C10004392 / invoice 10000

09/03/2026 HISTORY
- Chronic ear problems- now resolved 
- Recent chewing on paws- worse Right back 
- Rash on belly towards groin, appeared 2 weeks ago
- Use of eczema cream and Neocort on abdomen with good results 
- Lip fold dermatitis, history of bacterial and Malassezia infections
- Environmental allergies - suspect atopy causing skin inflammation
- here for health check feet / abdomen / before owner goes on holidays 

EXAM
Ears: No infection observed- not red or in, samples taken for further analysis
Abdomen: Secondary bacterial infection noted
Skin: General inflammation due to allergies, use of Neocort has been beneficial

DIAGNOSIS
- Allergic dermatitis with secondary bacterial infection on abdomen
- Lip fold dermatitis with historical bacterial and Malassezia infections

PLAN
1. Administer Cytopoint injection to manage allergies and prevent secondary infections
2. Continue application of Neocort on affected areas
3. Use Malaseb shampoo specifically on the abdomen, not the whole body
4. Chlorhexidine spray to be used between washes for antibacterial care
5. Recheck after the owner returns from travel in 4 weeks | 19/12/2025 BIB wife. Using squalene solution by syringe every second day and spray (?cortavance) 
Rod away until friday.

Ears -
no inflammation, L ear full of white cream. R ear clear.
Microscopy - both ears - yeast 5-10/hpf, occasional neutrophil.

Lip folds - nsf, healthy.

Assessment -
1/ Bilateral OE - Yeast persisting.

Plan -
1/ Rec oral itraconazole trial
2/ Rod has expressed financial constraints in the past - adv I will call Rod to make plan together prior to writing script / dispensing more meds

19/12/2025 NH spoke to Rod, line was not great, explained yeasts are persisting and my concern that ears will flare up again soon if treatment is stopped. Suggested trying itraconazole orally to see if we can further reduce numbers of yeasts. O expressed he would like to contact Guide Dogs to see if they have other ideas as he does not wish to continue 'pumping her with medications', also would like to seek advice of Robert Zammit who treated his dogs 10 years ago. Rec referral to dermatology team at SASH for further adv. O will consider. O to pls let us know when he makes appointment so we can forward our notes.