C09976222 / invoice 10000

Reason: Lethargic 24 Hours, On And Off Food For A Few DaysAppointment Notes: uneasy on her back legs not wanting to jump on the bed, also not wanting to go on walks either. JR only / knAttendees: Belinda and husbandHistory:Was fine yesterday at dog park went home ate normallyThen seemed to go off a couple of hours laterSeemed uncomfortableSome heavy breathingThis morning very flat lethargic not wanting to go for a walkNot interested in foodHad to take water to herDid pass a soft bowel motion but not unusual for her esp as giving milbemax at the moment broken in to three doses - seems to be off for about a weekUp until late last night:Eating drinking urinating defaecating normallyNo vomiting/retchingNo coughing, no exercise intolerance, no breathing difficultyNo lameness, stiffness or sorenessNo itching and scratchingQuiet Alert ResponsiveBody condition score 6Examination:Mucous membranes – pink warm moist crt <2sOral cavity – clear, no evidence of ulceration, tongue normal, hard palate fineTeeth – grade 1Nasal planum – normal pigmentation and architecture, no crusting, no dischargeEyes – eyelid conformation normal, PLR normal, no chemosis,  no dischargeEars – no discharge, no erythema, pinna fineLymph nodes - normalHeart – normal regular rhythm no pulse deficits, no murmur HR92Lungs – clear sounds bilaterally, no crackles or wheeze, tracheal pinch negativeAbdomen – comfortable on palpation, bladder normal, no masses palpatedLimbs – all good range of movement, no swelling or pain on palpationNeck and spine – no pain on palpationSkin – no sign of erythema, no alopecia,  Nails – fineAnal glands – not scooting or enlargedTemperature – 38.3Genital region - no masses or swellingsDiagnosis:Milbemax reaction vs gastrointestinal vs otherTreatment:Right jugular venipuncture for TAHPTAHP - NADCBC - NADWill monitor for next 24 hours May need cerenia vs other gut protectantsAdvised poss consider ceasing hwp and just testing q 6monthlyPlan: FUC 1 day    Vital Signs    Weight: 29;