C09986503 / invoice 10000

Appointment Notes: nail trim + health check + meds checkO reports they saw specialist and prescribed meloxicam ongoing for carpal dysplasia - O wanting to discuss use of this ongoing. O saw really good improvement on meloxicam SID, but became very active and O concerned he is going to hurt himself.Subjective: Very anxious. Difficult to examine due to growling. Objective: HR/PR/CV: No murmur or arrythmia MM/CRT/Hydration:  NE RESP/RR: Clear lung fields. Panting Temp: NE GIT/UG:  NE Skin/Ears: Thick, well kept coat.M/S: Marked bilateral carpal valgus.  No lameness in consult Eyes: NAD from afar Dental: NELymph Nodes: NE BCS: 5/9Assessment: carpal valgus likely to result in degenerative joint changes. Treatment: Meloxicam 7kd SID PO Plan: Recommended GHP q6mo to review renal enzymes with ongoing NSAIDs. Discussed use of gabapentin for additional pain relief when becoming lame/ may provide mild sedation and assist with resting. O aware that surgical repair may be an option, but are unable to commit to this due to finances and logistics of recovery. Discussed rehabilitation consult with JW to review options for conditioning / pain relief (laser vs. acupuncture etc.) Fine for rpts of 100mg Gabapentin BID PO (If O requests in next 6mo) Fine for rpts of Meloxicam 7kg SID PO next 6mo ____________________________INSURANCE HXInitial Assessment > medication review Suspected cause >  marked carpal valgus Date of first clinical signs > ongoing Any other conditions / treatments > nil today     Vital Signs    Weight: 7.9;       

Reason: Nails And Discussion About Licking FeetSubjective:  presented for nurse nail trim. O had lots of questions, changed to vet consultSeen in April for skin irritation. Put on apoquel but vomited after 2 days on this. DiscontinuedDiet: blackhawk dry EDUF WNL. No CSVDUsed to glucosamine tablets daily for 3 weeks over summerMalaseb shampoo was used in the past - seemed to make skin worseSometimes when running kicks out RH leg.Objective: Nervous, but ok with male owner. Muzzled as precaution for nail trim in tx)HR/PR/CV: 120 no murmur or arrhythmiaMM/CRT/Hydration: pk 1-2s moist, no skin tentRESP/RR: panting, no crackles or wheezingTemp: n/eGIT/UG: abdominal palpation comfortable and unremarkable Skin/Ears: saliva stained all 4 paws.Mild erythema foreleg interdigital spaceM/S: ambulatory all 4, MPL RH G2/4, LH G1/4. No crepitus, rom wnlEyes: nad, symmetrical pupils, no discharge or inflammationDental: G2/4Lymph Nodes: wnlBCS: 4/9Assessment: Pruritus and erythematous paws - ddx: Allergic skin disease vs contact allergy vs food allergy vs otherBilateral MPL R>LTreatment: Nails trimmedDiscussion with owner: MPL> surgery from G3+ typically unless impacting QOL/mobility. Currently at G2 but this may change. Can consider analgesia management  - O very concerned about QOL. Discussed can do xrays of pelvic +HL to fully assess for underlying OA/cruciate dz alongside MPL. O to consider.> discussed OA management and options for pain management if seeing lameness> given OA handout. Discussed supplements, zydax vs beransa (side effects discussed) vs gaba vs nsaids. Pros and cons + side effects discussedSkin allergyDiscussed suspect contact allergy given location of lesions.O suspects anxiety related. Discussed can be both occurring simultaneously.Discussed cytopoint as apoquel has not worked in the past.O wants to start glucosamine again as has worked well in the past. Discussed dosing of 500mg tablet PO SIDDiscussed antihistamine SID 10mg for bad days or as maintenanceGiven allergic skin dz handoutPlan: O to consider zydax vs xraysWill start glucosamine tablets in the mean timeRevisit INI or declines____________________________INSURANCE HXInitial Assessment > Suspected cause > Date of first clinical signs >Any other conditions / treatments >    Vital Signs    

Subjective: Client ConversationFemale O called, asked if will need to pay another consult fee if she would like Peanut to have another check of his tail issue, TML confirmed yes there would be at least a revisit fee of $85, if not a full consult fee of $95. O asked why this charge would be there if she asked for the tail issue to be resolved at the last consult & it has gotten worse since then. TML explained there is always a charge for the vet's time so revisit fee or a full consult fee will always be charged, explained Dr. Mackenzie offered Apoquel as a treatment option & this was accepted at the time of consult and unfortunately the initial treatment plan doesn't always work. O explained tail is now bleeding & worse, TML rec. An e-collar until next vet visit. TML offered to book a revisit today, O declined for now, will speak with her husband & call back if they would like a recheck.    Vital Signs