Do you do your own In-house skin scrapes, plucks & cytology etc?

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Richard Fox — Wed, 08 Aug 2012 09:09:51 GMT

I guess that plays a role Michael - i.e. vet who is not confident/interested in cytology may want and outside opinion?

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Michael Woodhouse — Tue, 07 Aug 2012 12:55:37 GMT

I like looking at skin samples in house and we stain urine, semen etc. Will do basic haematology but not much interest in FNA cytology as there often isn't much material and I prefer an outside opinion. IF we made the wrong call based on miss reading we'd end up with egg on our face, I'd rather blame an anonymous lab!

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Richard Fox — Tue, 07 Aug 2012 07:47:56 GMT

Yes I think that cytology should be covered at Uni more - It's historical (being a lecturer @ Liverpool) and I was the first to even introduce skin disease!!! Cytology could also be covered in teh clinical years with a pathology background but there is no time or inclanation to teach it!! But I agree its apauling pretty mych everywhere!

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Jo Cobbett — Mon, 06 Aug 2012 11:10:40 GMT

I'd love to do more cytology in house, and I'm building up my skills with CPD and keeping back a slide to check myself when I send them off, as I feel our cytology teaching at uni was poor. We spent ages looking at histology slides (and I haven't looked at one since I graduated), and very little time on cytology (which I could easily use every day in practice). Might be something to do with the course director being a histopathologist...

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Rajat — Fri, 03 Aug 2012 13:58:15 GMT

I meant seen it once on scrapes- seen it 4 times this year, and never saw a case prior to this. Anyone else seeing an upsurge in Sarcoptes?

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Rob Loxley — Fri, 03 Aug 2012 00:08:37 GMT

[quote user="Rajat"]As for sarcoptes- seen it once in my life...a few months ago! [/quote]

Pretty sure I've seen half a dozen cases this year. Definitely a few positives on bloods (usually the cases with classical symptoms that haven't responded to empirical therapy) and a few on scrapes (usually the really bad cases, though)

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Rajat — Thu, 02 Aug 2012 21:04:53 GMT

[quote user="Richard Fox"]

I'm not moaning as helps to pay my wages but we have more cytology and skin scrapes, hair plucks etc than we have ever had recently. I know that our biopsy submissions have not increased so I guess money has a contributing factor but I am left wondering if most vets either do not have the time (i.e. shorter consults) or just the inclination to do these tests in-house?

Just wanted feedback really?

[/quote]

I sent away far more slides as a new grad than now. I usually send out fnabs, but look at a slide inhouse too - part of the learning process for me as now I am pretty confident at diagnosing the more common tumours, and where finances are tight I can be reasonably confident about the diagnosis.

I never send skin stuff out now - eg ear cytology skin scrapes impression smears urine cytology- all very easy to do inhouse in a snap.

Will sometimes send haematology out especially if I want a second opinion on things like platelet counts or RBC regeneration.

As for sarcoptes- seen it once in my life...a few months ago! Never understood how some colleagues haven't seen demodex as I seem to get it on scrapes all the time.

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

emma o'connor — Thu, 02 Aug 2012 20:53:26 GMT

We are very fortunate to employ two part time dedicated lab techs. They do all our in house blood work including microscopy. We generally do all our blood smears in house unless they find something unusual then the slide is sent away, all urine microscopy, equine faecal egg counts, ear cytology, skin cytology, skin scrapes, and as I also have an interest in cytology we look at a number of FNA's ourselves and send away those we are unsure of. I do try to look at skin scrapes etc at the time of consultation but I do get 20 min appointments for skin cases which does help! There are vets at our practice less enthusiastic however about looking at their own slides, so thank goodness for a good lab team!

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Rob Loxley — Thu, 02 Aug 2012 20:12:52 GMT

I do a fair amount in house but I find the reports of good cytologists and clinical pathologists immensely good value for me and the client, when it comes to FNAs and odd haematology samples for instance.

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Martin Atkinson — Thu, 02 Aug 2012 19:05:55 GMT

[quote user="Mark Holmes"] I remember a puppy that I was sure had sarcopted but it took me 20 attempts to find one, and yes I was sampling the edge of the leisons and it was a few years before I found my first demodex mite,[/quote] I would say you hadn't seen a Demodex case before then - I always say: sarcoptes difficult to find, hard to treat; demodex easy to find, difficult to treat. How many send away for the sarcoptes blood test these days?

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Julian Earl — Thu, 02 Aug 2012 17:00:18 GMT

Tape strips on a lot - cheyletiella is far more common than I thought before doing these!

Sarcoptes - don't bother, just treat on symptoms.

Demodex - look but can be frustrating. I think I'm influenced by the first one I did as a student: a mongrel with a hairy head, hairy feet and a hairy tail, the rest of the dog looking like it was covered in cigarette ash. The slides were heaving with mites. Unfortunately (or otherwise!) they're not all that obvious.

Ear cytology - yep, easy, quick, cheap, useful.

