C09973044 / invoice 10000

Reason: D+HISTORY:- Presenting for lethargy, anorexia, and diarrhoea.- Symptoms began last week with sneezing and snorting while on a trip. On Thursday, he developed sloppy, cow-pat-like diarrhoea. He was started on a bland diet of chicken, rice, and pumpkin, which he initially ate. Over the last 24 hours, the diarrhoea has become more frequent (four times overnight) and consists of small, very slobbery stools. The most recent stool was pure mucus with some faecal staining. He has been anorexic since this morning, refusing food. He is lethargic and not displaying his usual play drive. He has lost 1.5 kg of weight.- He is drinking, but possibly less than usual. Urination is reported as normal. There was one episode of white, frothy vomit on Thursday. The night before the diarrhoea started, he was uncharacteristically difficult to wake. The owner reports his ears are consistently dirty and he has been shaking his head more than usual.- Adopted from a dog's home six months ago. He has a past history of gastroenteritis. Vaccinations and worming are up to date.- Diet is normally kibble (chicken and rice flavour), three cups per day, with an occasional topper of cooked sweet potato, rice, and chicken. He had a dehydrated beef/pork treat on Monday.- He was on a trip in a camper van last week. He has daily walks but has not recently been to a dog park.- No known allergies mentioned.EXAMINATION:HR: 80 bpm, increased to 120 bpmRR: 24 bpmTemp: 38MM: tackyCRT:  2wMentation: QARHydration status (%): 5% dehydrated Weight: 36.5 kgBody Condition Score: 5Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findings, no cranial nerve or proprioceptive deficits/gaitMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal: - Oral: normal, no mouth pain - Abdominal: no detectable pain on abdominal palpation, normal gut sounds - Rectal: no detectable abnormalities Urinary: bladder size small Reproductive (incl ext genitalia): desexed, prepuce normal anatomyIntegument/Ears: clean furcoat no evidence of otitis. The owner reports persistently dirty ears. He was sensitive to his face being touched.Lymph Nodes: peripheral lymph nodes normal size/shape & not painfulEyes: clear corneas, nil discharge or blepharospasmASSESSMENT AND PLAN:1. Gastroenteritis and Lethargy- Assessment: The clinical signs are consistent with gastroenteritis. The initial low heart rate was a concern but its subsequent increase is reassuring. Dehydration is a mild concern. Addison's disease is a differential diagnosis given the breed predisposition, lethargy, low heart rate, and gastrointestinal signs.- Recommended diagnostic tests: A baseline cortisol blood test was discussed to investigate for Addison's disease and check hydration levels. The owner has elected to monitor for now.- Treatment plan: Continue the bland diet. Recommended administration of Pro-Kolin paste from a tube the owner has at home, advising not to give it if he is nauseous or vomiting.- Follow-up care: Advised to return if his condition worsens. A re-assessment within 24 hours will not incur a further consultation fee.2. Upper Respiratory Signs (Sneezing/Snorting)- Assessment: The sneezing and snorting may be viral, allergic, or related to a foreign body, though a foreign body is less likely without discharge. It may be that he is generally run down, contributing to other signs.- Treatment plan: No specific treatment at this stage.- Follow-up care: Advised to monitor for the development of nasal discharge or fever.3. Otitis Externa (suspected)- Assessment: Based on the report of persistently dirty ears and increased head shaking, an ear infection is suspected. Cytology from the right ear had a yeasty appearance, suggesting a yeast overgrowth, possibly secondary to an underlying allergy. An otoscopic examination was declined by the owner.- Recommended diagnostic tests: The ear swab will be examined microscopically to confirm the presence of yeast.- cytology- yeast bilaterallyCLIENT COMMUNICATION:- Discussed Addison's disease- Provided education on ear care, advising that cleaning once or twice a week is sufficient and that over-cleaning can cause irritation. Discussed different ear cleaners, demonstrated how to administer Otoflush, and recommended its purchase for use no more than twice weekly.- Discussed the plan to monitor Zorro at home and to return for re-assessment and potential blood tests if he deteriorates. Confirmed that no further consultation fee would be charged for a re-check within 24 hours.DIAGNOSTICS:- Ear cytology (swab)TREATMENT:otoflush bilaterally to external ear canal PLAN:- Continue with the bland diet at home.- Administer Pro-Kolin paste to help restore gut microbiome.- Monitor for any worsening of lethargy, anorexia, or diarrhoea.- Monitor for the development of nasal discharge or a fever.- Return for re-evaluation if his condition worsens. A re-check within 24 hours will not incur a consultation fee.    Vital Signs    Weight: 1;       

REASON: Diarrhea for 1 week, inappetence todayTime: 1pmAES Vet:  Vincent ChanRegular clinic: North HobartHISTORY:- Presenting for diarrhoea and reduced water intake- Currently on Protexin probiotic- Drank from a stagnant pool about 10 days ago EXAMINATION:HR: 90RR: PantingTemp: 38 MM: Pink, slightly tackyCRT: <1s Mentation: BAR Pain Scale: 0 Hydration status (%): Euhydrated, skin tenting Weight: 30kgBody Condition Score: 4Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findings, no cranial nerve or proprioceptive deficits/gaitMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal: - Oral: normal, no mouth pain, dental score: - Abdominal: no detectable pain on abdominal palpation, increased gut sounds - Rectal: no detectable abnormalities, faeces:  Urinary: bladder sizeReproductive (incl ext genitalia): desexed, prepuce/vulva normal anatomyIntegument/Ears: clean furcoat no evidence of otitisLymph Nodes: peripheral lymph nodes normal size/shape & not painfulEyes: clear corneas, nil discharge or blepharospasmASSESSMENT AND PLAN:Likely indolent infectious D+, pathogen involved vs true dietary indiscretion vs idiopathic gastritis CLIENT COMMUNICATION:Owner to collect fecal sample on monday and submit to north Hobart clinic, advised owner to get fresh sample on the dayDIAGNOSTICS:Fecal testing on Monday TREATMENT:Sulcrafate 1000mg, 1/2 PO SID for 6 days, start today before starting metronidazole Metrobactin 500mg, PO BID for 5 daysPLAN:Should resolve with medication, if not, wait for fecal results Likely dietary change vs dental pain vs improper feedingGave two chulu tubes and ate all of it in consult CLIENT COMMUNICATION:Advised owner to get some other food, less dry food, cat has good appetite in consult TREATMENT:Get new food and trial it, advised owner to stop getting food from supermarket    Vital Signs    Weight: 30;