C09981751 / invoice 20000

23/01/2026 **

NURSE: HS

REASON: Check up - ex guide dog 

HISTORY
BIOP since start Dec 2025 - de-classified as guide dog due to allergies
Settling in well in new home
Started straight on Apoquel, no food trial etc
Very minimal itch at home 
RC adult dog diet, Ox recently changed to RC hypoallergenic  
DIET: RC hypoallergenic 
EDDU: all normal, no V+ or D+ 
CURRENT MEDICATIONS: Apoquel 16mg SID

CLINICAL EXAMINATION
Mentation: BAR
MM: pink and moist
CRT: <21sec
Oral Exam and Dental Score: Grade 0/4
Eyes: clear and bright 
Ears: externally clean
BCS: 3/5
Lumps:
Abdominal palpation: soft and comfortable 
Lymph nodes: WNL
Heart Rate: 88bpm, no murmurs or arrhythmias 
Respiratory Rate:
Temperature: not taken
MSK: ambulating well in consult 
Skin: skin and coat is in great condition 

ASSESSMENT:
Fit and healthy on exam 
Suspected atopy - food allergy less likely
Difficult to predict need for Apoquel ongoing - BIOP for only 6 weeks - may be seasonal and may be OK off this - worth trying

DISCUSSION:
- Discussed history of allergies and the use of Apoquel. The cause of the allergy (environmental vs food) is unknown.
- Advised that most skin allergies in dogs are environmental.
- Discussed a plan to trial weaning off Apoquel to determine ongoing need and potential triggers.
- Advised to transition back to the Royal Canin regular diet during the Apoquel withdrawal trial. Advised a slow transition, but as she was only on the hypoallergenic food for 4-5 days, a direct switch is acceptable.
- Discussed flea, tick, and worming prevention options: monthly all-in-one (NexGard Spectra) vs. three-monthly separate products (Bravecto and Milbemax). Owner to decide based on preference.
- Advised against giving bone marrow bones due to risks of GI upset, tooth fractures, and obstruction. 
- Discussed nail trimming for black nails. Demonstrated how to trim the hooked tip of the nail. Advised increasing walks on hard surfaces to help wear them down naturally.

PLAN
- Wean off Apoquel: Give one tablet every other day for two weeks, then reduce to one tablet twice weekly for two weeks, then stop if no breakthrough itchiness.
- Transition diet back to Royal Canin regular food.
- Monitor for any increase in itching, head shaking, or paw licking. If symptoms return, go back to the previously effective dose of Apoquel.
- Recheck consultation in one month to review progress and formulate a long-term management plan for her skin. Contact the clinic if itching returns before the scheduled recheck.
- Owner to start a new flea/tick/worming protocol. Information on options to be sent via email.
- Continue daily walks, increasing time on hard surfaces to assist with nail maintenance. | 24/02/2026 **
NURSE: Jen

REASON: Follow-up for allergic skin disease management and Apoquel tapering review.

HISTORY:
- Apoquel was dropped to 2 tablets every other day for two weeks with no noticeable difference in itch levels.
- When dropped further to twice weekly (Sunday and Thursday), there was a notable increase in itch, predominantly affecting the eyes and flank.
- Second week of twice weekly dosing was worse than the first week.
- Nexgard Spectra given yesterday (23/02/2026) and approximately one month ago.
- Transition to Royal Canin hyperallergenic food was fine with no obvious changes noted.
DIET: Transitioned to Royal Canin hyperallergenic food - one cup with a quarter of previous food. Transition was fine with no obvious changes.
CURRENT MEDICATIONS: Apoquel 32mg twice weekly. Nexgard Spectra monthly.

CLINICIAL EXAM:
- Mentation: BAR
No physical examination performed 

ASSESSMENT:
- Low grade allergic skin disease on current dosage of Apoquel (32mg every 4 days).
- Overall itch levels are negligible - scratching episodes last approximately 10 seconds before moving on, does not interrupt sleep or become sole focus.

DISCUSSION:
- Discussed that allergy is not an all or nothing condition - mild allergic skin disease may not require medication at all.
- Current itch levels described as very low grade and not having a major impact on quality of life.
- Advised to withdraw Apoquel completely and monitor for breakthrough itch.
- If itch becomes more significant, can reintroduce Apoquel.
- Keep a diary of itch episodes noting duration and frequency.

TREATMENT:
- Withdraw Apoquel

PLAN:
- Withdraw Apoquel and monitor closely.
- Keep a diary of itch episodes to monitor progression.
- For zero risk option can bath with Aloveen