C09980609 / invoice 10000

 Sedated    
 t 38.8 , HR 132  no murmur/rrythmia RR 54 
Oral exam  Gd 1 tartar and gingivitis 
Otherwise oral cvity looks normal 
in total 
Butorphanol 0.25ml +  0.1ml
Midazolam 0.3ml + 0.1 ml
 Ketamine 0.14ml + 0.05 ml 

 Placed 24G  R cephalic catheter 
  Blood  collected 
 
 Left and R  lateral and VD  chest xrays 
 The heart is silhouteed  caudo ventrally 
The liver looks to be elevated 
There is pulmonary leafing 
The LEFt diaghram is indistinct ? if overlaid by fluid 

U/S  There is  free fluid in the chest and on one view I thought there was tissue  between heart  and diaghram (? in mediastinum)

 Ideally needs Silvana  to u/s  to  better define the problem

DDX  Diaghragmatic hernia ,  Thoracic mass , FIP ,Pleaural effusion 

 

H:
Many years ago had a 10-15 min bout of intermittent coughing/convulsing, has never recurred until recently. Video shows hacking, gulping and goosenecking. This time round started a coughing bout 2-3 weeks ago, seems to be brought on by purring. Has been at Nat's Mum's house last couple of weeks. Video shows a harsh dry honking outwards cough with some lip licking or swallowing after. Has been happening every day but has improved slightly in the last few days, not as often. Did run into the ensuite the other day and was puffing and then coughing. Sudden onset on 13th feb, no paint jobs etc but did have reed diffuser out for a couple of months. 

O:
HR 144 bpm, no audible murmur but not sitting very still
RR 36 bpm, video of breathing when sleeping shows RRR 72bpm
Increased lung sounds throughout but no crackles/wheezes
FP feels adequate and in time with HR but again, movement makes this tricky to detect
MM not assessed as getting grouchy
Eyes/ears NSF
Unable to assess airflow through nares with glass slide dt temperament
Unable to have good abdo palpation dt temperament, getting grouchy and scratching and growling at nurses
Attempted temp taking - unable to get thermometer fully inserted as Milo jumping around
BCS 4.5/5
Skin/coat OK
NO cough in here but noticed lots of lip licking non-stop and after attempted exam, open mouthed breathing and lip licking

A:
Breathing issues - cough and increased RR, sudden onset 2.5 weeks ago
Increased lip licking

DDx:
Asthma, obstructive airway diz (eg poylp, growth, infection), other?

P:
Admit tomorrow for sedated exam of oral cavity/behind soft palate/check nares for airflow on glass slide/take temp
Then chest rads and bloods/urine for standard + T4 (as bloods impossible unless sedated)
Clip nails and around bum whilst under

Subjective:
Not jumping onto high furniture like he used to
sleeps a lot
eating and drinking normally
Very fussy with food - mostly wet food, only one brand of wet food that he will eat
will eat dry food more readily - brand changes from optimum, fancy feast
1 hills cup per day  of dry food that he grazes on
2 x 80gram sachets per day, 1 bid
vomits a bit, one vomit every couple of days - eats grass then vomits this up,  loose stools occasionally

Objective:
heart/lungs ok 
EENO ok teeth grade 1-2
abdo palpation ok skin/coat ok 
MSK - comfortable with spinal palpation and HL exam
BCS 8/9

Assessment:
overweight
reduced jumping - probably weight related
regular vomiting/occasional loose stool - due to grass vs adverse food reaction vs other

Plan:
feligen F3 vacc sc
suggest cutting back to 3/4 of a cup of dry food and see if looses weight on this
could also try transitioning to metabolic food to see if he will eat this
Milo lives between 2 houses, Os house and Os mums house, Os mum tends to feed him more - this will be difficult to stop.
clipped some matts from around bottom.