C10028161 / invoice 10000

Repeat medications for skin KV

Verified: NO

HISTORY
Presenting for: Rain presented for ongoing skin lesions that have not fully resolved despite previous treatment.
Historical Conditions: Previous skin condition diagnosed as allergic dermatitis with secondary bacterial infection. Previously treated with antibiotic injection and steroid injection. Has always licked the abdominal area but never to this extent previously.
Current Meds: No current medications - previous treatments have run out.
Other: Patient lives with Thunder (her son) who has been diagnosed with large cell lymphoma. Owner suspects stress from Thunder's illness may be contributing to Rain's increased licking behaviour. E-collar was used until Wednesday, after which patient immediately returned to licking the affected area. Patient also licking at feet.

EXAM
Mentation: BAR
Wt: 4.4 kg
Behavioural: Cooperative for examination
Nose: Runny nose present - likely from self-trauma while wearing E-collar
Integumentary: Abdominal lesion present with evidence of self-trauma from licking. Area shows signs of lick-scratch cycle with bacterial invasion. Feet show evidence of licking but underlying skin appears normal and pink with no ulceration - debris present appears to be from licking rather than primary skin disease.
Diagnostics: Cytology performed - confirmed coccal infection

ASSESSMENT
Recurrent pyoderma secondary to self-trauma - Likely psychogenic alopecia/pyoderma related to stress from household companion's illness. Lick-scratch cycle established with secondary bacterial infection.

PLAN
Medications/Treatments:
- Long-acting steroid injection (Malactin) administered to reduce itching and inflammation
- Long-acting antibiotic injection (Convenia) administered for bacterial infection - both treatments effective for 14 days
- E-collar to be used at home to prevent continued self-trauma
- Mirtazapine tablets discussed for Thunder but not dispensed - owner advised to contact specialist clinic for transdermal formulation as oral tablets may cause salivation and reduce appetite

Additional Discussion:
- Importance of maintaining E-collar use to break lick-scratch cycle
- Recheck appointment scheduled for day 13-14 to assess treatment response before medications wear off
- Early recheck essential to determine if infection resolved or if underlying psychological component requires different management approach
- Delayed follow-up risks antibiotic resistance and chronic infection development

Client Comms:
- Advised that stress from Thunder's condition may be contributing to Rain's excessive licking behaviour
- Explained self-perpetuating nature of lick-scratch cycle and bacterial invasion
- Emphasised critical importance of recheck appointment timing to prevent treatment failure