C10008987 / invoice 10000

WEIGHT: 20.50

WEIGHT: 20.40

HISTORY: 29 Oct 2025 04:01:43 pm KG
Presented for: Pruritic skin 
Hx: Has s history of presumptive atopic dermatitis - no food trial has been done. Skin has flared up for the past week and Ellie is pruritic on all paws, inguinal, chest and axilla regions. O reports pruritis worse in humid months. Has responded well to cytopoint in the past but has been a while since last injection. O reports had hive like welts along dorsum and back on Saturday - has been giving cirtec anti-histamines as previously instructed which has decreased these lesions. 
Breathe problems - does get fed bones, dental chews. O reports halitosis, has not had a dental procedure.  Toileting as normal, no V or D. EDDU as normal. No other concerns, no recent diet change or environmental change - O reports Ellie likes playing in a bush in the backyard. 
Diet (last meal time): Black hawk kibble, raw mince 
Vaccination & Worming status: simparica trio monthly, UTD
Medication given: none, occasionally uses neocort, malaseb and alloveen conditioner 

Physical Examination
BCS 7/9 overweight & Demeanour Bright & Responsive, friendly 
Temp: 38.4
Cardio/Respiratory: HR 128bpm no murmurs or arrhythmias noted Respiratory Rate panting  MM pink, CRT <2 seconds
Thoracic auscultation: Clear bronchiovesicular sounds
Eyes: Clear, no abnormalities, 3rd eyelid normal, conjunctiva does not appear inflamed or hyperemic. Menace and palpebral present 
Ears: Both ears clean, minimal debris, no signs of active ear infection
Integument system: Coat is clean, appears to be free of ectoparasites, focal erythemic pustules under both axilla and erythema non-raised rash in inguinal region. Erythema present between interdigital skin all paws. Urticaria x2 visible near tail base.
Lymph node: submandibular WNL, pre-scapular WNL, popliteal WNL
Dental score: 2/4 moderate calculus build up 
Abdominal palpation: Soft and comfortable, no pain on palpation, deep palpation difficult due ot large body mass
Rectal examination: not performed
Musculoskeletal examination: full exam not performed, ambulation normal
Neurological examination: full exam not perform, mentation normal
Urogenital examination: full exam not perform, NAD

Problem list: 
Pruritic skin ddx: FAD, contact allergy, atopic dermatitis, other
Overweight
Halitosis - dental disease vs fb vs infection vs other

Diagnostic plan/treatment: Discussed pruritis in dogs and went through step wise approach - FAD, contact allergy, food trial etc. Recommended food trial with novel protein such as prime 100 tapioca and crocodile roll or hypoallergenic food for 8 weeks. Discussed use of cytopoint vs apoquel - due to the degree of inflammation present would advise apoquel trial. 0.4mg/kg BID PO 2 weeks then maintenance dose dispensed, side effects discussed. INI in pruritis within the next week then represent and can trial cytopoint. Discussed if good response to apoquel to have Ellie on this for several months before trialing off it, advised some dogs need lifelong control. Dispensed more neocort to apply topically to the affected areas, malaseb (not on face as corneal toxicity) and use 1-2x weekly, continue oatmeal based conditioner. Continue antihistamines daily for a further week until urticaria lesions resolve.

Client communication: Represent INI. If good response to apoquel, O can ring up and request more to be dispensed as can legally have up to 6 months worth.