FNAs - more and more following doing a couple of courses. Diff-Quiking should be a core skill IMO, as almost every lump could be done for basic inflamm vs neoplasia/source cell/malignant vs benign screening. I'm a total convert to FNAs and cytology and wish I'd done them years ago. Some are sent for confirmation out of necessity, but many are not too complicated to give a non-specialist general diagnosis and prognosis.

Haematology - yes, but not differentials, just overviews of anaemias, neutrophilias etc. Quite easy, quite useful.

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Jo Cobbett — Thu, 02 Aug 2012 16:10:31 GMT

I would agree with what people have said above. I'll look at skin scrapes, hair plucks, tape strips (usually on bunnies looking for cheyletiella), urine, lipomas, other FNAs send away and keep one to compare with report when it comes back. Blood smears I'll look at in house and send off if there's anything I'm not sure about.

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

James Laidlaw — Thu, 02 Aug 2012 16:09:04 GMT

I do them, but don't really jump for joy at the prospect. Really just looking for mites, found some just today even!

I think skin problems are one of the things that people either love or hate...

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Richard Fox — Thu, 02 Aug 2012 15:17:27 GMT

TBH who ever looks at the skin scrapes they aren't the most exciting things to look at but that's life?

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Mark Holmes — Thu, 02 Aug 2012 15:14:33 GMT

I generally look at my samples but it is mind numbingly tedious so can understand people submitting them. You can look at loads of samples in firtst opinion practice before you find a sarcoptes mite and that is in dogs that are known to have mange. I remember a puppy that I was sure had sarcopted but it took me 20 attempts to find one, and yes I was sampling the edge of the leisons and it was a few years before I found my first demodex mite, I actually danced when I saw it because I had started to think they were a myth like Santa or the tooth fairy.

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Richard Fox — Thu, 02 Aug 2012 14:59:30 GMT

Good the hear - I used to aspirate lumps after I'd take them off and then have a look, come to my conclusions and then wait for the histo results (Told the pathologists I has aspirated it of course ;) )

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Busybee — Thu, 02 Aug 2012 14:45:21 GMT

[quote user="Martin Atkinson"]they don't make 'em like they used to, these new graduates[/quote]

and I'm only 2yrs graduated

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Busybee — Thu, 02 Aug 2012 14:44:39 GMT

Very similar to Martin. Definitely do all skin scrapes in house (though some have to wait for a few hours later if we're really busy - would this make much of a difference?). Also skin tape exams and hair plucks. Ear swabs, will generally send away if I think I've got a good sample and want C&S - have had some surprising resistances recently so am keen to do this if owner's funds are willing. FNAs - always look at one in house then, unless I'm pretty much 100% sure its a lipoma, I send them away. Find this is a useful learning tool too - does the pathologist agree with what I thought I was seeing? Urine, always in house. Blood smears - again, always check in house then if am unsure about anything, will send away along with a full haematology. Nurses do faecal egg counts

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Richard Fox — Thu, 02 Aug 2012 14:38:03 GMT

Yes I don't know either why some maybe have the time but not the inclination - at least you can charge for your time - we used to charge £15 for cyto and didn't charge if we had to send it off? Sometime some practices have shocking facilities I know - my first job was like that until I took it upon myself to change things :)

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Martin Atkinson — Thu, 02 Aug 2012 14:36:51 GMT

[quote user="Richard Fox"]

Wow that also sounds good Martin :)

[/quote] Sounds like what everyone should be doing to me! As you said, we all used to do it back in the day - they don't make 'em like they used to, these new graduates.

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Utlendigur — Thu, 02 Aug 2012 14:34:03 GMT

Pretty much the same as Tess. Skin scrapes, tape strips, ear swab cytology in house. Send most FNAs to lab but often have a look in-house too. Do do some in-house if the owner doesn't want to pay/wait for separate FNA to lab eg suspected MCTs (making sure the owner knows I am not a pathologist). But I am the only vet in the practice who does - nobody else goes near the microscope apart from urine microscopy - not really sure why.

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Richard Fox — Thu, 02 Aug 2012 14:33:03 GMT

Wow that also sounds good Martin :)

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Martin Atkinson — Thu, 02 Aug 2012 14:30:19 GMT

I also screen all my skin scrapes for parasitology and malassezia, ear swabs for same + rods and cocci, plain &/or diff quick, some FNAs if I have multiple samples (don't want to cock-up the only one if it needs to go to a lab), urine for crystals & cells, blood smears for differential counts after QBC, occasional wet faecal smear for parasites.

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

Richard Fox — Thu, 02 Aug 2012 14:15:31 GMT

Thanks Tess - sounds like a good approach to me :) Sound like when I was in practice and got a new lab installed with a mic and stains etc :)

Re: Do you do your own In-house skin scrapes, plucks & cytology etc?

tess — Thu, 02 Aug 2012 13:30:54 GMT

I would do all skinscrapes in house, and plucks for demodex. I'd send off a pluck if I suspected dermatophytes. I'm ok with ear swabs for basic cytology (rods, cocci , malassezia). For FNAs I would tend to stain one up for a look but always send one to the lab (unless it's a lipoma).

If consults are quiet I'll have a look straight away, but mostly I just get back to the owners later.