C09977351 / invoice 10000

Reason: Licking LF Paw, Ears And Itchy SkinAppointment Notes: webvet NICHistory: OR been licking at L paw fr the past few days No bleeding or discharge seen from paw OR will also occ scratch at ears - O not noticed an ear bothering more another Prev had issue with inflammation in tail tx with neocort and resolved OR been lethargic and not herself today at home - going between O bed and her own bed at home DUDE all normal - no C/S V+ once yesterday, OR no D+ but has a very sensitive GIT and can be affected by change to diet UTD with vaccinations UTD with FTW tx - Due 25/02 - NGS Not on any current medication Examination: BAR in consult - very bouncy dog Eyes, ears and nose = clear Oral mm pink and moist, CRT <2s Chest ausc = HR 120 RR panting - normal heart and lung sounds Abdo palp NAD soft and comf Palp LNs = all wnl Derm - LF paw -> mild erythema and crusting/scabbing between multiple feet and digits - worse between digits II and III No swelling or effusion to suggest and ID cyst or FB. Mild saliva staining  Tape impression cytology take for ID space -  marked debris +++ - mild cocci present ++ - occasional Malassezia + - No inflammatory cells Adv topical cleaner for foot - adv chlorhexidine based cleaner/medicated shampoo eg Malaseb OR not keen on bathing but can apply creams Adv okay to apply neocort as O already has at home - adv apply BID to affected area Adv apply before feeding or walk to distract so won't lick off Adv alongside this reducing dose of steroids adv 0.5-1mg/kg PO reducing dose from BID to EOD O happy with plan    Vital Signs