C10018604 / invoice 10000

Appointment Notes: VETSTORIA  Matt Parker (0438784192 matt.j.parker@hotmail.com) with Caesar (Dog) - Consult (Nail injury??) - [Veterinarian : Dr Tanisha (Preferred Clinician)] -  Web BookingClient name: Matt ParkerContact number: 0438784192Email address: matt.j.parker@hotmail.comPatient name: CaesarAttendees:History:Has skin allergies which has been managing with cytopoint injections at this stage >> last injection was on FRIDAY just gone, but hasn't been helping as much at the moment >> increase to 60mg-80mg cytopoint (40mg x 1 and 20mg x 1 vial >> max dose is 140mg of lokivetmab)Rear left paw has been chewing at and thought may have been change in nail appearance?Has hot spots back againGets Previcox 227mg PO SID for hindlimb painEating drinking urinating defaecating normallyNo vomiting/retchingNo coughing, no exercise intolerance, no breathing difficultyBright Alert ResponsiveBody condition score 8/10Examination:Mucous membranes – pink moist crt <2sOral cavity – clear, no evidence of ulceration, tongue normal, hard palate fineTeeth – grade 2Nasal planum – normal pigmentation and architecture, no crusting, no dischargeEyes – eyelid conformation normal, PLR normal, no chemosis,  no dischargeEars – no discharge, no erythema, pinna fineLymph nodes - normalHeart – normal regular rhythm no pulse deficits, no murmur HR 80Lungs – clear sounds bilaterally, no crackles or wheeze, tracheal pinch negativeAbdomen – comfortable on palpation, bladder normal, no masses palpatedLimbs – all good range of movement, no swelling or pain on palpationNeck and spine – no pain on palpationSkin – Diffuse erythema and numerous multi-focal areas of scabbing/ newly forming hot spotsNails – fine >> change that the O' was talking about is just clear section of nail that hadn't noticed previouslyAnal glands – not performedTemperature – not performedGenital region - no masses or swellingsDiagnosis:1. Atopy vs. Contact allergies vs. Food allergies vs. Other allergens2. Starting of superficial pyodermasTreatment:1. Cephalexin 600mg PO BID for 14 days2. Apoquel 16mg ONE and HALF tablets PO SID for 14 days3. Increase cytopoint mg dose at next cytopoint injection >> may be building a tolerance to cytopoint4. F/U call in 7 days5. Recheck in 14 days    Vital Signs    Weight: 42.5;