Standard Operating Procedures at Toa Payoh Vets: Chronic skin diseases in dogs

I had a meeting with Dr Vanessa and Dr Daniel to discuss standard operating procedures in the treatment of skin diseases in dogs yesterday, Mar 29, 2012.

"In many cases, the owner had gone to at least one vet or two when they come to Toa Payoh Vets," I said. "Steroids and all medication had not worked. They had spent a lot of money. Yet their dog still scratches and bleed. If the vet at Toa Payoh Vets can't solve their problem, then there will be no referral from them. Successful outcome bring referrals. Steroids is only a short-term answer to the dog scratching."

THE STANDARD OPERATING PROCEDURES:

1. A detailed history and record of past treatments at various vets. Onset of skin diseasse. Get an overall summary if history is given orally. Pay attention and listen carefully. This takes a lot of time. Food types eaten. Treats given, shampoos used etc.

2. General and detailed examination. Location of all skin disease areas to be mapped out and written down. No general statement of "generalised dermatitis".
3. Blood test is mandatory
4. Skin test including 5 scrapings of skin for mites (not just one) and microscopic examinations. These must be recorded in writing meticulously.
5. Bacterial, fungal and yeast cultures to be advised. Sensistivity tests for bacteria.
6. Clipping of coat and bathing in an anti-mite wash is mandatory.
7. Cleaning of ears and expression of anal sacs. If otitis externa is chronic, advise ear ablation surgery.
8. Treatment may need hospitalisation for 3-7 days. Anti-mite treatments, no steroids to be given. Monitor progress of skin healing.
9. AMD. Against Medical Advices to be written down.
10. Food allergy test for 3 months. No treats or other food. This is usually not complied with.
11. Follow up by phone 2-weekly.

I will audit all chronic skin cases done by the vets.