C09973745 / invoice 10000

  Hx: Client consent obtained for recording with VetNotes, brought in by female O Left ear problem noticed few days ago Minimal scratching noted, O had noticed dirty ears Known allergies presentUsing wipes and cleaner at homePaws redder when outsideYoung dog, not yet desexed, possibly coming into heat now History of skin issuesPE: Patient v excitable but tolerant during examNo signif abnormalities thoracic field or cardiac auscultationNo signif abnormalities abdo palp MMs pink, CRT <2secsTeeth all OK Poss v small umbilical hernia noted - approx 0.5cm, non-reducible BCS 5/9Vulva poss sl enlargedSome evidence of saliva staining both front feet, less-so hind feet. Mild erythema. L ear - some sensitivity to exam, erythema & dark wax, signif amt discharge removed when both ears cleaned Otoflush. No signif concerns R ear. Both ears difficult to exam with otoscope as C v wriggly. Cytology: L ear - cocci ++, occasional yeastR ear - no signif findings Client Comms:Discussed ear treatment options - once daily vs twice daily medication - agree that suspect that BID meds wd be challenging for Cuda given wriggly & likely uncomfortable. Advised monitoring for head tilt or other neurological signsDiscussed Malaseb shampoo as treatment option for skin condition - O wd like to research Disc suspected hernia - likely repair at time of desex Disc desexing - usually aim to do 3m after a season, O will monitor - poss in-season now Treatment:Left ear cleaned with significant discharge removedOnce daily ear medication dispensed Plan:Recheck in 2 weeksConsider ear cleaner for long-term management at recheckMonitor for any neurological signs (head tilt, ataxia) - call if any concerns ariseMalaseb shampoo option for ongoing skin management

HISTORYPresenting for: Kuga, a 17kg dog, presented for evaluation of a black spot on the eye and ongoing skin allergies.Historical Conditions: Black spot on the eye observed for some time, now appearing more irritated.Diet: Royal Canin diet.Skin: Pink/red paws with some irritation. Owner reports paws are dry.Current Meds: 1/2 tab Zyrtec (cetirizine) for allergies. Nappy rash cream used topically on affected areas.Lifestyle Risk Factors: Outdoor access in backyard.EXAMMentation: BARWt: 17kgBehavioural: Enthusiastic, friendly. Required multiple attempts to examine eye due to movement.Eyes: Small black pigment patch on the leading edge of the third eyelid. Not raised, no weeping or lumpy appearance. No evidence of occlusion of vision.Integumentary: Mild erythema of paws. No evidence of secondary infection.ASSESSMENTPigmentation on third eyelid - Normal anatomical variation, not pathological.Environmental allergies - Mild paw erythema present, partially controlled with current medication.PLANChanges to Existing Meds/Tx:- Increase Zyrtec dose from 1/2 tablet to 1 full tablet (10mg) daily due to increasing weightDiet Recs:- Continue current Royal Canin diet.Additional Discussion:- Discussed environmental vs food allergies. Environmental allergies much more common (80% vs 20%).- Explained allergies in dogs manifest as skin issues rather than respiratory symptoms.- Discussed that topical treatments (creams) help after allergic response while antihistamines and specific anti-allergy medications prevent reactions - cytopoint/apoquel/zenrelia- Advised that if increased Zyrtec dose is ineffective, specific canine anti-allergy medications (Cytopoint injections, Apoquel or Zemraylia tablets) could be considered, though these are significantly more expensive (>$100/month).- Discussed that coconut oil and collagen supplements would not be effective for skin barrier issues.- Advised that rinsing paws after outdoor exposure and using oatmeal shampoos may provide some reliefDiscussed iW and HW - cont on monthly milbEMAILThanks for bringing Cuda to the clinic today.As a recap, we examined the black spot on Cuda's eye. I believe it's just a normal pigment patch on the third eyelid, not something concerning. It doesn't appear raised or lumpy, which would be signs to worry about. If you can take a photo of it for our records, that would be helpful. We should monitor it, and if it starts to look raised, weepy, lumpy, or spreads/thickens, we should consider a biopsy.Regarding Kuga's pink paws, we discussed her environmental allergies. Since she's now 17kg, I recommend increasing her Zyrtec dosage to one full tablet (10mg) daily. Its common for bully breeds to have environmental allergies (inhaled allergens rather than contact allergies), which typically affect the feet, armpits and groin. These are much more common than food allergies.If increasing the Zyrtec doesn't provide enough relief, we could consider more specific anti-allergy medications like Cytopoint injections or tablets like Apoquel or Zenrelia, though these are significantly more expensive.Keep going with milpro monthly for heartworm and intestinal worming prevention.Thanks,Dr Louise

O called asking about the desexing reminders and heartworm reminders. O said that they are going to wait until at least her 1st heat to be desexed. Told O that if she needs a late desexing cert that we can provide one (unsure if needs app for this). O also said they for now she will contiune with the milpro monthly. will update reminders.//AC