C09992807 / invoice 10000

Reason: Fishy Smell - O Unsure Where FromAppointment Notes: Overdue remindersVerified: NoHISTORYPresenting for: Daisy, a 2-year-old female dog, presented for routine vaccinations (kennel cough and leptospirosis due), nail trim, and concerns about a fishy smell coming from her backside area that has been noticed recently.V/D/C/S:- Single episode of vomiting today in the car, suspected to have eaten mushroom or faeces while outside- No further vomiting since, eating normally- Regular bowel movements, solid stools daily- Occasionally has slight difficulty passing stools but generally regularDiet:- Dry kibble, 1 cup morning and 1 cup evening- Normal appetite, no changesCurrent Meds:- NexGard Spectra monthly - up to dateLifestyle Risk Factors:- Access to outdoor areas where she eats faeces and various materials- Known to eat anything available outdoorsOther:- Owner reports dog is distracted during defecation, often interrupted by environmental stimuli like birds- No excessive licking of backside, no scooting behaviour observedEXAMMentation: BARWt: 36 kgBCS: 6/9Behavioural: Friendly, social, readily accepts treats during examinationAbdominal: No abnormalities detected on palpationIntegumentary: Some excess tissue around anal areaRectal: Anal glands expressed - contained material with characteristic fishy odour, consistent with anal gland impactionASSESSMENTAnal gland impaction - first occurrence, characteristic fishy odour notedOverweight - BCS 6/9, requires dietary managementPLANVaccinations:- Kennel cough vaccine administered subcutaneously- Leptospirosis booster required in 3-4 weeksDiet Recs:- Reduce daily food intake by approximately 25% to support weight loss- Recheck weight in several weeks to monitor progressAdditional Discussion:- Anal gland expression performed today, recommend monitoring for signs of discomfort- Schedule anal gland expression every 3 months initially, may extend to 6 months if glands remain empty- Return sooner if signs of scooting, licking, or discomfort develop- Discussed vaccination health plan option ($750 lifetime coverage) vs individual vaccination costs ($339 today, annual requirement)- Client to review pet insurance coverage for vaccination benefits ($50 annual benefit confirmed)Client Comms:- Explained anal gland anatomy and function, normal for some dogs to require regular expression- Advised to monitor for signs of anal gland problems between visits- Weight management discussion and feeding reduction recommendations provided- Vaccination schedule and costs discussed, client to consider health plan option    Vital Signs