C10011334 / invoice 10000

Reason: Sore At The Back Of The Foot.Appointment Notes: Overdue remindersHISTORY:  Presented for assessment of an acute, large, sore lesion on a back leg. The owner reports the lesion appeared very quickly, as there was nothing present when bathed on Sunday. The lesion was reportedly moist yesterday but has dried significantly today and is now scabbed over. The owner described the appearance as dramatic and initially suspected a burn. Bella has a history of skin issues which have been well-managed on medication from a specialist, although she still gets minor sores under her arms. This is the first time a lesion of this nature has occurred. She is prone to getting moist skin. Current meds: Apoquel 1 tablet once daily, prescribed by Melbourne Bulldog Clinic for management of skin allergies.Vaccination: Not mentionedParasite Prevention: Not mentionedPre-existing conditions: Atopic dermatitis, previous BOAS surgery.Access to toxins eg. Rodenticide: none EXAMINATION:Body Condition Score: 7/9Pain Scale (0-4): 1/4Hydration status (%): hydration clinically adequateCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findingsMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:Oral: normal, no mouth pain, dental score (1-4): not gradedAbdominal: no detectable pain on abdominal palpationRectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: A large, dry, scabbed lesion is present on a back leg. The lesion is not actively oozing. The underlying skin is inflamed. A sample was taken for cytology. Mild skin fold dermatitis was also noted.Lymph Nodes: NSFEyes: NSFDemeanour/Behaviour: Quiet but tolerant of examination. PROBLEM LIST:1. Acute moist dermatitis/pyotraumatic dermatitis vs. possible contact burn on back leg.2. Overweight (28kg).3. Mild skin fold dermatitis. DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Acute moist dermatitis (hot spot).Contact/thermal burn. DIAGNOSTICS:A surface cytology sample was taken from the skin lesion. The impression smear shows the lesion is healing well and does not appear to require systemic antibiotic therapy at this stage. ASSESSMENT:Bella presented with an acute, large, and dramatic-looking skin lesion on her back leg, consistent with acute moist dermatitis (hot spot), though a contact burn cannot be ruled out given the rapid onset. The lesion has progressed well and is now dry and scabbed, indicating it is healing. Examination revealed she is also significantly overweight at 28kg, which is likely exacerbated by a lack of exercise due to hot weather. Mild skin fold dermatitis is also present. The current management with Apoquel for her underlying allergies appears to be helping, but a flare-up has occurred. TREATMENT:  A topical antibacterial gel was dispensed to be applied lightly around the area if it remains red after washing, or if she seems itchy. PLAN:The owner is to wash the affected area to remove scabs, pat it dry, and allow it to air.Apply the dispensed antibacterial gel lightly if the area remains red or irritated.Increase Apoquel to twice daily for a few days if she becomes itchy, then return to once daily.Continue weight management efforts, including a strict diet (chicken and biscuits, no snacks) and increasing walks as the weather cools down.Home into owner's care. CLIENT COMMUNICATION:Discussed the nature of the skin lesion, likely being a "hot spot" which can appear very rapidly in predisposed dogs, especially in humid weather. Advised that it is healing well. Instructed on cleaning the lesion, letting it dry, and applying the provided gel if needed. Advised to increase Apoquel to twice daily for a short period if pruritus is observed. The importance of weight loss was reiterated, aiming for a reduction from her current 28kg by controlling diet and increasing exercise. Discussed that while the lesion looks dramatic, it is superficial and responding well to drying out. Reassured owner that the current state is positive and that continued cleaning and drying are the most important steps.    Vital Signs    Weight: 28.5;