C10012929 / invoice 10000

Reason: Lumps

History:
- Presented by O today for a skin check - was initially in as a nurse cytopoint but has noticed more lumps on the rump area. Usually has one or two but has developed more.
- P has largely been doing well per O - just starting to get itchy in the last 24 - 48hrs as came up due for Cytopoint. 
- Otherwise bright and well, with no change in attitude, activity, appetite, thirst, urination or defecation per O. No V+/D+/C+/S+. 

- Vaccination status: UTD C5
- Parasite prevention: UTD Afilaria and NexGard Spectra monthly
- Known Medical Conditions:
     - Heart murmur heard previously but not since
- Current Medications/Supplements:
     - Cytopoint 20mg
     - Trazodone 100mg PO SIW when left home

Examination:
- Weight/BCS: 11.2kg
- Mentation: BAR 
- Eyes: Pupils symmetrical and even. No ocular discharge, chemosis, hyperaemia or blepharospasm noted OU.
- Ears: No inflammation or discharge noted externally AU. 
- Nose: No discharge, swelling or depigmentation noted. 
- Oral Cavity: MM pink and moist. CRT 1 -2 sec.
- CVS: 104 bpm. No murmur or arrhythmia appreciated. Pulses strong and synchronous. 
- Resp: Sniffing. Normal rate, pattern and effort. No adventitious sounds appreciated in all 4 quadrants. 
- Abdo: Soft and comfortable.No overt foreign body, mass or pain appreciated. 
- Integ: Multiple small crusts over dorsal rump/lumbar area. No other erythema, alopecia or lesions noted. 
- LNs: No peripheral lymphadenopathy appreciated.
- MSK/Neuro: No lameness or ataxia appreciated. Full neurological exam not performed.
- Temp: UTO

Assessment:
1. Known Allergies - Pruritus well controlled by Cytopoint
2. Skin Crusts - Ddx: Bacterial vs Yeast vs Fungal vs Other.
3. Previous heart murmur - not appreciated today

Treatment/Plan:
1. Has had Cytopoint with nurse today. Continue monthly.
2. Recommend cytology and then treatment as indicated - O consented. 
- Cytology from under crust: Neutrophils ++, Cocci +++, Epithelial Cells ++
Discussed cytology with O. Given neutrophils recommended topical and oral treatment. 
- Malaseb wash (10min soak) SID 1 - 2 weeks then as needed
- Cephalexin @ 22mg/kg PO BID 7d
- Recheck in 2 weeks.
3. Continue to monitor at vet visits or sooner if any noted EI, C+ or elevated RRR at home. 

Communication:
Discussed PE findings and recommendations as above. Recheck in 2 weeks or sooner if unwell/any changes or concerns. 

REASON: Cytopoint

FLEA PREVENTION: Yes     BRAND: Nexguard spectra

SCRATCHING: Yes inguinal area      CHEWING:  Yes paws      SHAKING HEAD: No 

CYTOPOINT: 20mg
Expiry:02/2027
Batch # 840616

NEXT DUE (Vet/nurse):

NURSE:ST