C09988250 / invoice 10000

Appointment Notes: VETSTORIA  Alison Wakelam (0421755585 awakelam@bigpond.net.au) with Kuma (Dog) - Consult (Cytopoint) - [Veterinarian : Dr. Daniel Richmond (Preferred Clinician)] -  Web BookingClient name: Alison WakelamContact number: 0421755585Email address: awakelam@bigpond.net.auPatient name: Kuma Original Appointment Type: ConsultHistory:Presenting for: Kuma, a 9-year-old dog, presented for severe skin condition with excessive moisture and crusting, with Cytopoint injection effectiveness declining after approximately 3 weeks (less than 30 days since last injection).Skin:- Severe skin changes with excessive moisture and crusting- Patient becomes absolutely drenched when coming home from work, which then dries and becomes crusty- Symptoms worsened approximately one week ago- Patient tends to run hot - floor becomes very hot where he has been lying- Given medicated wash this morningCurrent Meds:- Cytopoint injections - last injection less than 30 days ago, effectiveness lasted approximately 3 weeks- Cortavance spray - previously trialledExamination:Integumentary:- Severe skin changes observed- Secondary bacterial involvement present in moist areasDiagnostics:- Skin cytology performed - no acantholytic keratinocytes observed (ruling out pemphigus)- Bacterial involvement confirmed on cytologyAssessment:Severe allergic dermatitis with secondary bacterial infection - Cytopoint providing inadequate duration of control (only 3 weeks vs desired 4-6 weeks). Pemphigus ruled out on cytology. Likely requires systemic corticosteroid therapy for effective management given patient's age and severity of condition.Plan:New Meds/Tx:- Prednisolone (Macrolone) 20mg tablets: 1.5 tablets once daily initially, then reduce to once daily maintenance after 2 days. Aim for lowest effective dose. Can be used concurrently with Cytopoint if needed. Cannot be used with NSAIDs- Antibiotics prescribed for secondary bacterial infection- Script provided for prednisolone with repeats availableAdditional Discussion:- Discussed corticosteroid side effects including increased thirst, hunger, and panting, particularly in first 2-3 days- Explained difference between induced liver enzymes (expected with corticosteroids) vs leakage enzymes (indicating liver damage)- Humidity likely exacerbating condition- Medicated washes can be drying if used too frequently- At 9 years of age, prioritising comfort over avoiding corticosteroids long-term- Cost discussed: 100 tablets approximately $75 vs 50 tablets $60 due to dispensing fees- Expected rapid improvement in pruritus within 2 days of treatmentClient Comms:- Prednisolone expected to provide rapid relief of itching within 2 days- Monitor for increased thirst, hunger, and panting as normal side effects- Cannot use anti-inflammatory medications concurrently with prednisolone- Follow-up as needed to adjust dosing to lowest effective levelPlan: OK to write a macrolone script EXTERNALLY    Vital Signs