C10019880 / invoice 10000

Reason: Lame LegAppointment Notes: Went to boarding at another clinic yesterday, came back lame and O thinks it may be a sore nail bedReason for Presentation: Forelimb lameness.    General History:-   Owner noticed Sunny holding up a paw today - LF -   He is not licking the paw excessively.-   Owner noted some redness around two nails on the affected paw.-   Otherwise bright, eating, drinking, and toileting normally.-   Diet consists of Royal Canin digestive and gastrointestinal biscuits. History of a sensitive stomach.Parasite prevention: UTDMedications: NonePhysical ExamTemp: not taken MM: Pink and moist  CRT: <2 seconds  Femoral pulse: Normodynamic and synchronous    Mentation: Bright, Alert, and Responsive  Body condition score: 4Weight: 25.65 kg  CVS: No murmur or arrhythmia auscultated  RESP: Normal effort and pattern, thoracic auscultation unremarkable  ABDO: Soft, non-painful, no palpable abnormalities  MSK: Ambulatory on all 4 limbs. Reluctant to allow palpation of LF paw. The nails are long. No obvious foreign body, swelling, or purulent discharge noted from the paw or nail beds, no nails are torn. EYES: nsfNOSE: No nasal discharge.  EARS: Ears clean and free of discharge.  ORAL: Mild dental tartar present. Gums appear healthy.  NEURO: No neurological deficits noted  LNs: Palpable LN's are normal  INTEG: Normal skin turgor, good coat condition. Pododermatitis front paws, mild inflammation. RECTAL: Not performed. External appearance normalCLIENT COMMS:-   Discussed that the lameness could be secondary to a nail injury (bruise/sprain) as nails are long he could have caught on something or a possible secondary nail bed infection related to pododermatitis but other ddx cannot be ruled out. -   Discussed the plan for pain relief, rest and topical medicated shampooing.-   Advised to monitor for improvement and to return if the lameness worsens, or if swelling or discharge develops.-   Further diagnostics such as sedation for a more thorough examination and X-rays were discussed as the next steps if he does not improve.-   Advised on the importance of rest and using an Elizabethan collar if he starts licking the paw.-   Discussed long-term dental care, including the use of VOHC-approved products.-   Discussed diet, suggesting he could be fed more to improve his body condition.-   Discussed neutering in general terms. - Nail trimming is recommended but not performed today as he is painful.   PLAN:-   Dispensed meloxicam. -   Dispensed Malaseb shampoo. Instructed to begin bathing the affected paws in 1-2 days as he is painful now. Lather the shampoo into the paws, especially around the nail beds, leave on for 10 minutes, and then rinse thoroughly.-   Advised to trim his nails once he is less painful.-   Recheck if there is no improvement in the next few days as sedation to investigate further +/- x-ray might be indicated.- can add gabapentin if needed for rest    Vital Signs    Weight: 25.65;       

