C10004168 / invoice 10000

Sore foot.
Booking Notes: Sore foot and has bitten people this weekend (Front L)

**Owner reports**:
- Sudden onset of snapping/biting behaviour over the past 3 days, with 4 instances since Friday night.
- Bitten eldest child twice on the finger/hand while sitting on the sofa.
- Snapped at a random child at a cricket match on Saturday.
- Snapped at the owner while nuzzling on the sofa.
- History of snapping at owner during a dog play interaction a couple of weeks ago.
- Instantly comes out of the snapping behaviour and tries to apologise.
- History of hierarchy/anxiety issues at 7 months old, returned to the breeder for retraining approximately 2 years ago and has been good since.
- Increased itchiness noted over the past 1-2 weeks (owner rates 3-4/10), with evidence of licking on top of feet and some interdigital irritation.
- Intermittent sore on the left front paw pad stopper pad dorsally which seems to heal and then recur.

Otherwise eating drinking,urinating and defaecating normally,No known vomiting or diarrhoea

Owner has no other concerns

**Recent medication:**
- Currently on probiotic powder (Pets Park) added to kibble.
- Intermittent use of steroid cream on front paws.
- Ear drops applied after beach visits.
- NexGard monthly.
- Milbemax every 3 months.
- Vaccinations due April.
- Diet consists of fresh food and kibble.

**PRIMARY PROBLEM:**
Sudden onset of reactive/aggressive snapping and biting behaviour.

**EXAMINATION** Muzzled

Hydration normal,mm=pink,CRT=normal
**Eyes: **NAD
**Ears**:Clean bilaterally, no significant irritation.
**Nasal exam:**NAD
Oral exam
**     -Dental grade**: NOT assessed as muzzled 
**     -Dental conformation:** 

**Lung auscultation:** NAD, no dyspnoea present

**Cardiac auscultation**: NAD, Heart rate appropriate and regular, no arrhythmia,HR=PR,femoral pulses strong and synchronous

**Murmur auscultated**:no murmur present

**Abdominal palpation:**relaxed and comfortable on cranial abdominal palpation,no pain response

**Integument:**
- Evidence of licking on top of feet.
- Some interdigital irritation noted.
- Left front paw has a thickening  on the large pad laterally and dorsally wears down when walked on concrete ( like a callus), sensitive to touch, and is more red than the right paw.

**Ectoparasites:** none seen,tick search negative

**Musculoskeletal:** orthopaedic exam nad,ambulating well

**Neurological assessment:** nad

**Lymphatic system:**all peripheral lnn palpate normally with regards to size

**Urogenital system**:NAD

**Rectal palpation**:none performed

**Anal sac**: not examined

**ASSESSMENT**:
1. Reactive/Aggressive Behaviour: Sudden onset of snapping/biting, with 4 instances in 3 days. Three of these incidents occurred on the sofa. Possible contributing factors include foot irritation, pruritus, and potential thyroid dysfunction. The behaviour was more reactive with the female handler and during examination of his feet.

2. Pruritus/Allergic Dermatitis: Owner reports itchiness as 3-4/10. Foot licking and interdigital irritation are present.
 Paw Pad Callus: Intermittent abrasion on the large pad of the left front paw, sensitive to touch.

**PLAN**:
1. Reactive/Aggressive Behaviour:
- Blood test (TAHP including T4) performed to investigate potential underlying medical causes like thyroid dysfunction. Results expected by Wednesday.
- Behavioural training recommended.
- Medication options, including CBD oil, were discussed if requiredvs fluoxetine- will need behavioural training. 
- The option of rehoming via a cocker spaniel rescue was discussed if the behaviour cannot be managed.
- Euthanasia was discussed as a last resort if behaviour escalates and household safety cannot be maintained.
- Owner advised to keep Leo off the sofa.
- Utilise crate training and ensure he has his own bed/space.
- Advised to keep children away from his personal space.
- Monitor for improvement or deterioration in behaviour.

2. Pruritus/Allergic Dermatitis:
- Trial of Zenrelia (1.5 tablets daily) for 14 days to manage itchiness.
- If no improvement after 1 week, advised to apply Barazone (leave-on conditioner) to wet feet.
- Recommended switching to CalmCare (Purina ProPlan) probiotic once the current supply is finished.
- Discussed potential investigation of dietary allergens if an allergy is confirmed.
- Advised to monitor weight as he is slightly overweight.

3. Paw Pad Abrasion:
- Recommended applying coconut oil to the paw pad.
- Advised to avoid using cortisone on the open wound.

Follow-up scheduled for a 2-week recheck to assess itch and behaviour. The owner will be contacted with blood results by Wednesday. If Zenrelia is effective and behaviour improves, a recheck may not be necessary. If no improvement, the plan is to proceed with behavioural training +/- medication. Advised to contact the clinic if concerns escalate or further biting occurs.