C10015826 / invoice 10000

cytopoint 20mg bn 840616 exp 02/2027 NL

Reason: ears, cytopoint, apoquel

History:
- well in self, maybe a bit quieter than usual
- appetite: normal
- urination: normal
- defecation: normal
- vomiting / diarrhoea: none
- current meds: several, not discussed today
- flea / tick / worming: utd
- indoor & outdoor
- groomed on monday
- licking feet a lot, very itchy O thinks just generalised 
- BIB Mark (pat's husband)

Vitals
Attitude / mentation: BAR has traz on board, limited effect
BCS: 6/9
HR: 120
RR: 20
Temp: not taken
MM / CRT: not assessed
Thyroid palpable: no

Physical exam
Thoracic auscultation: clear lung sounds, no murmur, no arrhythmia
Abdominal palpation: not assessed
Pulses: strong and synchronous
Eyes: NAD
Ears: 
- unable to perform otoscope exam due to behaviour
- R ear yeast 10-15 per hpf, no rods or cocci, very hairy in canal mild redness
- L ear red and very moist mixed infection rods cocci and yeast > see photo, very hairy canals
Nose / mouth: not assessed
Dental grade: not assessed
Skin: unable to assess feet 
LNs: NAD
Gait: NAD
Genitourinary: NAD
Stifles / hips: not assessed
Lumps: none

Assessment
otitis externa L ear mixed infection (rods, cocci, yeast)
otitis externa R ear yeast infection
atopic dermatitis most likely > contact allergen vs food ??

Plan
neptra instilled into RIGHT ear
pseudomonas mix 0.4ml into LEFT ear BID for 3 weeks
recheck both ears in 3-4 weeks time at next cytopoint injection
Cytopoint 20mg given SC see above for batch - elected to increase dose from 10mg as only lasting just on 3 weeks 
dispense more apoquel for PRN use

Cytopoint 10mg light blue given SC L shoulder
Growls, does turn on stimulus so could snap (was muzzled)
AZ + DM