Blu — Health Record

Weight History

lbs over time — Aug 2021 to Apr 2026

Antibiotic Courses by Year

Distinct prescriptions per calendar year

Cytopoint Injection Frequency

Each bar = one injection visit — Jun 2022 through Apr 2026

Condition Status

15 total documented conditions

Skin Flare Events by Year

Pyoderma & dermatitis episodes

Antibiotic Resistance — Staph pseudintermedius (5 skin cultures)

R = resistant · S = sensitive across cultures · Note: Jan 2023 MRSP was resistant to nearly everything including enrofloxacin

Penicillin

R×5

Amoxicillin

R×5

Clindamycin

R×4

Erythromycin

R×4

Enrofloxacin

R×1

Cefpodoxime

R×1

Doxycycline

S×5

Amikacin

S×5

TMP/SMX

S×4

🔴 Resistant🔵 Sensitive

2026

Apr 28

Prescription — Enrofloxacin 136mg · 5 tablets, 1 daily with food

Active

Apr 24

Tech Appt — Cytopoint · DHPP, 4DX, PCP all deferred (antibiotics per Dr. Blount)

Vax deferred

Mar 24

Exam — Skin check · Pyoderma with TMTC cocci; Enrofloxacin extended; vet flagged resistance concerns

⚠ Resistance

Mar 13

Tech Appt — Cytopoint · On Enrofloxacin for bumps; bad allergy season

Routine

Feb–Mar

Multiple Enrofloxacin refills · Feb 24, Mar 4 — 7-day courses each

Feb 13

Tech Appt — Cytopoint + Gabapentin refill

Routine

Jan 14

Tech Appt — Cytopoint · DHPP deferred (reaction concerns)

Vax deferred

2025

Dec 24

Tech Appt — Cytopoint · Lepto, Bordetella, Influenza, DHPP all declined

All vax declined

Sep 5

Exam — Perivulvar dermatitis · Scooting, red vulvar area; UA: Protein 1+ (H), Bilirubin 1+

⚠ UA abnormal

Jul 8

Recheck — Right eye OD · Corneal ulcer resolved; 2mm residual edema; pyoderma improved

Resolved

May 28

Exam — Possible UTI · Urinary accidents indoors; UA: WBC 20–30 HPF (HIGH), Protein 1+ (H); AFAST normal

⚠ WBC elevated

Apr 16

Senior Bloodwork · SDMA 15 ug/dL (HIGH · ref 0–14); urine sample never received by lab

⚠ SDMA high

Mar 3

Recheck — Left eye OS · Corneal ulcer fully resolved; mild facial fold flare; Cytopoint given

Eye resolved

Feb 24

Recheck — Corneal ulcer OS · New linear ulcer; corneal debridement; switched Terramycin → ofloxacin

⚠ New ulcer

Feb 17

Recheck — Left eye OS · Worsened on Terramycin; gabapentin added for pain

Worsening

2024

Dec 30

Annual Exam + Cytopoint · DHPP 1-yr booster given; Lepto deferred; pyoderma improving

DHPP given

Sep 4

Recheck — Severe skin flare · Culture: Staph pseudintermedius 4+ (enrofloxacin-sensitive)

⚠ 4+ Staph

Apr 2

Exam — Heska panel review · Atopica started; HA vegetarian diet started; new protocol

New protocol

Jan 4

Recheck — Active pyoderma + corneal ulcer OS · Staph 2+ + Enterococcus faecalis on culture

⚠ Dual infection

2023

Jan 16

Skin Culture — MRSP confirmed · Resistant to enrofloxacin, methicillin, cefpodoxime, TMP/SMX, carbapenems — nearly everything

⚠ MRSP

Jun 29

Recheck — Corneal ulcer OS confirmed · Facial fold pyoderma; Tobramycin + Simplicef started

Corneal ulcer

Jul 18

Recheck — Both resolved · Corneal scar OS only; skin completely clear

Resolved

2022

Jul 18

Spay Surgery (OVH) · Routine; uneventful recovery

Completed

Apr 8

Exam — Severe pyoderma · Bilateral MPL noted (grade 2–3); Clindamycin + Ketoconazole

