C09980362 / invoice 20000

HISTORYPresenting for: Gracie presented for follow-up regarding constipation issues.Diet: Had chicken, pumpkin and rice late last night after 24 hours of not eating. No food today yet. Normal appetite returning.Drinking/Urination: Drinking water normally. Urinating normally.V/D/C/S: Had a few episodes this morning. Straining noted last night with defecation.Current Meds: Currently on lactulose and electrolyte supplementation.Lifestyle Risk Factors: Chases sheep on neighbouring property. Swims in dam. Was confined indoors for 10-11 hours recently while owners were out.Pet reluctant to get in car and hesitant on stairs, which is unusual behaviour. Swimming in dam and chasing sheep recently. Killed 2 chickens on neighbouring property.EXAMMentation: Curious and alertBehavioural: Well in herself, curious but showing some reluctance with normal activities like getting in car and going upstairsAbdominal: Palpation reveals feeling of thickened bowel/colon?Musculoskeletal: Moving gingerly on steps, reluctant to get in car (owner normally has to lift hind legs but now needs to coax and pull). Can still jump on bed and chase sheep. No reaction to manipulation, no signs of pain on examination.Rectal: Faeces produced - normal looking, 2 pieces, quite thick, not as large as expected given degree of strainingASSESSMENTConstipation - improving with current treatment. Faeces produced but still some thickening palpable abdominally.PLANNew Meds/Tx:- Continue lactulose until seeing regular bowel movements (few per day)- Continue bland diet (chicken, pumpkin, rice) tonightDiet Recs:- Once regular bowel movements established, consider adding fibre to diet (Metamucil or continue pumpkin)Additional Discussion:- Possible contributing factors discussed including prolonged confinement and reduced activity- Monitor for regular daily bowel movements before discontinuing treatment- Owner has insurance coverage up to 80%Client Comms:- Continue current treatment until regular bowel movements achieved- Monitor closely and return if sudden cessation of bowel movements or worsening-advise abdo imaging.    Vital Signs    

HISTORYPresenting for: Gracie presented for acute onset vomiting, lethargy and inappetence this morning following a 5-day stay at a farm.Diet:- Refused breakfast this morning- Normal appetite yesterday- Fed kibble, carrots and applesDrinking/Urination:- Decreased water intake this morning compared to normal high consumptionV/D/C/S:- Vomited undigested food overnight - kibble still visible, quite solid- No diarrhoea observed- No defaecation observed since returning homeCurrent Meds:- Flea and tick prevention up to dateLifestyle Risk Factors:- Recently spent 5 days on a 7-acre hobby farm with other dogs (pup and retriever)- Dogs escaped property and roamed surrounding area- Exposure to wildlife including foxes, wild dogs, deer- Rolled in sheep faeces after recent shearingOther:- Breeding female with one previous litter- Full pedigree health checks completed with no inherited conditions- Very stressed during car travel (unusual behaviour)- Normally very active dog, following owner around constantlyEXAMMentation: Lethargic, not following owner around as usualBehavioural: Markedly lethargic, lying on rug, not playing, seeking close contact with owner during transport, anxiousAbdominal: Colon feels full of faeces, not particularly hard but fully formedASSESSMENTConstipation - colon palpably full of faeces. Likely contributing to vomiting and lethargy.PLANNew Meds/Tx:- Anti-vomiting/anti-nausea injection administered today- Pain relief injection administered today- Oralade (canine electrolyte solution) dispensed- Lactulose to be obtained from pharmacy as laxative to promote bowel movementAdditional Discussion:- X-rays discussed as diagnostic option if conservative treatment fails - estimate $721 including sedation, hospitalisation, radiographs and IV catheterisation- Monitor for defaecation overnight- Enema may be required if no improvement- Return if no bowel movement or clinical improvementClient Comms:- Advised to monitor closely for faeces production and general improvement- Return for X-rays if no response to conservative treatment- Blockages can be serious in dogs that tend to eat inappropriate items    Vital Signs