C09996381 / invoice 10000

Reason: Recheck From ARH Appointment Notes: EEHistory: Had an anaphylactic reaction 6 days ago. Was at ARH (see attahcment). Elevated ALT and AST. Were told to come to us for recheck of liver values. Otherwise good. Eating, drinking normal again.Examination: Body Condition Score: 5/9Pain Scale (0-4): 0/4Hydration status (%): hydration clinically adequateCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findingsMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal, no mouth pain, dental score (1-4): 0/4- Abdominal: no detectable pain on abdominal palpation- Rectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: NSFLymph Nodes: NSFEyes: NSFDemeanour/Behaviour: BARLaboratory: Liver values much better, AST in normal range, ALT still a little bit increased but much better.Delilah presented as happy, active dog. Clinical examination without abnormal findings. AST is back to normal, ALT is almost back to normal. Everything should be good. Just in case monitor for the next time.    Vital Signs    Weight: 7;       HeartRate: 124;       RespirationRate: 16;       CRT: 1;       MMColour: pink;       BodyScore: 5;       

Reason: Ear RecheckAppointment Notes: Overdue remindersHISTORY:  Presented for ear recheck. Owner reports persistent scratching and rolling on paws. Suspected sensitive skin. Current meds: noneVaccination: Not mentionedParasite Prevention: Not mentionedPre-existing conditions: noneAccess to toxins eg. Rodenticide: none EXAMINATION:Body Condition Score: 5/9Pain Scale (0-4): 0/4Hydration status (%): hydration clinically adequateCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findingsMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal, no mouth pain, dental score (1-4): not graded- Abdominal: no detectable pain on abdominal palpation- Rectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: NSFLymph Nodes: NSFEyes: NSFDemeanour/Behaviour: not discussed PROBLEM LIST:- Pruritus- Suspected sensitive skin DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Suspected sensitive skin DIAGNOSTICS:Ear swabs clear ASSESSMENT:Delilah, a puppy, presented for evaluation of persistent scratching. The owner reports ongoing pruritus. Based on the history, sensitive skin is suspected. No treatment was administered today as the clinical signs were not deemed severe enough. TREATMENT:  No treatment was administered in the clinic today. Discharged home. PLAN:Recheck scheduled for next month.Monitor for increased scratching, particularly if it disrupts sleep.Home into owner's care. CLIENT COMMUNICATION:Discussed the possibility of sensitive skin. Cytopoint injection was recommended as a safe and effective option for pruritus in a puppy under 12 months if symptoms worsen. The cost of Cytopoint ($188) was discussed. An alternative oral medication was mentioned but noted to be off-label in dogs under 12 months. A brochure for Cytopoint was provided to the owner. Advised to return for treatment if the scratching becomes more severe.:    Vital Signs    Weight: 7;       

Reason: LumpAppointment Notes: Booked Online: 31/12/2025 15:07:07 PMBooking Type: Skin, Ears, Eyes or LumpsBooking Notes: Lump under armpit (definitely not a nipple lol) Owner Name: Mollie TophamOwner Email: mollietopham@hotmail.comOwner Mobile Number: 0413704237Pet Name: DelilahPet Species: DogWeb BookingClient name: TophamContact number: 0413704237Email address: mollietopham@hotmail.comPatient name: DelilahReason:  lump and check feet Client Present: yes Nurse: EE Wellness Testing: Urine or Faecal (When done/due?)Vaccination Type: C7 Intestinal worming: simapriac trio Heartworm Prevention: simapriac trio Flea Prevention: simapriact rio Tick control: simapriact rio Microchip: On file Insurance and Healthy Pets Plus: None Behaviour concerns: anxious Current Diet: Hypoallergenic has chicken aswell as hypoalllergenic and kanagroo. Chewing at her paws and front paws. Only. Little bit of DX but no vx. But has settled down nowED: yes is a grazer Other concerns: lump under armpit and her chewing her paws. No reactions to nything in the past: food allergies. __________________________________________________________________________HISTORY:  Recheck consultation for ear medication. Owner reports a small amount of diarrhoea recently. No vomiting reported.Current meds: Hypoallergenic diet. Ear medication to be labelled and dispensed.Vaccination: UTD. Simparica Trio.Parasite Prevention: UTD. Simparica Trio.Pre-existing conditions: noneAccess to toxins eg. Rodenticide: none EXAMINATION:Body Condition Score: 5/9Pain Scale (0-4): 0/4Hydration status (%): hydration clinically adequateCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory:thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological:neurologically no significant findingsMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal, no mouth pain, dental score (1-4):not graded- Abdominal: no detectable pain on abdominal palpation- Rectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: NSF (adjust if changes mentioned)Lymph Nodes: NSF (adjust if changes mentioned)Eyes: NSFDemeanour/Behaviour: not discussed PROBLEM LIST:- Mild intermittent diarrhoea. DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:None mentioned. DIAGNOSTICS:None ASSESSMENT:  Recheck for ear condition. A history of recent, mild diarrhoea was noted. Examination findings are otherwise unremarkable. TREATMENT:  Ear medication will be dispensed. PLAN:Book a recheck appointment. CLIENT COMMUNICATION:Discussed booking a follow-up appointment for re-evaluation. Instructed on dispensing and labelling of ear medication.    Vital Signs    Weight: 7.8;