C09986584 / invoice 10000

HISTORY: s,owner presented with following problems
Overdue for vaccination
Skin has been an ongoing problem. 
At the moment has a flare up on the top of his back paw

Always the back ones, rarely the front ones
Face got irritated. Last week scratched face really bad and it was fully bleeding. Has since calmed down. 
The newest concern is a whole bunch of crusty lumps on her back. 

Husband had washed him with a different shampoo- one off. 
No rubbing of the back noted- not trying to itch it. 
Most attention i too the back paws and face. 

Os wipe his folds- using warm face washer and dry them. Went sing anti-inflammatory cream to use if bad on paws, groin, and face. 

Diet:
was always on royal canin dry frenchy food. 
Was vomiting a lot so then moistened biscuits and it helped 
Has started i/d hill's id wet food after BOAS in May 2025
Have tried a few other foods. 
recently feeding royal canin frenchy and put a bit of plain shredded chicken through it- will eat it 
Have tried a fair few different wet foods as won't eat dry food on its own. 

If he goes for a walk or explores a park, may come home and his face looks aggrevated. 
Have give anti-histamines and it helps after a few days of giving.  

cephalexin and zenrelia given last time. 
Antibiotics worked within a couple of days. 
Has been on many anti=itch medications. 

3-4 times when infection cleanerd is licking. 
Had a bit of a stretch where he was very good. 
This time round started 1 week ago. 


o temp   38.6   HR=PR =124 rr=32
- chest auscultates normally
- eyes - normal
- ears - normal
- LN - normal
- abdominal palpation- normal
- musculoskeletal- normal
- skin and integument- normal
- oral and dental examination- normal
- other findings- NSF

a, 

p.
WEIGHT: 16.40

WEIGHT: 16.00

HISTORY: History: has not been itchy just that back hindlimb paws are red. licks in the morning a little bit but not seen pruritic during the day. 
Appetite: normal 
Water intake: normal 
Urination: normal 
Defecation: normal 
Diet: hill's i/d / digestive care 
Medication: 8mg apoquel sid - stopped - no to marginal difference in pruritis 
Parasite control: 
Energy levels: 


Exam: 
Eyes: nsf 
Ears nsf 
LN: mandibular WNL 
Oral: 0/4 
MM: pink and moist 
CRT: <2
CVS: 100bpm no murmurs no arrythmias 
Abdo: soft and pliable 
M/s: both hips ROM normal 
Integument: hindlimbs errythemic and alopecic on both plantar and palmar aspect. on skin folds of face - errythemic and alopecic 
Demeanor: bar 
BCS: 5/9 

Cytology: 
1. skin folds of face - cocci 2+
2. Feet - cocci 2+

Assessment:

Treatment: 

Plan:
WEIGHT: 15.70