C09985683 / invoice 10000

Clinical Notes checked: [ZS 25/02]History- Presenting for yellow discharge from right eye for last few days- Occasional rubbing at right eye noted- Also 1 month history of waking up around 3-4am barking and seeming anxious- this happens 50-60% of nights- Kobe does not need the toilet and stares at the owners while panting or sometimes paces around- He eventually settles after this- No change in routine- Mobility reducing over last few months, now strugging with stepsReported to shake in right hindlib when standing sometimes- BIB {Jennita}Diet - KibbleParasite control -Current meds nilMicrochip: Scanned + correctLast Database Check: Exam.Demeanour: BARTemp: not taken, nervous for examBCS - 6.5/9EyesRight eye- PLR, menace in tact- Tapetal reflex present bilaterally, no opacities in eye- Shirmer tear test - tear production adequate- Flourescein stain negative- Hyperaemic conjunctivaLeft eye NADEars NSFOral exam: Nodular red 2x2cm mass present ventral to 304 mandibular canine, reported to be unchanged - has previosuly been investigated at Boronia, FNA inconclusiveDental grade:Cardiac ausc: HR= 98bpm clearRespiratory: RR= heavily panting, clearAbdo: NSF on abdo palpationMSK:- Mild muscle wastage over HLs symmetrical- Vocalisation and discomfort on flexion and extension of right hip- Reduced range of motion on flexion and extension of hips, more pronounced on right- Reduced range of motion on stife flexion, more pronounced on rightSkin: NSFL/N: NSFOther findings:Tests performed- Occular examAssessment - Right eye conjunctivitisVocalisation at night - OA pain v. cognitive declineLump on chin - Offered repeat FNA or excision and histopath, O to considerPlan -Commence Meloxicam for OA pain and eye painCommence Gabapentin in evening to aid OA pain and overnight anxiety short termCommence Chloroint for conjunctivitis right eyePlan to evaluate in 1 week if night issues have improved- If imporved then create long term OA management strategy- If not then reccommend bloods and potential to explore more management options to trial for cognitive declineReccommend use of soft rugs at homeTreatments:Revisit in 1 week