C09984123 / invoice 20000

Reason: Behavioural Medication Review / PrescriptionAppointment Notes: Paws App Details:Booking Type: ConsultationBooking Notes: Repeat prescription review Behavioural Medication Review Owner Name: Gillian GleaveOwner Email: gillgleave@gmail.comOwner Mobile Number: 0421201905Pet Name: WallacePet Species: DogWeb BookingClient name: GleaveContact number: 0421201905Email address: gillgleave@gmail.comPatient name: WallaceHistory: Doing good at home Tried to reduce fluoxetine to 10mg SID but got quite anxious on this Tolerating 20mg SID well Gets very anxious when visiting O's daughter and her son - has bitten son once Going away next week - will be staying with other daughter who has a Greyhound Have only needed to give meloxicam twice - seems to be doing well O has been protecting it before going on walks Current Medication: fluoxetine 20mg SID Examination: Demeanour: BAR, anxious but nice boy BCS: 3/5HR/PR: 120. No murmur or arrhythmia, pulses strong and synchronous RR/Chest: 24. Normal effort and BV sounds MM/CRT: pink, moist/1.5Oral/Teeth/Gums: 0-1 Temp: not taken Ears: external pinna clean Eyes: nad LNs: SM, PS, P wnl Abdo/GIT: soft and comfortable U/G: not assessed M/Skel: - gr1-2 intermittent lameness RFL - large corn on digit 4 - very painful on palpation of this toe - suspected to have corns on digits 2 or 3 previously - could not clearly appreciate these today, digits were comfortable on palpation Neuro: mentation appropriate, no obvious deficits Derm: good coat quality, no lesions noted Problem List:1. AnxietyA: has responded well to fluoxetine - can continue on this. Discussed trialling additional anxiolytics ie gabapentin for specific situations, eg coming to the vet or visiting daughter's house - O consented.P: continue fluoxetine 20mg SID, gabapentin 300mg 2 hours before particularly stressful situations 2. CornA: very painful and is still causing limping. Discussed medical management generally not ideal - would recommend coring this out as Dr MDV has previously recommended. O very concerned about surgery and recovery - advised with coring, should be straightforward. Only corn would be removed, may need some bandaging afterwards depending on residual defect but they are already doing this. Main downside of coring is that this is often not curative, and SDFT is usually ultimately requiredP: O to book in for dental and corn removal once she is back    Vital Signs    

Reason: O wants to try conservative managment of corn as going away in March. Will consider dental and corn removal once she is back JR    Vital Signs    

Reason: Limping. Sore. CAHistory: EDUF all okay eating well since gum nut removal and Exlap (better even than before) Fluoxetine 1 tablet once per day for anxiety. Limping r front 4 days and worsening.OBJECTIVE: - Mentation: BAR.  - Cardiovascular: No murmur detected, pulses synchronous, rate and rhythm WNL- Respiratory: No adventitious lung sounds, rate and effort WNL- Abdominal palpation: Soft comfortable, NAD- Oral examination: pink moist MM 1b dental disease- Ocular examination: Clear no conjunctival erythema.- Aural examination: Clean, no erythema externally.- Integument: skin turgor WNL, corn on digit 3 and 4 on R fore. - Lymph nodes: NAD- Urogenital examination: NAD - Rectal exam: Not performed - Neurological examination: appropriate mentation- MSK: pain on palpation of the R fore paw - looks to have corns on the bottom of digit 3 and 4 on this foot. Otherwise no abnormalities detected. No other swellings or pain on palpation ASSESSMENT: Suspect lameness caused by Corns on the R fore digit 3 and 4. Client communication:Discussed suspect caused by corns, first option is to try to 'shell out' corns and see if there is improvement Other managment can be implemented after thisIf reccurent and ongoing can perform tenotomy but not first option with corns as changes weight bearing. TREATMENT:Nil today PLAN:Meloxicam SID 14 kg mark Paracetamol 1/4 tablet BID Dental and corn removal - consider dental X ray or digits at this time if indicated.    Vital Signs    Weight: 14.6;       MMColour: p/m;       HeartRate: 126;       BodyScore: 5;       DentalGrade: 1b;       RespirationRate: 20;       CRT: 1.5;