C09994404 / invoice 10000

Appointment Notes: panting ++ last nightBasic Summary:- Presented for acute onset of panting.- Significantly overweight at 11 kg (usual 9 kg).- Cardiopulmonary examination was unremarkable.- History of chronic atopic dermatitis; treated with an Apoquel injection.- Plan includes weight management, monitoring respiratory signs, and dental care recommendations.Subjective:- Clinical signs/progression: Acute onset of panting started last night at 11 PM, lasting about 2 hours. Kids noted it during the day yesterday, also that he drank no water yesterday despite it being 36*c. Eating grass, unusually clingy, and drank a full bottle of water last night. Been well this morning. - Significant past history: Chronic atopic dermatitis with constant licking.- Current medications: Malaseb shampoo as needed. Last cytopoint injection was six months ago.- Appetite & diet: Good appetite. Currently on an owner-reported "lyka" food.Objective:- Demeanour: BARGeneral exam:  - Overweight (11 kg). Target weight <9.5 kg.  - Cardiovascular: NAD. No murmur detected, mucous membranes well-perfused.  - Respiratory: Lungs clear on auscultation. Mild panting during exam.  - Integumentary: Saliva staining on paws.  - Oral: Moderate plaque and tartar with some gum recession.  - Otic: Ears noted to be mildly malodourous.  - Musculoskeletal: Possible stiffness in hindlimbs, no crepitus detected.  - Abdomen: Soft, non-painful on palpation.Problem List:- Acute onset of panting- Overweight- Chronic atopic dermatitis- Dental disease- Suspected hindlimb stiffnessAssessment:A 9-year-old male dog presented for acute panting. Examination revealed he is overweight, with otherwise unremarkable cardiopulmonary findings. Chronic conditions include atopic dermatitis and dental disease. Panting is a new clinical sign; differentials include pain, anxiety, or underlying disease, though the initial examination is reassuring.Treatment Plan:- Administered 20mg cytopoint injection for atopic dermatitis.- Weight management: Reduce current food intake by 10%. Gradually increase low-impact exercise (e.g., 5-minute walks).- Increase water intake by diluting food.- Home care: Monitor respiratory rate and effort.- Recommended diagnostics if panting persists or worsens: Chest radiographs and blood tests.- Recommended dental procedure and home care (brushing, dental chews).Client Communications:- Discussed potential causes for panting and the plan to monitor at home initially, but return for blood testing and diagnostic imaging if deterioration occurs. - Advised on weight management plan involving diet and exercise.- Recommended increasing frequency of medicated foot baths for allergies.- Outlined options for dental care. O declined dental procedure.     Vital Signs    Weight: 11;       MMColour: Pink;       RespirationRate: 32;       HeartRate: 122;       HeadEyes: Normal;       Nose: Normal;       Skin: Abnormal (saliva staining of all paws );       MusculoSkeletal: Normal;       Ears: Normal;       Neck: Normal;       LymphNodes: Normal;       Heart: Normal;       Lungs: Normal;       Abdomen: Normal;       RectalGenetalia: Normal;       Demeanour: BAR;       Gingivitis: 2;       Calculus: 3;       Observation: Abnormal;       Temperature: 37.8;       BodyScore: 6;       DentalGrade: 3;       PainScore: 0;       CRT: 1-2;