C10004581 / invoice 10000

Reason: Ear Infection JDAppointment Notes: Overdue remindersReason:History::Signalment - 7-8 year old female dog, 20 kg  Presenting complaint - Pruritus affecting the feet and ears.  Comorbidities - History of pancreatitis.  Current medications - Apoquel, Neocort cream.  Usual diet - Royal Canin Gastrointestinal Low-Fat dry food and Prime crock roll.  Current health status - Eating, drinking, urinating and defecating normally.Examination::BAR  HR - 100  RR - Pant  Temp DNP  CRT - < 2 sec  MM - Pink, moist  LN's - Mild bilateral popliteal lymphadenopathy.  Eyes - Mucoid discharge noted in the left eye.  Ears - Bilateral erythema and inflammation. Patient is sensitive to otoscopic examination.  Thoracic Auscultation - No murmurs or arrhythmias auscultated. Normal bronchovesicular sounds bilaterally.  Abdominal palpation - No pain response on palpation. No abnormalities palpated.  Urogenital - WNL  MSK - Ambulating normally for signalment.  Neuro - CN's function normal. No ataxia  Integ - Erythema of the paws, chin, and perivulvar region. Mild dental tartar and gingivitis.Laboratory::Cytological Sample Swab collected from the right ear canal.  Cytological Findings Yeast and cocci bacteria identified.Assessment::Problem 1 - Allergic skin disease  Notes/Comments - Underlying cause of otitis, pododermatitis, and likely ocular signs.    Problem 2 -  Bilateral otitis externa (yeast/cocci)  Notes/Comments - Secondary to underlying allergies.    Problem 3 -  Pododermatitis  Notes/Comments - Secondary to underlying allergies.    Problem 4 -  Mild generalized dental disease  Notes/Comments - Plaque and gingivitis present.    Problem 5 -  Mucoid ocular discharge  DDx - Keratoconjunctivitis sicca vs. allergic conjunctivitis.Treatment::Cytopoint injection administered.  Nail trim performed.Plan::Recommend scheduling a general anesthetic procedure in approximately 2 weeks for a dental scale and polish, bilateral ear flush with instillation of long-acting medication, and a Schirmer Tear Test.  Pre-anesthetic bloods to be collected at that time.  Discussed Atopica (cyclosporine) and dermatology referral as future options for long-term management.  Recommended discontinuing the Prime crock roll and using a complete low-fat prescription diet (e.g., Royal Canin GI Low Fat or Hill's z/d Low Fat).  Continue Apoquel and topical Neocort cream as needed.  Monitor for improvement in pruritus over the next 2-3 days.--- 07/03/2026 07:53:31 AM ASR:Examinations - Resolved - Follow up SMS through RxWorks sent to client.    Vital Signs