C10005910 / invoice 10000

Reason: Sore Foot + Poss Ear InfectionAppointment Notes: Overdue reminders  ------- Sms reply: YHISTORY:Ari presented for ongoing sore foot and itchy ears that have worsened. Chronic foot condition present for several years with persistent licking behaviour. Currently receiving itraconazole antifungal tablets - approximately 70 tablets into current prescription. Ear infection has recurred despite using leftover ear drops for one week without improvement. Generalised skin condition with hair loss, flaky skin, and persistent scratching under armpits. Previous mass removal from affected foot area. Interdigital lesions now present. Owner reports compulsive licking behaviour affecting foot and axillary regions.Owner concerned about thyroid function - reports runny stools and suspects thyroid involvement. Previous thyroid medication trial caused severe diarrhoea, discontinued after 1-1.5 months. Owner has been bathing 2-3 times monthly with malaseb shampoo when weather permits.Regular Vet prescribed cyclosporin concurrently with itraconazole but owner has not administered due to concerns about cancer contraindications following internet research.Current meds: Itraconazole antifungal tablets (ongoing), Neocort topical (as needed for symptomatic relief)Pre-existing conditions: Previous mass removed from leg, suspected thyroid dysfunction, cardiomyopathy risk (sibling died from DCM 3 years ago)EXAMINATION:BAR, enjoys veterinary visits, strong dog, calm during examination, dislike limbs being touched BCS: 7/9Eyes - NAD, both visual, corneas transparent, no blepharospasm or epiphora Oral - NAD, no evidence of gingivitis or calculus, periodontal disease grade 0/4Ears: Left ear more purulent discharge, right ear infectedLNS - NAD, submandibular, prescapular and popliteal lymph nodes symmetrical, normal size and consistencyIntegument: Generalised mild hair loss, flaky skin resembling dandruff, multiple small lumps throughout skin, bare patches present, very dry skin conditionCardiovascular: Heart sounds normal, no murmurs detectedRespiratory: Lung sounds clear, mild panting noted Musculoskeletal: Slight muscle mass loss in hind legs noted previously, still able to jump, ambulating normally despite foot discomfortAbdominal: Soft, no masses palpatedCytology: RIGHT: Yeast +LEFT: Cocci +++ Rods ++Skin: rods + , yeast resolved ASSESSMENT: Bacterial otitis externa (left ear) - cocci and rodsYeast otitis externa (right ear)Chronic (atopic) pedal dermatitis with interdigital lesions and secondary infection (rods)Previous malassezia dermatitis resolved TREATMENT:Easotic prescribed -  SID for minimally 7 days Apoquel 16mg chews TWO tablets BID for 7 days --> SID for maintainence Continue malaseb shampoo bathing ONCE weekly for 4-6 weeks follwed by barazone conditioner leave on (1 pump per 2 limbs) ONCE weekly (script provided) Cephalaxin script provided PLAN:Monitor response to new ear treatment protocol. Regular bathing with medicated shampoo and conditioner Discontinue current antifungal therapyCLIENT COMMUNICATION:Explained different bacterial types found in left ear requiring stronger treatment approach.  Discussed yeast infection in right ear. Arranged for Sarah to review case given her familiarity with patient's history and previous surgical procedures. Adviced regarding owner's concerns about cyclosporin safety in context of previous mass diagnosis, it can be withdrawn from current treatment plan.    Vital Signs    Weight: 53;