Reason: Day CareAppointment Notes: Special payment terms exist    Vital Signs    

Reason: Check Up Appointment Notes: Special payment terms existHistory: -- Duration - -- Chronic ocular discharge and mild redness - since a puppy -- Intermittent occurrence - usually just the right eye affected but have seen left eye having similar issue as well -- Wil see mucoid discharge - usually yellowish - with mild redness/conjunctivitis during flare-ups -- Flare-up usually lasts for 2-4 days then resolves on its own-- Owner has tried putting an unknown eye drop onto the right eye once before (more than 1m ago), no response seen and no other meds used since. -- Also having occasional soft faeces since changing diet to r/c adult food 2w ago-- Has had sensitive guts as a puppy but nothing recent until 2w ago-- Last soft faeces passed 3-4 days ago - no blood or mucus -- Fed a mix of wet and dry food, with occasional cooked chicken as treats-- No V+, still good appetite -- Drinking and urination has been normalUp to date with prevention:       -- yes/no - yes       -- type - unknown product q1mMedications on currently - nil Examine:-- BCS: 5/9-- Temp: not taken -- MM:  pink-- CRT: 2 secs-- Cardiovascular:      -- HR: 72    -- No obvious murmurs or arrhythmias -- Respiratory:     -- RR:  16    -- Respiratory effort - No increased insp or exp effort     -- Respiratory sounds - Normal bronchiovesicular lung sounds     ---- Abdomen:     -- Pliable, not painful, no masses obvious on palpation    -- -- Oral:    -- Examination: Mild calculus buildup on canines and cheek teeth, no gingivitis    -- Dental score: C1G0 (1/4)-- Eyes:     -- Left eye        -- Ocular discharge - none        -- Conjunctivitis - none        -- Sclera - normal with no injection        -- Corneal surface - No obvious defects       -- No obvious ectopic cilia        -- No miosis, no aq flare, normal anterior and posterior chambers       -- Pupils symmetrical. PLR normal x2.        -- Retinal examination normal.        -- Lens normal position with normal opacity        -- Eyelids normal with no FB/lesions on or under eyelids-- Right eye        -- Ocular discharge - mild mucoid - off-white       -- Conjunctivitis - minimal, only on bulbar conjunctiva        -- Sclera - normal with no injection       -- Corneal surface - No obvious defects       -- No obvious ectopic cilia        -- No miosis, no aq flare, normal anterior and posterior chambers       -- Pupils symmetrical. PLR normal x2.        -- Retinal examination normal.        -- Lens normal position with normal opacity        -- Eyelids normal with no FB/lesions on or under eyelids-- Nose:     -- Normal confirmation    -- No sneezing.     -- No nasal discharge.     -- Normal symmetry. -- Integument:     -- Clean coat,     -- No dermatitis or skin lesions present.    -- Normal skin turgor    -- No fleas or externa parasites    ---- Ears     -- Left ear - normal canal with minimal brown waxy discharge. Normal pinna    -- Right ear - normal canal with minimal brown waxy discharge. Normal pinna-- Lymph Nodes:     -- all palpable external lymph nodes normal size and shape-- Musculoskeletal:     -- Ambulatory with no lameness.     -- Joints palpate normally. No excesive heat or swelling palpable, no pain on manipulation     -- Normal musculoskeletal exam. PROM WNLs x4. Spinal palp WNLs     ---- Neurological:     -- Mentation - BAR.     -- Normal CN function. Palp and menace intact x2. PLR normal x2    -- No ataxia noted.     -- Full neuro not assessed     ---- Rectal exam: NSF, small amount of normal faeces retrieved, no blood or mucus, anal sacs WNLs -- Reproductive:     -- 2x normal testes -- Behaviour: -- Problem list: 1. Intermittent ocular irritation - usually R eye -- No obvious ocular lesions or abnormalities except for mild conjunctivitis and mild mucoid discharge -- Intermittent nature and seems to be chronic -- DDx conjunctivitis (bacterial vs physical irritant vs allergic) vs KCS vs superficial ulcer vs ectopic cilia vs others -- Consider Fluoroscein + STT as first step, otherwise trial eye lubricants2. Diarrhoea for 2w after dietary changes-- Most likely to be dietary-related-- No other pertinent abnormalities noted on PEx, patient otherwise appear well with no other GI symptoms-- DDx dietary vs parasites vs GI infection/inflammation vs others -- Consider GI diet or bland diet trial and assess response, otherwise faecal analysis and/or longer period of strict dietary trial 3.Plan: Explained findings and offered STT + Fluoro staining, owner declinedTrial ViscoTears OD SID to BID and assess response Recheck eye in 1-2w if not seeing improvement with lubricants, consider STT and Fluoro staining then Consider dietary change - reduce wet food OR trial gastrointestinal/digestive care diet OR trial bland diet for 3-4d and assess changesRecheck in 2w if soft faeces still persisting, or sooner if worsening or new symptoms    Vital Signs    Weight: 24.6;