C09992940 / invoice 10000

Reason: Skin Biopsy, Culture, Appointment Notes: Nurses - please check with LUC how to prep the skin BEFORE starting. Cultures will need to be taken from drianing sinuses. Biopsies on 2-4x feet, and tail base.    Vital Signs    

Reason: Booked for GA/ skin biopsy (all paws, ventral/dorsal tail base), deep cultures, nails, C5. **CANCELLED*** Procedure delayed until off abx for 7days. History: Zoe was placed on abx 5d ago against LUC instructions. On enrofloxacin. Systemic abx will render culture inaccurate. LUC called IDEXX path to discuss case. IDEXX advice: - deep pyoderma will likely have some infectious organisms present, but after even a few days of abx, the culture cannot be interpreted accurately. The short course of abx may result in the organisms dying en route to the lab - for accurate culture, no abx  7-14 days beforehand- ideally no pred/apoquel or zenreilia 4 weeks before biopsy- enro is not a low importance abx or an empirical choice for dermatology. Now the course has been started, it is better to finish course to reduce chance of multi resistant bacteria emerging. If there has been clinical improvement, can continue on abx until full resolution - may be upwards 12weeks - Zoe has had multiple broken courses of amoxiclav and enrofloxacin - high risk of MRSA - int med recommended referral to dermatologist - int med agreed that abx should be continued for 2 weeks beyond clinical resolution - guidelines: https://onlinelibrary.wiley.com/doi/10.1111/vde.13342 Discussion with O: - long discussion with O. Explained that culture will not be accurate whilst on abx. O has weaned off pred (last dose 2d ago), but will not be able to wean off Zenreilia. Options 1. Ideally delay biopsies until off abx for min 7days. 2. Continue on enrofloxacicin as we have seen some clinical improvement, but will need to continue on 5-20mg/kg SID until complete 2 weeks after clinical resolution of all pyoderma 3. Histopathology + biopsy today, may have inconclusive results (not ideal)Owner opt for 1. Rebooked surgery for next Thursday. Last abx dose to be given this Thursday. O can continue with topical chlorhexidine and zenreilia until day of surgery.PLEASE DO NOT DISPENSE MEDICATION WITHOUT APPROVAL FROM LUC PRIOR TO SURGERY ON 5/3/26    Vital Signs    

Reason: Can She Have Abs Appointment Notes: waiting to hear back from insurance re Sx, as discussed with Lucy yesterday, but really miserable today. Can she pls get abs to tide her over JWDiscussion: JE ok'd dispense ABs to manage symptoms whilst o makes a decision regarding treatment. Treatment: Enrofloxacin 150mg (1 tablet ONCE daily for 1 week)Plan: Await discussion with insurance company regarding surgery    Vital Signs