C10000066 / invoice 10000

diarr and couple of vomits

Vaccination:
Parasite prev: ngs
Diet: wet food, dry fo0od, treats

History:
Current medications: none
Current concerns from o: drr past  1-2week projectile liquid no blood, vomiting bile, white froth this morning
good app
playing
destroys toys

Examination:
BAR, MMs pink/moist, CRT <2s
Dental grade: /4
Cardiac ausc: NSF
Resp ausc: NSF
Abdo palp: NSF
Peripheral LNs: NSF
Temp: 38.8
Wt: kg, BCS: /9
Otherwise general PEx NSF

Laboratory:
Assessment:
Treatment:
Plan:

C5
History: 

Examination:  
Demeanor - , BAR, but very wary
coat ,  licks feet and still some issues around mouth
BCS,  5
Eyes clear bright, 
ears clean, 
Oral exam - teeth & gums , not examined
Dental Grade ?
Heart lungs sound Wnl
Abdominal palpation Wnl 
Peripheral LN wnl  
Musculoskeletal exam wnl. 

Problem list:

Treatment Plan: C5

Inflammed/tender R side of mouth

Vaccination: utd
Preventatives: mthly NGS
Diet: dry food, s/market wet food, treats

History:
Current medications: none
Current concerns from o: irritation R side mouth, eating normally, well otherwise
o thinks may have traumatised chewing on toy

Examination:
BAR, MMs pink/moist, CRT <2 secs, HR normal, RR normal, T not taken
Dental grade 0-1
Cardiac ausc: NSF, no murmur audible
Resp ausc: NSF, normal resp rate/effort
Abdo palp: NSF
LNs: NSF
O pointed out lumps - medial aspect L elbow small ~2mm slightly raised unpigmented cutaneous mass, small ~4mm unpigmented cutanous mass (cyst?) distal to elbow - o says present several yrs not changing, small ~2mm pigmented verrucous mass top of head. 
R mandibular labia at level of lingual frenulum unpigmented, possibly swollen/more prominent compared to L side? No obvious dental disease, no mass/neoplasia, no puncture/trauma. 
Mild lip fold dermatitis esp R side - doesn't appear related to above.
Became AGGRESSIVE toward end of exam
Otherwise general PEx NSF

Assessment: Depigmentation may occur due to trauma/inflammation etc (presume depigmentation is new per o description), chews on toys so may have traumatised?

Treatment: O has discontinued toys for now

Plan: 
Adv recheck if any sign of growth/lump. 
Offered dental, probe teeth, dental xrays, biopsy if labia or gingiva appear abnormal.
Adv revisit for FNA if any cutaneous lumps increasing in size or changing, adv option to excise same time as dental.
Has medicated shampoo - adv may use to scrub lip folds, otherwise dilute Betadine
Recheck if no improv