further skin biopsies together.
Click on the video below to view part of this consultation and see Andrea utilising the VVS platform to guide and support Pascal through the procedures. In this clip, Andrea is viewing in real-time, high definition:
- Otto – via the VVS mobile camera
- The surgical site – via the VVS high definition head cam, worn by Pascal
- Pascal – via the VVS laptop camera.
Pascal can view Andrea via the VVS laptop in his operating theatre. They could both share screens and hear each other clearly via VVS’s integrated technology system.
Pascal and Andrea were able to discuss which samples to take and why, how to take the samples, which suture materials to use, which transport media to use and more. Pascal was reassured to have Andrea live-guiding him through this procedure and Otto received world class specialist care from his local vet – a truly excellent and holistic service.
The skin biopsies were sent for histopathology and macerated tissue culture PCR was performed.
Whilst awaiting results of investigations, Andrea advised to start Otto on a combination of doxycycline (at 10 mg/kg once daily) with niacinamide (at 500 mg 3times daily). Andrea advised that in cases such as this, high doses of prednisolone are necessary to reduce the overwhelming immune response (whether the initial cause was infectious or not). Potential side effects of such therapy were discussed, but Pascal and Andrea were secure in the knowledge that should such issues arise, they could always consult a VVS internal medicine colleague for further assistance.
Lab results indicated that:
- Mycobacterium involvement was unlikely.
- No yeasts or fungi were grown.
- Nocardia/actinomycetes were not isolated.
- Staphylococcus intermedius and Streptococcus spp were identified on culture, although no organisms were seen on microscopy.
- Reactive lymphoid hyperplasia secondary to local or systemic antigenic stimulation was present.
The diagnosis received from the pathologist confirmed Granulomatous dermatitis and panniculitis. The aetiology was uncertain. Now that the diagnosis was confirmed, Andrea was able to offer a tailored treatment plan and with the addition chlorpheniramine, Otto continued to improve and is now recovering well and is being weaned from the corticosteroids.
This image is of the castration surgery site about four weeks after starting Andrea’s treatment plan.
Pascal’s practice is a VVS member practice. This means that the VVS workstation and equipment stay in the practice and all vets at the practice can use this equipment to seek specialist support whenever they need it.
Benefits of this system include:
- Patients receive world-class specialist care.
- Patients are treated in their usual practice, by vets that know them and their owners.
- Patients and owners do not have to travel to referral centres.
- Vets keep cases (and revenues) in house.
- Vets are upskilled, as they learn from VVS specialists.
- Time with a VVS specialist counts towards CPD hours, meaning that vets gain CPD whilst also bringing in practice revenue and without having days away from the practice.
- Vets have reassurance that they never need work alone. VVS’s friendly specialists become part of the practice team.
- COVID guidelines are easy to follow as all consults are virtual.