C09986246 / invoice 10000

Reason: Eye ProblemAppointment Notes: Overdue remindersDiagnosis: bilateral early dry eye weepingAryhtmia newTreatment: Opticare eye lube whislt waitimng on cyvclospirn eye dropsEcho with DamonVerified: NoHISTORYPresenting for: Joey presented for red, drippy eyes that have been very recent in onset, described as goofy discharge especially upon waking, and a dry, flaky nose.V/D/C/S: Coughing noted by ownerDiet: Appetite has decreased slightly but owner attributes this to ageCurrent Meds: On Quantum plan, not currently on tick preventionOther: Recently went swimming for half an hour over the weekend, sleeps significantly more but owner attributes this to ageEXAMMentation: BARWt: 18.4 kg (previous weight 19.3 kg)Behavioural: Cooperative during examination, allowed handling wellEyes: Bilateral ocular discharge described as goofy, red and drippy especially upon waking. Eyes appear dry with white-ish appearance noted.Nose: Very flaky and dryCardiovascular: Regular heartbeat with some abnormal beats noted approximately once every 30 beats. Irregular rhythm present but otherwise normal cardiac activity.Respiratory: Normal breathing pattern with no increased respiratory effort observedDiagnostics: Schirmer tear test performed - left eye just below 15mm/60 seconds, right eye results mentioned but specific value not clearly stated. Both eyes showed reduced tear production below normal range.Right eye 14 in 60 secondsASSESSMENTKeratoconjunctivitis sicca (dry eye) - Early presentation with reduced tear production bilaterally, common condition in Cocker Spaniels where immune system attacks tear-producing cellsCardiac arrhythmia - Irregular heartbeats noted, requires further evaluation to determine if benign or pathologicalPLANVaccinations:- Annual vaccination administered as part of Quantum planDiagnostics:- Echocardiogram scheduled for next Thursday morning (drop off before 10am) - cardiologist consultation to evaluate heart structure, size and electrical activity to determine significance of irregular heartbeats. Performed awake without sedation. Insurance should cover approximately 80% of cost (estimated couple hundred dollars out of pocket).New Meds/Tx:- Eye lubricant (OptixCare) to be used 3-4 times daily to lubricate eyes and reduce discharge while waiting for prescription drops- Prescription eye drops (compounded drops preferred over Optimmune for easier administration) - ongoing daily treatment required. Drops will be ordered and available Friday (2-3 days). Can be obtained from pet chemist online, Pet Barn, or compounding pharmacist.Additional Discussion:- Recheck appointment scheduled for 12th to assess treatment response and discuss echocardiogram results- Tear production will be retested in approximately one month to evaluate treatment effectiveness- Early intervention provides best treatment outcomes for dry eye conditionC4Vets orderedCyclosporinform: Eye Drops | strength: 2% | quantity: 20ml    Vital Signs