C10024760 / invoice 10000

13/03/2026 History:
- Pruritus and skin lesions ongoing for approximately one week
- Scratching at night, waking with erythematous skin
- Lesions from chin down sides, under fur, armpits, ventral abdomen
- Skin became scaly with small crusts
- Previous suspicion of mites - switched to NexGard Spectrum
- Using Malaseb wash - no improvement noted
- Tried coconut oil - no improvement
- Diet: dry food (Scratch), recently steak with carrot and broccoli; removed wet food roll approximately one week ago
- Energy: lethargic at times, seems depressed; owner away caring for mother over past year
- Previous colitis; history of skin flare-ups related to gut issues
- Dog walked Thursday/Fridays - rolling in park, gets wet and muddy
- Anti-anxiety medication given one hour prior to visit
- Stools normal

Physical Exam Findings:
- Behaviour: anxious, shaking, required carrying into clinic
- Ears: small spots noted bilaterally (owner had not noticed previously)
- Integument: erythematous skin on chin, sides, ventral abdomen, armpits; lesions appear sore; some areas smoother than previous day; no swelling; no lesions around mouth; no fleas visible

Diagnostic Results:
- Skin cytology: bacteria present on crusts

Assessment:
- Problem list:
1. Pyoderma (bacterial skin infection)
2. Allergic dermatitis flare-up

Plan:
- Oral antibiotics for one week
- Oral steroids for ten days: one tablet daily for first three days, then half tablet daily, then half tablet every second day
- Topical cream with antibiotic, steroid and numbing agent dispensed
- Malaseb conditioner recommended for post-wash use
- Antihistamine chart provided for future flare-ups 
- Probiotics recommended after antibiotic course to restore gut flora
- Continue medicated washes to remove environmental allergens

Communications:
- Discussed likely combination of allergy and secondary bacterial infection
- Discussed seasonal triggers for skin flare-ups
- Discussed itch-scratch cycle and importance of breaking this
- Discussed option of oral antihistamines for future flare management
- Discussed probiotic use post-antibiotics to support gut health