C10032314 / invoice 10000

H:Had 1 x 200mg ibuprofen tablet last night. Didnt realise til after when looked up that is toxic to dogs. Having issues around tail end, holding tail right under bottom, no scooting or dragging and no anal gland issues in the past.E:BAR, a bit stressy but loves treatsMM pink and moist -G2 dnetal diseaseLN WNLThorax WNLAbdo palp, soft and comfortableBack/spinal palp- WNLROM and palpation HLs OKanal glands- VERY hard firm balls approx grape sized bilateral, smooth, unable to manually express and painful to try to express- howling.T38A:Ibuprofen toxicity- Toxic GI doses at 25mg/kg and renal at 175mg/kg, central doses higher. Rocky dose around 11mg/kg so below concerns for renal toxicity. Recc PreGA screen to assess and get baseline and commence gastroprotectants. - Discussed with O that these toxic doses are based off other studies and every dog has potential to metabolise differently so cant say 100% kidneys will be fine and offered and discussed to be safest would be admission on IVFT 48h.Anal gland impaction- needs sedating to express and flush however don't want to do currently with ibuprofen ingestion. Recc booking in next week once we know kideys are clear to sort out anal glands, and provide analgesia in meantime. Discussed limitations in analgesia that is kidney safe.PreGA- normalT:Tramadol 100mg BID analgesia for anal glands- discussed sedation side effectRecc r/c Urea/Crea on Saturday (48hrs) or come back sooner if unwellLosec 20mg SID 7 daysDiscussed GI signs to watch forP:If bloods all good on Saturday then book in for AG flush Monday

History:Presenting with right eye discharge - purulent d/c present for a week. Nil pawing at the eye.Symptoms recurred quickly after stopping previous antibiotic treatment.Eating, drinking, defecating, urinating behaviour normalPhysical Examination:Demeanour: BARVital signs: HR 146, mucous membranes pink moist, CRT <2 secAuscultation: normal, no murmur or arrhythmia.Right eye: Mild to moderate purulent discharge in medial canthus, mild episcleritis and conjunctival hyperaemia, nil blepharospasm, nil photophobia, normal menace and PLR, nil fluorescein uptake, nil evidence of distichiasis or entropion, no visible foreign body.Left eye: NADEars: NADSkin: NADAbdomen: Soft and comfortableAssessment & Plan:1. Right eye unilateral conjunctivitisDifferential diagnosis: Irritant, allergies, transient foreign body, trauma, otherTreatment: Framixin H, BID to TID  7 days with warm compressAlternative antibiotic prescribed as previous treatment ineffective (symptoms recurred quickly after stopping)2. Ear maintenanceTreatment: Dexflanazine 0.5ml into both ears once weekly for 3 weeks, then fortnightlyNext Steps:Recheck INIReturn immediately if symptoms deteriorate

Has been doing well with current regimeO still thinks he has an ear infection though- yelped the otherhas been apply twice dailyhad ear infection before and cleared up quicklyPe; BAR, MM PM CRT <2very nice dogR ear- outercanal looks pretty good, some moist brown dishcarge still on swab down canalCytology- budding yeast numerous ++L ear normalskin generally looks ok otherwiseA; otitis R ear- improving but hasnt resolvedDiscussed cleaning + continuing dermotic vs neptra.O elected neptraP: Neptra placed in R ear.reassess in 2 weeks