C09997159 / invoice 10000

Reason: Check Skin - No ChargeAppointment Notes: Prior to Orthopedic Sx. DFHistory: Recheck of skin prior to orthopedic surgery next week.Cytopoint given and Cephalexin/PMP started 9 days ago.Laura reports very good response, but perhaps not perfect.NO pruritis for 2 days after Cytopoint but now a very slight amount - may be just "normal amount for a dog" scratching, but O describes, 95% better.Physical Examination: DF reviewed skin - erythema all gone (except some residual erythema and hair loss on the feet).Thighs/legs all normal in appearance > OK to proceed with MPL surgery next week.OTHER:Meloxicam has been given PO a few times (lameness has resolved).On a couple of consecutive occasions (but not in the first few days of use), vomitting has occurred within an hour of Meloxicam being given.......Advised may not tolerate Meloxicam very well - option to try again post-op and monitor closely, or consider alternative (Previcox) for post-op NSAID......Said I would pass this on to Dan.    Vital Signs    

Reason: Booking For LEFT MPL SxAppointment Notes: DFHistory: DF spoke to Laura.Booked Scount for LEFT MPL Sx at NNVH on Thurs 12th March.DF offered no charge check of the skin on Thurs 5th March in the leadup to Sx to make sure all looking good - DF to see next week.DF    Vital Signs    

Appointment Notes: VETSTORIA - laura king (0402808787 lauraking28@hotmail.com) with Scout (Dog) - Consultation (Allergies and slight limp on back left leg) No, this is not an emergency.  [Veterinarian : Dr. David Fowler (Preferred Clinician)] Web BookingClient name: laura kingContact number: 0402808787Email address: lauraking28@hotmail.comPatient name: ScoutHistory:See consultation in November - long discussion about skin/allergies.Started Fish & Potato kibble (only other food, a little yoghurt, and then only very recently).SIGNS HAVE ESCALATED despite the food trial.FOOD ALLERGY CAN BE RULED OUT - 10 weeks strict feeding and signs have worsened.No V or D issues.No real luck with anti-histamines or Cortavance spray.Signs too intense now.Main areas of concern > FEET, medial legs. One of her ears seems sore.OTHER - LEFT HIND LAMENESS (SEE BELOW).Physical Examination: LEFT ear normal.RIGHT ear: Deep ear canal NAD, but inner pinnal surface/canal entrance area red and inflamed (threatneing to worsen!).Ventral abdo skin > normal.Ventral thorax skin > mild erythema.Axillaa > mild to moderate erythema.MAIN LESIONS/changes are medial limbs (all 4) and feet (especially backs of paws and very dsital/cuadla aspects of limbs near paw pads: diffuse marked redness, interdigital dermatitis and small localised areas of skin ulceration also present.Assessment: Atopic dermatitis (food allergy ruled out by food trial already done).Signs have been mild for a year - but recently escalated to point of needing relief.Discussed needs relief - tapering course steroids, Cytoppoint, Apoquel (and mentioned Zenrelia also).O is aware of all these having other allergy suffering dogs.Discussed referral to dermatologist and intra-dermal skin testing in detail.Well worth considering given age and life ahead.Will commence with Cytopoint for relief - see response. Evolving situation.Treatment: Cephalexin 600mg BID for 10 days.Cytopoint inj 40mg given SCPMP: dose 0.4ml in R ear and coat inner pinna surface BID (for 10 days, assuming all looking OK can then stop). Did not do cytology - this done more for localised anti-inflamm effect.For now - see again as needed.BUT can have Cytopoint inj on request (from nurses) as long as seen by vet in prior 6 months).OTHER:For a while, when first gets up, mild LEFT HIND LAMENESS - which would resolve quickly.Lately, more ongoing mild lameness seen. To the point where she looks to be unloading the Left hind much of the time standing or walking around there is a mild persistent lameness.Physical Examination: RIGHT stifle and hip NAD. Cranial drawer check NEG.LEFT hip NAD.LEFT STIFLE - medial patellar luxation GRADE 2-3 present. Often patella is sitting in place, but slips out VERY readily (but can also be reduced easily).......L stifle feels thickened as well.Cranial drawer check NEG (slight movement, same/comparable with the R side).Assessment: Lameness/OA likely related ot persistent/ongoing luxation and movement of the LEFT patella.Can consider/try NSAIDs at this point as a trial but ultimately need to consider MPL surgery given age and degree of signs - which seem to be escalating.Sould look at Synovan inj's but again - if ultimately going to do Sx, best to do the inj's afterwards.EOC for MPL Sx given as $3050 (excludes PreAn bloods).Explained surgery method and parts. Sent handout. May book in soon.    Vital Signs    Weight: 33.6;