C10018206 / invoice 10000

Attending Nurse: SR TVNOwner(s) Present: DianeHistory: Still licking and dragging bottom a little bit, but nowhere near as much as before. O thinks it has become a habit for her. Noticed an improvement in the lameness as well and doesn't think its relapsed - dog is jumping up on the couch againExamination: Skin around anus and vulva still slightly inflamed with a little bit of a rash on anal sphincter, but is significantly improved compared to 2 weeks agoInitially looked ok ambulating around consult room, but when let out into waiting room and able to get more speed is lame on L hind, noticeably favouring itTreatment: Neocort for another weekBravecto and Milbemax taken to give at homeClient Advice: Recommend radiographs of stifles and hips to investigate lameness further in case underlying issue rather than just presuming arthritis. Will also facilitate better examination with muscle relaxation. Booked in for early next weekHave discussed starting on joint supplement (4cyte).Finish apoquel course and then monitor, it itch recurs again go back onto apoquel daily for 1-2 months and see if goes ok through winter. Have also mentioned trialling ZenreliaPlan: Radiographs next week, if ongoing issues with skin can discuss then as wellInsurance Form: Insurance claim submitted for dates :  11/3/26 - atopy, lameness    Vital Signs    Weight: 8.4;       MMColour: pink;       Temperature: 36.0;       HeartRate: 140;       BodyScore: 3;       RespirationRate: panting;