C10031707 / invoice 10000

Ear infection

Consult - General
PRESENTING COMPLAINT:  
(Discharge from L ear - noted a few days ago
Rubbing L ear, but not scratching
Hx of atopic dermatitis - Cytopoint inj 2 weeks ago
No V/D)

SUBJECTIVE/ HISTORY:
EDUF normally, no changes
  Current Medications: (Gabapentin 600mg evening before and 2 hours prior to appt +  Cytopoint injs)
  Vaccination Status:  (UTD)

OBJECTIVE/ EXAMINATION: PE very limited due to patient demeanour
Temperature:(not performed)
Mentation (BAR) BCS:(6)/9
Hydration:(WNL)
Mm pink and moist, CRT <2 sec
Dental:(Unable to examine)
Oral exam: (Unable to examine)
Eyes: (NAD)
Ears: (NAD)
HR: (unable to auscultate) bpm, rhythm (), Mumur (), pulses ()
RR: (unable to auscultate) pm, effort (), Aus pulmonary fields ()
Abdominal palpation: (Not performed)
Integ: skin and coat healthy, no obvious lesions or lumps noted, normal skin recoil
Msk: (Normal ambulation, NAD)
Peripheral LNs: (WNL)
Neurological: a full neurological exam not performed

LABORATORY:
(IH cytology for ears
L: Cocci+++, rods++, Malassezia++
R: Cocci+++, Malassezia+)

ASSESSMENT/ PROBLEM LIST:
(1. Bilateraly otitis externa - unable to visually examine ear canals due to patient demeanour)

DD's:
(1. Underlying atopic dermatitis/allergies (environmental vs food))

TREATMENT:
(Home with Baytril drops 1ml bilaterally BID for 14 days)

PLAN:
(Recheck 24-48 hours after compeletion of topical drops )

 

allergy  injec
Reprinted Oct gabapentin script. Not sure if O needs a new script today?? In drugs for collection. MG

S: Previously Ocean Keys client. Has been on apoquel, prenisolone and Cytopoint for allergies so O's are a bit confused as to what he needs. They tried an ellimination diet with a hydrolysed product but only got to 7 weeks and their child kept giving him other foods. He was also on allergy meds at the time so they don't know it if worked/helped. A blood test fro allergies was run through Oceans Keys - showed allergies to dust mites and some grass.

     Male O thinks the Cytopoint inj works well for 3 months
      Female O not giving apoquel tablets every day but starts them when Billy starts scratching.
       Not needing consult today, just cytopoint injection

O: no obvious skin rashes from distant visual and O's hx.

Tx: Cytopoint 40mg s/c while muzzled and eating treats

PLAN:
Reprinted gabapentin script for O to get before future visits as PVP's
Cytopoint injections as needed 
Consider a elimination diet if they can to see if a food componenet to allergies.
Do not give apoquel intermittently. If Cytopoint fails to work monthly, can get script for apoquel /zenrelia to use daily.

skin allergies
asked if any other concerns, O declined

Consult - General
PRESENTING COMPLAINT:  
( hx of pruritus/ allergies. 
were going to Ocean Keys Vets and was getting cytopoint injections and apoquel tablets in between. was going q3m but trying to push it to 6
had bloods done to see exactly what he was allergic to? showed that he was allergic to dust mites. 
has been about 6 months since last injection, now reg vet under new ownership 
gets grain free kangaroo kibble. have not put him on a truly hypoallergenic diet. 
had parvo? as a pup
is a nervous dog and doesn't like people touching the back of him 
)

SUBJECTIVE/ HISTORY:
  Appetite: ( normal)
  Water Intake: (normal)
  Urination: (normal)
  Faeces: (normal)
  Current Medications: (apoquel - unsure of dosage, 1 tablet - when he has flare ups)
  Vaccination Status:  (UTD)


OBJECTIVE/ EXAMINATION:
Temperature:()
Mentation (BAR) BCS:(4.5)/9
Hydration:(normal)
Mm pink and moist, CRT <2 sec (did manage to check while giving treats)
RR: (sniffing) pm, effort (normal), 
Integ: turgor wnl, unable to properly assess skin but coat overall still looks healthy
Msk: (ambulatory)
minimal exam as nervous, will take treats
Neurological: a full neurological exam not performed

LABORATORY:
()

ASSESSMENT/ PROBLEM LIST:
(1. pruritus )

DD's:
(1. likely underlying allergies/ atopy )

TREATMENT:
(cytopoint 40mg SC - male O holding, female O giving treats
apoquel 16mg- 10 tablets dispensed as per what they would usually get- 1 SID whilst cytopoint takes effect, wash hands after use
script for gabapentin PVPs 600mg 12h prior and 2h prior to vet visits)

PLAN:
( tx as above. did not charge consult today as minimal ex. )

OWNER COMMUNICATION NOTES:
(discussed tx as above, discussed PVPs- may need to add trazodone/ clonidine in addition to gabapentin. Discussed other things for more mild anxiety - zylkene, adaptil. May need to escalate to longer term  pharmaceuticals e.g. fluoxetine if others have poor effect and he is getting worse- generally fine at home but cautious of new people and can be reactive on walks with female O. O asked if cytopoint fine to use long term- adv generally tolerated well and minimal side effects. Apoquel does in theory increase the risk of cancers if used long term from a young age, however if only using relatively sparingly for flare ups this risk should be minimal. )