C10018670 / invoice 10000

Reason: Chewing/licking At Paws Non-Stop --AWAppointment Notes: rescheduled by O from 06/03 MMHistory:Brought in by female OHas been licking at paws non-stop - few weeks to month nowHas been washing paws - tried malaseb and another - unable to keep on for 10 minsNo improvementWorse FLs > HLs Not licking or scratching elsewhereLost their other dog in Oct - was a little off after this timeWell otherwiseO reports hx of elevated liver enzymes - currently being monitored, seems to have improved at last recheck in JanExamination: BAR, normal mentationVery sweet and excitable girl - very cuteEyes OK - typical exopthalmic eyeshape Integument - errythema of the interdigital space - more so palmar aspect compared to dorsal aspect. FL > HLs.Ambulatory in consult room, no lameness Laboratory: Sticky tape prep - intracellular cocci ++ 1 single yeast noted Treatment: Cytopoint 20mg/ml given SQ BATCH 840616 EXP 02/2027Plan: Amoxyclav 250mg PO BID for 2 weeksMalaseb wash paws BIW for 2-3 weeks - lickimat to distract with washingDiscussed apoquel vs cytopoint. O worried re hx of elevated liver enzymes. Elected for cytopoint inj.RC in 2 weeks    Vital Signs