C10028176 / invoice 10000

Appointment Notes: Loula (Dog) - General Consultation [Clinician : Dr Dave Lawson (Preferred Clinician)] - General check up.Advice on wheezingWeb BookingClient name: Harry RobertsonContact number: 0448951328Email address: ploys.pomp-0i@icloud.comPatient name: LoulaTwo years ago, had surgery for stenotic nares and elongated soft palate. Last few nights, has been wheezing when breathing in.Mostly at night, very occasionally if takes a deep breath in, will do it during the day. No vomiting. Doesn't pass out, doesn't last all night, doesn't go cyanotic (O is a dentist).Also just what are options to manage her skin?She manages pretty well, chews feet mostly, worse in summer. O gives her a Malaseb footbath after most walks. DDxBreathing: allergic airway disease, laryngeal stenosisPlanTrial Fluticasone inhaler with Aerodawg spacer, 1 puff BID for 7d, then just use as needed. If no progress, trial Ventolin (Salbutamol) inhaler, 1 puff as needed for wheezing. If Fluticason works, then likely allergic airway disease. If Ventolin works, then likely laryngeal stenosis. If neither work, would suggest GA and examine largynx and epiglottis. Skin is pretty well under control, could go with a short 5d course of 1mg Prednisolone (O can self prescribe) SID for flare ups. Fluticasone Proprionate (FLOVENT)The inhaled steroid I use is fluticasone. It comes in three doses (44, 110 and 220 mcg per actuation). I use the 110 dose. This drug has virtually no side effects! Reported problems in people included growth retardation and oral candidiasis, but this has not occurred to my knowledge in more than 100 cats or dogs treated with flovent over the past 4 years. It has the clinical effect of oral prednisone 1mg/kg bidThere are a few potential problems/limitations. First, the drug takes about 7-10 days to reach full effect. Second, the owner may not be aware when the canister is empty.How to Use1.  Rx the 110 mcg dose as one puffs into spacer BID.2.  The dog or cat should breath through mask and spacer for 7-10 second.3.  If the animal is currently symptomatic and can tolerate short-term prednisone begin 1mg/kg bid oral pred for 5 days concurrent with flovent, then D/C the pred.4.  Demonstrate how to use the mask/spacer/drug in front of the owner, with their pet.5.  Have them demonstrate the same technique to you, in the office, with their pet, by themselves. This is a one-person job.Albuterol (Proventil or Ventolin)The bronchodilator I use is albuterol. It only comes in one dose. I usually prescribe this drug as needed for cats with intermittent signs of asthma (not daily signs). Potential side effects include musculoskeletal twitchiness, excitability, insomnia, and anorexia.How to Use1.  Rx the drug as the generic (albuterol MDI)--two puffs into spacer BID.2.  Cat should breathe the drug through the mask and spacer for 7-10 seconds.3.  Positive clinical effect should be seen within 5-10 minutes.4.  Can be used every ½ hr for 2-4 hrs as needed in crisis.SUMMARYInhaled steroids and bronchodilators are the standard of care to treat humans with asthma. Over the past 4 years we have treated more than 100 steroid-dependent cats and dogs with twice-daily Flovent, and Proventil on an as needed basis. Approximately 80% of these patients no longer use oral prednisone. The methods described above are effective, practical and very safe, and avoid the complications associated with chronic oral steroid use.    Vital Signs    Weight: 11.2;       MMColour: Pink;       Skin: Abnormal (Palmar and plantar surfaces of feet, erythema and mild hyperkeratosis. );       Demeanour: QAR;       BodyScore: 5;       CRT: 1-2;