C10010461 / invoice 10000

Reason: RecheckAppointment Notes: khObjective: Skin good todayTape prep negAssessment: Malassezia secondary to allergies, has resolvedRecommend ongoing..Food trial anallergenic/crocodile 6-8 weeksMalaseb 1-2x/week + pyohex conditionerCytoopint as needed for pruritis    Vital Signs    Weight: 5.6;       

Reason: RecheckAppointment Notes: khSubjective and history: Had yeast around his mouth. Is a lot less itchy than he wasAlways scratches, but got a lot worse and more red around mouth before cytopoint/fluconazoleObjective: Tape prep - odd malassezia onlySkin okTreatment: Fluconazole 50mg sid 2 more weeksDiscussed malaseb/pyohex conditionerConsider repeat cytopoint. Food trial ideal if ongoing.    Vital Signs    

Reason: Paw And Mouth Red, InfectionAppointment Notes: khSubjective and history: Suspect cough resolved, possibly heard this morning O has been away for the last 2 weeksBefore O left him was red around his mouth, now worseHas been licking at feet, O has prev mentioned Milo has been itchyEDDU okObjective: BAR, nervousBCS 3/5MM pink, CRT <2secHeart/chest ok, no murmurAbdo okSalivary staining all 4 paws and around uzzleMild erythema lateral muzzle. No deep skin folds or ulceration. Laboratory: STT muzzle: malassezia +++STT feet: malassezia + (sparse)Assessment: Malassezia dermatitis across lip folds, suspect underlying allegic dermatopathy (contact, other)Treatment: 1. Fluconazole 50mg PO SID 2 weeks2. Cytopoint 10mg SQDiscussed malaseb but will be too hard to wash feetPlan: Recheck skin 2 weeks    Vital Signs    Weight: 5.4;