C10014704 / invoice 20000

Appointment Notes: ------- Sms reply: YESRecord Entered by: Vet student Jiwon Youn (DVM4)  Record Checked by: Dr Brooke McKeever 06-03-2026 BIOSECURITY STATUS: White  PRESENTING COMPLAINT: itchy ears and paws HISTORY: SPECIFIC HISTORY: Hugo 5yo MN Labradoodle presented for recurrence of pruritus in ears and hind paws. Presentation 06-03-2026: Hugo has a history of atopic dermatitis managed with cytopoint injections. Since yesterday afternoon owner noticed Hugo is scratching ears a few times and shaking his head which was unusual. Also started chewing on both hind paws. Owner thought the ears appeared very red and with small amount of blood. After noticing the scratching, owner cleaned the ears once at night. Hugo has a history of allergic dermatitis and otitis external since 2022 which has been managed with food elimination trial and medications when required, and the most recent treatment was in December 15, cytopoint 10mg injection which was shown to be effective. Owner also reported scooting a few times over the week. Today owner wishes to get another cytopoint injection today.  NON-SPECIFIC HISTORY: LIFESTYLE: Indoor & Outdoor, daily afternoon walks. BEHAVIOUR ISSUES: At Vet - very nervous and shaking, reluctant to move, tends to freeze and hide. No aggression.  OTHER PETS: none DIET: mostly red meat (partially cooked), minced meat, boiled veges (sweet potato) Previous history: 2022 - Visited Annandale. Chewing front paws. Treated with pyohex ointment.2023 - Ear painful, revealed otitis externa, Malassezia. Treated with PMP 14 days, Malaseb/Pyohex twice weekly. 2024 - Paws smell yeasty, treated with dermotic BID 2 weeks or until no smell and no discharge. 14/07/25 - UVTHS. Pruritus and otitis externa never resolved at previous vet. Chewing both hind foot, itchy L ear. Itch scale 6/10. Bilateral malassezia otitis externa (yeast++++), more on R ear. Also yeast in hindleg interdigital space (DDx atopic dermatitis, cutaneous adverse food reaction). Started on prednisolone tablet course, also easotic ear suspension for both ears SID 5 days. 24/07/25 - Recheck on itchy ears and chewing paws. Tapering off pred. Easotic ear suspension was also effective. Gave cytopoint 10mg SC (which had effect for 4-6 weeks).26/09/25 - vaccination. Informal food elimination trial was done by O, attempted to exclude chicken, but not strict and was discontinued before the recommended 6-8 week duration. O reported that pruritus signs appear seasonal, flare-ups most notable in Feb, then April to July. Occasional "bunny hops", has Hx of medial luxating patella (grade 1), with intermittent morning stiffness when rising. Advised to try strict 6-8 week food elimination trial (chicken). If pruritus persist/worsen during trial, can do cytopoint injection post trial. 15/12/25 - Pruritus recurred today and licking. Recently scratching ears. Cytopoint was in July, and didn't need it since. Have cut out chicken, once given last week. Before last week, scratching seen twice a week. Gave cytopoint 10mg SC. 06/03/26 - Pruritus recurred yesterday, scratching and shaking ears, chewing hind paws. Scooting. Record is written in specific history section. CURRENT OR RECENT MEDICATIONS: Cytopoint APPETITE,THIRST,COUGHING ETC: EDDU all normal and consistent. No coughing or sneezing, vomiting or diarrhoea.  VACCINATION: UTD with all: C3 due 04/10/27  (Duramune C4 + oral BB given 04/10/24) KC due 26/09/26 (was given 26/09/25) Lepto-2 due 02/07/26 (was given 02/07/25) PARASITE PREVENTION (incl. Compliance): UTD with Bravecto likely, O doesn't know exact product and he isn't usually the one in charge of parasite preventions. (previous record mentioned Bravecto and Drontal q3months) PHYSICAL EXAMINATION:WEIGHT: 						6.7 kgFAS SCORE  /5: 					2/5MENTATION: 						 QAR HR:                                                     	120bpmPULSE QUALITY:                            	strong, synchronousRR:                                                     	not measured, shaking TEMPERATURE:            	            		not measured   INTEGUMENT:                              		Abnormal - Caudal ventral abdomen and inguinal regions are erythematous, there are multiple well circumscribed epidermal collarettes, associated curst and scale, small amount of puruent discharge. Interdigital spaces of hind paws were mildly erythematous