C10005543 / invoice 10000

Reason: Irritated Feet Appointment Notes: Overdue remindersVerified: NoHistory:Presenting for: Storm, a 5-year-old dog, presented for skin irritation on the face with nibbling behaviour and blackened areas under the face.Skin: Irritated skin on face with blackened discolouration, patient nibbling at affected areas. Owner reports sneezing episodes.Examination:Mentation: BARIntegumentary: Facial dermatitis with erythema and hyperpigmentation. Skin on belly appears abnormal. No signs of secondary bacterial infection noted on examination of feet or other areas.Cardiovascular: Heart sounds normalRespiratory: Lungs sound normalOral: Teeth appear normalAssessment:Atopic dermatitis - Environmental allergies suspected given age (5 years falls within typical 6 months to 6 years manifestation range), facial and ventral distribution pattern, and absence of gastrointestinal signs. No evidence of secondary bacterial infection currently.Plan:New Meds/Tx:- Cytopoint injection discussed - monoclonal antibody that blocks itch sensation and reduces erythema, duration 4-8 weeks depending on dose. Cost $187 plus $141 consultation fee (total $328). Client to consider and return next week if condition persists.- Oral steroids discussed as alternative short-term option, approximately $40 cost- Medicated shampoos available for skin moisturising and long-term managementAdditional Discussion:- Allergy testing and desensitisation vaccines available but not routinely recommended for most cases- Condition typically seasonal (spring/summer) and environmental allergens include mould spores, grass pollen, dust mites- Daily foot washing discussed as management optionClient Comms:- Owner to monitor condition over next week and return if no improvement for Cytopoint injection- Explained difference between environmental vs food allergies (food allergies rare and typically associated with GI signs)    Vital Signs    Weight: 14.6;