C09989257 / invoice 10000

Reason: Cysts On Toes Again Appointment Notes: hrAttendees: Glen History:Penny presents for interdigital cysts Recurring concern for Penny - always licking feet Previously responded well to steroid and antibiotic therapy but recurs soon after completion. Diet of kangeroo mince and veggies - home cooked according to nutritional guidelines 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 5/9Examination:Mucous membranes – pink moist crt <2sOral cavity – clear, no evidence of ulceration, tongue normal, hard palate fineTeeth – grade Nasal planum – normal pigmentation and architecture, no crusting, no dischargeEyes – eyelid conformation normal, PLR normal, no chemosis,  no dischargeEars – no discharge, no erythema, pinna fineLymph nodes - normalHeart – normal regular rhythm no pulse deficits, no murmur HRLungs – 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 – medial interdigital spaces pelvic limbs bilateral cystsNails – fineAnal glands – not scooting/expressedTemperature – Genital region - no masses or swellingsDiagnosis:Interdigital cysts ddx Atopic skin disease Treatment:Apoquel 5.4mg 1/2 BID > SID PO Cephalexin 100mg BID PO Plan: FUC 4-weeks Reivist next week for vacicnations Advised salt water bathing SID Can apply dilute antiseptic after beach walks    Vital Signs