"Vet 1 said the grey circular spots on his belly and body are due to ageing," the lady disputed this finding. She would bring her dog for check up only when she's back home from the U.S where she was an undergraduate.  .

I had said that such grey spots are present in some white-skinned dogs and are natural as they are born with them. As to them caused by ageing, I am not sure. Sometimes the owner did not notice the grey patches when the dog is a puppy. These grey areas are not inflamed when I saw them.

"But the grey circles keep increasing in number compared to last year," she also pointed to 2 grey circles behind the eyes and below the ears. These were new developments. How and why do they exist?

"Some are due to the application of creams for a long time to treat skin diseases," I said. "The cream causes hyperpigmentation or black pigments to be deposited under the skin. Some are due to continuous scratching by the dog as in the skin below the ears. The two ears are red and some edges have crusts. The redness gives a clue that the dog scratches them to relieve his itchiness.

"Skin diseases like generalised ringworm are expensive and hard to cure," I said. "The increasing number of grey spots could be due to the application of shampoos or creams to cure the skin disease by your family members when you were overseas. After some time, the skin disease get cured and the result is the grey circles. Another spot of ringworm appears as you can see a fresh red bleeding circular one on the right beside the inflamed armpit. So, when you come home once a year in September, you see more and more grey circles in this old dog!"

The explanation seems credible to her.

To show and tell, I switched off the room lights and shone the Wood's lamp onto the right armpit. "Not every ringworm-infested hair will fluoresce in green," I said. "Around 70% will do." Well, she saw the shiny green hairs scattered around this right itchy armpit.

In addition, I put some hairs from the bleeding circle behind the right armpit and showed her the fungus in the hair shaft, under the microscope. So, the evidence was there.

I also scraped the skin and crusts of both ear edges till they bleed. But no skin mites were seen. My explanation was that the dog was on FrontLine spot on and the mites could have died but not eliminated. "Normally 3 skin scrapings or more should be done." As the dog's ears were bleeding, the lady wanted to wash her hand stained by the blood.

It takes a lot of time to show and tell. "Much of the lack of recovery is due to the owner not following up one month later with the vet and not de-contaminating the environment or checking the dog for new infections," I said. "They go to the groomer monthly as in your case but will not consult the vet. I can understand as there is the financial considerations."

"The groomer provides free transport and so my dog sees the groomer monthly," she was surprised that the dog still had copious volume of grey anal sac secretions which were expressed by my assistant. She presumed the groomer would do it.          

"You can get a dog transport man to bring your dog to the vet for the one-month follow up on generalised ringworm," I advised. "When the dog's body is infected widely, it is a very difficult disease to cure but there are successes. It is an expensive disease to cure if it is widespread."

Success in treatment of generalised ringworm elicits referrals but the vet needs to spend a lot of time communicating with the owner and delivering results of cure. A good clinical outcome depends much on the owner's compliance actually, in medicating and shampooing the dog, following up and in decontaminating the environment! The vet has to follow up but most of us don't have the time to keep following up!  So, the owner goes to the groomer who provides "free" transport and shampooing and ear cleaning.
 

I emailed the lady to get her dog home:

Kong Yuen Sing <99pups gmail.com="">	10:33 AM (22 hours ago)
to m,

Coming, flying over

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