C09986524 / invoice 10000

Reason: Chewing At PawAppointment Notes: Acute onset of itch. Going at it for 2 hours. KO13.4kgPresenting Complaint:Hx: Went for walk this morning in bush, started licking at foot incessantly (LH)Hasnt stopped chewing at itAlso incidental mention of harder stools and a bit of straining - on advance puppy kibble onlyCurrent Meds: nonePE:        BAR, lovely pup, likes treats, needs treat distraction for exam and needles    Query v mild anisocoria in her eyes, hard to determine bc woint stay still for long and also has varied darker pigment of irises around pupil (O to take pic at home w treat and send in to email). Otherwise eyes beuatiful, no concern     LH plantar aspect of foot mild erythema cf R, no ulceration/lesion/sting/bite noted.     Mms pink adn moist, pulses good, otherwise bright and happy pup. Skin nad. Problem List: Localised hypersensitivity reaction LHHard stools w some strainingTx/Plan:Dex 0.27mL IM, chrlpheniramine 1mL sq. O to trial adding advance wet puppy food into diet and 1t psyllium husk for smoother bowel movementsIf ongoing concerns, recheckClient Communications:Check up for irritation of her left hind paw -- suspected insect bite after walk this morning.Dexamethasone(anti-inflammatory, steriod) and Chlorpheniramine (antihistamine) given today. At home can trial 1.5x 10mg Cetirizine tablet (antihistamine, Zyrtec) if this happens again, it may not be sufficient to quel the itch.Follow-up:    Vital Signs    Weight: 13.4;       

Reason: 3rd Puppy Vacc - 9kgAppointment Notes: Special payment terms exist  ------- Sms reply: YesPresenting Complaint: Puppy Health CheckCurrent Medications:Current Parasite PreventionHx: PE:        Mouth:nce jaw alignment, good heart sounds, no hernia. In excellent condition, skin and coat are excellent.    CVS:    Resp:    Abdo:    MSK:    Neuro:    EENT:    LN:    Skin:    UroGen:    Rectal:    Any hernia'sAssessmentTx/Plan:Dx:Final puppy vaccinationFuture Prescription Authorities:Desexing Plan:Client Communications:Follow-up:    Vital Signs    

Presenting Complaint:Hx: Current Meds:PE:        Mouth:    CVS:    Resp:    Abdo:    MSK:    Neuro:    EENT:    LN:    Skin:    UroGen:    Rectal:Problem List: DDx:Tx/Plan:Dx:Client Communications:Follow-up:    Vital Signs    Weight: 9;