⚠ MPL noted

2021

Aug 17

Exam — Neck wound + possible seizure · 1-min episode of stiffness/unresponsiveness; never formally worked up

⚠ Seizure-like

Condition	First Noted	Status	Notes
Atopic Dermatitis	2021	Active — Chronic	Environmental allergies confirmed via Heska panel. Worse in spring.
Recurrent Pyoderma	2021	Active	Staph pseudintermedius on every culture. Currently on enrofloxacin.
Food Allergies	2022–2024	Managed	Multiple protein sensitivities. Controlled via Purina HA Vegetarian diet.
BOAS	Throughout	Active	Moderate stertor (breathing noise) at every exam. No surgical intervention.
MRSP Infection	Jan 2023	Historical	Later cultures show enrofloxacin-sensitive strains — but resistance can re-emerge.
Perivulvar Dermatitis	2021	Recurrent	Episodic redness/swelling. Linked to allergy flares.
Corneal Ulcer OS (Left Eye)	Jun 2023	Resolved	Recurred Feb 2025; required debridement. Fully resolved Mar 2025.
Corneal Ulcer OD (Right Eye)	Jul 2025	Resolved	Resolved by Jul 8, 2025 recheck.
Bilateral Patellar Luxation	Apr 2022	Unmanaged	Grade 2–3 left, grade 2 right. No surgery. Gabapentin PRN may relate.
Pododermatitis	2021	Improved	Interdigital erythema/swelling. Improved with diet + topicals.
Otitis Externa (Right Ear)	Aug 2023	Resolved	TNTC rods. Treated with Baytril/Conofite drops. No recurrence.
Urinary Symptoms / Possible Incontinence	May 2025	Unresolved	Accidents indoors; dripping urine at rest. UA: elevated WBC + protein. Not followed up.
Elevated SDMA (Kidney Marker)	Apr 2025	No follow-up	SDMA 15 ug/dL (high). Urine sample never received. No repeat test.
Dental Disease	Throughout	Active	Gingivitis grade 1–2/4, calculus at every exam. No cleaning ever performed.
Possible Seizure Episode	Aug 2021	Unworked-up	1-min stiffness/unresponsiveness. CNS normal. Never investigated.

Currently Active

Enrofloxacin (Baytril) 136mg

1 tablet orally every 24 hrs · Give with food · Antibiotic for pyoderma

Current

Cytopoint 30mg (Lokivetmab)

Subcutaneous injection approx. every 3 weeks · Targets IL-31 · Given at clinic

Current

Gabapentin 100mg

1 capsule every 8–12 hrs as needed for pain · May cause sedation

Current PRN

Diphenhydramine (Benadryl) 25mg

Once daily as needed · Antihistamine

Current PRN

Nexgard (Afoxolaner) 24–60lb

1 tablet orally every 30 days · Flea and tick prevention

Monthly

Heartgard (Ivermectin/Pyrantel)

Monthly oral tablet · Heartworm prevention

Monthly

Current Topical Protocol

MiconaHex+Triz Shampoo (medicated baths) · MiconaHex+Triz Wipes (daily fold/paw cleaning) · Vetericyn Plus VF Spray · Diluted chlorhexidine spray PRN

Diet: Purina Pro Plan HA Hydrolyzed Vegetarian — required long-term. No treats or food additions without vet approval.

Historical (Discontinued)

Medication	Used For	Notes
Atopica (Cyclosporine) 50mg	Atopy immune modulation	GI upset at higher doses; status unclear in 2026 records
Cefpodoxime (Simplicef) 100mg	Antibiotic	Used 2022–2024; replaced by enrofloxacin
Clindamycin 150mg	Antibiotic	Used 2021–2023; resistance developed
Amoxicillin/Clavulanate 125mg	Antibiotic	Used 2024; discontinued
Ketoconazole 200mg	Antifungal (with Atopica)	Liver monitoring required
Prednisolone 5mg	Severe flares	Owner: “the only thing that significantly helped”
Terramycin ophthalmic ointment	Corneal ulcer OS	Discontinued — adverse reaction (more redness, squinting)

⚠️

DHPP Repeatedly Deferred

The 3-year DHPP booster (Parvovirus, Distemper, Adenovirus, Parainfluenza) has been declined at every appointment from December 2024 through April 2026 due to reaction concerns and concurrent antibiotics. Now that antibiotics are completing, a specific vaccination plan with pre-medication should be scheduled.

