C09996201 / invoice 10000

BIB mum and daughter- itching mod amt, prob atopic, maybe mild effect or none with Cytopoint, no response apoquel- Lyka hypoallergenic not trialled yet - on Luna's next food order- have looked to book with dermatologist but diffic getting appt but will persist- spinning around on bottom still , ags checked last visit- trim nails- hooded vulva, moist and smelly folds, cytology cocci++++, cleaned/demo access- RF paw sl red underneath, other paws ok, ears looking ok (elocon)- ags sm amt each side- to bathe vulva folds malaseb diluted sid and ointment bid Apex PMP, longer term maintenance trial nappy rash powder- elect to give Cytopoint for mild effect, on antihist daily, option derm defense diet if hypoallerg not helpingCytopoint 30mg (B: 820640, exp 1/2027)Apex PMP - bid into vulva folds, r/chh 7-10d

History:DUDE wnl. Don't feel cytopoint did anything, is very itchy. Not keen to keep going. On Lyka + gut and skin powder. Been on it for 1 year. On nexgard spectra + tapeworm all utd Vomiting: noneDiarrhea: noneUrination:wnlAppetite: wnlWater Intake: wnlPhysical Examination:LOC: BARmm/crt: Pink 1sHR:  120RR:   panting FP: wnlT: --Teeth:  2/4 dental dx LN: wnlMouth: wnl Eye: wnl Ears: wnl - no wax and canals normalNose: wnl Skin: interdigital signs of licenification and mild erythema Abdomen: wnl Musckeletal: wnl Hydration: wnl BCS:   6/9Both AG expressed mod fullHooded vagina with discharge present - owner feels scooting cause of vulva  Assessment:Mild dental dxoverweightSigns of contact alergyHooded vulva  Plan:1) weigh tloss2) Try lyka hypoallergenic 3) Wipe with tissue vulva post urination and clean once a week. 4) Referral to dermatologist recommended*O ok to take off cytopoint reminders Treatment:1) Nobivac bb/pi bn 2526207

Anal glands expressed - L side few drops of brown liquid, R side 1/4 full of brown liquidCytopoint 30mg Batch 806984, Exp: 10/2026 given SQ, next due in 1 month