C09973329 / invoice 10000

28/02/2026 HISTORY
Presented for skin issues with scratching and ear problems
Chronic allergic skin disease with recurrent skin infections
Diet: Currently home cooking meats and vegetables with small amount of rice due to allergies, previously on commercial dog food but switched due to skin issues
Skin: Chronic scratching and skin irritation, particularly in arm/axilla areas, all lines are back indicating active skin disease, scratching behaviour continues, ears also affected with discharge
Current Meds: Allergy injections (immunotherapy vaccine from dermatologist), previously on Apoquel

EXAM
Mentation: Boisterous
BCS: Overweight, needs weight loss
MM: pink, CRT <2s
Eyes: clear
Ears: Bilateral ear infections present, scratching at ears noted, yellow-brown thick discharge on pinnae and in ear canals
Cardiovascular: difficult to auscultate as dog very excited and rolling around - few heart sounds heard sounded normal
Respiratory: panting in consult, clear lung sounds
Abdominal: relaxed and full
Integumentary: Chronic skin changes in axilla and groin areas with thickened, elephant-like alopecic skin, erythema across ventrum, crusty lesions scattered around affected areas
Diagnostics - ear swab showed marked numbers of cocci, minimal yeasts. Attempted to get tape smear but dog uncooperative

ASSESSMENT
Bilateral otitis externa - Active ear infections in both ears requiring treatment
Chronic bacterial infection - Ongoing skin disease with thickened chronic changes in axilla areas, currently flared
Obesity - Significantly overweight at 60kg, requires weight management program

PLAN
New Meds/Tx:
- Easotic ear drops - apply to both ears once daily for 5 days, recheck ears in 5 days if not improved
- Apoquel 1.5 tablets once daily for 10 days for skin inflammation, can increase to twice daily if needed
- Cephalexin 1000mg 1.5 tablets BID for 10 days
Diet Recs:
- Reduce current food portions
- Continue home cooking with lean meats and vegetables if skin tolerates well
- Increase fibrous vegetables to help with satiety
- Formulated weight management diet discussed as alternative option
Additional Discussion:
- Treadmill exercise discussed as option for consistent exercise regardless of weather - owners have just bought one
- Hydrotherapy recommended and discussed, would be beneficial for low-impact exercise
- Dog walking services mentioned as option for additional exercise
- Chronic skin changes in axilla areas are permanent and will not return to normal pink skin
Client Comms:
- Recheck ears in 5 days if not responding to treatment
- Return before Apoquel tablets finish for skin reassessment
- Monthly weight checks recommended to monitor progress