C09974278 / invoice 10000

27/02/2026 NURSE:NA
HISTORY:been licking the front left leg. owner cannot clean as dog does not allow. 
Also been aggressive at dinner time . Like he is not happy he is not getting attention. Owners both work from home so rarely away from the dog. new baby 3 weeks old. 
Cannot clean or assess skin or feet. Haven't given apoquel. also haven't used ecollar because can't get it on and because of the ear 
EDFU normal 
-Diet prime 100 and raw food, occas steals food 
-Env- in and out 
-Comp
-Prev- nrexgard
Current Meds:bathing fornightly with malaseb  - more of a spray in the sink than thorough washing. 
gaba 300mg bid
Current Meds:not been giving apoquel. cytopoint 40mg 3 weeks ago. 
-Insurance?
SUBJECTIVE: BAR
OBJECTIVE: T=  MM pink  CRT <2sec HR 88 = FP RR 24 RESP:NAD
BEHAVIOUR ASSESSMENT:happy dog when not examined. unsure of examination. need to take care. treats are great. 
BCS: 4/9
GIT:oral exam  - worn teeth from chewing, minimal tartar, 
U/G:- 
NEURO: NAD
M/S: NAD
SKIN: left cranial proximal  lick granuloma?, scar. brown staining surrounding. 
LAB tape test:  PMNS +++ cocci +
left ear crinkled post haematoma.  
OPHTHNAD
OTIC:  NAD - no otoscopic exam. 
left ear - aural haematoma healed. pinna disfigured. 
LYMPH/N:
ASSESSMENT:skin  - lick granuloma
history of mast cell tumour left lateral carpus 2016
aural haematoma healed. 
Tx OPTIONS:
TREATMENT:ceph 600mg bd 
owner to give apoquel twice daily for up to 7 days then revert to once daily . 
clean if can. owner reports dog doesn't allow him to clean feet, wound or ears. 
needs to wear ear collar to protect owners and the wound did not take one. will check at home. may need to give 600mg gabapentin before hand to put it on. 
PLAN:cytopoint in a week - if does not work then consider inappropriate choice for this dog. 
can trial on zenrelia. 
DISCUSSION:behaviour training as behaviour is changing and risk to new baby ( 3 weeks old) . gave Where you Lead card. recommend board and train. main concern is behaviour is deteriorating and there is a new born in the house. 
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DISCHARGE
Master Angus Finnegas has a mild skin infection and is generally itchy. We would like you to give apoquel 1 tablet twice daily for 5-7 days then reduce back to once daily . We will give the cytopoint as discussed at the 4 week mark to determine if it will be affective enough for him or not. If we do not have control after the second injection then we can consider this not a great option and we can consider different medications. 
Please use the chlorhex spray on his leg if you can without getting bitten. Then when its dry apply necort cream. To avoid biting an elizabethan collar should be worn and this will also prevent him licking at the area. You can give 2 gabapentin capsules to sedate him enough to do this. 
We have discussed his behaviour, especially around dinner time and the concerns around a new baby. 
We recommend you engage a behavioural trainer than try to assist with this. In the meantime we would really appreciate a video of his dinner time antics so we can appreciate the behaviour . You can either send it through on email or via our facebook page. 
We will recheck his skin with a vet about a week after his cytopoint injection so we can assess his response to the antibiotics and cytopoint and make a plan for managing his skin down the track. 
 If you have any concerns or queries please do not hesitate to contact the clinic