C09980398 / invoice 10000

vacc, skin, nails
gvh mvoed from 28/2 - do not move again ald

1. When the problem started (axilla rash - about 8mths)
2. Current diagnosis (vaccs, poss atopy)
3. Treatment  vaccs, antihistamines, diet, cytopoint()

History ()
Is shedding alot
Under arms gets a red rash, has been treating with an ointment (neocort), but when they stop it comes back
Licks at the region, also licks his feet often
eats his own poo - poss last 4-5 mths, maybe longer
O tries to pick up poo daily
walked 4-5 times a week
Sounds like having some reverse sneezing/coughing - normal

EDDU (mostly - O thinks is a picky eater)
Diet (cooked chicken/rice/veg, my dog canned food, some dry food
V+/D+ ( mthly)
Worming ()
Heartworm ()
Ectoparasites ()

Examine
Temperament  (BAR - very wriggly
Mucous Mem   ()
TEETH>       () unable to exam
EYES>      right axilla, pink skin some partial alopecia
left- similar best less alopecia

EARS>        NAD
Nares        ()
SKIN>        NAD
UROGENITAL>  NAD
LN>          NAD
H MURMUR?    ()  nil
H RHYTHM>    Regular 
CHEST AUSC>  NAD
ABDO PALP>   NAD
ANAL SACS    L () R ()
MUS/SKEL>    NAD

Assessment: (ok for vaccs
Maintain weight 3.5-3.7 kg
Laboratory: ()
Treatment: (Nobivac DHP, Bb/Pi sc
trimmed nails

Plan: (Trial antihistamine claratyne or zyrtec , 0.5 tab sid; if no improvement
Next step would be a diet trail (may also help with the coprophagia
Then do cytopoint trial.

Shedding - normal
Copraphagia - trial environmental enrichment, also suggest trial diet change