C09995721 / invoice 10000

CLINICIAN: Viola Wynne-Hoelscher
PRESENTING COMPLAINT: Consultation for episioplasty 
HISTORY: Oulu has a chronic history of UTIs. Recent culture of urine shows infection with proteus spp. sensitive to amoxyclav. Oulu is going well- UTI signs are much improved once she's on abs. Oulu has a hooded vulva which may be contributing the the recurring UTIs. Abdominal u/s performed at CARE earlier this year showed no other abnormalities of the urinary tract except for a subjectively smaller R kidney and some mineralization in the renal pelvis. She is on a urinary s/o diet and owners are frustrated that she regularly gets UTIs. Referring vet has recommended episioplasty as she has a hooded vulva. Owner reports that despite finishing 2 weeks of amoxyclav on Monday, she still has very pungent and malodorous urine. 
CLINICAL FINDINGS: 
*BAR, lovely dog 
*Vitals wnl
*significant hooding of dorsal vulva. Thickened tissue in this region. 
DIAGNOSTIC TESTS: NIL. Owner declined cystocentesis today for C &S of urine.
DIAGNOSIS: Hooded vulva
SURGERY: NIL today
PLAN:  
*Discussed that this surgery will eliminate the moist environment around the vulva and hopefully minimise the occurrence of UTIs.
*Estimate on file for pre-approval for insurance.
*Owner will book in surgery next week. 
*Estimate of $4,100-4,500
PROGNOSIS: good with surgery for reducing recurrence of UTIs. 

DATE/TIME of CONSULTATION: 15/12/16 2200
CLINICIAN:SEM
PRESENTING COMPLAINT:KKC
HISTORY:Since previous visit (few days ago for left corneal ulcer - current medications :metacam, doxycycline, tricin) all dogs  (3) coughing
Oulu has HX allergic rhinitis so often has Telfast antihistamines, especially when owner also suffering Hayfever as both signs tend to coincide. Has been giving Zyrtec lately
At home today Oulu having dry harsh cough - with terminal retch. Similar to other dogs however Oulu seems saddest. She is still eating and drinking and otherwisw appears well except for sitting down and head elevated

Eye has been doing well - owner giving medicaitons as prescribed

CLINICAL FINDINGS: Temp 38.4, HR 120, Resp 18, MM pink CRT<2
Resp chst ausc clear (ex referring URT sounds), tracheal sounds increased, coughs on tracheal pinch with terminal retch, watery eyes
Opth - minimal stain pickup rleft ulcer - apporx 0.5mm , eye doing we
DIAGNOSTIC TESTS:
Offered chest Xrays

DIAGNOSIS:
likely canine tracheobronchitis (given all 3  dogs affected) further enhance by unlying seasonal allergies
resolving left corneal ulcer
TREATMENT:
Recc rpt Telfast as ower feels provided better allergy control
Rx Codeine linctus - initial dose 0.1mg/kg  tid - can increase if required
Strict rest
Cont eye medicaitons as directed
PLAN: 
Discussed incresed antibiotics cover (currently on further 4 days doxycycline) however Oulu has previously had severe diarrhea with antibiotics (poss Clavulox) so owner less keen on using additional antibiotics if not required
Recc quarranteen period
CLIENT COMMUNICATION: As above
PROGNOSIS:Good

DATE/TIME of CONSULTATION:  13/12/16 20:12 
CLINICIAN: Jane Yu 
PRESENTING COMPLAINT: Sore left eye 
HISTORY: On the special diet for urolith in bladder and is doing well since last visit. 
Today at 5pm, owner noticed that she is sore on the left eye. 
CLINICAL FINDINGS: T: 39.3, HR 96, RR panting, heart and chest auscultation wnl, mm pink, crt<2. Abdominal palpation comfortable and unremarkable. FP= HR, normal strength. Quiet and alert. 
Left eye has some inflammation on the conjunctiva and sclera. Alcaine eye drops applied for examination. No foreign body found. But unable to examine fully behind the third eyelid as Oulu is moving. 
DIAGNOSTIC TESTS: Flurescein stain positive at the medial aspect of the left eye - about 0.4cm length. 
DIAGNOSIS: Corneal ulceration of the left eye - could be due to her scratching her eye/ foreign body. 
TREATMENT: Tricin - apply onto left eye BID for 7 days ( owner has it at home). Metacam measure to 7kg PO SID for 5 days. Doxycycline 50mg PO BID for 7 days. 
PLAN:  Revisit at regular vet in 3-4 days ( this Friday) for recheck. If no improvement in a week, may need to sedate Oulu for am ore thorough examination of the left eye to make sure there is no foreign body ie. grass seed behind the eyelids. 
CLIENT COMMUNICATION: Owner happy with the plan
PROGNOSIS: fair