C09983367 / invoice 10000

No stock of Apoquel 16 mg.  Going to try Zenrellia instead.

Hx: Presenting with  a weepy eye of a day or two. No known cause. Is squinting.Itching is almost but not quite controlled on apoquel and barazone. O is keen on hearing alternatives. Ex:BAR, mm pink, moist, CRT<2seoncds, DG 2 Right eye squinting. corneal oedema around a superficial ulcer - flourets positive.. No microvasculature. no evidence of epithelial flaps on indirect opthalmoscope or slit lamp. Assessment:Superficial corneal ulcer.ready for diet trial.Plan:  Start ocufloc 4 times daily , and metacam for up to 5 days. (2.5mg tablet SID Return if worsening or not healed within 5 days. Discussed starting a diet trial after next nexgard tablet, and gave handout on various allergy drugs from veterinary partner. Withhold barazone during diet trial, - see instructions in email below.It was an absolute pleasure to see Dudley today.His eye should heal rapidly with those drops. Please keep using them for 3 days after his symptoms resolve (squinting and redness)If it is not healing within 5 days, or is worsening, please return. I have attached some info on performing a diet trial.I would recommend putting Dudley and his housemate on Hills Z/D biscuits  )which also comes with a wet food variety) for at least 4 weeks. Continue with the apoquel, but please refrain from using the barazone during this period. I would start on the day of his next Nexgard Spectra tablet, as it likely has beef or chicken in it which will contaminate the trial.  At the end of the 4 weeks, you are welcome to skip a few days of apoquel. If he has an immediate return to itching (within 24-48 hours, generally) , then we know there is something aside from diet involved. If he doesn't start itching, it is time to start reintroducing foods. Start with chicken necks. We usually see a return to itching within 24-48 hours. You can use apoquel as needed to control the itch. If he itches, I would do another month of Z/d before introducint another food. Single source protein diets (suck as turkey, salmon, crocodile, kangaroo) are the best way to go as they help narrow down whatt he causes are. Be aware that packaging laws in Australia mean that "lamb and Rice"doesnt even need to have lamb as it's main ingredient, and unless you are using  one of the specifically produced single protein diets (eg SPD) , the food may well have other protein sources in it. For eg Black Hawkes lamb and rice has both chicken and fish in it alongside lamb.I have also attached a handout on other therapeutic medications for your perusal. If the diet isn't working and you want to we are able to switch to things like cytopoint (lokivetmab). We occaisionally  find some dogs appear to develop a tolerance to one drug, and benefit from switching between drugs. You are welcome to trial antihistamines (although not during the diet trial). We find that they rarely work, but if they do you have a low cost solution with a low side effect profile.  Hope Dudley recovers wellDr Sara, Tweed Coast vet 

half of each for itching control