C09988224 / invoice 10000

Presented for recurrence of pruritis. Last cytopoint inj Oct 2025
did well for several months until past 2 weeks- skin has flared up, owner has used about 1/2 bottle dermotic on skin ( applies this topically to affected areas as in past Bella has not tolerated oral antifungals well ). Also using malaseb for baths
Weight loss noted today since last visit
No recent V+/D+
Not drinking excessively ( still reasonable amount but owner doesn't think excessive)
Still on pred 5mg once weekly ( for possible IBD)
Anxiety is worsening with age, owners take her to work now several days/ week. Sometimes cries loudly when left alone.
CLIN_EXAM
bright, alert and responsive , likes liver treats
Senile lens changes bilat
Mouth- missing some teeth, mild tartar, no gingivitis
Heart/lungs-NAD
Abdomen- very mildly distended, no masses palpated, smooth, non-painful
Skin- some small patches alopecia- ear pinnas ( near tips), dorsal shoulder area ( partial alopecia here)
Dorsal nose inflamed ( skinfold), skinfold around tail inflamed. Tail partial alopecia
Feet mildly inflamed
TREATMENT
Discussed/ offered trial zenrelia again
Would require 8.5mg tablet sid- works out to $3/ daily
Kerry has some concerns about this possibly upsetting Bella's gastrointestinal tract ( as very sensitive)
So decided to stick to cytopoint as usually has a reasonable effect ( not perfect )
Cytopoint 20mg given- BN- 840616
Discussed anxiety shortly
Medications shortly mentioned- however also the same concern about possibly upsetting Bella's gastrointestinal tract declined for now.... may reconsider if necessary
FLRQ N WRMRQ N
DIAG
Discussed weight loss
Owner suspects may be due to recent very humid weather- appetite not as good as usual
Offered repeat bloods- last run June 2025 ( (8-9 months ago)- had mildly elevated ALT, moderately elevated ALP - these were repeated in July- ALT had normalised, ALP just mildly elevated. Also had abdominal ultrasound then- diffuse hepatopathy noted, otherwise all within normal limits
Kerry declined repeat bloods today
Advised monitor weight, will change feeding pattern slightly. IF weight loss continues should repeat bloods

Note- would usually do sticky tape impressions but Bella is covered in dermotic on affected areas
Previously has suffered from A.D. with secondary malasezzia infections
No obvious pyodermas today however will still treat with topical malaseb
BLDRQ N