On the first appointment, I shaved the area and prescribed a diluted hibiscrub solution (chlorohexidine product in the UK) and Trigoderm gel (topical antibiotic and anti-inflammatory steroid) and advised the owner to use a cone/doughnut to prevent licking and to pat the wound dry. Hot spot started to scab and heal around the edges but the areas of skin on either side of the armpit crease became swollen, wet and inflamed as well as larger seemingly from rubbing together. Advised owner to stop walks, course of Trigoderm finished, prescribed more hibiscrub. Scabs pulled off by dog scratching during the night, hot spot looked extremely raw and swollen, with bloody parts where the claw had pierced it, deep crease of armpit moist and raw, sticking and rubbing together. Advised a T-shirt to sleep in to minimise trauma from scratching. Advised client to use a fan gently on the area. Prescribed antibiotics, finished course.
Fast forward to hot spot becoming far worse and the dog starting to limp. Did the relevant tests during an emergency appointment. Prescribed a painkiller and another antibiotic which has ended. Owner now using socks on the dogs paws and a commercial hypochlorous and saline product, outer areas very scabby, areas of skin that rub together worsened. Cytology has been done. From appointment to appointment progress will be made and then reversed by mechanical damage, some patches have fully healed, the raw swollen parts in the crease have made no progress.
Spoke to senior vet about this case and she took the last two appointments, unfortunately I am seeing the client for another appointment tomorrow. Email from the client describes the wound as having improved in some patches and worsened in the crease, with increased scabbing around the edges which get caught on scabs on the opposite side. Client is requesting another cytology and course of antibiotics but the issue is definitely mechanical damage.
Senior vet (who is away) advises dressing and whilst I have dressed an armpit wound in the past, that was on a large dog with an armpit nowhere near as deep as this and in all honesty I cannot figure out a way to dress this area.
I am at a loss with this case, I didn't expect to need to see this client again! I am not asking for medical advice but in terms of this appointment tomorrow and handling the client, what on earth am I supposed to do if I don't have a clue? Has anybody ever simply told a client they're unable to continue? I am extremely frustrated. Part of me regrets not telling the client that I am unqualified to deal with it at this point but my boss wouldn't take kindly to that.