C10011691 / invoice 10000

Reason: Limping On Front Right Paw - TMGAP ONLY HISTORYFirst clinical signs - TodaySummary - Fell down, hurt front right legDiagnosis - Soft tissue injury - open diagnosisTreatment -  Pain relief, x-rays in future--- 10/03/2026 16:30:31 AEJ:Distemper, Hepatitis and Parvovirus Vaccination - Skipped on 10/03/2026Diet: Preventative healthcare:Vacc:HWP:IW:Flea/tick:HISTORY:O's presenting complaint(s): Examine:PHYSICAL EXAMINATION: BCS: ## / 9MCS: normal muscle mass #Mentation: alert and responsiveEYES: NAD - clear, no noted discharge #EARS: NAD - clear, no discharge, odour, erythema#NOSE: NAD - clear, no discharge, symmetrical, no lesions #ORAL: NAD - normal pink and moist mm, normal CRT, healthy teeth & gums#CARDIOVASCULAR - NAD - no murmur or arrhythmia auscultated, pulse pressures normal and synchronous#RESPIRATORY: NAD - thoracic auscultation clear sounds bilaterally, respiratory effort normal#ABDOMINAL: NAD - soft pliable, no detectable pain or palpable abnormalities#NEURO: NAD - neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait#MUSCULOSKELETAL: NAD - ambulating with normal gait & posture, no pain on palpation of joints, appropriate ROM#RECTAL: not performed#REPRODUCTIVE: externally normal #INTEGUMENT: NAD - clear coat and skin #LYMPH NODES: NAD - peripheral nodes palpate normal #Assessment:Plan:    Vital Signs    Weight: 8.4;       

Reason: Lump & Poss Losing Weight AS--- 06/03/2026 16:41:18 NJT:Distemper, Hepatitis and Parvovirus Vaccination - Skipped on 06/03/2026Worming - Skipped on 06/03/2026Verified: NoSubjective:Diet: Advanced puppy wet food (canned), previously on Advanced large breed puppy kibble but refused to eat it. Very picky eater, sometimes requires hand feeding. Has tried various treats including liver treats initially accepted then refused.Recent changes to diet: Changed from kibble to wet food due to refusal to eat dry foodPreventative healthcare:Vacc: First puppy vaccination completed at 8 weeksHWP: IW: Flea/tick: Nexgard Spectra (recently started, previously on different product from Parkinson vet)HISTORY:O's presenting complaint/s: Skin lesions on left ear and left hip, poor appetite and weight gain concerns- 9 week old male Neapolitan Mastiff- Microchipped- Not desexed- Joined family 2 weeks ago- Two skin lesions noted - one on left hip and 3 days later left ear( outside ofthe lobe- Lesions not increasing in size, one scabbing due to scratching from playing- Weight gain minimal - was 8kg last week, now 8.1kgAppetite: Poor - very picky with food, sometimes requires hand feedingThirst: NormalVomiting: NilDiarrhoea: NilAccess to chemicals or toxins: Nil knownAccess to rodenticides: Nil knownCurrent medications: Nexgard SpectraPrevious medical history: Nil relevantNo insurance at this stageExamine:PHYSICAL EXAMINATION:Mentation: alert and responsiveEYES: NAD - clear, no noted dischargeEARS: Lesion noted on outside of left earNOSE: NAD - clear, no discharge, symmetrical, no lesionsORAL: NAD - normal pink and moist mm, normal CRT, healthy teeth & gumsCARDIOVASCULAR - NAD - no murmur or arrhythmia auscultated, pulse pressures normal and synchronousRESPIRATORY: NAD - thoracic auscultation clear sounds bilaterally, respiratory effort normalABDOMINAL: NAD - soft pliable, no detectable pain or palpable abnormalitiesNEURO: NAD - neurologically no significant findings, no cranial nerve or proprioceptive deficits/gaitMUSCULOSKELETAL: NAD - ambulating with normal gait & posture, no pain on palpation of joints, appropriate ROMRECTAL: not performedREPRODUCTIVE: externally normalINTEGUMENT: Two lesions noted - one on outside of left ear, one on left hip. Slightly infected appearance.LYMPH NODES: NAD - peripheral nodes palpate normalAssessment:Problem List:- Dermatitis with two lesions on left ear and left hip about 1.5 cm dimater, with scabby leison. Acabb come off with cleaning the lesionand left bald patch fornow- Poor weight gain and appetite in 9 week old puppy- Slightly thin body conditionLaboratory:Cytology of skin lesions: No parasites or fungal organisms identifiedBlood chemistry panel:- Kidney parameters normal- Urea slightly low (normal variation)- GGT slight elevation (other liver parameters normal)- Mild anaemia (likely normal puppy variation)- Overall results not significantly abnormalTreatment:- Apex PMP cream applied to affected areas BID for 10 days- Worming tablet administered- Blood test performedPlan:- Apex PMP cream dispensed for topical application to lesions twice daily for 10 days- Trial different puppy foods including Hill's Science puppy food (money back guarantee if refused)- Consider puppy milk supplementation- Regular weight monitoring at home- Recheck appointment if appetite does not improve- Second puppy vaccination due in few weeks- Consider ultrasound if appetite issues persist- Mix preferred foods with complete balanced large breed puppy diet to encourage eating    Vital Signs    Weight: 8.1;       MMColour: pink;       Temperature: 38.0;       HeartRate: 90;       BodyScore: 4;       DentalGrade: 0;