C10003066 / invoice 10000

Appointment Reason: 1.2 CONSULT 2, Appointment Notes: Weepy left eye, green discharge this morning, squinting, doesn't seem otherwise bothered. GLSubjectivePresenting Concerns:  Doug, an 11-month-old male dog, presented for an acute onset of weeping from the OS. The owner first noticed a large clump of discharge this morning, and the eye has been weeping since. He began rubbing at the eye this afternoon. No known trauma was reported.    Diet/Appetite: Appetite is normal.    Drinking/Urination: Drinking and urination are normal.    V/D/C/S: Defecation is normal.    Preventatives: Up to date with preventatives.    Lifestyle Risk Factors: Socializes with other dogs at a dog park.ObjectiveMentation: Bright, alert, and responsive  Wt: 34 kg  BCS: --/9  T: Not taken  P: —  R: —  MM: pink/moist. CRT < 2sec.  Hydration: Normal    Emotional Assessment: Friendly and social; accepted treats.    Eyes: OS: Marked conjunctival hyperemia, blepharospasm, and mucoid discharge. OD: Within normal limits. Nasolacrimal ducts patent bilaterally.  Ears: Clean with no discharge or erythema AU.  Nose: Clear, moist without discharge.  Throat: No inducible cough upon tracheal palpation; no palpable masses.  Oral: Calculus and gingivitis absent. No masses or other lesions.  Cardiovascular: No murmurs or arrhythmias, strong synchronous pulses.  Respiratory: Normal bronchovesicular sounds bilaterally.  Abdominal: No organomegaly or mass effects. No pain on palpation.  Lymph Nodes: No peripheral lymphadenopathy.  Integumentary: No evidence of ectoparasites, full coat with clear skin.  Neurologic: No ataxia, normal mentation.  Musculoskeletal: Ambulation normal, no lameness observed.  Urogenital: Normal external anatomy.  Rectal: Not performed.    Point of Care Diagnostics: Fluorescein stain (OS): Negative for corneal ulceration.AssessmentBacterial conjunctivitis, OS - Suspected based on acute onset of mucoid discharge, conjunctival inflammation, patient's age, and history of socializing with other dogs. Corneal ulceration was ruled out via fluorescein stain.PlanMedications/Treatments:-   Oral anti-inflammatory liquid: Administer 2.3 mL PO SID with food for 3 days.-   Broad-spectrum antibiotic ointment: Apply a small strip into the OS 4 times daily for 7 days. The owner was advised they may treat the OD as well if it develops similar signs.  Additional Discussion:-   The owner was advised that bacterial conjunctivitis is contagious to other dogs and was instructed to avoid dog parks until the eye is resolved.-   Home care instructions were provided for cleaning discharge from around the eye.-   A recheck examination was recommended in 5-7 days.-   The owner consented to the plan, including the cost of the fluorescein stain ($38).-   The use of an Elizabethan collar was discussed as a contingency if he continues to rub at the eye.    Vital Signs    Weight: 34.5;       

Appointment Reason: 2. CONSULT 2, Appointment Notes: vaccination, no other health concerns - rjs   ------- Sms reply: Ycanine country - raw meat based for puppysome ziwi peaka little chubbynow interceptorand nexgard    Vital Signs    Weight: 18.5;       

TWPresenting Concerns:-   Doug, an 11-week-old puppy (12wo in a few days), presented for a health check and vaccination.  Diet/Appetite:-   Eating and drinking well. Diet is unchanged, but now eating more.  V/D/C/S:-   Toileting is normal.  Current Medications:-   Receives monthly NexGard for flea and tick prevention.-   Last intestinal worming treatment was with Milbemax on the 7th of June. O has interceptor to continue from next month.  Lifestyle Risk Factors:-   Attends puppy school.-   Restricted to the owner's property, which has a secure fence.-   No contact with unknown dogs or access to public areas on the ground.  Additional Information:-   Active and playful temperament.-   The owner has had him for 3 weeks.-   O had another dog years ago who came to our vet clinic.Physical examsMentation: BAR  BCS: 5/9  T: Not taken  MM: pink/moist. CRT < 2sec.  Hydration: Normal    Emotional Assessment: The patient exhibits a calm and relaxed demeanor throughout the consultation.    Eyes: No ocular d/c noted, clear corneas, normal and equal size of pupils.  Ears: Otoscope exam not performed. L ear had black d/c. Failed to check it. Need to check it at next vacc consult.  Nose: Clear, moist without discharge.  Oral: Calculus and gingivitis absent. No masses or other lesions. No cleft palate.  Cardiovascular: No obv murmurs or arrhythmias, strong synchronous pulses.  Respiratory: Normal bronchovesicular sounds bilaterally.  Abdominal: No obv pain/discomfort/organomegaly/mass/fluid waves noted. No umb hernia.  Lymph Nodes: No peripheral lymphadenopathy.  Integumentary: No evidence of ectoparasites, full coat with clear skin.  Neurologic: No ataxia, normal mentation.  Musculoskeletal: Ambulation normal, no lameness observed. No HDCs.  Urogenital: Normal external anatomy. Both testes are present.  Rectal: Not performed.Assessment- The patient is apparently healthy – Fit for vacc.Plan/TreatmentVaccinations:-   Protech C4 SC (B# 5257035B)-   Protech BS PO (B# 5245044A)-   The third puppy vaccination is due when he is 16 weeks old.-   Advised that he may attend public venues one week post final vaccination.  Medications/Treatments:-   Administer a dose of Milbemax today for intestinal helminthiasis.-   Continue monthly NexGard for ectoparasite prevention.-   Commence monthly Interceptor in one month for ongoing heartworm and intestinal helminth control.  Additional Discussion:-   Recommended continuation of puppy school for socialization and training.-   A discussion was conducted regarding the benefits of desexing, including the prevention of testicular neoplasia, anal gland adenocarcinoma, and herniation. This was recommended for future consideration (when Doug is 12-24mo).-   Recheck in 5 weeks for the final puppy vaccination.- Briefly discussed spc.    Vital Signs    Weight: 11.4;