C09982384 / invoice 10000

Appointment Notes: Koko (Cat) - Recheck Appointment (current issue) [Veterinarian : Dr Iris Tang(No Preference)] - Appetite is poor, vomiting a little pink fluidWeb BookingClient name: Leanne HorridgeContact number: 0452482471Email address: leanne.horridge@gmail.comPatient name: KokoHistory:Presenting for waxing and waning appetite that started on Weds - Sat/Sun ate, Monday and today inappetent. One episode of bile vomit, pink tinged this AM.Defecation: Unsure but thinks hasn't defecated in 2 days.  No lethargy. Drinking, urination normal.Diet: Dental kibble and raw mince. Not known scavenger. Environment: Indoors mainly, supervised access to fenced courtyard. Worming/ flea/tick: Revolution plus - no tapeworm coverage. Prev consult presented for weight loss - had since resolved after she passed a pinky finger length stick. Examine:Mentation: BAR Demeanour: Hissing/ nervous HR: 180, no murmurs or arrhythmias  RR: 60, lung fields clear - nervous cat Temp: 37.4BCS: 5/9 Eyes: NAD Ears: NAD Dental score: Grade 2/4 periodontal disease, moderat tartar accumulation on premolars, mild gingivitis MM/CRT : Pink, moist, CRT <2sLN: NAD Skin/Coat: NAD Fleas seen: NAbdomen: Tense and vocalising/ hissing on abdominal palpation. No organomegaly or masses noted                         Limbs/Gait: Ambulating well, weight-bearing on all four limbsLaboratory: Biochem: Mild hypokalemia Rest WNL Xrays: Sedation used: 0.075ml medetomidine (20ug/kg) / 0.075ml Methadone (0.2mg/kg) = profound sedation Abdominal radiographs: - Gritty/ radioopaque substance in faeces of distal colon noted - suspect boney substance - No obstructive pattern noted/ no FB noted - No organomegaly or masses notedThoracic radiographs -  NAD, no evidence of metastatic dx  Assessment:Inappetence and haematemesis Radioopaque / gritty substance in faeces of distal colon - suspect possible bone ingestion, however O notes that this is not possible as could not have had access to bones. Poss other FB ingestion Focal radioopaque substance poss in distal abdomen - no obstructive pattern noted. Mild hypokalemia - correct with IVFT Treatment: In hospital: 12ml/hr Hartmann's over 9h, added one potassium chloride 10mmol ampoule to 500ml Hartmann's bag. Difficult to conduct detailed observation throughout the day due to demeanour (hissing/ growling/ scratching) 0.37ml maropitant given IV Sedated with 10ug/kg medetomidine and 0.2mg/kg methadone IM for catheter check due to demeanour (growling/ scratching/ high FAS) Microlax enema given rectally At home: Ondansetron 4mg - half tablet PO q8h as needed Milbemax half tablet q3 moPlan: Return tmr if still inappetent/ vomiting - next step would be abdominal ultrasound for further investigation.  Estimates given for any procedures discussed.Consent forms signed for all admissions/procedures.    Vital Signs    Weight: 3.74;       

Reason: NM Unexplained Weight Loss (JHJ)Appointment Notes: Progressively losing weight,History:Normally on mixture of science dry food and pouches plus supermarket foods, variety offered. Keen to start eating but doesnt finish/eats less. O weighs at home and noticed lost 200gNormal stool. 1 of the 2 cats vomits from time to time but  o suspects it is other cat vomitingExamine:HR:180 no murmurRR:45Temp:37BCS:leanEyes:normalEars:cleanDental score:2MM/CRT :pink/1s LN:normalSkin/Coat:goodFleas seen: NAbdomen: soft, kidneys feel smooth, unable to collect urine (bladder small)                       Limbs/Gait: normalPlan:  Await bloodsLaboratory: Hct marginally incr 0.46Cholesterol marginally increased 5.6T4 normal 21Rest all wnl Reported to Leanne - will monitor for now, if wt loss continues reccommend abdo ultrasound and thoracic rads    Vital Signs    Weight: 3.5;       

Reason: NPC - Vaccinations (JH)History:Microchipped yesWorming product used - revolution plusFlea/tick product used - Diet fed - dental bicciesClinical Examination:Weight sl decreasedHR:124RR:growlEyes:normalEars:normalLN:normalCoat:normalFleas seen: NAbdomen:tense Dental: v mild tartar left molars, had dental 12mths ago        Limbs: nadTemperature:not takenFindings: fit to vaccTreatment: Vaccinated Annual F3Nobivac tricat F3Vaccine Batch No. : 2425302Vaccine Expiry Date:  8/27Plan: Worming: Fleas/Ticks:   Other: Estimates given for any procedures discussed.    Vital Signs    Weight: 3.7;