C09972392 / invoice 10000

02/03/2026 NURSE: RW 

REASON: Itchy ears, chewing at paws, scooting, and general irritability. O reports a flare-up of skin issues.

HISTORY:
- Strict dry and veggie diet. No treats or scraps. Psyllium husk added for fibre.
- History of allergy flare-ups.
- Previous use of Malaseb shampoo for paws.

DIET: Strict dry food and veggies. Psyllium husk added to diet. No treats or scraps. Recent slight weight gain noted after being in care.
TOILETING: Scooting at home.
CURRENT MEDICATIONS: Malaseb shampoo for paws used previously. Amoxyclav 

CLINICIAL EXAM:
- Mentation: QAR
- MM: Not assessed
-CRT: Not assessed
- Oral and Dental Score: Not assessed
- Eyes: Not assessed
- Ears: Right ear has wax and debris. Left ear has two yeast cells found on cytology. No active infection. A little bit of wax at the end of the canal in both ears.
- BCS: Not assessed
- Lumps: Not assessed
- Abdominal: Not assessed
- Lymph nodes: Not assessed
- HR: Not assessed
- RR: Not assessed
- Temp: Not assessed
- Urogenital: Anal glands expressed. Both were very full, hard to express. Normal contents.
- MSK: Not assessed
- Skin: Atopy between toes, paws are red and owner reports she has been chewing at them.
Hot spots drying up ventral neck area, scabby dried discharge present 

ASSESSMENT:
- Generalised allergic flare-up (ears, feet, skin, anal glands).
- No active ear infection.
- Full anal glands causing discomfort and scooting.

DISCUSSION:
- Discussed findings with owner (O). Explained this is likely an allergy flare-up.
- Advised on a short course of anti-itch medication to get the flare-up under control.
- Discussed that if symptoms return after medication is finished, long-term allergy management may be required.
- Discussed need for regular anal gland expression, possibly every few months.
- O advised on diet and weight. Elsie is now fully grown, so any weight gain will be fat.
- O educated on using Malaseb shampoo on paws.
- O declined us clipping neck to remove crusting today 

TREATMENT:
- Anal glands expressed.
- Otoflush ear clean BID q7d
- Apoquel 16mg BID PO 7d, then SID PO 7d
- Malaseb wash for feet recommended.

PLAN:
- Monitor for improvement on medication.
- If signs of itchiness return after the course is finished, a recheck is advised to discuss long-term allergy management.
- May require ongoing nurse appointments for anal gland expressions.
- Continue regular Malaseb washes on paws as needed.
- Continue strict diet and monitor weight.