C09979627 / invoice 10000

eyes 
had fight and swollen 
normal cat play fight - O says full fight  - other owner said play
tries to keep slow introduction  - this time got out of hand
1-3 sneezes but not really anything
HISTORY: sneezing, gastro symptoms - d+
also seems drowsy
not noticed any staining or tears / discharge 
not eating as much
started sneezing alst night
had soft stool few days ago and D+ started ysterday
BIB Amaka and mum
BIOP 
EDDU normally
No v/d/c/s. 
Diet: RC calm dry food 2 tablespoon and wet purina food + mixed water with food
Current medications: gabapentin sid
Parasite control: nexgard

EXAM:
BAR
MM pink and moist, CRT <2s, 
Teeth  , dental grade 1-2/4 infected k9 204 
Eyes, ears, nose NAD
Hydration
HR 192 , no murmur auscultated, normal rhythm, normokinetic and synchronous femoral pulses
RR  30 , lungs clear, normal effort
Peripheral LNs WNLs 
Comfortable on abdominal palpation, 
BCS  5/9 3.3kg
Temp 
MSK – 
Integument – 
Neuro -

ASSESSMENT:
Problem list
1. 204 inflamed / possibly infected - poss tooth root abscess - will need removal
2. 

Ddx
TREATMENT:

PLAN: Home with antibiotics / pain medications then k9 removal - check all teeth o make sure all healthy

DISCHARGE: 
DISCHARGE: 
Today we saw Billy and Beatrice for a few issues today.
Billy is looking okay - he does have some inflamed third eyelids which can be due to the cat flu symptoms
We cannot see any scratches which is good so continue to monitor him for now.
Continue the eye treatment for now with him.
Beatrice however does unfrequently have a infected K9 which will need removal.
To start we will send her home with antibiotics to help her cat flu symptoms before we put her under any anaesthetic for the tooth removal.
The eyes squinting could be pain related which would explain her not eating as well.
She will also get some pain relief as well to go home with.
 If you have any concerns or queries please do not hesitate to contact the clinic 

Photos of eye sent via email from O

NURSE:
HISTORY: Has been sneezing occasionally. Been very anxious and biting, worse since trying to introduce kitten.  Feliway at home 
EDFU normally no vomiting or diarrhoea 

-Diet RC calm dry food 2 tablespoons and regular wet food
-Env in/out 
-Comp 1x cats 
-Prev nexgard 
Current Meds: none 
-Insurance?
SUBJECTIVE: BAR
OBJECTIVE: T= 38.0 MM  pink CRT <2 sec HR = 188bpm no murmurs or arrhythmias audible RR 44bpm RESP: clear. No sneezing or snuffling
BEHAVIOUR ASSESSMENT: Anxious, tried to bite with nails 
BCS: 5/9
GIT: Teeth look good, abdomen comfortable, no obviously palpable abnormalities
U/G: NAD
NEURO: NAD
M/S: NAd
SKIN: NAD
OPHTH: NAD
OTIC: NAd
LYMPH/N: Normal peripheral LNs
ASSESSMENT: Anxiety, otherwise in good health 
Tx OPTIONS: gabapentin vs clomipramine
TREATMENT: Will trial gabapentin short term and monitor as may just be because of kitten being introduced. If worsens as coming off consider longer term solutions. Gabapentin 25mg 1 BID 2 weeks then 1 SID 2 weeks then stop. If too groggy reduce to 1/2, if not enough contact clinic
PLAN: As above, consider clomipramine longer term if required
DISCUSSION: Discussed introduction of kitten and anxiety medications
-----------
DISCHARGE Beatrice has been examined today and we have discussed her anxiety. We will trial her on some gabapentin tablets. Give these as directed. If they are making her too groggy contact the clinic and we can reduce her dose. Give them as directed. If she improves but her anxiety worsens as she comes off them we may need to consider some longer term anti anxiety medications so revisit for assessment. She can have a double dose prior to trying to brush her.  If you have any concerns or queries please do not hesitate to contact the clinic