C09996510 / invoice 10000

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Reason: L4 Anal Gland IssueTIME: 2020History:- A 5-year-old desexed male presented for investigation of overgrooming. A suspected abscess was noted at home today. - Past medical history includes megacolon, for which he is receiving laxatives. Stool consistency has been normal for the past 6 months with no recent diarrhoea. Appetite, thirst, and urination are normal. No previous history of anal gland conditions. Bloodwork was performed in August and was normal.Physical exam:A full physical examination could not be performed on presentation due to aggression. Reduced exam performed Demeanour: BARBCS: 6/9Temperature: 38.3Cardiovascular: Strong and synchronous pulse, no murmur or arrhythmiaResp:  clear bronchovesicular sounds across all quadrants, normal effortEyes: bilaterally clean, no discharge, no erythema, pupils symmetrical and appropriate size, no corneal changes, vision presentEars: bilaterally clean, no discharge or erythemaMM: pink and moistCRT: <2secDental: not assessedPeripheral lymph nodes: submandibular/ prescapular/ popliteal not palpably enlargedNose: nasal planum moist, normal pigment, no dischargeSkin/ coat: good condition, NAD, skin tent WNL, no ectoparasites, no skin lesionsAbdomen: not palpated conscious Musculoskeletal: ambulatory, full musculoskeletal exam not performed Urogenital: NAD, desexedNeurological: normal mentation,  full neurological exam not performedA ruptured left anal gland abscess was identified, with an open wound approximately 0.5-1 cm in size and associated perianal skin discolouration. Diagnosis:- Ruptured left anal gland abscess.Treatment:- Methadone 0.3 mg/kg intramuscularly on arrival. - Gabapentin approx 1/2 a 100mg capsule in consult GA:Pre-exam risk (ASA): 1General anaesthesia induced with zoletil 0.2 mL and additional methadone 0.1 mg/kg IM. ET tube placed and oxygen provided Anaesthesia was maintained with alfax IV Clipped and cleaned site. Expressed both anal glands, thick purulent discharge from both present. Flushed both anal glands with sterile saline. The procedure was short with no complications and recovery was uneventful.- Meloxicam 0.1 mg/kg SC during recovery.Plan:- Continue gabapentin one tablet twice daily.- The next dose of meloxicam is due tomorrow, to be continued for three days.- Start oral liquid amoxyclav 12.5mg/kg tonight.  - An e-collar is to be kept on at all times.- Recommended giving gabapentin the night before and two hours prior to any future veterinary consultations to help reduce anxiety.Client communication:- Discussed increased anaesthetic risks given unable to perform proper cardiac/ lung auscultation prior to sedation due to aggression. Also advised of general anaesthetic risks. - Instructed the owner to monitor for any signs of erythema, significant swelling, discharge, or significant distress and to contact the clinic if concerned. The owner was happy with the plan.    Vital Signs    

DISCHARGE NOTESPRESENTING CONCERNS:- Overgrooming- Perianal massPROBLEM LIST FROM PHYSICAL EXAMINATION:- Painful- Anal gland abscessASSESSMENT:Anal Gland AbscessDogs and cats have two small pouches on both sides of their anus that contain a smelly brown fluid that is normally expressed when your dog passes faeces. When this fluid doesn’t drain out how it should, this material will build up and can lead to infection. Pus and fluid will start to accumulate in the pouches and creates pressure. As this pressure increases it will become red, swollen and be very painful. As the pus and fluid continues to accumulate this can lead to rupture through the skin. Clinical signs with anal gland problems will often start with scooting. Once an abscess has formed you will see redness, swelling and if the abscess ruptures you may see discharge coming from under their tail or even a gaping hole. Drainage is the most important factor in allowing abscesses to heal; sometimes this will require a general anaesthesia and flush out of the glands. Treatment then includes antibiotics and pain relief. Once your pet has had an anal gland abscess they will require regular checkups and likely expression of their anal glands. This can be done at your regular veterinary clinic.   DIAGNOSTICS AND MANAGEMENT:PCV/TP – to assess hydration  General anaesthetic to clean and flush abscessIntravenous fluid therapy during surgery AntibioticsAnalgesiaNSAIDs to take home Antibiotics to take homeSPECIFIC HOME CARE INSTRUCTIONSPost Surgery Instructions:1. Keep your pet confined to a warm quiet environment, separate from other pets and small children for 12 hours after surgery2. Your pet will need to keep an Elizabethan collar on until the abscess has healed to prevent further trauma from licking 3. There will likely be some discharge from the abscess; this will decrease over the following 2-3 days4. Give small amount of food after surgery – your pet may not have their normal appetite until the following day which is completely normal 5. Your pet may have a slight cough for a few days – this is normal as a tube needs to be placed in the trachea during surgery to give your pet oxygen and anaesthesia, and this can cause some irritation. Exercise:In order to facilitate your pets recovery, walks should be stopped until after the abscess has healed. Diet:Your pet has no specific dietary requirements and can return to their normal diet. Medications:Metacam - give a 6kg dose ONCE daily for the next 3 days. Start at 10:30pm tomorrow night. Stop if vomiting or diarrhoea occurs. Amoxyclav - Give 1.5ml TWICE daily for one week. What to look for at home:1. Check the abscess daily – there will likely be some discharge for the first few days, as well as some redness until the abscess heals. If you notice a change in type or amount of discharge or your pet is lethargic, inappetant or otherwise unwell re-check with Animal Emergency Services or your regular veterinarian as soon as possible. 2. Re-check with your regular veterinarian in three days to track you pets’ progress. 3. Your regular veterinarian will advise when further re-checks are required.   If your pet is going home and has a pressure wrap over where an IV catheter was placed please remove it within 20 minutes of leaving the hospital. Thank you for trusting Animal Emergency Services with the care of Remy. Notes: You agree to make pre-payment of the deposit listed here. Initial estimate (treatment listed below): $1500-1800 till 2amDeposit: $1200    Vital Signs