C09997441 / invoice 10000

REASON- skin flare up

HISTORY-
BAR, eddu normal, no vcds. Head shaking and smelly, itching at spot on neck since Os came back from holidays. subdued and itching all over in places. 
Diet: reg dry food
F/T/W/HW: UTD
Medications: None
O just had a baby, 1mo, hectic at home

EXAM-
Demeanour: BAR
BCS  4/5
HR:  WNLs
RR:   pant
T:    not performed
CRT: 1sec    
MM: pink & moist
CHEST: NAD
EYES: NAD
EARS: bilateral erythema + odour
NOSE: NAD
ORAL EXAM:  NAD
SKIN:  hot spot ventral neck, dry flaky skin on dorsum and around tail, very itchy 
ABDOMINAL PALPATION: NAD
MUSCULOSKELETAL SYSTEM: NE

LAB:
Cytology - scant rods and cocci, no yeasts

ASSESSMENT:
OE - bacterial
Allergy flare up

Tx:
40mg cytopoint SC dorsal midline B836645 02/27
Ears cleaned otflush, start easotic 1ml AU SID for 5d
Clipped and cleaned hotspot, neocort BID PRN

PLAN:
Recheck ears 2 weeks to ensure infection cleared then get elocon lotion for long term use
discussed intermittent/ongoing cytopoint to control skin
discussed maalseb shampoo + given allergy handout for diet trials

came in this morning wanting a nail trim. 
was in last month for a sore LF dew claw. 

Same one is sore still. O went away for a week and notcied it looked a bit funny. 
Had a look and defs now a ripped dew claw. can see nail bed exposed, but nice clean and dry. doesnt look infected and seems like  its a few days old. 
Tinly bit of thin nail still hanging fro, the side. clipped off with clippers. 
Khushi wasnt super reactive today adn could have a good look and feel. 

O reports she has still been a bit bothered by it and licking. 
recc to give some more meloxicam if she still has it home. give for a few days and monitor. if it looks worse or still painful then to bring back in. hk 

CM seen photo and advised of the above. hk 

Called O back to relay info. 

Post Op Call - Left voicemail