C09972044 / invoice 10000

Appointment Notes: cut on paw pad, allergy flare up. bwHistory:Owner concerns: has been going really well with allergies for the last 6 months, hasn't needed cytopoint. O not sure what has happened, but she is getting itchy, particularly on front feet, and has 2 sores starting. Also has a graze on her paw pad, which O thinks she got from trying to play with other dog through the fence. Also walked through an ant hill the other day and had big ants all over her. Not sure if it was one of these things that set her off or just allergies. She is an anxious dog normally, but coping ok at the moment. Otherwise well EDDU normallyNo V/D/C/SMedications: noneExamine:QAR, good to examine Cardiorespiratory: no murmurs or arrhythmias appreciated, pulses normal, lung fields clearAbdominal palpation: comfortable, no masses or organomegaly appreciatedMouth: mild generalised tartarEars: NADEyes: NADInteg: lesion present on LF dorsal foot, approx 1cm across, slightly raised and red with mild alopecia, irritated to touch. Lesion present on RF dorsal foot, approx 1cm across, mild alopecia, no erythema and not raised, not sensitive to touch. Graze present on LF lateral metacarpal pad, not full thickness, no discharge present LNs: NADMSK/neuro: NADLaboratory:Sticky tape from lesions on dorsal feet showed mild cocci overgrowth but no neutrophils present Assessment:Early superficial pyodermaGraze on padAtopyPlan:Hopefully have caught pyoderma early enough to just treat topically, recommended starting with chlorhex scrub and bacticorten, plus e-collar to prevent licking if required. If ongoing irritation then may need to trial pred or oral ABs as indicatedDiscussed graze on pad, recommended keeping clean and stopping self trauma, can use vaseline/pawpaw to protect when going on walks while it is healing Discussed atopy, has been well controlled, but recommended cytopoint again to settle this flare and hopefully will go back to normal control. O happy with plan. R/v if not improving Treatment:Given cytopoint 20mg #840616 exp 02/2027Given cytopoint 30mg #840615 exp 02/2027Rx chorhex scrub 2-3 times daily on feet for 7 daysRx bacticorten 2-3 times daily following chlorhex for 7 days     Vital Signs    Weight: 49.6;       MMColour: Pink;       HeartRate: 104;       RespirationRate: 28;       BodyScore: 6;       DentalGrade: 1;       CRT: 1-2;