C09980053 / invoice 10000

Presented for -  grooming consult - EM noted crusty nipples, minor dermatitis ventral abd and wants ears checked
Rang Clare - she reports his feet are not currently itchy but he does lick his tummy for a bit every morning before getting out of bed
ears not bothering him - she uses aqua ear ear cleaner after baths at home

Current medications: 30mg cytopoint 9 days ago
Parasite control: 

Mentation: bright, alert, good to handle
EDUF: 
Diet: 
MM:  pink
CRT:  imm
DS: 1/4
Skin tent:  nad
LN:  nad
Ears: right ear slight discharge externally, canal and TM fine.  left ear clean externally, minor cerumen in canal
Eyes:  left eye has minor tear staining and associated skin erosion
Thyroid: 
HR:  120
Chest Auscultation:  nsf
Abdo Palpation:  nad
BCS: 5/9
Temp:  not taken
Rectal Exam:   nad - anal glands WNL
Skin:  skin generally looks good (freshly groomed) - minor crusting and low grade focal dermatitis along non haired ventrum.  Nipples are slightly crusted
Joints/Gait: gait normal, did not examine joints
Urogenital:  nad
Vaccination status: current
 
Problem list:  ongoing minor superficial dermatitis
DDx: there may be allergic / infectious / behaviour components - it may be enough to manage 1, but we might also need to fix all 3 at the same time (steroids or apoquel + abx + prevent licking or even anti-anxiety)
will try on just neocort first

*ok to put neocort on lesion below eye but be careful

Treatment in clinic:

Plan: 

Communication:

Has crusty lesion over left nipple and lots of smaller red lesions in groin area.
Feet inflammed and ears inflammed EM

Presented for repeat cytopoint injection: 

Current itch score: 8 /10 on belly , paws (licking +++) and base of tail.
Weeks since last tx:6 weeks
Cytopoint 30  mg given SC between shoulder blades. Giving 'double' dose as per last time, 
Batch number:840615  exp 02/2027