C10013499 / invoice 10000

Appointment Notes: sore pawHistory:EDDU: normally Has been licking R paw excessively. Started limping on R paw also. Has been shaking head. Would like ears checked Noticed paw looked quite redExamine: 1. BAR2. Vitals: nad3. Body condition: 5/94. Oral exam: mild tartar canines, otherwise lovely teeth 5. Eyes: nad6. Skin / ears:- RF paw mod erythema, brown d/c build up btw digits 4-5 - CYTOLOGY: malassezia 20+/hpf- ears nad 7. Auscultation: clear, regular rhythm 8. Abd palpation: soft, comfortable 9. Palpable lns: wnl 10. Anal glands / perianal area: nadAssessment:R paw malassezia pododermatitis Treatment:None in consult Plan: 1. Letoconazole 50mg po bid 10dd 2. Pred 5mg po sid 5dd 3. mediderm wash paws biweekly for this wek 4. r/c 10dd     Vital Signs    Weight: 8.1;       

BoosterHas been well, no concerns.Protec C2i SC     Vital Signs    

Appointment Notes: vacs + earsHistory:Doing well, sometimes scratches earsNose has been ok. Has been head flicking. EDDU: NAD, no V+/D+, no PUPDPreventatives: nexgard spectra UTD Medications: noneDiet: lyka + meat and kibbleExamine: 1. BAR2. Vitals: HR/RR WNL, CT<2sec, MMpink/moist 3. Body condition: 5/94. Oral exam: very mild calculus build-up 5. Eyes: NAD6. Skin / ears: NAD 7. Auscultation: clear lung fields, no murmur/arrhythmia8. Abd palpation: soft, comfortable 9. Palpable lns: NAD10. Anal glands / perianal area: -11. MSK: ambulating well, NAD of flexion/extension of all limbs, good rom CYTOLOGYR and L ear NADAssessment:Healthy on PE- fit for vaccination Suspect underlying allergies (env vs food) vs atopy vs other Treatment:Nobivac lepto2 inj SCNobivac KC IN (discussed potential SEs incl lethargy, site reaction and sneezing)*O good to hold for injKC IN no issuesPlan: 1. Lepto2 booster vaccination in 1 month then C7 in 1 yearO declined allergy medication trial. Discussed apoquel vs cytopoint     Vital Signs    Weight: 8;