C10000091 / invoice 10000

Check up
Hairloss on skin getting worse, chewing back legs, going blind (wants to talk about her eyes again), wants to dicuss diet if there's something that can help with with skin, recommend probiotics that work well and he will look online, ears are smelly again

H - Atopic, dry eye. On tracralimus.
Worst the skin has been. Limited response to last cytopoint injection.
Eye drops small amount left 

O - chronic lichenification, alopecia, large build up in both ears

A - dry eye, atopic

P - Cytopoint injection increased dose rate, Oral course of cephalexin. Order more tacrolimus.
shaved plucked and cleaned ears - large number of yeast present
PMP topically

C5 + Cytopoint

Reason: In for vaccination
Hx:-
Up to date with parasite prevention. EDDU ok. No other concerns.
Existing atopic dermatitis & dry eyes

Examination Findings:- 
Hydration: normal
General demeanour: QAR
BCS: 6/9
TPR - wnl, nil murmur auscultated

Respiratory: clear lung sounds and normal effort.
Abdomen:  Soft and comfortable, no masses or fluid wave palpated.

Nares: nil discharge
Eyes: slight discharge
Ears: nil discharge
Oral exam: mm pink and moist CRT 1-2 sec. Dental Score: 
Integument: seborrhoea on the hind lims mainl
Lymph Nodes: - Peripheral nodes palpate normal

Urogenital: nsf
Peripheral LNs: wnl
Musculoskeletal: nsf - ambulating normally, no palpable neck, spine, limb, joint pain, full M/S exam not performed
Neurological: nsf - alert, no cranial nerve or proprioceptive deficits/gait deficits 

Rectal exam: N/P

Assessment/Differential Diagnoses: seborrhoea, dry eyes

Plan & recommendations: Fit for vaccination

Clinical Reasoning: nsf
Client Communication: keep up with parasite prevention 
Informed Consent: yes

Rx:-
C4 given s/c
BB given p/o
Cytopoint inj given s/c

Eye discharges + ear check(clean)
Cytopoint due 22/12/2025 to early to give? O worry about cost if Vet gives jab in same consult.

Hx:-

Examination Findings:- 
Hydration: normal
General demeanour: QAR
BCS: 6/9
TPR - wnl, nil murmur auscultated
Respiratory: clear lung sounds and normal effort.
Abdomen:  Soft and comfortable, no masses or fluid wave palpated.

Ophthalmic Examination:
Discharge: Right eye: slightly creamy; Left eye: same
Vision test: Menace +ve OU 
Reflexes: Normal reflexes.
Globe/orbit: Right eye: globe + orbit  nsf; Left eye: same
Eyelids: Right eye: no spasm; Left eye: same
Conjunctiva: Right eye: Normal; Left eye: same
Sclera/episclera: Right eye: Normal; Left eye: same
Cornea: Right eye: nsf; Left eye: same
Anterior Chamber: Right eye: clear; Left eye: same
Intraocular Pressure: Right eye: not measured (mmHg); Left eye:  not measured (mmHg)
Lens: Right eye: nsf; Left eye: same
Vitreous: Right eye: nsf; Left eye: same
Fundus:nsf
General comments: Right eye: Normal. Blood vessels look normal. Optic disc looks normal; Left eye: same
Fluorescein stain: Right eye -ve; Left eye: same
Ears: evidnce of otitis

Diagnosis:
Atopy
Conjuctivitis
OE

Plan:

Clinical Reasoning: potentially dry eyes
Client Communication: will benefit for amacin and on-going tacrolimus
Informed Consent: yes

Rx:-
Easotic ear drops sid
Amacin eye oint
Cytopoint inj
Tacrolimus to be ordered