We put Kaswyn in the stall and soon were met by two students. One of them, a senior, took Kaswyn's vital signs. The other had a clipboard of info. After a few minutes Dr. Derm returned with a dermatology technician (she might have been a vet too, but I'm not sure) and two or three more students. We all stood in the hallway while I gave Kaswyn's history of hives, medications, and the ingredient lists for all the feeds and supplements that he is getting. While we were discussing Kaswyn another doctor form the medical team came over - Dr. Med. Then we were ready to start the preparation for the testing and Dr. Med said that he'd be back later.
The allergy test works like this - purified allergens are suspended in sterile saline and loaded into a syringe. Small amounts are injected just under the skin, which initially makes a small hive-like swelling because of the fluid. If Kaswyn is not allergic to it the swelling should go away and not return, but if he is allergic he'll get a welt or hive in the area, the size of which equals how allergic he is to the allergen. There were 76 allergens for Kaswyn's test, including a spot for saline alone (which should give no response - negative control) and histamine (which should give the strongest response - positive control). All the allergens will be compared to the negative and positive controls to judge if there is a reaction or not. For a spot to be considered reactive it must be more swollen than the negative control. The allergens were a variety of molds, grasses, weeds, trees, and animals.
Dr. Derm got the trays of syringes ready for injecting into Kaswyn's neck. Senior Student gave him a light sedative and we waited about ten minutes for it to take effect. He seemed to get a little sleepy, but not nearly as sleepy as I thought he would be. Dr. Derm commented that he didn't look very sleepy, and I said that I didn't think they even sedated him last time, so she said we could just go for it and start the testing. I held his head while she clipped an area on his neck and made dots with a black Sharpie to indicate where the allergens would be injected. She would use the dots later to read the test to determine what reactions he had.
I enlisted L to take pictures and videos while I held his head, and they began injecting. Although he wasn't very sleepy, he didn't move or shake his head during the whole time that they jabbed him in the neck with 76 tiny needles. When they were all done Dr. Derm said that he was a very good patient, and seemed impressed with his demeanor.
Picture of the Allergy Test
Video of Kaswyn during the allergy test
Before she left I had Dr. Derm take a look at a few other skin related issues since I had a dermatology expert on hand. When I was grooming Kaswyn the day before I found something on his shoulder that felt like another big splinter on the same side of his neck. Not as big as the other one, but about an inch long and a little puffy. I told her about the previous splinter extraction and showed her the old incision and then the new splinter. She had a feel and agreed that it was another splinter. After clipping the area for a better view, she began tryng to push the splinter out and was able to push out some of it, along with some pus, but was concerned that it was breaking off inside the wound. We also were able to find three or four more small splinters that were not inflamed so were easily removed.
As we were feeling around for more splinters, Dr. Med came back, examined the area, and agreed that it would have to be cut out. He said that we could take Kaswyn over to the triage area for a quick minor surgery to remove it. Dr. Derm asked how Dr. Med was going to sedate Kaswyn, and he asked what would be best so as not to interfere with the allergy test. She suggested local carbocaine, and Dr. Med looked at Kaswyn and said "Well, we can only do that if he's going to be very still and good about it" and Dr. Derm said "He wasn't very sleepy when we did the allergy test and he didn't move at all. In fact he was fantastic so I don't think you'll have any problem."
Dr. Med looked skeptical, and then looked at me and said "He's an arab?" I said "Yes, but he's really a good boy. He'll be still for it, I'm sure." He frowned a bit and said "Usually arabs are not that calm." I assured him that Kaswyn was a special case, and he agreed to go along with the plan. I could tell that he thought there was no way that he'd be able to locally numb the area without a sedative. I knew that Kaswyn had been poked and nerve blocked lots of times before with no sedatives and while he might flich a tiny bit he's never done anything remotely bad like kicking or rearing or running you over. He's just not like that.
Dr. Derm did the fifteen minute read with Senior Student and Derm Tech (with two other students watching). Before we took Kaswyn to triage I also had Dr. Derm look at a spot on his left hind pastern right above the hoof and also some areas on his hind cannon bones. I kind of knew what the cannon bone issue was, since he gets this flaky skin there every spring and fall that I've been able to clear up myself with antibacterial shampoo. The spots on his pastern I was unsure of, so she said she'd have the students do skin scrapings and look at them under the scope. She said she wouldn't charge me because she knew what it was and it was a classical case of bacterial dermatitis so having the students see it would be a good thing.
When the skin scrapings were complete, it was time to go to triage for minor surgery.
To be continued...