C09978868 / invoice 10000

Appointment Reason: Itchy, Appointment Notes: ecv + checkupHistory:Was seen early Jan and again early Feb for skin irritation. In Jan got abx and pred, which helped. Then itchy again early fed. Cytology showed no skin infection, so home with pred course and topical chlorhexidine. Same thing again. Have been applying liquid. Skin developed a rash and then solid scabs, 4-5 spots on dorsal lumbar region. Started suddenly when owners were away for a couple of months. Everything happened in the month of December. Was all good before then. Tries to bite them, then licks his paws as well. Objective:GEN: BAR, willing to be examined. EENT: No ocular or nasal discharge; clear eyes; ears clean of debrisORAL: MM pink and moist, CRT <2s; mild to moderate dental calculus/ gingivitisINTEG: 1 cm epidermal collarette with no scab right lateral thigh, x 2 cranial stifle, x 5-6 scabbed dorsal lumbar region. MS: Ambulatory x4, no pain on long bone palpationUG: Externally normal; clean perineum.ABD: Palpates soft and nonpainful, no organomegaly or masses palpatedRESP: Eupneic; normal bronchovesicular sounds; no crackles/wheezes ausculted.CV: Grade 1/6 left systolic murmur, no arrhythmias ausculted; femoral pulses strong, synchronous, and symmetricalLN: All external lymph nodes palpate soft, symmetrical, and of appropriate size.NEURO: Menace and palpebral reflexes intact; appropriate mentation.Laboratory:Lifted scabs and took impression smears of 2 lesions. Very rare rafts of neutrophils with intracellular cocci. Occasional budding malassezia. Occasional streaks of biofilm.Not as wet/ cellular as I expected. Assessment:Cutaneous lesions-- infectious (bacterial, fungal, dermatophytosis) vs immune mediated vs neoplasiaPlan:Recommend longer course of oral abx paired with antifungals. Also start bathing with malaseb three times weekly for the next two weeks. Revisit in 2 weeks to re-assess skin. If improvement, advised we might extend meds another 2 weeks to clear infection. If no change at all, consider scheduling GA/biopsy. No steroids today as reportedly not pruritic on lesions (although does have itchy feet). Treatment:Rx cephalexin 200 mg PO BID x 14 days #28Rx terbinafine 250 mg tabs 1 PO SID x 14 dayd #14Rx malaseb bathe 3x weekly x 2 weeks.     Vital Signs    Weight: 7.2;       MMColour: Pink;       HeartRate: 144;       RespirationRate: 20;       BodyScore: 6;       DentalGrade: 2;       CRT: 1-2;