C09988659 / invoice 10000

Reason: Heartworm / DentalAppointment Notes: Paws App Details:Booking Type: Consultation - Senior Pet (7+ yrs)Booking Vet: Dr KerriBooking Notes: Heartworm TestSUBJECTIVE:Presenting Concerns:  Trouble and Totoy presented for a general health check, dental check, and to have heartworm and vitamin D tests performed as recommended by their new nutritionist.    Trouble  Historical Conditions:-   History of reflux.-   Previously treated with steroids, which the owner reports had negative effects and will not be used again.-   Had an episode of vomiting 2 weeks prior to the visit.Diet/Appetite:-   The owner is working with a nutritionist to transition to a whole-food-oriented diet.V/D/C/S:-   Reports of intermittent reflux and occasional soft stools.Skin & Coat:-   The owner reports her skin and coat are in good condition.Current Medications:-   Recently discontinued a probiotic supplement.-   The owner brushes her teeth with water only due to her reflux.Additional Information:-   The owner is concerned about her dental health, noting a foul odor from the mouth and occasional bleeding when brushing her teeth.  Totoy  Historical Conditions:-   History of reflux, similar to his housemate.V/D/C/S:-   Reports of intermittent reflux.Current Medications:-   Recently discontinued a probiotic supplement.Additional Information:-   The owner expressed concern about his general state of health, feeling that he is "not well" and may be fragile, particularly regarding the prospect of general anesthesia.  OBJECTIVE:Vitals (Both Patients)  Mentation: BAR  BCS: --/9  T: Not taken  P:  R:  MM: pink/moist. CRT < 2sec.  Hydration: Normal    Trouble  Emotional Assessment: Initially nervous but friendly and affectionate during the examination.    Eyes: Clear. No discharge or erythema OU.  Ears: Clean with no discharge or erythema AU.  Nose: Clear, moist without discharge.  Throat: No inducible cough upon tracheal palpation; no palpable masses.  Oral: Significant, heavy calculus accumulation is present with an associated foul odor. There is minor gingival recession (1-2 mm) on one of the premolars, but good periodontal attachment remains at this site. The mandibular incisors are the most severely affected by periodontal disease, with food trapping noted due to their crowded positioning.  Cardiovascular: No murmurs or arrhythmias, strong synchronous pulses.  Respiratory: Normal bronchovesicular sounds bilaterally.  Abdominal: No organomegaly or mass effects. No pain on palpation.  Lymph Nodes: No peripheral lymphadenopathy.  Integumentary: Full coat with good quality.  Neurologic: No ataxia, normal mentation.  Musculoskeletal: Ambulation normal, no lameness observed.  Urogenital: Normal external anatomy.  Rectal: Anal glands were palpated and found to be empty and non-painful.    Point of Care Diagnostics:-   A blood sample was collected via jugular venipuncture.  Totoy  Emotional Assessment: Handled well for examination and blood collection.    Eyes: Clear. No discharge or erythema OU.  Ears: Clean with no discharge or erythema AU.  Nose: Clear, moist without discharge.  Throat: No inducible cough upon tracheal palpation; no palpable masses.  Oral: Moderate calculus accumulation is present. The third incisors are noted to be the most affected due to their position adjacent to the canines, which makes effective cleaning difficult. The overall severity of periodontal disease is less than his housemate's.  Cardiovascular: No murmurs or arrhythmias, strong synchronous pulses.  Respiratory: Normal bronchovesicular sounds bilaterally.  Abdominal: Appears lean and has a tucked abdomen. No organomegaly or mass effects. No pain on palpation.  Lymph Nodes: No peripheral lymphadenopathy.  Integumentary: A small area of darker coat was noted, possibly due to dirt.  Neurologic: No ataxia, normal mentation.  Musculoskeletal: Ambulation normal, no lameness observed.  Urogenital: Normal external anatomy.  Rectal: Not performed.    Point of Care Diagnostics:-   A blood sample was collected via jugular venipuncture.  ASSESSMENT:Trouble  Periodontal Disease – Moderate to severe. The most significant changes are affecting the mandibular incisors, which are at risk for requiring extractions without intervention.  History of gastrointestinal sensitivity – Characterized by reflux and intermittent vomiting/soft stool. Currently appears stable.  Otherwise apparently healthy – Bright, alert, and in good body condition.    Totoy  Periodontal Disease – Mild to moderate. Calculus accumulation is most prominent on the incisors. The condition is less urgent compared to his housemate.  Owner concern regarding general wellness – The owner perceives him as fragile. He appeared lean with a tucked abdomen on examination.  History of gastrointestinal sensitivity – Characterized by reflux.  PLAN:Pending Diagnostics:-   Blood samples were collected from both dogs.-   In-house heartworm antigen tests will be performed.-   Samples will be sent to an external laboratory (QML) for vitamin D level analysis.Medications/Treatments:-   For Trouble: A comprehensive dental procedure is strongly recommended to be performed within the next few months to address her periodontal disease. The owner is considering scheduling this for May. The procedure will involve a full oral examination under general anesthesia, dental scaling and polishing, periodontal probing, and dental radiographs to fully assess the health of the teeth, particularly the incisors. Discussed with the owner that delaying the procedure increases the risk of needing tooth extractions, which would necessitate post-operative pain medication and could potentially impact her sensitive gastrointestinal system.-   For Totoy: A dental procedure is also recommended for him, although it is considered less urgent than for Trouble. It was discussed that this could be performed at the same time as his housemate's procedure.Diet & Feeding Recommendations:-   Continue to work with the nutritionist on diet modification for both dogs.Additional Discussion:-   The owner's concerns regarding Totoy's overall health and fitness for anesthesia were acknowledged and will be taken into consideration when planning any future procedures.    Vital Signs    Weight: 3.1;