C09970290 / invoice 10000

Presenting for: Scratching/licking at tail

HISTORY
- O noticed a few days licking at tail. Hair coming off tail. Usually an itchy dogs - had some hotspots around neck and has had history. Treatment last time resolved hot spots.
- Recently washed at groomers
- Also licking at feet. 
- Some D+ recently. Normal today. Urination normal.
- ED normal. No V+
Parasite prevention: UTD - nexgard
Vaccinations: UTD
Current meds: none. 

EXAMINATION
Mentation: BAR, very wriggly
HR WNLs, RR panting, clear BVS bilaterally
MM moist, pink, CRT 1sec
Oral cavity: periodontal disease grade 1/4
Eyes: clear and bright corneas, no discharge, menace/ palpebrals intact
Ears/nose: clear, no discharge
LNs: NAD
Abdo comfortable and soft on palpation, no obvious masses
MSK: ambulatory x4, no obvious lameness. 
Integument: All 4 paws globally moist, oily and erythematous and oderous. Small erythematous lesions on the neck under the left ear (healing hot spot). Large hot spot along the lateral and dorsal aspect of the tail approximately midway down the tail. Discharging and ++++ erythema. 
BCS: 9/9

ASSESSMENT & PLAN
1. Discharging, maloderous, erythematous moist dermatitis along tail. 
Prednisolone 20mg (0.47mg/kg) SID PO for 5 days then every second day until finished. 
Neocort BID topical to affected area on tail and neck
Recheck in 7-10 days

2. Moist dermatitis of all 4 paws
Pyohex wash - shampoo twice weekly, conditioner everyday to use as cream on paws.

3. Overweight
Gave handout to start working on weight loss diet. Explained ideal weight would be around 26kg.

COMMUNICATION
As above
Discussed weight loss and risk of glucocortico-induced diabetes.

In for PC

HISTORY
OR last night noticed lump behind L ear, not letting O touch it
Not himself, sleeping a lot
DUDE ok, no VD
going on walks still
no meds currently

CEX
panting +++
BAR, nice-ish boy but extremely wriggly/bouncy. Painful and when put muzzle on, kept shaking to get it off. 
Clipped fur behind left ear and on shoulder, revealing approx 2-3cm hotspots, looking very sore. Cleaned one behind ear with hibi in consult.The other one, taken sample for smear cyto - cocci ++++ and WBCs ++
Rest of exam WNL. Gums pk moist, CRT <2s.Thoracic ausc WNL, abdomen soft and comfortable, LNs WNL. T WNL.

ASSESSMENT
Bacterial skin infection, likely strep cocci looking at slides. Also taken a swab that will keep in fridge for 2 weeks.

PLAN
Os would struggle with just topical and it has spread and he has lots of long hair, unsure if other areas.
- Clavaseptin BID PO 10d, then recheck at a vets (BVG or RV) - advs then may need abx for another week or two, past the resolution.
- Neocort cream BID for the area
- Meloxicam PO SID for anti-inflam/analgesia
Adv recheck in 10d to ensure resolving

BC LVM on Os phone - reporting results from the cyto, bacterial infection, no change in plan. Recheck either BVG or RV in 10d time

HISTORY:
- O not sure what happened but pet after beach visit yesterday pet now has very runny D+ 

OBJECTIVE:
BAR
HR:  120
RR:  20
mm: pink
Oral: wnl
LNs: wnl
Abdo: wnl
Integ: wnl
Eyes: wnl
Ears: wnl
MSK: wnl
Neuro: wnl

DIAGNOSIS:
- D+

TREATMENT:
- Pro-Kolin - BID PO 
- Metronidazole - 400mg- 1 tab BID PO 5 days
- Hills i/d food - BID PO 5 days 

CLIENT COMMUNICATION:
-- if not better in 24-48 hours O to come back and we do more testing