C09991092 / invoice 10000

Reason: Staining on FurSubjective: O reports staining on chin and paws still present, last seen 1mo ago for itching and started on Apoquel 3.6mg SID PO (Cytopoint not effective)Currently feeding MyDog, advised to transition to Hypoallergenic only but still feeding some otherO reports does sometimes still lick at paws but not as much as previously Currently on Viscotears into R eye BID ongoingO would like Trazodone dispensed for boarding stay in April, previously effectiveUTD with flea and worm treatmentNo other concerns, eating and drinking normally, no coughing/sneezing, no v/dObjective: BARHR/PR/CV: HR 120, unable to assess CV over pantingMM/CRT/Hydration: mm pink and moist RESP/RR: Panting and quiveringTemp: 39.2GIT/UG: Abdominal palpation comfortable and unremarkable Skin/Ears: Mild fur staining around mouth, medial canthus bilaterally, very mild fur staining on paws M/S:  Normal ambulation Eyes: R eye cherry eye, L eye NAD Dental: Grade 2/4Lymph Nodes: NAD BCS: 6/9Assessment: Allergies well controlled with Apoquel Cherry eye managed with Viscotears Discussion with Owner:Discussed skin disease and explained food vs environmental sensitivity, explained cannot be sure if food/environmental without trialling with foodAdvised hypoallergenic food only for at least 6 weeks to monitor responseO showed pictures of many different treats, explained would not be fitting with hypoallergenic trial and cannot feed theseO asked about cheese, explained would not fit with trial againDiscussed very wild fur staining, explained will continue to become less notable with regular washing and ongoing allergy controlDiscussed tooth brushing to prevent tartar build up and help with staining around face, explained will likely always have some degree of staining visibleDiscussed tooth brushing vs SPA if O very concerned about staining and teeth, O happy to trial with teeth brushing firstDiscussed Trazodone dose and side effects for when in boardingExplained ongoing Apoquel for next 6 weeks, then trial off to test if dietary sensitivity, not sure if O understanding, explained can be on Apoquel longterm and can call for repeats without needing to be seen for next 6moTreatment: Apoquel 3.6mg SID PO Trazodone 25mg SID-BID PO during boardingTransition to Derm Complete only for 6-8 weeksPlan:Ok for Apoquel/Trazodone/Viscotears repeats for 6mo    Vital Signs