C09988073 / invoice 10000

Reason: Cytopoint Didnt Work KgAppointment Notes: Overdue remindersAttendees:History:Still itching bum area and shaking headCytopoint not working as well this time >> likely need to increase dose (max doseage is 40mg)Eating drinking urinating defaecating normallyNo vomiting/retchingNo coughing, no exercise intolerance, no breathing difficultyNo lameness, stiffness or sorenessNo itching and scratchingBright Alert ResponsiveBody condition score 6/10Examination:Mucous membranes – pink moist crt <2sOral cavity – clear, no evidence of ulceration, tongue normal, hard palate fineTeeth – grade 2Nasal planum – normal pigmentation and architecture, no crusting, no dischargeEyes – eyelid conformation normal, PLR normal, no chemosis,  no dischargeEars – Bilateral mild yellow exudate >> smears performedLymph nodes - normalHeart – normal regular rhythm no pulse deficits, no murmur HR 100Lungs – clear sounds bilaterally, no crackles or wheeze, tracheal pinch negativeAbdomen – comfortable on palpation, bladder normal, no masses palpatedLimbs – all good range of movement, no swelling or pain on palpationNeck and spine – no pain on palpationSkin – Marked erythema of skin under tail (tail curls inwards and makes a little pocket of inflammed tissue). No more papules noted on ventral abdomen. Mild erythema of all four feet. Nails – fineAnal glands – not full >> expressedTemperature –  38.0Genital region - no masses or swellingsEar cytology:BOTHMalassezia ++ cocci ++Diagnosis:1. Atopy with concurrent secondary infection in tail area2. Otitis externa bilaterallyTreatment:1. Cytopoint 10mg SQ extraBatch 828805 Exp 01/20272. Malaseb baths weekly + apply topical malaseb to tail area and feet ONCE a day for 7 days3. Cephalexin 300mg pO BID for 10 days4. Dermotic 0.5ml to both ears, once a day for 10 days5. Recheck in 10 days**If no improvement with extra cytopoint, need to try either apoquel or pred    Vital Signs    Weight: 13.4;