C10011654 / invoice 10000

History:In with Sarahhas been off her food so has had to entice her with a different dietshe is now on ziwi food and some Royal Caninfood switched in august lastshe has been off her food over the last few weeks and is better now tripe has been addedhas had really smelly fartson nexgard spectraloves human food and happy to take treats hereExam:Stable weightdental disease mild to moderate, but mostly tartar on upper canines and upper back teeth, with minimal gum disease evidentskin and coat look goodears and eyes nadno raised lnn chest sounds clearnad on abdo palpation and anal area appears normalcalm, settled and responsive hereDiagnosis:Disrupted GIT biome, no indication of anything more sinister at this stageTreatment:Start with course Prokolinwean off tripe topperconsider adding prebiotic back to dietMay need to change diet alsoresee as needed

As prev but due 6mthly check in the next couple of months (similar to Lenny)

History: Presents for routine vacc.Metacam may have helped a small amount - no huge difference. No significant concerns for mobility at present though - slower on walks & doesn't run as much but doing okay considering age.Lump on chest (lipoma - previously sampled) growing.EDUD mostly normal (self-limiting D+ yesterday but nothing persistent).Nexgard Spectra monthly UTD.Fingerbrush on-hand but difficult to brush.Regular medications: fluoxetine 80mg PO SID4CyteExam:  BAR, loves treats. Vitals WNL. BCS 4/9Integument: 2 x SC masses (previously sampled - lipomas) - 1 x near L axilla as prev & 1 x cranial sternum; both soft, mobile, ovoid & relatively small (sternum some growth - approx 3cm)Ears: pinnae WNLOral: mild calculus & gingivitisEyes: NADLNs: NADCardioresp: NAD Abdomen: NADGenitourinary: NADMSK: ambulatory w normal gait; joints not manipulated today given recent ortho check upRectal: NPDiagnosis: Fit for vaccTreatment: Protech C4 s/c & Bronchi-shield POContinue fluoxetine 80mg PO SIDMetacam 37kg dose PO SID if requiredPlan: Booster C5 vacc annuallyOkay for repeats Metacam and/or fluoxetine as needed until Jan 2026.