C09991230 / invoice 10000

HISTORY:Presents for a broken tooth. Owner noticed the tooth was broken. Likely occurred during the week, possibly from chewing on a bone. The breath has become malodorous since Saturday.Eating and drinking normally. Has not stopped eating. No vomiting, diarrhoea, coughing or sneezing reported.Owner concerns: a broken tooth and resultant halitosis.Past medical history: 8-year-old Australian Shepherd.Examination:Behaviour in consult: grossly normalvitals are within normal limitsBAREyes: grossly normalEars: grossly normalMouth: Fractured canine tooth with exposed, necrotic pulp visible. Suspect tooth root abscess given the degree of halitosis.Integument: grossly normalCV: grossly normalResp: grossly normalAbdo palp: grossly normalNails/feet: grossly normalMusculoskeletal: grossly normalLNs: : grossly normalUrogenital: grossly normalNeuro: grossly normalProblem list:1. Fractured canine tooth with suspected tooth root abscessAssessment: The canine tooth is fractured with the pulp cavity exposed. The visible black material is necrotic root. This provides a direct path for oral bacteria into the root canal, leading to infection and abscess formation, which is the likely cause of the severe halitosis.Investigations: Dental X-rays at time of surgery to assess the full extent of root damage.2. HalitosisAssessment: Secondary to the fractured tooth and probable tooth root abscess.TREATMENT:Plan for surgical extraction of the fractured canine tooth. Procedure involves creating a gingival flap, removing alveolar bone to expose the root, extracting the tooth, and suturing the gingiva.Booked for dental surgery on Thursday next week.Dispensed medication to start now:Antibiotics amoxyclav 250mg BID: one tablet morning and night.Pain relief/anti-inflammatory Meloxicam oral SID: Administer 13 units (up to the 13 mark on the syringe) once daily. Instructed owner to not administer this medication on the Wednesday prior to surgery.Owner advised to call if concerned while away on holiday this week.Patient weighs 13 kg.Task summary:Surgical extraction of canine tooth booked for Thursday next week (2 weeks from initial consult).Drop off between 8-9 am.Pick up from 3:30 pm, likely 4-4:30 pm.

Hx: noticed to have some purulent discharge in the medial aspects of the eye, doesn't appear phasedPx: Normal appearance to the eyes bilaterally, mild erythema of the lower MM bilaterally. Fluoroscene negative, no scleral injection present, STT- 18 L only 13 RDx: KCS primary vs secondaryTx: Look to utilise amacin TID for 2 weeks then stop and we will re-assess tear flow if still low then look to start on tacrolimus trial.

Hx: Bite wounds at daycare.Px: L flank over the last rib there is a ventral hole roughly 3cm in diameter with clean granulation tissue, there is a second puncture 5cm dosrally that is simply a puncture- there is mild crepitus and under reun tissue in a 5cm radius around without a great deal of pain.Dx: Dog fight woundTx: Currently should get reasonable drainage from the ventral hole. Look to treat medically with amoxyclav 250mg BID 10 days and meloxicam 1ml SID. re-assess in 10 days time.