C09976416 / invoice 10000

History:- Presented for Cytopoint injection. Owner reports swelling and ulcers on the vulva, and increased respiratory effort on walks.- Last Cytopoint injection was in November, approximately two months ago. The effect is noted to be shorter than in colder months (up to 6 months).- Past medical history includes surgery for soft palate resection at under one year of age.- Diet consists of a combination of kibble and wet food, fed twice daily. A raw food diet was trialled but discontinued. Supplements (probiotics and fish oil) were also paused.- Occasional reverse sneezing reported. No coughing or sneezing.- Reduced exercise from 1-1.5 hours per walk due to weather and increased respiratory effort.- History of scooting, which has not been observed in the past two days.Exam:- Weight: 14 kg (previously 13.8 kg). Body condition is 7/9- General: Bright, alert, and responsive.- mucous membrane pink, CRT1-2s, euhydrated- Eyes, nose nad- Ears mild redness on the outter ear canals- Cardiovascular: Heart sounds are clear on auscultation, no murmurs detected.- Respiratory: Chest sounds clear on auscultation. No restrictions noises at the throat area.- Gastrointestinal: Abdomen soft, non-painful on palpation.- Urogenital: Vulvar area cleaned with chlorhexidine solution. Revealed erythema and warmth. Scabs present.- Anal glands are full on both sides - Ambulatory, no lameness- Skin and coat okAssessment & Plan:1. Allergic Dermatitis / Vulvitis or possible secondary to trying to scoot (anal glands)- Treatment:- Cytopoint injection 30mg SC- Advised owner to clean the vulvar area daily with diluted Betadine solution (1:1 with water), ensuring the area is kept dry.- Recommended reintroduction of probiotics and fish oil supplements.- Anal glands expressed; contents were liquid and easily expressed, not impacted.2. Overweight / Increased Respiratory Effort- Assessment: Weight gain and overweight is likely contributing to increased respiratory effort, especially given brachycephalic conformation. but cannot rule out brachycephalic obstructive airway syndrome (BOAS).- Treatment:- Institute a weight loss plan. Recommended reducing food quantity by half (e.g., from half a can and half a cup of kibble per meal to a quarter of a can and a quarter of a cup of kibble per meal, twice daily).- Encourage adding low-calorie vegetables (e.g., carrots, pumpkin) and fruit (e.g., pineapple, apple, berries) to the diet to increase satiety and fibre.- Advised that pumpkin can also help with natural anal gland expression.- Follow-up:- Monitor weight loss and respiratory effort.- If breathing does not improve with weight loss, a sedated upper airway examination to reassess the soft palate is recommended.

Reason for visit: cytopoint injTreatment: Cytopoint 20mg given scPlan: cytopoint inj due in 4 weeks

Visit reason: Skin allergies and Weepy eyesSubjective:Presenting for follow-up on eye issues.Onset of symptoms yesterday. Rubbing face. Eyes appear painful.Owner reports a walk on grass recently treated with pesticides at a stadium. Did not ingest grass.A nail quick came off approximately two weeks ago, with minor bleeding that has since resolved.No vomiting or diarrhoea. Eating and drinking normally.No current medications. History of injections for skin issues.Objective:Schirmer Tear Test (STT) performed.Right eye: STT reading did not reach 15 mm/min.Left eye: STT reading showed minimal to no tear production.Fluorescein stain applied to both eyes. No corneal ulcers detected.Facial skin appears irritated and inflamed.Assessment & Plan:Keratoconjunctivitis Sicca (Dry Eye)Assessment: Decreased tear production in both eyes, consistent with KCS. This may be transient or a permanent condition. Differential diagnoses include immune-mediated or neurogenic causes if persistent.Treatment plan:Artificial tears (e.g., Hylo-Forte or Genteal) to be applied to both eyes 3-4 times daily until recheck.Prednisolone tablets: 2 tablets once daily for 2 days, then 1 tablet once daily for 2 days, then 1 tablet every second day for 4 days.Follow-up care: Recheck appointment in 1-2 weeks. Discontinue artificial tears 24 hours prior to the recheck appointment for accurate STT re-evaluation.Additional Notes:Owner educated on the importance of regular application of artificial tears to protect the eyes from infection, ulceration, and damage. Advised that long-term medication may be required if the condition is permanent.If stools are not normal, to return for reassessment sooner.