C10006353 / invoice 10000

Reason: Follow Up On RashSeemed much better 3 days after last visit but has gotten worse again especially after reducing dose of prednisoloneO was also applying a lanolin paw balm but stopped and has gotten worse since stopping this. O reports nothing has changed in his diet, does not go for walks and no new plants in yard. Examine:BAREyes: clear, no discharge or inflammationEars: clean, no erythemaMM pink moist CRT <2secLN: WNLThorax: HR 120, no murmur, lungs clear, normal respiratory rate and effortIntegument: erythematous and dry skin distal legs from carpus/tarsus distallyLaboratory:Sticky tape prep Many cocci seen no malessezia. No mites seenAssessment:Pododermatitis - many cocci Underlying cause allergy? Vs demodecosis. Treatment:Amoxyclav 200mg 1/2 BIDCommunication:- explained should have expected a greater response to cephalexin by now if bacterial infection. Possible underlying cause still triggering problem or resistance. - not UTD parasite prevention - recommend HW test plan to do this at beginning of next visit. Recommended bravecto as effective against mitesPlan:Continue pred SID - recommended against tapering further at this stage.Recheck 2 weeks. Also recommend HW test. Consider skin scrape or C+S if still not resolving.    Vital Signs