C09986073 / invoice 10000

Reason: Rash Is Still ThereAppointment Notes: spp--- 04/03/2026 13:54:20 MBB:History:- Presenting Problem: The owner reported a recurrent papular rash present for one month. It began as circular lesions on the tummy and behind an ear, resolved with Neocort, then recurred as papules in the groin and a larger lesion in the left ear. Associated pruritus includes scratching, head shaking, and gnawing at feet.- Significant history: Previous episodes of hot spots. Recent dental cleaning.- Current medications: None. Neocort cream was used by the owner previously.- Appetite & diet: Consumes a kibble diet. Appetite is normal.Assessment: Demeanour: Bright, alert, and responsive.Examination Findings:- EENT: Irritation noted in the inner left pinna with a circular lesion and papules.- Oral: Mild dental calculus re-accumulating.- Peripheral lymph nodes: Not mentioned- Cardiovascular: Normal heart sounds, no murmurs detected.- Respiratory, breathing: NAD - Urinary/Genital: Papules noted around the groin.- Skin: Papules and urticaria observed, particularly on the caudal trunk. Lesions consistent with superficial pyoderma (staphylococcal collarettes) noted. Lesion present in the collar area.- Abdomen: NAD - Rectal examination: Not examined- Neurological: Grossly NAD - Musculoskeletal: NAD - BCS: 4.5/9- Integumentary: See Skin.- Hydration: Not mentioned- Other Findings: None notedAssessment:Problem List:1. Recurrent papular dermatitis with pruritus.2. Suspected environmental allergy (atopy).3. Secondary superficial pyoderma.4. Otitis externa (left).5. Mild dental calculus.Treatment: - discussed apoquel as an option but client wanting to trial supportive tx first - Topical therapy: Recommend weekly bathing with Aloveen shampoo/conditioner for anti-pruritic and moisturising effects.- Diet: Recommend transitioning to Hills TD diet for dental health. Discussed the benefits of omega-3 fatty acids for skin support.- Grooming: Advised keeping fur short, especially over summer.  Client Communications:- Discussed suspected environmental allergies as the underlying cause of recurrent skin and ear issues.- Explained treatment options, including the mechanism and cost of Apoquel.- Provided a handout on managing allergic dermatitis.Plan: Assess response to treatment with topical products and skin care diets etcIf minimal response, okay for client to have two week trial of apoquel then revisit before dispensing long term    Vital Signs