C09978444 / invoice 10000

Reason: Rash On LegsAppointment Notes: Plz leave long : consults often run overtime with client. Special payment terms exist - EHVeterinarian Name:Reason: Has been to dermotologist for skin previsouly (see extra notes)Has been going fine but paws have been a bit inflamed and the redness is increasing proximally over the legs now. O thinks its a bit different to last time, Not on any meds currentlyNot in contact with any purple plants o saysNot flared up over night, progressively gotten worse over a few monthsSkin has been discussed re causes being underlying skin allergies vs anxietySecond dog has helped with his anxiety after lacey it has settled down, hair has grown backO says she has canine version of sebbhoearic dermatitis, settled down on tx Unsure if tis an anxiety related issue or an allergyEverything generally getting better with skin and anxietyFungus between the toes,Dr Je Boom - dermatologist is who o went to (referred from usGave anxiety meds and did not work for skin, vomiting and diarrhoea etc. Was not going well. Went to emergency for itO unsure whether needing to go bac to the specialist todayExamination:COAT/SKIN: skin webbing between paws inflamed, caudal metatarsal areas/hock/ metacarpal areas iofnalemd and erythmatous. Tape impression smear showed sparse malasezzia, cocci, and neutrophils. EYES/EARS: limited check due to anxiety+++ very fearfulMOUTH/TEETH: limited check due to anxiety+++ very fearfulHEART: HR100, no murmur or arrythmiaLUNGS: clear ung auscABDOMEN/DIGESTIVE/URINARY: not assessed due to behaviourCNS/MUSCULOSKELETAL: gait comfortable in consult, full ROM not possilbe due to behaviourPERIPHERAL LYMPH NODES: wnlWEIGHT/DIET: Body Condition Score: 6/9REPRODUCTIVE: nadAssessment:Dermatitis, with secondary infDiscusseed with o still unsure of underlying cause ie anxiety vs allergies, poss a combination of both. Today we are seeing skin infRecommmend malaseb wash (o has an old bottle at home, happy to get a new one), to start twice weekly with this on legs again, start antibiotics (advised of side effects) and O has Daktarin which she has prev used (antifungal) can use this topically as wellOption to go back to the specialist, recc tx infection first and then if required revisit specialist    Vital Signs