C10022682 / invoice 10000

REASON- check eye

HISTORY-
BAR, eddu normal, no vcds. noticed a whitish spot on R eye recently, not bothering dog no squinting or rubbing or discharge noted, seems to be improving over last few days. Also checked his weight recently and has put on 8kg since desex, wondering if he is overweight and what to do about it?
Diet: adult good quality dry food, 1/2 big scoop BID, eats it all, + treats - small treats, broccoli, carrot, blueberries, watermelon, apple etc. 
F/T/W/HW: simparica trio monthly
Medications: none

EXAM-
Demeanour: BAR, very excitable, very food motivated
BCS  4/5 overweight, ideal weight 15kg
HR:  WNLs
RR:   pant
T:    not performed
CRT: 1sec    
MM: pink & moist
CHEST: NAD
EYES: NAD, fine white shadow on R cornea near lateral canthus - fluoro stain negative
EARS: NAD
NOSE: NAD
ORAL EXAM:   1/4 mild tartar early onset
SKIN:  NAD
ABDOMINAL PALPATION: NAD
MUSCULOSKELETAL SYSTEM: NAD

ASSESSMENT:
suspect healed ulcer on eye
overweight

Tx:
None

PLAN:
Monitor eye for now
Given weight loss handout, total food reduction by 15% and increase exercise if possible, reassess at vacc in next month or two. 

post op call - everything going well otis had been licking a bit without the cone O put it back on him. no other concerns with him 

 REASON – Castration

HISTORY- 
Admitted for castration, no health concerns. 
Fasted overnight
Medications: none

PERIOP EXAM-
Demeanour: unruly! Required 50mg trazodone prior to premed as relentless barking 
BCS  /5
HR:
RR:
T:
Oral exam: NAD, MM P&M CRT <1s
Chest: NAD
Hernia?
Dew Claws? 
1 Teste present in scrotum, able to only just palpate other teste in inguinal region- should be able to fit second teste through same incision. 

LAB-
Prep: O declined 

ASSESSMENT:
Fit for surgery

TREATMENT:
IV catheterisation, maintained on hartmanns IVFT maintenance & surgical rates. 
Premedication:  0.33 ml (0.3mg/kg) Methadone,   medetomidine 0.05ml 5ug/kg IM 
Induction:  1.7ml (2mg/kg) Alfaxan slow IV
Intubated with cuffed ET tube size 7.5 , maintained on Circle/Bain circuit with Iso/O2 + monitoring. 

Procedure: Routine prescrotal incision with closed castration performed.   2-0 mass (PDS) used for all ligatures and sutures. Able to exteriorise inguinal teste through prescrotal incision- smaller and malformed. Closure of subcutaneous tissues with simple interrupted suture pattern & simple continuous intradermal sutures. NO EXTERNAL SUTURES. 

Other procedures:
Nails clipped

GA Quality: Good, no complications, dysphoric recovery- settled without intervention. 

Post Op Meds:
1.1ml (2mg/kg) onsior SC in recovery

PLAN-
Routine post surgery discharge instructions given to client. 
Home with 20 mg onsior PO SID for 2d start tomorrow
E collar provided to wear for 2 weeks if licking at incision. 
Free rechecks 2 weeks if any concerns. 

*** Have zero'd cryptorchid charge as has been recorded as having 2 desecended testes in the past. Not in estimate.