C10008998 / invoice 10000

Appointment Reason: Annual Health Check, Appointment Notes: - LW Recent emergency visit last month for paradoxical breathing and mild increased temp TFAST WNL, o declined chest xraysHad some doxycycline 5d and inhaled salbutamol and settled quicklyEDUF well - emergency vet said he is a bit overweightO thinks RRR has been normal sinceThere have been two episodes where o has been concerned about Marmalade's breathing - once at 3m old and again last month - o is a recovery nurse and by her own admission watches Marmalades breathing very intenselyNo known trigger for episodes - no smoking, vaping, cooking, incense, candles - unsure if windy dayO concerned may have asthmaNo prev coughing or retching observedObjective: BAROverweight BCS 5/9 - need to reduce food intakeEyes, ears cleanMouth healthy - adult dentitionHeart regular, 200bpm, no murmur or arrythmiaRR 48, shallow breaths, seems a bit stressed in here, normal BV sounds on auscultationAbdomen comfortable on palpationTemp 38.4Assessment: Mild tachypnoea otherwise normal clinical examPlan: Discussed options with o:1. Work up for asthma, ideally proBNP rpt to rule out cardiac disease, chest rads +/- BAL/TTW q$12002. Monitor for repeat episodes and if recurs work up then; if want to be cautious can have some pred and salbutamol at home to use if repeat episode of resp distress.O elects for option 1, but will do after Easter (sooner if rpt episode), will dispense pred to have on hand at home (explained if underlying heart disease this is not ideal to use, but unlikely given overweight and no murmur) and gave script for salbutamol to use with paed mask and spacer in case of resp distress    Vital Signs    Weight: 5.77;       

Reason: Chin AcneSubjective:Black crusting around the chinNot wiping at it or rubbing at allObjective:BAREars: nsfEyes: nsfNose: nsfMouth: deciduous teeth, non gingivitisLN: nsfChest sounds; nsfAbd: comfortableSkin: very mild comedone formationAssessment:Cat acnePlan:Discussed that benign condition unless they become infectedO largely using metal or ceramic bowls currently Discussed duoxo s3 use off label, otherwise if continually infected can write scripts for mupicorinO to attempt to brush his teeth    Vital Signs    Weight: 2.5;       

Reason: O Sending Email Pic Of Chin    Vital Signs