C10014274 / invoice 10000

Appointment Reason: 1.1 CONSULT 1, Appointment Notes: Medication review and script for apoquel LG left vm/sms sent - KAGSubjectivePresenting Concerns:-   Marlee presented for a medication review due to pruritus not being fully controlled on Apoquel.  Historical Conditions:-   Received a Cytopoint injection in July 2024.  Diet/Appetite:-   Eating and drinking normally. A recent transient decrease in appetite resolved after reducing treats.  Skin & Coat:-   The owner reports ongoing scratching, particularly in the mornings.  Current Medications:-   Apoquel 5.4 mg, one tablet SID.  Additional Information:-   The owner reports cleaning the AS due to discharge.ObjectiveMentation: BAR  Wt: 10 kg  BCS: --/9  T: Not taken  P: 104 R: sniffMM: pink/moist. CRT < 2sec.  Hydration: Normal    Emotional Assessment: FriendlyEyes: Clear. No discharge or erythema OU.  Ears: Both ear canals are gunky, particularly the left.  Nose: Clear, moist without discharge.  Throat: No inducible cough upon tracheal palpation; no palpable masses.  Oral: No masses or other lesions.  Cardiovascular: No murmurs or arrhythmias, strong synchronous pulses.  Respiratory: Normal bronchovesicular sounds bilaterally.  Abdominal: No organomegaly or mass effects. No pain on palpation.  Lymph Nodes: No peripheral lymphadenopathy.  Integumentary: No evidence of ectoparasites, full coat with clear skin.  Neurologic: No ataxia, normal mentation.  Musculoskeletal: Ambulation normal, no lameness observed.  Urogenital: Normal external anatomy.  Rectal: Not performed.    Point of Care Diagnostics:-   Ear Cytology:-   AD: No significant findings.-   AS: Increased yeast and bacteria.AssessmentAtopic Dermatitis - Pruritus is inadequately controlled on the current dose of Apoquel.  Otitis Externa, AS - Secondary yeast and bacterial infection confirmed on cytology.PlanMedications/Treatments:-   Cytopoint 20 mg injection was administered SQ.-   PMP ear ointment was dispensed. 1ml to left ear TWICE daily for 7 days - recheck 7-10 days-   If pruritus is not controlled within 24-48 hours, the owner was advised to contact the clinic for an Apoquel Rx.  Additional Discussion:-   Treatment options were discussed, including increasing the Apoquel dose versus administering Cytopoint. The owner elected for Cytopoint after discussion with his wife.-   The cost of the Cytopoint injection ($217.55) was discussed and approved.    Vital Signs    Weight: 10;