C09999926 / invoice 10000

History: 15 min late for consult - but adequate time to cover all concerns today.Presented for cytopoint montly and noticed dry flakey skin from tips of ears yesterday - have not noticed increased head shaking, itch level as usual  ( no increase)Requires more gaba/traz as been using it for grooming - ran outEDDU wellotherwise no concernsExam: BAR, v nervousmm pink moist CRT<2sOral - upper carnassial mod tartar, other teeth no obv dental dzEyes - clearEars - otoscope clean, clear noad, no skin flaking. at the tip of both ears - some flakey dried skin, the skin is otherwise not inflamed/swollen/red/no exudate.RLns normalCVS/RESP - noadGIT/UG - noadMSK - noadDiagnosis:cytopoint is generally managing skin allergy wellDry skin - only at tip of ears, no other areas affected, less likely systemic issues such as underlying endocrinopathy. it does not appear to be causing any discomfort - no active lesion to take sample from. Suspect perhaps change in skin cycle - reasonable to brush off, monitor, consider applying mild oatmeal based ie aloveen conditionerok for more gaba and trazodoneTreatment:cytopoint 10mg sc 806981 11/2026gabapentin 100mg PO 2 hours before stressful event x 10 capsTrazodone 50mg - 25mg PO 2 hours before stressful event along w gabapentin x 5 -- total 10 doses Plan: monthly cytopointr/c if dry skin is worseR/V:

Nurse cytopoint 10mg given SQ as per vet instructions. 

History: Presents for recheck bilateral yeast OE & pruritis - rx Easotic 1ml each ear SID 10 days total & Cytopoint 10mg, respectively.Ears/skin:No signs of ear irritation.Itch responded well to Cytopoint - no signs at present (see hx re chronic, non-seasonal pruritis affecting trunk & feet).Other problem noted today:Hopping on the HL - reportedly the LHL - intermittently for 3wks.No known trauma.No prev musculoskeletal issues.Otherwise well. EDUD normal.Medications: gabapentin 100mg PO & trazodone 25mg PO definitely given about 1.5h prior to consult todayExam: BAR, highly anxiousIntegument: healthyEars: both external ear canals grossly healthyMSK: ambulatory without overt lameness in consult; consistently seems uncomfortable when attempting to elicit cranial drawer RIGHT stifle but no instability appreciable; otherwise NAD (no evidence of pain appreciable with the LHL at all today)Eyes: NADOral: healthyLNs: WNLCardioresp: NADAbdo: NADCytology: Ear swabs - both ears squames only, no microorganisms observedDiagnosis: - Resolved yeast OE- Chronic non-seasonal pruritis responsive to Cytopoint- Skin/ear issues as above presumed secondary to underlying atopy and/or food allergyTreatment: - Metacam 5kg dose PO SID 5 days for pain relief- Rec higher dose of gabapentin/trazodone prior to next vet visit - gabapentin 150mg PO in combination with trazodone 50mg PO 2h before vet visits to alleviate stressPlan: - Conservative management for HL lameness with rest 1-2wks & NSAIDs as above. If lameness persists then obtain video footage to verify the affected HL (L vs R) & then recheck - sedated exam/rads of the affected limb likely indicated in that case.- Okay to continue with nurses PRN with 6mthly checks. Did email Vanessa info for food trial to be conducted at some point when practical (if food trial pursued then would plan to recheck at week 6 or 8 prior to rechallenge as per email instructions).