C10005001 / invoice 10000

Reason: Check EarsHISTORY:Britney presented with ongoing skin issues affecting whole body. Owner reports continuous problems with constant licking, particularly affecting face and cheeks. Cytopoint injection given 02/02/2026 provided minimal improvement. Owner notes Britney is lethargic, lying on lounge constantly at home, not enjoying life. Previous treatments included various antibiotics, Apoquel, and Cytopoint injections with temporary relief only. Drinking and eating normally.Regular Vet diagnostics and treatments: Multiple previous antibiotic courses including Amoxiclav and Cephalexine. Cytopoint injections administered. Malaseb shampoo prescribed.Current meds: noneVaccination: Not mentionedParasite Prevention: Not mentioned  Pre-existing conditions: Chronic skin allergies, recent leg injuryAccess to toxins eg. Rodenticide: noneEXAMINATION:Body Condition Score: 5/9Pain Scale (0-4): 0/4Hydration status (%): hydration clinically adequateCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findingsMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal, no mouth pain, dental score (1-4): not graded- Abdominal: no detectable pain on abdominal palpation- Rectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: Severe ear inflammation bilaterally, ears swollen and painful, unable to examine properly. Generalised skin irritation and inflammation affecting feet and faceLymph Nodes: NSFEyes: Slight grey lens changes noted, Pigmentation changes on both eyes noted due to constant irritation by nasal folds Demeanour/Behaviour: Lethargic at home, not active at home, here BARPROBLEM LIST:Chronic allergic dermatitis with secondary bacterial infectionSevere bilateral otitis externaLethargy and reduced quality of lifePossible early lens changesDIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Chronic allergic dermatitis with secondary bacterial infectionBilateral otitis externa secondary to allergic skin diseaseDIAGNOSTICS:NoneASSESSMENT:Britney presented with chronic allergic dermatitis affecting generalised areas including private parts and face, with secondary bacterial infection. Severe bilateral otitis externa present with significant inflammation preventing proper examination. Previous treatments including Cytopoint, Apoquel, and multiple antibiotic courses have provided only temporary relief. Owner reports significant impact on quality of life with lethargy and reduced activity. Weight recorded at 13kg. Chronic skin condition requiring ongoing management with combination therapy.TREATMENT:Cytopoint injection administeredDoxycycline prescribed - 1.25 tablets once daily with food for 2 weeksMeloxicam still at home: give vor the next 4-5 days for pain relief - once daily with food for 4-5 daysEar drops prescribed for use in  a few days when ears not as swollen anymoreContinue Malaseb shampoo weeklyFish oil supplement recommended as skin barrier support (Blackmoor's Fish Oil Pet Barn)PLAN:Monitor response to doxycycline over 2 weeks, possible extention neededIf adverse reactions occur (particularly black faeces), discontinue and contact clinic Begin ear drops when ear canals are less swollen shutContinue Malaseb shampoo weeklyAdd fish oil supplement for skin barrier supportRecheck if ears do not improve within one weekLong-term management likely required with periodic antibiotic courses for bacterial flare-ups and constant anti allergy treatment. Consider dermatology referral if current treatment plan unsuccessfulCLIENT COMMUNICATION:Owner advised regarding chronic nature of allergic skin disease requiring ongoing management. Explained that periodic bacterial infections will likely recur requiring antibiotic treatment. Discussed proper administration of medications with food to prevent gastrointestinal irritation. Owner instructed to contact clinic immediately if black faeces develop with doxycycline. Advised to wait until ear inflammation reduces before starting ear drops due to current pain levels. Discussed financial constraints regarding specialist referral. Owner understands treatment plan and monitoring requirements.    Vital Signs    Weight: 13;