C09971807 / invoice 10000

Reason: Y - Licking Vulva TYLHISTORY:Loki presented for excessive licking of the vulva, which started approximately one hour prior to presentation. The owner reports that Loki growls when they attempt to stop her from licking, which is indicative of pain for her. The vulval area is wet from the licking, but no discharge has been noted. The owners applied Neosporin cream to the area shortly before arrival.Loki was diagnosed with a urinary tract infection (UTI) approximately two weeks ago at Green Cross Vets, confirmed via urinalysis. She completed a 10-day course of antibiotics which finished about two weeks ago. The current symptoms of licking have recurred since the cessation of the antibiotic course.Loki has a past medical history of gastroenteritis and known anxiety. She is spayed. Her urination and defecation habits are within normal limits, with no change in frequency and no scooting behaviour observed at home. Her appetite and thirst are also reported as normal, with no polyuria or polydipsia.Current medications: None.Prophylaxis: Not mentioned.Pre-existing conditions:- Recurrent urinary tract infection- History of gastroenteritis- Known anxietyAccess to toxins eg. Rodenticide: Not mentioned.TRIAGE:HR: 240 bpmRR: pant Temp: 39.6Mm: pink, moistCrt: <2 secondsMentation: Bright and alert but extremely anxious and stressed, constantly barking EXAMINATION:Body Condition Score: 4/9Pain Scale (0-4): 0 on abdominal palpation Hydration status (%): <5% dehydrated Cardiovascular: Pulses good quality. cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait detectedMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: no significant findings, no mouth pain- Abdominal: Soft, non-painful on palpation. normal gut sounds- Rectal: Anal glands soft and Urinary: Vulva appears wet from licking, no discharge or bleeding evident. Loki has a partially hooded vulva, which can predispose to infection.Reproductive (incl ext genitalia): Spayed. Vulva appears wet from licking, with no discharge or bleeding. A partially hooded vulva is noted.Integument/Ears: no significant findingsLymph Nodes: no significant findingsEyes: no significant findingsPROBLEM LIST:- Excessive licking of the vulva, indicative of pain.- Recurrent urinary tract infection signs.- Extreme anxiety during veterinary examination.DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:1. Recurrent Urinary Tract Infection (UTI):- Licking behaviour is likely secondary to a recurrent UTI, given the recent history and cessation of antibiotics. The hooded vulva is a predisposing factor.2. Stump Pyometra:- Less likely given the absence of systemic signs such as lethargy, significant fever, or vulvar discharge.DIAGNOSTICS:A quick POCUS was performed, bladder approximately 1-2cm. No urinary sediment noted on brief bladder ultrasonography. 		ASSESSMENT:Loki presented for excessive licking of her vulva, which is likely secondary to a recurrent urinary tract infection, given her history of a UTI two weeks prior and the recurrence of signs after finishing a 10-day antibiotic course. Her partially hooded vulva is a predisposing factor for recurrent infections. During examination, Loki was bright and alert but extremely anxious and stressed, with a heart rate of 240 bpm and a mild temperature elevation. Physical examination was otherwise largely unremarkable, with a soft, non-painful abdomen and no evidence of vulvar discharge and mild pyrexia attributed to ongoing infection and/or stress. A quick POCUS showed a small bladder with no obvious stones or sediment. Differentials such as stump pyometra are considered less likely due to the lack of systemic signs. The owner opted for outpatient management due to Loki's severe anxiety.TREATMENT:- Meloxicam 0.1mg/kg SC @1930- Methadone 0.2mg/kg SC @1930- Amoxiclav 250mg 0.5 tablet PO BID with food for 2 weeks, dispensed.- E-collar dispensed to prevent further licking.PLAN:- Continue Amoxiclav for a 2-week course as prescribed.- Owner to collect a free-catch urine sample at home using the provided sterile pot and syringe.- The urine sample should be taken to their local veterinarian as soon as possible for urinalysis. The owner was instructed to inform the vet that Loki is already on antibiotics, as this will affect the results.- A recheck with the local veterinarian is recommended in 1 week, or just before the antibiotic course finishes. A longer course of antibiotics (e.g., 4 weeks) may be necessary for a recurrent UTI.- NSAIDs were withheld at this stage due to the small possibility of underlying renal involvement.- Anxiolytic medication (e.g., gabapentin/trazodone) for future vet visits was offered to reduce stress, but the owner declined, stating Loki is usually more manageable at her local vet.CLIENT COMMUNICATION:The owner was advised to return if Loki becomes lethargic, stops eating, develops a vulvar discharge, or seems more uncomfortable. They were made aware that there would be no repeat consultation fee if Loki returns within 24 hours. The plan for outpatient management, including home urine collection and follow-up with their local vet, was discussed and agreed upon. The importance of preventing licking via the e-collar was emphasised. The owner was also educated on the potential for recurrent UTIs in dogs with a hooded vulva.    Vital Signs