C09979303 / invoice 10000

HISTORY:
Presented for: check skin
seen recently for OE, treated with BNT, pred
still on pred, weaning 
no head shaking
patch of yellow fur on neck area, skin red, next day yellow again
fru crusty
rubs everywehere
prev skin infections, normally gets hot spots everywhere
malaseb, pyohex every week with groomer, hasn't gone this week
ED normally, no v/d+
have tried cytopoint + apoquel, have been effective
prime 100 salmon 
no other meds other than pred

EXAM:
Mentation:
BCS:
Hydration status:
Eyes:
Ears:
Nose:
Mouth:
MM:
Throat:
LNs:
CV: HR:
Resp:
Abdo:
MSK:
Integ:
Neuro:
Genitourinary:
Rectal:
T:

ASSESSMENT:

PLAN:

COMMUNICATION:

SUBJECTIVE:

Previous vet = Lort smith

Had TECABO

back paw ?grass seed
BNT

Pred half tab 
PUPD on the pred

Paws still itchy






OBJECTIVE:



ASSESSMENT:



PLAN:



CLIENT COMMUNICATION:

SUBJECTIVE: Here to have lump on foot checked - grass seed?
Long history of recurrent ear infections, previously been on apoquel and topical steroid flushes but currently just getting pred 2.5mg EOD - probably for at least 6 months or closer to a year
Gets itchy and skin infections -has medicated wash every 2 weeks

OBJECTIVE:B+A
chest NAD
obese BCS 9/9
ID cyst LH foot - small amount bloody serous fluid, cytol + neuts, occ cocci. Suspect ID cyst due to chronic licking + anatomy/obesity but ddx grass seed
Bilateral OE with thick yellow d/c, ++++rods on cytol, painful to examine - O says she cleaned them yesterday

ASSESSMENT:ID cyst, bilateral OE

PLAN:BNT 1ml to both ears
RV 1 week to apply second dose (O to clean at home with otoflush in the morning)
increase pred to 5mg sid x 5dd then 2.5mg sid x 5dd then back to 2.5mg eod
topical chlorhex to cyst - has pyohex conditioner at home, thinks has shampoo too - otherwise can come back to get, or can use microshield from chemist followed by conditioner -do every 1-2 days
full recheck in 2 weeks
plan is to get ear infections resolved (ear flush if not responding) then discuss better long term management (regular cleaning + topical steroid lotion to ears and feet; ideally wean off pred -consider trial zenrelia?)
if cyst not resolving consider surgical exploration