C09977870 / invoice 10000

PROBLEM LIST:Pemphigus foliaceus - tentativeAllergic pododermatitisAllergic otitis externa - controlledBacterial folliculitis - controlledAnxiety/behavioural issuesConstipationVomiting/regurgitationHISTORY:Since the last consultation on 3 Feb 2026, Snow has been on Apoquel 1/4 tablet twice daily. This was started after discontinuing prednisolone in late January. The tablets are tolerated well.Reports recurrent erythematous papular lesions appearing every couple of weeks, primarily on the back of thighs, tummy/hip area, and front feet. Lesions cause significant pruritus in the axillary area. Also licks front feet. No new scabs noted.Hair has regrown but is patchy.Anxiety has worsened since ceasing all behaviour medications. Biting behaviour has returned.New issue: Vomiting/regurgitation of undigested food in the mornings for the past few days. No diarrhoea. Some constipation, with hard faeces if Osmolax is not given. Receives pumpkin for fibre every two weeks.PHYSICAL EXAMINATION:General condition bright and happy.Skin: Overall improved. Hair regrowth is present but patchy. Some old scars noted. A few scabs stuck in fur, but nothing attached to the skin. No significant redness or greasiness noted on trunk or groin.Ears: Small amount of hard crusting on ear tips.Feet: NAD. No interdigital issues noted.Tail: Greasy area noted on the tail gland (dorsal base of tail).Matted hair present in several areas.INVESTIGATIONS:Sticky tape cytology from groin: NAD.Sticky tape cytology from tail gland area: Showed significant numbers of yeast.PROCEDURES:Sticky tape samples collected from groin and tail base.ASSESSMENT:The skin condition, suspected pemphigus foliaceus, is improved and relatively well-controlled on the current dose of Apoquel. The lesions are not consistent with secondary infection.The greasy lesion on the tail base is consistent with a yeast overgrowth (Malassezia dermatitis).The morning vomiting appears to be regurgitation of undigested food, as it is only happening in the morning and some food is passing through. A partial oesophageal issue is possible but less likely as it is not intermittent at other times.The anxiety and biting behaviour has recurred since ceasing behaviour-modifying medications.Constipation is likely related to lack of dietary fibre.PLAN:The following recommendations and treatments were made for Snow:Continue current Apoquel dose.For the tail lesion: Apply a human athlete's foot cream containing 0.5% hydrocortisone and an antifungal (e.g., miconazole) to the affected area twice daily for one week. Distraction with treats/training post-application was advised to prevent licking. An email with a product example was sent.For constipation: Advised to increase dietary fibre. Suggested using psyllium husks sprinkled on food instead of Osmolax to bulk up faeces.For regurgitation: Advised to trial feeding smaller, more frequent bland meals (4-5 per day). Also suggested raising the food bowl off the floor. Could also try a very small meal at breakfast, with a larger meal later.For behaviour: Discussed the importance of routine, trigger avoidance, and positive reinforcement training as a distraction technique. Advised that if behaviour medications are to be restarted, to introduce them one at a time, allowing 3-4 weeks between each to monitor for skin relapse. A blood test should be performed before restarting any behaviour medications.Medications Dispensed:60.00 x Apoquel 16mg tab (Oclacitinib) Rx: Give 1/4 (ONE QUARTER) tablet TWICE daily.FOLLOW UP:Owner to monitor for any worsening of skin lesions. If the skin relapses or pruritus increases after starting any new medication, it should be stopped immediately.If the regurgitation persists after dietary changes, further investigation may be required.REVISIT:Revisit in one month for a follow-up consultation and screening blood test to monitor for any adverse effects from the high-dose Apoquel. Based on these results, a decision will be made on long-term management, including the possibility of dose reduction or handing care back to the local vet with a detailed monitoring program.    Vital Signs