C10008162 / invoice 10000

Pre-sedation check - HR: 132bpm, no murmur auscultated today, MM: p/m, CRT:<2s , Chest: nad, Abdo: nad  
R cephalic catheter placed. Sedation: 0.2ml butorphanol / 0.2ml medetomidine. 
Flow by O2 

ANAL SACS: 
Yellow-green purulent liquid discharge from both anal sacs prior to flushing. Clipped some fur away from anus for visualisation & cleaning. 
22G catheter + warm saline used to flush both anal sacs until flush returned clear. 
Placed ~5ml of Panapex ointment into both glands. 
Light layer of neocort applied to perianal/anal skin.

Reversal: 0.2ml atipamezole IM 

SKIN: small amount of epidermal collarettes on inguinal/ventral abdomen & a few in axillae regions. 

Plan:
- If well RV in 3 weeks for anal sac expression 
- Start cephalexin for skin infection: 300mg q12h q14h days
- Briefly discussed at discharge: O feels like food is not working for her skin issues, discussed trialing cytopoint & apoquel. O will think about this and potentially do at recheck appt in 3-4 weeks. 

Presented for -  AG expression
presented for nurse Ag expression
done by vet short of nurses today
AG's infected- purulent material expressed, difficult both sides and full. has been scooting and irritated by bottom
O's trialling delicate skin food
Current medications: pred prn for skin
Parasite control: 

Mentation: BAR 
EDUF: nad
Diet: delicate skin
MM: pink moist
CRT: < 2sec
HR:  reg murmur 2/6 100 bpm
Chest Auscultation: normal bronchovesicular
Abdo Palpation: soft
BCS: 5/9
Rectal Exam:  bilateral AG's full, hard to express
Skin: some crusts dorsum
Joints/Gait: ambulates well
Urogenital: nad
Vaccination status:
 
Problem list: 
1) AG infection
2) grade 2/6 L side systolic heart murmur
DDx:

Treatment in clinic: AG's expressed

Plan: sedation AG flush and AB's booked wednesday (O shift worker- best day for them)

Communication: discussed with O can trial oral AB's but often need AG flush and AB into area, O keen to wash out. discussed will need 2-3 repeats 2 weeks apart.

Reason: anal gland expression

Taken to tx room. Both glands extremely full and quite hard to express.Emptying very slowly. Strongly recommended RV in 4 weeks and to introduce psyllium husk and/or glandex chews to prevent any infections occurring.