C10006068 / invoice 10000

Appointment Notes: Overdue reminders  ------- Sms reply: YESHistory: EDDU normally Quantum plan Mass removed Hit by car previously Part of trail removedDiet: hills dry food, some chicken, sweet potato Most days licking paws Examine:BARModerate errythema all 4 pawsGiven milpro - 2 tablets every 3monthsVerified: NoPresenting reason: Annual vaccination and health checkHistory:Details about reason for presentation: Due for annual vaccinations including Leptospirosis, Heartworm injection, and flea and tick prevention. Owner reports ongoing paw licking behaviour.EDDU: In good health according to owner, no current concerns, eating, drinking, urinating and defecating normally.Diet: Lean chicken mince with rice, peas, carrots and sweet potatoExercise: Flea/tick/worming treatment: On Quantum plan for annual coverageOther: 8 year old rescue dog. History of paw licking behaviour - licks all 4 paws daily, particularly after waking up or going outside. Owner has tried probiotics with no improvement. Previous elevated cholesterol levels noted 6 months ago.Examine:HR: RR: T: MM: CRT: LOC: BAREars, eyes, nose: no abnormalities detectedOral cavity: no abnormalities detectedRespiratory: clear lung sounds, no crackles, wheeze, normal respiratory effortCardiovasc: sinus rhythm and synchronous peripheral pulsesAbdo: soft, pain free on palpation, no mass effect or fluid wave evidentMSK: appropriate ambulation and mentationIntegument: good conditionPeripheral lymph nodes: round and symmetrical, subjectively no enlargementLaboratory tests:Problem list:- Chronic paw licking behaviour affecting all 4 paws- Due for annual vaccinationsAssessment:Suspected underlying allergy causing paw licking - likely environmental allergens (atopic dermatitis) or food allergyTreatment:- Cytopoint injection administered for anti-itch effect- Malaseb wash for paws - apply for 15 minutes, twice daily for first 2 weeks then reduce frequency- Annual heartworm injection administered- Worming tablet dispensedPlan:- Leptospirosis booster vaccination in 4 weeks (new vaccine covers 2 strains instead of 1)- Monitor response to Cytopoint injection - can repeat if effective- Continue Malaseb wash as directed- Administer worming tablet every 3 months- Consider food trial if current treatment ineffective    Vital Signs    Weight: 28.6;       MMColour: pink;       Temperature: 38.0;       HeartRate: 100;       BodyScore: 5;       DentalGrade: 0;       RespirationRate: 20;       CRT: <2;