C10031405 / invoice 10000

Dermatology referral summary:Jaxon was diagnosed with allergic dermatitis (suspected food allergy and/or atopy) with secondary Malassezia dermatitis and mild mixed otitis externa (left ear).A Cytopoint injection (80 mg) was given in hospital for itch controlA sedated ear exam is planned in 4 weeks. If infection has resolved, maintenance ear therapy will be started. If not, general anaesthesia for ear flush ± middle ear treatment may be required.Management focuses on:8-week diet trialWeekly Malaseb bathingPyohex lotion to ventrum/groin daily for 3 weeks, then twice weeklyCompounded ear medication daily for 3 weeks, then twice weeklyMonitoring response to CytopointOptional Zyrtex trial depending on itch controlOwners were advised that allergy is a lifelong condition requiring ongoing management, and that allergy testing and immunotherapy may be considered after the diet trial and once Jaxon is older than 12 months.

Medication request details: Need enough until the 3rd of febMedication: Zenrelia 15mg (per tab)Dose: Give 1.5 tablets ONCE daily.Quantity needed: 20 tablets Urgency: Pick up either tonight or wednesday morning EDUD normally/any concerns:Contact: Support staff: Kiara Dispensing Vet: Next Recheck: Made up/Ordered:Owner notified: Paid & Collected:CJ STO to check in on Jaxon, O reports he has improved significantly on the Zenrelia tablets, skin looking so much less inflamed and he has stopped obsessively chewing/biting at his groin area. STO and explained that Zenrelia not labelled for use in pups <12 months, so recommend doing Cytopoint injections until 12 months of age and then can transition back to Zenrelia. O reports she has an appointment with derm specialists next week so is happy to trial him off the Zenrelia until then. Plan:1. Withhold any anti-itch medication until consult with derm specialists next week. 

History:Presenting for rash on groin. O reports P non-stop licking/chewing at groin area and now it is so red and irritated. Has improved a bit in the week but still bothered by it. Looks similar to rash seen when P walked through long grass in the past but O reports no walks near/on grass and O has been mindful to ensure grass in backyard has been very short. Ears currently not too bad, L ear is getting a little red again but O had stopped putting the steroid down his ears because thought it was getting better so forgot. Otherwise well - EDDU normally. No CSVD. O also wanting to get his nails cut but P won't let her get near him/do them due to previously cutting his quick by accident. Current diet: kibble + butcher meat cut offs (but no chicken according to O). Examine: mostly distance exam as very anxious here, but better than usual (accepting treats)Demeanor: BARBCS: 5/9Eyes: Open and comfortable. Full ophthalmologic exam not performedEars: L ear - mild ear pinnae erythema visible. No obvious discharge bilaterally. Responds to sound. Nose: No ulceration. No crusting. No nasal discharge. Oral exam: Halitosis. No pain opening the mouth,Integument: Shiny coat. Diffuse redness on groin and scrotum with some evidence of self-traumatic bruising. No obvious crusting noted. Respiratory: Panting.MSK: Ambulating normally - weight-bearing in all limbs. Not favouring a certain limb when standing still. Full MSK exam not performed.Neuro: Appropriate mentation. Full neurological exam not performed.Assessment:1. Pruritis  - suspect underlying allergies (itch pattern/distrubtion consistent with food vs atopy).2. No macroscopic evidence of secondary infection currently (no crusting or obvious discharge). Client comm:-- Lengthy conversation about allergies and work up (very strict food trial first to r/o CFH), also discussed Cytopoint vs Apoquel vs Zenrellia. Discussed option of dermatologist referral. After discussing pros and cons of these options O elected to look into referral. O worried about current itch level, recommended Zenrellia SID until can get in with dermatologist. O may change mind and not go ahead with referral, if this occurs O to update on how P is doing on Zenrellia as may need to be on this or equivalent tx ongoing.Treatment:1. Zenrellia 15mg 1.5 tabs SID.Plan:1. CJ to organise referral to dermatologist.2. Zenrellia SID until gets into seeing dermatologist.3. Recheck if get worse before getting to see dermatologist.4. Schedule phone check in for 2 weeks time.