C09972500 / invoice 10000

Appointment Notes: VETSTORIA - (New client) - Buddy (Dog) - Maxine Chisholm - 0417110452 - Consult - General (Sick) [Clinician : Dr Tara(No Preference)] - Insect bites -HISTORY:Doing well: Eating, drinking and toileting normallyCurrent Medications: Yes - O using purple spray (anti-inflammatory and numbing) on feetMedical conditions: Yes - Chronic skin allergies, previous interdigital infection treated with antibiotics at another clinicVomiting or diarrhoea: NoAny Concerns: Yes - Pruritus and chewing at feet (front right foot predominantly, also front left), bitten by midges on feet, O had to use Elizabethan collar to prevent self-trauma. Has been limping on the RFL.Diet: Primarily turkey and Ivory coat diet, previously fed vegetables and kangaroo.Appetite and thirst: NormalFlea/tick: UTD, uncertain of brandOther relevant history: Recently relocated. Chronic skin allergies ongoing issue. Enjoys swimmingEXAMINATION: Demeanour: BAR MM: Pink, moist, CRT <2 Eyes: Clean and clear, normal eyelids, no erythema or discharge.Ears: Minimal debris, no inflammation or odour.Lymph nodes: Peripheral lymph nodes palpably normal Oral: No oral lesions or abnormalities detected.Teeth: Dental grade 0-1/4, normal occlusion. COHAT Level Estimated: ACardiovascular: Normal heart sounds, no murmurs or arrhythmias detected, femoral pulses synchronous and normodynamic.Respiratory: No nasal discharge, normal bronchovesicular lung sounds in all 4 quadrants, no coughing seen.Abdomen: Soft and comfortable on palpation, no masses palpated, bladder unremarkable.MSK: Elbow inflammation present, lameness notedIntegument: Front right foot - evidence of self-trauma from chewing, healing. Front left foot improvingNeurological: Normal mentation, no ataxia or CP deficits observed. Full exam not performed.Reproductive/Urogenital: External genitalia normal in appearance.Rectal: Not performedPROBLEM LIST:- Bilateral Elbow pain/crepitus - suspected chronic DJD secondary to age and conformation- Pruritus and self-trauma to front feet secondary to midge bites- Chronic skin allergies - well managed with topical medsDIAGNOSTICS:None todayASSESSMENT:Patient presenting with elbow pain (likely OA) requiring anti-inflammatory intervention and rest. Chronic pruritic skin disease with current acute flare affecting feet from midge bites. Treatment plan includes anti-inflammatory medication, joint support supplements, exercise modification, and continued topical management of feet. Monitoring response to conservative management with escalation options available if inadequate response.MEDICATIONS:Meloxicam 2.5mg PO SID for 7 day then PRN up to SIDContinue cortavance spray and malaseb soaks to pawsPLAN:- Dispense 1 week course of Meloxicam SID with food, with additional supply for PRN use on sore days- Start joint supplements: fish oil, Antinol, and 4Cyte recommended- Rest for couple of days, then reintroduce gentle movement with lead walks only- Exercise modification: avoid jumping down and loading elbows, continue swimming (low impact exercise)- Continue topical management of feet with current spray- Monitor abdomen for GI side effects from NSAID- Consider Zydax (Cartrophen) injections (once weekly x 4 weeks, then boosters every 6 months or full course PRN) if inadequate response to current plan (O declined for today)- Beransa injection option available as last line if long-term pain control needed- Return if requiring daily anti-inflammatory medication, indicating need for additional interventions- Recheck PRN    Vital Signs    Weight: 24.3;       HeartRate: 110;