C09973735 / invoice 10000

Reason: 3x V+ This MorningAppointment Notes: Overdue remindersConsent for use of Heidi was obtained.History:Luna has a chronic history of vomiting and GI issues with multiple previous presentations for similar concernsThis morning at 5:20am experienced multiple episodes of vomiting including white foamOwner reports ongoing issues since previous illness episode in December/January when Luna became severely dehydratedSince that illness, Luna has developed apparent water aversion - will approach water bowl but walk away without drinkingOwner has been syringe feeding water since the dehydration episodeCurrently fed Royal Canin Gastrointestinal Low Fat wet food - changed from kibble to wet food following previous illnessNormal bowel movements typically twice daily, this morning both occurred together with second stool being gel-like with mucusPrevious faecal testing showed positive result for one pathogen which was treatedPrevious blood work showed some abnormalities but nothing of major concernOwner reports Luna tends to have mucus around eyes in mornings and sleepy eye appearance, possibly allergicPrevious vet recommended Claratyne 10mg based on weight but owner has not administeredNo current probiotics being givenOwner considering dental procedure but waiting until GI issues stabilisedExamination:Mentation - BAREars, eyes, nose - NADOral - slightly tacky due to panting from stressLNs - NADSkin, nails and coat - NADAbdo palpation - comfortable, no pain or nausea detectedMSK - NADGait - NADChest ausc - NADGenitalia - NADHydration - adequate, skin tent test normalCRT <2sMMs pink and moistBW - 8.2kgAssessment:Chronic intermittent vomiting and GI sensitivityPossible inflammatory bowel conditionBehavioural water aversion Client Communication:Discussed that current vomiting episode appears resolved with no further episodes since morningExplained that syringe feeding water is likely unnecessary and may be reinforcing avoidance behaviourDiscussed that Luna was dehydrated previously due to illness, not primary water aversionAdvised that Luna will drink when thirsty and knows where water is locatedSuggested monitoring with camera near water bowl to observe drinking behaviour when owner absentDiscussed option for abdominal ultrasound to investigate GI issues further but explained this would not provide definitive diagnosisExplained ultrasound may show intestinal thickening suggestive of inflammatory bowel but would require biopsies for definitive diagnosisDiscussed that current clinical presentation does not warrant invasive procedures at this timeConfirmed Claratyne 10mg is safe for Luna's weight if needed for allergic signsDiscussed delaying dental procedure for 3 months until GI issues stabilisedPlan:Start long-term probiotic supplementation - capsule form to be opened and sprinkled on wet foodContinue Royal Canin Gastrointestinal Low Fat wet foodDiscontinue syringe feeding water and allow natural drinking behaviourMonitor for further vomiting episodesConsider B12 supplementation if ongoing GI signs persistRecheck in 3 months if stable for dental procedure considerationReturn if vomiting persists or worsens    Vital Signs    Weight: 8.2;       HeartRate: 100;       DentalGrade: 1/4;       RespirationRate: sniff;       CRT: <2;       MMColour: p+m;       BodyScore: 3/5;