C10008277 / invoice 10000

recheck
in wellness room please 
Person () 
Insurance ()
Reminders ()
Preventatives ()

owner: Paul
Vet: RF

**HISTORY**

Owner reports: Ears cleared up with prednisolone treatment. Skin healed well. Developed urinary incontinence on full dose prednisolone - reduced to half tablet once daily with approximately 20% improvement in incontinence. New onset tremors/shaking since starting prednisolone - occurring at rest and during sleep. Long-standing diarrhoea present.

Otherwise eating drinking, urinating and defaecating normally, No known vomiting or diarrhoea

Owner has no other concerns

Recent medication: Prednisolone 20mg - started at 1 tablet daily, reduced to half tablet daily due to urinary incontinence,Neptra

PRIMARY PROBLEM: Otitis externa resolved, allergic dermatitis resolved, prednisolone side effects (urinary incontinence, tremors), chronic diarrhoea

**EXAMINATION**

oto exam left and right=nad,both TM's intact,no eryhtema

mild scabbing dermatitis-multifocal affecting ventral abdomen and inner thighs resolved

Hydration normal, mm=pink, CRT=normal
Eyes: NAD
Ears: Otoscopy NAD bilaterally, ear swab cytology - no evidence of infection, otitis resolved
Nasal exam: NAD

Oral exam
- Dental grade:0
- Dental conformation:

Lung auscultation: NAD, no dyspnoea present
Cardiac auscultation: NAD, Heart rate appropriate and regular, no arrhythmia, HR=PR, femoral pulses strong and synchronous
Abdominal palpation: relaxed and comfortable on cranial abdominal palpation, no pain response
Integument: NAD, non pruritic
Ectoparasites: none seen, tick search negative
Musculoskeletal: orthopaedic exam nad, ambulating well
Neurological assessment: nad
Lymphatic system: all peripheral lnn palpate normally with regards to size
Urogenital system: NAD
Rectal palpation: none performed
Anal sac: not examined

**ASSESSMENT**: Otitis externa resolved following prednisolone treatment. Allergic dermatitis resolved. Prednisolone side effects - urinary incontinence and tremors. Chronic diarrhoea - suspected dietary protein intolerance, differential includes infectious cause.

**PLAN**:
- Taper prednisolone: quarter tablet once daily for 7 days, then quarter tablet every second day for 7 days, then cease(will stop course completely in 2 weeks)
- Start hypoallergenic diet trial (Royal Canin Anallergenic) - feed exclusively for 6-8 weeks, no treats or other food
- Consider faecal PCR testing if no improvement after 2 weeks of diet trial as owner feels picked up after camping trip several months ago
- Remove irritant plant from yard (green and purple plant)
- Recheck in 4 weeks
- Revisit as needed if diarrhoea worsens, tremors worsen, or skin flares