C09988634 / invoice 10000

Eyes have been irritated since yesterday

Hx : overnight has had red eye, 

Exam : 
HR 160,no murmur or arrythmia, MM pink moist CRT <2sec 
Abdo palp soft and comfortable
Oral " Gr 3/4 food impactio between 103 and 104, mild gingivitis and gingival recession
Eye: mild mod cataracts, 
R eye & L eye , -ve fluorescie stain , 
R eye, squinting and blephritis, sclreal injection and mucoid discharge 
Exam under LA - no FB under TE 

assessment: 
r eye - conjuctivitis 
dental dz 

Plan: 
Amacin BID - TID 5 days INI r/v 
Estimate printed for O re dental 

RV - now V+ and further d+
Earlier appt requested, lives just 5 mins up the road

Vomited ham with amoxyclav yuesterday, has eaten today. 
Seesm much brighter
on amoxyclav, pro-kolin

left anal gland abscess is resolving but still has bloody fluid and is swollen from 7 o clock position ot 10 o'clock position. 
advised no nsaids because of recent v+/d+
Dog quitebright an dhappy
defecated small amoutn this morning. 

can return to normal diet as no d+ for a few days
can go back ot normal exercise, will hopefully get stool back to regularity

revisit monday (last day of antibiotics)
if further v+ on abs then consider switch to mtz

Recheck anal glands, possible abcess/infection

- seen on Friday for anal glands
- had little bit of diarrhoea on Friday
- straining on Saturday/Sunday 
- had diarrhoea this morning - large amt liquid, once, no blood
- had some non-productive straining just prior to visit
no vomiting seen 
- owner hasnt seen him eat - ate a treat last night 
- normally nibbles at food throughout day, but not seen eating much since Friday - will eat chicken, not offered today 
- perked up a bit today - prior not his nromal self, tail between legs

UTD flea/worm px - worm tablets from here last time

cv: no murmur/arrhythmia, normal/equal fem pulses
resp: normal BV sounds, normal rhythm/effort
git: no oral lesions, moderate calculus/gingivitis esp worse on 109, 209, also between 103, 104
Abd palp NAD, relaxed with no lesions
rectal: small amt secretion pale brown from R anal gland. 
no secretion from L anal gland, area feels very thickened around L anal gland and lateral to gland, open sinus consistent with ruptured anal gland abscess on L side of anus, no discharge present. 
small amt dark brown liquid on rectal.
ears/eyes/skin NAD
neuro: responsive, normal mentatio n
ms: ambulatory, no lamneess
ln: no lymph node enlargement

A: diarrhoea, ruptured anal gland abscess
diarrhoea ddx open - inflammatory, infection unlikely - likely small bowel and straining due to anal gland abscess but colitis not ruled out

T: clav 0.5ml sc 
P: home on clav 75mg PO q 12 hrs x 7 days for anal gland abscess + fibrosis
no nsaid due to diarrhoea/enteritis +/- colitis
prokolin 2ml BID +  bland diet for diarrhoea
re-ex and rpt rectal/check anal glands in 3-4 days

also rx dental - est $900 - 1000 if no extractions, $1200 - 2000 if multiple molar extractions, formal estimate to be done, 10% disc w/in 2 mths