C10000438 / invoice 10000

Reason: Scratching / Ears / ShakingAppointment Notes: Paws App Details:Booking Type: Consultation SkinBooking Notes: She keeps rubbing and scratching her ears and shaking her headPet Does your pet have more than 2 health concerns you'd like to discuss, or is this a complex case?: No - we'll be discussing 1-2 standard concernsHistory:Worming/Heartworm/Flea control status:Vaccination status:Nutrition:Examination:COAT/SKIN:EYES/EARS: MOUTH/TEETH:HEART: LUNGS: ABDOMEN/DIGESTIVE/URINARY: CNS/MUSCULOSKELETAL: PERIPHERAL LYMPH NODES: WEIGHT/DIET: Body Condition Score:REPRODUCTIVE: Assessment:Laboratory:  Treatment:Plan:    Vital Signs    Weight: 26;       

    Vital Signs    

Reason: Skin / LumpAppointment Notes: Paws App Details:Booking Type: Consultation SkinBooking Notes: Lump and skinPet Does your pet have more than 2 health concerns you'd like to discuss, or is this a complex case?: Yes - this is a complex case or we have 3+ issues to discusslump on chest ( been there awhile,) lump on back left and on side the of  paw,  red skin around side of mouth, still on apoquel ,Gap Only Summary: skin flare-upPet Primary Diagnosis/Suspected Diagnosis/Location: pelvic limb digits, inguinal bilaterallySuspect cause: allergic skin disease, malassezia presenceAny other conditions being treated (if any):Known health concerns:Date of first clinical signs (if known):History:On apoquel 16mg SIDLicking at feet, back digits worseBelly red, not scratching muchPreviously had cephalexin in October, cleared up all the welts on body, have not come back. Just inguinal areas and feetLump on right chest looks like it has gotten a bit bigger.No change in food, environment etcRan out of malaseb so had a normal shampoo bath on weekendNo vomiting or diarrhoea, good appetite and toiletingWorming/Heartworm/Flea control status: simparica trio UTDVaccination status: UTDNutrition: pedigreeExamination:Limited examination due to demeanour, muzzled by owner.Both pelvic limb digits erythematous around nails beds and ulcerated/inflamed between digits. Left foot worse than right.Erythema bilaterally in inguinal areas, no pustules presentRedness around anus/vulva, milder than previousErythema and crusting on chin and in lip foldsLaboratory:  Nail bed cytology: occasional malasseziaAssessment:Atopy + malassezia infectionTreatment:Increase apoquel to 16mg BID for 1-2 weeks, then reduce to SIDMalaseb wash 1-2 times weeklyNeocort topicallyPlan:Recommended GA, mass excision and C5 in May when next due for vaccines. Included PABT and histo on estimate. Might clean teeth at same time as unable to assess well    Vital Signs    Weight: 26.4;