C09977856 / invoice 10000

**
NURSE IL

REASON - BOAS + desexing discussion

HISTORY
Seen for pre desexing consult with BO yesterday 
Recommended BOAS referral with JS 
Frequent regurgitation & vomiting seen at home - generally only associated with exercise however. 
Exercise intolerance has become evident over the last few months. 
Struggling a dramatically last week after a 10 minute walk- extremely heavy panting & difficultly breathing and trouble getting him to settle down. 
Doesn't seem to regurgitate commonly without exercise  
BIOP since 8w- O's first French Bulldog 
Visited AES when younger for V+ & D+ but this has resolved. 
Eats well overall- mix of dry and wet morning & night, doesn't seem to scoff his food dramatically 
Normal stools majority of the time- does scavenge quite a lot 
Eats at a normal rate, doesn't seem to eat too rapidly 

APPETITE: WNL- occasionally doesn't eat his breakfast 
ACTIVITY:  Normal but owners control this to decrease risk of exercise associated problems.  
DIET: RC French bulldog dry food, Adult wet food, probiotic powder 
TOILETING: WNL
CURRENT MEDICATIONS:
Probiotics daily 

CLINICAL EXAMINATION
Mentation: BAR+
MM: Pink/moist
CRT:  1s
Eyes: Bright & clear
Ears: Clean externally 
BCS: 3.5
Lumps: None noted
Abdominal palpation: soft and comfortable no detectable hernias 
Lymph nodes: all PLN are WNL 
Heart Rate: NAD on auscultation
Respiratory Rate: Significant upper respiratory noise (stertor), stenotic nares (severe) 
Temperature: N/T
Urogenital: NAD, both testicles distended 
MSK: Ambulatory, great muscle mass.  Full MSK not performed 
Skin: NAD, coat in great condition

ASSESSMENT:
Features consistent with BOAS 
Exercise induced vomiting 

DISCUSSION:
>Discussed BOAS and breed predisposition 
>Discussed that doesn't just affect Frenchie's- all brachycephalic breeds can be affected to greater or lesser degree 
>With airway changes, very often secondary GI issues 
>Discussed the life-threatening nature of some conditions where severe or under the right conditions 
>Discussed the congential and acquired changes that can affected these patients and diagnostic methods to determine them (x-rays, CT, oral examination, scope assessment, fluoroscopy) 
>Advised that some features amenable to surgery (such as enlongated soft palate) but otherwise are not and then need to be managed (such as hypoplastic trachea) 
>Discussed that in some cases require referral to mainland for turbinate laser Sx if not enough relief from initial surgery 
>In some cases may require GI surgery- this would be after recovery from BOAS sx and changes to diet if still experiencing GI issues 
>Generally happy to castrate on day of Sx- would do this second incase of any complications
>Procedure isn't without risk- regurgitation post sx, aspiration pneumonia etc.  Major and minor complications discussed at length and discussed risk factors. 
>Very rare but in some cases requires tracheostomy & ventilation post sx.  
> Went through significant complications such as oxygen therapy, intubation, ventilation, tracheostomy, death. 
>At home changes recommend switching to soft food only or soaking dry food, small frequent meals, not feeding directly before exercise 
> EOC given and AES fees and complications discussed as additional 

PLAN
BOAS Sx + castration booked for 16/3

NURSE: RR

REASON: Pre-desexing consult

HISTORY:
- Vomiting episodes when younger, seen at Sorrel and AES
- Regurgitates when excited (75% of time after zoomies)
- Foamy, clear saliva only, no food content
- Exercise intolerance - only 10 mins walking before respiratory distress
- Started humping behaviour recently

APPETITE: Normal, occasionally skips breakfast/dinner but otherwise fine

ACTIVITY: Very excitable, gets zoomies

TOILETING: No diarrhoea

CURRENT MEDICATIONS: Probiotic

**CLINICIAL EXAM:**
- Mentation: BAR
- RR: Stertor noted on breathing, elongated soft palate suspected
- Skin: Erythema RF paw between digits 3 and 4. Saliva staining underside both forepaws. No obvious infection. Belly NAD - no erythema or alopecia. Saliva staining hind paws. Interdigital dermatitis LH paw between digits 3 and 4 - red, moist, yeast overgrowth suspected.

**ASSESSMENT:**
- Brachycephalic airway syndrome - staging required
- Interdigital dermatitis LH paw - yeast overgrowth

DISCUSSION:
- Discussed BOAS surgery staging at time of castration with specialist surgeon Jo at AFS Thurman Park
- Anti-anxiety tablets recommended pre-admission to reduce excitement and prevent regurgitation under anaesthetic
- Anti-nausea injection can be given with premedication
- Dedicated nurse for recovery, tube left in longer
- Malaseb shampoo for interdigital dermatitis - apply to feet, foam up between toes, 10 mins contact time, use cone or distraction if needed
- Can trial Malaseb on belly and penis area for humping behaviour

TREATMENT:
- Malaseb shampoo dispensed for interdigital dermatitis
- Trazodone dispensed for calm next vet visit

PLAN:
- Book consult with Jo at AES location for castration & BOAS 
- Anti-anxiety tablets to be given before vet visits
- Malaseb shampoo to feet - 10 mins contact time
- Monitor interdigital dermatitis - sticky tape impression if worsens

NURSE - Mon 

REASON - Vomiting and diarrhoea

HISTORY
- presented to AES for inappetance, discharged, began vomiting after. Saw regular vet (Montrose) on Monday, tried to get in today as vomiting worsening + not defecated, Montrose not able to get in until Friday IA 26/6 HX requested
- AES advised dehydrated, held overnight, fluids, tests WNL
- Gave pain killer and anti-nausea
- Ate a bit of food with meds, then vomited 4 times overnight, out of it, could not wake up, D+. 
- Vomited up after pain killer - went to normal vet Montrose, gave reflux medication and anti-nausea (24 hrs), 
- Monday went to toilet overnight, was runny
- Started vomiting at 2.30pm today - chunky, light brown, a bit foamy. 2 vomits in total 
- Stopped pain relief and 
- Last poo on Tuesday soft, some runny, normal in colour, some blood in poo (colitisy) 
- Back to eating chicken and rice, normal amount as of today. 
- Urine pale yellow 

APPETITE:
ACTIVITY:
DIET:
TOILETING:
CURRENT MEDICATIONS:

CLINICAL EXAMINATION
Mentation: BAR
MM: Pink, moist, normal skin tent
CRT: <2s
Oral Exam and Dental Score: Class 3 malocclusion
Eyes: Clear, pupils even
Ears: Externally clean
BCS: 3.5/5
Lumps: NAD
Abdominal palpation: Nausea induced on palpation, but no focal discomfort or foreign bodies. Some gurgling.   
Lymph nodes: WNL
HR: 126bpm, clear sounds 
RR: Sniffing
Temp: 38.8
Urogenital:
MSK: Ambulating well 
Skin: Coat clear

ASSESSMENT:
Well hydrated 
Enterocolitis

DISCUSSION:
- Discussed enterocolitis - may be caused by garbage toxicity, viral (unlikely), foreign body 
- Monitor for vomiting and coughing afterwards - higher risk of aspiration 

TREATMENT:
Cerenia 24mg 1 tab SID PO x 4

PLAN
- Monitor faeces for foreign bodies
- If becomes depressed and vomiting RV for U/S
- Ok to manage if only vomiting 1-2 days times a day 
- Continue bland diet