C10007538 / invoice 10000

Reason: Skin / InjectionHistoryPresenting Concerns:-   Kai presented for a recheck regarding recurrent pruritus.  History Updates:-   The owner reports that itching has started again.-   Stool quality has been more formed in the last 2 days.-   He is tolerating Vitamin B12 capsules well.-   The current diet is Hill's Gastrointestinal Biome with a small amount of turkey.-   Intermittent stiffness and hind limb wobbliness are still observed.-   Gabapentin is administered as needed for calming.ExaminationMentation: BAR  Wt:35.2  BCS: 4/9  T: Not taken    Emotional Assessment: Anxious during the visit; shows a strong aversion to injections.    Physical exam limited to the following areas today:  Integumentary: Pruritus reported.  Musculoskeletal: Owner reports intermittent stiffness and hind limb wobbliness.AssessmentPruritus - Consistent with atopic dermatitis. Transitioning from INJ to oral therapy to reduce patient stress.  Chronic enteropathy - Improving, with more formed stools on the current diet and Vitamin B12 supplementation.  Musculoskeletal stiffness - Intermittent signs reported, managed with gabapentin as needed.TreatmentMedications/Treatments:-   Discontinue Cytopoint injections.-   Start Apoquel 16mg : Give 1 tablet BID for flare ups , then 1 tablet SID. Dispensed 10 tablets.-   Continue current diet, Vitamin B12 capsules, and gabapentin as needed.  Additional Discussion:-   The change to oral medication is to avoid the stress associated with injections. If this approach is not successful, the plan is to return to INJ therapy.-   Financials were discussed: the cost of 10 tablets is $66, while the injection is $230.    Vital Signs