C09977693 / invoice 10000

Reason: Skin Flare UpAppointment Notes: Overdue remindersHistory: The past few days Bagel has started licking his prepuce region a lot and his skin seems quite red and sore there. Is on apoquel 16mg (1/2 BID PO) for cutaneous lymphoma and still happy in his demeanour. His other skin lesions are slowly increasing but not botherin ghim. Was pruritic for a few days when the next script (online) switched from apoquel chews to tablets and owners didn't initially realise that Bagel was spitting these out - now they've been dosing them down with peanut butter and his itchiness has resolved...Apart from the dermatitis/itch around his prepuceEating well (hence weight gain - getting bit too much food o admits...Will cut back) and no PUPD (def improved since coming off pred).Not struggling to urinate and no v+/d+Examination: BAR (usual happy food motivated self)MM pink CRT< 2secSkin: prepuce tip and skin around this area inflamed, alopecia with pink skin, slightly raw. Tip of penis appears normal and no discharge from penis. Rest of skin as before: multifocal areas of alopecia and scabbing/dermatitis from cutaneous lymphomaUrine sample (free catch in garden): USG 1.010, pH 7, protein trace rest NAD(had water to drink before visit to vet)Assessment: Cutaneous lymphoma - flare up of skin around prepuce and feetPoss secondary infection as on long term immunosuppressive doses of apoquelDdx progressing cutaneous lymphomaPlan: Start by adding in 3 weeks amoxyclav (higher dose) to eliminate any infection likely to be presentDisucssed Cytopoint but no hx of skin allergies prior to cutaneous lymphoma being diagnosedIf not resolving itch after 2-3 days then place eliz collar for 30 mins and apply amacin eye ointment to this area of skin BID (have this at home and stronger than neocort) for 5 daysMalaseb 1-2 x a weekIf still not improved then RV and need to consider switch from apoquel back to pred or repeat bx or QOL    Vital Signs    Weight: 17.1;