C09987604 / invoice 10000

HISTORY
Presenting for: 5.1 kg FS dog presented for scooting and anal gland issues.
Historical Conditions: History of anal gland issues. Grass seed up nose approximately 1 month ago.
Diet: Boiled chicken and lamb with Royal Canin digestive kibble. Very fussy eater, refuses dog food.
V/D/C/S: Normal faeces.
Skin: Pruritic since puppy age. Scratches around neck and other areas. No visible skin lesions.
Current Meds: NexGard up to date. No tapeworm treatment.
Other: Scooting started 2-3 days ago, occurring multiple times yesterday and today. Not consistently associated with defecation.

EXAM
Mentation: BAR
Wt: 5.1 kg
Behavioral: Slightly worried but generally good for examination. Accepted treats.
Oral: Teeth normal. Chews frequently.
Integumentary: Pruritic but no visible skin lesions.
Rectal: Anal glands slightly full but not impacted. No infection present. Some faecal material adhered to perianal area.
HR: 120bpm normal lung sounds 
RR: pant 
CRT:2s
MM: pink and moist 
ABDo: comfortable to palpation. 

Diagnostics: Anal gland expression performed - normal content.

ASSESSMENT
Anal gland irritation - Mild fullness without impaction
Pruritus - Possible underlying allergic disease

PLAN
New Meds/Tx:
- Tapeworm tablet prescribed (half tablet every 3 months)
- Anal gland expression performed
- Perianal area clipped to reduce faecal adherence

Diet Recs:
- Add fibre to diet (Metamucil - quarter tablet mixed with food or grated pumpkin) to help with natural anal gland expression

Client Comms:
- Discussed possible allergic component to anal gland issues
- Advised to monitor for continued scooting, Consider Cytopoint injection if pruritus persists vs allergy work up
- Explained importance of regular tapeworm treatment every 3 months in addition to NexGard