C10020179 / invoice 10000

Reason: Skin And Ears Appointment Notes: Special payment terms existrhhHistory: Current Medications:Antihistamine - zyrtec - approx 4 weeksCytotpoint - first only 2.5-3 weeks agoCephalexin - 10 days finished a week agoAdvocate monthylyPyohex shampoo at home - haven't used yet Megaderm Examine: Diet: Dental/oral cavity: Eyes: Ears: Cardiovascular/respiratory: GIT/abdomen: Urogenital: M/skeletal: Skin: Lumps: Lymph Nodes: Behaviour: Assessment: Treatment: Plan: Script status:  Checked and updated? Yes/NoVaccination / Blood test / Catrophen Reminders up to date? ADJUST ACCORDINGLYRevist/ Recall/ Reminder:Verified: NoHistory:Presenting for: Lulu presented for ongoing skin issues including belly rashes and ear problems that have developed over recent weeks.Historical Conditions:- Previous dog had allergies managed with Cytopoint and joint medication- Previous dog had chronic ear issues that were successfully managed with weekend ear treatments after initial clearanceDiet:- Recently changed to roll format food due to previous appetite issues where patient was refusing food and losing weight- Now eating well and passionate about foodSkin:- Belly rashes present for several weeks, initially thought to be improving but both owners decided treatment was needed- Occasional scratching and scabbing behaviour- One hot spot on chest, treated with Betadine, starting to lift and heal- No previous allergies noted until recent onset- Sudden onset of symptoms - previously no issues for first 10 months of lifeCurrent Meds:- Cetirizine (antihistamine) for 4 weeks- Cytopoint injection given 24th (approximately 3 weeks ago)- Cephalexin course completed (10 days, BID)- Advocate monthly flea/tick prevention- Pyohex shampoo recommended but not yet usedOther:- Well-behaved dog - no destructive behaviours, excellent toilet training, travels well in caravan- Lives with grandchildren and elderly family members- Uses local groomer who allows socialisation before and after groomingExamination:Wt: 30 kgEars: Bright red and inflamed ear canals bilaterally. Unable to visualise tympanic membrane due to inflammation. Sudden onset suggesting acute inflammatory response rather than chronic infection with debris.Integumentary: Multiple scabby lesions on ventral abdomen, most appearing to lift indicating healing underneath. No obvious new lesions noted. One healing hot spot on chest.Assessment:Atopic dermatitis with secondary bacterial skin infection - Poor response to Cytopoint suggests concurrent infection complicating allergic disease. Acute onset at 13 months of age fits typical pattern for environmental allergies.Acute otitis externa - Bright erythema in both ear canals with sudden onset, likely allergic inflammation that may progress to secondary infection if untreated.Plan:New Meds/Tx:- Prednisolone: 1.5 tablets once daily for 3 days, then 1 tablet once daily for 5 days, then 1 tablet every second day for 5 days, then 0.5 tablet every second day until resolved. Course includes antibiotics due to mild immunosuppressive effects.- Dermotic ear drops: 1mL each ear twice daily using provided syringe adapters for accurate dosing- Pyohex shampoo: Use on weekends, leave on for 10 minutes before rinsing for optimal efficacyAdditional Discussion:- Discussed three main allergy treatment options: Cytopoint (current), prednisolone (short-term with side effects), and Apoquel/Xenorelia (daily medication with fewer side effects than prednisolone)- Environmental allergies account for 90% of canine allergies vs 10% food allergies. Most common food allergens are chicken and beef if dietary trial considered.- Seasonal pattern likely given timing and age of onset. Most allergies develop between 1-3 years of age after initial exposure and immune system priming.- Prime 100 single protein diets mentioned as option if food trial desired- Megaderm omega supplement discussed - available through pet chemist or online retailers- Antihistamine options provided on handout for future referenceClient Comms:- Recheck appointment scheduled for when next Cytopoint injection due (approximately 12 days)- May consider Cytopoint booster after prednisolone course completed to assess ongoing efficacy- Short-term prednisolone course preferred approach to rapidly control current flare-up- Discussed that Cytopoint only addresses itching, not inflammation or infection, explaining partial response    Vital Signs    Weight: 30.5;