C09995400 / invoice 10000

Appointment Notes: loosing hair on ears   ------- Sms reply: YesSubjective: UTD with nexgard spectraMultiple month history of alopecia over his dorsal pinna, started at cranial most aspect but has progressed to include more caudalNo pruritusEDUF WNL. No CSVDNo other concernsO wasn't concerned about it but has noticed a recent very mild progressionObjective: QAR, nervousHR/PR/CV: 140 no murmur or arrhythmiaMM/CRT/Hydration: pk 1-2s moist, no skin tentRESP/RR: panting no crackles or wheezingTemp: n/eGIT/UG: abdominal palpation soft and unremarkableSkin/Ears: Multifocal alopecia over both pinna, L>R. Woods lamp negative. Very mild erythema over alopecia towards tip of pinna. no scaling/crusting. Ear cytology nsf (no yeast/bacteria). No gross accumulation of wax within ear canalsM/S: ambulatory all 4, no lamenessEyes: nsf, no discharge or inflammation. symmetrical pupilsDental: 1/4Lymph Nodes: wnlBCS: 4/9Laboratory:ear cytology: nsf, no yeast or bacteriaTape prep of pinna: nsf, no bacteriaSwab: nsf no yeast/bacteriaAssessment: Multifocal pinnal alopecia - ddx: colour dilution alopecia (known to occur in whippets & Derek is of 'lilac' colouring) vs allergic skin disease vs self trauma vs endocrine vs autoimmune vs fungal/bacterial vs ectoparasites vs otherClient conversation:Discussed differentials. Very mild erythema. Consider a treatment trial with prednisolone at an anti-inflammatory dose (side effects discussed). Discussed long hair follicle cycle relative to medication course so may take some time to see hair regrow but aiming to see resolution of mild erythema and early follicle regrowth. Discussed prednisolone taperingDiscussed consideration for hypoallergenic diet if successful response to pred trial. Advised we are only treating/managing the symptoms with pred currently. Cannot definitively diagnose without further testing, deep skin scrape + biopsy +/- derm referral for skin testingO happy to trial meds for now will revisit for biopsy INI or declinesDiscussed bloods to screen for endocrine/underlying disorders though no clinical signs to match this.Discussed fish oil as supplement Discussed colour dilution alopecia. Treatment: Prednisolone 10mg PO SID 7days then 5mg PO SID 5 days then 2.5mg PO SID 5 days Plan: FUC 10 days - how are earsINI revisit for deep skin scrape +/- recommend biopsy ____________________________INSURANCE HXInitial Assessment > Suspected cause > Date of first clinical signs >Any other conditions / treatments >     Vital Signs