C09976671 / invoice 10000

HISTORY:Recheck consultation for facial pruritus and erythema. The previous Depo-medrol injection on 07/01/2026 provided good relief for approximately six weeks - better relief than she has ever achieved. Symptoms of redness, itchiness, and facial heat have recurred over the last 10 days. The owner also reports some ocular irritation (rubbing eyes). No adverse effects were noted from the previous injection.Pre-existing conditions: Facial dermatitis/allergic skin disease.Current meds: noneVaccination: Not mentionedParasite Prevention: Not mentionedExamination:BCS: 5.2kg, has gained weight.Neurological: BAR, appropriate mentation. Cranial nerves appear normal. Full exam not performedMucus Membranes and Hydration: MM pink, moist, crt<2. Euhydrated.Rectal Temperature: Temperature not taken.Cardiovascular: HR 160, cardiac auscultation normal, no murmurs, normal rhythm.Respiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal discharge.LNs: normal size, NADDental grade/oral exam: not examined todayEyes: Pupils symmetrical, corneas clear, no ocular discharge or pain. Full ocular exam not performed.Ears: very mild pinna erythemaAbdominal palpation: soft, no palpable masses/FB/organomegalySkin: Mild facial and periocular erythema and puffiness. No significant scabbing or weeping noted at this visit.Musculoskeletal: ambulating normally, Full exam not performedUrogenital: No swelling or discharge, NADDemeanour/Behaviour: Feisty temperament noted by owner.DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Allergic skin disease vs other inflammatory skin condition vs otherASSESSMENT:Milley presented for a recheck of her allergic skin disease. The previous long-acting steroid injection provided good resolution of clinical signs for approximately six weeks. Signs have now returned, consistent with the medication wearing off. Examination revealed mild facial erythema. Given the good response to previous treatment and the difficulty in administering oral medications, another long-acting steroid injection is warranted.TREATMENT:Depo-medrol 10mg administered SQ.PLAN:Continue monitoring for recurrence of clinical signs. The owner is aware that the injection lasts approximately 6-8 weeks and can repeat as needed. The owner will consider transitioning to an oral liquid steroid (prednisolone) in the future for better cost-effectiveness and for better control of steroid use.CLIENT COMMUNICATION:Discussed the chronic nature of allergic skin disease and the need for ongoing management. Advised that long-term steroid use carries a small but potential risk of inducing diabetes mellitus (discussed at last visit). Alternative treatment options were discussed, including oral prednisolone liquid, which would be more cost-effective as it would not require a consultation fee for each administration. Cyclosporine was also mentioned as a more expensive, steroid-sparing alternative, but may not be the most appropriate choice for this condition. The owner understands the risks and benefits and will consider the oral liquid for future management. Advised to monitor weight.    Vital Signs    Weight: 5.2;