C09990538 / invoice 10000

Reason: Licking Paw And Cytopoint Hx: o done a few days of malaseb - started licking/biting a few days agoSeems uncomfortableIs scooting slightly as wellPEBARPink moist mmRH - saliva staining between digits on plantar aspect. Mildly inflammed skin, no swelling/wounds found. Dorsal aspect of tarsus nad on examAll other feet comfortableAG checked - L +++, R ++ - normal contents in both, both easily expressed.Conitnue EOD malaseb and strat SID cortivance spray for 5 days - call INI (o has other skin meds at home, might suggest neocort/isaderm)Inj 20mg cytopointHistory:Presenting for: Patient presented for breakthrough pruritus affecting a hindpaw, with onset a few days prior to presentation. Client reports redness on the affected paw and nocturnal restlessness/pacing.Historical Conditions:- Known atopic dermatitis - chronic, recurrent; client experienced in managing condition- Recurrent anal gland impaction - requires periodic anal gland checks- Wellsite (wellness) appointment approximately one month agoSkin:- Breakthrough pruritus noted a few days ago; client attributes possible contribution from increased humidity- Affected paw appears mildly erythematous; client uncertain which specific paw initially but confirmed hindpaw on examination- Client has been trialling Malaseb (antifungal/antibacterial shampoo) for a few days prior to presentation with limited effect- Client reports nocturnal pacing consistent with pruritic discomfort- Client notes occasional scooting; suspects some scooting may be frustration-related secondary to paw irritation rather than anal gland discomfort aloneCurrent Meds:- Malaseb shampoo - initiated by client a few days ago for affected pawLifestyle Risk Factors:- Daily walks to City Park (mixed surfaces: pavement and parkland/grass)- Seasonal/environmental allergen exposure likely given park access during summerExamination:Integumentary:- Mild erythema noted on affected hindpaw; remainder of paws and skin in good conditionRectal:- Anal glands assessed; full anal glands noted as potentially contributing to overall discomfortAssessment:Atopic dermatitis with breakthrough pruritus - Hindpaw erythema and pruritus consistent with breakthrough allergic flare, likely exacerbated by seasonal/environmental allergens and humidity. Presentation is within expected pattern given wellness appointment approximately one month ago. Anal gland fullness may be contributing to overall discomfort.Plan:New Meds/Tx:- Malaseb medicated shampoo: focal foot bath to affected hindpaw; leave in contact for minimum 10 minutes then rinse thoroughly; recommended every other day for the next several days- Topical corticosteroid spray (quarter mL per application): apply directly to affected area of hindpaw once daily for 5 days; client to monitor for improvement- Steroid cream: discussed as an option if insufficient improvement seen within 5 days; to be prescribed via phone consultation if needed - client has existing home pharmacy and may already have suitable productAdditional Discussion:- Anal glands expressed/assessed today; fullness may be contributing to generalised discomfort and scooting behaviour; anecdotally some dogs redirect anal gland discomfort to areas they can access (e.g. paws)- Contact dermatitis from park surfaces (e.g. grass/pollen during summer) discussed as possible contributing factor- Epsom salt foot baths recommended as a post-walk routine during high-pollen periods: prepare a foot bath, have patient stand in it for 5 minutes, then towel dry as normalClient Comms:- If no meaningful improvement in hindpaw erythema/pruritus within 5 days of current treatment, client to phone clinic; steroid cream can be prescribed remotely- Epsom salt foot soaks advised post-walk during summer months to reduce contact allergen load- Continue monitoring anal gland status; scooting to be reassessed once paw discomfort resolves to determine if anal gland contribution persists    Vital Signs