C09991318 / invoice 10000

REASON- Dry patches. 

HISTORY- Has developed dry patches around her neck and along her back, and has developed some on her head. 
Has been itching and scratching quite a lot. 
Currently on nexgard spectra 
UTD with vaccinations 
Diet - leaps and bounds (chicken and rice) dry biscuits, greenie per day, liver treats for training. Dry cookie Kong treats for toilet training. Carrot and cheese ocasionally. 
Mainly indoors, outdoors at the golf course and park. 
Oatmeal based shampoo and conditioner (aloveen) has only washed twice. 


HR:  132, no murmur auscultated
RR:   very wriggly 
T:    not performed
CRT: 1sec    
MM: pink & moist
EYES: NAD
EARS: NAD
NOSE: NAD
ORAL EXAM:  Clinically normal
SKIN:  Several crusted lesions around head/neck and along spine
ABDOMINAL PALPATION: nad
MUSCULOSKELETAL SYSTEM: nad

ASSESSMENT: Likely has skin allergies - atopic dermatitis vs food allergy 

DDx:

PLAN:
- Sticky tape prep, bacterial cocci present in inflammatory cells 
- Trial cytopoint injection 20mg - batch 840616
- Malaseb bathing bi-weekly, soak for 10 minutes. 

Rx:

REASON- Urine check

HISTORY-
Went to AREC over the weekend.
On Saturday - noticed that she was urinating alot, only trinkles would come out. Started squatting and nothing came out. 
Was getting quite distressed when she was urinating. 
Had an appointment over the phone with a vet. 
Seemed very hot and abdomen was quite swollen.
Did have a vomit last night. Nothing since. 
Went to AREC and had a urine sample - no bacteria in the sample. Urine was also quite dilute - arec vet worried that it was kidney related or hormone issue?
Had meloxicam twice - back to urinating yellow and doing normal urinations.
Urinations have normalised - getting bigger. 
Does drink alot of water - O concerned about kidney. 
Eating normal  - just eats kibble. 
Normal defecations. 
Was lethargic yesterday, today seems like more herself. 
UTD flea/tick prevention - nexgard spectra. 

BAR - excitable!
BCS 5/9
HR:  ~120bpm, nil cardiac arrhythmia or murmur auscultated. Pulses S+S
RR:   panting, normal respiratory sounds and effort. 
T:    not performed
CRT: 1sec    
MM: pink & moist
EYES: Mild conjunctival inflammation, trace yellow discharge lodged in medial canthus. Difficult to accurately examine eyes. 
EARS: NAD
NOSE: NAD
ORAL EXAM:  Grade 1/4 periodontal disease. 
SKIN:  NAD
ABDOMINAL PALPATION: NAD
MUSCULOSKELETAL SYSTEM: NAD
REPRO: Nil swelling around vagina, nil vulval discharge

LABORATORY:
CHEM11 - WNL
PCV/TP - 44% 58 g/L - clear

URINALYSIS:
*Unable to obtain urine sample in consult today, O to bring in tomorrow AM urine*
Urine sample: 
Reason - urinalysis (in house)
Collected via: free catch
USG: 1.050
URO: normal
PRO: neg
PH: 6.5
BLO: neg
KET: neg
BIL: neg
GLU: neg
Sediment exam: Nil crystalluria, nil microorganisms, occasional WBC, proteinacious material in the background

ASSESSMENT:
History of stranguria + pollakiuria - appears to be resolving with NSAIDs

DDx: vaginitis vs. cystitis vs. UTI vs. ectopic ureters vs. other

PLAN:
- Nil signs of kidney abnormalities based on bloodwork today, cannot rule out congenital abnormalities at this stage
- O to bring in urine sample to assess concentration + perform sediment exam to check for UTI
- Dispensed chloropt to help with ocular discharge 

UPDATED PLAN:
- Nil signs of UTI
- If symptoms re-occur, then recheck and further diagnostics warranted (sedation, abdo U/S, cysto for C&S)

Rx:
Chloropt BID both eyes x 5-7 days 

REASON - 3rd Puppy vaccination 

HISTORY - 
Presenting for 3rd puppy vaccination - due for C5 and lepto2.
Going well at home. No health concerns. 
No issues after eating a snake plant the other day. 
EDDU - normal. Solid stools. 
No recent V+, D+ or coughing. Had a bit of a sneezing fit this morning - no further sneezing. 
UTD flea/tick prevention - nexgard spectra (monthly).
Diet: Puppy dry food diet

BAR
BCS 5/9
HRT: 156bpm, nil cardiac arrhythmia or murmur auscultated. Pulses S+S
RR: sniffing, normal respiratory sounds and effort. 
CRT: 1 sec
TEMP: Not performed
MM: pink & moist
EYES: NAD
EARS: NAD
NOSE: NAD
ORAL EXAM: Decid teeth. Nil dental malocclusion. 
MUSCULOSKELETAL SYSTEM: Normal ambulation, normal gait. Normal patella palpation. Comfortable and good ROM in hips
SKIN:  Nil lesions. 
ABDOMINAL PALPATION: Soft, comfortable. Nil masses palpated. 

ASSESSMENT - 
Fit for vaccination

PLAN - 
- Boosters due in 12 months
- Discussed isolation - recommended waiting 10-14days until going to dog parks/high dog density regions
- Discussed desexing

Rx: 
MSD Nobivac DHP + Bb/Pi - 2505001 exp: 10.26 + 2523707 exp: 04.27
MSD Lepto2 - A002A02 exp: 06.26