C09974050 / invoice 10000

Discussion with DE 
  Things to ask 
 Meal time and is food left out  , is it happening at a time the batch is running out 
Related to time of  Simparica Rx 
 next step 
 Bloods and urine to  rule out organic disease , ideally  taken the morning after one of the episodes  ,  
 Dispense  gaba and trazadone for  that visit 
 Spoke to  Nathan 
  Is  mixing new diet with old  so  is not getting to end of batch 
He  wanted to stay outside last night , which is normally a cue that he was going to have an episode
O left him outside for 2-3 hrs this time  and still had to force him inside   but he didnt have an episode 
Adv  bloods and urine and dispense  gaba  and Trazadone  

NURSE: CC
HISTORY: Has been acting strange at night 10-1am. Panting and unsettled 
Has only happened 4 times  over a month 
Tries to tear apart pillows during these episodes 
No pattern O has noticed 
Not a destructive dog typically 
Eventually the episodes stop on its own. After this he goes back to normal behaviours 
Loki's diet has changed to a raw meat diet and was not very interested in it when O changed this. O slowly added in more raw meat diet and once he started to eat more of this these episodes became more frequently 
Before the episodes Loki stays outside for a long period of time just laying down. After this he lays down inside and O goes to bed after this the strange episodes happen.
No abnormal behaviour during the day
The days that Loki has these abnormal episodes he sleeps all day. The days these episodes don't happen his activity is normal 
Every so often has d+ but nothing abnormal for him 
Most night O puts Loki outside chained up to go to the toilet. On a normal night Loki is quite quick to come back inside. Before these episodes O has to drag Loki back inside from looking out into the backyard
No new people in the house   
-Diet Raw meat diet only just started in december. Previously was on ivory coat wet
-Env Indoor/Outdoor. Regular walks on lead 
-Comp None 
-Prev
Current Meds:
-Insurance? Expired 
SUBJECTIVE: BAR
OBJECTIVE: T=  MM  CRT  sec HR 108= FP RR  RESP: Clear 
BEHAVIOUR ASSESSMENT: Nervous 
BCS: /9
GIT: Abdomen comfortable on palpation 
U/G: NAD
NEURO: NAD
M/S: NAD
SKIN: NAD
OPHTH NAD
OTIC: NAD
LYMPH/N: NAD
ASSESSMENT:
Tx OPTIONS:
TREATMENT:
PLAN:
DISCUSSION:
-----------
DISCHARGE
Today we have seen Mr Loki for some unusual behaviour throughout the night.
On exam, we cannot pinpoint what is causing Loki to have these episodes. Please monitor Loki in the next few weeks and let us know if this persists.
If you could video these episodes to show us next time Loki is here that would be great.
 If you have any concerns or queries please do not hesitate to contact the clinic 

NURSE: MS
HISTORY: Thinks doing well
Infection gone down since being on tablets
Not too interested in it
hair is growing back
EDFU normal
-Diet ivory coat
-Env in/out
-Comp None
-Prev simp trio
Current Meds: Pred 3 doses left
-Insurance? Expired
SUBJECTIVE: BAR
OBJECTIVE: T=  MM  CRT  sec HR = FP RR  RESP:
BEHAVIOUR ASSESSMENT: nervous
BCS: /9
GIT: Not examined 
U/G: Not examined 
NEURO: Not examined 
M/S: Not examined 
SKIN: Nose R   Is now dry   and has  new hair growing   Loki unbothered by it 
 Cease  bathning  and  finish pred  course   
OPHTH Not examined 
OTIC: Not examined 
LYMPH/N: Not examined 
ASSESSMENT: Healing well, reduced size of ulceration region, no infection present
Tx OPTIONS:
TREATMENT:
PLAN: Finish pred 20mg - 3 doses left
DISCUSSION: Finish medication, if comes back - recheck
-----------
DISCHARGE
Today we saw Mr Loki for a nose recheck.
It has settled really well and is looking really good.
Continue to finish the steriod tablets, if you notice it does come back please let us know.
 If you have any concerns or queries please do not hesitate to contact the clinic