C09983299 / invoice 10000

Appointment Notes: R eye swelling and red plus general check up.  27.6kg\History: Developed a sore, weeping R eye a week ago after returning from the dog wash. Been wiping it but not getting better. Still well otherwise. Eye held open, no sneezing or any other issues seen. L eye unaffected stillExamination: BAR (anxious and head shy but coped with nurse restraint and no aggression - took treats well)MM pink CRT< 2secBCS 7/9Eyes :L nad, R = redness to sclera, cream exudate medial canthus R eye. No blepharospasm but epiphora seenFlurescein NEGPLN NADAssessment: Conjunctivitis R eye, no corneal ulcerPlan: Chloropt BID 5-7 days and RV if any deterioration or recurrence seenTreat both eyes if L becomes infected too    Vital Signs    Weight: 27.6;       

Reason: VaccinationHISTORY: Due vacc. Also not on anything for HW prevention and keen to get inj when options discussed.Still been licking foot (RF) despite course of pred and neocort ointment. Will limp on the foot sometimes too. Well otherwise and not been licking or chewing anywhere else. Not scratching either. Not on flea/tick prevention apart from flea/tick rinse after dog washEXAMINATION: BAR (happy and well behaved dog, good for inj with treats), T normalMM-pink/ Crt < 2 secDENTITION: grade 0/4HR = 104 bpm , Normal rate and rhythmEARS: nadEYES: nadSKIN: RF: paw diffusely swollen and inflamed especially palmar aspect. Few scabs on edges of paw pads but not injury or localised area triggering this found. Rest of feet and skin NADLN: R prescap LN enlarged (moderately), rest NADBCS: 6/9JOINTS - nadABDOMINAL PALPATION - nadASSESSMENT: Fit for Vaccination Overdue HW preventionSwollen RF foot - no improvement on pred and neocort - poss infection vs FB vs underlying pathology within footTREATMENT:Nobivac DHP / BB/Pi given SCProheart SR12 SC (brave for inj when held on exam tablet with treats)Recomm 10 days amoxyclav and 7 days SID cortavance spray and eliz collar to stop licking (esp 30 mins after cortavance but maybe leave on all day for 1- 3 days to break the itch cycle and allow meds to work)RV if ongoing licking or swelling and recomm xrays of footStill needs flea/tick preventionPLAN:    Vital Signs    Weight: 26;       

Reason: Sore Paw RFAssessment: Underside of the RF paw is swollen and inflamed - Credelio has been chewing and licking just this paw. Suspect an insect bite reaction that has turned into a lick-itch cycle.Other paws and rest of skin all look great. See prev consult - v+ has resolved.Treatment: Short course of pred tabs, and Neocort topically - will need to stop him licking the neocort off.If continues to lick despite the above then will need an eliz collar.    Vital Signs    Weight: 26.1;