C09981330 / invoice 10000

Primary Presenting Complaint - Vaccination/Check up for patient: Pepper DunningsOther Complaint - Dental disease progression, previous liver enzyme elevation requiring monitoringHistory - Previous lump treatment - no regrowth observed. Heart block treatment with associated liver enzyme elevation. Mixed breed female, middle-agedMedicine Hx - Previous liver enzyme elevation noted at time of dentalWorming Hx - Monthly broad spectrum anthelmintic with ectoparasite control - owner reports complianceExamination - Middle-aged mixed breed requiring routine vaccination with concurrent liver monitoring- Attitude - BAR but exhausted from intensive care period- Body Score - 5/10- Temperature - not taken- Heart - 100 HR. Murmur - no- RR - 24- Dental Score (0-4) and comments - Dental tartar accumulation, gr1- CRT - immediate- Eyes - NVL- Ears - clean and discharge free- Abd Palpation - Unremarkable- Gastrointestinal - No Sig Findings- Urogenital - No Sig Findings- Skin - NAD, lump removal site has healed super well- Musculoskeletal - No Sig Findings- Other Key Findings -General Health Assessment - Discussed - Owner consented to liver panel ($117) and canine cough vaccination (total ~$250). Discussed dental care technique - brushing external surfaces only, tongue cleans internal surfaces. Owner agreed to demonstration at front desk for proper toothbrush/finger thimble technique. 6-month recheck reminder set pending blood results, may adjust to yearly depending on findingsPlan - Canine cough vaccination SQ over shoulder. Laboratory: liver panel run today, alkp still mildly elevated but has come down from last time. Email sent to owner Good afternoon, It was lovely to see you again with Pepper today. We have the blood test results through and it is good news. She still has mild elevation in one liver enzyme (ALKP) but it has come down in the last few months. All other liver enzymes are normal. This is excellent news and means that we do not need to schedule any further blood tests for approximately 12 months. I will change the reminder to reflect this. If you have any questions or concerns, please do not hesitate to call. SincerelyDr Hannah BeveridgeDental care education and demonstrationPrescriptions(on-going) - Next Visit - 12 months for vacc and repeat bloods (comp profile)The above clinical notes were created with the assistance of Astro Scribe under the supervision of the consulting Vet.

PREVIOUS COMPLAINT / DIAGNOSIS:Wound infectionHISTORY:Previously presented with infected wound  on RHL after surgery.How has the disease progressed - Significant improvement. No longer producing purulent discharge. Patient no longer bothering the wound site. Increased activity tolerance.Medicine Hx - Previously prescribed medications completed. Has been using antiseptic wipes BID.Appetite - wnlToileting - wnlEXAMINATION:Healthy granulation tissue present. Appropriate crusting forming. No evidence of active infection.Attitude - BAR. Significantly improved from previous visit.Temperature - not takenHeart - not examinedRR - not examinedOther Key Findings - No pain on palpation of wound site. Appropriate healing progression with good granulation tissue formation.ASSESSMENT:Resolving wound with appropriate healing progression. Good prognosis if current trajectory maintained.PROBLEM LIST:Healing wound - previously infected, now showing appropriate granulation tissueDISCUSSED:Discussed importance of preventing patient from disturbing healing tissue to avoid delayed healing. Owner advised that continued improvement expected with current management. Owner understands to monitor for any deterioration in wound appearance.TREATMENT PLAN:Continue antiseptic wipes to wound BID for 2-3 more days to minimize pruritus during healing phase.PRESCRIPTIONS (ON-GOING): NEXT VISIT:No scheduled revisit required unless complications develop.The above clinical notes were created with the assistance of Astro Scribe under the supervision of the consulting Vet.

POC 2 weeks post opO reports she is doing generally really well. Stresses out with cone on so she has been applying a sock whenever unsupervised. O reports she pulled out a few of the sutures herself.I removed 2 remaining external sutures but wound appeared with a bit of breakdown and internal sutures exposed. Wound appeared a bit sticky/purulent. Cleaned with betadine and advised to keep sock on for a few more days, recheck in 3d