C10026754 / invoice 10000

13/03/2026 Phone consultation with owner regarding allergies and diarrhoea. 
Bao has recurrent diarrhoea and does have some itchy skin which was well controlled with the apoquel but has flared up. He has a good appetite but has lost weight on some of the dry foods. He generally has a mixed home cooked food. 
We have discussed the recommendation for a royal canin anallergenic trial and that this should be introduced slowly over a 2-3 week period, slowly increasing the amounts of new food and decreasing his old foods. 
We have discussed if we have to using crocodile and tapioca for training but nothing else, ideally anallergenic only if possible
We have discussed the difference between apoquel, zenrelia and cytopoint and that these may be required longer term. 
We discussed option for referral to a dermatologist for allergy testing, however they cannot test for every allergen. 
Ideally I would start with a dietary trial and then adjust after this depending how he goes. 
If diarrhoea an ongoing issue we may need to consider faecal analysis +/- vitamin B addition into the diet. 

DISCHARGE INSTRUCTIONS
We have discussed options moving forward for Bao's diarrhoea and itchy skin. We recommend a food trial of royal canin anallergenic (or hills z/d) for at least 6 weeks to monitor both the gut and the skin. Ideally this should be his sole diet, however if we have to, use crocodile and tapioca for training. 
We recommend apoquel in the meantime to settle his skin and can consider cytopoint injections longer term once it has settled, vs apoquel ongoing. 
We have discussed the option for referral to a dermatologist for further investigation and allergy testing but have explained the limitations of this. 
If his diarrhoea is ongoing despite the dietary change we may need a faecal analysis to assess further. 
We have dispensed some apoquel whilst you consider the other options.  If you have any concerns or queries please do not hesitate to contact the clinic