C10008902 / invoice 10000

Reason: Chewing PawsAppointment Notes: Overdue remindersVerified: NoHISTORYPresenting for: Poppy presented for examination of paw chewing, particularly affecting the right foot.Historical Conditions: Known allergiesSkin: History of paw chewing, previously affected multiple paws but now localised to right foot. Owner reports increased pruritus causing persistent licking/chewing of the affected area.Current Meds: Bookworm tablets, new flea tablet administered on the 4th (monthly), Apoquel once daily, Pyohex cleaning of feet, Isaderm cream application to affected areaOther: Weekly bathing with Alacid up to mid-limb for 10 minutes. Current E-collar (15cm) ineffective as patient can manipulate it to access foot. Patient sleeps under bed and has learned to flatten E-collar to fit underneath.EXAMBehavioural: Cooperative during examination, some resistance to restraint for treatmentEyes: No abnormalities notedEars: Otoscopic examination performed - ear canals clear bilaterally, tympanic membranes visualised and intact, no erythema, discharge or pain on palpationOral: Lips examined - no discharge, erythema or signs of lip fold dermatitisIntegumentary: Right foot showing localised inflammation and swelling with mild discharge present on dorsal aspect. Hair trimmed from affected area, cleaned with antiseptic solution, some adherent hair removed from lesion.ASSESSMENTFocal pododermatitis right foot - mild bacterial infection with ongoing inflammation secondary to chronic licking/chewing behaviourPLANNew Meds/Tx:- Larger E-collar provided to prevent access to affected foot- Isaderm cream to be applied once to twice daily to affected area- Continue current Apoquel once daily, may increase to twice daily temporarily if pruritus becomes severeAdditional Discussion:- Hair around lesion trimmed and area cleaned and treated in clinic- Advised 7-day resolution timeframe with appropriate compliance- Current weekly Alacid bathing routine to continue    Vital Signs    Weight: 8.7;