C10030904 / invoice 10000

Appointment Notes: itchy skin - havent seen before - stHistory:Recently washed after rolling in something dead.Presenting for: Mario presented for hot spot dermatitis behind the ears following unsuccessful treatment with Neocort from another veterinary clinic.Historical Conditions: Dog dislikes being dried after bathing, with fur around neck remaining damp. Previously taken to another vet where area was clipped and dried, and Neocort was dispensed. Mario became frantic when Neocort was applied and owner was unable to continue treatment.Skin: Owner reports significant shedding recently. Thick fur coat noted.Diet: Has lost some weight recently.Examination:Mentation: BARHR: Approximately 90 BPMMM: Pink and wetCRT < 2 secT: NormalEyes: FineEars: Both ear canals normal - checked as hshaking his head - have been using Paws recently and O says seemed to react to this one. Recommend go back to the previous (sounds like that was epi-otic)Oral: Some tartar on upper canines but acceptable. Other teeth good.Cardiovascular: Heart normalRespiratory: Lungs normalAbdominal: NormalIntegumentary: Thick fur with significant shedding reported by owner. Area behind ears has been clipped with extensive dotted reaction and swelling present. No significant infection noted.Assessment:Hot spot dermatitis - Extensive lesion behind ears with inflammatory reaction and swelling but no significant secondary infectionWeight loss - Recent weight loss noted by ownerPlan:New Meds/Tx:- Chlorhexidine to be applied to affected area followed by Isaderm spironol- Macriline 1 tablet BID for today then 1/2 for 3-5 days (preferably 3 days), then 1/2 tablet morning and night for 3 days, then 1/2 tablet every second morning several timesDiet Recs:- Increase feeding to address weight lossAdditional Discussion:- Weight monitoring recommended with blood work if weight does not improve- Vaccination records and previous history to be obtained if owner continues care with this clinicCan have more isaderm if needed.Recommend a professional groom once skin is better.If fur is still an issue then check for hypothyroid etc.Also if can't turn around weight then bloodsOnly  just moved into the are and young child that is screaming a lot at the moment so could be stress.    Vital Signs    Weight: 31.7;       Temperature: 38.7;