C10028677 / invoice 10000

History: Bathed yesterday.Last night would not stop itching face/paws.Apoquel 8mg PO BID. Sometimes 16mg PO PM.Meloxicam 0.1mg/kg PO SID for hip pain/OA/DJD, last given yesterday PM.Gabapentin 16mg/kg PO BID for hip pain/OA/DJD.Optimmune into each eye BID for KCS. No epiphora or blepharospasm. No change in diet or environment.Slipping more frequently on back legs;No lameness.Examination: Demeanour: BAR, always happy.Itch score: 10/10 lying on he floor and almost constantly rubbing his face.Integument:Moderate to severe erythema, alopecia and yellow crusting on muzzle and periocular skin.Interdigital erythema, some mild excoriations and alopecia.Ears: mild erythema, some yellow discharge/crusting present, + itch.MSK: No lameness at the walk, HL frequently slipping out from underneath him. Full exam not performed.Oral: Severe halitosis, heavy calculus build-up on upper carnassials and molars. Eyes: WNL bilaterally. Laboratory: Tape impressions from periocular skin, distal limbs and between digits;Occasional pair of cocci, +++ keratin. Ear cytology: NADAssessment: Ongoing KCSSore hips -> DJD/OA (previous bilateral hip replacements).Superficial pyoderma and malassezia infections.PododermatitisPeriocular dermatitis Lip fold dermatitis ---->> secondary to atopic dermatitis.Dental diseaseTreatment: NilConsent has been given by the client to proceed with this treatment  -  Yes/No Plan:Continue Optimmune eye-drop BID for ongoing KCS.Neocort as required for skin lesions.Had meloxicam yesterday, 3 days washout before beginning tapering course of prednisolone; 0.8mg/kg PO SID for 4 days, then 0.4mg/kg PO SID for 4 days, then 0.2mg/kg PO EOD for 2 days.Ideally need 3 days washout as had meloxicam last night, but if unable to settle can start prednisolone in 2 days.Cephalexin ~25mg/kg PO BID for 10 days.Can continue to Apoquel 16mg PO SID.Booked in for dental in 2 weeks, ideally finish prednisolone course 3 days before dental.    Vital Signs    Weight: 12.4;