C09995353 / invoice 10000

Appointment Notes: Recheck for some more Apoquel MVK  ------- Sms reply: Y HISTORY: CURRENT DIET:PREEXISTING CONDITIONS: CURRENT MEDICATION: PE:T-HR/CARDIAC-RR/RESP-MM-CRT-LNN-ABD-BCS-OTOSCOPY/EARS: ORAL HEALTH: EYES: MSK: INTEGUMENT: UROGENITAL: CNS: Not routinely examinedPROBLEM LIST:DX:DDX:RX:PLAN:?????HISTORY: Presenting for an Apoquel refill for allergies after a 3-4 week lapse in treatment. Clinical signs include pruritus around the ears, and alopecia on the dorsum of the hindlegs and pinnae. History of good response to Apoquel. Recent emotional stress in the household.CURRENT MEDICATIONS:PREEXISTING CONDITIONS: Allergic dermatitis. Brachycephalic Obstructive Airway Syndrome (BOAS).CURRENT DIET: Black Hawk chicken and rice kibble with occasional snacks.PE:- T-N- HR- RR/lungs: Audible stertor consistent with BOAS.- MM-- LNN-- ABD- Soft, non-painful on palpation.- BCS Lean.- Otoscopy/ears: Severe bilateral external ear canal stenosis preventing full otoscopic examination. Pinnae skin is hyperkeratotic with fissures and ulceration.- Oral health: Mild erythema around the mouth.- Eyes:- Msk system:- Integument: Alopecia on the caudal aspect of hindlegs and pinnae.- Urogenital: Not routinely examined.- CNS: Not routinely examined.Lab: Ear Cytology (bilateral): Significant yeast overgrowth (Malassezia spp.).PROBLEM LIST:1. Severe bilateral stenotic otitis externa.2. Pruritus and alopecia.3. Suspected allergic skin disease (food vs. atopy).4. Brachycephalic Obstructive Airway Syndrome (BOAS).Dx:1. Bilateral Malassezia otitis externa.2. Allergic dermatitis flare.3. Brachycephalic Obstructive Airway Syndrome (BOAS).DDx: Underlying cause for dermatitis/otitis: Atopic dermatitis, food allergy, or combination.Assessment: Flare-up of allergic skin disease and secondary otitis externa, likely due to cessation of Apoquel. Severe inflammation has caused significant ear canal stenosis. Concurrent BOAS is noted.Rx:- Apoquel 5.4mg tablets: 1 tablet orally once daily.- Prednisolone 5mg tablets: 1 tablet orally once daily for 4 days, then 1/2 tablet orally once daily for 4 days.- Medicated ear drops (Enrofloxacin/Miconazole/Dexamethasone): Apply 0.5-1.0mL into each ear twice daily for 10 days.PLAN:- Recheck consultation in 2 weeks (20/03/2026) to assess ears.- Discussed initiating a strict diet elimination trial (handout provided).- Discussed BOAS pathophysiology and surgical correction; owner advised to check insurance policy for coverage.- Advised pre-booking 6-monthly rechecks for ongoing medication authorisation.?????    Vital Signs    Weight: 10.2;