C10000931 / invoice 10000

skin flare

Subjective
Presenting Concerns:  
Coco, an 8-year-old female dog, presented for a flare-up of her allergies. The owner reports that she has been rubbing and scratching, and her skin appeared very pink yesterday.  
  
Historical Conditions:
-   Chronic, year-round allergies.
-   Known allergy to chicken.
-   History of anal gland impaction and infection, which required a previous operation.
  
Diet/Appetite:
-   Appetite is reported as normal.
-   Diet includes pumpkin and beans for added fibre.
  
Drinking/Urination:
-   Drinking and urination habits are reported as normal.
  
V/D/C/S:
-   Bowel function is normal. No vomiting, diarrhoea, coughing, or sneezing reported.
  
Skin & Coat:
-   The owner reports a flare-up of generalised pruritus (rubbing and scratching) that began yesterday.
-   The skin on the ventral abdomen was noted by the owner to be very pink.
-   The owner bathed Coco in Malaseb shampoo yesterday.
-   The patient has been observed rubbing on an old carpet in the house.
  
Current Medications:
-   Receives Cytopoint injections for allergies; the next dose is due in 10 days.
-   Malaseb shampoo is applied to the paws twice weekly for 10 minutes per application.
  
Lifestyle Risk Factors:
-   Attends a groomer regularly, with the last visit being 2 weeks ago.
-   Has access to a room with old carpet and is known to rub on it.
  
Additional Information:
-   Today is the patient's 8th birthday.

Objective
Mentation: BAR  
Wt: 8 kg  
BCS: -6/9  
T: Not taken  
P: 110
R: Ò  
MM: pink/moist. CRT < 2sec.  
Hydration: Normal  
  
Emotional Assessment: The patient was tolerant of examination and handling.  
  
Eyes: Clear. No discharge or erythema OU.  
Ears: Clean with no discharge or erythema AU.  
Nose: Clear, moist without discharge.  
Throat: No inducible cough upon tracheal palpation; no palpable masses.  
Oral: Calculus and gingivitis absent. No masses or other lesions.  
Cardiovascular: No murmurs or arrhythmias, strong synchronous pulses.  
Respiratory: Normal bronchovesicular sounds bilaterally.  
Abdominal: No organomegaly or mass effects. No pain on palpation.  
Lymph Nodes: No peripheral lymphadenopathy.  
Integumentary: Erythema and warmth were noted on the skin of the ventral abdomen, ventral neck, and flanks. The skin on the paws appears healthy with some mild staining but no active inflammation or redness. No evidence of ectoparasites, full coat with clear skin.  
Neurologic: No ataxia, normal mentation.  
Musculoskeletal: Ambulation normal, no lameness observed.  
Urogenital: Normal external anatomy.  
Rectal: The anal sacs were bilaterally full with very thick, inspissated contents. Both sacs were expressed with some difficulty.

Assessment
Allergic dermatitis flare-up Ñ Characterised by generalised pruritus and multifocal erythema on the ventral abdomen, neck, and flanks. This is consistent with her history of chronic, non-seasonal atopy. The current flare-up is occurring despite being on a Cytopoint injection schedule.  
  
Anal sac impaction Ñ Bilateral impaction with inspissated contents was noted on examination. This is a chronic issue for the patient, likely due to the abnormal consistency of the anal sac fluid, which makes normal expression difficult.

Plan
Pending Diagnostics:
-   Discussed referral to a veterinary dermatologist for intradermal allergy testing as a future option to identify specific allergens and potentially pursue desensitisation therapy. The owner will consider this.
  
Medications/Treatments:
-   Dispensed oral steroid tablets. Instructed to give half a tablet SID for 3 days. It was explained that this is a short, low-dose course to manage the acute flare-up while minimising risks associated with concurrent Cytopoint use. The owner was advised of potential side effects, including increased thirst and appetite.
-   Dispensed a topical steroid lotion. Instructed to apply a thin layer to reddened and itchy areas SID for up to 7 days. After the initial course, it can be used as a spot treatment as needed. Advised the owner to wear gloves during application and to prevent the patient from licking the area for approximately 10 minutes after application to allow for absorption.
-   Continue bathing paws with Malaseb shampoo twice weekly. Confirmed that it can also be applied to other inflamed areas during flare-ups.
-   Recommended regular anal sac expression at the clinic, particularly at the time of Cytopoint injections, due to the chronic nature of her impaction.
-   A recheck is scheduled in 10 days for her next Cytopoint injection and to reassess her skin.
  
Diet & Feeding Recommendations:
-   Continue the current diet, including the addition of pumpkin and beans for fibre, to aid in anal sac expression.
  
Additional Discussion:
-   Advised the owner to prevent the patient's access to the room with old carpet to minimise potential environmental allergen exposure. Suggested using a baby gate.
-   Discussed the use of topical honey, advising against it for this type of generalised inflammation as it may encourage licking.
-   Mentioned that surgical removal of the anal glands (anal sacculectomy) is a theoretical option for chronic impaction but is likely not necessary at this stage, given her age and successful management with regular expression.