C10002010 / invoice 10000

Reason: Red Bumps Along Bottom LipAppointment Notes: O first noticed on satruday morning. Sneezing more than normal. O mentioned maybe bitten by something but unlikely? No breathing concerns. O aware of sunday consult fee & placed on saturday afternoon waitlistEBHistory: Noticed red and swollen lips in the last few days. Few scabs under the chin and it was bleeding a little. Licking his paws a bit as well. Not notice head shaking or scratching ears. Have been otherwise well. EDUD ok. Examine: BAR, BCS 5/9 DG 1/4 mild tartar on 108 and 208. Mm p+m crt <2sec HR 140 Grade III/VI murmur normal bronchovesicular sounds. No nasal d/c. Ears- mild erythema. Mild brown wax. Lip fold- moderate erythema. Mild swelling. Ventral mandible, especailly right mandible- moderate crusts and moderate erythema.Ventral abdomen- no erythema, crusts or scales. Interdigital skin on palmar and plantar surfaces- mild erythema and mild saliva staining. Laboratory: Sticky tape cytology on ventral mandible and lip commissures: Moderate neutrophils and moderate clusters of cocci. Occasional small clusters of rods (likely bacteria from oral cavity)No malassezia. Assessment: Lip fold dermatitis with bacterial infection. Treatment:Cleaned ears with epiotic. Cephalexin 250 mg POBID for 2 weeks. Clean skin under mandible with diluted chlorhex (5 ml chlorhex concentrate + 35 ml 0.9% NaCl) once daily for 7 -10 days.To wash full body once with mediderm to reduce bacterial load on skin. Consider cytopoint or apoquel for pruritis and allergy control after bacterial infection resolved. Return for vaccine when skin problem resolved. Booked echo for 25/3. Could have vaccine done then if skin problem resolved.    Vital Signs    Weight: 10.1;