C09979757 / invoice 10000

Appointment Notes: General check up, discuss vaccination  ------- Sms reply: YHistory:-Does not want to do vaccinations anymore. -Wants to check large lump on left side chest and also sore on top of neck-Not wanting to do blood test as she needs sedation and she does not tolerate that well. -Not on hepatoadvanced anymore. -On 4cyteAssessment:-Discussed OA pain and alternatives. Beransa/gaba/NSAIDs   >> Owner not keen due to cost & possible side effects as history of liver disease. -Dicussed left sidechest lump, FNA vs excisionand histo but owner does not want to do anything that involves sedation/Gax so opd to leave todayTreatment:-Clipped and scrubbed pyoderma with chlorhexidine-Home on Cephalexin 8 days and owner to treat with saline solution and betadine    Vital Signs    Weight: 21.5;       HeadEyes: Normal;       Nose: Normal;       Skin: Abnormal (Left side chest 50 mm diam SC mobile growth. Also, right/dorsal neck base apears to have old scar and part of it deep pyoderma  >> may have been old dog bite from their other dog);       MusculoSkeletal: Abnormal (Obvious OA pain);       Ears: Normal;       Neck: Normal;       LymphNodes: Normal;       Heart: Normal (panting, hard to auscultate);       Lungs: Normal;       Abdomen: Normal (Tense);       HeartRate: 130;       Demeanour: QAR (Anxious dog, placed muzzle for exam);       Hydration: Normal;       Observation: Abnormal (No oral exam, owner unable to show me her mouth/teeth);       

Appointment Notes: noc History:-Due for c5.-Been quite well. -Still on hepatoadvanced. Ifshe stops even for a week then she stops eating.  Fed chicken minced /salmon / sweeet potato. Does not like yogurt much.-No V/D-Getting on and not able to jump as high. -Never had U/s at Animalius because concerned about sedatinve and unable to do withoutTreatment:-C5-Not keen on dental due to Gax    Vital Signs    Weight: 27;       MMColour: Pink;       MusculoSkeletal: Abnormal (Suspects OA, stiff gait);       Ears: Normal;       Neck: Normal;       Heart: Normal (hard to listen, panting, unable to heart murmur);       Lungs: Normal;       Abdomen: Normal;       HeartRate: 120;       Gingivitis: 1;       Calculus: 2 (Upper canines and 108/208);       BodyScore: 5;       DentalGrade: 2;       CRT: 1-2;       

Hepatoadvanced 30pk x2 boxes    Vital Signs