C10018754 / invoice 10000

Reason: Crying When Passing Poo Appointment Notes: Overdue reminders  ------- Sms reply: YHistory:Seen twice in October for similar issues, first visit expressed full a/g, second trialed prokolinSubjective:- Presented for ongoing issues with defecation, specifically a hard first stool and associated discomfort.- First stool is noted to be more formed and solid. .- Previous anal gland expression in October provided minimal relief. Previous advice to add more fibre was based on the assumption of anal gland issues, which are not currently present.Prokolin didn't affect it muchWorse in last couple of weeks, howling when trying to pass first part of first faeces on walk, after that fine, no issues passing second faeces, walks fineStill occ flare of right foreleg lamenessDiet = home cooked petmince or chicken with vege etcPetmince does contain bone fragementsPast Medical History:- Previous history of anal gland issues requiring expression.- Vaccinations are up to date, last performed in September.Objective:- Physical examination: Temperature check performed, 39.1. Rectal examination revealed mild perianal erythema. No masses or internal abnormalities palpated. Normal and symmetrical rectal space. Anal glands were empty and non-painful on palpation. Appears slightly stiff in right leg after rectal exam, improved through rest of visitMm pink, teeth clean since dental, ears and eyes clear, ht regular, lungs clear, abdo NAD, LN normalAssessment:- Dyschezia likely secondary to firm initial stool consistency, possibly related to dietary components (cooked bone in mince).Plan:- Recommendations and counselling: Counselled on dietary modification. Advised to cease feeding current chicken mince due to potential for cooked bone fragments to contribute to firm stools. Discussed that cooked bone can denature and form a 'cement-like' consistency with digesta. Discussed avoiding frequent diet changes to allow for adjustment.- Investigations planned:- Treatment planned:- trial use of a lubricant applied rectally before walk to assist with defecation in the short term.- If pain or discomfort is noted, paracetamol can be used at a dose of 250mg (half a 500mg tablet) up to three times daily as needed.- Probiotics (e.g., Zamipet Relax and Calm) suggested as a proactive measure. Can be given as a sachet mixed with food.- Discussed considering a trial of arthritis medication (e.g., Zydax injections) in the future if joint stiffness persists, as the dog is of an age where arthritis is a consideration.- Other actions such as referrals or follow-up: Re-evaluate based on response to dietary changes.    Vital Signs    Weight: 22.1;