C10016545 / invoice 10000

Client concerns:Itchines occ in spring summer- normal/regular diet = on HSD skin and stomach and some soft food.- preventative healthcare = Overdue several years. NUTD para control. Occ -Current medical conditions being treated: - current medications = Occ apoquel.  Subjective: Pet's signalment: Skye, History: - The owner reports the patient is doing well at home.- There is some mild pruritus, evidenced by the pet rubbing on blankets.- The patient is recovering from a previous injury near the eye, which appears to be healing well.- There is a history of seasonal pruritus, particularly in the spring.- No vomiting, diarrhoea, coughing, or sneezing has been observed.- The owner reports the patient has HALITOSIS.Diet: - A commercial dry food formulated for sensitive skin.- Occasionally receives soft food as a treat.HW/ flea + tick preventative:- The patient is NOT CURRENT on parasite prevention. The owner has used a monthly oral product in the past but not recently.Current Medications/ supplements:- The owner has an antihistamine at home that is used as needed for historical seasonal allergies.Any vaccine or medication reactions:- None reported.Recent blood test:- None.Objective:Mentation: BAR, sweet girlWeight: - kgTemperature: Not takenHR: WNLRR: WNLBCS: 5 out of 9FAS: GreenHydration: Hydration appears normalEyes: The eyes are bright and clear with no epiphora. Periorbital swelling has resolved. The healing laceration near the eye shows healthy underlying skin with some remaining crusting around the sutures. Some sutures loose near medial canthus.Ears: No debris or erythemaOral Cavity: Owner reports HALITOSIS.Cardiovascular: no murmur or arrhythmia, strong pulses.Respiratory: Lungs sounds are clear, no crackles or wheezesAbdomen: comfortable on palpation, no mass effect, no fluid waveMusculoskeletal: Normal ambulation, Normal ROMIntegument: The skin looks normal; hair coat in good condition. No ectoparasites. No masses found.Lymph nodes: Lymph nodes are soft and smallUrogenital: External genitalia appears normal; bladder palpates normallyNeurologic: Normal mentationAssessment: Problem List:1. Post-operative recheck - healing well2. Mild pruritus3. Halitosis4. Lapsed parasite prevention5. Annual vaccinations dueDifferentials: Stable on examPlan: Treatments: - C3 given SQ. Intranasal KC. Booster in 12 months.- Administered topical Lotilaner in clinic.Diagnostics Completed: - Physical ExaminationFollow up:- Continue the use of the Elizabethan collar for another week to prevent self-trauma to the healing wound.- The owner may trim any loose sutures if they become irritating to the patient.- Discussed future dental cleaning to address halitosis.- The owner will locate the patient's vaccination booklet at home.

Reason for call: post op checkOutcome of call:LVMFollow up required: Yes / No

Nurse/VL:Procedure: Stitch Up - Skin laceration dog fight distal to R eyePre-op exam: Values in chartsPre-ana blood results: Hematology: Very mild lymphopenia, otherwise WNLChem 11: WNLPre-med: Medetomidine   6mcg/kg = Methadone     0.3mg/kg = Moderate sedationInduction:Propafol IVMaintenance Agent: Iso / O2 ET tube size: 5mmSurgical Report:The area was clipped and aseptically prepared with dilute iodine.Few mm distal to the lower R eyelid - eyelid margin and medial canthus intact.~1cm triangular shaped flap. On exploration - pocket extends quite deep laterally ~1.5cm with maxillary bone exposure. No obvious nerves/vessels damaged. Unable to visualize NLD. Wound was copiously flushed with sterile saline, and then the subcutaneous tissue and some of the fascia of muscle layer closed in 4.0 simple interrupted. The skin was closed in 4/0 simple interrupted. Post Surgery meds:Meloxicam 0.25ml given SQAmoxyclav injection 0.56ml given SQMedication TGH:Amoxyclav 60mg PO BID starting tomorrow at 7ma.Meloxicam 0.1mg/kg PO SID starting 7pm tomorrow for 4 days.Advised O of wound breakdown, swelling, further tissue necrosis.Must wear e-collar.No sutures to be removed - absorbable. RV due:POC 3 days with a nurse.