C10007788 / invoice 10000

**HISTORY/REASON FOR VISITCoughing for approximately 1 month, SID or BID, sounds like a hoarse coughSeems a bit tired and lethargic for the last few days, less energy than usualLast night stood and whimpered at owner around 5pm, went to bed earlyStill eating well and wants to play ballAlways on lead, walks daily, has contact with other dogs PHYSICAL EXAM:Demeanour - BAR, brightBCS - 2.5-3/5Cardiovascular - Very mild heart murmur LHL side, mitral valve region, difficult to hear, approximately grade 2/6, heard intermittentlyRespiratory - RR: lung sounds clearMM colour/CRT - pink, moist, CRT <2Eyes - clear, minimal dischargeEars - no erythema or dischargeNose and Throat - NSFOral Assessment - NSFMusculoskeletal - NSFIntegument - healthy coat, no lesionsAbdominal palpation - comfortable with deep palpation, no abnormal structures feltRectal - not assessedTemperature - 38.2PROBLEM LIST:Coughing - canine cough, early airway inflammation, allergies, less likely related to heart murmur at this stageMild heart murmur LHL - mitral valve insufficiency/regurgitation, early degenerative valve diseaseLethargy - mild, likely related to coughing/airway inflammationDIAGNOSTICS:None performed todayTREATMENT:MeloxicamPLAN / DISCUSSION WITH OWNER:Heart murmur newly detected, very mild grade 1-2/6 on LHL side, likely mitral valveUnlikely to be causing cough at this stage - murmur too mild, lung sounds clear, no signs of CHFCough more likely canine cough, airway inflammation, or allergies given duration and naturePrescribed meloxicam 12.5mg (1/2 tablet) PO SID for several days to reduce airway inflammationGive with or after food to reduce GI upsetIf cough worsens, persists, or dog becomes more lethargic, recommend chest radiographsTry to get video of cough if possible to help characterize itEcho may be considered in future to baseline heart changes but not urgent at this stageMonitor resting respiratory rate at homeRecheck if any concerns or cough not improving

Nurse Laura: Recovery: Slept yesterday afternoonWounds/dressings: How are any wounds/dressing/bandages looking?Eating/drinking: Eating and drinkingToileting: Have they toileted?Medications: If any medications, have they managed to give them/reminder to give?Revisits: Recheck in 1 monthOther: 

Nurse: NM History: see admit cx Sedation:Medetate 0.15 ml / Butorphanol  0.35ml  IM Time:@9.35Sedation quality : Good Alfaxan given to affect. 2.5ml total given (2.5ml drawn up)IV catheter Placement: Not able to place catheter prior to sedation22g IV Catheter in right cephalic veinProcedure: Ear pluck under sedation Cytology - cocci bilaterallyCleaned both ears with otoflush mometamax instilled into both ears at discharge Recovery: SmoothAntipam 0.15ml IM @ 10.25am Medications: Mometamax in both ears Plan/Revisit:1 month ear recheck with vet Advised cardiac U/S to get baseline cardiac assessment. No indication for urgent intervention, medication or exercise moderation