but not to a noticeable degree. No parasites. Otherwise healthy coat and skin. CIRCULATORY:              	            	Normal - MM pink and moist, CRT <2sec, no heart murmurs or arrhythmias, femoral pulses strong and synchronous. RESPIRATORY:               	           	Normal -  No wheezing or crackles, normal bronchovesicular sounds bilaterally.DIGESTIVE:                                     	Normal - No palpable abnormalities on superficial or deep palpation of the abdomen. Comfortable on palpation.Oral Cavity:                 	                        Normal - Mild-moderate calculus and gingivitis.GENITOURINARY:                        		Normal - No discharges from prepuce. Desexed animal. Bladder small and comfortable, kidney palpation unremarkable.MUSCULOSKELETAL:                  		Normal - No lameness or ataxia appreciated. Full MSK exam not performed. NEURAL:                                          	Normal, appropriate mentation, full neuro exam not performed. LYMPH NODES:             	            	Normal - Submandibular, prescapular, inguinal and popliteal lymph nodes symmetrical and normal size and consistencyEYES:                                                 	Both visual, corneas transparent, no blepharospasm or epiphora EARS:                                                	Abnormal - Both ears erythematous, inflamed (narrowed canal), malodorous and there was purulent discharge present in the left ear canal and moderate ceruminous discharge present in the right. Responds to auditory stimulus. BODY CONDITION SCORE:        	5/9 IN-HOUSE DIAGNOSTICS:Ear swab cytology (diff-quik stain): - Right ear: >20  malassezia per high power field, 2-3+ cocci.- Left ear: Abundant rods++++Inguinal skin tape prep cytology (diffquik stain): - aggregated neutrophils+++, cocci 2+. No yeast.  ASSESSMENT:Problem list:1. Ears pruritus, with mixed bilateral otitis external associated with cocci, rods and malassezia infection - Likely secondary to Atopic dermatitis 2. Pruritic hind paws - DDx: Environmental atopic dermatitis, with possible underlying food allergy (chicken) 3. Caudal abdomen and inguinal superficial pyoderma- Description: erythematous, epidermal collarettes with crusting, mild pus- DDx: Likely secondary dermatitis from the concurrent atopic dermatitisIn accordance with the new dermatology guidelines, topical therapy has been recommended - chlorhexadine based medicated shampoos and Silver Ssulfadiazine cream. 4. Full anal glands (scooting) Include your clinical impression of the animal: Hugo appears clinically well, no pruritus was observed in consult but head shaking was noted. With the recent recurrence of pruritus of ears and hind paws, it is likely that the atopic dermatitis has been ongoing and the effect of the previous cytopoint injection has worn off. Underlying food allergy is less likely as Hugo has been strictly off of chicken the past few months, however not completely ruled out. Major clinical signs were the erythematous and inflamed ears with odour, and caudal abdomen and inguinal skin being erythematous with epidermal collarettes and scabbing. Hind paws interdigital spaces appeared less of a concern despite reported with chewing behavior. Based on the in house cytology of ears and inguinal skin revealing infectious agents, we decided that topical treatments are required to manage the infection, redness, inflammation, and scabs, in addition to cytopoint. These secondary infections will require treatment as they will not resolve with cytopoint therapy alone.  TREATMENT:- Anal glands were expressed and sprayed with deodorant.- Ears were cleaned with otoflush. - Cytopoint 10mg (1ml) injection given.- In consult, Aurizone ear drops given, 0.5ml to each ear. MEDICATION:	Flamazine (1% silver sulfadiazine)			PRESCRIBED DOSE: 	Apply to the affected skin 1-2 times a day for 7-10 days as needed.  PLAN (incl. alternative options):1. Rx Aurizon ear drops - administer 0.5ml to each ear using syringe, BID until finished. Demonstrated in consult today. Massage ears gently. Recheck in 2-3 days after course completion.  2. Prescription written for Flamazine cream - apply to caudal abdominal and inguinal skin regions  1-2 times a day for 7-10 days as needed. 3. Malaseb shampoo - wash the caudal abdominal and inguinal region 2-3 x weekly4. Given cytopoint injection today, monitor for management of pruritus - booster to continue every 4-6 weeks as previous 5. Recheck otitis external and superficial pyoderma in  2 weeksASA Classification (if applicable): 1 CYTOPOINT INJECTION DETAILS:Vaccination injection site: intrascapular SC Type of vaccination given: Cytopoint 10mg Brand of vaccination: ZoetisBatch number: 828805Expiry date of vaccination: 01/2027    Vital Signs    Weight: 6.7;       

