C10003880 / invoice 10000

Reason: Skin/ear Appointment Notes: Special payment terms existClient Concern: History: Noted 3 weeks ago-ish > developed scabs and itchy skin. At around this time too, O were in Bendalong (camping, so new environment). Not really bothered by ears. EDDU normal otherwise. Not on meds. Has not changed food. Up to date with flea/tick/worming. Season about 4 months ago. Sometimes licks vulva. Not had skin issues before. Physical Examination: CRT1sec, MM pink and moist. BAR. Bilateral ears a little pinker than expected but no overt discharge > swabbed for cytology. Generalised milliary scabs > predominantly on ventral chest, bilateral axillae, bilateral antebrachium, shoulders, extending up to around base of ears. Mild erythema if integument with these areas as well. Saliva staining around vulava. Vulva mature, not overly hooded. No obvious moist dermatitis. No discharge. Superficial LNs normal. No obvious hairloss. Feet look unaffected. Differential Diagnosis: Superficial pyoderma / infection... Underlying cause? Has not had recurrent episodes. Could be maturing into a patient that needs work up for allergies - food allergy trial and ongoing meds / referral etc... For now, treat as once off (has had recent camping), but if recurrent O has been prepped for ongoing issues possible. Laboratory: Sticky tape pred vulva, axillae, chest > intracellular budding cocci. No obvious yeast. Ear cytiology > NSF L ear, scant yeast R ear (1 yeast every 4-5 HPF). Plan: Pred and cephalexin as prescribed. RV in 2 weeks to check infection has cleared. No treatment for ears today, but cytology in 2 weeks to ensure not ramping up...    Vital Signs    Weight: 29;       

Wr check and tick prevCl.    Vital Signs    Weight: 29;       

    Vital Signs