C10015280 / invoice 10000

Reason: AntihistamineAppointment Notes: antihistamine and check up - experienced allergies in sydney - needs script  ------- Sms reply: YSubjective:- Check-up for a five-year-old cavoodle. Review of management for allergic skin disease.- while in Sydney tx allergies, characterised by constant chewing and licking of paws, resulting in brown saliva staining.- Commenced on Apoquel by another veterinarian, which resulted in significant improvement within two days. Initially dosed at two tablets daily, now on one tablet daily for maintenance. Owner also using a natural supplement ("Glow") which has reportedly reduced staining around the eyes and on teeth.- Previously seen in October 2024 for vaccination; separation anxiety was discussed at that time.- Allergic dermatitis, previously mild, worsened significantly in December 2025.Past Medical History:- History of mild allergies.- Blood tests in October 2025 were unremarkable.- Fully immunised.Objective:- Bright, alert, responsive.- Coat is in good condition. No evidence of saliva staining on paws and  periocular region clean- Examination of skin reveals a 4mm small, smooth lump on the right side of flank. Monitored for any rapid growth, change in appearance (e.g., becoming cauliflower-like), or if it becomes bothersome. First noticed by o 2 days ago, not bothering MicaMm pink, teeth ok, ears and eyes clear, LN normalAssessment:- Allergic skin disease, well-controlled on Apoquel.Plan:- Counselled owner on the management of allergic skin disease. Apoquel works on the immune system to reduce the allergic cascade. It is generally safe for long-term use, but it is worth attempting a break from the medication every few months (e.g., during winter) to assess if it is still required. If signs of pruritus return, the medication should be restarted.- Discussed an alternative medication, Cytopoint, which is an injectable monoclonal antibody. Some dogs respond better to one medication over the other, and the injection can be an alternative for owners who find daily tableting difficult.- Advised on management of flare-ups: dose of Apoquel can be increased to twice daily for a maximum of two weeks if pruritus is not controlled on the once-daily maintenance dose.- Discussed monitoring for lumps and bumps. Advised to seek re-examination if the lump grows quickly, changes in character, or appears to cause pain. Discussed the historical, weak association between Apoquel and the development of skin lumps, noting these often resolved upon cessation of the medication.- Discussed the "Glow" supplement. Advised that it is unlikely to cause harm provided there is no gastrointestinal upset, and may be contributing to the improvement in coat staining.- Dispensed Apoquel (100 tablets). .- Advised owner on costs and to submit the claim to their pet insurance.    Vital Signs    Weight: 8.4;