C09996873 / invoice 10000

Reason: Ears 16.5kgAppointment Notes: Overdue remindersReason: History: Suddenly bothered by R ear yesterday, put in some out of date PMP (exp 8/25) yest and this amYelped when touching the ear which is unusual.Live on a normal house block, not walked in places with grass awnsExamination: R ear has a pimple looking lesion at 10 oclock about 5mm inside canal with otosocpe. Not a lot of discharge but is quite painful to examineL ear has moderate brown discharge in canal, can't see to TMLaboratory: Nil R ear (possibly inaccurate due to meds)L ear 5 malasezzia phpfAssessment: Bilateral yeast infection suspected, pimple lesion in R ear? Trauma? Fb? Mass lesion?At this stage treat with topicals, plus pred inj. INI will need GA to examine properly and possibly lanceApoquel shouldn't be bid long term Treatment: Consent has been given by the client to proceed with this treatment  -  Yes/No Plan:    Vital Signs    

Reason: EarsAppointment Notes: Overdue remindersHistory: 3 days of ear irritationHas an OE flare up last year - resolved with PMP in the pastStarted putting PMP in R ear a couple days ago and has helped but still want it checkedExamination: BAREye/ears/nose: 	Grossly NAD> No sig waxy discharge or malodour bilat	No sig swelling or irritation or pain on samplingOtoscopic exam -> sig hair down entire length of canal. No sig erythema, discharge, or fbLaboratory: Ear swabs clear. Couple mallessezia /hpf in L ear, nothing in effected R ear samplePlan: Continue with couple days PMP at home in both ears to be extra sure its taken care ofMonitorContinue with apoquel for allergic inflamm and irritation rtreatment    Vital Signs    Weight: 16;       

Reason: Meds Check - Needs ApoquelBreed - SchnoodleSubjective:- Health check for ongoing Apoquel medication and discussion of diet. Itch is persistent.- Itch is present all year round, not seasonal.- Currently on Apoquel 16mg 0.5 tablet once daily, increased to twice daily during acute flare-ups. This is controlling the itch well.- Previously tried cutting out 'Liver treats' (beef-based treat) but no significant change noted.- Has been on a hypoallergenic diet but not strictly, also receives cooked food like chicken and beef.Past Medical History:- Ongoing atopic dermatitis/pruritus managed with long-term Apoquel.- Vaccination status: vaccinated at another clinic, not due for a booster. Unlikely to go into kennels.Objective:- General health check performed. Appears to be a healthy girl.- Skin and feet checked, no abnormalities noted on examination. No erythema seen - Weight ok - Chest auscultation NAD - no murmur, lungs clear.  - mild tartar on upper carnassials.Assessment & Plan:1. Pruritus / Atopic Dermatitis - Chronic Management- Investigations planned: Annual blood test to monitor for any side effects of long-term Apoquel use (e.g., low white blood cell count) and to check organ function (liver, kidneys, thyroid). This will be a full panel sent to an external laboratory, with results expected in 48 hours. Owner consented to the test. Cost discussed.- Treatment planned: Continue Apoquel. Dispensed 100 tablets.- Discussed diet. As a strict hypoallergenic diet trial was not performed and other proteins are being fed, the benefit of the current hypoallergenic food is questionable. Discussed an alternative option of a skin support diet with high omega-3 and -6 fatty acids to support the skin barrier.- Discussed a new medication, an alternative to Apoquel that targets different inflammatory markers and may be more effective for some dogs. Provided a brochure. Owner informed this is an option if Apoquel becomes less effective.2. Preventative Health- Submitted claim to pet insurance for consultation, blood test, and medication.--- 22/12/2025 12:18:22 FA3:Laboratory: SODIUM 154 mmol/L 139 - 153 HCHOLESTEROL 10.7 mmol/L 3.5 - 9.0 H AMYLASE 330 IU/L 333 - 1500 LClient Communication:LMOM on Peter's mobile informing of normal results.Non-signiificant changes - ok to stay on aqpoquel if she is continuing to doing well on it.    Vital Signs    MMColour: pink;       Weight: 16;       HeartRate: 104;       BodyScore: 4,5/9;       DentalGrade: 1/4;       RespirationRate: panting;       CRT: 1sec;