C10022681 / invoice 10000

Reason: Skin Issue Under Arms JhlHistory: Computers down during consult, notes finished afterwards.O says itchy skin has persisted. Wanting to explore other options.Simparica trio UTD, correct weight range.Puppy kibble and chicken mince.Examine: Eyes/ears: nadTeeth/mouth: nadChest: nadAbdomen: nadUrogenital: nadDigestive: nadLymph nodes: nadSkin: Excoriations both axillae, ventral abdomen. Rostral aspect mandible sparse fur, slightly pink. Occasional patchy areas of alopecia around shoulder/neck areas.Locomotion: ambulation normalNervous System: mentation normalBAR, very boisterous and friendly.Differential Diagnosis: Allergies (contact vs environmental vs food) vs parasites vs otherAssessment:Patient has mild skin inflammation. Likely skin allergies given hx and parasite px utd.Plan: Discussed long term allergy tx. Too young for apoquel so cytopoint recommended.Also mentioned steroids can be helpful in short term but not recommended long term especially not for puppy as side effects with chronic use.O wanting to try cytopoint.Cytopoint 30mg sc.Bacticorten to affected areas 2-3 times a day for 5 days (handwritten label).RV in one month to assess response, rpt cytopoint then see if needed over winter.RV sooner if no improvement.Consider trial no chicken in diet to see if food allergy component. Wipe down Apple with damp rag after running around in grass.    Vital Signs    Weight: 24.7;