C10004156 / invoice 10000

Reason: GHc And Bloo9dsHistory: Nurse: SanchiAlways has had fllakey skin, particularly last 2 years, groomers advised not to do oatmeal shampooHas been using the one in PetBarn and has been worseDoing bloos today to recheck thyroid levels, on ForthyronBAR, happyEDDU normalCSVD noALLERGIES on anallergenic diet for prev hx of ongoing d+MEDS Forthyron 1tab BIDDIET RC anallergenic dry VX not utd, O does not seem interested on doing themPP utd NGSHPP noTraffic light checkedNurse LNZReason: Recheck, flaky skin and medication refill.History:Presents for recheck bloods since starting medication for hypothyroidism.Owner reports skin is still very flaky, despite brushing this morning.Licking paws a lot.No vomiting, diarrhoea, coughing, sneezing, or itching.BAR EDDU normal no V+ or D+.Had non-stop diarrhoea in the past which resolved with a diet change.Owner reports that an oatmeal shampoo used to work but the groomer advised against it. Groomer recommended a fortifying shampoo. Pet balm was used but the flakiness has been worse since.Diet: Anallergenic diet.Pre-existing conditions: Hypothyroidism, previously borderline anaemic.Current medication: Thyroid medication twice daily (8am and 5:30pm). Omega oils in food.EXAMINATION:Body Condition Score: 7/9BAR MMs pink 1s euhydrateEyes/Nose/Throat: NAD clearEars: NAD clearThoracic ausc: NAD lungs clear, no murmur, no arrhythmia, pulses synchronousOral: mild tartar 1/4. No malocclusionsAbdominal: NAD comfy on palpation, no masses or swellings. No herniasMusculoskeletal: NAD ambulating normally, no palpable neck, spine, limb or joint pain. Hips and stifles goodIntegument: Flaky dander throughout coat. No erythema or discharge. Paws nad no erythema Neurological: NADRectal: not performedLymph Nodes: WNLDIAGNOSTICS:Blood collected for IDEXX full profile and thyroid levels.PROBLEM LIST:Flaky skin - suspect secondary to hypothyroidism.Pruritus (paw licking) - suspect secondary to allergies.History of diarrhoea - resolved with anallergenic diet vs due to thyroid treatment (started at the same time) ASSESSMENT:Recheck for hypothyroidism. Owner is concerned about persistent flaky skin. Physical exam shows significant dander but is otherwise unremarkable. The paw licking may be allergy-related but no erythema. The historic diarrhoea resolved on the anallergenic diet and started thyroid treatment at the same time. Discussed timing of blood tests for thyroid monitoring. Proceeding with a full blood profile to recheck thyroid levels and borderline anaemia from two years ago.TREATMENT:None administered in consult.PLAN:Return at 1:30 PM today for blood collection. Bloods to be taken 4-6 hours post-medication for accurate thyroid level assessment.Prescribed a leave-in conditioner (PawDerm conditioning conditioner) to moisturise the coat. Apply once or twice weekly.Will review blood test results once available.Continue current anallergenic diet until thyroid levels are stable, then can consider a slow diet transition.Discussed costs of diagnostics with owner, who consented to the full profile ($233).Owner counselled on management of dry skin and importance of timed blood tests.    Vital Signs    Weight: 38;