Vaccine	Last Given	Status	Notes
Rabies (3-year)	Jun 4, 2025	✓ Current	Due ~June 2028
DHPP	Dec 30, 2024 (1-yr)	⚠ Overdue	3-year booster needed; repeatedly deferred
4DX Test	Mar 27, 2025	All Negative	HW, Lyme, Anaplasma, Ehrlichia — all clear
Heartworm Prevention	Monthly (Heartgard)	✓ Current	Ongoing monthly oral
Bordetella	Never	Declined	Indoor lifestyle; owner declines
Leptospirosis	Never	Declined	Repeatedly deferred; worth discussing given Sacramento wildlife
Canine Influenza	Never	Declined	Indoor lifestyle; owner declines

Senior Panel — April 16, 2025

🔴

SDMA Elevated — Early Kidney Function Concern

SDMA 15 ug/dL (reference 0–14). SDMA is an early, sensitive marker of reduced glomerular filtration rate — it rises before creatinine. The urine sample ordered alongside this panel was never received by IDEXX and has not been followed up in over a year.

SDMA ↑

ug/dL

Ref: 0–14 · HIGH

Creatinine

0.9

mg/dL

Ref: 0.5–1.5 ✓

BUN

mg/dL

Ref: 9–31 ✓

Chloride ↓

105

mmol/L

Ref: 108–119 · Low

ALT

U/L

Ref: 18–121 ✓

ALKP

U/L

Ref: 5–160 ✓

Glucose

100

mg/dL

Ref: 63–114 ✓

Cholesterol

290

mg/dL

Ref: 131–345 ✓

T4 Thyroid

1.4

ug/dL

Ref: 1.0–4.0 ✓

Free T4

0.8

ng/dL

Ref: 0.6–3.7 ✓

HCT

54.3

Ref: 38.3–56.5 ✓

WBC

6.9

K/uL

Ref: 4.9–17.6 ✓

Platelets

311

K/uL

Ref: 143–448 ✓

Urinalysis — May 28, 2025

🔴

Elevated WBC + Protein (free-catch sample)

WBC 20–30 HPF (reference 0–5). Protein 1+ (high). Free-catch samples can produce false-negative bacteria results. Combined with elevated SDMA, a repeat urinalysis via cystocentesis + urine protein:creatinine ratio (UPC) is needed.

WBC ↑

20–30

per HPF

Ref: 0–5 · HIGH

Protein ↑

Should be negative

Bilirubin

Trace can be normal

Bacteria

None seen

Free-catch; may be false neg

Sp. Gravity

1.041

Ref: 1.030–1.098 ✓

6.5

Ref: 6.0–7.5 ✓

Skin Culture History — Staph pseudintermedius

Date	Organism / Load	Key Resistances	Enrofloxacin
Jan 2023	MRSP 2+ + Enterococcus faecalis	Resistant to methicillin, enrofloxacin, cefpodoxime, TMP/SMX, carbapenems — nearly everything	RESISTANT
Jun 2024	Staph pseudintermedius 1+	Penicillin, erythromycin, clindamycin, amoxicillin	Sensitive
Sep 2024	Staph pseudintermedius 4+	Penicillin, erythromycin, clindamycin, amoxicillin	Sensitive

🔴

1 · Elevated SDMA — No Follow-Up in 13+ Months

April 2025 bloodwork flagged SDMA at 15 ug/dL. This is an early, sensitive kidney marker that rises before creatinine. The urine sample ordered at the same time was never received. Blu is also on chronic enrofloxacin, which is renally cleared. A repeat kidney panel + clean cystocentesis urine is urgently needed.

🔴

2 · Persistent Proteinuria Across Two Urinalyses

Both May and September 2025 UAs showed protein 1+ (high). Combined with elevated SDMA, this raises concern for early kidney disease or chronic urinary inflammation. A urine protein:creatinine ratio (UPC) on a sterile sample should be requested.

