C10003550 / invoice 10000

Reason: Recheck EarsDiagnosis: R otitis externa - improving but not goneHistory: Doing well at homeEDUD all okNot shaking head or seemingly bothered by earO feels has improvedObjective: L ear - looks nad externallySwabbed and NADR ear - some scurff externallySwabbed and scurff still presentLaboratory: Cytology of R ear2-3 yeast per HPFNo cocci/rods or neutsAssessment: Improved r otitis externa but NOT resovledPlan: Continue rx for another 7-10 days    Vital Signs    

Reason: Behavioural DiscussionDiagnosis: Right ear otitis externa - exclusively yeastBehaviour-  needs work on recall issues at the moment.History: Always has hated a black poodleReally strains on the lead and can pull judith over as quite strongLosing vocal recall commandDidnt go to puppy preschoolJudith trained her herselfOtherwise fineEDUD all okObjective: Pe results pm:HR 120Grade II/VI holo murmur bilatLeft max pm1 and pm 2 rottenDs 1-2.4 generallyMm p and crt okLeft ear normalRight ear - evidence of otitis externallySwabbedBs 3/5Abdo palp nadLnodes okLaboratory: Cytology of R ear - 10-15 yeast per HPFNo cocci or rodsAssessment: Predom yeast otitis externa R ear Plan: Rx otitisGo back to basics with recall command  - judith to trial herslef and get guidance from net firstIf ongoiong issues will engage a trainerRec get an anti pull harness aswellRecheck r ear in 2 x weeks time    Vital Signs    Weight: 10.59;       

Reason: Vacc + HCDiagnosis: AHCHistory:Gen been wellJudith feels is going well and no major concernsEDUD all okExercising wellObjective: Pe results amHr - 120Ds 2-3/4Will need some extractions - could be a grade 2/4 but would esitmate for a grade 3/4 in case more than expectedGrade III/VI murmur bilatRegular rhythmChest clearR ear a little dirtyL ear okAbdomen palp normalBs 3/5Skin okLnodes okTreatment: Kc and c2iSr-12QuantumPlan: Rec dentalBook in as agrade 3.4 in case worse than expected. Hopefully will be a grade 2 with minor extractions but will def have extractionsEstimate 1500 - 2400 incklusive of PAS bloods Upper end if multiple or complicated extractions    Vital Signs    Weight: 10.27;