C10004819 / invoice 10000

Appointment Reason: Chewing at skinH: chewing paws, shaking earsfish oil on food. but lower quality food- chicken++did respond good initially with cytopoint but was giving apoquel in addition. E: bar, mmpink, crt <2. temp not taken.paws- red/inflammation, around muzzleears- no inflam noted, minor dischargeLab- skin cytology paws- minimal yeast/bacteria (betadine bath recent)T: Apoquel 16mg: Give 1/2 tablet TWICE daily  for maximum 2 weeks, then 1/2 tablet ONCE daily as needed.Ear cleaner weekly-fortnightly to avoid ear infectionsAllergy handout provided with options availablecontinue UTD parasite prevention.P: have option of derm referral if needed1) Diet trial if possible (anallergic/z/d) or novel protein/carb - 8-12w 2) apoquel (O said cytopoint not as good)3) add conditioner after maleseb or betadine soak  O able to pick up more apoquel and neocort next 6months.     Vital Signs    Weight: 13;