C10001431 / invoice 10000

HISTORY:
- Here for increase in Cushings signs again - PUPD 
- DUDE normal - but wants food more than normal - increase appetite 

EXAM:
Hydration: normal hydration
CRT: <2sec
Mentation: BAR
BCS: 6/9 
Eyes: Clear corneas, bright, no discharge noted
Ears: Clean and clear
Nose: clean and clear, no discharge noted
Mouth: unable pet not happy about this - O showed teeth - mild to mod tartar
MM: pink
Throat: (-)ve tracheal pinch
LNs: soft and small
CV: 
-- HR: 110bpm
-- regular rhythms, no murmur auscultated, femoral pulses strong and synchronous
Resp: 
-- RR: 20bpm
-- normal effort and pattern, all lung fields clear
Abdo: soft and comfortable
MSK: ambulatory x 4, no obvious limp, normal ROM on all legs
Integ: Clean and clear - VERY LONG NAILS - pet not happy with nails 
- LARGE LIPOMA ON LEFT SIDE OF THORAX 
Neuro: no gross CN deficits - normal reflexes
Genitourinary: no discharge noted - wnl
Rectal: not performed
T: not taken

ASSESSMENT:
- HyperA
- overweight
- long nails
- PUPD and PP

TESTS:
- FULL CHEM and CBC and ACTH to be done next week

TREATMENT:
- gave more Vetoryl - 10mg - 2 caps SID PO in AM 

COMMUNICATION:
- recom for O to have Dr Emily (ERR) as permanent vet and so we schedule O for pick up in with Emily to get to know her and get results with her 
- as above 

HISTORY:
Presented at MP for: arthritis injection, dental check
OR unsure why she received notification for arthritis injection and dental check, can't remember that she booked for this. Came anyway as due for vaccines. 
O has not noticed any struggles with mobility. Does tend to walk slow sometimes but O reckons it's due to her nails that she hasn't trimmed in a while. Still runs around fine at home and very keen with walks. 
Does seem to be a bit more grumpier than usual, but O unsure if painful anywhere. 
Cushingoid dog - currently on vetoryl 10 mg bid. 
Doing well on current dose. No concerning signs, does tend to be too eager for food in the morning.
EDUD normal, no V/D/C/S.

EXAM:
BAR
mm pink and moist, CRT < 2 seconds
HR 100, RR 16
Eyes: bilateral lenticular sclerosis
Mouth: tartar buildup in carnassials, unable to examine further as got nippy
LNs: not enlarged
Abdo: soft, comfortable
MSK: ambulatory x 4, normal gait. no back or neck pain. some stiffness in hips but allowed full ROM. mild crepitus in elbows. 
Integ: overgrown nails all 4 limbs


ASSESSMENT:
Fit for vaccination

PLAN:
Disc options for arthritis injections - beransa vs pentosan - disc costs and possible side effects. O to hold off for now but will monitor. 
O also elected to have nails done at home as can get anxious about it. 

C5 given SC
Disc possible vaccine reactions and adv to monitor.

COMMUNICATION:
As above

after reviewing case 
--> should reduce dose
--> trilostane 20mg PO SID (should dispense 10mg capsule and give 2 capsule once a day)