C10020801 / invoice 10000

Primary Presenting Complaint - allergies, vomiting 
Other Complaint - 
         Loyalty Reward Program - Y/N
History - 
vomiting this AM 5:30, just once, was bile. Ate brekky later on and kept it down.
Has been coughing? for 2 weeks. once or twice
         Last Normal -
         Frequency   -
         Last Ate       -
         Medicine Hx  - none 
         Diet              -
         Vacc Current -
         Worming Hx  -
         Heartworm    -
         Microchip       -  Y / N    -  scanned - ok?

Examination -
         Attitude - BAR
         Body Score -  6  /10
         Temperature - 39.1C
         Heart -   HR 120. Murmur - no
         RR -panting
         Dental - Score(0-4)= 0.5   .Comment
         CRT - immediate
         Eyes - NVL
         Ears - clean and discharge free, mild erythema but no evidence of infection
         Abd Palpation - Unremarkable
         Gastrointestinal -  No Sig Findings
         Urogenital -  No Sig Findings
         Skin - mild erythema ventral abdomen, paws, axillae and pinnae 
         Musculoskeletal -  No Sig Findings
         Neurological -  No Sig Findings
         Lymphatic - No Sig Findings
         Other key findings = 

Assessment - Allergic skin disease
Problem List - 
DDx                 - 
Discussed      - Has used HCA spray on and off and does help but now has generalised pruritis so suggest cytopoint better option to control when generalised itch. When starts wearing off if has localised itch then can use HCA spray to manage
Treatment Plan - repeat cytopoint inj increase dose to 40mg
Prescriptions(on-going) -cytopoint, HCA spray 6 months
Next Visit            - if pruririts recurs for repeat cytopoint inj

Presenting Complaint -  Vaccination/Check up
Other Complaint -  
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History -  cytopoint and malaseb work but not 100%
-check teeth L lower molars are may have worn them down while eating bones
         Medicine Hx  - none
         Worming Hx  - UTD
         Heartworm    - UTD
         Microchip      -  Y / N     scanned -  ok?

Examination -
         Attitude -bright
         Body Score -  5.5  /10
         Temperature - not indic
         Heart -   HR. Murmur - NIL
         RR -
         Dental - Score(0-4)=  0  .Comment - points of some teeth worn
         CRT - immediate
         Eyes - NVL
         Ears - clean and discharge free
         Abd Palpation - Unremarkable
         Gastrointestinal -  No Sig Findings
         Urogenital -  No Sig Findings
         Skin - erythema and mild excoriation on belly. Erythema on feet
         Musculoskeletal -  No Sig Findings
         Other key findings = 

General Health Assessment - well
Discussed - Skin has flaired up again despite removing chicken from diet so likely environmental and seasonal. Recomm trial topical steroid spray intermit as reqy=uired
Plan            -vac
Prescriptions(on-going) -
Next Visit    -

Primary Presenting Complaint - Red and itchy all over - paws, groin etc ; no food changes, O think environmental; skin issue is different than before; lumps behind neck 
Other Complaint - renos at home so there is a lot of dust and stress and people 
         Loyalty Reward Program - Y/N
History - Itching
         Last Normal - EDUF all fine 
         Frequency   -
         Last Ate       -
         Medicine Hx  - Maleseb shampoo
         Diet              -
         Vacc Current - today if possible 
         Worming Hx  -
         Heartworm    -
         Microchip       -  Y / N    -  scanned - ok?

Examination -
         Attitude -  BAR
         Body Score - 5   /10
         Temperature - not indic
         Heart -   HR. Murmur - none heard
         RR -wnl
         Dental - Score(0-4)= 0   .Comment
         CRT - immediate
         Eyes - NVL
         Ears - clean and discharge free
         Abd Palpation - Unremarkable
         Gastrointestinal -  No Sig Findings
         Urogenital -  No Sig Findings
         Skin - mild pododermatitis, LF rust staining D3 nailbed medial aspect of white claw, saliva staining, mild erythema ventral abdomen (O 
         Musculoskeletal -  No Sig Findings
         Neurological -  No Sig Findings
         Lymphatic - No Sig Findings
         Other key findings = 

Assessment - Allergic skin disease
Problem List - 
DDx                 - atopy vs food allergy
Discussed      - O feels malaseb sl improves skin but not fully. Pred did control itch very well and was ok for around a month after last visit, pruritis has recurred in last 2 months,
Treatment Plan - cytopoint trial 30mg sc (pending good response can consider increase dose to try to improve duration for future injections)
Prescriptions(on-going) -
Next Visit            -1-2 months when due for vac and cytopoint possibly starting to wear off