C10017803 / invoice 10000

Reason: Zenrelia PleaseO rang monday asking re cost of zenrelia vs apoquel. Given both. O wants to try zenrelia.Dispense 1m then advise recheck to see how P going and make longterm plan (as to whether better response to one or other.    Vital Signs    

Reason: Skin, Itchy,poss Check BloodsHistory: Presenting complaint: alopecia behind ears and licking paws obsessively. O believes hair loss has been worse since he was castrated. Spoke to an online vet through his insurance, who recommended a blood test for thyroid levels and allergy testing.Has changed diet in recent months to grain-free, no changes to skin.Otherwise well, eduf normal, no v/d.Ears have been very good recently, was giving the elocon regularly but run out now.No current meds.No other concernsExamination: BAREENO: eyes normal, no ocular or nasal discharge, ears clean, teeth in good conditionMM: pink + moist, normal CRTLNs: mandibular, suprascapular and popliteal LNs WNLHeart: normal rate and rhythm, no murmurs auscultatedFemoral pulses strong and synchronousLungs: normal rate and effort, normal bronchovesicular soundsAbdo palpation: soft and comfortableSkin: focal alopecia around base of ears, axillary area, and backs of legs. Generalised erythema in paws between paw pads (mild).MSK: normal gait, full exam not performed.Temp not taken to facilitate positive experienceAssessment: Pruritus + focal areas of alopeciaDdx: atopic dermatitis (most likely in signalment), food allergy, ectoparasites, endocrinopathies eg hypothyroidism.Treatment: Discussion with O regarding possible causes. Advised doing a blood test is definitely not a bad idea, but Floyds signalment and presentation doesnt really fit the usual clinical picture for hypothyroidism - generally 4-10 years old, and usually have weight gain etc. Advised I think in his case allergies are more likely - either food or environmental. Discussed food trial process and benefits, and also discuss referral to derm for allergy testing.Recommended a good first step is to try an anti-itch medication to see if that improves his current clinical signs. Compred costs of cytopoint, apoquel, and zenrelia, and decided to go with apoquel. Dispensed 14 days worth of apoquel to try, and then recommended a recheck afterwards to assess response, or if O is happy and no concerns, advised he can call us for repeat meds. O happy to postpone blood test for now, will do if not responding to allergy treatment. Consent has been given by the client to proceed with this treatment  -  YesPlan:Trial apoquel for 2 weeks - INI recheck and consider bloods or derm referral. If improving then consider continuing on apoquel +/- food trial.--- 26/02/2026 11:12:40 AM JUS:Examinations - Resolved - STO - doing well at home, already licking much less and didnt wake up the family overnight. O happy with progress will call if anything changes. Also adviced as per email request that we cant send hx direct to her butif she can provide email address and claim/policy number for insurance we can email hx to them directly.    Vital Signs    MMColour: p/m;       Weight: 18.5;       HeartRate: 108;       BodyScore: 5;       DentalGrade: 1;       RespirationRate: pant;       CRT: <2;       

Reason: Hair Loss Behind EarsReason: Name of Client Present: MO AthonyTBC Nurse Initials: SJClient Concerns: hair loss behind ears for a week or so Vaccination: (Type:  C5   ) (Last Given: UTD  )Parasite Prevention: (Product Name: drontal  ) (Last Given: dec   )Microchip # & Behaviour Indicator filled in: YesInsurance / Healthy Pets Plus: HPPIs patient on any medication? NoCurrent Diet:Product: dry food Hills + wet food wooliesFeeding schedule: Twice a dayLaboratory Testing Needed:_____________________________________________________________History: Noticed hair loss on the back of both ears over the past few months. Doesn't seems to scratch the ears incessantly or at least when owner is with the dog. Have had ear issues in the past. Otherwise well, EDUF normalExamination: Mentation: BARHR: no arrythmia or murmur noted.RR: clear lung soundsEyes, ears, nose, mouth: NAD on examEars seems fine externally, no inflammation on the outside. Alopecia at the back of both earsMandibular lymph nodes NADComfortable abdo palpMSK: Normal gait, full test not performedTemp: not takenLaboratory: Cytology: Yeast + in both earsAssessment: Client communication: Very mild yeast ear infection but may be enough to cause itching and causing hair loss behind the ear. Recommend treating the infection and starting fortnightly Elocon long term to keep ears stable. Owner happy with planTreatment: Dermotic + Elocon (to start after finishing dermotic)Plan: To start Elocon long term after finsihing Dermotic. Okay to dispense Elocon for the next 6 month as needed for the ears--- 23/12/2025 08:39:27 AM TDN:Examinations - Resolved - O say, P doing great, improving already.TD    Vital Signs    MMColour: pink moist;       Weight: 19.7;       HeartRate: 120;       BodyScore: 5;       DentalGrade: 1;       RespirationRate: panting;       CRT: <2;