Reason: Itchy Appointment Notes: AD 15.12Record Entered by: GD  BIOSECURITY STATUS: White PRESENTING COMPLAINT: Skin - itchyHISTORY: SPECIFIC HISTORY:Hugo presents today due to recurrence of itchiness. O reports skin has been really good for a while - last had cytopoint in July this year and hasn't needed it since. Also cut out chicken in diet - although last week did give him a small amount. Since today he has been irritated and uncomfortable - scratching and licking and bothering both dog and owner. Went to the groomers last week and had a trim - did not seem itchy after. Prior to this was only have scratching episodes about twice a week. Cytopoint seemed to help a lot. Was scratching ears recently. Not doing ear cleaning at home NON-SPECIFIC HISTORY: LIFESTYLE: Indoor & OutdoorBEHAVIOUR ISSUES: At Vet - nervous OTHER PETS: Only pet DIET: Fussy dog generally with food - currently on raw commercial dog food - has improved his appetite on this. Sweet potato. Dry biscuits always available - but only nibbles on them, eats a small amount of this per day. Gets bones also - O aware of potential risks but does not think Hugo will be affected. Tried lyka and he did not like it. CURRENT OR RECENT MEDICATIONS: None APPETITE,THIRST,COUGHING ETC: EDDU all normal and consistent. No coughing or sneezing, vomiting or diarrhoea VACCINATION: Next due in July 26 - lepto2, KC + proheart 26/9/26, C3 10/2027PARASITE PREVENTION (incl. Compliance): Due soon on 18th - bravecto & drontal q3monthls PHYSICAL EXAMINATION:WEIGHT: 6.7FAS SCORE  3/5: Tries to hide from approach, clinging to owner, nil aggressionMENTATION: BARHR:                                                     	120PULSE QUALITY:                            	strong, synchronousRR:                                                     	36TEMPERATURE:            	                Not takenINTEGUMENT:                              	On ventral abdomen and inner thighs are several well circumscribed circular epidermal collarettes with mild crusting and redness. Paws in good condition, Coat in good condition. CIRCULATORY:              	                MM pink and moist, CRT <2sec, no heart murmurs or arrhythmias, femoral pulses strong and synchronous. RESPIRATORY:               	                No wheezing or crackles, normal bronchovesicular sounds bilaterally.DIGESTIVE:                                     	No palpable abnormalities on superficial or deep palpation of the abdomen. Comfortable on palpation.Oral Cavity:                 	                mild gingivitis only with mild plaque build upGENITOURINARY:                        	No discharges from prepuce. Desexed animal. Bladder small and comfortable, kidney palpation unremarkable.MUSCULOSKELETAL:                  	No lameness or ataxia appreciated. Full MSK exam not performed. NEURAL:                                          	Normal, appropriate mentation, full neuro exam not performed. LYMPH NODES:             	                Submandibular, prescapular, inguinal and popliteal lymph nodes symmetrical and normal size and consistencyEYES:                                                 	Both visual, corneas transparent, no blepharospasm or epiphora EARS:                                                	Responds to auditory stimulus, both ears mild redness on pinnae, nil discharge presentBODY CONDITION SCORE:        	5/9 IN-HOUSE DIAGNOSTICS: ASSESSMENT:Problem list:1. Pruritis - likely underlying atopy, possible food allergy component TREATMENT:Administered cytopoint 10mg SC today PLAN (incl. alternative options):1. Bathe regularly with aloveen (O has at home) to support skin barrier2. Recommended checking and cleaning ears of any discharge every 2 weeks - demonstrated how to do with a clean tissueASA Classification (if applicable): I INJECTION DETAILS:injection site: SC between shoulder bladesType given: Cytopoint 10mgBrand: ZoetisBatch number: 812603Expiry date: 12/26    Vital Signs    Weight: 6.7;