C10014396 / invoice 10000

11/03/2026 HISTORY:
Sees Vets in Torquay
Stopped Ketoconazole
Stopped immunotherapy vaccine - was an ordeal to get to the vets and also got itchy after doses
No need for anti-itch medications in past few months
Didn't feel that many of the treatments were working

Treatments in use:
Baby shampoo for feet
Ears:Elocon onto ear flaps 2 x per week
Neocort Cream - used on feet a couple days last week

Gait - may be tender on front feet

Key concerns today:
-feet

EXAMINATION:
R fore - mild staining interpad. Dorsal surfaces.
Chin - mild lip fold dermatitis R>L sides.
Ventral chin - small degeree of acne on chin

Ear flaps:inflammation ++ at the openings of the ears. 
Managed to scope the RIGHT ear not the left, really doesn't like it
Right canal = clean

Ventral abdomen and chest all ok
Perineum ok

Heart ok
LN ok
BCS 6-7/9

Samples:
-ear canals - clean/no microbes
-feet - no microbes apart from mild bacterial overgrowth
-lips and chin - yeast overgrowth



ASSESSMENT:
Not itchy at present
R fore is a minor issue
Chin and lip folds - acne will progress if itch/infection / overgrowth of microbes not controlled
Ear canals and flaps - these are going well, and the Elocon is controlling the ear infections well.

PLAN:
Treat infections
Treat itch
Continue to prevent the ear changes / scarring/narrowing and infections
Furunculosis on the chin may become a problem over time
Lose weight -not helping feet and mobility
Need to check thyroid and TSH - breed predisposed to Hypothyroid

TREATMENTS:
1. SYMPTOMS:
Ear canals: Continue the Elocon Cream  -1 pea sized bleb into ear canal openings.

Cortavance Spray - feet - 2 pumps per foot max dose.
Spray underneath.
Once daily x 10 days then 2-3 x per week.

2. INFECTIONS:
Foot dips - vinegar (apples) - 1 part vinegar + 2 parts water R fore. Mix keeps for 48hrs. Use for 2 weeks to control mild overgrowth
Allergen dilution later on after that may help to reduce the foot itch that I think is due to allergen on his feet - weak detergent solution(baby shampoo)- keep for 2-3 days. Dip the feet after walks each day

Lip folds + chin: Initially forst 2 weeks max - Hydrozole cream (antifungal with steroid) - 2 x daily then after 14 days STOP 
Then later on: Douxo S3 wipes (Vivapets) - once daily x 10 days then 2-3 x per week

Oral antifungals - if we don't feel they were working don't use them
Ketoconazole ONE capsule ONCE daily x 28 days then ONE capsule 2 x per week


3. FATY ACID THERAPY:
Fish oil - 1000mg- 3-4 capsules per day, divided (2 Am and 2 PM)


4. WEIGHT LOSS:
Recommend visit your vet and book in for a Slim-Fit program
RC Satiety food
Start with target weight of 40kg
Start with 400mgrams per day. After 4 weeks, reduce to 350 grams per day
Recommend that you do see a nurse to arrange the SlimVet program.

5. BLOOD TESTS:
Vets to run Thyroid Total T4 and Canine TSH and biochem and haematology tests

6. FOLLOW UP:
Please call me as needed.