C09987479 / invoice 10000

CONSULT

REASON/CONDITION:
**DATE OF FIRST CLINICAL SIGNS

History:
**existing health concerns
- had HGE as a puppy
- skin problems since 6 months of age. 
- noticed its only when she has been around grass. 
- given cytopoint inj and apoquel and pred. 
- lick paws - back paws worse, ears neck mouth probs.
- sometimes had trazodone and gabapentin before vet visit - not given today
- diet: 
- have tried chicken and rice, sensitive mince (not sure protein) from pet barn, staffy vitamin thing to put on food. 
- current medication: Sebazole 2 times a week, steroids cleaned up her ears very well. 
- nexgard - maybe a month or 2 ago. 

Patient Data/exam
TEMPERAMENT: FAS 2
BEHAVIOUR/ CC EFFECT:
WEIGHT/BCS: 5/9
NORMAL DIET:
EDUD?: n
**CURRENT MEDICATIONS/CONDITIONS: 
TEMP:
HR & SOUNDS / PQ:
MM COLOUR & CRT:
RR / LUNG SOUNDS:
ABDO PALP:
RECTAL:
EENO: 
DENTAL: x
SKIN: axilla lichenification and ventral abdomen with erythema and thining of hair coat. L eye periocular alopecia. Moderate erythema base of Left pinna with evidence of excoriation. Obvious yeast infection hind feet with mild pododermatitis. Bilateral OE with moderate stenosis of ear canals. 
LNs: n
MSK: n
NEURO: n
UROGEN: n

**Assessment/Problem list:
1. prurtitis esp around L lower pinna
2. Bilateral OE with stenosis of ear canals visible
3. lichenification bilateral axilla, groin
4. situational anxiety at clinic - avoidant of exam
5. Generalised anxiety at home - wont leave owners side

Tx plan:
1. start pred 7.5mg BID 5 days then 7.5mg SID 5 days 
2. recheck 5 days with chill meds on board to examine ears and tx them.( Previously not treated for yeast infection at York vets as couldnt examine ear TM)
3. sebazole twice weekly all body
4. r/v until OE resolved then onto elocon twice weekly for maintanence
5. dietary trial - given client info on this - recommend anaallergenic
6. continue to decrease pred then consider pred or apoquel long term 
7. NEXGARD or bravecto long term

Communication/ future plan: recheck next week and examine ears with chill meds on board