🟠

3 · Antibiotic Resistance Risk — Culture Overdue

Blu was on enrofloxacin almost continuously from February through April 2026. The vet explicitly documented resistance concerns in March 2026. A confirmed MRSP infection in 2023 was resistant to nearly everything. A fresh culture before the next antibiotic course is overdue.

🟠

4 · DHPP Core Vaccine Severely Overdue

DHPP declined at every visit since December 2024. This covers Parvovirus, Distemper, and Hepatitis — core vaccines important even for indoor/walk-only dogs. Now that antibiotics are finishing, a specific plan with pre-medication should be scheduled.

🟨

5 · Urinary Incontinence Not Definitively Addressed

Urinary accidents and dripping urine at rest (May 2025) are classic signs of urethral sphincter mechanism incompetence (USMI) — common in spayed older female dogs. Management options like Proin (phenylpropanolamine) should be discussed if still occurring.

🟨

6 · Bilateral Patellar Luxation — Never Treated

Grade 2–3 MPL in both knees noted in April 2022. Blu receives gabapentin PRN. At 10+ years, this is a source of chronic pain. No surgical discussion or recent joint assessment has been documented.

🟨

7 · Dental Disease — Never Professionally Treated

Gingivitis grade 1–2 and moderate calculus at every single exam across years. No professional dental cleaning has ever been performed. Dental disease contributes to systemic inflammation and can worsen kidney and cardiac health — particularly relevant given the kidney concerns.

🟨

8 · 2021 Seizure-Like Episode — Never Worked Up

A single episode of stiffness and unresponsiveness (∼1 minute) reported August 2021. CNS exam was normal, but no imaging, EEG, or neurology referral was pursued. In a now 10-year-old Frenchie with multiple health issues, this history is worth discussing.

“Blu’s SDMA came back elevated in April 2025 and the urine sample was never received by the lab. Can we recheck her kidney function with a fresh blood panel, and collect a clean cystocentesis urine sample to properly evaluate her protein levels and rule out early kidney disease?”

“Given that Blu has been on enrofloxacin almost continuously for months, and given her MRSP history from 2023, can we do a fresh skin culture before the next antibiotic course to confirm the bacteria is still sensitive and rule out resistance developing again?”

“Blu’s DHPP vaccine has been deferred repeatedly. Now that the antibiotic course is finishing, can we schedule a specific vaccination appointment — and is there a pre-medication protocol we should follow given her history of reactions?”

“Blu was prescribed gabapentin for pain — can you confirm what this is treating: her skin discomfort, her bilateral knee caps (MPL diagnosed in 2022), or something else? Should we do a formal joint and pain evaluation given her age?”

“Blu had urinary accidents and was dripping urine while resting in 2025. If that’s still happening, should we evaluate her for urethral sphincter incontinence and discuss treatment options? And should Atopica still be part of her allergy protocol?”

Enrofloxacin + Kidney Function

Fluoroquinolones are renally cleared. Given Blu’s mildly elevated SDMA, prolonged use could put additional stress on kidney function. Needs monitoring, especially with her proteinuria pattern.

Benadryl + Gabapentin

Both cause sedation. If given together — even as-needed — Blu may be more drowsy than expected. Monitor for excessive sedation, weakness, or difficulty breathing.

Enrofloxacin + Calcium-rich Foods

Enrofloxacin absorption can be reduced by calcium. Avoid giving the pill at the same time as dairy or calcium-rich foods.

Atopica + Enrofloxacin (if restarted)

Cyclosporine can slightly increase fluoroquinolone blood levels. Both are processed by the kidneys. Kidney and liver values should be monitored if used together.

HA Vegetarian Diet — Strict Protocol

Do not supplement with any treats, table scraps, chews, flavored medications, or toppers without vet approval. Even small amounts of allergen proteins can trigger a skin flare.

Cytopoint + Immunosuppressants

Cytopoint (lokivetmab) is a targeted biologic with minimal systemic immune suppression — generally safe alongside gabapentin and antihistamines. Discuss combined immune effect if Atopica is restarted.

Blu.

The essentials.

Every visit.

15 documented conditions.

What Blu takes.

DHPP is overdue.

The numbers.

8 things that need attention.

Bring these five.

What to watch.