C09980006 / invoice 10000

Appointment Notes: Morris (Dog) - Samantha Saper - 0452301380 - Consultation [Veterinarian : Dr Annette(No Preference)] - Eating problems  -Web BookingClient name: Samantha SaperContact number: 0452301380Email address: sammisaper@gmail.comPatient name: Morris  ------- Sms reply: YHistory:History:Prolonged inappetence - longest episode to dateCurrently only accepting roast chicken with biscuitsRejecting all wet food, dry food, hand-feedingMultiple diet changes over past months - Big Dog raw food (~3/12), previously home-cooked chicken minceHx of intermittent "hunger strikes" but this episode most prolongedNo vomiting, no diarrhoea, faeces normalIntestinal worming UTD monthlyBloods last week - NADMetacam - no apparent effectCurrently on Royal Canin biscuitsWill accept treats,  chickenNo preference for bowl height/temperature notedNo burping or signs of refluxExamination:Demeanour/Temperament: Bright, healthy appearanceCardiovascular: NADRespiratory: NADAbdominal: NAD comfortable no discomfortIntegument: NADLymph nodes: NADMusculoskeletal: NADNeurological: NADUrogenital: NADOral: NADAssessment:Anorexia - cause undeterminedDDx: behavioural vs underlying pathology (grumbling pancreatitis, gastric neoplasia)Bloods unremarkable - further diagnostics indicatedadvised and recommended abdominal ussDiagnosis:Anorexia - investigation ongoingTreatment:Maxalon 1.5 tablets PO 30-45 mins prior to dinnerCease MetacamTrial joint supplement (e.g. 4cyte)Plan:Ultrasound abdomen with Dr Karen recommended to assess stomach, pancreas, liver. Pt to be fasted, dropped off morning of appointment, sedation required. Results to be discussed same day. If Pt improves on Maxalon, ultrasound may be postponed. Trial Maxalon with biscuits only first, add chicken topper if refuses. Sample of Royal Canin puppy biscuits provided. Nurse to contact O once appointment confirmed.Client Communication:Discussed need for further diagnostics given prolonged inappetence despite normal bloods. Ultrasound recommended to rule out underlying pathology. O agreeable to plan. Discussed that if Pt responds to anti-nausea medication, ultrasound may be delayed. O to monitor appetite response to Maxalon and contact if concerns.Examination:Demeanour/Temperament: BAREyes: NADEars: NADCardiovascular: NADRespiratory: NADAbdominal: NADRectal: NADIntegument: NADLymph nodes:  NADMusculoskeletal: NADNeurological: NADUrogenital: NADOral: NADLaboratory:Assessment:Diagnosis:Treatment:Plan: recheck if no improvement or if there are any further concernsClient Communication:    Vital Signs    Weight: 25.9;