C09979780 / invoice 10000

WEIGHT: 10.00
HISTORY: paraxysm dyskinesia. 
Blood test to rule out metabolic disease

WEIGHT: 9.95
HISTORY: Subjective
Presenting Concerns:  
Caesar presented for a 4-day history of a left eye issue. The owner reports observing discharge and occasional squinting. The owner notes the condition seems to be improving.  
  
Historical Conditions:
-   The owner reports a history of a yeast ear infection approximately one year ago.
  
Lifestyle Risk Factors:
-   Has access to a sand pit which he has been playing in

Objective
Mentation: BAR  
Wt: 9.95 
BCS: 6/9  
T: Not taken  
P: —  
R: —  
MM: pink/moist. CRT < 2sec.  
Hydration: Normal  
  
Emotional Assessment: — WATCH - WILL BITE -HAD A GO 
  
Eyes: Right eye is normal. The left eye has evidence of conjunctivitis - eye comfortable, no squinting, scant, serous discharge medial canthus. Mild conjunctival inflammation. Cornea clear - no dye uptake.  Pupils normally reactive
Ears: Clean with no discharge or erythema AU.  
Nose: Clear, moist without discharge.  
Throat: No inducible cough upon tracheal palpation; no palpable masses.  
Oral: Calculus and gingivitis absent. No masses or other lesions.  
Cardiovascular: No murmurs or arrhythmias, strong synchronous pulses.  
Respiratory: Normal bronchovesicular sounds bilaterally.  
Abdominal: No organomegaly or mass effects. No pain on palpation.  
Lymph Nodes: No peripheral lymphadenopathy.  
Integumentary: No evidence of ectoparasites, full coat with clear skin.  
Neurologic: No ataxia, normal mentation.  
Musculoskeletal: Ambulation normal, no lameness observed.  
Urogenital: Normal external anatomy.  
Rectal: Not performed.  
  
Point of Care Diagnostics:
-   Fluorescein stain (left eye): Negative for corneal ulceration.
-   A topical anesthetic was applied to the left eye to facilitate an examination for foreign material; none was found.

Assessment
Conjunctivitis, left eye - Likely secondary to environmental irritation. Ddx - allergy. A fluorescein stain test was negative for corneal ulceration, and no foreign body was identified on examination -unable to look under TE as dog going nuts trying to bite me...

Plan
Medications/Treatments:
-   Dispensed chlorpoptsone
-   Instructions: Apply a small amount of ointment into the lower eyelid of the left eye BID to TID. 
  
Additional Discussion:
-   The condition is expected to resolve in 3-5 days.
-   The owner was advised to return for a recheck if the eye condition worsens.
-   The owner was informed that the conjunctivitis is not considered contagious to the other dog in the household.
-   Discussed the owner's concern regarding a previous ear infection. Provided reassurance that a single infection one year ago is not indicative of a chronic issue.

WEIGHT: 9.95
HISTORY: Has had 2 episodes in last 2 days of "strange behaviour". Owner showed video and can see Caeser suddenly flexing a forelimb and stumbling due to the flexed leg, is conscious and no tonic/clonic movements, lasts about 20 seconds then he is normal. Owners said did not defecate or urinate and was playing with the other 2 dogs (seen in video) prior, has been caught on doggy cam in backyard. Was normal after and normal prior, no other signs and no gastro signs seen

see video attached (not sure if can attach) was sent to emails- looks like Paroxysmal Dyskinesia
suspect this as no pre or post ictal signs, not at rest prior and is conscious throughout, other Ddx is partial seizure but less likely
literature suggests a link between Gluten intolerance

BAR,TPR-WNL
teeth- mild gingivitis only- teeth quite clean
BCS 6.5/9
PLN-WNL
a bit snappy for exam
neuro-nsf
rest of exam-nsf

recommended bloods to rule out their is no metabolic trigger but suspect Paroxysmal Dyskinesia which is a benign condition

owners to report if frequency increases

C5 given (new Vanguard C5)