C10023516 / invoice 10000

Skin issuesHISTORY:Duke presented for ongoing management of allergic dermatitis. Owner reports continued pruritus despite monthly Cytopoint injections commenced in January. Previous consultation in February with Dr Walry discussed Apoquel and Zenrelia options, along with protein diet trial. No dietary changes implemented as condition considered unlikely to be dietary related. Last Cytopoint injection administered Tuesday of previous week (approximately 3 weeks ago). Owner uncertain about current efficacy of Cytopoint treatment.EDDU: Not mentionedCurrent meds: Steroids (short course previously prescribed)Vaccination: Not mentionedParasite Prevention: Not mentionedPre-existing conditions: Allergic dermatitisAccess to toxins eg. Rodenticide: noneEXAMINATION:Body Condition Score: 3.3/9Pain Scale (0-4): 0/4Hydration status (%): hydration clinically adequateCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findingsMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal, no mouth pain, dental score (1-4): not graded- Abdominal: no detectable pain on abdominal palpation- Rectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: NSFLymph Nodes: NSFEyes: NSFDemeanour/Behaviour: restless during examination, unable to sit stillPROBLEM LIST:Ongoing pruritus secondary to allergic dermatitisSuboptimal response to current Cytopoint therapyDIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Allergic dermatitis with possible secondary bacterial infectionDIAGNOSTICS:NoneASSESSMENT:Duke presented for ongoing management of allergic dermatitis with continued pruritus despite Cytopoint therapy. Current treatment providing insufficient duration of relief, requiring injections more frequently than standard 4-week intervals. Physical examination revealed restless behaviour consistent with discomfort from pruritus.TREATMENT:Antibiotics prescribed for short coursePrednisolone prescribed for short course (few days duration to avoid long-term steroid complications)PLAN:Short course antibiotics and steroids to address current flareMonitor response over next 3 weeksIf pruritus returns before 4-week mark, consider alternative immunomodulatory therapy (Apoquel or Zenrelia) instead of CytopointOption to reduce Cytopoint interval to 3 weeks if current medications provide temporary reliefNext Cytopoint injection due in 3 weeks if continuing current protocolCLIENT COMMUNICATION:Discussed multiple treatment options for allergic dermatitis including Cytopoint, Apoquel, and ZenreliaExplained that immune-mediated conditions may require treatment adjustments as immune system can develop resistance to single-target therapiesAdvised that if current medications only provide relief until end of next week, this would be acceptable timing to transition to alternative therapyNo contraindications to switching between immunomodulatory treatments    Vital Signs    Weight: 23.3;