C10013289 / invoice 10000

biting at the legs

History:
Reason: Increased scratching and chewing at legs
Diet: Light & Hock or Leaks and Bounds, plus Pitman's direct food, bone nightly
Preventatives: Bravecto once monthly (up to date)
Medications: nil
EDDU: normal
Coughing/Sneezing: no
Vomiting/Diarrhoea: no
Current Diagnoses: nil
Hx:
Owner reports Cleo has been scratching more over the past week since moving to Jimmy Fall. Initially thought colour changes might be winter coat coming through but noticed she is chewing at her legs, particularly through the front legs and under areas. No fleas visible. Dog sleeps in crate with cat that teases her. Owner has been bathing more frequently with cheap shampoo, no conditioner used. Bathing twice weekly, other times just hosed off. Weight approximately 25kg, has two sisters that are 32kg each. Dog does obedience training, good around other dogs but gets upset when restrained. Owner brushes few times weekly with undercoat rake and surface brush. Lives on one acre property where dog runs around. Currently giving fish oil supplement.

Examination:
DEMEANOUR: friendly -noodle, very mouthy
MENTATION: BAR
GENERAL: BCS: 5/9; HR:100 ; RR:pant ; MM: p,m; CRT: <2; T: not taken
EARS: no discharge, swelling or erythema
EYES: no discharge or erythema
NOSE: no discharge
ORAL: no discharge or halitosis; /4 dental disease
CV: unable to ausculate due to panty
RESP: clear bronchovesicular sounds on all fields with normal effort
ABDO: comfortable; no palpable abnormalities
UROGEN: no discharge or swelling
MSK: normal gait
NEURO: no gross abnormalities
DERM: erythema and chewing lesions on front legs and ventral areas, some bacterial infection present
LYMPH: no peripheral enlargement
RECTAL: not assessed

Problem list:
Pruritus with secondary bacterial infection

Diagnostics:
nil

Assessment:
Allergic dermatitis with secondary bacterial infection - likely atopic dermatitis (environmental allergies)

Client Communication:
Discussed that this is most likely atopic dermatitis (allergic to environmental allergens like pollen, dust, grass). Could potentially be contact allergies or food allergies (10% of cases). Food allergy diagnosis is complicated and would require food trial if other treatments unsuccessful. Discussed use of steroids short-term to break itch cycle but not recommended long-term in young dogs due to side effects. Mentioned Cytopoint injection as alternative - monthly injection that blocks itch receptors, approximately $170 with insurance likely to cover. Also discussed Apoquel tablets as another option. Recommended medicated shampoo twice weekly with oatmeal conditioner, wiping down with wet cloth after being outside to remove allergens. Fish oil supplementation recommended. Topical steroids discussed for localized areas. Mentioned dermatologist referral and allergy testing as gold standard but expensive and uncommon.

Treatments:
Prednisolone dispensed - 20mg PO SID for 7 days

Plan:
- Prednisolone for one week to break itch cycle
- Medicated shampoo twice weekly 
- Oatmeal conditioner
- fish oil supplementation - 1000mg SIDto start
- Wipe down with wet cloth after outdoor activity
- Monitor response and consider Cytopoint injection if pruritus returns

Discharge Instructions:
Give prednisolone as directed for one week. Use medicated shampoo twice weekly followed by oatmeal conditioner. Wipe dog down with wet cloth after outdoor activities. Continue fish oil once daily. Monitor for increased eating, drinking and urination while on steroids. Return if itching persists or worsens.

3rd puppy vacination.
tapeworm tablet.

History:
Reason: Puppy vaccination and health check
Diet: Royal Canin Maxi puppy - morning and night, approximately 200-300g per day, plus puppy bones and ice blocks for teething
Preventatives: Simparica - had free tube from puppy pack (10kg dose), due for another dose
Medications: nil
EDDU: normal
Coughing/Sneezing: no
Vomiting/Diarrhoea: no
Current Diagnoses: nil
Hx:
4 month old German Shepherd puppy presenting for routine vaccination. Owner reports puppy is doing well overall. Currently kept in fenced area at home and brought inside. Ears starting to stand up. Owner considering desexing timing - breeder advised parents have no joint issues and puppy has straight back from working line. Puppy not very food motivated, prefers attention. Owner works from home and spends time with puppy. Planning obedience training when old enough (5 months). Experiences some car sickness - was anxious on way to clinic but seemed better today compared to previous visits. Owner has pet insurance through top level coverage.

