C09991478 / invoice 10000

Appointment Notes: Overdue remindersReason: s/y    Vital Signs    

Reason: Call To C/uAppointment Notes: Overdue remindersAv -Sandy doing okay, O has to check her urethra again. Went to sash due to other problems and they had another look at it and told her to continue neocort. O is with her mum at the moment in hospital but she's going to have a look at sandy when she gets home. If theres aything she feels doesnt look good she will call to book an app.    Vital Signs    

Reason: Uti - Fever?Appointment Notes: Overdue reminders  ------- Sms reply: YesPATIENT:Sandy14 years, 10 months, DOB: [Date of Birth]Female, SpayedWeight: 6.55 kgReason: Suspected fever and UTI.History:Sandy is a 14 years, 10 months year old Crossbreed who was presented today for recheck to monitor her general health, skin condition, and medication effectiveness. The owner reports Sandy has been lethargic for the past two days. She is licking and her vulva is swollen. She has been licking her ventral abdomen. Her skin, particularly the ventral abdomen and right ear pinna, is very red. The owner also notes her eyes seem worse. She is eating well, consuming Prime 100 kangaroo and duck formula, which has resolved previous suspected irritable bowel syndrome symptoms. She is not drinking well unless the owner is home. The owner felt she was hot to the touch for the last two days.Current medications:- Hylo-Forte eye drops, twice daily- Tacrolimus eye ointment, twice daily- Hypertonic saline eye ointment, three times a day- Vita-Pos eye ointment- Vitamin B12 supplement- Cushing's medication (details to be reviewed)Examination:- Vitals:    - Temperature: 39.2°C    - Weight: 6.55 kg- Physical Exam:    - General Appearance: Quiet but alert.    - EENT: Bilateral nuclear sclerosis with significant corneal clouding. Evidence of eye ointment application. Right ear pinna is erythematous, left is pink. Nose clear.    - Oral Cavity: Mucous membranes pink and moist. Moderate dental staining present.    - Resp: Lungs clear on auscultation.    - Integument: Severe erythema and pinpoint inflammation on the ventral abdomen. Vulva is swollen and erythematous. Lipomas noted on the left flank and right shoulder.    - Musculoskeletal: Reluctance to use back legs, but managing without pain relief. Not jumping on furniture.    - Lymph: Peripheral lymph nodes within normal limits.ASSESSMENT:- Fever (39.2°C) of unknown origin.- Severe moist dermatitis and vulvitis, likely secondary to urine scald and/or allergic skin disease.- Diagnosed eye conditions by specialist: Corneal endothelial degeneration (likely left eye), keratoconjunctivitis sicca (KCS) with keratitis, and early corneal calcareous degeneration.- History of arthritis, currently managed without anti-inflammatory medication.- History of Cushing's disease with recent blood tests indicating over-suppression (low cortisol levels).- Suspected separation anxiety contributing to behavioural changes.PLAN:- Diagnostic/Treatment Plan:    - Convenia injection administered for suspected secondary bacterial infection.    - Cytopoint injection administered for allergic dermatitis.    - Dispensed Neocort cream for topical application to inflamed skin.    - Discussed continuing Synovan injections to support cartilage, but will hold for now.     - Owner to continue probiotics for gut health.- Recommendations:    - Owner to follow up with specialist veterinarian for re-assessment of Cushing's disease and medication dosage, given the previous low cortisol results.    - Continue all current eye medications as prescribed by the ophthalmologist.    - Monitor for improvement in skin condition, lethargy, and urinary leakage.    Vital Signs    Weight: 6.75;