C09977785 / invoice 10000

Reason: RV Consult With LB , CH Appointment Notes: ------- Sms reply: YReason:follow up consultation for skin allergiesrecent history of gastrointestinal upset- resolved.discussion regarding dental chewsHistory:follow up for Cytopoint injection for pruritus - - previous injection was 4 wks ago - - O still feels Cytopoint not as effective as previously, some improvement but still chewing feet - ?psychological componentO has been using Cortavance spray on feet and ears, which Luna tolerates wellrecent episode of gastrointestinal upset, but has resolved, with normal faeces for the last couple of daysO reports Luna can be off-colour for a couple of days post-Cytopoint injectionlicking at vulva area and scooting noted by O - using neocortExamination:Body Condition Score: 5.5/9GENERAL: BAR, good temperament, well-hydrated, mm pink and moist, CRT <2sHEART: HR WNL, regular heart sounds, no obvious murmurs or arrhythmias, strong and synchronous peripheral pulsesRESP: RR WNL, lung fields clear on auscultation - no crackles or wheezing, normal effort and no obvious nasal dischargeEARS: External exam only - no discharge, no odour, no obvious inflammation or irritation - looking goodEYES: Clear chambers, no occular discharge, symmetrical pupilsABDO: Soft and supple on palpation, no palpable organomegaly or masses. No pain foci or nausea detected todayLYMPH NODES: No peripheral lymph node enlargement on palpationORAL: Mild plaque build-up and gingivitisMSK: Good general conformation and ambulatory on all limbs. No pain, crepitus or thickening on manipulation of jointsINTEGUMENT: Feet and ears look good, no erythema. Fur and coat in good condition, no ectoparasites on skinUROGENITAL: hooded vulva, can predispose to urine scalding and dermatitis. Neocort has settled it well. Assessment:Chronic pruritus secondary to environmental allergies, currently managed with Cytopoint injections and topical Cortavance sprayUrogenital conformation (recessed vulva) predisposing to perivulvar dermatitis  - ok to use neocort as reqd.Recent resolving gastroenteritis of unknown aetiologyTreatment:Cytopoint 20mg injection administered SQ 855734 7/27Plan:Discussed that Cytopoint injections are given at a minimum of 4 wk intervals, but can be extended if pruritus is well controlled, particularly as weather coolsDiscussed potential side effects of Cytopoint including lethargy and gastrointestinal upset, which O has noticed in Luna post-injection. Advised to monitor, and as long as signs are mild and transient, it is acceptable to continue. Stop if signs of hypersensitivity occurIf Cytopoint becomes less effective, can consider trial of Apoquel tablets as an alternativeDiscussed perivulvar dermatitis secondary to recessed vulva. O is managing well with neocort as needed when licking or scooting is observedAdvised O on dental care. Recommended harder dental chews like Greenies, Oravet or Prozyme to help scrape teeth clean. Advised to start with the recommended size and can go up a size if tolerated well to improve efficacy    Vital Signs    Weight: 9.7;