C09989336 / invoice 10000

no more scratching and rubbing face on the floorhas noticed her straining and has softer yellow poo with some mucusno more vomitinghad a few visitors and she looks a bit worked upBAR pink mm and moisteyes ears nose in good conditionheart 120 no murmur or arrhythmiachest no wheezes or cracklesnormal REabdo palpation relaxed and comfortablerectal: small amount of grass with mucus, no blood softer faecespro-kolin to help with diarrhoea, more consistent with LI diarrhoeao has been feeding pumpkin too

History:Core presenting problem: vomitted once this morningalso has skin irritation around the groin and has been licking the vulvano diarrhoeahome cooked diet with mince and chickenno current medicationno known toxin or FBGeneral Examination: Very nervous General oral: normalDental score (0->4): 0Capillary refill: 2Mucous membrane colour: pinkRR: pantingHR: 102Heart auscultation: no murmur or arrhythmiaLung sounds: no wheezes or cracklesLymph Nodes: wnlEyes:wnlEars:wnlSkin: erythymatous groin and brown discharge around vulvadid not perform rectal examTreatment/Plan:vomiting: ondansetron and paracetamol monitor for any more GI signs, still taking treats in consultskin: trial on cytopoint, chlorhex spray daily and use swabs to clean vulva foldsdiet trial with kangaroo/fish (avoid chicken and beef) for 6-8 weekso would like bloods done for annual profile (canine total health profile - external) and will bring in urine too

REASON FOR VISITYearly vaccination and health checkup.Anxiety medication review.TODAYS HISTORYKristen (owner) presented Kellie.History: Kellie is a 3 year old German Shepherd who was presented today on the 27/08/2025 for her annual C5 vaccination, health check and a review of her anxiety medication. The owner reports that the current anti-anxiety medication is ineffective for her chronic anxiety and fear-based reactivity (Fluoxetine). She has recently changed Kellie's diet as per the behaviourist's recommendation and is tolerating the new food well with no gastrointestinal upset. Appetite, thirst and urination/defaecation are all normal.PAST HISTORYWeight: 28kg (27/08/2025).Kellie has a history of anxiety and reactivity, for which she is under the care of a veterinary behaviourist, Isabella Sims. She has previously been treated for impacted anal glands but is reportedly not showing any signs of discomfort recently, such as scooting.EXAMINATION/CONSULTATIONSubjective:3 yearsFSGerman ShepherdWeight: 28 kgThe Patient presented to the clinic today for:1. Annual C5 Vaccination2. Health Check3. Anxiety Medication ReviewObjective:Physical ExamWeight: 28 kgConstitutional/Demeanor: Bright, alert, and responsive. Anxious but manageable in the consult room.Ears: Both ears clean, no discharge or odour.Eyes: Both eyes clear, no discharge or abnormalities noted.Dental: Mild tartar buildup on canine teeth. Dental Grade 1/4.Mucus Membranes/Capillary Refill: Pink, moist, CRT <2 seconds.Cardiovascular: Heart rate strong and regular. No murmur detected.Respiratory: Lungs clear on auscultation. Normal respiratory rate and effort.Abdomen/GI: Soft, non-painful on palpation.Musculoskeletal: No abnormalities detected on ambulation or palpation.Integument: Coat in good condition. No abnormalities detected.Urogenital/Reproductive: FS. No abnormalities noted.Lymph: No peripheral lymphadenopathy.Rectal:NAASSESSMENT AND PLANKellie is a healthy 3-year-old German Shepherd presenting for routine preventative care and management of her ongoing anxiety. The physical examination was unremarkable. The primary concerns are her behavioural issues and dental health.Anxiety/Behavioural IssuesAssessment: Ineffective response to current anti-anxiety medication. Continues to show signs of chronic anxiety and fear-based reactivity.Plan: Discontinue previous medication. Commence Clomax, half a 80mg tablet orally twice daily.Counseling and Recommendations: Discussed the new medication, Clomax, with the owner. Advised it has a building effect. Potential side effects include vomiting and sedation. Instructed to stop the medication and contact the clinic if vomiting occurs. Advised to continue with behavioural training with Isabella Sims.Dental HealthAssessment: Mild tartar accumulation (Grade 1/4 dental disease).Plan: Recommended daily teeth brushing.Counseling and Recommendations: Advised owner to use a soft children's toothbrush for daily brushing to manage tartar build-up.Preventative CareAssessment: Due for annual C5 vaccination.Plan: Administered annual C5 vaccination. The vaccination booklet has been updated.FOLLOW UPS:No specific follow-up appointment was scheduled. The owner was advised to monitor Kellie's response to the new medication and contact the clinic as needed.SHORT SUMMARYKellie presented for her annual C5 vaccination and health check. A new anxiety medication, Clomax, was prescribed due to the ineffectiveness of her previous medication, and dental home care was discussed.