C10004520 / invoice 10000

Reason: Swelling On Neck Appointment Notes: Overdue remindersConsultation Time: Hospital Time Period: History:Last night noticed swelling on neck - seems to have doubled in size today. EDDU NAD. Known chewer of sticks and objects. Scavenger. Not on any medications. No chronic health issues. No vomiting or diarrhoea. UTD with vaccinations and preventatives. Most of the day indoors only. Never had any dental issues. Subjective:Objective:Temp:            MM:              CRT:             HR:             FP:              RR:BCS:    /9                Wgt:    kg Pain Score (CSU):   /4CV:    RESP:              GIT:   U/G:  Neuro:  M/S:  Integ:  Ophth:  LNs: Initial Tests:INTERNAL LABORATORYPCV/TS:(Dog: PCV 37-55%, TS 55-75 g/L)(Cat: PCV 30-45%, TS 62-81 g/L)LACTATE:   mmol/L	Blood Gas(sample type: arterial/venous)Abnormal parameters:Interpretation:CBCAbnormal parameters:Blood smear examination:BiochemistryAbnormal parameters:PT:APTT:UrinalysisCollection method: cystocentesis/urinary catheter/free catchpH:   Protein:   Glucose:   Ketones:   Urobilinogen:   Bil:   Ery:   Hb:USG:Sediment examination:EXTERNAL LABORATORYLab No: 	***** PENDING *****Sample: Interpretation:IMAGINGAFAST:TFAST/Vet Blue:Radiography:Problem List:Assessment: Options Offered to Client:Financial update:Referring Vet Communication: Treatment:  	Plan: Diagnostic plan :Therapeutic plan :Discharge plan :Referral plan :    Vital Signs    

Reason: Ear InfectionAppointment Notes: Overdue remindersHistory:Shaking head, ears seem irritatedCurrently on abx for anal gland infectionOtherwise acting normallyDiet is chicken and vegObjective:T 38.2 P80 R pant Wt [refused to step on scale]GEN: BARH, mm:pk/moist, crt: 1-2sEENT: EYES- cornea, anterior chamber clear OU. No conjunctival hyperemia. No ocular discharge. EARS- bilateral otitis externa with debris and erythema NOSE- nsf MOUTH-  No masses or ulcers.INTEG: Full hair coat.CV: II/VI LASM, no arrhythmias ausculted. Femoral pulses strong, synchronous, symmetrical.RESP: Clear lung sounds in all fields. No crackles, wheezes, stridor, stertor.ABD: Soft and non-painful abdomen.  No masses/organomegaly noted.MS: No overt lameness, muscling symmetric and appropriateLN: Mandibular, prescapular, and popliteal lymph nodes are soft, symmetrical and normal in sizeNEURO: Appropriate mentation. Menace response and palpebral reflex intact OU. No ataxia noted.RECTAL:  Anal gland ducts thickenedEar cytology: bilateral yeast infectionAssessment:Ear infections - given concurrent anal gland infection consider allergies as underlying causeHeart murmurPlan:Communication: SWO, discussed hx/PE. Discussed heart murmur - CXR/echo may be recommended - to discuss with GP at revisit for ears. See discharges.    Vital Signs    

Reason: Nose BleedConsultation Time: Hospital Time Period: History:O woke up this morning and found frank blood speckles on the ground. Rocky was actively licking his gum and it was all blood. The nose bleed stopped after awhile and none since then.Prior to this EDDU normal, ate breakfast well, no injury/trauma, no hx of travel/swimmingIndoor-outdoor, short grass in the backyard, no access to toxins eg. Rat bait, animal carcasses, snail baits, etcThere is another Tibetan Mastiff at home doing well, they do occasional play rough but no recent fightUTD with vacc and wormingDiet: Lyka wet food (from Sydney) - recommended by another vet (not for any prescription); a bit of kibbles Has arthritis, every now and then will be on oral meloxicam - the last dose was given 2 weeks agoNo recent blood test performedSubjective:BARObjective:Temp:  38.5          MM:  Pink, moist             CRT: <2s            HR:  68            FP:  SSFP            RR: 20BCS:    7/9                Wgt:    kg Pain Score (CSU):   0/4CV:    No heart murmur or arrhythmia auscultatedRESP:     Clear BV sounds bilaterally, normal resp effort, no obvious wheezes/crackles/nasal discharge. A pinpoint scab was found in the lateral aspect of the inner alar fold of the left nostrilGIT:   Abdomen soft and comfortable on palpation. No obvious petechia/ecchymosis/bleeding on the mucous membrane or from the oral cavityU/G:  Not assessedNeuro:  Appropriate mentation. CN exam unremarkable. No ataxia noticedM/S:  Ambulatory and WB x4Integ:  NAD, no obvious petechia/ecchymosis notedOphth:  NADLNs: NADProblem List:Unilateral epistaxis - LEFT, stoppedAssessment: Clinically and cardiovascularly stable on presentation. Unilateral epistaxis likely secondary to local wound (DDx foreign material like grass seed, injury) >> rhinitis, sinusitis, foreign material inhalation, coagulopathy (primary vs secondary), othersOptions Offered to Client:1. Home monitoring2. Blood tests including CBC (+/- biochem since Rocky has not had one done for awhile), blood smear +/- coag profileO elected for option 1 and will likely go back to the RV for the blood testsTreatment: Nil  	Plan: Close monitoring for RE, gum colour, frequency/volume of nose bleed, appetite, bleeding from elsewhere, petechiation/ecchymosis, NQRSoft diet only for now (in case of GI bleeding)Advised strict rest, ideally indoorApply cold compression if it happens again - consider calling us or RV for further investigation    Vital Signs