C10005437 / invoice 10000

Reason: Admit For Echo. EWAppointment Notes: Overdue remindersDIAGNOSIS:  1. Myxomatous valve disease (mitral + tricuspid) – Stage B1                ASSESSMENT:  The echocardiogram reveals myxomatous mitral valve disease (MMVD). There is also mild tricuspid valve degeneration. There is modest mitral regurgitation with no secondary cardiac remodeling or systolic dysfunction (i.e., stage B1). The risk of cardiac complications is currently low and there is no indication for therapy.  TREATMENT AND RECOMMENDATIONS:  Coco is currently classified as stage B1. The ACVIM Consensus Statement for chronic valve disease reached a consensus in this group; specifically, no drug or dietary therapy is recommended. A recheck echocardiogram is recommended in 1 year. Medication summary:  No cardiac medications are indicated.  ANESTHESIA: Damon Leeder BVSc DACVIM (Cardiology) vetcardiacimaging@gmail.com www.vetcardiacimaging.com Tel: 0490 790 241 Although there is a slight increase in anesthetic risk compared to an otherwise healthy dog, the risk is low. To minimize risk as much as possible, the use of moderate or high-dose alpha-2 agonists should be avoided. Consider pre-medication with an opioid + benzodiazepine combination, induction with Alfaxan, and maintenance with isoflurane or sevoflurane. IV fluids should be limited to <5 mL/kg/hr unless hypotension is documented.  FOLLOW-UP: A recheck echocardiogram is recommended in 1 year.    Vital Signs    

Reason: Check AG's + Paws. EWAppointment Notes: Overdue remindersHistory: Chewing his paws - chronicSees caroline homeopathic vet and gets CBD + a bunch herbal thingsCoughs: has chondromalaciaAssessment: All four paws overgrown nails: clipped in consultAll four paws interdigital inflammation consistent with allergic skin disease: red little pawsTeeth good for age however upper canines potentially problamtic - gum recession and plaque. Needs a dental (possible canine removal)Overweight 4.3kgAnal glands normal: left small amount of normal fluid, right emptyHeart murmur systolic - newPlan: 1/ Cytopoint 10mg SC for allergic skin disease: applied neocort to interdigital spaces2/ Clipped nails and expressed what was in anal glands3/ Recommend echocardiogram with Dr Damon. Booked for Monday. O dropping at 11am and picking up after his meeting later in the day. No sedation please (don't think it will be required) - a very good boy4/ Depending on heart situation dental required at some point this yearAllergic to grass and chews his pawsCBD, herbal thingsCoughsAssessment: Chewing his feet. Plan:Cytopoint 10mg B#840904    Vital Signs