C09981214 / invoice 10000

03/03/2026 Hx: ears and skin were going good up until 2 weeks ago but now she's irritated again, scratching lots, red skin, smells horrible. Her L ear has flared up again. O also noticed a bulge on her stomach. Been well, EDUF normal, no v+ or d+
O still bathing in Malaseb and using Neocort. O needs more Otoflush, has also been using Dermotic in R ear on and off to help keep clean.
Cx: HR120 BCS 7/9 39.1C BAR, timid, overweight. Gums pink, moist CRT<2sec. Grade 3 dental disease UC's. L ear severe erthema, crusting with mod yellow discharge. R ear clear. Eyes clear. No murmur, sinus arrhythmia, panting. Popliteal and submandibular LN mildly enlarged.
Multifocal circle/oval patches along dorsum of erythema and crusts. Both axillae and inguinal areas erythemic, thickened and alopecic
L ventral abdomen 10c piece size soft moveable SC lump, similar L lateral ribs and L dorsocaudal ribs (likely lipomas)
Skin scrape patches on dorsum: squames ++++ cocci ++ Malassezia +
Ear cytol: L ear Malassezia ++++ cocci +
Dx: OE secondary to severe atopy
Tx: 20mg Cytopoint SC, Neptra L ear, Neocort as needed, Otoflush then Elocon 0.6ml weekly
Add in Amoxicillin 200mg 1bid
Plan: continue bathing in Malaseb for 10 mins weekly at home. Can collect more Otoflush as needed.
Rec bring in regularly for 4 weekly Cytopoint inj with nurses as seems to be when her skin and ears flare up.
If her ear flares up and needs meds would need a vet consult.
Will order in bigger Neocort tube for O.