C10005631 / invoice 10000

History:Presenting for worsening licking of paws over 2 weeks, especially L hind paw. O reports also licking both front paws but is constantly licking and chewing L hind paw. Currently still on immunotherapy but would become flat for a day after the injection. Dermatologist said not to worry about this. O thinks immunotherapy may not be working as well now since paw chewing is coming back. Tried cytopoint 6 months ago - worked well. O unable to keep topical ointment on as Mia would lick it off straight away. Otherwise EDDU normal.Physical examination:Saliva stains on front paws and hind L paw. Very sensitive L hind paw. Erythematous interdigital space of L hind paw.No signs of inflammation in ears.See tab for rest.Sticky tape:- Front paws: ++cocci, +yeast- L hind paw: +++cocci, +yeast- R hind paw: +cocci but no yeastAssessment:Bacterial dermatitis of interdigital spacePlan:Cytopoint 10mg injection today, consider 1-3 monthly regular injections on top of immunotherapy.Cephalexin 200mg BID for 3 weeks, to be rechecked in 2 weeks as should be continued for 1 week after resolution of clinical signs.Terbinafine 250mg SID for 3 weeks.RC in 2 weeks.    Vital Signs    Weight: 9;       MMColour: Pink;       HeadEyes: Normal;       Nose: Normal;       Skin: Abnormal (saliva stains on front paws and hind L paw.);       MusculoSkeletal: Normal;       Ears: Normal;       Neck: Normal;       LymphNodes: Normal;       Heart: Normal;       Lungs: Normal;       Abdomen: Normal;       RectalGenetalia: Normal;       Demeanour: BAR;       Gingivitis: 0;       Calculus: 1;       Observation: Normal;       HeartRate: 120;       BodyScore: 5;       DentalGrade: 1;       CRT: Less than 1;