C10007579 / invoice 10000

H:Generally Has been scratching her ears again - L ear more so, shaking her head. Hx cocci ear infections No change to diet/environment EDUD - okNo c/s/v/dNo current medsCurrent diet: Aldo brand treats, hills adult dry food, greenies treats Adovcate monthly Indoors only E:BAR ; mm pink <2 ; HR 120 - 132 ; T 38.5 BCS 4/9 CVS no m/a but is bradycardic, and appears relatively stressed in consult ; FP S+S RESP ausc NSF ABDO comfortable, softEENT mouth gr 1/4 DD has had prev dental extractions ; EARS L ear has serous discharge and scratched pinna ; eyes bright and clear ; nose NSF PLN WNL INTEG small scratches L pinna Cytology: L ear lots of debris, the odd cocci but very rare (searched many HPF, only saw 2) ; R ear NSF A:Ear irritation - at present appears sterile ddx allergies vs anatomy vs polyp Fit to vacc P:Trimmed nails no issues Vacc F3 (feligen 2435210 10/26). Booster 1 year Adv monitor for possible vacc reactions - lethargy, inappetence, V+ , angioedema, etcRe ears - start steroids to settle irritation (does not tolerate topical at home ie elocon). SE discussed (PU/PD/PP, diabetes) Revisit ideally 1 week but I am away and O would prefer continuity - r/v 2 weeks, but adv if CS not improving to r/v 1 week or sooner Repeat swab at r/v - warned may still need meds in case infection hiding however would prefer to avoid tolical meds if possible For management in future - consider diet trial, or topical elocon if tolerated Offered referral to dermatologist + CT Re heart Adv bradycardic. Has ranged HR 132-156 prev. Possibly is just her and not a concern, however have seen bradycardia assoc with cardiac disease so adv to watch for these signs + elevated SRR just in case. Echo discussed. 

H:Urinated on O 2 days ago when resting Urination otherwise ok. No changes to routine  More chatty in herself last few weeks but otherwise demeanour unchanged Appetite, drinking unchanged No stressors/ changes to routine Hx ear issues - possibly scratching more than usual again Current diet: hills dry food adult Preventatives: not UTD No current meds Indoor/outdoor: indoor only E:- BAR ; mm pink <2 ; HR 156 ; T 38.7 - BCS: 6/9 - CVS: No audible murmur, regular rhythm. - RESP: RE WNL. BV sounds NSF - ABDO: Soft and comfortable. No palpable abnormalities. Bladder small. - EENT: Dental disease gr 2/4 - mild-moderate gingivitis - PLN: WNL - INTEG: NSF- MSK: no lameness, full exam not performedA:- Slightly overweight - Urinated on O P:Adv ideally do urinalysis +/- blood test O elects urinalysis Attempted cysto - unable bladder too small Given only once off and urination pattern otherwise WNL, offered1. monitoring 2. collect urine at home using catrine O elects option 1 If she has any changes to urination within next 48hr ok to dispense catrine and run UA without additional cons 

EDDU normal, no V+/D+/S/C Owner has no concernsEar problems appear to have resolved and have not recurred ExaminationBAR HR 200, no audible murmurs/arrhythmias, mm pink and moist, crt 2 secondsRR 32, no abnormal lung soundsTemp not takenWell for vaccinationF3 vaccination SC