C09971839 / invoice 10000

Reason: Itchy SkinAppointment Notes: Special payment terms existHistory:-- Presented for recurring skin pruritus -- Seen 2m ago for ear irritation and generalized skin pruritus – prescribed Dermotic and Apoquel-- Dermotic provided great relief – ear irritation resolved – no recent itching -- Apoquel ineffective – still scratching with no improvement seen-- Still scratching at the skin – worsening in the past week – mostly scratching at ventral abdomen and axillae, and chewing at front feet -- Has been on Lyka skin diet – minimal improvement seen-- Patient also has ongoing urinary issue ever since he was a pup – will urinate when stressed -- Does not seem to be PUPD or continuously incontinent – but will urinate when stressed – typically when startled – usually one to two episodes every few days – normal to large volume-- No stranguria or hematuria seen, not dribbling urine-- Currently on Zylkene for this issue – minimal response seen -- Otherwise EDDU normal, no V+/D+, bright and active still-- No recent dietary or environmental changes -- UTD with FTW -- Currently using Zylkene tablets  Examine:BARBCS 4.5-5/9EuhydratedT not takenMM CRT pink moist <2sCardiovascular:-- HR 100-- No murmurs or arrhythmias-- Normal synchronous pulsesRespiratory:-- RR panting -- Normal efforts and normal BV sounds, no abnormal resp noisesAbdo:-- Pliable with no masses palpable-- No organomegaly, no fluid waves-- No discomfort elicited-- Bladder small and soft – palpated after urinationLNs: -- WNLsIntegument:-- Mild erythema on ventral abdomen, bilateral inguinal region, and bilateral axillae, no alopecia/scabbing/pustules-- Mild erythema on interdigital spaces x4-- No obvious lesions or masses-- No evidence of ectoparasitesMSK: -- WB x4 and ambulatory, no obvious lameness -- All limb joints and bones palpably normal with no excessive heat or swelling, no pain or discomfort elicited on palpation-- PROM WNLs x4 -- Spinal palp WNLsNeuro: -- No gross deficits, no ataxia-- Palp and menace intact x2. -- Full neuro not assessedEyes: -- Bilaterally normal and symmetrical-- No swelling, discharge, or rednessEars: -- Left ear: Normal canal with no erythema, small amount of dark brown waxy discharge, pinna normal. Not sensitive to touch. -- Right ear: Normal canal with no erythema, small amount of dark brown waxy discharge, pinna normal. Not sensitive to touch.Nose: -- Bilaterally normal and symmetrical-- No dischargeOral: -- Mild calculus buildup on canines and carnassials mostly, no gingivitis-- C1G0 (1/4)Repro: -- n/a (desexed)Rectal: n/pUrination:-- Moderate volume of clear yellow urine produced, no stranguria or hematuria-- Not incontinent or dribbling urineProblem List:1. Skin erythema and pruritus-- Gross evidence of inflammation and irritation with no signs of skin infection-- Likely allergic skin condition – DDx atopic vs contact vs food vs others-- Poor response seen with Apoquel previously, consider other long-term pruritic control with Zenrelia/Cytopoint + Aloveen2. Inappropriate/stress urination -- No overt abnormalities on PEx, and no other urinary symptoms seen/reported-- Does not appear to be incontinent-- Likely behavioral-/stress-related vs detrusor instability vs USMI -- Consider U/A as first-line diagnostics-- Trial calming supplements + behavioral modification/training vs Propalin (PPA) trialTreatment:Lokivetmab (Cytopoint) 30mg (1mL) given s/c between shouldersBatch #: 820640Exp: 01/2027Plan:Discussed PEx findings and explained likely DDxDiscussed use of Zenrelia vs Cytopoint for ongoing pruritic control, owner opting for Cytopoint Cytopoint given s/c Repeat Cytopoint q1-3m depending on responseTrial Aloveen shampoo wash once to twice weeklyConsider hypo-/anallergenic diet trial if unresponsive to medical therapyAdvised to monitor for progression of urinary signs, trial calming suppls (Zylkene vs others) and behavioral training/modification first. Consider U/A as next step diagnostics. Consider trialling Propalin (PPA).    Vital Signs    Weight: 20.5;