C09987284 / invoice 10000

Presenting for: diarrhoea
HISTORY
- camping (high country - lake eildon) over the weekend, started Sunday night - getting up during the night
- Put her on chicken and rice and came good and then got worse last night and today. Tried to intergrate biscuits and get worse again. 
- Diarrhoea: has become mucoid, yellow-brown, jelly-like/loose.  
- Possible that she may have eaten something when camping - was fed on the ground, lots of ants and march flies (terrified or march flies). Not known scavenger. 
- Appetite still good, not drinking as much. Urination normal. No coughing/sneezing. Energy levels normal. 
- Tried to eat something on side of road this morning and threw up right away (was actively trying to bring it up). 
- Parasite prevention: nexgard (last had 3 weeks ago) 
- Vaccinations: UTD

EXAMINATION
Mentation: BAR, slightly anxious
FAS score: 2-3/5 
HR = bpm, no heart murmur or arrhythmia detected on ausc          Femoral pulses:
Resp rate = Normal resp effort and clear BVS, no crackles and wheezes 
MM pink/moist, CRT <2s
Hydration: skin tent?
Oral cavity: periodontal disease grade 0-1/4
Throat:
Eyes: clear and bright corneas, no discharge, PLR/ menace/ palpebrals intact
Ears/nose: clear, no discharge
LNs: NAD
Abdo comfortable and soft on palpation, no obvious masses
MSK: ambulatory x4, no obvious lameness, no spinal/ neck pain, decent ROM of FLs/HLs
Integument: NAD
Urogenital: NAD
Neuro: NAD
Rectal: empty, very small amount of soft yellow faeces. 
Temp: 38.9
BCS: 5/9

ASSESSMENT & PLAN
1. Diarrhoea for 4 days (ddx: dietary indiscretion vs gastroenteritis vs intestinal worms)
Prokolin and bland (chicken and rice) diet. 

COMMUNICATION
As above. 
Options offered 
1. Pokolin + bland diet
2. As above + bloods
3. As above + diagnostics (imaging + faecal testing)

HISTORY:
Presented for: NSAEC: In wait room
Went for a walk with owner (5:30-6:30pm), known snake area. since the walk, NQR, shaking back legs, high heart rate and unable to weight bare on back legs 
back legs were limp
very skittish, shaking at home
dialated pupils and pale gums
took a long time to go bathroom
previously had sore shoulder intermittently gets better with rest
not on any meds

EXAM:
Mentation: BAR, bit nervous
BCS: 5/9
Hydration status: euhydrated
Mouth: mild tartar
MM: pink moist crt <2
LNs: no enlarged LNs
CV: HR: 120bpm, no m/a
Resp: panting, normal bv sounds
Abdo: soft comfortable
MSK: amb x4, no lameness/ataxia. gr 1/4 luxating patella on LHL. non reactive on spinal/joint palpation
Integ: NAD
Neuro: no obvious deficit. PLR, menace and CP present
T: 39.2

ASSESSMENT:
gr 1/4 luxating patella on LHL

PLAN:
offered blood work if really concerned about snake bite - declined at this stage
meloxicam 0.2mg/kg PO SID

COMMUNICATION:
revisit INI

Mouth healed very well
Can go back to normal diet etc