C10004537 / invoice 10000

HISTORY
Chewing at feet and scratching at ears.
Otherwise eating, drinking, toileting well. Is also overdue for heartworm prophylaxis.
Owner feels Cytopoint doesn't work very well

EXAM
HR 88, no murmur
RR clear lung fields
MM pink, CRT <2s
Abdomen relaxed, no pain/obvious masses.
Eyes clear
Ears mildly erythemic but minimal discharge
Skin erythemic on pinnae and interdigital spaces, pedal aspect

PLAN
- Cytopoint 50mg given (40mg + 1/2 20mg vial given, can combine 20 + 30 next time)
- Offered HW antigen testing, declined today
- Proheart injection given
- Dispensed Cortavance to spray on feet if irritation continues
Client Comms:
- prev history noted last Cytopoint was in October 2025, and alerted owner to frequency of Cytopoint (up to every month) which may explain reoccurring signs.
- discussed novel protein diets to rule out food sensitivities
- discussed referral to dermatologist if wanting to investigate allergic cause
- discussed Apoquel vs Cytopoint - owner elected for Cytopoint as injection more convenient.
- discussed leptospirosis vaccination, owner declined for today.

Repeat osurina Right ear
Ear looks good 

surgical wound tiny (2-3 mm) pink area cranial wound feels like where knott would be , 
no concern just watch
wound apposition great 
no discharge
dog clinically well;