C10005070 / invoice 10000

PRESENTATION: Lump 

HISTORY:
Current medications: rose hip supp 
EDUD all normal
mobilty good
coughing resloved from last visit 
lump at FL noticed a few mth ago - thought initally was a tick - then found small skin tag 
noticed just grown a little and licking sometimes 

PHYSICAL EXAMINATION:
Demeanour- BAR, nervous, doesnt like a lot of restraint, good with treats 
Cardiovascular- nad 
Respiratory- nad
Neurological- nad
Musculoskeletal- nad
Lymph Nodes- nad
Gastrointestinal- nad
Genitourinary- nad 
Integument- LFL cranial aspect of carpus skin lump approx 4mm diameter, mbile regular smooth hairless nodule 
Oral- mild palque lower archade 
Eyes- nad 
Ears- nad 
Rectal-

PHYSICAL EXAMINATION PROBLEM LIST:
skin lump 

DIAGNOSTIC EXAMINATION:

DIAGNOSTIC EXAMINATION PROBLEM LIST:

ASSESSMENT: no sign of gross concern - too small for FNA - suspect benign at this stage 

DIFFERENTIAL DIAGNOSIS:

PROVISIONAL DIAGNOSIS:

TREATMENT:

PLAN: monitor for rapid change/growth 

RECOMMENDATIONS: continue supp for OA and monitor mobility 

Next visit booked: (N)

CLIENT COMMUNICATION:

PRESENTATION: Inappetant, lethargic, vomiting bile 

HISTORY: 
- Cough & wheeze for about 1 week, then he vomits
- Loves sniffing in the park, sometimes eats weeds, will make belly upset but that is normally more of a bile
- These are white foamy vomits. 
- Eating ad lib, usually eats meals straight away
- Last week foamy vomits, worsened today a lot so wants HC
- O can't discern any pattern
- Normal defecation & urination
- O notes Murphy can be a bit unsure of vets, especially with physical exam and ears, needed a muzzle for last exam.
Current medications: 
Diet: Blackhawk adult dog biscuits 

PHYSICAL EXAMINATION:
Salivating a bit 
Demeanour- QAR a bit nervous but loves liver treats and good boy for exam. FAS yellow - escalted to red for needle,owner did hold well
Cardiovascular- NAD nil concerns on auscultation
Respiratory- RR 16, no abnormal lung sounds, no cough on throat palpation. Did cough during consult, the wheezing that O noted is a low cough, suspect will have a terminal retch/bringing up of saliva, did not visualise that in consult.
Neurological- NAD
Musculoskeletal- NAD good body condition 
Lymph Nodes- NAD
Gastrointestinal- NAD comfortable on palpation 
Genito/Urinary- NAD
Integument- NAD
Oral- POD 3-4 minimal gingival inflammation but significant tartar, did not visualise pharyngeal area.
Eyes- NAD
Ears- NAD
Rectal- NP

PHYSICAL EXAMINATION PROBLEM LIST:
POD 3-4

DIAGNOSTIC EXAMINATION:
Nil today

DIAGNOSTIC EXAMINATION PROBLEM LIST:
Nil 

ASSESSMENT:
Presenting complaint appears to be a low cough, cannot auscultate thoracic pathology. Possibly kennel cough with Hx of dog park, but is UTd with vaccines. EAting treats well in consult with no signs of discomfort on swallowing.

DIFFERENTIAL DIAGNOSIS:
-Kennel cough
-Pneumonia
-Allergic airway disease
-vomiting rather than coughing/regurgitation?

PROVISIONAL DIAGNOSIS:
-Infectious cough

TREATMENT:
Meloxicam - inj administered today and 4 days disp for at home.

PLAN:
-If cough not resolving after Tx course to return for radiographs
-If symptoms worsen to return for radiographs sooner.

RECOMMENDATIONS:
-Discussed thoracic radiographs to investigate further as I suspect this is coughing rather than vomiting, but also add on PAB to check for any other underlying concern. VS trialing NSAID and recheck. O would prefer to trial NSAId and recheck.
-O wanting to discuss COHAT as has been advised but does not feel necessary as no overt gingivitis and also concern for his age, he is 8.5y old. MP advised COHAT and discussed that he only gets older from here so waiting not ideal, but also discussed that I would be quite comfortable to place a dog of this age under GA and discussed that we do take precautions to ensure safety.
-Estimate provided for radiographs added on to Cohat. - O likely to combine so only 1 GA needed.

Next visit booked: (N)

CLIENT COMMUNICATION:

PRESENTATION: C7 & Annual Health Check & Heartworm Prevention SR12

HISTORY:
- Skin tag on LFL that he licking at, looks a bit like a tick but hasn't grown significantly
- EDDU normal, no other concerns
Current medications: Nil, rose hip powder on food
Diet:

PHYSICAL EXAMINATION:
Demeanour- BAR. FAS orange, limited exam
Cardiovascular- NAD.
Respiratory- NAD.
Neurological- NAD.
Musculoskeletal- NAD.
Lymph Nodes- NAD.
Gastrointestinal- NAD.
Genito/Urinary- NAD.
Integument- Skin tag LFL.
Oral- Grade 2-3/4 POD.
Eyes- NAD.
Ears- NAD.
Rectal- Not performed.

PROBLEM LIST:
1) Due for vacc
2) POD

DIAGNOSTIC EXAMINATION:
Nil

ASSESSMENT:
1) Fit for vacc
2) Recommend COHAT

TREATMENT:
C7
Proheart

PLAN:
C7/proheart  in 12m

RECOMMENDATIONS:
COHAT- Estimate explained to owner in consult

Next visit booked: (N)