C09986388 / invoice 10000

Reason: Still Unwell And Has Alot Of Discharge Coming FromVerified: YesHistory:Scout presented with frequent tongue movements/licking behaviour that started after completing a 5-day course of Metacam, Panadol, and anti histamine following a previous consultation last Wednesday. Owner reports nasal discharge observed today while at a cafe, along with persistent swelling on one side of the nose and abnormal appearance of one nostril. Scout has been slightly flatter in energy levels than usual and did not eat this morning, though appetite had been normal until today. No excessive face rubbing noted beyond normal morning behaviour.Appetite: Off food this morning, otherwise normal until todayEnergy levels: Slightly flatter than usual but still active (swimming, rolling)Diet: Lyka, Mighty Munch with probioticsAny medications:- Recently completed 5-day course of Metacam, Panadol, and anti histamine- Pro-Kolin given occasionally- Synbiotic capsules availableExamine:BAR, anxiousMM pink/moist CRT 1-2sEyes - clearEars - clearDental grade - 0.5-1HR=PR= No murmur/arrhythmia. HR 180. All lung fields sound clear. Normal REAbdomen soft and comfortableSkin - NADAll peripheral LNs normal except left submandibular node a little more plump than the others. Ambulatory - no lameness or ataxia, full ortho exam not performedTemp - 38.9°CRostral slightly to the left of the midline there is a pink raised irregular mass just under 1cm diameter. Photo attached. No draining tract etc. General erythema has now settled. Laboratory: HUGE number degenerate neutrophils and mixed cocci and rods all over swab. Assessment:- Infected lip lesion - likely secondary bacterial infection following initial inflammatory reaction (possible insect bite/spider bite or penetrating foreign body). Differential diagnosis includes abscess or mass lesion.Treatment:Continue paracetamol +/- meloxicam pending appetite and GI signs. Start amoxyclav 250mg BID Plan:- Synbiotic probiotics can be added to food- Soft food for next couple of days in case mouth is tender- Monitor lesion size - if enlarging despite treatment, biopsy will be required- Contact if any concerns    Vital Signs    Weight: 13.49;       HeartRate: 38.9;       

Reason: Allergic Reaction On Face To Ant Bite?History: Yesteday was at park. Head on ground then reacted. Then seemed a bit lethargic. Then noticed face was a bit swollen. Given 2 x certizineHas been eating fine since. No vomiting noticed. Poo yesterdfay was fine. Yesterday more lethargic but better today. Seems red in mouth. Examine: QAR, good for exam. Subtle swelling of the left upper muzzle area compared to the right. MM pink moist, grade 0 dental disease. Left upper mucosa around incisors and premolar teeth - moderate increased inflammation, no wounds or trauma in the area seen. Rest of oral cavity unremarkable. Licking lips ++BT 38.49, CV normal no murmur, HR 180. Chest clear. Really hard to ultrasound but no obvious gallbladder halo sign. No urticaria elsewhere. Assessment: Possible localised ant or other insect bite. Treatment: Trial paracetamol, anti histamines, meloxicam for a few days. Monitor closely. Paracetamol - 125mg twice daily (1/4 tablet)Metacam - 13kg dose once daily WITH FOOD. Stop if any vomioting, diarrhoea or off foodCitirazine - 15mg (1.5 tablets) ONCE daily in the evening 3-5 days as needed Plan: Recehck INB    Vital Signs    Weight: 13.35;       Temperature: 38.49;       HeartRate: 180;       

1030am yesterday bitten by ant on face. Was lethargic and slow. Face swelling. gave 20mg cetirizine 5pm. Still swollen.Edud normally. Just lethargic    Vital Signs