C09995557 / invoice 10000

Reason: reCheck Appointment Notes: Special payment terms exist, Overdue remindersVerified: NoHistory:Presenting for: Jazz presented for recurrent skin allergies that had previously responded to treatment but returned approximately one week ago with constant licking, scratching, and head shaking.Historical Conditions: Previous allergic dermatitis with conjunctivitis in August. Previous treatments included steroids, antibiotics, Cytopoint injection, and Apoquel tablets with variable success. Steroids provided the best response but condition recurs when discontinued.Skin: Recurrent allergic dermatitis with periods of remission and flare-ups. Current episode involves constant licking, scratching, head shaking, and rubbing face against objects. Owner reports feeling crusted bits on skin and hot, inflamed areas under chin. Eyes becoming weepy again but not as severe as previous episode. Some crusting under chin present but less severe than previously.Current Meds: Malaseb shampoo for skin careExamination:Mentation: Wt: BCS: T: HR: R: MM: Hydration: Behavioural: Eyes: Mild weepy discharge developing, some gunky discharge from left eye. Improved compared to previous conjunctivitis episode.Ears: Red and inflamed bilaterally. No obvious infection or abnormal discharge noted on examination.Nose: Throat: Oral: Cardiovascular: Respiratory: Abdominal: Lymph Nodes: Integumentary: Hot, inflamed skin under chin. Crusting present on neck and under chin. Some crusting in axillary region. Overall improved compared to previous severe episode.Neurologic: Musculoskeletal: Urogenital: Rectal: Diagnostics: Nail trim performedAssessment:Recurrent allergic dermatitis with secondary bacterial skin infection - Chronic condition with pattern of good response to steroids followed by relapse when treatment discontinued. Current flare-up less severe than previous episode but causing significant discomfort.Plan:New Meds/Tx:- Prednisolone tablets: 1 tablet SID for 1 week, then 0.5 tablet SID for 1 week, then continue to decrease to lowest effective dose that maintains comfort. If itching returns, increase back to previous effective dose for one week before attempting to decrease again.- Antibiotics prescribed for secondary bacterial skin infectionAdditional Discussion:- Long-term steroid management discussed as most effective treatment option given poor response to Cytopoint and Apoquel- Potential side effects of long-term steroids discussed including slight muscle wastage, weight gain, and reduced organ function, but noted these are dose-dependent- Goal is to find lowest effective maintenance dose, potentially as low as 0.5 tablet every second day- Focus Malaseb shampooing on affected areas including under chest and axillary regions, leaving on skin before rinsingClient Comms:- Owner expressed frustration with recurrent nature of condition- Discussed that steroids appear to be most effective treatment for this patient- Advised to monitor for return of symptoms and adjust dosing as needed- Contact clinic when additional medication refills needed    Vital Signs