Examination:
DEMEANOUR: friendly - mouthy noodle
MENTATION: BAR
GENERAL: BCS: 5/9; HR:100 ; RR:pant ; MM: p,m; CRT: <2; T: not taken due to demour
EARS: no discharge, swelling or erythema
EYES: no discharge or erythema
NOSE: no discharge
ORAL: no discharge or halitosis; /4 dental disease
CV: no murmurs or arrythmias
RESP: clear bronchovesicular sounds on all fields with normal effort
ABDO: comfortable; no palpable abnormalities
UROGEN: no discharge or swelling
MSK: normal gait
NEURO: no gross abnormalities
DERM: no external parasites; good coat; no lesions, pruritus or erythema
LYMPH: no peripheral enlargement
RECTAL: not assessed

Problem list:
Routine puppy vaccination due

Diagnostics:
nil

Assessment:
stable on exam

Client Communication:
Discussed desexing timing for German Shepherds - recommended waiting until 18-23 months due to breed size and joint development considerations. Explained low risk of mammary cancer and pyometra at this age. Discussed parasite prevention schedule - monthly worming until 12 weeks then can extend to 3 monthly if low risk environment. Provided puppy pack information and desexing literature. Advised puppy may be sleepy after vaccination. Provided vaccination certificate as requested.Dicussed trianined required as she will be a big dog and is very mouthy at the moment.

Treatments:
Puppy vaccination administered
Nobivac DHP SC - inbetween shoulder blades
Nobivac KC inj - inbetween shoulder blades
Simparica parasite preventative dispensed

Plan:
- Continue monthly Simparica
- Return in 1 year for annual vaccination
- Consider desexing at 18-23 months
- Puppy training when 5 months old

Discharge Instructions:
Puppy may be sleepy after vaccination. Continue current diet and routine. Return if any concerns.

2nd vacc
History:
Reason: (second puppy vaccination)
Diet: (pet mince direct - chicken and beef, some puppy purina dry biscuits)
Preventatives: (simparica trio - under 10kg gave 4 days ago)
Medications: (nil)
EDDU: (normally)
Coughing/Sneezing: (nil)
Vomiting/Diarrhoea: (nil)
Current Diagnoses: (nil)
Hx:
(Doing well, had her for 5 days. No concerns)

Examination:
DEMEANOUR: (friendly)
MENTATION: (BAR)
GENERAL: BCS: (5)/9; HR: (100); RR: (30); MM: p,m; CRT: <2; T: (38.5)
EARS: no discharge, swelling or erythema
EYES: no discharge or erythema
NOSE: no discharge
ORAL: no discharge or halitosis; (0)/4 dental disease
CV: no murmurs or arrythmias
RESP: clear bronchovesicular sounds on all fields with normal effort
ABDO: comfortable; no palpable abnormalities
UROGEN: no discharge or swelling
MSK: normal gait
NEURO: no gross defecits noted
DERM: no external parasites; good coat; no lesions, pruritus or erythema
LYMPH: no peripheral enlargement
RECTAL: not assessed

Problem list:
(nil)

Diagnostics:
(nil)

Assessment:
(fit for vaccination)

Client Communication:
(microchip [reassignment]: (not reassigned yet - gave )
diet: (recommended a large breed puppy food)
grooming: (not discussed)
parasite prevention: (On simparica trio but gave the under 10kg dose - recommended giving her another dose and starting soem tapewormer)
vaccination: (c5)
desexing: (discussed options - o thinks they will desex at some point)
puppy preschool: (O going to get her into a class)
pet insurance: (not discussed))

Treatments:
(vaccinated with nobivac flex DHP SC; B:(2502816), E:(12-2026), L:(between shoulders)
vaccinated with nobivac BB/Pi SC; B:(2505001), E:(10-2026), L:(between shoulders))

Plan:
(vaccination due in (1 month)
worming due in (1 month)
flea/tick prevention due in (1 month))

Discharge Instructions:
(advised client of possible vaccine reactions
1 week after today is ok to socialise with friends/family whose dogs are UTD with vaccination but avoiding areas where there have been access by unknown dogs [such as dog parks, beaches etc] until after the third vaccination; puppy preschool is ok to attend usually from first vaccination as all pups are same age/risk status and taking precautions)