Consultations at Re-Fur-All Referrals last a lot longer than standard veterinary consultations. Patients with skin conditions have often been affected for a long time, many years in some cases! Every patient is unique, an individual, for whom it is so important to carry out a detailed investigation. For me to become familiar with all the details of the patient’s history typically takes about 20 minutes, examining the patient another 20 minutes, performing tests another 20 minutes, and discussing test results, drawing conclusions and outlining different treatment options can take another 20-30 minutes. Let us consider each of these in more detail.
Ideally, consultations are conducted with the patient physically present. Unfortunately, for various reasons including the current lockdown crisis, this is not always possible. Fortunately, today’s technology allows us to meet in the virtual world for online video consultations, or telemedicine. Once I have received the Referral Form from you, I will contact you to arrange a consultation. I will contact your usual, primary veterinary practice to inform them of the consultation and to request a copy of your pet’s clinical records. If we decide on an online video consultation, I will send you an invitation, probably using Zoom, WhatsApp or Skype, to meet at a pre-arranged time. You will be able to log into the consultation on your computer, laptop and/or phone. Payment is normally via direct bank transfer.
Testing is often indicated for patients with skin complaints. Although it may not always be possible to arrange tests immediately during these difficult days of lockdown, much can still be done to make a diagnosis, and treatment is usually possible.
After each consultation, I will send a written report to your own vets and liaise with them on appropriate treatment.
This starts with access to your pet’s clinical records supplied by your regular vet. I then need to expand on this information by obtaining your version of events over the weeks, months and years. The records from your vet will include previous visit dates and names of medications dispensed previously but you, the patient’s owner, are more likely to know whether or not these helped or made things worse, whether they were well tolerated, easy to give, or caused any side-effects. You live with your pet and know him/her better than anyone. You know whether he is itchy, licks his paws, bites his nails, shakes his head, and how often in a day he does these things. You know what he eats, how lively he is, his favourite haunts, the animals he plays with, whether he is gaining or losing weight, and whether he is nervous, anxious, depressed, lethargic, or more sensitive to stress. These are just some of the many things I will want you to share with me in order to help me find out the cause of your pet’s skin problems. If we can establish the cause, we have more hope of prescribing safe, long-lasting, effective treatment.
I then, of course, need to examine your pet, assessing not only the skin but also the whole body and temperament. Don’t be surprised if I don’t go immediately to the area of the skin you feel is the worst affected. I will be assessing him even as he sits in the waiting room and walks into the consulting room! I always examine the whole animal in detail, including face, ears, eyes, feet and back end, so as not to miss anything. It takes time but this approach is more comprehensive and can reveal important clues.
After taking a history and conducting a thorough examination, I should be in a position to discuss with you what I think may be going wrong. There may be a list of several possibilities which I need to narrow down as much as possible, and this leads into the next part of the consultation – tests. Wouldn’t it be great if one test gave us the answer? Sometimes, one test may be all that is needed but for most patients, I select from a range of tests most likely to help achieve a diagnosis. I can conduct many tests there and then, giving you results within 15-20 minutes. These would include skin scrapings, coat brushings, hair plucks, ear wax analysis and tape strip cytology, examined under the microscope, to give a rapid assessment of the structure of hair and skin cells, and to look for evidence of mites, fleas, lice, ticks, worms, bacteria, yeasts, ringworm fungus and other unwelcome guests! Some samples such as swabs, blood and hair, may need to be sent off to an external laboratory for further analysis, and other procedures, such as intradermal allergy testing or skin biopsies, may need to be scheduled for a later date.
At the end of the consultation, armed with new information, I will be in a much stronger position to give you a diagnosis, discuss the prognosis and suggest preliminary treatment.
My involvement does not stop when you walk out the consulting room door. After every consultation, including online video consultations, I send a written report to your regular vet, outlining my conclusions, detailing results of all the tests, giving an evidence-based prognosis, and suggesting treatment. I am then available by email or phone for further advice, both to you and your vet.
Further visits, typically lasting 20-30 minutes, may be appropriate to pursue a definitive diagnosis and monitor response to treatment, but your pet always remains under the care of your own primary, regular veterinary surgeon. Many skin disorders cannot be cured but can be managed in a way that optimises the chance of an excellent quality of life. Periodic monitoring is often the key to success.