C09996471 / invoice 10000

Reason:  
History: 
waking & stressing through the night
Increasing anxious
Escaping 
Been worsening over last few mths
Very bonded to Mo - following around
Sister is FIFO 
New neighbours moved in recently
Used to be fearful of rain - but this has been managed & resolved
Bit noise sensitive with wind etc


Current medications: 

What Preventative health cover is being used and do you need to purchase any today?
Vaccination:
Worming: 
Flea control: 
Heartworm Prevention: 

Examine: 
Mentation: 
Body condition score: 
MM:                CRT: 
HR:                RR: 
LN: 
Temperature: 

Ocular: 
Oral/Dental stage:
Ears: 
Cardiovascular: 
Respiratory: 
Gastrointestinal: 
Integumentary & lumps (measurement, location):
Musculoskeletal: 
Urogenital: 
Neurological: 

Problem List:

Assessment: 

Treatment: 

Plan: 

On-going medications required: Y/N (use prescription tab for further supply):

Followup: 

DERMATOLOGICAL EXAMINATION
There is very mild hypotrichosis of the latera flanks, forelimbs, and dorsal head with associated dilution in the blue
hair shaft (more silver).
The ventral abdomen is moderately hypotrichotic with regions of black-brown hyperpigmentation. No erythema is
present.
The ventral chin contains a focal region of erythema.
Diagnostics Tests:
Cytology:
Impression smear from:
Dorsal back: pollen, no significant findings
Ventral: no significant findings
Ventral chin: no significant findings

DIAGNOSIS:
Atopic Dermatitis (Environmental allergies)
Colour Dilute Alopecia (blue hair coat)

MANAGEMENT PLAN:
1.Symptomatic anti-itch/inflammatory therapy
Continue Apoquel 16 mg chewables: Give ONE (1) tablet ONCE daily for maintenance.
Commence Prednisolone (blue tablets) 20mg tablets: Give ONE tablet on two days of the week (e.g. Monday and
Thursday) for added itch control. Trial these tablets for three weeks, then discontinue to see if seasonal changes have
past and Ronnie can continue on Apoquel alone. You can start and stop this medication at this dose as required. If this
does not resolve Ronnie's itching then let me know as I can send you further dosage instructions.

2.Symptomatic antimicrobial therapy
Continue weekly to fortnightly bathing using Paws Mediderm and conditioner.
Today we have discussed the importance of bathing for dogs who may potentially have an environmental allergy
and/or bacterial or yeast (Malassezia) skin infections. We have dispensed a new product for you to use called Paws
Mediderm; the corresponding conditioner (Paws Nutriderm conditioner) will help to restore the skin barrier by
application of dog specific oils and ceramides. A stronger skin barrier will aid in preventing infections from
establishing. Please bathe Ronnie once a week ongoing, allowing these products to sit on the skin for 5 minutes before
rinsing off.

3.Diet
Continue the Anallergenic biscuits and Salmon rolls
Sun protection
Today we discussed that sunbathing in dogs (particularly in Staffy's who love the sun) can lead to the development of
skin cancers (particularly on their tummy) as they can for humans. Prevention is the best key, with management
strategies including:
Avoiding sun exposure during high UV times (e.g. 10am to 4pm)
Having Ronnie wear a t-shirt or clothing to protect his belly from direct sun exposure
Using a chemical based sunscreen (e.g. Cancer Council kids SPF 50+) to aid sun protection - chemical
sunscreens are best as they will continue to work once rubbed in (as opposed to being rubbed off such
as a zinc-based sunscreen).
Revisit: 6 months time

FUTURE PLAN:
Symptomatic treatment of environmental allergy has been elected for long-term in lieu of allergy testing and
desensitisation.

Reason: Vaccination
History: 
Ronnie has been well. 
Skin very well controlled. Very little pruritis. 
Due vaccination today. 
O has also noticed wart lump grown quickly in last week. 

EDVD: normal 
Diet: anallegenic diet + salmon roll 
Current medications: Apoquel 16mg SID, Maxiderm 
Proph: UTD 
Vacc: UTD 

Examine: 
Mentation: BAR 
BCS (0-5):  3/5      
MM: P/M                 
CRT: <2
HR: ~100                   
RR: panting 
Dental Stage: Stage 2
Temperature: not taken 
Gastrointestinal: soft and comfortable 
Integumentary & lumps (measurement, location): skin looking really good today, some mild coat thinning, mild erythema between toes of forelimbs, small 0.5cm medial hock LHL lump - pedunculated 
Musculoskeletal: nad

Assessment: 
Due vaccination 
Controlled pruritis 
Small warty pedunculated lump on medial left hock. 

Treatment: 
PI2 SC (5264015) + BB Oral (5245044b)

Plan: 
O has elected to monitor lump. 
INI consider FNA or removal.