C09973105 / invoice 10000

Appointment Notes: anal glands HISTORYPresenting for: Charlie presented for monthly follow-up appointment for ongoing skin allergies and pruritus management.Historical Conditions: Chronic allergic dermatitis with recurrent skin eruptions and pruritusSkin: Owner reports skin eruptions have been frustrating, with marked itching fits noted today. Scratching has become more rigorous since discontinuing Apoquel a few days ago. Previously scratched only a few times daily on half-dose Apoquel.Current Meds: Apoquel - discontinued 2 days ago (owner had been trialling half-dose). Owner reports still having some tablets remaining.Other: Last visit was one month ago. Patient has been receiving monthly appointments. Owner gave diabetic bath prior to today's visit.EXAMBehavioural: Patient was cooperative and did well during examination. Accepted treats readily.Rectal: Anal glands were impacted with liquid brown contents but expressed easily. Previous impaction noted one month ago.ASSESSMENTAllergic dermatitis - chronic condition with recent deterioration following cessation of Apoquel therapy. Anal gland impaction secondary to chronic inflammation, likely related to underlying allergic disease.PLANNew Meds/Tx:- Apoquel dispensed (20 tablets) - resume full dose daily as half-dose is sub-therapeutic and ineffective- Advised to use as needed but must give whole tablet when administeredDiet Recs:- Continue Royal Canin and sachets- Increase roasted pumpkin in diet for additional fibre to help prevent anal gland impaction- Can substitute some regular food with pumpkinAdditional Discussion:- Owner discussed insurance options, currently with Medibank with no pre-existing conditions- Recommended price comparison website (99 Pet Shops) for medication cost savings- Owner requested smaller quantity due to financial constraintsClient Comms:- Explained importance of full-dose Apoquel for therapeutic effect- Discussed relationship between allergic inflammation and anal gland problems- Advised regular pumpkin supplementation for anal gland health____________________________INSURANCE HXInitial Assessment > AGSuspected cause > allergies Date of first clinical signs > ongoing Any other conditions / treatments > nil     Vital Signs