C10028491 / invoice 10000

Appointment Notes: Overdue remindersReason: Client Present:Nurse:Healthy Pets Wellness Testing: Done Yes / NoVaccination Type:Intestinal worming:Heartworm Prevention:Flea Prevention:Tick control:Microchip:Insurance and Healthy Pets Plus:Behaviour concerns:Current medications:Current Diet:Type of Shampoo/Frequency:Toileting:__________________________________________________________________________HISTORY:Hunter presented for routine vaccinations and ongoing skin allergies. Hunter had been on Apoquel previously with good response but medication ran out and skin problems returned quickly. Started scratching ears significantly after stopping Apoquel. Ear infections appear to correlate with allergy flares. Alo has chronic skin issues with itchy, oily belly and characteristic red staining. Current meds: noneVaccination: UTDParasite Prevention: Not mentionedPre-existing conditions: Hunter - skin allergies, recurrent ear infections. Access to toxins eg. Rodenticide: noneEXAMINATION:Body Condition Score: Hunter 6/9, Pain 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): grade 0- Abdominal: no detectable pain on abdominal palpation- Rectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: Hunter - scabs on belly, red staining, scratching around neck area. Alo - papules and pustules on abdomen, not actively infected but developing, evidence of scratchingLymph Nodes: NSFEyes: NSFDemeanour/Behaviour: both dogs nervous but cooperativePROBLEM LIST:Hunter - skin allergies with secondary ear irritationDIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Environmental allergies (both dogs)Allergic dermatitisDIAGNOSTICS:Ear cytology performed on Hunter - minimal bacteria observed (approximately 5 bacteria), insufficient to warrant antibiotic treatmentASSESSMENT:Hunter presented for routine vaccination and ongoing management of skin allergies. Physical examination revealed characteristic signs of allergic dermatitis with scabs and red staining on ventral abdomen. Ear cytology showed no bacterial presence, suggesting early infection or allergic inflammation rather than active bacterial otitis. Also examined for skin problems showing papules and pustules consistent with allergic dermatitis flare. Both dogs appear to have environmental allergies given seasonal pattern and consistent diet history. TREATMENT:Hunter - vaccinated with C5 and intranasal kennel cough vaccinecommenced on Apoquel 5.4mg tablets - loading dose of one tablet twice daily for 14 days, then maintenance dose of one tablet dailyOtoflush ear cleaner dispensed for gentle ear cleaning at homePLAN:Continue Apoquel therapy as prescribedMonitor response to treatment over next few weeksConsider reducing frequency if good control achievedMoving house in 3 weeks may help identify environmental triggersWeight management to continue for AloReturn if ear problems worsen or skin condition fails to improveCLIENT COMMUNICATION:Discussed connection between allergies and ear infections. Explained that controlling underlying allergies often resolves secondary ear problems. Advised on proper ear cleaning technique using gentle cleaner. Discussed environmental allergy management and potential triggers including grass contact. Advised to avoid harsh ear cleaners like Epiotic during inflammatory episodes.    Vital Signs    Weight: 7.5;