C09988626 / invoice 10000

Reason: Rash CCRCAppointment Notes:  Rash on belly for several months, worsening despite previous ointment treatment. Rash located mid-torso down to bottom area with some bumps extending higher up body. Bumps also present in left ear. Excessive scratching noted. EDDU norm except inappropriate urination indoors occurring early morning (3-4am) since recent surgery. Previous dietary trial with kangaroo protein attempted but too restrictive. Owner suspects dust mites or environmental allergens as potential cause.History: Skin never really settled Using malseb twice weekly Metacam on occasion for pain in the ear - occasionallyOn joint supplements Occasioanlly nervous to use hip post op Some anxiety when owners away - last time - destroyed carpet in room  - was locked in room at the time Usually has freee roam of house, only ever alone for 3-4 hours Crate training didn't work Skin - scratching a lot - rash nearly gone before gong away on holiday Wakes herself up scratching soemtimes- but less than during the day Licking her feet On kanagaroo lyca mostly / sometimes beef  - sometimes has sensitive stomach - avoiding lamb, chicken, turkey, pork  Occasioanlly salmon Was on digestive care kibble - but not for sometimeNot had skin issues like this before Examination: Pustules along lower abdomen, inguinal region and extending up towards axillary region Erytheatous, no alopecia NAD on rest of exam Laboratory: No infectious agents seen Assessment: Treatment: 1 - skin - malaseb continue twice weekly Apoquel Dermalease twice weekly R/c 2 weeks - if skin not settled - consider TAHP to check for underlying issues Consider referral to dermatoologist 2 trainer - recommned goodog 1:1 to help with anxiety at home  3.R/c consult to discuss behaviour in more detail    Vital Signs    Weight: 5.3;