C09973305 / invoice 10000

Reason: Limping, Cant Weight Bear After Chasing Ball ELAppointment Notes: Overdue remindersHistory:Presenting for: Dog presented for acute onset agitation and visible irritation/trauma to the vulvar area following an incident during exercise where the dog yelped and immediately became distressed.Current Meds: Recently wormed - up to dateLifestyle Risk Factors: Exercised in areas where snakes are presentExamine: Behavioural: Very agitated and stressed initially, unable to stay still at home . Calmed down following treatment and accepted treats during examination. Appears anxious in new situations.Urogenital: Red mark visible on vulvar area with associated bruising. Medial left thigh Area caudally feels harder than contralateral side. 1cm area of inflammation to suggest insect bite (ant was seen by owner)  in caudal thigh areaNo nymph ticks seenT=38.2Mm's pinkP=112Assessment:Vulvar trauma and irritation - DDx: insect bite/sting (ants), snake bite (less likely), self-trauma from lickingPlan:New Meds/Tx:- Combination antihistamine plus corticosteroid injection administered- Human antihistamine (such as Telfast) 60mg BID for 48 hoursAdditional Discussion:- If agitation persists beyond one hour or dog remains very abnormal, recommend after hours care at Terry Hills- Snake bite considered unlikely but not impossible - urine snake detection test available at Terry Hills if concerns persist- Monitor for continued licking at vulvar area - if unable to leave area alone and condition doesn't settle quickly, recheck recommended tomorrow- Expected improvement within 30 minutes of treatmentEclaims    Vital Signs