C10021393 / invoice 60000

Appointment Notes: ame - req Subjective: Nose is a lot better no concerns she has been irritated by back end, it is very red and sometimes bleeding. AGs checked and were fine no issues urinating, not itchy in places DUDE all normal, no V+ or D+ BAR, good to examine Objective: MM/CRT/Hydration: p RESP/RR: normal breathing effort Temp: 39.4 GIT/UG: AGs empty Skin/Ears: perineal area diffuse erythema, in hood of vulva moderate erythema and sebaceous discharge. Clipped area M/S: ambulating well Eyes: clear and bright Lymph Nodes: WNLsBCS: 7/9Lab: UA > clear no UTI, uroliths or inflammation Assessment: dermatitis in perineal area ddx: allergies/ contact irritant, vaginal FB, other Treatment: cytopoint 80mg sc neocort, aloveen and pyohex SID INI after cytopoint can trial pred 30mg PO SID for 5 days, 20mg SID for 5 days Plan: cytopoint PRN INI r/c     Vital Signs    Weight: 71;       

Reason: Vacc, Zydax + Check SkinSubjective: Recent history over the last 6 months or so of skin lesions around nose and lipsMost recent pyoderma over HLs resolved after cephalexin course, but scabs on nose have recurred after finishing antibioticsSeen in October for nasal lesion + lip fold dermatitisCleans regularly with chlorhexidine, tried malaseb but seems to sting, tried neocort but no improvement. Has only ever cleared up while on cephalexin course.EDUD all ok otherwiseChanged diet to leaps & bounds and is doing well on this, no d+ or v+Shoulder OCD lesions as a puppy, has been doing well since. Due for zydax.Objective: BAR, good girlHR/PR/CV: 90, no murmur or arrhythmia auscultated, normokinetic pulsesMM/CRT/Hydration: pink, moist, adequateRESP/RR: nsfTemp: n/eGIT/UG: slightly tense on abdominal palpation, no obvious masses or organomegalySkin/Ears: ears clean externally. R lateral nostril is a ~5x3mm erosive crusted lesion on mucocutaneous junction with purulent material just on the inside of nare next to lesion. Bilateral lower lip folds erythemic, moist and mild crusting (R worse than L).M/S: ambulating well in consultEyes: clearDental: grade 1/4Lymph Nodes: pLNs wnlBCS: 5.5/9Assessment: Fit for vaccinationLip fold dermatitis + recurrent crusted nasal lesion - underlying allergy component, vs mucocutaneous pyoderma, pemphigus, DLE or immune mediated diseaseTreatment: @BronchiShield Oral Batch #5245044A 16/07/2026@Pi2 Protech s/c inj Batch #5264016 22/10/2026Proheart 3.6ml SCZydax 2.2ml SCPlan: C5 + proheart due next yearZydax q3mMonitor nasal and lip fold lesions with topical tacrolimus (just arrived) over the next couple of weeksINI or recurs consider longer course of cephalexin (4-6w) and continue topical chlorhexidine, cytopoint If still not resolved consider biopsies of nasal lesion___________________________    Vital Signs    Weight: 72.8;       

Appointment Notes: check skin 73kgSubjective: Since Monday noticed scabs back legs along caudal thighsScabs around nares, needed a/bs last time she had it.last night found a GS sinus LHLObjective: HR/PR/CV: 75MM/CRT/Hydration: pinkRESP/RR: pantingGIT/UG: nadSkin/Ears: Sinus underside left hind pawSmall flea found in fur on pawCaudal thighs several epidermal collarettes.M/S: ambulating normallyEyes:  clearAssessment: GS sinusTreatment: Methadone 1.5ml IM @ 4.30pmCephalexin 1600mg PO BIDBravecto for flea controlInstilled lignocaine into sinus, probes directly to interdigital space between digits 2-3.Cytopoint 40mg 2mL #806985 exp 11/2026 (2x 40mg vial)Neocort on naresPlan: Cephalexin if needed.____________________________INSURANCE HXInitial Assessment > Itchy skin and sore pawSuspected cause > Allergies, GS sinusDate of first clinical signs > Skin Monday, paw yesterday.Any other conditions / treatments > no    Vital Signs    Weight: 73;