C09971842 / invoice 10000

Presenting complaint/reason (check up - a number of concerns)
Presenting owner: (Mr O)

History
Current concerns 
1) Seems to be slowing down - healed well since HBC.  seems mobile, can run/jump.  less energetic - tires more easily - wants to go for a walk but then sits/lays down soon after.  no coughing or fast breathing.  
2) Check teeth 
3) Check AGs 
4) Check scab on belly.

Chronic medical conditions 
1) HBC -->  LHL instability at the tarsometatarsal level of the tarsus -->  initially thought would need partial arthrodesis, but palpable union and minimally lame - conservative management has been continued (2025) 
2) Cyst on head (2022) - surgically removed
3) AGs (2022) - regular expression required 
4) Exlap FB (2022) 
5) Hip dysplasia suspected (2023)

Current medications (nil; tried a few different meds for AGs - nothing helped.  analgesia - no improvement)

Prophylaxis: Tick/Flea (simparica trio) Vaccinations (KC due May 2026, C3 due July 2026)  Worming (simparica trio) HW (simparica trio)
EDDU (eating well; drinking - much the same.  no diarrhoea.  urine - no changes noted.  )
Vomiting/hairballs (occasionally vomits after drinking)
Diet (hills j/d.)
Environment (no changes)
Behaviour  (slowing down)

Examination
Weight changes (gained) BCS   (4/9) MCS (no overt muscle mass loss.)
Demeanour (QAR)
HR (Varies from 120 to 180, sounds like there is a fibrillation event.  Brief ECG - no VPC or atrial fib noted.  Query flutter, blood clot, or other? can not exclude arrhythmia occurring intermittently and missing it with ECG - holter monitor may be needed to detect.  Given exercise intollerance DCM is a consideration.  )
RR (24)
mm (pink)
Dental (gr1)
Ears (NAD)
Eyes (NAD)
Skin (small scab ventral abdomen - monitor for signs of infection.  r/c if not healing or other concerns develop)
Lymph nodes (NAD)
Heart and lungs (concerned arrhythmia (3 vets listened and all could hear an intermittent abnormal rhythm))
Musculoskeletal (OA changes)
Abdominal palpation (NAD)
Temperature (not taken FAS high)
AGS - expressed - difficult to express, normal material

Assessment (Concerned exercise intollerance due to cardiorespiratory disease)

Diagnostic plan (Echo + thoracic rads + cbc/biochem +/- order holter monitor)
Treatment plan (nil for now. )
Client communication (monitor RRR.  if concerns present to emergency over the w/end.  )

Reason: Anal Gland Expression

History: Has regular expressions

Treatment: Expressed both anal glands
Size and contents: 
Right = full and normal
Left = full and normal

Plan:
1. Anal gland expressions as required