C10008092 / invoice 10000

Skin issues
Will park out back come in and get muzzle to wait outside till Dr ready. She isn't great at the vets.


Consultation
Reason:
Itching - red raw skin under forearms and between hind legs.
No other signs of itching - paws, ears etc. No obvious sign of infection.

Hx: previous skin itching years ago, not seen here for several years, no signs of itching etc until a few days ago
UTD on bravecto and presenting owners wife handles HW/deworming which is done at their previous vet (on a cheap plan), unknown exactly what Maisy is getting

PEx:
Basic PE - muzzled, tolerated exam ok then lunged and tried to bite as muzzle was removed.
Chest: Clear chest, no murmurs or arrhythmias noted. No crackles or wheezes on auscultation
Pink mm, rr normal


Basic PE done, friendly at the start - sniffing me etc, muzzled for very brief exam tolerated this ok then lunged at me while owner was removing muzzle.

Ax: dermatitis, possible contact allergy

Tx:
Dispensed pred - 1/2x 10mg tablet BID for 3 days then 1/2x10mg tablet SID for 3 days then 1/2 tablet EOD until finished (3 doses)
Dispensed neocort cream for use on affected areas 4 times daily for up to 7 days.

Given antihistamine dose sheet.

Reason: weepy eye again & incontinent (occasionally)

Hx: 
- Owner concerned about incontinence developing
- Last few weeks has gotten worse, when she sits down, then gets up, she seems to dribble urine
- Has always urinated when excited but now seems to be doing it randomly 
- No v+, d+
- OR dog seems to be licking at her vulva too
- Not lethargic at all
- Left eye also weepy again, some clear/yellow discharge noted 
- Squinting a little 

PEx:
Mentation: BAR, very timid. Hiding under the chairs 
BCS:5/9
Eyes: Left- mild chemosis and blepharospasm noted. Mild hypereaemia of conjunctiva. Cornea appears clear. No stain given Right- Seems normal, no discharge noted
Mouth: mm pink, moist, CRT <2s
Teeth: Dental grade 1/4
Nose: No discharge noted
Ears: Clean, free of debris 
Chest:Clear chest, no murmurs or arrhythmias noted. No crackles or wheezes on auscultation
LNs:WNL
Abdo:Soft, no organomegaly palpable. Bladder not palpable
Gent: Vulva not red or swollen. Moderately hooded.

ddx: 
Conjunctivitis vs FB (grass seed?) 
Incontinence vs UTI 
 
Recommended owner try to bring in a urine sample as a next step. Owner said its going to be hard for him to collect a sample at home. I said the only other alternative would be to sedate for cystocentesis (Est $300). After hearing this, he was willing to try and get a sample at home. 

Tx: Chloropt TID for 5 days

Px: Bring in a urine sample (can drop off for urinalysis). If no improvement with the left eye, then dog needs sedation for a proper exam. 

URINE DROPPED OFF 6pm 
USG: 1.038
Dipstick
pH 5
1+ PRO 
the rest unremarkable 

Sediment: no crystals or casts seen. Scant cocci (but free catch sample) 

No evidence of a UTI. 

ddx: Possibly true incontinence. Ok to trial propalin (1.5mg/kg BID--> 0.65mls BID)

Px: Recheck in 4 weeks 

weepy eye again & incontinent (occasionally)