C09988979 / invoice 10000

Reason: B+B TransferHistory: Frankie is an approximately 11-year-old female neutered Old English Sheepdog who has been referred over tonight by Beach and Bay with signs of vomiting and diarrhoea. See regular vet's history for full record. Presented this morning with fairly profuse vomiting, developed into diarrhoea which became bloody during the afternoon at regular vet.Radiographs have been taken which looked messy. There was gas in various areas of the bowel and concern for possible mass effect and ex-lap being required. Ultrasound, however, did not reveal any major abnormalities and no signs of foreign bodies were observed. Referred overnight for ongoing care, repeat radiographs overnight and assess if surgery is required or not. Not known to be a foreign body eater, but is known to have a sensitive stomach. Regular vet reports some sludge in the gallbladder.Blood work from regular vet: mild stress leukogram, otherwise within normal limits. Mild increase in total protein, globulin, mild increase ALT, ALP, and total bilirubin up at 17. No explanation found for that at this stage. Electrolytes within normal limits.On reflection, owner realises that she did not eat dinner last night. They are also unsure when her last vaccination was, but likely to be within the last couple of years. She has pre-existing allergic skin disease and has seen dermatologist for that, but she has not had any of her oral desensitisation spray or Apoquel for the last few months.Examination Findings: She still looks nauseous and is drooling. There is some blood on the diarrhoea on the thermometer. Otherwise vital signs are stable.Assessment: Stable but not well enough for o/n care packageUnclear if AHDS vs git obstructionPlan: Discussed with owner at this stage, medical treatment plan is appropriate with ongoing medical care and radiographs. If radiographs become concerning or clinically deteriorates, can discuss ex-lap surgery from there. Owner agrees to plan. Admitted.Alex was wondering if Frankie could stay here tomorrow to make life easier for them given family commitments. In the morning, transferring her back and to and fro to her regular vet is a little difficult. Advised that we can certainly continue care here. However we will discuss plans in the morning depending on how we are doing.Examination Findings: See SF for full record. Profuse liquid brown to orange explosive diarrhoea with small amounts of blood in it, almost continuously being passed. Also thirsty and wanting to drink a lot, then regurgitating multiple times as well.Radiographic Findings: First set of X-rays: Not quite as messy as the initial set at regular vet clinic. However, some dilated loops of fluid-filled bowel were noted. Spleen appears to be partly folded and slightly caudal in the abdomen.05.00 rads under sedation. Most of gas has been moving. Still quite messy to look at. Bowel loops more consistently fluid filled. Liver extends back past costal arch. Spleen partly folded. Stomach moderate size some gas showing ruggal folds.Ultrasound Report: POCUS No free abdominal fluid, gallbladder appears fairly normal at this stage. Urinary bladder still quite small, behind on fluids. Sections of bowel were noted to be mildly dilated with bilateral flow of ingesta consistent with ileus. Stomach was moderately full with fluid swirling. No peristalsis seen during ultrasound.Area of liver looked abnormal- areas of hypoechoiec circular lesions. Spleen looked large but had blood flow- ?Related to sedation.Repeat pocus at 05.00. No focal dilatation. Signs of generalised ileus with bidirectional flow of gut contents. Abnormal liver lobe still visible and occasional circular hypoechoiec lesion seen in other liver lobe as well.Assessment: At this stage, still suspect a nasty gastroenteritis, behind on IV fluids. Foreign body/obstruction not yet ruled out, however, not yet ruled out. Elect to hold metoclopramide CRI until next set of X-rays. If these remain looking fairly non-obstructive, then we'll start metoclopramide CRI for ileus.Remains non surgical to me.Consider starting metoclop cri Laboratory: Lab: Given profuse liquid diarrhoea and unclear vaccination history, SNAP parvo test run, negative.Treatment: Metronidazole 10 mg/kg IV at 4:00 AM as planned, buprenorphine 0.02 mg/kg IV sedation for X-rays and analgesia, medetomidine 0.5 mL IV sedation for radiographs, reversed with 0.4 mL of atipamezole IM. Rectal catheter placed with closed collection set due to profuse liquid nature of the diarrhoea. 23.00. Removed at 05.00Fluid bolus given.Pantoprazole 1mg/kg iv q 12hrsOndansetron 0.3mg/kg iv q 8hrsDue maropitant Thursday afternoon.Client Communication: Owner quite cost aware and wanting reassurance on insurance company covering them for this sort of issue. Discussed we cannot provide that information. Discussed various options and elected to run pre-approval for a stable enterotomy patient through GAP only. Pre-authorisation was given, so this condition will be covered under the policy.Owner somewhat concerned with timing as they were due to go away this weekend and dog was to have a dog sitter. Discussed I don't know how long it will take Frankie to recover from this illness whether medically or surgically. Owner requested would we be able to medically board her here. Discussed can be possible in certain cases. No guarantees, but cost would be approximately $95 a day for a stable patient just requiring medication once or twice a day. Discussed we do not provide the benefits of a boarding kennel and this is within the confines of a veterinary hospital environment.    Vital Signs    Weight: 34.2;       MMColour: pink;       Temperature: 38.8;       HeartRate: 116;       RespirationRate: 136;       PainScore: 1/4;       BP: 155/103 113;       CRT: 1;