C10020406 / invoice 10000

Hx - first cytopoint worked really well.Second one didn't work that well (nothing like the first one).Now really itchy - face, ears, lateral belly.  Check ears - R ear itchy, little bit of head shaking.  Ears red all the time.Otherwise well.Exam - BAR.Both inside pinna very red.  Both ears - entrance to canals look thickened / lichenification.  No obvious discharge.  Attempted otoscopic exam-  impossible, would need sedation.Swab ears - dark brown discharge.  Cytology of ears - malassezia +++.Ventral abdo skin WNL.Patch of reddened / scabby skin under L armpit - sticky tape impression smear - cytology - scant malassezia.Rest of skin looks WNL.Problem list- allergic skin disease, suspect food allergy as so young.  Food trial discussed previously - o is willing to start now.  See prev notes re RC recommendation re food trials in young dogs - recc RC hypoallergenic 8 weeks.- secondary OE with malassezia overgrowth- starting to get some evidence of secondary malassezia overgrowth on skin.Tx plan- short reducing course of pred- won't repeat cytopoint at this stage as minimal effect last injection- PMP 1ml BID both ears 10 days- malaseb topically on affected skin- Start food trial as above, o wants to try to order food herself- recheck with vet 2 weeks to check how she is going and talk about long term management- will consider apoquel if needed at 2 week revisit

Nurse: HG Last vet review: 13.11.25Last cytopoint inj: 13.11.25HISTORY:Last inj was 5 weeks ago. Itching was well controlled up until a few days ago. Ears have been an issue also in the last few days possible due to allergies. Owner still seems keen to do the food trial in the new year - asked if it was worth starting the anallergenic in the meantime even though she maybe exposed to the triggering food. Can start but may not see much benefitTREATMENT:Cytopoint 20mg SCBatch number: 820641Expiry date: 01.2027** got most of injection in but wriggled and swung around to try nip (don't think it was an aggresive bite just uncomfortable/unsure)PLAN:Owner will wait until new year to try food trial Vet recheck in strict 4 weeks for cytopoint and food trial discussion 

Cytopoint has reduced Sunny's itch - less bothered and irritated.Advised I talked to RC and they advised RC hypoallergenic dry food is complete and balance for puppies over 6 mths old.  Sunny is just over 6 mths so it is safe to start her on a food trial of this.O is going to leave food trial to after Xmas period (going camping, lots of kids, can't guarantee she isn't eating other things).Will consider 8 weeks food trial with RC hypoallergenic in new year.