C09975272 / invoice 10000

History: Mia here with Hazel. Presents for lethargy, hyporexia, D+ & V+ - onset yesterday afternoon/evening with worsened lethargy/hyporexia (negligible food intake) today.V+/D+ not observed by Mia but by family - D+ reportedly liquid, possibly some blood but unsure; vomitus unsure re appearance. Eating grass.Diet: kibble to graze on; dog food roll - no recent change but can be a scavenger (despite being fussy with her own food!) as well as predation (ate a dead bird 1 week ago)Also known to ingest fluff and/or bits of rope from her toys after destruction but no recent ingestion observed.Parasite control: deworming due yesterdayEnvironment: single dog household; went to dog park yesterday on-lead - doesn't usually go to dog populous areas though; no known access to toxinsMedications: Apoquel 2.7mg PO SID for allergic skin dz - good responseExam: QAREventually ate a chicken treat but overall minimal interestMM mildly tacky, mildly reduced skin turgorOther vitals WNLBCS 4/9Integument: NADEars: pinnae WNLOral: slight calculusEyes: NADLNs: NADCardioresp: NADAbdomen: NAD - soft & comfortable; no palpable mass/FB/organomegalyGenitourinary: NADMSK:  ambulatory w normal gaitRectal: NP due to small patient sizeDiagnosis: Acute lethargy, hyporexia, V+/D+ - likely primary GI (dietary indiscretion, infectious, less likely FB or other structural), less likely extra-GI (hypoA, renal, liver, pancreatitis); mildly dehydrated but otherwise stable on presentation todayTreatment: Ondansetron 4mg PO q8-12h PRNPlan: Present to emergency if deterioration over weekend (bloodwork, IVFT &/or other supportive care or diagnostics as indicated in that case).Otherwise offer small portions bland, highly digestible diet. Recheck next week if signs failing to resolve.

History:   the cytopoint last given 10  - 11 weeks ago did work well, but recently itchy again. the Barazone is also being quite effective. Exam: skin with mild diffuse redness in the ventrum. one red spot, papule in the R groin area. feet ok. ears ok. Otherwise skin good. Diagnosis: ongoing atopic.intermittent and a long time since the cytopoint, so less liikely food. Treatment:  Will try Apoqule now , as per previous plan 2.7mg SID ongoing, can use BID at the start for a few days. Plan:  ok for repeats for 6 months if going well. continue with Barazone and med shampoo as required. R/V:

History:  more itching recently 5.5 weeks since last cytopoint. rashy in the groinchewing front legs, feeling that R worse. Exam: BARdiffuse papular rash in the whole groin and the medial thighs. Can't see an issue with the feet, broken skin/redness etc. > She 's a bit foot shy Diagnosis:  likely  atopic.  - likely mild second bacterial. havn'et ruled out food allergy. Treatment: Cytopoint 10mgWith a plan to try Apoquel 2.7mg SID after that ( Richard on Holiday for a copule of weeks, house sitter, so doesn't want to start tablets yet )Supplied Barazone for weekly use after Malaseb Discussed the option for  an Anallergenic trial _/ Croc/tap. Plan: R/V: