C10024861 / invoice 10000

Appointment Notes: Scabs and pustules all over skin jc - multiple epidermal collarettes and pustules over ventral abdomen- crusting and redness interdigitally- Cytol - SBP both locations, no yeast- recc short course of ABs- consider higher dose cytopoint next time and start 8 week novel protein dietVerified: NOHISTORYPresenting for: Kaspar presented for ongoing skin issues with scabby lesions and paw lickingHistorical Conditions: Chronic atopic dermatitis with seasonal flares, particularly in summer. On and off skin problems with scabby lesions that form pustules then scab overDiet: Recently transitioned to hypoallergenic goat recipe diet trialSkin: Current episode of scabby lesions noticed 1 week ago. Lesions present on back legs, under arms, and between toes. Forms pustules that then scab over. Still licking paws, particularly between toes and on top of feet. Less itching since starting Cytopoint but continues paw chewing. Fur softer since diet change but still gets very scabbyCurrent Meds: Cytopoint 10mg (patient at upper weight limit for this dose), medicated baths weekly with Malaseb, topical lotion application, Trazodone 50mg as needed for vet visits (current bottle slightly expired)EXAMMentation: BARBehavioural: Given Trazodone 15 minutes prior to examination. Accepts treats readily. Calm and cooperative during examinationIntegumentary: Red and scabby lesions noted on stifles, back of legs, under arms, and between toes. Dry feet noted. Pustular lesions present that scab over. Evidence of contact with ground after exercise potentially contributing to bacterial skin barrier compromiseDiagnostics: Skin cytology from paws and abdomen revealed excessive bacteria. No Malassezia organisms identified, likely due to current Malaseb treatmentASSESSMENTSuperficial bacterial pyoderma secondary to chronic atopic dermatitis - Cytology confirms bacterial overgrowth without concurrent Malassezia infection. Likely secondary to compromised skin barrier from underlying allergic disease. Current Cytopoint dose may be suboptimal given patient weightPLANNew Meds/Tx:- Antibiotics prescribed for 2 weeks course to address bacterial infection- Trazodone 50mg tablets dispensed (25 tablet bottle) to replace expired medicationChanges to Existing Meds/Tx:- Consider increasing Cytopoint dose to 20mg next administration as patient is at upper weight limit for current 10mg dose- Continue weekly Malaseb baths- Option to add Apoquel if pruritus increases, though currently well controlledAdditional Discussion:- Pyohex leave-on conditioner recommended as alternative to current lotion, can be used up to twice weekly- Rinsing after park visits recommended to remove topical allergens- Diet trial to continue as food allergy remains possible differential- Fungal culture offered ($45) but declined as ringworm considered unlikely given patient age, household exposure, and clinical presentation- Insurance claim to be processed    Vital Signs    Weight: 9.7;