C09975523 / invoice 10000

History: presented for recheck of ongoing skin issues, seen by JL about 10d ago, treated for facial fold dermatitis with ABs but has started to become very itchy and develop some areas of hair loss nowFlea/tick/worming /heartworm prevention: UTDExamination -FAS score: 2/5Behaviour: BARNeurological: Proprioception and mentation normalEyes: Open, comfortable, no dischargeEars: Clean, no dischargeTeeth: 1/4PLN: No lymphadenopathyRespiratory: Normal bronchovesicular soundsCardiovascular: MM pink, moist CRT <2s, Heart regular rhythmAbdomen: relaxed, soft and comfortable, no masses palpableIntegument: small areas of hair thinning on FLs and around face, no rashes/infection remainingMusculoskeletal: No pain or lamenessBCS: 4/9Urogenital: external appearance normalDiscussion: Susp allergy/atopy/contact allergy contributing to skin fold dermatitis prevTreatment: Infection resolved on neocort, can use on any further lesions, short apoquel course disp, iramine for insect bite allergies (prev happened). OK to collect more apoquel within 6months if needed

HISTORYPresenting for: presented for a skin tag and a skin infection on her nose.Historical Conditions:Skin: Owner noticed a skin tag approximately 2 months ago on left elbow. It has remained the same size for about a month. Also has a skin infection in the folds of her nose that she has been scratching at.Current Meds:Lifestyle Risk Factors:EXAMMentation: BARBCS: Good body condition, fit and healthyBehavioural: Good temperament during examinationEars: Nose: Infection noted in the nasal foldsOral: Integumentary: Small skin tag present, unchanged for approximately 1 month. Bacterial infection with occasional Malassezia in the nasal folds.Diagnostics: Skin cytology from nasal folds revealed significant bacteria and occasional Malassezia (less than one per high power field).ASSESSMENTBacterial dermatitis with minor Malassezia component - Localised to nasal foldsSkin tag - Benign, stable in sizePLANNew Meds/Tx:- Neocort cream BID for 1 week to nasal folds. Contains anti-inflammatory to help reduce itching and inflammation.Additional Discussion:- Advised that remaining Neocort can be kept at home for future minor skin issues- Discussed that small breed dogs can be prone to skin issues, particularly in fold areasClient Comms:- Return if nasal irritation worsens or if scratching continues despite treatment

Reason: Bee stingHistory:Brough in by pet sitter, about 2h ago saw her limping, found bee sting in her paw that she pulled out, just past 30min swelling came up around face, no resp distress, does have history or insect bite reactionsFlea/tick/worming /heartworm prevention: UTDExamination:Behaviour: BAR FAS 1Neurological: Proprioception and mentation normalEyes: Open, comfortable, no dischargeEars: Clean, no dischargeTeeth: 0/4PLN: No lymphadenopathyRespiratory: Normal bronchovesicular soundsCardiovascular: MM pink, moist CRT <2s, Heart regular rhythmAbdomen: relaxed, soft and comfortable, no masses palpableIntegument: RF paw swelling palmar aspect between MC and C pads. Bee sting, LHS upper lip and upper eyelid oedematous/swollen, nil urticariaMusculoskeletal: No pain or lamenessBCS: 4/9Urogenital: external appearance normal,Diagnosis: Allergic reaction bee stingTreatment: Niramine inj 0.5ml SCPlan: Recheck INI within 30min or any resp CSx