C09976238 / invoice 10000

Reason: Swollen Eyes Cant Come Ealier Appointment Notes: Overdue remindersReason: Allergy flare-up, skin and ear infections.History:Presents for allergy flare-up, including licking paws, pus from a lesion, and pimples.The owner reports that the eyes are better after using eye drops from a previous visit.The dog is squinting and pawing at his eyes.He is licking his paws "all the time".The dog is on Apoquel but continues to lick his paws, suggesting the current dose is insufficient.He has never been on twice-daily Apoquel dosing for a sustained period.The owner has been cleaning the paws and groin with Betadine spray.There was one day (Saturday) where he was lethargic and had no appetite, but was fine the next day.He seems to get out of breath and lies down in the middle of walks.The owner has noticed his paws shaking, which has always been present.Walks have been reduced due to bleeding paws and concerns about grass allergies.Diet: Royal Canin Hypoallergenic. Occasional treats.Parasite preventative: Not mentionedIndoor/outdoorOther pets in household: Not mentionedPre-existing conditions: Environmental allergies, previous ear infections.Current medication: Apoquel 1.5 tablets every other day.Weight:EXAMINATION:Body Condition Score: 5/9BAR MMs pink 1s euhydrateEyes/Nose/Throat: Gunky discharge from the left eye.Ears: Left ear inflamed with gunky discharge. Right ear NAD.Thoracic ausc: NAD lungs clear, no murmur, no arrhythmia, pulses synchronousOral: clean no tartar or gingivitis grade 0/4. No malocclusionsAbdominal: NAD comfy on palpation, no masses or swellings. No herniasMusculoskeletal: Ambulating normally. Paws are swollen between the toes.Integument: Pustules and pimples in the groin area. Swelling and inflammation of the paws, particularly the front feet. Chronic inflammation and trauma have led to hyperpigmentation (black spots) in the groin.Neurological: NADRectal: not performedUrogenital: Both testes descendedLymph Nodes: WNLDIAGNOSTICS:Urine sample collected via free catch. USG 1.030.Sticky tape prep of feet, armpits, and groin performed.Ear swab of left ear performed.EAR CYTOLOGY ear swab:Left ear: Mixed infection with rods (bacteria).Right ear: NAD.SKIN CYTOLOGY sticky-tape prep: Mild yeast infection on feet, armpits, and groin. Pustules noted in the groin.FLUORESCEIN TEST: NEGATIVEPROBLEM LIST:Severe allergic flare-up (atopy).Secondary pyoderma (groin) and Malassezia dermatitis (paws, armpits, groin).Otitis externa (left ear) - rod bacteria.Conjunctivitis (left eye).Paw swelling and discomfort.Pruritus ddx: FBH, mites, allergies (contact vs food vs atopic)ASSESSMENT:Presents with a severe allergy flare-up resulting in secondary skin and ear infections. The current dose of Apoquel is not controlling the pruritus. Examination reveals pyoderma in the groin, Malassezia dermatitis, significant paw inflammation, and a bacterial ear infection in the left ear. Diagnostics confirm a rod-based bacterial otitis externa and a mild yeast infection on the skin. A fluorescein stain was negative for corneal ulcers.TREATMENT:Prednisolone administered in consult.Ear cleaning performed in consult.PLAN:Restart Apoquel at twice a day dosing for two weeks to control the flare-up, then review.Prescribed Prednisolone for 3 weeks to reduce inflammation.Prescribed antibiotics for 3 weeks for the skin infection.Prescribed medicated ear drops for the left ear, once daily for 7 days.Prescribed steroid/antibiotic eye drops, twice daily for 5 days.Continue Malaseb shampoo washes on affected areas (paws, armpits, groin) 3 times per week for the first week, then reduce frequency. Leave on for 10 minutes before rinsing.Discussed that panting and reluctance to walk are likely signs of discomfort from his sore paws.Discussed that hyperpigmentation is a form of scarring from chronic inflammation and will fade slowly over time.Discussed diet change away from hypoallergenic food to a skin supportive diet (e.g., Pro Plan) in the future, once the current flare-up is controlled.Recheck consultation booked for 3 weeks' time on 20/03/2026 to reassess skin, ears, and overall progress. Will also check eligibility for Healthy Pet Plus annual blood test at that visit.Discussed that side effects from prednisolone are temporary and will resolve after the course is finished.Discussed options for long-term allergy management if Apoquel is not effective, including Cytopoint injections and Zemrela.Total estimate for today's consult, diagnostics and medications is $172.80. Owner approved.    Vital Signs    Weight: 41.4;