C09983777 / invoice 10000

Reason: Hot SpotAppointment Notes: Overdue remindersHISTORY:  Re-presentation for ongoing skin irritation. Owner reports the dog is persistently chewing and nibbling at his tail, causing significant irritation and preventing rest. A new sore has also developed on the lateral aspect of the left hind paw/ankle. The owner reports the condition is not improving.This is the second occurrence of this issue. The previous episode was in October/November of the prior year. A pattern of seasonal flare-ups every spring/summer (approximately October onwards) is noted.Current meds: on neocort, amoxyclav, meloxicamVaccination: Not mentionedParasite Prevention: Not mentionedPre-existing conditions: Suspected seasonal environmental allergies.Access to toxins eg. Rodenticide: none EXAMINATION:Body Condition Score: 5/9Pain Scale (0-4): 0/4Hydration status (%): hydration clinically adequateCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findingsMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal, no mouth pain, dental score (1-4): not graded- Abdominal: no detectable pain on abdominal palpation- Rectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: Main hotspot on tail base, red raw skin that is starting to scab over.Smaller focal hotspots on medial tarsus L>R in severity. Lymph Nodes: NSFEyes: NSFDemeanour/Behaviour: BAR. Owner reports he is very agitated at home due to the pruritus. PROBLEM LIST:- Severe pruritus, focused on the tail- Self-trauma to tail and left hind paw- Suspected seasonal atopic dermatitis (flare-up) DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Seasonal atopic dermatitis (environmental allergy)Food allergy (less likely) DIAGNOSTICS:None ASSESSMENT:Toasty presented for a recheck of severe pruritus and self-trauma, consistent with a seasonal allergy flare-up. The distribution of lesions and history of recurrence in spring/summer supports a diagnosis of atopic dermatitis. Examination revealed calluses and a sore on the left hock from his sitting position. The current anti-inflammatory is not providing adequate relief. A plan has been made to transition to oral corticosteroids after an appropriate washout period. Supportive care with bandaging will be implemented to protect the skin and promote healing. TREATMENT:  - Oral steroids (Prednisolone): 1.5 tablets once daily for 14 days. Owner instructed to START this medication on the evening of Friday, 06/03/2026, after a 3-day washout period from the previous anti-inflammatory medication.- Antibiotics: Continue current course until finished on 09/03/2026.- Topical cream: Owner to continue applying liberally to itchy areas as an interim measure.- Bandaging: Bandages with padding applied to all four limbs today to protect pressure sores, particularly on the left hock.PLAN:- Discontinue current liquid anti-inflammatory medication immediately.- Start Prednisolone on the evening of 06/03/2026 with food.- Recheck appointment for bandage change on Friday, 06/03/2026 at 4:30 PM. The bandage will be removed and the pressure sore assessed. A new bandage will be applied if required.- Recheck appointment on Monday, 09/03/2026 at 6:00 PM to assess response to treatment and determine if further antibiotics are required.- Home into owner's care. CLIENT COMMUNICATION:Discussed that the clinical signs are highly suggestive of a seasonal allergy flare-up, common in the warmer, more humid months. Explained that allergies are an over-reaction of the immune system and can be managed, but long-term treatment can be complex.Outlined the potential pathway for definitive diagnosis and treatment, including referral to a veterinary dermatologist for allergy testing and formulation of immunotherapy (vaccines). Discussed that success rates vary and provided a cost estimate from 2023 of approximately $3,000-$4,000 for the entire process, noting this is likely to have increased.Advised that a food trial would be recommended by a specialist prior to allergy testing to rule out food allergies. Agreed to defer discussion of a food trial until the current flare-up is controlled.Instructed owner on the treatment plan: stop the current liquid anti-inflammatory, continue antibiotics, and start Prednisolone on Friday evening (06/03/2026) to allow for a medication washout period. The importance of not starting the steroids earlier was stressed.Advised on potential side effects of steroids, including increased thirst and urination (polyuria/polydipsia). Recommended taking Toasty for a final walk to urinate before bed to prevent accidents overnight.Explained the plan for bandage management, with a recheck in 4 days to change/remove the bandage to prevent skin maceration. Follow-up appointments for Friday and the following Monday have been scheduled. The owner is aware that the Friday appointment is covered under their Healthy Pets Plus plan.--- 04/03/2026 10:11:20 AM TRC:Examinations - Resolved -    Vital Signs