C10015353 / invoice 10000

HISTORY
Presenting for: Sole, a Shar Pei, presented for follow-up examination of dermatological condition currently being managed with prednisolone therapy.

Current Meds:
- Prednisolone tablets every second day (currently 20mg every second day, )

Diet:
- Fish-based diet including tuna
- Increased appetite and thirst secondary to corticosteroid therapy

EXAM
Wt: 2kg weight gain since last visit
Behavioural: Wants to go for walks daily, more active, sleeping better at night
Eyes: Clear and bright
Ears: Insect irritation almost completely cleared, no rubbing or bothering
Nose: Puffy appearance consistent with healthy Shar Pei (good indicator of breed health)
Integumentary: Hair almost completely regrown across back with very little missing, face has filled out, minimal pruritus, not itching at night

ASSESSMENT
Dermatological condition - excellent response to prednisolone therapy with significant improvement in coat regrowth, reduced pruritus, and resolution of ear irritation. Weight gain of 2kg considered healthy rather than excessive.

PLAN
Changes to Existing Meds/Tx:
- Reduce prednisolone dose to half tablet (10mg) every second day
- Monitor for return of pruritic symptoms and increase dose if itching recurs
- Plan to further reduce dose in one month if current improvement maintained
- Anticipate potentially lower dose requirements through winter due to reduced environmental allergens

Diet Recs:
- Continue fish-based diet (tuna, sardines, oily fish) for omega-3 fatty acids to support coat health and reduce inflammation
- Chicken acceptable in moderation
- Limit red meat (beef, lamb) due to omega-6 content which can promote inflammation
- Cooked meat preferred over raw
- Avoid raw chicken due to salmonella risk

Additional Discussion:
- Explained omega-3 vs omega-6 fatty acid ratios and their impact on inflammatory pathways
- Discussed prednisolone effects on appetite, joint comfort, and potential muscle weakness at higher doses
- Weight monitoring recommended at next grooming appointment to prevent excessive weight gain

Client Comms:
- Contact clinic if pruritus returns for dose adjustment
- Monitor weight to prevent obesity
- Continue current exercise routine

Very growly with Imogen for bath so muzzled and got help to keep distracted for groom and drying. Does love a good pat but seems really scary at first due to his deep growl. 

HISTORY
Presenting for: skin issues including hair loss and pruritus.
Historical Conditions: Recently adopted on Saturday. Previous owner reported the dog had skin issues related to wheat grass. Was previously housed with another Shar Pei that would attack him.
Diet: Fed steak (medium rare) mixed with dry food. Also given turmeric with yogurt as recommended by previous caretaker.
Skin: Generalized hair loss, particularly noticeable on tail base. Pruritic. Owner reports dog has been scratching most of the night and unable to get good sleep.
Current Meds: None reported.
Lifestyle Risk Factors: Recently adopted.

EXAM
Mentation: BAR
HR: 100, good steady beat
Behavioural: Friendly, social dog with good temperament. Not aggressive.
Eyes: Pigmentation noted on tongue and gums, normal for breed.
Ears: Evidence of inflammation with signs of fly bites on pinnae.
Oral: Teeth look nice, all good. Blue/pigmented areas on tongue and gums normal for breed.
Cardiovascular: Normal heart sounds, no murmurs or arrhythmias.
Respiratory: Normal respiratory effort.
Abdominal: No abnormalities detected on palpation. No masses or tenderness noted.
Integumentary: Generalized hair loss throughout coat, more severe on abdomen. Malassezia overgrowth present, causing oily, yeasty coat with characteristic odor. Skin appears inflamed. Tail has firm area at base which is normal oil-producing gland in male dogs. Fly bites present on ears.
Musculoskeletal: Slipped a couple of times when running up steps at home.

ASSESSMENT
Allergic dermatitis with secondary Malassezia dermatitis - Likely multifactorial allergies including possible environmental allergens, not just grass contact allergy
Otitis externa - Secondary to allergic dermatitis with fly bite complications

PLAN
New Meds/Tx:
- Cortisone tablets prescribed at tapering dose: starting with 1-2 tablets daily for 1-2 weeks, then decreasing to every second day, then halving dose again for maintenance
- Antibiotics prescribed to treat secondary skin infection, to be given until finished
- Vaseline recommended for ears to keep soft and provide barrier against flies; can mix with citronella for insect repellent effect
- Recommend not spraying insect repellent directly on face to avoid eye contact

Diet Recs:
- Continue current diet of dry food with added protein
- Continue turmeric with yogurt as anti-inflammatory supplement

Additional Discussion:
- Discussed that this is not a curable condition but can be managed
- Long-term medication options include Apoquel tablets or injectable therapy once skin is under control
- Explained that Shar Peis are predisposed to skin problems
- Discussed that puffiness in nose is an indicator of health in Shar Peis
- Recommended swimming as beneficial for coat, but rinse after to remove salt

Client Comms:
- Grooming appointment scheduled for the 24th
- Advised to use patient's name Solly frequently with treats and positive experiences to help him learn it quickly
- Explained importance of name recognition for recall, especially when encountering other dogs
- Advised that pruritus should resolve tonight with medication