C09988633 / invoice 10000

JM - skin irritation, possible allergy needle

History: 
- EDDU: normally 
- No V/D/C/S
- UTD with preventatives: heartworm, flea, tick, worm & vaccines 
- O's concerns: itchy skin, has been to skin speciallist Dr jey thinks contact allergy v atopic dermatitis 
- Diet: Lyka and a chicken wing every so often (maybe once a week), Jack Russel Science Diet, Eureka food as well (just the biscuits) 
- Doggy day care astro turf -> skin normalises at the daycare and then as soon as she is home she has reaction
- Has steroids in the past and there was a definite improvement 
- Antihistamines used in past as well but not working as well 

Physical Examination: 
- HR wnl no murmur noted, normal and synchronous pulses 
- RR wnl no crackles or wheezes, no stertor or stridor noted 
- Abdo palpation normal no masses,  pain or hernias noted 
- MM moist pink and CRT <2s
- Ears/Eyes/Nose: normal no discharge noted 
- No lymphadenopathy noted 
- Skin and coat: alopecia along hamstrings, neck, ventral abdomen, axilla region - these areas also covered in small spots of erythema and excoriations 
- MSK: no lameness noted in consult, full MSK examination not performed today 
- Temperature: not taken today 
- BCS: 6/9
- BAR no neurological deficits noted 
- Rectal: not performed today 

Differentials: 
atopy v contact allergy 

Diagnostics: 
Cytology skin - cocci ++, neutrophils +++

Assessment: 
secondary staph dermatitis 
primary allergy - most like atopy due to distributiion of lesions 

Treatment: 
cytopoint 10mg sc 
pyohex topical sid for 7 days 
tapering course predx5 

Plan: 
use aloveen every 3-4 weeks 
talked about diet including megaderm as a supplement 
talked about alpha keri leave on conditioner as a lanolin supp