C09971997 / invoice 10000

Appointment Reason: Blood / Follow Up, Appointment Notes: Paws App Details:Booking Type: Consultation - $95 Booking Vet: Dr Lisa KavanaghBooking Notes: Follow up blood testHISTORY:- Recheck consultation for elevated SDMA on bloods two months prior.- History of intermittent vomiting and diarrhoea.- Previously presented to an emergency centre for pain, struggling to stand up and sit down. Was placed on medication at that time - zofran and cerenia.- Two weeks after the emergency visit, had a flare-up of vomiting and pain after ingesting cat vomit - presented to WFAH - faecal sample was sent for PCR and was positive for clostridium.  No treatment was needed. - Energy levels have been reduced, although improving over the last week. Was previously only managing 30-minute walks.- Episode of vomiting yesterday (three times) after a meal of chicken and pasta. Vomitus contained food and grass. This was the first episode in three weeks.- Stools are now normal.- Appetite and weight are good.- Owner notes hesitation to jump onto furniture or into the car, and reluctance to use stairs since the episode of pain.- Owner reports separation anxiety, which is a concern as the owner will be travelling for two weeks in July. Current meds: noneProphylaxis: UTD. Due for annual vaccination in May/June.Pre-existing conditions: Chronic GI symptoms but are resolving  VITALS: HR: 80 bpmMm: pinkCrt: < 2 secsMentation: Bright, alert, responsive. EXAMINATION:Behaviour: In consult takes treats well.  Is uncomfortable with touch but does tolerate it. Has episodes of chasing tail and biting rump ? frustration vs anxiety Cardiovascular: cardiac auscultation normal, normal rhythmMusculoskeletal: ambulating normally. Owner reports hesitation to jump.Gastrointestinal:- Oral: No abnormalities detected- Abdominal: Tense and resists deep palpation. Appears uncomfortable with palpation around the abdomen and hips.Integument/Ears: NADLymph Nodes: NADEyes: NAD PROBLEM LIST:- Chronic, intermittent gastrointestinal signs (vomiting)- Suspected chronic pain/discomfort (hesitation to jump, pain on palpation)- Reduced energy levels- Situational anxiety (separation from owner)- Previously elevated SDMA DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:- Suspected inflammatory bowel disease- Chronic pancreatitis- Renal disease (secondary to elevated SDMA)- Musculoskeletal pain (source undetermined)- Behavioural anxiety DIAGNOSTICS: Bloods taken for external laboratory analysis (IDEXX) for SDMA and creatinine. ASSESSMENT:- Bronx presented for a recheck of a previously elevated SDMA.- History of chronic intermittent vomiting and a significant episode of pain requiring emergency care.- Clinical signs have been waxing and waning but are generally improving, with a recent episode of vomiting yesterday.- Examination reveals some abdominal discomfort and possible hip pain.- The primary concerns are chronic gastrointestinal disease (such as IBD), potential underlying renal disease, and chronic pain.- A concurrent behavioural issue of situational anxiety was also discussed. CLIENT COMMUNICATION:- Discussed the clinical signs and potential for an underlying chronic condition like inflammatory bowel disease.- Recommended a referral to a specialist medicine service (e.g., SASH) for a specialist abdominal ultrasound to further investigate the gastrointestinal tract if signs persist or worsen. Explained this would be the next diagnostic step.- Discussed management options for chronic enteropathy, including hypoallergenic diets and potential need for immunosuppressive medications.- Discussed the plan to recheck SDMA and creatinine levels to assess kidney function. The cost of the consultation and blood test was quoted as $163 and the owner consented.- Discussed management of separation anxiety, particularly for the owner's upcoming trip in July.- Proposed a trial of medication to manage situational anxiety. Discussed options including Trazodone and Gabapentin.- Explained the potential side effects of these medications, including paradoxical excitement (Trazodone) and gastrointestinal upset.- Advised a trial of medication should be performed before the owner's trip to assess Bronx's response.- A plan was made for a follow-up phone call to discuss blood results and formulate a plan for the anxiety medication.TREATMENT:- Blood sample collected for external laboratory analysis (SDMA and creatinine). PLAN:- Phone consultation scheduled for Tuesday to discuss blood results and decide on a trial medication (Trazodone or Gabapentin) for situational anxiety.- Owner to monitor for ongoing vomiting, lethargy, or signs of pain.- Recommended referral to a medicine specialist for further investigation (specialist ultrasound) if clinical signs do not resolve, particularly before the owner's trip in July. Discussed this would be beneficial to rule out underlying organic disease causing behavioural changes.- Continue current diet and monitor response.- Annual vaccination due in May/June. Recommended booking this appointment before July.- To discuss measuring B12 and folate on current bloods that collected when call with results on Tuesday     Vital Signs    Weight: 29.2;       HeartRate: 80;